Factors Associated with the Duration of Breastfeeding in the Freiburg Birth Collective, Germany (FreiStill).

Purpose: The health benefits of breastfeeding for both infants and mothers are well-documented. The aim of this study was to clarify factors associated with successful breastfeeding. Methods: We performed a prospective, multi-centre cohort study of 443 mothers in person using a standardised questionnaire on postpartum day 1. Women who had started to breast-feed were interviewed by telephone after 3, 6 and 12 months. A statistical analysis was performed using the SAS system. Results: 92 % of women (409/443) were initially breastfeeding. After three months the rate decreased to 74 %, after six months to 61 % and after 12 months to 28 %, respectively. Bivariate analysis revealed a significant positive association with the following factors: maternal age > 35 years, higher educational level, intention to breastfeed on postpartum day one, high motivation after three months, partner's support of the decision to breastfeed, satisfaction with the care provided in the maternity clinic, a positive breastfeeding experience and follow-up care by a midwife. Elective caesarean delivery, the use of breastfeeding aids, formula supplementation early on and the mother's concern about the amount of milk correlated negatively. Following a multivariate logistic regression analysis, four factors were correlated with having a positive influence on duration of breastfeeding: higher educational level, satisfaction with the care provided within the maternity clinic, follow-up care by a midwife, and a positive current experience of breastfeeding. Conclusion: Our data demonstrate certain factors successfully influence breastfeeding. Competent care in the maternity clinic, postpartum care by a midwife and a positive experience with breastfeeding increase the rate of breastfeeding and thus have a positive impact on the health of mother and newborn.

VEGF-A, VEGFR-1, VEGFR-2 and Tie2 levels in plasma of premature infants: relationship to retinopathy of prematurity.

AIM: To study prospectively the plasma levels of vascular endothelial growth factor (VEGF-A), its soluble receptors sVEGFR-1, sVEGFR-2 and soluble Tie2 in premature infants. To identify their changes related to the onset of retinopathy of prematurity (ROP). METHODS: Blood samples of 63 preterm infants born at a postmenstrual age (PMA) of 23-32 weeks were obtained between 5 days and 15 weeks after birth. 42 infants had no ROP, two had stage 1, nine stage 2 and 10 stage 3. Of these, four infants were treated with retinal photocoagulation. VEGF-A, sVEGFR-1, sVEGFR-2, and sTie2 were measured in the plasma with a sandwich enzyme immunoassay using factor-specific monoclonal mouse antibodies. The time course of concentrations plotted by kernel smoothing in infants with and without ROP were compared and a paired subgroup with analysis of variance was analysed. RESULTS: ROP patients had raised plasma levels of sVEGFR-2 and sTie2 compared with premature infants without ROP. VEGF-A and sVEGFR-1 levels were similar in both groups. Analysis of a subgroup with pairs of measurements, one before 32 weeks and one after 36 weeks, showed a significant increase in sTie2 after 36 weeks of PMA independent of ROP (p = 0.03). CONCLUSION: This is the first study to measure plasma levels of angiogenic factors in ROP. Similar VEGF-A plasma levels in infants with and without ROP suggest that pathogenic retinal angiogenesis in ROP is mainly driven by local VEGF-A synthesis. Elevated plasma levels in active ROP were observed for sVEGFR-2 and sTie2. These increases have yet to be confirmed as predictive values for ROP.

Anti-inflammatory effect of pimecrolimus in the sodium lauryl sulphate test.

BACKGROUND: Pimecrolimus is a calcineurin inhibitor used for the topical treatment of inflammatory skin diseases. We have shown previously that pimecrolimus cream is not effective on intact skin in the ultraviolet erythema test. OBJECTIVE: To test the anti-inflammatory effect of pimecrolimus cream after damage of the skin barrier by sodium lauryl sulphate (SLS) in a randomised, placebo-controlled, observer-blinded study. METHODS: SLS (3% v/v) was applied under occlusion on the back of 36 healthy volunteers for 24 h. Subsequently, the test areas were treated for 24 h with pimecrolimus cream, 1% hydrocortisone in a hydrophilic ointment, and the vehicle alone over three consecutive days. One control area remained untreated. The erythema index and the transepidermal water loss (TEWL) served as readout parameters to assess the SLS-induced skin irritation. RESULTS: Pimecrolimus cream and 1% hydrocortisone cream significantly reduced the SLS-induced erythema. The two test preparations did not have a significant effect on the TEWL. CONCLUSION: After damage to the skin barrier by SLS, pimecrolimus seems to penetrate into the skin as shown by a reduction of the irritation-induced erythma. These data further support the notion that pimecrolimus is selectively effective in the treatment of skin disorders with an impaired function of the epidermal barrier.

Factors influencing surgical outcome in patients with focal cortical dysplasia.

A total of 120 patients with histologically proven focal cortical dysplasias (FCD) were retrospectively analysed for prognostic factors for successful epilepsy surgery. Multivariate data analyses showed that older age at epilepsy surgery, occurrence of secondarily generalised seizures and a multilobar extent of the dysplasia were significant negative predictors. In univariate analyses, longer duration of epilepsy, need for intracranial EEG recordings and incomplete resection of the FCD were factors which significantly reduced the chance of becoming seizure free. Histological subtype of the FCD and age at epilepsy onset had no significant predictive value. These findings strongly suggest early consideration of epilepsy surgery in FCD patients.

Systemic diseases in non-inflammatory branch and central retinal artery occlusion--an overview of 416 patients.

BACKGROUND: To determine the frequency of essential cardiovascular risk factors in different vascular ocular diseases. - METHODS: We compiled cardiovascular risk factor findings (RFs) from 416 patients with non-inflammatory ocular vascular occlusions in a retrospective study: 134 patients with BRAO, 253 patients with CRAO, and 29 patients with hemi-CRAO. 274 (65.9 %) male and 142 (34.1 %) female patients were examined. Mean age of all patients was 66 years (range: 18-90). The right eye was involved in 221 (53.1 %), left eye in 193 (46.4 %), and both eyes in 2 patients (0.5 %). - RESULTS: Cardiovascular risk factors (RFs) were found in 243 patients. Three hundred and eight (308) out of 406 patients (75.9 %) presented with arterial hypertension. Hypertension was present in 96 patients with BRAO (73.8 %), in 197 patients with CRAO (79.8 %), and in 15 patients with hemi-CRAO (78.9 %). - RFs such as arterial hypertension, carotid artery diseases, diabetes mellitus, hyperlipidemia, hyperuricemia, and chronic smoking did not differ statistically between patients with BRAO, CRAO or hemi--CRAO. But visible emboli in retinal arteries were observed in patients with BRAO (47 %,), or hemi-CRAO (41.4 %), much more often than in patients with CRAO (11.1 %). - CONCLUSIONS: No statistical differences between the RFs of patients with BRAO, CRAO, or hemi-CRAO were noted. We maintain that every patient with retinal arterial obstruction should undergo extensive examination of essential RFs.

Lymphocyte reconstitution following allogeneic hematopoietic stem cell transplantation: a retrospective study including 148 patients.

Here we investigated the influence of parameters known before hematopoietic stem cell transplantation (HSCT) as well as the relevance of graft-versus-host disease (GvHD) and cytomegalovirus (CMV) reactivation on post transplant lymphocyte reconstitution in 148 patients treated in our institution between 1996 and 2003. Median patient age was 42 (19-68) years, HSCT followed standard high dose (n=91) or reduced-intensity conditioning regimens (n=57) with bone marrow (BM, n=67) or peripheral blood stem cells (PBSC, n=81) from related (n=71) or unrelated (n=77) donors. In the first months, we observed a partially faster reconstitution of CD3+4+, CD3+8+ and CD4+45RA+ T cells in patients following peripheral blood stem cell transplantation when compared to bone marrow transplantation. Prolonged CD3+4+ and CD4+45RA+ lymphopenia was noted after unrelated donor HSCT and GvHD prophylaxis containing anti-T-lymphocyte globulin. Lymphocyte subset counts in patients older than the median age were comparable to those in patients transplanted at a younger age and not influenced by the conditioning regimen. CD3+8+ T cell reconstitution was strongly correlated with CMV reactivation, but not significantly affected by CMV serostatus before HSCT. Incidence or extent of GvHD did not significantly influence lymphocyte reconstitution. Therefore, the source of graft is the most predictive parameter in early lymphocyte reconstitution, but the differences in lymphocyte recovery completely resolved within the first year after HSCT.

Comparison in a laboratory model between the performance of a urinary closed system bag with double non-return valve and that of a single valve system.

BACKGROUND: Catheter-associated urinary tract infection is the most common nosocomial infection in clinical settings. For bacteria ascending to the bladder the most common route is the extraluminal, but the intraluminal route also plays a role. For this reason, we compared two urinary closed system bags (CSB), one with a double and the other with a single non-return valve (NRV), in a laboratory setting in order to establish their ability to prevent or delay the ascent of bacteria from the drainage bag to the bladder. PATIENTS AND METHODS: The tests were performed in two microbiological laboratories (Copenhagen (C), Denmark and Freiburg (F), Germany). These were blinded to each other. A urinary tract model using artificial urine was set up. Two sets of ten drainage bags each with a double NRV (CSB A), and two sets of ten drainage bags each with a single NRV (CSB B) were inoculated with Escherichia coli (F: ATCC 25922; C: clinical strain). Daily samples were taken from two drainage ports on each system - one above the NRV (Port I), the other above the top of the artificial bladder (Port II). Time till E. coli was detected at the drainage ports (time to positivity) was measured. Colonization of the 'bladder' was defined as time to positivity at Port II. RESULTS: No significant differences in time to positivity at Port I (median 9.0, range: 6-12 for CSB B vs median 9.5 days, range: 6-13 for CSB A) were observed between the two systems. However, substantial differences were seen between the two systems in time to positivity at Port II: Port II on the bladder model using CSB B became positive after a median of 14.0 days (range: 10-22), whereas Port II of the model using CSB A only became positive after 21.5 days (range: 13-24). This amounts to a highly significant difference of 7.5 days (p = 0.0001) in the mean. CONCLUSION: Under laboratory conditions, colonization of the 'bladder' was significantly delayed when the CSB with a double NRV was used in comparison to the results obtained from the single NRV-system. Clinical trials should be conducted to investigate whether the urinary CSB with the double NRV has the ability to prevent (or to delay the onset of) catheter-associated urinary tract infection.

Comparison of five prognostic scoring systems, the French-American-British (FAB) and World Health Organization (WHO) classifications in patients with myelodysplastic syndromes: Results of a single-center analysis.

We retrospectively studied 89 consecutive patients diagnosed with primary myelodysplastic syndrome (MDS) over a period of 10 years to (1) identify prognostic factors for overall survival (OS) and leukemia-free survival (LFS); (2) to assess and compare the Bournemouth-, Spanish-, Düsseldorf-, Lille-, and the International prognostic scoring systems (IPSS); and to (3) compare the French-American-British (FAB) and World Health Organization (WHO) classifications. The median age of patients was 63 years (range, 26-85). Karyotype analyses were done in 85 patients (96%). Median OS was 3 years; 67 patients (75%) have died, and 28 (31%) had progression to acute myeloid leukemia (AML). Major independent prognostic variables for both OS and LFS (multivariate analysis) were percentage of bone marrow (BM) blasts (P < 0.0001), and in patients with cytogenetic data available, cytogenetic risk groups by Lille-score (OS, P = 0.031/LFS, P = 0.002) and IPSS (OS, P = 0.024). All five prognostic scoring systems successfully discriminated risk groups as regards OS and LFS, but in patients with cytogenetic data available, the major independent prognostic score for OS (P < 0.0001) and LFS (P = 0.006) was the IPSS. The FAB and WHO classifications also successfully discriminated between risk groups. The new WHO subgroups [refractory cytopenia with multilineage dysplasia (RCMD), with (RCMD-RS) or without ringed sideroblasts] showed a significantly (P = 0.0454) different prognosis for OS, but not for LFS (P = 0.0839), in comparison to the subgroups having erythroid dysplasia only (RA/RARS). Risk stratification into refractory anemia with excess blast-I (RAEB-I) and RAEB-II tended to yield different prognoses for OS and LFS. The 5q-minus syndrome strongly predicted for a good prognosis. In patients treated with the demethylating agent decitabine (n = 24), IPSS "poor risk" cytogenetics were unable to predict for the expected worse prognosis when compared to "intermediate-risk" cytogenetics. In conclusion, we confirm in a single-center patient cohort that the use of the WHO classification improves the predictive value of the FAB classification and that, in patients with cytogenetic data available, the IPSS can be used for clinical decision-making.

Profilometric and microradiographic studies on the effects of toothpaste and acidic gel abrasivity on sound and demineralized bovine dental enamel.

The objective of this study was to assess the abrasive effects of toothpastes and acidic F gels on sound and demineralized enamel. Pairs of enamel specimens were cut from bovine incisors, embedded in epoxy resin and polished. An artificial subsurface lesion of 80-90 microm depth was created in one specimen from each pair. The samples were covered with adhesive tape, thereby exposing the enamel for abrasivity testing. All samples were divided into six groups of 15 and brushed with a slurry (1:3) of F gel or toothpaste and human saliva. Brushing with water (control) or with slurry was carried out (16,000 strokes) using a medium toothbrush (load 275 g) mounted in a brushing machine. Abrasion was evaluated using laser profilometry, and was about 50% less on sound than on demineralized enamel (p < 0.001). In the latter, brushing with water (0.09 +/- 0.03 microm) or with fluoride-free gel (0.08 +/- 0.03 microm) resulted in negligible wear. With a medium-abrasive paste (1.76 +/- 0.85 microm) and an acidic F gel (2.48 +/- 0.72 microm), brushing abrasion was significantly greater (p < 0.001) than with a low-abrasive paste (0.84 +/- 0.38 microm). The greatest wear (16.6 +/- 10.8 microm) was observed with high-abrasive paste (p < 0.001), and here transversal microradiography revealed a complete loss of the pseudointact surface after brushing. In vitro formed caries-like lesions can be abraded (by toothbrushing) more easily than sound enamel; hence, initial white spot lesions should preferably be brushed with oral hygiene products of low abrasivity.

The UV erythema test as a model to investigate the anti-inflammatory potency of topical preparations--reevaluation and optimization of the method.

BACKGROUND: The ultraviolet (UV) erythema test is one of the most frequently used methods to investigate the anti-inflammatory potency of topical dermatological preparations in vivo. METHODS: The following questions were addressed in four separate studies with healthy persons (skin types 2 and 3): (1) the optimal localization was determined by comparing light scales on the back, buttocks and volar forearms; (2) the optimal UV-B dose was determined by comparing the 1-fold, 1.5-fold and 2-fold minimal erythema doses (MEDs); (3) hydrocortisone and prednicarbate were evaluated as positive controls, and a sample size calculation was performed, and (4) betamethasone valerate and pimecrolimus were tested as further positive controls in the optimized study model. RESULTS: The back proved to be the best localization for the UV erythema test. It showed a good correlation between the light scale and the test areas. The 1.5-fold MED was the best irradiation dose. In contrast to prednicarbate and betamethasone valerate, hydrocortisone was a rather weak positive control. However, when the sample size was > or = 40 subjects, significant results were also obtained with hydrocortisone. Pimecrolimus was not effective in the UV erythema test. CONCLUSIONS: The UV erythema test should be performed on the back with at least 40 subjects using the 1.5-fold MED. It may be useful to include a potent corticosteroid, such as prednicarbate or betamethasone valerate, in addition to hydrocortisone. The UV erythema test seems to be suitable only for substances with corticosteroid-like effects, since in this test model the calcineurin inhibitor pimecrolimus was not effective.

Microradiographic study on the effects of salivary proteins on in vitro demineralization of bovine enamel.

The aim of this investigation was to evaluate the effects of various proteins on in vitro demineralization of bovine enamel. From each of 100 bovine incisors two samples were prepared. The specimens were embedded in epoxy resin and polished up to 4000 grit. Subsequently, the specimens' surfaces were partly covered with nail varnish, thus serving as control of sound enamel. The specimens were divided randomly into five groups (n = 40) and demineralized in a solution of constant composition (pH 5.0; 10 days). For each subgroup of specimens (n = 10) 4 L were taken and either low (50% of medium conc.), medium, or high (150%) concentrations of the proteins [human albumin (100% conc. = 7 mg L(-1)), mucin (577.5 mg L(-1)), immunoglobulin G (IgG) (46 mg L(-1)), casein isolated from bovine milk (1.2 g L(-1))] or amino acid [l-Proline (7 mg L(-1))] were added to 1 L of the demineralizing solution, whereas 1 L served as control. Mineral loss and lesion depth (LD) were evaluated from microradiographs of thin sections (110 mum) by a dedicated software package (TMR 1.24). No differences were found between the five control groups (P > 0.05; ANOVA). Albumin, l-Proline, and IgG did not affect enamel demineralization, whereas the addition of both casein and mucin resulted in significant reductions of both mineral loss and LDs (P < 0.01; Tukey's test). Within the limitations of an in vitro study, the present investigation indicates that casein and mucin seem to affect enamel demineralization significantly. Thus, these proteins might be helpful as an additive to saliva substitutes or mouthwashes if the quality of saliva is altered.

Prognostic value of proliferative responses to HIV-1 antigen in chronically HIV-infected patients under antiretroviral therapy.

BACKGROUND: In the chronic stage of HIV infection T cell proliferative responses to HIV antigens are rare, mostly of low level, and the influence of responses on antiretroviral therapy is not known. OBJECTIVES: To determine a potential correlation between HIV-specific proliferative responses and the subsequent course of infection under antiretroviral therapy. STUDY DESIGN: Proliferation assays were performed with freshly isolated blood mononuclear cells from 45 chronically HIV-infected HAART treated individuals using HIV-p24, other recall antigens, and mitogens as stimulants. Virus load was monitored at the time of stimulation and during 33 months follow-up. RESULTS: A proliferative response to HIV antigen stimulation was detectable in 7 of 45 patients (15.5% responders). This group showed elevated reactions against tetanus toxoid and tuberculin, whereas reactions against standard mitogens were equal in the HIV responder and nonresponder groups. None of the seven HIV-specific responders had a blood virus load rebound of more than 1000 genome copies/ml during follow-up, whereas in 50% of the non-responders higher virus rebounds occurred. CD4 cell levels were slightly higher in the responder group, but mostly independent of virus rebound within the non-responders. Only four patients with high and continuous virus rebound experienced a significant CD4 cell decline. CONCLUSIONS: In patients under HAART, HIV-specific proliferative response is frequently related to anamnestic antigen responses and an enduring control of virus replication.

Effects of ultrafiltration and peritoneal dialysis on proinflammatory cytokines during cardiopulmonary bypass surgery in newborns and infants.

OBJECTIVES: To assess the impact of balanced ultrafiltration and peritoneal dialysis (PD) on plasma and urinary cytokines and renal dysfunction after cardiopulmonary bypass (CPB) surgery in newborns and infants. METHODS: Twenty-three newborns and infants weighing less than 7 kg and scheduled for operation on congenital malformation were enrolled in this descriptive open clinical study. All patients received conventional ultrafiltration in the CPB rewarming period. Eleven newborns underwent Tenckhoff-catheter implantation in the operation theatre as a routine institutional procedure and received PD after admission to the ICU (the PD [+] group). No PD was used in another 12 patients (the PD [-] group). Interleukins (IL) 6 and 8 were measured four times pre- and post-operatively. Kidney function was assessed by creatinine clearances and urine protein and enzyme analyses. RESULTS: All patients had an uneventful clinical course. Age (10+/-2 days, PD [+] vs. 96+/-19 days, PD [-]), CPB duration (215+/-23 vs. 143+/-20 min), and degree of hypothermia (26+/-1.3 vs. 31+/-0.1 degrees C) differed significantly between the groups. Age, CPB duration and ultrafiltration influenced post-operative IL-levels in an analysis of variance. While there were few differences immediately after the end of ultrafiltration, post-operative levels of IL-6 and IL-8 were higher and more sustained in the newborns (PD [+]) than in the older infants (PD [-]). The median amount of IL-6 and IL-8 removed by ultrafiltration came to 28 and 59% compared to the amount of IL-6 and IL-8 remaining in the blood at the end of CPB. IL-clearance by ultrafiltration was more than 1000-fold and by PD more than 100-fold as effective as IL-clearance by the kidney. While the kidneys showed an unselective mixed glomerular and tubular pattern of injury, during CPB higher serum IL-concentrations correlated with lower urinary IL-clearances in both study groups. CONCLUSIONS: Ultrafiltration and PD are highly effective in removing proinflammatory cytokines. Impaired kidney function was associated with proinflammatory IL-serum concentrations. Thus, we raise the hypothesis that glomerular-filtered proinflammatory ILs damage the proximal tubular cells of the kidney in newborns and infants, thus contributing to post-operative renal dysfunction. Conversely, we conclude that removing proinflammatory ILs by ultrafiltration and PD acts renoprotectively. A future prospective randomised study could demonstrate whether this can indeed improve clinical outcome.

Low level of intracortical inhibition in children shown by transcranial magnetic stimulation.

Transcranial magnetic stimulation (TMS) is an established neurophysiological tool to evaluate the integrity and maturation of the corticospinal tract. TMS was used in this study to compare intracortical inhibition (ICI) in children, adolescents, and adults. The paired-pulse technique of TMS with interstimulus intervals of 2 ms was used to determine the ratio of conditioned (cMEP) and unconditioned amplitudes (ucMEP) that measures ICI. In experiment 1 (Exp 1) stimulus intensity was adapted to motor threshold (50 healthy subjects; 24 male, 26 female, median age 13.5 years, range 6.3 - 34 years) and in experiment 2 (Exp 2) stimulus intensity was adapted to the ucMEP (200 - 400 microV). Children (quotient of cMEP and ucMEP: Exp. 1: 0.71 +/- 0.41, Exp. 2: 0.82 +/- 0.25) had significantly less ICI compared to adults (Exp. 1: 0.21 +/- 0.19, mean +/- STD, Exp. 2: 0.35 +/- 0.22, in both experiments p < 0.001). Recently, ICI has been linked to the regulating function of GABAergic cortical interneurons on practice-dependent neuronal plasticity. Therefore, the lower ICI in children points to maturation processes that may have implications for the greater capacity of practice-dependent neuronal plasticity in children.

Initial in situ secondary caries formation: effect of various fluoride-containing restorative materials.

This study evaluated the effects of various restorative materials (Ariston pHc; Dyract; Vitremer; Tetric Ceram; Compoglass F, F2000; Hytac and Ketac Molar) on initial secondary caries formation in situ. Eighty-eight enamel slabs from sound human molars were sterilized (ethylene dioxide) and embedded in epoxy resin. Standardized tooth preparations were filled with the various restorative materials according to manufacturers' recommendations. One specimen from each group was inserted into one of two buccal aspects of an intraoral appliance worn by 11 volunteers for four weeks, day and night. Oral hygiene was performed without additional fluoride application. During meals and oral hygiene procedures, the appliances were stored in sucrose solution (10%). After in situ exposure, the samples were prepared for microradiographic assessment. Mineral content and lesion depth were evaluated by a dedicated software package (TMR 1.24). Lesion depth and mineral loss of the carious lesions close to Ariston pHc was significantly lower when compared to distant parts of the same lesions (p < 0.05; t-test, Bonferroni-Holm correction). All other materials containing fluoride showed no caries protective effect on surrounding enamel (p > 0.05; t-test, Bonferroni-Holm correction). A hydroxyl-, calcium- and fluoride-containing restorative material hampers demineralization next to the restoration, whereas, fluoride release of various fluoride-containing restorative materials does not affect demineralization of adjacent enamel in situ.

The effect of commercially available saliva substitutes on predemineralized bovine dentin in vitro.

OBJECTIVE: The objective of this study was to evaluate the effects of various saliva substitutes (Artisial; Glandosane; Oralube; Saliva medac; Oralbalance) on the lesion depth and the mineral content of predemineralized bovine dentin in vitro. MATERIALS AND METHODS: Ninety-six dentin samples were prepared from 24 freshly extracted bovine incisors. The samples were predemineralized (pH 5.5; 10 days), and subsequently exposed to the various artificial salivas. A carbonate-reduced mineral water (Hirschquelle) as well as the mouthwash solutions Meridol and biotène served as controls. Lesion depth and mineral loss were evaluated from microradiographs of thin sections (110 microm) by a dedicated software package (TMR 1.24). RESULTS: After storage in Glandosane and biotène, the results indicated a significant mineral loss and an increase in lesion depth (P < 0.01; Wilcoxon). In contrast, specimens stored in Oralube showed a decrease in lesion depth and an increase in mineral content (P < 0.05; Wilcoxon). CONCLUSIONS: Thus, the use of neither Glandosane nor biotène can be recommended in dentate patients with severe xerostomia.

Influence of a radiofrequency electromagnetic field on cardiovascular and hormonal parameters of the autonomic nervous system in healthy individuals.

The potential health risks of radiofrequency electromagnetic fields (EMFs) emitted by mobile phones are of considerable public interest. The present study investigated the hypothesis, based on the results of our previous study, that exposure to EMFs can increase sympathetic vasoconstrictor activity. Forty healthy young males and females underwent a single-blind, placebo-controlled protocol once on each of two different days. Each investigation included successive periods of placebo and EMF exposure, given in a randomized order. The exposure was implemented by a GSM-like signal (900 MHz, pulsed with 217 Hz, 2 W) using a mobile phone mounted on the right-hand side of the head in a typical telephoning position. Each period of placebo exposure and of EMF exposure consisted of 20 min of supine rest, 10 min of 70 degrees upright tilt on a tilt table, and another 20 min of supine rest. Blood pressure, heart rate and cutaneous capillary perfusion were measured continuously. In addition, serum levels of norepinephrine, epinephrine, cortisol and endothelin were analyzed in venous blood samples taken every 10 min. Similar to the previous study, systolic and diastolic blood pressure each showed slow, continuous, statistically significant increases of about 5 mmHg during the course of the protocol. All other parameters either decreased in parallel or remained constant. However, analysis of variance showed that the changes in blood pressure and in all other parameters were independent of the EMF exposure. These findings do not support the assumption of a nonthermal influence of EMFs emitted by mobile phones on the cardiovascular autonomic nervous system in healthy humans.

Fluoride uptake, retention, and remineralization efficacy of a highly concentrated fluoride solution on enamel lesions in situ.

Repeated topical application of concentrated fluorides is known to reduce caries. Little is known about fluoride retention and remineralization in incipient caries lesions following a single application. We investigated fluoride and the remineralization kinetics of a single application of elmex fluid (GABA International AG, Münchenstein, Switzerland; 10,000 ppm F) in initial enamel lesions. In this double-blind, placebo-controlled, randomized, crossover in situ study that conformed to good clinical practice, volunteers received intra-oral removable appliances carrying demineralized enamel samples after application of elmex fluid or placebo. After 5 min, 1, 2, 3, and 4 weeks in situ, KOH-soluble fluoride (KOHF), structurally bound fluoride (SBF), mineral gain, and lesion depth reduction were measured. Elmex fluid promoted higher KOHF and SBF at all times, decreased KOHF with time, increased SBF up to 3 weeks, and registered a higher mineral gain than placebo. Volunteers with higher stimulated salivary flow rates had lower fluoride uptake, but higher mineral gain. In conclusion, a single application of highly concentrated fluoride solution increases remineralization.

[Long term compliance with an oral protrusive appliance in patients with obstructive sleep apnoea]. / Obstruktive Schlafatmungsstörungen: Therapiecompliance mit einem intraoralen Protrusionsgerät.

BACKGROUND AND OBJECTIVE: Oral protrusive devices (OPD) are increasingly used in primary snoring and mild-to-moderate obstructive sleep disordered breathing. Due to evidence of reduced compliance with the well established standard treatment of nasal positive airway pressure (CPAP) and reports of patient preference for OPD treatment, particularly in mild cases, OPD may be considered another treatment alternative. PATIENTS AND METHODS: We contacted 192 patients suffering from obstructive sleep breathing disorder, who were treated between May 1996 and September 2001 with an OPD. The patients" use of the device was evaluated, as were any reasons for ceasing to use the device. RESULTS: 105 patients (54.4%) regularly used the appliance after a mean time of 22.7 12.3 month. 21 patients (10.9%) showed no primary compliance and stopped had using the device before the first somnographic follow-up after a mean time of 3.8 months. In this investigation 76 patients (80,2%) were classified as responders and 19 patients (20.8%) as primary non-responders. 22 responders (11.4%) demonstrated no secondary compliance after a mean of 21.9 8.8 months and the discontinued OPD treatment themselves. In 21 patients (10.9%) the nightly respiratory parameters decreased after a mean of 23.0 11.7 months; hence, those patients required CPAP. The cumulative risk using the device after four years as prescribed was 32.2%. We found a correlation between patient compliance, body-mass index and the amount of teeth in the upper and lower jaws. CONCLUSION: OPD compliance seems to be lower than frequently expected. Regular follow-up investigations are necessary to ensure adequate treatment. Poor dental status and an excess body-mass index reduce patient compliance.

Predictive factors for response to neoadjuvant therapy in patients with oesophageal cancer.

BACKGROUND: Preoperative radio-chemotherapy (RCX) was introduced to improve the outcome of patients with oesophageal cancer (EC), but conflicting results have been released. Some 20-30% of patients show a complete pathological response, however, the perioperative morbidity and mortality is increased. To search for factors indicating response prior to the onset of RCX we investigated the proliferative activity (MIB-1), the expression of vascular endothelial growth factor (VEGF), and the capillary density (CD34) in samples of EC obtained by endoscopy prior to the start of the treatment. METHODS: Forty-six (MIB-1) and 21 (VEGF, CD34) tissue specimens of ECs were available from 56 patients undergoing pretherapeutic endoscopy, RCX and surgery. Perioperative morbidity was divided into surgery and non-surgery related morbidity. MIB-1, VEGF and CD34 expression were investigated immunohistochemically. Multivariate analysis was carried out to prove independence of investigated variables. RESULTS: Postoperative morbidity was noticed in 54 of 56 operated patients. Eight of 56 patients who received RCX died in hospital. Survival was significantly different between the group of complete responders (n=14) and non-responders (n=23; P=0.0026). None of the investigated tumour samples from patients with a complete response (CR) had a proliferation index of less than 45. Tumour samples from patients with a CR showed a VEGF expression of 10.7 compared with 36.58 of tumours with no response (P=0.035). CD34 expression showed a correlation with VEGF expression. The relation of mean indices of VEGF expression and proliferative activity in tumours from patients with complete, partial or no response was 10.7:58.8, 18.3:53.8 and 36.6:43.5, respectively. CONCLUSIONS: According to these results, it may be expected that tumours with a VEGF/MIB-1 ratio of 1:6 or less prior to RCX will respond to this therapy.