Accumulation rate of advanced glycation end products in recent onset psychosis: A longitudinal study.

Schizophrenia is associated with excessive oxidative stress. Production of advanced glycation end products (AGEs) in the skin is strongly associated with oxidative stress. Increased skin AGE-levels have been demonstrated at cross-sectional level in recent onset psychosis and chronic schizophrenia, indicating increased cardiovascular risk. We aimed to investigate factors underlying AGE-accumulation and accumulation rate of AGEs in recent onset psychosis. From December 2016 through May 2017, 66 patients and 160 (highly educated) healthy controls from a previous case-control study of AGE-levels were assessed for a follow-up measurement 12-24 months after baseline. Possible determinants of AGE-accumulation were analyzed. AGE-accumulation rates in patients and controls were compared adjusted for relevant confounders. In healthy controls, a significant association of AGE-accumulation with ethnicity and tobacco exposure was found. An indication of a markedly higher AGE-accumulation rate was found in patients suffering from recent onset psychosis compared to healthy controls, independent of ethnicity and tobacco smoking, but not independent of cannabis use (more prevalent in patients than controls), although results were not significant.

The fitting accuracy of pre-bend reconstruction plates and their impact on the temporomandibular joint.

BACKGROUND: Various causes for bone defects of the lower jaw have been described. As a result, patients often suffer from compromised aesthetics and a loss of, or reduction in, important physiological functions, such as swallowing, breathing, and speaking. A change in the shape of the lower jaw can impair the natural occlusion and leads to an atypical or modified position of the temporomandibular joint. Titanium reconstruction plates are the standard approach to jaw reconstruction, and are used for temporary bridging of a jaw defect or fixation of a bone graft. Conventionally these plates are intraoperatively adjusted to the mandible by the surgeon. Computer-aided manufacturing, computer-aided design, and rapid prototyping have gained increasing importance in the field of medicine, as they allow the production of individual models of the lower jaw, with the possibility of preoperatively bending the reconstruction plates. In this retrospective study, the accuracy of pre-bent titanium plates and their effect on the temporomandibular joint situation in comparison with intraoperatively curved plates will be discussed. MATERIALS AND METHODS: Patients who attended our department for lower jaw reconstruction between March 2013 and February 2015 were included in this retrospective study. Within that time 20 patients were treated with pre-bent reconstruction plates (group 1). 20 comparable patients were selected with reconstruction and conventional intraoperative bending (group 2). To evaluate the accuracy of the plates and the condylar position, postoperative cone beam computed tomograms and computed tomograms were used to assess the bone-plate distance at 12 defined points and four angles in axial reconstruction. The results were compared, statistically evaluated, and discussed. RESULTS: Regarding the maximum bone-plate distances and the sum of distances, there was a significant difference between the accuracy of the pre-bent and the conventionally bent reconstruction plates (p = 0.022, p = 0.048). Regarding the condylar position, there was no significant difference between both methods (p = 0.867). CONCLUSION: The results of this study show that a better fitting accuracy can be achieved using pre-bent plates. Preparation of the plates proves to be advantageous and meaningful, especially in complex bone defects and deformations of the lower jaw. Nevertheless, concerning the position of the temporomandibular joint, no significant difference could be ascertained between the shown methods, contradicting several studies.

[In search of a travel guide-results from a survey of E­health startup companies]. / Reiseführer gesucht ­ Ergebnisse einer Umfrage bei E­Health-Start-ups.

As is the case in other sectors, innovative digital products have started to enter the health market, too. If digital products like apps are considered medical devices, startups are often confronted with regulatory procedures that they deem to be slow and with which they are not familiar. This applies to both the certification procedures and the requirements and procedures for reimbursement, where problems could occur. The aim of this article is to better understand the startups' experience in navigating through these procedures, the hurdles they encounter, and their need for support. Therefore, the digital association Bitkom e. V. and the Federal Institute for Drugs and Medical Devices (BfArM) conducted a web-based survey on five themes with a total of 23 questions. These questions focused inter alia on the composition of the team, product planning, familiarity with regulatory requirements, experience with institutions and different sources of information, the assessment of challenges in the process, and the resulting need for support.The analysis on the basis of 18 complete replies has shown that startups work on products with documentation and communications functions, but also integrate diagnostic and therapeutic features. The latter are characteristics of medical devices. Startups consider themselves to be relatively familiar with regulatory requirements regarding medical devices. The largest hurdles are associated with reimbursement: long and costly processes until the startups' products could be reimbursed.Both with regard to reimbursement and certification, startups see a need for low-threshold, cost-efficient advisory services and a simplification and acceleration of existing procedures with regard to medical devices.

[From idea to standard care-a field report]. / Der lange Weg von der Idee bis zur Erstattung ­ ein Reisebericht.

Digital health products and services have started to fundamentally change healthcare and prevention. Products intended for a medical use require CE-marking and potentially certification (ISO 13485) of the company. Startups play an important role in the development of new digital products and services. Two startups share their experience with these processes. Becoming a part of standard care and hence being reimbursed is a challenge for startups. For this reason, startups pursue alternative sources of income, too. The statutory health insurance's procedures for assessing new products and services are perceived as long. Startups are required to provide evidence of the benefit of their product at an early stage in the procedure. This requires time-consuming and costly studies. Startups would therefore appreciate support in generating this evidence, e. g. through adequate procedures for testing.

Advanced Glycation End Products in Recent-Onset Psychosis Indicate Early Onset of Cardiovascular Risk.

OBJECTIVE: Profoundly increased mortality rates in schizophrenia, largely caused by a higher risk and earlier onset of cardiovascular disease, remain a major challenge. During the human lifespan, advanced glycation end products (AGEs) accumulate, and their concentration is strongly linked to cardiovascular mortality. AGE accumulation can be accelerated by several pathways, including oxidative stress. METHODS: From March 2015 through January 2016, a case-control study including 111 patients with a recent-onset psychosis, 135 controls from a validation cohort, and 286 healthy controls was performed. Patients fulfilled the DSM-IV criteria for schizophrenia spectrum disorders with an illness duration shorter than 5 years. Main outcome parameters were skin autofluorescence levels of AGEs, controlled for age, gender, and smoking. Correlations of AGEs with cardiovascular risk factors and clinical variables were analyzed by hierarchical linear regression analyses. RESULTS: An AGE measurement was possible in 77.4% of cases. AGEs were elevated by 15.1% in recent-onset psychosis compared to healthy controls (P < .001), corresponding to an increased accumulation of AGEs normally occurring in approximately 10 years. AGEs were not related to traditional risk factors. However, duration of illness (P = .008), duration of antipsychotic treatment (P = .009), and cumulative exposure to antipsychotics (P = .023) correlated with AGEs. CONCLUSIONS: Patients with a recent onset of psychosis have increased AGE levels compared to healthy controls. These findings argue for an earlier implementation of treatment strategies aimed at preventing cardiovascular disease. Also, low-dose strategies of antipsychotics in schizophrenia could beneficially influence AGE levels.