Knowledge and attitudes of emergency medicine physicians and nurses regarding emergency management of dentofacial trauma in pediatric patients.

OBJECTIVES: Considering that the first visit for dentofacial trauma is generally in emergency departments, the awareness and knowledge of the emergency medicine staff regarding the treatment of dentofacial injuries is very important for the prognosis. The aim of this study was to investigate the knowledge, education, and self-confidence levels of emergency medicine physicians and nurses concerning the diagnosis and treatment of dentofacial traumatic injuries in pediatric patients. METHODS: This questionnaire-based, cross-sectional study included emergency medicine physicians and emergency medicine nurses. The survey contained questions and three sections on participants' general data, attitudes, basic knowledge, and confidence levels in managing dentofacial trauma. RESULTS: A total of 407 participants (250 emergency medicine physicians and 157 emergency medicine nurses) were included in this study. There was a significant difference between the groups regarding the correct answers to the questions about trauma management and emergency management of crown fractures and avulsed permanent teeth (p <0.05). CONCLUSION: Our findings show that there is a lack of information on dentofacial trauma for emergency medicine physicians and nurses. In order to increase knowledge in this area and to improve the diagnosis and management of dentofacial trauma, interdisciplinary seminars, case discussions, and continuing education programs should be held for emergency medicine staff.

[Hypertension and nutrition. Position paper of the Austrian Nutrition Society]. / Hypertonie und Ernährung. Positionspapier der Österreichischen Gesellschaft für Ernährung (ÖGE).

Arterial hypertension is one of the leading causes of overall mortality and is responsible for a high proportion of deaths due to stroke as well as coronary heart disease. It is defined as a pathological elevation of blood pressure which leads to damage of the cardiovascular system. Cut-off values for hypertension are defined as blood pressure levels higher than 140/90 mmHg (systolic/diastolic). In the pathogenesis of hypertension genetic factors, age and sex play a role, as well as body weight and lifestyle factors, such as nutrition and physical exercise. Lifestyle optimization reduces the risk of developing hypertension and contributes to the treatment in patients with established hypertension. Nutritional factors associated with hypertension are discussed in this article and recommendations regarding diet are made based on the literature. The nutritional factors with the highest impact on blood pressure are reduction of salt intake, a diet rich in potassium, weight management, the DASH (dietary approach to stop hypertension) diet and moderation of alcohol consumption. Salt restriction is essential in the prevention and treatment of hypertension. Based on the literature, in this article recommendations for nutrition and hypertension are given.

Chronobiological aspects of food intake and metabolism and their relevance on energy balance and weight regulation.

Overweight and obesity are the result of a chronic positive energy balance, and therefore the only effective therapies are a diet which, on the long term, provides lower calories than the daily expended energy and exercise. Because nearly every physiological and biochemical function of the body shows circadian variations it can be suggested that also different chronobiological aspects of food intake, like time of day, meal frequency and regularity, and also circadian desynchronizations like in shift work may affect energy metabolism and weight regulation. The aim of this review is therefore to summarize and discuss studies that have addressed these issues in the past and to also provide an overview about circadian variations of selected aspects of metabolism, gut physiology and also factors that may influence overall energy regulation. The results show that a chronic desynchronization of the circadian system like in shift work and also sleep deprivation can favour the development of obesity. Also, regarding energy balance, a higher meal frequency and regular eating pattern seem to be more advantageous than taking the meals irregularly and seldom. Additional studies are required to conclude whether time of day-dependent food intake significantly influences weight regulation in humans.

Decreased expression of the melatonin receptor 1 in human colorectal adenocarcinomas.

Melatonin exerts anti-proliferative and pro-apoptotic effects in various cancer cell lines. Furthermore, there is evidence for impaired melatonin secretion in human breast and colorectal cancer. Additionally, several studies revealed a modulated expression of the melatonin receptor 1 (MT1), in human breast cancer specimens. Since melatonin binding sites were already identified in the human intestine, our aim is to identify the expression and to characterize the localization of the MT1 receptor in the human colon and in particular to compare MT1 expression levels between non-malignant and malignant colonic tissue. We assessed MT1 transcript levels with real time RT-PCR in colon adenocarcinomas and the adjacent normal colonic mucosa of 39 patients and observed a significant decrease of MT1 mRNA expression in colorectal cancer compared with the healthy adjacent mucosa tissue (0.67 mean difference, P < 0.0001). The results were confirmed at the protein level by Western blot analysis and by immunohistochemistry. MT1 was localized mainly supranuclear in colonic epithelial cells lining the crypts. We also evaluated mRNA expression of different clock genes in the colon samples and found a significant correlation between MT1 and Cryptochrome 1 (Cry1) expression (P < 0.01 for normal and P < 0.05 for tumour tissue). In conclusion, the decreased expression of MT1 in human colorectal cancer could point to a role of melatonin in this disease.

Coexpression of the melatonin receptor 1 and nestin in human breast cancer specimens.

Activation of the G-protein-coupled receptor (GPCR) for melatonin (MT1) suppresses breast cancer cell growth in experimental models. To elucidate whether MT1 might play a role in cancer cells positive for the stem cell marker nestin, we assessed paired carcinomatous (Ca) and adjacent noncancerous (NCa) samples from 42 patients with primary breast cancer for MT1 and nestin by double immunofluorescence staining and quantitative image analysis with Tissue-Quest software. MT1 was located in luminal and myoepithelial cells in milk ducts and in tumor cells in 40/42 and 39/42 of NCa and Ca specimens, respectively, independent of hormone receptor and HER-2 status. Nestin was located together with MT1 in myoepithelial cells in 38 NCa specimens (total n = 42) and in 18 Ca specimens with intact milk ducts. Quantitative evaluation of selected 16 NCa and Ca samples revealed that MT1 levels were higher in invasive Ca sections than in NCa specimens in eight and lower in six cases. Specimens from higher tumor stages (TII/III) with a higher risk of relapse were associated with MT1/nestin co-staining in more than 10% of tumor cells, whereas a lack of co-staining correlated with lower tumor stages. Abundant expression of MT1 and, particularly, coexpression of MT1 with nestin in invading tumor cells in more advanced tumors suggest an important role for this GPCR in the pathogenesis of breast cancer.

Melatonin receptors in humans: biological role and clinical relevance.

In addition to its antioxidative effects melatonin acts through specific nuclear and plasma membrane receptors. To date, two G-protein coupled melatonin membrane receptors, MT(1) and MT(2), have been cloned in mammals, while the newly purified MT(3) protein belongs to the family of quinone reductases. Screening studies have shown that various tissues of rodents express MT(1) and/or MT(2) melatonin receptors. In humans, melatonin receptors were also detected in several organs, including brain and retina, cardiovascular system, liver and gallbladder, intestine, kidney, immune cells, adipocytes, prostate and breast epithelial cells, ovary/granulosa cells, myometrium, and skin. This review summarizes the data published so far about MT(1) and MT(2) receptors in human tissues and human cells. Established and putative functions of melatonin after receptor activation as well as the clinical relevance of these findings will be discussed.

Does oxygenated water support aerobic performance and lactate kinetics?

It has been asserted that the consumption of oxygenated water can support physical working capacity. As this has not been accurately investigated yet we analyzed effects of a two-week period of daily O2-water ingestion on spiroergometric parameters and lactate metabolism in healthy adults. Twenty men (24 +/- 2.5 years of age) with comparable aerobic abilities performed four exhaustive bicycle spiroergometric tests. Applying a double-blind crossover study design 10 subjects drank 1.5 liters of highly oxygenated water every day during the two weeks between the initial two tests whereas the other group consumed 1.5 liters untreated water from the same spring. After a two-week wash-out period subjects underwent a second period consuming the opposite type of water. Spiroergometric parameters and lactate kinetics between both groups at submaximal and maximal levels were analyzed using a MANOVA. Results showed no significant influence on aerobic parameters or lactate metabolism, neither at submaximal nor at maximal levels (all p-values > or = 0.050). Merely increments of VEO2 at submaximal levels were demonstrable (p = 0.048). We conclude that the consumption of oxygenated water does not enhance aerobic performance or lactate kinetics in standardized laboratory testing.

Does aerobic training improve mental stress tolerance in job situations?

AIM: Effects of aerobic fitness on cognitive performance (CP) in elderly persons have been investigated with contradictory RESULTS: However, these effects have not been explored in occupationally active young and healthy subjects yet. Therefore we studied the effects of an aerobic training on CP during mental stress and in low demanding situations. METHODS: Twenty-seven healthy volunteer students performed a maximal bicycle exercise test and 2 computerized psychological examinations at the begin and the end of a 3 month period of individualized aerobic training. The psychological tests were the ''Determinations-test'' (DT), which is a multi-task stress test, and the ''Vigilance test'' (VT), representing a low demanding situation. According to the outcome of the aerobic training 2 groups were formed: those with moderate and those with good training effects. RESULTS: Results showed no significant differences between the 2 groups over the training period (5 parameters at DT and 4 at VT were n.s., 1 result at VT with p<0.05 was interpreted as a regression to the mean). CONCLUSIONS: We conclude that neither CP at high stress nor vigilance during low demanding periods can be influenced by an improvement of aerobic fitness in occupationally active young and healthy persons.

Seasonal variation of lipid-lowering effects of complex spa therapy.

BACKGROUND AND OBJECTIVE: It has been shown that spa therapy has a lipid-lowering effect. Also, seasonal variations in spa therapy effects have been found for some outcome measures. The aim of the present study is to investigate whether the lipid-lowering effects of spa therapy as a complex health intervention also are subject to seasonal variation. METHOD: The effect of 3-week resident spa therapy at the Austrian spa Bad Tatzmannsdorf was studied in 395 patients with moderate musculoskeletal chronic pain over a time of 2 years. Spa therapy included balneotherapy, exercise therapy, and dietary measures. Total cholesterol (CHOL), HDL, LDL, triglycerides (TG), and the CHOL/HDL ratio were assessed at the beginning and end of therapy. RESULTS: Spa therapy was associated with a decrease of CHOL, HDL, and LDL (p < 0.001). TG and CHOL/HDL did not change. The decrease of lipids was smaller for older patients, females, and normal weight individuals. CHOL decrease showed a seasonal variation independent of weight loss (p = 0.04), being largest in fall (-6.1%) and smallest in spring (-2.4%). CHOL and CHOL/HDL for obese individuals showed the greatest decrease in winter (-10% for CHOL, -9% for CHOL/HDL ratio), whereas corresponding measures increased for normal-weight subjects. CONCLUSIONS: The lipid-lowering effect of spa therapy could be confirmed; it is partly moderated by season. The results suggest that the effect of some components of spa therapy such as exercise therapy, diet, and relaxation may be subject to seasonal variation.

Enhanced accumulation of the isoprostane, 8-epi-PGF2 alpha, in human aortic and pulmonary valves of patients with coronary heart disease.

The aim of the present study was to investigate whether the isoprostane 8-epi-PGF2 alpha differently accumulates in semilunar valves of patients suffering from coronary heart disease (CHD, n = 19) as compared to valves from healthy heart donors (controls, n = 6). Sections from isolated aortic and pulmonary valves were analyzed by semiquantitative immunohistochemistry. The 8-epi-PGF2 alpha-content was determined by using a specific radioimmunoassay. The accumulation of 8-epi-PGF2 alpha in both valves was higher in CHD-patients in comparison to controls (Aortic valves: 36.49 +/- 11.26% vs. 15.78 +/- 3.04%; pulmonary valves: 46.79 +/- 9.80% vs. 14.99 +/- 3.57%). The results from the radioimmunoassay revealed comparable findings in both groups (CHD vs. controls: 395.95 +/- 86.09 vs. 139.50 +/- 47.46 pg/mg protein in the aortic valves and 430.47 +/- 76.30 vs. 147.33 +/- 53.84 pg/mg protein in pulmonary valves). Pulmonary valves seem to be more susceptible to oxidative stress than aortic valves as evidenced by a higher accumulation of 8-epi-PGF2 alpha in CHD patients. Considering the data presented in this study, we suggest that 8-epi-PGF2 alpha is a valuable indicator of oxidative injury in human semilunar valves.

Effect of sulfur baths on antioxidative defense systems, peroxide concentrations and lipid levels in patients with degenerative osteoarthritis.

BACKGROUND: Due to possible antiinflammatory effects, sulfur baths are widely used for the treatment of rheumatic diseases. Previously it was demonstrated that drinking cures with sulfur can improve the antioxidative defense system and lower the peroxide levels of patients with chronic degenerative osteoarthritis. OBJECTIVE: This study therefore sought to investigate the effect of 3-week therapy with sulfur baths on antioxidative defense systems, peroxide concentrations, and lipid levels in patients with degenerative osteoarthritis. PATIENTS AND METHODS: After randomization one group of patients (n = 19) received sulfur baths during their stay at a health resort (sulfur group), whereas the other age-matched patient group served as controls (n = 19, control group), only receiving spa therapy. Total cholesterol levels, HDL, LDL, triglycerides and the antioxidative status, glutathione peroxidase, and superoxide dismutase (SOD) activities, and peroxide concentration, as an oxidative stress parameter, were evaluated at the begin and end of therapy. RESULTS: A 17.2% decline in peroxide concentrations (p = 0.10, n.s.) and significant lower SOD activities (p < 0.001) were detected in the sulfur group at the end of the therapy. Until the end of therapy total cholesterol levels changed differentially (p = 0.007) in the sulfur group (from 229.11 +/- 34.47 mg/dl to 217.46 +/- 40.45 mg/dl) and in the control group (from 197.63 +/- 34.66 mg/dl to 207.95 +/- 33.02 mg/dl). A similar significant group difference was found for LDL (p = 0.017), with a 5.9% reduction in the sulfur group and a 6.1% increase in the control group. Triglyceride concentrations were nonsignificantly reduced in both groups after 3 weeks at the health resort (sulfur group 11.2%, control group 20.2%). HDL values only minimally changed in both groups. CONCLUSIONS: The results presented here suggest that a sulfur bath therapy could cause a reduction in oxidative stress, alterations of SOD activities, and a tendency towards improvement of lipid levels.

The role of trace elements for the health of elderly individuals.

Elderly individuals have a higher risk to develop trace element deficiencies due to modified dietary habits and requirements, age related physiological changes, drug therapy, and chronic diseases leading to or associated with enhanced consumption or excretion of trace elements. This review gives an overview about the role of zinc, iron, selenium, copper, chromium and fluoride for the health of elderly people in regard of physiological functions, trace element status and intake, and effect of supplementation on clinical parameters and disease outcome.

Expression of the MT1 melatonin receptor subtype in human coronary arteries.

Previous experimental data suggest a possible influence of melatonin on the circulatory system of animals after binding to G-protein coupled melatonin receptors. The present study sought to investigate whether the melatonin receptor, mt1, is expressed in human coronary arteries derived from healthy heart donors (n = 8). Expression of the mt1-receptor was studied in sections of isolated coronary arteries by a reverse transcriptase-polymerase chain reaction (RT-PCR) and Western immunoblot technique. The analyses of the results from both methods indicated the presence of the mt1-receptor in all of the subjects. Referring to these data we assume that melatonin regulates physiological processes in human coronary arteries after receptor binding.

The isoprostane 8-epi-PGF(2alpha) is a valuable indicator of oxidative injury in human heart valves.

To date, little information is available concerning oxidative injury in human cardiac valves. Therefore, we sought to investigate whether the isoprostane, 8-epi-PGF(2alpha), a novel oxidative stress marker, is localized in aortic and pulmonary valves derived from explanted hearts of patients suffering from idiopathic dilative cardiomyopathy (IDC). By using semiquantitative immunohistochemistry, we demonstrated that 8-epi-PGF(2alpha) is localized in both valves with pulmonary valves accumulating more of this isoprostane compared to aortic valves (36.69+/-12.04% vs. 31.54+/-11.49%, P<.05). These results were confirmed by a radioimmunoassay (RIA) analysis showing a similar, but not significant, difference between the two valves (288.50+/-72.18 pg/mg protein in the pulmonary valves and 267.30+/-58.77 pg/mg protein in aortic valves, P=.09). Considering the data presented in this study, we suggest that 8-epi-PGF(2alpha) is a valuable indicator of oxidative injury in human semilunar valves.

Concentrations of seven trace elements in different hematological matrices in patients with type 2 diabetes as compared to healthy controls.

This study aimed to compare the trace element status of patients with type 2 diabetes (n = 53) with those of nondiabetic healthy controls (n = 50). The concentrations of seven trace elements were determined in the whole blood, blood plasma, erythrocytes, and lymphocytes of the study subjects. Vanadium and iron levels in lymphocytes were significantly higher in diabetic patients as compared to controls (p < 0.05 for iron and p < 0.01 for vanadium). In contrast, lower manganese (p < 0.01) and selenium (p < 0.01) concentrations were detected in lymphocytes derived from patients with type 2 diabetes versus healthy subjects. Furthermore, significantly lower chromium levels (p < 0.05) were found in the plasma of diabetic individuals as compared to controls. Trace element concentrations were not dependent on the degree of glucose control as determined by correlation analysis between HBA1c versus metal levels in the four blood fractions. In summary, this study primarily demonstrated that trace element levels in lymphocytes of patients with type 2 diabetes could deviate significantly from controls, whereas, in general, no considerable differences could be found when comparing the other fractions between both patient groups. Therefore, it seems reasonable to analyze metal levels in leukocytes to determine trace element status in patients with type 2 diabetes and perhaps in other diseases.

Angiogenesis stimulation in explanted hearts from patients pre-treated with intravenous prostaglandin E(1).

BACKGROUND: Prostaglandin E(1) (PGE(1)) is a potent vasodilator and induces angiogenesis in animal tissues. Previous clinical studies demonstrated that PGE(1) improves hemodynamic parameters in patients with heart failure listed for heart transplantation (HTX). Therefore, we designed a retrospective immunohistochemistry study to investigate various markers of angiogenesis using hearts explanted from PGE(1)-treated patients with idiopathic dilated cardiomyopathy (IDCM). METHODS AND RESULTS: We investigated neovascularization in 18 hearts explanted from patients with IDCM: 9 patients received treatment with chronic infusions of PGE(1) for end-stage heart failure before HTX, whereas the remaining patients with IDCM did not receive PGE(1) and served as controls. We used immunoreactivity against CD34, von Willebrand factor (vWf), vascular endothelial growth factor (VEGF), and MIB-1 (Ki-67) to quantify angiogenesis, and used sirius red staining to determine the degree of fibrosis. Compared with the control group, PGE(1)-treated patients had significantly more CD34-, vWf- and MIB-1-positive cells in the sub-endocardium, myocardium and sub-epicardium (p < 0.01). The degree of fibrosis in the hearts of PGE(1)-treated patients was significantly lower than in control patients (p < 0.05), but we did not see any difference in the percentage of muscle mass. Finally, throughout the ventricles, we found significantly more VEGF-positive capillaries in the PGE(1) group (p < 0.0001). CONCLUSIONS: The data suggest that PGE(1) could be a potent inducer of angiogenesis and the angiogenic factor VEGF, and could cause reduced fibrosis in the failing human heart.

24h variation in the expression of the mt1 melatonin receptor subtype in coronary arteries derived from patients with coronary heart disease.

Previous studies presented evidence for impaired nocturnal secretion and synthesis of melatonin in patients with coronary heart disease (CHD). This study aimed to investigate whether the melatonin receptor subtype mt1 is differentially expressed in coronary arteries derived from patients with CHD (n = 9) compared to patients with dilative cardiomyopathy (CMP; n = 10) who served as controls. Expression of the mt1 receptor was studied in sections of isolated coronary arteries by a reverse transcriptase-polymerase chain reaction (RT-PCR) and a Western immunoblot technique. In addition, the data from the Western blotting of 15 patients were interpolated against the exact time of aortic clamp to study the 24h expression of the mt1 receptor. The analyses of the results from both methods indicated the presence of the mt1 receptor in all of the individuals. No statistically significant difference was observed in the receptor expression between patients with CHD and those with CMP (in arbitrary units: 3.39 +/- 3.08 versus 3.91 +/- 2.78). Expression of the melatonin receptor in the coronary arteries of the whole patient group presented a 24h variation, with the lowest values detectable after 02:00 up to the late morning hours and a progressive increase beginning after 13:00 until 00:00 (mesor = 3.66, amplitude = 3.23, acrophase = 20.45, P = .0003). When studying the 24h variation in patients with CHD and CMP separately, a nearly similar circadian course was observed. In conclusion, we demonstrated for the first time a 24h variation of a melatonin receptor subtype in human vessels. Furthermore, in relation to our results, we suggest that the expression of the mt1 melatonin receptor in the coronary arteries is probably not impaired in patients with CHD.

The effect of balneotherapy on ambulatory blood pressure.

CONTEXT: Balneotherapy, a treatment that includes carbon dioxide and mud baths as well as massages and physical therapy, is successfully used in the treatment of rheumatic pain and other disorders such as cardiovascular and gynecological disease. OBJECTIVE: To study the effect of a 3-week treatment of balneotherapy on 24-hour ambulatory blood pressure in 35 patients. DESIGN: Balneotherapeutic applications were applied between 2 and 5 times a week and had a duration of 20 minutes. The mean 24-hour blood pressure, daytime blood pressure (7 AM to 10 PM), nighttime blood pressure (10 PM to 6 AM), nighttime dipping, and 24-hour blood pressure variability were measured. The effect of balneotherapy was evaluated using analysis of variance. In addition, the circadian variation of blood pressure was calculated using a cosinor analysis. SETTING: The Austrian spa resort Bad Tatzmannsdorf. PARTICIPANTS: 35 balneotherapy patients (15 men, 20 women). INTERVENTION: Balneotherapy. MAIN OUTCOME MEASURES: 24-hour ambulatory blood pressure was measured with an ambulatory monitor using an oscillometric method. RESULTS: The results indicated that the 24-hour blood pressure and day- and nighttime blood pressure of patients with medium and high initial values decreased significantly (P < .05) after 3 weeks of balneotherapy, whereas patients with low blood pressure showed almost no change. The 24-hour blood pressure variation pattern of patients with medium values remained nearly unchanged during the balneotherapy. In contrast, a clear improvement in the circadian variation variables of patients with high initial blood pressure could be detected at the end of balneotherapy. CONCLUSION: Patients with medium and, especially, higher initial blood pressure values seem to benefit from balneotherapy.

Magnesium transport from aqueous solutions across Caco-2 cells--an experimental model for intestinal bioavailability studies. Physiological considerations and recommendations.

The Caco-2 cell model is gaining more and more importance as an in vitro method to study intestinal nutrient bioavailability from foods. In a previous article we presented evidence that fractional Mg2+ transport from different aqueous solutions containing differing amounts of magnesium varies considerably in some cases. In the present article we discuss the role of electrolytes, such as calcium and the anions HCO3-, SO4(2-) and Cl-, in modulating magnesium absorption. Another purpose of this manuscript is to give recommendations, based mainly on physiological knowledge, which can be helpful when planning and conducting intestinal bioavailability studies using either the Caco-2 culture system or other in vitro models in order to achieve nearly similar conditions as in vivo.

Does vacation enable recuperation? Changes in well-being associated with time away from work.

The objective of this paper was to study the change of well-being associated with vacation and the effect of vacation related variables on these changes. Fifty-three employees (16 women, 37 men) of a medium sized aluminium hardware manufacturer in Austria participated. Measures were taken 10 days before and 3 days after vacation. A small follow-up group at 5 weeks post-vacation was included. Three days after vacation, physical complaints, the quality of sleep and mood had improved as compared to before vacation. Average life satisfaction did not change during vacation. Five weeks after vacation subjects still reported less physical complaints than before vacation. The experienced recuperation during vacation explained 56% of the variance regarding the change of well-being. Moderating variables of recuperation were the amount of personally available time and vacation satisfaction. Furthermore, the number of stressful days at home were associated negatively, while the number of non-stressful days at home and the number of days away from home correlated moderately positively with recuperation. The study indicates that vacation may improve well-being on a short term basis.