Quality of orthodontic care-A multicenter cohort study in Germany : Part 1: Evaluation of effectiveness of orthodontic treatments and predictive factors.

AIMS: Orthodontic care and its effectiveness have increasingly become the focus of political and public attention in the recent past. Therefore, this multicenter cohort study aimed to report about the effectiveness of orthodontic treatments in Germany and to identify potential influencing factors. METHODS: A total of 586 patients from seven German study centers were screened for this cohort study, of which 361 patients were recruited at the end of their orthodontic treatment. Of these, 26 patients had missing study models and/or missing treatment information. Thus, 335 participants were included. The severity of malocclusion was rated using the Peer Assessment Rating (PAR) Index at baseline (T0) retrospectively and-prospectively-after the retention period (T1). Practitioner-, treatment- and patient-related information were analyzed in order to detect potential predictive factors for treatment effectiveness. RESULTS: Study participants (202 female and 133 male) were on average 14.8 (standard deviation [SD] ± 6.1) years old at start of active treatment. Average PAR score at T0 was 25.96 (SD ± 10.75) and mean posttreatment PAR score was 3.67 (SD ± 2.98) at T1. An average decrease of total PAR score by 22.30 points (SD ± 10.73) or 83.54% (SD ± 14.58; p < 0.001) was detected. Furthermore, 164 treatments (49.1%) were categorized as 'greatly improved' but only 3 treatments (0.9%) as 'worse or no different'; 81.5% of all cases finished with a high-quality treatment outcome (≤5 PAR points at T1). Logistic regression analyses detected staff experience as a significant predictive factor for high-quality results (odds ratio 1.27, p = 0.001, 95% confidence interval 1.11-1.46). CONCLUSION: The improvement rate among this selected German cohort indicated an overall very good standard of orthodontic treatment. Staff experience proved to be a predictive factor for high-quality results.

Aviation Contrail Cirrus and Radiative Forcing Over Europe During 6 Months of COVID-19.

The COVID-19 pandemic led to a 72% reduction of air traffic over Europe in March-August 2020 compared to 2019. Modeled contrail cover declined similarly, and computed mean instantaneous radiative contrail forcing dropped regionally by up to 0.7 W m-2. Here, model predictions of cirrus optical thickness and the top-of-atmosphere outgoing longwave and reflected shortwave irradiances are tested by comparison to Meteosat-SEVIRI-derived data. The agreement between observations and modeled data is slightly better when modeled contrail cirrus contributions are included. The spatial distributions and diurnal cycles of the differences in these data between 2019 and 2020 are partially caused by differences in atmospheric and surface conditions, particularly for solar radiation in the spring of 2020. Aviation signals become discernible in the observed differences of these data between 2019 and 2020 when subtracting numerical weather prediction model results that approximate the atmosphere and surface conditions without contrails.

Moderate intensity continuous training reverses the detrimental effects of ovariectomy on RyR1 phosphorylation in rat skeletal muscle.

High 17ß-Estradiol (E2) concentrations in isolated ventricular myocytes as well as a lack of ovarian hormones in cardiac muscle of ovariectomized (OVX) rodents has been shown to lead to arrhythmogenic effects by inducing post-translational modifications, including phosphorylation of the sarcoplasmic reticulum (SR) Ca2+ release channel ryanodine receptor-2 (RyR2). The effects of estrogens on the phosphorylation status of the RyR1 in skeletal muscle have not been investigated before. Furthermore, while high intensity exercise has been shown to increase RyR phosphorylation, there is no data on the effects of moderate intensity continuous training (MICT). The aims of the study were to investigate the effects of a 3-day treatment with low (1 nM, moderate (5 nM) and high (10 nM, 100 nM) E2 concentrations on RyR1 mRNA and protein expression and phosphorylation status (pRyRSer2844) in cultured C2C12 myotubes and to study the effects of OVX on RyR1 expression and phosphorylation in rat skeletal muscle in combination with 3 weeks of MICT. Treatment with low, physiological E2 concentrations reduced dihydropyridine receptor (DHPR) and RyR1 mRNA content in C2C12 myotubes compared to untreated control cells, whereas RyR1 protein phosphorylation (pRyRSer2844) was significantly increased after treatment with high, non-physiological E2 concentrations (p ≤ 0.05). RyR1 protein content (p ≤ 0.05) and pRyRSer2844 (p ≤ 0.05) were significantly elevated in skeletal muscle of OVX vs. sham-operated rats. Importantly, pRyRSer2844 levels were similar to sham-operated controls in OVX rats after MICT (OVX vs. OVX + MICT, p ≤ 0.05). Our results indicate, that one of the actions of estrogens is to alter skeletal muscle Ca2+ homeostasis by modulating the expression and phosphorylation of the RyR1 in skeletal muscle. Notably, regular MICT was able to counteract RyR1 phosphorylation in skeletal muscle of OVX rats.

[Gallop in the Routineergometrie: Only Chore or Diagnostic Challenge?] / Extrasystolie in der Routineergometrie: lästige Pflicht oder diagnostische Kür?

ANAMNESIS: A 47-year-old recreational sportsman showed in a routine ergometry polymorphic ventricular extrasystoles with good physical performance. INVESTIGATIONS: In resting ECG impressed ventricular extrasystoles (VES) predominantly right-hand-block-like with superior axis, a long-term ECG yielded up to 100 VES per hour. Echocardiographically imposing 4 - 5 trabeculae, feathered, reticular structures apically in the left and lower in the right ventricle. The cardio-MRT revealed a wall dilation laterally and apically with increased trabecularization, no late enhancement. DIAGNOSIS: mild form of NCCM, currently asymptomatic THERAPY: Cardiac insufficiency treatment is based on the guidelines, including ICD-CRT therapy. We recommended ramipril and decided against transvenous ICD implantation. At the time of the presentation, subcutaneous ICD systems were not available. Family screening and genotyping of affected persons are recommended. CONCLUSION: Most patients have cardiac insufficiency, rhythmic symptoms, or thrombi formation in the noncompact portions of the left ventricular wall. Ventricular tachycardias are frequent and sudden cardiac death is the leading cause of death. Arrythmias are accessible to medication or ablation treatment. Endurance sports lead to favorable adaptations of the cardiovascular system in spite of increased risk of sudden cardiac death. The example shows that asymptomatic boundary findings also exist. Whether a sporting activity has a protective influence must be further investigated.

Attenuated heart rate recovery predicts risk of incident diabetes: insights from a meta-analysis.

AIMS: To assess the association between attenuated heart rate recovery, a non-invasive measure of autonomic dysfunction, and risk of diabetes in the general population. METHODS: Databases were searched for cohort studies up to May 2017 that reported the association of heart rate recovery with the risk of diabetes. The overall hazard ratios for slowest vs fastest heart rate recovery (the referent) and for every 10-beats-per-min decrement in heart rate recovery were calculated using a random effects meta-analysis model. RESULTS: Four cohort studies with 430 incident cases of diabetes among a total of 9113 participants during a mean follow-up period of 8.1 years were included. Results showed that the slowest heart rate recovery was associated with a higher risk of diabetes (hazard ratio 1.66, 95% CI 1.16 to 2.38) vs the fastest heart rate recovery, and the hazard ratio of risk of diabetes for every 10-beats-per-min decrement in heart rate recovery was 1.29 (95% CI 1.13 to 1.48). No significant interaction effect was observed regarding the efficacy of 1-min and 2-min heart rate recovery in predicting risk of diabetes (both Pfor interaction >0.60); however, a linear dose-response relationship existed for overall studies and for studies using 1-min heart rate recovery as the exposure (both P >0.60 for non-linearity). CONCLUSIONS: Attenuated heart rate recovery is associated with an increased risk of diabetes in a dose-dependent manner, and measurement of heart rate recovery is worth recommending as part of diabetes risk assessment in clinical routines.

The role of sex, adiposity, and gonadectomy in the regulation of irisin secretion.

A sexual dimorphism has been reported for the adipo-myokine irisin at rest and in response to exercise. The effects of male and female sex, adiposity, and gonadectomy on irisin secretion have not been investigated before. The objective of this study was to elucidate the effects of sex, adiposity, and gonadectomy in the regulation of irisin secretion as well as PGC-1α/FNDC5 mRNA and protein expression. We hypothesized that a lack of female sex hormones by ovariectomy reduces irisin levels and inhibits skeletal muscle expression of PGC-1α and FNDC5. Circulating irisin was measured in vivo in serum samples of healthy and obese men and women at rest and in response to acute exercise. The effects of gonadectomy on serum irisin, PGC-1α and FNDC5 muscle mRNA, and protein expression were investigated in ovariectomized (OVX) and orchiectomized (ORX) Wistar rats. Serum irisin at rest was not significantly different between men and women (lean or obese). However, in response to acute aerobic exercise, irisin levels increased significantly more in lean women versus men (p ≤ 0.05). In obese individuals, resting irisin concentrations were significantly higher compared to lean subjects (p ≤ 0.001) and the irisin response to acute exercise was blunted. Only the lack of gonadal hormones in OVX but not ORX rats increased serum irisin levels (p ≤ 0.01) and resulted in significantly increased body weight (p ≤ 0.01), adipose tissue content (p ≤ 0.05), muscle FNDC5 mRNA (p ≤ 0.05), and protein (p ≤ 0.01) expression without altering PGC-1α expression. Testosterone treatment in ORX rats leads to increased PGC-1α mRNA content and reduced PGC-1α protein content without affecting FDNC5 expression or serum irisin levels. We show that a sexual dimorphism exists for the acute irisin response to exercise in normal-weight but not in obese subjects. OVX, which is associated with increased adiposity and insulin insensitivity, increases basal FNDC5 expression and serum irisin, without altering PGC-1α expression. This may be an early sign for metabolic disturbances associated with menopause, such as a developing irisin resistance or an attempt of the organism to improve glucose metabolism.

Pedometer intervention and weight loss in overweight and obese adults with Type 2 diabetes: a meta-analysis.

AIM: Although pedometer intervention is effective in increasing physical activity among adults with Type 2 diabetes, its impact on weight loss remains unclear. This meta-analysis was aimed to assess whether pedometer intervention promotes weight loss. METHODS: Three different databases were searched for randomized controlled trials (RCTs) published in English up to April 2015. Studies were included if they investigated the effects of pedometer intervention on weight loss, as measured by BMI or weight. Effect sizes were aggregated using a random-effects model. Subgroup and meta-regression analyses were used to identify potential moderators. Eleven RCTs with 1258 participants were included. All enrolled participants were overweight or obese. RESULTS: Pedometer intervention led to significantly decreased BMI [weighted mean difference (WMD) -0.15 kg/m(2) , 95% confidence interval (CI) -0.29 to -0.02 kg/m(2) ] and reduced weight (WMD -0.65 kg, 95% CI -1.12 to -0.17 kg). Dietary counselling seemed to be a key predictor of the observed changes. However, none of the following variables had a significant influence: step goal setting, baseline age, BMI, weight, sex distribution, disease duration, intervention duration, and baseline values or change scores for total or moderate-to-vigorous physical activity. After completion of the pedometer intervention, non-significant declines in BMI and weight were observed during the follow-up periods. CONCLUSIONS: Pedometer intervention promotes modest weight loss, but its association with physical activity requires further clarification. Future studies are also required to document dietary and sedentary behaviour changes to facilitate the use of pedometers for weight loss in overweight and obese adults with Type 2 diabetes.

Transport impacts on atmosphere and climate: Aviation.

Aviation alters the composition of the atmosphere globally and can thus drive climate change and ozone depletion. The last major international assessment of these impacts was made by the Intergovernmental Panel on Climate Change (IPCC) in 1999. Here, a comprehensive updated assessment of aviation is provided. Scientific advances since the 1999 assessment have reduced key uncertainties, sharpening the quantitative evaluation, yet the basic conclusions remain the same. The climate impact of aviation is driven by long-term impacts from CO2 emissions and shorter-term impacts from non-CO2 emissions and effects, which include the emissions of water vapour, particles and nitrogen oxides (NO x ). The present-day radiative forcing from aviation (2005) is estimated to be 55 mW m-2 (excluding cirrus cloud enhancement), which represents some 3.5% (range 1.3-10%, 90% likelihood range) of current anthropogenic forcing, or 78 mW m-2 including cirrus cloud enhancement, representing 4.9% of current forcing (range 2-14%, 90% likelihood range). According to two SRES-compatible scenarios, future forcings may increase by factors of 3-4 over 2000 levels, in 2050. The effects of aviation emissions of CO2 on global mean surface temperature last for many hundreds of years (in common with other sources), whilst its non-CO2 effects on temperature last for decades. Much progress has been made in the last ten years on characterizing emissions, although major uncertainties remain over the nature of particles. Emissions of NO x result in production of ozone, a climate warming gas, and the reduction of ambient methane (a cooling effect) although the overall balance is warming, based upon current understanding. These NO x emissions from current subsonic aviation do not appear to deplete stratospheric ozone. Despite the progress made on modelling aviation's impacts on tropospheric chemistry, there remains a significant spread in model results. The knowledge of aviation's impacts on cloudiness has also improved: a limited number of studies have demonstrated an increase in cirrus cloud attributable to aviation although the magnitude varies: however, these trend analyses may be impacted by satellite artefacts. The effect of aviation particles on clouds (with and without contrails) may give rise to either a positive forcing or a negative forcing: the modelling and the underlying processes are highly uncertain, although the overall effect of contrails and enhanced cloudiness is considered to be a positive forcing and could be substantial, compared with other effects. The debate over quantification of aviation impacts has also progressed towards studying potential mitigation and the technological and atmospheric tradeoffs. Current studies are still relatively immature and more work is required to determine optimal technological development paths, which is an aspect that atmospheric science has much to contribute. In terms of alternative fuels, liquid hydrogen represents a possibility and may reduce some of aviation's impacts on climate if the fuel is produced in a carbon-neutral way: such fuel is unlikely to be utilized until a 'hydrogen economy' develops. The introduction of biofuels as a means of reducing CO2 impacts represents a future possibility. However, even over and above land-use concerns and greenhouse gas budget issues, aviation fuels require strict adherence to safety standards and thus require extra processing compared with biofuels destined for other sectors, where the uptake of such fuel may be more beneficial in the first instance.

[A 78-year-old woman suffering from diarrhea, abnormal fatigue, and depression]. / 78-jährige Patientin mit Durchfall, Abgeschlagenheit und depressivem Syndrom.

A 78-year-old woman was admitted with diarrhea, abnormal fatigue, and depression. Routine diagnostic tests were to a large extent without pathological findings. Suppressed TSH was initially considered as subclinical hyperthyreosis because of substitution with L-thyroxin. The endocrinological diagnostics showed hypopituitarism because of an empty sella. After substitution with hydrocortisone and adapted L-thyroxin the patient recovered promptly. Diarrhea, abnormal fatigue, and depression might be hints for hypopituitarism with hypocortisolism.

A soybean plastid-targeted NADH-malate dehydrogenase: cloning and expression analyses.

A typical soybean (Glycine max) plant assimilates nitrogen rapidly both in active root nodules and in developing seeds and pods. Oxaloacetate and 2-ketoglutarate are major acceptors of ammonia during rapid nitrogen assimilation. Oxaloacetate can be derived from the tricarboxylic acid (TCA) cycle, and it also can be synthesized from phosphoenolpyruvate and carbon dioxide by phosphoenolpyruvate carboxylase. An active malate dehydrogenase is required to facilitate carbon flow from phosphoenolpyruvate to oxaloacetate. We report the cloning and sequence analyses of a complete and novel malate dehydrogenase gene in soybean. The derived amino acid sequence was highly similar to the nodule-enhanced malate dehydrogenases from Medicago sativa and Pisum sativum in terms of the transit peptide and the mature subunit (i.e., the functional enzyme). Furthermore, the mature subunit exhibited a very high homology to the plastid-localized NAD-dependent malate dehydrogenase from Arabidopsis thaliana, which has a completely different transit peptide. In addition, the soybean nodule-enhanced malate dehydrogenase was abundant in both immature soybean seeds and pods. Only trace amounts of the enzyme were found in leaves and nonnodulated roots. In vitro synthesized labeled precursor protein was imported into the stroma of spinach chloroplasts and processed to the mature subunit, which has a molecular mass of ∼34 kDa. We propose that this new malate dehydrogenase facilitates rapid nitrogen assimilation both in soybean root nodules and in developing soybean seeds, which are rich in protein. In addition, the complete coding region of a geranylgeranyl hydrogenase gene, which is essential for chlorophyll synthesis, was found immediately upstream from the new malate dehydrogenase gene.

[Foreign body granuloma of the head of the pancreas caused by a fish bone--a rare differential diagnosis in head of the pancreas tumor]. / Fremdkörpergranulom des Pankreaskopfes durch eine Fischgräte--eine sehr seltene Differentialdiagnose des Pankreaskopftumors.

Despite highly developed scanning methods there is no absolute certainty of delineating malignant pancreatic tumor from chronic pancreatitis. Pancreatitis caused by foreign bodies has occasionally been mentioned in literature. Our report is on the first case of a foreign body granuloma of the pancreatic head caused by a fish-bone transduodenally perforating the pancreas. On preoperative CT and ultrasound as well as by intraoperative inspection and palpation the lesion appeared malignant, so we saw the indication for Whipple's operation. Although the histological examination showed a benign state, taking into account the generally bad prognosis, in case of suspected malignant pancreatic tumor we plead for resection as the only possible form of curative therapy.

The vacuolar targeting signal of the 2S albumin from Brazil nut resides at the C terminus and involves the C-terminal propeptide as an essential element.

Genetic constructs in which different N- and C-terminal segments of Brazil nut (Bertholletia excelsa H.B.K.) 2S albumin were fused to secretory yeast invertase were transformed into tobacco (Nicotiana tabacum) plants to investigate the vacuolar targeting signal of the 2S albumin. None of the N-terminal segments, including the complete precursor containing all propeptides, was able to direct the invertase to the vacuoles. However, a short C-terminal segment comprising the last 20 amino acids of the precursor was sufficient for efficient targeting of yeast invertase to the vacuoles of the transformed tobacco plants. Further analyses showed that peptides of 16 and 13 amino acids of the C-terminal segment were still sufficient, although they had slightly lower efficiency. When segments of 9 amino acids or shorter were analyzed, a decrease to approximately 30% was observed. These segments included the C-terminal propeptide of four amino acids (Ile-Ala-Gly-Phe). When the 2S albumin was expressed in tobacco, it was also localized to the vacuoles of mesophyll cells. If the C-terminal propeptide was deleted from the 2S albumin precursor, all of this truncated 2S albumin was secreted from the tobacco cells. These results indicate that the C-terminal propeptide is necessary but not sufficient for vacuolar targeting. In addition, an adjacent segment of at least 12 amino acids of the mature protein is needed to form the complete signal for efficient targeting.

[Degenerative colorectal polyps]. / Le polype colo-rectal dégénéré.

In 23 patients with malignant colorectal polyps we reviewed the frequency of recurrence. In the group without subsequent local resection, 8 of 11 patients were without recurrent tumour after 2.7 (0.8-4.1) years, in the group with subsequent local or conventional colon resection, 10 of 12 patients after 5.3 (0.8-9.0) years. None of the patients showed any evidence of residual tumour or lymph node metastasis. All recurrent tumours (2 x carcinoma, 3 x benign polyps) could be resected curatively. There was no difference in recurrence in both groups. For safe histopathological examination of malignant colorectal polypi in respect of depth of invasion, free resection margins and lymphatic vessel invasion, intraoperative fixation and marking must be performed, since local recurrence was seen after more than 5 years, long-term follow up is necessary.

[Ilisarov ring fixation and its technical application]. / Der Ilisarow-Ringfixateur und seine technische Anwendung.

The Ilisarov ring fixator is an extremely versatile external fixation device. There is a wide range of indications for its use, e.g. fractures, pseudarthroses and non-unions, large defects, deformities and limb shortening. The device consists of rings or half-rings, which are connected to each other by threaded rods or plates and to the bone by wires under tension. This design allows neutral fixation, compression or distraction of the bone fragments. Because of its low axial stiffness at low loads and increased stiffness at higher loads, this fixator promotes osteogenesis and reduces strain on the tissues in functional treatment. Surgical intervention for its application is minimally invasive. This is a useful addition to the orthopaedic surgeon's armamentarium, providing proper attention is paid to preoperative planning, the principle rules of frame design and wire insertion technique, and postoperative management.

[Biomechanics of the ring fixator--contributions of individual structural elements]. / Zur Biomechanik des Ringfixateurs--Beiträge einzelner Strukturelemente.

The mechanical behaviour of the circular external fixation device using thin, pre-tensioned wires is difficult to predict, because the individual elements, such as rings, rods and wires, can be assembled in a large variety of configurations. This behaviour is of particular importance in the treatment of large segmental defects and in bone lengthening, because most of the load is transmitted through the fixator. In this study, the mathematical basis of the widely varying definitions of stiffness under axial, bending and torsional loads is presented. The principal variables influencing a particular configuration and their effects are indicated. Particular consideration must be given to the fact that the wires under tension generate a non-linear behaviour of the frame. The information needed for reporting on different fixator systems is indicated. Finally, the effect of individual structural elements, such as number, direction and tension of the wires, number of threaded rods and distance between the planes of the rings on the different stiffnesses, is presented and discussed with respect to clinical significance.

[Initial modifications of the ring fixator apparatus]. / Erste Modifikationen des Ringfixateursystems.

To increase the practicability of Ilisarov's ring fixation apparatus, we introduced the following modifications: Clamping of the fixation wires using a quick collet with a force indicator, which enables reproducibly preuse and rapid clamping. Hardened screws to maintain the tension longer. Production of the olive wire from homogeneous implant steel by the cold-press method. Optimization of the cutting edge at the wire tip. Measurement of tension in the fixation wire. A distractor incorporating a clock and a device showing the distraction achieved so that doctor and patient can better supervise the distraction procedure. Simplifications of the wound dressing.

[Initial results following implantation of resorbable micro-patches of polydioxanone in the rat aorta]. / Erste Ergebnisse nach Implantation resorbierbarer Mikro-Patchs aus Polydioxanon an der Ratten-Aorta.

Polydioxanon micro-patches were inserted into the infrarenal aorta of 21 rats by means of microsurgical techniques. Histologic characteristics were analysed by light microscopy up to 8 weeks after implantation. The following observations were made: After 4 weeks a regenerated artery with different layers could be seen: Neo-Endothelium-, Neo-Media-, Neo-Adventitia-Patch-layer. Two different proliferation zones were evaluated: the anastomotic adventitial layer, responsible for regenerating the Neo-Adventitia-Patch-layer as a chronic foreign body reaction, the anastomotic intima layer, responsible for regenerating the Neo-Media with differentiation of cells into smooth-muscle-like cells. The lining cells appeared like endothelium-like cells. These study demonstrates the possibility of regenerating arterial tissue over polydioxanon patch in the rat aorta.

[Intracutaneous skin suture with a resorbable synthetic monofilament suture]. / Intracutane Hautnaht mit einem resorbierbaren monofilen Kunststoffaden.

We report about our good experience with a monofile, synthetic, absorbable Polydioxanone thread used for skin suture in an intracutaneous technique, after we performed more than 1,500 sutures of 7 to 30 cm length in patients of any age. We consider the suture to be suitable for children to achieve a cosmetically fine scare without a subsequent necessity to pull out the thread. The breaking strength, the absorbtion rate and the loss of inflammatory reaction is so satisfactory that we could not see any disadvantage by using this absorbable, synthetic thread for skin closure. Especially there was no disturbance in wound healing. In contrast, because of the secure and undisturbed wound-edge adaptation a non-irritant, firm, and hairline-like scar could be achieved. The time to carry out the suture is no longer than for other techniques.