Reduced prevalence of obesity in children with primary fructose malabsorption: a multicentre, retrospective cohort study.

BACKGROUND: Studies in animals and in man have demonstrated that excessive consumption of fructose can cause all components of the metabolic syndrome. OBJECTIVE: To investigate the impact of a condition resulting in decreased absorption of fructose, on obesity. METHODS: In a multicentre study, we analyzed a cohort of paediatric patients with suspected primary fructose malabsorption (FM). Patients with chronic intestinal diseases were excluded. The final cohort comprised 628 patients. RESULTS: 302 patients were diagnosed with primary FM (48.1%). The proportion of obese patients was lower among FM patients, compared to non-FM patients (2.3 vs. 6.1%, P = 0.029). Logistic regression analysis with inclusion of various covariates showed that FM was negatively associated with obesity (OR 0.35, 95% CI [0.13; 0.97]). We discuss several mechanisms involving the metabolic, endocrine and gastrointestinal system. CONCLUSIONS: Our data indicate that primary FM is negatively associated with childhood obesity.

Long-term results of mechanical and biological heart valves in dialysis and non-dialysis patients.

INTRODUCTION: We wanted to answer the question whether biological heart valves are inferior compared to mechanical heart valves in end-stage renal disease (ESRD) patients. METHODS: Between 01/1996 und 12/2006, 44 of 3293 patients undergoing aortic valve replacement (AVR) in a single institution suffered from dialysis-dependent ESRD and underwent a follow-up investigation after 1.9 years (median). Twelve (28.9 %) of these patients received a biological, 32 (71.1 %) of these patients a mechanical aortic valve prosthesis. To evaluate a possible influence of the valve type (biological/mechanical) on survival, uni- and multivariate logistic regression was used. RESULTS: ESRD patients after AVR had a relatively poor short-term (30-day mortality: 22.7 %) and long-term survival (median survival time: 24.7 months; 95 % CI: 0.2-47.7 months), irrespective of the type of heart valve prosthesis (hazard ratio for mortality depending on heart valve type in dialysis patients: 1.31, P = 0.400). Dialysis-dependent patients were not reoperated due to valve-related reasons. CONCLUSIONS: The long-term survival of dialysis-dependent patients after AVR is low (5-year survival: 29.5 %) irrespective of the type of heart valve prosthesis. Therefore, the use of biological AVR is not contraindicated in this group of patients.

Use of platelet-rich plasma in periodontal surgery--a prospective randomised double blind clinical trial.

The aim of this prospective controlled randomized clinical trial was to evaluate the additional effect of platelet-rich plasma (PRP) in attachment gain. Twenty-two patients showing contralateral intrabony defects were included. Defects were randomized to beta-TCP (Cerasorb) in combination with PRP (test) or alone (control). Probing pocket depth (PPD), clinical attachment level (CAL), and relative AL (RAL) were assessed at the first, initial, re-evaluation (or basis examinations) and 6 months after surgery. Defect dimensions were recorded at baseline surgery (day 0) and during re-entry surgery (after 6 months), with vertical depth of the defect as primary outcome variable. An early healing index (EHI) was assessed 3 days, 1, 2 and 4 weeks after surgery. Both treatments led to clinical improvements. The median reduction of open vertical depth was 1.9 mm (interquartile intervals, 0.75 and 2.5 mm) at test sites, compared with 2.6 mm (1.8 and 3.5 mm) at control sites (p = 0.19, Wilcoxon). The median reductions of PPD and CAL at the four sites in close proximity to the defect in the interproximal area at test sites were 0.8 and 0.28 mm, and at control sites 0.4 and 0.13 mm, respectively. The EHI showed a reduction from grade 3 after 3 days to grade 1 after 4 weeks. PRP did not improve the results achieved with beta-TCP in the treatment of intrabony defects.

Topical use of platelet-rich plasma to influence bone volume in maxillary augmentation: a prospective randomized trial.

BACKGROUND AND OBJECTIVES: The atrophic posterior maxilla often requires restoration of the alveolar ridge due to a lack of bone quantity and quality before dental implant placement. The aim of this study was to verify the hypothesis that platelet-rich plasma (PRP) has an influence on bone density in the maxilla after sinus floor elevation in combination with autologous cancellous bone from the iliac crest. Therefore, a randomized, prospective, controlled trial was set up in two centres. STUDY DESIGN AND METHODS: Fifty-three patients who underwent osteoplastic bone grafting for sinus floor elevation were included. The intervention group was treated with defined concentrations of PRP in addition to transplanted bone. Bone biopsy was performed 4 months after augmentation. Bone volume was then measured using the histomorphometric parameter bone volume. RESULTS: The histomorphometric evaluation of the biopsies did not indicate superiority of any of the treatments in terms of bone volume. CONCLUSION: Topical use of PRP did not improve maxillary bone volume either clinically relevant or statistically significant compared to that in conventionally treated patients. The use of PRP to support bone regeneration cannot be recommended as a standard method for maxillary augmentation.

Elevated Lipoprotein(a) does not promote early atherosclerotic changes of the carotid arteries in young, healthy adults.

BACKGROUND: Elevated levels of Lipoprotein(a) [Lp(a)] have been linked to an increased risk of ischemic cardiovascular events. Yet the mechanism by which Lp(a) might contribute to this increased risk is not clear. METHODS: To elucidate whether high plasma levels of Lp(a) contribute to the development of early atherosclerotic vessel wall changes, the intima-media thickness of the common carotid arteries [CCA-IMT] of 151 healthy young volunteers without additional relevant cardiovascular risk factors was measured by high-resolution ultrasound. Plasma concentrations of Lp(a) were quantified and other established risk factors, such as body mass index [BMI], plasma levels of cholesterol, triglycerides and homocysteine, were determined. Furthermore, the carotid arteries were examined for the presence of plaques and stenoses. RESULTS: Univariate analysis showed a significantly negative correlation of CCA-IMT with HDL cholesterol and positive correlations with age, BMI, total and LDL cholesterol, triglycerides and even with homocysteine, but not with Lp(a). When the study population was dichotomized according to Lp(a) levels, no statistically significant differences in CCA-IMT could be detected between persons with plasma Lp(a)<300mg/l or >or=300mg/l, respectively. CONCLUSION: Our data suggest that elevated Lp(a) levels alone do not contribute to increased cardiovascular risk by promoting early atherogenesis in vivo.

Minimal immunoreactive plasma beta-endorphin and decrease of cortisol at standard analgesia or different acupuncture techniques.

BACKGROUND AND OBJECTIVE: Acupuncture has been claimed to be associated with activation of the endogenous antinociceptive system. The analgesic effects of acupuncture have been ascribed to beta-endorphin interacting with opioid receptors. However, firstly, the release of beta-endorphin into the blood has been proven to be induced by stress, i.e. under dysphoric conditions, and, secondly, if released under stress, beta-endorphin has been shown not to be analgesic. Our aim was to test whether beta-endorphin immunoreactive material is released into the cardiovascular compartment during acupuncture comparing the most frequently used types of acupuncture with standard pain treatment under apparently low stress conditions. METHODS: This prospective study included 15 male patients suffering from chronic low back pain. beta-Endorphin immunoreactive material and cortisol were measured in the plasma of patients who underwent, in random order, therapy according to a standard pain treatment, traditional Chinese acupuncture, sham acupuncture, electro acupuncture and electro acupuncture at non-acupuncture points before, at and after the treatment. Statistical analysis was performed using two-way ANOVA with repeated measures. RESULTS: A decrease in plasma cortisol concentration measured over the five treatment protocols was highly significant (P < 0.001). The beta-endorphin immunoreactive material concentrations in plasma were minimal at all times and in all treatment conditions. The influence of treatments by various acupuncture procedures on cortisol and beta-endorphin immunoreactive material plasma concentrations over the three time points was not significantly different. CONCLUSIONS: beta-endorphin immunoreactive material in blood is not released by any type of acupuncture as tested under low stress conditions.

Plasma arginine and urinary nitrate and nitrite excretion in bronchopulmonary dysplasia.

The aim of this prospective study was to determine whether preterm infants with bronchopulmonary dysplasia (BPD) and signs of increased pulmonary artery pressure have a deficiency of plasma arginine (ARG) and systemic nitric oxide (NO) synthesis. Plasma amino acid concentrations, Doppler pulmonary systolic time intervals (ratio of acceleration time and ejection time corrected for heart rate: AT/ET(C)) and urinary nitrate and nitrite concentrations were determined at the 28th day postnatal age and at 36 weeks postmenstrual age in 73 preterm infants less than 30 weeks gestational age. The AT/ET(C) ratios were significantly lower in infants with BPD (n = 32) compared to controls. However, total amino acid concentrations, ARG intake as well as plasma ARG concentrations were not different between groups (median (interquartile-range) micromol/l): control: 58 (42.5-75.5) and 54.5 (42-71) at day 28 and 36 weeks; BPD: 54.5 (31.5-70.5) and 43 (35-62), respectively. Urinary nitrate and nitrite concentrations, were not different between groups at day 28, but significantly higher in infants with BPD at 36 weeks (p = 0.014). In conclusion, plasma ARG concentrations and systemic NO synthesis were not deficient in preterm infants with BPD and signs of elevated pulmonary artery pressure.

Effects of bioaerosol polluted outdoor air on airways of residents: a cross sectional study.

BACKGROUND: Bioaerosol pollution of workplace and home environments mainly affects airways and mucous membranes. The effect of environmental outdoor residential bioaerosol pollution, for example, livestock holdings, farming, and waste disposal plants, is unclear. AIMS: To investigate the perceived health of residents living in areas with measurable outdoor bioaerosol pollution (for example, spores of Aspergillus fumigatus and actinomycetes), and effects of accompanying odours. METHODS: In a cross sectional study, double blinded to ongoing microbial measurements, doctors collected 356 questionnaires from residents near a large scale composting site, and from unexposed controls in 1997. Self reported prevalence of health complaints during the past year, doctors' diagnoses, as well as residential odour annoyance were assessed. Microbiological pollution was measured simultaneously in residential outdoor air. RESULTS: Concentrations of >10(5) colony forming units of thermophilic actinomycetes, moulds, and total bacteria/m(3) air were measured 200 m from the site, dropping to near background concentrations within 300 m. Positive adjusted associations were observed for residency within 150-200 m from the site versus unexposed controls for self reported health complaints: "waking up due to coughing", odds ratio (OR) 6.59 (95% confidence interval (CI) 2.57 to 17.73); "coughing on rising or during the day", OR 3.18 (95% CI 1.24 to 8.36); "bronchitis", OR 3.59 (95% CI 1.40 to 9.4); and "excessive tiredness", OR 4.27 (95% CI 1.56 to 12.15). Reports of irritative airway complaints were associated with residency in the highest bioaerosol exposure, 150-200 m (versus residency >400-500 m) from the site, and period of residency more than five years, but not residential odour annoyance. Lifetime prevalence of self reported diseases did not differ with exposure. CONCLUSIONS: Bioaerosol pollution of residential outdoor air can occur in concentrations found in occupational environments. For the first time residents exposed to bioaerosol pollution were shown to report irritative respiratory complaints similar to mucous membrane irritation independently of perceived odours.

Concentration of interleukin-1beta and neutrophil elastase activity in gingival crevicular fluid during experimental gingivitis.

BACKGROUND/AIM: The aim of the present study was to measure interleukin-1beta concentrations and neutrophil elastase activity in gingival crevicular fluid (GCF) during experimental gingivitis in humans. MATERIAL AND METHODS: 12 healthy young men participated. After prophylaxis, they performed optimal hygiene to reach plaque and gingivitis indices of or approaching zero. All oral hygiene measures were then ceased for a period of 18 days. The Quigley-Hein plaque index (PLI) and Saxer & Mühlemann papillary bleeding index (PBI) were assessed. GCF samples were taken from the mesiobuccal site of two contralateral teeth in the upper jaw by means of periopapers at baseline and on days 3, 7, 14 and 18. After measuring the gingival crevicular fluid volume (GCFV) with the Periotron 8000, the samples were analyzed in our laboratory for the detection of IL-1beta concentration by ELISA. RESULTS: PLI and PBI showed a reduction prior to baseline reaching almost zero, both increasing from day 0 to day 18 (PLI=from 0.1 to 2.9, PBI=from 0 to 2.0). IL-1beta concentration increased from 229.25 ng/ml (day 0) to 526.13 ng/ml (day 18). Clinical data and IL-1beta concentrations were correlated with elastase activity (EA). No significant correlation could be demonstrated between the clinical parameters assessed and IL-1beta or EA (Spearman rank correlation coefficient). A correlation between GCFV and PBI from day 0 to day 18 could be demonstrated. CONCLUSION: Overall, both IL-1beta and EA showed an increase from baseline throughout the whole study.

Microassay for the detection of elastase activity in the gingival crevice.

BACKGROUND, AIMS: A new microassay for the detection of elastase activity (EA) in gingival crevicular fluid (GCF) has been established. GCF was collected with Periopaper strips and quantified in a Periotron. METHODS: Enzyme activity was measured in a microtiter plate reader, using a fluorometric assay. To ensure quality and precision of the assay, recovery rates were determined at different activities with a recovery of >90%. In a 2nd step, stability of the enzyme was investigated during storage at room temperature, +4 degrees C, -22 degrees C, -88 degrees C. GCF samples retained elastase activity of almost 100% after a storage of 3 days at -22 degrees C. In a group of 12 healthy volunteers, elastase activity was assayed throughout an 18 day experimental gingivitis protocol. RESULTS: Median activity increased from 481 microU/microl at baseline to 1444 microU/microl at day 18, which was accompanied by the development of the signs of gingivitis. The increase of EA during the experimental phase of the study was highly significant (p<0.001) and correlated well with the increasing severity of gingivitis. CONCLUSION: The data suggest that elastase activity in GCF is an excellent quantitative measure of gingival inflammation.

[Accuracy of right and left ventricular heart volume and left ventricular muscle mass determination with cine MRI in breath holding technique]. / Genauigkeit der rechts- und linksventrikulären Herzvolumen- und linksventrikulären Muskelmassenbestimmung mittels Cine MRT in Atemanhaltetechnik.

PURPOSE: To assess the accuracy of right- (RV) and left-ventricular (LV) heart volume and muscle mass determinations by cine MR imaging. MATERIALS AND METHODS: Ten subjects were examined twice by a segmented, ECG-triggered cine sequence in the short axis plane and breath-hold technique by two independent operators and again 4 weeks later by one of the operators. The contours were evaluated manually by two independent examiners and again four weeks later by one of the examiners. LV and RV end-diastolic and end-systolic volumes, stroke volume, cardiac output, ejection fraction (EF), and left-ventricular muscle mass were compared. RESULTS: The RV evaluation variations (RV-EF: 6.46%) were higher than the LV (LV-EF: 4.46%). The intra-examiner variations were smaller than the inter-examiner variations. The generally operators did not cause a significantly increased variation (LV-EF: 5.77%). In contrast, the repeat examinations at different times did lead to a significant increase in the variation (LV-EF: 10.15%). CONCLUSIONS: The rapid ECG-triggered cine MRI in breath-hold technique allows the simultaneous RV and LV, artefact-free determination of heart volumes and LV muscle mass. The LV volumes can be determined more accurately than the RV. The examiner has a distinct influence on the accuracy, the operator has a lesser effect. Physiological fluctuations of cardiac activity significantly influence the follow-up.

Struvite stones: long term follow up under metaphylaxis.

This study presents the results of a 10-year metaphylaxis of 19 former struvite stone formers, each having had 2-3 stone operations. In these patients, urine was acidified with L-methionine (Acimethin) using a dose of three to six tablets 500 mg/day. Every three months, 11 laboratory parameters were checked in 24-hour urine. 6 parameters were determined in serum. In addition, urine samples were tested for infection. Statistical analysis of analytical data, which was supported by computer graphs, provided the results for the urinary parameters. They were described by geometric means and 95% confidence intervals using ANOVA (analysis of variance). During therapy, the mean pH values decreased significantly from 7.5 to 5.5. Signific-ant increases were found in the excretion of citrate, magnesium, potassium, and uric acid. An increase was also found for calcium, which, however, could not be confirmed to be statistically significant (p = 0.08). In serum, changes of parameters could only be registered for calcium and phosphate. However, at all times, total serum concentrations stayed within their normal limits. Three patients suffered occasional infections (16%), only two of them formed recurrent stones (10%). In assessing the efficacy of L-methionine therapy, the drop in urinary pH to acidic values was the most relevant factor for metaphylaxis.

Surface microscopy of naevi and melanomas--clues to melanoma.

In this present study, 260 histologically confirmed melanocytic skin tumours (188 benign naevi and 72 malignant melanomas; from 1989 to 1990) were investigated with regard to valid surface microscopical criteria of malignancy. The tumours were analysed using a system which assessed eight components. Most melanomas were characterized by the following pattern: asymmetrical pigment distribution, more than three colours, black pigment, peripheral stripes, and asymmetrical depigmentation. The results were evaluated statistically by contingency tables and logistic regression procedures. On the basis of the classification derived, the sensitivity and specificity were determined for lesions from 1991, and were 0.9 and 0.85, respectively. Many melanocytic naevi were not identified by the above criteria, or were found only occasionally. Pigment network was often absent in naevi and melanomas, and was not decisive for the diagnosis. The present investigation demonstrates that in vivo diagnosis of pigmented melanocytic lesions can be improved by surface microscopy.

Changing pattern of brain hemorrhage during 12 years of computed axial tomography.

BACKGROUND AND PURPOSE: We examined whether the pattern of cerebral hemorrhage changed after the introduction of computed tomography. METHODS: Using a prospective data base we analyzed the case-fatality ratio, early mortality, and the incidences of hypertension and anticoagulant medication in 488 consecutive cases with supratentorial hemorrhage between 1978 and 1989. Blood pressure at admission of all patients for the years 1978-1979 and 1988-1989 and the Mathew and activities of daily living scores for the years 1978-1979, 1982-1983, and 1988-1989 were assessed retrospectively. RESULTS: The case-fatality ratio decreased from 49% in the period 1978-1981 to 31% in 1986-1989 (p = 0.006); early mortality (day 1-4) decreased from 28% to 12% (p = 0.0017). The incidence of hypertension decreased from 78% in the period 1978-1981 to 64% in 1986-1989 (p = 0.01). Systolic and diastolic blood pressure at admission sank (p = 0.09). The decrease of the case-fatality ratio correlated best with a less severe initial disturbance of consciousness (p less than 0.01) and with a higher Mathew score (p = 0.038). The activities of daily living score remained unchanged. CONCLUSIONS: The case-fatality ratio and early mortality decreased after the introduction of computed tomography. This was basically due to a decreased incidence of comatose and stuporous patients with severe neurological deficit paralleled by a decrease of mean systolic and diastolic blood pressure values at admission.