Prevalence of molar-incisor-hypomineralisation (MIH) among 6-12-year-old children in Central Hesse (Germany).

AIM: The aim of the present cross-sectional study was to assess and compare the prevalence of MIH among 6-12-year-old school children living either in a rural area of Central Hesse (Germany) or in the city of Frankfurt on the Main (Germany). A possible association between hypomineralised second primary molars (HSPM) and MIH was investigated. Furthermore, the MIH prevalence data of the rural area were compared with those of a previous study conducted in this area in the school year 2002/2003. METHODS: In the school year 2014/2015, 2103 children (6-12 years of age) were examined during the annual school-based dental examinations prescribed by law at nine schools in the rural area of Central Hesse (LDK) and five schools in the city of Frankfurt on the Main (Ffm). Eight previously calibrated dentists working for the public healthcare authorities assessed the prevalence of HSPM/MIH (EAPD criteria/severity scale by Wetzel and Reckel) and the caries experience (dmft/DMFT). RESULTS: The prevalence of HSPM/MIH amounted 3.2%/9.4% in LDK and 2.9%/17.4% in Ffm. In the majority of cases, children with MIH had demarcated opacities. In LDK, hypomineralised first permanent molars were most commonly affected by severity degree 2, whereas in Ffm, severity degree 1 was predominant. Children suffering from HSPM had an odds ratio of 11.32 (95% CI: 6.73-19.03) for having MIH as well. Compared with the results of 2002/2003 in LDK (prevalence of MIH 5.9%), the MIH prevalence increased by 3.5% in the rural area. All in all, the caries experience among children under investigation was low (DMFT 0.14-0.15). SIGNIFICANCE: MIH may be diagnosed in school children living in different areas of Germany with regional variations (rural-urban comparison). The presence of HSPM is of predictive value for MIH. The increasing number of hypomineralised first permanent molars over 12 years of time in the rural area indicates a need for further investigation on the aetiology of MIH.

Exploring effects of a natural combination medicine on exercise-induced inflammatory immune response: A double-blind RCT.

Traumeel (Tr14) is a natural, combination drug, which has been shown to modulate inflammation at the cytokine level. This study aimed to investigate potential effects of Tr14 on the exercise-induced immune response. In a double-blind, randomized, controlled trial, healthy, untrained male subjects received either Tr14 (n = 40) or placebo (n = 40) for 24 h after a strenuous experimental exercise trial on a bicycle (60 min at 80%VO2 max). A range of antigen-stimulated cytokines (in vitro), white blood cell count, lymphocyte activation and apoptosis markers, and indicators of muscle damage were assessed up to 24 h following exercise. The area under the curve with respect to the increase (AUCI ) was compared between both groups. The Tr14 group showed a reduced exercise-induced leukocytosis and neutrocytosis (P < 0.01 for both), a higher AUCI score of antigen-stimulated IL-1ß and IL-1α (absolute and per monocyte, all P < 0.05), a lower AUCI score of antigen-stimulated GM-CSF (P < 0.05) and by trend a lower AUCI score of antigen-stimulated IL-2 and IL-4 as well as a higher AUCI score of antigen-stimulated IL-6 (all P < 0.1). Tr14 might promote differentiated effects on the exercise-induced immune response by (a) decreasing the inflammatory response of the innate immune system; and (b) augmenting the pro-inflammatory cytokine response.

IABP before cardiac surgery: clinical benefit compared to intraoperative implantation.

BACKGROUND: The aim of this study was to determine whether preoperative compared to intraoperative intra-aortic balloon counterpulsation (IABP) is advantageous regarding 30-day and 2-year survival in high-risk patients (acute myocardial infarction, severely impaired left ventricular ejection fraction (LVEF), low output syndrome) undergoing coronary surgery. METHODS: In the years 2004 to 2008, 156 consecutive patients undergoing coronary surgery with IABP support (119 preoperative, 37 intraoperative IABP) were observed. Applying Fisher's exact test, as well as Wilcoxon and median tests, possible group differences were evaluated. After univariate analysis, models of logistic regression and Cox-regression were built. RESULTS: Preoperative hemodynamic state and risk profile of the two patient groups were comparable: patients with preoperative IABP showed a similar level of urgency (21.9% vs. 18.9% emergencies), cardiogenic shock (8.4% vs. 10.8%), inotropes (8.4% vs. 8.1%), impaired LVEF (30.3% vs. 29.7%) and ventilation (5.9% vs. 5.4%) compared to patients with intraoperative IABP. Nevertheless, patients with intraoperative IABP demonstrated a significantly higher 30-day mortality rate (37.8% vs. 5.9%) and 2-year mortality rate (54.0% vs. 18.1%) compared to patients with preoperative IABP. Logistic regression revealed that patients with intraoperative IABP have a 16-times higher 30-day mortality rate after coronary surgery (OR: 16.386, 95% CI: 4.858-55.266) than patients with preoperative IABP. Two-year mortality (OR: 9.317, 95% CI: 3.430 to 25.311) and survival time were significantly better in patients with preoperative IABP therapy. CONCLUSION: Considering the significant benefit for patients with preoperative compared to intraoperative IABP and the absence of vascular problems after IABP insertion, the results of this study indicate a more liberal indication for IABP in high-risk patients before coronary bypass surgery.

Octogenarians undergoing combined aortic valve replacement and myocardial revascularization: perioperative mortality and medium-term survival.

OBJECTIVE: Aim of the study was to answer the question whether the mortality and morbidity of octogenarians undergoing combined aortic valve replacement and myocardial revascularization (AVR + CABG) is higher than that of younger patients. PATIENTS AND METHODS: Between 01/1995 and 12/2002, 242 patients underwent AVR + CABG in our institution. 37 patients were older than 80 years (16 male, 21 female, median pressure gradient over the aortic valve: 53 mmHg, median EF: 62%), 205 patients were younger than 80 years (133 male, 72 female, median gradient 48 mmHg, median EF: 61%). NYHA class, aortic valve area and valve calcification were worse in the 80+ group. Biological valve prostheses were implanted in 94.6% of the older and in 45.4% of the younger patients (p < 0.001). RESULTS: Perioperative complications occurred more often (p = 0.0188) in the 80+ group (86.5% experienced 1 or more complications) than in the 80- group (66.3%). Similarly, the MACE (Major Adverse Cardiovascular Events) rate was higher (p = 0.0448) in the 80+ group than in the 80- group. Bleeding occurred (p = 0.092) more often in younger (9.3%) than in older (0%) patients, while renal insufficiency was more frequent (p = 0.0164) in older (21.6%) than in younger patients (7.8 %). The 30-day mortality was higher (p = 0.0045) in older (21.6%) than in younger patients (5.8%). Multivariate analysis revealed an odds ratio for early death of 2.9 (CI 1.014-8.397) for patients older than 80 years. The late death rate within the first 5 years after surgery was comparable in both groups (80- group 24.4%, 80+ group 24.3%). Postoperative quality of life was significantly worse in the 80+ group in 4 out of 8 functions. CONCLUSIONS: Octogenarians undergoing AVR + CABG have a relatively high perioperative complication rate and mortality, but show a stable medium-term survival. The perioperative complication rate is higher in older than in younger patients, and the postoperative quality of life with regard to bodily functions is acceptable but significantly worse than that of younger patients.