Remotely sensing potential climate change tipping points across scales

Potential climate tipping points pose a growing risk for societies, and policy is calling for improved anticipation of them. Satellite remote sensing can play a unique role in identifying and anticipating tipping phenomena across scales. Where satellite records are too short for temporal early warning of tipping points, complementary spatial indicators can leverage the exceptional spatial-temporal coverage of remotely sensed data to detect changing resilience of vulnerable systems. Combining Earth observation with Earth system models can improve process-based understanding of tipping points, their interactions, and potential tipping cascades. Such fine-resolution sensing can support climate tipping point risk management across scales.

Correction of symbrachydactyly: a systematic review of surgical options

Symbrachydactyly is a rare congenital malformation of the hand characterized by short or even absent fingers with or without syndactyly, mostly unilaterally present. The hand condition can vary from a small hand to only nubbins on the distal forearm. This study aims to systematically review the surgical management options for symbrachydactyly and compare functional and aesthetic outcomes.The review was performed according to the PRISMA guidelines. Literature was systematically assessed searching the Cochrane Library, PubMed, Embase, and PROSPERO databases up to January 1, 2023. Studies were identified using synonyms for 'symbrachydactyly' and 'treatment'. Inclusion criteria were the report of outcomes after surgical treatment of symbrachydactyly in humans. Studies were excluded if they were written in another language than English, German, or French. Case reports, letters to the editor, studies on animals, cadaveric, in vitro studies, biomechanical reports, surgical technique description, and papers discussing traumatic or oncologic cases were excluded.Twenty-four studies published were included with 539 patients (1037 digit corrections). Only one study included and compared two surgical techniques. The quality of the included studies was assessed using the Modified Coleman Methodology Score and ranged from 25 to 47. The range of motion was the main reported outcome and demonstrated modest results in all surgical techniques. The report on aesthetics of the hand was limited in non-vascularized transfers to 2/8 studies and in vascularized transfers to 5/8 studies, both reporting satisfactory results. On average, there was a foot donor site complication rate of 22% in non-vascularized transfers, compared to 2% in vascularized transfers. The hand-related complication rate of 54% was much higher in the vascularized group than in the non-vascularized transfer with 16%.No uniform strategy to surgically improve symbrachydactyly exists. All discussed techniques show limited functional improvement with considerable complication rates, with the vascularized transfer showing relative high hand-related complications and the non-vascularized transfer showing relative high foot-related complications.There were no high-quality studies, and due to a lack of comparing studies, the data could only be analysed qualitatively. Systematic assessment of studies showed insufficient evidence to determine superiority of any procedure to treat symbrachydactyly due to inadequate study designs and comparative studies. This systematic review was registered at the National Institute for Health Research PROSPERO International Prospective Register of Systematic Reviews number: CRD42020153590 and received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.Level of evidenceI.Systematic review registrationPROSPERO CRD42020153590.

Management of acute periprosthetic knee infection: a comparison of arthroscopic and open debridement

INTRODUCTION

In acute periprosthetic knee infections, debridement and implant retention (DAIR) is the preferred treatment prior to one- and two-stage revisions. The aim of this study is to compare the outcomes of arthroscopic and open debridement of infected primary total knee arthroplasties (TKA).

MATERIAL AND METHODS

We analyzed clinical, laboratory, and antibiotic treatment data, collected in patients with periprosthetic knee infection treated with DAIR at a Swiss Level 1 orthopedic and trauma center over a 10-year period between January 2005 and May 2015. Inclusion criteria were primary total knee arthroplasty and early postoperative or acute hematogenous periprosthetic joint infection (PJI). The primary endpoint was the need for further revision surgery due to persistent infection. The secondary endpoint was the prosthesis salvage in further infection surgeries.

RESULTS

Forty-two patients with 44 acute or hematogenous periprosthetic knee infections were included. We recorded 20 recurrent infections (45%) in our study population: 10 (77%) out of 13 in the arthroscopic DAIR group and 10 (32%) out of 31 in the open DAIR group. Two-stage revision, meaning complete removal of the TKA, insertion of a spacer and replantation at a second stage, had to be performed in three patients treated initially arthroscopically (23%) and in six patients treated initially with an open surgical procedure (21%).

CONCLUSIONS

Open debridement for acute periprosthetic knee infection shows clear benefits in terms of infection eradication and prosthesis salvage compared to arthroscopic DAIR.

Vasogenic Brain Edema During Maintenance Hemodialysis : Preliminary Results from Tract-based Spatial Statistics and Voxel-based Morphometry

BACKGROUND

Hemodialysis (HD), especially when first initiated, can cause neurological deterioration. Presumably this is due to transient cerebral edema, which has been observed using diffusion weighted magnetic resonance imaging (MRI) in experimental and human studies; however, this has not been investigated under maintenance hemodialysis (mHD). Moreover, there are no studies to date investigating regional effects of mHD on grey and white matter volumes.

METHODS

In this study eight patients with end stage renal disease (ESRD) were examined immediately before and after mHD sessions with multimodal MRI, including diffusion tensor imaging (DTI) and high-resolution structural imaging. Additionally, eight healthy, age-matched and sex-matched controls were examined for comparison. Data were analyzed using tract-based spatial statistics and voxel-based morphometry.

RESULTS

At baseline, ESRD patients had significantly reduced values of fractional anisotropy (FA) and axial diffusivity as well as bilaterally reduced grey matter volume in the insula, compared with controls. After the mHD session, FA further decreased while axial, radial, and mean diffusivity significantly increased ubiquitously throughout the white matter. Voxel-based morphometry revealed a corresponding significant increase in white matter volume in the central right hemisphere and splenium, as well as in cortical grey matter in the anterior medial frontal and cingulate cortex. None of the patients showed neurological deterioration.

CONCLUSION

In this study ESRD patients showed white matter changes indicative of chronic microstructural damage when compared with healthy controls, as previously reported. In addition, patients showed signs of a transient extracellular cerebral edema, which has not yet been observed in the absence of neurological symptoms.

Evaluation of a MetOp ASCAT-Derived Surface Soil Moisture Product in Tundra Environments

Satellite-derived surface soil moisture data are available for the Arctic, but detailed validation is still lacking. Previous studies have shown low correlations between in situ and modeled data. It is hypothesized that soil temperature variations after soil thaw impact MetOp ASCAT satellite-derived surface soil moisture (SSM) measurements in wet tundra environments, as C band backscatter is sensitive to changes in dielectric properties. We compare in situ measurements of water content within the active layer at four sites across the Arctic in Alaska (Barrow, Sagwon, Toolik) and Siberia (Tiksi), taken in the spring after thawing and in autumn prior to freezing. In addition to the long-term measurement fields, where sensors are installed deeper in the ground, we designed a monitoring setup for measuring moisture very close to the surface in the Lena River Delta, Siberia. The volumetric water content (VWC) and soil temperature sensors were placed in the moss organic layer in order to account for the limited penetration depth of the radar signal. ASCAT SSM variations are generally very small, in line with the low variability of in situ VWC. Short-term changes after complete thawing of the upper organic layer, however, seem to be mostly influenced by soil temperature. Correlations between SSM and in situ VWC are generally very low, or even negative. Mean standard deviation matching results in a comparably high root-mean-square error (on average 11%) for predictions of VWC. Further investigations and measurement networks are needed to clarify factors causing temporal variation of C band backscatter in tundra regions.

The role of lake size and local phenomena for monitoring ground-fast lake ice

In this study, we assess the effect of the lake size on the accuracy of a threshold-based classification of ground-fast and floating lake ice from Sentinel-1 Synthetic Aperture Radar (SAR) imagery. For that purpose, two new methods (flood-fill and watershed method) are introduced and the results between the three classification approaches are compared regarding different lake size classes for a study area covering most of the Yamal Peninsula in Western Siberia. The focus is on April, the stage of maximum lake ice thickness, for the years 2016 and 2017. The results indicate that the largest lakes are likely most prone to errors by the threshold classification. The newly introduced methods seem to improve classification results. The results also show differences in fractions of ground-fast lake ice between 2016 and 2017, which might reflect differences in temperatures between the winters with severe impact on wildlife and freshwater fish resources in the region. Patterns of low backscatter responsible for the classification errors in the centre of the lakes were investigated and compared to the optical Sentinel-2 imagery of late-winter. Strong similarities between some patterns in the optical and SAR data were identified. They might be zones of thin ice, but further research is required for clarification of this phenomenon and its causes.

Sea ice, rain-on-snow and tundra reindeer nomadism in Arctic Russia

Sea ice loss is accelerating in the Barents and Kara Seas (BKS). Assessing potential linkages between sea ice retreat/thinning and the region's ancient and unique social-ecological systems is a pressing task. Tundra nomadism remains a vitally important livelihood for indigenous Nenets and their large reindeer herds. Warming summer air temperatures have been linked to more frequent and sustained summer high-pressure systems over West Siberia, Russia, but not to sea ice retreat. At the same time, autumn/winter rain-on-snow (ROS) events have become more frequent and intense. Here, we review evidence for autumn atmospheric warming and precipitation increases over Arctic coastal lands in proximity to BKS ice loss. Two major ROS events during November 2006 and 2013 led to massive winter reindeer mortality episodes on the Yamal Peninsula. Fieldwork with migratory herders has revealed that the ecological and socio-economic impacts from the catastrophic 2013 event will unfold for years to come. The suggested link between sea ice loss, more frequent and intense ROS events and high reindeer mortality has serious implications for the future of tundra Nenets nomadism.

Point-of-care PT and aPTT in patients with suspected deficiencies of coagulation factors

INTRODUCTION

There are several clinical settings and patient conditions especially in intensive care units, emergency departments, and operating theaters, where the coagulation status of a patient must be known immediately and point-of-care (POC) systems are beneficial due to low time to result.

METHODS

This noninterventional, single-blinded, multicenter study with prospectively collected whole blood samples was performed to evaluate the diagnostic accuracy of the CoaguChek PT Test (POC PT) and CoaguChek aPTT Test (POC aPTT) compared to standard laboratory testing in patients with suspected deficiencies of coagulation factors.

RESULTS

In total, 390 subjects were included. Both POC PT and POC aPTT showed concordance with the laboratory PT and aPTT. Lot-to-lot variation was below 2% both for POC PT and for POC aPTT. The mean relative difference of capillary blood compared to venous blood was 0.2 % with POC PT and 8.4% with POC aPTT. The coefficients of variation for repeatability of POC PT using whole blood were found to be between 2% and 3.6%.

CONCLUSION

Our findings suggest reliable quantitative results with this POC system to support on-site decision-making for patients with suspected deficiencies of coagulation factors in acute and intensive care.

A novel approach for the characterization of tundra wetland regions with C-band SAR satellite data

A circumpolar representative and consistent wetland map is required for a range of applications ranging from upscaling of carbon fluxes and pools to climate modelling and wildlife habitat assessment. Currently available data sets lack sufficient accuracy and/or thematic detail in many regions of the Arctic. Synthetic aperture radar (SAR) data from satellites have already been shown to be suitable for wetland mapping. Envisat Advanced SAR (ASAR) provides global medium-resolution data which are examined with particular focus on spatial wetness patterns in this study. It was found that winter minimum backscatter values as well as their differences to summer minimum values reflect vegetation physiognomy units of certain wetness regimes. Low winter backscatter values are mostly found in areas vegetated by plant communities typically for wet regions in the tundra biome, due to low roughness and low volume scattering caused by the predominant vegetation. Summer to winter difference backscatter values, which in contrast to the winter values depend almost solely on soil moisture content, show expected higher values for wet regions. While the approach using difference values would seem more reasonable in order to delineate wetness patterns considering its direct link to soil moisture, it was found that a classification of winter minimum backscatter values is more applicable in tundra regions due to its better separability into wetness classes. Previous approaches for wetland detection have investigated the impact of liquid water in the soil on backscatter conditions. In this study the absence of liquid water is utilized. Owing to a lack of comparable regional to circumpolar data with respect to thematic detail, a potential wetland map cannot directly be validated; however, one might claim the validity of such a product by comparison with vegetation maps, which hold some information on the wetness status of certain classes. It was shown that the Envisat ASAR-derived classes are related to wetland classes of conventional vegetation maps, indicating its applicability; 30% of the land area north of the treeline was identified as wetland while conventional maps recorded 1-7%.

Filtration of sea louse, Lepeophtheirus salmonis, copepodids by the blue mussel, Mytilus edulis, and the Atlantic sea scallop, Placopecten magellanicus, under different flow, light and copepodid-density regimes

Population management of Lepeophtheirus salmonis in Canada currently relies on chemotherapeutants to remove attached stages of the ectoparasite. However, some populations of L. salmonis are developing resistance to chemotherapeutants making alternate management measures necessary. This article explores the ability of filter-feeding shellfish [i.e. blue mussels (Mytilus edulis) and Atlantic sea scallops (Placopecten magellanicus)] to consume the copepodid stages of L. salmonis in the laboratory under static and flowing water conditions, with variable copepodid densities, and with the aid of a light attractant. Mytilus edulis consumed copepodids under both static and flowing water conditions, and the proportion of individuals ingested was similar at low and high copepodid densities, suggesting that M. edulis was not saturated at the concentrations tested. Also, M. edulis consumed more copepodids when a light attractant was present, suggesting that lights may be useful to concentrate widely dispersed copepodids around cultured shellfish in the field. Finally, P. magellanicus consumed the same number of copepodids as an equivalent total wet weight of M. edulis. During each of the four separate experiments, shellfish consumed between 18 and 38% of the copepodids presented per hour, suggesting that both species are well suited for low level removal of copepodids over time.

Detection of snow surface thawing and refreezing in the Eurasian Arctic with QuikSCAT: implications for reindeer herding

Snow conditions play an important role for reindeer herding. In particular, the formation of ice crusts after rain-on-snow (ROS) events or general surface thawing with subsequent refreezing impedes foraging. Such events can be monitored using satellite data. A monitoring scheme has been developed for observation at the circumpolar scale based on data from the active microwave sensor SeaWinds on QuikSCAT (Ku-band), which is sensitive to changes on the snow surface. Ground observations on Yamal Peninsula were used for algorithm development. Snow refreezing patterns are presented for northern Eurasia above 60 degrees N from autumn 2001 to spring 2008. Western Siberia is more affected than Central and Eastern Siberia in accordance with climate data, and most events occur in November and April. Ice layers in late winter have an especially negative effect on reindeer as they are already weakened. Yamal Peninsula is located within a transition zone between high and low frequency of events. Refreezing was observed more than once a winter across the entire peninsula during recent years. The southern part experienced refreezing events on average four times each winter. Currently, herders can migrate laterally or north-south, depending on where and when a given event occurs. However, formation of ice crusts in the northern part of the peninsula may become as common as they are now in the southern part. Such a development would further constrain the possibility to migrate on the peninsula.

Rapid-onset central motor plasticity in multiple sclerosis

OBJECTIVE

To study rapid-onset central motor plasticity, and its relationship to motor impairment and CNS injury in patients with multiple sclerosis (MS).

METHODS

In this cross-sectional observational study, motor plasticity was examined neurophysiologically and behaviorally in 22 patients with moderately severe (median Expanded Disability Status Scale score 2.5 [0-6]) stable MS and matched healthy controls. First, plasticity was assessed using paired associative stimulation (PAS), a protocol modeling long-term synaptic potentiation in human cortex. PAS combines repetitive electric nerve stimulation with transcranial magnetic stimulation (TMS) of the contralateral motor cortex. Second, motor learning was tested by a force production task. Motor impairment was assessed by functional tests. CNS injury was evaluated by obtaining normalized N-acetyl-aspartate (NAA/Cr) spectra using magnetic resonance spectroscopy and by the corticomuscular latency (CML) to the abductor pollicis brevis muscle as tested by TMS.

RESULTS

Patients with MS performed worse than controls in functional motor tests, CMLs were prolonged, and NAA/Cr was decreased. PAS-induced enhancement of corticospinal excitability and training-induced increments of motor performance were comparable between patients with MS and controls. Neither PAS-induced plasticity nor motor learning performance correlated with motor impairment or measures of CNS injury. Patients with high CNS injury and good motor performance did not differ significantly from those with high CNS injury and poor motor performance with respect to PAS-induced plasticity and motor learning success.

CONCLUSIONS

Despite motor impairment and CNS injury in patients with multiple sclerosis (MS), rapid-onset motor plasticity is comparable to that in healthy subjects. Compensation of MS-related CNS injury is unlikely to be constrained by insufficient rapid-onset neuroplasticity.

Global monitoring of wetlands--the value of ENVISAT ASAR Global mode

This paper elaborates on recent advances in the use of ScanSAR technologies for wetland-related research. Applications of active satellite radar systems include the monitoring of inundation dynamics as well as time series analyses of surface soil wetness. For management purposes many wetlands, especially those in dry regions, need to be monitored for short and long-term changes. Another application of these technologies is monitoring the impact of climate change in permafrost transition zones where peatlands form one of the major land cover types. Therefore, examples from boreal and subtropical environments are presented using the analysed ENVISAT ASAR Global mode (GM, 1 km resolution) data acquired in 2005 and 2006. In the case of the ENVISAT ASAR instrument, data availability of the rather coarse Global Mode depends on request priorities of other competing modes, but acquisition frequency may still be on average fortnightly to monthly depending on latitude. Peatland types covering varying permafrost regimes of the West Siberian Lowlands can be distinguished from each other and other land cover by multi-temporal analyses. Up to 75% of oligotrophic bogs can be identified in the seasonal permafrost zone in both years. The high seasonal and inter-annual dynamics of the subtropic Okavango Delta can also be captured by GM time series. Response to increased precipitation in 2006 differs from flood propagation patterns. In addition, relative soil moisture maps may provide a valuable data source in order to account for external hydrological factors of such complex wetland ecosystems.

Neuroradiologische Diagnostik bei Patienten mit sensorineuralem Hörverlust vor Cochlea-Implantation

Cochlear implantation (CI) is an established technique for enabling speech perception in patients suffering from severe bilateral sensorineural hearing loss (SNHL). Thorough preoperative radiological assessment is essential for correctly evaluating the indication for surgery and safely performing cochlear implantation. CT and conventional and functional MRI are available for radiological assessment. Therefore, knowledge of the most frequent congenital syndromal, non-syndromal, and acquired malformations of inner ear structures is fundamental. This article provides information about imaging techniques prior to CI and relevant malformations of the inner ear. Safety aspects for patients with a cochlear implant undergoing MR imaging are also discussed.

Sind zykloide Psychosen atypische manisch-depressive Erkrankungen?

BACKGROUND

Whereas a growing body of evidence suggests that cycloid psychoses have to be separated from schizophrenic psychoses, their relations to bipolar affective disorder are less clear.

PATIENTS AND METHODS

In a controlled family study, we recruited 46 patients with cycloid psychosis (CP), 33 with manic-depressive illness (MDI), and 27 controls. Three hundred fifty-six of 389 living first-degree relatives were personally examined by experienced psychiatrists blinded to the diagnosis of the index proband.

RESULTS

The relatives of CP patients showed significantly lower morbidity risk of functional psychoses than relatives of patients with MDI in Kaplan-Meier life table calculation. The morbidity risk for functional psychoses in relatives of patients with CP did not differ significantly from that in relatives of controls.

CONCLUSION

These results suggest that CP are etiologically different from bipolar affective psychoses and cannot be integrated into the spectrum of bipolar affective disorders. The findings provide further evidence for a nosological independence of CP.

Cycloid psychoses are not part of a bipolar affective spectrum: results of a controlled family study

BACKGROUND

Whereas a growing body of evidence suggests that cycloid psychoses have to be separated from schizophrenic psychoses, their relations to bipolar affective disorder are less clear. To further clarify this issue a controlled family study was undertaken.

METHODS

All living and traceable adult first-degree relatives of 45 cycloid psychotic, 32 manic-depressive and 27 control probands were personally examined by an experienced psychiatrist blind to the diagnosis of the index proband. Data about not traceable relatives were collected by the "Family-History"-Method. A catamnestic diagnosis was established for each of the 431 relatives blind to family data. Age-corrected morbidity risks were calculated using the life-table method.

RESULTS

Relatives of cycloid psychotic patients showed a significantly lower morbidity risk for endogenous psychoses in general and manic-depressive illness compared to relatives of patients with manic-depressive illness. The familial morbidity risk for cycloid psychoses was low and did not differ significantly in both proband groups. Relatives of cycloid psychotic patients however did not differ significantly from relatives of controls regarding familial morbidity.

LIMITATIONS

Our time-consuming methodical procedure implicated a relatively small number of participants due to restricted personnel resources. The restriction to hospitalised probands could possibly cause a limited representativity of the study sample.

CONCLUSIONS

Our results suggest that cycloid psychoses are aetiologically different from manic-depressive illness and could not be integrated into a spectrum of bipolar affective disorders. The findings provide further evidence for a nosological independence of cycloid psychoses.

[Reversible loss of vision in severe preeclampsia: case report and review of the literature]

Visual disturbances occur in up to 25 % of the patients with preeclampsia. However, blindness remains a rare phenomenon. A 39 year old primigravida was admitted for observation at 30 weeks gestation with signs of preeclampsia. After 11 days she suffered a complete loss of vision. The blindness reversed completely after cesarean section and antihypertensive treatment. Blindness in preeclamptic patients is mostly caused by hypertensive encephalopathy. We discuss pathophysiological aspects as well as diagnostic approaches and therapeutic options with respect to the available literature.

Parental reactions following the birth of a cleft child

Parental experiences and behaviour following the birth of a cleft child were studied by comparing the results of 2 interview studies conducted at a 7-year interval. The parents of a total of 55 cleft children, most of whom had passed the primary treatment, were interviewed about their psychosocial adaptation, using an interview scheme with the focus on: a) emotional, cognitive and social reactions following birth, b) information-giving and support provided by the medical staff, c) interaction with the cleft child, and d) impact on family life. In both studies, more than 70% of the parents were very shocked at the birth of the cleft child. In the later study, parents more often expressed depression, social avoidance and feelings of guilt. They indicated better psychosocial care and more understanding provided by the medical staff compared to the earlier study. Twice as many parents were satisfied with the information provided by the cleft centre, however, the amount of information had little impact on coping with the shock. In conclusion, further sensitisation of the medical staff with respect to parental coping processes and needs for information and emotional support was called for, along with the inclusion of these topics in the respective curricula.

Lüscher colour test in orthodontic patients. Practicability for compliance assessment?

The Lüscher colour test has been repeatedly recommended as a tool for the prediction of orthodontic treatment course and patient cooperation despite its scientific shortcomings. A series of studies involving patients aged 9 to 16 years undergoing treatment with removable appliances at various orthodontic practices and at one university clinic provided no evidence of systematic correlations between Lüscher test colour preferences and cooperation with appliance wear. There was only slight consistency in colour preferences in a re-test conducted a few months after baseline measurements. Statistical evaluation of specific hypotheses and exploratory analysis of the global potential of the test provided no support for generalizable and useful correlations between colour preferences and patient compliance. Therefore the Lüscher test cannot be generally recommended for the rating of patient compliance in the clinical orthodontic practice.

Patterns and prediction of orthodontic treatment course

Most attempts at the identification and prediction of treatment-related changes and outcome in orthodontics thus far have relied upon single biometric parameters instead of employing a systemic and ecological approach. The concept of facial harmony and the availability of sophisticated multivariate statistics offer new chances for a deeper understanding of the mechanisms of change. A longitudinal study has been conducted on approximately 500 youths aged 9-11 years, on average. Numerous parameters of cephalometric analysis, study casts, growth, treatment regimen and patient co-operation were assessed at the onset of treatment (T0) and after 1 year (T1) to determine treatment-related changes under therapy with removable appliances. Exploratory cluster analyses were based on five fundamental cephalometric parameters (SNA, SNB, ML-NSL, NL-NSL, NS-Ba) that establish an operational approach to harmonious facial relations (Segner and Hasund, 1991). As a first step, analyses were restricted to 281 Class II division 1 patients selected for good co-operation by an expert rating by the first author on a three-point rating scale. They all were treated with bionators either with anterior or posterior traction. Both subgroups were studied separately. Based on cluster analytic procedures, different patterns of change were identified for both types of appliance. A slight tendency toward harmonization of the initial skeletal relations was observed throughout all subgroups, with reactions being most obvious in the maxilla. The clusters produced for either appliance group were then screened for additional predictors of group membership by means of discriminant analysis. The findings are discussed in terms of the suitability of the methodological approach chosen.

Effects of information-giving and communication during orthodontic consultation and treatment. Part 3: Optimized orthodontist-patient communication

Effective, orthodontist-patient communication must meet certain minimum requirements whose importance might vary, depending on the individual case and stage of treatment. In the course of treatment the following tasks are of primary importance: 1. Before the start of treatment, during preliminary consultation, information tailored in extent and quality to the individual patient has to be provided, a professional assessment of treatment needs made, and a relationship of mutual trust established. 2. In the initial phase of treatment, the individual shaping and optimisation of treatment needs is a matter of priority if initial acceptance of the appliance is to be assured. The patient should be advised how to meet the treatment needs in his individual situation. 3. In the further course of treatment, the fulfillment of the demands has to be repeatedly clarified. Feedback with regard to patient cooperation should be handled with caution. A tight recall schedule, a time-keeping record and involvement of the parents are obvious interventions in cases of inadequate cooperation. The treatment may also have to be reevaluated.

Activated transcription factor nuclear factor-kappa B is present in the atherosclerotic lesion

Nuclear factor-kappa B (NF-kappaB)/Rel transcription factors play an important role in the inducible regulation of a variety of genes involved in the inflammatory and proliferative responses of cells. The present study was designed to elucidate the implication of NF-kappaB/Rel in the pathogenesis of atherosclerosis. Activation of the dimeric NF-kappaB complex is regulated at a posttranslational level and requires the release of the inhibitor protein IkappaB. The newly developed mAb alpha-p65mAb recognizes the IkappaB binding region on the p65 (RelA) DNA binding subunit and therefore selectively reacts with p65 in activated NF-kappaB. Using immunofluorescence and immunohistochemical techniques, activated NF-kappaB was detected in the fibrotic-thickened intima/media and atheromatous areas of the atherosclerotic lesion. Activation of NF-kappaB was identified in smooth muscle cells, macrophages, and endothelial cells. Little or no activated NF-kappaB was detected in vessels lacking atherosclerosis. Electrophoretic mobility shift assays and colocalization of activated NF-kappaB with NF-kappaB target gene expression suggest functional implications for this transcription factor in the atherosclerotic lesion. This study demonstrates the presence of activated NF-kappaB in human atherosclerotic tissue for the first time. Atherosclerosis, characterized by features of chronic inflammation and proliferative processes, may be a paradigm for the involvement of NF-kappaB/Rel in chronic inflammatory disease.

[The influence of information and communication in the orthodontic consultation and treatment visit. II. The communication style and compliance]

The establishment of a good rapport between dentist and patient is together with providing information a basic prerequisite for successfully motivating the patient to comply with the guidance the dentist provides. Both the style adopted in verbally communicating with the patient and also nonverbal communication play a decisive role in the establishment and maintenance of such a relationship. In the pilot study presented here, which draws on psychological interaction analysis of video recordings taken of the initial consultation with 27 patients and of 28 routine treatment sessions with different patients, the typical interaction patterns between the orthodontist and the patient are objectively assessed and compared. The most important findings of the study were: (1) The mean duration of the chairside sessions was lowest during routine encounters with cooperative patients. (2) During consultations approximately 2/3 of the time was taken up talking to each other. On the other hand, in treatment sessions with uncooperative patients only 1/4 of the time was devoted to verbal communication. (3) The orthodontist dominated the conversation in all groups and especially in conversing with the uncooperative patients. (4) In the consultation sessions the dentist and the patient related relatively strongly to each other. (5) Providing mere information significantly predominated over any discussion of the professional aspects of the treatment. (6) During the consultations eye contact was maintained over almost all of the sessions.(ABSTRACT TRUNCATED AT 250 WORDS)

[The evaluation of orthodontic treatments. Reflections on the Eismann procedure]

This study presents a broad overview of the fundamental questions involved in evaluating orthodontic treatment methods using a formalized index system. Eismann's numerical success evaluation, which he published 25 years ago and which is an example of this method, is examined in some detail. Both the dividends and limits of the Eismann method are discussed on the basis of our own studies and those of others and modifications to the method are suggested. Not withstanding the limitations inherent in any model based analysis, the Eismann approach is shown to be superior to many similar systems and it thus remains the method of choice for conducting scientific studies of the course of treatment over time. In addition possibilities of further developing and enhancing the method are presented.

[The effect of information and communication in the orthodontic consultation. 1. The imparting of the information]

The initial consultation has a crucial impact on the patient's decision whether or not to undergo orthodontic treatment. The consultation is the occasion for providing information regarding the nature of the malocclusion and its possible treatment. The consultation has a threefold objective: first, the ethical, i.e. assisting the patient in making an informed and responsible decision; second, the legal, i.e. facilitation of an informed consent; and third, the psychological, i.e. motivation to treatment and enhanced health behavior. The basic prerequisites to a successful consultation are the patient's accurate comprehension and retention of the given information. In the course of an ongoing quasi-experimental study the Wuerzburg orthodontic department has made video recordings of initial consultations. All information was coded according to a standardized schematic. After ten days the patients were interviewed about the consultation. With help of the schematic, retention and comprehension of the information given were assessed quantitatively by comparing the number of information units actually given with those recalled, understood, or forgotten. In addition, the recordings were analyzed for provider interaction patterns.

Correlates of objective patient compliance with removable appliance wear

Patient compliance is considered a major problem in orthodontics. Yet, to date, few conclusive findings have been noted on determinants and consequences of failing adherence, probably because of method flaws and a lack of objective criteria. By following an outline of conceptual issues and selected research, we considered an investigation into correlates of patient compliance with removable appliance wear. We studied a sample of 77 university clinic patients ages 9 to 14 years over several months by means of psychologic inventories and electronic measurement of removable appliance wear. The actual compliance rate proved to be associated with many variables. Among those, characteristics of the patient and his family background, such as conformity and degree of consistent parental support and supervision are interpreted as determinants of satisfactory adherence, whereas treatment related and interactional correlates, such as duration of treatment, dominance of provider, and interpersonal perceptions, are conceived of in terms of mutually interdependent and/or consequent variables. The factors identified might be paralleled in the wearing of headgear and intraoral elastics that require a similar degree of active patient cooperation. After a critical discussion of our data in the light of previous findings, suggestions are provided for future research along with conclusions for clinical practice.

[The clinical and psychological indicators of behavior in wearing a removable appliance]

Compliance with wearing removable appliances cannot be determined directly from progress noted in the course of treatment. The orthodontist's judgement is influenced by many and varied observations and the evidence they yield is often unclear. We studied 104 orthodontic patients aged nine to 16 years using as data treatment records, provider and patient questionnaires, and oral hygiene indexes. In addition the Luescher psychological color test was administered to a subgroup and the duration of compliance wear was objectively measured. We found little consistency among different compliance indicators. Studying the patient's keeping of appointments, his oral hygiene habits, and appliance maintenance did not result in general conclusions pertaining to the patient's compliance with wearing the appliance. Only over a longer period it is possible to determine through clinical observation the patient's cooperation in his treatment. More promising on the other hand for better evaluating patient compliance behavior is the combination of information obtained clinically with the results obtained through psychological tests.