Messungen der Compliance und Bestimmungsfaktoren für einen Therapieerfolg mit herausnehmbaren funktionskieferorthopädischen Apparaturen

Zielsetzung Ziel dieser Studie war es, die Patientencompliance beim Tragen herausnehmbarer funktionskieferorthopädischer Apparaturen zu bestimmen und Faktoren zu definieren, die den Erfolg einer Behandlung beeinflussen könnten.

Methoden Bei 88 Klasse-II-Patienten, die konsekutiv mit herausnehmbaren funktionskieferorthopädischen Apparaturen behandelt worden waren, wurden die Tragezeiten quantifiziert und mithilfe des TheraMon®-Mikrosensors in Verbindung mit anderen behandlungsbezogenen Faktoren analysiert.

Ergebnisse Die mittlere Tragezeit (±SD) betrug 10,2 (±2,86) Stunden/Tag, die mittlere Overjet-Reduktion 4,7 mm (±2,50) und die mittlere Gesamtbehandlungsdauer 6,9 (±3,0) Monate. Die objektiven und geschätzten Tragezeiten waren signifikant unterschiedlich (p<0,001), und die objektive Tragezeit war positiv mit der Gesamtreduktion des Overjets korreliert (r=0,29, p=0,007). Die mittlere Overjet-Reduktion während der Beobachtungsphase war am niedrigsten bei Patienten mit einer Tragezeit von<8 Stunden/Tag. Der Grad der Schmerzen/Beschwerden und die objektive Tragezeit waren umgekehrt korreliert (r=–0,41, p<0,001). Die Motivation war umgekehrt mit Schmerzen/Beschwerden korreliert (r=–0,23, p=0,03) und positiv mit der Tragezeit assoziiert (r=0,37, p=0,001). Das Ausmaß der Schmerzen/Beschwerden und die Motivation trugen unabhängig voneinander zur täglichen Tragezeit der funktionskieferorthopädischen Apparatur bei.

Schlussfolgerungen Die empfohlene Tragezeit wird nahezu nie erreicht, und die Reduktion des Overjets und die Tragezeit zeigen eine moderate Korrelation. Die Compliance ist unabhängig mit Schmerzen/Beschwerden und Motivation assoziiert, korreliert jedoch nicht mit dem Alter, dem Geschlecht, Mobbing oder der Mundhygiene. Die direkte Quantifizierung der Tragezeit und die klinischen Ergebnisse während der Behandlung ermöglichen es dem Zahnarzt, personalisierte Empfehlungen zur Tragezeit zu geben.

Consensus definition of sarcopenia, cachexia and pre-cachexia: joint document elaborated by Special Interest Groups (SIG) "cachexia-anorexia in chronic wasting diseases" and "nutrition in geriatrics"

Chronic diseases as well as aging are frequently associated with deterioration of nutritional status, loss muscle mass and function (i.e. sarcopenia), impaired quality of life and increased risk for morbidity and mortality. Although simple and effective tools for the accurate screening, diagnosis and treatment of malnutrition have been developed during the recent years, its prevalence still remains disappointingly high and its impact on morbidity, mortality and quality of life clinically significant. Based on these premises, the Special Interest Group (SIG) on cachexia-anorexia in chronic wasting diseases was created within ESPEN with the aim of developing and spreading the knowledge on the basic and clinical aspects of cachexia and anorexia as well as of increasing the awareness of cachexia among health professionals and care givers. The definition, the assessment and the staging of cachexia, were identified as a priority by the SIG. This consensus paper reports the definition of cachexia, pre-cachexia and sarcopenia as well as the criteria for the differentiation between cachexia and other conditions associated with sarcopenia, which have been developed in cooperation with the ESPEN SIG on nutrition in geriatrics.

Quadriceps muscle strength in scoliosis

Quadriceps muscle weakness is an important component of chronic obstructive pulmonary disease (COPD). We hypothesised that quadriceps weakness would also be a feature of restrictive lung disease due to scoliosis. We studied 10 patients with severe scoliosis (median (interquartile range (IQR)) forced expiratory volume in 1 s (FEV(1))() 35.3 (11)% predicted), 10 patients with severe COPD (FEV(1) 26.5 (9.0)% pred) and 10 healthy age-matched adults. We measured quadriceps strength, exercise capacity and analysed quadriceps muscle biopsies for myosin heavy-chain (MyHC) isoform expression and the presence of oxidative stress. Both groups exhibited quadriceps weakness with median (IQR) maximal voluntary contraction force being 46.0 (17.0) kg, 21.5 (21.0) kg and 31.5 (11.0) kg, respectively (p = 0.02 and 0.04, respectively, for each patient group against controls). Oxidative stress was significantly greater in the quadriceps of both restrictive and COPD patients. The scoliosis patients exhibited a decrease in the proportion of MyHC type I compared with controls; median (IQR) 35.3 (18.5)% compared with 47.7 (9.3)%, p = 0.028. The scoliosis patients also showed an increase in MyHC IIx (26.3 (15.5)% compared with 11.3 (13.0)%, p = 0.01. Quadriceps weakness is a feature of severe scoliosis; the similarities between patients with scoliosis and patients with COPD suggest a common aetiology to quadriceps weakness in both conditions.

Transcutaneous oxygen saturation and carbon dioxide tension during meals in patients with chronic obstructive pulmonary disease

The effect on transcutaneous SaO2 and transcutaneous carbon dioxide tension (PtCO2) of eating was assessed in 44 patients with severe COPD (FEV1 less than 50 percent). The SaO2, PtCO2, and heart rate (HR) were measured every minute before, during, and until 30 minutes after a standardized meal (445 kcal) was consumed. All patients were measured twice on the same day, while eating a meal with high (80 percent) and low (28 percent) carbohydrate content, respectively. The mean meal desaturation (delta SaO2) was less than 1 percent in normoxemic patients but was -3.2 +/- 0.7 percent (p less than 0.001) in hypoxemic (PaO2 less than 7.3 kPa) patients. Significant differences between hypoxemic patients with a delta SaO2 greater than 4 percent and less than or equal to 4 percent, respectively, were found in FEV1 (16 +/- 3 percent and 29 +/- 8 percent; p less than 0.001), respiratory muscle strength (3.9 +/- 1.2 kPa and 5.9 +/- 1.2 kPa; p less than 0.01), HR (112 +/- 12 beats per minute and 90 +/- 18 beats per minute; p less than 0.001), body weight (54.9 +/- 7.5 kg and 74.7 +/- 10.4 kg; p less than 0.001), and fat-free mass (42.0 +/- 6.6 kg and 52.6 +/- 5.8 kg; p less than 0.005) but not in baseline SaO2 and PtCO2. The decrease in SaO2 and the increase in HR were less during the carbohydrate-rich meal. No significant fluctuations in PtCO2 were found after either meal. Meal-related oxygen desaturation cannot explain weight loss in normoxemic patients with COPD but may contribute to a limited dietary intake in a subgroup of hypoxemic patients exhibiting marked oxygen desaturation during meals. A single carbohydrate-rich meal does not have an immediate impact on PtCO2 in stable COPD.

Inventory of nutritional status in patients with COPD

Assessment of nutritional status was performed in 153 patients with COPD, admitted to a rehabilitation center. All patients had moderate to severe COPD and were in stable pulmonary condition. Nutritional parameters studied were percentage of ideal body weight, creatinine height index, serum albumin, serum prealbumin, serum transferrin, and total lymphocyte count. A nutritional index composed of four commonly used parameters (PIW, ALB, PALB, TLC) was calculated. This NI was used to separate patients who had a compromised nutritional status (NI greater than or equal to 0.5; 29 patients, 19 percent) from patients who had a normal nutritional status. The results demonstrated a relation between impaired gas exchange and parameters used to assess nutritional status and not between the degree of bronchial obstruction and such parameters.