Osteoidosteom: CT-gesteuerte Bohrexzision und Radiofrequenzablation

Zusammenfassung: Hintergrund: Die CT-geführte Entfernung des Nidus eines Osteoidosteoms anstelle herkömmlicher Verfahren der offenen Resektion bietet den Vorteil, die Läsion intraoperativ exakt zu lokalisieren und deren Entfernung korrekt zu kontrollieren. Zudem tritt anstelle eines oft großen Eingriffs der Vorteil eines minimal-invasiven Vorgehens. Patienten und Methode: Zwischen 1996 und 2005 wurden 52Patienten anhand von Klinik und Bildgebung diagnostizierten Osteoidosteomen entweder mittels Bohrexzision (BE, n=41) oder Radiofrequenzablation (RFA, n=11) behandelt. Das Alter der Patienten lag zwischen 7 und 48 (Durchschnitt 22,3) Jahren, der Follow-up betrug 31,3Monate. Ergebnisse: Das Osteoidosteom konnte bei allen Patienten erfolgreich behandelt werden. 50Patienten waren nach einmaligem Eingriff anhaltend beschwerdefrei. Bei 2Patienten wurde in der 1. Operation der Nidus verfehlt, sodass kurze Zeit später mit der gleichen Methode eine 2. Behandlung notwendig wurde. Schlussfolgerung: Die CT-geführte Therapie des Osteoidosteoms hat dessen Behandlung durch exakte Lokalisierung und Verkleinerung des Eingriffs entscheidend vereinfacht und besser kontrollierbar gemacht. Das Verfahren kann analog zur Biopsie von Weichteil- und Knochenprozessen genutzt werden, was den Vorteil der exakten Dokumentation des Biopsieweges und der Entnahmestelle biete

Verlängerung des kongenital kurzen Femurs (PFFD) mittels Hybridfixateur unter Einbeziehung des Kniegelenks

Hintergrund: Kontrakturen und Luxationen in Knie- und Hüftgelenk sind bekannte Komplikationen bei der Verlängerung des proximalen fokalen Femurdefekts (PFFD). Insbesondere ist das Kniegelenk wegen der fehlenden oder insuffizienten Kreuzbänder beim PFFD gefährdet. Achsenabweichungen muss ebenfalls besondere Beachtung geschenkt werden. Patienten und Methoden: Bei 4Patienten (Alter 2,5-11Jahre) mit PFFD (Pappas-KlasseIII (1Patient), KlasseVII (3Patienten)) wurden 5Verlängerungen mit Achsenkorrektur durchgeführt. Es wurde ein kniegelenküberbrückender Fixateur externe (Monotube, Triax®) verwendet, der Tibia und Femur mit einem Scharniergelenk verbindet und das Kniegelenk vor Kontraktur oder Luxation schützt. Die Verlängerungen lagen zwischen 3 und 11cm. Resultate: Alle Patienten erreichten nach Verlängerung die vorherige Knie- und Hüftbeweglichkeit. Eine Hüftgelenkkontraktur kann während der Verlängerung die Einbeziehung des Hüftgelenks in das Fixateursystem notwendig machen. Dies war bei den in diesem Beitrag beschriebenen 4Patienten nicht erforderlich. Schlussfolgerung: Vier konsekutive Verlängerungen bei angeborenem longitudinalem Femurdefekt erfolgten unter Luxationsschutz des Kniegelenks durch ein kniegelenküberbrückendes Flexionsbewegungen erlaubendes Fixateursystem. Bei diesen Patienten konnte eine Kontraktur bzw. Luxation vermieden werden. Wir denken, dass ein solches System bei entsprechenden Verlängerungen in Betracht gezogen werden sollt

Results of the US contribution to the joint US/USSR Bering Sea experiment

The atmospheric circulation which occurred during the Bering Sea Experiment, 15 February to 10 March 1973, in and around the experiment area is analyzed and related to the macroscale morphology and dynamics of the sea ice cover. The ice cover was very complex in structure, being made up of five ice types, and underwent strong dynamic activity. Synoptic analyses show that an optimum variety of weather situations occurred during the experiment: an initial strong anticyclonic period (6 days), followed by a period of strong cyclonic activity (6 days), followed by weak anticyclonic activity (3 days), and finally a period of weak cyclonic activity (4 days). The data of the mesoscale test areas observed on the four sea ice option flights, and ship weather, and drift data give a detailed description of mesoscale ice dynamics which correlates well with the macroscale view: anticyclonic activity advects the ice southward with strong ice divergence and a regular lead and polynya pattern; cyclonic activity advects the ice northward with ice convergence, or slight divergence, and a random lead and polynya pattern

Recession coverage using the modified coronally advanced tunnel and connective tissue graft with or without enamel matrix derivative: 5-year results of a randomised clinical trial.

OBJECTIVES To evaluate the 5-year results of single and multiple recession type (RT) 1 and 2 (Miller I to III) recessions treated with the modified coronally advanced tunnel (MCAT) and connective tissue graft (CTG) with or without an enamel matrix derivative (EMD). The main outcome variable was the stability of obtained root coverage from 6 months to 5 years. MATERIALS AND METHODS In 24 patients, both complete and mean root coverage (CRC and MRC) and gain of keratinised tissue (KT) were assessed at 6 months and 5 years after recession coverage by means of MCAT and CTG with or without EMD. Aesthetic outcomes after 5 years were evaluated using the root coverage aesthetic score (RES). RESULTS At 5 years, 24 patients with a total of 43 recessions were evaluated. Eight patients (57.14%) of the test and 6 (60.0%) of the control group showed complete root coverage. MRC revealed no statistically significant differences between the two groups, with 73.87 ± 26.83% (test) and 75.04 ± 22.06% (control), respectively. KT increased from 1.14 ± 0.57 mm to 3.07 ± 2.27 mm in the test group and from 1.24 ± 0.92 mm to 3.02 ± 1.55 mm in the control group, respectively. CONCLUSION Treatment of single and multiple RT 1 and 2 recessions by means of MCAT and CTG with or without EMD yielded comparable clinical improvements which could be maintained over a period of 5 years. The additional use of EMD did not influence the clinical outcomes. CLINICAL RELEVANCE The use of MCAT + CTG yielded successful coverage of single and multiple RT 1 and 2 gingival recessions, while the additional application of EMD did not seem to influence the results

Contemporary educational methods in periodontology.

AIM The 1st European Workshop on Periodontal Education in 2009 made recommendations regarding the scope of periodontal education at undergraduate (UG), postgraduate (PG) and continuing professional development (CPD) levels, defining competencies and learning outcomes that were instrumental at the time in helping to define periodontal teaching curricula. The 19th European Workshop on Periodontology and 2nd European Consensus Workshop on Education in Periodontology (Education in Periodontology in Europe) was held in 2023 to identify changes and future developments in periodontal education (including those informed by the COVID-19 pandemic) and embracing methods and formats of periodontal teaching and training. The aim of this review was to assess current knowledge regarding education methods in periodontology, including traditional face-to-face (F2F) teaching and the move to student-centred methods, virtual learning methods and use of digital technology, as well as blended teaching and learning (including teaching delivery and assessment) at UG, PG and CPD levels. MATERIALS AND METHODS Systematic searches were conducted to identify relevant studies from the literature. Data were extracted and descriptive summaries collated. RESULTS The pandemic was a major disruptor of traditional F2F teaching but provided opportunities for rapid implementation of alternative and supplementary teaching methods. Although online learning has become an integral part of periodontal education, teachers and learners alike favour some form of F2F teaching. Blended teaching and learning are feasible in many areas of periodontal education, both for knowledge and skills acquisition as well as in assessment. Student-centred methods and blended approaches such as the flipped classroom seem highly effective, and online/virtual classrooms with both synchronous and asynchronous lectures are highly valued. Learning with haptic methods and virtual reality (VR) enhances the educational experience, especially when VR is integrated with traditional methods. The quality of the teacher continues to be decisive for the best knowledge transfer in all its forms. CONCLUSIONS Live F2F teaching continues to be highly trusted; however, all types of student-centred and interactive forms of knowledge transfer are embraced as enhancements. While digital methods offer innovation in education, blended approaches integrating both virtual and traditional methods appear optimal to maximize the achievement of learning outcomes. All areas of periodontal education (UG, PG and CPD) can benefit from such approaches; however, more research is needed to evaluate their benefits, both for knowledge transfer and skills development, as well as in assessment

From DNA sequence to application: possibilities and complications

The development of sophisticated genetic tools during the past 15 years have facilitated a tremendous increase of fundamental and application-oriented knowledge of lactic acid bacteria (LAB) and their bacteriophages. This knowledge relates both to the assignments of open reading frames (ORF’s) and the function of non-coding DNA sequences. Comparison of the complete nucleotide sequences of several LAB bacteriophages has revealed that their chromosomes have a fixed, modular structure, each module having a set of genes involved in a specific phase of the bacteriophage life cycle. LAB bacteriophage genes and DNA sequences have been used for the construction of temperature-inducible gene expression systems, gene-integration systems, and bacteriophage defence systems. The function of several LAB open reading frames and transcriptional units have been identified and characterized in detail. Many of these could find practical applications, such as induced lysis of LAB to enhance cheese ripening and re-routing of carbon fluxes for the production of a specific amino acid enantiomer. More knowledge has also become available concerning the function and structure of non-coding DNA positioned at or in the vicinity of promoters. In several cases the mRNA produced from this DNA contains a transcriptional terminator-antiterminator pair, in which the antiterminator can be stabilized either by uncharged tRNA or by interaction with a regulatory protein, thus preventing formation of the terminator so that mRNA elongation can proceed. Evidence has accumulated showing that also in LAB carbon catabolite repression in LAB is mediated by specific DNA elements in the vicinity of promoters governing the transcription of catabolic operons. Although some biological barriers have yet to be solved, the vast body of scientific information presently available allows the construction of tailor-made genetically modified LAB. Today, it appears that societal constraints rather than biological hurdles impede the use of genetically modified LAB.

Existing benchmark systems for assessing global warming potential of buildings – Analysis of IEA EBC Annex 72 cases

Life cycle assessment (LCA) is increasingly being used as a tool by the building industry and actors to assess the global warming potential (GWP) of building activities. In several countries, life cycle based requirements on GWP are currently being incorporated into building regulations. After the establishment of general calculation rules for building LCA, a crucial next step is to evaluate the performance of the specific building design. For this, reference values or benchmarks are needed, but there are several approaches to defining these. This study presents an overview of existing benchmark systems documented in seventeen cases from the IEA EBC Annex 72 project on LCA of buildings. The study characterizes their different types of methodological background and displays the reported values. Full life cycle target values for residential and non-residential buildings are found around 10-20 kg CO$_2$e/m$^2$/y, whereas reference values are found between 20-80 kg CO$_2$e/m$^2$/y. Possible embodied target- and reference values are found between 1-12 kg CO$_2$e/m$^2$/y for both residential and non-residential buildings. Benchmark stakeholders can use the insights from this study to understand the justifications of the background methodological choices and to gain an overview of the level of GWP performance across benchmark systems

The Swiss Multiple Sclerosis Cohort-Study (SMSC): A Prospective Swiss Wide Investigation of Key Phases in Disease Evolution and New Treatment Options.

The mechanisms leading to disability and the long-term efficacy and safety of disease modifying drugs (DMDs) in multiple sclerosis (MS) are unclear. We aimed at building a prospective cohort of MS patients with standardized collection of demographic, clinical, MRI data and body fluids that can be used to develop prognostic indicators and biomarkers of disease evolution and therapeutic response. The Swiss MS Cohort (SMSC) is a prospective observational study performed across seven Swiss MS centers including patients with MS, clinically isolated syndrome (CIS), radiologically isolated syndrome or neuromyelitis optica. Neurological and radiological assessments and biological samples are collected every 6-12 months. We recruited 872 patients (clinically isolated syndrome [CIS] 5.5%, relapsing-remitting MS [RRMS] 85.8%, primary progressive MS [PPMS] 3.5%, secondary progressive MS [SPMS] 5.2%) between June 2012 and July 2015. We performed 2,286 visits (median follow-up 398 days) and collected 2,274 serum, plasma and blood samples, 152 cerebrospinal fluid samples and 1,276 brain MRI scans. 158 relapses occurred and expanded disability status scale (EDSS) scores increased in PPMS, SPMS and RRMS patients experiencing relapses. Most RRMS patients were treated with fingolimod (33.4%), natalizumab (24.5%) or injectable DMDs (13.6%). The SMSC will provide relevant information regarding DMDs efficacy and safety and will serve as a comprehensive infrastructure available for nested research projects

Assessing implementation difficulties in tobacco use prevention and cessation counselling among dental providers

<p>Abstract</p> <p>Background</p> <p>Tobacco use adversely affects oral health. Clinical guidelines recommend that dental providers promote tobacco abstinence and provide patients who use tobacco with brief tobacco use cessation counselling. Research shows that these guidelines are seldom implemented, however. To improve guideline adherence and to develop effective interventions, it is essential to understand provider behaviour and challenges to implementation. This study aimed to develop a theoretically informed measure for assessing among dental providers implementation difficulties related to tobacco use prevention and cessation (TUPAC) counselling guidelines, to evaluate those difficulties among a sample of dental providers, and to investigate a possible underlying structure of applied theoretical domains.</p> <p>Methods</p> <p>A 35-item questionnaire was developed based on key theoretical domains relevant to the implementation behaviours of healthcare providers. Specific items were drawn mostly from the literature on TUPAC counselling studies of healthcare providers. The data were collected from dentists (n = 73) and dental hygienists (n = 22) in 36 dental clinics in Finland using a web-based survey. Of 95 providers, 73 participated (76.8%). We used Cronbach's alpha to ascertain the internal consistency of the questionnaire. Mean domain scores were calculated to assess different aspects of implementation difficulties and exploratory factor analysis to assess the theoretical domain structure. The authors agreed on the labels assigned to the factors on the basis of their component domains and the broader behavioural and theoretical literature.</p> <p>Results</p> <p>Internal consistency values for theoretical domains varied from 0.50 ('emotion') to 0.71 ('environmental context and resources'). The domain environmental context and resources had the lowest mean score (21.3%; 95% confidence interval [CI], 17.2 to 25.4) and was identified as a potential implementation difficulty. The domain emotion provided the highest mean score (60%; 95% CI, 55.0 to 65.0). Three factors were extracted that explain 70.8% of the variance: motivation (47.6% of variance, α = 0.86), capability (13.3% of variance, α = 0.83), and opportunity (10.0% of variance, α = 0.71).</p> <p>Conclusions</p> <p>This study demonstrated a theoretically informed approach to identifying possible implementation difficulties in TUPAC counselling among dental providers. This approach provides a method for moving from diagnosing implementation difficulties to designing and evaluating interventions.</p