Comparison of mucosal and mucoperiosteal wound cover for the treatment of medication-related osteonecrosis of the jaw lesions: a retrospective cohort study.

OBJECTIVES: Actually, there is no detailed guidance on how to deal with wound closure after surgical removal of medication-related osteonecrosis of the jaw (MRONJ) lesions. This study attempts to compare the difference in outcome between the mucosal and the mucoperiosteal flap closure after surgery. PATIENTS AND METHODS: In this retrospective monocentric cohort study, patients (n = 61; 35 female/26 male) suffering from MRONJ and requiring surgical therapy at the University of Aachen between 2013 and 2015 were included. Due to intra-institutional variances, one group was treated with the mucosal, the other group with the mucoperiosteal technique. The success rate, i.e., mucosal closure and no relapse at the point of follow-up, was evaluated and compared. All patients were clinically investigated for the postoperative follow-up during a special consultation appointment. RESULTS: The success rates between the different techniques after 2 years follow-up were very similar. In the group of mucosal wound closure, 22 of 29 (75.86%) patients revealed mucosal integrity without signs of MRONJ. The rate in the mucoperiosteal wound closure group was almost identical (24 of 32 (75%)). CONCLUSION: No differences in the success rates between the two different techniques could be evaluated. CLINICAL RELEVANCE: The results of this study suggest that the complete removal of the necrotic bone might have a higher impact on the success rates than the technique of the wound closure. Due to the fact that the mucoperiosteal wound closure technique offers a better overview of the extent of the MRONJ lesion, the authors advise to use this technique.

Neuropattern: a new translational tool to detect and treat stress pathology I. Strategical consideration.

Translational research is most prominently represented by the search for biomarkers and preclinical research. Aside from generating such new measures and methodologies, translational research additionally refers to translation of integrated knowledge. This strategy involves synthesis, exchange, and dissemination of available knowledge, with the goal of improving health services and health care systems. For stress-related disorders, such as depression and anxiety disorders, this strategy meets numerous challenges, as the great majority of these patients are treated by family physicians. Here, we introduce Neuropattern, a new diagnostic tool, which allows translation of psychobiological knowledge to this stress "bedside." Neuropatterns are conceptualized endophenotypes of the activity and reactivity status of neurobiological interfaces, which participate in the crosstalk between the brain and peripheral organs under stressful conditions. Neuropattern can easily be implemented in routine clinical work, and helps the physician to individualize those therapeutic interventions that are already available.

[The quality of diagnostic classification using abridged versions of the tinnitus questionnaire: comparative analysis]. / Diagnostische Klassifikationsgüte von Kurzversionen des Tinnitus-Fragebogens : Vergleichende Analyse.

BACKGROUND: There are different abridged versions of the tinnitus questionnaire (TQ) and reference values for grading tinnitus-related distress, the diagnostic value of which is unclear, as is the relation of sensitivity to specificity, as well as positive and negative predictive values. The present study is aimed at clarifying these issues and at benchmarking the existing abridged TQ versions. PATIENTS AND METHODS: TQ data from 209 outpatients who had tinnitus for a period of at least 4 months were collected at the beginning of treatment. The rate of correct severity ratings, the quality of making a distinction between (extremely) severe and compensated/moderate tinnitus (area-under curve under the receiver-operating-characteristics curve, and rate of correct classifications), as well as positive and negative predictive values were calculated. RESULTS: Applying unspecific reference values (independent of inpatient/outpatient status), the most favourable evaluation was achieved by the shortest TQ version (10 items). With the 12-item version (mini-TQ), better classification was achieved when reference values specific for outpatients were applied instead of unspecific values.

[Distraction and relaxation training in acute tinnitus : effects of a complement to otorhinolaryngological treatment]. / Ablenkungs- und Entspannungstraining bei akutem Tinnitus : Effekte einer Ergänzung HNO-ärztlicher Behandlung.

BACKGROUND: We examined whether training conceptualized as a complement to standard medical treatment (ST) for acute tinnitus to promote patients' capacity to distract attention from their tinnitus and to relax (distraction and relaxation training) has a positive effect on tinnitus-specific distress (tinnitus loudness, tinnitus-related distress and disability), as well as on general well-being. PATIENTS AND METHODS: Study participants comprised 29 patients with tinnitus of maximum 4 weeks' standing (first lifetime tinnitus episode) who were randomized to ST (rheological therapy) or advanced standard treatment (AST) (rheological therapy complemented by distraction and relaxation training). RESULTS: Tinnitus-specific distress was reduced to a significantly greater extent in the EST group as compared to ST, especially in patients with a striking psychopathology. The improvement in general well-being was comparable in both groups. CONCLUSION: In acute tinnitus, distraction and relaxation training should be conducted as a complement to standard medical treatment, especially in high-risk patients demonstrating abnormal psychopathological status, since treatment results can be improved in this way.

How to determine whether conceptual endophenotypes can improve clinical outcomes in patients suffering from major depression: An exploratory approach.

Depression is a complex mental health disorder, resulting in a high degree of disability. Since symptom constellation, course, and outcome are heterogeneous in these patients, current research initiatives are striving to establish stratified diagnostic and treatment approaches. In the past two decades, Dirk Hellhammer and his team introduced Neuropattern, a new diagnostic concept, which is based on conceptual endophenotypes of the stress response network. We explore how to use this concept in clinical practice in order to ultimately determine whether it brings any value over standard care. In view of the novelty of the concept and the difficulties dealing with such a concept at a practical level, it was necessary to initiate an exploratory study to determine key factors for planning future clinical trials. We report results and knowledge gained from an exploratory single-site study investigating the use and potential benefits of Neuropattern in standard care. Inpatients (ICD-10 diagnosis F32, F33; Nö=ö178) were allocated to either treatment as usual (standard group, SG) or a novel Neuropattern oriented exploratory treatment (intervention group, IG). Symptom severity was assessed with psychometric tests at admission to hospital, during the first six weeks, and upon discharge from the hospital. In addition, direct and indirect costs were assessed for the 3-month-intervals prior to and after the hospital stay. Compared to the SG, depression scores of patients in the IG showed a faster decline once psychotherapeutic and pharmacological treatment were based on an individualized explanatory model. The patients in the IG with an F33 diagnosis showed a more pronounced reduction of depression severity during the stay in the hospital and a stronger and quicker reduction of general symptom severity. Comparing the average depression scores at the start of the study and after six weeks, symptom severity was reduced in all Neuropattern groups. Some limitations of the study have to be mentioned: The study was not blinded, was single-site, included highly depressed inpatients only, and was conducted for no longer than 8 months. The results highlight some important issues regarding taking the Neuropattern approach to the bedside and researching its efficacy and effectiveness to support personalized treatments in clinical care.

Reliability and validity studies of the Facial Discrimination Task for emotion research.

The Facial Discrimination Task (FDT) (Erwin, R.J., Gur, R.C., Gur, R. E., Skolnick, B., Mawhinney-Hee, M., Smailis, J., 1992. Facial emotion discrimination: I. Task construction and behavioural findings in normal participants. Psychiatry Research 42, 231-240.) consists of standardized black-and-white photographs of Caucasian actors exhibiting happy, sad, and neutral faces. Originally designed for brain-imaging research in emotion recognition in schizophrenia and major depression, it has since been successfully employed in emotion recognition studies on mental retardation and psychosomatic disorders. This article presents new basic psychometric data from three studies with a total of 401 college undergraduates. Content validity, item reliability (test-retest, item-total correlation, item difficulty) and test reliability (internal consistency) were established. Happy and sad items were easier to agree upon than neutral ones. In general, happy items had the highest validity, highest test-retest reliability, and highest item-total correlations. Recognition errors of neutral items were biased toward negative affect. Advantages and limitations of the FDT for clinical research applications are discussed.

Sealing ability of five different retrograde filling materials.

The sealing ability of Amalgam, Harvard-Cement, Diaket, gold-leaf, and Ketac-Endo as retrofilling materials was investigated. Paper cones were fixed with Harvard-Cement in the instrumented roots of 100 extracted human incisors. Apicectomy was performed and a 2-mm-deep retrograde cavity was prepared. Teeth were assigned to five groups (n = 20); each group received a different filling material. Surfaces of the roots were isolated with nail polish. Teeth, were stored in 1% methylene blue dye for 72 h. Roots were sectioned, and the depth of dye penetration was evaluated through a stereomicroscope. Retrofills with Ketac-Endo showed significantly less leakage compared with amalgam. There was no significant difference between the amalgam and Diaket groups. The sealing ability of Harvard-Cement and gold foil was lower than amalgam. It was concluded that retrograde fillings with Ketac-Endo or Diaket can be considered as alternatives for amalgam.

Pathological fractures of the mandible. A review of the etiology and treatment.

A retrospective study was undertaken to analyse the etiology, site and treatment procedures of 30 pathological fractures of the mandible. Fifty percent of the fractures had an inflammatory cause. The remaining cases were associated with severe atrophy of edentulous mandibles (4), benign tumours (3), cysts (3), and primary or secondary malignancies (5). Regardless of the cause, the majority of the fractures occurred in the body of the mandible. Pathological fractures of the mandible most often have to be treated by eliminating the cause of the underlying condition while immobilizing the fragments either with osteosynthesis or archbars and intermaxillary fixation.

Decoding of facially expressed emotions in patients with psychosomatic gastrointestinal disorders.

The hypothesis that individuals with psychosomatic conditions are lacking in empathy was tested by investigating decoding abilities of facially expressed emotions. Fourteen subjects with psychosomatic gastrointestinal disorders and 14 matched controls participated. Slides of one male and one female model's facial expressions of anger, disgust, fear, happiness, sadness, and surprise, and a neutral face, were presented to subjects, with exposure durations of 1/60, 1/15, and 4 seconds. Subjects had to decide whether the face presented was neutral or expressed one of the basic emotions. There were no significant group differences in decoding neutral expressions, but significant differences resulted in decoding emotional expressions. This was mainly due to the significantly poorer performance of the psychosomatic group in decoding disgust. Subjects' responding was found to be reliable. The findings show that at least certain subgroups of psychosomatic patients tend to misinterpret another person's facial expressions that signal unpleasantness or interpersonal conflict.

The impact of medical, reeducational, and psychological variables on rehabilitation outcome in amputees.

178 male unilateral above-knee amputees (cause of amputation: war injury or accident) participated in the study. Medical reeducational, social, vocational, and psychological predictor variables as well ad medical, social, vocational, and psychological outcome variables were assessed by means of interviews, expert ratings, questionnaires, and by ratings from the amputees partners. A series of risk factors for poor rehabilitation was specified by means of discriminant and correlational analyses. Optimization of medical/reeducational care, helping the amputee to gain insight into the necessity of amputation, making available to him a person to confide in with personal problems, and helping him to overcome social withdrawal seem to be the most important measures to prevent poor rehabilitation outcome.

[Motivation and proposals for revising the stock trading law]. / Begründung und Vorschläge zur Neuordnung des Viehkaufrechts.

The German stock-trading law is a special statute that has been put into effect at the end of the last century (sections 482-492 BGB, i.e. civil code, and Kaiserliche Verordnung, i.e. imperial regulation). It promotes agricultural interests and contains guarantees which are out-of-date. This state had led to serious irritabilities with the general law of trade (sections 459-480 BGB). The difference in legal treatment of persons buying stock (i.e. equines, cattle, sheep and swine) or those buying other animals (e.g. dogs, cats, poultry) seems to be unsupportable any longer. For this reason the constitutional principle of equality in legal matters (section 3.1, German constitution) will be used and interpreted as a motivation for the importance to revise the antiquated stock-trading law.

Subjective stress sensitivity and physiological responses to an aversive auditory stimulus in migraine and control subjects.

Subjective stress sensitivity and physiological parameters were compared between 24 migraine subjects and 24 matched headache-free controls during a multifrequency 85-dB (A) aversive auditory stressor and during a recovery period. Measures consisted of frontalis EMG, temporal artery blood volume pulse, heart rate, a stress sensitivity questionnaire, stress reaction during the stress-expectation period, and ratings of noise aversiveness. Migraine subjects showed a higher level of general stress sensitivity, increased situational stress sensitivity, and higher ratings of noise aversiveness; this supports the general notion that migraine sufferers are psychologically more sensitive toward stress stimulation than nonheadache controls. Physiologically, the migraine subjects differed from the control group only with regard to the temporal blood volume pulse during stress stimulation; this finding is consistent with Wolff's weak-link theory.

[Aberrant salivary gland tissue in differential diagnosis of branchiogenic neck cyst]. / Aberrantes Speicheldrüsengewebe in der Differentialdiagnose branchiogener Halszysten.

A neck fistula next to the sternocleidomastoid muscle is suspicious of a branchial origin. Here we report on a 29-year-old patient with a discharging cutaneous orifice caused by an ectopic salivary gland. The clinical and histological findings are demonstrated and discussed with reference to the literature. Surgical removal of ectopic salivary gland tissue is the treatment of choice. However, surgery is limited in extent compared to surgical removal of a branchial fistula. Our case demonstrates that an ectopic salivary gland should be considered in the differential diagnosis of a branchial fistula.

[Attention diversion in tinnitus therapy. Comparison of the effects of different treatment methods]. / Aufmerksamkeitslenkung in der Tinnitustherapie. Vergleich von Effekten unterschiedlicher Behandlungsmethoden.

BACKGROUND: Diversion or distraction of auditory attention is a core principle of tinnitus retraining therapy as introduced by P. Jastreboff and J. Hazell. The aim of this study was to evaluate the effectiveness of a different form of attention diversion in tinnitus therapy. METHODS AND PATIENTS: In a prospective and randomized study, 40 patients suffering from chronic tinnitus were assigned to two different groups, A or B. All patients received appropriate counselling and were instructed in relaxation training. Patients in group A learned to distract attention away from the tinnitus by using sound or music. White noise generators or hearing aids were applied in this group. Patients in group B were instructed to direct their attention away from the tinnitus using imagination that was facilitated by the use of light and warmth stimuli as distracters. Different standardized questionnaires were used for an evaluation of therapy effectiveness. RESULTS: In both groups, patients were significantly less annoyed and disabled by their tinnitus immediately after therapy and after 6 months. Tinnitus annoyance still proved to be reduced 1 year after the end of the therapy. There were no significant differences in the effects of each treatment. CONCLUSIONS: Attention diversion is an important method for decreasing tinnitus-related distress. Patients should be instructed to use not only auditory but also visual and thermal sensations in order to distract attention away from their tinnitus.

Retraining therapy for chronic tinnitus. A critical analysis of its status.

Tinnitus retraining therapy (TRT), as conceived of mainly by PJ Jastreboff, has recently received increasing attention in the media, as well as in seminars and congresses on treatment methods for chronic tinnitus. It is often claimed, though not explicitly in scientific publications, that TRT is currently the most efficacious therapy for tinnitus, obtaining improvement rates exceeding 80%. This assertion is highly significant in light of the most likely increasing prevalence of chronic tinnitus and ensuing urgent demand for effective therapies. Before examining the evidence regarding the effectiveness of TRT, Jastreboff's theoretical idea of tinnitus as a neurophysiological disorder is examined and evaluated. This idea is plausible and is supported by some evidence. The interaction between neuroacoustic and emotional processes emphasized by Jastreboff is, however, neither new nor sufficiently elaborated with respect to the underlying psychological factors. The TRT intervention technique and its main components 'directive counselling' and use of 'noise generators' are found to be theoretically well grounded. The lack of detailed information concerning TRT implementation and the potential consequence that differing interventions may be labelled TRT are criticized. Jastreboff's obvious opposition to psychologists' participation in TRT, despite the increase in efficacy they could affect through utilization of cognitive restructuring techniques and behaviour modification interventions, is also criticized. Finally, studies regarding the efficacy of TRT are reviewed and severe methodological shortcomings (e.g. lack of controlled randomized group studies) in TRT research are noted. Taking the current state of evidence into account, we conclude that there is no convincing empirical support for the assumption that TRT is superior to other treatments, since no comparative studies have been conducted. It is contended that there is more substantial empirical support for the efficacy of cognitive-behavioural interventions in reducing tinnitus annoyance and tinnitus-related suffering. The necessity for methodologically well-designed studies to pinpoint effect sizes of TRT and compare them with other techniques, especially cognitive-behavioural ones, is emphasized.