Search

The aim of this systematic review was to compare patient-reported outcomes after harvesting calvarial or anterior iliac crest bone grafts to repair severe jaw defects and enable implant placement. The MEDLINE, Embase, Cochrane Central Register of Controlled Trials databases, and OpenGrey were searched for studies on patient satisfaction, pain, disturbances in daily functioning, sensory alterations, donor site aesthetics, and complication rates. Of the 1946 articles identified, 43 reporting 40 studies fulfilled the inclusion criteria; the studies were one randomized controlled clinical trial, one retrospective controlled clinical trial, and 23 prospective and 15 retrospective cohort studies. A meta-analysis of two studies (74 patients) showed no difference in satisfaction (mean difference (MD) - 0.13, 95% confidence interval (CI) - 1.17 to 0.92; P = 0.813) or postoperative pain (directly postoperative: MD -2.32, 95% CI -5.20 to 0.55, P = 0.113; late postoperative: MD -0.01, 95% CI -0.14 to 0.11, P = 0.825) between donor sites. However, the level of evidence is limited, due to the retrospective, non-randomized design of one study. Postoperative gait disturbances were highly prevalent among the anterior iliac crest patients (28-100% after 1 week). The incidence rates of sensory disturbances and other complications were low, and the donor site aesthetic outcomes were favourable for both graft types. To conclude, harvesting bone grafts from the calvarium or anterior iliac crest to augment the severely resorbed edentulous jaw results in similar patient satisfaction. However, the findings for postoperative pain and disturbances in daily living suggest a trend in favour of calvarial bone grafts if harvested using an adjusted technique.

Purpose The purpose of this first-in-human study was to evaluate the effect of a polycarbonate anatomical meniscus prosthesis system, including the surgical procedure, on knee pain and describe potential adverse events in patients with post-meniscectomy pain syndrome. Methods Eleven patients with post-meniscectomy pain syndrome and limited underlying cartilage damage were enrolled in the study. Five received a medial polycarbonate urethane meniscus prosthesis which was clicked onto 2 titanium screws fixated at the native horn attachments on the tibia. The KOOS score was planned to be collected at baseline and at 3, 6, 12 and 24 months following the intervention including radiographs at 6, 12 and 24 months. MRI scans were repeated after 12 and 24 months. Results The surgical technique to select an appropriately sized implant and correct positioning of the fixation screws and meniscus prosthesis onto the tibia was demonstrated to be feasible and reproducible. Inclusion stopped after 5 patients because of serious adverse device-related events. All patients reported knee joint stiffness and slight effusion in their knee at 6 months follow-up. In 3 patients the implant was removed because of implant failure and in 1 patient the implant was removed because of persistent pain and extension limitation. In none of the patients did the KOOS score improve in the first 6 months after surgery. However, in the patient who still has the implant in situ, PROMs started to improve 1 year after surgery and this improvement continued through 2 years of follow-up. The KOOS Pain, symptoms and ADL were close to the maximal 100 points. KOOS QoL and sport did improve but remained suboptimal. Conclusion This first version of the meniscus prosthesis led to impaired knee function and failed in four out of five patients. The patients where the prosthesis was removed were salvable and the PROMs returned to pre-study levels. The results in the patient where the device is still in place are promising. Level of evidence Level II.

The aim of this study was to perform a systematic review of the literature on the temporomandibular joint (TMJ) prosthesis as a treatment option after mandibular condyle fracture. Three databases were searched (PubMed, Embase, Cochrane Library) and 2670 unique papers were identified. A total of 337 studies were included (121 case reports, 89 case series, and 127 cohort/clinical studies). In total 14,396 patients and 21,560 prostheses were described. Of the 127 cohort or clinical studies, 100 (79%) reported inclusion criteria, 54 (43%) reported exclusion criteria, and 96 (76%) reported the inclusion period. The base population from which patients were recruited was reported in 57 studies (45%). The reason for TMJ prosthesis implantation was reported for 4177 patients (29.0%). A history of condylar fracture was present in 83 patients (2.0%); a history of mandibular trauma was present in 580 patients (13.9%). The meta-analysis showed a pooled prevalence of condylar fracture of 1.6% (95% confidence interval 0.9-2.4%) and a pooled prevalence of trauma or condylar fracture of 11.3% (95% confidence interval 7.1-16.0%). Heterogeneity was highly significant (P < 0.001). The TMJ prosthesis appears to be reserved for patients with persistent pain, bony or fibrous ankylosis, or osteomyelitis after primary closed or open treatment of fractures of the mandibular condyle.

Discussion of the various poll tax rates in Roman Egypt, which can be reduced to a simple scheme drawn up by the Romans upon their conquest of Egypt. This scheme suggests that in 30 BC the distribution of the population in Egypt was roughly uniform except for the Fayyum (underpopulated) and the western oases (overpopulated), possibly also Thebes (overpopulated). It also suggests that in 30 BC the distribution of the Greek population was uneven, with virtually no Greeks in Upper Egypt, possibly also the oases, and fewer Greeks in Oxyrhynchus than in other metropoleis in Lower and Middle Egypt.

Purpose: Several limited midcarpal arthrodeses have been used in the treatment of midcarpal osteoarthritis as part of scapholunate advanced collapse and scaphoid nonunion advanced collapse. There is no consensus on whether two-carpal arthrodesis (2CA), three-carpal arthrodesis (3CA), bicolumnar arthrodesis, or four-carpal arthrodesis (FCA) results in the best outcomes. The objective of this study was to determine whether there is a difference in outcomes in patients undergoing FCA, 3CA, 2CA, or bicolumnar arthrodesis for midcarpal osteoarthritis. Methods: A systematic review and meta-analysis were performed in multiple databases following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies reporting the four surgical techniques were included. The primary outcomes were postoperative visual analog scale pain score, the Disabilities of the Arm, Shoulder, and Hand score, and the Mayo Wrist Score. The secondary outcomes were active range of motion, grip strength, and reported complications. Results: Of 2,270 eligible studies, 80 articles were selected, including a total of 2,166 wrists. The visual analog scale pain scores for both the 2CA and FCA groups reached an adequate pain reduction based on the Patient Acceptable Symptom Scale. The Disabilities of the Arm, Shoulder, and Hand score was also comparable between these two groups. The 2CA group also showed a significantly better active range of motion than the FCA group for both flexion-extension and radioulnar deviation arc. The incidence of nonunion was 6.9% in the FCA group compared with 10.0% in the 2CA group. Conclusions: Although the 2CA procedure has a theoretical advantage over the FCA method, the analysis of data showed that generally, these techniques have similar outcomes and complications. Therefore, both (2CA and FCA) are good options for midcarpal osteoarthritis in scapholunate advanced collapse and scaphoid nonunion advanced collapse wrists. Type of study/level of evidence: Therapeutic IV.

Purpose To assess the diagnostic accuracy of physical examination findings and to construct clinical decision aids to discern emergency department patients without and with midfacial and mandibular fractures that require treatment. Methods A prospective multicentre cohort study was conducted in four hospitals in the Netherlands. Consecutive maxillofacial trauma patients were included whereupon each patient underwent a standardized physical examination consisting of 15 and 14 findings for midfacial and mandibular trauma, respectively. The primary outcome was the decision whether to treat during the emergency department stay or within 24 h of admission. The diagnostic accuracy was calculated for the individual physical examination findings and ensuing clinical decision aids with the focus being on detecting midfacial and mandibular fractures that require active treatment. Results A total of 766 midfacial trauma patients were identified of whom 339 (44.3%) had midfacial fractures. Of those, 74 (21.8%) required active treatment. A total of 280 mandibular trauma patients were identified of whom 66 (23.6%) had mandibular fractures. Of those, 37 (56.0%) required active treatment. The decision aid for midfacial trauma consisting of facial depression, epistaxis, ocular movement limitation, palpable step-off, objective malocclusion and tooth mobility or avulsion had a sensitivity of 97.3 (90.7–99.3), a specificity of 38.6 (35.0–42.3), and a negative predictive value of 99.3 (97.3–99.8). The decision aid for mandibular trauma consisting of mouth opening limitation, jaw movement pain, objective malocclusion and tooth mobility or avulsion resulted in a sensitivity of 100.0 (90.6–100.0), a specificity of 39.1 (33.2–45.4), and a negative predictive value of 100.0 (96.1–100.0). Conclusion The clinical decision aids successfully identified midfacial and mandibular trauma patients requiring active fracture treatment and so may be useful in preventing unnecessary radiological procedures in the future. Trial Registration The study was registered at ClinicalTrials.gov with the identifier NCT03314480.

PURPOSE: With the increased use of both e-bike and conventional bicycle, the number of bicycle-related accidents has increased accordingly. To determine whether there are differences in maxillofacial injuries between these 2 types of bicycle accidents, e-bike and conventional bicycle accidents were compared.MATERIAL AND METHODS: A retrospective cohort study was conducted for all the consecutive patients with maxillofacial injury due to e-bike and conventional bicycle accidents attending the emergency department of 4 hospitals in the Netherlands between May 2018 and October 2019. Primary outcomes are maxillofacial fractures present or absent and the severity of maxillofacial injury using the Maximum Abbreviated Injury Scale and Facial Injury Severity Scale (FISS) after e-bike and conventional bicycle accidents. A binary logistic regression analysis was used to assess differences in risk between an e-bike and conventional bicycle accident, where age, alcohol use, and comorbidities were added as covariates, for maxillofacial fractures, dental injury, and severe maxillofacial fractures.RESULTS: In total, 311 patients were included (73 e-bikers and 238 conventional cyclists). Sex distribution was equal in both groups (45% male vs 55% female). The e-bike group was older (66 vs 53 median age in years, P < .001) and had more comorbidities (0 vs 1, P < .001), while alcohol use was higher in the conventional bicycle group (32% vs 16%, P = .008). e-Bikers sustained midfacial fractures more frequently (47% vs 34%, P = .04), whereas conventional cyclists more often had mandibular fractures (1% vs 11%, P = .01). Although median Maximum Abbreviated Injury Scale and FISS scores did not differ between e-bike and conventional bicycle accidents, severe maxillofacial fractures (FISS score ≥ 2) were observed more often in the conventional cyclists (45% vs 25%, P = .04). No significant differences in risk of midfacial, mandibular, and severe maxillofacial fractures were found between e-bikers and conventional cyclists irrespective of their age, alcohol use, and comorbidities.CONCLUSION: Both the distribution and the severe maxillofacial fractures differed between the e-bike and conventional bicycle accident patients. Patient-specific characteristics, such as age, alcohol use, and comorbidities, may have a greater influence on sustaining maxillofacial fractures than the type of bicycle ridden.

Background Exposure-based therapy is the treatment of choice for anxiety disorders, but many patients do not benefit sufficiently from it. Distressing images of threat related to the future or past may maintain the anxiety symptomatology or impede exposure therapy. An intervention that targets threat-related imagery is eye movement desensitization and reprocessing (EMDR) therapy. The main goal of this multicenter randomized controlled trial is to investigate whether EMDR therapy plus exposure therapy, relative to supportive counseling plus exposure therapy, improves treatment efficacy, tolerability, and adherence in patients with panic disorder. In addition, we will examine potential predictors of optimal treatment allocation, mechanisms of change as well as the long term effects of treatment. Finally, we will assess cost-effectiveness. Methods A multicenter randomized controlled trial mixed design will be conducted. Participants will be 50 patients, aged ≥ 18, diagnosed with a panic disorder. They will be randomly assigned to one of two conditions: EMDR therapy (i.e., flashforward strategy) or supportive counseling (each consisting of four weekly sessions of 90 min each) prior to exposure therapy (consisting of eight weekly sessions of 90 min each). Assessments will be made pre-treatment (T1), between-treatments (T2), post-treatment (T3), one month post-treatment (FU1) and six months post-treatment (FU2) by an assessor blind to treatment condition. The primary outcome measure is severity of panic-related symptoms. Secondary outcome measures are: tolerability of exposure therapy (initial avoidance, willingness to start exposure therapy, considered drop-out; no-show and drop-out), related symptomatology (generalized anxiety, depression), and functional impairment. Discussion The primary goals of this research are to compare the efficacy, tolerability, and adherence of EMDR therapy plus exposure therapy and supportive counseling plus exposure therapy and to identify predictors, moderators, and mediators for treatment success. This multi-center research aims to make a significant contribution to our understanding as to how treatment for patients with anxiety disorders can be optimized, and elucidate who can benefit most from this novel approach. Trial registration ISRCTN—ISRCTN29668369: Improving anxiety treatment by modifying emotional memories before real-life exposure. Registered 27 June 2022—retrospectively registered. ISRCTN—ISRCTN29668369.

The structural similarity index metric is used to measure the similarity between two images. The aim here was to study the feasibility of this metric to measure the structural similarity and fracture characteristics of midfacial fractures in computed tomography (CT) datasets following radiation dose reduction, iterative reconstruction (IR) and deep learning reconstruction. Zygomaticomaxillary fractures were inflicted on four human cadaver specimen and scanned with standard and low dose CT protocols. Datasets were reconstructed using varying strengths of IR and the subsequently applying the PixelShine™ deep learning algorithm as post processing. Individual small and non-dislocated fractures were selected for the data analysis. After attenuating the osseous anatomy of interest, registration was performed to superimpose the datasets and subsequently to measure by structural image quality. Changes to the fracture characteristics were measured by comparing each fracture to the mirrored contralateral anatomy. Twelve fracture locations were included in the data analysis. The most structural image quality changes occurred with radiation dose reduction (0.980036±0.011904), whilst the effects of IR strength (0.995399±0.001059) and the deep learning algorithm (0.999996±0.000002) were small. Radiation dose reduction and IR strength tended to affect the fracture characteristics. Both the structural image quality and fracture characteristics were not affected by the use of the deep learning algorithm. In conclusion, evidence is provided for the feasibility of using the structural similarity index metric for the analysis of structural image quality and fracture characteristics.

Background New intensive trauma-focused treatment (TFT) programmes that incorporate physical activity have been developed for people with post-traumatic stress disorder (PTSD). However, the unique contribution of physical activity within these intensive TFT programmes has never been investigated in a controlled manner. Objectives This randomized controlled trial will investigate the effectiveness of physical activity added to an intensive TFT programme. In addition, the study aims to investigate the underlying mechanisms of the effects of physical activity on the change in PTSD symptoms. Methods Individuals with PTSD (N = 120) will be randomly allocated to two conditions: a physical activity or a non-physical active control condition. All participants will receive the same intensive TFT lasting eight days within two consecutive weeks, in which daily prolonged exposure and EMDR therapy sessions, and psycho-education are combined. The amount of physical activity will differ per condition. While the physical activity condition induces daily physical activities with moderate intensity, in the non-physical active control condition no physical activity is prescribed; but instead, a controlled mixture of guided (creative) tasks is performed. The two primary outcome measures are change in PTSD symptoms from pre- to post-treatment and at six months follow-up, measured with the Clinician-Administered PTSD Scale (CAPS-5), and the PTSD Checklist for DSM-5 (PCL-5). Additionally, self-reported sleep problems, depressive symptoms, emotion regulation, dissociation symptoms and anxiety sensitivity will be measured as potential underlying mechanisms. Conclusions This study will contribute to the research field of augmentation strategies for PTSD treatment by investigating the effectiveness of physical activity added to intensive TFT. Trial registration This trial is registered in the Netherlands Trial Register (Trial NL9120)., HIGHLIGHTS This study will be the first to determine the effectiveness of physical activity as add-on to an intensive TFT programme, and to investigate the underlying mechanisms of the effects of physical activity on the treatment-related change in PTSD symptoms.

Zusammenfassung. Theoretischer Hintergrund: Der Sprachstand von Kindern im Kindergarten-Alter ist prädiktiv für ihre späteren Schulleistungen. Fragestellung: Untersucht wurde, wie sich der Sprachstand monolingual deutscher Kinder von 2009 bis 2019 entwickelte. Methode: Zwei Stichproben vierjähriger Kinder wurden mit dem Sprachtest „Kindersprachscreening“ (KiSS.2) untersucht und in Bezug auf metrische (Punktzahlen) und dichotomisierte (pass/fail) Ergebnisse einander gegenüber gestellt. Die erste Stichprobe ( n = 698) entstammt dem Zeitraum 2009 – 2012, die zweite ( n = 732) 2017 – 2019. Ergebnisse: Der Sprachstand verringerte sich signifikant in den KiSS.2-Untertests, dennoch blieben die dichotomisierten KiSS.2-Ergebnisse stabil. Die Mehrheit der sprachauffälligen Kinder war weder sprachpädagogisch noch therapeutisch versorgt. Diskussion und Schlussfolgerung: Um die negative Entwicklung der letzten Jahre zu nivellieren, sind flächendeckende Sprachstandserfassung und Sprachfördermaßnahmen erforderlich.

Background: Research indicates that intensive trauma-focused therapy can be effective in alleviating symptoms of post-traumatic stress disorder (PTSD) and borderline personality disorder (BPD). However, these studies have relied on self-report of BPD symptoms and follow-up data are scarce. Objective: The purpose of this feasibility study was to determine the effects of an intensive trauma-focused treatment programme on the severity of PTSD and BPD symptoms and the diagnostic status up to a 12-month follow-up. Methods: A total of 45 (60% female) individuals meeting the diagnostic criteria of both PTSD and BPD participated in an intensive eight-day trauma-focused treatment programme which combined prolonged exposure and EMDR therapy in an inpatient treatment setting. Severity of PTSD and BPD symptoms were assessed at pre-treatment, post-treatment, 6 months, and 12 months after treatment (CAPS-5, BPDSI-IV). Diagnostic status was determined using clinical interviews (CAPS-5 and SCID-5-P) at pre-treatment and 12-month follow-up. Results: Of all participants, 93.3% had been exposed to physical abuse, and 71.1% to sexual abuse prior to the age of 12 years. PTSD and BPD symptom severity significantly decreased from pre- to post-treatment (Cohen's ds: 1.58 and 0.98, respectively), and these results were maintained at 6- (ds: 1.20 and 1.01) and 12-month follow-up (ds: 1.53 and 1.36). Based upon CAPS-5, 69.2% no longer met the diagnostic criteria of PTSD at 12-month follow-up, while according to the SCID-5-P 73.1% no longer fulfilled the diagnostic criteria of BPD at that time. No significant worsening of symptoms occurred. Conclusion: The findings of this study, which is the first to examine the effects of psychotherapeutic treatment of PTSD on the presence of a borderline personality disorder one year after treatment, add support to the notion that a brief intensive trauma-focused treatment can be a valuable option for individuals suffering from both PTSD and BPD.

Background: It is unknown whether remotely delivered intensive trauma-focused therapy not only is an effective treatment for PTSD, but also for Complex PTSD. Objective: Testing the hypothesis that a brief, fully remotely administered intensive trauma-focused treatment programme for individuals with PTSD and Complex PTSD would be safe, and associated with a significant decline of the corresponding symptoms and diagnostic status. Method: The treatment sample consisted of 73 consecutive patients diagnosed with PTSD according to the CAPS-5. According to the ITQ (n = 70) 33 (47.1%) patients also fulfilled the diagnostic criteria of Complex PTSD. The 4-day treatment programme contained a combination of prolonged exposure, EMDR therapy, physical activities and psycho-education. Treatment response was measured using the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5), the PTSD Checklist for DSM-5 (PCL-5), and the International Trauma Questionnaire (ITQ) for classifying Complex PTSD and indexing disturbances in self-organization (DSO). Results: Overall CAPS-5, PCL-5, and ITQ-DSO scores decreased significantly from pre- to post-treatment (Cohen’s ds 2.12, 1.59, and 1.18, respectively), while the decrease was maintained to six months follow-up. At post-treatment, 60 patients (82.2%) no longer met the diagnostic criteria of PTSD, while the proportion of patients with Complex PTSD decreased from 47.1% to 10.1%. No drop out, and no personal adverse events occurred. Conclusions: The results support the notion that intensive, trauma-focused treatment is feasible, safe and associated with a large decrease in PTSD and Complex PTSD symptoms, even when it is brief, and applied fully remote. HIGHLIGHTS Second study to examine the effectiveness of a fully remote intensive trauma-focused treatment for PTSD and Complex PTSD. Significant decrease of DSO symptoms. Over 80 percent of the patients no longer met the diagnostic criteria of PTSD and Complex PTSD following treatment.

Background: Prolonged exposure (PE) is an effective treatment for post-traumatic stress disorder (PTSD). Objective: This study aimed to analyse the cost-effectiveness of three exposure-based treatments in patients with childhood abuse-related PTSD. Method: A net–benefit analysis was conducted alongside a pragmatic randomized controlled trial with participants (N = 149) randomized to three conditions: PE (n = 48), intensified PE (i-PE, n = 51), and phase-based PE [Skills Training in Affective and Interpersonal Regulation (STAIR) + PE, n = 50]. Assessments took place at baseline (T0), post-treatment (T3), 6 month follow-up (T4), and 12 month follow-up (T5). Costs stemming from healthcare utilization and productivity losses were estimated using the Trimbos/iMTA questionnaire for Costs associated with Psychiatric Illness. Quality-adjusted life-years (QALYs) were based on the 5-level EuroQoL 5 Dimensions (EQ-5D-5L) using the Dutch tariff. Missing values of costs and utilities were multiply imputed. To compare i-PE to PE and STAIR + PE to PE, pair-wise unequal-variance t-tests were conducted. Net–benefit analysis was used to relate costs to QALYs and to draw acceptability curves. Results: Intervention costs did not differ across the three treatment conditions. Total medical costs, productivity losses, total societal costs, and EQ-5D-5L-based QALYs did not differ between treatment conditions either (all p >.10). At the relevant €50,000/QALY threshold, the probability of one treatment being more cost-effective than another was 32%, 28%, and 40% for PE, i-PE, and STAIR-PE, respectively. Conclusion: Three equally effective treatments were compared and no differences in cost-effectiveness between treatments were found. Therefore, we advocate the implementation and adoption of any of the treatments and endorse shared decision making.

In de Ruimtelijke Verkenning 2023 heeft het PBL scenario’s ontwikkeld voor de inrichting van Nederland in 2050. In dit hoofdrapport worden vier mogelijke ruimtelijke toekomsten gepresenteerd. Dat zijn: Mondiaal Ondernemend (een toekomstscenario waarin grote bedrijven de lead hebben), Snelle Wereld (de nog verder toegenomen digitalisering doet afstanden verdwijnen), Groen Land (veel ruimte voor de natuur) en Regionaal Geworteld (burgers nemen het initiatief in hun eigen leefomgeving). Voor elk scenario zijn op basis van ruimtelijke modellering en ontwerpend onderzoek gedetailleerde kaarten van het bijbehorende Nederland van 2050 gemaakt. Deze scenariokaarten brengen in beeld welke gevolgen verschillende keuzes hebben.

For dental anxiety, cognitive behavioral therapy is the treatment of choice and exposure therapy is a major part of this treatment program. This article describes the underlying working mechanism of exposure therapy. Exposure should be directed toward the patient's harm expectancies. Moreover, the patient needs to be ensured that their harm expectation will not be violated, despite being challenged to the maximum. In addition, it is important that patients perform exposure exercises in as many different contexts as possible and to ensure a lot of repetition. Combining different fear-inducing stimuli during exposure sessions is also recommended. Currently, the inhibition model is the best explanatory working mechanism model and this article contrasts the new inhibition model with the older habituation model, that is still often used in clinical practice. The most important clinical implications of the inhibition model are described and illustrated with practical examples.Voor behandelangst is cognitieve gedragstherapie de behandeling van eerste keus, waarvan exposure de belangrijkste component is. Op dit moment is het inhibitiemodel het beste verklarende model achter de werking van exposure. Volgens dit model moet de exposure worden gericht op de gevreesde uitkomsten van de patiënt, waarbij de kans op het uitkomen van die rampverwachting maximaal wordt uitgedaagd. Daarnaast is van belang te oefenen in zo veel mogelijk verschillende contexten en te zorgen voor veel herhaling. Ook het combineren van verschillende angstopwekkende stimuli wordt aangeraden Het inhibitiemodel kan worden afgezet tegen het habituatiemodel, een ouder verklaringsmodel dat nog steeds vaak in de klinische praktijk wordt gebruikt, maar wat inmiddels achterhaald is.

Introduction Many people with psychotic disorders experience symptoms of post-traumatic stress disorder (PTSD). In recent years, several trauma-focused therapies (TFTs), including cognitive restructuring (CR), prolonged exposure (PE), and eye movement desensitization and reprocessing (EMDR) have been studied and found to be safe and effective in reducing PTSD symptoms in individuals with psychosis. However, studies were conducted in different countries, with varying inclusion criteria, therapy duration, control groups, and trial outcomes. RE.PROCESS will be the first study to compare the impact of CR, PE, and EMDR with a waiting list control condition within the same context. Methods and analysis This is the protocol of a pragmatic, single-blind, multicentre, superiority randomized controlled trial, in which CR, PE, and EMDR are compared to a waiting list control condition for TFT (WL) in a naturalistic treatment setting. Inclusion criteria are as follows: age ≥ 16 years; meeting full DSM-5 diagnostic criteria for PTSD on the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5), with a total CAPS score ≥ 23; and a psychotic disorder in the schizophrenia spectrum confirmed by the Structured Clinical Interview for DSM-5 (SCID-5). Participants (N=200) will be randomly allocated to 16 sessions of one of the TFTs or WL, in addition to receiving treatment as usual (TAU) for psychosis. The primary objective is to compare the effects of CR, PE, and EMDR to WL on researcher-rated severity of PTSD symptoms over time from baseline to 6-month follow-up. Secondary objectives are to examine these effects at the separate time-points (i.e., mid-treatment, post-treatment, and at 6-month follow-up) and to test the effects for clinician-rated presence of PTSD diagnosis, and self-rated severity of (complex) PTSD symptoms. Discussion This is the first RCT to directly compare the effects of CR, PE, and EMDR within the same context to TAU on PTSD symptoms in individuals with psychosis and PTSD. Secondary effects on clinical and functional outcomes will be investigated both directly after therapy and long term. Trial registration ISRCTN ISRCTN56150327. Registered 18 June 2019.

bBackground:/bIt is unknown whether remotely delivered intensive trauma-focused therapy not only is an effective treatment for PTSD, but also for Complex PTSD.bObjective:/bTesting the hypothesis that a brief, fully remotely administered intensive trauma-focused treatment programme for individuals with PTSD and Complex PTSD would be safe, and associated with a significant decline of the corresponding symptoms and diagnostic status.bMethod:/bThe treatment sample consisted of 73 consecutive patients diagnosed with PTSD according to the CAPS-5. According to the ITQ (in /i= 70) 33 (47.1%) patients also fulfilled the diagnostic criteria of Complex PTSD. The 4-day treatment programme contained a combination of prolonged exposure, EMDR therapy, physical activities and psycho-education. Treatment response was measured using the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5), the PTSD Checklist for DSM-5 (PCL-5), and the International Trauma Questionnaire (ITQ) for classifying Complex PTSD and indexing disturbances in self-organization (DSO).bResults:/bOverall CAPS-5, PCL-5, and ITQ-DSO scores decreased significantly from pre- to post-treatment (Cohen'sids/i2.12, 1.59, and 1.18, respectively), while the decrease was maintained to six months follow-up. At post-treatment, 60 patients (82.2%) no longer met the diagnostic criteria of PTSD, while the proportion of patients with Complex PTSD decreased from 47.1% to 10.1%. No drop out, and no personal adverse events occurred.bConclusions:/bThe results support the notion that intensive, trauma-focused treatment is feasible, safe and associated with a large decrease in PTSD and Complex PTSD symptoms, even when it is brief, and applied fully remote.bHIGHLIGHTS/bSecond study to examine the effectiveness of a fully remote intensive trauma-focused treatment for PTSD and Complex PTSD.Significant decrease of DSO symptoms.Over 80 percent of the patients no longer met the diagnostic criteria of PTSD and Complex PTSD following treatment.bAntecedentes:/bSe desconoce si la terapia centrada en el trauma intensiva entregada remotamente no es solo un tratamiento efectivo para el TEPT, sino que también para el TEPT Complejo.bObjetivo:/bTestear la hipótesis de que un programa de tratamiento centrado en el trauma para individuos con TEPT y con TEPT Complejo, intensivo, administrado completamente de forma remota y breve es seguro, y se asocia con una disminución significativa de los síntomas correspondientes y el cambio del estado diagnóstico.bMétodo:/bLa muestra del tratamiento consistió en 73 pacientes consecutivos diagnosticados con TEPT de acuerdo a la entrevista CAPS-5. De acuerdo al ITQ (in/i= 70), 33 (47.1%) pacientes también cumplieron los criterios diagnósticos para TEPT Complejo. El programa de tratamiento de cuatro días comprende una combinación de exposición prolongada, terapia EMDR, actividades físicas y psicoeducación. La respuesta al tratamiento fue medida usando la Escala de TEPT Administrada por el Clínico para el DSM-5 (CAPS-5 en su sigla en inglés), la Lista de Chequeo de TEPT para el DSM-5 (PCL-5 en su sigla en inglés), y el Cuestionario Internacional de Trauma (ITQ en su sigla en inglés) para clasificar TEPT Complejo y las distorsiones en la auto-organización (DSO en su sigla en inglés) asociadas.bResultados:/bEn general, los puntajes de CAPS-5, PCL-5, y ITQ-DSO disminuyeron significativamente desde el pre al post tratamiento (Cohen’sids/i2.12, 1.59, and 1.18, respectivamente), mientras que la disminución se mantuvo en el seguimiento de los seis meses. Al término del tratamiento, 60 pacientes (82.2%) ya no cumplieron con los criterios diagnósticos de TEPT, mientras que la proporción de pacientes con TEPT Complejo disminuyó desde 47.1% a 10.1%. No ocurrieron abandonos ni eventos adversos personales.bConclusiones:/bLos resultados apoyan la noción de que tratamiento centrado en el trauma intensivo es factible, seguro y está asociado con una gran disminución en los síntomas de TEPT y TEPT Complejo, incluso cuando es breve, y es aplicado de forma completamente remota.b背景：/b目前尚不清楚远程提供的聚焦创伤强化治疗是否不仅是治疗 PTSD 的有效治疗方法，也适用于复杂性 PTSD 。b目的：/b检验以下假设，即一项简短、完全远程管理的针对 PTSD 和复杂性 PTSD 患者的聚焦创伤强化治疗方案是安全的，并且与相应症状和诊断状态的显著下降相关。b方法：/b治疗样本由 73 名根据 CAPS-5 诊断为 PTSD 的连续患者组成。根据 ITQ (in/i= 70) ， 33 名 (47.1%) 患者也符合复杂性 PTSD 的诊断标准。为期 4 天的治疗计划包含延长暴露、EMDR 治疗、体育活动和心理教育的组合。使用DSM-5临床用 PTSD 量表 (CAPS-5)、DSM-5 PTSD 检查表 (PCL-5) 和用以对复杂性 PTSD 进行分类和索引自组织障碍（DSO）的国际创伤问卷 (ITQ) 测量治疗反应。b结果：/b总体 CAPS-5、PCL-5 和 ITQ-DSO 评分从治疗前到治疗后显著下降（Cohen’sid/i分别为 2.12、1.59 和 1.18），而下降保持到 6 个月的随访。治疗后，60 名患者（82.2%）不再符合PTSD诊断标准，而复杂性PTSD患者比例从 47.1%下降到10.1%。没有流失，也没有发生个人不良事件。b结论：/b结果支以下观点，即强化的聚焦创伤治疗是可行的、安全的，并且与 PTSD 和复杂性 PTSD 症状的大幅减少相关，即使它是短暂且完全远程施行的。.

OBJECTIVES: To retrospectively assess the treatment outcomes of endosseous implants placed to retain craniofacial prostheses.MATERIAL AND METHODS: Patients with craniofacial defects resulting from congenital disease, trauma, or oncologic treatment had implant retained prostheses placed in the mastoid, orbital, or nasal region and then assessed over a period of up to 30 years. Implant survival rates were calculated with the Kaplan-Meier method. Clinical assessments consisted of scoring skin reactions under the prosthesis and the peri-implant skin reactions. Possible risk factors for implant loss were identified. Patient satisfaction was evaluated using a 10-point VAS-scale.RESULTS: A total of 525 implants placed in 201 patients were included. The median follow up was 71 months (IQR 28-174 months). Implants placed in the mastoid and nasal region showed the highest overall implant survival rates (10-year implant survival rates of 93.7% and 92.5%, respectively), while the orbital implants had the lowest overall survival rate (84.2%). Radiotherapy was a significant risk factor for implant loss (HR 3.14, p CONCLUSION: Implants used to retain craniofacial prostheses have high survival and patient satisfaction rates and can thus be considered as a predictable treatment option. Radiation is the most important risk factor for implant loss.

Purpose To investigate the applicability of finite element analysis (FEA) in Oral and Maxillofacial (OMF) surgery, by studying the effect of mandibular body height and osteosynthesis positioning on unilateral mandibular body fractures based on Champy’s technique. This proof of principle is a step towards developing a validated FEA simulation method that may be useful in the clinical setting for optimising mandibular fracture management. Methods Mandibles made of polyurethane foam (Synbone®), with heights of 18, 14, and 10 mm were used to create a FEA model with a unilateral straight-line fracture, fixated with a standard commercially available 6-hole 2 mm titanium miniplate (KLS Martin Group). Two different FEA programs were used for the comparison, namely: Solidworks and Comsol Multiphysics. The FEA outcomes were compared with a series of mechanical tests with polymeric models fixed in a customised device and loaded onto a mechanical test bench. Results First, the study illustrated that the optimal plate position appeared to be the upper border. Second, lower mandibular height increases instability and requires a stronger osteosynthesis system. Conclusion The FEA’s and polymeric model testing outcomes of unilateral non-comminuted fractures were highly comparable with current opinions of mandibular fracture management. FEA is an applicable tool in OMF surgery, as it can be used to predict the treatment outcome of mandibular fractures. The promising outcome of this study makes it worthwhile to do more extensive analysis in order to determine whether FEA alone is sufficient for optimisation of fracture management.

BACKGROUND: Deep vein thrombosis (DVT) after decannulation of extracorporeal life support (ECLS) is not uncommon. Moreover, the impact of anticoagulation and potential risk factors is unclear. Furthermore, it is unclear if cannula-associated DVT is more common in ECLS patients compared to critically ill patients without ECLS.METHODS: All adult patients who were successfully weaned from ECLS and were screened for DVT following decannulation were included in this observational cohort study. The incidence of post-ECLS-DVT was assessed and cannula-associated DVT rate was compared with that of patients without ECLS after central venous catheter (CVC) removal. The correlation between level of anticoagulation, risk factors and post-ECLS-DVT was determined.RESULTS: We included 30 ECLS patients and 53 non-ECLS patients. DVT was found in 15 patients (50%) of which 10 patients had a DVT in a cannulated vein. No correlation between level of anticoagulation and DVT was found. V-V ECLS mode was the only independent risk factor for post-ECLS-DVT (OR 5.5; 95%CI 1.16-26.41). We found no difference between the ECLS and non-ECLS cohort regarding cannula-associated DVT rate (33% vs 32%).CONCLUSION: Post-ECLS-DVT is a common finding that occurs in half of all patients supported with ECLS. The incidence of cannula-associated DVT was equal to CVC-associated DVT in critically ill patients without ECLS. V-V ECLS was an independent risk factor for post-ECLS-DVT.

The purpose of this research is to evaluate the lubrication properties of a synthetic synovial fluid in combination with biocompatible polyurethanes, versus materials commonly used in biomedical implants. This combination is found in endurance testing of meniscal implants made from polyurethane. Two different polyurethanes were used for friction measurements, applying a synthetic lubricant, containing a Ringer's solution, hyaluronic acid and bovine serum albumin. The results were compared with friction measurements, using a polyurethane sphere against bovine cartilage, lubricated with bovine synovial fluid. The influence of the lubricants was tested by comparing water, synthetic- and bovine synovial fluids with the various material combinations, found in existing knee implants. From the measurements it was shown that the friction pairs including metal surfaces did not show the common Stribeck behaviour, with respect to transitions from the boundary regime to full film lubrication, and friction remained relatively constant over the whole velocity range. Friction pairs including the polymer counter surfaces and the water lubricated contacts, showed the expected transitions from boundary to mixed lubrication. From this it was concluded that protein adsorption mainly defined the frictional behaviour when using metal surfaces, leading to a coefficient of friction (COF)≈0.2 using synthetic synovial fluid, and COF≈0.15 when using bovine synovial fluid. PEEK samples showed higher values in the boundary lubrication region, which decreased to values of COF≈0.1 at higher velocities. Polyethylene samples showed higher friction results, which was attributed to the surface roughness. From the observed friction results and wear tracks it was concluded that a synthetic synovial lubricant performs very well with all material combinations, when more attention is paid to the polyethylene surface finish.

OBJECTIVES: The objective of this study was to quantitatively assess the image quality of Advanced Modeled Iterative Reconstruction (ADMIRE) and the PixelShine (PS) deep learning algorithm for the optimization of low-dose computed tomography protocols in midfacial trauma.STUDY DESIGN: Six fresh frozen human cadaver head specimens were scanned by computed tomography using both standard and low-dose scan protocols. Three iterative reconstruction strengths were applied to reconstruct bone and soft tissue data sets and these were subsequently applied to the PS algorithm. Signal-to-noise ratios (SNRs) and contrast-to-noise ratios (CNRs) were calculated for each data set by using the image noise measurements of 10 consecutive image slices from a standardized region of interest template.RESULTS: The low-dose scan protocol resulted in a 61.7% decrease in the radiation dose. Radiation dose reduction significantly reduced, and iterative reconstruction and the deep learning algorithm significantly improved, the CNR for bone and soft tissue data sets. The algorithms improved image quality after substantial dose reduction. The greatest improvement in SNRs and CNRs was found using the iterative reconstruction algorithm.CONCLUSION: Both the ADMIRE and PS algorithms significantly improved image quality after substantial radiation dose reduction.

Study about the influence of emotion regulation in the treatment of CA-PTSD.

Mechanism of change of exposure therapy

Applying the right torque to osteosynthesis screws is important for undisturbed bone healing. This study aimed to compare test–retest and intra-individual reliabilities of the torque applied to 1.5 mm and 2.0 mm osteosynthesis screws by residents and oral and maxillofacial surgeons (OMF-surgeons), to define the reference torque intervals, and to compare reference torque interval compliances. Five experienced OMF-surgeons and 20 residents, 5 of each 4 residency years, were included. Each participant inserted six 1.5 × 4 mm and six 2.0 × 6 mm screws into a preclinical model at two test moments 2 weeks apart (T1 and T2). Participants were blinded for the applied torque. Descriptive statistics, reference intervals, and intra-class correlation coefficients (ICC) were calculated. The OMF-surgeons complied more to the reference intervals (1.5 mm screws: 95% and 2.0 mm screws: 100%) than the residents (82% and 90%, respectively; P = 0.009 and P = 0.007) with the ICCs ranging between 0.85–0.95 and 0.45–0.97, respectively. The residents’ accuracy and reliability were inadequate regarding the 1.5 mm screws but both measures improved at T2 for both screw types compared to T1, indicating a learning effect. Training residents and/or verifying the applied torque by experienced OMF-surgeons remains necessary to achieve high accuracy and reliability, particularly for 1.5 mm screws.

As 2D quantitative measurements are often insufficient, a standardized 3D quantitative measurement method was developed to analyze mandibular condylar fractures, and correlate the results with the mandibular condylar fracture classifications of Loukota and Spiessl and Schroll and clinical parameters. Thirty-two patients with a unilateral mandibular condylar fracture were evaluated using OPT, 2D (CB)CT images, and 3D imaging to measure the extent of the fractures. The maximum mouth opening (MMO) was measured. Ramus height loss could be measured only in OPT, but not in 2D CT images. The Intraclass Correlation Coefficient was excellent in the 3D measurements. In the Loukota classification, condylar neck fractures had the largest median 3D displacement and the highest rotations of the fracture fragments. The largest fracture volume was observed in base fractures. According to the Spiessl and Schroll classification, type V fractures had the largest median 3D displacement and the highest rotation in the X-axis and Z-axis. Type I fractures had the largest fracture volume. We found a moderate negative correlation between MMO and 3D displacement and rotation on Z-axis. The 2D quantitative analysis of condylar fractures is limited, imprecise, and not reproducible, while quantitative 3D measurements provide extensive, precise, objective, and reproducible information.

Osteosynthesis systems are used to fixate bone segments in maxillofacial surgery. Titanium osteosynthesis systems are currently the gold standard. However, the disadvantages result in symptomatic removal in up to 40% of cases. Biodegradable osteosynthesis systems, composed of degradable polymers, could reduce the need for removal of osteosynthesis systems while avoiding the aforementioned disadvantages of titanium osteosyntheses. However, disadvantages of biodegradable systems include decreased mechanical properties and possible foreign body reactions. In this review, the literature that focused on the in vitro and in vivo performances of biodegradable and titanium osteosyntheses is discussed. The focus was on factors underlying the favorable clinical outcome of osteosyntheses, including the degradation characteristics of biodegradable osteosyntheses and the host response they elicit. Furthermore, recommendations for clinical usage and future research are given. Based on the available (clinical) evidence, biodegradable copolymeric osteosyntheses are a viable alternative to titanium osteosyntheses when applied to treat maxillofacial trauma, with similar efficacy and significantly lower symptomatic osteosynthesis removal. For orthognathic surgery, biodegradable copolymeric osteosyntheses are a valid alternative to titanium osteosyntheses, but a longer operation time is needed. An osteosynthesis system composed of an amorphous copolymer, preferably using ultrasound welding with well-contoured shapes and sufficient mechanical properties, has the greatest potential as a biocompatible biodegradable copolymeric osteosynthesis system. Future research should focus on surface modifications (e.g., nanogel coatings) and novel biodegradable materials (e.g., magnesium alloys and silk) to address the disadvantages of current osteosynthesis systems.

Background Joint distraction is a fairly new treatment for patients with symptomatic thumb carpometacarpal osteoarthritis (CMC1 OA). A previous pilot study of five patients showed that CMC1 joint distraction is technically feasible. The current study presents the results of CMC1 joint distraction in 20 patients with a 2-year follow-up period. Purposes The primary study aim was to assess if patients with CMC1 OA have better physical function and less pain 2 years after CMC1 joint distraction. Second, we assessed the number of patients who achieved a minimal clinically important difference (MCID) in patient-reported outcome measures at each follow-up time point. Furthermore, this study sought differences on magnetic resonance imaging (MRI) of the CMC1 joint before and after distraction. Adverse events were noted and reported. Methods Twenty patients (median age of 54 years) with symptomatic CMC1 OA and an established indication for a trapeziectomy were enrolled. An external distractor device was placed over the CMC1 joint and left in situ for 8 weeks. Disabilities of the Arm, Shoulder, and Hand (DASH) score, Michigan Hand Outcome Questionnaire (MHQ), visual analogue scale (VAS), and grip strength were recorded preoperatively and at 3, 6, 12, and 24 months postoperatively. Results Two years after joint distraction, physical function and pain scores had improved significantly compared with baseline: DASH from 48 to 17, MHQ from 56 to 83, and VAS for pain from 50 to 18 mm. Fourteen of 19 patients (74%) reached an MCID in DASH and MHQ scores. One patient was not satisfied with treatment outcome and chose to proceed with a trapeziectomy 14 months after initial distraction therapy. Conclusions This study demonstrates that CMC1 joint distraction can postpone more invasive surgical interventions (e.g., trapeziectomy) for at least 2 years. Larger comparative studies are needed to assess the value of CMC1 joint distraction in the treatment of CMC1 OA. Level of Evidence This is a Level IV, prospective case series study.

Background Despite systemic anticoagulation and antithrombotic surface coating, oxygenator dysfunction remains one of most common technical complications of Extracorporeal membrane oxygenation (ECMO). Several parameters have been associated with an oxygenator exchange, but no guidelines for when to perform an exchange are published. An exchange, especially an emergency exchange, has a risk of complications. Therefore, a delicate balance between oxygenator dysfunction and the exchange of the oxygenator exists. This study aimed to identify risk factors and predictors for elective and emergency oxygenator exchanges. Methods This observational cohort study included all adult patients supported with veno-venous extracorporeal membrane oxygenation (V-V ECMO). We compared patients’ characteristics and laboratory values of patients with and without an oxygenator exchange and between an elective and emergency exchange, defined as an exchange outside office hours. Risk factors for an oxygenator exchange were identified with cox regression analyses, and risk factors for an emergency exchange were identified with logistic regression analyses. Results We included forty-five patients in the analyses. There were twenty-nine oxygenator exchanges in nineteen patients (42%). More than a third of the exchanges were emergency exchanges. Higher partial pressure of carbon dioxide (PaCO2), transmembrane pressure difference (ΔP), and hemoglobin (Hb) were associated with an oxygenator exchange. Lower lactate dehydrogenase (LDH) was the only risk factor for an emergency exchange. Conclusion Oxygenator exchange is frequent during V-V ECMO support. PaCO2, ΔP and Hb were associated with an oxygenator exchange and lower LDH with the risk of an emergency exchange.

Background Although life-saving in selected patients, ECMO treatment still has high mortality which for a large part is due to treatment-related complications. A feared complication is ischemic stroke for which heparin is routinely administered for which the dosage is usually guided by activated partial thromboplastin time (aPTT). However, there is no relation between aPTT and the rare occurrence of ischemic stroke (1.2%), but there is a relation with the much more frequent occurrence of bleeding complications (55%) and blood transfusion. Both are strongly related to outcome. Methods We will conduct a three-arm non-inferiority randomized controlled trial, in adult patients treated with ECMO. Participants will be randomized between heparin administration with a target of 2–2.5 times baseline aPTT, 1.5–2 times baseline aPTT, or low molecular weight heparin guided by weight and renal function. Apart from anticoagulation targets, treatment will be according to standard care. The primary outcome parameter is a combined endpoint consisting of major bleeding including hemorrhagic stroke, severe thromboembolic complications including ischemic stroke, and mortality at 6 months. Discussion We hypothesize that with lower anticoagulation targets or anticoagulation with LMWH during ECMO therapy, patients will have fewer hemorrhagic complications without an increase in thromboembolic complication or a negative effect on their outcome. If our hypothesis is confirmed, this study could lead to a change in anticoagulation protocols and a better outcome for patients treated with ECMO. Trial registration ClinicalTrials.gov NCT04536272. Registered on 2 September 2020. Netherlands Trial Register NL7969

The purpose of this first-in-human study was to evaluate the effect of a polycarbonate anatomical meniscus prosthesis system, including the surgical procedure, on knee pain and describe potential adverse events in patients with post-meniscectomy pain syndrome.Eleven patients with post-meniscectomy pain syndrome and limited underlying cartilage damage were enrolled in the study. Five received a medial polycarbonate urethane meniscus prosthesis which was clicked onto 2 titanium screws fixated at the native horn attachments on the tibia. The KOOS score was planned to be collected at baseline and at 3, 6, 12 and 24 months following the intervention including radiographs at 6, 12 and 24 months. MRI scans were repeated after 12 and 24 months.The surgical technique to select an appropriately sized implant and correct positioning of the fixation screws and meniscus prosthesis onto the tibia was demonstrated to be feasible and reproducible. Inclusion stopped after 5 patients because of serious adverse device-related events. All patients reported knee joint stiffness and slight effusion in their knee at 6 months follow-up. In 3 patients the implant was removed because of implant failure and in 1 patient the implant was removed because of persistent pain and extension limitation. In none of the patients did the KOOS score improve in the first 6 months after surgery. However, in the patient who still has the implant in situ, PROMs started to improve 1 year after surgery and this improvement continued through 2 years of follow-up. The KOOS Pain, symptoms and ADL were close to the maximal 100 points. KOOS QoL and sport did improve but remained suboptimal.This first version of the meniscus prosthesis led to impaired knee function and failed in four out of five patients. The patients where the prosthesis was removed were salvable and the PROMs returned to pre-study levels. The results in the patient where the device is still in place are promising.Level II.

A 64-year-old man has deep caries in tooth 37 without acute pain; extraction is indicated, however. According to his list of medications, he takes the antithrombotics apixaban and clopidogrel. Or: a 78-year-old woman has upper and lower dentures that don't function well, and she experiences retention problems. Implant-bearing upper and lower dentures on 4 and 2 implants, respectively, are indicated. The patient takes acenocoumarol and reports that the clotting time value of her blood (INR) sometimes fluctuates. The clinical guidelines 'Dental procedures in patients using antithrombotic medication', which recently appeared, offer oral healthcare providers recommendations for reducing the risk of bleeding while observing the risk of thrombosis. These guidelines by the Dutch Institute of Expertise for Oral Healthcare replace the previous guidelines from 2012. The recommendations are up to date with current practice in the Netherlands and take into account all antithrombotics patients may currently use in an outpatient setting. Furthermore, the responsibilities of the oral healthcare providers and the agreements with thrombosis services are formalised in these guidelines.Een 64-jarige man heeft cariës profunda in gebitselement 37 zonder acute pijnklachten, maar extractie is geïndiceerd. Uit zijn medicatielijst blijkt hij de antitrombotica apixaban en clopidogrel te gebruiken. Of: een 78-jarige vrouw heeft een niet goed functionerende boven- en onderprothese met retentieproblemen. Een implantaatgedragen boven- en onderprothese op respectievelijk 4 en 2 implantaten is geïndiceerd. De patiënt gebruikt acenocoumarol en vertelt dat de stollingstijdwaarde van het bloed (INR) bij haar nog wel eens wil schommelen. De recent verschenen klinische praktijk­richtlijn ‘Bloedige ingrepen in de mondzorg, bij patiënten die antitrombotica gebruiken’ biedt mondzorgverleners aanbevelingen voor het verkleinen van het bloedingsrisico met inachtneming van het tromboserisico. Deze richtlijn van het Kennisinstituut Mondzorg vervangt de vorige richtlijn uit 2012. De adviezen zijn geactualiseerd naar de huidige praktijkvoering in Nederland en omvatten alle antitrombotica die patiënten momenteel in een poliklinische setting mogelijk kunnen gebruiken. Tevens zijn de verantwoordelijkheden van een mondzorgverlener en de afspraken met de trombosedienst vastgelegd.

The aim of this study was to assess implant retreatment in a group of patients whose maxillary implants were all failing after full arch rehabilitation. Treatment involved implant removal, augmentation, and placement of an overdenture supported by four to six implants. All consecutive patients referred between 2008 and 2018, following multiple late implant failures in the rehabilitated maxilla, were included in the study. Seventy implants in 15 patients were evaluated at 3.3 +/- 2.5 years (range 1.1-8.6 years) after loading. Implant survival, complications, clinical parameters, marginal bone loss, and patient-related outcome measures were recorded at the time of evaluation. Overall implant survival was 95.7%. Three implant failures occurred within the first year of function. Marginal bone loss was 0.32 +/- 0.46 mm; pocket probing depth was 4.55 +/- 1.59 mm. Plaque, calculus, inflammation, and bleeding were hardly seen (median index score 0). Patients scored their satisfaction with their overdentures as high (mean overall score 8.7 +/- 1.2, maximum 10). Chewing soft and tough food was scored as 'good' and hard food as 'moderate'. The mean Oral Health Impact Profile score was 29.5 +/- 33.3. It can be concluded that the replacement of multiple failing implants in an edentulous maxilla after bone augmentation is a safe and predictable treatment procedure when applied as an implant-supported overdenture.

Titanium osteosynthesis is currently the fixation system of choice in maxillofacial traumatology. Biodegradable osteosynthesis systems have the ability to degrade in the human body. The aim of this study was to conduct a systematic review, with meta- and trial sequential analyses, to assess the efficacy and morbidity of biodegradable versus titanium osteosynthesis after maxillofacial trauma. MEDLINE, Embase, and CENTRAL were searched for randomized controlled trials and prospective and retrospective controlled studies. Five time periods were studied: perioperative, short-term (0-4 weeks), intermediate (6-12 weeks), long-term (>12 weeks), and overall follow-up. After screening 3542 records, 24 were included. All had a high risk of performance and detection bias due to the nature of the interventions. Meta-analysis showed no differences in efficacy or morbidity between biodegradable and titanium osteosynthesis. The risk of perioperative screw breakage was significantly higher (risk ratio 17.13, 95% confidence interval 2.19-34.18) and the symptomatic plate removal rate lower in the biodegradable group (risk ratio 0.11, 95% confidence interval 0.02-0.57), which was confirmed by the trial sequential analysis. The quality of evidence ranged from very low to moderate. Based on the narrative review and meta-analyses, current evidence shows that biodegradable osteosynthesis is a viable alternative to titanium osteosynthesis when applied in the treatment of maxillofacial trauma, with similar efficacy but significantly lower symptomatic plate removal rates. Perioperative screw breakage occurred significantly more often in the biodegradable group compared to the titanium group.

Edition of a poll-tax receipt from Hermopolis in the Bayerische Staatsbibliothek, München. The receipt is dated August 6, AD 195, and is one of the few poll-tax receipts from Hermopolis.

Eye movement desensitization and reprocessing (EMDR) therapy is an evidence-based treatment for posttraumatic stress disorder (PTSD). Preliminary findings suggest the application of an adapted, addiction-focused EMDR procedure, AF-EMDR therapy, may also be helpful in treating addictions, such as gambling disorder (GD). In this study eight participants with GD received AF-EMDR therapy, using modules from Markus and Hornsveld's Palette of EMDR Interventions in Addiction (PEIA). A multiple baseline design was used to investigate whether AF-EMDR therapy reduced gambling urge and increased experienced self-control. Six weekly AF-EMDR sessions (treatment phase) were preceded by a 3- to 7-week non-treatment baseline phase. During both phases, participants kept a daily diary. Visual inspection as well as an interrupted time series analysis demonstrated mixed findings. Results showed that three participants experienced spontaneous recovery during the baseline period, two did not respond to treatment, and three others showed improvements during the EMDR phase. No adverse effects were noted. In sum, AF-EMDR therapy may have potential in the treatment of gambling addiction. However, more research is needed regarding the efficacy, contra-indications, focus, and application as well as the optimal dose of AF-EMDR therapy using the PEIA modules.

BGU I 295; BGU III 751; CPR X 26; CPR X 39; CPR X 136; CPR XVIIA 19; P.Berl.Bibl. 5; P.Corn. inv. II 48; P.Eirene II 28; P.Erl. 74; P.Kramer 11; P.Leipz. 2; P.Leipz. 4 verso; P.Leipz. 5; P.Leipz. 10; P.Leipz. 18 recto; P.Leipz. 31 recto; P.Leipz. 20 verso; P.Leipz. 23; P.Leipz. 24; P.Leipz. 30; P.Lips. I 35 (= ChLA XII 524); P. Lips. I 38 (= M. Chr. 97; ChLA XII 520); P.Petersb. 7; P.Prag. I 37; P.Ross.Georg III 26; P.Ross.Georg. III 53; P.Vind.Sal. 8; P.Vind. Tand. 32; SB I 4504; SB I 4505; SB I 4675; SB I 4681; SB I 4853; SB I 5259; SB VI 9151; SB VI 9456; SB XVI 12492; SPP III2 141; SPP VIII 708; SPP VIII 752; SPP VIII 821; SPP VIII 826; SPP VIII 830; SPP VIII 842; SPP VIII 1077; SPP VIII 1236; SB VIII 9778; SPP VIII 1238; SPP VIII 1286b; SPP VIII 1301; SPP VIII 1310; SPP VIII 1327; SPP VIII 1346; ChLA III 213; ChLA X 425; ChLA X 463; ChLA XI 484; ChLA XII 518; ChLA XII 525; ChLA XLI 1187; ChLA XLI 1189; ChLA XLV 1321; CEL 222; CEL 223; CEL 242 Mary ������������������������ in Egypt The abbreviation d(ixit) Scribes in court proceedings Latin scripts in court proceedings, TYCHE ��� Beitr��ge zur Alten Geschichte, Papyrologie und Epigraphik, Bd. 34 (2019)

Korr. Tyche 950���988, TYCHE ��� Contributions to Ancient History, Papyrology and Epigraphy, Bd. 35 (2020)

Additional file 2. SPIRIT Checklist for Trials.

Contains fulltext : 285203.pdf (Publisher’s version ) (Open Access) Background: Research indicates that intensive trauma-focused therapy can be effective in alleviating symptoms of post-traumatic stress disorder (PTSD) and borderline personality disorder (BPD). However, these studies have relied on self-report of BPD symptoms and follow-up data are scarce.Objective: The purpose of this feasibility study was to determine the effects of an intensive trauma-focused treatment programme on the severity of PTSD and BPD symptoms and the diagnostic status up to a 12-month follow-up.Methods: A total of 45 (60% female) individuals meeting the diagnostic criteria of both PTSD and BPD participated in an intensive eight-day trauma-focused treatment programme which combined prolonged exposure and EMDR therapy in an inpatient treatment setting. Severity of PTSD and BPD symptoms were assessed at pre-treatment, post-treatment, 6 months, and 12 months after treatment (CAPS-5, BPDSI-IV). Diagnostic status was determined using clinical interviews (CAPS-5 and SCID-5-P) at pre-treatment and 12-month follow-up.Results: Of all participants, 93.3% had been exposed to physical abuse, and 71.1% to sexual abuse prior to the age of 12 years. PTSD and BPD symptom severity significantly decreased from pre- to post-treatment (Cohen's ds: 1.58 and 0.98, respectively), and these results were maintained at 6- (ds: 1.20 and 1.01) and 12-month follow-up (ds: 1.53 and 1.36). Based upon CAPS-5, 69.2% no longer met the diagnostic criteria of PTSD at 12-month follow-up, while according to the SCID-5-P 73.1% no longer fulfilled the diagnostic criteria of BPD at that time. No significant worsening of symptoms occurred.Conclusion: The findings of this study, which is the first to examine the effects of psychotherapeutic treatment of PTSD on the presence of a borderline personality disorder one year after treatment, add support to the notion that a brief intensive trauma-focused treatment can be a valuable option for individuals suffering from both PTSD and BPD. 12 p.

BackgroundInterventions aimed at easing negative moral (social) emotions and restoring social bonds – such as amend-making and forgiving—have a prominent role in the treatment of moral injury. As real-life contact between persons involved in prior morally injurious situations is not always possible or desirable, virtual reality may offer opportunities for such interventions in a safe and focused way.ObjectiveTo explore the effects of the use of deepfake technology in the treatment of patients suffering from PTSD and moral injury as a result of being forced by persons in authority to undergo and commit sexual violence (so-called betrayal trauma).MethodsTwo women who had experienced sexual violence underwent one session of confrontation with the perpetrator using deepfake technology. The women could talk via ZOOM with the perpetrator, whose picture was converted in moving images using deepfake technology. A therapist answered the questions of the women in the role of the perpetrator. Outcome measures were positive and negative emotions, dominance in relation to perpetrator, self-blame, self-forgiveness, and PTSD-symptom severity.ResultsBoth participants were positive about the intervention. Although they knew it was fake, the deepfaked perpetrator seemed very real to them. They both reported more positive and less negative emotions, dominance in relation to the perpetrator and self-forgiveness, and less self-blame and PTSD-symptoms after the intervention.ConclusionVictim-perpetrator confrontation using deepfake technology is a promising intervention to influence moral injury-related symptoms in victims of sexual violence. Deepfake technology may also show promise in simulating other interactions between persons involved in morally injurious events.

Additional file 1. Model Consent Form.