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Objective: Evidence on the optimal "dose" of cognitive behavioral therapy (CBT) for treating major depressive disorder is sparse. This analysis aimed to evaluate the dose-response curve in CBT using a nonlinear approach, whereby "dose" was defined as number of treatment sessions. The dose-response curve of CBT was compared to other psychotherapies and pharmacological treatments for depression., Method: A systematic review and metaregression analysis of randomized controlled trials (RCTs) examining the efficacy of CBT in adults with acute depression was conducted. Treatment arms examining other psychosocial or pharmacological interventions were also analyzed. Cubic spline metaregression techniques were used to model nonlinear dose-response curves., Results: Seventy-two studies and 7,377 participants were included. Modeling the dose-response curve between change of depression symptom severity and the number of CBT sessions resulted in a nonlinear curve characterized by a strong improvement in symptom severity from baseline within the first eight sessions. Symptom reduction continues in the further course of the treatment, but at a slower pace. A similar pattern of symptom development was found for other therapies as well, although the prominence of early improvement and overall effect sizes vary across treatment arms., Conclusion: Results imply a general tendency for the strongest alleviation of depressive symptom severity in early stages of CBT treatment, thus, if aiming at symptom alleviation, speak for short CBT interventions. However, these findings have to be discussed in the light of the limited data regarding the sustainability of treatment effects in short-term therapies and effects beyond symptomatic changes. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Gambling usually involves wagering real money but can also be conducted with virtual money, chips, or coins. This phenomenon is sometimes referred to as simulated gambling, social gambling, or play money gambling. This study explores correlations and transitions between simulated gambling and real money gambling with an emphasis on gambling-related harms and public health concerns. The analysis is based on a national representative survey of 46,136 German Internet users which included 5,191 real money online gamblers (RMG), 54% of whom had also participated in simulated gambling (SG). The data set is divided into subsamples based on participation in SG to carve out significant differences in these groups in regard to various socio demographics, gambling patterns, and gambling problems. Regression models are used to predict RMG frequency, participation in SG, SG participation frequency, and problem gambling. The results show a clear proximity between SG and RMG with 17% of the total sample and 54% of problem gamblers reporting being "quite sure" or "certain" that simulated gambling had led them to gambling with real money. While 7% of individuals that engaged exclusively in RMG showed gambling problems, the rate is 33% for those that engaged in both RMG and SG. Regression results provide further evidence of a relationship between SG and problem gambling, although with differing effect sizes for different game forms. We argue that SG can be both a substitute and a primer for RMG, especially for problem gamblers., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Online gambling has demonstrated a significant and growing impact on overall gambling involvement. To examine online gambling practices and associated problems, we conducted surveys with national samples of Internet users in several European countries. The objective of this paper is to provide a portrait of online gambling practices and problems in five European countries (i.e., France, Italy, Germany, Switzerland, and Poland) with different online gambling regulatory systems. This paper is the first presenting national comparisons of online gambling practices. Participants reported on their gameplay patterns, demographic characteristics, gambling-related problems, gambling frequency, average spending on different online gambling activities, and offline gambling participation over the past 12 months. The Problem Gambling Severity Index was used to assess the severity of gambling problems in relation to online gambling (Ferris & Wynne, 2001 in The Canadian Problem Gambling Index: Final report, Canadian Centre on Substance Abuse, 2001). Pairwise logistic regressions examined the association between problem gambling and sociodemographic variables as well as gambling patterns and problem gambling. In all countries except Italy, the most popular online gambling activity was lotteries with nearly three quarters of participants reporting participation. The prevalence of at-risk and problem gambling was high in all countries with Poland reporting the highest prevalence and Switzerland the lowest. Gamblers who participated in gambling activities other than lottery were more likely to experience gambling-related problems. The rates in the present study are well above the levels usually found in surveys. High online gambling frequency, high spending, and participation in multiple online gambling activities were significantly associated with experiencing gambling-related problems., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Pay-to-Win gaming describes a common type of video game design in which players can pay to advance in the game. The frequency and value of payments is unlimited, and payments are linked to players' competitiveness or progress in the game, which can potentially facilitate problematic behavioral patterns, similar to those known from gambling. Our analyses focus on assessing similarities and differences between Pay-to-Win and different forms of gambling. Based on a survey among 46,136 German adult internet users, this study presents the demographic and socio-economic profile of (1) Pay-to-Win gamers who make purchases in such games, (2) heavy users who conduct daily payments, and (3) gamers who are also gamblers. Motives for making payments were assessed and participation, frequency and spending in gambling by Pay-to-Win gamers are presented. To assess the similarity of Pay-to-Win gaming and gambling, we tested whether Pay-to-Win participation, frequency of payments and problematic gaming behavior are predictors for gambling and cross-tested the opposite effects of gambling on Pay-to-Win. We find that Pay-to-Win gamers are a distinct consumer group with considerable attraction to gambling. High engagement and problematic behavior in one game form affects (over)involvement in the other. Common ground for Pay-to-Win gaming and gambling is the facilitation of recurring payments., (© 2021. The Author(s).)

Biomaterials of natural origin have recently gained increasing attention in the field of dental implantology. The requirements for such materials, however, are very high. In addition to high clinical efficiency in tissue regeneration, wound healing should be demonstrably positively influenced. The translational division for regenerative orofacial medicine of the Clinic and Polyclinic for Oral and Maxillofacial Surgery of the University Medical Center Hamburg-Eppendorf (UKE) is examining this research topic by investigating which innovative treatment methods for the reconstruction of bone defects or for augmentative procedures can be applied in the future or are already being applied in the field of oral and maxillofacial surgery., Competing Interests: The authors declare that they have no competing interests., (Copyright © 2022 Smeets et al.)

Oral wounds are among the most troublesome injuries which easily affect the patients' quality of life. To date, the development of functional antibacterial dressings for oral wound healing remains a challenge. In this regard, we investigated antibacterial silk protein-based membranes for the application as wound dressings in oral and maxillofacial surgery. The present study includes five variants of casted membranes, i.e., i) membranes-silver nanoparticles (CM-Ag), ii) membranes-gentamicin (CM-G), iii) membranes-control (without functionalization) (CM-C), iv) membranes-silk sericin control (CM-SSC), and v) membranes-silk fibroin/silk sericin (CM-SF/SS), and three variants of nonwovens, i.e., i) silver nanoparticles (NW-Ag), ii) gentamicin (NW-G), iii) control (without functionalization) (NW-C). The surface structure of the samples was visualized with scanning electron microscopy. In addition, antibacterial testing was accomplished using agar diffusion assay, colony forming unit (CFU) analysis, and qrt-PCR. Following antibacterial assays, biocompatibility was evaluated by cell proliferation assay (XTT), cytotoxicity assay (LDH), and live-dead assay on L929 mouse fibroblasts. Findings indicated significantly lower bacterial colony growth and DNA counts for CM-Ag with a reduction of bacterial counts by 3log levels (99.9% reduction) in CFU and qrt-PCR assay compared to untreated control membranes (CM-C and CM-SSC) and membranes functionalized with gentamicin (CM-G and NW-G) (p < 0.001). Similarly, NW-G yielded significantly lower DNA and colony growth counts compared to NW-Ag and NW-C (p < 0.001). In conclusion, CM-Ag represented 1log level better antibacterial activity compared to NW-G, whereas NW-G showed better cytocompatibility for L929 cells. As data suggest, these two membranes have the potential of application in the field of bacteria-free oral wound healing. However, provided that loading strategy and cytocompatibility are adjusted according to the antibacterial agents' characteristic and fabrication technique of the membranes., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Temporomandibular joint osteoarthritis (TMJ-OA) is a chronic degenerative disease that is often characterized by progressive impairment of the temporomandibular functional unit. The aim of this randomized controlled animal trial was a comparative analysis regarding the chondroregenerative potency of intra-articular stem/stromal cell therapy. Four weeks after combined mechanical and biochemical osteoarthritis induction in 28 rabbits, therapy was initiated by a single intra-articular injection, randomized into the following groups: Group 1: AB Serum (ABS); Group 2: Hyaluronic acid (HA); Group 3: Mesenchymal stromal cells (STx.); Group 4: Mesenchymal stromal cells in hyaluronic acid (HA + STx.). After another 4 weeks, the animals were euthanized, followed by histological examination of the removed joints. The histological analysis showed a significant increase in cartilage thickness in the stromal cell treated groups (HA + STx. vs. ABS, p = 0.028; HA + ST.x vs. HA, p = 0.042; STx. vs. ABS, p = 0.036). Scanning electron microscopy detected a similar heterogeneity of mineralization and tissue porosity in the subchondral zone in all groups. The single intra-articular injection of a stem cell containing, GMP-compliant advanced therapy medicinal product for the treatment of iatrogen induced osteoarthritis of the temporomandibular joint shows a chondroregenerative effect.

For the post-surgical treatment of oral wounds and mucosal defects beyond a certain size, the gold standard is still an autologous skin or mucosal graft in combination with complex suturing techniques. A variety of techniques and biomaterials has been developed for sutureless wound closure including different tissue glues or collagen patches. However, no wound covering that enables for sutureless fixation has yet been introduced. Thus, a new system was developed that allows for sutureless wound covering including a transparent collagen membrane, which can be attached to the mucosa using a specially modified 2λ laser beam with integrated temperature sensors and serum albumin as bio-adhesive. The sutureless wound closure system was tested for its applicability and its cytocompatibility by an established in vitro model in the present study. The feasibility of the laser system was tested ex vivo on a porcine palate. The in vitro cytocompatibility tests excluded the potential release of toxic substances from the laser-irradiated collagen membrane and the bio-adhesive. The results of the ex vivo feasibility study using a porcine palate revealed satisfactory mean tensile strength of 1.2-1.5 N for the bonding of the membrane to the tissue fixed with laser of 980 nm. The results suggest that our newly developed laser-assisted wound closure system is a feasible approach and could be a first step on the way towards a laser based sutureless clinical application in tissue repair and oral surgery.

Gain or loss-of-function mutations in fibroblast growth factor receptor 3 (FGFR3) result in cranial vault defects highlighting the protein's role in membranous ossification. Zebrafish express high levels of fgfr3 during skull development; in order to study FGFR3's role in cranial vault development, we generated the first fgfr3 loss-of-function zebrafish (fgfr3 lof/lof ). The mutant fish exhibited major changes in the craniofacial skeleton, with a lack of sutures, abnormal frontal and parietal bones, and the presence of ectopic bones. Integrated analyses (in vivo imaging and single-cell RNA sequencing of the osteoblast lineage) of zebrafish fgfr3 lof/lof revealed a delay in osteoblast expansion and differentiation, together with changes in the extracellular matrix. These findings demonstrate that fgfr3 is a positive regulator of osteogenesis. We conclude that changes in the extracellular matrix within growing bone might impair cell-cell communication, mineralization, and new osteoblast recruitment. © 2020 American Society for Bone and Mineral Research., (© 2020 American Society for Bone and Mineral Research.)

Background: Clinical practice guidelines are not easily implemented, leading to a gap between research synthesis and their use in routine care., Aims: To summarise the evidence relating to the impact of guideline implementation on provider performance and patient outcomes in mental healthcare settings, and to explore the performance of different strategies for guideline implementation., Method: A systematic review of randomised controlled trials, controlled clinical trials and before-and-after studies comparing guideline implementation strategies v. usual care, and different guideline implementation strategies, in patients with severe mental illness., Results: In total, 19 studies met our inclusion criteria. The studies did not show a consistent positive effect of guideline implementation on provider performance, but a more consistent small to modest positive effect on patient outcomes., Conclusions: Guideline implementation does not seem to have an impact on provider performance, nonetheless it may influence patient outcomes positively., (© The Royal College of Psychiatrists 2017.)