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Background: Urinary involvement is common in hereditary spastic paraplegias (HSPs), but has rarely been assessed systematically., Methods: We characterized urinary complaints in 71 German HSP patients (mean age 55.4 ± 13.9 years; mean disease duration 20.7 ± 14.3 years; 48% SPG4-positive) using validated clinical rating scales (SCOPA-AUT, ICIQ-SF, ICIQ-LUTSqol). Treatment history and satisfaction with medical care was also assessed., Results: 74.6% of patients had one or more urological problems, most commonly nocturia and urgency. Incontinence was more severe in women, correlating with SCOPA-AUT. Female gender and SPG4 mutations were associated with higher urinary frequency and severity of urological involvement. QoL was overall reduced, more in women and in SPG4 mutation carriers. Almost 90% consulted a medical specialist; more than half were largely satisfied. 43.4% received oral medication and 5.7% received intravesical botulinum toxin. However, more than one-third of patients remained untreated., Conclusion: Urinary complaints are common in HSP and should be addressed and treated.

Objectives: The aim of the present study was to assess human and bacterial peptidylarginine deiminase (PAD) activity in the gingival crevicular fluid (GCF) in the context of serum levels of antibodies against citrullinated epitopes in rheumatoid arthritis and periodontitis., Materials and Methods: Human PAD and Porphyromonas gingivalis-derived enzyme (PPAD) activities were measured in the GCF of 52 rheumatoid arthritis (RA) patients (48 with periodontitis and 4 without) and 44 non-RA controls (28 with periodontitis and 16 without). Serum antibodies against citrullinated epitopes were measured by ELISA. Bacteria being associated with periodontitis were determined by nucleic-acid-based methods., Results: Citrullination was present in 26 (50%) RA patients and 23 (48%) controls. PAD and PPAD activities were detected in 36 (69%) and 30 (58%) RA patients, respectively, and in 30 (68%) and 21 (50%) controls, respectively. PPAD activity was higher in RA and non-RA patients with periodontitis than in those without (p = 0.038; p = 0.004), and was detected in 35 of 59 P. gingivalis-positive samples, and in 16 of 37 P. gingivalis-negative samples in association with high antibody levels against that species., Conclusions: PAD and PPAD activities within the periodontium are elevated in RA and non-RA patients with periodontitis. PPAD secreted by P. gingivalis residing in epithelial cells may exert its citrullinating activity in distant regions of the periodontium or even distant tissues., Clinical Relevance: In periodontitis, the citrullination of proteins/peptides by human and bacterial peptidylarginine deiminases may generate antibodies after breaching immunotolerance in susceptible individuals., Competing Interests: There are no conflicts of interest to declare.

Objective: The hypothesis of the present study was that topically applied bisphosphonate (BP) on a collagen membrane or alternatively bovine bone mineral prevents surface resorption of onlay bone grafts., Material and Methods: In eight adult pigs, bone blocks were harvested bilaterally from the mandible and fixed to the lateral cortex of the horizontal ramus to simulate a ridge augmentation. In a split-mouth study design, we used alendronate in aqueous solution (1 mg/ml) on the test-side in three different ways: on a collagen membrane (Bio-Gide®), soaked in bovine bone mineral granules (Bio-Oss®), or applied to the bone graft directly. The same materials without BP were used as controls on the contralateral side. After 3 months, the animals were sacrificed. The evaluation included sequential fluorochromic labeling and measurement of bone height in microradiography and toluidine blue staining., Results: In five cases, necrosis of the overlying periosteal tissues with BP was observed macroscopically. A statistically significantly lower loss in graft height was seen on the test-side for Bio-Gide® + alendronate (0.65 %) versus Bio-Gide® (1.52 %), p = 0.002; Bio-Oss® + alendronate (1.16 %) versus Bio-Oss® (4.20 %), p = 0.001; and bone graft + alendronate (1.25 %) versus bone graft alone (6.01 %), p = 0.006. An inhibitory effect on bone remodeling was observed by a statistically significantly lower number of resorption lacunae., Conclusion: The hypothesis was accepted that a bisphosphonate-treated membrane reduced bone graft resorption; however, periosteal necrosis requires better adaptation of the dosage., Clinical Relevance: A bisphosphonate membrane could be a helpful tool to preserve augmentation height of onlay bone grafts.

Impulsive-compulsive disorders are frequent in patients with Parkinson's disease (PD). Recently, a screening questionnaire and rating scale were developed for these disorders: the questionnaire for impulsive-compulsive disorders (QUIP) and QUIP-rating scale (QUIP-RS). We assessed the validity of these instruments in the German language in order to reevaluate the benefit and to obtain German screening tools in clinical practice. A convenience sample of 156 patients was assessed in Kiel and Vienna. The patients filled out the QUIP-current, the QUIP-anytime and the QUIP-RS. We validated the questionnaires against a gold standard diagnosis via receiver operating characteristic curves and determined optimal cut-off scores for the instruments. Excluding walkabout, which was not shown to be valid, sensitivities ranged from 60-92 % for the QUIP-current, 68-91 % for the QUIP-anytime, and 73-100 % for the QUIP-RS. Specificities were >71 % for QUIP-current, >69 % for QUIP-anytime and >62 % for QUIP-RS. With its very good sensitivities, the QUIP-RS is a valid instrument to assess impulsive-compulsive disorders and makes an early detection of behavioral disorders in PD possible. The QUIP-anytime was also shown to be a valid screening instrument. Both are expected to prove useful in scientific and clinical practice.

Background: Systematic reviews have reported a wide range of prevalence rates for depressive, anxiety and posttraumatic stress disorders (PTSD) in patients with fibromyalgia syndrome (FMS) which have been partially explained by setting differences. No data are currently available on the prevalence of potential mental disorders depending on the medical specialty in Germany., Material and Methods: All consecutive FMS patients of 8 study centres (3 rheumatology/orthopaedic surgery, 3 psychosomatic/pain medicine, 2 physical/integrative medicine) were assessed from February 1 to July 31, 2012 with standardised questionnaires. Patients with FMS diagnosed by a study physician were included. Non-German speaking and mentally retarded patients were excluded. The German version of the Patient Health Questionnaire 4 was used to screen for potential depressive and anxiety disorders. Severe life events were assessed by the trauma list of the Munich Composite International Diagnostic Interview and symptom criteria of PTSD of the Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV) using the Posttraumatic Diagnostic Scale., Results: Of 538 patients, 396 patients (93.9 % women, mean age 52.3 years, mean duration since chronic widespread pain 12.8 years, mean duration since FMS diagnosis 4.5 years) were analysed. In all, 65.7 % of patients met the criteria of a potential depressive disorder, 67.9 % of a potential anxiety disorder and 45.5 % of a potential PTSD. Potential depressive disorders were more frequent in the psychosomatic/pain medicine setting than in the rheumatology setting., Conclusion: Potential mental disorders were frequent in FMS patients regardless of the medical specialty. All FMS patients of all types of clinical settings should be screened for mental disorders.

Background: Consumer reports provide information on benefits and harms in routine clinical care. We report the first fibromyalgia syndrome (FMS) consumer reports in Europe., Material and Methods: The study was carried out from November 2010 to April 2011. The benefits and harms of pharmacological and non-pharmacological therapies experienced by the patient were assessed in an 11-point Likert scale (0=no, 10=very high benefit or harm) by a questionnaire. The questionnaire was distributed by the German League against Rheumatism and the German Fibromyalgia Association to their members and to all consecutive FMS patients of nine clinical centers of different levels of care., Results: A total of 1,661 questionnaires (95% women, mean age 54 years) were analyzed. Self-management strategies (distraction, resting, aerobic exercise), physical therapies (warm and pool therapies), psychological therapies (education, psychotherapy), and inpatient multicomponent therapies were judged to be more efficacious and less harmful than all types of pharmacological therapies., Conclusion: The German fibromyalgia consumer reports highlight the importance of non-pharmcological therapies in the long-term management of FMS.

From 60 species of the genus Clostridium tested 26 species were able to degrade one to three of the following compounds: betaine, choline, creatine, and ethanolamine. Degradation of betaine and choline was always associated with the formation of trimethylamine as one of the products. Creatine was converted to N-methylhydantoin and with one species (Clostridium sordellii) to sarcosine in addition. The diagnostic value of the ability of clostridial species to degrade the compounds mentioned is discussed. N,N-dimethylglycine, N,N-dimethylethanolamine or sarcosine were not metabolized by the strains tested.