Long-term effects of splint therapy in patients with posttraumatic stress disease (PTSD).

OBJECTIVES: The aim of a pilot study was to clarify the question of whether mouth opening restrictions in patients with PTSD by means of splint therapy (st) show long-term therapeutic effects in the case of functional disorders. MATERIAL AND METHODS: In 31 of 36 inpatients (soldiers, average age 37.1 ± 7.3 years, 26.7 ± 2.1 teeth) with confirmed posttraumatic stress disorder, chronic pain intensity > 6 (visual analogue scale 0 to 10), the mouth opening was determined, and the functional status (RDC-TMD) was recorded. All participants received a splint that was worn at night. A control of the therapeutic effect of the splint occurred after 6 weeks, 3, 6, and 12 months. RESULTS: The mouth opening initially had an average of 30.9 ± 6.5 mm (median 31 mm). The pain intensity (PI) was reported to be on average VAS 8.3 ± 0.9, the chronic degree of pain according to von Korff was 3.9 ± 03. Six weeks after the st (n = 31), the average mouth opening was 49.5 ± 6.3 mm (median 51.5). PI was given as VAS 2.3 ± 1.1 on average. After 3, 6, and 12 months, 24, 15, and 14 subjects could be interviewed regarding PI. Based on the last examination date of all subjects, the average PI was given as 1.1 ± 0.9 (median 1). CONCLUSION: The presented data show that the therapeutic short-term results achieved by means of a splint remain valid on the long term despite continued PTSD. CLINICAL RELEVANCE: The presented study shows that patients will benefit in the long term from a splint and remain symptom-free, even if this mental illness persists.

[Orofacial dysfunction and posttraumatic stress disorder : A context analysis of soldiers after military deployment]. / Orofaziale Funktionsstörung und posttraumatisches Belastungssyndrom : Eine Zusammenhangsanalyse bei Soldaten nach militärischen Einsätzen.

BACKGROUND: In studies on posttraumatic stress disorder (PTSD, ICD 10: F43.1) and in clinical observation, the high proportion of soldiers with painful craniomandibular dysfunction (CMD) is conspicuous. AIM: This study aimed to clarify if there is a connection between orofacial dysfunction, pain in this region, stress and PTSD. MATERIAL AND METHODS: A total of 36 inpatients (PTSD group) with specialist psychiatrically confirmed PTSD after up to 17 foreign deployments and 36 control subjects with 2-40 foreign deployments underwent a functional dental examination. All participants filled out a form for the gradation of chronic pain (GCP, degrees 0-4) as well as the depression, fear and stress scale (DFSS). RESULTS: Soldiers with PTSD had significantly worse orofacial functional diagnoses and higher pain scores, although on average they had less combat deployments (PTSD: maximum mouth opening 31.4 ± 8.0 mm vs. 57 ± 6 mm, GCP 3.5 ± 1.0 vs. 0.5 ± 0.5).The PTSD group showed a depression score of 14.9 ± 4.2 vs. the control group 1.4 ± 2.1, a fear score of 13.7 ± 3.9 vs. 1.0 ± 1.5 and a stress score of 16.1 ± 3.4 vs. 3.3 ± 2.9. CONCLUSION: The data from this pilot study show an obvious connection between PTSD and orofacial dysfunctions. Through further prospective studies it should be evaluated if there is a general vulnerability of those afflicted for pathological orofacial stress. This could be used for screening before combat deployment.

Hematopoietic progenitor cell mobilization by granulocyte colony-stimulating factor and erythropoietin in the absence of matrix metalloproteinase-9.

The use of mobilized hematopoietic progenitor cells (HPC) has largely replaced the use of bone marrow HPC for autologous and allogeneic transplantation; however, the mechanisms of HPC mobilization remain unclear. A better understanding of these mechanisms, may allow the development of improved (potentially more rapid and/or higher yield) HPC mobilization strategies, especially for patients who mobilize poorly using current mobilization protocols. Clinically, granulocyte colony-stimulating factor (G-CSF) is widely used to induce HPC mobilization, and evidence suggests that metalloproteinase enzymes released by activated granulocytes play an important role in the G-CSF-induced HPC mobilization. These enzymes may act to disrupt putative cell-cell and/or cell-extracellular matrix interactions within the hematopoietic microenvironment thereby releasing HPC into the blood. Matrix metalloproteinase-9 (MMP-9) appears to be important for G-CSF-induced mobilization. Using an MMP-9 knock-out (KO) mouse model, we investigated the role of MMP-9 in G-CSF and erythropoietin (EPO)-based HPC mobilization at clinically relevant cytokine doses. There were few hematologic or hematopoietic differences between the wild-type and MMP-9KO mice during steady-state hematopoiesis. When treated subcutaneously with EPO (500 U/kg per day) and G-CSF (15 microg/kg per day) for 5 days and assayed on day 6, similarly increased extramedullary hematopoiesis and numbers of HPC in the spleen and blood were observed for both the wild-type and MMP-9KO mice. These data demonstrate that MMP-9 is not required for EPO + G-CSF mobilization and that alternative mobilization mechanisms must be active at clinically relevant cytokine concentrations.

Evidence for a qualitative hierarchy within the Hoechst-33342 'side population' (SP) of murine bone marrow cells.

In vitro cobblestone area (CA)-forming cell (CAFC) and in vivo (short-term and competitive repopulation) assays demonstrate that a qualitative hierarchy exists within the Hoechst-33342-defined side population (SP) in murine bone marrow (BM). Consistent with and extending previous studies, we demonstrate that (i) hematopoietic activity found in whole BM (WBM) is concentrated within the SP, rather than the non-SP (NSP); and (ii) within the SP, those cells that more strongly efflux the dye (lower SP, LSP) are qualitatively different from those that less strongly efflux the dye (upper SP, USP). Qualitative differences are highlighted by evidence that (i) CA derived from LSP CAFC persist in culture significantly longer than CA derived from USP CAFC; (ii) short-term, multilineage repopulation of lethally irradiated mice by LSP cells is more rapid than that in mice receiving USP, NSP, whole SP (WSP), or WBM cells and (iii) LSP cells out-compete USP cells in the multilineage hematopoietic repopulation of lethally irradiated recipients. These data suggest that LSP cells are of higher quality than USP cells and potentially provide a means by which qualitative changes in primitive hematopoietic progenitors occurring naturally with aging, or clinically as a consequence of therapeutic manipulation, can be assessed.