Altered thermal sensitivity in facial skin in chronic whiplash-associated disorders

There is a close functional relationship between the jaw and neck regions and it has been suggested that trigeminal sensory impairment can follow whiplash injury.Inclusion of manageable routines for valid assessment of the facial sensory capacity is thus needed for comprehensive evaluations of patients exposed to such trauma.The present study investigated facial thermal thresholds in patients with chronic whiplash-associated disorders（WADs）with both a qualitative method and quantitative sensory testing（QST）.Ten women with pain and dysfunction following a whiplash injury were compared to 10 healthy age-matched women.Thermal detection thresholds were assessed by qualitative chair-side testing and by QST according to the method-of-limits.Seven test sites in the facial skin（overlying each trigeminal branch bilaterally,and the midpoint of the chin）were examined.The detection warm and cold thresholds were defined as the mean values of 10 individual thresholds.For the WAD patients,the qualitative assessment demonstrated both reduced and increased sensitivity compared to the healthy,whereas QST systematically showed significantly higher detection thresholds（i.e.,decreased sensitivity）for both cold and warm stimuli.For the individuals who were assessed as having increased sensitivity in the qualitative assessment,the QST displayed either normal or higher thresholds,i.e.,decreased sensitivity.The results suggest that QST is more sensitive for detecting thermal sensory disturbances in the face than a qualitative method.The impaired thermal sensitivity among the patients corroborates the notion of altered thermal detection capacity induced by WAD-related pain.     

The Sensational Hand: Clinical Assessment after Nerve Repair

Following the transection and repair of major nerve trunks in the forearm, the functional outcome is influenced by mechanisms in the peripheral, as well as in the central nervous system. In the present thesis the interest is focused on assessment of the outcome after nerve repair, central nervous factors influencing the outcome, and sense substitution to compensate for sensory loss. A new model instrument for routine documentation of the outcome after repair of a peripheral nerve is identified. The model includes assessments reflecting sensory, motor and pain/discomfort domains. Investigations of frequently used assessment instruments led to the construction and evaluation of a new test instrument for assessment of discriminative sensibility (tactile gnosis) to fit in the model. The summarised outcome, calculated from the model instrument and with a numerical scoring system, conforms well with the patient's opinion on the influence on activities of daily living resulting from the nerve injury, and demonstrates good reliability and validity. A reference interval for the outcome is presented, with the estimated 95% predicted values for the outcome up to five years after the nerve repair. Brain plasticity is a factor sensibility - tactile gnosis - in the adaptive process after a nerve injury, when the mind has to interpret new signal patterns, when objects are touched. For better understanding of the sensory outcome after nerve repair, central nervous factors were examined. Specific cognitive capacities, such as verbal learning and visuo-spatial logic capacity could be identified as being of importance for recovery of tactile gnosis. For patients with temporary or permanent sensory loss, a new principle for artificial sensibility based on sense substitution is presented. The hearing sense substitutes the sense of touch. The resemblance in perceptual experience between sound and touch is bridged by the stereophonic friction sound generated by touching objects, which is then amplified and transmitted to earphones. The delicate capacity of the sense of hearing to discriminate between the complex pattern of frequencies makes it reasonable to assume that hearing is able to take over functions normally devoted to touch. This is demonstrated in the thesis.     

Methodenintegration in Beratung und Psychotherapie

The article in the journal “Zeitschrift für Psychodrama und Soziometrie” discusses the question as to how methods can be satisfactorily integrated in psychotherapy and counselling. The author shows how the process of integration takes place in a field of tension between continuous differentiation and integration. The view of integration presented contrasts with unreflected eclecticism. The attempt is also made to describe valid integrators that practitioners can employ to make fruitful use of new experiences and knowledge for their therapeutic interventions. A further perspective throws light on phenomena of the implicit knowledge acquired and utilized by practitioners in the course of their careers.     

The host defense peptide LL‐37 is detected in human parotid and submandibular/sublingual saliva and expressed in glandular neutrophils

The human host defense peptide, LL‐37, is an important player in the first line of defense against invading microorganisms. LL‐37 and its precursor, hCAP18, have been detected in unstimulated whole saliva but no reports showing hCAP18/LL‐37 in isolated, parotid, and/or submandibular/sublingual saliva have been presented. Here, we measured the levels of hCAP18/LL‐37 in human parotid and submandibular/sublingual saliva and investigated the expression of hCAP18/LL‐37 in parotid and submandibular gland tissue. Parotid and submandibular/sublingual saliva was collected from healthy volunteers, and the levels of hCAP18/LL‐37 in saliva were analyzed by dot blot, ELISA, and western blotting. Cellular expression of hCAP18/LL‐37 in human parotid and submandibular glands was investigated by immunohistochemistry. Immunoreactivity for hCAP18/LL‐37 was detected in both parotid and submandibular/sublingual saliva of all individuals. The concentration of hCAP18/LL‐37 was similar in parotid and submandibular/sublingual saliva, and was determined by densitometric scanning of each dot and normalization to the total protein concentration of each sample, and by ELISA. Double immunohistochemistry revealed that intravascular neutrophils of both parotid and submandibular glands express hCAP18/LL‐37. For the first time, we demonstrate hCAP18/LL‐37 in isolated human parotid and submandibular/sublingual saliva and expression of hCAP18/LL‐37 in glandular intravascular neutrophils, indicating that neutrophils of the major salivary glands contribute to the LL‐37 content of whole saliva.