TY - JOUR A1 - Perra, Alessandra A1 - Riccardo, Chiara Laura A1 - De Lorenzo, Valerio A1 - De Marco, Erika A1 - Di Natale, Lorenzo A1 - Kurotschka, Peter Konstantin A1 - Preti, Antonio A1 - Carta, Mauro Giovanni T1 - Fully immersive virtual reality-based cognitive remediation for adults with psychosocial disabilities: a systematic scoping review of methods intervention gaps and meta-analysis of published effectiveness studies JF - International Journal of Environmental Research and Public Health N2 - Background: Cognitive Remediation (CR) programs are effective for the treatment of mental diseases; in recent years, Virtual Reality (VR) rehabilitation tools are increasingly used. This study aimed to systematically review and meta-analyze the published randomized controlled trials that used fully immersive VR tools for CR programs in psychiatric rehabilitation. We also wanted to map currently published CR/VR interventions, their methods components, and their evidence base, including the framework of the development intervention of CR in fully immersive VR. Methods: Level 1 of evidence. This study followed the PRISMA extension for Scoping Reviews and Systematic Review. Three electronic databases (Pubmed, Cochrane Library, Embase) were systematically searched, and studies were included if they met the eligibility criteria: only randomized clinical trials, only studies with fully immersive VR, and only CR for the adult population with mental disorders. Results: We found 4905 (database) plus 7 (manual/citation searching articles) eligible studies. According to inclusion criteria, 11 studies were finally reviewed. Of these, nine included patients with mild cognitive impairment, one with schizophrenia, and one with mild dementia. Most studies used an ecological scenario, with improvement across all cognitive domains. Although eight studies showed significant efficacy of CR/VR, the interventions’ development was poorly described, and few details were given on the interventions’ components. Conclusions: Although CR/VR seems to be effective in clinical and feasibility outcomes, the interventions and their components are not clearly described. This limits the understanding of the effectiveness and undermines their real-world implementation and the establishment of a gold standard for fully immersive VR/CR. KW - virtual reality KW - cognitive remediation KW - mental health KW - recovery KW - psychiatric rehabilitation Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-304948 SN - 1660-4601 VL - 20 IS - 2 ER - TY - JOUR A1 - Perra, Alessandra A1 - Galetti, Alessia A1 - Zaccheddu, Rosanna A1 - Locci, Aurora A1 - Piludu, Federica A1 - Preti, Antonio A1 - Primavera, Diego A1 - Di Natale, Lorenzo A1 - Nardi, Antonio Egidio A1 - Kurotshka, Peter Konstantin A1 - Cossu, Giulia A1 - Sancassiani, Federica A1 - Stella, Giusy A1 - De Lorenzo, Valerio A1 - Zreik, Thurayya A1 - Carta, Mauro Giovanni T1 - A recovery-oriented program for people with bipolar disorder through virtual reality-based Cognitive Remediation: results of a feasibility randomized clinical trial JF - Journal of Clinical Medicine N2 - Background: Cognitive impairment is a frequent consequence of bipolar disorder (BD) that is difficult to prevent and treat. In addition, the quality of the preliminary evidence on the treatment of BD through Cognitive Remediation (CR) with traditional methods is poor. This study aims to evaluate the feasibility of a CR intervention with fully immersive Virtual Reality (VR) as an additional treatment for BD and offers preliminary data on its efficacy. Methods: Feasibility randomized controlled cross-over clinical study, with experimental condition lasting three months, crossed between two groups. Experimental condition: CR fully immersive VR recovery-oriented program plus conventional care; Control condition: conventional care. The control group began the experimental condition after a three months period of conventional care (waiting list). After the randomization of 50 people with BD diagnosis, the final sample consists of 39 participants in the experimental condition and 25 in the control condition because of dropouts. Results: Acceptability and tolerability of the intervention were good. Compared to the waitlist group, the experimental group reported a significant improvement regarding cognitive functions (memory: p = 0.003; attention: p = 0.002, verbal fluency: p = 0.010, executive function: p = 0.003), depressive symptoms (p = 0.030), emotional awareness (p = 0.007) and biological rhythms (p = 0.029). Conclusions: The results are preliminary and cannot be considered exhaustive due to the small sample size. However, the evidence of efficacy, together with the good acceptability of the intervention, is of interest. These results suggest the need to conduct studies with larger samples that can confirm this data. Trial registration: ClinicalTrialsgov NCT05070065, registered in September 2021 KW - virtual reality KW - Cognitive Remediation KW - mental health KW - recovery Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-311201 SN - 2077-0383 VL - 12 IS - 6 ER - TY - JOUR A1 - Albert, Judith A1 - Lezius, Susanne A1 - Störk, Stefan A1 - Morbach, Caroline A1 - Güder, Gülmisal A1 - Frantz, Stefan A1 - Wegscheider, Karl A1 - Ertl, Georg A1 - Angermann, Christiane E. T1 - Trajectories of Left Ventricular Ejection Fraction After Acute Decompensation for Systolic Heart Failure: Concomitant Echocardiographic and Systemic Changes, Predictors, and Impact on Clinical Outcomes JF - Journal of the American Heart Association N2 - Prospective longitudinal follow‐up of left ventricular ejection fraction (LVEF) trajectories after acute cardiac decompensation of heart failure is lacking. We investigated changes in LVEF and covariates at 6‐months' follow‐up in patients with a predischarge LVEF ≤40%, and determined predictors and prognostic implications of LVEF changes through 18‐months' follow‐up. Methods and Results Interdisciplinary Network Heart Failure program participants (n=633) were categorized into subgroups based on LVEF at 6‐months' follow‐up: normalized LVEF (>50%; heart failure with normalized ejection fraction, n=147); midrange LVEF (41%–50%; heart failure with midrange ejection fraction, n=195), or persistently reduced LVEF (≤40%; heart failure with persistently reduced LVEF , n=291). All received guideline‐directed medical therapies. At 6‐months' follow‐up, compared with patients with heart failure with persistently reduced LVEF, heart failure with normalized LVEF or heart failure with midrange LVEF subgroups showed greater reductions in LV end‐diastolic/end‐systolic diameters (both P<0.001), and left atrial systolic diameter (P=0.002), more increased septal/posterior end‐diastolic wall‐thickness (both P<0.001), and significantly greater improvement in diastolic function, biomarkers, symptoms, and health status. Heart failure duration <1 year, female sex, higher predischarge blood pressure, and baseline LVEF were independent predictors of LVEF improvement. Mortality and event‐free survival rates were lower in patients with heart failure with normalized LVEF (P=0.002). Overall, LVEF increased further at 18‐months' follow‐up (P<0.001), while LV end‐diastolic diameter decreased (P=0.048). However, LVEF worsened (P=0.002) and LV end‐diastolic diameter increased (P=0.047) in patients with heart failure with normalized LVEF hospitalized between 6‐months' follow‐up and 18‐months' follow‐up. Conclusions Six‐month survivors of acute cardiac decompensation for systolic heart failure showed variable LVEF trajectories, with >50% showing improvements by ≥1 LVEF category. LVEF changes correlated with various parameters, suggesting multilevel reverse remodeling, were predictable from several baseline characteristics, and were associated with clinical outcomes at 18‐months' follow‐up. Repeat hospitalizations were associated with attenuation of reverse remodeling." KW - acute heart failure KW - left ventricular ejection fraction KW - morbidity KW - mortality KW - natriuretic peptide KW - recovery Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-230210 VL - 10 ER - TY - JOUR A1 - Sperlich, Billy A1 - Becker, Martin A1 - Hotho, Andreas A1 - Wallmann-Sperlich, Birgit A1 - Sareban, Mahdi A1 - Winkert, Kay A1 - Steinacker, Jürgen M. A1 - Treff, Gunnar T1 - Sedentary behavior among national elite rowers during off-training — a pilot study JF - Frontiers in Physiology N2 - The aim of this pilot study was to analyze the off-training physical activity (PA) profile in national elite German U23 rowers during 31 days of their preparation period. The hours spent in each PA category (i.e., sedentary: <1.5 metabolic equivalents (MET); light physical activity: 1.5–3 MET; moderate physical activity: 3–6 MET and vigorous intense physical activity: >6 MET) were calculated for every valid day (i.e., >480 min of wear time). The off-training PA during 21 weekdays and 10 weekend days of the final 11-week preparation period was assessed by the wrist-worn multisensory device Microsoft Band II (MSBII). A total of 11 rowers provided valid data (i.e., >480 min/day) for 11.6 week days and 4.8 weekend days during the 31 days observation period. The average sedentary time was 11.63 ± 1.25 h per day during the week and 12.49 ± 1.10 h per day on the weekend, with a tendency to be higher on the weekend compared to weekdays (p = 0.06; d = 0.73). The average time in light, moderate and vigorous PA during the weekdays was 1.27 ± 1.15, 0.76 ± 0.37, 0.51 ± 0.44 h per day, and 0.67 ± 0.43, 0.59 ± 0.37, 0.53 ± 0.32 h per weekend day. Light physical activity was higher during weekdays compared to the weekend (p = 0.04; d = 0.69). Based on our pilot study of 11 national elite rowers we conclude that rowers display a considerable sedentary off-training behavior of more than 11.5 h/day. KW - recovery KW - sedentary behavior KW - accelerometer KW - microsoft band 2 KW - multi-sensor KW - wearable Y1 - 2017 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-158753 VL - 8 IS - 655 ER - TY - JOUR A1 - Dempfle, Astrid A1 - Herpertz-Dahlmann, Beate A1 - Timmesfeld, Nina A1 - Schwarte, Reinhild A1 - Egberts, Karin M. A1 - Pfeiffer, Ernst A1 - Fleischhaker, Christian A1 - Wewetzer, Christoph A1 - Bühren, Katharina T1 - Predictors of the resumption of menses in adolescent anorexia nervosa JF - BMC Psychiatry N2 - Background: The resumption of menses is an important indicator of recovery in anorexia nervosa (AN). Patients with early-onset AN are at particularly great risk of suffering from the long-term physical and psychological consequences of persistent gonadal dysfunction. However, the clinical variables that predict the recovery of menstrual function during weight gain in AN remain poorly understood. The aim of this study was to investigate the impact of several clinical parameters on the resumption of menses in first-onset adolescent AN in a large, well-characterized, homogenous sample that was followed-up for 12 months. Methods: A total of 172 female adolescent patients with first-onset AN according to DSM-IV criteria were recruited for inclusion in a randomized, multi-center, German clinical trial. Menstrual status and clinical variables (i.e., premorbid body mass index (BMI), age at onset, duration of illness, duration of hospital treatment, achievement of target weight at discharge, and BMI) were assessed at the time of admission to or discharge from hospital treatment and at a 12-month follow-up. Based on German reference data, we calculated the percentage of expected body weight (%EBW), BMI percentile, and BMI standard deviation score (BMI-SDS) for all time points to investigate the relationship between different weight measurements and resumption of menses. Results: Forty-seven percent of the patients spontaneously began menstruating during the follow-up period. %EBW at the 12-month follow-up was strongly correlated with the resumption of menses. The absence of menarche before admission, a higher premorbid BMI, discharge below target weight, and a longer duration of hospital treatment were the most relevant prognostic factors for continued amenorrhea. Conclusions: The recovery of menstrual function in adolescent patients with AN should be a major treatment goal to prevent severe long-term physical and psychological sequelae. Patients with premenarchal onset of AN are at particular risk for protracted amenorrhea despite weight rehabilitation. Reaching and maintaining a target weight between the 15th and 20th BMI percentile is favorable for the resumption of menses within 12 months. Whether patients with a higher premorbid BMI may benefit from a higher target weight needs to be investigated in further studies. KW - girls KW - amenorrhea KW - brain KW - increases KW - return KW - menarche KW - target weight KW - adolescence anorexia nervosa KW - resumption of menses KW - recovery KW - ovarian function KW - weight gain KW - eating disorders KW - bone-mineral density KW - menstrual recovery KW - outcome KW - body mass index Y1 - 2013 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-122106 VL - 13 IS - 308 ER - TY - THES A1 - Rieger, Reinhard T1 - Einflussfaktoren auf die Thrombozytenregeneration nach Hochdosischemotherapie und autologer Stammzelltransplantation - Untersuchung anhand multipler Regressionsanalysen T1 - Influencing factors for the recovery of the platelet count after high-dose therapy and autologous stem cell transplantation - Study based on multiple regression analyses N2 - Das Verfahren der Hochdosischemotherapie mit nachfolgender autologer Stammzelltransplantation ist eine etablierte, gut untersuchte Therapieoption in der Behandlung hämatoonkologischer Erkrankungen. Die sich dabei entwickelnde Thrombozytopenie stellt einen der therapielimitierenden Faktoren dar, wobei sich hier große interindividuelle Unterschiede zeigen. Das Ziel dieser Arbeit war es, mögliche Einflussfaktoren auf die Regeneration der Thrombozytenzahlen nach Hochdosistherapie und autologer Transplantation zu untersuchen. Hierzu erfolgte eine retrospektive Untersuchung von 110 Patientendaten, die von 1994 bis 2003 an der Medizinischen Klinik und Poliklinik II des Universitätsklinikums behandelt wurden. Die Thrombozytenzahlen wurden vier Wochen, drei Monate und sechs Monate nach Transplantation dokumentiert, außerdem wurde die Dauer in Tagen bis zu dem Erreichen der beiden Thrombozytenschwellenwerte 10.000/µl und 20.000/µl untersucht. An potentiellen Einflussfaktoren gingen das Alter zum Zeitpunkt der Transplantation, der body mass index zum Zeitpunkt der Transplantation, das Geschlecht, das Vorhandensein einer vorausgegangenen Ganzkörperbestrahlung, das Vorhandensein einer Antibiotikagabe aufgrund einer transplantationsassoziierten Infektion, die Aplasiedauer, die Anzahl der transfundierten CD34+-Zellen, die Anzahl der transfundierten colony forming units (CFUs), die Anzahl der transfundierten blood forming units (BFUs), das Vorliegen eines Rezidivs und der Thrombozytenausgangswert vor Hochdosistherapie in die Analyse ein. An statistischen Testverfahren wurde der Mann-Whitney-U-Test, der Kruskal-Wallis-Test und der Korrelationskoeffizient nach Spearman verwendet, bei nachgewiesenem potentiellen Zusammenhang erfolgte eine Quantifizierung mittels multipler Regressionsanalysen. Anhand der beiden nichtparametrischen Testverfahren und der Bestimmung des Korrelationskoeffizienten nach Spearman konnte gezeigt werden, dass für die Parameter „Ausgangswert der Thrombozyten vor Hochdosistherapie“, „Dauer der Aplasie“ und „Vorliegen einer Ganzkörperbestrahlung“ ein systematischer Zusammenhang zu den Thrombozytenwerten nach vier Wochen, drei Monaten bzw. sechs Monaten vorliegt. An den beiden Schwellenwerten „Dauer bis Thrombozytenzahl 10.000/µl“ und „Dauer bis Thrombozytenzahl 20.000/µl“ galt das für die Variablen „Dauer der Aplasie“, „Vorhandensein einer Antibiotikatherapie“ und „Geschlecht“. Für die restlichen Parameter konnte keine signifikante Korrelation zu den Thrombozytenzahlen gezeigt werden, was insbesondere für Anzahl der transfundierten CD34+-Zellen, CFUs bzw. BFUs überraschte und anhand klinischer Vorüberlegungen nicht zu erwarten war. Mit Hilfe der oben genannten Parameter, für die ein nichtzufälliger Zusammenhang zu den Thrombozytenzahlen gezeigt werden konnte, erfolgten zu den drei Messpunkten und den zwei Schwellenwerten separate multiple Regressionsanalysen. Im Ergebnis konnten fünf Gleichungen formuliert werden, die, nach Einsetzen der Prädiktoren „Dauer der Aplasie“, „Thrombozytenausgangswert vor Transplantation“ und „Geschlecht“ eine Prognose der Thrombozytenzahlen zu den entsprechenden Zeitpunkten und Zielwerten ermöglichen. Ein möglicher klinischer Einsatz dieser Ergebnisse wäre die Identifikation von Risiko- und Hochrisikogruppen im Vorfeld einer Hochdosischemotherapie und autologer Stammzelltransplantation anhand prognostizierter Thrombozytenwerte. Dies würde ein angepasstes therapeutisches und diagnostisches Vorgehen ermöglichen, wodurch die Sicherheit des Verfahrens und der Krankheitsverlauf verbessert werden könnten. N2 - The protocol of high-dose chemotherapy with autologous stem cell transplantation is an approved and established option in the treatment of haematological malignancies. The developing thrombocytopenia is one of the limiting factors of this therapy, but there are large interindividual differences. The purpose of this study was to identify possible factors of influence for the recovery of the platelet count after high-dose therapy and autologous stem cell transplantation. In order to do this we did a retrospective study that analyses the data of 110 patients, who were treated by the department of medical clinic II of the University Hospital in Würzburg in the years 1994 to 2003. The platelet counts were documented four weeks, three months and six months after the autologous transplantation. Furthermore the duration of time taken for the platelet count of 10.000/µl and 20.000/µl was reviewed. The following parameters were used as potential predictors: age at the time of transplantation, body mass index at the time of transplantation, gender, previous total body irradiation, antibiotics given because of transplantation-associated infections, duration of aplasia, number of transfused CD34+-cells, number of transfused colony forming units (CFUs), number of transfused blood forming units (BFUs), relapse, and the platelet count before high-dose therapy. For the statistical evaluation the Mann-Whitney-U-Test, the Kruskal-Wallis-Test and Spearman´s rank correlation coefficient were used. The quantification of proved correlation was done by multiple regression analyses. The results of the two nonparametric tests and Spearman´s correlation coefficient showed that there was a systematic correlation for the parameters “platelet count before high-dose therapy”, “duration of aplasia” and “previous total body irradiation” to the platelet count after four weeks, three months and six months. There were also significant correlations to the two thresholds “duration until platelet count 10.000/µl” and “duration until platelet count 20.000/µl” for the variables “duration of aplasia”, “antibiotics because of associated infections” and “gender”. The remaining parameters were tested negative. This was surprising under clinical considerations, especially for the numbers of transfused CD34+-cells, CFUs and BFUs. The above mentioned significant, non-random parameters were used for the multiple regression analyses, one analysis for each of the three measurement points and the two thresholds. In the result there were five equations, which allow you to predict the platelet counts at the measurement points and thresholds. You only have to know and insert the duration of aplasia, the gender and the platelet count before high-dose therapy. A possible clinical application of predicted platelet counts could be the identification of risk and high risk groups before the application of high-dose therapy with autologous transplantation. Adjusted therapeutic and diagnostic procedures could improve the safety of the protocol with a possible positive effect on the course of the disease. KW - Regeneration KW - Thrombozyt KW - Blutstammzelle KW - Stammzelle KW - Autogene Transplantation KW - Hochdosischemotherapie KW - Regressionsanalyse KW - Multiple Regression KW - Einflussfaktoren KW - Thromboyztenregeneration KW - CFU KW - BFU KW - influencing factors KW - recovery KW - platelet count KW - high-dose chemotherapy KW - autologous stem cell transplantation Y1 - 2011 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-76288 ER - TY - THES A1 - Pracher, Florian T1 - Verhalten von C-Fasern der Maus während repetitiver elektrischer Stimulation : Bedeutung für die Fasererregbarkeit und die Rolle von Ih und Nav1.8 T1 - Behaviour of c-fibres in mice during repetitive electrical stimulation: contribution to fibre excitability and role of Ih and Nav1.8 N2 - Die Axone im peripheren Nerven unterliegen während elektrischer Erregung kontinuierlichen dynamischen Änderungen ihrer Membraneigenschaften. Auf ein Aktionspotential folgt zunächst die absolute und die relative Refraktärperiode, dann eine Periode der Übererregbarkeit („superexcitability“) und schliesslich die Zeit der späten Untererregbarkeit („delayed subexcitability“). Stimuliert man unmyelinisierte Nervenfasern über einen längeren Zeitraum, so kommt es zu einer kontinuierlichen Erhöhung der Reizschwelle und damit einhergehend zu einer Zunahme der Latenz (=“activity dependent slowing“). Dabei bestehen Unterschiede zwischen den einzelnen funktionellen Faserklassen. In dieser Arbeit konnte erstmals bei Ableitung von C-Fasern in C57BL/6 Mäusen in vitro gezeigt werden, dass hitzeunempfindliche CM- und CMC-Fasern während elektrischer Stimulation eine geringere Latenzzunahme erfuhren als hitzesensible CMH- und CMHC-Fasern, auch in der Fasererholung bestanden Unterschiede zwischen beiden Gruppen. Dass in diesem Porozess Ih–Kanäle die Latenzzunahme v.a. bei den hitzeunempfindlichen Fasern limitieren, konnte in Experimenten mit den Ih-Kanal-Blockern CsCl (5mM) und ZD 7288 (1-50µM) gezeigt werden. In Ableitungen von C-Fasern in Mäusen mit Inaktivierung des Gens von Nav1.8 kam es vor allem bei den hitzeempfindlichen Fasern häufiger zu Leitungsblocks, die Latenzänderungen waren geringer als bei den Wildtyp-Tieren. Ströme durch diesen Kanal scheinen einerseits für die Leitungssicherheit der Fasern eine Rolle zu spielen, andererseits scheinen sie auch über einen erhöhten Natriumeinstrom während des Aktionspotentials und damit einer stärkeren Aktivierung der Na+/K+-ATPase die Dauer der Refraktärperiode zu beeinflussen. Beide Mechanismen beeinflussen somit die Reizschwelle und damit die Erregbarkeit einer Faser. Sowohl die Kinetik von Ih als auch die von Nav1.8 wird durch Entzündungsmediatoren beeinflusst, damit werden sie zu interessanten Kandidaten bei der Sensibilisierung von Fasern im Rahmen von inflammatorischen und neuropathischen Schmerzen. N2 - During electrical stimulation axons of a peripheral nerve are subject to dynamic changes of their membrane properties. An action potential is directly followed by the absolute and relative refractory period, subsequently a period of superexcitability and finally a period of delayed subexcitability. Stimulating an unmyelinated nerve fibre over a longer period of time leads to a continuous increase of threshold together with a prolongation of latency, a phenomena named activity dependent slowing. These properties differ for distinct functional fibre classes. Here, using recordings of C-fibres in C57Bl6 mice in vitro it could be shown for the first time that heat-insensitive CM- and CMC-fibres showed a smaller latency increase following electric stimulation than heat-sensitive CMH- and CMHC-fibres. Corresponding differences in recovery between both groups could be observed. In experiments with the Ih–channel blockers CsCl (5 mM) and ZD 7288 (1-50µM) it could be shown that currents through Ih–channels limited the latency increase especially in heat-insensitive units. In recordings of C-fibres in mice with an inactivation of the gene encoding for Nav1.8 the number of conduction blocks increased and the latency shifts decreased compared to fibres recorded in wild type mice. Therefore on the one hand currents carried by this channel seem to be important for conduction safety, on the other hand they seem to influence the duration of the refractory period through an increased sodium influx during the action potential and a consequent increased activation of the sodium pump. Both mechanisms therefore determine threshold and excitability of a fibre. The kinetics of Ih as well as that of Nav1.8 are effected by mediators of inflammation which makes them interesting candidates for fibre sensitisation in inflammatory and neuropathic pain. KW - C-Faser KW - Erregbarkeit KW - Latenzänderung KW - Ih KW - Nav1.8 KW - c-fibre KW - excitability KW - recovery KW - latency shift KW - activity-dependent slowing Y1 - 2004 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-7933 ER -