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Fricke S, Seinsche RJ, Neudert MK, Schäfer A, Zehtner RI, Stark R, Hermann A. Neural correlates of context-dependent extinction recall in social anxiety disorder: relevance of intrusions in response to aversive social experiences. Psychol Med 2024; 54:548-557. [PMID: 37553977 DOI: 10.1017/s0033291723002179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/10/2023]
Abstract
BACKGROUND There are phenomenological similarities between social anxiety disorder (SAD) and posttraumatic stress disorder, such as a provoking aversive event, posttraumatic stress symptoms (e.g. intrusions) in response to these events and deficient (context-dependent) fear conditioning processes. This study investigated the neural correlates of context-dependent extinction recall and fear renewal in SAD, specifically in patients with intrusions in response to an etiologically relevant aversive social event. METHODS During functional magnetic resonance imaging a two-day context-dependent fear conditioning paradigm was conducted in 54 patients with SAD and 54 healthy controls (HC). This included fear acquisition (context A) and extinction learning (context B) on one day, and extinction recall (context B) as well as fear renewal (contexts C and A) one day later. The main outcome measures were blood oxygen level-dependent responses in regions of interest and skin conductance responses. RESULTS Patients with SAD showed reduced differential conditioned amygdala activation during extinction recall in the safe extinction context and during fear renewal in the acquisition context compared to HC. Patients with clinically relevant intrusions moreover exhibited hypoactivation of the ventromedial prefrontal cortex (vmPFC) during extinction learning, extinction recall, and fear renewal in a novel context, while amygdala activation more strongly decreased during extinction learning and increased during fear renewal in the acquisition context compared with patients without intrusions. CONCLUSIONS Our study provides first evidence that intrusions in SAD are associated with similar deficits in context-dependent regulation of conditioned fear via the vmPFC as previously demonstrated in posttraumatic stress disorder.
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Affiliation(s)
- Susanne Fricke
- Department of Psychotherapy and Systems Neuroscience, Justus Liebig University Giessen, Giessen, Germany
- Bender Institute of Neuroimaging, Justus Liebig University Giessen, Giessen, Germany
| | - Rosa J Seinsche
- Department of Psychotherapy and Systems Neuroscience, Justus Liebig University Giessen, Giessen, Germany
- Bender Institute of Neuroimaging, Justus Liebig University Giessen, Giessen, Germany
| | - Marie K Neudert
- Department of Psychotherapy and Systems Neuroscience, Justus Liebig University Giessen, Giessen, Germany
- Bender Institute of Neuroimaging, Justus Liebig University Giessen, Giessen, Germany
| | - Axel Schäfer
- Bender Institute of Neuroimaging, Justus Liebig University Giessen, Giessen, Germany
- Center for Mind, Brain and Behavior, Phillips University Marburg and Justus Liebig University Giessen, Giessen, Germany
| | - Raphaela I Zehtner
- Department of Psychotherapy and Systems Neuroscience, Justus Liebig University Giessen, Giessen, Germany
- Bender Institute of Neuroimaging, Justus Liebig University Giessen, Giessen, Germany
| | - Rudolf Stark
- Department of Psychotherapy and Systems Neuroscience, Justus Liebig University Giessen, Giessen, Germany
- Bender Institute of Neuroimaging, Justus Liebig University Giessen, Giessen, Germany
- Center for Mind, Brain and Behavior, Phillips University Marburg and Justus Liebig University Giessen, Giessen, Germany
| | - Andrea Hermann
- Department of Psychotherapy and Systems Neuroscience, Justus Liebig University Giessen, Giessen, Germany
- Bender Institute of Neuroimaging, Justus Liebig University Giessen, Giessen, Germany
- Center for Mind, Brain and Behavior, Phillips University Marburg and Justus Liebig University Giessen, Giessen, Germany
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Neudert MK, Schäfer A, Zehtner RI, Fricke S, Seinsche RJ, Stark R, Hermann A. Decontextualized fear memories? Stronger conditioned fear responses during extinction learning and extinction recall in a safe context predict the development of long-term analog intrusions. Psychol Med 2024; 54:159-168. [PMID: 37129070 DOI: 10.1017/s0033291723001125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
BACKGROUND Difficulties in the context-dependent modulation of conditioned fear are known for posttraumatic stress disorder and may explain the occurrence of intrusive memories in safe contexts. The current study therefore investigated if reduced context-dependent modulation of conditioned fear and its underlying neural circuitry constitute risk factors for the development of analog intrusions in response to an experimental trauma. METHODS Eighty-five healthy women participated in the trauma film paradigm to investigate the development of analog intrusions as well as explicit memory for an experimental trauma after one week and three months, respectively. Before, participants underwent a context-dependent fear conditioning paradigm during functional magnetic resonance imaging with fear acquisition in context A and extinction training in context B on a first day, as well as extinction recall in context B and fear renewal in a novel context C one day later. Skin conductance responses (SCRs) and blood oxygen level dependent responses were main outcome measures. RESULTS In addition to stronger fear acquisition in context A, stronger conditioned fear responses in the safe context B, as indicated by stronger conditioned SCRs or stronger activation of fear expressing regions during extinction learning and recall, predicted the development of long-term analog intrusions. CONCLUSIONS Stronger fear responses in safe and danger contexts were risk factors for the development of long-term analog intrusions and point to decontextualized fear memories and difficulties in the context-dependent modulation of conditioned fear. Altered fear conditioning processes and reduced storage of contextual information may cause the occurrence of fear independent of context.
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Affiliation(s)
- Marie K Neudert
- Department of Psychotherapy and Systems Neuroscience, Justus Liebig University Giessen, Giessen, Germany
- Bender Institute of Neuroimaging, Justus Liebig University Giessen, Giessen, Germany
| | - Axel Schäfer
- Bender Institute of Neuroimaging, Justus Liebig University Giessen, Giessen, Germany
- Center for Mind, Brain and Behavior, Phillips University Marburg and Justus Liebig University Giessen, Giessen, Germany
| | - Raphaela I Zehtner
- Department of Psychotherapy and Systems Neuroscience, Justus Liebig University Giessen, Giessen, Germany
- Bender Institute of Neuroimaging, Justus Liebig University Giessen, Giessen, Germany
| | - Susanne Fricke
- Department of Psychotherapy and Systems Neuroscience, Justus Liebig University Giessen, Giessen, Germany
- Bender Institute of Neuroimaging, Justus Liebig University Giessen, Giessen, Germany
| | - Rosa J Seinsche
- Department of Psychotherapy and Systems Neuroscience, Justus Liebig University Giessen, Giessen, Germany
- Bender Institute of Neuroimaging, Justus Liebig University Giessen, Giessen, Germany
| | - Rudolf Stark
- Department of Psychotherapy and Systems Neuroscience, Justus Liebig University Giessen, Giessen, Germany
- Bender Institute of Neuroimaging, Justus Liebig University Giessen, Giessen, Germany
- Center for Mind, Brain and Behavior, Phillips University Marburg and Justus Liebig University Giessen, Giessen, Germany
| | - Andrea Hermann
- Department of Psychotherapy and Systems Neuroscience, Justus Liebig University Giessen, Giessen, Germany
- Bender Institute of Neuroimaging, Justus Liebig University Giessen, Giessen, Germany
- Center for Mind, Brain and Behavior, Phillips University Marburg and Justus Liebig University Giessen, Giessen, Germany
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Pagels L, Lüdtke K, Schäfer A. [Validation of the German version of the Fear-Avoidance Beliefs Questionnaire (FABQ-D) for shoulder disorders]. Schmerz 2023; 37:350-359. [PMID: 36692550 PMCID: PMC10511372 DOI: 10.1007/s00482-022-00689-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 12/09/2022] [Accepted: 12/12/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND With a prevalence of up to 30%, shoulder disorders form the third largest group of musculoskeletal complaints worldwide. Their formation and development are influenced by psychosocial factors such as movement-related fear. One of the internationally most common measurements for quantifying fear of movement is the Fear-Avoidance Beliefs Questionnaire (FABQ). OBJECTIVES To investigate the reliability (internal consistency) and validity (structural validity, construct validity, predictive validity) of the FABQ‑D in a shoulder pain population. MATERIALS AND METHODS Subjects with shoulder pain were included in a multicenter cross-sectional study. In addition to fear-avoidance beliefs, pain intensity, subjective impairment in daily life and kinesiophobia were recorded. To this end, the FABQ‑D, numeric rating scale (NRS), Shoulder and Pain Disability Index (SPADI) and the Tampa Scale for Kinesiophobia (TSK-GV) were used. RESULTS A total of 49 subjects (24 women and 25 men) with a mean age of 41.8 years (SD = 12.8) were included. The descriptive evaluation at item level showed good internal consistency of the FABQ‑D (Cronbach's α = 0.88). The homogeneity factor differs significantly between the subscales (Loevinger's H = 0.66-0.9). The correlation analyses did not show any clear convergence of the FABQ‑D with the TSK-GV (r = 0.3501; p = 0.0137). A divergence to the constructs of the NRS (r = 0.1818; p = 0.2112) and SPADI (r = 0.4415; p = 0.0015) were confirmed. The hypothesis testing resulted in 42.87% of the assumed hypotheses and therefore a low construct validity. The FABQ‑D and the TSK-GV showed a significant influence on the duration of the complaints (R2 = 0.3652; p ≤ 0.0001). It was also shown that the greatest factors for a high FABQ‑D value were functional impairment (SPADI) and duration of symptoms (R2 = 0.3066; p = 0.0002). The subgroup analysis showed a significantly higher FABQ‑D value in older subjects (40-65 years; t = 3.8084/df = 47, p = 0.0002). CONCLUSION The FABQ‑D is a reliable measurement tool. The construct validity should be further investigated in future studies. This study reproduced results from previous studies in other populations. The FABQ‑D appears to be an adequate measurement tool for quantifying fear of movement in patients with shoulder disorders.
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Affiliation(s)
- Larissa Pagels
- Institut für Gesundheitswissenschaften, Universität zu Lübeck, Ratzeburger Allee 160, 23562 Lübeck, Deutschland
- Fakultät für Soziale Arbeit und Gesundheit, HAWK: Hochschule für angewandte Wissenschaft und Kunst Hildesheim, Hildesheim, Deutschland
| | - Kerstin Lüdtke
- Institut für Gesundheitswissenschaften, Universität zu Lübeck, Ratzeburger Allee 160, 23562 Lübeck, Deutschland
| | - Axel Schäfer
- Fakultät für Soziale Arbeit und Gesundheit, HAWK: Hochschule für angewandte Wissenschaft und Kunst Hildesheim, Hildesheim, Deutschland
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Zehtner RI, Neudert MK, Schäfer A, Fricke S, Seinsche RJ, Stark R, Hermann A. Weathering the storm of emotions: immediate and lasting effects of reinterpretation and distancing on event-related potentials and their association with habitual use of cognitive reappraisal. Cogn Affect Behav Neurosci 2023; 23:1113-1128. [PMID: 37231103 PMCID: PMC10400673 DOI: 10.3758/s13415-023-01105-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/19/2023] [Indexed: 05/27/2023]
Abstract
Reinterpretation and distancing, two cognitive reappraisal tactics, are known to effectively reduce negative feelings and event-related potentials (ERPs), such as the P300 and the late positive potential (LPP), in the short-term. Less is known about differential and lasting effects on ERPs as well as their association with habitual reappraisal. Fifty-seven participants were instructed to passively view or reappraise (reinterpretation, distancing) pictures that were repeatedly presented with the same instruction (active regulation phase). Thirty minutes later, these pictures were shown again without instruction for the assessment of lasting effects (re-exposure phase). ERPs were recorded and participants rated the intensity of negative feelings following picture presentation. Reappraisal led to an attenuation of the LPP, and both tactics decreased negative feelings during active regulation, whereby reinterpretation had a stronger impact on the subjective level. Passive re-exposure resulted in reduced negative feelings for previously reappraised pictures but had no lasting effects on ERPs. Higher habitual reappraisal was associated with higher P300 and early LPP amplitudes for emotional reactivity during the active regulation phase. During the re-exposure phase, higher habitual reappraisal was not related to ERPs. The current findings emphasize the effectiveness of both tactics in the short-term and lasting effects on the subjective experience of negative feelings. Enhanced emotional reactivity on the electrocortical level in individuals with a more frequent habitual use of reappraisal might indicate a higher preparedness to regulate.
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Affiliation(s)
- Raphaela I Zehtner
- Department of Psychotherapy and Systems Neuroscience, Justus Liebig University Giessen, Otto-Behaghel-Str. 10H, Giessen, 35394, Germany.
- Bender Institute of Neuroimaging, Justus Liebig University Giessen, Gießen, Germany.
| | - Marie K Neudert
- Department of Psychotherapy and Systems Neuroscience, Justus Liebig University Giessen, Otto-Behaghel-Str. 10H, Giessen, 35394, Germany
- Bender Institute of Neuroimaging, Justus Liebig University Giessen, Gießen, Germany
| | - Axel Schäfer
- Department of Psychotherapy and Systems Neuroscience, Justus Liebig University Giessen, Otto-Behaghel-Str. 10H, Giessen, 35394, Germany
- Bender Institute of Neuroimaging, Justus Liebig University Giessen, Gießen, Germany
- Center for Mind, Brain and Behavior (CMBB), University of Marburg and Justus Liebig University Giessen, Marburg, Giessen, Germany
| | - Susanne Fricke
- Department of Psychotherapy and Systems Neuroscience, Justus Liebig University Giessen, Otto-Behaghel-Str. 10H, Giessen, 35394, Germany
- Bender Institute of Neuroimaging, Justus Liebig University Giessen, Gießen, Germany
| | - Rosa J Seinsche
- Department of Psychotherapy and Systems Neuroscience, Justus Liebig University Giessen, Otto-Behaghel-Str. 10H, Giessen, 35394, Germany
- Bender Institute of Neuroimaging, Justus Liebig University Giessen, Gießen, Germany
| | - Rudolf Stark
- Department of Psychotherapy and Systems Neuroscience, Justus Liebig University Giessen, Otto-Behaghel-Str. 10H, Giessen, 35394, Germany
- Bender Institute of Neuroimaging, Justus Liebig University Giessen, Gießen, Germany
| | - Andrea Hermann
- Department of Psychotherapy and Systems Neuroscience, Justus Liebig University Giessen, Otto-Behaghel-Str. 10H, Giessen, 35394, Germany
- Bender Institute of Neuroimaging, Justus Liebig University Giessen, Gießen, Germany
- Center for Mind, Brain and Behavior (CMBB), University of Marburg and Justus Liebig University Giessen, Marburg, Giessen, Germany
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Neudert MK, Schäfer A, Zehtner RI, Fricke S, Seinsche RJ, Kruse O, Stark R, Hermann A. Behavioral pattern separation is associated with neural and electrodermal correlates of context-dependent fear conditioning. Sci Rep 2023; 13:5577. [PMID: 37019951 PMCID: PMC10076331 DOI: 10.1038/s41598-023-31504-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 03/13/2023] [Indexed: 04/07/2023] Open
Abstract
Hippocampus-dependent pattern separation is considered as a relevant factor for context discrimination and might therefore impact the contextual modulation of conditioned fear. However, the association between pattern separation and context-dependent fear conditioning has not been investigated so far. In the current study, 72 healthy female students completed the Mnemonic Similarity Task, a measure of behavioral pattern separation, in addition to a context-dependent fear conditioning paradigm during functional magnetic resonance imaging. The paradigm included fear acquisition in context A and extinction training in context B on a first day, as well as retrieval testing of the fear and extinction memories in the safe context B (extinction recall) and a novel context C (fear renewal) one day later. Main outcome measures comprised skin conductance responses (SCRs) and blood oxygen level-dependent responses in brain regions of the fear and extinction circuit. Regarding retrieval testing, pattern separation did not correlate with extinction recall, but with stronger dorsal anterior cingulate cortex activation and conditioned SCRs (trend) during fear renewal, indicating a stronger retrieval of the fear memory trace. Our findings suggest that behavioral pattern separation ability seems to be important for context-dependent fear modulation, which is impaired in patients with posttraumatic stress disorder.
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Affiliation(s)
- Marie K Neudert
- Department of Psychotherapy and Systems Neuroscience, Justus Liebig University Giessen, Giessen, Germany.
- Bender Institute of Neuroimaging, Justus Liebig University Giessen, Giessen, Germany.
| | - Axel Schäfer
- Bender Institute of Neuroimaging, Justus Liebig University Giessen, Giessen, Germany
- Center for Mind, Brain and Behavior, Phillips University Marburg and Justus Liebig University Giessen, Giessen, Germany
| | - Raphaela I Zehtner
- Department of Psychotherapy and Systems Neuroscience, Justus Liebig University Giessen, Giessen, Germany
- Bender Institute of Neuroimaging, Justus Liebig University Giessen, Giessen, Germany
| | - Susanne Fricke
- Department of Psychotherapy and Systems Neuroscience, Justus Liebig University Giessen, Giessen, Germany
- Bender Institute of Neuroimaging, Justus Liebig University Giessen, Giessen, Germany
| | - Rosa J Seinsche
- Department of Psychotherapy and Systems Neuroscience, Justus Liebig University Giessen, Giessen, Germany
- Bender Institute of Neuroimaging, Justus Liebig University Giessen, Giessen, Germany
| | - Onno Kruse
- Department of Psychotherapy and Systems Neuroscience, Justus Liebig University Giessen, Giessen, Germany
- Bender Institute of Neuroimaging, Justus Liebig University Giessen, Giessen, Germany
| | - Rudolf Stark
- Department of Psychotherapy and Systems Neuroscience, Justus Liebig University Giessen, Giessen, Germany
- Bender Institute of Neuroimaging, Justus Liebig University Giessen, Giessen, Germany
- Center for Mind, Brain and Behavior, Phillips University Marburg and Justus Liebig University Giessen, Giessen, Germany
| | - Andrea Hermann
- Department of Psychotherapy and Systems Neuroscience, Justus Liebig University Giessen, Giessen, Germany
- Bender Institute of Neuroimaging, Justus Liebig University Giessen, Giessen, Germany
- Center for Mind, Brain and Behavior, Phillips University Marburg and Justus Liebig University Giessen, Giessen, Germany
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Ranker AH, Schäfer A, Schöttker-Königer T, Davies-Knorr T, Greitemann B, Ranker A. Validity and Reliability of the German Version of the Locomotor Capabilities Index-5 (LCI-5). Z Orthop Unfall 2023; 161:19-28. [PMID: 33946116 DOI: 10.1055/a-1447-2170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Before foreign language questionnaires, such as patient reported outcome measures (PROMs), can be scientifically used in the national language, guideline-based translation, cultural adaptation and comprehensive verification of their validity and reliability are needed. The aim of this study was to assess the psychometric properties of the German version of the LCI-5 (LCI-5-D) on a sample of people with lower limb amputation (LLA). METHODS The LCI-5 was translated into German (LCI-5-D) based on the ISPOR guidelines for cross-cultural adaptation following pilot testing. The final LCI-5-D was administered to n = 52 lower limb amputees in order to determine the validity and reliability of both the total score and the subscores ("basic items" and "advanced items"). Internal consistency (Cronbach's alpha), test-retest reliability (ICC2,1), standard error of the mean (SEM), minimal detectable change (MDC), item-to-total correlation, and item-to-subscale correlation were calculated. Floor and ceiling effects were checked. For construct validity, the Rivermead Mobility Index (RMI) and timed up and go (TUG) test were correlated, and differences of defined subgroups (amputation height and prosthesis user type) were calculated. RESULTS On average, the score of the LCI-5-D was 40.13 ± 16.64 points. High ceiling effects were present for the subscale "basic items" (57.7% maximum score). Internal consistency showed excellent results (Cronbach's α = 0.97). A strong correlation to the RMI (r = 0.863; p < 0.001) and to the TUG (r = - 0.714; p < 0.001) demonstrated construct validity. Test-rest reliability was measured after an averaged time span of 5.3 ± 2.47 days and resulted in very high reliability [ICC (2,1) = 0.97; p < 0.001]. MDC was 7.57 points for the total score. CONCLUSION The LCI-5-D is a valid and reliable PROM for measuring mobility with prostheses in German-speaking lower limb amputees, which is rather suitable for people with low to moderate mobility abilities. It can be used in a German-speaking population.
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Affiliation(s)
- Anna Helena Ranker
- Klinik und Poliklinik für Orthopädie Physikalische Medizin und Rehabilitation, Klinikum der Universität München Klinik und Poliklinik für Orthopädie Physikalische Medizin und Rehabilitation, München, Germany.,Hochschule für angewandte Wissenschaft und Kunst Hildesheim/Holzminden/Göttingen, Hildesheim, Germany
| | - Axel Schäfer
- ELP, Hochschule für angewandte Wissenschaft und Kunst Hildesheim/Holzminden/Göttingen, Hildesheim, Germany
| | - Thomas Schöttker-Königer
- ELP, Hochschule für angewandte Wissenschaft und Kunst Hildesheim/Holzminden/Göttingen, Hildesheim, Germany
| | - Trisha Davies-Knorr
- Klinik und Poliklinik für Orthopädie Physikalische Medizin und Rehabilitation, Klinikum der Universität München Klinik und Poliklinik für Orthopädie Physikalische Medizin und Rehabilitation, München, Germany
| | | | - Alexander Ranker
- Klinik für Rehabilitationsmedizin, Medizinische Hochschule Hannover, Hannover, Germany
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Moaeri S, Hildebrandt O, Cassel W, Viniol C, Schäfer A, Kesper K, Sohrabi K, Gross V, Koehler U. [Analysis of Snoring in Patients with Obstructive Sleep Apnea (OSA) by Polysomnography and LEOSound]. Laryngorhinootologie 2023; 102:118-123. [PMID: 36580974 DOI: 10.1055/a-1949-3135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Snoring was monitored in patients with obstructive sleep apnea (OSA) using the LEOSound-Monitor and simultaneously polysomnographic (PSG) recording. In obstructive apneas snoring is normally apparent after apnea termination and the beginning of ventilation. We wanted to know how often obstructive apneas are terminated by ventilation in combination with snoring. METHODS AND INTENTION In 40 patients with OSA (AHI > 15/h) simultaneous polysomnographic recordings were performed amongst long-term respiratory sound monitoring using the LEOSound monitor. Patients' average age was 57±11 years. Average weight was 100±19 kg by a mean body mass index (BMI) of 33±7 kg/m2. 12 out of 40 recordings had to be rejected for further analysis because of artifacts. Snoring recorded by polysomnography was compared with snoring monitored by LEOSound. RESULTS 3778 obstructive apnea episodes were monitored. LEOSound identified snoring in 1921 (51,0%), polysomnography in 2229 (58,8%) obstructive apneas. Only in one patient there was a higher difference in snoring episodes between PSG and LEOSound. DISCUSSION In nearly 60% of obstructive apnea events we found snoring during apnea-terminating hyperpnoea. LEOSound is a good diagnostic tool to monitor snoring. It is necessary to clarify why only 60% of all obstructive events/hyperpnoea develop snoring. From a pathophysiological point of view opening of collapsed upper airway should lead in a very high percentage to turbulences in airstream and committed snoring.
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Affiliation(s)
- S Moaeri
- Klinik für Innere Medizin, SP Pneumologie, Intensiv- und Schlafmedizin, Philipps-Universität Marburg, Marburg
| | - Olaf Hildebrandt
- Klinik für Innere Medizin, SP Pneumologie, Intensiv- und Schlafmedizin, Philipps-Universität Marburg, Marburg
| | - W Cassel
- Klinik für Innere Medizin, SP Pneumologie, Intensiv- und Schlafmedizin, Philipps-Universität Marburg, Marburg
| | - C Viniol
- Klinik für Innere Medizin, SP Pneumologie, Intensiv- und Schlafmedizin, Philipps-Universität Marburg, Marburg
| | - A Schäfer
- Klinik für Innere Medizin, SP Pneumologie, Intensiv- und Schlafmedizin, Philipps-Universität Marburg, Marburg
| | - K Kesper
- Klinik für Innere Medizin, SP Pneumologie, Intensiv- und Schlafmedizin, Philipps-Universität Marburg, Marburg
| | - K Sohrabi
- Fachbereich Gesundheit, Technische Hochschule Mittelhessen, Gießen
| | - V Gross
- Fachbereich Gesundheit, Technische Hochschule Mittelhessen, Gießen
| | - Ulrich Koehler
- Klinik für Innere Medizin, SP Pneumologie, Intensiv- und Schlafmedizin, Philipps-Universität Marburg, Marburg
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Collasius V, Krämer J, Müller C, Schäfer A, Wittmar S, Beushausen U. Copingstrategien und Stimme – Einfluss von Stressbewältigungsstrategien auf stimmliche Missempfindungen und die stimmbezogene Lebensqualität bei Patient*innen mit Dysphonien. Sprache · Stimme · Gehör 2023. [DOI: 10.1055/a-1847-2825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
ZusammenfassungStrategien zur Stressbewältigung (Coping) sind für die Rehabilitation von Stimmpatient*innen von großer Bedeutung. Es fehlen jedoch aktuelle Evidenzen, die Zusammenhänge zwischen Copingstrategien und Dysphonien ausreichend belegen. Mithilfe einer Online-Befragung wurden erwachsene Stimmpatient*innen zum Grad der stimmlichen Missempfindung mittels der deutschen Fassung der Vocal Tract Discomfort Scale (VTD), der stimmbezogenen Lebensqualität mit dem Voice-Related Quality of Life-Fragebogen (VRQOL) und ihrem Umgang mit Stresssituationen im Coping-Inventar zum Umgang mit Stress-Situationen (CISS) befragt.Es lagen 72 gültige Fragebögen vor. Signifikante Korrelationen bestanden zwischen Aussagen, die mit maladaptivem Coping assoziiert sind und Werten der VTD bzw. des VRQOL. In Regressionsanalysen konnten maladaptive Copingstrategien als Prädiktor für den Grad der stimmlichen Missempfindung identifiziert werden. In der Stimmtherapie sollte zukünftig berücksichtigt werden, welche Rolle maladaptives Coping im individuellen Fall spielt.
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Affiliation(s)
- Valerie Collasius
- HAWK – Hochschule für angewandte Wissenschaft und Kunst Hildesheim/Holzminden/Göttingen
| | - Judith Krämer
- HAWK – Hochschule für angewandte Wissenschaft und Kunst Hildesheim/Holzminden/Göttingen
| | - Christin Müller
- HAWK – Hochschule für angewandte Wissenschaft und Kunst Hildesheim/Holzminden/Göttingen
| | - Axel Schäfer
- HAWK – Hochschule für angewandte Wissenschaft und Kunst Hildesheim/Holzminden/Göttingen
| | - Silke Wittmar
- HAWK – Hochschule für angewandte Wissenschaft und Kunst Hildesheim/Holzminden/Göttingen
| | - Ulla Beushausen
- HAWK – Hochschule für angewandte Wissenschaft und Kunst Hildesheim/Holzminden/Göttingen
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Pagels L, Lüdtke K, Schäfer A. [Kinesiophobia in shoulder disorders : Validation of the German version of the Tampa scale for kinesiophobia (TSK-GV)]. Schmerz 2022:10.1007/s00482-022-00678-2. [PMID: 36459204 DOI: 10.1007/s00482-022-00678-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 08/09/2022] [Accepted: 10/17/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND With a prevalence of 7-30%, shoulder disorders form the third largest group of musculoskeletal complaints. Their formation and development is influenced by, e.g. psychological factors. The Tampa scale for kinesiophobia (TSK) is the most common measure for quantifying fear of movement. OBJECTIVES To investigate the reliability and validity of the German version of the TSK (TSK-GV) in a shoulder pain population. MATERIALS AND METHODS Subjects with shoulder pain were included in a multicenter cross-sectional study. In addition to kinesiophobia, pain intensity, subjective impairment in daily life and fear-avoidance beliefs were recorded. RESULTS A total of 49 subjects (24 women and 25 men) with a mean age of 41.8 (SD = 12.8) were included. The descriptive evaluation at item level showed good internal consistency (Cronbach's α = 0.81). The homogeneity of the scale is poor (Loevinger's H = 0.35). The correlations did not show any clear convergence of the TSK-GV with the fear-avoidance beliefs questionnaire (FABQ) (r = 0.3501; p = 0.0137). The divergent validity was confirmed for both the numerical rating scale (NRS) (r = 0.1216; p = 0.4052) and the shoulder pain and disability index (SPADI) (r = 0.2571; p = 0.0745). The hypothesis testing resulted in 28.57% accepted hypotheses. There was a significant influence of the TSK-GV and the FABQ on the duration of complaints (R2 = 0.3652; p ≤ 0.0001), as well as an explained variance of the duration of complaints on the TSK-GV of R2 = 0.1834 (p = 0.0021). The subgroup analysis showed a significantly higher degree of kinesiophobia in male subjects (t = 3.8084/df = 47; p = 0.0002). CONCLUSION The TSK-GV is a reliable measurement tool. The construct validity should be further investigated in future studies. This study shows comparable values to previous studies in other populations. The TSK-GV is to date the only validated German language measure for recording fear of movement in shoulder disorders and shows an acceptable fit for this population.
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Affiliation(s)
- Larissa Pagels
- Institut für Gesundheitswissenschaften, Universität zu Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Deutschland.
| | - Kerstin Lüdtke
- Institut für Gesundheitswissenschaften, Universität zu Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Deutschland
| | - Axel Schäfer
- Hochschule für angewandte Wissenschaften und Kunst (HAWK) Hildesheim, Goschentor 1, 31134, Hildesheim, Deutschland
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10
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Papen A, Schöttker-Königer T, Schäfer A, Morrison F, Hollinger B, Burkhart KJ, Nietschke R, Zimmerer A, Maffulli N, Migliorini F, Schneider MM. Reliability, validity and critical appraisal of the cross-cultural adapted German version of the Mayo Elbow Performance Score (MEPS-G). J Orthop Surg Res 2022; 17:328. [PMID: 35752835 PMCID: PMC9233775 DOI: 10.1186/s13018-022-03210-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 05/31/2022] [Indexed: 11/30/2022] Open
Abstract
Background The Mayo Elbow Performance Score (MEPS) is a rating system consisting of four dimensions to evaluate elbow performance. It is a common tool for assessment of elbow impairments worldwide. We determined the validity and reliability of its German version (MEPS-G) after cross-cultural adaptation.
Methods Six investigators examined 57 patients with elbow pathologies. The MEPS-G was compared to validated elbow scores such as the German versions of DASH, the Oxford Elbow Score, pain level and subjective elbow performance on a VAS. Inter-rater reliability (IRR) and validity of the score and its dimensions were also reviewed. Verification was performed using the intraclass correlation coefficient (ICC), the prevalence and bias with adjusted Kappa (PABAK) and the Spearman correlation.
Results The IRR of the MEPS-G score was moderate (ICC (2.1) = 0.65). The IRR of the four individual dimensions was moderate to high (KPABAK = 0.55 -0.81). Validity for the sum score (r = 0.52–0.65) and the dimensions pain (r = 0.53–0.62), range of motion (r = 0.7) and stability (r = − 0.61) was verified. The function subscale reached insufficient validity (r = 0.15–0.39). Conclusion The MEPS-G is not sufficiently valid, which is consistent with its English version. The patient-based dimensions were a weakness, demonstrating high risk of bias. There is no general recommendation for the utilization of the MEPS-G as outcome measurement for patients with elbow pathologies.
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Affiliation(s)
- A Papen
- Faculty of Social Work and Health, University of Applied Science and Art (HAWK), Hildesheim, Germany
| | - T Schöttker-Königer
- Faculty of Social Work and Health, University of Applied Science and Art (HAWK), Hildesheim, Germany
| | - A Schäfer
- Faculty of Social Work and Health, University of Applied Science and Art (HAWK), Hildesheim, Germany
| | - F Morrison
- German Association for Manual Therapy (DVMT e.V.), Dresden, Germany
| | - B Hollinger
- Centre for Sports Orthopedics and Special Joint Surgery, Orthopedic Hospital Markgroeningen, Markgroeningen, Germany
| | - K J Burkhart
- Arcus Sportklinik, Pforzheim, Germany.,University of Cologne, Cologne, Germany
| | | | | | - N Maffulli
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Italy.,School of Pharmacy and Bioengineering, Keele University School of Medicine, Thornburrow Drive, Stoke on Trent, UK.,Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - F Migliorini
- Department of Orthopedics, Trauma and Reconstructive Surgery, RWTH Aachen University Hospital, Aachen, Germany
| | - Marco M Schneider
- Arcus Sportklinik, Pforzheim, Germany. .,University of Witten/Herdecke, Witten, Germany.
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11
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Schäfer A, Löffler-Idel I, Adelt E, Fielder C, Reinhardt A, Wilhelm N, Lochwitz A, Paelke V. Evaluation eines mHealth unterstützten Heimübungsprogramms für Menschen mit Kniearthrose (mhexos). physioscience 2022. [DOI: 10.1055/a-1405-5023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Zusammenfassung
Hintergrund Kniearthrose ist einer der Hauptgründe für Behinderungen und Mobilitätseinschränkungen bei älteren Menschen, die mit Leid und hohen Krankheitskosten verbunden sind. Nicht operative Therapien wie Übungstherapie, Maßnahmen zur Steigerung der körperlichen Aktivität und zur Unterstützung des Selbstmanagements können Schmerzen verringern sowie die Funktion und gesundheitsbezogene Lebensqualität verbessern. Entsprechende Heimübungsprogramme sind ein wichtiger Baustein der Therapie, die Adhärenz ist jedoch oft nicht ausreichend. Digitale Gesundheitsanwendungen sind, insbesondere unter den Bedingungen der aktuellen COVID-19-Pandemie, eine vielversprechende Möglichkeit, um Barrieren zu überwinden.
Ziel Untersuchung der Implementierbarkeit eines mHealth-Heimübungsprogramms für Patient*innen mit Kniearthrose (mhexos) in Hinblick auf Bedienbarkeit, Erfahrungen von Nutzer*innen, Nutzungsverhalten und der Veränderung gesundheitsbezogener Endpunkte.
Methode Patient*innen mit Kniearthrose führten das mHealth Heimübungsprogramm mhexos 4 Wochen lang durch. Die Umsetzung erfolgte über ein Tablet mit insgesamt 39 Übungsvideos zur Kräftigung, Balance und Koordination, die in 3 Schwierigkeitsstufen konfiguriert werden können. Über eine App wurden Daten zur Schmerzintensität und der selbst wahrgenommenen Belastung erfasst. Es wurden leitfadengestützte Interviews durchgeführt und Fragebögen zur Erfassung der Bedienbarkeit und der Erfahrungen der Nutzer*innen sowie zu gesundheitsbezogenen Endpunkten an 2 Messzeitpunkten eingesetzt.
Ergebnisse Es wurden 10 Patient*innen und 7 Therapeut*innen eingeschlossen. Das mHealth-Heimübungsprogramm konnte in die Praxis und den Alltag der Teilnehmenden implementiert werden. Die App wurde überwiegend als bedienungsfreundlich und motivierend eingeschätzt, die Therapietreue war mit einer Übungsfrequenz von 2,7 × pro Woche (SD 0,6) hoch. In den gesundheitsbezogenen Endpunkten zeigten sich im Interventionszeitraum kleine, klinisch und statistisch nicht signifikante Veränderungen.
Schlussfolgerung: mhexos scheint geeignet, Heimübungsprogramme für Menschen mit Kniearthrose unter den Rahmenbedingungen der Routineversorgung zu unterstützen. Für eine weitergehende Beurteilung der klinischen Wirksamkeit sind kontrollierte Studien nötig.
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Affiliation(s)
- Axel Schäfer
- Hochschule für angewandte Wissenschaft und Kunst (HAWK) Hildesheim, Fakultät Soziale Arbeit und Gesundheit, Studiengänge Ergotherapie, Logopädie und Physiotherapie, Hildesheim, Deutschland
| | - Ingrid Löffler-Idel
- Hochschule für angewandte Wissenschaft und Kunst (HAWK) Hildesheim, Fakultät Soziale Arbeit und Gesundheit, Studiengänge Ergotherapie, Logopädie und Physiotherapie, Hildesheim, Deutschland
| | - Elisabeth Adelt
- Hochschule für angewandte Wissenschaft und Kunst (HAWK) Hildesheim, Fakultät Soziale Arbeit und Gesundheit, Studiengänge Ergotherapie, Logopädie und Physiotherapie, Hildesheim, Deutschland
| | - Christina Fielder
- Hochschule für angewandte Wissenschaft und Kunst (HAWK) Hildesheim, Fakultät Soziale Arbeit und Gesundheit, Studiengänge Ergotherapie, Logopädie und Physiotherapie, Hildesheim, Deutschland
| | - Angelika Reinhardt
- Hochschule für angewandte Wissenschaft und Kunst (HAWK) Hildesheim, Fakultät Soziale Arbeit und Gesundheit, Studiengänge Ergotherapie, Logopädie und Physiotherapie, Hildesheim, Deutschland
| | - Nathalie Wilhelm
- Hochschule für angewandte Wissenschaft und Kunst (HAWK) Hildesheim, Fakultät Soziale Arbeit und Gesundheit, Studiengänge Ergotherapie, Logopädie und Physiotherapie, Hildesheim, Deutschland
| | - Andreas Lochwitz
- Hochschule Bremen, Fakultät Elektrotechnik und Informatik, Bremen, Deutschland
| | - Volker Paelke
- Hochschule Bremen, Fakultät Elektrotechnik und Informatik, Bremen, Deutschland
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Sarwari H, Schäfer A, Reichenspurner H, Conradi L. Novel Percutaneous Plug-Based Vascular Closure Device for Minimally Invasive Valve Surgery: From Initial Experience to Routine Use. Thorac Cardiovasc Surg 2022. [DOI: 10.1055/s-0042-1742915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- H. Sarwari
- University Heart and Vascular Center Hamburg, Hamburg, Deutschland
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13
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Sarwari H, Bhadra O, Ludwig S, Schirmer J, Schofer N, Pecha S, Seiffert M, Blankenberg S, Reichenspurner H, Conradi L, Westermann D, Schäfer A. Transcatheter Aortic Valve Implantation after Previous Mitral Valve Repair or Replacement: Technical Considerations and Clinical Outcomes. Thorac Cardiovasc Surg 2022. [DOI: 10.1055/s-0042-1742922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- H. Sarwari
- University Heart and Vascular Center Hamburg, Hamburg, Deutschland
| | - O. Bhadra
- University Heart and Vascular Center Hamburg, Hamburg, Deutschland
| | - S. Ludwig
- Martinistraße 52, Hamburg, Deutschland
| | - J. Schirmer
- University Heart Center Hamburg GmbH, Hamburg, Deutschland
| | | | - S. Pecha
- Martinistraße 52, Hamburg, Deutschland
| | - M. Seiffert
- University Medical Center Hamburg-Eppendorf, Hamburg, Deutschland
| | | | | | | | - D. Westermann
- University Heart Centre Hamburg, Hamburg, Deutschland
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14
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Grüne B, Burger R, Bauer D, Schäfer A, Rothfuss A, Stallkamp J, Kriegmair M, Rassweiler-Seyfried MC. Robotic-assisted versus manual Uro-Dyna CT-guided puncture in an ex-vivo kidney model. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)01095-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Schrod S, Schäfer A, Solbrig S, Lohmayer R, Gronwald W, Oefner PJ, Beißbarth T, Spang R, Zacharias HU, Altenbuchinger M. OUP accepted manuscript. Bioinformatics 2022; 38:i60-i67. [PMID: 35758796 PMCID: PMC9235492 DOI: 10.1093/bioinformatics/btac221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
MOTIVATION Estimating the effects of interventions on patient outcome is one of the key aspects of personalized medicine. Their inference is often challenged by the fact that the training data comprises only the outcome for the administered treatment, and not for alternative treatments (the so-called counterfactual outcomes). Several methods were suggested for this scenario based on observational data, i.e. data where the intervention was not applied randomly, for both continuous and binary outcome variables. However, patient outcome is often recorded in terms of time-to-event data, comprising right-censored event times if an event does not occur within the observation period. Albeit their enormous importance, time-to-event data are rarely used for treatment optimization. We suggest an approach named BITES (Balanced Individual Treatment Effect for Survival data), which combines a treatment-specific semi-parametric Cox loss with a treatment-balanced deep neural network; i.e. we regularize differences between treated and non-treated patients using Integral Probability Metrics (IPM). RESULTS We show in simulation studies that this approach outperforms the state of the art. Furthermore, we demonstrate in an application to a cohort of breast cancer patients that hormone treatment can be optimized based on six routine parameters. We successfully validated this finding in an independent cohort. AVAILABILITY AND IMPLEMENTATION We provide BITES as an easy-to-use python implementation including scheduled hyper-parameter optimization (https://github.com/sschrod/BITES). The data underlying this article are available in the CRAN repository at https://rdrr.io/cran/survival/man/gbsg.html and https://rdrr.io/cran/survival/man/rotterdam.html. SUPPLEMENTARY INFORMATION Supplementary data are available at Bioinformatics online.
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Affiliation(s)
- S Schrod
- To whom correspondence should be addressed. E-mail: or
| | - A Schäfer
- Department of Physics, Institute of Theoretical Physics, University of Regensburg, Regensburg 93051, Germany
| | - S Solbrig
- Department of Physics, Institute of Theoretical Physics, University of Regensburg, Regensburg 93051, Germany
| | - R Lohmayer
- Leibniz Institute for Immunotherapy, Regensburg 93053, Germany
| | - W Gronwald
- Institute of Functional Genomics, University of Regensburg, Regensburg 93053, Germany
| | - P J Oefner
- Institute of Functional Genomics, University of Regensburg, Regensburg 93053, Germany
| | - T Beißbarth
- Department of Medical Bioinformatics, University Medical Center Göttingen, Göttingen 37077, Germany
| | - R Spang
- Department of Statistical Bioinformatics, Institute of Functional Genomics, University of Regensburg, Regensburg 93053, Germany
| | - H U Zacharias
- Department of Internal Medicine I, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel 24105, Germany
- Institute of Clinical Molecular Biology, Kiel University and University Medical Center Schleswig-Holstein, Campus Kiel, Kiel 24105, Germany
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Adelt E, Schoettker-Koeniger T, Luedtke K, Hall T, Schäfer A. Lumbar movement control in non-specific chronic low back pain: Evaluation of a direction-specific battery of tests using item response theory. Musculoskelet Sci Pract 2021; 55:102406. [PMID: 34139514 DOI: 10.1016/j.msksp.2021.102406] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 04/10/2021] [Accepted: 06/01/2021] [Indexed: 11/15/2022]
Abstract
QUESTION What tests are most useful to identify poor lumbar movement control (LMC) and what are the dimensional and psychometric properties of these tests? DESIGN Multicenter, cross-sectional cohort study. PARTICIPANTS Adults with non-specific chronic low back pain (NSCLBP). METHODS A literature review was conducted to identify LMC tests with good reliability (κ≥ 0.61) and their dimensionality was examined. Based on item response theory, psychometric properties of individual items and the entire battery of LMC tests were determined. RESULTS 277 participants with NSCLBP were included and tested by 21 physiotherapists in 19 clinics in Germany and Austria. 15 tests for LMC were assessed. The battery of LMC tests showed a direction-specific structure representing extension, flexion and rotation/lateral flexion control, for which unidimensionality and local independence were confirmed (eigenvalue >1; factor loading >0.4, Yen's Q3 <0.2). 4 items for flexion control, 4 items for extension control and 5 items for rotation/lateral flexion control were extracted. The flexion control items were the easiest items (item difficulty: 1.98 to -1.31). The rotation/lateral flexion control items were the most difficult (-1.3 to -0.08). More than 80% of all participants showed at least one incorrect direction of LMC. CONCLUSIONS A battery of LMC tests is proposed as the most appropriate to examine individuals with precise to poor LMC. Each direction of LMC should be examined separately. Tests can be sorted according to test difficulty, so that only three tests are initially required to screen for poor LMC.
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Affiliation(s)
- Elisabeth Adelt
- University of Applied Sciences and Arts Hildesheim, Faculty of Social Work and Health, Germany.
| | | | - Kerstin Luedtke
- University of Luebeck, Institute of Health Sciences, Department of Physiotherapy, Pain and Exercise Research (P.E.R.L.), Luebeck, Germany; Laboratory of Pain Research, Institute of Physiotherapy and Health Sciences, The Jerzy Kukuczka Academy of Physical Education, Katowice, Poland.
| | - Toby Hall
- Curtin School of Allied Health, Curtin University, Perth, WA, Australia.
| | - Axel Schäfer
- University of Applied Sciences and Arts Hildesheim, Faculty of Social Work and Health, Germany.
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Klute M, Laekeman M, Kuss K, Petzke F, Dieterich A, Leha A, Neblett R, Ehrhardt S, Ulma J, Schäfer A. Cross-cultural adaptation and validation of the German Central Sensitization Inventory (CSI-GE). BMC Musculoskelet Disord 2021; 22:708. [PMID: 34407773 PMCID: PMC8375049 DOI: 10.1186/s12891-021-04481-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 06/14/2021] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND The Central Sensitization Inventory (CSI) is a screening tool designed to detect symptoms related to Central Sensitization (CS) and Central Sensitivity Syndromes (CSS) by measuring the degree of related phenomena. The objective of this study was to create a German, culturally-adapted version of the CSI and to test its psychometric properties. METHODS A German version of the CSI (CSI-GE) was developed, culturally-adapted, and pretested for comprehensibility. The psychometric properties of the resulting version were validated in a clinical study with chronic pain and pain-free control subjects. To assess retest reliability, the CSI-GE was administered twice to a subgroup of patients. Structural validity was tested using factor analyses. To investigate construct validity a hypotheses testing approach was used, including (1) correlations between the CSI-GE and several other well-established questionnaires as well as (2) an investigation of the CSI-GE discriminative power between different subgroups of participants believed to have different degrees of CS. RESULTS The CSI-GE showed excellent reliability, including high test-retest characteristics. Factor analyses confirmed a bi-factor dimensionality as has been determined previously. Analysing construct validity 6 out of 11 hypotheses (55%) were met. CSI-GE scores differentiated between subgroups according to expectations. Correlations between CSI-GE scores and other questionnaires suggested that none of the correlated constructs was identical, but there was overlap with other questionnaires based on symptom load. Several correlations did not fit with our current understanding of CS. CONCLUSION The CSI-GE appears to be a reliable tool for measuring CS/CSS-related symptomatology. Whether this implies that the CSI-GE measures the degree of CS within an individual subject remains unknown. The resulting score should be interpreted cautiously until further clarification of the construct.
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Affiliation(s)
- Michel Klute
- Pain Clinic, Department of Anaesthesiology, University Medical Center, Georg August University of Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany.
| | - Marjan Laekeman
- Physiological Psychology, Otto-Friedrich- University of Bamberg, Bamberg, Germany
| | - Katrin Kuss
- Department of General Practice/Family Medicine, Philipps University Marburg, Marburg, Germany
| | - Frank Petzke
- Pain Clinic, Department of Anaesthesiology, University Medical Center, Georg August University of Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - Angela Dieterich
- Physiotherapy, Faculty of Health, Safety, Society, Furtwangen University, Furtwangen, Germany
| | - Andreas Leha
- Department of Medical Statistics, University Medical Center Göttingen, Göttingen, Germany
| | | | - Steffen Ehrhardt
- Faculty of Social Sciences, City University of Applied Sciences, Bremen, Germany
| | - Joachim Ulma
- Clinic for Pain Medicine Bremen, Rotes-Kreuz-Krankenhaus Bremen, Bremen, Germany
| | - Axel Schäfer
- Faculty of Social Work and Health, University of Applied Science and Art, Hildesheim, Germany
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Konnerth D, Schönecker S, Reitz D, Schäfer A, Niyazi M, Belka C, Corradini S. PO-1526 Targeted RT study: preliminary results on acute toxicity of targeted therapies and radiotherapy. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07977-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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19
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Hermann A, Neudert MK, Schäfer A, Zehtner RI, Fricke S, Seinsche RJ, Stark R. Lasting effects of cognitive emotion regulation: neural correlates of reinterpretation and distancing. Soc Cogn Affect Neurosci 2021; 16:268-279. [PMID: 33227135 PMCID: PMC7943369 DOI: 10.1093/scan/nsaa159] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 11/08/2020] [Accepted: 11/22/2020] [Indexed: 12/27/2022] Open
Abstract
Reinterpretation and distancing are two cognitive reappraisal tactics, used to regulate one’s emotions in response to emotion-eliciting stimuli or situations. Relatively less is known about their (differential) lasting effects on emotional responding and related neural correlates. This functional magnetic resonance imaging study investigated 85 healthy females, participating in a 2-day cognitive emotion regulation experiment. On the first day, participants were instructed to passively look at, reinterpret or distance from repeatedly presented aversive pictures. One week later, they were re-exposed to the same stimuli without regulation instruction, in order to assess lasting effects. The main outcome measures comprised ratings of negative feelings and blood-oxygen-level-dependent responses. Lasting effects for reinterpretation compared with looking at aversive pictures during passive re-exposure 1 week later were reflected in stronger activation of the left amygdala, the ventromedial prefrontal cortex (vmPFC) and reduced negative feelings. Neither distancing compared with looking at aversive pictures nor reinterpretation compared with distancing did result in significant effects during re-exposure. These findings indicate that reinterpretation leads to reduced negative feelings 1 week later, which might be mediated by inhibitory vmPFC activation or stronger positive emotions during re-exposure. However, the missing difference compared with distancing questions the specificity of the results and the mechanisms underlying these two cognitive reappraisal tactics.
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Affiliation(s)
- Andrea Hermann
- Department of Psychotherapy and Systems Neuroscience, Justus Liebig University Giessen, 35394 Giessen, Germany.,Bender Institute of Neuroimaging, Justus Liebig University Giessen, 35394 Giessen, Germany.,Center for Mind, Brain and Behavior (CMBB), University of Marburg and Justus Liebig University Giessen, 35394 Giessen, Germany
| | - Marie K Neudert
- Department of Psychotherapy and Systems Neuroscience, Justus Liebig University Giessen, 35394 Giessen, Germany.,Bender Institute of Neuroimaging, Justus Liebig University Giessen, 35394 Giessen, Germany
| | - Axel Schäfer
- Bender Institute of Neuroimaging, Justus Liebig University Giessen, 35394 Giessen, Germany.,Center for Mind, Brain and Behavior (CMBB), University of Marburg and Justus Liebig University Giessen, 35394 Giessen, Germany
| | - Raphaela I Zehtner
- Department of Psychotherapy and Systems Neuroscience, Justus Liebig University Giessen, 35394 Giessen, Germany.,Bender Institute of Neuroimaging, Justus Liebig University Giessen, 35394 Giessen, Germany
| | - Susanne Fricke
- Department of Psychotherapy and Systems Neuroscience, Justus Liebig University Giessen, 35394 Giessen, Germany.,Bender Institute of Neuroimaging, Justus Liebig University Giessen, 35394 Giessen, Germany
| | - Rosa J Seinsche
- Department of Psychotherapy and Systems Neuroscience, Justus Liebig University Giessen, 35394 Giessen, Germany.,Bender Institute of Neuroimaging, Justus Liebig University Giessen, 35394 Giessen, Germany
| | - Rudolf Stark
- Department of Psychotherapy and Systems Neuroscience, Justus Liebig University Giessen, 35394 Giessen, Germany.,Bender Institute of Neuroimaging, Justus Liebig University Giessen, 35394 Giessen, Germany.,Center for Mind, Brain and Behavior (CMBB), University of Marburg and Justus Liebig University Giessen, 35394 Giessen, Germany
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Braun U, Harneit A, Pergola G, Menara T, Schäfer A, Betzel RF, Zang Z, Schweiger JI, Zhang X, Schwarz K, Chen J, Blasi G, Bertolino A, Durstewitz D, Pasqualetti F, Schwarz E, Meyer-Lindenberg A, Bassett DS, Tost H. Brain network dynamics during working memory are modulated by dopamine and diminished in schizophrenia. Nat Commun 2021; 12:3478. [PMID: 34108456 PMCID: PMC8190281 DOI: 10.1038/s41467-021-23694-9] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Accepted: 04/27/2021] [Indexed: 02/06/2023] Open
Abstract
Dynamical brain state transitions are critical for flexible working memory but the network mechanisms are incompletely understood. Here, we show that working memory performance entails brain-wide switching between activity states using a combination of functional magnetic resonance imaging in healthy controls and individuals with schizophrenia, pharmacological fMRI, genetic analyses and network control theory. The stability of states relates to dopamine D1 receptor gene expression while state transitions are influenced by D2 receptor expression and pharmacological modulation. Individuals with schizophrenia show altered network control properties, including a more diverse energy landscape and decreased stability of working memory representations. Our results demonstrate the relevance of dopamine signaling for the steering of whole-brain network dynamics during working memory and link these processes to schizophrenia pathophysiology. Working memory requires the brain to switch between cognitive states and activity patterns. Here, the authors show that the steering of these neural network dynamics is influenced by dopamine D1- and D2-receptor function and altered in schizophrenia.
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Affiliation(s)
- Urs Braun
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany. .,Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, USA.
| | - Anais Harneit
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Giulio Pergola
- Department of Basic Medical Science, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Tommaso Menara
- Mechanical Engineering Department, University of California at Riverside, Riverside, CA, USA
| | - Axel Schäfer
- Bender Institute of Neuroimaging, Justus Liebig University Giessen, Gießen, Germany.,Center for Mind, Brain and Behavior, University of Marburg and Justus Liebig University Giessen, Gießen, Germany
| | - Richard F Betzel
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN, USA
| | - Zhenxiang Zang
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Janina I Schweiger
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Xiaolong Zhang
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Kristina Schwarz
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Junfang Chen
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Giuseppe Blasi
- Department of Basic Medical Science, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Alessandro Bertolino
- Department of Basic Medical Science, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Daniel Durstewitz
- Department of Theoretical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Fabio Pasqualetti
- Mechanical Engineering Department, University of California at Riverside, Riverside, CA, USA
| | - Emanuel Schwarz
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Andreas Meyer-Lindenberg
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Danielle S Bassett
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, USA.,Department of Psychiatry, University of Pennsylvania, Philadelphia, USA.,Department of Neurology, University of Pennsylvania, Philadelphia, USA.,Department of Physics & Astronomy, University of Pennsylvania, Philadelphia, USA.,Department of Electrical & Systems Engineering, University of Pennsylvania, Philadelphia, USA.,The Santa Fe Institute, Santa Fe, NM, USA
| | - Heike Tost
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
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Schäfer A, Wand BM, Lüdtke K, Ehrenbrusthoff K, Schöttker-Königer T. Validation and investigation of cross cultural equivalence of the Fremantle back awareness questionnaire - German version (FreBAQ-G). BMC Musculoskelet Disord 2021; 22:323. [PMID: 33794840 PMCID: PMC8017790 DOI: 10.1186/s12891-021-04156-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 03/08/2021] [Indexed: 11/21/2022] Open
Abstract
Background Disrupted self-perception of the low back might contribute to chronic non-specific low back pain. The Fremantle back awareness questionnaire is a simple questionnaire to assess back specific self-perception. The questionnaire has recently been translated to German (FreBAQ-G). The aim was to further investigate the psychometric properties of the FreBAQ-G, to evaluate its cross cultural validity in patients with chronic non-specific LBP and to explore potential relationships between body perception, pain, disability and back pain beliefs. Methods In this cross-sectional multicentre study, sample data were merged with data from the validation sample of the original English version to examine cross-cultural validity. Item Response Theory was used to explore psychometric properties and differential item function (DIF) to evaluate cross-cultural validity and item invariance. Correlations and multiple linear regression analyses were used to explore the relationship between altered back specific self- perception and back pain parameters. Results Two hundred seventy-two people with chronic low back pain completed the questionnaires. The FreBAQ-G showed good internal consistency (Cronbach’s alpha = 0.84), good overall reliability (r = 0.84) and weak to moderate scalability (Loevinger Hj between 0.34 and 0.48). The questionnaire showed unidimensional properties with factor loadings between 0.57 and 0.80 and at least moderate correlations (r > 0.35) with pain intensity, pain related disability and fear avoidance beliefs (FABQ total - and subscores). Item and test properties of the FreBAQ-G are given. Only item 7 showed uniform DIF indicating acceptable cross-cultural validity. Conclusions Our results indicate that the FreBAQ-G is a suitable questionnaire to measure back specific self-perception, and has comparable properties to the English-language version. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-021-04156-1.
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Affiliation(s)
- Axel Schäfer
- Faculty of Social Work and Health, University of Applied Sciences and Arts (HAWK), Hildesheim, Germany.
| | - Benedict M Wand
- School of Physiotherapy, University of Notre Dame Australia, Fremantle, Australia
| | - Kerstin Lüdtke
- University of Luebeck, Medical Section, Orthopaedics and Trauma Surgery, Academic Physiotherapy, Pain and Exercise Research (PERL), Luebeck, Germany
| | - Katja Ehrenbrusthoff
- Department of Applied Health Sciences, Hochschule für Gesundheit, Bochum, Germany
| | - Thomas Schöttker-Königer
- Faculty of Social Work and Health, University of Applied Sciences and Arts (HAWK), Hildesheim, Germany
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Schäfer A, Plassmeier F, Schofer N, Ludwig S, Schneeberger Y, Linder M, Demal TJ, Seiffert M, Blankenberg S, Reichenspurner H, Westermann D, Conradi L. Early Commercial Experience with a Novel Balloon-Expandable Transcatheter Heart Valve: 30-Day Outcomes and Implications of Preprocedural Computed Tomography. Thorac Cardiovasc Surg 2021. [DOI: 10.1055/s-0041-1725723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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23
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Schneeberger Y, Naito S, Schäfer A, Reiter B, Sill B, Reichenspurner H, Conradi L. Complex Coronary Artery Bypass Grafting: A Safe Concept for Surgical Training. Thorac Cardiovasc Surg 2021. [DOI: 10.1055/s-0041-1725659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Schäfer A, Schofer N, Schirmer J, Seiffert M, Blankenberg S, Reichenspurner H, Westermann D, Conradi L. Transaxillary Transcatheter Aortic Valve Implantation as First-Line Alternative to Transfemoral Access: A Single-Center Experience. Thorac Cardiovasc Surg 2021. [DOI: 10.1055/s-0041-1725720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Schäfer A, Naito S, Sill B, Reiter B, Reichenspurner H, Schneeberger Y. Gender Differences in Patients Undergoing Cardiac Surgery. Thorac Cardiovasc Surg 2021. [DOI: 10.1055/s-0041-1725743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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26
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Sarwari H, Schäfer A, Reichenspurner H, Conradi L. Initial Experience with Fully Percutaneous Plug-Based Vascular Closure for Minimally Invasive Mitral Valve Surgery. Thorac Cardiovasc Surg 2021. [DOI: 10.1055/s-0041-1725821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Schirmer J, Ludwig S, Schofer N, Schäfer A, Seiffert M, Pecha S, Blankenberg S, Reichenspurner H, Conradi L, Westermann D. Feasibility, Safety and Efficacy of Bioprosthetic or Native Aortic Scallop Intentional Laceration to Prevent Iatrogenic Coronary Artery Obstruction (BASILICA) during Transcatheter Aortic Valve Implantation (TAVI): A Single-Center Experience. Thorac Cardiovasc Surg 2021. [DOI: 10.1055/s-0041-1725823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Ludwig S, Kalbacher D, Schofer N, Schäfer A, Koell B, Seiffert M, Schirmer J, Schäfer U, Westermann D, Reichenspurner H, Blankenberg S, Lubos E, Conradi L. Early results of a real-world series with two transapical transcatheter mitral valve replacement devices. Clin Res Cardiol 2020; 110:411-420. [PMID: 33074368 PMCID: PMC7907022 DOI: 10.1007/s00392-020-01757-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 10/02/2020] [Indexed: 12/17/2022]
Abstract
Aims Transcatheter mitral valve replacement (TMVR) with dedicated devices promises to fill the treatment gap between open-heart surgery and edge-to-edge repair for patients with severe mitral regurgitation (MR). We herein present a single-centre experience of a TMVR series with two transapical devices. Methods and results A total of 11 patients were treated with the Tendyne™ (N = 7) or the Tiara™ TMVR systems (N = 4) from 2016 to 2020 either as compassionate-use procedures or as commercial implants. Clinical and echocardiographic data were collected at baseline, discharge and follow-up and are presented in accordance with the Mitral Valve Academic Research Consortium (MVARC) definitions. The study cohort [age 77 years (73, 84); 27.3% male] presented with primary (N = 4), secondary (N = 5) or mixed (N = 2) MR etiology. Patients were symptomatic (all NYHA III/IV) and at high surgical risk [logEuroSCORE II 8.1% (4.0, 17.4)]. Rates of impaired RV function (72.7%), severe pulmonary hypertension (27.3%), moderate or severe tricuspid regurgitation (63.6%) and prior aortic valve replacement (63.6%) were high. Severe mitral annulus calcification was present in two patients. Technical success was achieved in all patients. In 90.9% (N = 10) MR was completely eliminated (i.e. no or trace MR). Procedural and 30-day mortality were 0.0%. At follow-up NYHA class was I/II in the majority of patients. Overall mortality after 3 and 6 months was 10.0% and 22.2%. Conclusions TMVR was performed successfully in these selected patients with complete elimination of MR in the majority of patients. Short-term mortality was low and most patients experienced persisting functional improvement. Graphic abstract ![]()
Electronic supplementary material The online version of this article (10.1007/s00392-020-01757-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- S Ludwig
- Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistrasse 52, 20246, Hamburg, Germany. .,Partner Site Hamburg/Kiel/Lübeck, German Centre for Cardiovascular Research (DZHK), Hamburg, Germany.
| | - D Kalbacher
- Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistrasse 52, 20246, Hamburg, Germany.,Partner Site Hamburg/Kiel/Lübeck, German Centre for Cardiovascular Research (DZHK), Hamburg, Germany
| | - N Schofer
- Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistrasse 52, 20246, Hamburg, Germany
| | - A Schäfer
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - B Koell
- Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistrasse 52, 20246, Hamburg, Germany
| | - M Seiffert
- Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistrasse 52, 20246, Hamburg, Germany.,Partner Site Hamburg/Kiel/Lübeck, German Centre for Cardiovascular Research (DZHK), Hamburg, Germany
| | - J Schirmer
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - U Schäfer
- Marienkrankenhaus Hamburg, Department of Cardiology, Angiology and Intensive Care, Hamburg, Germany
| | - D Westermann
- Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistrasse 52, 20246, Hamburg, Germany.,Partner Site Hamburg/Kiel/Lübeck, German Centre for Cardiovascular Research (DZHK), Hamburg, Germany
| | - H Reichenspurner
- Partner Site Hamburg/Kiel/Lübeck, German Centre for Cardiovascular Research (DZHK), Hamburg, Germany.,Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - S Blankenberg
- Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistrasse 52, 20246, Hamburg, Germany.,Partner Site Hamburg/Kiel/Lübeck, German Centre for Cardiovascular Research (DZHK), Hamburg, Germany
| | - E Lubos
- Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistrasse 52, 20246, Hamburg, Germany
| | - L Conradi
- Partner Site Hamburg/Kiel/Lübeck, German Centre for Cardiovascular Research (DZHK), Hamburg, Germany.,Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
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Schäfer A, Laekeman M, Egan Moog M, Dieterich AV. [On the move-Prevention of chronic pain with physical activity and movement]. Schmerz 2020; 35:14-20. [PMID: 33048190 DOI: 10.1007/s00482-020-00509-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 08/28/2020] [Accepted: 09/16/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Sufficient physical activity and exercise shows a variety of health-promoting positive effects. In the context of pain therapy, promotion of physical activity could be an important contribution to primary, secondary and tertiary prevention of chronic pain. OBJECTIVES The aim is to investigate the relationship between physical activity and chronic pain, the preventive effect of physical activity on pain and the factors to successfully promote physical activity in people with chronic pain. METHODS For this narrative review databases of the Cochrane Library, MEDLINE (via PubMed) and the Physiotherapy Evidence Database (PEDro) were searched for reviews and studies with the keywords chronic pain, physical activity, movement, exercise and prevention. RESULTS A total of 10 reviews, 10 clinical studies and 4 surveys were included and summarized. CONCLUSION Although the evidence base on this topic is still insufficient, positive effects of physical activity on the prevention of chronic pain could be demonstrated. Interventions for people with chronic pain that sustainably increase physical activity should take into account individual resources, address barriers such as maladaptive beliefs, and create positive movement experiences.
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Affiliation(s)
- Axel Schäfer
- Studiengänge Ergotherapie, Logopädie und Physiotherapie, Fakultät Soziale Arbeit und Gesundheit, Hochschule für Angewandte Wissenschaft und Kunst (HAWK) Hildesheim, Goschentor 1, 31134, Hildesheim, Deutschland.
| | - Marjan Laekeman
- Fakultät für Gesundheit, Department für Pflegewissenschaft, Ph.D.-Kolleg, Universität Witten/Herdecke, Witten, Deutschland.,Physiologische Psychologie, Otto-Friedrich-Universität Bamberg, Bamberg, Deutschland
| | - Martina Egan Moog
- Pain Management, Precision Ascend, Melbourne, Australien.,Neuro Orthopaedic Institute, Adelaide, Australien
| | - Angela V Dieterich
- Physiotherapie, Fakultät Gesundheit, Sicherheit, Gesellschaft, Hochschule Furtwangen, Furtwangen, Deutschland
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30
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Luedtke K, Schoettker-Königer T, Hall T, Reimer C, Grassold M, Hasselhoff-Styhler P, Neulinger C, Obrocki M, Przyhoda P, Schäfer A. Correction to: Concurrent validity and reliability of measuring range of motion during the cervical flexion rotation test with a novel digital goniometer. BMC Musculoskelet Disord 2020; 21:624. [PMID: 32957948 PMCID: PMC7507653 DOI: 10.1186/s12891-020-03633-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
An amendment to this paper has been published and can be accessed via the original article.
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Affiliation(s)
- Kerstin Luedtke
- Laboratory of Pain Research, Institute of Physiotherapy and Health Sciences, The Jerzy Kukuczka Academy of Physical Education, Katowice, Poland. .,Institute of Health Sciences, Academic Physiotherapy, University of Luebeck, Lübeck, Germany.
| | - Thomas Schoettker-Königer
- Faculty of Social Work and Health, University of Applied Science and Art (HAWK), Goschentor 1, 31134, Hildesheim, Germany
| | - Toby Hall
- School of Physiotherapy and Exercise Science, Curtin University, Perth, WA, Australia
| | - Christine Reimer
- Faculty of Social Sciences, University of Applied Sciences Bremen, Neustadtswall 30, 28199, Bremen, Germany
| | - Maike Grassold
- Faculty of Social Sciences, University of Applied Sciences Bremen, Neustadtswall 30, 28199, Bremen, Germany
| | - Petra Hasselhoff-Styhler
- Faculty of Social Work and Health, University of Applied Science and Art (HAWK), Goschentor 1, 31134, Hildesheim, Germany
| | - Christian Neulinger
- Faculty of Social Work and Health, University of Applied Science and Art (HAWK), Goschentor 1, 31134, Hildesheim, Germany
| | - Max Obrocki
- Faculty of Social Sciences, University of Applied Sciences Bremen, Neustadtswall 30, 28199, Bremen, Germany
| | - Philipp Przyhoda
- Faculty of Social Work and Health, University of Applied Science and Art (HAWK), Goschentor 1, 31134, Hildesheim, Germany
| | - Axel Schäfer
- Faculty of Social Work and Health, University of Applied Science and Art (HAWK), Goschentor 1, 31134, Hildesheim, Germany
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Schäfer A, Reuter K. Machine learning and AI in the materials context. CHEM-ING-TECH 2020. [DOI: 10.1002/cite.202055203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- A. Schäfer
- BASF SE Carl-Bosch-Str. 38 67056 Ludwigshafen am Rhein Germany
| | - K. Reuter
- Fritz-Haber-Institut der Max-Planck-Gesellschaft Faradayweg 4-6 14195 Berlin Germany
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32
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Luedtke K, Schoettker-Königer T, Hall T, Enns C, Grassold M, Hasselhoff-Styhler P, Neulinger C, Obrocki M, Przyhoda P, Schäfer A. Concurrent validity and reliability of measuring range of motion during the cervical flexion rotation test with a novel digital goniometer. BMC Musculoskelet Disord 2020; 21:535. [PMID: 32781990 PMCID: PMC7422569 DOI: 10.1186/s12891-020-03525-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 07/20/2020] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Headache is a common and costly health problem. Although the pathogenesis of headache is heterogeneous, reported contributing factors are dysfunctions of the upper cervical spine. The flexion rotation test (FRT) is a commonly used diagnostic test to detect upper cervical movement impairment. A digital goniometer may support precise measurement of movement impairment in the upper cervical spine. However, its reliability and validity is not assessed, yet. The aim of this study was to investigate the reliability and validity of the digital goniometer compared to an ultrasound-based movement analysis system. METHODS Two separate cross-sectional studies were conducted using the digital goniometer EasyAngle (Meloq AB, Stockholm, Sweden) for a) investigating the concurrent validity of upper cervical range of motion (ROM) during the FRT and b) determining the inter- and intra-rater reliability in the target population of patients with head and neck pain. Sixty-two participants, 39 with and 23 without head and neck pain, were recruited for the concurrent validity study. For the reliability study, a total of 50 participants were recruited. Intraclass correlation coefficients (ICC) and Bland Altmann plots were used to assess validity and ICC values, Bland Altmann plots as well as Kappa coefficients were used for estimating intra-rater and inter-rater reliability. RESULTS Concurrent validity was strong with an ICC (2,1) of 0.97 for ROM to either side (95%CI = 0.95-0.98). Bland Altman Plots revealed a mean difference between measurement systems of 0.5° for the left and 0.11° for the right side. The inter-rater ICC (2,1) was 0.66 (95%CI 0.47-0.79, p < 0.001, SEM 6.6°), indicating good reliability. The limits of agreement were between 10.25° and - 11.89°, the mean difference between both raters was - 0.82°. Intra-rater reliability for the measurement of ROM during the FRT was between 0.96 (ICC 3,1) for rater 1 and 0.94 (ICC 3,1) for rater 2. CONCLUSIONS The digital goniometer demonstrated strong concurrent validity and good to strong reliability and can be used in clinical practice to accurately determine movement impairment in the upper cervical spine. TRIAL REGISTRATION German Registry of Clinical Trials DRKS00013051 .
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Affiliation(s)
- Kerstin Luedtke
- Laboratory of Pain Research, Institute of Physiotherapy and Health Sciences, The Jerzy Kukuczka Academy of Physical Education, Katowice, Poland
- Institute of Health Sciences, Academic Physiotherapy, University of Luebeck, Lübeck, Germany
| | - Thomas Schoettker-Königer
- Faculty of Social Work and Health, University of Applied Science and Art (HAWK), Goschentor 1, 31134 Hildesheim, Germany
| | - Toby Hall
- School of Physiotherapy and Exercise Science, Curtin University, Perth, WA Australia
| | - Christine Enns
- Faculty of Social Sciences, University of Applied Sciences Bremen, Neustadtswall 30, 28199 Bremen, Germany
| | - Maike Grassold
- Faculty of Social Sciences, University of Applied Sciences Bremen, Neustadtswall 30, 28199 Bremen, Germany
| | - Petra Hasselhoff-Styhler
- Faculty of Social Work and Health, University of Applied Science and Art (HAWK), Goschentor 1, 31134 Hildesheim, Germany
| | - Christian Neulinger
- Faculty of Social Work and Health, University of Applied Science and Art (HAWK), Goschentor 1, 31134 Hildesheim, Germany
| | - Max Obrocki
- Faculty of Social Sciences, University of Applied Sciences Bremen, Neustadtswall 30, 28199 Bremen, Germany
| | - Philipp Przyhoda
- Faculty of Social Work and Health, University of Applied Science and Art (HAWK), Goschentor 1, 31134 Hildesheim, Germany
| | - Axel Schäfer
- Faculty of Social Work and Health, University of Applied Science and Art (HAWK), Goschentor 1, 31134 Hildesheim, Germany
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Moaeri S, Hildebrandt O, Cassel W, Viniol C, Schäfer A, Kesper K, Sohrabi K, Gross V, Koehler U. [Analysis of Snoring in Patients with Obstructive Sleep Apnea (OSA) by Polysomnography and LEOSound]. Pneumologie 2020; 74:509-514. [PMID: 32492719 DOI: 10.1055/a-1155-8772] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Snoring was monitored in patients with obstructive sleep apnea (OSA) using the LEOSound-Monitor and simultaneously polysomnographic (PSG) recording. In obstructive apneas snoring is normally apparent after apnea termination and the beginning of ventilation. We wanted to know how often obstructive apneas are terminated by ventilation in combination with snoring. METHODS AND INTENTION In 40 patients with OSA (AHI > 15/h) simultaneous polysomnographic recordings were performed amongst long-term respiratory sound monitoring using the LEOSound monitor. Patients' average age was 57 ± 11 years. Average weight was 100 ± 19 kg by a mean body mass index (BMI) of 33 ± 7 kg/m2. 12 out of 40 recordings had to be rejected for further analysis because of artifacts. Snoring recorded by polysomnography was compared with snoring monitored by LEOSound. RESULTS 3778 obstructive apnea episodes were monitored. LEOSound identified snoring in 1921 (51,0 %), polysomnography in 2229 (58,8 %) obstructive apneas. Only in one patient there was a higher difference in snoring episodes between PSG and LEOSound. DISCUSSION In nearly 60 % of obstructive apnea events we found snoring during apnea-terminating hyperpnoea. LEOSound is a good diagnostic tool to monitor snoring. It is necessary to clarify why only 60 % of all obstructive events/hyperpnoea develop snoring. From a pathophysiological point of view opening of collapsed upper airway should lead in a very high percentage to turbulences in airstream and committed snoring.
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Affiliation(s)
- S Moaeri
- Klinik für Innere Medizin, SP Pneumologie, Intensiv- und Schlafmedizin, Philipps-Universität, Marburg
| | - O Hildebrandt
- Klinik für Innere Medizin, SP Pneumologie, Intensiv- und Schlafmedizin, Philipps-Universität, Marburg
| | - W Cassel
- Klinik für Innere Medizin, SP Pneumologie, Intensiv- und Schlafmedizin, Philipps-Universität, Marburg
| | - C Viniol
- Klinik für Innere Medizin, SP Pneumologie, Intensiv- und Schlafmedizin, Philipps-Universität, Marburg
| | - A Schäfer
- Klinik für Innere Medizin, SP Pneumologie, Intensiv- und Schlafmedizin, Philipps-Universität, Marburg
| | - K Kesper
- Klinik für Innere Medizin, SP Pneumologie, Intensiv- und Schlafmedizin, Philipps-Universität, Marburg
| | - K Sohrabi
- Fachbereich Gesundheit, Technische Hochschule Mittelhessen, Gießen
| | - V Gross
- Fachbereich Gesundheit, Technische Hochschule Mittelhessen, Gießen
| | - U Koehler
- Klinik für Innere Medizin, SP Pneumologie, Intensiv- und Schlafmedizin, Philipps-Universität, Marburg
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Schäfer A, Gehwolf P, Umlauft J, Dziodzio T, Biebl M, Perathoner A, Cakar-Beck F, Wykypiel H. Revisional Gastric Bypass After Failed Adjustable Gastric Banding-One-Stage or Two-Stage Procedure? Obes Surg 2020; 29:943-948. [PMID: 30484173 DOI: 10.1007/s11695-018-3614-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Revisional laparoscopic Roux-en-Y gastric bypass (R-LRYGB) is the preferred procedure after failed adjustable gastric banding. Little is known about whether a one-stage procedure (one surgery for band removal and R-LRYGB) or a two-stage procedure (first band removal and later R-LRYGB) is superior. Aim of this study is to compare early- and long-term results of both methods at our institution. METHODS Retrospective analysis of 165 (m 26/f 139) consecutive patients (98 one-stage, 67 two-stage) with R-LRYGB. Mean follow-up time was 50.1 ± 38.8 months. Indications for one-stage vs. two-stage procedures, operating time, peri- and postoperative complications, morbidity, mortality, and length of stay (LOS) were analyzed. Data are reported as total numbers (%) and mean ± standard deviation. RESULTS Mean age at R-LRYGB was 43.9 ± 10.7 vs. 44.3 ± 10.7 years with a BMI of 37.1 ± 6.8 vs. 39.8 ± 7.1 (one-stage vs. two-stage). In the one-stage group, the main indication for revisional surgery was weight regain (57.1%), followed by dilatation of the esophagus or pouch (37.7%) and gastroesophageal reflux disease (GERD) (36.7%), whereas in the two-stage group, it was band erosion (52.2%) and dilatation of the esophagus or pouch (17.9%) and GERD (11.9%). There was no significant difference in operative time (208.5 ± 61.2 vs. 206.3 ± 73.5 min), LOS (8.6 ± 3.4 vs. 9.3 ± 5.7 days) or mortality (0% overall). Major complications (Clavien-Dindo ≥ IIIa) occurred similarly often in both groups: 15.3% vs. 16.9% (one-stage vs. two-stage). CONCLUSION Both approaches achieve good results. However, the one-stage R-LRYGB is the preferable procedure because it reduces costs and LOS by doing without an additional surgical procedure.
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Affiliation(s)
- A Schäfer
- Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Philipp Gehwolf
- Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.
| | - J Umlauft
- Department of Dermatology, Venereology and Allergology, Medical University of Innsbruck, Innsbruck, Austria
| | - T Dziodzio
- Department of Surgery, Charité-Universitätsmedizin, Berlin, Germany
| | - M Biebl
- Department of Surgery, Charité-Universitätsmedizin, Berlin, Germany
| | - A Perathoner
- Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - F Cakar-Beck
- Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - H Wykypiel
- Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
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Schäfer A, Nitschmann S. Prasugrel oder Ticagrelor bei Patienten mit akutem Koronarsyndrom. Internist (Berl) 2020; 61:223-225. [DOI: 10.1007/s00108-020-00752-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Sarwari H, Schäfer A, Schirmer J, Schofer N, Seiffert M, Schneeberger Y, Blankenberg S, Reichenspurner H, Westermann D, Conradi L. Transcatheter Aortic Valve Implantation for Pure Noncalcified Native Aortic Valve Regurgitation. Thorac Cardiovasc Surg 2020. [DOI: 10.1055/s-0040-1705411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Conradi L, Ludwig S, Kalbacher D, Schäfer A, Schneeberger Y, Schofer N, Schäfer U, Blankenberg S, Reichenspurner H, Lubos E. Results of an Early Series of Transcatheter Mitral Valve Implantation with Dedicated Devices: Experience with Three Different Transapical and Transseptal Devices. Thorac Cardiovasc Surg 2020. [DOI: 10.1055/s-0040-1705341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Schäfer A, Conradi L, Schneeberger Y, Sill B, Reichenspurner H, Kastrati A, Von Scheidt M, Schunkert H. Complete versus Incomplete Revascularization and Influence of Postoperative Antiplatelet Therapy in Coronary Artery Bypass Grafting: Results from the TiCAB Study. Thorac Cardiovasc Surg 2020. [DOI: 10.1055/s-0040-1705400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Schäfer A, Conradi L, Schäfer U, Blankenberg S, Reichenspurner H. TAVI für alle. Z Herz- Thorax- Gefäßchir 2019. [DOI: 10.1007/s00398-018-0265-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Blanck-Köster K, Becker T, Gaidys U, Keienburg C, Kaltwasser A, Schäfer A. [Scientific development of critical care : Position paper]. Med Klin Intensivmed Notfmed 2019; 113:672-675. [PMID: 30327818 DOI: 10.1007/s00063-018-0496-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Demographic changes in Germany means that nursing and medical care is becoming increasingly complex. This is especially true for intensive care. Despite the closure of hospitals in Germany, the number of beds in intensive care units rose between 2002 from 23,113 to 26,162 in 2010. At the same time the number of patients treated in intensive care units increased by 148,989 to 2,049,888. The increasing complexity requires specific education for nurses in intensive care based on a model of advanced nursing practice (ANP). Nursing experts who fulfill an advanced practise nursing are competent to make decisions autonomously and accountably within complex care situations. This includes decisions such as artificial ventilation, weaning, nutrition management and the management of delirium, wounds and pain. Nursing experts are responsible for specific clearly defined areas of care and initiate nurse-led services and practice. Scientific and research based evidence are transferred directly into health care practice and can be implemented directly. The DGF demands a scientific and with it academic development of critical care as advanced nursing practice based on a master level qualification. This also includes the request for expansion of competencies and roles and the assignment of decision making authority within complex health care situations and an orientation on the Competencies for European Critical Care Nurses of the European Federation of Critical Care Nursing Associations (EfCCNa).
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Affiliation(s)
- K Blanck-Köster
- Fakultät für Wirtschaft und Soziales - Department Pflege & Management, Hochschule für Angewandte Wissenschaften Hamburg, Alexanderstraße 1, 20099, Hamburg, Deutschland.
| | - T Becker
- , Rißbergweg 7, 82445, Grafenaschau, Deutschland
| | - U Gaidys
- Fakultät für Wirtschaft und Soziales - Department Pflege & Management, Hochschule für Angewandte Wissenschaften Hamburg, Alexanderstraße 1, 20099, Hamburg, Deutschland
| | - C Keienburg
- , Simmerner Str. 4, 55469, Pleizenhausen, Deutschland
| | - A Kaltwasser
- Akademie der Kreiskliniken Reutlingen GmbH, Steinenbergstr. 31, 72764, Reutlingen, Deutschland
| | - A Schäfer
- , Hainstr. 7, 34621, Frielendorf, Deutschland
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Abstract
Dual antiplatelet therapy (DAPT) is the cornerstone of maintenance medication following elective percutaneous coronary intervention and also after acute coronary syndrome (ST-elevation myocardial infarction, non-ST-elevation myocardial infarction, unstable angina pectoris); however, DAPT is not sufficient for stroke prevention in atrial fibrillation (SPAF). For SPAF, oral anticoagulation (OAC) with vitamin K antagonists (VKA) or non-vitamin K-dependent anticoagulants (NOAC) is required. If a patient who is receiving anticoagulants for SPAF, requires a coronary intervention, triple therapy consisting of OAC plus DAPT is given, at least for a limited time following the procedure. This article reviews the current data from studies testing strategies with NOACs plus one or two antiplatelet substances in comparison to triple therapy with VKA.
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Affiliation(s)
- A Schäfer
- Klinik für Kardiologie und Angiologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30659, Hannover, Deutschland.
| | - J Bauersachs
- Klinik für Kardiologie und Angiologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30659, Hannover, Deutschland
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Richter R, Höppner H, Schäfer A. Was ist Physiotherapiewissenschaft? physioscience 2019. [DOI: 10.1055/a-0832-9657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
| | - Heidi Höppner
- Studiengang Physio- und Ergotherapie, Alice Salomon Hochschule Berlin
| | - Axel Schäfer
- Studiengänge Ergotherapie, Logopädie und Physiotherapie, Hochschule für Angewandte Wissenschaft und Kunst (HAWK), Hildesheim
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Kapitza C, Hoch A, Schöttker-Königer T, Schäfer A. Validität und Intratester-Reliabilität der Fotometrie zur Beurteilung der Position des Schultergürtels gesunder Probanden. physioscience 2019. [DOI: 10.1055/a-0833-2160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Zusammenfassung
Hintergrund Da die Körperhaltung möglicherweise ein relevanter, beitragender als auch prognostischer Faktor bei muskuloskeletalen Problemen ist, stellt deren Beurteilung einen wichtigen Bestandteil der physiotherapeutischen Untersuchung dar. Das klinimetrische Verfahren der digitalen Fotometrie kann Parameter der Haltung objektiv erheben.
Ziel Die Studie untersuchte die Validität und die Intratester-Reliabilität eines Fotometrie-Programms zur Beurteilung der Güte seiner Anwendung in der Praxis und Forschung.
Methode In der Messgruppe wurde die Haltung des Schultergürtels von 48 Probanden im Alter von 19 bis 46 Jahren zu 2 Messzeitpunkten in 4 Ebenen gemessen, um folgende Variablen zu bestimmen: Skapula-Rotation, Pro- und Retraktion, Skapula-Kippung, kraniovertebraler Winkel, thorakale Kyphose und Schulterschiefstand. Die Intratester-Reliabilität wurde in einem Abstand von 3 Wochen untersucht. Die Bestimmung der Kriteriumsvalidität erfolgte über die Korrelation der Messwerte der Fotometrie mit denen eines digitalen Inklinometers, eines CROM und eines Zentimetermaßes.
Ergebnisse Validität: Die Korrelationskoeffizienten der gemessenen Winkel lagen zwischen r = 0,63, 95 %-Konfidenzintervall (KI) und r = 0,95, 95 %KI (p > 0,001), die Zentimetermessungen zwischen r = 0,57 und r = 0,96, 95 %KI (p < 0,0001). Intratester-Reliabilität: Die Intraklassenkorrelationskoeffizienten (ICC) der Winkelmessungen erreichten zwischen 0,77 und 0,96 CI und die ICC der Zentimetermessung zwischen 0,62 und 0,93 KI. Der Standardfehler der Messungen (SEM) betrug je nach Winkel zwischen 0,64° und 3,46° bzw. Abstand zwischen 0,35 cm und 0,98 cm.
Schlussfolgerung Die Ergebnisse lassen darauf schließen, dass die Fotometrie für die Winkel Skapula-Rotation, Skapula-Kippung und Akromioklavikulargelenk sowie für die Abstände zwischen Trigonum scapulae zur Wirbelsäule und Angulus inferior zur Wirbelsäule als valides und reliables Messinstrument zur Beurteilung des Schultergürtels bei gesunden Probanden verwendet werden kann. Insbesondere die Winkelmessungen zeigten gute Resultate.
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Affiliation(s)
- Camilla Kapitza
- Hochschule für angewandte Wissenschaft und Kunst (HAWK), Hildesheim
| | - Anke Hoch
- Hochschule für angewandte Wissenschaft und Kunst (HAWK), Hildesheim
| | | | - Axel Schäfer
- Hochschule für angewandte Wissenschaft und Kunst (HAWK), Hildesheim
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Schweiger JI, Bilek E, Schäfer A, Braun U, Moessnang C, Harneit A, Post P, Otto K, Romanczuk-Seiferth N, Erk S, Wackerhagen C, Mattheisen M, Mühleisen TW, Cichon S, Nöthen MM, Frank J, Witt SH, Rietschel M, Heinz A, Walter H, Meyer-Lindenberg A, Tost H. Effects of BDNF Val 66Met genotype and schizophrenia familial risk on a neural functional network for cognitive control in humans. Neuropsychopharmacology 2019; 44:590-597. [PMID: 30375508 PMCID: PMC6333795 DOI: 10.1038/s41386-018-0248-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 09/25/2018] [Accepted: 10/16/2018] [Indexed: 12/16/2022]
Abstract
Cognitive control represents an essential neuropsychological characteristic that allows for the rapid adaption of a changing environment by constant re-allocation of cognitive resources. This finely tuned mechanism is impaired in psychiatric disorders such as schizophrenia and contributes to cognitive deficits. Neuroimaging has highlighted the contribution of the anterior cingulate cortex (ACC) and prefrontal regions (PFC) on cognitive control and demonstrated the impact of genetic variation, as well as genetic liability for schizophrenia. In this study, we aimed to examine the influence of the functional single-nucleotide polymorphism (SNP) rs6265 of a plasticity-related neurotrophic factor gene, BDNF (Val66Met), on cognitive control. Strong evidence implicates BDNF Val66Met in neural plasticity in humans. Furthermore, several studies suggest that although the variant is not convincingly associated with schizophrenia risk, it seems to be a modifier of the clinical presentation and course of the disease. In order to clarify the underlying mechanisms using functional magnetic resonance imaging (fMRI), we studied the effects of this SNP on ACC and PFC activation, and the connectivity between these regions in a discovery sample of 85 healthy individuals and sought to replicate this effect in an independent sample of 253 individuals. Additionally, we tested the identified imaging phenotype in relation to schizophrenia familial risk in a sample of 58 unaffected first-degree relatives of schizophrenia patients. We found a significant increase in interregional connectivity between ACC and PFC in the risk-associated BDNF 66Met allele carriers. Furthermore, we replicated this effect in an independent sample and demonstrated its independence of structural confounds, as well as task specificity. A similar coupling increase was detectable in individuals with increased familial risk for schizophrenia. Our results show that a key neural circuit for cognitive control is influenced by a plasticity-related genetic variant, which may render this circuit particular susceptible to genetic and environmental risk factors for schizophrenia.
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Affiliation(s)
- J. I. Schweiger
- 0000 0001 2190 4373grid.7700.0Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - E. Bilek
- 0000 0001 2190 4373grid.7700.0Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - A. Schäfer
- 0000 0001 2190 4373grid.7700.0Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - U. Braun
- 0000 0001 2190 4373grid.7700.0Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - C. Moessnang
- 0000 0001 2190 4373grid.7700.0Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - A. Harneit
- 0000 0001 2190 4373grid.7700.0Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - P. Post
- 0000 0001 2190 4373grid.7700.0Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - K. Otto
- 0000 0001 2190 4373grid.7700.0Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - N. Romanczuk-Seiferth
- 0000 0001 2218 4662grid.6363.0Department of Psychiatry and Psychotherapy, Charité - University Medicine Berlin, Campus Mitte, Berlin, Germany
| | - S. Erk
- 0000 0001 2218 4662grid.6363.0Department of Psychiatry and Psychotherapy, Charité - University Medicine Berlin, Campus Mitte, Berlin, Germany
| | - C. Wackerhagen
- 0000 0001 2218 4662grid.6363.0Department of Psychiatry and Psychotherapy, Charité - University Medicine Berlin, Campus Mitte, Berlin, Germany
| | - M. Mattheisen
- 0000 0001 1956 2722grid.7048.bDepartment of Biomedicine and Centre for Integrative Sequencing, iSEQ Aarhus University, Aarhus, Denmark ,grid.452548.a0000 0000 9817 5300The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus and Copenhagen, Denmark
| | - T. W. Mühleisen
- 0000 0001 2297 375Xgrid.8385.6Institute of Neuroscience and Medicine (INM-1), Research Centre Jülich, Jülich, Germany ,0000 0004 1937 0642grid.6612.3Department of Biomedicine, University of Basel, Basel, Switzerland
| | - S. Cichon
- 0000 0001 2297 375Xgrid.8385.6Institute of Neuroscience and Medicine (INM-1), Research Centre Jülich, Jülich, Germany ,grid.410567.1Institute of Medical Genetics and Pathology, University Hospital Basel, Basel, Switzerland
| | - M. M. Nöthen
- 0000 0001 2240 3300grid.10388.32Institute of Human Genetics, University of Bonn, Sigmund-Freud-Str. 25, Bonn, 53127 Germany ,0000 0001 2240 3300grid.10388.32Department of Genomics, Life & Brain Center, University of Bonn, Sigmund-Freud-Str. 25, Bonn, 53127 Germany
| | - J. Frank
- 0000 0001 2190 4373grid.7700.0Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - S. H. Witt
- 0000 0001 2190 4373grid.7700.0Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - M. Rietschel
- 0000 0001 2190 4373grid.7700.0Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - A. Heinz
- 0000 0001 2218 4662grid.6363.0Department of Psychiatry and Psychotherapy, Charité - University Medicine Berlin, Campus Mitte, Berlin, Germany
| | - H. Walter
- 0000 0001 2218 4662grid.6363.0Department of Psychiatry and Psychotherapy, Charité - University Medicine Berlin, Campus Mitte, Berlin, Germany
| | - A. Meyer-Lindenberg
- 0000 0001 2190 4373grid.7700.0Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - H. Tost
- 0000 0001 2190 4373grid.7700.0Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
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Conradi L, Deuschl F, Ludwig S, Schäfer A, Kalbacher D, Voigtländer L, Schneeberger Y, Schofer N, Blankenberg S, Reichenspurner H, Schäfer U. Transcatheter Mitral Valve Implantation Using Dedicated Devices: Early Experience Using Different Transapical and Transseptal Devices. Thorac Cardiovasc Surg 2019. [DOI: 10.1055/s-0039-1678844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- L. Conradi
- Universitäres Herzzentrum Hamburg, Hamburg, Germany
| | - F. Deuschl
- Universitäres Herzzentrum Hamburg, Hamburg, Germany
| | - S. Ludwig
- Universitäres Herzzentrum Hamburg, Hamburg, Germany
| | - A. Schäfer
- Universitäres Herzzentrum Hamburg, Hamburg, Germany
| | - D. Kalbacher
- Universitäres Herzzentrum Hamburg, Hamburg, Germany
| | | | | | - N. Schofer
- Universitäres Herzzentrum Hamburg, Hamburg, Germany
| | | | | | - U. Schäfer
- Universitäres Herzzentrum Hamburg, Hamburg, Germany
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Sequeira M, Bhadra O, Kalbacher D, Schofer N, Deuschl F, Schäfer A, Schneeberger Y, Blankenberg S, Reichenspurner H, Schäfer U, Conradi L. Percutaneous Management of Vascular Injury after Transfemoral Aortic Valve Implantation. Thorac Cardiovasc Surg 2019. [DOI: 10.1055/s-0039-1678873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- M. Sequeira
- Universitäres Herzzentrum Hamburg, Hamburg, Germany
| | - O. Bhadra
- Universitäres Herzzentrum Hamburg, Hamburg, Germany
| | - D. Kalbacher
- Universitäres Herzzentrum Hamburg, Hamburg, Germany
| | - N. Schofer
- Universitäres Herzzentrum Hamburg, Hamburg, Germany
| | - F. Deuschl
- Universitäres Herzzentrum Hamburg, Hamburg, Germany
| | - A. Schäfer
- Universitäres Herzzentrum Hamburg, Hamburg, Germany
| | | | | | | | - U. Schäfer
- Universitäres Herzzentrum Hamburg, Hamburg, Germany
| | - L. Conradi
- Universitäres Herzzentrum Hamburg, Hamburg, Germany
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Zang Z, Geiger LS, Braun U, Cao H, Zangl M, Schäfer A, Moessnang C, Ruf M, Reis J, Schweiger JI, Dixson L, Moscicki A, Schwarz E, Meyer-Lindenberg A, Tost H. Resting-state brain network features associated with short-term skill learning ability in humans and the influence of N-methyl-d-aspartate receptor antagonism. Netw Neurosci 2018; 2:464-480. [PMID: 30320294 PMCID: PMC6175691 DOI: 10.1162/netn_a_00045] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 01/11/2018] [Indexed: 01/21/2023] Open
Abstract
Graph theoretical functional magnetic resonance imaging (fMRI) studies have demonstrated that brain networks reorganize significantly during motor skill acquisition, yet the associations between motor learning ability, brain network features, and the underlying biological mechanisms remain unclear. In the current study, we applied a visually guided sequential pinch force learning task and graph theoretical analyses to investigate the associations between short-term motor learning ability and resting-state brain network metrics in 60 healthy subjects. We further probed the test-retest reliability (n = 26) and potential effects of the N-methyl-d-aspartate (NMDA) antagonist ketamine (n = 19) in independent healthy volunteers. Our results show that the improvement of motor performance after short-term training was positively correlated with small-worldness (p = 0.032) and global efficiency (p = 0.025), whereas negatively correlated with characteristic path length (p = 0.014) and transitivity (p = 0.025). In addition, using network-based statistics (NBS), we identified a learning ability–associated (p = 0.037) and ketamine-susceptible (p = 0.027) cerebellar-cortical network with fair to good reliability (intraclass correlation coefficient [ICC] > 0.7) and higher functional connectivity in better learners. Our results provide new evidence for the association of intrinsic brain network features with motor learning and suggest a role of NMDA-related glutamatergic processes in learning-associated subnetworks. Learning a new motor skill prompts immediate reconfigurations of distributed brain networks followed by adaptive changes in intrinsic brain circuits related to synaptic plasticity. Here, we identify global brain network properties and a cerebellar-cortical functional subnetwork that are both significantly associated with motor learning ability in a previously trained visuomotor task in humans. We further show that the associated functional subnetwork connectivity but not the global brain network properties are susceptible to ketamine. Our findings suggest a distinct functional role for learning-related global versus local network metrics and support the idea of a preferential susceptibility of learning-associated subnetworks to N-methyl-d-aspartate antagonist and plasticity-related consolidation effects.
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Affiliation(s)
- Zhenxiang Zang
- Department of Psychiatry and Psychotherapy, Research Group System Neuroscience in Psychiatry, Central Institute of Mental Health, University of Heidelberg, Medical Faculty Mannheim, Mannheim, Germany
| | - Lena S Geiger
- Department of Psychiatry and Psychotherapy, Research Group System Neuroscience in Psychiatry, Central Institute of Mental Health, University of Heidelberg, Medical Faculty Mannheim, Mannheim, Germany
| | - Urs Braun
- Department of Psychiatry and Psychotherapy, Research Group System Neuroscience in Psychiatry, Central Institute of Mental Health, University of Heidelberg, Medical Faculty Mannheim, Mannheim, Germany
| | - Hengyi Cao
- Department of Psychiatry and Psychotherapy, Research Group System Neuroscience in Psychiatry, Central Institute of Mental Health, University of Heidelberg, Medical Faculty Mannheim, Mannheim, Germany
| | - Maria Zangl
- Department of Psychiatry and Psychotherapy, Research Group System Neuroscience in Psychiatry, Central Institute of Mental Health, University of Heidelberg, Medical Faculty Mannheim, Mannheim, Germany
| | - Axel Schäfer
- Department of Psychiatry and Psychotherapy, Research Group System Neuroscience in Psychiatry, Central Institute of Mental Health, University of Heidelberg, Medical Faculty Mannheim, Mannheim, Germany
| | - Carolin Moessnang
- Department of Psychiatry and Psychotherapy, Research Group System Neuroscience in Psychiatry, Central Institute of Mental Health, University of Heidelberg, Medical Faculty Mannheim, Mannheim, Germany
| | - Matthias Ruf
- Department of Neuroimaging, Central Institute of Mental Health, University of Heidelberg, Medical Faculty Mannheim, Mannheim, Germany
| | - Janine Reis
- Department of Neurology and Neurophysiology, Albert-Ludwigs-University, Freiburg, Germany
| | - Janina I Schweiger
- Department of Psychiatry and Psychotherapy, Research Group System Neuroscience in Psychiatry, Central Institute of Mental Health, University of Heidelberg, Medical Faculty Mannheim, Mannheim, Germany
| | - Luanna Dixson
- Department of Psychiatry and Psychotherapy, Research Group System Neuroscience in Psychiatry, Central Institute of Mental Health, University of Heidelberg, Medical Faculty Mannheim, Mannheim, Germany
| | - Alexander Moscicki
- Department of Psychiatry and Psychotherapy, Research Group System Neuroscience in Psychiatry, Central Institute of Mental Health, University of Heidelberg, Medical Faculty Mannheim, Mannheim, Germany
| | - Emanuel Schwarz
- Department of Psychiatry and Psychotherapy, Research Group System Neuroscience in Psychiatry, Central Institute of Mental Health, University of Heidelberg, Medical Faculty Mannheim, Mannheim, Germany
| | - Andreas Meyer-Lindenberg
- Department of Psychiatry and Psychotherapy, Research Group System Neuroscience in Psychiatry, Central Institute of Mental Health, University of Heidelberg, Medical Faculty Mannheim, Mannheim, Germany
| | - Heike Tost
- Department of Psychiatry and Psychotherapy, Research Group System Neuroscience in Psychiatry, Central Institute of Mental Health, University of Heidelberg, Medical Faculty Mannheim, Mannheim, Germany
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48
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Geiger LS, Moessnang C, Schäfer A, Zang Z, Zangl M, Cao H, van Raalten TR, Meyer-Lindenberg A, Tost H. Novelty modulates human striatal activation and prefrontal-striatal effective connectivity during working memory encoding. Brain Struct Funct 2018; 223:3121-3132. [PMID: 29752589 PMCID: PMC6132644 DOI: 10.1007/s00429-018-1679-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 05/03/2018] [Indexed: 12/13/2022]
Abstract
The functional role of the basal ganglia (BG) in the gating of suitable motor responses to the cortex is well established. Growing evidence supports an analogous role of the BG during working memory encoding, a task phase in which the "input-gating" of relevant materials (or filtering of irrelevant information) is an important mechanism supporting cognitive capacity and the updating of working memory buffers. One important aspect of stimulus relevance is the novelty of working memory items, a quality that is understudied with respect to its effects on corticostriatal function and connectivity. To this end, we used functional magnetic resonance imaging (fMRI) in 74 healthy volunteers performing an established Sternberg working memory task with different task phases (encoding vs. retrieval) and degrees of stimulus familiarity (novel vs. previously trained). Activation analyses demonstrated a highly significant engagement of the anterior striatum, in particular during the encoding of novel working memory items. Dynamic causal modeling (DCM) of corticostriatal circuit connectivity identified a selective positive modulatory influence of novelty encoding on the connection from the dorsolateral prefrontal cortex (DLPFC) to the anterior striatum. These data extend prior research by further underscoring the relevance of the BG for human cognitive function and provide a mechanistic account of the DLPFC as a plausible top-down regulatory element of striatal function that may facilitate the "input-gating" of novel working memory materials.
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Affiliation(s)
- Lena S Geiger
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Carolin Moessnang
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Axel Schäfer
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Zhenxiang Zang
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Maria Zangl
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Hengyi Cao
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Tamar R van Raalten
- Department of Psychiatry, Rudolf Magnus Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Andreas Meyer-Lindenberg
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Heike Tost
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.
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49
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Duerschmied D, Brachmann J, Darius H, Frey N, Katus HA, Rottbauer W, Schäfer A, Thiele H, Bode C, Zeymer U. Antithrombotic therapy in patients with non-valvular atrial fibrillation undergoing percutaneous coronary intervention: should we change our practice after the PIONEER AF-PCI and RE-DUAL PCI trials? Clin Res Cardiol 2018; 107:533-538. [PMID: 29679144 DOI: 10.1007/s00392-018-1242-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Accepted: 04/09/2018] [Indexed: 12/18/2022]
Abstract
The number of patients with atrial fibrillation undergoing percutaneous coronary intervention (PCI) is increasing. Since these patients have a CHA2DS2-VASc score of 1 or higher, they should be treated with oral anticoagulation to prevent stroke. However, combination therapy with oral anticoagulation for prevention of embolic stroke and dual platelet inhibition for prevention of coronary thrombosis significantly increases bleeding complications. The optimal combination, intensity and duration of antithrombotic combination therapy is still not known. In the rather small randomized WOEST trial, the combination of a vitamin K antagonist (VKA) and clopidogrel decreased bleeding compared to the conventional triple therapy with VKA, clopidogrel and aspirin. In the PIONEER AF-PCI trial, two rivaroxaban-based treatment regimens significantly reduced bleeding complications compared to conventional triple therapy without increasing embolic or ischemic complications following PCI. Dual therapy with rivaroxaban and clopidogrel appeared to provide an optimal risk-benefit ratio. In the RE-DUAL PCI trial, dual therapy with dabigatran also reduced bleeding complications compared to conventional triple therapy. With respect to the composite efficacy end point of thromboembolic events (myocardial infarction, stroke, or systemic embolism), death, or unplanned revascularization dabigatran-based dual therapy was non-inferior to VKA-based triple therapy. The upcoming trials AUGUSTUS with apixaban and ENTRUST-PCI with edoxaban will further examine the use of NOACs in this setting. While recent guidelines recommend NOAC-based dual therapy in only a subset of patients (those who are at increased risk of bleeding), the available data now suggest that this should be the preferred choice for the majority of patients. Adding aspirin to this primary choice for up to 4 weeks in patients at especially high ischemic risk would likely prevent atherothrombotic events, but this needs further investigation. Taken together, it is time to adjust our practice and move to dual therapy consisting of a NOAC plus clopidogrel in most patients.
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Affiliation(s)
- D Duerschmied
- Cardiology and Angiology I, Faculty of Medicine, Heart Center, University of Freiburg, Freiburg, Germany
| | - J Brachmann
- Department of Cardiology, Angiology, and Pneumology, Second Medical Clinic, Coburg Hospital, Coburg, Germany
| | - H Darius
- Department of Cardiology, Vascular Medicine and Intensive Care Medicine, Vivantes Neukoelln Medical Centre, Berlin, Germany
| | - N Frey
- Department of Cardiology and Angiology, University of Kiel, Kiel, Germany
| | - H A Katus
- Department of Internal Medicine III, University of Heidelberg, Heidelberg, Germany
| | - W Rottbauer
- Department of Internal Medicine II, Cardiology, Angiology, Pneumology, University of Ulm, Ulm, Germany
| | - A Schäfer
- Department of Cardiology and Angiology, Hannover Medical School, Hanover, Germany
| | - H Thiele
- Department of Internal Medicine/Cardiology, Heart Center Leipzig - UniversityHospital, Leipzig, Germany
| | - C Bode
- Cardiology and Angiology I, Faculty of Medicine, Heart Center, University of Freiburg, Freiburg, Germany
| | - Uwe Zeymer
- Klinikum Ludwigshafen and Institut für Herzinfarktforschung, Bremserstrasse 79, 67063, Ludwigshafen/Rhein, Germany.
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50
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Maier B, Kulzer B, Schäfer A, Tombek A, Greiner J, Brämswig S, Haak T. Junge Erwachsene mit Typ-1-Diabetes (18 – 25 Jahre): ein neues stationäres Therapiekonzept. DIABETOL STOFFWECHS 2018. [DOI: 10.1055/s-0038-1641979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- B Maier
- Diabetes Zentrum Bad Mergentheim, Bad Mergentheim, Germany
| | - B Kulzer
- Diabetes Zentrum Bad Mergentheim, Bad Mergentheim, Germany
| | - A Schäfer
- Diabetes Zentrum Bad Mergentheim, Bad Mergentheim, Germany
| | - A Tombek
- Diabetes Zentrum Bad Mergentheim, Bad Mergentheim, Germany
| | - J Greiner
- Diabetes Zentrum Bad Mergentheim, Bad Mergentheim, Germany
| | - S Brämswig
- Diabetes Zentrum Bad Mergentheim, Bad Mergentheim, Germany
| | - T Haak
- Diabetes Zentrum Bad Mergentheim, Bad Mergentheim, Germany
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