Physiological synchronization and innovative moments in psychotherapy: A single-case study of micro-process.

OBJECTIVE: Interpersonal synchronization is increasingly studied as a biomarker of empathy, therapeutic alliance, and treatment outcome. However, most studies average data over sessions, leaving associations between synchrony and actual interactions largely unexplored. We aim to showcase a novel approach examining synchronization during specific micro-processes: Innovative Moments (IM) as markers of exceptions to clients' problematic patterns of meaning. METHODS: Electrodermal activity was recorded over 15 sessions of a psychodynamic psychotherapy single case. Moment-to-moment patient-therapist synchrony was calculated using the Adaptive Matching Interpolated Correlations (AMICo) algorithm. The Innovative Moments Coding System was utilized to identify IMs within session transcripts with precise timing. Monte-Carlo permutation tests were conducted to examine the association between physiological synchrony and IM Levels of increasing complexity (Levels 1-3). RESULTS: Higher-than-random synchronization emerged during Level 3 IMs (p = 0.046; d = 0.21) but not in lower Levels. Post-hoc qualitative analyses linked high synchrony to sub-processes of Level 3 IMs, such as positive contrasts and attributions for change. CONCLUSION: Our findings show it is possible to link moment-by-moment physiological co-regulation to theoretically identified meaning-making processes. While generalization of these observations is undue, this work demonstrates a robust and promising application of a multimodal approach to investigating psychotherapy, providing insights into both the clinical case and the theoretical model adopted.

Feasibility of Optical Biopsy During Endoscopic Sinus Surgery With Confocal Laser Endomicroscopy: A Pilot Study.

OBJECTIVE: Confocal laser endomicroscopy (CLE) is an optical imaging technique that allows in vivo, real-time, microscope-like assessment of superficial lesions. Although there is substantial data on CLE use in the upper GI tract, there is limited information regarding its application in the nasal cavity and paranasal sinuses. This study aims to assess the feasibility and diagnostic metrics of CLE in the nasal cavity and paranasal sinuses regarding differentiation between healthy/benign and malignant tissue. These structures show, however, a wider variety of frequent and concomitant benign and malignant pathologies, which could pose an increased challenge for optical biopsy by CLE. METHODS: We performed CLE on a case series of six patients with various findings in the nose (three chronic rhinosinusitis, adenocarcinoma, meningoenzephalozele, esthesionneuroblastoma). Forty-two sequences (3792 images) from various structures in the nasal cavity and/or paranasal sinuses were acquired. Biopsies were taken at corresponding locations and analyzed in hematoxylin and eosin staining as a standard of reference. Three independent examiners blinded to the histopathology assessed the sequences. RESULTS: Healthy and inflamed mucosa could be distinguished from malignant lesions with an accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of 84.1%, 85.4%, 83.1%, 72.5%, and 92.1%, respectively, with a substantial agreement between raters (Fleiss κ = 0.62). CONCLUSION: This technique shows, despite its limitations, potential as an adjunctive imaging technique during sinus surgery; however, the creation of a scoring system based on reproducible and defined characteristics in a larger more diverse population should be the focus of further research to improve its diagnostic value and clinical utility. LEVEL OF EVIDENCE: NA Laryngoscope, 2024.

Oral mucosa - an examination map for confocal laser endomicroscopy within the oral cavity: an experimental clinical study.

OBJECTIVES: Confocal laser endomicroscopy (CLE) is an optical method that enables microscopic visualization of oral mucosa. Previous studies have shown that it is possible to differentiate between physiological and malignant oral mucosa. However, differences in mucosal architecture were not taken into account. The objective was to map the different oral mucosal morphologies and to establish a "CLE map" of physiological mucosa as baseline for further application of this powerful technology. MATERIALS AND METHODS: The CLE database consisted of 27 patients. The following spots were examined: (1) upper lip (intraoral) (2) alveolar ridge (3) lateral tongue (4) floor of the mouth (5) hard palate (6) intercalary line. All sequences were examined by two CLE experts for morphological differences and video quality. RESULTS: Analysis revealed clear differences in image quality and possibility of depicting tissue morphologies between the various localizations of oral mucosa: imaging of the alveolar ridge and hard palate showed visually most discriminative tissue morphology. Labial mucosa was also visualized well using CLE. Here, typical morphological features such as uniform cells with regular intercellular gaps and vessels could be clearly depicted. Image generation and evaluation was particularly difficult in the area of the buccal mucosa, the lateral tongue and the floor of the mouth. CONCLUSION: A physiological "CLE map" for the entire oral cavity could be created for the first time. CLINICAL RELEVANCE: This will make it possible to take into account the existing physiological morphological features when differentiating between normal mucosa and oral squamous cell carcinoma in future work.

Spinal Muscular Atrophy (SMA) Mortality Despite Novel Medications: Case Reports.

ABSTRACT: Despite new effective medications, patients with SMA types 1-3 can continue to have inadequate cough flows to prevent episodes of acute respiratory failure. Ventilator unweanable intubated patients are thought to require tracheostomy tubes. As a result, potentially beneficial medications may be discontinued and patients die despite receiving these medications. Three cases are presented of medically treated, physically strengthening children, with SMA type 1. All three subsequently died or underwent tracheotomy. However, there is no evidence of extubation attempts to noninvasive ventilatory support settings or optimal mechanical insufflation-exsufflation despite this option being described to be over 98% successful for extubating unweanable medically untreated children with SMA1.

Diagnosis of malignancy in oropharyngeal confocal laser endomicroscopy using GPT 4.0 with vision.

PURPOSE: Confocal Laser Endomicroscopy (CLE) is an imaging tool, that has demonstrated potential for intraoperative, real-time, non-invasive, microscopical assessment of surgical margins of oropharyngeal squamous cell carcinoma (OPSCC). However, interpreting CLE images remains challenging. This study investigates the application of OpenAI's Generative Pretrained Transformer (GPT) 4.0 with Vision capabilities for automated classification of CLE images in OPSCC. METHODS: CLE Images of histological confirmed SCC or healthy mucosa from a database of 12 809 CLE images from 5 patients with OPSCC were retrieved and anonymized. Using a training data set of 16 images, a validation set of 139 images, comprising SCC (83 images, 59.7%) and healthy normal mucosa (56 images, 40.3%) was classified using the application programming interface (API) of GPT4.0. The same set of images was also classified by CLE experts (two surgeons and one pathologist), who were blinded to the histology. Diagnostic metrics, the reliability of GPT and inter-rater reliability were assessed. RESULTS: Overall accuracy of the GPT model was 71.2%, the intra-rater agreement was κ = 0.837, indicating an almost perfect agreement across the three runs of GPT-generated results. Human experts achieved an accuracy of 88.5% with a substantial level of agreement (κ = 0.773). CONCLUSIONS: Though limited to a specific clinical framework, patient and image set, this study sheds light on some previously unexplored diagnostic capabilities of large language models using few-shot prompting. It suggests the model`s ability to extrapolate information and classify CLE images with minimal example data. Whether future versions of the model can achieve clinically relevant diagnostic accuracy, especially in uncurated data sets, remains to be investigated.

Stereotactic radiotherapy in the management of oligometastatic and recurrent head and neck cancer: a single-center experience.

INTRODUCTION: Oligometastatic disease (OMD) is a metastatic stage that could benefit maximally from local therapies. Patients in this state have a better prognosis relative to those with disseminated metastases. Stereotactic radiotherapy provides a non-invasive ablative tool for primary malignant tumors and metastases. MATERIALS AND METHODS: We searched our register for patients with oligometastatic or recurrent head and neck cancer (OMD/R-HNC) who received stereotactic radiotherapy to manage their OMD/R. We evaluated the survival outcomes and prognostic factors that affected the survival of those patients. RESULTS: In all, 31 patients with 48 lesions met the inclusion criteria for the analysis. The lesions comprised various metastatic sites, with the majority being pulmonary (37 lesions). Squamous cell cancer was the most common histology (26 patients). The median overall survival (mOS) was 33 months, with a progression-free survival (PFS) of 9.6 months. Eight patients received subsequent stereotactic radiotherapy after disease progression. The local control (LC) rates were 91.3, 87.7, and 83% at 6, 12, and 36 months. Patients with the de novo OMD who received stereotactic radiotherapy as their initial treatment had a median systemic treatment-free survival of 23.9 months. In univariate analysis, a trend for better OS was observed in patients with p16-positive squamous cell tumors; patients who progressed within 150 days after diagnosis had a significantly lower OS. De novo OMD showed significantly better PFS compared to induced OMD. Multivariate analyses identified p16-positive squamous cell cancer, metachronous OMD and a longer time to progression as positive predictors of OS, while de novo OMD was the only positive predictor for PFS. Treatment-related toxicities were generally mild, with two cases of grade 3 dysphagia reported. CONCLUSION: Stereotactic radiotherapy demonstrated favorable outcomes in patients with OMD/R-HNC with limited toxicities. Further studies are warranted to validate these findings and optimize treatment strategies for this patient population.

Critical Phase Dualities in 1D Exactly Solvable Quasiperiodic Models.

We propose a solvable class of 1D quasiperiodic tight-binding models encompassing extended, localized, and critical phases, separated by nontrivial mobility edges. Limiting cases include the Aubry-André model and the models of Sriram Ganeshan, J. H. Pixley, and S. Das Sarma [Phys. Rev. Lett. 114, 146601 (2015)PRLTAO0031-900710.1103/PhysRevLett.114.146601] and J. Biddle and S. Das Sarma [Phys. Rev. Lett. 104, 070601 (2010)PRLTAO0031-900710.1103/PhysRevLett.104.070601]. The analytical treatment follows from recognizing these models as a novel type of fixed points of the renormalization group procedure recently proposed in Phys. Rev. B 108, L100201 (2023)10.1103/PhysRevB.108.L100201 for characterizing phases of quasiperiodic structures. Beyond known limits, the proposed class of models extends previously encountered localized-delocalized duality transformations to points within multifractal critical phases. Besides an experimental confirmation of multifractal duality, realizing the proposed class of models in optical lattices allows stabilizing multifractal critical phases and nontrivial mobility edges in an undriven system without the need for the unbounded potentials required by previous proposals.

Structured Reporting of Head and Neck Sonography Achieves Substantial Interrater Reliability.

Purpose Ultrasound examinations are often criticized for having higher examiner dependency compared to other imaging techniques. Compared to free-text reporting, structured reporting (SR) of head and neck sonography (HNS) achieves superior time efficiency as well as report quality. However, there are no findings concerning the influence of SR on the interrater reliability (IRR) of HNS. Materials and Methods Typical pathologies (n=4) in HNS were documented by video/images by two certified head and neck ultrasound instructors. Consequently, structured reports of these videos/images were created by n=9 senior physicians at departments of otolaryngology or maxillofacial surgery with DEGUM instructors on staff. Reports (n=36) were evaluated regarding overall completeness and IRR. Additionally, user satisfaction was assessed by a visual analog scale (VAS). Results SR yielded very high report completeness (91.8%) in all four cases with a substantial IRR (Fleiss' κ 0.73). Interrater agreement was high at 87.2% with very good user satisfaction (VAS 8.6). Conclusion SR has the potential to ensure high-quality examination reports with substantial comparability and very high user satisfaction. Furthermore, big data collection and analysis are facilitated by SR. Therefore, process quality, workflow, and scientific output are potentially enhanced by SR.

Guild Vertical Stratification and Drivers of Bat Foraging in a Semi-Arid Tropical Region, Kenya.

Africa faces significant challenges in reconciling economic and social development while preserving its natural resources. Little is known about the diverse bat community on the continent, particularly in drier ecosystems. A better understanding of the bat community will help improve and inform the management of these ecosystems. Our study aimed to provide detailed information on the main drivers of bat richness and activity at three different heights above the ground in a semi-arid region of Kenya. We assessed how bat activity varied with space and height using acoustic sampling and complementary methods. We sampled 48 sites at ground level and two sites on meteorological masts at 20 m and 35 m above the ground. We recorded more than 20 bat species, including one species of concern for conservation. Our models showed that the use of space varies with bat guild, creating trade-offs in the variables that affect their activity. Low-flying bat species are mostly associated with habitat variables, whereas high-flying species are more dependent on weather conditions. Our study highlights the richness of bat assemblages in semi-arid environments and emphasizes the need for management measures to protect bat diversity in the face of habitat degradation caused by climate change, land management, and development projects.

Innovative moments with young patients treated for depression: An analysis of post-therapy interviews.

INTRODUCTION: Innovative moments (IMs) pinpoint new and more adaptative meanings that emerge in clients' discourse during psychotherapy. Studies with adult clients have found a greater proportion of IMs in recovered compared to unchanged cases, but similar studies have yet to be conducted with adolescents. AIMS: The paper aims (1) to study retrospectively the emergence of IMs in therapy, using a post-therapy interview, in adolescents that underwent psychotherapy for depression, and (2) to characterize the themes present in IMs identified retrospectively in the interviews. METHOD: Semi-structured post-treatment interviews conducted with 24 adolescents on the experience of taking part in a clinical trial of youth depression, were coded using the Innovative Moments Coding System. After identifying IMs, a thematic analysis identified the prominent themes within them. RESULTS: Higher presence of IMs were found in recovered compared to unchanged cases. Two main themes emerged in the IMs, changes that occurred with therapy and attributions of changes. Recovered cases presented more IMs centred on the self, whereas unchanged cases identified more non-specific changes. CONCLUSION: This study suggests that it is possible to code IMs, identified retrospectively, based on post-therapy interviews with adolescents. Meaningful differences were found between recovered compared to unchanged cases. Therapeutic recovery was associated with a higher focus on the self and more specificity in clients' representations of the change process.

[Data from the 2022 ASCO Annual Meeting on surgical therapy]. / Daten vom ASCO-Kongress 2022 zum Thema "chirurgische Therapie".

Last year, studies on immuno-oncologic treatment approaches for recurrent or metastatic head and neck cancer were the main focus at the two major international cancer congresses of the American Society of Clinical Oncology (ASCO) and the European Society for Medical Oncology (ESMO). The success of these therapeutic strategies has led to many new studies, including their use in the neoadjuvant setting. This review article summarizes presented studies from ASCO 2022 in which surgical therapy is the focus of the study protocol and also includes study results on neoadjuvant treatment strategies. No surgical trials were presented at ESMO 2022. At ASCO 2022 as well as in previous years, it became increasingly clear that treatment de-escalation in the context of human papillomavirus (HPV)-associated oropharyngeal carcinoma treatment involving surgical measures appears to be oncologically safe and functionally beneficial. In addition, a number of studies indicate that in the setting of neoadjuvant administration of immuno-oncologic agents, a proportion of patients have pathologic complete remission. In this fraction of patients, which is usually significantly smaller than 50%, survival data are better than in those who have already failed to respond to neoadjuvant therapy. Unfortunately, however, significant toxicities or tumor progression with the risk of inoperability were also seen under these current therapeutic regimens, leading to discontinuation of therapy in 5-20% of cases. It remains to be seen whether neoadjuvancy with immune checkpoint inhibitors can establish itself, in contrast to the failed attempts of the past with the use of cytostatics.

Percutaneous Endoscopic Gastrostomy Placement under NIV in Amyotrophic Lateral Sclerosis with Severe Ventilatory Dysfunction: A Safe and Effective Procedure.

Introduction: Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disorder with an inexorably progressive course which leads to a progressive neuromuscular weakness. Weight loss is one of the major bad prognostic factors in ALS. The placement of percutaneous endoscopic gastrostomy (PEG) is of paramount importance in patients with dysphagia to improve the disease outcomes, although some fear exists regarding the possible ventilatory complications during the procedure. The aim of this study was to evaluate the safety and effectiveness of PEG tube insertion under non-invasive ventilation (NIV) in patients with ALS and severe ventilatory impairment. Methods: A retrospective study of all consecutive PEGs placed in our department from May 2011 to January 2018 in patients with ALS was performed. The procedure was performed under non-invasive positive-pressure ventilation for ventilatory support. Results: We included 59 patients with ALS with severe ventilatory impairment, 58% were female, with a mean age of 67.2 ± 10.1 years and a median follow-up of 6 [2-15] months. The main indication for PEG placement was dysphagia (98%). The median time for PEG tube insertion since the established diagnosis of ALS was 12 [6-25] months and 4 [2-18] months since the beginning of bulbar symptoms. The majority of the patients had placed a 20-Fr PEG (63%) and under mild sedation with midazolam (80%), all under NIV. There were no immediate complications during and after the procedure (no episodes of aspiration or orotracheal intubation) and mortality. Conclusion: The placement of PEG is a very important procedure in patients with ALS and severe ventilatory impairment. The interdisciplinary department collaboration permitted the placement of PEG under NIV, in a safe and effective procedure in this special population.

Introdução: A esclerose lateral amiotrófica (ELA) é uma doença neurodegenerativa com um curso inexorável que leva a fraqueza neuromuscular progressiva. A perda de peso é um dos principais fatores de mau prognóstico na ELA. Apesar do receio de complicações ventilatórias durante o procedimento, a colocação de gastrostomia percutânea endoscópica em doentes com disfagia é extremamente importante para melhorar o prognóstico. O objetivo deste estudo é avaliar a segurança e eficácia da colocação de gastrostomia percutânea endoscópica (GEP) sob ventilação não invasiva (VNI) em doentes com ELA e disfunção ventilatória grave. Métodos: Estudo retrospetivo de todas as gastrostomias percutâneas endoscópicas colocadas em doentes com ELA no nosso departamento entre Maio 2011 e Janeiro 2018. O procedimento foi realizado sob VNI para suporte ventilatório. Resultados: Foram incluídos 59 doentes com ELA e disfunção ventilatória grave, 58% do sexo feminino, com uma idade média de 67.2 ± 10.1 anos e um follow-up mediano de 6 [2­15] meses. A principal indicação para colocação de gastrostomia percutânea endoscópica foi disfagia (98%). O tempo mediano para a colocação de GEP desde o diagnóstico de ELA foi 12 [6­25] meses e 4 [2­18] meses desde o início dos sintomas bulbares. A maioria dos doentes colocaram uma GEP de 20 Fr (63%) e sob sedação com midazolam (80%), todos sob VNI. Não se verificaram complicações imediatas durante e após o procedimento (sem episódios de aspiração ou entubação orotraqueal) e mortalidade. Conclusão: A colocação de GEP é um procedimento muito importante em doentes com ELA e disfunção ventilatória grave. A colaboração interdisciplinar permitiu a colocação de GEP sob ventilação não invasiva, tornando-o um procedimento seguro e eficaz nesta população especial.

Pneumoparotid: Practical impact of Surgeon performed Ultrasound in an effective Diagnostic Approach.

OBJECTIVES: Pneumoparotid is characterized by air inclusions in the parotid duct system. Use of ultrasound has proved valuable for evaluating air inclusions in various parts of the body; the diagnostics of this condition has not been systematically analyzed, however. The aim of this study was to evaluate the value of ultrasound in the detection of air inclusions along the parotid duct system and its closer characterization. METHODS: Retrospective analysis was carried out of patients diagnosed with pneumoparotid between 2005 and 2020 in a salivary gland center. Ultrasound was performed in all cases, and features of air inclusions were described. Reference standard was the clinical demonstration of foamy saliva after gland massage and/or sialendoscopic evidence of intraductal air inclusions. RESULTS: Twenty-one patients were identified (48.8 ± 3.8 years). Two were associated with wind instruments; seven were iatrogenic, following treatment for duct stenosis; one after radiotherapy; four with known bruxism and seven were idiopathic and without associated conditions. On ultrasound examination, pneumoparotid was characterized by three phenomena: flattened, mobile hyperechoic reflexes, dirty shadows with reverberation or "sunbeam effect," and shifting shadows during gland massage. CONCLUSIONS: Ultrasound was useful for characterizing pneumoparotid in a fast and practical way and could serve as imaging tool of first choice.

Ambivalence Resolution in Meaning Reconstruction Grief Therapy: An Exploratory Study.

In psychotherapy, ambivalence may be conceptualized as a conflict between two distinct motivations: one that is favorable to change (pro-change) and another that favors the maintenance of a problematic pattern (pro status quo). Previous studies identified two processes by which clients resolve this conflict: imposing the innovative part and silencing the problematic one (dominance), and establishing negotiations between the innovative and the pro status quo parts (negotiation). The present exploratory study examined ambivalence resolution in a sample of clients diagnosed with complicated grief. Results revealed that, in recovered cases, negotiation increases and dominance decreases from the beginning until the middle sessions of therapy and the opposite tendency is observed from the middle to the final sessions. Unchanged cases reveal an overall high proportion of dominance and an overall low proportion of negotiation. These results are partially divergent from those reported in previous studies with samples of clients diagnosed with major depression.

Postinflammatory Medial Meatal Fibrosis: Histopathologic Features and Outcomes of Surgical Management.

OBJECTIVES: The aims of our study were to investigate the clinical and audiometric outcome of the surgical treatment of postinflammatory medial meatal fibrosis (PIMMF) and to review the histopathologic changes in the specimens of the fibrotic plug, in order to try to shed light on the pathogenesis of the disease. MATERIALS AND METHODS: The clinical records and the histopathologic specimens of all patients who underwent tympanomeatoplasty for PIMMF at the ENT Clinic of the University of Erlangen between 2006 and 2020 were evaluated retrospectively. RESULTS: Thirty-four patients (41 primary surgical procedures) made up our study cohort. Of this, 28 cases were managed by means of meatoplasty and 13 cases with tympanomeatoplasty. The mean preoperative air-bone gap (ABG) was 27.8 dB (10-44 dB). Postoperative ABG was significantly improved compared to preoperative values at both short- and long-term follow-ups (P < .001 for both). No significant difference was noted between short-term and long-term ABG (P = .240). An ABG ≤20 dB was achieved in 65.8% of patients (short term) and 50% (long term). The overall rate of revision surgery for restenosis was 29.3% (12/41). Histopathologic reevaluation of the fibrotic plugs revealed a mosaic of patterns with frequent occurrence of secondary cholesteatoma-like lesions and keloid-like tissue changes. Lichenoid submucosal inflammation and increased ectopic ceruminous gland lobules were seen less frequently. DISCUSSION: The moderate long-term outcome of surgical management and the identification of histologic changes with therapeutic implications might pave the way for alternative nonsurgical treatment options.

Acceptance and commitment therapy and its unacknowledged influences: Some old wine in a new bottle?

Recently, Goldfried suggested that one main reason for the underdevelopment of psychotherapy as a scientific enterprise was the lack of acknowledgment of past contributions. In this article, this issue is illustrated by analysing the particular case of acceptance and commitment therapy (ACT). ACT has clear overlaps with therapies from the systemic tradition, such as strategic therapy in the line of the Mental Research Institute in Palo Alto and with the more recent models of solution-focused therapy and narrative therapy. This article analyses theoretical overlaps with these models (e.g. the paradoxical nature of human problems and the nature of language) as well as examples of similarities in therapeutic strategies (externalization and the miracle question). It concludes by suggesting that this practice of inadvertently obliterating the past does not favour the development of the field or the creation of consensus but rather contributes to the ongoing proliferation of 'new' psychotherapy models. Trends that may contribute to circumventing this problem are discussed.

Differentiation of Salivary Gland and Salivary Gland Tumor Tissue via Raman Imaging Combined with Multivariate Data Analysis.

Salivary gland tumors (SGTs) are a relevant, highly diverse subgroup of head and neck tumors whose entity determination can be difficult. Confocal Raman imaging in combination with multivariate data analysis may possibly support their correct classification. For the analysis of the translational potential of Raman imaging in SGT determination, a multi-stage evaluation process is necessary. By measuring a sample set of Warthin tumor, pleomorphic adenoma and non-tumor salivary gland tissue, Raman data were obtained and a thorough Raman band analysis was performed. This evaluation revealed highly overlapping Raman patterns with only minor spectral differences. Consequently, a principal component analysis (PCA) was calculated and further combined with a discriminant analysis (DA) to enable the best possible distinction. The PCA-DA model was characterized by accuracy, sensitivity, selectivity and precision values above 90% and validated by predicting model-unknown Raman spectra, of which 93% were classified correctly. Thus, we state our PCA-DA to be suitable for parotid tumor and non-salivary salivary gland tissue discrimination and prediction. For evaluation of the translational potential, further validation steps are necessary.