Klinik Barmelweid

Introduction: Treatment for individuals living with chronic pain often aims to shift patients from helplessness to resourcefulness, fostering self-efficacy. This study tested the feasibility of integrating Mindful Self-Compassion (MSC) techniques into music therapy (MT) and explored their potential effects on pain experience, acceptance, and self-compassion.Method: In a convergent parallel mixed-methods feasibility study, adults with chronic pain attended weekly individual MT sessions. Quantitative measures included the Self-Compassion Scale (SCS), Chronic Pain Acceptance Questionnaire, and a Numeric Rating Scale (NRS) for pain, assessed at baseline and post-therapy. Focused interviews provided qualitative data, analyzed thematically, according to Braun and Clarke (2006, 2021). Pre-and post-results were compared using descriptive and non-parametric statistics.Results: Feasibility in terms of recruitment could be shown, with some challenges in retention and compliance, with eight participants (n = 8) completing the whole study. Qualitative findings highlighted the value of MT, with participants reporting moments of self-care, refocusing, and exploring their pain and emotions with a validating and accepting attitude. While no substantial changes were observed in the SCS or pain perception, there was a tendency for increased pain acceptance.Discussion:This study was the first to integrate MSC within MT. Despite the small sample size, feasibility was demonstrated. Although generalizability is limited, these findings may offer a foundation for future research on combining MSC and MT for chronic pain management.

The international Swiss Primary Hypersomnolence and Narcolepsy Cohort Study (iSPHYNCS) is a multicentre study aimed at identifying novel biomarkers for central disorders of hypersomnolence (CDH). We analysed questionnaires and metadata to uncover distinct clusters of participants and explore phenotypic variability within CDH. Data were collected from 227 patients with CDH and 33 healthy controls. Participants completed validated clinical questionnaires and study-specific questions addressing CDH-related symptoms such as excessive daytime sleepiness, fatigue, cataplexy, disrupted sleep, and sleep paralysis. Demographic metadata (age, gender, BMI) were included. After excluding participants with missing over 30% of data (n = 40), missing values were imputed using a multiple random forest algorithm. A robust clustering pipeline was employed: (1) random sampling of 60% of the dataset, (2) dimensionality reduction via UMAP, (3) K-means clustering, and (4) consensus clustering across 500 iterations. Post hoc analysis was performed to identify biomarkers in data not used for clustering. We identified four distinct clusters. One predominantly comprised healthy controls, while another primarily contained individuals with narcolepsy type 1 (NT1). Two clusters represented predominantly the narcolepsy borderland group (NBL), with one distinctly characterised by higher symptom severity and psychiatric comorbidities. The clustering pipeline produced reproducible results, with the NT1 and healthy control clusters serving as internal validation. The differentiation between the two NBL clusters aligns with prior studies, suggesting a possible NBL subtype marked by increased fatigue and psychiatric comorbidities. These findings emphasise the phenotypic heterogeneity of CDH and the potential for cluster-based approaches in management. Trial Registration: ClinicalTrials.gov identifier: NCT04330963.

Background: Differences in subjective stress perception and acute response of the hypothalamic-pituitary-adrenal axis have been reported in internet gaming disorder (IGD). The present study aimed to further investigate alterations in diurnal profiles of the endocrine stress response system in IGD compared to healthy controls (HCs). Methods: The diurnal course of endocrine markers (salivary cortisol and α-amylase) was investigated in a clinical sample of n = 29 adolescents with IGD compared to n = 26 HC. Further, the effect of unrestricted gaming versus restricted gaming was examined within the IGD group. Results: No significant differences in salivary cortisol and α-amylase were observed comparing adolescents with IGD and HC. In addition, in the IGD group, there were no significant differences in salivary cortisol and α-amylase between conditions of unrestricted gaming versus restricted gaming. Compared to the HC group, the IGD group showed a significantly higher body mass index. Conclusions: Our results indicate no alteration in diurnal profiles of the endocrine stress response in IGD.

Patients recovering from COVID-19 often present with impaired health and persisting symptoms such as exercise intolerance ⩾3 months post-infection. Uncertainty remains about long-term recovery. We aimed to review studies examining cardiac function, macro- or microvascular function, blood biomarkers and physical activity in adult patients post-COVID-19 and highlight current knowledge gaps. Using echocardiography, persistent cardiac involvement of the left ventricle was observed in a fraction of patients both hospitalized and non-hospitalized. Ventricular dysfunction was often subclinical but may partly contribute to exercise intolerance post-COVID-19. Endothelial dysfunction was seen on micro- and macrovascular levels using retinal vessel imaging methods and brachial artery flow-mediated dilation, respectively. Studies reporting blood biomarkers of disease-specific impairment and endothelial dysfunction yielded upregulated inflammation, hypercoagulability, organ and endothelial damage up to several months after infection. Omics' scale lipid profiling studies provide preliminary evidence of alterations in several lipid subspecies, mostly during acute COVID-19, which might contribute to subsequent endothelial and cardiometabolic dysfunction. Yet, more robust evidence is warranted. Physical activity may be reduced up to 6 months post-COVID-19. However, studies measuring physical activity more precisely using accelerometry are sparse. Overall, there is growing evidence for long-term multiple organ dysfunction. Research combining all the above methods in the search for underlying mechanisms of post-COVID-19 symptoms is mostly missing. Moreover, studies with longer follow-ups (i.e. ⩾18 months) and well-matched control groups are lacking. The findings may aid the development of rehabilitation regimes for post-COVID-19 syndrome. This review examined cardiac function, vascular function, blood biomarkers and physical activity in patients post-COVID-19. Evidence suggests long-term dysfunction in multiple organ systems and exercise intolerance due to various factors, including endothelial damage and, in some patients, subclinical ventricular dysfunction. We highlight knowledge gaps for further research to aid post-COVID-19 rehabilitation.

Abstract Background Previous studies demonstrated that insulin resistance, hyperglycemia contribute to the development of a pro-thrombotic state characterized by increased platelet activation, activation of coagulation cascade and elevated number of extracellular vesicles (EVs) in type 2 diabetes mellitus (T2DM) patients. There is a less known impact of glycaemia control in T2DM patients with concomitant heart failure (HF) and atrial fibrillation (AF) on a number of erythrocytes-derived EVs. The aim of the study was to elucidate whether glucose control in T2DM patients with HF and AF affect a circulating number of erythrocytes-derived EVs. Methods The entire patient population composes of 417 patients (231 male, 55.4% and 186 female, 44.6%) with average age of 53 years as well as 25 healthy volunteers and 30 T2DM non-HF individuals. As inclusion, age ≥ 18 years, T2DM, established HF, and written consent to participate in the study was used. Patients after successful ablation procedure (mainly radiofrequency ablation) were included in the group non-AF in 6 weeks after procedure if cardiac rhythm is sinus. All patients were divided into two groups depending on criteria of poor glycemic control (HbA1c < 6.9% and ≥7.0%, respectively). Hemodynamics features, conventional biochemistry parameters and EVs measure were performed at the baseline. Flow cytometry was performed according to conventional protocol with FMO standards to detect and measure EVs. Results Circulating levels of CD235a+ PS+ erythrocytes-derived vesicles differed amongst T2DM patients depending on HF presentation when compared with healthy volunteers (Figure 1). Figure 2 illustrated the differences in circulating amount of CD235a+ PS+ RBC-derived vesicles in AF and non-AF patients with T2DM and HF depending on glycaemia control. There were significantly lower levels of CD235a+ PS+ RBC-derived vesicles were detected in those with HbA1c < 6.9% than in patients with HbA1c ≥ 7.0%. To note, there were no significant differences in circulating amount of CD235a+ PS+ erythrocytes-derived vesicles between patients in entire cohort (p = 0.24) and in non-AF sub-cohort (p = 0.40) with HbA1c < 6.9% and HbA1c ≥ 7.0%, respectively. The Receive Operation Characteristics curve analysis revealed that the well-balanced cut-off point for circulating amount of CD235a+ PS+ erythrocytes-derived vesicles (HbA1c ≥ 7.0% versus HbA1c < 6.9%) were 545 particles in µL (area under curve = 0.91, sensitivity = 74.2%, specificity = 90.3%; p = 0.0001). Multivariate linear regression yielded that NT-proBNP (OR = 1.07; 95% CI = 1.02–1.10, p = 0.04) and CD235a+ PS+ erythrocytes-derived vesicles ≥ 545 particles in µL (OR = 1.06; 95% CI = 1.01–1.11, p = 0.044) remained independent predictors for HbA1c ≥ 7.0%. Conclusion Poor glycaemia control is associated with elevated levels of CD235a+ PS+ EVs, which were found to be independent predictor for AF presentation in T2DM patients with HF.Circulating levels of EVsEVs in AF and non-AF patients

Abstract IntroductionIncreased narcolepsy type 1 (NT1) incidence rates have been reported globally in 2010, and were linked to the type A H1N1 2009-2010 influenza pandemic and Pandemrix vaccination. A European child-specific NT1 incidence peak was additionally observed in 2013 post the H1N1 pandemic. Thus, the relationship between NT1 and influenza infection remains unclear. Whether other influenza viruses may also trigger NT1 or other central disorders of hypersomnolence (CDH), is unknown. This study investigated annual European incidence patterns of all CDH in complete samples from multiple European centers, in relation to the severity of individual flu strains in preceding influenza seasons.MethodsIncidence rates of NT1 (N=981) and the combined group of narcolepsy type 2 (NT2) and idiopathic hypersomnia (IH) (N=545) from eight European countries were temporally analysed to identify possible incidence peaks from 1995 to 2019. Linear mixed models and spearman correlations were conducted between hypersomnolence disorder incidence rates and the number of influenza infections of preceding influenza season, split for types A H1N1 and H3N2, and in the Netherlands also types B Victoria and Yamagata influenza.Results2010 and 2013 incidence peaks were present in NT1, and a 2010 children peak was unexpectedly found in the combined group of NT2 and IH. Both hypersomnolence groups exhibited a significantly positive relationship with preceding H1N1 influenza season severity and a negative relationship with H3N2 influenza. NT1 was additionally significantly positively correlated with influenza type B Victoria in the Netherlands and showed highest correlation in children.ConclusionsBesides H1N1 influenza, the temporal association and severity correlation suggest that influenza type B Victoria may be a novel potential trigger for NT1 that requires further investigation. We additionally provide insights into possible immune-related pathophysiologies of NT2 and IH associated with the 2009-2010 H1N1 influenza pandemic. Further immunological investigations are warranted to unravel the complexities of these relationships and their implications for CDH.