Kliniken Schmieder

The human visual system continuously extracts a wealth of dynamic information from the incoming retinal signal. One important task is the simultaneous tracking of multiple items that are moving within the visual environment. Past work has proposed that such multiple-object tracking relies on attentional resources that are location-based, i.e. resources are respectively associated with the individual items spatial positions. However, another possibility is that attentional resources are object-based, i.e. allocated to the combination of all items as an abstract shape configuration. Indeed, recent data suggests that during multiple-object tracking, the visual system continuously maintains a configuration represented by an illusory polygon formed by the shortest closed path connecting all tracked items. Here, we test this hypothesis by comparing signatures in the electroencephalographic (EEG) signal of 38 subjects with topological transitions of the polygon's shape. The topological transitions are qualitative changes in the polygon shape that go beyond mere quantitative changes in item positions (i.e., polygon corners). During object motion, the shapeshifting polygon can display switches between a convex and a concave shape. Concave shortest-path polygons can exhibit changes in the order in which the tracked objects are connected ('flips'). We demonstrate that topological transition events can be decoded from the ongoing EEG signal, revealing how the abstract configuration and its qualitative changes are represented throughout the tracking. Taken together, our work demonstrates that an object-based attentional mechanism is crucial during multiple-object tracking.

Introduction: Post-COVID syndrome (PCS) can lead to severe restrictions in the ability to work and participate in society and can lead to the development of depressive symptoms. The aim of this study was to investigate how many PCS patients suffer from clinically relevant depressive symptoms and to what extent PCS rehabilitation can modulate psychological symptoms as well as limitations in functional health. Methods: Prospective multicenter cohort study PoCoRe (N = 1,028). Assessment of depressiveness (PHQ-9, PHQ-2), fatigue (FSMC) and functional health and disability (WHO-DAS2.0). Frequency analyses, mean comparisons. Results: At the start of rehabilitation, 71.4% (n = 734) fulfilled the core symptoms of depressive disorders in general in the PHQ-2. In the screening-positive patients, the PHQ-9 total score was on average M = 23.74 (standard deviation = 4.43). As expected the depressive symptom burden was reduced more in depressed PCS patients (d = 0.50) than in nondepressed PCS patients (d = 0.32). Fatigue symptoms did not change. Functional health (WHO-DAS) improved above all in coping with everyday life (d = 0.71, or 1.04), and in the nondepressed patients also in mobility (d = 0.27). In the sociomedical assessment, 24.7% of the total samples were assessed as having an impaired capacity for the reference occupation and 19.5% as having an impaired capacity for the general labor market. Depressive patients had the worse sociomedical outcome. Conclusion: Depressiveness is common and can be well influenced by PCS rehabilitation. Fatigue is less easily influenced, which indicates that they are independent symptoms. Patients with persistent depression and fatigue have a poorer sociomedical prognosis.

Functional neurological disorder (FND) is often associated with trauma and dissociation. There is insufficient data on sleep disturbances and nightmare frequency. Patients with FND (n=87) were compared with psychosomatic patients (PSM; mainly with affective and somatoform disorders; n=97) and post-stroke patients (STR; n=92). Questions focused on subjective sleep behaviour, nightmare frequency and nightmare distress. Current physical and mental health, childhood trauma and dissociative symptoms were used for ordinal regression analyses. Nightmare frequency was also compared to a representative sample of the general population. More than 70% of FND and PSM patients reported insomnia symptoms. The restorative value of sleep was low in FND and PSM patients and was associated with physical and mental health (effect sizes d=0.47 and d=0.56) and dissociative symptoms (d=-0.26) across all groups, showing trends for the latter two in FND patients (d=0.38 and d=-0.39). Thirty percent of FND and PSM patients reported nightmares at least once a week, compared to 10% of STR patients and about 2% in the representative sample. Across all groups, nightmare frequency was associated with current mental health (d=-0.43), dissociative symptoms (d=0.37) and childhood trauma (d=0.32), and in FND patients specifically with dissociative symptoms (d=0.58). Nightmare distress was high in FND and PSM patients. FND patients showed high prevalences of insomnia and nightmares, which is of clinical relevance. Associations with (daytime) mental health and dissociative symptoms underline the interplay between waking-life psychopathology, sleep and dreams, i.e. the continuity hypothesis of sleep and wakefulness.

Abstract Rationale: Severe or symptomatic hyponatremia is a common and potentially dangerous condition that requires careful management to avoid complications such as osmotic demyelination syndrome (ODS). Desmopressin has been proposed as a therapeutic option to control sodium correction rates safely, yet its effectiveness and safety remain uncertain. This study aims to evaluate the impact of desmopressin on safe sodium correction and secondary outcomes, including overcorrection rates and ODS incidence. Methods: We conducted a systematic review and meta-analysis following Cochrane guidelines. The search strategy identified studies in PubMed, Scopus, and Cochrane databases. Manual deduplication and study screening were performed using Rayyan AI, with two authors independently reviewing studies and resolving disagreements through discussion. Statistical analyses were carried out in R Studio, using a random-effects model to account for anticipated heterogeneity across studies. Primary outcomes included safe sodium correction within 24 hours, overcorrection rates, and ODS incidence. Additional analyses compared overcorrection rates in proactive versus reactive desmopressin use. A leave-one-out sensitivity analysis assessed heterogeneity in safe sodium correction and overcorrection outcomes. Results: Out of 2,026 initial studies, six met the inclusion criteria. The meta-analysis revealed an odds ratio (OR) of 1.14 (95% CI, 0.02-73.11; p = 0.90; I² = 58%) for safe sodium correction in 24 hours. For any 24-hour period, the OR for safe correction was 0.69 (95% CI, 0.05-9.05; p = 0.59; I² = 88.5%). Overcorrection rates showed an OR of 3.09 (95% CI, 0.47-20.26; p = 0.15; I² = 67.5%). Comparing proactive to reactive desmopressin, the OR for overcorrection was 0.46 (95% CI, 0.30-5.96; p = 0.35; I² = 70.9%). ODS risk had an OR of 1.82 (95% CI, 0.02-160.27; p = 0.25; I² = 0%). High heterogeneity was observed across outcomes except for ODS. The leave-one-out analysis notably reduced heterogeneity for 24-hour safe sodium correction, bringing I² to 0% with the exclusion of a single study. Conclusions: Desmopressin's role in managing severe or symptomatic hyponatremia remains complex, with varied impacts on safe sodium correction and secondary endpoints. High confidence intervals, p-values, and substantial heterogeneity limit the statistical significance of these findings. Differences in study populations, methodologies, and lack of randomization contribute to these variabilities. Further randomized trials with improved confounder control are needed to define desmopressin's therapeutic value better and refine management protocols for hyponatremia.

The most common symptoms of PCS are persistent fatigue and cognitive impairment, which significantly affect participation in work and daily life. There is increasing evidence for the effectiveness of rehabilitative treatment approaches. Nevertheless, voices are being raised, especially in the social media, that negatively evaluate rehabilitation for PCS. The aim of this study was to objectify the subjective success of treatment and the satisfaction of inpatients with PCS with the rehabilitation.As part of a prospective multicentre cohort study (n=1028), the subjective treatment success and patient satisfaction (ZUF-8) at the end of PCS rehabilitation were examined (PCS rehabilitation indications: Dual rehabilitation, psychosomatics, neurology and pneumology). Frequency analyses, mean value comparisons, correlation analyses and regression models were used.The subjective success of treatment was rated as good to very good across all PCS rehabilitation indications. Approximately 62% of PCS patients experienced improvement in physical symptoms, about 58% improvement in mental well-being. The general State of health and performance improved in 62% and 47% of patients, respectively. If all categories of treatment success are considered together, at least one area improved in 87.5%. Around 90% of PCS patients would recommend rehabilitation to others or return for treatment. Comparable results also showed that the treatment met the patients' needs. The vast majority of PCS patients (around 90%) would recommend the rehabilitation programme to others or return for treatement. Global patient satisfaction correlated to r=-0.727 (p<0.001) with the subjectively experienced psychological relief, but not with the 6-minute walking test (6MWT) as a somatic surrogate parameter. Regression analyses showed that only improvement in depression had a significant influence on patient satisfaction and subjective treatment success, but not improvement in walking distance or the socio-medical assessment (general labour market performance).PCS rehabilitants were satisfied with the therapy programme across all indications examined and experienced successful treatment. The vast majority of PCS rehabilitants found a multimodal rehabilitation program to be helpful.

Hand proprioception is essential for fine movements and therefore many activities of daily living. Although frequently impaired after stroke, it is unclear how hand proprioception evolves in the sub-acute phase and whether it follows a similar pattern of changes as motor impairments. This work investigates whether there is a corresponding pattern of changes over time in hand proprioception and motor function as comprehensively quantified by a combination of robotic, clinical, and neurophysiological assessments. Finger proprioception (position sense) and motor function (force, velocity, range of motion) were evaluated using robotic assessments at baseline (<3 months after stroke) and up to 4 weeks later (discharge). Clinical assessments (among others, Box & Block Test [BBT]) as well as Somatosensory/Motor Evoked Potentials (SSEP/MEP) were additionally performed. Complete datasets from 45 participants post-stroke were obtained. For 42% of all study participants proprioception and motor function had a dissociated pattern of changes (only 1 function considerably improved). This dissociation was either due to the absence of a measurable impairment in 1 modality at baseline, or due to a severe lesion of central somatosensory or motor tracts (absent SSEP/MEP). Better baseline BBT correlated with proprioceptive gains, while proprioceptive impairment at baseline did not correlate with change in BBT. Proprioception and motor function frequently followed a dissociated pattern of changes in sub-acute stroke. This highlights the importance of monitoring both functions, which could help to further personalize therapies.

We describe an atypical delayed neurologic recovery from coma and unresponsive wakefulness syndrome (i.e., persistent vegetative state) in a patient with severe drug-induced toxic leukoencephalopathy (presumably due to synthetic cannabinoid intake). The patient underwent standardized behavioral and multimodal neuroimaging assessments to monitor clinical evolution and brain function over a 5-month period after presumed intoxication. A progressive clinical recovery was observed, from an initial state of coma to emergence from a minimally conscious state after 2 months. Despite the stability of extensive white matter lesions documented by CT and structural MRI, fluorodeoxyglucose PET showed partial recovery of cortical metabolism after 5 months. This case report illustrates that the temporal dynamics of recovery from toxic acute leukoencephalopathy may be atypical and delayed. Multimodal monitoring with repeated behavioral and functional neuroimaging assessments tends to improve the prognosis reliability, while early prognosis based on structural damage may result in misleading statements.

Introduction Endometriosis significantly reduces patients' quality of life and is additionally a burden on healthcare and social security systems. There are currently no quality indicators for the treatment of endometriosis. The care of patients with endometriosis must be considered inadequate. QS ENDO aims to record the quality of care available in the DACH region and to introduce quality indicators for the diagnosis and treatment of endometriosis as part of providing quality assurance in endometriosis care. The first phase, QS ENDO Real, recorded the reality of current care using a questionnaire. The second phase, QS ENDO Pilot, investigated the treatment of 435 patients who underwent surgical treatment within a defined one month period in certified endometriosis centers. Material and Methods An online tool was used to gather information about 9 points which covered both prior patient history and the process of clinical diagnosis. Surgery reports were reviewed to obtain information about the surgical approach, the investigated sites, findings of any histological examinations, the use of classification systems, and information about resection status. Results 85.3% of patients were asked all 4 questions about their prior medical history. All 5 diagnostic steps were carried out in 34.5% of patients. The 3 areas needed to describe potential sites of disease were recorded in 67.1% of patients. Samples for histological examination were taken in 84.1% of patients. The endometriosis stage was classified in 94.7% of surgeries. A combination of the rASRM and the ENZIAN classifications, which is needed for complex cases, was used in 46.1% of patients. Complete resection was achieved in 81.6% of surgical procedures. Conclusion For the first time, the quality of care in certified endometriosis centers has been recorded using QS ENDO Pilot. Despite the high certification standards, a substantial number of required indicators were omitted.