High-dimensional omics data are typically measured on limited sample sizes, which challenges model-based clustering methods such as Gaussian mixture models (GMMs), often leading to instability and poor generalization under complex mixture structures. To address these limitations, we developed Praxis-BGM, a natural-gradient variational inference framework for GMMs. Praxis-BGM enables semi-supervised transfer learning by incorporating an informative prior GMM estimated from large-scale reference data with robust cluster structures. The prior model can encode cluster-specific means, covariance structures, and structural connectivity patterns, and is updated using the target data with variational inference to improve clustering in small-sample settings. Using the Variational Online Newton (VON) algorithm, we derived natural-gradient updates for the standard parameters of GMMs. Implemented in the Python library JAX for accelerator-oriented computation, Praxis-BGM is computationally efficient and scalable. Across extensive simulations and two real-world applications-breast cancer bulk transcriptomics for subtype recovery and single-cell transcriptomics for cross-platform cell-type label transfer-Praxis-BGM improves posterior clustering performance, stability, and biological interpretability, even when priors are partially mismatched. Praxis-BGM is freely available at https://github.com/ContiLab-usc/Praxis-BGM, and an archival version is available on Zenodo at https://doi.org/10.5281/zenodo.19657680. Supplementary data are available at Bioinformatics online.
BACKGROUND Physical activity has a general impact on cognitive processes, but evidence on the effects of specific exercises on particular cognitive or executive functions remains limited. Previous studies suggest that movements crossing the body's midline stimulate excitability and plasticity in the dorsolateral prefrontal cortex and superior parietal cortex. This study aimed to investigate whether such exercises produce long-term functional changes in these areas. MATERIAL AND METHODS The study involved 22 children aged 6 to 8 years with symptoms of developmental coordination disorder (DCD), divided into 2 equal groups. Both groups completed approximately 9 weeks of coordination training based on Bilateral Integration by Sheila Dobie OBE (the total diagnostic and therapeutic cycle lasted approximately 16 weeks, including a break). The intervention group performed exercises involving midline crossing, while the control group performed exercises without this element. Assessments (sensory integration and praxis tests and the bilateral motor coordination test) were conducted 3 times: before intervention, after 9-week program, and at follow-up. RESULTS Significant improvements were observed in both groups in sequencing praxis (P=0.041 in the control group; P<0.001 in the intervention group) and bilateral motor coordination (P=0.013; P=0.020), but at different rates. In the intervention group, improvements appeared after the intervention, while in the control group only at follow-up. Large effect sizes were found (η² ϵ [0.293, 0.670]), with high statistical power. No significant changes were observed in other functions. CONCLUSIONS The Bilateral Integration method improves sequencing praxis and interhemispheric integration in children with DCD symptoms. Midline-crossing exercises may yield relatively fast improvements in short-term programs.
This study examined the long-term development of environmental social work as a field characterized by strong political-normative claims about what social work ought to do in relation to environmental crises, alongside a comparatively limited cumulative empirical evidence base concerning actual professional practice and impact. Using a mixed bibliometric and full-text topic-modeling design, the study analyzed peer-reviewed ESW scholarship retrieved from the Web of Science Core Collection, Scopus, and Google Scholar. Bibliometric analyses covered 761 publications (1966-2025), while full-text topic modeling and lexical-semantic analyses were conducted on 716 extractable full-text articles (1972-2025) using Latent Dirichlet Allocation (LDA), Structural Topic Modeling (STM), and bibliometric science-mapping techniques implemented in R. The findings suggest that environmental social work expanded additively rather than paradigmatically, with successive discourses and vocabularies accumulating without displacing earlier ones. This pattern produced wide thematic dispersion, conceptual plurality, and multiple centers of gravity without clear paradigmatic dominance. Four dominant framing styles ‒ crisis-emergency, normative justice-advocacy, pedagogical-competency, and ecological-relational-spiritual ‒ coexisted across the literature but remained weakly integrated. Overall, the study argues that environmental social work is best understood as a polycentric, evolving political-normative praxis field rather than a coherent theoretical sub-discipline.
Children with amblyopia commonly present with sensory integration difficulties, however, there is a paucity of validated tools to assess these issues in this clinical population. This study aimed to evaluate the psychometric properties of the Chinese Revised version of the Sensory Integration and Praxis Tests (SIPT-R) for use in children with amblyopia. We conducted a psychometric validation study using baseline data from the China Amblyopia Behavioral Cohort (CABC). Participants included 629 children aged 4-9 years diagnosed with amblyopia; subtypes included bilateral ametropic (55.7%), anisometropic (38.8%), and strabismic amblyopia (5.6%). Based on severity, 32.1% were classified as mild amblyopia, 59.3% as moderate amblyopia, and 8.6% as severe. Because the learning ability subscale was only applicable to children aged 6 years and older, scale structure differed between age groups. Thus, reliability and validity were evaluated separately for the aged 4-5 and 6-9 years. Internal consistency and construct validity were examined via Cronbach's α, split-half reliability, and confirmatory factor analysis (CFA). Convergent and discriminant validity were assessed via factor loadings, composite reliability (CR), and average variance extracted (AVE). The SIPT-R demonstrated excellent internal consistency (Cronbach's α = 0.968 - 0.969) and strong subscale reliability (α = 0.906 - 0.959). All split-half coefficients exceeded 0.80. CFA indicated an acceptable model fit for both age groups: for aged 4-5 years, χ 2/df = 2.712, root mean square error of approximation (RMSEA) = 0.079, comparative fit index (CFI) = 0.832, incremental fit index (IFI) = 0.833; for aged 6-9 years, χ 2/df = 2.951, RMSEA = 0.074, CFI = 0.804, IFI = 0.805. Most items demonstrated adequate factor loadings, with CR values ranging from 0.91 to 0.96 and AVEs between 0.41 and 0.68. Discriminant validity was largely satisfactory; however, a high correlation was observed between tactile defensiveness and proprioception (r = 0.86), which exceeded the square root of their respective AVE (0.69), suggesting some overlap between these constructs. The Chinese revised SIPT-R demonstrates strong reliability and acceptable validity for screening sensory integration function in children with amblyopia. Further research should focus on refining specific subscales and evaluating additional psychometric properties, such as test-retest reliability and criterion validity.
Digital Psychotherapy for Depression in Children and Adolescents: Evidence-Based Efficacy, Conditions and Recommendations for Clinical Practice Depressive disorders in childhood and adolescence are among the most common mental disorders, often follow a recurrent course, and are associated with substantial individual, social, and economic consequences. Against the background of limited treatment success and multiple barriers to help-seeking, digital psychotherapeutic interventions are increasingly being discussed as a potentially low-threshold and scalable addition to routine care. Based on 13 meta-analyses, this article provides a narrative overview of the effectiveness of digital interventions for depressive symptoms and disorders in children and adolescents and situates these findings within relevant ethical, legal, and clinical practice frameworks. Overall, the evidence suggests predominantly small to moderate effects, particularly for cognitive behavioral therapy-based and guided self-management interventions. However, the interpretability of these findings is limited by the heterogeneity of interventions, predominantly subclinical samples, methodological shortcomings, and the limited evidence on adverse effects. For AIbased and especially large language model (LLM)-based applications, the evidence remains very limited, while ethical and legal requirements are particularly demanding. In Germany, no reimbursable digital health applications are currently available for minors with depressive disorders. Digital interventions may meaningfully complement care, but their use requires careful evaluation of effectiveness, safety, data protection, and clinical suitability. Zusammenfassung Depressive Störungen im Kindes- und Jugendalter zählen zu den häufigsten psychischen Erkrankungen, verlaufen häufig rezidivierend und sind mit erheblichen individuellen, sozialen und ökonomischen Folgen verbunden. Vor dem Hintergrund begrenzter Behandlungserfolge und vielfältiger Barrieren der Inanspruchnahme gewinnen digitale psychotherapeutische Anwendungen als potenziell niedrigschwellige und skalierbare Ergänzung der Versorgung an Bedeutung. Der vorliegende Beitrag gibt anhand von 13 Metaanalysen einen narrativen Überblick über die Wirksamkeit digitaler Anwendungen bei depressiven Symptomen und Störungen im Kindes- und Jugendalter und ordnet diese im Hinblick auf ethische, rechtliche und klinisch-praktische Rahmenbedingungen ein. Insgesamt zeigen sich überwiegend kleine bis mittlere Effekte, insbesondere für kognitiv-verhaltenstherapeutisch fundierte und begleitete Selbstmanagementinterventionen. Die Aussagekraft der Befunde wird jedoch durch die Heterogenität der Interventionen, überwiegend subklinische Stichproben, methodische Limitationen sowie die geringe Datenlage zu unerwünschten Wirkungen eingeschränkt. Für KI- und insbesondere Large Language Model (LLM)-basierte Anwendungen ist die Evidenz bislang sehr begrenzt, während zugleich erhöhte ethische und rechtliche Anforderungen bestehen. In Deutschland stehen derzeit keine erstattungsfähigen digitalen Gesundheitsanwendungen (DiGA) für Minderjährige mit depressiven Störungen zur Verfügung. Digitale Anwendungen können die Versorgung sinnvoll ergänzen, ihr Einsatz erfordert jedoch eine sorgfältige Prüfung von Wirksamkeit, Sicherheit, Datenschutz und klinischer Eignung.
Chronic obstructive pulmonary disease (COPD) is one of the leading causes of death worldwide. In recent years, both clinical guidelines and therapeutic options have evolved significantly. The aim of the DELFIN COPD 2 study (Deutsche Expert*innenbefragung: Leitlinien, Fakten, Informationen, Nutzereinschätzungen zur COPD 2), was to provide an up-to-date overview of outpatient care for COPD patients led by pulmonologists in Germany. As part of a nationwide cross-sectional survey, 377 office-based pulmonologists were interviewed using a standardised questionnaire between March and October 2024. Data were analysed descriptively.The results show that fixed combinations of long-acting muscarinic antagonists (LAMA) and long-acting beta-agonists (LABA) are commonly used as the preferred initial therapy in clinical practice. Many pulmonologists consider twice-daily inhalation beneficial, particularly in cases of evening and night-time symptoms. The majority of respondents observe the circadian pattern of COPD symptoms. They attribute this to a combination of physiological changes, waning medication effects and insufficient nocturnal ventilation. International recommendations, especially those from the Global Initiative for Chronic Obstructive Lung Disease (GOLD), play a key role in therapeutic decision-making, whereas economic factors, such as rebate contracts with health insurance providers, are less influential. Correct inhaler use is typically demonstrated by practice staff. Two-thirds of respondents offer smoking cessation support and half use digital tools to assist with patient care.DELFIN COPD 2 highlights the typical challenges of managing COPD in an outpatient setting, such as underutilisation of digital support options. Key elements of future COPD care include consistent smoking cessation efforts, personalised treatment strategies and greater integration of digital health tools. Die chronisch obstruktive Lungenerkrankung (COPD) zählt weltweit zu den häufigsten Todesursachen. In den letzten Jahren haben sich sowohl Leitlinien als auch Therapieoptionen deutlich weiterentwickelt. Ziel der Versorgungsstudie DELFIN COPD 2 (Deutsche Expert*innenbefragung: Leitlinien, Fakten, Informationen, Nutzereinschätzungen zur COPD 2) war es, ein aktuelles Bild der lungenfachärztlichen Versorgung von COPD-Patientinnen und -Patienten in Deutschland zu erheben. Im Rahmen einer bundesweiten Querschnittsbefragung wurden zwischen März und Oktober 2024 insgesamt 377 niedergelassene Pneumologinnen und Pneumologen mittels eines standardisierten Fragebogens interviewt. Die Auswertung erfolgte deskriptiv.Die Ergebnisse zeigen, dass Fixkombinationen aus langwirksamen muskarinergen Antagonisten (LAMA) und langwirksamen Beta-2-Agonisten (LABA) in der Praxis als bevorzugte Initialtherapie eingesetzt werden. Insbesondere bei Symptomen in den Abend- und Nachtstunden bewerten viele Pneumologinnen und Pneumologen die zweimal tägliche Inhalation als vorteilhaft. Die zirkadiane Rhythmik der COPD-Symptomatik wird von der Mehrheit der Befragten beobachtet. Ursachen hierfür sehen sie in einer Kombination aus physiologischen Veränderungen, nachlassender Medikamentenwirkung und unzureichender nächtlicher Ventilation. Internationale Empfehlungen wie der Bericht der Global Initiative for Chronic Obstructive Lung Disease (GOLD) sind für die Therapieentscheidung maßgeblich, während wirtschaftliche Aspekte wie Rabattverträge mit Krankenkassen eine geringere Rolle spielen. Die korrekte Inhalationstechnik wird mehrheitlich durch das Praxisteam geschult. Zwei Drittel der Befragten bieten Tabakentwöhnung an, etwa die Hälfte nutzt digitale Begleittools.DELFIN COPD 2 zeigt typische Herausforderungen in der ambulanten Versorgung, wie z. B. ungenutzte digitale Potenziale. Für eine zukunftsorientierte COPD-Versorgung sind konsequente Rauchentwöhnung, individualisierte Therapien und eine stärkere digitale Unterstützung zentrale Punkte.Schlüsselwörter: COPD, Praxisbefragung, Deutschland, Inhalationstherapie, zirkadianer RhythmusEingereicht am 4. Dezember 2025 – Revision akzeptiert am 30. März 2026.
Cognitive impairments in Parkinson's disease (PD) commonly affect executive function, attention, and visuospatial abilities. These deficits may precede motor symptoms and are often undetected by screening tools such as the Standardized Mini-Mental State Examination (SMMSE). The utility of the Dynamic Lowenstein Occupational Therapy Cognitive Assessment-Geriatric Version (DLOTCA-G) has not been evaluated in older adults with PD. This study aims to investigate the effectiveness of DLOTCA-G in detecting cognitive deficits in PD patients with and without cognitive impairment. In this prospective controlled study, 90 participants aged 65 and above were recruited: 30 PD patients with cognitive impairment (PD-CI), 30 PD patients without cognitive impairment (PD-NCI), and 30 healthy controls. All participants underwent cognitive assessment using SMMSE and DLOTCA-G. The total SMMSE score and eight subscales of the DLOTCA-G were analyzed. Except for the spatial perception score, there was a statistically significant difference between the groups in all DLOTCA-G subscales. The PD-CI group had significantly lower awareness and visuomotor construction scores than the PD-NCI and healthy groups (p < 0.01). The PD-NCI group showed significantly lower awareness and visuomotor construction scores than the healthy group (p < 0.01). Total SMMSE scores showed a moderate positive correlation with orientation, praxis, visuomotor construction, and thinking operations (p < 0.01). In the Parkinson's group (n = 60), SMMSE Orientation correlated strongly with DLOTCA-G Orientation, Visuomotor Construction, and Awareness (p < 0.001). SMMSE Attention/Calculation and Language showed moderate associations with praxis and visuomotor domains (p ≤ 0.001; Table 4). The results indicate that DLOTCA-G subscales associated with executive function are impaired in individuals with PD, even in the absence of cognitive impairment. These findings suggest that DLOTCA-G may offer a more differentiated cognitive profile than SMMSE across multiple domains, although its comparative sensitivity and diagnostic accuracy require further validation in studies using comprehensive neuropsychological references. The study was retrospectively registered (registration number NCT06131619), prospective registration prior to participant enrollment was not completed due to logistical reasons. Protocol adherence was maintained throughout the study.
Social justice is increasingly emphasised in medical education, yet students often struggle to translate awareness of inequity into meaningful action. Drawing on Paulo Freire's critical pedagogy, this study explores how international medical students conceptualise social justice, encounter inequity within clinical and educational environments, and perceive their capacity to act as agents of change. Given the growing internationalisation of UK medical schools, understanding how international learners develop critical consciousness and experience inequity is essential. A qualitative study was conducted using three online focus group studies with 11 Year 2 international medical students at a UK medical school. Data was audio-recorded, transcribed verbatim and thematically analysed using a Freirean framework. Analysis focused on students' expression of critical consciousness, experiences of structural inequity, engagement with the hidden curriculum, sense of belonging and perception of agency and praxis. Four interconnected themes were identified. (1) Emerging critical consciousness: students demonstrated early awareness of social injustice, recognising how poverty, racism, disability, immigration status and biased curricular representations shaped health outcomes. (2) Witnessing inequities in clinical practice: clinical placements in General Practice (GP) settings exposed students to structural constraints such as language barriers, limited resources, inaccessible services and challenges faced by asylum seekers, reinforcing their understanding of health inequity as systemic rather than individual. (3) The hidden curriculum, inequity and belonging: while students identified financial and representational inequities within medical education, they also described a strong sense of belonging fostered through stable Team-Based Learning (TBL) groups, supportive peers and approachable staff. For international students this relational inclusion provided psychological safety and enabled engagement with justice-focused reflection. (4) Awareness without agency: despite growing critical consciousness, students reported limited power to enact change, citing hierarchical norms, lack of authority and resource-constrained systems, reflecting a predominantly banking model of education. International medical students demonstrated emerging critical consciousness and strong relational and institutional belonging, yet faced systemic barriers that constrained their ability to translate awareness into action. Medical education must move beyond awareness-raising to intentionally create opportunities for praxis, address the hidden curriculum, and support faculty to foster action-oriented, socially just learning environments. Integrating belonging with structured opportunities for participation and change is essential to developing critically conscious, socially responsive future practitioners.
African, Caribbean, and Black (ACB) populations in high-income countries (HICs) continue to experience long-standing health inequities rooted in structural and anti-Black racism embedded in health systems, policies, and institutional practices. From an ecosocial perspective, these inequities reflect the embodiment of intersecting forms of oppression structured through racialized, gendered, and socioeconomic relations. Critical racial literacy (CRL) has emerged as a promising framework for recognizing and addressing structural racism in ways that foster critical reflection and support justice-oriented action in health contexts. However, evidence on how CRL is conceptualized and operationalized in health research, policy, and practice concerning ACB communities remains fragmented and limited. This scoping review aims to map how CRL is conceptualized and operationalized in HICs and examine its potential to advance health equity for ACB populations. This scoping review will be conducted in accordance with the Joanna Briggs Institute guidance. Comprehensive searches will be conducted in MEDLINE (Ovid), Embase, CINAHL, PsycInfo, ERIC, Scopus, and ProQuest Dissertations and Theses Global from inception to March 31, 2026. Peer-reviewed articles and theses or dissertations will be included, with no restrictions on study design or publication type. At least 2 independent reviewers will conduct screening, charting, and analysis of the data. A 3-phase thematic mapping process guided by critical race theory, intersectionality, and ecosocial theory will be used to analyze and interpret the findings. Searching, screening, data charting, and analysis will be undertaken between April 2026 and July 2026. Manuscript preparation will be completed by July 31, 2026, and dissemination will occur between August 2026 and October 2026. The findings will identify key CRL components, applications, strategies, barriers, and equity pathways across clinical, policy, and community contexts. This scoping review will provide a comprehensive overview of how CRL is conceptualized and applied in health contexts involving ACB populations in HICs. By clarifying current conceptualizations, applications, and gaps in the literature, the review will identify priorities for future theoretical, methodological, and practice-based development. In doing so, the findings will inform more critically grounded, praxis-oriented, and structurally focused antiracism efforts across health systems. Results will be disseminated through open access publications, conference presentations, and stakeholder engagement activities to advance evidence-informed health equity action. PROSPERO CRD42024623132; https://www.crd.york.ac.uk/PROSPERO/view/CRD42024623132. PRR1-10.2196/79361.
Multimodale Herzbildgebung: Neue Impulse für die klinische Praxis.
This convergent mixed-methods study explores how Theater of the Oppressed (TO) fosters critical consciousness among gay, bisexual, queer, and transgender men (n = 16) in Singapore. Grounded in Freirean praxis, the study assessed pre- and post-intervention changes across four domains: perceived inequality, egalitarianism, critical motivation, and support networks. Quantitative findings showed a significant improvement in support networks and positive shifts in motivation. Qualitative insights revealed how TO's embodied and dialogic methods promoted reflection, solidarity, and agency. Furthermore, this study operationalizes support networks as a distinct, measurable component of critical consciousness within a TO framework. Findings highlight the potential of arts-based, relational interventions to advance psychosocial resilience and collective empowerment among marginalized queer communities in non-Western contexts.
Mainstream global mental health continues to privilege individual-level risk factors and biomedical approaches and treatments while sidelining the structural forces that shape mental distress. Despite calls for more socially embedded and decolonial approaches, policy and research too often neglect how structural phenomena such as globalization, colonialism, and neoliberal reforms directly drive mental health inequities. Drawing on Latin American traditions of social medicine-particularly Jaime Breilh's paradigm of social determination of health-this debate article critiques reductionist frameworks that fragment structural causation into depoliticized lists of risk factors. We articulate a social determination approach for mental health research and practice, emphasizing the multi-level embodiment of power relations, the historical-political organization of social life, structural drivers embedded in institutions and policies, and the role of collective agency and praxis. Illustrative vignettes from Latin America (employment, discrimination, and environment) demonstrate how historically structured processes linking global political economy, institutional arrangements, and everyday social relations become embodied as mental distress, and how participatory and mixed-method research can help document these dynamics while supporting transformative, community-led responses. We argue that adopting a social determination lens can reorient global mental health policy and scholarship toward structural justice, in line with recent international calls to decolonize and politicize mental health research. Not applicable.
Muscle relaxation is one of the most specific domains of anaesthesiology. Both the interaction between the physiology of the motor end plate and the pharmacology of the substances used as well as the impressive effects immediately following injection explain the fascination of this core competence of anaesthesiological work. A profound pharmacological understanding particularly of the pharmacodynamics and pharmacokinetics of the drugs used and the expertise with respect to the monitoring procedures employed are essential prerequisites for the safe use of muscle relaxants and their antagonists. The aim of this continuing education article is therefore to summarise the basic knowledge of muscle relaxation and neuromuscular monitoring from a clinical perspective. Based on research findings published in recent years and guideline recommendations from various professional associations, a possible approach to clinical practice is outlined. Der Themenkomplex Muskelrelaxierung ist eine der spezifischsten Domänen der Anästhesiologie. Sowohl das Zusammenspiel zwischen der Physiologie der motorischen Endplatte und der Pharmakologie verabreichter Substanzen als auch die Eindrücklichkeit der unmittelbar nach der Injektion einsetzenden Effekte erklären die Faszination dieser Kernkompetenz anästhesiologischer Tätigkeit. Pharmakologisches Wissen, insbesondere zu Pharmakodynamik und -kinetik der verabreichten Medikamente, sowie Expertise bezüglich der Monitoringverfahren sind weiterhin essenzielle Voraussetzungen der sicheren Verwendung von Muskelrelaxanzien und ihren Antagonisten. Der vorliegende Weiterbildungsartikel fasst das Basiswissen der Muskelrelaxierung und des neuromuskulären Monitorings mit klinischem Fokus zusammen. Basierend auf aktuellen Forschungserkenntnissen sowie Leitlinienempfehlungen der verschiedenen Fachgesellschaften wird eine mögliche Vorgehensweise für die klinische Praxis aufgezeigt.
Individuals with intellectual disabilities (ID) are at an increased risk of developing dementia. Early detection is essential for providing appropriate support, yet identifying dementia-related changes is challenging due to pre-existing cognitive impairments. Informant-based adapted tools have been developed to support dementia screening in individuals with ID. Among those, the Dementia Screening Questionnaire for Individuals with Intellectual Disabilities (DSQIID) aims to assess behavioural and functional changes related to dementia. This study aimed to examine the associations between the DSQIID total scores, cognitive performance and demographic characteristics of adults with ID. This cross-sectional study included 322 individuals with ID (n Down syndrome [DS] = 55; n non-DS ID = 267). Behavioural and functional changes were assessed using the DSQIID, whereas cognitive functioning was measured with the Test for Severe Impairment (TSI), Brief Praxis Test (BPT) and a semantic verbal fluency task. Negative binomial regression analyses were conducted to explore associations between DSQIID total scores and selected demographic and cognitive variables. Age was significantly associated with behavioural dementia-related changes, as assessed by the DSQIID, whereas ID severity was not associated. Results further showed that participants with DS had significantly higher scores on the DSQIID compared to participants with ID without DS. Higher DSQIID scores were significantly associated with higher semantic verbal fluency performance. Our findings suggest that caregivers may more readily detect behavioural and functional changes in adults with ID who exhibit relatively good verbal capacities. This study underscores the elevated risk of dementia in adults with DS and highlights the importance of supporting caregivers in recognizing early signs of dementia in adults with ID who exhibit lower verbal capacities. The findings underscore the importance of monitoring behavioural, functional and cognitive changes over time. Further research is needed to explore the associations between reported dementia-related changes and the severity of ID.
A 58-year-old patient presented with progressive cerebellar ataxia and lymphocytic pleocytosis with normal MRI findings. Detection of Anti-TR(DNER) antibodies led to the diagnosis of paraneoplastic encephalitis. Tumor workup revealed anaplastic large cell lymphoma. Combined immunotherapy and chemotherapy resulted in clinical stabilization. Ein Patient mit Schwindel und Gangunsicherheit – eine diagnostische Herausforderung. Ein 58-jähriger Patient mit progredientem Schwindel, Gangunsicherheit und Dysarthrie zeigte eine lymphozytäre Liquorpleozytose bei unauffälliger MRT. Der Nachweis von Anti-Tr(DNER)-Antikörpern führte zur Diagnose einer paraneoplastischen Enzephalitis. Die Tumorsuche ergab ein anaplastisches grosszelliges Lymphom. Unter kombinierter immunmodulatorischer und Chemotherapie kam es zu einer klinischen Stabilisierung. Schlüsselwörter: Autoimmunenzephalitis, paraneoplastisches Syndrom, zerebelläre Ataxie, Autoantikörper, Lymphom.
Digital transformation is fundamentally reshaping dermatology, creating new opportunities in diagnostics, therapy, and healthcare organization. Large datasets combined with Artificial Intelligence (AI) enable more precise classification and prognosis, particularly through the analysis of clinical and dermoscopic imaging. Increasingly, synthetically generated data is used to train new algorithms, though its clinical validity remains under evaluation. Teledermatology has established itself as an integral part of care. Video consultations and asynchronous image transfers enhance accessibility to dermatological expertise and can bridge care gaps, especially in structurally weak regions. Furthermore, mobile applications and digital platforms promote adherence, self-monitoring, and active patient engagement. Despite these opportunities, challenges regarding data protection, interoperability, and regulatory frameworks must be addressed to ensure sustainable implementation. Interdisciplinary collaboration between medicine, technology, and health economics is crucial. Physicians play a central role as subject matter experts in assessing data quality and providing clinical interpretation of digital systems. Continuous training of medical staff remains essential. Overall, digitalization offers significant potential to improve dermatological care, provided there are structured processes, quality assurance, and consistent patient involvement.
Since the publication of the previous consensus document on point-of-care lung ultrasound (PoCLUS) in 2012, new evidence has emerged. This consensus aims to update current recommendations by focusing on the clinical applications of PoCLUS as a standalone tool, while acknowledging that this focused approach represents a necessary preliminary step toward its effective integration with other organ-specific ultrasound examinations and complementary diagnostic modalities. A Delphi-based consensus process was conducted under the supervision of a Steering Committee (five voting members) and a Delphi Committee (two non-voting members). Experts were selected according to strict predefined criteria based on highly impactful scientific output and were assigned to specific domains. A structured literature review covering publications from 2012 to 2025 was performed. Statements were drafted, discussed through multiple online rounds, and iteratively refined. Anonymous voting was conducted for each statement using a predefined agreement threshold (80% full agreement); abstentions were excluded from percentage calculations. The process adhered to ACCORD recommendations. Twenty-one experts participated in the entire process. A total of 1775 new publications were reviewed, including 892 original studies, 62 meta-analyses, 38 guidelines, 162 original studies discussed in the first consensus. New statements were developed across multiple domains addressing ultrasound signs, technical aspects, monitoring strategies, and clinical applications of PoCLUS. Consensus was achieved for 83 statements following iterative discussion and voting rounds. This updated consensus provides evidence-based recommendations on the use of PoCLUS in clinical practice, defining its strengths and limitations as a standalone tool and identifying areas requiring further investigation.
The relationship between atopic dermatitis (AD), weight, height, and body mass index (BMI) in children and adolescents and the impact of systemic treatments is controversial. We report the distribution of weight, height, and BMI in the German TREATkids cohort compared to a standardized German cohort (Kromeyer-Hauschild) and the impact of systemic glucocorticoids. This multicenter, prospective study analyzed weight and height data from pediatric patients (2-17 years) with moderate-to-severe AD enrolled in TREATkids. According to Kromeyer-Hauschild metrics, the median height, weight, and BMI of the TREATkids cohort were 42nd, 52nd, and 59th percentiles, respectively. A height deficit was observed compared to the reference population. Despite shorter stature, the children exhibited weight percentiles comparable to the general population. This combination of reduced height and normal weight led to high BMI-for-age percentiles. A sensitivity analysis excluding patients who had received systemic corticosteroids showed similar results for height-for-age, weight-for-age, and BMI-for-age percentiles. Children and adolescents with moderate-to-severe AD in TREATkids exhibit distinct anthropometric patterns, characterized by height deficits but normal weight distribution, independent of systemic glucocorticoid treatment.
This study investigates the postoperative mobility following partial semitendinosus tendon harvesting performed during pelvic organ prolapse (POP) repair using the Hornemann Tendon Transplantation (HoTT®) method. The aim was to evaluate whether the procedure causes functional impairments and which patient-related factors influence postoperative mobility outcomes. A single-arm prospective observational study was conducted involving 142 women with POP-Q stage II-IV prolapse who underwent laparoscopic sacropexy with partial autologous semitendinosus tendon harvest. Mobility was assessed preoperatively and at 6 weeks, 3 months, and 6 months postoperatively using the validated Prosthetic Limb Users Survey of Mobility (PLUS-M™). Statistical analysis included mixed logistic regression with age, BMI, and time as fixed effects and patient identity as a random effect. Mean age was 60.1 ± 10.3 years; mean BMI was 24.3 ± 3.7 kg/m2. Median mobility (T-score) increased from 64.5 before surgery to 67.1 at 6 weeks and 71.4 at both 3 and 6 months (p < 0.001). Higher age (OR 0.94; p = 0.022) and BMI (OR 0.82; p = 0.009) were independently associated with lower odds of achieving a high mobility score (T ≥ 71.4). No significant change in continence status was observed. Patient satisfaction and quality of life improved markedly, with 96.6% recommending the procedure. Partial semitendinosus tendon harvesting in HoTT® surgery does not impair mobility and is associated with significant improvements in function and quality of life. Advanced age and higher BMI mildly reduce postoperative mobility potential but do not contraindicate the procedure.
Major depressive disorder (MDD) and treatment-resistant depression (TRD) are prevalent and debilitating conditions. Over 50% of patients have inadequate response to first-line serotonergic antidepressants and are left with suboptimal treatment options. Rapid-acting and individually tailored treatments for MDD remain major unmet needs. This review discusses promising rapid-acting treatments, including psychedelic and neuroplastogen compounds, currently under investigation for the treatment of MDD and TRD. Among these, psilocybin has advanced to late-stage trials. In addition, we examine the emerging role of repetitive transcranial magnetic stimulation (rTMS), including novel personalized interventions, such as the Stanford Accelerated Intelligent Neuromodulation Therapy (SAINT) protocol, which has demonstrated rapid antidepressant effects and is now FDA-cleared for TRD, positioning it closest to clinical translation. We also highlight the ongoing ALTO-300 trial, which is evaluating an adjunctive treatment for MDD in patients identified by an EEG biomarker-representing another promising step toward personalized treatment. Finally, we review the results of a Phase 2 study reporting outcomes that vary by a specific genotype sequence, underscoring the potential for genetically guided personalized interventions. Despite these advances, key limitations, including unblinding in psychedelic trials, scalability challenges of intensive neuromodulation protocols, and the need for validated biomarkers, pose ongoing challenges for real-world implementation.