Addressing psychosocial needs in patients with Long-COVID (PsyLoCo-Study): study protocol of a pilot-study of a specialized modular intervention

Introduction

After an acute infection with the corona virus 10-20% of those affected suffer from ongoing or new symptoms. A causal therapy for the phenomenon known as Long/Post-COVID is still lacking and specific therapies addressing psychosocial needs of these patients are imperatively needed. The aim of the PsyLoCo-study is developing and piloting a psychotherapeutic manual, which addresses Long/Post-COVID-related psychosocial needs and supports in coping with persistent bodily symptoms as well as depressive or anxiety symptoms.

Methods and analysis

This pilot trial implements a multi-centre, 2-arm (N=120; allocation ratio: 1:1), parallel group, randomised controlled design. The pilot trial is designed to test the feasibility and estimate the effect of 1) a 12-session psychotherapeutic intervention compared to 2) a wait-list control condition on psychosocial needs as well as bodily and affective symptoms in patients suffering from Long/Post-COVID. The intervention uses an integrative, manualized, psychotherapeutic approach. The primary study outcome is health-related quality of life. Outcome variables will be assessed at three timepoints, pre-intervention (t1), post-intervention (t2) and three months after completed intervention (t3). To determine the primary outcome, changes from t1 to t2 are examined. The analysis will be used for the planning of the RCT to test the efficacy of the developed intervention.

Discussion

The pilot study will evaluate a 12-session treatment manual for Long/Post-COVID sufferers and the therapy components it contains. The analysis will provide insights into the extent to which psychotherapeutic treatment approaches improve the symptoms of Long/Post-COVID sufferers. The treatment manual is designed to be carried out by psychotherapists as well as people with basic training in psychotherapeutic techniques. This approach was chosen to enable a larger number of practitioners to provide therapeutic support for Long/Post-COVID patients. After completion of the pilot study, it is planned to follow up with a randomized controlled study and to develop a treatment guideline for general practitioners and interested specialists.

Trial registration

The pilot trial has been registered with the German Clinical Trials Register (Deutsches Register Klinischer Studien; Trial-ID: DRKS00030866; URL: https://drks.de/search/de/trial/DRKS00030866) on March 7, 2023.

Multivalent, Bispecific αB7-H3-αCD3 Chemically Self-Assembled Nanorings Direct Potent T Cell Responses against Medulloblastoma

Few therapeutic options have been made available for treating central nervous system tumors, especially upon recurrence. Recurrent medulloblastoma is uniformly lethal with no approved therapies. Recent preclinical studies have shown promising results for eradicating various solid tumors by targeting the overexpressed immune checkpoint molecule, B7-H3. However, due to several therapy-related toxicities and reports of tumor escape, the full potential of targeting this pan-cancer antigen has yet to be realized. Here, we designed and characterized bispecific chemically self-assembling nanorings (CSANs) that target the T cell receptor, CD3ε, and tumor associated antigen, B7-H3, derived from the humanized 8H9 single chain variable fragment. We show that the αB7-H3-αCD3 CSANs increase T cell infiltration and facilitate selective cytotoxicity of B7-H3⁺ medulloblastoma spheroids and that activity is independent of target cell MHC class I expression. Importantly, nonspecific T cell activation against the ONS 2303 medulloblastoma cell line can be reduced by tuning the valency of the αCD3 targeted monomer in the oligomerized CSAN. Intraperitoneal injections of αB7-H3-αCD3 bispecific CSANs were found to effectively cross the blood-tumor barrier into the brain and elicit significant antitumor T cell activity intracranially as well as systemically in an orthotopic medulloblastoma model. Moreover, following treatment with αB7-H3-αCD3 CSANs, intratumoral T cells were found to primarily have a central memory phenotype that displayed significant levels of characteristic activation markers. Collectively, these results demonstrate the ability of our multivalent, bispecific CSANs to direct potent antitumor T cell responses and indicate its potential utility as an alternative or complementary therapy for immune cell targeting of B7-H3⁺ brain tumors.

PDTM-19. MYC AND FAK/SRC COMBINATION TREATMENT OF FOXR2-HIGH BRAIN TUMORS

Brain tumors are the leading cause of cancer-related deaths in children. To identify novel therapeutic targets in two types of pediatric brain tumors, medulloblastoma (MB) and central nervous system primitive neuroectodermal tumors (CNS-PNETs), we performed a Sleeping Beauty transposon mutagenesis screen in mice. In doing this, we identified FOXR2 (Forkhead box R2) as a candidate oncogene in MB. FOXR2 is expressed at high levels in a subset of human MB and increased FOXR2 expression drives MB formation in mice. FOXR2 has been implicated as an oncogene in several cancers of neural original, including CNS-PNET, adult and pediatric high-grade glioma, and malignant peripheral nerve sheath tumors. We have also found that FOXR2 is upregulated in non-MYCN amplified high-risk neuroblastoma. Therefore, we propose that FOXR2 represents a strong candidate for targeted therapy across multiple brain tumor entities. We have uncovered a dual role of FOXR2 in stabilization of CMYC protein and activation of the FAK/SRC signaling pathway. We are working to further define the mechanism of FOXR2-mediated MYC stabilization and FAK/SRC activation. We plan to treat FOXR2-high tumors with combinations of drugs effective against tumors with high MYC, FAK, or SRC in clinical development. Inhibitors or combinations of that score well in vitro will be used to treat mice with orthotopically injected FOXR2-high tumor cells (MB, neuroblastoma, and glioma). In addition, we are working to construct mouse models of FOXR2-driven neural tumors for use in drug testing. We hypothesize that FOXR2-high tumors will be sensitive to MYC and FAK/SRC inhibitor combination therapy, establishing FOXR2 as a molecular marker for treatment success of MYC and FAK/SRC inhibitors in patients.

Cerebrovascular reactivity during the Valsalva maneuver in migraine, tension-type headache and medication overuse headache

The aim of this study was to investigate, by means of transcranial Doppler ultrasound (TCD), cerebrovascular reactivity during the Valsalva maneuver (VM) during the headache-free interval in patients with migraine (M), migraine plus tension-type headache (M+TTH), and migraine plus medication overuse headache (M+MOH). A total of 114 patients (n=60 M, n=38 M+TTH, n=16 M+MOH) and n=60 controls were investigated; diagnoses were made according to the International Headache Society criteria. All subjects underwent TCD monitoring and, simultaneously, non-invasive assessment of arterial blood pressure and end-tidal CO2. Two indices were determined: the cerebrovascular Valsalva ratio (CVR) was calculated as the maximum end-diastolic flow velocity acceleration during the late straining phase of the VM [cm/s2] and the centroperipheral Valsalva ratio (CPVR) was defined as the quotient of CVR to the concomitant arterial blood pressure acceleration [cm/mmHg x s]. The dynamic cerebrovascular autoregulatory response to the VM, measured as CVR, was increased in patients with M and M+TTH compared to age-matched healthy subjects. By contrast, CPVR (i.e. the quotient of the cerebrovascular to the peripheral autonomic response), was increased in M patients compared to healthy subjects and all other headache conditions tested. Cerebrovascular autoregulatory response during the VM was increased in M patients compared to age-matched normal healthy subjects, indicating a disturbed autonomic control of cerebral vasoreactivity. The CPVR seems to be a sensitive parameter for distinguishing between M patients and M+TTH or M+MOH patients.

Automatische Klassifikation der Lebersegmente nach Couinaud: Entwicklung eines neuen Algorithmus und Evaluierung an Spiral-CT-Datensätzen

PURPOSE

To develop a software tool that analyzes the anatomy of the portal vein branches and assigns segmental and subsegmental branches according to Couinaud's classification system and to evaluate its accuracy.

MATERIALS AND METHODS

The algorithm was developed in C++ on a PC. The algorithm recognizes the three major branching patterns of the portal vein. Segmental and subsegmental branches are assigned to 8 segments following Couinaud and encoded by 8 colors. The software was evaluated using CT data sets of 39 patients. After the individual segmental anatomy of each patient was determined by an experienced radiologist, automatic classification was performed and the results were compared on a branch by branch basis.

RESULTS

The numbering was accurate according to Couinaud's system in 358 of 409 segmental and subsegmental branches (88 %). The assignment failed in 51 of 409 branches due to unexpected anatomy or software problems.

CONCLUSION

Automatic classification of portal vein branches and their appendant parenchyma is possible. The automatic designation of liver segments enables the three-dimensional visualization of the segmental anatomy. In the future, automatic analysis might facilitate the reporting and communication of CT findings.

JAK3 associates with the human interleukin 4 receptor and is tyrosine phosphorylated following receptor triggering

In human B cells, interleukin 4 (IL4) acts in regulating proliferation, antigen expression, isotype switching and differentiation. These different effects are mediated through the IL4R complex including the IL2R gamma chain (gamma c) and a specific p130/140 binding unit referred below as human Interleukin 4 Receptor (IL4-R). Here, we studied the signal transduction events following IL4R activation and leading to CD23 expression on resting B cells. We demonstrate that IL4R triggering induced the tyrosine phosphorylation of JAK3 and of a p170 protein. Coimmunoprecipitation of JAK3 with the IL4R suggests a physical association which exists prior to IL4R complex stimulation. Orthovanadate treatment, while having no effect on IL4-induced p130 phosphorylation, leads to the hyperphosphorylation of the p170 and inhibits IL4-induced CD23 expression. These suggest that two mandatory steps exist in early IL4 signaling: one controlled by JAK3 activation and the other by the p170 phosphoprotein.

Nonlinear analysis of sleep EEG data in schizophrenia: calculation of the principal Lyapunov exponent

The generating mechanism of the electroencephalogram (EEG) points to the hypothesis that EEG signals derive from a nonlinear dynamic system. Hence, the unpredictability of the EEG might be considered as a phenomenon exhibiting its chaotic character. The essential property of chaotic dynamics is the so-called sensitive dependence on initial conditions. This property can be quantified by calculating the system's first positive Lyapunov exponent, L1. We calculated L1 for sleep EEG segments of 13 schizophrenic patients and 13 control subjects that corresponded to sleep stages I, II, III, IV and REM (rapid eye movement), as defined by Rechtschaffen and Kales, for the lead positions Cz and Pz. During REM sleep, for both electrode positions, the principal Lyapunov exponent L1 was significantly increased in schizophrenic patients compared with control subjects. This finding points to altered nonlinear brain dynamics during REM sleep in schizophrenia.

Nonlinear analysis of sleep EEG in depression: calculation of the largest lyapunov exponent

Conventional sleep analysis according to Rechtschaffen and Kales (1968) has provided meaningful contributions to the understanding of disturbed sleep architecture in depression. However, there is no characteristic alteration of the sleep cycle, which could serve as a highly specific feature for depressive illness. Therefore, we started to investigate nonlinear properties of sleep electroencephalographic (EEG) data in order to elucidate functional alterations other than those obtained from classical sleep analysis. The application of methods from nonlinear dynamical system theory to EEG data has led to the assumption that the EEG can be treated as a deterministic chaotic process. Chaotic systems are characterized by a so-called sensitive dependence on initial conditions. This property can be quantified by calculating the system's Lyapunov exponents, which measure the exponential separation of nearby initial states in phase space. For 15 depressive inpatients (major depressive episodes according to DSM-III-R criteria) and 13 healthy controls, matched in gender, age, and education, we computed the principal Lyapunov exponents L1 of EEG segments corresponding to sleep stages, I, II, III, IV, and rapid eye movement (REM), according to Rechtschaffen and Kales, for the lead positions CZ and PZ. We found statistically significant decreased values of L1 during sleep stage IV in depressives compared with a healthy control group.

The calculation of the first positive Lyapunov exponent in sleep EEG data

To help determine if the EEG is quasiperiodic or chaotic we performed a new analysis by calculating the first positive Lyapunov exponent L1 from sleep EEG data. Lyapunov exponents measure the mean exponential expansion or contraction of a flow in phase space. L1 is zero for periodic as well as quasiperiodic processes, but positive in case of chaotic processes expressing the sensitive dependence on initial conditions. We calculated L1 for sleep EEG segments of 15 healthy male subjects corresponding to sleep stages I, II, III, IV and REM (according to Rechtschaffen and Kales). Our investigations support the assumption that EEG signals are neither quasiperiodic waves nor simple noise. Moreover, we found statistically significant differences between the values of L1 for different sleep stages.

Deterministic chaos and the first positive Lyapunov exponent: a nonlinear analysis of the human electroencephalogram during sleep

Under selected conditions, nonlinear dynamical systems, which can be described by deterministic models, are able to generate so-called deterministic chaos. In this case the dynamics show a sensitive dependence on initial conditions, which means that different states of a system, being arbitrarily close initially, will become macroscopically separated for sufficiently long times. In this sense, the unpredictability of the EEG might be a basic phenomenon of its chaotic character. Recent investigations of the dimensionality of EEG attractors in phase space have led to the assumption that the EEG can be regarded as a deterministic process which should not be mistaken for simple noise. The calculation of dimensionality estimates the degrees of freedom of a signal. Nevertheless, it is difficult to decide from this kind of analysis whether a process is quasiperiodic or chaotic. Therefore, we performed a new analysis by calculating the first positive Lyapunov exponent L1 from sleep EEG data. Lyapunov exponents measure the mean exponential expansion or contraction of a flow in phase space. L1 is zero for periodic as well as quasiperiodic processes, but positive in the case of chaotic processes expressing the sensitive dependence on initial conditions. We calculated L1 for sleep EEG segments of 15 healthy men corresponding to the sleep stages I, II, III, IV, and REM (according to Rechtschaffen and Kales). Our investigations support the assumption that EEG signals are neither quasiperiodic waves nor a simple noise. Moreover, we found statistically significant differences between the values of L1 for different sleep stages.(ABSTRACT TRUNCATED AT 250 WORDS)

Interaction of the trp repressor with trp operator DNA fragments

The interaction of the trp repressor with several trp operator DNA fragments has been examined by DNA gel retardation assays and by circular dichroism, in the absence and presence of the corepressor L-tryptophan. The holorepressor binds stoichiometrically to both the trpO and aroH operators, forming 1:1 complexes. In the presence of excess protein, additional complexes are formed with these operator fragments. The relative electrophoretic mobilities of the 1:1 complexes differ significantly for trp and aroH operators, indicating that they differ substantially in gross structure. A mutant trp operator, trpOc, has low affinity for the holorepressor, and forms only complexes with stoichiometries of 2:1 (repressor: DNA) or higher, which have a very low electrophoretic mobility. Specific binding is also accompanied by a large increase in the intensity of the near ultraviolet circular dichroism, with only a small blue shift, which is consistent with significant changes in the conformation of the DNA. Large changes in the chemical shifts of three resonances in the 31P NMR spectrum of both the trp operator and the aroH operator occur on adding repressor only in the presence of L-tryptophan, consistent with localised changes in the backbone conformation of the DNA.

[Registration and analysis of airway pressure and gas flow in ventilated patients. The "Hyper-DAQ Respiration Mechanics Recorder"]

Respiratory data monitored in ventilated patients commonly consists of monitoring some inspiratory and expiratory pressures and volumes. For a more sophisticated analysis of respiratory mechanics in ventilated patients, a combined hardware and software system is presented that allows for continuous monitoring of airway pressure and gas flow. Gas flow is measured using a pneumotach. The "Hyper-DAQ" is an 8-channel 12-bit analog to a digital converter that can be connected to IBM PCs as well as to Macintosh computers using a standard RS 232 link. A special module consisting of three pressure transducers (airway pressure, differential pressure for a Fleisch head and ambient pressure) and five additional analog inputs is used for recording respiratory data. Once set up, the Hyper-DAQ records all the data in real time, independently of the host system that can query the data via the RS 232 link. The software runs on IBM and compatible PCs, as well as on Macintosh computers. The software simulates a strip-chart recorder and can be controlled by the keyboard and the mouse. We developed special software for the calibration of pressure and flow. Using models of the gas distribution in the lung compliance, resistance and lung time constants can be calculated from the raw data. For special purposes the data can be transferred to spread-sheet software. A mainstream CO2-detector connected to one of the additional analog inputs allows for additional data: alveolar ventilation, series deadspace, etc. The system presented can be recommended in routine work as well as for scientific studies in ventilated patients.

Sequence-specific NMR assignments of the trp repressor from Escherichia coli using three-dimensional 15N/1H heteronuclear techniques

Sequence-specific 15N and 1H assignments for the trp holorepressor from Escherichia coli are reported. The trp repressor consists of two identical 107-residue subunits which are highly helical in the crystal state [Schevitz, R., Otwinowski, Z., Joachimiak, A., Lawson, C. L. & Sigler, P. B. (1985) Nature 317, 782-786]. The high helical content and the relatively large size of the protein (Mr = 25,000) make it difficult to assign even the main-chain resonances by conventional homonuclear two-dimensional NMR methods. However, we have now assigned the main-chain resonances of 94% of the residues by using three-dimensional 15N/1H heteronuclear experiments on a sample of protein uniformly labelled with 15N. The additional resolution obtained by spreading out the signals into three dimensions proved indispensable in making these assignments. In particular, we have been able to resolve signals from residues in the N-terminal region of the A helix for the first time in solution. The observed NOE results confirm that the repressor is highly helical in solution, and contains no extended chain conformations.

Determination of the orientations of tryptophan analogues bound to the trp repressor and the relationship to activation

The antirepressor indole 3-propanoate has been shown by X-ray crystallography to bind in a different orientation compared with the natural corepressor for the tryp repressor, L-tryptophan (Lawson, C.L. & Sigler, P. B. (1988) Nature 333, 869-871). This suggests a simple difference between what constitutes a corepressor versus an antirepressor. We have used visible absorption and 1H-NMR spectroscopy to characterise the nature of several ligand-repressor complexes and DNA-binding assays to assess the relative operator binding affinities. 5-Fluorotryptophan binds with similar affinity and in the same orientation as L-tryptophan, and is an equally effective corepressor. In contrast, the tight-binding antirepressor indole 3-acrylate binds in the same orientation as indole 3-propanoate. Indole, also an antirepressor, also binds in the indole-3-propanoate orientation. 5-Methyltryptamine, a corepressor, shows spectroscopic characteristics of both tryptophan and indoleacrylate, though NOEs indicate that the tryptophan orientation is preferred. These results indicate that the ammonium group in the side chain is essential both for activation and binding in the L-tryptophan orientation. Antirepressors, lacking the ammonium group, bind in the more favourable indole-3-propanoate orientation. Differences in the NMR signatures of the different repressor-ligand complexes indicate that the details of the conformations depend on the nature of the ligands and their orientation within the binding site. Despite any conformational rearrangement of the protein on binding, dissociation of ligands is facile: 5-fluorotryptophan dissociates rapidly at 313 K. These findings complement and extend the X-ray and thermodynamic analyses of ligand binding.

[Physical factors in animal experiments for testing antimasspsychotic drugs]

Lemmingson et al. have observed that the movement of masspsychotic lemmings (Lemmus lemmus) shows a distinct preference for the left direction. They suggested that this is due to the influence of the Coriolis force. According to this proposition the influence of the Coriolis force on a group of masspsychotic animals has been investigated quantitatively. The results suggest the following model: Normally the influence of the Coriolos force, which on the northern hemisphere acts to the right, is compensated by a neuromuscular feedback mechanism. The tendency towards the left under masspsychotic conditions corresponds to overcompensation. The tendency to the left should also be observed on the southern hemisphere, if the direction of this compensation is determined genetically. Therefore, the test proposed by Lemmingson et al. is not suited to distinguish between the influence of the Coriolis force and the influence of biologically active left-isomer molecules.

A Polarographic Investigation of Perinaphthenone

The polarographic reduction of perinaphthenone and of some of its derivatives has been investigated. It was found that these compounds are reduced in two one-electron steps. The adsorptive behaviour of the intermediate reduction product, the free radical, is compared with that of the fully reduced form and the decomposition rate of the free radical estimated.

Direct current polarography of the ferrous-ferric oxolate system in the presence of alternating voltages

The effect of the superposition of a small alternating voltage on the normal direct voltage applied to the dropping mercury electrode (D.M.E.) was investigated in the case of the ferrous-ferric oxalate system. The wave obtained was of the type found previously for ions which are reversibly reduced at the D.M.E. (e.g. Cd++ etc.). That is, the rectification of the A.C. produced a D.C. wave (the Z wave) which crossed the normal D.C. wave (the Y wave) at the half-wave potential (E�), When surface active materials were added (e.g. cyclohexanol) the reduction became " irreversible " and at certain concentrations of the surface active substance a maximum appeared on the Y wave of a somewhat unusual nature. The effect of a superposed alternating voltage was studied in these cases and it was found that the adsorption of the cyclohexanol was influenced by the presence of the alternating voltage.