Virtual reality jogging as a novel exposure paradigm for the acute urge to be physically active in patients with eating disorders: Implications for treatment.

The acute urge to be physically active is a relevant clinical phenomenon in patients suffering from eating disorders. In this study with n = 20 female patients with anorexia nervosa and n = 10 female patients with bulimia nervosa, a virtual reality (VR) jogging paradigm was applied as a novel highly immersive 3D exposure paradigm. Patients were asked to rate their acute urge to be physically active during the exposure procedure. A 10-item self-report questionnaire (smQ) was developed to capture the cognitive, emotional, and behavioral aspects of the acute urge to move. We hypothesized that exposure would lead to habituation of the urge to be physically active. We also hypothesized that leptin levels would be associated with the degree of the subjective urge to be physically active, while habituation would be associated with a decrease in stress hormones (α-amylase, cortisol, and cortisone in saliva). A statistically significant change in subjective scores in the smQ from baseline to postexposure was seen. Our novel VR paradigm may serve as a therapeutic tool for exposure and habituation of the urge of acutely engaging in physical activity in patients with eating disorders.

Explicit and implicit approach vs. avoidance tendencies towards high vs. low calorie food cues in patients with anorexia nervosa and healthy controls.

Patients with anorexia nervosa (AN) have a strong ability to limit food intake. Thus, dysfunctional approach vs. avoidance behaviors towards food are evident in AN. We applied an approach-avoidance task (AAT), in which n = 41 AN patients and n = 42 controls either approached ("pull") or avoided ("push") high (HC) vs. low calorie (LC) food pictures based solely on the presented picture format (landscape vs. portrait). We tested the hypothesis that -in opposition to controls displaying an approach bias towards HC food cues- AN patients would show an avoidance bias (measured as different response times) towards HC food. Explicit ratings of food cues were also performed. We found a significant interaction "group" x "direction" (p = 0.03). rm-ANOVAs performed for each of the two groups separately showed a main effect for "direction" of motion in controls (p = 0.02), but not in AN patients (p = 0.40). The two groups did not differ in their reaction times (RTs) with regard to "push" (p = 0.27). However, RTs with regard to "pull" were significantly different between the groups (p = 0.04). Controls show a clear approach bias, expressed by significantly faster RTs for "pull" compared to "push", independent of "calorie" content of the food stimuli. This approach bias is absent in the group of AN patients. This is indicative of a global loss of incentive value of food in AN. Implicit trainings as add-on to psychotherapy in AN patients are asked for.

Intraoperative assessment of surgical margins during breast conserving surgery of ductal carcinoma in situ by use of radiofrequency spectroscopy.

Assessment of margins when excising ductal carcinoma in situ (DCIS) of the breast is difficult. Frozen section is unreliable and specimen intraoperative radiography only provides information regarding the extent of the visualized lesion or the microcalcifications. A multi-center, single arm study was conducted to evaluate the benefit of a novel device (MarginProbe) in intraoperative margin assessment during breast conserving surgery (BCS) of DCIS, and the associated reduction of re-excisions. We present results for 22 patients, from those enrolled in our institution. The device was used as an adjunctive tool to current practice. Based on permanent histology reporting, the rate of successful procedures was 86%. The improvement in intraoperative assessment with device use was associated with a reduction in re-excision rates, from 38.8 to 18%.

159C>T CD14 genotype--functional effects on innate immune responses in term neonates.

Given the susceptibility of newborns to infection and the potential harm of overwhelming proinflammatory immune responses, the impact of genetic variation in innate immune molecules is of increasing interest for risk stratification and prevention. We studied the functional relevance of the 159C>T CD14 single nucleotide polymorphism in cord blood samples of n=135 healthy term neonates by investigation of sCD14, interleukin (IL)-6, IL-10, and tumor necrosis factor (TNF)-alpha concentrations in whole-blood culture supernatants and intracellular assessment of IL-1beta, IL-6, and TNF-alpha expression by flow cytometry. The 159C>T CD14 genotype frequencies were n=42 (0.31) for homozygous CD14-159 CC, n=69 (0.51) for heterozygous CD14-159 CT, and n=24 (0.18) for homozygous CD14-159 TT. No genotype-associated differences were noted for ex vivo baseline expression of sCD14, IL-6, IL-10, and TNF-alpha. After in vitro stimulation of cord blood cultures with lipopolysaccharide, carriers of the CD14-159 T allele were determined to have higher levels of sCD14 compared with carriers of the CD14-159 C allele (p=0.04) and increased concentrations of IL-6 (p=0.009) in culture supernatants (one-way analysis of variance). The 159C>T CD14 polymorphism is associated with soluble CD14 expression and cytokine expression, which might influence the balance of pro- and anti-inflammatory immune responses in healthy term neonates. Further studies are needed to delineate whether the 159C>T CD14 genotype is a risk factor for severity of neonatal infection in the clinical setting and a potential target for prevention strategies.