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Monitoring stress is relevant in many areas, including sports science. In that scope, various studies showed the feasibility of stress classification using eye tracking data. In most cases, the screen-based experimental design restricted the motion of participants. Consequently, the transferability of results to dynamic sports applications remains unclear. To address this research gap, we conducted a virtual reality-based stress test consisting of a football goalkeeping scenario. We contribute by proposing a stress classification pipeline solely relying on gaze behaviour and pupil diameter metrics extracted from the recorded data. To optimize the analysis pipeline, we applied feature selection and compared the performance of different classification methods. Results show that the Random Forest classifier achieves the best performance with 87.3% accuracy, comparable to state-of-the-art approaches fusing eye tracking data and additional biosignals. Moreover, our approach outperforms existing methods exclusively relying on eye measures.

The visual depth perception is composed of monocular and binocular depth cues. Studies show that in absence of binocular depth cues the performance of visuomotor tasks like pointing to or grasping objects is limited. Thus, binocular depth cues are of great importance for motor control required in everyday life. However, binocular depth cues like retinal disparity (basis for stereopsis) might be influenced due to developmental disorders of the visual system. For example, amblyopia in which one eye's visual input is not processed leads to loss of stereopsis. The primary amblyopia treatment is occlusion of the healthy eye to force the amblyopic eye to train. However, improvements in stereopsis are poor. Therefore, binocular treatments arose that equilibrate both eyes' visual input to enable binocular vision. However, most approaches rely on divided stimuli which do not account for loss of stereopsis. We created a Virtual Reality (VR) with reduced monocular depth cues in which a stereoscopic task is shown to both eyes simultaneously, consisting of two balls jumping towards the user. One ball appears closer to the user which must be identified. To evaluate the task performance the reaction time is measured. We validated our approach with 18 participants with stereopsis under three contrast settings including one leading to monocular vision. The number of correct responses reduces from 90% under binocular vision to 52% under monocular vision corresponding to random guessing. Our results indicate that it is possible to disable monocular depth cues and create a dynamic stereoscopic task inside a VR.

Purpose The tumorigenesis of squamous cell cancer of unknown primary (SCCUP) in the head and neck area has not been decoded so far, while poor survival rates and limited therapeutic options pose a serious challenge. The aim of this project was to investigate immunological characteristics of SCCUPs and compare them to oropharyngeal squamous cell carcinoma (OPSCC). Methods PD-L1 expression (TC) was examined by immunohistochemistry in 50 lymph node metastases of SCCUP and 47 primaries of OPSCC. CD3 + and CD8 + lymphocytic infiltration was measured in 5 high power fields. Expression of p16 and HPV ISH were assessed. Results SCCUP demonstrated a significantly higher expression of PD-L1 than OPSCC. In p16-negative SCCUPs PD-L1 proved to be an independent prognostic factor to prioritize high-risk patients. Conclusions Immunologic differences between SCCUP and OPSCC were detected. A higher PD-L1 expression in SCCUP could potentially facilitate further evaluation of checkpoint inhibitor therapy.

ACE inhibitor (ACEi) induced angioedema predominantly affects the upper aerodigestive tract. As ACEi induced angioedema is mediated by bradykinin, therapeutic response to antihistamines and glucocorticoids remains unsatisfactory. In bradykinin mediated hereditary angioedema, C1-esterase inhibitor (C1INH) is an effective and approved treatment since many years. Our aim was to evaluate the therapeutic effect of C1INH in ACEi induced angioedema.We performed a double-blind, parallel-group, multicentre randomised placebo-controlled trial between December 2013 and September 2018. Eligible were adults with ACEi induced angioedema with airway obstruction. Participants were randomised 1:1 to single doses of either C1INH (20 IU/kg) or placebo (0.9% NaCl) i.v in addition to standard care (i.v. 500 mg prednisolone and 2.68 mg clemastine) i.v. Composite symptom scores were assessed at baseline and up to 48 h, at discharge and 1 week after discharge. Physician assessed time to complete oedema resolution (TCER) and time to onset of relief (TOR).30 patients (16 C1INH, 14 placebo) were randomised and dosed. 25 (9 C1INH, 12 placebo) completed the study. TCER was 29.63 h ± 15.56 h in the C1INH and 17.29 h ± 10.40 h in the placebo arm (p = 0.0457). TORs were 4.13 h ± 3.38 h and 2.86 h ± 1.29 h for C1INH and placebo, respectively (p = 0.4443). There were no adverse events related to study medication.In the context of baseline application of steroids and antihistamines C1INH was inferior in the treatment of ACEi induced angioedema when compared to placebo with respect to time to complete resolution of symptoms. Eudra-CT Number: 2012-001670-28.

Objective: The human gut microbiome is strongly influenced by the administration of drugs, namely antibiotics. We hypothesized that the effectiveness of immunotherapy with pembrolizumab in oral squamous cell carcinoma patients is decreased by the administration of antibiotics three months before and after immunotherapy. Methods: We retrieved data from patients diagnosed with head and neck squamous cell carcinoma (HNSCC) (International Classification of Diseases [ICD]-10 codes C00-C14) and receiving immunotherapy with pembrolizumab from the TriNetX network. Two cohorts were built: patients in cohort I did not receive any antibiotics within three months before or up to three months after immunotherapy, while patients in cohort II were administered antibiotics at least once within three months before or after immunotherapy. To exclude confounders, we matched cohorts 1:1 for age, sex, secondary lymph node metastases, nicotine dependence, the insertion of feeding devices, body mass index (BMI) and severe sepsis. After defining the primary outcome as “death”, a Kaplan–Meier analysis was performed, and the risk ratio (RR), odds ratio (OR) and hazard ratio (HR) were calculated. Results: A total of 3651 patients were enrolled, and after matching, each cohort consisted of 1362 patients. Among cohorts I and II, 346 and 511 patients were deceased within one year (risk of death = 25.5 and 38.3%, respectively), whereby the risk difference was significant (p = 0.000; log-rank test). The RR was 0.68 (95% confidence interval: 0.60–0.76), OR was 0.57 (0.48–0.67) and HR was 0.58 (0.51–0.67). Conclusions: Our hypothesis was confirmed: administering antibiotics significantly decreases the drug effectiveness of immunotherapy. We hypothesize that this finding is associated with antibiotic-related changes in the gut microbiome. Prospective clinical studies on the gut microbiome in cancer patients are necessary to understand the complex ecosystem of microbiota during immunotherapy. Trial Registration: Due to the retrospective nature of the study, no registration was necessary.

STUDY OBJECTIVES: Hypoglossal nerve stimulation (HNS) is a novel therapy in the treatment of obstructive sleep apnea. Previous studies have focused on the effectiveness of HNS, but there are no studies specifically investigating the long-term changes of the stimulation intensities in HNS. Increasing stimulation intensity requirements have been reported in the past in other peripheral nerve stimulation therapies. The aim of this study was to investigate the development of stimulation intensities over the observation period of 4 years. METHODS: All patients who were implanted with an HNS system since December 2013 and maintained a bipolar configuration over the observation period were included. Sensation threshold (ST), functional threshold, the titrated stimulation intensity (SI), and the apnea-hypopnea index (AHI) were recorded. RESULTS: A total of 82 patients were enrolled (sex: 69 men, 13 women, age: 60 ± 11 years, body mass index: 29. 8 ± 4.0 kg/m(2)). Two months after surgery, the median ST was 0.8 ± 0.5 V. During the observation period of 48 months, no significant change of ST was observed. The median ST was 1.0 ± 0.4 V (P = 0.93) at 48 months. Similar results were found for functional threshold and the titrated stimulation intensity. There was a significant reduction of the baseline median AHI when compared with the median AHI at 1, 12, 24, 36 and 48 months after surgery (P < 0.05). CONCLUSIONS: The stimulation intensities in HNS show no significant changes over 4 years. Despite the constant stimulation intensity, AHI was significantly reduced. This indicates that the stimulation threshold of the hypoglossal nerve does not change over time with this therapy. CITATION: Zhu Z, Hofauer B, Wirth M, Heiser C. Long-term changes of stimulation intensities in hypoglossal nerve stimulation. J Clin Sleep Med. 2020;16(10):1775–1780.

Knowledge is one of the most important resources for businesses. Knowledge management systems (KMS) are implemented to guarantee an adequate handling of this resource. While innovations in Knowledge Management often focus on technical approaches or structural aspects of knowledge storing, less attention is paid to the different aspects of human motivation and the individual willingness to knowledge sharing. The employee as sharer and receiver of knowledge, however, has to be motivated properly in order to ensure a high content quality within the KMS and appropriate handling of knowledge. Gamification has proven to be a feasible approach to increase employee motivation. This paper, therefore, analyses the effects of game mechanics on motivation and knowledge sharing behavior. In addition, advantages and risks of implementing game components in KMS are illustrated.

Strabismus is a visual disorder characterized by eye misalignment. The extent of ocular misalignment is denoted as the deviation angle. With the advent of Virtual Reality (VR) Head-Mounted-Displays (HMD) and eye tracking technology, new possibilities measuring strabismus arise. Major research addresses the novel field of VR strabismus assessment by replicating prism cover tests while there is a paucity of research on screen tests. In this work the Hess Screen Test was implemented in VR using a HMD with eye tracking for an objective measurement of the deviation angle. In a study, the functionality was tested and compared with a 2D monitor-based test. The results showed significant differences in the measured deviation angle between the methods. This can be attributed to the type of dissociation of the eyes.

Maternity records (”Mutterpass”) are a central tool in Germany’s antenatal care. Its digitalisation offers advantages such as improved readability, data standardisation, analysability, digital assistance and the avoidance of media breaks. Despite the examined necessity and technical possibility, no system has been implemented yet. In this work, we address this gap by assessing physicians’ and midwives’ perception, motivation, acceptance and requirements of a digital maternity record and its user interface in particular. Nine medical professionals participated in semi-structured interviews. Based on the results, an interface prototype was subsequently developed. The prototype laid a particular focus on two different gravidogram implementations. Thirteen medical professionals participated in the interactive user interface study, which aimed to assess general acceptance, completion time, error rate and implemented assistance functions compared to the analogue counterpart. Results show that the implementation of the digital maternity logbook is of value and that its advantages are both accepted and demanded by medical professionals. Eight key requirements were identified. A tabular gravidogram prototype, inspired by the analogue maternity record, was favoured over a more novel list prototype. Users presented a clear learning curve of the digital system. Nevertheless, the digital average completion time is 30% higher than its analogue counterpart. The digital prototype lead to a lower average number of errors per entry (0.45±0.3 vs. 0.58±0.4). With respect to digital maternity records, this work underlines user acceptance, summarizes key user requirements and presents a first step on the path to a digital maternity record interface for medical professionals. On a broader scale, it delivers insights based on several metrics with respect to digitalisation in an area that is still highly dominated by long established paper-based tools.

Markus Wirth: Hohenloher Herrschaft im Elsass. Handlungsspielräume eines mindermächtigen Reichsstandes in geographisch entlegenen Besitzungen am Beispiel der Seigneurie Oberbronn, 1727-1789/93. Berlin (UT) 2009. 368 S., Abb. , eine ausklappbare Karte

We explore motion parameters, more specifically gait parameters, as an objective indicator to assess simulator sickness in Virtual Reality (VR). We discuss the potential relationships between simulator sickness, immersion, and presence. We used two different camera pose (position and orientation) estimation methods for the evaluation of motion tasks in a large-scale VR environment: a simple model and an optimized model that allows for a more accurate and natural mapping of human senses. Participants performed multiple motion tasks (walking, balancing, running) in three conditions: a physical reality baseline condition, a VR condition with the simple model, and a VR condition with the optimized model. We compared these conditions with regard to the resulting sickness and gait, as well as the perceived presence in the VR conditions. The subjective measures confirmed that the optimized pose estimation model reduces simulator sickness and increases the perceived presence. The results further show that both models affect the gait parameters and simulator sickness, which is why we further investigated a classification approach that deals with non-linear correlation dependencies between gait parameters and simulator sickness. We argue that our approach could be used to assess and predict simulator sickness based on human gait parameters and we provide implications for future research.

Cochlear implantation meanwhile is a well established standard therapy in different forms of hearing loss in most ages. Clear depiction of the cochleovestibular anatomy and the cochlear nerve are very important for indication and effectiveness of cochlear implantation. Aim/objectives: Therefore the question raises whether Highfield MRI improves precision of preoperative diagnostic imaging especially along the the intrameatal portion of the vestibulocochlear nerve.We analyzed the MRI scans of 216 temporal bones from 2007 until 2017. In all patients, CI was planned. We compared examinations using 1.5 and 3.0 T MR systems under the aspect of intracanalicular detection of the facial nerve, cochlear nerve, and the vestibular branches.3 T-MRI was able to detect the cochlear nerve in all cases, a very important criterion for CI-indication. 3 T-MRI was also superior in the detection of facial nerve and especially the vestibular branches.The most effective preoperative examination of CI-candidates is the combination of 3 T MRI and multislice HR-CT of the temporal bone.

Gait supervision plays an important role in the diagnosis, analysis and rehabilitation of motor impairments and neurodegenerative disorders. For example, in Parkinson's disease, gait assessment is used for progression observation and medication guidance. Previous work has presented the potential of virtual reality (VR) supported gait applications. While virtual environments and user representation strategies are used for gait applications, the influence of appearance and context cues on gait performance is not extensively researched. In this paper, we analyzed the influence of avatar appearance, environment awareness, and camera perspective on gait parameters relevant for clinical application. Four different avatar appearances, varying in abstraction, two environmental settings, as well as an egocentric and exocentric camera perspective were compared in three walking tasks on a treadmill. Our results show that variability, as an indicator for gait stability, is significantly impacted by VR exposure in comparison to a real world (in vivo) baseline. Further, our results revealed that walking tasks influence gait behavior significantly different in VR compared to in vivo. Overall, these findings suggest that particular care has to be taken when assessing gait characteristics acquired from subjects immersed in VR and that equivalence of results with in vivo may not be blindly assumed.

Purpose Selective hypoglossal nerve stimulation (sHNS) constitutes an effective surgical alternative for patients with obstructive sleep apnea (OSA). sHNS results in tongue protrusion and consecutive alleviation of obstructions at the tongue base level (lower obstructions). Furthermore, obstructions at the soft palate level (upper obstructions) may be prevented through palatoglossal coupling as seen on sleep endoscopy. However, it has not been studied if the distribution of obstruction level during a whole night measurement is a relevant factor for the treatment outcome. Methods Obstruction levels were measured with a manometry system during a whole night of sleep in 26 patients with OSA (f = 1, m = 25; age 59.4 ± 11.3; BMI = 29.6 ± 3.6) either before (n = 9) or after sHNS implantation (n = 12). Five patients received a measurement before and after implantation. Obstructions were categorized into velar (soft palate and above), infravelar (below soft palate), and multilevel obstructions. An association between obstruction level and treatment outcome was calculated. Results The mean distribution of preoperative obstruction level could be divided into the following: 38% velar, 46% multilevel, and 16% infravelar obstructions. Patients with a good treatment response (defined as AHI (17% vs. 54%, p-value = 0.006). In patients measured after sHNS implantation, a significantly higher rate of multilevel obstructions per hour was measured in non-responders (p-value = 0.012). Conclusions Selective hypoglossal nerve stimulation was more effective in patients with fewer obstructions at the soft palate level. Manometry may be a complementary diagnostic procedure for the selection of patients for HNS.

Background: Since 2004, the use of the monoclonal antibody cetuximab has been preferred over platinum-based therapy for patients with advanced Head and neck squamous cell carcinoma (HNSCC). However, the response rate to the treatment is only around 20%. Currently, no biomarkers have been identified to differentiate potential responders from non-responders to cetuximab therapy.Methods: We evaluated the predictive and prognostic properties of AurkA polymorphism and HPV infection in HNSCC patients treated with cetuximab. Clinical data of 434 patients was collected and tissue was analyzed for AurkA polymorphism using PCR. Immunohistochemistry was used to stain for various markers and their expression levels were scored. Cell culture experiments were performed to complement clinical findings.Results: We demonstrated in vivo as well as in vitro that both AurkA polymorphism and HPV status have predictive and prognostic value. Conclusions: AurkA polymorphism and HPV status could be beneficial for response prediction and therapy optimization for HNSCC patients.

Strabismus is a visual disorder characterized by eye misalignment. The effect of Panum’s Fusional Area (PFA) compensates for small misalignments. However, prominent misalignments affect binocular vision and when present in childhood it may lead to amblyopia, a developmental disorder of the visual system. With the advent of Virtual Reality (VR) technology, possibilities for novel binocular treatments to amblyopia arise in which the measurement of strabismus is crucial to correctly compensate for it. Thus, VR yields great potential due to the ability of displaying content to each eye independently. Major research in VR addresses this topic using eye-tracking while there is a paucity of research on image-based assessment methods. In this work, we propose a VR application for measuring strabismus in nine lines of sight. We conducted a study with 14 healthy participants to evaluate the system under two conditions: no strabismus and an artificial deviation induced by prism lenses. Further, we evaluated the effect of PFA on the system by measuring its extent in horizontal and vertical lines of sight. Results show significant difference between the expected deviation induced by prism lenses and the measured deviation. The existing difference within the measurements can be explained with the recorded extent of the PFA.

Assessment of personality traits is highly relevant in team sports in order to analyze the performance of an athlete under pressure when in competitive situations, for team-strategic decisions, to optimize command transmission, and ultimately to understand top-level performers. It further facilitates the development and application of personalized exercises, coaching to improve performance in competition, and can be considered a valuable criterion for talent scouting and development. The current state of the art method to assess personality traits in sports relies on validated questionnaires. However, these often provide non-sport-specific, subjective self-reported information and lack the ability to measure how these characteristics are reflected in context-based performance.We developed a virtual reality (VR) tool for the assessment of personality traits in team sports, in our case for soccer. An evaluation of this tool within a study with 24 subjects yielded a benchmark of its immersion through user experience and provided an objective description of athletes’ personalities based on performance indicators extracted from activity-tracking. Within the tool, we implemented two realistic virtual soccer environments to assess the motivational orientation of soccer players (i.e. action-and state-orientation) which we discerned from the gold standard questionnaire.Results show that user experience and presence of the implemented virtual environments scored significantly higher compared to benchmark measurements. Additionally, a significant difference between the two groups of action and state-oriented athletes could be observed. Measures of failure rate, pass accuracy, number of perceived opponents, and achieved bonus goals are parameters that differ significantly among the two athlete groups. These findings show that VR technology is applicable for the assessment of athletes’ motivational orientation and thus demonstrate the feasibility of virtual environments as functional game scenario-based assessment tools for athletes.

STUDY OBJECTIVES: Hypoglossal nerve stimulation (HNS) is an effective surgical alternative for patients with obstructive sleep apnea (OSA). HNS therapy relies on the stimulation of the hypoglossal nerve to open the upper airways. This stimulation could lead to alterations in tongue strength and fatigability, which could alter treatment outcome over time. The aim of the study was to investigate whether HNS alters tongue strength and fatigability. METHODS: Tongue protrusion strength (peak pressure in kPa) and fatigability (time to task failure during 50% of peak pressure contraction) were measured with a pressure transducer at least 2 months after HNS implantation (n = 30). These results were compared to a group of patients with OSA (n = 38) and a non-OSA control group (n = 35). RESULTS: Median tongue protrusion strength was lower (54.7 [43.8, 63.0] versus 60.7 [53.7, 66.0] kPa, P = .013) and fatigue occurred more quickly (21.3 [17.4, 26.3] versus 26.0 [19.3, 31.3] seconds, P = .017) in the patients with OSA compared to the non-OSA control group. In multiple regression analysis, age was a significant factor for tongue strength and diagnosis of OSA for tongue fatigability. Tongue strength and fatigability did not differ between patients with OSA with conservative therapy or observation versus after HNS implantation (51.8 [41.3, 63.4] versus 56.3 [45.0, 62.3] kPa, P = .502; 20.8 [16.3, 26.2] versus 21.8 [18.3, 26.8] seconds, P = .418). CONCLUSIONS: Tongue strength decreases with age. Tongue fatigability is more pronounced in people with OSA. However, approximately 1.5 years of HNS therapy on average does not alter tongue strength or fatigability compared to an OSA control group. CLINICAL TRIAL REGISTRATION: Registry: ClinicalTrials.gov; Title: Change in Tongue Strength and Fatigue After Upper Airway Stimulation Therapy; Identifier: NCT03980158 CITATION: Wirth M, Unterhuber D, von Meyer F, et al. Hypoglossal nerve stimulation therapy does not alter tongue protrusion strength and fatigability in obstructive sleep apnea. J Clin Sleep Med. 2020;16(2):285–292.

(1) Background: NOTCH1 is the second most common mutated gene in whole-exome sequencing of HNSCC. The aim of this project was to gain further insight into the relevance of NOTCH1 in HNSCC, potentially establishing NOTCH1 as a prognostic marker or therapeutic target; (2) Methods: NOTCH1 was silenced via RNA interference in six HNSCC cell lines and the impact was evaluated in migration and proliferation assays. Subsequently, the protein expression of NOTCH1 intracellular domain (NICD) and NOTCH1 mRNA expression were examined in 70 oropharyngeal squamous cell cancer tissue samples. Lastly, the NICD expression was compared with the local infiltration of lymphocytes, measured with the immunoscore; (3) Results: Knockdown of NOTCH1 decreased migration and proliferation. A high NICD expression was associated with lower OS. A high immunoscore resulted in significantly better OS. NICD expression was independent of the immunoscore and as a whole differentiated three distinct prognostic groups; (4) Conclusions: These data suggest that NOTCH1 is involved in migration and proliferation of HNSCC cell lines. In vivo, NICD expression was associated with overall survival and could, therefore, be used as a prognostic marker. NICD expression differs from NOTCH1 mRNA levels, potentially explaining the previously suggested bimodal role as an oncogene and tumor suppressor in HNSCC.

While metastases directed therapy for oligometastatic disease is recommended in different cancer entities, the treatment of solitary metastases in head and neck squamous cell carcinoma (HNSCC) patients is not clearly defined. A retrospective analysis was performed on data from 143 HNSCC patients treated between 2001 and 2016 in a tertiary university hospital. Clinical factors and outcome were measured using the median survival of patients receiving metastases specific therapy in comparison with matched control patients. In 37 patients, distant metastases were treated specifically with either surgery and/or stereotactic ablative radiotherapy and had with 23.97 months a more than three times higher median survival than 10 untreated matched controls with potentially treatable distant metastases (7.07 months). Our retrospective analysis demonstrates a significant survival benefit for HNSCC patients who received a specific therapy regarding distant metastasis irrespective of localization as compared to a matched control cohort.

About 50% of all hydropower plants (HPPs) worldwide were originally commissioned more than 40 years ago, so that the advanced age of the fleet is a major concern across all continents, and especially in Europe. The modernization of HPPs can generate several benefits in terms of generation, flexibility, safety, operation, and may have neutral or even positive implications for the environment. In this work, we appraise several options for the modernization of existing plants, with the exclusion of measures expected to increase the hydro-morphological pressure on water bodies (e.g. increase of withdrawals or new parallel waterways): dam heightening, head loss reduction in waterways, increase of weighted efficiency of electro-mechanical equipment, digitalization and inflow forecast, and floating photovoltaic (evaporation reduction). We provide an indicative estimation of the additional power and annual generation that could be obtained compared to the current condition. We estimate that the overall energy generation could be increased by 8.4% for European Union and 9.4% for the whole Europe by implementing the above-mentioned strategies. The additional energy gain achievable by increasing the inflow was discussed but not included in the above mentioned overall indicator, because it is very site-specific. The additional energy storage achievable by reservoir interconnection and coordinated operation has been estimated in literature as 169 TWh. This suggests that the modernization of HPPs can generate significant benefits in terms of energy, and should be considered as an important element of energy policy, also considering the additional benefits in terms of reliability and flexibility of the energy system that it may deliver. The modernization options considered here, insofar as not entailing a worsening of the hydro-morphological alterations, are also expected to cause limited or no conflict with the environmental objectives of water policies in Europe., Energy Conversion and Management, 246, ISSN:0196-8904, ISSN:1879-2227

Background: Tracheostomy is a common procedure in critical care. The aim of this study was to evaluate the application of a liposomal inhalation compared to standard physiologic saline (SPS) inhalation on basis of objective and subjective parameters of airway inflammation. Methods: We evaluated in this two-armed, double-blinded and randomized control group study the effect of liposomal compared with SPS inhalation in newly tracheotomized patients. The primary endpoint was defined as trend of tracheobronchial IL-6 secretion at day 1 compared to day 10. Further objective and subjective parameter were evaluated. Results: Fifty patients were randomized in each arm. Tracheal IL-6 levels decreased significantly only after liposomal inhalation. Both inhalative agents seem to have an effect on the respiratory impairment after tracheostomy. Subjective patient impairment was reduced significantly from day 1 to day 10 after tracheostomy with liposomal inhalation. Conclusions: Liposomal inhalation demonstrated an advantage over SPS inhalation in newly tracheotomized patients.

Selective upper-airway stimulation (UAS) is a novel therapy for patients with obstructive sleep apnea (OSA). The aim of this study was to compare changes in sleep architecture during the diagnostic polysomnography and the post-implantation polysomnography in UAS in patients with OSA. Twenty-six patients who received a UAS device (Inspire Medical Systems) were included. Treatment outcome was evaluated 2 and 3 months after surgery. Data collection included demographics, body mass index (BMI), apnea hypopnea index (AHI), oxygen saturation and desaturation index (ODI), Epworth sleepiness score (ESS), arousal parameter, and sleep patterns. The mean age was 60.2 years, 25 patients were male, 1 patient was female. Mean BMI was 29.0 kg/m2. The mean pre-implantation AHI of 33.9/h could be reduced to 9.1/h at 2 months post-implantation (p

// Dominik Thomas Koch 1 , Anja Pickhard 1 , Lena Gebel 1 , Anna Maria S. Buchberger 1 , Murat Bas 1 , Carolin Mogler 2 , Rudolf Reiter 3 , Guido Piontek 1 , Markus Wirth 1 1 Department of Otorhinolaryngology Head and Neck Surgery, Technical University of Munich, 81675 Munich, Germany 2 Institute of Pathology, Technical University of Munich, 81675 Munich, Germany 3 Department of Otolaryngology Head and Neck Surgery, Section of Phoniatrics and Pedaudiology, University of Ulm, 89070 Ulm, Germany Correspondence to: Markus Wirth, email: markus.wirth@tum.de Keywords: head and neck squamous cell cancer, EGFR variant III, cetuximab, TKI, radiation Received: October 11, 2016 Accepted: February 21, 2017 Published: March 06, 2017 ABSTRACT Background: The epidermal growth factor receptor (EGFR) is an important regulator of cell growth and survival, and is highly variable in tumor cells. The most prevalent variation of the EGFR extracellular domain is the EGFR variant III (EGFRvIII). Some studies imply that EGFRvIII may be responsible for the poor response to the monoclonal EGFR-antibody Cetuximab, used therapeutically in head and neck squamous cell carcinoma (HNSCC). Due to inconsistent data in the literature regarding EGFRvIII prevalence and clinical relevance in HNSCC, especially its predictive value, we examined EGFRvIII-transfected cell lines and patient tissue samples. Results: In contrast to other recent publications, we were able to demonstrate EGFRvIII expression in HNSCC. However, we noted that the different detection methods yielded inconsistent results. Furthermore, our EGFRvIII transfected and EGFR wild type cell lines exhibited similar characteristics and response rates in the performed in vitro experiments. Materials and Methods: We conducted various inhibition and combined irradiation experiments using three EGFRvIII-transfected cell lines. Moreover, a patient cohort of 149 cases consisting of formalin fixed and paraffin embedded (FFPE) and fresh-frozen specimens was assayed via reverse transcriptase PCR (rtPCR) with gel electrophoresis and sequencing for EGFRvIII prevalence. In the rtPCR assays, we used five previously published EGFRvIII primers and EGFRvIII-positive glioblastoma tissue as a positive control. In addition, immunohistochemical staining was conducted. Conclusions: EGFRvIII can be detected in HNSCC patient samples. Nevertheless, the low prevalence and similar response rates to targeted drugs and irradiation in vitro cast doubt regarding the clinical relevance of EGFRvIII in HNSCC.

The Stroop Test is a well known and regularly employed stressor in laboratory research. In contrast to other methods, it is not based on fear of physical harm or social shame. Consequently, it is more likely accepted by a wide population. In our always-on, technology-driven, social-media centered world, large-scale in-field stress research will need adequate experimental tools to explore the increasing prevalence of stress-related diseases without bringing subjects into laboratories. This is why we designed the Stroop Room: A virtual reality-based adaptation of the Stroop Test using elements of the virtual world to extend the demands of the original test and at the same time make it easily accessible. It is open source and can be used and improved by anyone as an in-the-wild, repeatable, laboratory-quality stressor. In this work, the method is presented and an evaluation study described, to demonstrate its effectiveness in provoking cognitive stress. 16 male and 16 female subjects were tested in the Stroop Room while recording the electrocardiogram, electrodermal activity, saliva based cortisol and alpha-amylase, performance metrics and an array of questionnaire-based assessments regarding psychological confounders, stress state and likability of the simulation. Our results show that the Stroop Room increases heart rate on average by 19%, other heart rate variability time-domain parameters (RMSSD, pNN50) decrease by 24%-47%, and its most stress-correlated frequency-parameter (LF/HF) increases by 107%. Skin conductance (SC) level increases by 63% and non-specific SC responses by 135% on average. Salivary cortisol and alpha-amylase concentrations increase significantly in some specific conditions. Compared to related work using the Stroop Test, this is an improvement for some metrics by around 30%-40%. Questionnaire evaluation show a strong engagement of users with the simulation and some aspects of a flow-induction. These findings support the effectiveness of a Stroop Test involving 3-dimensional interactivity and thus the Stroop Room demonstrates how this can be applied in a playful interaction that could be used pervasively.

Negative consequences of stress are a pervasive problem in our modern society. Recent developments in wearable lifestyle hardware have led to unobtrusive, sensor-packed, always-on devices that might finally be able to continuously monitor biosignals to detect, determine or even prevent stress or some of its negative outcomes. In this work, we give a concise overview of a majority of biosignals that are in some way relevant for stress classification and outline state-of-the-art machine learning algorithms for this task. Additionally, we provide a list of all recent wearables including an evaluation of their feasibility to implement such algorithms as well as directions to look for an assessment of the accuracy and validity of their recorded data with respect to stress tracking.