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Prevalences for mental disorders within minor refugees are comparatively high and heterogeneous. To reduce heterogeneity and identify high-risk subgroups, we compared unaccompanied refugee minors (URM) to accompanied refugee minors (ARM) regarding depressive symptoms and mental distress. Furthermore, we examined associative factors of mental distress in URM on a broad scale. We conducted a survey with a cross-sectional design in four German University hospitals. The sample consisted of n = 172 URM and n = 52 ARM aged 14–21. Depressive symptoms were assessed via the Patient Health Questionnaire (PHQ-9). Mental distress was assessed by the Refugee Health Screener (RHS-15). Mann–Whitney test was used to examine differences between URM and ARM. Associated factors of mental distress were evaluated via a stepwise multiple regression analysis. URM showed significantly higher mean scores for PHQ-9 (p <.001) and RHS-15 (p <.001) compared to ARM indicating medium effect sizes. Furthermore, URM were significantly more likely to surpass the cut-off for depression (61.6% vs. 30.8%) and overall mental distress (81.4% vs. 53.8%) compared to ARM. The factors Number of stressful life events (SLE), Female gender, and Fear of deportation were found to be associated with an increased mental distress in URM, whereas Weekly contact to a family member, School attendance, and German language skills were accompanied with lower distress scores. All six factors accounted for 32% of the variance of mental distress in URM (p <.001). Within minor refugees, URM are a highly vulnerable subgroup, which should receive particular attention and more targeted measures by health authorities. Our results indicate that these measures should comprise a rapid promotion of family contact, school attendance, language acquisition, and the fast processing of asylum applications. However, the cross-sectional design limits the interpretability of the results. [ABSTRACT FROM AUTHOR]

Introduction: The russian invasion in Ukraine has significantly affected the mental health (MH) of the local population while access to mental health support remains limited due to multiple reasons coming from both the provider and acceptor sides. The war obviously negatively impacts MH but has also paradoxically given an "open window" for shifting current practices both in the healthcare system and within society. Investigation of current people's attitudes on this matter should be the primary step to address the issue and initiate any change. Objectives: 5 main objectives identified to analyze within the convenience sample were: MH state and self-care behaviors during the full-scale invasion, MH stigma and self-stigma, intention to use professional MH support, beliefs on access to professional MH support, query to change current MH attitudes and practices. Methods: This research was conducted using primary data collection. The online questionnaire consisted of 5 blocks and was designed based on PHQ-9, DASS-21, PCL-5, Brief-COPE and CAMI. 332 civilians underwent the survey in March-April 2023 and were divided by age, gender, location and situation; inclusion criteria were to be >16 y.o. being affected by war and capable of completing the survey in Ukrainian. Relevant ethical measures were applied. Descriptive and correlational analysis was used to analyze the data. Results: The majority of respondents rated their mental health as good. Anxiety was the most prevalent emotion, particularly among younger age groups. Different genders and age groups exhibited varying combinations of emotions, such as fatigue, peace, anger, sadness etc. Many participants felt self-reproach for not doing enough; coping strategies varied among age groups. Females were 8.14 times more likely to seek mental health support, and those inside Ukraine were 0.32 times less inclined. 66.2% never seek any MH services, with older men leading; only 8.7% consult specialists during crises, showing gender differences. Distrust in specialist qualifications is one of the barriers on access in people's beliefs and is more prevalent among older generations. The absence of self-mental health stigma makes individuals 1.91 times more open to accessing support. Location affects openness to change, with Ukraine-based individuals being less open. Lastly, 29.5% consider alternative stress-coping methods, with 40% open to future psychological help. Conclusions: Our findings show differences in populational attitudes towards MH in Ukraine during the war and therefore the importance of any potential intervention to precisely tailor certain subgroups, beliefs behaviors and needs within them to have a higher chance of being accepted and increase MH support utilization in the population overall. Disclosure of Interest: None Declared [ABSTRACT FROM AUTHOR]

Genome-Wide Association Studies (GWAS) of Schizophrenia (SCZ) have provided new biological insights; however, most cohorts are of European ancestry. As a result, derived polygenic risk scores (PRS) show decreased predictive power when applied to populations of different ancestries. We aimed to assess the feasibility of a large-scale data collection in Hanoi, Vietnam, contribute to international efforts to diversify ancestry in SCZ genetic research and examine the transferability of SCZ-PRS to individuals of Vietnamese Kinh ancestry. In a pilot study, 368 individuals (including 190 SCZ cases) were recruited at the Hanoi Medical University's associated psychiatric hospitals and outpatient facilities. Data collection included sociodemographic data, baseline clinical data, clinical interviews assessing symptom severity and genome-wide SNP genotyping. SCZ-PRS were generated using different training data sets: (i) European, (ii) East-Asian and (iii) trans-ancestry GWAS summary statistics from the latest SCZ GWAS meta-analysis. SCZ-PRS significantly predicted case status in Vietnamese individuals using mixed-ancestry (R2 liability = 4.9%, p = 6.83 × 10−8), East-Asian (R2 liability = 4.5%, p = 2.73 × 10−7) and European (R2 liability = 3.8%, p = 1.79 × 10−6) discovery samples. Our results corroborate previous findings of reduced PRS predictive power across populations, highlighting the importance of ancestral diversity in GWA studies. [ABSTRACT FROM AUTHOR]

Transcranial direct current stimulation (tDCS) of prefrontal cortex regions has been reported to exert antidepressant effects, though large scale multicenter trials in major depressive disorder (MDD) supporting this notion are still lacking. Application of tDCS in multicenter settings, however, requires measurement, storage and evaluation of technical parameters of tDCS sessions not only for safety reasons but also for quality control. To address this issue, we conducted an interim analysis of supervised technical data across study centers in order to monitor technical quality of tDCS in an ongoing multicenter RCT in MDD (DepressionDC trial). Technical data of 818 active tDCS sessions were recorded, stored in a data cloud, and analysed without violating study blinding. Impedance, voltage and current were monitored continuously with one data point recorded every second of stimulation. Variability of impedance was considerable (1,42 kΩ, to 8,23 kΩ), inter-individually and even more intra-individually, but did not significantly differ between the study centre in Munich and all other sites. Measurement, centralized data storage via data cloud and remote supervision of technical parameters of tDCS are feasible and proposed for future RCTs on therapeutic tDCS in multiple settings. [ABSTRACT FROM AUTHOR]

Approximately 1.2 million refugees have arrived in Germany since autumn 2014. They are often appraised as being a challenge for the German healthcare system because the acute need for healthcare support was large and appeared suddenly while at the same time resources were limited. This situation was previously unknown for a western European healthcare system, whereas it constitutes a typical challenge for nongovernmental organizations that are active in the field of emergency relief and development aid and that have developed a large number of successful intervention concepts. Of central importance in this context are the basic principles of equal rights, participation of those affected, the principle of nonmaleficence, the resource orientation instead of a deficit orientation as well as the need for integrated and stepped care models. These can serve as general principles not only in the setting of development aid in crisis areas worldwide but also in the health services provided to refugees in the current situation in Germany. [ABSTRACT FROM AUTHOR]

Introduction: The therapeutic effectiveness of mindfulness-based interventions (MBIs) has been shown for various mental disorders. However, for schizophrenia spectrum disorders (SSD), only a few trials have been conducted, mostly in outpatient settings. Objectives: This study aimed to investigate feasibility, acceptability, and preliminary effectiveness of a four-week mindfulness-based group therapy (MBGT) for in-patients with SSD. Methods: A pre-registered randomized controlled trial (RCT) was conducted at the in-patient ward for SSD. All measures were employed at baseline, post-intervention (4-weeks), and follow-up (12-weeks). The primary outcome was 'mindfulness'. Secondary outcomes were rater-blinded positive- and negative symptoms, depression, social functioning, as well as self-rated mindfulness, depression, anxiety, psychological flexibility, quality of life, and medication regime. Results: N=40 participants were randomized into either four-week treatment-as-usual (TAU; n=19) or MBGT+TAU (n = 21). Protocol adherence was 95.2%, and the retention rate to treatments was 95%. ANCOVA analysis revealed significant improvements in the MBGT+TAU compared to TAU for the primary outcome and negative symptoms. Exploratory analyses showed medium-to-large intervention effects on secondary outcomes mindfulness, positive, negative, and depressive symptoms, psychological flexibility, quality of life, and social functioning for MBGT+TAU and small-tomoderate changes on positive symptoms and social functioning for TAU. No serious adverse effects were reported. Conclusions: This study supports the feasibility and acceptability of MBGT for in-patients with SSD, including high protocol adherence and retention rates. A proof of concept of the MBIs and corresponding improvements on various clinical and process parameters warrant a fully powered RCT to determine effectiveness, cost-efficiency, and longitudinal outcomes of MBGT for SSD. [ABSTRACT FROM AUTHOR]

Aim: To determine the long-term effect of argon plasma coagulation (APC) of gastric inlet patches in the cervical esophagus for patients suffering from globus sensation. Methods: We intended to follow up all patients between 2004 and 2011 (n = 49) who received argon plasma ablation of gastric inlet patches for globus sensation at our clinic. Symptoms were assessed by a visual analogue scale (VAS) in 31 of 49 patients. Follow-up endoscopy of the upper gastrointestinal tract was performed to confirm residual or relapsed cervical inlet patches. Results: After a median period of 27 months, APC was assessed as a successful therapy in 23 of 31 patients (74%). VAS scores decreased significantly from 7.6 to 4.0 in the long term. Twenty-two of 31 patients were willing to undergo follow-up endoscopy. Endoscopy revealed recurrent/residual gastric inlet patches after APC in 11 of 22 cases. These patients suffered from a significant relapse of symptoms in the postinterventional period (p < 0.001). Conclusion: This retrospective study indicates that APC of gastric inlet patches for the treatment of globus sensation might be a sufficient therapy option. Recurrences or residual heterotopic gastric mucosa are possible and seem to be associated with a relapse of symptoms. Therefore, endoscopic follow-up and retreatment might be necessary if globus sensation is not sufficiently eliminated. © 2013 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Introduction: Bispectral index (BIS) monitoring provides a non-invasive measure of the level of sedation. The purpose of this randomized, singleblind clinical trial was to evaluate whether BIS monitoring of sedation would lead to improved oxygenation and a reduced rate of cardiopulmonary complications during endoscopy. Patients and methods: Patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) under procedural sedation with a combination of low dose midazolam and propofol were randomly assigned to either standard monitoring of sedation only (BIS-blinded arm) or an open arm in which additional BIS monitoring was available (BIS-open arm). In the BIS-open arm, propofol administration was to be withheld if BIS values were <55.The primary study end point was the mean oxygen saturation per patient. Secondary end points were the rates of cardiopulmonary complications, propofol dose, quality of sedation (patient cooperation as rated by the endoscopist and patient satisfaction), and recovery. Results: A total of 144 patients were enrolled and included in the intention-to-treat analysis. Mean oxygen saturation per patient was 97.7% in the BIS-open arm and 97.6% in the BIS-blinded arm (P=0.71). Total rates of cardiopulmonary complications, single numbers of hypoxemic, bradycardic, and hypotensive events, mean propofol doses, and quality of sedation also showed no statistically significant differences between the groups. However, BIS monitoring did result in faster recovery of patients as reflected by shorter times to eye opening (P=0.001), first verbal response (P=0.02), and leaving the procedure room (P< 0.001). Conclusions: The use of additional BIS monitoring did not lead to improved oxygenation or a reduced rate of cardiopulmonary complications. Recovery times after the procedure were shorter than with standard monitoring alone, but the clinical benefit for daily practice may be limited. [ABSTRACT FROM AUTHOR]

Background: Autofluorescence imaging (AFI) is sensitive but not specific for differentiating neoplastic from non-neoplastic colorectal polyps. We aimed to determine the sensitivity and specificity of fluorescein-enhanced AFI (FAFI) in differentiating neoplastic from non-neoplastic colorectal polyps. Methods: All patients with colorectal polyps detected during AFI colonoscopy received intravenous fluorescein followed by AFI (FAFI). The video sequences were recorded and divided into a learning group and a test group. AFI and FAFI criteria for neoplastic and non-neoplastic lesions were determined after viewing videos in the learning group unblinded to histology. Videos in the test group were viewed blinded to histology, and diagnoses of neoplastic versus non-neoplastic were made for AFI and FAFI using the predetermined criteria. Still frames were objectively measured for red:green ratio (AFI) and green contrast (FAFI). Results: Eight videos (four neoplastic, four nonneoplastic) were used for the learning group. Criteria for neoplasia when using FAFIwere determined as the presence of a patchy or granular pattern which appeared more fluorescent green compared with the background. For AFI, purple or pink represented neoplasia; green represented non-neoplasia. In the test group (13 neoplastic, 12 non-neoplastic), for differentiating between neoplasia and non-neoplasia, subjective analysis of video sequences yielded a sensitivity of 100% for AFI and 100% for FAFI (P = 1.000), and a specificity of 16.7% for AFI and 91.7% for FAFI (P = 0.004). Using objective color analysis, the area under the receiver operating characteristics curve was 0.647 for AFI using the red:green ratio to distinguish between neoplasia and non-neoplasia, and 0.994 for FAFI using green contrast. Conclusions: FAFI accurately differentiated between neoplastic and non-neoplastic colorectal polyps. [ABSTRACT FROM AUTHOR]

Local endoscopic procedures are increasingly used and accepted treatments for unifocal superficial esophageal squamous cell carcinoma (SESCC). In multifocal SESCC, esophagectomy with or without chemoradiotherapy is often regarded as standard therapy. However, a combination of local endoscopic resection and new techniques such as radiofrequency ablation may play an increasing role in the treatment of selected patients with multifocal SESCC. The aim of this series was to evaluate the feasibility of a multimodal endoscopic approach. We report a case series of six consecutive patients from a European tertiary center who underwent endoscopic treatment for multifocal SESCC. The treatment comprised endoscopic mucosal resection using the cap technique or endoscopic submucosal dissection, in combination with radiofrequency ablation. The main outcome measure was complete tumor eradication after therapy and during the follow-up period. Using such an approach, complete eradication of cancer was achieved in all patients during follow-up. No major adverse events occurred. In conclusion, in selected patients with multifocal or residual SESCC, local resection techniques in combination with radiofrequency ablation may be safe and potentially curative alternative treatments. [ABSTRACT FROM AUTHOR]

Introduction: Major depressive disorder (MDD) as one of the most prevalent mental disorders is still lacking therapeutic treatment methods with a short onset of action. Ketamine exhibits a rapid antidepressive effect, which is most pronounced 24h after a single infusion. Working memory (WM) impairments that play a major role in MDD appear to be positively influenced by ketamine. Neuroimaging studies have demonstrated that cognition-emotion interaction-related fronto-cingulate structures are often dysregulated in depressive patients during cognitive engagement. Objectives: To our knowledge, the influence of ketamine on WM-related brain activity in severely depressed patients has not been investigated yet. Methods: In order to shed light on the underlying mechanisms we investigated brain activity levels pre and post a single ketamine infusion in a sample of 16 severely depressed patients during an emotional WM task. Results: Our results indicate that baseline activity levels in the lateral and medial prefrontal cortex and in the anterior cingulate cortex predict symptom improvement 24 hours after ketamine. Additionally, activity changes after ketamine in the left DLPFC were linked to reduction in depressive symptoms. Conclusions: Interestingly, these effects were most pronounced regarding the improvement of cognitive symptoms. As the ACC and prefrontal cortex are both thought to be crucially involved in the regulation of cognition-emotion interaction and MDD mechanisms, the observed interaction might be directly linked to the neurobiological processes underlying the antidepressive effect of ketamine. [ABSTRACT FROM AUTHOR]

Aim: To describe the ocular changes in patients with mucopolysaccharidosis type I (MPS I) and receiving enzyme replacement therapy (ERT). Patients: Eight patients with MPS I (four females and two males with Scheie syndrome; one male with Hurler-Scheie syndrome; one female with Hurler syndrome) were enrolled in a 3-year follow-up study of ERT. The effects of treatment on visual acuity, corneal clouding (slit lamp examination), intraocular pressure (TOP) and optic nerve morphology were measured on a yearly basis. Two patients had undergone bilateral corneal transplant prior to ERT. Bilateral corneal transplant was performed in a third patient during the course of ERT. Results: All patients exhibited the typical corneal stromal opacities. In two of the eight patients we detected elevated IOP, but no IOP-related optic nerve damage. In five patients there was no optic nerve pathology. One patient showed marked bilateral papilloedema that deteriorated during ERT, while one patient exhibited stable bilateral temporal pallor of the optic disc. In the patient with Hurler syndrome, severe corneal clouding prevented evaluation of the optic disc. During the course of ERT, visual acuity was stable in five patients; however, it deteriorated by two or more Snellen lines in both eyes of one patient suffering from progressive optic nerve swelling, as well as in one eye of a second patient as a result of endothelial decompensation of a corneal transplant. This deterioration was due to progressive optic nerve swelling in one patient and to endothelial decompensation of a corneal transplant in the other patient. In one patient with progressive corneal clouding, bilateral corneal transplant lead to substantial improvement of visual acuity. Conclusion: In the majority of patients, ocular findings and visual acuity are stable during ERT. However, ERT does not seem to prevent progression of corneal opacity or optic disc swelling. In contrast to previous reports, patients with Scheie syndrome also may exhibit optic nerve pathology. [ABSTRACT FROM AUTHOR]

Whybra C, Kampmann C, Krummenauer F, Ries M, Mengel E, Miebach E, Baehner F, Kim K, Bajbouj M, Schwarting A, Gal A, Beck M. The Mainz Severity Score Index: a new instrument for quantifying the Anderson–Fabry disease phenotype, and the response of patients to enzyme replacement therapy. Anderson–Fabry disease (AFD) is an X-linked disorder caused by deficient activity of the lysosomal enzyme α-galactosidase A. The availability of enzyme replacement therapy (ERT) for this debilitating condition has led to the need for a convenient and sensitive instrument to monitor clinical effects in an individual patient. This study aimed to develop a scoring system – the Mainz Severity Score Index (MSSI) – to measure the severity of AFD and to monitor the clinical course of the disease in response to ERT. Thirty-nine patients (24 males and 15 females) with AFD were assessed using the MSSI immediately before and 1 year after commencing agalsidase alfa ERT. Control data were obtained from 23 patients in whom AFD was excluded. The MSSI of patients with AFD was significantly higher than that of patients with other severe debilitating diseases. The MSSI indicated that, although more men than women had symptoms classified as severe, overall, the median total severity scores were not significantly different between male and female patients. One year of ERT with agalsidase alfa led, in all patients, to a significant (p < 0.001) reduction in MSSI score (by a median of nine points). This study has shown that the MSSI score may be a useful, specific measure for objectively assessing the severity of AFD and for monitoring ERT-related treatment effects. [ABSTRACT FROM AUTHOR]