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Background: Cognitive behavioural therapy (CBT) is an effective treatment for panic disorder with agoraphobia (PDA). However, implementation of some of the procedures involved, particularly in vivo exposure, can be time consuming and taxing for routine health care services. CBT with exposure taking place in virtual reality (VR-CBT) is a more time-efficient option and has shown promising results in the treatment of PDA. However, VR-CBT requires expensive equipment and appropriate virtual environments, which historically has been costly and cumbersome to produce. Thus, access to VR-CBT has been sparse in regular care environments. Aims: The aim of this study was to investigate whether VR-CBT using filmed virtual environments produced with a low-cost 360-degree film camera can be a feasible and acceptable treatment for PDA when implemented in a primary care context. Method: This was an open feasibility trial with a within-group design, with assessments conducted at pre-test, post-test, and 6-month follow-up. Participants (n = 12) received a 10-12 week treatment programme of VR-CBT and PDA-related symptoms were assessed by the primary outcome measure The Mobility Inventory for Agoraphobia (MIA) and the Panic-Disorder Severity Scale-Self Rated (PDSS-SR). Results: The results showed that treatment satisfaction was high and participants were significantly improved on PDA-related measures at post-treatment and at 6-month follow-up with large effect sizes (Cohen's d range = 1.46-2.82). All 12 participants completed the treatment. Conclusions: These findings suggest that VR-CBT with 360-degree video virtual environments delivered to primary care patients with PDA is feasible, acceptable, and potentially efficacious., QC 20220608

Non-germinal center (non-GC) phenotype is an adverse prognostic factor in chemotherapy (CT)-treated diffuse large B-cell lymphoma (DLBCL) patients. To determine how high-dose therapy (HDT) supported with auto-SCT as first line therapy influences GC-associated outcome in young high-risk DLBCL patients GC and non-GC phenotypes were determined immunohistochemically from 63 patients. Of these, 29 primary high-risk DLBCL patients were treated with auto-SCT, whereas 34 CT-treated patients served as a control group. Consistent with previous studies, non-GC phenotype was associated with adverse outcome in CT-treated high-risk patients. In contrast, immunohistochemical classification by cell of origin did not associate with survival after auto-SCT. When the impact of treatment on the predictive value of cell of origin was analyzed, the non-GC patients, who received HDT, had a better failure-free survival (FFS) and overall survival (OS) than the patients treated with CT alone. In multivariate analyses, both age-adjusted International Prognostic Index (aaIPI) and treatment were independent prognostic factors for FFS and OS. For the patients with GC phenotype, the influence of auto-SCT on survival was not significant. The data imply that auto-SCT can overcome the adverse prognostic impact of the non-GC phenotype in patients with high-risk DLBCL and warrant additional prospective studies.

Context: Capsulotomy is sometimes used as a treatment of last resort in severe and treatment refractory cases of Obsessive-Compulsive Disorder (OCD). Objective: To evaluate the long-term efficacy and safety of capsulotomy in OCD. Design: Non-controlled long-term follow-up trial (mean 10.9 years after surgery). Setting: University hospital referral center. Patients: 25 consecutive OCD patients having undergone capsulotomy between the years 1988 and 2000. Intervention: Unilateral or bilateral capsulotomy. Lesions were created either by conventional heating or by gamma-radiation (radiosurgery). Main Outcome Measure: Yale-Brown Obsessive-Compulsive Rating Scale (Y-BOCS). Results: Mean Y-BOCS was 34 preoperatively and dropped to 18 at long-term follow-up (p<0.0001). Response (defined as ≥ 35 % reduction at long-term compared to baseline) was seen in 12 patients at long-term. Eight patients were in remission (Y-BOCS < 16) at long-term follow-up. Response rates did not differ between surgical method. A mean weight gain of 6 kg was reported in the first postoperative year. Ten patients were considered to sufferer from significant problems in the area of executive functioning, apathy or disinhibition. Six of these ten patients had either had high doses of radiation or multiple surgical procedures. Our MRI analysis of 11 patients suggests that the OCD symptom reduction may be increased by reducing the lateral extension of the lesions, and a reduction in the medial and posterior extension may limit the risk of side effects, that is, smaller lesions may produce better results. Conclusions: Capsulotomy is effective in reducing OCD symptoms. There is a substantial risk of side effects and the risk may vary between surgical methods. Our findings suggest that smaller lesions are safer and that high radiation doses and multiple procedures should be avoided., VR-Neuroscience