Search Results (38)

Background and Clinical Significance: Avatar Therapy (AT) for individuals with treatment-resistant auditory verbal hallucinations (AVHs) in schizophrenia aims to address emotional responses, beliefs about voices, self-perception, and coping strategies. This study focuses on three participants who, during AT, shifted their belief about the origin of their most distressing voice from an external source to a self-generated one. Case Presentation: The objective of this study was to explore the evolution of the reattribution of the participants’ most distressing voice to oneself during AT and the patients’ perception of this reattribution. Immersive sessions and semi-structured interviews were transcribed and qualitatively described to provide a session-by-session account of the evolution of each participant’s AVH reattribution to themselves during the course of AT, along with their perceptions of this reattribution. This process led to the recognition that initially perceived as external voices were internally generated thoughts, reflecting how participants viewed themselves. Two participants reported a reduction in AVH severity. All three described positive changes in how they related to their voices and self-perception. Additional improvements were observed in emotional regulation, social functioning, and engagement in personal projects. Conclusions: This reassignment of the voice from an external source to an internal one suggests that AT can modify how individuals relate to their voices and may empower them to regain control over their hallucinations. However, given the exploratory nature of this study, the results should be interpreted as examples. Full article

Despite remarkable progress in cancer immunotherapy, many agents that show efficacy in murine or in vitro models fail to translate clinically. Zebrafish (Danio rerio) have emerged as a powerful complementary model that addresses several limitations of traditional systems. Their optical transparency, genetic tractability, and conserved immune and oncogenic signaling pathways enable high-resolution, real-time imaging of tumor–immune interactions in vivo. Importantly, zebrafish offer a unique opportunity to study the core mechanisms of health and sickness, complementing other models and expanding our understanding of fundamental processes in vivo. This review provides an overview of zebrafish immune system development, highlighting tools for tracking innate and adaptive responses. We discuss their application in modeling immune evasion, checkpoint molecule expression, and tumor microenvironment dynamics using transgenic and xenograft approaches. Platforms for high-throughput drug screening and personalized therapy assessment using patient-derived xenografts (“zAvatars”) are evaluated, alongside limitations, such as temperature sensitivity, immature adaptive immunity in larvae, and interspecies differences in immune responses, tumor complexity, and pharmacokinetics. Emerging frontiers include humanized zebrafish, testing of next-generation immunotherapies, such as CAR T/CAR NK and novel checkpoint inhibitors (LAG-3, TIM-3, and TIGIT). We conclude by outlining the key challenges and future opportunities for integrating zebrafish into the immuno-oncology pipeline to accelerate clinical translation. Full article

This paper presents the development and initial evaluation of a novel protocol for robot-assisted lower limb rehabilitation. It integrates dual-modal patient interaction, employing mirror therapy and an auto-adaptive EMG-driven control system, designed to enhance lower limb rehabilitation in patients with hemiparesis impairments. The system features a robotic platform specifically engineered for lower limb rehabilitation, which operates in conjunction with a virtual reality (VR) environment. This immersive environment comprises a digital twin of the robotic system alongside a human avatar representing the patient and a set of virtual targets to be reached by the patient. To implement mirror therapy, the proposed protocol utilizes a set of inertial sensors placed on the patient’s healthy limb to capture real-time motion data. The auto-adaptive protocol takes as input the EMG signals (if any) from sensors placed on the impaired limb and performs the required motions to reach the virtual targets in the VR application. By synchronizing the motions of the healthy limb with the digital twin in the VR space, the system aims to promote neuroplasticity, reduce pain perception, and encourage engagement in rehabilitation exercises. Initial laboratory trials demonstrate promising outcomes in terms of improved motor function and subject motivation. This research not only underscores the efficacy of integrating robotics and virtual reality in rehabilitation but also opens avenues for advanced personalized therapies in clinical settings. Future work will investigate the efficiency of the proposed solution using patients, thus demonstrating clinical usability, and explore the potential integration of additional feedback mechanisms to further enhance the therapeutic efficacy of the system. Full article

The burden of chronic liver disease (CLD) is dramatically increasing. It is estimated that 20–30% of the population worldwide is affected by CLD. Hepatic fibrosis is a symptom common to all CLDs. Although it affects liver functional activities, it is a reversible stage if diagnosed at an early stage, but no resolutive therapy to contrast liver fibrosis is currently available. Therefore, efforts are needed to study the molecular insights of the disease. Emerging cutting-edge fields in cellular and molecular biology are introducing innovative strategies. Spatial and single-cell resolution approaches are paving the way for a more detailed understanding of the mechanisms underlying liver fibrosis. Cellular models have been generated to recapitulate the in-a-dish pathophysiology of liver fibrosis, yielding remarkable results that not only uncover the underlying molecular mechanisms but also serve as patient-specific avatars for precision medicine. Induced pluripotent stem cells (iPSC) and organoids are incredible tools to reshape the modeling of liver diseases, describe their architecture, and study the residents of hepatic tissue and their heterogeneous population. The present work aims to give an overview of innovative omics technologies revolutionizing liver fibrosis research and the current tools to model this disease. Full article

This study investigates how the behavioural realism of avatars can enhance virtual reality (VR) social interactions involving self-disclosure. First, we review how factors such as trust, enjoyment, and nonverbal communication could be influenced by motion capture technology by enhancing behavioural realism. We also address a gap in the prior literature by comparing different motion capture systems and how these differences affect perceptions of realism, enjoyment, and eye contact. Specifically, this study compared two types of avatars: an iClone UNREAL avatar with full-body and facial motion capture and a Vive Sync avatar with limited motion capture for self-disclosure. Our participants rated the iClone UNREAL avatar higher for realism, enjoyment, and eye contact duration. However, as shown in our post-experiment survey, some participants reported that they preferred the avatar with less behavioural realism. We conclude that a higher level of behavioural realism achieved through more advanced motion capture can improve the experience of VR social interactions. We also conclude that despite the general advantages of higher motion capture, the simpler avatar was still acceptable and preferred by some participants. This has important implications for improving the accessibility of avatars for different contexts, such as therapy, where simpler avatars may be sufficient. Full article

Background: The advent of virtual reality in psychiatry presents a wealth of opportunities for a variety of psychopathologies. Avatar Interventions are dialogic and experiential treatments integrating personalized medicine with virtual reality (VR), which have shown promising results by enhancing the emotional regulation of their participants. Notably, Avatar Therapy for the treatment of auditory hallucinations (i.e., voices) allows patients to engage in dialogue with an avatar representing their most persecutory voice. In addition, Avatar Intervention for cannabis use disorder involves an avatar representing a significant person in the patient’s consumption. In both cases, the main goal is to modify the problematic relationship and allow patients to regain control over their symptoms. While results are promising, its potential to be applied to other psychopathologies, such as major depression, is an exciting area for further exploration. In an era where VR interventions are gaining popularity, the present study aims to investigate whether technological advancements could overcome current limitations, such as avatar realism, and foster a deeper immersion into virtual environments, thereby enhancing participants’ sense of presence within the virtual world. A newly developed virtual reality platform was compared to the current platform used by our research team in past and ongoing studies. Methods: This study involved 43 subjects: 20 healthy subjects and 23 subjects diagnosed with severe mental disorders. Each participant interacted with an avatar using both platforms. After each immersive session, questionnaires were administered by a graduate student in a double-blind manner to evaluate technological advancements and user experiences. Results: The findings indicate that the new technological improvements allow the new platform to significantly surpass the current platform as per multiple subjective parameters. Notably, the new platform was associated with superior realism of the avatar (d = 0.574; p < 0.001) and the voice (d = 1.035; p < 0.001), as well as enhanced lip synchronization (d = 0.693; p < 0.001). Participants reported a significantly heightened sense of presence (d = 0.520; p = 0.002) and an overall better immersive experience (d = 0.756; p < 0.001) with the new VR platform. These observations were true in both healthy subjects and participants with severe mental disorders. Conclusions: The technological improvements generated a heightened sense of presence among participants, thus improving their immersive experience. These two parameters could be associated with the effectiveness of VR interventions and future studies should be undertaken to evaluate their impact on outcomes. Full article

Background/Objectives: A high number of patients who suffer the amputation of a lower limb will present psychological problems such as anxiety, depression, and post-traumatic stress disorder after surgery. This study embodies participants in a self-avatar with a right lower-limb amputation in a virtual reality environment. The aim was to determine if this experience increases anxiety levels compared to embodiment in a normal avatar. The study also examines whether body appreciation is related to anxiety levels. Methods: Subjects completed the Body Appreciation Scale (BAS) questionnaire before being immersed in the virtual environment, the Visual Analogue Scale for Anxiety (VAS-A) after each condition, and the Embodiment Questionnaire at the end of the experiment. Results: Univariate analysis showed that participants reported significantly higher levels of anxiety when exposed to the virtual avatar with an amputation compared to the full virtual body avatar. These results indicate that lower levels of body appreciation were associated with higher levels of anxiety across conditions, suggesting that participants with lower body appreciation experienced greater psychological maladjustment (measured by anxiety) in response to the virtual scenarios. Conclusions: The results suggest that the virtual avatar with a lower-limb amputation elicited significantly greater anxiety, and that body appreciation plays a key role in moderating this psychological response. Future research could focus on developing virtual exposure-based therapy for amputees using virtual reality to help reduce the anxiety experienced by patients during this process. Full article

Background/Objectives: Adolescents with idiopathic scoliosis require emotional support to change their experience of their desired body shape and to feel optimistic about the cosmetic results of surgical treatment. Recently, the use of virtual reality in psychological assessment and treatment has given specialists a technology that appears particularly well-suited for addressing body image disorders. The study objectives were two-fold. Firstly, we aimed to evaluate changes within the body image of scoliosis patients pre- and postoperatively. Secondly, we aimed to investigate if differences in body image exist in scoliosis females after implementing cognitive-behavioral therapy. Methods: Thirty-six total scoliosis patients participated in the 1st and 2nd study phases. The psychotherapy took place before and after surgery and during the patient’s stay in the hospital. Body image was assessed using a virtual reality-based application, “Avatar Scoliosis 3D”. Results: Regarding body image dissatisfaction evaluated via virtual tasks, the difference between the desired by patients and actual (based on the radiographic parameters) body shape is significant preoperatively in both scoliosis samples: with and without therapy (p < 0.000001 and p < 0.000001, respectively). Conclusions: The results of the present study may have important implications for developing standards for body image disorder treatments in scoliosis patients. We revealed that irrespective of received therapeutic support, scoliosis patients accurately estimate their body shape pre- and postoperatively, and they feel dissatisfied with their body preoperatively but not postoperatively. Full article

Avatar therapy (AT) is a novel virtual reality-based psychotherapy that has been developed to treat auditory verbal hallucinations (AVH) in treatment-resistant schizophrenia. Various psychotherapeutic components, such as emotions and sense of presence, could contribute to clinical outcomes. However, the interplay between sense of presence, emotions, and clinical response has seldom been investigated. This study aimed to explore the relations between sense of presence, emotions, and clinical outcomes in AT. To conduct this investigation, data from previous and ongoing AT trials were used. Sense of presence and emotions were assessed using standardized questionnaires. AVH were evaluated using the Psychotic Symptom Rating Scales. While sense of presence was positively associated with positive emotions such as control and serenity, no significant associations were found for negative emotions. Moreover, a higher level of sense of presence was associated with a bigger decrease in AVH. Overall, positive emotions seem to be associated with sense of presence in AT. Sense of presence also seems to be involved in the therapeutic outcome, thereby suggesting that this could be an important component related to clinical response. More studies are needed to confirm these trends, which could be generalized to other virtual reality-based psychotherapies. Full article

This case study explores the potential of integrating attentional bias modification training (ABMT) with mirror exposure therapy (MET), utilizing virtual reality and eye-tracking, for a 14-year-old girl diagnosed with anorexia nervosa (AN). The ABMT-MET intervention was used alongside a standard treatment program called Home Treatment (HoT), which combines cognitive behavioral therapy with family-based therapy. Though the patient began HoT with a 3-week inpatient phase, the ABMT-MET intervention specifically took place during the subsequent Home Treatment sessions. The experimental treatment, comprising five consecutive weekly sessions, was bookended by pre- and post-assessment sessions and included a six-month follow-up. During the sessions, the patient engaged in systematic and hierarchical exposure to a virtual representation of her silhouette, with gradual adjustments made to the avatar’s body mass index (BMI) toward a healthier range. ABMT sessions, conducted before each MET session, aimed to redistribute the patient’s focus evenly across her body, successfully neutralizing her initial attentional bias toward non-weight-related body parts. The patient demonstrated consistent decreases in anxiety and fear of weight gain, effectively progressing through the BMI hierarchy in the virtual setting. Post-treatment assessments indicated significant enhancements in body dissatisfaction, drive for thinness, body-checking behaviors, and body appreciation, with these gains preserved at the six-month follow-up, although the attentional bias returned to pre-treatment levels. Though the single-case design limits definitive conclusions, these findings suggest ABMT-MET may be a promising adjunct therapy for AN, requiring further research for confirmation. Full article

No standardized in vitro cell culture models for glioblastoma (GBM) have yet been established, excluding the traditional two-dimensional culture. GBM tumorspheres (TSs) have been highlighted as a good model platform for testing drug effects and characterizing specific features of GBM, but a detailed evaluation of their suitability and comparative performance is lacking. Here, we isolated GBM TSs and extracellular matrices (ECM) from tissues obtained from newly diagnosed IDH1 wild-type GBM patients and cultured GBM TSs on five different culture platforms: (1) ordinary TS culture liquid media (LM), (2) collagen-based three-dimensional (3D) matrix, (3) patient typical ECM-based 3D matrix, (4) patient tumor ECM-based 3D matrix, and (5) mouse brain. For evaluation, we obtained transcriptome data from all cultured GBM TSs using microarrays. The LM platform exhibited the most similar transcriptional program to paired tissues based on GBM genes, stemness- and invasiveness-related genes, transcription factor activity, and canonical signaling pathways. GBM TSs can be cultured via an easy-to-handle and cost- and time-efficient LM platform while preserving the transcriptional program of the originating tissues without supplementing the ECM or embedding it into the mouse brain. In addition to applications in basic cancer research, GBM TSs cultured in LM may also serve as patient avatars in drug screening and pre-clinical evaluation of targeted therapy and as standardized and clinically relevant models for precision medicine. Full article

Background: Psychotherapeutic approaches such as Avatar Therapy (AT) are novel therapeutic attempts to help patients diagnosed with treatment-resistant schizophrenia. Qualitative analyses of immersive sessions of AT have been undertaken to enhance and refine the existing interventions taking place in this therapy. To account for the time-consuming and costly nature and potential misclassification biases, prior implementation of a Linear Support Vector Classifier provided helpful insight. Single model implementation for text classification is often limited, especially for datasets containing imbalanced data. The main objective of this study is to evaluate the change in accuracy of automated text classification machine learning algorithms when using an ensemble approach for immersive session verbatims of AT. Methods: An ensemble model, comprising five machine learning algorithms, was implemented to conduct text classification for avatar and patient interactions. The models included in this study are: Multinomial Naïve Bayes, Linear Support Vector Classifier, Multi-layer perceptron classifier, XGBClassifier and the K-Nearest-Neighbor model. Accuracy, precision, recall and f1-score were compared for the individual classifiers and the ensemble model. Results: The ensemble model performed better than its individual counterparts for accuracy. Conclusion: Using an ensemble methodological approach, this methodology might be employed in future research to provide insight into the interactions being categorized and the therapeutical outcome of patients based on their experience with AT with optimal precision. Full article

Considering the harmful effects of cannabis on individuals with a severe mental disorder and the limited effectiveness of current interventions, this case report showcases the beneficial results of a 10-session Avatar intervention for cannabis use disorder (CUD) on a polysubstance user with a comorbid schizoaffective disorder. Virtual reality allowed the creation of an Avatar representing a person significantly related to the patient’s drug use. Avatar intervention for CUD aims to combine exposure, relational, and cognitive behavioral therapies while practicing real-life situations and learning how to manage negative emotions and cravings. Throughout therapy and later on, Mr. C managed to maintain abstinence from all substances. Also, an improvement in the severity of CUD, as well as a greater motivation to change consumption, was observed after therapy. As observed by his mother, his psychiatrist, and himself, the benefits of Avatar intervention for CUD extended to other spheres of his life. The drastic results observed in this patient could be promising as an alternative to the current treatment available for people with a dual diagnosis of cannabis use disorder and psychotic disorder, which generally lack effectiveness. A single-blind randomized control trial comparing the treatment with a classical intervention in a larger sample is currently underway to evaluate whether the results are reproducible on a larger sample. Full article

(1) Background: Approximately 30% of schizophrenia patients are known to be treatment-resistant. For these cases, more personalized approaches must be developed. Virtual reality therapeutic approaches such as avatar therapy (AT) are currently undergoing investigations to address these patients’ needs. To further tailor the therapeutic trajectory of patients presenting with this complex presentation of schizophrenia, quantitative insight about the therapeutic process is warranted. The aim of the study is to combine a classification model with a regression model with the aim of predicting the therapeutic outcomes of patients based on the interactions taking place during their first immersive session of virtual reality therapy. (2) Methods: A combination of a Linear Support Vector Classifier and logistic regression was conducted over a dataset comprising 162 verbatims of the immersive sessions of 18 patients who previously underwent AT. As a testing dataset, 17 participants, unknown to the dataset, had their first immersive session presented to the combinatory model to predict their clinical outcome. (3) Results: The model accurately predicted the clinical outcome for 15 out of the 17 participants. Classification of the therapeutic interactions achieved an accuracy of 63%. (4) Conclusion: To our knowledge, this is the first attempt to predict the outcome of psychotherapy patients based on the content of their interactions with their therapist. These results are important as they open the door to personalization of psychotherapy based on quantitative information about the interactions taking place during AT. Full article

Uveal melanoma is the most common primary intraocular malignancy in adults. Up to 50% of UM patients develop metastatic disease, usually in the liver. When metastatic, the prognosis is poor, and few treatment options exist. Here, we investigated the feasibility of establishing patient-derived xenografts (PDXs) from a patient’s tumor in order to screen for therapies that the patient could benefit from. Samples obtained from 29 primary tumors and liver metastases of uveal melanoma were grafted into SCID mice. PDX models were successfully established for 35% of primary patient tumors and 67% of liver metastases. The tumor take rate was proportional to the risk of metastases. PDXs showed the same morphology, the same GNAQ/11, BAP1, and SF3B1 mutations, and the same chromosome 3 and 8q status as the corresponding patient samples. Six PDX models were challenged with two compounds for 4 weeks. We show that, for 31% of patients with high or intermediate risk of metastasis, the timing to obtain efficacy results on PDX models derived from their primary tumors was compatible with the selection of the therapy to treat the patient after relapse. PDXs could thus be a valid tool (“avatar”) to select the best personalized therapy for one third of patients that are most at risk of relapse. Full article