Sexual violence: the victim

Molestation and rape in childhood or adulthood is sexual violence. This chapter discusses issues for sexual violence victims and suggests several best practices for this population.     

Recovery from a recurrent major depressive episode

Episode-related factors and antidepressant treatment adequacy may be important determinants of recovery from a major depressive episode (MDE). We compared recovered and nonrecovered patients on baseline sociodemographic, clinical and episode-related measurements. Twenty-five inpatients with recurrent major depressive disorder diagnosed by SADS-L participated in this naturalistic, prospective, longitudinal study. Recovery, which was defined as a sustained return to non-depressed status lasting > or = 8 consecutive weeks, was assessed at 6- and 12-month follow-up with the Streamlined Longitudinal Interval Continuation Evaluation (SLICE). Thirteen (52%) patients met recovery criteria. The cumulative proportion remaining depressed for at least 52 weeks was 42.5%. Recovered patients had shorter episodes preceding the index hospitalization (P = .01). Despite adequate antidepressant pharmacotherapy, the length of the current episode remains the most important correlate of recovery from MDE recurrence. Our small sample size and the uncontrolled nature of treatment may limit the generalizability of these findings.     

Receptor-Binding Domain (RBD) Antibodies Contribute More to SARS-CoV-2 Neutralization When Target Cells Express High Levels of ACE2

Neutralization assays are experimental surrogates for the effectiveness of infection- or vaccine-elicited polyclonal antibodies and therapeutic monoclonal antibodies targeting SARS-CoV-2. However, the measured neutralization can depend on the details of the experimental assay. Here, we systematically assess how ACE2 expression in target cells affects neutralization by antibodies to different spike epitopes in lentivirus pseudovirus neutralization assays. For high ACE2-expressing target cells, receptor-binding domain (RBD) antibodies account for nearly all neutralizing activity in polyclonal human sera. However, for lower ACE2-expressing target cells, antibodies targeting regions outside the RBD make a larger (although still modest) contribution to serum neutralization. These serum-level results are mirrored for monoclonal antibodies: N-terminal domain (NTD) antibodies and RBD antibodies that do not compete for ACE2 binding incompletely neutralize on high ACE2-expressing target cells, but completely neutralize on cells with lower ACE2 expression. Our results show that the ACE2 expression level in the target cells is an important experimental variable, and that high ACE2 expression emphasizes the role of a subset of RBD-directed antibodies.     

Endocyclophotocoagulation combined with phacoemulsification in surgically naive primary open-angle glaucoma: three-year results

ObjectiveTo assess the safety and efficacy of endocyclophotocoagulation with phacoemulsification (phaco-ECP) in surgically naive, primary open-angle glaucoma (POAG).MethodsA retrospective case series of patients undergoing phaco-ECP between 2007 and 2017 at a single centre in London, UK. The primary outcome was intraocular pressure (IOP). Secondary outcomes were visual acuity, visual field global indices, topical medications and surgical complications. Failure criteria were: (1) IOP > 21 mmHg or <20% reduction at two consecutive visits, (2) IOP <5 mmHg and (3) further IOP-lowering surgery.ResultsEighty-three eyes from 83 patients were eligible. Pre-operatively, mean IOP (±SD) was 18.4 ± 5.2 mmHg. The mean number of topical agents (±SD) was 2.7 ± 0.9. Mean IOP (±SD) significantly reduced to 14.3 ± 4.7 at 1 year, 14.1 ± 4.0 at 2 years and 13.6 ± 3.7 at 3 years (p < 0.0001). Topical medications were significantly reduced to 1.3 ± 1.2 at 1 year, 1.7 ± 1.2 at 2 years and 1.8 ± 1.3 at 3 years (p < 0.0001). Annual IOP ‘survival’ was 70%, 54% and 45% at year 1, 2 and 3, respectively. Complications included uveitis (6%), macular oedema (2%), IOP spikes (1%) and corneal decompensation (1%) with no episodes of hypotony or retinal detachment. One patient underwent filtration surgery within 3 years (1%).ConclusionPhaco-ECP facilitates significant IOP lowering and reduction of medication burden in surgically naive POAG requiring cataract extraction. The procedure is relatively safe and without the use of implants and their associated risks.Subject terms: Optic nerve diseases, Surgery     

ON THE ORIGIN OF HEPARIN : AN EXAMINATION OF THE HEPARIN CONTENT AND THE SPECIFIC CYTOPLASMIC PARTICLES OF NEOPLASTIC MAST CELLS

This plate should be substituted for the original Plate 8 which appeared in Vol. 86, No. 2, August l, 1947, and showed faulty register of the colors.     

ON THE ORIGIN OF HEPARIN : AN EXAMINATION OF THE HEPARIN CONTENT AND THE SPECIFIC CYTOPLASMIC PARTICLES OF NEOPLASTIC MAST CELLS

1. The spontaneous mast cell tumor of the dog contains heparin. 2. The cytoplasmic particulate content of the tumor mast cells varies with their anaplasia. This conclusion is based on the following findings: (a) in the immature cell of the more malignant tumor the particulate matter appeared in the living cells by phase microscopy to be composed of greyish illdefined particles or as a fine, weakly metachromatic granulation in the fixed and stained preparation; (b) in the mature cells of a relatively benign mast cell tumor, both in the living cell and in stained preparations, the particulate matter occurred in the form of discrete, dense, and strongly metachromatic granules, resembling those of the normal mast cell. 3. The heparin content was large (fifty times that of dog liver) in the growth with mature cells and only moderate (1.7 times) in that with immature cells. 4. Since there may be a great amount of greyish particulate matter (or fine stained granules) in a tumor of relatively low heparin content, it is suggested that this material represents an early or precursor phase in the development of heparin. 5. This possibility and the fact that the blood stream may be invaded by mature tumor mast cells of large heparin content without evident disturbance in the coagulability of the blood suggest the value of a comprehensive biochemical study of the heparin of mast cell tumors.