Attachment organization in Vietnam combat veterans with posttraumatic stress disorder

Attachment organization in a combat-related PTSD sample was investigated and compared with previously published clinical and non-clinical samples. The association between insecure attachment and unresolved mourning classification (U-loss) and between U-loss and PTSD symptoms was investigated. Vietnam combat veterans diagnosed with PTSD and in treatment (N = 48) were administered the Adult Attachment Interview, the SCID-IV, and CAPS. The PTSD sample was like non-clinical samples in the incidence of secure attachment (50%), but were more commonly unresolved. Veterans with insecure attachment organizations were more likely than those with secure attachment to be classified U-loss. U-loss classification was associated with greater likelihood of comorbid anxiety disorders and PTSD avoidance/numbing symptoms. The results suggest that while insecure attachment organization is associated with unresolved mourning in response to loss, it is not differentially associated with combat-related PTSD. The relationship between U-loss and PTSD is discussed in light of current literature.     

Sofosbuvir plus ribavirin in Japanese patients with chronic genotype 2 HCV infection: an open‐label,phase 3 trial

Genotype 2 hepatitis C virus (HCV) accounts for up to 30% of chronic HCV infections in Japan. The standard of care for patients with genotype 2 HCV – peginterferon and ribavirin for 24 weeks – is poorly tolerated, especially among older patients and those with advanced liver disease. We conducted a phase 3, open‐label study to assess the efficacy and safety of an all‐oral combination of the NS5B polymerase inhibitor sofosbuvir and ribavirin in patients with chronic genotype 2 HCV infection in Japan. We enrolled 90 treatment‐naïve and 63 previously treated patients at 20 sites in Japan. All patients received sofosbuvir 400 mg plus ribavirin (weight‐based dosing) for 12 weeks. The primary endpoint was sustained virologic response at 12 weeks after therapy (SVR12). Of the 153 patients enrolled and treated, 60% had HCV genotype 2a, 11% had cirrhosis, and 22% were over the aged 65 or older. Overall, 148 patients (97%) achieved SVR12. Of the 90 treatment‐naïve patients, 88 (98%) achieved SVR12, and of the 63 previously treated patients, 60 (95%) achieved SVR12. The rate of SVR12 was 94% in patients with cirrhosis and in those aged 65 and older. No patients discontinued study treatment due to adverse events. The most common adverse events were nasopharyngitis, anaemia and headache. Twelve weeks of sofosbuvir and ribavirin resulted in high rates of SVR12 in treatment‐naïve and previously treated patients with chronic genotype 2 HCV infection. The treatment was safe and well tolerated by patients, including the elderly and those with cirrhosis.     

Community use of face masks and similar barriers to prevent respiratory illness such as COVID-19: a rapid scoping review

BackgroundEvidence for face-mask wearing in the community to protect against respiratory disease is unclear.AimTo assess effectiveness of wearing face masks in the community to prevent respiratory disease, and recommend improvements to this evidence base.MethodsWe systematically searched Scopus, Embase and MEDLINE for studies evaluating respiratory disease incidence after face-mask wearing (or not). Narrative synthesis and random-effects meta-analysis of attack rates for primary and secondary prevention were performed, subgrouped by design, setting, face barrier type, and who wore the mask. Preferred outcome was influenza-like illness. Grading of Recommendations, Assessment, Development and Evaluations (GRADE) quality assessment was undertaken and evidence base deficits described.Results33 studies (12 randomised control trials (RCTs)) were included. Mask wearing reduced primary infection by 6% (odds ratio (OR): 0.94; 95% CI: 0.75–1.19 for RCTs) to 61% (OR: 0.85; 95% CI: 0.32–2.27; OR: 0.39; 95% CI: 0.18–0.84 and OR: 0.61; 95% CI: 0.45–0.85 for cohort, case–control and cross-sectional studies respectively). RCTs suggested lowest secondary attack rates when both well and ill household members wore masks (OR: 0.81; 95% CI: 0.48–1.37). While RCTs might underestimate effects due to poor compliance and controls wearing masks, observational studies likely overestimate effects, as mask wearing might be associated with other risk-averse behaviours. GRADE was low or very low quality.ConclusionWearing face masks may reduce primary respiratory infection risk, probably by 6–15%. It is important to balance evidence from RCTs and observational studies when their conclusions widely differ and both are at risk of significant bias. COVID-19-specific studies are required.     

Opponent melanopsin and S-cone signals in the human pupillary light response

In the human, cone photoreceptors (L, M, and S) and the melanopsin-containing, intrinsically photosensitive retinal ganglion cells (ipRGCs) are active at daytime light intensities. Signals from cones are combined both additively and in opposition to create the perception of overall light and color. Similar mechanisms seem to be at work in the control of the pupil’s response to light. Uncharacterized however, is the relative contribution of melanopsin and S cones, with their overlapping, short-wavelength spectral sensitivities. We measured the response of the human pupil to the separate stimulation of the cones and melanopsin at a range of temporal frequencies under photopic conditions. The S-cone and melanopsin photoreceptor channels were found to be low-pass, in contrast to a band-pass response of the pupil to L- and M-cone signals. An examination of the phase relationships of the evoked responses revealed that melanopsin signals add with signals from L and M cones but are opposed by signals from S cones in control of the pupil. The opposition of the S cones is revealed in a seemingly paradoxical dilation of the pupil to greater S-cone photon capture. This surprising result is explained by the neurophysiological properties of ipRGCs found in animal studies.Under daylight conditions, human visual perception originates with signals generated by three classes of cone photoreceptors (the L, M, and S cones; Fig. 1A, Left) with peak sensitivities at long, middle, and short wavelengths of visible light (Fig. 1A, Center).Open in a separate windowFig. 1.Experimental design. (A, Left) L, M, and S cones and melanopsin-containing ipRGCs mediate vision at daytime light levels. (Center) Photoreceptor spectral sensitivities. (Right) Physiological measurements of ipRGCs find excitatory L and M cone inputs and inhibitory S-cone inputs (12). (B) A digital spectral integrator produces sinusoidal photoreceptor-directed modulations that pass through an artificial pupil into the pharmacologically dilated left eye. The consensual pupil response of the right eye is recorded. (C) Photoreceptor-directed modulations. Balanced changes in the spectrum of light around a background spectrum nominally isolate targeted photoreceptors.Distinct neural pathways process signals originating in cone photoreceptors for visual perception. Luminance pathways combine signals from separate classes of cones synergistically, providing a spectrally broadband indication of the overall light intensity at each location in the retinal image. Red–green and blue–yellow chromatic channels combine signals from separate classes of cones in an opponent (subtractive) fashion, providing sensitivity to the relative spectral content of light and supporting the perception of color independent of luminance (1).A parallel set of pathways contributes to the response of the pupil of the eye to light. Most familiar is a synergistic cone effect that causes the pupil to constrict in response to increased luminance. Illustrating a commonality of principles that characterize neural mechanisms for perception and pupil response, rectified signals from red–green and blue–yellow opponent channels also contribute to the pupil’s light response (2–7).Recently, it has been discovered that mammalian retinas contain an additional photoreceptor class that also operates under daylight conditions. Intrinsically photosensitive retinal ganglion cells (ipRGCs) express the photopigment melanopsin, which has a peak spectral sensitivity (480 nm) between that of S and M cones (8, 9). Among other, “non-image-forming” functions of the eye, melanopsin-containing ipRGCs contribute to a delayed and sustained constriction of the pupil (10). Studies in patients with loss of photoreceptor function (11) suggest that melanopsin may also contribute to conscious visual perception.The discovery of an additional photoreceptor class raises the fundamental question of how melanopsin signals are combined with those from the cones. Do melanopsin signals add to cones to measure overall light intensity, or do they interact in an opponent fashion, enhancing the ability to detect changes in the relative spectrum of incident light?Single-unit studies of the primate retina find that L- and M-cone signals add with those of melanopsin to produce the responses of ipRGCs but suggest that signals from S cones are inhibitory (12) (Fig. 1A, Right). Prior studies of short-wavelength light upon the human pupil response preceded the discovery of melanopsin and have offered complicated results. A transient constriction of the pupil was found to follow the offset of a short-wavelength stimulus on a long-wavelength background (2), and the results were interpreted in terms of an S-cone opponent input to the control of the pupil. However, alternation between short- and long-wavelength tritanopic metamers that yielded equivalent excitation of L and M cones was found to modulate the pupil in a manner suggesting in-phase S and L/M cone contributions to the pupillary light response (13). Critically, the interpretation of these earlier results—and particularly the relative contribution of the S cones and melanopsin to the pupil response—must be revisited given the overlapping spectral sensitivities of these two photoreceptor classes and the unknown role of melanopsin in mediating the earlier results.Here we study how melanopsin and the three classes of cones contribute to the human pupillary light response (PLR). Despite the intuition that pupil size should be responsive to the overall intensity of the incident light, our results reveal that a spectrally opponent system involving melanopsin contributes to pupil control at photopic light levels. The nature of this response reflects, qualitatively, the spectral opponency seen in ipRGCs: Signals from melanopsin combine additively with those from L and M cones and are opposed by signals from S cones.     

Symptomatic vaginal bleeding in a postmenopausal woman: a case report of pancreatic adenocarcinoma metastasizing exclusively to the vagina

Although primary vaginal cancer is uncommon, representing 1-2% of all female genital malignancies, metastatic disease to the vagina is not. Most cases represent metastases from other pelvic organs or the colon. We present the second case in the literature of a pancreatic adenocarcinoma metastasizing exclusively to the vagina.     

Perception of color and material properties in complex scenes

How do human observers estimate the location, form, and color of objects? Accurate estimation is challenging because the light arriving at the eyes depends not only on object properties, but also on the spectra and spatial layout of the light sources (Nassau, 1983; Foley et al., 1990). How well the visual system separates illuminant and object properties to achieve a stable representation has traditionally been studied under the rubric of color and lightness constancy. Most previous work used very simple stimuli, typically a few diffusely illuminated surfaces arranged perpendicular to the line of sight. Over the past several years, however, there has been an evident increase of interest in expanding the conceptualization of this area to incorporate effects that emerge only for complex, typically three-dimensional, scenes. The current issue features papers that represent various manifestations of this interest. One line of research investigates how the three-dimensional layout of a scene affects the perception of lightness and color. Although the current work has long-standing antecedents (e.g. Mach, 1886/1959; Hochberg and Beck, 1954; Gilchrist, 1980), methodological advances in i) experimentation with real illuminated objects (e.g. Brainard et. al, 1987; Rutherford and Brainard, 2002; Ripamonti et al., 2004; Robilotto and Zaidi, 2004), ii) the use of sophisticated graphics simulations (e.g. Yang and Maloney, 1999; Fleming, Dror, & Adelson, 2003; Boyaci, Maloney, & Hersh, 2003; Delahunt and Brainard, 2004), iii) the design of hybrid systems that combine real objects with image-based graphics and video projection (Ling and Hurlbert, 2004), and iv) psychophysical procedures (Maloney and Yang, 2003; Obein, Knoblauch, & Vienot, 2004) have opened the door for systematic exploration of a wider range of phenomena. Recent papers include work on how well vision compensates for changes in surface orientation (Boyaci et al., 2003; Ripamonti et al., 2004), how effectively it discounts inter-reflections among nearby surfaces (Bloj, Kersten, & Hurlbert, 1999; Doerschner, Boyaci, & Maloney, 2004; Delahunt and Brainard, 2004), and how the visual system effectively estimates the spectral properties and spatial layout of the illuminant in three-dimensional scenes (Kraft & Brainard, 1999; Yang & Maloney, 1999; Boyaci, Maloney, & Hersh, 2003; Bloj et al., 2004; Boyaci, Doerschner, & Maloney, 2004; Khang and Zaidi, 2004). The second thread that leads to papers in the current issue is a focus on the functional utility of color and lightness perception -- the idea that these percepts inform us about the properties of objects rather than those of light spectra. This focus resulted in a renaissance of research in color constancy over the past two decades, with particular progress being made in the development of computational models that explore how, in principle, object surface properties can be estimated from image data. As with the experimental lines, early work focused on simple scene geometries (for reviews see Hurlbert, 1998; Maloney, 1999) but consideration has recently expanded to three-dimensional configurations (Adelson and Pentland, 1996; Yang and Maloney, 1999; Bell and Freeman, 2001; Dror, Willsky, & Adelson, 2004) Of particular interest has been the elaboration of purely computational formulations into parametric models of human performance (e.g. Brainard Brunt, & Speigle, 1997; Brainard Kraft, & Longere, 2003; Boyaci et al., 2003; Doerschner et al., 2004; Boyaci et al., 2004; Bloj et al., 2004), tests of how well the visual system exploits image information identified in computational studies (Yang and Maloney, 2001; Delahunt and Brainard, 2004; Smithson and Zaidi, 2004), investigations of how well the visual system recovers perceptual correlates of material properties other than diffuse surface reflectance, such as gloss and translucency (Lu, Koenderink, & Kappers, 2000; Fleming et al., 2003; Pont & Koenderink, 2003; Obein et al., 2004), as well as how geometric aspects of surface reflectance interact with the perception of shape (Fleming et al., 2003).     

Ureteral tissue balloon expansion for laparoscopic bladder augmentation: survival study

BACKGROUND AND PURPOSE: The search for the perfect urinary bladder substitute continues. Despite their inherent limitations, intestinal segments remain the commonest material for bladder reconstruction. The ureter, with its transitional epithelium, may be the ideal tissue to augment the bladder. Ikeguchi et al reported the feasibility of chronic ureteral balloon expansion by open surgery (J Urol 1998;159:1665). Herein, we propose a completely minimally invasive approach to balloon overdilate a segment of juxtavesical ureter incrementally and to use this in-line tissue-expanded ureteral patch to augment the bladder laparoscopically. MATERIALS AND METHODS: In five female pigs, a novel ureteral expansion balloon device (Microvasive, MA) was inserted percutaneously and advanced antegrade into the juxtavesical ureter. The device has two channels: one for balloon inflation and the other for draining the kidney. After progressive ureteral expansion over a 3- to 4-week period, laparoscopic augmentation ureterocystoplasty was performed. Animals were euthanized at 15 days (N = 1), 1 month (N = 1), 2 months (N = 1), and 3 months (N = 2). RESULTS: Percutaneous balloon device placement was technically successful in all five cases (mean operating room time 52 minutes). The mean volume of the tissue-expanded ureter at 1, 2, and 3 weeks was 12.9 cc, 60.3 cc, and 171.8 cc, respectively. Laparoscopic augmentation ureterocystoplasty with (N = 3) or without (N = 2) concomitant subtotal cystectomy was technically successful in all five cases without any open conversion. The mean operative time was 126.5 minutes, and the mean blood loss was 29 mL. Postoperative complications consisted of one case each of pyelonephritis and ureteral stricture. At autopsy, the mean capacity of the bladder was 574 mL, and the P(ves) at maximum capacity was 14 cm H(2)O. Histologic examination of the tissue-expanded ureter revealed regenerated transitional epithelium and muscle hypertrophy. CONCLUSIONS: Chronic ureteral tissue expansion can be carried out safely and efficaciously. The expanded tissue is thick, healthy, and vascular, with histologic features of normal transitional epithelium and muscle hypertrophy and hyperplasia. This expanded ureteral tissue can be used to augment the bladder with laparoscopic techniques. Such augmented bladders do not show significant shrinkage and possess urodynamic characteristic of normal capacity and normal compliance over a follow-up of 3 months.     

Light-induced stimulation of retinal dopamine: a dose-response relationship

Light stimulates dopamine (DA) release in the retina. The purpose of this was to determine the threshold and dose-response relationship between ocular light exposure and retinal DA synthesis in vivo. Groups of dark-adapted rats were exposed to 0, 1, 3, 5, 10, 25, 50, 100 or 1000 microwatts per square centimeter (μW/cm² of white light for 15 min. Retinal DA and dihydroxyphenylalanine (DOPA) were subsequently quantified by liquid chromatography with electrochemical detection. Both the DA and DOPA data fit hyperbolic curves significantly (Pˇ0.01). Exposure to white light at 25 μW/cm² or greater appears to elicit the maximum response of these neurons. Threshold irradiance is calculated to be 3–5 μW/cm². These results indicate that retinal DA synthesis and presumably DA neuron activity have a graded response to increasing irradiances of white light.