Characterisation of ectasia after penetrating keratoplasty in keratoconus eyes using anterior segment optical coherence tomography.

BACKGROUND/AIMS: Ectasia of the cornea can occur decades after penetrating keratoplasty (PK), especially in keratoconus eyes. The purpose of this study was to characterise ectasia after PK by morphological findings in anterior segment optical coherence tomography (AS-OCT). METHODS: In this retrospective, single-centre case series, 50 eyes of 32 patients with a history of PK at an average of 25±10 years earlier were included. The eyes were classified either as ectatic (n=35) or as non-ectatic (n=15). The main parameters included central corneal thickness (CCT), lowest corneal thickness at the interface (LCTI), anterior chamber depth, graft-host interface angle at the thinnest point and host cornea-iris angle. Furthermore, steep and flat keratometry readings obtained by AS-OCT (CASIA-2, Tomey) and Scheimpflug tomography (Pentacam, Oculus) were assessed. OCT findings were correlated with clinical grading of ectasia. RESULTS: There was a highly significant difference in LCTI, graft-host interface angle and anterior chamber depth (in pseudophakic eyes) between the groups. The ratio calculated by the quotient of LCTI divided by CCT was significantly lower in ectatic than non-ectatic eyes (p<0.001). In eyes with an LCTI/CCT ratio of ≤0.7, the OR for the occurrence of a clinical detectable ectasia was 2.4 (CI 1.5 to 3.7). Steep keratometry values were significantly higher in ectatic eyes. CONCLUSION: AS-OCT is a helpful tool to recognise and quantify ectasia in post-PK eyes objectively.

The seafloor from a trait perspective. A comprehensive life history dataset of soft sediment macrozoobenthos.

Biological trait analysis (BTA) is a valuable tool for evaluating changes in community diversity and its link to ecosystem processes as well as environmental and anthropogenic perturbations. Trait-based analytical techniques like BTA rely on standardised datasets of species traits. However, there are currently only a limited number of datasets available for marine macrobenthos that contain trait data across multiple taxonomic groups. Here, we present an open-access dataset of 16 traits for 235 macrozoobenthic species recorded throughout multiple sampling campaigns of the Dutch Wadden Sea; a dynamic soft bottom system where humans have long played a substantial role in shaping the coastal environment. The trait categories included in this dataset cover a variety of life history strategies that are tightly linked to ecosystem functioning and the resilience of communities to (anthropogenic) perturbations and can advance our understanding of environmental changes and human impacts on the functioning of soft bottom systems.

[Psychoanalysts Online: Media regulation and digital boundary crossings]. / Psychoanalytiker im Cyberspace: Medieneinsatz in der Behandlung und digitale Grenzüberschreitungen.

Objectives: The present explorative study evaluates the question of media regulation in treatment and the question of psychoanalysts' experiences with digital crossings of boundaries. Methods: Using a self-constructed questionnaire, N = 50 completed questionnaires were distributed to psychoanalysts (age: M = 48,64, SD = 12,71; m = 44 %, f = 56 %) at the 51st IPA Congress held in July 2019 that were analyzed using aMann-Whitney U-test and Chi square test. Results: The majority of the psychoanalysts surveyed 68 %, (n = 34) do not regularly discuss the use ofmedia with their patients at the beginning of treatment, 28%(n = 14) of the analysts surveyed contacted their patients using digital media services without discussing this possibility of contact beforehand, 16 % (n = 8) contacted their patients at night, 46 %, n = 23 googled their patients and 24 %, (n = 12) secretly used a mobile phone during analysis. Conclusions: Due to the advancing technology of the health care system, further psychoanalytic research that accompanies the process of using media in treatment is necessary.

Dysregulated Retinoic Acid Signaling in the Pathogenesis of Pseudoexfoliation Syndrome.

Pseudoexfoliation (PEX) syndrome, a stress-induced fibrotic matrix process, is the most common recognizable cause of open-angle glaucoma worldwide. The recent identification of PEX-associated gene variants uncovered the vitamin A metabolic pathway as a factor influencing the risk of disease. In this study, we analyzed the role of the retinoic acid (RA) signaling pathway in the PEX-associated matrix metabolism and evaluated its targeting as a potential candidate for an anti-fibrotic intervention. We provided evidence that decreased expression levels of RA pathway components and diminished RA signaling activity occur in an antagonistic crosstalk with TGF-ß1/Smad signaling in ocular tissues and cells from PEX patients when compared with age-matched controls. Genetic and pharmacologic modes of RA pathway inhibition induced the expression and production of PEX-associated matrix components by disease-relevant cell culture models in vitro. Conversely, RA signaling pathway activation by natural and synthetic retinoids was able to suppress PEX-associated matrix production and formation of microfibrillar networks via antagonization of Smad-dependent TGF-ß1 signaling. The findings indicate that deficient RA signaling in conjunction with hyperactivated TGF-ß1/Smad signaling is a driver of PEX-associated fibrosis, and that restoration of RA signaling may be a promising strategy for anti-fibrotic intervention in patients with PEX syndrome and glaucoma.

Bitter taste signaling in tracheal epithelial brush cells elicits innate immune responses to bacterial infection.

Constant exposure of the airways to inhaled pathogens requires efficient early immune responses protecting against infections. How bacteria on the epithelial surface are detected and first-line protective mechanisms are initiated are not well understood. We have recently shown that tracheal brush cells (BCs) express functional taste receptors. Here we report that bitter taste signaling in murine BCs induces neurogenic inflammation. We demonstrate that BC signaling stimulates adjacent sensory nerve endings in the trachea to release the neuropeptides CGRP and substance P that mediate plasma extravasation, neutrophil recruitment, and diapedesis. Moreover, we show that bitter tasting quorum-sensing molecules from Pseudomonas aeruginosa activate tracheal BCs. BC signaling depends on the key taste transduction gene Trpm5, triggers secretion of immune mediators, among them the most abundant member of the complement system, and is needed to combat P. aeruginosa infections. Our data provide functional insight into first-line defense mechanisms against bacterial infections of the lung.

Ultrastructural analysis of explanted CyPass microstents and correlation with clinical findings.

PURPOSE: The purpose of this study was to obtain insight into cellular processes after CyPass microstent implantation into the supraciliary space. With this knowledge, we expected to find some reason for surgical failure. METHODS: Nine CyPass microstents of 8 patients with primary open-angle glaucoma (n = 1), pseudoexfoliation glaucoma (n = 5), uveitic glaucoma (n = 1), and posttraumatic open-angle glaucoma (n = 1) were explanted due to recurrence of IOP elevation, corneal decompensation, or persistent hypotony. The explants were processed for light and transmission electron microscopy. RESULTS: Fibrotic material, consisting of collagen fibrils, microfibrils, pseudoexfoliation fibrils produced by activated fibroblasts, was detected in the stent lumen of 4/5 pseudoexfoliation glaucoma patients and also in posttraumatic open-angle glaucoma. Fibrotic material was also present on the outer surface and within fenestrations of the majority of stents. Complete absence of fibrotic reaction was noticed in 3 of 9 microstents. CONCLUSION: Although MIGS is known to be less invasive than conventional surgery, implants placed in the suprachoroidal space may be adversely affected by a fibrotic tissue reaction resulting in implant failure. Understanding mechanisms and risk factors leading to fibrotic scarring following antiglaucomatous surgery may help to develop novel strategies that improve surgical outcome.

The Relationship Between the Implementation of Statutory Preventative Measures, Perceived Susceptibility of COVID-19, and Personality Traits in the Initial Stage of Corona-Related Lockdown: A German and Austrian Population Online Survey.

Background: Particularly during the early and middle stages of the COVID-19 pandemic, a population's compliance with precautionary measures (e.g., hygiene rules, smart working, travel restrictions, and quarantine) is paramount in preventing the virus from spreading. Objective: The investigation and documentation of different socio-demographic and personality-specific factors in regards to preventative measures and consequent specific health behaviors during the COVID-19 pandemic, based on the Health Belief Model. Method: An online survey was conducted on N = 3,006 individuals living in Germany and Austria during the early stages of lockdown. The questionnaire consisted of a self-administered section, exploring the dimensions posited in the Health Belief Model: perceived severity, perceived susceptibility, perceived barriers, perceived benefits of health-promoting measures, and engagement in health-promoting behaviors. Additionally, the following standardized scales were used to record personality determinants: the Stress Coping Style Questionnaire SVF 78 to evaluate coping and processing strategies in stressful circumstances, the Positive and Negative Affect Schedule (PANAS) to assess the emotional state induced by the coronavirus crisis, the UI-18 scale to diagnose the intolerance of uncertainty, and the State-Trait Anxiety Inventory (STAI) to assess anxiety. Results: In line with the Health Belief model, four groups were created based on perceived susceptibility and engagement in health-promoting behaviors, and consequently studied in relation to personality determinants. Those four groups differed significantly in regards to almost all personality dimensions (p ≤ 0.005). Group 1 (n = 450) shows a reduced engagement with protective measures and displays underestimation of the COVID-19-pandemic. Group 2 (n = 984) displays many positive personality variables and high compliance with protective measures. Group 3 (n = 468) perceives the subjective risk of disease as high, but high emotional discomfort and stress caused by the protective measures leads to the activation of a complex fear defense. Group 4 (n = 1,004) is highly anxious and therefore compliant. Conclusion: This typification has implications for establishing the appropriate support systems. This is particularly important to encourage compliance with preventive regulations within the groups, which showed poor abidance for several reasons. For Group 1, further education on the realistic threat and efficient protective measures is as central as the fostering of empathy for others; with its resource-conscious exemplary behavior Group 2 could be used as a positive social role model. Group 3 would benefit from promoting self-care, while Group 4 requires information on psychosocial assistance availability in order to mitigate the high stress to which the group members are subjected.

The Attitudes of Therapists and Physicians on the Use of Sex Robots in Sexual Therapy: Online Survey and Interview Study.

BACKGROUND: Various types of robots have already been successfully used in medical care, and the use of new technologies is also playing an increasing role in the area of sexuality. Sex robots are marketed as advanced sex toys and sex dolls with artificial intelligence. Only a few considerations about the therapeutic use of sex robots in sexual therapy are debated in expert discussions. OBJECTIVE: The aim of this study was to conduct a first exploratory survey on the attitudes of sex therapists and physicians toward the therapeutic benefits of sex robots. METHODS: This study comprised a quantitative online survey and a qualitative interview study. A self-constructed questionnaire was used to survey the general attitudes of sex therapists and physicians regarding the benefits of sex robots in therapy. The qualitative study was designed to gain in-depth insight into the participants' beliefs and attitudes. Therefore, semistructured interviews were conducted. The quantitative data were evaluated by statistical analysis, and the interviews were transcribed and analyzed by using a grounded theory approach. RESULTS: A total of 72 sex therapists and physicians completed our self-constructed questionnaire (response rate 15%, 72/480). Only a few respondents (11%, 8/72) said that the use of sex robots was not conceivable for them, and almost half of all therapists and physicians could imagine recommending sex robots in therapy (45%, 33/72). The attitude toward sex robots as a therapeutic tool was very heterogeneous, with gender (P=.006), age (P=.03), and occupational differences (P=.05); female therapists, older therapists, and psychologists (in contrast to physicians) were more critical toward the therapeutic use of sex robots. The analysis of the 5 interviews identified 3 high-level core themes that were representative of the participants' responses: (1) the importance of the personal definition of sex robots for the assessment of their therapeutic benefits, (2) therapeutic benefits and dangers of sex robots, and (3) considerations on the quality of human-robot sexuality. Initial insights into the possible therapeutic use of sex robots in different disorders (eg, sexual dysfunction or pedophilia) and situations were gained from the perspective of sex therapists. CONCLUSIONS: The results of this study provide a first overview of the potential therapeutic use of sex robots. Moral, ethical, and treatment-related issues in this context are still unresolved and need to be further researched. We suggest integrating the topic into the training of sex therapists to form opinions beyond media images and to show therapy possibilities. Scientists engaged in sexual research should be involved in the development of sex robots to design robots with positive effects on sexual education, sexual therapy, sexual counseling, and sexual well-being for interested groups.

Validation of two accelerated 4D flow MRI sequences at 3 T: a phantom study.

BACKGROUND: Four-dimensional (4D) flow magnetic resonance imaging (MRI) sequences with advanced parallel imaging have the potential to reduce scan time with equivalent image quality and accuracy compared with standard two-dimensional (2D) flow MRI. We compared 4D flow to standard 2D flow sequences using a constant and pulsatile flow phantom at 3 T. METHODS: Two accelerated 4D flow sequences (GRAPPA2 and k-t-GRAPPA5) were evaluated regarding the concordance of flow volumes, flow velocities, and reproducibility as well as dependency on measuring plane and velocity encoding (Venc). The calculated flow volumes and peak velocities of the phantom were used as reference standard. Flow analysis was performed using the custom-made software "Bloodline". RESULTS: No significant differences in flow volume were found between the 2D, both 4D flow MRI sequences, and the pump reference (p = 0.994) or flow velocities (p = 0.998) in continuous and pulsatile flow. An excellent correlation (R = 0.99-1.0) with a reference standard and excellent reproducibility of measurements (R = 0.99) was achieved for all sequences. A Venc overestimated by up to two times had no impact on flow measurements. However, misaligned measuring planes led to an increasing underestimation of flow volume and mean velocity in 2D flow accuracy, while both 4D flow measurements were not affected. Scan time was significantly shorter for k-t-GRAPPA5 (1:54 ± 0:01 min, mean ± standard deviation) compared to GRAPPA2 (3:56 ± 0:02 min) (p = 0.002). CONCLUSIONS: Both 4D flow sequences demonstrated equal agreement with 2D flow measurements, without impact of Venc overestimation and plane misalignment. The highly accelerated k-t-GRAPPA5 sequence yielded results similar to those of GRAPPA2.