Moderators of short- and long-term outcomes in panic control treatment and panic-focused psychodynamic psychotherapy.

OBJECTIVE: The objective was to test the hypothesis that externalizing and internalizing helpfulness beliefs and learning styles at baseline moderate panic severity and overall mental illness as short-term and long-term outcomes of two panic-focused psychotherapies, Panic Control Treatment (PCT) and Panic-Focused Psychodynamic Psychotherapy (PFPP). METHOD: Participants were 108 adults with DSM-IV Panic Disorder with or without Agoraphobia (PD/A) who were randomized to treatment in a trial of PCT and PFPP. Piece-wise/segmented multilevel modeling was used to test three-way interactions (Treatments × Moderator × Time), with participants and therapists as random factors. Outcome variables were clinician-rated panic severity and self-rated mental illness post-treatment and during follow-up. RESULTS: Patients' externalizing (but not internalizing) helpfulness beliefs moderated mental illness outcomes during follow-up (but not during treatment); low levels of Externalization were facilitative for PFPP but not PCT. Internalizing and externalizing helpfulness beliefs and learning style did not moderate clinician-rated panic severity, whether short- or long-term. CONCLUSIONS: These results suggest that helpfulness beliefs and learning style have limited use in assignment to either PCT or PFPP for PD/A. Although further research is needed, low levels of helpfulness beliefs about externalizing coping may play a role in mental illness outcomes for PFPP.

"I'm fighting with BPD instead of my partner": A dyadic interpretative phenomenological analysis of the lived experience of couples navigating borderline personality disorder.

Borderline personality disorder (BPD) is associated with romantic relationship distress and dissolution. The complex interaction between BPD and romantic relationships warrants further attention. Dyadic interviews (N = 10) were conducted to examine the experience and impact of BPD on couples' relationships. The results of interpretative phenomenological analysis consisted of two superordinate themes describing the couple experience of navigating BPD: (a) the shared experience of BPD as a relational stressor; and (b) adaptive dyadic coping in the context of BPD. Although BPD was experienced as a relational stressor, dyadic coping and shared externalization of BPD emerged as central components to adaptive couple functioning. Most couples reported that therapy was a critical external resource in their journey toward adaptively functioning in the context of BPD, both intrapersonally and interpersonally. The lived experiences of these couples provides therapists with an increased understanding of the resources that support adaptive dyadic coping with BPD.

Sound externalization in dynamic binaural listening: A comparative behavioral and EEG study.

Binaural reproduction aims at recreating a realistic sound scene at the ears of the listener using headphones. Unfortunately, externalization for frontal and rear sources is often poor (virtual sources are perceived inside the head, instead of outside the head). Nevertheless, previous studies have shown that large head-tracked movements could substantially improve externalization and that this improvement persisted once the subject had stopped moving his/her head. The present study investigates the relation between externalization and evoked response potentials (ERPs) by performing behavioral and EEG measurements in the same experimental conditions. Different degrees of externalization were achieved by preceding measurements with 1) head-tracked movements, 2) untracked head movements, and 3) no head movement. Results showed that performing a head movement, whether the head tracking was active or not, increased the amplitude of ERP components after 100 ms, which suggests that preceding head movements alters the auditory processing. Moreover, untracked head movements gave a stronger amplitude on the N1 component, which might be a marker of a consistency break in regards to the real world. While externalization scores were higher after head-tracked movements in the behavioral experiment, no marker of externalization could be found in the EEG results.

Does Temporary Externalization of Electrodes After Deep Brain Stimulation Surgery Result in a Higher Risk of Infection?

OBJECTIVES: Deep brain stimulation (DBS) is a well-established surgical therapy for movement disorders that comprises implantation of stimulation electrodes and a pacemaker. These procedures can be performed separately, leaving the possibility of externalizing the electrodes for local field potential recording or testing multiple targets for therapeutic efficacy. It is still debated whether the temporary externalization of DBS electrodes leads to an increased risk of infection. We therefore aimed to assess the risk of infection during and after lead externalization in DBS surgery. MATERIALS AND METHODS: In this retrospective study, we analyzed a consecutive series of 624 DBS surgeries, including 266 instances with temporary externalization of DBS electrodes for a mean of 6.1 days. Patients were available for follow-up of at least one year, except in 15 instances. In 14 patients with negative test stimulation, electrodes were removed. All kinds of infections related to implantation of the neurostimulation system were accounted for. RESULTS: Overall, infections occurred in 22 of 624 surgeries (3.5%). Without externalization of electrodes, infections were noted after 7 of 358 surgeries (2.0%), whereas with externalization, 15 of 252 infections were found (6.0%). This difference was significant (p = 0.01), but it did not reach statistical significance when comparing groups within different diagnoses. The rate of infection with externalized electrodes was highest in psychiatric disorders (9.1%), followed by Parkinson's disease (7.3%), pain (5.7%), and dystonia (5.5%). The duration of the externalization of the DBS electrodes was comparable in patients who developed an infection (6.1 ± 3.1 days) with duration in those who did not (6.0 ± 3.5 days). CONCLUSIONS: Although infection rates were relatively low in our study, there was a slightly higher infection rate when DBS electrodes were externalized. On the basis of our results, the indication for electrode externalization should be carefully considered, and patients should be informed about the possibility of a higher infection risk when externalization of DBS electrodes is planned.

Externalization of an infected vagus nerve stimulator generator without a break in anti-seizure therapy: a technical note.

INTRODUCTION: Vagus nerve stimulation (VNS) is a widely used treatment for drug-resistant epilepsy. An infection of the VNS generator pocket occurs in 3-8% of cases. Current standard of care requires the removal of the device, antibiotic therapy, and then replacement of the device. The consequential break in VNS therapy leaves patients highly susceptible to seizures. METHODS: Retrospective case report. RESULTS: The externalized generator continued to provide electroceutical coverage of the patient's seizures while the pocket was sterilized with IV antibiotics as well as betadine and local antibiotics. The externalized generator was kept safe against the patient's chest with ioban and an entriely new system was implanted on post-externalization day 5. The patient is now 7 months post-operative and without any evidence of infection. CONCLUSIONS: We report successful management of an infected VNS generator with externalization and short interval replacement of the entire system without any break in anti-seizure therapy.

[Placenta percreta management in a patient with a severe congenital hypofibrinogenemia]. / Gestion d'un placenta percreta chez une patiente atteinte d'une hypofibrinogénémie congénitale sévère.

The obstetrical follow-up of patients with a severe hypofibrinogenemia requires a multidisciplinary collaboration because of potential maternal-fetal complications (recurrent miscarriages, intrauterine fetal demise, post-partum hemorrhage, thrombosis). We report the obstetrical management of a multiparous patient with a severe congenital hypofibrinogenemia associated with a platelet disorder (abnormal phospholipid externalization). A therapeutic strategy based on a biweekly administration of fibrinogen concentrates associated with enoxaparin and aspirin allowed the maintenance of pregnancy. But this last one got complicated by a placenta percreta requiring a salvage hysterectomy with an appropriate hemorrhage prophylaxis.

Percutaneous Superficial Temporal Artery Access Facilitating Carotid Artery Stenting Performed From Distal Radial Artery.

PURPOSE: The purpose of the study is to describe carotid artery stenting (CAS) via distal transradial access (dTRA) facilitated by additional superficial temporal artery (STA) access, in a patient with complex aortic arch vessel anatomy. TECHNIQUE: A 72-year-old woman with a prior history of complex cervical surgery and radiotherapy due to laryngeal malignancy, presented with a symptomatic 90% stenosis of the left internal carotid artery (ICA). Due to high cervical lesion, the patient was rejected from carotid endarterectomy. Angiography demonstrated 90% stenosis of the left ICA and a type III aortic arch. After failure of left common carotid artery (CCA) cannulation with appropriate catheter support via dTRA and transfemoral approaches, CAS was attempted a second time. After percutaneous ultrasound guided access to right dTRA and left STA, a 0.035 inch guidewire introduced to the left CCA from the contralateral dTRA was snared and externalized via left STA to improve wire support for guiding advancement. Thereafter, the left ICA lesion was successfully stented with a 7×30 mm self-expanding stent via right dTRA. All vessels involved were patent at 6-month follow-up. CONCLUSION: The STA may be a promising adjunctive access site to increase transradial catheter support for CAS or neurointerventional procedures in the anterior circulation. CLINICAL IMPACT: Transradial cerebrovascular interventions have been gaining popularity, however, unstable catheter access to distal cerebrovascular structures limits its widespread use. Guidewire externalization technique via additional STA access may improve transradial catheter stabilty and increase procedural success with possibly low access stie complication rate.

Age-Related Variations of Genetic and Environmental Contributions to the Covariation of Fear, Distress and Externalizing Symptoms: A Twin Study in Childhood and Adolescence.

The frequency with which Internalizing and Externalizing symptoms co-occur suggests that, behind both domains, there may be a common susceptibility represented by a general psychopathology factor. However, it's still unclear whether this common susceptibility is affected by age-related variations. Internalizing (i.e., Fear and Distress) and Externalizing symptoms were evaluated in 803 twin pairs from the population-based Italian Twin Registry. Model-fitting analysis was performed separately in the 6-14 and 15-18 age groups to estimate genetic and environmental contributions to the covariance among symptoms. For the 6-14 group, a multivariate Cholesky model best fitted the data, while, for the 15-18 group, the best fit was provided by a Common Pathway model in which nearly 50% of total variance of each trait was mediated by common genetic factors. Our findings support a common susceptibility behind Internalizing and Externalizing symptoms, mainly genetic in origin, that becomes more evident at the beginning of puberty.

Spontaneous externalization of a ventriculoperitoneal shunt tip through the navel.

The authors describe spontaneous externalization of a ventriculo-peritoneal shunt through the navel.

Facilitated trailing haptic externalization technique for intrascleral intraocular lens fixation.

PURPOSE: To describe the facilitated trailing haptic externalization technique for intrascleral intraocular lens (IOL) fixation. METHODS: In this technique, first the direction of the 4-5 mm tip of the trailing haptic is straightened with the help of forceps. After the second needle enters the posterior chamber, the edge of the IOL optic is pushed towards the opposite scleral tunnel with the needle. The trailing haptic approaching the center from the periphery and the straightened distal part of the haptic towards the direction of the needle facilitate the relatively easily and gently placing of the haptic into the lumen with a one-time use of forceps. RESULTS: This technique was performed on 65 eyes of 58 patients, with a mean patient age of 53.0 ± 14.6 years (range, 22-78). No complications such as endothelial touch, vitreous loss, iris or ciliary body damage, and hyphema were encountered during surgery. The mean operation duration was 14.8 ± 2.3 min (range, 12-20). In the postoperative period, there was only mild postoperative anterior chamber reaction in all eyes. Postoperative transient intraocular pressure (IOP) elevation that responded well to topical antiglucomatous therapy was observed in only two cases (3%). No patient developed haptic exposure, IOL dislocation, iris capture, postoperative hypotony, vitreous hemorrhage, choroidal effusion, cystoid macular edema, or retinal detachment. CONCLUSION: The facilitated trailing haptic externalization technique provides a safer, simpler, and minimally invasive surgery without significant complications while easing the surgical difficulties of the Yamane technique.

Mobilizing phospholipids on tumor plasma membrane implicates phosphatidylserine externalization blockade for cancer immunotherapy.

In "healthy" tumor cells, phosphatidylserine (PS) is predominately localized in the inner plasma membrane leaflet. During apoptosis, PS relocates to the outer leaflet. Herein, we established PSout tumor models with tumor cells lacking PS flippase component CDC50A, constantly exposing PS but alive. PSout tumors developed bigger than wild-type (WT) tumors, featuring M2 polarized tumor-associated macrophages (TAMs) and fewer tumor-antigen-specific T cells. The PS receptor TIM-3 is responsible for PS recognition. Employing an opposite tumor model, PSin, with tumor cells lacking the PS scramblase Xkr8 and unable to expose PS during otherwise normal apoptosis, we find that the accumulated apoptotic tumor cells produce and release cyclic GAMP (cGAMP) to immune cells to activate the STING pathway, leading to TAM M1 polarization, suppressed interleukin (IL)-10 secretion, and natural killer (NK) cell cytotoxicity. Silencing Xkr8 in vivo by either short hairpin RNA (shRNA) or small interfering RNA (siRNA) to achieve a PS externalization blockade provides robust therapeutic anti-tumor efficiency.

Phosphatidylserine exposure modulates adhesion GPCR BAI1 (ADGRB1) signaling activity.

Brain-specific angiogenesis inhibitor 1 (BAI1; also called ADGRB1 or B1) is an adhesion G protein-coupled receptor known from studies on macrophages to bind to phosphatidylserine (PS) on apoptotic cells via its N-terminal thrombospondin repeats. A separate body of work has shown that B1 regulates postsynaptic function and dendritic spine morphology via signaling pathways involving Rac and Rho. However, it is unknown if PS binding by B1 has any effect on the receptor's signaling activity. To shed light on this subject, we studied G protein-dependent signaling by B1 in the absence and presence of coexpression with the PS flippase ATP11A in human embryonic kidney 293T cells. ATP11A expression reduced the amount of PS exposed extracellularly and also strikingly reduced the signaling activity of coexpressed full-length B1 but not a truncated version of the receptor lacking the thrombospondin repeats. Further experiments with an inactive mutant of ATP11A showed that the PS flippase function of ATP11A was required for modulation of B1 signaling. In coimmunoprecipitation experiments, we made the surprising finding that ATP11A not only modulates B1 signaling but also forms complexes with B1. Parallel studies in which PS in the outer leaflet was reduced by an independent method, deletion of the gene encoding the endogenous lipid scramblase anoctamin 6 (ANO6), revealed that this manipulation also markedly reduced B1 signaling. These findings demonstrate that B1 signaling is modulated by PS exposure and suggest a model in which B1 serves as a PS sensor at synapses and in other cellular contexts.

Problem type and externalization in problem-solving.

We compared problem-solving in four sets of classical insight and analytic problems in the verbal and spatial domains, and examined the impact of externalization (verbalization or sketching). In a within-participants factorial design, we presented 24 classical insight and analytic problems, half verbal and half spatial. Participants solved these problems either while thinking aloud, while sketching, or in a baseline condition where neither was allowed. Higher solving accuracy was found in the analytic problems than in the insight ones as well as in the verbal problems than in the spatial ones. The verbal problems were also found to be solved faster than were spatial ones; in particular, verbal-insight problems were solved faster than spatial-insight and verbal-analytic ones. Therefore, spatial-insight problems stand out as particularly hard among the ones typically found in the literature. Surprisingly, no effects of externalization were found on problem-solving speed or accuracy. We discuss the implications of our results for the theses that insight problems involve special processes.

Apoptotic Features in Non-Apoptotic Processes.

Apoptosis is the most thoroughly studied type of regulated cell death. Certain events, such as externalization of phosphatidylserine (PS) into the outer leaflet of plasma membrane, mitochondrial outer membrane permeabilization, caspase cascade activation, DNA fragmentation and blebbing, are widely considered to be hallmarks of apoptosis as well as being traditionally viewed as irreversible. This review shows that under particular circumstances these events can also participate in physiological processes not associated with initiation of apoptosis, such as cell differentiation, division, and motility, as well as non-apoptotic types of cell death. Moreover, these events may often be reversible. This review focuses on three processes: phosphatidylserine externalization, blebbing, and activation of apoptotic caspases. Mitochondrial outer membrane permeabilization and DNA fragmentation are not discussed.

MACS-annexin V cell sorting of semen samples with high TUNEL values decreases the concentration of cells with abnormal chromosomal content: a pilot study.

We question whether, in men with an abnormal rate of sperm DNA fragmentation, the magnetic-activated cell sorting (MACS) could select spermatozoa with lower rates of DNA fragmentation as well as spermatozoa with unbalanced chromosome content. Cryopreserved spermatozoa from six males were separated into nonapoptotic and apoptotic populations. We determined the percentages of spermatozoa with (i) externalization of phosphatidylserine (EPS) by annexin V-Fluorescein isothiocyanate (FITC) labeling, (ii) DNA fragmentation by TdT-mediated-dUTP nick-end labeling (TUNEL), and (iii) numerical abnormalities for chromosomes X, Y, 13, 18, and 21 by fluorescence in situ hybridization (FISH), on the whole ejaculate and selected spermatozoa in the same patient. Compared to the nonapoptotic fraction, the apoptotic fraction statistically showed a higher number of spermatozoa with EPS, with DNA fragmentation, and with numerical chromosomal abnormalities. Compared to the whole ejaculate, we found a significant decrease in the percentage of spermatozoa with EPS and decrease tendencies of the DNA fragmentation rate and the sum of disomy levels in the nonapoptotic fraction. Conversely, we observed statistically significant higher rates of these three parameters in the apoptotic fraction. MACS may help to select spermatozoa with lower rates of DNA fragmentation and unbalanced chromosome content in men with abnormal rates of sperm DNA fragmentation.

Do metacognitions mediate the path from reading deficits to internalization and externalization behaviours in Pakistani adolescents?

The present research examines the mediating role of metacognition in the relationship between RD and internalization and externalization in a normative sample of Pakistani adolescents. The participants were 210 adolescents ranging from 11 to 17 years. The data were collected using a Metacognitions index of the Behavioral Rating Inventory and two internalization and externalization indexes of the Personality Inventory for Children. A series of regression analyses were conducted to examine metacognition's mediating role in the relationship between reading deficits and internalization and externalization. The findings illustrate that meta-cognition significantly mediated the relationship between reading deficits and internalization and externalization in adolescents. The current findings have implications for clinicians, school psychologists, and policymakers for the early identification and intervention of reading deficits to reduce and manage the occurrence of adolescents' internalization and externalization behaviors.

Blame Attributions Against Heterosexual Male Victims of Sexual Coercion: Effects of Gender, Social Influence, and Perceptions of Distress.

If heterosexual male victims had been more active in the #MeToo movement, how might they have been judged? Although the #MeToo movement has been regarded as an historic milestone for women who were victimized by men in positions of power, participation in the movement by male victims has been noticeably absent. Research indicates that victims may avoid disclosure if they anticipate negative social reactions, and male victims may attract greater levels of victim blaming than female victims, particularly if their perpetrator was female. The current study investigated attributions of victim blame against a fictional heterosexual male in a between-subjects vignette design. Perpetrator gender and their social influence were manipulated in a sample of 208 college students. Results did not support the hypothesized main effects of perpetrator gender or social influence. Greater blame attributions were made against victims of a male perpetrator compared to one of an unspecified gender. Male participants attributed greater blame than females, and the relationship between shame proneness and blame was moderated by participant gender, males experiencing higher levels of shame engaged in less victim blame. Blame increased when participants believed the court case to be more distressing than the victimizing act. Results support the male rape myth framework, which posits that beliefs about a male victim's experience of his own violation, particularly whether he experienced distress or pleasure, are related to gendered norms of masculinity, which include normative traits of toughness, dominance, and high sexual performance. Implications on the role of gender as a barrier to disclosure by male victims are discussed.

Riata lead failure manifests as electrical storm with lead parameters showing unique postural variations: a case report.

BACKGROUND: Riata implantable cardioverter-defibrillator (ICD) leads are prone to a unique type of mechanical lead failure causing conductor externalization (CE) which may be complicated by a delayed-onset electrical lead failure (ELF). CASE SUMMARY: A 60-year-old male with symptomatic, severe ischaemic cardiomyopathy, and atrial fibrillation following a prior anterior wall myocardial infarction received a dual-chamber ICD with 7F-RiataST ventricular lead as a primary prevention strategy against sudden cardiac death in 2008. In 2017, a pulse generator replacement was performed for elective replacement indicator status. At that time, CE was noted in the ventricular lead but the electrical lead parameters were normal, hence lead replacement was decided against and the patient was closely followed up thereafter. Four years later, the patient presented with multiple ICD shocks within 48 h. Implantable cardioverter-defibrillator interrogation showed noise on the ventricular electrogram (EGM) channel that was detected as ventricular fibrillation (VF) episodes, triggering inappropriate ICD therapy (five ICD detected VF events within 24 h triggering three antitachycardia pacing therapies and one shock). Lead impedance and R-wave amplitude were within normal range in supine position but dramatically worsened in sitting posture. A new ventricular lead was implanted and the old lead abandoned. The patient has not experienced any device therapy in the follow-up period. DISCUSSION: An electrically inert CE of Riata ICD leads needs close follow-up because an ELF may occur even after several years. A careful analysis of EGMs including postural changes in lead parameters can aid in detection and better characterization of underlying electrical dysfunction following CE.