Frontal alpha asymmetry is associated with chronic stress and depression, but not with somatoform disorders.

Cardinal characteristics of somatoform disorders (SFDs) are worry of illness, and impaired affective processing. We used relative frontal alpha asymmetry (FAA), a method to measure functional lateralization of affective processing, to investigate psychobiological correlates of SFDs. With alpha activity being inversely related to cortical network activity, relative FAA refers to alpha activity on the right frontal lobe minus alpha activity on the left frontal lobe. Less relative left frontal activity, reflected by negative FAA scores, is associated with lower positive and greater negative affectivity, such as observed in depression. Due to its negative affective component (illness anxiety), we expected to find less relative left frontal activity pattern in SFDs, and positive associations with self-reported chronic stress and depression symptoms. We recorded resting-state EEG activity with 64 electrodes, placed in a 10-10 system in 26 patients with a primary SFD, 23 patients with a major depressive disorder and 25 healthy control participants. The groups did not differ in FAA. Nevertheless, across all participants, less relative left frontal activity was associated with chronic stress and depression symptoms. We concluded that FAA may not serve as an indicator of SFDs. As the relationship of FAA and depressive symptoms was fully mediated by chronic stress, future studies have to clarify whether the association between FAA and chronic stress may represent a shared underlying factor for the manifestation of mental health complaints, such as depression.

Games, hormones, and "dark" personalities: Dark tetrad and the effects of violent gaming on aggression, cortisol, and testosterone.

We investigated how playing a violent versus non-violent video game affects cortisol and testosterone levels, whether these hormonal changes increase implicit aggressive cognition, and whether so-called Dark Tetrad personality traits (i.e., Machiavellianism, psychopathy, narcissism, everyday sadism) moderate these effects. Fifty-four men played either a violent or a non-violent video game for 25 min. Participants provided salivary samples at the beginning of the experiment (T1), after 25 min of gameplay (T2), and 20 min after gameplay ended (T3). In the violent condition, participants showed a significant decrease in cortisol levels (T1 to T2) and a significant negative trend in cortisol levels from T1 to T3. Moreover, higher Machiavellianism scores were related to a significantly stronger decrease in cortisol (T1 to T2) in this condition. In the non-violent condition, however, participants with higher scores in Machiavellianism had a higher increase in cortisol (T1 to T2). In contrast to changes in hormonal levels, there were no significant effects on implicit aggressive cognition. The present findings illustrate the complex interplay between personality, hormones, and game content, thus further specifying current notions on the effects of violent video games. Playing a violent video game can have a stress-reducing calming effect depending on personality traits such as Machiavellianism and the psychological need satisfaction associated with it. Also, the fact that VVG exposure was not automatically accompanied by an aggression-increasing effect proves that simple cause-effect models are not sufficiently specified without taking the underlying mechanisms into account.

Development and initial validation of a self-report measure to assess eating disorder-specific interoceptive perception.

Interoceptive deficits-particularly with respect to the perception of emotions, hunger, and satiety-constitute important targets for intervention in eating disorders (EDs). Suitable self-report measures to identify these deficits, however, are lacking. We, therefore, developed and validated a multidimensional questionnaire to assess eating disorder-specific interoceptive perception (EDIP) in terms of the ability to perceive and discriminate between emotions, hunger, and satiety. In two independent samples with a total of 2058 individuals (22.74% with self-reported EDs), exploratory and confirmatory factor analyses revealed a four-factor solution of the EDIP Questionnaire (EDIP-Q) with the subscales Emotions, Hunger, Satiety, and Discrimination. The EDIP-Q has sound psychometric properties and was related to convergent questionnaires but unrelated to divergent self-report measures, supporting its construct validity. Participants with self-reported EDs had significantly lower EDIP-Q scores compared to participants without self-reported ED diagnosis. While individuals with self-reported anorexia nervosa (AN), bulimia nervosa (BN), and binge-eating disorder (BED) report similar difficulties in perceiving emotions, participants with BN and BED report greater difficulties in perceiving satiety and differentiating between hunger and emotional states compared to participants with AN. In contrast, individuals with AN report higher sensibility to satiety but lower sensibility to hunger compared to individuals with BN and BED. The EDIP-Q is a valuable clinical tool to establish profiles of deficits in EDIP that provide the basis for developing more targeted treatment approaches for EDs. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The relationship between self-reported chronic stress, physiological stress axis dysregulation and medically-unexplained symptoms.

The positive feedback model of medically-unexplained symptoms posits that chronic stress affects the activity of the physiological stress axes, which in turn generates medically-unexplained symptoms. As a first step to empirically test its model assumptions, we investigated potential associations between chronic stress, physiological stress axis activity and medically-unexplained in a cross-sectional study. One hundred-ninety-nine healthy individuals provided self-reports on chronic stress and medically-unexplained symptoms, resting heart rate/variability (HR/HRV; e.g., root mean square of successive differences/RMSSD, low frequency/LF power), cortisol awakening response (CAR) and diurnal cortisol. Significant positive contributors to medically-unexplained symptoms were the chronic stress scales 'lack of social appreciation' and 'chronic worries', as well as CAR and LF HRV; diurnal cortisol was a negative contributor. Mediation analyses showed that the impact of neural indicators associated with physiological stress axis activity (HR/HRV) related to medically-unexplained symptoms, which was mediated by chronic stress, whereas the mediation effect as suggested by the positive feedback model was not significant. These cross-sectional findings do not support the positive feedback model. Longitudinal studies are required to conclude about potential mechanistic and causal relationships in the model. Nevertheless, our mediation analyses give first indication that the constitution of physiological stress axes may play a major role in how stressors are perceived and which kind of health-consequences (e.g., medically-unexplained symptoms) this may have.

Reduced concentration performance and heartbeat-evoked potential in individuals with a history of a SARS-CoV-2 infection.

The goal of characterizing long-term psychological and neural consequences of a SARS-CoV-2 infection has recently gained importance. Here, we examined the effect of a prior SARS-CoV-2 infection on neural markers of exteroceptive (P300) and interoceptive (heartbeat-evoked potential; HEP) signal processing, as well as on neuropsychological tests of attention, inhibition and episodic memory, in 23 adults with a self-reported history of SARS-CoV-2 infection versus 23 healthy controls. We found that the group with a prior infection showed decreased HEP (but not P300) amplitudes, as well as reduced attention/concentration performance. These results suggest that SARS-CoV-2 may damage neural structures of cardiac interoception, thereby potentially contributing to cognitive and psychological long-term deficits. Modulations of interoceptive processing after a SARS-CoV-2 infection are thus a promising target for future research.

Lower gastric sensitivity in quiescent inflammatory bowel disease than in irritable bowel syndrome.

OBJECTIVE: Visceral hypersensitivity is considered a key symptom in inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS), both of which seriously affect health-related quality of life (HrQoL). Previous findings are mostly based on invasive procedures that may interfere with the assessment of visceral perception. The current study, therefore, investigates whether IBD and IBS are characterized by altered perception of 'natural' gastric distensions ('interoception'). METHODS: Twenty IBD patients in remission (13 Crohn's disease, 7 ulcerative colitis), 12 IBS patients, and 20/12 matched healthy control (HC) individuals, respectively, underwent the water load test, in which they could drink ad libitum until the subjective thresholds of satiation (stage 1) and fullness (stage 2) were reached. Gastric motility was assessed using electrogastrography. RESULTS: IBD patients drank significantly more water until satiation than IBS patients, whereas no differences between patients and HC groups were observed. Electrogastrographic patterns were comparable between groups, suggesting no pathologies in gastric motility in IBD or IBS. The amount of water consumed until satiation negatively correlated with HrQoL related to bowel symptoms in IBD patients, but was positively associated with emotional well-being in IBS patients. CONCLUSION: Our findings implicate relative gastric hypersensitivity in IBS, and relative hyposensitivity in IBD patients, which are both related to specific HrQoL aspects.

Safety and performance assessment of hyaluronic acid-based vitreous substitutes in patients with phthisis bulbi.

PURPOSE: To assess the safety and performance of hyaluronic acid-based vitreous substitutes in phthitic eyes. METHODS: In this retrospective interventional study a total of 21 eyes from 21 patients with phthisis bulbi were treated at the Eye Clinic Sulzbach between August 2011 and June 2021. Patients who underwent a 23G pars plana vitrectomy received a vitreous substitute composed of (I) a non-crosslinked hyaluronic acid (Healon GV), (II) a crosslinked hyaluronic acid-based hydrogel (UVHA), or (III) silicone oil (SO-5000). Main outcome measures were the intraocular pressure (IOP), the visual acuity and the structural integrity of the retina and choroid assessed by optical coherence tomography. RESULTS: An increase in IOP ≥ 5 mmHg was achieved with SO-5000 in 5/8 eyes (6/10 interventions, 60.0%) for 36.4 ± 39.5 days, with Healon GV in 4/8 eyes (7/11 interventions, 63.6%) for 82.6 ± 92.5 days and with UVHA in 4/5 eyes (5/6 interventions, 83.3%) for 93.6 ± 92.5 days. Visual acuity increased in 5/21 eyes (23.8%), remained constant in 12/21 eyes (57.1%) and decreased in 4/21 eyes (19.0%). No enucleations were required during the mean follow-up time of 192 ± 182 days. The OCT images indicated the preservation of retinal structures, while choroidal folds were only diminished in UVHA eyes. CONCLUSIONS: Hyaluronic acid-based hydrogels are biocompatible vitreous substitutes in humans and can increase and stabilize IOP in patients with phthisis bulbi for about 3 months.

A rabbit model for outer retinal atrophy caused by surgical RPE removal.

PURPOSE: We aimed to establish a rabbit model with retinal atrophy induced by an iatrogenic retinal pigment epithelium (RPE) removal, for future testing of the efficacy and safety of cell therapy strategies. METHODS: A localized detachment of the retina from the RPE/choroid layer was created in 18 pigmented rabbits. The RPE was removed by scraping with a custom-made extendable loop instrument. The resulting RPE wound was observed over a time course of 12 weeks with optical coherence tomography and angiography. After 4 days (group 1) and 12 weeks (group 2), histology was done and staining with hematoxylin and eosin, as well as immunofluorescence performed to further investigate the effects of debridement on the RPE and the overlying retina. RESULTS: Already after 4 days, we observed a closure of the RPE wound by proliferating RPE and microglia/macrophage cells forming a multilayered clump. This pattern continued over the observation time course of 12 weeks, whereby the inner and outer nuclear layer of the retina became atrophic. No neovascularization was observed in the angiograms or histology. The observed changes were limited to the site of the former RPE wound. CONCLUSIONS: Localized surgical RPE removal induced an adjacent progressive retinal atrophy. Altering the natural course of this model may serve as a basis to test RPE cell therapeutics.

The impact of traumatic childhood experiences on interoception: disregarding one's own body.

BACKGROUND: Deficient interoception, the processing and perception of internal bodily signals, has been discussed as a mechanism underlying various mental disorders. First results indicate a mediating role of interoception in the interplay of traumatic childhood experiences and adult mental disorders. Traumatic childhood experiences may hinder the adequate processing, integration, and trust in bodily signals that are important in order to understand and regulate own needs and emotions, thereby increasing the vulnerability for mental disorders. However, an overarching study investigating alterations in different interoceptive measures and trauma-related disorders as well as their mediating role between early trauma and emotion dysregulation is still missing. METHODS: One hundred thirty-six individuals with varying levels of traumatic childhood experiences who either had a current diagnosis of major depression, posttraumatic stress disorder, or somatic symptom disorder, or no mental disorder, took part in a multidimensional assessment of interoceptive processes, including interoceptive accuracy, sensibility, and awareness. Kruskal-Wallis tests were used to compare groups regarding interoceptive processes and associations with traumatic childhood experiences and emotion dysregulation were analyzed with Spearman correlations. Furthermore, mediation analyses were computed to examine and compare interoceptive processes as potential mediators between traumatic childhood experiences and emotion dysregulation. RESULTS: Only body dissociation, a measure for interoceptive sensibility, was significantly reduced in individuals with a current mental disorder. Body dissociation was also the only interoceptive measure significantly associated with traumatic childhood experiences and emotion dysregulation and the only significant mediator in the relationship between traumatic childhood experiences and emotion dysregulation across groups. CONCLUSION: Results suggest body dissociation, but not other interoceptive measures, as an important feature linking traumatic childhood experiences to current emotion dysregulation, an important transdiagnostic feature. As body dissociation refers to a habitual non-attendance or disregard of interoceptive signals, integrative therapeutic interventions could help affected individuals to overcome difficulties in emotion perception and regulation. TRIAL REGISTRATION: The general study design was preregistered; see the German Clinical Trials Register (DRKS-ID: DRKS00015182). This study's analysis plan was not preregistered.

Mothers' and fathers' reflective functioning and its association with parenting behaviors and cortisol reactivity during a conflict interaction with their adolescent children.

We assessed parental reflective functioning (PRF) with the Parent Development Interview-Revised and investigated its association with parenting behaviors, that is, autonomy support and psychological control (operationalized in terms of behaviors promoting and undermining autonomy relatedness), and stress responses (cortisol reactivity) during a parent-child conflict interaction task (Family Interaction Task). Participants were 40 mothers and 28 fathers, who took part in the study together with their adolescent children (N = 49). Mothers had significantly lower PRF and displayed more psychologically controlling behaviors in the interaction with their children than fathers. Rather than sex per se, high levels of PRF were the best predictors of autonomy support, whereas lower levels of PRF predicted more psychological control. Higher levels of PRF were also the best predictor for lower levels of parenting stress. Stress in the context of parenting was neither related to autonomy support nor to psychological control, which were best predicted by divorced family status and, for psychological control only, by parental sex. The findings point to the potential utility of interventions aimed at improving PRF, especially in divorced families, given its protective effect on parenting behaviors and stress in the context of parenting. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Polatuzumab vedotin with infusional chemotherapy for untreated aggressive B-cell non-Hodgkin lymphomas.

The POLARIX trial demonstrated the superiority of polatuzumab vedotin (Pola) over vincristine in the rituximab-cyclophosphamide-doxorubicin-vincristine-prednisone (R-CHOP) regimen for large B-cell lymphomas, but it is unknown whether Pola can be safely incorporated into intensified regimens (eg, dose-adjusted [DA]-EPOCH-R [etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin, and rituximab]) typically used for the highest risk histologies. This was a single-center, open-label, prospective clinical trial of 6 cycles of Pola-DA-EPCH-R (vincristine omitted) in aggressive large B-cell lymphomas. The primary end point was to estimate the safety of Pola-DA-EPCH-R as measured by the rate of dose-limiting toxicities (DLTs) in the first 2 cycles with prespecified suspension rules. Secondary and exploratory end points included efficacy and correlation with circulating tumor DNA (ctDNA) levels. We enrolled 18 patients on study, and with only 3 DLTs observed, the study met its primary end point for safety. There were 5 serious adverse events, including grade 3 febrile neutropenia (3, 17%), grade 3 colonic perforation in the setting of diverticulitis, and grade 5 sepsis/typhlitis. Among 17 evaluable patients, the best overall response rate was 100%, and the complete response rate was 76%. With a median follow-up of 12.9 months, 12-month event-free survival was 72%, and 12-month overall survival was 94%. No patient with undetectable ctDNA at the end of treatment has relapsed to date. Using Pola to replace vincristine in the DA-EPOCH-R regimen met its primary safety end point. These data support the further evaluation and use of this approach in histologies where the potential benefit of both an intensified regimen and Pola may be desired. This trial was registered at www.clinicaltrials.gov as #NCT04231877.

Translation of hyaluronic acid-based vitreous substitutes towards current regulations for medical devices.

PURPOSE: Hydrogel-based vitreous substitutes have the potential to overcome the limitations of current clinically used endotamponades. With the goal of entering clinical trials, the present study aimed to (I) transfer the material synthesis of hyaluronic acid-based hydrogels into a routine, pharmaceutical-appropriate production and (II) evaluate the properties of the vitreous substitutes in terms of the current regulations for medical devices (MDR/ISO standards). METHODS: The multistep manufacturing process of the vitreous substitutes, including the modification of hyaluronic acid with glycidyl methacrylate, photocopolymerization with N-vinylpyrrolidone, and successive hydrogel purification, was developed under laboratory conditions, characterized using 1 H-NMR, FT-IR and UV/Vis spectroscopies and HPLC, and transferred towards a pharmaceutical production environment considering GMP standards. The optical and viscoelastic characteristics of the hyaluronic acid-based hydrogels were compared with those of extracted human vitreous and silicone oil. The effect of the hydrogels on the metabolic activity, proliferation and apoptosis of fibroblast (MRC-5, BJ, L929), retinal pigment epithelial (ARPE-19, hiPSC-derived RPE) and photoreceptor cells (661W) was studied as well as their mucosal tolerance via a HET-CAM assay. RESULTS: Hyaluronic acid-based hydrogels having a suitable purity, sterility, high transparency (>90%), appropriate refractive index (1.3365) and viscoelasticity (G' > G″) were prepared in a standardized manner under controlled process conditions. The metabolic activity, proliferation and apoptosis of various cell types as well as egg choroid were unaffected by the hyaluronic acid-based vitreous substitutes, demonstrating their biocompatibility. CONCLUSIONS: The present study demonstrates the successful transferability of the crucial synthesis steps of hyaluronic acid-based hydrogels into a routine, GMP-compliant production process while achieving the optical and viscoelastic properties, biocompatibility and purity required for their clinical use as vitreous substitutes.

Color-Encoded Links Improve Homophily Perception in Node-Link Diagrams.

Node-link diagrams enable visual assessment of homophily when viewers can identify and evaluate the relative number of intra-cluster and inter-cluster links. Our online experiment shows that a new design with link type encoded edge color leads to more accurate perception of homophily than a design with same-color edges.

Vitreous Substitutes as Drug Release Systems.

Vitreous substitutes are traditionally used to stabilize the retina after vitrectomy. In recent years, various approaches have been developed for using the vitreous substitute not only as a tamponade but also as a drug release system to tackle ocular diseases. This review provides an overview of the requirements for vitreous substitutes and discusses the current clinically applied as well as novel polymer-based vitreous substitutes as drug delivery systems, including their release mechanisms, efficiencies, challenges, and future perspectives.

A Theory-Informed, Personalized mHealth Intervention for Adolescents (Mobile App for Physical Activity): Development and Pilot Study.

BACKGROUND: Evidence suggests that physical activity (PA) during childhood and adolescence is crucial as it usually results in adequate PA levels in adulthood. Given the ubiquitous use of smartphones by adolescents, these devices may offer feasible means to reach young populations and deliver interventions aiming to increase PA participation and decrease sedentary time. To date, very few studies have reported smartphone-based interventions promoting PA for adolescents. In addition, most available fitness apps do not include the latest evidence-based content. OBJECTIVE: This paper described the systematic development of a behavior change, theory-informed Mobile App for Physical Activity intervention with personalized prompts for adolescents aged 16 to 18 years. The within-subject trial results provided the first evidence of the general effectiveness of the intervention based on the outcomes step count, sedentary time, and moderate to vigorous PA (MVPA) minutes. The effectiveness of the intervention component personalized PA prompt was also assessed. METHODS: A 4-week within-subject trial with 18 healthy adolescents aged 16 to 18 years was conducted (mean age 16.33, SD 0.57 years). After the baseline week, the participants used the Mobile App for Physical Activity intervention (Fitbit fitness tracker+app), which included a daily personalized PA prompt delivered via a pop-up notification. A paired 1-tailed t test was performed to assess the effectiveness of the intervention. Change-point analysis was performed to assess the effectiveness of a personalized PA prompt 30 and 60 minutes after prompt delivery. RESULTS: The results showed that the intervention significantly reduced sedentary time in adolescents during the first week of the trial (t17=-1.79; P=.04; bootstrapped P=.02). This trend, although remaining positive, diminished over time. Our findings indicate that the intervention had no effect on metabolic equivalent of task-based MVPA minutes, although the descriptive increase may give reason for further investigation. Although the results suggested no overall change in heart rate-based MVPA minutes, the results from the change-point analyses suggest that the personalized PA prompts significantly increased heart rate per minute during the second week of the study (t16=1.84; P=.04; bootstrapped P=.04). There were no significant increases in participants' overall step count; however, the personalized PA prompts resulted in a marginally significant increase in step counts per minute in the second week of the study (t17=1.35; P=.09; bootstrapped P=.05). CONCLUSIONS: The results of the trial provide preliminary evidence of the benefit of the Mobile App for Physical Activity intervention for modest yet significant reductions in participants' sedentary time and the beneficial role of personalized PA prompts. These results also provide further evidence of the benefits and relative efficacy of personalized activity suggestions for inclusion in smartphone-based PA interventions. This study provides an example of how to guide the development of smartphone-based mobile health PA interventions for adolescents.

Addressing the need for new interoceptive methods.

Internal bodily signals are dynamically coupled to brain dynamics; interoception, the 'sensing' of internal signals, can influence cognition, emotion and perception. An appreciation of the wide-ranging implications of interoceptive processing has surpassed the range and breadth of available interoceptive methods. New techniques are required to support the scientific study of interoception and this special issue brings together a diverse array of novel interoceptive methods and assessments, spanning psychophysiology, experimental psychology, affective neuroscience and computational approaches, divided into 5 core sections. Section 1 presents novel theoretical and computational models of interoception, while section two brings together a range of perspectives on questionnaire measures of interoception. Section 3 is devoted to the development of novel methods to assess interoception in behavioral tasks and section 4 focuses on the validity and confounds present in a range of methods used to assess interoception. Finally, section 5 details new methodological insights of interoception in the domains of emotion, cognition and health. Improved interoceptive methods are needed to progress this field; greater precision in techniques and core interoceptive constructs will aid in the mapping of interoceptive measures to cognition and emotion factors, as well as help to elucidate precise interoceptive alterations observed in clinical conditions.

Comparison of clinical outcomes after precut DMEK with or without dextran-containing medium compared to standard DMEK: a prospective pilot study.

PURPOSE: To investigate the clinical outcome and complication rate of precut Descemet membrane endothelial keratoplasty (DMEK) in two different culture conditions, dextran-containing and dextran-free medium, and compare the results with the current standard DMEK procedure. METHODS: A prospective study of 32 eyes suffering from Fuchs endothelial dystrophy were scheduled for DMEK with a follow-up of one year. The eyes were divided into four subgroups. Group + D (n = 7) received a precut DMEK stored in dextran-containing transport medium, and Group - D (n = 9) received a precut DMEK without dextran-containing medium. The respective fellow eyes received a standard DMEK (S) (preparation directly prior to surgery) stored in dextran-containing medium (S-D + ; n = 7) or without (S-D-; n = 9). RESULTS: Clinical outcome (visual acuity, endothelial cell count, central corneal thickness) and rebubbling rate were comparable for all four groups. None of the patients had a graft failure. CONCLUSION: The preliminary data of the pilot study show that precut liquid-bubble DMEK leads to comparable clinical results regardless of dextran-containing or dextran-free organ culture medium and is further comparable to the standard DMEK procedure.

Disorganized attachment in adolescence: Emotional and physiological dysregulation during the Friends and Family Interview and a conflict interaction.

The current study examined the effects of attachment on autonomy, relatedness, and emotion regulation during an attachment interview (Friends and Family Interview; FFI) and a Parent×Child Conflict interaction (Family Interaction Task; FIT) in 49 adolescents (11 to 17 years old). Disorganized adolescents displayed behaviors promoting autonomy and relatedness less frequently and at a lower extent than organized ones in the FIT with mothers but not with fathers. Disorganized adolescents also showed a steeper decrease in heart rate variability (HRV) than organized ones, during both the FFI and the FITs. Moreover, disorganized adolescents responded with a more marked increase in skin conductance level to the FIT with mothers than organized individuals. Dismissing adolescents showed behaviors promoting autonomy and relatedness less frequently and to a lesser extent than secure ones, while displaying more often behaviors undermining autonomy and relatedness in the FITs. Dismissing adolescents also showed a more pronounced decrease in HRV during the FFI than secure and preoccupied individuals; no differences were found between these groups in HRV during the FITs. The results suggest that disorganized adolescents had more difficulties in regulating their emotions during both the FFI and the FITs, whereas dismissing individuals seemed effectively challenged only during the interview.