In vivo confocal microscopy findings after Descemet stripping only with and without topical ripasudil supplementation in Fuchs endothelial dystrophy.

Objective: To report corneal epithelial and corneal endothelial cell (CEC) changes following Descemet stripping only (DSO) with and without topical ripasudil using in vivo confocal microscopy (IVCM).

Methods: Prospective interventional case series of patients who underwent DSO for Fuchs endothelial dystrophy with or without postoperative topical ripasudil (4%, 6 times per day). Patients underwent IVCM (ConfoScan 3; NIDEK Technologies, Padova, Italy) at baseline, monthly until corneal clearance, and then every 6 months.

Teaching old presumptive tests new digital tricks with computer vision for forensic applications.

Presumptive (or 'spot') tests have served forensic scientists, law enforcement, and legal practitioners for over a hundred years. Yet, the intended design of such tests, enabling quick identification of drugs by-eye, also hides their full potential. Here, we report the development and application of time-resolved imaging methods of reactions attending spot tests for amphetamines, barbiturates, and benzodiazepines.

Listen to Your Gut: Key Concepts for Bioengineering Advanced Models of the Intestine.

The intestine performs functions central to human health by breaking down food and absorbing nutrients while maintaining a selective barrier against the intestinal microbiome. Key to this barrier function are the combined efforts of lumen-lining specialized intestinal epithelial cells, and the supportive underlying immune cell-rich stromal tissue. The discovery that the intestinal epithelium can be reproduced in vitro as intestinal organoids introduced a new way to understand intestinal development, homeostasis, and disease.

Outcomes of XEN Stent in Patients With Glaucoma and Previous Corneal Transplantation.

Prcis: The XEN stent safely and effectively controls intraocular pressure in select patients with history of corneal transplantation.

Purpose: Glaucoma is a common complication after corneal transplantation and can be difficult to manage in these patients. This study reports outcomes of XEN stent implantation in eyes with glaucoma in the setting of previous corneal transplantation.

Retrospective analysis of ophthalmology consults to a tertiary academic teaching centre.

Objective: This study was conducted to analyse data from emergency ophthalmology referrals after-hours from different hospitals to identify the most common pathologies and compare accuracy of diagnoses. The primary objective was to identify common presenting entities and common causes of misdiagnosis in the emergency department to help guide education initiatives.

Design: This was a retrospective chart review that looked at consults occurring between September 1, 2015, and October 21, 2016.

Interoception and Mental Health: A Roadmap.

Interoception refers to the process by which the nervous system senses, interprets, and integrates signals originating from within the body, providing a moment-by-moment mapping of the body's internal landscape across conscious and unconscious levels. Interoceptive signaling has been considered a component process of reflexes, urges, feelings, drives, adaptive responses, and cognitive and emotional experiences, highlighting its contributions to the maintenance of homeostatic functioning, body regulation, and survival. Dysfunction of interoception is increasingly recognized as an important component of different mental health conditions, including anxiety disorders, mood disorders, eating disorders, addictive disorders, and somatic symptom disorders.

A case of cerebellar psychopathology.

Background: Pathology of the cerebellum has traditionally been associated with motor symptoms, vertigo, and nystagmus. Patients with cerebellar disorders do not usually receive psychiatric evaluations.

Objective: The authors seek to alert clinicians to the association between cerebellar disease and psychiatric symptoms.

Visceral brain-body information transfer.

Organisms interact with their environments through various afferent (sensory) and efferent (motor) mechanisms. While the usual environment of interest has been external to the organism, the internal environment is also of fundamental importance. This article briefly reviews many of the interactive mechanisms between the brain and the visceral environment, along with identification of relevant brain structures and linkages related to these peripheral functions (particularly the hypothalamus).

The rebirth of neuroscience in psychosomatic medicine, Part I: historical context, methods, and relevant basic science.

Neuroscience was an integral part of psychosomatic medicine at its inception in the early 20th century. Since the mid-20th century, however, psychosomatic research has largely ignored the brain. The field of neuroscience has burgeoned in recent years largely because a variety of powerful new methods have become available.

The rebirth of neuroscience in psychosomatic medicine, Part II: clinical applications and implications for research.

During the second half of the last century, biopsychosocial research in psychosomatic medicine largely ignored the brain. Neuroscience has started to make a comeback in psychosomatic medicine research and promises to advance the field in important ways. In this paper we briefly review select brain imaging research findings in psychosomatic medicine in four key areas: cardiovascular regulation, visceral pain in the context of functional gastrointestinal disorders, acute and chronic somatic pain and placebo.

Delirium, depression, and other psychosocial and neurobehavioral issues in cardiovascular disease.

Understanding relevant psychosocial (neural, behavioral, psychiatric) issues is essential to optimal care of individuals who have cardiovascular disorders. Delirium, a condition of diffuse cerebral dysfunction caused by underlying systemic or central nervous system pathology, and often requiring measures of acute neurobehavioral management with nonpharmacological and pharmacological means, in addition to treatment of the underlying medical disorder, often occurs in association with severe cardiovascular disease. Depression is a psychiatric disorder known to be associated with cardiovascular disease.

Psychosomatic medicine: the scientific foundation of the biopsychosocial model.

Objective: This article presents major concepts and research findings from the field of psychosomatic medicine that the authors believe should be taught to all medical students.

Method: The authors asked senior scholars involved in psychosomatic medicine to summarize key findings in their respective fields.

Results: The authors provide an overview of the field and summarize core research in basic psychophysiological mechanisms-central nervous system/autonomic nervous system, psychoneuroimmunology, and psychoendocrinology-in three major disease states-cardiovascular, gastrointestinal, and HIV virus infections.

Reduced gamma-aminobutyric acid(A)-benzodiazepine binding sites in insular cortex of individuals with panic disorder.

Context: Benzodiazepine drugs are highly effective anxiolytic medications, but the role of the benzodiazepine-gamma-aminobutyric acid(A)-chloride ion channel macromolecular complex in the pathophysiologic mechanism of anxiety is not well understood. Previous human imaging studies have indicated involvement of specific regions of the brain in anxiety disorders, especially the frontal-prefrontal, temporal, and cingulate cortical and the limbic areas.

Objective: To identify potential abnormalities of brain benzodiazepine receptor binding number and distribution in anxiety disorders.

Anxious-depressive comorbidity: effects on HPA axis and CNS noradrenergic functions.

Psychiatric comorbidity is all too common. An important example is the high comorbidity frequency of depressive and anxiety disorders, 25%-50%, much higher than the 5% or less expected by chance. Possible reasons for this comorbidity include definitional, environmental, and biological factors.

Interaction of brain noradrenergic system and the hypothalamic-pituitary-adrenal (HPA) axis in man.

Background: Numerous interactions between the brainstem locus coeruleus system and the HPA axis have been shown in experimental animals. This relationship is less well characterized in humans and little is known about the influence of psychiatric disorders, which disturb one of these systems, on this relationship.

Methods: Untreated subjects with pure MDD (n = 13), MDD with comorbid anxiety disorders (n = 17), and pure anxiety disorders (n = 15) were recruited by advertising.

Validation of retrospective reports of early experiences with smoking.

Initial sensitivity to the pharmacological effects of a drug may affect patterns of future use and dependence for a wide variety of drugs. Retrospective reports of sensations experienced upon early experimentation, however, may be limited by recall bias based on time elapsed and subsequent experiences. To validate reports of early experiences with nicotine, we studied 34 smokers who had contributed retrospective data on early experiences with smoking.

Relative rectal bioavailability of fluoxetine in normal volunteers.

This study was conducted to determine the relative rectal bioavailability of fluoxetine capsules as well as the acceptability of the rectal route of fluoxetine capsule administration. Using a 2-period, crossover design with a 30-day washout between study sessions, 20 mg fluoxetine capsules were administered to 7 healthy, drug-free, nonsmoking volunteers by the oral and rectal routes. Blood samples were collected at baseline, and 1, 2, 4, 6, 8, 10, 12, 24 hours, as well as 2, 3, 4, 5, 7, 14, 21, 28 days following drug administration.

Anxious and depressive disorders and their comorbidity: effect on central nervous system noradrenergic function.

Background: Although comorbidity of anxiety with depression is common, investigations of physiologic abnormalities related specifically to comorbidity are rare. This study examined relationships of DSM-IV-defined depression, anxiety, and their comorbidity to noradrenergic function measured by blunting of the growth hormone (GH) response to the alpha2 adrenoreceptor agonist (and imidazoline receptor agent) clonidine and by blood pressure and symptom responses.

Methods: Fifteen subjects with pure social anxiety or panic disorder, 15 with pure major depression, and 18 with both depression and anxiety were compared with healthy control subjects matched for age and gender.

Depression, smoking abstinence and HPA function in women smokers.

To determine whether smokers with a history of depression are differentially susceptible to smoking withdrawal, depressed mood induction and/or hypothalamic-pituitary-adrenal (HPA) axis dysregulation during smoking abstinence, 24 women smokers with and without such a history were studied. During one 5-day interval, participants smoked ad libitum; during a second they abstained. On day 4, the participants were exposed to the Velten mood induction procedure (VMIP).

Effect of comorbid anxiety disorders on the hypothalamic-pituitary-adrenal axis response to a social stressor in major depression.

Background: Major depressive disorder (MDD) is often complicated by anxiety symptoms, and anxiety disorders occur in approximately 30% of mood cases. This study examined the influence of anxiety comorbidity on the hypothalamic-pituitary-adrenal (HPA) axis response to stress in patients with MDD.

Methods: Untreated subjects with pure MDD (n = 15), MDD with comorbid anxiety disorders (n = 18), and pure anxiety disorders (n = 15) were recruited by advertising.

Regional brain activation due to pharmacologically induced adrenergic interoceptive stimulation in humans.

Objective: Identifying the brain regions associated with visceral sensory activation and awareness (interoception) was a neglected area of neural science until quite recently despite being essential to a comprehensive understanding of psychosomatic processes, baroreception, and higher brain functions such as fear and anxiety, other emotions, and pain.

Methods: In this study regional changes in the cerebral metabolic rate for glucose were determined with positron emission tomography in response to cardiovascular-respiratory activation induced in healthy humans by beta-adrenergic stimulation produced with intravenous isoproterenol, which acts predominantly in the periphery because of minimal transport across the blood-brain barrier.

Results: Interoceptive activation raised heart rate to approximately 120 beats per minute, produced somatic and to a lesser extent psychological symptoms, and significantly increased cerebral glucose metabolism in the left primary somatosensory cortex and medial portion of the cingulate gyrus; right insular cortex showed a trend toward an increase that was significant in homogeneous subgroups of right-handed or female subjects.