Do emotion regulation difficulties affect outcome of intensive trauma-focused treatment of patients with severe PTSD?

Background: There is ongoing debate as to whether emotion regulation problems should be improved first in order to profit from trauma-focused treatment, or will diminish after successful trauma processing. Objective: To enhance our understanding about the importance of emotion regulation difficulties in relation to treatment outcomes of trauma-focused therapy of adult patients with severe PTSD, whereby we made a distinction between people who reported sexual abuse before the age of 12, those who were 12 years or older at the onset of the abuse, individuals who met the criteria for the dissociative subtype of PTSD, and those who did not. Methods: Sixty-two patients with severe PTSD were treated using an intensive eight-day treatment programme, combining two first-line trauma-focused treatments for PTSD (i.e. prolonged exposure and EMDR therapy) without preceding interventions that targeted emotion regulation difficulties. PTSD symptom scores (CAPS-5) and emotion regulation difficulties (DERS) were assessed at pre-treatment, post-treatment, and six month follow-up. Results: PTSD severity and emotion regulation difficulties significantly decreased following trauma-focused treatment. While PTSD severity scores significantly increased from post-treatment until six month follow-up, emotion regulation difficulties did not. Treatment response and relapse was not predicted by emotion-regulation difficulties. Survivors of childhood sexual abuse before the age of 12 and those who were sexually abused later in life improved equally well with regard to emotion regulation difficulties. Individuals who fulfilled criteria of the dissociative subtype of PTSD showed a similar decrease on emotion regulation difficulties during treatment than those who did not. Conclusion: The results support the notion that the severity of emotion regulation difficulties is not associated with worse trauma-focused treatment outcomes for PTSD nor with relapse after completing treatment. Further, emotion regulation difficulties improved after trauma-focused treatment, even for individuals who had been exposed to early childhood sexual trauma and individuals with dissociative subtype.

Antecedentes: hay un debate en curso sobre si los problemas de regulación de las emociones deben mejorar primero para beneficiarse del tratamiento centrado en el trauma o si disminuirán después del procesamiento exitoso del trauma.Objetivo: mejorar nuestra comprensión sobre la importancia de las dificultades de la regulación emocional en relación con los resultados del tratamiento de la terapia centrada en el trauma de pacientes adultos con trastorno de estrés postraumático grave, para lo cual hicimos una distinción entre las personas que informaron abuso sexual antes de los 12 años, aquellas que tenían 12 o más años al inicio del abuso, personas que cumplieron con los criterios para el subtipo disociativo de TEPT y aquellos que no lo hicieron.Métodos: Sesenta y dos pacientes con trastorno de estrés postraumático grave fueron tratados mediante un programa de tratamiento intensivo de ocho días, que combina dos tratamientos de primera línea centrados en el trauma para el trastorno de estrés postraumático (exposición prolongada y EMDR) sin intervenciones previas dirigidas a las dificultades de regulación emocional. Los puntajes de síntomas de TEPT (CAPS-5) y las dificultades de regulación emocional (DERS) se evaluaron antes, después del tratamiento y a los seis meses de seguimiento.Resultados: la severidad del TEPT y las dificultades de regulación emocional disminuyeron significativamente después del tratamiento centrado en el trauma. Si bien los puntajes de severidad del TEPT aumentaron significativamente desde el postratamiento hasta los seis meses de seguimiento, las dificultades de regulación emocional no lo hicieron. La respuesta al tratamiento y la recaída no fueron precedidas por las dificultades de regulación de las emociones. Los sobrevivientes de abuso sexual infantil antes de los 12 años y aquellos que fueron abusados sexualmente más tarde en la vida mejoraron igualmente bien con respecto a las dificultades de regulación de las emociones. Las personas que cumplieron con los criterios del subtipo disociativo de TEPT mostraron una mayor disminución en las dificultades de regulación emocional durante el tratamiento que aquellos que no lo hicieron.Conclusión: Los resultados apoyan la noción de que la gravedad de las dificultades de regulación de las emociones no se asocia con peores resultados del tratamiento centrado en el trauma para el TEPT ni con recaídas después de completar el tratamiento. Además, las dificultades de regulación de las emociones mejoraron después del tratamiento centrado en el trauma, incluso para las personas que habían estado expuestas a traumas sexuales en la primera infancia y las personas con subtipo disociativo.

Role of the alpha1 and alpha2 integrin cytoplasmic domains in cell morphology, motility and responsiveness to stimulation by the protein kinase C pathway.

The alpha1beta1 and alpha2beta1 integrins, extracellular matrix receptors for collagens and/or laminins, have similarities in structure and ligand binding. Recent studies suggest that the two receptors mediate distinct post-ligand binding events and are not simply redundant receptors. To discern the mechanisms by which the two receptors differ, we focused on the roles of the cytoplasmic domains of the alpha subunits. We expressed either full-length alpha1 integrin subunit cDNA (X1C1), full-length alpha2 integrin subunit cDNA (X2C2), chimeric cDNA composed of the extracellular and transmembrane domains of alpha2 subunit and the cytoplasmic domain of alpha1 (X2C1), chimeric cDNA composed of the extracellular and transmembrane domains of alpha1 subunit and the cytoplasmic domain of alpha2 (X1C2), alpha1 cDNA truncated after the GFFKR sequence (X1C0) or alpha2 cDNA truncated after the GFFKR sequence (X2C0) in K562 cells. Although the cytoplasmic domains of the alpha1 and alpha2 subunits were not required for adhesion, the extent of adhesion at low substrate density was enhanced by the presence of either the alpha1 or alpha2 cytoplasmic tail. Spreading was also influenced by the presence of an alpha subunit cytoplasmic tail. Activation of the protein kinase C pathway with phorbol dibutyrate-stimulated motility that was dependent upon the presence of the alpha2 cytoplasmic tail. Both the phosphatidylinosotide-3-OH kinase and the mitogen-activated protein kinase pathways were required for phorbol-activated, alpha2-cytoplasmic tail-dependent migration.

Fundamental voice frequency and jitter in girls and boys measured with electroglottography: influence of age and height.

The fundamental frequency and jitter of the voice was measured by electroglottography in 71 children between the age of 7 and 15 years. In this series of children the fundamental frequency and jitter did not depend on the gender. The median (range) fundamental frequency was 244 (182-331) Hz in girls and 250 (205-293) Hz in boys. It decreased with increasing height (r = -0.59; P < 0.0005) and age (r = -0.57; P < 0.001). The median jitter ratio was 9.7 (1.6-33.3) in girls and 10.3 (2.0-4.3) in boys. The jitter ratio was negatively related to height (r = -0.31; P < 0.05), but not to age.

Immunogenicity of MHC class I alloantigens expressed on parenchymal cells in the human kidney.

The goal of the present study was to examine the capacity of human kidney cell lines (KCL) to elicit T cell responses to MHC class I alloantigens. KCL exhibited the phenotypic characteristics of tubular epithelial cells and were devoid of detectable contamination with leukocytes. Coculture of normal peripheral blood leukocytes (PBL) with allogeneic KCL elicited cytolytic T lymphocytes (CTL) that lysed the stimulating KCL but failed to lyse third-party KCL. Cell panel and antibody blocking studies demonstrated that the CTL were directed to the HLA class I alloantigens expressed on the KCL stimulators. Purified T cells completely failed to mount a CTL response to KCL, but the response could be reconstituted by supplementing the cultures with either autologous non-T cells or supernatant from a mixed lymphocyte culture (MLC). IL-2, but not IL-1, IL-4, IL-6, or gamma-interferon, restored the anti-KCL response, suggesting that IL-2 is the active factor in the MLC supernatant. Induction of class II antigens on the KCL stimulators with gamma-IFN failed to restore a CTL response, suggesting that KCL are deficient in a costimulatory factor important for class II restricted T helper responses. Nonetheless, our data demonstrate that parenchymal cells in the kidney are capable of presenting class I antigens to alloreactive T cells and, therefore, may contribute to the immunogenicity of renal allografts.