Skills training followed by either EMDR or narrative therapy for posttraumatic stress disorder in adult survivors of childhood abuse: a randomized controlled trial.

Background: Individuals suffering from PTSD following childhood abuse represent a large subgroup of patients attending mental health services. The aim of phase-based treatment is to tailor treatment to the specific needs to childhood abuse survivors with PTSD with a Skills Training in Affective and Interpersonal Regulation (STAIR) phase, in which emotion dysregulation and interpersonal problems are targeted, and a trauma-focused phase.Objective: The purpose of this study was to compare STAIR + Eye Movement Desensitization and Reprocessing (EMDR) vs. STAIR + Narrative Therapy (NT) as treatments for PTSD following childhood-onset trauma in a routine clinical setting.Method: Sixty-eight adults were randomly assigned to STAIR/EMDR (8 STAIR-sessions followed by 12 EMDR-sessions) or STAIR/NT (8 STAIR-sessions followed by 12 NT-sessions). Assessments took place at pre-treatment, after each treatment phase and at 3 and 12 months post-intervention follow-up. Primary outcomes were interviewer-rated and self-reported symptom levels of PTSD. Secondary outcomes included symptom levels of depression and disturbances in emotion regulation and interpersonal skills.Results: Multilevel analyses in the intent-to-treat sample indicated that patients in both treatments improved substantially on PTSD symptom severity (CAPS: d = 0.81 to 1.29; PDS: d = 1.68 to 2.15), as well as on symptom levels of depression, anxiety, emotion regulation, dissociation and interpersonal skills. Effects increased or were maintained until 12-month follow-up. At mid-treatment, after STAIR, patients in both treatments improved moderately on PTSD symptom severity (PDS: d = 1.68 to 2.15), as well as on symptom levels of depression (BDI: d = .32 to .31). Symptoms of anxiety, emotion dysregulation, interpersonal problems and dissociation were not decreased after STAIR. There were no significant differences between the two conditions on any outcome.Conclusion: PTSD in adult survivors of childhood interpersonal trauma can effectively be treated by phase-based interventions using either EMDR or NT in the trauma-processing phase.Trial registration: ClinicalTrials.gov identifier: NCT01443182..

The study directly compares Skills Training in Affective and Interpersonal Regulation (STAIR) followed by either EMDR or Narrative Therapy in the trauma-processing phase in routine clinical setting.The brief phase-based treatment was found to be effective in reducing both symptoms of PTSD as well as emotion regulation and interpersonal problems in survivors of childhood abuse.Posttraumatic Stress Disorder in adult survivors of childhood interpersonal trauma can effectively be treated by phase-based interventions using either EMDR or Narrative Therapy in the trauma-processing phase.

Implementation and evaluation of a nurse-led decision-coaching program for healthy breast cancer susceptibility gene (BRCA1/2) mutation carriers: a study protocol for the randomized controlled EDCP-BRCA study.

BACKGROUND: Female BRCA mutation carriers have an increased lifetime risk for breast and ovarian cancer compared to the general population. Women who carry this mutation have several options to deal with their cancer risk, such as risk-reducing surgeries or intensified breast cancer screening. Previous research has shown that preferences in this scenario are highly dependent on affected women's personalities and value systems. To support these women in the decision-making process, a structured decision support consisting of decision coaching combined with a decision aid might be helpful. METHODS/DESIGN: A randomized controlled trial will be conducted in order to compare usual care with structured decision support alongside usual care. The decision support program entails nurse-led decision coaching as well as an evidence-based patient decision aid. Nurses are qualified by a 4-day training program in informed decision-making and decision coaching. Six centers for Familial Breast and Ovarian Cancer in Germany will be included in the study, with a planned sample size of 398 women. The primary outcome is the congruence between the preferred and the actual played role in the decision-making process as measured by the Control Preferences Scale. It is hypothesized that the structured decision support will enable women to play the preferred role in the decision-making process. Secondary outcomes include the knowledge and attitudes about preventive options, decisional conflict, depression and anxiety, coping self-efficacy, impact of event, and self-concept. A process evaluation will accompany the study. DISCUSSION: The EDCP-BRCA study is the first study to implement and evaluate decision coaching combined with a decision aid for healthy BRCA mutation carriers worldwide. TRIAL REGISTRATION {2A}: DRKS-ID: DRKS00015527. Registered 30 October 2019.

Inhibitors of DNA Methylation, Histone Deacetylation, and Histone Demethylation: A Perfect Combination for Cancer Therapy.

Epigenetic silencing and inappropriate activation of gene expression are frequent events during the initiation and progression of cancer. These events involve a complex interplay between the hypermethylation of CpG dinucleotides within gene promoter and enhancer regions, the recruitment of transcriptional corepressors and the deacetylation and/or methylation of histone tails. These epigenetic regulators act in concert to block transcription or interfere with the maintenance of chromatin boundary regions. However, DNA/histone methylation and histone acetylation states are reversible, enzyme-mediated processes and as such, have emerged as promising targets for cancer therapy. This review will focus on the potential benefits and synergistic/additive effects of combining DNA-demethylating agents and histone deacetylase inhibitors or lysine-specific demethylase inhibitors together in epigenetic therapy for solid tumors and will highlight what is known regarding the mechanisms of action that contribute to the antitumor response.

Evaluation of the packaging and encapsulation reliability in fully integrated, fully wireless 100 channel Utah Slant Electrode Array (USEA): Implications for long term functionality.

The encapsulation and packaging reliability in fully integrated, fully wireless 100 channel Utah Slant Electrode Array (USEA)/integrated neural interface-recording version 5 (INI-R5) has been evaluated by monitoring the extended long term in-vitro functional stability and recording longevity. The INI encapsulated with 6-µm Parylene-C was immersed in phosphate buffer saline (PBS) at room temperature for a period of over 12 months. The USEA/INI-R5, while being soaked was powered and configured wirelessly through 2.765 MHz inductive link and the transmitted frequency shift keying (FSK) modulated radio-frequency (RF) (900 MHz Industrial, scientific, medical-ISM band) signal was also recorded wirelessly as a function of soak time. In order to test the long term recording ability, in-vitro wireless recording was performed in agarose for few channels. The full functionality and the ability of the electrodes to record artificial neural signals even after 12 months of PBS soak provides a measure of encapsulation reliability, the functional and recording stability in fully integrated wireless neural interface and potential usefulness for future chronic implants.

[Smoking habits of employees and patients in the psychiatric department of a general hospital]. / Rauchverhalten von Mitarbeitern und Patienten der psychiatrischen Abteilung eines Allgemeinkrankenhauses.

OBJECTIVE: Health promotion is becoming an increasingly more meaning in hospitals within their health promotion, primary and secondary prevention programmes. With reference to the preventive measures regarding nicotine dependence, it was first of all the objective of this study to determine the smoking habits of employees and patients in a psychiatric clinic. The question was also which implications for clinical practice could be drawn from this. METHODOLOGY: Apart from the Fagerstroem Test for nicotine dependence, a new questionnaire was developed, supported by the questionnaire "Smoke free in hospital", developed by the Federal Agency for Health Education, and implemented. 382 Patients and 484 employees were questioned. The statistical analysis was done using SPSS, and in addition thereto, the T-Test and the chi (2)-Test were used. RESULTS: Definite gender differences pertaining to smoking habits could be demonstrated. Women smoked less often (p < 0.001) and less (p < 0.01) than men and were less dependent on nicotine (p < 0.007). With increasing age, the number of smokers declined. In questioning the employees, it was clear, that there were no significant differences between doctors and nurses regarding their smoking habits. However, employees in the clinic working shifts were consuming more cigarettes daily (p < 0.044) and had a higher degree of dependence (p < 0.01). On questioning the patients, it was demonstrated that the number of smokers (92%) consuming cigarettes, dependence were significantly higher on the wards for dependence diseases. Overall it was clear that there were definite qualitative and quantitative differences in the smoking habits of both patients and employees. Patients smoke more often (p < 0.001) and are more dependent (p < 0.001) than employees. There were no differences between the two groups regarding the motivation to stop smoking (smokers willing to stop: 36%). However, more patients (38.5%) than employees (23.8%) expressed the opinion, that it is the task of the Hospital employees to regularly point out the risks of smoking. DISCUSSION: In the psychiatric clinic in question, the results demonstrated that cigarette consumption and nicotine dependency, for both patients and employees, are serious problems that can be transferred into comparable clinics and departments. Patients are more affected than employees. Other studies proved that psychiatric patients smoke twice as much as people without psychiatric diseases. CONCLUSION: Against the background, that health promotion and prevention should increasingly become the task of every hospital, further studies will be necessary to establish health promotive activities influencing smoking patients and employees. Specific treatment modalities regarding the motivation to change are still not available. Added to that, it must be tested within the German Health System, whether a clinically supervised smoking cessation programme complementing the treatment of the main diagnosis (a psychiatric disease) is demanded by the affected person, whether the clinic can finance it, and whether it can be successfully implemented.

Sarcocystis mephitisi n. sp. (Protozoa: Sarcocystidae), Sarcocystis neurona-like and Toxoplasma-like infections in striped skunks (Mephitis mephitis).

Two structurally distinct types (A, B) of microscopic sarcocysts were found in muscles of 4 of 5 feral skunks. Type A sarcocysts had sarcocyst walls of up to 6 microm thick. The villar protrusions (Vp) on the sarcocyst wall were up to 5 microm long. The Vp were constricted at the base, expanded in the middle, and had a blunt tip. Numerous microtubules were present in the Vp and in the granular layer. Bradyzoites were up to 11 microm long and up to 3.2 microm wide. Based on the distinctiveness of the Vp, a new name, Sarcocystis mephitisi is proposed for type A sarcocysts. Type B sarcocysts had a relatively thin (approximately 1-2 microm thick) sarcocyst wall and the Vp were slender and tapered toward the tip. These sarcocysts were structurally similar to S. neurona sarcocysts. A Toxoplasma gondii-like tissue cyst was found in a section of tongue of 1 of the 4 skunks.

Biologic response to passive dissolution of titanium craniofacial microplates.

The effect of anodization on passive dissolution of titanium was studied by measuring titanium levels in peritoneal leukocytes and tissues of laboratory animals with titanium plates implanted into the peritoneal cavity. Fifteen Sprague-Dawley rats were assigned randomly to three treatment groups of five animals. One group served as controls, the other two groups had an anodized or an unanodized implant placed in the left paracolic gutter. Peritoneal lavage samples and blood samples, organ tissues and tissue surrounding the implants, were removed for histologic examination and titanium levels. Titanium was not detected in any distant organs or in the peritoneal lavage fluid. The capsular tissues surrounding the implants contained titanium at levels ranging from 2610 to 16786 ng/g for unanodized plates, and 888-5933 ng/g for anodized plates. The titanium levels within the peritoneal leukocytes of animals with unanodized implants were significantly elevated (P = 0.01) over time, as compared with controls. The level of titanium in the peritoneal leukocytes of animals with anodized implants was not significantly elevated when compared with controls. Titanium levels in the trace range, as measured in the capsular tissues, are likely a result of corrosion. Surface treatment of titanium by anodization reduces passive dissolution.

Neospora caninum-associated equine protozoal myeloencephalitis.

Equine protozoal myeloencephalitis (EPM) was clinically diagnosed in a 20-year-old horse with severe ataxia. The cerebrospinal fluid was positive for Sarcocystis neurona antibodies by western blot. The horse was administered corticosteroids to facilitate in vitro culture of S. neurona from its spinal cord following necropsy. Microscopic lesions of EPM were present in the brain and in the spinal cord, including multifocal inflammatory cellular infiltrates and several large groups of protozoa. Immunohistochemical, and light and electron microscopic examinations revealed that the protozoa were Neospora caninum and not S. neurona. The protozoa divided by endodyogeny, tachyzoites had rhoptries, and organisms reacted specifically to N. caninum antibodies. Veterinarians should be aware of increasing diagnosis of N. caninum as another etiological agent responsible for the lesions of EPM.

Cryptosporidiosis in a bat (Eptesicus fuscus).

Cryptosporidial infection was diagnosed histologically in the small intestine of a big brown bat (Eptesicus fuscus) from Oregon. This is the first report of cryptosporidiosis in a bat.

Muscular Sarcocystis infection in a bear (Ursus americanus).

Sarcocysts of an unidentified Sarcocystis species were found in sections of skeletal muscles of a black bear (Ursus americanus) from North Carolina. Two sarcocysts in a section measured 45 x 37.5 microm and 67.5 x 50 microm and had a thin (<2 microm) sarcocyst wall. The villar protrusions on the cyst wall were up to 2 microm long and up to 0.7 microm wide. The bradyzoites were approximately 6 X 2.5 microm in size. This is the first report of muscular Sarcocystis in a bear.

Chromogenic assays for equine coagulation factors VII, VIII:C, IX, and X, and C1-esterase inhibitor.

OBJECTIVES: To adapt manual human chromogenic assays for coagulation factors VII (F.VII), VIII:coagulant (F.VIII:C), IX (F.IX), and X (F.X), and C1-esterase inhibitor (C1-INH) for use with an automated analyzer, and to measure the activity of these proteins in horses. ANIMALS: 10 healthy horses were used to determine ranges for the assays. Pooled plasma for standards was collected from an additional 20 healthy horses. PROCEDURE: A computer-assisted analyzer was programmed from the manual method for commercially available human F.VII, F.VIII:C, F.IX, F.X, and C1-INH chromogenic assay kits. Standards were prepared from pooled citrated equine plasma for the F.VII, F.VIII:C, and F.X assays, and from commercial pooled citrated human plasma for F.IX and C1-INH assays. RESULTS: Mean +/- SD activities in citrated equine plasma from 10 horses were 226 +/- 19% for F.VII; 209 +/- 31% for F.VIII:C; 149 +/- 38% for F.IX; 88 +/- 12% for F.X; and 18.4 +/- 8.4% for C1-INH. Intra-assay coefficients of variation (CV) were 5.3% for F.VII; 2.1% for F.VIII:C; and 3.0% for C1-INH. Interassay CV were 5.7% for F.VII; 7.4% for F.VIII:C; 3.8% for F.IX; 14.4% for F.X; and 22.0% for C1-INH. CONCLUSIONS: Human chromogenic assay kits can be automated and used to measure F.VII, F.VIII:C, F.IX, F.X, and C1-INH activities in citrated equine plasma. CLINICAL RELEVANCE: Human chromogenic assays can be routinely used to measure F.VII, F.VIII:C, F.IX, F.X, and C1-INH in horses, and may be useful in evaluation of horses with disorders of hemostasis.

Analysis of coagulation proteins as acute-phase reactants in horses with colic.

OBJECTIVES: To measure coagulation factor VIII:coagulant (F.VIII:C) and C1-esterase inhibitor (C1-INH), hemostasis-associated acute-phase reactant proteins and coagulation factors VII (F.VII), IX (F.IX), and X (F.X), hemostasis proteins not associated with an acute-phase response, in a select population of horses with colic and hemostasis abnormalities, and presumed to have acute-phase changes. To compare these values and other routine hemostasis test results in the horses with colic with values for a population of healthy horses. To correlate the values of known equine acute-phase reactants, F.VIII:C and fibrinogen, to those of other tests of hemostasis. To identify hemostasis-associated acute-phase reactant proteins and gain insights into the effects the acute-phase response has on hemostatic abnormalities in horses with colic syndrome. SAMPLE POPULATION: 54 plasma samples from horses with colic attributable to inflammatory (n = 39) or strangulating (n = 15) intestinal disorders. PROCEDURE: Plasma samples were evaluated for activities of F.VII, F.VIII:C, F.IX, F.X, C1-INH, antithrombin III, protein C, plasminogen, and alpha 2-antiplasmin (alpha 2AP); fibrinogen concentration; and prothrombin (PT) and activated partial thromboplastin (APTT) times. RESULTS: Horses with colic had significantly higher fibrinogen concentration, greater alpha 2AP and protein C activities, and longer PT and APTT than did healthy horses. Horses with colic also had significantly lower mean F.VII activity than did healthy horses. Significant positive correlations between fibrinogen concentration and F.VIII:C, C1-INH, and alpha 2AP values, and between F.VIII:C activity and fibrinogen, C1-INH, alpha 2AP, and plasminogen values were identified. CONCLUSIONS: An acute-phase response contributes to changes observed in coagulation proteins in horses with colic attributable to inflammatory and strangulating intestinal disorders. The data suggest that plasminogen, alpha 2AP, and C1-INH, should be considered equine acute-phase proteins.

Hydrocephalus associated with Neospora caninum infection in an aborted bovine fetus.

This paper describes Neospora caninum-associated hydrocephalus in an aborted Hereford bovine fetus of 7 months' gestational age. Numerous tachyzoites were observed in areas of the cerebrum with lesions of non-suppurative necrotizing encephalitis.

Sarcocystosis in capercaillie (Tetrao urogallus) in Finland: description of the parasite and lesions.

Acute generalized sarcocystosis was diagnosed in a capercaillie (Tetrao urogallus) from Finland. Microscopic lesions were seen in the heart, lungs, spleen, liver, and brain. Protozoa were found in all organs, especially in the lungs and spleen. Only asexual stages were observed. The parasite divided by endopolygeny. Schizonts were usually 10 microm wide and up to 55 microm long. Merozoites are 3-4 microm long and 1.5-2.0 microm wide. Sarcocysts and sexual stages are unknown. The parasite was considered to be a species of Sarcocystis with an unknown life cycle. This is the first report of acute sarcocystosis in capercaillie from Finland.

The development of an outcomes management system for acute medical rehabilitation.

In 1993, Continental Medical Systems, Inc. (CMS), a provider of comprehensive medical rehabilitation, developed the Total Outcomes and Prediction Program (TOPP) to measure and evaluate key medical rehabilitation outcomes, quality indicators, and patient satisfaction at its 37 acute rehabilitation hospitals. The broad purposes of TOPP are to manage patient treatment, improve the cost-effectiveness of care, and provide outcomes reporting for managed care and other interested parties. The challenge was to develop a system which could measure, evaluate, and report medical rehabilitation patient outcomes in a way that could be easily understood by multiple audiences, including payers, accrediting organizations, physicians, patients and families, case managers, and CMS clinical staff. Using data from the Uniform Data System for Medical Rehabilitation database, CMS created descriptive outcomes reports for each hospital and for the corporation overall, including performance statistics, outcomes report cards, and quality report cards. These initial reports, as well as updates, quarterly reports, and special ad hoc requests, provide CMS corporate and hospital staff with statistically valid and reliable information to manage the outcomes of medical rehabilitation treatment. TOPP has assisted CMS with meeting accreditation standards for outcomes management and measurement and has been used in managed care contract negotiations. Future TOPP efforts will integrate resource use data, medical acuity and outcomes from acute, subacute, and outpatient rehabilitation levels into CMS' outcomes reporting system.

Immunogenicity and efficacy against lethal aerosol staphylococcal enterotoxin B challenge in monkeys by intramuscular and respiratory delivery of proteosome-toxoid vaccines.

Staphylococcal enterotoxin B (SEB), a primary cause of food poisoning, is also a superantigen that can cause toxic shock after traumatic or surgical staphylococcal wound [correction of would] infections or viral influenza-associated staphylococcal superinfections or when aerosolized for use as a potential biologic warfare threat agent. Intranasal or intramuscular (i.m.) immunization with formalinized SEB toxoid formulated with meningococcal outer membrane protein proteosomes has previously been shown to be immunogenic and protective against lethal respiratory or parenteral SEB challenge in murine models of SEB intoxication. Here, it is demonstrated that immunization of nonhuman primates with the proteosome-SEB toxoid vaccine is safe, immunogenic, and protective against lethal aerosol challenge with 15 50% lethal doses of SEB. Monkeys (10 per group) were primed i.m. and given booster injections by either the i.m. or intratracheal route without adverse side effects. Anamnestic anti-SEB serum immunoglobulin G (IgG) responses were elicited in all monkeys, but strong IgA responses in sera and bronchial secretions were elicited both pre- and post-SEB challenge only in monkeys given booster injections intratracheally. The proteosome-SEB toxoid vaccine was efficacious by both routes in protecting 100% of monkeys against severe symptomatology and death from aerosolized-SEB intoxication. These data confirm the safety, immunogenicity, and efficacy in monkeys of parenteral and respiratory vaccination with the proteosome-SEB toxoid, thereby supporting clinical trials of this vaccine in humans. The safety and enhancement of both bronchial and systemic IgA and IgG responses by the proteosome vaccine delivered by a respiratory route are also encouraging for the development of mucosally delivered proteosome vaccines to protect against SEB and other toxic or infectious respiratory pathogens.

Release of chromaffin granular content from staphylococcal enterotoxin B (SEB)-treated and -untreated PC12 cells.

The release of chromaffin granular content from staphylococcal enterotoxin B (SEB)-treated and -untreated PC12 cells was studied by electron microscopy. The treatment of the cells with SEB at the concentration of 20 micrograms/ml caused marked increase of the chromaffin granules that either bound to the plasma membrane by the characteristic rods, measuring 15 to 20 nm in length and showing a tubular structure, or budded off at the free cell surface, surrounded by a layer of rod-containing cytoplasm and enclosed by the plasma membrane. The binding between the granular and plasma membranes by the rods did not lead to membrane fusion and exocytosis of the granular content. Many of the bound granules showed vesiculation with loss of the electron-dense core material; at the same time, some of the binding rods contained intraluminal electron-dense material similar to the granular core material. These findings suggested that the electron-dense material (i.e., norepinephrine) of the bound granules was released extracellularly through channels within the rods. Although the granules were bound to the plasma membrane with equal frequency at the free and contiguous cell surfaces, the granular budding occurred only at the free cell surface, indicating that it occurred incidentally to some granules bound at the free cell surfaces. On the basis of the morphological observations, it is postulated that the electron-dense material of the bound granule is selectively released extracellularly through the rods, leaving the vesiculated granules behind in the cytoplasm. The same mode of release of the granular content was observed, though less frequently, in the untreated control cells. No morphological evidence that indicated that the granular content was released extracellularly by exocytosis was found in the treated and control cells. The present observations indicated that the SEB treatment of PC12 cells stimulated the binding of chromaffin granules to the plasma membrane by the rods and the budding of the bound granules at the free cell surface.

Enzyme-linked immunosorbent assay for thrombin-antithrombin III complexes in horses.

OBJECTIVES: To adapt and characterize a human ELISA kit to quantify thrombin-antithrombin III (TAT) complexes in horses, and to evaluate TAT as a marker for hypercoagulation in horses. ANIMALS: 29 clinically normal horses used as controls, and 4 ill horses used to evaluate assay for known causes of hypercoagulation. PROCEDURE: A commercially available human sandwich-type ELISA kit with 2 antibodies against human thrombin and antithrombin III that bind selectively to their corresponding TAT antigenic sites was used. Equine TAT standards were made from purified equine thrombin and antithrombin III. Proteins diluted in a phosphate-buffered saline solution containing 0.1% Tween and 1 U of heparin/ ml were used to establish standard curves. Reference intervals for TAT concentration in citrated equine plasma, and intra- and interassay coefficients of variation were determined. RESULTS: Mean +/- SD values were 3.95 +/- 1.93 micrograms/L, with median of 3.18 micrograms/L and range of 1.95 to 9.03 micrograms/ L. One horse with cecal perforation had TAT concentration of 174.30 micrograms/L, and a horse infused IV with endotoxin had TAT concentration of 62.98 micrograms/L 12 hours after infusion. CONCLUSIONS: The data suggest that human TAT ELISA kits can be used to measure TAT concentration in citrated equine plasma, and that TAT is a marker for hypercoagulation in horses. CLINICAL RELEVANCE: Assays for equine TAT many help to further characterize the hypercoagulable state in horses.