Comparing the unified protocol for transdiagnostic treatment of emotional disorders to prolonged exposure for the treatment of PTSD: Design of a non-inferiority randomized controlled trial.

Background: Prolonged Exposure (PE), a trauma-focused therapy, is one of the most efficacious treatments available for PTSD. However, many people with PTSD do not lose their diagnosis following delivery of PE. The Unified Protocol (UP) for Transdiagnostic Treatment of Emotional Disorders is a non-trauma focused treatment that may offer an alternative treatment for PTSD. Methods: This paper describes the study protocol for IMPACT, an assessor-blinded randomized controlled trial that examines the non-inferiority of UP relative to PE for participants who meet DSM-5 criteria for current PTSD. One hundred and twenty adult participants with PTSD will be randomized to receive either 10 × 90-min sessions of UP or PE with a trained provider. The primary outcome is severity of PTSD symptoms assessed by the Clinician Administered PTSD Scale for DSM-5 (CAPS-5) at post-treatment. Discussion: While evidence-based treatments are available for PTSD, high levels of treatment dropout and non-response require new approaches to be tested. The UP is based on emotion regulation theory and is effective in treating anxiety and depressive disorders, however, there has been limited application to PTSD. This is the first rigorous study comparing UP to PE in a non-inferiority randomized controlled trial and may help improve clinical outcomes for those with PTSD. Trial registration: This trial was prospectively registered with the Australian New Zealand Clinical Trials Registry, Trial ID (ACTRN12619000543189).

Influence of indomethacin on the regenerative process of the tail fin of teleost: morphometric and ultrastructural analysis.

When partially amputated or severely injured, teleost fins suffer a regenerative process called epimorphic regeneration characterised by the following stages: the formation of a multistratified epidermal layer, the disorganisation and distal migration of multipotent mesenchymal cells, the proliferation of these cells in order to form the blastema, continuous proliferation of distal blastema to facilitate the growth, and differentiation of the proximal blastema in order to restore its lost structure. The regeneration of the fin is extremely sensitive to the action of some drugs that can interfere in its structure restoration. For this reason, and also based on papers relating that indomethacin can interfere somehow in the tissue restoration of many different organisms, the aim of this work is to evaluate the possible effects of this drug in three different doses in the regeneration of the teleost fish tail fin, taking into consideration the synthesis, the disposition and organisation of lepidotrichial matrix components, the restoration of actinotrichia, as well as the fin area itself. Therefore, histochemical, ultrastructural and morphometric analysis were done and it was observed that indomethacin in doses of 20 and 30 mg.L-1 caused a delay in the regenerative process of the dermal skeleton (lepidotrichia and actinotrichia) of the tail fins. These doses could have interfered, momentarily, in the process of blastemal cell differentiation in the cells responsible for the synthesis and disposition of actinotrichia and lepidotrichia or, even interfered in the signalling necessary for the recent differentiated cells to begin synthesising the components of the dermal skeleton.

Histological study of the dynamics in epidermis regeneration of the carp tail fin (Cyprinus carpio, Linnaeus, 1758).

Teleostean fins when partially amputated suffer a regenerative process called epimorphic regeneration, characterized by the following stages: healing, based on the formation of a multistratified epidermal layer, the formation of a mass of pluripotent cells known as blastema, the differentiation of these cells, the synthesis and disposition of the extracellular matrix, morphological growth and restoration. The epidermis has a fundamental role in the regenerative process of fish fins, as the healing time of this structure leads it to a faster regenerative process and it also works as a defense against the external environment. In this sense, due to the fast regeneration shown by the epidermis, the aim of this paper is to study the histology of the regenerative dynamics of the carp fin tail (Cyprinus carpio), under the light and transmission electron microscope. Epidermic regeneration begins right in the first hours after the fin amputation and it continues throughout the regenerative process. After 24 hours, an apical epidermal cap is established. Cytoplasmatic prolongations and intercellular junctions are observed and the cells of the basal layer of the epidermis change from the cubic form to the cylindrical, due to the development of the cytoplasmatic organelles responsible for the synthesis of the basal membrane, lost after amputation. These results show the importance of histological studies in regenerative processes. We believe that the association of molecular biology with histological studies can throw further light onto these regenerative dynamics.

The regeneration of the tail fin actinotrichia of carp (Cyprinus carpio, Linnaeus, 1758) under the action of naproxen.

A conglomerate of small, rigid, fusiform spicules known as actinotrichia sustains the edge of tail fins of teleost. After amputation, these structures show an extremely fast regenerative capacity. In this study we observed the effect of a nonsteroidal anti-inflammatory drug, naproxen, used in the treatment of degenerative articular diseases, during the process of actinotrichia regeneration. For this purpose, regenerating tissue from animals in contact with the drug was submitted to histochemical and ultrastructural analysis in comparison to tissue from animals under normal conditions, i.e., not in contact with the drug in question. Actinotrichia regeneration was similar in both animals, indicating that naproxen, at the dose used in the present study, did not interfere with actinotrichia synthesis during the regenerative process of the tail fin. This could be because naproxen did not influence the expression of the genes required for the regeneration process, such as the Sonic hedgehog (Shh) gene, which is involved in actinotrichia formation.

Effect of naproxen on tail fin regeneration in teleost.

In the present investigation we studied the effect of naproxen, a non-steroidal anti-inflammatory drug used for the treatment of rheumatic disease, on the synthesis of the lepidotrichial matrix of the tail fin of the teleost fish Cyprinus carpio (carp) during the regeneration process. The lepidotrichial synthesis was observed by standard and polarized light microscopy and by transmission electron microscopy. In general, naproxen at the dose used in the present study did not affect the organization of the extracellular matrix components and the mineralization of the fundamental substance of the lepidotrichia during the process of tail fin regeneration. Since the effect of naproxen, as well as of other non-steroidal anti-inflammatory drugs, depends on the dose used, the route of administration and the metabolism of the animal in which the drug is being tested, higher doses of the drug may perhaps delay or even fully inhibit this process, possibly also provoke disorganization of the lepidotrichial matrix.

[Regulations on the interruption of pregnancy in current German criminal law]. / Die Regelung des Schwangerschaftsabbruchs im geltenden deutschen Strafrecht.

The necessity of a revised law for induced abortion (section 218 StGB) originated by the insufficiency of the existing law and by the liberal standpoint of foreign laws which allowed an escape to foreign countries creating at the same time the danger of a "privilege for the rich". In the so-called "Indikationslösung induced abortion is generally liable to prosecution. This does not include the hindrance of nidation, the morning-after-pill, intrautere devices and timely curettage. The woman is unpunished if the operation is done by a physician and if preceeded by the legal council. Insufficient is the term "special distress" (besondere Bedrängnis) in which the court can withdraw a punishment. The new law favours the woman and burdens the physicians with responsibility to determine the indication, to give the medical and in some instances the social consultation. Each of these requirements is under penalty if not followed.

[On the legal situation associated with prophylactic measures in ophthalmology (author's transl)]. / Zur rechtlichen Situation bei prophylaktischen Massnahmen in der Ophthalmologie.

Every medical procedure (diagnosis, prophylaxis, treatment) is in German law an assault and must be preceded by evidence of actual consent of the patient. Is this consent not present, then the requirements for a legal process are there. The doctor has freedom of choice of treatment, but he must explain to the patient possible side-effects and complications i.e. enlighten the patient. A significant proportion of damage- and criminal processes are due to incomplete explanation. The kind, form and complications of a procedure must be mentioned understandibly--the complications independent of their incidence. The guidelines resulting from processes are vague and ambiguous. Formed notes with confirmation by a witness are advisable. The value of an explanatory booklet seems doubtful.