An Emotional Exposure-Based Treatment of Traumatic Stress for People with Chronic Pain: Preliminary Results for Fibromyalgia Syndrome.

Emotional trauma occurs in many patients with chronic pain, particularly fibromyalgia syndrome (FMS). Current cognitive-behavioral treatments for chronic pain have limited effects, perhaps because the trauma is not addressed, whereas emotional exposure-based treatments improve post-traumatic stress, but have not been tested on chronic pain. We present a novel, brief treatment protocol for people with chronic pain and unresolved trauma (Multi-Stimulus, Multi-Technique Emotional Exposure Therapy), which involves detecting avoidance of a range of emotion-related stimuli, implementing exposure techniques tailored to the patient's avoidances, and negotiating the process and therapeutic alliance.

Preclinical safety and biodistribution of Sindbis virus measles DNA vaccines administered as a single dose or followed by live attenuated measles vaccine in a heterologous prime-boost regimen.

Measles still causes considerable morbidity and mortality among infants and young children in developing countries. To develop a new public health tool to reduce this burden, we designed two Sindbis virus replicon vaccines encoding measles virus (MV) hemagglutinin (H) and fusion (F) proteins (pMSIN-H and pMSINHFdU). Our goal is to administer the vaccines to young infants at 6 and 10 weeks of age to prime the immune system to safely and effectively respond to subsequent immunization at age approximately 14 weeks with the licensed attenuated measles vaccine.

Comparing the effect of arginine vasopressin on ear and finger photoplethysmography.

Study Objective: To test whether the relative insensitivity of craniofacial vessels to catecholamines differs in response to arginine vasopressin.

Design: Prospective, observational human study.

Setting: University hospital.

Functional impairment in body dysmorphic disorder: a prospective, follow-up study.

Cross-sectional/retrospective studies indicate that individuals with body dysmorphic disorder (BDD) have markedly impaired psychosocial functioning. However, no study has prospectively examined functioning in BDD. In this study, which is to our knowledge the first prospective study of the course of BDD, psychosocial functioning was assessed at baseline and over 1-3 years (mean=2.

New episodes and new onsets of major depression in borderline and other personality disorders.

Background: In the context of much literature and conjecture about the relationship of personality disorders (PD) and major depressive disorder (MDD), this paper uses longitudinal data to assess the frequency with which PD patients, and especially those with borderline personality disorder (BPD), have recurrences (for patients with lifetime histories), or new onsets (for patients without lifetime histories) of MDD.

Methods: A sample of 478 PD patients received reliable repeated follow-up assessments over a period of 6 years. The rates of new onsets and recurrences of MDD in all PD patients, and in BPD patients compared to OPD patients were analyzed.

Relationship of hemoglobin A1c to mortality in nonsmoking insurance applicants.

Objective: Determine the relationship between hemoglobin A1c value and 5-year, all-cause mortality in nonsmoking life insurance applicants.

Method: By use of the Social Security Master Death Index, mortality was examined in 286,443 non-smoking insurance applicants aged 40 and up for whom blood samples for hemoglobin A1c were submitted to the Clinical Reference Laboratory. Results were stratified by hemoglobin A1c value, gender and age bands 40 to 59, 60 to 69 and 70 and up.

Using liver enzymes as screening tests to predict mortality risk.

Objective: Determine the relationship between liver function test results (GGT, alkaline phosphatase, AST, and ALT) and all-cause mortality in life insurance applicants.

Method: By use of the Social Security Master Death File, mortality was examined in 1,905,664 insurance applicants for whom blood samples were submitted to the Clinical Reference Laboratory. There were 50,174 deaths observed in this study population.

Estimated plasma bupivacaine concentration after single dose and eight-hour continuous intra-articular infusion of bupivacaine in normal dogs.

Objective: To estimate maximum plasma concentration (C(max)) and time to maximum plasma (t(max)) bupivacaine concentration after intra-articular administration of bupivacaine for single injection (SI) and injection followed by continuous infusion (CI) in normal dogs.

Study Design: Cross-over design with a 2-week washout period.

Animals: Healthy Coon Hound dogs (n=8).

Heterologous prime-boost strategy to immunize very young infants against measles: pre-clinical studies in rhesus macaques.

Infants in developing countries are at high risk of developing severe clinical measles if they become infected during the "window of vulnerability" (age 4-9 months), when declining maternal antibodies do not protect against wild virus, yet impede successful immunization by attenuated measles vaccine. We developed two Sindbis replicon-based DNA vaccines expressing measles virus hemagglutinin and fusion protein with the goal of priming young infants to respond safely and effectively to subsequent boosting with attenuated measles vaccine. Intradermal prime with DNA vaccines by needle-free injection followed by aerosol or parenteral boost with licensed measles vaccine was well tolerated by juvenile and young infant rhesus macaques, and protected against clinical measles and viremia on wild-type virus challenge.

The relationship between the photoplethysmographic waveform and systemic vascular resistance.

Objective: The objective of this study was to determine the relationship between systemic vascular resistance (SVR), finger & ear photoplethysmographic measurements in 14 adult patients undergoing coronary artery bypass grafting (CABG).

Methods: Patients were monitored with photoplethysmographs of the finger and ear and continuous cardiac output (QT) via thermodilution catheter. The relationship between SVR, finger plethysmographic amplitude, width and ear plethysmographic amplitude, width was assessed with linear regression.

Topical non-iontophoretic application of acetylcholine and nitroglycerin via a translucent patch: a new means for assessing microvascular reactivity.

Objective: Assessments of endothelial cell function with acetylcholine have typically used systemic, regional intra-arterial, or iontophoretic delivery of drug. Each of these techniques induces systemic and/or local changes that compromise their safety or effectiveness. Using translucent drug preparations applied under laser Doppler flowmetry (LDF) probes, we tested whether local vasodilation can be induced with non-iontophoretic transdermal delivery of acetylcholine and how such dilation would compare to the dilation achieved with topical nitroglycerin in healthy volunteers.

Impact of withdrawal of 450 ml of blood on respiration-induced oscillations of the ear plethysmographic waveform.

Objective: It has been widely appreciated that ventilation-induced variations in systolic blood pressure during mechanical ventilation correlate with changes in intravascular volume. The present study assessed whether alterations in volume status likewise can be detected with noninvasive monitoring (ear plethysmograph) in non-intubated subjects (awake volunteers).

Methods: Eight healthy adults were monitored with EKG, noninvasive blood pressure, an unfiltered ear plethysmograph, and a respiratory force transduction belt before (PRE) and after (POST) withdrawal of 450 ml of blood from an antecubital vein.

Longitudinal diagnostic efficiency of DSM-IV criteria for borderline personality disorder: a 2-year prospective study.

Objective: To examine the longitudinal diagnostic efficiency of the DSM-IV criteria for borderline personality disorder (BPD).

Methods: At baseline, we used semistructured diagnostic interviews to determine criteria and diagnoses; blinded assessments were performed 24 months later with 550 participants. Diagnostic efficiency indices (specifically, conditional probabilities, total predictive power, and kappa) were calculated for each criterion determined at baseline, with the independent BPD diagnosis at follow-up used as the standard.

Positive childhood experiences: resilience and recovery from personality disorder in early adulthood.

Objective: Recent follow-along studies of personality disorders have shown significant improvement in psychopathology over time. The purpose of this study was to prospectively investigate the association between positive childhood experiences related to resiliency and remission from personality disorder.

Method: Five hundred twenty patients with DSM-IV-based semistructured interview diagnoses of schizotypal, borderline, avoidant, or obsessive-compulsive personality disorders were evaluated 6 times over 4 years between September 1996 and June 2002.

Intracellular targeting of CEA results in Th1-type antibody responses following intradermal genetic vaccination by a needle-free jet injection device.

The route and method of immunization, as well as the cellular localization of the antigen, can influence the generation of an immune response. In general, intramuscular immunization results in Th1 responses, whereas intradermal delivery of DNA by gene gun immunization often results in more Th2 responses. Here we investigate how altering the cellular localization of the tumor antigen CEA (carcinoembryonic antigen) affects the quality and amplitude of DNA vaccine-induced antibody responses in mice following intradermal delivery of DNA by a needle-free jet injection device (Biojector).

Advancing the analysis of treatment process.

Aims: To review the role of process research in clinical research, to summarize progress in statistical methods for process analyses, and to describe a dynamic analytical approach that can provide new insights into the processes responsible for the effects of treatments and other variables.

Summary: Process research helps us to understand what happens during our interventions, and can yield valuable knowledge regardless of whether an intervention is found to have significant effects. This is a review of recent statistical advances for dealing with missing data, tests for mediation and hierarchical modeling and demonstrate how these advances can help process researchers overcome obstacles that had limited past studies.

Pre-clinical evaluation of a CEA DNA prime/protein boost vaccination strategy against colorectal cancer.

In preparation for a clinical trial in patients diagnosed with colorectal cancer, a vaccination strategy targeting the carcinoembryonic antigen (CEA) was evaluated in mice using a GMP-produced plasmid DNA vaccine, CEA66, encoding a truncated form of the tumour-associated antigen, CEA. The GMP-produced CEA DNA vaccine was also evaluated for toxicity. Repeated intradermal administration of the GMP-produced vaccine using a novel needle-free jet injection device (Biojector) induced robust CD4 and CD8 T-cell responses in mice, and did not result in any vaccine-related toxicity.

A new multi-clade DNA prime/recombinant MVA boost vaccine induces broad and high levels of HIV-1-specific CD8(+) T-cell and humoral responses in mice.

The results presented here are from the preclinical evaluation in BALB/c mice of a DNA prime/modified vaccinia virus Ankara (MVA) boost multi-gene multi-subtype human immunodeficiency virus-1 (HIV-1) vaccine intended for use in humans. The plasmid DNA vaccine was delivered intradermally using a Biojector, and the MVA was delivered intramuscularly by needle. This combination of recombinant DNA and MVA proved to induce extraordinarily strong cellular responses, with more than 80% of the CD8(+) T cells specific for HIV-1 antigens.

Deficiency of fatty acid-binding proteins in mice confers protection from development of experimental autoimmune encephalomyelitis.

Fatty acid-binding proteins (FABPs) act as intracellular receptors for a variety of hydrophobic compounds, enabling their diffusion within the cytoplasmic compartment. Recent studies have demonstrated the ability of FABPs to simultaneously regulate metabolic and inflammatory pathways. We investigated the role of adipocyte FABP and epithelial FABP in the development of experimental autoimmune encephalomyelitis to test the hypothesis that these FABPs impact adaptive immune responses and contribute to the pathogenesis of autoimmune disease.

Natural course of bulimia nervosa and of eating disorder not otherwise specified: 5-year prospective study of remissions, relapses, and the effects of personality disorder psychopathology.

Objective: To examine prospectively the natural course of bulimia nervosa and eating disorder not otherwise specified (EDNOS) and to test for the effects of personality disorder psychopathology on remission and relapse.

Method: Subjects were 92 female patients with current bulimia nervosa (N = 23) or EDNOS (N = 69) at baseline enrollment in the Collaborative Longitudinal Personality Disorders Study. Axis I psychiatric disorders (including eating disorders) were assessed with the Structured Clinical Interview for DSM-IV Axis I Disorders-Patient Version, and personality disorders were assessed with the Diagnostic Interview for DSM-IV Personality Disorders (DIPD-IV).

Enhanced immunity to Plasmodium falciparum circumsporozoite protein (PfCSP) by using Salmonella enterica serovar Typhi expressing PfCSP and a PfCSP-encoding DNA vaccine in a heterologous prime-boost strategy.

Two Salmonella enterica serovar Typhi strains that express and export a truncated version of Plasmodium falciparum circumsporozoite surface protein (tCSP) fused to Salmonella serovar Typhi cytolysin A (ClyA) were constructed as a first step in the development of a preerythrocytic malaria vaccine. Synthetic codon-optimized genes (t-csp1 and t-csp2), containing immunodominant B- and T-cell epitopes present in native P. falciparum circumsporozoite surface protein (PfCSP), were fused in frame to the carboxyl terminus of the ClyA gene (clyA::t-csp) in genetically stabilized expression plasmids.

Five-factor model personality traits associated with alcohol-related diagnoses in a clinical sample.

Objective: Personality variables may have important implications for the description and treatment of individuals with alcohol problems. The purpose of this article was to examine the specificity of previously observed trait/alcohol relations and the temporal relations of trait elevations and alcohol problems.

Method: The relationships between Five-Factor Model personality traits, as measured by the Revised NEO Personality Inventory, and past and current alcohol diagnoses were examined among 704 participants in the Collaborative Longitudinal Personality Disorders Study (CLPS).

Moderate drinking in the first year after treatment as a predictor of three-year outcomes.

Objective: The relationship between moderate alcohol consumption in the first year following alcohol treatment admission and longer-term functioning is clinically important and pertains to the clinical course of alcohol-use disorders. This study investigated these relationships, focusing on the first year posttreatment admission and 3 years later.

Method: Analyses were conducted on the outpatient Project MATCH (Matching Alcoholism Treatments to Client Heterogeneity) sample (n = 952 at baseline, and n = 802 at Months 37-39).

Taboo thoughts and doubt/checking: a refinement of the factor structure for obsessive-compulsive disorder symptoms.

The purpose of this report was to improve upon earlier factor analyses of obsessive-compulsive disorder (OCD) symptom categories by minimizing the heterogeneity in the aggressive obsessions category. An exploratory factor analysis was conducted on data from 293 adults with primary OCD. The resulting five factors (Symmetry/Ordering, Hoarding, Doubt/Checking, Contamination/Cleaning, and Taboo Thoughts) are phenomenologically more homogeneous than prior category-based factors and are consistent with those derived in previous item-level analyses.