In conclusion, EA and hydrotherapy, both in combination with patient education, induce long-lasting effects, shown by reduced pain and ache and by increased functional activity and quality of life, as demonstrated by differences in the pre- and post-treatment assessments.

SummaryProthrombin complexconcentrates (PCCs) arewidelyadministeredf or emergencyo ral anticoagulation reversal andf or coagulation defects in liver disease.Pharmacokinetic datamay help to optimize treatment.Theobjectiveofthis study was to characterizethe pharmacokineticsofaPCC (BeriplexP/N) containing coagulation factors II (FII),VII (FVII), IX (FIX)and X(FX) and anticoagulant proteins Ca nd S. Fifteen healthyv olunteersr eceived as ingle rapid 50 IU/kgi nfusiono fP CC and underwent frequent blood sampling until 144 hours (h) after infusion. Coagulationfactors and anticoagulantprotein pharmacokinetic parameterswereestimated by non-linear regression.The mean infusionrate of PCC was 7.9ml/min, equivalent to 196.4 IU/min. By the earliestpost-infusion sampling point at 5minutes(min), KeywordsProthrombin complexc oncentrates, pharmacokinetics, safety, blood coagulationfactors, anticoagulation reversal plasma FIX concentration increasedbyamedian of 73%. Median increasesi nF II, FVII and FX at 5m in were 122%,62% and 158%,respectively. Proteins Cand Salsoincreasedrapidly.The median terminal half-lifeofFIX was16.7 h, FII 59.7 h, FVII 4.2 h and FX 30.7 h. Them edian in-vivor ecoveryo fF IX was1 .57 %/IU/kga nd thato ft he othert hree coagulation factors >2 %/IU/kg. Plasma concentration of thrombogenicity marker D-dimer didnot increase,and therewas no clinical evidence of thrombosis.Through up to 12 weeks follow-up there were no laboratoryfindingsindicating PCC-relatedviralexposure.Rapid PCC infusionp roducedp rompts ustained increasesi nc oagulation factors and anticoagulantp roteins with no clinical evidence of thrombosis or viral transmission.

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Background: The feeling of being contaminated (FBC) is a common phenomenon in survivors of childhood sexual abuse (CSA) suffering from posttraumatic stress disorder (PTSD). Thus far, this symptom has been neglected in research and therapy. For this reason, we developed Cognitive Restructuring and Imagery Modification (CRIM), a two-session treatment (lasting 90 and 50 min) that specifically targets the FBC. The present study examined the efficacy of the treatment. Methods: Thirty-four women with CSA-related PTSD (mean age = 37 years) were randomized to either the CRIM group or a waitlist control group. Primary outcomes were intensity, vividness, and uncontrollability of the FBC, associated distress, and PTSD symptoms, which were assessed using the Clinician-Administered PTSD Scale and the Posttraumatic Diagnostic Scale. Outcomes were measured pre- and posttreatment, and at the 4-week follow-up. (M)ANOVAs were used to compare improvements across conditions. Results: All FBC scores yielded a greater reduction in the CRIM group than the waitlist control (WL) group. Between-group effect sizes at follow-up were large and highly significant (intensity: d = 1.52, p < 0.001; vividness: d = 1.28, p < 0.001; uncontrollability: d = 1.77, p < 0.001; distress: d = 1.80, p < 0.001). PTSD symptoms also yielded a greater reduction in the CRIM group than the WL group, with large between-group effect sizes (Clinician-Administered PTSD Scale: d = 0.93, p < 0.001). Conclusions: Our findings support the efficacy of the newly developed CRIM in reducing the FBC and PTSD symptoms in adult survivors of CSA.

Clinical experiences show that many survivors of childhood sexual abuse (CSA) suffer from a distressing feeling of being contaminated (FBC) even years or decades after the last experience of sexual violence. So far, this symptom has been neglected in research. The aim of this article is to illustrate this symptom and the necessity of a specialized treatment. Phenomenology, consequences, and possible concepts of explanation are described. The article presents a newly developed short-time treatment, cognitive restructuring and imagery modification, to reduce the FBC in adult survivors of CSA. Two case studies on women suffering from chronic CSA-related posttraumatic stress disorder (PTSD) plus the FBC demonstrate the outcome of the two-session program that can easily be integrated in a whole treatment program. They show that the treatment results in a reduction of the FBC and PTSD symptoms after CSA.

Electrical low-frequency stimulation (LFS) of spinal afferents induces long-term depression (LTD) of nociceptive processing in rodents. LTD and its parameters in man are largely unknown. This study addresses the hypothesis that LTD of spinal nociception and pain in man depends on LFS frequency (0.5, 1, 2 Hz), number of electrical pulses (300, 600, 1200), intensity (relating to pain threshold I(P): 1 x I(P), 2 x I(P), 4 x I(P)), and on LFS repetition. One hundred and twenty electrophysiological and psychophysical experiments were performed in 29 healthy volunteers. Painful electrical test stimulation (0.125 Hz) and conditioning LFS were applied to right hand dorsum by a concentric electrode. Somatosensory evoked cortical potentials (SEP) were recorded and volunteers rated stimulus intensity. LFS with 0.5, 1, and 2 Hz induced significant reduction of SEP and pain ratings as compared to Control group. Effect on SEP amplitude after 1 Hz LFS preponderated that of 2 Hz stimulation. LTD of SEP and pain perception was induced by noxious LFS with 300-1200 pulses. SEP suppression augmented with increasing number of pulses. LFS with intensities 2 x I(P) and 4 x I(P) evoked sustained depression of SEP and pain perception in comparison to Control and 1 x I(P) LFS. Established LTD after single LFS was amplified by an additional second LFS. Hence this study provides electrophysiological and psychophysical evidence for LTD of spinal nociceptive processing and pain perception in man and indicates appropriate LFS parameters 1 Hz, 1200 pulses and 4 x I(P) for future studies on human LTD.

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Electrical low-frequency stimulation (LFS) of cutaneous afferents reliably induces long-term depression (LTD) of nociception and pain in man. In this study LFS effects on cerebral activation were investigated by functional magnetic resonance imaging (fMRI). In 17 healthy volunteers, nociceptive fibers of right hand dorsum were electrically stimulated via a concentric electrode. Test stimulation sessions consisted of three alternating stimulation periods and rest periods. They were performed before (Pre) and after (Post) conditioning LFS (1200 stimuli, 1Hz) or 20 min break (Control). Volunteers rated sensory and affective pain perception. Before LFS, test stimulation produced activation in bilateral primary and secondary somatosensory cortex (S1,S2), insula, anterior cingulate cortex (ACC), superior temporal cortex (STG), prefrontal cortex and right inferior parietal lobule (IPL). After LFS, exclusively right IPL was activated. Contrast between Pre and Post LFS indicated significant activity decrease in bilateral S1,S2, and ACC and right insula, IPL, and STG. Pre Control and Pre LFS were not different. Activity in Control experiments remained unchanged. Sensory and affective pain rating solely decreased after LFS. Subsequent regression analysis showed significant correlation between pain relief and increased activity after LFS in ACC, anterior insula, striatum, frontal and temporal cortex. The study revealed LTD of pain-related cerebral activation, involving sensory, affective, cognitive, and attentional processes. Positive correlation between pain relief and increased brain activation after LFS may indicate involvement of endogenous pain control mechanisms in LTD. These experiments may help to judge the potency of LTD for future chronic pain treatment.