An Evidence-Based Review of Early Intervention and Prevention of Posttraumatic Stress Disorder.

We present an evidence-based review of post-trauma interventions used to prevent posttraumatic stress disorder (PTSD). Literature search of PubMed from 1988 to March 2016 using keywords "Early Intervention AND Prevention of PTSD" yielded 142 articles, of which 52 intervention studies and 6 meta-analyses were included in our review. Trauma-focused cognitive behavioral therapy and modified prolonged exposure delivered within weeks of a potentially traumatic event for people showing signs of distress have the most evidence in the treatment of acute stress and early PTSD symptoms, and the prevention of PTSD. Even though several pharmacological agents have been tried, only hydrocortisone prior to high-risk surgery, severe traumatic injury, or during acute sepsis has adequate evidence for effectiveness in the reduction of acute stress symptoms and prevention of PTSD. There is an urgent need to determine the best targets for interventions after trauma to accelerate recovery and prevent PTSD.

Effects of changing from full range of motion to partial range of motion on squat kinetics.

It is commonplace for people involved in recreational weight training to limit squat depth to lift heavier loads. This study compares differences in movement kinetics when squatting in the full range of motion (FROM) vs. partial range of motion (PROM). Ten men with a 1-year minimum of resistance training attended 4 sessions each comprising 4 sets of squats following one of FROM for 10 repetitions (FROM10) at an intensity of 67% 1 repetition maximum (1RM) FROM squat, PROM for 10 repetitions (PROM10) at 67% 1RM PROM squat, FROM for 5 repetitions (FROM5) at 83% FROM squat or PROM for 5 repetitions (PROM5) at 83% 1RM PROM squat. Movement velocity was not specified. Squat kinetics data were collected using an optical encoder. Differences between conditions were analyzed by repeated-measures analysis of variance and expressed as mean differences and standardized (Cohen) effect sizes with 95% confidence limits. The PROM5 power was substantially more than the PROM10 (98 W, -21 to 217; mean, lower and upper 95% confidence limits), FROM5 (168 W, 47-289), and FROM10 (255 W, 145-365). The force produced during PROM5 was substantially more than PROM10 (372 N, 254-490), FROM5 (854 N, 731-977), and FROM10 (1,069 N, 911-1227). The peak velocity produced during FROM10 was substantially more than FROM5 (0.105 m·s(-1), 0.044-0.166), PROM10 (0.246 m·s(-1), 0.167-0.325), and PROM5 (0.305 m·s(-1), 0.228-0.382). The FROM5 was substantially more than FROM10 (86 J, 59-113), PROM5 (142 J, 90-194), and PROM10 (211 J, 165-257). Therefore, either range of motion can have practical implications in designing resistance training programs depending on if the training goal is related to power and force development, maximizing work output or speed. Moderate-load PROM training, common among recreational weight trainers, is unlikely to provide higher movement kinetics.

Excellent outcome using "impaired" standard criteria donors with elevated serum creatinine.

INTRODUCTION: To maximize organ utilization, the United Network for Organ Sharing (UNOS) encourages use of Expanded Criteria Donors (ECD). However, Standard Criteria Donors (SCD) may also be under-utilized, some centers discarding kidneys with serum creatinine (S.Cr) >2.0 at nephrectomy. Our experience with the use of such "impaired'' kidneys was reviewed retrospectively. RESULTS: From January 1, 2003 to October 1, 2006, of 130 DD kidneys transplanted at our center, 26 were ECD. Also, 22 kidneys were from Impaired SCD (ISCD), with mean S.Cr 3.2 (2.1-4.4) at nephrectomy; eight of these had S.Cr >4.0. For these 22 ISCD, mean age was 22 yrs (11-42), sex: 16 Males; race:12 Caucasians/10 African-Americans; All had evidence of rhabdomyolysis (Mean peak CPK 11,924 u/l). Thirty-seven percent came from outside OPOs. Recipient demographics: age 45 years; sex 50% male, 45% African-American. Mean HLA match was 1; dialysis was required in 28% within the first week. Mean length of stay was 10.7 days. Average discharge S.Cr was 4.2. All kidneys are currently functioning (S.Cr at 3 months, 6 months and 1 year 1.6, 1.7 and 1.7 respectively). CONCLUSION: An elevated creatinine should not be the only cause for discarding deceased donor kidneys.

Involvement of the mitochondrial pathway in cold storage and rewarming-associated apoptosis of human renal proximal tubular cells.

The cellular and molecular mechanisms of cold storage-ATN are not well characterized. In our earlier studies, cold storage caused necrosis of human proximal tubular epithelial (RPTE) cells, whereas apoptosis was prominent during rewarming. An intriguing finding was the pronounced swelling of the mitochondria in the cold, which promoted us to further characterize its role in rewarming-associated apoptosis. Human proximal tubular epithelial cells were cold stored in University of Wisconsin (UW) solution for 48 h followed by 24 h of rewarming in regular cell culture medium. During the cold storage, there was no significant change in the Bcl-2 to Bax protein ratio, mitochondrial location of cytochrome C or caspse-3 activity. However, during rewarming, the Bcl-2 to Bax ratio increased, cytochrome C was translocated to cytosol, and caspase-3 was activated: events and timing were consistent with the occurrence of apoptosis during rewarming. In a time-course experiment, mitochondrial swelling was discernable by electron microscopy as early as at 2 h. Cold storage of isolated-mitochondria for 2 h was attended by an increase in the opening of the permeability transition pores (PTP), suggesting PTP opening as an early mechanism for mitochondrial swelling. Addition of antioxidants (deferoxamine or 2-methyaminochroman) to the storage solution suppressed mitochondrial pore opening and swelling, Bcl-2 to Bax ratio increase, cytochrome C translocation, caspase-3 activation as well as rewarming-induced apoptosis. Our data demonstrate for the first time that apoptosis following cold storage and rewarming of human renal tubular cells is accompanied by specific mitochondrial events, and that these events and apoptosis can be suppressed by adding antioxidants to the cold storage solution.