1.Investigation of parasitic infection in food on market in Qingpu District of Shanghai during 2015‒2023
Chengcheng WANG ; Changpo LIN ; Yanli DAI ; Zhicheng ZHANG ; Qunqun LIU ; Yadong MA ; Xueqin YU
Shanghai Journal of Preventive Medicine 2025;37(3):260-264
ObjectiveTo understand the status of parasitic infection in the food sold on market in Qingpu District of Shanghai, and to provide an evidence for the development of prevention and control strategies for parasitic infection applicable to Qingpu District. MethodsAquatic products, meat products and other foodstuffs sold on online shops, at farm product markets, supermarkets/foodstores and restaurants were sampled in Qingpu District, Shanghai, during 2015‒2023, based on the administrative division of Qingpu District. The parasitic infection in the food samples were examined using pressing method and digestion for detecting metacercariae in freshwater products and pickled products, using dissection microscopy for Anisakis larvae in seawater products, Taenia cysticercus and Trichinella encysted larvae in meat products. ResultsA total of 1 079 samples of food products were examined during 2015‒2023, with a total parasite infection rate of 13.44%. The total parasite infection rate of freshwater fish products was 3.40% (16/471), and the difference of parasite infection rates between different freshwater fish species was statistically significant (χ2=229.609, P=0.001). The total infection rate of Clonorchis sinensis was 3.18% (15/471), which had been detected in Pseudorasbora parva, Cyprinidae rhodeus, and Carassius auratus, with a positive rate of 77.78% (7/9), 50.00% (5/10) and 3.90% (3/77), respectively. Metorchis orientalis was detected in in Pseudorasbora parva, with a positive rate of 33.33% (3/9). The positive rate of Gnathostoma spinigerum (third-stage larvae) was 0.81%. Paragonimus metacercariae were not detected in the freshwater shrimps and crabs. The infection rate of seawater fish products was 26.46%. The difference of parasite infection rate in seawater fishes was statistically significant (χ2=109.181, P=0.001). A total of 53 pork and beef samples were tested, none was detected with Trichinella larva cysts, Taenia solium metacercariae, and Taenia saginata metacercariae. The total infection rate of pickled yellow mud snail products was 58.11% (43/74). Paragonimus metacercariae was not detected in any of the pickled aquatic product samples. ConclusionThere are different degrees of parasitic infection in freshwater products, seawater products and pickled aquatic products in Qingpu District of Shanghai. The risk of parasite infection from raw or undercooked foods is high. Health education on healthy dietary practices such as throughly cooked food should be strengthened for local residents.
2.Vascular suture, closure and occlusion devices at femoral artery puncture hemostasis after neuro-intervention: a clinical comparative study
Shuailong SHI ; Shuhai LONG ; Sun YU ; Chengcheng SHI ; Ji MA ; Renying MIAO ; Yan SONG ; Xinwei HAN ; Tengfei LI
Chinese Journal of Radiology 2024;58(1):71-78
Methods:From February 2018 to January 2022, the clinical data of 1 123 patients who underwent Starclose vascular closure device, Angio-Seal and Exoseal vascular occlusion devices and Perclose ProGlide vascular suture device at femoral artery puncture hemostasis after neuro-intervention, in the Department of Interventional Radiology (Eastern District), The First Affiliated Hospital of Zhengzhou University, were retrospectively analyzed. The patients were divided into three groups based on the intervention method: the closure group (Starclose, n=271), the occlusion group (Angio-Seal, n=327 and Exoseal, n=352) and the suture group (ProGlide, n=173). Next, the hemostatic efficacy and complications associated with the three devices were analyzed and compared. Additionally, regression analysis was conducted to identify any relevant factors that may contribute to complications. Results:Three vascular hemostatic devices demonstrated effective hemostasis and the success rate were 92.6% in the closure group (Starclose), 93.4% in the occlusion group (Angio-Seal 93.0% and Exoseal 93.8%) and 89.6% in the suture group (ProGlide). There was no statistically significant difference( χ2=3.026, P=0.388). Single or multiple complications were observed in 102 patients (9.1%), including local oozing (16 cases in the closure group, 39 cases in the occlusion group, 13 cases in the suture group), local hematoma (14 cases in the closure group, 31 cases in the occlusion group, 11 cases in the suture group), pseudoaneurysm (13 cases in the closure group, 35 cases in the occlusion group, 10 cases in the suture group), local infection (2 cases in the closure group, 3 cases in the occlusion group, 1 case in the suture group). There were no statistically significant differences ( P>0.05). Moreover, serious complications such as femoral artery occlusion, embolus shedding and permanent nerve injury weren′t observed in the three groups. Multivariate logistic regression analysis revealed that overweight ( OR=1.562,95% CI 1.023—2.385, P=0.039), femoral artery with calcified plaque ( OR=1.934,95% CI 1.172-3.189, P=0.010), combined use of multiple antiplatelet drugs ( OR=1.769,95% CI 1.103—2.839, P=0.018), use of an 8F sheath( OR=2.824,95% CI 1.406—5.671, P=0.004) and the operator′s proficiency ( OR=0.508,95% CI 0.328—0.788, P=0.002) were the independent factors influencing complications, of which the first four were identified as risk-promoting factors for complications while the operator′s rich experience and high proficiency were the protective factors. Conclusions:Three hemostatic devices demonstrate effective hemostasis and comparable rates of complications at femoral artery puncture hemostasis after neuro-intervention. Overweight, femoral artery with calcified plaque, combined use of multiple antiplatelet drugs, use of an 8 F sheath and the operator′s proficiency were independent factors influencing complications.Ojective:To investigate the efficacy and complications associated with vascular suture, closure and occlusion devices at femoral artery puncture hemostasis after neuro-intervention.
3.Breast imaging reporting and data system classification combined with mammography radiomics for differentiating breast benign and malignant amorphous calcification lesions
Xinxin LI ; Xiuting CHEN ; Jie LI ; Li YANG ; Xiaomin TANG ; Jing YAN ; Chengcheng MA ; Zhizhen GAO
Chinese Journal of Medical Imaging Technology 2024;40(10):1519-1523
Objective To observe the value of breast imaging reporting and data system(BI-RADS)classification combined with mammography(MG)radiomics for differentiating breast benign and malignant amorphous calcification lesions.Methods A total of 217 breast amorphous calcification lesions in 206 female patients,including 43 malignant and 174 benign ones were retrospectively enrolled and randomly divided into training set(n=151)and validation set(n=66)at the ratio of 7∶3.Then radiomics features were screened based on breast MG images.BI-RADS model,radiomics model and combined model were established,and the value of each model for distinguishing benign and malignant lesions was observed.Results Eight optimal radiomics features were selected.The area under the curve(AUC)of BI-RADS model,radiomics model and combined model for differentiating breast benign and malignant amorphous calcification lesions was 0.821,0.763 and 0.897 in training set,0.800,0.746 and 0.893 in validation set,respectively,AUC of combined model was significantly higher than that of the other two(both P<0.05).Conclusion BI-RADS classification combined with MG radiomics was helpful for differential diagnosis of breast benign and malignant amorphous calcification lesions,with efficacy higher than that of each alone.
4.Rho kinase inhibitor Y27632 promotes survival of human induced pluripotent stem cells during differentiation into functional midbrain dopaminergic progenitor cells in vitro
Yangyang LI ; Jiajia XU ; Chengcheng JIANG ; Zilong CHEN ; Ying CHEN ; Mengjiao YING ; Ao WANG ; Caiyun MA ; Chunjing WANG ; Yu GUO ; Changqing LIU
Journal of Southern Medical University 2024;44(2):236-243
Objective To improve the efficiency of induced differentiation of primitive neural epithelial cells derived from human induced pluripotent stem cells(hiPSCs-NECs)into functional midbrain dopaminergic progenitor cells(DAPs).Methods HiPSCs were cultured in mTeSRTM medium containing DMH1(10 μmol/L),SB431542(10 μmol/L),SHH(200 ng/mL),FGF8(100 ng/mL),purmorphamine(2 μmol/L),CHIR99021(3 μmol/L),and N2(1%)for 12 days to induce their differentiation into primitive neuroepithelial cells(NECs).The hiPSCs-NECs were digested with collagenase IV and then cultured in neurobasal medium supplemented with 1%N2,2%B27-A,BDNF(10 ng/mL),GDNF(10 ng/mL),AA,TGF-β,cAMP,and 1%GlutaMax in the presence of different concentrations of Rho kinase inhibitor Y27632,and the culture medium was changed the next day to remove Y27632.Continuous induction was performed until day 28 to obtain DAPs.Results Human iPSCs expressed the pluripotency markers OCT4,SOX2,Nanog,and SSEA1 and were positive for alkaline phosphatase staining.The hiPSCs-NECs were obtained on day 13 in the form of neural rosettes expressing neuroepithelial markers SOX2,nestin,and PAX6.In digested hiPSCs-NECs,the addition of 5 μmol/L Y27632 significantly promoted survival of the adherent cells,increased cell viability and the proportion of S-phase cells(P<0.01),and reduced the rate of apoptotic cells(P<0.05).On day 28 of induction,the obtained cells highly expressed the specific markers of DAPS(TH,FOXA2,NURR1,and Tuj1).Conclusion Treatment with Y27632(5 μmol/L)for 24 h significantly promotes the survival of human iPSCs-NECs during their differentiation into DPAs without affecting the cell differentiation,which indirectly enhances the efficiency of cell differentiation.
5.Efficacy analysis of precise and empirical bismuth-containing quadruple therapy guided by clarithromycin sensitivity testing in the first eradication of Helicobacter pylori in Ningxia
Chengcheng FENG ; Linke MA ; Jun LIU ; Xue LI ; Xiaoming SU ; Yuanyuan TANG ; Xiaofei LI ; Yanling LI ; Qiang WEI ; Zhanbin HOU ; Xilong ZHANG ; Shengjuan HU
Chinese Journal of Digestion 2024;44(5):302-307
Objective:To explore the efficacy of precise and empirical bismuth-containing quadruple therapy guided by clarithromycin sensitivity testing in the first eradication of Helicobacter pylori ( H. pylori) in Ningxia. Methods:From August 12, 2022 to March 22, 2023, 600 patients diagnosed as H. pylori-positive by 14C-urea breath test ( 14C-UBT) for the first time in People′s Hospital of Ningxia Hui Autonomous Region, Ningnan Hospital of People′s Hospital of Ningxia Hui Autonomous Region, Zhongwei People′s Hospital, Yanchi County People′s Hospital, and Pingluo People′s Hospital were selected, and divided into empirical treatment group (hereinafter referred to as the empirical group), genetic testing group (hereinafter referred to as the genetic group), and drug sensitivity testing group (hereinafter referred to as the drug sensitivity group) by using random number table with 200 patients in each group. The empirical group did not undergo drug sensitivity testing and genetic testing, while the genetic and drug sensitivity groups were confirmed to be sensitive to clarithromycin through genetic testing and drug sensitivity testing, and the patients with drug-resistant were excluded, respectively. All the patients of the 3 groups received the same clarithromycin bismuth-containing quadruple therapy. Intention-to-treat (ITT) and per-protocol (PP) analyses were performed to compare the eradication rates of H. pylori among 3 groups. Cost-effectiveness ratio (CER) and incremental cost-effectiveness ratio (ICER) were used for cost-effectiveness and sensitivity analysis based on the ITT. Chi-square test was used for statistical analysis. Results:There were 200, 126, and 168 patients included in the empirical group, genetic group, and drug sensitivity group in ITT analysis, and 190, 123, and 164 patients were enrolled in the 3 groups in PP analysis, respectively. The results of ITT analysis showed that the eradication rates of H. pylori in the empirical group, genetic group, and drug sensitivity group were 80.5% (161/200), 94.4% (119/126), and 95.2% (160/168), respectively. The results of PP analysis indicated that the eradication rates of H. pylori in the 3 groups were 84.7% (161/190), 96.7% (119/123), and 97.6% (160/164), respectively, and the differences were statistically significant ( χ2=25.39 and 24.93, both P<0.001). The H. pylori eradication rates of genetic group and drug sensitivity group were both higher than that of empirical group in ITT and PP analysis( χ2=12.40, 17.80, 11.42, and 17.13; all P<0.001). The cost-effectiveness analysis showed that the direct treatment cost of the empirical group, genetic group, and drug sensitivity group was 400.8, 729.2, and 779.2 yuan, respectively, and the CER was 4.98, 7.72, and 8.18 yuan/%, respectively. Compared to the empirical group, the ICER of the genetic group and drug sensitivity group was 23.6 and 25.7 yuan/%, respectively. The sensitivity analysis demonstrated that, when the cost of genetic testing reduced or increased by 20%, the ICER of the genetic group compared to the empirical group was 21.8 or 25.5 yuan/%, respectively. When the cost of drug sensitivity testing reduced or increased by 20%, the ICER of the drug sensitivity group compared to the empirical group was 23.3 or 28.2 yuan/%. When the cost of gastroscopy reduced or increased by 20%, the ICER of the genetic group compared to the empirical group was 20.8 or 26.5 yuan/%, and the ICER of the drug sensitivity group compared to the empirical group was 23.0 or 28.4 yuan/%, respectively. Conclusion:In Ningxia, if the clarithromycin bismuth-containing quadruple regimen is applied as the first H. pylori eradication regimen, in order to achieve the clinical eradication efficacy of H. pylori, and the patients can accept an additional payment of 23.6 or 25.7 yuan for each 1% increasing in the H. pylori eradication rate, then the precision treatment after clarithromycin resistance test is recommended.
6.Rho kinase inhibitor Y27632 promotes survival of human induced pluripotent stem cells during differentiation into functional midbrain dopaminergic progenitor cells in vitro
Yangyang LI ; Jiajia XU ; Chengcheng JIANG ; Zilong CHEN ; Ying CHEN ; Mengjiao YING ; Ao WANG ; Caiyun MA ; Chunjing WANG ; Yu GUO ; Changqing LIU
Journal of Southern Medical University 2024;44(2):236-243
Objective To improve the efficiency of induced differentiation of primitive neural epithelial cells derived from human induced pluripotent stem cells(hiPSCs-NECs)into functional midbrain dopaminergic progenitor cells(DAPs).Methods HiPSCs were cultured in mTeSRTM medium containing DMH1(10 μmol/L),SB431542(10 μmol/L),SHH(200 ng/mL),FGF8(100 ng/mL),purmorphamine(2 μmol/L),CHIR99021(3 μmol/L),and N2(1%)for 12 days to induce their differentiation into primitive neuroepithelial cells(NECs).The hiPSCs-NECs were digested with collagenase IV and then cultured in neurobasal medium supplemented with 1%N2,2%B27-A,BDNF(10 ng/mL),GDNF(10 ng/mL),AA,TGF-β,cAMP,and 1%GlutaMax in the presence of different concentrations of Rho kinase inhibitor Y27632,and the culture medium was changed the next day to remove Y27632.Continuous induction was performed until day 28 to obtain DAPs.Results Human iPSCs expressed the pluripotency markers OCT4,SOX2,Nanog,and SSEA1 and were positive for alkaline phosphatase staining.The hiPSCs-NECs were obtained on day 13 in the form of neural rosettes expressing neuroepithelial markers SOX2,nestin,and PAX6.In digested hiPSCs-NECs,the addition of 5 μmol/L Y27632 significantly promoted survival of the adherent cells,increased cell viability and the proportion of S-phase cells(P<0.01),and reduced the rate of apoptotic cells(P<0.05).On day 28 of induction,the obtained cells highly expressed the specific markers of DAPS(TH,FOXA2,NURR1,and Tuj1).Conclusion Treatment with Y27632(5 μmol/L)for 24 h significantly promotes the survival of human iPSCs-NECs during their differentiation into DPAs without affecting the cell differentiation,which indirectly enhances the efficiency of cell differentiation.
7.Prediction of benign and malignant amorphous calcifications in the breast based on clinical and mammographic features
Xinxin LI ; Huiyu DUAN ; Xiaomin TANG ; Dawei ZHOU ; Xiuting CHEN ; Chengcheng MA ; Jing YAN ; Zhizhen GAO
Journal of Practical Radiology 2024;40(8):1276-1280
Objective To investigate the risk factors affecting the malignancy of amorphous calcifications in the breast and to establish a predictive nomogram.Methods Patients with amorphous calcifications detected by mammography were retrospectively collected,clinical data were obtained from electronic medical record(EMR),and the mammographic features of the patients were assessed by diagnostic physicians.The risk factors affecting the malignancy of amorphous calcifications were analyzed to develop a predictive model and to assess the performance of the model.Results A total of 153 amorphous calcifications in 144 patients were included in the study,and the overall malignancy rate of calcifications was 20.92%.Patient's age ≥45 years,linear distribution of calcifications,unilateral single or unilateral multiple calcifications,and a larger maximum ratio of calcification extent all predicted a higher probability of malignancy,establishing a nomogram based on these 4 risk factors,with a 3.65%predicted probability of malig-nancy as the cut-off,33.99%(52/153)of patients were allowed to be spared biopsy.Conclusion Patient's age and the distribution,number,and maximum ratio of calcifications may be the risk predictors of malignancy for amorphous calcifications,with nomogram con-struction for distinguishing benignity from malignancy of amorphous calcifications via combining with mammographic features and clinical data.
8.Parkin deletion affects PINK1/Parkin-mediated mitochondrial autophagy to exacerbate neuroinflammation and accelerate progression of Parkinson's disease in mice.
Chengcheng JIANG ; Yangyang LI ; Kexin DUAN ; Tingting ZHAN ; Zilong CHEN ; Yongxue WANG ; Rui ZHAO ; Caiyun MA ; Yu GUO ; Changqing LIU
Journal of Southern Medical University 2024;44(12):2359-2366
OBJECTIVES:
To investigate the role of mitochondrial autophagy disorder caused by deletion of E3 ubiquitin ligase Parkin in neuroinflammation in a mouse model of MPTP-induced Parkinson's disease (PD).
METHODS:
Wild-type (WT) male C57BL/6 mice and Parkin-/- mice were given intraperitoneal injections with MPTP or PBS for 5 consecutive days, and the changes in motor behaviors of the mice were observed using open field test. The effects of Parkin deletion on PD development and neuroinflammation were evaluated using immunofluorescence and Western blotting. The changes of the PINK 1/Parkin signaling pathway in the midbrain substantia nigra of the mice were examined to explore the molecular mechanism of Parkin-mediated regulation of mitochondrial autophagy and its effect on neuroinflammation in PD mice.
RESULTS:
Compared with their WT counterparts, the Parkin-/- mice with MPTP injections exhibited significant impairment of motor function with decreased TH+ neurons, increased α-synuclein (α-syn) accumulation, and increased numbers of GFAP+ and I-ba1+ cells in the midbrain substantia nigra. Parkin deletion obviously affected PINK1/Parkin-mediated mitochondrial autophagy to result in significantly increased mtDNA and upregulated expressions of STING and NLRP3 inflammatosomes in the midbrain substantia nigra of MPTP-treated transgenic mice.
CONCLUSIONS
Parkin deletion causes mitochondrial autophagy disorder to accelerate PD progression and exacerbates neuroinflammation in mice by affecting the PINK1/Parkin signaling pathway, suggesting the important role of Parkin in early pathogenesis of PD.
Animals
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Ubiquitin-Protein Ligases/genetics*
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Mice
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Mice, Inbred C57BL
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Male
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Parkinson Disease/genetics*
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Protein Kinases/genetics*
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Mitochondria/metabolism*
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Disease Models, Animal
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Autophagy
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Signal Transduction
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Neuroinflammatory Diseases/metabolism*
;
Mice, Knockout
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alpha-Synuclein/metabolism*
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Substantia Nigra/metabolism*
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Mitophagy
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Disease Progression
9.Effect of Gualou Xiebai Banxiatang on Mitochondrial Dysfunction and AMPK/PGC-1α Signaling Pathway in Rats with Ischemic Myocardial Injury
Yingying TAN ; Hui WANG ; Yanbing WANG ; Hong LI ; Chengcheng MA ; Qi ZHANG
Chinese Journal of Experimental Traditional Medical Formulae 2023;29(1):9-17
ObjectiveTo observe the effect of Gualou Xiebai Banxiatang on mitochondrial dysfunction and adenosine 5'-monophosphate (AMP)-activated protein kinase (AMPK)/peroxlsome proliferator-activated receptor-γ coactlvator-1α (PGC-1α) signaling pathway in rats with ischemic myocardial injury. MethodSeventy male SD rats were used in this experiment. Six rats from them were randomly selected as the control (CON) group, and the others were given high fat diet combined with isoproterenol injection (5 mg·kg-1·d-1, 7 d) to induce the rat model of ischemic heart disease based on hyperlipidemia. Successfully modeled rats were then randomly divided into model (MOD) group, high-dose Gualou Xiebai Banxiatang (GXBD-H) group, medium-dose Gualou Xiebai Banxiatang (GXBD-M) group, low-dose Gualou Xiebai Banxiatang (GXBD-L) group, and metoprolol (MET) group. Rats in the GXBD-H, GXBD-M, and GXBD-L groups were given 11.2, 5.6, 2.8 g·kg-1·d-1 Gualou Xiebai Banxiatang, those in the MET group were given 2.6 mg·kg-1·d-1 metoprolol, and those in the CON and MOD groups were given equal volume of pure water for 28 d. Hemodynamics were measured in rats by cardiac catheterization. Transmission electron microscopy was used to analyze myocardial mitochondria. Serum brain natriuretic peptide (BNP) and cardiac troponin T (cTnT) levels were detected by enzyme-linked immunosorbent assay (ELISA). Mitochondrial membrane potential assay kit (JC-1 method) was applied for detecting mitochondrial membrane potential. The changes in the mitochondrial DNA copy number were measured by real-time quantitative polymerase chain reaction (Real-time PCR). The content of adenosine triphosphate (ATP) in myocardial tissues was determined by spectrophotometer. The expression levels of p-AMPK, AMPK, PGC-1α, nuclear respiratory factor 1 (NRF1), and mitochondrial transcription factor A (TFAM) in myocardium was detected by Western blot. ResultAs compared with the CON group, left ventricular end-systolic pressure (LVESP) and left ventricular end-diastole pressure (LVEDP) in the MOD group were significantly increased (P<0.05, P<0.01), and +dp/dtmax and -dp/dtmax were significantly decreased (P<0.01). In the MOD group, cardiac index and myocardial interstitial fibrosis area were significantly increased (P<0.01), accompanied by mitochondrial damage, serum BNP, cTnT, and malondialdehyde (MDA) were significantly increased (P<0.01), and serum superoxide dismutase (SOD) level was significantly decreased (P<0.01). The myocardial mitochondrial membrane potential, DNA copy number, and ATP level were significantly decreased (P<0.01), and the protein expression levels of p-AMPK/AMPK, PGC-1α, NRF1, and TFAM in myocardial tissues were significantly decreased in the MOD group (P<0.01). Compared with the MOD group, the GXBD-H and GXBD-M groups significantly improved LVESP, LVEDP, +dp/dtmax, and -dp/dtmax (P<0.05, P<0.01), significantly decreased heart index and myocardial interstitial fibrosis area (P<0.05, P<0.01), and alleviated mitochondrial damage. In the GXBD-H and GXBD-M groups, serum BNP, cTnT, and MDA were decreased significantly (P<0.05, P<0.01), serum SOD level was increased significantly (P<0.05), and myocardial mitochondrial membrane potential, DNA copy number, and ATP level were significantly increased (P<0.05, P<0.01). The protein levels of p-AMPK/AMPK, PGC-1α, NRF1, and TFAM in myocardial tissues were significantly increased in the GXBD-H and GXBD-M groups (P<0.05, P<0.01). ConclusionGualou Xiebai Banxiatang has the effects of reducing the changes in cardiac function and myocardial pathology of rats with myocardial injury, inhibiting mitochondrial dysfunction, and up-regulating the protein expression levels of p-AMPK/AMPK, PGC-1α, NRF1, and TFAM in myocardial tissues. This study provides new laboratory evidence for in-depth exploration of the mechanism of this classical compound in preventing and treating myocardial injury.
10.Research progress in multi-omics biomarkers involved in post-traumatic stress disorder
Chinese Journal of Trauma 2023;39(1):83-88
Post-traumatic stress disorder (PTSD) is a psychiatric illness induced by exposure to severe stress-induced traumatic events. Repeated traumatic re-experience, avoidance, negative cognition and emotional changes seriously reduce the quality of life of PTSD patients. Currently, it is urgent to further clarify the etiology and molecular mechanism of PTSD in order to guide the diagnosis and treatment of PTSD. Considering the underlying pathophysiology is not entirely known, to identify the pertinent biomarkers of PTSD is critical in researching its incidence and progression. In contrast with the single-omics researches, multi-omics studies may methodically expand on biomolecular interactions from a range of angles, creating a new potential to comprehend the development of complicated human illnesses. Therefore, the authors review the research progress in PTSD biomarkers from aspects of genomics, transcriptomics and proteomics, hoping to provide a reference for future research and treatment of PTSD.

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