Transsexualisme/transgenderism : psychothérapie et transformation hormonale et chirurgicale

Objectives

At the end of the French evaluations and the international revision concerning the standard of care (SOC) for transsexual and transgender patients, the interest to propose psychotherapy as a supplement to the sex reassignment therapy (SRT) was unanimously recognized. But, it is clear that the works concerning this subject are rare, and that the methods of this proposal remain ill-defined. So, many questions remain unsettled such its frame, modalities, methods, objectives and its place and relation with or in the SRT, as well as on the theoretical models on which these psychotherapies base themselves. The goal of this article is therefore to present the conception and the evolution of this psychotherapy in the various versions of the standards of care, as well as the theoretical approaches on which the current model is established, then to expose the questions which according to us, still persist concerning this subject, as well as our remarks and proposals relating to the latter.

Computation of a high‐resolution MRI 3D stereotaxic atlas of the sheep brain

The sheep model was first used in the fields of animal reproduction and veterinary sciences and then was utilized in fundamental and preclinical studies. For more than a decade, magnetic resonance (MR) studies performed on this model have been increasingly reported, especially in the field of neuroscience. To contribute to MR translational neuroscience research, a brain template and an atlas are necessary. We have recently generated the first complete T1‐weighted (T1W) and T2W MR population average images (or templates) of in vivo sheep brains. In this study, we 1) defined a 3D stereotaxic coordinate system for previously established in vivo population average templates; 2) used deformation fields obtained during optimized nonlinear registrations to compute nonlinear tissues or prior probability maps (nlTPMs) of cerebrospinal fluid (CSF), gray matter (GM), and white matter (WM) tissues; 3) delineated 25 external and 28 internal sheep brain structures by segmenting both templates and nlTPMs; and 4) annotated and labeled these structures using an existing histological atlas. We built a quality high‐resolution 3D atlas of average in vivo sheep brains linked to a reference stereotaxic space. The atlas and nlTPMs, associated with previously computed T1W and T2W in vivo sheep brain templates and nlTPMs, provide a complete set of imaging space that are able to be imported into other imaging software programs and could be used as standardized tools for neuroimaging studies or other neuroscience methods, such as image registration, image segmentation, identification of brain structures, implementation of recording devices, or neuronavigation. J. Comp. Neurol. 525:676–692, 2017. © 2016 Wiley Periodicals, Inc.     

共面模板辅助CT引导下125I粒子植入治疗脊柱转移瘤疗效分析

目的 探讨共面模板（co-planar template, CPT）辅助CT下植入¹²⁵I放射性粒子近距离治疗脊柱转移瘤质量控制与近期疗效。方法 12例原发肿瘤经病理学明确诊断,影像学改变符合脊柱转移瘤特征,患者共有16个病灶。处方剂量（prescribed dose, PD）80 Gy,粒子活度（1.48×10⁷~2.59×10⁷）Bq（0.4~0.7 mCi）,CPT辅助CT引导下将植入针按术前计划穿刺并种植放射性¹²⁵I粒子。术后即刻扫描观察粒子分布情况,剂量评估。随访复查CT判定瘤体直径变化,进行疗效评估。随访时间为3~29个月。同时给予疼痛分级,评判疼痛改善情况。结果 16个病灶全部穿刺成功植入粒子。植入后剂量验证显示肿瘤靶区接受的平均照射剂量（209.21±37.16）Gy,D₉₀为（115.29±7.87）Gy,D₁₀₀为（76.59±5.53）Gy,V₉₀为（99.30±0.51）%,V₁₀₀为（98.06±1.15）%,适形指数（CI）0.981±0.012,靶区外体积指数（EI）0.012±0.007。脊髓接受的平均照射剂量为（30.47±4.83）Gy。靶区和脊髓接受的平均照射剂量与术前计划比较,差异无统计学意义（P>0.05）。术后3个月病灶完全缓解（CR）18.8%（3/16）, 部分缓解（PR）62.5%（10/16）,疾病进展（PD）6.25%（1/16）,疾病稳定 （SD）6.25%（1/16）,有效率（CR+PR）81.3%;疼痛完全缓解3例,部分缓解7例,轻度缓解2例;生存期11~39个月,中位生存期24个月。所有患者脊髓无放射性损伤发生。结论 应用CPT辅助CT引导可以按照术前计划控制粒子植入的位置和放射剂量,达到治疗肿瘤、并发症少、患者可耐受的目的。     

GTR联合植骨术在显微根尖外科手术中应用的临床观察

目的:评价引导组织再生术(Guide Tissue Regeneration,GTR)联合植骨术应用于显微根尖外科手术中治疗大范围持续性根尖周病的临床疗效。方法:将X线片显示根尖病损最大直径大于10 mm的持续性根尖周病患者80例随机分为两组行显微根尖外科手术。其中,实验组术中对根尖骨缺损处植入无机骨粉、覆盖胶原膜,对照组骨腔不做特殊处理。观察两组病例术后半年、1年的临床疗效。结果:实验组术后半年成功率明显高于对照组,差异有统计学意义(P＜0.05);两组术后1年的术后成功率差异无统计学意义。颊、舌侧骨板缺损的病例实验组术后半年、1年成功率均明显高于对照组,差异有统计学意义(P＜0.05)。结论:GTR联合植骨术应用于显微根尖外科手术能明显促进根尖部骨再生,缩短骨腔愈合时间,有利于伴有颊、舌侧骨板缺损的大范围根尖周病变愈合。     

数控机床技术在下颈椎个体化导向模板制作中的应用

目的　利用计算机辅助设计与数控机床加工技术为下颈椎椎弓根螺钉个体化导向模板提供一种新的加工方法。 方法　取1具下颈椎标本（C3~7）进行CT扫描,在Mimics14.11中重建颈椎三维数字椎骨模型,依据三维椎骨模型在Geomagic studio12软件设计椎弓根导向模板,采用数控机床技术制造出金属材质的个体化导向模板,使用个体化导向模板辅助在下颈椎标本上置入椎弓根钉,根据术后CT数据评价椎弓根钉道位置。 结果　使用5个导向模板辅助钻削10个椎弓根钉道,术后CT扫描示所有钉道均位于椎弓根内。计算水平面绝对偏差值为（0.44±0.23）mm,矢状面为（0.37±0.20）mm,计算机模拟置入3.5 mm椎弓根螺钉置入椎弓根内,1级螺钉9枚,2级螺钉1枚。 结论　应用现代数字化技术,利用逆向工程原理设计并数控机床进行加工制作椎弓根螺钉导向模板,操作简单,准确性高,为下颈椎椎弓根导向模板提供了一种全新、安全的方法。     

28例X射线引导下介入治疗子宫肌瘤临床疗效分析

目的 探讨X射线引导下介入治疗子宫肌瘤的临床疗效,评价其临床应用效果,为今后临床治疗提供参考和借鉴。方法 本研究回顾性分析我院2010年3月至2013年3月期间收治的28例子宫肌瘤患者的临床资料,所以患者均行X射线引导下介入治疗,观察并记录患者治疗前后子宫及肌瘤体积、月经、激素水平、术后并发症等情况。结果 患者术后每隔3个月复查1次,发现患者术后子宫体积、肌瘤体积均明显小于术前(P < 0.05),差异有统计学意义;术后月经周期、月经量、月经时间均明显优于术前(P < 0.05),差异有统计学意义;术后LH、E2、FSH水平较术前均无明显变化(P > 0.05),差异无统计学意义;术后3~5 d内出现短暂闭经、呕吐、血尿各1例,经对症治疗1周后,上述症状均消失,未出现盆腔感染等严重并发症。结论 X射线引导下介入治疗子宫肌瘤能有效地改善患者的临床症状,具创伤小、术后恢复快、并发症少、疗效显著且安全性高等优点,值得在临床实践中广泛的应用和推广。     

3D打印共面模板辅助放射性粒子植入治疗恶性肿瘤剂量学研究

目的 对比3D打印共面模板辅助放射性粒子植入治疗恶性肿瘤的术前与术后剂量学结果,探讨该技术在粒子植入治疗中的精确性。方法 选取2015年11月至2016年12月于山东省滕州市中心人民医院实施3D打印共面模板辅助粒子植入患者32例,植入病灶36个：包括肺部10个、颈部淋巴结5个、盆腔3个、椎体3个、胰腺2个、腹腔淋巴结2个、门静脉2个、其余9个。所有患者行术前计划设计,在共面模板引导下一次性完成所有层面的进针,依据术前计划植入粒子,行术后剂量学评估。对比术前、术后剂量学参数,包括90%和100%靶体积的最小吸收剂量D₉₀和D₁₀₀,90%、100%、150%和200%处方剂量覆盖的体积V₉₀、V₁₀₀、V₁₅₀和V₂₀₀,适形指数（CI）、靶区外体积指数（EI）和均匀性指数（HI）。统计学采用配对 t 检验。结果 全部病灶、运动病灶和固定病灶植入前后D₉₀、D₁₀₀、V₉₀、V₁₀₀、V₁₅₀、V₂₀₀、CI、EI和HI等指标参数配对 t检验,各指标手术前后比较差异均无统计学意义（P>0.05）。结论 3D打印共面模板引导粒子植入剂量指标术前与术后比较无差别,对于固定和运动脏器肿瘤,有良好的治疗准确性,可能成为未来粒子植入重复性好的标准术式。     

自模板法制备中空介孔硅球及其载药释药性能的研究

目的: 采用自模板法合成中空介孔硅球（HMSNs）,并对其载药释药性能进行研究。方法: 采用自模板法,通过控制反应物摩尔数、温度、时间等反应条件制备HMSNs,并进行载药研究,计算载药率、包封率与释药率。结果:合成的HMSNs球形度良好,具有典型的介孔分子筛特征及硅基骨架特征峰,可以进行结构确证,药物在42 h的累积释药百分数达70%以上。结论:HMSNs可用于抗癌药物伊马替尼的装载,达到缓释的目的。     

Difference of cancer core distribution between first and repeat biopsy: In patients diagnosed by extensive transperineal ultrasound guided template prostate biopsy

BACKGROUND: We performed extensive transperineal ultrasound guided template prostate biopsy and evaluated cancer core distribution. METHODS: From August 2000 to May 2002, 113 men with prostate specific antigen levels between 4.0 and 10.0 ng/ml underwent template biopsy. Eighty-six had no previous biopsy (first group) and 27 had previous transrectal sextant biopsies (repeat group). A mean of 18.4 biopsy cores were taken. We defined the region over 2 cm from the rectal face of the prostate as the anterior region and the other as the posterior. RESULTS: Cancer was detected in 49 of 113 (43%) men. Forty-two were in the first group and seven in the repeat group. In the first group, the cancer core rate (cancer core number/biopsy core number) in the anterior region (7.0%) had no difference from that in the posterior region (8.6%) (P = 0.7111). But in the repeat group, the cancer core rate in the anterior region (4.6%) was higher than in the posterior (1.5%) (P < 0.0001). CONCLUSIONS: These results suggest that transrectal sextant biopsies miss more cancers in the anterior region than in the posterior. We believe template technique has an advantage to be able to detect cancer equally in the anterior and posterior.     

大肠杆菌asd基因PCR引物设计及其长模板PCR扩增

目的 获得大肠杆菌全长ａｓｄ基因，方法 采用计算机引物设计软件，长模板ＰＣＲ扩增法及限制性内切酶切分析。结果 设计一对Ｅ．ｃｏｌｉａｓｄ基因ＰＣＲ引物，经长模板ＰＣＲ扩增获得１５１０ｂｐＰＣＲ扩增片段，经限制性内切酶酶切分析，证明该片段与电脑查询的Ｅ．ｃｏｌｉａｓｄ基因酶切谱相同。结论 本文设计的引物用长模板ＰＣＲ扩增法得到的片段初步确认为Ｅ．ｃｏｌｉａｓｄ基因。