Fear-avoidance and its consequences in chronic musculoskeletal pain: a state of the art

In an attempt to explain how and why some individuals with musculoskeletal pain develop a chronic pain syndrome, Lethem et al. (Lethem J, Slade PD, Troup JDG, Bentley G. Outline of fear-avoidance model of exaggerated pain perceptions. Behav Res Ther 1983; 21: 401-408).ntroduced a so-called 'fear-avoidance' model. The central concept of their model is fear of pain. 'Confrontation' and 'avoidance' are postulated as the two extreme responses to this fear, of which the former leads to the reduction of fear over time. The latter, however, leads to the maintenance or exacerbation of fear, possibly generating a phobic state. In the last decade, an increasing number of investigations have corroborated and refined the fear-avoidance model. The aim of this paper is to review the existing evidence for the mediating role of pain-related fear, and its immediate and long-term consequences in the initiation and maintenance of chronic pain disability. We first highlight possible precursors of pain-related fear including the role negative appraisal of internal and external stimuli, negative affectivity and anxiety sensitivity may play. Subsequently, a number of fear-related processes will be discussed including escape and avoidance behaviors resulting in poor behavioral performance, hypervigilance to internal and external illness information, muscular reactivity, and physical disuse in terms of deconditioning and guarded movement. We also review the available assessment methods for the quantification of pain-related fear and avoidance. Finally, we discuss the implications of the recent findings for the prevention and treatment of chronic musculoskeletal pain. Although there are still a number of unresolved issues which merit future research attention, pain-related fear and avoidance appear to be an essential feature of the development of a chronic problem for a substantial number of patients with musculoskeletal pain.     

CT导引下氩氦刀冷冻治疗肺癌并发症分析

目的 探讨CT导引下经皮穿刺氩氦刀冷冻消融治疗肺癌的并发症.方法 对8例肺癌患者进行CT导引下氩氦刀冷冻治疗,CT动态观察治疗前后的变化、并发症发病率及治疗效果.结果 所有手术后即刻冰球覆盖满意.1例患者出现声嘶加重,1例出现少量气胸,1例患者出现穿刺道少量出血.结论 本组有限的病例提示,在CT导引下经皮穿刺氩氦刀冷冻治疗肺癌是安全有效的,并发症较少.     

Thermal ablation: update and technique at a high-volume institution

In the era of nephron-sparing surgery for small renal tumors, thermal ablation is gaining popularity. Both cryoablation and radiofrequency ablation have well-demonstrated short-term oncologic efficacy and safety. This article shares the current literature and the radiofrequency ablation technique at a high-volume institution. Cases are presented that illustrate solutions to obstacles frequently encountered during percutaneous ablation of renal masses.     

Argon-helium cryoablation for thoracic vertebrae with metastasis of hepatocellular carcinoma-related hepatitis B: A case report

BACKGROUND Spinal metastasis of hepatocellular carcinoma(HCC) is rare, with an extremely poor prognosis and results in severe pain. Argon-helium cryotherapy is a local ablation method for HCC.CASE SUMMARY A 54-year-old man was diagnosed with HCC related to hepatitis B one year ago and underwent surgical tumor resection and tenofovir antiviral treatment.However, a new lesion developed on the right liver after 1 mo. Transarterial chemoembolization was performed four times. One month ago, the patient developed back pain, and metastasis on the 11 th thoracic vertebra was detected.Argon-helium cryoablation was performed to treat the right occupancy and metastatic lesion, which immediately alleviated the pain and prolonged survival.CONCLUSION The use of argon-helium cryoablation for thoracic vertebrae with metastasis of HCC achieved favorable results.     

Feasibility of CT-CT fusion imaging for evaluation of the cryoablation margins in visible hepatocellular carcinoma on unenhanced CT images: Initial experience

ObjectiveTo demonstrate the feasibility of CT-CT fusion imaging for assessment of the cryoablation margins in visible hepatocellular carcinoma (HCC) on unenhanced CT images.MethodsThis retrospective study analyzed 14 patients with 14 HCC lesions treated with CT-guided cryoablation. Nine lesions in nine patients who developed local tumor progression (LTP) during the follow-up period of at least 8 months were reviewed. The unenhanced CT data were used to retrospectively create fusion images of the intraoperative CT images on a workstation. The minimal ablative margin (MAM) was assessed on the fusion images. The concordance between the site of LTP and the MAM area was also assessed.ResultsEight of the nine lesions with LTP were in the subcapsular region of the liver. Seven of the nine cases were treated by cryoablation combined with transcatheter arterial chemoembolization. The median time required to fuse the images for the nine lesions was 5:17 min (range, 5:04–7:37 min). The site of LTP relative to the HCC lesion was craniocaudal in nine, dorsoventral in six, and lateral in seven lesions. In all lesions, the site of LTP was congruent with the MAM area.ConclusionsCT-CT fusion imaging enables a real-time intraoperative treatment evaluation for HCC lesions visible on unenhanced CT images. Fused imaging evaluation has proved to be an accurate and useful tool for assessment of the cryoablation margins.     

表达性写作对心房颤动患者冷冻消融术后焦虑情绪及睡眠质量的影响

目的:评价表达性写作在改善心房颤动患者冷冻消融术后焦虑情绪及睡眠质量中的应用效果.方法:采用随机数字表法将120例心房颤动患者分为对照组60例和观察组60例.观察组接受表达性写作干预,对照组给予心房颤动冷冻消融术围手术期护理.两组患者在出院前1天和术后3个月分别应用状态焦虑问卷(S-AI)和匹兹堡睡眠质量指数量表(PS...     

超声和CT引导下氩氦刀冷冻治疗恶性肿瘤的临床应用

目的探讨超声和CT引导下氩氦刀冷冻治疗恶性肿瘤的临床应用价值。方法无法手术切除或不愿手术切除的恶性肿瘤患者45例49个病灶，在超声或CT引导下进行氩氦刀冷冻治疗，肿瘤分为≤3cm和〉3cm两组，观察术中冰球形成和冰球覆盖病灶率、术后病理变化和病灶缩小率。结果87．5％的冰球在冷冻开始后50S内形成，声像图表现为横断面上靶区内的弧形强光带后方伴声影，纵断面上靶区内“成角凸起”的强光带后伴声影。随着复温，强光带消失，冷冻区呈不均匀高回声；CT扫描，冷冻消融区为类圆形的低密度区。治疗后组织病理学可见细胞浆疏松、空泡样改变、细胞核固缩、核浓染、核碎裂及溶解。两组术中冰球覆盖率≥80％、〈80％者分别为72．7％、27．3％和26．3％、73．7％，两组冰球覆盖率差别有显著性意义（P〈O．05）。术后3个月，≤3cm和〉3cm两组中，病灶缩小率≥50％的分别占81．8％和28．9％，两组病灶缩小率差别有极显著性意义（P〈0．01）。结论超声和CT引导下氩氦刀冷冻治疗恶性肿瘤，定位准确，影像学改变明显、疗效确切、安全可靠，特别对小病灶效果显著。     

Myocardial first-pass perfusion cardiovascular magnetic resonance: history,theory, and current state of the art

In less than two decades, first-pass perfusion cardiovascular magnetic resonance (CMR) has undergone a wide range of changes with the development and availability of improved hardware, software, and contrast agents, in concert with a better understanding of the mechanisms of contrast enhancement. The following review provides a perspective of the historical development of first-pass CMR, the developments in pulse sequence design and contrast agents, the relevant animal models used in early preclinical studies, the mechanism of artifacts, the differences between 1.5T and 3T scanning, and the relevant clinical applications and protocols. This comprehensive overview includes a summary of the past clinical performance of first-pass perfusion CMR and current clinical applications using state-of-the-art methodologies.     

CT引导下经皮穿刺氩氦刀冷冻消融术治疗肾癌的临床应用研究

目的 探讨CT引导监测,经皮穿刺氩氦刀冷冻消融术治疗肾癌的技术方法、安全性及临床疗效.方法 选取2008年9月至2011年1月于我院就诊的肾肿瘤患者27例,采用CT引导氩氦刀冷冻消融疗法,对治疗后局部靶病灶变化、术后肾功能变化、中位生存时间及生存率进行动态随访观察,并记录并发症情况.结果 本组27例患者,术后即刻CT扫描显示冰球覆盖率均为100％.术后3个月复查CT示靶病灶密度减低,瘤体不同程度缩小,按实体瘤评价标准,其中完全缓解(CR)23例,部分缓解(PR)2例,病灶稳定(SD)2例,缓解率(CR+PR)为92.6％.术后第3～4天复查肾功能(尿素氮、尿酸和肌酐等),与术前相比均未见明显变化.本组术后无严重并发症(包括皮肤冻伤、感染、穿刺种植转移等)发生,6例子术后1d出现发热(38℃左右),对症治疗后3～5d消退,8例出现局部轻度疼痛,服用止痛药后缓解;2例出现术后出血,应用凝血酶后迅速止血.结论CT引导监测,经皮穿刺氩氦刀冷冻消融术治疗肾肿瘤近期疗效肯定,是一种安全可靠、值得推广的微创治疗方法.     

Inhibitor treatment: state of the art

The treatment of hemophilic patients with inhibitors presents many challenges. Recombinant activated factor VII (rFVIIa; NovoSeven, Novo Nordisk, Copenhagen, Denmark) is a new therapeutic option for this patient population. Optimization of dosing regimens may be achieved by considering (1) individual pharmacokinetics (especially in the pediatric population); (2) high-dose bolus regimens; (3) continuous infusion (CI) including high-dose CI; (4) early treatment with NovoSeven in the course of a bleeding event; and (5) use of NovoSeven as a prophylactic therapy. The literature involving these issues is reviewed here. Institution of early therapy has been shown to decrease total NovoSeven requirement while increasing efficacy. Pediatric patients may require a higher dose of NovoSeven due to the higher clearance rate and shorter half-life demonstrated by this population. Therefore, the patient's age and/or individual pharmacokinetics and clearance rate should be considered when calculating doses and CI rates. High-dose NovoSeven has been shown to be effective in some patient populations without increased reported adverse events. Despite its short half-life, prophylactic use of NovoSeven has been reported in a small number of patients, with an apparent decrease in bleeding episodes experienced. There has been significant interest in administration of NovoSeven by CI, particularly in patients requiring prolonged treatment, and it has been shown to be successful, although the optimal target factor VII activity has yet to be established and some authors have recommended the use of concomitant antifibrinolytics.     

Kidney transplantation: state of the art

Despite ever-improving health care and new advances in medical technology, the number of Americans who develop end-stage renal disease continues to increase. Diabetes remains the leading cause of new cases, followed by hypertension and glomerulonephritis. More than 200,000 patients require dialysis and more than 40,000 are awaiting kidneys for transplantation. Kidney transplantation has been extremely successful with 1-year patient and graft survival rates at 95% and 90%, respectively. The advantages of kidney transplantation are reversal of many of the pathophysiologic changes associated with renal failure as normal kidney function is restored, elimination of dependence on dialysis and the associated dietary restrictions, the opportunity to return to normal life activities, and lower medical costs than dialysis after the first year. The shortage of donor kidneys is the major limiting factor. Because of the supply and demand discrepancy, maximum use of donors from all sources, appropriate recipient selection, and equitable allocation are critical.     

Psychosomatic medicine: state of the art

Contemporary psychosomatic medicine must take into consideration developments in psychobiology. The difficulty in accepting dualistic concepts is a serious challenge to positions distinguishing between psychological and 'real' causes of disease. There is more emphasis on life style factors for disease and on the impact of psychosocial factors on illness rather than on disease. The neurophysiological concept of activation or arousal has been important in the development of rational pathophysiological models that describe how sustained arousal may be a pathophysiological factor. For illness, sensitization may be an acceptable psychobiological mechanism underlying very frequently occurring and expensive medical conditions that require medical and economical assistance. One possible alternative to old dynamic concepts is the development of a cognitive arousal theory of stress.     

Heart transplantation: state of the art

Outcomes in cardiac transplantation have improved during the past 30 years because of advances made in medicine and surgery. Patients referred for cardiac transplantation are examined through a rigorous evaluation process that involves a multidisciplinary approach to determine candidacy. The list for candidates awaiting transplantation has grown more rapidly than the donor pool, resulting in a need to expand the criteria for donors. Some centers now extend criteria to include older donors, those with prolonged periods of ischemia, donor-recipient mismatches, and donors requiring bypass surgery. Long-term outcomes from the expanded donor pool are under evaluation. Studies are currently in progress to explore inducing tolerance through bone marrow infusion and rejection detection with the use of a pacemaker. Future alternatives to transplantation include the left ventricular assist device as a bridge to recovery, xenotransplantation, and the totally artificial heart.     

Oral contraceptives: the state of the art

This paper presents a state-of-the-art review of oral contraceptives (OCs), termed one of the epochal developments of modern times. OCs have had both direct and indirect influences on moral, social, and cultural values and on the interaction of population resources and the environment. In recent years there has been a trend away from OC use because of increased mortality rates, especially in women over 35 years of age and smokers. However, epidemiologic studies have indicated that the incidence of death from cardiovascular disease, thromboembolic disease, and stroke was greatly reduced when newer preparations with lower steroidal doses became available. The reduction of the estrogen content from 150 mcg of ethinyl estradiol-3-methylether to 30-35 mcg of ethinyl estradiol and of the progestin component from 10 mg of norethindrone to 1 mg or less has not interefered with effective conception control. The progestin component of the pill was linked to high blood pressure, lipid changes, and cardiovascular changes with an unfavorable impact on arterial disease. Although many insist that the question of whether OCs cause or predispose to cardiovascular problems cannot be answered at this time, the potential risks involved in OC use are generally regarded to be outweighed by the benefits. Reductions in OC dosages have also reduced the incidence of galactorrhea, amenorrhea, and on-pill amenorrhea. New triphasic formulations that more closely imitate the hormonal fluctuations of the menstrual cycle are considered to hold much promise in terms of safety and effectiveness.