高强度聚焦超声不完全消融对体外培养肝癌细胞的影响

目的通过高强度聚焦超声不完全消融筛选残留肝癌细胞,探讨其生物学行为改变及对血管形成的影响。方法在声功率5 W下,获得高强度聚焦超声辐照肝癌细胞的温度-时间关系,在某一温度下筛选出高强度聚焦超声不完全消融最佳肝癌细胞亚系并继续培养获得稳定子代。细胞活性实验检测细胞增殖率及热耐受性;划痕实验和Transwell小室侵袭实验检测迁移和侵袭能力;观察内皮细胞管腔形成的变化。结果随着高强度聚焦超声照射时间增加,温度增加,细胞死亡率增加,在48℃及以上温度肝癌SMMC7721细胞基本全部死亡,而47℃筛选出的SMMC7721肝癌细胞亚系增殖率、热耐受性较正常肝癌细胞增强(P<0.05),运动能力、侵袭能力无明显变化(P>0.05);并能促进内皮细胞增殖、迁移和管腔形成(P<0.05)。结论高强度聚焦超声能够杀灭肿瘤细胞,然而高强度聚焦超声不完全消融会促使肝癌细胞生物学行为转变并能促进血管形成。     

经阴道分娩后胎盘植入的高强度聚焦超声治疗进展

高强度聚焦超声(HIFU)是一种无创治疗技术,具有非侵入性、无放射性污染、可实时监控、治疗时间可控及治疗后恢复快等优点,现已广泛应用于多种实体肿瘤及良性病变的治疗。本文从胎盘植入的治疗现状出发,引出了HIFU治疗胎盘植入的优势,并从热效应、空化效应、机械效应以及声化学效应方面探讨了HIFU治疗的可行性;同时通过对已有治疗病例的分析,总结了HIFU治疗胎盘植入的适应证、疗效评价、可能并发症及有效性,展望了HIFU无创新技术治疗胎盘植入的良好应用前景。     

子宫腺肌病的微无创诊治现状

子宫腺肌病是妇科常见病,发病率呈年轻化及上升趋势。传统的针对该病的保守治疗主要有药物和手术治疗,但都存在治疗不彻底、易复发等问题。高强度聚焦超声治疗是一种可保留子宫的新的无创治疗途径,临床研究已证实其安全性和有效性,且具有较好的中期疗效,远期疗效还需要进一步观察。子宫腺肌病的治疗需要从"根治性"向"功能性"转变,提高患者生活质量。     

Witnessing Clients’ Emotional Transformation: An Emotion‐Focused Therapist's Experience of Providing Therapy

Emotion‐focused therapy (EFT) is an integrative–humanistic, research‐informed, psychological intervention characterized by sustained focus on the client's emotional pain and its transformation. This article discusses the impacts on the therapist when encountering and transforming the client's vulnerability. It is organized around the different phases of the therapy process: meeting a new client, accessing the client's core emotional pain, transforming the client's emotional pain, and ending the therapeutic work. The article also contains personal experiences of the author and provides illustrations of impactful events from therapy sessions. The work, it is suggested, provides significant learning for the therapist on both a personal and a professional level, leading, for example, to the therapist's maturation, better connection with personal hurts and vulnerabilities, greater courage in regard to sharing such feelings, greater kindness toward others and the self, and greater determination to be braver when facing adversity or injustice.     

Cerebrovascular Events Post-Transcatheter Aortic Valve Replacement in a Large Cohort of Patients: A FRANCE-2 Registry Substudy

ObjectivesThe aim of this study was to analyze the incidence, impact, and predictors of cerebrovascular events (CVEs) in patients undergoing transcatheter aortic valve replacement (TAVR).BackgroundSeveral issues remain unresolved post-TAVR, including CVEs.MethodsThe FRANCE-2 (French Aortic Nation CoreValve and Edwards-2) registry prospectively included all patients who underwent TAVR in France and Monaco from January 2010 to October 2011. A total of 3,191 patients were analyzed. Six-month follow-up data were obtained. Events were adjudicated according to Valve Academic Research Consortium (VARC)-1 definition.ResultsOf the cohort, 3.98% experienced a CVE: 55% were major strokes, 14.5% minor strokes, and 30.5% transient ischemic attacks. The mean delay for CVE occurrence was 2 days (interquartile range: 0 to 7 days) with 48.5% of CVEs occurring within 2 days. There was no statistically significant difference in CVE rate with regard to the type of valve (p = 0.899) and the access route (p = 0.128). Patients with a CVE more frequently had new-onset paroxysmal atrial fibrillation (13.6% vs. 7.6%; p = 0.015). During follow-up, the unadjusted mortality rate was higher in patients with a CVE (26% vs. 16.5%; p = 0.002). By multivariate analysis, only advanced age (odds ratio: 1.05; 95% confidence interval: 1.02 to 1.08; p = 0.02) and having 2 valves implanted (odds ratio: 3.13; 95 confidence interval: 1.40 to 7.05; p = 0.006) were associated with a significant risk of CVEs.ConclusionsCVEs occur frequently after TAVR and are associated with an increased mortality rate. No difference exists in the CVE rate when exploring the type of valve or the access route. Advanced age and multiple valves implanted during the same procedure are predictors of CVE.     

Feasibility and Exploratory Efficacy Evaluation of the Embrella Embolic Deflector System for the Prevention of Cerebral Emboli in Patients Undergoing Transcatheter Aortic Valve Replacement: The PROTAVI-C Pilot Study

ObjectivesThis study sought to determine the feasibility, safety, and exploratory efficacy of the Embrella Embolic Deflector (EED) system (Edwards Lifesciences, Irvine, California) in patients undergoing transcatheter aortic valve replacement (TAVR).BackgroundFew data exist on the value of using embolic protection devices during TAVR.MethodsThis pilot study included 52 patients who underwent transfemoral TAVR. The EED system was used in 41 patients, whereas 11 patients underwent TAVR without embolic protection (control group). Cerebral diffusion-weighted magnetic resonance imaging (DW-MRI) was performed at baseline and within 7 days and 30 days after TAVR.ResultsThe EED system was successfully deployed at the level of the aortic arch in all patients with no complications. The deployment of the EED system was associated with high-intensity transient signals (HITS) as evaluated by transcranial Doppler (median: 48 [interquartile range: 17 to 198] HITS), and a higher total number of HITS was observed in the EED group (p < 0.001 vs. control group). DW-MRI performed within 7 days after TAVR showed the presence of new ischemic lesions in all patients in both groups, with a median number of 7 (interquartile range: 3 to 13) lesions per patient. The use of the EED system was associated with a lower lesion volume compared with the control group (p = 0.003). All new cerebral lesions had disappeared on the DW-MRI performed at 30 days after TAVR. Two strokes unrelated to the EED system occurred 2 and 29 days after TAVR.ConclusionsThis study showed the feasibility and safety of using the EED system in TAVR procedures. The EED system did not prevent the occurrence of cerebral microemboli during TAVR or new transient ischemic lesions as evaluated by DW-MRI, but it was associated with a reduction in lesion volume. Further studies are warranted to determine the efficacy of using the EED system during TAVR procedures.     

Modified constraint-induced therapy for children with hemiplegic cerebral palsy: A feasibility study

Purpose: To determine the feasibility of family-focused, modified constraint-induced therapy with children with hemiplegic cerebral palsy and test study procedures in preparation for a randomized controlled trial.

Design: Prospective pre–post feasibility study.

Methods and procedures: Ten children (median age: 3 years 6 months) were assessed at baseline, at completion of intervention and at 6 months post-baseline. Intervention consisted of a mitt worn on the unaffected hand for 2?hours per day for 8 weeks. Targeted adjunct therapy was provided during the time the mitt was worn. Primary assessments included the Canadian Occupational Performance Measure, Goal Attainment Scaling, Assisting Hand Assessment and the Melbourne Assessment of Unilateral Upper Limb Function.

Outcomes: Modified constraint-induced therapy as implemented in this study was acceptable to participants. Over the intervention period, participants experienced improvements in the performance of important daily activities as determined by the primary outcome measures.

Conclusions: Modified constraint-induced therapy which targets participant-identified goals and which is family-focused warrants further investigation utilizing randomized trial methodology.

Propósito: Determinar la viabilidad de la terapia modificada de inducción de restricción enfocada en la familia en niños con parálisis cerebral hemipléjica, y evaluar procedimientos de estudio en la preparación de una prueba controlada aleatorizada. Diseño: Estudio prospectivo pre-post viabilidad. Métodos y procedimientos: Se evaluaron a diez niños (edades medias: 3años 6 meses) en una etapa inicial, al completar el tratamiento y a los seis meses después de la evaluación inicial. La intervención consistió del uso de un guante en la mano no afectada durante 2 horas al día por 8 semanas. La terapia adjunta fue proporcionada durante el periodo de tiempo en que el guante fue usado. Los instrumentos de evaluación primaria incluyeron: Canadian Occupational Performance Measure, Goal Attainment Scaling, Assisting Hand Assessment y the Melbourne Assessment of Unilateral Upper Limb Function. Resultados: La terapia de inducción de restricción modificada fue aceptada por los participantes de la forma en que fue implementada en este estudio. Los participantes experimentaron mejoría en el desempaño de las actividades de la vida diaria durante el periodo de tratamiento, siendo determinado esto por los resultados de las mediciones primarias. Conclusiones: El hecho de que las terapias de inducción de restricción modificada tengan como objetivo metas identificadas por los pacientes y un enfoque familiar, sienta precedente para la realización de investigaciones futuras que utilicen una metodología de pruebas aleatorizadas. Palabras clave: Terapia de inducción restringida modificada, parálisis cerebral, función del miembro superior, pediátrica, enfocado en la familia, hemiplejia     

Kinaesthetic narratives: Interpretations for children's dance movement therapy process

The present case study was aimed at producing research-based information on developmental dance movement therapy (DMT) in Finland. The hypothesis was that DMT enables non-verbal and verbal expression in children at risk of social displacement and long-term learning disabilities. A dance movement therapist and a preschool teacher co-led a year long, weekly DMT group for six preschool children of whom five had recently immigrated to Finland. The theory and practical methods were founded in DMT, attachment theory and solution focused therapy. The sessions used creative movement, movement observation, kinesthetic attunement and mirroring. The evaluation of the group process was based on participant observation, body memory and children's drawings. Bodily dialogue and supportive holding became integral parts of each session. The themes observed in children's drawings suggested developmental changes and externalisation of emotional experiences. The conclusion was that DMT supported the development of group dynamics and movement as a form of interaction.     

超声引导高强度聚焦超声治疗肌壁间子宫肌瘤的效果

目的探讨超声引导高强度聚焦超声(HIFU)治疗肌壁间子宫肌瘤的效果及其对前、后壁子宫肌瘤疗效的差异。方法对54例症状性肌壁间子宫肌瘤患者行超声引导下HIFU治疗;消融后当日或次日及术后3个月时行增强MR检查,评估肌瘤消融范围并计算消融率:消融率≥50%为显效,0<消融率<50%为有效,增强信号无减低为消融无效。结果共消融治疗肌壁间子宫肌瘤57个,其中前壁肌瘤32个,后壁肌瘤25个;消融前肌瘤体积为16.27～502.12cm3,消融后增强MRI显示无灌注区域体积为5.75～292.42cm3,平均消融率为(68.14±16.19)%,显效率为89.47%(51/57),有效率为100%(57/57)。3个月后消融肌瘤无灌注区域体积较术后1天或次日进一步缩小(t=6.365,P<0.05)。前壁肌瘤平均消融率为(74.35±12.24)%,后壁肌瘤平均消融率为(60.93±17.62)%,差异有统计学意义(t=2.366,P<0.05)。结论超声引导HIFU治疗肌壁间子宫肌瘤安全、有效,对前壁肌瘤的消融率高于后壁肌瘤。