Time in Motion: Qualities of Temporality Within Psychotherapeutic Psychodynamic Counselling

Our relationship to time is both a developmental and a relational one; an inter- and intra-psychic experience. Exploring how the theories of Freud, Klein, Winnicott, and their successors offer explanations of how the psychoanalytic subject develops and sustains a concept of time and the factors that may hinder this, this essay suggests that different qualities of time, such as continuity, rhythm, repetition and interruption, can reveal themselves through the client's transferential and countertransferential relationship with the therapist. Using fictionalized clinical examples it explores how a bodily felt experience of time was thought about by the therapist/author using Laban movement analysis to support a client in ‘working through’ early material that felt stuck. The exploration of a client's perspective is brought in through the writings of the activist Passerini on her psychoanalytic treatment (cited by Baraitser in Enduring Time) and her experience of trauma's capacity to stop time. The essay also looks at how psychoanalytic ideas of temporality challenge the ‘recruiting’ of time by the wider culture to create more time-efficient late-capitalist subjects but by using ideas from movement studies and a Lacanian influenced time register it is suggested that cultural attacks on subjective experiences of temporality could be challenged within therapy. It is hoped the essay encourages the therapist to become alert to the manifestations of different temporal experiences within the therapeutic relationship and to develop a creative, embodied language with which to explore it with the client.     

Quality comparison between three-dimensional T2-weighted SPACE and two-dimensional T2-weighted turbo spin echo magnetic resonance images for the brachytherapy planning evaluation of prostate and periprostatic anatomy

PurposeThe purpose of this study was to compare an isotropic three-dimensional (3D) T2-weighted sequence sampling perfection with application-optimized contrasts by using flip angle evolution (SPACE) with an axial two-dimensional T2-weighted turbo spin echo (TSE) sequence with regard to overall image quality and the delineation of normal prostate and periprostatic anatomy for low-dose-rate prostate cancer brachytherapy planning evaluation.Methods and MaterialsPatients (n = 69) with prostate cancer who had pelvic magnetic resonance imaging (MRI) for low-dose-rate brachytherapy treatment planning were included. Three radiologists independently assessed the visibility of nine anatomic structures on each sequence by using a 5-point scale and overall image quality by using a 4-point scale. The significance of the differences in diagnostic performance was tested with a Wilcoxon signed rank test.ResultsNo significant intersequence differences were found for most (7/9) anatomical structures and overall image quality. The mean scores for visibility of anatomical structures on the 3D SPACE and 2D TSE sequences, respectively, were as follows: the zonal anatomy (3.7; 3.9, p = 0.05), prostate capsule (3.9; 4.0, p = 0.08), neurovascular bundle (2.9; 2.9, p = 0.9), rectoprostatic angle (3.8; 3.8, p = 0.35), rectum (4.2; 4.3, p = 0.26), urethra (3.8; 3.9, p = 0.12), urinary bladder (4.6; 4.6, p = 0.61), and overall image quality (2.9; 2.9, p = 0.33). 3D SPACE was superior for delineation of the genitourinary diaphragm (3.8; 3.6, p = 0.003), whereas 2D TSE was superior for delineation of the seminal vesicles (3.5; 4.0, p < 0.0001).ConclusionsAnatomic delineation of the prostatic and periprostatic anatomy provided by the 3D SPACE sequence is as robust in quality as that provided by a conventional 2D TSE sequence with superior delineation of the genitourinary diaphragm. For MRI-based brachytherapy treatment planning, the 3D SPACE sequence with subcentimeter isotropic resolution can replace the 2D TSE sequence and be incorporated into standard MRI protocols.     

The Influence of Surgically-Induced Weight Loss on the Knee Joint

Background: The causal relationship between obesity and osteoarthritis (OA) of the knee is generally accepted. Weight loss has been shown to reduce the development of OA and improve the radiological parameters of existing disease. However, inducing weight reduction is difficult, and thus the number of patients studied has been small. We wished to determine the effects of surgically-induced weight loss on objective, radiological evidence of OA in the knee joint. Methods: 64 consecutive patients that were referred to the Bariatric Surgical Unit were enrolled in the study. The only exclusion criterion was the prior diagnosis of OA. Knee pain alone did not exclude patients from the study. The study was performed in a prospective manner as a before-after trial. Radiographic data was evaluated by an independent radiologist not involved in the patient care or follow-up. Upright film of the knee was taken prior to surgery and 3 months following surgery. Minimal medial joint space width (JSW) was measured by a digital image computer. In addition, patients were clinically assessed using the American Knee Society Score (AKSS) at these times. Results: 59 of 64 patients were available for followup. BMI decreased from 43.4 to 36.9 (P<0.01). The medial joint space increased from 4.6 mm to 5.25 mm (P<0.001). The AKSS improved from 78.5 points (perfect function = 100 points) to 90.69 points (P<0.01). Conclusion: Surgically-induced weight loss is an effective, rapid and dependable means of reversing the radiological signs of early changes associated with OA.     

Protein tyrosine phosphatase conjugated with a novel transdermal delivery peptide,astrotactin 1–derived peptide recombinant protein tyrosine phosphatase (AP-rPTP), alleviates both atopic dermatitis–like and psoriasis-like dermatitis

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I Am,a Central Concept of Winnicott

The attainment of unit status or I AM is a crucial stage in Winnicott's theory of development and arguably ranks amongst Winnicott's more well known ideas, such as transitional object, true and false self, and primary maternal preoccupation. Using Winnicott's 1968 paper ‘Sum, I am’, the author traces the dangers inherent in attaining I AM and what might hamper this achievement, the personal significance of numbers and divisibility, and how this links with his subsequent ideas on monotheism and a radical revision of Freud's dual drive theory. Returning to the ‘Sum, I am’ paper, the author briefly explores the importance Winnicott places on play in pedagogy and the significance of an intermediate space followed by Winnicott's thoughts about death, dissociation, and the importance of a mouse! Four clinical examples are used to illustrate difficulties in achieving I AM. Finally, the author suggests the spatula game in ‘Observation of infants in a set situation’ published over a quarter of a century earlier is a prime example of an I AM experience, with a beginning, middle and end.     

Lactation‐Induced Changes in the Volume of Osteocyte Lacunar‐Canalicular Space Alter Mechanical Properties in Cortical Bone Tissue

Osteocytes can remove and remodel small amounts of their surrounding bone matrix through osteocytic osteolysis, which results in increased volume occupied by lacunar and canalicular space (LCS). It is well established that cortical bone stiffness and strength are strongly and inversely correlated with vascular porosity, but whether changes in LCS volume caused by osteocytic osteolysis are large enough to affect bone mechanical properties is not known. In the current studies we tested the hypotheses that (1) lactation and postlactation recovery in mice alter the elastic modulus of bone tissue, and (2) such local changes in mechanical properties are related predominantly to alterations in lacunar and canalicular volume rather than bone matrix composition. Mechanical testing was performed using microindentation to measure modulus in regions containing solely osteocytes and no vascular porosity. Lactation caused a significant (～13%) reduction in bone tissue‐level elastic modulus (p < 0.001). After 1 week postweaning (recovery), bone modulus levels returned to control levels and did not change further after 4 weeks of recovery. LCS porosity tracked inversely with changes in cortical bone modulus. Lacunar and canalicular void space increased 7% and 15% with lactation, respectively (p < 0.05), then returned to control levels at 1 week after weaning. Neither bone mineralization (assessed by high‐resolution backscattered scanning electron microscopy) nor mineral/matrix ratio or crystallinity (assessed by Raman microspectroscopy) changed with lactation. Thus, changes in bone mechanical properties induced by lactation and recovery appear to depend predominantly on changes in osteocyte LCS dimensions. Moreover, this study demonstrates that tissue‐level cortical bone mechanical properties are rapidly and reversibly modulated by osteocytes in response to physiological challenge. These data point to a hitherto unappreciated role for osteocytes in modulating and maintaining local bone mechanical properties. © 2016 American Society for Bone and Mineral Research.     

Guidelines for single fiber EMG

This document is the consensus of international experts on the current status of Single Fiber EMG (SFEMG) and the measurement of neuromuscular jitter with concentric needle electrodes (CNE – CN-jitter). The panel of authors was chosen based on their particular interests and previous publications within a specific area of SFEMG or CN-jitter. Each member of the panel was asked to submit a section on their particular area of interest and these submissions were circulated among the panel members for edits and comments. This process continued until a consensus was reached. Donald Sanders and Erik Stålberg then edited the final document.     

High spatial resolution 3D MR cholangiography with high sampling efficiency technique (SPACE): comparison of 3T vs. 1.5T

Purpose

The aim of this study was to evaluate image quality of 3D MR cholangiography (MRC) using high sampling efficiency technique (SPACE) at 3 T compared with 1.5 T.

Methods and materials

An IRB approved prospective study was performed with 17 healthy volunteers using both 3 and 1.5 T MR scanners. MRC images were obtained with free-breathing navigator-triggered 3D T2-weighted turbo spin-echo sequence with SPACE (TR, >2700 ms; TE, 780 ms at 3 T and 801 ms at 1.5 T; echo-train length, 121; voxel size, 1.1 mm × 1.0 mm × 0.84 mm). The common bile duct (CBD) to liver contrast-to-noise ratios (CNRs) were compared between 3 and 1.5 T. A five-point scale was used to compare overall image quality and visualization of the third branches of bile duct (B2, B6, and B8). The depiction of cystic duct insertion and the highest order of bile duct visible were also compared. The results were compared using the Wilcoxon signed-ranks test.

Results

CNR between the CBD and liver was significantly higher at 3 T than 1.5 T (p = 0.0006). MRC at 3 T showed a significantly higher overall image quality (p = 0.0215) and clearer visualization of B2 (p = 0.0183) and B6 (p = 0.0106) than at 1.5 T. In all analyses of duct visibility, 3 T showed higher scores than 1.5 T.

Conclusion

3 T MRC using SPACE offered better image quality than 1.5 T. SPACE technique facilitated high-resolution 3D MRC with excellent image quality at 3 T.     

SPACE序列在正常臂丛神经节后段磁共振成像中的应用

目的：探讨SPACE序列三维快速自旋回波成像技术在正常臂丛神经节后段磁共振成像中的应用价值。方法：对35名无臂丛神经损伤病史的健康志愿者行臂丛神经DWIBS序列、SPACE序列扫描。分析比较DWIBS序列、SPACE序列可清晰显示臂丛神经的数目,以及两组序列图像平均信噪比（SNR）和对比噪声比（CNR）。结果：35名共70侧臂丛神经节后段在冠状DWIBS序列、SPACE序列上均能清晰显示,SPACE序列中部分臂丛内侧束、后束和外侧束也可显示。SPACE序列的图像信噪比和对比噪声比高于DWIBS序列,且差异具有统计学意义。结论：SPACE序列可以清楚地显示臂丛神经节后段,与DWIBS序列相比较对正常臂丛神经显像具有更高的清晰度。