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Lozinski T, Filipowska J, Pyka M, Baczkowska M, Ciebiera M. Magnetic resonance-guided high-intensity ultrasound (MR-HIFU) in the treatment of symptomatic uterine fibroids - five-year experience. Ginekol Pol 2021; 93:VM/OJS/J/71567. [PMID: 33914323 DOI: 10.5603/gp.a2021.0098] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 01/17/2021] [Accepted: 01/18/2021] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES Uterine fibroids (UF) are the most common benign tumors of the female reproductive organ. It is crucial to recognize that the appropriate treatment of UFs requires an individualized approach. The present paper aimed at the presentation of the five-year experience of our center in the treatment of UFs with the use of magnetic resonance-guided high-intensity ultrasound (MR-HIFU) therapy. MATERIAL AND METHODS The study enrolled a total of 1284 patients with symptomatic UFs. The Sonalleve MR-HIFU system (Philips Ingenia 3.0T System) was used for magnetic resonance imaging (MRI) qualification and treatment. RESULTS The group of patients qualified for thermal ablation included 356 (28%) women. No significant differences were observed between the group undergoing thermal ablation and patients who were disqualified. A complete procedure was performed in 22.6% of patients who presented at the center. Non-perfused volume (NPV) is one of the most important parameters assessed during MR-HIFU procedures. The mean NPV value in the present study was 71%. The average UF volumes decreased by 27% at three-month follow-up ultrasound, by 34% after six months and by 39% as shown by MRI measurements performed 6 months post-treatment. CONCLUSIONS According to our data, MR-HIFU therapy is associated with good clinical outcomes in patients with symptomatic UFs. The method facilitates a marked symptom reduction and, in many cases, diminishing tumor volume. The presented five-year outcomes as regards our experience in the MR-HIFU therapy of patients with symptomatic UFs indicate that the method offers an attractive alternative to the traditional methods of UF treatment in selected cases.
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Affiliation(s)
- Tomasz Lozinski
- Department of Obstetrics and Gynaecology Pro-Familia Hospital, Rzeszow, Poland
| | - Justyna Filipowska
- Department of Obstetrics and Gynaecology Pro-Familia Hospital, Rzeszow, Poland
- Faculty of Medicine, Institute of Nursing and Health Sciences, University of Rzeszow, Poland
| | - Magdalena Pyka
- Department of Obstetrics and Gynaecology Pro-Familia Hospital, Rzeszow, Poland
| | - Monika Baczkowska
- Second Department of Obstetrics and Gynecology, Center of Postgraduate Medical Education, Warsaw, Poland
| | - Michal Ciebiera
- Second Department of Obstetrics and Gynecology, Center of Postgraduate Medical Education, Warsaw, Poland.
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Krug A, Cabanis M, Pyka M, Pauly K, Kellermann T, Walter H, Wagner M, Landsberg M, Shah NJ, Winterer G, Wölwer W, Brinkmeyer J, Müller BW, Kärgel C, Wiedemann G, Herrlich J, Vogeley K, Schilbach L, Rapp A, Klingberg S, Kircher T. Attenuated prefrontal activation during decision-making under uncertainty in schizophrenia: a multi-center fMRI study. Schizophr Res 2014; 152:176-83. [PMID: 24325976 DOI: 10.1016/j.schres.2013.11.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Revised: 11/04/2013] [Accepted: 11/11/2013] [Indexed: 10/25/2022]
Abstract
Decisions are called decisions under uncertainty when either prior information is incomplete or the outcomes of the decision are unclear. Alterations in these processes related to decisions under uncertainty have been linked to delusions. In patients with schizophrenia, the underlying neural networks have only rarely been studied. We aimed to disentangle the neural correlates of decision-making and relate them to neuropsychological and psychopathological parameters in a large sample of patients with schizophrenia and healthy subjects. Fifty-seven patients and fifty-seven healthy volunteers from six centers had to either indicate via button-press from which of two bottles red or blue balls were drawn (decision-making under uncertainty condition), or indicate whether eight red balls had been presented (baseline condition) while BOLD signal was measured with fMRI. Patients based their decisions on less conclusive evidence and had decreased activations in the underlying neural network, comprising of medial and lateral frontal as well as parietal areas, as compared to healthy subjects. While current psychopathology was not correlated with brain activation, positive symptoms led to longer decision latencies in patients. These results suggest that decision-making under uncertainty in schizophrenia is affected by a complex interplay of aberrant neural activation. Furthermore, reduced neuropsychological functioning in patients was related to impaired decision-making and task performance was modulated by distinct positive symptoms.
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Affiliation(s)
- A Krug
- Department of Psychiatry and Psychotherapy, Philipps University, Marburg, Germany.
| | - M Cabanis
- Department of Psychiatry and Psychotherapy, Philipps University, Marburg, Germany
| | - M Pyka
- Department of Psychiatry and Psychotherapy, Philipps University, Marburg, Germany
| | - K Pauly
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Medical School, RWTH Aachen University, Aachen, Germany
| | - T Kellermann
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Medical School, RWTH Aachen University, Aachen, Germany
| | - H Walter
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Berlin, Germany
| | - M Wagner
- Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany
| | - M Landsberg
- Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany
| | - N J Shah
- Institute of Neuroscience and Medicine, Medical Imaging Physics (INM4), Research Centre Juelich, Germany; Department of Neurology, Faculty of Medicine, JARA, RWTH Aachen University, Aachen, Germany
| | - G Winterer
- Cologne Center for Genomics, University of Cologne, Köln, Germany
| | - W Wölwer
- Department of Psychiatry and Psychotherapy, Heinrich Heine University, Rhineland State Clinics for Psychiatry, Düsseldorf, Germany
| | - J Brinkmeyer
- Department of Psychiatry and Psychotherapy, Heinrich Heine University, Rhineland State Clinics for Psychiatry, Düsseldorf, Germany
| | - B W Müller
- LVR-Hospital Essen, Department of Psychiatry and Psychotherapy, Faculty of Medicine, University of Duisburg-Essen, Rhineland State Clinics for Psychiatry, Essen, Germany
| | - C Kärgel
- LVR-Hospital Essen, Department of Psychiatry and Psychotherapy, Faculty of Medicine, University of Duisburg-Essen, Rhineland State Clinics for Psychiatry, Essen, Germany
| | - G Wiedemann
- Clinic of Psychiatry and Psychotherapy, Clinical Center, Fulda, Germany
| | - J Herrlich
- Department of Psychiatry and Psychotherapy, Johann Wolfgang Goethe University, Frankfurt/Main, Germany
| | - K Vogeley
- Department of Psychiatry and Psychotherapy, University of Cologne, Köln, Germany; Institute for Neurosciences and Medicine, Cognitive Neuroscience (INM3), Research Center Juelich, Germany
| | - L Schilbach
- Department of Psychiatry and Psychotherapy, University of Cologne, Köln, Germany
| | - A Rapp
- Department of Psychiatry and Psychotherapy, Eberhard Karls University, Tübingen, Germany
| | - S Klingberg
- Department of Psychiatry and Psychotherapy, Eberhard Karls University, Tübingen, Germany
| | - T Kircher
- Department of Psychiatry and Psychotherapy, Philipps University, Marburg, Germany
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Cabanis M, Krug A, Pyka M, Walter H, Winterer G, Müller B, Wiedemann G, Vogeley K, Wittorf A, Rapp A, Klingberg S, Kircher T. Neural correlates of Cognitive Behavioural Therapy effects on positive symptoms in patients with schizophrenic disorders. Pharmacopsychiatry 2011. [DOI: 10.1055/s-0031-1292457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Konrad C, Kugel H, Zwitserlood P, Dannlowski U, Pyka M, Domschke K, Arolt V, Kircher T, Schöning S. Serotonin-transporter polymorphism modulates anterior cingulate cortex activation during working memory tasks – an fMRI study. Pharmacopsychiatry 2011. [DOI: 10.1055/s-0031-1292508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Sehlmeyer C, Dannlowski U, Schöning S, Kugel H, Pyka M, Pfleiderer B, Zwitserlood P, Schiffbauer H, Heindel W, Arolt V, Konrad C. Neural correlates of trait anxiety in fear extinction. Psychol Med 2011; 41:789-798. [PMID: 20550755 DOI: 10.1017/s0033291710001248] [Citation(s) in RCA: 131] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Fear conditioning involves the amygdala as the main neural structure for learning fear responses whereas fear extinction mainly activates the inhibitory prefrontal cortex (PFC). In this study we investigated whether individual differences in trait anxiety affect amygdala and dorsal anterior cingulate cortex (dACC) activation during fear conditioning and extinction. METHOD Thirty-two healthy subjects were investigated by functional magnetic resonance imaging (fMRI) at 3 T while performing a cued fear-conditioning task. All participants completed the trait version of the State-Trait Anxiety Inventory (STAI-T). Activations of the amygdala and the dACC were examined with respect to the effects of trait anxiety. RESULTS Analysis of the fMRI data demonstrated enhanced activation in fear-related brain areas, such as the insula and the ACC, during both fear conditioning and extinction. Activation of the amygdala appeared only during the late acquisition phase whereas deactivation was observed during extinction. Regression analyses revealed that highly trait-anxious subjects exhibited sustained amygdala activation and reduced dACC involvement during the extinction of conditioned responses. CONCLUSIONS This study reveals that high levels of trait anxiety are associated with both increased amygdala activation and reduced dACC recruitment during the extinction of conditioned fear. This hyper-responsivity of the amygdala and the deficient cognitive control during the extinction of conditioned fear in anxious subjects reflect an increased resistance to extinct fear responses and may thereby enhance the vulnerability to developing anxiety disorders.
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Affiliation(s)
- C Sehlmeyer
- Department of Psychiatry, University Hospital of Muenster, Germany
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