Deep Healing Research Articles

Research advancements and perspectives of inflammatory bowel disease: A comprehensive review.

Inflammatory bowel disease (IBD) is a chronic inflammatory disease with increasing incidence, such as Crohn's disease and ulcerative colitis. The accurate etiology and pathogenesis of IBD remain unclear, and it is generally believed that it is related to genetic susceptibility, gut microbiota, environmental factors, immunological abnormalities, and potentially other factors. Currently, the mainstream therapeutic drugs are amino salicylic acid agents, corticosteroids, immunomodulators, and biological agents, but the remission rates do not surpass 30-60% of patients in a real-life setting. As a consequence, there are many studies focusing on emerging drugs and bioactive ingredients that have higher efficacy and long-term safety for achieving complete deep healing. This article begins with a review of the latest, systematic, and credible summaries of the pathogenesis of IBD. In addition, we provide a summary of the current treatments and drugs for IBD. Finally, we focus on the therapeutic effects of emerging drugs such as microRNAs and lncRNAs, nanoparticles-mediated drugs and natural products on IBD and their mechanisms of action.

Ritual dance, authentic movement and dance movement therapy among indigenous Wiwan females in the Sierra Nevada de Santa Marta (Colombia)

This article presents results of a collaborative research with indigenous women from Sierra Nevada de Santa Marta in Colombian. Here, I discuss the possibilities of the intercultural dialogue between authentic movement, dance movement-therapy and rituals and communitarian Wiwa dances. I seek to answer certain questions such as: How does an authentic movement from dance movement therapy dialogue with the ritual dances of Wiwa women in Colombia to restore human and nonhuman sexualities in the postconflict scenario? What functions do the roles of mover and witness discharge? What challenges and possibilities emanate from such a dialogue vis-à-vis the deep healing of our sexualities and the reconceptualization of dance movement-therapy and authentic movement? The results presented here are the mixture of a fieldwork in Sierra Nevada de Santa Marta during the last four years and the intercultural authentic movement experience with Wiwa Elders and women.

Deep healing-Comments on the ethical risks and chances of artificial intelligence

Hardly any other field of application of artificial intelligence (AI) needs more ethics by design than medicine; however, if adeep integration of ethical principles succeeds there is achance of "deep healing", for each individual and also for medicine and the healthcare system itself. Thus, AI in medicine could also become ablueprint for how AI should enter society and culture.

"Holding Space": A Phenomenological Exploration of Mindfulness-Based Practice With Veterans Who Have Experienced Trauma.

The current phenomenological study examined the lived experiences of Veterans who completed a 4-month mindfulness program. One-on-one interviews were conducted with 12 Veterans using a Socratic method of interviewing, which yielded rich contextual narratives. Analysis was guided by a hermeneutic process to disclose concealed meanings. Findings demonstrate how holding space allowed deep healing and are presented under two distinct themes: It's a We Thing! encompasses what being in a community with nonjudgmental others afforded participants; and Quiet Your Mind, Quiet Yourself, Your Body is related to how practices of mindfulness taught participants to cope with daily challenges. Nurses working with Veterans may use mindfulness and peer support interventions to help transform trauma into profound healing and help Veterans find new meaning in life. [Journal of Psychosocial Nursing and Mental Health Services, 61(7), 47-55.].

A narrative review of pitfall and progress in management of inflammatory bowel disease in children

Background and Objective: Inflammatory bowel diseases (IBDs) broadly classified as ulcerative colitis (UC) and Crohn’s disease (CD), are progressive chronic intestinal disorders commonly diagnosed in the pediatric age group. Studies report 10–25% of IBD is diagnosed before 16 years of age. IBD in children is more aggressive, with more widespread involvement of ileum and colon and a higher disease burden compared to adult-onset IBD, despite greater immune-suppression use. While the immediate purpose of therapy in IBD is controlling symptoms and restoring good quality of life, long-term goals are preventing complications such as nutritional failure, stricture, fistula, hospitalization and surgery. The best long-term goals are achievable with tight monitoring strategies aiming for healing of intestinal mucosa in addition to controlling symptoms, also known as deep-remission. There has been phenomenal progress in IBD therapies, especially newer biologic agents and oral small synthetic molecules. These newer generations of drugs are safer, less immunogenic and also capable of inducing deep healing. However, despite rapidly expanding treatment paradigms in the management of IBD, integrated care to optimize diet, nutrition, psychological well-being is a crucial long-term goal. The main purpose of this narrative review is to provide a contemporary overview of the IBD in children, with a focus on common pitfalls and progress in the modern management of pediatric IBD.

Exosomes from human induced pluripotent stem cells-derived keratinocytes accelerate burn wound healing through miR-762 mediated promotion of keratinocytes and endothelial cells migration

BackgroundThe use of keratinocytes derived from induced pluripotent stem cells (iPSCs-KCs) may represent a novel cell therapy strategy for burn treatment. There is growing evidence that extracellular vesicles, including exosomes, are primary mediators of the benefits of stem cell therapy. Herein, we thus explored the effects of exosomes produced by iPSCs-derived keratinocytes (iPSCs-KCs-Exos) in a model of deep second-degree burn wound healing and evaluated the mechanistic basis for the observed activity.MethodsiPSCs-KCs-Exos were isolated from conditioned medium of iPSCs-KCs and verified by electron micrograph and size distribution. Next, iPSCs-KCs-Exos were injected subcutaneously around wound sites, and its efficacy was evaluated by measuring wound closure areas, histological examination, and immunohistochemistry staining. The effects of iPSCs-KCs-Exos on proliferation and migration of keratinocytes and endothelial cells in vitro were assessed by EdU staining, wound healing assays, and transwell assay. Then, high-throughput microRNA sequencing was used to explore the underlying mechanisms. We assessed the roles of miR-762 in iPSCs-KCs-Exos-induced regulation of keratinocytes and endothelial cells migration. Furthermore, the target gene which mediated the biological effects of miR-762 in keratinocytes and endothelial cells was also been detected.ResultsThe analysis revealed that iPSCs-KCs-Exos application to the burn wound drove the acceleration of wound closure, with more robust angiogenesis and re-epithelialization being evident. Such iPSCs-KCs-Exos treatment effectively enhanced endothelial cell and keratinocyte migration in vitro. Moreover, the enrichment of miR-762 was detected in iPSCs-KCs-Exos and was found to target promyelocytic leukemia (PML) as a means of regulating cell migration through a mechanism tie to integrin beta1 (ITGB1).ConclusionThese results thus provide a foundation for the further study of iPSCs-KCs-Exos as novel cell-free treatments for deep second-degree burns.Graphical

Evolving Short- and Long-Term Goals of Management of Inflammatory Bowel Diseases: Getting It Right, Making It Last

Short- and long-term treatment targets in inflammatory bowel diseases (IBDs) evolved during the last decade, shifting from symptom control to endoscopic healing and patient-centered parameters. The STRIDE-II consensus placed these targets on a timeline from initiating treatment and introduced additional targets, normalization of serum and fecal biomarkers, restoration of quality of life, prevention of disability, and, in children, restoration of growth. Transmural healing in Crohn's disease and histologic healing in ulcerative colitis currently serve as adjunct measures to gauge remission depth. However, whether early treatment according to a treat-to-target paradigm affects the natural course of IBD remains unclear, leading to the need for prospective disease-modification trials. The SPIRIT consensus defined the targets for these trials to assess the long-term impact of early treatment on quality of life, disability, disease complications, risk of neoplastic lesions, and mortality. As further data emerge about the risk-benefit balance of aiming toward deeper healing, the targets in treating IBDs may continue to shift.

Combined Endoscopic and Radiologic Healing Is Associated With a Better Prognosis Than Endoscopic Healing Only in Patients With Crohn's Disease Receiving Anti-TNF Therapy.

INTRODUCTION:Although endoscopic healing (EH) is recommended as the therapeutic goal in patients with Crohn's disease (CD), combined EH and radiologic healing (RH) could be a more ideal therapeutic goal considering the transmural nature of CD. We compared the prognosis of patients with CD who achieved EH, RH, both EH and RH (deep healing; DH), or no healing under treatment with anti-tumor necrosis factor (TNF) agents.METHODS:We analyzed 392 patients with CD who received anti-TNF treatment for more than 1 year and evaluated with CT enterography or magnetic resonance enterography together with colonoscopy within 3 months between July 2017 and December 2018. Major outcomes (anti-TNF dose intensification, switch to other biologics, CD-related bowel resection, and hospitalization) were compared according to the EH and RH status.RESULTS:During the follow-up (median 18 months; interquartile range, 15–21), the DH group showed a better rate of major outcome-free survival compared with other groups (P < 0.001). In multivariable analysis, elevated C-reactive protein (adjusted hazard ratio [aHR], 2.166; 95% confidence interval [CI], 1.508–3.110; P < 0.001), EH-only (aHR, 3.903; 95% CI, 1.635–9.315; P = 0.002), RH-only (aHR, 3.843; 95% CI, 1.545–9.558; P = 0.004), and no healing (aHR, 8.844; 95% CI, 4.268–18.323; P < 0.001) were associated with increased risks of major outcomes.DISCUSSION:Patients with CD who achieved DH under anti-TNF therapy showed a better prognosis compared with those who only achieved EH. The possibility of DH being used as a new therapeutic target for patients with CD should be investigated in further studies.

Protective Effect of Conditioned Media of Human Fetal Dermal Mesenchymal Stem Cells Can Inhibit Burn-induced Microvascular Hyperpermeability.

Burns often cause loss of skin barrier protection, fluid exudation, and local tissue edema, which hinder functional recovery. Effectively improving the quality of deep burn wound healing, shortening the wound healing time, and reducing tissue fluid leakage are urgent problems in the medical field. Human mesenchymal stem cells (MSCs) can effectively stabilize vascular endothelial injury. Fetal dermal MSCs (FDMSCs) are a newly discovered source of MSCs derived from the skin of accidentally aborted fetuses. However, the effect of FDMSCs on vascular permeability remains poorly understood. In this study, conditioned media from FDMSCs (F-CM) extracted from fetal skin tissue was prepared. The effect of F-CM on vascular permeability was evaluated using the internal circulation method FITC-dextran in vivo, and several in vitro assays, including cell viability assay, transwell permeability test, immunofluorescence, and western blotting. Altogether, our results demonstrate that F-CM could inhibit burn-induced microvascular hyperpermeability by increasing the protein expression levels of occludin and VE-cadherin, while restoring the expression of endothelial F-actin, and providing the foundation of a novel therapy for the treatment of burns with F-CM.

Increased mucosal IL-12 expression is associated with relapse of ulcerative colitis

BackgroundThe role of IL-12/23 in the pathogenesis of ulcerative colitis (UC) is unclear. We analyzed mucosal IL-12/23 expression and its relationship with endoscopic severity, histological activity, and UC relapse.MethodsRectal biopsies were collected from 70 UC patients with clinical remission. IL-12, IL-23, IFN-γ, IL-17A, and IL-17F mRNA expression was measured by real-time PCR. Endoscopic severity and histological activity were evaluated using the Mayo endoscopic subscore (MES) and the Geboes score, respectively.ResultsThe longest follow-up period was 51 months. Thirty-four patients relapsed during the study period. Samples from these subsequently relapsed patients formed the “relapse” group, while those from patients that did not relapse formed the “remission” group. IL-12 (P = 0.0003) and IL-23 (P = 0.014) mRNA expression was significantly higher in the relapse than the remission group. Expression of IL-23 (P = 0.015) but not IL-12 (P = 0.374) was correlated with MES. However, in patients with an MES of 0 and 1, IL-12 expression was statistically higher in the relapse than the remission group (P = 0.0015, P = 0.0342). IL-12 and IL-23 expression did not vary significantly between histologically active and inactive mucosa; both were higher in histologically inactive patients in the remission group (IL-12: P = 0.0002, IL-23: P = 0.046).ConclusionsRectal IL-12 and IL-23 expression was elevated in the relapse group, but IL-12 was more strongly associated with UC relapse, irrespective of endoscopic severity and histological activity. Mucosal IL-12 was elevated in patients with deep mucosal healing. Our results suggest an important role of IL-12 in UC pathogenesis and the molecular mechanism of UC relapse.

HEART OF THE MOUNTAIN

This arts-based co-inquiry engages the intersection of the Western medical-based world/reality and the Natural world/reality. To bridge these worlds the co-authors utilize a spiritual-based trance-formative practice using trance and arts-based inquiry. Instigated by a diagnosis and open-heart surgery of one of the co-authors, the purpose of their project is to offer an example of how a relational approach embracing Nature and art within a connective aesthetic of co-inquiry can offer deep healing and renewal. This spirit healing transcends the physical recovery from the medical intervention, extending a fearful experience into a gift of fearlessness. The writing weaves theoretical, dialogical script, images and poetic texts with an invitation to experience an eight minute art video that includes poetic voice, improvised vocal sounding, visual art and narrative reflection. The story explores the areas of intimate wit(h)nessing, therapeutic resilience and transformative learning at the physical, emotional and spiritual levels.

My Experience Using Traditional Cherokee Medicine in the Treatment of Substance Use Disorders

ABSTRACT I have been employed in a residential substance use disorder treatment center. The talented therapists I worked with were well focused on western therapeutic models. These therapeutic models work, but the component that seems to be missing from these scientific models is about the spirit. At this facility, they recognized the effectiveness of Native Indian healing modalities and they were viewed as an integral part of the healing process for these clients. My job was to reach clients on their deepest levels and to give them additional perspectives on deep healing; healing the spirit. I used my intuition and my heart energy in treating these clients. This is the Indian way. The Pueblo Indians told my medicine man, J.T. Garrett, that all Americans are crazy, and of course, he was somewhat astonished and asked them why. They said – “Well, they say they think in their heads. No sound man thinks in his head. We think in the heart.”. This can be difficult to understand when using a strictly Western medical model. This article will outline how I use Cherokee Native traditions in my work with those with substance use disorders and the effectiveness of them.

Revisiting medication: listening to lived experiences from persons in mental health recovery without ongoing medication use

ABSTRACTThis qualitative study used a grounded theory approach to explore the lived experience of psychotropic medication use in the recovery process of 18 participants who had a diagnosis of schizophrenia, bipolar disorder, or major depression but who were successful in recovery without ongoing medication use. Participants’ narratives depicted a continuum of medication experiences in their recovery process centered on three key recovery factors identified by participants: basic functioning, deeper healing, and hope for recovery. For each recovery factor, participants’ experiences ranged from perceiving medication as promoting recovery to perceiving medication as impeding their recovery, with mixed experiences in between. Findings suggested that the role of medication in recovery is multifaceted and individualized. Mental health providers should avoid a one-size-fits-all philosophy on medication for major mental health conditions, and should be responsive to individual situations and needs.

Association of Faecal Calprotectin Level and Combined Endoscopic and Radiological Healing in Patients With Crohn's Disease Receiving Anti-tumour Necrosis Factor Therapy.

Combined endoscopic and radiological healing, or deep healing, is associated with favourable outcomes in patients with Crohn's disease; thus, a non-invasive biomarker for predicting deep healing would be invaluable. We evaluated the usefulness of faecal calprotectin for predicting deep healing in patients with Crohn's disease receiving anti-tumour necrosis factor [TNF] therapy. We analysed the records of patients with Crohn's disease who received anti-tumour necrosis factor therapy and underwent endoscopic evaluation, radiological evaluation, and faecal calprotectin measurement within a period of 3 months between August 2017 and November 2018. Results of endoscopic and radiological studies were independently reviewed by two gastrointestinal endoscopists and a gastrointestinal radiologist, respectively. Serum C-reactive protein and albumin were also measured. Out of 268 patients analysed, 77 [28.7%] had deep healing, 36 [13.4%] had endoscopic healing only, 36 [13.4%] had radiological healing only, and 119 [44.4%] had neither. The median duration of anti-TNF treatment was 40.0 months. The deep healing group had the lowest median faecal calprotectin level [56.5 mg/kg] among the four groups [p <0.001]. The faecal calprotectin cutoff level of 81.1 mg/kg showed a sensitivity of 0.623 and a specificity of 0.817 in predicting deep healing (area under the receiver operating characteristic curve [AUROC], 0.767; 95% confidence interval, 0.702-0.832). Adding serum C-reactive protein and serum albumin to faecal calprotectin further increased the AUROC to 0.805 [95% confidence interval, 0.752-0.858]. Faecal calprotectin, when combined with serum C-reactive protein and albumin, showed acceptable performance in predicting deep healing in patients with Crohn's disease.

The Role of Autologous PRP on Deep Partial-Thickness Burn Wound Healing in Bama Pigs.

In this study, we aimed to evaluate the therapeutic effects of autologous platelet-rich plasma (PRP) on deep partial-thickness burns in Bama pigs. Deep partial-thickness burn wounds were created on the back of Bama pigs. The reepithelialization time was compared between the PRP and control groups. The mean score of Ki67 (+) cells and α-SMA (+) vessels, the mean thickness of epidermis and dermis of the healing wounds were determined via H&E staining and immunohistochemical assay. The levels of the growth factors epidermal growth factor (EGF), basic fibroblast growth factor (bFGF), and vascular endothelial growth factor (VEGF) were examined by ELISA. Our data showed that the time to wound reepithelialization was shorter in the PRP group compared with the control group. The thickness of the epidermis was larger in the PRP group compared with the control group. On the 7th and 14th days after the treatment, the mean score of Ki67 (+) cells and α-SMA (+) vessels were higher in the PRP group compared with the control group. The PRP group showed higher levels of growth factors (EGF, bFGF, and VEGF) compared with the control group by ELISA. The results indicated that PRP could improve wound healing process of deep partial-thickness burns in Bama pigs. The PRP increased the thickness of epidermis of the healed wounds, cell proliferation, and angiogenesis. We demonstrated that applying PRP had a greater potential for the treatment of deep partial-thickness burns.

‘Learning to re-create your life’: an evaluation of a residential mental health recovery program

ABSTRACT Personal recovery is enshrined in Australian and international mental health policy. Services seeking to support people to lead meaningful lives of their choosing require mental health professionals to embrace alternative practices. In this paper, we present the findings of an evaluation of a 15-week residential program aspiring to promote personal recovery in Perth, Western Australia. Group work is the main service delivery mode, and the program is premised on the belief that a therapeutic peer community environment has the potential to create conditions for recovery. Semi-structured interviews were conducted with 13 consumers following graduation, and at six months follow-up (n = 9) which explored their experiences of the program, its strengths, areas for improvement, and impact. Data were analysed using a general inductive approach which was guided by the evaluation objectives. Participants reported that the Recovery House was emotionally challenging, personally transformative, and unlike any other service or program experience. Key elements that supported recovery were the live-in nature of the program; the emphasis on commitment and taking personal responsibility; use of a peer community as a therapeutic tool; and the focus on deep emotional healing and making meaning. Challenges included communal living, and transitioning back into the community post-program. Recovery House represents an attempt to depart from traditional relationships and ways of working within mental health services by emphasising self-determination, equal relationships, and creating opportunities to deeply explore emotional distress. Evaluation findings suggest that intensive therapeutic group work may be a powerful contributor to supporting recovery.

Disrupting Intergenerational Maternal Maltreatment in Middle Childhood: Therapeutic Objectives and Clinical Translation.

Background: Child Maltreatment is a concerning worldwide problem. The population of distressed mothers with their highly disturbed children, in middle-childhood, often present to child and adolescent mental health services (CAMHS). Finding effective therapies for this population has proved elusive. This led the authors to undertake a theory-driven research program to better understand intergenerational child maltreatment from a clinical perspective, in order to determine how best to treat the entrenched distressing and destructive behaviors.Methods: The model describing the mechanisms of the intergenerational transmission of maternal maltreatment is briefly described, from which the objectives of any effective treatment for these mothers and children are derived. A clinical model for achieving the therapeutic objectives is then elucidated.Findings: Core objectives of therapy are; first to support the mother and child to develop differentiated senses of self and, second to disrupt a relationship style built on a competitive dominance and submission hierarchy, replacing it with a hedonic (cooperative and compassionate relationship style). This requires a deep healing of the mother and child's trauma histories. A clinical operationalization of these objectives, through a novel dyadic psychotherapeutic protocol, Parallel Parent and Child Therapy is described, which addresses the therapeutic objectives while attending to the safety of mother and child.Interpretation: This research contributes to a better understanding of the components of effective treatment in what is a notoriously hard to treat population. It also illustrates the value of clinically informed theory development in understanding and refining treatment strategies for highly distressed and distressing populations.

Using ustekinumab to treat Crohn's disease

Ustekinumab is an IV induced, SC maintained biological therapy that has been shown to induce and maintain remission in Crohn's disease, as well as promoting deep mucosal healing. Ustekinumab has been licensed for use in patients who have not responded to a traditional medical therapy, such as an aminosalicylate, corticosteroid or immunosupressant, or another biologic, such as infliximab. There is debate as to whether biologics should be commenced at the end of a step-up approach or the beginning of a step-down approach.

Issue Highlights

Issue Highlights

Associations Among Mucosal and Transmural Healing and Fecal Level of Calprotectin in Children With Crohn’s Disease

Bowel healing is an important goal of therapy for patients with Crohn's disease (CD). Although there have been many studies of mucosal healing, transmural healing (ie, in the bowel wall) has not been investigated in children. We analyzed data from the ImageKids study to determine associations among mucosal, transmural healing and levels of calprotectin and C-reactive protein in children with CD. We collected data from a multi-center study designed to develop 2 magnetic resonance enterography (MRE)-based measures for children with CD (6-18 years old). In our analysis of 151 children (mean age, 14.2 ± 2.4 years), all patients underwent MRE and a complete ileocolonoscopic evaluation; fecal levels of calprotectin and blood levels of C-reactive protein were measured. Mucosal healing was defined as simple endoscopic severity index in CD score below 3, transmural healing as an MRE visual analogue score below 20 mm, and deep healing as a combination of transmural and mucosal healing. We identified mucosal healing with transmural inflammation in 9 children (6%), transmural healing with mucosal inflammation in 38 children (25%), deep healing in 21 children (14%), and mucosal and transmural inflammation in 83 children (55%). The median level of calprotectin was lowest in children with deep healing (mean level, 10 μg/g; interquartile range, 10-190 μg/g), followed by children with either transmural or mucosal inflammation, and highest in children with mucosal and transmural inflammation (810 μg/g; interquartile range, 539-1737 μg/g) (P < .001). Fecal level of calprotectin identified children with deep healing with an area under the receiver operating characteristic curve value of 0.93 (95% CI, 0.89-0.98); level of C-reactive protein identified children with deep healing with an area under the receiver operating characteristic curve value of 0.81 (95% CI, 0.71-0.9). A calprotectin cutoff value of 100 μg/g identified children with deep healing with 71% sensitivity and 92% specificity; a cutoff value of 300 μg/g identified children with mucosal healing with 80% sensitivity and 81% specificity. In a prospective study of children with CD, we found that one-third have healing in only the mucosa or the bowel wall (not both). Levels of fecal calprotectin below 300 μg/identify children with mucosal healing, but a lower cutoff value (below 100 μg/g) is needed to identify children with deep healing. Clinicaltrials.gov no: NCT01881490.