可控性丝线留置术治疗体表难治性海绵状静脉畸形的实验及临床研究

目的研究可控性丝线的致栓效果及其治疗体表难治性海绵状静脉畸形的初步疗效。方法将丝线一端留置于不同管腔大小的静脉内,另一端挂于血管壁埋于皮下,实现其可控性,用经过不同处置的丝线,分别留置于兔耳缘静脉、股静脉,观察其引起血管栓塞的效果。选择致栓效果较好的丝线组,用于临床治疗难治性体表海绵状静脉畸形的患者。结果几种经不同处置的丝线,均能不同程度地起到闭塞血管的作用,对于管腔稍大,血流较快的静脉(兔股静脉),浸泡丝裂霉素并打结的丝线组,致栓效果最好;临床初步应用证实,可控性丝线治疗体表难治性静脉畸形,安全有效。结论可控性丝线静脉内留置术,是一种安全、有效、损伤小、操作简便的治疗体表难治性海绵状静脉畸形的新方法。     

单丝聚丙烯合成非吸收齿状线在美容整形应用中并发症的防治及应用改进

目的探讨单丝聚丙烯合成非吸收齿状线在美容整形中的并发症产生的原因及应用方法及技术的改进。方法对近两年的单丝聚丙烯合成非吸收齿状线在美容整形中的应用进行总结与分析。结果改进应用方法后，并发症明显减少，效果加强。结论单丝聚丙烯合成非吸收齿状线在美容整形中应用得当，可减少并发症、取得显著效果。     

Provider networks and health plan premium variation

ObjectiveTo examine how plan premiums are associated with physician network breadth, hospital network breadth, and hospital network quality on the Affordable Care Act''s Health Insurance Marketplaces in all 50 states and the DC in 2016.Data SourcesData on plan premiums and characteristics came from 2016 Robert Wood Johnson Foundation Health Insurance Exchange (HIX) Compare. Provider network information was obtained from Vericred. Hospital characteristics were obtained from CMS Hospital Compare and the American Hospital Association (AHA) survey.Study DesignWe analyzed how plan premiums were associated with variations in physician network breadth, hospital network breadth, and hospital network quality using ordinary least square regressions with state‐rating area fixed effects and carrier fixed effects.Principal FindingsPlan premiums were positively associated with physician network breadth and hospital network breadth. We find the following statistically significant results: a one standard deviation increase in physician network breadth was linked to a premium increase of 2.8 percent or $101 per year; a one standard deviation increase in hospital network breadth was linked to a premium increase of 2.4 percent or $86 per year. There was no significant association between premiums and hospital network quality, as measured by hospital star ratings and the inclusion of teaching hospitals or the top‐20 hospitals nationwide.ConclusionsPhysician network breadth and hospital network breadth contributed positively to plan premiums. The roles of the two types of provider network breadth are quantitatively similar. Premiums appear to be insensitive to hospital network quality.     

壮医药线点灸配合针刺治疗失眠症疗效观察

目的 观察壮医药线点灸配合针刺治疗失眠症的临床疗效。方法 将95例失眠症患者随机分为治疗组50例和对照组45例。治疗组采用壮医药线点灸配合针刺治疗,对照组采用单纯针刺治疗。比较两组治疗前后睡眠质量指数（PSQI）评分和临床疗效。结果 治疗组治疗1、2个疗程后PSQI评分与同组治疗前比较,差异均具有统计学意义（P＜0.05,P＜0.01）。对照组治疗2个疗程后PSQI评分与同组治疗前比较,差异具有统计学意义（P＜0.05）。治疗组治疗2个疗程后PSQI评分与对照组比较,差异具有统计学意义（P＜0.05）。治疗组总有效率为90.0%,对照组为71.1%,两组比较差异具有统计学意义（P＜0.05）。结论 壮医药线点灸配合针刺是一种治疗失眠症的有效方法。     

Optimal asymmetric thread for orthodontic microimplants: Laboratory and clinical evaluation

Objectives:To investigate the performance of microimplants incorporating a newly designed asymmetric thread.Materials and Methods:Three microimplants were compared. The control group comprised microimplants with the original v-shaped thread. The two experimental groups (Taper 1.0 and Taper 1.25) comprised prototype microimplants constructed with the new asymmetric thread; the Taper 1.25 specimens had a 1.25-mm-long and sharper tip, while the Taper 1.0 and control groups had a less sharp 1-mm tip. Two specially designed artificial bone blocks mimicking soft (maxillary) and hard (mandibular) bone were used to evaluate the microimplant insertion characteristics and postinsertion lateral stability. The peak insertion torque, insertion time, Periotest value (PTV), and torsional strength were measured. Then the microimplants were evaluated clinically over a 3-month period.Results:Significant differences in peak insertion torque, insertion time, and PTV were observed and favored the experimental groups. Although statistically insignificant, the clinical success rate was also higher in the Taper 1.25 experimental group than in the control group (87.2% vs 75.6%).Conclusions:The better performances of the experimental microimplant, under both laboratory and clinical conditions (although statistically insignificant in the latter), demonstrate the superiority of the new asymmetric thread.     

切开挂线术治疗复杂肛瘘中的临床疗效观察

目的探讨切开挂线术治疗复杂肛瘘中的临床疗效。方法将60例复杂性肛瘘患者,随机分为两组,每组30例,分别标记为挂线组、结扎组。挂线组采用切开挂线术治疗,结扎组采用括约肌间瘘管结扎术治疗,比较两组术后疗效。结果挂线组愈合率为83．33％,结扎组愈合率为76．67％,差异无统计学意义（P〉0．05）。结扎组患者愈后肛门功能评分明显低于挂线组,差异有统计学意义（P〈0．05）。结论切开挂线术治疗复杂性肛瘘效果良好,能有效地保护了肛门括约肌的功能,提高患者的生活质量。     

The disproportionate burden of HIV and STIs among male sex workers in Mexico City and the rationale for economic incentives to reduce risks

Introduction

The objective of this article is to present the rationale and baseline results for a randomized controlled pilot trial using economic incentives to reduce HIV and sexually transmitted infection (STI) risk among male sex workers (MSWs) in Mexico City.

Methods

Participants (n=267) were tested and treated for STIs (chlamydia, gonorrhoea, syphilis and HIV) and viral hepatitis (hepatitis B and C), received HIV and STI prevention education and were randomized into four groups: (1) control, (2) medium conditional incentive ($50/six months), (3) high conditional incentive ($75/six months) and (4) unconditional incentive ($50/six months). In the conditional arms, incentives were contingent upon testing free of new curable STIs (chlamydia, gonorrhoea and syphilis) at follow-up assessments.

Results

Participants’ mean age was 25 years; 8% were homeless or lived in a shelter, 16% were unemployed and 21% lived in Mexico City less than 5 years. At baseline, 38% were living with HIV, and 32% tested positive for viral hepatitis or at least one STI (other than HIV). Participants had a mean of five male clients in the previous week; 18% reported condomless sex with their last client. For 37%, sex work was their main occupation and was conducted mainly on the streets (51%) or in bars/discotheques (24%) and hotels (24%). The average price for a sex transaction was $25 with a 35% higher payment for condomless sex.

Conclusions

The findings suggest that economic incentives are a relevant approach for HIV prevention among MSWs, given the market-based inducements for unprotected sex. This type of targeted intervention seems to be justified and should continue to be explored in the context of combination prevention efforts.     

牙科即刻种植中不同螺纹形态及深度设计参数种植体的生物力学性能

目的分析牙科即刻种植中不同螺纹形态和螺纹深度种植体周围骨质应力分布情况,为种植体的设计和选择提供依据。方法利用Geomagic Studio、Solid Works和ANSYS Workbench建立下颌骨骨块、种植体及下颌磨牙简化模型,施加垂直载荷和斜向载荷,观察不同螺纹形态和螺纹深度的种植体及其周围骨组织应力分布情况。结果垂直载荷作用下,种植体、皮质骨、松质骨应力峰值变化范围分别为120. 51～129. 63 MPa、9. 94～13. 25 MPa、3. 92～8. 01 MPa,V形、矩形、支撑形、反支撑形种植体周围皮质骨在螺纹深度0. 40～0. 45 mm范围内应力变化平稳;斜向载荷作用下,种植体、皮质骨、松质骨应力峰值变化范围分别为220. 23～286. 51 MPa、33. 39～45. 08 MPa、4. 96～12. 5 MPa。螺纹深度为0. 45 mm,V形、支撑形、反支撑形种植体应力最小。结论 V形、支撑形、反支撑形螺纹种植体选择螺纹深度为0. 45 mm,矩形种植体选择螺纹深度0. 40 mm,呈现出较好的生物力学特性。     

The impact of a modified cutting flute implant design on osseointegration

Information concerning the effects of the implant cutting flute design on initial stability and its influence on osseointegration in vivo is limited. This study evaluated the early effects of implants with a specific cutting flute design placed in the sheep mandible. Forty-eight dental implants with two different macro-geometries (24 with a specific cutting flute design – Blossom group; 24 with a self-tapping design – DT group) were inserted into the mandibular bodies of six sheep; the maximum insertion torque was recorded. Samples were retrieved and processed for histomorphometric analysis after 3 and 6 weeks. The mean insertion torque was lower for Blossom implants (P < 0.001). No differences in histomorphometric results were observed between the groups. At 3 weeks, P = 0.58 for bone-to-implant contact (BIC) and P = 0.52 for bone area fraction occupied (BAFO); at 6 weeks, P = 0.55 for BIC and P = 0.45 for BAFO. While no histomorphometric differences were observed, ground sections showed different healing patterns between the implants, with better peri-implant bone organization around those with the specific cutting flute design (Blossom group). Implants with the modified cutting flute design had a significantly reduced insertion torque compared to the DT implants with a traditional cutting thread, and resulted in a different healing pattern.     

经络氧电针合药线灸治疗失眠症的对照研究

目的:观察经络氧电针合药线灸治疗失眠症的临床疗效及安全性.方法:将90例失眠症患者随机分为观察组和对照组,每组45例,观察组予经络氧电针合药线灸治疗,对照组予佐匹克隆胶囊口服治疗,疗程4周.采用修订的匹兹堡睡眠质量指数(PSQI)、不良反应量表(TESS)评定临床疗效和安全性.结果:观察组PSQI治疗前(17.20±2.35)分、治疗后(1.71±1.25)分比较,差异有统计学意义(P<0.05).对照组治疗前(17.80±2.08)分、治疗后(4.42±2.01)分比较,差异有统计学意义(P<0.05);观察组和对照组的有效率分别为88.89%和86.67%,2组有效率的比较差异无统计学意义(P>0.05);观察组治疗1周、2周、3周、4周PSQI评分均显著低于对照组(P<0.01);治疗4周后观察组TESS评分(0.02±0.15)分与对照组(0.42±0.50)分比较差异有统计学意义(P<0.05),观察组的不良反应小于对照组.结论:经络氧电针合药线灸治疗失眠症有较好的临床疗效,不良反应比佐匹克隆胶囊少.