植入物乳房重建一步法和二步法临床对比研究

目的:探讨即刻乳房假体重建（一步法）和应用扩张器的假体重建（二步法）两种不同手术方式在术后并发症、美容效果和成本效益的差异。方法:回顾性分析我院乳腺外科2015年5月至2018年5月收治的285例乳腺癌植入物重建患者，依据手术方式不同分为一步法组（145例）和二步法组（140例），比较两组患者临床资料的差异。结果:一步法组术后出血发生率（6.8%）高于二步法组（1.4%），差异有统计学意义（P=0.021）。一步法组术后伤口皮瓣坏死率（6.2%）高于二步法组（1.4%），差异有统计学意义（P=0.036）。二步法组乳房满意度评分（81.5±7.1）分高于1步法组（78.6±6.2）分，差异有统计学意义（P=0.035）。二步法组住院总花费（80 334.8±6 149.8）元高于一步法组（60 966.5±5 544.9）元，差异有统计学意义（P=0.049）。二步法组住院天数（34.3±3.2）天多于一步法组（17.5±3.9）天，差异有统计学意义（P=0.014）。结论:在植入物乳房重建两种手术方式中，二步法相较于一步法，其并发症少，美容效果好，但在成本效益上并不优于一步法。     

Cognitive defusion versus experiential avoidance in the reduction of smoking behaviour: an experimental and preliminary investigation

Background: Brief procedures that reduce smoking behaviour may be useful in reaching the many people that do not seek help for smoking addiction.

Objectives: The current study aimed to determine if one component of Acceptance and Commitment Therapy (ACT), cognitive defusion, could be useful in reducing smoking behaviour in a sample of students.

Methods: The study employed a between-subjects three-arm design. For one week, participants were asked to reduce their cigarette consumption. To aid them in their reduction, participants were randomly allocated to one of three conditions: the first received a defusion procedure, the second received an experiential avoidance procedure and a control condition received no procedure. For a second week, the instruction to reduce cigarette consumption was lifted. During both weeks participants were required to monitor their smoking behaviour via a tally diary system.

Results: The defusion condition smoked significantly less than the control condition during week one and significantly less than the control and experiential avoidance conditions during week two.

Conclusion: Results are discussed in terms of the potential utility of defusion in this domain, and the limitations of this preliminary research that would need to be addressed in future investigations.     

Clinical and biochemical effects of diode laser as an adjunct to nonsurgical treatment of chronic periodontitis: a randomized, controlled clinical trial

The aim of this randomized, parallel, controlled clinical trial was to examine the clinical and biochemical efficacy of diode laser as an adjunct to scaling and root planing (SRP). Thirty chronic periodontitis patients were randomly assigned into two groups to receive SRP alone (control) or SRP followed by diode laser (test). Plaque index, gingival index, bleeding on probing, probing depth, and clinical attachment level were measured at baseline and at 1, 3, and 6 months after treatment. The gingival crevicular fluid levels of interleukin-1β (IL-1β), interleukin-6 (IL-6), interleukin-8 (IL-8), matrix metalloproteinase-1 (MMP-1), matrix metalloproteinase-8 (MMP-8) and tissue inhibitor matrix metalloproteinase-1 (TIMP-1) were analyzed by enzyme-linked immunosorbent assay. Test group showed significantly a better outcome compared to the control group in full-mouth clinical parameters. MMP-1, MMP-8, and TIMP-1 showed significant differences between groups after treatment compared to baseline (p?<?0.05). The total amount of IL-1β, IL-6, MMP-1, MMP-8, and TIMP-1 decreased (p?<?0.05) and IL-8 increased after treatment in both test and control groups (p?<?0.05). Diode laser provided significant improvements in clinical parameters and MMP-8 was significantly impacted by the adjunctive laser treatment at first month providing an insight to how lasers can enhance the outcomes of the nonsurgical periodontal therapy.     

Where is the fracture? Penetrating injury with a foreign bone

Injuries in the explosion scenarios are usually hollow organ injuries including rapid gas expansion, thermal injuries, penetrating injuries due to secondary projectiles and secondary injuries like falls and burns. Our case is a penetrating injury that was considered open knee fracture (Gustilo Anderson Type 3A) and peroneal nerve palsy in the emergency service after bomb attack but later it was seen that the secondary projectile was a foreign bone and the patient's bone integrity was intact. Our aim is to show that specific human tissues must be considered as a factor in the secondary injuries.     

Congenital coronary artery fistulas in adults: concomitant pathologies and treatment

Background Coronary artery fistula is a rare congenital malformation. Complications such as intracardiac shunts, endocarditis, myocardial infarction, aneurysm and sudden death can be observed. The purpose of this article is to present our experience with concomitant cardiac pathologies and discuss various therapeutic approaches including surgical and percutaneous intervention. Materials and methods During 18,272 diagnostic cardiac catheterizations, coronary artery fistulas were identified incidentally in 10 patients (0.05%). There were 3 female and 7 male patients. The patients’ ages ranged from 42 to 76 years. All patients with coronary artery fistula were preoperatively in New York Heart Association functional class and Canadian Cardiovascular Society class II or III. Results In addition to coronary artery fistula, coronary artery disease was detected in 4 patients (40%), a ventricular septal defect and an aneurysm of the sinuses of Valsalvae with aortic regurgitation in one patient (10%) and an anomalous origin of the LAD from the pulmonary trunk in one patient (10%) during cardiac catheterization. Four (40%) of the total of 10 patients had only coronary artery fistula. Surgical closure of the coronary artery fistula was performed in 7 patients (70%). An interventional fistula closure with a coil device was confirmed by cardiac catheterization in another 3 patients (30%). One patient of the latter group showed a small residual shunt from the LAD to the pulmonary trunk. No death or long-term morbidities could be observed. Conclusions Coronary artery fistulas are incidentally diagnosed during coronary artery angiographies in adults and should be closed to prevent complications.     

新疆地区ⅠB～ⅡA期宫颈癌不同治疗模式的疗效及并发症分析

目的 探讨新疆地区ⅠB～ⅡA期宫颈癌不同治疗模式的疗效及并发症。方法 回顾性分析本院215例ⅠB～ⅡA期宫颈癌患者的临床病理资料并随访其生存情况,分析总体及不同临床病理参数的5年生存率,采用Cox模型分析影响预后的独立因素;根据治疗方案将215例患者分为根治性手术（81例）、根治性放疗（65例）、术前辅助治疗（25例）及术后辅助治疗（44例）,分析各种治疗模式的预后及并发症情况。结果 总体5年生存率为79.3％。不同FIGO分期、族别、肿瘤直径、分化程度及术后病理高危因素的5年生存率差异均有统计学意义（P＜0.05）;Cox模型分析显示,FIGO分期、肿瘤直径及术后病理高危因素是宫颈癌预后的独立危险因素（P＜0.05）。根治性手术、根治性放疗、术前辅助治疗及术后辅助治疗者的5年生存率依次为80.9％、82.5％、78.8％和72.4％,并发症发生率依次为25.9％、18.5％、24.0％和38.6％,差异均无统计学意义（P＞0.05）。结论 对术后有危险因素或术前肿瘤体积较大患者行相应辅助治疗可达到无危险因素患者根治性手术或根治性放疗的治疗效果,故建议临床工作中对不同患者施行个体化治疗,在保证治疗效果的前提下尽量减少并发症及患者治疗负担。     

The effect of hyperbaric oxygen therapy on the survival of random pattern skin flaps in nicotine-treated rats

Previous studies have shown that nicotine increases the risk of necrosis in skin flaps. We investigated the effect of hyperbaric oxygen (HBO(2)) treatment on the survival of random skin flaps in nicotine-treated rats. Thirty-two Sprague-Dawley rats were divided into four groups with eight rats in each group. Group 1 (n=8) was the control, group 2 (n=8) received HBO(2) treatment without being exposed to nicotine, group 3 (n=8) received nicotine and group 4 (n=8) received HBO(2) treatment with exposure to nicotine. The rats in the nicotine-treated groups were prepared by treating them with nicotine for 28 days. At the end of the 28th day, standard McFarlane-type random skin flaps were lifted from the backs of all the rats. In groups 2 and 4, HBO(2) treatment started at the 30th min following the surgery and continued once a day for 7 days. The flap survival rates and histopathological evaluation results related to neovascularisation and granulation tissue formation were significantly better in the HBO(2)-treated groups (groups 2 and 4) than in the groups that did not receive HBO(2) treatment (groups 1 and 3) (p < 0.05). The flap survival rates, neovascularisation and granulation tissue formation were highest in group 2 and lowest in group 3 (p ≤ 0.001). No significant difference was observed between group 4, which received HBO(2) treatment with nicotine exposure, and the control group (group 1) (p > 0.05). In conclusion, our study demonstrates that HBO(2) treatment has a positive effect on flap survival in nicotine-treated rats.     

A serologic study of naturally acquired leprosy in chimpanzees

Data from longitudinally obtained serum samples spanning several years has permitted us to identify two chimpanzees with leprosy and to estimate the time of Mycobacterium leprae exposure/infection. The results confirm high levels of specific anti-M. leprae phenolic glycolipid-I (PGL-I) as well as anti-lipo-arabinomannan (anti-LAM) antibodies in both chimpanzees, and identify additional chimpanzees with possible M. leprae exposure. The observations are consistent with the hypothesis that leprosy exists in chimpanzees in the U.S.A. and suggest the possibility that M. leprae may be transmitted among chimpanzees. The data suggest that monitoring anti-PGL-I and anti-LAM IgG and IgM levels longitudinally in leprosy contacts may be useful in the recognition of preclinical leprosy.     

Experimental leprosy in a rhesus monkey: necropsy findings

A 6-month-old male rhesus monkey (Macaca mulatta) was inoculated intravenously and intracutaneously with Mycobacterium leprae obtained from a naturally infected mangabey monkey. The animal developed generalized lepromatous leprosy, and was killed for pathological examination 56 months after inoculation. Lesions were observed in the skin, nasal mucosa, peripheral nerves, and peripheral lymph nodes, with relative sparing of viscera. The monkey was carefully evaluated for the retrovirus STLV-III infection and was found negative. The rhesus monkey thus provides another animal model for the study of leprosy.