A型肉毒毒素在面部美容中的应用体会

目的观察A型肉毒毒素在面部美容中的应用效果.方法对以面部美容为目的的240例患者应用A型肉毒毒素定点、定量注射治疗,注射点均匀、对称分布于面部肌肉层,其中额横纹、眉间皱纹、鱼尾纹患者166例,眉下垂患者12例,咬肌肥大患者30例,瘢痕患者5例,其他患者27例.结果 240例患者经A型肉毒毒素治疗后显效者179例(74.58%),有效者61例(25.42%),无效者为0例.结论 A型肉毒毒素在面部美容的外科应用中有确切的疗效,而且不良反应少,创伤小,具有广阔的应用前景.     

A型肉毒毒素治疗面部皱纹300例

目的：观察A型肉毒毒素治疗面部皱纹的运用效果。方法：对以面部美容为目的的300例患者应用A型肉毒毒素定点、定量注射治疗,注射点均匀、对称分布于面部肌肉层。其中包括额部皱纹、鱼尾纹、眉间皱纹、下睑纹、鼻唇沟纹。结果：300例患者行A型肉毒毒素治疗后显效者234例（占78％）,有效者66例（占22％）,无效者为0例。结论：A型肉毒毒素在治疗面部皱纹确切有效,操作简便、易行,无痛苦,不影响工作,易于推广。     

A型肉毒毒素在下面部及颈部的应用

目的 观察A型肉毒毒素在下面部及颈部美容中的应用效果。方法 用生理盐水1．1ml稀释A型肉毒毒素55U，对引起口周、颈部皱纹及露龈笑特定的肌肉进行定点、定量注射。结果 对110例患者进行注射A型肉毒毒素治疗，显效者70例，有效者35例，不对称5例，无效者0例，进行重复注射者92例。结论 注射A型肉毒毒素用于下面部及颈部的美容，操作方法简单、损伤小、安全、有效，并为手术提供了对照研究方法和辅助治疗手段。     

A型肉毒毒素治疗眉外侧段与上睑外侧的老年性皮肤松垂

目的 探讨A型肉毒毒素注射治疗眉和上睑外侧老年性皮肤松垂的非手术治疗方法。方法 采用A型肉毒毒素注射治疗眉外侧段和上睑外侧皮肤松垂的面部老化求美者，对皱眉肌，降眉肌，眉中、外1／3交界垂线内侧的额肌。外眦部眼轮匝肌行计量定点注射。结果 对26例求美者52侧眉和上睑外侧皮肤不同的松垂程度，经一次或二次注射后均得到了明显的改善。结论 A型肉毒毒素用于治疗眉和上睑外侧老年性皮肤的松垂，操作方法简单，安全有效。     

A型肉毒毒素治疗面部皱纹效果观察

目的:探讨A型肉毒毒素行面部老化治疗中的最佳注射点位,探讨A型肉毒毒素应用的特点,适应证及并发症等。方法:分析2009年8月至2012年12月之间198例面部老化患者行A型肉毒毒素注射治疗的临床资料,根据注射点位的不同,术后随访观察额纹、鱼尾纹、眉间纹等处皱纹的改变情况。结果:按实验中的点位注射,198例患者中180例效果显著,18例自觉效果不够理想,无患者出现眉下垂、睑外翻等并发症,也无晕厥休克等严重过敏性反应。结论:应用A型肉毒毒素治疗面部老化,治疗效果肯定,治疗过程安全,可扩大A型肉毒毒素应用于面部老化治疗的范围,也可采用多点位、小剂量注射可起到个性化去皱的效果。     

A型肉毒毒素在面部注射美容中的临床应用

目的探讨A型肉毒毒素在面部注射美容中的应用效果。方法自2017年4～11月对接受面部注射美容的80例求美者(面部皱纹者60例,咬肌肥大者20例),根据面部皱纹和咬肌肥大的评估情况来选择相应的注射部位、剂量和方法。采用皱纹疗效评估、面部测量比值、主观满意度调查来评价A型肉毒毒素注射后的效果。结果面部皱纹术后的求美者总有效率为100%(其中显效率为90.00%,有效率为10.00%)。咬肌肥大的求美者术后,上面宽/中面宽与面高/中面宽在治疗前后比较,其差异无统计学意义(P0.05);下面宽/中面宽在治疗后变小。主观满意度调查结果示,非常满意为96.25%(77/80);基本满意为3.75%(3/80);无不满意者。结论 A型肉毒毒素在面部注射美容中的效果较好,求美者的满意度较高,是一种微创、安全、有效且可逆的面部注射美容方法。     

A型肉毒毒素治疗眉外侧段与上睑外侧的老年性皮肤松垂

目的探讨A型肉毒毒素注射治疗眉和上睑外侧老年性皮肤松垂的非手术治疗方法.方法采用A型肉毒毒素注射治疗眉外侧段和上睑外侧皮肤松垂的面部老化求美者,对皱眉肌,降眉肌,眉中、外1/3交界垂线内侧的额肌,外眦部眼轮匝肌行计量定点注射.结果对26例求美者52侧眉和上睑外侧皮肤不同的松垂程度,经一次或二次注射后均得到了明显的改善.结论A型肉毒毒素用于治疗眉和上睑外侧老年性皮肤的松垂,操作方法简单,安全有效.     

A型肉毒毒素V形对称注射法面部除皱

目的：探讨A型肉毒毒素V形对称注射法在面部除皱中的应用优势。方法：采用A型肉毒毒素V形对称注射治疗面部皱纹，注射点均在靶肌肉内呈V形排布，位置、间距对称，分布均匀，且精确定量。行A型肉毒毒素以V形对称注射法治疗面部皱纹的患者116例，其中额部皱纹患者49例，眉间部皱纹患者23例，鼻背部皱纹患者11例，双侧鱼尾纹患者33例。结果：116例患者中效果优良96例占82.76％，满意18例占l5．52％，失败2例占1．72％。无一例发生中毒、过敏、上睑下垂、复视、下睑外翻等严重并发症。结论：A型肉毒毒素V形对称注射治疗面部皱纹，注射点均在靶肌肉内呈V字形排布，位置、间距对称，分布均匀，且精确定量，能有效的防止并发症的发生，临床效果优良。     

A型肉毒毒素在下面部及颈部的应用

目的观察A型肉毒毒素在下面部及颈部美容中的应用效果.方法用生理盐水1.1ml稀释A型肉毒毒素55U,对引起口周、颈部皱纹及露龈笑特定的肌肉进行定点、定量注射.结果对110例患者进行注射A型肉毒毒素治疗,显效者70例,有效者35例,不对称5例,无效者0例,进行重复注射者92例.结论注射A型肉毒毒素用于下面部及颈部的美容,操作方法简单、损伤小、安全、有效,并为手术提供了对照研究方法和辅助治疗手段.     

A型肉毒毒素联合减张压迫法在面部整形美容切口中的应用

目的：探讨A型肉毒毒素联合减张压迫法在面部整形美容切口中的应用效果。方法：随机选择30例面部整形美容手术治疗患者作为治疗组,另外选择30例为对照组,其中治疗组患者行整形美容术后即给予A型肉毒毒素注射并于拆线后用3M免缝胶布减张压迫切口,对照组术后不予A型肉毒毒素注射,拆线后即终止治疗。术后9个月对患者进行随访,并对术后切口进行评价,作统计学分析。结果：60例患者切口均为一期愈合。治疗组25例（83.3%）患者切口愈合为成熟期瘢痕,对治疗十分满意;5例（16.7%）患者切口瘢痕稍增宽,对治疗不太满意;治疗组患者表情均完全恢复,未发生A型肉毒毒素注射并发症。对照组仅7例（23.3%）患者切口为基本成熟瘢痕,对切口瘢痕较满意;23例（76.7%）患者切口瘢痕增宽,对治疗不太满意。结论：通过A型肉毒毒素联合减张压迫法在面部整形美容切口中的应用,术后切口愈合理想,患者满意度高,以期更好地促进整形美容术后切口的愈合并防治瘢痕增生。     

Is the reexcision rate higher if breast conservation surgery is performed by surgical trainees?

BACKGROUND: It is essential that surgical trainees obtain adequate operative experience without compromising patient outcome. The aim of this study was to compare the reexcision and local recurrence rates between consultants (attending surgeons) and surgical trainees (residents) after breast conservation surgery. METHODS: Prospective data were obtained from the local breast cancer registry for all patients who had breast-conservation surgery between 1994 and 2000. Reexcision was carried out if the margins were deemed inadequate after taking the clinical and pathologic features into consideration. RESULTS: The primary operation (n = 505) was wide local excision = 377; wire-guided excisions = 107; and quadrantectomy = 21 patients. Sixty-five percent (n = 330) were operated on by consultants and 35% (n = 175) by residents. Second procedures (n = 137) were performed for involved margins in 95 and close margins in 31 patients. The patients in both groups were equally matched. The reexcision rate was similar for both groups of surgeons (P = 0.58). On multivariate analysis, the factors determining reexcision were nodal status, type of first procedure, and tumor type. The local recurrence rate was comparable in both groups (P = 0.33). CONCLUSIONS: In patients with breast cancer treated by conservation surgery during a 7-year period, the reexcision and local recurrence rates were similar for both groups of surgeons.     

Effect of immunosuppressive drugs on the release of metalloproteinases from human polymorphonuclear leukocytes

The concentration of the metalloproteinases type I collagenase and gelatinase was measured in isolated polymorphonuclear leukocytes (PMNLs) of renal transplant recipients treated either with cyclosporin A (CyA) and prednisolone (Pr) (n=8) or azathioprine (Aza) and Pr (n=8), and of healthy subjects (n=12). PMNLs of CyA- and Aza-treated transplant patients displayed markedly higher gelatinase content (2427±489 and 3284±357 ng/10⁷ cells) than PMNLs of controls (528±83 ng/10⁷ cells). There was also a higher content of type I collagenase in PMNLs (3374±292 ng/10⁷ cells) of Aza-treated patients and significantly elevated levels in PMNLs of patients receiving CyA (3625±229 ng/10⁷ cells) compared with healthy subjects (2878±151 ng/10⁷ cells). In contrast, neutrophil lactoferrin content was lower in transplant patients. Thus, immunosuppressive drugs may reduce the release of leukocyte proteinases, which are known for their deleterious role in proteolytic tissue and matrix breakdown. In vitro, the effects of different immunosuppressive drugs on the release of lactoferrin, collagenase and gelatinase were investigated on FMLPNTL-stimulated PMNLs isolated from healthy subjects. CyA but not Aza or Pr caused inhibition of gelatinase, collagenase and lactoferrin release.     

Clinicopathologic Impact of Early Medullary Ray Injury in Patients Following Kidney Transplantation

Background

Previously, we explored the histopathologic characteristics of medullary ray injury (MRI) inducing interstitial fibrosis and tubular atrophy (IF/TA) to determine its etiologies, which include calcineurin inhibitor (CNI) toxicity and urologic complications. However, we did not examine the effects of these etiologies on long-term kidney allograft prognosis, because biopsy timing differed among cases.

Electroencephalographic investigations in sellar tumours,with special regard to different methods of operative treatment

Summary Sixty-six patients with tumours in the sellar region were examined. All were operated on either by the transfrontal or the transsphenoidal route. Pre- and postoperative longitudinal electroencephalographic investigations were performed.Preoperative electroencephalograms showed a normal frequency content in cases of intrasellar tumours or those reaching the chiasma. Nearly all cases had irregularities in the temporal regions. Tumours compressing the third ventricle had slower average frequencies and a general slowing in all cases. Besides these alterations unilateral delta waves or bitemporal dysrhythmic groups were sometimes found.A connection between extension of the tumour and its histological nature could not be found, but the operative approach influenced the electroencephalographic disturbances enormously. After a transfrontal approach and removal of the tumour the electroencephalogram was unchanged. Sometimes a mild transient bitemporal slowing was present. But after a transfrontal operative approach a general slowing was common, usually with focal marked slow activity in the right fronto-temporal area.     

Aspects of personality in patients with pituitary adenomas

Summary In 24 patients suffering from pituitary tumours, aspects of personality as covered by the FPI (Freiburger Personality Inventory), the Gie\en test and the STAI (State-Trait-Anxiety Inventory) were investigated in order to find out changes or problems which demand special treatment.The most interesting result concerns state and trait-anxiety scores being increased pre-surgically and normalizing to some extent after treatment. Most of the other explored aspects did not show but tendencies which demand further investigation.Relationships between hormone levels and tumour size could not be shown. As a result of this investigation, special psychological treatment should be considered in acromegaly and Cushing's disease.Dedicated to Prof. Dr. Friedrich Loew on the occasion of his 65th birthday and the 25th anniversary of the Homburg Neurosurgical University Clinic, which has been founded and built up by him.     

Functional, life-threatening disorders and splenectomy following liver transplantation

Splenectomy (SPL) in cirrhotic patients undergoing liver transplantation (LTx) may resolve specific problems related to the procedure itself, in case of functional and life-threatening clinical situations often occurring as a result of liver cirrhosis and portal hypertension. METHOD: A single-center experience of ten splenectomies in a series of 180 consecutive adult liver transplant patients over a period of 6 yr is reported. The mean patient age was 46.8 +/- 9.5 yr (range 25 57 yr). Indications for SPL were post-operative massive ascitic fluid loss (n = 3), severe thrombocytopenia (n = 3), acute intra-abdominal hemorrhage (n = 2), infarction of the spleen (n = 1), and multiple splenic artery aneurysms (n = 1). RESULTS: Extreme ascites production due to functional graft congestion disappeared post-SPL, with an improvement of the hepatic and renal functions. SPL was also effective in cases of thrombocytopenia persistence post-LTx, leading to an increase in the platelet count after about 1 wk. Bleeding episodes related to left-sided portal hypertension or trauma were also resolved. The rejection rate during hospitalization was 0%, and no other episodes were recorded in the course of the long-term follow-up. However, sepsis with a fatal outcome occurred in 4 patients, i.e. between 2 and 3 wk post-SPL in three cases and 1 yr after the procedure as a result of pneumococcal infection in the last case. Fatal traumatic cranial injury occurred 3 yr post-LTx in another case. Five patients (50%) are still alive and asymptomatic after a median follow-up period of 36 months. CONCLUSION: The lowering of the portal flow appears to resolve unexplained post-operative ascitic fluid loss as a result of functional graft congestion following LTx. However, because of the enhanced risk of SPL-related sepsis, a partial splenic embolization (PSE) or a spleno-renal shunt could be used as an alternative procedure because it allows us to preserve the immunological function of the spleen. SPL is indicated in case of post-transplant bleeding due to left-sided portal hypertension and trauma, spleen infarction, and to enable prevention of hemorrhage in liver transplant patients with multiple splenic artery aneurysms. Severe and persistent thrombocytopenia could be treated with PSE. Because the occurrence of fatal sepsis post-SPL is a major complication in LTx, functional disorders, such as ascites and thrombocytopenia, should be treated with a more conservative approach.     

Cash transfers for HIV prevention: considering their potential

Introduction

Cash payments to vulnerable households and/or individuals have increasingly garnered attention as a means to reduce poverty, improve health and achieve other development-related outcomes. Recent evidence from Malawi and Tanzania suggests that cash transfers can impact HIV-related behaviours and outcomes and, therefore, could serve as an important addition to HIV prevention efforts.

Discussion

This article reviews the current evidence on cash transfers for HIV prevention and suggests unresolved questions for further research. Gaps include (1) understanding more about the mechanisms and pathways through which cash transfers affect HIV-related outcomes; (2) addressing key operational questions, including the potential feasibility and the costs and benefits of different models of transfers and conditionality; and (3) evaluating and enhancing the wider impacts of cash transfers on health and development.

Conclusions

Ongoing and future studies should build on current findings to unpack unresolved questions and to collect additional evidence on the multiple impacts of transfers in different settings. Furthermore, in order to address questions on sustainability, cash transfer programmes need to be integrated with other sectors and programmes that address structural factors such as education and programming to promote gender equality and address HIV.     

Macronutrients,minerals, vitamins and energy

Carbohydrates have the general formula C_n(H₂O)_n. Monosaccharides have between three and six carbon atoms and exist as chains or ring structures. As rings, they link with other monosaccharide rings. The major carbohydrate in humans is glucose, which is stored as glycogen: branching chains of glucose molecules. Fat (triglyceride), which makes up adipose tissue, consists of three fatty acids bonded to glycerol, but other lipids include phospholipids and steroids. Proteins are composed of chains of amino acids linked by amide bonds folded on each other to form protein structures. Vitamins and minerals are obtained from the diet and are required in varying quantities for a variety of metabolic processes. Energy is derived from the oxidation of carbohydrate, fat and protein. Energy expenditure and substrate oxidation can be calculated from oxygen consumption, carbon dioxide production and urinary nitrogen excretion.