家庭参与支持联合积极心理干预对肠癌术后造口患者的影响

目的:探讨家庭参与支持联合积极心理干预对肠癌术后造口患者的影响。方法:将84例肠癌术后造口患者随机分为研究组和对照组各42例,对照组给予常规护理,研究组在此基础上实施家庭参与支持联合积极心理干预,比较两组干预效果。结果:两组干预2个月后造口适应量表(OAS)评分高于干预前(P<0.05),研究组干预2个月后OAS评分高于对照组(P<0.05);研究组干预2个月后家庭功能评定量表(FAD)评分低于干预前和对照组(P<0.05);两组干预2个月后自我护理能力测定量表(ESCA)评分高于干预前(P<0.05),研究组干预2个月后ESCA评分高于对照组(P<0.05);研究组干预2个月后中国癌症患者生活质量问卷调查表(EORTCQLQ-30)评分高于干预前和对照组(P<0.05)。结论:家庭参与支持联合积极心理干预有助于改善肠癌术后造口患者的自我造口适应状态,提升其家庭功能和自我护理能力,提高生活质量。     

基于ERAS理念下的全程化护理管理对甲状腺癌手术患者的影响

目的:探讨基于加速康复外科(ERAS)理念下的全程化护理管理对甲状腺癌手术患者的影响。方法:将60例甲状腺癌手术患者随机分为对照组和观察组各30例,对照组给予常规护理,观察组实施基于ERAS理念下的全程化护理管理,比较两组护理效果。结果:观察组术前准备依从率高于对照组(P<0.05),术后舒适度评分高于对照组(P<0.01),并发症发生率低于对照组(P<0.05)。结论:基于ERAS理念下的全程化护理管理能够提高甲状腺癌手术患者的术前准备依从率和术后舒适度,减少术后并发症。     

The altering in sensory sensitivity: a current issue of female breast surgery

Breast surgery is an important treatment for women with malignant breast diseases. In addition to breast appearance, the integrity of breast function is increasing in patients with breast diseases. As the basis of breast physiological function, breast skin sensitivity is important to the quality of life of patients after surgery. Breast skin sensitivity gives the patient a “real” breast feeling. The sensory recovery after breast surgery has also become one of the important goals of breast surgery. In this review, we aim to discuss the research progress on recovery of breast skin sensitivity after different treatment modalities for breast disease.     

后巩膜加固术联合斜视矫正术治疗轴性近视合并斜视

目的探讨后巩膜加固术联合斜视矫正术治疗轴性近视合并斜视的可行性。方法对26例46只眼轴性近视合并不同类型斜视的患者同时行斜视矫正术与后巩膜加固术,术中先表麻加结膜下浸润麻醉后行斜视矫正术,再在球后麻醉下行后巩膜加固术。结果术后眼位全部迭美容效果,部分病例恢复不同程度双眼视功能,斜视合并青少年进展性近视者观察2年近视程度较术前进展减慢,眼轴增长减慢,病理性近视视力稳定无下降。结论后巩膜加固术同时合并斜视手术是治疗轴性近视合并斜视的可行性方法,同时手术解剖层次清晰,操作方便,可避免二次手术因粘连等形成的困难,一次性手术成功率高,疗效可靠。     

Malignancy Rate and Malignancy Risk Assessment in Different Lesions of Uncertain Malignant Potential in the Breast (B3 Lesions): An Analysis of 192 Cases from a Single Institution

BackgroundThe question of how to deal with B3 lesions is of emerging interest.MethodsIn the breast diagnostics of 192 patients between 2009 and 2016, a minimally invasive biopsy revealed a B3 lesion with subsequent resection. This study investigates the malignancy rate of different B3 subgroups and the risk factors that play a role in obtaining a malignant finding.ResultsThe distribution of B3 lesions after minimally invasive biopsy was as follows: atypical ductal hyperplasia (ADH), 7.3%; flat epithelial atypia (FEA), 7.8%; lobular neoplasia (LN), 7.8%; papilloma (Pa), 49.5%; phylloidal tumour (PT), 8.9%; radial sclerosing scar (RS), 3.1%; mixed findings, 10.4%; and other B3 lesions, 5.2%. Most B3 lesions were detected by stereotactic vacuum-assisted biopsy (44.3%), 36.5% by ultrasound-assisted biopsy, and 19.3% by magnetic resonance imaging-assisted biopsy. Most B3 lesions (55.2%) were verified by surgical resection, whereas 30.7% were downgraded to a benign lesion. About 14.1% of the cases were upgraded to malignant lesions, 9.4% to ductal carcinoma in situ and 4.7% to invasive carcinoma. In relation to individual B3 lesions, the following malignancy rates were found: 28.6% (ADH), 13.3% (FEA), 33.3% (LN), 12.6% (Pa), 5.9% (PT), and 0% (RS). The most important risk factor was increasing age. Postmenopausal status was considered an increased risk for an upgrade (p = 0.015). A known malignancy in the ipsilateral breast was a significant risk factor for a malignant upgrade (p = 0.003).ConclusionIncreasing knowledge about B3 lesions allows us to develop a “lesion-specific” therapy approach in the heterogeneous group of B3 lesions, with follow-up imaging for some lesions with less malignant potential and concordance with imaging or further surgical resection in cases of disconcordance with imaging or higher malignant potential.     

Orthopedic Patients with Mental Disorder: Literature Review on Preoperative and Postoperative Precautions

Because of the increasing global trend of patients with mental disorders, orthopedic surgeons are more likely to encounter orthopedic patients with mental disorders in clinical settings. Identifying the characteristics of these patients and implementing psychiatric management can affect the clinical outcome of orthopedic treatment. Thus, orthopedic surgeons need to assess the psychiatric medical history of orthopedic patients with mental disorders before surgery and understand the psychological and behavioral patterns of patients with mental disorders. In addition, appropriate psychiatric consultations and evaluations are necessary to prevent worsening of mental disorders before and after surgery.     

Midterm survival of imaging-assisted robotic lung segmentectomy for non-small-cell lung cancer

Open in a separate window OBJECTIVESOur goal was to report our midterm results using imaging-assisted modalities with robotic segmentectomies for non-small-cell lung cancer (NSCLC).METHODSThis was a retrospective study of all robotic segmentectomies, with confirmed NSCLC, performed at our general and thoracic surgery unit in the Rouen University Hospital (France), from January 2012 through December 2019. Benign and metastatic lesions were excluded. Data were extracted from the EPITHOR French nationwide database.RESULTSA total of 121 robotic segmentectomies were performed for 118 patients with a median age of 65 (interquartile range: 60, 69) years. The majority had clinical stage T1aN0M0 (71.9%) or T1bN0M0 (13.2%). The mean (standard deviation) number of resected segments was 1.93 (1.09) with 80.2% imaging-assisted segmentectomies. Oriented (according to tumour location) or systematic lymphadenectomy or sampling was performed for 72.7%, 23.1% and 4.1% of patients. The postoperative course was uneventful for 94 patients (77.7%), whereas 34 complications occurred for 27 patients (22.3%), including 2 patients (1.7%) with Clavien-Dindo ≥III complications. The mean thoracic drainage duration was 4.12 days, and the median hospital stay was 4 days (interquartile range: 3, 5) after the operation. The 2-year survival rate was 93.9% (95% confidence interval: 86.4–97.8%). Excluding stage IV (n = 3) and stage 0 tumours (n = 6), the 2-year survival rate was 95.7% (95% confidence interval: 88.4–98.8%) compared to an expected survival rate of 94.0% according to stage-specific survival rates found in a large external reference cohort.CONCLUSIONSImaging-guided robotic-assisted thoracic surgery segmentectomy seems to be useful and oncological with good midterm results, especially for patients with early-stage NSCLC.     

Multiscale Analogue Modelling of Clinching Process to Investigate Thickness Tolerance and Tool Misalignment

NEED—The effect of dimensional variability of sheet thickness (tolerance) and tool misalignment is poorly understood for the clinching process. Finite element analysis (FEA) is valuable but requires a lot of and is difficult to verify in this situation due to the asymmetrical geometry and nonlinear plasticity. OBJECTIVE—The objective of this work was to determine the effect of thickness tolerance, tool misalignment and sheet placement (top vs. bottom) in the clinching process, by use of analogue modelling with plasticine. METHOD—Experiments used a scaled-up punch and die, with plasticine as the analogue. Thickness tolerances were represented by sheet thicknesses of 11 and 7 mm, 12 and 8 mm, 8 and 12 mm and 13 and 9 mm for upper and lower sheets, respectively. Two types of lubricant were tested between sheets: glycerine and silicone oil. Angular variability was also introduced. Measured parameters were interlock (also called undercut) and neck thickness. Analogue results for deformation were compared with microscopy of metal clinching. FINDINGS—The results reveal that the multiscale analogue model is an efficient tool for studying the effect of dimensional deviation on a clinch joint. Thickness tolerance showed a critical relationship with interlock, namely a reduction to about half that of the nominal, for both maximum and least material conditions. Increased angular misalignment also reduced the interlock. Compared with glycerine, silicone oil tests showed reduced interlock, possibly the result of a lower coefficient of friction. ORIGINALITY—This work demonstrates the usefulness of analogue modelling for exploring process variability in clinching. The results also show that significant effects for sheet placement are ductility, lubricant (friction), thickness of samples and tool misalignment.     

Newly Diagnosed Multifocal GBM: A Monocentric Experience and Literature Review

Simple SummaryGlioblastoma is an aggressive brain tumor with a dismal prognosis. In a minority of cases, it presents with multiple lesions already at the time of diagnosis, affecting patients’ survival and treatment. Our retrospective study aims to increase the current understanding and define a treatment for this sub-entity, to improve patient survival. Chemoradiotherapy is a also safe and efficacy treatment in patients with multiple lesions. Survival advantages from extensive resection remain unclear.AbstractGlioblastomas with multiple foci at presentation (mGBMs) account for 2–35% of all GBMs. mGBMs have limited existing data and no standardized treatment. This study aims to determine their incidence, demographic and clinical features, outcome, and prognostic factors in terms of overall survival. We performed a monocentric retrospective study, reviewing patients treated at the Istituto Oncologico Veneto. Inclusion criteria were: new diagnosis of GBM and presence of multiple lesions on pre-treatment MRI. ECOG PS was used to evaluate clinical condition, RANO criteria for radiological assessment, and CTCAE v5.0 for treatment-related adverse events. The incidence of newly diagnosed mGBM was 7.2% and the study population consisted of 98 patients. Median age was 63 years, M:F ratio of 1.8:1, and a surgical approach was undertaken in 73 patients (mostly partial resection). MGMT was methylated in 47.5%, and 82 patients received active oncological treatment (65.9% radiotherapy plus temozolomide (RT + TMZ)). The disease control rate with RT + TMZ was 63%. Median OS of the entire study population was 10.2 months (95% CI 6.6–13.8), and median PFS was 4.2 months (95% CI 3.2–5.2). The ECOG PS, the extent of resection, and the RT + TMZ were significant prognostic factors in the univariate analysis for OS, but only the RT + TMZ was a significant independent OS predictor in the multivariate analysis (HR = 3.1, 95% IC 1.3–7.7, p = 0.014). The incidence of mGBM is not rare. RT + TMZ is confirmed to be an independent prognostic factor for survival and a safe and effective treatment. When feasible, RT + TMZ should be considered as a possible first-line treatment. The role of the extent of resection is still unclear.     

标准面移位进路术治疗颅中窝底前外侧良性肿瘤

目的：观察改良标准面移位进路术治疗颅中窝底前外侧良性肿瘤的可行性及效果。方法：对10例原发于翼腭窝、鼻咽部并向颅中窝海绵窦旁、颞下窝或翼颌间隙呈扩张性生长的较大良性肿瘤行单纯改良标准面移位进路和颅面联合进路2种术式切除,术中对面部切口、上颌骨拆卸、复位、固定、窦内黏膜取舍及鼻腔外侧壁保留等做了部分改进。结果：术后平均随访3年2个月,成功9例,死亡1例,无出血、感染和移位骨坏死脱出等并发症。结论：采用改良标准面移位进路术治疗颅中窝底前外侧良性肿瘤,手术安全,疗效好。