单孔与多孔腹腔镜手术治疗妇科良、恶性肿瘤的疗效及患者满意度比较

目的探讨单孔腹腔镜手术(SPLS)与多孔腹腔镜手术(MPLS)在妇科良、恶性肿瘤治疗中的安全性、疗效及患者满意度等。 方法选择2017年11月至2018年9月,于四川大学华西第二医院接受SPLS或MPLS治疗的171例妇科良、恶性肿瘤患者为研究对象,进行前瞻性对照研究。根据患者接受的腹腔镜手术治疗方式,将其分别纳入SPLS组(n＝85,接受SPLS治疗)与MPLS组(n＝86,接受MPLS治疗)。收集2组患者一般临床资料,手术失败率、手术时间、术中出血量、术后视觉模拟评分法(VAS)评分、术后排气时间、住院时间与手术前、后血红蛋白(Hb)值等手术相关指标,以及围术期并发症发生率。于术后1、4、24周,采用《身体意象问卷》,包含《身体意象量表》(BIS)和《美容量表》(CS) 2个部分,对患者对自身身体意象的满意度,以及对手术切口瘢痕的患者满意度进行调查,并分别计算BIS评分与CS评分。采用成组t检验、重复测量资料的方差分析、Mann-Whitney U检验、χ²检验或Fisher确切概率法,对上述资料进行统计学比较。本研究遵循的程序符合2013年新修订的《世界医学协会赫尔辛基宣言》要求,并与所有受试者签署临床研究知情同意书。2组患者年龄、人体质量指数(BMI)、孕次、产次、腹部手术史、术前Hb值、手术方式构成比等一般临床资料分别比较,差异均无统计学意义(P>0.05)。 结果①SPLS组总体手术时间为170 min(120～230 min),显著长于MPLS组的134 min(105～210 min),差异有统计学意义(Z＝2.204、P＝0.028),进一步对良、恶性肿瘤患者手术时间的分层分析结果显示,SPLS组良性肿瘤患者手术时间为160 min(115～197 min),显著长于MPLS组的120 min(100～156 min),差异有统计学意义(Z＝2.888、P＝0.004);而2组恶性肿瘤患者手术时间比较,差异无统计学意义(P>0.05)。SPLS组术后12、24、36 h时VAS评分分别为3分(2～3分)、2分(2～3分)、1分(1～2分),均显著低于MPLS组的3分(2～4分)、2分(2～4分)、2分(1～2分),并且差异均有统计学意义(Z＝2.507、2.398、3.110,P＝0.012、0.016、0.002)。SPLS组围术期并发症发生率为4.7%(4/85),显著低于MPLS组的14.0%(12/86),并且差异有统计学意义(χ²＝4.310、P＝0.038)。2组患者术中出血量、术后排气时间、住院时间、手术失败率及手术前、后Hb值分别比较,差异均无统计学意义(P>0.05)。②SPLS组患者术后1、4、24周BIS评分分别为(18.2±1.5)分、(18.9±0.9)分与(19.4±0.9)分,MPLS组分别为(16.8±2.3)分、(16.9±2.2)分与(17.5±2.1)分。SPLS组患者术后1、4、24周CS评分分别为(19.8±2.9)分、(20.6±1.2)分与(22.6±1.4),MPLS组分别为(18.2±2.1)分、(18.6±1.9)分与(19.2±1.9)分。2组患者术后不同时间BIS、CS评分,经重复测量资料的方差分析结果显示：对于BIS评分,不同处理措施与时间因素无交互效应(F_{处理×时间}＝2.205、P＝0.085);对CS评分,不同处理措施与时间因素有交互相应(F_{处理×时间}＝9.609、P<0.001)。进一步固定时间因素进行分析的结果显示,SPLS组术后1、4、24周BIS、CS评分,均分别显著高于MPLS组,并且差异均有统计学意义(P<0.05)。进一步固定处理措施因素进行分析的结果显示,SPLS组术后24周BIS、CS评分,均显著高于组内术后1、4周,术后4周BIS、CS评分亦显著高于组内术后1周,并且差异均有统计学意义(P<0.05);MPLS组术后24周BIS、CS评分,均显著高于组内术后1、4周,差异均有统计学意义(P<0.05)。 结论与MPLS相比,SPLS对妇科良、恶性肿瘤的治疗具有安全性、可行性,不增加患者术中出血量及围术期并发症发生率,可减轻其术后疼痛,增加其治疗满意度。由于本研究仅为单中心非随机对照试验,仍需要大样本、多中心、随机对照试验及对患者进行更长时间随访,对SPLS治疗妇科良、恶性肿瘤的疗效及患者满意度进一步研究、证实。     

Assessing and managing risk and uncertainty: Women living with breast implants

This qualitative study explores how people assess and manage being identified as potentially 'at risk' when levels of risk are currently unknown or contested. It uses breast implants as a case study. Their safety has been the subject of much recent controversy. Using a qualitative approach, 23 women were interviewed about their experience of having breast implants. In this article we present three themes pertaining to personal risk assessments and management. Findings highlight powerful contextual issues, which influenced how these women thought about risk. Participants used various strategies to manage uncertainty in their lives and derived their interpretations of new information from their own experience and beliefs. A process is proposed for the way people formulate and reformulate risk perceptions over time, as new and sometimes conflicting information becomes available.     

美容性角膜接触镜的验配探讨

目的：为各种角膜白斑、虹膜异常的病人寻求医学美容及保留有用视力。方法Ｚ：对各种角膜白斑、虹膜异常的病人按有用视力和无用视力。分别进行有孔和无孔美容性角膜接触镜（俗称美容镜）的配戴。与健眼的虹膜色泽、瞳孔大小、舍适程度、配戴前后有用视力的评估。进一步统计分析探讨。结果：共收集４３０眼美容镜配戴者,有用视力的角膜旁中央白斑戴有孔美容镜４３眼,视力范围在眼前指数至０．６之间,戴镜前后的有用视力基本保持不变;无用视力的各种角膜白斑戴无孔美容镜３８７眼,能有效遮盖白斑,起到角膜美容的作用。结论：（１）各种角膜白斑的医学美容应首选配戴美容性隐形眼镜,既可逆性,又经济、安全、有效。（２）有孔美容镜既能有效遮盖角膜旁中央白斑,又能保留有用视力,两全其美。     

牙龈和牙槽嵴修整手术在牙齿修复中的应用价值

目的 探讨牙齿修复中采取牙龈+牙槽嵴修整手术的治疗价值.方法 选取2018年6月至2020年6月间来我院治疗的76例牙齿修复患者,以随机法为基准,A组39例予以牙龈+牙槽嵴修整手术,B组37例予以常规牙齿修复手术.比较两组患者的修复效果.结果 A组的总有效率(94.87％)高于B组(72.97％),差异有统计学意义(χ...     

美容缝合法与传统缝合法在动静脉内瘘手术皮肤切口中的对比研究

目的 探讨美容缝合法与传统缝合法在动静脉内瘘手术皮肤切口缝合中的效果差异。方法 选取南充市中心医院血液净化中心2020年10月~12月行动静脉内瘘手术的40例患者作为研究对象,随机分为美容缝合法组和传统缝合法组,各20例;前者采用美容缝合法缝合内瘘手术皮肤切口,后者采用传统缝合法缝合内瘘手术皮肤切口。观察两组患者的皮肤切口缝合时间,术后即刻的内瘘通畅率,内瘘血流量,观察两组患者术后1周、2周皮肤切口的并发症（红肿、感染）发生及线结反应情况,观察两组患者术后3周的皮肤切口愈合及切口瘢痕形成情况,比较两组患者的满意度。结果 与传统缝合法相比,美容缝合法组的缝合时间更长,线结反应程度以及瘢痕评分更低,然而满意度更高（P＜005）;美容缝合法发生切口并发症的例数较少、甲级愈合比例较高,但是与传统缝合法相比,并无统计学差异（P＞005）;两组患者在术后即刻的内瘘通畅率以及内瘘血流量方面,无统计学差异（P＞005）。结论 美容缝合法具有并发症发生程度低,患者满意度高的优势,值得临床推广。     

Method for detecting the reactivity of chemicals towards peptides as an alternative test method for assessing skin sensitization potential

Cosmetics are normally composed of various ingredients. Some cosmetic ingredients can act as chemical haptens reacting toward proteins or peptides of human skin and they can provoke an immunologic reaction, called as skin sensitization. This haptenation process is very important step of inducing skin sensitization and evaluating the sensitizing potentials of cosmetic ingredients is very important for consumer safety. Therefore, animal alternative methods focusing on monitoring haptenation potential are undergoing vigorous research. To examine the further usefulness of spectrophotometric methods to monitor reactivity of chemicals toward peptides for cosmetic ingredients. Forty chemicals (25 sensitizers and 15 non-sensitizers) were reacted with 2 synthetic peptides, e.g., the cysteine peptides (Ac-RFAACAA-COOH) with free thiol group and the lysine peptides (Ac-RFAAKAA-COOH) with free amine group. Unreacted peptides can be detected after incubating with 5,5′-dithiobis-2-nitrobenzoic acid or fluorescamine™ as detection reagents for free thiol and amine group, respectively. Chemicals were categorized as sensitizers when they induced more than 10% depletion of cysteine peptides or more than 30% depletion of lysine peptides. The sensitivity, specificity, and accuracy were 80.0%, 86.7% and 82.5%, respectively. These results demonstrate that spectrophotometric methods can be an easy, fast, and high-throughput screening tools predicting the skin sensitization potential of chemical including cosmetic ingredient.     

Phthalates in cosmetic and personal care products: concentrations and possible dermal exposure

Phthalates are multifunctional chemicals that are used in a variety of consumer products including cosmetic and personal care products. This study aims at determining phthalate levels in cosmetic and personal care products obtained from the Canadian market. Overall 252 products including 98 baby care products were collected at retail stores in several provinces across Canada in year 2007. These products included fragrances, hair care products (hair sprays, mousses, and gels), deodorants (including antiperspirants), nail polishes, lotions (body lotions and body creams), skin cleansers, and baby products (oils, lotions, shampoos and diaper creams). Samples were extracted with different organic solvents, depending on the types of the products, followed by gas chromatography-mass spectrometry (GC–MS) analysis. Of the 18 investigated phthalates, diethyl phthalate (DEP), dimethyl phthalate (DMP), diisobutyl phthalate (DiBP), di-n-butyl phthalate (DnBP) and di(2-ethylhexyl) phthalate (DEHP) were detected. The detection frequencies were in the following order: DEP (103 out of 252 products)>DnBP (15/252)>DiBP (9/252)>DEHP (8/252)>DMP (1/252). DEP was detected in almost all types of surveyed products with the highest levels (25,542 μg/g, equal to 2.6%) found in fragrances. DnBP was largely present in nail polish products with the highest concentration of 24,304 μg/g (2.4%). DnBP was also found in other products such as hair sprays, hair mousses, skin cleansers and baby shampoos at much lower concentrations (36 μg/g and less). Levels of other detected phthalates were generally low in the products. Based on these values, daily dermal exposure dosage to five phthalates was estimated for three age groups, female adults (60 kg); toddlers (0.5–4 years) and infants (0–6 months), through the use of cosmetic and personal care products. The exposure estimation, however, was based on existing products use pattern data, instead of probabilistic model based population use distribution. For female adults, the maximal daily exposure of 78 μg/kg bw/d was determined for DEP. The maximal daily exposure was much lower for the other four phthalates (DEHP, 0.82 μg/kg bw/d; DnBP, 0.36 μg/kg bw/d; and DMP, 0.03 μg/kg bw/d). The exposure for DiBP was not calculated due to its very low levels (<10 μg/g) in products. Toddlers and infants in this case had a maximal daily exposure to DEP of 20 and 42 μg/kg bw/d, respectively.     

光固化复合树脂临床口腔美容修复的研究

目的:探讨针对口腔美容修复中使用光固化复合树脂进行修复的临床疗效和应用价值。方法:选取2004年12月-2006年12月牙科接受治疗的128例患者,均实施光固化复合树脂分层实施塑性固化,对比不同牙科疾病的治疗结果,保持对患者1~6年的随访,观察分析长期效果。结果:45例前牙邻面龋患者治疗优秀36例(80.00%),总有效率91.11%;染色牙、四环素牙、斑釉牙40例患者治疗后优秀32例(80.00%),总有效率90.00%;15例颌面磨损患者治疗后优秀14例(93.33%),总有效率100%;15例折断牙患者治疗后优秀12例(80.00%),总有效率93.33%;8例牙缝间隙修补患者治疗后优秀7例(87.50%),总有效率100%;5例畸形牙患者治疗后优秀3例(60.00%),总有效率80.00%。其中颌面磨损修补优秀率最高,畸形牙修补优秀率最低,两者比较差异有统计学意义(P0.05)。随访显示共有10例失败,其中1例患者1年之后发生脱落,其余9例患者发生脱落时间为修复后5年。结论:光固化复合树脂用于口腔美容修复,总体临床效果较为理想。光固化复合树脂的选材较为简便,操作过程不复杂,安全性高,且长期效果不错,方便再次修复,值得推广应用。     

保乳术综合三维适形放疗治疗Ⅰ期乳腺癌的临床观察

目的观察Ⅰ期乳腺癌保乳术后三维适形放疗疗效及副作用。方法30例确诊Ⅰ期乳腺癌患者保乳术后进行三维适形放疗。照射靶区为患侧全乳及胸壁和腋窝锁骨上区。全乳及胸壁采用半野切线对穿照射,90％门VD,50Gy／25次／5周,靶区内剂量分布±5．0％,患侧肺V20〈20％。瘤床野以术痕外扩3．0cm,避开乳头,银夹的位置为瘤床深度,5mm等效膜填充,6MeV电子线追加照射,DT10Gy／5次／1周。患侧腋窝锁骨上区6MV—X照射Dr50Gy／25次／5周。结果随访5年未见局部复发。美容效果“优”和“好”100％。近期毒副反应可耐受。结论早期乳腺癌保乳术加术后三维适形放疗局部控制率及美容效果满意,无严重并发症。