Surgical treatment of piles

PURPOSE: The present prospective, randomized clinical trial compares the outcome of surgical hemorrhoidectomy according to Parks and Milligan-Morgan in terms of hospital stay, duration of incapacity to work, symptom relief, length of morbidity, and patient convenience. METHODS: Thirty-four consecutive patients with third or fourth degree internal hemorrhoids were randomly allocated to the two groups. Before surgery, all patients were interviewed using a standard questionnaire, followed by rectal examination. All patients underwent a follow-up interview and examinations 1, 2, 4, 8, and 12 weeks after the operation. RESULTS: No serious postoperative complications were seen. Length of hospital stay (3.2 days for Parks hemorrhoidectomyvs. 4.6 days for Milligan-Morgan hemorrhoidectomy; 95 percent confidence interval, 0.2 and 2.6, respectively;P=0.02) and mean duration of incapacity to work (12.3 days for Parks hemorrhoidectomyvs. 20.2 days for Milligan-Morgan hemorrhoidectomy; 95 percent confidence interval, 5.7 and 10.2, respectively;P<0.001) differed significantly between the Milligan-Morgan and Parks patients. Until two weeks after the operation, Milligan-Morgan hemorrhoidectomy patients experienced significantly more pain. CONCLUSIONS: Our study confirms that both operations are safe, easy to perform, and lead to satisfactory results. However, the Parks procedure is the preferred option, because it minimizes patients' postoperative discomfort, is more economic, has a significantly reduced hospital stay, and has a shorter time for return to work.     

显微镜下Parks切口无线结连续缝合在小儿共同性斜视手术后临床观察

目的探究显微镜下Parks切口无线结连续缝合在小儿共同性斜视手术后的应用效果。方法选取2017年1月—2018年5月接受显微镜下Parks切口手术的共同性斜视患儿共68例(117只眼),通过随机数字表法,分为观察组34例(60只眼)和对照组34例(57只眼)。对照组患儿于术中接受有线结连续缝合方法缝合切口,观察组患儿术中接受无线结连续缝合方法缝合切口。比较2组患儿斜视度、治疗总有效率、术后1 d舒适度以及术后1 d、3 d、5 d、7 d视觉模拟评分(VAS),并统计2组患儿术后不良反应发生情况。结果(1)斜视度:2组患儿治疗后比较,差异无统计学意义(P>0.05)。(2)有效率:观察组治疗总有效率(97.06%)与对照组(94.12%)比较,差异无统计学意义(P>0.05)。(3)舒适度:观察组患儿术后1 d舒适度优的例数高于对照组,舒适度差的例数低于对照组,差异具有统计学意义(Х²=7.619,P=0.006)。(4)VAS评分:观察组患儿术后1 d、3 d VAS评分低于对照组,差异具有统计学意义(t_1d=3.847,t_3d=4.367,均P=0.000)。(5)不良反应:观察组不良反应发生率(3.33%)低于对照组(14.04%),差异有统计学意义(Х²=4.283,P=0.038)。结论显微镜下Parks切口无线结连续缝合可提高患儿术后舒适度,降低术后疼痛感,减少瘢痕形成,但在施术过程中需有更高要求的缝合技术操作,避免影响切口愈合。     

部分悬吊法在parks切口直肌徙后术中的应用

目的观察部分悬吊法在parks切口直肌徙后术中使用的效果。方法分悬吊组和对照组(对照组不悬吊),悬吊组缝合点位于肌止端后3mm,悬吊一定量,以达到总的徙后量。结果悬吊组切口平均6.2mm,对照组切口平均9.6mm。悬吊组切口无需缝合,对照组切口做单纯连续缝合,均未见筋膜脱垂,结膜切口均I/甲愈合。悬吊组直肌一次钩不全占19.4%,对照组直肌钩不全占13.5%。悬吊组术后正位率83.7%,对照组术后正位率84.4%。两组术后均未产生新的垂直斜视。结论悬吊法在parks切口直肌徙后术中的使用可减小手术切口、使切口无需缝合。     

园区健身人群一般情况的调查与分析

对保定市区部分园区健身人群４５４人从年龄、性别、从业情况、健康状况、健身方式五方面进行了调查。结果：３６岁以上参与健身者３９７人，占８７．４％，３６岁以下参与健身者５７人，占１２．６％；４５４人中离休人员３１２人，占６８．７％，在职人员１４２人，占３１．３％；健康状况良好２０６人，占４５．４％，健康状况一般２４８人，占５４．６％；健身方式有晨舞、气功、拳剑。以上数据提示，在职职工、年轻人、健康状况较差者参与健身活动的人数较少，望有关部门引起重视。并提出了园区健身活动存在的意义与作用、发展与外延。     

Quality or quantity? Exploring the relationship between Public Open Space attributes and mental health in Perth,Western Australia

Mental health is a public health priority globally. Public Open Space (POS) may enhance mental health by facilitating contact with nature and the development of supportive relationships. Despite growing interest in the influence of the built environment on mental health, associations between POS attributes and mental health remain relatively unexplored. In particular, few studies have examined the relative effects of the quantity and quality of POS within a neighbourhood on mental health. Guided by a social-ecological framework, this study investigated the relationship between POS attributes (i.e., quantity and quality) and better mental health (i.e., low risk of psychological distress) in residents of new housing developments in the Perth metropolitan area, Western Australia. The extent to which relationships between POS attributes and mental health were confounded by psychosocial factors (e.g., social support, sense of community) and frequent use of POS was also explored. Data were obtained from a cross-sectional survey (n = 911), a POS audit, and Geographical Information Systems, and was analysed using logistic regression. Approximately 80% of survey participants were at low risk of psychological distress. Residents of neighbourhoods with high quality POS had higher odds of low psychosocial distress than residents of neighbourhoods with low quality POS. This appeared to be irrespective of whether or not they used POS. However, the quantity of neighbourhood POS was not associated with low psychological distress. From a mental health perspective, POS quality within a neighbourhood appears to be more important than POS quantity. This finding has policy implications and warrants further investigation.     

Comparing Perceived and Objectively Measured Access to Recreational Facilities as Predictors of Physical Activity in Adolescent Girls

A number of studies in recent years have identified both self-report and objectively measured accessibility of recreational facilities as important predictors of physical activity in youth. Yet, few studies have: (1) examined the relationship between the number and proximity of objectively measured neighborhood physical activity facilities and respondents’ perceptions and (2) compared objective and self-report measures as predictors of physical activity. This study uses data on 1,367 6th-grade girls who participated in the Trial of Activity for Adolescent Girls (TAAG) to explore these issues. Girls reported whether nine different types of recreational facilities were easily accessible. These facilities included basketball courts, golf courses, martial arts studios, playing fields, tracks, skating rinks, swimming pools, tennis courts, and dance/gymnastic clubs. Next, geographic information systems (GIS) were used to identify all the parks, schools, and commercial sites for physical activity located within a mile of each girl’s home. These sites were then visited to inventory the types of facilities available. Girls wore accelerometers to measure their weekly minutes of non-school metabolic equivalent weighted moderate-to-vigorous physical activity (MW-MVPA). The number of facilities within a half-mile of girls’ homes strongly predicted the perception of easy access to seven out of nine facility types. Both individual facility perceptions and the total number of facilities perceived were associated with increased physical activity. For each additional facility perceived, girls clocked 3% more metabolic equivalent weighted moderate-to-vigorous physical activity (p < 0.001). Although girls tended to record 3% more of this kind of physical activity (p < 0.05) per basketball court within a mile of their homes, objective facility measures were otherwise unrelated to physical activity. The results from this study suggest that raising the profile of existing facilities may help increase physical activity among adolescent girls. Scott is with the RAND Corporation, Arlington, VA 22202, USA; Cohen is with the RAND Corporation, Santa Monica, CA 90401, USA; Evenson and Cox are with the UNC Chapel Hill, School of Public Health, Chapel Hill, NC, USA.     

Molecular weight differences between human platelet and placental monoamine oxidase

The molecular weights of the active site subunits of human placental and platelet monoamine oxidase have been compared. These tissues were chosen as each appears to contain only one form of the enzyme, type A in placenta and type B in platelets. We found that the biochemical properties (substrate affinity and inhibitor sensitivity) clearly distinguish between the enzymes from these two sources, whether in the membrane-bound or detergent-solubilized state. The suggestion that such differences result from the existence of distinct molecular forms was strengthened by the observation that the active site subunits labelled specifically with [³H]pargyline differ in their apparent molecular weights and in the electrophoretic pattern of their partial proteolytic digest products.     

直肌后徙调整缝线术治疗共同性外斜视

目的观察改良Parks切口联合外直肌后徙调整缝线术治疗共同性外斜视的临床效果。方法采用改良Parks结膜切口联合外直肌后徙调整缝线术治疗共同性外斜视46例,术后随访3～24个月,观察治疗效果。结果 46例患者中13例术后未达到预期效果,欠矫4例,过矫9例,手术后24～48 h内于表面麻醉下进行眼位调整,13例均将眼位调整至预期效果。随访3～24个月显示,未调整者欠矫2例,过矫2例,调整者欠矫2例,余40例正位。所有患者术后球结膜切口对合整齐,轻度充血、水肿,术后5～8 d完全愈合,睑裂部无明显瘢痕。4例患者调整缝线结对应的结膜面局部结节状隆起水肿,给予0.1%氟美瞳眼水点眼后消退。未见感染、巩膜穿通、肌肉滑脱等并发症。结论采用改良Parks结膜切口联合外直肌后徙调整缝线术在提高手术的准确性和减少手术并发症上有诸多的优越性。     

Reconsidering Access: Park Facilities and Neighborhood Disamenities in New York City

With increasing concern about rising rates of obesity, public health researchers have begun to examine the availability of parks and other spaces for physical activity, particularly in cities, to assess whether access to parks reduces the risk of obesity. Much of the research in this field has shown that proximity to parks may support increased physical activity in urban environments; however, as yet, there has been limited consideration of environmental impediments or disamenities that might influence individuals’ perceptions or usage of public recreation opportunities. Prior research suggests that neighborhood disamenities, for instance crime, pedestrian safety, and noxious land uses, might dissuade people from using parks or recreational facilities and vary by neighborhood composition. Motivated by such research, this study estimates the relationship between neighborhood compositional characteristics and measures of park facilities, controlling for variation in neighborhood disamenities, using geographic information systems (GIS) data for New York City parks and employing both kernel density estimation and distance measures. The central finding is that attention to neighborhood disamenities can appreciably alter the relationship between neighborhood composition and spatial access to parks. Policy efforts to enhance the recreational opportunities in urban areas should expand beyond a focus on availability to consider also the hazards and disincentives that may influence park usage.