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Objective:To investigate and analyze the status quo of death cognition and hospice care attitude of clinical medical graduate students, to compare the differences between the two groups, and to explore the correlation between death cognition and hospice care attitude, so as to provide the reference for the reform and construction of death cognition and hospice care education in medical colleges and universities in China.Methods:A survey was carried out on 496 doctoral and postgraduate students majoring in clinical medicine by using the "Questionnaire of General Sociology Survey", the Chinese version of the "Death Attitude Profile Revised Scale", and the Chinese version of the "Frommelt Attitudes Toward Care of the Dying Scale Form B (FATCOD-B)" to investigate the death cognition and hospice care attitude of 496 doctoral and postgraduate students majoring in clinical medicine, and classified and compared the survey results of the two groups. The results of this study were statistically analyzed by t-test, Pearson correlation analysis and other statistical methods. Results:A total of 469 valid questionnaires were recovered after excluding 27 unqualified questionnaires. Statistical analysis showed that the scores of each dimension in the death attitude description scale of doctoral students were ranked as follows: approach acceptance (4.28±0.53), neutral acceptance (3.99±0.41), death avoidance (2.74±0.63), fear of death (2.65±0.57) and escape acceptance (2.47±0.69) the scores of postgraduates were ranked as neutral acceptance (3.96±0.52), approach acceptance (2.84±0.61), fear of death (2.78±0.65), death escape (2.62±0.73), escape acceptance (2.39±0.77). At the same time, the scores of hospice care attitude in the doctoral group were higher than those in the master group [(110.63±8.96) vs. (106.78±6.52)], and the difference was statistically significant ( P<0.001). In addition, the scores of "fear of death" and the scores of hospice care attitudes were negatively correlated with the scores of doctoral and master students ( r=-0.25, r=-0.21), while the scores of hospice care attitudes were positively correlated with the scores of "neutral acceptance" in death cognition ( r=0.50, r=0.32). However, the hospice care attitude scores of doctoral students were negatively correlated with the "death avoidance" scores in death cognition ( r=-0.27). Conclusion:Doctoral and postgraduate students have a certain awareness of hospice care, while their death cognition and hospice care attitude still need to be improved and strengthened from sociology, psychology, ethics and other perspectives. The above will promote the harmony between doctors and patients while meeting the needs of an aging society in China.
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Objective:To investigate the effect of expanded polytetrafluoroethylene (E-PTFE) combined with autologous costal cartilage in rhinoplasty.Methods:Forty-two patients who underwent rhinoplasty in the form of E-PTFE combined with autologous costal cartilage in the Department of Plastic Surgery, Jiangsu Province Hospital of Chinese Medicine from January 2017 to December 2018 were selected as the research object. The polytetrafluoroethylene combined with autologous costal cartilage was used for rhinoplasty. The dorsal nasal skin was dissected through an inverted " V" type combined with subalar cartilage incision, and then the costal cartilage was cut into appropriate cartilage slices to build the nasal tip stent. According to the degree of elevation of the nasal dorsum, the sculpted E-PTFE was placed under the nasal dorsal fascia. The rectus abdominis fascia covered the apex of the nose, and the incision was closed by suture.Results:The nasal appearance of the forty-two patients was significantly improved, with good nasal shape and no serious complications. After 6-12 months of follow-up, 40 cases were satisfacted with the effect of the rhinoplasty, accounting for 95.2%.Conclusions:The use of polytetrafluoroethylene combined with autologous costal cartilage can effectively raise the dorsum of the nose, extend the length of the nose, project the nasal tip in the rhinoplasty. This procedure is accurate and safe, reach a favorable long-term shape and own high satisfaction, and it thus is worthy of popularization in clinic.
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Objective:To investigate the modified application of orbicularis oculi muscle-levator aponeurosis composite tissue flap fixation technique (modified Park method) in double-eyelid surgery.Methods:From June 2019 to March 2021, 823 patients included 92 males and 731 females, aged from 18 to 45 years with mean (31.4±7.9) years, in which 142 patients with slightly ptosis were selected to receive the treatment in the Department of Plastic Surgery of the Affiliated Hospital of Nangjing University of TCM. The symmetry of bilateral double eyelids after operation was evaluated by the third party. The marginal reflex distance (MRD1) was measured before and 6 months after operation, and the difference between preoperative and postoperative MRD1 (ΔMRD1) was calculated. And the postoperative complications were counted. The patients were followed up from 6 to 12 months after surgery to evaluate the long-term results.Results:The patients were followed up for 4-22 months (mean 10 months) after operation. And the incisions of all the 823 cases had primary healling. Most patients had smooth upper eyelid crease, upturned lashes and dynamic fold. The skin tended to spread evenly without dimple. The symmetry evaluation by the third party showed that there were 764 patients with symmetry and basic symmetry after operation, the symmetry rate was 92.8%; 59 patients with asymmetry, the asymmetry rate was 7.2%. The data of MRD1 increased significantly 6 months after operation, from (3.25±0.72) mm to (3.64±0.61) mm, and the ΔMRD1 was (0.38±0.76) mm ( t=-20.41, P<0.05). The difference between the two groups was statistically significant. The double eyelid line became shallow in 8 cases and disappeared completely in 3 cases. The double eyelid curve of the patients was natural and smooth after the operation. And there was no obvious sunken scar and pretarsal fullness. Conclusions:The " modified Park technique" blepharoplasty can obtain a more firm, symmetrical and natural appearance. And the mild ptosis could be corrected by this method. The anatomical structure can be identified clearly, and the surgical results are highly repeatable. It is worth promoting.
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Objective:To evaluate the curative effect of autogenous cartilage transplantation in the correction of nasal soft-tissue triangle deformities aided by 3D technology.Methods:From January 2016 to January 2018, 32 patients with nasal soft-tissue triangle deformities were collected, with 7 males and 25 females, aged from 18 to 32 years (mean 28.5±6.8 years). A part of the costal cartilage/nasal septum cartilage or auricular cartilage was cut as repair material, which was carved into strips, and used as nasal alar rim grafts to reconstruct the dome shape and correct the nasal soft triangle deformities. The costal cartilage or nasal septum cartilage was used to strengthen the support of the columella nasi and augmentation rhinoplasty was performed with prosthesis, and the fascia was placed on nose tip to relieve tension. The surgical results were evaluated by comparing the pre- and post-operative images; statistical analysis was conducted to compare the difference of alar cartilage angle along inside and outside implants before and after the fornix reconstruction, and the difference of maximum distance from the nostrils long shaft to the nose flange between pre- and post-operation, and so the effect of nasal soft triangular deformity correction was evaluated.Results:The alar cartilage angle of the 32 patients was (51.5±10.9)° before surgery, and decreased to (37.2±5.9)° after surgery; the difference was statistically significant ( P<0.05). The maximum distance from the nostrils long shaft to the nose flange was (3.3±0.6) mm before surgery, and it reduced to (1.9±0.7) mm after surgery; the difference was statistically significant ( P<0.05). The patients were followed up for 6 to 18 months, and the result showed that the curative effect was significant, with good appearance and natural feeling, and there were no serious complications, and the satisfactory rate was 87.5%. Conclusions:Autogenous cartilage is used to repair nasal soft-tissue triangle deformities aided by 3D technology; the nasal morphology is improved delicately, and the postoperative satisfaction of curative effect is high, which is an ideal surgical method.
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Objective:To investigate the efficacy and safety of partial resection or enhanced suture of retro-orbicularis oculi fat (ROOF) through double eyelid or subeyebrow incision to correct upper eyelid swelling and depression.Methods:From May 2017 to June 2018, 166 beauty seekers underwent the operation. Among them, 81 cases were corrected by double eyelid incision, 33 cases were corrected by double eyelid incision, 30 cases were corrected by subeyebrow incision and 22 cases were corrected by subeyelid incision.Results:The swelling and depression of the upper eyelid were improved and the patients were satisfied. Two of the patients developed hematoma after operation and all healed after debridement.Conclusions:Preorbital septum fat combined with ROOF partial excision or enhanced suture can effectively improve the upper eyelid swelling or depression, with high satisfaction, safety and less trauma, which can be an important supplement for upper eyelid plastic surgery.
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Objective To develop a new technique of upper eyelid blepharoplasty for reducing surgical complications and improving cosmetic results.Methods In this study,721 cases (9 males and 712 females,range in age 17-32 years) with single eyelid were performed with double eyelid blepharoplasty using this method (dermis orbicularis muscle flap technique,DOMF),698 cases of which were simultaneously operated with epicanthoplastic surgery.In the operation,DOMF was harvested in the dermis edge in lower incision margin.The flap was sutured to levatoraponeuros at the superior border of the tarsus.Patients were followed up for three months to three years.Results It was concluded that unfavorable results included low fold in 12 cases,relapse in 3 cases,asymmetric crease in 4 cases,puffy eyelids in 5 cases,and sunken appearance in 4 cases.The physicians and patients were satified with the results.The eyelid appeared smooth without fold depression on downward gaze or eyes closed,and it was gentle and not overly puff as eyes opening.Conclusions The DOMF technique mimics the movement of congenital crease fold,which is easy to perform,creating a delicate,firm and smooth upper lid orientation.
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Objective To analyze the clinical efficacy and safety of fludarabine combined with cyclophosphamide (FC) and fludarabine and cyclophosphamide combined with rituximab (FCR) in the treatment of chronic lymphocytic leukemia (CLL). Methods FCR regimen was selected as the experimental group, and FC regimen was selected as the control group. The studies were retrieved from PubMed, Cochrane Library, Embase, CNKI, Wangfang and VIP databases by computer and the references listed in these studies were further searched. The randomized controlled trials (RCT) meeting inclusive criteria were extracted, and the quality was evaluated and cross-checked independently according to Cochrane Handbook for Systematic Reviews of Interventions, and then the Meta-analysis was conducted by using StataMP 14.0 software. Results A total of 7 studies and 1 985 patients were included. The complete remission rate and overall response rate of FCR regimen were better than those of FC regimen, and the differences were statistically significant ( RR＝1.89, 95% CI 1.64-2.18, P<0.01; RR＝1.15, 95% CI 1.10-1.21, P<0.01). In terms of gradeⅢ-Ⅳadverse reactions, the neutropenia of FCR regimen was more severe than that of FC regimen, and the difference was statistically significant ( RR＝1.25, 95% CI 1.01-1.55, P＝0.004). Conclusion The FCR regimen has a better clinical outcome and prognosis than the FC regimen, and is accompanied by more severe grade Ⅲ-Ⅳneutropenia.
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Objective@#To analyze the clinical efficacy and safety of fludarabine combined with cyclophosphamide (FC) and fludarabine and cyclophosphamide combined with rituximab (FCR) in the treatment of chronic lymphocytic leukemia (CLL).@*Methods@#FCR regimen was selected as the experimental group, and FC regimen was selected as the control group. The studies were retrieved from PubMed, Cochrane Library, Embase, CNKI, Wangfang and VIP databases by computer and the references listed in these studies were further searched. The randomized controlled trials (RCT) meeting inclusive criteria were extracted, and the quality was evaluated and cross-checked independently according to Cochrane Handbook for Systematic Reviews of Interventions, and then the Meta-analysis was conducted by using StataMP 14.0 software.@*Results@#A total of 7 studies and 1 985 patients were included. The complete remission rate and overall response rate of FCR regimen were better than those of FC regimen, and the differences were statistically significant (RR = 1.89, 95% CI 1.64-2.18, P < 0.01; RR = 1.15, 95% CI 1.10-1.21, P < 0.01). In terms of grade Ⅲ-Ⅳ adverse reactions, the neutropenia of FCR regimen was more severe than that of FC regimen, and the difference was statistically significant (RR = 1.25, 95% CI 1.01-1.55, P = 0.004).@*Conclusion@#The FCR regimen has a better clinical outcome and prognosis than the FC regimen, and is accompanied by more severe grade Ⅲ-Ⅳ neutropenia.
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Objective To identify the influence of the comprehensive rhinoplasty on the body image of the persons with various degrees of abnormal body image receiving the rhinoplasty.Methods Eighty-six patients who have never undergone any kinds of plastic surgeries were tested with the self-rating body dysmorphic disorder scale before and 6 months after the comprehensive rhinoplasty by the same doctor in Chinese Medicine Hospital of Jiangsu Province during October 2016 to October 2017,and the results were analyzed.Results Among 86 paients who underwent the comprehensive rhino plasty,the score of the preoperative scales of patients with body-image troubles was 19.92 ±5.59,and that of the postoperative scales was 7.33±4.10 (P＜0.05).The score of the preoperative scales of patients with body image disturbance was 45.00± 7.44,and that of the postoperative scales was 18.86±5.52 (P＜0.05).Scores about the degree of the body image concerned and the degree of the emotion damnified were higher than those about other aspects preoperatively among patients with abnormal body image.The degree of body image cognitive had not been well improved.Conclusions The patients receiving the rhinoplasty pay much attention to their own body image,and their emotion is damnified severely.The comprehensive rhinoplasty can relief the symptoms of abnormal body image which mainly manifests in it can eliminates the negative emotion and social relationship of the patients with self-conscious physical appearance defect.Otherwise,these patients are still keep a watchful eye on their physical appearance.
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Objective@#To discuss the orbital fat autograft for lower baggy eyelid with tear trough deformity and its therapeutic effect through tranconjunctival approach.@*Methods@#The patients with lower eyelid bag and tear trough deformity were included into the study. The included 32 patients met the following criterias: ①less than 40 years old; ②lower eyelid skin was not relaxed; ③less than 1 s in Snap test; ④Hirmand type Ⅰ and Ⅱ. They were treated with tranconjunctival lower blepharoplasty combined with the tears ligament relaxation. The orbital fat was repositioned on the depression site above orbital periosteum to correct tear trough deformity. The effect was evaluated through Tear Trough Rating Scale (TTRS) and satisfaction degree.@*Results@#Three cases with Hirmand type Ⅱ didn’t have good effect. Among them, the baggy eyelid was corrected in 2 cases, while the tear trough deformity need additional hyaluronic acid injection. One patient underwent secondary lower blepharoplasty through cutaneous incision. Good effect was achieved in the other 29 cases with no depression deformity and eyelid withdrawal. The TTRS scores 6 months after operation was significantly improved(P<0.01). Satisfaction degree was 100%(14/14) and 83.3%(15/18) in type Ⅰ and Ⅱ patients.@*Conclusions@#The technique can simultaneously improve lower eyelid bag and the tear trough deformity. It can be applied in periorbital rejuvenation for middle-aged and young patients.
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Objective To evaluate CT findings and dynamic changes of post-traumatic intrapulmonary hematoma.Methods CT data of 43 patients with traumatic intrapulmonary hematomas were analyzed retrospectively.Results A total of 52 lesions were found in 43 patients with intrapulmonary hematomas.The majority of hematomas were located in the peripheral lung fields close to the pleura,single or multiple in number.CT showed nodular,mass,fusiform,ribbon and irregular shadows with uniform and high density in lung.There are two types of evolution: (1) The hematomas gradually reduced in size and finally disappeared;(2)The hematomas evolved into gas-liquid cyst cavity or gas cyst cavity, and then was absorbed gradually.Conclusion CT examination is helpful in the early diagnosis of post-traumatic intrapulmonary hematomas, and can monitor the morphology changes over time.
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Smad3 is a major transporter in the transforming growth factor β (TGF-β) signaling pathway.It is in charge of the transfer of TGF-β signal from the surface of the cell membrane into the nucleus.The TGF-β signal can be bound to the target gene in the nucleus and regulate its expression.Abnormalities in Smad3 expression level and functional status will lead to abnormal signal transduction,involving cell growth,proliferation,development,differentiation,migration,apoptosis and other basic life activities.This review focused on the differential expression of Smad3 in hepatocellular carcinoma (HCC)and the adjacent tissue.The character of Smad3 in HCC is outlined in three parts:Smad3 upstream signaling source,Smad3 self-assembly maturation and Smad3 downstream effects,which may provide a summary and reference for the follow-up study on Smad3.
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Objective To investigate the application of orbicularis oculi-levator aponeurosis fixation technique (Park) in double-eyelid operation.Methods From June 2014 to March 2016,136 male and 1248 female patients (436 patients with ptosis) were selected to receive the treatment.Results The incision healed well without obvious postoperative hematoma.The patients were followed up to 4-22 months (mean 10m) after operation.Most patients had smooth upper eyelid crease,upturned lashes and dynamic fold.The skin tended to spread evenly without dimple.The ptosis were also corrected.Still,there were 16 patients with the crease disappeared,11 patients with asymmetry crease,10patients showing an incomplete line,and 9 patients with the accordion effect.Conclusions The orbicularis oculi-levator aponeurosis fixation technique is a minimally-invasive procedure and decreases the recovery time.It is more solid compared with suturing technique,and can avoid sunken,depression,puffiness compared with a traditional full-cutting method.It looks more like a natural double eyelid because of protecting the orbicularis oculi muscle.
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Long non-coding RNAs (lncRNAs) have gradually become a research hotspot in recent years. The abnormal expression of some lncRNAs has been proven to promote tumorigenesis and progression. Among the lncRNAs, metastasis-associated lung adenocar-cinoma transcript 1 (MALAT-1) has attracted considerable attention in various tumor studies, particularly lung cancer. Therefore, the mechanism in which MALAT-1 regulates the cellular activities of tumors should be analyzed. This review mainly discusses the molecu-lar structure, biological function, and role of MALAT-1 in regulating cell proliferation, tumor metastasis, cell cycle, apoptosis, and so on. Furthermore, the role of MALAT-1 in epigenetic regulation is appropriately illustrated to provide a novel perspective in literature on the prevention and treatment of tumors.
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Objective To evaluate masseter thickness and its complications of radiofrequency ablation and botulinum toxin type A in the treatment of masseter hypertrophy.Methods Totally 36 patients of benign masseter hypertrophy were randomly divided into radiofrequency ablation therapy group (18 patients) and the injection of botulinum toxin type A treatment group (18 patients).The thickness of the masseter and complications were analyzed before treatment,6 months and 12 months after treatment.Results The average thickness of masseter muscle in botulinum toxin type A and radiofrequency ablation groups was significantly reduced 6 or 12 months after treatment,and the difference was statistically significant (P＜0.05).However,the thickness of masseter muscle in radiofrequency ablation group after 12 months reduced greater than that in botulinum toxin type A group (P＜0.05).Complications of botulinum toxin type A group were swallow difficulty (one patient),unnatural facial expressions (4 patients) and pain at injection site (10 patients) and that in radiofrequency ablation treatment group were that 18 patients had swelling of the skin 1 to 2 weeks after treatment.All patients had recovery 2 weeks after treatment.There was no facial nerve,parotid duct injury,or oral dysfunction.Conclusions The lasting effect of radiofrequency ablation treatment for benign masseter hypertrophy is longer than that of botulinum toxin type A.
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Objective To introduce a method of using perforators flap adjacent to the defect to repair small sized skin defect.Methods From October 2009 to December 2013,a total of 23 cases of skin lesions were treated with perforators flap adjacent to the defect.The perforator artery was preoperatively detected with Portable Doppler in the region of relative slack skin.Skin defects with the area changed from 1.5 cm × 2.0 cm to 5.0 cm × 4.0 cm.Results All the flap survived smoothly,with pleased appearance and primary healing.Postoperative follow-up of 3 to 6 month showed no recurrence in tumor patients during the follow-up period.Conclusions Application of perforators flap adjacent to defect to repair small sized skin defect has the advantages of flexibility,reliable blood supply,which obtains good result.
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Objective The aims of this study were to assess the efficacy of video-assisted thoracoscopic extended thymectomy(VATET) as a treatment for non-thymomatous myasthenia gravis (NTMG) and to identify prognostic factors for thymectomy.Methods Retrospectively analyzed clinical datas of 112 patients received VATET for the treatment of NTMG.Clinical efficacy and variables influencing outcome were evaluated by Kaplan-Meier method and Cox proportional hazards regression analysis.Results At 3.2 years averaged (1.5-6.2 years) of follow-up,none of these patients were lost to follow up.According to the MGFA post-intervention status,54 patients(48.2％) obtained complete stable remission during follow-up,21 patients(18.8％) obtained pharmacologic remission,10 patients (8.9％) obtained minimal manifestations,7 patients (6.3％) improved,20 patients(17.8％) unchanged,and none of these patients were worse or died of MG.By multivariate analysis,the chance of complete stable remission was significantly increased when age ＜ 40 years (P ＜ 0.01,OR =3.468),symptom duration ＜ 12 months(P ＜ 0.01,OR =3.203) and the presence of thymic hyperplasia (P ＜ 0.01,OR =3.064).Conclusion Video-assisted thoracoscopic extended thymectomy achieved satisfactory long-term results in patients with nonthymomatous myasthenia gravis,while age,symptom duration,the presence of thymic hyperplasia correlated with response to operation.
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AIM: To explore the therapeutic effect of malleolus radialis implantation with vascularized periosteal flap for disunion of carpal navicular fracture, and investigate the characteristics of tissue implantation. METHODS: Thirty-two patients with disunion in carpal navicular fracture were selected from Jiangyin People's Hospital from January 2000 to January 2006, with the informed consents of all the patients. They were treated with implantation of malleolus radialis with vascularized periosteal flap, fixed with plaster cast for 8-10 weeks. Therapeutic effect was evaluated as: ①excellent: normal activity of carpal joints, without soreness sense, fracture line disappeared by X ray;②fine: uncomfortable activity of carpal joints, with slight limitations, fracture line disappeared by X ray. RESULTS: ①All 32 cases of the disunion in carpal navicular fracture were synostosis displayed by X ray.②There were 23 cases followed up for 3-12 months, 7 cases for 13-24 months, and 2 cases for 25-36 months. Carpal joints function achieved the standard of the uninjured side, without pain or affection on daily life.③The therapeutic effect was excellent in 22 cases, fine in 10 cases, and good rate was 100%. CONCLUSION: Implantation of malleolus radialis with vascularized periosteal flap is an effective way to treat the disunion of carpal navicular fracture.
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Objective To restore the profile of the youthful human fa ce, the concept of three dimensions in the full face rejuvenaton is presented. Methods Under general anaesthesia, the operation was perf ormed, in which the lap of buccal soft tissues, the liposuction of part of face, the mobilization and/or repositioning of fat pockets, the transplantation of fa t, implantation of variant plastic materials etc. were applied. Resul ts We performed the procedures for 18 patients using three dimension s facial rejuvenation and obtained good results from February 2001 to May 2004. Conclusion Through above-mentioned procedures, three-di mensional concept is embodied, and the patients not only obtain better effect o f full face rejuvenation, but also improve the facial profile.