ABSTRACT
Objective:To explore the effect of mastoscopic axillary lymph node dissection (MALND) and conventional axillary lymph node dissection (CALND) in breast conserving surgery for breast cancer.Methods:This study adopts a case-control study. We selected 40 female breast cancer patients who underwent MALND in Tangshan People's Hospital from July 2016 to August 2019 (observation group), and 40 female breast cancer patients who underwent CALND in the same period as the control group. The two groups of patients were operated by the same group of doctors. After tracheal intubation and general anesthesia, the patients underwent breast conserving surgery first. After the intraoperative frozen pathology showed that breast conserving was successful, the control group underwent MALND, and the observation group underwent breast endoscopic axillary lymph node dissection. The levels of blood biochemical indicators, inflammatory factors, stress response indicators, myocardial injury markers and tumor blood circulation micrometastasis indicators, the number of lymph node dissection, operation time, intraoperative bleeding, postoperative drainage, hospital stay, hospital expenses and other surgical observation indicators, as well as the incidence of postoperative complications were compared between the two groups 3 days after operation. The measurement data with normal distribution was expressed by xˉ± s, and the comparison between the two groups was conducted by independent sample t-test; The counting data was expressed in cases (%), and the χ 2 test or Fisher exact probability method was used for comparison between groups. Results:Three days after operation, the erythrocyte count and hemoglobin level in the observation group were lower than those in the control group ((4.03±0.57)×10 12/L vs (4.33±0.54)×10 12/L, (110.90±24.20) g/L vs (129.70±14.90) g/L), cTnI, creatine kinase and CK-MB levels were higher than those in the control group ((17.4±2.3) μg/L vs (13.1±1.8) μg/L, (178.1±35.4) U/L vs (133.1±45.1) U/L, (10.7±1.6) U/L vs (7.0±1.2) U/L), the operation time was longer than that of the control group ((89.4±15.6) min vs (69.6±13.8) min), the intraoperative bleeding volume and postoperative drainage volume were more than that of the control group ((69.5±6.4) mL vs (33.3±7.7) mL, (334.5±51.1) mL vs (236.8±44.3) mL), but the hospital stay was shorter than that of the control group ((7.1±3.1) d vs (15.5±4.7) d). The cost of hospitalization was lower than that of the control group ((13 689.7±1 204.2) yuan compared with (19 734.5±1 391.5) yuan), and the difference was statistically significant ( t values were 2.16, 3.71, -11.69, -4.68, -11.34, -6.01, -22.87, -9.14, 9.44, 20.78; all P<0.05). There was no statistically significant difference between the two groups in inflammatory factors, stress response indicators, cell adhesion factor levels, number of lymph node dissection and postoperative complications (all P>0.05). Conclusions:Compared with CALND, MALND for breast cancer patients will not cause serious inflammatory reaction and stress reaction, and will not increase the risk of tumor blood micrometastasis and the incidence of complications, but will cause some damage to myocardial cells. Lipolysis and liposuction during MALND can increase intraoperative bleeding volume and postoperative drainage volume, and prolong the operation time while improving the quality of the operation field, However, it has obvious advantages in shortening hospitalization time and reducing hospitalization expenses.
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Objective:To investigate the physical and mental experience, treatment compliance and use barriers of patients with insomnia in using digital cognitive behavioral therapy for insomnia (dCBT-I) in order to provide qualitative evidence for the development and application optimization of the dCBT-I technology paradigm.Methods:From July to November 2021, a semi-structured interview outline was used to conduct in-depth interviews with the dCBT-I users ( n=10) to record their original feelings about the use of dCBT-I. Interpretative phenomenology's text analysis was used to explore the participants' experience and cognition of dCBT-I. Results:Text analysis and key information calibration were carried out on the verbatim transcripts of semi-structured interview recordings, and three core themes were extracted, namely stickiness factor, use barrier and optimization direction, as well as eight sub-themes, namely professionalism, accessibility, benefit experience, difficulty in task execution, instruction generalization, difficulty in software operation, enrich treatment content and personalized guidance.Conclusion:The present study showed that participants were receptive to the dCBT-I intervention and would be benefited from it.However, dCBT-I still needs to be optimized and improved to reduce the operating difficulty and explore more appropriate timing of manual intervention.
ABSTRACT
Objective To observe the long-term visual quality and clinical effect of aspheric diffractive multifocal intraocular lens (IOL) implantation for congenital and developmental cataracts in childhood.Methods A retrospective cohort study on multifocal IOL implantation for congenital and developmental cataracts in childhood (aged 8 to 14 years) was performed in the First Affiliated Hospital of Zhengzhou University from August 2013 to January 2015.The clinical data of 67 eyes from 46 congenital cataract patients who received phacoemulsification with IOL implantation were collected.The AMO (ZMB00) IOL was implanted in 34 eyes of 24 patients in the multifocal IOL group,and Bausch & Lomb (MI60) IOL was implanted in 33 eyes of 22 patients in the monofocal IOL group.The distance,intermediate and near vision acuity were analyzed in 3,6 and 12 months after surgery,including uncorrected visual acuity (UCVA) and best corrected visual acuity (BCVA).The wavefront aberrations,modulation transfer functions (MTF) and stereopsis were obtained with iTrace Analysis System,Optec-6500 Visual Functional Analyzer and Titmus Stereo Test Chart,respectively in 12 months after surgery.The near additional degree,removing glasses rate and myopic shift were compared between the two groups in postoperative 12 months.Results The intermediate and near UCVA in the multifocal IOL group were obviously better than those in the monofocal IOL group 3,6 and 12 months after surgery (intermediate:Z=-3.74,-4.36,-3.66;all at P=0.00.near:Z=-2.67,-2.50,-2.33;all at P＜0.05).There were no significant differences between the two groups in total aberration,high and low order total aberrations,comatic aberration,trefoil aberration,spherical aberration and secondary astigmatism under the 5.0 mm optical zone in 12 months after surgery (all at P＞0.05).The MTFs under the 5.0 mm optical zone and 5,10,15,20,25,30 c/d in the multifocal IOL group were insignificantly lower than those in the monofocal IOL group (all at P＞0.05).In addition,the near stereopsis,near additional degree and myopic shift (AD) were reduced in the multifocal IOL group compared with monofocal IOL group (both at P＜0.05).The glasses removing rate was 93.3％ in the multifocal IOL group,which was significantly higher than 33.3％ in the monofocal IOL group (x2 =23.25,P =0.00).No significant difference in the incidence of posterior capsular opacification was found between the two groups (P＞0.05).The myopic shifting rates were 16.7％ and 83.3％ in the multifocal IOL group and monofocal IOL group,with a significant difference between the two groups (x2=15.02,P=0.00).Conclusions The aspheric multifical IOL implantation can achieve good and stable distance,intermediate and near visual acuities,provide better near stereopsis,reduce postoperative dependence on spectacles and decrease the incidence of myopic shift in child cataract patients.