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0 percent of patients undergoing only lymph node transfer (p = 0.019). Perometer measurements demonstrated a significant reduction between the groups at early time points [3 months, 40.7 percent versus 20.0 percent (p = 0.037); 6 months, 57.0 percent versus 44.5 percent (p = 0.043)]; however, the difference was not statistically significant at 12 months (60.4 percent versus 57.8 percent; p = 0.43). CONCLUSION This is the first prospective study demonstrating the safety and efficacy of a combined DIEP flap with vascularized inguinal lymph node transfer and lymphovenous anastomosis, which may be superior to lymph node transfer alone. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.BACKGROUND Within the multidisciplinary management of breast cancer, variations exist in the reconstructive options offered and care provided. The authors evaluated plastic surgeon perspectives on important issues related to breast cancer management and reconstruction and provide some insight into factors that influence these perspectives. SKI II cost METHODS Women diagnosed with early-stage breast cancer (stages 0 to II) between July of 2013 and September of 2014 were identified through the Georgia and Los Angeles Surveillance, Epidemiology, and End Results registries. These women were surveyed and identified their treating plastic surgeons. Surveys were sent to the identified plastic surgeons to collect data on specific reconstruction practices. RESULTS Responses from 134 plastic surgeons (74.4 percent response rate) were received. Immediate reconstruction (79.7 percent) was the most common approach to timing, and expander/implant reconstruction (72.6 percent) was the most common technique reported. Nearly one-third ofe spent in the operating room, and insurance reimbursement, to negatively influence the performance of autologous reconstruction.The theory of "disinhibition" has been very influential in psychiatry and neurology for over a century. Disinhibition has been used to explain clinical findings in many neurological and psychiatric disorders including dementia, traumatic brain injury, attention deficit hyperactive disorder, substance abuse, impulsivity in personality disorders, and neurodevelopmental disorders. In addition, disinhibition has been used as a unifying theory to link clinical observations with cognitive findings, and even cellular findings. This review discusses the origins and history of the theory of disinhibition and its strengths and weaknesses in four domains face validity, consistency with other brain mechanisms, consistency with evolutionary mechanisms, and empiric support. I assert that the vagueness of the theory, inconsistency with other brain mechanisms, and lack of empiric support limit the usefulness of this theory. Alternative approaches, based on findings in other motor, language, and cognitive functions, are discussed.Subjective well-being is decreased in war-affected populations. However, no previous research has investigated the role of temperament and character dimensions in life satisfaction among war veterans with posttraumatic stress disorder (PTSD). This study enrolled 148 Croatian male war veterans being treated for combat-related PTSD. The participants completed the Beck Depression Inventory-Second Edition, Satisfaction with Life Scale, and Temperament and Character Inventory-Revised. Two multivariate regression analyses with life satisfaction as a dependent variable and temperament and character dimensions, respectively, as predictor variables, were performed. Temperament dimensions harm avoidance and novelty seeking as well as character dimensions self-directedness and cooperativeness were unique predictors of life satisfaction, while controlling for the influence of depressive symptoms, education level, and employment status. Given the influence of personality dimensions on life satisfaction, the routine assessment of these dimensions might help to establish the individually tailored treatment among war veterans with PTSD.Therapeutic alliance determines medical treatment adherence, the success of psychotherapy, and the effectiveness of care. This systematic review aims at better understanding its determinants. The electronic databases Pubmed, Cochrane Library, and Web of Science were searched, using combinations of terms relating to psychosis and therapeutic alliance. Studies were selected and data were extracted using a PRISMA statement. Forty-one studies were selected, including 20 cross-sectional studies, 10 cohort studies, five randomized controlled trials, four literature reviews, and two retrospective studies. The quality of therapeutic alliance correlates with clinical symptoms, insight, social and family support, the therapist's qualities, the availability of shared therapeutic decision making, and the types of hospitalization. Although current evidence needs to be completed with further studies, it is already clear that group and family psychoeducation, cognitive remediation, community-based psychiatric services, and shared therapeutic decision making are essential approaches in the management of patients with psychosis.We conducted this updated meta-analysis to evaluate the effects of relaxation therapy for depression. We searched PubMed, MEDLINE, PsycINFO, the Cochrane Library, Web of Science, and CINAHL for randomized controlled trials evaluating the effects of relaxation therapy in patients with depression. Finally, 14 studies were included in this meta-analysis. The efficacy of the intervention was evaluated using depression scale scores. We found that there was no significant difference between the effects of relaxation therapy and psychotherapy on decreasing self-rated depressive symptoms (standardized mean difference [SMD] = 0.19; 95% confidence interval [CI], -0.11 to 0.48). In addition, eight trials compared relaxation therapy with no treatment, waiting list, or minimal treatment and showed that the relaxation group reported lower levels of self-reported depression scores postintervention (SMD = -0.57; 95% CI, -0.98 to -0.15). Therefore, this meta-analysis showed that relaxation might reduce depressive symptoms, and the effect is not worse than that of psychotherapy.
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