Contralateral prophylactic mastectomy: A narrative review of the evidence and acceptability

The uptake of contralateral prophylactic mastectomy (CPM) has increased steadily over the last twenty years in women of all age groups and breast cancer stages. Since contralateral breast cancer is relatively rare and the breast cancer guidelines only recommend CPM in a small subset of patients with breast cancer, the drivers of this trend are unknown. This review aims to evaluate the evidence for and acceptability of CPM, data on patient rationales for choosing CPM, and some of the factors that might impact patient preferences. Based on the evidence, future recommendations will be provided. First, data on contralateral breast cancer risk and CPM rates and trends are addressed. After that, the evidence is structured around four main patient rationales for CPM formulated as questions that patients might ask their surgeon: Will CPM reduce mortality risk? Will CPM reduce the risk of contralateral breast cancer? Can I avoid future screening with CPM? Will I have better breast symmetry after CPM? Also, three different guidelines regarding CPM will be reviewed. Studies indicate a large gap between patient preferences for radical risk reduction with CPM and the current approaches recommended by important guidelines. We suggest a strategy including shared decision-making to enhance surgeons’ communication with patients about contralateral breast cancer and treatment options, to empower patients in order to optimize the use of CPM incorporating accurate risk assessment and individual patient preferences.     

黄背草与2种菅属植物叶绿体基因组特征比较及系统发育分析

目的 以黄背草Themeda japonica为试验材料,比较分析其与阿拉伯黄背草T. triandra、中华菅T. quadrivalvis2种同属植物的叶绿体基因组特征及其与近缘物种的系统发育关系。方法 采用Illumina HiSeq高通量测序平台首次对黄背草叶绿体基因组进行测序,使用SPAdes和CpGAVAS2分别对其进行组装和注释,并用Codon W、DnaSP和MISA等对其与2种同属植物进行一系列比较基因组分析,利用最大似然法（maximum likelihood,ML）构建系统进化树。结果 3个叶绿体基因组全长为138 735～138 961 bp,具有典型的四分体结构,共注释出129个基因;黄背草与其同属的2个物种相比,反向重复区（inverted repeats,IR）收缩了2132 bp,大单拷贝区（large single copy region,LSC）扩张了约4000 bp,而小单拷贝区（small single copy region,SSC）变化不大。密码子偏好性分析显示,3个叶绿体基因组相对丰度最大和最小的密码子都相同,同义密码子相对使用丰度略有不同...     

基于一测多评多组分定量质控联合主成分分析、正交偏最小二乘法-判别分析及熵权逼近理想解排序法的盐沙苑子饮片综合质量评价

目的 建立一测多评（quantitative analysis of multicomponents by single-marker,QAMS）法同时检测盐沙苑子饮片中杨梅素、扁蓄苷、杨梅素-3-O-β-D-葡萄糖苷、毛蕊异黄酮葡萄糖苷、西伯利亚落叶松黄酮、沙苑子苷B、沙苑子苷A、毛蕊异黄酮、芒柄花素、鼠李柠檬素、豆甾醇、胡萝卜苷、β-谷甾醇含量的方法,并采用主成分分析法（principal component analysis,PCA）、正交偏最小二乘法-判别分析（orthogonal partial least squares-discriminant analysis,OPLS-DA）法及熵权逼近理想解排序（entropy weight-technique for order preference by similarity to ideal solution,EW-TOPSIS）法对其质量进行评价。方法 采用Lichrospher C18色谱柱;乙腈-0.2%磷酸水溶液为流动相梯度洗脱。以沙苑子苷A为内参物,建立内参物与其他12个待测成分的相对校正因子（relative co...     

Reinforcing aspects of androgens

Are androgens reinforcing? Androgenic-anabolic steroids (AAS) are drugs of abuse. They are taken in large quantities by athletes and others to increase performance, often with negative long-term health consequences. As a result, in 1991, testosterone was declared a controlled substance. Recently, Brower [K.J. Brower, Anabolic steroid abuse and dependence. Curr. Psychiatry Rep. 4 (2002) 377-387.] proposed a two-stage model of AAS dependence. Users initiate steroid use for their anabolic effects on muscle growth. With continued exposure, dependence on the psychoactive effects of AAS develops. However, it is difficult in humans to separate direct psychoactive effects of AAS from the user's psychological dependence on the anabolic effects of AAS. Thus, studies in laboratory animals are useful to explore androgen reinforcement. Testosterone induces a conditioned place preference in rats and mice, and is voluntarily consumed through oral, intravenous, and intracerebroventricular self-administration in hamsters. Active, gonad-intact male and female hamsters will deliver 1 microg/microl testosterone into the lateral ventricles. Indeed, some individuals self-administer testosterone intracerebroventricularly to the point of death. Male rats develop a conditioned place preference to testosterone injections into the nucleus accumbens, an effect blocked by dopamine receptor antagonists. These data suggest that androgen reinforcement is mediated by the brain. Moreover, testosterone appears to act through the mesolimbic dopamine system, a common substrate for drugs of abuse. Nonetheless, androgen reinforcement is not comparable to that of cocaine or heroin. Instead, testosterone resembles other mild reinforcers, such as caffeine, nicotine, or benzodiazepines. The potential for androgen addiction remains to be determined.     

用于评价动物社交偏好程度的新方法

目的：利用一种改进的三箱社交装置评价动物的社交偏好程度,并探索该方法的可行性。方法：采用注意力缺陷多动障碍(ADHD)大鼠作为社交障碍模型动物,以同源大鼠（WKY)大鼠和Wistar大鼠作为对照组,模型组采用治疗ADHD的临床常用中成药小儿黄龙颗粒（1.88 g/kg、3.75 g/kg）灌胃给药16 d。利用改进的三箱社交箱,以待测鼠在陌生鼠侧密切交流区的时间、频次、路程及相关比例作为行为学指标,检测该方法对社交行为评价的可行性。结果：与Wistar大鼠组比较,模型组大鼠与WKY组大鼠在密切交流区域及有陌生鼠侧区域的时间显著减少（P<0.01）,其他指标如频次、路程及比例也均有不同程度减少,小儿黄龙颗粒两剂量均能增加模型大鼠上述各指标数值。结论：该方法能准确捕捉动物的社交行为特征,实现对动物社交偏好程度的全面、客观评价。     

肾上腺切除对强迫游泳大鼠吗啡成瘾行为的影响

为探索应激和肾上腺切除在药物成瘾行为中的作用机制 , 将40只雄性Wista r大鼠随机分为肾上腺切除组、糖皮质激素Ⅰ组(肾上腺切除+氢化考的松20mg/kg)、糖皮质激素Ⅱ组(肾上腺切除+氢化考的松40mg/kg)及生理盐水对照组,每组各10只, 观察肾上腺切除及给予糖皮质激素对强迫游泳大鼠条件性位置偏爱形成的影响.结果: ①肾上腺切除组动物在药物搭配侧箱体中停留的时间与在对侧箱体中停留时间相比无明显差异(t=1.84 , P＞0.05),而其它3组中均存在显著性差异(P＜0.05或P＜0.01);②与其它3 组相比,肾上腺切除组动物在药物搭配侧箱体中停留时间明显缩短,而其它3组之间则无明显差异.由此表明,切除肾上腺能够减弱强迫游泳对大鼠吗啡条件性位置偏爱的强化作用, 而给予外源性糖皮质激素能够逆转这种作用.     

The effects of dopamine D1 and D2 receptor antagonists on the rewarding effects of δ1 and δ2 opioid receptor agonists in mice

The effects of the dopamin D₁ antagonist SCH23390 and the D₂ antagonist sulpiride on the rewarding effects of opioid receptor agonists were examined in mice. Both [d-Pen², Pen⁵]enkephalin (DPDPE, 1–15 nmol, ICV), a selective ₁ opioid receptor agonist, and [d-Ala²]deltorphin II (DELT, 0.5–5 nmol, ICV), a selective ₂ opioid receptor agonist, produced a dose-dependent place preference in mice. The DPDPE (15 nmol, ICV)-induced place preference was abolished by BNTX (0.5 mg/kg, SC), a ₁ opioid receptor antagonist, but not by NTB (0.5 mg/kg, SC), a ₂ opioid receptor antagonist. In contrast, the DELT (5 nmol, ICV)-induced place preference was antagonized by NTB, but not BNTX. Pretreatment with SCH23390 (3 µg/kg, SC) abolished the DPDPE-induced place preference, but not affect the DELT-induced place preference. Moreover, pretreatment with sulpiride (40 mg/kg, SC) did not modify the place preference induced by DPDPE or DELT. In the present study, we found that the activation of both central ₁ and ₂ opioid receptors produced rewarding effects. Furthermore, these results suggest that the rewarding effects of ₁ opioid receptor agonist may be produced through activation of the central dopaminergic system, especially dopamine D₁ receptors, whereas the rewarding effects of ₂ opioid receptor agonists may be produced by some other mechanism(s).     

青藤碱对小鼠吗啡的精神依赖以及cAMP水平的影响

目的　观察中药单体成分青藤碱 (sinomenine ,Sin)对吗啡诱导的小鼠精神依赖及其中枢cAMP水平的变化的影响。方法　采用有倾向性程序引起小鼠显著的位置偏爱效应 ,利用条件性位置偏爱实验观察ipSin 10、30、6 0mg·kg-1对小鼠吗啡奖赏效应的影响 ,用放射免疫法测定小鼠脑中cAMP含量。结果　Sin可剂量依赖性地缩短小鼠在吗啡伴药箱的时间 ,对吗啡慢性作用引起的小鼠脑内cAMP含量增加具有抑制作用。结论　Sin能减弱小鼠对吗啡的精神依赖 ,降低中枢cAMP水平 ,且其本身未显示精神依赖性反应。     

Effects of histaminergic neuron on the developmental process of conditioned reward induced by morphine

To investigate the effect of histaminergic neuron on morphine - induced conditioned place preference （ CPP）, the model of CPP was used to assess the rewarding effect of morphine. Morphine （2, 5, 10 mg/kg） significantly produced a CPP in a dose-dependent manner. In addition, morphine simultaneously and markedly lessened the histaminergic neurons in the TM,