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1.
Tamoxifen prevents recurrence of breast cancer and is suggested for preventive risk-reducing therapy. Tamoxifen reduces mammographic density, a proxy for therapy response, but little is known about its effects in remodelling normal breast tissue. Our study, a substudy within the double-blinded dose-determination trial KARISMA, investigated tamoxifen-specific changes in breast tissue composition and histological markers in healthy women. We included 83 healthy women randomised to 6 months daily intake of 20, 10, 5, 2.5, 1 mg of tamoxifen or placebo. The groups were combined to “no dose” (0-1 mg), “low-dose” (2.5-5 mg) or “high-dose” (10-20 mg) of tamoxifen. Ultrasound-guided biopsies were collected before and after tamoxifen exposure. In each biopsy, epithelial, stromal and adipose tissues was quantified, and expression of epithelial and stromal Ki67, oestrogen receptor (ER) and progesterone receptor (PR) analysed. Mammographic density using STRATUS was measured at baseline and end-of-tamoxifen-exposure. We found that different doses of tamoxifen reduced mammographic density and glandular-epithelial area in premenopausal women and associated with reduced epithelium and increased adipose tissue. High-dose tamoxifen also decreased epithelial ER and PR expressions in premenopausal women. Premenopausal women with the greatest reduction in proliferation also had the greatest epithelial reduction. In postmenopausal women, high-dose tamoxifen decreased the epithelial area with no measurable density decrease. Tamoxifen at both low and high doses influences breast tissue composition and expression of histological markers in the normal breast. Our findings connect epithelial proliferation with tissue remodelling in premenopausal women and provide novel insights to understanding biological mechanisms of primary prevention with tamoxifen.  相似文献   
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ObjectiveThe use of mechanical circulatory support (MCS) in lung transplantation has been steadily increasing over the prior decade, with evolving strategies for incorporating support in the preoperative, intraoperative, and postoperative settings. There is significant practice variability in the use of these techniques, however, and relatively limited data to help establish institutional protocols. The objective of the AATS Clinical Practice Standards Committee (CPSC) expert panel was to review the existing literature and establish recommendations about the use of MCS before, during, and after lung transplantation.MethodsThe AATS CPSC assembled an expert panel of 16 lung transplantation physicians who developed a consensus document of recommendations. The panel was broken into subgroups focused on preoperative, intraoperative, and postoperative support, and each subgroup performed a focused literature review. These subgroups formulated recommendation statements for each subtopic, which were evaluated by the entire group. The statements were then developed via discussion among the panel and refined until consensus was achieved on each statement.ResultsThe expert panel achieved consensus on 36 recommendations for how and when to use MCS in lung transplantation. These recommendations included the use of veno-venous extracorporeal membrane oxygenation (ECMO) as a bridging strategy in the preoperative setting, a preference for central veno-arterial ECMO over traditional cardiopulmonary bypass during the transplantation procedure, and the benefit of supporting selected patients with MCS postoperatively.ConclusionsAchieving optimal results in lung transplantation requires the use of a wide range of strategies. MCS provides an important mechanism for helping these critically ill patients through the peritransplantation period. Despite the complex nature of the decision making process in the treatment of these patients, the expert panel was able to achieve consensus on 36 recommendations. These recommendations should provide guidance for professionals involved in the care of end-stage lung disease patients considered for transplantation.  相似文献   
4.
Background and aimsSkin autofluorescence (SAF) can non-invasively assess the accumulation of tissue AGEs. We investigated the association between SAF and kidney dysfunction in participants with T2D.MethodsOf 4030 participants consecutively measured SAF at baseline, 3725 participants free of end-stage kidney disease (ESKD) were included in the analyses. The association of SAF with incident ESKD or ≥30% reduction in estimated glomerular filtration rate (eGFR) was examined with Cox regression, linear mixed-effects model for the association with annual eGFR decline, and mediation analyses for the mediating roles of renal markers.ResultsDuring a median (IQR) 1.8 (1.1–3.1) years of follow-up, 411 participants developed the outcome. SAF was associated with progression of kidney disease (hazard ratio 1.15 per SD, 95% confidence interval [CI] [1.04, 1.28]) and annual decline in eGFR (β ?0.39 per SD, 95% CI [?0.71, ?0.07]) after adjustment for risk factors, including baseline eGFR and urinary albumin-creatinine ratio (UACR). Decreased eGFR (12.9%) and increased UACR (25.8%) accounted for 38.7% of the effect of SAF on renal outcome.ConclusionsSAF is independently associated with progression of kidney disease. More than half of its effect is independent of renal markers. SAF is of potential to be a prognostic marker for kidney dysfunction.  相似文献   
5.
目的 运用标准化患者法评估四川农村地区基层医生不稳定型心绞痛和2型糖尿病两种慢性病诊断准确性现状,探讨基层医生两种慢性病诊断准确性的主要影响因素,为提升基层医生两种慢性病诊断准确性提供科学依据。方法 采用多阶段随机整群抽样方法,抽取四川省自贡市5个区/县50个乡镇100个村为研究现场,以调查当日在岗的全科及内科医生作为研究对象。共进行两轮数据采集,第1轮采集样本乡镇卫生院和村卫生室医生的基本信息;第1轮调查完成1个月后,运用标准化患者法开展第2轮调查,收集农村基层医生对不稳定型心绞痛和2型糖尿病诊断结果信息。运用Logistic回归分析农村基层医生不稳定型心绞痛和2型糖尿病诊断准确性的影响因素。结果 共纳入172名农村基层医生,完成186次标准化患者访问,正确诊断率为48.39%。其中不稳定型心绞痛的正确诊断率为18.68%(17/91),2型糖尿病的正确诊断率为76.84%(73/95)。Logistic回归分析显示,具有执业医师资质的农村基层医生更有可能做出正确诊断(OR=4.857,95%CI=1.076~21.933,P=0.040)。农村基层医生在诊断过程中涉及的必要问诊和检查条目越多,做出正确诊断的概率越高(OR=1.627,95%CI=1.065~2.485,P=0.024)。与不稳定型心绞痛相比,农村基层医生对2型糖尿病做出正确诊断的可能性更高(OR=6.306,95%CI=3.611~11.013,P<0.001)。结论 四川农村基层医生不稳定型心绞痛和2型糖尿病诊断准确性整体较差,建议以基层医生慢性病诊断过程质量改善为突破口,提升基层医生执业水平,进而提高慢性病诊断准确性。  相似文献   
6.
Obstructive sleep apnea (OSA) is a sleep disorder common among patients with type 2 diabetes (T2D). The aim of this quality improvement project was to increase identification and referral for sleep study for individuals with T2D at moderate to high risk for OSA. Pre- and post-intervention patient samples were analyzed to compare the number of referrals for sleep study. Results demonstrated that none of the patients pre-intervention were referred for sleep study compared with 77% of patients post-intervention. This project demonstrated implementing an evidence-based tool to screen patients with T2D for OSA leads to higher rates of detection and referral.  相似文献   
7.
目的 探讨基层医院ICU病房责任分组护理管理模式的构建方案以及临床实践应用效果。方法 2020年7~12月ICU采取常规ICU管理模式(实施前),2021年1~6月ICU实施责任分组护理管理模式(实施后),包括责任组长选拔、护士分层搭配、护理工作实施、小组组内沟通、弹性合理排班等。结果 实施后护士满意度、护士团队协作能力评分及护理质量评分显著高于实施前(均P<0.05)。结论 根据基层医院实际情况,构建ICU病房责任分组护理管理模式,可有效提升护士满意度,增强护理人员之间的协作能力,提升护理质量,增强ICU运作效率,实现护理效益最大化。  相似文献   
8.
目的:比较高聚焦超声睫状体成形术(UCP)和睫状体冷冻术治疗难治性青光眼的疗效。方法:回顾性研究。收集2017-01/2020-12本院收治的难治性青光眼患者45例81眼,依据患者治疗方法不同分为睫状体冷冻术组22例40眼,高聚焦超声睫状体成形术组23例41眼。观察两组患者术前,术后1d,1wk,1、3mo眼压变化情况,采用疼痛数字等级评定量表(NRS)评估眼球疼痛程度,比较两组患者手术效果和并发症发生情况。结果:高聚焦超声睫状体成形术组手术总有效率明显高于睫状体冷冻术组(P<0.05),两组患者术后1d,1wk,1、3mo眼压和眼球疼痛程度均低于术前(均P<0.05),两组间患者术后各时间点眼压和眼球疼痛程度比较均有差异(均P<0.05)。高聚焦超声睫状体成形术组患者结膜充血、角膜水肿、前房炎性渗出、反应性高眼压和前房积血并发症发生率低于睫状体冷冻术组(P<0.05)。结论:高聚焦超声睫状体成形术治疗难治性青光眼疗效明确,在降低患者眼压、减少眼球疼痛和并发症发生方面较睫状体冷冻术有明显优势。  相似文献   
9.

目的:对西安市同一行政区域不同学段学生进行视力筛查,了解该区域不同学段学生近视率的差异,并进行原因分析。

方法:采用随机抽样法,选取小学21所、初中和普通高中各3所及职业高中1所共28所学校13 707人进行裸眼远视力和电脑屈光检测。

结果:西安市同区域小学、初中、高中和职业高中近视检出率分别为32.27%、72.07%、81.22%、65.12%; 总近视率为47.81%; 各年级女生近视率均高于男生; 小学和初中近视率随年级升高而升高; 随着学段的升高,高度近视占比由小学的2.40%升高至高中的16.51%。

结论:西安市同区域不同学段学生近视率具有差异性,随着学段的上升,近视率呈一定升高趋势; 女生近视率高于男生; 与2018年全国不同学段儿童青少年近视调查结果对比,2021年西安市同区域小学阶段近视率下降显著,初中及高中阶段近视率虽没有上升,但降幅不明显。  相似文献   

10.
晶状体位置异常是原发性闭角型青光眼的重要发病机制之一,往往与晶状体悬韧带异常相关。晶状体悬韧带异常主要影响晶状体的厚度、屈光力与位置,进而影响眼前节解剖结构和屈光状态,导致前房深度变化或不稳定。衰老、遗传、外伤、炎症等因素均可影响悬韧带结构与功能。深入研究悬韧带的病理生理有助于理解一些常见的临床现象如合并近视(甚至是高度近视)的闭角型青光眼、闭角型青光眼中的隐匿性晶状体不全脱位、一些闭角型青光眼对缩瞳及虹膜周切治疗的反常反应、年轻的闭角型青光眼往往是全身遗传性疾病的眼部表现等。目前亟需研究与开发简便、精准的术前和术中悬韧带的评估手段和标准。(眼科,2022, 31: 169-174)  相似文献   
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