Effects of tamoxifen on normal breast tissue histological composition: Results from a randomised six-arm placebo-controlled trial in healthy women

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.     

红外光谱数据融合对栽培滇重楼产地鉴别*

目的 多样的环境因素使得不同产地栽培滇重楼的化学成分也丰富多样，不同居群栽培滇重楼的甾体皂苷类成分具有很大的差异，多源数据融合分析能更全面的表征药材化学信息，建立一个高效而准确的产地鉴别模型，为其资源合理开发利用提供依据。方法 以来自云南和四川的8个产地（保山、楚雄、大理、红河、丽江、成都、文山、玉溪）共366份栽培滇重楼根茎为实验材料，采集其傅里叶变换近红外光谱（FT-NIR）和衰减全反射-傅里叶变换中红外光谱（ATR-FTMIR）数据。采用Kennard-Stone算法将不同产地的样品分为2/3的训练集和1/3的预测集，基于4种特征变量提取方法（CARS、VIP、SPA、SO-Covsel）结合2种数据融合策略（低级数据融合和中级数据融合），建立偏最小二乘产地判别分析模型。根据模型参数交叉验证均方根误差（RMSECV）和预测均方根误差（RMSEP）评估模型的稳定性，模型训练集和预测集准确率（ACC）评估模型分类性能。结果 近红外光谱和中红外光谱均能反应不同产地栽培滇重楼的化学成分差异，在中级数据融合中，基于VIP和SPA提取的特征变量建立的模型正确率均大于94%。相较于中级数据融合，低级数据融合模型得到了最为满意的结果，其预测集分类正确率达到100%。结论 根据近红外和中红外数据建立的低级数据融合PLS-DA模型，能够用于栽培滇重楼的产地鉴别分析。     

医院信息化平台住院陪护人员管理功能的开发与应用

目的 探讨医院信息系统中增加住院陪护管理功能的应用效果。方法 基于互联网医院、智慧医院等信息系统，开发信息化住院陪护管理功能，包括流行病学史调查、免费核酸申请、电子陪护证办理、体温监测登记及上报和统计查询。该功能与医院智慧护理链接后全院应用。比较功能应用前和应用后的遵医嘱一患一陪达标率、有效陪护证达标率、体温监测并登记日上报达标率和陪护证使用追溯率，评价护士和管理者疫情防控管理的人均耗时以及对该管理功能的满意度。结果 应用信息化陪护管理功能后，一患一陪达标率、有效陪护证达标率、体温监测并登记日上报达标率和陪护证使用追溯率显著高于应用前（均P＜0.05）；护士陪护管理人均耗时从（554.13±30.77）s降至（311.67±21.54）s（P＜0.05）；护士和管理者对该信息化陪护管理功能的满意度显著提高（均P＜0.05）。结论 信息化住院陪护管理功能的应用有效提升了疫情期间陪护的管理质量和管理效率，提高了一线护士和管理者的满意度。     

Policy Analysis for Prevention and Control of Influenza in Aged Care

ObjectiveThis study aimed to analyze national influenza infection control policy documents within aged care settings by identifying the consistencies, inconsistencies, and gaps with the current evidence and by evaluating methodological quality. Aged care providers can use these findings to identify their policy documents' strengths and weaknesses.DesignA quality and content analysis of national level policy documents.Setting and ParticipantsAged care settings rely on national agencies' policy recommendations to control and prevent outbreaks. There is limited research on the effectiveness of control measures to prevent and treat influenza within aged care settings. Because of the complexities around aged care governance, the primary responsibility in developing a comprehensive facility-level, infection-prevention policy, falls to the providers.MethodsThe analysis was conducted using the (1) International Appraisal of Guidelines, Research and Evaluation assessment tool, containing 23 items across 6 domains; and the (2) Influenza Related Control Measures in Aged Care settings checklist, developed by the authors, with 82 recommendations covering: medical interventions, nonmedical interventions, and physical layout.ResultsThere were 19 documents from 9 different high-income countries, with a moderately high methodological quality in general. The quality assessment's average score was 40.2% (95% CI 31.9%–44.7%). “Stakeholder involvement” ranked third, and “Editorial independence” and “Rigor of development” had the lowest average scores across all domains. The content analysis' average score was 37.2% (95% CI 10.5%–21.5%). The highest scoring document (59.1%) included term definitions, cited evidence for recommendations, and clear measurable instructions. “Physical Layout” had the least coverage and averaged 21.9% (95% CI 4.2%–37.5%), which shows a substantial gap in built environment recommendations.Conclusions and ImplicationsExisting policy documents vary in their comprehensiveness. The higher scoring documents provide an ideal model for providers. The checklist tools can be used to assess and enhance documents. Further research on document end-user evaluation would be useful, as there is room for improvement in methodological quality and coverage of recommendation coverage, especially related to physical layout.     

风险管理在儿科急诊护理工作中的应用研究

目的研究风险管理在儿科急诊护理工作中的应用。方法选取2021年10月至12月间来我科室就诊的100例患儿作为研究对象,将其分为研究组、对照组两组,每组各50例患儿。运用常规护理模式护理对照组患儿,运用风险管理模式,为研究组患儿给予护理干预,分析二组发生不良护理事故的情况并统计护理满意度。结果研究期间,研究组不良护理事件发生率为2.0%,对照组不良护理事件发生率为12.0%；研究组对护理工作的满意度为98.0%,对照组对护理工作的满意度为84.0%,P<0.05,组间差异具统计学意义。结论将风险管理应用于儿科急诊护理工作,可降低不良事件发生几率,保障患儿安全,具有推广应用价值。     

Effects of anteriorly-loaded treadmill walking on dynamic gait stability in young adults

BackgroundAnteriorly-loaded walking is common in many occupations and may increase fall risk. Dynamic gait stability, defined by the Feasible Stability Region (FSR) theory, quantifies the kinematic relationship between the body’s center of mass (COM) and base of support (BOS). FSR-based dynamic gait stability has been used to evaluate the fall risk.Research questionHow does front load carriage affect dynamic gait stability, step length, and trunk angle among young adults during treadmill walking?MethodsIn this between-subject design study, 30 healthy young adults were evenly randomized into three load groups (0%, 10%, or 20% of body weight). Participants carried their assigned load while walking on a treadmill at a speed of 1.2 m/s. Body kinematics were collected during treadmill walking. Dynamic gait stability (the primary variable) was calculated for two gait events: touchdown and liftoff. Step length and trunk angle were measured as secondary variables. One-way analysis of variance was conducted to detect any group-related differences for all variables. Post-hoc analysis with Bonferroni correction was performed when main group differences were found.ResultsNo significant differences but medium to large effect sizes were found between groups for dynamic gait stability at touchdown (p = 0.194, η² = 0.114) and liftoff (p = 0.122, η² = 0.139). Trunk angle significantly increased (indicating backward lean) with the front load at touchdown (p < 0.001, η² = 0.648) and liftoff (p < 0.001, η² = 0.543). No significant between-group difference was found related to the step length (p = 0.344, η² = 0.076).SignificanceCarrying a front load during walking significantly alters the trunk orientation and may change the COM-BOS kinematic relationship and, therefore, fall risk. The findings could inform the design of future studies focusing on the impact of anterior load carriage on fall risk during different locomotion.     

A Priori Subcell Limiting Approach for the FR/CPR Method on Unstructured Meshes

A priori subcell limiting approach is developed for high-order flux reconstruction/correction procedure via reconstruction (FR/CPR) methods on two-dimensional unstructured quadrilateral meshes. Firstly, a modified indicator based on modal energy coefficients is proposed to detect troubled cells, where discontinuities exist. Then, troubled cells are decomposed into nonuniform subcells and each subcell has one solution point. A second-order finite difference shock-capturing scheme based on nonuniform nonlinear weighted (NNW) interpolation is constructed to perform the calculation on troubled cells while smooth cells are calculated by the CPR method. Numerical investigations show that the proposed subcell limiting strategy on unstructured quadrilateral meshes is robust in shock-capturing.     

银杏叶制剂联合地塞米松在老年突聋治疗中对血清炎症指标的影响

目的: 探讨银杏叶制剂联合地塞米松在老年突聋治疗中对血清炎症指标的影响。方法: 按随机数字表法将我院2016年7月-2021年7月收治的102例老年突聋患者分入两组（各51例）。对照组用地塞米松治疗，治疗组加用银杏叶制剂治疗。观察两组治疗前后纯音听阈和血管内皮功能指标[超氧化物歧化酶（SOD）、脂质过氧化物（LPO）、一氧化氮（NO）]、血清炎症指标[肿瘤坏死因子-α（TNF-α）、C反应蛋白（CRP）、白细胞介素-6（IL-6）]，分析其疗效与不良反应。结果: 与对照组比较，治疗组总有效率更高（96.08％vs 82.35％）（χ2=4.993，P=0.025）；两组治疗后各频率点阈值均下降，且相比对照组，治疗组治疗后各频率点阈值更低（P<0.05）；治疗后两组SOD、NO水平均升高，LPO水平降低（P<0.05），且相比对照组，治疗组治疗后SOD、NO水平更高，LPO水平更低（P<0.05）；治疗后两组血清TNF-α、CRP、IL-6水平降低，且相比对照组，治疗组TNF-α、CRP、IL-6水平更低（P<0.05）；治疗组不良反应发生率5.88％，对照组为9.80％，两组比较差异无统计学意义（P=0.543，χ2=0.461）。结论: 银杏叶制剂联合地塞米松治疗老年突聋患者疗效理想，能恢复各频率点听力，安全可靠，推测改善患者血管内皮功能和炎症因子水平是其重要作用机制。