MRI诊断乳腺黏液腺癌

目的 观察乳腺黏液腺癌及其不同病理分型的MRI特点。方法 回顾性分析30例经手术病理证实的乳腺黏液腺癌的MRI表现,对比不同病理分型的MRI特点。结果 30例乳腺黏液腺癌,类圆形17例,分叶状10例,不规则形3例;边缘清楚19例,模糊10例,边缘伴毛刺1例;T1WI(VIBRANT蒙片)示低信号19例,等信号8例,高信号3例;T2WI IDEAL示高信号10例,高亮信号20例;强化方式为均匀强化6例,不均匀强化13例,环形强化10例,无强化1例;动态增强曲线类型为Ⅰ型21例,Ⅱ型6例,Ⅲ型2例,Ⅳ型1例;DWI呈高信号15例,高亮信号15例。30例乳腺黏液腺癌的平均ADC值为(1.91±0.28)×10^-3 mm²/s。单纯型和混合型黏液腺癌在形态和T2WI IDEAL信号强度方面差异有统计学意义(P<0.05)。结论 乳腺黏液腺癌的MRI表现有一定特征,主要为T2WI高亮信号、高ADC值、以流入型为主要动态增强方式;病变形态和T2WI信号强度对鉴别不同病理分型黏液腺癌有一定价值。     

乳腺黏液腺癌超声声像图特征与临床病理分型的对照及误诊分析

目的:探讨不同类型乳腺黏液腺癌的超声声像图特点和病理学特征,并分析超声误诊的原因。方法:回顾性分析68例乳腺黏液腺癌患者共70个病灶的超声声像图表现、临床资料及病理检查结果。结果:68例乳腺黏液腺癌患者的平均发病年龄为(54.5±23.3岁)(30～86岁),其中40例(58.8%)患者为50岁以上。病理检查结果提示,单纯型黏液腺癌占57.4%(39/68),混合型占42.6%(29/68); 16.2%(11/68)的患者发生了淋巴结转移。本组共70个病灶中,位于右侧乳房的占41.4%(29/70),位于左侧乳房的占58.6%(41/70),病灶位置以外上象限多见41.4%(29/70)。单纯型黏液腺癌患者中,病灶形态不规则形占76.9%(30/39),混合型患者中病灶呈不规则形占80.6%(25/31);与混合型黏液腺癌相比,单纯型黏液腺癌病灶形态不规则病灶中呈分叶状者较多(25例比7例)(P0.05);单纯型黏液腺癌病灶边界欠清者占48.7%(19/39),混合型黏液腺癌病灶则以边界不清为主77.4%(24/31);单纯型及混合型病灶均以后方回声增强最为多见,分别为74.4%(29/39)、48.4%(15/31)。单纯型病灶探及血流信号者占71.8%(28/39),混合型病灶探及血流信号占80.6%(25/31)。单纯型及混合型黏液腺癌中乳腺影像报告和数据系统(Breast Imaging Reporting and Data System, BI-RADS)分类为可疑恶性者分别占87.2%(34/39)和93.5%(29/31),误诊率分别为12.8%(5/39)、6.5%(2/31),均是因肿块多表现为形态规则、边界尚清晰、后方回声无改变等类似良性病变特征而被误诊。结论:乳腺黏液腺癌超声表现与病理分型间有一定相关性,单纯型乳腺黏液腺癌病灶多呈分叶状,边界欠清,后方回声增强,有时与良性肿瘤难以鉴别;混合型黏液腺癌则常有浸润性生长的影像学特征。     

乳腺黏液癌MRI表现与免疫组化对照分析

目的探讨35例乳腺黏液癌MRI与免疫组化表现,提高对该病的认识和诊断水平。方法回顾我院经手术病理证实的35例乳腺黏液癌,分析对照MRI表现及免疫组化指标。结果单纯型22例,混合型13例。MRI上表现为肿块22例,非肿块6例,结节状7例;平扫T_1WI低信号24例,等信号9例,混杂高信号2例;T_2WI抑脂高信号15例,稍高混杂信号20例;动态增强早期呈典型环形强化11例;时间信号曲线呈流入型9例,流出型强化9例,平台型强化17例;全部病灶ER、PR、HER-2、Ki-67阳性率分别为91.43%(32/35),68.57%(24/35),28.57%(10/35),62.86%(22/35)。单纯型具有较高的ER、PR阳性率,混合型具有较高的Ki-67、HER-2阳性率;ER、PR与强化形态相关,HER-2与最大径及形状相关,Ki-67与TIC曲线及淋巴结转移相关(P0.05)。结论乳腺黏液癌的MRI表现与免疫组化表现具有一定特征及联系。     

乳腺黏液癌的MRI诊断

目的探讨乳腺黏液癌在MRI上的影像表现特点及诊断要点。材料与方法搜集2013-2015年我院15例术前接受乳腺MR检査并经手术病理证实的乳腺黏液癌患者,对其MR图像进行回顾性分析,包括:病变位置、大小、形态,平扫时TIW1、T2WI及抑脂序列信号强度,增强后肿块强化方式及动态增强曲线类型,DWI表现及ADC值测定,并结合术前乳腺影像报告和数据系统(BI-RADS)MRI的影像诊断结果进行分析。结果15例乳腺黏液癌(12例单纯型、3例混合型,4例术后示腋窝淋巴结转移)发生于左乳者8例(53.3%),右乳者7例(46.7%);位于中央前部者1例(6.7%),余丨4例(93.3%)均位于外周偏上、偏内侧区域,其中位于中部者10例(66.7%)、后部者4例(26.6%);均表现为肿块,最大径7?45 mm不等,其中8例(53.3%)呈类圆形,边界清晰光整或伴浅分叶,7例(46.7%)形态欠规则,边缘局部模糊、毛糙或伴毛刺;平扫T1WI呈等或稍低信号,T2WI及脂肪抑制序列上均呈高或明显高信号;动态增强后,9例(60%)以增强早期肿块边缘明显环形強化伴肿块内向心性渗透样强化为主,6例(40%)以肿块内不均匀強化为主;TIC除1例(6.7%)为平台型,佘14例(93.3%)均为上升型。DWI上全部或局部区域呈明显高信号,平均ADC值mm~2/s时为(2.0S±0.44)×10~(-3)mm~2/s,高于正常乳腺组织(1.45±0.56)×10~(-3)mm~2/s。结论乳腺黏液癌的MRI表现具有一定的特征性,术前MRI检查有助提高影像诊断的准确性、并对预后有提示价值。     

DWI联合MRI动态增强特征对乳腺癌的诊断价值

目的:探究DWI联合MRI动态增强特征对乳腺癌诊断的价值。方法:回顾性分析经手术病理证实的90例乳腺病变患者(共98个病灶)的临床及影像学资料,所有病例术前均行DWI和MRI动态增强检查,观察病灶的形态、强化方式、时间-信号强度曲线(TIC)以及病灶的表面扩散系数(ADC)值。结果:98个乳腺病灶中,良性病变39个,恶性病变59个。强化的方式:19个边缘强化(2个纤维腺瘤、15个乳腺癌、1个炎症、1个囊肿合并感染);5个导管状强化(4个导管癌、1个增生);3个无强化(乳腺囊肿);40个不均匀强化(30个乳腺癌、1个叶状肿瘤、6个纤维腺瘤、2个增生,1个脂肪坏死并纤维化);28个均匀性强化(10个乳腺癌、7个乳腺增生、8个纤维腺瘤、1个叶状肿瘤、2个导管内乳头状瘤);3个网状强化(2个乳腺炎、1个巨乳症)。时间-信号强度曲线(TIC):29个I型流入型,21个II型平台型,48个III型流出型。表面扩散系数(ADC)值:恶性病变的平均ADC值为(1.06±0.19)×10~(-3)mm~2/s,良性病变的平均ADC值为(1.60±0.20)×10~(-3)mm~2/s,P0.05,两者之间差异具有统计学意义,正常腺体的平均ADC值为(1.8+0.32)×10~(-3)mm~2/s。结论:DWI联合MRI动态增强扫描可对乳腺良恶性病变做出鉴别诊断,对乳腺癌的诊断具有重要的临床价值。     

乳腺黏液癌的影像学特征与病理对照研究

目的探讨乳腺黏液癌X线、CT、超声表现及其病理学基础。方法回顾性分析本院2010年1月—2013年1月同时具有手术病理和影像资料的33例乳腺黏液癌患者,分析临床影像学表现和病理学结果及其相关性。结果 33例乳腺黏液癌患者中,单纯型17例、混合型16例。单纯型黏液癌组13例X线表现为局限性边界清楚的结节,其余4例呈边界不清的不规则致密影(P<0.01)。所有混合型均为边界不清或毛刺状肿块(P<0.01),且簇状、沙砾样钙化多见。单纯型黏液癌组8例(80%)CT上呈边界清楚的局限性结节且无明显强化,所有混合型黏液癌均为边界不清弥漫性病灶且多为不均匀明显强化。单纯型黏液癌组多数(76%)为弱回声;而所有混合型黏液癌为不均匀低回声,边界不清,形态不规则。单纯型黏液癌淋巴结转移率(11.8%)较混合型黏液癌(50%)低(P<0.05)。结论单纯型与混合型乳腺黏液癌相比,淋巴结转移少,分期低。单纯型和混合型黏液癌因病理学基础不同而影像学特征不同,前者最常见为边界清楚的肿块,而边缘不规则实性占位多为混合型黏液癌的特点。     

ADC值与eADC值对乳腺浸润性导管癌与纤维腺瘤的鉴别诊断价值

目的：探讨表观扩散系数（ADC值）与指数表观扩散系数（eADC值）对乳腺浸润性导管癌（IDC）与纤维腺瘤的鉴别诊断价值。方法对50例乳腺病变患者进行扩散加权成像（DWI）扫描,66个病灶均被病理证实,包括40例IDC及26例纤维腺瘤。测量两组病变病灶的ADC值及eADC值,并采用独立样本t检验比较两组病变ADC值及eADC值。通过ROC曲线（受试者工作特征曲线）曲线下面积（AUC）,评价ADC与eADC对IDC与纤维腺瘤诊断能力,并通过约登指数,计算ADC值与eADC值鉴别两者的最佳阈值。结果IDC的ADC值为（0.8±0.24）×10^-3mm^2/s,纤维腺瘤的ADC为（1.4±0.36）×10^-3mm^2/s,两者差异有统计学意义（t=-5.983,P＜0.05）。IDC的eADC值为0.4542±0.13074,纤维腺瘤的eADC值为0.2069±0.07356,两者差异有统计学意义（t=6.193,P＜0.05）。ADC值、eADC值的AUC分别为0.962、0.950。ADC值的阈值为1.1×10^-3mm^2/s,此时敏感性为90%,特异性为92.3%。eADC值的阈值为0.3183,此时敏感性为90%,特异性为100%。结论ADC值与eADC值对鉴别IDC与纤维腺瘤具有很高的灵敏性及特异性,可成为动态增强扫描的重要补充。     

磁共振动态增强成像联合扩散加权成像对乳腺良恶性疾病鉴别诊断价值

目的探讨磁共振动态增强成像中的动态增强时间信号强度曲线(time-signal intensitycurve,TIC)类型、早期强化率及扩散成像的表观扩散系数(apparentdiffusion coefficient,ADC)值在乳腺良、恶性病变中的鉴别诊断价值。材料与方法回顾性分析2017年4月至2019年4月中国医学科学院肿瘤医院深圳医院140个经病理证实的乳腺病灶的术前磁共振以及临床病理资料,依据病理分为良性病变组及恶性病变组。比较乳腺良、恶性病变间的TIC类型及早期强化率有无差异;并比较两组间ADC值的差异性。结果140个病灶中良性病变43个病灶,恶性病变97个病灶。乳腺良、恶性病变的TIC类型、第一期早期强化率类型差异具有统计学意义(P<0.05)。乳腺恶性病变平均ADC值[(0.965±0.215)×10^-3 mm^2/s]低于良性病变平均ADC值[(1.335±0.266)×10^-3 mm^2/s],两者间差异有统计学意义(P<0.05),ADC阈值取1.085×10^-3mm^2/s时,曲线下面积最大为0.857,其鉴别乳腺良、恶性病变的敏感性为73.2%,特异性为86.0%,准确性为77.1%。TIC曲线、第一期早期强化率及ADC三者联合诊断,诊断乳腺良、恶性病变的敏感性为83.5%,特异性为79.1%,准确性为78.5%,曲线下面积AUC为0.882,高于其他三者单独诊断的曲线下面积(0.728、0.562、0.857)。结论动态增强成像中的TIC曲线类型及第一期早期强化率与扩散加权成像的ADC值三者联合进行诊断,对乳腺良、恶性病变的鉴别诊断具有较好的价值。     

磁共振弥散加权成像量化分析在乳腺病变诊断中的价值

目的：评价磁共振弥散加权成像（Diffusion-weighted Imaging,DWI）量化分析在乳腺病变诊断中的价值。方法对经病理证实的72例乳腺疾病患者（85个病灶）以及10名健康自愿者行DWI,扩散敏感系数（b）值分别为0、500、1,000 s/mm^2。分别测量40个正常乳腺,22个恶性病灶,50个良性病灶,13个炎性病灶在不同b值时的ADC值,比较分析各组ADC值;采用两种方法确定乳腺良恶性病变ADC诊断阈值,并分析比较两者在乳腺恶性病变诊断中的效能。结果①b=500 s/mm^2时,恶性病变、炎性病变、良性病变、正常腺体的平均ADC值分别为（1.10±0.13）、（0.90±0.19）、（1.68±0.30）、（2.03±0.30）×10^-3mm^2/s;b=1,000 s/mm^2时,恶性病变、炎性病变、良性病变、正常腺体的平均ADC值分别为（0.96±0.16）、（0.68±0.20）、（1.53±0.33）、（1.85±0.31）×10^-3mm^2/s。②取乳腺恶性病变平均ADC值的95%可信区间上限作为阈值时,b=500 s/mm^2时ADC阈值为1.16×10^-3mm^2/s;b=1,000 s/mm^2时ADC阈值为1.03×10^-3mm^2/s。采用受试者工作特征（ROC）曲线确定ADC阈值,b=500 s/mm^2时ADC阈值为1.30×10^-3mm^2/s;b=1,000 s/mm^2时ADC阈值为1.14×10^-3mm^2/s。结论DWI量化分析对乳腺良（不包括炎性病变）、恶性病变的诊断有较高的价值;采用ROC曲线确定的b=1,000 s/mm^2时的ADC阈值对诊断乳腺恶性病变的准确性、敏感性、特异性均较高。     

全容积ADC直方图分析联合ADC值鉴别乳腺单纯型黏液癌与纤维腺瘤

目的:探讨MRI全容积表观扩散系数(ADC)直方图参数联合ADC值鉴别乳腺单纯型黏液癌(PMBC)与纤维腺瘤(FA)的价值.方法:回顾性分析16例(16枚肿块)PMBC与20例(20枚肿块)FA患者的ADC图资料,均经病理证实.将两组患者ADC图导入Mazda软件并手动勾画全层病变区域,经软件获得9个直方图参数;另外在...     

输尿管负压吸引鞘在输尿管软镜碎石术中的价值探讨

目的探讨输尿管负压吸引鞘在输尿管软镜碎石术治疗肾结石中的安全性及有效性。方法回顾性分析96例行输尿管软镜碎石术治疗肾结石患者的临床资料,应用输尿管负压吸引鞘46例(治疗组),未应用50例(对照组),比较两组患者的结石清除率、手术时间、肾盂内压、术后肾绞痛、石街形成情况、术后全身炎症反应综合征(SIRS)、降钙素原(PCT)浓度、白细胞计数、住院时间、住院费用和治疗有效率。结果治疗组肾盂内压在最小值、最大值和平均值方面均明显小于对照组(P0.05);在1个月后检查发现,对照组患者治疗有效率为70.0%,清除率为82.0%,而治疗组患者治疗有效率为84.7%,清除率95.6%,治疗组患者结石治疗有效率和清除率明显优于对照组(P0.05);治疗组和对照组手术时间分别为(86.3±5.2)和(108.6±3.5)min,治疗组明显短于对照组(P0.05);对照组和治疗组术后肾绞痛例数分别为13和2例(P0.05);对照组和治疗组术后石街形成例数分别为11和2例(P0.05);对照组和治疗组术后SIRS分别为10和2例,治疗组术后肾绞痛和石街形成、SIRS例数均明显低于对照组(P0.05);对照组和治疗组住院时间分别为(8.8±1.1)和(7.7±1.2)d,住院费用分别为(23 067.5±392.8)和(21 957.3±378.6)元,治疗组住院时间和住院费用与对照组比较差异无统计学意义(P0.05);对照组和治疗组术后PCT分别为(1.5±0.3)和(0.3±0.1)ng/ml,白细胞计数分别为(14.6±0.5)×109/L和(6.4±0.6)×109/L,术后治疗组患者PCT和白细胞计数明显低于对照组(P0.05)。结论输尿管负压吸引鞘在输尿管软镜碎石术治疗肾结石中安全、有效,缩短手术时长,同时提高结石清除率,减少不良反应发生,应当推广。     

Development of Oil-in-Gelatin Phantoms for Viscoelasticity Measurement in Ultrasound Shear Wave Elastography

Because tissues consist of solid and fluid materials, their mechanical properties should be characterized in terms of both elasticity and viscosity. Although the elastic properties of tissue-mimicking phantoms have been extensively studied and well characterized in commercially available phantoms, their viscous properties have not been fully investigated. In this article, a set of 14 tissue-mimicking phantoms with different concentrations of gelatin and castor oil were fabricated and characterized in terms of acoustic and viscoelastic properties. The results indicate that adding castor oil to gelatin phantoms decreases shear modulus, but increases shear wave dispersion. For 3% gelatin phantoms containing 0%, 10%, 20% and 40% oil, the measured shear moduli are 2.01 ± 0.26, 1.68 ± 0.25, 1.10 ± 0.22 and 0.88 ± 0.17 kPa, and the Voigt-model coupled shear viscosities are 0.60 ± 0.11, 0.89 ± 0.07, 1.05 ± 0.11 and 1.06 ± 0.13 Pa·s, respectively. The results also confirm that increasing the gelatin concentration increases shear modulus. For phantoms containing 3%, 4%, 5%, 6% and 7% gelatin, the measured shear moduli are 2.01 ± 0.26, 3.10 ± 0.34, 4.18 ± 0.84, 8.05 ± 1.00 and 10.24 ± 1.80 kPa at 0% oil and 1.10 ± 0.22, 1.97 ± 0.20, 3.13 ± 0.63, 4.60 ± 0.60 and 8.43 ± 1.39 kPa at 20% oil, respectively. The phantom recipe developed in this study can be used in validating ultrasound shear wave elastography techniques for soft tissues.     

Involvement of the extracellular matrix proteins periostin and tenascin C in nasal polyp remodeling by regulating the expression of MMPs

BackgroundTissue remodeling caused by increased MMPs is involved in the pathogenesis of chronic rhinosinusitis with nasal polyposis (CRSwNP). We previously found higher levels of periostin and tenascin C in CRSwNPs, but whether they are associated with the dysregulation of MMPs is unknown. Therefore, the present study aimed to investigate the regulatory roles of these two ECM proteins in the expression of MMPs in nasal polyps.MethodsThe concentrations of MMP‐2, MMP‐3, MMP‐7, MMP‐8, MMP‐9, MMP‐12, MMP‐13, TIMP‐1, TIMP‐2, TIMP‐3, TIMP‐4, periostin, and tenascin C in tissue homogenates of 51 patients with chronic rhinosinusitis with and without nasal polyps and 15 control subjects were measured and were analyzed by adjusted logistic regression and spearman correlation test. Primary human nasal polyp fibroblasts and epithelial cells were stimulated ex vivo with periostin and tenascin C and the gene expression of MMPs and TIMPs was determined by means of real‐time PCR.ResultsThe protein levels of MMP‐3, MMP‐7, MMP‐8, MMP‐9, TIMP‐1, TIMP‐2, periostin, and tenascin C were significantly higher in patients with CRSwNPs than in healthy control subjects. The adjusted logistic regression analyses showed that MMP‐3, MMP‐7, MMP‐8, MMP‐9, TIMP‐2, periostin, and tenascin C were related to the occurrence of CRSwNP. Spearman correlation test showed periostin was positively correlated with MMP‐3 and TIMP‐2, and tenascin C was positively correlated with MMP‐3, MMP‐7, MMP‐8, MMP‐9, and TIMP‐2. Periostin stimulated the gene expression of MMP‐3, MMP‐7, MMP‐8, and MMP‐9 in fibroblasts and MMP‐9 in epithelial cells ex vivo. Tenascin C stimulated the expression of MMP‐3, MMP‐7, MMP‐8, and MMP‐9 in epithelial cells. The expression of TIMPs in fibroblasts and epithelial cells was affected by neither periostin nor tenascin C.ConclusionsPeriostin and tenascin C might be involved in the remodeling of nasal polyps by regulating the expression of different MMPs in epithelial cells and fibroblasts. Our findings have the potential to identify key factors of tissue remodeling in CRSwNPs.     

Dancer perceptions of the cognitive,social, emotional,and physical benefits of modern styles of partnered dancing

ObjectiveTo study dancers’ perceptions of the physical, cognitive, affective, and social benefits of partnered dancing.Method225 dancers (71% female) were recruited through a community ballroom dance center and completed an online survey designed to measure their perceptions of the physical, cognitive, affective, and social benefits of modern, partnered dance styles (swing, Lindy Hop, and ballroom dancing). Subgroups were formed for analyses. For one set of analyses, groups based on length of dance participation were formed: experienced (dancing for more than 2 years) or novice (dancing for less than a year) dancers. For another set of analyses, groups based on frequency of dance practice were formed: committed (dancing at least one or more times per week) or occasional (dancing two or fewer times per month).ResultsThe majority of participants reported perceived benefits in physical fitness, cognition, affect, and social functioning. Experienced dancers reported significantly greater self-perceived physical, social, and cognitive benefits than novice dancers. Committed dancers were more likely than occasional dancers to report improvements in physical fitness, U = 6942, z = 2.38, r = 0.16, p < 0.05. A Mann-Whitney test indicated that self-reported improvements in mood (i.e., feeling less depressed and more happy) were greater for women than for men, U = 3945, z = −3.07, r = 0.20, p < 0.001. Length and frequency of dance participation significantly predicted perceived physical benefits [Χ² (1,6) = 35.463, p <0.001, R² = 0.16] and social benefits [Χ² (1,6) = 15.776, p < 0.05, R² = 0.07], but not cognitive benefits.ConclusionsResults suggest that participation in partnered dance styles is associated with perceived improvements in physical fitness, cognitive functioning, social functioning, mood, and self-confidence, and that perceived benefits may increase as individuals dance more frequently and over longer periods of time.     

Mechanical determinants of early acute ventilatory failure in COPD patients: a physiologic study

Objective  The purpose of this study is to investigate the respiratory mechanics, breathing pattern, and pressure-generating capacity of respiratory muscles during the early phases of an acute exacerbation of COPD. Design  Prospective study. Setting  Division of Emergency Critical Care and Chronic Ventilator Unit. Patients  A total of 24 COPD patients: nine patients requiring ventilatory support because of acute respiratory acidosis due to COPD exacerbation (NPPV group, pH 7.28 ± 0.02); seven patients successfully managed with medical therapy only (SB group, pH 7.39 ± 0.04); eight clinically stable, long term mechanically ventilated, COPD patients (IPPV group). Measurements  Respiratory mechanics during a period of unsupported breathing. Results  A rapid shallow breathing, in the presence of a high drive to breath and a high diaphragmatic tension-time index (TT_di), was found in NPPV and IPPV groups compared to the SB group (f/V _T ratio: 118 ± 43 and 137 ± 65, respectively, versus 37 ± 12 breaths/min/L; P _0.1: 5.0 ± 1.0 and 5.4 ± 1.4, respectively, versus 2.2 ± 0.2 cmH₂O, TT_di: 0.168 ± 0.035 and 0.161 ± 0.039, respectively, versus 0.057 ± 0.033); at variance, PEEPi_dyn was greater in IPPV compared to the other two groups. A significant relationship was observed between TT_di ratio and f/V _T (Rho 0.756). Conclusion  During the early phases of an acute exacerbation, patients with COPD and acute respiratory failure had an imbalance between the decreased capacity of the respiratory muscles to generate pressure and the increased respiratory load. This imbalance was similar to that recorded in patients with COPD and chronic ventilatory failure. In both groups, the imbalance was associated with rapid shallow breathing. Among the mechanical constraints to ventilation, only PEEPi,dyn was different between acute and chronic patients with ventilatory failure. Electronic supplementary material  The online version of this article (doi:) contains supplementary material, which is available to authorized users.     

Effects of educational intervention on nurses’ knowledge, attitudes, and behavioral intentions toward supplying artificial nutrition and hydration to terminal cancer patients

Introduction  This study aimed to investigate the effects of educational intervention on nurses’ knowledge, attitudes, and behavioral intentions regarding supplying artificial nutrition and hydration (ANH) to terminal cancer patients. Materials and methods  A quasi-experimental design was adopted. A structured questionnaire evaluated the effects of educational intervention. From April to June 2005, 88 nurses were enrolled in the gastroenterology, general surgery, and intensive care unit of Taipei Veterans General Hospital in Taiwan. The nurses were randomly assigned into experimental and control groups in equal numbers (44 nurses in each group). After the experimental and control groups completed the pretest, the experimental group participated in a 50-min lecture. Both groups received a post-test 2 weeks after the lecture. Results  This study showed that prior to educational intervention, nurses have possessed experiences of ANH use in routine caring for terminal cancer patients. However, due to the lack of knowledge about supplying ANH to terminal cancer patients, the nurses trended toward the negative behavioral intention, although they realized the burdens of ANH in these patients. After educational intervention, mean scores of knowledge, attitudes and behavioral intentions of the experimental group increased significantly (z = −5.255, p < 0.001; t = −5.191, p < 0.001; z = −3.274, p ≦ 0.001). Mean score changes of knowledge and attitude between these two groups reached significant differences (t = −7.306, p < 0.001; t = −4.165, p < 0.001), but no significant difference was observed in the mean score change of behavioral intention (z = −1.943, p > 0.05). Conclusion  The educational intervention remarkably improved nurses’ knowledge and attitudes regarding supplying terminal cancer patients with ANH. As for the changes in the behavioral intentions, it requires long-term moral and ethical training and communication. The results of this research emphasized the importance of educational interventions, which should be considered seriously in future reference nursing education program.     

Short-term Evidence in Adults of Anorexigenic Drugs Acting in the Central Nervous System: A Meta-Analysis

PurposeObesity is a chronic clinical condition that is considered one of the most serious health problems in the world because it can cause other chronic metabolic disorders. A meta-analysis was conducted to evaluate the safety and efficacy of 4 central-acting drugs, all approved in Brazil's market for weight loss.MethodsPubMed, EMBASE, and Cochrane library databases were searched from inception until January 2018 to retrieve randomized controlled trials comparing sibutramine, diethylpropion, mazindol, and fenproporex versus placebo in overweight or obese patients. Language was not a restriction for the database searches. We extracted and combined data from studies that reported adverse drug events and weight change. A random effects meta-analytic model was applied in all calculations. The Cochrane Collaboration tool was used to assess the quality and bias of all included studies. Quality of evidence was assessed by using the Grading of Recommendations, Assessment, Development, and Evaluation criteria.FindingsFifty-three studies were included, with a total of 16,903 patients with a median follow-up of 12 weeks (2–260 weeks). The appetite suppressants showed a significant weight loss compared with placebo (mean difference [MD], −4.70 kg; 95% CI, −5.25 to −4.15; I² = 100%; 43 studies). There was an increased total number of adverse events, dry mouth, constipation, insomnia, dizziness, and tachycardia reported in the intervention group (risk ratio [RR], 1.06; 95% CI, 1.01 to 1.10; I² = 20% [22 studies]; RR, 2.08; 95% CI, 1.76 to 2.47; I² = 34% [25 studies]; RR, 2.31; 95% CI, 1.88 to 2.84; I² = 0% [25 studies]; RR, 1.84; 95% CI, 1.40 to 2.39; I² = 0% [17 studies]; RR, 1.78; 95% CI, 1.24 to 2.58; I² = 0% [13 studies]; and RR, 2.01; 95% CI, 1.42 to 2.86; I² = 0% [10 studies], respectively). Sibutramine showed a significant increase in heart rate and mean diastolic pressure compared with placebo (MD, 4.17 beats/min [95% CI, 3.60 to 4.74; I² = 99%; 23 studies]; MD, 1.68 mm Hg [95% CI, 1.29 to 2.07; I² = 98%; 22 studies]).ImplicationsThese drugs are effective for weight loss in overweight and obese patients; however, they increase the risk of adverse events. In fact, the evidence is of low quality, the data availability of studied agents (especially for cardiovascular outcomes) are limited, and the studies are of short duration. PROSPERO identifier: CRD42018091083.     

Unguided Clinical and Actuarial Assessment of Re-offending Risk: A Direct Comparison with Sex Offenders in Denmark

Meta-analyses suggest that actuarial risk assessments outperform unguided clinical judgment for prediction of recidivism in criminal offenders. However, there is a lack of direct comparisons of the predictive accuracy of clinical judgment and actuarial risk scales for sexual offenders. We followed up 121 male sex offenders (≥18 years) subjected to pre-trial forensic psychiatric assessment in Denmark in 1978–1992 (mean post-detainment time = 16.4 years) to compare the predictive validity of unstructured clinical judgment of recidivism risk with that of the well-established Static-99 (Hanson and Thornton, Law and Human Behavior 24:119–136, 2000) and an extension of the Static-99, the Static-2002 (Hanson and Thornton, Notes on the development of Static-2002 (Rep. No. 2003–01), Public Safety and Emergency Preparedness Canada, Ottawa, Canada, 2003). The predictive accuracy of unguided judgment did not exceed chance for any sexual, severe sexual or any violent (sexual or non-sexual) reconviction (AUCs of the ROC curve = 0.52, 95%CI = 0.41–0.63; 0.50, 95%CI = 0.34–0.67; and 0.57, 95%CI = 0.40–0.73, respectively). In contrast, all three outcomes were predicted significantly better than chance by the Static-99 (AUC = 0.62, 95%CI = 0.52–0.72; 0.72, 95%CI = 0.59–0.84; and 0.71, 95%CI = 0.56–0.86) and the Static-2002 (AUC = 0.67, 95%CI = 0.57–0.77; 0.69, 95%CI = 0.56–0.83; and 0.70, 95%CI = 0.55–0.86). Static-99 outperformed clinical judgment for sexual recidivision (χ² = 5.11, df = 1, p < .05). The Static-2002 was significantly more accurate for the prediction of any sexual recidivism as compared to unguided clinical judgment but its advantage fell just short of statistical significance for severe sexual recidivism (χ ² = 3.56, df = 1, p = 0.06). When tested for recidivism within 2 years, none of the three prediction methods yielded results significantly better than chance for any outcome. This direct trial of the unguided clinical method argues against its continued use for risk assessment of sexual offenders.     

Three LHPP gene‐targeting co‐expressed microRNAs (microRNA‐765, microRNA‐21, and microRNA‐144) promote proliferation,epithelial‐mesenchymal transition,invasion, and are independent prognostic biomarkers in renal cell carcinomas patients

BackgroundRenal cell carcinoma (RCC) is one of the highly malignant tumors in the world. Global Cancer Statistics 2020 estimated that there were 179,368 deaths from kidney tumors. Therefore, exploring the prognostic biomarkers of RCC is of great significance for RCC patients. This study aims to explore the potential mechanism and prognostic value of phospholysine phosphohistidine inorganic pyrophosphate phosphatase (LHPP) gene‐targeting co‐expression microRNAs in RCC patients.MethodsA total of 60 RCC patients were included. Quantitative real‐time PCR (qRT‐PCR), western blotting, and immunohistochemistry were used for LHPP, microRNA‐765, microRNA‐21, and microRNA‐144 levels evaluation. Cell Counting Kit‐8 assay, dual‐luciferase reporter gene assay, invasion assay, and RNA fluorescence in situ hybridization were used for functional analyses.ResultsCompared with adjacent tissues, LHPP levels in cancer tissues were significantly increased (p < .001). Herein, we confirmed that microRNA‐765, microRNA‐21, and microRNA‐144 were direct biological targets of LHPP. MicroRNA‐765 (r = −0.570, p < 0.001), microRNA‐21 (r = −0.495, p < .001), and microRNA‐144 (r = −0.463, p < .001) expression levels were negatively correlated with LHPP expression levels. The high expression levels of microRNA‐765, microRNA‐21, and microRNA‐144 in RCC tissues were associated with poor differentiation, recurrence, and poor prognosis (p < .05). In vitro, microRNA‐765, microRNA‐21, and microRNA‐144 act as oncogenes to promote proliferation, invasion, and epithelial‐mesenchymal transition (EMT) through targeting LHPP.ConclusionsMicroRNA‐765, microRNA‐21, and microRNA‐144 are independent risk biomarkers for RCC patients. Inhibiting the expression levels of microRNA‐765, microRNA‐21, and microRNA‐144 can reduce the proliferation, EMT, and invasion of RCC cells. Therefore, the above three microRNAs are expected to become molecular biomarkers for RCC therapy.     

The Role of Viscosity Estimation for Oil-in-gelatin Phantom in Shear Wave Based Ultrasound Elastography

Shear wave based ultrasound elastography utilizes mechanical excitation or acoustic radiation force to induce shear waves in deep tissue. The tissue response is monitored to obtain elasticity information about the tissue. During the past two decades, tissue elasticity has been extensively studied and has been used in clinical disease diagnosis. However, biological soft tissues are viscoelastic in nature. Therefore, they should be simultaneously characterized in terms of elasticity and viscosity. In this study, two shear wave-based elasticity imaging methods, shear wave dispersion ultrasound vibrometry (SDUV) and acoustic radiation force impulsive (ARFI) imaging, were compared. The discrepancy between the measurements obtained by the two methods was analyzed, and the role of viscosity was investigated. To this end, four types of gelatin phantoms containing 0%, 20%, 30% and 40% castor oil were fabricated to mimic different viscosities of soft tissue. For the SDUV method, the shear elasticity μ₁ was 3.90 ± 0.27 kPa, 4.49 ± 0.16 kPa, 2.41 ± 0.33 kPa and 1.31 ± 0.09 kPa; and the shear viscosity μ₂ was 1.82 ± 0.31 Pa•s, 2.41 ± 0.35 Pa•s, 2.65 ± 0.13 Pa•s and 2.89 ± 0.14 Pa•s for 0%, 20%, 30% and 40% oil, respectively in both cases. For the ARFI measurements, the shear elasticity μ was 7.30 ± 0.20 kPa, 8.20 ± 0.31 kPa, 7.42 ± 0.21 kPa and 5.90 ± 0.36 kPa for 0%, 20%, 30% and 40% oil, respectively. The SDUV results demonstrated that the elasticity first increased from 0% to 20% oil and then decreased for the 30% and 40% oil. The viscosity decreased consistently as the concentration of castor oil increased from 0% to 40%. The elasticity measured by ARFI showed the same trend as that of the SDUV but exceeded the results measured by SDUV. To clearly validate the impact of viscosity on the elasticity estimation, an independent measurement of the elasticity and viscosity by dynamic mechanical analysis (DMA) was conducted on these four types of gelatin phantoms and then compared with SDUV and ARFI results. The shear elasticities obtained by DMA (3.44 ± 0.31 kPa, 4.29 ± 0.13 kPa, 2.05 ± 0.29 kPa and 1.06 ± 0.18 kPa for 0%, 20%, 30% and 40% oil, respectively) were lower than those by SDUV, whereas the shear viscosities obtained by DMA (2.52 ± 0.32 Pa·s, 3.18 ± 0.12 Pa·s, 3.98 ± 0.19 Pa·s and 4.90 ± 0.20 Pa·s for 0%, 20%, 30% and 40% oil, respectively) were greater than those obtained by SDUV. However, the DMA results showed that the trend in the elasticity and viscosity data was the same as that obtained from the SDUV and ARFI. The SDUV results demonstrated that adding castor oil changed the viscoelastic properties of the phantoms and resulted in increased dispersion of the shear waves. Viscosity can provide important and independent information about the inner state of the phantoms, in addition to the elasticity. Because the ARFI method ignores the dispersion of the shear waves, namely viscosity, it may bias the estimation of the true elasticity. This study sheds further light on the significance of the viscosity measurements in shear wave based elasticity imaging methods.