Nipple discharge in a screening programme: imaging findings with pathological correlation

BreastScreen Australia provides free mammographic screening for asymptomatic women over the age of 40, targeting women aged 50-69. Occasionally women will present to screening programmes with a history of nipple discharge, which is uncommonly associated with significant underlying breast disease. Seventy-six women with a history of nipple discharge were recalled to BreastScreen Western Australia assessment centres from 2004 to 2008, of whom 72 were recalled primarily for their symptoms. Thirty-six of these patients had pathology investigations, including 18 nipple discharge smears, 17 fine needle aspirations, 11 core biopsies and eight surgical biopsies or therapeutic resections. The biopsies found 11 intraduct papillomas and one invasive ductal carcinoma with ductal carcinoma in situ. Fourteen patients had imaging findings consistent with benign mammary duct ectasia. Our findings confirm that the presentation of nipple discharge in a screening programme is uncommonly associated with significant breast disease, and present representative cases of the radiological findings with pathological correlation of benign and malignant causes including mammary duct ectasia, intraduct papillomas, multiple papillomas, invasive ductal carcinoma and ductal carcinoma in situ.     

胫股关节吻合性对人工膝关节聚乙烯磨损的影响

人工关节置换术是矫正关节畸形、解除关节疼痛、重建关节功能的主要手段。多年来 ,人工全髋、全膝皆以聚乙烯为关节形成表面 ,随着人工关节置换的广泛开展 ,聚乙烯磨损问题越来越引起人们的关注。聚乙烯磨损及其产生的碎屑和磨损颗粒所引发的生物学反应及导致的骨吸收、骨溶解 ,是造成假体松动、人工关节翻修的主要原因[1,2 ] 。与人工髋关节的球洞几何形态相比 ,人工膝关节的几何形态要不吻合的多 ,胫骨假体表面常承受较大的接触应力 ,较易产生磨损[2 ,3 ] ,理论上关节形成表面越吻合 ,聚乙烯磨损越少 ,不同的胫股关节吻合性 ,对假体磨损产…     

Effectiveness of maternity support belts in reducing low back pain during pregnancy: a review

Aims. This article aims to review the literature published to date on the types, current use, the biomechanical effects and adverse effects of maternity support belts for low back pain during pregnancy, to identify future research directions. Background. Lumbar/pelvic support belts are frequently recommended for the prevention and treatment of low back pain during pregnancy. Design. Systematic review. Methods. MEDLINE, CINAHL, the Cochrane Library and patents databases were electronically searched. Results. Maternity support belts belong to one of the four main types of maternity support garments, which are widely commercially‐available. Current research showed limited evidence in support of the commercial maternity products regarding the effectiveness in the prevention and/or treatment of low back pain during pregnancy, other than that from the manufacturers. However, potential stabilisation effect of maternity support belt was demonstrated in some studies. Adverse effects reported include increased pain, fetal heart rate changes, skin irritation and discomfort. Conclusions. There is insufficient scientific evidence to conclude that wearing maternity support belts reduces pregnancy‐related low back pain and/or pelvic girdle pain. Future research directions in the area of biomechanics and physiology are recommended. Relevance to clinical practice. This review provides comprehensive understanding of the effectiveness of maternity support belts for the relief of low back pain during pregnancy which will facilitate healthcare professionals in providing evidence‐based advice to their patients.     

Airway narrowing associated with inhibition of deep inspiration during methacholine inhalation in asthmatics.

Reduced bronchodilatation in response to deep inspiration (DI) has been demonstrated in asthmatics. We have previously shown that inhibition of DI for 10 min or more during methacholine inhalation increases airway narrowing in normals. We tested the hypothesis that inhibition of DIs during methacholine inhalation in asthmatics would not affect the magnitude of airway narrowing. We administered the PC(15) dose of methacholine to eight asthmatics every 5 min for 5 doses and measured spirometry after each dose. On four separate days, subjects received either 2, 3, 4, or 5 doses selected randomly, but DIs were inhibited during the challenge and spirometry was measured only at the start and after the final dose. Geometric mean PC(15) was 1.6 mg/ml. Mean values for FEV(1) (+/- SEM) after Doses 2 through 5 were 84 +/- 4, 78 +/- 6, 79 +/- 5, and 81 +/- 3% of baseline, respectively, when DIs were allowed. During inhibition of DIs, they were 73 +/- 6, 67 +/- 5, 64 +/- 6, and 61 +/- 7% of baseline values. Decreases in FEV(1) after Doses 4 and 5 were significantly greater when DIs were inhibited (p < 0.05). We conclude that in this group of asthmatics, inhibition of DI for 15 min is associated with increased airway narrowing in response to methacholine inhalation, and therefore, DI may be an important factor limiting induced airway narrowing in asthmatics as well as in normal subjects.     

Transient bone marrow oedema: A variant pattern of sacral insufficiency fractures

A 71-year-old woman presenting with severe low back pain was found to have a large oval area of increased sacral uptake on Tc-99m MDP scan, with corresponding T1-hypointense and T2-hyperintense areas on magnetic resonance (MR) images, highly suggestive of malignancy. Open biopsies showed only callus formation. The patient responded clinically to conservative measures, with twice-repeated follow-up Tc-99m MDP and MR scans documenting resolution of transient bone marrow oedema. We suggest that this form of marrow oedema represents a variant pattern of sacral insufficiency fractures.     

4-烷硫基-4-脱氧-4′-去甲表鬼臼毒素的合成和抗肿瘤活性

对4’-去甲表鬼臼毒素的C₄位进行化学修饰,合成和筛选了10个4-烷硫基-4-脱氧-4’-去甲表鬼臼毒素衍生物以进一步研究C₄位不同的原子和取代基与活性之间的关系及寻找结构简单、活性更强的抗肿瘤新药。4’-去甲表鬼臼毒素与硫醇在三氟化硼·乙醚或三氟乙酸存在下生成相应的硫醚,也可用硫醇与4β-溴-4-脱氧-4’-去甲表鬼臼毒素反应生成相应的硫醚。在体外筛选中,化合物10和12抑制L1210白血病细胞的活性与依托泊甙相当或更强,化合物9,10,12和15抑制KB细胞的活性与依托泊甙相当或更强。     

取代苄基/萘甲基异喹啉类及有关季铵衍生物的合成与生物活性

以具心血管活性的异喹啉类生物碱为先导物,结合某些钾通道阻滞剂的结构特征,设计合成了28个3,4-二氢(I_1～4)和1,2,3,4-四氢苄基/萘甲基异喹啉化合物(II_1～18)及有关季铵衍生物(I_5,6和II_19～22)。药理试验表明:除化合物I₄有一定升压作用外,大多化合物有不同程度的降压和减慢心率活性,其中化合物II1的降压活性最强。分析定量构效关系发现:化合物母核氮原子电荷愈大(即其绝对值愈小),降压作用愈强;反之,减慢心率作用愈强。异喹啉母核氮原子电荷可能为影响作用于血管或心脏组织的重要因素之一。