Digital Breast Tomosynthesis: A New Diagnostic Method for Mass‐Like Lesions in Dense Breasts

To compare the rates and accuracy of digital breast tomosynthesis (DBT) and 2D digital mammography (DM) for detecting and diagnosing mass‐like lesions in dense breasts. Mediolateral and craniocaudal images taken with DBT (affected breast) and DM (both breasts) of the dense breasts of 631 women were assessed independently using Breast Imaging Reporting and Data System (BI‐RADS) scores. Images were compared for detection and diagnostic accuracy for masses; sensitivity and specificity of diagnosis; false‐negative and recall rates; and clarity of display, particularly of margins and spicules. Histopathology was conducted via surgical biopsies of all patients. The detection and diagnostic accuracy rates of DBT images (84.3% and 82.3%, respectively) were significantly higher than that of DM (77.3% and 73.4%; p < 0.01, both). The sensitivity and specificity of DBT (68.1% and 95.2%) were higher than that of DM (58.8% and 86.7%), whereas the recall rate of DBT was lower (3.6% cf. 9.8%). The number of cases of benign circumscribed masses and malignant spiculated masses detected by DBT (172 and 182) was significantly higher than the number detected through DM (75 and 115; p < 0.01, both). Radiologists assigned higher BI‐RADS scores for probability of malignancy to DBT images than DM, to lesions proved malignant (p = 0.025); for benign cases, the methods were comparable (p = 0.065). Compared with DM, DBT yielded significantly higher rates of detection and diagnostic accuracy for benign and malignant masses, with greater sensitivity and specificity and lower recall rates. In addition, DBT images facilitated analysis of margins, and the rate of accuracy for judgments of malignancy probability was higher, as proved on biopsy.     

Visceral hyperalgesia induced by neonatal maternal separation is associated with nerve growth factor-mediated central neuronal plasticity in rat spinal cord

Neonatal maternal separation (NMS) has been shown to trigger alterations in neuroendocrine, neurochemical and sensory response to nociceptive stimuli along the brain-gut axis. These alterations may be the result of a cascade of events that are regulated by neurotrophic factors. Nerve growth factor (NGF), a member of the neurotrophin family, is essential for the development and maintenance of sensory neurons and for the formation of central pain circuitry. The present study aimed to investigate whether NMS causes changes in neuronal plasticity and the relationship of these changes in plasticity with the expression of NGF and its high affinity tyrosine kinase receptor A (TrkA) in the lumbosacral spinal cord in adult rats. Male Wistar rat pups were either subjected to 180 min daily of NMS or not handled (NH) for 13 consecutive days. The expression of NGF and TrkA was examined in NH and NMS rats with or without colorectal distention (CRD) as determined by Western blot analysis and immunohistochemistry. The present results of Western blot analysis indicated NMS and CRD have a significant effect on NGF protein level in the lumbosacral spinal cord of rats. Assessments of optical densities revealed that NMS enhanced TrkA-ir fiber densities in laminae I-III and laminae V-VI of rats in both conditions with or without CRD. Double immunofluorescence revealed that TrkA co-expressed with calcitonin gene-related peptide (CGRP) in afferent fibers, while no significant difference in terms of the intensity of TrkA-ir in these fibers was found among groups. Quantitative analysis of TrkA-ir neurons indicated a significant interactive effect of NMS and CRD on the mean number of TrkA-ir neurons in laminae V-VI of rats, in which significant difference was found between NMS+CRD and NH+CRD. Double immunofluorescence of TrkA and Fos showed that CRD has a significant effect on TrkA expression in Fos-positive neurons in laminae V-VI and lamina X of rats, while no significant difference was found between NMS+CRD and NH+CRD. These results demonstrate that NMS induced alterations in NGF protein level and TrkA expression in adult rat spinal cord and indicate that NGF is a crucial mediator for the changes in neuronal plasticity that occur in NMS-induced visceral hyperalgesia.     

胶质瘤干细胞研究进展

随着对肿瘤干细胞（tumor stem cells）理论的深入认识和分离、培养肿瘤干细胞实验技术的不断进步,胶质瘤内肿瘤干细胞的存在已经有较多的证据和研究。这方面的研究不仅有助于深化人们对胶质瘤发生、复发和侵袭机制的认识,更重要的是可能改变以往胶质瘤的治疗策略,影响十分深远。新近,有学者将来自胶质瘤的肿瘤干细胞或具有干细胞特性的胶质瘤细胞称为“胶质瘤干细胞（glioma stem cells,GSC）”,较好地反映了这类细胞的特性。     

脑卒中后抑郁病人的心理护理对照研究

[目的]探讨心理护理对脑卒中后抑郁病人的抑郁症状缓解和神经功能康复的影响。[方法]将114例脑卒中后抑郁病人随机分为治疗组58例和对照组56例,对照组只进行常规护理,治疗组在常规护理基础上加用心理护理。采用汉密顿抑郁量表（HAMD）、脑卒中神经功能缺损评分表（CNS）和护士用住院病人观察量表（NOSIE-30）分别于治疗前及治疗后6周进行疗效评定。[结果]两组HAMD评分、CNS评分治疗前差异无统计学意义（P〉0.05）;治疗后6周治疗组均低于对照组,差异有统计学意义（P〈0.05）。[结论]心理护理能显著改善病人的抑郁症状和改善神经功能,有助于脑卒中后抑郁病人的全面康复。     

三种不同肠内营养支持方案对胃癌胃切除病人预后影响的比较

目的比较三种不同肠内营养支持方案对胃癌胃切除病人临床结局的影响。方法纳入90例术前营养风险筛查无风险的胃癌胃切除病人,围术期分别接受三种不同肠内营养支持方案,回顾性分析三种方案的营养支持效果、不良反应,以及术后住院时长、术后并发症发生率等指标。将90例病人分为A、B、C三组,A组(肠道预适应组):术前常规进食+术前口服、术后管饲整肠内营养混悬液[整蛋白-中链三酰甘油(TP-MCT)];B组(整蛋白组):术前常规进食、术后管饲肠内营养混悬液(TP-MCT);C组(短肽组):术前常规进食、术后管饲肠内营养混悬液[短肽(SP)]。比较三组病人术前及术后第1、7天营养指标(白蛋白、总白蛋白、前白蛋白);术前及术后第7天人体测量指标:体重、体质量指数、上臂围、三头肌皮褶厚度、上臂肌围,人体成分指标以及术前及术后第1、3、7天胰岛素抵抗指标(血糖、血清胰岛素、胰岛素敏感指数)。同时观察比较三组并发症的发生情况、术后肠功能恢复时间、恢复流质饮食时间、耐受经口进食时间、术后住院时长。结果三组病人术后营养相关指标、胰岛素抵抗指标,以及术后住院时长差异均无统计学意义(均P>0.05)。A组术后腹胀例数显著低于B组(P<0.05),与C组差异无统计学意义(P>0.05),C组腹胀例数与B组间差异无统计学意义(P>0.05);A组术后感染例数显著低于B组(P<0.05),C组感染例数与B组间差异无统计学意义(P>0.05);A组与C组术后胃瘫例数显著低于B组(P<0.05),A组与C组间差异无统计学意义;A组与C组术后恢复经口进食时间显著早于C组(P<0.05),A组与C组间差异无统计学意义。结论三种营养支持方案在改善术后营养状况以及住院时长方面差异无统计学意义。对于术前无营养风险的病人,术前3 d常规口服肠内营养混悬液(TP-MCT)行肠道预适应,能够减少术后腹胀等不良反应的发生,降低感染、胃瘫的发生率,尽早恢复病人经口进食,提高了病人术后使用肠内营养的依从性,有利于病人术后恢复。术前无肠道预适应病人,术后使用短肽型营养剂在不良反应、并发症的发生方面优于使用肠内营养混悬液(TP-MCT)。     

奎宁与三种逆转剂联合对耐药细胞系K562/HHT多药耐药逆转作用的研究

目的：寻找有效的多药耐药联合逆转剂。方法：用ＭＴＴ法、联合效应分析和流式细胞仪测定技术研究奎宁（Ｑｕｉｎ）分别与环孢菌素Ａ（ＣｓＡ）、他莫西酚（Ｔａｍ）、潘生丁（ＤＰＭ）联合逆转耐药细胞系Ｋ５６２／ＨＨＴ对柔红霉素（ＤＮＲ）和高三尖杉酯碱（ＨＨＴ）耐药。结果：逆转倍数是单用药的２～３倍，达到或超过单用２倍剂量的逆转效果，逆转剂间有联合协同作用，其中Ｑｕｉｎ与ＤＰＭ或Ｔａｍ联合的协同作用大于Ｑｕｉｎ与ＣｓＡ联合，可增加细胞内ＤＮＲ浓度。结论：Ｑｕｉｎ与ＣｓＡ、ＤＰＭ或Ｔａｍ联合具有协同作用，不同机制逆转剂联合的协同作用更为显著。     

70岁以上住院老年慢性病病人抑郁和焦虑的调查

随着医学科学技术的飞速发展和人民物质精神生活水平的日益提高，我国人口的平均预期寿命不断增长，现已接近70岁。据统计：目前我国老年病人口（我国以60岁以上为老年病人）总数已近I．3亿，约占总人口数的10．09％，而75岁以上老年病人以每年平均3．62％的速度增长，预测到2025年将上升到20％，2050年将达到顶峰25．5％。老年人是慢性病的主要患病人群。因此，本研究针对70岁以上患慢性病的住院普通老年人和住院离休干部进行调查，采用Brink老年抑郁量表（GDS）、Zung焦虑自评量表（SAS），以了解住院老年人中存在的焦虑、抑郁情况以及分析两组病人的性别、年龄、文化程度、婚姻状况、个人习惯和经济收入情况。现将结果报道如下。[第一段]     

常规超声与超声造影微血管增强显像对乳腺恶性病变的诊断价值

目的 探讨常规超声、超声造影微血管增强显像及两者联合对乳腺恶性病变的诊断价值.方法 收集152例乳房单发肿块病例,术前行常规超声、超声造影微血管增强显像,术后均行常规病理检查,通过与术后病理对照,分析常规超声、超声造影微血管增强显像及两者联合对乳腺恶性病变诊断的敏感性、特异性、阴性预测值、阳性预测值、准确性,ROC曲线下面积、95％可信区间.结果 超声造影微血管增强显像较常规超声在诊断敏感性、特异性、阳性预测值、阴性预测值、准确性上均有不同程度的提高（P =0.002）,而两者联合又较单一检查更能提高恶性肿瘤的检出率（常规超声同两者联合比较,P =0.002;超声造影同两者联合比较,P =0.000）,增加了ROC曲线下面积（P =0.000）.结论 常规超声和超声造影微血管增强显像联合,具有很好的优势互补性,可提高乳腺恶性肿瘤的早期检出率.     

Non-continuous versus continuous wound drainage after total knee arthroplasty: a meta-analysis

Purpose

So far, controversy still exists regarding the use of non-continuous or continuous wound drainage after total knee arthroplasty. The aim of this study was to assess the efficacy and safety of these two drainage techniques after total knee arthroplasty.

Methods

We searched the established electronic literature databases of Pubmed, Embase, Cochrane Library, CNKI, VIP and WANFANG. Nine RCTs including a total of 761 patients involving 811 knees were eligible for this meta-analysis.

Results

Our results showed that non-continuous drainage was associated with less haemoglobin loss (WMD,  −0.43, 95 % CI −0.62 to −0.24; P < 0.00001) and postoperative visible blood loss (WMD,  −305.09, 95 % CI −408.10 to −202.08; P < 0.00001) compared with continuous drainage. No significant difference was found between the two groups in terms of range of motion (WMD, 0.99, 95 % CI −1.01 to 2.98; P = 0.33), incidence of blood transfusion (OR, 0.63, 95 % CI 0.38 to 1.06; P = 0.80) or postoperative complications (OR, 1.09, 95 % CI 0.35 to 3.40; P = 0.89).

Conclusion

The existing evidence indicates that non-continuous drainage can achieve less haemoglobin loss (especially the four- to six-hour drain clamping) and postoperative visible blood loss with no increased risk of postoperative complications compared with continuous drainage.