乳腺癌患者应对方式的研究

由于乳腺癌生存人数的日益增多,进一步全面深刻地理解患者的应对方式,有助于护理人员促进患者的积极应对,提高患者生活质量。笔者重点分析了乳腺癌患者屈服、回避和面对3种主要应对类型,以及患者采取不同应对方式的影响因素,并提出运用危机干预理论,帮助患者积极应对癌症。     

冬虫夏草中砷及其安全性评价研究进展

传统名贵中药冬虫夏草Cordyceps sinensis中砷超标及其安全性问题近年来备受关注,针对冬虫夏草中砷的研究逐渐增加并不断深入。在文献查阅的基础上,从冬虫夏草砷及砷形态的分析方法,砷的含量、分布、存在形态,安全性评价,以及野生和人工仿生繁育冬虫夏草中砷含量等方面进行归纳总结,并对冬虫夏草中砷的认知及研究进行展望,以期为冬虫夏草安全性评价的深入研究提供参考。     

双眼透明边缘角膜变性一例

患者,男,36 岁,因“双眼视力下降半年余”于我科就诊。患者自述半年来双眼视力渐进性下降,矫正视力不佳,不伴眼红、眼痛、眼胀、畏光、流泪等症状。既往近视20余年,约-7.5 D,度数稳定,矫正视力可达1.0。否认眼病家族史,个人史无特殊。门诊行视力检查：右眼裸眼视力（UCVA）0.15,经-13.00-7.50×75矫正至0.3+1,左眼UCVA 0.15,经-12.00-7.50×80矫正至0.3。眼压（iccare回弹眼压计测量）检查：右眼9 mmHg（1 mmHg=0.133 kPa）,左眼7 mmHg。双眼结膜无充血,双眼角膜透明,下方4-8 点位角膜带状变薄,变薄带与角膜缘间有2 mm宽的正常角膜,变薄带上方角膜曲率增大,角膜膨隆（见图1A）。直接检眼镜下双眼眼底模糊,视盘边界清、颜色尚可,C/D约0.5。     

抗结核药致药物超敏反应综合征1例

1例34岁女性肺结核患者,予口服四联抗结核药治疗（异烟肼片,利福平胶囊,吡嗪酰胺片）,用药35天后出现皮疹,38天后出现发热、腹痛、皮疹加重。实验室检查：丙氨酸氨基转氨酶460 U/L,天冬氨酸氨基转氨酶533 U/L,γ-谷氨酰基转移酶80 U/L,胆碱酯酶3336 U/L。考虑为抗结核药导致的药物超敏反应综合征。停用所有抗结核药物,予支持对症治疗,患者腹痛逐渐缓解,仍反复发热,皮疹逐渐加重。后经保肝、激素冲击和免疫调节治疗后好转出院。     

MSCT诊断胰腺无功能性囊性神经内分泌肿瘤

目的探讨胰腺无功能性囊性神经内分泌肿瘤(NF-CNETP)的MSCT表现。方法回顾性分析10例经手术病理证实的NF-CNETP的MSCT表现,对照病理进行分析。结果 10例NF-CNETP中,位于胰头5例,胰尾4例,同时位于胰体尾部1例;肿瘤最大径2.5~6.2cm。10例肿瘤均边界清楚,其中9例见完整包膜。平扫肿瘤密度不均匀,实性囊壁呈等或稍低密度,10例中2例可见钙化。增强扫描动脉期9例呈明显环状不均匀强化,1例含壁结节者明显强化,门静脉期均呈持续性强化。肿瘤囊壁动脉期平均CT值为(128.00±62.62)HU,门静脉期为(132.40±44.66)HU。4例胰管轻度扩张。1例胰周淋巴结转移。6例接受能谱CT双能扫描,肿瘤囊壁动脉期及门静脉期的碘浓度值与腹主动脉的碘浓度值进行标准化后分别为0.40±0.16、0.79±0.22。结论 NF-CNETP的MSCT强化方式及包膜显示具有一定特征性,对诊断与鉴别诊断有一定意义。     

Temperature independence of piezoelectric properties for high-performance BiFeO3–BaTiO3 lead-free piezoelectric ceramics up to 300 °C

The temperature-dependence behaviors of ferroelectric, piezoelectric, k_p and electrical-field-induced strain were carefully evaluated for high-performance BiFeO₃–0.3BaTiO₃ (BF–0.3BT) ceramics. There results indicate, combined with Rayleigh analysis and temperature-dependence XRD and PFM, that the increase of strain and large signal with increasing the temperature from room temperature to 180 °C is related to the joint effect of intrinsic contribution (lattice expansion) and extrinsic contribution (domain switching). With further increasing the temperature to 300 °C, the large signal d₃₃ and electrical-field-induced strain mildly decrease because of the increase of conductivity for BF–0.3BT ceramics. However, different from strain and large signal the small signal d₃₃(E₀) and k_p exhibit excellent temperature stability behavior as the temperature increases from room temperature to 300 °C.

The temperature-dependence behaviors of ferroelectric, piezoelectric, k_p and electrical-field-induced strain were carefully evaluated for high-performance BiFeO₃–0.3BaTiO₃ (BF–0.3BT) ceramics.     

When the At-Risk Do Not Develop Heart Failure: Understanding Positive Deviance Among Postmenopausal African American and Hispanic Women

BackgroundAfrican American and Hispanic postmenopausal women have the highest risk for heart failure compared with other races, but heart failure prevalence is lower than expected in some national cohorts. It is unknown whether psychosocial factors are associated with lower risk of incident heart failure hospitalization among high-risk postmenopausal minority women.Methods and ResultsUsing the Women's Health Initiative Study, African American and US Hispanic women were classified as high-risk for incident heart failure hospitalization with 1 or more traditional heart failure risk factors and the highest tertile heart failure genetic risk scores. Positive psychosocial factors (optimism, social support, religion) and negative psychosocial factors (living alone, social strain, depressive symptoms) were measured using validated survey instruments at baseline. Adjusted subdistribution hazard ratios of developing heart failure hospitalization were determined with death as a competing risk. Positive deviance indicated not developing incident heart failure hospitalization with 1 or more risk factors and the highest tertile for genetic risk. Among 7986 African American women (mean follow-up of 16 years), 27.0% demonstrated positive deviance. Among high-risk African American women, optimism was associated with modestly reduced risk of heart failure hospitalization (subdistribution hazard ratio 0.94, 95% confidence interval 0.91–0.99), and social strain was associated with modestly increased risk of heart failure hospitalization (subdistribution hazard ratio 1.07, 95% confidence interval 1.02–1.12) in the initial models; however, no psychosocial factors were associated with heart failure hospitalization in fully adjusted analyses. Among 3341 Hispanic women, 25.1% demonstrated positive deviance. Among high-risk Hispanic women, living alone was associated with increased risk of heart failure hospitalization (subdistribution hazard ratio 1.97, 95% confidence interval 1.06–3.63) in unadjusted analyses; however, no psychosocial factors were associated with heart failure hospitalization in fully adjusted analyses.ConclusionsAmong postmenopausal African American and Hispanic women, a significant proportion remained free from heart failure hospitalization despite having the highest genetic risk profile and 1 or more traditional risk factors. No observed psychosocial factors were associated with incident heart failure hospitalization in high-risk African Americans and Hispanics. Additional investigation is needed to understand protective factors among high-risk African American and Hispanic women.     

Juxtatumoral perinephric fat analysis in clear cell renal cell carcinoma

Purpose

The purpose of the study was to evaluate the feasibility of using contrast-enhanced computed tomography (CECT)-based texture analysis (CTTA) metrics to differentiate between juxtatumoral perinephric fat (JPF) surrounding low-grade (ISUP 1–2) versus high-grade (ISUP 3–4) clear cell renal cell carcinoma (ccRCC).

Methods

In this IRB-approved study, we retrospectively queried the surgical database between June 2009 and April 2016 and identified 83 patients with pathologically confirmed ccRCC (low grade: n = 54, mean age = 61.5 years, 18F/35M; high grade n = 30, mean age = 61.7 years, 8F/22M) who also had pre-operative multiphase CT acquisitions. CT images were transferred to a 3D workstation, and nephrographic phase JPF regions were manually segmented. Using an in-house developed Matlab program, a CTTA panel comprising of texture metrics extracted using six different methods, histogram, 2D- and 3D-Gray-level co-occurrence matrix (GLCM) and Gray-level difference matrix (GLDM), and 2D-Fast Fourier Transform (FFT) analyses, was applied to the segmented images to assess JPF textural heterogeneity in low- versus high-grade ccRCC. Univariate analysis and receiver-operator characteristics (ROC) analysis were used to assess interclass differences in texture metrics and their prediction accuracy, respectively.

Results

All methods except GLCM consistently revealed increased heterogeneity in the JPF surrounding high- versus low-grade ccRCC. FFT showed increased complexity index (p < 0.01). Histogram analysis showed increased kurtosis and positive skewness in (p < 0.03), and GLDM analysis showed decreased measure of correlation coefficient (MCC) (p < 0.04). Several of the GLCM metrics showed statistically significant (p < 0.04) textural differences between the two groups, but with no consistent trend. ROC analysis showed that MCC in GLCM analysis had an area under the curve of 0.75.

Conclusions

Our study suggests that CTTA of ccRCC shows statistically significant textural differences in JPF surrounding high- versus low-grade ccRCC.

     

Association of cytotoxic T lymphocyte-associated protein 4 gene -1772T/C polymorphism with gastric cancer risk: A prisma-compliant meta-analysis

Background:We performed a meta-analysis to more precisely evaluate the association between the cytotoxic T lymphocyte-associated protein 4 (CTLA-4) -1772T/C polymorphism and overall gastric cancer (GC) risk and the influence of ethnicity and the source of controls on that association.Methods:A systematic literature search was performed in PubMed, EMBASE, the Cochrane Library, Web of Science (WOS) Database, Chinese National Knowledge Infrastructure (CNKI), China biomedical literature database (CBM), Wanfang database, and VIP. Two investigators independently reviewed the articles, and disagreements were resolved by discussion and consensus. The odds ratio (OR) with 95% confidence intervals (CIs) was used to assess the strength of the association between the CTLA-4 -1722T/C polymorphism and GC risk, based on the genotype frequencies in cases and controls. The meta-analyses were performed with Stata 12.0, using two-sided P values. Trial sequential analysis (TSA) was calculated by TSA Software.Results:Overall, we identified 5 studies including 1039 GC cases and 2136 controls that evaluated the association of the CTLA-4 -1722T/C polymorphism and GC risk. Overall, there was no significant association between the CTLA-4-1722T/C polymorphism and the risk of GC. In the subgroup analysis based on ethnicity, the results showed that the relationship between the CTLA-4 -1722T/C polymorphism and GC susceptibility was strongest in the Chinese population rather than in the Iranian population (TC vs CC: OR = 1.405, 95% CI: 1.100–1.796, P = .007; TC+TT vs CC: OR = 1.329, 95% CI: 1.052–1.680, P = .017). Then, there was a significant association between the CTLA-4 -1722T/C polymorphism and the risk of GC in studies with HB controls. However, the above correlation can only be reflected in specific populations and gene models. Therefore, we believe that the evidence of this correlation is insufficient.Conclusion:Our meta-analysis showed that the CTLA-4 -1722T/C polymorphism may be associated with the susceptibility to GC. However, the slight correlation can only be reflected in specific populations and gene models. Therefore, we believe that this association is negligible. The large and well-designed case-control studies are needed to validate our findings.