损伤胶囊联合依降钙素治疗绝经后骨质疏松症的临床疗效观察

目的：通过对比研究,观察损伤胶囊联合依降钙素治疗绝经后骨质疏松症的临床疗效。方法：将 2013年6月到2015年3月我科收治的绝经后骨质疏松患者随机分为两组,观察组(n=36例)给予我院制剂损伤胶囊口服配合依降钙素肌注并；对照组(n=36例)单纯予以依降钙素肌注,对所有患者均进行不少于1年的随访。采用视觉模拟疼痛评分( visual analogue scale,VAS) 及Oswestry功能障碍指数(oswestry dability index,ODI)对纳入患者腰背部疼痛、活动功能进行评估；采用双能X线骨密度仪(DXA)测量腰椎(L_2-4)骨密度值(BMD)；行腰/胸椎正侧位检查,观察两组骨折发生率。定期对患者进行随访,记录相关测量数据。结果：两组患者治疗后3月腰背部疼痛及功能障碍均缓解,但对照组治疗后6月、末次随访时VAS评分及ODI指数均高于观察组(P＜0.05)。末次随访,观察组与对照组骨密度T值分别为(-2.01±0.680)、(-2.24±0.023),差异有统计学意义(P＜0.05)。两组骨折发生率分别为对照组22.3%、观察组5.6%,差异有统计学意义(P＜0.05)。结论：损伤胶囊联合依降钙素可有效的减轻因骨质疏松进行性加重导致的腰背痛、提高骨密度,同时损伤胶囊可降低早期骨折的发生率,预防骨质疏松骨折,提高临床疗效。     

Effect of transcranial direct current stimulation on neuroplasticity in corticomotor pathways of the tongue muscles

The aim of this study is to investigate effects of transcranial direct current stimulation (tDCS) on neuroplasticity in corticomotor pathways related to tongue muscles evoked by a training task using the tongue drive system (TDS). Using a crossover design, 13 healthy participants completed two sessions of tDCS while performing 30 min of TDS training. Sessions were spaced at least 2 weeks apart and participants randomly received anodal and sham tDCS stimulation in the first session and the other condition in the second session. Single and paired pulse transcranial magnetic stimulation was used to elicit motor evoked potentials (MEPs) of the tongue at three time‐points: before, immediately after and 30 min after training. Participant‐based reports of fun, pain, fatigue and motivation, level of difficulty and effort were evaluated on numerical rating scales. There was no consistent significant effect of anodal and sham stimulation on single or paired pulse stimulation MEP amplitude immediately or 30 min after TDS training. Irrespective of tDCS type, training with TDS induced cortical plasticity in terms of increased MEP amplitudes for higher stimulus intensities after 30 min compared with before and immediately after training. Participant‐based reports revealed no significant difference between tDCS conditions for level of fun, fatigue, motivation, difficulty and level of effort but a significant increase in pain in the anodal condition, although pain level was low for both conditions. In conclusion, tongue MEP amplitudes appear to be sensitive to training with the tongue using TDS; however, anodal tDCS does not have an impact on training‐evoked neuroplasticity of tongue corticomotor pathways.     

Non-Mass Breast Lesions on Ultrasound: Feature Exploration and Multimode Ultrasonic Diagnosis

The aim of this study was to analyze the features of non-mass breast lesions (NMLs) on B-mode ultrasound (US), color Doppler US, strain elastography (SE) and contrast-enhanced ultrasound (CEUS) and to develop a multimode ultrasonic method for NML differentiation. Seventy-one NMLs were included in this retrospective study. Binary logistic regression was used to identify the independent risk factors. Pathology results were used as the standard criterion. Microcalcification on US, high stiffness on SE and hyper-enhanced intensity on CEUS were identified as features correlated with malignancy. A multimode method to evaluate NMLs based on the logistic regression was developed. The sensitivity and specificity for US, US?+?Doppler, US?+?SE, US?+?CEUS and the multimode method were 100% and 29%, 92.5% and 41.9%, 97.5% and 58.1%, 90.0% and 58.1% and 95.0% and 77.4%, respectively. The accuracy of these methods was 69.0%, 70.4%, 80.2%, 76.1% and 87.3%, respectively. The multimode ultrasonic method is simple and exhibited high diagnostic performance, which might be helpful for predicting the potential malignancy of NMLs.     

Local and Regional Staging of Invasive Breast Cancer With Sonography: 25 Years of Practice at MD Anderson Cancer Center

At The University of Texas MD Anderson Cancer Center, we have used sonography (US) extensively for more than 2 decades to refine the local and regional staging of invasive breast cancer. Although magnetic resonance imaging is superior to all other imaging modalities in the measurement of the primary tumor and detection of additional foci of malignancy, in our experience US has shown sufficient accuracy in clinical practice to stage most invasive breast cancers. The exceptions are ill‐defined tumors such as invasive lobular cancers and tumors in breasts containing extensive diffuse benign disease. An advantage of US is that multifocality or multicentricity can be confirmed via US‐guided fine‐needle aspiration within 15 minutes and the information shared immediately with the patient and the breast surgeon or medical oncologist. US has also proved indispensable in the evaluation of lymphatic spread because it can evaluate more nodal basins (e.g., the supraclavicular fossa and low neck) than magnetic resonance imaging can and because it can guide needle biopsy to confirm the status of any indeterminate node (including internal mammary nodes) within minutes.     

The prevalence of overweight and obesity in a breast clinic population: Consideration for weight loss as a therapeutic intervention

BackgroundObesity is an important risk factor for breast cancer and weight loss may be associated with a decreased risk for breast cancer and its recurrence. We evaluated the prevalence of overweight, obesity, and obesity-related co-morbidities in a breast health clinic population to determine the potential need for weight loss intervention.MethodsA retrospective review was conducted of sequential patients seen at a breast health clinic from July 1 to December 31, 2011. Body mass index (BMI), reason for visit (breast cancer diagnosis, high risk for breast cancer, or benign condition), and presence of obesity-related co-morbidities were recorded.ResultsThe 302 patients who met inclusion criteria had a median age of 52 years (10–91) and median BMI of 26 kg/m² (15.4–56.5). Overall, 36.8% of patients had a BMI between 18.5–24.9 kg/m²; 32.1%, 25–29.9 kg/m²; 14.2%, 30–34.9 kg/m²; 8.3%, 35–39.9 kg/m²; and 4.3%,≥40 kg/m². Overweight or obesity (BMI≥25 kg/m²) occurred in 64.2% of breast cancer, 65.0% of high-risk, and 57.1% of benign patients (P value not significant). Criteria for bariatric surgery (BMI 35–39.9 kg/m² with≥1 obesity-related co-morbidity or BMI≥40 kg/m²) were met in 8.2% of breast cancer, 16.7% of high-risk, and 11.5% of benign patients (P value not significant).ConclusionsRegardless of diagnosis, a significant proportion of patients visiting the breast health clinic meet criteria for weight loss intervention, including bariatric surgery. Weight management represents an underutilized therapeutic modality that could potentially decrease the risk of breast cancer and its recurrence, and improve overall prognosis.