乳腺癌内分泌治疗患者症状评估量表的编制和信效度检验

目的 根据乳腺癌内分泌治疗患者的症状特征,编制适用于我国乳腺癌内分泌治疗患者的症状评估量表,并检验其信效度。方法 在文献回顾及参照现有症状评估量表的基础上编制量表初始条目池;通过2轮德尔菲专家函询,形成初始版量表;通过对11例患者的认知性访谈,对量表条目进一步修订,形成临床测试版量表。便利选取2020年7月—9月在浙江省某三级甲等肿瘤医院门诊或住院的325例乳腺癌内分泌治疗患者进行问卷调查,检验量表信效度。 结果 形成的最终版乳腺癌内分泌治疗患者症状评估量表包括33个条目,探索性因子分析提取7个公因子,累计方差贡献率为68.76%;各条目内容效度指数为0.78~1.00,量表内容效度指数为0.91;内在相关性检验结果显示,量表各维度与总量表相关系数为0.58~0.79（P<0.05）;维度间相关系数为0.26~0.52（P<0.05）;总量表Cronbach’s α系数为0.94,重测信度为0.95,折半信度为0.84。结论 编制的乳腺癌内分泌治疗患者症状评估量表具有良好的信效度,适用于相关人群的症状测评。     

Bone mineral density changes after parathyroidectomy are dependent on biochemical profile

Background

Bone mineral density (BMD) has been found to improve after parathyroidectomy (PTX) in patients with primary hyperparathyroidism. There are few data on the effect of PTX on BMD in normocalcemic and normohormonal primary hyperparathyroidism.

关于抑制素的回顾与展望

1923年,随着生殖腺反馈调节垂体功能的概念的提出,关于抑制素的研究开始了。抑制素是一种非类固醇类物质,能够抑制垂体细胞的活性。1932年,这种物质在水状的睾丸提取物中得到证实,并被命名为抑制素。又经过了50多年的研究,到1985年,抑制素才被纯化和克隆。而直到化验技术的进步使人和动物的循环浓度得以分析,抑制素的生理活性的揭示才得以完成。本文综述抑制素的历史、生理作用及其在辅助生殖技术中的最新的应用和研究。     

Endocrine therapy with or without radical prostatectomy for T1b-T3N0M0 prostate cancer

BACKGROUND: We retrospectively compared the 5-year survival rates of T1b-T3N0M0 prostate cancer patients treated either by endocrine therapy plus radical prostatectomy or endocrine therapy alone. METHODS: Clinical T1b-T3N0M0 prostate cancer patients were enrolled at 104 institutions in Japan. They were assigned to study 1 (n = 176), if they were indicated to prostatectomy, if not indicated, they were assigned to study 2 (n = 151). The indication of prostatectomy was based on the clinical judgement of physicians and/or patients. Those assigned to study 1 underwent prostatectomy and adjuvant endocrine therapy with or without preoperative androgen deprivation. Those assigned to study 2 were treated with leuprorelin acetate with or without chlormadinone acetate. They were followed-up every 3 months until death or for 5 years and over. RESULTS: Those assigned to study 1 were younger (mean age 67.2 vs 75.7 years), less advanced in clinical stage, and had lower prostate specific antigen levels (mean 43.8 vs 103.6 ng/mL). Death for any reason was observed less frequently in study 1 (n = 29, 16%) than study 2 (n = 50, 33%), and the 5-year overall survival rate was higher in study 1 (87 vs. 68%). However, prostate cancer deaths were comparatively seldom (9% in study 1 and 7% in study 2), resulting in the identical 5-year cause specific survival rate in both study groups (91%). In both study groups the overall survival was almost equal to the natural survival of age-matched men. CONCLUSIONS: Endocrine therapy offers a reasonable survival rate in T1b-T3 prostate cancer patients within a 5-year follow-up. Observation will be extended to determine 10-year outcomes.     

Bone mineral density in patients with prostatic cancer treated with orchidectomy and with estrogens

Bone mineral density (BMD) and bone mineral content (BMC) were measured in the femoral neck area, trochanteric area and Wards triangle, and in the distal radius of the left forearm before and after 1 year of endocrine treatment in 27 patients with prostatic cancer. Eleven of the patients were treated with orchidectomy and 16 with combined oral and intramuscular estrogens. The patients were free from metastases during the entire observation period. In the orchidectomized patients, BMD and BMC of the distal radius decreased significantly following treatment, whereas no changes were observed in the estrogen-treated patients. These preliminary results demonstrate that estrogens may protect bone in male subjects also and may merit further investigations on larger groups of patients.     

Lack of modifying effects of atrazine and/or tamoxifen on thyroid carcinogenesis in rats pretreated with N-bis(2-hydroxypropyl)nitrosamine (DHPN)

The modifying effects of atrazine, and/or tamoxifen, on thyroid carcinogenesis were investigated in a rat two-stage carcinogenesis model following N-bis(2-hydroxypropyl)nitrosamine (DHPN) initiation. Five-week-old male F344 rats were given a single subcutaneous injection of DHPN (2800 mg/kg, body weight) or vehicle alone. Starting 1 week later, the animals were fed a diet supplemented with 0, 5, 50 or 500 ppm of atrazine, 500 ppm atrazine plus 5 ppm tamoxifen, or 5 ppm tamoxifen in the DHPN-treated groups, and 0 or 500 ppm of atrazine in the DHPN-untreated groups for 24 weeks. At autopsy major organs, including the thyroid, pituitary, liver, kidney, testis, epididymis, and brain, were collected and histopathologically examined. Body weights were significantly (P<0.05) decreased by the high doses of atrazine or tamoxifen, the effect being enhanced in combination. Relative thyroid weights were significantly increased (P<0.05) only in the tamoxifen-treated group and pituitary weights were elevated with 500 ppm atrazine plus tamoxifen (P<0.05). Relative liver weights were increased by the high dose of atrazine. However, the atrazine and/or tamoxifen treatments did not induce significant histopathological changes in the major organs, including the thyroid, nor cause significant changes in serum TSH levels. These results suggest that neither atrazine nor tamoxifen may promote thyroid carcinogenesis, alone as well as in combination.     

From laparoscopic training on an animal model to retroperitoneoscopic or coelioscopic adrenal and renal surgery in human

So far, laparoscopic approaches to kidney and adrenal have been limited because of their retroperitoneal location. We here report eight renal and adrenal endoscopic procedures performed in seven patients: two adrenalectomies for hyperaldosteronism, one adrenalectomy for isolated metastasis from an adenocarcinoma of the lung; two nephrectomies for end-stage infected hydronephrosis, two partial nephrectomies for small circumscribed lesions of the kidney, and one endoscopic resection for pain relief of a voluminous cyst at the kidney. The approach was transperitoneal in two cases and retroperitoneal in five cases using the retropneumoperitoneum insufflation technique. One patient was operated by a combined approach using the retro- and transperitoneal routes. All procedures were successfully completed endoscopically. The retroperitoneoscopic approach of the kidney is safe and does not interfere with the peritoneal organs. Its working space is tenuous, but allows a direct access on the kidney with good exposure of its pedicle. For adrenal surgery, the retroperitoneoscopic dissection is more difficult, because movements of instruments are often impaired by the closeness of the costal margin and the iliac crest. However, in case of difficulties we found it very convenient to switch from a retroperitoneal endoscopic approach to a combined coelioscopic and retroperitoneoscopic operation. Far from excluding each other, both approaches are complementary, particularly for difficult situations (i.e., previous peritoneal or retroperitoneal surgery).     

从脂肪组织的内分泌功能角度探讨其在慢性阻塞性肺疾病中的作用机制研究

脂肪组织除了通过其力学特征或机械功能对周边组织器官产生影响以外,还可以凭借非物理性的内分泌功能通过脂肪因子输出信号方式有效地建立起与呼吸系统等远程器官的互作信息网络,进而参与多种肥胖相关疾病的发生与发展。作为内分泌领域的突破性进展之一,脂肪组织的内分泌功能受到生命科学领域的关注。近年来,多项流行病调查研究揭示了肥胖是造成慢性阻塞性肺疾病（COPD）等呼吸系统疾病肺功能损害重要的危险因素。基于此,本文将分别梳理脂联素、瘦素、内脂素等脂肪因子在COPD中的作用机制,从脂肪组织内分泌功能角度为COPD的防治研究提供新思路。