Standardised or individualised X-ray tube angle for mediolateral oblique projection in digital mammography?

IntroductionWe aimed to investigate whether there were any differences in positioning criteria related to the presentation of the pectoralis major muscle (pectoral muscle) for women of different heights using a standardized 60° X-ray tube angle for mammograms in mediolateral oblique (MLO) projection.MethodsData from MLO mammograms of right breasts of 45,193 women screened in BreastScreen Norway 2016–2019 were used. The positioning criteria were related to the pectoral muscle length (measure A and measure B), width and shape and considered adequate or inadequate depending on the degree of fulfilling the criteria. Data associated with the pectoral muscle were extracted from Volpara, an automated software for breast density assessment. Information on height was obtained from a self-reported questionnaire received by the women together with the invitation to attend the screening program. Women were divided into three groups based on the height percentiles (P) in the Norwegian growth curves: < 25th percentile (<P25th: ≤163 cm), 25th-75th percentile (P25–P75th: 164–170 cm), and >75th percentile (>P75th: >170 cm). Logistic regression was used to analyse the odds of adequate pectoral muscle length A and B, and shape, adjusting each model for screening technique and equipment model. Results were presented with odds ratios (OR) and 95% confidence intervals (CI).ResultsMean age of the screened women was 61.5 (SD = 4.8) years. The adequate measure for the pectoral muscle length A was obtained for 25.9% (11,724/45,193), length B for 76.3% (34,489/45,193), width for 75.0% (33,894/45,193) and shape for 97.6% (44,118/45,193) of the mammograms. Adjusted odds of an adequate pectoral muscle length A were lower for women of <P25th (OR = 0.90, 95% CI: 0.86–0.95) compared to women of P25-75th. Odds of an adequate pectoral muscle length B were lower for women of <P25th (OR = 0.88, 95% CI 0.84–0.93) and higher for women of >P75th (OR = 1.08, 95% CI 1.02–1.14) compared to women of P25-75. Odds of an adequate pectoral muscle shape were higher for women of <P25th (OR = 1.14, 95%CI 1.08–1.19) and lower for women of >P75th (OR = 0.92, 95% CI 0.87–0.97) compared to women of P25-75th.ConclusionThe 60° X-ray tube angle might suit most of the female population offered mammographic screening in Norway, but women of a relatively low height (163 cm or lower) might benefit from an X-ray tube angle less than 60-degrees.Implications for practiceUsing 60° X-ray tube angle for the MLO mammograms in BreastScreen Norway fit the majority of the participating women. More research is needed to change the protocol associated with the tube angle for women shorter than 163 cm.     

中部地区陆军驻训官兵消化系统疾病谱调查及其危险因素分析

目的 调查中部地区陆军驻训官兵消化系疾病患病情况,分析相关危险因素,初探消化系统疾病防治策略.方法 设计调查问卷,并通过预调查评估问卷质量;采用分层整群随机抽样方法,在我国中部地区7省市各抽取一个陆军基层单位,对所属的驻训官兵进行电子或纸质问卷调查,总结分析官兵消化系统疾病谱,并探讨疾病发生的危险因素.结果 共收集有效...     

鞘内注射胶质细胞源性神经营养因子对大鼠糖尿病神经病理性疼痛的影响

 目的 探讨胶质细胞源性神经营养因子(glail cell line-derived neurotrophic factor,GDNF)对糖尿病神经病理性疼痛(diabetic neuropathic pain,DNP)大鼠行为学的影响及机制。方法 将雄性SD大鼠50只随机分为对照组(N组,10只)、模型组(40只),造模后的模型组再随机分成DNP组(DC组,10只,仅给予10 μl PBS缓冲液)、GDNF治疗组(DG组,10只,注射2 μg GDNF+10 μl PBS缓冲液)。各组大鼠均测造模前,造模后第3、21天,首次给药或PBS缓冲液后第1、3、7、14天的压尾机械阈值(TFT)与热痛缩爪潜伏期(PWL);处死大鼠后,取L_4-6脊髓组织,采用Western blot法测定脊髓背角磷酸化PI3K、p-AKT、磷酸化哺乳动物雷帕霉素靶蛋白(p-mTOR)以及磷酸化核糖体S6蛋白激酶(p-S6K)蛋白表达水平。结果 造模后第21 天,与N组比较,模型组的血糖明显升高(P<0.01),且TFT与PWL也均明显缩短(P<0.01);给药后第14 天,与DC组相比较,DG组TFT和PWL均明显升高(P<0.01),且磷酸化PI3K、p-AKT、p-mTOR、p-S6K表达均明显降低(P<0.01);给药后第14天,与N组相比较,DC组TFT和PWL均明显降低(P<0.01),且磷酸化PI3K、p-AKT、p-mTOR、p-S6K表达均明显升高(P<0.01);给药后第14 天,DG组与N组相比较,在TFT、PWL以及磷酸化PI3K、p-AKT、p-mTOR、p-S6K表达等方面的差异均无统计学意义。结论 鞘内注射GDNF能够减轻大鼠DNP,其机制可能与GDNF通过调控PI3K-AKT信号通路,降低p-AKT表达水平,从而抑制p-mTOR和p-S6K的表达有关。     

Incidence and predictors of post-reperfusion syndrome in living donor liver transplantation

A characteristic pattern of hemodynamic changes that may occur in reperfusion phase of liver transplantation (LT) is known as post-reperfusion syndrome (PRS). In this study, we determined the frequency of PRS and evaluated possible predictors of PRS. The medical records of 152 patients who underwent living donor LT were reviewed. PRS was defined as a decrease in mean arterial pressure of more than 30% from the baseline value for more than one min during the first five min after reperfusion. The frequency of PRS was determined, and patients were divided into two groups: PRS group and non-PRS group. Donor factors, preoperative and intraoperative recipient factors, and postoperative outcomes were compared between the two groups. PRS occurred in 58 recipients (34.2%). Preoperative model for end-stage liver disease scores of recipients and percentage of graft steatotic changes were higher in PRS group. PRS group showed higher heart rates and lower hemoglobin values preoperatively. Before reperfusion, PRS group received more transfusion and their urine output was less than that of non-PRS group. Postoperatively, peak bilirubin during the first five d after LT was higher in PRS group. In conclusion, both severity of liver disease and graft steatosis may increase risk for PRS in LT. Further prospective studies of PRS in its relationship to outcome are indicated.     

音猬因子调控BMSCs表达和分泌VEGF及bFGF的实验研究

目的音猬因子(Sonic hedgehog,Shh)介导的信号参与调控血管生成的重要环节。研究不同浓度的重组Shh-N(recombinant Shh N-termitant,rShh-N)对BMSCs表达和分泌VEGF和bFGF的影响。方法取健康3日龄SD大鼠骨髓分离培养BMSCs,体外扩增至第3代,分别用含0、10、100、200 ng/mL rShh-N的L-DMEM培养BMSCs,作为A、B、C、D组。培养12、24、48、72 h后行ELISA法检测各组上清液中VEGF和bFGF的浓度,实时荧光定量PCR法检测各组VEGF和bFGF mRNA的表达水平。结果在基因表达水平上,D组各时间点的VEGF和bFGF mRNA表达量均明显高于A组(P<0.05),且在12、48 h表达量高于24、72 h(P<0.01);C组在各时间点均促进bFGF mRNA表达(P<0.05),在24～72 h促进VEGF mRNA表达(P<0.05),且在72 h时表达量均最高(P<0.01);B组在12 h抑制VEGF mRNA表达(P<0.05),48 h和72 h表现出促进作用(P<0.05),在12～48 h明显促进bFGF mRNA表达(P<0.05),且在48 h时的表达量最高(P<0.01)。在蛋白水平上,D组各时间点VEGF和bFGF分泌量均高于A组(P<0.01);C组在24～72 h VEGF和bFGF分泌量明显多于A组(P<0.05);B组在12 h和48 h抑制VEGF的分泌(P<0.05),24 h增加其分泌作用(P<0.05),而在24 h和48 h促进bFGF的分泌(P<0.05)。各组在48 h和72 h时的VEGF和bFGF分泌量明显多于12 h和24 h(P<0.05)。结论 rShh-N可促进BMSCs表达和分泌VEGF和bFGF,为进一步探讨rShh-N和MSCs联合应用于治疗缺血性相关疾病以及促进骨修复重建的可行性提供了实验依据。     

人RUNT相关转录因子3、细胞周期素在胰腺癌组织中mRNA水平的表达及其与临床病理因素的关系

目的 探讨人RUNT相关转录因子3(RUNX3)、细胞周期素(Cyclin D1)基因在胰腺癌组织和癌旁组织中mRNA表达水平与临床意义.方法 采用逆转录-聚合酶链反应(RT-PCR)检测RUNX3、Cyclin D1基因在42例胰腺癌组织及其癌旁组织中mRNA表达水平,并分析RUNX3、Cyclin D1基因mRNA表达与临床病理因素的关系.结果 (1)RUNX3基因在42例胰腺癌组织中mRNA表达量相对值为:0.2469±0.0708;相应癌旁组织中相对值为:0.7091±0.1764,两者差异有统计学意义(t=15.7036,P＜0.01).(2) RUNX3基因mRNA表达水平在分化程度、淋巴结转移、临床分期等病理因素的差异有统计学意义(P＜0.05),而与性别、年龄等因素无明显相关(P＞0.05).(3) Cyclin D1基因在42例胰腺癌组织中mRNA表达量相对值为:0.7769±0.1456;相应癌旁组织中相对值为:0.2860±0.1224,两者差异有统计学意义(t=18.9158,P＜0.01).(4) Cyclin D1基因mRNA表达水平在分化程度、淋巴结转移、临床分期等病理因素的差异有统计学意义(P＜0.05),而与性别、年龄等因素无明显相关(P＞0.05).(5)胰腺癌中RUNX3基因的mRNA表达抑制与Cyclin D1基因的过表达呈明显相关(r=-0.320,P＜0.05).结论 RUNX3基因在胰腺癌组织中mRNA 表达抑制,Cyclin D1基因在胰腺癌组织中mRNA过表达,RUNX3表达抑制或缺失及Cyclin D1过表达与胰腺癌的发生、发展有关.     

膜型基质金属蛋白酶-1在浸润性肝细胞癌组织的表达及其意义

目的 探讨在浸润性肝细胞肝癌(HCC)中,膜型基质金属蛋白酶-1(MT1-MMP)的表达和意义.方法 随机选取2004年1月至2006年12月间根治性手术切除的HCC标本123例,通过对肿瘤的个数、包膜是否完整、门静脉有无癌栓、有无肝外转移等标准的划分,将其分为浸润转移组(74)及无浸润组(49).术前所有病例均采用酶联免疫吸附试验(ELISA)测定血清血管内皮生长因子(VEGF)水平;并通过免疫组织化学法(ABC),测定两组术后标本癌组织的MT1-MMP蛋白及肿瘤微血管密度(MVD)的表达;定量聚合酶链反应(PCR)测定癌组织MT1-MMP mRNA的表达.结果 浸润组术前血清VEGF:(1 33.89±68.56) μg/L;无浸润组:(100.64±81.37) μg/L,差异有统计学意义(P＜0.01).MT1-MMP主要定位表达在肝癌细胞的胞膜和间质.在浸润组中,MT1-MMP蛋白及mRNA表达量明显高于无浸润组(P＜0.05);浸润组MVD:11.24±1.49,无浸润组:8.11±2.51,两者比较浸润组MVD的形成量明显增多(P＜0.01).结论 在浸润性肝细胞肝癌中,MT1-MMP的表达明显增高,并伴随血清VEGF的表达上调、癌组织内新生肿瘤微血管的形成增多.MT1-MMP高表达可作为浸润性肝癌的判定指标,并提示临床预后较差.     

丙戊酸对大鼠急性脊髓损伤后神经功能恢复的影响及作用机制

目的:探讨丙戊酸(VPA)对大鼠脊髓损伤(SCI)后运动功能恢复的影响及作用机制。方法:60只雄性SD大鼠随机均分为3组:假手术组(C组)、损伤组(SCI组)和丙戊酸保护组(VPA组)。SCI组和VPA组采用改良Allen法制作大鼠T10 SCI模型。VPA组术后即刻及其后每12h皮下注射VPA 300mg/kg,至取材;C组和SCI组在相应时间点注射等体积的生理盐水。伤后6h,每组取5只大鼠处死取材,其余大鼠在伤后24h、48h和72h每组取5只先行后肢运动功能BBB评分,随后处死取材。切片后分别行HE染色观察脊髓组织病理变化,免疫荧光双标法在激光共聚焦显微镜下观察核因子κB(NF-κB)途径的激活状态,免疫组化法检测白介素1β(IL-1β)的表达。结果:C组大鼠各时间点BBB评分均为21分,VPA组和SCI组各时间点的评分均低于C组(P<0.05),但VPA组各时间点的评分均高于同时间点SCI组,在伤后48h和72h两组差异有显著性(P<0.05)。病理检查显示C组脊髓组织形态正常,VPA组和SCI组伤后6h损伤中央区即可见明显出血灶,灰质中神经元肿胀坏死,白质中神经纤维肿胀;伤后24h、48h出血灶界限更明显,并可见空洞形成和炎症细胞浸润;伤后72h上述病理变化仍明显;VPA组各时间点的病理变化与SCI组相似,但炎症细胞浸润减少。C组偶见或未见NF-κB核阳性细胞和IL-1β表达,与C组相比,SCI组和VPA组NF-κB核阳性细胞百分比和IL-1β表达量从伤后6h即显著性增高,24h达高峰,以后逐渐减少,72h仍显著性高于C组(P<0.05);VPA组各时间点NF-κB核阳性细胞百分比和IL-1β表达量均低于同时间点SCI组(P<0.05)。结论:VPA可促进大鼠SCI后运动神经功能恢复,其机制可能与抑制炎症反应有关。     

糖尿病大鼠治疗后膀胱和腰骶背根神经节中神经生长因子的表达及超微结构研究

目的通过动物实验研究糖尿病大鼠治疗后膀胱和腰骶背根神经节中神经生长因子（NGF）的表达和超微结构变化及意义。方法参照Schmeichel等方法制备糖尿病大鼠模型,造模成功后4周应用NGF和胰岛素治疗4周,然后应用免疫组织化学方法检测大鼠膀胱和背根神经节中NGF的表达情况,利用透射电镜观察膀胱和腰骶背根神经节的超微结构变化。结果糖尿病大鼠经NGF和胰岛素治疗后膀胱和腰骶背根神经节中NGF的含量明显增加,差异有统计学意义（P〈0.05）,并且其形态学明显改善。结论 NGF的异常在糖尿病膀胱病变（DC）的发病中可能具有重要作用,给予外源性NGF可能有助于DC病变减轻和功能改善。     

TGF-β1/Smad3信号转导通路与创伤后瘢痕形成

目的对近年TGF-β1/Smad3信号转导通路与创伤后瘢痕形成的相关研究作一综述。方法广泛查阅国内外近年有关TGF-β1/Smad3信号转导通路及与创伤后瘢痕形成的文献,并进行综述。结果 TGF-β1是纤维化疾病的重要影响因子,通过TGF-β1/Smad3信号通路转导产生其生物学效应。该途径受多种因子调控并在细胞及分子水平与其他信号通路串话。该途径参与创伤后早期炎性反应、创面愈合及后期病理性瘢痕的形成。在分子水平干预转导途径的各个环节,可以影响纤维化及细胞外基质沉着的进程。结论 TGF-β1/Smad3信号转导途径是影响创伤后瘢痕形成及细胞外基质沉着的重要途径。对该途径进行深入研究,可为临床促进创面的愈合及病理性瘢痕的防治奠定理论基础。