Improving State-Mandated Breast Density Notifications

PurposeEffective written communication directly affects health care outcomes. Since 2016, the complex language of state-mandated breast density notifications (BDNs) has been challenged, because it is perceived to be beyond the comprehension of most patients. The aim of this study was to assess whether a revised BDN written at a lower reading grade level improves understanding compared with the current state-mandated BDN.MethodsA revised notification with similar content to the current state-mandated BDN was developed. Both notifications were presented to patients for direct comparison, using a paper survey asking questions that evaluated patients’ perceptions and convictions associated with breast density. Surveys were distributed at four outpatient imaging centers to screening mammography patients.ResultsThe current BDN’s mean readability metric was 13.4, and that of the revised BDN was 6.6. Five hundred surveys were analyzed. Survey data demonstrated that 56.6% of all women perceived that dense breast tissue results indicated a “high” associated lifetime breast cancer risk from the current state-mandated BDN compared with only 2.2% with the revised notification (P < .001). Nearly all women were more likely to initiate discussions with their providers regarding their breast tissue density after reading the revised notification (96.0%) as opposed to the current state-mandated BDN (32.8%; P < .001).ConclusionsA significant portion of women misinterpret the intended messages of the current state-mandated BDN. Thus, a revised notification at a lower reading grade level may improve understanding of breast density, leading to improved individualized breast cancer screening for women with dense breasts.     

卡马西平与左乙拉西坦治疗成人癫痫的效果及对认知功能和骨密度的影响分析

目的探究卡马西平与左乙拉西坦治疗成人癫痫的效果及对认知功能、骨密度的影响。方法92例成人癫痫患者作为研究对象,随机分为左乙拉西坦组与卡马西平组,各46例。左乙拉西坦组采用左乙拉西坦治疗,卡马西平组采用卡马西平治疗。比较两组患者治疗前及治疗6个月后认知功能[语言智商(VIQ)、操作智商(PIQ)、总智商(FIQ)]评分、骨密度(腰椎、股骨大转子、股骨颈)变化情况。结果治疗6个月后,两组患者VIQ、PIQ、FIQ评分均较治疗前显著提升,且左乙拉西坦组患者VIQ评分(101.2±3.1)分、PIQ评分(108.1±2.3)分、FIQ评分(105.2±1.8)分均明显高于卡马西平组的(95.1±2.8)、(94.1±2.0)、(93.5±1.6)分,差异有统计学意义(P<0.05)。治疗6个月后,卡马西平组患者腰椎、股骨大转子、股骨颈骨密度均较治疗前显著下降,且明显低于卡马西平组,差异有统计学意义(P<0.05);左乙拉西坦组治疗6个月后腰椎、股骨大转子、股骨颈骨密度与治疗前比较差异无统计学意义(P>0.05)。结论左乙拉西坦与卡马西平治疗成人癫痫,左乙拉西坦更能明显提升患者认知功能,且对患者骨密度无影响。     

Role of optical coherence tomography angiography in the characterization of vascular network patterns of ocular surface squamous neoplasia

PurposeTo visualize and quantify vascular networks in individuals with ocular surface squamous neoplasia (OSSN) through optical coherence tomography angiography (OCTA).MethodCross-sectional study of OSSN patients. Vascular networks were measured by OCTA in the epithelium and sub-epithelial space in the tumors, adjacent tissue, and in the contralateral eye. Vessel area density (VAD, percent of blood vessels within 2.14 mm²), was calculated for each location. Total tumor density (TTD, percent of blood vessels within the entire tumor) was calculated. VAD was assessed separately for corneal and conjunctival locations and compared.ResultsFifteen patients with OSSN were included. The mean age was 61 ± 12 years and the majority were male (80%). The mean tumor area, volume, depth, and TTD were 28.0 ± 9.0 mm² (range, 10.9–39.7), 9.1 ± 4.1 mm³ (range, 3.4–18.8), 334 ± 125 μm (range, 177–571), and 33.2% ± 11.0% (range, 18.7–58.8), respectively. The VAD was highest within the tumor (28.9% ± 8.7%) followed by the adjacent sub-epithelial tissue and the tissue underneath the conjunctival component of tumor. These densities were higher than the VAD in the tissues of the non-involved eye (all P < 0.05). The VAD within conjunctival component of tumor was significantly higher than those with corneal component (29.8% ± 9.5% vs. 21.1% ± 5.5%, p = 0.006). The VAD under conjunctival tumor was also significantly higher than under corneal component (24.1% ± 7.8% vs. 17.0% ± 6.1%, p = 0.024).ConclusionsOCTA imaging allowed for visualization and quantification of vessel structure and density within, under, and surrounding OSSN.     

低密度脂蛋白在2型糖尿病骨质疏松中的作用研究进展

2型糖尿病及骨质疏松已成为我国最主要的慢性代谢性疾病。2型糖尿病常伴有血脂紊乱，常表现为低密度脂蛋白升高，而越来越多的研究表明血脂通过不同的方式影响骨代谢，其机制可能是通过抑制骨髓间充质干细胞成骨分化，通过RANK/RNAKL/OPG信号通路及炎症反应调节破骨细胞等方式调节骨代谢。     

Inactivated influenza vaccine formulated with single-stranded RNA-based adjuvant confers mucosal immunity and cross-protection against influenza virus infection

Influenza vaccination is considered the most valuable means to prevent and control seasonal influenza infections, which causes various clinical symptoms, ranging from mild cough and fever to even death. Among various influenza vaccine types, the inactivated subunit type is known to provide improved safety with reduced reactogenicity. However, there are some drawbacks associated with inactivated subunit type vaccines, with the main ones being its low immunogenicity and the induction of Th2-biased immune responses. In this study, we investigated the role of a single-stranded RNA (ssRNA) derived from the intergenic region in the internal ribosome entry site of the Cricket paralysis virus as an adjuvant rather than the universal vaccine for a seasonal inactivated subunit influenza vaccine. The ssRNA adjuvant stimulated not only well-balanced cellular (indicated by IgG2a, IFN-γ, IL-2, and TNF-α) and humoral (indicated by IgG1 and IL-4) immune responses but also a mucosal immune response (indicated by IgA), a key protector against respiratory virus infections. It also increases the HI titer, the surrogate marker of influenza vaccine efficacy. Furthermore, ssRNA adjuvant confers cross-protective immune responses against heterologous influenza virus infection while promoting enhanced viral clearance. Moreover, ssRNA adjuvant increases the number of memory CD4⁺ and CD8⁺ T cells, which can be expected to induce long-term immune responses. Therefore, this ssRNA-adjuvanted seasonal inactivated subunit influenza vaccine might be the best influenza vaccine generating robust humoral and cellular immune responses and conferring cross-protective and long-term immunity.     

胰腺导管癌中血管生成、细胞增殖指数、DNA倍性检测的临床意义

目的:探讨血管生成、细胞增殖指数、DNA倍性在胰腺导管癌发生、发展中的作用及临床意义。方法:对29例胰腺导管癌和7例慢性胰腺炎患者的石蜡包埋标本作苏木精鄄伊红(HE)染色,CD34、Ki67免疫组织化学染色,镜下计算微血管密度(MVD)及Ki67阳性细胞比例,同时用流式细胞仪(FCM)检测细胞核DNA倍性,计算异倍体出现率及S期比例,并结合临床病理资料对各项指标作相关分析。结果:胰腺导管癌和慢性胰腺炎都有较多的新生血管。MVD值在胰腺导管癌高、中、低分化3组之间差异无显著性。按肿瘤直径分为≤1.5cm、1.6～2.9cm、≥3cm3组,此3组间MVD值、Ki67阳性细胞百分率、DNA异倍体出现率及肿瘤周围有无浸润的差异都非常显著(P<0.01)。肿瘤越大,MVD值、Ki67阳性细胞百分率及DNA异倍体出现率越高。结论:胰腺导管癌的发生、发展伴血管生成和DNA合成增加,联合测定MVD、Ki67阳性细胞百分率、DNA倍型可能为胰腺导管癌临床预后预测提供辅助参考指标。     

带浅静脉干逆行皮瓣早期微血管构筑变化的体视学研究

目的 探讨带浅静脉干的逆行皮瓣早期微血管构筑变化的特点以供临床实践参考。方法 应用生物体视学技术测量带浅静脉干皮瓣微血管体积密度，结合组织学观察，与不带静脉干皮瓣作对照比较。结果 带浅静脉干皮瓣组微血管密度整体水平高于不带静脉干皮瓣组（P〈0．05）。结论 浅静脉干的存在有利于皮瓣的血管化进程，保留浅静脉干对皮瓣成活有利。     

Relationship between insulin-like growth factor I, dehydroepiandrosterone sulfate and proresorptive cytokines and bone density in cystic fibrosis

Introduction Patients with cystic fibrosis (CF) are known to be at risk for early osteoporosis, and the mechanisms that mediate bone loss are still being delineated. The aim of the present investigation was to investigate if a correlation exists in these patients between skeletal measurements by dual-energy x-ray absorptiometry (DXA) and two anabolic factors, dehydroepiandrosterone (DHEA) and insulin-like growth factor I (IGF-I), and proresorptive factors such as the cytokines interleukin-1β, tumor necrosis factor α, and interleukin-6. Methods We studied 32 outpatients (18 females; mean age: 26.2 ± 7.9 years) at a tertiary care medical center. The subjects had venous samples obtained, underwent anthropometric and bone mineral density (BMD) measurements, and completed a health survey. Serum IGF-I concentrations were below the age-adjusted mean in 78% of the participants, and DHEA sulfate (DHEAS) concentrations were low in 72%. Serum concentrations of all cytokines were on the low side of normal; nonetheless, there was a modest inverse correlation between IL-1β and BMD at all sites. Results In univariate analyses, IGF-I and DHEAS were significant correlates of BMD or bone mineral content. In final multivariate models controlling for anthropometric and other variables of relevance to bone density, only IGF-I was identified as a significant independent skeletal predictor. While alterations in DHEAS, IGF-I, and specific cytokines may contribute to skeletal deficits in patients with CF, of these factors a low IGF-I concentration appears to be most strongly correlated with BMD. Conclusions These findings may have therapeutic implications for enhancing bone density in these patients.     

Risedronate Reduces the Risk of First Vertebral Fracture in Osteoporotic Women

Risedronate treatment reduces the risk of vertebral fracture in women with existing vertebral fractures, but its efficacy in prevention of the first vertebral fracture in women with osteoporosis but without vertebral fractures has not been determined. We examined the risk of first vertebral fracture in postmenopausal women who were enrolled in four placebo-controlled clinical trials of risedronate and who had low lumbar spine bone mineral density (BMD) (mean T-score =–3.3) and no vertebral fractures at baseline. Subjects received risedronate 5 mg (n= 328) or placebo (n= 312) daily for up to 3 years; all subjects were given calcium (1000 mg daily), as well as vitamin D supplementation (up to 500 IU daily) if baseline serum 25-hydroxyvitamin D levels were low. The incidence of first vertebral fracture was 9.4% in the women treated with placebo and 2.6% in those treated with risedronate 5 mg (risk reduction of 75%, 95% confidence interval 37% to 90%; P= 0.002). The number of patients who would need to be treated to prevent one new vertebral fracture is 15. When subjects were stratified by age, similar significant reductions were observed in patients with a mean age of 64 years (risk reduction of 70%, 95% CI 8% to 90%; P= 0.030) and in those with a mean age of 76 years (risk reduction of 80%, 95% CI 7% to 96%; P= 0.024). Risedronate treatment therefore significantly reduces the risk of first vertebral fracture in postmenopausal women with osteoporosis, with a similar magnitude of effect early and late after the menopause. Received: 12 September 2001 / Accepted: 11 December 2001