老年结直肠癌的治疗

老年患者占结直肠癌患者的70%,因此老年人是结直肠癌的主要患病人群.为了提高结直肠癌治疗的总体疗效,我们应当特别关注老年性结直肠癌的治疗.以往,手术治疗和化疗的应用随着年龄的增高而明显减少.我们一直以为老年人手术和化疗的效果不令人满意.近期的研究改变了这一认识.证据表明辅助化疗和姑息性化疗对一般情况良好的老年人是有效而安全的.即使存在一些与年龄相关的基础疾病的老年结直肠癌患者仍然能从合理的治疗方案中获益.所以我们尚有许多工作需做,以提高老年性结直肠癌患者的疗效.腹腔镜下结肠癌根治术是对老年人安全有效的手术技术.我们期待随着经腔道的内窥镜手术技术的发展,将来会使老年性结直肠癌患者受益.     

肠癌肝转移综合治疗的现状和展望

结直肠癌肝转移是影响结直肠癌预后的重要因素,目前提倡综合治疗,以手术为核心,辅以化疗、靶向治疗、局部治疗(放疗、介入治疗等).随着新药的研发,新技术的应用,个体化治疗、转化治疗的开展,其预后显著改善.而生物心理社会医学模式同样使患者获益.本文对结直肠癌肝转移的综合治疗进行综述.     

老年结直肠癌的治疗

老年患者占结直肠癌患者的70%,因此老年人是结直肠癌的主要患病人群。为了提高结直肠癌治疗的总体疗效,我们应当特别关注老年性结直肠癌的治疗。以往,手术治疗和化疗的应用随着年龄的增高而明显减少。我们一直以为老年人手术和化疗的效果不令人满意。近期的研究改变了这一认识。证据表明辅助化疗和姑息性化疗对一般情况良好的老年人是有效而安全的。即使存在一些与年龄相关的基础疾病的老年结直肠癌患者仍然能从合理的治疗方案中获益。所以我们尚有许多工作需做,以提高老年性结直肠癌患者的疗效。腹腔镜下结肠癌根治术是对老年人安全有效的手术技术。我们期待随着经腔道的内窥镜手术技术的发展,将来会使老年性结直肠癌患者受益。     

代谢组学在结直肠癌中的研究进展

结直肠癌是常见的恶性肿瘤,近年来其发病率和病死率都很高,因此做到早发现、早诊断、早治疗很有必要,肿瘤标志物在结直肠癌的诊治中发挥了重要作用,但癌胚抗原等传统肿瘤标志物远远不能满足临床需要,代谢组学的出现解决了这一难题.代谢组学是近年来新发展起来的一门组学技术,随着各种代谢组学分析技术的发展和联用,使其在结直肠癌中有着越来越深入的研究,可用此技术在结直肠癌患者的组织、血液和尿液中寻找差异性代谢产物作为新的肿瘤标志物,在结直肠癌的诊断和治疗上有很大优势.本文将对代谢组学的概况及其在结直肠癌中的研究进展做一综述.     

接受不同术式的直肠癌患者的心理评估比较

对在吉林大学第一医院接受186例直肠癌手术患者进行术前及术后的心理评估.术前第一天和术后第七天分别用汉密顿抑郁量表(HRSD)对病人进行心理评估,接受腹会阴联合根治术(Miles手术)的患者术前有明显抑郁情绪,而术后无缓解,接受经腹直肠癌根治术(Dixon手术)的患者术前有一定抑郁情绪,术后明显缓解.单纯结肠造口患者术前抑郁情绪较重,术后加重.     

启动子区甲基化导致ZNF331在结直肠癌中表达缺失

通过分析锌指蛋白331 (ZNF331)在结直肠癌中的甲基化及表达情况,探讨ZNF331基因的甲基化与结直肠癌的关系,为结直肠癌的早期诊断和治疗提供新的靶点.采用甲基化特异性PCR(MSP)检测7株结直肠癌细胞系和66例结直肠癌组织标本中ZNF331基因启动子区的甲基化情况.结果7株结直肠癌细胞系中LOVO、RKO、DLD1和HCT116启动子区完全甲基化,SW620和HT29呈部分甲基化,SW480为非甲基化.LOVO、RKO、DLD1、HCT116细胞系中ZNF331mRNA不表达,经5-Aza处理后恢复表达.在SW480、SW620、HT29细胞系中,5-Aza处理前后均表达,处理后表达量增加.在66例结直肠癌组织中,ZNF331启动子区甲基化率为72.7％(48/66),而正常结直肠组织中无甲基化(0/7).     

结直肠癌多学科专家组诊疗模式

结直肠癌多学科专家组诊疗模式(colorectal cancer multidisciplinary team,CRC-MDT),最早始于英国,它以病人为中心,多个学科共同参与诊治过程,制定出最适合病情的多模式相结合的科学合理的诊疗方案.此后,结直肠癌多学科专家组诊疗模式逐渐在德国、法国、意大利、美国等医疗中心相对集中的国家得到推广和完善.北京大学人民医院胃肠外科于2D02年成立了包括内科、外科,病理科、影像科等8个学科专家组成的胃肠MDT.越来越多的临床实践证实,结直肠癌多学科专家组的诊疗方案,更具有科学性和合理性,明显改善结直肠癌病人预后,增加了患者的临床获益.目前,结直肠癌多学科专家组诊疗模式在世界范围内已经成为现代医院医疗体系的重要组成部分.结直肠癌MDT模式不只是对患者进行多学科会诊,而是对整个医疗过程全程指导,促进学科间的交流,增进学科间了解.在欧美CRC-MDT发展完善的地区,人们的目光不仅关注MDT在结直肠癌诊治中的应用,而且注意到了MDT作为一套宏观的医疗管理模式,在结直肠癌诊治流程运作中的社会效益、经济学价值的推动作用.     

老年早期结直肠癌患者内镜下黏膜剥离术安全性、疗效及术后整体生活质量调查

针对内镜下黏膜剥离术(ESD)对老年患者早期结直肠癌治疗的安全性、疗效及术后整体生活质量加以评价。68例病例组(老年组)和同时期52例对照组(非老年组)纳入研究。结果显示两组患者在性别比例、体质量指数、病变部位、内镜分型、病理类型、病变大小、手术操作时间、住院天数、完整切除和整块切除率上差异均无统计学意义(P0.05)。两组患者在"术中出血"、"迟发性术后出血"、"穿孔"这三项并发症上差异无统计学意义(P0.05)。在生活质量指数量表(QL-Index)评分上,两组差异无统计学意义。在欧洲肿瘤研究和治疗联盟关于癌症患者生活质量调查评分30(QLQ-C30)评分上,除去"失眠"项目老年组患者得分显著高于非老年组患者(P=0.028),其他各项目上两组得分差异无统计学意义。因此,老年早期结直肠癌患者ESD手术治疗是相对安全和有效的。     

腹腔镜与开腹手术治疗直肠癌术后早期肠梗阻的疗效分析

对比分析腹腔镜与开腹手术治疗直肠癌术后早期肠梗阻的疗效。选择我科收治的直肠癌根治术患者120例,随机分为腹腔镜手术组60例和开腹手术组60例,观察对比两组患者围手术期因素及术后早期并发症情况。腹腔镜手术组术中出血量、术后腹部胀痛时间、术后排气时间、术后进食时间及术后早期肠梗阻发生率明显低于开腹手术组,但其手术时间明显长于开腹手术组(P0.05)。腹腔镜手术是直肠癌术后早期肠梗阻的独立保护因素(P0.05)。直肠癌术后早期肠梗阻的发生与术式的选择有着密切的关系;与开腹手术相比,腹腔镜手术治疗直肠癌术后肠梗阻发生率减少。     

结直肠癌相关肿瘤标志物的最新研究进展

结直肠癌是最常见的恶性肿瘤之一.其起病隐匿、病死率较高,治疗成功的关键在于早期发现、早期诊断,结直肠癌相关肿瘤标志物曾为此做出了贡献.近年又发现了许多新的结直肠癌相关肿瘤标志物,其中有的已进入临床应用,还将有更多标志物为结直肠癌的早期诊断、疗效观察、预后判断和复发监测提供新思路和新方法.     

Colon cancer information as a source of exercise motivation for relatives of patients with colon cancer

Using a Protection Motivation Theory (PMT) framework, this study examined whether factual colon cancer information is a meaningful source of exercise motivation for relatives of patients with colon cancer. One hundred sixty-six inactive relatives were randomly assigned to one of two treatment conditions: PMT group (intervention); and non-PMT group (attention control). At baseline (T1) participants completed demographic information, a questionnaire designed to assess their beliefs toward exercise and colon cancer as well as their exercise intentions. At T2 (one week following T1) participants watched one of two DVD videos that were created for the study. The intervention DVD contained exercise and colon cancer information that was yoked within the four major components of PMT: perceived vulnerability (PV); perceived severity (PS); response efficacy (RE); and self-efficacy (SE), while the attention control DVD contained general diet and cancer information. Immediately following watching the DVD, participants completed the same measures as in T1. Participants assigned to the PMT intervention group showed significant improvement in PV, RE, SE and exercise intentions, whereas participants assigned to the attention control group showed significant improvement only in RE. RE, SE, and PS made significant and unique contributions to prediction of exercise intention. Overall, the results of the present study demonstrate that a single exposure media intervention grounded in a PMT framework can change individuals' exercise and colon cancer beliefs, as well as change their exercise intentions. Implications of these findings and direction for future research are discussed.     

A pilot evaluation of the efficacy of a couple-tailored print intervention on colorectal cancer screening practices among non-adherent couples

The objective of this study was to evaluate the efficacy of a couple-tailored print (CTP) intervention on colorectal cancer screening (CRCS), CRCS intentions, and on knowledge and attitudes among couples in which neither partner is on schedule with regard to CRCS. A total of 168 married couples with both members non-adherent with CRCS were randomly assigned to receive either a CTP pamphlet accompanied by a generic print (GP) pamphlet or a GP pamphlet only. Couples completed measures of CRCS, intentions, relational perspective on CRCS, discussions about CRCS, spouse support for CRCS, spouse influence strategies, CRC knowledge, perceived CRC risk, and CRCS benefits and barriers. Results indicated there was no significant benefit of CTP vs. GP on CRCS, but there was a significant increase in CRCS intentions in CTP compared with GP. There was also a significant increase in relationship perspective on CRCS, a significant increase in husbands’ support of their wives’ CRCS, and a significant increase in CRCS benefits in CTP. In summary, CTP did not increase CRCS practices but increased intentions and perceived benefits of CRCS as well as improving couples’ ability to view CRCS as having benefit for the marital relationship.     

大肠癌的早期诊断与治疗研究进展

大肠癌的早期诊断与治疗是临床研究的热点。本文主要从大肠癌人群筛查、粪便检查、基因诊断以及内镜诊断,从早期大肠癌内镜下黏膜切除术和内镜下黏膜剥离术的研究进展进行述评。     

The Influence of Gender Identities on Body Image and Breast Health among Sexual Minority Women in Taiwan: Implications for Healthcare Practices

The present paper presents constructions of gender roles among Taiwanese sexual minority women with different gender identities (i.e., butch and femme, known as T and Po, respectively, in Taiwan) and associations between their views toward their own breasts and breast healthcare intentions and behaviour. A total of 37 face-to-face interviews were conducted among women aged 20 years or older who self-identified as lesbians or women who partnered with other women in four areas of Taiwan between August 2012 and October 2012. The majority of the T –identity lesbians held negative views toward their own breasts. The T-identified lesbians’ negative intentions toward breast cancer screenings were associated with their negative views toward their own breasts and body construction process. All Po-identified lesbians reported positive views toward their own breasts; these views facilitated positive breast healthcare intentions and behaviour. The study findings can be used to help healthcare providers in understanding the importance of providing competent cultural care to sexual minority women and to help policymakers in formulating suitable policy to meet women’s healthcare needs.     

Breast Cancer Genetics Knowledge and Testing Intentions among Nigerian Professional Women

Genetic testing services for breast cancer are well established in developed countries compared to African populations that bear a disproportionate burden of breast cancer (BC). The objective of this study is to examine the knowledge of professional Nigerian women about BC genetics and their intentions to utilize genetic testing services when it is made available in Nigeria. In this study, 165 lecturers and 189 bankers were recruited and studied using a validated self-administered questionnaire. The respondents’ mean age was 34.9 years (SD?=?10.9), 6.5% had family history of BC, and 84.7% had limited knowledge of breast cancer genetics. The proportion of women with genetic testing intentions for breast cancer was 87.3%. Health care access (OR?=?2.35, 95% CI, 1.07–5.13), religion (OR?=?3.51, 95% CI, 1.03–11.92), and perceived personal risk if a close relative had breast cancer (OR?=?2.31, 95% CI, 1.05–5.08) independently predicted testing intentions. The genetic testing intentions for BC were high despite limited knowledge about breast cancer genetics. Promotion of BC genetics education as well as efforts to make BC genetic testing services available in Nigeria at reduced cost remains essential.     

Patients' intentions in primary care: Measurement and preliminary investigation

Abstract

A questionnaire to assess patients' intentions in primary care was completed by 206 patients. Patients also rated the amount of help with their presenting problem which they thought could be provided by each of 11 secondary services. A principal components analysis of the intentions revealed 4 components: “Explanation and understanding,” “Support,” “Medical treatment” and “Information-seeking.” Individual patients' intentions were quantified on each of these dimensions. Requests for “Explanation and understanding” did not correlate with expectation of help from any of the 11 sources. In contrast, each of the remaining 3 types of request correlated with expectation of help from a number of sources. These results show, first, a way of measuring patients' intentions on multiple independent dimensions. Secondly, they indicate that patients look solely to the general practitioner for general information and reassurance about their problems. For emotional support they look to additional, mainly psychiatric, sources. This calls into question the view that general practitioners are seen by patients as more appropriate providers of emotional support than specialist services.     

Cancer and the threat of death: the cognitive dynamics of death-thought suppression and its impact on behavioral health intentions

Five studies examined the cognitive association between thoughts of cancer and thoughts of death and their implication for screening intentions. Study 1 found that explicit contemplation of cancer did not increase death-thought accessibility. In support of the hypothesis that this reflects suppression of death-related thoughts, Study 2 found that individuals who thought about cancer exhibited elevated death-thought accessibility under high cognitive load, and Study 3 demonstrated that subliminal primes of the word cancer led to increased death-thought accessibility. Study 4 revealed lower levels of death-thought accessibility when perceived vulnerability to cancer was high, once again suggesting suppression of death-related thoughts in response to conscious threats associated with cancer. Study 5 extended the analysis by finding that after cancer salience, high cognitive load, which presumably disrupts suppression of the association between cancer and death, decreased cancer-related self-exam intentions. Theoretical and practical implications for understanding terror management, priming and suppression, and responses to cancer are discussed.     

肿瘤患者的认知纠治及“圆桌诊疗”的启示

分析肿瘤患者认知过程中常见的不良认知,认为改变不良认知是治疗肿瘤的第一步。在认知纠治中,通过“圆桌诊疗”模式可巧妙地树立肿瘤患者的正确认识;有助于分析其错误的思维类型;并通过树立榜样的“示范”、成立自救组织与“集体疗法”以及提供沟通倾述的平台和管道,进而实现对肿瘤患者不良的认知纠治。“圆桌诊疗”的模式和方法正是在潜移默化中,通过融合了集体治疗、心理疏导、示范疗法、情境疗法、交友疗法等而起到了纠正不良认知的作用。     

Children's Attitudes towards Peers with Disabilities: Associations with Personal and Parental Factors

The purpose of this study was to investigate the following: (i) associations among children's prior contact with people with disabilities and the three dimensions of children's attitudes towards people with disabilities: children's understanding of and their feelings about people with disabilities and their behavioural intentions to make inclusion decisions; (ii) the relation between children's behavioural intentions to make inclusion decisions and the demands of activity contexts and the types of disabilities; and (iii) the association between parents' attitudes and children's attitudes. Participants included 94 typically developing four‐ and five‐year‐old preschoolers. Children's understanding of disabilities and their prior contact with people with disabilities were found to be positively related to their feelings about people with disabilities; children's understanding of disabilities was a significant moderator of the relation between their behavioural intentions and activity contexts or types of disabilities. The hypothesized association between parents' attitudes and children's attitudes was not significant. Preschoolers may benefit from having more regular contact with people with disabilities to develop positive feelings towards their peers with disabilities, which is also related to their understanding of disabilities. Children's behavioural intentions to make inclusion decisions need to be understood in relation to their understanding of disabilities, the demand of activity contexts, and types of disabilities. Copyright © 2013 John Wiley & Sons, Ltd.     

Children's understanding of drivers' intentions

To become more skilled as pedestrians, children need to acquire a view of the traffic environment as one in which road users are active agents with different intentions and objectives. This paper describes a simulation study designed to explore children's understanding of drivers' intentions. It also investigated the effect of training children's sensitivity, through peer discussion and adult guidance, to the cues by which drivers signal their intentions. Results confirmed that children's ability to accurately predict drivers' intentions improves with age and that sensitizing children through training to the options for action available to drivers when signalling a manoeuvre improves their accuracy in predicting drivers' intentions. Training was also found to shift children's focus from contextual infrastructural features of the traffic environment (e.g. traffic signals, stop signs) by which to judge drivers' likely intentions to the explicit cues that drivers use to signal their imminent actions (e.g. slowing down, moving into the kerb). Training on the simulation was also shown to transfer to practical decision making at the roadside.