早期前列腺癌治疗的临床决策

早期前列腺癌治疗方法多种多样,临床医生根据患者不同的病理分期、分级及身体条件,做出符合患者个体的临床治疗决策,以期在目前条件下达到最佳治疗效果,降低医疗费用及提高生活质量.     

临床决策与疾病发展的"度"

临床决策是十分复杂的专业劳动,良好而科学的临床决策取决于众多因素,包括医师的临床经验、知识水平、医师的爱心与责任心、患者病情的复杂性、医疗水平与条件、患者及家属的条件与配合程度等等,辩证法的"度"在临床的良好应用会帮助医师准确地把握病情,给予更加适度治疗;真正的个体化临床决策必须由医师与患者及家属的密切配合才能实现.     

临床决策与疾病发展的“度”

临床决策是十分复杂的专业劳动,良好而科学的临床决策取决于众多因素,包括医师的临床经验、知识水平、医师的爱心与责任心、患者病情的复杂性、医疗水平与条件、患者及家属的条件与配合程度等等,辩证法的“度”在临床的良好应用会帮助医师准确地把握病情,给予更加适度治疗;真正的个体化临床决策必须由医师与患者及家属的密切配合才能实现。     

终末期肾病患者替代治疗方法的临床决策

血液透析、腹膜透析和肾移植是终末期肾病患者替代治疗的主要方法,三种治疗方法各有优缺点.临床上应根据患者原发病因、替代治疗并发症、卫生经济学、生存质量、所在地医疗条件、非医疗因素等作出科学临床决策,最大限度延长患者生命,提高生存质量.     

终末期肾病患者替代治疗方法的临床决策

血液透析、腹膜透析和肾移植是终末期肾病患者替代治疗的主要方法,三种治疗方法各有优缺点。临床上应根据患者原发病因、替代治疗并发症、卫生经济学、生存质量、所在地医疗条件、非医疗因素等作出科学临床决策,最大限度延长患者生命,提高生存质量。     

原发性三叉神经痛两种治疗方法的比较

原发性三叉神经痛的治疗方法以神经毁损术最为常用。通过对经皮射频热凝毁损术和阿霉素化学毁损术的疗效、安全性、复发率、并发症及费用等方面的比较,揭示两种方法的利弊。用比较治疗学的理念及方法来指导三叉神经痛治疗的临床决策,以期能在目前条件下提高患者的治疗效果、降低医疗费用及提高生活质量。     

影响百草枯中毒患者预后的因素分析

百草枯广泛用于农业生产,在中国仍然是中毒患者死亡的主要原因.由于目前无特效治疗方法,而且中毒后早期判断预后困难,因此死亡率较高.虽然血或尿中的百草枯浓度能够初步判断患者的病情,但由于条件所限,并非每个医院均能开展,而且在后期治疗中血或尿中的百草枯浓度不能用于评估患者病情.如果能够在救治百草枯中毒的不同阶段探索出评估病情的不同因素,则能利用这些因素评估百草枯中毒患者的病情轻重及病情变化趋势,进而指导临床治疗,本文就目前关于百草枯中毒预后研究现状做简要综述,以期对临床有所指导.     

人文关怀在消除IVF—ET患者心理压力中的作用

近年我国不少生殖医学中心在如何提高体外受精一胚胎移植（IVF—ET）治疗成功率问题上,都将注意力集中在临床用药的研究、控制性超促排卵方案的改进以及实验室条件的改善上,大多忽视IVF—ET患者心理方面的治疗。有研究表明：IVF—ET治疗的成功,不仅与患者自身的病理及生理状况有关,更与患者在治疗过程中产生的心理压力有关。因此,建议医护人员在给不孕症患者实施IVF-ET助孕治疗的全过程中,应给予患者更多人文关怀,这样不仅能够减少IVF—ET患者心理健康问题的发生,而且可以改善患者的身心状态和应对治疗能力,从而提高IVF—ET治疗成功率。     

临终患者不同救治态度的转归及影响因素分析

分析ICU终末期患者不同救治方式的临床转归及其影响因素。根据患者家属救治态度分为三组,1组明确要求积极救治;2组要求维持现有治疗;3组放弃所有治疗。结果发现积极还是放弃治疗的选择与患者家属经济状况明显相关,家庭经济条件较好的患者家属倾向于选择积极治疗,经济差者倾向于选择放弃治疗。1组患者ICU住院时间长、日均费用最高,...     

脊柱转移瘤个体化综合治疗中的临床决策

脊柱转移是恶性肿瘤最重要的并发症,其个体化综合治疗应遵循循证医学原则,根据患者机体状况、肿瘤病理类型、临床分期和发展趋势等,优化多学科综合治疗手段,努力做到临床决策的科学性,以期最大幅度地提高患者临床疗效及改善患者生活质量。     

The Impact of Social Roles on the Experience of Men in BRCA1/2 Families: Implications for Counseling

Recent advances in genetics have identified several genes associated with inherited susceptibility to breast and ovarian cancer and have led to the commercial availability of mutation analyses. Although the majority of cancers associated with BRCA1/2 mutations are seen in women, men with BRCA1/2 mutations are at increased risk for male breast cancer, prostate cancer, pancreatic cancer and melanoma. Limited data available on the response of men in BRCA1/2 families suggest that the majority do not pursue genetic counseling, thus they may forgo the opportunity to improve health practices and to pass on valuable cancer risk information to offspring. The patterns of relationships of men within the family and society can pose challenges to their recognition of genetic health threats and the need for preventive interventions. Genetic counselors are in a position to inform at-risk males of their genetic risk, and to help them explore their personal health options.     

应用PSA筛查前列腺癌的争论焦点

前列腺癌是最常见的导致欧美国家男性死亡的疾病之一,我国男性前列腺癌发病率呈明显上升趋势。血PSA检测作为筛查前列腺癌的手段被广泛应用于临床。然而PSA筛查的价值还是成为当今泌尿和肿瘤学界争论最多的问题之一。本文着重介绍了男性接受PSA筛查前列腺癌的重要性以及前列腺癌筛查的潜在危害。     

Aspirin Use is Associated with Lower Prostate Cancer Risk in Male Carriers of BRCA Mutations

Previous studies have shown that male BRCA mutation carriers stand at increased risk of developing prostate cancer and have concerns about developing cancer. Genetic counseling practitioners often discuss strategies for reducing the risk of cancer for patients at high risk due to their genetic background. Addressing modifiable health habits is one such strategy. Unfortunately, modifiable risk factors for prostate cancer have only been documented in the general population and have not yet been studied in the BRCA carrier subpopulation. Therefore, this study aimed to identify modifiable risk factors for prostate cancer in BRCA carriers. We examined prostate cancer risk factors in 74 men who were part of families with a BRCA mutation. This study examined nine dichotomous variables including: exercise, history of vasectomy, smoking history, alcohol use, finasteride use, statin use, aspirin use, coffee use, and vitamin use. The survey was sent to all cases of prostate cancer in the Hereditary Cancer Center Database at Creighton University with a known BRCA status. This study confirmed the protective benefits of daily aspirin use, which have been observed in previous studies of the general population, and suggests its benefit in BRCA carriers. Protective benefits from regular vigorous exercise and daily coffee use trended towards significance, but neither factor withstood the Bonferroni Correction for multiple comparisons.     

Prostate cancer prevention: do the 5-ARIs make the grade?

Although imperfect, PSA testing is here to stay. Men who undergo PSA testing should do so with an understanding of the potential benefits (decreased prostate cancer mortality) and known risks (increased likelihood of being diagnosed with prostate cancer) of screening. The diagnosis of prostate cancer often leads to radical therapy in men who would never have known they had the disease if not for early detection. Although it is possible that 5-ARIs may occasionally cause a high-grade prostate cancer, the magnitude of this potential harm is likely to be tempered by earlier detection. Also balancing this potential harm is the well-established fact that the 5-ARIs decrease the likelihood that a man who desires PSA testing will become a prostate cancer patient. These are admittedly difficult risk–risk calculations. However, to suggest that only “unambiguously safe” drugs should be approved for cancer risk reduction sets a standard that can only be met by homeopathic nostrums. That is not the standard to which we should aspire.     

非那雄胺与前列腺癌发病率及病理分级的Meta分析

应用Meta分析法对有关非那雄胺与前列腺癌发病率及病理分级关系的研究进行综合评价。符合标准的8篇文献进行Meta分析,计算比值比（OR）、95％可信区间（95％C1）。结果8篇文献,无异质性（Q=6．26,P=0．51）,非那雄胺治疗组降低前列腺癌发病风险高于对照组,合并OR值为0．68（95％CI：0．65～O．71...     

Prevalence of the HOXB13 G84E Mutation Among Unaffected Men with a Family History of Prostate Cancer

HOXB13 (G84E) was reported to significantly increase risk for prostate cancer. The goal of the current analysis was to assess the prevalence of G84E in ethnically-diverse high-risk men undergoing prostate cancer screening and place the carrier frequency within the context of prevalence estimates from reported studies to gain insight into the future role of this mutation in genetic counseling. PRAP is a prostate cancer screening program for unaffected men ages 35–69 with a family history of prostate cancer or African descent. HOXB13 G84E was genotyped by pyrosequencing in 649 PRAP participants with available DNA. Prevalence of the mutation was calculated for PRAP and for reported studies and exact binomial confidence intervals were generated. Prevalence of the G84E mutation in non-African PRAP men was 0.73 %. When placed in context of the literature, this was higher than reported controls. One G84E mutation carrier was notably of Hispanic background. While the HOXB13 G84E mutation may be rare, there may be a future role in genetic testing for this mutation after further studies of clinical utility in assessing prostate cancer risk.     

Sexuality, society, and senior citizens: An analysis of sex talk among prostate cancer support group members

After attending meetings of a prostate cancer support group for three years, I considered the ways group members talked about sex and sexuality. I reviewed extant research on the disease and its effects on sexual function, along with relevant work on sexuality in general. In my role as a participant-observer at the group meetings, I noted the amount and prevalence of talk about sex in the survivors’ conversations about prostate cancer. I investigated the survivors’ efforts to contest and revise the definition of sex that they inferred from society at large—a definition that limits “real” sexual activity to spontaneous acts of penile-vaginal penetration. Such a definition also denounced anything else as phony at worst, and incomplete at best. Consequently, the meetings illustrated the dissonance between group members’ prior expectations, beliefs, and experiences of sexuality and a new set of behaviors that could constitute sexuality. My observations also revealed the significance of support group facilitators in generating talk about sexuality. I thank Professors Christy M. Ponticelli and Marsha L. Vanderford for the constructive critiques and encouragement that facilitated the evolution of this article.     

非雄激素依赖型前列腺癌与肿瘤干细胞——浅析辩证思维之于临床医学的方法论作用

在前列腺癌的治疗中,由于癌细胞的不断“升级”使得治疗屡屡受挫。近来提出的肿瘤干细胞理论认为:肿瘤是一种干细胞疾病,只有消灭了“种子”,才能克服癌症。从自然辩证法的角度,结合肿瘤干细胞理论对前列腺癌的诊疗加以分析,解释非雄激素依赖型前列腺癌的发病机制,以一种新的思维指导临床治疗。     

Some probabilistic models of best, worst, and best-worst choices

Over the past decade or so, a choice design in which a person is asked to select both the best and the worst option in an available set of options has been gaining favor over more traditional designs, such as where the person is asked, for instance, to: select the best option; select the worst option; rank the options; or rate the options. In this paper, we develop theoretical results for three overlapping classes of probabilistic models for best, worst, and best-worst choices, with the models in each class proposing specific ways in which such choices might be related. The models in these three classes are called random ranking and random utility, joint and sequential, and ratio scale. We include some models that belong to more than one class, with the best known being the maximum-difference (maxdiff) model, summarize estimation issues related to the models, and formulate a number of open theoretical problems.     

Perceived stigma,self-blame,and adjustment among lung,breast and prostate cancer patients

People who suffer from disease have often been stigmatised. The internalisation of stigma leads to the experience of self-blame. The relationship among stigma, self-blame and adjustment was framed with two theoretical perspectives: the looking-glass self and learned helplessness models. These models were studied in 96 lung, 30 breast and 46 prostate cancer patients. Consistent with the looking-glass-self model, we predicted that perceived stigma and self-blame would be associated with poorer psychological adjustment; the data supported these hypotheses. Consistent with the learned helplessness model, we predicted that self-blame would mediate the link between perceived stigma and psychological adjustment; data supported these hypotheses. The mediation model explained a greater percentage of the variance in adjustment in the lung cancer sample compared to the breast and prostate cancer sample. Participants who reported internal causal attributions reported poorer psychological adjustment. Lung cancer patients were more likely than breast or prostate cancer patients to report internal causal attributions for their cancer. Future research and cancer care are discussed in light of these findings.