修复基因XRCC4启动子-1394多态性与胃癌关联性的研究

XRCC4基因是一个非常重要的DNA损伤修复基因,在维持基因组的完整性与稳定性方面起着重要的作用,有效预防肿瘤的发生。本研究选取了210例胃癌患者及254例性别、年龄相匹配的正常对照者进行研究,采用限制性片段长度多态性方法,明确胃癌患者及正常对照者基因型。XRCC4基因启动子-1394多态性两组间有显著差异。XRCC4基因启动子-1394多态性的G等位基因频率,胃癌组明显高于正常对照组（OR=2．35,95％CI=1．24～4．46,P=0．007）;基因型频率胃癌组与正常对照组有显著差异（P=0．008）：携带基因型TG的个体比TT的个体罹患胃癌的风险提高了2．46倍（95％CI=1．27—4．76）。总之,XRCC4基因启动子-1394位点的G等位基因在胃癌的发生过程中起着至关重要的作用。     

论中医的辨证论治与肿瘤的分子靶向治疗

辨证论治是中医认识和治疗疾病的基本原则,“同病异治”和“异病同治”是辨证论治的精神实质。恶性肿瘤的分子靶向治疗在很多方面都贯彻了“辨证论治”观念,将所辨的证候落实到受体、基因和各种调控系统上。尽管两者理论基础完全不同,但都强调以患者为中心的综合治疗和个体化治疗理念,对建立正确的临床思维非常重要。     

急诊医生和人文关怀

急诊科倡导人文关怀是非常必要的,当代医学模式已从生物医学转变为生物-心理-社会模式,从而更重视对人的关怀,急诊医生每天面对的是急危重症,不仅要有精湛的医术、临危不乱的心态,同时在治疗抢救过程中还要有一颗仁爱之心,生命至上的信念,应当突出“人本思想”,体现“人文关怀”,尊重生命,关爱健康,减轻痛苦,尊重患者的权利和隐私,体现人道主义精神。急诊医生只有富于人文修养,方能建立良好的医患关系,有利于减少医疗纠纷,提升医院的竞争力。     

进展期非小细胞肺癌维持治疗进展

化疗在进展期非小细胞肺癌的地位已经确立,现有的方案已经达到“化疗疗效平台”。延长化疗无潜在益处,有什么办法可以保持现有的疗效。为此,提出了维持治疗的概念,维持治疗是指患者在完成标准的几个周期化疗且疾病得到控制后再接受的化疗,架起一二线治疗间的桥梁。带来进一步的临床获益。     

局限期小细胞肺癌放疗中预防野照射和累及野照射的疗效分析

局限期小细胞肺癌综合治疗中采用三维适型或调强放疗技术,按不同照射范围分为累及野照射和预防野照射2个组进行比较,分析不同照射野对预后的影响。 67例局限期小细胞肺癌患者,随机分为累及野照射组37例和预防野照射组30例。累及野照射组照射范围包括化疗前CT所见肿瘤及转移淋巴结范围,预防野照射组照射范围包括原发灶、同侧肺门、纵隔及锁骨上淋巴引流区。两组均采用三维适形或调强技术,放疗剂量为DT50Gy～66Gy/5周～6周。结果全组总有效率为82.1%,局部复发率为29.9%,远处转移率为56.7%,1年、2年、3年生存率分别为68.7%、36.2%和20.1%,分组比较以上指标均无显著性差异（P＞0.05）。而两组病例急性放射性肺炎和食道炎发生率分别为5.4%、16.7%和2.7%、20.0%,累及野照射食管炎发生率显著低于预防野（P＜0.05）。     

临床工作中应重视“安慰剂”效应

目前我国临床工作中对“安慰剂”效应重视不够。“安慰剂”效应建立在患者对医生的信任之上。生物医学模式重视疾病的生物学意义而忽视社会、心理因素的影响,导致医生对患者态度冷漠,患者对医生缺乏信任,已成为我国医患关系恶化的重要原因,继而弱化了医疗的“安慰剂”效应。推行生物-心理-社会医学模式,提倡临床工作以人为本而非以疾病为主,建立医患共赢的医疗体制,改善医疗环境,有利于产生和加强临床工作的“安慰剂”效应,切实促进医疗和谐。     

门诊老年患者医疗服务中存在的问题及其改进

文章从门诊老年患者就医需求的角度对医疗服务进行思考,认为医护人员在服务理念、有效沟通以及主动服务等方面存在的问题亟需改进。提出医护人员应当确立以老年患者需求为中心的门诊医疗服务理念,做到主动关心、及时询问、有效沟通、合理安排,从而提高老年患者就诊的满意度。     

Development of an Interactive Decision Aid for Female BRCA1/BRCA2 Carriers

Shared decision making between patients and providers is becoming increasingly common, particularly when there is no clear preferred course of action. As a result, decision aids are being adopted with growing frequency and have been applied to many medical decision-making issues. One such issue where there is uncertainty is breast cancer risk management among BRCA1/BRCA2 carriers. We present the development of a CD-ROM decision aid to facilitate risk management decision making in this population. Our decision aid was developed with the intention of providing it through a randomized clinical trial. The CD-ROM is a multimedia, interactive intervention which provides information about breast cancer, risks associated with BRCA1 and BRCA2 mutations, risk management options for hereditary breast cancer, and a breast cancer risk management decision aid. The goal of this CD-ROM, offered as an adjunctive intervention, is to reduce decisional conflict and psychological distress and improve comprehension of risk information, decisional satisfaction, medical adherence, and quality of life for this population of women at increased risk for breast cancer.     

Subjective and Objective Risks of Carrying a BRCA1/2 Mutation in Individuals of Ashkenazi Jewish Descent

This repeated measures study examines (1) the change in subjective risk of mutations pre- to postcounseling, (2) the accuracy of BRCAPRO estimates of mutations, and (3) the discrepancy between subjective risk and BRCAPRO estimates of mutations before and after genetic counseling. Ninety-nine Ashkenazi Jewish individuals pursued testing for BRCA1/2 mutations. Most had a personal cancer history (N = 51; family only: N = 48); and received uninformative negative results (N = 66; positives: N = 23; informative negative: N = 10). The coping strategy of defensive pessimism predicts that individuals will believe the worst case scenario to better cope with a potential negative outcome. Consistent with this, most felt they would have a mutation, if not mutations in both genes. The BRCAPRO model appeared to overestimate risk of having a mutation in this sample (p < .001). BRCAPRO overestimates notwithstanding, genetic counseling increased accuracy of subjective risk (p < .01). Individuals with a family-only cancer history had the least accurate estimates of risk (p < .05) and may need further intervention to either manage anxiety or improve knowledge.