晚期非小细胞肺癌TKIs治疗：关注与思考

以表皮生长因子受体（EGFR）为靶点的酪氨酸激酶抑制剂（TKIs）对晚期非小细胞肺癌EGFR突变患者的治疗效果令人瞩目。本文分析总结近年国内外相关研究,指出低剂量TKIs的应用虽有待进一步证实,但优于标准剂量组,并从安全性、改善肿瘤血管结构和功能、与细胞毒化疗的关系三方面探讨大剂量TKIs的应用效果。进一步分析指出大剂量联合小剂量TKIs能够最大程度地防止或延迟耐药的发生,进而控制疾病的进展。从而,为晚期非小细胞肺癌EGFR突变患者的TKIs治疗选择提供参考。     

达标心率对缺血型心肌病和扩张型心肌病患者的影响

为观察达标心率对缺血型心肌病（ICM）和扩张型心肌病（DCM）患者预后的影响,所有入选ICM和DCM患者均给予常规抗心力衰竭药物及β受体阻滞剂（β-b）治疗,使心率维持于55次/分~60次/分,观察随访1年时的病死率、再入院率、舒张末期左室内径（LVEDd）、左室射血分数（LVEF）、氨基末端脑利钠肽前体（NT-proBNP）水平来评估二者的预后。结果显示,随访结束时ICM患者较DCM患者再入院率低（P=0.037）,LVEDd低（P=0.034）,LVEF高（P=0.028）,收缩压高（P=0.029）;对于ICM患者,随访结束时较出院时LVEDd低（P=0.047）,LVEF高（P=0.018）,收缩压高（P=0.042）。因此,心率达标对ICM患者有助于改善预后,对DCM患者改善不明显,ICM患者心率达标时获益更大。     

Sense and Sensibility Educated: A Note on Experience and (Minimal) Empiricism

Abstract

McDowell’s minimal empiricism holds that experience, understood as providing conceptually articulated contents, plays a role in the justification of our beliefs. We question this idea by contrasting the role of perceptual experience in moral and non-moral judgments and conclude that experience per se is irrelevant in the former case and should also be so in the latter one: only with the help of adequate beliefs experience can provide a connection with the world. We conclude with some remarks concerning the importance of experience.     

健康焦虑的研究现状

健康焦虑是一种由轻到重的连续性的症状谱,它的极端形式被称之为疑病症.关于健康焦虑的流行病学数据很少,发病的机制和原因也不清楚,但大多数的研究证实健康焦虑与焦虑障碍有相同的认知过程.疑病症的临床表现为疾病观念、躯体症状、歪曲信念和行为,健康焦虑只是在程度上轻于疑病症,并没有发生质的改变.在健康焦虑的治疗中最受关注的应属正念认知疗法,它在很多方面都优于传统的认知行为疗法,当然其他治疗方法也能起到一定的辅助作用.健康焦虑带来的危害是巨大的,因此社会将面临重大挑战.     

患者报告结局（PRO）在临床疗效评价体系中的应用与思考

现代医疗模式的转变,使得患者对疾病的直接感受,对疗效的评价,成为临床决策和药物安全性评价的重要指标。而PRO量表的问世,使患者有机会真正参与到医疗过程中来,也为临床疗效评价及药物管理提供了珍贵资料。本文将通过什么是PRO、PRO的价值以及PRO的发展近况来对PRO做一个初步的介绍,以便为后来的研究者提供可能的帮助。     

宫颈癌病毒病因学说的确立及其发展

德国病毒学家Harald zur Hausen博士创立的宫颈癌人乳头瘤病毒（HPV）病因学说荣获2008年度诺贝尔生理学/医学奖。笔者从辩证唯物主义认识论角度,回顾了该学说的确立及其发展。宫颈癌将有望成为人类通过疫苗接种、筛查和早诊早治等综合措施来预防乃至消除的第一个恶性肿瘤。     

吸烟对椎基底动脉供血不足患者血液流变学的影响

吸烟可引起椎基底动脉供血不足（VBI）患者血液流变学的异常,本文在吸烟与非吸烟两组VBI患者间进行各项血液流变学指标的比较,发现吸烟组各项指标均高于非吸烟组。证实吸烟可使VBI患者血液流变学异常更为明显,加重动脉硬化,增加脑梗塞的危险性,戒烟是椎基底动脉供血不足的重要预防措施。     

维生素D_3及其受体的临床意义

1,25-(OH)2D3是维生素D在体内发挥生理作用的活性形式。活性维生素D3通过与细胞内特异性维生素D受体结合,除了具有调节钙磷代谢的功能外,还发现其可预防和治疗骨质疏松、心血管疾病、自身免疫性疾病和一些肿瘤等。然而,维生素D缺乏在人群中非常普遍。     

The Need for a Revolution in the Philosophy of Science

There is a need to bring about a revolution in the philosophy of science, interpreted to be both the academic discipline, and the official view of the aims and methods of science upheld by the scientific community. At present both are dominated by the view that in science theories are chosen on the basis of empirical considerations alone, nothing being permanently accepted as a part of scientific knowledge independently of evidence. Biasing choice of theory in the direction of simplicity, unity or explanatory power does not permanently commit science to the thesis that nature is simple or unified. This current ‘paradigm’ is, I argue, untenable. We need a new paradigm, which acknowledges that science makes a hierarchy of metaphysical assumptions concerning the comprehensibility and knowability of the universe, theories being chosen partly on the basis of compatibility with these assumptions. Eleven arguments are given for favouring this new ‘paradigm’ over the current one. This revised version was published online in August 2006 with corrections to the Cover Date.     

A New Task for Philosophy of Science

This paper argues that we philosophers of science have before us an important new task that we urgently need to take up. It is to convince the scientific community to adopt and implement a new philosophy of science that does better justice to the deeply problematic basic intellectual aims of science than that which we have at present. Problematic aims evolve with evolving knowledge, that part of philosophy of science concerned with aims and methods thus becoming an integral part of science itself. The outcome of putting this new philosophy into scientific practice would be a new kind of science, both more intellectually rigorous and one that does better justice to the best interests of humanity.