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.     

Breast Cancer in Men: A Need for Psychological Intervention

Male breast cancer is a serious issue that needs to be addressed more fully by the medical and public community. However, due to a lack of awareness and limited research on the topic, there is a general absence of knowledge concerning the psychological implications of this disease in men as well as a need for greater understanding of the medical diagnosis and treatment of male breast carcinoma. Similarly, there still remains a considerable gender difference between the awareness of female breast cancer and male breast cancer Although breast cancer in men makes up only 1% of all breast cancers reported in the United States, it is increasing in incidence. There are approximately 2000 new cases and approximately 450 deaths due to male breast cancer each year. Breast cancer diagnosis and treatment in men is very similar to that described in women, however, it has been shown that men are being diagnosed at a later stage of the disease than women.     

An efficient cervical disease diagnosis approach using segmented images and cytology reporting

Cervical cancer is the second most common cancer in women globally. A computer aided cervical disease diagnosis system that can relieve pressure on medical experts and save the cost is proposed. To implement our approach in the reality of cervical diseases diagnosis, a multi-modal framework is designed for three kinds of cervical diseases diagnosis that integrates uterine cervix images, Thinprep Cytology Test, human papillomavirus test, and patients’ age. However, too many features increase memory storage costs and computational costs, and it affects the spread of this system in poor areas. Feature selection not only eliminates redundant or irrelevant features but also finds the factors that influence the disease most first is performed in multi-modal frameworks for cervical diseases diagnosis. The detailed process of the method is as follows: first, according the representative color, an efficient image segmentation algorithm is developed; then from three different types of segmented images, we extract color features and texture features for interpreting uterine cervix images; next, Boruta algorithm is applied to feature selection; finally, the performance of Random Forests that utilizes selected features for cervical disease diagnosis is investigated. In the experiment, the proposed multi-modal diagnostic approach gives the final diagnosis for three different kinds of cervical diseases with 83.1% accuracy, which significantly outperforms methods using any single source of information alone. The validation cohort is applied to validate the efficiency of our method, and the performance of random forest obtained by using only 1.2% of features is like or even better than using 100% of features.     

对肺癌TNM分期的思考

TNM分期系统是进行肿瘤诊断和治疗的“国际语言”。1997年新版的肺癌TNM分期标准作为指导肺癌诊断和治疗的重要参考指标,能在一定程度上反映肺癌的预后,但并没有完全反映肺癌的本质生物学行为。本文认为真正反映肺癌本质生物学行为的是肺癌的组织学类型及分化程度等指标,传统的TNM分期系统应当进一步完善。     

肺癌肿瘤干细胞研究的科学方法论

肺癌肿瘤干细胞研究是肺癌与肿瘤干细胞学说交叉所形成的新研究领域,将根本改变临床肺癌防治的方式。反思从肿瘤干细胞学说的提出到肺癌肿瘤干细胞研究,树立自然辨证观念,用科学方法论指导肺癌肿瘤干细胞研究。     

如何对妇科肿瘤手术后患者进行观察

对手术后患者的观察和处理是疾病外科治疗过程中的重要环节之一。本文从妇科肿瘤手术后患者面临的四大主要问题（术后出血、术后感染、特殊外科并发症的出现和内科合并症的加重）入手,对上述问题的临床特点、早期征兆、出现规律、观察指标和相应辅助检查进行总结,并简要指出处理原则,目的是帮助青年医师形成有逻辑的术后观察思维。     

肝癌综合治疗的发展与展望

原发性肝癌是我国最常见的恶性肿瘤之一,预后较差,病死率较高。经过多年的探索与努力,人们利用辩证思维的方法,在总结了各种治疗方法的优、缺点后,取长补短兴起了肝癌的综合治疗。包括手术治疗、化疗、放疗、导向治疗、局部治疗、中医治疗、免疫治疗、基因治疗的综合治疗,成为进一步提高肝癌疗效的新途径。     

以树突状细胞为基础的前列腺癌免疫治疗的研究

探讨以人外周血单个核细胞（peripheral blood monouclear cells,PBMC）来源的树突状细胞（dendritic cell,DC）为基础的抗前列腺癌免疫作用。分离外周血PBMC,用重组人粒细胞巨噬细胞集落刺激因子（rhGM—CSF）和重组人白介素-4（rhIL-4）诱导PBMC产生DC。提取前列腺癌PC-3细胞总RNA,致敏DC并用流式细胞仪检测细胞的表面标志物CD14、CD40、CD80、CD86。致敏后的DC与淋巴细胞共同培养诱导产生特异性细胞毒性T淋巴细胞（cytotoxic Tlymphocyte,CTL）,用MTT细胞毒检测试剂盒检测特异性CTL对肿瘤细胞的杀伤率。结果总RNA致敏后的DC细胞CD40、CD80、CD86显著增高,CD14显著降低（P〈0．05）。前列腺癌组杀伤率（55．27＋9．76）与空白对照组杀伤率（36．75＋7．06）之间的差异有统计学意义（P=0．009〈0．05）。胃癌对照组杀伤率（36．75＋7．06）与空白对照组杀伤率（35．66＋7．85）之间差异无统计学意义（P=0．834〉0．05）。结论是经RNA致敏的DC可以诱导产生对前列腺癌细胞有特异性杀伤活性的CTL。     

良性前列腺增生手术适应证探讨与方法的选择

良性前列腺增生（benign prostatic hyperplasia,BPH）是中老年患者的常见疾病,生活水平提高和寿命延长使得患者数量在逐年增加。电切镜的应用使下尿路疾病尤其是前列腺增生症的治疗发生了根本性的改变,新的治疗方法近年发展较快,并在BPH治疗过程中得到了广泛运用。前列腺增生症患者症状和程度各不相同,并且高龄高危患者居多,其手术适应证需要进一步探讨。开放前列腺切除术、经尿道前列腺电切术、经尿道前列腺汽化电切术、经尿道等离子前列腺电切术是目前常用的治疗方法,经尿道激光治疗、腹腔镜手术近几年开始尝试,初步应用证实其应用得当是有效、微创、并发症少的治疗方法,因此发展迅速。微波、超声消融、支架植入治疗目前较少应用,但有其适应证,尚不能替代经尿道前列腺电切术,可作为对症辅助治疗或适用于无法耐受手术者。结合国内外BPH诊治指南提出的手术适应证,查阅近年国内外发表相关文献,对于指南在实际应用和执行中遇到的问题与解决办法进行探讨。对各种外科手术的临床疗效予以对比和总结,探讨良性前列腺增生症外科治疗的临床决策问题。