当前恶性肿瘤治疗存在的问题与失误

恶性肿瘤的临床治疗发展迅速,在取得巨大成绩的同时,也存在着一些失误：其一是广泛存在的过度治疗,由于相当一相分肿瘤患者并不能得益于临床治疗,但几乎所有虱都不倒外地去接治疗,其结果必是这种部分患者受治疗之基。其二是肿瘤治疗目的的不明确,提高肿瘤患者的生存质量并延长生存其工没落到实处,治疗没有长远规划;其三是只注重治疗这一外因,忽视肿瘤因有生物学特性这一内因及肿瘤治疗中的免疫机制;预防是最好的治疗,而目     

Performance-based and parent ratings of attention in children treated for a brain tumor: The significance of radiation therapy and tumor location on outcome

Children are at increased risk for cognitive difficulties following the diagnosis and treatment of a brain tumor. Radiation therapy (RT) and tumor location are commonly-cited predictors of neurocognitive functioning. Disruptions to foundational neurocognitive processes such as attention, working memory, and processing speed underlie declines on measures of general intellectual functioning. While several studies have examined visual sustained attention in pediatric brain tumor patients, auditory sustained attention has yet to be examined. This study employs a longitudinal design to examine performance-based and parent ratings of attention in children undergoing surgical resection of a brain tumor (n = 29) and treated with (n = 11) or without (n = 18) RT at 6.79 months post-surgery (baseline) and then again at 30.56 months post-surgery (follow-up). The measures include an auditory continuous performance test (CPT) and parent ratings of attention and hyperactivity on a behavior rating scale. Ultimately, children treated with and without RT performed similarly on performance-based and parent ratings of attention. However, the performance on the auditory CPT differed according to tumor location, with children with infratentorial tumors committing more inattention and inhibitory control errors compared to children with supratentorial tumors. Parent ratings did not differ according to tumor location, and parent ratings and auditory sustained attention performance are not significantly correlated. The findings are interpreted in the context of neurocognitive and brain development.     

4例肾上腺区局限性Castleman病临床诊治分析

探讨肾上腺区局限性Castleman病的临床特点及诊治方法。回顾性分析4例经术后病理证实的肾上腺区局限性 Castle-man病患者的临床资料,并结合文献复习讨论Castleman病的临床特点及诊治方法。结果4例肾上腺区局限性Castleman病均顺利手术切除,术后随访1个月～22个月,未见肿瘤复发。Castleman病临床上少见,表现为不明原因的淋巴结肿大,临床表现无特异性,最终确诊依靠病理诊断。病变可发生在淋巴组织的任何部位,肾上腺区罕见,手术切除为首选治疗。     

Identification of cognitive profiles among women considering BRCA1/2 testing through the utilisation of cluster analytic techniques

Based on the cognitive-social health information processing model, we identified cognitive profiles of women at risk for breast and ovarian cancer. Prior to genetic counselling, participants (N?=?171) completed a study questionnaire concerning their cognitive and affective responses to being at genetic risk. Using cluster analysis, four cognitive profiles were generated: (a) high perceived risk/low coping; (b) low value of screening/high expectancy of cancer; (c) moderate perceived risk/moderate efficacy of prevention/low informativeness of test result; and (d) high efficacy of prevention/high coping. The majority of women in Clusters One, Two and Three had no personal history of cancer, whereas Cluster Four consisted almost entirely of women affected with cancer. Women in Cluster One had the highest number of affected relatives and experienced higher levels of distress than women in the other three clusters. These results highlight the need to consider the psychological profile of women undergoing genetic testing when designing counselling interventions and messages.     

Tumor Locus Moderates Anxiety Symptoms in a Pediatric Neuro-Oncologic Sample

Despite the prevalence of pediatric Central Nervous System (CNS) solid tumors, little is understood about patients' disease-related anxiety experience. Data from 25 remitted pediatric CNS tumor patients posttreatment were collected. Significant symptoms of anxiety were reported by 32% of patients. MRI studies showed all anxious patients had right cortical tumors or left cerebellar tumors. Confound analyses suggest these results are not better accounted for by demographic, disease, or treatment variables. These results evidence the risk some pediatric neuro-oncologic patients face for developing significant anxiety symptoms.     

抑癌基因ARIDlA的研究进展

SWI／SNF复合物是一种ATP依赖的染色质重塑复合物。ARIDlA蛋白是SWI／SNF的亚基之一,具有非序列特异性DNA结合活性,参与DNA的复制、转录、修复、重组等。在消化道肿瘤、妇科肿瘤、肺腺癌等多种肿瘤中存在频繁的基因突变。可能通过上调P21、P53及下调c—Myc、E2F反应基因等发挥抑癌作用。本文介绍了ARIDlA基因的分子特征、作用机制及与多种肿瘤的关系,以期对该抑癌基因有全面深入的了解。     

高凝状态肿瘤患者抗凝联合化疗的临床观察

观察伴高凝状态恶性肿瘤患者抗凝联合化疗的临床疗效.观察组68例,给予一线标准方案化疗,同时给予低分子肝素钙6 000U,1次/d,皮下注射,阿司匹林100mg口服,1次/d,21d为1个周期,共2个周期.对照组56例,给予一线标准方案化疗.结果显示,治疗组和对照组有效率分别为23.69％和19.44％,两组比较,差异无统计学意义(P＞0.05);治疗组和对照组生存状态评分(KPS)改善率分别为64.71％和35.39％,两组比较,差异有统计学意义(P＜0.05).治疗组出现了纤维蛋白原(Fbg)、组织因子(TF)和D-二聚体(D-D)含量的降低,与对照组相比差异有统计学意义(P＜0.01).从而得出伴高凝状态恶性肿瘤患者进行抗凝联合化疗,临床疗效较好,同时可以降低血液高凝状态和血栓形成的风险.     

Risk Reduction Behaviors and Provider Communication Following Genetic Counseling and BRCA1 Mutation Testing in an African American Kindred

Little is known about the impact of cancer genetic counseling and testing on health behaviors in racial and ethnic subgroups. This prospective observational study examined use of risk reduction strategies following BRCA1 counseling and testing. Participants were female members of an African American kindred who received genetic education, counseling and testing (n = 40) and completed a 1-year follow-up interview. Mutation carriers were more likely to opt for breast (100%, 7/7) and ovarian (25%; 1 of 4) cancer surveillance than prophylactic surgery. Following genetic counseling, 71% (5/7) of the BRCA1 carriers who opted for surveillance reported having a mammogram within the year following receipt of their genetic test results. Ovarian cancer screening among mutation carriers increased from 0% at baseline to 25% (one of four) at 1 year. Compared to noncarriers (23%, 7/30), carriers (70%, 7/10) were more likely to discuss their BRCA1 test results with their primary health care providers. Surveillance for breast cancer was preferred to prophylactic surgery and chemoprevention as a way to reduce risk for these cancers. Our data indicate that patient-provider communication about BRCA1 test results is suboptimal.     

Risk-Reduction Surgery Decisions in High-Risk Women Seen for Genetic Counseling

Women at greatest risk for hereditary breast and ovarian cancer may consider prophylactic removal of breasts or ovaries as a risk-reduction measure. This report describes uptake of risk-reduction mastectomy (RRM), risk-reduction oophorectomy (RRO), and related factors in 62 high-risk women who received genetic counseling. Seven (11%) participants underwent RRM and 13 (21%) underwent RRO. Of these women, 37% did not have BRCA testing, suggesting other factors influence decisions to undergo surgery. Women who had indicated (pre-genetic counseling) their intent not to have surgery chose not to have surgery. Information received during genetic counseling that women perceived as being most important for influencing risk-reduction surgery decisions was BRCA test result (positive or negative), followed by discussion of family cancer history. Reasons for indecision about risk-reduction surgery included genetic testing results, concerns about surgery, timing in life, and early menopause. The findings enhance our understanding of information that is helpful to women considering this surgery.     

Uptake of BRCA1 Genetic Testing in Adult Sisters and Daughters of Known Mutation Carriers in Norway

This study was undertaken to examine transmission of information to first-degree relatives of BRCA1 mutation carriers and uptake of genetic testing. The intention was to consider revision of current legislation related to privacy if information on life-saving health care was not disseminated to at-risk family members. The Norwegian Radium Hospital provides clinical genetics services for families at high risk for hereditary breast and ovarian cancer. Together with major hospitals nationwide we provide medical surveillance. Nearly all expenses are covered by the National Health insurance. Because of the high number of families with founder mutations in BRCA1, we are in a unique position to gather information about these groups. Within a consecutive series, we identified 75 BRCA1 mutation carriers and registered information transmission and uptake of genetic testing 6 months or more after the index mutation carriers had been informed about their mutation status. These 75 BRCA1 mutation carriers had 172 living first-degree relatives, aged 18 years or older (84 females, 88 males). Forty-four out of 54 (81.5%) of females over 30 had opted for genetic testing. The testing rate among all relatives was 43%. At any age, 63% of the females underwent genetic testing compared with 24% of the males (p<0.05). The overwhelming majority of adult females at risk opted for genetic testing. Males with daughters more frequently than males without daughters asked for testing. The findings give neither reason to reconsider legislation on privacy, nor for us to consider more aggressive methods of contacting relatives.