关于恶性肿瘤发病年轻化的思考

恶性肿瘤的发病多在50岁以后,以中老年人常见。近年发现青年(≤40岁)患癌有增高趋势。从恶性肿瘤的高危因素及分子机制方面,探讨恶性肿瘤发病年轻化的可能原因。辩证地剖析机体内部和外界环境之间的关系,是研究恶性肿瘤发病年轻化的重要环节。     

Case Report—Loyalty, Legacy, and Ledger: Contextual Therapy in a Patient with a Family History of Ovarian Cancer

A client's emotional experiences and reactions to those experiences are influenced by his/her family of origin and direct or indirect interactions with various family members. Contextual therapists propose that a client's satisfaction with a relationship depends on the equity of his/her emotional interactions with family members. When relationships are inequitable, trust between individuals disintegrates. In order to reestablish trust in a relationship, a balance of interests must be restored. If not, imbalances may be passed down to future generations. A case of a woman with a family history of ovarian cancer is reviewed with the principles of contextual therapy in mind. In her family, several legacies have resulted in unbalanced relationships between family members that lead to difficulty in establishing trust within the genetic counseling session.     

早期目标血糖管理下严重脓毒症患者HMGB1的变化及其临床意义

探讨早期目标血糖管理对严重脓毒症患者HMGB1变化的影响.严重脓毒症患者随机分为血糖控制A（4.4mmol/L~6.1mmol/L）、B（6.2mmol/L~8.3mmol/L）、C（8.4mmol/L~10.0mmol/L）三组.给予早期目标血糖管理,入ICU后0d、1d、3d、5d、7d采血测TNF-α、HMGB1浓度.三组TNF-α、HMGB1浓度及APACHEⅡ评分均呈下降趋势,A组HMGB1浓度及APACHEⅡ评分在第7d较B、C组明显降低（P＜0.05）.A组28d病死率较B、C组降低（P＆gt;0.05）.严重脓毒症患者在早期目标血糖管理下,显著降低HMGB1浓度,降低病死率和改善预后,HMGB1可用来评价脓毒症的严重程度及预后.     

关注肿瘤患者避免过度诊疗——解析ASCO大会关于肿瘤诊疗的5项建议

现代肿瘤的诊疗水平已经有了长足的进步,先进的诊断技术使得很多肿瘤得以早期发现并积极治疗,很多晚期患者也不再面临无药可用的境地,但由于临床医生的认识存在偏差,存在过度诊断和过度治疗的问题,进而给患者带来不必要的负担和痛苦。美国临床肿瘤学会（ASC0）年会上发布了一篇名为“ASCO为改善肿瘤治疗质量及医疗花费的5项建议”的文章,特别提出要重视五项临床广泛应用、花费较大,但缺乏高级临床证据的肿瘤治疗或干预措施,也提示我们需要充分评估,综合思考,为合适的患者提供正确的诊治方案,才能给患者带来更大的获益。     

Executive functions and social skills in survivors of pediatric brain tumor

Medical advances have resulted in increased survival rates for children with brain tumors. Consequently, issues related to survivorship have become more critical. The use of multimodal treatment, in particular cranial radiation therapy, has been associated with subsequent cognitive decline. Specifically, deficits in executive functions have been reported in survivors of various types of pediatric brain tumor. Survivors are left with difficulties, particularly in self-monitoring, initiation, inhibition, and planning, to name a few. Another domain in which survivors of pediatric brain tumor have been reported to show difficulty is that of social skills. Parents, teachers, and survivors themselves have reported decreased social functioning following treatment. Deficits in executive functions and social skills are likely interrelated in this population, as executive skills are needed to navigate various aspects of social interaction; however, this has yet to be studied empirically. Twenty-four survivors of pediatric brain tumor were assessed using a computerized task of executive functions, as well as paper-and-pencil measures of social skills and real-world executive skills. Social functioning was related to a specific aspect of executive functions, that is, the survivors' variability in response time, such that inconsistent responding was associated with better parent-reported and survivor-reported social skills, independent of intellectual abilities. Additionally, parent-reported real-world global executive abilities predicted parent-reported social skills. The implications of these findings for social skills interventions and future research are discussed.     

Treatment, Age, and Time-Related Predictors of Behavioral Outcome in Pediatric Brain Tumor Survivors

The research has shown that children surviving cancer are at risk for long-term emotional and behavioral problems secondary to the cumulative effects of cranial irradiation and chemotherapy. The purpose of this study was to investigate the emotional and behavioral outcome of children diagnosed with brain tumor and treated with cranial irradiation and chemotherapy by looking at the association between treatment, time, age, and cognitive-related variables on externalizing and internalizing behaviors at 3 years posttreatment. Fifty-four brain tumor survivors were administered a neuropsychological test battery, whereas the parents filled out the CBCL and Conners' Parent Rating Scale. The results indicate that chemotherapy treatment with vincristine, cytoxan, cisplantinum, and/or VP16 was related to poorer internalizing and externalizing behavioral outcome, especially attention, social withdrawal, and anxious–depressive symptomatology. Age at time of diagnosis or treatment, time since discontinuation of treatment, type and/or total dose of radiation therapy was not significantly correlated with any of the behavioral outcome scales. Verbal memory and learning deficits accounted for a significant portion of the variance in social withdrawal, whereas lower scores in overall intellectual functioning and verbal fluency was related to disturbances in attention, inhibition, and social functioning. The findings suggest that children treated with 1 or a combination of any of the aforementioned chemotherapy agents who exhibit declines in intellectual functioning and memory are at increased risk for long-term behavioral problems 3 years after treatment cessation. These findings support the importance for early psychotherapeutic and supportive intervention services immediately after treatment cessation, with the goal of circumventing these potentially debilitating emotional problems.     

直肠间质瘤致下消化道大出血1例报告

胃肠道间质瘤是一种发生于消化道的少见的间叶肿瘤,直肠间质瘤更为罕见,在直肠肿瘤中的发生率0．1％以下。直肠问质瘤的临床表现无特异性,与其他直肠肿瘤相似,随肿瘤逐渐增大可表现为排便习惯改变、便血、排便困难等。临床确定诊断困难。手术治疗是能够治愈直肠问质瘤的唯一方法。格列卫作为一线化疗药物对术前降期及改善预后都有良好疗效。本例患者因下消化道大出血入院,肿瘤近肛缘,术中病理考虑为直肠闻质瘤,完整切除肿瘤后行保肛术。术后应用格列卫,随诊3个月无复发、转移。     

Hidden reality: sexual sphere in brain tumor patients

Most reports emphasize that tumors and their treatments affect sexual function. To date, no studies have focused on sexual functioning in patients with brain tumors. Our study’s objective is to describe the sexual sphere of patients with brain tumors and examine the possible differences between patients who reported sexual dysfunctions and those who did not with respect to their psychological and functional status. We tested 46 patients with brain tumors. We used an ad hoc questionnaire to assess patients’ subjective perception of their own sexual sphere. To assess patients’ psychological status, we used the following questionnaires: Hospital Anxiety and Depression Scale; Psychological Distress Inventory; EORTC QLQ-C30; EORTC QLQ-BN20. Fifty-eight percent of patients reported sexual disturbance. Our data showed that a lack of or decrease in sexual desire is the most common sexual problem reported by our patients (56%). Patients with sexual problems reported higher levels of anxiety and depression and a worse self-reported quality of life (QoL) than did those who did not perceive adverse changes in their sexual sphere. In addition, we found that patients with a better performance status (KPS) reported more changes in sexual behaviors than did those who had performance difficulties. Of the patients, 15.2% received information regarding possible changes in the sexual sphere by physicians. Additionally, 10.8 of 15.2% of the patients reported having explicitly requested information from physicians. The study demonstrated a relation between QoL and sexual function. Therefore, it would be important to encourage clinicians to ask questions regarding patients’ sexual issues, thus providing them with an opportunity to expose their difficulties and receive adequate support.     

恶性肿瘤综合治疗的策略

肿瘤综合治疗是根据病人的机体情况以及肿瘤的病理类型、侵犯范围(病期)和发展趋向,将现有的手术治疗、放射治疗、化学治疗、生物治疗和中医中药治疗等各种手段有目的地、科学地、有计划地作一个序贯性的安排和实施,力争取得最佳的治疗效果。肿瘤的综合治疗是一个多学科协作的合理的新型模式。     

《史记·扁鹊仓公列传》的治疗学思想

《史记·扁鹊仓公列传》是记述扁鹊和仓公医事活动的专篇.目前,中医界大多集中在对其原文的医古文语言学分析、扁鹊和仓公医事活动年代的考证、所载病案的病因病机与诊法的探讨等方面,而专篇探讨扁鹊和仓公治疗学思想的研究尚缺,本文就此加以论述,并与《内经》简单地对照.