血管内皮生长因子与结直肠癌的研究

血管内皮生长因子（vascular endothelial growth factor,VEGF）是一高度特异作用于内皮细胞的糖蛋白,是目前发现的最重要的肿瘤血管生长因子之一。结直肠癌的生长、侵袭和转移与血管内皮生长因子有密切的关系,VEGF在结直肠癌治疗中的作用日益突出。本文就VEGF的功能、在结直肠癌中的表达和治疗的作用作一综述。     

Multidimensional treatment foster care (MTFC): results from an independent replication

This study examines 24‐months post‐baseline outcomes for thirty‐five Swedish antisocial youths who received either treatment in multidimensional treatment foster care (MTFC) or treatment as usual (TAU). MTFC is a community‐based treatment programme that has been successful in treating chronic juvenile offenders in the USA. This study is the first randomized control study outside the USA. The youth treated in the MTFC programme consistently showed some statistically significant positive treatment effects compared to the youth exposed to TAU. The results suggest that MTFC might be an effective method in treating youth with severe behaviour problems in a Swedish context. The authors conclude that the programme ought to be of great interest for Swedish social services as an alternative to traditional care.     

A review of recommendations for sequencing receptive and expressive language instruction

We review recommendations for sequencing instruction in receptive and expressive language objectives in early and intensive behavioral intervention (EIBI) programs. Several books recommend completing receptive protocols before introducing corresponding expressive protocols. However, this recommendation has little empirical support, and some evidence exists that the reverse sequence may be more efficient. Alternative recommendations include teaching receptive and expressive skills simultaneously (M. L. Sundberg & Partington, 1998) and building learning histories that lead to acquisition of receptive and expressive skills without direct instruction (Greer & Ross, 2008). Empirical support for these recommendations also is limited. Future research should assess the relative efficiency of receptive-before-expressive, expressive-before-receptive, and simultaneous training with children who have diagnoses of autism spectrum disorders. In addition, further evaluation is needed of the potential benefits of multiple-exemplar training and other variables that may influence the efficiency of receptive and expressive instruction.     

骨科疾病诊治中的临床思维

医学哲学是对医学科学成就总的概括,并以此为基础探讨生命活动和病程的一般规律,研究医学科学的思维方式,直至疾病预防、诊断治疗。同时研究辩证规律和范畴在医学科学中的表现,从而指导骨科医师解决在骨科疾病诊治中遇到的诸多问题,并有助于形成正确的临床思维。结合临床工作体会,探讨医学哲学在骨科疾病诊治临床思维中的应用。     

高新技术临床应用中不合理诊疗行为的思考

高新医疗技术临床应用中的不合理诊疗行为,主要包括医方趋利性医疗行为和防御性医疗行为。通过典型案例对高新医疗技术临床应用中的不合理诊疗行为的成因进行分析,剖析不合理的诊疗行为,提出了规范应用高新医疗技术的对策。     

自我保护性医疗的伦理扫描--论患方知情同意与医方规避风险

自我保护性医疗是近年来医方为应对医患关系重构而采取的一种行为模式,其本身和影响具有全新特点,充满价值冲突;这种行为模式,客观上是对应医疗风险尤其是重大医疗风险的;主观上同医方免责期待的张扬以及对知情同意的解读直接相关;因而,正当的自我保护性医疗既取决于医方合理的免责期待,以及改变对知情同意的误读,更依赖于自身的医学伦理综合素质的打造和完善。     

Treatment Foster Care in a System of Care: Sequences and Correlates of Residential Placements

We examined Treatment Foster Care (TFC) in residential trajectories for youth with psychiatric disorders and aggressive behavior. We analyzed residential placements of a statewide sample of youth during the 12 months preceding and following admission to TFC. Prior to TFC, the majority of youth were residing in more restrictive settings (group homes or residential treatment). Two-thirds of youth remained in TFC throughout the follow-up year. Of those who left, nearly half returned home, and slightly fewer were discharged to group homes. By the end of the 12-month follow-up period, rates of group home use were similar to those seen in the pre-TFC period. Movement out of TFC during the year was associated with being older at placement and with increased problem behavior (particularly externalizing behaviors). TFC serves as a step-down placement for a substantial number of youth. However, this is not the only way it is used, and models based on short-term transitioning or reunification with families may not be widely implemented or relevant in practice. Additional research is needed to understand current functions of TFC in residential trajectories and to maximize its utility in systems of care.     

The Treatment Planning of Experienced Counselors: A Qualitative Examination

Using consensual qualitative research, the authors examined the treatment planning process of experienced counselors (N = 9). The data analysis resulted in 4 domains: assessment steps, clinical impressions, treatment factors, and treatment strategies. These domains describe the process used by experienced counselors in making clinical decisions and offer insight into the nature of clinical expertise and the need for further research on treatment planning.     

阿卡波糖、二甲双胍联合胰岛素类似物治疗肥胖糖尿病短期疗效

观察阿卡波糖、二甲双胍联合胰岛素类似物治疗肥胖2型糖尿病的短期疗效。将60例符合标准患者随机分为观察组和对照组各30例,均给予重组甘精胰岛素联合赖脯胰岛素强化治疗控制血糖,观察组同时给予阿卡波糖及二甲双胍口服,出院时进行疗效评价。观察组血糖达标时间、胰岛素用量少于对照组,餐时胰岛素停用比例大于对照组,差异有统计学意义（P＜0．05）;两组患者出院时体重较入院时均有所下降,观察组较对照组体重变化更明显（P＜0．01）。阿卡波糖、二甲双胍联合胰岛素类似物治疗方案,可作为初诊肥胖2型糖尿病治疗的理想方法之一。     

手术治疗单一局部复发或远处转移病灶乳腺癌的临床观察

探索手术治疗单一局部复发或唯一远处转移病灶乳腺癌的临床价值。收集2006年6月至2013年6月湖南省人民医院乳甲外科收治的64例局部复发或术后远处转移乳腺癌患者,其中28例为单发病灶病例。根据是否采取了包含手术的综合治疗,将其分为手术组与非手术组。回顾性分析两组的临床资料和随访数据,分析手术治疗局部复发或远处转移乳腺癌有无临床意义。结果28例都采取了含化疗的综合治疗,8例局部单发病灶与9例远处单一脏器转移病例进行了手术治疗。手术组的局部缓解率与控制率明显优于非手术组,均为100％。两组无进展生存时间（PFS）和总生存时间（（）S）比较,手术组明显长于非手术组;但在单一远处脏器转移手术组中0S没有优势。2年生存率方面手术组与非手术组比较有统计学意义。对于术后单一局部复发病灶或唯一远处脏器转移的乳腺癌患者,采取含手术的综合治疗方案能带来明显的PFS优势,若有手术机会和条件成熟,手术仍是不应放弃的有效治疗方法。