非小细胞肺癌 EG FR 基因突变检测与临床意义

采用荧光PCR法对199例晚期非小细胞肺癌（NSCLC ）组织进行表皮生长因子受体（EGFR ）基因突变检测,分析EGFR基因突变的分布特征及其与临床病理特征的相关性。结果显示56例（28．1％）存在EGFR基因突变,其中27例（13．6％）为外显子19突变,25例（12．6％）为外显子21突变,2例为外显子18突变,1例外显子20突变,1例外显子18和20的共突变。另外,除广东及安徽省铜陵市外,辽宁地区NSCLC患者EGFR基因突变率及主要突变类型与其他地区相符,常见于外显子19、21突变,其中腺癌、不吸烟患者突变率更高,更适宜EGFR-TKI靶向治疗。     

我们应该“创造生命”吗？

人造细胞是现代生物科学技术中的热点问题之一,由人造细胞及其衍生出来人造生命的伦理问题也备受关注,关于是否应该继续研究人造生命,支持者和反对者之间各执其词。以克莱格·文特“创造人造细胞”事件为切入点,回顾了人造生命的历史,简要介绍人造细胞的产生过程,分析人造细胞的正面和负面影响;同时提出马克思主义哲学可以为医学伦理问题的研究提供不同的维度与角度,让人们对人造细胞产生的道德问题做出更全面的判断。     

Eating behaviors and emotional distress are predicted by treatment and adverse outcome in patients with type 2 diabetes

Depression and anxiety are hightly prevalent among patients with Type 2 Diabetes (T2D), however not commonly related to outcomes, treatment and comorbidities. Eating behaviors could also have an implication. To evaluate the relation between mood and eating behaviors with demographic, physical, treatment, biochemical profiles and chronic comorbidities in T2D we conducted this exploratory cross sectional study in a population from Mexico. Hospital Anxiety and Depression Scale and the Three Factor Eating Questionnaire Revised 21 (TFEQ-R21) were correlated with age, gender, blood pressure, treatment and comorbidities (nephropathy, neuropathy, retinopathy and cardiopathy). Multi-linear regression models and 2^k factorial analyses were conducted. Sixty-one patients (31 male) 55 years old (SD 13) with at least 5 years of T2D were included. Anxiety correlated with depression (r = 0.25, p < 0.05). Gender (women) (std B 0.026, p < 0.001), insulin therapy (std B 0.3, p = 0.11), systolic blood pressure (std B 0.263, p = 0.02) and cardiovascular disease (std B 0.232, p = 0.035) predicted depression. Insulin therapy had a positive effect in cognitive restraint. (std B 0.32, p = 0.001). Age (std B 0.37, p = 0.003) and systolic blood pressure (std B 0.237, p = 0.048) predicted positively emotional eating (not previously published). 2^k factorial analyses proved additive interaction between complications and insulin therapy with depression. This study supports the relation between mood disorders and eating behaviors with demographic, physical, treatment, biochemical profiles and chronic comorbidities in T2D and the additive interaction between factors and mood disorders.     

Maternal distress in the context of their child’s type 1 diabetes: exploring the role of adaptive maternal emotion regulation on child outcomes

Parents of children with Type 1 diabetes (T1D) experience high levels of distress, which may negatively impact child functioning. However, little is known about mechanisms that may buffer the adverse impact of parental distress. The current study explored the possible buffering role of maternal adaptive cognitive emotion regulation (CER) for the relationship between maternal distress and child psychological functioning. Forty-three children with T1D (8–15 years) completed measures assessing trait anxiety and depressive symptoms. Their mothers reported on general distress, illness-related parenting stress, and adaptive CER. Maternal illness-related parenting stress (but not general distress) was significantly associated with child psychological functioning. No buffering role for maternal adaptive CER was observed. As the current study is rather preliminary, future research using other methods to examine maternal adaptive CER, and examining other parental variables that may buffer against the negative impact of parental distress is warranted.     

Cell Phone-Related Near Accidents Among Young Drivers: Associations With Mindfulness

Cell phone use while driving (CPWD) has been shown to significantly reduce driver safety. This is a particular concern among young drivers who possess less driving experience and tend to engage in high rates of cell phone use. The present study identified psychological predictors of near accidents related to CPWD among a sample of 385 college student drivers. Participants answered a series of questions regarding their use of a cell phone while driving and completed measures of mindfulness, polychronicity, and intrusive thinking. Students who reported talking on their phone or texting more frequently while driving reported a higher incidence of near accidents related to each behavior. However, after controlling for CPWD, multiple regression analysis indicated that those who reported experiencing more cell phone-related intrusive thoughts also experienced more near accidents. Furthermore, two facets of mindfulness—acting with awareness and nonjudging of inner experience—were negatively associated with near accidents. These findings suggest that individuals who are more aware of the present moment and accepting of their affective responses may better regulate their attention while using a cell phone behind the wheel.     

“More on Respect for Embryos and Potentiality: Does Respect for Embryos Entail Respect for In Vitro Embryos?”

It is commonly assumed that persons who hold abortions to be generally impermissible must, for the same reasons, be opposed to embryonic stem cell research [ESR]. Yet a settled position against abortion does not necessarily direct one to reject that research. The difference in potentiality between the embryos used in ESR and embryos discussed in the abortion debate can make ESR acceptable even if one holds that abortion is impermissible. With regard to their potentiality, in vitro embryos are here argued to be more morally similar to clonable somatic cells than they are to in vivo embryos. This creates an important moral distinction between embryos in vivo and in vitro. Attempts to refute this moral distinction, raised in the recent debate in this journal between Alfonso Gómez-Lobo and Mary Mahowald, are also addressed.     

Parent–adolescent conflict,treatment adherence and glycemic control in Type 1 diabetes: The importance of adolescent externalising symptoms

Parent–adolescent conflict has been demonstrated to relate to treatment adherence and glycemic control in adolescents with Type 1 diabetes. The present longitudinal study investigated how these variables were interrelated over time, and examined whether externalising and internalising symptoms function as mediating variables. A total of 109 adolescents with diabetes participated at four annual time points and completed measures on conflict with parents, internalising and externalising symptoms. Information on treatment non-adherence and glycemic control was obtained from treating physicians. Cross-lagged analyses from a structural equation modelling approach indicated that father–adolescent but not mother–adolescent conflict positively influenced treatment non-adherence over time, which, in turn, was associated with higher glycosylated haemoglobin-values. Further, externalising but not internalising symptoms were found to mediate the pathway from father–adolescent conflict to treatment adherence over time. Finally, mother–adolescent conflict was found to relate indirectly to treatment non-adherence through its relationship with externalising symptoms. Hence, the present longitudinal study provides evidence that externalising symptoms represent an important mechanism through which earlier experiences of parent–adolescent conflict may influence later treatment non-adherence and poorer glycemic control. Implications and suggestions for future research are outlined.     

Physical activity and diabetes: An application of the theory of planned behaviour to explain physical activity for Type 1 and Type 2 diabetes in an adult population sample

Physical activity (PA) plays a key role in the management of Type 1 (T1D) and Type 2 diabetes (T2D) but there are few theory-based, effective programs to promote PA for individuals with diabetes. The purpose of this study was to investigate the utility of the Theory of Planned Behaviour (TPB) in understanding PA in an adult population with T1D or T2D. A total of 2311 individuals (691 T1D; 1614 T2D) completed self-report TPB constructs of attitude, subjective norms, perceived behavioural control (PBC), intention and PA at baseline and 1717 (524 T1D; 1123 T2D) completed the PA measure again at 6-month follow-up. Multi-group Structural Equation Modelling was conducted to: (1) test the fit of the TPB structure (2) determine the TPB structural invariance between the two types of diabetes and (3) to examine the explained variances in PA and compare the strength of associations of the TPB constructs in the two types of diabetes. The TPB constructs explained ≥40% of the variance in intentions for both diabetes groups. In cross-sectional models, the TPB accounted for 23 and 19% of the variance in PA for T1D and T2D, respectively. In prospective models, the TPB explained 13 and 8% of the variance in PA for T1D and T2D, respectively. When adjusting for past PA behaviour, the impact of PBC and intention on behaviour was reduced in both groups. The findings provide evidence for the utility of the TPB for the design of PA promotion interventions for adults with either T1D or T2D.     

Comparison of the role of self-efficacy and illness representations in relation to dietary self-care and diabetes distress in adolescents with type 1 diabetes

This cross-sectional study examined the joint effects of self-efficacy and illness representations on dietary self-care and diabetes distress in adolescents with type 1 diabetes by comparing two theoretical models: the Self-regulation Model (Leventhal, H., Meyer, D., & Nerenz, D. (1980). The common-sense representations of illness danger. In S. Rachman (Ed.), Medical Psychology (Vol. 2, pp. 7–30). New York: Pergamon.) and Social Cognitive Theory (Bandura, A. (1997). Self efficacy: The exercise of control. New York: W.H. Freeman.). One hundred and fifty-one adolescents with type 1 diabetes completed self-report measures of dietary self-efficacy, illness representations, dietary self-care and diabetes distress. Data were analysed using structural equation modelling. The model best supported by the data (Leventhal's Self-regulation Model) showed that dietary self-efficacy, perceived consequences and treatment effectiveness had direct and independent effects on both dietary self-care and diabetes distress. Together with dietary self-efficacy, perceived short-term treatment effectiveness was a significant predictor of dietary self-care. Age was found to be a negative predictor of short-term treatment effectiveness beliefs. Diabetes distress was best predicted by self-efficacy and perceived consequences. It can be concluded that to target effectively dietary self-care and distress, clinicians should focus on key illness representation variables (perceived short-term treatment effectiveness and perceived consequences) in conjunction with self-efficacy.