外科手术在晚期乳腺癌中的作用与地位

首诊Ⅳ期乳腺癌的外科治疗是否获益,是当前热议的问题,目前争议很大。本文就外科手术在晚期乳腺癌中的作用与地位问题,进行了探讨,认为需要更多的实践才能得出结论;提出晚期乳腺癌外科手术治疗的辩证观点,即处理好局部与整体的关系,抓住主要矛盾,根据不同的分子分型进行个体化的治疗选择。     

CXCR4／CXCL12在胃癌及结直肠癌中的研究进展

消化道肿瘤是一种常见的恶性肿瘤,远处转移是其预后不良的主要原因。近年来消化道肿瘤的发病率逐年上升,其相应的研究得到了广泛的重视。趋化因子对肿瘤的侵袭和转移作用也备受关注。 CXCR4及 CXCL12在肿瘤研究中已逐渐成为热点;最近研究表明,其与胃癌、结直肠癌等的转移密切相关,将为消化道肿瘤转移的防治提供新的思路。此文对CXCR4／CXCL12在胃癌及结直肠癌中的研究进展做一简要综述,CXCR4／CXCL12轴的深入研究将有望使其成为消化道肿瘤靶向治疗的特异靶点。     

急性心肌梗死患者小动脉弹性指数水平与各项危险因素的关系

探讨急性心肌梗死（AMI）患者小动脉弹性指数（C2）水平与各项风险因素的关系。纳入我院心血管内科于2010年1月～2013年7月间收治的AMI患者,并纳入同期入院的不稳定心绞痛（UA）患者作为对照组,收集相关临床资料,比较不同C2水平与相关指标的关联性发现：C2等11项危险因素存在显著差异,经多因素Logistic回归...     

放疗科的医患共同决策

放疗是恶性肿瘤最重要的治疗手段之一。由于诊疗体系的特殊性,放疗科与其他临床学科在医患共同决策方面有着巨大的差异性。在知情问题的处理上,需要选择性地与患者进行交流。在医患共同决策中,医生作为主导者具有纠偏的功能。按照放疗的治疗目的,达到不同层级的共同决策是放疗科的特征。放疗的疗程时间长,医患共同决策在整个放疗周期中被分解为多个,体现出差异性。了解这些特点,在放疗中应用共同决策,将使治疗的依从性得到改进。

     

The Social Context of Organized Nonbelief: County‐Level Predictors of Nonbeliever Organizations in the United States

Many recent social scientific studies have noted that the percentage of Americans with no religious affiliation is on the rise, but few have examined the nonbeliever organizations that some of these “nones” might join. This study uses an original data set, the first attempt at documenting the population of local nonbeliever organizations in the United States, to explore where these groups are more likely to flourish. Though one might assume that less religious counties, as measured by the percentage of those with no stated religious affiliation, would be more likely to contain nonbeliever organizations, this article provides evidence that they emerge more frequently and in greater numbers in counties with proportionally more evangelical Protestants. The percentage of evangelicals among a county's population is strongly associated with both the existence (dichotomously coded) and the number of nonbeliever organizations, even when controlling for a range of demographic and institutional factors.     

Dimensions of Operational Stress and Forms of Unacceptable Risk-Taking With Small Arms

This research studied the association between dimensions of operational stress, forms of risk-taking with small arms, and possible mediators. Operational threat and negative affect were predictors, unauthorized preparedness and risky games were dependent variables, and safety climate and personality profile from the Eysenck Personality Questionnaire—Revised Short Form were mediators. The participants were 461 compulsory service soldiers in 31 companies. The results revealed that operational threat is related to unauthorized preparedness, and positive–negative affect is related to risky games. Safety climate mediated risky games only. Unauthorized preparedness and risky games were influenced by the interaction of Psychoticism and the Lie scale from the Eysenck Personality Questionnaire—Revised Short Form.     

恶性肿瘤的过度治疗及其防范

恶性肿瘤的过度治疗涉及到手术、放疗、化疗、靶向治疗、生物治疗等多个方面,严重影响了患者的生存质量。造成这一现象的原因是多方面的：患者由于对肿瘤的恐惧而形成过分关注;医生未及时更新治疗观念,过于注重对肿瘤的彻底杀伤,并对自己行医的过分保护;医院的不恰当管理。为了促进肿瘤治疗环境的合理化,我们应该防范过度治疗,加强宣传教育,完善医德医风,促进医疗改革的顺利完成。倡导合理、受益性治疗,使患者达到长期带瘤生存的目的。     

努力避免肿瘤的过度化疗

化疗是肿瘤治疗的主要手段之一,在临床实践中发挥着十分重要的作用,但是其有明显的毒副作用,避免过度化疗是医疗的基本要求。临床过度化疗的原因与现行医疗管理与流程、医生的诊疗水平有关。近年来,人们对肿瘤生物学行为规律认识不断深入,更加注重个体化治疗,肿瘤治疗领域快速更新,因此对医疗决策水平也提出更高的要求。需要通过规范肿瘤诊疗流程、更新知识、积累经验、临床试验并结合我国国情,权衡利弊,使患者接受恰当治疗。     

严格掌握使用粒细胞集落刺激因子的适应证

粒细胞集落刺激因子（G—CSF）可以作用于粒系前体造血干细胞和外周成熟的效益细胞,促进其增殖、分化。G—CSF促使组织修复和血管生成的效能使其在临床上得到广泛使用,与此同时,G—CSF及受体在肿瘤中的表达及该药物的不良反应也引起了关注,本文旨在探讨G—CSF功效及副作用,引起临床医师的重视,把握适应证,指导合理用药。