学习与推行“恶性肿瘤诊治规范”是临床（肿瘤）医生紧迫而持久的任务

恶性肿瘤是迄今威胁人民生命健康最常见、最凶险的一大类疾病,关于它的诊断和治疗,既十分复杂而又涉及多学科协作,制定一种权威性的临床肿瘤诊治规范或指南,去规范临床(肿瘤)医生的医疗实践,有着多方面的重要意义,学习与贯彻指南需要采取一系列措施。     

关于肿瘤专科诊疗最优化与过度医疗

肿瘤专科诊疗最优化准则有狭义、广义之分,二者既有区别,更有联系.肿瘤专科诊疗的过度医疗的内容是动态发展的,在特定情况下有其积极意义.实现肿瘤专科诊疗最优化,避免过度医疗,要重视矛盾问题"底线"的研究,提供相对宽松的技术、学术、文化氛围;医者持续的、有计划的专业学习与培训是增强其主体性的保证和前提;要充分考虑"可承受性"原则;用新的医德价值观指导现实中的医学道德实践;积极发挥医院伦理委员在肿瘤专科诊疗决策中的作用;建立与利用医务人员诚信档案.     

Living with a pituitary tumour: A narrative analysis

This study aimed to synthesise the illness narratives of individuals living with a pituitary tumour. Eight adults with a pituitary tumour were recruited from an endocrinology service in the north-west of England. A narrative methodology was adopted which investigated elements of the individual narratives such as metaphor and structure but which also aimed to produce a joint account of experience in this particular illness context by extracting themes across the stories; these are presented as part of a chronological narrative. However, the resulting group story was also analysed in terms of different types of narrative plots. The group narrative started from the recognition of symptoms and then diagnosis though treatment to post-treatment and future plans. In terms of narrative plots, one notable element of the joint narrative was the flow between the culturally dominant restitution narrative, where participants focused on treatment and recovery and the chaos narrative when recovery did not seem possible. The findings contain many elements consistent with previous research; however, the use of a celebrity figure to communicate about the illness experience and a perception that objects or individuals should not be taken at face value emerged as more novel findings.     

Role of cerebellum in fine speech control in childhood: persistent dysarthria after surgical treatment for posterior fossa tumour

Dysarthria following surgical resection of childhood posterior fossa tumour (PFT) is most commonly documented in a select group of participants with mutism in the acute recovery phase, thus limiting knowledge of post-operative prognosis for this population of children as a whole. Here we report on the speech characteristics of 13 cases seen long-term after surgical treatment for childhood PFT, unselected for the presence of post-operative mutism (mean time post-surgery = 6y10 m, range 1;4-12;6 years, two had post-operative mutism), and examine factors affecting outcome. Twenty-six age- and sex- matched healthy controls were recruited for comparison. Participants in both groups had speech assessments using detailed perceptual and acoustic methods. Over two-thirds of the group (69%) with removal of PFT had a profile of typically mild dysarthria. Prominent speech deficits included consonant imprecision, reduced rate, monopitch and monoloudness. We conclude that speech deficits may persist even up to 10 years post-surgery in participants who have not shown mutism in the acute phase. Of cases with unilateral lesions, poorer outcomes were associated with right cerebellar tumours compared to left, consistent with the notion based on adult data that speech is controlled by reciprocal right cerebellar/left frontal interactions. These results confirm the important role of the cerebellum in the control of fine speech movements in children.     

用耗散结构理论浅析妇科肿瘤的发生机制

根据耗散结构理论说明机体和细胞都具有耗散结构,从机体与外界环境的关系,细胞与机体的关系两个层次阐明了妇科肿瘤的病因和发病机制。以全新的思维方式为妇科肿瘤的研究提供了方法论的指导,具有很大的启迪和借鉴作用。     

Lesion-symptom mapping of language impairments in people with brain tumours: The influence of linguistic stimuli

People with tumours in specific brain sites might face difficulties in tasks with different linguistic material. Previous lesion-symptom mapping studies (VLSM) demonstrated that people with tumours in posterior temporal regions have more severe linguistic impairments. However, to the best of our knowledge, preoperative performance and lesion location on tasks with different linguistic stimuli have not been examined. In the present study, we performed VLSM on 52 people with left gliomas to examine whether tumour distribution differs depending on the tasks of the Aachen Aphasia Test. The VLSM analysis revealed that single-word production (e.g. object naming) was associated with the inferior parietal lobe and that compound and sentence production were additionally associated with posterior temporal gyri. Word repetition was affected in people with tumours in inferior parietal areas, whereas sentence repetition was the only task to be associated with frontal regions. Subcortically, word and sentence production were found to be affected in people with tumours reaching the arcuate fasciculus, and compound production was primarily associated with tumours affecting the inferior longitudinal and inferior fronto-occipital fasciculus. Our work shows that tasks with linguistic stimuli other than single-word naming (e.g. compound and sentence production) relate to additional cortical and subcortical brain areas. At a clinical level, we show that tasks that target the same processes (e.g. repetition) can have different neural correlates depending on the linguistic stimuli used. Also, we highlight the importance of left temporoparietal areas.