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。     

胃肠道肿瘤的分子靶向治疗:未来的方向?

分子靶向治疗是这几年来消化道肿瘤治疗领域的热门话题.这类新一代的分子靶向生物治疗模式,将在临床治疗肿瘤实践中具有广阔的应用前景.从事肿瘤研究的临床医务人员需要综合归纳这些信息,融汇入自己的认知将之合理应用于患者.我们将真正进入传统的细胞毒性药物攻击与非细胞毒性靶向性药物相结合使用的时代,真正实现延长患者的生命,改善其生活质量的目标.     

IMPACT OF JOINT ATTENTION ON SOCIAL‐COMMUNICATION SKILLS IN INTERNATIONALLY ADOPTED CHILDREN

Internationally adopted (IA) children have often experienced early adversity and are at risk for long‐term deficiencies in multiple developmental domains. This study examined the association between IA children's joint attention (JA) soon after arrival and later cognitive, communicative, and socioemotional competency 6 months’ postadoption. We expected a child's initial JA would positively predict later cognitive, communication, and social ability. IA children (n = 63) adopted from Eastern Europe were seen soon after their arrival into the United States to assess their JA. Their socioemotional competency, social communication, and cognitive abilities were measured at a follow‐up session 6 months’ postadoption. We found that higher order JA was positively associated with measures of social relatedness. Furthermore, individual hierarchical regressions of each measure of JA (higher order JA, initiating JA, responding to JA, and initiating behavior requests [BR]) considered with age‐at‐adoption showed that each measure was an independent and positive predictor of Mullen outcomes in the receptive and expressive language domains. These results suggest that JA may be a sensitive predictor of subsequent functioning in the social, communicative, and cognitive domains. Thus, assessing JA soon after arrival has the potential to identify at‐risk IA children, and interventions targeting JA may support those children in overcoming the negative impacts of early adversity.     

超声联合微泡剂介导的肿瘤靶向治疗研究进展

包被气体的微泡剂作为超声造影剂不仅显著提高了临床超声显像诊断能力,而且其作为一种新型药物载体的靶向治疗作用正逐步被揭示。携带基因或药物的超声微泡剂介导肿瘤靶向治疗已经成为超声研究领域中的研究热点。这种微泡剂在超声能量作用下因空化效应导致自身破裂并定向释放所携带的药物或者基因,使特定肿瘤组织或细胞部位浓度大大提高,从而起...     

大肠癌靶向药物治疗进展评述

21世纪以来,靶向药物如抗VEGF的人源化单克隆抗体(Bevacizumab,贝伐单抗)和抗EGFR单克隆抗体(人鼠嵌合性单抗Cetuximab,C225,西妥昔单抗和全人源化单抗EGFR抗体,Panitumumab,帕尼单抗)的临床应用,已使复发转移性结直肠癌患者的总生存取得了长足的进步,但临床上应如何更加合理有效地使用这些药物,仍有许多亟待解决的问题。     

原发性肝癌分子靶向治疗的进展

不能手术和已转移的原发性肝细胞癌（hepatocellular carcinoma,HCC）预后很差,放化疗难以使患者受益。近年来,分子靶向治疗对一些肿瘤已取得突破性进展,肝癌的分子靶向治疗也在临床试验中取得了令人鼓舞的结果。目前的肝癌临床研究主要针对EGFR、VEGF／VEGFR、HGF、MMP、乙肝表面抗原等靶点。本文针对肝癌的分子靶向治疗的研究进展进行了综述。     

靶向药物不良反应的认识与思考

新的靶向药物出现提高了抗癌疗效,降低了毒性,使转移性恶性肿瘤患者从治疗中获益。靶向药物耐受性好,通常出现轻微或中度的毒副反应。尽管大多数不良反应是可以得到迅速处理的,但是严重的甚至危及生命的不良反应仍能够发生。因此,为更好地指导临床实践工作,该文综述了实体瘤治疗中常用靶向药物的主要不良反应和安全数据,并按照药物的作用靶...     

脱贫内生动力机制的质性探究

内生动力是世代贫困个体得以脱贫的核心心理资源。当前, 对脱贫的内生动力仍然缺乏系统性的解释框架。文章以脱贫的内生动力为切入点, 基于内生和外生融合性视角, 采用基于深度访谈的扎根理论方法, 运用强度抽样的策略, 以海南岛某深度贫困村的成功脱贫个体(7人)、世代贫困个体(10人)及扶贫干部(4人)为研究对象, 构建出世代贫困家庭的整体内生动力资源枯竭模型。研究表明：1)以消极的价值观、消极的自我观和被动脱贫的行为倾向为主体的“三因素洋葱模型”是世代贫困个体的消极内在驱动力; 2)作为社会心理动力的控制感缺失是引致世代贫困个体内生动力匮乏的重要诱因, 而贫困个体缺少市场理性及扶贫的运动式治理可能是导致控制感缺失的外部肇因; 3)家长亲职能力在家庭内部建设能力培植子代内生动力的过程中起着中间作用, 即家庭内部建设能力可促进家长亲职能力的提高, 进而激发子代脱贫的内生动力。     

大肠癌常见诊疗误区解析

大肠癌是最常见的恶性肿瘤之一。尽管近年诊疗水平不断提高,但在临床诊疗工作中,仍存在一些误区。本文主要针对肠镜检查的必要性、肝转移是否能手术治疗、术后辅助化疗的适应证、靶向药物的适应证以及K-RAS基因检测的必要性等5方面进行分析。逐步规范大肠癌的诊断和治疗,提高大肠癌综合治疗水平。     

Parenting programmes for parents of children and young people with behavioural difficulties

Children and young people exhibiting behavioural difficulties present a major challenge not only to parents but also to education and health professionals and to society as a whole. In this paper, I shall address some key issues regarding these parenting programmes, based particularly on a programme of research over 13 years in the Centre for Educational Development, Appraisal and Research at the University of Warwick. This has comprised large‐scale studies across all areas of England, both programmes targeted at parents whose children are presenting or at risk of developing behavioural difficulties: the Parenting Early Intervention Pathfinder and Parenting Early Intervention Programme; and universal programmes aimed at all parents, as a positive contribution to behavioural development across the population: the CANparent trial. All were funded by the Department for Education plus the continuation of the CANparent trial was funded by the Department of Health. In addition, I consider studies that have built on this research to examine the use of parenting programmes with parents of children and young people with special educational needs; and also the effectiveness of programmes during sustained implementation, beyond formal trials and similar research initiatives, that is, as day‐to‐day practice. I show that well‐constructed parenting programmes that are acceptable to parents are effective, that these positive effects on parents can remain over time, and also that the positive effects found in well‐organised trials can be maintained when programmes are delivered by community services as part of their normal practice.