Harnessing Behavioral Economics Principles to Promote Better Surgeon Accountability for Operating Room Cost: A Prospective Study

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针刺治疗PTSD神经生物学研究进展

近年来，随着经济社会的快速发展与社会关系的复杂化和多元化，诸如自然灾害、暴力犯罪、性侵害等创伤性事件频频发生，创伤后应激障碍（PTSD）的关注度正在逐年上升，如何防治PTSD成为重要的研究课题。针灸作为我国传统医学的瑰宝，在精神疾病的预防和治疗方面有着丰富的经验和独特的优势，临床研究证实，针刺能有效改善PTSD的相关症状，然而其神经生物学机制到底为何，至今仍无定论。基于此，本文综述了近些年发表的相关研究，企图初步揭示针刺治疗PTSD内在的神经生物学机制，为临床治疗提供参考。     

浅谈食管胃结合部腺癌的中医病机特点及治疗

介绍笔者对食管胃结合部腺癌(Adenocarcinomas of the Esophagogastric Junction,AEG)即近端胃癌的中医病机特点的认识,认为食管胃结合部结构与功能不同于胃体及幽门,食管胃结合部主司贲门的契合开闭与食物的传输,是食物、药物进入胃内的狭窄通道,同时也是预防胃内容物返流进入食道的重要防线。其法天而用阳,主受纳通降,易耗气伤阴,受损胃络,表现为气滞、气逆、气虚等气机失调及由此而来痰、热、瘀、毒积聚,最终导致贲门枢机不利,进食不畅、哽噎、呕吐白色痰涎,甚至不能进食等症状。其病机特点是气机失调、痰毒郁结。治疗的关键是调理气机,驱邪扶正,把握贲门开合和降的生理,当补则补,当降则降。     

Chemotherapy rechallenge in metastatic colon cancer: A case report and literature review

BACKGROUNDColorectal cancer (CRC) is the third leading cause of cancer-related death in males and females in the United States. Approximately, 20%-22% of patients have metastatic disease at the time of presentation, and 50%-60% will develop metastasis over the course of their disease. Despite advances in systemic therapies, there remains a paucity of effective third- and later-line therapies for patients with ongoing disease progression. However, rechallenging chemo-resistant CRC tumors with previously administered therapies is an emerging concept that may be a life-prolonging option for heavily treated metastatic colorectal cancer (mCRC).CASE SUMMARYA 41-year-old man with no previous medical history initially presented with worsening diffuse abdominal tenderness. Computed tomography was significant for a splenic flexure mass and hepatic lesions concerning for metastatic disease. He underwent a colectomy with anastomosis. Postoperative pathology was diagnostic for moderately to well-differentiated adenocarcinoma (T4bN1bM1a). He received adjuvant 5-fluorouracil, leucovorin, and oxaliplatin (FOLFOX), but therapy was discontinued due to the development of atrial fibrillation. Additional workup indicated a carcinoembryonic antigen level of 508.2 ng/mL, and mutational analysis found that the tumor was microsatellite instability-high and KRAS/BRAF wild-type. He was started on irinotecan with oxaliplatin (IROX), and bevacizumab (14 cycles), developed disease progression, was transitioned to FOLFOX and cetuximab, and then eventually three cycles of pembrolizumab. Following disease progression, he was rechallenged with IROX therapy, as he previously responded well to oxaliplatin-based therapy. The IROX rechallenge provided this patient with a ten-month survival benefit, decreased metastatic burden, and marked improvement in his clinical condition.CONCLUSIONRechallenge of previous lines of well-tolerated systemic chemotherapy regimens may be a valuable therapeutic strategy in patients with heavily-treated mCRC.     

Changes in DNA Damage Repair Gene Expression and Cell Cycle Gene Expression Do Not Explain Radioresistance in Tamoxifen-Resistant Breast Cancer

Tamoxifen-induced radioresistance, reported in vitro, might pose a problem for patients who receive neoadjuvant tamoxifen treatment and subsequently receive radiotherapy after surgery. Previous studies suggested that DNA damage repair or cell cycle genes are involved, and could therefore be targeted to preclude the occurrence of cross-resistance. We aimed to characterize the observed cross-resistance by investigating gene expression of DNA damage repair genes and cell cycle genes in estrogen receptor-positive MCF-7 breast cancer cells that were cultured to tamoxifen resistance. RNA sequencing was performed, and expression of genes characteristic for several DNA damage repair pathways was investigated, as well as expression of genes involved in different phases of the cell cycle. The association of differentially expressed genes with outcome after radiotherapy was assessed in silico in a large breast cancer cohort. None of the DNA damage repair pathways showed differential gene expression in tamoxifen-resistant cells compared to wild-type cells. Two DNA damage repair genes were more than two times upregulated (NEIL1 and EME2), and three DNA damage repair genes were more than two times downregulated (PCNA, BRIP1, and BARD1). However, these were not associated with outcome after radiotherapy in the TCGA breast cancer cohort. Genes involved in G₁, G₁/S, G₂, and G₂/M phases were lower expressed in tamoxifen-resistant cells compared to wild-type cells. Individual genes that were more than two times upregulated (MAPK13) or downregulated (E2F2, CKS2, GINS2, PCNA, MCM5, and EIF5A2) were not associated with response to radiotherapy in the patient cohort investigated. We assessed the expression of DNA damage repair genes and cell cycle genes in tamoxifen-resistant breast cancer cells. Though several genes in both pathways were differentially expressed, these could not explain the cross-resistance for irradiation in these cells, since no association to response to radiotherapy in the TCGA breast cancer cohort was found.     

微创Nuss手术治疗儿童漏斗胸的研究进展

漏斗胸是一种胸壁凹陷性畸形,Nuss手术是治疗漏斗胸的一种微创手术,具有创伤小、操作简便、并发症少、手术效果良好等优点,已成为治疗漏斗胸的首选术式。随着Nuss手术的不断改良以及腔镜技术的提高,Nuss手术的适用范围不断扩大,胸腔镜辅助Nuss手术在临床应用广泛。作者在Pubmed、万方数据、中国知网等数据库,以漏斗胸、Nuss手术、手术治疗为关键词,查阅相关文献,将微创Nuss手术治疗漏斗胸的概况、技术要点、争议及改良方法等作一综述。虽然Nuss手术的发展给漏斗胸患儿带来福音,但其临床应用的具体问题和中远期疗效仍需进一步研究。     

氩离子凝固术加黏膜下药物注射治疗放射性肠炎初步临床分析

目的 初步探讨内镜下氩离子凝固术(APC)联合黏膜下去甲肾上腺盐水注射治疗放射性肠炎的临床疗效,尤其是对难治性放射性肠炎的疗效评估。方法 回顾分析22例患者临床资料,分别采用改良内镜评分法(A)和Sherman′s classification (B)对患者进行严重程度评分。治疗成功的标准是临床症状的改善或便血停止(或仅有少量便血不需要进一步干预)。结果 22例患者疗后均达到临床症状改善,其中18例(82%)便血完全停止。A评估法:轻度肠炎15例(68%),重度肠炎7例(32%)。B评估法:轻度9例(41%),重度13例(59%)。采用A评估法进行相关分析发现,治疗次数与内镜等级(或内镜评分)有很好的相关性(r=0.86,P<0.001)。结论 初步证明内镜下APC联合黏膜下去甲肾上腺盐水注射治疗放射性肠炎不仅对轻-中患者有效,对难治性放射性肠炎同样可维持长久疗效。A评估法更适合在临床中推广。     

临床护理路径（CNP）在腹部CT增强扫描检查中的应用研究

目的 探究临床护理路径在行腹部CT增强扫描检查患者中的应用效果。方法 收集本院2017年7月～2018年6月收治的120例行腹部CT增强扫描检查患者的临床资料,依据不同的干预方法归纳为对照组和实验组,各60例。前者采取常规护理方法,后者采取临床护理路径。对照并分析两组患者的检查配合度、不良反应发生率、护理满意度及护理差错数。结果 实验组患者的检查配合度为93.3%,明显优于对照组的73.3%(P0.05);实验组患者的不良反应发生率为5.0%,明显低于对照组的18.3%(P0.05);实验组患者的满意度评分为(4.37±0.40)分,明显优于对照组患者的(3.26±0.73)分(P0.05);实验组护理差错共1次,明显少于对照组的8次(P0.05)。结论 临床护理路径在腹部CT增强扫描检查中应用效果较好,能够明显提升患者的依从性,进而更好地配合检查,提高患者的满意度,具有较高的临床实用性。