What We're Not Talking about When We Talk about Addiction

The landscape of addiction is dominated by two rival models: a moral model and a model that characterizes addiction as a neurobiological disease of compulsion. Against both, I offer a scientifically and clinically informed alternative. Addiction is a highly heterogenous condition that is ill-characterized as involving compulsive use. On the whole, drug consumption in addiction remains goal directed: people take drugs because drugs have tremendous value. This view has potential implications for the claim that addiction is, in all cases, a brain disease. But more importantly, it has implications for clinical and policy interventions. To help someone overcome addiction, you need to understand and address why they persist in using drugs despite negative consequences. If they are not compelled, then the explanation must advert to the value of drugs for them as an individual. What blocks us from acknowledging this reality is not science but fear: that it will ignite moralism about drugs and condemnation of drug users. The solution is not to cleave to the concept of compulsion but to fight moralism directly.     

Active surveillance and focal therapy for low-intermediate risk prostate cancer

Low risk and many cases of low-intermediate risk prostate cancer, are indolent, have little or no metastatic potential, and are not life threatening. Major advances have been made in understanding who these patients are, and in encouraging the use of conservative management in such individuals. Conservative management incorporates the early identification of those ‘low risk’ patients who harbor higher risk disease, and benefit from definitive therapy. Based on the current algorithm of PSA followed by systematic biopsy, this represents about 30% of newly diagnosed low risk patients. A further small proportion of patients with low risk disease demonstrate biological progression to higher grade disease. Men with lower risk disease can defer treatment, usually for life. Men with higher risk disease that can be localized to a relatively small volume of the prostate may be candidates for focal, prostate sparing therapy. The results of active surveillance, embodying conservative management with selective delayed intervention for the subset who are re-classified as higher risk over time based on repeat biopsy, imaging, or biomarker results, have shown that this approach is safe in the intermediate to long term, with a 1-5% cancer specific mortality at 15 years. Further refinement of the surveillance approach is ongoing, incorporating MRI, targeted biopsies, and molecular biomarkers.     

Expecting the Holistic Regulation from Chinese Medicine Based on the "Solar System" Hypothesis of Ischemic Heart Disease

Stenosis of the coronary artery has been considered as an essential component of ischemic heart disease (IHD). Consequently, revascularization [e.g., percutaneous coronary intervention (PCI) and coronary artery bypass] has been the primary therapeutic approach to IHD. Such strategy has indeed revolutionized the management of IHD patients. However, not all patients with myocardial ischemia have visible coronary stenosis. Moreover, cardiovascular events occur in nearly 20% patients with stable coronary artery disease who have undergone PCI. The recently proposed “solar system” hypothesis of IHD postulates that coronary stenosis is only one (albeit important) of its features. Mechanistic contribution and clinical implication of multiple pathophysiological processes beyond coronary stenosis are highlighted in this hypothesis. On the basis of a holistic regulation and individualized medicine, Chinese medicine (CM) has been used in the real-world setting to manage a variety of diseases, including IHD, for more than two thousands years. In this article, we summarize the evidence of CM that supports the “solar system” IHD hypothesis, and argue for a comprehensive approach to IHD. At the theoretical level, the central features of this approach include a holistic view of disease and human subjects, as well as individualized medicine. At the practical level, this approach emphasizes anoxia-tolerance and self-healing.     

中性粒细胞与淋巴细胞比率对NSTE-ACS患者左主干或三支病变的预测价值

目的 探讨中性粒细胞与淋巴细胞比率(NLR)对非ST段抬高型急性冠脉综合征(NSTE-ACS)患者左主干或三支病变独立预测价值。方法 选取150例NSTE-ACS患者,根据冠脉造影结果分析NLR水平对NSTE-ACS患者左主干或三支病变的预测价值。结果 150例患者纳入最后的分析,通过受试者工作特征曲线分析,NLR水平预测NSTE-ACS患者左主干或三支病变的最佳截断值为2.58(曲线下面积0.72,特异性78.8%,敏感性61.2%)。150例NSTE-ACS患者中,NLR水平≥2.58的患者平均年龄较NLR<2.58的患者偏大(P=0.02),出现左主干或三支病变的比例明显升高(P<0.01)。logistic回归分析显示NLR≥2.58是对NSTE-ACS患者左主干或三支病变的独立预测因素(OR:4.73,95% CI:1.94~11.54,P<0.01)。结论 NLR≥2.58是预测NSTE-ACS患者左主干或三支病变的独立危险因素。     

经脐单孔腹腔镜治疗泌尿系疾病的围手术期护理体会

目的：讨论泌尿系疾病使用经脐单孔腹腔镜手术治疗的护理方法及体会。方法对我科2012年4月~12月住院患者行单孔腹腔镜手术治疗20例进行完善的术前准备、术后密切观察生命体征，实施各项护理措施预防并发症的发生。结果20例患者均顺利手术，手术后未发生并发症。结论单孔腹腔镜手术治疗泌尿系疾病在临床迅速发展，对手术患者实施针对性的护理，预防并发症，有助于加快康复，提高患者生活质量。