化疗在大肠癌综合治疗中的作用

本文对化疗在大肠癌综合治疗中的作用进行评述。近年来治疗晚期与转移性大肠癌的策略有了明显的进展,新药新方法不断涌现,全身化疗能提高晚期大肠癌的缓解率,延长生存期,改善生活质量;辅助化疗已成为高危复发患者的标准治疗;新辅助化疗越来越受到重视;然而,在具体实施综合治疗中如何按照大肠癌的生物学行为,在规范化治疗的前提下,充分考虑患者潜在的预后亚群、效益-成本比、患者的依从性等因素实施个体化,选择最佳治疗方式值得研究。     

‘It’s not the government’s responsibility to get me out running 10 km four times a week’ - Norwegian men’s understandings of responsibility for health

The individualization of health has been extensively discussed in the last few decades. Empirical work, however, has mainly had its origins within neoliberal societies. Norway, as a social democratic welfare state based on universal social rights and egalitarianism is thus of interest in understanding how people’s talk reflects national policies. Through a series of 18 in-depth interviews with a heterogeneous group of middle-aged and elderly men in rural Norway, this paper explores lay men’s understandings of individuals’ responsibility for health vis-à-vis the state’s. The men in this study expressed complex but shared notions of the state’s and the individual’s responsibility for health. The individual’s main responsibility was to act in specific ways in order to maintain good health. However, little blame was placed on those who did not act in the expected way. The state’s main responsibilities were to facilitate the healthy lifestyle of individuals and act as a safety net for those in need. The state was also viewed as being responsible for providing universal health care free of charge, regardless of the reason for the need. We argue that the political and societal values of Norway are reflected in the men’s talk about responsibility for health, alongside neoliberal ideas found in other Western societies. Importantly, however, we conclude that a social democratic welfare state system supports and facilitates agency with regard to health, lifestyle and one’s life more broadly.     

Developing a Risk Score to Guide Individualized Treatment Selection in Attention Deficit/Hyperactivity Disorder

ObjectiveTo develop a risk score for treatment failure that could potentially be used to individualize treatment selection between lisdexamfetamine dimesylate (LDX) and osmotic-release oral system methylphenidate (OROS-MPH) in children and adolescents with attention deficit/hyperactivity disorder (ADHD).MethodsThe study used data from patients with ADHD receiving LDX (N = 104) or OROS-MPH (N = 107) in a phase III randomized clinical trial. A prediction model was developed to estimate risk scores for failing OROS-MPH, where treatment failure was defined as less than 25% improvement in the ADHD Rating Scale IV total score from baseline. Patients were ranked by their predicted risks of OROS-MPH failure to define high-risk subpopulations. Outcomes of LDX and OROS-MPH were compared within subpopulations.ResultsThe prediction model for OROS-MPH failure selected seven predictors (age, disease duration, and five ADHD Rating Scale IV item scores) and had an in-sample C statistic of 0.860. Among all patients, LDX had a 17% (95% confidence interval 7.1%–27.8%) lower treatment failure rate than that of OROS-MPH; differences in failure rates ranged from 17% to 43% across subpopulations, increasingly enriched for high-risk patients. Similar heterogeneity across subgroups was observed for other efficacy measures.ConclusionsIn the overall trial population, LDX was associated with a lower rate of treatment failure compared with OROS-MPH in patients with ADHD. A more pronounced benefit of LDX over OROS-MPH was observed among subpopulations with a higher predicted risk of failing OROS-MPH. The present study showed the feasibility of individualizing treatment selection. Future research is needed to prospectively verify these results.     

浅谈《数字信号处理》课程个性化教学模式

从了解前期课程情况、建立师生交流渠道和在作业批改及实验过程中深层次了解3个方面介绍了师生之间的交流互动,从在课堂上重点讲解共性难点、合理布置作业与批改作业、课间个别辅导、在线响应学生提问、让学生独立完成编程实验、晚自习答疑6个方面阐述了个性化的教学方法,指出了个性化教学模式在保证主要知识讲授的同时必须要兼顾学生个体之间的差异.开展个性化教学,明显改善了教学效果,是一种很好的教学方法.     

航天运动病发生发展中的个体化研究策略

在人类的载人航天活动中,近半数航天员会在其飞行的24~72 h内受到运动病的困扰。运动病可能对航天员的健康和安全造成威胁。同时,航天员在运动病期间工作能力上受到的限制会对飞行任务造成巨大影响,尤其是对短期飞行任务。个体化研究策略关注影响运动病发生发展中的个体化因素,对载人航天事业有着重要的应用意义。基于个体化特征的个体化治疗理念对于治疗和缓解运动病病症,指导临床治疗和康复策略方案的制定将具有重要的指导意义。本文回顾了航天运动病发生率及其生理改变特点并进行了评价,对后续的运动病个体化研究提出了建议。     

Treatment algorithm in 2014 for advanced non-small cell lung cancer: Therapy selection by tumour histology and molecular biology

The availability of antineoplastic monoclonal antibodies, small molecules and newer cytotoxics such as pemetrexed, the EGFR-tyrosine kinase inhibitors erlotinib, gefitinib, afatinib as well as the anti-angiogenic bevacizumab and the ALK-inhibitor crizotinib has recently changes the treatment algorithm of advanced non-small cell lung cancer.Decision making in 2014 is characterized by customizing therapy, by selecting a specific therapeutic regimen based on the histotype and the genotype of the tumour. This refers to first-line induction therapy and maintenance therapy as well, but also to subsequent lines of therapy since anti-neoplastic drugs and regimens used upfront clinically influence the selection of agents/regimes considered for second-/third-line treatment. Consequently, therapy customization through tumour histology and molecular markers has significantly influenced the work of pathologists around the globe and the process of obtaining an extended therapeutically relevant tumour diagnosis. Not only histological sub-typing became standard but molecular information is also considered of increasing importance for treatment selection. Routine molecular testing in certified laboratories must be established, and the diagnostic process should ideally be performed under the guidance of evidence based recommendation. The process of investigating and implementing medical targeting in lung cancer therefore, requires advanced diagnostic techniques and expertise and because of its large dimension is costly and influenced by the limitation of financial and clinical resources.     

Estimated intermediate risk endometrial cancer: debate and new perspectives on therapy individualization and prognosis establishment starting from a peculiar case

The adequate treatment for stage IB endometrial cancer (EC) with G1-G2 grading (intermediate risk patients) is still debated. FIGO guidelines recommend adjuvant radio-therapy in order to avoid recurrences, despite it has been demonstrated that this does not improve the overall survival. Recently, other than the conventional risk-factor (histology, stage and grading), lymph-vascular involvement, tumor size and neoplasia molecular patterns has been proposed with intent to establish the most appropriated EC oncologic treatment and prognosis. We report an interesting case of a patient affected by an early stage EC (estimated intermediate low risk), treated by the adequate surgical staging and subsequent adjuvant radio-therapy that showed, in a follow up period, a very poor prognosis, similarly to patients affected by high risk cancer. Even if the classical validated risk factors remain the “cornerstone” in risk assessment, adjuvant treatments and follow up planning after surgery, the molecular investigation of estimated intermediate risk EC could represent a “keystone” to solve and avoid the “oncologic dilemma” of cases in which the observed prognosis results very different from the expected one. Only a detailed molecular evaluation of these cases could allow a more specific treatment targeting, leading to an individualized therapy and low recurrence-risk. The importance of recurrence-risk reduction is linked to difficulties in both their early detection and appropriate management. The delay in diagnosis as well as the performance of not adequate treatment can potentially make the prognosis of these cases worst that the one detected in case of uterine sarcoma or mixed müllerian tumors.     

精神分裂症伴糖尿病病人的个体化综合护理干预效果观察

[目的]探讨精神分裂症伴发糖尿病病人应用个体化综合护理干预的效果。[方法]选取2016年1月-2019年1月收治的50例精神分裂症伴发糖尿病病人作为研究对象,采用随机分组方法分为对照组(常规护理)和观察组(个体化综合护理干预),比较两组护理效果。[结果]观察组护理依从率(96.0%)明显高于对照组(68.0%)(P<0.05);干预后观察组血糖水平较对照组更低(P<0.05);两组病人生活质量评分比较,观察组病人干预后生活质量评分明显高于对照组(P<0.05);观察组护理满意率(96.0%)明显高于对照组(72.0%,)(P<0.05)。[结论]对精神分裂症伴糖尿病病人实施个体化综合护理干预效果显著。     

Receptor pharmacogenetics: relevance to CNS syndromes

Pharmacogenetic research dedicated to the investigation of inherited factors that influence drug response has produced exciting results over the past decade. Adding to the knowledge that genetic variation in metabolic enzymes may cause drug-related adverse reactions, recent studies indicate that variation in neurotransmitter receptors can also be the cause of treatment failure. In addition, recent studies have attempted to use genetic information for the prediction of treatment outcome. The aim of this review is to summarize the most significant findings in pharmacogenetic research in relation to CNS drugs and to outline how these studies could lead to the individualization of drug treatment.     

个体化舒适护理在妇科腹腔镜手术患者中的应用

目的探讨个体化舒适护理在妇科腹腔镜手术患者的应用方法和效果。方法选择2007年1月-2008年12月,在本院实施妇科腹腔镜手术患者328例为对照组,采用传统的舒适护理;选择2009年2月-2010年2月,选择同类手术患者328例为观察组,采用个体化舒适护理模式。比较两组患者心理及心血管系统应激方面、手术后疼痛水平和并发症发生率、行为知识情况和满意度及舒适度方面的差异。结果观察组患者在心理和心血管系统应激方面低于对照组;在遵医行为、知识、技能及满意度和舒适度方面优于对照组;术后疼痛水平、并发症发生率低于对照组,两组比较,均P<0.05,差异具有统计学意义。结论个体化舒适护理可提高患者满意度和舒适度,减轻患者痛苦和并发症的发生,促进患者康复和改善护患关系。