“临床早期接触”对医学生关怀能力养成的效果分析——以汕头大学医学院“医者之心（HEART）”课程为例

目的探讨医者之心（HEART）课程中“临床早期接触社会实践环节”对关怀能力养成的效果，对该课程纳入“临床早期接触”的教学设计做小结。方法编纂临床早期接触中的“隐性课程”体验问卷，对参加医者之心（HEART）课程的临床早期接触社会实践环节的学生进行事后访问及问卷调查，以此评估“隐形课程”对医学生关怀能力养成的初步情况。 结果医学实习生对各种具有隐性课程内涵举措的各个维度对其关怀能力培育的帮助，均呈偏正向的态度。“带教教师教学示范”“关怀展现”“专业胜任能力对学生关怀能力影响”这3个构面的强弱程度，会因“学生临床早期接触时长”“带教教师年资”“临床早期接触过程满意程度”的不同而呈现显著差异。结论“临床早期接触各类组织形式”对第一次进入临床体验的医学生关怀能力认知有重要影响，典范学习及同伴影响对医学生关怀能力认知有正向影响。     

Coping Strategies for HIV-Related Stigma in Liuzhou,China

This study explores the feelings, experiences, and coping strategies of people living with HIV (PLHIV) in Liuzhou, China. In a southwestern Chinese city with high HIV prevalence, we conducted semi-structured in-depth interviews with 47 PLHIV selected to represent individuals who had acquired HIV via different acquisition routes. Many participants felt severely stigmatized; they commonly reported having very low self-esteem and feelings of despair. Based on style of coping and whether it occurred at the interpersonal or intrapersonal level, four types of coping that participants used to deal with HIV-associated stigma were identified: (1) Compassion (Passive/Avoidant—Interpersonal); (2) Hiding HIV status (Passive/Avoidant—Intrapersonal); (3) Social support (Active/Problem-focused—Interpersonal; and (4) Self-care (Active/Problem-focused—Intrapersonal). Educational and stigma-reduction interventions targeting potential social support networks for PLHIV (e.g., family, close friends, and peers) could strengthen active interpersonal PLHIV coping strategies. Interventions teaching self-care to PLHIV would encourage active intrapersonal coping, both of which may enhance PLHIV quality of life in Liuzhou, China.     

大学生人格的年级变异性

目的探讨大学生人格变化与所处年级的关系。方法采用卡特尔人格问卷(16PF)对浙江农林大学健康管理专业大一至大三104名学生进行为期一学年前后测评。结果①具有统计学显著性变异的人格因子一年级有:C(t=2.079,P<0.05)、E(t=-3.606,P<0.01)、G(t=-2.456,P<0.05)、L(t=-4.86,P<0.01)、Q3(t=2.447,P<0.05)、Q4(t=-2.893,P<0.01);二年级有:E(t=-3.438,P<0.01)、I(t=3.369,P<0.01)、X3(t=-3.747,P<0.01)、Y2(t=-2.5277,P<0.05);三年级有:E((t=-2.832,P<0.01)、M(t=-3.092,P<0.01)、Q1(t=-2.361,P<0.05)、X4(t=-4.629,P<0.01)、Y2(t=-2.603,P<0.05);②不同年级相比,变异程度大的人格因子主要有C(t=-2.103,P<0.05)、I(t=2.321,P<0.05)、X1(t=2.25,P<0.05)、X3(t=-2.052,P<0.05);Q4(t=2.081,P<0.05)、X4(t=-2.322～-2.143,P<0.05)。结论大学生人格变异具有年级特点,一年级人格因子值提高的有C、Q3;降低的有E、G、L、Q4;二年级提高的有I,降低的有E、X3、Y2;三年级人格因子值降低的有E、M、Q1、X4、Y2。并且,情绪性因子变异程度较大。     

Therapie der rezidivierten und fernmetastasierten Plattenepithelkarzinome des Kopf-Hals-Bereichs

This year, the treatment of patients with recurrent or metastatic head and neck squamous cell carcinoma (R/M-HNSCC) was mainly dominated by immunotherapy. The corresponding studies are presented in another article. Beside this, results of phase II studies in particular were presented at the ASCO Annual Meeting, in which—as in recent years—new drugs (monoclonal antibodies, small molecules) played a major role. Furthermore, a clinical scoring system for prognosis evaluation in R/M-HNSCC patients was presented and the influence of HPV status on survival in this patient cohort was investigated. The studies presented herein reflect the different drug-based treatment concepts in R/M-HNSCC and represent the variety of therapeutic approaches in the recurrent and metastatic setting.     

丹参川芎嗪联合疏血通治疗慢性脑供血不足30例临床研究

目的 观察丹参川芎嗪注射液联合疏血通注射剂治疗慢性脑供血不足(CCCI)的临床疗效及对患者血液动力学的影响.方法 在就诊患者中随机选取90例CCCI患者,随机分为3组,丹川组给予丹参川芎嗪注射液,疏血通组给予疏血通,联合组给予疏血通和丹参川芎嗪,3组均为1次/d,疗程14 d.在治疗前后分别对3组采用经颅多普勒超声(TCD)进行脑血流动力学检测;观察治疗前后患者头晕、头痛等临床症状改善情况等的变化.结果 疏血通注射液和丹参川芎嗪注射液均有改善头晕、头痛等症状及改善脑血流动力学的作用,但联合组治疗后头晕、头痛等临床症状减轻更明显,血液流变学改善更显著(P＜0.05).结论 丹参川芎嗪联合疏血通治疗CCCI比单独用药疗效更佳.     

Composition and plasticity of triple-negative breast carcinoma-infiltrating regulatory T cells

Low Foxp3⁺ regulatory T-cell (Treg) presence in the tumor-infiltrating lymphocytes (TILs) is considered favorable in breast cancer, and numerous CD25-targeting agents have been applied in the attempt to remove Foxp3⁺ Treg cells, which typically present CD4⁺CD25^+/hi surface phenotype. However, CD25 is not Treg-exclusive and can be upregulated by effector T cells. Hence, CD25 depletion may cause the elimination of activated T cells that are responding to tumor-specific antigens. In this study, the composition and function of CD4⁺CD25⁺ cells inside the microenvironment of triple-negative breast carcinoma (TNBC) were investigated. Directly ex vivo, the Foxp3⁺ Treg cells represented a minor subset in total CD4⁺CD25⁺ TILs. Significant differences were observed in the expression of Treg-associated molecules between CD4⁺CD25⁺Foxp3⁺ TILs and CD4⁺CD25⁺Foxp3⁻ TILs. While both the CD4⁺CD25⁺Foxp3⁺ and the CD4⁺CD25⁺Foxp3⁻ TILs could express CTLA-4 and LAG-3, the expression levels were significantly higher in CD4⁺CD25⁺Foxp3⁺ TILs than in CD4⁺CD25⁺Foxp3⁻ TILs. Upon TCR stimulation, the expression of TGF-beta was significantly higher in CD4⁺CD25⁺Foxp3⁺ TILs, while the expression of IL-10 was significantly higher in CD4⁺CD25⁺Foxp3⁻ TILs. These differences were conserved in the blood counterparts of these cells. Interestingly, the level of CD25⁺Foxp3⁺ cells in circulating CD4⁺ T cells was positively correlated with the level of CD25⁺Foxp3⁺ cells in CD4⁺ TILs, but the level of CD25⁺Foxp3⁻ cells in circulating CD4⁺ T cells was not associated with the level of CD25⁺Foxp3^- cells in CD4⁺ TILs. Th17-polarizing medium could readily remodel CD4⁺CD25⁺Foxp3⁻, but not CD4⁺CD25⁺Foxp3⁺, T cells into RORgammat and IL-17-expressing T cells, demonstrating stronger plasticity of the former subset. Together, these data demonstrated that the CD4⁺CD25⁺ TILs were composed of distinctive Foxp3⁻ and Foxp3⁺ cells, with the former representing the major subset. The antigen specificity and effector molecule expression of the CD4⁺CD25⁺Foxp3⁻ thus require further analyses.     

Publishing in open access era: focus on respiratory journals

We have entered an open access publishing era. The impact and significance of open access is still under debate after two decades of evolution. Open access journals benefit researchers and the general public by promoting visibility, sharing and communicating. Non-mainstream journals should turn the challenge of open access into opportunity of presenting best research articles to the global readership. Open access journals need to optimize their business models to promote the healthy and continuous development.