中国政治文明建设的价值选择

中国社会主义政治文明建设是既要置于人类政治文明的背景之中 ,又要具有中国特色。政治文明建设价值选择是对政治文明发展趋向的整体确认 ,必须从政治理念、政治制度、政治行为、政治关系层面来把握。人类政治文明同质价值选择主要体现在权力制约、人民主权、治理方式 ;中国政治文明特质价值即社会主义定向和中国国情 ,这种价值选择体现在制度形态、治理形态、文化形态之中。     

王左论脉症从舍及其临床治验

从标本缓急和虚实真假两方面系统总结王左教授对脉症从舍的认识，并附舍脉从症案及舍症从脉案以具体分析。     

丹蒌片联合比索洛尔治疗冠心病心绞痛的临床研究

目的探讨丹蒌片联合比索洛尔治疗冠心病心绞痛的临床疗效。方法选取2015年2月—2018年2月于天津市第三中心医院收治的冠心病心绞痛患者104例作为研究对象,随机分成对照组和治疗组,每组各52例。对照组口服富马酸比索洛尔片,1片/次,1次/d。治疗组患者在对照组治疗基础上口服丹蒌片,5片/次,3次/d。两组均连续治疗6周。观察两组患者的临床疗效标准和心电图疗效,比较两组患者ADL评分、硝酸甘油用量、颈动脉内中膜厚度(IMT值)、血清指标的变化情况。结果治疗后,对照组和治疗组的临床总有效率分别是76.92%、92.31%;心电图总有效率分别是82.69%、96.15%,两组比较差异具有统计学意义(P0.05)。治疗后,两组患者ADL评分均显著升高,而硝酸甘油用量及颈动脉IMT值均显著降低,同组治疗前后比较差异有统计学意义(P0.05);治疗后,治疗组ADL评分显著高于对照组,而硝酸甘油用量及颈动脉IMT值低于对照组,两组比较差异有统计学意义(P0.05)。治疗后,两组患者血清可溶性CD105(sCD105)、P选择素及氨基末端脑钠肽前体(NT-proBNP)水平均较治疗前显著降低,同组治疗前后比较差异有统计学意义(P0.05);治疗后,治疗组这些血清学指标显著低于对照组,两组比较差异有统计学意义(P0.05)。结论丹蒌片联合比索洛尔治疗冠心病心绞痛疗效显著,能显著改善患者生活质量水平,改善血清学相关指标,具有一定的临床推广应用价值。     

Line-up Member Similarity Influences the Effectiveness of a Salient Rejection Option for Eyewitnesses

Visually salient line-up rejection options have not been systematically studied with adult eyewitnesses. We explored the impact of using a non-verbal, salient rejection option on adults' identification accuracy for line-ups containing low- or high-similarity fillers. The non-verbal, salient rejection option had minimal impact on accuracy in low-similarity line-ups, but in high-similarity line-ups its inclusion increased correct rejections for target-absent line-ups as well as incorrect rejections in target-present line-ups, relative to a verbal rejection condition. The improved performance in target-absent line-ups suggests that adults, like children, may experience pressure to choose and guess during difficult tasks. This pressure is reduced when a prominent non-verbal rejection option is displayed in the line-up. However, the salient rejection option also appears to increase the attractiveness of avoiding a difficult choice between the target and highly similar fillers. Implications of these findings for the experimental literature and justice system are discussed.     

Facilitating surgical decisions for patients who are uncertain: a pilot surgical option process within an interdisciplinary functional restoration program

Background contextFor chronic pain patients, recovery may be slowed by indecisiveness over optional surgery. These patients may be delayed from participating in interdisciplinary functional restoration (FR), pending resolution of the surgical decision. Uncertainty about surgery or rehabilitation leads to delayed recovery. A surgical option process (SOP) was developed to permit patients with chronic disabling occupational musculoskeletal disorders to enter FR, make a final determination halfway through treatment, and return to complete rehabilitation after surgery, if surgery was elected.PurposeThis study assessed the frequency with which an FR program can resolve an uncertain surgical option. It also assessed program completion rate and 1-year post-program outcomes for subgroups that decline surgery, request and receive surgery, or request surgery but are denied by surgeon or insurance carrier.Study designRetrospective study of a consecutive cohort.Patient sampleA cohort of 44 consecutively treated chronic disabling occupational musculoskeletal disorder patients were admitted to an FR program and identified as candidates for a surgical procedure but were either ambivalent about undergoing surgery, had a difference of opinion by two or more surgeons, or were denied a surgical request by an insurance carrier. Patients attended half (10 full day visits) of an FR program before making their own final determination to pursue a request or decline surgery.Outcome measuresPatients were assessed on surgical requests and whether surgery was ultimately performed, program completion status after the surgical determination, demographic variables, and 1-year outcomes on work status, additional surgery, and other health utilization measures.MethodsPatients became part of the SOP on program entry and were included in the study if they participated in a surgical-decision interview halfway through the program. Those who elected to decline surgery (DS) completed the program without delay, but those requesting surgery were placed on hold from the program while consultation and preauthorization steps took place. Those requesting surgery, but denied (RSD), and those undergoing surgery (US) were given the opportunity to complete FR following postoperative physical therapy or resolution of the surgical re-evaluation process.ResultsThere were 32 DS patients (73%), indicating that a large majority of patients declined the surgery that was still being considered when offered participation in the SOP. Of the 12 patients wanting a surgery, there were four US patients who received surgery previously denied (9% of cohort), and eight RSD patients (18% of cohort). Patients from the DS group completed the FR program at an 88% rate, as did 75% of US patients. However, despite an opportunity to re-enter and complete rehab, only 50% of RSD patients completed the FR option. Overall, patients who persistently sought surgery, contrary to the recommendations of a surgeon, had poorer outcomes. These 1-year post-FR outcomes included lower return-to-work and work retention rates, with higher rates of treatment seeking from new providers (resulting in higher rates of post-discharge surgery) and higher rates of recurrent injury claims after work return.ConclusionsA SOP tied to participation in an interdisciplinary FR program resolves uncertainty regarding surgical options in a high proportion of cases, resulting in a large majority declining surgery and completing the FR program. Timely surgery is also promoted decisively when needed. Findings suggest that patients who persistently seek surgery, contrary to the recommendations of a surgeon, frequently fail to complete FR and have poorer outcomes overall.     

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.     

Vessel co‐option is common in human lung metastases and mediates resistance to anti‐angiogenic therapy in preclinical lung metastasis models

Anti‐angiogenic therapies have shown limited efficacy in the clinical management of metastatic disease, including lung metastases. Moreover, the mechanisms via which tumours resist anti‐angiogenic therapies are poorly understood. Importantly, rather than utilizing angiogenesis, some metastases may instead incorporate pre‐existing vessels from surrounding tissue (vessel co‐option). As anti‐angiogenic therapies were designed to target only new blood vessel growth, vessel co‐option has been proposed as a mechanism that could drive resistance to anti‐angiogenic therapy. However, vessel co‐option has not been extensively studied in lung metastases, and its potential to mediate resistance to anti‐angiogenic therapy in lung metastases is not established. Here, we examined the mechanism of tumour vascularization in 164 human lung metastasis specimens (composed of breast, colorectal and renal cancer lung metastasis cases). We identified four distinct histopathological growth patterns (HGPs) of lung metastasis (alveolar, interstitial, perivascular cuffing, and pushing), each of which vascularized via a different mechanism. In the alveolar HGP, cancer cells invaded the alveolar air spaces, facilitating the co‐option of alveolar capillaries. In the interstitial HGP, cancer cells invaded the alveolar walls to co‐opt alveolar capillaries. In the perivascular cuffing HGP, cancer cells grew by co‐opting larger vessels of the lung. Only in the pushing HGP did the tumours vascularize by angiogenesis. Importantly, vessel co‐option occurred with high frequency, being present in >80% of the cases examined. Moreover, we provide evidence that vessel co‐option mediates resistance to the anti‐angiogenic drug sunitinib in preclinical lung metastasis models. Assuming that our interpretation of the data is correct, we conclude that vessel co‐option in lung metastases occurs through at least three distinct mechanisms, that vessel co‐option occurs frequently in lung metastases, and that vessel co‐option could mediate resistance to anti‐angiogenic therapy in lung metastases. Novel therapies designed to target both angiogenesis and vessel co‐option are therefore warranted. © 2016 The Authors. The Journal of Pathology published by John Wiley & Sons Ltd on behalf of Pathological Society of Great Britain and Ireland.     

Case Histories of Six Consumers and Their Families in Cash and Counseling

Objective. To examine how the lives of consumers and their caregivers were affected by making choices and controlling their own resources with the cash option, this paper focuses on six case studies from the Cash and Counseling Demonstration Program.
Data Sources. Twenty-one consumers, caregivers, and state consultants were interviewed about their experiences in the program.
Study Design. The data come from a larger study of over 200 interviews conducted from June 2000 to August 2004. Interview data were analyzed for themes about caregiving and program satisfaction.
Principal Findings. Cash and Counseling benefited consumers and caregivers by allowing consumers increased continuity and reliability of care, increased ability to set hours of care, more satisfaction with how caregiving is offered and more satisfaction with the quality of care.
Conclusions. The cash option allowed consumers to create, schedule, and manage their own model of care. Some consumers faced challenges in the program with paperwork, accounting, worries about receiving care, and some ineffective state consultants who could have been more helpful.     

Broadening the Concept of Value: A Scoping Review on the Option Value of Medical Technologies

ObjectivesA recent debate in health economics and outcomes research community identified option value as one of the elements warranting consideration in the assessment of medical technologies. To conduct a scoping review of contributions on option value in the healthcare sector and identify relevant conceptual aspects and methods used to incorporate it in standard economic evaluations.MethodsA systematic search was conducted up to July 2020 to identify contributions from electronic bibliographic database and gray literature. Data on the proposed definitions of option value, theoretical implications of its use in economic evaluations, and methods used to estimate it were extracted and analyzed.ResultsWe found 57 eligible studies. Three different definitions emerged: insurance value, real option value, and option value of survival. Focusing on the latter (24 studies), we analyzed in depth 8 empirical applications across 7 therapeutic areas. The most relevant methodological challenges were on the perspective used in economic evaluations and how to robustly manage forecasting uncertainty, update cost-effectiveness thresholds, and avoid double-counting issues. For empirical studies assessing the total value of the technology, including option value, estimates ranged from +7% to +469% of its conventional value.ConclusionsThis review synthesizes theoretical and empirical aspects on option value of healthcare technologies and proposes a terminology to distinguish 3 different concepts identified. Future work should focus primarily on agreeing on whether option value should be included in economic evaluations and, if so, on developing and validating reliable methods for its ex-ante estimation.