肿瘤科新入职医护人员姑息照护培训及效果分析

目的对肿瘤科新入职医护人员开展姑息照护培训,以提高其姑息照护知识水平。方法对116名新入职医护人员在规范化培训的同时进行姑息照护培训,培训内容包括姑息照护的哲理、原则,失眠、呼吸、营养、便秘、疲乏等症状管理,疼痛管理,与患者及家属的沟通与交流,患者的心理护理,丧亲后家属哀伤辅导6个主题,以专题讲座、角色扮演、情景模拟、小组反思讨论等方式进行培训。于培训前后对肿瘤科新入职医护人员姑息照护知识掌握水平进行评价。结果培训后新入职医护人员姑息照护知识总分及姑息护理哲理和原则、心理精神社会支持、疼痛和症状控制3个维度得分显著高于培训前(均P0.01)。结论姑息照护培训能有效提高肿瘤科新入职医护人员姑息照护知识水平,促进形成积极的姑息照护态度。     

Lysophosphatidylcholine‐induced cytotoxicity and protection by heparin in mouse brain bEND.3 endothelial cells

A pathological feature in atherosclerosis is the dysfunction and death of vascular endothelial cells (EC). Oxidized low‐density lipoprotein (LDL), known to accumulate in the atherosclerotic arterial walls, impairs endothelium‐dependent relaxation and causes EC apoptosis. A major bioactive ingredient of the oxidized LDL is lysophosphatidylcholine (LPC), which at higher concentrations causes apoptosis and necrosis in various EC. There is hitherto no report on LPC‐induced cytotoxicity in brain EC. In this work, we found that LPC caused cytosolic Ca²⁺ overload, mitochondrial membrane potential decrease, p38 activation, caspase 3 activation and eventually apoptotic death in mouse cerebral bEND.3 EC. In contrast to reported reactive oxygen species (ROS) generation by LPC in other EC, LPC did not trigger ROS formation in bEND.3 cells. Pharmacological inhibition of p38 alleviated LPC‐inflicted cell death. We examined whether heparin could be cytoprotective: although it could not suppress LPC‐triggered Ca²⁺ signal, p38 activation and mitochondrial membrane potential drop, it did suppress LPC‐induced caspase 3 activation and alleviate LPC‐inflicted cytotoxicity. Our data suggest LPC apoptotic death mechanisms in bEND.3 might involve mitochondrial membrane potential decrease and p38 activation. Heparin is protective against LPC cytotoxicity and might intervene steps between mitochondrial membrane potential drop/p38 activation and caspase 3 activation.     

辨体-辨病-辨证诊疗模式在慢性病防治中的应用策略

依据中国防治慢性病中长期规划（2017-2025年），按照国医大师王琦教授倡导的"辨体-辨病-辨证诊疗模式"，提出慢性病"3+4+3"防治路向：面向三类人群（一般、高危、患病人群），朝向四种状态（无病、病前、病中、病后状态），指向三辨模式（辨体-辨病-辨证诊疗模式）。进而探讨其应用策略：对于一般人群无病状态——辨体养生，固本防病；对于高危人群病前状态——辨体干预，治本救萌；针对患病人群病中状态——"三辨"施治，标本兼顾；针对患病人群病后状态——辨体调理，固本防复。文中结合案例加以佐证，具有临床指导价值。     

中医体质研究40年回顾与展望

文章回顾中医体质研究40年来在6大理论创新、3大技术创新、4大转化应用、2大学术平台方面取得的辉煌成就。展望未来，中医体质研究将积极策应国家需求，进一步发挥其原创优势、深化理论研究、完善技术方法、加快平台建设、提升服务能力，为实施“健康中国”战略作贡献。     

冠心病从体质干预与通调阴维脉论治

冠心病西医药物治疗虽可控制发作，但有时不能延缓病情发展，非药物治疗过程中围手术期多风险，易病情反复。中医辨证治疗存在证型不统一且证候消失后难根治的问题。倪诚教授秉承王琦国医大师"体病相关""体质可调"理论，认为血瘀体质、痰湿体质、气虚体质是冠心病的发病基础，瘀阻阴维是冠心病的病机要点，祛瘀化痰、补气通维是冠心病的主要治法，临床上自创通维止痛汤，取得良好疗效。     

Renal cell carcinoma staging: pitfalls,challenges, and updates

Renal cell carcinoma (RCC) is unusual among cancers in that it often grows as a spherical, well‐circumscribed mass. Increasing tumour size influences the pathological pT stage category within pT1 and pT2, with cutoffs of 40, 70 and 100 mm; however, with increasing size also comes a sharp increase in the likelihood of renal sinus or renal vein tributary invasion, such that clear cell RCC rarely reaches 70 mm without invading one of these. To clarify some previous challenges in assigning tumour stage, the American Joint Committee on Cancer 2016 tumor–node–metastasis classification has removed the requirements than vein invasion be recognised grossly and that vein walls contain muscle for the diagnosis of vein invasion. Renal pelvis invasion has also been added as an additional route to pT3a. Multinodularity or finger‐like extensions from a renal mass should be viewed with great suspicion for the possibility of vein or renal sinus invasion, and, as tumour size increases to over 40–50 mm, thorough sampling of the renal sinus interface should always be undertaken. With increasing interest in adjuvant therapy in renal cancer, the pathologist's role in RCC staging will continue to be an important prognostic parameter and a tool for selection of patients for enrolment in clinical trials.