目的 调查癌症生存者经济毒性现状,并分析其影响因素,为制订降低经济毒性的针对性干预策略提供参考.方法 选取1 065例癌症生存者为研究对象,采用一般资料问卷、慢性病治疗的经济毒性功能评估综合评分量表、心理弹性量表简化版、癌症孤独和负面社会期望量表、领悟社会支持量表、安德森症状量表进行横断面调查.结果 癌症生存者经济毒性总分为(24.20±7.75)分,其中535例(50.23％)存在经济毒性.多重线性回归分析结果显示:家庭月收入、可支配的家庭存款、截止目前自付费用、治疗费用信息了解程度、患肿瘤部位、抗肿瘤治疗方式,以及症状严重程度、心理弹性、孤独感、社会期望是癌症相关经济毒性的主要影响因素(均P＜0.05),可解释经济毒性总变异的39.0％.结论 经济毒性在癌症生存者中普遍存在,除人口学、疾病、经济层面因素外,症状严重程度、心理弹性、孤独感和社会期望均会影响癌症生存者相关经济毒性,需采取针对性干预措施以降低其经济毒性水平.

阿米巴感染性肠炎是一种较少见的胃肠道感染性疾病，临床症状表现为不同程度的腹痛、腹泻伴血便，暴发型阿米巴肠病为其最严重的并发症，病死率高。本文回顾性分析复旦大学附属华山医院收治的1例以转移性右下腹痛表现起病，最终确诊为暴发型阿米巴肠病患者的临床资料和治疗过程，并结合国内外文献分析该病临床特点、影像学表现、病理特点及治疗。

在恶性肿瘤依然位居第一死亡原因的今天,患者对此产生恐惧、无助、愤怒、焦虑、抑郁甚至绝望等负面情绪,是很正常的心理反应.只是,考虑到情绪因素在肿瘤的发生、发展及预后过程中所具有的重要影响,如何缓解患者的不良情绪,成为患者、家属及相关专业人员急于了解和解决的问题之一. 在确诊、治疗到最终康复出院的整个过程中,不同患者因个体差异及周围支持系统的不同,会出现不同程度的不良情绪反应.临床上,我们常常感到与肿瘤患者难以有效沟通.他们往往表现出孤僻、多疑、易激惹、愤怒等负面情绪.其中有些情绪与疾病本身有关,而另一些情绪可能由我们的沟通不当所致.

目的 评价CD4+T淋巴细胞(简称CD4细胞)计数与艾滋病病毒(HIV)病毒载量检测,对于HIV检测与病情诊断和治疗监测的经济性.方法 设定检索时间与检索关键词,查阅中英文文献,比较两种检测技术的经济性,并分析其影响因素.结果 相比仅依靠CD4细胞计数指导治疗,病毒载量检测指示的抗病毒治疗(ART)能够带来更好的治疗效果和健康结果,但是成本较高.在社会经济发展程度不高的地区,尚没有绝对的证据证明病毒载量检测较CD4细胞计数检测的经济性;而在经济较发达地区,病毒载量检测技术显示出更好的经济性;两种技术共用时,较CD4细胞计数单独使用时往往不具有经济性;仅在南非等经济较发达地区,合并使用两种检测技术更具备成本效果.ICER阈值、具体的检测方案、包含的成本范围以及考虑的健康收益范围,通常是影响经济性评价的重要因素.结论 在资源限制的欠发达地区,CD4细胞计数显示出较好的经济性,应优先使用;在经济发展水平较好的地区,可尝试发展和使用病毒载量检测技术,或联合CD4细胞计数共同使用以指导ART.

Objective To describe the influencing factors of postoperative uncertainty level in the patients with esophageal carcinoma .Methods Mishel Uncertainty in Illness Scale for Adults ( MUIS-A) was used to inves-tigate the postoperative uncertainty level in 80 patients with esophageal carcinoma who were selected by conven-ience sampling from Zhongshan Hospital from October 2011 to June 2012.Results The postoperative uncer-tainty was at medium level .The average score was 89.22 ±13.62.The influencing factors of uncertainty in-cluded education background , complications and family support .Conclusion The nursing staff should pay at-tention to postoperative uncertainty in the patients with esophageal carcinoma .It is helpful to decrease the pa-tients′uncertainty and improve their life quality .

脉络膜黑色素瘤是成人最常见的眼内恶性肿瘤之一,因早期可无症状而不易被发现,可严重威胁患者的生命.太田痣作为一种先天性眼部皮肤色素沉着类疾病,易于发现和诊断,其脉络膜的色素增多常伴发脉络膜痣,而后者恶变的概率很高,因此定期随访对早期诊断太田痣可能发生的脉络膜黑色素瘤有着重要的意义.早期较小的脉络膜黑色素瘤与其他脉络膜占位性病变鉴别的难度很大,本病例汇集了各位专家在病例讨论中的观点,希望能对广大眼科医师有所启发和帮助.

Objective To investigate the relationship between structure and function in diabetic macular edema(DME).Methods Optical coherence tomography(OCT),fundus fluorescein angiography(FFA) and visual field measurements were used for comparative analyses in 30 normal eyes of 20 volunteers and(69 cases) 131 eyes with diabetic macular edema (DME).Results The correlations between macular central thickness and macular visual sensitivity,macular central thickness and visual acuity,and macular visual sensitivity and visual acuity(r=0.663;P<0.01) were statistically significant.The differences between the macular thickness map findings and the FFA in macular abnormality were not statistically significant.Conclusion When macular structure was altered,there were corresponding changes in the visual function of DME eyes to some extent.However,visual functions were not in complete accord with macular structure.The condition of the macular area could be fully and objectively displayed only with OCT and perimetry.OCT and perimetry are each superior in their own way.Taken together,they can assist in the early diagnosis of DME.

AIM: To investigate the effects of exendin-4 on glucose level and glucose tolerance in non-diabetic mice. METHODS: Non-diabetic mice were divided into exendin-4 and normal saline (NS) groups. After a bolus intraperitoneal administration of 0.1 μg·g -1 exendin-4, glucose levels were tested at 1 h after administration, followed by daily 10 d of injection and after the injection of 2 wk. Intraperitoneal glucose tolerance test (IPGTT) was performed on d 20 after the cessation. In addition, three different doses of exendin-4 (0.1, 0.2, 0.4 μg·g -1) were injected daily for 3 d and glucose levels were also tested daily during the injection. RESULTS: The glucose level of mice treated with 0.1 μg·g -1 exendin-4 1 h after the injection was significantly lower as comparing to NS treated mice, ((6.2±s 1.3) mmol·L -1 vs (10.6±1.1) mmol·L -1,P0.01). The average glucose levels were not affected either during the injection or after the cessation. The results of IPGTT also showed no statistical difference between the two groups. Different doses of exendin-4 did not show notable difference in comparing to the NS group. CONCLUSION: The instant effect of exendin-4 on non-diabetic mice is to decrease glucose level, but daily injection shows no significant influence on glucose level and glucose tolerance.

Objective To investigate the effectiveness of exendin-4 on glucose level of streptozotocin(STZ)-induced diabetic mice. Methods Male eight-week-old C57BL/6 mice were divided into six groups: aqua-injected group, exendin-4 0.1 μg/g weight group, STZ group, STZ+exendin-4 (0.1, 0.2, 0.4 μg/g weight) groups. The blood glucose levels were determined on the first 10 days during the treatment and on day 12, 15, 18, 24 after the treatment. All mice were subjected to an intraperitoneal glucose tolerance test (IPGTT) on day 30. Results There was no statistical difference between the groups of aqua-injected group and exendin-4 groups 0.1 μg/g weight group during and after the treatment. As compared with STZ treated group only, STZ+varying doses of exendin-4 groups showed a lower blood glucose level throughout the study (P 0.05); the 0.1 μg/g weight dose gave the best result, there was no significant difference as compared with the aqua-injected group in normal mice (P 0.05), and there was no notable difference among the three groups after the treatment. The results of IPGTT on 30th day showed no distinct difference either.Conclusion Exendin-4 would not lead to hypoglycemia in normal mice but can improve the hyperglycemia in STZ-induced diabetic mice, it also has a prolonged effect on blood glucose level independent of dose.