乳腺癌护理中英文对照外文翻译文献
乳腺癌常用化疗方案及相关文献详解
乳腺癌常用化疗方案及相尖文献检索1激素治疗以下为供参考的综述文章：HOWELL and DORSETT, Br. Med. J. 315 (1997):863-866 THURLIMANN, Oncology 55(1998):501-5072抗雌激素/选择性雌激素受体修饰剂(SERMS )三苯氧胺2mg/d 针对雌激素受体阳性可手术的肿瘤病人的辅助治疗，与年龄及肿瘤情况无尖。
治 疗持续时间：大约五年。
同时也是对绝经后的雌激素受体阳性的肿瘤进展或转移患者的姑息治 疗。
参考文献：EARLY BREAST CANCER TRIALISTS ' COLLABORATIVE GROUP, Lancet 351 (1998):1451 -1467FISHER et al, J. Natl. Cancer Inst. 88(1996):1529-1542 GOLDHIRSCH et al, J. Natl. Cancer Inst. 90(1998):1601-1608SWEDISH BREAST CANCER COOPERATIVE GROUP, J. Natl. Cancer Inst. 88(1996);1543-1549三苯氧胺60mg/d Droloxifene 20mg/d Raloxifene60mg/d二年(尤其中以预防骨质疏松症)参考文献:DELMAS et al, N. Engl. J. Mde. 337(1997):1641-16473芳香酶抑制剂：尤其是对绝位后的患者在抗雌激素治疗后的二线激素治疗。
CLEMONS et al, Eur. J. Cancer 33(1997):2171-2182, and Eur. J. Cancer 33 (1997):2183- 2193(advaneed disease)CROWN, Eur. J. Cancer 33(Supp1.7):S15-S19(metastatic disease)ELLIS & SMITH, Cancer Treat. Rev. 22(1996):437-450(neoadjuvant therapy) FOSSATI et al, J. Clin. Oncol. 16(1998):3439-3460(metastatic disease)GRADIHAR, Semin. Oncol. 25(Supp1.3)(1998):25-30(neoadjuvant therapy) HONKOOR et al,安鲁米特 250氢化可的松An astrozole 1mg/d P-0 来曲哩 2.5mg/d p.o Vorozole2.5mg/dP-0 4孕激素甲地孕酮(梅格施) 160mg/d P-0醋酸甲疑孕酮400-1200mg/dp.o.参考文献 Miller, Cancer Treat. Rev. 23(1997):1641-1647以下为供参考的综述文章:5化疗Oncology 55(1998):218-227(stage III)6单药化疗：对于那些进展期，有远处转移的乳癌患者，单药的一线或二线姑息性化疗与联合化疗相比，生存率上似，治疗相尖毒性较少且生存质量较高。
乳腺癌_中文版NCCN指南(2016+v
检查
• 病史和体检 • 双侧乳房X线摄片，乳腺超声检查 • 病理检查a • 明确肿瘤ER、PR及HER-2状态b • 遗传性乳腺癌高危患者进行遗传学咨询 • 乳腺MRI d （可选），特别对于经X线摄片查出的隐匿性肿瘤c • 必要时进行生育咨询e • 心理评估f 对于临床I-IIB类患者，如果出现症状或体征，应增加检查： g • 全血细胞计数 • 肝功能检查，碱性磷酸酶 • 如果出现局部骨痛或碱性磷酸酶升高，行骨扫描检查 • 如果出现碱性磷酸酶升高、肝功能异常、腹部不适症状或腹部盆腔
切缘状况 e使用MRI并没有显示出增加阴性切缘或者减少转变为全乳切除的可能性。目前缺乏改善长期预后的数据。
f对于希望保乳的患者，可行再次切除以得到切缘阴性的结果。对于不适合保乳手术的患者应该行全乳切除术。
g见DCIS的切缘状态（DCIS-A）
h对于表面上单纯DCIS或者钼靶检测DCIS微钙化的患者，在没有浸润性癌证据或证明腋窝转移性疾病的情况下，不应施行彻底的腋窝淋巴结清扫。但是，
任何T N3：同侧锁骨下淋巴结转移伴或不伴腋窝淋巴结转移； 或临床上发现同侧内乳淋巴结转移伴腋窝淋巴结转移； 或同侧锁骨上淋巴结转移伴或不伴腋窝或内乳淋巴结 转移 N3a：同侧锁骨下淋巴结转移 N3b：同侧内乳淋巴结及腋窝淋巴结转移 N3c：同侧锁骨上淋巴结转移 pN3：≥10个腋窝淋巴结转移
IA期： T1、N0、M0
监测/随访
• 每6~12个月进行病情随 访并行体格检查，持续5 年，以后每年1次
• 每12个月进行1次乳房X 线摄片（如果行保乳术， 则在放疗后6-12个月行 乳房X线摄影检查[2B类]）
• 如果应用内分泌治疗， 则根据NCCN乳腺癌降低 风险指南进行监测
o对于使用他莫昔芬的患者，不推荐行CYP2D6基因检测。
乳腺癌化疗通用前言范文
乳腺癌化疗通用前言范文英文回答：Breast cancer chemotherapy is a common treatment method for patients diagnosed with breast cancer. It involves the administration of drugs that kill or prevent the growth of cancer cells in the body. Chemotherapy is usually used in combination with other treatments such as surgery or radiation therapy to ensure the best possible outcome for the patient.Chemotherapy drugs work by targeting rapidly dividing cells, which includes cancer cells. These drugs can be given orally or intravenously, and they circulate throughout the body to reach cancer cells in different parts. The goal of chemotherapy is to destroy or shrink the tumor, prevent its spread to other parts of the body, and reduce the risk of recurrence.Chemotherapy is often administered in cycles, with eachcycle consisting of a treatment period followed by a rest period. The duration and number of cycles depend on various factors, including the stage and type of breast cancer, overall health of the patient, and the specific drugs being used. The side effects of chemotherapy can vary from person to person, but common ones include hair loss, nausea, fatigue, and a weakened immune system.Despite the potential side effects, chemotherapy has proven to be an effective treatment for many breast cancer patients. It can significantly improve survival rates and increase the chances of a complete recovery. However, it is important to note that chemotherapy is not suitable for every patient, and the decision to undergo chemotherapy should be made in consultation with a healthcare professional.中文回答：乳腺癌化疗是一种常见的乳腺癌治疗方法。
浸润性乳腺癌(英文版)护理课件
01 Overview of invasive breast cancer
Definition and Type
Definition
Invasive breast cancer is a malignant tumor that has spread from the breast ducts to the surrounding breast tissue.
03 Nursing of invasive breast cancer
Mental Nursing
01 02
Psychological Support
Provide patients with emotional support and counseling to help them cope with the emotional impact of a breast cancer diagnosis.
Diagnosis and Staging
Diagnosis
Diagnosis of invasive breast cancer typically involves a physical examination, mammogram, ultrasound, and biopsy.
Staging
Education
Educate patients about breast cancer, its treatment, and possible side effects to reduce their anxiety and fear.
03
Mindfulness and Relaxation
Teach patients mindfulness and relaxation techniques to help
乳腺癌患者护理管理介绍总结-SakaiatMDAndersonGateway
乳腺癌患者护理管理介绍
Mandarin Chinese Translation
Jennifer McKenzie, MSN, RN, OCN, CBCN
总结： 德克萨斯大学 MD Anderson 癌症中心乳腺癌中心和护理专业人员培训部高 级护理讲师 Jennifer McKenzie 在其题为“乳腺癌患者护理管理介绍”的讲座 中讨论了乳腺癌的症状管理。McKenzie 女士介绍了乳腺癌患者常见的症 状，包括疼痛、淋巴水肿、化疗引起的恶心和呕吐、疲乏、认知功能障 碍、潮热和骨质疏松。McKenzie 女性描述了以上每种常见症状的风险因 素、评估、管理和护理意义。 学习目标： 1. 确认乳腺癌患者的常见症状 2. 描述对乳腺癌患者常见症状的管理 3. 识别乳腺癌患者常见症状的护理意义
English Text Introduction to Nursing Management of the Breast Cancer Patient Jennifer McKenzie, MSN, RN, OCN, CBCN Summary: Jennifer McKenzie, Senior Nursing Instructor for the Breast Cancer Center and Nursing Professional Development at The University of Texas MD Anderson Cancer Center discusses symptom management of breast cancer in her lecture, “Introduction to Nursing Management of the Breast Cancer Patient.” Ms. McKenzie identifies common symptoms experienced by patients with breast cancer, including pain, lymphedema, chemotherapy-induced nausea and vomiting, fatigue, cognitive dysfunction, hot flashes, and osteoporosis. Ms. McKenzie describes risk factors, assessment, management, and nursing implications of each of these common symptoms.
乳腺癌2022年最新英文文献
乳腺癌2022年最新英文文献Background Digital breast with 3D images might overcome some of the limitations of conventional 2D mammography for detection of breast cancer.We investigated the effect of integrated 2D and 3D mammography in population breast-cancer screening.Methods Screening with OR standard Mammography(STORM)was a prospective comparative study.We recruited asymptomatic women aged 48 years or older who attended population-based breast-cancer screening through the and Verona screening services(Italy)from August,2011,to June,2012.We did screen-reading in two sequential phases-2D only and integrated 2D and 3D mammography-yielding paired data for each screen.Standard double-reading by breast radiologists determined whether to recall the participant based on positive mammography at either screen read.Outcomes were measured from final assessment or excision histology.Primary outcome measures were the number of detected cancers,the number of detected cancers per 1000 screens,the number and proportion of false positive recalls,and incremental cancer detection attributable to integrated 2D and3D mammography.We compared paired binary data with test.Findings 7292 women were screened(median age 58 years[IQR 54-63]).We detected 59 breast cancers(including52 invasive cancers)in 57 women.Both 2D and integrated 2D and 3D screening detected 39 cancers.We detected20 cancers with integrated 2D and 3D only versus none with 2D screening only(p-0-0001).Cancer detection rates were5.3 cancers per 1000 screens(95%CI 3·8-7.3)for 2D only,and 8.1 cancers per 1000 screens(6·2-10-4)for integrated2D and 3D screening.The incremental cancer detection rate attributable to integrated 2D and 3D mammography was2.7 cancers per 1000 screens(1.7-4-2).395screens(5·5%;95%CI 5-0-6-0)resulted in false positive recalls:181 at both screen reads,and 141 with 2D only versus 73 with integrated 2D and 3D screening(p-0-0001).We estimated that conditional recall(positive integrated 2D and 3D mammography as a condition to recall)could have reduced false positive recalls by 17.2%(95%CI 13·6-21·3)without missing any of the cancers detected in the study population.Interpretation Integrated 2D and 3D mammography improves breast-cancer detection and has the potential to reduce falsepositive recalls.controlled trials are needed to compare integrated 2D and 3D mammography with。
医学文参：2021年乳腺癌StGallen共识中文版
2021年乳腺癌StGallen共识中文版2021年乳腺癌St Gallen共识〔中文版〕早期乳腺癌个体化治疗：2021早期乳腺癌治疗国际专家共识亮点广东省中医院大学城医院乳腺科陈前军翻译在早期乳腺癌局部与区域治疗领域，第13届St Gallen国际乳腺癌会议〔2021〕回忆并认可了重要的新临床证据，这些证据支持更小创伤的腋窝评估手术与更短的放疗周期。
此次会议细化了HER2基因无扩增或过表达的luminal型乳腺癌的分类与处理，但对HER2阳性乳腺癌与“三阴乳腺癌〞的系统治疗方面根本上维持原来的推荐。
专家组还是接受既往的根据临床-病理因子的乳腺癌亚型替代分类方法，同时指出，在那些能够用多基因分子分析的地区，许多医生更愿意基于后者来对luminal型乳腺癌决策是否化疗，而不是前者。
几个多基因分子分析技术已经被确认可以提供准确和可重复的预后信息，并在某些情况下，还可以预测对化疗的反响。
当前，在许多情况下，由于其昂贵的本钱与技术层面的限制阻碍了这些技术的推广运用。
本文呈现了此次会议专家组对早期乳腺癌领域广泛的治疗建议。
这些建议并不意味着每个专家组成员都同意：确实，在超过100个问题中，只有一个问题〔曲妥珠单抗辅助治疗时间〕得到了专家组100％的同意。
事实上，各项建议都得了专家组成员不同程度的支持，详细情况会表达在下文的文字描述中以及补充附录S1的投票记录中〔可登陆Annals of Oncology online查阅〕。
与以前一样，我们认为具体的临床治疗决策应考虑到具体临床中疾病程度、宿主因素、患者意愿以及社会学和经济学因素。
关键词: 手术，放疗，系统辅助治疗，早期乳腺癌，St Gallen 共识，亚型前言自2021年St Gallen共识[1]以来，早期浸润性乳腺癌不同治疗领域的循证医学证据都涌现出重大进展。
基因图谱[2]显示乳腺癌具有异质性，也提示基因研究可能告知我们如何进行治疗决策，例如芳香化酶抑制剂的使用方面[3，4]。
乳腺癌英文教学课件breast cancer
Pathology
Noninvasive lesions
Lobular neoplasia
Lobular carcinoma in situ
Intraductal proliferative lesions
Usual ductal hyperplasia Ductal carcinoma in situ
Risk factors
Lifestyle factors
- high body mass index (BMI), moderately increases the risk of
post-menopausal breast cancer - physical activity （reduce risk） - alcohol
Risk factors
Family history
Genetics
Carriers of alterations in either of two familial breast cancer genes BRCA1 or BRCA2 up to an 80% risk of being diagnosed with breast cancer
Breast Cancer
Epidemiology and risk factors Dignosis Prognstic factors Treatments
Epidemiology and risk factors
Epidemiology
The most common invasive cancer in women. Comprises 22.9% of invasive cancers in women, 16%
Radiation exposure The effect is strongly related to age at exposure
医药学类文献双语版_汉译英
介导性shRNA能抑制肺癌细胞中livin沉默基因的表达从而促进SGC-7901细胞凋亡背景—由于肿瘤细胞抑制凋亡增殖,特定凋亡的抑制因素会对于发展新的治疗策略提供一个合理途径。
Livin是一种凋亡抑制蛋白家族成员，在多种恶性肿瘤的表达中具有意义。
但是, 在有关胃癌方面没有可利用的数据。
在本研究中,我们发现livin基因在人类胃癌中的表达并调查了介导的shRNA能抑制肺癌细胞中livin沉默基因的表达，从而促进SGC-7901细胞凋亡。
方法—mRNA及蛋白质livin基因的表达用逆转录聚合酶链反应技术及西方吸干化验进行了分析。
小干扰RNA真核表达载体具体到livin基因采用基因重组、测序核酸。
然后用Lipofectamin2000转染进入SGC-7901细胞。
逆转录聚合酶链反应技术和西方吸干化验用来验证的livin基因在SGC-7901细胞中使沉默基因生效。
所得到的稳定的复制品用G418来筛选。
细胞凋亡用应用流式细胞仪(FCM)来评估。
细胞生长状态和5-FU的50%抑制浓度(IC50)和顺铂都由MTT比色法来决定。
结果—livin mRNA和蛋白质的表达检测40例中有19例(47.5%)有胃癌和SGC-7901细胞。
没有livin基因表达的是在肿瘤邻近组织和良性胃溃疡病灶。
相关发现在livin基因的表达和肿瘤的微小分化和淋巴结转移一样(P < 0.05)。
4个小干扰RNA真核表达矢量具体到基因重组的livin基因建立。
其中之一,能有效地减少livin基因的表达,抑制基因不少于70%(P < 0.01)。
重组的质粒被提取和转染到胃癌细胞。
G418筛选所得到的稳定的复制品被放大讲究。
当livin基因沉默,胃癌细胞的生殖活动明显低于对照组(P < 0.05)。
研究还表明,IC50上的5-Fu 和顺铂在胃癌细胞的治疗上是通过shRNA减少以及刺激这些细胞(5-Fu proapoptotic和顺铂)(P < 0.01)。
乳腺癌英文相关之欧阳文创编
乳腺癌相关英文单词转移性乳腺癌metastatic breast cancer (MBC)early menarche 初潮nulliparity 未经产late age at first birth 头胎生育年龄大mutations of tumor suppresser genes 抑癌基因突变BRCA1 and BRCA2 乳腺癌易感基因1和2 radiation exposure 射线暴露contiguityenvironmental and lifestyle factors 环境和生活方式的因素solitary 孤立（病灶）unilateral 单侧nonmobile 活动性查nipple changes 乳头改变prominent skin edema 皮肤水肿严重redness 皮肤发红warmth 皮温升高induration 硬结bone pain 骨痛difficulty breathing 呼吸困难abdominal pain or enlargement 腹痛或腹胀jaundice 黄疸mental status changes. 精神状态改变routine screening mammography 常规乳腺钼靶筛查asymptomatic women. 无症状的患者Initial workup 初始的检查localized lesion 局限的病灶suggestive symptoms 具有提示意义的症状breast imaging techniques 乳腺成像技术ultrasound 超声magnetic resonance imaging (MRI) 核磁共振Breast biopsy 活检a palpable mass on physical examination 体格检查可触及肿块indicated for a mammographic abnormality （预示）乳腺异常the size of the primary tumor extent 原发灶大小presence and extent of lymph node involvement 是否存在淋巴结转移及数目presence or absence of distant metastases 是否存在远处转移assists with treatment decisions 协助治疗方案决策Simplistically stated 简单来说basement membrane 基底膜Involvement of regional lymph nodes 区域淋巴结受侵extensive nodal involvement 淋巴结广泛受侵fixed to the chest 固定于胸壁inflammatory breast cancer 炎性乳腺癌rapidly progressive 进展迅速preinvasive 转移前adenocarcinomas 腺癌ductal 导管的lobular 小叶的maximize quantity and quality of life 延长生存期，提高生活质量axillary lymph nodes 腋窝淋巴结the risk for breast cancer recurrence 乳腺癌复发的风险disease characteristics 疾病特点provide prognostic information 提供预后信息histologic subtype 组织学亚型nuclear or histologic grade 核分级及组织分级lymphatic and vascular invasion 淋巴或血管侵犯转移proliferation indices 增殖指数The estrogen receptor (ER) 雌激素受体progesterone receptor (PR) 孕激素受体predict response to hormone therapy 预测对激素治疗的反应HER2/neu (HER2) overexpression HER2过表达transmission of growth signals that control aspects of normal cell growth and division 控制正常细胞生长分裂的生长信号的传递increased tumor aggressiveness 肿瘤侵袭性增加rates of recurrence 复发率mortality 死亡率favorable prognostic features 好的预后因素cure 治愈prolong survival 延长生存rapidly evolving 快速发展the most promising interventions 最具希望的干预措施in the primary literature 在原始文献中combination regimen 联合治疗方案appropriate references should be consulted. 查找适宜的参考文献Breast-conserving therapy (BCT) 保乳术modified radical mastectomy 改良根治术cosmetically superior results 效果更美观lumpectomy 乳腺肿瘤切除术radiation therapy (RT) 放疗prevent local recurrence. 预防局部复发Reddening and erythema of the breast tissue 乳腺组织红肿Simple or total mastectomy 简单或全乳切除术dissection of underlying muscle or axillarynodes切除下方肌肉及腋窝淋巴结carcinoma in situ 原位癌Lymphatic mapping with sentinel lymph nodebiopsy前哨淋巴结活检了解淋巴结定位及受侵invasive phases 广泛转移期Local-Regional Therapy 局部治疗preferable to 更优于subsequent shrinkage 治疗后缩小minor complications 轻微的并发症definitive local therapy 精准局部治疗reflect the trend toward the use ofchemotherapy倾向于化疗menopausal status 月经状态decision-support tools 决策辅助工具distant recurrence 远处转移at a time of low tumor burden 肿瘤负荷小emergence of drug-resistant tumor cell clones 耐药的肿瘤细胞出现Selected Adjuvant Chemotherapy Regimens 优选的辅助治疗方案Anthracycline-containing regimens 含蒽环类的治疗方案doxorubicin 多柔比星epirubicin 表柔比星taxanes 紫杉类docetaxel 多西他赛paclitaxel 紫杉醇Dose intensity 剂量强度Dose density 剂量密度Dose-dense regimens 剂量密集方案serotonin-antagonist 5-羟色胺拮抗剂substance P/neurokinin 1–antagonist P物质/神经激肽1拮抗剂colony-stimulating factors 集落刺激因子ADJUVANT BIOLOGIC THERAPY 辅助生物治疗adjuvant trastuzumab 辅助曲妥珠治疗optimal concurrent chemotherapy 适宜的同时应用的化疗方案Tamoxifen 他莫昔芬toremifene 托瑞米芬oophorectomy 卵巢切除术ovarian irradiation 卵巢放疗luteinizing hormone–releasing hormone (LHRH) agonists 促黄体生成激素释放激素（LHRH）激动剂aromatase inhibitors 芳香化酶抑制剂adjuvant hormonal therapy of choice 最佳辅助内分泌治疗premenopausal women 未绝经女性estrogenic 雌激素的antiestrogenic properties 抗雌激素的特点estrogen withdrawal 雌激素撤退hot flashes 潮热vaginal bleeding 阴道出血decrease in frequency and intensity over time 频率和强度随着时间推移而下降hip radius 髋关节半径spine fractures 脊柱骨折stroke 中风pulmonary embolism 肺栓塞deep vein thrombosis 深静脉血栓endometrial cancer 子宫内膜癌ovarian ablation with LHRH agonists 应用LHRH激动剂使卵巢去势goserelin 戈舍瑞林anastrozole 阿那曲唑letrozole 来曲唑exemestane 依西美坦bone loss 骨量丢失osteoporosis 骨质疏松myalgia 肌痛arthralgia 关节痛rendering inoperable tumors resectable 使不可切除肿瘤降级为可切除increasing the rate of BCT 保乳率提高extend survival 延长生存The choice of therapy 治疗方案的选择hormone receptor–positive metastases 转移灶激素受体阳性soft tissue 软组织pleura 胸膜viscera 腹腔sequentially treated with endocrine therapy 逐一内分泌治疗cease to respond 不再获益circulating and target organ estrogens 循环中及靶器官的雌激素blocking peripheral conversion from an抑制外周雄激素转化androgenic precursorprototype 原型aminoglutethimide 氨鲁米特lower incidence of thromboembolic events 较低的血栓时间发生率Fulvestrant 氟维司群progressed on tamoxifen 他莫昔芬应用后进展Medical castration 药物去势reserved for third-line therapy 作为三线治疗方案weight gain 体重增加fluid retention 液体潴留leuprolide 亮丙瑞林triptorelin 曲普瑞林The choice of treatment depends on the个体化治疗individualtime to progression 至进展时间sequential single agents 序贯单药化疗recommended over 相比于**，推荐objective responses 客观应答The median duration of response 中位应答持续时间unequivocal evidence of progressive disease 疾病进展的可靠证据cardiotoxicity 心脏毒性unacceptably high 不可接收地高doublet/triplet combinations 二药/三药联合方案Trastuzumab 曲妥珠单抗an oral tyrosine kinase inhibitor 口服酪氨酸激酶epidermal growth factor receptor 表皮生长因子受体rash 皮疹diarrhea 腹泻painful bone metastases 骨转移致骨痛brain and spinal cord lesions 脑和脊柱的病灶Pain relief 疼痛缓解retinoids 类视黄醇raloxifene 雷洛昔芬therapeutic end point 治疗重点objective assessment 客观评价The least toxic therapies 毒性最低的疗法in a sequential manner 序贯治疗significantly compromise quality of life 严重影响生活质量。
有关HAMLET治疗肿瘤疾病4篇重要文献部分翻译稿
Apoptosis induced by a human milk protein人乳蛋白诱导细胞凋亡Proc. Natl. Acad. Sci. USA Vol. 92, pp. 8064-8068, August 1995ABSTRACT To the breast-fed infant, human milk is more than a source of nutrients; it furnishes a wide array of molecules that restrict microbes, such as antibodies, bactericidins, and inhibitors of bacterial adherence. However, it has rarely been considered that human milk may also contain substances bioactive toward host cells. While investigating the effect of human milk on bacterial adherence to a human lung cancer cell line, we were surprised to discover that the milk killed the cells. Analysis of this effect revealed that a component of milk in a particular physical state-multimeric a-lactalbumin- is a potent Ca2+-elevating and apoptosis-inducing agent with broad, yet selective, cytotoxic activity. Multimeric a-lactalbumin killed all transformed, embryonic, and lymnphoid cells tested but spared mature epithelial elements. These findings raise the possibility that milk contributes to mucosal immunity not only by furnishing antimicrobial molecules but also by policing the function of lymphocytes and epithelium. Finally, analysis of the mechanism by which multimeric a-lactalbumin induces apoptosis in transformed epithelial cells could lead to the design of antitumor agents.对母乳喂养婴儿来说，母乳不仅是营养来源，而且也提供着丰富的分子用以抵御微生物体，如抗体和细菌素，并限制细菌粘附。
乳腺癌英文版
乳腺癌英文版Breast Cancer: Understanding and Overcoming the ChallengeIntroductionBreast cancer is a prevalent and life-changing disease that affects millions of individuals worldwide, regardless of gender. In recent years, there have been significant advancements in medical research and treatment options, improving survival rates and overall quality of life for patients. This article aims to provide a comprehensive overview of breast cancer, its causes, symptoms, diagnosis, treatment, and prevention.Understanding Breast CancerBreast cancer refers to the uncontrolled growth of abnormal cells in the breast tissue. While the exact cause remains unknown, certain risk factors have been identified. These include age, gender, family history, genetic mutations, hormonal factors, and environmental influences. It is essential to highlight that men can also develop breast cancer, although it is relatively rare compared to women.Symptoms and DiagnosisDetecting breast cancer at an early stage plays a vital role in successful treatment. While symptoms may vary, common signs include a lump or thickening in the breast or underarm area, changes in breast size or shape, nipple discharge, or skin changes, such as redness, dimpling, or puckering. Regular self-examinations and mammograms are recommended as essentialtools for early detection. Diagnostic procedures may involve imaging tests, biopsies, or genetic testing to determine the presence and stage of cancer.Treatment OptionsThe treatment of breast cancer depends on several factors, including the stage of cancer, overall health, and personal preferences. Treatment modalities often include surgery, radiation therapy, chemotherapy, hormonal therapy, targeted therapy, or a combination of these. Surgery may involve a lumpectomy (removal of the tumor) or a mastectomy (removal of the breast). Radiation therapy uses high-energy rays to destroy cancer cells, while chemotherapy employs drugs to kill or prevent the growth of cancer cells throughout the body. Hormonal therapy and targeted therapy specifically target hormone receptors or specific genetic mutations within tumor cells.Support and RehabilitationCoping with breast cancer can be physically and emotionally challenging for patients and their loved ones. Alongside medical treatment, support from healthcare providers, family, friends, and support groups is crucial. The availability of psychotherapy, counseling, or support services can empower individuals to manage the psychological and emotional aspects of the disease. Additionally, rehabilitation programs and post-treatment care can help patients regain physical strength, manage side effects, and adapt to the changes brought about by their diagnosis.Importance of Awareness and PreventionEducating oneself about breast cancer is essential for early detection and prevention. Engaging in a healthy lifestyle, including regular exercise,maintaining a balanced diet, limiting alcohol consumption, and refraining from smoking, can reduce the risk of developing breast cancer. Additionally, individuals should be aware of their family history and consider genetic counseling if necessary. While breast cancer cannot always be prevented, early detection significantly improves outcomes.ConclusionBreast cancer affects individuals globally and warrants attention from both individuals and healthcare systems. Understanding the risk factors, symptoms, diagnosis, treatment options, and prevention strategies is essential for effective management of the disease. With advancements in medical technology and ongoing research, the prognosis for breast cancer patients continues to improve, bringing hope to those affected. By promoting awareness, supporting research, and fostering a supportive environment, we can collectively combat breast cancer and help individuals lead fulfilling lives beyond their diagnosis.。
英文文献：2008乳腺癌抑郁与生活质量文献回顾
REVIEWDepression,quality of life and breast cancer:a review of the literatureM.Reich ÆA.Lesur ÆC.Perdrizet-ChevallierReceived:17July 2007/Accepted:17July 2007/Published online:3August 2007ÓSpringer Science+Business Media,LLC 2007Abstract Depression is misdiagnosed and undertreated among breast cancer population.Risk factors for depres-sion in the 5years after diagnosis are related more to the patient rather than to the disease or its treatment.The breast cancer stage (early and advanced)is not statistically sig-nificant in terms of rates of psychosocial distress except for recurrence.Risk factors of depression might impair quality of life such as fatigue,past history or recent episode of depression after the onset of cancer,cognitive attitudes of helplessness/hopelessness,resignation.Body image impairment from mastectomy and sexuality aftermath generates higher rates of mood disorders.The link between increased risk of breast cancer and depression is contro-versial among the literature.Some studies suggest a protective factor,others find a relation between stress,immunity and cancer occurrence or even mortality.Breast cancer survivors report a higher prevalence of mild to moderate depression with a lower quality of life in all areas except for family functioning.Treatment of depression in breast cancer women improves their quality of life and may increase longevity.Antidepressant medications remain thecornerstone of depression treatment.The hypothetical link between their prescription and increased breast cancer risk is not supported by literature’s data.Keywords Breast cancer ÁDepression ÁMood disorders ÁQuality of lifeIntroductionBreast cancer is one of the most important cancer in Occidental countries in terms of incidence and mortality rates.In Europe,breast cancer incidence is about 28.9%of all cancer cases and responsible of 7.8%of all death in 2006[1].Nowadays,its treatment is offering to the patients high rates of survival.These survivors will be at high risk of developing psychological distress and therefore poten-tial mood disorders [2,3].Psychological discomfort among breast cancer patients is related with depression and depressive disorders,anxiety and anxiety disorders,anger and low self-esteem and low emotional support [4].Importance of fears and concerns regarding death and disease recurrence,impairment of body image,alteration of femininity,sexuality and attractiveness are factors that can precipitate psychological distress [5]even years after diagnosis and treatment [6].Prevalence of mood disorders in breast cancer The spectrum of psychiatric disorders and psychological distress in cancer has been assessed for many years and among several studies [7–10].One of the most classical studies was done by Derogatis et al.[7].They collectedThis work was presented during the Fifteen European Congress of Psychiatry at Madrid,March 19–21,2007in the following workshop:Anxiety and Mood Disorders and Gynecologic Cancer Patients.M.Reich (&)Psycho-oncology Unit,Centre Oscar Lambret,3rue Fre´de ´ric Combemale,59020Lille,France e-mail:m-reich@o-lambret.frA.LesurSenology Department,Centre Alexis Vautrin,54511Vandoeuvre-Les-Nancy,FranceC.Perdrizet-ChevallierIHPACCA-CMP Exelmans,55000Bar Le Duc,France123Breast Cancer Res Treat (2008)110:9–17DOI 10.1007/s10549-007-9706-5data from three cancer centers with a pool of215patients. They looked at the prevalence of psychiatric disorders and reported that50%of patients will have a normal response to cancer in terms of day to day stress or response to crisis. Thefifty other percentages will present adjustment disor-ders with depressed or anxious symptoms and among these 50,20%of patient will have major depressive episode.For Harter et al.[8],through a cross-sectional design,among 517patients(75%female patients)recruited from two acute inpatient care clinics,two rehabilitation clinics and nine specialized practices for oncology,the prevalence rates of mental disorders was estimated to56.5%for the lifetime periods.Interestingly,they found that the current rates of affective and anxiety disorders were approximately 25–33%higher than prevalence rates found in general population.The most prevalent current disorders were affective(9.5%),and anxiety disorders(13%)especially among the female population[8].Prevalence of depression among early breast cancer women is twice as many than seen in the general female population,especially during thefirst year after diagnosis [11].First breast cancer recurrence is an extreme difficult time and is often associated with psychological distress which include higher rates of anxiety and depressive dis-orders(>40%)[12].The highest rates of prevalence for depression are classically found among the following localization:head and neck,lung and pancreas.Neverthe-less,prevalence of depression in breast cancer is estimated around52.65%by Zabora et al.[9]in a large sample of cancer patients(n=4,496).In227advanced breast cancer,Grabsch et al.[10]found a 42%rate of psychiatric disorders and35.7%of these had depression or anxiety or both.Minor depression was found in 25.6%,major depression in7%and anxiety disorder in6.2%.Around a quarter of all breast cancer patients have co-morbid depression:estimation between20and30%in earlier breast cancer[13]with increased rates during advanced and palliative stage(more than50%)[14]. Table1summarizes the main studies assessing the preva-lence of depressive disorders among early and late breast cancer stage.Diagnosis of depression among breast cancerIn order to make a diagnosis of depression among this specific population,several parameters have to be taken into account such as the diagnosis system used which mean what kind of criteria might be the more relevant regarding the nosography used:DSM,CIM10[15]and the time of evaluation which is an important factor since psychological disturbance changes in the course of time[16,17].Moreover,incidence of depression,appears to be dependent of the following parameters:disease severity, level of patient disability and physical impairment,per-formance status and past history of depression[18–20].Paradoxically,major depression and depressive symp-toms are underrated and undertreated in women with breast cancer[21].One explanation could be that women with breast cancer are generally reluctant to disclose their affective concern [22].Another reason could be that oncologists are not so familiar with depressive symptoms screening[23].Diag-nosis failure of mood disorders can be problematic because depression and its associated symptoms diminish quality of life,affect compliance with medical therapies and might reduce survival[21].Besides clinical classical symptom-atology of depression such as sadness,anhedonia,guilt, helplessness,hopelessness,suicidal ideation’s,the follow-ing risk factors of depression among breast cancer patients must be looked for:•past history of psychiatric illness[24],•the nature and more than four cancer-related concerns(e.g.,pain)[25],•a lack of confiding relationship[26],•a personality characterizes by neuroticism[27],•a minority status from a racial and ethnic point of view[27].Relation between depression and breast cancerWhen we consider an hypothetical relation between breast cancer and depression,several questions might be raised:•Is depression a risk factor for breast cancer?•Is depression a prognostic factor for breast cancer mortality?•Is there a correlation between depression and disease severity(breast cancer advanced stage)?•Is depression a protective factor for breast cancer?•Is breast cancer a risk factor for depression?•What is the impact of depression on quality of life among breast cancer patients?Depression as a risk factor for breast cancer Considering women with a depressive state at high risk of developing breast cancer is not a fanciful question.In the Geek Antiquity,Galien had already noticed that women with melancholy mood due to‘‘an increase rate of black bile’’were prone to develop breast cancer[28].Several metaanalysis tried tofind a link between mood disorders123and breast cancer.One of them has been done by McKenna et al.[29].These authors have assessed46studies with the following criteria:•anxiety/depression,childhood family environment, conflict-avoiding personality,denial/repression coping, anger expression,extraversion–introversion,stressful life events,separation/loss,•significant effect sizes for denial/repression coping, separation/loss experiences and stressful life events. Their results overall support a modest association between specific psychosocial factors and breast cancer occurrence, specially when considering denial/repression coping and separation and loss experiences[29].Since years,female patients had the fantasy that stress and special life events could be linked with the develop-ment of breast cancer.Studies examining the relationship between stressful life events and breast cancer risk have produced conflicting results.A metaanalysis done by Duijts et al.[30]have assessed several studies between1966and2002.They evaluated the relationship between stressful life events and breast cancer risk with the following criteria:•stressful life events such as death of spouse,death of relative or friend,personal and non personal health difficulties,change in marital,financial and environ-mental status.They found a statistically significant effect for stressful life events especially for death of spouse,death of relative or friend.The conclusion of their work does not support an overall association between stressful life events and breast cancer risk.Regarding all the parameters studied,only a modest association could be identified between death of spouse and breast cancer risk[30].A biological hypothesis through disturbances of various areas of the immune systems predisposing to cancer could be an explanation of this association[31].Moreover,there is no evidence that severely stressful life experiences occurring5years before breast cancer diagnosis negatively affect survival among women with non metastatic breast cancer[32]or increase the risk of recurrence[33].Depression and risk factors in breast cancerAmong a breast cancer population,depressive disorder can be correlated with the following factors:ethnic minority women(e.g.Southern California),low-income women, pain,anxiety and health related quality of life[34].Poor social and cultural environment among these disadvan-taged sections of the population can be a cause of depression.Being depressed,these patients are not prone to seek earlier consultation for screening when a breast lump appears.But still,cancer stage and treatment status are not cor-related with depression[34].Other factors can be related with increased depression and anxiety during breast cancer disclosure:speaking about life expectancy and survival speaking about disease after-math’s and treatment outcomes on quality of life,speaking about importance of being involved in cancer treatment decision process,using the word cancer which remains for the majority of patients synonym of inescapable death[35].In a study done by Gallo et al.[36]among2,017persons with203new cases of cancer,the aims was to demonstrate a relationship between major depression and new onset of cancer at thirteen year follow-up.If mainly for all type of cancer,no overall association of depression(RR=1,95%Table1Prevalence of depressive disorders and breast cancerAuthors Tumoral site breast DSM Mood disorders(%)Major depression(%)Minor depression(%)Grabsch et al.[10]227BC(AS)DSM-IV35.7725.6Hegel et al.[94]236BC(ES)DSM-IV6011Not mentioned Mehnert et al.[95]127BC(ES)DSM-IV16 4.7 3.1Burgess et al.[11]222BC(ES)SCID504020Okamura et al.[57]50BC(AS)(recurrence)DSM-IV22220Ell et al.[34]250BC(stage0-III)PHQ-930.43865Kissane et al.[58]503BC303ES200AS DSM-IV ES:36.7AS:31ES:9.6AS:6.5ES:27.1AS:24.5Okamura et al.[12]55AS(recurrence)DSM-III-R AS:42AS:7AS:35 Kissane et al.[96]3O3ES DSM-IV ES:42ES:9.6ES:27.1BC breast cancer,ES early stage,AS advanced stage123CI)or dysphoric episode(RR=1.3,95%CI)was found with increased risk of cancer at follow-up,except an increased risk of breast cancer among women with major depression(adjusted RR=3.8,95%CI).Jacobs et al.[37]studied among1,273women with29 breast cancer hospitalized psychosocial variables that pre-dicted increased risk of breast cancer with an occurrence 20years prior to breast cancer diagnosis.Although the number of breast cancer patients is small regarding the population studied,they found that maternal death in childhood(OR=2.56,P<0.001)and chronic depression with severe episodes in adulthood(OR=14.0, P<0.001)could be considered as psychosocial variables that would predict increased risk of breast cancer[37].Neither relatively recent life events nor other recent depressive and anxiety disorders were associated with increased risk of breast cancer.Other prospective studies are needed to confidently establish these variables as risk factors.In another study done by Lokugamage et al.[38],among 2,253women with83breast cancer hospitalized,the same psychosocial variable were studied by Cox proportional hazards models:parental death or parental divorce in childhood before age16and psychiatric disorders between 15and32years.Interaction between these psychosocial variables was non-significant(P=0.1)even if both of these events had an increased breast cancer risk compared with those who experienced neither(Hazard Ratio=2.64,95%Confidence interval).This study does not provide strong support for the hypothesis that early loss or adult psychiatric disorders are associated with breast cancer risk.In an other control and randomized study,Montazeri et al.[39]comparing breast cancer(N=243)versus benign tumor(N=486),suggested that depression (P<0.0001)and related symptoms such as hopelessness (P<0.001),loss of interest and pleasures(P<0.001) could be considered as a factor for breast cancer risk.Regarding recent metaanalysis,depression cannot be considered as a risk factor for breast cancer although depression may predispose individuals to behavioural risk factors(alcohol consumption,smoking)[40]and delay for screening mammography when confronted to a breast lump [41]that would lead them at higher breast cancer risk.Another explanation for a possible link between depression and breast cancer risk could be the psycho-neuroimmunology pathway.Nunes et al.[42]have found that immune and hormonal measurements differed significantly between a depressed group(N=40)versus a non-depressed group(N=34).In the depressed group control,they found a significant lower proliferation of lymphocyte in response to a mitogen and a significant decreased production of cytokines,which nor-mally activate the immune system and specially Natural Killer cells.Specific neuroimmunology pathway might link depres-sion and breast cancer-related morbidity and mortality due to dysregulation of cortisol secretion(reduced diurnal variability)and lower lymphocyte proliferation and decreased production of cytokines and therefore natural killer cell activity[43].Metastatic breast cancer that exhibited a reduced diurnal variability in cortisol secretion had diminished NK cell function and earlier mortality[43].At this point,we still agree with the conclusion of Bernard Fox almost twenty years ago in his editorial published in JAMA in1989[44],looking at the association between depression and cancer morbidity and mortality:‘‘Nevertheless,the combined evidence is…not consistent with a strong relationship between depressive symptoms and cancer among major segments of the population’’[44]. Depression as a prognostic factor for breast cancer mortalityCould depression be a risk factor for breast cancer evolu-tion?Regarding the literature,there are some positive arguments supporting this assertion.First,major depression decreases motivation and redu-ces compliance with treatment such as chemotherapy[45].Secondly,major depression could be an important pre-dictor of late-stage breast cancer diagnosis because patients when confronted to a lump will delay seeking for medical consultation[46].Thirdly,considering the two previous points,major depression might have a detrimental effect on outcome in breast cancer patient[47].Can depression being considered as a possible prog-nostic factor for breast cancer mortality?The answer to that question remains unclear.Some studies suggest a link between depression and breast cancer mortality[35,47,48].Watson et al.[47]in a prospective study among578 early breast cancer found that depressive symptoms and hopelessness are linked with a significantly reduced chance of survival at5years follow-up(HR=3.59,CI95%).Hjerl et al.[48]made an analysis of data from breast cancer central registers in a retrospective cohort Danish study comparing early stage(N=10,382)and late stage (N=10,211).In this study,they found that breast cancer with depression had a modestly but significantly higher risk of mortality,depending on stage of cancer and time of depression.123When women are confronted to advance and even to palliative or terminal stage,they can have suicidal ideation or even suicide attempts that can hasten death[49,50].Depression can also affect compliance with medical cancer therapies(chemotherapy,surgery and radiotherapy) and give the possibility to the cancer to run by itself[21]. Depression and disease severityIs there a correlation between depression and breast cancer advanced stage?Here also,it is very difficult to give a clear answer.They might be an unclear support for such a correlation due to multiple bias[51].Side effect of treatment(chemotherapy or radiotherapy) such as nausea,fatigue and pain are often associated with depressive symptoms[52,53]but are not necessarily induced by depression and low self esteem and loss of autonomy are commonly seen in advanced breast cancer.Depressive symptoms among young women with breast cancer are not predictors of disease severity[51].Regarding literature,studies remain contradictory to find a link between depression and breast cancer recurrence or depression and breast cancer advanced stage. Depression as a protective factor for breast cancer? Two prospective studies one Dutch and the other one Finnish conclude that women with depressive symptoms might have a lower risk of developing further breast can-cer.In the Dutch study[54],a cohort of5,191women was followed during5years.Depression screening was made by Edinburgh Depression Scale.Two years after the questionnaire screening, 1.1%(58women)developed breast cancer.Women with depressive symptoms had a lower risk for breast cancer(OR=0.29,95%CI=0.09–0.92,P=0.04).In the Finnish study[55],a cohort of 10,892women were followed during6–9years with a breast cancer incidence estimated1.15times the average in age group50–59.There was no evidence of depression being significant predictor of increasing breast cancer incidence.Breast cancer as a risk factor for depressionCould breast cancer be considered as a risk factor for depression?In other words,are women with breast cancer more at risk to develop depression than healthy women?Morasso et al.[56]tried to detect depression among132 breast cancer patients with several stage of disease(stage I–III).Using screening tools for detecting mood disorders such as Psychological Distress Inventory,HADS and DSM-III-R criteria,they found a prevalence of psychiatric disorders near 38%with a classical rate of depression(major episode, adjustment disorder)near25:9.8%had Major Depressive Disorder during the follow-up,10.6%had adjustment dis-orders with depressed mood,4.5%had adjustment disorders with mixed anxiety and depressed mood.Increased age among breast cancer population was predictive of mood disorders during follow-up but not the type of surgery(mastectomy/conservative surgery).One could expect that women treated with mastectomy would develop more depression than women treated by lumpec-tomy(conservative surgery).Depression,quality of life and breast cancerRisks factors of depression might impair quality of life such as fatigue,past history or recent episode of depression after the onset of breast cancer,cognitive attitudes of helplessness/hopelessness and resignation[57,58].Considering the problematic of quality of life and its measurement,the following parameters need to be taken into account:attractiveness,body image impact,sexuality, importance of menopausal symptoms such as hotflashes burden and presence of lymphedema[10].During breast cancer disclosure,quality of information delivered by doctors and communication about disease concerns and feelings are two important parameters to preserve quality of life[59].Depression can have a detrimental impact on quality of life in breast cancer patient.Many studies have clearly demonstrated that depression and its associated symptoms such as dysphoria diminish quality of life,affect compli-ance with medical therapies and reduce survival.This is due to the fact that depression affects interpersonal rela-tionships,occupational performance,stress and perceptions of health and physical symptoms.Therefore,it impacts patients’overall quality of life[3,21,60,61].Two studies[62,63]found that depression is correlated with lower quality of life.Weitzner et al.[62]studied60long-term stage I-III breast cancer survivors(disease-free for5years)versus93 low risk breast cancer screening patients.Depression was assessed by the Beck Depression Inventory Scale.Among breast cancer survivors and low risk breast cancer patients, respectively,29and15%had depression.In both groups, increased depression is correlated with lower quality of life functioning except for family functioning.Breast cancer survivors report a higher prevalence of mild to moderate depression with a lower quality of life in all areas (e.g.sexual activity)[64]except family functioning[65].123Quality of life among breast cancer population needs assessment and treatment of mood disorders.In a population of691old women(>65-years old)with breast cancer,Ganz et al.[63]assessed psychosocial adjustment at15months after surgery.They showed a decline in mental health scores at the MHI-5(Mental-Health-Inventory)and noticed that physical,emotional and social dimensions impact their quality of life but cancer specific psychosocial quality of life improved over time(15months).Another point is that depressed breast cancer patients are frequently more interested and users of alternative medi-cine[66].Even if for some patients,complementary medicine could alleviate side effects of classical breast cancer treatment and so increases their quality of life,it might also be the sign of depressed and hopelessness behavior.The thoughts of these patients can be deciphered as‘‘regular medicine cannot save me anymore,so let us turn to unproved medicine’’.Quality of life can be impaired by the number of stressful life events,body image problem,sexual inter-course,financial problems,anxious preoccupations and of course depression[67].Depression burden which has a negative impact,influences severity and number of side effects from medical treatment(surgery,chemotherapy, radiotherapy,hormonotherapy)by increasing digestive inconvenient(nausea),sense of fatigue and decreasing cognitive function(difficulty concentrating)[5,68]which can lower quality of life.But medical variables such as tumor stage or sociode-mographic data(education,marital status)except younger age do not have an adverse impact on quality of life[69].Breast cancer treatment can be traumatic for women who can develop afterwards different patterns of depres-sion that might worsen quality of life[3].Deshields et al.[3]among84women assessed depression3and6months after completion of treatment for breast cancer.Depression and quality of life were measured,respectively by two scales CES-D(center for epidemiological studies-depres-sion scale)and FACT-B(functional assessment of cancer therapy breast).The following results showed:•never depressed:51(61%):better quality of life •become depressed:3(4%):poorer quality of life •recover:8(9%):better quality of life•stay depressed:10(12%):poorer quality of life •vacillate(variable patterns):12(14%):worse quality of life.Antidepressant medications and Breast Cancer risk Treatment of depression in breast cancer women improves their quality of life and may increase longevity[21].Antidepressant medications remain the cornerstone of mood disorders treatment.The possible link between the prescription of antide-pressant medications and the later development of breast cancer remain controversial.Is there a risk using psycho-tropic medications such as antidepressant and breast cancer occurrence?This is an important issue for the medical community who is used to give frequently to depressed patients these types of drugs.So far,epidemiological data have shown conflicting and inconsistent results for any association between antidepressant use and breast cancer [70].There is controversial hypothesis due to methodo-logical limitation bias case control studies,lack of accounting for potential confounding factors and multiple statistical comparisons[71].Some studies suggested the possible implication of antidepressant such as sertraline[72],paroxetine[73]and tricyclics if used greater than two years’duration[73,74] and breast cancer risk occurrence by an increased rate of prolactin[75].In a recent paper[76],a large population-based case-control study among women enrolled in Group Health Cooperative was done between1990and2001with 2904primary breast cancer diagnosed andfive controls were selected for each case(N=14,396).Women of34% had used antidepressants up to one year,20%hadfilled two prescriptions for tricyclic antidepressants(TCAs)and6% for selective serotonin reuptake inhibitors(SSRIs)or atypical antidepressants.No patterns of increased risk were seen sincefirst use or time since last use of these several antidepressants.This result was confirmed in others studies [77–79].Studies do not support a specific link between antide-pressant medications and increased breast cancer risk regardless of duration of use,daily dose,specific drug used (SSRIs,TCAs)[77–82].The possibility of an association has not been excluded, although further studies are needed before the body of scientific evidence can be definitively conclusive[82].In order to take care of breast cancer patients with depressive disorders,pharmacological treatment must be combined with psychosocial interventions.Psychosocial interventions improves the well-being of cancer patients by decreasing emotional distress and depression in women diagnosed with breast cancer but not necessarily survival[83–86].In a recent randomized controlled trial among485women with advanced breast cancer,Kissane et al.[87]have compared the impact of supportive-expressive group therapy(SEGT)versus relaxation ther-apy on survival.These authors did notfind a significant prolong survival from these therapies(median survival 24months in SEGT and18.3in controls)[87].But SEGT improved quality of life and treatment and protection against depression.123Many psychotherapeutic interventions for this particular population can be implemented such as individual psy-chosocial support[88],adjuvant psychological therapy [89],cancer support group[90],online support for adjuvant psychological treatment[91],cognitive-behavioral stress management intervention[92].All these psychosocial interventions can be used to treat depression and will also improve the range of coping strategies and therefore quality of life[93].ConclusionComorbid depression significantly increases the burden of distress and dysfunction for patients with breast cancer.Diagnosis,surgery and recurrence of breast cancer are important period for clinical psychological distress and depression screening in order to manage them appropri-ately and to prevent recurrence of psychiatric disorders [57].Unidentified and untreated depression among breast cancer patients significantly compromises women’s quality of life[51].A psycho-oncologist is required to treat these mood disorders and to deal with psychological aspects such as representation of femininity,sexuality and risk of sterility.As treatment of depression remain paramount for improving their quality of life[20],there is no need to support a change in the current use of antidepressant medications in the management of depression among breast cancer patient[77,82].References1.Ferlay J,Autier P,Boniol M et al(2007)Estimates of the cancerincidence and mortality in Europe in2006.Ann Oncol 18(3):581–5922.Porter LS,Clayton MF,Belyea M et al(2006)Predicting nega-tive mood state and personal growth in African American and White long-term breast cancer survivors.Ann Behav Med 31:195–2043.Deshields T,Tibbs T,Fan MY,Taylor M(2006)Differences inpatterns of depression after treatment for breast cancer.Psych-ooncology15:398–4064.Meyerowitz BE(1980)Psychosocial correlates of breast cancerand its treatments.Psychol Bull87(1):108–1315.Baucom DH,Porter LS,Kirby JS et al(2006)Psychosocial issuesconfronting young women with breast cancer.Breast Dis23:103–1136.Spiegel D(1997)Psychosocial aspects of breast cancer treatment.Semin Oncol1(Suppl1):S1.36–S1.477.Derogatis LR,Morrow GR,Fetting J et al(1983)The prevalenceof psychiatric disorders among cancer patients.JAMA 249(6):751–7578.Harter M,Reuter K,Aschenbrenner A et al(2001)Psychiatricdisorders and associated factors in cancer:results of an interviewstudy with patients in inpatient,rehabilitation and outpatient treatment.Eur J Cancer37(11):1385–13939.Zabora J,BrintzenhofeSzoc K,Curbow B,Hooker C,PiantadosiS(2001)The prevalence of psychological distress by cancer site.Psychooncology10(1):19–2810.Grabsch B,Clarke DM,Love A,McKenzie DP,Snyder RD,Bloch S et al(2006)Psychological morbidity and quality of life in women with advanced breast cancer:a cross-sectional survey.Palliat Support Care4(1):47–5611.Burgess C,Cornelius V,Love S,Graham J,Richards M,RamirezA(2005)Depression and anxiety in women with early breast cancer:five year observational cohort study.BMJ330:702–705 12.Okamura H,Watanabe T,Narabayashi M,Katsumata N,AndoM,Adachi I et al(2000)Psychological distress followingfirst recurrence of disease in patients with breast cancer:prevalence and risk factors.Breast Cancer Res Treat61:131–13713.Fallowfield LJ,Hall A,Maguire GP,Baum M(1990)Psycho-logical outcomes of different treatment policies in women with early breast cancer outside a clinical trial.BMJ301(6752):575–58014.Fulton CL(1997)The physical and psychological symptomsexperienced by patients with metastatic breast cancer before death.Eur J Cancer Care6(4):262–26615.Kathol RG,Mutgi A,Williams J,Clamon G,Noyes Rjr(1990)Diagnosis of major depression in cancer patients according to four sets of criteria.Am J Psychiatry147:1021–102416.Van’t Spijker A,Trijsburg RW,Duivenvoorden HJ(1997)Psy-chological sequelae of cancer diagnosis:a meta-analytical review of58studies after1980.Psychosom Med59:280–29317.Ramirez AJ,Richards MA,Jarrett SR,Fentiman IS(1995)Canmood disorder in women with breast cancer be identified pre-operatively?Br J Cancer72(6):1509–1512nsky SB,Herrmann CA,Ets-Hokin EG,DasGupta TK,Wil-banks GD,Hendrickson FR(1985)Absence of major depressive disorder in female cancer patients.J Clin Oncol3:1553–1560 19.Massie MJ,Holland JC(1990)Depression and the cancer patient.J Clin Psychiatry51(Suppl7):12–1720.Aapro M,Cull A(1999)Depression in breast cancer patients:theneed for treatment.Ann Oncol10:627–63621.Somerset W,Stout SC,Miller AH et al(2004)Breast cancer anddepression.Oncology(Williston Park)18(8):1021–103422.Maguire GP,Lee EG,Bevington DJ,Kuchemann CS,CrabtreeRJ,Cornell CE(1978)Psychiatric problems in thefirst year after mastectomy.BMJ1:963–96523.Greenberg DB(2004)Barriers to the treatment of depression incancer patients.J Natl Cancer Inst Monogr32:127–13524.Mermelstein HT,Lesko L(1992)Depression in patients withcancer.Psychooncology1:199–21525.Ibbotson T,Maguire P,Selby P,Priestman T,Wallace L(1994)Screening for anxiety and depression in cancer patients:the effects of disease and treatment.Eur J Cancer30A(1):37–40 26.Razavi D,Delvaux N,Farvacques C,Robaye E(1990)Screeningfor adjustment disorders and major depressive disorders in cancer in-patients.Br J Psychiatry156:79–8327.Golden-Kreutz DM,Andersen BL(2004)Depressive symptomsafter breast cancer surgery:relationships with global,cancer-related,and life event stress.Psychooncology13:211–22028.Jacques JM(1998)The black bile in Greek Antiquity:medicineand literature.Rev E´tud Anc100(1–2):217–23429.McKenna MC,Zevon MA,Corn B,Rounds J(1999)Psychoso-cial factors and the development of breast cancer:a meta-analysis.Health Psychol18(5):520–53130.Duijts SF,Zeegers MP,Borne BV(2003)The associationbetween stressful life events and breast cancer risk:a meta-analysis.Int J Cancer107(6):1023–1029123。
乳腺癌-英文版解读
Anatomy
Anatomy
乳房主要由腺体、 导管、脂肪组织 和纤维组织等构 成。其内部结构 有如一棵倒着生 长的小树。
内部
1. Introduction
Western countries
>100/100,000 stable incidence declined mortality
The choice of the tracer
示踪剂的选择
Combination of radioactive isotopes and chemical dyeing agent can significantly improve the detection positive rate and accuracy . The effect of the radioactive isotope is better than that of chemical stain
3. Pathological typing
一、Noninvasive breast carcinoma 二、Early invasive breast carcinoma 三、Special types of invasive breast cancer 四、Ordinary types of invasive breast cancer--most special type： 1. Inflammatory breast cancer 2.Paget’s carcinoma of the breast
Inflammatory breast cancer
high malignant degree, fast development, poor prognosis younger women
护士对乳腺癌患者实施舒适护理的效果探讨
2014.09护理经验164手术创伤对患者造成的疼痛比较大，大多数的患者会对手术产生恐惧，对疾病比较惧怕，对手术后的体型改变有所担心、担心疾病术后的预防等等，这些都会使患者普遍产生心理上的负担。
舒适护理已经成为了主流趋势，是现代护理学中的主要内容，该项护理学的目的是为了让患者在手术前后提高舒适度和满意度。
舒适护理不仅使患者在与病魔斗争中减缓病情，还更注重对患者心理、生理、精神上的满足与愉悦。
1 资料和方法1.1 资料挑选我院乳腺癌外科的2009年12月到2013年12月期间的乳腺癌患者病例80例，她们都将接受乳腺癌的手术治疗。
随机分为两组，一组为对照组41例，一组为实验组39例，实验对象在年龄、接受文化的程度上并无差异，肿瘤分期方面也没有很大的差异，这样就排除了实验以外的因素影响。
1.2 实验方法在实验中，我们对对照组的乳腺癌患者在围手术期进行常规的护理，在手术治疗期间进行的护理有：术前的访视，也就是在手术的前一天，护士到病房对患者进行病情的大概评估和术前的一些指导；术中配合：各手术人员进行手术时的各项配合工作；术后的回访：在手术后的两到三天到病房去了解患者身体恢复的情况。
而在常规护理上还要根据病人的心理、生理、疾病等各方面的差异对患者因地适宜地采取舒适的护理计划。
对实验组进行舒适护理，具体的措施如下。
1.3 舒适护理1.3.1体位的舒适护理体位的舒适护理步骤：在做手术的侧肢垫个软枕，减少水肿现象。
①环境：要调节好手术室的环境温度湿度，医护工作人员的护士对乳腺癌患者实施舒适护理的效果探讨张 宇 宋美琳 齐 佳吉林省肿瘤医院 吉林省长春市 130012【摘 要】目的：意在讨论和研究出对乳腺癌患者在做手术期间实施舒适护理的应用效果。
方法：实验对象为在我医院实施乳腺癌手术的患者80例，分为对照组41例和实验组39例。
实验中对照组进行正常的护理，实验组做舒适护理。
结果：实验组对比对照组有显著差异，实验组的满意度高（P<0.05）。
护理外文文献汇报 PPT
CONTENT
1 2 3
文献的来源期刊、作者
文献的摘要组成 文献正文部分
文献的来源期刊、作者
Author:Emiko Kohno1, Saori Murase2 Author corporat： 1.Department of Hospital Pharmacy, Kansai Medical University Takii Hospital, 10-15 Fumizono-cho, Moriguchi, Osaka 570-8507, Japan 2.Department of Clinical Pharmacy, School of Pharmaceutical Sciences, Mukogawa Women’s University, 11-68 Koshien-Kyuban-cho, Nishinomiya, Hyogo 663-8179, Japan Journal：International Journal of Medical Sciences
IF:2.232
Keyword
1 vinorel bine 2 phlebit is 3 rabbit ear vein
infusio n rate 4
solutio n concent ration 5
Purpose
In order to identify methods for preventing phlebitis caused by intravenous administration of vinorelbine （长春瑞滨）(VNR), we established a procedure for estimating the severity of phlebitis in an animal model.
乳腺癌护理中英文对照外文翻译文献
乳腺癌护理中英文对照外文翻译文献乳腺癌护理中英文对照外文翻译文献(文档含英文原文和中文翻译) 翻译：宗教信仰在应对乳腺癌患者以后生活中的作用目的：识别并检查新诊断为乳腺癌的老年患者中是否存在宗教和精神应对策略现象。
方法：一个简易样本，由被招募来进行为期6个月的诊断的33名65岁女性组成。
受访者被要求参加一个会提出灵活性问题的结构式访谈。
访谈的誊本由三名研究人员各自独立分析讨论其主题,直至达成共识。
结果：参加者的宗教背景为:17名新教徒,五,六名犹太人,天主教和另外四个其它教徒。
她们在出席宗仪式的频率上存在着很大的不同。
而在健康危机期她们的宗教和/或精神信仰或增加或保持不变。
誊本分析显示出了三个主题。
宗教和宗教信仰为受访者提供了必要的情感支持（91%)、社会支持(70%)来面对她们的乳腺癌，以及赋予了她们一些使日常生活变得有意义的能力,特别是癌症经验(64%)。
结论：宗教和宗教信仰为新诊断为乳腺癌的老年女性患者提供了一些重要的应对这些疾病的方法,这些方法也得到了诊断医生的认可。
这可能对于鼓励这些患者寻求宗教的支持和/或重新与她们的宗教团体再结合是非常重要的。
引言一个关于乳腺癌的新的诊断已被证实对女性有重大的影响(格里，1979;琼斯和格林伍德1994；罗兰和马西，1996分;安徒生,1998)。
在老年妇女中，乳腺癌是最常见的癌症，其影响还会因为人口老龄化继续上升。
更好的了解老年妇女如何应对乳腺癌可以使人们更好的增强功能和改善生活质量。
最近日益让人们产生浓厚兴趣的是，宗教或信仰在患者对乳腺癌的反应中所扮演的角色。
在这些老年人中，宗教经常可以帮助她们缓解生理疾病中的固有压力,比如那些伴随着医师会诊、治疗及其它事件所产生的相关压力(包括罗斯,1982;考恩威博士(1985 - 1986);曼弗雷德和皮克特,1987)。
宗教或者精神依赖的正面效应，一直被认为是社会支持的次要规定，其通过与社会性的或教会有关的方式来进行宗教活动。
- 1、下载文档前请自行甄别文档内容的完整性，平台不提供额外的编辑、内容补充、找答案等附加服务。
- 2、"仅部分预览"的文档,不可在线预览部分如存在完整性等问题,可反馈申请退款(可完整预览的文档不适用该条件!)。
- 3、如文档侵犯您的权益，请联系客服反馈,我们会尽快为您处理(人工客服工作时间：9:00-18:30)。
乳腺癌护理中英文对照外文翻译文献(文档含英文原文和中文翻译)翻译：宗教信仰在应对乳腺癌患者以后生活中的作用目的：识别并检查新诊断为乳腺癌的老年患者中是否存在宗教和精神应对策略现象。
方法：一个简易样本，由被招募来进行为期6个月的诊断的33名65岁女性组成。
受访者被要求参加一个会提出灵活性问题的结构式访谈。
访谈的誊本由三名研究人员各自独立分析讨论其主题,直至达成共识。
结果：参加者的宗教背景为:17名新教徒,五,六名犹太人,天主教和另外四个其它教徒。
她们在出席宗仪式的频率上存在着很大的不同。
而在健康危机期她们的宗教和/或精神信仰或增加或保持不变。
誊本分析显示出了三个主题。
宗教和宗教信仰为受访者提供了必要的情感支持（91%)、社会支持(70%)来面对她们的乳腺癌，以及赋予了她们一些使日常生活变得有意义的能力,特别是癌症经验(64%)。
结论：宗教和宗教信仰为新诊断为乳腺癌的老年女性患者提供了一些重要的应对这些疾病的方法,这些方法也得到了诊断医生的认可。
这可能对于鼓励这些患者寻求宗教的支持和/或重新与她们的宗教团体再结合是非常重要的。
引言一个关于乳腺癌的新的诊断已被证实对女性有重大的影响(格里，1979;琼斯和格林伍德1994；罗兰和马西，1996分;安徒生,1998)。
在老年妇女中，乳腺癌是最常见的癌症，其影响还会因为人口老龄化继续上升。
更好的了解老年妇女如何应对乳腺癌可以使人们更好的增强功能和改善生活质量。
最近日益让人们产生浓厚兴趣的是，宗教或信仰在患者对乳腺癌的反应中所扮演的角色。
在这些老年人中，宗教经常可以帮助她们缓解生理疾病中的固有压力,比如那些伴随着医师会诊、治疗及其它事件所产生的相关压力(包括罗斯,1982;考恩威博士(1985 - 1986);曼弗雷德和皮克特,1987)。
宗教或者精神依赖的正面效应，一直被认为是社会支持的次要规定，其通过与社会性的或教会有关的方式来进行宗教活动。
人们去教堂敬拜时通过培养友情和社会关系来获得能够提供正式的和非正式的社会网络的支持。
另一些人认为,宗教允许人们获得一种在某种意义上能够控制她们的命运的感觉。
虽然我们知道宗教和精神信仰有助于应对癌症诊断的影响以及随后的调整，但是信念所给予的帮助机制却还没有得到很好的阐明。
在这个探索性研究中,我们调查了宗教和精神在确诊为乳腺癌的老年妇女的生活中所扮演的角色。
研究的问题包括:宗教和精神在乳腺癌的确诊后扮演什么角色?宗教和精神有没有提供一种应对确诊时的不幸感的方法？如果是这样的话,又该如何？这里所讨论的数据来自于一个更大的研究，是在加州大学洛杉矶分校家庭医学部门正在进行的关于老年女性乳腺癌患者的生命质量的研究。
本研究使用定性方法,为了评估新诊断出患有乳腺癌的老年患者的心理、社会、信息、健康需求。
本研究的长期目标是为了发展使病人能够获取信息、情感和社会支持的干预能力,这会提高她们的生活质量。
方法：样本我们使用了一个方便抽样策略,招收来自8个研究基地的参与者,这其中就有社区及医院乳癌和癌症研究中心、私人外科病房和肿瘤实验所,分别坐落于洛杉矶县的五个不同地区(东洛杉矶,洛杉矶市中心,长长的海滩上,圣莫尼卡和西洛杉矶)。
参与的社区医师(包括外科医师、医学肿瘤学家,放射肿瘤学家)在之前的6个月被要求能够分辨出65岁以及年龄更大的确诊患有乳腺癌的女性。
规定半年期限制是为了保证受试者能够足够接近准确地回忆起，当得知确诊为乳腺癌时对她们的生活所造成的影响。
其它入选标准包括是否能够熟练掌握英文或西班牙语中的其中一种语言，以及在面试时的认知能力。
医生写信邀请她们参与研究，写信者们并不知道所发信函的总人数。
90个病人收到了信,49个(54%)表示出参与这项研究的兴趣。
49个人中,2位(4%)妇女拒绝了，因为她们住在洛杉矶，地理距离超过100英里,6人(12%)尽管在调查人员的不懈努力下也不可能到达,7人(14%)在定性访谈研究结束后才回复，1个(2%)不符合纳入标准。
剩下的33名女性完成了面试。
每场面谈都为参与者提供了一个方便的位置选择(94%的人选择了她们自己的家园)。
为了符合社会大众的经济利益标准,受试者被给予30美元现金以激励她们继续参与。
面试被结构化的录下来,然后原封不动地选取转录。
工具：一份有着开放性主题的结构式问卷被用于个人采访中。
问题集中在参与者与她们的诊断医生的交往,在得到乳腺癌的诊断后她们需要什么样的社会心理支持，反抗什么样的心理支持,得了乳腺癌决定如何治疗等等。
面试官也会提问关于宗教和精神方面的问题。
这些问题集中在宗教对这些参加者的日常生活的影响，特别突出在乳腺癌方面。
例如一个关于宗教/精神的开放性问题是这样的:你的宗教或者精神信仰在乳腺癌期间起到了什么作用?每场面谈都持续大约2小时。
数据分析：面谈内容被不同理论背景的研究人员(一位在宗教中培养的社会学家,一个家庭医生和老年医学专家，一位医科学生研究助理) 独立鉴定了循环主题审核并且进行了文本分析。
谈话内容的简版和主题由每个研究员写一部分。
访谈内容被分成不同段落并根据主题重新编排。
每个研究员在结果进行比较和讨论之前都会独立的编排数据并且分类。
最终的分类都是寻求饱和主题——就是观察哪个主题最终会从数据中显露出来。
之所以会认同这个模式是因为一致性是定性分析的标志，以及等价于定量工作的有效性。
现在的工作中值得注意的是, 虽然每个研究员都会在她们的训练中给出特定的敏感性分析，但是共识却是在宗教和精神的主题中达成的。
结果这33个人的平均年龄是74.4岁，受访者年龄范围为65 - 86岁。
尽管大约四分之一的样本由少数民族组成，但这些妇女主要是白人,(见表1)。
一半的受访者和配偶住在一起,另一半则是离了婚,分居或丧偶，独自一人或和孩子一起居住或者有守护者。
大多数的患者接受过大学教育，她们的财务状况非常多样。
33个女性中只有七个女性(21%)认为她们的财务资源、独立的收入不足以满足她们的财政需要。
对于本例的治疗包括接受肿瘤切除,乳房切除,放疗、化疗和一些混合了两种或两种以上的治疗方法。
大多数的被调查者(n = 20)接受肿瘤切除和辐射。
从当提到宗教时,大多数(79%)的受试者更愿使用术语“宗教”或“神灵”(相对于精神)谈论她们的信仰。
尽管还有少数其它的宗教代表，但大多数的受访者信仰新教。
这是一次宗教服务的出勤率(见表1)。
那些感觉能够明确回应(n = 3),以确定她们在健康危机中的信心是否结束,或者削弱,有一半的人说,她们的信心保持不变,另一半的人则在报告中表现为加强了。
有趣的是,没有人报道,她们的信心已有所减弱。
文本分析揭示了三个关于信仰带给调查者的相互联系的主题:(1)情感支持(2)社会支持(3)人生意义。
这些主题有许多的次级主题将在下文进行讨论, 具体罗列在表2中。
情感支持：30名女性谈到了宗教或精神信仰是如何给她们以必要的的情感支持以应对乳腺癌的(见表2)。
这些参与者觉得在她们生病期间能够依靠上帝是十分重要的,因为大多数的受访者觉得,她们无法承受其它人对乳腺癌的恐惧(例如,她们对死亡的畏惧)。
在访问时她们认为，她们永远不会感到孤独,因为上帝一直在自己的身边,上帝不会抛弃她们,上帝会看着她们渡过艰难的时光。
一个令人惊讶的发现是，当宗教被质疑时,这些妇女中的大多数能够表达出当得知诊断为乳腺癌时的痛苦,即当直接询问她们的情绪反应时，她们的反应都是非常忍耐的。
关于情感支持的主题被分成八个次级主题，具体例子如下。
其中的一些种类不同于受访者如何采取积极措施对抗消极角色。
陪伴。
情感支持主题下最常见的子主题，意味着感受到陪伴。
对于许多失去了伴侣和/或独自生活的受访者来说,这个意义神的相伴是尤为重要的。
一名美籍华人的笔记:我相信有一个神在那里,帮助我们每一个人,否则我想我会觉得很糟糕。
如果我没有那种信仰,我很可能是脑海里的“cookoo”。
感觉到被照顾。
十二位受访者觉得,如果她们有足够的信心，神是不会轻易放弃对她们的庇佑的,并且她们会得到最好的结果。
正是这些受访者的积极心态以及对上帝的信任,使她们觉得上帝在照顾她们。
一个拉蒂那的受访者解释说:似乎,关于乳腺癌的这整件事情,我觉得我能够很好地走出来。
我之所以我觉得自己能够很好地走出来,是因为我的信念在一个制高点，我相信我的上帝将要来照顾我,我的家庭可能会用一种或其它的方式来安慰我，但是这些强大的关于神的信念给与我比家人更多更重要的的慰藉。
另一种方法中,当一些受访者(n = 3)谈论到上帝时,她们觉得是上帝在指导和帮助外科医生照顾好她们。
换句话说,医生只是一种被神用来操作的工具，上帝操纵着医生；“上帝是医生c 1以及医生d，或者是医生c”。
信仰依赖。
11位受访者在谈论到她们的乳腺癌经历时提到了依赖上帝或她们的信仰。
例如,一个白人新教的女人在回答为什么宗教对她来说很重要时说,“我觉得我有可以依赖的力量。
总是有人在支持我。
当事情变得很艰难时,我可以去请求神的帮助而且它通常都是有求必应的。
满足感。
11位女人认为精神/宗教带给她们满足感。
信仰给予她们癌症能够治愈的希望,使她们感到乐观,并给她们一些提供这些（满意感）的自我价值的感觉。
一位非裔美国受访者说，当得知被确诊为乳腺癌时从诊断医生的办公室到回家的路上一直在哭泣:我记得我沮丧极了。
之后,当我向上帝祷告时,我似乎听到了鼓舞“继续走下去,这会对你有好处的”。
你懂的。
所以,这真的很美好,对于那些打倒我的事情我并没有感到害怕。
安慰。
八个受访者从她们的宗教和宗教信仰中得到安慰,它为她们提供了安全、保证、和平、安宁、平静和支持。
一名受访者报告说每当她在午夜醒来的时候，她发现阅读基督教沉思录对自己特别有帮助:我阅读它,它会帮助我....这些就像是关于所有癌症受害者和癌症病人,而且它很美好。
我把它放在我的床边,我会每天晚上读它并且感觉很好......它能够使我保持理智......如果让我来提问的话,让我想一想。
我会说,“好吧,不是每一个人?”她说,“噢,不。
”社会支持第二个主要主题有70%的受访者参与讨论了宗教信仰为她们提供的社会支持。
社会支持的主题在这里被广泛地定义为，不是实际存在的，和他人之间建立的亲密关系。
报告者通过祈祷或其它与受访者的过去或未来有联系的志同道合的信徒,或宗教社区成员中的个人关系来发现社会支持。
宗教也为受访者提供了社会对外出口,无论是通过参加宗教仪式,志愿工作,或是其它与她们的宗教信仰有关的社会活动。
社会支持的主题被分成五个次级主题,以具体例子如下。
为或者被别人祈祷。
十位女性谈论到了患乳腺癌期间祷告的重要性。
对一些人来说,在这个焦虑的时刻为他人祈祷是很重要的。
有些人则当得知有人为她祈祷时感到很欣慰。
一位女性说:我想,当我知道我的命运掌握在上帝的手中,而且在全国各地有很多的朋友和家人，还有一些身在英国和德国的人在为我祷告时，我不应该坐在这里为自己难过。