前列腺癌联合治疗策略研究

根据《每日电讯报》的报道,前列腺癌患者应该在接受激素治疗的同时也接受放射治疗。报道说,科学家们建议联合治疗的方法应该被看作是前列腺癌的治疗标准,从而取代现在的单纯以激素治疗的方法。这篇报道基于一项对患有局部晚期前列腺癌的男性患者的最新研究。癌症只在前列腺的局部有扩散,而在身体的其他部分没有转移。研究者将875位患者随机分成两组,其中一组只用标准的激素治疗方法,另一组除了激素治疗以外辅助一段时间的放射治疗。     

巴曲酶联合甲泼尼龙治疗突发性耳聋疗效分析

分析巴曲酶治疗平坦型突发性耳聋联合应用甲泼尼龙的疗效.巴曲酶+激素组,共38例,平均听阈75.1dB.巴曲酶组,共16例,平均听阈74.7dB.两组治疗前后平均听阈差无统计学差异(t=0.063,P＞0.05).提示联合应用甲泼尼龙(24mg,5天)对巴曲酶治疗平坦型突发性耳聋不能降低患者治疗后听阈.     

化学性免疫调节剂在溃疡性结肠炎中的应用

近年来,免疫调节剂（如硫唑嘌呤、6-巯基嘌呤、甲氨喋呤、环孢素等）已广泛应用于临床中,主要用于治疗激素依赖型或激素无效的溃疡性结肠炎患者,显示有良好的疗效。然而,这些药物的剂量、副作用和长期维持治疗,应根据个人的具体情况适当选择适应证,以达到最佳疗效。     

糖皮质激素联合中医温阳法治疗原发性肾病综合征系统评价

系统评价糖皮质激素联合温阳法治疗原发性肾病综合征的效果.检索PubMed、Cochrane Library、CNKI、CBM、万方、维普,查找糖皮质激素联合温阳法与单用糖皮质激素比较,治疗原发性肾病综合征的随机对照试验（RCTs）.按照Cochrane手册5.1.0,采用RevMan5.2.0软件进行Meta分析.最终纳入4个RCTs,共272例患者.经Meta分析,糖皮质激素联合温阳法可能在升高血浆白蛋白,降低24h尿蛋白定量、降血脂、改善血液流变学,提高临床疗效等方面有积极作用.但对减少激素副作用、降低疾病复发率缺乏证据.     

产前筛查的几点思考

在临床工作中,患者因某些原因不能得到有效或常规的治疗,而最终选择停止继续治疗、即放弃治疗,及时、合理、正确地处理放弃治疗对患者、医务人员、家庭、社会等是极其重要的。对临床上常见的放弃治疗原因进行了全面分析,包括患方、医生、功利、无奈、道德等方面的原因,并提出了解决放弃治疗的临床决策,该研究为临床治疗过程中提供了重要的理论参考。     

前列腺癌联合治疗策略研究

根据<每日电讯报>的报道,前列腺癌患者应该在接受激素治疗的同时也接受放射治疗.报道说,科学家们建议联合治疗的方法应该被看作是前列腺癌的治疗标准,从而取代现在的单纯以激素治疗的方法.这篇报道基于一项对患有局部晚期前列腺癌的男性患者的最新研究.癌症只在前列腺的局部有扩散,而在身体的其他部分没有转移.     

有关放弃治疗的临床决策

在临床工作中,患者因某些原因不能得到有效或常规的治疗,而最终选择停止继续治疗、即放弃治疗,及时、合理、正确地处理放弃治疗对患者、医务人员、家庭、社会等是极其重要的.对临床上常见的放弃治疗原因进行了全面分析,包括患方、医生、功利、无奈、道德等方面的原因,并提出了解决放弃治疗的临床决策,该研究为临床治疗过程中提供了重要的理论参考.     

以高血压治疗为例谈以患者为中心的医疗模式

高血压是我国心脑血管病致死的主要危险因素,我国高血压的发病率仍在不断增高.但近年高血压的“知晓率,治疗率和达标率”改变仍不明显.在大量的临床工作中,由于患者多,工作繁忙等原因,医生在日常工作中,与患者没有机会交流,对高血压患者的处理,只限于开药,并不能与患者进行健康生活方式的指导,更缺乏心理交流.因此,对高血压患者的治疗,并不能得到很好的治疗依从性,影响治疗效果.本文根据本人的一点临床工作经验,提出必须重视与患者的交流,加强对患者不良生活方式的纠正,积极鼓励戒烟,降低钠盐摄入等综合防治措施,力争达到较好的高血压治疗效果.     

肝门部胆管癌外科治疗的现状与展望

肝门部胆管癌是一种罕见的胆道原发性肿瘤,其临床症状隐匿,早期检测方法匮乏,以至于患者总体生存率低下。手术治疗仍然是目前的主要治疗方法,包括规则性肝切除联合肝外胆管切除,淋巴结清扫,均给予患者带来长期存活和潜在治愈的可能。尤其是联合新辅助放化疗后行肝移植术,为不能切除的肿瘤患者提供了新的治疗方法。但是关于手术切除的范围、术前减黄的执行标准、动静脉的切除与重建均存在争议,亟需联合多诊疗中心开展大型临床随机对照研究以确定肝门部胆管癌手术的执行标准。     

难治性丙型肝炎研究新进展

随着聚乙二醇化干扰素（IFN）的普及应用和慢性丙型肝炎规范化治疗的开展,其治愈率不断提高.但疗效不佳的慢性丙型肝炎患者不断积累,难治性慢性丙型肝炎患者成为临床医生必须面对的挑战.难治性丙型肝炎患者应当分为两类,第一类为“难治疗”性慢性丙型肝炎患者,该类患者由于宿主条件限制,不能耐受IFN联合利巴韦林（RBV）的标准治疗,如儿童和老年人、慢性肾功能衰竭患者等.第二类为“难治愈”性慢性丙型肝炎患者,该类患者可以耐受标准治疗方案,但按照应答指导的治疗原则（RGT）治疗后,效果仍然不佳或复发.本文就近年关于难治性丙型肝炎的研究进展,从难治性丙型肝炎的定义、机制、治疗诸方面作一综述.     

原发性肾病综合征合并甲状腺功能异常患者临床资料分析

分析原发性肾病综合征合并甲状腺功能异常患者的临床特征,探讨其,I盏床意义。对37例原发性肾病综合征合并甲状腺功能异常患者的,陆床资料进行回顾性分析,治疗前检测甲状腺过氧化物酶抗体（Anti～TPO）、甲状腺球蛋白抗体（Anti—TG）,并分别于治疗前后检测血清游离T3（FT3）、血清游离甲状腺激素（FT4）、促甲状腺激...     

不同程度尿蛋白患者血清甲状腺激素水平变化及其临床意义

探讨不同程度蛋白尿患者血清甲状腺激素水平的变化及其临床意义。66例不同程度蛋白尿患者,肾病综合征组28例,非肾病综合征组38例,健康对照组60例。发现蛋白尿水平与甲状腺激素水平尤其是FT3水平关系密切。在肾病综合征患者,主要表现为FT3显著降低,提示肾病综合征是正常甲状腺病态综合征的一种。     

EGFR基因突变NSCLC全程管理

表皮生长因子受体（EGFR）基因突变的非小细胞肺癌（non-small cell lungcancer,NSCLC）是一类具有独特病理和临床特征的恶性肿瘤。目前由于针对EGFR基因突变阳性NSCLC治疗中TKIs的应用,患者的生存期已超过三年,所以此类患者从诊断到治疗应进行全程管理。首先要进行分子检测,发现EGFR基因突变NSCLC,以避免失去EGFR—TKIs的治疗机会。研究证明,EGFR基因突变NSCLC任何线接受第一代抑制剂治疗,患者疗效及生存获益且耐受性良好。一代EGFR—TKIs耐药后根据失败模式选择后续局部或全身治疗,或根据耐药失败分子机制给予新的分子靶向治疗。对EGFR基因突变NSCLC应实施科学、有序的全程管理。     

炎症性肠病的药物治疗现状及进展

炎症性肠病（IBD）病程迁延反复,影响患者生活质量,耗费卫生资源。虽然传统药物如5-氨基水杨酸、糖皮质激素、免疫抑制剂等仍是目前治疗主流,但是大量有关发病机制的研究以及循证医学的发展对IBD的治疗产生了积极的推进作用。IBD的治疗正步入免疫调节的生物学时代,多种新型生物制剂的出现为IBD的治疗提供了新的策略和选择。现就目前IBD药物治疗现状以及最新进展进行综述,以期对临床IBD治疗提供参考。     

Initial experiences with the Reiber 1979 determination of autochthonous IgG production within the scope of clinical and immunologic follow-up studies in multiple sclerosis treated with immunosuppressive therapy

We carried out clinical and immunological follows-up to 21 patients suffering from multiple sclerosis, 16 of whom had been immunosuppressively treated. A remission in clinical way was possible to point out with 8 of 12 patients (66%) -average remission by 1 score acc. to the Bronx-Scale- and with these patients a local formation of immunoglobulin acc. to Reiber (1979) could be proven. With 40 to 60% of the patients pathological changes were found out by determining of routine parameters by means of liquor examinations (total number of cells, sediment, total protein, electrophoresis) in which the humoral values responded not so sensitively to immunosuppressive therapy than the cellular values. For the present, liquor- and immunodiagnostic is being considered as a solid part of diagnostic programm and therapy control with regard to patients suffering from multiple sclerosis.     

Metabolic and endocrine disturbances in psychiatric disorders: a multidisciplinary approach to appropriate atypical antipsychotic utilization

Patients with psychiatric disorders have an increased rate of cardiovascular morbidity and mortality compared with the general population. Metabolic issues such as weight gain, dyslipidemia, diabetes mellitus, diabetic ketoacidosis,and pancreatitis have been reported with the use of antipsychotic agents. Although atypical antipsychotics have not been linked directly to the development of metabolic syndrome, these medications have been shown to increase risk factors that can lead to metabolic and endocrine disturbances. Therefore, clinicians should provide ongoing monitoring for patients who are being treated for psychiatric disorders with these agents. According to the 2004 Consensus Report on Antipsychotics, screening measures should include baseline and follow-up monitoring of personal/family histories, weight (body mass index), waist circumference, blood pressure, fasting plasma glucose, and fasting lipid profile.     

Role of serotonin and serotonin-selective pharmacotherapy in alcohol dependence

The majority of studies that have examined the usefulness of pharmacotherapies selective for serotonin (5-hydroxytryptamine; 5-HT) as a treatment for alcohol dependence have been standard, double-blind clinical trials that include patients with a variety of clinical presentations. Almost all of the early studies evaluated heavy social drinkers and found only a modest advantage for 5-HT pharmacotherapies in reducing the number of drinks per day. Also, the advantage of these pharmacotherapies was observed primarily when these agents were given at higher daily dosages than suggested prescribing practices for use as an antidepressant. The few studies that evaluated treatment-seeking patients found that 5-HT pharmacotherapies were not instrumental in reducing drinking rates compared with placebo. These results led to a dampening of enthusiasm for use of these agents in treating alcohol dependence. However, more recent investigations have begun to target subgroups with potential abnormalities in 5-HT neurotransmission. The thinking is that these medications should be most useful in alcohol-dependent individuals who have more clearly delineated suggestive signs of 5-HT dysfunction, such as concomitant depression or anxiety. Although few results are available to date, there is growing evidence to suggest that alcohol-dependent subgroups are differentially responsive to 5-HT pharmacotherapies with respect to drinking-related outcomes. This may explain the modest and variable 5-HT pharmacotherapeutic effects that were reported in the earlier studies, which included large heterogeneous patient groups. Further investigations are needed to confirm these initial optimistic results.     

Memory and metamemory: a study of the feeling-of-knowing phenomenon in amnesic patients

Accuracy of the feeling of knowing was tested in patients with Korsakoff's syndrome, patients prescribed electroconvulsive therapy, four other cases of amnesia, and control subjects. In Experiment 1, we tested feeling-of-knowing accuracy for the answers to general information questions that could not be recalled. Subjects were asked to rank nonrecalled questions in terms of how likely they thought they would be able to recognize the answers and were then given a recognition test for these items. Only patients with Korsakoff's syndrome were impaired in making feeling-of-knowing predictions. The other amnesic patients were as accurate as control subjects in their feeling-of-knowing predictions. In Experiment 2, we replicated these findings in a sentence memory paradigm that tested newly learned information. The results showed that impaired metamemory is not an obligatory feature of amnesia, because amnesia can occur without detectable metamemory deficits. The impaired metamemory exhibited by patients with Korsakoff's syndrome reflects a cognitive impairment that is not typically observed in other forms of amnesia.