肿瘤临床治疗中应关注肝脏

抗肿瘤细胞毒性药物有不同程度毒副作用.有些严重毒副反应是限制药物剂量或使用的直接原因.肝脏是药物代谢的主要器官,也是药物损伤的主要靶器官.随着临床肿瘤治疗关注治疗带来的副作用与关注疗效同等重要的发展,本文对抗肿瘤细胞毒性药物与肝损伤、发生机制、诊断、分型和临床治疗进展进行了阐述.     

肿瘤细胞耐药的哲学内涵

化学疗法是目前治疗肿瘤的主要措施 ,而肿瘤细胞对化学药物往往容易产生耐受 ,并成为临床治疗肿瘤取得满意疗效的主要障碍之一。肿瘤细胞对一种使用过的抗肿瘤化疗药物产生耐药之后 ,同时对多种不同结构、不同作用机制的抗肿瘤药物也产生交叉耐药现象 ,称为肿瘤多药耐药性 (Ｍｕｌｔｉｄｒｕｇｒｅｓｉｓｔａｎｃｅ ,ＭＤＲ)。肿瘤耐药的形成既是细胞生物发展的一种自然规律 ,也是细胞生物行为的必然现象。其间包含了许多哲学的内涵。1　生物进化与肿瘤细胞耐药的形成进化的概念衍生于人们对生物起源的认识。拉马克、达尔文等人根据大量事实…     

肿瘤化疗相关心脏毒性研究现状及进展

恶性肿瘤与心脏疾病已成为危害人类健康的主要疾病,肿瘤治疗的不断进步使得患者获益于生存期的延长,而肿瘤治疗带来的心血管毒性得到广泛关注。肿瘤心脏病学(cardio-oncology)定位于肿瘤治疗引起的心脏毒性及肿瘤合并心脏疾病。本文对常用化疗药物心脏毒性的研究现状及其监管进行综述,为防治肿瘤化疗相关心脏毒性提供经验。     

药物性肝损伤的临床处置策略

本文讨论了药物性肝损伤治疗的相关临床问题,概括出以下几点：（1）可预知性与不可预知性肝毒性药物的临床处置方法,强调治疗的关键是停止肝毒性药物的使用以及停药的具体指征;（2）支持治疗不应被忽视,以及如何实施;（3）解毒药物的概念和种类;（4）保肝药物应用中存在的问题,主要是不按药理机理选择和多重用药,介绍了保肝药的不同机理和代表药物,阐述不要多种保肝药联合的基本原则;（5）根据肝损伤临床类型选择不同的治疗方案,肝细胞损伤以保肝药物治疗为主,胆汁淤积以利胆治疗为主,对重症肝损伤者应人工肝支持治疗,必要时进行肝移植.     

关于肿瘤生物治疗的思考

肿瘤临床治疗的方法多种多样 ,每一种方法都能给患者带来福音 ,但每一种方法都有其不足之处。手术治疗和放疗有着立竿见影的效果 ,但一旦肿瘤发生远端转移 ,手术治疗将束手无策 ;化疗方案应用最为广泛 ,但大多数化疗药物都是针对肿瘤细胞新陈代谢快的特点设计的 ,必然祸及人体内同样代谢快的组织如肝、肾、血细胞等 ;某些药物能诱导细胞分化 ,正所谓让肿瘤细胞“改邪归正” ,或是触发肿瘤细胞凋亡 ,正所谓让肿瘤细胞“自取灭亡” ,但这类药物的临床应用是十分有限的。近年来 ,被人们十分看好的肿瘤生物治疗方法 ,给肿瘤治疗带来新的希望 ,但…     

肺癌分子靶向治疗的实践与展望

随着分子病理学发展,我们对肺癌,尤其是非小细胞肺癌的潜在病理机制及显著异质性有了更深刻的理解,也确定了多条信号通路及致癌性驱动突变,针对这些位点(蛋白分子或基因片段)的药物与之结合,使肿瘤细胞特异性死亡,而不累及周围正常组织,即分子靶向治疗,相较经验性细胞毒性治疗,已表现出显著的临床获益,但获得性耐药仍常见。本文将基于现有循证医学证据,对肺癌分子靶向治疗临床实践的现状及未来发展的趋势作一篇综述。     

抗肿瘤药物心脏毒性的监测和治疗进展

许多临床常用的抗肿瘤药物均有不同程度的心脏毒性,常见的心血管并发症包括心力衰竭、心肌缺血、心律失常、高血压、低血压、血栓形成等。现就国内外近年对抗肿瘤药物心脏毒性的监测和治疗等方面的进展进行综述。     

抗肿瘤药物心脏毒性的监测和治疗进展

许多临床常用的抗肿瘤药物均有不同程度的心脏毒性.常见的心血管并发症包括心力衰竭、心肌缺血、心律失常、高血压、低血压、血栓形成等.现就国内外近年对抗肿瘤药物心脏毒性的监测和治疗等方面的进展进行综述.     

癌痛治疗指南解析

对多国成人癌痛指南进行检索、回顾,发现近年癌痛治疗领域新进展和各国普遍遵循的共同原则,为临床医生改进癌痛治疗提供参考。采用现有的互联网临床实践指南检索平台,对成人癌痛指南进行检索,分析各国指南的异同之处,重点对疼痛评估、WHO三阶梯药物治疗及辅助治疗进行比较、归纳。全面的癌痛评估是指痛治疗的必要前提,也是众多癌痛指南强调的重点;按疼痛程度选择三阶梯镇痛药物仍是药物止痛的基本原则;口服途径是止痛治疗的首选给药途径;第一阶梯药物中阿司匹林的应用逐渐淡化,NSAIDs的毒性反应受到关注;第二阶梯药物的选择更灵活。应根据疼痛性质、患者的具体情况合理选择复合制荆。吗啡仍是强阿片类药物中的首选,可用于中、重度疼痛的治疗。因此,我国成人癌痛治疗需要改进,应重点推广全面的疼痛评估,提倡根据患者的具体情况合理、灵活的选择三阶梯药物,个体化治疗是止痛治疗的关键。     

关于阿尔茨海默病个体化治疗的思考

阿尔茨海默病（Alzheimer＇s disease ,AD）患者是亟需社会关注的特殊群体,因老年人常罹患多个系统疾病,用药种类繁多,考虑到药物不良反应与相互作用,临床医生在针对老年人用药时,在注重整体性的同时更要关注个体化治疗,辩证施治。药物基因组学是研究基因多态性及其他形式变异引起药物代谢酶、药物转运体和药物作用靶点功能异常,导致药动学和药效学在群体和个体差异的一门科学。它以药物效应及安全性为目标,研究各种基因突变与药效及安全性的关系,掀起了临床用药观念的颠覆性变革,为阿尔茨海默病个体化治疗提供了崭新的视角。     

Anticipatory nausea in cancer patients receiving chemotherapy: Classical conditioning etiology and therapeutical implications

The delivery of cytotoxic drugs in cancer treatment is often accompanied by posttreatment side effects (e.g., nausea). Moreover, there is evidence that cancer patients are at risk to develop these side effects in anticipation of chemotherapy (i.e., anticipatory nausea [AN]). AN can be explained as the result of a classical conditioning process with the cytotoxic drug as the unconditioned stimulus (US). Stimuli paired with the US (e.g., smells, tastes) can become conditioned stimuli (CSs) eliciting AN as the conditioned response (CR). The present study was conducted to test whether AN shows characteristics of a CR. Fifty-five ambulatory cancer patients were asked to record nine kinds of physical symptoms (e.g., nausea, vomiting, sweating) on time-scheduled symptom lists: after an infusion (indicating posttreatment symptoms) and prior to their next infusion (indicating anticipatory symptoms). Each measurement period covered a maximum of 48 hours. AN was reported by ten patients (18.08%). Data revealed (a) a statistically significant association between posttreatment nausea and vomiting, respectively, and AN; (b) the occurrence of AN increased with drug emetogenity (i.e., US-intensity); and (c) the duration of AN increased with temporal proximity to the infusion. The results support the conditioning model. Thus, it is proposed to prevent AN by classical conditioning techniques (e.g., overshadowing).     

Neuropsychological and Behavioral Effects of Antiepilepsy Drugs

Antiepilepsy drugs work by decreasing neuronal irritability, which may also result in the non-desired side effect of decreased neuropsychological function. In addition to cognitive side effects, antiepilepsy drugs (AEDs) may be associated with behavioral effects which may range from irritability and hyperactivity to positive psychotropic effects on mood. There have been many new medications released since the 1990s, and although they tend to have more favorable side effect profiles compared to their older counterparts, there continues to be a risk of decreased cognitive function with the majority of these agents. The effects of in utero antiepilepsy drug exposure are increasingly being investigated, and differential drug risk is beginning to be described for both anatomic and cognitive outcomes. Patients with epilepsy undergoing neuropsychological evaluations are commonly on AEDs, and it is important for the clinician to recognize the potential contribution of AED therapy to neuropsychological profiles. The present article serves to provide an overview of our current understanding regarding the risks of antiepilepsy drug use for both cognitive and behavioral side effects.     

溃疡性结肠炎生物免疫治疗进展

目前临床上对溃疡性结肠炎患者的治疗有氨基水杨酸、糖皮质激素、免疫抑制剂、抗生素、益生菌、生物免疫制剂和手术切除等。近年来在临床上应用生物免疫制剂治疗溃疡性结肠炎,尤其是抗肿瘤坏死因子、a4β7整合素、CD25等单克隆抗体已经显示良好的疗效,但这些生物免疫抑制剂的长期疗效、副作用及其与其他药物之间的相互作用需要进一步研究。     

米非司酮对体外培养绒毛组织SPAG9表达的影响

孕早期的绒毛组织体外分为两组培养：米非司酮干预组和对照组。应用免疫组化、Westernblot和RT—PCR检测两组绒毛SPAG9的表达。结果显示,米非司酮干预组SPAG9的表达与对照组相比显著减弱（P〈0．05）。提示米非司酮可抑制早孕绒毛组织SPAG9的表达,其可能通过此机制发挥抗肿瘤的作用。     

Current status of psychological research in organ transplantation

Research addressing the psychological concomitants of organ transplantation is reviewed. Specifically, cognitive, behavioral, and psychosocial correlates of kidney, heart, liver, and bone marrow transplantation in both children and adults are discussed. Despite several conceptual and methodological shortcomings of the psychologically-based research in this area, results seem to indicate that organ transplantation is associated with many psychological issues at pretransplantation, posttransplantation, and follow-up periods. Implications of these general findings for the advancing roles of the health psychologist in organ transplantation are discussed.     

谈中医认知方式及中医理论体系的构建

提出开箱式思维和闭箱式思维的概念,并以此为基础对中医认知方式和中医理论体系的构建进行初步的探讨.整体上,中医认知方式是一种宏观性闭箱式思维,中医学是一种闭箱式理论体系.     

肝移植的伦理学问题

肝脏移植和其它器官移植一起实现了人类长期以来渴望生命再生的梦想,并成为终末期肝病的有效治疗方法。器官移植也面对许多伦理道德方面的难题。供体,特别是活体器官的摘取,受体的选择等,都受到社会道德观的制约。从伦理道德角度来分析如何制定相关的法律法规,成为当前社会关注的热点。从受体的利益、人体科研的道德规范以及相关制度的伦理学要求等方面,较为详细的阐述肝移植伦理学的基本原则。     

Accountability amplifies the status quo effect when change creates victims

This study assesses the impact of accountability, the status quo, and anticipated costs and benefits on judgement of the acceptability of a drug in the US pharmaceuticals market. Several effects are documented: (1) subjects were more accepting of a drug, the lower the anticipated risks of side effects and the greater the anticipated benefits; (2) subjects were especially unwilling to accept risk when the drug was not yet on the market and when they felt accountable for their decisions; (3) accountable subjects confronted by an off-the-market drug that posed moderate or high risk were also especially likely to procrastinate, to buckpass, and to think in integratively complex ways about the problem, notwithstanding the fact that many more lives would be saved than lost. We explain these results by positing that perceptual-cognitive processes (loss aversion) and political processes (blame avoidance) mutually reinforce each other when decision makers are accountable for choices that raise the possibility of changing the status quo in ways that impose losses on identifiable constituencies. We conclude by commenting on the complex normative issues that arise in labelling response tendencies as biases. Choices that look irrational within one ethical or political framework sometimes appear quite reasonable with another.     

EGFR靶向治疗中敏感性预测指标的启示

EGFR抗肿瘤靶向治疗药物临床疗效存在明显个体差异,与其疗效敏感性相关的预测标志物能指导临床用药,成为临床关注的热点,本文从哲学的角度思考靶向治疗敏感性预测指标与恶性肿瘤的关系,试图以此为指导,更好地加强临床用药的预见性。