肿瘤同步放化疗合理应用的思考

同步放化疗的疗效明显优于单一放化疗和序贯放化疗,但毒副作用的叠加效应可引起严重的并发症,甚至造成死亡.本文从同步放化疗的作用机制和临床实践出发,通过对疗效与毒副作用之间的辩证关系进行具体分析,探讨了如何制定合理的肿瘤治疗决策.     

紫杉醇、顺铂在中晚期宫颈癌同步放化疗中的临床疗效比较

探讨61例中晚期宫颈癌患者分别行紫杉醇、顺铂同步放化疗的疗效和不良反应。两组近期有效率,1年、2年、3年总生存率,无瘤生存率差异无统计学意义（P＞0．05）。紫杉醇同步放化疗组主要表现为白细胞计数下降、神经毒性和心脏毒性;顺铂同步放化疗组主要表现为消化道反应和肝肾功能受损;两组的消化道反应、神经毒性、肝肾功能受损发生率差异有统计学意义（P＜0．05）,紫杉醇组骨髓抑制、心脏毒性发生率均高于顺铂组,但差异无统计学意义（P ＞0．05）。顺铂组肝功能受损发生率稍高于紫杉醇组,但差异无统计学意义（P＞0．05）。同步放化疗中使用紫杉醇治疗中晚期宫颈癌疗效与顺铂相当,不良反应可耐受。     

肿瘤大剂量化疗矛盾剖析与对策

1　大剂量化疗效应1.1　化疗历史并不漫长 ,它开始于 2 0世纪 4 0年代 ,当时只发现几种药物单独使用对淋巴瘤、白血病的治疗有效 ,到了 6 0年代 ,由于细胞动力学和药物代谢动力学知识应用于临床化疗 ,并由此设计出多种药物联合化疗方案 ,大大提高了治疗效果 ,并广泛应用于各类肿瘤 ,而 70年代以来 ,化疗方案日趋成熟 ,给药方式的改进 ,5 -羟色胺拮抗剂和大剂量类固醇有效止吐药物应用 ,粒细胞刺激因子和抗菌素 ,抗真菌药的使用 ,使得化疗剂量成倍增加 ,实现大剂量化疗并由此而产生的骨髓移植真正成为化疗史上的一次革命 ,使化疗效果也起到根…     

生存质量在晚期肿瘤疗效评价中的思考

传统的肿瘤疗效评价方法多采用治愈率、生存率等指标来衡量。随着传统医学模式向生物一心理一社会医学模式转变,生存质量越来越受到重视。生存质量从一个新的角度评价治疗效果,更重视患者的主观感受,而不是仅将临床客观指标作为评价标准,能更客观地指导治疗方案的选择。     

肿瘤与肿瘤标志物研究中证据的思考

随着对肿瘤研究的深入,人类发现的肿瘤标志物越来越多。目前有一定临床价值的肿瘤标志物已达100多种,但经过10多年的临床实践发现,肿瘤与其标志物之间的关系错综复杂。现有的许多研究中实验设计以及对结果的分析都存在着一些问题,得出的结论缺乏直接或确凿的证据,甚至出现偏差的结论,以致于影响到临床的准确应用。所以,有必要对此进行总结和探讨,以期有效发挥肿瘤标志物的临床应用价值。     

肿瘤与肿瘤标志物研究中证据的思考

随着对肿瘤研究的深入,人类发现的肿瘤标志物越来越多.目前有一定临床价值的肿瘤标志物已达100多种,但经过10多年的临床实践发现,肿瘤与其标志物之间的关系错综复杂.现有的许多研究中实验设计以及对结果的分析都存在着一些问题.得出的结论缺乏直接或确凿的证据,甚至出现偏差的结论,以致于影响到临床的准确应用.所以,有必要对此进行总结和探讨,以期有效发挥肿瘤标志物的临床应用价值.     

肿瘤相关物质在肿瘤诊断及疗效观察中的意义

探讨TSGF(tumor supplied group of factors肿瘤相关物质)检测在肿瘤诊断及疗效观察中的意义.用比色法测定恶性肿瘤患者、良性疾病患者及健康查体者血清TSGF含量,用SPSS软件包进行分析.结果是Ⅰ期肿瘤患者TSGF阳性率66.67%和总阳性率75.67%之间统计学无明显差异;恶性肿瘤组阳性率(75.67%)明显高于良性疾病组(18.76%)和健康查体组(8.27%);特异性达84.57%;6种恶性肿瘤患者TSGF含量及阳性率无显著差异;恶性肿瘤治疗有效组TSGF阳性率(38.24%)明显低于治疗前(94.12%).结论认为TSGF具有早期性、敏感性、特异性、广谱性.     

肿瘤相关物质在肿瘤诊断及疗效观察中的意义

探讨TSGF（tumor supplied group of factors肿瘤相关物质）检测在肿瘤诊断及疗效观察中的意义。用比色法测定恶性肿瘤患者、良性疾病患者及健康查体者血清TSGF含量,用SPSS软件包进行分析。结果是I期肿瘤患者TSGF阳性率66.67％和总阳性率75.67％之间统计学无明显差异;恶性肿瘤组阳性率（75.67％）明显高于良性疾病组（18.76％）和健康查体组（8.27％）;特异性达84.57％;6种恶性肿瘤患者TSGF含量及阳性率无显著差异;恶性肿瘤治疗有效组TSGF阳性率（38.24％）明显低于治疗前（94.12％）。结论认为TSGF具有早期性、敏感性、特异性、广谱性。     

肿瘤基因治疗的哲学思考

一、癌基因与抑癌基因 肿瘤分子生物学的发展指出:癌症是一种基因病,是癌基因的激活和抑癌基因的失活发生发展的结果。在历史上对癌基因的认识先于抑癌基因,当癌基因被阐明后,马上有人想到既然在细胞基因组中有促使癌症发生的力量,那么可能也有     

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…     

Optimality And Concurrent Variable-interval Variable-ratio Schedules

Despite claims to the contrary, all leading theories about operant choice may be seen as models of optimality. Although melioration is often contrasted with global maximization, both make the same core assumptions as other versions of optimality theory, including momentary maximizing, hill climbing, and the various versions of optimal foraging theory. The present experiment aimed to test melioration against more global optimality and to apply the visit-by-visit analysis suggested by foraging theory. Rats were exposed to concurrent schedules in which one alternative was always variable-ratio 10 and the other alternative was a variable-interval schedule. Although choice relations varied from rat to rat, the overall results roughly confirmed the matching law, a result often taken to support melioration. Pooling the data across sessions and across rats, however, resulted in no increment in unsystematic variance, lending support to the contention by Ziriax and Silberberg (1984) that the choice relation is partly constrained. When the data were analyzed at the level of visits, the results either disconfirmed predictions of melioration or showed regularities about which melioration is silent. Instead, performance tended toward a rough optimization, in which responding favored the variable ratio, but with relatively brief visits to the variable interval. There were no asymmetries in travel or variability that would indicate that different processes were involved in generating visits at the two different schedules. The findings point toward a more global optimality model than melioration and demonstrate the value of per-visit analysis in the study of concurrent performances.     

Concurrent performances: rate constancies without changeover delays

Pigeons' pecks on two keys were maintained, without changeover delays, by independent variable-interval schedules of food reinforcement. Four regularly cycling 2-min components scheduled reinforcement respectively for both keys, left key only, both keys, and right key only. Initially, reinforcement scheduled for one key alone produced more responding on that key than reinforcement scheduled concurrently for both keys. Continued sessions reduced this difference; response rate on a given key approached constancy, or invariance with respect to the performance on and schedule for the other key. When extinction replaced the reinforcement schedule on either key, responding on that key decreased more during components that scheduled reinforcement for the other key than during those that did not. This demonstration that responses on one key were not supported by reinforcers on the other key suggested that the alternation of concurrent responding and either-key-alone responding prevented concurrent superstitions from developing.     

Concurrent phencyclidine and saccharin access: presentation of an alternative reinforcer reduces drug intake.

Six monkeys self-administered orally delivered phencyclidine ("angel dust") and saccharin under concurrent fixed-ratio 16 schedules during daily three-hour sessions. Liquid deliveries were contingent upon lip-contact responses on solenoid-operated drinking spouts. Three saccharin concentrations (0.003%, 0.03% and 0.3%, wt/vol) were tested in a nonsystematic order. For each saccharin concentration, the following series of phencyclidine concentrations (mg/ml) was presented: 0.25, 0.5, 1, 0.25 (retest), 0.125, 0.0625, 0.0312, 0.25 (retest) and 0 (water with stimuli signaling phencyclidine). As the saccharin concentration increased, the number of drug deliveries decreased, and the peaks of the concentration-response functions were shifted to the right. The lowest saccharin concentration (0.003%, wt/vol) maintained responding in excess of phencyclidine levels in only one monkey. The two higher saccharin concentrations maintained behavior far in excess of phencyclidine, but saccharin deliveries decreased in some monkeys as phencyclidine concentration and intake (mg/kg) increased. The time course and patterns of phencyclidine-reinforced responding were also altered when saccharin was concurrently available. The results are discussed in terms of strategies to reduce drug-reinforced behavior, preference between different reinforcers, and measures of reinforcing efficacy.     

Concurrent random-interval schedules and the matching law

In Experiment I, a group of eight pigeons performed on concurrent random-interval schedules constructed by holding probability equal and varying cycle time to produce ratios of reinforcer densities of 1:1, 3:1, and 5:1 for key pecking. Schedules for a second group of seven were constructed with equal cycle times and unequal probabilities. Both groups deviated from simple matching, but the two forms of the schedules appeared to produce no consistent patterns of deviation. The data were found to be consistent with those obtained in concurrent variable-interval situations. The parameters of the matching equation in the form of Y=k X^a were estimated; the value of k was unity and a was 0.84. In Experiment II, six pigeons were exposed to two conc RI RI schedules in which one component increasingly approximated an FI schedule. The value of k was not 1.0. Concurrent RI RI schedules were shown to represent a continuum from conc FI VI to conc VI VI schedules. The use of the exponential equation in testing “matching laws” suggests that a<1 will continue to be observed, and this will set limits on the form of new laws and the assumed or rational values of the component variables in these laws.     

Concurrent reinforcement schedules: behavior change and maintenance without extinction

We evaluated the effects of concurrent schedules of reinforcement on negatively reinforced problem behavior and task completion with 3 children with autism. Results indicated that problem behavior occurred at high levels and relatively few tasks were completed when problem behavior produced a break (from tasks) and task completion produced either no consequence or a break. By contrast, problem behavior was eliminated and tasks were completed when problem behavior produced a break and task completion produced a break with access to preferred activities. Treatment gains were maintained without the use of extinction when the response requirement was increased and the schedule of reinforcement was thinned.     

Breast Cancer in Men: A Need for Psychological Intervention

Male breast cancer is a serious issue that needs to be addressed more fully by the medical and public community. However, due to a lack of awareness and limited research on the topic, there is a general absence of knowledge concerning the psychological implications of this disease in men as well as a need for greater understanding of the medical diagnosis and treatment of male breast carcinoma. Similarly, there still remains a considerable gender difference between the awareness of female breast cancer and male breast cancer Although breast cancer in men makes up only 1% of all breast cancers reported in the United States, it is increasing in incidence. There are approximately 2000 new cases and approximately 450 deaths due to male breast cancer each year. Breast cancer diagnosis and treatment in men is very similar to that described in women, however, it has been shown that men are being diagnosed at a later stage of the disease than women.     

Concurrent schedules: reinforcer magnitude effects

Five pigeons were trained on pairs of concurrent variable-interval schedules in a switching-key procedure. The arranged overall rate of reinforcement was constant in all conditions, and the reinforcer-magnitude ratios obtained from the two alternatives were varied over five levels. Each condition remained in effect for 65 sessions and the last 50 sessions of data from each condition were analyzed. At a molar level of analysis, preference was described well by a version of the generalized matching law, consistent with previous reports. More local analyses showed that recently obtained reinforcers had small measurable effects on current preference, with the most recently obtained reinforcer having a substantially larger effect. Larger reinforcers resulted in larger and longer preference pulses, and a small preference was maintained for the larger-magnitude alternative even after long inter-reinforcer intervals. These results are consistent with the notion that the variables controlling choice have both short- and long-term effects. Moreover, they suggest that control by reinforcer magnitude is exerted in a manner similar to control by reinforcer frequency. Lower sensitivities when reinforcer magnitude is varied are likely to be due to equal frequencies of different sized preference pulses, whereas higher sensitivities when reinforcer rates are varied might result from changes in the frequencies of different sized preference pulses.