聚焦非小细胞肺癌：个体化治疗的新时代

在过去10 年中,大量靶向药物被研究用于非小细胞肺癌的治疗,目前应用于临床的主要有三类。调节血管内皮生长因子的药物如安维汀结合细胞毒药物治疗对于提高患者的生存率具有里程碑式的意义,而调节表皮生长因子受体的药物如特罗凯和易瑞沙亦有显著疗效,并提供了有价值的与疾病相关的生物学信息。ALK 抑制剂在有相关基因易位的患者中展现出良好前景。关键信号通路如RAS/RAF/MEK、PI3K/AKT/mTOR 和MET 激酶的异常也已被确定为重要靶标,尤其对于耐药性患者。针对这些突变者的新型药物目前已应用于临床。靶向药物和辅助常规肿瘤分析的发展,是通过整合分子水平的研究结果划定患者人群,进而实现非小细胞肺癌真正个体化治疗的实质性的一步。伴随诊断是个体化给药的关键,自2009 年起涌现了大量制药公司和诊断试剂公司之间的授权交易,使公司在此领域获得正确的、实用性的技术。     

1例重度药疹的护理

药疹是药物过敏反应中最常见的表现,起病急,皮肤损伤重且广泛,如治疗护理不及时,易死于感染等并发症,有效的护理是治疗药疹的关键。现将我科收治的1例重度药疹患者的护理体会报告如下。     

口服氟康唑致固定性药疹1例

临床医师经常用氟康唑口服来治疗念珠菌性阴道炎,很少发生固定性药疹.固定性药疹是一种轻型药疹,每次服用同样药物后常在同一部位发生相同皮疹.该文报道1例48岁女性,口服氟康唑治疗复发性念珠菌性阴道炎后出现固定性红斑的病程经过,改用伊曲康唑口服没有出现交叉过敏现象.     

1例别嘌醇致慢性肾衰患者重症药疹的护理

正别嘌醇是一种黄嘌呤氧化酶抑制剂,可减少尿酸的产生,降低血尿酸水平,是临床常用于治疗高尿酸血症和痛风病的药物。据报道约0.4%使用别嘌醇的患者出现不良反应[1],主要不良反应有皮疹、胃肠道反应、发热、骨髓抑制、肝肾功能损害等。重症药疹的类型较多,病情严重、发展迅速,常见有大疱性表皮松解型药疹、多形红斑型药疹以及剥脱型皮炎型[2]。若治疗护理不当,易造成严重的后果。2015年8     

特罗凯靶向治疗联合培美曲塞和顺铂对非小细胞肺癌患者血清肿瘤标志物、免疫球蛋白和T淋巴细胞亚群的影响

摘要 目的：探讨特罗凯靶向治疗联合培美曲塞和顺铂对非小细胞肺癌（NSCLC）患者血清肿瘤标志物、免疫球蛋白和T淋巴细胞亚群的影响。方法：选取2018年2月~2020年2月期间我院接收的NSCLC患者80例,采用抽签法分为对照组、观察组两组,各40例。对照组给予培美曲塞和顺铂化疗方案治疗,观察组在对照组基础上联合特罗凯靶向治疗,对比两组总有效率、血清肿瘤标志物、免疫球蛋白、T淋巴细胞亚群及不良反应发生率。结果：对比两组不良反应无差异（P>0.05）。治疗3个疗程后,对照组、观察组的临床总有效率分别为37.50%、60.00%,观察组的总有效率高于对照组（P<0.05）。治疗3个疗程,观察组CD3⁺、CD4⁺、CD4⁺/CD8⁺高于对照组,CD8⁺低于对照组（P<0.05）。治疗3个疗程,观察组免疫球蛋白G（IgG）、免疫球蛋白A（IgA）、免疫球蛋白M（IgM）高于对照组（P<0.05）。治疗3个疗程,观察组细胞角蛋白19片段（CYFRA21-1）、糖类抗原50（CA50）、癌胚抗原（CEA）低于对照组（P<0.05）。结论：特罗凯靶向治疗联合培美曲塞和顺铂治疗NSCLC患者,疗效较好,可能与该方案可降低患者血清肿瘤标志物含量、调节免疫应答等因素有关。     

15 例重症药疹患者临床特征及激素联合免疫球蛋白的疗效分析

目的:探讨15例重症药疹患者的临床特点及采用激素联合免疫球蛋白治疗改病的临床效果。方法:回顾性分析2012年12月至2014年12月在我院就诊的15例重症药疹患者的临床资料,患者采用激素联合免疫球蛋白进行治疗,观察患者的发病类型、致敏药物及疗效,分析血常规、肝功能、肾功能指标与与预后的关系。结果:15例患者中,中毒表皮坏死松解8例,占53.33%,药疹重型4例,占26.67%,中毒表皮坏死松解并支气管炎患者、史蒂文斯并支气管肺炎患者及重症药疹并重症肝炎患者各1例,占6.67%。致敏药物主要是中药、卡马西平、柳氮磺吡啶、头孢他啶、布洛芬、青霉素、别嘌呤醇、感冒药。治疗总有效率86.67%。白细胞、中性比、总胆红素(TBIL)、谷丙转氨酶、胆碱酯酶、胱抑素、肌酐(Cr)、乳酸脱氢酶(LDH)、肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)与重症药疹患者治愈预后有关(P0.05)。结论:重症药疹以中毒表皮坏死松解患者为主,对不同致敏药物引起的重症药疹患者应进行区别治疗,重症药疹患者的预后与患者内脏受累程度密切相关,临床采用激素联合丙种球蛋白持续治疗,可提高治愈率,改善患者临床症状及预后,     

头孢羟氨苄甲氧苄啶胶囊致固定性药疹1例

目前,头孢羟氨苄甲氧苄啶胶囊致固定性药疹尚未见有文献报道,作者2012年1月10日诊治1例,现报告如下。1临床资料患者,男,49岁,干部。因口腔、包皮及龟头红斑、糜烂,伴痒痛2天入院。患者2天前因咽痛、咳嗽在个体门诊诊治,诊断：上呼吸道感染。     

遮光处理对观赏栀子氮、磷、钾分配与生长的影响

为探究观赏栀子在不同遮光条件下生长和光合及氮、磷、钾(N、P、K)分配的规律,该研究对3种观赏栀子设置5种不同的遮光处理(0%、60%、70%、80%、90%),通过对观赏栀子的生长和光合及各器官N、P、K含量进行统计与分析,探究了不同遮光处理对观赏栀子栽植效果的影响。结果表明:(1)60%和0%遮光率的大花栀子、80%和70%遮光率的雀舌栀子、0%遮光率的花叶栀子均长势较好。(2)随着遮光率的增加,雀舌栀子和花叶栀子的净光合速率、胞间CO₂浓度、蒸腾速率逐渐降低,气孔导度、水分瞬时利用率在遮光率60%下达到最大值。(3)大花栀子总N量最高,器官含N量高低排序为叶、根、茎; 雀舌栀子总P量最高,器官含P量排序为根、茎、叶; 大花栀子在90%遮光率下含K量最高。综合考虑认为,雀舌栀子更耐荫蔽,适合在80%和70%的遮光条件下生长; 大花栀子次之,适合在60%和0%遮光条件下生长; 花叶栀子最不耐荫,适合在0%遮光条件下生长。     

热毒灵过敏致大泡表皮松解型药疹伴全身感染死亡相关问题的研究

目的:对1例热毒灵致大泡表皮松解型药疹伴全身感染和血气胸死亡的相关问题进行讨论分析。方法:详细报道1例热毒灵致大泡表皮松解型药疹伴全身感染和血气胸死亡的案例,并对该案例的相关性理论进行回顾性分析,对案例进行详细的尸体检验与死亡原因的鉴定。结果:本案结合案情资料、尸体检验及包括病理组织学检查在内的其他相关法医学检验证实因大泡表皮松解型药疹伴皮肤及全身感染和血气胸死亡,最终导致多器官功能障碍而死亡。结论:热毒灵致大泡表皮松解型药疹伴全身感染和血气胸死亡的法医学鉴定应根据案情资料并结合用药史、有关病历资料、生前临床表现、解剖发现、病理组织学检验、法医毒化检验并参考特殊检查结果等多种因素进行综合评定。     

听、说、读、写、演教学方法在中职内科护理学中的应用

内科护理学是护理专业的一门主干学科,笔者在文章中讨论了"听、说、读、写、演"等教学方法在内科护理学教学中的综合运用,希望对内科护理学的教学发展起些推波助澜的作用。     

Treatment of Shock Caused by Bacterial Infections

Bacteremia caused by Gram-negative enteric organisms accounts for the majority of instances of shock complicating bacterial infection. Control of the infection and maintenance of normal blood volume constitute the primary considerations in immediate treatment. The use of three or four doses of corticosteroid agent over a period of 24 hours is regarded as advantageous for routine treatment. Conservative and selective use of isoproterenol and phentolamine are justified for management of patients who do not respond to the administration of bactericidal drugs and volume repletion. Levarterenol and metaraminol are rarely indicated. Intravascular coagulation complicated by bleeding diathesis may serve as an indication for anticoagulation.With more effective management of the hemodynamic defects, patients are now more likely to survive the shock state only to develop a fatal form of pulmonary failure which is yet poorly understood. Close attention to respiratory management is therefore advised.     

Seed Treatment with Trichoderma Species for Control of Damping-off of Cowpea Caused by Macrophomina phaseolina

Cowpea seeds treated with three Trichoderma spp. at four inoculum doses, and at four exposure times in three different formulations were planted in soils amended with Macrophomina phaseolin a, and assessed for stand establishment and post-emergence damping off. The highest percentage plant stands at 21 days after planting were 66% for T. koningii and T. harzianum , and 51% for Trichoderma sp., at 6.8 ×10 7 , 2.0 ×10 10 , and 1.0 ×10 7 colony forming units (CFUs) ml -1 , respectively. Across sampling dates and irrespective of time of exposure to the formulations, the T. harzianum and T. koningii formulations resulted in significantly greater percentage plant stands than the seeds treated with a Trichoderma sp. and the controls. Seed treatment formulations with Trichoderma spp. were derived from propagule suspensions at the most effective inoculum dose in Tween 80, in suspension with cooked cassava starch as an adhesive, or in a slurry with uncooked cassava starch. At 21 days, the suspensions with Tween 80 and cooked starch resulted in significantly higher percentage plant stands than the control, while stands from seeds treated in a slurry formulation and starch solutions were not different. Seed exposure to the different formulations for 10, 20, 30, or 40 min, provided mixed results. Seeds treated with benomyl at 0.5 g a.i/50 g resulted in 95 and 100% stands for the two sets of experiments, respectively.     

D,L-甘油醛处理引起的小麦叶片表观光合量子效率的降低（英文）

D,L-甘油醛(磷酸核酮糖激酶抑制剂,10mmol/L)处理小麦旗叶1 h可降低叶片净光合速率和表观量子效率.同时,光系统Ⅱ光化学效率(△F/Fm′)、电子传递速率(ETR)和单位叶面积ATP含量均降低,而胞间二氧化碳浓度(Ci)和叶绿素荧光非光化学猝灭(NPQ)增加.这些结果说明,D,L-甘油醛引起的小麦旗叶表观量子效率降低是由于光合碳同化受阻对光合电子传递的反馈抑制.     

Alterations of Tubulin Function Caused by Chronic Antidepressant Treatment in Rat Brain

1. Antidepressants have been used clinically for many years; however, the neurochemical mechanism for their therapeutic effect has not been clarified yet. Recent reports indicate that chronic antidepressant treatment directly affects the postsynaptic membrane to increase the coupling between the stimulatory GTP-binding (G) protein, G_s, and adenylyl cyclase. Tubulin, a cytoskeletal element, is involved in the stimulatory and inhibitory regulation of adenylyl cyclase in rat cerebral cortex via direct transfer of GTP to G proteins. In this study, we investigated whether the functional change of the adenylyl cyclase system caused by chronic antidepressant treatment involves an alteration of tubulin function in the regulation of adenylyl cyclase activity.2. Male Sprague–Dawley rats were treated once daily with amitriptyline or saline by intraperitoneal injection (10 mg/kg) for 21 days, and their cerebral cortex membranes and GppNHp-liganded tubulin (tubulin-GppNHp) were prepared for what.3. GppNHp-stimulated adenylyl cyclase activity in cortex membranes from amitriptyline-treated rats was significantly higher than that in control membranes. Furthermore, tubulin–GppNHp prepared from amitriptyline-treated rats was more potent than that from control rats in the stimulation of adenylyl cyclase activity in the cortex membranes of the controls. However, there was no significant difference in manganese-stimulated adenylyl cyclase activity between control and amitriptyline-treated rats.4. The present results suggest that chronic antidepressant treatment enhances not only the coupling between G_s and the catalytic subunit of adenylyl cyclase but also tubulin interaction with G_s in the cerebral cortex of the rat.     

中华眼镜蛇咬伤致局部组织损伤三种疗法的临床疗效观察

目的对中华眼镜蛇咬伤致局部组织损伤的各种治疗方法进行疗效优劣比较,找出最佳治疗方法。方法总结我院569例中华眼镜蛇咬伤致局部组织损伤的各种治疗方法。结果治疗方法从优到劣依次是：抗蛇毒血清局部注射-糜蛋白酶局部注射-蛇伤药酒外敷-坏死组织早期切除-局部烧灼法-局部组织切开冲洗。结论中华眼镜蛇伤致局部组织损伤的治疗方法应首选抗蛇毒血清局部注射和糜蛋白酶局部注射,其次选用蛇伤药酒外敷。