肿瘤营养内科医疗质量管理体系概述

摘 要：恶性肿瘤住院患者营养不良发生率高且重度营养不良患者多见。为规范肿瘤内科临床营养和抗肿瘤药物治疗等医疗服务行为,保证和提升临床医疗质量和服务技术水平,加强肿瘤内科和临床营养科两个学科的充分融合,做好肿瘤营养内科临床管理的核心和质量保证,本中心结合自身实践经验建立涵盖临床营养和肿瘤内科两方面的质量管理体系,为临床医师、临床营养师及卫生管理人员的实践提供参考依据。     

第三届全国中医药临床学术研究科技论坛征文

中华中医药学会拟于今年秋季在黄山举办“第三届全国中医药临床学术研究科技论坛”,现向全国中医药临床工作者征文。一、征文内容1.在对病因不明性和多因素性疾病的诊治等中医药具有比较优势的方面,在传染性非典型肺炎、艾滋病等重大传染性疾病的诊治上,临床各科从不同角度和方面所开展和进行的各项临床研究和分析。2 .循证医学、DME、GCP等方法在中医药临床研究中的具体运用,中医药临床研究的科研设计、评价、质量控制等方面的分析研究。3 .中医药临床如何适应现代社会政治、经济、科技、文化和思想观念等发展变化的探讨。4.中医药临床…     

贝伐单抗在肿瘤治疗中相关毒副反应

贝伐单抗具有低毒、高效和特异性强等特点,临床应用安全性、耐受性良好。高血压和出血是其临床较为常见的毒副反应,但可以对症处理和预防,不影响临床的继续治疗。血栓和蛋白尿也是其临床常见的毒副反应,且血栓与贝伐单抗剂量无关,蛋白尿为短暂性及可逆性,临床上仍需加强监测。     

血液净化对多发性骨髓瘤并急性肾损伤的疗效分析

目的探讨多发性骨髓瘤并急性肾损伤患者进行血液净化疗法的临床效果。方法选取2013年6月至2014年6月间简阳市人民医院收治的42例多发性骨髓瘤并急性肾损伤患者,根据随机数字表法分为观察组和对照组,每组各21例。观察组患者采用血液净化+化疗法+急性肾损伤疗法,对照组患者采用化疗+急性肾损伤治疗,比较两组患者的临床效果;评估比较两组患者治疗前后的乳酸脱氢酶(LDH)、C反应蛋白、血清球蛋白和血沉等临床实验室指标情况;评估比较两组患者治疗前后的血清中尿素氮(BUN)、肌酐(Cr)、β_2-微球蛋白(β_2-MG)和胱抑素C(CysC)等临床指标情况。结果观察组患者的临床有效率为90.5%,对照组为57.1%,组间差异有统计学意义(P<0.05);两组患者治疗后LDH、C反应蛋白、血清球蛋白和血沉等临床指标均有改善,但观察组患者治疗后LDH、C反应蛋白、血清球蛋白和血沉指标显著优于对照组,差异均有统计学意义(P<0.05)。两组患者治疗后血清中BUN、Cr、β_2-MG和CysC等临床指标均有改善,观察组患者治疗后血清中BUN、Cr、β_2-MG和CysC等临床指标显著高于对照组,差异均有统计学意义(P<0.05)。结论多发性骨髓瘤并急性肾损伤进行血液净化疗法,可显著改善患者的临床症状,降低肾损害程度,临床效果确切,值得临床推广。     

受体三阴性乳腺癌的分子特征与治疗研究进展

乳腺癌现有的临床病理参数（如淋巴结状态、肿瘤大小、病理分级、类固醇激素受体、HER-2等）对于判断预后和指导临床治疗有非常重要的作用,DNA微阵列技术和多基因RT—PCR定量检测等分子生物学技术对乳腺癌进行分子分型、研究新亚型乳腺癌的生物学特性和预后,对于指导临床治疗与随访有更高价值。如受体三阴性乳腺癌（TNBC）与luminal A、luminal B、HER-2^＋和normal—like亚群相比复发早、进展快、生存短,成为临床普遍关注的重点之一,这些ER／PR／HER-2三阴性乳腺癌患者的预后和治疗有诸多困难,至今没有针对性的治疗,本文综述了相关的分子病理、体外研究、临床探索性治疗和新药研究等进展。     

重视临床基本问题，推动乳腺外科学科发展

中华医学会外科学分会乳腺外科学组(CSBrS)成立3年以来,共针对10项乳腺外科临床基本问题撰写了共识意见。其中,强调乳腺病灶空芯针穿刺活检和前哨淋巴结活检的临床价值;推广中心静脉输液港的临床应用范围;重申并规范真空辅助旋切和乳腺标记物植入技术的临床适应证;以及中国妊娠相关性乳腺癌的诊治策略等内容获得临床医生的广泛认同。2019年,CSBrS共完成10项中国乳腺外科领域的多中心真实世界研究。2020年,已经启动包括：《疫情期间乳腺外科临床工作多中心研究》和《多基因检测和BRCA基因检测中国现状》等15项研究课题。作为中国乳腺外科领域的专业学术团体,CSBrS始终关注乳腺外科临床基本问题,并以加强多学科合作,搭建适宜国情的学术研究平台为己任,努力为推动中国乳腺外科临床规范化进程做出贡献。     

针对多发性骨髓瘤并发症的支持治疗

 多发性骨髓瘤（MM）的临床症状繁多,常见的有骨病、肾功能不全、感染、贫血和周围神经病变等,并且常伴有浆细胞瘤和淀粉样变性等疾患。MM出现这些临床症状是进行抗骨髓瘤治疗的重要依据。文章重点介绍多发性骨髓瘤常见并发症的病理生理和治疗进展。     

癌胚抗原放射免疫分析的临床观察

 癌胚抗原放射免疫分析(CEA-RIA)对于某些癌症,如直肠癌、胃癌、肺癌和乳腺癌等患者的临床观察,尤其是对它们临床治疗效果的观察,临床复发或转移的监测、预后的判断以及良恶性的鉴别等。     

肿瘤代谢调节治疗临床建议路径

摘 要：恶性肿瘤住院患者营养不良发生率高且重度营养不良患者多见。患者机体组织因子和炎性反应因子常过表达,使机体常处于应激状态。代谢调节治疗在营养不良肿瘤患者的治疗中必不可少。本临床诊疗路径以循证医学证据为基础,以临床规范诊疗为目的,旨在为广大临床医师、临床营养师等提供肿瘤代谢调节治疗的可行性和规范性流程。     

抗肿瘤新药天仙丸研究进展(综述)(摘要)

天仙丸是根据我国传统医药学发展起来的一种抗癌新药。已完成临床前药理和Ⅰ期临床。Ⅱ期临床证明,天仙丸对食管、胃和肺癌等有明显抑制作用。发展史自1972年至1983年,对我国中医药传统方、秘方和验方共1200余种进行了拆方和组方筛选,从中选中了以天花粉、威灵仙等近     

A study of cell membrane structure

Neoplastic transformation has been associated with a variety of structural changes, among which are changes in membrane carbohydrates. Not much is known, though, e.g., how early in the tumourogenic event these changes take place and what effect these changes have on cell growth, invasion, and ability to metastasize. We were able to identify the B-D-Gal(1-3)DGal-NAc as a membrane carbohydrate component present in malignant laryngeal tissue, but not on adjacent normal mucous membrane. This carbohydrate structure was found to be present in metastatic as well as in nonmetastatic tumours. It was also found in well-differentiated as well as poorly differentiated carcinomas. We suggest that changes in carbohydrate components on the cell membrane of the laryngeal cancer cell are an early event in tumour progression and probably are not related to the degree of invasion or the ability to metastasize.     

Cancer patients' experience of positive and negative changes due to the illness: relationships with psychological well‐being,coping, and goal reengagement

Objective: Most studies in cancer patients on psychological changes focused on positive changes (so‐called ‘posttraumatic growth’), with surprisingly little attention on the possibility that patients may experience both positive and negative changes. This study investigated the relationship between positive and negative changes, and their association with positive and negative affect. We also examined the correlates of positive and negative changes, specifically the role of coping and goal reengagement. Methods: This cross‐sectional study was conducted in 108 patients. We used Pearson correlations and Regression analyses to examine the research questions. Results: Positive and negative changes were relatively unrelated to each other. More positive changes were related to more positive affect, whereas more negative changes were related to more negative affect and less positive affect. Approach coping by more positive reappraisal and goal reengagement was significantly associated with more positive changes. More use of avoidant coping by self‐distraction was related to more negative changes. Conclusions: Patients experienced both positive and negative changes as a result of cancer. These changes were significantly related to patients' well‐being, as well as to their coping and goal reengagement strategies. This knowledge may be incorporated in psychological interventions. Cancer patients can be assisted to learn to acknowledge both positive and negative changes in their life and to approach rather than avoid difficult situations. Patients may also be supported to engage in alternative meaningful goals in life. This is likely to help them find positive meaning. Copyright © 2010 John Wiley & Sons, Ltd.     

Histological effects of endocrine therapy for prostatic cancer in relation to clinical course

In order to evaluate histological changes in cases of prostatic cancer following endocrine therapy, 25 extensive specimens were removed from prostates during periods of local control, and were examined with respect to prognosis. Shortly after the commencement of the endocrine therapy, there were noticeable degenerative changes in the cancer cells as well as structural changes such as desquamation of cells and loss of cancer nests. Later than two months from the start of therapy, stromal changes such as fibrosis and scar formation appeared. Coagulation necrosis of tumor tissue, inflammatory cell infiltration and granulomatous reactions were not as prominent. Within the first two months of treatment, the endocrine therapy uniformly affected the cancer tissues to some extent. After then, some showed relapsing viable cells in a part of the tumor, being judged to be no response. The others continued to respond to the therapy. The response was estimated as marked when such therapeutic changes appeared diffusely and profoundly over the tissues removed. Patients with a marked response had a good prognosis, indicating histological evaluation after endocrine therapy to provide a prognostic factor.     

The epigenome as a target for cancer chemoprevention

Epigenetic events, a key driving force in the development of cancer, are alterations in gene expression without changes in the DNA coding sequence that are heritable through cell division. Such changes occur throughout all stages of tumorigenesis, including the early phases, and are increasingly recognized as major mechanisms involved in silencing tumor suppressor genes. Epigenetic changes can be reversed by the use of small molecules and, thus, such changes are promising targets for cancer chemopreventive drug development. This review examines the basis for targeting the epigenome as a prevention strategy, focusing on understanding the epigenetic changes that occur before the development of frank malignancy, when chemopreventive intervention will have the maximal impact.     

Time course of radiological lung density changes after postmastectomy radiotherapy

The purpose of this study was to quantify the time course of radiological lung changes in patients after postmastectomy radiotherapy assessed from routine follow-up chest x-rays. Radiological density changes in the apex of the irradiated lung were quantified by a recent lung densitometry assay. Lung changes were expressed as the so-called Relative change in Equivalent Absorber Thickness (REAT). The clinical series comprised 329 patients treated with postmastectomy radiotherapy between 1978 and 1982. Of these patients 100 were treated with chemotherapy (CTX or CMF) and 41 were given tamoxifen as an additional adjuvant treatment; 290 patients (88.2%) had pretreatment x-rays and at least one x-ray after completion of radiotherapy and these were included in the study. A total of 2,209 chest x-rays was taken during follow-up, and among these 1921 x-rays (86.9%) were judged to be assessable. Late changes were defined as changes occurring more than a year after radiotherapy. A total of 280 patients had at least one chest x-ray taken more than one year after radiotherapy and these were evaluable with respect to late changes. There were 1,390 follow-up x-rays in these patients and 207 patients (73.9%) had three or more follow-up x-rays. Linear regression of REAT vs. observation time was used to identify three patterns of time changes: progressive, regressive, and stable. The results were as follows. Two phases of lung changes were observed. The early phase peaks around 6 months and the density changes may subsequently resolve, completely or in part. In most cases (173 patients or 84%), the lung density changes reached a stable level 12 months after irradiation. Yet, in 16 patients (7.7%) the lung changes progressed for five or more years. Regression of the density changes was seen in 18 patients (8.7%), and in some cases there were signs that this apparent regression was caused by contraction of the fibrotic tissue. We conclude that two phases of lung response can be distinguished and can be graded according to severity using this assay. Early lung changes reach a maximum around 6 months after RT. Late reactions reach a plateau in most patients after one year, but progress in some cases for five or more years.     

Genetic instability in cancer: theory and experiment

Epidemiologic data and molecular biology have combined to demonstrate that multiple genetic changes may be required in carcinogenesis. Mutator mutations, defined as genetic changes which increase the rate of genetic change, including both single base changes and chromosomal instability, may accelerate this process. Key questions remain in defining the role of mutator mutations in carcinogenesis as well as in cancer therapy. Theoretical approaches, including deterministic and stochastic models, have played a significant role in hypothesis generation, experimental design, and refinement of conclusions in this field, and are expected to continue to do so in the future.     

Epigenetic Therapy in Breast Cancer

Breast carcinogenesis is a multistep process involving both genetic and epigenetic changes. Epigenetics is defined as reversible changes in gene expression, not accompanied by alteration in gene sequence. DNA methylation, histone modification, and nucleosome remodeling are the major epigenetic changes that are dysregulated in breast cancer. Several genes involved in proliferation, anti-apoptosis, invasion, and metastasis have been shown to undergo epigenetic changes in breast cancer. Because epigenetic changes are potentially reversible processes, much effort has been directed toward understanding this mechanism with the goal of finding effective therapies that target these changes. Both demethylating agents and the histone deacetylase inhibitors (HDACi) are under investigation as single agents or in combination with other systemic therapies in the treatment of breast cancer. In this review, we discuss the role of epigenetic regulation in breast cancer, in particular focusing on the clinical trials using therapies that modulate epigenetic mechanisms.     

食管癌高发区居民口腔细胞学状况及其与食管脱落细胞学相关性的研究

  目的 以口腔脱落细胞学方法探讨食管癌高发区居民口腔黏膜病变和食管黏膜病变的可能关系。方法 对河北省磁县食管癌高发区2 674名30岁以上成年居民进行口腔脱落细胞学检查。并在双盲条件下对其中335人进行了食管脱落细胞学检查，对比分析其相关关系。结果 受检居民中口腔黏膜炎症检出较为普遍，口腔黏膜炎症发生率近30.00 %，各年龄组居民发生率随年龄增高而增加，56岁以上人群发生率达到50.00 %以上，而30～35岁组只有13.30 %。口腔黏膜上皮细胞增生病变的发生率比较低，仅占1.16 %。除炎症、增生等病变外，55.90 %的当地居民口腔黏膜涂片中可见真菌菌丝。口腔黏膜炎症居民食管黏膜增生病变的发生率明显高于口腔黏膜无炎症者，口腔黏膜炎症与食管黏膜增生病变有明显相关关系（P＜0.001）。结论 食管癌高发区居民口腔黏膜炎症发生率较高，口腔黏膜炎症与食管黏膜增生病变明显相关。     

Phosphorus-31 magnetic resonance spectroscopy and blood perfusion of the RIF-1 tumor following X-irradiation

Phosphorus-31 magnetic resonance spectra were obtained from the RIF-1 tumor in C3H mice before and up to 2 days after various doses of X rays. Parallel studies were performed to measure relative changes in tumor blood perfusion using [14C]iodo-antipyrine and changes in % tumor necrosis using Chalkley's method. Tumor ratios of phosphocreatine to inorganic phosphate (PCr/Pi) and nucleotide triphosphates to inorganic phosphate (NTP/Pi) as well as pH as measured by 31P-MRS increased significantly at most time points after irradiation with doses of 5, 10, and 20 Gy. Tumor blood perfusion was found to significantly improve after a dose of 20 Gy but not after a dose of 2 Gy. Percent tumor necrosis increased to about 3 times its control level at 1 day after a dose of 20 Gy and then declined to about twice its control value at 2 days. The magnitude of the changes in the 31P-MRS parameters makes it unlikely that any of them are entirely due to radiation-induced changes in the radiobiologically hypoxic fraction of these tumors. Changes in the necrotic fraction did not appear to influence the tumor spectra. However, the observed improvement in tumor blood perfusion may have resulted in an increase in oxidative phosphorylation of the whole tumor population as well as a clearance of inorganic phosphate and acid metabolites, so that 31P-MRS changes may indirectly reflect changes in tumor blood perfusion.     

Microenvironment and tumor cell plasticity: An easy way out

Cancer cells undergo genetic changes allowing their adaptation to environmental changes, thereby obtaining an advantage during the long metastatic route, disseminated of several changes in the surrounding environment. In particular, plasticity in cell motility, mainly due to epigenetic regulation of cancer cells by environmental insults, engage adaptive strategies aimed essentially to survive in hostile milieu, thereby escaping adverse sites. This review is focused on tumor microenvironment as a collection of structural and cellular elements promoting plasticity and adaptive programs. We analyze the role of extracellular matrix stiffness, hypoxia, nutrient deprivation, acidity, as well as different cell populations of tumor microenvironment.