吉非替尼致问质性肺炎并文献回顾

目的：探讨吉非替尼治疗晚期非小细胞肺癌所致问质性肺炎的临床特点和治疗策略。方法：报告1例吉非替尼治疗晚期非小细胞肺癌所致间质性肺炎的临床资料，并进行系统文献回顾，对吉非替尼所致间质性肺炎的临床特点，机理和治疗进行分析。结果：综合本病例患者特点和国内外文献分析，老年男性、长期吸烟史、吸烟指数高、腺癌、特别是细支气管肺泡癌患者在服用吉非替尼期间更容易发生间质性肺炎，发生时间多在服药后1—2月，临床表现以胸闷、气短、进行性呼吸困难为特点，伴有严重低氧血症，甚至呼吸衰竭。影像学检查以双肺弥漫性浸润性阴影及蜂窝状间质改变为代表，及时判断病因并停药，给予糖皮质激素、吸氧、抗感染等对症处理可缓解。结论：一旦发现吉非替尼所致的间质性肺炎应及时停药，大多数患者病情可缓解，早期可控制的间质性肺炎，不是永久停用吉非替尼的绝对指标，应根据患者的获益和药物治疗相关风险综合考虑。     

Targeting the PI3K/AKT/mTOR pathway in biliary tract cancers: A review of current evidences and future perspectives

Biliary tract cancers (BTCs) are a group of invasive neoplasms, with increasing incidence and dismal prognosis. In advanced disease, the standard of care is represented by first-line chemotherapy with cisplatin and gemcitabine. In subsequent lines, no clear recommendations are currently available, highlighting the need for novel therapeutic approaches.The PI3K/AKT/mTOR pathway is a core regulator of cell metabolism, growth and survival, and is involved in BTCs carcinogenesis and progression. Mutations, gene copy number alterations and aberrant protein phosphorylation of PI3K, AKT, mTOR and PTEN have been thoroughly described in BTCs and correlate with poor survival outcomes.Several pre-clinical evidences state the efficacy of PI3K/AKT/mTOR pathway inhibitors in BTCs, both in vitro and in vivo. In the clinical setting, initial studies with rapamycin analogs have shown interesting activity with an acceptable toxicity profile. Novel strategies evaluating AKT and PI3K inhibitors have risen serious safety concerns, pointing out the need for improved patient selection and increased target specificity for the clinical development of these agents, both alone and in combination with chemotherapy.This review extensively describes the role of the PI3K/AKT/mTOR pathway in BTCs and examines the rationale of its targeting in these tumors, with particular focus on clinical activity, toxicities and perspectives on further development of PI3K/AKT/mTOR pathway inhibitors.     

Nestin and vimentin colocalization affects the subcellular location of glucocorticoid receptor in cutaneous melanoma

Aims: Nestin (a neuronal stem cell/progenitor cell marker of central nervous system development), vimentin (which is ubiquitously expressed in mesenchymal cells), and the glucocorticoid receptor (GR, which is involved in the immune response, cell proliferation, and apoptosis) have been shown to interact in embryonic and undifferentiated tissues in modulating cell proliferation. The aim of this study was to analyse nestin, vimentin and GR expression in tumour tissue (melanoma), and their association with clinicopathological variables, to evaluate any effect on tumour progression. Methods and results: Immunohistochemistry, double‐label immunofluorescence and confocal laser scanning microscopy were performed on biopsy specimens of cutaneous melanoma from 81 patients. Fisher’s and Pearson’s tests showed a correlation between nestin, vimentin and subcellular GR location (P = 0.008). Their concomitant expression also correlated with Clark level and thickness (P = 0.02 and P = 0.029, respectively). Kaplan–Meier analysis revealed a poorer outcome for stage III and IV patients with associated expression of nestin, vimentin and cytoplasmic GR in tumour tissue (P = 0.02). Conclusions: These results suggest the presence in melanoma of growth mechanisms involving nestin, vimentin, and GR, similarly to that occurring in embryonic and undifferentiated cells, and may help in understanding tumour biology to provide a molecular basis for clinical therapies.     

The role of glucocorticoid in SIRPα and SHP-1 gene expression in AIHA patients

The aim of this work was to evaluate the regulation of SIRPα, an inhibitory phagocyte receptor, and the phosphatase SHP-1 in monocytes of patients with autoimmune hemolytic anemia, and the role of dexamethasone on SIRPα and SHP-1 gene expression and erythrophagocytosis in vitro. SIRPα and SHP-1 expression was higher in monocytes from AIHA patients compared with normal, returning to normal after glucocorticoid therapy. SIRPα and SHP-1 mRNA expression was upregulated in healthy monocytes treated with dexamethasone compared with basal; however, the erythrophagocytic ability was not altered. Our results point to a minor role of SIRPα and SHP-1 in determining AIHA.     

早产两个临床热点问题探讨

<正>早产是多病因引起的一种综合征,是造成新生儿死亡和发病最主要的原因~([1])。据报道,世界范围内的早产率约为11%,也就是说,每年约有1500万早产儿出生,因此,早产一直是产科学界最关注的主题之一~([2])。但近几十年来,产科的一系列防治早产的干预措施并没有明显降低早产率,目前认为产前糖皮质激素促胎肺成熟的治疗以及硫酸镁保护脑神经的使用是改善围产儿结局的最重要的产科干预措施~([2])。     

糖皮质激素治疗突发性耳聋的临床效果观察

目的：研究分析糖皮质激素治疗突发性耳聋的临床效果。方法：选取在我院治疗的突发性耳聋患者80例（2014年5月～2015年5月）。将其动态随机化分2组，研究组和对照组各40例。对照组患者给予非激素常规治疗，研究组患者在常规治疗的基础上给予糖皮质激素进行治疗，对比两组患者突发性耳聋的临床疗效。结果：研究组患者治愈率为27．50％，总有效率为87．50％，与对照组患者对比存在明显差异（P＜0．05）。结论：采用糖皮质激素对突发性耳聋患者进行治疗的效果显著，能有效改善患者听力情况，在临床上可以广泛应用。     

循证护理在大剂量甲强龙冲击治疗系统性红斑狼疮的应用

目的探讨循证护理方法在系统性红斑狼疮患者中的应用效果。方法成立循证小组,利用信息网络搜索相关文献,并结合临床,选择最佳的护理依据,制订最符合患者需求的护理方案,对2012年10月—2014年10月接受大剂量甲强龙冲击的系统性红斑狼疮患者(实验组)实施循证护理,并与2011年9月—2012年9月实施常规护理的患者比较感染率、胃肠道反应率、电解质变化及睡眠时间。结果采用循证护理后,实验组各项观察指标均显著优于对照组(P0.05)。结论采用循证护理方法规范地对大剂量甲强龙冲击治疗的系统性红斑狼疮患者进行护理,能降低冲击治疗后感染、胃肠道反应及出血、电解质紊乱、睡眠型态紊乱等的发生率。     

Glucocorticoids and prostate cancer treatment： friend or foe？

Glucocorticoids have been used in the treatment of prostate cancer to slow disease progression, improve pain control and offset side effects of chemo- and hormonal therapy. However, they may also have the potential to drive prostate cancer growth via mutated androgen receptors or glucocorticoid receptors （GRs）. In this review we examine historical and contemporary use of glucocorticoids in the treatment of prostate cancer, review potential mechanisms by which they may inhibit or drive prostate cancer growth, and describe potential means of defining their contribution to the biology of prostate cancer.