Optimizing systemic therapy for advanced hepatocellular carcinoma: the key role of liver function

The number of effective systemic therapies for the treatment of advanced hepatocellular carcinoma (HCC) is rapidly increasing, and the advent of immunotherapy has changed the treatment paradigm for these patients, leading to significantly improved survival outcomes. However, many patients with HCC will continue to receive tyrosine kinase inhibitors, partly because of contraindications to immune checkpoint inhibitors. Currently, the best sequential first- and second-line systemic treatment remains elusive. Maintenance of optimal liver function is crucial, it is likely to impinge on temporary or permanent treatment discontinuation, and should also be considered when defining the treatment sequence. Hepatic decompensation, which does not always coincide with disease progression, is part of this complex dynamically evolving system, and must be promptly recognized and adequately managed to allow the patient to continue in the therapeutic course. The purpose of this review is to highlight and summarize the evidence on the efficacy and safety of systemic agents, with a focus on the impact of underlying cirrhosis, and to suggest new clinical outcomes for randomized controlled trials for advanced HCC to better assess the net health benefit in this specific setting.     

不同时期经皮内镜胃造瘘术在神经外科长期昏迷患者中的应用

目的 探讨不同时期经皮内镜胃造瘘术（PEG）在神经外科长期昏迷鼻饲患者中的应用价值.方法 将51例长期昏迷鼻饲患者随机分为25～39 d造瘘组和40～60 d造瘘组,在相应时间内行PEG术.对两组患者造瘘前后的上消化道出血率、出血患者的平均出血次数及平均止血时间、误吸率和吸入性肺炎发生率进行分析比较.结果 造瘘后上消化道出血率、误吸率和吸人性肺炎发生率均明显低于造瘘前（P〈0.05）.25～39 d造瘘组造瘘前上消化道出血率、出血患者平均出血次数、误吸率及吸入性肺炎发生率均明显低于40～60 d造瘘组（P〈0.05）,两组出血患者平均止血时间的差异无统计学意义（P〉0.05）.造瘘后两组患者的上消化道出血率、误吸率及吸入性肺炎发生率的差异无统计学意义（P〉0.05）.结论 在神经外科长期昏迷患者中,PEG能减少因长期置鼻胃管所致的上消化道出血、误吸和吸人性肺炎的发生,发病后25～39 d行PEG比发病≥40 d行PEG对患者更有利.如无PEG禁忌证,发病后25～39 d可能是行PEG的合适时机.     

河南省疟疾发病与太阳磁暴关系初探

目的 探索太阳磁暴对河南省疟疾发病的影响,为河南省疟疾的防治和监测提供科学依据.方法 收集1968-2007年河南省疟疾发病资料和同期的太阳磁暴指数资料,用研究灾变规律的关键时方法进行分析,计算出统计量U,若|U|值超过某限度μ_α,就在相应显著性水平下认为当与关键时错位l个时刻时,因素|X_t|可能有灾异发生.结果 1968-2007年河南省疟疾发病率为0.04/万～1695.98/万,平均为172.43/万,同期太阳磁暴指数为14.95～37.08,平均为23.8.在太阳磁暴指数高年后的第2、3年,河南省疟疾发病率升高的可能性超过90%.结论 太阳磁暴指数可能对河南省疟疾发病率有影响.     

复发性脑出血

复发性脑出血是一种极为严重的脑血管病,其发生率呈明显上升趋势,致残率和病死率较首次脑出血明显增高.文章对复发性脑出血的临床分类、特征、危险因素、发病机制和预后进行了综述.     

New early prophylaxis regimen that avoids immunological danger signals can reduce FVIII inhibitor development

Summary. The most problematic complication of haemophilia A treatment is the development of inhibitors to FVIII. The highest risk of developing inhibitors is during the first 20 exposure days (EDs). If the patient can be brought through this high risk period without inhibitor development, the subsequent risk is low. Therefore, as a pilot project, we developed a prophylaxis regimen for the first 20–50 EDs specifically designed to induce tolerance to the administered FVIII and to minimize inhibitor development by avoiding immunological danger signals. Twenty‐six consecutive previously untreated patients (PUPs) with severe haemophilia A were treated with the new prophylaxis regimen and the incidence of inhibitor development in this group was compared with that in a historical control group of 30 consecutive PUPs treated with a standard joint protection prophylaxis regimen (40–50 IU kg^?1, three times a week). There were no significant differences between the study and control groups in patient‐related inhibitor risk factors such as ethnicity (all Caucasian), severity of haemophilia (all <1% FVIII), severity of FVIII gene mutation (P < 0.0006) nor in some treatment‐related factors such as product type, age at first exposure, vaccination regimen or the need for surgery. 14 of 30 subjects given standard prophylaxis but only one of the 26 subjects given the new regimen developed an inhibitor (P = 0.0003, odds ratio 0.048, 95% CI: 0.001–0.372). Our results indicate that minimizing danger signals during the first 20 EDs with FVIII may reduce the risk of inhibitor formation. These results should be confirmed in a larger prospective clinical study.     

冯崇廉主任应用小柴胡汤经验浅释

小柴胡汤出自《伤寒论》,是仲景为少阳伤寒而设的主方。原为治疗少阳证而设,其组方合理,疗效卓著,后世医家对其适应症有了广泛的发展,冯崇廉主任医师深刻领会方义,略有加减,在临床各科疾病的治疗方面取得了良好的疗效。     

中药归经与组方配伍的相关性探索

归经学说是指祖国医学根据脏腑经络理论,结合中药的作用特点,把所有中药分别与经络、脏腑加以联系,以说明某一药物对某些脏腑、经络病变的选择性治疗作用。其与方剂学密切相关。本文通过对中药归经理论的认识,从其对方剂用药配伍的指导及其对方剂的组方配伍规律的阐释两方面探析归经理论与方剂学的关系。归经理论使理、法、方、药更紧密结合,在一定程度上推动了方剂学的发展。