1例难治性癌痛的药物转换及药学监护

目的 探讨临床药师在难治性癌痛患者中的个体化药学服务,为该类患者药学监护提供参考。方法 通过参与1例晚期胃癌伴难治性癌痛患者出现阿片类药物耐受后的药学监护,临床药师对其镇痛方案分析,综合疼痛评估,及时优化给药方案,将吗啡转换为氢吗啡酮,快速有效地控制疼痛。结果 患者疼痛缓解,未出现爆发痛,患者生活质量改善。结论 临床药师对难治性癌痛患者开展目标性药学服务,不断提高专业能力,在疼痛治疗团队中发挥了重要的协作作用。     

1例癌痛患者治疗的药学监护

目的 探讨癌痛患者有效的治疗方案及药学监护思路。方法 对临床药师参与的1例癌痛患者的药物治疗进行全过程药学监护,并提出合理化建议。结果 通过对患者的癌痛药物的选择、不良反应及减量处理开展药学监护,提高了临床药师的癌痛治疗思维能力。结论 临床药师参与癌痛治疗工作,旨在优化治疗方案,确保患者用药安全、有效。     

1例晚期宫颈癌伴难治性疼痛患者的药学实践

摘要：临床药师参与1例晚期宫颈癌伴难治性疼痛患者镇痛治疗过程,对治疗期间患者疼痛部位、性质、评分及不良反应发生情况进行评估,依据指南及共识,对患者实施个体化镇痛治疗方案建议。医生采纳临床药师建议,经治疗患者疼痛明显改善,不良反应可耐受,予以出院。临床药师参与难治性癌痛患者的药物治疗,为临床医生提供循证医学证据,为患者提供个体化治疗方案建议,在提高治疗效果的同时减少不良反应的发生,实现合理用药。     

浅析临床药师在癌痛规范化治疗示范病房中的作用

目的：探讨临床药师在癌痛患者规范化治疗中的作用。方法：结合临床典型案例,对临床药师深入癌痛规范化治疗示范病房中开展药学服务工作进行分析、总结。结果与结论：疼痛是恶性肿瘤患者最常见的症状之一,严重影响患者的生活质量,通过规范化的镇痛治疗,多数患者能够得到完全缓解。多学科的团队协作对癌痛的治疗至关重要,其中临床药师在镇痛团队中扮演着重要角色,大连市中心医院通过专职肿瘤临床药师参与到疼痛治疗团队中,对癌痛管理工作进行了初步的探索。临床药师通过药学服务,纠正了一临床上镇痛药使用的常见误区,提高了用药合理程度。     

临床药师参与1例癌痛患者治疗的实践与体会

目的：探讨临床药师参与癌痛管理工作的模式。方法通过临床药师参与该院1例癌痛患者阿片类药物滴定方案的制定与调整、不良反应的监护及患者用药教育,寻找临床药师在癌痛管理工作中切入点。结果1例癌痛患者通过临床药师的干预,其疼痛得到有效控制,不良反应有效缓解,依从性明显提高。结论临床药师从个体化用药角度出发,在癌痛管理工作中发挥重要作用。     

临床药师在创建癌痛规范化治疗示范病房中的作用

目的：探讨临床药师在创建癌痛规范化治疗示范病房过程中的作用。方法：分析我院在创建“癌痛规范化治疗示范病房”过程中,临床药师参与癌痛患者的规范化治疗,对患者及其家属进行用药宣教和指导,对癌痛药物使用情况进行动态化分析等方法协助临床医生进行癌痛管理。结果：通过临床药师的干预,患者的NRS评分均有不同程度的下降。结论：癌痛临床药师通过药学服务,纠正了镇痛药物的常见误区,提高了用药合理性。     

1例癌痛患者大剂量盐酸羟考酮缓释片治疗的药学监护

目的：探讨癌痛患者予大剂量盐酸羟考酮缓释片镇痛疗效的药学监护,为优化临床药物治疗提供参考。方法：临床药师参与1例癌痛患者予大剂量盐酸羟考酮缓释片治疗的全过程,评估患者的镇痛疗效,提出用药方案。结果：临床药师参与癌痛患者治疗过程的监护,确保癌痛患者予大剂量盐酸羟考酮缓释片的安全性、有效性,使癌痛得到有效缓解。结论：临床药师为患者制订癌痛用药方案和用药监护,提高了患者癌痛治疗水平。     

临床药师参与癌痛管理的实践及作用

目的:探讨临床药师在癌痛管理中的作用。方法:通过案例分析介绍临床药师参与癌痛管理的内容和方法。结果:临床药师可为医师提供专业化的镇痛药建议,参与制订个体化的镇痛方案;通过开展患者监护和患者教育,发现潜在用药风险,及时纠正用药错误,提高患者依从性;通过实施患者家属培训,改善家属对患者的支持,提高癌痛管理效能。结论:临床药师全程参与癌痛管理,有利于促进镇痛药合理应用,保障患者用药安全,提高癌痛管理水平。     

临床药师参与癌症患者临床癌痛规范化用药的实践与体会

目的:探究临床药师在癌症患者临床癌痛规范化用药治疗中的作用.方法:以2017年—2019年医院肿瘤科癌症患者临床癌痛规范化治疗病房创建实践为背景,参与制定个体化的镇痛方案,并分析了临床药师参与癌症患者临床癌痛规范化用药中药学服务过程和用药管理.结果:临床药师参与癌症患者癌痛用药的药物管理,满足临床用药需求;融入了多学科治疗团队,为临床提供专业化的用药建议,通过开展用药教育,发现潜在用药风险,及时纠正用药误区,提高了患者用药的依从性.结论:临床药师参与癌症患者癌痛用药的规范化治疗,促进了临床合理用药,确保了患者用药的安全性和镇痛效果,避免或延缓了用药的成瘾.     

临床药师参与癌症患者临床癌痛规范化用药的实践与体会

目的:探究临床药师在癌症患者临床癌痛规范化用药治疗中的作用.方法:以2017年—2019年医院肿瘤科癌症患者临床癌痛规范化治疗病房创建实践为背景,参与制定个体化的镇痛方案,并分析了临床药师参与癌症患者临床癌痛规范化用药中药学服务过程和用药管理.结果:临床药师参与癌症患者癌痛用药的药物管理,满足临床用药需求;融入了多学科治疗团队,为临床提供专业化的用药建议,通过开展用药教育,发现潜在用药风险,及时纠正用药误区,提高了患者用药的依从性.结论:临床药师参与癌症患者癌痛用药的规范化治疗,促进了临床合理用药,确保了患者用药的安全性和镇痛效果,避免或延缓了用药的成瘾.     

Combining cancer vaccines with chemotherapy

Clinical experience is now demonstrating the efficacy of combining chemotherapy and targeted therapies. Although the combination of chemotherapy and immunotherapy would at first seem to be counterproductive, supportive preclinical and clinical data have revealed that cyclophosphamide, gemcitabine and doxorubicin enhance the efficacy of vaccines when used as a form of 'pretreatment'. Possible mechanisms of action include inhibition of regulatory T cells, enhancement of antigen presentation by tumours, or some yet unknown method. As such, more preclinical and clinical trials are needed to explore the synergistic effects of chemotherapy combined with immunotherapy, particularly the proper dose and timing of chemotherapy.     

Targeting cancer with phosphodiesterase inhibitors

Importance of the field: For many cancers, there has been a shift from management with traditional, nonspecific cytotoxic chemotherapies to treatment with molecule-specific targeted therapies that are used either alone or in combination with traditional chemotherapy and radiation therapy. Accumulating data suggest that multi-targeted agents may produce greater benefits than those observed with single-targeted therapies, may have acceptable tolerability profiles, and may be active against a broader range of tumour types. Thus, regulation of cyclic nucleotide signalling is properly regarded as a composite of multiple component pathways involved in diverse aspects of tumour cell function. The impairment of cAMP and/or cGMP generation by overexpression of PDE isoforms that has been described in various cancer pathologies, and the effects of PDE inhibitors in tumour models in vitro and in vivo, may offer promising insight into future cancer treatments because of the numerous advantages of PDE inhibitors.

Areas covered in this review: In this review, we focus on the expression and regulation of cyclic nucleotide phosphodiesterases (PDEs) in tumour progression and provide evidence that PDE inhibitors may be effective agents for treating cancer; the review covers literature from the past several years.

What the reader will gain: PDEs have been studied in a variety of tumours; data have suggested that the levels of PDE activity are elevated and, therefore, the ratio of cGMP to cAMP is affected. In addition, PDE inhibitors may be potential targets for tumour cell growth inhibition and induction of apoptosis. This review explores the prospects of targeting PDEs with therapeutic agents for cancer, as well as the shortcomings of this approach such as dose-limiting side effects, toxicity/efficacy ratio and selectivity towards tumour tissue. In addition, it includes opinions and suggestion for developing PDE inhibition for cancer treatment from initial concept to potential therapeutic application and final relevance in clinical use.

Take home message: Impaired cAMP and/or cGMP generation upon overexpression of PDE isoforms has been described in various cancer pathologies. Inhibition of selective PDE isoforms, which raises the levels of intracellular cAMP and/or cGMP, induces apoptosis and cell cycle arrest in a broad spectrum of tumour cells and regulates the tumour microenvironment. Therefore, the development and clinical application of inhibitors specific for individual PDE isoenzymes may selectively restore normal intracellular signalling, providing antitumour therapy with reduced adverse effects.     

Combining cancer vaccines with chemotherapy

Clinical experience is now demonstrating the efficacy of combining chemotherapy and targeted therapies. Although the combination of chemotherapy and immunotherapy would at first seem to be counterproductive, supportive preclinical and clinical data have revealed that cyclophosphamide, gemcitabine and doxorubicin enhance the efficacy of vaccines when used as a form of ‘pretreatment’. Possible mechanisms of action include inhibition of regulatory T cells, enhancement of antigen presentation by tumours, or some yet unknown method. As such, more preclinical and clinical trials are needed to explore the synergistic effects of chemotherapy combined with immunotherapy, particularly the proper dose and timing of chemotherapy.     

消化道肿瘤的脉管内侵犯与微转移、微血管密度关系的研究

目的研究胃肠癌微转移与微血管密度的特点,分析肿瘤的脉管内侵犯与微转移、微血管密度之间的关系。方法采用HE染色和免疫组化染色判断肿瘤的脉管内侵犯;采用RT-PCR技术,检测46例胃癌、大肠癌患者门静脉血中CK20 mRNA的表达;采用免疫组化方法,检测46例患者的微血管密度。结果46例患者存在脉管内侵犯的17例中,12例CK20 mRNA阳性,5例阴性。29例非脉管内侵犯的患者中,9例CK20 mRNA阳性,20例阴性。脉管内侵犯的微转移阳性率高于无脉管内侵犯的阳性率（P〈0.05）;脉管内侵犯的平均微血管密度为（29.2±3.3）,高于非脉管内侵犯的平均微血管密度25.4±4.7（P〈0.05）;免疫组化染色发现脉管内侵犯17例,优于HE染色发现脉管内侵犯的9例（P〈0.05）。结论用分子生物学的方法证实了肿瘤对血管的侵犯与微转移、微血管密度之间的关系密切,可能是影响患者预后的因素之一;免疫组化染色在检测脉管内侵犯方面优于HE染色。     

Antiphospholipid antibodies in patients with cancer

Antiphospholipid antibodies are generally associated with Antiphospholipid Syndrome, which can occur as a primary disorder or may be secondary to connective tissue disease or tumour. The presence of antiphospholipid antibodies in patients with tumour disease is responsible for thrombotic complications. In a population of 53 tumor patients with positive carcinoembryonic antigen CEA, carbohydrate antigen CA19.9, CA125 and CA15.3 markers, IgM and IgG anticardiolipin and antiphosphatidylinositol were detected by solid-phase immunoassays. Our results show that moderate or high levels of antiphospholipid antibodies are present in a great number of patients with CEA and CA19.9 markers, suggesting a specific association with gastroenteric tumors. By testing for antiphosphatidylinositol antibodies, many patients not evidenced by the standard anticardiolipin assay were found to be antiphospholipid-positive. The analysis of antiphosphatidylinositol antibodies as a diagnostic tool in gastroenteric cancer to highlight patients with the risk of thromboembolic complications is discussed.     

Chemoprevention of prostate cancer with finasteride

Prostate cancer is a significant cause of disease and death, making it an attractive target for chemoprevention. The association between lifetime exposure to dihydrotestosterone and risk of developing prostate cancer suggests that chemoprevention is possible with 5alpha-reductase inhibition. The recently completed Prostate Cancer Prevention Trial indicates that chemoprevention is possible with the 5alpha-reductase inhibitor finasteride. Development of a cost-effective chemoprevention strategy for prostate cancer is evolving, and is expected to have significant positive economic and public health benefits.