5个企业枸橼酸他莫昔芬片的体外溶出度考察

目的对国内5个企业枸橼酸他莫昔芬片进行体外溶出度考察,为临床合理用药提供依据。方法以紫外分光光度法测定含量,浆法测定溶出度。利用Excel软件的VBA编写宏命令,在计算机上快速算出枸橼酸他莫昔芬片的累积溶出百分率和溶出参数,并对各组之间的溶出参数进行方差分析。结果所测产品的体外溶出均达到中国药典规定的30min溶出应大于标示量75%的要求,但各企业枸橼酸他莫昔芬片的溶出参数（m、t50、td、t80）间存在着高度显著性差异（P〈0.01）。结论不同企业枸橼酸他莫昔芬片的溶出参数存在着显著差异,临床用药时应加以注意。     

Two cases with pachydermoperiostosis and discussion of tamoxifen citrate treatment for arthralgia

Idiopathic hypertrophic osteoarthropathy is a rare syndrome, characterized by clubbing, progressive enlargement of the joints, coarse facial features suggesting acromegaly, palmoplantar hyperhidrosis, fibrous covering at the ends of long bones (periostosis), and acro-osteolysis. It is a self-limiting condition but arthralgia may be as severe as limiting social life and activity, and it is the main complaint to be treated. We report on two siblings with pachydermoperiostosis (PDP), one of whom had arthralgia. Although several drugs have been used, we used tamoxifen for his arthralgia and his complaint disappeared. To the best of our knowledge, this is the second case treated by tamoxifen reported in the literature.     

Aromatase inhibitors in breast cancer

Estrogens play important roles in breast cancer development and progression. In postmenopausal women, traditional endocrine therapies such as tamoxifen have sought to inhibit estrogen action by targeting the estrogen receptor itself. However, newer treatments are evolving that target estrogen production in postmenopausal tissues through inhibition of the aromatase enzyme. Clinical data demonstrate that these aromatase inhibitors are superior to tamoxifen as adjuvant therapy for breast cancer and have now replaced tamoxifen as first line therapy in a number of treatment regimens for postmenopausal breast cancer patients.     

不同治疗方法对绝经后乳腺癌患者骨密度的影响

目的 探讨不同治疗方法 对绝经后乳腺癌患者骨密度(BMD)的影响.方法 研究分为健康对照组(50例)、肿瘤组[48例,其中24例再行他莫昔芬(TAM)组治疗].采用双能X线骨密度仪(DEXA)测定所有研究对象的基线BMD.肿瘤组术后均进行辅助化疗,其中24例(TAM组)化疗后继续使用TAM行内分泌治疗.用DEXA测量腰椎和左髋部位的BMD,比较肿瘤组化疗前、后以及TAM组行内分泌治疗8个月后BMD变化.结果 肿瘤组化疗后腰椎部位BMD(0.87±0.15)g/cm2比化疗前(0.93±0.15)g/cm2明显降低(P<0.05);TAM组行内分泌治疗8个月后腰椎BMD(0.90±0.04)g/cm2和股骨颈(0.74±0.05)g/cm2等左髋部位的BMD均有明显增加(P<0.05).结论 化疗可能导致绝经后乳腺癌患者BMD的下降,而TAM治疗能缓解化疗引起的BMD降低.     

Ductal carcinoma in-situ: an update for clinical practice

Introduction

Ductal carcinoma in-situ (DCIS) is a heterogeneous entity with an elusive natural history. The objective of radiological, histological and molecular characterisation remains to reliably predict the biological behaviour and optimise clinical management strategies. Increases in diagnostic frequency have followed the introduction of mammographic screening and increased utility of magnetic resonance imaging. However, progress remains limited in distinguishing non-progressive incidental lesions from their progressive and clinically relevant counterparts. This article reviews current management strategies for DCIS in the context of recent randomized trials, including the role of sentinel lymph node biopsy (SLNB), adjuvant radiotherapy (RT) and endocrine treatment.

Methods

Literature review facilitated by Medline, PubMed, Embase and Cochrane databases.

Results

DCIS should be managed in the context of a multidisciplinary team. Local control depends upon adequate surgical clearance with margins of at least 2 mm. SLNB is not routinely indicated and should be reserved for those with concurrent or recurrent invasive disease. SLNB can be considered in patients undergoing mastectomy (MX) and those with risk factors for invasion such as palpability, comedo morphology, necrosis or recurrent disease. RT following BCS significantly reduces local recurrence (LR), particularly in those at high-risk. There remains a lack of level-1 evidence supporting the omission of adjuvant RT in selected low-risk cases. Large, multi-centric or recurrent lesions (particularly in cases of prior RT) should be treated by MX with the opportunity for immediate reconstruction. Adjuvant Tamoxifen may reduce the risk of LR in selected cases with hormone sensitive disease.

Conclusion

Further research is required to determine the role of contemporary RT regimes and endocrine therapies. Biological profiling and molecular analysis represent an opportunity to improve our understanding of the tumour biology of this condition and rationalise its treatment. Reliable identification of low-risk lesions could allow treatment to be less radical or safely omitted.     

三苯氧胺与脂肪性肝病

三苯氧胺用于雌激素受体阳性乳腺癌患者的内分泌治疗效果肯定,但长期应用可诱发脂肪性肝病.其机制包括药物聚集于肝细胞线粒体、脂肪酸氧化异常、雌激素拮抗作用等.对服用三苯氧胺的乳腺癌患者需定期监测肝功能、血脂、超声及CT等.可选择托瑞米芬、芳香化酶抑制剂替代治疗及应用降脂药物等进行防治.     

三苯氧胺诱导人乳腺癌MCF-7细胞株耐药及自噬的关系研究

背景与目的:三苯氧胺(tamoxifen)作为第一代选择性雌激素受体调节剂(selective estrogen receptor modulator,SERM)被广泛地应用于激素敏感型乳腺癌的内分泌一线治疗。三苯氧胺耐药的发生严重限制了临床治疗,是乳腺癌患者用药面临的重大难题,明确其耐药机制对乳腺癌的治疗有重要临床意义。本研究通过体外诱导人乳腺癌细胞MCF-7三苯氧胺耐药,探讨细胞产生三苯氧胺耐药时自噬水平的变化与MAPK家族蛋白细胞外信号调节激酶(extracellular signal-regulated kinase,ERK)蛋白表达量及磷酸化水平的变化。方法:浓度递增筛选法诱导MCF-7细胞耐药,透射电镜观察MCF-7细胞与耐药细胞内的自噬泡数量,CCK8法检测细胞增殖状态,应用Western blot检测LC3Ⅱ、ERK1/2、Phospho-ERK1/2蛋白的表达情况。结果:诱导的三苯氧胺耐药细胞株TR5达到5μmol/L的耐药浓度。TR5细胞内的自噬泡数量与LC3Ⅱ表达量明显高于MCF-7细胞。ERK蛋白在两种细胞中的表达量差异无统计学意义,但其在TR5中的磷酸化水平比MCF-7细胞高。结论:...     

他莫西芬联合十一酸睾酮治疗特发性少精及弱精子症的临床观察

目的探讨他莫西芬和十一酸睾酮联合应用对男性特发性少精、弱精症精液参数及生殖激素水平的影响。方法将60例特发性少弱精症患者随机分成Tc组、Tu组及TT组,各20例。分别接受他莫西芬、十一酸睾酮、他莫西芬和十一酸睾酮联合应用,于1个月、3个月取患者精液分别进行精子形态学分析,检测精子数量（密度）、精子活力（a＋b百分率）及血清中FSH、LH、T水平。结果治疗1个月后,他莫西芬和十一酸睾酮联合应用组（TT组）精子的数量、活力及功能明显改善,血清中FSH、LH水平升高,T水平变化不大;3个月后,精子的数量,活力及功能等显著提高,血清中FSH、LH、T水平明显升高,均显著优于Tc组及Tu组（P〈0.01或P〈0.05）。结论他莫西芬与十一酸睾酮联合应用能够显著提高特发性少弱精症患者精液主要参数,改善生殖激素水平。     

乳核散结片联合三苯氧胺 维生素E治疗乳腺囊性增生病

目的探讨乳核散结片联合三苯氧胺、维生素E治疗乳腺囊性增生病的疗效。方法收集本所265例乳腺囊性增生病患者,随机分为治疗组（乳核散结片联合三苯氧胺、维生素E）,对照组（三苯氧胺、维生素E）,疗程均为8周,观察其临床疗效。结果治疗组的总有效率为91．7％,对照组的总有效率为75．8％（P〈0．05）。结论乳核散结片联合三苯氧胺、维生素E治疗乳腺囊性增生病比三苯氧胺加维生素E疗效更显著。