中医药治疗原发性肝癌的研究进展

原发性肝癌是消化系统常见的恶性肿瘤,发现时多处于中晚期,预后差。中医药在防治原发性肝癌方面有其独特的优势,简述了原发性肝癌的病因、病机和中医对肝癌的辩证治疗,总结了中医药联合经肝动脉化疗栓塞术、肝癌根治术、放化疗以及分子靶向药物等综合治疗方面取得的进展,以期对原发性肝癌的临床治疗及改善预后提供一定的参考。     

索拉非尼在乙型肝炎病毒相关晚期肝细胞癌中的应用价值

中国是乙型肝炎病毒(HBV) 感染的高流行区,HBV 感染是导致原发性肝癌的最常见危险因素,乙肝肝硬化是 肝癌发生的高危因素。在中国近年来原发性肝癌的发病率和病死率呈逐年上升趋势。原发性肝癌起病隐匿,恶性程 度高,病情进展快,大多数发生在肝硬化基础上,确诊时多已进展至中晚期甚至出现远处转移,丧失根治性治疗时机, 治疗手段有限,预后极差。索拉非尼的临床应用使晚期肝癌患者的治疗取得了突破性进展,能有效阻止疾病进展,延 长患者生存时间,开创了晚期肝癌的靶向治疗时代。文章从索拉非尼的作用机制、不良反应处理、HBV 相关原发性 肝癌的内科综合治疗进展,以及笔者近年来应用以索拉非尼为核心的内科综合治疗手段治疗HBV 相关中晚期肝癌 的临床体会等几个方面,对索拉非尼在乙肝相关晚期肝癌患者中的临床应用进行论述。     

原发性肝癌

原发性肝癌染色体17P微卫星不稳定性及突变型P53蛋白的表达，原发性肝癌细胞核和线粒体DNA微卫星不稳定性研究，转化生长因子-β1对原发性肝癌诊断与鉴别的临床价值，肝脾动脉联合栓塞治疗原发性肝癌合并脾功能亢进的临床观察，沙培林在原发性肝癌介入治疗(TACE)中的初步应用研究，中晚期原发性肝癌二期切除26例临床分析。     

原发性肝癌综合介入治疗进展

<正>原发性肝癌是全球最常见的恶性肿瘤之一,为全球第5位常见肿瘤,占癌症相关死亡的第三位[1],而其中就有55%肝癌患者发生在我国。手术切除仍然是早期肝癌的主要根治性治疗方法,但由于肝癌早期症状不典型,恶性程度高,易发生转移等原因,临床发现时多数已发展为中晚期肿瘤,可以根治性切除的患者不足20%[2],而以肝动脉栓塞化疗(Transarterial chemoembolization,TACE)为基础的综合介入治疗作     

中医药治疗原发性肝癌的切入点与难点

原发性肝癌是我国常见的恶性肿瘤之一,大多数发现时已经是中晚期,生存期短,预后差。近年来,中医药在原发性肝癌的防治方面展现了其独特的优势,在改善肝癌患者的生存质量、增强免疫力、延长生命等方面有着显著疗效。就原发性肝癌的中西医治疗现状进行了综述,结合临床治疗特点提出中医药治疗的切入点与难点,以期为临床治疗原发性肝癌提供一定的参考。     

高尔基体蛋白73联合甲胎蛋白在原发性肝癌诊断中的应用

<正>原发性肝癌是严重威胁我国人民健康的恶性肿瘤之一,其发病率位列世界第5,死亡率位居第3位~([1])。原发性肝癌早期往往无特异性临床表现和体征,临床确诊时已发展至中晚期,预后极差。早发现、早诊断、早治疗是提高原发性肝癌患者生存率的最佳途径。AFP作为肝癌诊断及疗效观察指标已用多年,但其他疾病也可能引起AFP升高,尤其是慢性肝炎、肝硬化患者~([2、3])。另外也有部分肝癌患者AFP呈阴性。有分析认     

中西医结合治疗原发性肝癌研究进展

原发性肝癌(PLC)是我国最常见的恶性肿瘤之一,在我国其死亡率为20.37/10万,占恶性肿瘤死亡率的第2位[1]。原发性肝癌病情凶险,发展迅猛,中位生存期一般3~6个月。中西医结合治疗在临床已逐渐成为趋势,现将近十年临床中西医结合治疗原发性肝癌的进展综述如下。1临床治疗1.1中药与肝动脉栓塞化疗(TACE)联合治疗TACE是目前应用较广泛的姑息治疗方法。邵中兴等[2]将60例中晚期肝癌随机分成两组,A组30例,应用中药肝癌I号(口服)、II号(外敷)联合肝动脉化疗栓塞术治疗,B组30例仅肝动脉化疗栓塞术治疗。结果显示在肿瘤缩小、甲胎球蛋白降低、…     

靶向Hippo信号通路治疗原发性肝癌的研究进展

<正>原发性肝癌(肝癌)是临床常见恶性肿瘤,包括肝细胞癌(HCC)和肝内胆管细胞癌(ICC)。近年来,肝癌发病率呈不断上升趋势,2020年全球原发性肝癌发病率为4.7%,死亡率为8.3%,位居全球常见恶性肿瘤第5位和肿瘤致死病因第3位^[1]。因早期诊断难,且具有高转移、高复发等特点,大多数患者确诊时已处于中晚期,导致肝癌预后差,5年生存率低于15%^[2]。     

原发性肝癌淋巴细胞表型变化与转移和复发的关系

原发性肝癌是最常见的恶性肿瘤之一 ,虽然手术是其首选有效的治疗方法 ,但由于患者多合并肝硬化 ,且易发生肝内及远处转移 ,能获手术治疗者仅占 2 0 %左右 ,放、化疗难以彻底消灭肿瘤细胞 ,同时易损伤正常组织 ,降低全身和肝脏局部免疫力。因此 ,近年来生物免疫治疗已渐成为肿瘤治疗的第四模式。为探讨免疫治疗与介入治疗对原发性肝癌患者淋巴细胞表型的影响及其临床相关性 ,2 0 0 0～2 0 0 1年 ,我们对 42例中晚期原发性肝癌患者采用动脉栓塞 (TACE)与干扰素联合治疗 ,现报告如下。1　资料与方法1 .1　一般资料　本文中晚期原发性肝癌患…     

199例乙型肝炎病毒感染相关中晚期肝癌患者生存时间及影响因素的分析

目的:分析并探讨乙型肝炎病毒(HBV)感染相关中晚期原发性肝癌(PLC)生存时间及影响因素。方法:选取1997年1月1日至2017年12月31日,在深圳市第三人民医院确诊为HBV感染相关中晚期原发性肝癌在院死亡患者199例,回顾性分析患者生存时间及其主要影响因素。结果:199例死亡患者首次确诊中晚期原发性肝癌后平均生存时间(4.985±1.262)月,中位生存时间2.00月。规律复诊、AFP、胆道系统结石、抗病毒治疗、手术及其他治疗、是否参与医保是患者生存时间的影响因素(P0.05)。其中规律复诊、抗病毒治疗、手术及其他治疗、AFP是影响患者生存时间的独立因素,前面三个因素为影响生存时间的保护因素,而AFP反之。结论:本组HBV感染相关中晚期原发性肝癌死亡患者生存时间较短,规律复诊、抗病毒治疗、手术等干预对延长生存期有一定帮助。     

Determining treatment effectiveness and period of treatment

• Judging the effect of treatment for hospital-acquired pneumonia is difficult using only inflammatory parameters or findings from chest radiography.
• Preferably, treatment effects should be judged comprehensively from body temperature, findings of chest radiography, inflammatory parameters, status of purulent discharge, bacteriological findings and oxygenation.
• In VAP, the parameter most closely correlated with prognosis is trend in PaO₂/FiO₂.
• Clinical improvements are normally seen within 72 h. Antimicrobials thus should not be changed until the third day unless a dramatic deterioration in symptoms is seen.
• With the exception of pneumonia from microbes that tend to possess strong resistance, such as Pseudomonas aeruginosa , a treatment period of 7–10 days is adequate if the early-stage drugs are effective.
• If no improvements in the course are achieved by 3 days after starting treatment, an investigation should be made into whether treatment should be continued or changed to a different antimicrobial agent.     

Cognitive-behavioral treatment of rheumatoid arthritis pain maintaining treatment gains

Objective. This paper critically reviews research studies examining the long-term effects of cognitive-behavioral therapy interventions for managing pain in rheumatoid arthritis patients. Methods and Results. The first section of the paper evaluates long-term results obtained in studies of cognitive-behavioral therapy, arthritis education inter ventions, and combined cognitive-behavioral therapy-arthritis education interventions. These studies show that although some rheumatoid arthritis patients are able to maintain initial improvements inpain and disability, other rheumatoid arthritis patients do not. In the second section of this review, a cognitive-behavioral model of maintenance of pain coping skills is presented. This modelmay be useful in increasing our understanding of the relapse process and in planning interventions toenhance and prolong cognitive-behavioral therapy treatment gains. The final section of thispaper addresses important future directions for research. The need for empirical studies of relapse and maintenance processes is underscored. Conclusions. Controlled studies are needed to test the utility of new cognitive-behavioral interventions designed to enhance the long-term maintenance of treatment gains inRA patients. We suggest that a focus on issues of relapse and maintenance may be just as important for medical and surgical interventions for rheumatoid arthritis pain, as it is for cognitive-behavioral therapy interventions.     

Current treatment of acute type A aortic dissection. Surgical treatment and treatment of malperfusion syndrome

Acute type A aortic dissection is a surgical emergency. Treatment is based on dissected ascending aortic replacement and correction of an associated aortic insufficiency. Catheterization of the axillary artery, open distal anastomosis and systematic resection of the intimal tear are the main surgical evolutions of the last years. They allowed to significantly reduce intraoperative mortality rate particularly due to bleeding. Thirty days mortality rate of operated aortic dissection is about 20 to 30%. Visceral malperfusion syndromes induced by aortic dissection represent an important cause of postoperative death. An early diagnosis and treatment appears necessary. Thoracoabdominal CT scan allows understanding mechanisms inducing malperfusion. Aortography and an emergency endovascular procedure allow restoring arterial blood flow before renal or mesenteric irreversible ischemia. Collaboration between radiologist, anesthesiologist and surgeon is necessary to optimize survival of acute type A aortic dissection.     

Discontinuous calcitonin treatment of established osteoporosis--effects of withdrawal of treatment

PURPOSE: The purpose of this study was to examine the effects of discontinuous treatments with intranasal salmon calcitonin on bone and calcium metabolism in postmenopausal women and to establish the effects of withdrawing treatment. PATIENTS AND METHODS: This report presents data from 26 postmenopausal women with established osteoporosis (forearm fracture) 12 months after withdrawal of a 1-year double-blind, placebo-controlled therapy with intranasal calcitonin. The women then resumed treatment with calcitonin 200 IU plus calcium 500 mg daily in an open design for an additional 1-year period. A control group of 19 age-matched women (no forearm fracture) did not receive any treatment. RESULTS: At the end of the 3 years, the control group had lost significantly more bone in the forearm (single photon absorptiometry) and spine (dual photon absorptiometry) than had the group treated with intranasal calcitonin for 2 years, whereas the group receiving calcitonin for 1 year had intermediate values. During the year of withdrawal, the rate of bone loss was similar in the women who had received calcitonin and those who had received placebo. Calcitonin was especially effective in women with initially high bone turnover and low bone mass. The bone response in the spine could, furthermore, be estimated by the changes in bone turnover. CONCLUSION: Discontinuous treatment with intranasal calcitonin affects bone and calcium metabolism in established osteoporosis. In women with high-turnover osteoporosis, therapy results in a net gain of bone in both the peripheral and axial skeleton. Response to treatment may be monitored by changes in bone turnover.     

Refusal of treatment

The decision regarding refusal of treatment ultimately rests with competent adult patients. When the elderly patients is an inadequate or incompetent decision-maker, in order to protect the interests of the patient, the physician should have some knowledge of the way decisions are and ought to be made, particularly when a decision to forgo life-sustaining treatment is being deliberated. In acquiring this knowledge, the physician needs to develop clear understanding about who has the authority and responsibility to speak for the patient and what standards are to guide the decision-making process involving the incompetent patient. This is not an easy task for any physician. In many instances, the process can become clouded by a host of complex ethical and legal issues that make any decision a questionable one. A beginning point might be the acceptance of the fact that every elderly patient possesses values and goals that are quite unique to him, even though they might seem identical to those held by many other patients. This fact, more than anything else, will help to remove many of the impediments that face the physician during the decision-making process.     

Surgical treatment of hemorrhoids

PURPOSE: The object of this study was to evaluate technique using the ultrasonically activated scalpel as an alternative to closed hemorrhoidectomy in an unbiased evaluation of this new technology. METHODS: Thirty patients with Grade 2 or 3 symptomatic hemorrhoids were prospectively randomized to undergo closed hemorrhoidectomy assisted by electrocautery or hemorrhoidectomy with the ultrasonically activated scalpel,i.e., the Harmonic Scalpel®. We evaluated the difference between techniques in operative time, postoperative pain, incontinence, and quality of life (using the Short Form-36 survey), as well as complications. RESULTS: Mean operative time for closed hemorrhoidectomy with electrocautery was 35.7 ± 3 minutes; for Harmonic Scalpel® patients, it was 31.7 ± 2 minutes (P<0.37). There was no statistical difference in operative time for two- or three-column hemorrhoidectomy. There was no significant difference in pain measurements reported on Day 1 (5.8 ± 0.4 for electrocautery and 5.6 ± 0.6 for Harmonic Scalpel®,P<0.82). On postoperative Dayaq 7, the difference in pain between groups approached significance, with pain reported as 3.7 ± 0.3 for electrocautery and 5.1 ± 0.7 for Harmonic Scalpel® (P<0.06). At six weeks, both groups were pain free. There was a significant decrease in pain between postoperative Days 1 and 7 in the electrocautery patients that was not seen in the Harmonic Scalpel® patients. Incontinence measured preoperatively, at postoperative Day 7, and at postoperative Week 6 was similar for both groups and reflected occasional incontinence of gas. When the various items of the Short Form-36 survey were compared, there was no significant difference between posttreatment and preoperative values. There was no difference in the number of complications between patient groups. CONCLUSION: Although the Harmonic Scalpel® is an effective tool in the treatment of hemorrhoidal disease, we found no specific advantage in postoperative pain, fecal incontinence, operative time, quality of life, or complications compared with traditional closed hemorrhoidectomy.Supported by a grant from Ethicon EndoSurgery, Cincinnati, Ohio.     

Endoscopic treatment of gastroparesis

Gastroparesis has traditionally been a largely medically managed disease with refractory symptoms typically falling under the umbrella of the surgical domain.Surgical options include, but are not limited to, gastrostomy,jejunostomy, pyloromyotomy, or pyloroplasty,and the Food and Drug Administration approvedgastric electrical stimulation implantation. Endoscopic management of gastroparesis most commonly involves intrapyloric botulinum toxin injection; however, there exists a variety of endoscopic approaches on the horizon that have the potential to radically shift standard of care.Endoscopic management of gastroparesis seeks to treat delayed gastric emptying with a less invasive approach compared to the surgical approach. This review will serve to highlight such innovative and potentially transformative, endoscopic interventions available to gastroenterologists in the management of gastroparesis.     

Pharmacological treatment of alcoholism

This paper presents an overview on pharmacologic treatment of alcoholism. A wide range of drugs have been tested over the years, some showing a reduction of alcohol drinking in alcoholics. However, at present, there is little evidence that phnrmacotherapy is effective in the rehabilitation of alcoholics. Although research in this area still has several methodological problems and much needs to be done, a greater understanding of the neuropharmacoiogy and neurobiology of alcohol use and abuse will certainly open new avenues for investigation and drug development. Patient-treatment matching and the combination of two or more modalities of intervention may also help increase overall effectiveness of alcohol treatment. (Aust NZ J Med 1992; 22: 220–223.)