急性心肌梗塞溶栓治疗综述

综述了急性心肌梗塞形成的原因、临床特点、溶栓治疗的作用及目前常用的溶栓药物.     

肺部真菌感染的药物选择及治疗策略

由于高危人群的不断增多,侵袭性真菌感染的患病率和病死率均呈显著上升趋势。近年来提出应根据患者危险因素高低的不同,采取相应的治疗策略,包括预防治疗、经验治疗、临床诊断治疗和确诊治疗。肺部是真菌最常受累的器官,所以本文拟从循证医学的角度,就目前在侵袭性真菌感染,尤其是在肺部真菌感染中的各种抗真菌药物选择及其治疗策略作一综述。     

纳米药物递送系统在前列腺癌治疗中的应用

前列腺癌（PCa）是全球最常见的男性泌尿生殖系统恶性肿瘤。手术、内分泌治疗、放疗和化疗是PCa的主要临床治疗选择。纳米药物递送系统具有良好的可控释放特性和较好的肿瘤靶向能力，并可通过增强的渗透性和保留（EPR）效应被动靶向肿瘤。通过精巧的设计组装和外表修饰赋予纳米递药系统与众不同的肿瘤治疗效果。本文介绍用于PCa治疗的先进纳米药物递送系统以及未来发展。     

以Avastin登场为契机 分子靶向药物成为治疗的支柱

在目前不能手术的患者以及复发患者缺乏有效的直肠癌治疗药的情况下，抗血管新生的药物等具有新机理的分子靶向药物相继登场。2005年，Avastin的销售额达到1545亿日元（约合101．97亿元人民币），在业内处于领先地位。分子靶向药物正在成为直肠癌药剂治疗的一支主力军。[编者按]     

抗肿瘤药物的研发态势分析

恶性肿瘤（癌症）是导致人类死亡的主要原因之一,为此,全球各国的研究者进行了大量的研究。本文分析了抗肿瘤药物近年来的研究进展和趋势,特别对分子靶向抗肿瘤药物、生物标志物在抗肿瘤药物治疗中的应用,以及肿瘤治疗性疫苗的研究进展进行了总结。     

脊索瘤的临床治疗进展

脊索瘤是一种罕见的低度恶性肿瘤,临床治愈率低,复发率较高。手术切除是治疗脊索瘤的首选方法,目前公认的脊索瘤治疗方法是完整（或大块）切除。术后辅助放射治疗越来越多的应用于临床,而新药物的研发、术前动脉栓塞的应用,以及射频消融等都被用于脊索瘤的临床治疗。本文综述了目前临床上应用的诊疗进展,包括手术治疗、放射治疗、药物治疗及射频消融治疗等方法。     

新冠肺炎COVID-19临床治疗的药物选择

新型冠状病毒病COVID-19,如大多数病毒感染疾病一样,除了疫苗以外,尚无特效药,也没有针对性的治疗方法。在临床上,药物治疗主要是针对患者在感染病毒以后,免疫系统被激活到极限程度或者失去控制,从而给患者带来伤害。本研究系统地回顾了新冠肺炎爆发以来的临床治疗案例,结合中国国家卫健委发布的《新型冠状病毒病肺炎诊疗方案(试行第一至七版)》,提出了治疗新冠肺炎COVID-19临床药物的选择策略,评估了各种目前应用于临床实践的西药的疗效和风险,旨在为临床医生在药物选择上提供理论依据和临床上的案例。     

脊索瘤的临床治疗进展

脊索瘤是一种罕见的低度恶性肿瘤,临床治愈率低,复发率较高。手术切除是治疗脊索瘤的首选方法,目前公认的脊索瘤治疗方法是完整(或大块)切除。术后辅助放射治疗越来越多的应用于临床,而新药物的研发、术前动脉栓塞的应用,以及射频消融等都被用于脊索瘤的临床治疗。本文综述了目前临床上应用的诊疗进展,包括手术治疗、放射治疗、药物治疗及射频消融治疗等方法。     

大分子的吸入治疗

随着重组DNA技术和分子生物学的发展,以蛋白质和多肽为主的大分子成为一类新型药物,并越来越受到重视,新兴的基因治疗技术使得核酸大分子也有可能成为药物。目前,绝大部分大分子药物都是通过注射途径给药,病人在医院注射费用昂贵且不方便,因而许多注射替代给药途径成为研究热门,通过肺部吸入给药就是一种很有吸引力的非侵入性给药途径。本介绍了肺吸收大分子的可能机制和大分吸入治疗的临床与基础研究以及面临的问题。     

卵巢癌的靶向药物治疗研究进展

卵巢癌死亡率居女性生殖系统恶性肿瘤之首,早期诊断困难,晚期患者治疗效果差,分子靶向药物成为近年的研究热点。目前许多靶向药物已经进入临床试验阶段,给卵巢癌特别是术后复发及化疗耐药患者的治疗带来新的希望。本文主要对单克隆抗体,酪氨酸激酶抑制剂等几种药物在卵巢癌的研究进行综述。     

甲状腺相关性眼病的研究及治疗进展

甲状腺相关性眼病(TAO)是具有一系列体征和症状的多因素自身免疫性疾病。糖胺聚糖(GAG)的过量沉积、炎性浸润以及细胞因子的过度产生是甲状腺相关性眼病的主要特征。甲状腺相关性眼病的临床表现多种多样,可以从轻度的眼睑肿胀、上睑退缩、结膜充血、眼球突出乃至重度的威胁视力的暴露性角膜溃疡和压迫性视神经病变。通常,根据病史和查体是可以直接诊断甲状腺相关性眼病。实验室检查和影像学检查对于诊断甲状腺相关性眼病也具有一定的作用。目前可以根据"NO SPECS"法、临床活动评分(CAS)和VISA分类这三种方法对TAO病情情况进行分类。甲状腺相关性眼部的治疗包括保守治疗、药物治疗、眼眶放射治疗和手术治疗等,需根据患者的病情来决定其治疗方案。本文的目的是帮助眼科医生了解甲状腺相关性眼病的分期(轻度,中度至重度和视力威胁)的重要性和相关的可用治疗方式。     

Recurrent Neutropenia Due to Dopamine Agonists in a Patient with Microprolactinoma

ObjectiveThe objective of our case report is to increase the awareness of neutropenia as a rare but potentially serious adverse outcome of commonly used dopamine agonists for the treatment of prolactinomas.MethodsThis report reviews the clinical history, diagnosis, investigations, and drug treatment of our patient.ResultsNeutropenia was recurrent after changing to various different dopamine agonists necessitating surgical treatment of a prolactinoma.ConclusionThis case serves a reminder of this adverse drug reaction. Considering the significant impact and potentially a life threatening outcome, we advocate routine monitoring of full blood count prior to and during the treatment with dopamine agonists. (Endocr. Pract. 2013;19:e122-e123)     

Oral Octreotide: A Review of Recent Clinical Trials and Practical Recommendations for Its Use in the Treatment of Patients With Acromegaly

ObjectiveAcromegaly is characterized by chronic growth hormone (GH) and insulin-like growth factor 1 (IGF-1) hypersecretion, often caused by a GH-secreting pituitary adenoma. Even though surgery remains the first line of treatment, medical therapy is essential if surgery is contraindicated, does not achieve remission, or does not prevent recurrence despite apparent surgical remission. Oral octreotide capsules (OOCs) that combine octreotide with a transient permeability enhancer technology are the first oral somatostatin receptor ligands (SRLs) approved in the United States for acromegaly.MethodsWe review the literature and clinical trial data on OOC therapy in patients with acromegaly and discuss the clinical assessment of OOC use, potential drug–drug interactions, drug initiation, dose titration, and monitoring of drug efficacy and tolerability.ResultsIn 4 pivotal clinical trials involving 238 patients with acromegaly treated with OOC, effective suppression of serum GH and IGF-1 levels, maintenance of disease control, decreased breakthrough symptoms and symptomatic improvement with non-inferiority of OOCs to injectable SRLs in maintaining biochemical response was seen. Additionally, the safety profile of OOC therapy is comparable to that of injectable SRLs. Most patients who completed the clinical trials of OOCs have also expressed preference for oral compared with injectable SRL administration.ConclusionOOCs are an effective treatment option for patients with acromegaly who previously responded to injectable SRLs, with the benefits of avoiding injection-related side effects. This article provides a review of the pharmacology, safety, and efficacy and offers practical recommendations on the use of OOCs to treat injectable SRL-responsive patients with acromegaly.     

An epidemic of depression or the medicalization of distress?

The syndrome of major depression is widely regarded as a specific mental illness that has increased to the point where it will be second in the International Burden of Disease ranking by 2020. This article examines the assumption that major depression is a specific illness, that it is rapidly increasing, and that a medical response is justified. I argue that major depression is not a natural entity and does not identify a homogenous group of patients. The apparent increase in major depression results from: confusing those who are ill with those who share their symptoms; the surveying of symptoms out of context; the benefits that accrue from such a diagnosis to drug companies, researchers, and clinicians; and changing social constructions around sadness and distress. Standardized medical treatment of all these individuals is neither possible nor desirable. The major depression category should be replaced by a clinical staging strategy that acknowledges the continuous distribution of depressive symptoms. Trials that test social and lifestyle treatments as well as drugs and cognitive behavioral therapy across different levels of severity, chronicity, and symptom patterns might lead to the development of a coherent evidence-based stepped treatment model.     

A New Therapeutic Approach in the Medical Treatment of Cushing’S SYNDROME: GLUCOCORTICOID RECEPTOR BLOCKADE WITH MIFEPRISTONE

ObjectiveCushing’s syndrome (CS) is a serious endocrine disorder caused by prolonged exposure to high cortisol levels. Initial treatment of this condition is dependent upon the cause, but is generally surgical. For patients whose hypercortisolism is not cured by surgery, medical therapy is often required. Drugs that have typically been used for CS medical therapy act by decreasing cortisol levels. Mifepristone is a glucocorticoid receptor antagonist now available for use in patients with CS. Unlike other agents, mifepristone does not decrease cortisol levels, but directly antagonizes its effects. Our objective is to review the pharmacology and clinical use of this novel agent and to discuss detailed guidance on the management of CS patients treated with mifepristone.MethodsWe review the literature regarding mifepris-tone use in CS and recently published clinical trial data. Detailed information related to clinical assessment of mifepristone use, potential drug interactions, drug initiation and dose titration, and monitoring of drug tolerability are provided.ResultsClinical trial data have shown that mifepris-tone improves glycemic control and blood pressure, causes weight loss and a decrease in waist circumference, lessens depression, and improves overall wellbeing. However, adverse effects include adrenal insufficiency, hypokalemia, and endometrial thickening with vaginal bleeding. These findings are supported by the earlier literature case reports.ConclusionThis article provides a review of the pharmacology and clinical use of mifepristone in Cushing’s syndrome, as well as detailed guidance on the management of patients treated with this novel agent. (Endocr Pract. 2013;19:313-326)     

Osilodrostat: A Review of Recent Clinical Studies and Practical Recommendations for its Use in the Treatment of Cushing Disease

ObjectiveCushing disease (CD) is characterized by chronic hypercortisolism caused by an adrenocorticotropic hormone-secreting pituitary adenoma. Surgery remains the first-line treatment option; however, medical therapy is essential if surgery is contraindicated or fails to achieve remission or when recurrence occurs after surgical remission. Osilodrostat (Isturisa), a novel steroidogenic inhibitor, is now approved for the treatment of CD in the United States and Cushing syndrome in Europe. Herein, we review pharmacology and data on the efficacy, safety, and clinical use of osilodrostat and provide guidance on its use in treating patients with CD.MethodsWe reviewed the literature and published clinical trial data of osilodrostat use in patients with Cushing syndrome. Detailed information related to the clinical assessment of osilodrostat use, potential drug-to-drug interactions, drug initiation, dose titration, and the monitoring of drug tolerability were discussed.ResultsClinical trial data demonstrated that osilodrostat, by virtue of inhibiting 11-β hydroxylase, potently and rapidly decreased the 24-hour urinary free cortisol levels and sustained these reductions, with improved glycemia, blood pressure, body weight, and quality of life as well as lessened depression. Osilodrostat may interact with certain drugs, resulting in QT prolongation, which requires careful assessment of concomitant medications and periodic monitoring using electrocardiogram, respectively. The common adverse effects include adrenal insufficiency, hypokalemia, edema, and hyperandrogenic symptoms, which can be minimized using a slower up-titration dosing regimen.ConclusionOsilodrostat is an effective, new treatment option for CD, with positive effects on cardiovascular and quality of life parameters as well as tolerable adverse effects. This article provides a review of the pharmacology of osilodrostat and offers practical recommendations on the use of osilodrostat to treat CD.     

A high-quality model for predicting the prognosis of breast neuroendocrine carcinoma to help clinicians decide on appropriate treatment methods: A population-based analysis

BackgroundBreast neuroendocrine carcinoma (NEC) is a rare malignancy with unclear treatment options and prognoses. This study aimed to construct a high-quality model to predict overall survival (OS) and breast cancer-specific survival (BCSS) and help clinicians choose appropriate breast NEC treatments.Patients and methodsA total of 378 patients with breast NEC and 349,736 patients with breast invasive ductal carcinoma (IDC) were enrolled in the Surveillance, Epidemiology, and End Results (SEER) database between 2010 and 2018. Propensity score matching (PSM) was performed to balance the clinical baseline. Prognostic factors determined by multivariate Cox analysis were included in the nomogram. C-index and calibration curves were used to verify the performance of the nomogram.ResultsNomograms were constructed for the breast NEC and breast IDC groups after PSM. The C–index of the nomograms ranged from 0.834 to 0.880 in the internal validation and 0.818–0.876 in the external validation, indicating that the nomogram had good discrimination. The risk stratification system showed that patients with breast NEC had worse prognoses than those with breast IDC in the low-risk and intermediate-risk groups but had a similar prognosis that those in the high-risk group. Moreover, patients with breast NEC may have a better prognosis when undergoing surgery plus chemotherapy than when undergoing surgery alone or chemotherapy alone.ConclusionsWe established nomograms with a risk stratification system to predict OS and BCSS in patients with breast NEC. This model could help clinicians evaluate prognosis and provide individualized treatment recommendations for patients with breast NEC.     

Eliciting Low-Risk Thyroid Cancer Treatment Preferences Using Clinical Vignettes: A Pilot Study

ObjectiveWhile surgical resection has been the traditional standard treatment for small (≤1 cm), differentiated thyroid cancers, active surveillance (AS) and radiofrequency ablation (RFA) are increasingly considered. The aim of this study was to explore patient preferences in thyroid cancer treatment using a series of clinical vignettes.MethodsThyroid cancer survivors and general population volunteers were recruited to rank experience-driven clinical vignettes in order of preference. Rankings were compared using Wilcoxon signed rank. Formative qualitative methods were used to develop and refine clinical vignettes that captured 4 treatments—thyroid lobectomy (TL), total thyroidectomy (TT), AS, and RFA—along with 6 treatment complications. Content was validated via interviews with 5 academic subspecialists.ResultsNineteen volunteers participated (10 survivors, 9 general population). Treatment complications were ranked lower than uncomplicated counterparts in 99.0% of cases, indicating excellent comprehension. Counter to our hypothesis, among uncomplicated vignettes, median rankings were 1 for AS, 2 for RFA, 3.5 for TL, and 5 for TT. Trends were consistent between thyroid cancer survivors and the general population. AS was significantly preferred over RFA (P = .02) and TT (P < .01). Among surgical options, TL was significantly preferred over TT (P < .01).ConclusionWhen treatments for low-risk thyroid cancer are described clearly and accurately through clinical vignettes, patients may be more likely to choose less invasive treatment options over traditional surgical resection.     

扩张型心肌病治疗研究进展

扩张型心肌病是一种以单侧或双侧心腔扩大和收缩功能障碍等为特征,治疗困难、预后较差的临床常见疾病,致病因素及临床表现复杂多样,其治疗方法一直是医学研究的热点。扩张型心肌病的治疗手段涵盖常规药物治疗及非药物治疗,后者包括手术治疗及不断发展的免疫治疗、干细胞移植和基因治疗等,且每种治疗方法都有各自的优缺点,本文针对扩张型心肌病治疗方法的最新研究进展进行综述,以期为临床治疗提供新的依据和方向,提高扩张型心肌病患者的生活质量和生存率。     

帕瑞昔布钠在术后镇痛中应用的研究进展

手术方式的不断完善和创新,对术后镇痛提出了更高要求。非甾体抗炎药为我国临床术后镇痛常用的一类药物,近年来应用范围仍在不断扩大,但总结长期术后镇痛用药经验发现,传统的非甾体抗炎药易引起胃肠道毒性反应和血小板抑制,因此迫切需要寻找一种安全、有效的术后镇痛药物。帕瑞昔布钠是一种环氧合酶-2(COX-2)特异性抑制剂,注射使用,可用于术后不同程度疼痛的短期治疗,近年来已被临床实践证实具有良好的疗效和较高的安全性。本文结合已经发表的临床研究报道对该药物在术后镇痛中的应用进展进行综述,旨在对该药物的作用机制、疗效、安全性有一个系统性的认识。