在临床实践中,诊断和预后评估通常依赖多种实验室和评分指标。近年来,红细胞分布宽度(RDW)、中性粒细胞与淋巴细胞比值(NLR)和红细胞分布宽度与血小板计数比值(RPR)作为新兴复合实验室指标,在疾病诊断和预后评估中展现出显著价值。尤其是在急性疾病中,这些指标因其快速获得的特性而备受关注。文章综述了RDW和RPR在脑卒中、急性心肌梗死、冠状动脉介入治疗、脓毒症及恶性肿瘤中的最新研究进展,强调其在预测疾病严重程度和预后中的潜力。研究表明,RDW和RPR作为早期获取的指标,能够有效评估上述疾病患者的病情演变和预后。其进一步研究有望推动这些指标在临床中的广泛应用。In clinical practice, diagnosis and prognosis assessment often rely on various laboratory and scoring indices. In recent years, emerging composite laboratory indices such as red blood cell distribution width (RDW), neutrophil-to-lymphocyte ratio (NLR), and the ratio of red blood cell distribution width to platelet count (RPR) have demonstrated significant value in disease diagnosis and prognosis evaluation. Particularly in acute diseases, these indices have gained attention due to their rapid availability. This review summarizes the latest research on RDW and RPR in conditions such as stroke, acute myocardial infarction, coronary artery interventions, sepsis, and malignancies, highlighting their potential in predicting disease severity and outcomes. Studies indicate that RDW and RPR, as early accessible markers, can effectively evaluate disease progression and prognosis in these patients. Further research is expected to promote the widespread clinical application of these indices.
糖尿病是常见的代谢性疾病,2型糖尿病(T2DM)在发病过程中,容易产生不同程度的认知功能障碍,主要集中在注意力及记忆力减退和信息处理速度及执行能力减低,严重者会出现痴呆等。但目前T2DM认知障碍发生过程中脑部变化特征以及发病机制尚未完成阐明。磁共振在T2DM认知障碍脑结构改变研究中具有重要作用。随着磁共振技术的进步,一些高级成像技术如扩散量成像、灌注加权成像及血氧水平依赖功能磁共振成像、波谱成像等广泛应用于T2DM脑病的研究。本文对磁共振评估T2DM合并认知障碍脑结构改变情况进行综述。Diabetes is a common metabolic disease. During the course of type 2 diabetes mellitus (T2DM), patients are prone to develop cognitive impairment to varying degrees. This mainly manifests as decreased attention and memory, as well as reduced information processing speed and executive function. In severe cases, dementia may occur. However, at present, the characteristics of brain changes and the pathogenesis of T2DM cognitive impairment have not been elucidated. Magnetic resonance imaging plays an important role in the study of brain structural changes in T2DM cognitive impairment. With the development of magnetic resonance technology, some advanced imaging techniques such as diffusion volume imaging, perfusion weighted imaging, blood oxygen level dependent functional magnetic resonance imaging and spectral imaging are widely used in the study of T2DM encephalopathy. This article reviews the evaluation of brain structural changes in T2DM complicated with cognitive impairment by magnetic resonance imaging.
人表皮生长因子受体-2 (HER-2)阳性乳腺癌约占乳腺癌患者的20%~30%,同其他类型乳腺癌相比,其更易侵袭、复发时间更短、总体预后更差,且无瘤生存期及总生存期更短。乳腺癌新辅助化疗是指在手术治疗或放疗前进行化疗,以控制癌细胞扩散,抑制其增殖,使肿瘤降期和降级,目前在临床已得到广泛应用。随着针对HER-2基因过表达而研发的靶向药物出现,HER-2阳性乳腺癌患者的治疗得到了显著突破,尤其是此类药在新辅助治疗阶段的应用,已经被证实可以显著提高患者临床病理完全缓解(pCR)率,增加了患者的临床获益。随着研究的深入,越来越多新辅助阶段的药物被开发出来,这对改善患者预后具有积极的意义。本文就HER-2阳性乳腺癌患者新辅助阶段常用药物的应用作一综述。HER-2 positive breast cancer accounts for about 20%~30% of breast cancer patients. Compared with other types of breast cancer, HER-2 positive breast cancer is more likely to invade, has shorter recurrence time, worse overall prognosis, and shorter disease-free survival and overall survival. Neoadjuvant chemotherapy for breast cancer refers to chemotherapy before surgical treatment or radiotherapy to control the spread of cancer cells, inhibit their proliferation, and downstage and downgrade tumors. It has been widely used in clinical practice. With the emergence of targeted drugs developed for HER-2 gene overexpression, the treatment of HER-2 positive breast cancer patients has made a significant breakthrough, especially the application of such drugs in the neoadjuvant treatment stage, which has been proved to significantly improve the patient’s pCR rate and increase the clinical benefits of patients. With the deepening of research, more and more new adjuvant drugs have been developed, which is of positive significance for improving the prognosis of patients. This article reviews the application of commonly used drugs in the neoadjuvant stage of HER-2 positive breast cancer patients.
本文报道一例乳腺化生性癌伴BRCA1基因突变患者的临床资料。患者为26岁女性,因“发现左乳腺结节1月”入院,彩超示左乳分叶状低回声结节,形态不规则,内未探及血流信号。行乳腺区段切除术,术后病理提示形态学结合免疫组化符合伴间叶分化的化生性癌,癌细胞ER(−)、PR(−)、Her-2(0),BRCA1基因突变检测结果:c.192T > G (p.C64W),突变类型为4类–疑似有害变异,术后予AC-T方案化疗6个周期,序贯奥拉帕尼使用1年,目前随访25个月,无局部复发和远处转移。This paper reports the clinical data of a case of breast metaplastic carcinoma with BRCA1 gene mutation. The patient was a 26-year-old woman who was admitted to the hospital with a left breast nodule that had been detected for one month. Ultrasound showed a lobulated hypoechoic nodule in the left breast with an irregular morphology, and no blood flow signals were detected in it. We performed segmental mastectomy for the patient, and postoperative pathology suggested that the morphology combined with immunohistochemistry was consistent with a metaplastic carcinoma with mesenchymal differentiation, and the cancer cells were ER(−), PR(−), and Her-2(0), and the results of the mutation test of the BRCA1 gene were: c.192T > G (p.C64W), and the mutation type was class 4-suspected deleterious variant. After surgery, she was given 6 cycles of chemotherapy with AC-T regimen, sequential Olaparib had been used for one year, and she was followed up for 25 months with no obvious signs of local recurrence or distant metastasis.
脑胶质瘤是成人中枢神经系统中最常见的恶性肿瘤之一,尤其是恶性程度高的胶质母细胞瘤,其预后极差,传统的手术、放疗和化疗等治疗方式效果有限。蛋白酶体抑制剂作为一种新兴的抗肿瘤治疗方式,通过抑制细胞蛋白降解的通路,干扰细胞内蛋白质稳态,进而诱导肿瘤细胞死亡。本文综述了蛋白酶体抑制剂在脑胶质瘤治疗中的作用机制、临床前和临床研究进展,并探讨了其应用前景和面临的挑战。Gliomas are one of the most common malignant tumors in the adult central nervous system, especially highly malignant glioblastomas, which have a very poor prognosis. Traditional treatments such as surgery, radiotherapy, and chemotherapy have limited effectiveness. Proteasome inhibitors, as an emerging anti-tumor therapy, interfere with intracellular protein homeostasis by inhibiting the pathway of cellular protein degradation, thereby inducing tumor cell death. This article reviews the mechanism of action, preclinical and clinical research progress of proteasome inhibitors in the treatment of glioblastoma, and explores their application prospects and challenges.
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