Objective: The purpose of the study was to explore the application effects of the cloud platform-based comprehensive online management for breast cancer patients using dual-targeted therapy with macromolecular monoclonal antibodies. Methods: 120 breast cancer patients treated by dual-targeted therapy with macromolecular monoclonal antibodies were managed by a cloud platform from March to November 2019. Comprehensive online management included consultation about drugs and side effects and frequently asked questions in the dual-targeted therapy with macromolecular monoclonal antibodies. Results: In the consultation about drugs and side effects, there were five patients with fever, neutrophil, cough, and fatigue; 24 with diarrhea; 25 with nausea; 11 with oral mucosal inflammation; 10 with rashes and dry skin; 8 with insomnia; and 1 with palpitation. Moreover, 110 patients with anxiety about the missed or delayed treatment were properly handled. Conclusion: The comprehensive online management of dual-targeted therapy with macromolecular monoclonal antibodies based on the cloud platform is helpful to satisfy the at-home breast cancer patients’ needs, ensure the continuity of dual-targeted therapy with macromolecular monoclonal antibodies for breast cancer patients, prevent misinformation, alleviate patients’ negative psychological emotions, and reduce patients’ economic losses. The online cloud platform integrated management model is crucial for managing patients with breast cancer treated by dual-targeted therapy.

目的 探讨综合消肿疗法联合泡沫型颗粒绷带在恶性肿瘤患者下肢淋巴水肿压力治疗中的应用效果.方法 选取2019年1—8月在我院淋巴水肿门诊就诊的恶性肿瘤根治术后单侧下肢淋巴水肿患者50例,均由同1名淋巴水肿治疗师资质的专科护士给予每例患者进行综合消肿疗法联合泡沫型颗粒绷带进行治疗,包括:皮肤护理、徒手淋巴引流、泡沫型颗粒绷带联合空气波压力治疗、泡沫型颗粒绷带加压包扎、功能锻炼.每天1次,1个疗程(20次)的治疗,并分别在治疗前(第0次)、治疗后(第20次)采用Inbody S10 SMF BIA分析仪检测患者的身体水分变化,并比较患者治疗前中后的主观症状.结果 经过1个疗程治疗后,本组患者的生物电阻抗、细胞外水分、节段水分分析、细胞外水分比率均优于治疗前,此外,患者的主观症状均得到改善.结论 综合消肿疗法联合泡沫型颗粒绷带在下肢淋巴水肿压力治疗中,取得满意的效果.

Objective:To study the application effect of modified butterfly needle fixation method for implantable venous access port in breast cancer patients, in order to povide reference for the clinical applicaiton.Methods:A total of 300 patients with breast cancer from Janurary to December 2019 in Sun Yat-Sen University Cancer Center were divided into two groups by random digits table method: experimental group and control group, 150 cases in each group. The experimental group was treated with modified implantable intravenous port butterfly needle fixation method, while the control group was treated with conventional fixation method. The Visual Analogue Scale of pain during needle extraction, the incidence of needle stick injury and the time of needle extraction were measured between the two groups.Results:The Visual Analogue Scale of pain, the time of needle pulling were (4.01±0.89) points, (2.71±0.52) min in the control group, and (1.84±0.84) points, (1.86±0.39) min in the experimental group, the differences were statistically significant ( t values were -21.70, -16.02, P<0.01). The incidence of needle stick injury was 4.00% (6/150) in the control group and no needlestick injury event occurred in the experimental group, the difference was statistically significant (Fisher exact probability, P<0.05). Conclusions:The modified method of dressing fixation can effectively reduce the pain during needle pulling, reduce the incidence of needle stick injury, and effectively shorten the time of needle pulling.

Electrolyte disturbances are well-known but frequently ignored side effects during hemotherapy.Cyclophosphamide,as a first-line antineoplastic agent,has been widely used in the adjuvant therapy for breast cancer.We reported two cases with breast cancer who developed severe hyponatremia following the therapy with low-dose cyclophosphamide and reviewed the associated literature.Clinicians and nurses must always keep in mind that even low-dose cyclophosphamide could be associated with severe hyponatremia and it should be used with ution.Furthermore,they should improve the awareness level of hyponatremia,and could effectively prevent its incidence,rapidly diagnose and properly treat it.

沸沸扬扬的上海“眼药门”事件及2012年5月“拜瑞妥”在中国“超适应证推广”,使公众越来越关注“药物超注册用药”的话题。药物超注册用药( off-label drug use)是指药物使用的适应人群、适应证、给药剂量及途径不在药物监管部门批准的说明书规定的范围内[1-2]。药物超注册用药在全球广泛存在且备受关注,2012年9月美国《制药行业的刑事和民事处罚》报告显示美国1991~2010年针对跨国制药企业的239例司法案件中超过50%涉及超适应证推广[3]。赞同者认为药物说明书仅代表一般学术状态,滞后于科研进展与文献报道,医师应根据专业知识、临床判断制订对患者最有利、可能包含药物超注册用药的治疗方案,一些有证据支持的药物超注册用药已被广泛应用且逐渐成为标准治疗,这说明超注册用药的必然性[4-5]；反对者则认为药物超注册用药会引发用药安全问题,增加不良事件,甚至引起伤亡或医疗纠纷。由于目前少有指南列出超注册用药的证据支持,本文就国内外超注册用药现象、存在基础、用药程序及存在的问题作一综述,探讨超注册用药对乳腺癌治疗领域的影响,期待从政策、学术、人道层面引导科学的超注册用药,保障患者权益及医疗秩序。

<正>选择性雌激素受体调节剂他莫昔芬(tamoxifen,TAM)广泛应用于激素受体阳性乳腺癌的内分泌治疗[1],其药理学活性主要依赖于肝脏药物代谢酶细胞色素P4502D6(CYP2D6)催化生成的活性代谢产物4-羟基-N-去甲基他莫昔芬(endoxifen)的水平。CYP2D6的基因型改变与酶抑制剂的使用均可降低