capsuled bacterea

Capsule 莢膜
Gran positive or negative 都可以有莢膜，但G(+)的稍多見一些。
G(+):Streptococcus, Hemophilus influenzae type b, Group B streptococcus
G(-):KP, salmonella, meningococcus

[實習生涯][內科]血腫-Anemia

Hct: 1.5 for Hct = 35%, 2 for Hct = 25%, 2.5 for Hct = 15%

Hypoproliferative:
Marrow damage, early iron deficiency, and decreased erythropoietin production or action may produce anemia of this type.
Marrow damage may be caused by infiltration of the marrow with tumor or fibrosis that crowds out normal erythroid precursors or by the absence of erythroid precursors (aplastic anemia) as a consequence of exposure to drugs, radiation, chemicals, viruses (eg, hepatitis), autoimmune mechanisms, or genetic factors, either hereditary (eg, Fanconi's anemia) or acquired (eg, paroxysmal nocturnal hemoglobinuria).
Early iron-deficiency anemia (or iron-deficient erythropoiesis) is associated with a decrease in serum ferritin levels (<15 capacity="" elevated="" g="" iron-binding="" moderately="" total="">380 μg/dL), serum iron (SI) level <50 an="" and="" but="" dl="" g="" iron="" of="" saturation="">10%.
Most cases of aplasia are idiopathic. The tumor or fibrosis that infiltrates the marrow may originate in the marrow (as in leukemia or myelofibrosis) or be secondary to processes originating outside the marrow (as in metastatic cancer or myelophthisis).

Hemolysis/Hemorrage
Trauma, GI hemorrhage (may be occult) are common causes;less common are genitourinary sources (menorrhagia, gross hematuria), internal bleeding such as intraperitoneal from spleen or organ rupture, retroperitoneal, iliopsoas hemorrhage (eg, in hip fractures).chronic bleeding is associated with iron deficiency, hypochromia, microcytosis.

[實習生涯][內科][血腫]Target therapy

基本上可以分兩種
1. 單株抗體，IV給，和細胞表面分子結合 (~mab)
2. 口服 tyrosin kinase inhibitors (~nib)


1.–cept：以生物科技將特殊受體與人體IgG1之Fc part融合者稱之
2.–mab：指單株抗體(monoclonal antibody)
3.–ximab：指部分結構源自於動物的嵌合式單株 抗體(chimeric monoclonal antibody )
4.–zumab或 –mumab：經由生物科技修飾， 以增進與人類抗體相似度之仿人類單株抗體 (humanized monoclonal antibody)





特別有效的標靶：
CML---imatinib, 延長remission的時間
GIST---imatinib, 減緩疾病惡化
有EGFR mutation的lung cancer(大概一成）--gefitinib and erlotinib
有EML4-ALK translocation的lung cancer（大概五趴）--crizotinib
開過刀的乳癌病人使用transtuzumab (Herceptin)可以降低五成復發率

副作用基本上EGFR inhibitor會造成臉上和胸部出現像青春痘的紅疹，可用局部類固醇藥膏或口服minocycline
Her2 inhibitor會造成可逆性的心臟收縮功能異常，所以需要定期做個心超
抑制血管新生的藥物會造成內皮損傷，所以會有HTN、proteinurea、傷口難癒合、些微心臟毒性、增加出血、靜脈栓塞跟GI tract穿孔瘻管之類的風險。開刀期間記得停藥！！

[實習生涯][內科]血腫-RECIST 1.1

是for solid tumor 治療的評估，可能四個禮拜左右就可以評估一下吧
看Chemo的療效之類的

4.3. Response criteria
This section provides the definitions of the criteria used to determine objective tumour response for target lesions.
4.3.1. Evaluation of target lesions

Complete Response (CR):
Disappearance of all target lesions. Any pathological lymph nodes (whether target or non-target) must have reduction in short axis to <  10 mm<10mm 10="" mm.="" nbsp="" p="">


<10 mm.="" nbsp="" p="">Partial Response (PR):
At least a 30% decrease in the sum of diameters of target lesions, taking as reference the baseline sum diameters.

Progressive Disease (PD):
At least a 20% increase in the sum of diameters of target lesions, taking as reference the smallest sum on study (this includes the baseline sum if that is the smallest on study). In addition to the relative increase of 20%, the sum must also demonstrate an absolute increase of at least 5 mm. (Note: the appearance of one or more new lesions is also considered progression).

Stable Disease (SD):
Neither sufficient shrinkage to qualify for PR nor sufficient increase to qualify for PD, taking as reference the smallest sum diameters while on study

關於淋巴結：就算效果超級無敵好，病變是小到量不到，也不可能消到0......應該默認有個5mm；除非放射科醫師覺得病變不見了才算0

還有non-target lesion的評估：比如pleural effusion啦淋巴管啦此略不提

<10 mm.="" nbsp="" p="">
<10 mm.="" nbsp="" p="">