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It was unusual that Jack _____________(behaviour) well today

2023-08-03 23:42:21
共3条回复
南yi

behaved

首先,behavior 是名词,意思是行为,在这个空格处很明显前边是主语jack,后边是well是个副词,没有谓语,只有动词形式才能做谓语,behavior的动词是behave

其次,主句谓语用的是was,说明是过去时态,主句和从句的时态要一致,所以填写 behaved

北境漫步

behaves

behaviour的动词形式,单三

Jack今天表现这么好不太寻常

豆豆staR

?????????快快快看看

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2023-08-03 20:31:572

雅思议论文有哪些审题思路? ?

首先,我们来整理一下雅思议论文审题的思路,一般雅思议论文的题目都由两部分组成:“背景?+?指令”,前者决定了文章所写的内容,后者决定了论文的文体。如"Some?people?believe?that?the?charity?organisations?should?give?aid?to?those?in?greatest?need,?wherever?they?live.?Some?people?believe?that?the?charity?organisations?would?better?concentrate?on?helping?people?who?live?in?own?country?instead.?Discuss?both?views,?and?give?your?opinion."?背景涉及的是慈善援助问题,讨论是应该不顾地域限制,援助最需要救助的人?还是优先帮助本国人?指令则要求写一篇辩论型的文章。只有对题目的两个要求都作出准确的回应,在内容和文体上完美的结合,才能取得理想的分数。官方对于"Task?Achievement"的9分规定就指出"fully?satisfies?all?the?requirements?of?the?task;?clearly?presents?a?fully?developed?response"(完全满足所有题目要求,清晰地给出充分的回应)。根据这一思路,满分路上的一大拦路虎就是审题,理解片面导致扣分。我们可以将其分成两种类型:1、片面理解文章背景内容导致偏题一些考生在不理解题意的时候最喜欢抓住题目的某几个字眼着力说明和描述,忽视了题目的整体立意,导致偏题。①?不理解题目意思以下面这道真题为例"Today?there?is?a?great?increase?in?anti-social?behaviour?and?lack?of?respect?to?others.?What?are?the?causes?of?this??What?measures?can?be?taken?to?reduce?this?problem?"?许多考生反映题目难以理解,这主要是源于对"anti-social?behaviour"的定义不清,于是把重点放在了后半句"lack?of?respect?to?others"上,有人大书特书当今年轻人不尊重老年人,有人着重描写偷盗等极端犯罪行为,将原因归结为贫穷缺钱。尽管两者之间存在一定联系,但绝对不能将其片面地理解为诸如“谩骂他人,不给老年人让座”的狭隘例子。"Anti-social?behaviour?is?behaviour?that?lacks?consideration?for?others?and?that?may?cause?damage?to?society,?whether?intentionally?or?through?negligence,?as?opposed?to?pro-social?behaviour,?behaviour?that?helps?or?benefits?society?(Berger?2003,?p.?302)."?这是在维基百科里给出的解释,包括校园暴力、公众场合醉酒、破坏公物等都在此范围内,以偏概全,再去分析产生的原因和解决方式,就很难达到对题目充分回应的要求。针对该点,建议考生应在备考时加强对雅思题目涉及范围的了解,平时对社会热点问题加以关注并熟悉其英语词汇,以免偏离主题。②?从题目个别字眼出发再来看一道真题"Air?travel?can?only?benefit?the?richest?people?in?the?world.?The?ordinary?people?can?get?no?advantage?with?the?development?of?air?travel.?To?what?extent?do?you?agree?or?disagree?"?许多考生看到了飞机旅行的字眼就匆忙下笔,大书特书飞机旅行的利弊如耗费能源、造成污染等。殊不知本题讨论的是飞机旅行给富人和一般人带来的好处。等写完定睛一看,悔之晚矣。针对这类“性急”的考生的建议是,“三思而后行”,认真体会题目的意思。背景理解的片面常源于考生性急的心理或是对某些词汇句式无法很好的把握。要避免此类问题的发生,建议平时要加强对写作真题题目的审题练习并对常见热点问题词汇加以记忆。2、片面理解指令要求导致偏题题目的指令常常隐含着出题者对文章的期待和要求,考生应该认真琢磨,以免偏题。①?片面理解指令个别字眼Many?people?think?it?is?very?important?to?protect?environment?but?they?make?no?effort?to?do?it?themselves.?Why?does?it?happen??How?to?solve?this?problem??有些考生只注意到"why"和题目背景中的环保场景,没有将背景和指令结合起来理解,结果仅仅说明了人们保护环境的原因而忽视了题目的要求“人们明知环保重要却不为之的原因”。我认为,就几十个字的题目来说,考生宁可多花上一点时间认真理解题意,只有主题立意准确,才谈得上词汇、句式和整体连贯性的得分。②?没有认真把握指令之间的联系Many?people?are?optimistic?about?the?21st?century?and?see?it?as?an?opportunity?to?make?positive?changes?to?the?world.?To?what?extent?do?you?agree?or?disagree?with?their?optimism??What?changes?would?you?like?to?see?in?the?new?century??该题有两个指令,分别是“是否同意题目的乐观态度”及“你希望在新世纪看到哪些改变?”乍看之下,考生可以同意背景中的态度,对一些积极的变化加以评述,但第二个指令其实隐含着出题人对正反两面都进行分析的要求,否则就显得多余。因此,双边或者让步的文章结构会更适合该题。指令理解的片面性常常源于考生的过度自信,看了个大概就匆匆下笔。
2023-08-03 20:32:041

behavior,act,manner,way的区别

behavior是行为举止,act是动作表演,manner是礼仪,way是方式
2023-08-03 20:32:131

组织行为学 翻译

The organization behavior study is studies in the organization individual, the community and the organizational structure to the organization behavior influence rule, by enhances the organization to manage the valid discipline. The organization behavior study to manages in the process human"s factor research, mainly includes the individual, the community and the organization three domains. In the individual behavior domain, organization behavior study main research individual consciousness, the study, the drive, the personality, the staff select, aspect content and so on the achievements and manner survey, working pressure, individual decision-making, work degree of satisfaction, core domain is to drives the question the research. In group behavior domain, organization behavior study main attention official aspect and so on community and unofficial community, community"s organization function, community dynamics, communication and exchange, community decision-making process content. In the organization behavior domain, the organization behavior study main research organization culture and the environment, the organization leaders, the conflict, the organization behavior validity, authorized, the organizational structure design, the work team design, the organization power and organization cultural reconstruction the aspect and so on transforms and develops content.
2023-08-03 20:32:202

ob是什么意思?

OB是高尔夫运动规则中“Out of Bounds”的简称,其中文是“界外”,是指球场界限以外的区域或被委员会标定位界线以外的球场的任何部分。电子竞技:OB在电子竞技中的含义. Observer,观察者.OB在学生中也流行着OB会,OB会就是老毕业生的聚会,老校友的聚会。open beta 意思是游戏的公测,相近的还有CB,close beta 意思是游戏的内测组织行为学:OB =Organizational Behaviour,指组织行为(学)。GAL游戏:OB=Oblivious Garden(遗忘花园)扩展资料:当界外被立桩或栅栏限定,或作为越过立桩或栅栏的地方被标示时,界外线由立桩或除去斜支桩以外的栅栏支柱在地平面的最内侧点决定。标定界外的物体诸如墙壁、栅栏、立桩和栏杆不是妨碍物,并被视为时固定的。当界外由地面上的线标示时,该线本身属于界外。界外线垂直向上下延伸。当球的整体位于界外时即为界外球。球员可以站在界外打位于界内的球。参考资料:OB(高尔夫运动术语)_百度百科
2023-08-03 20:33:021

哪位大侠可以帮我翻译一下下面的文章,感激不尽,谢谢您!请不要在google等翻译工具中翻译,再次感谢。

不要采纳LS!他是个NB!他喜欢用翻译机直译后复制给人家!质量差就算了人还一点素质都没有!
2023-08-03 20:33:092

___it seems that there is a discrepancy between your expectations and his behaviour.

选 B 。
2023-08-03 20:33:185

nature human behaviour送审时间

nature human behaviour的送审时间一般在三个月左右。《自然·人类行为》从社会、生物、健康和物理科学学科的广泛领域中,发表了对人类个体或集体行为的任何方面都具有突出意义的研究。该杂志欢迎来自任何学科的研究,为这些问题提供重要的原创见解。自然人类行为特性广泛的话题,包括(但不限于)感知、动作、记忆、学习、奖励、判断、决策、语言、沟通、情感、个性、社会认知、社会行为、神经精神、神经发育、神经障碍,经济和政治行为,信仰体系,社会网络、社会规范、社会结构、行为改变,集体认知和行为,文化,公共政策。除了发表原创研究,《自然·人类行为》还发表与人类行为相关的各个学科的评论、观点、评论、新闻、特写和通信。并且一般的送审时间大概是在是三个月左右。
2023-08-03 20:33:351

英语44444444444

1.__B__ all behaviour is learned behaviour is a basic assumption of social scientists. A) Nearly B) That nearly C) It is nearly D) When nearly 2. On cloudy nights it is not possible to see the stars with __A__ eye. A) naked B) bare C) flesh D) pure 3. During the storm we took __B__ in the doorway of a shop. A) rescue B) shelter C) shield D) proof 4. The ship"s captain and members of the __A or B__welcomed us on board. A) staff B) crew C) team D) chain 5. At the first __B__ of twelve everyone stopped for lunch. A) sound B) stroke C) moment D) minute 6. The map was drawn to the standard__D__ of 1/100,000 so there was not much detail. A) base B) line C) rate D) scale 7. Her skirt had been so __D__ in packing that she had to iron it before going out. A) crushed B) torn C) dirty D) untidy 8. We are taking __B__a collection to buy flowers for John because he is in the hospital. A) to B) up C) over D) off 9. It"s not what she says that bothers me. It"s the reason she says it. You"ve got to read __C__ the lines with her. A) among B) amongst C) between D) through 10. I mistook you __A__ your brother. A) for B) as C) to be D) by 11. I am easily hurt because my feelings are very __C__. A) sensible B) sensational C) sensitive D) sentimental 12. The medical record shows that it was the drug, not the disease, __D__ killed him several years ago. A) the effects of which B) the effects of it C) finally D) that 13. What you have done is __D__ the doctor"s orders. A) attached to B) responsible to C) resistant to D) contrary to 14. You can"t see through a telescope unless it is __C__ correctly to your sight. A) adapted B) adopted C) adjusted D) accustomed 15. An ambulance must have priority as it usually has to deal with some kind of __C__. A) crisis B) urgency C) emergency D) emergence 16.__D__ nothing more to discuss, the secretary-general got to his feet, said goodbye and left the room. A) There was B) Being C) There being D) As there being 17. I __C__you that the machine will arrive next week. A) insist B) confirm C) assure D) undertake 18. Many new __A__ will be opened up in the future for those with a university education. A) opportunities B) necessities C) probabilities D) realities 19. His discovery counts __for__nothing though he tried very hard. A) on B) for C) in D) up 20. He has never felt himself so powerfully __D__to the scientific ideal. A) interested B) absorbed C) confident D) attracted
2023-08-03 20:33:451

Psychologists say that our behaviour is influence

主要就是这个句型:too....to...可以这样理解: ...到...比如 too fast fo detect ----- 形容快到无法察觉too small to see ---- 小到看不见所以too subtle for us to consciously scheme 也是一个句型
2023-08-03 20:33:542

ansys workbench中“stiffness behaviour"怎么设置 默认是flexible的 做普通静力分析需要改为rigid吗

做普通静力分析需要设置成flexible,不能设置成rigid(刚性),刚性性能是用来分析动态的情况。
2023-08-03 20:34:021

Unity几个基类的大致关系

Unity里C#脚本中最基本的类 派生自 UnityEngine.Object ,Unity里另一个重要的类,同时也是所有能添加到游戏对象GameObject上的组件(Componet)的基类。 派生自 UnityEngine.Component ,有两个自己新的特有成员 enabled --启用状态,会执行每帧的更新,禁用状态下则不会执行更新 isActiveAndEnabled --表示当前的Behaviour是否被启用 派生自 UnityEngine.Behaviour 所有Unity里的脚本都显式的继承自这个 UnityEngine.MonoBehaviour UnityEngine.Object --> UnityEngine.Component --> UnityEngine.Behaviour --> UnityEngine.MonoBehaviour
2023-08-03 20:34:111

手机无线充电有什么弊病?

手机无线充电的缺点1、虽然设备技术含量高,但设备的经济成本投入较高,维修费用大。2、因实现远距离大功率无线磁电转换,所以设备的耗能较高。随着无线充电设备的距离和功率的增大,无用功的耗损也就会越大。3、无线充电技术设备本身实现的是二次能源转换,也就是将网电降压(或直接)变为直流电后在进行一次较高频率的开关控制交流变换输出。由于大功率的交直交电流转换是进行电能的二次性无线传输原因,所以电磁的空间磁损率太大。扩展资料1、经过国家3C认证的手机,其进行无线充电不会致癌给手机无线充电会产生一定的辐射,但在有质量保证和使用正确的前提下,这种辐射对人体几乎没有危害,更不会致癌。一方面,在无线充电时,磁场是封闭的,对外界辐射很小;另一方面,只要是经过国家3C认证的产品,都会经过严格的检查,其产生的辐射也必须符合一定的标准,不会对人体产生危害。2、手机无线充电原理所谓的无线充电技术,其基本原理和变压器的原理一样,就是中学物理课上学过的‘电生磁、磁生电"的原理。以手机为例,手机的充电器中有一个磁芯,外面绕有线圈,能将电转换为电磁场,而电磁场能够在空间传播,同时,手机中也有一个相应的接收线圈,这个接收线圈接触到充电器发出的电磁场后,经过一定的电路进行处理,就可以给手机充电了。参考资料来源:百度百科--无线充电参考资料来源:人民网--给手机无线充电会致癌?这个真没有
2023-08-03 20:27:031

为什么irinotecan在使用前推荐进行ugtia1的检测

Irinotecan的作用机制 Irinotecan(抗癌妥, CPT-11)是一种前驱药物,在体内经酵素催化成有活性的SN-38之后,抑制细胞内的第一型脱氧核糖核酸拓朴异构酶(DNA topoisomerase I),这是Irinotecan治疗癌症的机制,但同时也是病患化疗产生毒性的主要原因。在细胞内,SN-38经由胆红素尿苷二磷酸葡萄醣醛酸酶(UDP- glucuronosyltransferase, UGT1A1)催化之后,便经由胆汁和尿液排出。基因多型性与Irinotecan的副作用 UGT1A1中已发现许多基因多型性,其中,有些会影响UGT1A1的功能或表现量,因此会影响癌症病患接受Irinotecan的治疗情形。Irinotecan最主要的化疗毒性为嗜中性白血球减少及腹泻,而造成个体之间毒性程度不同的差异主要在于UGT1A1基因启动子(promoter)中的一个基因多型性,其含有数量不等的TA重复,通常有5到8个 TA重复,最常见的是6个,并且重复的数量越多,UGT1A1蛋白质表现量就会降低,从而减低具细胞毒性的SN-38在细胞内的代谢速度,毒性副作用也就此产生了!一般人带有6/6 TA重复,少数人则是6/7或7/7个TA重复,7个TA重复的基因型被命名为UGT1A1*28。许多研究发现,基因型为7/7或6/7个TA重复的病患,发生毒性副作用的机率比6/6个TA重复的病患高很多。因此美国食品药物管理局在2006年更新了Irinotecan的药品标示,其中建议若用药前基因检测结果为UGT1A1*28同型合子(homozygote)的病患,则应减少Irinotecan治疗的起始剂量;而检测结果若为UGT1A1*28异型合子(heterozygote)者,其使用Irinotecan治疗后,产生嗜中性白血球减少之毒性反应的风险亦较高,也应特别注意这类病患。 应用药物基因体学评估Irinotecan剂量并追踪病患治疗副作用 2006年,美国食品药物管理局(U.S. Food and Drug Administration; FDA)已经将UGT1A1*28基因多型性的信息加入Irinotecan的药品标示,建议病患使用Irinotecan前先了解自身是否带有UGT1A1*28基因型,以协助决定病患的起始剂量(UGT1A1*28同型合子),抑或于治疗中特别注意其血液毒性副作用的发生(UGT1A1*28异型合子)。 2008年由阳明大学、台北荣民总医院等研究团队共同发表的研究成果,也证实了台湾人UGT1A1*28基因型鉴定可预测转移性大肠直肠癌病患之Irinotecan治疗后毒性副作用的严重程度。经由以上诸多证据,建议国内的病患若是能在接受Irinotecan治疗前,先检测UGT1A1的基因多型性,就可于治疗前先予以评估是否减低起始剂量,以使病患减低承受治疗副作用的不适与风险的机会。
2023-08-03 20:27:051

style是什么牌子

叫style的品牌实在太多了,如果是Mjstyle,那Mjstyle属于Fishop旗下的主力潮流品牌,是国内的服装品牌。Mjstyle设计风格简单轻巧,颜色亮丽,注重时尚甜美。MJStyle是快时尚品牌,服装风格多为欧美风格,设计出彩款式多元化。MJStyle主要经营范围在国内四川、湖北、湖南、福建、浙江、吉林等十几个省以及北京、上海等地。
2023-08-03 20:27:061

学好英语一般要多少时间?

来玛可勃罗VIP学习管理中心,系统科学高效学习英语,一对一专享定制服务。让你的英语学习快速进步。
2023-08-03 20:27:0712

非洲全部位于什么半球

问题一:亚洲 欧美和非洲主要位于哪个半球 亚洲、欧洲、北美洲主要位于北半球,非洲南北半球几乎各半,南美洲主要位于南半球;亚洲、欧洲、非洲主要位于东半球,南恭美洲位于西半球。 问题二:非洲属于哪个半球东西南北 你好,非洲大陆南北半球均有,而东西半球划分,它位于东半球。 问题三:非洲全部位于东半球还是位于东西二个半球,地图上看非洲最西面位于西经17度,但是资料书上面没写跨东西? 非洲位于东西两个半球上。 东半球是指西经20°以东,东经160°以西,非洲有17,18,19这三个经线的区域是西半球,其余是东半球 问题四:非洲位于哪个半球〈东西半球〉 非洲大部分位于东半球,西非部分国家位于西半球; 2/3部分位于北半球,1/3位于南半球; 不是每个大洲的面积都大于他所在的面积,唯一的例外:欧洲在欧亚大陆上,但欧洲的面积小于欧亚大陆的面积。 问题五:非洲位于东半球还是西半球,原因是什么? 东半球:20°W~0°~160°E,西半球:160°E~180°~20°W.非洲大陆经纬度范围是:17°33′W―51°24′E,37°21′N―34°51′S,非洲绝大部分在东半球。 非洲的西部在西经,但为避免被本初子午线分割,所以东半球及西半球的分界线常用西经20°及东经160°。通经相比,小东大西,(例如一个地方位于东经150度,北纬45度,东经150度小于160度,那么就位于东半球。)
2023-08-03 20:26:571

style是什么词性呢?

style名词 n. 1.风格,作风[C][U]2.文体;文风;语调[C][U]The letter is written in a formal style. 这封信以正式文体写成。3.风度;体面,时髦[U]That gentleman has great style. 那位先生很有风度。
2023-08-03 20:26:571

北京信息科技大学是几本

北京信息科技大学是一本。北京信息科技大学在北京是第一批次招生,我们通常认为北京信息科技大学在北京是一本大学。北京信息科技大学位于北京,是以工科为主,工程、管理、科学、经济、文化、法律协调发展的重点配套大学。北京信息科技大学先后被评选为“优秀工程师教育培训计划”、国家“111计划”、首批北京市深化创新创业教育改革示范大学,以及北京市首批高等教育数字化校园示范学校。2023北京信息科技大学研究生报考条件1、中华人民共和国公民。拥护中国共产党的领导,品德良好,遵纪守法。身体健康状况符合国家和我校规定的体检要求。2、国家承认学历的应届本科毕业生(含普通高校、成人高校、普通高校举办的成人高等学历教育等应届本科毕业生)及自学考试和网络教育届时可毕业本科生。考生录取当年入学前必须取得国家承认的本科毕业证书或教育部留学服务中心出具的《国(境)外学历学位认证书》,否则录取资格无效。3、具有国家承认的大学本科毕业学历的人员。4、获得国家承认的高职高专毕业学历后满2年(从毕业后到录取当年入学之日,下同)或2年以上的人员,以及国家承认学历的本科结业生,符合我校根据培养目标对考生提出的具体学业要求的,按本科毕业同等学力身份报考。5、已获硕士、博士学位的人员。在校研究生报考须在报名前征得所在培养单位同意。
2023-08-03 20:26:521

盐酸伊立替康注射液的注意事项

应用:本品须在有使用细胞毒化疗药物经验的肿瘤专科医师的监督指导下使用。只有在能方便地获得充足的诊断和治疗设备的情况下,才可能给予并发症恰当的处理。药物外渗:本品是通过静脉滴注给药的。需要注意防止外渗,静滴部位要注意观察是否有炎症发生。一旦发生外渗,用无菌水冲洗并推荐给予冰敷。Mayo Clinic 方案:除非是设计完善的临床研究,本品不能与“Mayo Clinic”方案中的5-FU/LV 给药方法(连续给药4-5 天,每4 周一次,参见表9)联用是因为报告显示毒性有所增加,包括中毒性死亡。应根据“用法用量”部分的推荐使用盐酸伊立替康。免疫抑制剂效应/感染易感性增加:由于使用化疗药物包括盐酸伊立替康而导致免疫功能低下的患者接种活疫苗或减毒活疫苗,可能导致严重或致命的感染。使用盐酸伊立替康的患者应当避免接种活疫苗。可以接种死疫苗或灭活疫苗,但是可能会减弱疫苗的疗效。心血管系统:使用本品的患者血栓事件罕有发生。具体发生的原因仍然不明(参见心血管系统不良反应)。腹泻和处理方法本品可以引起早发性和迟发性腹泻,它们由不同的机制产生。两种腹泻都可能是严重的。早发性腹泻(在静滴盐酸伊立替康时或结束后的短时间内发生)是因为胆碱能作用所致。它通常是暂时性的,很少为严重性的。它有可能同时伴有鼻炎、流涎增多、瞳孔缩小、流泪、出汗、潮红、心动过缓和可引起腹部绞痛的肠蠕动亢进症状。对使用盐酸伊立替康时或结束后短时间内出现胆碱能综合症的患者静脉内或皮下注射0.25 至1mg(总剂量≤1mg/d)的阿托品(除非有使用禁忌症)。在下次使用本品时,应预防性使用硫酸阿托品。年龄≥65 岁的患者中,发生早发性腹泻的可能性较大,应该多加监测。迟发性腹泻(通常在使用本品24 小时后发生,出现第一次稀便的中位时间为滴注后第5 天)持续时间可能较长,可能导致脱水、电解质紊乱或感染,甚至为致命性的。一旦发生迟发性腹泻需要及时给予易蒙停治疗。应指导患者备有易蒙停,一旦出现粪便不成形或解稀便或排便频率比以往增多时就要开始易蒙停治疗。临床研究中的易蒙停给药方案为,首剂4mg,然后每2 小时给予2mg 直至患者腹泻停止后12 小时。 在晚上,患者可以每4 小时服用易蒙停4mg。不推荐连续使用以上剂量易蒙停48 小时以上,因为有出现麻痹性肠梗阻的风险,也不推荐使用时间少于12 小时。不推荐易蒙停预防性给药。腹泻患者须密切监护,如果出现脱水要补充水和电解质,如果出现肠梗阻、发热或严重的中性粒细胞减少需给予抗生素治疗。首次治疗以后,应推迟后续的化疗,直到患者在不使用止泻药的情况下至少24 小时不再腹泻(恢复到治疗前的肠功能状态)。如果出现NCI 2、3 或4 级腹泻,需要降低本周期中后续的盐酸伊立替康给药剂量(参见用法用量)。在下列情况中,除了抗生素治疗以外,尚推荐住院治疗腹泻:伴发热的腹泻、严重腹泻(需要静脉补液)、伴有与迟发性腹泻相关的呕吐以及在接受首剂高剂量易蒙停治疗后腹泻持续时间超过48 小时;另外个别情况下,治疗不良反应时患者有不遵医嘱的可能(一旦出现迟发性腹泻需要立即并长时间接受止泻治疗并大量补液)。血液系统疾病盐酸伊立替康通常会引起中性粒细胞下降、白细胞减少和贫血。上述症状都可能很严重,因此盐酸伊立替康不能用于有严重骨髓抑制的患者(参见血液系统不良反应)。严重的血小板减少并不常见。中性粒细胞减少有报道患者使用盐酸伊立替康后死于由严重的中性粒细胞减少而导致的脓毒血症。出现中性粒细胞减少的并发症时应及时给予抗生素治疗。如果出现中性粒细胞减少性发热或中性粒细胞绝对计数低于1.5x 109/L 时,应暂停盐酸伊立替康化疗。新疗程的化疗应该在粒细胞计数恢复到]1.5 x 109/L 后再开始。在患者恢复之后,后续的盐酸伊立替康治疗剂量应该根据患者中性粒细胞减少的情况而降低(参见用法用量)。并不需要常规给予集落刺激因子(CSF)治疗,但是医师可以考虑给予中性白细胞减少患者使用CSF。结肠炎/肠梗阻曾有结肠炎病例的报道。在一些病例中,结肠炎同时并发溃疡、出血、肠梗阻和感染。也曾报道先前无结肠炎的肠梗阻病例。发生肠梗阻的患者应该及时接受抗生素治疗。慢性炎性肠病和/或肠梗阻在肠梗阻症状消除前,患者不能接受盐酸伊立替康治疗。具有UGT1A1 酶活性减低的患者尿苷二磷酸葡萄糖醛酸转移酶(UGT1A1)由UGT1A1 基因编码,介导了活性代谢产物SN-38 的结合反应(参见药代动力学:代谢和排泄)。UGT1A1 基因的高度多态性,造成不同个体间代谢活性的差异。其中一种多态性发生在UGT1A1 的启动子区,即UGT1A1*28等位基因变异型。这种变异型和先天性UGT1A1 表达缺乏的疾病(如Crigler-Najjar 综合征和Gilbert 综合征)与UGT1A1 酶活性的降低及SN-38 全身暴露量的增加有关。与具有1 或2 条野生型等位基因的患者相比,具有UGT1A1*28 等位基因纯合子(又被称为UGT1A1 7/7基因型)的患者观察到较高的血浆SN-38 浓度。Crigler-Najjar 综合征(I 型及II 型)或具有UGT1A1*28 纯合子的患者(Gilbert 综合征)在使用中、高剂量的伊立替康(]150mg/m2)后,发生3~4 级血液毒性的风险增大。但是UGT1A1 基因型和伊立替康相关腹泻之间的关系还没有完全明确。UGT1A1*28 纯合子的患者,初始给药时,应给予常规剂量的伊立替康,并监测血液毒性。既往治疗时发生过血液毒性的患者应该考虑降低伊立替康的初始剂量。但在此类患者中,初始剂量具体降低多少并未明确,后续剂量的调整应当基于患者对治疗的耐受情况。在下述情况时慎用有特殊风险的患者:体力状态差的、年老的和曾接受过盆腔/腹部放疗的患者接受本品治疗的时候,医师要特别注意监测(参见不良反应)。体力状态差的患者发生盐酸伊立替康相关不良事件的风险会增加。临床研究中比较接受盐酸伊立替康/5-FU/LV 或5-FU/LV 的患者,发现住院率、中性粒细胞减少性发热、血栓栓塞、第一疗程化疗中断率和早期死亡的发生率在体力状态评分为2 分的患者高于0 或1 分的患者。体力状态评分为3 或4 分的患者不能接受本品治疗。肾功能损害:目前没有对肾功能不全患者进行临床研究(参见药理学、药代动力学和特殊人群药代动力学)。因此要特别注意监测肾功能不全患者。不推荐透析患者使用本药物。放疗:曾接受盆腔/腹部放疗的患者在接受盐酸伊立替康治疗后,发生严重骨髓抑制的风险增加。关于放疗与本品同时进行的方案没有充分的研究,不推荐这种治疗方案。肝功能不全:高胆红素血症的患者,盐酸伊立替康的清除率下降,所以其血液毒性的风险增加(参见药理学、药代动力学和特殊人群药代动力学)。血清总胆红素大于正常值上限3 倍的患者,盐酸伊立替康作为单药每3 周一次给药方案尚未确定。在单药每周给药方案的临床研究中,血清总胆红素中度增高(17-34 μmol/L)的患者在治疗第一周期中发生3 或4 级中性粒细胞减少的可能性高于血清总胆红素小于17 μmol/L 的患者(50% 比18%; p[0.001)(参见药理学、药代动力学和特殊人群药代动力学和剂量与用法)。胆红素糖脂化过程异常的患者,如有Gilbert 综合症的患者,在接受本品治疗后发生骨髓抑制的风险较高。胆碱能效应:盐酸伊立替康具有胆碱能效应,有哮喘或心血管疾病的患者在使用时要谨慎。有机械性肠梗阻或尿路梗阻的患者使用时也要谨慎。呼吸系统:表现为肺内浸润的间质性肺部疾病在盐酸伊立替康治疗中很少见。间质性肺部疾病可能是致命的。先前存在的肺部疾病、使用有肺毒性的药物、放疗和使用集落刺激因子都可能是发生间质性肺部疾病的风险因子。有以上风险因子的患者在使用盐酸伊立替康之前和治疗期间都要密切观察呼吸系统症状。给药前监测:推荐在每次使用本品前要密切监测白细胞计数及分类,血红蛋白和血小板计数。在每次用药前、每月或有临床指征时监测肝功能。恶心和呕吐:盐酸伊立替康可以引起呕吐。推荐患者用药前先给予止吐剂。在每周给药方案的临床研究中,大部分患者接受地塞米松10mg 联合另一种止吐剂如5-HT3 阻滞剂(例如恩丹司琼或格拉司琼)的治疗。应该在化疗的当天,输注本品前至少30 分钟给予止吐药。根据随后的需要,医师也可以考虑给予患者止吐药(例如丙氯拉嗪)。如果患者呕吐伴有迟发性腹泻则需要尽快住院治疗。患者须知:应该告知患者使用本品后的毒副作用,尤其是胃肠道并发症例如腹泻、恶心、呕吐、腹部痉挛和感染。告知患者一旦在使用本品后出现下述任一情况,必须向医师咨询:第一次腹泻;24 小时内无法控制腹泻;呕吐;发热或有感染的征象;脱水症状如身体衰弱、轻度的头晕或头昏;血便或黑便;因为恶心或呕吐而不能摄入液体。告知患者有脱发的可能。禁止使用泻药(参见药物相互作用),如需使用任何泻药应联系自己的医师。其它因为本品含有山梨糖醇,所以不适用于患有遗传性果糖不能耐受的患者。实验室检查的影响目前尚不知盐酸伊立替康和实验室检查之间有相互作用。对驾驶和机械操作的影响盐酸伊立替康对于驾驶和机械操作的影响尚未被评估。然而,应该告知患者在使用盐酸伊立替康后24 小时内有可能出现头晕或视觉障碍,并建议如果出现这些症状不要进行驾驶或机械操作活动。
2023-08-03 20:26:511