正念癌症康复训练对术后化疗期肺癌患者癌因性疲乏的影响

目的 分析正念癌症康复训练对术后化疗期肺癌患者癌因性疲乏的影响.方法 将住院化疗的肺癌患者79例采用抽签法分为观察组40例和对照组39例.对照组实施常规护理,观察组实施正念癌症康复训练,于干预前、干预后、随访1个月和3个月时采用癌症疲乏量表进行效果评价.结果 两组干预后、随访1个月和3个月癌因性疲乏得分比较,时间效应、干预效应及交互效应显著(均P＜0.01).结论 正念癌症康复训练可有效缓解肺癌术后化疗期患者的癌因性疲乏.     

乳腺癌术后化疗患者癌因性疲乏及其影响因素调查

目的 了解乳腺癌术后化疗患者癌因性疲乏的状况,探讨影响乳腺癌术后化疗患者癌因性疲乏的因素.方法 对北京市4所三级甲等医院的165例乳腺癌术后化疗患者,采用Piper疲乏量表、数字疼痛评估量表、医院焦虑抑郁量表、社会支持评定量表和阿森斯失眠量表进行调查.结果 乳腺癌术后化疗患者均经历了癌因性疲乏,其中中重度疲乏占87.27%.疼痛、工作情况、化疗方案、其他不良反应和支持的利用度是影响癌因性疲乏的主要因素(均P＜0.01).结论 乳腺癌术后化疗患者癌因性疲乏的发生率较高,且多数属于中重度疲乏,疼痛是最主要的影响因素.应采取针对性措施,降低患者癌因性疲乏的程度,以提高其生活质量.     

老年肺癌化疗患者营养状态及与癌因性疲乏的相关性

目的探讨老年非小细胞肺癌患者化疗期间营养状态变化特点及与癌因性疲乏的相关性,为制定缓解癌因性疲乏干预措施提供参考。方法选取115例老年非小细胞肺癌化疗患者,在化疗第1个周期前1 d(T0)及第7天(T1)、第2个周期前1 d(T2)及第7天(T3)、第4个周期结束后第7天(T4)采用营养风险评估表(NRS-2002)进行营养状态评估,在T4同时采用癌因性疲乏量表(CRF)评估。结果在T0、T1、T2、T3、T4 NRS-2002评分分别为(3.05±1.19)、(3.80±1.24)、(2.85±1.22)、(3.19±1.21)、(3.06±1.09)分,各时间点评分比较,差异有统计学意义(P0.01);营养不良发生率分别为10.4%、27.8%、8.7%、18.3%、14.8%。T4时间点CRF总分及躯体疲乏、情感疲乏、认知疲乏维度评分分别为(40.60±6.48)、(14.58±3.87)、(14.28±1.17)、(11.74±2.84)分。各时间点NRS-2002评分与T4时间点躯体疲乏、认知疲乏及CRF总分呈正相关性(均P0.05)。结论老年非小细胞肺癌患者化疗期间营养不良及营养风险比例较高,其变化趋势呈现"波浪"形;营养状态与CRF发生有关,需积极开展营养支持,以降低CRF程度。     

督灸辅助治疗大肠癌术后化疗患者癌因性疲乏

目的观察督灸辅助治疗大肠癌术后化疗患者癌因性疲乏的效果。方法将大肠癌术后化疗具有癌因性疲乏患者64例,按随机数字表法分为观察组和对照组各32例。对照组给予常规对症支持治疗,观察组在此基础上辅以督灸治疗。比较两组患者疲乏程度和体力状况。结果观察组癌因性疲乏总分及行为、情感、感觉、认知4个维度得分显著低于本组干预前及对照组干预后(均P0.01);其KPS体力状况评分显著高于本组干预前及对照组干预后(P0.05,P0.01)。结论督灸能明显改善大肠癌术后患者的癌因性疲乏程度,并能提高患者的体力状况。     

肺癌术后化疗患者多团队协同按需延续护理研究

目的探索基于需求导向的延续性护理干预对肺癌术后化疗患者生活质量及疲乏的影响。方法运用德尔菲法编制患者院外护理需求量表评估需求内容,将符合标准的76例患者随机分为观察组和对照组各38例。对照组按照常规护理,观察组根据院外护理需求实施延续性护理干预,分别在干预后3个月、6个月末使用肺癌治疗功能评定量表,癌症疲乏量表评估两组患者生活质量和疲乏状况。结果干预后3个月末,观察组肺癌特异性、生活质量总分得分显著高于对照组(均P0.01);干预后6个月末,观察组社会/家庭、情感、生活质量总分得分显著高于对照组(均P0.01),情感疲乏、认知疲乏、疲乏总分得分低于对照组(均P0.01)。结论基于肺癌术后化疗患者延续性护理需求研究,采用延续性干预可提高肺癌术后化疗患者生活质量,并一定程度减轻患者癌因性疲乏。     

乳腺癌术后化疗患者癌因性疲乏及其影响因素调查

目的了解乳腺癌术后化疗患者癌因性疲乏的状况，探讨影响乳腺癌术后化疗患者癌因性疲乏的因素。方法对北京市4所三级甲等医院的165例乳腺癌术后化疗患者，采用Piper疲乏量表、数字疼痛评估量表、医院焦虑抑郁量表、社会支持评定量表和阿森斯失眠量表进行调查。结果乳腺癌术后化疗患者均经历了癌因性渡乏，其中中重度疲乏占87．27％。疼痛、工作情况、化疗方案、其他不良反应和支持的利用度是影响癌因性疲乏的主要因素（均P〈0．01）。结论乳腺癌术后化疗患者癌因性疲乏的发生率较高，且多数属于中重度疲乏，疼痛是最主要的影响因素。应采取针对性措施。降低患者癌因性疲乏的程度，以提高其生活质量。     

耳穴手法按压对肺癌术后化疗患者肺功能、癌因性疲乏的改善研究

目的 探讨耳穴手法按压对肺癌术后化疗患者肺功能、癌因性疲乏的作用。方法 选取2022年1月至2023年6月在本院胸部肿瘤病区就诊的80例肺癌术后化疗患者为研究对象,所有80例研究对象依照随机数字表法将其随机分为对照组40例和观察组40例。对照组采用本科室常规护理,观察组在对照组常规护理方法的基础上结合耳穴手法按压的特色护理方法。对比两组患者肺功能、癌因性疲乏。结果 干预后,观察组FEV1/FVC、用力肺活量高于对照组（P<0.05）;观察组躯体、情感、认知疲乏及总得分均较对照组低（P<0.05）。结论 耳穴手法按压能够显著改善肺癌术后化疗患者肺功能、癌因性疲乏。     

直肠癌造瘘术后伴癌因性疲乏患者的护理

目的 总结直肠癌造瘘术后伴癌因性疲乏患者的护理经验.方法 对32例直肠癌造瘘术后伴癌因性疲乏患者,加强肠造口相关知识的教育,指导患者正确选择及应用造口用品,评估癌因性疲乏,加强排便护理、运动锻炼、中医调护、饮食护理等.结果 患者癌因性疲乏减轻,无疲乏17例,轻度疲乏9例,中度疲乏4例,重度疲乏2例.住院时间为25～46 d.结论 对直肠癌造瘘术后癌因性疲乏患者采取护理干预,可消除或减轻患者癌因性疲乏,提高其生活质量.     

化疗期胃癌患者癌因性疲乏的自我管理干预

目的评价自我管理对化疗期胃癌患者癌因性疲乏的干预效果。方法采用便利抽样法将67例胃癌化疗患者按照入院时间分成干预组(32例)和对照组(35例)。对照组给予常规护理,干预组在常规护理的基础上增加自我管理干预措施。采用癌症疲乏量表及癌症治疗功能评价量表进行效果评价。结果干预后干预组癌因性疲乏总分和各维度得分显著低于对照组,生命质量总分和各维度得分显著高于对照组(P0.05,P0.01)。结论自我管理能有效地缓解化疗期胃癌患者的癌因性疲乏症状,提高生命质量。     

结直肠癌患者癌因性疲乏的多维度纵向研究

目的探讨结直肠癌患者在手术和化疗过程中经历的癌因性疲乏变化规律,为针对性干预提供参考。方法采用Piper疲乏量表中文修订版(RPFS-C),对符合入选条件的115例结直肠癌患者,分别在术前及术后每个疗程开始前对癌因性疲乏进行多维度追踪随访。结果结直肠癌患者癌因性疲乏整体及感觉、认知/情绪2个维度得分在第4次化疗前呈显著上升趋势(均P0.05),行为/严重程度、情感2个维度疲乏得分在第3次化疗前呈显著上升趋势(均P0.05)。情感维度疲乏得分一直处于高位。行为/严重程度维度中"疲乏引起的忧虑"条目得分最低。感觉维度中"身体虚弱"条目得分最高。认知/情绪维度中"不能清晰思考"和"无记性"条目得分较低。在接受治疗后的1周内疲乏达到最高峰。结论结直肠癌患者癌因性疲乏在整个治疗阶段不断加重,临床医护人员应在围手术期及化疗早期及时开展疲乏干预,从心理支持、饮食指导和有氧运动训练等方面缓解患者的疲乏,其中情感疲乏护理是重点。     

Vasopressor hormone response following mesenteric traction during major abdominal surgery

Background : We investigated the vasopressor hormone response following mesenteric traction (MT) with hypotension due to prostacyclin (PGI₂) release in patients undergoing abdominal surgery with a combined general and epidural anesthesia. Methods : In a prospective, randomized, placebo-controlled study we administered 400 mg ibuprofen (i.v.) in 42 patients scheduled for abdominal surgery. General anesthesia was combined with epidural anesthesia (T4-L1). Before as well as 5, 15, 30, 45, and 90 min after MT we recorded plasma osmolality, hemodynamics and measured 6-keto-PGFlα (stabile metabolite of PGI₂), TXB₂ (stabile metabolite of thromboxane A₂) active renin, and arginine vasopressin (AVP) plasma concentrations by radioimmunoassay. Catecholamine levels were assessed by high-pressure liquid chromatography (HPLC) with electrochemical detection. Results : Following MT, arterial hypotension occurred along with a substantial PGI₂ release. This was completely abolished by ibuprofen administration. Although plasma levels of 6-keto-PGF_1α (1133 (708) vs. 60 (3) ng/L, median (median absolute deviation), P=0.0001, placebo vs. ibuprofen) remained significantly elevated, blood pressure was restored within 30 min after MT in the placebo group. At the same point in time plasma concentrations of TXB² (164 (87) vs. 58 (1) ng/L, P=0.0001), epinephrine (46 (33) vs. 14 (6) ng/L, P=0.001), AVP (41 ± (18) vs. 12 (7) ng/L, P=0.0004), and active renin (27 (12) vs. 12 (4) ng/L, P = 0.001) were significantly higher in placebo-treated patients. Conclusion : Under combined general and epidural anesthesia arterial hypotension following MT due to endogenous PGI₂ release is associated with enhanced release of AVP, active renin, epinephrine and thromboxane A₂, presumably contributing to hemodynamic stability within 30 min after MT.     

A comparison of the inhibitory effects of four volatile anaesthetics on the metabolism of chlorzoxazone, a substrate for CYP2E1, in rabbits

Background: Halothane inhibits in vitro and in vivo activity of cytochrome P-450 (CYP) 2E1. There are several fluorinated volatile anaesthetics besides halothane, and most of them are defluorinated by CYP2E1. It is unclear whether other fluorinated anaesthetics inhibit the in vivo activity of CYP2E1.
Methods: We compared the inhibitory effects of therapeutic concentrations of four inhalational anaesthetics, halothane, enflurane, isoflurane, and sevoflurane, on chlorzoxazone metabolism in rabbits receiving artificial ventilation.
Results: All four inhalational anaesthetics decreased arterial blood pressure and increased plasma chlorzoxazone concentration. However, no significant differences in the plasma chlorzoxazone concentration were found between the four anaesthetics. The estimated chlorzoxazone clearance increased after beginning inhalation with all four agents, but no significant difference in clearance was noted between agents.
Conclusions: At therapeutic concentrations, the in vivo inhibitory effect on chlorzoxazone metabolism was similar for all four inhalational anaesthetics examined, even though their chemical characteristics and extent of hepatic metabolism differ considerably.     

A Teaspoon Pump for Pumping Blood with High Hydraulic Efficiency and Low Hemolysis Potential

Abstract: Virtually all blood pumps contain some kind of rubbing, sliding, closely moving machinery surfaces that are exposed to the blood being pumped. These valves, internal bearings, magnetic bearing position sensors, and shaft seals cause most of the problems with blood pumps. The original teaspoon pump design prevented the rubbing, sliding machinery surfaces from contacting the blood. However, the hydraulic efficiency was low because the blood was able to "slip around" the rotating impeller so that the blood itself never rotated fast enough to develop adequate pressure. An improved teaspoon blood pump has been designed and tested and has shown acceptable hydraulic performance and low hemolysis potential. The new pump uses a nonrotating "swinging" hose as the pump impeller. The fluid enters the pump through the center of the swinging hose; therefore, there can be no fluid slip between the revolving blood and the revolving impeller. The new pump uses an impeller that is comparable to a flexible garden hose. If the free end of the hose were swung around in a circle like half of a jump rope, the fluid inside the hose would rotate and develop pressure even though the hose impeller itself did not "rotate"; therefore, no rotating shaft seal or internal bearings are required.     

Microspheres Based Detoxification System: A New Method in Convective Blood Purification

Abstract: A variety of protein-bound or hydrophobic substances, accumulating as a result of pathologic conditions such as exogenous or endogenous intoxications, are removed poorly by conventional detoxification methods because of low accessibility (hemodialysis), insufficient adsorption capabilities (hemosorption), low efficiency (peritoneal dialysis), or economic limitations (high-volume plasmapheresis). Combining advantages of existing methods with microspheric technology, a module-based system was designed. Major operating parameters of the latter can be modified to allow for adjustment to individual clinical situations. An extracorporeal blood circuit including a plasmafilter is combined with a secondary high-velocity plasma circuit driven by a centrifugal pump. Different microspheric adsorbers can be combined in one circuit or applied in sequence. Thus, a prolonged treatment can be tailored using specially designed selective adsorber materials. Comparing this system with existing methods (high-flux hemodialysis, molecular adsorbent recycling system), results from our in vitro studies and animal experiments demonstrate the superior efficiency of substance removal.     

Tissue perfusion in relation to cardiac output during continuous positive-pressure ventilation and administration of propranolol or verapamil

Background : Our objective was to determine whether administration of propranolol or verapamil modifies the hemodynamic adaptation to continuous positive-pressure ventilation (CPPV), in particular the regional distribution of cardiac output (CO).
Methods : General hemodynamics and regional blood flows assessed by microsphere technique (15 (μm) were recorded in 16 anesthetized pigs during spontaneous breathing (SB) and CPPV with 8 cm H₂O end-expiratory pressure (CPPV8) before and after intravenous administration of propranolol (0.3 mg · kg⁻¹ followed by 0.15 mg · kg⁻¹ · h⁻¹, n=8) or verapamil (0.1 mg · kg⁻¹ followed by 0.3 mg · kg⁻¹ · h⁻¹, n=8).
Results : CPPV8 depressed CO by 25% without shifts in its relative distribution with the exception of a noteworthy increase in adrenal perfusion. Propranolol increased arterial blood pressure, and due to a fall in heart rate, CO dropped by 25%. The kidneys and, to a lesser extent, the splanchic region and central nervous system received increased fractions of the remaining CO at the expense of skeletal muscle flow. Similar patterns were seen during SB and CPPV8 such that the combination of propranolol and CPPV8 depressed CO by 50%. The circulatory effects of verapamil were less evident but myocardial perfusion tended to increase.
Conclusions : The combination of propranolol or verapamil with CPPV does not result in any specific hemodynamic interaction in anesthetized pigs, except that the combined effect of propranolol and CPPV may severely reduce CO.     

Volatile anaesthetics reduce adhesion of blood platelets under low-flow conditions in the coronary system of isolated guinea pig hearts

Background : Inhibitory effects of volatile anaesthetics on platelet aggregation have been demonstrated in several studies. However, the influence of volatile anaesthetics on intracoronary platelet adhesion has not been elucidated so far.
Methods : Isolated hearts of guinea pigs were perfused with buffer in the absence or presence of volatile anaesthetics (0.5 and 1 MAC) at constant coronary flow rates of 5 ml/min for 25 min, then 1 ml/min for 30 min and again 5 ml/min for 10 min. Before, during and after low-flow perfusion, a bolus of human platelets was applied into the coronary system. To simulate thrombogenic conditions, 0.3 U/ml human thrombin was infused during low-flow perfusion and reperfusion. The number of platelets sequestered to the endothelium was calculated from the difference between coronary in- and output of platelets. The myocardial production of lactate and consumption of pyruvate and coronary perfusion pressure were also determined.
Results : At a flow rate of 5 ml/min only about 3% of the applied platelets did not emerge from the coronary system, in any group. In contrast, 13.1±1.2% (mean±SEM) of infused platelets became adherent in low-flow perfusion in the control group without anaesthetic. The adherence was reduced with each 1 MAC isoflurane (to 6.2±1.2%), sevoflurane (to 4.4±0.9%) or halothane (to 3.2±1.5%) (each P <0.05 vs. control). Volatile anaesthetic, 0.5 MAC, did not inhibit platelet adhesion to a statistically significant extent in any case. Perfusion pressure and metabolic parameters were not statistically different between the control and the hearts exposed to anaesthetics.
Conclusion : Volatile anaesthetics in a concentration of 1 MAC can reduce the adhesion of platelets in the coronary system under reduced flow conditions. This action does not arise from vasodilation or inhibition of ischaemic stress.     

Bariatric Surgery in Some "Central and East-European (former Eastern bloc)"Countries - Current Status and Prediction for the Next Millennium

Background: Obesity is increasing globallly, including in the formerly "Eastern Bloc" countries. Methods: A survey was made of obesity and bariatric surgery. Results: In the 8 East and Central European countries studied, with total population 300 million, roughly 43% of the population was overweight (BMI 25-30), 23% obese (BMI > 30), with about 15 million people morbidly obese (BMI > 40). From 0-10 morbidly obese individuals/100,000/year undergo bariatric surgery. Conclusion: Most countries were found to provide inadequate treatment for obesity.The majority of the morbidly obese are not treated effectively. However, health-care awareness of obesity and bariatric surgeons are slowly increasing.     

Is the recovery profile of mivacurium independent of the rate of decay of its plasma concentration in patients with normal plasma cholinesterase activity?

Background: The duration of action of muscle relaxants is poorly correlated to the rate of decay of their plasma concentration. The plasma concentration of mivacurium may rapidly decrease below its active concentration because of the extensive hydrolysis of mivacurium. By inflating a tourniquet on one upper limb for 3 min after the administration of atracurium, mivacurium or vecuronium, we studied the influence of the initial decline of their plasma concentration on their effect. Methods: In 50 patients anaesthetised with thiopental, isoflurane and fentanyl, the effect of bolus doses of 0.15 or 0.25 mg . kg^?1 mivacurium (MIV 15, MIV 25), 0.3 or 0.5 mg . kg^?1 atracurium (ATR 30, ATR 50) and 0.06 or 0.1 mg . kg^?1 vecuronium (VEC 06, VEC 10) were measured on both arms (evoked response of the adductor pollicis to train-of-four stimulation every 12 s), a tourniquet being applied on one arm just before and during 3 min after the muscle relaxant bolus. Results: Tourniquet inflation of 3 min almost abolished the neuromuscular effect of mivacurium. In the vecuronium groups and in the ATR 50 group, tourniquet inflation did not modify the maximum degree of depression of the twitch response. Also, the duration of action of vecuronium was unaffected by the tourniquet. In the ATR 30 group, times to return of the twitch response to 25% (duration 25%) and 75% (duration 75%) of control response were significantly shorter in the cuffed arm, 23 min vs 27 min, and 41 min vs 45 min, respectively. In the ATR 50 group, only duration 25% was significantly shorter in the cuffed arm (41 min vs 45 min). Conclusion: The results suggest that the rate of decline of the plasma concentration of mivacurium is so rapid, that a very low and almost clinically ineffective concentration is present as soon as 3 min after its administration. The results also indicate that the recovery from a mivacurium-induced neuromuscular blockade is not influenced by the rate of decay of its plasma concentration in patients with genotypically normal plasma cholinesterase.     

Membranes in Artificial Organs

Abstract: Membrane processes play a pivotal and enabling role in modern replacement therapy for acute and chronic organ failure and in the management of immunologic diseases. In fact, virtually all contemporary extracorporeal blood purification methods employ membrane devices, and the next generation of artificial organs and tissue engineering therapies are almost certain to be similarly grounded in membrane technology. In this short essay, we comment on the similarities and differences among synthetic membranes and their natural counterparts and also provide a critical overview of the demographics and technology of hemodialysis, hemofiltration, apheresis, oxygenation, and emerging membrane technologies and applications.     

Synergistic interaction between the effects of propofol and midazolam with fentanyl on phrenic nerve activity in rabbits

Background: It has been shown that the depressive effects of both propofol and midazolam on consciousness are synergistic with opioids, but the nature of their interactions on other physiological systems, e. g. respiration, has not been fully investigated. The present study examined the effect of propofol and midazolam alone and in combination with fentanyl on phrenic nerve activity (PNA) and whether such interactions are additive or synergistic. Methods: PNA was recorded in 27 anaesthetised and artificially ventilated rabbits. In three groups, propofol, fentanyl and midazolam were administered intravenously in incremental doses to construct dose-response curves for the depressant effects of each one on PNA. In another two groups, the effect of pretreatment with either fentanyl 1 μg · kg^?1 i. v. or midazolam 0.05 mg · kg^?1 i. v. on the effects of propofol and fentanyl respectively on PNA were studied. Results: Propofol and fentanyl caused a dose-dependent depression of PNA with complete abolition at the highest total doses of 16 mg · kg^?1 i. v. and 32 μg · kg^?1 i. v., respectively. In contrast, midazolam in incremental doses to a total of 0.8 mg · kg^?1 reduced mean PNA by 63%, but approximately 12% of PNA remained at a total dose as high as 6.4 mg · kg^?1. The mean ED₅₀s, calculated from dose-response curves, were 5.4 mg · kg^?1, 3.9 μg · kg^?1 and 0.4 mg · kg^?1 for propofol, fentanyl and midazolam, respectively. Initial doses of either fentanyl 1 μg · kg^?1 i. v. or midazolam 0.05 mg · kg^?1 i. v. acted synergistically with subsequent doses of either propofol or fentanyl to abolish PNA at total doses of 8 mg · kg^?1 and 8 μg · kg^?1, respectively. Conclusion: Fentanyl has a synergistic interaction with both propofol and midazolam on PNA and hence potentially on respiration.