不同方案治疗肿瘤骨转移性疼痛的临床效果比较

目的 比较不同方案治疗肿瘤骨转移性疼痛的临床效果.方法 将80例肿瘤骨转移性疼痛患者按照随机数字表法分为实验组和对照组,各40例.实验组患者采用唑来磷酸联合化疗方案治疗,对照组患者仅给予化疗诊治.分析2组患者疼痛缓解状况,比较2组患者治疗前后AKP、NRS以及KPS的变化,观察2组患者治疗后不良反应的状况.结果 治疗前,2组患者的AKP值、NRS评分以及KPS评分相差不大(P＞0.05).经过治疗,实验组患者AKP值与NRS评分均较治疗前以及对照组患者治疗后显著降低,KPS较治疗前以及对照组患者显著提高,均具有统计学意义(P＜0.05).经过治疗,实验组发生6例恶心呕吐,2例食欲不振,3例皮疹,1例发热,5例嗜睡等不良症状;对照组发生5例恶心呕吐,3例食欲不振,4例皮疹,2例发热,4例嗜睡.2组患者不良反应均未经处理,3～5d后自行消失,均未见严重不良反应发生.结论 唑来膦酸联合化疗方案治疗肿瘤骨转移性疼痛,能够显著提高疼痛缓解的有效率,且显著降低AKP值与NRS评分,提高KPS评分,具有一定的安全性.     

射频消融辅助治疗转移性骨肿瘤的疗效研究

目的 探讨射频消融辅助治疗转移性骨肿瘤的临床效果,以期提高临床诊治水平.方法 选取52例转移性骨肿瘤患者作为研究对象,分成2组,对照组26例,予放化疗等对症处理;观察组26例,辅助射频消融,观察治疗前后生活质量、NAS评分等指标变化.结果 对照组6个月生存率为23.08％、18个月以上生存率为15.38％,观察组6个月生存率为11.53％、18个月以上生存率为34.62％,两组比较差异有统计学意义(P＜0.05);VAS评分上,治疗前与治疗后3d、3个月两组内VAS评分比较差异均有统计学意义(P＜0.05),治疗后3d、3个月两组间比较差异有统计学意义(P＜0.05);治疗前后两组在躯体、情绪、社会功能、疲劳、便秘方面比较差异均有统计学意义(P＜0.05),治疗后躯体、情绪、社会功能、疲劳、便秘组间比较差异有统计学意义(P＜0.05).结论 射频消融辅助治疗转移性骨肿瘤能提高患者生活质量,延长生存时间.     

外固定支具与股骨远端非接触桥接钢板倒置对股骨近端良性骨肿瘤髋关节功能及安全性的影响

目的探讨外固定支具与股骨远端非接触桥接钢板倒置对股骨近端良性骨肿瘤髋关节功能及安全性的影响。方法选取2015年1月至2019年10月间陕西省韩城市韩城矿务局总医院收治的80例股骨近端良性骨肿瘤患者,根据治疗方式不同分为观察组38例和对照组42例。观察组患者采用股骨远端非接触桥接钢板倒置内固定治疗,对照组患者采用外固定支具治疗,比较两组患者的手术时间、术中出血量、治疗有效率、不良反应发生率、开始负重时间及术后不同时间点的患肢功能评分。结果两组患者手术时间和术中出血量比较,差异无统计学意义(P> 0. 05)。观察组患者有效率为94. 7%,高于对照组的81. 0%,差异有统计学意义(P <0. 05)。两组患者不良反应发生率比较,差异无统计学意义(P>0. 05)。观察组患者开始负重时间少于对照组,术后1个月和术后3个月患肢功能评分均低于对照组,差异均有统计学意义(均P <0. 05)。术后6个月时,两组患者患肢功能评分比较,差异无统计学意义(P>0. 05)。结论与外固定支具方法相比,对股骨近端良性骨肿瘤患者采用股骨远端非接触桥接钢板倒置治疗,可提高治疗效果,缩短开始负重时间,提高患者髋关节功能。     

可旋转稳定型假体与单纯铰链型假体治疗胫骨近端恶性骨肿瘤的疗效比较

目的探讨可旋转稳定型假体与单纯铰链型假体治疗胫骨近端恶性骨肿瘤的效果比较。方法选取2016年9月至2017年9月间重庆市开州区人民医院收治的100例胫骨近端恶性肿瘤患者作为研究对象。将采用植入可旋转稳定型膝关节假体治疗的50例患者纳入观察组,采用植入单纯铰链型假体治疗的50例患者纳入对照组。观察比较两组患者治疗后的关节功能、疼痛改善、术后并发症和生活质量指标。结果观察组膝关节功能优良率为94. 0%,高于对照组的80. 0%,差异有统计学意义(P <0. 05)。观察组膝关节伸直度高于对照组,差异有统计学意义(P <0. 05)。术后,观察组的视觉模拟评分(VAS)分值均显著低于对照组,差异有统计学意义(P <0. 05)。术后,观察组关节腔积血3例(6. 0%),对照组中腓总神经损伤4例(8. 0%),两组比较,差异无统计学意义(P> 0. 05)。术后6个月及12个月时,观察组生活质量评分中生理功能、生理职能和情感职能评分均高于对照组,差异均有统计学意义(均P <0. 05)。结论采用可旋转稳定型膝关节假体治疗胫骨近端恶性肿瘤患者可有效改善和提高患者的膝关节功能和生活质量,适于临床推广。     

射频消融联合经肝动脉化疗治疗原发性肝癌对患者血清甲胎蛋白及生活质量的影响

目的探讨射频消融联合经肝动脉化疗治疗原发性肝癌对血清甲胎蛋白(AFP)及生活质量的影响。方法选取2012年12月至2014年12月间陕西省铜川市人民医院收治的90例原发性肝癌患者进行回顾性分析,采用肝动脉栓塞化疗加用射频消融术治疗的45例患者纳入观察组,仅采用肝动脉栓塞化疗治疗的45例患者纳入对照组。比较两组患者的临床疗效、血清AFP变化、生活质量评分和随访3年的生存率及复发率。结果观察组患者临床总有效率为86. 7%,高于对照组的62. 2%,差异有统计学意义(P <0. 05)。治疗后,与治疗前比较,两组患者的血清AFP水平均降低,生活质量评分升高,观察组患者较对照组上述指标改善更多,差异均有统计学意义(均P <0. 05)。观察组患者的2年和3年的生存率均高于对照组,2年和3年复发率低于对照组,差异均有统计学意义(均P <0. 05)。结论射频消融联合经肝动脉化疗治疗原发性肝癌能够获得一定的疗效,近期生存率更高,生活质量更好。     

高频热消融和微波热消融联合肝动脉化疗栓塞术治疗中晚期原发性肝癌的疗效

目的探讨高频热消融和微波热消融联合肝动脉化疗栓塞术(TACE)治疗中晚期原发性肝癌的临床疗效。方法选取2015年8月至2018年8月间成都三六三医院收治的86例中晚期原发性肝癌患者,采用随机数表法分为治疗组和对照组,每组43例。对照组患者采用单纯TACE术治疗,治疗组患者采用高频热消融、微波热消融联合TACE术治疗,比较两组患者术后疗效、生存时间、血清甲胎蛋白(AFP)水平及并发症情况。结果治疗组患者临床总有效率为97. 7%,优于对照组的86. 0%,差异有统计学意义(P <0. 05)。两组患者术后出现胃肠道不适、肝功能损伤、疼痛及发热等并发症情况比较,差异均无统计学意义(P> 0. 05)。术前,两组患者血清AFP水平比较,差异无统计学意义(P> 0. 05)。术后,两组患者血清AFP水平均下降,且治疗组下降程度大于对照组,差异均有统计学意义(均P <0. 05)。两组患者术后3个月和6个月生存率比较,差异无统计学意义(P> 0. 05)。术后12个月和24个月,对照组患者生存率均低于治疗组,差异均有统计学意义(均P <0. 05)。结论高频热消融、微波热消融联合TACE术治疗中晚期原发性肝癌患者,临床疗效满意,值得临床推广。     

基于冰山理论的个性化护理在宫颈癌根治术患者中的应用

目的探讨基于冰山理论的个性化护理在宫颈癌根治术患者中的应用效果。方法选取2016年1月至2018年1月间湖北省荆门市第二人民医院收治的69例行宫颈癌根治术患者。其中,采用常规护理的34例患者纳入对照组,在常规护理基础上给予基于冰山理论的个性化护理的35例患者纳入观察组。比较两组患者干预前后生活质量(KPS评分)、焦虑情绪(SAS评分)、术后性生活质量和护理工作满意度。结果干预6个月后,两组患者的生活质量和负性情绪均得到不同程度改善,且观察组患者的SAS评分较对照组患者低,KPS评分较对照组患者高,差异均有统计学意义(均P <0. 05)。观察组患者性心理、性生理及夫妻关系方面优于对照组患者,差异均有统计学意义(均P <0. 05)。观察组患者护理工作满意度为94. 3%高于对照组患者的70. 6%,差异有统计学意义(P <0. 05)。结论给予宫颈癌根治术患者基于冰山理论的个性化护理可缓解其焦虑情绪,且患者生活质量及性生活质量均显著提升,患者对护理工作满意度高。     

贝伐珠单抗疗法在局部晚期及转移性鼻咽癌中的应用

目的探讨基于贝伐珠单抗疗法在局部晚期及转移性鼻咽癌中的应用价值。方法选取2014年8月至2017年4月间陕西省核工业215医院收治的79例局部晚期及转移性鼻咽癌患者,采用随机数表法分为观察组(40例)和对照组(39例)。对照组患者采用常规化疗,观察组患者在对照组治疗基础上采用贝伐珠单抗治疗,比较两组患者的预后疗效。结果观察组患者总有效率为75. 0%,高于对照组的48. 7%,差异有统计学意义(P <0. 05)。观察组患者治疗期间白细胞减少、血小板降低、恶心呕吐、皮肤反应及肝肾损害等不良反应发生情况与对照组比较,差异均无统计学意义(P> 0. 05),多数为Ⅰ～Ⅱ级,可耐受。治疗后,两组患者Ig M与Ig A均高于治疗前,且观察组高于对照组,差异均有统计学意义(均P <0. 05)。观察组患者总生存时间与无瘤生存时间均长于对照组,差异均有统计学意义(均P <0. 05)。结论基于贝伐珠单抗的疗法在局部晚期及转移性鼻咽癌中,可在不增加不良反应的基础上提高治疗效果,改善患者免疫功能,延长生存时间。     

帕米磷酸二钠治疗恶性肿瘤骨转移高钙血症的临床疗效分析

目的探讨帕米磷酸二钠注射液治疗恶性肿瘤骨转移所致高钙血症的临床疗效及安全性。方法选择52例诊断为恶性肿瘤骨转移所致高钙血症的患者为研究对象,随机分为研究组和对照组,每组各26例。研究组患者采用帕米磷酸二钠治疗,对照组患者采用唑来磷酸治疗。两组均每月治疗1次,共治疗6个月。比较两组患者的血钙（Ca）、血磷（P）、甲状腺旁素（PTH）、碱性磷酸酶（AKP）、骨钙素（BGP）以及骨密度（BMD）的差异,随访6个月比较两组的临床疗效、止痛效果、转移灶改善、KPS评分及不良反应发生率的差异。结果与对照组相比,研究组患者的Ca、PTH、AKP、BGP和BMD均显著降低,而研究组的血P则显著升高（P〈0.05）;研究组的总有效率较高,各种不良反应发生率较高（P〈0.05）,而止痛效果、转移灶改善、KPS评分与对照组相比差异无统计学意义（P〉0.05）。结论帕米磷酸二钠治疗恶性肿瘤骨转移所致高钙血症的临床疗效显著,但不良反应较多。     

基于主观整体营养评分的个体化营养干预对胃癌术后化疗患者生活质量的影响

目的探讨基于主观整体营养评分量表(PG-SGA)的个体化营养干预对胃癌术后化疗患者生活质量的影响。方法选取2017年12月至2018年12月间榆林三院收治的82例行胃癌手术后化疗患者作为本次研究对象。采用随机数表法将患者分为观察组和对照组,每组41例。两组患者均行胃癌术后化疗常规护理,观察组患者在常规护理基础上行基于PG-SGA的个体化营养干预。比较两组患者护理干预后营养情况以及护理干预前后生活质量情况。结果干预后,对照组患者预后营养指数(PNI)低于治疗前,且观察组PNI指数高于对照组,差异均有统计学意义(均P <0. 05)。干预后,两组患者的躯体功能、角色功能、认知功能、情绪功能、社会功能和总体生活质量评分均上升,差异均有统计学意义(均P <0. 05);两组组间比较,观察组躯体功能、角色功能、认知功能、情绪功能、社会功能和总体生活质量评分均高于对照组,差异均有统计学意义(均P <0. 05)。干预后,两组患者症状维度评分下降,差异均有统计学意义(均P <0. 05);两组组间比较,观察组疲乏、疼痛和恶心呕吐评分低于对照组,差异均有统计学意义(均P <0. 05)。干预后,两组患者单项维度中呼吸困难、食欲丧失、便秘和腹泻评分均降低,差异均有统计学意义(均P <0. 05);两组组间比较,观察组呼吸困难、失眠和食欲丧失评分低于对照组,差异有统计学意义(P <0. 05)。结论基于PGSGA的个体化营养干预有助于改善胃癌术后化疗患者营养状态和生活质量。     

Experience in the treatment of synchronous and metachronous carcinoma of the oesophagus and the head and neck

BACKGROUND AND OBJECTIVES: Treatment of multiple primary squamous cell carcinomas of the head and neck and oesophagus is controversial. The poor prognosis of these 2 types of carcinoma taken individually and their anatomic proximity complicate the therapeutic strategy and limit the treatment choices for each location. METHODS: From 1986 to 1998, 43 patients received curative treatment for multiple synchronous (n = 30) or metachronous (n = 13) primary neoplasms of the oesophagus and head and neck. For synchronous cancers, the therapeutic strategy consisted of first curing the head and neck cancer and then planning oesophagectomy according to the type of head and neck cancer therapy. RESULTS: Ten total oesopharyngolaryngectomies and 33 subtotal oesophagectomies were performed. The postoperative mortality rate was 9.3% (4/43). The rate of anastomotic leakage was 30% (13/43), and all such leaks were cervical. Pulmonary infection occurred in 19% of cases (8/43). A past history of cervical radiation therapy or cervicotomy did not appear to be a significant risk factor for anastomotic leakage or pulmonary complications. Oesophagectomy did not affect the functional results in the 31 patients whose larynx could be preserved. CONCLUSIONS: Oesophagectomy after head and neck cancer treatment is possible with a low mortality rate and acceptable morbidity.     

Clinicopathological study of carcinomas of the lip and the mucosa of the upper and lower lips

BACKGROUND: Lip carcinomas are rare oral tumors, and there have been few reports of lip carcinoma in Japan. METHODS: Of 914 patients with oral carcinomas treated between January 1980 and December 1998, 12 (1.3%) had lip carcinoma and 5 (0.5%) had lip mucosal carcinoma. We investigated the clinicopathological features of these 17 patients. RESULTS: Of the 12 patients with carcinoma of the lip, 10 had squamous cell carcinomas (9, external lower lip; 1 commissures) and 2 had mucoepidermoid carcinomas (external upper lip). Of the 5 patients with lip mucosal carcinoma, 3 had squamous cell carcinomas (2, mucosa of the lower lip; 1, mucosa of the upper lip), 1 had mucoepidermoid carcinoma (mucosa of the lower lip), and 1 had acinic cell carcinoma (mucosa of the lower lip). Of the 12 patients with lip carcinoma, 9 were classified as stage I, 2 as stage II, and 1 as stage III; all 5 of the patients with lip mucosal carcinoma were stage I. Five patients with lip carcinoma were treated by resection, 5 by a combination of resection and reconstruction, and 2 by radiotherapy alone. All patients with lip mucosal carcinoma were treated by resection. After the initial therapy, 3 patients without neck dissection had regional recurrences and received delayed neck dissection, and 2 died with neck regional recurrence after dissection. The 5-year cumulative survival rates of the patients with lip carcinoma and those with lip mucosal carcinoma were 82.5% and 80.0%, respectively. CONCLUSION: We suggest that early-stage carcinomas of the lip and of the mucosa of the upper and lower lips are frequent, and we found that the outcome of these patients was excellent. However, an aggressive therapeutic approach to the lip carcinoma patient with cervical metastasis appears warranted, in an attempt to improve locoregional control and ultimate survival.     

The relation between the aging of the steroid generating system and the geneses of cancers of the stomach, the breast and the uterine cervix

The purpose of the present study is to test the validity of the steroid carcinogenesis hypothesis in humans by investigating the problem whether or not a cancer-specific change of the hormonal milieu emerges at a specified stage of life where the growth rate of cancer risk is at its zenith. A case-control study of 14 urinary steroid excretions was conducted for each of 3 human neoplasias. The identification and the size (in parenthesis) of the population units used in this study were,given as follows: a) the male gastric cancer group (421); b) the male control group (104); c) the female breast cancer group (245); d) the cervical cancer group (345); e) the female control group (127). Two kinds of steroid parameters were employed for the statistical analysis of hormonal data: a) the logarithm of a steroid excretion figure (mu g/day), as expressed by log x; b) the logarithm of a relative weight of a given steroid to tetrahydrocortisol, as expressed by log x/THF. The case-control difference for each parameter was expressed in terms of a t-value of Student's t-test. The steroid deviation profile was prepared for each neoplasia and for each of the log x data set and the log x/THF data set. The results obtained are as follows: a) the 2 steroid parameters (log x and log x/THF) for each of 14 urinary steroids were both subject to change with the progress of host age. The rate of age-dependent change was different for each steroid parameter and for each population unit. b) The above differential age dependency of the steroid parameters gave rise to a continual transition of the steroid deviation profile in the course of aging. c) The hormonal traits of male gastric cancer, female breast cancer and cervical cancer were described each as a complex of androgen depression and glucocorticoid stimulation (male gastric cancer), a sequential emergence of premenopausal progestin depression and postmenopausal predominance of glucocorticoid over androgen (female breast cancer), and a complex of androgen-glucocorticoid depression over progestin (cervical cancer). d) The emergence of the above cancer-specific steroid disorders chronologically coincided with the quasiexponential growth phase of cancer risk (and slow growth phase of cancer risk in postmenopausal breast cancer). e) The usefulness of the log x/THF type deviation profile for the assessment of the hormonal milieu of the host was verified by both theoretical approach to the problem and its application to the real data of a case-control study. f) The age dependent decline of androgens was generally much faster in their progressions than that of glucocorticoids - a finding to suggest the possibility that the production of a cancer-specific steroid deviation profile might have taken the form of the stress shift of Hans Selye, since both phenomena share depletion of gonadal steroids relative to glucocorticoid in common. The etiological relevancy of the 3 cancer-specific steroid changes to the geneses of 3 cancers:was discussed in the light of the experimental pathology studies in our laboratory as well as in other laboratories.     

Degree of manifestation of therapeutic pathomorphosis and the nature of the change in the estrogen and progesterone receptors after the radiation and chemotherapy of breast cancer

Estradiol and progesterone receptor levels were measured in 130 patients with stage III breast tumors before treatment and following preoperative radiation or chemotherapy. The data were evaluated versus the morphologic features of posttreatment pathomorphosis of tumor. Standard fractionated radiation (total dose of 70 Gy) was followed by pronounced postradiation pathomorphosis and a decrease in the level and incidence of steroid receptors in 72.7-87.5%. The essentially unchanged receptor profile of tumor following large-fraction (total dose-20 Gy) irradiation as well as presence of estradiol and progesterone receptors in the originally receptor-negative neoplasms after chemotherapy were matched by a slight degree of pathomorphosis.     

Effect of freezing the helix and the rim or edge of the human and pig ear

We have studied the effect of increasing freeze times on the normal pig's ear and on a variety of lesions of the human ear. The clinical and laboratory data suggest that cartilage necrosis secondary to cryosurgery is a dose-related phenomenon and is uncommon with the freeze times used in clinical practice. Cryosurgery is an effective and cosmetically acceptable treatment for superficial skin lesions of the ear.     

Patient-reported outcomes: Assessment and current perspectives of the guidelines of the Food and Drug Administration and the reflection paper of the European Medicines Agency

AimsPatient-reported outcomes (PROs) have recently gained greater credibility with regulatory bodies aiming to standardise their use and interpretation in RCTs, thereby supporting medicinal product submissions. For this reason, the United States (US) Food and Drug Administration (FDA) and the European Medicines Agency (EMEA) have released guidelines. This review paper provides an overview of the current perspectives and views on these guidelines.MethodTo evaluate the FDA and EMEA PRO guidelines, 47 expert responses to the FDA guidance were qualitatively reviewed. Two reviewers independently extracted data from these letters and checked these responses to warrant consistency and agreement in the evaluation process. A PubMed literature review was systematically examined to obtain supporting evidence or related articles for both the guidance documents.ResultsGenerally, there is agreement between regulatory authorities and the research community on the contents of the FDA and EMEA PRO draft guidance. However, disagreements exist on significant philosophical topics (e.g. the FDA focuses more on conceptual models and symptoms than the EMEA) and design topics (e.g. the FDA is more restrictive on issues of recall bias, blinding of oncology trials and degrees of psychometric validation than researchers and the EMEA). This could influence the approval of PRO claims.ConclusionPRO guidance from the EMEA and FDA has been valuable, and has raised the profile and active debate of PROs in oncology. However, our review of the current opinion shows that there are controversial aspects of the guidance. Consequently, greater latitude should be given to how the guidance is interpreted and applied.     

Osteonecrosis of the jaw and the role of macrophages

Nitrogen-containing bisphosphonates have been associated with the development of osteonecrosis of the jaws (ONJ), but the lack of reliable epidemiological data and appropriate animal models has restricted our understanding of ONJ pathophysiology and limited its management. The best available information is from histopathologic findings, which implicate bone necrosis and infection, although it is not clear which is primary. However, there are data suggesting that macrophages could well be the central factor in allowing the infection to develop first, followed by local necrosis, which could also account for the development of ONJ in patients treated with denosumab, a human monoclonal antibody to the receptor activator of nuclear factor-κB ligand. This review examines the evidence that macrophages could play a prominent role in development of ONJ and the proposal that it may be more appropriate to view ONJ as a drug and not only a bisphosphonate-related complication.     

Urbanization and the incidence of abnormalities of squamous and glandular epithelium of the cervix

BACKGROUND: The large data bases of the Dutch cervical screening program can be exploited to establish the relation between urbanization and the incidence of abnormalities of the squamous and glandular epithelium, including mild or greater changes of the squamous and glandular epithelium of the cervix. METHODS: Six cytology laboratories in the context of the Dutch cervical screening program screened over 190,000 cervical smears. Urbanization (place of residence) data were derived from postal codes. All smears were coded with the Dutch national coding system, the Dutch national classification system KOPAC, in which squamous abnormalities are coded S4-S9, and glandular cell changes are coded G4-G9. From the scores per 1000 screened women, the relative risk (RR) of living in a large city compared with living in rural areas was calculated. To investigate a trend in incidence in relation to urbanization, the Schaafsma method was used. RESULTS: Of the smears with positive cytology, mild squamous dysplasia (S4) had the highest incidence per 1000 screened women (4.32), and the lowest incidence was found for adenocarcinoma (in situ; G7/G9; RR, 0.07). The RR for urban women ranged from 1.73 for moderate squamous dysplasia (S5) to 7.55 for adenocarcinoma (in situ; G7/G9). For smears with positive cytology for both squamous and glandular abnormalities, the Schaafsma method indicated a significant positive trend. CONCLUSIONS: The incidence of squamous and glandular abnormalities are maximal in women who live in a large city, which, in The Netherlands, is where there also is a population at high risk for human papillomavirus and bacterial vaginosis.