Clinical research on nourishing yin and unblocking meridians recipe combined with opioid analgesics in cancer pain management

Objective： To investigate the analgesic effects of Nourishing yin and Unblocking meridians Receipe （NUR） combined with opioid analgesics in managing cancer pain. Methods： All the patients enrolled were differentiated as of yin deficiency and meridian blocked syndrome type of TCM. Forty-one of them in the treated group were treated with NUR combined with opioid analgesics, while 43 of them in the control group were given opioid analgesics alone with successive 14 days as one treatment course for both groups. Results： The indexes of the treated group were superior to those in the control group as to the degree of pain-relieving, the therapeutic effect of analgesia, the occurrence frequency of cancer pain every day and its duration each time, the analgesic initial time, and the quality of life. Conclusion： NUR combined with opioid analgesics in cancer pain management was more effective than opioid analgesics alone. KEY WORDS     

TREATMENT OF PAIN ACCORDING TO SYNDROME DIFFERENTIATION IN 169 CASES OF LIVER CANCER

In 169 cases with liver cancer pain,thetherapeutic effects of TCM and the authors'“analgesictherapy of four steps”were analysed.The resultswere that most patients with advanced liver cancerhad mild pain,and only a small number of patients(14.2%)had moderate or severe pain.By the firststep analgesic therapy,46.1% of the patients wererelieved and with the second or third step of analgesictherapy,93.5% of the patients were relieved,only6.5% of the patients with wade Ⅲ pain needed thefourth step therapy.With TCM treatment alone,theremission rate of grade Ⅰ and grade Ⅱ pain was 100%and 76.9% respectively.“Analgesic therapy of foursteps”produced less side effects or addiction tonarcotics.     

CLINICAL STUDY ON ACUPUNCTURE TREATMENT OF STOMACH CARCINOMA PAIN

Clinical observation on 48 cases of stomach carcinoma pain indicated that acupuncture including filiform needle group and point-injection group had better therapeutic effects in treatment of stomach carcinoma pain when patient's mind was concentrated at the site of disease. After treatment for 2 months, the long-term effective rates of analgesia in both the filiform needle group and the point-injection group were similar to that in the western medicine group, all being about 81%. While the long-term markedly effective rates in the two groups were superior to that in the western medicine group. Life quality of the patients in all the groups were improved. The toxic action and side effects caused by chemotherapy were prevented, the high viscous state showed by indexes of blood rheology was unproved, and the lowered Cu-Zu-SOD activity in erythrocytes in patients of stomach carcinoma was increased in the filiform needle group and the point-injection group. Based on the results of clinical study, we consider that acupuncture analgesic effect on stomach carcinoma is related to the increase of PLEK, improvement of cellular immune function and the elevation of life quality after acupuncture.     

Surgical treatment of 21 patients with spinal metastases of differentiated thyroid cancer

Background Differentiated thyroid cancer （DTC） is a common primary cancer for spinal metastases （SM）.The treatments for DTC spinal metastases （SM） have evolved from simple surgery and radiotherapy to a multidisciplinary comprehensive therapeutic strategy of combined spinal surgery,general surgery,radiotherapy,nuclear medicine and endocrinology.The purpose of this study was to discuss the efficacy and prognosis associated with different surgical treatments of SM patients with DTC.Methods A total of 21 consecutive patients with SM of DTC that were treated between 1999 and 2013 were studied.Biopsy was routinely performed to achieve the pathological diagnosis before treatment.Three patients underwent total spondylectomy intralesionally or piecemeally,and 18 had curettage.Postoperative recurrence and survival times were analyzed by the Kaplan-Meier methods.Results Nineteen patients （90％） had an average of 42.7 months （range,7-170 months） follow-up.The median visual analogue scale for pain reduced from 5 points to 1 point （P ＜0.01）,and the median Karnofsky performance score increased from 70 to 90 points after surgery （P ＜0.01）.Seventeen patients with neurological deficits attained improvements after surgeries,of at least one level according to the Frankel classification （P ＜0.01）.Eight patients with curettage had recurrence.Four patients died of DTC,12 patients lived with disease,and three patients were disease-free.No significant effects on postoperative recurrence or survival were observed between surgery combined with conservative treatment,total spondylectomy,the number of bone metastases and visceral metastasis.Conclusions DTC-SM have a relatively favorable prognosis,and curettage and stabilization can effectively relieve the pain and improve the quality of life and neurological status of the patients.For patients with Tomita scores of ＜3,total spondylectomy may have better clinical outcomes.Comprehensive therapeutic strategies including surgery,radioiodine,external beam     

Unilateral sacrospinous ligament fixation for treatment of genital prolapse

Background Genital prolapse affects 30% of middle-aged and older women and is becoming a major public health concern. Sacrospinous ligament fixation is an effective and safe procedure for vaginal vault prolaps with a low recurrence and complication rate. This study aimed to investigate the efficacy and safety of unilateral sacrospinous ligament fixation （SSLF） for the management of pelvic organ prolapse （POP）.Methods Forty patients with severe prolapse of pelvic organ undergoing unilateral SSLF were retrospectively studied.In this study, all patients were staged by the value of POP-Q. All procedures were performed by a senior physician. The characteristics of these patients and their immediate and short-term post-operative outcome were recorded. All patients were seen six weeks and six months after the surgery. The evaluation included standardized questionnaire and site-specific vaginal examination by one physician.Results The average operation time was 65-92 minutes. The average blood loss was 83-188 ml. The average hospitalization time was 6.1 days. The average cost was 5885 yuan. The average day of urethral catheter removal after the operation was 2.1 days. The incidence of postoperative morbidity was 17.1%. One （2.4%） patient had hematoma in the right pelvic. The mean length of postoperative follow-up for 35 patients was 13.1 months. The rate of follow-up was 87.5%. One （2.9%） patient showed recurrent vaginal vault prolapse six months after the surgery. The objective success rate of pelvic organ prolapse was 85% （34/40）. There was significant difference between the POP-Q of Aa, Ba, Ap, Bp,and D before and after operation （P 〈0.001 ）. Five （14.3%） patients complained lower back pain, gluteal pain or right groin pain. Three （8.6%） patients developed de novo stress incontinence. Vaginal disabsorbable sutures were found in three （8.6%） patients. One （2.9%） patient had de novo urge incontinence.Conclusions Unilateral SSLF was both cost and treatment effective management for severe pelvic organ prolapse,especially for severe ovaginae anterior prolapse and uterus prolapse of POP Ⅰ, Ⅱ or Ⅲ. Main complications from this procedure included lower back pain, gluteal and groin pain and new onset of stress incontinence.     

Prognostic significance of MDR-1 P-glycoprotein expression in breast cancer

Objective: To investigate the expression of MDR-1 P-glycoprotein(MDR-1 Pgp) in breast cancer and analyze its correlation to the biological behavior and prognosis of the disease. Methods:The expression of MDR-1 Pgp was examined in 75 cases of breast cancer patients by using three different monoclonal antibodies(JSB1, C219 and C494) with S-P immunohistochemisty. These patients were followed up for 5 years, and the correlation between MDR-1 Pgp expression, survival rate and lymph metastasis was analyzed. Results: Positive detection of MDR-1 Pgp by JSB1, C219 and C494 in 75 cases of breast cancer was 86.7%, 48% and 85.3%, respectively. MDR-1 Pgp expression was not related to ages of patients (P > 0.05). JSB1-detected expression of MDR-1 Pgp was related to lymph node metastasis(P < 0.05); while C219 and C494 were not(P > 0.05). The patients with MDR-1 Pgp expression positively detected by either two of the three antibodies, had five-year survival rate that was significantly higher than those positively detected by all the three antibodies(P < 0.05). Conclusion:Three antibodies should be used simultaneously to detect MDR-1 Pgp expression in breast cancer. Positive MDR-1 Pgp expression in breast cancer detected by all the three antibodies may represent a poor prognosis; while positive MDR-1 Pgp detection by JSB1 and C494 is associated with lymph metastasis.     

THE TREATMENT OF PAIN IN BONE METASTASIS OF CANCER WITH THE ANALGESIC DECOCTION OF CANCER AND THE ACUPOINT THERAPEUTIC APPARATUS

The pain in 286 cases of bone metastasis of cancer was treated with an analgesic decoction of herbal drugs in combination with the Acupoint Therapeutic Apparatus that generated low frequency electric impulses into the acupoints. This series of patients comprised 104 cases of medium pain and 182 cases of severe pain, which was practically or completely relieved in 17 or 29 minutes respectively after the treatment; the total effective rate was 74.2% for 212 cases, and the duration of analgesic effect lasted 2.7 hours to 5.2 hours, averaging 3.6 hours. The cases that needed considerable dosages of analgesic tablets or sedatives markedly re-duced their requests of such drugs. Determination of bone marrow stem cells indicated that the herbal treatment produced effects of promoting and protecting the stem cells. The rate of lymphocyte transformation was 45-76% before the treatment and rose to 57-96% after the treatment, demonstrating an increase of 15.2%, which was statistically significant (P< 0.001). The analgesic effect of the decoction was not correlated to the age and sex of the patients or the variety of cancer, except that it was not effective for uterine carcinoma. The main side effects included nausea, vomiting, somnolence, and numbness of the tongue.     

Detection of human papillomavirus types 16, 18 DNA related sequences in bronchogenic carcinoma by polymerase chain reaction.

In studying the relationship between human papillomavirus (HPV) and bronchogenic carcinoma, "high-risk" HPV 16, 18 DNA sequences were detected in samples from 50 lung cancer patients, 18 patients with benign pulmonary diseases and 4 fetal lung tissues by polymerase chain reaction (PCR) and dot-blot hybridization with biotin-labelled probes. The results showed that HPV 16, 18 DNA related sequences were found in 32% of lung cancer specimens, with 10 cases of HPV 16, 5 cases of HPV 18 and I case of both types. 48.15% (13 / 27) of squumous cell carcinomas were shown to be positive for HPV 16, 18 DNA. In addition, two adenocarcinomas and one small cell carcinoma were positive for HPV 16 DNA. No specimens from benign diseases tissues and fetal lung tissues showed positive results. These results suggest that primary bronchogenic carcinoma is related to HPV infection.     

Effect of Oral Chinese Medicine Combined with Western Medicine on Cancer Pain: A Meta-Analysis

Objective: To assess the effect of oral Chinese medicine (OCM) combined with Western medicine (WM) on cancer pain. Methods: PubMed, Embase, Cochrane Library, Clinical Trials Registry Platform, Chinese National Knowledge Infrastructure (CNKI), Wanfang and VIP databases were searched from their inception to September 2019. Randomized controlled trials (RCTs) treating cancer pain by Chinese medicine (CM) combined with WM were included. The primary outcome were total pain relief rate and the quality of life (QOL), and the other outcomes were the average daily dosage of analgesics, the primary time of pain, the analgesic duration time, and adverse events. The methodological quality of RCTs was assessed in accordance with Cochrane 5.1.0 handbook of systematic reviews of interventions. Evidence level was assessed by the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) approach. Results: There were 1,087 patients in the 14 studies, with 544 in the experiment group and 543 in the control group. These studies were all conducted in China, and published between 2006 and 2019. Compared with the WM, OCM combined with WM could significantly relieve the cancer pain [risk ratio (RR)=1.43, 95% confidence interval (CI): 1.32, 1.56), improve QOL (RR=8.57, 95% CI: 4.25, 12.89), decrease the primary time of pain (RR=–0.20, 95% CI: –0.24, –0.16], prolong the analgesic duration time (RR=3.47, 95% CI: 2.09, 4.85), reduce the dosage of analgesics (RR=–19.52, 95% CI: –36.32, –2.72), and reduce side events (RR=0.49, 95% CI: 0.37, 0.65). Evidence levels for total pain relief rate, primary time of pain and side events were low, evidence level for QOL, analgesic duration time and average daily dosage of analgesics were very low. Conclusions: Compared with the WM, OCM combined with WM could significantly relieve the cancer pain, improve the QOL, decrease the primary time of pain, prolong the analgesic duration time, reduce the dosage of analgesics and side events. The evidence levels were low or very low.     

CLINICOPATHOLOGICAL CHARACTERISTICS OF ADVANCED COLORECTAL CANCER 30 mm OR SMALLER IN DIAMETER

Objective To investigate the clinicopathological characteristics of advanced colorectal cancer which was 30 mm or smaller in diameter. Methods Retrospective analysis documented 80 patients with small advanced colorectal cancer from May 1985 to May 2002. According to the diameter of tumors, all patients were divided into three groups: Group A (10 mm or less), Group B (11-20 mm), Group C (21-30 mm). Considering the number of patients in Group A was smaller, we combined Group A with Group B as Group D. Then various clinicopathological characteristics were compared between Group C and Group D. Results The most common site of small advanced colorectal cancer was sigmoid colon and rectum that accounted for 36.2% and 35.0% of all cases. The average diameter of total tumors was 23.3 mm. Type 2 was the most common macroscopic type (63.7%) and the moderate differentiation was seen in 77.5% of cases. Thirty-eight (47.5%) cases had lymph node metastasis. Three (3.8%) cases had liver metastasis and three (3.8%) cases had peritoneal metastasis. The frequency of lymph node metastasis was found significantly different between Group C and Group D (54.2% vs. 28.6%, P<0.05), as well as between the groups with different depth of invasion (P<0.05). Curability A resection was performed in 69 (86.2%) cases. Conclusions Tumor size and depth of invasion are related to lymph node metastasis in small advanced colorectal cancer. However, the small size of tumor may not always be a.reliable parameter for estimating the risk of lymph node metastasis. Small colorectal cancers also do not always mean the early stage. Surgeons should be aware of the features of small advanced colorectal cancers to select ideal management and perform perfect resection.     

乐山市医护人员癌痛认知调查分析

目的：了解乐山市相关医护人员对癌痛的认知现状,以期对癌痛的规范化诊治做全面评估及科学指导。方法对本地区18家医院的肿瘤诊治相关科室医护人员共318人,以问卷形式进行癌痛认知调查,调查问卷用SPSS 软件行信度分析,Cronbach 阿尔法数值大于0.7,表明问卷信度可靠,问卷涉及各项内容以百分数统计呈现。结果完全相信病人疼痛程度的占31.8%,担心病人使用阿片类药易成瘾的占30.7%,了解并应用疼痛分级数字化评分确定癌痛等级的占46.2%,有26%的医护人员秉持不痛就不给药的观点,使用杜冷丁止痛治疗的占16.4%,对于吗啡类药物副反应有18%的医护人员在症状严重时才处理或不处理,用药后很少或不评估的占23.5%,有31.2%的很少或不遵循三阶梯止痛原则,大剂量吗啡缓释片治疗疼痛的只占6.5%。结论乐山地区癌痛治疗尚存在医护自身判断疼痛程度、担心病人成瘾、阿片类药剂量不足及对副反应处理不及时等情况,需加强基层医疗机构医护工作者的癌痛相关知识的不断培训,提高各级医疗卫生单位医护人员癌痛诊治专业素质及专业技能,进行癌痛的规范化治疗,切实提高患者生活质量。     

应用三阶梯止痛治疗晚期癌症53例疗效观察

目的：观察三阶梯止痛对晚期癌症病人的止痛效果。方法：应用世界卫生组织推荐的三阶梯止痛法,即第一阶梯给非激素消炎镇痛药,第二阶梯给弱阿片类止痛药,第三阶梯给强阿片类止痛药。结果：本组53例有效率94．3％,其中：CR43例,占81．1％;PR6例,占11.3%;NR3例,占5．7％,结论：三阶梯止痛法为晚期癌症病人解除疼痛,提高生活质量提供了有效的手段。     

Treatment of pain according to syndrome differentiation in 169 cases of liver cancer

In 169 cases with liver cancer pain, the therapeutic effects of TCM and the authors' "analgesic therapy of four steps" were analysed. The results were that most patients with advanced liver cancer had mild pain, and only a small number of patients (14.2%) had moderate or severe pain. By the first step analgesic therapy, 46.1% of the patients were relieved and with the second or third step of analgesic therapy, 93.5% of the patients were relieved, only 6.5% of the patients with grade III pain needed the fourth step therapy. With TCM treatment alone, the remission rate of grade I and grade II pain was 100% and 76.9% respectively. "Analgesic therapy of four steps" produced less side effects or addiction to narcotics.     

阿片类药在癌痛治疗时能否产生依赖

所有阿片类药的控、缓释片都必须整片吞服,不可掰开、嚼碎或压碎,否则会造成过量致命的风险。忧虑阿片类药滥用和成瘾不应该妨碍癌痛的适当治疗。阿片类药在癌痛治疗时的合理使用发生心理依赖(成瘾)是很罕见的。     

腕踝针对中重度肝癌疼痛的镇痛疗效观察

目的:观察腕踝针对中重度肝癌疼痛的镇痛疗效.方法:将94例肝癌疼痛患者根据疼痛程度分为5组,即中度疼痛2组,重度疼痛3组.中度疼痛分为腕踝针治疗Ⅰ组与可待因治疗组,每组20例;重度疼痛分为腕踝针治疗Ⅱ组16例、美施康定治疗组20例、腕踝针加美施康定治疗组18例.观察各组的镇痛效果、镇痛特点及不良反应.结果:腕踝针治疗对中度疼痛的缓解率为85.0%,对重度疼痛的缓解率为63.0%,腕踝针加美施康定治疗对重度疼痛的缓解率为83.3%.腕踝针治疗具有起效快,持续缓解时间长的特点,对重度疼痛患者可降低药物不良反应发生率.结论:腕踝针治疗中重度肝癌疼痛疗效肯定.     

大剂量强阿片类药物副反应的临床观察

目的：观察大剂量强阿片类药物对重度疼痛的晚期癌痛患者的镇痛效果及不良反应。方法通过对460例晚期癌痛患者根据疼痛评估和疼痛程度给予大剂量强阿片类药物(HDM≥300mg／d)治疗。根据镇痛效果调整用药量。回顾性分析临床诊断、阿片类药物剂量、及不良反应。结果镇痛显效率为100%。并连续随访记录用药后不良反应。观察无1例出现呼吸抑制及成瘾。结论大剂量吗啡具有安全、镇痛效果稳定等优点,能提高患者的生活质量。     

盐酸羟考酮控释片治疗中重度癌痛的临床观察

目的:观察盐酸羟考酮控释片治疗中重度癌痛的疗效,不良反应及生活质量改善情况,同时观察不同的心理状态对疼痛程度和镇痛疗效的影响。方法:应用盐酸羟考酮控释片治疗62例中重度癌痛患者,盐酸羟考酮控释片起始剂量10mg/12h,根据患者的疼痛缓解程度对患者的剂量进行调整,以达到满意的镇痛效果。分析患者的镇痛改善情况,生活质量和治疗中的不良反应。分析心理状态的不同对疼痛缓解的影响。结果:62例患者中,有58例患者疼痛缓解满意,占93.5%。而消极悲观的患者,其疼痛更为严重,患者的镇痛效果不佳;积极乐观的患者,其疼痛相对较为轻微,其镇痛效果较好。经过治疗后,患者的生活质量得到明显的改善。所有患者治疗中主要不良反应为便秘。结论:盐酸羟考酮控释片治疗中重度癌痛安全有效,且能明显改善患者的生活质量;心理状态与疼痛程度和镇痛疗效密切相关。     

牙科患儿拒诊行为的因素分析及护理对策

目的：探讨牙科患儿拒诊行为的各种因素及护理对策。方法：通过对我科1200名牙科患儿的行为进行临床观察分析。拒诊原因主要有内向胆小的性格；患儿在就诊中有疼痛的经历；对牙科疾病性质的认识不够；患儿家长的态度；医护人员的言行举止等导致患儿产生恐惧心理而拒诊。结果：针对不同原因的牙科患儿采取不同的护理对策，使牙科患儿复诊拒诊率降低了41％。结论：牙科患儿的拒诊行为严重影响了儿童口腔的保健，对患儿进行相应的心理护理、行为训练、及不同年龄患儿的护理技术，可有效地减少患儿的拒诊行为。     

β-内啡肽与阿片类药物治疗癌痛疗效的关系

20世纪70年代,随着阿片受体的发现,体内的内源性阿片肽也被陆续发现.人们对内源性阿片肽的释放与癌痛的控制,以及应用阿片类药物对机体自身内源性阿片系统的影响进行了许多研究.本文就β-内啡肽的结构特点、受体结合特性与其镇痛作用,以及β-内啡肽的血浆浓度与应用阿片类药物治疗癌痛效果的关系做一综述.