Granisetron transdermal system and dexamethasone for the prevention of nausea and vomiting in multiple myeloma patients receiving chemo-mobilization: An observational real-world study of effectiveness and safety

PURPOSECyclophosphamide (CY) in a dose of 2–4 g/m² is widely used for hemopoietic progenitor stem cells mobilization. CY administration is associated with several adverse effects, including chemotherapy-induced nausea and vomiting (CINV). This study aimed to evaluate the efficacy and tolerability of granisetron transdermal system (GTDS) plus dexamethasone in the management of CINV in MM patients undergoing chemo-mobilization with CY.METHODSIn this single-center, prospective, observational, real world study, GTDS plus dexamethasone was administered to MM patients receiving chemo-mobilization based on CY 2 g/m2 plus G-CSF in an outpatient setting. The rate of complete response was evaluated as the main outcome. Other outcomes were rate of complete control of CINV, incidence of nausea/vomiting of any grade and safety.RESULTSA total of 88 patients were enrolled. A complete response was achieved in 45.5 % of patients; among them, 39.77 % attained complete control of CINV. Nausea and vomiting never occurred in 34.1 % and 45.5 % of patients, respectively. No episodes of grade 3–4 nausea and/or vomiting were documented. GTDS was safe and well tolerated.CONCLUSIONIn real world, GTDS provided an innovative, effective, and well-tolerated control of CINV in MM patients after chemo-mobilization with CY. The study found out effectiveness of a non-invasive delivery system of antiemetic.     

针刺治疗癌症化疗后恶心呕吐疗效的Meta分析＊

目的 系统评价针刺治疗癌症化疗后恶心呕吐的有效性和安全性。方法 采用计算机检索PubMed、荷兰医学文献数据库（Embase）、Cochrane图书馆（Cochrane Library）、中国期刊全文数据库（CNKI）、中国生物医学文献数据库（CBM）、维普中文科技期刊全文数据库（VIP）、万方学术期刊全文数据库（Wan fang）建库至2021年02月28日针刺治疗化疗后恶心呕吐的随机对照试验。采用RevMan5.4软件进行Meta分析。结果 本研究共纳入18篇文献，涉及1538名患者。Meta分析结果显示，针刺治疗化疗后的恶心呕吐在有效率（P<0.01，RR=1.17，95%CI=［1.09，1.26］）、症状完全缓解率（恶心：P<0.01，RR=1.42，95%CI=［1.14，1.76］；呕吐：P=0.01，RR=1.18，95%CI=［1.04，1.34］）及Karnofsky功能状态评分（KPS）（P<0.01，MD=3.97，95%CI=［1.55，6.39］］）等方面均优于对照组。亚组分析显示，消化道肿瘤试验组与对照组治疗有效率相当（P=0.45，RR=1.07，95%CI=［0.89，1.29］）；非消化道肿瘤试验组有效率优于对照组（P<0.01，RR=1.29，95%CI=［1.10，1.52］）。同时，试验组药物不良事件发生数远低于对照组，且针刺不良事件发生数较少。结论 针刺治疗癌症化疗后恶心呕吐是安全的，并可以提高有效率、症状完全缓解率，改善化疗后KPS评分，提高患者生活质量。     

Monitoring,prevention and treatment of side effects of long-acting neuraxial opioids for post-cesarean analgesia

Long-acting neuraxial opioids such as morphine and diamorphine, administered via spinal or epidural routes, are staple components of a multimodal approach to postoperative analgesia following cesarean delivery. The widespread use of neuraxial opioids is due largely to their significant analgesic efficacy and favorable safety profile. The most common side effects of neuraxial opioids are pruritus, nausea and vomiting. These symptoms appear to be dose-related. The most serious complication of neuraxial opioids is respiratory depression, which occurs in 0–0.9% of cases. Hypothermia has also been reported in association with neuraxial morphine use at cesarean delivery. This article will review recent advances in prophylaxis, treatment and monitoring of the side effects of long-acting neuraxial opioids.     

Vagal changes following cancer chemotherapy: implications for the development of nausea

Many physiological changes that occur contemporaneously with nausea are mediated by the autonomic nervous system, but the specific autonomic changes associated with nausea have not been characterized. Cardiac parasympathetic (vagal) activity as indicated by heart rate variability, measured as the standard deviation of successive differences (SDSD) in beat-to-beat intervals, was assessed in 24 women with ovarian cancer immediately prior to and accompanying nausea that occurred following anticancer chemotherapy. A progressive increase in SDSD followed infusion of the chemotherapy agent, indicating a rise in cardiac parasympathetic (vagal) activity, with onset of nausea consistently occurring after the peak activity had been reached, at a time when SDSD was decreasing. An increase in parasympathetic activity seems to set the stage for the expression of nausea but an additional stimulus is apparently needed to finally trigger the event.     

昂丹司琼对比托烷司琼预防上腹部分割放疗所致恶心呕吐的临床研究

目的 比较昂丹司琼和托烷司琼预防上腹部分割放疗所致恶心呕吐的有效性与安全性。方法 选择84例接受上腹部分割放疗的肿瘤患者为研究对象,采用随机数字表法分为昂丹司琼组（O组）和托烷司琼组（T组）,每组42例。记录两组患者放疗期间恶心呕吐及其他不良反应的发生情况。结果 O组急性期恶心的完全缓解（CR）率显著低于T组（81.0% vs. 57.1%, P=0.018）;两组延迟期和全期恶心的CR率（61.9% vs. 50.0%, P=0.272; 61.9% vs. 45.2%, P=0.126）比较,差异无统计学意义。两组急性期、延迟期及全期呕吐的CR率（71.4% vs. 64.3%, P=0.483; 59.5% vs. 57.1%, P=0.825; 66.7% vs. 57.1%, P=0.369）比较,差异均无统计学意义。两组头晕、头痛、疲乏、腹泻和便秘的发生率比较,差异均无统计学意义（P>0.05）。结论 昂丹司琼和托烷司琼预防上腹部分割放疗所致恶心呕吐具有相似的疗效和安全性,昂丹司琼预防急性恶心的效果优于托烷司琼。     

消瘤通腑散膏摩防治化学治疗后消化道反应临床观察

目的 观察消瘤通腑散膏摩防治化学治疗后消化道反应的疗效。方法 将60例化学治疗患者随机分为治疗组和对照组各30例,治疗组在化学治疗期间使用消瘤通腑散膏摩联合常规西医对症处理,对照组仅予常规西医对症处理,比较两组患者化学治疗后恶心、呕吐及便秘的情况。结果 治疗组在延迟性呕吐观察期总有效率高于对照组（P＜0.05）,且可以降低恶心、呕吐发生的程度（P＜0.05）,但在急性呕吐观察期优势不明显（P＞0.05）。治疗组防治化学治疗后便秘的有效率高于对照组,差异有统计学意义（P＜0.05）。结论 消瘤通腑散膏摩可以有效改善化学治疗后的延迟性呕吐及便秘症状,提高患者的生活质量。     

Mechanism of the prostanoid TP receptor agonist U46619 for inducing emesis in the ferret

U46619 is a potent thromboxane A₂ mimetic with emesis-inducing actions that are mediated via prostanoid TP receptors. We investigated its emetic mechanism of action in more detail using the ferret as model animal. The emesis induced by U46619 (30 μg/kg, intraperitoneal) was antagonized significantly by (+)-(2S,3S)-3-(2-methoxybenzylamino)-2-phenylpiperidine hydrochloride (CP-99,994; 1 and 10 mg/kg; P < 0.05) and metoclopramide (0.3 and 3 mg/kg), but not by domperidone (3 mg/kg), sulpiride (0.1 mg/kg), ondansetron (0.1 and 1 mg/kg) alone or combined with droperidol (3 mg/kg), GR125487 (1 mg/kg), promethazine (3 mg/kg), or scopolamine (3 mg/kg); GR 125487 (1 mg/kg) prevented the anti-emetic action of metoclopramide (3 mg/kg). U46619 0.3 μg administered into the fourth ventricle rapidly induced emesis. However, bilateral abdominal vagotomy was ineffective in reducing the emetic response (P > 0.05). Our data suggests that U46619 induces emesis via an extra-abdominal mechanism, probably within the brain. Metoclopramide probably has a mechanism of action to prevent U46619-induced emesis via 5-HT₄ receptor activation and NK₁ tachykinin receptor antagonists could be useful to prevent emesis induced by TP receptor activation in man.     

昂丹司琼联合止呕方案防治化疗所致呕吐60例

目的：观察小剂量昂丹司琼联合止呕方案对化疗所致恶心呕吐的疗效及不良反应。方法：采用自身对照方法,第１周期化疗时单用推荐剂量的昂丹司琼止呕（单用组）;第２周期用小剂量昂丹司琼联合甲氧氯普胺、地塞米松、地西泮、异丙嗪止呕（联合组）。结果：单用组有效率９１．７％,联用组９０．０％（Ｐ〉０．０５）;化疗后两组间逐日比较止呕疗效差异不显著（Ｐ〉０．０５）。结论：小剂量昂丹司琼联合止呕方案与单用推荐剂量昂丹司