草乌甲素胶丸辅助硫酸吗啡缓释片治疗中晚期癌痛

目的比较草乌甲素胶丸辅助硫酸吗啡缓释片与硫酸吗啡缓释片单药治疗中晚期癌痛的疗效差别。方法从我院疼痛门诊及病房就诊的中晚期癌痛患者中选符合入选标准的病例40例进行分组研究。随机分为草乌甲素胶丸辅助硫酸吗啡缓释片（A组）和硫酸吗啡缓释片单药（B组）。疼痛强度评价采用视觉模拟评分（VAS）,疗效评定标准采用VAS加权值计算。每隔1周记录1次,共4周,观察2组患者在镇痛有效率无差异时,硫酸吗啡缓释片使用剂量及患者不良反应发生率;监测治疗前及治疗2周后血清PGE-2、TNF-α数值。结果 A、B组疼痛缓解有效率均达95%时,A组每周硫酸吗啡缓释片使用剂量少于B组（P〈0.05）;A组不良反应发生率为35%,B组为55%,B组较A组明显升高;实验室指标显示治疗2周后A组血清PGE-2、TNF-α平均水平低于B组,有统计学意义（P〈0.05）。结论草乌甲素胶丸辅助硫酸吗啡缓释片治疗中晚期癌痛能减少硫酸吗啡缓释片使用剂量,并减少不良反应发生率。     

脊髓ERK-CREB信号通路在吗啡依赖大鼠戒断反应中的作用

目的 评价脊髓背角神经元细胞外信号调节激酶-cAMP反应元件结合蛋白(ERKCREB)信号通路在吗啡依赖大鼠戒断反应中的作用.方法 健康雄性SD大鼠,体重200 ～ 250 g,2月龄.经枕骨大孔行鞘内置管,取置管成功的50只大鼠,采用随机数字表法,将其随机分为5组(n=10):对照组(C组)、吗啡依赖组(MD组)、吗啡戒断组(MW组)、U0126组和二甲基亚砜组(DMSO组).皮下注射吗啡10mg/kg,2次/d,隔天每次增加10 mg/kg,至第6天末次注射50 mg/kg,建立吗啡依赖模型.末次注射后4h,MW组、U0126组和DMSO组腹腔注射纳洛酮激发吗啡戒断反应.给予纳洛酮前30 min时,U0126组和DMSO组分别鞘内注射U0126(溶于10μlDMSO中)150 μg和DMSO 10 μl.于注射纳洛酮后1h内行戒断反应评分和促诱发痛评分,注射纳洛酮后1h处死大鼠,取脊髓组织,分别采用免疫组织化学法和Western blot法测定脊髓背角磷酸化ERK(p-ERK)和磷酸化CREB(p-CREB)的表达.结果 与C组比较,MW组脊髓背角p-ERK和p-CREB表达上调(P＜0.05);与MD组比较,MW组、U0126组和DMSO组戒断反应评分和促诱发痛评分升高(P＜0.05);与MW组比较,U0126组戒断反应评分和促诱发痛评分降低,脊髓背角p-ERK和p-CREB表达下调(P＜0.05),DMSO组上述指标差异无统计学意义(P＞0.05).结论 脊髓背角神经元ERK-CREB信号通路参与了吗啡依赖大鼠的戒断反应.     

CX3C趋化因子受体1对骨癌痛大鼠吗啡耐受时脊髓背角μ受体和辣椒素受体表达的影响

目的 评价CX3C趋化因子受体1(CX3 CR1)对骨癌痛大鼠吗啡耐受时脊髓背角μ受体和辣椒素受体(TRPVl)表达的影响.方法 清洁级成年雌性SD大鼠,体重180-200 g,月龄3月,经L3.4棘突间隙行鞘内置管,取鞘内置管成功的大鼠48只,采用随机数字表法,将大鼠随机分为4组(n=12):对照组(A组)、鞘内注射生理盐水组(AM组)、鞘内注射IgG组(GM组)和鞘内注射CX3CR1中和抗体组(BM组).A组仪手术暴露右侧胫骨七段;其余3组右侧胫骨上段骨髓腔注入Walker256 乳腺癌细胞10μl(400个/ μl)建立骨癌痛模型,术后第10天开始鞘内注射吗啡20tg/kg,2次/d,连续7d,建立骨癌痛-吗啡耐受模型,注射吗啡第8天分别经鞘内注射相应溶液10μl,1次/d,连续3d.分别于接种Walker 256乳腺癌细胞前(T0)、接种后第3、6、9天、注射吗啡第3、7天、鞘内注射抗体第3天(T1-T6)时测定机械缩足阈值(MWT)和机械缩足持续时间(MWD),于T6时测定痛阈后处死大鼠,取脊髓L4-6节段组织,采用Western blot法检测脊髓背角小胶质细胞CX3 CR1蛋白的表达,采用免疫组化法检测神经元μ受体和TRPV1的表达.结果 与A组比较,BM组T2.3.5时、AM组和GM组T2,3,5,6时MWT下降,MWD升高,T6时CX3CR1蛋白和TRPV1表达上调,μ受体表达下调(P＜0.01);与AM组和GM组比较,BM组T6时MWT上升,MWD降低,CX3CR1蛋白和TRPV1表达下调,μ受体表达上调(P＜0.01).AM组和GM组上述指标差异无统计学意义(p＞0.05).结论 CX3CR1可通过下调大鼠脊髓背角μ受体和上调TRPVI参与骨癌痛大鼠吗啡耐受的形成.     

冠心病合并糖尿病患者护理依赖性现状及影响因素分析

目的：调查冠心病合并糖尿病患者护理依赖性情况,并分析其影响因素。方法：采用便利抽样法选择142例冠心病合并糖尿病患者为研究对象,使用护理依赖性量表（CDS）对患者的护理依赖性进行调查。结果：冠心病合并糖尿病患者CDS 总分为（44.85 ± 16.47）分,护理依赖发生率为 64.79%。文化程度、服药种类、是否了解病情、是否合并其他慢性疾病、是否行介入手术影响患者的护理依赖程度（P<0.05）。结论：冠心病合并糖尿病患者的护理依赖性发生率偏高,在护理过程中多关注文化程度低、服药种类多、不了解病情、合并其他慢性疾病及接受介入手术治疗的患者,制定合理的护理计划,实行有效的护理干预措施,以降低冠心病合并糖尿病患者的护理依赖性。     

Intravenous drug dependence in adolescence

Purpose To explore psychosocial background and preceding substance use related to intravenous drug dependence (IDD) among adolescents.

Methods A clinical sample of 278 adolescents (age 12–17) admitted to psychiatric inpatient hospitalization between April 2001 and January 2004 was studied. Data concerning psychosocial variables and substance use were gathered from the Schedule for Affective Disorder and Schizophrenia for School‐Age Children Present and Lifetime (K‐SADS‐PL), the European Addiction Severity Index (EuropASI) and the interview schedule of the First Treatment Demand protocol of the Pompidou Group of the Council of Europe.

Results The prevalence of IDD was increased if the adolescent was living without biological father or mother, had history of truancy or had been transferred to special class. Initiation age of IDD was significantly lower if the adolescent was living without biological father or mother, the mother of the adolescent was employed full‐time or if the adolescent had been transferred to special class. Early substance experiment was associated with IDD and with earlier initiation of intravenous use. The progression from regular tobacco use to IDD was faster among girls compared to boys.

Implications Common milestones in the progression of IDD are school problems, disturbed relations to parents and previous substance experiments at young age.     

The Fagerstrom test for nicotine dependence and its relationship to NRT use and readiness‐to‐quit

Scores on the Fagerstrom Test for Nicotine Dependence are used as a basis for recommending nicotine replacement therapy (NRT) as an aid to smoking cessation on a number of commercial websites. This study investigated (a) whether dependence on nicotine per se was necessary to score highly on the FTND and (b) whether successful quitters using NRT, with matched scores on the FTND, would report greater difficulty in stopping than successful quitters not using NRT. The paper reports a study with two inter‐related parts. In the first part, 24 smokers and 24 never‐smokers completed the FTND. The never‐smokers were asked to respond as if they were smokers. No significant differences were found between groups either at the total or individual‐item level, suggesting that results can derive from motivated or strategic responding. In part 2, 28 ex‐smokers were matched for age, gender, and FTND scores. Half had used NRT (nicotine patches) and half had not. NRT users reported that smoking was subjectively harder to give up (p<0.05). There was a general attribution across both NRT and non‐NRT groups to internal psychological factors being important for cessation. It is suggested that both high‐dependent scores on the FTND and NRT use are consequences of common motivation and a general ‘readiness to quit’.     

The efficacy and predictive value of the Heavy Smoking Index for smoking cessation among daily smokers in a public health center

Objective: The present study tested the effectiveness of the Heavy Smoking Index (HSI) for the screening of high nicotine dependence and the predictive value of HSI on smoking cessation within a community sample in a public health center. Methods: The Fagerström Test for Nicotine Dependence (FTND) scores from 1069 smokers who visited a public health center in Korea was analyzed. Receiver operating characteristic analyses were performed to calculate sensitivity and specificity values to compare the effectiveness of HSI to items 1 and 4 of FTND. In addition, HSI at baseline was found to predict smoking cessation after 4 weeks and after 6 months using logistic regression. We assessed whether HSI at baseline would predict smoking cessation after 4 weeks and after 6 months using logistical regression. Results: For the results, a score of 4 on HSI was considered optimal. Additionally, the predictive value for smoking cessation of both HSI and FTND were found to be statistically valid at baseline. Conclusions: Our results indicate that HSI is a useful brief screening tool to detect high nicotine dependence in a public health center.     

A Morphine Manifesto

EDITOR'S ABSTRACT

In conjunction with World Cancer Day 2012, three leading pain and palliative care organizations developed a statement on access to analgesics to provide freedom from pain as a human right. Numerous other professional organizations subsequently signed this manifesto calling upon governments, the pharmaceutical industry, and health institutions to make available immediate-release morphine at affordable prices for all in need of pain relief.

?This report is reprinted with permission of the originating organizations. For more information see: http://palliumindia.org/manifesto/.