蒙脱石散剂治疗白血病化疗所致口腔粘膜炎的效果观察

目的探讨蒙脱石散剂用于治疗白血病化疗所致口腔粘膜炎的临床效果。方法将89例白血病化疗后发生口腔粘膜炎的患者随机分为两组,均用3%双氧水和生理盐水擦拭口腔,丽珠口爽漱口及含漱,试验组45例,用蒙脱石散剂局涂,对照组44例予口腔药膜外贴,比较两组口腔粘膜炎患者的愈合情况。结果试验组与对照组在恢复进食时间和愈合时间上存在显著性差异(P<0.05),试验组明显短于对照组。结论蒙脱石散剂对化疗所致的不同程度的口腔粘膜炎作用明显优于普通的口腔药膜治疗。     

Radical scavenging activity of bisbenzylisoquinoline alkaloids and traditional prophylactics against chemotherapy-induced oral mucositis

Background and objective: Oral mucositis is a major severe toxic side‐effect of systemic chemotherapy and irradiation in patients with cancer. Various free radical scavengers have been shown to prevent chemotherapy‐induced skin necrosis. The objective of this study was to determine the antioxidant activity of a bisbenzylisoquinoline alkaloidal compound (BIQAC) and a series of chemicals, including allopurinol, used clinically for the treatment of chemotherapy‐induced mucositis. Methods: Allopurinol, melatonin, camostat mesilate, gabexate mesilate, hydroquinone and BIQAC were tested for their radical scavenging activities on four different radical species: 1,1‐diphenyl‐2‐picrylhydrazyl (DPPH) radical and 2,2′‐azino‐bis(3‐ethylbenzothiazoline‐6‐sulphonic acid) cation radical (ABTS^•+) using standard methods, and superoxide anion radical (O₂⁻) and hydroxyl radical (OH^•) using electron spin resonance. Results: Allopurinol had radical scavenging activity against O₂⁻ only. Melatonin had strong radical scavenging activity against ABTS^•+, and weak activity against DPPH radical and OH^•. Camostat mesilate had weak radical scavenging activity against OH^•. Gabexate mesilate had no radical scavenging activity against any of these radicals. Hydroquinone had strong radical scavenging activity against DPPH radical and ABTS^•+, and moderate activity against both O₂⁻ and OH^•. BIQAC had moderate radical scavenging activity against DPPH radical, strong radical scavenging activity against ABTS^•+ and O₂⁻, and weak activity against OH^•. Conclusion: The BIQAC had the most braod‐spectrum radical scavenging activity, suggesting that it may be effective against chemotherapy‐induced mucositis. These findings also suggest that this radical‐scavenging activity screening method, against four kinds of radicals, may be useful for the screening of radical scavenging activity of new natural and synthetic chemicals.     

Developing evidence-based guidelines for management of alimentary mucositis: process and pitfalls

Introduction It is important yet difficult to maintain currency in clinical oncology practice. The emergence of new diagnostic technologies and new paradigms for cancer treatment combine to produce a rapidly changing clinical approach to patients aided by the increasing use of multidisciplinary care teams and development of evidence-based protocols.Methods Teams of experts review the literature in a given area and produce management guidelines and protocols for use by practicing clinicians. Traditionally within Hematology/Oncology, these guidelines have been directed to management of a given tumor type. However, in recent years, attention has increasingly turned to supportive oncology; for example, there are now management guidelines for conditions such as neutropenic fever [Hughes et al. Clinical Infectious Diseases 34(6):730–751, 2002], antiemetic (The Antiemetic Subcommittee of the Multinational Association of Supportive Care in Cancer Annals of Oncology 17:20–28, 2006) and most recently, mucositis [Rubenstein et al. Cancer 100(9 Suppl):2026–2046, 2004]. It is critical that any guideline process should include education, evaluation, and timely update in its remit, because guidelines become highly compromised if their existence is not widely known, if they do not facilitate clinical practice, or if they are not reflective of contemporary medical literature.Results The Mucositis Study Group (MSG) of the Multinational Association for Supportive Care in Cancer/International Society for Oral Oncology was created in 1998 to specifically address the multiprofessional approach to clinical care, research, and education associated with mucosal injury in cancer patients. A specific outcome has been the development of evidence-based guidelines for the management of mucositis [Rubenstein et al. Cancer 100(9 Suppl):2026–2046, 2004; The Mucositis Study Group of MASCC/ISSO 2005]. The original guidelines [Rubenstein et al. Cancer 100(9 Suppl):2026–2046, 2004] and a companion paper discussing the science behind mucositis [Sonis et al. Cancer 100(9):1995–2025, 2004], were published in 2004. The MSG has recently updated the guidelines [The Mucositis Study Group of MASCC/ISSO 2005].Discussion This paper discusses the process involved and the lessons learned that might help other groups planning to undertake a similar project.     

降低白血病患者化疗相关口腔炎发生率的品管圈实践

目的探讨开展品管圈活动降低白血病患者化疗相关口腔炎发生率的效果。方法组建品管圈小组,以“降低白血病患者化疗相关口腔炎发生率”为主题,通过品管圈活动进行PDCA循环改进,根据口腔炎发生的原因制定对策并实施,最后评价实施效果。品管圈活动前(2019年2月—4月)和品管圈活动后(2019年5月—12月)白血病患者化疗总次数分别为45例次和54例次。结果化疗相关口腔炎由品管圈活动前的37.78%(17/45)降低至活动后的18.52%(10/54),差异有统计学意义(P<0.05)。结论开展品管圈活动能有效降低白血病患者化疗相关口腔炎发生风险。     

肿瘤病人口腔黏膜炎的综合处理

综述了肿瘤病人口腔黏膜炎的发病机制．重点论述了血液生长素、低温保护剂以及其他措施在治疗肿瘤病人口腔黏膜炎中的应用方法。     

肿瘤病人口腔黏膜炎的综合处理

综述了肿瘤病人口腔黏膜炎的发病机制,重点论述了血液生长素、低温保护剂以及其他措施在治疗肿瘤病人口腔黏膜炎中的应用方法。     

New pharmacotherapy options for noninfectious posterior uveitis

Introduction: Noninfectious posterior uveitis is a leading cause of visual impairment. Although conventional immunosuppressive agents have been successfully used, these are nonspecific and their long-term use may induce significant adverse effects. The purpose of this article is to identify recent advances and future therapeutic options in noninfectious posterior uveitis.

Areas covered: A MEDLINE database search was conducted through May 2014 using the terms: uveitis, treatment, intravitreal and corticosteroid, biological. To provide ongoing and future perspectives in treatment options, also clinical trials as registered at ClinicalTrials.gov were included.

Expert opinion: For individuals who do not respond to conventional immunotherapy, two major lines of treatments can be identified as focus in recent years: i) the intraocular application of anti-inflammatory drugs and ii) the introduction of new agents, for example, biologicals and small-molecule inhibitors. Whereas intravitreal treatments have the beauty of avoiding systemic side effects, new agents are gaining increased importance because of their highly targeted molecular effects. Even when current treatment strategies are still hampered by the paucity of randomized controlled trials, promising progress and continuous efforts are undertaken to close this gap. Still, a critical evaluation of new agents has to be made because ‘new’ agents are almost exclusively based on experience in other autoimmune disorders.     

口腔黏膜炎护理研究进展

从口腔黏膜炎的发生机制、评估量表的选用、相关危险因素及护理等方面对放疗及化疗所致口腔黏膜炎的护理研究进展进行综述。认为应依据循证医学证据,选用安全且疗效可靠的防治措施,积极处理并发症。     

New treatment options for chemotherapy-induced nausea and vomiting

Significant progress has been made in the development of effective, convenient, and well-tolerated means to prevent nausea and vomiting associated with cancer chemotherapy (CINV). Nevertheless, a substantial minority of patients continues to have suboptimal antiemetic control, and additional treatment approaches are needed. One avenue of investigation being pursued involves the evaluation of a new 5-HT₃ receptor antagonist (palonosetron) that differs from available serotonin antagonists in its markedly longer half-life (40 h) and greater binding affinity for the type-three serotonin receptor. Analysis of available clinical data demonstrates that palonosetron is an active and well tolerated new 5-HT₃ antagonist. Additional studies incorporating dexamethasone and repetitive-day conventional 5-HT₃ antagonist dosing will be necessary to definitively determine the relative efficacy of palonosetron compared to available agents. Another very promising area that moves beyond serotonin focuses on Substance P as a therapeutic target. Substance P is a tachykinin found in neurons in the brainstem. It is the preferred ligand for the neurokinin-1 (NK-1) receptor. Preclinical studies with selective NK-1 antagonists have demonstrated promising antiemetic activity. Subsequent clinical trials with selective NK-1 antagonists for the prevention of CINV have validated the preclinical promise demonstrated with these agents. One agent in this new therapeutic class (aprepitant) recently received regulatory approval in the United States for use in combination with a 5-HT₃ antagonist and dexamethasone, defining a new standard of care for highly-emetogenic chemotherapy.Presented in part at the Annual Meeting of the Multinational Association of Supportive Care in Cancer, Berlin, Germany, June 19, 2003.     

Gastrointestinal mucositis: a new biological model

The history of research into gastrointestinal mucositis (GIM), and how the future directions are informed by the progress made in the study of oral mucositis (OM) are discussed. It is proposed that OM and GIM should both be considered to be elements of alimentary mucositis (AM), which covers mucosal damage through the entire alimentary tract, with regional differences being due to the specialized needs of each area.This work was presented as an invited lecture at the 15th International Symposium Supportive Care in Cancer, Berlin, Germany, 18–21 June 2003.     

Prophylaxis with povidone-iodine against induction of oral mucositis by radiochemotherapy

Oral mucositis is a frequent complication of radiochemotherapy. The origin of radiation-induced mucosal lesions is iatrogenic in nature, although further development of mucositis is essentially influenced by infection. It can be assumed that disinfection measures should decrease the severity of mucositis induced by radiochemotherapy. Therefore, in a prospective randomised study the efficacy of prophylactic oral rinsing with a disinfection agent was investigated. A randomised, prospective comparative trial was conducted with 40 patients undergoing radiochemotherapy of the head and neck region because of malignant disease. The treatment scheme consisted of irradiation to the tumour region and adjacent lymph nodes, with a total dose of 71.3 Gy, and simultaneous chemotherapy with carboplatin (60 mg/m²) on days 1–5 and 29–34. In all patients mucositis prophylaxis with nystatin, rutosides, panthenol and immunoglobulin was undertaken. In addition, 20 patients rinsed the oral cavity 4 times daily with povidone-iodine solution, while the group for comparison rinsed with sterile water. Clinical examination of the oral mucosa was performed weekly. Onset, grading and duration of mucositis were used as the main variables. Clinically manifest oral mucositis was observed in 14 patients in the iodine group (mean grading: 1.0) and in all 20 patients in the control group (mean grading: 3.0). The total duration (mean) of clinically observed mucositis was 2.75 weeks in treatment patients and 9.25 weeks in control patients. Median AUC (area under curve for grade vs duration) was 2.5 in the iodine rinsing patients and 15.75 in control patients. All differences found between the two groups were statistically significant. Increased iodine incorporation was not observed. A pathologic rise in thyroid hormone levels was not found in the iodine group. The results obtained indicate that incidence, severity and duration of radiochemotherapy-induced mucositis can be significantly reduced by oral rinsing with povidone-iodine in addition to the standard prophylaxis scheme. It can be concluded that rinsing with povidone-iodine is an easy, cheap and safe prophylactic method and can be recommended as a supportive treatment during antineoplastic treatment of the head and neck region.     

Chemotherapy: the effect of oral cryotherapy on the development of mucositis

Aims and objective. The aim of this study is to investigate the effect of oral cryotherapy on the development of chemotherapy‐induced mucositis in patients administered combined chemotherapy. Background. Mucositis has been of interest to scientists for more than 20 years. Unfortunately, this has not resulted in the development of standard procedures for prevention and management. To cope with this side‐effect and to prevent opportunistic infections that may emerge during treatment, attempts are taken to provide preventative and comfort measures. In this context, cryotherapy (oral cooling) has become popular as a cheap and readily applicable method in preventing the developing due the rapid infusion of chemotherapy agents, or decreasing its severity. Design and method. Study involved 60 patients, 30 of whom were in the study group and 30 in the control group. Ice cubes at a size that can be moved easily in the mouth and whose corners have been smoothed in order that they will not cause irritation in the mouth has been used in oral cryotherapy in the study group. Oral chemotherapy was initiated five minutes before chemotherapy and maintained during venous infusions of etoposide (Vepesid®), platinol (Cisplatin®), mitomycin (Mitomycin‐C®) and vinblastin (Velbe®) depending on the chemotherapy course. Results. According to Patient‐Judged Mucositis Grading, the rate of mucositis is 36.7% in study group and 90.0% in control group, the difference between two groups being statistically significant (P < 0.05). According to Physician‐Judged Mucositis Grading, the rate of mucositis is 10.0% in the study group and 50.0% in the control group, the difference between two groups being statistically significant (P < 0.05). Oral pH values decreased in 90% of the subjects in study group, i.e. mucositis risk was reduced whereas oral pH values remained unchanged or decreased in 86.7% of the subjects in the control group, namely mucositis risk increased. The difference between study and control groups in terms of the change in pH values after chemotherapy was found to be statistically significant (P < 0.05). Conclusion. Our findings have demonstrated that oral cryotherapy makes an important contribution to the protection of oral health by reducing the mucositis score according to patient‐ and physician‐judged mucositis score and by increasing oral pH values. Relevance to clinical practice. Aggressive cancer therapy places patients at greater risk for oral complications and treatment‐related consequences. Unfortunately, prevention and/or treatment of such oral sequelae have often become overlooked as priorities of the treatment team. Effective approaches for the prevention or treatment of oral mucositis have not been standardized, and vary considerably among institutions. Prophylactic measures begin with an increased emphasis on improved oral status. Oral cryotherapy, the therapeutic administration of cold, is a prophylactic measure for oral inflammation. The relevance for clinical practice will be to understand the content of mucositis; comprehensive care should focus on the prevention of this complication in the clinical practice.     

脑外伤后康复用药

脑外伤的康复用药主要是防止脑外伤后脑组织的继发性损害及促进神经功能的恢复 . 前者包括钙通道阻滞剂、抗自由基及抗兴奋性氨基酸等药物 ; 后者主要是促进中枢神经功能的恢复 . 本文就其药理、用法和注意事项予以阐述 .     

异基因造血干细胞移植相关性口腔黏膜炎的防治

目的探讨口腔黏膜炎发生原因,规律和防治对策。方法对42例移植患者的口腔黏膜加强临床观察和护理并详细记录。结果本组口腔黏膜炎发生率为83%,部位多见于舌系带及舌缘两侧、双侧颊黏膜及上腭。口腔黏膜炎的发生与粒细胞减少和细胞毒性药物对黏膜上皮细胞损伤有关,一般为10～16d愈合,与造血重建相平行。本组患者口腔黏膜炎100%愈合。结论口腔黏膜炎是造血干细胞移植患者常见而严重的并发症,加强观察和护理能降低口腔黏膜炎发生率和程度,促进愈合。