小剂量氯胺酮辅助吗啡皮下自控镇痛治疗顽固性中/重度晚期癌痛

背景与目的: 疼痛是晚期癌症患者最主要的症状,也是影响癌症患者晚期生活质量的主要问题,如何治疗顽固性中/重度晚期癌痛,同时不增加不良反应的发生率是癌痛治疗的最人难题.本研究观察小剂量氯胺酮辅助患者吗啡皮下自控镇痛(PCSA)对顽同性中、重度晚期癌痛患者的可行性及镇痛疗效.方法: 选择52例中/重度晚期癌症疼痛患者,均为经三阶梯药物方案治疗未能很好控制疼痛、同时药物毒副作用较大的患者.按入院前后随机分成两组,分别采用PCSA吗啡(对照组)和小剂量氯胺酮联合吗啡PCSA(观察组)对患者进行镇痛治疗.两组均采用PCSA方法,镇痛液两组均为100 ml,对照组内含吗啡80 mg 2%利多卡因20 ml 氟哌利多2.5mg 0.9%氯化钠溶液共计100 ml.观察组内含吗啡40 mg 2%利多卡因20 ml 氟哌利多2.5 mg 0.9%氯胺酮200 mg 0.9%氯化钠溶液共计100 ml.采用上海博创电子泵,负荷量为10 ml,背景剂量均为每小时2 ml,患者自控镇(PCA)为3 ml,锁定时间为15 min.分别在安装止痛泵后30 min、1、3、5、24、48 h采用视觉模拟评分法(VAS)评估疼痛程度,统计两组不良反应发生率.结果: 经治疗,两组病例疼痛基本缓解.两组VAS各时段差异无显著性(P＞0.05).但PCA按压次数与吗啡用量对照组显著多于观察组;后者生活总满意度显著高于前者.不良反应:恶心呕吐、便秘、嗜睡、皮肤瘙痒对照组显著高于观察组;呼吸抑制、幻觉发生率两组间差异无显著性(P＞0.05). 结论:经皮下小剂量氯胺酮辅助吗啡PCSA具有镇痛作用强、不良反应小、方法简便等优点,适合治疗中/重度晚期顽固性癌痛.     

吗啡自控静脉镇痛在晚期顽固性癌痛中的临床应用

目的 评价吗啡自控静脉镇痛治疗晚期顽固性癌痛的效果及可行性.方法 选择晚期顽固性癌痛患者22例,应用PCIA方法治疗,观察疼痛程度(PI)及疼痛缓解程度(PAR),并记录疼痛开始缓解的时间、持续缓解的治疗时间.结果 吗啡PCLA给药前后疼痛评分分别为8.45±1.057和2.95±2.42(P＜0.05);疼痛缓解程度完全缓解率18.2%,明显缓解率36.4%,中度缓解率31.8%;吗啡PCIA治疗时间平均达1.15个月,疼痛开始明显缓解时间平均为1.12 h.结论 晚期顽固性癌痛治疗中吗啡PCIA给药效果满意,且简单、易行,提高了癌痛患者的生活质量,可作为口服、肌注吗啡或外用芬太尼镇痛无效时的二线治疗手段.     

凯纷注射液联合吗啡治疗重度难治性癌性疼痛20例

[目的]观察凯纷注射液（氟比洛芬酯脂微球注射液）联合吗啡治疗重度难治性癌性疼痛的镇痛效果及不良反应。[方法]口服或肌注镇痛药物效果欠佳、药物不良反应明显或不能口服镇痛药物的重度癌痛患者40例,数字表法随机分为单纯吗啡自控静脉镇痛（PCIA）治疗组（A组）和凯纷注射液联合吗啡PCIA治疗组（B组）,每组20例,连续观察10d为1个疗程。分别就两组治疗后疼痛缓解、阿片类剂量滴定、生活质量改善及不良反应等方面进行评价。[结果]A组疼痛缓解率70.0%（14/20）,B组为75.0%（15/20）,镇痛效果差异无显著性（P〉0.05）。B组在减少阿片类止痛药剂量、提高患者生活质量及减轻阿片类药物引起恶心、便秘发生率方面明显优于A组（P〈0.05）。[结论]凯纷注射液与吗啡联合治疗重度难治性癌痛,可减少阿片类药物用量,降低胃肠道反应,提高生活质量。     

东莨菪碱、乌头注射液辅助吗啡治疗顽固性晚期癌痛的临床探讨

目的:应用东莨菪碱、乌头注射液辅助吗啡治疗8例顽固性癌痛患者,比较治疗前后的镇痛效果,行为、休息状况以及吗啡用量.方法:选择8例经吗啡反复治疗且效果欠佳的顽固性晚期癌痛患者,应用东莨菪碱、乌头注射液、氟哌利多持续静脉泵注治疗,并按患者需要给予吗啡,观察治疗前后的镇痛效果、行为评分,休息状况以及吗啡用量.结果:8例患者经中药辅助吗啡治疗后镇痛效果、行为评分、休息评分均明显优于单纯吗啡治疗(P＜0.05);同时,治疗后吗啡用量比治疗前少(P＜0.05).结论:东莨菪碱、乌头注射辅助吗啡治疗顽固性晚期癌痛具有较好效果.     

可调控输液器在晚期顽固性癌痛中的应用

目的:评价应用可调控输液器持续静脉滴注吗啡治疗晚期顽固性癌痛的疗效及可行性.方法:应用可调控输液器持续静脉滴注吗啡治疗晚期顽固性癌痛患者18例,观察治疗前后的疼痛程度、生活质量和不良反应.结果:18例患者持续静脉滴注吗啡前后疼痛评分分别为8.72±1.21和2.72±1.54 (P<0.05);其中完全缓解(CR)4 例(22.2 %),部分缓解(PR)9 例(50.0%),轻度缓解(MR)5例(27.8%).疼痛缓解率(CR+PR)为 72.2%.疼痛开始明显缓解时间为0.5-2小时,平均1.2小时.不良反应主要为恶心、呕吐、便秘、嗜睡和轻度呼吸抑制.所有患者经治疗后生活质量明显提高.结论:应用可调控输液器持续静脉滴注吗啡能有效缓解晚期顽固性癌痛,提高患者生活质量,是一种安全、经济、简单、易行的方法.     

东莨菪碱、乌头注射液辅助吗啡治疗顽固性晚期癌痛的临床探讨

目的 :应用东莨菪碱、乌头注射液辅助吗啡治疗 8例顽固性癌痛患者 ,比较治疗前后的镇痛效果 ,行为、休息状况以及吗啡用量。方法 :选择 8例经吗啡反复治疗且效果欠佳的顽固性晚期癌痛患者 ,应用东莨菪碱、乌头注射液、氟哌利多持续静脉泵注治疗 ,并按患者需要给予吗啡 ,观察治疗前后的镇痛效果、行为评分 ,休息状况以及吗啡用量。结果 :8例患者经中药辅助吗啡治疗后镇痛效果、行为评分、休息评分均明显优于单纯吗啡治疗(P <0 .0 5 ) ;同时 ,治疗后吗啡用量比治疗前少 (P <0 .0 5 )。结论 :东莨菪碱、乌头注射辅助吗啡治疗顽固性晚期癌痛具有较好效果。     

硫酸吗啡控释片与盐酸吗啡缓释片治疗121例中、重度癌痛患者的疗效比较

背景与目的:硫酸吗啡控释片、盐酸吗啡缓释片均是治疗中、重度癌痛的首选药物之一,两者在作用、代谢、不良反应等方面有一定差异.本研究的目的是比较硫酸吗啡控释片、盐酸吗啡缓释片治疗中、重度癌痛患者的疗效和不良反应.方法:对121例有中、重度癌痛的患者进行随机分组,其中61例采用硫酸吗啡控释片、60例采用盐酸吗啡缓释片治疗,观察两药疗效和不良反应.结果:硫酸吗啡控释片组中中度疼痛12例,重度疼痛的例,治疗后有效率91.80%;盐酸吗啡缓释片组中中度疼痛13例,重度疼痛47例,治疗后有效率91.67%,两组比较在镇痛效果上差异无统计学意义.消化道反应(恶心、呕吐、便秘),盐酸吗啡缓释片较硫酸吗啡控释片发生率高(66.66%vs.4.43%),差异有统计学意义(P＜0.05).结论:硫酸吗啡控释片、盐酸吗啡缓释片用于治疗中、重度癌痛,疗效相近,安全性好,不良反应可耐受.对年龄大,既往有消化道疾病的患者,推荐使用硫酸吗啡控释片.     

羟考酮缓释片联合吗啡片12小时或24小时滴定治疗癌痛的对比研究

目的:观察盐酸羟考酮缓释片联合吗啡片12小时或24小时滴定治疗中、重度癌痛的疗效及不良反应.方法:选择120例中、重度癌痛患者,根据患者入院顺序单双号,将患者分为羟考酮缓释片联合吗啡片12小时滴定组60例和24小时滴定组60例.对两组的镇痛疗效及不良反应进行观察及评估.结果:与24小时滴定组比较,12小时滴定组的24小时镇痛缓解率明显提高;疼痛达稳态时间明显缩短,差异具有统计学意义(P＜0.05);两两组滴定平均滴定剂量、镇痛起效时间及主要毒副反应的发生率相似,差异无统计学意义(p＞0.05).结论:羟考酮缓释片联合吗啡片12小时滴定方案对中、重度癌痛镇痛效果好,不良反应轻,是治疗癌痛的理想选择之一.     

盐酸羟考酮缓释片与硫酸吗啡缓释片治疗重度癌痛的疗效分析

 目的　比较盐酸羟考酮缓释片（商品名：奥施康定,简称羟考酮）和硫酸吗啡缓释片（商品名：美施康定,简称吗啡）治疗晚期恶性肿瘤重度疼痛的疗效及患者不良反应。方法　将204例重度癌性疼痛患者用数字表法随机分为两组,每组102例,分别接受羟考酮和吗啡镇痛治疗,每48 h进行 1次疼痛评估,根据疼痛缓解情况调整药物剂量。用药后疼痛评分≤3分者为有效。对两组患者镇痛起效时间、镇痛效果及不良反应进行分析比较。结果　镇痛效果羟考酮组有效率79.4 %（81／102）,吗啡组有效率75.5 %（77／102）,两组差异无统计学意义（χ2＝0.225,P＞0.05）;对疼痛控制的起效时间羟考酮组比吗啡组更快,两组比较差异有统计学意义（χ2＝22.916,P＜0.05）。羟考酮组总不良反应发生率为62.7 %（64／102）,吗啡组为98.0 %（99／102）,两组间差异有统计学意义（χ2＝20.151,P＜0.05）。结论　羟考酮和吗啡对重度癌痛控制效果相当,但羟考酮镇痛起效快,患者不良反应发生率低,程度轻,具有一定优势。     

晚期癌痛病人自控芬太尼静脉镇痛与吗啡硬膜外镇痛的临床应用

[目的]观察比较晚期癌痛病人芬太尼病人自控静脉镇痛(patient controlled intravenousanalgesia,PCIA)与吗啡病人自控硬膜外镇痛(patient controlled epidural analgesia,PCEA)临床镇痛效果及副作用.[方法]晚期癌痛病人29例,随机分为两组:F组(PCIA)15例,药物配方:Fentanyl1.0mg Droperidol 5mg Ondansetrone 8mg 0.9%NS至100 ml PCIA;M组(PCEA)14例,药物配方:Morphine 5mg Droperidol 5mg Bupivacaine150mg 0.9%NS至100ml PCEA.采用英国佳士比9300PCA泵.设定持续输注2ml/h,单次PCA0.5ml,锁定时间15min.观察病人镇痛(VAS)、镇静(SS)评分;满意度及副作用.[结果]两组VAS、SS评分及满意度差异无显著性(P＞0.05).优良率均＞92%.恶心、呕吐发生率及呼吸循环影响两组无明显差异.但PCEA组皮肤瘙痒发生率37.5%.[结论]芬太尼PCIA与吗啡PCEA镇痛效果确切,安全有效.     

Ringworm in animals in a farm in Assiut

Bericht über das Auftreten von Hautmykosen bei Tieren auf der Farm der Landwirtschaftlichen Fakultät der Universität Assiut. Von 70 Kälbern waren 42 pilzkrank, davon 22 durch T. mentagrophytes, 20 durch T. verrucosum. Von 180 Kühen waren 8 pilzbefalien, sämtlich durch T. mentagrophytes. Von 2 kranken Bullen wurde T. verrucosum isoliert. Auch die 3 Pferde und 2 Maultiere der Farm waren pilzinfiziert; Erreger war in diesen Fällen T. equinum. Auch ein Kalb war von T. equinum befallen. Die gleiche Pilzart wurde ferner von 3 Tierpflegern isoliert, die Pilzherde am Hals und an den Armen aufwiesen.     

Statistical challenges in preprocessing in microarray experiments in cancer

Many clinical studies incorporate genomic experiments to investigate the potential associations between high-dimensional molecular data and clinical outcome. A critical first step in the statistical analyses of these experiments is that the molecular data are preprocessed. This article provides an overview of preprocessing methods, including summary algorithms and quality control metrics for microarrays. Some of the ramifications and effects that preprocessing methods have on the statistical results are illustrated. The discussions are centered around a microarray experiment based on lung cancer tumor samples with survival as the clinical outcome of interest. The procedures that are presented focus on the array platform used in this study. However, many of these issues are more general and are applicable to other instruments for genome-wide investigation. The discussions here will provide insight into the statistical challenges in preprocessing microarrays used in clinical studies of cancer. These challenges should not be viewed as inconsequential nuisances but rather as important issues that need to be addressed so that informed conclusions can be drawn.     

Trends in zygomycosis in children

Zygomycosis, or mucormycosis, is associated with significant morbidity and mortality in both children and adults. Studies in adults have shown an increase in the incidence of zygomycosis, particularly among haemtopoietic stem cell transplant (HSCT) recipients and patients with haematologic malignancies. There is a paucity of data on the epidemiology of zygomycosis in children. We performed a retrospective analysis to describe trends in zygomycosis between 1 January 2003 and 31 December 2010. We used the Pediatric Health Information System (PHIS) database to identify paediatric patients who were diagnosed with zygomycosis during the study period. Administrative data on diagnoses, demographics, underlying conditions and clinical experiences were collected. Summary statistics were calculated and tests for trend were conducted. We identified 156 unique patients with zygomycosis. The prevalence of zygomycosis did not significantly increase over time (P=0.284). The most common underlying condition was malignancy (58%) and over half received intensive care. Voriconazole utilisation among all hospitalised children significantly increased during the period (P=0.010). Our study demonstrates that the incidence of zygomycosis is not significantly increasing. During the time period there was a significant increase in the use of voriconazole among children.     

Hemoglobin in lymphogranulomatosis in children

The peculiarities of hemoglobin content and properties in lymphogranulomatosis were studied in children by different methods. In most patients the content of fetal hemoglobin and methhemoglobin was found to increase and the rate of ferricyanide oxidation of hemoglobin also increases. Simultaneously, the rate of non-homogenicity of basic hemoglobin fractions was observed to increase on account of immunologically different components.     

Dermatomycosis in Goats in India

Summary: In an extensive survey involving 2176 goats 1.56% of goats manifested clinical lesions of ringworm infection. Animals below the age of 6 months were affected most (4.20%). The incidence of infection was higher during the winter months. T. verrucosum, T. mentagrophytes and M. gypseum were isolated from the skin scrapings of 12, 4, and 2 goats respectively. It is suggested that the infected animals could be a source of disease to human population in which the zoophilic dermatophyte invasion is characterized by severe inflammatory lesions of the skin. The zoonotic importance of different dermatophytes is stressed.
Zusammenfassung: In einer ausgedehnten Untersuchung an 2176 Ziegen wurden bei 1,56% klinische Zeichen einer Hautmykose festgestellt. Tiere, die jühger als 6 Monate alt waren, zeigten mit 4,20% am häfigsten Krankheitssymptome. In den Wintermonaten war die Erkrankungshäufigkeit am gröBten. T. vermcosum, T. mentagrophytes and M. gypseum wurden jeweils von 12,4 bzw. 2 Ziegen isoliert. Die inflzierten Tiere köinnen eine Infektionsquelle für die menschliche Bevölkerung darstellen und dort Mykosen mit stark entzündlichen Veränderungen auslösen. Die Bedeutung verschiedener Dermatophyten als Erreger von Zoonosen wird hervorgehoben.     

Sex hormones in women in rural China and in Britain

Plasma concentrations of certain hormones linked to breast cancer risk were measured in age-pooled samples from 3,250 rural Chinese women in 65 counties, and 300 British women, all aged 35-64. In age-groups 35-44, 45-54 and 55-64 respectively, mean oestradiol concentrations were 36% (P = 0.043), 90% (P less than 0.001) and 171% (P = 0.001) higher in the British than in the Chinese women, and mean testosterone concentrations were 48% (P less than 0.001), 68% (P less than 0.001) and 53% (P = 0.001) higher in the British than in the Chinese women. The difference in testosterone concentrations between the two countries appeared to be due largely to the lower average body weight in the Chinese women. Sex hormone binding globulin did not differ significantly between the two countries in age groups 35-44 and 45-54, but was 15% (P = 0.002) lower in the British than in the Chinese women at ages 55-64. Prolactin concentrations did not differ significantly between the two countries in any age group.     

Temozolomide treatment in glioma--experiences in two university hospitals in Finland

Thirty-two patients with relapsing glioma were treated with temozolomide in two university hospitals in Finland. One patient (3%) had complete response and 9 (28%) partial response, with 8 patients (25%) showing stable disease. Median progression-free survival for these 18 patients (56%) was 7 months (range 2-11+). The remaining either had progressive disease (25%) or only clinical evaluation (19%). Karnofsky score improved in 34% of patients and decreased in 3%. Symptoms were alleviated in 44% and deteriorated in 9%. Grade 3-4 toxicity was detected in 9% of the patients. Only 4% of the days in treatment were spent in hospital. An average 1.8 neuroradiological investigations, 6.9 laboratory visits, and 5.3 visits to the oncologist were made. This study confirms that temozolomide has positive effects on the outcome of often heavily pretreated glioma patients. High drug costs are compensated by prolonged home care and even the possibility to maintain working capacity.