关于住院癌症患者疼痛调查及健康教育体会

目的了解本地区住院癌症患者的疼痛控制情况,总结健康教育体会,进一步推动＂癌症镇痛三阶梯＂治疗工作。方法通过调查问卷及采用线性视觉模拟评估尺,对300例癌症患者的疼痛发生率、用药、疼痛控制满意度等情况进行全面评估。结果共完成300例癌痛患者的调查,其中96.33%的癌症患者接受过止痛治疗,选用药物治疗的占92.7%,镇痛效果最满意的是使用静脉止痛泵,疼痛缓解率达91.7%。结论本地区住院癌症患者癌痛控制的效果尚可,癌痛健康教育需进一步深化。     

癌痛规范化治疗中的不良影响因素及处理

目的通过对癌痛规范化治疗过程中的不良影响因素及处理进行分析,使癌痛患者能够得到规范化治疗,减轻疼痛。方法对入院评估存在癌痛的30例癌症患者,建立癌痛病历;实施癌痛规范化治疗;记录影响癌痛治疗的因素及处理方案。为癌痛规范化治疗提供可靠的依据,最大限度的治疗癌痛。结果正确的癌痛评估直接决定了癌痛的规范化治疗。年龄≥60岁的患者癌痛评分高于<60岁的患者;入院后4h的平均评分最高;通过癌痛的规范化治疗后癌痛评分逐渐降低,48h后平均评分呈稳定状态,患者的癌痛缓解率高,生活质量明显提高。结论癌痛规范化治疗可以做到让癌痛患者无痛生活。     

规范化管理对癌症患者疼痛的影响

目的探讨规范化管理对癌痛患者的影响。方法将癌症疼痛患者120例随机分为干预组与对照组各60例,对照组采用常规护理模式实施癌痛护理;干预组采用规范化疼痛管理模式实施癌痛管理。结果干预组干预后疼痛感评分为（1.76±0.32）分低于对照组的（2.35±0.33）分,差异有统计学意义（P〈0.05）。结论癌痛规范化管理能有效缓解癌症患者的疼痛。     

艾迪注射液提高晚期癌症患者生存质量的临床研究

目的 研究艾迪注射液缓解癌痛及提高晚期癌症患者生存质量的作用。方法 晚期癌症患者66例,其中伴有癌症疼痛患者57例,占86．36％。给予艾迪注射液50～100ml静脉注射1次／d,共用30天,观察患者治疗前后疼痛缓解程度、生活质量改善情况、免疫功能变化及不良反应。结果 癌症疼痛控制总有效率达75．44％(部分缓解54．37％,完全缓解21.05％),用药结束后疼痛缓解仍可维持1～7天以上,且无成瘾性。60例晚期患者生存质量有所提高。艾迪注射液对心、肝、肾功能无明显损害,4例患者伴有轻度静脉炎。结论 艾迪注射液在提高晚期癌症患者生活质量及控制癌痛中疗效满意,且安全可行。     

芬太尼透皮贴剂治疗37例中重度晚期癌痛疗效观察

目的观察合并中重度疼痛癌症患者使用芬太尼透皮贴剂(多瑞吉)的镇痛效果及不良反应。方法采用多中心开放式研究，37例中重度癌痛患者使用芬太尼透皮贴剂治疗，观察并记录疼痛变化，生活质量改善情况，不良反应等。结果使用芬太尼透皮贴剂后疼痛完全缓解率37．84％，明显缓解率51．35％，轻度缓解率8．11%，未缓解率3．23％，不良反应主要为：头晕、恶心及呕吐、便秘、嗜睡、排尿困难、局部皮肤瘙痒等。结论芬太尼透皮贴剂治疗癌痛效果良好，毒副作用轻微，使用方便。     

癌痛规范化治疗示范病房的建立与实施

癌痛是造成癌症晚期患者主要痛苦的原因之一,对患者的抗癌治疗和生存质量起着非常重要的影响。本文对广州医科大学附属第五医院肿瘤科建立和实施癌痛规范化治疗示范病房的癌痛护理工作进行了详细介绍,在创建过程中重视医护人员的培训和制订编写相关规章制度,严格按照“疼痛评估-实施镇痛-健康教育-观察记录-随访”的流程进行实施。建立癌痛规范化治疗示范病房后,规范了护士对疼痛处理的流程,提升了护理人员正确处理疼痛的能力,有效促进了患者的治疗和康复,提高了患者的满意度,为我院无痛病房的全面实施起到了很好的示范带头作用。     

奥施康定治疗中重度癌性疼痛的疗效观察

目的观察奥施康定治疗中重度癌性疼痛的疗效与不良反应。方法对96例中重度癌痛患者进行治疗,奥施康定起始剂量10mg／12h,根据疼痛缓解程度调整剂量,评价镇痛效果及不良反应。结果96例中重度癌痛患者,平均镇痛时间12．8h,总有效率95．8％。中度疼痛组有效率100％,重度疼痛组有效率92．6％。不良反应主要为便秘20例（20．8％）。结论奥施康定治疗中重度癌性疼痛疗效确切,不良反应轻微,服用安全。     

从典型病例探讨超大剂量吗啡的管理及癌痛规范化治疗

目的回顾性分析2例晚期癌痛患者持续静脉泵入超大剂量吗啡镇痛的用药情况,探讨其临床应用的合理性及管理措施。方法对2例癌痛患者的疼痛性质、原因、缓解或加重因素、生活质量、PS及疼痛NRS评分进行综合评估。临床药师通过监护患者疼痛缓解情况和不良反应,对吗啡使用剂量进行动态评估和调整,同时给予辅助止痛用药合理化建议。结果持续静脉泵入超大剂量吗啡可降低患者的NRS评分,有效缓解重度顽固性癌痛。吗啡最大日剂量达1 000 mg与4 000 mg。除便秘、恶心、呕吐、嗜睡等不良反应外,2例患者均未观察到昏迷、呼吸抑制等吗啡中毒症状。结论临床药师在癌痛规范化病房全程参与了超大剂量使用阿片类药物的管理及使用工作,不仅保障了吗啡使用的可及性与安全性,还在癌痛规范化治疗中发挥了重要作用。     

盐酸吗啡缓释片治疗晚期癌症疼痛102例

目的 观察盐酸吗啡缓释片对晚期癌症的镇痛效果。方法 对102例中、重度癌痛患者进行治疗，盐酸吗啡缓释片开始剂量为30mg．每12h服药1次，在用药的过程中根据疼痛缓解程度来调整剂量。结果 102例显效68例（66．7％），有效29例（28．4％），无效5例（4．9％），总有效率为95．1％。结论 盐酸吗啡缓释片治疗癌症疼痛疗效显著，毒副反应轻，安全可行。     

双克因治疗癌痛22例的临床观察

目的：研究双克因用于癌症疼痛的镇痛疗效。方法：对癌症疼痛病人采用双克因治疗５～７天,观察其镇痛效果和毒副反应。结果,镇痛的显著有效率（完全＋中度缓解）和有效率分别为７７．３％（１７／２２）和９１．０％（２０／２２）,毒副反应主要是便秘、恶心、呕吐、晕眩等。结论：双克因是治疗中度癌痛有效药物之一,特别适用于伴有咳嗽的癌痛。     

Efficacy of gut lavage,hemodialysis, and hemoperfusion in the therapy of paraquat or diquat intoxication

Clinical and in vitro investigations were carried out to test the efficacy of gut lavage, hemodialysis, and hemoperfusion in the treatment of poisoning with paraquat or diquat. In a patient suffering from diquat intoxication 130 times more diquat was removed by gut lavage 30 h after ingestion than was removed by complete aspiration of the gastric contents.Determination of in vitro clearances for paraquat and diquat by hemodialysis showed that, at serum concentrations of 1–2 ppm, such as are frequently encountered in poisoning in man, toxicologically relevant quantities of herbicide cannot be removed from the body. At a concentration of 20 ppm, on the other hand, hemodialysis proved to be effective, the clearance being 70 ml/min at a blood flow rate of 100 ml/min. The efficacy of hemoperfusion with coated activated charcoal was on the whole better. Especially at concentrations around 1–2 ppm, the clearance values for hemoperfusion were some 5–7 times higher than those for hemodialysis.In a patient suffering from paraquat poisoning, both hemodialysis as well as hemoperfusion were carried out. The in vitro results could be confirmed: At serum concentrations of paraquat less than 1 ppm no clearance could be obtained by hemodialysis while by hemoperfusion with activated charcoal quite high clearance values were measured and the serum level dropped down to zero.

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Zusammenfassung Klinische Untersuchungen und Laboratoriumsversuche wurden durchgeführt, um die Wirksamkeit von Darmspülung, Hämodialyse und Hämoperfusion bei Paraquat- und Deiquat-Vergiftungen zu prüfen.Bei einem Patienten wurde 30 Std nach Deiquat-Aufnahme durch Darmspülung 130mal mehr Deiquat entfernt als durch vollständige Aspiration des Mageninhaltes. In vitro-Versuche ergaben, daß bei Blutserumkonzentrationen von 1–2 ppm, die bei Vergiftungen oft gemessen werden, durch Hämodialyse keine toxikologisch relevanten Paraquat- oder Deiquat-Mengen entfernt werden können. Dagegen erwies sich die Hämodialyse bei 20 ppm und einer Blutumlaufgeschwindigkeit von 100 ml/min mit einer Clearance von 70 ml/min als wirksam. Die Hämoperfusion mit beschicheter Aktivkohle war in diesen Versuchen aber eindeutig überlegen, denn insbesondere bei Konzentrationen um 1–2 ppm waren die Clearance-Werte 5–7mal höher als bei der Hämodialyse.Die in vitro-Ergebnisse wurden bei einem Patienten mit einer Paraquat-Vergiftung bestätigt: Bei Konzentrationen unter 1 ppm war die Hämodialyse wirkungslos, während durch Hämoperfusion relativ hohe Clearance-Werte erreicht wurden, so daß der Serumspiegel rasch unter die Nachweisgrenze abfiel.

     

In vitro studies on sterically stabilized liposomes (SL) as enzyme carriers in organophosphorus (OP) antagonism

This study describes a new approach for organophosphorous (OP) antidotal treatment by encapsulating an OP hydrolyzing enzyme, OPA anhydrolase (OPAA), within sterically stabilized liposomes. The recombinant OPAA enzyme was derived from Alteromonas strain JD6. It has broad substrate specificity to a wide range of OP compounds: DFP and the nerve agents, soman and sarin. Liposomes encapsulating OPAA (SL)* were made by mechanical dispersion method. Hydrolysis of DFP by (SL)* was measured by following an increase of fluoride ion concentration using a fluoride ion selective electrode. OPAA entrapped in the carrier liposomes rapidly hydrolyze DFP, with the rate of DFP hydrolysis directly proportional to the amount of (SL)* added to the solution. Liposomal carriers containing no enzyme did not hydrolyze DFP. The reaction was linear and the rate of hydrolysis was first order in the substrate. This enzyme carrier system serves as a biodegradable protective environment for the recombinant OP-metabolizing enzyme, OPAA, resulting in prolongation of enzymatic concentration in the body. These studies suggest that the protection of OP intoxication can be strikingly enhanced by adding OPAA encapsulated within (SL)* to pralidoxime and atropine.     

Aquatic Insects and Trace Metals: Bioavailability,Bioaccumulation, and Toxicity

Abstract

The uptake of metals from food and water sources by insects is thought to be additive. For a given metal, the proportions taken up from water and food will depend both on the bioavailable concentration of the metal associated with each source and the mechanism and rate by which the metal enters the insect. Attempts to correlate insect trace metal concentrations with the trophic level of insects should be made with a knowledge of the feeding relationships of the individual taxa concerned. Pathways for the uptake of essential metals, such as copper and zinc, exist at the cellular level, and other nonessential metals, such as cadmium, also appear to enter via these routes. Within cells, trace metals can be bound to proteins or stored in granules. The internal distribution of metals among body tissues is very heterogeneous, and distribution patterns tend to be both metal and taxon specific. Trace metals associated with insects can be both bound on the surface of their chitinous exoskeleton and incorporated into body tissues. The quantities of trace meals accumulated by an individual reflect the net balance between the rate of metal influx from both dissolved and particulate sources and the rate of metal efflux from the organism. The toxicity of metals has been demonstrated at all levels of biological organization: cell, tissue, individual, population, and community. Much of the literature pertaining to the toxic effects of metals on aquatic insects is based on laboratory observations and, as such, it is difficult to extrapolate the data to insects in nature. The few experimental studies in nature suggest that trace metal contaminants can affect both the distribution and the abundance of aquatic insects. Insects have a largely unexploited potential as biomonitors of metal contamination in nature. A better understanding of the physico-chemical and biological mechanisms mediating trace metal bioavailability and exchange will facilitate the development of general predictive models relating trace metal concentrations in insects to those in their environment. Such models will facilitate the use of insects as contaminant biomonitors.     

Pharmacological treatment of COVID-19: an opinion paper

The precocity and efficacy of the vaccines developed so far against COVID-19 has been the most significant and saving advance against the pandemic. The development of vaccines has not prevented, during the whole period of the pandemic, the constant search for therapeutic medicines, both among existing drugs with different indications and in the development of new drugs. The Scientific Committee of the COVID-19 of the Illustrious College of Physicians of Madrid wanted to offer an early, simplified and critical approach to these new drugs, to new developments in immunotherapy and to what has been learned from the immune response modulators already known and which have proven effective against the virus, in order to help understand the current situation.     

Alzheimer’s disease – current trends in basic and clinical research. Highlights from the 16th ECNP

Advances in the molecular biological knowledge of neuronal nicotinic acetylcholine receptors (nAChRs) have led to a growing interest by the pharmaceutical industry in the development of novel compounds that selectively modulate nAChR function. The ability of (-)-nicotine, an activator of nAChRs, to enhance attentional aspects of cognition in animals and humans, to exert neuroprotective and anxiolytic-like effects, and presumably to mediate the negative correlation between smoking and Alzheimer's (and Parkinson's) Disease, has focused interest on the potential therapeutic utility of modulators of nAChR function for treatment of some of the deficits associated with these progressive, neurodegenerative conditions. Numerous compounds are known which activate nAChRs and which might serve as lead compounds toward the development of such agents. The pharmacologic diversity of neuronal nAChR subtypes suggests the possibility of developing selective compounds which would have more favourable side-effect profiles than existing agents. This broader class of agents, collectively called cholinergic channel modulators (ChCMs), is anticipated to encompass compounds which would have more favourable side-effect profiles than existing agents, which generally exhibit low selectivity. This selectivity may be achieved by preferentially activating some subtypes of nAChRs (i.e., Cholinergic Channel Activators, ChCAs) or inhibiting the function of other subtypes (Cholinergic Channel Inhibitors, ChCIs). An overview of the biology of nAChRs and the rationale for the use of ChCMs for the treatment of dementia related to neurodegenerative diseases are presented, followed by a discussion of lead compounds and compounds under consideration for clinical evaluation.     

Steroidal sapogenin contents in some domestic plants

In order to find out the values of the steroid resources for the future use. the compositions and contents of steroidal sapogenins from 13 domestic plants have been investigated. As a result,Dioscorea nipponica, D. quinqueloba andSmilax china were found to have large amount of diosgenin. And pennogenin inTrillium kamtschaticum andParis verticillata, yuccagenin inAllium fistulosum, hecogenin inAgave americana and neochlorogenin inSolanum nigum were appeared to be major steroidal sapogenins.