Management Strategies for Pain in Breast Carcinoma Patients: Current Opinions and Future Perspectives

Breast cancer is the most frequently encountered carcinoma in women worldwide. Pain is the most distressing symptom in patients with breast carcinoma and can occur at all stages of the disease due to the cancer per se as well as due to various diagnostic and treatment modalities. A proper pain assessment helps in identification of pain syndromes and guides in formulating analgesic strategies. Primary therapies of breast carcinoma like surgery, chemotherapy, and radiotherapy for bony metastases can cause substantial pain relief. However, multimodal analgesic approaches incorporating pharmacological, interventional as well as non-conventional techniques should be employed prior to, in conjunction with, and after primary therapies of breast cancer. The prevalence of chronic neuropathic pain following breast cancer surgery may exceed 50% by current estimates, and with the increase in life expectancy of these patients, providing adequate pain relief is of paramount importance to improve their quality of life. In this review, we discuss prevailing methods of evaluation and management of pain in patients of breast carcinoma and the new techniques that may become the mainstay of pain management protocols in future.     

磁共振胰胆管成像对肝移植术后胆系的评价

背景:由于肝移植术后患者出现胆道并发症时,没有特征性体征,此种并发症很难发现。MRI特别是磁共振胰胆管成像是一种具有安全、准确、非侵袭性特点,可用于综合评估移植后肝脏功能和并发症的有效手段。目的:评估磁共振胰胆管成像对肝移植术后胆系的显示以及诊断胆管并发症的价值。设计:对比观察。单位:南方医科大学南方医院影像中心。对象:于2003-01/2005-01在南方医科大学南方医院影像中心接受影像学检查肝移植患者13例,均为男性,年龄40-58岁。术前临床诊断为原发性肝癌2例,重症肝硬化11例。10例行原位经典式肝移植,3例行背驮式原位肝移植术,所有胆管吻合方式为胆总管端-端吻合。移植后至首次MR检查时间15d-1年。所有患者对检测项目均知情同意。方法:13例原位肝移植患者术后均用磁共振快速自选回波序列及快速小角度激发梯度回波序列常规扫描、磁共振胰胆管成像、钆喷替酸葡甲胺动态增强检查,分析各序图像特点。主要观察指标:磁共振胰胆管成像对重建胆道和胆道并发症的显示。结果:3例患者胆管管径正常,吻合口无狭窄。1例厚层磁共振胰胆管成像胆管未显影。胆管扩张8例;胆管狭窄5例;胆总管结石2例;胆囊管残端黏液囊肿2例;T管拔管后胆漏1例;排斥反应2例。结论:磁共振胰胆管成像不仅可显示肝移植术后外科重建胆道的影像,而且可准确、快速诊断肝移植术后胆道并发症。     

临床护士工作疲溃感与工作压力源的相关研究

工作疲溃感(professional burnout)又称职业性疲溃、心身耗竭综合征、工作倦怠、枯竭等,是一种情绪疲惫感、工作冷漠感和工作成就感的降低,可表现为旷工、与同事冲突和离职,并且影响工作的完成和自身家庭的照顾,它常发生于从事人际工作的人员中[1].护理工作主要是与人打交道的职业,高工作疲溃感不仅导致其身心痛苦,而且影响护理质量.为了解临床护士工作压力源对工作疲溃感的影响,本研究采用描述性、相关性的研究方法,调查了临床护士的工作疲溃感与工作压力源之间的关系.现将其介绍如下.     

大学生静态平衡能力与运动及性别的关系:定量对比分析

目的:采用定量分析方法比较体育与非体育专业大学生静态平衡能力,分析运动及性别对大学生静态平衡功能的影响。方法:于2007-01/03选取首都体育学院在校大学生共78名为受试对象,其中体育(武术)专业学生40名,非体育(康复)专业学生38名。所有选取对象了解试验目的,并同意参与本实验。采用意大利PosturalEqua平静分析系统,对实验对象分别在睁眼60s、闭眼60s两种状态下测试其静态平衡的各项指标,包括压力中心,线形图总长度,最大摆幅,线形图面积,LFS指数,压力分布,稳定性图及隆伯格值。结果:78名为受试对象均进入结果分析。①两专业学生压力中心X轴短于Y轴、压力分布前(%)高于后(%)(P<0.01)。②在闭眼状态下,体育专业男大学生在指标LFS指数和额状面上大于非体育专业(P<0.05)。③非体育业大学生在睁眼状态下,Y值女性小于男性,额状面值女性大于男性。男、女生睁闭眼差值进行比较时,女性在线形图总长度、额状面和LFT指数均大于男性(P<0.01),而线形图面积小于男性(P<0.05)。④体育专业大学生在睁眼状态下,指标参数Y值女性小于男性,额状面值女性大于男性;闭眼状态下,指标参数Y值女性小于男性,额状面值和LFS值女性大于男性。男、女生睁闭眼差值比较,女性在线形图总长度、额状面和LFT指数均大于男性(P<0.05,P<0.01),而线形图面积小于男性(P<0.05)。结论:①运动训练对大学生静态平衡影响不大,但对男性大学生的某些平衡指标却有显著影响。②性别对大学生的静态平衡均产生影响,表现为男性平衡的微控制能力优于女性。     

Seropositivity of hepatitis B e antigen and hepatocellular carcinoma

Chronic infection with hepatitis B virus (HBV) is an important clinical problem due to its worldwide distribution and potential of adverse sequelae including hepatocellular carcinoma (HCC). Hepatitis B e antigen (HBeAg) is a biomarker of active viral proliferation in hepatocytes and infectivity. The prevalence of HBeAg among subjects chronically infected with HBV decreases with the increase in age. Case series studies have found a lowest seroprevalence of HBeAg in HCC patients compared with patients affected with chronic hepatitis B and liver cirrhosis. Case-control studies have shown a significantly higher seroprevalence of HBeAg in HCC cases than matched controls. A recent long-term follow-up study has shown a significantly elevated HCC risk for seropositives of both hepatitis B surface antigen (HBsAg) and HBeAg compared with seropositives of HBsAg only and seronegatives. The biological gradient remained in further stratification analyses by serum level of alanine transaminase and status of liver cirrhosis detected by ultrasonography. The cumulative HCC risk from age 30 to 70 years has been estimated to be 87% for those who were persistently seropositive on HBsAg and HBeAg, 12% for those with persistent seropositivity of HBsAg only, and 1% for those who were seronegative on HBsAg and HBeAg.     

Patterns of Insulin Dependence in an African Diabetic Clinic

SUMMARY Analysis of the age of onset of diabetes amongst insulin-treatedpatients in a large African diabetic clinic revealed a bimodaltype of distribution, 23 per cent having an age of onset before30 years and 77 per cent with onset at 30 years of age. All66 of the young insulin-treated group (21.7±4.8 years(mean±1 SD)), and a random selection of 50 older insulin-treatedpatients (49.7±10 years), were studied. The older groupwere better controlled (HbA₁ 8.4±1.7 per cent vs. 10.8±2.6per cent, p<0.001), on lower doses of insulin (49±23vs. 71±23 u/day, p<0.001) and had higher body massindex (26.0±5.6 vs. 21.8±3.5, p<0.001). SerumC-peptide (0.24±0.15 vs. 0.07±0.10 nmol/l, p<0.0001),and C-peptide/glucose ratio (2.57±2.65 vs. 0.56+0.98nmol/mmolx 10², p<0.001) were very significantly higher inolder patients. Patients with later onset disease thus had betterpreservation of pancreatic function, higher body mass indexand better glycaemic control on lower doses of insulin. Thesefeatures suggest that older insulin-treated patients could infact be ‘Type 2’ or non-insulin dependent patients,and the condition may be controllable with diet and/or oralhypoglycaemic agents, at least in some.     

四君子汤修复脾虚大鼠线粒体细胞色素氧化酶的作用及机制

目的:运用灌服耗气破气中药联合饥饱失节复合因素建立脾虚大鼠模型,观察四君子汤对脾虚大鼠线粒体细胞色素含量及其氧化酶活性的影响。方法:实验于2004-04/2005-02在广州中医药大学第一附属医院内科实验室和广州中医药大学基础医学实验室完成。①选取清洁级1月龄SD大鼠40只,随机数字表法分成4组:正常组、脾虚模型组、自然复健组、四君子汤治疗组,10只/组。②除正常组以普通饲料进行常规喂养外,其余3组均建立脾虚模型。脾虚模型组隔日喂食,并以小承气汤(厚朴、枳实、大黄比例为3∶3∶2,制成100%水煎剂)灌胃,每次3mL/只,隔日1次,共30周。自然复健组前26周同脾虚模型组,后4周同正常组。四君子汤治疗组前26周同脾虚模型组,后4周以四君子汤(党参、白术、茯苓、甘草按1∶1∶1∶1制成100%水煎剂)灌胃,每次4mL/只。③检测各组大鼠骨骼肌、心肌、肝脏、胃黏膜4种不同组织线粒体细胞色素a,b,c,c1含量及细胞色素氧化酶水平,提取线粒体DNA,进行细胞色素氧化酶亚基COXⅠ、COXⅡ和COXⅢ序列分析。结果:40只SD大鼠全部进入结果分析。①不同组织线粒体各种细胞色素含量检测结果:实验第30周,脾虚模型组骨骼肌、心肌、肝脏、胃黏膜部位的线粒体细胞色素a,b,c,c1均显著低于正常组(P<0.05);自然复健组均有所升高,接近正常组(P>0.05);四君子汤治疗组显著升高,超过正常组水平(P<0.05)。②不同组织线粒体细胞色素氧化酶含量检测结果:四君子汤治疗组骨骼肌、心肌、肝脏、胃黏膜部位的细胞色素氧化酶含量均高于脾虚模型组、自然复健组(P<0.01或0.05),与正常组基本相似(P>0.05)。③线粒体细胞色素氧化酶基因序列分析:脾虚模型组和自然复健组COXⅠa,COXⅡ,COXⅢ存在突变现象,正常组和四君子汤组未见COX亚基突变。结论:四君子汤能够修复脾虚所导致的mtDNA编码COX亚基损伤,提高细胞色素含量及其氧化酶的活性。     

联合应用冰冻单采血小板与冷沉淀治疗弥散性血管内凝血

目的研究冰冻单采血小板与冷沉淀联合应用(冰冻联合组)治疗弥散性血管内凝血(DIC)的效果。方法将41例DIC患者随机分成两组：24例为冰冻联合组,17例为联合应用新鲜单采血小板和冷沉淀(新鲜联合组)。测定两组患者输前1 h和输后2 h指标：①凝血酶时间(TT)；②活化部分凝血活酶时间(APTT)；③凝血酶原时间(PT)；④纤维蛋白原(Fbg)；⑤血小板(PLT)；⑥统计比较两组输后24 h内续用悬浮红细胞量。结果冰冻联合组与新鲜联合组输后2 h比较：TT、PT、APTT及Fbg差异无统计学意义(P＞0．05),PLT显著减少(P＜0．05),24 h内人均续用红细胞量显著减少(P＜0．05)。结论冰冻单采血小板和冷沉淀联合应用治疗DIC具有更佳的止血疗效。     

癌症初期放化疗病人焦虑抑郁情绪及应对状况的研究

[目的]探讨癌症初期放化疗病人焦虑、抑郁及应对状况,为临床护理计划的制定提供依据.[方法]采用焦虑、抑郁自评量表和医学应对问卷对78例癌症初期放化疗病人进行调查.[结果]癌症初期放化疗病人焦虑、抑郁的发生率显著高于其他病期癌症病人(P＜0.001),女性病人抑郁程度明显高于男性(P＜0.05);面对和回避维度得分均显著高于正常人(P＜0.01),不同年龄、居住地的病人应对方式不同.[结论]癌症初期放化疗病人的焦虑、抑郁情绪反应较重,多采用面时和回避的保护性应对策略.