Fentanyl buccal tablets for breakthrough pain in highly tolerant cancer patients: preliminary data on the proportionality between breakthrough pain dose and background dose

Context

Cancer patients receiving high doses of opioids as background medication are challenging, and it would be useful clinically to know whether a rapid-onset opioid (ROO) for breakthrough cancer pain (BTcP) may be started at a dose proportional to the background opioid dose.

Objectives

The aim of this study was to assess the efficacy and safety of the fentanyl buccal tablet (FBT) in doses proportional to the opioid dose administered for background analgesia in a sample of patients with BTcP who were receiving high doses of opioids.

Methods

Twelve patients who were receiving opioids for background analgesia at doses equivalent to more than 500 mg of oral morphine and had adequately controlled pain were prospectively recruited. BTcP was treated with proportional doses of FBT: patients receiving 600 mg of oral morphine equivalents were administered 1000 μg of FBT, patients receiving 900 mg of oral morphine equivalents were administered 1500 μg of FBT, and so on. For each episode of BTcP, trained nurses collected pain intensity (on a 0–10 numerical rating scale) and emerging problems when called for increases in pain considered to be severe in intensity by patients (T0) and 15 minutes after FBT administration (T15).

Results

Patients were receiving mean doses of oral morphine equivalents of 1340 mg (±585; range 720–2400). Seventy-nine events were treated with FBT (6.6 ± 4.9 for each patient). The median pain intensity of BTcP events was 8 (range 7–10), and the mean dose of FBT administered was 2233 μg (±975; range 1200–4000). In most events, a decrease in pain intensity >33% and >50% was observed (n = 14 and n = 48, respectively) 15 minutes after the administration of FBT. Data on 11 episodes were missed. Only six events were unsuccessfully treated. In all the patients, the level of adverse effects after FBT administration was mild and indistinguishable from that associated with the background opioid analgesia.

Conclusion

FBT in doses proportional to the high doses of opioids used for background analgesia was efficacious and well tolerated when administered for BTcP. Controlled studies with a specific design and a large number of patients should confirm such preliminary results.     

手术治疗颅内蛛网膜囊肿及其正常灌注压突破的防治

目的 分析不同手术方式治疗颅内蛛网膜囊肿(IAC)37例的疗效,探讨手术治疗IAC时正常灌注压突破(NPPB)的预防措施及治疗方法.方法 24例行囊肿切除及脑池交通术,3例行囊肿切除术,10例行神经内镜下造瘘术.结果 术后平均随访7月,34例症状或体征有不同程度改善,2例无明显改善,1例死亡.2例发生NPPB(1例治愈,1例死亡),头颅CT或MRI提示囊肿较大,占位效应明显,有小脑幕上抬或颅骨变形、受压征象.内镜手术病例中未发生NPPB.结论 显微手术疗效确切,是大多数IAC的首选治疗方法;如预计发牛NPPB可能性较高,可行神经内镜下造瘘术;头颅CT或MRI可为选择手术方式提供参考;大剂量脱水、激素治疗对NPPB有效.     

玉树地震伤病员空中急救转运初论

目的探讨“空中急救”的必要性和紧迫性。方法对2010年青海玉树地震的空中急救进行回顾性分析,提出了空中救援体系建设的展望。结果自2010年4月14日～5月7日,民航运送各类抗震救灾人员14178人次,物资1406吨,转运伤员4459人次,无一例空中转运死亡病例,也未造成一例因转运不当所致的伤病员二次损伤。结果表明,传统的、封闭的、单一的救护活动已无法满足当代社会生活工作的特点和日益增加的急救需求,政府统一指挥,各方救援力量团结协作,救援方案科学、有效落实,实现了民航应急救护参加社会救援的重大突破。结论“空中急救”是一个系统的组织架构、指挥调度、科学运作、规范操作、物资保障等新兴的医学救援行业、学术领域。拓展民航医学救援兼容性,树立“大救援”观念,在医学救援培训的内容和方式上要有突破。     

中医定向透药治疗仪对癌性疼痛患者疼痛及生命质量影响

目的：探究中医定向透药治疗仪对癌性疼痛患者疼痛及生命质量的影响。方法：选取2018年1月至2019年12月柳州市中医医院肿瘤科收治的癌性疼痛患者120例作为研究对象,以随机数字表法分为对照组和观察组,每组60例。对照组采取三阶梯止痛疗法治疗,观察组采取中医定向透药治疗仪治疗,观察患者治疗后疼痛分级情况变化、治疗后1 d、治疗后7 d、治疗后14 d、2组患者疼痛评分（视觉模拟评分法,VAS）情况、镇痛起效时间、疼痛缓解持续时间、治疗前后爆发痛发作次数变化、美国东部肿瘤协作组体力状态评分表（ECOG）变化、治疗不良反应情况。结果：治疗前,2组患者疼痛分级情况、爆发痛发作次数、ECOG评分比较,差异无统计学意义（P>0.05）,治疗后2组患者疼痛分级情况、爆发痛发作次数、ECOG评分等指标均改善,观察组患者治疗后疼痛分级情况、爆发痛发作次数、ECOG评分等指标优于对照组,差异有统计学意义（P<0.05）;治疗后1 d,2组患者VAS评分比较,差异无统计学意义（P>0.05）,治疗后7 d、治疗后14 d,观察组患者VAS评分低于对照组,差异有统计学意义（P<0.05）;与对照组比较,观察组患者镇痛起效时间、疼痛缓解持续时间均更短,差异有统计学意义（P<0.05）;对照组出现1例便秘,1例恶心;观察组出现1例嗜睡,1例便秘,差异无统计学意义（P>0.05）。结论：中医定向透药治疗仪可减轻癌性疼痛患者疼痛,提升其生命质量。     

脑正常灌注压突破综合征7例报道及治疗体会

目的探讨部分脑外科患者手术后病变邻近脑组织发生正常灌注压突破综合征(NPPB)的可能发病机制、防止其发生的手术技巧以及对降低并发症的影响。方法对2001至2011年脑部手术治疗后出现的7例脑正常灌注压突破综合征患者的临床资料进行回顾性分析。结果所有患者术前均进行了CT、MRI或DSA的检查。7例病例均显微镜下切除病灶,3例清除血肿同时切除病灶,2例行术前造影,然后手术切除病灶。出院时疗效优良共2例(28.5%),病残3例(42.80%),死亡2例(28.5%)。病灶周围的脑组织内病理解剖可见病理性血管,血管周围的星形细胞足突明显减少或破坏。结论当血液灌注压力突然加大时,病变周围的病理性血管就可能发生破裂或液体外渗而发生正常灌注压突破并发症。正确地掌握显微外科手术技巧,对预防及减轻NPPB,降低病死率是有益的。     

十二指肠溃疡患者夜间酸突破现象分析

目的探讨十二指肠溃疡患者(DU)的夜间酸突破(NAB)现象及其与幽门螺杆菌(Hp)感染之间的关系.方法十二指肠溃疡患者随机分为五组,每组8例,分别接受A组静脉注射奥美拉唑40 mg,每日2次;B组静脉注射奥美拉唑40 mg,每日1次;C组口服奥美拉唑20 mg,每日2次;D组口服奥美拉唑20 mg,每日1次;E组静脉注射西米替丁600 mg,每日2次.均用药5 d并于第5天早上8时起连续24 h监测其胃内pH值.结果五组患者的平均胃内pH、平均中位pH、夜间平均胃内pH和夜间平均中位pH均有不同程度升高,A组升高明显,显著高于B、D、E组,差异有显著性(P＜0.05);B、D、E组夜间pH＜4.0的时间占夜间监测时间的百分比显著高于A、C组(P＜0.05);五组分别有0例(A组,0%)、4例(B组,50.0%)、1例(C组,12.5%)、4例(D组,50.0%)、3例(E组,37.5%)患者发生NAB;奥美拉唑2次用药组(包括静脉和口服用药组)仅有1例NAB发生(6.3%),显著低于1次用药组(包括静脉和口服用药组,56.3%,P＜0.05);合计18例Hp阴性者中有10例(55.6%)发生NAB,22例Hp阳性者中只有3例(13.6%,P＜0.05).结论 DU患者中,中国人的NAB发生率低,NAB与奥美拉唑剂量、用药方法及Hp感染相关.     

十二指肠溃疡患夜间酸突破现象初探

目的探讨十二指肠溃疡患者的夜间酸突破现象及其与Hp感染之间的关系.方法十二指肠溃疡患者随机分为三组,每组8例,分别接受①每12h一次静注奥美拉唑40mg(静注1组);②每24h一次静注奥美拉唑40mg(静注2组);③每日二次口服奥美拉唑20mg(口服组).均用药5日并于第5天早上7.30时起连续24小时监测其胃内pH值.结果三组的平均胃内pH、平均中位pH、夜间平均胃内pH、和夜间平均中位pH均升高,以静注1组显著高于其它二组静注2组的夜间pH＜4.0的时间占夜间监测时间的百分比(35.7%±40.3%)显著长于口服组(1.5%±1.9%)和静注2组(1.2±2.3)(p＜0.05);静注2组和口服组分别有4例(50.0%)和1例(12.5%)发生NAB,而静注1组无酸突破发生;合计9例Hp阴性中4例(44.4%)发生NAB,15例Hp阳性中只有1例(6.7%)出现NAB(p＜0.05).结论十二指肠溃疡患者中,中国人的NAB发生率低,可能与国人对奥美拉唑高敏感,且Hp感染率高有关.     

SARS-CoV-2 Vaccine Breakthrough by Omicron and Delta Variants,New York,USA

Recently emerged SARS-CoV-2 variants have greater potential than earlier variants to cause vaccine breakthrough infections. During emergence of the Delta and Omicron variants, a matched case–control analysis used a viral genomic sequence dataset linked with demographic and vaccination information from New York, USA, to examine associations between virus lineage and patient vaccination status, patient age, vaccine type, and time since vaccination. Case-patients were persons infected with the emerging virus lineage, and controls were persons infected with any other virus lineage. Infections in fully vaccinated and boosted persons were significantly associated with the Omicron lineage. Odds of infection with Omicron relative to Delta generally decreased with increasing patient age. A similar pattern was observed with vaccination status during Delta emergence but was not significant. Vaccines offered less protection against Omicron, thereby increasing the number of potential hosts for emerging variants.