Volume 99 ·  Issue 17 ·  2019

Cancer pain is the most common symptom of middle and advanced cancer patients, which affects the quality of life of patients. It is a thorny problem faced by clinicians and patients. Eliminating cancer pain is the basic right of cancer patients and the responsibility of clinicians. Clinical reports include etiological treatment, drug treatment and minimally invasive treatment for cancer pain, which have achieved certain curative effects. However, there is still a lack of systematic research and reports on the individualized precision treatment and step-by-step diagnosis and treatment process of cancer pain. The review of individualized precision treatment of cancer pain is as follows.

The concept and judgment criteria of brain death have reached consensus in most countries around the world. The recognition and awareness of all walks of life in China is also getting higher and higher. The "Chinese Adult Brain Death Judgment Standards and Operational Specifications (Second Edition)" retains the operability and reliability characteristics of the first edition, and revises the number of judgments and prerequisites. It is hoped that the continuous improvement of brain death judgment in China will promote medical and social progress.

Brain death refers to the irreversible loss of function of the whole brain, including the brainstem, that is, death.

To investigate the change and relationship between serum high-mobility group box-1(HMGB1) and related inflammatory cytokines level in patients suffer with bone metastatic pain.

Collection of the bone cancer pain patients who received analgesic therapy the department of pain in The First Affiliated Hospital of Jiaxing University from November 2016 to August 2016. Serum concentration of HMGB1, the Receptor of Advanced Glycation Endproducts (RAGE), monocyte chemotactic protein-1(MCP-1), tumor necrosis factor -α (TNF-α), interleukin-1β (IL-1β), interleukin-10 (IL-10), interleukin-13 (IL-13), and transforming growth factor-β (TGF-β) levels were determined in 15 healthy individuals as healthy donor and 15 patients with bone metastatic pain by enzyme-linked immunosorbent (ELISA) . The healthy individuals and patients with bone metastatic pain were collected before treatment and on 7 d after the treatment.

The serum concentration of HMGB1 and RAGE were significantly increased in tumorous group compared with healthy group[(8.8±2.3) vs (1.9±1.1) μg/L,(231±16) vs (46±20) ng/L); t=7.10,12.44, both P<0.05], then decreased after analgesic therapy [(4.77±1.36) μg/L, (129.80±29.32) ng/L, t=7.10, 12.44, both P<0.05]. The serum concentration of proinflammatory cytokines such as MCP-1, TNF-α, and IL-1β were significantly increased in tumorous group when compared with healthy group, and decreased after analgesic therapy (allP<0.05). The expression of anti-inflammatory cytokines such as IL-10, IL-13, and TGF-β were significantly increased in tumorous group when compared with healthy group, and decreased after analgesic therapy (allP<0.05).Compared with healthy group, the levels of MCP-1/IL-10, MCP-1/IL-13, MCP-1/TGF-β, TNF-α/IL-10, TNF-α/IL-13, TNF-α/TGF-β, IL-1β/IL-10, IL-1β/IL-13, IL-1β/TGF-β were significantly increased in tumorous group (allP<0.05).

HMGB1 may adjust the proinflammatory-anti-inflammatory system homeostasis to participate in the development of bone metastatic pain.

To explore the effects of remifentanil gradual withdrawal on remifentanil induced postoperative hyperalgesia.

Ninety patients from January to June 2018 undergoing elective laparoscopic hysterectomy under general anaesthesia at Ningbo NO.2 hospital, ASA Ⅰ or Ⅱ grade, aged 20-60, were enrolled in this study and randomly assigned to 3 groups (n=30): Group L (low dose remifentanil), Group H (high dose remifentanil) and Group G (high dose remifentanil with gradual withdrawal). Mechanical pain thresholds (MPT), visual analogue scale (VAS) and additional analgesics were recorded at 6 and 24 hours after the operation.

There was no significant difference among the VAS and additional analgesics in three groups at 6 and 24 hours after operation (P>0.05). There was no significant difference among the MPT in three groups before operation (P>0.05). The MPT of group L, group H and group G were (49.8±12.2), (35.5±13.0) and (48.6±11.4) g at 6 hours after surgery, and (51.4±14.3), (36.9±11.1) and (48.8±11.5) g at 24 hours after surgery, respectively, with statistically significant differences (F=12.6, 11.668, both P<0.01). The MPT of group H at 6 h and 24 h after surgery was lower than that of group L (all P<0.01), while the MPT of group G at 6 h and 24 h after surgery was significantly higher than that of group H (all P<0.01). No correlation was observed between MPT and VAS scores or additional analgesics at 6 and 24 hours postoperatively (P>0.05).

Remifentanil gradual withdrawal significantly alleviated intraoperative administration of remifentanil induced postoperative hyperalgesia in laparoscopic hysterectomy patients.

To explore the effects of dexmedetomidine combined with propofol or sevoflurane general anesthesia on stress and postoperative quality of recovery (QoR-40) in patients undergoing laparoscopic surgery.

Two hundreds patients with laparoscopic gastrointestinal tumor resection (100 cases of gastric tumor and 100 cases of colon tumor) from March 2016 to January 2018 at Henan Cancer Hospital,were randomly divided into 4 groups(n=50): group SP (gastric neoplasm + propofol anaesthesia), group SS (gastric tumor + sevoflurane anaesthesia), group CP (colon tumor+ propofol anaesthesia), and group CS (colon tumor + sevoflurane anaesthesia). The four groups were all induced by dexmedetomidine, etomidate, sufentanil and cisatracurium. The patients in group SP and group CP were administered with propofol, and the patients in group SS and group CS were given general anesthesia with sevoflurane. The results of the operation and the quality of recovery were compared. The heart rate, mean arterial pressure change, norepinephrine, epinephrine and cortisol were measured in T0 (before anesthesia started), T1 (30 min after surgery), T2 (10 min after tracheal catheter extraction), T3 (24 h after surgery), T4 (postoperative 48 h), respectively. The postoperative recovery quality after operation was evaluated by QoR-40.

There were no significant differences in operation time, bleeding volume and other operation conditions between each group (all P>0.05), and also no significant differences in heart rate and mean arterial pressure from T0 to T4 time points (all P>0.05). There were significant differences in the levels of norepinephrine and cortisol among the four groups at T1 and T2 time points (F=54.135,140.733,12.037, 21.644,all P<0.05). The levels of norepinephrine and cortisol in SP group at T1 and T2 time points were less than SS group (all P<0.05). Similar, those in CP group were less than CS group (P<0.05). However, there was no significant difference among the 4 groups at other time points (all P>0.05). The scores of VAS and RS in SP group were (0.9±0.4) and (0.8±0.4), which were lower than that of SS group(1.4±0.5,1.4±0.5,all P<0.05).At the same time, the time of regain consciousness was (9.3±1.4) min, which was also lower than SS group [(10.1±1.4)min,P<0.05]. The scores of VAS and RS in CP group were (0.8±0.5) and (0.8±0.4), which were lower than that of CS group(1.4±0.5,1.4±0.4,all P<0.05).At the same time, the time of regain consciousness was (9.2±1.2)min,which was also lower than CS group [(10.1±1.2)min,P<0.05]. The recovery quality scores of the SP and CP group were (164±11) and (168±11) after 24 hours, which were greater than that of the SS and CS group(146±10, 143±12, all P<0.05).

Dexmedetomidine combined with propofol in laparoscopic surgery can effectively suppress intraoperative stress, reduce postoperative pain and agitation, and improve the quality of postoperative recovery.

To evaluate the analgesic effects of cinobufagin (CBG) on cancer-induced bone pain in rat and study the role of the muscarinic receptor M4 subtype (M4 mAChR) in its involvement.

A total of 100 Female Sprague-Dawley rats were randomly divided into 5 groups (n=20): Sham group (group S), Cancer group (group A), Normal saline + CBG vehicle solution group (group ANS), Normal saline + 1 mg/kg CBG group (group ANC) and Tropicamide + 1 mg/kg CBG group (group ATC). Rats in group S were injected 10 μl Hank′s solution into the left tibia medullar cavity, while rats in group A, ANS, ANC, and ATC were injected Walker 256 mammary cancer cells (10 μl, 2×10 ⁷ cells/ml) into the same place. On day 9 post-inoculation rats in group ANS, ANC, and ATC were respectively received Saline (0.9%, 15 μl, i.t.), Saline (0.9%, 15 μl, i.t.)and 10 nmol of M4 mAChR blocker Tropicamide. After 10 min, ANS group, ANC group and ATC group were intraperitoneally injected with CBG vehicle solution, 1 mg/kg CBG and 1 mg/kg CBG. Model rats in each group were tested three times average as its basis pain threshold before injection cancer cells (T ₀). Mechanical withdrawal thresholds were measured on left hind paws, before 20 min (T₁) and after 10 min (T₂), 30 min (T₃), 60 min (T₄), 90 min (T₅) and 120 min (T₆) intrathecal injection. Left L4-L6 spinal dorsal horn and DRG were removed for determination of the expression of CaM-dependent kinaseⅡa (CaMKⅡa) and pCaMKⅡa by Western Blot after 60 min drug delivery.

At each time point from T₁ to T₆, the mechanical pain thresholds of group S were (8.69±0.45), (8.63±0.44), (8.65±0.39), (8.84±0.23), (8.80±0.14), (8.75±0.14) g, respectively, and the mechanical pain thresholds of group A were (6.37±0.30), (6.42±0.13), (6.29±0.17), (6.25±0.22), (6.34±0.33), (6.36±0.34) g, the difference was statistically significant (t=-16.41, -23.47, -30.25, -17.35, -19.52, -22.56, all P<0.01). At each time point from T₃ to T₅, the mechanical pain thresholds of the ANS group were (6.42±0.32), (6.39±0.34), (6.26±0.32) g, respectively, and the mechanical pain thresholds of the ANC group were (7.29±0.34), (7.81±0.15), (7.54±0.19) g, the difference was statistically significant (t=13.52, 14.22, 17.33, all P<0.01). At each time point from T₃ to T₅, compared with the ANC group, the mechanical pain threshold of the ATC group decreased (6.55±0.23), (6.84±0.46), (6.80±0.43) g, and the difference was statistically significant (t=-12.69, -11.26, -10.33, all P<0.01). At the time of T₄, the expressions of pCaMKⅡa in the spinal dorsal horn of each group were (0.67±0.05), (1.64±0.12), (1.57±0.14), (0.78±0.09), (1.39±0.11), respectively, and the expressions of pCaMKⅡa in DRG of each group were (1.65±0.39), (3.59±0.17), (3.43±0.32), (2.17±0.34), (2.95±0.23). The differences were statistically significant (F=179.89, 198.76, both P<0.01). Compared with the S group, the expression of pCaMⅡa was up-regulated in group A. Compared with ANS group, the expression of pCaMKⅡ a was down-regulated in ANC group. Compared with ANC group, the expression of pCaMK Ⅱ a was up-regulated in ATC group. The expression of CaMKⅡa in spinal dorsal horn and DRG was not statistically significant (F=1.25, 2.79, both P>0.05).

These results demonstrated that M4mAChR participated in mediating the alleviation of hyperalgesia by cinobufagin in rats with bone cancer pain, and its mechanism may be related to pCaMKⅡa/CaMKⅡa signaling pathway.

To observe the effect of modified micro titanium plate for extensor attachment point reconstruction in open-door laminoplasty.

From January 2016 to February 2017, 26 patients with cervical spondylotic myelopathy underwent open-door laminoplasty+modified micro-titanium plate fixation+extensor muscle attachment point reconstruction at Tianjin Hospital were enrolled in this study. There were 14 males and 12 females in this group, aged (59±18) years. The improvement of neurological function based on the Japanese Orthopedic Association (JOA) score and the changes cervical curvature based on the cervical curvature index (CCI), especially the atrophy of the back muscles and the occurrence axial symptoms were recorded and analyzed. Intra-group comparisons were performed by using repeated measures of variance analysis or paired t-test.

The operations were performed well without injury to spinal cord. The operation time was (116±32) min with a blood loss of (196±41) ml. The JOA scores was improved form 7.8±2.1 preoperatively to 13.5±3.4 three months after surgery, and 13.9±3.7 at the final follow up (F=30.619, P<0.05). The improvement rate of neurological function was 66%±13%. The CCI decreased from 14.3%±3.9% preoperatively to 13.7%±3.7% three months after surgery and 13.0%±3.3% at the last follow-up (F=0.829, P>0.05). The cross-sectional area of the posterior cervical muscle was (35.9±7.6) cm² before surgery, and it was (33.5±6.7) cm² at the last follow-up (t=1.208, P>0.05). The spinal cord drift distance was (2.6±0.5) mm. The axial symptoms occurred in three patients, the incidence rate was 11.5%.

In the open-door laminectomy, modified micro titanium plate can maintain the stability of the cervical spine, it also can rebuild the extensor attachment points and reduce the atrophy of the posterior cervical muscles, which avoid the occurrence of kyphotic deformity and reduce the occurrence of axial symptoms.

To investigate the effect of esmolol in septic shock patients with tachycardia.

A prospective randomized controlled trial was conducted. Screening septic shock patients that admitted to Department of General Intensive Care Unit of the First Affiliated Hospital of Zhengzhou University from June 2016 to August 2017. After 24 h resuscitation therapy, 100 cases of septic shock patients with tachycardia (heart rate>100 bpm) were divided into esmolol group (n=50) and control group (n=50) with random number table. Patients in esmolol group accepted standard treatment plus esmolol injection with an initial dose of 25 mg/h. Heart rate target is 80 to 100 bpm. Patients in esmolol group continued to use esmolol for 7 days or to the day the patient left the ICU when the heart rate didn′t achieve the target. Patients in control group were given standard treatment. Primary outcome was 28 d mortality. Secondary outcomes included heart rate, norepinephrine dosages, lactate level, inflammatory markers in per day during the trial; acute physiology and chronic health evaluation (APACHE Ⅱ) and sequential organ failure assessment (SOFA) on day 1, 3, 5, 7; length of hospital stay, length of mechanical ventilation, medication time of vasoactive agent. The data were compared with t test or rank sum test between the two groups.

The 28 d mortality of esmolol group and control group was 62%, 68%, respectively(χ²=0.529, P=0.529). Logistic regression analysis showed that primary heart rate (increase of 10 bpm, OR=1.568, 95%CI: 1.039-1.238, P=0.027), primary APACHEⅡ (OR=1.134, 95%CI: 1.026-1.239, P=0.005), integral heart rate (per 10 bpm, OR=2.207, 95%CI: 1.400-3.479, P=0.001) were independent risk factors for 28 d mortality. Compared with control group, the esmolol group had a lower heart rate on day 1-7; but over all, there was no statistically significant difference in heart rate between the two groups (P>0.05). There was no significant difference in total does of norepinephrine, lactate level, inflammatory markers, APACHE Ⅱ, SOFA, length of hospital stay between the two groups (all P>0.05).

Tachycardia significantly increases the risk of death in patients with septic shock, esmolol may decrease the mortality by controlling heart rate.

To investigate the relationship between miR-126 in plasma and coronary slow flow (CSF) phenomenon.

A total of 109 patients without coronary artery disease who underwent coronary angiography at Beijing Anzhen Hospital Affiliated to Capital Medical University from August 2016 to March 2018 were enrolled. The patients were divided into CSF groups (53 cases) and the control group (56 cases) according to CSF existing or not. Clinical data and blood samples of the participants in two groups were collected. Real-time quantitative PCR (RT-qPCR) was used to determine the expression of miR-126 in plasma, and the relationship between miR-126 and CSF and its predictive effect were analyzed.

Mean TIMI frame counts (34±4 vs 20±3), left anterior descending TIMI frame counts (35±5 vs 21±3), left gyroscopic TIMI frame counts (36±5 vs 20±3), right coronary TIMI frame counts (34±5 vs 20±35) and expression level of hypersensitive C-reactive protein (hs-CRP, (3.0±1.2) mg/L vs (2.1±0.9) mg/L) and plasma miR-126 (0.25±0.09 vs 0.19±0.10) of the CSF group were significantly higher than those of the control group (P<0.05). Correlation analysis showed that miR-126 and hs-CRP levels were significantly correlated with mean TIMI frame count (r=0.367, P<0.05), and miR-126 was also significantly associated with the hs-CRP level (r=0.388, P<0.05). Logistic regression analysis showed that miR-126 (OR=2.513) and hs-CRP (OR=1.568) were independent risk factors for coronary slow flow. The area under the ROC curve of miR-126 predicting for CSF was 0.661. When the cutoff value was set at 0.225, the Youden index reached the maximum with a sensitivity of 0.660 and a specificity of 0.714.

The expression level of miR-126 in plasma is significantly correlated with CSF, and miR-126 can be used as a predictor of coronary slow flow phenomenon.

To investigate the relationship between preoperative evaluation, surgery and prognosis of microvascular decompression (MVD) for the treatment of hemifacial spasm (HFS).

The clinical data of 128 HFS patients treated with MVD in the department of neurosurgery of Taizhou Hospital of Zhejiang Province were retrospectively analyzed. According to the SMC grading system, the patients were divided into general spasm group and severe spasm group, and the clinical characteristics, offending vessel, prognosis and surgical complications of the two groups were compared.

In the general spasm group,the age at MVD was (48.6±10.6) years, the disease duration was (4.2±3.3) years;while in the severe spasm group,the age at MVD was (51.8±9.9) years, the disease duration was (8.1±4.5) years;the differences of age and disease duration between the two groups were statistically significant (P<0.05).In the general spasm group, there were 41 cases in which the offending vessel were AICA, 21 cases were PICA, 1 case was VA, 63 cases were single offending vessel, and 7 cases were multiple offending vessels. In the severe spasm group, there were 29 cases in which the offending vessel were AICA, 13 cases were PICA, 2 cases were VA, the total of 44 cases were single offending vessel and 14 cases were multiple offending vessels.There was a significant difference in the proportion of multiple offending vessels in the two groups, and the difference was statistically significant (P<0.05).Patients in the two groups were followed up for 12 to 32 months after surgery, and the difference in effective rate and recurrence rate was not statistically significant (P>0.05).Some kinds of postoperative complications were different between the two groups, the incidence of postoperative delayed facial paralysis was statistically significant (P<0.05), and the other complications were not statistically significant (P>0.05).

Compared with the general spasm group, the patients in the severe spasm group were older, with longer disease duration, higher probability of multiple offending vessels and higher incidence of postoperative delayed facial paralysis. Therefore, preoperative SMC grading is helpful for the evaluation and prediction of intraoperative and postoperative conditions, which is worthy of wide clinical application.

To investigate the factors of first misdiagnosis, treatment and prognosis of acute pregnancy complicating with Guillain-Barré syndrome (GBS) in order to improve the first diagnosed rate.

A total of 45 acute pregnancy complicating with GBS patients were retrospectively analyzed recruited from January 2009 to October 2017 at the Tianjin Fourth Central Hospital.Patients were divided into the first diagnosis group and the first misdiagnosis group, and GBS clinical types were classified into classic and variant types to analyze the misdiagnosis factors of the first diagnosis. All patients received intravenous immunoglobulin (IVIG) treatment, and the therapeutic effect and prognosis were compared and analyzed.

There were 20 cases in the first diagnosis group, 25 cases in the first misdiagnosis group, 35 cases in the typical GBS group, and 10 cases in the variant GBS group.There was no statistically significant difference in the baseline data of the patients(P>0.05).The misdiagnosis factors are divided into four categories: physician factors, patient factors, disease itself factors and laboratory factors. Variant GBS is more likely to lead to misdiagnosis in the first diagnosis than typical GBS. The therapeutic effect of the first diagnosis group was better than that of the first misdiagnosis group(P<0.05).Three patients died in the first misdiagnosis group, and the rest of the pregnant patients gave birth normally, and the babies were born without congenital malformation.

Pregnancy is one of the inducing factors of GBS. Early diagnosis and correct treatment can improve maternal and infant clinical outcomes.

To build a stable animal model simulating pelvic nerve injury in female pelvic floor dysfunction.

A total of 55 10-week-old female SD rats weighing (220±15) g were randomly divided into 3 groups: 5 for normal group, 25 for sham operation group (SO), 25 for bilateral pudendal nerve block group (BPNB). Samples of rat anterior vaginal wall were obtained in 3 days, 1 week, 1 month and 3 months after the operation. The number of nerve fibers was counted per high power field under microscope, with UCHL immunohistochemical staining of nerve fibers. RNA was extracted and the expression of RNA related to nerve tissue was tested.

The numbers of nerve fibers had no significant difference between the normal group and the sham operation group. The numbers of nerve fibers in anterior vaginal wall of rats in BPNB group, was obviously decreased in 3 days after the operation, reached a minimum value at 1 weeks, and lasting till 3 months. QRT-PCR indicated that the expression of UCHL mRNA in the BPNB group was significantly decreased after 1 week, 1 month and 3 months, while the expression of Nestin was significantly decreased 1 month and 3 months after the operation.

Bilateral pudendal nerve block could be used to make rat models of anterior vaginal nerve injury for further exploratory research on pelvic nerve injury theory of pelvic floor dysfunction.

This paper reports a case of remitting seronegative symmetric synovitis with depressed edema syndrome, which mainly showed pain and discomfort in both shoulder joints with distal edema of the limbs. Whole body bone scan suggested that multiple joints of the limbs were likely to consider inflammatory lesions; The synovial membrane of the bilateral fourth proximal phalangeal joint of the elbow, knee and ankle joints was thickened, and the joint cavity of the right knee and left ankle joints was effused. After oral treatment with low-dose prednisolone acetate (15 mg/d), the distal edema of the limbs and the joint pain of the limbs were significantly improved.

The child was a 1-year-old male. One month ago, vomiting occurred without obvious trigger. One week ago, vomiting worsened. Magnetic resonance imaging in a local hospital showed that the lateral ventricle occupied huge space. For further treatment, I came to the First Affiliated Hospital of Zhengzhou University. Lateral ventriculectomy was performed after general anesthesia. Final diagnosis (lateral ventricle) atypical teratoid/rhabdoid tumor.

A rare case of ectopic intrauterine device diagnosed to the bladder and stone formation during cesarean section is reported. Pregnant womanPregnant 38⁺Zhou, caesarean section due to "scar uterus". During the operation, an ectopic IUD was seen at the adhesion between the bladder and the right uterine horn. One arm was inserted into the bladder to form a stone, and the bladder was incised and removed.

The standard treatment for glioma is surgery, radiotherapy and chemotherapy, but the survival period is still very short. Immunotherapy is another effective method for glioma treatment. Immunotherapy for glioma includes tumor vaccines, oncolytic viruses, immune checkpoint inhibitors such as PD-1 and chimeric antigen receptor T cell immunotherapy.

As a new geriatric syndrome, sarcopenia has attracted more and more attention, but its pathogenesis is still inconclusive. This paper summarizes the current research status and summarizes the signaling pathways that play a major role in the pathogenesis of sarcopenia, hoping to provide new ideas and targets for the future treatment of sarcopenia by summarizing some signaling pathways related to sarcopenia.

Cardiovascular medicine is shifting to the model of precision medicine. Various imaging techniques play a crucial role in the diagnosis, treatment and prognostic management of cardiovascular diseases. In recent years, cardiovascular imaging technology has developed rapidly and produced a large amount of data. The exponential growth of big data analytics in cardiovascular diseases and advances in bioinformatics have revolutionized cardiovascular medical care, so AI help is particularly needed. Artificial intelligence includes machine learning and cognitive computing, among others. Machine learning is an important part of artificial intelligence and has been applied to cardiovascular medicine. The development of computer and imaging technology jointly promotes the application of machine learning in cardiovascular imaging. Machine learning methods can solve data-related problems, ranging from simple queries of existing measurement data to more complex challenges involved in analyzing raw images. This review will elaborate from the concepts of machine learning, classification, application of machine learning in cardiovascular imaging, and current limitations and deficiencies.

Intranuclear inclusion body disease is a chronic progressive neurodegenerative disease characterized by eosinophilic hyaline inclusion body shape in the nucleus of central and peripheral nervous system neurons. The clinical symptoms are highly heterogeneous. Magnetic resonance diffusion-weighted imaging of hyperintensity in the epitheliomedullary junction is the characteristic imaging manifestation of this disease.