Objective To observe the clinical effect and adverse reaction of oxycodone sustained-release tablet and morphine tablet in dose titration therapy on moderate and severe chronic cancer pain. Methods Sixty patients suffering from moderate and severe cancer pain, without using opioid drugs, were divided into oxycodone sustained-release tablet group and morphine tablet group by random digits table method with 30 cases each. The patients in oxycodone sustained-release tablet group were administered 10 mg oxycodone sustained-release tablet every 12 h, and the patients in morphine tablet group were administered 5 or 10 mg morphine tablet whenever needed. The total dose of opioid drugs was acquired after 24 h, and was converted into equal dose of oxycodone sustained-release tablet. The condition of pain control and adverse reaction were observed and recorded in a week. Results During the titration, the number of daily outbreak pain and daily medication in oxycodone sustained-release tablet were significantly lower than those in morphine tablet:(1.27 ± 1.53) times vs. (4.87 ± 1.98) times and (3.37 ± 1.78) times vs. (5.10 ± 2.20) times, and there were statistical differences (P<0.05). At the first day after titration, the pain relief rate of oxycodone sustained-release tablet was significantly higher than that of morphine tablet:83.33%(25/30) vs. 60.00%(18/30), and there was statistical difference (P<0.05). While at the third day after titration, there was no statistical difference in the pain relief rate between 2 groups (P>0.05). At the first day after titration, the incidence of daily outbreak pain in oxycodone sustained-release tablet was significantly lower than that in morphine tablet:23.33%(7/30) vs. 53.33% (16/30), the rate of reaching steady pain control state was significantly higher than that in morphine tablet: 86.67% (26/30) vs. 63.33% (19/30), and there were statistical differences (P<0.05). There were no statistical difference in the incidence of daily outbreak pain, rate of reaching steady pain control state at the third day after titration, time of reaching steady pain control state, and incidence of adverse reaction (P>0.05). Conclusions The pain relief rate and side effect of oxycodone sustained-release tablet is similar to that of morphine tablet in dose titration therapy on moderate and severe chronic cancer pain, but analgesic effect is faster than morphine tablet. Oxycodone sustained-release tablet decreases the number of outbreak pain and relieves patients′ pain in the titration process. Oxycodone sustained-release tablet may have advantage of time and effect, which is worth to be widely used in clinical therapy.

Objective To evaluate the value of energy spectrum CT with multimodal quantitative parameters in diagnosis of the metastatic lymph nodes of gastric adenocarcinoma compared with the conventional CT.Methods 37 patients with gastric adenocarcinoma diagnosed by gastroscopy underwent enhanced CT scan with gemstone spectral imaging mode.We positioned and marked the stomach lymph nodes on CT images and compared with postoperative pathologic results one to one.ROC was used to identify the critical quantitative index of energy spectrum CT in distinguishing the metastasis from benign lymph node,and to evaluate the diagnostic effect compared with CT features.Results The 40-80 keV single energy spectrum curve slope (λHU )and normalized iodine concentration (NIC)in metastasis group were lower than those in the benign one in the arterial phase with statistical differences (P <0.05 ),but without statistical differences in venous phase.The combination of arterialλHU and NIC showed significant advantages compared with CT features(P <0.01), with the sensitivity,specificity and accuracy of 84.3% vs 61.4 %,88.4% vs 81.3 % and 86.8% vs 73.6 %.Conclusion The energy spectrum CT can provide quantitative analysis for differential diagnosis of gastric cancer metastasis from benign lymph nodes,and significantly improve the diagnostic accuracy of lymph node metastasis of the cancer.

Objective To explore the feasibility of using short-latency somatosensory evoked potentials (SLSEP) to quantitate Deqi.Methods A randomized crossover controlled trial was carried out. Healthy subjects were enrolled and allocated to treatment (thick needle, deep insertion and manipulation for Deqi) and control (thin needle, shallow insertion and no manipulation without Deqi) groups. Somatosensory evoked potentials were recorded before, during and after acupuncture. Deqi was assessed using the score scale in the subjets. The effects of Deqi and no Deqi at point Sanyinjiao (SP 6) on the potentials were observed.Results The preliminary exploration of the feasibility by the trial test showed that the effect of Deqi on short-latency somatosensory evoked potentials had certain regularity. It was worthy to be observed.Conclusion The plan is feasible. The formal test can be conducted.

Objective To investigate the current status of the beliefs and attitudes about sleep and to discuss its influencing factors in patients with hepatocellular carcinoma. Methods A total of 206 patients with hepatocellular carcinoma were investigated with (beliefs and attitudes about sleep scale, BASS). Single factor analysis was used to compare the difference of beliefs and attitudes about sleep among hepatocellular carcinoma patients with different basic data. Multiple linear stepwise regression was adopted to explore the influencing factors of the beliefs and attitudes about sleep in patients with hepatocellular carcinoma. Results The total score of BASS in patients with hepatocellular carcinoma was (85. 15 ± 13. 36). There were statistically significant differences in the beliefs and attitudes about sleep in patients with hepatocellular carcinoma among different degrees of education, family incomes, occupations, duration of disease, the Karnofsky score and knowledge of the facts (P<0. 05). The multiple linear stepwise regression analysis results showed that the influencing factors the beliefs and attitudes about sleep in patients with hepatocellular carcinoma were the Karnofsky score, informed situation, duration of disease, occupation, family income (P<0. 05). Conclusions The beliefs and attitudes about sleep in patients with hepatocellular carcinoma were in low level and were influenced by various factors. Targeted interventions should be taken to strengthen their beliefs and attitudes about sleep.

Objective To investigate the learning curve of Da Vinci robot-assisted laparoscopic radical gastrectomy for gastric cancer.Methods The retrospective cohort study was conducted.The clinicopathological data of 42 patients who underwent Da Vinci robot-assisted radical gastrectomy for gastric cancer in the First Affiliated Hospital of Xi'an Jiaotong University from October 2017 to August 2018 were collected.There were 30 males and 12 females,aged from 36 to 84 years,with an average age of 59 years.The learning curve was evaluated using the cumulative sum (CUSUM) analysis and the best fitting curve method.According to the minimum number of surgeries required to cross the learning curve,the patients were divided into learning stage group and mastery stage group.Then general data and surgical efficacy of the two groups were compared.Observation indicators:(1) surgical situations;(2) results of CUSUM analysis;(3) comparison of general data between the two groups;(4) comparison of surgical efficacy between the two groups;(5) follow-up.Patients were followed up by outpatient examination or telephone interview to detect the postoperative complications,tumor recurrence and metastasis up to February 2019.Measurement data with normal distribution were presented as Mean±SD,and comparison between groups was done using the independent sample t test.Count data were represented as absolute number,and comparison between groups was analyzed using the chi-square test or Fisher exact propability.Comparison of ordinal data between groups was analyzed using the Mann-Whitney U test.Results (1) Surgical situations:all the 42 patients underwent Da Vinci robot-assisted radical gastrectomy for gastric cancer successfully,without conversion to open surgery or perioperative death.Fourteen out of 42 patients underwent Da Vinci robot-assisted total radical gastrectomy and 28 underwent Da Vinci robot-assisted distal radical gastrectomy.The operation time and docking time were (213±31)minutes and (26± 11)minutes.The operation time and docking time had a tendency to decreasing as the surgical cases increasing.(2) Results of CUSUM analysis.The CUSUM learning curve were best modeled as a polynomial with equation:CUSUM (operation time)=0.016 9X3-1.913 3X2+ 50.985X-16.595,CUSUM (docking time) =0.012 8X3-1.070 7X2 + 22.189X-23.097 respectively (X means the surgical case).The P value of fitting test of models was ＜ 0.05,with goodness-of-fit (R2) as 0.960 and 0.985.The CUSUM learning curve of operation time reached its peak when the number of surgical cases accumulated to the 19th case.Nineteen cases were the minimum number of surgeries required to cross the learning curve.Similarly,The CUSUM learning curve of docking time reached its peak when the number of surgical cases accumulated to the 14th case,and 14 cases were the minimum number of surgeries required to skillfully master robot installation across the learning curve.(3) Comparison of general data between the two groups:patients were divided into learning stage group and mastery stage group with 19 cases as the cut-off point.Males,females,age,body mass index (BMI),cases in grade 1,2,3 of American society of anesthesiologists (ASA),cases with previous abdominal surgery history,cases with basic diseases,cases in T1,T2,T3,T4 stages of preoperative ultrasonic gastroscopic tumor T staging,maximum tumor diameter,cases in Ⅰ,Ⅱ,Ⅲ stages of postoperative clinical staging,cases with total gastrectomy and distal gastrectomy (surgical method) were 14,5,(60± 13)years,(23.7±2.9)kg/m2,1,16,2,3,8,5,3,3,8,(4.1±3.5)cm,6,7,6,10,9 in the learning stage group,and 16,7,(58±10)years,(23.7±1.3)kg/m2,1,17,5,2,14,3,6,9,5,(4.7±2.7)cm,8,9,6,18,5 in the mastery stage group,respectively.There was no significant difference in the sex,age,BMI,ASA score,basic diseases,preoperative ultrasonic gastroscopic tumor T staging,maximum tumor diameter,postoperative clinical staging,and surgical method between the two groups (x2 =0.086,t =0.475,-0.007,Z =-0.884,x2 =1.469,Z =-0.301,t =-0.651,Z =-0.079,-0.236,x2 =3.076,P ＞ 0.05).There was no significant difference in the previous abdominal surgery history between the two groups (P ＞ 0.05).(4) Comparison of surgical efficacy between the two groups:operation time,volume of intraoperative blood loss,number of lymph nodes harvested,time to first liquid food intake,cases with postoperative complications and duration of postoperative hospital stay were (230±25) minutes,(176± 103) mL,21±7,(5.1 ± 2.0) days,2,(9.3± 2.5)days in the learning stage group,and (191±18) minutes,(95±41)mL,21±6,(4.7±1.7)days,3,(8.4± 2.1)days in the mastery stage group,respectively.There were statistically significant differences in the operation time and volume of intraoperative blood loss between the two groups (t =5.951,-3.359,P＜0.05).There was no statistically significant difference in number of lymph nodes harvested,time to first liquid food intake,and duration of postoperative hospital stay between the two groups (t =-0.120,0.538,1.303,P＞0.05).There was no significant difference in the cases with postoperative complications between the two groups (P＞0.05).(5) Follow-up:all the 42 patients were followed up for 6-16 months,with a median time of 11 months.No serious long-term complications,tumor recurrence and metastasis or death occurred during the follow-up.Conclusions The CUSUM learning curve of Da Vinci robot-assisted radical gastrectomy for gastric cancer can be divided into the learning stage and the mastery stage.It is suggested that the surgeons need to finish 19 cases or more to master Da Vinci robot-assisted radical gastrectomy for gastric cancer.

Background: The impact of para-aortic lymphadenectomy (PALD) on prognosis and quality of life (QoL) for IB2-IIA2 cervical cancer patients remain controversial. And whether intraoperative frozen pathology exam on common iliac lymph nodes could help predict para-aortic lymph node (PALN) metastasis was unanswered with high-level evidence. Methods A multi-center, randomized controlled study is intended to investigate the effect of PALD on the prognosis and QoL in cervical cancer patients and to assess the value of intraoperative frozen pathological evaluation of common iliac nodes metastasis for the prediction of PALN metastasis. After choosing whether to receive intraoperative frozen pathological examination of bilateral common iliac lymph nodes, eligible patients will be randomly assigned (1:1) to receive PALD or not. The primary end point is 2-year progression-free survival (PFS). The secondary end points include 5-year PFS, 2-year overall survival (OS), 5-year OS, adverse events (AEs) caused by PALD, AEs caused by radiotherapy and QoL. A total of 728 patients will be enrolled from 8 hospitals in China within 3-year period and followed up for 5 years.

Objective To investigate the expression of autophagy-related gene Beclinl and P62 in nasal polyps and its relationship with the pathogenesis of this disease.Methods The specimens were divided into two groups:nasal polyp tissue (n =50) and normal inferior turbinate mucosa (n =20).The general morphology was detected with hematoxylin-eosin(HE) staining,the expression of Beclin1 and P62 was examined with immunohistochemistry(IHC) and real-time fluorescent quantitative reverse transcription-polymerase chain reaction (RT-PCR).SPSS 20.0 software was used to analyze the data.Results Protein level:The expression of Beclinl in nasal polyp tissue was lower than inferior turbinate mucosa (U =-13.36,P ＜0.01),in contrast,P62 in experimental group was higher than control group(U =12.99,P ＜0.01).mRNA level:The relative quantity of Beclinl and LC3B expressions in nasal polyp were 0.46 ±0.17and 0.46 ± 0.11,which was lower than those in turbinate mucosa 1.11 ± 0.47 and 0.96 ± 0.25.The differences were significant(t value was-4.61,-4.61,both P ＜0.01).But the relative quantity of P62 expression in nasal polyp was 2.19 ± 0.44,which was higher than that in turbinate mucosa (1.05 ± 0.33).The difference was all significant (t =6.16,P ＜ 0.01).Conclusions Compared with control group,the expression of Beclin1 was deficient and P62 was much more.Autophagy was deficient in nasal polyps,which might be in connection with the pathogenesis of the disease.

Objective: To evaluate the efficacy and safety of bevacizumab in the treatment of radiation brain necrosis, and to provide guidance for rational clinical application. Methods: A retrospective analysis was made of 14 patients with radiation brain necrosis who had failed to receive mannitol and hormone treatment or had been treated for the first time. All the patients were divided into two groups according to different treatment regimens (5.0 mg/kg repeated every 14 d and 7.5 mg/kg repeated every 21 d). The changes of enhanced lesions in MRI T1W1 phase and edema in T2W1 phase were compared separately in the two groups. The clinical symptoms, changes of KPS score and adverse drug reactions were recorded. Results: Totally 14 patients completed at least two cycles of treatment. After two cycles of treatment, the KPS scores of both groups were improved. The KPS scores of 5.0 mg/kg group were increased by 31.66 points on average compared with those before treatment. The KPS scores of 7.5 mg/kg group were increased by 27.50 points on average compared with those before treatment. The volume of CRN lesions were decreased(46.0±9.4)%(t=6.57, P<0.05) and the volume of edema lesions decreased(68.9±8.9)%(t=3.32, P<0.05) in 5.0 mg/kg group. In 7.5 mg/kg group, these two parameters were reduced by(53.9±10.7)%(t=7.89, P<0.05 and (77.1±14.3)%(t=4.22, P<0.05), respectively. There was no significant difference in the reduction of the mean volume of CRN lesions and the volume of edema area between the two groups (P>0.05). In this study, the incidence of adverse events in the 5.0 mg/kg group was similar to that in the 7.5 mg/kg group, with no significant difference(P>0.05). Conclusions Bevacizumab can significantly improve the clinical symptoms and quality of life of patients with radiation brain necrosis. The safety of 5.0 mg/kg treatment regimen repeated every 14 d is similar to that of 7.5 mg/kg treatment regimen repeated every 21 d, which can be used for reference in the treatment of CRN.

Objective: To evaluate combined robotic and endoscopic surgery in the third space for gastric submucosal tumors(SMTs). Methods: Combined surgery in 4 patients were compared with 19 patients who underwent laparoscopic wedge resection between Aug 2017 and Feb 2018. Results: R₀ resection was achieved in all combined surgery patients. The operation time was longer (112±29 )min vs. (93±11 ) min (t=2.338, P<0.05), but less blood loss, (11±6)ml vs.(59±6)ml (t=15.102, P<0.01). In combined surgery group, there was a larger tumor over resected tissue percentage, 65.4%±28.2% vs.22.8%±19.6% ( t=3.680, P<0.05). Combined surgery group patients were with earlier first breaking wind (3±1.4) d vs.(4.1±0.9) d (t=2.026, P>0.05), and shorter hospital stay (6.5±1.3) d vs.( 8.5±0.6) d (t=4.902, P<0.01), but a little higher hospitalization costs(57 651±10 097)rmb vs.(42 620±5 086)rmb (t=4.508, P<0.01). There were no major postoperative complications occurred in neither groups, nor tumor recurrences after 3-month follow-up. Conclusion Combined robotic and endoscopic surgery in the third space for submucosal gastric tumors is a novel operation with short operation time, less blood loss and good result.

OBJECTIVE: To investigate the early effectiveness of transiliac-transsacral screws internal fixation assisted by augmented reality navigation system HoloSight (hereinafter referred to as "computer navigation system") in the treatment of posterior pelvic ring injuries. METHODS: A retrospective analysis was made in the 41 patients with posterior pelvic ring injuries who had been treated surgically with transiliac-transsacral screws between June 2022 and June 2023. The patients were divided into navigation group (18 cases, using computer navigation system to assist screw implantation) and freehand group (23 cases, using C-arm X-ray fluoroscopy to guide screw implantation) according to the different methods of transiliac-transsacral screws placement. There was no significant difference in gender, age, body mass index, causes of injuries, Tile classification of pelvic fracture, days from injury to operation, usage of unlocking closed reduction technique between the two groups ( P>0.05). The time of screw implantation, the fluoroscopy times, the guide wire adjustment times of each screw, and the incidence of complications were recorded and compared between the two groups. The position of the transiliac-transsacral screw was scanned by CT within 2 days after operation, and the position of the screw was classified according to Gras standard. RESULTS: The operation was successfully completed in both groups. The time of screw implantation, the fluoroscopy times, and the guide wire adjustment times of each screw in the navigation group were significantly less than those in the freehand group ( P<0.05). There were 2 cases of incision infection in the freehand group, and the incision healed by first intention after active dressing change; there was no screw-related complication in the navigation group during operation and early period after operation; the difference in incidence of complications between the two groups (8.7% vs. 0) was not significant ( P=0.495). According to the Gras standard, the screw position of the navigation group was significantly better than that of the freehand group ( P<0.05). CONCLUSION Compared with the traditional freehand method, the computer navigation system assisted transiliac-transsacral screws internal fixation in the treatment of posterior pelvic ring injuries has advantages of improving the accuracy of screw implantation and reducing radiation damage and the time of screw implantation.
Humans ; Retrospective Studies ; Surgical Wound Infection ; Replantation ; Body Mass Index