Objective To explore the efficacy of electroacupuncture treatment in cancer induced bone pain (CIBP)-morphine tolerance rat model and the expression of calcitonin-gene related peptide(CGRP) immunohistochemisty in dorsal root ganglion (DRG).Methods Forty SD rats were divided into four groups:sham group,CIBP + morphine tolerance group (BM),CIBP + electroacupuncture group (BE),and CIBP + morphine tolerance + electroacupuncture group (BME).BM,BE and BME groups were prepared CIBP model by carcinoma cell tibia implanted.After six days,the three CIBP groups accepted treatment of morphine,electroacupuncture,and morphine combined electroacupuncture,separately,nine days continuously.Acupoints were selected Zusanli (ST36) and Sanyinjiao (SP6).50％ mechanical withdraw threshold was evaluated by mechanical stimulation.CGRP expression in dorsal root ganglion was detected by immunohistochemisty.Results After five days of electroacupuncture treatment,pain threshold was (10.9 ± 0.8) g in BME group,(8.7 ± 0.6) g in BM group and (6.2 ± 0.9) g in BE group.The results had significant statistic differences (P ＜ 0.01,separately).IOD value of CGRP expression in dorsal root ganglion was 9026.5 ± 1827.4 in BME group,compared with 14803.1 ± 2086.7 in BM group and 15730.6 ± 2712.5 in BE group (P ＜ 0.01,separately).Results Electroacupuncture can relieve CIBP-morphine tolerance rat pain behavior.The mechanism is related to inhibiting CGRP overdue expression in DRG.

Objective To observe the effect of a novel pressure controlled water jet used in transurethral resection of bladder tumor. Methods Clinical data of 12 patients who underwent a transurethral resection of bladder tumor by using a novel water jet was retrospectively analyzed. Results All 12 cases were successfully operated. Estimated blood loss during operation was less than 5 ml. Operation time was 20-45 minutes (median was 28 min), time of water injection was 8-15 minutes (median was 12 min). There were no significant complications. All patients were followed up for 4-10 months, and tumor recurrence or progression was not found by cystoscopic examination. Conclusion Transurethral resection of bladder tumor by using a novel pressure controlled water jet is advantageous with favorable safety and feasibility.

Objective To assess the clinical efficacy of a modified complete retroperitoneal laparoscopic nephroureterectomy via 3 port approach.Methods From August 2013 to February 2016,23 patients with complete retroperitoneal laparoscopic renal and ureteral sleeve resection were treated with modified three port approach,including 15 males and 8 females.The average age was 67 years old (ranging 44-83 years old).All patients had complained about the hematuria before operation and urine exfoliated cells showed moderate to severe nuclear atypia.All patients accepted the abdominal CT and urography CTU examination,pre-operatively.All of them was diagnosed localized upper urinary tract malignant tumors based on those images,including 13 cases in the pelvis,and 10 cases in the upper segment of the ureter.No chemotherapy,radiotherapy or immunotherapy was performed before surgery.No patients have the history of severe basic disease or upper urinary procedure.The operations were performed under general anesthesia,patients take the contralateral back 30 degrees slope,low elevation head foot,waist bridge,side waist stretch.In the anterior superior iliac spine perpendicular to the line 2 cm parallel to the lower intersection of the rib border were disposed into the 12 mm trocar.Above the anterior superior iliac spine two cross finger level with the intersection of the anterior axillary node,we placed into the 10 mm trocar placement lens.Laparoscopic placement of third casing form an isosceles triangle with the first two casing.The renal fascia was incised with an ultrasonic knife from the renal dorsal side,and the renal hilum was isolated from the kidney by suction aspirator.The renal artery and vein were separated and closed by hem-o-lok.Along the psoas muscle surface to ureter,ureteral clipping by hem-o-lok but not to cut off the free distal ureteral,the lens is composed of first casing into,using ultrasonic knife to free ureter to the bladder wall segment,with 30 mm endoscopic stapler ureter and bladder wall cut off part.Operation time,blood loss and postoperative recovery were recorded in 23 cases.Results All 23 cases were successfully operated without related the operative complication.The operative duration ranged from 3.5 to 6.1 h (mean 4.8 h),the blood loss was 30-880 ml (mean 304 ml),and the postoperative stay was 8-30 d (mean 17.8 d).There are 3 cases of positive lymph node by postoperative pathological reports.Within 2 to 30 months following up,2 patients died of tumor progression in 6 months after surgery.4 patients were diagnosed with bladder cancer in 15 months,15 months,21 months,24 months after surgery,respectively.And the transurethral resection of bladder tumor was performed.Conclusion The modified complete retroperitoneal laparoscopic nephroureterectomy via three ports is safe and reliable.

OBJECTIVETo observe therapeutic effect of acupuncture combined with antiemetic on cisplatin-induced nausea and vomiting.

METHODSBy using paired, cross-controlled trial design, 66 cases of chemotherapy were divided into group A and B, 33 cases in each group. For the group A, chemotherapy, tropisetron and acupuncture therapy were adopted in the first chemotherapy cycle and the same chemotherapy program, tropisetron and sham acupuncture were used in the next cycle. For the group B, chemotherapy, tropisetron and sham acupuncture were given in the first chemotherapy cycle and the same chemotherapy program, tropisetron and acupuncture therapy were applied in the next cycle. Zusanli (ST 36), Neiguan (PC 6) and Gongsun (SP 4) and auricular point Wei (stomach) were selected for acupuncture therapy, and the points at 3 cm lateral to Zusanli (ST 36) , Neiguan (PC 6) and Gongaun (SP 4) and auricular point corresponding to scapha level were selected for sham acupuncture. Acupuncture treatment or sham-acupuncture was given for 6 consecutive days, once each day and antiemetic tropisetron 5 mg was given to the two groups as basic antiemetic prophylaxis for 6 days, once daily. The therapeutic effects on nausea and vomiting in the 6 days were compared between the acupuncture group and the sham-acupuncture group in the two chemotherapeutic cycles.

RESULTSThe effective rates for nausea in the 2nd day and the 4th day were 87.1% and 79.0% in acupuncture group, which were superior to 59.4% and 57.8% in the sham-acupuncture group, respectively (both P < 0.05); and the therapeutic effects on vomiting in the 3rd-6th day in the acupuncture group were better than those in the sham-acupuncture group (P < 0.05).

CONCLUSIONAcupuncture combined with antiemetic can effectively decrease the incidence and degree of cisplatin-induced delayed nausea and vomiting. The effect of acupuncture is better than that of sham acupuncture.

Acupuncture Points ; Acupuncture Therapy ; Adolescent ; Adult ; Aged ; Antiemetics ; administration & dosage ; Breast Neoplasms ; complications ; drug therapy ; Cisplatin ; adverse effects ; therapeutic use ; Female ; Humans ; Lung Neoplasms ; complications ; drug therapy ; Male ; Middle Aged ; Nausea ; drug therapy ; etiology ; therapy ; Vomiting ; drug therapy ; etiology ; therapy

Objective To investigate the efficacies and differences of spinal cord stimulation (SCS) and pulsed radiofrequency (PRF) in the treatment of herpes zoster neuralgia in the elderly. MethodsSixty-three patients with herpes zoster neuralgia over 50 years old, admitted to our hospital from January 2018 to January 2019, were divided into SCS group (n=31) and PRF group (n=32) by prospective, randomized and controlled study. The stimulating electrodes were placed in epidural spinal ganglion segment for two weeks after percutaneous puncture in SCS group. In the PRF group, the radiofrequency needles were percutaneously punctured to the dorsal root ganglion under the guidance of X-ray. After the location of contrast medium was confirmed, each target was treated by pulsed radiofrequency for 360 seconds, followed by anti-inflammatory compound liquid injection. Numeric Rating Scale (NRS) scores, effective rate (percentage of patients having pain relief>50％) and signficant differences were noted between the two group at each time point (P>0.05).The effective rates of pain treatment of patients from the two group reached to 56.67%-81.25%,and there was no significant difference between the two groups at each time point (P>0.05).The complete pain relief rate reached to 37%-71% in the two groups,and there was no significant difference between the two groups at each time point (P>0.05).Number of patients used analgesics and calcium channel antagonists before and after operation in the two groups showed significant differences (χ2=20.917,P=0.000; χ2=18.273,P=0.000),and number of patients used analgesics and calcium channel antagonists 4,12 and 24 weeks after operation in the two groups was significantly smaller than that before operation (P<0.05); but,there were no significant differences between the two groups at each time point (P>0.05).Conclusion SCS and PFR can effectively treat herpes zoster neuralgia and reduce the incidence of sequelae,without no significant difference in the clinical efficacy.

Objective To evaluate the efficacy and economic results in the treatment of upper ureteral calculi by surgery of ureteroscopic Holmium laser lithotripsy under the supine half-sitting lithotomy position.Methods To analyze the clinical data of upper ureter calculi patients who underwent ureteroscopy Holmium laser lithotripsy retrospectively.Patients in traditional lithotomy position with assistance of stone basket during the surgery were in group A.Those in traditional position surgery without stone basket were in group B.Those in supine,half-sitting,lithotomy position and without the assistance of stone basket were in group C.There were 62,31 and 75 patients in group A,B and C respectively.In group A,there were 32 males and 30 females;37 cases in left side,25 in right side,with degree of hydronephrosis of (2.9 ±0.6) cm and stone size of (1.7 ±0.4) cm.In group B,there were 18 males and 13 females;14 cases in left side,17 in right side,with degree of hydronephrosis of (2.8 ± 0.6) cm and stone size of (1.6 ±0.5) cm.In group C,there were 44 males and 31 females;36 cases in left side,39 in right side,with degree of hydronephrosis of (2.8 ± 0.7) cm and stone size of (1.7 ± 0.5) cm.There was no significant difference in aspects of age,degree of hydronephrosis and stone maximum diameter.Statistical analysis was performed regarding operation time,fee for hospitalization and stone free rate among the three groups.Results Ittook (71.8±9.6) min,(62.2±ll.4) min and (65.4±6.8) min in group A,BandC respectively,and there was significant difference among three groups.When comparing two groups respectively,the operation time in group A was more than group B and C significantly,while group B and C shared no difference.As for fees in hospitalization,they were (27.2 ± 4.0),(22.4 ± 5.0) and (22.4 ±3.8) thousand Yuan in three groups,and significant difference was found.By comparing two groups,we found that the fees in group A were more than group B and C significantly,while group B and C had no difference.Finally,stone free rate was compared among three groups,they were 90.3％,64.5％,96％ respectively,and there was significant difference as well.By further study,we found that stone free rate in group C was the highest,followed by A and B group.Conclusions There were higher stone free rates,less operation time and expense to perform ureteroscopic Holmium laser lithotripsy in supine half-sitting lithotomy position.

Objective To examine the efficacy and safety of pregabalin in patients with neuropathic cancer pain (NCP).Methods A prospective randomized control multicenter trial was conducted in five hospitals;from January 2015 to January 2016,one hundred and twenty two eligible inpatients and outpatients were divided into pregablin treatment group (n=60) and control group (n=62).Patients in the pregablin group added pregablin to opiod background analgesia,while those in the control group raised opioid dose instead.The Numerical Pain Rating Scale (NRS) scores,paraesthesia scale scores,Hamilton's Depression (HAMD) scale scores,analgesia dose,patiends satisfaction,and adverse events were recorded 14 d after each treatment.Results After each treatment,the NRS scores were decreased by (2.3 ±1.1) and (1.3±1.5),the paraesthesia scale scores were decreased by (1.6±0.6) and (0.4±0.3),and the HAMD scale scores were decreased by (4.4±1.2) and (2.4±1.0) in the pregablin treatment group and control group,respectively,with significant differences (P＜0.05).Morphine dose for breakthrough pain in pregabalin group was statistically less than that in control group ([30.6±3.5] mg/d vs.[70.9±12.3] mg/d,P＜0.05).Patients satisfaction in the pregablin treatment group was significantly higher than that in the control group (P＜0.05).Pregabalin treatment group had less severe adverse effects (3/56,5％) as compared with control group (10/59,16.1％,P＜0.05).Conclusion Pregabalin has positive roles in patients with NCP already receiving opioid;pregabalin has better pain-control and mood improvement.

Objective:To examine the effect of minimally invasive radiofrequency(RF)thermocoagulation of the posterior medial branch of the spinal nerves on lumbar facet joint(LFJ)pain in the elderly.Methods:Patients over 60 years old with LFJ pain were randomly divided into an RF group and a control group.The primary outcome measures were the numerical rating scale(NRS)for pain assessment and the proportion of patients whose NRS decreased by 2 points or more, while the secondary outcome measures were the lumbar Oswestry dysfunction index(ODI), the proportion of patients whose ODI score decreased by 15 points or more, and the Macnab criteria.Results:Patients who met the inclusion criteria were divided into an RF group and a control group, with 135 patients in each group, including 171 women and 99 men.Compared with baseline values, changes in NRS scores in the RF group were significantly different from those in the control group at the 1st, 3rd and 6th months[(-2.3±1.1) vs.(-1.2±1.2), (-2.3±1.1) vs.(-1.2±1.2), (-2.3±1.1) vs.(-1.2±1.2), t=13.204, 16.366, 20.319, all P<0.001], and the proportions of patients whose NRS decreased by ≥2 at the 3rd and 6th months were higher in the RF group than in the control group[61.1%(80/131) vs.26.0%(32/123), 52.9%(64/121) vs.22.5%(25/111), χ2=18.287, 11.844, both P<0.001]. Compared with baseline values, there were also significant differences in ODI score changes between the RF group and the control group at the 1st, 3rd and 6th months[(-15.2±6.7) vs.(-10.1±7.4), (-14.6±6.8) vs.(-8.6±6.2), (-13.6±8.8) vs.(-7.7±9.2), t=5.563, 8.912, 7.721, all P<0.001], and the proportions of ODI reduction ≥15 were higher in the RF group than in the control group at the 3rd and 6th months[45.8%(60/131) vs.34.1%(42/123), 36.4%(44/121) vs.27.0%(30/111), χ2=6.668, 9.825, P=0.024, 0.031]. The proportions of patients achieving outcomes categorized as excellent and effective based on the Macnab criteria were significantly higher in the RF group than in the control group at the 6th month[60.3%(73/121) vs.36.0%(40/111), 81.0%(98/121) vs.54.1%(60/111), χ2=11.787, 8.890, both P<0.001)]. Conclusions:Minimally invasive radiofrequency thermocoagulation in the posterior medial branch of the spinal nerves can effectively reduce pain of the lumbar facet joints and improve movement disorders in the elderly, and the therapeutic effect is good 6 months after the procedure.

Pressure injury is a common problem faced by global health care institutions, which seriously threatens the lives and health of patients. The treatment and care of pressure injuries need people in multiple professional fields to work together. This article interprets the assessment and planning part of the clinical practice guideline for the third edition of " Assessment and Management of Pressure Injuries for the Interprofessional Team" developed by the Registered Nurses' Association of Ontario, Canada. This article aims at helping the interprofessional team conduct accurate, comprehensive, and full-process assessments of patients with pressure injuries, formulate a reasonable diagnosis and treatment plan, and providing a basis for the implementation of correct treatment measures, so as to promote the improvement and healing of pressure injuries.