OBJECTIVES: To explore the efficacy of DSA-guided intrathecal drug delivery system combined with Zi Wu Liu Zhu Acupoint Therapy for management of cancer pain and provide reference for its standardized clinical application. Methods and. RESULTS: Recommendations were formulated based on literature review and expert group discussion, and consensus was reached following expert consultation. The consensus recommendations are comprehensive, covering the entire treatment procedures from preoperative assessment and preparation, surgical operation process, postoperative management and traditional Chinese medicine treatment to individualized treatment planning. The study results showed that the treatment plans combining traditional Chinese with Western medicine effectively alleviated cancer pain, reduced the use of opioid drugs, and significantly improved the quality of life and enhanced immune function of the patients. Postoperative follow-up suggested good treatment tolerance among the patients without serious complications. CONCLUSIONS The formulated consensus is comprehensive and can provide reference for clinicians to use DSA-guided intrathecal drug delivery system combined with Zi Wu Liu Zhu Acupoint Therapy. The combined treatment has a high clinical value with a good safety profile for management of cancer pain.
Humans ; Medicine, Chinese Traditional ; Cancer Pain/therapy* ; Drugs, Chinese Herbal/therapeutic use* ; Drug Delivery Systems ; Pain Management/methods* ; China

Objective Analysis of misdiagnosis and causes of neck pain related diseases,and to explore the different diagnostic ideas of Chinese and Western medicine and the countermeasures to reduce misdiagnosis,so as to help acupuncturists improve their understanding of this disease.Method The relevant literature on conditions with neck pain as the chief complaint was systematically searched,using data mining for retrospective analysis,sorting out the different diagnostic ideas of Chinese and Western medicine,proposing individualized countermeasures for reducing misdiagnosis.Results ①After retrieval,126 case reports were included,totaling 445 cases of diagnostic error,involving 9 systems and 38 conditions,of which cervical spondylosis was the most commonly misdiagnosed.The confirmed cases involved 7 systems and 46 conditions,of which tumors,subacute thyroiditis,eagle syndrome,acute myocardial infarction and thoracic outlet syndrome were the most commonly misdiagnosed.②The are various causes for the misdiagnosis of this condition,including atypical symptoms,insufficient understanding of the condition,lack of understanding of rare conditions,incomplete physical and auxiliary examina-tions,or wrong guidance.③There are many erroneous diagnosis of neck pain,which can delay the condition and even endanger lives.A clear diagnosis is the premise and basis for effective Traditional Chinese and Western medical intervention.Conclusion There exists a number of possibilities for the misdiagnosis of this disease.Therefore,we must meticulously collect medical history,improve specialist physical and auxiliary examination,emphasizing holistic thinking and differential diagnosis.Acupuncture department as the main department of patients with neck pain,in order to improve the level of diagnosis and treatment of neck pain,requires acupuncturists to consolidate the Western medicine diagnosis of neck pain,closely linked to the Traditional Chinese Medicine"three principles"of"treatment based on disease differentiation",in order to reduce misdiagnosis,cure the disease,improve long-term efficacy.

Lung is one of the most sensitive target organs of human beings under the shock waves. Due to its serious injury, rapid development and high mortality, blast lung injury has been a widely concerned research topic in the field of military medicine. In the normal physiological state, the body is in a dynamic balance between pro-inflammaton and anti-inflammation, oxidation and anti-oxidation, promoting apoptosis and inhibiting apoptosis. While blast lung injury breaks the balance and causes physiological, biochemical and pathological changes in the body, seriously leading to acute respiratory distress syndrome and multiple organ dysfunction syndrome, and eventually the mortality. So far, the researches on blast lung injury mainly involve damage model, pathogenesis, pathological changes, intervention treatment and so on, which has achieved great research findings. In the review, the authors summarize the progress of molecular mechanism for blast lung injury from the perspective of inflammatory reaction, oxidative stress, apoptosis and so on, which may promote the discovery of new targets for the diagnosis, treatment and rehabilitation intervention of blast lung injury.

Objective: To examine the impact of metabolic syndrome (MS) on the clinicopathological characteristics and prognosis of patients with colorectal cancer (CRC). Methods: The clinical data of 650 patients with CRC admitted in Shanxi Provincial Cancer Hospital between January 2010 and December 2011 were retrospectively analyzed. Among 650 patients there were 190 cases complicated with MS (MS group) and 460 cases without MS (non-MS group), the clinicopathological features and prognosis were compared between two groups. Results: The serum insulin and insulin-like growth factor-1 (IGF-1) levels in MS group were significantly higher than those in non-MS group [(9.2±4.7) vs.(6.8±4.7)μIU/L, t=8.88, P<0.01 and (200.2±44.1) vs.(136.7±63.2)mg/L,t=12.63, P<0.01]. The proportions of stage T₃ and T₄ cancer, extra-regional lymph node metastasis (ELN), and TNM stage Ⅲ and Ⅳ patients in MS group were significantly higher than those in non-MS group [(83.2% (158/190) vs. 72.6% (334/460), χ²=8.19, P=0.04; 9.5% (18/190) vs. 4.8%(22/460),χ²=8.61, P=0.04; 56.3% (107/190) vs. 45.2%(208/460), χ²=8.22, P=0.04, respectively]. The 5-year disease-free survival (DFS) in MS group was significantly lower than that in non-MS group [57.9%(99/171)vs. 66.1%(279/422), P<0.01]. Multivariate analysis indicated that MS(HR=1.623, 95%CI:1.511-1.963, P=0.03), IGF(HR=1.382, 95%CI:1.031-1.765, P=0.02) and, ELN(HR=4.270, 95%CI:2.177-7.463, P<0.01)were independent factors affecting the prognosis of CRC patients. Conclusion Metabolic syndrome is one of the risk factors affecting the prognosis of CRC patients.

Objective To investigate the value of detecting peripheral blood epidermal growth factor receptor (EGFR) gene in predicting the therapeutic efficacy of advanced non-small cell lung cancer. Methods A total of 150 patients with stage ⅢA-Ⅳ non-small cell lung cancer diagnosed in Shanxi Provincial Cancer Hospital from October 2013 to February 2015 were collected. The peripheral blood EGFR gene was detected by amplification refractory mutation system (ARMS). The relationship between the mutation rate and the clinicopathological features of patients was observed, and 80 patients were selected into the follow-up treatment according to the inclusion criteria. Forty patients (all 19 or 21 exon mutations) in group A with EGFR gene mutation were treated with gefitinib orally. Forty patients with wild type EGFR gene in group B underwent 4 cycles of NP regimen. Efficacy and progression-free survival were evaluated in both groups. Results The mutation rate of EGFR gene was 33.3 ％ (50 cases), of which 29 were exon 19, 18 were exon 21 and 3 were exon 18 and 20. The mutation rate of EGFR gene was higher in female, adenocarcinoma and non-smoker (all P<0.05). Among the 80 patients who received follow-up treatment, the effective rate [67.5％(27/40) vs. 32.5 ％ (13/40)] and disease control rate [85.0 ％ (34/40) vs. 65.0 ％ (26/40)] in group A were significantly higher than those in group B, and the median PFS was prolonged (9.00 months vs. 4.25 months),the differences were statistically significant (χ2=9.800, P=0.002;χ2=4.267, P=0.039;χ2= 15.792, P<0.001). Conclusion The detection of peripheral blood EGFR mutation can be used to predict the efficacy of tyrosine kinase inhibitors in non-small cell lung cancer.

Objective To investigate the value of magnetic resonance diffusion-weighted imaging (DWI) in combination with peripheral serum tumor markers in the diagnosis and therapeutic evaluation of small cell lung cancer (SCLC) brain metastases.Methods Retrospective analysis of 368 SCLC cases diagnosed by histopathology or cytology from February 2009 to February 2012 in Shanxi Provincial Cancer Hospital was made.All patients underwent pathological examination of progastrin-releasing peptide (ProGRP),neuron-specific enolase (NSE) and brain DWI,and measured the apparent diffusion coefficient (ADC) of DWI sequences of brain metastases.The difference between the positive rates of ProGRP and NSE in patients with or without brain metastases was compared by the X2 test,and the diagnostic efficiency of ProGRP,NSE,DWI and combined detection for brain metastases were analyzed.The Kruskal-Wallis H test was used to compare the changes of ADC value,ProGRP and NSE before and after brain irradiation therapy in brain metastases of SCLC.Pearson correlation analysis was made to evaluate the correlation between the changes of ADC value and the levels of ProGRP and NSE in SCLC patients with brain metastases before and after treatment.Results The median expression of serum ProGRP in 169 SCLC patients was 2 664.7 pg/ml (98.4-4 876.8 pg/ml),with a positive rate of 98.2 ％ (166/169).The median expression of NSE was 41.9 μg/L (9.4-264.3 μg/L),with a positive rate of 70.4 ％ (119/169).The median expression of serum ProGRP level was 514.3 pg/ml (3.9-2 899.3 pg/ml) in 199 SCLC patients without brain metastasis,the positive rate was 89.4 ％ (178/199).The median expression of NSE was 40.4 μg/L (0.3-176.1 μ,g/L),with a positive rate of 64.8 ％ (129/199).The difference of ProGRP level between the two groups was statistically significant (u =121.47,P ＜ 0.001),but there was no significant difference in NSE level (u =1.35,P =0.12).The sensitivities of ProGRP,NSE,DWI,ProGRP+DWI and NSE+DWI were 68.4 ％,41.2 ％,66.7 ％,92.2 ％,and 82.4 ％,and the specificities were 52.9 ％,35.3 ％,76.5 ％,94.1％,and 88.2 ％.The sensitivity and specificity of ProGRP+DWI and NSE+DWI were higher than those of single test,and the differences were statistically significant (all P ＜ 0.001).One hundred and fifty-six SCLC patients with brain metastases were treated with whole brain radiotherapy.Pearson correlation analysis showed that ADC values were negatively correlated with ProGRP and NSE levels (r =-0.945,P ＜ 0.001;r =-0.995,P ＜ 0.001).Conclusion DWI combined with ProGRP and NSE can provide objective evidence and clinical guidance for the diagnosis of SCLC brain metastases and the evaluation of whole brain radiotherapy.

Objective: To investigate the effects and mechanism of Holothurian Glycosaminoglycan (hGAG) alone in combination with cisplatin (DDP) on apoptosis of pulmonary adenocarcinoma cell A549. Methods: A549 cells were separately treated with blank, hGAG, DDP and hGAG combined with DDP (hGAG + DDP). The cell morphology in 4 groups was observed using light microscope. CCK8 assay was used to determine the cell viability. Flow cytometry by Hoechst 33258 and AnnexinV-FITC/PI staining was applied to detect cell apoptosis. Western blot was then used to detect the protein expression of Bax, Bcl-2, survivin and caspase-3. Results: After treatment for 24 h, the inhibitory rates of A549 cells in control, hGAG, DDP and hGAG + DDP groups were 0, (19.74±5.39)%, (42.01±2.57)% and (53.89±4.58)%, respectively. Moreover, after treatment for 48 h and 72 h, the inhibitory rates in each group were 0, (23.17±4.78)% and (29.17±4.21 )%, (54.00±7.64)% and (59.35±7.31)%, as well as (77.58±4.26)% and (79.94±4.58)%, respectively. The cell viability was significantly lower in drug treatment groups compared with those in control group at the same time point (P<0.05). Hochest 33258 staining showed that no obvious apoptotic cells were detected in the control group, while apoptotic cells were visible in hGAG, cisplatin and combination groups. Flow cytometry showed that cell apoptotic rates were (2.38±0.59)%, (12.59±4.22)%, (16.36±3.63)% and (44.60±5.45)% in the control, hGAG, DDP and hGAG + DDP groups, respectively. The cell apoptosis was significantly lower in drug treatment groups compared with those in control group at the same time point (P<0.05). Furthermore, western blot results showed that the expression of Bax and caspase-3 protein was increased (P<0.05), whereas Bcl-2 and survivin was decreased (P<0.05) in the hGAG+ DDP group compared with cisplatin alone (P<0.05). Conclusions HGAG can inhibit the proliferation and promote the apoptosis of human lung adenocarcinoma A549 cells. Meanwhile, it can strengthen the chemosensitivity of A549 cells to DDP via up-regulation of Bax, caspase-3 and down-regulation of Bcl-2 and survivin.

Objective To investigate the apoptosis and toxicity of oncolytic virus H101 combined with radiation on apoptosis of A549 lung adenocarcinoma cells. Methods A549 lung adenocarcinoma cells in exponential growth phase were divided into four groups: control ( PBS) group, radiation ( IR) group, oncolytic virus (H101) group and radiation combined with oncolytic virus (IR+H101) group. The cells were double dyed with Annexin fluorescein isothiocyanate ( V-FITC/PI ) and then the apoptosis ratio of cells in every group was detected by the flow cytometry. The cytotoxic effect of cells in every group was detected by lactate dehydrogenase ( LDH) release test. The mRNA expression of oncolytic viruses H101 capsid protein Hexon was detected by real-time fluorescence PCR ( RT-PCR) to compare the oncolytic virus replication in each group. Results Cell apoptosis rate in H101 group (55. 37%) was significantly higher than that in PBS group (1.03%) (t =36.51, P <0.05). Cell apoptosis rate in IR + H101 group (93. 06%) was significantly higher than that in H101 group (55. 37%), IR group (12. 67%) and PBS group (1. 03%) (t=13. 51, 24. 14, 38. 99, P<0. 05). LDH releasing percentage in IR group and H101 group at different time after virus transfection was significantly higher than that in PBS group ( t=25. 84,39. 38, 32. 51, 78. 18, P<0. 05;t=31. 40, 2. 68, 23. 43, 60. 98, P<0. 05). LDH releasing percentage in IR+H101 group was significantly higher than that in PBS group (t=80. 71, 119. 74, 109. 80, 123. 94, P<0. 05), IR group (t=28. 80, 54. 34, 72. 34, 61. 91, P<0. 05) and H101 group (t=42. 02, 57. 45, 57. 01, 58. 83, P<0. 05). Compared with H101 group at the same time point, the mRNA expression of Hexon in IR + H101 group at 24, 48 and 72 h was increased by 16. 26, 28. 37 and 39. 58 times, respectively (t=54. 50, 33. 73, 29. 28, P<0. 05). Conclusions The oncolytic virus H101 plays a role of radiosensitization in tumor cells. Radiation also increases the replication of the oncolytic virus H101 and thereby enhances the oncolytic effect of the oncolytic virus H101. Therefore, oncolytic virus H101 combined with radiotherapy has synergistic effect on killing tumor cells.

Even though a large amount of researches showing the clinical effectiveness of acupuncture, there are the researches indicating the absent difference between acupuncture and sham-acupuncture (placebo), which provides the doubts on the specificity of acupuncture. It may be considered that acupuncture intervention is complica-ted and may produce unique non-specific effect, which results in the failure to evaluate effectively the acupuncture efficacy. The influential factors of the non-specific effect of acupuncture include the interaction between physician and patient, expectancy, physician authority, acupuncture treatment experiences, etc. It may be also relevant with the anticipated biological effect, Hawthorne effect, Pavlovian conditioned reflex, etc.

Objective To investigate the diagnosis value of homocysteine (Hcy) combined with carcinoembryonic antigen (CEA) and squamous cell carcinoma (SCC) antigen for esophageal cancer.Methods The serum levels of Hcy,CEA,CA199,CA724,CA50 and SCC antigen in 163 patients with esophageal cancer and 49 healthy people were measured.The diagnosis efficacy between the combination of Hcy,CEA and SCC antigen and the combination of CEA,CA199,CA724,CA50 and SCC antigen was compared.Results The levels of Hcy,CEA and SCC antigen were significantly raised in patients group as compared with the levels in control group (all P ＜ 0.05).The area under the ROC curve of Hcy was 0.722 (95 ％ CI 0.633-0.811),CEA was 0.619 (95 ％ CI 0.533-0.704) and SCC antigen was 0.685 (95 ％ CI 0.608-0.762),respectively.There were no significant differences among the three area under the ROC curve.The sensitivity,specificity and accuracy of the combination of CEA,CA199,CA724,CA50,SCC antigen were 69.9 ％,59.2 ％ and 67.5 ％,respectively,but the sensitivity,specificity and accuracy of the combination of Hcy,CEA,SCC antigen were 96.3 ％,69.4 ％ and 90.1％,respectively.There was significant difference between the combination of Hcy,CEA,SCC antigen and the combination of CEA,CA199,CA724,CA50,SCC antigen (P ＜ 0.05).Conclusion The combination of Hcy,CEA,SCC antigen is helpful to determine the diagnosis and efficacy of esophageal cancer.