目的 探讨在老年中度癌痛患者中,羟考酮与曲马多作为初始止痛治疗方案的疗效.方法 96例老年中度癌痛患者,按治疗方式不同分为观察组(n=49)和对照组(n=47).观察组患者初始治疗直接采用盐酸羟考酮缓释片10 mg q12 h口服;对照组先采用盐酸曲马多缓释片100 mg q12 h口服,根据疼痛控制情况逐渐加量改用盐酸羟考酮缓释片20 mg q12 h继续止痛治疗,两组患者观察时间为14天.分别采用数字评分法(NRS)、卡氏功能状态(KPS)评分、汉密尔顿抑郁量表(HAMD)、生活质量评分量表对患者的疼痛情况、功能状态、抑郁情况、生活质量进行评估.结果 治疗前两组患者NRS、HAMD及KPS评分比较,差异均无统计学意义(P﹥0.05);治疗后两组患者NRS、HAMD评分均下降,与治疗前比较,差异均有统计学意义(P﹤0.05),且观察组患者NRS、HAMD评分均明显低于对照组,差异均有统计学意义(P﹤0.01);治疗后两组患者KPS评分均提高,与治疗前比较,差异均有统计学意义(P﹤0.05),且观察组患者KPS评分明显高于对照组,差异有统计学意义(P﹤0.01).观察组患者疼痛缓解总有效率为95.9％(47/49),明显高于对照组患者的72.3％(34/47),差异有统计学意义(P﹤0.01).治疗后观察组患者生活质量优于对照组,差异有统计学意义(P﹤0.05).治疗过程中,观察组患者便秘发生率明显高于对照组,差异有统计学意义(P﹤0.01);而两组患者其他不良反应发生率比较,差异均无统计学意义(P﹥0.05).结论 以羟考酮作为老年中度癌痛患者的初治用药,与曲马多比较,能明显减轻患者的痛苦,改善患者体力,有效消除患者负面情绪,降低患者的心理困扰程度,改善患者的生活质量,提高癌痛治疗效果,对老年肿瘤患者的中度癌痛初始治疗选择策略具有重要意义.

Abstract Objective Colorectal cancer (CRC) is a heterogeneous disease in which both epigenetic alterations and gene mutations transform normal cells into cancer cells. Apart from a variety of standard treatments, there are few options available to improve a CRC patient’s overall survival (OS) and quality of a life. The objective of the present retrospective study was to analyze the response and toxicity associated with apatinib in patients with metastatic CRC (mCRC). Method Data on the use of apatinib as salvage therapy were collected from patients diagnosed with mCRC, Eastern Cooperative Oncology Group (ECOG) performance status ≤ 3, from the Luhe Hospital. A total of 17 patients with stage IV unresectable mCRC, who received at least one cycle of apatinib, between October 2015 and February 2017, were involved in this study. Our primary endpoints were the overall response rate (ORR) and disease control rate (DCR), and the secondary objectives were progression-free survival (PFS), OS and safety. Result Seventeen patients with a median age of 62 years (34-83 years) were enrolled. Twelve patients were male, and the location of the primary tumor was in the colon and the rectum in 9 and 8 patients, respectively. Liver metastasis was observed in 9 patients and lung metastasis in 5. The ECOG performance status was 0 to 2 in 13 patients. The ORR at the first evaluation was 17.6 % (3/17). The DCR was 82.4% (14/17). The median PFS was 3.0 months (95% confidence interval (CI): 1.924-4.076 months) and the median OS was 5.4 months (95% CI: 3.383-7.417 months). Grade 1-2 adverse events included hypertension (52.9%), fatigue (64.7%), anorexia (29.4%), hoarseness (23.5%), proteinuria (23.5%), and development of rashes (17.6%). Grade 3 adverse events included thrombocytopenia (5.9%) and proteinuria (5.9%). There were no Grade 4 adverse events in our analysis. Conclusions Apatinib was found to be both safe and effective in the treatment of advanced mCRC, and its associated toxicities were acceptable and manageable. However, further studies are required to validate these findings.

Received: 18 July 2017 Revised: 5 August 2017 Accepted: 25 August 2017 Objective Colorectal cancer (CRC) is a heterogeneous disease in which both epigenetic alterations and gene mutations transform normal cells into cancer cells. Apart from a variety of standard treatments, there are few options available to improve a CRC patient’s overall survival (OS) and quality of a life. The objective of the present retrospective study was to analyze the response and toxicity associated with apatinib in patients with metastatic CRC (mCRC). Method Data on the use of apatinib as salvage therapy were collected from patients diagnosed with mCRC, Eastern Cooperative Oncology Group (ECOG) performance status ≤ 3, from the Luhe Hospital. A total of 17 patients with stage IV unresectable mCRC, who received at least one cycle of apatinib, between October 2015 and February 2017, were involved in this study. Our primary endpoints were the overall response rate (ORR) and disease control rate (DCR), and the secondary objectives were progression-free survival (PFS), OS and safety. Result Seventeen patients with a median age of 62 years (34–83 years) were enrolled. Twelve patients were male, and the location of the primary tumor was in the colon and the rectum in 9 and 8 patients, respectively. Liver metastasis was observed in 9 patients and lung metastasis in 5. The ECOG performance status was 0 to 2 in 13 patients. The ORR at the first evaluation was 17.6 % (3/17). The DCR was 82.4% (14/17). The median PFS was 3.0 months (95% confidence interval (CI): 1.924–4.076 months) and the median OS was 5.4 months (95% CI: 3.383–7.417 months). Grade 1–2 adverse events included hypertension (52.9%), fatigue (64.7%), anorexia (29.4%), hoarseness (23.5%), proteinuria (23.5%), and development of rashes (17.6%). Grade 3 adverse events included thrombocytopenia (5.9%) and proteinuria (5.9%). There were no Grade 4 adverse events in our analysis. Conclusions Apatinib was found to be both safe and effective in the treatment of advanced mCRC, and its associated toxicities were acceptable and manageable. However, further studies are required to validate these findings.

With the increasing incidence of malignant tumor, different patients may see their doctor in different clinical departments due to their symptoms. The clinicians should master the basic knowledge of common tumors and the treatment principle, so that more patients with malignant tumor can be timely diagnosis and treatment, reduce the incidence of missed diagnosis and misdiagnosis. Currently, more and more standardized training of residents rotate in department of oncology. Under integrative medicine mode, our hospital carry out the multidisciplinary collaboration mode and strengthen the close cooperation between departments, and we choose different diseases in clinical teaching. Each of specialized subject works together. We wish it can makes students learn more about tumor specialized knowledge and makes their clinical thinking expanded and makes their interest in learning increased and makes the quality of teaching improved.

Analyzed the actual problems existing in the current clinical oncology teaching, this paper expounds the concept of evidence-based medicine(EBM), multi diciplinary treatment(MDT), and the teaching of multimedia and network technology, the connotation and its role in medical education. Discussion on the teaching of cliniccal oncology introduce a variety of new models of medical education urgency, feasibility and signiifcance. Teachers should update teaching ideas, to build a variety of teaching methods under the combination of oncology clinical teaching mode, cultivate translational oncology talents with comprehensive ability.

目的:通过北京市多中心癌痛状况调查,了解北京市癌痛控制现状.方法:采用问卷调查的方法对北京地区11家医院的477例患者和217名医师调查.统计分析使用SAS 9.1.3软件、采取双侧检验方法,并与1992年调查结果进行比较.结果:中重度癌痛患者仍有较高比例(65.82％)；但强阿片类药物的使用比例已经明显提高(占48.85％)；医患双方对癌痛知识的了解都有待进一步提高；医患对阿片类药物使用的主要顾虑是担心“成瘾”.结论:北京地区癌痛控制二十年来有明显发展,包括阿片类药物应用比例升高,医师对阿片类药物不良反应关注度提高等；但针对癌痛控制存在的问题,医师培训和患者教育仍是推动癌痛控制的重要任务.

Objective: To determine the prevalence, correlates and recognition rates of depressive disorders (DDs) in Chinese inpatients with cancer.Methods: Four hundred and sixty cancer inpatients were recruited from the oncology ward of a university hospital in Beijing, China. Patients were interviewed with a Chinese version of the Mini International Neuropsychiatric Interview 5.0 by eight trained psychiatrists. Case records of inpatients with DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) DDs were reviewed to determine whether treating oncologists made a diagnosis of depression, prescribed antidepressant medications and/or recommended psychiatric consultation/referral.Results: The 1-month prevalence rates (95% confidence intervals) of DDs and major depressive disorder (MDD) were 25.9% (21.9%-29.9%) and 12.6% (9.6%-15.6%), respectively. In our multiple logistic regression analysis, being unmarried [odds ratio (OR)=1.41], cancer stage of metastasis (OR=2.35), time since cancer diagnosis <= 20 months (OR=2.05), frequent pain (OR=1.99 similar to 6.83) and being scored between two and four on the Eastern Cooperative Oncology Group Scale (OR=2.25 similar to 4.97) were independently associated with depression. Only 6.9% of patients with MDD were recognized by treating oncologists.Conclusions: DDs are very common among Chinese inpatients with cancer. The high prevalence rate and low recognition rate of depression in cancer patients indicate a pressing need for routine screening, evaluation and treatment of depression in this patient population. (C) 2014 Elsevier Inc. All rights reserved.

Objective:To observe the analgesic effect and adverse effect of oral administration Oxycontin (Oxycodone Hydrochloride Controlled- release Tablets) before and after Transcatheter arterial chemoembolization (TACE) treatment of hepatic carcinoma,discuss the reasonable and feasible pain control method for TACE.Methods:90 patients were given 10mg Oxycontin 1h before the interventional therapy,and after operation 10mg for every 12h for 3 days.The efficacy and side effects were observed and recorded. Results:12 and 24 hours after interventional therapy,the incidences of pain were respectively 32.2% and 8.9%.48h after TACE,the incidences of pain were remained around 3.3%.Among all patients,incidence of severe pain is zero.Conclusion:Oral treatment of Oxycontin can be effective in controlling pain of interventional therapy in hepatic carcinoma,less adverse reactions and take safety.

目的 观察康艾注射液联合化疗治疗晚期消化道肿瘤的临床效果及其减毒增效作用.方法 将90例明确诊断的胃癌、食管癌、结直肠癌的患者按随机数字表法分为两组,治疗组(46例)采用化疗加康艾注射液,对照组(44例)单用化疗.观察两组近期疗效、化疗不良反应及生活质量改善情况.结果 治疗组与对照组近期疗效有效率分别为43.5％(20/46)和43.2％(19/44),两组比较差异无统计学意义(P＞0.05);治疗组生活质量改善率为82.6％(38/46),明显高于对照组的59.1％(26/44),差异有统计学意义(P＜0.05);治疗组Ⅲ～Ⅳ级白细胞减少、恶心呕吐发生率分别为6.52％(3/46)、8.70％(4/46),对照组分别为34.09％ (15/44)、38.64％(17/44),两组比较差异有统计学意义(P＜0.05).结论 康艾注射液对消化道肿瘤可协助化疗抗癌,改善患者生活质量,降低化疗不良反应.

Objective To investigate the effect of thromboelastography(TEG) in combination with routine haemostatic assays and ultrasonic doppler examination in deep veins of lower limbs in diagnosis of hypercoagulability of malignant tumor.Methods One hundred and sixty-two malignant tumor patients were examined by TEG,routine haemostatic assays and deep venous ultrasonic examination in lower limbs.According to the results,the patients were classified into deep venous thrombosis group(group A,n=12),erythrocyte aggregation group(group B,n=23) and non-thrombus and erythrocyte aggregation group(group C,n=127).The relationships between reaction time(R value),maximum amplitude value(MA),α angle,D-Dimer,fibrinogen(FIB),fibrinogen degradation products(FDP) and platelet count of three groups were compared.Results There was no statistical significance in each parameter between groups A and B.The R values in groups A and B were significantly lower than that in group C,and the rest of the parameters were significantly higher than that in group C.Conclusion TEG combined with routine haemostatic assays and ultrasonic doppler examination in deep veins of lower limbs can assess the coagulant state in patients with tumor,predict occurred risk of deep venous thrombosis.It can be used to judge whether the patients need anticoagulation,and is one method of reducing the risk of thrombus.

<正>目前,对于胃癌的治疗采取以手术为主,多学科综合治疗手段。但是对于许多胃癌患者来说,因多种原因导致就诊晚,分期晚,一旦确诊失去手术机会,或因患者自身因素放弃手术治疗,在这类患者中,我们采取经导管动脉灌注化疗栓塞(transcatheter arterial chemoembolization,TACE),术后联合替吉奥胶囊口服[1~2],患者临床症状明显改善,生

Objective To investigate the clinical methods of venous thromboembolism(VTE) prevention for patients with malignant tumor.Methods Eighty hospitalized patients with malignant tumor were randomly divided into intervention group(n=60) and control group(n=20).The intervention group was intervened according to thrombelastogram and clotting results,whereas the control group was not intervened.According to different hypercoagulable factors,intervention group was further grouped into deep venous thrombosis(DVT) group(group A),erythrocyte aggregation group(group B) and erythrocyte aggregation group without thrombosis(group C),20 cases in each group.DVT in lower limbs,pulmonary thromboembolism(PTE) and occurrence of hemorrhagic events of patients in each group were observed.Results During hospitalization,both incidences of DVT and fatal PTE in the intervention group were significantly lower than those in the control group.Compared with hemorrhagic events in each group during hospitalization and follow-up visit,all the differences showed no statistical significance.Conclusion For patients with malignant tumor,understanding early clotting changes of thrombosis according to thrombelastogram and clotting presentation and taking positive interventions can effectively reduce the incidence rates of DVT and PTE.Seeking different causal factors based on different hypercoagulable states and applying individual treatment can ensure the efficiency and safety of treatment.

Objective To investigate the safety and effectiveness of S-1 capsule combined with oxaliplatin in the treatment of advanced gastric cancer.Methods Fifty-two patients with advanced gastric cancer were treated with the chemotherapy: composed of S-1 capsule 80 mg·m-2·d-1,twice daily,oral,d1-14;oxaliplatin 130 mg·m-2,intravenous drip,d1.One treatment cycle covered 3 weeks.The effects and toxicities were evaluated after 4 cycles.Results The effective rate was 44.2%(23/52).The clinical beneficial response was 76.9%(40/52).The main side effects included myelosuppressio,gastrointestinal reactions and neurotoxicity.ConclusionS-1 capsule combined with oxaliplatin is effective in the treatment of advanced gastric cancer,and the toxicities can be tolerated.These results indicate that further clinical study and application are warranted.

Objective:To investigate the expression and significance of CXCL12 and CXCR4 in gastric cancer.Methods:Fiftyfour patients with gastric cancer were examined with immunohistochemistry to measure the expression of CXCL12 and CXCR4.The corresponding adjacent tissues of gastric cancer were taken as control.The correlation of CXCL12 and CXCR4 expression and clinicopathological features was analyzed.Results:Positive staining for CXCL12 and CXCR4 was identified in 83.3% and 87.0% of the primary gastric tumor tissues,respectively,with significantly higher expression intensities observed in the primary gastric tumor tissues than in the adjacent normal mucosa tissues.Expression of CXCL12 in the gastric tumor tissues was significantly associated withlymph node and peritoneal metastasis.Significant association between CXCR4 and lymph node metastases was seen.Conclusion:CXCL12 and CXCR4 are related to formation of gastric tumors and metastasis.Furthermore,the expression of CXCL12 and CXCR4 could be used as a biomarker to predict lymph node and peritoneal metastasis of gastric cancer.

Objective To investigate the expression and significance of IGFBP-2 in lung adenocarcinoma.Methods Fifty patients with lung adenocarcinoma were examined with immunohistochemistry to measure the expression of IGFBP-2 and their corresponding adjacent tissues were taken as the control.The correlation of IGFBP-2 expression and clinicopathological features was analyzed.Results The expression rate of IGFBP-2 in lung adenocarcinoma(74%) was significantly higher than in adjacent normal lung tissues(8%).In lung adenocarcinoma,IGFBP-2 expression was associated with lymph node metastasis and poor differentiation.Conclusion The higher expression of IGFBP-2 in lung adenocarcinoma may contribute to the occurrence,development and turnover of lung adenocarcinoma.

Objective: To investigate the value of kelp micro gelation (KMG) and lipiodol in transcatheter hepatic artery chemoembolization (TACE) for primary hepatocarcinoma. Methods: TACE was performed with KMG and lipiodol in 136 patients with primary hepatocarcinoma. Results: Complete response was found in 38 patients, tumor volume reduced greater than 50% in 65, 25%-50% in 25, while no change in 8 patients. After TACE with KMG and lipiodol, the incidence of abdominal pain was 47.79% (65/136), within which 80.00% was slight or moderate. The incidence of fever was 41.18% (56/136). The damage to liver function was slight, and no serious complications occurred. Conclusion: TACE with KMG and lipiodol is simple and easy, may overcome the loss of lipiodol, reinforce the effect of vascular embolism and improve curative effect.

目的探讨微血管密度(microvessel density,MVD)、组织蛋白酶D(cathepsin D,CatD)与腋窝淋巴结阴性乳腺癌(axillary-node-negative breast cancer,ANNBC)预后的关系。方法采用免疫组化法及流式细胞术测定各标本的MVD及CatD,将所测值与部分预后指标的关系进行统计学分析。结果 MVD与ANNBC患者的总生存率及无瘤生存率有明显关系(P=0.002 1,P=0.000 2)。CatD仅与ANNBC患者的无瘤生存率有明显关系(P=0.002 2)。MVD与CatD呈正相关(P=0.005)。结论 MVD、CatD均为ANNBC患者不良预后因子。

Objective To investigate the clinical significance to determine the tumor necrosis factor α (TNF-α) levels in serum and sputum of patients with chronic obstructive pulmonary disease (COPD).Methods The enzyme-linked immunosorbent assay (ELISA) was used to monitor dynamic changes of TNF-αin serum and induced sputum of 30 COPD patients before treatment and 1,3,6,12,24 months after the treatment.St George′s respiratory questionnaire(SGRQ)score was also recorded.Results There was significant difference in levels of serum and induced sputum of the patients before treatment and 1,3,6,12,24 months after the treatment (P<0.05).There was significant difference in SGRQ score of the patients before treatment and 1,3,6,12,24 months after the treatment (P<0.05).Serum TNF-α and the SGRQ score was positively correlated (P<0.05);and so was induced sputum TNF-α and the SGRQ score (P<0.05).Conclusion The condition of COPD patients is correlated with the levels of serum and sputum TNF-α,and the TNF-α level reflects the change of airway inflammation of COPD.So TNF-α can be used as an index to predicate the condition and determine the prognosis for COPD patients.

目的探讨微血管密度(microvesseldensity,MVD)、S期细胞百分率(S-phase fraction,SPF)与腋窝淋巴结阴性乳腺癌(axillary-node-negative breastcancer,ANNBC)预后的关系。方法采用免疫组化和流式细胞术测定各标本的MVD值及SPF值,将检测值与部分预后指标的关系进行统计学分析。结果 MVD与ANNBC患者的总生存率及无瘤生存率有明显关系(P=0.0021,P=0.0002)。SPF与ANNBC患者的总生存率及无瘤生存率有明显关系(P=0.0210,P=0.0022)。相关性分析显示MVD值与SPF值无关。结论 MVD值、SPF值增高均提示ANNBC患者预后不良;MVD值与SPF值无关。