Vulvar and vaginal cancers significantly impact women’s health and quality of life. This study analyzes the prevalence of human papillomavirus (HPV), clinicopathological characteristics, treatment patterns, and survival outcomes, to understand their relationships and better guide prevention and therapy for Chinese patients with vulvar or vaginal cancer. We conducted a retrospective, multicenter study across nine tertiary hospitals located in seven regions of China, including patients diagnosed and treated between 2017 and 2021. Data were collected from medical records and standardized questionnaires, with routine clinical follow-up. Continuous variables were analyzed using the Wilcoxon rank-sum test, while categorical variables were compared using the chi-square test or Fisher’s exact test, as appropriate. Survival outcomes, including overall survival and disease-free survival, were evaluated using the Kaplan-Meier method and multivariable cox proportional hazards regression. A total of 218 patients (131 vulvar, 87 vaginal) were analyzed. HPV infection was significantly higher in vaginal than vulvar cancer (76.1

Human papillomavirus (HPV) has emerged as a major cause of head and neck cancer (HNC), yet nationwide HPV-stratified disease data are still lacking in China. The literature remains divided on the prognostic impact of HPV infection. The HNC patients treated from 1 January 2017 to 30 June 2021 were retrospectively identified at nine tertiary A centers representing the seven geographic regions of China. Event-free survival (EFS) and cancer-specific survival (CSS) were estimated with the Kaplan-Meier method and compared using the log-rank test. Early survival differences by subsite and HPV status were assessed using restricted mean survival time differences for EFS (ΔRMEFST) and CSS (ΔRMCSST), adjusting for confounders with pseudo-value regression. The study included 345 cases. Most of the Chinese HNC patients in this study were male (84.64

To investigate the risk factors of bone metastasis in lung adenocarcinoma and construct a risk prediction model. Patients with newly diagnosed primary lung adenocarcinoma admitted to our hospital between 1 March 2018 and 1 March 2023 were retrospectively enrolled as the study participants. Finally, 273 patients were included in strict accordance with the inclusion and exclusion criteria and divided into a bone metastasis group (n = 123) and a non-bone metastasis group (n = 150) according to whether bone metastasis had occurred. The clinical data of all the study participants were collected and retrospectively analysed. Bone metastases were more common in the vertebrae, ribs and hip bones, followed by the scapula, femur, sternum and skull, but they were rare in the humerus, fibula and clavicle. The bone metastasis group exhibited more clinical symptoms than the non-bone metastasis group, including the presence of primary lung adenocarcinoma > 3 cm in diameter, and the differences were statistically significant (P < 0.05). The positive rate of EGFR gene mutation and CEA, CYFRA21-1 and ALP levels in the bone metastasis group were higher than those in the non-bone metastasis group, and the differences were statistically significant (P < 0.05). Multivariate logistic regression analysis showed that positive EGFR gene mutation (P < 0.001), CEA > 5 ng/mL (P < 0.001) and primary lung adenocarcinoma diameter > 3 cm (P = 0.003) were independent risk factors for bone metastasis in lung adenocarcinoma. A receiver operating characteristic curve was used to verify the predictive value of the regression model, and the area under the curve was 0.912 (P < 0.001). The most common sites of bone metastases in newly diagnosed lung adenocarcinoma are the spine and ribs. Positive EGFR gene mutation, CEA > 5 ng/mL and primary lung adenocarcinoma diameter > 3 cm are independent risk factors for bone metastasis in lung adenocarcinoma. Not applicable.

BACKGROUND:Cancer remains a major cause of mortality and a significant economic burden in China. Exploring the disparities in cancer patterns and control strategies between China and developed countries may offer valuable insights for policy formulation and enhance cancer management efforts. This study examined the incidence, mortality, and disability-adjusted life year (DALY) burden of cancer in China, and compared these metrics with those observed in the United States (US) and the United Kingdom (UK). METHODS:Data on cancer incidence, mortality, and DALYs for China, the US, and the UK were sourced from the GLOBOCAN 2022 online database and the Global Burden of Disease 2021 study (GBD 2021). We utilized Joinpoint regression models to analyze trends in cancer incidence and mortality across these countries, calculating annual percent changes (APCs) and determining the optimal joinpoints. RESULTS:In 2022, China recorded around 4,824,703 new cancer cases and 2,574,176 cancer-related deaths, contributing to 71,037,170 DALYs. China exhibited a lower cancer incidence rate compared to the US and the UK. Although cancer-related mortality in China is slightly lower than that in the UK, it is significantly higher than that in the US. Additionally, China experienced significantly higher DALY rates compared to both the US and UK. The cancer landscape in China was also undergoing significant changes, with a rapid rise in the incidence and burden of lung, colorectal, breast, cervical, and prostate cancers. Meanwhile, the incidence and burden of stomach cancer continued to decline. Although the incidence of liver and esophageal cancers was decreasing, the burden of liver cancer was increasing, while the burden of esophageal cancer remained largely unchanged. CONCLUSIONS:The cancer profile of China is shifting from that of a developing country to one more typical of a developed country. The ongoing population aging and the rise in unhealthy lifestyles are expected to further escalate the cancer burden in China. Consequently, it is crucial for Chinese authorities to revise the national cancer control program, drawing on successful strategies from developed countries, while also accounting for the regional diversity in cancer types across China.

BACKGROUND:Liver cancer remains the sixth most commonly diagnosed cancer and the third leading cause of cancer-related deaths worldwide, causing a heavy burden globally. An updated assessment of the global epidemiology of the liver cancer burden that addresses geographical disparities is necessary to better understand and promote healthcare delivery. METHODS:Data were extracted from the GLOBOCAN 2022 database, including the number, crude, and age-standardized rates of incidence and mortality at the global, country, continent, and human development index (HDI) regional levels. Age-standardized rates (incidence and mortality) per 100,000 person-years were adjusted based on the Segi-Doll World standard population. The mortality-to-incidence ratios (MIR) for each region and country were calculated. The HDI and gross national income (GNI) for 2022 were obtained, and a Pearson correlation analysis was conducted with the incidence, mortality, and MIR. RESULTS:In 2022, approximately 866,136 new liver cancer cases and 758,725 related deaths were recorded worldwide, with a global MIR of 0.86. Males had a disproportionately higher burden than females across all levels, and the highest burden was observed in the elderly population. Geographically, the regions with the highest incidence rates included Micronesia, Eastern Asia, and Northern Africa, and the regions with the highest mortality rates included Northern Africa, Southeastern Asia, Eastern Asia, and Micronesia. Notably, Mongolia had a strikingly high burden compared to other countries. The highest MIR was observed in North America and the lowest in Africa. Negative associations of HDI and GNI with liver cancer mortality and MIR were identified, irrespective of sex. CONCLUSIONS:The current liver cancer burden underscores the presence of remarkable geographic heterogeneity, which is particularly evident across countries with varying HDI levels, highlighting the urgent need to prioritize health accessibility and availability to achieve health inequities.

疼痛是恶性肿瘤最常见的症状之一,约80％的肿瘤患者在诊疗过程中会出现癌性疼痛,癌性爆发痛的发生率可达33％～95％.癌痛已经成为备受关注的医学、心理及社会问题.如何切实解决癌痛患者的实际需求,为癌痛病人提供合理、有效、可行的治疗方法和人文关怀,意义重大.

BackgroundOvarian cancer is the most lethal gynecology malignancy in the world, therefore, research on the molecular biological mechanism of ovarian cancer tumorigenesis and progression has received widespread attention.MethodsWe identified RPS6KA2 as the prognosis-related gene of ovarian cancer from TCGA, GSE26712 and GSE26193 database via bioinformatic analysis. qRT-PCR and western blot detected the differential expression of RPS6KA2 in normal ovaries and ovarian cancer tissues. The biological functions of RPS6KA2 were verified by in vitro and in vivo. GSEA analysis was used to select candidate signaling pathway of RPS6KA2 which was further verified by western blot. The possible binding sites of RPS6KA2 with miRNAs and circRNAs were predicted by bioinformatics analysis, and then a circRNA-miRNA-mRNA interaction network was constructed.ResultsWe found the expression of RPS6KA2 was down-regulated in ovarian cancer tissues. Overexpression of RPS6KA2 could suppress cell proliferation, whereas knockdown of RPS6KA2 had the opposite effects on proliferation. GSEA analysis showed that the MARK signaling pathway was closely associated with RPS6KA2. Bioinformatics analysis and dual-luciferase reporter assay showed that RPS6KA2 was regulated with miR-19a-3p, miR-106a-5p and miR-519d-3p. Further analysis showed that circFAM169A was the common ceRNA of miR-19a-3p, miR-106a-5p and miR-519d-3p. Dual-luciferase reporter assay showed the relationship of circFAM169A and miR-106a-5p and miR-519d-3p. After network analysis, one circRNA-miRNA-mRNA axis (circFAM169A/miR-106a-5p, miR-519d-3p/RPS6KA2) was identified.ConclusionsWe demonstrated that circFAM169A/miR-106a-5p, miR-519d-3p mediated low expression of RPS6KA2 could affect the proliferation of ovarian cancer cells via p38/MAPK signaling pathway.

Cancer is a major contributor to global disease burden. Many countries experienced or are experiencing the transition that non-infection-related cancers replace infection-related cancers. We aimed to characterise burden changes for major types of cancers and identify global transition patterns. We focused on 10 most common cancers worldwide and extracted age-standardised incidence and mortality in 204 countries and territories from 1990 to 2019 through the Global Burden of Disease Study. Two-stage modelling design was used. First, we applied growth mixture models (GMMs) to identify distinct trajectories for incidence and mortality of each cancer type. Next, we performed latent class analysis to detect cancer transition patterns based on the categorisation results from GMMs. Kruskal-Wallis H tests were conducted to evaluate associations between transition patterns and socioeconomic indicators. Three distinct patterns were identified as unfavourable, intermediate and favourable stages. Trajectories of lung and breast cancers had the strongest association with transition patterns among men and women. The unfavourable stage was characterised by rapid increases in lung, breast and colorectal cancers alongside stable or decreasing burden of gastric, cervical, oesophageal and liver cancers. In contrast, the favourable stage exhibited rapid declines in most cancers. The unfavourable stage was associated with lower sociodemographic index, health expenditure, gross domestic product per capita and higher maternal mortality ratio (P < .001 for all associations). Our findings suggest that unfavourable, intermediate and favourable transition patterns exist. Countries and territories in the unfavourable stage tend to be socioeconomically disadvantaged, and tailored intervention strategies are needed in these resource-limited settings.

Background: Tumor morcellation happened to facilitate iatrogenic metastasis for patients with occult uterine sarcoma. The optimal completion surgery for these patients needed to be established. Methods: Data were retrospectively collected and analyzed from patients with occult uterine sarcoma undergoing morcellation. Results: 19 consecutive patients with uterine sarcomas undergoing morcellation were accessed between January 2008 and December 2018, including 12 patients with uterine leiomyosarcoma and 7 with endometrial stromal sarcoma. Compared with a simple hysterectomy and individualized surgical resection for suspicious extra-uterine lesions, cytoreduction was significantly associated with a lower recurrence rate (p = 0.017), and none of the seven patients undergoing cytoreduction suffered a recurrence. However, the interval between the initial operation and re-operation, transabdominal route (laparoscopic vs. open surgery), and adjuvant therapy had no such significant difference. Conclusions: Cytoreduction was considered as the optimal completion surgery for patients with occult uterine sarcoma undergoing morcellation.

目的:比较腹横肌平面阻滞(TAPB)与手术部位局部浸润麻醉(LIA)对卵巢癌患者开腹肿瘤细胞减灭术后的镇痛效果.方法:择期行开腹肿瘤细胞减灭术的卵巢癌患者 80 例,美国麻醉医师协会(ASA)分级Ⅰ～Ⅲ级,随机分为TAPB组和LIA组,术后分别行TAPB和LIA,术毕行静脉自控镇痛(PCIA).采用视觉模拟量表(VAS)评估术前及术后 2、12、24 h静息和咳嗽时疼痛程度,记录术后PICA的按压次数、爆发性疼痛挽救治疗的次数以及术后不良反应.结果:两组术前疼痛VAS评分差异无统计学意义(P＞0.05);两组术后VAS评分均先升高,至12 h达最高,然后均下降,且TAPB组术后 2、12、24 h静息和咳嗽时VAS评分均明显低于LIA组(P＜0.05);术后PICA按压次数和挽救性治疗次数明显少于LIA组(P＜0.05).TAPB组和LIA组术后不良反应发生率分别是46.1％(18 例)和 69.2％(27 例),两组比较差异无统计学意义(χ2=3.788,P＞0.05),但TAPB组恶心发生率明显低于LIA组(P＜0.05).结论:开腹卵巢癌肿瘤细胞减灭术后应用TAPB减轻术后疼痛的效果要优于LIA,并且与LIA比较,术后阿片类药物用药量少.

BACKGROUND:Risk-stratified endoscopic screening (RSES), which offers endoscopy to those with a high risk of esophageal cancer, has the potential to increase effectiveness and reduce endoscopic demands compared with the universal screening strategy (i.e., endoscopic screening for all targets without risk prediction). Evidence of RSES in high-risk areas of China is limited. This study aimed to estimate whether RSES based on a 22-score esophageal squamous cell carcinoma (ESCC) risk prediction model could optimize the universal endoscopic screening strategy for ESCC screening in high-risk areas of China. METHODS:Eight epidemiological variables in the ESCC risk prediction model were collected retrospectively from 26,618 individuals aged 40-69 from three high-risk areas of China who underwent endoscopic screening between May 2015 and July 2017. The model's performance was estimated using the area under the curve (AUC). Participants were categorized into a high-risk group and a low-risk group with a cutoff score having sensitivities of both ESCC and severe dysplasia and above (SDA) at more than 90.0%. RESULTS:The ESCC risk prediction model had an AUC of 0.80 (95% confidence interval: 0.75-0.84) in this external population. We found that a score of 8 (ranging from 0 to 22) had a sensitivity of 94.2% for ESCC and 92.5% for SDA. The RSES strategy using this threshold score would allow 50.6% of endoscopies to be avoided and save approximately US$ 0.59 million compared to universal endoscopic screening among 26,618 participants. In addition, a higher prevalence of SDA (1.7% vs. 0.9%), a lower number need to screen (60 vs. 111), and a lower average cost per detected SDA (US$ 3.22 thousand vs. US$ 5.45 thousand) could have been obtained by the RSES strategy. CONCLUSIONS:The RSES strategy based on individual risk has the potential to optimize the universal endoscopic screening strategy in ESCC high-risk areas of China.

Objective There is little information about contributions of the well-known risk factors to the liver cancer burden. We conducted a comparative study to estimate the liver cancer burden attributable to major risk factors. Methods Liver cancer deaths for adults were estimated from 978 county-level surveillance points in China in 2014. Risk factors were identified from the International Agency for Research on Cancer and the World Cancer Research Fund International. Population attributable fraction (PAF) by age, sex, and province was calculated using multiple formulas. Results In total, 72.4% of liver cancer deaths could be attributable to the studied risk factors. Hepatitis B virus (HBV) was responsible for the largest fraction of liver cancer burden in both genders (PAF=55.6% in males, PAF=46.5% in females). PAFs for liver cancer burden attributable to smoking (15.7% vs. 4.8%), and alcohol drinking (10.3% vs. 1.6%) were significantly higher in males than in females. The burden of HBV-attributable deaths was the highest in Qinghai province. Conclusions HBV still contributes to the majority of liver cancer burden than any other risk factors. Targeted preventive measures should be implemented based on the degree of contributions of risk factors to liver cancer deaths.

Lymph node (LN) metastasis is known as one of the most important prognostic factors for early gastric cancer (EGC) patients. Patients without LNM normally have better prognosis. However, there is no evaluation criteria to accurately assess the possibility of LN metastasis. Therefore, this study aims to establish an effective nomogram for prognosis prediction. In this study, 285 EGC patients from January 2010 to December 2015 were enrolled. Pearson's Chi-Square (χ2) test (including continuity correction when appropriate) and logistics regression analyses was used to identify the risk factors for LN metastasis. The independent risk factors identified were then incorporated in a nomogram model. The predictive accuracy and discriminative ability of the nomogram were evaluated by receiver operating characteristic curve (ROC) and calibration curve. LN metastasis occurred in 59 (20.7%) EGC patients. And most of these patients were submucosal cancers (48/59). Chi-square test indicated lymphovascular emboli, carbohydrate antigen 19-9 (CA19-9), ulcer, tumor size, tumor infiltration and histological grade were the risk factors, and multivariate logistics analyses confirmed all these six factors were independent risk factors of LN metastasis, which were selected to construct the nomogram. The nomogram proved well calibrated and had good discriminative ability (C-index value: 0.842). The proposed nomogram could result in more-accurate risk prediction for EGC patients.

The present study explored the possible functions and the underlying mechanism of tumor necrosis factor-α (TNF-α) and heterogeneous nuclear ribonucleoprotein L (hnRNPL)–related immunoregulatory lncRNA plasmacytoma variant translocation 1 (THRIL) in rheumatoid arthritis (RA). Serum samples were collected from patients with RA. Primary fibroblast-like synoviocytes (FLSs) were separated from synovial tissues and cultured for subsequent cell experiments by transfecting different vectors. The qRT-PCR analysis was employed for evaluating the levels of THRIL in the serum. Enzyme-linked immunosorbent assay (ELISA) analysis was employed to detect the levels of inflammatory cytokines. MTT assay and Annexin V-FITC/PI apoptosis assay were used to evaluate the cell viability and apoptosis, respectively. Besides, the levels of the apoptotic proteins and the pathway-related proteins were measured by western blotting. Pearson’s correlation analysis was used to assess the correlation between THRIL and clinical parameters. THRIL was overexpressed in the blood of patients with RA as compared with healthy participants (p < 0.05). The THRIL levels in the RA blood sample were positively associated with TNF-α levels, DAS 28, and ESR (p < 0.001). TNF-α treatment significantly inhibited cell viability and enhanced cell apoptosis. Furthermore, it elevated the levels of IL-1β and MMP-3 (p < 0.05), whereas the suppression of THRIL reversed these effects in TNF-α-treated RA-FLSs (p < 0.05). Moreover, the reduced THRIL remarkably reduced the expression of p-PI3K and p-AKT (p < 0.05) in TNF-α-treated RA-FLSs. The present study revealed that THRIL could regulate cell growth and inflammatory response of FLSs by activating the PI3K/AKT signaling pathway, subsequently playing important roles in promoting the occurrence and development of RA.

Objective: Estimating the incidence and mortality rate of cervical cancer became necessary to establish prevention measures and healthy policies.The aim of this study was to estimate the updated incidence and mortality rate of cervical cancer in 2013 in China.Methods: According to the evaluation criteria developed by the National Central Cancer Registry of China,the data submitted from 255 cancer registries met the required standards in 2013.Cervical cancer cases were retrieved from the national database and combined with the 2013 national population data.The age-standardized incidence and mortality rates were based on the demographic structure of the national census 2000 and Segi’s world population.Results: In 2013,the estimated number of new cases and deaths from cervical cancer were 100,700 and 26,400,respectively.The crude incidence of cervical cancer was 15.17/100,000.The age-standardized incidence rates based on the Chinese standard population（ASIRC） and the world standard population（ASIRW） were 11.30/100,000 and10.30/100,000,respectively.The incidence of cervical cancer in urban areas was 15.62/100,000 and the ASIRC was11.12/100,000.The incidence of cervical cancer in rural areas was 14.65/100,000 and the ASIRC was11.47/100,000.The mortality rate of cervical cancer was 3.98/100,000.The age-standardized mortality rates based on the Chinese（ASMRC） and world standard populations（ASMRW） were 2.76/100,000 and 2.62/100,000,respectively.The mortality rate of cervical cancer in urban areas was 3.85/100,000 and in rural areas was4.14/100,000.Cervical cancer incidence and mortality increased with age.Urban areas had a higher incidence of cervical cancer and lower mortality rates when compared with rural areas.Conclusions: Dynamic monitoring of cervical cancer incidence and mortality is the fundamental work of cervical cancer prevention and control.Cervical cancer is a serious issue in women’s health,and prevention strategies need to be enhanced,such as human papilloma virus（HPV） vaccination and screening programs.

Objective To investigate HLA-B27 positive rate and the clinical characteristics of ankylosing spondylitis(AS) patients complicated with uveitis,in order to improve the understanding of ankylosing spondylitis associated uveitis level,reduce the misdiagnosis or missed diagnosis.Methods 32 patients with ankylosing spondylitis were conducted for the examination of HLA-B27,vision,slit lamps and fundus.Results In patients with ankylosing spondylitis and uveitis,28 patients were HLA-B27-positive,with a positive rate of 87.5％.The mean age at onset of ankylosing spondylitis with uveitis was (27.6 ± 12.5) years old,including 26 males and 6 females.Ankylosing spondylitis with uveitis were detected in 4 patients with binocular onset,in 28 patients with monocular disease,previous uveitis reaction was detected in 29 patinets,and uveitis in 3 patients.Conclusion Most of AS patients complicated with uveitis are HLA-B27 positive and young males,which is often characterized by anterior uveitis and single eye disease.HLA-B2 patients are mostly HLA-B27-positive young men,mostly with monocular disease,and previous uveitis is prior in uveitis.

OBJECTIVE:This study was designed to explore the time trends in geographical variations of cervical cancer mortality in mainland China over the period 1973 to 2013, to provide subnational spatio-temporal patterns for targeted promotion of human papillomavirus vaccine in China.METHODS:Data were extracted from three national retrospective death surveys and cancer registry. The rate ratio (RR) was estimated for the aggregated data for seven geographical regions using generalized linear models to evaluate time trends in geographical disparities of cervical cancer mortality.RESULTS:There was a significant decrease in cervical cancer mortality in China from 1973-1975 to 2004-2005, but leveled off thereafter to 2011-2013. Compared to the period 1973-1975 the RR for the three last time periods were 0.33 [95% confidence interval (95% CI): 0.30-0.37] for 1990-1992, 0.21 (95% CI: 0.19-0.24) for 2004-2005 and 0.24 (95% CI: 0.22-0.26) for 2011-2013. Females living in the Northwest China and Central China have a high risk of mortality from cervical cancer compared to the nationwide, with the RR being 2.09 (95% CI: 1.83-2.38) and 1.26 (95% CI: 1.11-1.44) respectively, while the RRs for South China, Northeast China and Southwest China were below 1.00, indicating the lower death risk. Despite the mortality rate had increased slightly from 2004 to 2013, there was an encouraging sign that the geographical disparities in cervical cancer mortality had gradually narrowed over time across China.CONCLUSIONS:Although cervical cancer mortality in China has reduced to very low levels, the high risk of cervical cancer in Northwest China and Central China is still noteworthy. Public health policies including the promotion of vaccine should be targeted to further reduction of geographical disparities in cervical cancer mortality.

Objective To evaluate the analgesia effect, drug-related toxicity, and survival of neuraxial epidural analgesia ( EPI) and nonneuraxial comprehensive medical management ( CMM) in patients with abdominal intractable pain caused by cancer of pancreas. Method Randomized controlled study of 48 abdominal intractable pancreas cancer pain patients assigned to each of two groups ( all patients had Visual Analogue Scores VAS for pain≥5/10 on at least 200 mg morphine or equivalent daily):epidural analgesia group ( EPI,24 patients):adopted by epidural implantable drug delivery system, doing side abdominal subcutaneous tunnel, long-term indwelling epidural catheters and external controlled analgesia pump;comprehensive medical management group ( CMM,24 patients) following standard guide-lines in management of cancer pain, adopted by non-invasive treatment, combined analgesia according the WHO's three ladders method, including oral, intravenous, intramuscular, transdermal, PCA and other methods. For this study, measurements are reported for all patients alive at 12 weeks. The measurement point for primary objective was 2 weeks after randomization. Secondary objectives:pain scores over time ( comparison of changes in VAS for pain over the duration of the trial);the NCI-CTC( Common Toxicity Criteria) standardizes the comparison of drug-related ad-verse events over the duration of the follow-up period. Overall survival was represented using curves. Result At 4 weeks,19 of 24 (79. 2%) EPI patients compared with 9 of 23 (39. 1%) CMM patients achieved>20% reduction in both pain VAS and toxicity, 21 of 24 (87. 5%) EPI patients compared with 8 of 23 (34. 8 %) CMM patients a-chieved both>50% reduction in pain VAS and >20% reduction in toxicity, at 4 weeks the EPI patients VAS pain scores decreased from 7. 9 to 3. 2 (59. 5% reduction) compared with 7. 8 to 4. 8 (38. 5% reduction) for CMM patients;the EPI patients NCI CTC scores decreased from 6. 9 to 2. 9(58. 0% reduction) compared with 6. 8 to 5. 8 (14. 7% reduction) for CMM patients . All individual VAS pain scores and drug toxicities improved with EPI at both 4 and 12 weeks than CMM. At 4 weeks,the MOED (Morphine oral equivalent dose,mg/day) was decrease 94. 5% in EPI group and 31. 2% in CMM groups(P<0. 01). At 12 weeks, only 79. 2% of the patients randomized to EPI were a-live, compared with 33. 3% for patients in CMM groups. Conclusion EPI improved clinical success, reduced pain scores, decreased the MOED and relieved most toxicity of pain control drugs, and was associated with increased sur-vival in patients with abdominal intractable pancreas cancer pain for the duration of this 3 month trial.

目的 研究老年食管癌患者全身麻醉术后认知功能障碍(POCD)与术中脑氧饱和度(rSO2)降低之间的关系.方法 随机选取78例年龄大于65岁,拟静吸复合全身麻醉下行左后外切口开胸食管癌根治术的患者,采用双腔支气管导管进行单肺通气(SLV)管理,应用脑氧饱和度监测仪监测从清醒状态到气管拔管阶段的脑氧饱和度( rSO2)变化,并观察记录脑电双频指数(BIS)和标准监测参数,在对应时间点进行血气分析,所有患者术后均使用静脉镇痛,在术前2天和术后4天采用简易智力状态检查法(MMSE)评估患者认知功能,根据评估结果分为POCD组和非POCD组,进行对比研究.结果 64例老年食管癌患者入组,全身麻醉术后POCD发生率为28.1％ (18/64);在SLV期间,rSO2绝对值低于50％的患者比率为29.7％( 19/64),POCD与rSO2绝对值低于50％具有明显相关性；POCD组的MMSE基线变化率明显大于非POCD组.结论 老年食管癌患者术后早期POCD发病率较高,与单肺通气期间脑氧饱和度绝对值低于50％有明显相关性.

目的 研究老年食管癌患者开胸手术单肺通气期间局部脑氧饱和度( rSO2)的变化及影响因素.方法 随机选取20例年龄大于65岁,拟静吸复合全身麻醉下行左后外切口开胸食管癌根治术的患者,采用双腔支气管导管进行开胸后单肺通气(SLV)管理,应用脑氧饱和度监测仪监测从清醒状态到气管拔管阶段的脑氧饱和度变化,并观察记录脑电双频指数( BIS)和标准监测参数,在对应时间点进行血气分析.结果 ①清醒状态时测定局部脑氧饱和度( rSO2)为66.5％±2.2％,麻醉诱导后侧卧位双肺通气时rSO2为56.2％±2.6％,在SLV期间rSO2降为50.4％±2.2％,拔管时rSO2为62.2％±2.1％；在SLV期间,所有患者rSO2下降≥18％,70％ (14/20)的患者降幅超过20％,30％ (6/20)的患者降幅超过25％；SLV期间rSO2绝对值低于50％的患者占30％ (6/20).②rSO2的降低与SLV时间、BIS值、SpO2、MAP、体温、PaCO2、PaO2、Hcr、Hgb、SaO2等临床监测参数均无相关性.结论 老年食管癌患者单肺通气期间均发生脑氧饱和度的降低,有30％的患者rSO2绝对值低于50％；rSO2的降低与常规临床监测参数间无明显相关性.