Objective:To design and practise a Chinese scale for the diagnosis and assessment of neuropathic pain.Methods:Firstly, development of a tentative version of the scale: based on the common clinical features of neuropathic pain and the pain diagnostic scales commonly used in the current international, the preliminary draft of the scale was developed, and the tentative version of the scale was formed after consideration and pre-survey revision by the expert group. Secondly, validation of the tentative version of the scale: 118 patients with neuropathic pain and 112 patients with non-neuropathic pain were randomly studied from 8 research centres in China. Thirdly, the validity of the scale (surface validity, construct validity, including exploratory factor analysis and confirmatory factor analysis) and reliability test, parallel diagnostic evaluation.Results:The validity of the tentative version of the scale was positive, with the exploratory factor analysis extracting five common factors with a cumulative variance contribution of 59.481% and factor loadings ranging between 0.407 and 0.739 for each entry. The model constructed by the confirmatory factor analysis fitted the relevant parameters reasonably well properly: χ2/ df of 1.760, RMSEA of 0.058, GFI of 0.901, AGFI of 0.868, CFI of 0.920, IFI of 0.922 and TLI of 0.904. The AUC value was 0.773, with a sensitivity of 85.6%, a specificity of 63.4% and a cut-off value of 66.5. Conclusion:The Chinese scale for diagnosis and assessment efficacy of neuropathic pain designed in this study has high reliability and stable structure, and can be popularly used in clinical practice.

Background: Pancreatic ductal adenocarcinoma (PDAC) is difficult to diagnose and resistant to therapy and has a poor prognosis. Autophagy plays a vital role in PDAC development and progression. This study aimed to establish an autophagy-related gene (ARG) signature to predict the prognosis of patients with PDAC. Materials and Methods: The expression profiles of PDAC and healthy pancreatic tissues were obtained from The Cancer Genome of Atlas (TCGA) and GTEx (Genotype-Tissue Expression) databases, respectively. Univariate and multivariate Cox regression analyses were performed on differentially expressed ARGs to identify the optimal prognosis-related genes. Results: A total of 73 ARGs demonstrated significant differences in expression levels between PDAC and healthy pancreatic tissues. Several pathways that play crucial roles in biological processes were identified via enrichment analyses. Furthermore, an ARG signature was established based on overall survival–related ARGs (CASP4, BAK1, PIK3R4, CASP8, BIRC5, RPTOR, and CAPN1) using least absolute shrinkage and selection operator (LASSO) regression. Cox regression analysis confirmed that the 7-gene signature was an independent prognostic factor for patients with PDAC (P<0.001). In addition, the GSE21501 and GSE28735 datasets were used to validate the predictive value of the prognostic model for PDAC. We also constructed a clinical nomogram with a concordance index of 0.712 to predict the overall survival of patients by integrating clinical characteristics and the ARG signature. Calibration curves substantiated fine concordance between nomogram prediction and actual observation. Conclusion: We constructed a new ARG-related prognostic model, which can be a prognostic biomarker and offers insights into identifying potential therapeutic targets for PDAC.

BACKGROUND:Cancer has been considered as the leading cause of death in the world. In patients with cancer, up to 80% display a cachectic period after diagnosis. Cachexia is known to have a negative impact on function, treatment tolerance, higher rates of hospitalizations, and mortality. Anorexia is often used as a warning sign of precachexia. Long-term anorexia may lead to malnutrition and, then, accelerate the occurrence of cachexia. A safe and effective treatment, which can both improve appetite and assist nutritional support for precachexia cancer patients shows its particular important role.METHODS:A retrospective analysis comparing the different therapeutic effects on precachexia cancer patients with anorexia-malnutrition. We recorded 46 patients with the improved-Sijunzi decoction combined with enteral nutrition emulsion (ISJZ group) and 35 patients with single enteral nutrition emulsion (SEN group). The different therapeutic effects of the two groups were observed by recording indicators before and 2 weeks after treatment, including patient-generated subjective global assessment score, quality of life score, Karnofsky performance status scale, Eastern cooperative oncology group scale standard and traditional Chinese medicine syndrome, daily total dietary intake, red blood cells, hemoglobin, prealbumin, albumin, total protein cholinesterase, C-reactive protein, leukocytes, alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, urea nitrogen, and creatinine.RESULTS:ISJZ group exhibited prominent improvement of traditional Chinese medicine syndrome (TCMS), nutritional condition, and quality of life compared with the SEN group (QOL: p=0.0001, PG-SGA: p=0.019, dietary intake: p=0.0001, TCMS: p=0.0001). The levels of HGB (p=0.006), PAlb (p=0.001), Alb (p=0.0001), TP (p=0.008), and ChE (p=0.0001) in the ISJZ group were higher than the SEN group after treatment. Moreover, the ratios of CRP/ALB (p=0.028) and CRP/PALB (p=0.005) in the two groups have obvious differences; they were lower for the ISJZ group than the SEN group.CONCLUSIONS:Enteral nutrition combined with ISJZ decoction is an effective treatment in precachexia cancer patients for the prevention of cachexia. This treatment therapy can alleviate the inflammatory response, improve malnutrition state, and promote the performance status. Tianjin Medical University Cancer Institute and Hospital approved this study (Trial No. 1913).

癌性爆发痛是恶性肿瘤患者的常见症状,也是临床工作中的难点.为规范国内癌性爆发痛的诊疗过程,中国抗癌协会癌症康复与姑息治疗专业委员会难治性癌痛学组联合中华医学会疼痛学分会癌痛学组,共同撰写了《癌性爆发痛专家共识(2019年版)》(简称《共识》).该文对《共识》相关重点内容进行解读,以期加深医务工作者对《共识》的认识,促进爆发痛的规范化治疗.

Objective To investigate the nutritional status, inflammation level and the correlation among various indicators in patients with cancer pain. Methods A total of 146 patients with cancer pain were enrolled. NRS, NRS-2002, PG-SGA, anthropometric, dietary assessment, hematology and other methods were used for pain assessment, nutrition risk screening and nutritional status assessment, and to analyze the differences and correlation among various nutritional indicators in different degree of pain. Results There were significant differences in NRS-2002, PG-SGA and CHE between the two groups of different NRS scores (P < 0.05). There were significant differences in theprealbumin (PA), albumin (ALB), hemoglobin(HGB), cholinesterase (CHE), white blood cell (WBC), neutrophil ratio (N%) and lymphocyte (LYM) between the two groups of different C-reactive protein (CRP) concentrations (P < 0.05). NRS was negatively correlated with total number of CHE, LYM and BMI (P=0.000, P=0.003, P=0.000), and positively correlated with NRS-2002 and PG-SGA (P=0.003, P=0.000). The concentration of CRP was negatively correlated with the total number of PA, ALB, CHE, HGB and LYM (P=0.000, P=0.000, P=0.000, P=0.002, P=0.004), and positively correlated with NRS-2002 and PG-SGA (P=0.020, P=0.028). Conclusion The nutritional risk and malnutrition incidence are high in patients with cancer pain. The cancer patients with higher serum C-reactive protein concentration have worse nutritional status.

Purpose This study evaluated the analgesic effect of stereotactic body radiotherapy (SBRT) in combination with celiac plexus block (CPB), relative to SBRT alone, in locally advanced pancreatic cancer (LAPC) patients. Patients and Methods We reviewed medical records of all patients with LAPC, who received SBRT between 1 January 2017 to 31 August 2019 at our center. The average numeric rating scale (NRS) of ≥3 was used in all patients at admission. We recorded average and worst NRS in a 24-hour period, and daily narcotic doses before SBRT, followed by weekly for 1 month and monthly for 3 months. Results A total of 23 patients in the SBRT group and 12 under SBRT+CPB who met the inclusion criteria were enrolled. All patients in the SBRT+CPB group received CPB within 10 days after SBRT. Pain intensity and narcotic consumption were comparable in both groups at initial assessment. However, a significant decrease (P < 0.05) in average NRS was recorded in the SBRT+CPB group relative to SBRT at 2, 3 and 4 weeks after SBRT. A comparison of daily narcotic consumption with baseline values showed a significant decrease in the SBRT+CPB group at 3 and 4 weeks after SBRT (P < 0.05), while no significant differences were observed in the SBRT group. Conclusion CPB after SBRT appears to be an effective therapeutic option in patients with LAPC and warrants further evaluation with increased number of patients in prospective clinical trials.

Objective This study aimed to provide support for the extensive application of Distress Thermometer (DT) in advanced cancer inpatients with pain and explored factors associated with high DT scores among this population. Methods Advanced cancer patients with pain were recruited from Department of Pain Relief in Tianjin Cancer Hospital and Institute, China. They completed the DT with problems list and HADS within 48 h after admission. The cutoff score of DT was evaluated against Hospital Anxiety and Depression Scale (HADS) for its sensitivity and specificity by using receiver operating characteristic (ROC) curves. Multiple logistic regression model analysis was performed to investigate correlates of DT scores. Results Four hundred forty one inpatients with mixed diagnoses were recruited. Referring to the cutoff of 15 on HADS, DT cutoff score of 5 yielded AUC of 0.757, with an optimal sensitivity of 0.861 and specificity of 0.531. Using the cutoff scores of greater than or equal to 5, 70.5% of the patients were distressed. Logistic regression analysis of DT found that the breakthrough pain, poorer KPS, higher pain degree, and emotional problems were the predictive factor for current distress. Conclusion DT is efficacious in screening for psychological distress in advanced cancer inpatients with pain. Psychological distress is prevalent with a cutoff score of greater than or equal to five. To better identify the distressed cancer patients with pain, pain degree, performance status, and emotional problems should be considered together.

目的:比较简略版患者主观评估量表(PG-SGA SF)与完整版PG-SGA在肝癌营养评估中的有效性. 方法:本研究是前瞻性观察性研究,选取接受肝脏切除术的肝癌病人.使用PG-SGA、PG-SGA SF、NRS2002、握力、皮褶厚度和生化检验等评估围术期病人的营养状况.以PG-SGA完整版为标准绘制ROC曲线,评估不同简略版评估方式的组合,并分析最佳截断值的灵敏度和特异度等. 结果:共纳入88例原发性肝癌病人.结果显示,以Boxesl,2,3,4(简称Boxesl-4)判定营养不良时,ROC曲线下面积为0.986,截断值为6分,灵敏度为1,特异度尚可为0.833:Boxesl+3判定营养不良时,截断值为3分,曲线下面积为0.985,灵敏度和特异度为1、0.798,省略Box2和Box4后对评估能力影响小. 结论:肝胆外科应用PG-SGA SF评估与完整版有相近的信度和效度,是一种简便、有实用价值的营养评估工具,应用Boxes1+3可节约时间并得到满意的评估结果.

目的:探讨丹参酮ⅡA (TSN ⅡA)对完全弗氏佐剂(CFA)引起的炎性痛大鼠机械性痛敏的影响及其作用机制.方法:雄性Wistar大鼠完全随机数字法分为4组(n=6只):正常对照组(Control)、TSA ⅡA处理组(TSA ⅡA)、炎性痛组(CFA)、炎性痛+TSA ⅡA处理组(CFA+ TSA ⅡA).利用CFA注射大鼠左下肢足底制作炎性痛大鼠模型,各组大鼠分别用腹腔注射法给予20 mg/kg TSN ⅡA或等量生理盐水,利用yon Frey丝检测各组大鼠的痛行为学变化,利用Western Blot检测各组大鼠脊髓Toll样受体4(TLR4)和高迁移率蛋白-1(HMGB1)蛋白表达变化,利用Real-time RT-PCR检测TNF-α、IL-1β和IL-6等分子mRNA表达变化.结果:CFA可诱发大鼠出现明显的痛敏反应,TSN ⅡA可以显著地缓解炎性痛大鼠机械性痛敏;CFA引起的炎性痛大鼠脊髓TLR4、HMGB1、TNF-α、IL-1β和IL-6等分子表达增加,而TSN ⅡA可以显著逆转上述分子的表达上调.结论:TSN ⅡA可通过抑制HMGB1-TLR4通路缓解CFA引起的大鼠炎性痛.

恶性肿瘤是一种慢性消耗性疾病,营养支持治疗是肿瘤治疗的重要基本组成部分.科学、合理的饮食结构可以改善患者的营养状态,如预防体重下降,减缓肌肉过度消耗,延缓恶病质发生,最终增强体质,改善生活质量. 但在实际生活中,很多肿瘤患者却陷入了以下常见的饮食误区. 吃海参能治疗肿瘤吗 大多数肿瘤患者都听说过或者吃过海参,很多患者描述自己一天的饮食时,会重点强调“我每天都会吃一个海参,煮在粥里或单独煮汤”.海参的营养丰富,价格昂贵,每天吃一个海参就能治疗肿瘤吗?

OBJECTIVES:Literature is limited on the relationship between opiate analgesics and the development of infections in cancer patients. This study aimed to determine whether opiate analgesics contribute to the advancement of infections and how infection rates differ among the various opiates used for cancer management.MATERIALS AND METHODS:From January 2013 to October 2014, we analyzed retrospectively 642 consecutive advanced cancer patients who received single types of opiates, including morphine, oxycodone, or fentanyl, or a combination of these drugs, continuously for >14 days. Binominal logistic regression analysis was used to analyze the factors that may promote the development of infections.RESULTS:A total of 303 patients were included in the final analysis. Of these patients, 85, 41, and 68 patients received only morphine, oxycodone, and fentanyl, respectively. Altogether, 87 (28.7%) patients developed infections; 20 (23.5%), 10 (24.4%), and 14 (20.6%) patients developed infections in the groups that received only morphine, oxycodone, and fentanyl, respectively (P>0.05). Logistic regression analysis found that the daily oral morphine equivalent (OME) is the an independent factor that influences the development of infection in the single-opiate group (odds ratio=1.002, P<0.01). The risk for developing infection increased by 2% per 10 mg increase in the daily OME.CONCLUSIONS:Our clinical results did not display any difference among the single-opiate groups in the development of infections. However, the increase in daily OME may serve as a risk factor for the development of infections in advanced cancer patients using one opiate type for pain management.

疼痛加重说明恶性肿瘤复发或转移 由于恶性肿瘤对人体脏器、神经系统的压迫和损伤都会导致疼痛,因此,疼痛程度往往也能表明肿瘤对人体脏器或神经损伤的程度.患者感到疼痛加重,大多说明疾病有新进展.同时,肿瘤复发或者转移时,疼痛往往也会加重.

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Systemic immune-inflammation index (SII), based on lymphocyte (L), neutrophil (N), and platelet (P) counts, was recently developed and reflects comprehensively the balance of host inflammatory and immune status. We explored its prognostic value in localized gastric cancer (GC) after R0 resection and the potential associations with Thymidine phosphorylase (TYMP), which was reported to increase the migration and invasion of gastric cancer cells. A total of 455 GC patients who received D2 gastrectomy were enrolled. Blood samples were obtained within 1 week before surgery to measure SII (SII = P × N/L). TYMP expression was measured on tumor sections by immunohistochemical analysis. Preoperative high SII indicated worse prognosis (HR: 1.799; 95% CI: 1.174-2.757; p = 0.007) in multivariate analysis and was associated with higher pathological TNM stage, deeper local invasion of tumor and lymph node metastasis (all p < 0.001). SII predicted poor overall survival in pathological TNM stage I subgroup also (p < 0.001). Furthermore we found that in high SII group, positive rate of TYMP expression increased (53.7% vs 42.7%, p = 0.046) and TYMP positive patients had higher SII score (median 405.9 vs. 351.9, p = 0.026). SII, as a noninvasive and low cost prognostic marker, may be helpful to identify higher-risk patients after R0 resection, even for stage I GC patients.

Objectives: To identify prevalence and severity of nonpain symptoms and to clarify possible influences on each nonpain symptom. Methods: The study used a descriptive survey design. Chinese version of the Edmonton Symptom Assessment System was used. Patients' demographic and pain characteristics were collected. Results: The most common symptoms reported were loss of appetite (94.3%) followed by insomnia (93.3%), and tiredness (91.6%). Prevalence rates of nonpain symptom were all above 70% except thinking clearly. Prevalence and severity of nonpain symptoms varied by gender, age, primary cancer, and pain characteristics, especially intensity, number of breakthrough pain episodes per day, and number of pain sites. Conclusions: Most inpatients with cancer pain experienced concurrent nonpain symptoms. Comprehensive symptom assessment and intervention managing multiple symptoms are essential for these inpatients.

癌痛指肿瘤、肿瘤相关性病变、治疗所致的疼痛，一般也包括肿瘤患者伴随的非癌痛，多数为持续疼痛，逐渐加重。临床研究表明，癌痛发生率大约为52%~77%；晚期癌痛发生率大约为62%~86%；积极抗癌治疗时癌痛发生率大约为24%~60%；临床治愈后疼痛持续发生比率为34%。

Purpose The number of cancer cases in China has increased rapidly from 2.1 million in 2000 to 4.3 million in 2015. As a consequence, pain management as an integral part of cancer treatment became an important health care issue. In March 2011, the Good Pain Management (GPM) program was launched to standardize the treatment of cancer pain and improve the quality of life for patients with cancer. With this work, we will describe the GPM program, its implementation experience, and highlight key lessons that can improve pain management for patients with cancer. Methods We describe procedures for the selection, implementation, and assessment procedures for model cancer wards. We analyzed published results in areas of staff training and patient education, pain management in practice, analgesic drugs administration, and patient follow-up and satisfaction. Results Pain management training enabled medical staff to accurately assess the level of pain and to provide effective pain relief through timely dispensation of medication. Patients with good knowledge of treatment of pain were able to overcome their aversion to opioid drugs and cooperate with nursing staff on pain assessment to achieve effective drug dose titration. Consumption of strong opioid drugs increased significantly; however, there was no change for weaker opioids. Higher pain remission rates were achieved for patients with moderate-to-severe pain levels. Proper patient follow-up after discharge enabled improved outcomes to be maintained. Conclusion The GPM program has instituted a consistent and high standard of care for pain management at cancer wards and improved the quality of life for patients with cancer.

Objective The aim of this study was to discuss whether Shengbai Guben granule can improve the nutritional status and the degree of fatigue in advanced cancer patients.Methods From February 24, 2015 to June 18, 2016, 37 patients who received pain management and oral Shengbai Guben granule therapy more than 2 weeks in our hospital were observed. The change of nutritional status and the degree of fatigue were evaluated by BFI-C, MFI-20, PG-SGA, albumin level, grip strength, and daily intake.Results The mean score of the degree of BFI-C before treatment was 4.57±2.26 and the score was 2.62±1.93 after treatment, the score has signiifcant difference (P=0.001). Similarly, the score of the effect of BFI-C after treatment were signiifcant lower than pre-treatment (P=0.001). The score of MFI-20 mental fatigue (P=0.001), brain fatigue (P=0.003) after treatment were also lower than pre-treatment. The PG-SGA score after treatment was also lower than pre-treatment (10.54 versus 12.17,P=0.001). The average energy intake of patients before treatment was 786.49 kcal, the average energy intake was 1002.70 kcal after treatment, and the mean change before and after treatment was statistically signiifcant (P=0.000).Conclusions Oral Shengbai Guben granule can relief the degree of fatigue, and increase the energy intake and improve the nutritional status, however, it needs further study.

BACKGROUND:Chronic pancreatitis (CP) is a long-standing inflammation of the exocrine pancreas, which typically results in severe and constant abdominal pain. Previous studies on the mechanisms underlying CP-induced pain have primarily focused on the peripheral nociceptive system. A role for a central mechanism in the mediation or modulation of abdominal pain is largely unknown. Tanshinone IIA (TSN IIA), an active component of the traditional Chinese medicine Danshen, exhibits anti-inflammatory properties via downregulation of the expression of high-mobility group protein B1 (HMGB1), a late proinflammatory cytokine. HMGB1 binds and activates toll-like receptor 4 (TLR4) to induce spinal astrocyte activation and proinflammatory cytokine release in neuropathic pain.OBJECTIVE:In this study, we investigated the effect of TSN IIA on pain responses in rats with trinitrobenzene sulfonic acid (TNBS)-induced CP. The roles of central mechanisms in the mediation or modulation of CP were also investigated.STUDY DESIGN:A randomized, double-blind, placebo-controlled animal trial.METHODS:CP was induced in rats by intrapancreatic infusion of trinitrobenzene sulfonic acid (TNBS). Pancreatic histopathological changes were characterized with semi-quantitative scores. The abdomen nociceptive behaviors were assessed with von Frey filaments. The effects of intraperitoneally administered TSN IIA on CP-induced mechanical allodynia were tested. The spinal protein expression of HMGB1 was determined by western blot. The spinal mRNA and protein expression of proinflammatory cytokines IL-1β, TNF-α, and IL-6 were determined by RT-PCR and western blot, respectively. The spinal expression of the HMGB1 receptor TRL4 and the astrocyte activation marker glial fibrillary acidic protein (GFAP) were determined by western blot or immunohistological staining after intraperitoneal injection of TSN IIA or intrathecal administration of a neutralizing anti-HMGB1 antibody.RESULTS:TNBS infusion resulted in pancreatic histopathological changes of chronic pancreatitis and mechanical allodynia in rats. TSN IIA significantly attenuated TNBS-induced mechanical allodynia in a dose-dependent manner. TNBS significantly increased the spinal expression of HMGB1 and proinflammatory cytokines IL-1β, TNF-α, and IL-6. These TNBS-induced changes were significantly inhibited by TSN IIA in a dose-dependent manner. Furthermore, TSN IIA, but not the neutralizing anti-HMGB1 antibody, significantly inhibited TNBS-induced spinal TLR4 and GFAP expression.LIMITATIONS:In addition to TLR4, HMGB1 can also bind to toll-like receptor-2 (TLR2) and the receptor for advanced glycation end products (RAGE). Additional studies are warranted to ascertain whether HMGB1 contributes to CP-induced pain through activation of these receptors.CONCLUSIONS:Our results suggest that spinal HMGB1 contributes to the development of CP-induced pain and can potentially be a therapeutic target. TSN IIA attenuates CP-induced pain via downregulation of spinal HMGB1 and TRL4 expression. Therefore, TSN IIA may be a potential anti-nociceptive drug for the treatment of CP-induced pain.

The purpose of this study is to evaluate the relationship between extracapsular extension (ECE) and clinicopathology, and its influence on the prognosis in non-small cell lung cancer (NSCLC) patients. Clinical data from 388 stage IIA-IIIA NSCLC patients who underwent curative resection and confirmed ECE positive were reviewed. The Fisher's exact or Chi-square test was used to analyze the associations between ECE and the clinical pathology. The log-rank test and Cox regression model were used to evaluate the factors influencing disease-free survival (DFS) and overall survival (OS). ECE was detected in 85 (21.9%) patients, and it had a significant correlation with advanced T stage, pathological stage and histologic type of adenocarcinoma. For the whole population, the median OS was 39.0 months, and the 5-year OS rate was 33.9%. In multivariate analysis, both ECE status and postoperative chemotherapy were significant factors for OS. The median DFS for all patients was 26.0 months, and the 5-year DFS rate was 21.7%. In multivariate analysis, pathologic stage, ECE, and postoperative chemotherapy were the independent predictor factors for DFS. Further analysis found that the locoregional recurrence-free survival and the distant recurrence-free survival rates in ECE negative group were also significantly higher than in the ECE positive group. For NSCLC patients with lymph node metastasis, the presence of ECE occurs more frequently in advanced stage and histologic type of adenocarcinoma and it may be a powerful prognostic factor which reflects the aggressive biological behavior.