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With the increasing number of cancer patients in China, the lack of hospice communication between medical staff and cancer patients can easily cause doctor-patient conflicts. Facing the special group of cancer patients, by introducing the concept of hospice communication and comparing the current situation of hospice communication of cancer patients at home and abroad, this paper found the shortcomings of hospice communication between medical staff and cancer patients in China. This paper aimed to analyze the influencing factors of cancer patients’ hospice communication from three aspects of medical staff, cancer patients and social and cultural background, summarized the assessment tools and matters needing attention related to hospice communication, so as to provide reference for domestic medical staff to develop relevant tools for hospice communication with cancer patients, and help medical staff to implement more effective hospice communication with cancer patients in the context of tranquil care. It is also conducive to help patients open the topic of death from the perspective of doctors and build an open hospice communication environment that is more in line with national conditions of China.
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Objective:To investigate the risk factors of moderate to severe cancer-related fatigue (CRF) in patients undergoing chemotherapy of prostate cancer, and to construct a nomogram model to predict the occurrence of CRF.Methods:Using the case data questionnaire, Brief Fatigue Inventory, Social Support Rating Scale and International Prostate Symptom Scores, 724 patients of prostate cancer treated by chemotherapy in Shanghai Tenth People′s Hospital from August 2016 to June 2021 were selected and were treated with 1∶1 ratio, and the indexes of the moderate and severe CRF group (216 cases) and the non-moderate and severe CRF group (216 cases) were compared. According to the ratio of 7∶3, the envelope method was used to divide into training set and validation set. The independent risk factors of moderate and severe CRF were explored by univariate analysis and multivariate Logistic regression analysis, and the risk prediction model was established and the nomogram model was constructed. The C-index and area under ROC curve were used to verify the prediction effect of the model.Results:Multivariate Logistic regression analysis showed that BMI ranged from 24.0 to 27.9 kg/m 2 ( OR=1.733), BMI≥28.0 kg/m 2 ( OR=3.126), neutropenia occurred during chemotherapy ( OR=1.747), chemotherapy course >6 months ( OR=1.893), moderate social support level ( OR=1.244), low social support level ( OR=2.434), mild urinary tract symptoms ( OR=1.264), moderate urinary tract symptoms ( OR=3.371) and severe urinary tract symptoms ( OR=5.297) were independent risk factors for moderate and severe CRF. The nomogram model constructed according to the above risk factors was internally verified by the training set and the validation set, and its C-index was 0.854 and 0.741 respectively. The area under ROC curve training set was 0.823, and the validation set was 0.733. Conclusions:The nomogram model can effectively predict the occurrence of moderate to severe CRF in patients with prostate cancer undergoing chemotherapy.
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Objective:To investigate the clinical value of Octreotide plus Ulinastatin in the treatment of severe acute pancreatitis(SAP)in elderly patients.Methods:From May 2016 to February 2019, 124 elderly SAP patients admitted to the gastroenterology department of our hospital were enrolled and divided into the combination therapy group and the control group, with 62 patients in each group.The combination therapy group was treated with Octreotide and Ulinastatin, while the control group was treated with Octreotide alone.Serum leukocyte count, C-reactive protein(CRP), interleukin(IL)-6, tumor necrosis factor(TNF)-α and amylase levels were monitored before and 1, 3, 5, 7 and 14 days after treatment by automated biochemical analysis and enzyme-linked immunosorbent assays.The pain grade scale, APACHE-Ⅱ score and efficacy evaluation were analyzed for the two groups 7 days after treatment.The time to oral refeeding and length of hospitalization were compared between the two groups, and related complications during the treatment were recorded.Complications and the recurrence of pancreatitis within 1 year were followed up in both groups.Results:There was no statistically significant difference in serum white blood cell count, CRP, amylase, IL-6 and TNF-α levels between the two groups before treatment(all P>0.05). Serum white blood cell count, CRP and TNF-α levels had significant differences( t=3.735, 2.851 and -2.147, P=0.036, 0.029 and 0.043)and serum amylase and IL-6 levels had no significant difference( P>0.05)between the two groups 3 days after treatment.All the above parameters had significant differences between the two groups 7 days after treatment( t=3.624, 2.918, -2.166, 2.684 and -2.593, P=0.023, 0.011, <0.001, 0.015 and <0.001). Serum amylase, IL-6 and TNF-α levels had significant differences( t=-3.515, 4.627 and -3.189, all P<0.001)and serum white blood cell count and CRP had no significant difference(all P>0.05)between the two groups 14 days after treatment.There were significant differences in visual analogue scale(VAS)and APACHE-Ⅱ score between the two groups 7 days after treatment( t=-2.346 and -3.245, P=0.021 and 0.002). On the 7th day after treatment, the effectiveness rate was 79.0%(49/62)in the combination therapy group and 61.3%(38/62)in the control group, with a significant difference between the two groups( χ2=4.661, P=0.031). Compared with the control group, time to oral refeeding and hospitalization length were shorter in the combination therapy group than in the control group(6.72±1.87 d vs.7.65±1.69 d, 11.23±2.98 d vs.13.85±3.42 d, t=-2.868 and -4.565, both P<0.05). There were significant differences in the incidences of infectious pancreatic necrosis, gastrointestinal adverse reactions and organ failure between the combination therapy group and the control group(11.3% or 7/62 vs.25.8% or 16/62, 43.5% or 27/62 vs.21.0% or 13/62, 1.6% or 1/62 vs.11.3% or 7/62, χ2=4.324, 7.233 and 4.810, P=0.038, 0.007 and 0.028). There were significant differences in mean length of time without complications and recurrence between the combined group and the control group(10.25±3.26 months vs.8.72±3.73 months, 10.69±2.51 months vs.9.62±2.92 months, Log Rank χ2=7.463 and 4.589, P=0.006 and 0.032). Conclusions:Octreotide combined with Ulinastatin can effectively alleviate local symptoms, slow clinical progression, reduce the risk of complications, decrease the recurrence rate and promote early recovery in elderly SAP patients.
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A 89-year-old female patient presented with skin lesions of the groin, vulva and intergluteal sulcus for 10 months, and blisters for 3 weeks. Skin examination revealed the red-white hyperplastic plaques on the groin, vulva and intergluteal sulcus, on which mung-bean- to pea-sized erosions and blisters scattered, and several similar blisters were scattered on the right axilla and right leg, some of which were broken and covered with crusts. Histopathological examination of the skin lesion on the intergluteal sulcus showed thickened spinous layer without acantholysis, subepidermal fissures and blisters in some areas, focal papillary dermal edema with eosinophil infiltration, and perivascular infiltration composed mainly of lymphocytes in the superficial dermis. Direct immunofluorescence assay showed linear deposition of IgG and C3 at the epidermal basement membrane zone, clustered deposition of IgM in the dermis, but no IgA deposition. Indirect immunofluorescence on salt-split skin revealed that IgG and C3 were deposited on the epidermal side. Enzyme linked immunosorbent assay (ELISA) showed that serum levels of anti-BP180 and anti-BP230 antibodies were 26.92 U/ml and 68.17 U/ml respectively, and those of anti-desmoglein 1 (Dsg1) and anti-Dsg3 antibodies were normal. The patient was diagnosed with pemphigoid vegetans. After the treatment with oral methylprednisolone combined with topical halometasone ointment and tacrolimus 0.03% ointment, the skin lesions gradually subsided.
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Objective To establish a method for determinning quetiapine in human hair by HPLC.Methods A reverse phase HPLC system was performed on Inertsil ODS-C18 column (4.6 mm ×150 mm,5μm)with the mobile phase consisted of 0.01 mol/Lammonioum-methanol(32︰68).The flow rate was 1.0 mL/min,column temperature was 40℃,the detection wavelength was 254 nm.N-hexane was used as extracting solvent.Results The calibration curve was linear in the range of 5-200 ng/mg.for quetiapine.The recovery of extraction >75.0%, the recovery of method was between 95.0% and 105.0%, the intra-day and inter-day precision were all no more than 10.0%.This method met the requirements of biological samples. Conclusion A HPLC method of concentration of quetiapine in human hair is established, which is simple,sensitive,accurate and has a certain value.
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Objective To observe the clinical effects of prostaglandin E1 on liver cirrhosis patients and evaluate its security. Methods 68 cases with liver cirrhosis admitted in Luqiao hospital were randomly divided into experimental group(34 cases)and control group(34 cases)equally. Patients in control group were received normal therapy,while in experimental group were added prostaglandin E1 on basis of normal therapy. The efficacy and adverse reactions were observed and compared. Results Compared with before treatment,the average value of albumin in two groups were increased obviously,which in experimental group from (27.9 ±4.1)g/L to (36.5 ±4.3)g/L,control group from (27.8 ±4.0)g/L to (31.7 ±4.2)g/L,the differences were significant(P<0.05 ),and the difference between two groups was significant(P<0.05 ),too. The content of alanine aminotransferase and aspartase aminotransferase in two groups were decreased significantly(P<0.05 ),and experimental group was more lower than control group(P<0.05 ). The number of effcacy in experimental group was 28 and account for 82.35%,while in control group was 1 1 and account for 32.35%,the difference was significant(P<0.05). Conclusion Prostaglandin E1 can improve liver function,and has good clinical effects and high security in treatment with liver cirrhosis patients.
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Bcl-2 gene is the human homologous gene of anti-apoptotic gene Ced-9 in c-elegans, which can participate in regulations of cells apoptosis including suppression of neuronal apoptosis in cerebral ischemic penumbra.This review is about Bcl-2 anti-ischemic neuron injury, its possible mechanisms and the effects of anti-ischemic drugs on Bcl-2.
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Objective To investigate the effect of recombinant intestinal trefoil factor(rITF)on the intestinal mucosa of acute necrotizing pancreatitis(ANP)rats and explore the mechanism.Methods 60 male SD rats were randomly divided into control group(n=20),ANP group(n=20),rITF group(n=20).ANP was induced by retrograde injection of 5%sodium taurocholate(100μl/100 g)into biliopancreatic duct.Rats in rITF group were injected with rITF(0.5 mg/100 g)before and after ANP induction.The rats in ANP group and control group received same amount of normal sailne.Each group were sacrificed 12 h or 24 h later.respectively.Blood sample was taken to determine the serum level of amylase.Terminal ileum was resected to observe the pathologic changes;immunohistochemistry method was applied to detect the activity of NF-κB;the expression of TNF-α mRNA,ICAM-1 mRNA in intestinal mucosa was measured by RT-PCR.Results Intestinal injury score of ANP group was higher than that ofcontrol group(P＜0.05),intestinal injury score of ANP 12 h group was higher than that of rITF 12 h group(P＜0.05),but there was no significant difference between ANP 24 h group and rITF 24 h group.The number of positive NF-κB cells was 26±4,55±8,49±4,respectively;the relatively expression of TNF-α mRNA in terminal ileum was 0.050±0.005,1.040±0.031 and 0.792±0.0256,respectively;the relatively expression of ICAM-1 mBNA was 0.045±0.010,0.795±0.037 and 0.400±0.031,respectively,in control group,ANP group and rITF 12 h group.The corresponding values in the ANP group were significantly increased compared with those values in the control group (P＜0.05 or P＜0.01).Conclusions rITF may protect the intestinal mucosa.the mechanism may include inhibit NF-κB activation,down-regulate TiNF-α mBNA,ICAM-1 mRNA expression.