Comparison of the effects of Valsalva maneuver, EMLA cream, and the combination of both in relieving pain of needle insertion on totally implantable access port: A randomized controlled study.

BACKGROUND: Totally implantable access port (TIAP) is a subcutaneously implanted, long-term infusion device that is widely used in oncology patients. However, multiple needle insertions into TIAP may lead to pain, anxiety, and dread in patients. This study aimed to compare the effectiveness of Valsalva maneuver, eutectic mixture of local anesthetics (EMLA) cream, and the combination of both in relieving pain of cannulations on TIAP. METHODS: This was a prospective randomized controlled study. We included 223 patients treated with antineoplastic drugs and randomized them into four groups: EMLA Group (Group E), control Group (Group C), Valsalva maneuver Group (Group V), and EMLA cream combing with Valsalva maneuver Group (Group EV). Each group was given the corresponding intervention before non-coring needle insertion. The data on pain scores and overall comfort were collected by numerical pain rating scale (NPRS) and visual analog scale (VAS). RESULTS: Group E and Group EV experienced the least amount of pain scores in needle insertion, which was significantly lower than Group V and Group C (p < 0.05). Meanwhile, Group E and Group EV obtained the highest comfort level, which was significantly higher than group C (p < 0.05). Fifteen patients developed localized skin erythema after the application of medical Vaseline or EMLA cream and subsided within half an hour after rubbing. CONCLUSION: EMLA cream is a safe and effective way to alleviate pain during non-coring needle insertion in TIAP and enhance the overall comfort of patients. We recommend applying EMLA cream 1 h before needle insertion of TIAP, especially in patients having needle phobia or high pain scores from previous non-coring needle insertion.

Tumor stromal type is associated with stromal PD-L1 expression and predicts outcomes in breast cancer.

BACKGROUND/AIM: The aim of this study is to determine the relationship between stromal types, PD-L1 status and clinicopathological characteristics in patients with different molecular subtypes of breast cancer. MATERIALS AND METHODS: Protein expression levels of PD-L1 were determined by immunohistochemistry assay. Stromal type was classified based on the maturity of the tumor stroma. RESULTS: Different subtypes of breast cancer had distinct stromal types. Tumors from patients with mature stroma had lower pathological N stage and AJCC stage, more frequent high p53 expression and positive stromal PD-L1 staining. Hormone receptor negative patients had higher frequency of positive stromal PD-L1 staining. Stromal PD-L1 status was also associated with different breast cancer subtypes and EGFR expression level. Importantly, our data revealed that stromal types and stromal PD-L1 status were independent prognostic factors. CONCLUSION: This study highlighted the importance of stromal types and stromal PD-L1 status in determining clinical outcomes in patients with breast cancer, and suggested that stromal type classification might be readily incorporated into routine clinical risk assessment following curative resection or optimal therapeutic design.