Clinical efficacy of sufentanil combined with dexmedetomidine in patient-controlled subcutaneous analgesia for advanced cancer pain.

To evaluate the efficacy of sufentanil combined with dexmedetomidine in patient-controlled subcutaneous analgesia (PSCA) for advanced cancer pain, 62 patients with advanced cancer pain treated in Department of Oncology of Hebei PetroChina Central Hospital from January 2017 to May 2020 were recruited and assigned via the random number table method to either the control group or the observation group. The control group (group A) received PSCA with sufentanil and the observation group was divided into group B1 receiving PSCA with sufentanil and dexmedetomidine (20:1) and group B2 given PSCA with sufentanil and dexmedetomidine (10:1). The numeric rating scale (NRS) scores of patients in the three groups decreased significantly after medication (P<0.05), with significantly lower NRS scores in groups B1 and B2 than in group A (P<0.05) and comparable results between groups B1 and B2 (P>0.05). Significantly higher Ramsay sedation scores were observed in groups B1 and B2 than in group A after drug administration (P<0.05), without significant differences between groups B1 and B2 (P>0.05). The incidence of constipation, nausea and vomiting in group B1 and group B2 was significantly lower than that in group A. PSCA with sufentanil and dexmedetomidine is effective in patients with cancer pain.

Retrospective analysis of safety and efficacy of enhanced recovery pathways in stage II-III colorectal cancer patients submitted to surgery and adjuvant therapy.

BACKGROUND: The American Society of Colon and Rectal Surgeons is suggesting laparoscopic surgeries for colorectal cancer. Conventional perioperative procedures like long preoperative fasting and bowel procedures are not useful and harmful to patients undergoing surgeries for colorectal cancer. The objectives of the study were to compare surgery outcomes, hospital stays, and survival of patients who received fast-track (laparoscopy/open) surgical procedure followed by chemotherapy against those who received conventional (laparoscopy/open) surgical procedure followed by chemotherapy for colorectal cancer. METHODS: The study analyzes the outcomes of a total of 542 colorectal cancer (preoperative biopsies stage II or III) patients submitted to surgery and adjuvant chemotherapy. The study cohort is retrospectively subdivided in 4 groups submitted to open or laparoscopic resection with or without fast-track protocol appliance and two different chemotherapy regimens. Patients who ended up being TNM stage I have not received the adjuvant chemotherapy. RESULTS: The fast-track surgical procedure had shorter total hospital stays and postoperative hospital stays than the conventional surgical procedures. Flatus resumption time, the time until first defecation, and intraoperative blood loss were shorter for the fast-track surgical procedures than the conventional surgical procedures. Those surgery outcomes were also shorter for the fast-track laparoscopy than the open fast-track. Resumption of a fluid diet and ambulation onset time were shorter for the fast-track surgical procedures than the conventional surgical procedures. The surgical checkpoints that were compliance by patient of fast-track surgeries were significantly fewer than those of the conventional surgeries. Clinically significant difference for QLQ-C30/CR38 score after chemotherapy was reported between patients who received open conventional surgeries and those patients who received fast-track laparoscopy (59.63 ± 2.26 score/patient vs. 71.67 ± 5.19 score/patient). There were no significant differences for the number of patients with any grade adverse effects (p = 0.431) or with grade 3-4 adverse effects (p = 0.858), and the disease-free and overall survival among cohorts. CONCLUSIONS: The fast-track surgical procedure is effective and safe even in a multidisciplinary scenario as colorectal cancer treatment in which surgery is only a part of management. LEVEL OF EVIDENCE: III: Technical efficacy stage: 4.

The Predictive Value of Neutrophil Extracellular Trap-Related Risk Score in Prognosis and Immune Microenvironment of Colorectal Cancer Patients.

Colorectal cancer (CRC) has brought great healthy burden for patients. Neutrophil extracellular traps (NETs) have been explored in several tumors, while it remains largely unclear in CRC. CRC-related data were downloaded from Cancer Genome Atlas and Gene Expression Omnibus databases. Then, a NET risk score was built after univariate Cox and LASSO Cox regression analysis. Prognostic value was evaluated via survival analysis, stratification analysis, and ROC analysis. The functional enrichment analysis was conducted basing on bulk and scRNA-seq data. The immune landscape difference was analyzed using CIBERSORT, XCell, and MCPcounter portals. NET risk score was built for CRC patients, basing on G0S2, HIST1H2BC, CRISPLD2, and IL17A. In TCGA-CRC and validation datasets, regardless of age or gender, high-risk CRC patients had significantly worse prognosis, besides higher NET risk score was mainly found in samples with MSI-H and advanced T, N, and M stages. Employing multiple databases, we noticed that M0 and M2 Macrophages infiltrated the most in high-risk CRC patients, besides M2 Macrophages and neutrophils showed positive correlation with NET risk score. A novel reliable prognostic NET risk score was developed for CRC patients, and high-risk patients had unfavorable prognosis with advanced disease status.

Treatment of afferent loop syndrome using fluoroscopic-guided nasointestinal tube placement: Two case reports.

BACKGROUND: Afferent loop syndrome (ALS) is a rare mechanical complication that occurs after reconstruction of the stomach or esophagus to the jejunum, such as Billroth II gastrojejunostomy, Roux-en-Y gastrojejunostomy, or Roux-en-Y esophagoje-junostomy. Traditionally, an operation is the first choice for benign causes. However, for patients in poor physical condition who experience ALS soon after R0 resection, the type of treatment remains controversial. Here, we present an efficient conservative method to treat ALS. CASE SUMMARY: Case 1 was a 69-year-old male patient who underwent total gastrectomy with Roux-en-Y jejunojejunostomy. On postoperative day (POD) 10 he developed symptoms of ALS that persisted and increased over 1 wk. Case 2 was a 59-year-old male patient who underwent distal gastrectomy with Billroth II gastrojejunostomy. On postoperative day POD 9 he developed symptoms of ALS that persisted for 2 wk. Both patients underwent fluoroscopic-guided nasointestinal tube placement with maintenance of continuous negative pressure suction. Approximately 20 d after the procedure, both patients had recovered well and were discharged from hospital after removal of the tube. At 3-mo follow-up, there were no signs of ALS in these two patients. CONCLUSION: This is the first report of treating postoperative ALS by fluoroscopic-guided nasointestinal tube placement. Our cases demonstrate that this procedure is an effective and safe method to treat ALS that relieves patients' symptoms and avoids complications caused by other invasive procedures.

Abscopal effect of local irradiation treatment for thymoma: a case report.

INTRODUCTION: With the rapid development of immunotherapy in recent years, growing clinical evidence suggests that a combination of radiotherapy and immunotherapy could improve the abscopal response rates and increase survival. However, observations on abscopal effects in patients receiving radiotherapy alone are still very rare. This study reports a rare case of a patient with type B3 thymoma with multiple lung metastases, who received localized irradiation. CASE PRESENTATION: A 76-year-old Chinese woman was admitted to our hospital in November 2017, and her physical examination revealed a thymus mass with multiple lung metastases. Although the left lower lobe lesion was slightly larger than before, the patient presented with regression of the non-irradiated metastases after treatment with radiotherapy alone. CONCLUSION: This patient experienced an apparent regression of metastatic mass, suggesting a radiation-induced abscopal effect.