Association between salivary α-amylase activity and pain relief scale scores in cancer patients with bone metastases treated with radiotherapy

Background Subjective assessment tools such as visual analog scales （VAS） or pain scores are commonly used to evaluate the intensity of chronic cancer-induced pain.However,their value is limited in some cases.We measured changes in VAS pain scores and salivary a-amylase （sAA） concentrations in cancer patients receiving radiotherapy for bone metastases to ascertain the correlation between these measures.Methods We enrolled 30 patients with bone metastases attending a single institution from June 2010 to March 2011.All patients with cancer-induced bone pain received radiation therapy （RT） at the same dose （30 Gy） and fractionation （3 Gy/ fraction,5 days/week） for palliative pain relief.We assessed heart rate （HR）,systolic and diastolic blood pressures （DBP/SBP） and VAS pain scores before （d0） and after five （d5） and ten fractions （d10） of irradiation,sAA and salivary cortisol （SC）concentrations were measured using a portable analyzer and automated chemiluminescence analyzer,respectively.Results Radiotherapy markedly decreased VAS scores from （82.93±9.29） to （31.43±t16.73） mm （P ＜0.001） and sAA concentrations from （109.40±26.38） to （36.03±19.40） U/ml （P ＜0.001）.Moreover,there was a significant correlation between these two indices （P ＜0.01,r=0.541）.HR decreased by 6.5％ after radiotherapy,but did not correlate with VAS scores （P ＞0.05）.SC concentrations and BP did not change significantly during the study （P ＞0.05）.Conclusions The significant correlation between sAA concentrations and VAS pain scores identified in these preliminary results suggests that this biomarker may be a valuable,noninvasive and sensitive index for the objective assessment of pain intensity in patients with cancer-induced bone pain.     

Pain relief by palliative radiotherapy in patients with advanced bone metastases

Objective: To compare 3 local field radiation therapies for bone metastases to determine the strategy producing the best results. Methods: Among 104 patients with bone metastases, 30 patients were given 8Gy in single fraction, 31 given 20Gy in 5 fractions, 43 given 40 Gy in 20 fractions. Results and Conclusion: The method of 40Gy in 20 fractions had a higher pain relief rate and a lower pain relapse rate, suggesting that large-dose fraotioned treatment regimen is more appropriate for patients with bone meiastasis.     

Relationships among pain intensity and Heart Rate Variability in Patients after Abdominal Surgery : A pilot study

Background A link between postoperative pain intensity and heart rate variability had not been well established. This study aims to investigate the correlation between postoperative pain intensity and heart rate variability. Methods The subjects in this cross-sectional correlation study comprised patients who had undergone abdominal surgery in a regional teaching hospital in central Taiwan during the period July 2009 to November 2009. The Visual Analogue Scale (VAS) and the Short-Form McGill Pain Questionnaire (SF-MPQ) were used to measure postoperative pain. Heart rate variability was measured as standard deviation of normal RR interval (SDNN), and by power spectral analysis where high frequency (HF), low frequency (LF), very low frequency (VLF) power, and LF/HF ratio. Results A total of 34 subjects were included in this study. We found that the day after the surgery, the mean VAS score was 47.50 ± 20.98 and the mean SF-MPQ score was 18.06 ± 8.90, indicating a moderate degree of pain. Moderate to severe degrees of tenderness were reported by 70.6% of the patients, moderate to severe degrees of gnawing pain were experienced by 67.7% of the patients, moderate to severe degrees of tiring-exhaustion pain were reported by 64.7% of the patients, and 41.2% of the patients who experienced moderate to severe pain believed that the pain was punishing-cruel. The SDNN and HF values obtained from male patients or married patients were higher than female patients or unmarried (p< 0.05). The correlation of the SDNN, HF, VLF value and patient's age were negative (p< 0.05). The total SF-MPQ pain scores positively correlated with the LF/HF ratio (p< 0.05). Conclusions We concluded that the multidimensional pain assessment tool (SF-MPQ) better reflects patients’ postoperative pain than the single-dimensional assessment tool (VAS). Heart rate variability positively correlated with SF-MPQ scores in patients after abdominal surgery.     

Percutaneous radiofrequency thermocoagulation for the treatment of different types of trigeminal neuralgia: Evaluation of quality of life and outcomes

Radiofrequency thermocoagulation(RFT) of the gasserian ganglion is a routine and effective technique for the treatment of classical trigeminal neuralgia(CTN).In this study we compared its efficacy in patients with CTN and atypically symptomatic or mixed trigeminal neuralgia(MTN).Fifty-seven patients were treated with RFT for trigeminal neuralgia from June 2006 to February 2009.Thirty patients had CTN,and 27 had MTN.Outcomes were measured by using the visual analog pain scale(VAS) and patients' reports of qu...     

Correlation between Steroids and Prostaglandins in the Plasma and Peritoneal Fluid Collected from Women with Pelvic Pain after Sterilization

Estradiot (E2), progesterone (P), prostagtandin F2a (PGF2a ), prostagtandin E (PGE), 6-keto-prostaglandin F1a (6-keto-PGF1a ) and thromboxane B2(TxBe) levels in ptasma and peritoneal fluid were determined in 44 women with pelvic pain after tubal ligation and 15 women with normal pelvis as well as 11 women requesting reversal of fertility after sterilization. The results showed that the correlation between E, and PGF2a was positive and the correlation between E2 and TxB2, P and PGF2a was negative in plasma. Ee was negatively, correlated with PGF2a and TxB2 in peritoneal fluid. Some PG levels in peritoneal fluid collected from patients suffered from endometriosis, pelvic pain but without visible lesion and pelvic congestion were significantly higher than those from other groups. The results suggested that PGs levels in plasma and peritoneal fluid were influenced by steroids, and they were also related to pelvic pain.     

Surgical treatment of 21 patients with spinal metastases of differentiated thyroid cancer

Background Differentiated thyroid cancer （DTC） is a common primary cancer for spinal metastases （SM）.The treatments for DTC spinal metastases （SM） have evolved from simple surgery and radiotherapy to a multidisciplinary comprehensive therapeutic strategy of combined spinal surgery,general surgery,radiotherapy,nuclear medicine and endocrinology.The purpose of this study was to discuss the efficacy and prognosis associated with different surgical treatments of SM patients with DTC.Methods A total of 21 consecutive patients with SM of DTC that were treated between 1999 and 2013 were studied.Biopsy was routinely performed to achieve the pathological diagnosis before treatment.Three patients underwent total spondylectomy intralesionally or piecemeally,and 18 had curettage.Postoperative recurrence and survival times were analyzed by the Kaplan-Meier methods.Results Nineteen patients （90％） had an average of 42.7 months （range,7-170 months） follow-up.The median visual analogue scale for pain reduced from 5 points to 1 point （P ＜0.01）,and the median Karnofsky performance score increased from 70 to 90 points after surgery （P ＜0.01）.Seventeen patients with neurological deficits attained improvements after surgeries,of at least one level according to the Frankel classification （P ＜0.01）.Eight patients with curettage had recurrence.Four patients died of DTC,12 patients lived with disease,and three patients were disease-free.No significant effects on postoperative recurrence or survival were observed between surgery combined with conservative treatment,total spondylectomy,the number of bone metastases and visceral metastasis.Conclusions DTC-SM have a relatively favorable prognosis,and curettage and stabilization can effectively relieve the pain and improve the quality of life and neurological status of the patients.For patients with Tomita scores of ＜3,total spondylectomy may have better clinical outcomes.Comprehensive therapeutic strategies including surgery,radioiodine,external beam     

Variations and Clinical Significance of Coagulation and Fibrinolysis Parameters in Patients with Diabetes Mellitus

We observed the changes of parameters of coagulation and fibrinolytic system in order to understand the clinical implication of these variations in type diabetic patients. Subjects consisted of 22 patients with type Ⅱ diabetes mellitus and 25 healthy controls. Compared with the control, activated partial thromboplastin time, prothrombin time were shortened in the patients. The diabetic subjects also displayed higher levels of D-dimer, serum fibrin degradation products,median concentrations of fibrinogen (3.99 vs 2.96 g/L, P<0.01) and yon Willebrand factor (149% vs 87%, P<0.01). Levels of antithrombin Ⅲ activity or antigen were not different from control values. Simple linear regression analysis revealed a negative correlation between antithrombin Ⅲ activity and fast blood glucose. Diabetic patients with vascular complications had significantly higher levels of fibrinogen and D-dimer than those without diabetic angiopathy. Our data demonstrated that patients with type Ⅲ diabetes mellitus had a hyperco     

Relationships between pain intensity and heart rate variability in patients after abdominal surgery: a pilot study

Background  A link between postoperative pain intensity and heart rate variability (HRV) had not been well established. This study aimed to investigate the correlation between post-operative pain intensity and HRV.

Methods  The subjects in this cross-sectional correlation study comprised of patients who had undergone abdominal surgery in a regional teaching hospital in central Taiwan during the period July 2009–November 2009. The visual analogue scale (VAS) and the short-form McGill pain questionnaire (SF-MPQ) were used to measure post-operative pain. HRV was measured as the standard deviation of normal RR interval, and by power spectral analysis that included high frequency (HF), low frequency (LF), very low frequency power, and LF/HF ratio.

Results  A total of 34 subjects were included in this study. We found that the day after the surgery, the mean VAS score was 47.50±20.98 and the mean SF-MPQ score was 18.06±8.90, indicating a moderate degree of pain. Moderate to severe degrees of tenderness were reported by 70.6% of the patients, moderate to severe degrees of gnawing pain were experienced by 67.7% of the patients, moderate to severe degrees of tiring-exhaustion pain were reported by 64.7% of the patients, and 41.2% of the patients who experienced moderate to severe pain believed that the pain was punishing-cruel. The standard deviation of normal RR interval and high frequency values obtained from male patients or married patients were higher than female patients or unmarried (P <0.05). The correlation of the standard deviation of normal RR interval, high frequency, very low frequency value and patient’s age were negative (P <0.05). The total SF-MPQ pain scores positively correlated with the LF/HF ratio (P <0.05).

Conclusions  The multidimensional pain assessment tool (SF-MPQ) reflects better the patients’ post-operative pain than the single-dimensional assessment tool (VAS). HRV positively correlated with SF-MPQ scores in patients after abdominal surgery.

     

Increased expression of receptor activator of nuclear factor-κB ligand in osteoblasts from adolescent idiopathic scoliosis patients with low bone mineral density

Persistent generalized low bone mineral density (BMD) has been reported in patients with adolescent idiopathic scoliosis (AIS).However,the exact mechanisms and causes of the low BMD in AIS patients are largely unknown.The purpose of this study was to examine the relationship between the receptor activator of NF-κB ligand (RANKL)/osteoprotegerin (OPG) levels in osteoblasts (OBs) from AIS patients with low BMD and with comparison made between the patients and controls.Twenty AIS patients and eight age-matched controls were included in the present study.The BMD of lumbar spine and proximal femur was measured in all subjects.OBs from the cancellous bone of each subject was harvested and primarily cultured.The mRNA and protein expression of RANKL and OPG in OBs was detected by RT-PCR and Western blotting.The results showed BMD was lower in AIS patients than in controls.A significantly higher mRNA and protein expression of RANKL was observed in OBs from AIS patients,while no significant difference was found in the expression of OPG between AIS patients and controls.As a result,RANKL/OPG ratio in patients with AIS was remarkably higher than controls.Our study preliminarily demonstrated expression of RANKL was higher in OBs from AIS patients with low BMD as compared with controls,suggesting the unbalanced RANKL/OPG ratio caused by an over-expression of RANKL in OBs may be responsible for the low BMD in AIS patients.     

Surgical management of metastatic disease of long bone

Objective To improve the life quality of cancer patients with metastasis to long bone and to long bone and to select suitable surgical treatment. Methods Fifty-two patients with metastasis 27 men and 25 women, were June 2003 Vol12 No2 treated from 1990 to 1999. Their average age was 56. 8 years (33 - 74). In 16 patients with multiple lesions, underwent surgery at bone shaft (29 patients) and bone epiphysis (26). Thirty patients were treated for pathologic fracture and the rest for impending fracture. Operations included limb-salvage (51 patients) and amputation (4) Limb salvage consisted of intralesional curettage (3 patients ), intramedullary nailing reconstruction (29 ), endoprosthesis ( 18 ), and temporary spacer ( 1 ). 21 patients accepted postoperative chemotherapy or radiotherapy. Results Follow-up of 52 patients for a mean of 28. 2 months (2 - 122 months) showed pain relief (41 patients), (75%) and full or part weight-bearing stability ( 36 ) 69 % . Local tumor recurrence occurred in 11 patients.     

经皮椎体成形术治疗骨质疏松椎体骨折的远期疗效与影像学表现

Background  Percutaneous vertebroplasty (PVP) has become a popular procedure for painful vertebral osteoporotic fracture (VOF), with immediate pain relief and improved mobility; however, polymethylmethacrylate (PMMA) injected into the vertebral body is not absorbable and little information is available concerning the long-term results. In this retrospective study, we evaluated the long-term clinical results and radiological changes after PVPs for VOFs.

Methods  Fifty-one patients with VOFs were treated by PVPs with PMMA between 2000 and 2004. After >7 years of follow-up, eight patients had died from causes unrelated to the intervention and 12 patients were lost to follow-up, thus leaving 31 patients available for evaluation with an average length of follow-up of 9.2 years (follow-up rate, 72.1%). Among these 31 patients, the PMMA was injected at 43 levels with a mean volume of 4.3 ml per level (range, 2-6 ml). The pain was assessed with a visual analog scale (VAS), and the mobility was graded as walking without difficulty (grade 1), walking with assistance (grade 2), and bedridden (grade 3). Plain radiographs and computed tomography (CT) were obtained and assessed pre-operatively, immediately post-operatively, and after 7 years of follow-up. The PMMA, vertebral height, and Cobb angle were assessed and compared.

Results  All of the patients experienced pain relief and improved mobility after intervention and during the follow-up period. Cement leakage was detected in post-operative CT scans in 9 of 51 patients, but without neurological compromise. For the 31 patients followed up over 7 years, the VAS decreased from 8.3±2.6 pre-operatively, to 2.1±1.6 immediately post-operatively, and 1.0±0.9 at the final follow-up evaluation, with significantly improved mobility. Additional compression fractures occurred at adjacent levels in three patients, and there were no new fractures at the augmented vertebrae. Based on a review of the radiographs, neither loose nor displaced cement was detected. The changes in vertebral height and Cobb angle were not significant. On CT scans, the cement closely contacted or infiltrated the trabecular bone. The boundary between the cement and trabecular bone was indistinct and there was no evident radiolucent gap between the cement and trabecular bone.

Conclusions  At an average follow-up of 9.2 years, PVPs provided sustained pain relief and improved mobility in patients with VOFs. The PMMA injected into the vertebral body combined closely with the host trabecular bone without adverse reactions.

     

Development of a disease-specific health-related quality of life questionnaire for patients with post-stroke spasticity

OBJECTIVE:This study was designed to develop a disease-specific health-related quality of life(HR-QOL) measure for patients with post-stroke spasticity.METHODS:Based on responses from 20 patients with post-stroke spasticity and an extensive literature search,items potentially used to measure these patients’ recovery status were identified and the Apoplexy Spastic-Paralysis Questionnaire(ASPQ) was formed.A sample of 106 patients was then tested twice using the ASPQ,the Self-rating Depression Scale(SDS) and the Stroke-specific Quality of Life(SS-QOL).Clinicians also examined all the patients using the Ashworth Scale(AS).Internal reliability was assessed using Cronbach’s coefficient α,while construct validity was determined using principal component analysis(PCA).Empirical validity was evaluated between patients with depression and those without depression by single factor analysis.Sensitivity was examined by calculating the Spearman correlation coefficient between the changes in scores of the ASPQ,the AS and the SS-QOL.RESULTS:The ASPQ had adequate internal consistency reliability(α=0.874) and sensitivity,with significant correlations between the changes in scores of the AS,the SS-QOL and the ASPQ,with three domains.In a construct validity test,six factors were extracted;the overall variance explained by all factors was 72.6%.For empirical validity,mean values of 19 items and 3 domains were all higher in the depressive patients than in the non-depressive patients.CONCLUSION:The ASPQ is a reliable and valid self-rating scale for measuring the HR-QOL in patients with post-stroke spasticity.     

The early risk stratification of the patients with acute chest pain

Objective: This investigation was designed to stratify patients with acute chest pain based on their symptoms, electrocardiogram (ECG), cardiac injury markers and the number of accompanying traditional risk factors(smoking, obesity, hyperlipemia, hypertension, diabetes), and to assess the effect of the above factors to obtain a risk stratification for patients with chest pain. Methods: We identified 139 patients with acute chest pain, including 45 myocardiac infarction patients, 65 unstable angina patients and 29 chest pain patients without identified acute coronary syndrome(ACS) admitted to our Coronary Heart Center during December 2004 to February 2005. All patients accepted coronary angiography. All data was collected using questionnaires. Based on reported symptom, electrocardiogram (ECG), cardiac injury markers and the number of the accompanying traditional risk factors, we stratified all patients into four groups: Group 1, patients with acute chest pain, ECG changes and abnormal cardiac injury biomarkers. Group 2, patients with acute chest pain and ECG changes(without abnormal cardiac injury biomarkers). Group 3, patients with acute chest pain, normal ECG, normal cardiac injury biomarkers and >2 traditional risk factors. Group 4, patients with acute chest pain, normal ECG and normal cardiac injury biomarkers, but only≤2 traditional risk factors. From this data we examined the difference of ACS incidence in the four groups. Results:After stratification the ACS incidence of the grouped patients in turn was 100%, 84%, 69.6% and 53.3%. The combination of early phase ECG and cardiac injury markers identified 70.9% patients with ACS(the specificity being 90.7%). The mortality of group 3 was higher compared with group 4(69.6% vs 53.3%), however the P value was more than 0.05 and didn’t show significant statistical difference. The correlation analysis found the number of the traditional risk factors had a significant positive correlation (r = 0.202, P = 0.044) with the number of stenosis being more than 50% of the artery diameter. Multiple linear regression showed the hypertension had a significant correlation with the number of the diseased regions(P = 0.014). Conclusions:The risk stratification based on the symptom, ECG, cardiac injury markers and accompanying traditional risk factors is both important and available in practice. It is unsuitable for patients with a normal ECG and cardiac injury markers to differentiate ACS from non-cardiac chest pain relying only on the number of the accompanying traditional risk factors. However we found the number of the risk factors can indicate the disease severity.     

De-qi, not psychological factors, determines the therapeutic efficacy of acupuncture treatment for primary dysmenorrhea

<正>Objective:To study the impact of De-qi(得气,obtaining qi) and psychological factors on the efficacy of acupuncture treatment for primary dysmenorrhea,with an attempt to explore the relationship among De-qi, psychological factors,and clinical efficacy.Methods:The patients with primary dysmenorrhea were randomly assigned to a group of acupuncture with manual manipulation(manipulation group,n=67) and an acupuncture group without manipulation(non-manipulation group,n=64).Pain intensity and pain duration were used as measures for evaluating the therapeutic efficacy of the acupuncture treatment.De-qi,the sensations a patient experienced during the acupuncture treatment,was scored on a 4-point scale by the subjects.In addition,the psychological factors,including belief in acupuncture,the level of nervousness,anxiety,and depression,were quantitatively assessed.The personality of the subject was assessed using the Eysenck personality questionnaire (EPQ) and 16 personality factor questionnaire(16PF).Results:Complete data were obtained from 120 patients,60 patients in each group.There were statistically significant differences in pain intensity(W=2410.0,P0.01) and pain duration(W=3181.0,P0.01) between the two groups.The number of De-qi acupoints(W=1150.5,P0.01) and the average intensity of De-qi(W=1141.0,P0.01) were significantly higher in the manipulation group as compared with their non-manipulation counterparts.The correlation coefficients between De-qi and therapeutic efficacy of acupuncture were greater than those between psychological factors and therapeutic efficacy.Conclusions: Compared with the psychological factors,De-qi contributed more to the pain-relieving effect of acupuncture in subjects with primary dysmenorrhea.Moreover,manual manipulation is a prerequisite for eliciting and enhancing the De-qi sensations,and De-qi is critical for achieving therapeutic effects.     

Efficacy of the Dynamic Interspinous Assisted Motion system in clinical treatment of degenerative lumbar disease

Background The Dynamic Interspinous Assisted Motion （DIAM） system was designed to stabilize degenerative spinal segments without fusion surgery, maintain segment motion and prevent adjacent segment degeneration. The aim of thisstudy was to investigate clinical efficacy of the DIAM system in treatment of degenerative lumbar disease in China.Methods Eight cases of lumbar vertebral instability were treated with the DIAM system at Peking Union MedicalCollege Hospital from June 2006 to January 2008. There were 6 female and 2 male subjects with a mean age of 46.9years and a range of 40-52 years. Radiographs and scores on outcome measures included the visual analogue scale （VAS） for pain and the Oswestry disability index （ODI）. These scores were recorded before surgery and after surgery at intervals of 3-month, 6-month, 1-year and the final follow-up visit.Results The follow-up time ranged from 12-31 months, with an average of 20.6 months. There were significant differences between preoperative and postoperative scores at each follow-up evaluation （P 〈0.05）. However, there was no significant difference between each postoperative follow-up score （P 〉0.05）. There were significant differences between preoperative and postoperative L4-5 segment activity at each time interval （P 〈0.05）, but no obvious difference was found within each postoperative follow-up evaluation （P 〉0.05）. The ODI and VAS score improvements were directly correlated with segment activity （r 〉0.7, P 〈0.05）.Conclusions The DIAM system appears to be a useful and effective treatment in the surgical management of degenerative lumbar disease in certain patients. However, long-term follow-up is needed to evaluate the clinical outcomes of the device.     

针灸治疗慢性跟腱病：一项随机对照研究

Objective： To examine whether acupuncture treatment would improve outcome in chronic Achilles tendinopathy. Methods： A randomized, controlled trial at two centers of 64 randomized patients aged 18 to 70 years with chronic Achilles tendinopathy was conducted from July 2007 to April 2010, with follow-up until October, 2010. These patients were randomly allocated into an acupuncture treatment group （acupuncture group） and an eccentric exercises group （control group）. The validated Victorian Institute of Sports Assessment- Achilles （VISA-A） questionnaire was completed at baseline and 8, 16, and 24 weeks. The pain at rest and after activity was accessed at baseline and 8 weeks with Visual Analogue Scale （VAS）. Results： After randomization into the acupuncture group or control group, one patient was loss of follow-up. The mean VISA-A score improved significantly after 8 weeks in the acupuncture group to 67.1 points [95% confidence interval （CI）, 64.1-70.2] and in the control group to 48.5 points （95% CI, 45.5-51.6） with an additional 18.6 points increase in acupuncture treatment patients （P=0.0000）. Acupuncture treatment resulted in a significant increase from baseline in VISA-A of 25.8 after 16 weeks and 28.4 after 24 weeks. Whereas, in the control group the increase from baseline in VISA-A were 10.0 and 16.6 after 16 and 24 weeks, respectively （P=0.0000）. The VAS diminished by 2.0 cm after activity, and by 1.5 cm at rest after 8 weeks in the control group. In the acupuncture group, the pain scores diminished significantly more than in the control group, with pain reduction of 3.7 cm after activity （P=0.0000） and 3.2 cm at rest （P=0.0000）. Conclusion： Acupuncture intervention could improve pain and activity in patients with chronic Achilles tendinopathy compared with eccentric exercises.     

Renal impairment in multiple myeloma: Presenting features in different departments

In order to analyze the causes of delayed diagnosis and raise the level of early diagnosis of atypical multiple myeloma (MM),the differences of presenting features between the patients presented to nephrologists and those presented to hematologists were compared.MM patients in our hospital were studied retrospectively.Those who referred renal impairment were divided into two groups:group I presented to nephrologists prior to MM diagnosis (n=29) and group II presented to hematologists di-rectly (n=62).The age,sex,initial symptoms,haematological and biochemical parameters,the pheno-type of paraprotein,bone marrow biopsy and cytology were undertaken and analyzed.The results showed that the median time between the initial symptoms and diagnosis in the patients of group I was longer than that in group II (P<0.001);patients in group I had significantly lower incidence of bone pain (P<0.01) and worse renal function (P<0.05) on presentation.There were lower level of myeloma cells (P<0.05),lower incidence of hypergammaglobulinemia (P<0.05),lower positive rate of monoclonal immunoglobulin (M protein) (P<0.05) and M protein level (P<0.05) in the patients of group I than those in group II.The ratio of monoclonal to lambda monoclonal proteins in a population was 1:3.67 in pa-tients of group I,whereas 1:0.90 in patients of group II (P<0.01).Moreover,patients with λ type had a higher degree of renal insufficiency than those with κ type (P<0.05).It was suggested that the median time between the initial symptoms and diagnosis in the patients presented to nephrologists was longer than that in those presented to hematologists;the patients presented to nephrologists had the lower inci-dence of bone pain,lower level of myeloma cells and M protein,which made early diagnosis more dif-ficult;more patients presented to nephrologists had the majority of λ light chain type,moreover,patients with λ light chain type had a higher incidence of renal insufficiency.     

Brain glucose metabolic changes associated with chronic spontaneous pain due to brachial plexus avulsion: a preliminary positron emission tomography study

Background Previous brain imaging studies suggested that the brain activity underlying the perception of chronic pain may differ from that underlying acute pain. To investigate the brain regions involved in chronic spontaneous pain due to brachial plexus avulsion （BPA）, fluorine-18^fluorodeoxyglucose （18^F-FDG） positron emission tomography （PET） scanning was applied to determine the glucose metabolic changes in patients with pain due to BPA.
Methods Six right-handed patients with chronic spontaneous pain due to left-BPA and twelve right-handed age- and sex-matched healthy control subjects participated in the 18^F-FDG PET study. The patients were rated by visual analog scale （VAS） during scanning and Hamilton depression scale and Hamilton anxiety scale after scanning. Statistical parametric mapping 2 （SPM2） was applied for data analysis.
Results Compared with healthy subjects, the patients had significant glucose metabolism decreases in the right thalamus and SI （P 〈0.001, uncorrected）, and significant glucose metabolism increases in the right orbitofrontal cortex （OFC） （BAll）, left rostral insula cortex and left dorsolateral prefrontal cortex （DLPFC） （BA10/46） （P 〈0.001, uncorrected）.
Conclusion These findings suggest that the brain areas involved in emotion, attention and internal modulation of pain may be related to the chronic spontaneous pain due to BPA.     

Paraoxonase activity in type 2 diabetes mellitus patients with and without complications

Objective:Type 2 diabetes mellitus(DM)is a disease of metabolic dysregulation.Current study was undertaken to know the relation between fasting lipid profile and paraoxonase 1(PON1)activity in type 2 diabetic patients with and without complications.Methods:The study group consisted of a total of 155 subjects which included non-diabetic healthy control subjects(n = 50)and diabetic patients with complications(group I,n = 66)and without complications(group II,n=39).PON1 activity was measured all the subjects based on spectrophotometric methods,and fasting lipid profile and fasting plasma glucose(FPG)levels were determined in clinical chemistry analyzer Hitachi 912.Results:FPG(P<0.001)and TAG(P<0.001)significantly increased,and HDL-C(P<0.001)and PON1(P<0.001)were significantly decreased in group I patients when compared to normal controls.In group II patients FPG(P<0.001),TAG(P<0.001)and TC(P<0.05)significantly increased and HDL-C(P<0.05)was significantly decreased when compared to normal controls.On Pearson correlation,HDL-C was positively correlated with PON1 in group I patients(r=0.317,P<0.01).Conclusion:type 2 DM patients with complications have significantly decreased HDL-C levels and PON1 activity possibly indicating its decreased biochemical role in these patients.     

The evaluation of Tracp5b as a marker for monitoring treatment results of bone metastasis in breast cancer patients

Objective:To evaluate the sensitivity of serum tartrate-resistant acid phosphatase 5b(Tracp5b)activity in monitoring bisphosphonate treatment results of bone metastasis in breast cancer(BC)patients.Methods:The serum activities of Tracp5b,CEA,CA153 were mea- sured in 58 BC patients,including 26 without bone metastasis,32 with bone metastasis.The serum activities of Tracp5b,CEA,CA153 were also measured in 19 patients with bone metastasis after 3 months of bisphosphonate treatment.Eighteen healthy women with age from 34 to 70 served as control.Results:Serum Tracp5b was significantly elevated in patients with bone metastasis compared with that in all any other groups(P<0.05).The sensitivity of Tracp5b was 78.13%and the specificity was 86.36%.The sensitivity of CA153 was 37.50%and the specificity was 77.27%.The sensitivity of CEA was 21.88%and the specificity was 84.09%.The serum activity of Tracp5b decreased significantly(P<0.05)after 3 months of bisphosphonate treatment,while the levels of CA153 and CEA were unchanged.Conclusion:Serum Tracp5b activity is a useful diagnostic marker for bone metastasis in BC patients and can be used to evaluate the treatment results of bisphosphonate.