Colorectal neoplasm:Magnetic resonance colonography with fat enema-initial clinical experience

AIM： To assess Magnetic resonance colonography with fat enema as a method for detection of colorectal neoplasm.METHODS： Consecutive twenty-two patients underwent MR colonography with fat enema before colonoscopy. Tl-weighted three-dimensional fast spoiled gradient- echo with inversion recovery sequence was acquired with the patient in the supine position before and 75 s after Gadopentetate Dimelumine administration. Where by, pre and post MR coronal images were obtained with a single breath hold for about 20 s to cover the entire colon. The quality of MR colonographs and patients＇ tolerance to fat contrast medium was investigated. Colorectal neoplasms identified by MR colonography were compared with those identified on colonoscopy and sensitivity of detecting the lesions was calculated accordingly.RESULTS： MR colonography with fat enema was well tolerated without sedation and analgesia. 120 out of 132 （90.9%） colonic segments were well distended and only 1 （0.8%） colonic segment was poor distension. After contrast enhancement scan, mean contrast-to-noise ratio （CNR） value between the normal colonic wall and lumen was 18.5 ± 2.9 while mean CNR value between colorectal neoplasm and lumen was 20.2± 3.1. By Magnetic resonance colonography, 26 of 35 neoplasms （sensitivity 74.3%） were detected. However, sensitivity of MRC was 95.5% （21 of 22） for neoplasm larger than 10 mm and 55.6% （5 of 9） for 5-10 mm neoplasm.CONCLUSION： MR colonography with fat enema and Tl-weighted three-dimensional fast spoiled gradientecho with inversion recovery sequence is feasible in detecting colorectal neoplasm larger than 10 mm.

Effect of Oral Chinese Medicine Combined with Western Medicine on Cancer Pain:A Meta-Analysis

Objective:To assess the effect of oral Chinese medicine(OCM)combined with Western medicine(WM)on cancer pain.Methods:Pub Med,Embase,Cochrane Library,Clinical Trials Registry Platform,Chinese National Knowledge Infrastructure(CNKI),Wanfang and VIP databases were searched from their inception to September 2019.Randomized controlled trials(RCTs)treating cancer pain by Chinese medicine(CM)combined with WM were included.The primary outcome were total pain relief rate and the quality of life(QOL),and the other outcomes were the average daily dosage of analgesics,the primary time of pain,the analgesic duration time,and adverse events.The methodological quality of RCTs was assessed in accordance with Cochrane 5.1.0 handbook of systematic reviews of interventions.Evidence level was assessed by the Grades of Recommendation,Assessment,Development and Evaluation(GRADE)approach.Results:There were 1,087 patients in the 14 studies,with 544 in the experiment group and 543 in the control group.These studies were all conducted in China,and published between 2006 and 2019.Compared with the WM,OCM combined with WM could significantly relieve the cancer pain risk ratio(RR)=1.43,95% confidence interval(CI):1.32,1.56,improve QOL(RR=8.57,95%CI:4.25,12.89),decrease the primary time of pain(RR=-0.20,95%CI:-0.24,-0.16),prolong the analgesic duration time(RR=3.47,95%CI:2.09,4.85),reduce the dosage of analgesics(RR=-19.52,95%CI:-36.32,-2.72),and reduce side events(RR=0.49,95%CI:0.37,0.65).Evidence levels for total pain relief rate,primary time of pain and side events were low,evidence level for QOL,analgesic duration time and average daily dosage of analgesics were very low.Conclusions:Compared with the WM,OCM combined with WM could significantly relieve the cancer pain,improve the QOL,decrease the primary time of pain,prolong the analgesic duration time,reduce the dosage of analgesics and side events.The evidence levels were low or very low.