Resource Constraints as a Barrier to Lung Cancer Management: Developing Nations

Resource constraints are a major barrier to lung cancer management, especially in ASIAN developing countries. The availability of data in these issues is very limited. Therefore, this survey was initiated in order to understand the situation of resource constraints in ASIAN developing nations. A 17-item, self-administered, online questionnaire was developed and distributed to IASLC members in ASIAN countries in May-June 2013. A questionnaire was composed of 2 sections: general and specific information focusing on several issues related to resource constraints such as lagging period of new cancer drug approval, economic data submission, man power, availability and accessibility to diagnosis and treatment, waiting time, and payment. There were a total of 75 respondents from China, India, Indonesia, Malaysia, Nepal, Philippines, and Thailand. The findings of this survey demonstrate that ASIAN developing countries still need the improvement in their resources such as man power, diagnostic procedures, and treatment especially new agents like targeted drugs.

A multicenter randomized, double-blind, placebo-controlled trial to evaluate the safety and efficacy of rhubarb in treating acute exacerbation of chronic obstructive pulmonary disease of the syndrome type phlegm-heat obstructing the lungs

Objective:To observe the clinical efficacy and safety of oral administration of the traditional Chinese herb rhubarb to treat acute exacerbation of chronic obstructive pulmonary disease(AECOPD).Method:This was a multicenter randomized double-blinded placebo controlled study that took place in 7 provinces of China that enrolled 244 patients(aged 18e80 years)who had acute exacerbation of COPD with the traditional Chinese syndrome pattern of phlegm-heat obstructing lung.Participants were divided into experimental and control groups.The experimental group received 4.5 g of rhubarb granules twice daily and the control group received placebo granules.Both groups also received conventional Western therapy consisting of oxygen therapy,an antibiotic,expectorant,and a bronchodilator.Treatment lasted 10 days.Symptom scores for cough,sputum volume and color,wheezing and chest tightness before treatment and on days 3,5,7,and 10 during the treatment were recorded.Lung function,arterial blood gas and levels of serum inflammatory factors,interleukin-4(IL-4),interleukin-8(IL-8),and interleukin-10(IL-10)and tumor necrosis factor-alpha(TNF-a),before and after treatment were measured.Results:The sample size of the full analysis set(FAS)was 244 participants,and the sample size of per protocol set(PPS)was 235.Following 10 days’treatment,symptom scores of the experimental group were markedly lower than those of the placebo group(FAS:mean difference
1.67,95%CI:e2.66 to
0.69,P Z 0.001;PPS:mean difference
1.55,95%CI:
2.56 to
0.54,P Z 0.003).Lung function in the experimental group was significantly higher than in the placebo group(FEV1,FAS:mean difference 0.12,95%CI:0.06 to 0.18;P<0.001;PPS:mean difference 0.12,95%CI 0.05 to 0.18;P<0.001.FVC:FAS:mean difference 0.16,95%CI:0.06 to 0.26;P Z 0.002;PPS:mean difference 0.16,95%CI 0.05 to 0.26;P Z 0.003.FEV1%,FAS:mean difference 5.95,95%CI:3.36 to 8.53;P<0.001;PPS:mean difference 5.92,95%CI 3.28 to 8.56;P<0.001.).PaO2,PaCO2,as well as serum inflammatory factors were also improved when compared to the placebo group.There were no significant differences in the incidence rate of adverse reaction between the two groups.Conclusions:Compared with placebo,rhubarb granules significantly reduced symptom scores,improved blood oxygen level,controlled systemic inflammatory response,without significant adverse effects.Thus,rhubarb may be a beneficial adjuvant method for treating the phlegm-heat obstructing the lung syndrome pattern of AECOPD.

Application Value of Lung-Fire-Clearing,Phlegm-Resolving,and Bowels-Relaxing Decoction in Treating Lung Cancer of Phlegm-Heat Pattern

Objective:This article explores the clinical effects of lung-fire-clearing,phlegm-resolving and bowels-relaxing decoction in the treatment of lung cancer of phlegm-heat pattern.Methods:A total of 6 cases of lung cancer patients with phlegm-heat pattern were randomly selected from Inner Mongolia Baicaotang Qin's Zhong Meng Medical Hospital from March 2018 to December 2020 to conduct the study.They were divided into the reference group and the study group by using the digital table method.The patients in the reference group were treated with conventional Western medicine whereas the patients in the study group were treated with lung-fire-clearing,phlegm-resolving,and bowels-relaxing decoction to observe the curative effect.Results:There were no significant differences in the levels of the tumor markers between the two groups before treatment(P>0.05).However,after treatment,the levels of cytokeratin 19 soluble fragments(CYFRA21-1),carbohydrate antigen 125(CA125),and carcinoembryonic antigen(CEA)in the study group were lower than those in the control group(P<0.05).The effective rate and the quality of life score of the study group were higher than those of the reference group while the incidence of adverse reactions was lower than that of the reference group,P<0.05.Conclusion:Lung-fire-clearnig,phlegm-resolving,and bowels-relaxing decoction can effectively improve the symptoms of patients with lung cancer and improve their quality of life.

Effects of acetylcysteine on micro-inflammation and pulmonary ventilation in chronic obstructive pulmonary disease exacerbation

BACKGROUND Acute exacerbation of chronic obstructive pulmonary disease(AECOPD)is a serious complication of chronic obstructive pulmonary disease,often characterized by increased morbidity and mortality.In traditional Chinese medicine,AECOPD is linked to phlegm-heat and blood-stasis,presenting symptoms like thick sputum,fever,and chest pain.It has been shown that acetylcysteine inhalation in conjunction with conventional therapy significantly reduced inflammatory markers and improved lung function parameters in patients with AECOPD,suggesting that acetylcysteine may be an important adjunctive therapy for patients with phlegm-heat-blood stasis type AECOPD.AIM To investigate the effect of acetylcysteine on microinflammation and lung ventilation in patients with phlegm-heat and blood-stasis-type AECOPD.METHODS One hundred patients with phlegm-heat and blood-stasis-type AECOPD were randomly assigned to two groups.The treatment group received acetylcysteine inhalation(10%solution,5 mL,twice daily)along with conventional therapy,whereas the control group received only conventional therapy.The treatment duration was 14 d.Inflammatory markers(C-reactive protein,interleukin-6,and tumor necrosis factor-alpha)in the serum and sputum as well as lung function parameters(forced expiratory volume in one second,forced vital capacity,and peak expiratory flow)were assessed pre-and post-treatment.Acetylcysteine inhalation led to significant reductions in inflammatory markers and improvements in lung function parameters compared to those in the control group(P<0.05).This suggests that acetylcysteine could serve as an effective adjunct therapy for patients with phlegm-heat and blood-stasis-type AECOPD.RESULTS Acetylcysteine inhalation significantly reduced inflammatory markers in the serum and sputum and improved lung ventilation function parameters in patients with phlegm-heat and blood-stasis type AECOPD compared with the control group.These differences were statistically significant(P<0.05).The study concluded that acetylcysteine inhalation had a positive effect on microinflammation and lung ventilation function in patients with this type of AECOPD,suggesting its potential as an adjuvant therapy for such cases.CONCLUSION Acetylcysteine inhalation demonstrated significant improvements in reducing inflammatory markers in the serum and sputum,as well as enhancing lung ventilation function parameters in patients with phlegm-heat and bloodstasis type AECOPD.These findings suggest that acetylcysteine could serve as a valuable adjuvant therapy for individuals with this specific type of AECOPD,offering benefits for managing microinflammation and optimizing lung function.

中晚期肺癌患者心理困扰与感知社会约束的相关性及对策

目的调查中晚期肺癌患者心理困扰及其与感知社会约束的相关性及制订对策,为减轻癌症患者心理困扰提供依据。方法采用便利抽样法,选取本院2020年1月至2022年10月收治的中晚期肺癌患者120例,采用一般资料调查表、心理困扰筛查工具(screening tools for measure distress,DM)和社会约束量表((social constraints scale-15,SCS-15)进行调查。结果120例中晚期患者心理困扰平均(4.05±1.20)分,发生率60.00%,中重度的首要问题是经济压力(70.83%,85/120),其次是疾病相关信息不足(69.17%,83/120),排第3为给家人造成负担(63.33%,76/120)。患者感知社会约束得分(33.50±6.92)分,与心理困扰呈正相关(P<0.05);Logistic回归分析显示家庭月收入(<3000元)、疼痛、感知社会约束是心理困扰发生的独立危险因素(均P<0.05),其共同解释总变异的42.50%。结论中晚期肺癌患者心理困扰处于中等程度,与感知社会约束密切相关,通过减轻患者感知社会约束、疼痛等可改善其心理困扰。

基于“金郁泄之”理论从气血论治肺结节

基于“金郁泄之”理论探讨肺结节的病因病机及治疗方法,认为“金郁”是指五行属金脏腑所发郁滞之证,“泄之”为“金郁”的治疗方法,凡是能祛除属金脏腑郁滞状态的方法,均属于“泄之”范畴。肺结节为有形之体,由于痰、瘀、虚三者相互作用郁滞于体内而形成,属于“金郁”的范畴,其病机包括气虚血瘀而成郁、气滞血瘀而成郁,因此治疗应当顺应“泄之”的原则,通过活血化瘀散结祛除有形之郁,加以补益元气以恢复脏腑功能,从而达到治疗肺结节的目的。

王书臣从肺肾论治过敏性鼻炎经验介绍

介绍王书臣教授从肺肾论治过敏性鼻炎的经验。王书臣教授认为肾精不足,肾阳亏虚,肺卫不固是过敏性鼻炎的关键病机;久病肝郁气滞,气机不畅是过敏性鼻炎的重要病机;风邪犯鼻是过敏性鼻炎的重要诱因。治疗多从肺肾出发,温肾阳,益精气,固肺卫,通鼻窍;兼顾调畅气机,疏肝解郁,搜风通络,祛风散邪以通窍。

从肝论治肺癌的优势

本文以中医学及现代医学理论为出发点,结合部分近现代学者从肝论治肺癌的经验,阐述其理论基础,分析作用机制,总结临床疗效。分析从肝论治肺癌的优势。中医学理论支持从肝论治肺癌治则,认为肝肺生理相关、病理相连,临床可分为肝郁气滞、气滞血瘀、肝火犯肺、肝肺阴虚四证。临床研究亦支持此观点,从肝论治是肺癌治疗中的重要治则,能明显改善患者身心及呼吸系统症状,提高免疫功能,增强正气,改善生命质量,最终达到扶正祛邪的抗肿瘤目的。其作用机制与诱导细胞凋亡、抑制肿瘤细胞增殖有关。

肺癌调强放射治疗方案中约束环的应用研究

目的研究肺癌调强放射治疗方案设计过程中约束环的剂量设置、大小以及距离靶区的距离对最终剂量分布的影响。方法选取肺癌患者45例,放疗方案分为单环方案和双环方案。2种方案中,每个患者均分别设定7个照射野,约束环的环宽设置为0.6 cm、0.8 cm、1.0 cm、1.2 cm,距离靶区的距离分别是0.6 cm、0.8 cm、1.0 cm、1.2 cm。单环方案将约束环内径与靶区之间的距离定为0.8 cm,每个患者有16个约束环方案;双环方案中,第一个环的设置同单环方案,第二个环将约束环内径与靶区之间的距离定为2.0 cm,每个患者有16个有2个环的方案。比较单环方案和双环方案的适形指数(CI)、均匀指数(HI)以及正常组织所受剂量。结果单环方案HI、CI都比双环方案略高。双环方案中正常组织肺的受量V 20、V 30参数都比单环方案要高,而脊髓的受量单环方案要低一些。在照射野数目相同、其他参数也相同的情况下,单环方案中环距设置为0.8 cm,环宽为0.8 cm时,CI最好,但HI降低;环距为0.8 cm,环宽为1.2 cm时,HI为最佳,但方案的CI降低。单环方案中,环宽0.8 cm达到肺部参数最佳,此时剂量约束为49 Gy;环宽0.8 cm达到脊髓参数最佳,剂量约束为53 Gy。双环方案中,环宽1.0 cm达到肺部的V 20参数最佳,此时剂量约束为43 Gy;环宽1.2 cm达到肺部的V 30参数最佳,此时剂量约束为45 Gy;环宽0.6 cm达到脊髓的参数最佳,此时剂量约束为51 Gy。结论在照射野数目相同的情况下,约束环越小越有利于靶区剂量的适形度提高,而不利于靶区均匀度。约束环大小相同的情况下,限制环距离靶区越近越有利于靶区剂量的适形度提高,而不利于靶区均匀度。在肺癌调强放射治疗方案中双环方案优于单环方案。

基于连续最大流的三维肺实质快速分割算法

肺结节是肺癌的表征形式,形状结构多样且易与正常组织产生粘连,使分割存在困难.提出了一种基于空间约束的三维肺实质分割算法,实现对肺实质组织的分割及目标区域的获取.首先使用SLIC方法将二维CT序列图像构建成超像素图像矩阵,并对矩阵进行稀疏化处理,降低矩阵维度.然后连接相邻切片间的超像素构造肺实质组织的三维结构.最后采用连续最大流方法对构造的三维肺部结构进行分割.实验结果表明,所提算法能够快速准确地分割三维肺实质组织,对不同类型肺结节的分割均取得较好结果,具有一定的临床应用价值.

黄龙咳喘胶囊治疗慢性阻塞性肺疾病稳定期肺肾气虚、痰热郁肺证160例——一项多中心随机、双盲、安慰剂对照临床研究

目的观察黄龙咳喘胶囊治疗慢性阻塞性肺疾病稳定期肺肾气虚、痰热郁肺证的临床疗效及安全性。方法采用多中心、随机、双盲、安慰剂对照的设计方法,将240例慢性阻塞性肺疾病稳定期肺肾气虚、痰热郁肺证患者随机分为治疗组(160例)和对照组(80例)。两组在接受西医治疗方案基础上,治疗组给予黄龙咳喘胶囊,对照组给予黄龙咳喘胶囊模拟剂,两组均口服给药,每次1.2g,每日3次,均治疗3个月。治疗前及治疗1个月、3个月对主要症状(咳嗽、咯痰、喘息气短)、次要症状(乏力、自汗、恶风、腰膝酸软、耳鸣头晕)进行评分,治疗后比较两组患者中医证候疗效;治疗前及治疗1个月、3个月比较两组患者6分钟步行距离(6MWD)、慢性阻塞性肺病评估测试(CAT)评分、第一秒用力呼气流量(FEV1)、用力肺活量(FVC)、修订的呼吸困难量表(mMRC)评分的变化。治疗前后比较两组患者病情严重程度分布情况,治疗期间记录合并用药情况及不良反应。结果治疗组中医证候疗效总有效率为81.65%,对照组为41.25%,差异有统计学意义(P<0.05)。治疗组患者治疗1个月及3个月时咳嗽、咯痰、喘息气短、乏力、自汗、恶风、易感冒、腰膝酸软、耳鸣头昏症状积分,CAT评分、mMRC评分、急性发作频次均较治疗前明显降低,而FEV1、6MWD均较治疗前明显提高(P<0.05);而对照组治疗前后各指标差异无统计学意义(P>0.05)。治疗后治疗组病情严重程度轻于对照组(P<0.05)。两组患者合并用药种类比较差异无统计学意义(P>0.05)。两组均未出现严重不良事件。结论黄龙咳喘胶囊可改善慢性阻塞性肺疾病缓解期肺肾气虚、痰热郁肺证患者临床症状,提高运动耐量和生活质量,且安全性较好。

基于CT图像的肺穿刺术路径规划系统

为了解决传统肺穿刺手术路径规划方法手术并发症风险大、受医师熟练度影响大、无法量化分析手术路径风险等特有的临床问题,设计了一套肺穿刺术最优路径规划方案。首先,基于胸部CT图像对胸部重要器官进行图像分割。然后,将手术风险量化为3个约束性条件和6个目标性条件,用于衡量手术路径的优劣与风险。3个约束性条件为穿刺深度、重要器官避障、入刺角度,6个目标性条件为胸壁厚度、肺内穿刺长度、重要器官之间的距离、路径延长线与重要器官之间的距离、皮肤入刺角、胸膜入刺角。最后,设计自适应凝聚层次聚类算法将路径聚类为“簇”,并利用多目标优化方案对聚类中心点进行量化分析,确定肺穿刺最优路径。实验结果表明,自动规划得到的最优路径经医生确认均符合手术要求,且计算得到的最优路径在医生排序中排名均为前3,证明了本文路径规划方法的合理性与有效性,满足肺穿刺手术路径规划临床需求,可以为医生提供有效的3维可视化穿刺路径指导。

一种基于多级约束的肺部穿刺路径规划方法

电子计算机断层扫描(CT)引导下经皮肺穿刺是获取肺部病变组织以确诊肺癌的最有效的手段之一,规划科学合理的穿刺路径是避免穿刺并发症,减少患者痛苦及穿刺死亡率的重要环节。本文提出了一种基于多级约束的肺部穿刺路径规划方法:首先利用患者CT建立胸部数字化模型;然后在以肿瘤病灶为中心的理想球面上构造斐波那契网格采样,得到待选路径集合;最后根据临床穿刺准则提出了一种多级约束策略,并结合方向包围盒层次树(OBBTree)算法和帕累托(Pareto)优化算法,获取最优穿刺路径。模拟仿真实验结果证明了该算法的有效性,能够规避物理和生理障碍,可以作为医生选择穿刺路径的辅助手段。