(Anesth Analg. 2017;124(2):560–569)
Epidural (EPL) and combined spinal epidural (CSE) are commonly used and effective labor analgesia neuraxial techniques. EPL has minimal adverse effects, but has a slow onset time and may result in insufficient sacral spread/patchy sensory blockade. In contrast, CSE has rapid onset and excellent sacral coverage but has greater risk of adverse effects. The dural puncture epidural (DPE) technique (passing a spinal needle through the EPL needle, puncturing the dura but not injecting medication into the intrathecal space) has been shown to improve caudal spread of analgesia compared with the EPL technique, without the side effects seen with CSE. In the present study, the authors determined whether or not overall analgesia characteristics and side effects would favor the DPE technique, and hypothesized that onset of labor analgesia is most rapid with CSE, followed by DPE and EPL.
Lung cancer is a malignancy with the highest incidence of morbidity and mortality worldwide. The lack of effective detection methods leads to the ineffectiveness of convetional therapy. The aim of the current study was to analyze the hydrothorax epidermal growth factor receptor (EGFR) mutation in patients with advanced non-small lung cancer (NSCLC) and malignant pleural effusion. A new method for clinical treatment was developed through a comparison of the difference of EGFR tyrosine kinase inhibitor (EGFR-TKI)-targeted therapy. Between January 2013 and January 2015, 68 cases diagnosed with advanced non-small lung cancer and malignant pleural effusion, were enrolled in the study. Previous first-line chemotherapeutic treatment schemes had been unsuccessful. EGFR 19 and EGFR 21 sites were detected for all the patients. Platinum-based drugs were provided for patients with wild-type EGFR. These patients served as the control group and underwent four cycles of treatments, with each cycle lasting 3 weeks. TKI medicine Gefitinib (Iressa™) was administered to patients with mutant EGFR tid, po, for a duration of 4–8 months. These patients served as the experimental group. There were 41 cases of EGFR mutations, of which 13 cases had EGFR 19 site mutations, 16 cases EGFR 21 site mutations, and the remaining 12 cases had 2 site mutations. EGFR mutations were not significant for gender, age, tumor type, stage and diameter (P>0.05). The results showed that the six-month survival rate, progression-free survival time (PFS), objective response rate (RP) and disease control rate (DCR) in the experimental group were higher than those in the control group. The drug side-effects in the experimental group indicated no statistical differences compared to the control group (P>0.05). The incidence of EGFR mutation was higher in patients with advanced non-small lung cancer and malignant pleural effusion. Targeted therapy improved the survival rate and was deemed to be a safe and effective method for patients with EGFR mutations.
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