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Morphine infusion through Intrathecal Drug Delivery System (IDDS) is widely used to relieve refractory cancer pain. However, continuous escalation of morphine dose caused by opioid tolerance and/or progress of cancer was commonly observed. Combining morphine with medications of different analgesic mechanisms is applied to blunt the rate of morphine increase. The purpose of this study was to determine the analgesic efficacy and safety of combining gabapentin with morphine after IDDS implantation. This study compared patients that received IDDS implantation from January 1, 2017 to November 10, 2018 in our institute. Key outcomes included change in mean pain score, dose of morphine used in patients, percentage of patients with 30% and 50% reduction in mean pain score, Patient Global Impression of Change scores, breakthrough pain characters and side effects. 34 patients in the combination group (morphine + gabapentin) and 40 patients in the monotherapy group(morphine)were analyzed. The results showed that both therapy groups achieved similar analgesic efficacy, demonstrated by Numerical rating scale (2.42 ± 0.88 vs 2.57 ± 0.85; Combination vs Monotherapy), PGIC and responder status. Mean daily dose of morphine was significantly lower in combination group compared to monotherapy group (3.54 ± 1.29 mg vs 4.64 ± 1.28 mg, P = 0.007). More patients experienced dizziness and somnolence after receiving combination therapy compared to morphine-alone treatment although no statistical significance was found (P = 0.49). Addition of gabapentin achieved similar analgesic efficacy with lower dose of morphine compared to morphine alone accompanying with higher incidence of dizziness and somnolence.

Intra-operative use of opioid analgesics might have an impact on cancer recurrence and survival after surgery. The objective of this study was to investigate the association between the intra-operative fentanyl equivalents and survival outcomes in patients with primary liver cancer after receiving hepatectomy.This was a retrospective single-center cohort study, and clinical data of 700 patients with primary liver cancer who underwent hepatectomy in Harbin Medical University Cancer Hospital from September 2013 to August 2018 were reviewed. After propensity matching, 376 patients were included. Patients were divided into high-dose and low-dose groups according to the median intra-operative fentanyl equivalents (1.500 mg). Kaplan Meier curve and Cox proportional hazards regression model were used.Results of univariable analysis showed there were no significant differences in recurrence-free survival (RFS) (p = 0.136) and overall survival (OS) (p = 0.444) between high-dose fentanyl equivalents and low-dose fentanyl equivalents group. The multivariable Cox regression analysis found that the dose of intra-operative fentanyl equivalents was not associated with RFS (HR: 1.119, 95%CI: 0.851-1.472, p = 0.422) or OS (HR: 0.939, 95%CI: 0.668-1.319, p = 0.715).The amounts of intra-operative fentanyl equivalents had no impact on recurrence-free or overall survival in patients with primary liver cancer after curative hepatectomy.

ObjectivesThis study evaluated the analgesic efficacy and safety of CT-guided iodine-125 (125I) brachytherapy in patients with spinal metastasis-induced pain who were not suitable to receive radiotherapy.MethodsA cohort of 68 patients with spinal metastasis induced pain not fully relieved by opioids and did not receive external beam radiation therapy due to poor general status were enrolled and underwent CT-guided 125I brachytherapy for analgesic treatment.ResultsPatients were followed for 8 weeks after brachytherapy. Mean Numerical Rating Scale score before brachytherapy was 7.3±1.3 and decreased to 3.3±0.9, 2.6±0.8, 2.7±0.8, 2.9±0.9 and 3.3±1.1 at weeks 1, 2, 4, 6 and 8, respectively, after brachytherapy. Daily dose of morphine equivalent was 105.1±28.0 mg before brachytherapy and decreased to 45.3±13.7, 39.9±14.2, 40.4±14.9, 48.5±18.0 and 62.4±17.5 mg at weeks 1, 2, 4, 6 and 8, respectively, after brachytherapy. Patients had fewer daily episodes of breakthrough pain after brachytherapy (pConclusionsCT-guided 125I brachytherapy is an effective and safe intervention for patients with spinal metastasis-induced pain who are not able to receive radiation therapy.

The construction of cultural identity is a very complex issue and is affected by many factors, one of which is education. To make Chinese people acknowledge their own political civilization and cultural tradition, after the founding of the People's Republic of China in 1949, the Chinese education departments integrated Marxist education by using Chinese language courses in junior-senior high schools (JSHSs) as a medium. To achieve such integration, Chinese language courses must teach language knowledge while disseminating Marxism. A large number of works with Sinicized Marxism content was included in textbooks and interpreted according to relevant theories. Additionally, teachers of Chinese language courses must have high literacy regarding Marxist theory. Judging from the current social reality, the Chinese language courses in China’s JSHSs have prompted the adherence, identification and internalization of Marxism among JSHS students since the founding of the People’s Republic of China and have laid the foundation for the formation of a socio-political culture guided by Marxism in the general public.