Intravesical Instillation of Kangfuxin Liquid Combined with Thrombin and Epidermal Growth Factor for Radiation-induced Hemorrhagic Cystitis in Patients with Cervical Cancer: A report of 34 cases

A visualization analysis of hotspots and global trends on pelvic floor dysfunction in cervical cancer

BACKGROUND/OBJECTIVE

Cervical cancer is the major cause of cancer-related mortalities in women globally. It constitutes one of the life-threatening conditions for women in developing countries. The popularization of cervical cancer screening and the improvement of treatment levels has caused the mortality rate of cervical cancer to decrease gradually, but pelvic floor dysfunction before and after cervical cancer treatment has become prominent and attracted more and more attention. Bibliometric analysis has been carried out in this research. The main goal of this research is to provide a comprehensive insight into the knowledge structure and global research hotspots about pelvic floor dysfunction in cervical cancer.

METHODS

Literature related to cervical cancer and pelvic floor dysfunction as of May 2023 was searched on the Web of Science Core Collection (WOSCC). The visualization and bibliometric analyses of the number and contents of publications were performed to analyze the temporal trends, spatial distribution, collaborative networks, influential references, keyword co-occurrence, and clustering.

RESULTS

There were 870 publications from 74 countries or regions, with the U.S. publications in a leading position. Since 2020, the number of publications has rapidly increased with the emphasis on the quality of life of cervical cancer patients. Although pelvic floor dysfunction in cervical cancer mainly occurs in developing countries, developed countries have made great contributions to this disease. However, in developing countries such as China and India, the quality of publications needs to be improved. In this field, the studies focused on the sexual dysfunction or urinary incontinence of cervical cancer patients, and the most cited papers discussed the effect of cervical cancer treatment on the sexual activities of females. The frontier keywords were represented by pelvic radiotherapy and risk factors.

CONCLUSION

This study provides an objective and comprehensive analysis of the literature available on pelvic floor dysfunction in cervical cancer and identifies future trends and current hotspots. It can provide a valuable reference for researchers in this field.

Research advances on the restorative effect of Periplaneta americana extracts on mucosa

In addition to the pharmacological effects of Periplaneta americana extracts (PAEs), including their antitumor, hepatic protection, antioxidant, antibacterial, anti-inflammatory, and tissue regeneration characteristics, their mucosal restorative effects have also attracted significant attention. The mucosa serves as a "gateway" into the body and its functions include the surveillance and clearance of bacteria and pathogens; it also has the immunological function of acquiring beneficial antigens from the external environment and removing non-beneficial ones, a mechanism controlled by the mucosal immune system. In the present study, the relevant modern research literature on the mucosal restorative effect of PAEs was reviewed via a summarization of its restorative effects on respiratory, digestive, dermal, and genitourinary mucosa. The aim of doing so was to present a comprehensive understanding of the mucosal restorative effect of PAEs and their related mechanisms and to provide a reference for their further development and clinical application.

Advances in the management of radiation-induced cystitis in patients with pelvic malignancies

OBJECTIVE

Radiotherapy plays a vital role as a treatment for malignant pelvic tumors, in which the bladder represents a significant organ at risk involved during tumor radiotherapy. Exposing the bladder wall to high doses of ionizing radiation is unavoidable and will lead to radiation cystitis (RC) because of its central position in the pelvic cavity. Radiation cystitis will result in several complications (e.g. frequent micturition, urgent urination, and nocturia) that can significantly reduce the patient's quality of life and in very severe cases become life-threatening.

METHODS

Existing studies on the pathophysiology, prevention, and management of radiation-induced cystitis from January 1990 to December 2021 were reviewed. PubMed was used as the main search engine. Besides the reviewed studies, citations to those studies were also included.

RESULTS AND DISCUSSIONS

In this review, the symptoms of radiation cystitis and the mainstream grading scales employed in clinical situations are presented. Next, preclinical and clinical research on preventing and treating radiation cystitis are summarized, and an overview of currently available prevention and treatment strategies as guidelines for clinicians is provided. Treatment options involve symptomatic treatment, vascular interventional therapy, surgery, hyperbaric oxygen therapy (HBOT), bladder irrigation, and electrocoagulation. Prevention includes filling up the bladder to remove it from the radiation field and delivering radiation based on helical tomotherapy and CT-guided 3D intracavitary brachytherapy techniques.

Efficacy of kangfuxin liquid on radiotherapy-induced oral mucositis for patients with head and neck squamous cell carcinoma and its effect on salivary glands and immune function

OBJECTIVE

To observe the efficacy of Kangfuxin liquid on radiotherapy-induced oral mucositis for patients with head and neck squamous cell carcinoma and its effects on salivary glands and immune function.

METHODS

A total of 97 patients with head and neck squamous cell carcinoma receiving radiotherapy in Guigang City People's Hospital from January 2019 to June 2021 were retrospectively analyzed and divided into a control group and a test group according to different treatment plans. The two groups received the same radiation therapy. Patients in the control group (n=46) were given borax-containing gargles, while those in the test group (n=51) were treated with Kangfuxin liquid. We observed the incidences and grades of oral mucositis and oral pain, changes in saliva flow rate, pH of saliva, levels of epidermal growth factor (EGF) and amylase, levels of CD4+/CD8+, CD19+/CD69+ and natural killer (NK) cells, and serum cytokine (TGF-β1, IL-6 and C-reactive protein (CRP)) levels in the two groups before radiotherapy, and after 21 d and 42 d of radiotherapy. Quality of Life Instruments for Cancer Patients-Head and Neck Cancer (QLICP-HN) scores were compared in both groups before radiotherapy, and after 42 d of radiotherapy.

RESULTS

No oral mucositis or oral pain was found before radiotherapy in both groups. The incidences of oral mucositis and oral pain after 21 d and 42 d of radiotherapy in the test group were not significantly different from those in the control group (all P>0.05). The grades of oral mucositis and oral pain in the test group after 21 d and 42 d of radiotherapy were lower than those in the control group (all P<0.05). The test group had higher saliva flow rate, pH of saliva, levels of EGF and amylase, and levels of CD4+/CD8+, CD19+/CD69+ and NK cells. The test group had lower serum levels of TGF-β1, IL-6, and CRP than the control group after 21 d and 42 d of radiotherapy (all P<0.05). The scores of each item of the QLICP-HN scale and total scores in the test group were higher than those of the control group after 42 d of radiotherapy (all P<0.05).

CONCLUSION

Kangfuxin liquid effectively prevents the occurrence of radiotherapy-induced oral mucositis for patients with head and neck squamous cell carcinoma, reduces oral mucosal reactions and oral pain, improves salivary gland function, reduces inflammatory response, promotes cellular immune function, improves quality of life, and improves prognosis.

Effects of Four Types of Watermelon Frost Combination Medications for the Treatment of Oral Ulcers: A Network Meta-Analysis

Objective

The aim of this study is to identify the effectiveness of the four different watermelon frost combination medications in the treatment of oral ulcers through network meta-analysis and rank them based on their performances.

Methods

Five randomized controlled studies of four distinct types of a combination medication for the treatment of oral ulcers were observed in numerous databases, and a network meta-analysis was conducted to evaluate the odds ratio (OR) and sequence of the diverse treatments using Stata software (version 13.0). The underlined studies were categorized into two groups: the control group (watermelon frost alone) and the observation group (one of four watermelon frost combinations).

Results

The study comprised of 598 cases and the findings indicated that the pooled OR and 95% CI of oral ulcers that improved relative to watermelon frost alone were 3.26 (1.28 to 8.30) for watermelon frost and Kangfuxin fluid, 8.74 (2.94 to 26.02) for watermelon frost and erythromycin, 6.53 (1.81 to 23.50) for watermelon frost and metronidazole, and 2.62 (0.63 to 10.95) for watermelon frost and cydiodine buccal tablets. The study showed the significant efficacy of watermelon frost combination medications. In terms of clinical efficacy, the combination of watermelon frost and erythromycin was the most promising concomitant medication. It had an 86.3 surface under cumulative ranking (SUCRA).

Conclusion

All the studied watermelon frost combinations were effective against oral ulcers validating the use of watermelon frost for oral ulcers. The combination of watermelon frost and erythromycin is the most promising candidate among the four combinations for the treatment of oral ulcers.

Current management of radiation cystitis after pelvic radiotherapy: a systematic review

INTRODUCTION

We aimed to summarize current literature about radiation cystitis treatments, providing physician of a summary of current management options.

EVIDENCE ACQUISITION

A systematic literature review searching on PubMed (Medline), Scopus, and Web of Science databases was performed in March 2021. PRISMA guidelines were followed. Population consisted of patients with a diagnosis of radiation cystitis after pelvic radiotherapy (P). We focused our attention on different treatments, such as conservative or surgical one (I). Single or multiple arms studies were deemed eligible with no mandatory comparison (C). Main outcomes of interest were symptoms control and adverse events rates (O).

EVIDENCE SYNTHESIS

The search identified 1,194 records. Of all, four studies focused on the use of hyperbaric oxygen therapy showing complete response rates ranging from 52 to 87% approximately. Oral administration of cranberry compounds was investigated in one study showing no superiority to placebo. Intravesical instillation of different compounds were investigated in five studies showing the highest complete response rates after alum (60%) and formalin administration (75%). Endoscopic conservative surgical treatments (fibrin glue or vaporization) also showed 75% complete response rates. In patients who did not respond to conservative treatments robotic cystectomy is feasible with overall complication rates of about 59.3% at 90 days.

CONCLUSIONS

Radiotherapy induced cystitis is an under-reported condition after pelvic radiotherapy. Several treatments have been proposed, but in up to 10% of cases salvage cystectomy is necessary. A stepwise approach, with progressive treatment aggressiveness is recommended.