Breakthrough pain in patients with cancer is common, often unpredictable, and can rapidly become severe. Treatment using the oral administration of opioids is not optimal due to the slow onset of pain relief. Nasal administration of analgesics potentially offers more rapid pain relief. This study investigates the tolerability and efficacy of a novel morphine-chitosan formulation. Twenty episodes of breakthrough pain were observed in 14 patients with cancer who received 5-80 mg of nasal morphine-chitosan. Nasal symptoms, sedation, giddiness, nausea, and other volunteered symptoms, along with pain scores (pain intensity and pain relief), were recorded at baseline and at regular intervals up to 4 hours after administration, together with an overall satisfaction rating. The formulation was acceptable to patients, generally well tolerated, and had an onset of pain relief 5 minutes after dosing. This formulation warrants further study.
The novel formulation might allow a 75% dose reduction with significant reduction of inter-individual variability. The negative food effect observed requires further investigations; however, elimination of the significant positive food effect could be adequate to negate the restriction of a food label.
Hyperpolarized 129Xe gas MRI provides a spatially resolved method of monitoring gas exchange function in the lungs via 3D reconstruction of RBC/gas and barrier/gas signals. However, the strength of these signals is affected by patient hemoglobin concentration (Hgb). Thus, correcting for Hgb is important for establishing normative healthy reference distributions and accurately assessing the degree of gas exchange impairment. Here, we use a 1D physical diffusion model to establish Hgb-dependent correction factors to standardize gas exchange MRI relative to a fixed Hgb value. This correction can result in substantial changes in the visualization and quantification of gas exchange MRI.
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