Nursing effect of narrative nursing intervention on postoperative patients with severe lung cancer

BACKGROUND Lung cancer is a common disease with high mortality,and psychological support is very important in the diagnosis and treatment of postoperative patients with cancer pain.AIM To explore the application effect of the narrative nursing method in postoperative lung cancer patients in the intensive care unit.METHODS A total of 120 patients diagnosed with lung cancer and experiencing cancer-related pain were randomly allocated into two groups:an observation group and a control group,each consisting of 60 cases.The control group was given routine analgesic and psychological care,while the research group applied the five-step narrative nursing method based on routine care,comparing the visual analogue scale scores,sleep status,anxiety and depression status,and quality of life of the two groups of patients before and after the intervention.RESULTS The pain scores,anxiety scores,and depression scores of the study group were lower than those of the control group after the intervention using the narrative nursing method,and the difference was statistically significant(P<0.05).CONCLUSION Using narrative nursing methods to intervene in patients with lung cancer combined with cancerous pain can help patients to correctly recognize their disease,adjust their mentality,establish confidence,alleviate patients'subjective pain feelings,and improve their adverse emotions.

Whole-process case management effects on mental state and selfcare ability in patients with liver cancer

BACKGROUND Regarding the incidence of malignant tumors in China,the incidence of liver cancer ranks fourth,second only to lung,gastric,and esophageal cancers.The case fatality rate ranks third after lung and cervical cancer.In a previous study,the whole-process management model was applied to patients with breast cancer,which effectively reduced their negative emotions and improved treatment adherence and nursing satisfaction.METHODS In this single-center,randomized,controlled study,60 randomly selected patients with liver cancer who had been admitted to our hospital from January 2021 to January 2022 were randomly divided into an observation group(n=30),who received whole-process case management on the basis of routine nursing mea-sures,and a control group(n=30),who were given routine nursing measures.We compared differences between the two groups in terms of anxiety,depression,the level of hope,self-care ability,symptom distress,sleep quality,and quality of life.RESULTS Post-intervention,Hamilton anxiety scale,Hamilton depression scale,memory symptom assessment scale,and Pittsburgh sleep quality index scores in both groups were lower than those pre-intervention,and the observation group had lower scores than the control group(P<0.05).Herth hope index,self-care ability assessment scale-revision in Chinese,and quality of life measurement scale for patients with liver cancer scores in both groups were higher than those pre-intervention,with higher scores in the observation group compared with the control group(P<0.05).CONCLUSION Whole-process case management can effectively reduce anxiety and depression in patients with liver cancer,alleviate symptoms and problems,and improve the level of hope,self-care ability,sleep quality,and quality of life,as well as provide feasible nursing alternatives for patients with liver cancer.

Influence of initial check, information exchange, final accuracy check, reaction information nursing on the psychology of elderly with lung cancer

BACKGROUND As one of the fatal diseases with high incidence,lung cancer has seriously endangered public health and safety.Elderly patients usually have poor self-care and are more likely to show a series of psychological problems.AIM To investigate the effectiveness of the initial check,information exchange,final accuracy check,reaction(IIFAR)information care model on the mental health status of elderly patients with lung cancer.METHODS This study is a single-centre study.We randomly recruited 60 elderly patients with lung cancer who attended our hospital from January 2021 to January 2022.These elderly patients with lung cancer were randomly divided into two groups,with the control group taking the conventional propaganda and education and the observation group taking the IIFAR information care model based on the conventional care protocol.The differences in psychological distress,anxiety and depression,life quality,fatigue,and the locus of control in psychology were compared between these two groups,and the causes of psychological distress were analyzed.RESULTS After the intervention,Distress Thermometer,Hospital Anxiety and Depression Scale(HADS)for anxiety and the HADS for depression,Revised Piper’s Fatigue Scale,and Chance Health Locus of Control scores were lower in the observation group compared to the pre-intervention period in the same group and were significantly lower in the observation group compared to those of the control group(P<0.05).After the intervention,Quality of Life Questionnaire Core 30(QLQ-C30),Internal Health Locus of Control,and Powerful Others Health Locus of Control scores were significantly higher in the observation and the control groups compared to the pre-intervention period in their same group,and QLQ-C30 scores were significantly higher in the observation group compared to those of the control group(P<0.05).CONCLUSION The IIFAR information care model can help elderly patients with lung cancer by reducing their anxiety and depression,psychological distress,and fatigue,improving their tendencies on the locus of control in psychology,and enhancing their life qualities.

Bladder metastasis from epidermal growth factor receptor mutant lung cancer:A case report

BACKGROUND Bladder metastasis from lung cancer with epidermal growth factor receptor(EGFR)mutation is extremely rare.Here,we report a case of bladder metastasis from lung adenocarcinoma with EGFR mutation.CASE SUMMARY A 53-year-old female patient was diagnosed with advanced lung adenocarcinoma with EGFR exon 19 deletion.Multiple nodules on the bladder wall were found by regular examination of the pelvic cavity through computed tomography during targeted therapy.Further cystoscopy and histological examination of bladder biopsy tissues confirmed the bladder metastasis from lung adenocarcinoma.In addition,genetic analysis of the bladder metastasis revealed EGFR T790M mutation.The patient achieved a good response to a third-generation EGFR tyrosine kinase inhibitor.CONCLUSION During routine follow-up of lung cancer patients,imaging examination of the pelvic cavity should be performed to avoid missing bladder metastasis.The ultimate diagnosis of bladder metastasis sill depends on the pathological result of biopsy tissues.

Circular RNA PIP5K1A promotes colon cancer development through inhibiting mi R-1273a

BACKGROUND Circular RNAs (circRNAs) are considered to be highly stable due to the closed structure, which are predominately correlated with the development and progression of a wide variety of cancers. Colon cancer is one of the most common malignancies worldwide. A recent study demonstrated the upregulated expression of circPIP5K1A in non-small cell lung cancer. However, few studies have investigated the relationship between circ_0014130 level and colon cancer. Therefore, elucidating the underlying mechanisms of circPIP5K1A’s role may help with the identification of novel diagnostic and therapeutic targets for colon cancer. AIM To investigate the status of circPIP5K1A in colon cancers and its effects on the modulation of cancer development. METHODS The expression level of circPIP5K1A in tissue and serum samples from colon cancer patients, as well as human colonic cancer cell lines was detected by realtime quantitative reverse transcription-polymerase chain reaction. Following the transfection of specifically synthesized small interfering RNA (siRNA) into colon cell lines, we used Hoechst staining assay to measure the ratio of cell death in the absence of circPIP5K1A. Moreover, we also used the Transwell assay to assess the migratory function of colon cells overexpressing circPIP5K1A. Additionally, we employed a series of bioinformatics prediction programs to predict the potential of circPIP5K1A-targeted miRNAs and mRNAs. The miR-1273a vector was constructed, and then transfected with or without circPIP5K1A vector into colon cancer cells. Afterwards, the expression of activator protein 1 (AP-1), interferon regulating factor 4 (IRF-4), caudal type homeobox 2 (CDX-2), and zinc finger of the cerebellum 1 (Zic-1) was detected by western blotting. RESULTS CircPIP5K1A was significantly upregulated in colon cancer tissue relative to their adjacent normal tissues. Knockdown of circPIP5K1A in colon cancer cells impaired cell viability and suppressed cell invasion and migration, while enforced expression of circPIP5K1A exhibited the opposite effects on cell migration. Bioinformatics prediction program predicted that the association of circPIP5K1A with miR-1273a, as well as AP-1, IRF-4, CDX-2, and Zic-1. Subsequent studies showed that overexpression of circPIP5K1A augmented the expression of AP-1 but attenuated the expression of IRF-4, CDX-2, and Zic-1. Reciprocally, overexpression of miR-1273a abrogated the oncogenic function of circPIP5K1A in colon cancers. CONCLUSION Overall, our data demonstrate the oncogenic role of circPIP5K1A-miR-1273a axis in regulation of colon cancer development, which provides a novel insights into colon cancer pathogenesis.

Clinicopathological Features of Breast Cancer with Different Molecular Subtypes in Chinese Women

A retrospective study was performed to explore the relationship between molecular subtypes and clinicopathological features of breast cancer in Chinese women. Six hundred and twenty-eight Chinese women with breast cancer were classified into four molecular subtypes according to their estrogen receptor (ER), progesterone receptor (PR) and Her-2 status. The prevalence rate of each molecular subtype was analyzed. Relationship between the subtypes and clinicopathologic features was determined. The distribution of molecular subtypes was as follows:luminal A 46.5%, luminal B 17.0%, basal 21.5%, HER2/neu 15.0%. The subtypes had no significant difference under different menopausal status. How- ever, in the age-specific groups, the age group of ≤35 years was more likely to get basal cell-like cancer (36.9%). Statistically significant differences were found among molecular subtypes by age, nuclear grade, tumor size, lymph node (LN) metastasis, tumor stage by American Joint Committee on Cancer (AJCC), radiotherapy but not by chemotherapy, types of surgery. After adjusting for several relative confounding factors, the basal subtype more likely had lower nodal involvement in both the incidence of LN metastasis (≥1 positive LN) and incidence of high-volume LN metastasis (≥4 positive LN). The HER2/neu subtype had higher nodal involvement in the incidence of high-volume LN metastases. After adjusting for relative confounding factors, the HER2/neu subtype more likely had higher AJCC tumor stages. It was suggested that there existed close relationship between molecular subtypes and clinicopa-thological features of breast cancer. In addition, the breast cancer subtypes have been proven to be an independent predictor of LN involvement and AJCC tumor stage. These findings are very important for understanding the occurrence, development, prognosis and treatment of breast cancer in Chinese population.

Predictive Values of Postoperative and Dynamic Changes of Inflammation Indexes in Survival of Patients with Resected Colorectal Cancer

The aim of the present study was to evaluate the prognostic potential of postoperative scores of inflammation indexes and the dynamic changes of scores before and after tumor resection in colorectal cancer patients.The study included 516 colorectal cancer patients with primary colorectal tumor resection.Cox regression was applied to estimate the associations of postoperative and dynamic changes of inflammation indexes with progression-free survival and overall survival.As results,we found that higher postoperative neutrophil to lymphocyte ratio (NLR),neutrophil and monocyte to lymphocyte ratio (NMLR),platelet to lymphocyte ratio (PLR) and systemic immune inflammation index (SII)were associated with shorter progression-free survival.The increased NLR,NMLR,PLR,SII and C-reaction protein (CRP)to albumin (ALB) ratio (CAR)were associated with poor progression-free survival,with HRs (95% CIs)of 1.92 (1.27-2.90),1.46(1.11-2.09),2.10(1.34-3.30),1.81(1.22-2.70)and 1.65(1.03-2.67), respectively.Postoperative NMLR,SII,CAR,and their dynamic changes were also significantly correlated with overall survival,with the HRs (95% CIs)of 2.63(1.30-3.97), 2.44(1.43-4.17),2.74(1.31-5.74),2.08(1.21-3.60),1.97(1.12-3.45)and 2.55(1.21-5.38)respectively.In conclusion,postoperative inflammation indexes and their dynamic changes,particularly for NMLR,SII and CAR are promising prognostic predictors of CRC patients.

Feasibility of MRI Radiomics for Predicting KRAS Mutation in Rectal Cancer

The mutation status of KRAS is a significant biomarker in the prognosis of rectal cancer.This study investigated the feasibility of MRI-based radiomics in predicting the mutation status of KRAS with a composite index which could be an important criterion for KRAS mutation in clinical practice.In this retrospective study,a total of 127 patients with rectal cancer were enrolled.The 3D Slicer was used to extract the radiomics features from the MRI images,and sparse support vector machine(SVM)with linear kernel was applied for feature reduction.The radiomics classifier for predicting the KRAS status was then constructed by Linear Discriminant Analysis(LDA)and its performance was evaluated.The composite index was determined with LDA model.Out of 127 rectal cancer subjects,there were 44 KRAS mutation cases and 83 wild cases.A total of 104 radiomics features were extracted,54 features were filtered by linear SVM with L1-norm regularization and 6 features that had no significant correlations within them were finally selected.The radiomics classifier constructed using the 6 features featured an AUC value of 0.669(specificity:0.506;sensitivity:0.773)with LDA.Furthermore,the composite index(Radscore)had statistically significant difference between the KRAS mutation and wild groups.It is suggested that the MRI-based radiomics has the potential in predicting the KRAS status in patients with rectal cancer,which may enhance the diagnostic value of MRI in rectal cancer.

Expression and Significance of HIF-1α and HIF-2α in Pancreatic Cancer

The expression levels of hypoxia-inducible factor 1alpha(HIF-1α) and HIF-2α in pancreatic cancer(PC) and their association with clinicopathologic characteristics were investigated in order to elucidate their roles in the development of PC. HIF-1α and HIF-2α m RNA levels in 20 patients with PC were detected by quantitative real-time polymerase chain reaction. The expression of HIF-1α and HIF-2α protein in samples from other 90 patients with PC was measured by immunohistochemistry. Correlations between the expression of HIF-1α or HIF-2α and clinicopathologica features and prognosis were analyzed. The expression of both HIF-1α and HIF-2α m RNA was up-regulated in most cancer tissues(P<0.05). HIF-1α staining was weakly positive in most cancer tissues and strongly positive in adjacent pancreas tissues(P<0.05). Clinicopathologic analysis revealed that relatively strong HIF-1α expression in cancer tissues was related to greater invasion(P<0.05), higher tumor pathologic stage(P<0.05), higher American Joint Committee on Cancer(AJCC) stage(P<0.05) and shorter overall survival time(P<0.05). Conversely, HIF-2α staining was strongly positive in most cancer tissues and weakly positive in adjacent pancreas tissues. Clinicopathologic analysis revealed that relatively strong HIF-2α expression in cancer tissues was related to less invasion(P<0.05), lower tumor pathologic stage(P<0.05), lower AJCC stage(P<0.05) and longer overall survival time(P<0.05). Moreover, the HIF-1αhigh/HIF-2αlow group showed a shorter survival time than the HIF-1αlow/HIF-2αhigh group. In conclusion, although HIF-1α and HIF-2α m RNA expression patterns are the same, their protein expression patterns are significantly different and they play different roles in PC. Combined analysis of HIF-1α and HIF-2α expression might be useful to predict the prognosis of patients with PC.

Comparative Study on Cancer Cell Apoptosis between Gastric and Intestinal-type Human Gastric Carcinoma

Apoptosis of cancer cells between the gastric and intestinal-type human gastric carci-noma were compared in terms of the expression of oncogene MDM2 and CD68, the histological types, the infiltration depth, and lymph node metastasis. Terminal deoxynucleotidyl trans-ferase-mediated dUTP-biotin nick end-labeling (TUNEL) assay was employed to stain apoptotic cells. Histochemical method(AB-PAS) was applied to stain mucus that is neutral or acidic in nature. Im-munohistochemical method (SABC) was used to detect expression of MDM2 and CD6. The results showed that the mean apoptosis index (AI) of total 48 cases was 8.60±2.60. AI in the 30 intestinal type cases was significantly higher than that in the 18 gastric type cases (t=4.67, P<0.01). In the 30 intestinal type cases, the spontaneous apoptosis index of MDM2 negative cases was significantly higher than that of the positive cases (t=7.16, P<0.01). And in the 18 gastric type cases, the same re-sult was found. (t=11.39, P<0.01). The MDM2 positive ratio in gastric type cases was higher than that in intestinal type cases (x2=4.68, P<0.05). There is no significant difference in AI between cases of lymph node metastasis and non-metastasis cases in intestinal type cases (t=0.26, P>0.05). But in the gastric type cases, a significant difference existed (t=5.87, P<0.01). A significant difference in lymph node metastasis ratio was found between the two gastric carcinoma types (x2=4.48, P<0.05). The CD68 expression ratio in the 30 intestinal type cases was much lower than that in the 18 gastric type cases (t=4.29, P<0.01). AI of 25 MDM2-positive cases was much lower than that of the 23 MDM2-negative cases (t=7.80, P<0.01). CD68 positive ratio in the 25 MDM2-negative cases was much lower than that in the 23 negative cases. The difference was statistically significant (t=10.90, P<0.01). Except for few cells scattering within the cancer nest, most CD68 positive cells infiltrated in the interstitium around the cancer tissue. In the high-AI cases, CD68-positive cells increased. And the CD68-positive cells decreased in low-AI cases (r=0.96, P<0.01). Logistic regression analysis sug-gested that among the control variables, only AI was a statistically significant factor in the regression model (x2=9.64, P<0.01). We concluded that (1) the spontaneous apoptosis index in gastric-type cases of gastric carcinoma was significantly lower than that in intestinal type cases; (2) AI in the two types was influenced by the expression of MDM2 and lymph node metastasis, but no visible connection was found between AI and the infiltration depth or histological types; (3) in the intestinal type cases, AI and the CD68-positive cells increased in MDM2-negative cases.

A Meta-analysis Reveals Prognostic Role of Programmed Death Ligand-1 in Asian Patients with Non-small Cell Lung Cancer

Accumulating studies explored the clinicopathologic and prognostic value of programmed death ligand-1(PD-L1) in non-small cell lung cancer(NSCLC), but the results were controversial. We therefore conducted a meta-analysis to evaluate the predictive role of PD-L1 in NSCLC patients. We systematically collected relevant studies from Pub Med, Embase, Web of Science and China National Knowledge Infrastructure. The pooled hazard ratios(HRs) with 95% confidence intervals(CIs) for overall survival(OS), and odd ratios(ORs) with 95% CIs for clinicopathologic factors were calculated. A total of 15 studies involving 3605 patients were included in this meta-analysis. The results showed no prognostic role of PD-L1 in the whole patients(HR=1.60, 95% CI: 0.88–2.89, P=0.123). Subgroup analysis showed that PD-L1 was associated with decreased OS in Asian patients(HR=2.00, 95% CI: 1.55–2.57, P<0.001). Among all the clinicopathologic factors, PD-L1 overexpression was significantly in relevance with poor tumor cell differentiation(HR=1.84, 95% CI: 1.49–2.28, P<0.001), late stage(HR=1.21, 95% CI: 1.02–1.43, P=0.026) and anaplastic lymphoma kinase(ALK) translocation(HR=2.63, 95% CI: 1.08–6.40, P=0.034), but not with other factors. In conclusion, our meta-analysis demonstrated that PD-L1 has a prognostic role in Asian patients with NSCLC.

Multicenter Clinical Study for Evaluation of Efficacy and Safety of Transdermal Fentanyl Matrix Patch in Treatment of Moderate to Severe Cancer Pain in 474 Chinese Cancer Patients

Objective: Although a new matrix formulation fentanyl has been used throughout the world for cancer pain management, few data about its efficacy and clinical outcomes associated with its use in Chinese patients have been obtained. This study aimed to assess the efficacy and safety of the new system in Chinese patients with moderate to severe cancer pain. Methods: A total of 474 patients with moderate to severe cancer pain were enrolled in this study and were treated with the new transdermal fentanyl matrix patch (TDF) up to 2 weeks. All the patients were asked to record pain intensity, side effects, quality of life (QOL), adherence and global satisfaction. The initial dose of fentanyl was 25 ?g/h titrated with opioid or according to National Comprehensive Cancer Network (NCCN) guidelines. Transdermal fentanyl was changed every three days. Results: After 2 weeks. The mean pain intensity of the 459 evaluated patients decreased significantly from 5.63?1.26 to 2.03?1.46 (P<0.0001). The total remission rate was 91.29%, of which moderate remission rate 53.16%, obvious remission rate 25.49% and complete remission rate 12.64%. The rate of adverse events was 33.75%, 18.78% of which were moderate and 3.80% were severe. The most frequent adverse events were constipation and nausea. No fatal events were observed. The quality of life was remarkably improved after the treatment (P<0.0001). Conclusion: The new TDF is effective and safe in treating patients with moderate to severe cancer pain, and can significantly improve the quality of life.

Effect of BRCA2 Mutation on Familial Breast Cancer Survival:A Systematic Review and Meta-analysis

Reports of BRCA2 genetic mutations on the prognosis of familial breast cancer(BC) patients have been contradictory. True difference in survival,if it exists,would have important implications for genetic counseling and in treatment of hereditary BC. The purpose of this study was to compare overall survival rate(OSR) among BRCA2 mutation carriers,non-carriers and sporadic BC patients. We searched the PUBMED and EMBASE databases and retrieved 4529 articles using keywords that included breast cancer,BRCA,prognosis and survival. Nine articles were selected for systematic review and among them 6 were included in our meta-analysis. We used the fixed and random effect models to calculate the summary odds ratio(OR) and corresponding 95% confidence interval(CI). BRCA2 mutation carriers had significantly higher long-term OSR than non-carriers(OR=0.69 [95% CI=0.5–0.95]),while both short-term and long-term OSR of BRCA2 mutation carriers did not differ from those of patients with sporadic disease(OR=1.11 [95% CI=0.74–1.65]; 0.85 [95% CI=0.38–1.94],respectively). For BC-specific survival rate(BCSSR),BRCA2 mutation carriers had a similar BCSSR to the non-carriers(OR=0.61 [95% CI=0.28–1.34]). There was no significant difference in disease-free survival(DFS) between BRCA2 mutation carriers and patients with sporadic disease. Our results suggest that BRCA2 mutation increases long-term OSR in hereditary BC,which reminds us a new prospect of management of the disease.

Histological transformation of non-small cell lung cancer:Clinical analysis of nine cases

BACKGROUND Histological transformation is one of the numerous mechanisms of acquired resistance to epidermal growth factor receptor tyrosine kinase inhibitors(EGFRTKIs).Given its rarity,the underlying transformational mechanisms,clinical features,and therapeutic prognoses are only studied through limited case reports.AIM To analyze the clinical characteristics and underlying mechanisms in non-small cell lung cancer(SCLC)patients with histological transformation after treatment with EGFR-TKIs.METHODS We retrospectively investigated nine patients diagnosed with non-SCLC transforming to SCLC,large-cell neuroendocrine carcinoma(LCNEC),or squamous cell carcinoma on re-biopsy after first-or third-generation EGFR-TKIs.RESULTS The median age of nine patients was 60 years.Among them,six patients had the EGFR 19del mutation,one had the L858R mutation,and one had wild-type EGFR.The level of plasma NSE was measured in six patients with SCLC or LCNEC transformation when transformation occurred,and five patients had elevated plasma NSE levels.All patients received standard chemotherapy after transformation with the exception of one patient who received chemotherapy and anlotinib.CONCLUSION Tumor re-biopsy should be performed routinely when EGFR-TKI therapy fails in lung cancer patients to avoid ignoring histological transformation and to select a subsequent therapeutic strategy.The transformed tumor retained the original EGFR mutation,indicating that histological transformation represents an evolution from the initial tumor.

Added value of systemic inflammation markers for monitoring response to neoadjuvant chemotherapy in breast cancer patients

BACKGROUND Complete response after neoadjuvant chemotherapy(r NACT) elevates the surgical outcomes of patients with breast cancer, however, non-r NACT have a higher risk of death and recurrence.AIM To establish novel machine learning(ML)-based predictive models for predicting probability of r NACT in breast cancer patients who intends to receive NACT.METHODS A retrospective analysis of 487 breast cancer patients who underwent mastectomy or breast-conserving surgery and axillary lymph node dissection following neoadjuvant chemotherapy at the Hubei Cancer Hospital between January 1, 2013, and October 1, 2021. The study cohort was divided into internal training and testing datasets in a 70:30 ratio for further analysis. A total of twenty-four variables were included to develop predictive models for r NACT by multiple MLbased algorithms. A feature selection approach was used to identify optimal predictive factors. These models were evaluated by the receiver operating characteristic(ROC) curve for predictive performance.RESULTS Analysis identified several significant differences between the r NACT and nonr NACT groups, including total cholesterol, low-density lipoprotein, neutrophilto-lymphocyte ratio, body mass index, platelet count, albumin-to-globulin ratio, platelet-to-lymphocyte ratio, and lymphocyte-to-monocyte ratio. The areas under the curve of the six models ranged from 0.81 to 0.96. Some ML-based models performed better than models using conventional statistical methods in both ROC curves. The support vector machine(SVM) model with twelve variables introduced was identified as the best predictive model.CONCLUSION By incorporating retreatment serum lipids and serum inflammation markers, it is feasible to develop ML-based models for the preoperative prediction of r NACT and therefore facilitate the choice of treatment, particularly the SVM, which can improve the prediction of r NACT in patients with breast cancer.

Pretreatment serum albumin-to-alkaline phosphatase ratio is an independent prognosticator of survival in patients with metastatic gastric cancer

BACKGROUND Previous studies have suggested that a low albumin-to-alkaline phosphatase ratio(AAPR)is associated with a lower survival rate in patients with various malignancies.However,the relationship between pretreatment AAPR and the prognosis of patients with gastric cancer(GC)remains unclear.AIM To investigate the prognostic value of AAPR in distant metastatic GC.METHODS A total of 191 patients with distant metastatic cancer from a single institute were enrolled in this study.Pretreatment clinical data,including serum albumin and alkaline phosphatase levels,were collected.A chi-square test or Fisher’s exact test was applied to evaluate the correlations between AAPR and various clinical parameters in GC patients.The Kaplan-Meier method and Cox proportional hazards regression model were used to evaluate the prognostic efficacy of AAPR in metastatic GC patients.A two-sided P value lower than 0.05 was considered statistically significant.RESULTS A receiver operating characteristic curve indicated that 0.48 was the optimal threshold value for AAPR.AAPR≤0.48 was significantly associated with bone(P<0.05)and liver metastasis(P<0.05).Patients with high levels of AAPR had better survival in terms of overall survival(OS)and progression-free survival(PFS),regardless of the presence of liver/bone metastasis.Pretreatment AAPR was found to be a favorable predictor of OS and PFS based on a multivariate cox regression model.AAPR-M system,constructed based on AAPR and number of metastatic sites,showed superior predictive ability relative to the number of metastatic sites for predicting survival.CONCLUSION Pretreatment AAPR may serve as an independent prognostic factor for predicting PFS and OS in patients with metastatic GC.Furthermore,AAPR may assist clinicians with individualizing treatment.

Evaluation of triage strategies for high-risk human papillomavirus-positive women in cervical cancer screening:A multicenter randomized controlled trial in different resource settings in China

Objective:We aimed to evaluate the effectiveness of different triage strategies for high-risk human papillomavirus(hrHPV)-positive women in primary healthcare settings in China.Methods:This study was undertaken in 11 rural and 9 urban sites.Women aged 35-64 years old were enrolled.HrHPV-positive women were randomly allocated to liquid-based cytology(LBC),visual inspection with acetic acid and Lugol’s iodine(VIA/VILI)(rural only)triage,or directly referred to colposcopy(direct COLP).At 24 months,hrHPV testing,LBC and VIA/VILI were conducted for combined screening.Results:In rural sites,1,949 hrHPV-positive women were analyzed.A total of 852,218 and 480 women were randomly assigned to direct COLP,LBC and VIA/VILI.At baseline,colposcopy referral rates of LBC or VIA/VILI triage could be reduced by 70%-80%.LBC(n=3 and n=7)or VIA/VILI(n=8 and n=26)could significantly decrease the number of colposcopies needed to detect one cervical intraepithelial neoplasia(CIN)2 or worse and CIN3+compared with direct COLP(n=14 and n=23).For the 24-month cumulative detection rate of CIN2+,VIA/VILI triage was 0.50-fold compared with LBC triage and 0.46-fold with the direct COLP.When stratified by age,baseline LBC triage+performed best(P<0.001),peaking among women aged 35-44 years(Ptrend=0.002).In urban sites,1,728 women were hrHPV genotyping test positive.A total of 408,571 and 568women were randomly assigned to direct COLP for HPV16/18+,direct COLP for other hrHPV subtypes+,and LBC triage for other hrHPV subtypes+.LBC(n=12 and n=31)significantly decreased the number of colposcopies needed to detect one CIN2+and CIN3+compared with direct COLP(n=14 and n=44).HPV16/18+increased the 24-month cumulative detection rate of CIN2+(17.89%,P<0.001).Conclusions:LBC triage for hrHPV-positive women in rural settings and direct COLP for HPV16/18+women and LBC triage for other hrHPV subtype+women in urban settings might be feasible strategies.

Knowledge,Attitude and Practice(K-A-P)of Cancer Nutrition in Chinese Medical Staff

Objective The present study was designed to investigate knowledge,attitude,and practice(K-A-P)toward cancer nutrition among medical staff in China,and to provide a basis for nutritional oncology training in clinical oncology practice in China in order to improve clinical treatment outcomes.Method This was a multicenter,cross-sectional study involving 3036 clinicians selected from 138 hospitals in 13 provinces across China.KAP scores were collected via questionnaires.Results The overall mean K score was 41.26±23.68,with a pass rate of 35.31%and honoring rate of 12.48%,respectively.The overall mean A score was 82.23±12.63,with pass rate of 96.57%and honoring rate of 69.37%,respectively.The overall mean P score was 73.03±15.06,with a pass rate of 85.64%and honoring rate of 39.86%,respectively.The correlation coefficient between K and A scores was 0.136(P<0.05).The correlation coefficient between K and P scores was 0.179(P<0.05).These results suggested positive correlations between K and A,and K and P scores.While the pass rate for K score in male staff was higher than that in female(P<0.05),there was no significant difference for A and P scores between the two groups(P >0.05).The K-A-P scores,and their associated pass rates and honoring rates among doctors were higher than that among nurses and medical technicians(P<0.05).Senior medical technicians had higher K and P scores than their junior counterparts(P<0.05).However,there was no significant difference in A scores among medical technicians with different ranks(P >0.05).Mean K-A-P scores and their associated pass rates and honoring rates in clinicians with higher degrees were superior,compared with those with lower degrees(P<0.05).Surgeons had higher K-A-P scores,pass rates,and honoring rates than others(P<0.05).Those who worked in teaching hospitals showed higher K-A-P scores,pass rates,and honoring rates than their counterparts in other work settings.There were no significant differences in K and P scores,and associated pass rates and good rates between medical staff from general hospitals and those from specialized oncology hospitals(P >0.05).However,higher P scores and associated pass rates were observed in staff from general hospitals than that from other settings(P<0.05).Over half(58.41%)of the medical staff spent less than 10%of their work time on nutritional education.About half(52.71%)of the medical staff expressed desires to work on nutritional research projects.Nutritional knowledge of medical staff primarily came from work experience(66.22%),reference textbooks and journals(65.40%),and formal education(61.25%).Conclusion While medical staff in China demonstrated positive attitude and good practice in nutritional therapy,they need more training to improve nutritional knowledge.

Midday Napping,Nighttime Sleep,and Mortality:Prospective Cohort Evidence in China

Objective In developed countries,midday napping and nighttime sleep duration have been linked to long-term survival;however,little is known about such effects in less developed regions.Therefore,this study aimed to assess the associations of midday napping and nocturnal sleep with mortality in middle-aged and older Chinese adults.Methods A nationwide cohort of 15,524 adults aged≥45 years was enrolled from 28 provincial regions across China's Mainland and followed up from 2011 to 2018,using data from the Chinese Health and Retirement Longitudinal Study.Midday napping and nighttime sleep duration were assessed using standardized questionnaires.Cox proportional hazards models with random intercepts for the surveyed provinces were used to estimate hazard ratios(HRs)of all-cause mortality,adjusting for sociodemographic characteristics,behavioral factors,and health status.Results A total of 1,745 deaths occurred during a median follow-up of 7.1 years,and the mean(standard deviation)age was 59(10.1)years at baseline.Compared with non-nappers,over 60 min nappers had a higher risk of all-cause mortality[HR:1.35,95%confidence interval(CI):1.17–1.56],while no significant associations were observed among<30 min nappers.Compared with sleep duration of 6–8 h/night,both short(<6 h)and long(≥8 h)sleep duration were significantly associated with increased mortality,with corresponding HR(95%CI)estimates of 1.21(1.05–1.38)and 1.26(1.10–1.44),respectively.We observed significant patterns for greater risks associated with longer nap duration,with a Ptrend value<0.001 for all-cause mortality.No significant evidence of an additive interaction was identified between midday napping and nighttime sleep.Conclusion Long midday napping and inappropriate nighttime sleep were independently associated with an increased risk of all-cause mortality in middle-aged and older Chinese populations.Biological studies are needed to validate our findings and clarify the mechanisms underlying this association.

Annexin A1 Mimetic Peptide AC2-26 Inhibits Sepsis-induced Cardiomyocyte Apoptosis through LXA4/PI3K/AKT Signaling Pathway

The aim of the present study was to explore the effects of annexin A1(ANXA1) mimetic peptide AC2-26 on sepsis-induced cardiomyocyte apoptosis in vivo and in vitro and the underlying mechanisms.In the in vivo study,a rat septic model was established by the cecal ligation and puncture (CLP).The rats were divided into control group,sepsis group and AC2-26 group.The rats in the AC2-26 group were intraperitoneally injected with AC2-26(1mg/kg)2h before CLP,and those in the control group and sepsis group were injected with the same volume of normal saline.The myocardial tissue was examined by hematoxylin and eosin (HE)staining and transmission electron microscopy (TEM).Furthermore,myocardial apoptosis was measured by terminal dUTP nick end-labeling (TUNEL)assay.In the in vitro study,H9C2cells were cultured and divided into three groups:control group,in which cells were only given the basic culture medium;LPS group,in which cells were treated with 10μg/mL LPS;AC2-26 group,in which cells were treated with 0.5μmol/L AC2-262h before 10μg/mL LPS was given.The apoptosis of H9C2 cells was detected by flow cytometry.The levels of lipoxin A4 receptor (LXA4),phosphoinositide3-kinase (PI3K)and protein kinase B (PKB or AKT)protein were measured by Western blotting, the activity of NF-KB and the level of TNF-α by ELISA and the activities of caspase-3/8by using the caspase activity kits.The in vivo study showed that the myocardial pathological damage and myocardial ultrastructural damage were significantly alleviated and the myocardial apoptosis significantly decreased in the AC2-26 group as compared with the sepsis group (P<0.05 for all). The in vivo study revealed that the apoptosis of H9C2 cells was profoundly ameliorated in the AC2-26 group relative to the sepsis group (P<0.05).The protein expression levels of LXA4 were significantly up-regulated,and those of PI3K and AKT prominently down-regulated in the AC2-26 group when compared with those in the LPS group (P<0.05 for all).The activity of NF-κB was greatly inhibited and the level of TNF-α markedly decreased in the AC2-26 group as compared with those in the LPS group (P<0.05 for all).AC2-26 treatment also significantly suppressed the activities of caspase-3/8 in H9C2 cells.In conclusion,these findings suggest that AC2-26 may alleviate the sepsis-induced cardiomyocyte apoptosis in vivo and in vivo through the LXA4/PI3K/ AKT signaling pathway.