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BACKGROUND@#The treatment mode of lung cancer is epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs) as a first-line treatment for patients with EGFR mutant in non-small cell lung cancer (NSCLC). At the same time programmed death receptor 1 (PD-1) and its programmed death receptor ligand 1 (PD-L1) inhibitors therapy as the representative immune checkpoint inhibitors (ICIs) has a significant effect in the treatment of lung cancer. The aim of this study was to investigate the correlation between the expression of PD-1 and PD-L1 in NSCLC and clinicopathologic feature, EGFR gene mutation.@*METHODS@#The protein expression of PD-1 and PD-L1 was detected by immunohistochemistry from 127 patients with NSCLC and EGFR gene mutation was detected by quantitative polymerase chain reaction (qPCR) to analyze its relation with clinicopathologic feature. Also, the correlation between protein expression of PD-1 and PD-L1 and EGFR mutation.@*RESULTS@#The PD-1 positive expression in NSCLC tumor cells and tumor infiltrating immune cells is 53.5% (68/127), PD-L1 is 57.5% (73/127). The PD-1 and PD-L1 expression significantly higher in well-differentiated and moderately-differentiated carcinoma than poorly differentiated carcinoma, I+II than III+IV in clinical staging (P<0.05). The EGFR mutation rate was 46.5% (59/127), correlate with female, without smoking history, adenocarcinoma and well-differentiated and moderately-differentiated patients respectively higher than male, smoking history, squamous carcinoma and poorly differentiated patients (P<0.05). The protein expression of PD-L1 and PD-1 had the consistency in NSCLC patients (kappa=0.107,5, P=0.487). There was a negative correlation between the EGFR mutation and PD-1 and PD-L1 expression (Φ=-0.209, Φ=-0.221, P<0.05). Follow-up of NSCLC patients, the median total survival in under the age of 65, adenocarcinoma, well-differentiated and moderately-differentiated, with PD-L1 expression patients respectively higher than over the age of 65, squamous carcinoma, poorly differentiated, without PD-L1 expression patients (P<0.05). The median survival of hypo expression patients of PD-L1 significantly higher than hyper expression patient (P=0.04).@*CONCLUSIONS@#According to the Chinese Expert Consensus on Standards of PD-L1 immunohistochemistry testing for NSCLC, we tested the PD-L1 expression in NSCLC and then the dominant population of anti-PD-1/PD-L1 treatment was screened out. Patients with EGFR mutation were also detected and EGFR mutation was negatively correlated with the expression of PD-1 and PD-L1 as well. On the basis of PD-L1 expression and EGFR mutation status, it may benefit NSCLC patients from individualized treatment. Meanwhile, patients who were under the age of 65, adenocarcinoma, well-differentiated and moderately-differentiated, hypo expression of PD-L1 have a relatively good prognosis, to provide reference for the prognosis evaluation of NSCLC.
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Objective To explore how to carry out the evidence-based nursing care on multiple myeloma(MM)patients with incontinence associated dermatitis(IAD)by combining with a case of MM in clinic.Methods According to the patient′s situation, the clinical questions were pertinently put forward and converted according to the principle of PICO.And then some databases such as NGC,CDSR,Medline and PubMed were retrieved from January 1,2006 to December 31,2016 for collecting high-quality clinical evidences of the prevention and nursing care of IAD.Results Three clinical practice guidelines,1 expert opinion,3 systematic re-views and 3 RCT were included.According to the final retrieval results and combining with the patient′s condition and wish,the ab-sorbent products were appropriately used,and the contaminated skin was cleaned in time;at the same time the disposable non-woven fabric coordinated with pH balanced skin cleanser was selected to clean skin gently.Based on the principles of cleaning,preserving moisture and skin protection,some superior products,such as 3-in-1 incontinence care wipes or Cavilon transparent protective film, were given priority to select and regularly evaluated.Conclusion Applying the evidence-based evidence can pertinently provide the individualized nursing scheme for the patients,thus reduces the incidence rate of IAD.
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Objective To evaluate the effect of inpatient early palliative care (EPC) in nasopharyngeal carcinoma (NPC) patients receiving concurrent radiochemotherapy. Methods Totally 130 NPC patients were divided into the experimental group (64 cases) and the control group (66 cases) according to random digit table. Both groups received routine nursing and anti-cancer therapy, in addition, the experimental group received inpatient EPC. Psychological pain, myelosuppression and hospitalization expenses were compared between two groups. Results After the inpatient EPC intervention, the Distress Thermometer (DT) scores of the control group vs. the experimental group was 3.53±1.45 vs. 4.32±1.29, the scores of quality of life was 86.03±6.24 vs. 101.7±8.82, the incidence of myelosuppression was 95.45% (63/66) vs. 56.25%(36/64), and the hospitalization expenses of the patients was 110 862.82±4 849.58 vs 105 047.75±2 751.41 yuan, there were significant differences between the two groups (t=3.274,-11.665, Z=-6.701, t=8.441, P<0.01 or 0.05). Conclusions Inpatient EPC can be effective in reducing psychological distress, myelosuppression and the hospitalization expenses as well as improving the quality of life in NPC patients receiving concurrent chemoradiotherapy.
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Objective To investigate psychosocial distress status of hospitalized patients with nasopharyngeal carcinoma and then analyze its influencing factors.Methods Using the method of convenience sampling,the level of psychosocial distress of hospitalized patients with nasopharyngeal carcinoma was measured with psychosocial distress thermometer (DT),then by orderly classification Logistic regression analysis methods,the main factors affecting the degree of psychosocial distress were obtained.Results This study in cluded 235 patients,and 228 patients completed the survey effectively,DT score was (4.030±2.993) points,including DT ＜ 4 points (mild pain) accounted for 36.8％ (84/228),DT 4-6 points (moderate pain) accounted for 38.2％ (87/228),DT≥7 points (severe pain) accounted for 25.0％ (57/228).Regression analysis showed that the economic problems,emotional problems (depression,fear,sadness),body problems (eating,oral ulcer,sleep problems),age,education degree,stressful life events in the recent year,the time of disease diagnosis,and disease recurrence were the main factors influencing the degree of psychosocial distress.Conclusions Hospitalized patients with nasopharyngeal carcinoma have widespread psychosocial distress,clinical medical personnel should take individualized psychological evaluation and intervention according to the related factors of psychosocial distress in order to reduce the degree of psychosocial distress.
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Objective To investigate the suicide related psychological status of cancer patients in hospital. Methods 508 cancer patients in the Affiliated- Tumor- Hospital- of- Guangxi- Medical- University were recruited and using the hospital anxiety and Depression Scale (HADS) and Beck Hopelessness Scale (BHS) for evaluating cancer patients′anxiety, depression, hopelessness. According to age, the patients were divided into three groups, comparing the differences in three groups′scores of anxiety, depression, hopelessness. Results Of all the respondents, there were 38.7% (172/445) patients with anxiety, and 26.3% (117/445) patients with depression, and 59.1% (263/445) patients with different degrees of hopelessness. In the comparison of three groups of patients, anxiety scores existed differences (U=7.083,P 0.05). Conclusions Many people have anxiety / depression in cancer patients, most cancer patients have varying degrees of hopelessness. The health care workers should get attention to these suicide related psychology, take appropriate intervention, in order to avoid the occurrence of hospitalized cancer patients committing suicide.
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Objective To investigate the status of hospitalized cancer patients sense of hopelessness.Methods 508 cancer patients in the Affiliated Tumor Hospital of Guangxi Medical University were recruited and divided into the youth group and the middle aged group.Beck Hopelessness Scale (BHS) was assessed to compare the depression degree between the youth group and the middle aged group.Results In general,without a sense of hopelessness in 182 patients (40.9％),mild hopelessness in 178 patients (40.0％),moderate hopelessness in 68 patients (15.3％),severe hopelessness in 17 patients (3.8％).However,no statistical difference was significantly different on the depression degree between the youth group and the middle aged group,while significat difference existed between patients with different dwelling places and treatment time.Conclusions Most cancer patients have different degree of hopelessness.Duration of treatment,dwelling conditions and other factors can affect the patients sense of hopelessness.
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Objective To investigate illness uncertainty state and explore its influencing factors in hospitalized children and adolescents with cancer.Methods A cross-sectional survey was performed in 112 children and adolescents with cancer aged 7～18 years old from two hospitals with the Chinese version of Uncertainty Scale for Kids-20 and the self-designed demographic questionnaire.Results The mean total scores of illness uncertainty was (45.16±6.67) points.The results of single-factor analysis showed that the factors influencing the uncertainty in illness of children and adolescents with cancer were as follows:age,personality characteristics,course of disease,the methods of treatment,current disease status,absence from school or not,the times of hospitalization,family monthly income,and the extent of parents' understanding about the disease-related knowledge.Multi-factor stepwise regression analysis showed that the main influencing factors of the uncertainty in illness were the current condition,family monthly income,absence from school or not and the extent of parents' understanding about the disease-related knowledge.Conclusions Illness uncertainty is common in children and adolescents with cancer.Nurses should attach importance to the impacts of illness uncertainty,and take effective interventions to decrease it,alleviate psychological pressure and improve quality of life in children and adolescents with cancer.
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Objective To evaluate the reliability and validity of the Chinese version of Uncertainty Scale for Kids-22 (USK-22).Methods The Uncertainty Scale for Kids was translated and adapted according to Chinese culture.The reliability and validity of the Chinese version of USK were tested in 117children and adolescents with cancer.Results The rate of recovery was 100％.The rote of effective questionnaire was 95.7％.The patients were easily to understand and it cost them average 8 minutes to finish the questionnaires.Three factors were extracted by factor analysis and could explain 57.043％ of total variance.The correlations between each item and subscale ranged from 0.526 to 0.762.The Cronbach α of USK was 0.872 and the Cronbach α of each subscale ranged from 0.774 to 0.826.The testretest reliability was 0.835.Conclusions The Chinese version of USK is reliable and valid,and can be used to measure the level of uncertainty among Chinese children and adolescents with cancer.
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Background and purpose: Thyroid carcinoma cells spread mainly through lymph node metastasis, and lymphangiogenesis plays an important role during the lymph node metastasis, but it is not very clear to understand the formation mechanism. This study was to investigate the correlative expressions of HPSE, VEGF-C, D2-40 and lymphangiogenesis in thyroid carcinoma. Methods: Immunohistochemistry SP method was used to detect the expressions of HPSE, VEGF-C and D2-40 in 77 patients with thyroid carcinoma including papillary thyroid carcinoma (PTC), follicular thyroid carcinoma (FTC),medullary thyroid carcinoma (MTC), 32 of them with lymph node metastasis was enrolled into the study, D2-40 stained the lymphatic vessels, and lymphatic vessel density (LVD) was scanned under the light-microscope, and the correlation among the above indexes in different thyroid carcinoma types were analyzed respectively. Results: The expressions of HPSE, VEGF-C and D2-40 were observed to have a different degree in thyroid carcinoma, and the highest expression of the protein could be seen in the patients with papillary carcinoma (P<0.05),The expression ratios of HPSE,VEGF-C and D2-40 in different carcinoma types were 54.9%, 68.6%, 12.8±5.7 for PTC, 37.5%, 50%, 8.6±1.7 for FTC, 20% and 20%, 4.9±0.8 for MTC, respectively. There were significant different expressions of HPSE, VEGF-C and D2-40 between the patients with lymph node-positive group and node-negative group (P=0.014, P=0.048, respectively). In addition, the expressions of them were positively correlated (P<0.001, r=0.616). Conclusion: HPSE, VEGF-C and D2-40 have a close relationship with lymph node metastasis, HPSE and VEGF-C are related to the lymphangiogenesis.