Effectiveness of mHealth diet interventions in cancer survivors: A systematic review and meta-analysis of randomized controlled trials.

Objective: To evaluate the effects of mobile health (mHealth) diet interventions on cancer survivors' diet intake, weight change, waist circumference, hip circumference, and quality of life (QoL). Methods: The PubMed, Embase, Web of Science, Cochrane Library, Scopus, ProQuest, China National Knowledge Infrastructure, Wanfang, and SinoMed databases were searched from their inception to September 25, 2022. Randomized controlled trials (RCTs) on the effects of mHealth diet interventions in cancer survivors were identified. Two researchers independently selected the included studies and appraised their quality. The methodological quality of the included studies was assessed using the Revised Cochrane risk-of-bias tool for RCTs (RoB2). Results: A total of 15 RCTs involving 2363 cancer survivors were included. MHealth diet interventions significantly improved fruit and vegetable intake (standardized mean difference [SMD] â€‹= â€‹0.19, 95% confidence interval [CI] [0.05, 0.33], P â€‹< â€‹0.01), and QoL (SMD â€‹= â€‹0.13, 95% CI [0.01, 0.26], P â€‹= â€‹0.04) and reduced fat intake (SMD â€‹= â€‹-0.22, 95% CI [-0.34, -0.11], P â€‹< â€‹0.01), weight (SMD â€‹= â€‹-0.35, 95% CI [-0.48, -0.22], P â€‹< â€‹0.01), waist circumference (MD â€‹= â€‹-1.43, 95% CI [-2.33, -0.53], P â€‹< â€‹0.01), and hip circumference (MD â€‹= â€‹-3.54, 95% CI [-4.88, -2.19], P < 0.01) in cancer survivors. No significant differences were observed in energy intake (P â€‹= â€‹0.46) or whole grain intake (P â€‹= â€‹0.14). Conclusions: MHealth diet interventions may be an effective strategy for cancer survivors. Large-scale RCTs with rigorous study designs are needed to examine the effect of diet intervention delivered via mHealth.

Feasibility of an Individualized mHealth Nutrition (iNutrition) Intervention for Post-Discharged Gastric Cancer Patients Following Gastrectomy: A Randomized Controlled Pilot Trial.

(1) Background: A major challenge for post-discharged gastric cancer patients following gastrectomy is the impact of the anatomy change on decreased oral intake, nutritional status, and, ultimately, quality of life. The purpose of this study is to examine the feasibility and preliminary effects of an individualized mHealth nutrition (iNutrition) intervention in post-discharged gastric cancer patients following gastrectomy. (2) Methods: A mixed-method feasibility study with a parallel randomized controlled design was conducted. Patients were randomly assigned to either the iNutrition intervention group (n = 12) or the control group (n = 12). Participants completed measures at baseline (T0), four (T1), and twelve weeks (T2) post-randomization. (3) Results: Recruitment (33%) and retention (87.5%) rates along with high adherence and acceptability supported the feasibility of the iNutrition intervention for post-discharged gastric cancer patients following gastrectomy, echoed by the qualitative findings. The iNutrition intervention significantly improved participants' nutritional behavior (p = 0.005), energy intake (p = 0.038), compliance with energy requirements (p = 0.006), and compliance with protein requirements (p = 0.008). (4) Conclusions: The iNutrition intervention is feasible and potentially benefits post-discharged gastric cancer patients following gastrectomy. A larger trial is required to establish the efficacy of this approach. Trial Registration: 19 October 2022 Chinese Clinical Trial Registry, ChiCTR2200064807.

The relationship between emotional neglect and non-suicidal self-injury among middle school students in China: the mediating role of social anxiety symptoms and insomnia.

BACKGROUND: Non-suicidal self-injury (NSSI) is a vital public concern around the world, and it often starts in adolescence. Emotional neglect (EN) has been considered a distal risk factor for NSSI, but the effects of social anxiety symptoms (SA) and insomnia on this relationship have remained unclear. This study aimed to investigate the potential pathways from EN to NSSI, examining the role of SA and insomnia in this association. METHODS: One thousand three hundred thirty seven Chinese middle school students (Mage = 13.040, SD = 0.981, 50.2% males) in China were enrolled in this cross-sectional study. Participants completed the Emotional Neglect sub-scale of Childhood Trauma Questionnaire (CTQ-SF), the Social Anxiety Scale for Adolescent (SAS-A), Athens Insomnia Scale (AIS) and non-suicidal self-injury assessment. Structural equation modelling (SEM) was used to test the possible mediation model among these variables. RESULTS: 231(17.3%) students reported NSSI history during last year and 322 (24.1%) participants reported experiences of EN. Students who experienced EN have higher rates of NSSI compared to students without EN history (29.2% vs 13.5%). EN, SA, insomnia and NSSI were positively related to each other. Furthermore, both SA and insomnia played a mediating role in the relationship between EN and NSSI, the series mediating effect of SA and insomnia on this association was also significant after controlling for demographics. Indirect effects accounted for 58.26% of the total effects (EN → NSSI). CONCLUSIONS: Our study revealed that EN was associated with NSSI, SA and insomnia play indirect roles in the association between EN and NSSI. The findings of our research may have implications for clinicians, families, and schools in their efforts to lower the risk of NSSI in adolescents.

CXCL8 delivered by plasma-derived exosomes induces the symptoms of post-traumatic stress disorder through facilitating astrocyte-neuron communication.

Extracellular vesicles (EVs) play an important role in post-traumatic stress disorder (PTSD). This study is aimed to investigate the possible molecular mechanism of CD63 mediating CXCL8 delivery via EVs to affect astrocyte-neuron communication in PTSD. The neuron-derived EVs (NDEVs) and astrocyte-derived EVs (ADEVs) were isolated from plasma in PTSD patients. Next, the uptake of EVs by neurons was assessed. Following determination of the interaction between CD63 and CXCL8, gain- and loss-of-function experiments were performed in astrocytes. Finally, a PTSD mouse model was established using the single prolonged stress and electric foot shock to confirm the effects of plasma-derived EVs delivering CXCL8 on anxiety- and depression-like behaviors in PTSD mice. EVs derived from plasma of PTSD patients aggravated anxiety- and depression-like behaviors in PTSD mice. CXCL8 was a key gene upregulated in both NDEVs and ADEVs from plasma of PTSD patients, which could be delivered into EVs by CD63. Meanwhile, CXCL8 was also highly expressed in plasma-derived EVs. In vivo experiments also verified that plasma-derived EVs could enhance astrocyte-neuron communication by delivering CXCL8, and silencing of CXCL8 ameliorated anxiety- and depression-like behaviors in PTSD mice. Taken together, CD63 promotes delivery of CXCL8 via EVs to induce PTSD by enhancing astrocyte-neuron communication, suggesting the potential of CD63 mediating delivery of CXCL8 via EVs as a therapeutic target for PTSD.

The vicious circle of UHRF1 down-regulation and KEAP1/NRF2/HO-1 pathway impairment promotes oxidative stress-induced endothelial cell apoptosis in diabetes.

BACKGROUND: Oxidative stress is recognized as a key factor in the induction of endothelial dysfunction in diabetes. However, the specific mechanisms have not been fully elucidated. We herein hypothesized that ubiquitin-like containing PHD and RING finger domains 1 (UHRF1) might have a role in oxidative stress-induced endothelial cell (EC) apoptosis in diabetes. METHODS: Western blot, qPCR, wound healing assay, apoptosis assay, reactive oxygen species (ROS) detection, dual-luciferase reporter assay, methylation-specific PCR, bisulfite sequencing PCR and chromatin immunoprecipitation assay were performed. RESULTS: UHRF1 expression levels were significantly decreased in endothelial colony-forming cells derived from peripheral blood of participants with type 2 diabetes compared with individuals without diabetes. ECs treated with high glucose, palmitate or hydrogen peroxide in vitro also exhibited decreased UHRF1 protein levels. Silencing of UHRF1 led to decreased migration ability and increased apoptosis and ROS production in ECs, which might be related to impaired Kelch-like ECH-associated protein 1 (KEAP1)/nuclear factor erythroid 2-related factor 2 (NRF2)/haeme oxygenase-1 pathway. Mechanistically, UHRF1 is closely implicated in epigenetic regulation of chromatin modification status at KEAP1 genomic locus via histone acetylation. NRF2 down-regulation in turn inhibits UHRF1 protein level, which might be due to increased ROS generation. CONCLUSION: Diabetes-induced oxidative stress can mediate down-regulation of UHRF1, which enhances ROS production by regulating KEAP1/p-NRF2 pathway through histone acetylation and might also form a self-perpetuating feedback loop with KEAP1/p-NRF2 to further promote oxidative stress-induced apoptosis of ECs in diabetes.

Compliance with Oral Nutritional Supplementation among Gastric Cancer Patients at Nutritional Risk: A Cross-Sectional Study.

AIMS: To explore compliance with oral nutritional supplementation (ONS) and to identify the risk factors for noncompliance among gastric cancer patients based on the health belief model (HBM). METHODS: This prospective, observational study included gastric cancer patients at nutritional risk who were prescribed ONS from July to September 2020. Demographic factors, clinical factors, ONS-related factors, social factors and variables derived from the HBM were collected. The outcome of interest was compliance with ONS, which was measured by self-reported intake of ONS. Uni- and multivariate analyses of potential risk factors for noncompliance were performed. RESULTS: A total of 162 gastric cancer patients in the preoperative and adjuvant chemotherapy periods were analyzed. The compliance rate with ONS was 24.7%. Univariate analysis identified thirteen variables as risk factors for decreased compliance. Multivariate logistic analysis indicated that ONS compliance was independently associated with the treatment period, perceived barriers to ONS, the motivation to take ONS, and the timing of taking ONS. CONCLUSION: This study showed that overall ONS compliance among gastric cancer patients was notably low. Patients in the chemotherapy treatment period who took ONS at random times each day perceived more barriers to taking ONS and had a lower level of motivation were associated with lower compliance with ONS.

Heavy metal redistribution mechanism assisted magnetic separation for highly-efficient removal of lead and cadmium from human blood.

Magnetic nano capture agent (MNCA)-based magnetic separation is considered as a promising approach to rapidly isolate heavy metals from blood. Limited removal efficiency and potential biosafety risks are the major challenges for the clinical use of MNCA-based magnetic separation. Here, we report a highly-efficient MNCA-based magnetic separation of heavy metals from blood in continuous multi-stage adsorption mode. The interactions between MNCA and blood components (e.g. blood cells and plasma proteins) and the MNCA-induced cellular immune responses are studied in detail. The distribution and redistribution of heavy metals in blood are quantitatively analyzed. It demonstrates that concentration dependent redistribution can increase the contact between heavy metals and MNCA, leading to improvement on heavy metal removal efficiency. The removal performance is tested in batch mode and in continuous mode. Results show that 97.97% of Pb and 96.53% of Cd are removed from blood in 120 min using continuous multi-stage adsorption mode, and the residual concentrations of Pb and Cd in blood decrease from 400 µg L-1 to 8.11 µg L-1 and 13.84 µg L-1, respectively. This study paves an effective way for heavy metal intoxication therapy by MNCA-based magnetic separation.

Epidemiology, susceptibility, and risk factors for acquisition of MDR/XDR Gram-negative bacteria among kidney transplant recipients with urinary tract infections.

BACKGROUND: Multiple drug resistant/extensively drug resistant (MDR/XDR) Gram-negative urinary tract infections (UTIs) represent a growing threat to kidney transplant recipients. This retrospective study aimed to assess the incidence and microbiological profile of MDR/XDR Gram-negative UTIs, to identify drug susceptibility of MDR/XDR bacteria, and to determine the potential risk factors for MDR/XDR UTIs in kidney recipients. MATERIALS AND METHODS: During the study period, 1569 patients underwent consecutive kidney transplantation in two transplantation centers. We studied the demographics, clinical characteristics, and urine culture data from kidney recipients with MDR/XDR Gram-negative UTIs, and verified the risk factors associated with MDR/XDR infections. RESULTS: Eighty-one kidney recipients yielded 88 episodes of MDR/XDR Gram-negative UTIs with five patients (6.2%) succumbing to all-cause in-hospital mortality. The most frequently isolated bacterium was Escherichia coli (62.5%). Almost all MDR/XDR Gram-negative bacteria were resistant to first- and second-generation cephalosporin, and monocyclic beta-lactam. They were relatively sensitive to meropenem, amikacin, and tigecycline. As for the 12 XDR bacteria, all of them were resistant to meropenem and 25% of them were resistant to tigecycline. All XDR Acinetobacter baumannii and E. coli were susceptible to tigecycline. Nosocomial infection (odds ratio [OR] = 11.429, 95% CI = 1.311-99.625, P = 0.027) was the only independent predictor of MDR/XDR Gram-negative UTIs. Non-fermenting bacterial infection (OR = 20.161, 95% CI = 3.409-119.240, P = 0.001), polycystic kidney disease (OR = 39.871, 95% CI = 1.979-803.384, P = 0.016), and serum creatinine level > 1.5 mg/dL (OR = 8.688, 95% CI = 1.354-55.747, P = 0.023) were significantly different between XDR and MDR Gram-negative UTIs. CONCLUSION: Meropenem, amikacin, and/or tigecycline can be prescribed for MDR/XDR Gram-negative infections. Tigecycline can also be prescribed for XDR A. baumannii and E. coli. Nosocomial infection was a risk factor for MDR/XDR Gram-negative UTIs, while XDR UTIs were associated with non-fermenting bacterial infection, polycystic kidney disease, and impaired renal function.

Can therapeutic drug monitoring increase the safety of Imatinib in GIST patients?

Imatinib at 400 mg daily is the standard treatment for patients affected with CML and GIST. The intervariability in plasma concentration is very significant. In many reports, a good therapeutic effect is attributed to an adequate concentration of Imatinib. However, few studies have been conducted to investigate the association between plasma concentration and side effects. Besides, no upper concentration limit of Imatinib plasma concentration detection has been established. The correlation of Imatinib trough concentrations (Cmin ) with adverse effects (AEs) was described here. Plasma samples were obtained from patients after 3 months treatment with Imatinib (steady state, n = 122). Liquid chromatography/ tandem mass spectrometry was used to determine the concentration of Imatinib and its metabolite NDI. The incidence of myelosuppression was increased significantly with the increased Imatinib trough plasma concentration. The plasma level of Imatinib and NDI in patients who developed myelosuppression are 1698.3 ± 598.6 ng/mL and 242.1 ng/mL, respectively, which were significantly higher than those in patients who did not (1327.2 ± 623.4 ng/mL, P = 1.75 × 10-4 ; 206.3 ng/mL, P = 0.006). Estimated exposure thresholds of Imatinib and NDI were 1451.6 ng/mL with ROCAUC (95%CI) of 0.693 (0.597-0.789) and 207.1 ng/mL with ROCAUC (95%CI) of 0.646 (0.546-0.745), respectively. Multivariate regression confirmed the correlation of Imatinib Cmin with myelosuppression. Other side effects such as fluid retention and rash were not found to be correlated with Imatinib concentrations. These results suggest that trough concentration of Imatinib should be taken into consideration to increase the safety of Imatinib therapy in GIST patients.

Identification of an ND4 Mutation in Leber Hereditary Optic Neuropathy.

SIGNIFICANCE: We identified a missense mutation, m.11778G>A (p.R340H), in the mitochondrially encoded NADH dehydrogenase 4 gene (ND4) in eight patients and three asymptomatic carriers, even though the incidence of this has been considered low in Chinese population. These results have implications for the families' genetic counseling and clinical management. PURPOSE: Leber hereditary optic neuropathy (LHON OMIM 535000) is one of the most common inherited optic neuropathies. The aim of this study was to identify the genetic cause in two Han Chinese families with LHON. METHODS: We used Sanger sequencing to identify the genetic cause of two Han Chinese families from Hunan, China, with LHON. RESULTS: The patients in these two families presented with typical LHON, with male patients experiencing more severe phenotypes. A missense mutation, m.11778G>A (p.R340H), in the ND4 gene was identified in eight patients and three asymptomatic carriers, even though the incidence of this has been considered low in Chinese population. CONCLUSIONS: Eight of 11 family members (72.7%) manifested some vision loss, which is far higher percentage than reported in other studies. The variant is predicted to be the disease-causing mutation and results in seriously abnormal function of complex I subunits of the mitochondrial respiratory chain. These results have implications for the families' genetic counseling and clinical management and help to develop new LHON target-gene therapy strategies.

Simultaneous quantification of imatinib and its main metabolite N-demethyl-imatinib in human plasma by liquid chromatography-tandem mass spectrometry and its application to therapeutic drug monitoring in patients with gastrointestinal stromal tumor.

The aim of this study was to improve and validate a more stable and less time-consuming method based on liquid chromatography and tandem mass spectrometry (LC- MS/MS) for the quantitative measurement of imatinib and its metabolite N-demethyl-imatinib (NDI) in human plasma. Separation of analytes was performed on a Waters XTerra RP18 column (50 × 2.1 mm i.d., 3.5 µm) with a mobile phase consisting of methanol-acetonitrile-water (65:20:15, v/v/v) with 0.05% formic acid at a flow-rate of 0.2 mL/min. The Quattro MicroTM triple quadruple mass spectrometer was operated in the multiple-reaction-monitoring mode via positive electrospray ionization interface using the transitions m/z 494.0 → 394.0 for imatinib, m/z 479.6 → 394.0 for NDI and m/z 488.2 → 394.0 for IS. The method was linear over 0.01-10 µg/mL for imatinib and NDI. The intra- and inter-day precisions were all <15% in terms of relative standard deviation, and the accuracy was within ±15% in terms of relative error for both imatinib and NDI. The lower limit of quantification was identifiable and reproducible at 10 ng/mL. The method was sensitive, specific and less time-consuming and it was successfully applied in gastrointestinal stromal tumor patients treated with imatinib.

Genetic analysis of the RIC3 gene in Han Chinese patients with Parkinson's disease.

Parkinson's disease (PD) is the second-most common etiologically complex neurodegenerative disease. Genetic abnormalities are thought to play an important role in the development of PD. Recently, mutations in the resistance to inhibitors of cholinesterase 3 gene (RIC3) have been reported to cause autosomal-dominant PD in Indian population. To determine whether RIC3 gene coding variant(s) are associated with PD in Han Chinese population, the RIC3 gene coding region in 218 mainland Han Chinese patients with PD and the identified variants in 242 normal controls were examined using direct sequencing analysis. Four known single nucleotide variants (c.354C>A, p.L118L, rs10839976; c.389G>A, p.C130Y, rs55990541; c.403C>T, p.P135S, rs73411617; and c.1054G>A, p.D352N, rs11826236) were identified in the RIC3 gene coding region. No significant differences were observed in either genotypic or allelic distributions between the PD patients and the normal controls (all P>0.05) for these four variants. Haplotype analysis showed that the presence of haplotype A-G-C-G (rs10839976-rs55990541-rs73411617-rs11826236) was associated with a 0.764-fold decreased risk (P=0.049, OR=0.764, 95% CI=0.585-0.999) for PD, whereas the presence of haplotype C-A-C-A was associated with a 2.143-fold increased risk (P=0.039, OR=2.143, 95% CI=1.023-4.488) for PD. The findings indicate that four variants: rs10839976, rs55990541, rs73411617 and rs11826236 in the RIC3 gene coding region may play little or no role in the development of PD. Two RIC3 gene haplotypes of four variants: A-G-C-G, and C-A-C-A might relate to either protection against or increased susceptibility to PD in the Han Chinese population, respectively.

[Alexithymia and negative emotions in cancer patients: Mediating effects of intrusive thoughts].

OBJECTIVE: To explore associations of negative emotions with alexithymia and intrusive thoughts in cancer patients.
 Methods: A total of 115 cancer patients were assessed by Impact of Event Scale-Revised, the 20-item Toronto Alexithymia Scale, the Center for Epidemiological Studies Depression Scale, and the state anxiety subscales of State-Trait Anxiety Inventory.
 Results: Negative emotions were positively correlated with alexithymia and the intrusive thoughts (r 0.251 to 0.600, P<0.01). Intrusive thoughts were significantly associated with the total score of alexithymia, difficulty in identifying feelings, and difficulty in describing feelings (r 0.261 to 0.430, P<0.01). The relation between alexithymia and negative emotions was partially mediated by intrusive thoughts, accounting for 40.71% of the alexithymia in total negative emotions.
 Conclusion: Intrusive thoughts play a role, at least partially in mediation of alexithymia and negative emotions.

Endocrine MPA enhances the effects of TAC chemotherapy on improvement of prognosis and increase in long-term survival rates for patients with endometrial cancer.

The aim of the present study was to investigate the effect of taxol, adriamycin and carboplatin (TAC) chemotherapy combined with endocrine medroxyprogesterone acetate (MPA) therapy for the treatment of patients with endometrial cancer. A retrospective analysis of 124 patients with endometrial cancer was performed by dividing the cohort into an experimental and control group. The 64 patients in the experimental group received TAC and MPA chemotherapy, whereas the 60 patients in the control group were treated with TAC chemotherapy only. Tissue samples scraped from the uterus were used to extract the total proteins and RNAs for the western blot and reverse transcription-quantitative polymerase chain reaction analyses, respectively. All the patients were followed up for 20-45 months, during which time prognostic data, and one- to three-year survival rates were recorded and compared. The rate of recurrence or metastasis was significantly lower in the experimental group compared with that in the control group (P<0.05) and the three-year survival rate of the experimental group was significantly higher than that of the control group (P<0.05). Furthermore, the mean metastasis-associated 1 (MTA1) protein and RNA expression levels were significantly lower in the experimental group compared with the control group (P<0.05), exhibiting ~30 and ~15% of the levels in the control group, respectively. Therefore, a treatment strategy of TAC chemotherapy combined with endocrine MPA therapy appears to effectively improve the prognosis and increase the long-term survival rates of patients with endometrial cancer. Such an enhancing effect may be mediated by the transcriptional downregulation of MTA1 expression.

Pain-related mediators underlie incision-induced mechanical nociception in the dorsal root ganglia.

Approximately 50-70% of patients experience incision-induced mechanical nociception after surgery. However, the mechanism underlying incision-induced mechanical nociception is still unclear. Interleukin-10 and brain-derived neurotrophic factor are important pain mediators, but whether interleukin-10 and brain-derived neurotrophic factor are involved in incision-induced mechanical nociception remains uncertain. In this study, forty rats were divided randomly into the incision surgery (n = 32) and sham surgery (n = 8) groups. Plantar incision on the central part of left hind paw was performed under anesthesia in rats from the surgery group. Rats in the sham surgery group received anesthesia, but not an incision. Von Frey test results showed that, compared with the sham surgery group, incision surgery decreased the withdrawal threshold of rats at 0.5, 3, 6 and 24 hours after incision. Immunofluorescence staining in the dorsal root ganglia of the spinal cord (L3-5) showed that interleukin-10 and brain-derived neurotrophic factor were expressed mainly on small- and medium-sized neurons (diameter < 20 µm and 20-40 µm) and satellite cells in the dorsal root ganglia of the spinal cord (L3-5) in the sham surgery group. By contrast, in the surgery group, high expression of interleukin-10 and brain-derived neurotrophic factor appeared in large-sized neurons (diameter > 40 µm) at 6 and 24 hours after incision surgery, which corresponded to the decreased mechanical withdrawal threshold of rats in the surgery group. These experimental findings suggest that expression pattern shift of interleukin-10 and brain-derived neurotrophic factor induced by incision surgery in dorsal root ganglia of rats was closely involved in lowering the threshold to mechanical stimulus in the hind paw following incision surgery. Pain-related mediators induced by incision surgery in dorsal root ganglia of rats possibly underlie mechanical nociception in ipsilateral hind paws.

Normal carcinoembryonic antigen indicates benefit from perioperative chemotherapy to gastric carcinoma patients.

AIM: To evaluate pretreatment serum carcinoembryonic antigen (CEA) as a predictor of survival for patients with locally advanced gastric cancer receiving perioperative chemotherapy. METHODS: We retrospectively studied a cohort of 228 gastric cancer patients who underwent D2 gastrectomy combined with chemotherapy at the Sun Yat-sen University Cancer Center between January 2005 and December 2009. Among them, 168 patients received 6-12 cycles of oxaliplatin-based adjuvant (post-operative) chemotherapy, while 60 received perioperative chemotherapy (2 cycles of FOLFOX6 or XELOX before surgery and 4-10 cycles after surgery). Serum CEA was measured using an enzyme immunoassay. The follow-up lasted until December 2010. RESULTS: In the group that had elevated serum CEA, the difference in survival time between patients receiving perioperative chemotherapy and those receiving adjuvant chemotherapy had no statistical significance (P > 0.05). However, in the group that had normal serum CEA, patients receiving perioperative chemotherapy had a longer survival time. In multivariate analysis, T staging and lymph node metastatic rate were independent prognostic factors for the patients. Perioperative chemotherapy improved the overall survival of patients who had a normal pretreatment CEA level (P = 0.070). CONCLUSION: Normal pretreatment serum CEA is a predictor of survival for patients receiving perioperative chemotherapy.

Significance of palliative gastrectomy for late-stage gastric cancer patients.

PURPOSE: To investigate the significance of palliative gastrectomy for different types of metastatic gastric cancer patients displaying peritoneal dissemination, hepatic metastasis, distant lymph node metastasis occurring locally during late-stage disease, and multi-organ metastases. METHODS: We performed a retrospective study of 862 patients who were histologically diagnosed as late-stage gastric cancer who could not undergo radical surgery at the Sun Yat-sen University Cancer Center between January 1993 and December 2008. The follow-up lasted until December 2010. Chi-square tests and Kaplan-Meier methods were employed to compare the adverse events and prognoses. RESULTS: In the peritoneal dissemination and multi-organ metastases groups, palliative gastrectomy has no survival benefit (P = 0.705, 0.331, respectively). In the patients with distant lymph-node metastases, liver metastasis and locally late-stage gastric cancer patients, palliative gastrectomy was a prognostic factor (P < 0.001, P < 0.001, P = 0.010, respectively). Multivariable analysis demonstrated that palliative gastrectomy was an independent prognostic factor for distant lymph-node metastases, liver metastasis, and local late-stage gastric cancer patients. Palliative gastrectomy combined with hepatectomy proved to be an independent prognostic factor to improve the overall survival of patients with liver metastases who underwent palliative gastrectomy (P = 0.008). CONCLUSION: For late-stage gastric cancer patients, palliative gastrectomy should be considered for locally late-stage, distant lymph node metastasis, and resectable liver metastasis patients. Especially among patients with liver metastasis, transfer medicine is essential for potentially curable patients to obtain access to radical surgery to improve the prognosis.

Efficacy and safety of XELOX and FOLFOX6 adjuvant chemotherapy following radical total gastrectomy.

The purpose of this study was to compare the efficacy and safety of capecitabine and oxaliplatin (XELOX) with 5-fluorouracil, folinic acid and oxaliplatin (FOLFOX6) for advanced gastric cancer following total gastrectomy. We performed a retrospective study of 148 gastric cancer patients undergoing total gastrectomy combined with adjuvant chemotherapy from January, 2003 to June, 2009. The follow-up lasted until December, 2010. The Chi-square test and Kaplan-Meier methods were employed to compare the adverse events and prognosis. The total 1-, 3- and 5-year survival rates were 95, 80 and 32%, respectively, and there was no significant difference between the two groups (P=0.273). Similarly, the total incidence of side effects was similar, but each treatment was associated with unique disturbances. The number of patients developing hand-foot syndrome in the XELOX group was far higher compared to the FOLFOX6 group (P=0.000). By contrast, more patients in the FOLFOX6 group suffered from nausea (P=0.024), vomiting (P=0.029), alopecia (P=0.033) and peripheral phlebitis (P=0.004). The total completion rate of the XELOX group was higher compared to the FOLFOX6 group (P=0.015). No significant difference was found in the prognosis of patients receiving XELOX therapy or FOLFOX6 therapy following total gastrectomy. XELOX was, however, more tolerable for patients with total gastrectomy.

[Emotional problems and parenting locus of control in children with anxiety disorders].

OBJECTIVE: To carry out a preliminary study on the emotional problems and parenting locus of control among children with anxiety disorders. METHODS: A total of 110 children with simple anxiety disorders (AD group) and 113 normal children (control group) from September to December 2005 were enrolled. Children were asked to complete the Depression Self-Rating Scale for Children (DSRSC), the Screen for Child Anxiety Related Emotional Disorders (SCARED), and the Parenting Locus of Control Scale (PLOC).A total of 197 valid scales were returned. RESULTS: The scores of somatic, generalized anxiety, separation anxiety, social phobia anxiety, school phobia anxiety, total anxiety, and total depression were all higher in the AD group than in the control group (P<0.01). The score of "education effects" for parents was significantly higher in the AD group than that in the control group (P<0.01). CONCLUSIONS: Children with anxiety disorders tend to have more emotional problems and poorer parental education effects.

Incorporation of extranodal metastasis of gastric carcinoma into the 7th edition UICC TNM staging system.

BACKGROUND: To assess the clinical significance and prognostic impact of extranodal metastasis (EM) in gastric carcinoma and establish an optimal classification in the staging system. METHODOLOGY/PRINCIPAL FINDINGS: A total of 1343 patients with gastric carcinoma who underwent surgical resection were recruited to determine the frequency and prognostic significance of EMs. EMs were divided into two groups (EM1 and EM2) and then incorporated into the 7(th) edition UICC TNM staging system. EMs was detected in 179 (13.3%) of 1343 patients who underwent radical resection. Multivariate analysis identified EMs as an independent prognostic factor (HR = 1.412, 95%CI = 1.151-1.731, P<0.001). After curative operation, the overall survival rate were worse in patients with ≥3 cases of EM (EM2) than those with the number of 1 and 2 cases (EM1) (P<0.001). Survival of patients with EM1 was found almost comparable to that of N3 stage (P = 0.437). Survival of patients with EM2 showed similar to that of stage IV patients (P = 0.896). By using the linear trend X(2), likelihood ratio X(2), and Akaike information criterion (AIC) test, EM1 treated as N3 stage and EM2 treated as M1 stage performed higher linear trend X(2) scores, likelihood ratio X(2) scores, and lower AIC value than the 7(th) edition UICC TNM staging system, which represented the optimum prognostic stratification, together with better homogeneity, discriminatory ability, and monotonicity of gradients. CONCLUSIONS/SIGNIFICANCE: EMs might be classified based on their number and prognostic information and should incorporate into the TNM staging system.