Higher serum carotenoid concentrations were associated with the lower risk of cancer-related death: Evidence from the National Health and Nutrition Examination Survey.

The study focuses on the association between serum carotenoids and cancer-related death. Using data from the National Health and Nutrition Examination Survey (2001-2006 and 2017-2018), the study encompasses 10,277 participants older than age 20 years, with recorded baseline characteristics and serum carotenoid concentrations (including α-carotene, trans-ß-carotene, cis-ß-carotene, ß-cryptoxanthin, trans-lycopene, and lutein/zeaxanthin). We hypothesized that serum carotenoid concentrations were negatively associated with cancer-related death. The weighted chi-square analyses indicate significant negative correlations between higher serum concentrations of α-carotene, ß-cryptoxanthin, trans-lycopene, and total carotenoids, and the risk of cancer-related deaths. Using weighted Cox regression analysis, this study confirms that α-carotene, ß-cryptoxanthin, trans-lycopene, and total carotenoids, as continuous or categorical variables, are inversely related to cancer mortality (P < .0001). Furthermore, considering competitive risk events, lower concentrations of serum ß-cryptoxanthin (Fine-Gray P = 1.12e-04), trans-lycopene (P = 5.68e-14), and total carotenoids (P = .03) are associated with an increased risk of cancer-related deaths. The research reveals a crucial inverse relationship between serum carotenoid concentrations and cancer-related death.

Salt Anion Amphiphilicity-Activated Electrolyte Cosolvent Selection Strategy toward Durable Zn Metal Anode.

One effective solution to inhibit side reactions and Zn dendrite growth in aqueous Zn-ion batteries is to add a cosolvent into the Zn(CF3SO3)2 electrolyte, which has the potential to form a robust solid electrolyte interface composed of ZnF2 and ZnS. Nevertheless, there is still a lack of discussion on a convenient selection method for cosolvents, which can directly reflect the interactions between solvent and solute to rationally design the electrolyte solvation structure. Herein, logP, where P is the octanol-water partition coefficient, a general parameter to describe the hydrophilicity and lipophilicity of chemicals, is proposed as a standard for selecting cosolvents for Zn(CF3SO3)2 electrolyte, which is demonstrated by testing seven different types of solvents. The solvent with a logP value similar to that of the salt anion CF3SO3- can interact with CF3SO3-, Zn2+, and H2O, leading to a reconstruction of the electrolyte solvation structure. To prove the concept, methyl acetate (MA) is demonstrated as an example due to its similar logP value to that of CF3SO3-. Both the experimental and theoretical results illustrate that MA molecules not only enter into the solvation shell of CF3SO3- but also coordinate with Zn2+ or H2O, forming an MA and CF3SO3- involved core-shell solvation structure. The special solvation structure reduces H2O activity and contributes to forming an anion-induced ZnCO3-ZnF2-rich solid electrolyte interface. As a result, the Zn||Zn cell and Zn||NaV3O8·1.5H2O cell with MA-involved electrolyte exhibit superior performances to that with the MA-free electrolyte. This work provides an insight into electrolyte design via salt anion chemistry for high-performance Zn batteries.

Long-term aspirin administration suppresses inflammation in diabetic cystopathy.

Diabetic cystopathy (DCP) is one of the most common and troublesome urologic complications of diabetes mellitus, characterized by chronic low-grade inflammatory response. However, the correlation between inflammation and disease progression remains ambiguous and effective drugs interventions remain deficient. Herein, during 12-week study, 48 male Sprague-Dawley rats were randomly assigned to four groups: negative control (NC), NC treated with aspirin (NC+Aspirin), DCP, and DCP treated with aspirin (DCP+Aspirin). Type 1 diabetes mellitus was established by intraperitoneal injection of streptozotocin (65 mg/kg). After 2 weeks modeling, the rats in treatment groups received daily oral aspirin (100 mg/kg/d). After 10 weeks of treatment, aspirin ameliorated pathological weight loss and bladder weight increase in diabetic rats, accompanied by a 16.5% decrease in blood glucose concentrations. H&E, Masson, immunohistochemistry and transmission electron microscopy revealed that a dilated bladder with thickened detrusor smooth muscle (DSM) layer, inflammatory infiltration, fibrosis and ultrastructural damage were observed in diabetic rats, which were obviously ameliorated by aspirin. The dynamic investigations at 4, 7 and 10 weeks revealed inflammation gradually increased as the disease progresses. After 10 weeks of treatment, the expression of TNF-α, IL-1ß, IL-6, and NF-κB has been decreased to 78%, 39.7%, 44.1%, 33.3% at mRNA level and 67.6%, 76.7%, 71.4%, 67.1% at protein level, respectively (DCP+Aspirin vs. DCP, p < 0.01). Aspirin partially restored the increased expression of inflammatory mediators in bladder DSM of diabetic rats. The study provided insight into long-term medication therapies, indicating that aspirin might serve as a potential strategy for DCP treatment.

Identification and initial validation of maximal tumor area as a novel prognostic factor for overall and disease-free survival in patients with resectable colon cancer: a retrospective study.

BACKGROUND: The tumor area may be a potential prognostic indicator. The present study aimed to determine and validate the prognostic value of tumor area in curable colon cancer. METHODS: This retrospective study included a training and validation cohorts of patients who underwent radical surgery for colon cancer. Independent prognostic factors for overall survival (OS) and disease-free survival (DFS) were identified using Cox proportional hazards regression models. The prognostic discrimination was evaluated using the integrated area under the receiver operating characteristic curves (iAUCs) for prognostic factors and models. The prognostic discrimination between tumor area and other individual factors was compared, along with the prognostic discrimination between the tumor-node-metastasis (TNM) staging system and other prognostic models. Two-sample Wilcoxon tests were carried out to identify significant differences between the two iAUCs. A two-sided P <0.05 was considered statistically significant. RESULTS: A total of 3051 colon cancer patients were included in the training cohort and 872 patients in the validation cohort. Tumor area, age, differentiation, T stage, and N stage were independent prognostic factors for both OS and DFS in the training cohort. Tumor area had a better OS and DFS prognostic discrimination characteristics than T stage, maximal tumor diameter, differentiation, tumor location, and number of retrieved lymph nodes. The novel prognostic model of T stage + N stage + tumor area (iAUC for OS, 0.714, P <0.001; iAUC for DFS, 0.694, P <0.001) showed a better prognostic discrimination than the TNM staging system (T stage + N stage; iAUC for OS, 0.664; iAUC for DFS, 0.658). Similar results were observed in an independent validation cohort. CONCLUSIONS: Tumor area was identified as an independent prognostic factor for both OS and DFS in curable colon cancer patients, and in cases with an adequate number of retrieved lymph nodes. The novel prognostic model of combining T stage, N stage, and tumor area may be an alternative to the current TNM staging system.

Highly durable aqueous Zn ion batteries based on a Zn anode coated by three-dimensional cross-linked and branch-liked bismuth-PVDF layer.

Rechargeable aqueous Zn ion batteries have been regarded as one of the most promising candidates for next-generation energy storage devices due to their low cost, non-toxicity and high safety. However, the dendrite growth of Zn anode and severe undesired side-reactions largely limited their practical application. Here, we developed a bismuth (Bi)-PVDF layer with unique 3D cross-linked and branch-liked structures as a protective layer on the Zn surface (Zn@Bi-PVDF) to suppress the formation of Zn dendrites and side-reactions, leading to the uniform plating and stripping of Zn during the cycles. Consequently, the symmetric cell with Zn@Bi-PVDF electrodes exhibits long cycling life over 2400 h at a current density of 1 mA cm-2 with a fixed capacity of 1 mAh cm-2. When the Zn@Bi-PVDF anode is paired with a NaV3O8·1.5H2O (NVO) cathode, the fabricated Zn@Bi-PVDF//NVO cell maintains a high reversible capacity of 175.5 mAh g-1 at 1 A g-1 after 500 cycles with an initial capacity retention of 64.1%.

Suppression of Grape White Rot Caused by Coniella vitis Using the Potential Biocontrol Agent Bacillus velezensis GSBZ09.

Grape white rot caused by Coniella vitis is prevalent in almost all grapevines worldwide and results in a yield loss of 10-20% annually. Bacillus velezensis is a reputable plant growth-promoting bacterial. Strain GSBZ09 was isolated from grapevine cv. Red Globe (Vitis vinifera) and identified as B. velezensis according to morphological, physiological, biochemical characteristics and a multilocus gene sequence analysis (MLSA) based on six housekeeping genes (16S rRNA, gyrB, rpoD, atpD, rho and pgk). B. velezensis GSBZ09 was screened for antifungal activity against C. vitis under in vitro and in vivo conditions. GSBZ09 presented broad spectrum antifungal activity and produced many extracellular enzymes that remarkably inhibited the mycelial growth and spore germination of C. vitis. Furthermore, GSBZ09 had a high capacity for indole-3-acetic acid (IAA) production, siderophore production, and mineral phosphate solubilization. Pot experiments showed that the application of GSBZ09 significantly decreased the disease index of the grape white rot, directly promoted the growth of grapes, and upregulated defense-related enzymes. Overall, the features of B. velezensis GSBZ09 make it a potential strain for application as a biological control agent against C. vitis.

Simplified flow cytometry scoring for diagnosis and prognosis of myelodysplastic symptom.

A flow cytometric score (FCM-score) to diagnose myelodysplastic syndromes (MDS) was proposed in 2012 that used four parameters to distinguish low-grade MDS from non-clonal cytopenias. This study was carried out to further simplify the method for better clinical application. Combinations of antibodies CD34, CD19, CD33 and CD45 were analyzed for the four parameters. Compared with the published method that used low side scatter (SSC) and CD45 expression to separate B lymphocyte progenitor cells and myeloblasts, our method (MFCM-Score) used CD19 and CD33 to separate B lymphocyte progenitor cells and myeloblasts within the CD34+CD45dimm population. Subjects were analyzed and compared using the two schemes. In addition, the relationships between the MFCM-Score and the Revised International Prognostic Scoring System (IPSS-R) for MDS were analyzed. There was no significant difference between the MFCM-score and FCM-score in the diagnosis of MDS (P > 0.05); MFCM-score had a positive correlation with the IPSS-R prognosis classification for MDS (Spearman r = 0.848, P < 0.001). All parameters in the MFCM-score were positively correlated to the IPSS-R grades in MDS (P < 0.01). Our work demonstrates that the FCM score using four parameters is simple and practical for screening MDS patients and the MFCM-score could be used to evaluate the risk of MDS patients.

Influence of patient characteristics on chimeric antigen receptor T cell therapy in B-cell acute lymphoblastic leukemia.

CD19-specific chimeric antigen receptor T cell (CD19 CAR T) therapy has shown high remission rates in patients with refractory/relapsed B-cell acute lymphoblastic leukemia (r/r B-ALL). However, the long-term outcome and the factors that influence the efficacy need further exploration. Here we report the outcome of 51 r/r B-ALL patients from a non-randomized, Phase II clinical trial (ClinicalTrials.gov number: NCT02735291). The primary outcome shows that the overall remission rate (complete remission with or without incomplete hematologic recovery) is 80.9%. The secondary outcome reveals that the overall survival (OS) and relapse-free survival (RFS) rates at 1 year are 53.0 and 45.0%, respectively. The incidence of grade 4 adverse reactions is 6.4%. The trial meets pre-specified endpoints. Further analysis shows that patients with extramedullary diseases (EMDs) other than central nervous system (CNS) involvement have the lowest remission rate (28.6%). The OS and RFS in patients with any subtype of EMDs, higher Tregs, or high-risk genetic factors are all significantly lower than that in their corresponding control cohorts. EMDs and higher Tregs are independent high-risk factors respectively for poor OS and RFS. Thus, these patient characteristics may hinder the efficacy of CAR T therapy.

The prognostic value of tumour-associated macrophages in Non-Hodgkin's lymphoma: A systematic review and meta-analysis.

Tumour-associated macrophages (TAMs) play an important role in the tumour environment and were reported to be associated with poor prognosis in several tumours. However, the prognostic significance of TAMs in Non-Hodgkin's Lymphoma (NHL) remains controversial. Consequently, we aimed to evaluate the relationship between subpopulations of TAMs and clinical outcomes in NHL patients. We did a comprehensive search of the PubMed, elsevier ScienceDirect, and Cochrane databases and extracted hazard ratio (HR) and their corresponding 95% confidence intervals (95% CIs) from eligible studies. Pooling total effect value by the stata statistical software and analysing correlation of TAMs with overall survival (OS) and progression-free survival (PFS). Furthermore, subgroup analysis and sensitivity analysis were also conducted. We deemed eleven studies, including 1211 NHL patients. Our study demonstrated that high-density CD68+ TAMs are associated with poor OS (HR: 1.17; 95% CI, 0.81-1.54; P = .000) and poor PFS (HR: 1.15; 95% CI, 0.63-1.67; P = .000) compared with low-density CD68+ TAMs in the tumour microenvironment. Similarly, high-density CD163+ TAMs can also predict poor OS (HR: 1.52; 95% CI, 1.11-1.92; P = .000) and shorter PFS (HR: 1.52; 95% CI, 0.73-2.30; P = .000). In addition, the high CD163+ /CD68+ TAMs ratio is significantly correlated with poor OS (HR: 3.59; 95% CI, 0.77-6.40; P = .013). However, in our subgroup analysis, high-density CD68+ TAMs in the tumour microenvironment is associated with better OS (HR: 0.75; 95% CI, 0.41-1.09; P = .000) in NHL patients treated with rituximab chemotherapy. Our results suggest that TAMs are a robust predictor of outcomes in NHL.

Hepatosplenic T-Cell Lymphoma in an Immunocompetent Male with Central Nervous System Invasion: A Rare Clinical Entity.

Hepatosplenic T-cell lymphoma (HSTCL) is a very rare non-Hodgkin lymphoma with an aggressive clinical course and poor prognosis. Patients of this disease usually presented with hepatosplenomegaly, which can be misdiagnosed or delayed. Bone marrow (BM) and peripheral blood (PB) are frequently involved, however, central nervous system (CNS) involvement is less common. Here, we are reporting an unusual case of hepatosplenic γδ T-cell lymphoma in a 64-year-old man with CNS involvement. Flow cytometry immunophenotyping was proved of great diagnostic contribution. © 2018 International Clinical Cytometry Society.

Immune dysregulation in primary immune thrombocytopenia patients.

OBJECTIVES: To explore the immunological abnormalities in patients with primary immune thrombocytopenia (ITP), and analyze its relationship with treatment. METHODS: Proportion of different immune cell subsets were detected in the peripheral blood of 124 ITP patients at different time points and 45 normal controls by flow cytometry. The treatments included glucocorticoids, intravenous IgG as first-line treatment and second-line drugs. RESULTS: Elevated CD4/CD8 ratio and decreased the proportion of NK and CD4 + CD25 + CD127low regulatory T cells (Tregs) were found in pre-treated ITP patients than healthy controls. The newly diagnosed group had a significantly higher CD4/CD8 ratio than the relapsed group, but no differences in the proportion of B cells, NK cells and Tregs. No relationships were found between the curative effect and the pre-treated cell subsets within both the effective and ineffective groups. Furthermore, compared with the ineffective group, the effective group had higher Tregs and lower CD4/CD8 ratio post-treatment, but no significant differences in NK and B cells. CONCLUSION: ITP patients presented with a high CD4/CD8 ratio and low levels of Tregs and NK cells, suggesting that immune deregulation was involved in the pathogenesis of ITP. The pre-treated immune status of ITP patients may not be related to the curative effect. Tregs significantly increased in the effective group post-treatment, highlighting that the mechanism of restoring Tregs may be involved in the treatment of ITP. However, whether or not the targeted regulation of Tregs is an effective treatment for ITP still requires further studies.

Low dose IL-2 increase regulatory T cells and elevate platelets in a patient with immune thrombocytopenia.

Immune thrombocytopenia (ITP) is an autoimmune disorder in which its immune system destroys platelets and leads to haemorrhage symptom. Recent studies have found that regulatory T cells (Tregs) in peripheral blood, bone marrow, and spleen were reduced in ITP patients and recovered after effective ITP therapy. Low-dose Interleukin-2 (IL-2) has been reported recently to increase Tregs and used to treat autoimmune disease including graft-versus-host disease (GVHD) after organ transplantation and HCV-related autoimmune vasculitis. However, it is unknown whether IL-2 is able to treat ITP. We have used low-dose IL-2 (1.0 million IU/day) on 5 consecutive days per week for 4 weeks in a 36-year-old patient with ITP. The result has shown that low-dose IL-2 induces expansion of Tregs significantly and increase platelet count was gradually from 36 × 109 /L to maximum 85 × 109 /L. No side effects of IL-2 have been found. This result suggested that low-dose of IL-2 may have therapeutic potential for ITP. © 2016 International Clinical Cytometry Society.

Therapeutic potential of low-dose IL-2 in immune thrombocytopenia: An analysis of 3 cases.

Immune thrombocytopenia (ITP) is an acquired immune-mediated disorder with regulatory T cells (Tregs) reduction. Recent studies have shown that low-dose interleukin-2 can preferentially induce Treg expansion in vivo, and therefore offers a therapeutic strategy against immune thrombocytopenia. We have demonstrated in a previous study that Tregs and platelet counts significantly improve in an adult with ITP following low-dose IL-2 treatment. Here we report the efficacy of low-dose IL-2 in another three adults with immune thrombocytopenia who failed the first-line treatment. All patients received a dose of 1.0 million IU IL-2/day for 5 consecutive days per week as a cycle for 2 or 4 weeks. In addition to IL-2, vincristine (2 mg IV weekly × 3 weeks) was added to one patient as a combination therapy. No specific treatment was added in the other two patients. Two cases exhibited significantly increased platelet counts with improved levels of Tregs, while no changes were observed for the remaining patient. In summary, administration of daily subcutaneous low-dose IL-2 was safe, and it may be a new therapeutic option for treatment of ITP, especially refractory ITP. © 2017 International Clinical Cytometry Society.

MicroRNA-497 acts as a tumor suppressor in gastric cancer and is downregulated by DNA methylation.

Gastric cancer (GC) is one of the most common malignant tumors in the world and microRNAs (miRNAs) play an important role in GC. In this study, we found miR­497 played an important role and served as a novel biomarker in GC. Quantitative real-time PCR (qRT-PCR) was used to measure the miR­497 expression in GC cell lines and 86 paired GC samples and we also analyzed its correlation with GC clinicopathological parameters. A series of cellular function experiments were applied to validate the effects of miR­497 on GC. In addition, methylation-specific PCR (MSP) was applied to detect the gene methylation status. Finally, the correlation between miR­497 and the target gene was analyzed by western blotting assay. miR­497 was reduced obviously in GC cells and tissues and significantly associated with the pathologic stage. Low expression of miR­497 significantly inhibited the proliferation, invasion and migration of GC cell lines and accelerated apoptosis. Moreover, we found that the aberrant expression of miR­497 may be ascribed to DNA methylation. microRNA.org and luciferase reporter assay suggested that RAF1 was a direct target of miR­497 in GC. This study suggested that miR­497 could serve as a tumor suppressor and a potential early diagnostic marker of GC by targeting Raf-1 proto-oncogene, serine/threonine kinase (RAF1).

Up-regulation of CRKL by microRNA-335 methylation is associated with poor prognosis in gastric cancer.

BACKGROUND: MicroRNAs have been suggested to play a vital role in regulating carcinogenesis, tumor progression and invasion. MiR-335 is involved in suppressing metastasis and invasion in various human cancers. However, the mechanisms responsible for the aberrant expression of miR-335 in gastric cancer (GC) remain unknown. METHODS: Expression of miR-335 in four GC cell lines and 231 GC tissues was determined by real-time quantitative reverse transcriptase-polymerase chain reaction (qRT-PCR). DNA methylation status in the CpG islands upstream of miR-335 in GC cell lines and tissues was determined by methylation-specific PCR and bisulfite sequence-PCR. The effects of the demethylating agent 5-aza-2'-deoxycytidine on cell proliferation, apoptosis, cell cycle, migration, and invasion were investigated in GC cell lines. RESULTS: Cancer-specific methylation was detected in the upstream CpG-rich regions of miR-335, which dramatically silenced its transcriptional activity in GC cell lines and tissues. Low levels of miR-335 expression and high levels of miR-335 methylation in GC tissues were associated with poor clinical features and prognosis. Restoration of miR-335 expression in GC cells promoted cell apoptosis, inhibited tumor cell migration, invasion, and proliferation, and arrested the cell cycle at G0/G1 phase. Overexpression of miR-335 significantly reduced the activity of a luciferase reporter containing the 3' untranslated region of V-crk avian sarcoma virus CT10 oncogene homolog-like (CRKL). CONCLUSIONS: MiR-335 functions as a tumor suppressor and may be silenced by promoter hypermethylation. It plays a role in inhibiting tumor cell migration, invasion, and proliferation, arresting the cell cycle at G0/G1 phase, and promoting apoptosis in GC cells through targeting CRKL.

Downregulation of ADAMTS8 by DNA Hypermethylation in Gastric Cancer and Its Clinical Significance.

A disintegrin and metallopeptidase with thrombospondin motif type 8 (ADAMTS8), a member of the ADAMTS family, was discovered as a novel angiogenesis inhibitor. We analyzed the expression and methylation of ADAMTS8 in primary gastric tumors and gastric cancer cell lines. We also examined the relationship between ADAMTS8 expression and methylation and clinicopathologic features. The results showed that the significant downregulation of ADAMTS8 mRNA expression was observed in gastric cancer cell lines and tissues, and its expression was related to invasive depth and lymph node metastasis. CpG was hypermethylated in gastric cancer cell lines MKN45, MGC803, and BGC823, as well as primary gastric cancer specimens. ADAMTS8 mRNA expression was significantly lower in methylated primary gastric tumors. A significant association was found between ADAMTS8 methylation status and lymph node metastasis in primary gastric cancer. Moreover, ADAMTS8 expression was upregulated in the gastric cancer cell lines MGC803, BGC823, and MKN45 after treatment with 5-aza-2'-deoxycytidine. Thus, our results demonstrate that expression of ADAMTS8 mRNA is significantly decreased and DNA methylation is frequent in gastric cancer. ADAMTS8 hypermethylation is associated with decreased expression in gastric cancer and may play an important role in the invasion and metastasis of gastric cancer.

MiR-455-5p acts as a novel tumor suppressor in gastric cancer by down-regulating RAB18.

AIM: To detect the potential regulation pathway of microRNA-455-5p (miR-455-5p) and RAB18, member RAS oncogene family (RAB18) in gastric cancer (GC) cells and tissues and discuss the clinical significance of miR-455-5p in GC genesis and progression. METHODS: Real-time PCR was used to measure mRNA level of miR-455-5p in GC, TargetScan and dual luciferase assay were used to predict and demonstrate the candidate target gene of miR-455-5p, Western blot were utilized to detect the protein level of RAB18. Cell function assays were also performed to determine the function of miR-455-5p in GC. RESULTS: miR-455-5p was reduced significantly in gastric cancer cells and tissues compared with the corresponding normal control, the lower expression of miR-455-5p was related to advanced clinical stage in gastric cancer, re-expression of miR-455-5p could inhibit human GC cell proliferation and invasion, overexpression of miR-455-5p could also promote GC cell apoptosis. Furthermore, we found that RAB18 was a candidate target of miR-455-5p. Re-expression of miR-455-5p could inhibit the protein level of RAB18. CONCLUSION: MiR-455-5p might serve as a novel biomarker in gastric cancer by targeting RAB18.

Ti3C2Tx Filler Effect on the Proton Conduction Property of Polymer Electrolyte Membrane.

Conductive polymer electrolyte membranes are increasingly attractive for a wide range of applications in hydrogen-relevant devices, for instance hydrogen fuel cells. In this study, two-dimensional Ti3C2Tx, a typical representative of the recently developed MXene family, is synthesized and employed as a universal filler for its features of large specific surface area, high aspect ratio, and sufficient terminated -OH groups. The Ti3C2Tx is incorporated into polymer matrix to explore its function on membrane microstructure and proton conduction property. Both phase-separated (acidic Nafion and sulfonated poly(ether ether ketone)) and non-phase-separated (basic chitosan) polymers are utilized as membrane matrixes. The microstructures, physicochemical properties, and proton conduction properties of the membranes are extensively investigated. It is demonstrated that Ti3C2Tx generates significant promotion effect on proton conduction of the composite membrane by facilitating both vehicle-type and Grotthuss-type proton transfer, yielding several times increased proton conductivity for every polymer-based composite membrane under various conditions, and the composite membrane achieves elevated hydrogen fuel cell performance. The stable Ti3C2Tx also reinforces the thermal and mechanical stabilities of these composite membranes. Since the MXene family includes more than 70 members, this exploration is expected to open up new perspectives for expanding their applications, especially as membrane modifiers and proton conductors.

Type D Personality in Gastric Cancer Survivors: Association With Poor Quality of Life, Overall Survival, and Mental Health.

CONTEXT: The associations between Type D personality and poor quality of life, overall survival, and mental health in gastric cancer survivors. OBJECTIVES: The aim of this research was to explore quality of life (QoL), mental health status, Type D personality, symptom duration, and emergency admissions of Chinese gastric cancer patients, as well as the relationship between these factors. METHODS: Eight hundred thirty eligible Chinese patients newly diagnosed with gastric cancer between July 2009 and July 2011 were enrolled in this prospective study. Type D personality was measured with the 14-item Type D Personality Scale (DS14). Mental health status was measured with the Hospital Anxiety and Depression Scale. The QoL outcomes were assessed longitudinally using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 and Quality of Life Questionnaire-STO22 at baseline and six months after diagnosis. RESULTS: The proportion of patients with symptom duration of more than one month and who were diagnosed after emergency admissions in the Type D group was significantly higher than that in the non-Type D personality group. At both of the time points, Type D patients reported statistically significant lower scores on role, emotional, cognitive, and social functioning (all Ps < 0.001) functional scales, global health status/QoL scales (P < 0.001), and worse symptom scores compared to patients without a Type D personality. During the six-month time frame, a higher percentage of patients in the Type D group demonstrated a considerable QoL deterioration. Clinically elevated levels of anxiety and depression were more prevalent in Type D than in non-Type D survivors (both Ps < 0.001). There was a statistically significant difference in three-year overall survival between the patients in the Type D group and the non-Type D personality group. CONCLUSION: Type D personality is associated with poor QoL, three-year overall survival and mental health status among survivors of gastric cancer, even after adjustment of confounding background variables. The Type D personality group experienced increased levels of pain and fatigue compared to non-Type D patients. Type D personality might be a general vulnerability factor to screen for subgroups at risk of longer symptom duration and emergency admissions in clinical practice.