RESUMEN

Background: The role of fear-avoidance beliefs (FAB) in patients with chronic pain has been widely confirmed. However, few conclusions have been drawn about its role in postoperative patients. Objective: To explore the characteristics of FAB in postoperative patients after lung surgery as well as the effect of threat learning on FAB. Methods: Between May and September 2022, this study recruited 150 participants who had undergone thoracoscopic surgery. Variables such as age, gender, education, chronic pain, fear of pain, surgery method, pain intensity, FAB, cough, ambulation and threat learning were collected and subjected to correlation analysis and stepwise regression. Results: The correlation analysis revealed that FAB was associated with age (r = -0.183, p < 0.05), gender (r = -0.256, p < 0.01), and preoperative FOP-9 (r = 0.400, p < 0.01). Postoperative variables such as pain intensity (r = 0.574, p < 0.01), initiation day of ambulation (r = 0.648, p < 0.01), total numbers of ambulation (r = -0.665, p < 0.01), and cough performance (r = -0.688, p < 0.01) were correlated with FAB. Furthermore, FAB was highly correlated with indicators of threat learning: direct (r = 0.556, p < 0.01), observation (r = 0.655, p < 0.01), and instruction (r = 0.671, p < 0.01). The highest variance explanation model of stepwise regression which explained 52.8% of the variance including instruction (B=1.751; p<0.01), direct (B=1.245; p<0.01), observation (B=0.768; p<0.01), age (B=-0.085; p<0.01), and surgery method (B=1.321; p<0.05). Conclusion: Patients commonly experience FAB after lung surgery, which can directly affect their recovery behaviors such as ambulation and active coughing. The formation of FAB is influenced by threat learning, which suggests that controlling threat learning is important in preventing postoperative FAB.

RESUMEN

Studies have shown that the physical, psychological, and social problems of liver cancer patients are more serious than those of other cancer patients and their quality of life is significantly reduced. This may be related to the poor treatment effect of patients with advanced liver cancer. Patients often have adverse symptoms such as cancer pain, pleural effusion, and ascites, etc., which have a great impact on patients' psychology and recovery from illness. With the change of the medical model, it has become history to rely solely on drugs to care for patients with advanced liver cancer and comprehensive nursing intervention has become very important. Continuous nursing intervention focuses on individualized and full-hearted care, effectively alleviating patients' anxiety and fear and improving patients' environmental adaptability and psychological defense mechanisms. However, in the field of liver cancer, there is no detailed comparison between the efficacy of continuous nursing and traditional conventional nursing. This article applies the hidden Markov model, starts with medical data mining, and describes the process achieved by the application of this article and the analysis of the results obtained by the two nursing methods, which reflect the difference in curative effect evaluation, and it proves that continuous nursing has more advantages in the curative effect of patients with liver tumors.

Asunto(s)

Minería de Datos/métodos , Neoplasias Hepáticas/enfermería , Modelos de Enfermería , Algoritmos , China , Biología Computacional , Minería de Datos/estadística & datos numéricos , Humanos , Cadenas de Markov

RESUMEN

Background: A lack of knowledge and inadequate practices of health care providers (HCPs) are the main obstacles to effective cancer pain management (CPM). The main objective of the study was to evaluate the CPM knowledge, CPM practice, and attitudes towards pharmacists' participation and advanced methods in CPM of physicians, nurses, and pharmacists in China. Methods: An open online survey was adopted using social media software (WeChat) as the platform to conduct a nationwide survey of HCPs involved in CPM in public medical institutions at all levels in China from March to June 2019. Results: A total of 1279 physicians, 2267 nurses, and 1466 pharmacists participated in the survey. Among the three types of professionals, nurses had the highest level of practical ability (61.63 ± 28.99) and best attitudes towards pharmacists' participation and advanced methods in CPM (72.05 ± 33.71) and physicians had the best mastery of CPM-related knowledge (69.60 ± 28.45), while pharmacists performed the worst in these three aspects (50.04 ± 26.69, 61.49 ± 28.95, and 62.07 ± 36.46, respectively). Only 19.69% of the hospitals had a pharmacist to tumor patient ratio ≥1 : 50. Hierarchical analysis showed that passing a good pain management (GPM) ward program and participating in advanced training had positive impacts on the scores of all three parts in the three professions (ptrend <0.05). Conclusions: HCPs' levels of practice, knowledge, and attitudes towards pharmacists and advanced methods of CPM were average in China; however, pharmacists had the worst performance, which demonstrates a need for further improvement. Furthermore, GPM ward programs and advanced trainings are helpful for improving CPM levels.

Asunto(s)

Dolor en Cáncer , Neoplasias , Actitud del Personal de Salud , Conocimientos, Actitudes y Práctica en Salud , Humanos , Farmacéuticos , Médicos , Encuestas y Cuestionarios

RESUMEN

COVID-19 exhibits both variability and rapid progression, particularly in patients with comorbidities such as diabetes, hypertension or cancer. To determine how these underlying disorders exacerbate pneumonia in COVID-19, we evaluated 79 patients with severe COVID-19 and grouped them according to whether or not they had comorbidities. Clinical information, laboratory examinations, immunological function, and treatment outcomes were retrospectively analyzed. Our study revealed that severe COVID-19 patients with comorbidities had higher levels of inflammatory indices, including blood interferon-γ, interleukin (IL)-6 and c-reactive protein levels as well as the erythrocyte sedimentation rate. These were accompanied by lymphopenia, hypokalemia, hypoalbuminemia, a decrease in either CD4+ T cells or lymphocyte count, and coagulation disorders, which were closely related to poor prognosis. Patients with comorbidities also had longer disease remission times (27 ± 6.7 days) than those without comorbidities (20 ± 6.5 days). Cox multivariate analysis indicated that glucocorticoid therapy and IL-6 were independent prognostic factors. Our findings suggest that coexisting comorbidities aggravate COVID-19 through the excessive release of inflammatory factors and that glucocorticoid therapy may be beneficial.

Asunto(s)

COVID-19/inmunología , Glucocorticoides/uso terapéutico , Mediadores de Inflamación/sangre , Inflamación/diagnóstico , SARS-CoV-2/inmunología , Adulto , Anciano , Anciano de 80 o más Años , Sedimentación Sanguínea , Proteína C-Reactiva/análisis , Proteína C-Reactiva/inmunología , Recuento de Linfocito CD4 , COVID-19/sangre , COVID-19/epidemiología , Comorbilidad , Femenino , Humanos , Inflamación/sangre , Inflamación/tratamiento farmacológico , Inflamación/inmunología , Interleucina-6/sangre , Interleucina-6/inmunología , Masculino , Persona de Mediana Edad , Pandemias , Pronóstico , Estudios Retrospectivos , SARS-CoV-2/aislamiento & purificación , Índice de Severidad de la Enfermedad , Resultado del Tratamiento , Tratamiento Farmacológico de COVID-19

RESUMEN

PURPOSE: Considering the effects of P53 binding protein 1 (53BP1) expression and T lymphocyte infiltration density on tumor radiosensitivity, we investigated the relation of 53BP1 expression and immunoscore based on T lymphocyte infiltration density with the efficacy of neoadjuvant chemoradiotherapy (CRT) for rectal cancer. METHODS: Fifty-five patients with rectal cancer receiving neoadjuvant CRT followed by surgery were enrolled. The 53BP1 expression level and the density of CD3+, CD8+, and CD45RO+ T lymphocytes in the tumor tissues were examined by immunohistochemistry, and the relation of these findings to the rates of tumor regression, disease-free survival (DFS), and overall survival (OS) was analyzed. RESULTS: The levels of 53BP1 and the CD3/CD8 immunoscore were closely correlated with the response to CRT (p < 0.05), with an area under the receiver operating characteristic curve for CRT efficacy prediction of 0.626 and 0.717, respectively. Further survival analysis revealed that high 53BP1 expression effectively prolonged 2­year DFS compared with low 53BP1 expression (87.5% [95%CI 77.3-97.7] vs. 53.3% [95%CI 28.1-78.6]; p < 0.05), while the effect of immunoscore on survival was restricted by the expression status of 53BP1. Cox multivariate analysis confirmed 53BP1 as an independent prognostic factor in DFS. CONCLUSION: The pretreatment levels of 53BP1 and the immunoscore based on CD3+/CD8+ T cell infiltration density in tumor tissues are effective predictors for the CRT response, and 53BP1 has a more pronounced impact on prognosis.

Asunto(s)

Quimioradioterapia Adyuvante , Regulación Neoplásica de la Expresión Génica/genética , Terapia Neoadyuvante , Neoplasias del Recto/genética , Neoplasias del Recto/terapia , Proteína 1 de Unión al Supresor Tumoral P53/genética , Adulto , Anciano , Terapia Combinada , Femenino , Regulación Neoplásica de la Expresión Génica/efectos de los fármacos , Regulación Neoplásica de la Expresión Génica/efectos de la radiación , Humanos , Inmunohistoquímica , Recuento de Leucocitos , Linfocitos Infiltrantes de Tumor/efectos de los fármacos , Linfocitos Infiltrantes de Tumor/patología , Linfocitos Infiltrantes de Tumor/efectos de la radiación , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Proctectomía , Tolerancia a Radiación , Neoplasias del Recto/mortalidad , Neoplasias del Recto/patología , Estudios Retrospectivos , Tasa de Supervivencia , Linfocitos T/efectos de los fármacos , Linfocitos T/patología , Linfocitos T/efectos de la radiación , Resultado del Tratamiento , Proteína 1 de Unión al Supresor Tumoral P53/análisis , Adulto Joven

RESUMEN

Peritoneal carcinomatosis (PC) resulting from metastatic dissemination of gastric cancer (GC) cells carries a dismal prognosis, and current treatments have shown little efficacy. This study aimed to evaluate the efficacy and safety of recombinant human endostatin (Endostar), a broad-spectrum anti-angiogenic peptide, in combination with chemotherapy in PC derived from GC. From January 2014 to December 2016, 33 patients with advanced stage GC associated with PC were enrolled. Pathological, imaging, and treatment data were retrospectively analyzed. Twenty-one patients received systemic chemotherapy (control group), while 12 patients were administered Endostar and chemotherapy. Combined treatment with Endostar/chemotherapy showed the tendency to increase objective response rate (41.7% vs. 23.8%) and disease control rate (83.3% vs. 61.9%) compared with the control group, although the differences were not statistically significant. Endostar plus chemotherapy effectively extended time to progression (4.6 ± 0.3 months vs. 3.5 ± 0.3 months, P = 0.03) and median overall survival (15.8 ± 1.7 months vs. 9.8 ± 0.9 months, P = 0.01) compared with chemotherapy alone. The combination therapy did not cause more adverse reactions than chemotherapy alone. Thus, the addition of Endostar to conventional chemotherapy treatment effectively attenuated the development of PC and extended survival, with high safety and tolerance.