Effectiveness of a multimodal standard nursing program on health-related quality of life in Chinese mainland female patients with breast cancer: protocol for a single-blind cluster randomized controlled trial.

BACKGROUND Breast cancer and its treatment-related adverse effects are harmful to physical, psychological, and social functioning, leading to health-related quality of life (HRQoL) impairment in patients. Many programs have been used with this population for HRQoL improvement; however, few studies have considered the physical, psychological, and social health domains comprehensively, and few have constructed multimodal standard nursing interventions based on specific theories. The purpose of this trial is to examine the effect of a health belief model (HBM)-based multimodal standard nursing program (MSNP) on HRQoL in female patients with breast cancer. METHODS This is a two-arm single-blind cluster randomized controlled trial (cRCT) in clinical settings. Twelve tertiary hospitals will be randomly selected from the 24 tertiary hospitals in Xi'an, China, and allocated to the intervention arm and control arm using a computer-generated random numbers table. Inpatient female patients with breast cancer from each hospital will receive either MSNP plus routine nursing care immediately after recruitment (intervention arm), or only routine nursing care (control arm). The intervention will be conducted by trained nurses for 12 months. All recruited female patients with breast cancer, participating clinical staff, and trained data collectors from the 12 hospitals will be blind with respect to group allocation. Patients of the control arm will not be offered any information about the MSNP during the study period to prevent bias. The primary outcome is HRQoL measured through the Functional Assessment of Cancer Therapy-Breast version 4.0 at 12 months. Secondary outcomes include pain, fatigue, sleep, breast cancer-related lymphedema, and upper limb function, which are evaluated by a visual analogue scale, the circumference method, and the Constant-Murley Score. DISCUSSION This trial will provide important evidence on the effectiveness of multimodal nursing interventions delivered by nurses in clinical settings. Study findings will inform strategies for scaling up comprehensive standard intervention programs on health management in the population of female patients with breast cancer. TRIAL REGISTRATION Chictr.org.cn ChiCTR-IOR-16008253 (April 9, 2016)

Decreasing TfR1 expression reverses anemia and hepcidin suppression in β-thalassemic mice

Iron availability for erythropoiesis and its dysregulation in β-thalassemia are incompletely understood. We previously demonstrated that exogenous apotransferrin leads to more effective erythropoiesis, decreasing erythroferrone (ERFE) and derepressing hepcidin in β-thalassemic mice. Transferrin-bound iron binding to transferrin receptor 1 (TfR1) is essential for cellular iron delivery during erythropoiesis. We hypothesize that apotransferrin's effect is mediated via decreased TfR1 expression and evaluate TfR1 expression in β-thalassemic mice in vivo and in vitro with and without added apotransferrin. Our findings demonstrate that β-thalassemic erythroid precursors overexpress TfR1, an effect that can be reversed by the administration of exogenous apotransferrin. In vitro experiments demonstrate that apotransferrin inhibits TfR1 expression independent of erythropoietin- and iron-related signaling, decreases TfR1 partitioning to reticulocytes during enucleation, and enhances enucleation of defective β-thalassemic erythroid precursors. These findings strongly suggest that overexpressed TfR1 may play a regulatory role contributing to iron overload and anemia in β-thalassemic mice. To evaluate further, we crossed TfR1+/- mice, themselves exhibiting iron-restricted erythropoiesis with increased hepcidin, with β-thalassemic mice. Resultant double-heterozygote mice demonstrate long-term improvement in ineffective erythropoiesis, hepcidin derepression, and increased erythroid enucleation in relation to β-thalassemic mice. Our data demonstrate for the first time that TfR1+/- haploinsufficiency reverses iron overload specifically in β-thalassemic erythroid precursors. Taken together, decreasing TfR1 expression during β-thalassemic erythropoiesis, either directly via induced haploinsufficiency or via exogenous apotransferrin, decreases ineffective erythropoiesis and provides an endogenous mechanism to upregulate hepcidin, leading to sustained iron-restricted erythropoiesis and preventing systemic iron overload in β-thalassemic mice

Delayed Presentation of Symptomatic Breast Cancer in Chinese Women

The Plan for Healthy China 2030 has made early detection and treatment of cancers a priority. Delay before treatment initiation increases the likelihood of a later-stage diagnosis of breast cancer and reduces survival. This delay is a complex and multifactorial phenomenon, and the factors contributing to delay among Chinese women are unclear. This dissertation aimed to deepen our understanding of delay and provide evidence to inform the development of strategies to reduce delay. Chapter 1 is an integrative review that aimed to characterize delay intervals among Chinese women living in mainland China, Hong Kong, and Taiwan; to identify factors contributing to delay; and to develop a conceptual model of these factors. Using Whittemore and Knafl’s methodology for integrative reviews, PubMed, CINAHL, Web of Science, SCOPUS, PsycINFO, and China National Knowledge Infrastructure were searched for primary research articles. For the 15 selected studies, quality evaluation was performed employing the Crowe Critical Appraisal Tool. A narrative synthesis was developed to summarize and explain the findings. I found that total delay intervals (from the first discovery of breast symptoms to treatment initiation) exceeded 3 months for 50.2%-52% of breast cancer patients. The greatest delay occurred between symptom discovery and the first presentation of symptoms to healthcare providers. I identified eight categories of factors that affect delay in presentation, diagnosis, and treatment, including symptom appraisal, Chinese culture, knowledge of breast cancer symptoms and breast cancer screening, health history, personality, social factors, healthcare factors, and background factors. I concluded that half of Chinese breast cancer patients delayed long enough to lower their chances of survival. Factors identified in this review can inform nursing interventions to raise breast cancer awareness and promote timely diagnosis and treatment among Chinese women. As revealed in Chapter 1, a high-quality study about delay in seeking breast evaluation in mainland China is needed. Most breast cancers in China are diagnosed when women present their self-discovered symptoms to healthcare providers rather than through screening. Thus, Chapter 2 presents a cross-sectional study that aimed to identify the time intervals of presentation delay among women with symptomatic breast cancer, describe the impact of the COVID-19 pandemic on delay, identify factors contributing to delay, and examine the potential moderation effects of healthcare factors on delay. In the study, 154 Chinese women with symptomatic breast cancer were surveyed and interviewed. Up to 24.7% of the subjects delayed ≥ 3 months before presentation, which is long enough to lower the chance of survival and is longer than in western countries (14-18% in previous research). The COVID-19 pandemic contributed to delay for 13.8% of the subjects, but the impact appeared to be limited, as the delay intervals were comparable with pre-pandemic data in China. Factors contributing to delay ≥ 1 month included preferring female physicians for clinical breast examination, less negative emotional response to symptoms, more competing role demands, believing folk therapy can help treat lumps, not knowing someone with breast cancer, and visiting a secondary or tertiary hospital rather than a primary healthcare provider. For women with lower perceived healthcare access and lower trust in physicians, the effects of perceived seriousness of symptoms on presentation delay were significant: the higher their perceived seriousness of symptoms, the less likely they were to delay seeking breast evaluation ≥ 1 month. In addition, awareness of breast cancer screening should be promoted among Chinese women, and access to screening urgently needs to be increased. The study findings demonstrated the impact of the COVID-19 pandemic on Chinese women’s help-seeking and can inform the development of programs to reduce delay. Furthermore, the findings provide insights that other low- and middle-income countries can consider to improve early detection of breast cancer. These study contributions could ultimately improve the survival rates and quality of life of breast cancer patients

Delayed Presentation of Symptomatic Breast Cancer in Chinese Women

The Plan for Healthy China 2030 has made early detection and treatment of cancers a priority. Delay before treatment initiation increases the likelihood of a later-stage diagnosis of breast cancer and reduces survival. This delay is a complex and multifactorial phenomenon, and the factors contributing to delay among Chinese women are unclear. This dissertation aimed to deepen our understanding of delay and provide evidence to inform the development of strategies to reduce delay. Chapter 1 is an integrative review that aimed to characterize delay intervals among Chinese women living in mainland China, Hong Kong, and Taiwan; to identify factors contributing to delay; and to develop a conceptual model of these factors. Using Whittemore and Knafl’s methodology for integrative reviews, PubMed, CINAHL, Web of Science, SCOPUS, PsycINFO, and China National Knowledge Infrastructure were searched for primary research articles. For the 15 selected studies, quality evaluation was performed employing the Crowe Critical Appraisal Tool. A narrative synthesis was developed to summarize and explain the findings. I found that total delay intervals (from the first discovery of breast symptoms to treatment initiation) exceeded 3 months for 50.2%-52% of breast cancer patients. The greatest delay occurred between symptom discovery and the first presentation of symptoms to healthcare providers. I identified eight categories of factors that affect delay in presentation, diagnosis, and treatment, including symptom appraisal, Chinese culture, knowledge of breast cancer symptoms and breast cancer screening, health history, personality, social factors, healthcare factors, and background factors. I concluded that half of Chinese breast cancer patients delayed long enough to lower their chances of survival. Factors identified in this review can inform nursing interventions to raise breast cancer awareness and promote timely diagnosis and treatment among Chinese women. As revealed in Chapter 1, a high-quality study about delay in seeking breast evaluation in mainland China is needed. Most breast cancers in China are diagnosed when women present their self-discovered symptoms to healthcare providers rather than through screening. Thus, Chapter 2 presents a cross-sectional study that aimed to identify the time intervals of presentation delay among women with symptomatic breast cancer, describe the impact of the COVID-19 pandemic on delay, identify factors contributing to delay, and examine the potential moderation effects of healthcare factors on delay. In the study, 154 Chinese women with symptomatic breast cancer were surveyed and interviewed. Up to 24.7% of the subjects delayed ≥ 3 months before presentation, which is long enough to lower the chance of survival and is longer than in western countries (14-18% in previous research). The COVID-19 pandemic contributed to delay for 13.8% of the subjects, but the impact appeared to be limited, as the delay intervals were comparable with pre-pandemic data in China. Factors contributing to delay ≥ 1 month included preferring female physicians for clinical breast examination, less negative emotional response to symptoms, more competing role demands, believing folk therapy can help treat lumps, not knowing someone with breast cancer, and visiting a secondary or tertiary hospital rather than a primary healthcare provider. For women with lower perceived healthcare access and lower trust in physicians, the effects of perceived seriousness of symptoms on presentation delay were significant: the higher their perceived seriousness of symptoms, the less likely they were to delay seeking breast evaluation ≥ 1 month. In addition, awareness of breast cancer screening should be promoted among Chinese women, and access to screening urgently needs to be increased. The study findings demonstrated the impact of the COVID-19 pandemic on Chinese women’s help-seeking and can inform the development of programs to reduce delay. Furthermore, the findings provide insights that other low- and middle-income countries can consider to improve early detection of breast cancer. These study contributions could ultimately improve the survival rates and quality of life of breast cancer patients

Expression and correlation of COX-2 and NUCB1 in colorectal adenocarcinoma

Objective To investigate the expression and correlation of COX-2 and NUCB1 in colorectal adenocarcinoma and adjacent tissues. Methods The expression of COX-2 and NUCB1 and their effects on prognosis were predicted using bioinformatics. Immunohistochemistry was used to identify the expression of two molecules in 56 cases of colorectal adenocarcinoma and the surrounding tissues. The expression of two molecules and their association with clinicopathological variables were examined using the chi-square test. The association between COX-2 and NUCB1 was investigated using the Spearman correlation test. Results The STRING database revealed that COX-2 and NUCB1 were strongly linked. According to the UALCAN and HPA database, COX-2 was upregulated while NUCB1 was downregulated in colorectal adenocarcinoma, both at the protein and gene levels. The OS times for COX-2 and NUCB1 high expression, however, exhibited the same patterns. The rate of positive COX-2 immunohistochemical staining in cancer tissues was 69.64% (39/56), which was significantly higher than the rate in healthy tissues 28.57% (16/56). NUCB1 was expressed positively in cancer tissues at a rate of 64.29% (36/56) compared to just 19.64% (11/56) in neighboring tissues. The positive expression levels of COX-2 and NUCB1 were both closely related to clinical stage, differentiation degree, and lymphatic metastases (P < 0.05). In colorectal cancer, COX-2 and NUCB1 expression were significantly correlated (rs = 0.6312, P < 0.001). Conclusion Both COX-2 and NUCB1 are overexpressed and significantly associated in colorectal adenocarcinoma

Table_1_Effectiveness of the COVID-19 Community Vulnerability Index in explaining COVID-19 deaths.docx

ObjectivesTo explore the effectiveness of a COVID-19 specific social vulnerability index, we examined the relative importance of four COVID-19 specific themes and three general themes of the COVID-19 Community Vulnerability Index (CCVI) in explaining COVID-19 mortality rates in Cook County, Illinois.MethodsWe counted COVID-19 death records from the Cook County Medical Examiner's Office, geocoded incident addresses by census tracts, and appended census tracts' CCVI scores. Negative binomial regression and Random Forest were used to examine the relative importance of CCVI themes in explaining COVID-19 mortality rates.ResultsCOVID-19 specific Themes 6 (High risk environments) and 4 (Epidemiological factors) were the most important in explaining COVID-19 mortality (incidence rate ratio (IRR) = 6.80 and 6.44, respectively), followed by a general Theme 2 (Minority status & language, IRR = 3.26).ConclusionThe addition of disaster-specific indicators may improve the accuracy of social vulnerability indices. However, variance for Theme 6 was entirely from the long-term care resident indicator, as the other two indicators were constant at the census tract level. Thus, CCVI should be further refined to improve its effectiveness in identifying vulnerable communities. Also, building a more robust local data infrastructure is critical to understanding the vulnerabilities of local places.</p