Cognitive Behavioral Therapy plus Coping Management for Depression and Anxiety on Improving Sleep Quality and Health for Patients with Breast Cancer.

Cancer-related treatments may lead to side effects that undermine a patients' quality of life (QOL). Although cognitive behavioral therapy plus coping management (CBTM) may appear to improve health-related QOL in cancer patients, limited documentation exists on the effectiveness of psychosocial interventions for patients with breast cancer (BC) during recovery. The purpose of this study was to examine the effectiveness of CBTM for sleep quality, anxiety, depression, and health among patients with BC. An experimental study was conducted to assess the efficacy of a CBTM intervention (experimental group = 36, control group = 34). The experimental group received a 12-week CBTM intervention focused on their identity, challenges, the replacement of dysfunctional beliefs, coping skills, relaxation, and rehabilitation exercises, while the control group received usual care. The follow-up evaluations were performed immediately after the intervention (T1), and at one (T2) and three months (T3). The generalized estimating equation (GEE) model showed significant effects from the CBTM intervention over time. The experimental group showed significant improvement in sleep quality, anxiety and depressive symptoms, and significant increases in their mental and physical QOL from baseline, T1, T2, and T3-except for the mental and physical QOL showing no significant change at T3-while the control group receiving usual care showed no changes over time. The results suggest that CBTM increases sleep quality, reduces anxiety and depressive symptoms, and enhances health-related QOL for participants. CBTM is efficacious and can be provided by nurses to enhance patients' coping skills and consequently improve their QOL.

Psychometric and Linguistic Evaluation of a Coping Scale for Breast Cancer Survivors in Taiwan.

BACKGROUND: Coping strategies are essential in dealing with threatening situations or difficulties for better psychological adjustments and quality of life. A short-form modified Ways of Coping Questionnaire (MWCQ) would be useful to quickly assess the coping strategies used by breast cancer survivors. OBJECTIVES: The aim of this study was to evaluate the psychometric properties of a Chinese version of a brief version of the MWCQ in breast cancer survivors. METHODS: A methodological, cross-sectional design was used in this study. The study has internal consistency reliability, face/content, construct, and convergent/divergent validity. Factor analysis and confirmatory factor analysis were used to examine the psychometric properties of the MWCQ-brief in a convenience sample of 207 women with breast cancer from 2 general hospitals in Taiwan. RESULTS: From the initial 35-item coping scale, factor analysis results supported a 24-item questionnaire, and the following 4 factors were extracted: effective coping, optimistic coping, unpractical coping, and escape coping. Confirmatory factor analysis results revealed an 18-item questionnaire with 3 factors extracted: active coping, avoidance coping, and minimizing the situation. CONCLUSIONS: The 24- and 18-item MWCQ-brief versions demonstrate fair psychometric properties to measure adaptability among women with breast cancer in Taiwan. This scale is simple but contains 4 or 3 concepts for coping that can be appropriately used to assess underlying states of adaptation in women with breast cancer. IMPLICATIONS FOR PRACTICE: The MWCQ-brief is a valid and reliable tool to understand the adaptability states of female breast cancer survivors by exploring reactions to the disease. Healthcare professionals can provide appropriate psychosocial interventions based on assessment results.

Resilience and coping styles as predictors of health outcomes in breast cancer patients: A structural equation modelling analysis.

INTRODUCTION: Resilience has been associated with psychological adaptation to many threatening life events, but previous studies have rarely analysed the integrated relationships among demographic and disease characteristics and various health outcomes in Taiwan. This study examined the associations among demographic factors, disease characteristics, resilience, coping styles and adverse health outcomes, including anxiety and depressive symptoms and sleep disorders. METHODS: A descriptive, cross-sectional study design was used. Data from a convenience sample of 175 patients with breast cancer aged 20 years or older were collected using a self-reported questionnaire. A structural equation modelling approach was applied to examine the relationships among the variables. RESULTS: The results showed that greater resilience was related to fewer depressive symptoms, lower anxiety levels and better sleep quality. All three coping styles, including active coping, minimising the situation and avoidance coping, were negatively correlated with depressive symptoms, but only active coping was significantly correlated with sleep quality. Resilience had a direct effect on depressive symptoms, anxiety and sleep disorders. Furthermore, a mediating effect of resilience was observed on the relationship between marital satisfaction and depressive symptoms. CONCLUSION: Resilience can strengthen breast cancer-related adaptation. Additionally, breast cancer survivors who used mainly the active and minimising coping styles tended to experience fewer depressive symptoms.

Relationships among personality, coping, and concurrent health-related quality of life in women with breast cancer.

BACKGROUND: Theory has suggested that personality plays an important role related to health behavior and results in health outcomes, but inconsistent with the findings exist. Moreover, limited research has focused on style of coping with personality traits and health-related quality of life (HRQOL) for patients with breast cancer. We tested how ways of coping and personality traits are associated with HRQOL in patients with breast cancer, after controlling for age, education, disease severity, and sleep disorders. METHODS: In a cross-sectional study of 207 patients with breast cancer, they completed a set of questionnaires at two general hospitals. The measures used were demographic and individual characteristics, personality traits, ways of coping, and health surveys. We used correlations and hierarchical regressions to determine all relationships among factors, sleep disorders, personality, coping, and HRQOL. RESULTS: Most participants were reported as having stage II (77, 37.2%) breast cancer. About 60% patients with breast cancer have poor sleep and sleep disorders having a negative association with HRQOL. Participants using more active coping, with lower neuroticism, and higher agreeableness traits are more likely to have a better physical quality of life (PQOL). In the PQOL regression model, clinical conditions (duration since cancer diagnosis; sleep disorders) and two personality traits (neuroticism and agreeableness) significantly explained 23% of variance. Moreover, fewer sleep disorders and two personality traits (neuroticism and conscientiousness) significantly explained 31% of variance in the mental quality-of-life (MQOL) regression model. CONCLUSIONS: A high prevalence of sleep disorders for patients with breast cancer has occurred and sleep disorders were negatively associated with PQOL and MQOL. In addition, neuroticism was positively related to sleep disorders and could be relevant to psycho-educational interventions.

Robotic mitral valve replacements with bioprosthetic valves in 52 patients: experience from a tertiary referral hospital.

OBJECTIVES: Robotic mitral valve replacement (MVR) emerged in the late 1990s as an alternative approach to conventional sternotomy. With the increased use of bioprosthetic valves worldwide and strong patient desire for minimally invasive procedures, the safety and feasibility of robotic MVRs with bioprosthetic valves require investigation. METHODS: Between January 2013 and May 2017, 52 consecutive patients underwent robotic MVRs using the da Vinci Si surgical system (Intuitive Surgical Inc., Sunnyvale, CA, USA). Their mean age was 55.1 ± 13.8 years, and mean EuroSCORE II was 2.25% ± 1.25%. Among the enrolled patients, 32 (61.5%) patients presented with preoperative atrial fibrillation, 6 (11.5%) patients had experienced embolic stroke and 5 (9.6%) patients had undergone previous cardiac surgery. The operations were performed using cardiopulmonary bypass (CPB) under an arrested heart status. RESULTS: Five porcine valves and 47 bovine valves were implanted. A total of 38 (73.1%) patients received concomitant cardiac procedures, including 26 Cox-maze IV procedures, 12 tricuspid valve repairs and 5 atrial septal defect repairs. The mean aortic cross-clamp and CPB times were 141.3 ± 34.3 min and 217.1 ± 42.0 min, respectively. There was no operative mortality. During the mean follow-up of 29 ± 15 months, no prosthesis degeneration was noted. The average left atrial dimension exhibited a significant decrease from 51.4 ± 11.5 mm to 42.6 ± 10.1 mm. CONCLUSIONS: Robotic MVR with bioprosthetic valves is safe, feasible and reproducible. Mid-term results are encouraging. Both aortic cross-clamp and CPB times can be improved with experience.

Depressive Symptoms and Health-Related Quality of Life Among Prostate Cancer Survivors.

BACKGROUND: Prostate cancer is a global health problem; its incidence is on the rise in Chinese and usually fraught with both physical and psychological symptomatology. OBJECTIVE: The aim of this study is to explore the relationships among demographic and disease characteristics, resourcefulness, depressive symptoms, and health related quality of life (HRQOL). METHODS: A descriptive, correlational design was used. A total of 200 individuals with prostate cancer were recruited. The participants completed a self-report regarding their depressive symptoms and HRQOL. Using a structural equation modeling approach, all relationships among the factors, mediators, depressive symptoms, and HRQOL were analyzed. RESULTS: The more resourcefulness that participants perceived, the more likely they were to report better HRQOL. The best-fitted structural equation model included individual demographics and disease characteristics and resourcefulness as significant predictors of HRQOL. Moreover, this structural model explained 72%, 76%, and 57% of the variance in physical quality of life, mental quality of life, and depressive symptoms, respectively. In addition, resourcefulness had a positive mediating effect on increasing the physical and mental quality of life and decreasing the depressive symptoms for patients with prostate cancer. CONCLUSIONS: Resourcefulness helps patients with prostate cancer build a positive attitude and that it is crucial for enhancing the HRQOL of patients. By using the proper resourcefulness strategy, that is, either personal (self-help) or social (help-seeking), nursing professionals can substantially contribute to enhancing the HRQOL for patients with PC. IMPLICATIONS FOR PRACTICE: Knowledge of risk factors for HRQOL would be useful for nursing professional in detecting health problems and treatment options.

Depression and Health-Related Quality of Life and Their Association With Resourcefulness in Survivors of Prostate Cancer.

OBJECTIVE: This study aimed to identify the determinants of depressive symptoms (DSs) and health-related quality of life (HRQOL) in survivors of prostate cancer (PC). METHODS: This study used a descriptive, correlational design to assess a sample of 133 individuals with PC. The participants were face-to-face interviewed to collect demographic data and disease characteristics, assess self-control schedule, and survey health status. Correlation analysis, Student's t-test, ANOVA, and regression analysis were applied. RESULTS: Over half the patients had depressive symptoms, and 96.1% had erectile dysfunction. Lack of resourcefulness was found to decrease PC-specific quality of life (PCQOL) and physical quality of life (PQOL). The participants who were more resourceful showed a better mental quality of life (MQOL) and PQOL (r=0.53**; r=0.41**) and fewer DSs (r=-0.52**). Most participants were stage II and IV, and there were significantly different effects on PQOL and MQOL related to cancer stage. Regarding the different outcomes of various therapies, the findings suggested that survivors of PC who underwent radical prostatectomy were more likely to have a better MQOL than those who underwent other treatments. In addition, resourcefulness had mediating effects on pain, PQOL/MQOL, and DSs in the patients with PC. CONCLUSIONS: Good mental health and resourcefulness can help patients with PC reduce pain and enhance positive thinking and may augment PQOL and MQOL.

Robotic totally endoscopic coronary artery bypass for isolated ostial stenosis of the left coronary artery.

Isolated ostial stenosis (IOS) is a rare disease that encroaches on aorto-coronary junction of uncertain etiology. All distal coronary vessels present normally. IOS occurs predominantly in premenopausal young women with few risk factors for atherosclerotic disease. Here, we report a 40-year-old woman who had experienced crescendo angina for 4 months. Surgical revascularization was achieved by robotic totally endoscopic coronary artery bypass (TECAB) with left internal thoracic artery (LITA) graft. She resumed her daily tasks without difficulties 1 week after the operation. Postoperative computed tomographic angiography disclosed good opacification of the LITA graft and distal runoff. Robotic TECAB is a potentially feasible alternative for IOS patients, particularly in premenopausal young woman, with obvious benefits of cosmetic appearance and speedy recovery.

Enhanced expression of beta 3-galactosyltransferase 5 activity is sufficient to induce in vivo synthesis of extended type 1 chains on lactosylceramides of selected human colonic carcinoma cell lines.

In general, an elevated expression of beta 3-galactosyltransferase (beta 3GalT) activity contributed by beta 3GalT5 correlates well with increased biosynthesis and expression of type 1 chain (Gal beta 1-3GlcNAc beta 1-) derivatives such as Lewis A and sialyl Lewis A, which are mostly recognized as terminal epitopes and not further extended. Most known beta 3-N-acetylglucosaminyltransferases show a higher activity toward extending type 2 chain (Gal beta 1-4GlcNAc beta 1-), and an over-expression of beta 3GalT5 could suppress the formation of the type 2 chain poly-N-acetyllactosaminoglycans. The potential of extending instead the predominant type 1 chain termini synthesized under such circumstances was, however, not investigated, partly due to technical difficulty in unambiguous identification of extended type 1 chains. Using an advanced mass spectrometry-based glycomic mapping and glycan sequencing approach, we show here that type 1 chains carried on the lacto-series glycosphingolipids of colonic carcinoma cells can be extended when the endogenous beta 3GalT activity relative to competing beta 4GalT activity, as defined against a common GlcNAc beta 1-3Gal beta 1-4Glc acceptor, is sufficiently high, as found in Colo205 and SW1116, but not in DLD-1 cells. In support of this positive correlation, the lacto-series glycosphingolipids isolated from stably transfected DLD-1 clones over-expressing beta 3GalT5 were shown to comprise fucosylated dimeric type 1 chains, whereas a mock transfectant and the DLD-1 parent carried only fucosylated dimeric type 2 chains on their lactosylceramides. It suggests that while the natural expression of extended type 1 chain is likely to be determined by many contributing factors including the relative amounts of competing glycosyltransferases and the UDP-Gal level, the enhanced expression of beta 3GalT5 is sufficient to promote in vivo extension of type 1 chains by furnishing a significantly higher amount of type 1 chain precursors relative to competing type 2 chains.

Characterization of oligosaccharide ligands expressed on SW1116 cells recognized by mannan-binding protein. A highly fucosylated polylactosamine type N-glycan.

Mannan-binding protein (MBP) is a C-type serum lectin and activates complement through the lectin pathway when it binds to ligand sugars such as mannose, N-acetylglucosamine, and fucose on microbes. In addition, the vaccinia virus carrying the human MBP gene was shown to exhibit potent growth inhibitory activity toward human colorectal carcinoma, SW1116, cells in nude mice. We have proposed calling this activity MBP-dependent cell-mediated cytotoxicity (MDCC) (Ma, Y., Uemura, K., Oka, S., Kozutsumi, Y., Kawasaki, N., and Kawasaki, T. (1999) Proc. Natl. Acad. Sci. U. S. A. 96, 371-375). In this study, the MBP ligands on the surface of SW1116 cells were characterized. Initial experiments involving plant lectins and anti-Lewis antibodies as inhibitors of MBP binding to SW1116 cells indicated that fucose plays a crucial role in the interaction. Subsequently, Pronase glycopeptides were prepared from whole cell lysates, and oligosaccharides were liberated by hydrazinolysis. After being tagged by pyridylamination, MBP ligand oligosaccharides were isolated with an MBP affinity column, and then their sequences were determined by mass spectrometry and tandem mass spectrometry after permethylation, in combination with endo-beta-galactosidase digestion and chemical defucosylation. The MBP ligands were shown to be large, multiantennary N-glycans carrying a highly fucosylated polylactosamine type structure. At the nonreducing termini, Le(b)/Le(a) or tandem repeats of the Le(a) structure prevail, a substantial proportion of which are attached via internal Le(x) or N-acetyllactosamine units to the trimannosyl core. The structures characterized are unique and distinct from those of other previously reported tumor-specific carbohydrate antigens. It is concluded that MBP requires clusters of tandem repeats of the Le(b)/Le(a) epitope for recognition.