Risk Factors of Demoralization Among Lung Cancer Patients in Mainland China.

Objectives: Due to the severity of cancer, patients may experience feelings of helplessness and despair, resulting in demoralization among lung cancer patients. In this study, we investigated the risk factors of demoralization in middle-aged and older Chinese lung cancer patients via their relationship with patients' demographic data and disease characteristics. Methods: This study is a cross-sectional descriptive study using a structured questionnaire including assessments of demographic data and disease, the Demoralization Scale Mandarin Version (DS-MV), the Social Support Rate Scale (SSRS), the Medical Coping Modes Questionnaire (MCMQ), as well as The European Organization for Research and Treatment of Cancer (EORTC QLQ-C30). Results: Overall, 289/300 (96.3%) patients with lung cancer completed questionnaires. The mean score of DS-MV was 49.27 (SD=15.19) (range, 21-81) and the mean score of SSRS was 33.37 (SD=5.43) (range,17-48). Multiple linear regression analysis identified high demoralization was significantly related to age (p<.001), medical payment (p=.003), times of chemotherapy (p=.026), family monthly income (p=.025), avoidance dimension (p<.001), surrender dimension (p<.001), social support (p=.001), symptom score (p<.001), overall health score (p=.009) and function score (p<.001). Conclusion: This study demonstrates the factors influencing demoralization among middle-aged and older lung cancer patients. Demoralization is a prevalent psychiatric problem in Chinese lung cancer patients. Therefore, we recommend strong social support to be protective against demoralization. We suggest that medical staff establish the concept of social support for patients with lung cancer, actively seek effective resources from family, friends, and other social support organizations to help patients establish a social support system that improves patient courage and confidence in their post-cancer life.

[Effect of estrogen-depletion and 17beta-estradiol replacement therapy upon rat hippocampus beta-amyloid generation].

OBJECTIVE: To observe the effects of estrogen depletion and 17beta-estradiol replacement therapy upon ratbeta-amyloid (Abeta) generation and the possible related mechanisms. METHODS: Rat ovaries were ectomized to mimic estrogen-depletion models and then 17beta-estradiol was administered by powdering hormone into soy-free chow as a way of replacement therapy. ELISA was carried out to detect rat hippocampus Abeta levels and alpha- and beta-secretase activities were measured after the experiment. The effects of estrogen depletion and 17beta-estradiol replacement therapy upon beta-secretase (BACE1) and neprilysin (NEP) expression were also analyzed by Western blot. RESULTS: Ovariectomy significantly decreased estrogen level [(11 + or - 4) pg/ml, P < 0.01] as compared with control group [(21 + or - 8) pg/ml] while 17beta-estradiol administration increased the estrogen level [(63 + or - 13) pg/ml, P < 0.01] in blood. The Abeta40 [(28.5 + or - 4.5) ng/ml, P < 0.01] and Abeta42 [(4.5 + or - 1.2) ng/ml, P < 0.01] levels were higher in ovariectomy group as compared with their respective control group [with Abeta40 (14.4 + or - 2.4) ng/ml and Abeta42 (2.8 + or - 0.4) ng/ml respectively]. But the effects of ovariectomy on Abeta content can be partially reversed by 17beta-estradiol replacement therapy [with Abeta40 (20.3 + or - 3.2)ng/ml, P < 0.01 and Abeta42 (3.8 + or - 0.5)ng/ml, P < 0.01 respectively]. Estrogen depletion decreased alpha-secretase activity (67.5%, P < 0.01) and increased beta-secretase activity (145.8%, P < 0.01) and this effect can be blocked by 17beta-estradiol administration [with alpha-secretase activity to 90.2% (P < 0.01) and beta-secretase activity to 92.4% (P < 0.01)]. Ovariectomy increased BACE1 expression (135.4%, P < 0.01) and decreased NEP expression (40.8%, P < 0.01) and this effect can be partially antagonized by 17beta-estradiol supplementary [with BACE to 103.5% (P < 0.01) and NEP to 88.4% (P < 0.01)]. CONCLUSION: Estrogen depletion can increase Abeta generation through the effects of increased beta-secretase activity and decreased alpha-secretase activity. Ovariectomy also increases BACE1 expression and decreases NEP expression. The 17beta-estradiol supplementary can decrease Abeta generation and this may to some extent explain why estrogen replacement therapy can decrease the risk of Alzheimer's disease in postmenopausal women.