Analysis of trajectory changes and predictive factors of sense of coherence in patients after colorectal cancer surgery.

OBJECTIVE: To investigate the trajectories and potential categories of changes in the sense of coherence (SOC) in patients after colorectal cancer surgery and to analyze predictive factors. METHODS: From January to July 2023, 175 patients with colorectal cancer treated at a tertiary Grade A oncology hospital in Jiangsu Province were selected as the study subjects. Prior to surgery, SOC-13 scale, Patient-Generated Subjective Global Assessment (PG-SGA), Brief Illness Perception Questionnaire (BIPQ), and Social Support Rating Scale (SSRS) were used to survey the patients. SOC levels were measured multiple times at 1 week, 1 month, and 3 months post-surgery. Growth Mixture Modeling (GMM) was applied to fit the trajectory changes of SOC in patients after colorectal cancer surgery. Multinomial logistic regression was used to analyze the predictive factors of SOC trajectory changes. RESULTS: The SOC scores of patients at points T1-T4 were (65.27 ± 9.20), (63.65 ± 10.41), (63.85 ± 11.84), and (61.56 ± 12.65), respectively. Multinomial logistic regression results indicated that gender, employment status, disease stage, household monthly income, intestinal stoma, nutritional status, illness perception, and social support were predictors of SOC trajectory changes (P < 0.05). CONCLUSION: There is heterogeneity in the trajectory changes of SOC in patients after colorectal cancer surgery. Healthcare professionals should implement early precision interventions based on the patterns of changes and predictive factors in each trajectory category.

Risk factors for the development of a parastomal hernia in patients with enterostomy: a systematic review and meta-analysis.

PURPOSE: Parastomal hernia (PSH) is a common and serious complication in patients with enterostomy, but there is no current consensus for the risk factors for PSH from previous studies. Therefore, this study systematically analyzed the risk factors for PSH to provide a reference for prevention and treatment of this condition. METHODS: Seven databases and 3 registers were systematically searched from database inception to January, 2021. Study quality was assessed by Newcastle-Ottawa Scale. Review Manager 5.3 software was used for statistical analysis. The data that could not be combined quantitatively were only analyzed qualitatively. RESULTS: Sixteen studies with 2031 patients were included. Higher BMI (OR, 1.29; 95% CI,1.02-1.63), older age (OR, 1.04; 95% CI, 1.02-1.07), female (OR, 2.55; 95% CI,1.39-4.67), lager aperture size (OR, 2.8; 95%CI, 1.78-4.42), transperitoneal stoma creation (OR, 2.4; 95% CI, 1.33-4.35), and lager waist circumference (OR, 1.01; 95% CI,1.0-1.01) were significant risk factors for PSH. The laparoscopic approach was not a risk factor for PSH (OR, 2.09; 95% CI, 0.83-5.27). Other risk factors, including the thickness of abdominal subcutaneous fat, no mesh, a stoma not through the middle of the rectus abdominis, atrophy of left lower medial part of rectus abdominis, α1(III) procollagen expression level, emergency surgery, no preoperative stoma site marking, end colostomy, smoking, diabetes, peristomal infection, severe abdominal distention, severe cough, chronic obstructive pulmonary disease, operation time and hypertension, were significant on the multivariate analysis of each individual study. CONCLUSIONS: The current available evidence showed that higher BMI, older age, female, larger aperture size, the creation of a transperitoneal stoma, and a larger waist circumference were independent risk factors for PSH. For factors without exact cutoff value, further explorations are needed in the future. In addition, reference to the limited number of studies in the pooled analysis, these factors still need to be interpreted carefully.

An ECG method for positioning the tip of a PICC in "mirror people" with dextrocardia: A case report.

Intracavitary electrocardiogram (ECG) has been widely used for PICC tip positioning in patients with a normal left heart. However, there is little information about using ECG for PICC insertion in patients with mirror dextrocardia. We report a 70-year-old stomach cancer patient with mirror dextrocardia admitted to our vascular access center for four Fr silicon Groshong PICC insertion. We successfully performed an ultrasound-guided modified Seldinger technique for insertion. First, the usual standardized ECG technique was used for tip positioning, and it failed. Then, we changed the procedure slightly, using the opposite electrode connections (RA: the first intercostal space of the midline of the left clavicle; LA: the first intercostal space of the midline of the right clavicle; and LL: the inferior margin of the right costal arch) to obtain an evident P-wave change to guide catheter placement in this case. We confirm that we can use the opposite electrodes to obtain an apparent P-wave for locating the catheter tip in patients with mirror dextrocardia.

Effects of Walking on Fatigue in Cancer Patients: A Systematic Review and Meta-analysis.

BACKGROUND: Walking is a simple form of exercise that is easily accepted by patients. Exercise is one of the main ways to control cancer-related fatigue (CRF). However, there are conflicting data on the association between walking and severity of CRF. OBJECTIVE: The aim of this study was to assess the overall effect of walking on CRF among adult cancer patients. METHODS: Databases including PubMed, CINAHL, EMBASE, and Cochrane Library were systematically reviewed to identify suitable randomized controlled trials from inception to February 29, 2020. Two reviewers independently evaluated the risk of bias and extracted correlated data with Cochrane Handbook of Systematic Reviews on Interventions. The data analysis was performed by Review Manager 5.3. RESULTS: A total of 12 studies with 1064 patients were identified. Integrated result analysis of walking yielded a statistically significant effect on CRF (standard mean difference [SMD], -0.66; 95% confidence interval [CI], -1.06 to -0.26). Subgroup analysis demonstrated that intervention time longer than 6 weeks (SMD, -0.89; 95% CI, -1.22 to -0.57) had a better effect on fatigue compared with that of less than 6 weeks (SMD, 0.03; 95% CI, -0.39 to 0.45). The study showed walking was statistically more effective than the control intervention in patients undergoing cancer treatment (SMD, -0.79; 95% CI, -1.16 to -0.42). Descriptive analysis also showed that walking was effective for cancer patients who completed treatment. CONCLUSIONS: Walking is effective for CRF during and after cancer therapy. IMPLICATIONS FOR PRACTICE: The results provide evidence for a general exercise form to relieve fatigue in cancer patients and facilitate support for future clinical trials and work.

Adverse drug reactions and nursing interventions in the treatment of non-Hodgkin's lymphoma by Aidi injection.

BACKGROUND: To explore adverse drug reactions (ADRs) and the effects of nursing interventions after Aidi injection for the treatment of non-Hodgkin's lymphoma (NHL). METHODS: A total of 104 NHL patients treated in our hospital from March 2019 to March 2020 were selected. All patients underwent conventional chemotherapy, with a concomitant Aidi injection administered at different doses (40, 60, 80, and 100 mL). ADRs were analyzed for all patients, and the clinical outcomes of ADRs were recorded after specific nursing interventions were performed. RESULTS: A total of 17 NHL patients had ADRs, with a total incidence rate of 15.89% (total of 30 ADRs). In terms of different types of ADRs, inappetence accounted for the largest proportion, followed by skin pruritus and fever, phlebitis, nausea and vomiting, and chest distress and/or palpitation, the last of which shared the same proportion as chills and/or low fever and urticaria. The incidence rate of ADRs (total of 18 ADRs, 60.00%) was higher in NHL patients who were given 100 mL of Aidi injection. In terms of age and gender distribution of ADRs, there were 10 males (55.56%) and 7 females (44.44%), and ADRs were more common in patients aged 46-60 years old (total of 6 ADRs, 35.29%). Aidi injection mainly induced mild ADRs (total of 22 ADRs, 73.33%), and the resulting ADRs mostly occurred for <2 hours (total of 19 ADRs, 60.00%). After the specific nursing interventions were performed, no deaths due to ADRs occurred, and 12 (64.71%) cases were cured, 5 (29.41%) cases improved, and 1 (5.88%) case had no progression. CONCLUSIONS: Particular attention should be paid to ADRs in the treatment of NHL patients with Aidi injection. After ADRs occur, specific nursing interventions can aid in recovery and lead to improvements in prognosis.

Impact of body posture change on peripherally inserted central catheter tip position in Chinese cancer patients.

PURPOSE: To evaluate the influence of body posture change on the peripherally inserted central catheter tip position in Chinese cancer patients. METHODS: A prospective observational trial was conducted in a tertiary cancer hospital from August to September 2018. After the insertion of peripherally inserted central catheter, chest X-ray films were taken to check the catheter tip in the upright and supine positions, respectively. The distance from the carina to the catheter tip was separately measured on both chest films by nurses. The primary study outcome was the distance and direction of the catheter tip movement. The secondary study outcome was to analyze the influence factors on the catheter tip movement. The third study outcome was to observe the related adverse events caused by the catheter tip movement. RESULTS: A total of 79 patients were included, the results showed that 61 moved cephalad, 14 moved caudally, and 4 did not move with body change from the supine to the upright position. When moved cephalad, the mean distance was 19.34 ± 11.95 mm; when moved caudally, the mean distance was -15.83 ± 8.97 mm. The difference between the two positions was statistically significant (p < 0.001). There was also a statistically significant difference between catheter tip movement direction and body mass index (p = 0.009) and height (p = 0.015). Two patients developed arrhythmias; no cardiac tamponade was found due to body posture change. CONCLUSION: The results of this work implied that the tips of the catheter tend to shift toward the cephalad with body change from the supine to the upright position. A study involving a larger sample size is needed to find more information in the future.

Complications and Costs of Peripherally Inserted Central Venous Catheters Compared With Implantable Port Catheters for Cancer Patients: A Meta-analysis.

BACKGROUND: Peripherally inserted central catheters (PICCs) and implantable port catheters (IPCs) are 2 most common central venous access for cancer patients receiving chemotherapy. However, no specific evidence exists to guide practitioners on safety and less cost. OBJECTIVE: To compare the differences of complications and costs of PICC and IPC in the treatment of cancer patients with chemotherapy and to provide a basis for better clinical decision making. METHODS: All the cohort studies were searched in the Cochrane Library, JBI, PubMed, Elsevier, Web of Science, CINAHL, CBM, and CNKI from inception to July 2018. Two reviewers screened and selected trials, evaluated quality, and extracted data. Meta-analysis and description of the outcomes were performed by using the RevMan 5.3 software. RESULTS: A total of 761 articles were retrieved, with 15 articles meeting eligibility criteria. Outcome analysis showed no difference in 1-puncture success rate. Peripherally inserted central catheter use was associated with higher complication rates than IPC, including occlusion, infection, malposition, catheter-related thrombosis, extravasation, phlebitis, and accidental removal rate. The life span of IPC was longer than that of PICC, and the costs of IPC were lower. CONCLUSIONS: Implantable port catheter has advantages over PICC in reducing cancer patients' complications and less cost in terms of long-term cancer chemotherapy. IMPLICATIONS FOR PRACTICE: In terms of safety, the results provide evidence for practitioners to choose which type of central venous catheters is better for cancer chemotherapy patients. In terms of costs, practitioners need to make decisions about which type of central venous catheters has less cost.

Gastric juice piR-1245: A promising prognostic biomarker for gastric cancer.

BACKGROUND: Emerging reports demonstrated that PIWI-interacting RNAs (piRNAs) played an indispensable role in tumorigenesis. However, it still remains elusive whether piR-1245 in gastric juice specific in stomach could be employed as a biomarker for gastric cancer (GC). The present work is aiming at exploring the possibility of piR-1245 in gastric juice as a potential marker to judge for diagnosis and prognosis of gastric cancer. METHODS: Gastric juice was collected from 66 GC patients and 66 healthy individuals. Quantitative real-time reverse transcriptase polymerase chain reaction (qRT-PCR) was employed to measure the levels of piR-1245 expression. Then, the pattern of piR-1245 expression in gastric juice was determined between GC patients and healthy individuals. A receiver operating characteristic (ROC) curve was constructed for distinguishing GC from healthy individuals. RESULTS: Gastric juice piR-1245 levels in GC were higher than those of controls (P < .0001). The value of area under ROC (AUC) was 0.885 (sensitivity, 90.9%; specificity, 74.2%; 95% confidence interval, 0.8286 to 0.9414). High gastric juice piR-1245 expression was signally correlated with tumor size (P = .013) and TNM stage (P = .001). GC patients with high piR-1245 expression in gastric juice exerted a poorer overall survival (OS) (P = .0152) and progression-free survival (PFS) (P = .013). COX regression analysis verified that gastric juice piR-1245 expression was an independent prognostic risk variable for OS (P < .05). CONCLUSIONS: The current study suggested that piR-1245 in gastric juice had the potential to be a useful biomarker for GC detection and prognosis prediction.

Nursing Interventions to Reduce Peripherally Inserted Central Catheter Occlusion for Cancer Patients: A Systematic Review of Literature.

BACKGROUND: Cancer patients are considered the most at risk of the consequences of catheter occlusion. Therefore, nursing interventions that can effectively reduce the occlusion of peripherally inserted central catheter (PICC) lines must be identified to ensure a smooth treatment. OBJECTIVE: This study aimed to evaluate nursing interventions to minimize PICC line occlusion and make recommended measures for preventing or decreasing occlusion and abnormal extubation. METHODS: Studies about PICC occlusion that were published up to January 2017 were searched and screened in PubMed, Web of Science, Science Direct (Elsevier), EMBASE, Cochrane Library, and Chinese databases CNKI and Wanfang. Two independent reviewers screened the literature in accordance with the inclusion and exclusion criteria, assessed the quality of the included studies, and extracted the data. Further meta-analysis was performed using RevMan 5.3. RESULTS: Thirteen trials were included. Meta-analysis revealed that education for nurses (relative risk, 0.31; 95% confidence interval, 0.19-0.51; P < .00001) was significantly associated with PICC occlusion, whereas PICC type (relative risk, 0.60; 95% confidence interval, 0.32-1.15; P = .12) was not significantly associated with PICC occlusion. The solution to washing pipes and the PICC insertion techniques were descriptively analyzed to reach statistical significance. CONCLUSION: This study determined the correlation of PICC occlusion with the nurses' knowledge and skills, PICC types, flushing liquid and methods, and insertion techniques. IMPLICATIONS FOR PRACTICE: The findings of this study can serve as a guide for clinical work and for developing targeted measures to reduce occlusion.

Superior success rate of intracavitary electrocardiogram guidance for peripherally inserted central catheter placement in patients with cancer: A randomized open-label controlled multicenter study.

BACKGROUND: Intracavitary electrocardiogram (IC ECG) guidance emerges as a new technique for peripherally inserted central catheters (PICCs) placement and demonstrates many potential advantages in recent observational studies. AIMS: To determine whether IC ECG-guided PICCs provide more accurate positioning of catheter tips compared to conventional anatomical landmarks in patients with cancer undergoing chemotherapy. METHODS: In this multicenter, open-label, randomized controlled study (ClinicalTrials.gov number, NCT02409589), a total of 1,007 adult patients were assigned to receive either IC ECG guidance (n = 500) or anatomical landmark guidance (n = 507) for PICC positioning. The confirmative catheter tip positioning x-ray data were centrally interpreted by independent radiologists. All reported analyses in the overall population were performed on an intention-to-treat basis. Analyses of pre-specified subgroups and a selected large subpopulation were conducted to explore consistency and accuracy. RESULTS: In the IC ECG-guided group, the first-attempt success rate was 89.2% (95% confidence interval [CI], 86.5% to 91.9%), which was significantly higher than 77.4% (95% CI, 73.7% to 81.0%) in the anatomical landmark group (P < 0.0001). This trend of superiority of IC ECG guidance was consistently noted in almost all prespecified patient subgroups and two selected large subpopulations, even when using optimal target rates for measurement. In contrast, the superiority nearly disappeared when PICCs were used via the left instead of right arms (interaction P-value = 0.021). No catheter-related adverse events were reported during the PICC intra-procedures in either group. CONCLUSIONS: Our findings indicated that the IC ECG-guided method had a more favorable positioning accuracy versus traditional anatomical landmarks for PICC placement in adult patients with cancer undergoing chemotherapy. Furthermore, there were no significant safety concerns reported for catheterization using the two techniques.

Effects of Home Nursing Intervention on the Quality of Life of Patients with Nasopharyngeal Carcinoma after Radiotherapy and Chemotherapy.

BACKGROUND: The effects of home nursing intervention on the quality of life in patients with nasopharyngeal carcinoma (NPC) after radiotherapy and chemotherapy are unclear. According to the characteristics of nursing home patients with nasopharyngeal carcinoma, we should continuously improve the nursing plan and improve the quality of life of patients at home. MATERIALS AND METHODS: We selected 180 patients at home with NPC after radiotherapy and chemotherapy. The patients were randomly divided into experimental and control groups (90 patients each). The experimental group featured intervention with an NPC home nursing plan, while the control group was given routine discharge and outpatient review. Nursing intervention for patients was mainly achieved by regular telephone follow-up and home visits. We use the quality of life scale (QOL-C30), anxiety scale (SAS) and depression scale (SDS) to evaluate these patients before intervention, and during follow-up at 1 month and 3 months after the intervention. RESULTS: Overall health and quality of life were significantly different between the groups (p<0.05), Emotional function score was significantly higher after intervention (p<0.05), as were cognitive function and social function scores after 3 months of intervention (p<0.05). Scores of fatigue, nausea and vomiting, pain, appetite and constipation were also significantly different between the two groups (p<0.05). Rates of anxiety and depression after 3 months of intervention were 11.1%, 22.2% and 34.4%, 53.3%, the differences being significant (p<0.05). CONCLUSIONS: NPC home nursing plan could effectively improve overall quality of life, cognitive function, social function (after 3 months) of patients, but improvement regarding body function is not suggested. Fatigue, nausea and vomiting, pain, appetite, constipation were clearly improved. We should further pursue a personalized, comprehensive measurements for nursing interventions and try to improve the quality of life of NPC patients at home.

Nadir CA-125 level as prognosis indicator of high-grade serous ovarian cancer.

PURPOSE: The capacity of nadir CA-125 levels to predict the prognosis of epithelial ovarian cancer remains controversial. This study aimed to explore whether the nadir CA-125 serum levels could predict the durations of overall survival (OS) and progression free survival (PFS) in patients with high-grade serous ovarian cancer (HG-SOC) from the USA and PRC. MATERIALS AND METHODS: A total of 616 HG-SOC patients from the MD Anderson Cancer Center (MDACC, USA) between 1990 and 2011 were retrospectively analyzed. The results of 262 cases from the Jiangsu Institute of Cancer Research (JICR, PRC) between 1992 and 2011 were used to validate the MDACC data. The CA-125 immunohistochemistry assay was performed on 280 tissue specimens. The Cox proportional hazards model and the log-rank test were used to assess the associations between the clinicopathological characteristics and duration of survival. RESULTS: The nadir CA-125 level was an independent predictor of OS and PFS (p < 0.01 for both) in the MDACC patients. Lower nadir CA-125 levels (≤10 U/mL) were associated with longer OS and PFS (median: 61.2 and 16.8 months with 95% CI: 52.0-72.4 and 14.0-19.6 months, respectively) than their counterparts with shorter OS and PFS (median: 49.2 and 10.5 months with 95% CI: 41.7-56.7 and 6.9-14.1 months, respectively). The nadir CA-125 levels in JICR patients were similarly independent when predicting the OS and PFS (p < 0.01 for both). Nadir CA-125 levels less than or equal to 10 U/mL were associated with longer OS and PFS (median: 59.9 and 15.5 months with 95% CI: 49.7-70.1 and 10.6-20.4 months, respectively), as compared with those more than 10 U/mL (median: 42.0 and 9.0 months with 95% CI: 34.4-49.7 and 6.6-11.2 months, respectively). Baseline serum CA-125 levels, but not the CA-125 expression in tissues, were associated with the OS and PFS of HG-SOC patients in the MDACC and JICR groups. However, these values were not independent. Nadir CA-125 levels were not associated with the tumor burden based on second-look surgery (p = 0.09). Patients who achieved a pathologic complete response had longer OS and PFS (median: 73.7 and 20.7 months with 95% CI: 63.7-83.7 and 9.5-31.9 months, respectively) than those with residual tumors (median: 34.6 and 10.6 months with 95% CI: 6.9-62.3 and 4.9-16.3 months, respectively). CONCLUSIONS: The nadir CA-125 level was an independent predictor of OS and PFS in HG-SOC patients. Further prospective studies are required to clinically optimize the chances for a complete clinical response of HG-SOC cases with higher CA-125 levels (>10 U/mL) at the end of primary treatment.

Comparison of psychological influence on breast cancer patients between breast-conserving surgery and modified radical mastectomy.

OBJECTIVE: To compare the influence of breast-conserving surgery (BCS) and modified radical mastectomy (MRM) on the psychological state of breast cancer patients. METHODS: Patients receiving MRM or BCS, and fulfilling the study criteria, were recruited. Patients were required to complete a self-reporting inventory (SCL- 90) on admission and 6 months after surgery and a self-rating depression scale (SDS) when discharged from hospital and 6 months after surgery. RESULTS: A total of 70 patients received MRM and 50 BCS. Compared with the national standard, patients suffered to some extent psychological problems on admission, at discharge from hospital and at 6 months after surgery. Patients received BCS had a higher score of SDS compared with those with MRM when discharged from hospital. However, 6 months after surgery, SDS score increased in MRM and decreased in the BCS group, so the difference was significant. CONCLUSION: The short-term psychological state of patients receiving BCS is worse than that with MRM but superior to MRM 6 months postoperatively. BCS imposed less influence on long term psychological state of breast cancer patients compared with MRM.

Comparison of complications of peripherally inserted central catheters with ultrasound guidance or conventional methods in cancer patients.

OBJECTIVE: To compare the complications of peripherally inserted central catheters (PICC) by a modified Seldinger technique under ultrasound guidance or the conventional (peel-away cannula) technique. METHODS: From February to December of 2010, cancer patients who received PICC at the Department of Chemotherapy in Jiangsu Cancer Hospital were recruited into this study, and designated UPICC if their PICC lines were inserted under ultrasound guidance, otherwise CPICC if were performed by peel-away cannula technique. The rates of successful placement, hemorrhage around the insertion area, phlebitis, comfort of the insertion arm, infection and thrombus related to catheterization were analyzed and compared on days 1, 5 and 6 after PICC and thereafter. RESULTS: A total of 180 cancer patients were recruited, 90 in each group. The rates of successful catheter placement between two groups differed with statistical significance (P<0.05), favoring UPICC. More phlebitis and finger swelling were detected in the CPICC group (P<0.05). From day 6 to the date the catheter was removed and thereafter, more venous thrombosis and a higher rate of discomfort of insertion arms were also observed in the CPICC group. CONCLUSION: Compared with CPICC, UPICC could improve the rate of successful insertion, reduce catheter related complications and increase comfort of the involved arm, thus deserving to be further investigated in randomized clinical studies.