The relationship between fear of cancer recurrence and death anxiety among Chinese cancer patients: the serial mediation model.

AIMS: This study aims to investigate the association between fear of cancer recurrence (FCR) and death anxiety (DA) among Chinese cancer patients, while considering the mediating effects of experiential avoidance (EA) and meaning in life (MIL). METHODS: From February to June 2023, convenience sampling was used to select newly diagnosed cancer patients in a tertiary Cancer Hospital in Chinese Hunan Province as the survey objects. A total of 436 cancer patients completed the Fear of Cancer Recurrence Inventory, the Meaning in Life Questionnaire, the Acceptance and Action Questionnaire-II, and the Templer's death anxiety scale. Descriptive analysis and Pearson correlation analysis were conducted using SPSS 28.0 software. Serial mediation analysis was performed by Hayes' PROCESS macro. RESULTS: Gender, age, educational level, marital status, residence, occupation, per capita monthly household income, tumor type, and cancer stage were controlled in the model. The results revealed that fear of cancer recurrence had a significant direct effect on death anxiety (Effect = 0.075, 95% CI: 0.064 to 0.087). Additionally, three indirect pathways were identified: (1) through experiential avoidance (Effect = 0.037, 95% CI: 0.026 to 0.049), (2) through meaning in life (Effect = 0.022, 95% CI: 0.014 to 0.031), and (3) through the serial mediators involving meaning in life and experiential avoidance (Effect = 0.016, 95% CI: 0.010 to 0.023). The total indirect effect of the three mediation paths was 63.56%. CONCLUSION: Fear of cancer recurrence is a significant psychological distress experienced by cancer patients, which not only directly contributes to death anxiety but also may triggers changes, such as experiential avoidance and meaning in life. Ultimately, this comprehensive psychological distress leads to death anxiety.

The mediating role of meaning in life between experiential avoidance and death anxiety among cancer patients: a cross-sectional study.

BACKGROUND: Death anxiety is thought to cause a range of mental disorders among cancer patients, which may affect their mental health and even quality of life. This study sought to investigate experiential avoidance, meaning in life, and death anxiety among Chinese cancer patients and then explore the relationship between these 3 variables. METHODS: A total of 300 cancer patients recruited from a tertiary cancer hospital participated in this study from October to December 2021. A cross-sectional survey was conducted using a demographic and clinical characteristics questionnaire, the Acceptance and Action Questionnaire II, the Meaning in Life Questionnaire, and Templer's Death Anxiety Scale. Correlation analysis, hierarchical regression analysis, and mediating effect analysis were used to analyze the relationship among experiential avoidance, meaning in life (including 2 dimensions: presence of meaning and search for meaning), and death anxiety. RESULTS: A total of 315 questionnaires were distributed, and 300 valid questionnaires were returned, resulting in a valid response rate of 95.2%. Experiential avoidance (r = 0.552, p < 0.01) was moderately positively correlated with death anxiety. Presence of meaning (r = - 0.400, p < 0.01) was moderately negatively correlated with death anxiety, while search for meaning (r = - 0.151, p < 0.01) was weakly negatively correlated with death anxiety. Regression analysis showed that experiential avoidance (ß = 0.464) and presence of meaning (ß = -0.228) were predictors of death anxiety. Mediating effect analysis revealed that presence of meaning either completely or partially mediated the effect of experiential avoidance and death anxiety, and the indirect effect accounted for 14.52% of the total effect. CONCLUSION: Overall, experiential avoidance predicts death anxiety in cancer patients, and meaning in life can mediate this effect. The results of this study provide a new path for studying the mechanism of death anxiety and suggest a more positive and promising strategy for its management.

Experiences of patients with advanced cancer coping with chronic pain: a qualitative analysis.

OBJECTIVES: To gain insight into the perceptions, and beliefs of patients with advanced cancer coping with chronic pain and to identify their attitudes and demands on pain management. METHODS: From July to September 2022, 17 patients with advanced cancer living with chronic pain were recruited from a tertiary cancer hospital in Hunan Province, China. Qualitative and semi-structured interviews were conducted individually, with 30-45 minutes for each. The Colaizzi 7-step analysis method in phenomenological research was used for data analysis. RESULTS: The experience of pain acceptance by advanced cancer patients with chronic pain was summarized into four themes: pain catastrophizing (unable to ignore the pain, try various methods to relieve the pain, exaggerating pain perception, and lack of knowledge about proper pain management), rumination (compulsive rumination and worrying rumination), avoidance coping (situational avoidance and repressive avoidance) and constructive action (setting clear value goal and taking reciprocal action). CONCLUSION: Most patients with advanced cancer had low pain acceptance and negative attitudes. Feeling helpless in the face of pain and suffering alone were their norm. Long-term negative emotions could lead to gradual depression and loss of hope for treatment, resulting in pain catastrophizing and persistent rumination. Nevertheless, a few patients accepted pain with positive attitudes. Medical professionals should pay more attention to the psychological status of advanced cancer patients with chronic pain, and employ alternative therapies, for example, cognitive behavioral therapy. More efforts are needed to reduce patients' pain catastrophizing, and promote their pain acceptance by a better understanding of pain through health education.

Psychological adjustment to death anxiety: a qualitative study of Chinese patients with advanced cancer.

OBJECTIVES: Death anxiety (DA) refers to the negative emotions experienced when a person reflects on the inevitability of their own death, which is common among patients with cancer. It is crucial to understand the causes, coping styles and adjustment processes related to DA. The purpose of this qualitative study is to explore the adaptation process and outcome of patients with advanced cancer with DA and to provide evidence-based support for the development of targeted intervention measures to improve the mental health of such patients. DESIGN: This cross-sectional qualitative study sampled patients with advanced cancer (n=20). Grounded theory procedures were used to analyse transcripts and a theoretical model generated. SETTING: All interviewees in this study were from a tertiary oncology hospital in Hunan Province, China. The data analysis followed the constructive grounded theory method, involving constant comparison and memo writing. PARTICIPANTS: A purposive and theoretical sampling approach was used to recruit 20 patients with advanced cancer with diverse characteristics. RESULTS: A total of 20 participants were included in the study. Four stages of DA in patients with advanced cancer were extracted from the interview data: (1) death reminder and prominence; (2) perception and association; (3) defence and control; (4) transformation and Acceptance. CONCLUSIONS: This study highlights the psychological status and coping strategies of dynamic nature of patients with advanced cancer when confronted with negative emotions associated with death. It emphasises the importance of timely identification of DA in psychological nursing for patients with advanced cancer and the need for targeted psychological interventions based on their specific psychological processes. IMPLICATIONS: Knowing interventions that aim to promote the integration of internal and external resources, enhance self-esteem and facilitate a calm and accepting attitude towards death could ultimately reduce the overall DA of patients with advanced cancer.

Trajectories of fear of cancer recurrence and its influence factors: A longitudinal study on Chinese newly diagnosed cancer patients.

OBJECTIVE: The fear of cancer recurrence (FCR) is an ongoing and common psychological problem faced by cancer patients. The objective of this study was to explore the variation trend of FCR and its influencing factors in Chinese newly diagnosed cancer patients from admission to 2 months after discharge. Demographic and tumor characteristics, as well as experiential avoidance (EA), were used as predictors. METHOD: A longitudinal design and a consecutive sampling method were used to select 266 newly diagnosed cancer patients admitted to a tertiary cancer hospital in China from July to December 2022. Measurements of FCR and EA were obtained at admission (T1), 1 month after discharge (T2), and 2 months post-discharge (T3). Generalized estimating equations were used to identify factors associated with FCR for longitudinal data analysis. RESULTS: A total of 266 participants completed the follow-up. Both FCR and EA scores of patients with newly diagnosed cancer showed a significant trend of first increasing and then decreasing at baseline and follow-up (p < 0.001). The junior secondary and less education level, rural residence, advanced tumor and high EA level were risk factors for higher FCR. CONCLUSIONS: Our findings suggest that the FCR levels of most newly diagnosed cancer patients in China are different at the three time points and affected by different factors, with the highest level at 1 month after discharge. These results have significant implications for future identifying populations in need of targeted intervention based on their FCR trajectories.

Perioperative change trajectories and predictors of swallowing function and swallowing-related quality of life in patients with oral cancer: a longitudinal observational study.

OBJECTIVE: To determine change trajectories and predictors of swallowing function and swallowing-related quality of life (QoL) in perioperative patients with oral cancer. DESIGN: Longitudinal observational study. SETTING: A tertiary cancer hospital in Hunan Province, China. PARTICIPANTS: Patients with oral cancer scheduled for surgery were recruited using convenience sampling. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcomes were swallowing function and swallowing-related QoL. The secondary outcomes were the predictors of the swallowing function and swallowing-related QoL. METHODS: The participants completed the sociodemographic and clinical data questionnaire, Nutritional Risk Screening 2002 and MD Anderson Dysphagia Inventory before surgery, 7 days after operation and 1 month after operation. Data were analysed using t-test, analysis of variance and generalised linear models. RESULTS: Among 138 participants who completed all the three surveys, 41 (29.71%) had moderate to severe dysphagia before surgery. Swallowing function and swallowing-related QoL changed over time, showing the trend of decline first and then increase. Preoperative swallowing function and swallowing-related QoL were affected by sex, lymphocyte level, preoperative nutritional risk and primary tumour site. At 7 days postoperatively, tracheotomy affected swallowing function. At 1 month postoperatively, age and marital status influenced swallowing function, whereas age, type of job and preoperative nutritional risk influenced swallowing-related QoL. CONCLUSIONS: Our study demonstrates that perioperative patients with oral cancer generally faced swallowing disorders, especially in the acute phase after surgery. Healthcare providers should pay attention to the swallowing function of perioperative patients with oral cancer, especially those with preoperative nutritional risk, tongue tumour, tracheotomy, age <60 years, and no spouse and the employed patients, and provide available interventions, such as swallowing and nutritional therapy, as early as possible to improve their swallowing function. Meanwhile, doctors should recommend the most evidence-based treatment options, such as reconstruction or not, preoperative chemotherapy or not, to patients.

The Role of In-Group and Out-Group Facial Feedback in Implicit Rule Learning.

Implicit learning refers to the fact that people acquire new knowledge (structures or rules) without conscious awareness. Previous studies have shown that implicit learning is affected by feedback. However, few studies have investigated the role of social feedback in implicit learning concretely. Here, we conducted two experiments to explore how in-group and out-group facial feedback impact different difficulty levels of implicit rule learning. In Experiment 1, the Chinese participants in each group could only see one type of facial feedback, i.e., either in-group (East Asian) or out-group (Western) faces, and learned the implicit rule through happy and sad facial expressions. The only difference between Experiment 2 and Experiment 1 was that the participants saw both the in-group and out-group faces before group assignment to strengthen the contrast between the two group identities. The results showed that only in Experiment 2 but not Experiment 1 was there a significant interaction effect in the accuracy of tasks between the difficulty levels and groups. For the lowest difficulty level, the learning accuracy of the in-group facial feedback group was significantly higher than that of the out-group facial feedback group, whereas this did not happen at the two highest levels of difficulty. In conclusion, when the contrast of group identities was highlighted, out-group feedback reduced the accuracy of the least difficult task; on the contrary, there was no accuracy difference between out-group and in-group feedback conditions. These findings have extensively important implications for our understanding of implicit learning and improving teaching achievement in the context of educational internationalization.

Perioperative nutritional risk and its influencing factors in patients with oral cancer: a longitudinal study.

Introduction: We aimed to investigate the nutritional risk status and dynamic changes in patients with perioperative oral cancer at different stages and analyze the factors influencing nutritional risk and the correlation among body mass index, nutrition-related symptoms, and nutritional risk. Methods: In total, 198 patients with oral cancer who were hospitalized in the Head & Neck Surgery Departments of a tertiary cancer hospital in Hunan Province, China, from May 2020 to January 2021, were selected as participants. The Nutritional Risk Screening 2002 scale and Head and Neck Patient Symptom Checklist were used to assess patients on admission day, 7 days post-surgery, and 1 month post-discharge. Multivariate analysis of variance, paired t-test, and generalized estimating equation were used to analyze the trajectory and influencing factors of nutritional risk in patients with perioperative oral cancer. Spearman's correlation analysis was used to explore the correlation among body mass index, symptoms, and nutritional risk. Results: The nutritional risk scores of patients with oral cancer at the three time points were 2.30 ± 0.84, 3.21 ± 0.94, and 2.11 ± 0.84, respectively, and the differences were significant (p < 0.05). The incidences of nutritional risk were 30.3, 52.5, and 37.9%, respectively. The factors influencing nutritional risk included education level, smoking status, clinical stage, flap repair, and tracheotomy (ß = -0.326, 0.386, 0.387, 0.336, and 0.240, respectively, p < 0.05). Nutritional risk was negatively correlated with body mass index (rs = -0.455, p < 0.01) and positively correlated with pain, loss of appetite, sore mouth, bothersome smells, swallowing difficulty, taste changes, depression, chewing difficulty, thick saliva, and anxiety (rs = 0.252, 0.179, 0.269, 0.155, 0.252, 0.212, 0.244, 0.384, 0.260, and 0.157, respectively, p < 0.05). Conclusion: The incidence of nutritional risk in patients with perioperative oral cancer was high, and the trajectory of nutritional risk changed over time. Strengthening the nutritional monitoring and management of postoperative patients or those with low education level, advanced-stage cancer, flap repair, tracheotomy, and low body mass index; strengthening tobacco control management; and controlling nutrition-related discomfort symptoms in perioperative oral cancer patients are necessary.

Psychometric validation of the modified Chinese version of the personalized psychological flexibility index in patients with cancer.

Objective: The aim of this study was to perform across-cultural adaptation of the English version of the personalized psychological flexibility index (PPFI) into Chinese, and to evaluate its psychometric properties in patients with cancer. Methods: This study was conducted in two phases. In phase 1, we followed Beaton's guidelines for cross-cultural adaptation of PPFI. In phase 2, we conducted a cross-sectional study to assess the validity and reliability of the PPFI among a total of 455 patients with cancer in Hunan Province of China. Item analysis was used to evaluate and screen items, while content validity, construct validity, convergent validity, and concurrent validity were used to evaluate the validity. Reliability was assessed using Cronbach's ɑ coefficient, retest reliability, and composite reliability. Results: The item-level content validity index of the modified Chinese version of PPFI (PPFI-C) ranged from 0.89 to 1.00, the scale-level CVI/universal agreement was 0.87, and the S-CVI/average was 0.99. Exploratory factor analysis identified a 14-item, three-factor structure of PPFI (item 11 deleted). Confirmatory factor analysis showed χ2/df â€‹= â€‹2.42, RMSEA â€‹= â€‹0.07, GFI â€‹= â€‹0.92, NFI â€‹= â€‹0.91, TLI â€‹= â€‹0.93, CFI â€‹= â€‹0.95, and IFI â€‹= â€‹0.95. PPFI-C demonstrated positive correlations with the 8-item Commitment Action Questionnaire, and negative correlations with Acceptance and Action Questionnaire-II, Hospital Anxiety and Depression Scale, and Short Form Quality Life Scale. The Cronbach's ɑ coefficient of modified PPFI-C stood at 0.84. Conclusions: The results suggest that the 14-item PPFI-C is a reliable and valid tool for measuring PF in Chinese patients with cancer. However, additional studies are needed to validate the psychometric properties of PPFI-C in other populations.

Development and preliminary validation of Cancer-related Psychological Flexibility Questionnaire.

The Cancer-related Psychological Flexibility Questionnaire (CPFQ) was developed and validated for assessing cancer patients' psychological flexibility, including attitudes and behavior toward cancer. In a systematic process, the CPFQ identified four factors through principal component analysis and confirmatory factor analysis: Cancer Acceptance, Cancer Avoidance, Activity Engagement, and Valued Action. The results of this study reveal that the CPFQ has a clear factor structure and good psychometric properties. The specific nature of cancer and the need for a specific measure of cancer patient psychological flexibility make this questionnaire valuable for research on psychological flexibility in cancer patients.

Perioperative symptom burden and its influencing factors in patients with oral cancer: A longitudinal study.

Objective: The aim of this study was to identify the symptom burden of perioperative oral cancer patients, its trajectory, and the factors influencing it. Methods: A longitudinal, repeated measures design with consecutively identified sampling was used to recruit oral cancer patients scheduled for surgical treatment. Data collected included sociodemographic and clinical information, nutritional risk by the Nutritional Risk Screening 2002, and symptom burden by M. D. Anderson Symptom Inventory-Head and Neck Module (MDASI-HN) at preoperation, 7 days postsurgery, and 1 month postsurgery. Results: Perioperative patients with oral cancer had multiple symptoms. Pain, difficulty swallowing/chewing, and mouth/throat sores (61.9%-76.1%) were the most prevalent symptoms before surgery. The symptom burden was the highest at 7 days after surgery, with the most prevalent symptoms, including difficulty swallowing/chewing, difficulty with voice/speech, and problems with mucus (87.8%-95.4%). At 1 month postsurgery, the 3 main symptoms were numbness or tingling, difficulty swallowing/chewing, and difficulty with voice/speech (all 87.8%). Treatment stage, job, comorbidity, cancer stage, adjuvant therapy, and Nutritional Risk Screening 2002 score were correlated with symptom burdens. Conclusions: Our study illustrates that perioperative oral cancer patients have multiple symptoms and high symptom burdens, especially at 7 days postsurgery, with prominent symptoms and symptom burdens varying with the treatment stage.

Chinese Version of the Psychological Inflexibility in Pain Scale for Cancer Patients Reporting Chronic Pain.

BACKGROUND: Cancer-related chronic pain is reported by many patients during treatment. There are very few Chinese tools for measuring psychological inflexibility caused by cancer pain, particularly with regard to psychological processes that might influence pain severity and function disorder during cancer treatment. OBJECTIVE: To culturally adapt the Psychological Inflexibility in Pain Scale (PIPS) to Chinese cancer patients experiencing chronic pain, including the determination of psychometric properties of the translated PIPS. METHODS: This cross-sectional study included 2 phases: (1) translation and cultural adaptation and (2) determination of psychometric properties of the translated PIPS. In total, 389 cancer patients with several types of cancer experiencing chronic pain enrolled from May to September 2018 at a tertiary cancer hospital in Yuelu District of Hunan Province, China. RESULTS: The Chinese PIPS version was semantically equivalent to the original. It had a 2-factor structure with satisfactory content validity (content validity index = 0.78-1.00), convergent and discriminant validity (composite reliability and average variance extracted at 0.41-0.89, P < .001), criterion-related validity (r = 0.54 and 0.41, P < .001), Cronbach's α coefficients (α = .87), and test-retest reliability (0.9 ≤ r ≤ 0.98). CONCLUSIONS: The Chinese PIPS version has been culturally adapted and has strong psychometric properties. The scale is a psychometrically sound assessment of psychological inflexibility that can be used for future studies of pain and pain management for cancer patients. IMPLICATIONS FOR PRACTICE: The study provides a vital tool for the psychological management of cancer patients with chronic pain.

Factors Related to Nurses' Knowledge and Attitudes Toward Pain in Hospitals in Low-Income Areas.

BACKGROUND: Effective pain management is closely related to nurses' knowledge and attitudes toward pain. Limited studies have been performed related to nurses' knowledge and attitudes toward pain in hospitals in low-income areas. AIMS: This study surveyed the knowledge and attitudes of nurses toward pain management in county hospitals from low-income areas in Hunan Province, China. SETTING AND PARTICIPANTS: The study included 4,668 registered nurses working in 48 county hospitals in low-income areas in China. METHODS: A cross-sectional study examined the knowledge and attitudes of nurses with regard to pain using the Chinese version of the Knowledge and Attitude Survey Regarding Pain (KASRP) via the WeChat application. RESULTS: The 4,668 registered nurses completed the survey; of these, 43.6% indicated they had never received continuing education for pain. The mean percentage score for KASRP was (40.3 ± 7.95), and none of the respondents achieved a percentage score of >80%. Further, of the 40 items, only two had a correct rate of >80%. Continuing pain education did not significantly affect KASRP. Multiple stepwise linear regression showed that education level, ethnicity, professional title, position, and department were independent influencing factors for KASRP scores. CONCLUSION: Almost all nurses in county hospitals of low-income areas had deficiencies in various aspects of pain management knowledge. Better educated nurses with higher professional title or management position, those from the Han ethnicity, and those from the oncology department had higher mean KASRP scores. Current continuing education programs for pain did not improve the pain management capability of the nurse. High-quality and standardized pain educational programs should be implemented to improve pain management.

Pain acceptance in cancer patients with chronic pain in Hunan, China: A qualitative study.

OBJECTIVE: The purpose of this qualitative study was to describe the experiences of pain acceptance in Chinese cancer patients with chronic pain. METHODS: Twelve hospitalized cancer patients with chronic pain participated in this qualitative descriptive study from August to November 2017. In-person semi-structured interviews were conducted, recorded, transcribed, and analyzed using Colaizzi's seven-step method. RESULTS: The following four main themes and 15 subthemes emerged. Theme 1 (adaptation): pain is overwhelming and pain relief is a top priority, avoidance of pain-inducing factors, and resignation; theme 2 (emotional reactions to pain): feeling misunderstood, hopelessness, frustration, irritability, and concern for loved ones; theme 3 (functional limitations): daily life activities, social communication, and work; theme 4 (coping strategies): pharmacological therapies, behavioral strategies, social support strategies, and spiritual strategies. CONCLUSIONS: This study provides a description of cancer patients' experiences related to the need for pain acceptance. These findings provide insight into the essential role of pain acceptance and underline the need to apply acceptance-based cognitive behavioral interventions as adjunctive non-pharmacological alternatives for chronic cancer pain.

Pain Acceptance and Its Associated Factors among Cancer Patients in Mainland China: A Cross-Sectional Study.

BACKGROUND: Pain acceptance is associated with disability, pain interference, depression, and anxiety. Few studies have been conducted on the acceptance of cancer pain and its correlates. OBJECTIVES: The aim of this study was to examine the level and correlates of pain acceptance in cancer patients from mainland China. SETTING AND PARTICIPANTS: The study comprised 156 cancer patients in a tertiary cancer hospital in Hunan Province of China. DESIGN: The study is based on a cross-sectional survey design. SUBJECTS AND METHODS: The 8-item Chronic Pain Acceptance Questionnaire (CPAQ-8) was completed by 156 cancer patients with chronic pain from a tertiary cancer hospital. Demographics, pain, and negative mood assessed by the Hospital Anxiety and Depression Scale (HADS) were explored in relation to the CPAQ-8 scores using descriptive univariate analysis. RESULTS: For the 156 patients, the mean CPAQ-8 score was 25.99 (SD = 8.56; range: 9 to 44). The scores were associated with age, gender, marital status, pain duration, number of pain sites, and duration of taking analgesics. The total scores on the CPAQ-8 and its two subscales (activity engagement and pain willingness) were negatively correlated with the HADS scores. CONCLUSIONS: The findings suggest that the prevalence of pain acceptance is relatively low for Chinese cancer patients. The cancer pain acceptance is affected by age, gender, pain duration, number of pain sites, and duration of taking analgesics. The acceptance of cancer pain is negatively correlated with depression and anxiety. Therefore, patients with risk factors for low pain acceptance should receive more attention in Chinese medical settings.

Psychological Flexibility of Nurses in a Cancer Hospital: Preliminary Validation of a Chinese Version of the Work-related Acceptance and Action Questionnaire.

OBJECTIVE: To translate the English work-related acceptance and action questionnaire (WAAQ), make cross-cultural adaptations, and examine its psychometric properties when used by Chinese oncology nurses. METHODS: After translation, the psychometric properties of the Chinese WAAQ were analyzed among 417 nurses, and content validity was determined by six experts. RESULTS: Item-level content validity index (CVI) values were between 0.83 and 1.00; scale-level CVI/universal agreement (S-CVI/UA) and S-CVI/average were 0.86 and 0.98, respectively, which implicated a good content validity. The correlation of the Chinese WAAQ with AAQ-II (rs = -0.247, P < 0.001) suggested criterion validity, and those with General Health Questionnaire-12 (-0.250, <0.001) and general self-efficacy scale (0.491, <0.001) and Utrecht work engagement scale (UWES) (0.439, <0.001) suggested convergent validity. Exploratory factor analysis identified a seven-item, one-factor structure of WAAQ. The Chinese version of WAAQ had high internal consistency (Cronbach's α = 0.920), with an item-total correlation coefficient of 0.702-0.828 (P < 0.05), split-half reliability of 0.933, and test-retest reliability of 0.772. CONCLUSIONS: The Chinese WAAQ is a reliable and valid tool for assessing psychological flexibility in Chinese oncology nurses.

[Impact of sitagliptin on aspirin resistance in patients with Type 2 diabetes mellitus].

OBJECTIVE: To explore the impact of sitagliptin on aspirin resistance (AR) in patients with Type 2 diabetes mellitus (T2DM).
 METHODS: A total of 68 cases of AR were chosen from 136 cases of T2DM patients. The clinical data, including blood samples, fasting plasma glucose (FPG), glycosylated hemoglobin (HbAlc), and high sensitive C reactive protein (hs-CRP) were collected. Aenosine diphosphate (ADP) and arachidonic acid (AA) -induced platelet aggregation rate (PAG) were detected in 1, 3, 6 and 12 months after the treatment to evaluate the impact of sitagliptin on AR. 
 RESULTS: After 6 months of hypoglycemic treatment, FPG and HbAlc in two groups were at the normal level. The hypoglycemic effect was not obviously different (P>0.05), but the hsCRP and ADP or AA-induced PAG were decreased in the sitagliptin group with statistical significance when compared with the metformin group (P<0.05).
 CONCLUSION: Sitagliptin can significantly improve the oxidative stress inflammatory state in T2DM patients and AR, which is independent on blood glucose control.

The association between mean platelet volume and chronic atrial fibrillation and the presence of thrombotic events.

Mean platelet volume (MPV), a marker of platelet activation, is a surrogate marker of platelet function and a potential mediator of the association between inflammation and thrombosis. The present retrospective study sought to investigate the association between MPV and the presence of thrombotic events (TEs) in patients with chronic atrial fibrillation (AF). A total of 114 consecutive patients with chronic AF were enrolled from a Chinese hospital. Individuals were divided into three groups: The AF+TE group (n=57, 33.1%), which comprised patients in AF with concomitant TEs; the AF group (n=57, 33.1%), which comprised patients in AF with no identifiable TEs, as confirmed by brain computed tomography, transesophageal echocardiography, or a combination of the two; and a control group (n=58, 33.7%), which consisted of patients who were in sinus rhythm. MPV, high-sensitivity C-reactive protein (hsCRP), D-dimer and the left atrial diameter (LAD) were analyzed in the 172 participants. The MPV level of patients in the AF+TE group was significantly higher than that of patients in the AF and control groups (P<0.05). In the correlation analysis, MPV levels were found to be positively correlated with LAD, D-dimer concentrations and hsCRP levels in patients with AF (r=0.960, P<0.05; r=0.896, P<0.05; and r=0.924, P<0.01, respectively). In the receiver operating characteristic curve analysis, the value for MPV levels required to detect TEs with a sensitivity of 77.5% and specificity of 78% was 10.5 femtoliter (fl). A high MPV level (>10.5 fl) was significantly associated with the occurrence of TEs (odds ratio, 3:1; 95% confidence interval, 1.6-5.1; P=0.000). The results of the present study suggest that an additional biomarker, MPV, has a predictive value for the presence of TEs in patients with AF. MPV may be a potential mediator between inflammation and thrombosis.