[Relationship between Muscle Mass of Limbs and aGVHD in Patients with Allogeneic Hematopoietic Stem Cell Transplantation].

OBJECTIVE: To explore the correlation of limb muscle mass and acute graft-versus-host disease. METHODS: Clinical data from 144 patients treated by allo-HSCT in Guangzhou First People's Hospital were collected and analyzed retrospectively. The age, sex, diagnosis, donor age, sex of the donors, preparative regimen, ATG dose, HLA match, graft source, and number of infused stem cells of the patients were collected as baseline information. Meanwhile, bioelectrical impedance principle (BIA) was used to measure the limb muscle mass, body weight, body mass index (BMI), waist-to-hip ratio, upper arm muscle circumference, triceps skinfold thickness, and body fat rate of the patients before and after transplantation, so as to compare the changes of limb muscle mass and investigate its correlation with aGVHD. RESULTS: It was found that 61.11% of allo-HSCT patients showed muscle mass loss, and the proportion of male and female was 35.42% and 25.69%, respectively. There were reduction in the body weight, BMI, upper arm muscle circumference and muscle mass of limbs after transplantation as compared with those before transplantation (P<0.05). By comparing with the cumulative incidence of aGVHD between the patients in low muscle mass group and normal muscle mass group, it was found that the cumulative incidence of Ⅱ-Ⅳdegree aGVHD in patients with low muscle mass (30.38%) was higher than those with normal muscle mass (8.93%), which showed statistical difference (P<0.05). Univariate analysis showed that muscle mass, the sex of the donors, and preparative regimen were the influencing factors of aGVHD (P<0.05). Binary logistic regression showed that low muscle mass was the independent risk factor affecting aGVHD (P<0.05). CONCLUSION: Patients treated by allo-HSCT shows a decline in muscle mass after transplantation, and the incidence of aGVHD is high in patients with low muscle mass. Therefore, the assessment of muscle quality in early stage in patients with HSCT can facilitate earlier detection of aGVHD.

[Efficacy of thunder-fire moxibustion combined with external applicaion of Shuangbai powder for mild and moderate knee osteoarthritis].

OBJECTIVE: To compare the therapeutic effect between thunder-fire moxibustion combined with external applicaion of Shuangbai powder and thunder-fire moxibustion alone for mild and moderate knee osteoarthritis. METHODS: A total of 70 patients with mild and moderate knee osteoarthritis were randomly divided into an observation group and a control group, 35 cases in each group. In the observation group, thunder-fire moxibustion combined with external applicaion of Shuangbai powder were applied, Thunder-fire moxibustion was applied at Xuehai (SP 10), Liangqiu (ST 34), Neixiyan (EX-LE 4), Yanglingquan (GB 34) and ashi point, external applicaion of Shuangbai powder was given to the affected knee after the treatment of thunder-fire moxibustion. Simple thunder-fire moxibustion was given in the control group. All patients in the two groups were treated once a day, 7 days as one course and the consecutive 4 courses were required, with an interval of 1 day between courses. Before and after treatment, the visual analogue scale (VAS) score and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score were used to assessed knee pain, stiffness and physical function in the two groups. In addition, the efficacy was evaluated. RESULTS: Compared before treatment, the VAS scores, total scores of WOMAC, pain scores, stiffness scores and physical function scores were reduced after treatment in the two groups (P<0.01), and the scores in the observation group were significantly lower than those in the control group (P<0.01, P<0.05). The total effective rate was 97.0% (32/33) in the observation group, which was superior to 91.2% (31/34) in the control group (P<0.05). CONCLUSION: Thunder-fire moxibustion combined with external applicaion of Shuangbai powder are superior to simple thunder-fire moxibustion in improving the symptoms and delaying the development of the disease for mild and moderate knee osteoarthritis.

Validation and application of the Chinese version of the 10-item Connor-Davidson Resilience Scale (CD-RISC-10) among parents of children with cancer diagnosis.

PURPOSE: Parents of children diagnosed with cancer often experience considerable emotional distress for their children with negative emotions, such as disbelief, depression, anxiety, hope and shock. Resilience is defined as the psychological characteristics that promote positive adaptation in the face of stress and adversity, which has been demonstrated to relate to positive coping and less psychological distress. Thus, a quick screening tool to evaluate the levels of resilience of parents with cancer-diagnosed children is urgently required. METHODS: The Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA) were used to evaluate the CD-RISC-10 using a sample size of 500 parents. Velicer's Minimum Average Partial (MAP) Test and a parallel analysis were also supplemented to confirm the EFA-derived structure of the scale. The participants were given the 10-item Kessler Psychological Distress Scale (K-10), Perceived Social Support Scale (PSSS) and Medical Coping Modes Questionnaire (MCMQ) to test the associates with CD-RISC-10 and obtain the cut-off of the scale. RESULTS: The Chinese version of CD-RISC-10 has good psychometric properties and retains its single dimension in the original English version, which can explain 49.602% of the total variance. The CFA demonstrates the fit indices of a one-order model: Chi-Square = 39.987, CMIN/DF = 1.333, P < 0.001, TLI = 0.914, CFI = 0.981, GFI = 0.962, NFI = 0.926, IFI = 0.979, RFI = 0.889, RMR = 0.042, and RMSEA = 0.041. The CD-RISC presents statistical associations with other scales, and the cut-off is 25.5. CONCLUSIONS: The Chinese version of the CD-RISC-10, which is reliable, valid and easy to use, is suitable for clinical settings. The CD-RISC-10 enables a quick understanding of the level of resilience of the parents when their children undergo treatment, which can be the most important indicator to their psychological health.

Resilience model for parents of children with cancer in mainland China-An exploratory study.

PURPOSE: Parents have psychosocial functions that are critical for the entire family. Therefore, when their child is diagnosed with cancer, it is important that they exhibit resilience, which is the ability to preserve their emotional and physical well-being in the face of stress. The Resilience Model for Parents of Children with Cancer (RMP-CC) was developed to increase our understanding of how resilience is positively and negatively affected by protective and risk factors, respectively, in Chinese parents with children diagnosed with cancer. METHODS: To evaluate the RMP-CC, the latent psychosocial variables and demographics of 229 parents were evaluated using exploratory structural equation modeling (SEM) and logistic regression. RESULTS: The majority of goodness-of-fit indices indicate that the SEM of RMP-CC was a good model with a high level of variance in resilience (58%). Logistic regression revealed that two demographics, educational level and clinical classification of cancer, accounted for 12% of this variance. CONCLUSIONS: Our results indicate that RMP-CC is an effective structure by which to develop mainland Chinese parent-focused interventions that are grounded in the experiences of the parents as caregivers of children who have been diagnosed with cancer. RMP-CC allows for a better understanding of what these parents experience while their children undergo treatment. Further studies will be needed to confirm the efficiency of the current structure, and would assist in further refinement of its clinical applications.

Predicting changes in quality of life and emotional distress in Chinese patients with lung, gastric, and colon-rectal cancer diagnoses: the role of psychological resilience.

BACKGROUND: Patients with cancer often experience considerable emotional distress, which decreases their quality of life (QOL). Resilience is defined as the psychological characteristics that promote positive adaptation in the face of stress and adversity; however, the relationships among QOL, resilience, and emotional distress in patients with cancer, especially Chinese patients with cancer, are under-researched in the literature. METHODS: Quality of Life Questionnaire Core 30 items, Zung Self-Rating Anxiety Scale, and the Zung Self-Rating Depression Scale were applied in this study. Univariate correlated analysis and multivariate logistic regression analysis were used to test the associations among resilience, emotional distress, and QOL with a sample of 276 participants. A Sobel test was conducted to determine whether the indirect effect of resilience was significant. RESULTS: The mean ratings of QOL (59.2), resilience (20.8), anxiety (43.1), and depression (47.7) were reported. The correlations between resilience and QOL in patients with lung cancer were significantly increased compared with patients with gastric or colorectal cancer (Spearman coefficient squares of 0.284, 0.189, and 0.227, respectively). The highest quartile of the resilience level was associated with a 64% (odds ratio = 0.36, 95% confidence interval = 0.17-0.75, P = .006), 70% (odds ratio = 0.30, 95% confidence interval = 0.14-0.63), and 90% (odds ratio = 0.10, 95% confidence interval = 0.04-0.26, P < .001) reduction in the risk of emotional distress compared with the lowest quartile. The Sobel test indicated a buffering effect of resilience that was significant for depression (Sobel value = 2.002, P = .045) but not anxiety (Sobel value = 1.336, P = .182). CONCLUSIONS: The present study suggests that psychological resilience is positively associated with QOL and may comprise a robust buffer between depression and QOL in Chinese patients with cancer.

Effect of a multidiscipline mentor-based program, Be Resilient to Breast Cancer (BRBC), on female breast cancer survivors in mainland China-A randomized, controlled, theoretically-derived intervention trial.

To reduce the risk of adjustment problems for breast cancer patients in mainland China, we examined the efficacy of a multidiscipline mentor-based program, Be Resilient to Breast Cancer (BRBC), delivered after breast surgery to (a) increase protective factors of social support, hope for the future, etc.; (b) decrease risk factors of Physical and Emotional Distress; and (c) increase outcomes of Resilience, Transcendence and Quality of Life (QOL). A multisite randomized controlled trial was conducted at 6 specialist cancer hospitals. 101 and 103 breast cancer patients were allocated to intervention group (IG) and control group (CG), respectively, and 112 general females (without breast cancer) were allocated to the norm group (NG). Participants completed measures that were related to latent variables derived from the Resilience Model for Breast Cancer (RM-BC) at baseline (T1), 2 months (T2), 6 months (T3), and 12 months (T4) after intervention. At T2, the IG reported significantly lower Depression (ES = 0.65,P = 0.0019) and Illness Uncertainty (ES = 0.57, P = 0.004), better Hope (ES = 0.81, P < 0.001) and QOL (ES = 0.60, P = 0.002) than did the CG. At T3, the IG reported significantly lower Anxiety (ES = 0.74, P < 0.001), better Social Support (ES = 0.51,P = 0.009), Transcendence (ES = 0.87, P < 0.001), and Resilience (ES = 0.83, P < 0.001) compared with the CG. At T4, the IG reported better Resilience though not significant (P = 0.085) and better Transcendence (P = 0.0243) than did the NG. The BRBC intervention improves the positive health outcomes and decreases the risk factors of illness-related distress of breast cancer patients during the high-risk cancer treatment.

Resilience and Psychosocial Function Among Mainland Chinese Parents of Children With Cancer: A Cross-sectional Survey.

BACKGROUND: Resilience is commonly used to refer to the capacity to resist negative psychological reactions when encountering aversive circumstances. However, clinicians generally define resilience as a lack of psychological distress or an adoption of positive attitude in response to a potentially traumatic event. Although resilience was initially considered to be a psychological variable, it has gradually become seen as a psychosocial indicator now used in clinical settings in the Western world but is still a relatively new topic in most Eastern countries. In this study, we aimed to extend our understandings of the psychological responses of a group of mainland Chinese parents upon being informed that their children were diagnosed with cancer, using resilience as a major indicator. OBJECTIVE: The aim of this study was to evaluate the level of resilience among mainland Chinese parents in response to knowing that their children were diagnosed with cancer and to examine the relationships between resilience and other psychosocial outcomes. METHODS: A descriptive and a cross-sectional survey design was used and involved a sample of 125 parents who visited a specialist cancer hospital in southeast China between September 2013 and February 2014. RESULTS: The participants reported lower level of resilience as compared with a control population in the Chinese community (P < .01). Resilience was negatively correlated with uncertainty in illness (P < .01) and depression (P < .01) and was positively correlated with social support (P < .01) and all other positive coping strategies subscales (P < .01). Parents from the high- resilience group reported better psychosocial functions than did those from the low-resilience group (P < .01). In addition, 6 influencing factors were identified and entered into the multiple linear regression equation of psychological resilience, which predicts 38.3% (adjusted R) of total variation in psychological resilience. CONCLUSION: A high level of resilience in parents of children diagnosed with cancer is associated with better psychosocial function in response to the traumatic event. IMPLICATIONS FOR CLINICAL PRACTICE: Additional attention should be given to those Mainland Chinese parents who demonstrated a low level of resilience in response to their child's diagnosis. This is particularly important because of the long and stressful process for cancer treatment. Clinicians should also provide targeted interventions to those parents to promote their psychological resilience.