Survivorship Experiences of Allogeneic Hematopoietic Stem Cell Transplantation Survivors: A Qualitative Systematic Review.

BACKGROUND: The number of allogeneic hematopoietic stem cell transplantation (allo-HSCT) survivors is increasing globally. Although qualitative studies in this population are reported, clear understanding of how allo-HSCT survivors experience survivorship is lacking. OBJECTIVE: This study aimed to identify, appraise, and synthesize evidence from qualitative research on survivorship experience among allo-HSCT survivors. METHODS: A qualitative systematic review was conducted. A literature search of 9 databases and OpenGrey, Google Scholar, and Google was performed from inception to February 2023. Two reviewers independently screened and assessed the eligibility of each study. Descriptive information was extracted from the studies by one reviewer and checked by another. Findings were extracted and analyzed using thematic synthesis. RESULTS: Seventeen articles were included. Four themes and 12 subthemes regarding allo-HSCT survivors' experiences emerged: (1) recovery as being a longer process than they thought (influenced by long-term physical symptoms, disturbed by survivorship uncertainty); (2) experiencing a restricted survivorship life (shrunken social world, forced dietary limitations, centered around hospitals); (3) suffering from stigma and discrimination (perceived as a burden, seen differently by others, difficulties establishing and maintaining romantic relationships and marriage, limited opportunities in work); and (4) realizing something positive obtained during survivorship (enriched survivorship self-management skills, enhanced personal growth, developed positive relationships). CONCLUSIONS: The findings reveal the challenges, needs, and growth that allo-HSCT survivors experienced during survivorship. Some understudied areas were identified, which warrant further exploration. IMPLICATIONS FOR PRACTICE: Targeted survivor-centered care should be provided to allo-HSCT survivors, and interventions to resolve issues experienced during survivorship should be developed.

DNA damage induced by CDK4 and CDK6 blockade triggers anti-tumor immune responses through cGAS-STING pathway.

CDK4/6 are important regulators of cell cycle and their inhibitors have been approved as anti-cancer drugs. Here, we report a STING-dependent anti-tumor immune mechanism responsible for tumor suppression by CDK4/6 blockade. Clinical datasets show that in human tissues, CDK4 and CDK6 are over-expressed and their expressions are negatively correlated with patients' overall survival and T cell infiltration. Deletion of Cdk4 or Cdk6 in tumor cells significantly reduce tumor growth. Mechanistically, we find that Cdk4 or Cdk6 deficiency contributes to an increased level of endogenous DNA damage, which triggers the cGAS-STING signaling pathway to activate type I interferon response. Knockout of Sting is sufficient to reverse and partially reverse the anti-tumor effect of Cdk4 and Cdk6 deficiency respectively. Therefore, our findings suggest that CDK4/6 inhibitors may enhance anti-tumor immunity through the STING-dependent type I interferon response.

Everyday life experiences of Chinese community-dwelling oldest old who live alone at home.

PURPOSE: Older adults aged ≥ 80 years living alone at home are more likely to experience challenges. Daily life experiences regarding living alone are still limited in the Asian context. This study explored the everyday life experiences of older Chinese residents living alone at home. Research questions included: (1) How do Chinese community-dwelling old people describe everyday life experiences related to living alone? (2) What kind of difficulties and needs do Chinese community-dwelling older people living alone face in everyday lives? (3) How do Chinese community-dwelling older people cope with challenges faced in their everyday lives related to living alone? METHODS: This was qualitative descriptive research. Purposive sampling was adopted to recruit 13 participants aged 80-92 years of age from communities and one hospital. Semi-structured interviews were conducted to collect data which was analysed by conventional content analysis. RESULTS: Three themes were identified: theme 1-difficulty in finding a sense of belonging, theme 2-striving to maintain independence, theme 3-hard to gain a sense of control. CONCLUSIONS: This study provided novel insights into understanding the difficulties and needs of Chinese older people living alone at home. Three key challenges and associated strategies they used to cope with in daily lives were presented.

Factors associated with severe depressive symptoms among Chinese secondary school students in Hong Kong: a large cross-sectional survey.

Background: Many adolescents were reported to have severe depressive symptoms, and a careful assessment of its correlates is essential for prevention and intervention programs. This study aimed to gain insight into the prevalence of severe depressive symptoms and its association with factors at four levels (individual, relationship, school and society) in a large sample of Hong Kong Chinese secondary school students. Methods: Secondary school students from Secondary 1 through 7 were selected as participants using a cluster random sampling method. A questionnaire including inventories measuring 24 factors at the four levels (six individual factors, 11 relationship factors, three school factors, and four society factors) was completed by 8,963 participants (56.3% female) with a mean age of 15.1 (SD = 1.8) years. Students with a score of ≥15 on the Patient Health Questionnaire were defined as having severe depressive symptoms. The association between severe depressive symptoms and correlates were examined by t-test and χ2 test. Logistic regression models using a hierarchical approach then examined the individual contribution of these 24 factors to severe depressive symptoms with the control of other factors in the model. Results: 7.4% of the students have severe depressive symptoms. Twenty-two of the 24 factors were significantly associated with severe depressive symptoms in bivariate analyses. In the logistic regression, 11 factors (three individual factors: age, self-esteem and self-mastery; six relationship factors: tobacco use, alcohol drinking, drug use, paternal psychological control, dinner with parents, and perceived social support from friends; one school factor: felt pressure from homework; and one society factor: number of sibling) were statistically significant. Felt pressure from homework, alcohol drinking, and perceived social support from friends were the strongest correlates of severe depressive symptoms. Conclusion: The prevalence of self-reported severe depressive symptoms in Hong Kong Chinese secondary school students was high, and the identification of multiple associated factors at the four levels simultaneously provides a knowledge basis for the development of a comprehensive, multivariate model of factors influencing severe depressive symptoms in Chinese secondary school students. The factors identified in the present study may be helpful when designing and implementing preventive intervention programs.

Traditional Chinese medicine-based integrated health interventions for depression: A systematic review and meta-analysis.

BACKGROUND: Some traditional Chinese medicine (TCM)-based integrated health interventions have been used for depression, but pooled efficacy remains unknown. AIMS AND OBJECTIVES: This study aimed to systematically evaluate the efficacy of TCM-based integrated health interventions for relieving depression. DESIGN: Systematic review and meta-analysis. METHODS: A comprehensive literature search was conducted on 17 databases from inception up to June 2022. Randomised controlled trials (RCTs) that examined an integrated health intervention based on TCM theory for depression were included. The risk of bias was assessed using the second version of the Cochrane risk-of-bias tool for randomised trials, and the quality of evidence was evaluated using the Grading of Recommendations, Assessment, Development and Evaluation system. RESULTS: Eighteen RCTs with a total of 1448 depressed participants were included. Health care providers, mainly nurses (14 studies), implemented TCM-based integrated health interventions. The pooled results showed that TCM-based integrated health interventions had larger effects on reducing depressive symptoms (15 studies; standardised mean difference = -2.05; 95% CI: -2.74, -1.37; p < .00001) compared with usual care at posttreatment but showed no significant difference contrasted to cognitive behavioural therapy (two studies, p = .31). However, the overall evidence was low. CONCLUSIONS: The meta-analysis results indicated that TCM-based integrated health interventions were effective in reducing depression. However, the results should be interpreted with caution because of the low quality of the included studies. Future RCTs with rigorous designs should be conducted to provide robust evidence of the efficacy of TCM-based integrated health interventions in treating depression. RELEVANCE TO CLINICAL PRACTICE: TCM-based integrated health interventions might be a potentially effective alternative for depression. Nurses could play an important role in designing and providing TCM-based integrated nursing interventions for patients with depression. NO PATIENT OR PUBLIC CONTRIBUTION: This is a systematic review and meta-analysis based on data from previous studies.

Survivorship Experiences of Chinese Hematopoietic Stem Cell Transplantation Survivors: A Qualitative Study.

BACKGROUND: The number of global hematopoietic stem cell transplantation (HSCT) survivors is increasing rapidly. Survivors encounter many challenges, but studies regarding survivorship experiences in China are scarce. OBJECTIVES: This study aimed to explore the survivorship experiences of Chinese patients with hematological cancers after HSCT and to describe the impact of HSCT on the survivors' lives. METHODS: Descriptive qualitative research was used. Purposive sampling was used to recruit HSCT survivors who were treated in a teaching hospital in Zhejiang Province from June 2021 to June 2022. Audio-recorded semistructured interviews were conducted, transcribed verbatim, and analyzed via conventional content analysis. RESULTS: Fifteen HSCT survivors aged 18 to 59 years participated in this study. Four themes and 11 subthemes emerged: (1) transplant being harder than you thought (body function impaired, forced to modify diet, disturbed by survivorship uncertainty), (2) difficulty blending into circles (limited activity space, suffering from discrimination), (3) adjusting value judgment (health being a top priority, contributing to family as much as possible, feeling worthless), and (4) still being the lucky one (recovered better than others, genuine relationships acquired, self-improvement achieved). CONCLUSION: This study offers insight into subjective survivorship experiences of patients with hematological cancers post-HSCT within a Chinese sociocultural context and presents changed perceptions of HSCT, life alterations, adjusted value judgments, and positive self-evaluation since treatment. IMPLICATIONS FOR PRACTICE: Nurses can provide person-centered survivorship care based on the understanding of survivorship experiences of Chinese HSCT survivors. Intervention programs and informational materials should be developed to address difficulties encountered by Chinese HSCT survivors.

Enhancing the HSV-1-mediated antitumor immune response by suppressing Bach1.

BACKGROUND: In 2015, herpes simplex virus 1 (HSV-1)-derived talimogene laherparepvec (T-VEC) was the first oncolytic virus approved by the US Food and Drug Administration as a therapeutic agent for cancer treatment. However, its antitumor application is limited to local treatment of melanoma, and there is a lack of understanding of the mechanisms underlying the regulation of HSV-1 replication in cancer cells and the associated antitumor immunity. We hypothesized that increasing the replication capacity of HSV-1 in tumor cells would enhance the antitumor effect of this virus. METHODS: We systematically identified IFN-stimulated genes induced by HSV-1 by performing functional screens and clarified the mechanism by which BACH1 acts against HSV-1. Then, we tested the effect of BACH1 deficiency on immunogenic cell death induced by HSV-1. Furthermore, we investigated the antitumor effect of BACH1 deficiency on HSV-1 in MCA205 and B16 murine tumor models. RESULTS: We identified eight IFN-stimulated genes (ISGs) controlling HSV-1 replication, among which BTB and CNC homology 1 (BACH1) suppressed HSV-1 replication by inhibiting the transcription of ICP4, ICP27, and UL39. Loss of Bach1 function not only increased HSV-1 proliferation but also promoted HSV-1-induced cell apoptosis, HMGB1 secretion, and calreticulin exposure in tumor cells. More importantly, hemin, an FDA-approved drug known to downregulate BACH1, significantly enhanced HSV-1-mediated antitumor activity with increased T lymphocyte infiltration at the tumor site. CONCLUSIONS: Our studies uncovered a novel antiviral activity of BACH1 and provided a new strategy for improving the clinical efficiency of the oncolytic virus HSV-1.

Histone deacetylase 3 contributes to the antiviral innate immunity of macrophages by interacting with FOXK1 to regulate STAT1/2 transcription.

It is well known that interferon (IFN)-α/-ß activates the JAK/STAT signaling pathway and suppresses viral replication through the induction of IFN stimulated genes (ISGs). Here, we report that knockout of HDAC3 from macrophages results in the decreased expression of STAT1 and STAT2, leading to defective antiviral immunity in cells and mice. Further studies show that HDAC3 interacts with a conserved transcription factor Forkhead Box K1 (FOXK1), co-localizes with FOXK1 at the promoter of STAT1 and STAT2, and is required for protecting FOXK1 from lysosomal system-mediated degradation. FOXK1-deficient macrophages also show low STAT1 and STAT2 expression with defective responses to viruses. Thus, our studies uncover the biological importance of HDAC3 in regulating the antiviral immunity of macrophages through interacting with FOXK1 to regulate the expression of STAT1 and STAT2.

Experiences of Body Image Changes in Chinese Patients Living with Inflammatory Bowel Disease: A Descriptive Qualitative Study.

PURPOSE: Body image changes are common among patients living with inflammatory bowel disease (IBD) because of the illness and related treatments. Currently, there is little known about how those patients experience and perceive their altered body image in the literature. The aim of this study was to explore the experiences of body image changes in patients with IBD in China and to describe how those changes influence patients' perception of body and self. METHODS: This study used a descriptive qualitative approach. A total of 16 participants from three tertiary hospitals in southeast China were recruited through purposive sampling combined with maximum variation strategy. Data were collected through semistructured interviews and analyzed using conventional content analysis method. RESULTS: The following six themes were extracted: (1) "being a constrained person," (2) "being a flawed person," (3) "being a disliked person," (4) "being an alienated person," (5) "being a reconciled person," and (6) "being a blessed person." CONCLUSION: With the diagnosis of IBD and its side effects of treatments, patients' life changed significantly and they were struggling to reinterpret their body and self. As a result, negative self-evaluations and/or positive self-evaluations towards themselves generated. Further studies are required to explore the underlying mechanism and related influencing factors about how those different images were produced.

Prognostic Value of the Combination of CEA and Fibrinogen/Albumin Ratio in Resectable Gastric Cancer.

PURPOSE: To investigate the prognostic value of combined serum carcinoembryonic antigen (CEA) levels and fibrinogen/albumin ratio (FAR) in patients with resectable gastric cancer (GC). INTRODUCTION: This retrospective study evaluated the CEA, fibrinogen, and albumin levels and other clinicopathological features of GC patients. The prognostic significance of these factors for overall survival (OS) was assessed using Kaplan-Meier curves and univariate and multivariate Cox proportional models. PATIENTS AND METHODS: A total of 267 patients were included. The optimal cutoff values of CEA and FAR were 3.2 ng/mL and 0.086, respectively. Patients were stratified into three groups based on this cutoff value: CEA-FAR=0 (CEA <3.2 ng/mL and FAR <0.086), CEA-FAR=1 (CEA ≥3.2 ng/mL or FAR ≥0.086), and CEA-FAR=2 (CEA ≥3.2 ng/mL and FAR ≥0.086). RESULTS: Higher CEA-FAR was strongly associated with age, tumor size, tumor invasion, lymph node status, and TNM stage (all P<0.05). The OS rates differed significantly between these 3 groups (88.9% vs 65.0% vs 46.9%, P<0.001). Multivariate analysis showed that CEA-FAR was an independent prognostic factor for OS (P<0.001). The area under the curve was larger for CEA-FAR than for either CEA or FAR alone (0.683, 0.644, and 0.669, respectively). CONCLUSION: Preoperative CEA-FAR could be a potential blood marker for predicting tumor progression and the prognosis of GC patients. Patients with a higher CEA-FAR should undergo extensive follow-up.

The Illness Experiences of Chinese Patients Living With Lymphoma: A Qualitative Study.

BACKGROUND: Lymphoma patients encounter many problems. Studies investigating the illness experiences of Chinese patients with lymphoma are limited. OBJECTIVE: The objectives of this study were to explore the illness experiences of lymphoma patients in China and describe the impacts of this disease on the everyday lives of these individuals. METHODS: A descriptive qualitative design was used. The data were collected through face-to-face semistructured interviews and analyzed using the conventional content analysis method. RESULTS: Nine men and 7 women participated in this study. The following 6 themes emerged: (1) cancer diagnosis reactions, (2) self-image altered, (3) interpersonal relationships influenced, (4) career development hindered, (5) life philosophy changed, and (6) personal growth achieved. CONCLUSIONS: This study contributes new knowledge to the understanding of the illness experiences of lymphoma patients within the Chinese social and cultural context. This study also reveals how these individuals cope with the complex problems they face. IMPLICATIONS FOR PRACTICE: Nurses could help Chinese patients with lymphoma accept the disease and its treatments by emphasizing the importance of family integrity. Information, such as how to act in response to workplace discrimination, should be provided to patients by oncology nurses.

Regaining normality: A grounded theory study of the illness experiences of Chinese patients living with Crohn's disease.

BACKGROUND: Crohn's disease is a chronic condition causing inflammation of the lining of the digestive system. Individuals suffering from this illness encounter various challenges and problems, but studies investigating the illness experiences of patients with Crohn's disease in East Asian countries are scarce. OBJECTIVES: The objective of this study was to explore the illness experiences of patients with Crohn's disease in China and construct an interpretive understanding of these experiences from the perspective of the patients. DESIGN: A constructivist grounded theory approach was used to develop a theoretical understanding of illness experiences. SETTINGS: This study included participants from the following four provincial capital cities in China: Hangzhou, Nanjing, Guangzhou, and Wuhan. PARTICIPANTS: Purposive sampling and theoretical sampling were used to select Chinese patients living with Crohn's disease. METHOD: Between February 2015 and January 2018, audio-recorded interviews were conducted. The data analysis included initial coding, focused coding, and theoretical coding using the constant comparative method and memo writing. RESULTS: Thirty-one participants were included in the study. "Regaining normality" was identified as the core category. The following four categories were conceptualized: comparing, struggling, reflecting, and realizing. Comparing refers to distinguishing the similarities and differences or evaluating the superiority and inferiority of similar things. Comparisons could occur between patients with Crohn's disease and healthy individuals or between patients and people in similar or more unfortunate situations. Struggling reflects the dilemmas experienced by patients with Crohn's disease in acknowledging their patient identity and informing others of this identity. Reflecting refers to the consideration of the values and life attitudes held by patients before and after the diagnosis of Crohn's disease. Realizing involves patients gaining a deeper understanding of the suffering associated with Crohn's disease after experiencing the illness. CONCLUSION: This study offers an interpretive understanding of the illness experiences of patients with Crohn's disease. Regaining normality represents the basic social psychological process. Regaining normality is related to reassessing and reconstructing the self after receiving a Crohn's disease diagnosis. This paper provides new insight into patients' lives and describes the strategies patients use to cope with the challenges and problems caused by the illness. These study findings can be used to develop future complex interventions and studies.

Development and Validation of a Questionnaire to Assess the Quality of Life in Patients with Inflammatory Bowel Disease in Mainland China.

BACKGROUND: Inflammatory bowel disease (IBD) affects the quality of patients' life in many ways. The aim of this study was to develop and validate a mainland Chinese version of IBD quality-of-life questionnaire for ulcerative colitis (UC) and Crohn's disease (CD). METHODS: A draft questionnaire containing 30 items was generated from a descriptive qualitative study, literature review and consulting with IBD patients and experts. The validity, discriminant ability, reliability, and sensitivity to change were validated in 336 patients with IBD. RESULTS: A 22-item IBD quality-of-life questionnaire (IBDQOL-22) with 4 domains was developed. The 4 domain scores of the IBDQOL-22 correlated well with the related SF-36 (36-Item Short Form Health Survey) dimensional scores in UC (r = 0.42-0.75) and CD (r = 0.41-0.66). The total scores of the IBDQOL-22 correlated well with the physical component summary scores of the SF-36 in UC (r = 0.74) and CD (r = 0.74), the mental component summary scores of the SF-36 in UC (r = 0.77) and CD (r = 0.71), the colitis activity index in UC (r = -0.61) and the CD activity index (r = -0.53). It was able to discriminate between patients with active and inactive disease. Cronbach's alpha for the 4 domains of the IBDQOL-22 ranged from 0.77 to 0.90 in UC and from 0.76 to 0.89 in CD. Test-retest reliability was excellent (intraclass correlation coefficient was 0.88-0.95 in UC and 0.72-0.90 in CD). The 3 domains of the IBDQOL-22 (emotional function, symptoms and discomfort, bowel symptoms and its influences) were able to detect changes in patients whose clinical activity index changed more than one point. CONCLUSIONS: The IBDQOL-22 is a valid, reliable, and responsive instrument for assessing disease-specific quality-of-life in patients with IBD in Mainland China.