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.

Authentication of ten distinctive triterpenoids in Antrodia cinnamomea serves as a crucial aspect for ensuring the quality control of associated nutraceutical products.

Edible mushroom Antrodia cinnamomea is distinctive for its use in many health supplement products in relieving of diverse health-related conditions. A. cinnamomea is known for its rich array of bioactive secondary metabolites, predominantly terpenoids, that possess anti-inflammatory properties. Despite the abundance of these compounds, only some compounds have demonstrated notable anti-inflammatory activity. Moreover, there is a lack of established quality control methods specifically tailored to the active constituents of these products. Consequently, there is a great need for the development of precise and effective quality control methods for A. cinnamomea-based products, targeting their active components to ensure the consistency and reliability of these products in harnessing their anti-inflammatory potential. Herein we report a quantitative HPLC method for better evaluating the quality of A. cinnamomea based dietary supplements. Based on their bioactivities, we selected ten benchmark compounds, i. e. antcin K, (25S)-antcin H, (25R)-antcin H, (25R)-antcin C, (25S)-antcin C, (25R)-antcin A, 15α-acetyl-dehydrosulphurenic acid, versisponic acid D, dehydroeburicoic acid, and eburicoic acid and developed and validated a HPLC-UV method for quantification of these compounds simultaneously with high sensitivity, linearity and range, precision, and accuracy. Furthermore, we applied our method to quantify the commercially available A. cinnamomea containing supplements and found that the quality of these supplements varies greatly with only one product containing good amount of the active compounds. Our method provides a needed solution to quality control problem of the highly priced A. cinnamomea food and nutraceutical products that show great variety and inconsistency.

Exploring the spiritual needs of patients with advanced cancer in China: a qualitative study.

This qualitative study aimed to gain a deep understanding of the spiritual needs of patients with advanced cancer. A qualitative study using semi-structured interviews was conducted. The interviews were audio-recorded, transcribed verbatim, and subjected to thematic analysis. Two researchers coded the interviews independently in NVivo 12 plus and developed major themes and subthemes by inductive and constant comparison. This study was conducted in the inpatient ward of a tertiary cancer hospital in Hunan Province, Chinese Mainland. Eligible participants with advanced cancer were recruited using the purposive sampling method. The sample size was determined by data saturation. All interviews were conducted face-to-face individually from May 2021 to July 2021. A total of 13 patients with advanced cancer patients were interviewed. Six themes were identified, namely being treated as normal and independent individuals, receiving and giving love, seeking inner peace, connecting with spiritual sources, finding meaning and purpose, and preparing for death. Different categories of spiritual needs of patients with advanced cancer were identified in this study. Healthcare professionals need to develop interventions that aim to meet patients' spiritual needs.

Moral courage and its influencing factor among oncology specialist nurses: A multi-centre cross-sectional study.

AIM: Moral courage among healthcare workers has been extensively studied. However, few studies have been conducted on oncology specialist nurses, who frequently encounter complex moral situations. This study aimed to describe the current situation regarding moral courage and explored its influence on oncology specialist nurses in China. DESIGN: This was an exploratory, descriptive study. METHODS: A convenience sample of 390 nurses was conducted from 15 hospitals in Sichuan Province, China, between March and May 2023. Participants were assessed using the Moral Distress Scale-Revised, Nurses' Moral Courage Scale and the Moral Sensitivity Questionnaire. RESULTS: The results demonstrated that moral courage was negatively associated with moral distress, and positively associated with moral sensitivity. Having a master's degree or above, an intermediate title or senior title, medical ethics training, moral distress or moral sensitivity contributed to explaining 54.1% of the variance in moral courage. CONCLUSIONS: Moral courage was associated with several factors. Developing clinical intervention strategies and effective teaching methods will be critical for improving moral courage. No Patient or Public Contribution.

Agricultural insurance and rural revitalization-an empirical analysis based on China's provincial panel data.

Agricultural insurance is a kind of compensation insurance designed to provide protection for the economic losses caused by insured accidents suffered by agricultural producers in agricultural production. Rural revitalization refers to the strategy of improving the level of rural economic, social and cultural development and achieving coordinated and sustainable development of urban and rural development. Agricultural insurance can effectively diversify risks and reduce losses for agricultural producers, which plays an important role in stabilizing farmers' income, helping rural economic development, and promoting rural revitalization. Based on the theoretical analysis of the mechanism of agricultural insurance on rural revitalization, this paper empirically studies the effect of agricultural insurance on rural revitalization by using panel data from various provinces in China from 2011 to 2020. In this paper, the TOPSIS entropy weight method, the system generalized method of moments (GMM) and the threshold model are used to calculate the actual development level of rural revitalization in each province of China, the promotion effect of agricultural insurance on the development level of rural revitalization and the promotion of rural revitalization in five dimensions, and whether there is a threshold effect of agricultural insurance on rural revitalization. The empirical results show that: (1) The level of rural revitalization in various provinces in China shows a dynamic trend of "overall slow rise, with obvious differences between provinces." (2) Improving the development level of agricultural insurance can drive the improvement of China's rural revitalization level, and every 1 unit increase in the development level of agricultural insurance will drive the level of China's rural revitalization to increase by 0.1633 units. At the same time, the role of agricultural insurance on social etiquette and civility is not significant, and the role of the remaining four rural revitalization goals is significant. (3) Agricultural insurance has a significant effect on the level of rural revitalization in eastern provinces, but does not play a significant role in rural revitalization in central and western provinces. (4) The role of agricultural insurance on rural revitalization has a double threshold effect. Accordingly, this paper puts forward some suggestions for increasing the capital investment in agricultural insurance, innovating the new mode of agricultural insurance operation, promoting the in-depth development of agricultural insurance according to local conditions, and reasonably adjusting the capital investment of agricultural insurance. Finally, because the data used in this paper do not cover the entire process of rural revitalization and the research is mainly carried out from a macro perspective, there are still some shortcomings in this paper.

Development of care quality indicators for palliative care in China: A modified Delphi method study.

Objective: While there are limited studies addressing palliative care quality in China, the availability of an effective set of care quality indicators is scarce. This study aimed to develop a comprehensive set of quality indicators for palliative care in China. Methods: Conducting a systematic literature search across databases and guideline websites from inception to October 2020, combined with qualitative interviews, we established a preliminary pool of indicators. Subsequently, two rounds of Delphi expert consultation surveys were administered to 19 multidisciplinary experts (specializing in clinical nursing/medicine, nursing/medicine management, and health care administration, as well as those engaged in teaching and research) from 12 provinces in Mainland China (three each from North, East, and South China, and four from Central China) via email from March to June 2021. The analytic hierarchy process was employed to determine indicator weights. Results: Both rounds of expert consultation yielded a 100% positive coefficient, with expert authority coefficient values of 0.91 and 0.93, respectively. Kendall coefficient of concordance values for the two rounds were 0.148 and 0.253 (P < 0.001), indicating consensus among experts. Consequently, 71 quality indicators deemed important in the Chinese palliative care setting were identified, comprising 22 structure indicators, 35 process indicators, and 14 outcome indicators. Conclusions: This study established an evidence-based set of quality indicators, addressing previously unmet needs and providing a novel approach to assessing and monitoring palliative care quality. Furthermore, ongoing refinement and integration with the evolving social context are warranted.

Epstein-Barr virus immediate-early protein Zta mediates the proliferation and migration of HER2-overexpressing cancer cells.

Epstein-Barr virus immediate-early protein Zta plays an active role in altering cellular gene expression, which may be fundamentally linked to the viral life cycle, cell cycle, cell growth, and differentiation. HER2 is associated with a wide variety of human cancers, and its knockdown significantly reverses the malignant features of HER2-positive cancers. The aim of this study was to investigate the potential role of Zta in regulating HER2 expression and phenotype changes of MDA-MB-453 cells. Our results indicate that ectopic expression of Zta resulted in downregulation of the HER2 protein in cancer cells (MDA-MB-453, SKBR-3, BT474, and SKOV-3). The Zta protein significantly decreased HER2 mRNA and protein expression in MDA-MB-453 cells in a dose-dependent manner. Mechanistically, Zta recognized and targeted the promoter of HER2 gene, reducing the transcriptional activity of the HER2 gene. Zta induced G0/G1 arrest of MDA-MB-453 cells, inhibiting their proliferation and migration activity. These data suggest that Zta may act as a transforming suppressor of the HER2 gene.

Factors influencing death anxiety among Chinese patients with cancer: a cross-sectional study.

OBJECTIVE: The purpose of this study was to investigate death anxiety status among Chinese patients with cancer and identify factors that affect death anxiety. DESIGN: Cross-sectional study. SETTING: Changsha, Hunan Province, China. PARTICIPANTS: A total of 286 inpatients diagnosed with cancer were randomly recruited from a tertiary cancer centre and completed the questionnaires between January and June 2021. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome was the status of death anxiety. The secondary outcomes were the factors that affect death anxiety among Chinese patients with cancer. METHODS: A total of 286 Chinese patients with cancer were recruited from a tertiary cancer hospital to complete the demographic and clinical characteristics questionnaire, Templer's Death Anxiety Scale, Acceptance and Action Questionnaire-second edition, and Meaning in Life Questionnaire from January to June 2021. Data were analysed using t-test, analysis of variance, Kruskal-Wallis H test, Pearson correlation analysis and multiple linear regression analysis. RESULTS: On average, patients with cancer scored 7.72±4.17 for death anxiety, 25.71±9.69 for experiential avoidance and 45.19±8.22 for meaning in life. Ultimately, the statistically significant factors influencing death anxiety were education levels, insurance, pain scores, experiential avoidance and meaning in life. These factors explained 40.6% of the difference in death anxiety. CONCLUSIONS: Patients with cancer in China experienced a high level of death anxiety. This study showed that experiential avoidance and meaning in life were important factors that affected death anxiety in patients with cancer. Further studies should be conducted to explore effective interventions to prevent experiential avoidance and increase meaning in life for patients with cancer. Attention should be paid to patients without insurance but with lower education levels and higher pain scores to ultimately relieve death anxiety and improve their quality of life.

Three-Dimensional Quantitative Structure and Activity Relationship of Flavones on Their Hypochlorite Scavenging Capacity.

Flavonoids, a class of polyphenolic substances widely present in the plant realm, are considered as ideal hypochlorite scavengers. However, to our knowledge, little study has focused on the structure-activity relationship between flavonoids and hypochlorite scavenging capacity. Herein, we report for the first time the three-dimensional quantitative structure and activity relationship (3D-QSAR) combined with comparative molecular field analysis (CoMFA) and comparative molecular similarity indices analysis (CoMSIA). Four models derived from CoMFA and CoMSIA with different combinations of descriptors were built and compared; the CoMFA model, which included both steric and electrostatic fields, showed great potential (R2 = 0.989; Q2 = 0.818) in predictive quality according to both internal and external validation criteria. Additionally, the average local ionization energy (ALIE), electrostatic potential (ESP), and orbital weighted dual descriptor (OWDD) were determined to identify the key structural moiety for scavenging capacity of flavonoids against hypochlorite. The computational results indicated that hypochlorous acid (HClO) serves as an electrophile undergoing electrophilic addition to the C6 carbon, which has the highest negative charge density, which are influenced by the functional groups on the flavones. The DFT calculated mechanism revealed the catalytic role of water of mono- and di-chlorination reactions, characterized by low activation barriers, and the involvement of neutral, instead of high-energy carbocation, intermediates.

Structure and Anti-Inflammatory Activity Relationship of Ergostanes and Lanostanes in Antrodia cinnamomea.

Antrodia cinnamomea is a precious edible mushroom originating from Taiwan that has been popularly used for adjuvant hepatoprotection and anti-inflammation; however, the chemical principle for its anti-inflammatory activity has not been elucidated, which prevents the quality control of related products. Using the RAW264.7 model for the anti-inflammatory activity assay as a guide, we reported the isolation and structural elucidation of three potent anti-inflammatory compounds from isolated ergostanes (16) and lanostanes (6). Their structures were elucidated on the basis of spectroscopic data analysis including NMR and HR-QTOF-MS. Particularly, the absolute configurations of (25R)-antcin K, (25R)-antcin A, versisponic acid D, and (25R)-antcin C were determined by single crystal X-ray diffraction (XRD). The representative and most promising compound antcin A was shown to suppress pro-inflammatory biomolecule release via the down-regulation of iNOS and COX-2 expression through the NF-κB pathway while the mRNA levels of IL-1ß, TNF-α and IL-6 were also decreased. The high dependency on structural variation and activity suggests that there might be special biological targets for antcin A. Our work makes it possible to develop evidence-based dietary supplements from Antrodia cinnamomea based on anti-inflammatory constituents.

Needs assessment instruments for family caregivers of cancer patients receiving palliative care: a systematic review.

PURPOSE: Family caregivers of palliative cancer patients experience various supportive care needs. Appropriate self-reported instruments with robust psychological properties are required to identify these needs of family caregivers. Therefore, we conducted a systematic review to identify self-reported supportive care needs assessment instruments for family caregivers of palliative cancer patients and assess their contents, psychometric properties, and applicability. METHODS: Systematic searches were conducted in six English databases and four Chinese databases from inception to October 2020 and updated in June 2021. The instruments identified were evaluated using an 18-item checklist consisting of six domains: conceptual model, content validity, reliability, construct validity, scoring and interpretation, and respondent burden and presentation. RESULTS: Six articles, describing four self-reported needs assessment instruments, were included in the review. These instruments varied significantly in terms of contents, constructs, scoring methods, and applicability. Three of these instruments were developed to assess the comprehensive supportive care needs of family caregivers, while one was specifically developed to assess the spiritual needs of family caregivers. With respect to psychometric properties, none of the instruments identified met all the criteria. Three major shortcomings were identified, namely, lack of longitudinal validity, lack of a strategy for interpreting missing data, and lack of a description of the literacy level required to understand the questions. Additionally, the instrument development processes assessed in this study lacked qualitative elements. CONCLUSIONS: End-users need to consider contents, psychometric properties, and applicability when choosing an appropriate needs assessment instrument according to individual purpose and context. Further evaluation or development of needs assessment for the family caregivers of palliative cancer patients is needed, with a particular emphasis on caregivers' perspectives.

Knowledge, attitudes and preferences of palliative and end-of-life care among patients with cancer in mainland China: a cross-sectional study.

OBJECTIVES: This study aimed to investigate the knowledge and attitudes of patients with cancer of palliative care and their preferences regarding end-of-life care in mainland China. DESIGN: A cross-sectional study. SETTING: This study was conducted in a tertiary cancer hospital. PARTICIPANTS: Two hundred forty-seven patients with cancer were recruited and consented to fill out the questionnaires. OUTCOME MEASURES: The participants' knowledge and attitudes of palliative care and their preferences of end-of-life care involving place of care, place of death, truth disclosure and treatments during end-of-life were measured. RESULTS: In total, 239 questionnaires were valid. The vast majority of patients with cancer (81.2%) had never heard about palliative care or related policies, and only a few of them (5.8%) had somewhat or totally understanding of palliative care. Most participants (75.3%) had supportive attitudes towards palliative care. In terms of preferences for end-of-life care, most patients with cancer preferred to be cared for at home at the end of their life and to die at home. The majority of patients with cancer (65.7%) wanted to know their diagnosis or prognosis of the disease, regardless of the type of disease. More than half of the participants (54%) wished to improve their quality of life rather than prolong their life expectancy. More than a third of the patients with cancer preferred to entrust a family member or agent to sign medical decision agreements for them. CONCLUSIONS: It is essential for healthcare providers to improve the understanding of patients with cancer of palliative care and be aware of the end-of-life care preferences of patients with cancer, in order to provide support that enables patients with cancer to receive end-of-life care that is accordant with their wishes.

Iron-Catalyzed Regioselective Alkenylboration of Olefins.

The first examples of an iron-catalyzed three-component synthesis of homoallylic boronates from regioselective union of bis(pinacolato)diboron, an alkenyl halide (bromide, chloride or fluoride), and an olefin are disclosed. Products that bear tertiary or quaternary carbon centers could be generated in up to 87 % yield as single regioisomers with complete retention of the olefin stereochemistry. With cyclopropylidene-containing substrates, ring cleavage leading to trisubstituted E-alkenylboronates were selectively obtained. Mechanistic studies revealed reaction attributes that are distinct from previously reported alkene carboboration pathways.

Association Between Organic Dust Exposure and Adult-Asthma: A Systematic Review and Meta-Analysis of Case-Control Studies.

BACKGROUND: Exposure to organic dust has been widely investigated as a potential risk factor for asthma with different results. To clarify a potential relationship, we performed the present meta-analysis to integrate the results of studies examining the association of organic dust exposure with asthma. METHODS: A comprehensive literature search in the electronic databases including EMBASE, PubMed and Cochrane Library databases (up to August 2018) was conducted. The adjusted odds ratios (ORs) with corresponding 95% confidence interval (CI) for organic dust exposure and asthma were retrieved and pooled to generate summary effect estimates in Revman 5.2. RESULTS: Database searches retrieved 1,016 records. A total of 17 studies containing 3,619 cases and 6,585 controls were finally included in our meta-analysis. The summary estimates suggested that organic dust exposure was positively associated with asthma (OR, 1.48; 95% CI, 1.26-1.75; P < 0.00001), whether among population-based case-control studies (OR, 1.24; 95% CI, 1.13-1.35; P < 0.00001) or hospital-based case-control studies (OR, 2.79; 95% CI, 1.27-6.12; P = 0.01). Subgroup analysis showed that paper/wood (OR, 1.62; 95% CI, 1.38-1.90; P < 0.00001), flour/grain (OR, 1.48; 95% CI, 1.11-1.97; P = 0.008), and textile dust (OR, 1.50; 95% CI, 1.08-2.09; P = 0.02) exposure were significantly associated with asthma. CONCLUSIONS: Based on the studies evaluated, our meta-analysis results prompt that organic dust exposure is a risk factor inducing asthma, although precise analysis focus on specific organic dust materials is still warranted.

Induction of an effective anti-tumor immune response and tumor regression by combined administration of IL-18 and Apoptin.

Immunization strategies using plasmid DNA can potentially improve humoral and cellular immune responses that protect against cancer and infectious diseases. The chicken anemia virus-derived Apoptin protein exhibits remarkable specificity in its ability to induce apoptosis in tumor cells, but not in normal diploid cells. Interleukin-18 (IL-18) is a Th1-type cytokine that has demonstrated potential as a biological adjuvant in murine tumor models. In this study, we analyzed the anti-tumor potential and mechanism of action of simultaneous Apoptin and IL-18 gene transfer in C57BL/6 mice bearing Lewis lung carcinoma (LLC). Here we report that the growth of established tumors in mice immunized with pAPOPTIN in conjunction with pIL-18 was significantly inhibited compared with the growth of tumors in mice immunized with the empty vector (EV) or pAPOPTIN alone. Furthermore, the immunization of mice with pAPOPTIN in conjunction with pIL-18 elicited strong natural killer activity and LLC tumor-specific cytotoxic T lymphocyte (CTL) responses in vitro. In addition, T cells from lymph nodes of mice vaccinated with pIL-18 or pAPOPTIN + pIL-18 secreted high levels of the Th1 cytokine IL-2 and IFN-gamma, indicating that the regression of tumor cells is related to a Th1-type dominant immune response. These results demonstrate that vaccination with Apoptin together with IL-18 may be a novel and powerful strategy for cancer immunotherapy.

Antitumor effects of a recombinant fowlpox virus expressing Apoptin in vivo and in vitro.

Apoptin is a chicken anemia virus-derived, p53-independent, bcl-2-insensitive apoptotic protein with the ability to specifically induce apoptosis in tumor cells. To explore the use of the Apoptin gene in cancer gene therapy, we constructed a recombinant fowlpox virus expressing the Apoptin protein (vFV-Apoptin) and compared the tumor-killing activity of the recombinant virus with that of wild-type fowlpox virus in the human hepatoma cell line HepG2. We found that although cells were somewhat resistant to the basal cytotoxic effect of wild-type fowlpox virus, infection with vFV-Apoptin caused a pronounced, additional cytotoxic effect. Furthermore, cell death and disruption of tumor integrity were apparent in the vFV-Apoptin-infected cells. We also tested whether fowlpox virus-mediated expression of Apoptin in tumor cells could stimulate an antitumor effect by injecting aggressive subcutaneous tumors derived from H22 mouse hepatoma cells in C57BL/6 mice with vFV-Apoptin. We found that fowlpox virus-mediated intratumoral expression of the Apoptin gene can induce protective and therapeutic antitumor effects and significantly increase survival. Taken together, these data indicate that infection of tumors with fowlpox virus expressing Apoptin inhibits tumor growth, induces apoptosis and may be an effective cancer treatment.