Effect and pathway of abortion stigma on depressive symptoms before terminating the pregnancy in pregnant women with fetal anomaly. / èƒŽå„¿ç•¸å½¢å­•å¦‡å¼•äº§ç— è€»æ„Ÿå¯¹å¼•äº§å‰æŠ‘éƒç—‡çŠ¶çš„å½±å“æ•ˆåº”åŠè·¯å¾„.

OBJECTIVES: To explore the effect and pathway of abortion stigma on depressive symptoms before terminating the pregnancy in pregnant women with fetal anomaly. METHODS: Based on literature review, a self-made general demographic information questionnaire, the Edinburgh Postnatal Depression Scale, the Individual Level Abortion Stigma Scale, the Acceptance and Action Questionnaire-II, the Cognitive Fusion Questionnaire-Fusion, the Responses to Stress Questionnaire and the Perceived Social Support Scale were used to investigate pregnant women with fetal anomaly before abortion in tertiary general hospitals and specialist maternity hospitals in Changsha, to develop a hypothesis model of the factors influencing depressive symptoms before terminating the pregnancy. The hypothesis model was verified by applying structural equation modelling analysis. RESULTS: The structural equation model showed that the stigma directly or indirectly influenced depressive symptoms before terminating the pregnancy via psychological flexibility, social support and avoidance coping. The total effect value was 0.55 (P<0.05), the direct effect value was 0.22 (P<0.05), and the indirect effect value was 0.33 (P<0.05). Psychological flexibility and social support had protective mediating effects, while avoidance coping had harmful mediating effects. CONCLUSIONS: Abortion stigma has large positive effect on the depressive symptoms before terminating the pregnancy in pregnant women with fetal anomaly. Among direct and indirect effect, the indirect effect is major. Effective measures to reduce the stigma, increase psychological flexibility, improve social support and coping style will have an important influence on the prevention and reduction of depressive symptoms before terminating the pregnancy.

Psychosocial intervention programme based on the needs of women undergoing termination of pregnancy for foetal anomalies: A modified Delphi study.

AIM: To construct a psychosocial intervention programme for women diagnosed with foetal anomalies based on their needs in China. DESIGN: A three round-modified Delphi survey from September to November 2020. METHODS: In Round 1, based on literature review and qualitative interviews, a face-to-face meeting with eight taskforce members was conducted to generate the initial intervention indicators. In Round 2 and 3, 15 experts and three stakeholders (women undergoing termination of pregnancy for foetal anomalies) were invited by email to evaluate the importance of the indicators and built the final psychosocial intervention programme. RESULTS: The response rate for both two rounds is 100%. The experts' authority coefficient was 0.86. The Kendall W value of the two rounds ranged between 0.191 and 0.339. A needs-based psychosocial intervention programme was established, including four periods (denial, confirmation, decision-making and recovery), three needs-based supports (information, social and acceptance commitment therapy) and 27 intervention indicators. The mean value of the importance of each index was 4.00-5.00. Further research is required to evaluate whether this programme is realistic and effective for the target audiences.

Stigma and its influencing factors among women with termination of pregnancy for fetal anomaly: A cross-sectional study.

OBJECTIVE: To investigate the level of stigma and identify its influencing factors among women with termination of pregnancy for fetal anomaly(TOPFA) in China. DESIGN: This was a cross-sectional study design. SETTING AND PARTICIPANTS: A total of 469 women with TOPFA were recruited from a tertiary care hospital in China using a convenience sampling method. MEASUREMENT AND FINDINGS: Women with TOPFA participating in the study completed the Demographic Characteristics Questionnaire, Individual Level Abortion Stigma Scale(ILASS), Acceptance and Action Questionnaire- II scale(AQQ- II), Cognitive Fusion Questionnaire scale (CFQ), Multidimensional Perceived Social Support Scale(MPSS), Responses to Stress Questionnaire (RSQ). Women with TOPFA reported moderate levels of stigma(1.49±0.60). Multiple linear regression showed that correlates influencing their stigma included gestational age (ß =0.103, P < 0.05), psychological flexibility (ß =-0.319, P < 0.01), social support(ß =-0.190, P < 0.01), and disengagement coping(ß =0.148, P < 0.05). KEY CONCLUSION AND IMPLICATION FOR PRACTICE: Gestational age and disengagement coping are positive predictors of stigma, but psychological flexibility and social support are negative predictors of stigma. Further attention should focus on developing targeted intervention strategies to improve protective and reduce harmful factors to confront the stigma-related challenges faced by women with TOPFA.

The Molecular Mechanism of Traditional Chinese Medicine Prescription: Gu-tong Formula in Relieving Osteolytic Bone Destruction.

Bone metastasis is a common complication in patients with advanced tumors, causing pain and bone destruction and affecting their quality of life. Typically, complementary and alternative medicine (CAM), with unique theoretical guidance, has played key roles in the treatment of tumor-related diseases. Gu-tong formula (GTF), as a representative prescription of traditional Chinese medicine, has been demonstrated to be an effective clinical medication for the relief of cancer pain. However, the molecular mechanism of GTF in the treatment of osteolytic metastasis is still unclear. Herein, we employ network pharmacology and molecular dynamics methods to uncover the potential treatment mechanism, indicating that GTF can reduce the levels of serum IL6 and TGFB1 and thus limit the scope of bone cortical damage. Among the active compounds, sesamin and deltoin can bind stably with IL6 and TGFB1, respectively, and have the potential to become anti-inflammatory and anticancer drugs. Although the reasons for the therapeutic effect of GTF are complex and comprehensive, this work provides biological plausibility in the treatment of osteolytic metastases, which has a guiding significance for the treatment of cancer pain with CAM.

Dual Position Relationship Transformer for Image Captioning.

Employing feature vectors extracted from the target detector has been shown to be effective in improving the performance of image captioning. However, it is considered that existing framework suffers from the deficiency of insufficient information extraction, such as positional relationships; it is very important to judge the relationship between objects. To fill this gap, we present a dual position relationship transformer (DPR) for image captioning; the architecture improves the image information extraction and description coding steps: it first calculates the relative position (RP) and absolute position (AP) between objects, and integrates the dual position relationship information into self-attention. Specifically, convolutional neural network (CNN) and faster R-CNN are applied to extract image features and target detection, then to calculate the RP and AP of the generated object boxes. The former is expressed in coordinate form, and the latter is calculated by sinusoidal encoding. In addition, to better model the sequence and time relationship in the description, DPR adopts long short-term memory to encode text vector. We conduct extensive experiments on the Microsoft COCO: Common Objects in Context (MSCOCO) image captioning data set that shows that our method achieves superior performance that Consensus-based Image Description Evaluation (CIDEr) increased to 114.6 after training 30 epochs and runs 2 times faster, compared with other competitive methods. The ablation study verifies the effectiveness of our proposed module.

Effect of Oral Chinese Medicine Combined with Western Medicine on Cancer Pain: A Meta-Analysis.

OBJECTIVE: To assess the effect of oral Chinese medicine (OCM) combined with Western medicine (WM) on cancer pain. METHODS: PubMed, Embase, Cochrane Library, Clinical Trials Registry Platform, Chinese National Knowledge Infrastructure (CNKI), Wanfang and VIP databases were searched from their inception to September {dy2019}. Randomized controlled trials (RCTs) treating cancer pain by Chinese medicine (CM) combined with WM were included. The primary outcome were total pain relief rate and the quality of life (QOL), and the other outcomes were the average daily dosage of analgesics, the primary time of pain, the analgesic duration time, and adverse events. The methodological quality of RCTs was assessed in accordance with Cochrane 5.1.0 handbook of systematic reviews of interventions. Evidence level was assessed by the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) approach. RESULTS: There were 1,087 patients in the 14 studies, with 544 in the experiment group and 543 in the control group. These studies were all conducted in China, and published between 2006 and {dy2019}. Compared with the WM, OCM combined with WM could significantly relieve the cancer pain [risk ratio (RR)=1.43, 95% confidence interval (CI): 1.32, 1.56), improve QOL (RR=8.57, 95% CI: 4.25, 12.89), decrease the primary time of pain (RR=-0.20, 95% CI: -0.24, -0.16], prolong the analgesic duration time (RR=3.47, 95% CI: 2.09, 4.85), reduce the dosage of analgesics (RR=-19.52, 95% CI: -36.32, -2.72), and reduce side events (RR=0.49, 95% CI: 0.37, 0.65). Evidence levels for total pain relief rate, primary time of pain and side events were low, evidence level for QOL, analgesic duration time and average daily dosage of analgesics were very low. CONCLUSIONS: Compared with the WM, OCM combined with WM could significantly relieve the cancer pain, improve the QOL, decrease the primary time of pain, prolong the analgesic duration time, reduce the dosage of analgesics and side events. The evidence levels were low or very low.

Investigating the Multitarget Mechanism of Traditional Chinese Medicine Prescription for Cancer-Related Pain by Using Network Pharmacology and Molecular Docking Approach.

Gu-tong formula (GTF) has achieved good curative effects in the treatment of cancer-related pain. However, its potential mechanisms have not been explored. We used network pharmacology and molecular docking to investigate the molecular mechanism and the effective compounds of the prescription. Through the analysis and research in this paper, we obtained 74 effective compounds and 125 drug-disease intersection targets to construct a network, indicating that quercetin, kaempferol, and ß-sitosterol were possibly the most important compounds in GTF. The key targets of GTF for cancer-related pain were Jun proto-oncogene (JUN), mitogen-activated protein kinase 1 (MAPK1), and RELA proto-oncogene (RELA). 2204 GO entries and 148 pathways were obtained by GO and KEGG enrichment, respectively, which proved that chemokine, MAPK, and transient receptor potential (TRP) channels can be regulated by GTF. The results of molecular docking showed that stigmasterol had strong binding activity with arginine vasopressin receptor 2 (AVPR2) and C-X3-C motif chemokine ligand 1 (CX3CL1) and cholesterol was more stable with p38 MAPK, prostaglandin-endoperoxide synthase 2 (PTGS2), and transient receptor potential vanilloid-1 (TRPV1). In conclusion, the therapeutic effect of GTF on cancer-related pain is based on the comprehensive pharmacological effect of multicomponent, multitarget, and multichannel pathways. This study provides a theoretical basis for further experimental research in the future.

Cancer Survivors Could Get Survival Benefits from Postdiagnosis Physical Activity: A Meta-Analysis.

BACKGROUND: Physical activity presents significant protection against death from cancer in the general population, so the global recommendations on physical activity for health are recommended by the WHO. While the recommendation is a guideline for general population, whether all cancer patients could get benefits from physical activity and whether the cancer patients who did not meet the requirement of the recommendation could get benefits from the physical activity, compared with the cancer patients with no physical activity, are unclear. Accordingly, we conducted a meta-analysis to identify whether the physical activity, even if low level of physical activity, could reduce the mortality of various cancer patients. METHOD: We conducted a systematic search of PubMed, Embase, and Cochrane Library for published cohorts and case-control studies of cancer survivors with physical activity comparing with no physical activity and reported outcomes of mortality through October 15, 2018. Two investigators independently reviewed the included studies and extracted relevant data. The effect estimate of interest was the hazard ratios (HRs). RESULTS: There are 21811 participants in total in the nine studies, and 2386 cancer deaths in this meta-analysis. Among them, 1 was a case-control study and 8 were cohort studies. The meta-analysis results showed that physical activity was associated with a significantly reduced risk of mortality in cancer survivors, with a pooled HR and 95% CI of 0.66 (0.58∼0.73), reducing mortality by 34% and also suggested that low level of physical activity could reduce the mortality with an HR and 95% CI of 0.60 (0.50∼0.69). CONCLUSION: The results of this meta-analysis demonstrated that postdiagnosis physical activity, no matter the level of physical activity, could significantly reduce the mortality by 34%, compared with the no physical activity. At the same time, the results also suggested that cancer survivors undergoing low level of physical activity had a 40% reduction in mortality, which means that the cancer patients with poor ECOG need to do physical activity as much as they can, even if the amount of physical activity was low.

Efficacy of combined medication of nifedipine and magnesium sulfate on gestational hypertension and the effect on PAPP-A, VEGF, NO, Hcy and vWF.

OBJECTIVE: To investigate the effects of combined medication of nifedipine and magnesium sulfate on the blood pressure, pregnancy-associated plasma protein A (PAPP-A), vascular endothelial growth factor (VEGF), nitric oxide (NO), homocysteine (Hcy) and von Willebrand factor (vWF) in gestational hypertension patients. METHODS: A total of 220 gestational hypertension patients were enrolled as the subjects, and divided into two groups randomly, i.e. the observation group and the control group. In observation group, patients took combined medication of nifedipine and magnesium sulfate, while those in the control group only took magnesium sulfate for treatment. Clinical efficacy, and the changes in blood pressure, PAPP-A, VEGF, NO, Hcy and vWF before and after treatment were compared between two groups. RESULTS: In the observation group and the control group, total effectiveness rates were 92.7% and 70.9%, respectively (p < 0.05). After treatment, we found significant decreases in PAPP-A, VEGF, NO, Hcy and vWF in patients of two groups, with more significant decreases in the observation group (p < 0.05). Incidence rates of the adverse reactions in two groups were 5.5% and 6.4%, respectively, without any statistically significant differences (p > 0.05). In the observation group, patients had fewer complications (p < 0.05). CONCLUSION: Combined medication of magnesium sulfate and nifedipine can decrease the levels of PAPP-A, VEGF, NO, Hcy and vWF in serum as well as the blood pressure of patients with gestational hypertension, with a reduction in incidence rate of complications and improvement in efficacy.

Using single-patient (n-of-1) trials to determine effectiveness of traditional Chinese medicine on chemotherapy-induced leukopenia in gastric cancer: a feasibility study.

BACKGROUND: Gastric cancer has been the second cause of cancer death worldwide. Chemical comprehensive treatment programs primarily were the main therapy method with modest efficacy to gastric cancer. Traditional Chinese medicine (TCM) has been reported to alleviate adverse events induced by chemotherapy, but has not yet developed clinical trials to test and needs scientific evidence for making policy. Single-patient (N-of-1) trials might be an eligible study design for TCM since it well represented the individualized treatment philosophy of TCM. The aim of this study is to obtain information necessary to design a more series trial. METHODS: Individuals who underwent gastrectomy were included. Each patient suffered 3-week standard chemotherapy and 3-day treatment periods (decoction with Astragalus mongholicus and Semen Cuscutae or placebo: decoction without Astragalus mongholicus and Semen Cuscutae). Each trial lasted up to a maximum of 30 weeks or a minimum of 20 weeks. Staffs and participants were blinded to the randomization. This study was approved by Ethics Committee of First Hospital, Lanzhou University in November, 2014. RESULTS: From August, 2014 to March, 2015, 6 participants were included. There were 16 cycles compared between intervention and control decoction (2.28, 95% CI: 1.24-5.47), P<0.0001. The quality of life (QoL) score after the trial was reported is a little higher than before, t=3.87, P=0.01. Two participants reported symptoms had improved after taken trial decoction. CONCLUSIONS: This is the first N-of-1 trials of testing the effectiveness of TCM decoction on alleviative treatment to gastric cancer. The feasibility study will help to develop a practical design for the more series trial.

Review on Research about Traditional Chinese Medicine in Cancer Stem Cell.

Cancer stem cells (CSCs) are small subpopulations of neoplastic cells within a tumor, which have self-renewal and differentiation abilities and could generate new tumors with few cells. Researches have showed that CSCs are considered the most likely reason for cancer recurrence and metastasis. Accumulating evidences have showed that traditional Chinese medicine (TCM) has significant effect on CSCs. It could inhibit the proliferation, self-renew, and multidifferentiation of CSCs. We aimed to summarize the theories of CSCs in TCM, the inhibitory effect, and the pathway on CSCs of TCM. This review will provide potential new strategies and alternative perspectives for CSCs treatments and basic research into complementary and alternative medicine.