Objective To evaluate the effect of a nurse-led case management intervention on arm function and uncertainty for women with breast cancer.Methods 90 women with breast cancer were divided into the intervention group and the control group according to their nurses,with 45 patients in each group.All participants were followed six months after surgery.The intervention group attended a 6-month nurse-led case management program,while the control group received the routine care and follow-up only.Questionnaires on arm function and uncertainty were administered 1 month,3 months and 6months after the surgery respectively.Score changes were compared by repeated-measure ANOVA and MANOVA.Results The arm function of the intervention group was better than the control group,except for the 10th day after the operation,there were significant differences at other three time points.The disease uncertainty level of the intervention group was better than that of the control group,except for the dimension of unpredictability,there were evident differences in other dimensions at other three time points.Conclusions The nurse-led case management intervention could improve arm function recovery and decrease the uncertainty to disease of breast cancer survivors.

[Objective]To compare the clinical outcomes of fresh embryo transfer of the in vitro fertilization/intracytoplasmic sperm injection and embryo transfer(IVF/ICSI-ET)in different age groups as well as in different responders using gonadotropin-re-leasing hormone agonist(GnRH-a)long protocol or GnRH antagonist(GnRH-ant)protocol.[Methods]A retrospective analysis was performed on 737 IVF/ICSI cycles,including 386 cycles of GnRH-a long protocol(group A)and 351 cycles of GnRH-ant protocol (group B),from August 28,2015 to December 31,2016. Then all the cycles were divided into sub-groups by ages and retrieved oo-cyte numbers:group a1(<38 years),group a2(≥38 years);group b1(n≤5),group b2(6≤n≤15),group b3(n>15). The basic information of patients and clinical outcomes were compared.[Results](1)Comparable results were obtained from group A and group B in these following variables such as fertilization rate,normal fertilization rate,biochemical pregnancy rate and miscarriage rage. But the stimulation period,the total gonadotropin(Gn)dosage,estradiol(E2)level and endometrial thickness on the day of human chorionic gonadotropin(hCG)administration,number of oocytes retrieved and mature oocytes,ovarian hyperstimulation syn-drome(OHSS)rate,implantation rate and clinical pregnancy rate were significantly higher in group A than group B(P<0.05),and significantly higher cancellation rate of fresh embryo transfer was observed in group B(P<0.001).(2)When divided by ages,no mat-ter in sub-group a1 or sub-group a2,the implantation rate was slightly lower in GnRH-ant protocol than in GnRH-a long protocol, although they failed to reach significant difference(sub-group a1:32.6%vs 39.8%,P=0.067;sub-group a2:9.7%vs 17.9%,P=0.066). The clinical pregnancy rate was comparable using these two protocols in sub-group a1(54.8%vs 50.4%,P=0.429),but it was significantly lower by using GnRH-ant protocol than GnRH-a long protocol in sub-group a2(19.6%vs 39.1%,P=0.021).(3) When divided by numbers of oocytes retrieved,the implantation rate was significantly lower when using GnRH-ant protocol in sub-group b1(13.1%vs 26.0%,P=0.026),but we failed to observe significant differences in other two sub-groups. The clinical preg-nancy rates were comparable in all sub-groups ,whereas differed considerably in sub-group b1 (36.6% vs 19.3%,P = 0.056).[Conclusion]Overall,the implantation rate and clinical pregnancy rate were higher in GnRH-a long protocol than those in GnRH-ant protocol. Nevertheless,GnRH-ant protocol could reduce the dosage of Gn,shorten the treatment duration,and effectively reduce the occurrence of OHSS. There were similar pregnancy outcomes in two protocols for normal responders and high responders ,while for advanced patients or other poor responders,the implantation rate and clinical pregnancy rate were higher in GnRH-a protocol.

Objective To evaluate the efficiency and safety of exercise interventions on cancer related fatigue. Methods Cochrane Library, JBI Database of Systematic Reviews, MEDLINE, EMbase, CINAHL, Chinese Journal Full- text Database, Chinese Biomedical Literature Database, and Wanfang Databse were searched from the inception to November 2014 to screen the systematic review and Meta-analysis conforming to the inclusion criteria. Two authors independently appraised their methodological qualities with Overview Quality Assessment Questionnaire (OQAQ), and analyzed the data using descriptive analysis. The primary outcome included the scaling of cancer related fatigue, the secondary outcome included adherence to exercise intervention and the incidence of adverse events. Results Fourteen systematic review/Meta-analysis were identified, twelve of them had a high methodological quality (Scoring 5-7). Six systematic review/Meta-analysis found that aerobic exercise could effectively alleviate cancer related fatigue, especially for breast cancer patients;seven articles showed that exercise could modulate cancer related fatigue of patients under active treatments;seven articles reported the compliance to the exercise intervention, four articles reported adverse events occurring during the intervention, very few of them resulted directly from the exercise intervention. Conclusions Exercise intervention can modulate cancer related fatigue with good safety.

Objective To develop training program of evidence implementation(EI) based on PARIHS model and to evaluate the effectiveness on clinical nurses for evidence-based nursing knowledge,attitudes and ability,and to understand the evaluation of participants about the methodological training.Methods A quasi-experiment design was conducted.A 6-month comprehensive evidence implementation training program was developed including methodological lecture,group discussion,EI case analysis,EI project development and implementation,and was carried out among 44 clinical nurses from 11 tertiary hospitals in Shanghai.The participants' EBN knowledge,attitudes and ability were measured by EBN knowledge,attitudes and ability questionnaire at 3 months and 6 months after training.Results Participants' EBN knowledge and ability were significantly improved at 3 months and 6 months after training(P＜0.05),and participants' EBN attitude had no significant difference before and after training (P＞0.05).The level of training satisfaction among participants was higher than 80.0％,and participants had finished 22 evidence implementation programs.Conclusion Evidence implementation training based on PARIHS can enhance clinical nurses' EBN knowledge and ability.Participants' EBN attitude hasn't been significantly improved.Participants have high satisfaction towards methodological training.

BACKGROUND:For pediatric patients with aplastic anemia in China, it is difficult to find human leucocyte antigen-matched sibling donors that are mostly replaced by parental donors.
OBJECTIVE:To retrospectively analyze the clinical efficacy and safety of parental haploidentical peripheral blood hematopoietic stem cel transplantation in children with relapsed and refractory severe aplastic anemia.
METHODS:Seventeen children with relapsed and refractory severe aplastic anemia who had no matched sibling or unrelated donor and failed to respond to immunosuppressive therapy were subjected to parental haploidentical peripheral blood hematopoietic stem cel transplantation. A conditioning regimen of fludarabine+cyclophosphamide+rabbit anti-human thymocyte immunoglobulin antibody and the triple therapy of methotrexate, cyclosporine A and mycophenolate mofetil were applied to prevent graft-versus-host disease.
RESULTS AND CONCLUSION: (1) Of the 17 children, 16 cases (94%) reached hematopoietic reconstitution, and the median time of neutrophils≥ 0.5×109/L and platelets≥ 20×109/L was 13 (11-15) days and 17 (12-28) days, respectively. (2) Incidence of acute graft-versus-host disease was 47% (8 of 17 cases), including 29% (5/17) of grades I-II and 18% (3/17) of grades III-IV. Incidence of chronic graft-versus-host disease was 41% (7/17). (3) With a median folow-up duration of 268 (43-753) days, the overal survival rate was 70.6% (12/17). Five dead cases (29%) belonged to transplantation-related death, including one case of fungal skin infections, one case of graft-versus-host disease, three cases of severe lung infection. No relapse case was reported. These findings indicate that if there are no matched sibling or unrelated donors and the immunosuppression effect is poor, parental haploidentical peripheral blood hematopoietic stem cel transplantation is a safe and effective salvage treatment for children with relapsed and refractory severe aplastic anemia.

Objective To investigate the differences of the vascular risk factors for anterior circulation and posterior circulation ischemic stroke.Methods The unified diagnosis and treatment questionnaires of ischemic stroke in Qingdao city were developed.The data of 943 consecutive patients with acute ischemic stroke treated in the Departments of Neurology in 11 hospitals with imaging facilities such as computerized tornography (CT) or magnetic resonance imaging (MRI) in Qingdao city and its surrounding counties from June 2008 to February 2009 were retrospectively collected.The risk factors for anterior circulation and posterior circulation ischemic stroke were analyzed.Results Univariate analysis showed that there were significant differences in the age,sex,history of coronary heart disease,hyperlipidemia,atrial fibrillation and basdine National Institutes of Health Stroke Scale (NIHSS) score between anterior circulation and posterior circulation ischermic stroke (all P ＜0.05).Multivariate logistic regression analysis showed that the age (odds ratio [ OR ] 1.025,95％ confidence interval [ CI ] 1.009-1.042) and the baseline NIHSS score (OR 1.052,95％ CI 1.019-1.086) tended to the interior circulation ischernic stroke,whereas coronary heart disease (OR 0.512,95％ CI 0.341-0.768) and hyperlipidemia (OR 0.585,95％ CI 0.386-0.884) tended to posterior circulation ischemic stroke,and hyperlipidemia was an independent risk factors for posterior circulation ischemic stroke.Conclusions Vascular risk factors exerted different effects on anterior circulation and posterior circulation ischemic stroke.

Objective To apply flow cytometry-panel reactive antibody (FLOW-PRA) and compare the application of traditional (enzyme-linked imrnunosorbent assay) ELISA-PRA in clinical organ transplantarion,so as to evaluate the concordance,sensitivity,accuracy and practicability of FLOW-PRA.Methods PRA was detected in 212 serum samples from 185 patients awaiting organ transplantation using FLOW-PRA and ELISA-PRA.Results It took 1.5 h and 3 h for FLOW-PRA vs ELISA-PRA.Concordance correlation coefficient for the results of the two methods was 94% (class Ⅰ)and 89% (class Ⅱ),respectively.Of all sera,24.5% (in comparison to ELISA-PRA,P<0.005)were class I positive,18.4% (P<0.05) class Ⅱ positive by flow cytometry,and 17.9% and 14.6% by ELISA,respectively.The positive incidence in Flow group was higher than in ELISA group.Low titer of antibodies was detected positively only by flow eytometry,furthermore,the antigen specificity of PRA could only be discriminated by FLOW-PRA.Conclusion Flow cytometry is more sensitive and more accurate than ELISA in PRA detection.FLOW-PRA is easy to operate and time-effective,and suitable for clinical application.

This review introduces the concept,design and implementation of longitudinal mixed methods research.It summarizes its common applications,including the in-depth exploration of potential causes and association among variables of the complex phenomenon over time,the comprehensive evaluation of intervention effectiveness,the identification of facilitators and challenges for implementation,as well as the exploration of changes in behavior and underlying mechanisms.Moreover,this review analyzes existing challenges and future insights of this method.In conclusion,this review aimed to strengthen the nursing researchers'understanding of longitudinal mixed methods research and provide insights for future related studies.

Objective To establish WeChat official account-based platform for evidence dissemination,and to evaluate the effects of the platform.Methods The WeChat official account-based platform for evidence dissemination was established,and big data analysis and sampling survey were adopted to analyze information and its communication effects published from December,2014 to September,2016.Results Totally 22 369 followers used the platform and conducted 404 232 hits on its pages in total.The most frequent searches were Evidence and Knowledge of evidence-based nursing.The WeChat Communication Index was 433.07.The overall evaluation score was 4.34± 0.67.Conclusion WeChat official account-based platform for evidence dissemination can promote the accessibility of evidence and receives high evaluation score from followers.

Objective:To explore the causes and influencing factors of financial toxicity in young breast cancer survivors, and to provide evidence for intervention program development to improve financial toxicity in young breast cancer survivors.Methods:Using descriptive qualitative research methods, 29 young breast cancer patients from September to December 2021 in Breast Surgery Follow-up Clinic of Fudan University Shanghai Cancer Center were interviewed. The Nvivo 12.0 qualitative data analysis software was used to analyze the data.Results:Four themes were extracted as following, direct cost of cancer treatment was the primary cause of financial toxicity, indirect costs related to cancer and treatment cannot be ignored, long-term effects of cancer and treatment further exacerbated financial toxicity, and cancer-related financial toxicity was also influenced by a variety of other factors.Conclusions:Multiple causes affected the experience of financial toxicity in young breast cancer survivors. The occurrence and risks of financial toxicity in young breast cancer survivors should be assessed. Intervention and support should be provided to meet the needs of young breast cancer survivors.