Exosomes are nanometer sized membrane vesicles, released in the extracellular milieu following the fusion of the external membrane of multivesicular body (MVB) with plasma membrane. They perform a certain function in immune regulation. Exosomes have been shown to be released by cells of hematopoietic and non-hematopoietic origin. Tumour-derived exosomes (TEX) exist in the supernatant of tumour cells, plasma and malignant effusions of tumour patients. They contain native candidate tumour associated antigen and are capable of transferring antigens to T lymphocytes, therefore efficiently promoting cytotoxic T lymphocyte (CTL) activation and producing antitumor immunity. However, recent evidence shows that tumor exosomes may induce immunologic tolerance and even activate immunosuppression which makes tumour escape from the immune surveillance of the host immune system. In addition, tumor exosomes may mediate a growth-promoting effect on tumor cells. These discrepancies are almost certainly due to differences in the phenotype of the exosomes.
Antigen-Presenting Cells ; immunology ; Antigens, Neoplasm ; immunology ; Cytoplasmic Vesicles ; immunology ; Endosomes ; immunology ; metabolism ; Exosomes ; immunology ; Humans ; Neoplasms ; immunology ; T-Lymphocytes, Cytotoxic ; immunology ; Tumor Escape

Objective To explore the value of endocervical curettage (ECC) in the detection of high-grade cervical squamous intraepithelial lesion (HSIL). Methods We retrospectively analyzed the clinical features and colposcopical characteristics of 678 female patients with complete clinical data. Results Among 678 cases, 391 cases were confirmed by cervical biopsy only and 7 cases by ECC only (57.67% vs. 1.03%, P < 0.001). ECC checked out 287 HSIL patients (42.33%, including cervical biopsy positive and negative cases) and cervical biopsy checked out 671 HSIL cases (98.97%, including ECC positive and negative cases). There were 68 positive ECC cases in the conversion area of Type 1+Type 2 and 247 positive ECC cases in the conversion area of Type 3(33.33% vs. 52.11%, P < 0.001). The positive rates of ECC in patients≥45 years old and < 45 years old were 145 and 170, respectively (55.13% vs. 40.96%, P < 0.001). Conclusion The cervical biopsy plays a dominant role in the detection of HSIL, and ECC can only be used as a supplement to it. Female patients older than 45 years or with Type 3 transformation zone examined by colposcopy should be concerned with cervical lesions.

Objective To analyze the expression of KCNJ11 mRNA in gliomas and its prognostic value. Methods The clinical, histopathological and molecular pathological features of 273 patients with gliomas were collected from CGGA. We analyzed the differences of KCNJ11 mRNA expression in different types of gliomas and the survival time of patients with high and low expression of KCNJ11 mRNA in different subtypes of gliomas. Results The expression levels of KCNJ11 mRNA in young glioma and primary glioma patients were higher than those in old glioma and recurrent glioma patients, respectively (P=0.008, 0.001). The expression of KCNJ11 mRNA in oligodendroglioma was the highest, astrocytoma was the second, and glioblastoma was the lowest (P=0.000). The expression of KCNJ11 mRNA in WHOⅡ grade glioma was the highest, WHOⅢ was the second, and WHOⅣ was the lowest (P=0.000). The expression levels of KCNJ11 mRNA in IDH-mutant type glioma patients were higher than those in IDH-wild type glioma patients (P=0.000). The expression of KCNJ11 mRNA in deletion of 1p/19q glioma patients was higher than that in non-deletion of 1p/19q ones (P=0.000). The expression of KCNJ11 mRNA in MGMT methylated glioma patients was higher than that in non-methylated ones (P=0.036). The survival time of patients with high expression of KCNJ11 mRNA (≥2.77) was longer than that with low expression (P=0.000). Multivariate Cox analysis showed that the high expression of KCNJ11 mRNA was an independent factor affecting the good prognosis of patients with glioma. Conclusion The expression of KCNJ11 mRNA is negatively related to the malignant degree of the tumor. The high expression of KCNJ11 mRNA is an independent factor affecting the good prognosis of patients with glioma.

Objective:To construct advance care planning (ACP) interventions for end-stage cancer patients based on Watson care theory, so as to provide basis for ACP practice in end-stage cancer patients.Methods:Semi-structured interviews were conducted to establish items pool for "ACP interventions based on Watson care theory for end-stage cancer patients ". Delphi expert inquiry method was used to evaluate, revise and supplement the items, and the final version of "ACP interventions for end-stage cancer patients" was formed. The positive coefficient and authority coefficient of experts were calculated, and Kendall harmony coefficient and variation coefficient were used to evaluate the degree of expert consensus.Results:The "ACP interventions for end-stage cancer patients" was constructed with 19 items in 4 dimensions, including 7 items in the preparation phase, 6 items in the initiation phase, 4 items in the execution phase and 2 items in the follow-up phase. The effective recovery rates of the 2 rounds of questionnaire were both 100%. The authority coefficient of expert consultation was 0.835. The coefficient of variation of each item was 0 to 0.21. The Kendall harmony coefficients of the two rounds of consultation were 0.290 and 0.267, respectively.Conclusions:The ACP interventions for end-stage tumor patients constructed in this study has good authority and coordination, and reflects Watson care theory, which has certain reference significance for clinical ACP implementation.

Objective:To analyze the risk factors for hospital acquired pulmonary infections in elderly lung cancer patients during chemotherapy, and construct a prediction model to provide personalized guidance for clinical nursing work.Methods:Using convenience sampling, clinical case data of 405 elderly lung cancer patients who underwent chemotherapy at the First Affiliated Hospital of Zhengzhou University from January 2021 to December 2022 were collected. A total of 226 patients from January to December 2021 were selected as the modeling group, and 179 patients from January to December 2022 were selected as the validation group. In the modeling group, the patients were divided into two groups based on whether or not they had hospital acquired pulmonary infection, including the hospital acquired pulmonary infection group and the non-hospital acquired pulmonary infection group. Single factor analysis and multivariate Logistic regression analysis were used to determine the risk factors for hospital acquired pulmonary infection in elderly lung cancer patients during chemotherapy. A risk prediction model for hospital acquired pulmonary infection in elderly lung cancer patients during chemotherapy was constructed based on the results of multivariate analysis. The area under the receiver operating characteristic (ROC) curve was used to evaluate the predictive performance of the prediction model, and a calibration map was drawn for consistency testing. The prediction model was validated in the validation group to evaluate its predictive performance.Results:The incidence of hospital acquired pulmonary infection in the modeling group was 14.6% (33/226). The results of multivariate Logistic regression analysis showed that basic diseases, tumor-node-metastasis (TNM) staging, neutropenia, and invasive procedures were risk factors for hospital acquired pulmonary infections in elderly lung cancer patients undergoing chemotherapy ( P<0.05). Based on this result, a prediction model was constructed, with an area under the ROC curve of 0.832 [95% CI (0.764, 0.900) ] in the modeling group and 0.759 [95% CI (0.695, 0.824) ] in the validation group. The calibration curves of the modeling and validation groups showed a good coincidence between the predicted results and the actual results. Conclusions:Basic diseases, neutropenia, invasive procedures, and advanced stages of tumors are risk factors for hospital acquired pulmonary infections in elderly lung cancer patients undergoing chemotherapy. For high-risk patients, individualized intervention should be carried out as soon as possible to reduce the incidence of hospital acquired pulmonary infection.

Objective:To explore the effect of case management cloud service based on smart hospital in patients with lung cancer undergoing chemotherapy.Methods:From March 2019 to June 2020, a total of 148 patients with lung cancer who received regular chemotherapy in the First Affiliated Hospital of Zhengzhou University were selected by convenience sampling method, and randomly divided into the control group and the observation group with 74 cases in each group. The control group received routine case management, and the observation group received case management cloud service based on smart hospital. Quality of life, treatment compliance and mortality were compared between the two groups.Results:Of the 148 patients, 17 cases died and did not complete the whole course of chemotherapy, including 4 cases in the observation group and 13 cases in the control group. The survival rates of the observation group and the control group during chemotherapy were 94.6% and 82.4%, respectively. There were statistically significant differences in physiological status, social and/or family status, function and total scores of quality of life of the control group before and after chemotherapy ( P<0.05) . There were statistically significant differences in physiological status, function and total score of quality of life of the observation group before and after chemotherapy ( P<0.05) . After chemotherapy, physiological status, emotional status, functional status, total score of quality of life and treatment compliance of the observation group were higher than those of the control group, and the differences were statistically significant ( P<0.05) . Conclusions:Compared with conventional case management, case management cloud service based on smart hospital has more advantages in maintaining quality of life, improving treatment compliance and survival prognosis of patients with lung cancer undergoing chemotherapy.

Objective:To understand the attitudes of end-stage cancer patients to the adjunctive intervention program of the advance care planning, and analyze the influencing factors of their attitudes and choices.Methods:The purpose sampling was used to select 11 end-stage cancer patients hospitalized from January to December 2019. Face-to-face semi-structured in-depth interviews was conducted with the phenomenological research method in qualitative research. The Colaizzi 7-step method was used to organize, analyze data and refine themes.Results:A total of three themes were extracted, namely the attitude towards the advance care planning: mainly support or affirmation, not rejection; the acceptance of adjunctive intervention program: preference for basic supportive treatment, avoiding suffering and increasing family burdens due to invasive rescue; factors that affected patients' attitudes and choices of adjunctive intervention program: personal wishes, family members' attitudes, and information about disease and treatment methods.Conclusions:Patients with end-stage cancer do not reject advance care planning, and prefer basic supportive treatment based on the selection of adjunctive intervention programs, so as to avoid suffering and increasing family burdens due to invasive rescue. In the process of promotion and practice, the patient's personal wishes are important, but the key role of family members in medical decision-making cannot be ignored.

BACKGROUND: Fibroblast activation protein (FAP) is one of the surface markers of cancer-associated fibroblasts (CAFs) and is closely related to the malignant characterization of CAFs. SP13786 is a specific micromolecule inhibitor of FAP and this study is to investigate the effects and mechanism of SP13786 on the migration and invasion of A549 cells through regulating exosomes of CAFs. METHODS: CAFs and paracancerous fibroblasts (PTFs) were isolated and subcultured from freshly resected lung adenocarcinoma tissues and paracancerous normal tissues separately. MTT assay was used to detect the proliferation of CAFs incubated by different concentrations of SP13786; PTFs-exo, CAFs-exo and CAFs+SP13786-exo were extracted by polymer precipitation method. The A549 cells were divided into Ctrl group, PTFs group, CAFs group and SP13786 group and each group was incubated with DMEM, PTFs-exo, CAFs-exo and CAFs+SP13786-exo separately. Laser confocal microscope was used to observe the endocytoses of exosomes by A549 cells. The expression of alpha-smooth muscle actin (α-SMA) and FAP in PTFs and CAFs and the expression of E-cadherin, N-cadherin, Slug, Stat3 and P-Stat3 in A549 cells were detected by immunofluorescence, immunohistochemistry and Western blot. The migration and invasion ability of A549 cells were detected by cell scratch and transwell methods. RESULTS: α-SMA and FAP were expressed much higher in CAFs than that in PTFs which indicate that CAFs and PTFs were successfully obtained from lung adenocarcinoma and paracancerous tissues (P<0.05). MTT showed that the 50% inhibitory concentration (IC50) of SP13786 for CAFs was about 3.3 nmol/L. In addition, SP13786 can significantly decrease the expression of α-SMA and FAP in CAFs which means that targeted inhibition of FAP could reduce the malignant characteristics of CAFs (P<0.05). Laser confocal microscope found that exosomes from CAFs could be taken up by A549 cells and scratch and transwell tests showed that the endocytosed CAFs-exo could promote the migration and invasion of A549 cells (P<0.001), while FAP inhibitor SP13786 could inhibit the effects of CAFs-exo on A549 cells (P<0.05). Furthermore, Immunofluorescence and Western blot showed that CAFs-exo could promote EMT by decreasing E-cadherin expression and increasing N-cadherin, Slug expression in A549 cells while FAP inhibitor SP13786 could significantly supress CAFs-exo-induced epithelial-mesenchymal transition (EMT) of A549 cells (P<0.05). Moreover, the expression of P-Stat3 was obviously increased in A549 cells of CAFs group and significantly down-regulated in SP13786 group (P<0.05) whereas there was no significant difference in total Stat3 between CAFs and SP13786 groups (P>0.05). Finally, WP1066 (a specific inhibitor of Stat3) was used to comfirm whether SP13786 could influence EMT of A549 cells by inhibiting Stat3 phosphorylation via CAFs-Exo. The results showed that when the phosphorylation of Stat3 in CAFs group was inhibited by WP1066, SP13786 could not influence the P-Stat3 expression and EMT of A549 cells anymore (P>0.05). CONCLUSIONS As a specific micromolecule inhibitor of FAP, SP13786 indirectly inhibits the migration and invasion of A549 cells by affecting exosomes of CAFs. The possible mechanism is to inhibit the phosphorylation of Stat3 and thus affect the EMT of A549 cells.