Objective To investigate the clinical effects and the quality of life of flupentixol-melitracen or paroxetine hydrochloride in treatment of the breast cancer patients with anxiety and depression after chemotherapy.Methods 135 breast cancer patients with anxiety and depression after chemotherapy were selected from November 2012 to January 2014 in the hospital.They were randomly divided into the treatment group ( n=68 ) and control group ( n =67 ).The control group were treated by paroxetine hydrochloride treatment, and the treatment group were treated by flupentixol-melitracen.The anxiety, depression and its impact on quality of life of patients were observed between two groups.Results After treatment, the HAMD score and HAMA score decreased significantly in two groups (P<0.05), HAMD score and HAMA score in treatment group after treatment significantly decreased compared with control group (P<0.05).After treatment, the WHOQOL-BREF score of mental health status scale of subjective feeling, the physiological domain, domain score levels in treatment group significantly increased (P<0.05), however, the quality of life of subjective feeling, social relationship and environment domains showed no significant difference.Compared with pre-treatment, only the health status of subjective feeling levels in control group post-treatment significantly increased (P<0.05).The mental health status scale of subjective feeling, the physiological domain, domain score levels in treatment group significantly decreased compared with control group ( P<0.05 ).The adverse reactions of treatment group were 5 cases (7.35%), which was significantly lower than 24 cases (35.82%) of control group(χ2 =16.22,P <0.05).Conclusion Flupentixol-melitracen combined with paroxetine hydrochloride has an obvious clinical effect in treatment of anxiety and depression in patients with breast cancer after chemotherapy.It could effectively control their anxiety and depression, and improve the quality of life of patients.It is worthy of clinical popularization and application.

Objective:To examine the expression of programmed cell death 1 (PD-1) and its ligand (PD-L1) in epithelial ovarian cancer (EOC) tissues, and investigate the correlation among their expression, clinicopathological features and prognosis.Methods:The specimens of 180 patients with EOC treated in the First Affiliated Hospital of Dalian Medical University from October 2002 to December 2013 were confirmed by pathological examination. The pathological tissue specimens of subtypes ，included 120 cases of serous carcinoma, 30 cases of mucinous carcinoma, 20 cases of endometrioid carcinoma, and 20 cases of clear cell carcinoma. The normal paracancerous tissues of 50 cases randomly selected from the 180 patients as control group. Immunohistochemical SP method was used to detect the expressions of both PD-1 and PD-L1 in epithelial ovarian cancer tissues, and the relationships among their expressions,the clinicopathological parameters and prognosis were respectively analyzed.Results:（1） PD-1 was expressed in lymphocytes infiltrated in EOC tissues, and PD-L1 was expressed in the cell membranes of cancer tissues. In all EOC cases, 33 cases (18.3%, 33/180) of both PD-1 and PD-L1 were highly expressed, and only 1 (2.0%, 1/50) of control group showed high expression. There was statistically significant difference between two groups ( P<0.01). (2) Among the four subtypes tissue specimens of EOC, the high expression rate of PD-1 was 25.0% (30/120) for serous carcinoma, 3/15 for endometrioid carcinoma, 0 (0/30) for mucinous carcinoma, and 0 (0/15) for clear cell carcinoma. The high expression rate of PD-L1 was 23.3% (28/120) for serous carcinoma, 3.3% (1/30) for mucinous carcinoma, 2/15 for endometrioid carcinoma, and 2/15 for clear cell carcinoma. Both PD-1 and PD-L1 expressions in the four sub-types of tissue specimens were significantly different ( P<0.05). The high expression rate of both PD-1 and PD-L1 was 9.2% (8/87) in the early stage and 26.9% (25/93) in the late stage. There was a statistically significant difference between the two groups ( P<0.01). Similarly, the expression of both PD-1 and PD-L1 were significantly higher in the cases of high-grade EOC （type Ⅱ） than those of low-grade （type Ⅰ） and in the cases of EOC distributed bilaterally than that distributed unilaterally, and there were statistically significant differences ( P<0.05). (3) The Kaplan-Meier survival analysis showed that the survival time were respectively 35 and 36 months in the cases with high expressions of both PD-1 and PD-L1, and the survival time were the same as 61 months in the cases with low expression of both PD-1 and PD-L1, and the comparison was statistically significant ( P<0.05). Conclusions:The expression levels of PD-1 and PD-L1 in EOC tissues are higher than those in adjacent tissues, especially in serous carcinomas. The expression of both PD-1 and PD-L1 is higher in specimens of the patients with advanced stages. The results showed that the high expression of both PD-1 and PD-L1 is an indicator of poor prognosis of patients suffering from EOC.

Objective:To understand the characteristics of scientific research cooperation network, research hotspots, evolution paths and development trends of advance care planning (ACP) , so as to provide reference for follow-up related research.Methods:With the theme of "advance care planning", the retrieval results based on Web of Science core collection database were respectively imported into VOS viewer and CiteSpace for visual analysis, and the retrieval time was from database construction to February 3, 2021.Results:A total of 2 456 articles meet the selection criteria. The annual publications were all less than 50 from 1993 to 2009, which showed a rapid upward trend from 2010 to now. The distribution trend of citation frequency was basically the same as that of publications. Most of the authors and institutions are European and American. Chan Helen Yue-lai of the Chinese University of Hong Kong ranked first in China and 19th in the world in terms of publicationsand Chinese scholars' research in this field is still in its infancy. Research hotspots included ACP alternative decision-making skills training, and the research frontiers and evolutionary paths included ACP, severe mental illness, alternative decision-making, life planning, end-stage renal disease, doctor's orders, ACP model, advanced dementia, chronic heart failure, etc.Conclusions:Since 2010, the number of articles published in this field and the frequency of citations have shown a rapid upward trend. The United States, Belgium, Canada and other countries have developed well in this field and Scholars of China have a wide space for development in this field. The advanced research experience reported in the foreign ACP literature can be used for reference to deepen and speed up the clinical practice research in the field of ACP in China.

Objective:To explore the impact of pediatric nurses' presenteeism behavior and emotional commitment on psychological capital, so as to provide a reference for promoting pediatric nurses' positive organizational behaviors.Methods:From July to August 2020, convenience sampling was used to select pediatric nurses from three ClassⅢ hospitals in Henan Province as the research objects. The general information questionnaire, Presenteeism Behavior Questionnaire, Emotional Commitment Scale and Psychological Capital Scale were used for investigation. Pearson correlation and structural equation model were used to analyze the relationship between presenteeism behavior, emotional commitment and psychological capital. A total of 897 questionnaires were distributed, and 673 valid questionnaires were returned with the effective response rate of 75.03%.Results:Among 673 pediatric nurses, the scores of the Presenteeism Behavior Questionnaire, Emotional Commitment Scale and Psychological Capital Scale were (6.16±1.52) , (28.26±5.67) and (81.40±10.60) respectively. The results of Pearson correlation analysis showed that presenteeism behavior was negatively correlated with emotional commitment and psychological capital ( P<0.05) , and emotional commitment was positively correlated with psychological capital ( P<0.01) , and the differences were statistically significant. The structural equation model showed that presenteeism behavior and emotional commitment had a direct effect on psychological capital (effect values were -0.32 and 0.42, respectively) , and presenteeism behavior also had an indirect effect on psychological capital through emotional commitment (effect value was -0.48) . Conclusions:Emotional commitment acts as an intermediary between presenteeism behavior and psychological capital. Nursing managers should take effective measures to create a good organizational atmosphere, reduce presenteeism behavior, and improve the psychological capital of pediatric nurses.

【Objective】 To investigate the central sedative and hypnotic effects and mechanisms of Shumian Capsule. 【Methods】 The blank control group, the positive drug diazepam group, and the low-, medium-, and high-dose groups of Shumian Capsule were designed in the experiments. Male Kunming mice were administered orally by gavage. We conducted the experiment of mouse autonomous activity, and assessed supra- and sub-threshold dose sleep with pentobarbital sodium, respectively. The levels of γ-aminobutyric acid (GABA) and glutamic acid (Glu) in the brain tissue of the mice were measured by enzyme-linked immunosorbent assay (ELISA) or colorimetric method. Male SD rats were injected intraperitoneally with p-chlorophenyl alanine [PCPA, 350 mg/(kg·d)] to establish an insomnia rat model, after which rats were continuously administered intragastrically for 7 days. The general status and body weight of the rats were observed. Total distance and standing times of rats were measured by open field test. Western blotting and immunohistochemistry assays were used to evaluate the protein expression of 5-HT1A receptor (5-HT1AR) in the rat hippocampus. 【Results】 Compared with the blank control group, the three dose groups of Shumian Capsule [1.6, 3.2, 6.4 mg/(kg·d)] for 14 consecutive days had significantly reduced the number of spontaneous activities and standing times in the mice (P<0.01). The high dose significantly prolonged the sleep duration of the mice induced by the supra-threshold dose of pentobarbital sodium (P<0.01). Compared with the blank control group, each dose group of Shumian Capsule had an increased GABA level in the mouse brain tissue in a dose-dependent manner (P<0.05); the medium- and high-dose groups had significantly reduced Glu levels in the hippocampus (P<0.05), while the high-dose group had significantly reduced Glu level in the cortex (P<0.05). In insomnia model rats, their activity was sluggish; their circadian activity rhythm disappeared; the hair became hard, rough and dull, with severe hair loss; and their weight reduced. After 7 consecutive days of the drug administration, the rats’ mental state in each Shumian Capsule dose group was improved. Compared with the blank control group, the rats’ body weight gains were significantly reduced after intraperitoneal injection of PCPA (P<0.01). Compared with the model group, each rat group of Shumian capsule treatment had significantly increased body weight gains (P<0.01). Compared with the blank control group, the distance of the rats in the model group increased in the open field test, and the expression level of 5-HT1AR protein in the hippocampus decreased. However, the distance of rats in diazepam group and each dose group of Shumian Capsule was significantly reduced (P<0.01), and the expression level of 5-HT1AR protein in the hippocampus of the high- and medium-dose groups of Shumian Capsule and diazepam group increased significantly (P<0.01). 【Conclusion】 Shumian Capsule has obvious effects of sedation, hypnosis and insomnia improvement, and its underlying mechanisms may be related to the increased GABA and decreased Glu contents in brain tissues, as well as up-regulated 5-HT1AR protein expression in the hippocampus.