Actinic keratosis (AK) is a precursor to cutaneous squamous cell carcinoma (SCC),and molecular mechanisms of transformation from AK to SCC have been a research hotspot.This review focuses on four aspects of the molecular mechanisms,including chromosomal variation,gene mutations,signaling pathways and other factors,summarizes advances in selective mutations in chromosomes 3p,9p,9q,13q,17p and 17q,heterozygous deletion mutations in chromosome 18q,mutations of p53,p16 and Ras genes,abnormality of the transforming growth factor β1 signaling pathway and Fas/FasL signaling pathway,and aberrant expression of matrix metalloproteinases in the transformation from AK to SCC,which will provide a reference for further researches.

Objective To investigate if distribution of stone composition and onset age in the upper urinary tract changed during the past 12 years in China.Methods There were 1 878 urolithiasis patients of the upper urinary tract in our hospital from 2003 to 2014 enrolled in present cross-sectional study.There were 1 300 male and 578 female patients with a median onset age of 46 (6-95) years.Stone composition was measured by infrared spectrophotometry.All the patients were divided into 3 groups according to the onset year:Year 2003-2006,Year 2007-2010 and Year 2011-2014.The distributions of stone types were compared among the 3 groups.Age and gender were included as potential confounders.Chi square test,P trend test,Kruskal-Wallis test and logistic regression were employed in the statistical analysis.Results Calcium oxalate was the most common type with a dominant proportion of 78.1％ (1 466/1 878),while uric acid had a small proportion of 4.8％ (91/1 878).The proportions of uric acid in the 3 groups were 2.7％ (12/441),5.1％ (39/758) and 5.9％ (40/679),showing an increasing trend (P ＜0.05).Multivariate analysis showed that year group was independently correlated with the proportion of uric acid,with an OR of 1.385 (95％ CI,1.027-1.867).From 2003 to 2014,the proportion of uric acid calculus increased by 0.42％ (95％ CI,0.25％-0.59％) annually.The median ages of disease onset were 43,46 and 49 years respectively in those three groups,also showing an increasing trend with time (P ＜0.01).Conclusion From 2003 to 2014,the proportion of uric acid and onset age in patients of upper urinary tract calculi were increased in the present cohort.

Objective To investigate the proportion , risk factors and tendency of change of stone composition in recurrent urolithiasis .Methods Eighty-five recurrent urolithiasis patients from 2002 to 2014 were enrolled in this retrospective cohort study .There were 61 male and 24 female patients with a median age of 51 (21-89) years at initial events.Among those patients, 70 had two events, 12 had three events, and 3 had more than 3 events.Compositions of initial and recurrent stones were measured by infrared spectrophotometry.Stone type, recurrence interval and recurrence frequency were studied as potential risk factors for composition change . Chi square test and logistic regression analysis were employed in the statistical analysis.Results Stone composition changed during recurrence in 26 patients ( 30.6%) . Univariate analysis showed the risk ratio of composition change in the patients with recurrence interval of 1-5 years was 0.518 (95%CI, 0.277-0.967, P<0.05) when compared with those of less than 1 year or more than 5 years.Logistic regression analysis showed the odds ratio of recurrence interval of 1-5 years was 0.231 (95%CI, 0.075-0.707, P=0.010).The mutual conversion between calcium oxalate and infection stones was mostly observed when stone composition changed during recurrence .Twenty percent of calcium oxalate stones changed to infection stones and 29.2% of infection stones changed to calcium oxalate .
Conclusions Stone composition changes in about one third patients of recurrent urolithiasis .The mutual conversion between calcium oxalate and infection stones is the most common change .Recurrence interval is an independent risk factor to predict composition change .Repeated stone analysis should be suggested to patients with recurrent interval of less than 1 year or more than 5 years.

Objective To investigate the effect of comprehensive nursing for pain,quality of life and satisfaction of hepatocellular carcinoma (HCC) patients after TACE.Methods A total of 180 patients with HCC treated with TACE were enrolled.The patients were equally divided into intervention group and control group (each n＝ 90).Comprehensive nursing was performed,including routine nursing care,psychological support,painful health education,nursing interventions with relaxation therapies and pressing acupoints combined with drug analgesia in intervention group.The control group was given routine nursing care.The numerical rating scale (NRS) scores for pain assessment,satisfaction and quality of life were compared between the two groups.Results NRS scores at the 1st,2nd,3rd day after operation in the intervention group at resting state and exercise state were all lower than those in the control group (all P＜0.05).The satisfaction rate of the intervention group (94.11％ [85/90]) was higher than that of the control group (76.67％ [69/90];X2 ＝63.47,P＜0.05).The quality of life in intervention group was also significantly higher than that in control group (X2 ＝7.476,P＜0.05).Conclusion In HCC patients,comprehensive nursing can effectively reduce the pain from TACE and improve the satisfaction and quality of life.

Objective To explore the clinical symptom clusters in breast cancer patients with anthracycline treatment, which could provide evidence for prevention. Methods The M.D.Anderson Symptom Inventory of Chinese version (MDASI-C) was applied to assess clinical symptoms in 506 breast cancer patients received anthracycline therapy during their 1stto 4thcycle chemotherapy.Thirteen symptoms were analyzed using main-component analysis and variance orthogonal rotation. The exploratory factor analysis was conducted to find factors value greater than 1. Results The number of symptoms with incidence rate more than 50% was 5, 6, 7 and 9 during the 1stto the 4thcycle, respectively. Fatigue, poor appetite, and nausea were the most common symptoms, and the incidence of these symptoms were 92.5% to 97.1% ,84.8% to 95.1% and 81.1% to 91.3% with the increasing cycle of chemotherapy.Three factors value greater than 1 were detected during the 1stto 2ndcycle chemotherapy by exploratory factor analysis.The cumulative variance contribution rates were 63.233% and 61.434% in the 1stand 2ndcycle, respectively. The main symptom clusters concentrate on fatigue and digestive tract symptoms, including fatigue, sleep disturbance, hypersomnia, nausea, vomit, poor appetite, dry mouth. Two factors value greater than 1 were detected during 3rdto4thcycle in chemotherapy. The cumulative variance contribution rates were 62.660% and 61.148% in the 3rdand 4thcycle, respectively. The main symptom clusters concentrate on psychological and nervous system symptoms including sadness, pain, dry mouth, numbness, hypersomnia, shortness of breath, amnesia and so on. The Cronbach α of cluster symptoms from the 1stto the 4thcycle chemotherapy was between 0.829 to 0.911. Conclusions Symptom clusters vary with the cycles of chemotherapy in breast cancer patients treated with anthracycline. Nurses should provide targeted intervention measures to improve symptom and enhance quality of life, according to specific situation.

There are different symptom clusters among lung cancer patients, influenced by physical, psychological and treatment factors, which may even threaten patients′ life. In this study, we reveal the survey results of symptom clusters among lung cancer patients through both qualitative research and quantitative research to provide theoretical basis for the practice of nursing intervention, so that we can further relieve patients′symptom burden and improve their life quality.

Objective To learn the intention and demand of nurses of cancer hospitals to train abroad, so as to promote international exchange and management of nursing work. Methods Investigation was carried out by self-designed questionnaires among the nurses at the cancer hospital.The questionnaire covered the basic information of the nurses, the intention and demand of studying abroad, and information of those who have completed study abroad. The differences among different age groups were compared by descriptive statistics and χ2 test. Results Of the 700 people surveyed, 71.7% (502/700) of the nurses expect to study and train abroad.Their main purpose was to learn new nursing skills, new knowledge and nursing supervision methods.Nurses expect to study and train abroad for updating their concepts, promoting nursing skills, improving their command of a foreign language, and enhancing knowledge update ability. 54.9% (384/700)of the respondents were found with concerns for studying abroad.67.4% (33/49) of the respondents had the assessments after returning home. And 69.4% (34/49) of the respondents had more opportunities after their return. Conclusions It is important for nurses to study and train abroad.To this end, a gradient and hierarchical platform should be developed for nurses to go abroad for study under an institutionalized framework. It is also necessary to build an international communication platform and to establish a long-term evaluation and assessment mechanism.

BACKGROUND: The clinical trials of new anti-tumor drugs are prospering in China. The acceptance of clinical trials in patients is an important factor affecting the speed and quality of clinical trials. Previous studies have investigated the acceptance of clinical trials in those cancer patients, who have never participated in a trial. This study is designed to investigate and compare the acceptance and related causes of clinical trials in cancer patients who have once participated in a clinical trial or not. METHODS: From June 2018 to April 2019, a standardized questionnaire-based survey was conducted among two groups of cancer patients classified by history of clinical trial participation in Cancer hospital, Chinese Academy of Medical Science, mainly focusing on their overall acceptance of clinical trials and related considerations, including the role of attending doctors, as well as group differences between the two participants. RESULTS: A total of 538 patients were enrolled with an average age of 53.5 years old, 51.1% of whom were males, and 43.3% of whom have never participated in a clinical trial. Overall, 502 patients (93.3%) were willing to or recommend their relatives or friends to participate in clinical trials, and patients with history of clinical trial participation had higher willingness (96.6% vs 90.8%, P=0.008). Patients were most likely to be motivated by expectation of optimal treatment (100.0% vs 99.3%) for both those who had once participated in a clinical trial or those not, respectively followed by financial burden reduction (56.0%) and recommendation by attending doctor (43.7%). The main reasons for unwillingness-to-participate for those who had once participated in a clinical trial were abandoning other treatment options, divided into control group or additional visits, while for those who had never participated in a clinical trial, ineffective treatment or serious adverse reactions were their main concerns. In the decision-making of clinical trial participation, 88% patients highly valued the role of recommendation by attending doctors. Among patients without trial participation history, 60.9% of those had no unwillingness-to-participate expressed that recommendation by attending doctors would change their decisions. The study also reported patients' preferences for information and access to clinical trials. CONCLUSIONS The acceptance of clinical trials in cancer patients in our hospital is generally high, especially in patients who had a history of trial participation. It's of substantial significance to give full play to the role of doctors in improving the acceptance of clinical trials of cancer patients in China.

BACKGROUND: Early investigation suggested patients' level of awareness regarding clinical trials was related with willingness to participation. This study was intended to evaluate the level of awareness of cancer patients regarding clinical trials and related influencing factors, and to compare the differences of awareness between patients who attended clinical trials before and not. METHODS: From Jun, 2018 to April, 2019, standardized question-naires were gathered from cancer patients (attended clinical trials vs not attended clinical trials) in our hospital regarding basic information and 10 other questions about awareness. The level of awareness was evaluated and patients were classified into "low cognition" and "high cognition" groups. Logistic regression analysis was performed to determine whether certain characteristics would predict for awareness. RESULTS: Of the 617 participants, 38.6% have attended clinical trials before. 338 (54.6%) patients had a correct overall understanding of clinical trials, while 44 (7.1%) patients still thought participants were the victim of scientific research. Except for the compensation of medical expenses (51.5% vs 48.7%) and related laws of clinical trials (52.3% vs 45.5%), other parts of understanding were elevated in patients attended clinical trials before comparing with patients who didn't, including significance (86.2% vs 77.6%), risk disclosure (91.2% vs 71.6%), confidentiality (73.2% vs 59.7%), voluntariness (95.8% vs 76.3%), withdrawal (86.6% vs 68.2%) and expenses (62.8% vs 39.2%). The proportion of participants who understand these components did not increase even in 239 patients who had attended clinical trials before. Participants who attended clinical trials before (OR=1.83, 95%CI: 1.11-3.00), unmarried/divorced (OR=5.04, 95%CI: 1.73-14.66), retired (OR=2.53, 95%CI: 1.16-5.50) had a higher level of awareness, while patients who had bad impression with doctors (OR=0.43, 95%CI: 0.26-0.72) had lower awareness. CONCLUSIONS The current level of awareness for clinical trials of cancer patients in our hospital was relatively low, even in patients who had attended clinical trials before. It's necessary to improve patients' awareness of clinical trial by promoting harmony relationship between patients and doctors, as well as by enhancing related propagation. Strengthening the adequacy and efficacy of informed consent in clinical trials also needs to be achieved in the future.