Objective To explore the effects of mindfulness-based stress reduction ( MBSR ) on anxiety, depression and immune function in patients with gastric cancer .Methods The study investigated 118 patients with gastric cancer who were hospitalized from March 2011 to February 2015 .The participants were randomly divided into the intervention group ( n=59 ) and the control group ( n=59 ) .Both groups received conventional mental health education while the intervention group complemented with MBSR intervention once a week ( six weeks in total ) .Self-rating anxiety scale ( SAS) and self-rating depression scale ( SDS) were used to evaluate patients′anxiety and depression status before and after the intervention .Moreover , T-cell subsets status could reflect the immune function using phosphatase bridging ELISA .Results Before the intervention , the scores of SAS and SDS had no significant differences between the two groups ( P>0.05).However, after the MBSR intervention, the scores for the intervention group significantly reduced and lower than the control group (P<0.05) since the scores for the control group had limited changes (P>0.05).Furthermore, the CD3+, CD4+, CD8 +and CD4+/CD8+had little differences between the two groups before the intervention ( P>0.05) . However , the CD3+, CD4+ and CD4+/CD8+ for the intervention group significantly increased with CD 8+reduced after MBSR (P<0.05), and the differences between the two groups were statistically significant after MBSR(P<0.05), but there were little changes in the control group ( P>0.05).Conclusions The MBSR intervention can significantly reduce the negative emotions such as anxiety and depression , and can increase the immunity in patients with gastric cancer .

Objective To explore the influence of preoperative anxiety on T-cell subsets and related nursing intervention in patients with lung cancer .Methods The study selected lung cancer patients who were operated during July 2012 and July 2014 using purposive sampling .After evaluated by self-rating anxiety scale (SAS), 84 patients with preoperative anxiety were randomly selected as group A and 84 patients without preoperative anxiety were randomly selected as group B .According to the random number table , the patients were divided into four subgroups:double intervention subgroup , mental intervention subgroup , drug intervention subgroup and control subgroup , 21 in each subgroup .The anxiety status and the effects of different nursing interventions on T-cell subsets and SAS scores were compared between the two groups .Results In general , T-cell subsets for group A were less than group B (P<0.05).In group A:the SAS score and T-cell subsets for double intervention subgroup were better than other subgroups ( P <0.05 ) .In group B: the SAS score for double intervention subgroup were better than the control subgroups ( P <0.05 ) but T-cell subsets had no significant differences compared to other three subgroups (P>0.05).Moreover, the adverse effect rates also had no significant differences between the two groups (P>0.05).Conclusions Preoperative anxiety can reduce T-cell subsets and inhibit the immunity of patients with lung cancer . The mental intervention complemented by the drug intervention not only can relieve patients ′anxiety but also can improve their immunity .

Objective:To compare the histologic features of immune-mediated hepatitis (IMH) due to immune checkpoint inhibitors (ICIs) monotherapy and combined ICIs anti-angiogenesis tyrosine kinases (TKIs) targeted therapy.Methods:Twenty-one IMH patients who had liver biopsy during ICIs treatment in Zhongshan Hospital of Fudan University from 2015 to 2019 were included. Among them, ten were treated with ICIs monotherapy, and 11 were treated with combined ICIs and anti-angiogenesis targeted therapy. The histologic features of IMH were assessed by HE staining and PD-L1/2 was evaluated by immunohistochemical staining.Results:Patients treated with monotherapy ICIs presented with different levels of lobular hepatitis and portal inflammation. Besides, there were also cholangitis, endothelialitis, Kupffer cells activation and peliosisi hepatitis. Eight cases (8/10) showed mild and two cases (2/10) showed moderate hepatic injury. As for patients receiving combined ICIs and TKIs therapy, the extent of IMH was more severe, with four cases (4/11) showing moderate-severe liver injury, with confluent or bridging necrosis, portal inflammation, cholangitis, interface hepatitis. Among these, one patient developed acute severe hepatitis with massive hepatocyte necrosis and died of multisystem dysfunction. In those cases with severe liver injury, many CD8 positive lymphocytes aggregated in the portal area and hepatic sinusoid, and PD-L1 was expressed in many endothelial cells. There were both 2 cases of death in ICIs monotherapy and combination therapy group. Among the latter group, 1 patient developed acute severe hepatitis with massive hepatocyte necrosis and died of multisystem dysfunction.Conclusion:Compared with ICIs monotherapy, combined ICIs and anti-angiogenesis targeted TKIs therapy may cause overlapping hepatic injury, leading to severe IMH.

Objective To establish and assess the new method of APTT assay based on the combinations of Mg2+and Ca2+for lupus anticoagulants(LA)measurements.Methods This prospective study included 309 trisodium citrate anticoagulated plasma samples from 244 random patients and 65 patients with different autoimmune diseases(AID)to establish and assess the method of LA measurement, respectively.Final concentrations of 0,2.0, 4.0, 8.0,16.0 mmol/L Mg2+were added into 25 mmol/L Ca2+solution, and Actin reagent was used to measured plasma APTT of 94 patients.The applied concentration of Mg2+-Ca2+solution was confirmed through the special and significant alteration of APTT from LA-positive and -negative plasma observed in the presence of Mg 2+(test solution).Based on Actin reagent use,the test solution and 25 mmol/L Ca2+solution were applied to measure APTT of patients and normal individuals, respectively, and the ratio of Mg2+-Ca2+-APTT to Ca2+-APTT(Mg2+-Ca2+-APTT indices)and normalized Mg2+-Ca2+-APTT indices(NAR)were calculated, respectively.Mixed plasma NAR was measured,and CV%was calculated to evaluate the repeatability and stability of Mg 2+-Ca2+-APTT method.APTT of 150 patients was measured with the test solution and Actin reagent to calculate Mg 2+-Ca2+-APTT indices, and normalized LA ratio was determined with dRVVT method.The applicability of Mg2+-Ca2+-APTT assay was assessed through comparisons of the results from the two methods.Finally, NAR and NLR of 65 patients with AID(including 26 SLE patients)were measured with Mg2+-Ca2+-APTT assay and dRVVT method, respectively, and ROC curve was also used to assess the efficacy of the two methods for LA measurements.Results In all LA-negative plasma,APTT increased from 28.1 ±4.5 s to 61.2 ±7.9 s in normal APTT group,47.2 ±8.9 s to 97.5 ±10.3 s in increased APTT group,and 27.6 ± 5.1 s to 61.2 ±7.9 s in ACA-positive group when Mg2+increased from 0 to 8 mmol/L in Mg2+-Ca2+solution(F=34.12, 38.9 and 28.35,P<0.01).Following increased Mg2+concentration, APTT shortened from 0 to 4.0 mmol/L, but simultaneously prolonged from 4.0 to 16.0 mmol/L in LA-positive plasma with prolonged or normal APTT(F=31.55 and 39.51, P<0.01), and APTT was significantly higher in 8.0 mmol/L than that in 4.0 mmol/L(P<0.001).The test concentration of Mg 2+/Ca2+solution was 4.0 mmol/L.The within, inter-day CV% of NAR was 1.39%,2.30%, and 3.44%, respectively. According to the judging criteria of <0.966 and >1.034 of Mg2+/Ca2+indices, there was 141 patients with increased indices and NLR <1.20, and 9 patients with decreased ones and NLR≥1.20 in all 150 patients.The area under ROC curve of NAR and NLR for LA detection was 0.913(95%CI:0.848-0.978) and 0.892(95%CI:0.817-0.966), respectively, and the cut-off value was 0.87 and 1.13, respectively. The sensitivity and specificity of NAR(85% and 77%)was higher than that of NLR(81% and 74%), respectively.The accordant rate of positive,negative,and total results between NAR and NLR was 94.4%, 98.5%,and 98%,respectively.Conclusion The method of APTT assay based on Mg2+combining Ca2+for LA measurements is feasible,and can be used to detect plasma LA of patients.