Objective:To develop a culturally adapted Advance Care Planning (ACP) Decision Balance Scale for Family Members of Patients with Advanced Cancer in China, and to test its reliability and validity.Methods:Based on the transtheoretical model-decisional balance framework, the item pool was established through literature analysis, qualitative interviews, and research team discussions. After expert panel meetings and semantic debugging pre-surveys among family members of patients with advanced cancer, item screening was conducted to form the pilot scale. From October to December 2024, the scale was administered to 310 family members of inpatients with advanced cancer in five Class Ⅲ Grade A hospitals in Chongqing. SPSS and AMOS software were used for item analysis and reliability and validity testing, and the final formal scale was developed.Results:The ACP Decision Balance Scale for Family Members of Patients with Advanced Cancer consisted of 2 dimensions, perceived cost of choice and perceived benefit of choice, with a total of 12 items. The Cronbach's α coefficient of the scale was 0.875, the split-half reliability was 0.905, and the test-retest reliability was 0.856. The item-level content validity index ranged from 0.880 to 1.000, and the scale-level content validity index was 0.980. Exploratory factor analysis extracted 2 common factors, with a cumulative variance contribution rate of 65.365%. Confirmatory factor analysis showed χ 2/ df=1.743, and the model fit indices met the requirements. The scale also demonstrated good convergent validity and discriminant validity. Conclusions:The ACP Decision Balance Scale for Family Members of Patients with Advanced Cancer developed in this study demonstrated good reliability and validity. It can be used as a tool to assess the level of ACP decision-making participation of family members of patients with advanced cancer, and to systematically, comprehensively, and effectively evaluate, collect, and analyze their behavioral intentions and barriers regarding ACP decision-making.

Objective:To explore the influence of Stat1 on Foxp3 expression and production of Treg.Methods:C57BL/6 mice were used and separated into normal control group and Stat1 specific inhibitor Fludarabine(Flud)treatment group.Ratio of CD4+Foxp3+Treg and expression of Foxp3 in spleen,lymph nodes and peripheral blood of mice in each group were detected by flow cy-tometry.Human Stat1 overexpression plasmid was constructed and transfected into human breast cancer MCF-7 cells,and expression changes of Foxp3 was detected by RT-qPCR and Western blot.Results:Compared with mice in normal control group,proportion of Treg and expression of Foxp3 in lymph nodes and peripheral blood of mice in Flud treatment group were increased,while Stat1 overex-pression resulted in decreased Foxp3 mRNA and protein expression in MCF-7 cells.Conclusion:Stat1 inhibits expression of Foxp3 and production of Tregs.

Objective:To develop a culturally adapted Advance Care Planning (ACP) Decision Balance Scale for Family Members of Patients with Advanced Cancer in China, and to test its reliability and validity.Methods:Based on the transtheoretical model-decisional balance framework, the item pool was established through literature analysis, qualitative interviews, and research team discussions. After expert panel meetings and semantic debugging pre-surveys among family members of patients with advanced cancer, item screening was conducted to form the pilot scale. From October to December 2024, the scale was administered to 310 family members of inpatients with advanced cancer in five Class Ⅲ Grade A hospitals in Chongqing. SPSS and AMOS software were used for item analysis and reliability and validity testing, and the final formal scale was developed.Results:The ACP Decision Balance Scale for Family Members of Patients with Advanced Cancer consisted of 2 dimensions, perceived cost of choice and perceived benefit of choice, with a total of 12 items. The Cronbach's α coefficient of the scale was 0.875, the split-half reliability was 0.905, and the test-retest reliability was 0.856. The item-level content validity index ranged from 0.880 to 1.000, and the scale-level content validity index was 0.980. Exploratory factor analysis extracted 2 common factors, with a cumulative variance contribution rate of 65.365%. Confirmatory factor analysis showed χ 2/ df=1.743, and the model fit indices met the requirements. The scale also demonstrated good convergent validity and discriminant validity. Conclusions:The ACP Decision Balance Scale for Family Members of Patients with Advanced Cancer developed in this study demonstrated good reliability and validity. It can be used as a tool to assess the level of ACP decision-making participation of family members of patients with advanced cancer, and to systematically, comprehensively, and effectively evaluate, collect, and analyze their behavioral intentions and barriers regarding ACP decision-making.

Objective:To explore the influence of Stat1 on Foxp3 expression and production of Treg.Methods:C57BL/6 mice were used and separated into normal control group and Stat1 specific inhibitor Fludarabine(Flud)treatment group.Ratio of CD4+Foxp3+Treg and expression of Foxp3 in spleen,lymph nodes and peripheral blood of mice in each group were detected by flow cy-tometry.Human Stat1 overexpression plasmid was constructed and transfected into human breast cancer MCF-7 cells,and expression changes of Foxp3 was detected by RT-qPCR and Western blot.Results:Compared with mice in normal control group,proportion of Treg and expression of Foxp3 in lymph nodes and peripheral blood of mice in Flud treatment group were increased,while Stat1 overex-pression resulted in decreased Foxp3 mRNA and protein expression in MCF-7 cells.Conclusion:Stat1 inhibits expression of Foxp3 and production of Tregs.

Objective·To systematically integrate relevant influencing factors of advanced cancer patients'engagement behavior in advance care planning(ACP).Methods·The systematic search of Chinese and English literature on factors influencing ACP engagement behavior in advanced cancer patients from inception to December 2022 in China National Knowledge Infrastructure(CNKI),Wanfang,China Biomedical Literature Database(Sinomed),PubMed,Cochrane Library,Embase,CINAHL,and PsycINFO was conducted.After the literature quality evaluation,content extraction and summary were conducted by two researchers,and the data of quantitative research and qualitative research were extracted and integrated respectively.The final influencing factors of ACP engagement behavior of advanced cancer patients were obtained.With the help of the theoretical domain,they were mapped to the capability,opportunity,motivation-behavior(COM-B)model step by step.Results·A total of 21 studies were included and 27 factors were summarized,including 9 theoretical domains.Mapping to the COM-B model included 9 capability factors(knowledge of ACP,education level,accurate knowledge of prognosis,knowledge of the time of disease diagnosis,prior experience,subjective life expectancy,age,cancer site,and disease symptom burden),13 opportunity factors(gender,marital status,race/ethnicity,religious belief,dependent children,family economic condition,place of living,housing type,family support,social support,doctor-patient relationship,acculturation,and whether or not to establish a hospice service center)and 5 motivational factors(ACP attitude,ACP belief,ACP motivation,anxiety and depression,and death attitude).Among them,doctor-patient relationship,religious belief,ACP attitude,educational level,marital status,family support,knowledge of ACP,accurate knowledge of prognosis,age,place of living,attitude toward death,prior experience,and race/ethnicity were more influential factors on ACP engagement behavior.Conclusion·Based on the COM-B model,the influencing factors of ACP engagement behavior in advanced cancer patients can be comprehensively summarized.Future studies can use the above factors as an entry point to design continuous,multifaceted,and comprehensive interventions based on the COM-B model to promote the practice of ACP engagement behavior in advanced cancer patients.

The majority of diagnosed cases of gastric cancer are in the middle and late stages, while less than 10% of patients are diagnosed in the early stages in China. The standard treatment strategy for patients with progressive gastric cancer is surgery combined with postoperative adjuvant therapy or preoperative neoadjuvant followed by surgery combined with postoperative adjuvant therapy. Immunotherapy is now recognized as an innovative approach for cancers. It is worth exploring how to best use immunotherapy in neoadjuvant therapy to achieve better clinical benefit. Therefore, this paper reviews the progress of immunotherapy in neoadjuvant therapy for GC. Further studies and the understanding of immune system function by neoadjuvant therapy combined with immunotherapy will help to improve the treatment of gastric cancer.

Objective:To explore the effect of rhythm activation exercise on loneliness and physical activity ability of empty nest elderly.Methods:Using the convenient sampling method, a total of 90 empty nest elderly who were admitted to the elderly unaccompanied ward of the First People's Hospital of Hefei from January to June 2019 were selected as the research objects. They were randomly divided into the control group, the observation group 1 and the observation group 2, with 30 cases in every group. The patients in the control group took conventional nursing methods, the observation group 1 performed rehabilitation exercises, while the observation group 2 performed rhythm activation exercises under the guidance of nurses. After the intervention for 12 weeks, the differences in Barthel Index Scale, the short form of UCLA Lone lines scale (ULS-8) and the range of motion of each joint of limb movement were compared among the three groups.Results:After the intervention, the total score of Barthel index of the observation group 2 was (68.66±6.00) , which was higher than (58.00±8.16) of the control group and (60.00±6.64) of the observation group 1, and the differences were statistically significant ( P<0.05) . The total score of loneliness of the observation group 2 was (20.06±1.93) , which was lower than (27.11±1.77) of the control group and (26.32±1.74) of the observation group 1, and the differences were statistically significant ( P<0.05) . The scores of all dimensions of limb motor activity in observation group 2 were higher than those in the control group and the observation group 1, and the differences were statistically significant ( P<0.01) . Conclusions:Rhythm activation exercise can well improve the loneliness of empty-nest elderly, improve their self-care ability and improve physical mobility of the elderly to a certain extent.

Objective To investigate the expression and significance of FBXW7 and ENO1 in ovarian serous adenocarcinoma of different grades. Methods Immunohistochemistry was used to study the expression of FBXW7 and ENO1 in 60 cases of ovarian serous adenocarcinoma. The relationship between FBXW7 and ENO1 proteins and the prognosis of ovarian serous adenocarcinoma was analyzed. Results The positive rate of FBXW7 expression was 22. 5％ ( 9/40) in 40 cases of ovarian high grade adenocarcinoma and 10 cases in 15 cases of normal oviduct. The positive rate of FBXW7 expression was 66. 7％ ( 10/15) ,and the difference was statistically significant ( P=0. 003) . The expression of FBXW7 in 20 cases of low grade adenocarcinoma was 5 cases,and the positive rate was 25. 0％( 5/20) . In 15 cases of normal ovarian tissue,9 cases were positive,and the positive rate was 60. 0％( 9/15) . The difference was statistically significant ( P=0. 04) . The expression of ENO1 protein was 27 in 40 cases of high grade adenocarcinoma,and the positive rate of expression was 67. 5％( 27/40) . 5 cases were positive in 15 normal fallopian tubes, and the positive rate was 33. 3％( 5/15 ) . The difference was statistically significant ( P = 0. 024 ) . The expression of ENO1 protein was 15 in 20 cases of low grade adenocarcinoma,and the positive rate of expression was 75. 0％( 15/20) . In 15 cases of normal ovarian tissue,4 cases were positive, and the positive rate was 26. 7％( 4/15 ) . The difference was statistically significant ( P=0. 006) . There was no correlation between the low expression of FBXW7 and the high expression of ENO1 in high grade ovarian adenocarcinoma ( P= 0. 199 ) , but there was a significant correlation between the low expression of FBXW7 and the high expression of ENO1 in low grade ovarian adenocarcinoma ( P<0. 05) . In low grade serous adenocarcinoma,the 5-year survival rates were 44. 4％ and 32. 1％ respectively,with no significant difference ( P = 0. 052 ) . In ovarian high-grade serous adenocarcinoma, the 5-year survival rates of high-expression group and low-expression group were 20. 0％ and 7. 7％, respectively, with no significant difference ( P=0. 097) . In low grade ovarian serous adenocarcinoma,the 5-year survival rate was 7. 4％ in high expression group and 50. 0％ in low expression group ( P=0. 023) . The 5-year survival rates of ENO1 in high-grade serous adenocarcinoma were 0％ and 40. 0％ in high-expression group and low-expression group respectively ( P=0. 001) . Conclusion The low expression of FBXW7 in ovarian adenocarcinoma suggests that FBXW7 may be a tumor suppressor gene in ovarian serous adenocarcinoma, and ENO1 may be an oncogene in ovarian adenocarcinoma. The high expression of FBXW7 in serous adenocarcinoma indicates that ENO1 may be an oncogene,and the survival rate of FBXW7 in serous adenocarcinoma is higher than that in low expression group. The survival rate of the high-expression group was lower than that of the low-expression group. Therefore, they may become a new diagnostic index and therapeutic target for ovarian serous adenocarcinoma.

Objective To explore the application of endometriosis fertility index (EFI) in guidance after laparoscopic surgery of endometriosis patients combined with infertility and to explore methods to improve pregnancy rate in different EFI groups. Methods A prospective research was done in endometriosis patients combined with infertility in Beijing Obstetrics and Gynecology Hospital from January 2010 to June 2011, after laparoscopic surgery, these 146 patients were divided into 3 groups by EFI score. Using different pregnancy guidance, these patients had 5 years follow-up. Results (1) The 5 years overall pregnancy rate was 89.0%(130/146). The pregnancy rate was 95.7%(45/47) in EFI≥9 group, 92.8%(77/83) in EFI 5-8 group and 8/16 in EFI≤4 group, three groups were all reach satisfactory pregnancy rate;the rate of the first two groups had no statistically significance (P=0.498), but had significant difference with the last group (P<0.01). (2) In EFI≥5 patients, pregnancy rate was the highest in 6 months after operation;in EFI≥9 group, the pregnancy rate was 66.7%(30/45), and EFI 5-8 group was 50.6%(39/77). (3) EFI≥9 group had the highest natural pregnancy rate [83.6% (46/55)], natural pregnancy rate was significant statistical different in different EFI groups (P=0.001). Conclusions EFI score is a useful evaluation in predicting and guiding pregnancy in endometriosis patients combined with infertility after laparoscopic surgery. EFI score guidance, strict post-operation management and positive pregnancy scheme could significantly improve the pregnancy rate of endometriosis patients with infertility.

Objective To explore changes of the myeloid derived suppressor cell (MDSC), regulatory T cell (Treg), traditional T cell, and their mechanisms in lung tumor mice. Methods Twenty C57BL/6 mice were randomly divided into the experimental and the normal control groups. The experimental group was injected with Lewis lung cancer cells (LLC, 100μL 1 × 106) subcutaneously to prepare the lung tumor model mice, the normal control group was given the same amount of saline (NC). Spleen cells were obtained from LLC and NC groups. Flow cytometry was used to detect the ratio and number changes of MDSC, Treg, CD4+and CD8+T cells in the lung tumor of mice. CD4+and CD8+T cell apoptosis were detected by Annexin-Ⅴstaining, and their proliferation were detected by 5-bromine deoxidization uracil nucleoside (BrdU) incorporation. Results Compared with normal control mice, the ratio and number of MDSC in spleen increased significantly in LLC group (P<0.01), in addition, the ratio of CD4+Foxp3+Treg in CD4+T cells and their number in spleen increased significantly in LLC group. However, the ratio and number of CD4+and CD8+T cells in spleen decreased significantly in LLC group (P<0.05). The proliferation of CD4+and CD8+T cells decreased significantly in LLC group compared with that of NC group (P<0.05), while the apoptosis of CD8+T cells increased significantly (P<0.05). Conclusion MDSC and Treg cells increase in lung tumor model mice, which inhibit proliferation of CD4+and CD8+T cells and promote apoptosis of CD8+T cells.