The incidence of cancer continues to rise, and improving treatment outcomes and quality of life for cancer patients has become a major goal. Death anxiety is prevalent throughout the entire disease trajectory of cancer patients. It not only severely impairs their psychological well-being and quality of life but also undermines treatment confidence and rational decision-making. Therefore, it warrants significant clinical attention. This paper reviews the current status of assessment, influencing factors, and intervention strategies for death anxiety in cancer patients, aiming to provide a reference for healthcare professionals.

The incidence of cancer continues to rise, and improving treatment outcomes and quality of life for cancer patients has become a major goal. Death anxiety is prevalent throughout the entire disease trajectory of cancer patients. It not only severely impairs their psychological well-being and quality of life but also undermines treatment confidence and rational decision-making. Therefore, it warrants significant clinical attention. This paper reviews the current status of assessment, influencing factors, and intervention strategies for death anxiety in cancer patients, aiming to provide a reference for healthcare professionals.

Objective To evaluate the effectiveness of a blended teaching model integrating the HBOPPPS framework(Hybrid Bridge-in,Objectives,Pre-assessment,Participatory learning,Post-assessment,Summary)and the"Cloud-based PAD Class"(Presentation-Assimilation-Discussion)in online clinical clerkship teaching for palliative oncology.Methods A self-con-trolled trial was conducted in October 2023,involving 41 undergraduate students majoring in Food Hygiene and Nutrition(Grade 2021)from Kunming Medical University.Phase 1 implemented conventional online teaching(control group),while Phase 2 adopted the"HBOPPPS+Cloud-based PAD Class"blended approach(experimental group).Teaching effectiveness was assessed via post-class examination scores,classroom participation rates,and satisfaction surveys.Results The experimental group dem-onstrated significantly higher outcomes than the control group:examination scores(86.34±4.19 vs.80.02±3.63,P＜0.05),classroom participation(51.2％vs.12.2％,P＜0.05),and teaching satisfaction(95.1％vs.80.5％,P＜0.05).Conclu-sionThe"HBOPPPS+Cloud-based PAD Class"blended teaching model effectively enhances online clinical clerkship outcomes in palliative oncology,significantly improving students' learning initiative,engagement,and classroom participation.

Objective To evaluate the effectiveness of a blended teaching model integrating the HBOPPPS framework(Hybrid Bridge-in,Objectives,Pre-assessment,Participatory learning,Post-assessment,Summary)and the"Cloud-based PAD Class"(Presentation-Assimilation-Discussion)in online clinical clerkship teaching for palliative oncology.Methods A self-con-trolled trial was conducted in October 2023,involving 41 undergraduate students majoring in Food Hygiene and Nutrition(Grade 2021)from Kunming Medical University.Phase 1 implemented conventional online teaching(control group),while Phase 2 adopted the"HBOPPPS+Cloud-based PAD Class"blended approach(experimental group).Teaching effectiveness was assessed via post-class examination scores,classroom participation rates,and satisfaction surveys.Results The experimental group dem-onstrated significantly higher outcomes than the control group:examination scores(86.34±4.19 vs.80.02±3.63,P＜0.05),classroom participation(51.2％vs.12.2％,P＜0.05),and teaching satisfaction(95.1％vs.80.5％,P＜0.05).Conclu-sionThe"HBOPPPS+Cloud-based PAD Class"blended teaching model effectively enhances online clinical clerkship outcomes in palliative oncology,significantly improving students' learning initiative,engagement,and classroom participation.

Objective:To investigate the expression of HER2 and its relationship with clinicopathological features in patients with urothelial carcinoma.Methods:Urothelial carcinoma specimens collected from January 2019 to June 2022 were used. The expression of HER2, cytokeratin 20 and cytokeratin 5/6 was examined using immunohistochemistry. The HER2 expression was assessed according to the clinical pathological expert consensus on HER2 testing in urothelial carcinoma in China. Cases with HER2 2+/3+ were classified as HER2 positive. The relationship between HER2 expression and clinicopathological and molecular features was analyzed.Results:Four hundred and twenty-nine urothelial carcinoma specimens were analyzed, including 166 cases of raclical resection and 263 cases of local tumor resection. The median patient-age was 69 years (range: 31-93 years). The male: female ratio was 2.9∶1.0. The positive rate of HER2 was 45.7%(196/429). The positive rate of HER2 in patients with local tumor resection was higher than that in patients with radical resection [51.7%(136/263) vs.36.1%(60/166), P<0.05]. In the upper urinary tract (renal pelvis/ureter) urothelial carcinomas, the positive rate of HER2 was 35.2% (37/105). In bladder urothelial carcinoma, the positive rate of HER2 was 49.1%(157/320), and higher than that in upper urinary tract urothelial carcinoma ( P<0.05). In high grade urothelial carcinoma, the positive rate of HER2 was 52.8%(168/318) and higher than that in low grade urothelial carcinomas (25.2%, 28/111, P<0.01). In 166 radical resection specimens, the positive rate of HER2 was not differentially distributed by tumor pT stage [Ta (26.1%, 6/23), T1 (41.7%, 20/48), T2 (40.0%, 10/25), T3 (28.1%, 16/57), T4 (8/13) ( P>0.05)]. In urothelial carcinomas with muscle invasion, the HER2 positive rate was 35.8%(34/95), while the rate in non-muscle-invasion urothelial carcinoma was 36.6%(26/71, P>0.05). CK20 and CK5/6 were used to refine the urothelial carcinoma molecular subtypes. The positive rate of HER2 was highest in CK20 +/CK5/6 -group (124/194, 63.9%), followed by CK20 +/CK5/6 +group (18/40, 45.0%), CK20 -/CK5/6 -group (14/41, 34.1%) and CK20 -/CK5/6 +group (25/131, 19.1%, P<0.01). The positive rate of HER2 in micropapillary urothelial carcinoma was highest (14/15), followed by urothelial carcinoma with glandular differentiation (11/14), conventional urothelial carcinoma (161/360, 44.7%) and urothelial carcinoma with squamous differentiation (6/35, 17.1%, P<0.01). In the cases with lymph node metastasis, the positive rate of HER2 was 45.5% (10/22) and higher than the cases without lymph node metastasis (31.0%, 13/42). But there was no statistically significant association between HER2 expression and lymph node metastasis ( P>0.05). Conclusions:Expression of HER2 in urothelial carcinoma is closely correlated with tumor location, grade, histologic subtypes, molecular subtypes and surgical approach, but not with pT stage, muscle invasiveness or lymph node metastasis.

Objective:To investigate the clinical and pathological features and prognosis of patients with microfocal prostate adenocarcinoma.Methods:Clinical and pathological data of the patients diagnosed with microfocal adenocarcinoma on prostate biopsy at the West China Hospital from 2013 to 2019 were collected. Microfocal adenocarcinoma was defined as follows: Gleason score of 3+3=6, total number of the cores ≥10, number of the positive cores ≤2, and proportion of the tumor in each positive core<50%. Clinicopathological parameters, treatment plans and follow-up data were collected. Pathological information of the biopsy and radical resection specimens was used to analyze the correlation between pathological parameters in the biopsy report and adverse pathological features of radical resection specimens, including increased Gleason score, capsule invasion, positive surgical margin and perineural invasion.Results:A total of 206 cases of microfocal adenocarcinoma were diagnosed on prostate biopsies from 2013 to 2019, accounting for 6.7% of all adenocarcinoma cases. There were 139 cases of 1 positive core and 67 cases of 2 positive cores. Patients with microfocal adenocarcinoma were younger than those with non-microfocal adenocarcinoma (69 years versus 71 years, P<0.001). Compared with patients with non-microfocal adenocarcinoma, the pre-biopsy total prostate specific antigen (tPSA) and free prostate specific antigen (fPSA) levels in patients with microfocal adenocarcinoma were both lower (11.2 μg/L 2 versus 23.7 μg/L 2; 1.4 μg/L 2 versus 3.0 μg/L 2, P<0.001), the fPSA/tPSA level was higher (12.9% versus 10.7%, P<0.05), the prostate volume was larger (38.9 mL versus 34.3 mL, P<0.05), and the PSA density was lower (0.3 μg/L 2 versus 0.8 μg/L 2, P<0.001). 130 patients underwent radical prostatectomy, 30 patients chose active monitoring, 31 patients chose endocrine or radiation therapy, and 15 patients were lost to follow-up. Three patients in the active surveillance group underwent radical prostatectomy for disease progression after 21-39 months observation. Biochemical relapses occurred in two patients in the radical prostatectomy group. The remaining patients have no disease progression or recurrence at present. Compared with radical prostatectomy specimens, Gleason score in the biopsy material was increased in 64/115 patients (55.7%). Among resection excision specimens, 14 cases (12.2%) had extraprostatic extension (EPE), 35 cases (30.4%) had perineural invasion, and 16 cases (13.9%) had a positive margin. Univariate and multivariate analyses showed that low fPSA/tPSA ratio and 2 positive cores were independent risk factors for Gleason score increase in the radical prostatectomy specimens. A low fPSA/tPSA ratio was an independent risk factor for perineural invasion. Low fPSA/tPSA ratio and low prostate volume were associated with a positive margin in radical prostatectomy specimens. Conclusions:In this study, patients diagnosed with microfocal adenocarcinoma on prostate biopsy account for a high proportion of the patients with increased Gleason score in the radical prostatectomy specimens, and there is a certain proportion of adverse pathological features in the radical specimens. Therefore, for the patients with only a small amount of low-grade adenocarcinoma found in biopsy, PSA levels and PSA density should be taken into consideration in treatment selection.

Objective:To study the expression of coagulation factorⅢin patients with non-small cell lung cancer(NSCLC)with hyperco-agulability and its clinical significance,and to explore the relationship between its expression level and the clinicopathological features and the survival period.Methods:There were 74 patients with NSCLC with hypercoagulability and 42 without hypercoagulability,con-firmed using pathological and biochemical tests in Yunnan Cancer Hospital from January 2013 to October 2014.The enzyme-linked im-munosorbent assay(ELISA)was performed to detect the expression of serum coagulation factorⅢand its relationship with clinico-pathological features and prognosis was analyzed.Results:Serum coagulation factorⅢlevel in patients with hypercoagulable NSCLC before chemotherapy was 560.32-200.34 ng/L,which was significantly higher than that in patients without hypercoagulability(463.29-159.22 ng/L)(P=0.008),and significantly higher than that in patients after chemotherapy(471.39±160.31 ng/L)(P=0.000).Serum coag-ulation factorⅢlevel in patients with hypercoagulable state of NSCLC was related to lymph node metastasis(P=0.026),distant metas-tasis(P=0.025),and tumor-node-metastasis staging(P=0.007).They were negatively correlated with prothrombin time(r=?0.638,P=0.032)and activated partial thromboplastin time(r=?0.702,P=0.028),and positively correlated with fibrinogen(r=0.715,P=0.008)and platelets (r=0.597,P=0.007).The 1-to 3-year overall survival of patients with NSCLC with high coagulation factorⅢexpression was significantly lower than that of patients with low coagulation factorⅢexpression.Conclusions: The expression level of serum coagu-lation factorⅢin patients with high coagulation state of NSCLC is related to lymph node metastasis and TNM staging,which has cer-tain guiding significance for predicting the survival of patients.

Objective: To investigate the status and prognostic significance of TERT and IDH1/2 genes mutations in diffusely infiltrating gliomas. Methods: Hot spot mutations of TERT and IDH1/2 genes were detected by DNA sequencing in 236 cases of gliomas at West China Hospital from 2012 to 2016, including pilocytic astrocytoma (WHO grade Ⅰ, 16 cases), diffuse astrocytoma and oligodendroglioma (WHO grade Ⅱ, 89 cases), anaplastic astrocytoma and oligodendroglioma (WHO grade Ⅲ, 72 cases) and glioblastoma (WHO grade Ⅳ, 59 cases). The prognostic significance of TERT and IDH1/2 hot spot mutations was evaluated. Results: No IDH or TERT mutations were detected in pilocytic gliomas. TERT promoter mutation frequency was higher in patients aged ≥40 years(60.8%, 93/153) than in patients aged <40 years (32.8%, 22/67; P<0.01). TERT promoter mutation rate was also significantly higher in oligodendroglioma (87.5% , 56/64) than that in astrocytoma(37.8%, 59/156; P<0.01). Young age (<40 years), oligodendroglioma and IDH1 mutation were favorable prognostic factors for diffusely infiltrating astrocytic and oligodendroglial tumors. TERT mutation alone was not of prognostic significance. Diffusely infiltrating astrocytic and oligodendroglial tumors were divided into four molecular subtypes according to TERT and IDH1 mutation status: IDH(+ )/TERT(+ ), IDH(+ )/TERT(-), IDH(-)/TERT(-) and IDH(-)/TERT(+ ). There was significant prognostic difference among the 4 subtypes. Conclusions Combined IDH and TERT gene mutation analysis may be useful for prognostic subgrouping. Notably, IDH1 wild-type cases can be further subdivided into TERT(+ ) or (-) subgroups with significant prognostic difference.

Objective To explore the efficacy,safety and life quality of patients of morphine hydrochloride sustained-release tablets combined with celecoxib in the treatment of advanced lung cancer with moderate to severe cancer-induced pain.Methods A total of 247 patients of advanced lung cancer with moderate to severe cancer-induced pain were randomly divided into combination therapy group (n =127) and morphine monotherapy group (n =120) using simple random sampling digital table method.The differences of dose,efficacy,adverse drug reactions and life quality between the two groups were analyzed.Results In achieving similar analgesic effect,the average maintenance dose of morphine in combination therapy group was (52.51 ±19.92)mg/d,lower than that in monotherapy group [(58.75 ±20.64)mg/d,t =-2.414,P =0.017].The incidence of constipation in combination therapy group was 34.6％,lower than that in monotherapy treatment group (47.5 ％,x2 =4.218,P =0.040).The life quality of the two groups were improved,and the life quality improvement rate in combination therapy group was 59.8％,higher than that in monotherapy treatment group (43.3％,x2 =6.736,P =0.009).Conclusion Morphine hydrochloride sustained-release tablets combined with celecoxib is effective in the treatment of moderate to severe cancer pain,which can reduce the dosage of morphine and reduce adverse reaction,so as to improve the life quality of the patients with advanced lung cancer.

Objective To explore the influence of laparoscopic CO2 pneumoperitoneum on blood metastasis of colorectal cancer.Methods Sixty colorectal cancer patients were randomly divided into laparoscopic surgery group and open surgery group.RT-PCR was used to detect the expressions of CK20mRNA before treatment,in operation and after operation,and effect of different surgical methods on the metastasis of tumor cells in peripheral blood was analyzed.Results There were no significant differences in positive expression of CK20mRNA before treatment,in operation and after operation between two groups (P ＞ 0.05).There was no significant difference in 3-year survival rate between the two groups (P ＞ 0.05).Conclusion Laparoscopic CO2 pneumoperitoneum does not increase the positive rate of CK20mRNA in peripheral blood in treatment of patients with laparoscopic resection of colorectal cancer.