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 the changes of number of CD4+ CD25 + foxp3 + regulatory T cells (Treg)and natural killer cells (NK)in the peripheral immune organs and tumor tissue of the murine models of lung cancer,and to clarify their effects on the development of lung cancer.Methods:The C57BL/6 mice were divided into Lewis lung carcinoma cells (LLC)injection group and normal control group.The mice in LLC injection group were injected with LLC subcutaneously in the armpit to establish the tumor models,while the mice in normal control group were injected with the same amount of saline.The number of CD4+ CD25 + T cells,CD4+ CD25 + foxp3 + Tregs in the spleen,lymph nodes and lung cancer tissues,and the number of NK cells in the spleen tissue were labeled by cell surface or intracellular antibody staining,and detected by flow cytometry.Results:The ratios of CD4+ CD25 + T cells to CD4+ T cells,foxp3+ cells to CD4+ CD25 + T cells,and the number of CD4+ CD25 + foxp3 + Treg in the spleen and lymph nodes of the mice in LLC injection group were increased significantly compared with normal control group (P <0.05 or P <0.01).Moreover,the ratios of CD4+ CD25 + T cells to CD4+ T cells and foxp3 + cells to CD4+ CD25 + T cells in the tumor tissue were significantly higher than those in the spleen and lymph nodes of the mice in LLC injection group.However,the ratio of NK cells in the spleen tissue of the mice in lung cancer group was significantly decreased compared with normal control group (P <0.05).Conclusion:The increase of ratio and the number of Treg cells and the decrease of ratio of NK cells in the main immune organs of lung cancer mice may promote the development of tumor and inhibit the immune response to cancer cells in vivo .

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.

Objective To explore the effect of p21Waf1/Cip1 methylation changes on the process of cellular senescence .Methods Bisulfite sequencing was used to analyze the methylation changes of p21Waf1/Cip1 in the process of cellular senescence;p21Waf1/Cip1 ex‐pression was detected by RT‐PCR and Western‐blot ;Middle‐aged 2BS cells was treated by 5‐aza‐CdR and cellular senescence was detected by MTT and SA‐β‐Gal staining .Results Bisulfite sequencing analysis of p21Waf1/Cip1 promoter showed that CpGs were methylated by 1 .25% in the young 2BS cells ,by 27 .27% in the middle‐aged 2BS cells ,while only by 0 .64% in the senescent cells . The expression of p21Waf1/Cip1 was low in the young(28 PD) 2BS cells ,it increased first(35 PD) but decreased later in the middle‐aged(42 PD) cells .In the senescent 2BS cells ,p21Waf1/Cip1 expression was further increased .5‐aza‐CdR treatment resulted in de‐creased growth rate but increasedβ‐Gal staining of middle‐aged 2BS cells .Conclusion The process of cellular senescence is regula‐ted by the status of p21Waf1/Cip1 methylation ,and p21Waf1/Cip1 demethylation accelerates cellular senescence .

To explore the effects of microRNA-150 deletion on the development and homeostasis of regulatory T cells (Treg),γδT cells,NK and NKT cells.Methods:microRNA-150 knockout mice were used and microRNA-150 expression was detected by Real-time PCR.The numbers of Treg ,γδT,NK and NKT cells in the thymus and spleen of normal control and microRNA-150 knockout mice were detected by Flow cytometry.Cell apoptosis was detected by Annexin V staining , and cell proliferation was detected by 5-Bromo-2-deoxyUridine ( Brdu ) incorporation.Results: microRNA-150 deletion did not affect the development and homeostasis of regulatory T cells (Treg) andγδT cells.However,microRNA-150 deletion resulted in a significant reduction of the NK and thymic NKT cell number.In addition, microRNA-150 deleted NK and NKT cells showed an arrested developmental and maturational phenotype with a reduced expression of NK 1.1 and CD122.Moreover , cell apoptosis was significantly increased in microRNA-150 deleted NK and thymic NKT cells ,while a lower cell proliferation rate was shown in the microRNA-150 deleted NK but not NKT cells.Conclusion: CD122 may play an important role in the development and homeostasis of mouse NK and NKT cells regulated by microRNA-150.

ObjectiveTo explore application effect of predictive nursing in children severe craniocerebral injury combined with pulmonary contusion.Methods 60 children severe craniocere-bral injury combined with pulmonary contusion were divided into observation group and control group.The control group was received routine nursing while the observation group was given pre-dictive nursing.Nursing effect was compared between the two groups.Results The blood oxygen saturation in the observation group was higher than that in the control group,the infection time was longer than that in the control group,the infection rate and mortality rate was lower than that in control group,Karnofsky scores after intervention was higher than that in the control group,the hospitalization time was shorter than that in the control group,the results revealed that the differ-ence was statistical significant (P <0.05).The difference was statistical significant since nursing satisfaction in the observation group was higher than that in the control group (P <0.05).Con-clusion Preventive nursing could reduce infection in children severe craniocerebral injury combined with pulmonary contusion and improve the prognosis.