Objective To develop a evidence-based and local decision supporting tool for breast reconstruction for breast cancer surgery based on Ottawa decision support framework to guide clinical decision-making and promote the implementation of shared decision-making.Methods Based on Ottawa decision support framework and International Patient Decision Aid Standards 4.0(IPDAS4.0),the initial version of breast reconstructive surgery decision support tool was proposed through a literature review.Eighteen clinical and nursing experts specialised in breast cancer and breast reconstruction were invited to participate in 2 rounds of Delphi consultations and resulted in a revised version of the tool.Following a pilot test involving 5 patients and 5 family members in clinical settings,their feedback was integrated into the revised version to create a final version of the tool.Results The initial version of the tool were developed based on the literature review and evidence synthesis,comprising 7 primary indicators,14 secondary indicators and 49 tertiary indicators.In the first round of consultation on the 3-tier indicators,the average importance scores ranged from 4.06 to 4.94,with coefficients of variation were 0.05-0.22,and proportions of full marks ranged from 0.53 to 0.88.In the second round of consultation on the 3-tier indicators,the average importance scores ranged from 4.71 to 4.94,with coefficients of variation were 0.05-0.15,and proportions of full marks ranged from 0.72 to 1.00.Kendall's W coefficients for the primary,secondary and tertiary indicators in the second round were 0.509,0.437,and 0.425,respectively.The finalised decision support tool for breast cancer and breast reconstruction included 7 primary indicators covering decision evaluation,disease information support,risk and benefit analysis,decision support system,balance value and preference,promotion of decision making,evaluation of decision quality,alongside 14 secondary indicators and 50 tertiary indicators.Clinical trials confirmed the finalised effectiveness of the tool.Conclusion The decision support tool for breast cancer and breast reconstruction which developed on the basis of Ottawa decision support framework demonstrates scientific rigor and clinical value.It provides solutions for breast cancer patients when facing difficulties in making a decision for breast reconstruction surgery.

Objective:To explore the current status of decision conflict in breast cancer patients with immediate breast reconstruction, and analysis the relationship with personality traits, which can provides new ideas for understanding decision-making behavior and promotes effective decision-making.Methods:A cross-sectional survey was conducted to select 175 breast cancer patients who met the inclusion and exclusion criteria for immediate breast reconstruction in Cancer Hospital of Tianjin Medical University from May to December 2022 by convenient sampling method. A questionnaire was conducted using the general information questionnaire, Revised NEO Personality Inventory, Decisional Conflict Scale, and the Control Preference Scale. Single factor analysis and multiple linear regression were used to analyze the current situation and influencing factors of decision-making conflict.Results:The 175 patients with immediate breast reconstruction were all female, aged 24-67(45.26 ± 8.01) years. The decision conflict score of 175 breast cancer patients with immediate breast reconstruction was (25.05 ± 7.05), the standardized decision conflict score was (39.14 ± 10.04), the dimension score of factors affecting decision making was(7.18 ± 2.58), the score of decision uncertainty dimension was (7.34 ± 2.28). 37 patients (21.14%) had no decision conflict, 64 patients (36.57%) had moderate decision conflict, and 74 patients (42.29%) had high level decision conflict. The scores of altruism, neuroticism, openness, sociality and moral sense of patients in this survey were (15.16 ± 3.43), (18.14 ± 4.95), (13.71 ± 3.71), (18.12 ± 4.40) and (17.46 ± 4.03) respectively. The decision conflict was negatively correlated with altruism, sociality and moral sense ( r=-0.355, -0.543, -0.331, all P<0.05), and positively correlated with neuroticism( r=0.208, P<0.05). Multivariate regression analysis showed that age, decision type, neuroticism and sociality were the influencing factors of decision conflict ( F=16.39, P<0.05), accounted for 47.1% of the variation. The variance inflation factor of the above variables was less than 10, indicating no collinearity. Conclusions:The decision conflict of breast cancer patients with immediate breast reconstruction needs to be improved urgently. Based on the influencing factors (age, decision-making type and personality traits) of decision conflict, medical staff should implement personalized decision-making aid process to meet decision-making information needs, reduce decision-making conflict and optimize decision-making quality.

Objective:Over the past decade,China has seen rapid development and significant achievements in the field of oncoplastic breast surgery.To understand our current academic standing and further the high-quality development of oncoplastic breast surgery in China,the Committee of Oncoplastic Surgery and Committee of Integrated Nursing for Breast Reconstruction(COPS and CINBR,respectively),under the China Anti-Cancer Association(CACA),conducted a cross-sectional study in 2023.Methods:The cross-sectional study assessed the current state of technological advancements and decision-making factors among member hospitals of COPS and CINBR within the year 2022 using an electronicquestionnaire.The results were analyzed by χ2 test or Fisher's precision probability test,multiple re-sponse analysis and displayed by Pareto chart.Results:Among the 195 participating hospitals,165 hospitals(84.6%)had performed onco-plastic breast surgery,including 42hospitals(21.5%)which reported an adoption rateof oncoplastic proceduresover 50%.Meanwhile,166 hospitals(85.1%)already introduced the immediate breast reconstruction into their clinical practice,indicating that the popularization of the concepts and techniques in oncoplastic breast surgery had significantly improved.The adoption rates of nipple reconstruction(173/195,88.7%)and revision procedures(167/195,85.6%)were less than 10%,suggesting that low prevalence of those procedures after breast re-construction still require attention.Factors including geographic location(multivariate Logistic regression analysis,P<0.05),hospital grade and size(multivariate Logistic regression analysis,P<0.05),and patient preferences(multiple response analysis:popularity rate>90%,re-sponse rate>30%)significantly influence the adoption of oncoplastic breast surgery and decisions regarding breast conservation or recon-struction.Conclusions:Although increased attention on the oncoplastic breast surgeryhas been paid in China,the prevalence and innova-tion ability of oncoplastic breast surgerystill need further improvement.This research offers crucial evidence-based insightsforfuture policy-making and academic planning by CACA andothergovernmentalagencies.

Objective:To construct Doctor-Nurse-Patient shared decision-making framwork for breast cancer surgery patients, so as to provide a foundation for clinical practice.Methods:The content of the shared decision-making framwork were initially constructed through systematic literature search and group discussion. From March to May 2021, 24 experts were consulted by the Delphi method, and the weight of each element would be determined by the analytic hierarchy process.Results:A total of 2 rounds of expert letter questionnaires were implemented. The authority coefficient of the experts in this study was 0.832, the Kendall coefficient of the experts in the first round was 0.130-0.261 ( P<0.01), and the Kendall coefficient of the experts in the second round was 0.130-0.272 ( P<0.01). The final shared decision-making framwork includes 5 first-level indicators, 15 second-level indicators and 52 third-level indicators. Conclusions:The Doctor-Nurse-Patient shared decision-making framwork of breast cancer surgery patients constructed in this study is scientific and practical, and provides a reference for clinical practice of shared decision-making in the future.

Objective:To investigate the effects and significance of acute and chronic trauma on brain degree centrality (DC) in patients with post-traumatic stress disorder (PTSD) who lost their only child at resting state.Methods:Retrospectively, the study enrolled a total of 51 parents with PTSD, including 35 PTSD parents whose children was lost in emergencies (acute bereaved PTSD group) and 16 PTSD parents whose children was lost of chronic causes such as diseases (chronic bereaved PTSD group). Fifty local adults were also included as healthy controls (HC group). The clinical administered PTSD scale(CAPS) was used to evaluate the severity of the subjects' clinical symptoms.Resting-state functional magnetic resonance imaging(fMRI) data of all subjects were collected and DC values were calculated.SPSS 22.0 software was used for statistical analysis.Covariance analysis was performed among three groups, while post hoc was performed between any two groups.What's more, correlation analyses were utilized between abnormal brain regions and the scores of CAPS.Results:Significant group effects were found in multiple regions, including the right inferior temporal gyrus (MNI: x, y, z=66, -27, -21), right temporal pole (MNI: x, y, z=54, 15, -9), right orbital inferior frontal gyrus (MNI: x, y, z=42, 21, -15), bilateral medial superior frontal gyri (MNI: right x, y, z=6, 63, 12; left x, y, z=-3, 60, 18), left inferior parietal angular gyrus (MNI: x, y, z=-45, -36, 51) and left postcentral gyrus (MNI: x, y, z=-45, -33, 51). Compared with HC group, the DC of two patient groups increased in the right inferior temporal gyrus (MNI: acute x, y, z=63, -27, -21; chronic x, y, z=63, -21, -27); the DC of acute bereaved PTSD group decreased in the right temporal pole (MNI: x, y, z=45, 21, -15) and the right orbital inferior frontal gyrus (MNI: x, y, z=48, 24, -12), while the DC of chronic bereaved PTSD group decreased in the left inferior parietal angular gyrus (MNI: x, y, z=-45, -36, 51) and left postcentral gyrus (MNI: x, y, z=-45, -33, 51). Compared with chronic bereaved PTSD group, the DC of acute bereaved PTSD group increased in the left inferior parietal angular gyrus (MNI: x, y, z=-33, -39, 42) and left postcentral gyrus (MNI: x, y, z=-45, -33, 51), while decreased in the right temporal pole (MNI: x, y, z=51, 12, -9), right orbital inferior frontal gyrus (MNI: x, y, z=42, 21, -15) and bilateral medial superior frontal gyri (MNI: left x, y, z=0, 57, 15; right x, y, z=3, 57, 15). In chronic bereaved PTSD group, the DC of the left postcentral gyrus was negatively correlated with C1 (avoid trauma-related thoughts, feelings) score in CAPS ( r=-0.606, P=0.028). In acute bereaved PTSD group, the DC of the left medial superior frontal gyrus was negatively correlated with D4 (high vigilance) score ( r=-0.416, P=0.020). Conclusion:There exist functional abnormalities of multiple brain regions in acute and chronic bereaved parents with PTSD.The high arousal symptoms of the former may be related with the abnormalities of prefrontal-amygdala neural circuit, while the latter show higher avoidance which may be associated with the dysfunction of somatosensory brain regions such as postcentral gyrus.

Objective:To investigate the effect of coping style on the gray matter volume in patients with post-traumatic stress disorder (PTSD) who lost their only child, and the mediating role of gray matter volume in evaluating the influence of coping style in clinical symptoms of these parents.Methods:A total of 57 parents with PTSD (PTSD group) and 162 parents without PTSD (non-PTSD group) who lost their only child from September 2016 to March 2017 were enrolled from Jiangsu Province, China. Brain MRI data at resting state were collected. Voxel-based multiple regression analysis was performed to confirm the brain areas in which coping style main effect, diagnosis main effect and their interaction had significant influences in gray matter volumes. Correlations among gray matter volume of brain areas related to coping style, coping style scale scores, and clinician-administered PTSD scale (CAPS) scores were analyzed. Structural equation modeling was used to analyze the mediating role of gray matter volume in the influence of coping style in clinical symptoms of parents lost their only child.Results:(1) The coping style main effect did not significantly influence the gray matter volume in all subjects, and the diagnosis main effect had significant influence in gray matter volume in the right lingual gyrus; their interaction had significant influence in gray matter volume in the right peritalar fissure cortex and lingual gyrus. The positive coping style in the PTSD group had significant influence in the gray matter volumes of the right peritalar fissure cortex and lingual gyrus. (2) In the PTSD group, the scores of positive coping style were positively correlated with the gray matter volumes of the right talus fissure and the lingual gyrus ( P<0.05); the scores of positive coping style, and the gray matter volumes of the right talus fissure and the lingual gyrus were negatively correlated with scores of CAPS-C 5 and CAPS-C ( P<0.05). (3) In the PTSD group, positive coping style can positively predict the gray matter volumes of the right talus fissure and the lingual gyrus; the gray matter volumes of the right talus fissure and the lingual gyrus can negatively predict the avoidance-related symptoms. Conclusion:Positive coping style has influence in the gray matter volumes of the right talar fissure and lingual gyrus of PTSD patients lost their only child; and less positive coping style may affect the brain areas related to visual information processing, thus aggravating avoidance-related symptoms of PTSD patients.

As a member of the AFF (AF4/FMR2) family, AFF4 is a transcription elongation factor that is a component of the super elongation complex. AFF4 serves as a scaffolding protein that connects transcription factors and promotes gene transcription through elongation and chromatin remodelling. Here, we investigated the effect of AFF4 on human dental follicle cells (DFCs) in osteogenic differentiation. In this study, we found that small interfering RNA-mediated depletion of AFF4 resulted in decreased alkaline phosphatase (ALP) activity and impaired mineralization. In addition, the expression of osteogenic-related genes (DLX5, SP7, RUNX2 and BGLAP) was significantly downregulated. In contrast, lentivirus-mediated overexpression of AFF4 significantly enhanced the osteogenic potential of human DFCs. Mechanistically, we found that both the mRNA and protein levels of ALKBH1, a critical regulator of epigenetics, changed in accordance with AFF4 expression levels. Overexpression of ALKBH1 in AFF4-depleted DFCs partially rescued the impairment of osteogenic differentiation. Our data indicated that AFF4 promoted the osteogenic differentiation of DFCs by upregulating the transcription of ALKBH1.
Biomarkers ; metabolism ; Cell Differentiation ; Cells, Cultured ; Dental Sac ; drug effects ; metabolism ; Gene Expression Regulation ; Humans ; Osteogenesis ; genetics ; Repressor Proteins ; Transcription Factors ; genetics ; metabolism ; Transcriptional Elongation Factors ; metabolism

Objective To explore oncology nurses′attitudes and beliefs and its influencing factors toward sexuality care. Methods A total of 208 oncology nurses were investigated by convenience sampling method. The nurses were investigated with the Sexuality Attitudes and Beliefs Survey Scale and the Literacy of Sexual Health Care Scale. Results The total score of attitudes and beliefs of oncology nurses toward sexuality care was (44.88 ± 11.45). Multivariate linear regression analysis showed that age, sexual health education and training experience, knowledge of sexual health care and efficacy of sexual health care were the influencing factors of SABS. A total of 41.2％variance was explained. Conclusions We should strengthen the training of oncology nurses about sexuality care to reduce the barriers of sexual health education in clinical work and help nursesform the right attitudes and beliefs of health care so that they can provide patients with better care.

Objective:This study aims at exploring the impact of the health resources allocation on healthcare seeking behavior of inpatients with different income in China. Methods:Data at individual level were collected from China National Health Service Surveys conducted in 2008 and 2013 , interlinked with the data of health resources in county level. Multilevel zero-inflated negative binomial regression and multilevel multinomial logit model were respec-tively used to examine the impact of the health resources allocation on inpatient visits and the influence of the choice of healthcare providers by inpatients. Results: The results show that the increase of the number of beds in primary health centers ( PHCs) and physicians in county hospitals increased inpatient visits within counties. The investments in health resources in PHCs had greater impact on improving the likelihood of inpatient visits within counties for the low-income populations than that for the high-income populations. Conclusion: Investments in health resources in PHCs are vital to improve the healthcare seeking behaviors of the low-income populations in China.

Objective To investigate the benefit finding for caregivers of patients with cancer and its influencing factors. Methods Totally 330 couples of cancer patients and caregivers were investigated from October 2014 to September 2015 by convenience sampling method. The cancer patients were investigated with the Hospital Anxiety and Depression Scale. The caregivers of cancer patients were investigated with Benefit Finding Scale, Zarit Caregiver Burden Interview, Medical Outcomes Study Social Support Survey. Results The total score of benefit finding was (59.65 ± 11.12) points. Regression analysis indicated that caregivers' education, religious, informational and emotional support, caregiver burden, patients' depression symptom, cancer stage and self-caring were influencing factors of benefit finding for caregivers (t=-3.689-5.913, P<0.01 or 0.05), which explained 30.0% of the variance. Conclusions The caregivers of patients with cancer have a low level of benefit finding. Oriented by influencing factors of benefit finding, the health workers should enhance targeted interventions, promote positive perception in the process of caring, develop the quality of caring and life.