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Coping as mediator among patients with advanced cancer in Indonesia

為了解決fwb醫學的問題，作者Nurul Huda 這樣論述：

Background: Diagnosing advanced cancer and the complex treatment it requires is stressful and affects all domains of a patient’s life including mental aspects. Failure to acknowledge such emotional problems early on may greatly increase the severity of patients’ cancer symptoms, and negatively impa

ct their wellbeing, quality of life (QOL), and the oncological process itself. Coping is considered the intermediate process between stress onset and health outcomes in patients with advanced cancer. In patients with advanced cancer, the use of certain coping strategies is associated with outcomes i

ncluding QOL, symptoms of depression, and anxiety. Therefore, coping is critical in determining whether a stressful event results in adaptive or maladaptive outcomes. However, the process of coping across distress trajectories among advanced cancer patients is dynamic. Hence, it is important to iden

tify pathways by which advanced cancer patients create and maintain appropriate coping that ease emotional disorders associated with illnesses trajectories to better regain wellbeing.Purpose: to test the mediating effects of coping on the relationships of psychological distress and stress with emoti

onal symptoms (anxiety and depression) and QOL. We hypothesized that coping fully or partially mediates the relationships of psychological distress and stress with anxiety, depression, and QOL in patients with advanced cancer in Indonesia.Method: A cross-sectional and correlational research design

was used to explore coping as mediating variables in the relationship between psychological distress, stress with anxiety, depression, and quality of life. The study was conducted at the outpatient oncology ward at Arifin Ahmad General Hospital, Pekanbaru, Riau Province, Indonesia. A non-probability

sampling technique, purposive sampling, was used in the current study. A total of 440 participants who had met the inclusion and exclusion criteria were initially recruited for this study Descriptive statistics and frequency distributions were used to analyze the participants’ demographics and clin

ical characteristics. The Mann–Whitney U and Kruskal–Wallis H tests were used to determine the relationships between sociodemographic characteristics of the patients with advanced cancer with the outcomes of anxiety, depression, and the four QOL domains. Finally, The PROCESS Macro for SPSS version 3

.3 was used to test the mediating effects of coping.Results: Our results showed that Problem-Focused Coping (PFC) mediated the relationships of psychological distress and stress with depression, anxiety, and functional wellbeing. Additionally, PFC also mediated the relationship between stress and so

cial wellbeing but it did not mediate that of psychological distress and social wellbeing. Emotional-Focused Coping (EFC) mediated relationships of psychological distress with physical wellbeing. In terms of stress, EFC could mediate the relationship of stress with both physical and emotional wellbe

ing.Conclusion: This study highlighted the importance of PFC and EFC for advanced cancer patients. Thus, oncology nurses in clinical practice should identify the specific coping strategies that advanced cancer patients use to manage their stress and distress paying specific attention to cultural-spe

cific conditions. This will help with the development of appropriate interventions that can be implemented to diminish depression and anxiety and promote higher QOL.

探討經紋球藻萃取物對口腔癌細胞株抑制作用的機制

為了解決fwb醫學的問題，作者黃政諺 這樣論述：

口腔癌為全球前十大癌症之一，名列台灣男性常見癌症的第四位。口腔癌中有超過90％的患者被確定為所謂的口腔鱗狀細胞癌(Oral Squamous Cell Carcinoma；OSCC)，主要造成的原因為長期嚼食檳榔、抽菸、飲酒，或是人類乳突病毒的感染。多數患者就診時已進入第三或四期，此時的癌細胞已經逐漸轉移至其他部位，造成五年存活率低下，所以新藥物的開發及探討誘導癌病變之檳榔成分益顯重要。而微藻已被發現具抗發炎及抗癌活性，成為新藥物開發的新目標。本研究所使用的材料為微藻中經紋球藻屬(Coelastrella)之經紋球藻C. F50，是於台灣南部新鑑定出的品種，其有機萃取物，以不同濃度分別處理

OC2和OCSL二株國內建立的口腔癌細胞株，並於處理後不同的時間點透過MTT試驗來測試細胞生長情況，結果發現C. F50萃取物能降低二株細胞株的生存率，其IC50皆約為500 μg/ml。在細胞侵入試驗(Cell invasion assay)中也發現C. F50萃取物處理後確實可以抑制OC2和OCSL的侵入能力。另外，也測試臨床上用來治療口腔癌常見的第一線的化療藥物Cisplatin和C. F50萃取物一同處理之效果，結果顯示兩者一同添加處理比個別單一藥物處理更能夠抑制癌細胞株生長。此外，為進一步探討此抑制作用的機制，以實驗室先前發現活性氧化物質(Reactive Oxygen Specie

s, ROS)和內質網壓力(ER stress)啟動未摺疊蛋白反應(Unfolded Protein Respond, UPR)所造成的一系列訊息傳遞途徑為主要目標，因為C. F50萃取物處理OC2和OCSL後其UPR相關的p-PERK、IRE1α、GRP78等標記蛋白之量皆有下降的現象，但ROS卻有上升的情況，所以推測C. F50萃取物可能使ROS堆積過量，而抑制UPR的作用，進而造成細胞壞死。我的初步實驗結果也顯示:與細胞增殖、生長和遷移相關的蛋白p-Akt (Akt)和p-mTOR (mTOR) 在以C. F50萃取物處理時均有被下調的情形。另外，因先前有文獻指出mTOR本身會抑制細胞自

噬的發生，所以我也透過LC3的表現來評估C. F50是否會造成細胞自噬，發現C. F50處理後的LC3的量並無明顯變化，以Acridine orange染色結果亦是如此，故推測細胞自噬並非C. F50造成細胞死亡的主因。 另外，本實驗室先前的研究中發現檳榔水萃取物中有誘發細胞核固縮壞死(pyknotic necrosis)的能力，其核固縮壞死發生時會先造成細胞的腫脹，這樣的現象跟臨床上有檳榔嚼食患者的病理組織切片觀察相當類似，故我們想要更進一步的去分析檳榔水萃取物中主要造成這種現象的成分為何。以HPLC (高效液相層析儀)從檳榔水萃取物中初步分離出幾個波峯，分別處理細胞並觀察是否造成細胞

核固縮，目前有發現數個波峯段之成分是具有效果的，未來希望找出造成細胞核固縮的有效成分。