Aim To evaluate the feasibility and effects of the WeChat‐based life review programme on anxiety, depression, self‐transcendence, meaning in life and hope among cancer patients. Background Life review is effective in improving the psychospiritual well‐being of palliative patients. However, traditional life review programmes are limitedly applied in clinical practice. Design A non‐concurrent controlled quasi‐experimental design. Methods Ninety‐two cancer patients were recruited from April 2017 – February 2018, with 44 patients in the control group receiving routine care and 48 in the experimental group receiving a 6‐week WeChat‐based life review programme plus routine care. Compliance with the programme, difficulty in participation and satisfaction with the programme were used to explore its feasibility. Anxiety, depression, self‐transcendence, meaning in life and hope were measured at baseline and immediately after the programme. Results All experimental participants who completed the programme used the WeChat platform; 39 participants had no difficulties in operating the platform and 40 were satisfied with the programme. Statistically significant effects were identified on anxiety, depression and self‐transcendence. An increase in the levels of meaning in life and hope was observed in the experimental group after the programme. Conclusion and impact The innovative WeChat‐based life review programme is an effective non‐pharmacological intervention in improving psychospiritual well‐being of community‐dwelling cancer patients. It could be integrated into transitional care for cancer patients. Future research with rigorous design is necessary to test the effects online life reviews among cancer patients. Trial registration This study was registered on the Chinese Clinical Trial Registry (Registration No: ChiCTR‐IOR‐17011998).

Our findings for AD-related brain changes before AD provide insight about early AD-related biological processes.

No abstract

IMPORTANCE Previous genome-wide association studies of common variants identified associations for Alzheimer disease (AD) loci evident only among individuals with particular APOE alleles. OBJECTIVE To identify APOE genotype-dependent associations with infrequent and rare variants using whole-exome sequencing. DESIGN, SETTING, AND PARTICIPANTS The discovery stage included 10 441 non-Hispanic white participants in the Alzheimer Disease Sequencing Project. Replication was sought in 2 independent, whole-exome sequencing data sets (1766 patients with AD, 2906 without AD [controls]) and a chip-based genotype imputation data set (8728 patients with AD, 9808 controls). Bioinformatics and functional analyses were conducted using clinical, cognitive, neuropathologic, whole-exome sequencing, and gene expression data obtained from a longitudinal cohort sample including 402 patients with AD and 647 controls. Data were analyzed between March 2017 and September 2018. MAIN OUTCOMES AND MEASURES Score, Firth, and sequence kernel association tests were used to test the association of AD risk with individual variants and genes in subgroups of APOE ε4 carriers and noncarriers. Results with P Յ 1 × 10 −5 were further evaluated in the replication data sets and combined by meta-analysis. RESULTS Among 3145 patients with AD and 4213 controls lacking ε4 (mean [SD] age, 83.4 [7.6] years; 4363 [59.3.%] women), novel genome-wide significant associations were obtained in the discovery sample with rs536940594 in AC099552 (odds ratio [OR], 88.0; 95% CI, 9.08-852.0; P = 2.22 × 10 −7) and rs138412600 in GPAA1 (OR, 1.78; 95% CI, 1.44-2.2; meta-P = 7.81 × 10 −8). GPAA1 was also associated with expression in the brain of GPAA1 (β = −0.08; P = .03) and its repressive transcription factor, FOXG1 (β = 0.13; P = .003), and global cognition function (β = −0.53; P = .009). Significant gene-wide associations (threshold P Յ 6.35 × 10 −7) were observed for OR8G5 (P = 4.67 × 10 −7), IGHV3-7 (P = 9.75 × 10 −16), and SLC24A3 (P = 2.67 × 10 −12) in 2377 patients with AD and 706 controls with ε4 (mean [SD] age, 75.2 [9.6] years; 1668 [54.1%] women). CONCLUSIONS AND RELEVANCE The study identified multiple possible novel associations for AD with individual and aggregated rare variants in groups of individuals with and without APOE ε4 alleles that reinforce known and suggest additional pathways leading to AD.

Surgery after CCRT for advanced cervical cancer enabled evaluation of the pathologic response to therapy, improved local disease control in patients with a partial pathologic response, and enhanced survival. The most appropriate surgical approach was extrafascial hysterectomy with pelvic lymph node dissection.