ObjectiveTo develop a community-family management model for older adults with mild cognitive impairment (MCI) and to formulate detailed application specifications, and to fully leverage the initiative of communities and families under limited resource conditions, for achieving community-based early detection and early intervention for older adults with MCI. MethodsA systematic literature review was conducted to identify pertinent publications. Corpus-based research methodologies were employed to extract, refine, integrate and synthesize management elements, thereby establishing the specific content and service processes for each stage of the management model. Utilizing the 5W2H analytical framework, essential elements such as management stakeholders, target populations, content and methods for each stage were delineated. The model and its application guidelines were finalized through expert consultation and demonstration. ResultsAn expert evaluation of the management model yielded mean scores of 4.84, 4.32 and 4.84 for acceptability, feasibility and systematicity, respectively. By integrating the identified core elements with expert ratings and feedback, the final iteration of the community-family management model for older adults with MCI was formulated. This model comprised of five stages: screening and identification, comprehensive assessment, intervention planning, monitoring and referral pathways to ensure implementation, and enhanced support for communities, family members and caregivers. Additionally, it included 18 specific application guidelines. ConclusionThe proposed management model may theoretically help delay cognitive decline, improve cognitive function and potentially promote reversal from MCI to normal cognition. It may also enhance the awareness and coping capacity of older adults and their families, strengthen community healthcare professionals' ability to early identify and manage MCI.

Objective:To investigate the clinicopathological and molecular genetic characteristics of Crohn′s disease (CD).Methods:A retrospective analysis was conducted on 52 CD patients who underwent surgical resection at the First Affiliated Hospital of Nanjing Medical University between January 2014 and June 2023. Clinical presentations and histopathological features were assessed. Whole-genome sequencing was performed on 17 of the samples, followed by sequencing and pathway enrichment analyses. Immunohistochemistry was used to assess the expression of frequently mutated genes.Results:Among the 52 patients, 34 were males and 18 were females, male-to-female ratio was 1.9∶1.0, with a median age of 45 years at surgery and 35 years at diagnosis. According to the Montreal classification, A3 (51.9%,27/52), B2 (61.5%, 32/52), and L3 (50.0%,26/52) subtypes were the most predominant. Abdominal pain and diarrhea were the common symptoms. Histopathological features seen in all 52 patients included transmural inflammation, disruption of cryptal architecture, lymphoplasmacytic infiltration, varying degrees of submucosal fibrosis and thickening, increased enteric nerve fibers and neuronal proliferation. Mucosal defects, fissure ulcers, abscesses, pseudopolyps, and adenomatous proliferation were also observed in 51 (98.1%), 38 (73.1%), 28 (53.8%), 45 (86.5%), and 28 (53.8%) cases, respectively. Thirty-one (59.6%) cases had non-caseating granulomas, and 3 (5.8%) cases had intestinal mucosal glandular epithelial dysplasia. Molecular analysis showed that 12/17 CD patients exhibited mutations in at least one mucin family gene (MUC2, MUC3A, MUC4, MUC6, MUC12, MUC17), and MUC4 was the most frequently mutated in 7/17 of cases. Immunohistochemical stains showed reduced MUC4 expression in epithelial cells, with increased MUC4 expression in the epithelial surface, particularly around areas of inflammatory cell aggregation; and minimal expression in the lower half of the epithelium.Conclusions:CD exhibits diverse clinical and pathological features, necessitating a comprehensive multidimensional analysis for diagnosis. Mutations and expression alterations in mucin family genes, particularly MUC4, may play crucial roles in the pathogenesis of CD.

ObjectiveTo investigate the distribution and trend of rehabilitation personnel of China Disabled Persons' Federation (CDPF) system and the people with disabilities (PWDs) using geographical gravity model. MethodsBased on ArcGIS and statistical data, the distribution of geographical center of gravity of the rehabilitation personnel of the CDPF system from 2011 to 2021 was analyzed. According to the economic development, the areas were divided into three regions, and the eastern region included eleven provincial units, the central region includes eight provincial units, and the western region included twelve provincial units. ResultsCompared with 2011, rehabilitation staffs per thousand PWDs increased at 107.5% in 2021, 81.1%, 114.2% and 174.1% for the eastern, central, and western regions, respectively; professional staffs increased at 190.5%, 148.8%, 284.6% and 280.6% for the eastern, central, and western regions, respectively; managerial staff increased at 80.0%, 46.8%, 554.3% and 128.1% for the eastern, central, and western regions, respectively. Compared with 2011, the geographical center of gravity of the rehabilitation personnel moved about 330.9 km in 2021, while the geographical center of gravity of the PWDs moved about 169.64 km. ConclusionThe rehabilitation personnel in the CDPF system is the most in the eastern region and least in the western region. The tracks of the geographical center of gravity of the three kind of rehabilitation personnel in the CDPF system are relatively consistent. The rehabilitation personnel in the eastern region are more concentrated than those in the western region, and the density of the PWDs is more westward than that of the rehabilitation personnel, and coordination is not a perfect match yet. It is necessary to strengthen the rehabilitation personnel allocation in the western region, to balance distribution of human resources for rehabilitation of PWDs among regions.

Humans ; Consensus ; Liver Neoplasms/therapy* ; China

Objective:To investigate the relationship between clinicopathologic features and prognosis of pancreatic ductal adenocarcinoma located in the head of pancreas.Methods:A retrospective study was performed on 169 patients undergoing radical resection for pancreatic head cancer collected in the First Affiliated Hospital with Nanjing Medical University from January 2018 to April 2019. Univariate analysis and multivariate analysis were performed.Results:Patient′s age, tumor differentiation, tumor maximum diameter, resection margin (several resection margins including portal vein groove resection margin, posterior resection margin, and uncinate resection margin), number of positive lymph nodes, number of regional lymph node dissected, and some preoperative and postoperative indicators were associated with prognosis ( P<0.05). Direct tumor invasion of organs and surrounding tissues, perineural and vascular invasion, pathologic variants etc. had no statistical significance for survival time. Patient′s age, maximum tumor diameter, degree of differentiation, uncinate incision margin, number of regional lymph nodes dissected, and preoperative CA19-9 were independent factors affecting prognosis. Patients older than 74 years of age, with tumors larger than 3 cm in diameter, poorly differentiated, less than 7 regional lymph node dissected, positive uncinate margin, and preoperative CA19-9 higher than 1.5×10 5 U/L were independent risk factors in patients with pancreatic head cancer. Conclusions:Old age, tumor lager than 3 cm, poor differentiation, low examined lymph nodes, direct uncinate margin involvement and (or) with preoperative CA19-9 higher than 1.5×10 5 U/L are related to poor prognosis of head pancreatic cancer.

Diffuse large B-cell lymphoma (DLBCL) is the most common non-Hodgkin lymphoma, with high clinical and biological heterogeneity. Only 60% of patients can benefit from standard immunochemotherapy. Looking for new clinical parameters and biomarkers to better classify and stratify the prognosis of DLBCL patients has been the focused area in recent years. This article reviews the classifications and their prognostic significances of DLBCL by analyzing the related studies of genome and transcriptome.

Objective:To compare the clinical, pathological features and prognosis of patients who underwent pancreaticoduodenectomy with standard or extended lymph node dissection for pancreatic ductal adenocarcinoma.Methods:A retrospective study was performed on 158 pancreatic head cancer patients who underwent radical resection at the First Affiliated Hospital of Nanjing Medical University from Jul 2017 to Feb 2019. The clinicopathological characteristics and prognosis between the standard dissection group and the extended dissection group were compared. The relationship between the number of examined lymph nodes, positive lymph nodes, and the lymph node ratio, together with their relationship with survival were analyzed.Results:Survival analysis showed no statistical difference in survival between the standard resection group and the extended resection group ( P=0.99). There were statistical differences in gender and age composition between the two group, but no significant differences in operation time, blood loss, or postoperative complications were found. Patients with less examined lymph nodes tended to be of stage N0. examined lymph nodes is positively correlated with positive lymph nodes but is not significantly correlated with lymph node ratio. Positive lymph nodes is strongly correlated with lymph node ratio. The location of lymph node metastasis was not survival-related. Conclusions:There is no prognostic difference between standard lymph node dissection and extended lymph node dissection in pancreatic cancinoma patients after Whipple procedure.

Objective:To study the clinical pathological features of patients with relapsed diffuse large B-celllymphoma (DLBCL) and to provide evidence for early clinical screening of recurrent cases.Methods:The clinical and pathological data of the 20 patients, who had relapsed DLBCL (relapsed group) and were admitted to the First Affiliated Hospital of Nanjing Medical University from January 2015 to December 2019, were included. Meanwhile, other 34 patients with DLBCL who had achieved complete response (CR) for 36 months or more (CR group) were used as controls.Statistical methods were used to retrospectively analyze the differences in general conditions, clinical characteristics, lab resultsand pathological features between the two groups.Results:Clinically, there were 6 males and 14 females with a median age of 55.5 (33-85) years in the relapsed group and 14 males and 20 females with a median age of 53 (15-89) years in the CR group. The relapsed and CR groups had significant difference in Ann Arbor stage ( P=0.001), International Prognostic Index score ( P=0.006), primary lesions ( P=0.003), extranodal involvement ( P=0.002), and hepatitis B viral infection ( P=0.046), β2-MG level ( P=0.029), LDH level ( P=0.005) and CRP level ( P=0.006), while the age ( P=0.732), gender ( P=0.416), ECOG score ( P=0.248), B symptoms ( P=0.511), the presence of hypoalbuminemia ( P=0.279), anemia ( P=0.983) and A/G( P=0.416) showed no statistical difference.Pathologically, compared with the CR group, the relapsed group was mostly non-GCB type (85% vs. 59%, P=0.048), with a higher CD5 positive rate (25% vs.3%, P=0.014) and a lower bcl-6　positive rate (60% vs. 88%, P=0.017), while the expression of Ki-67, CD10, bcl-2, MUM1, CD20 and PAX5 was not different between the two groups. Conclusion:Most of the patients with relapsed DLBCL are non-GCB type. The patients with CD5 positivity, stage III-IV, International Prognostic Index score 3-5, nodal origin, often involving>1 extranodal organ, abnormally elevated LDH, CRP and β2-MG level, and HBV infection are more likely to relapse.

Diffuse large B-cell lymphoma (DLBCL) is an aggressive B-cell lymphoma, and its etiology and molecular mechanism has not been fully elucidated. Recently, increasing evidence has indicated that long non-coding RNA (LncRNA) participates in the occurrence, development, invasion and metastasis of DLBCL. This article reviews lncRNA-related genes and signaling pathways as well as the molecular mechanism of DLBCL.