Objective: To investigate the value of decreased carbohydrate antigen 19-9(CA19-9) kinetics in predicting short-term outcomes and determining prognosis among advanced biliary or pancreatic cancer patients receiving first-or second-line therapy in the real world. Methods : Eighty-nine patients were retrospectively collected with advanced biliary or pancreatic cancer, especially on the CA19-9 dynamics and decline rates at different time points. This study evaluated the association of CA19-9 changes with clinicopathological features, short-term response to antitumor therapy, and survival outcomes. Results : The enrolled patients recorded baseline CA19-9 levels ranging from 1.20 to 65 706.40 U/ml, with a median of 303.11 U/ml. There was no statistical correlation between baseline CA19-9 levels and gender, age, body mass index, primary tumor site, hepatic metastases, pulmonary metastases, lymph node metastases, peritoneal metastases, performance status, treatment lines, and combinations of drug types. Baseline CA19-9 levels were not associated with systemic immunoinflammatory index, prognostic nutritional index, and total bilirubin. A 25% or 50% decrease in CA19-9 after 2-3 therapy courses indicated short-term efficacy in reaching tumor objective remission or disease control. Both combinations of multiple drug types and a 25% decline in CA19-9 after one course of treatment were independent prognostic factors that affected the longer progression-free survival of patients receiving first or second line of treatment. Conclusion Decreased CA19-9 kinetics has specific values in predicting the efficacy and prognosis of advanced biliary or pancreatic cancer.

This study aims to innovate a homogeneous outpatient service management system across multiple hospital campuses to enhance service quality.Based on the practical experience of a tertiary general hospital in Guangdong Province and in accordance with the"Interim Regulations on Outpatient Quality Management in Healthcare Institutions,"we constructed a"6+1"homogeneous outpatient service management system.This system includes:① a multi-stakeholder co-governance outpa-tient management system,②a vertical and cross-hierarchical management network,③ a democratic-centralized clinical coordina-tion strategy,④ a guidance-encouragement performance evaluation standard,⑤a collaborative dynamic supervision mechanism,⑥a spiral retrospective evaluation and improvement method,and ⑦ an integrated outpatient diagnosis and treatment system.Af-ter over two years of implementation,the hospital's outpatient volume has grown by an average of over 15％annually,patient waiting time after appointment has been reduced to 20 minutes,and patient satisfaction in the tertiary public hospital performance evaluation achieved full marks.The electronic medical record system functionality reached Level 6,significantly improving healthcare service efficiency and quality while enhancing homogeneous management across campuses.

This study aims to innovate a homogeneous outpatient service management system across multiple hospital campuses to enhance service quality.Based on the practical experience of a tertiary general hospital in Guangdong Province and in accordance with the"Interim Regulations on Outpatient Quality Management in Healthcare Institutions,"we constructed a"6+1"homogeneous outpatient service management system.This system includes:① a multi-stakeholder co-governance outpa-tient management system,②a vertical and cross-hierarchical management network,③ a democratic-centralized clinical coordina-tion strategy,④ a guidance-encouragement performance evaluation standard,⑤a collaborative dynamic supervision mechanism,⑥a spiral retrospective evaluation and improvement method,and ⑦ an integrated outpatient diagnosis and treatment system.Af-ter over two years of implementation,the hospital's outpatient volume has grown by an average of over 15％annually,patient waiting time after appointment has been reduced to 20 minutes,and patient satisfaction in the tertiary public hospital performance evaluation achieved full marks.The electronic medical record system functionality reached Level 6,significantly improving healthcare service efficiency and quality while enhancing homogeneous management across campuses.

Objective:To understand the current situation and relationship between parents′ mental health knowledge level and the attribution of common mental disorders in children and adolescents.Methods:From January to February 2022, an anonymous survey was conducted among the parents of children and adolescents in the form of an online electronic questionnaire. The questionnaire consisted of three parts: demographic information, mental health knowledge questionnaire, and a case-based questionnaire on four common mental disorders among children and adolescents.Results:A total of 386 valid questionnaires were retrieved. The pass rate of the parents′ mental health knowledge questionnaire was 60.1%(232/386). The distribution differences of mental health knowledge scores in terms of demographic factors such as place of residence, disposable monthly family income, educational background, and occupation were statistically significant (all P<0.05), while there were no statistically significant differences in the distribution of gender, and marital status (all P>0.05). The most common causes attributed by parents to cases of depression were: high study pressure (66.1%), recent traumatic events (11.9%), and daily conflicts (6.0%). The most common causes of conduct disorder cases were: personality defects (25.6%), problems in childhood (21.5%), and daily conflicts (14.5%). The most common causes of social anxiety cases were: problems in childhood (34.7%), personality defects (32.6%), and high study pressure (6.0%); The most common causes of attention deficit and hyperactivity disorder (ADHD) cases are: problems in childhood (34.5%), personality defects (21.8%), and daily conflicts (9.3%). There were statistically significant differences between the passing score of parents′ mental health knowledge and the attribution of conduct disorders, social anxiety, and ADHD (all P<0.05). Conclusions:The level of mental health knowledge of parents is relatively low and urgently needs to be improved. The place of residence, the disposable monthly income of the family, educational background and occupation are the influencing factors of parents′ awareness rate of mental health knowledge. Parents attribute common mental disorders in children and adolescents to psychosocial factors, ignoring biological factors. Parents have a relatively low competence in maintaining the mental health of children and adolescents.

Objective:To understand the current situation and relationship between parents′ mental health knowledge level and the attribution of common mental disorders in children and adolescents.Methods:From January to February 2022, an anonymous survey was conducted among the parents of children and adolescents in the form of an online electronic questionnaire. The questionnaire consisted of three parts: demographic information, mental health knowledge questionnaire, and a case-based questionnaire on four common mental disorders among children and adolescents.Results:A total of 386 valid questionnaires were retrieved. The pass rate of the parents′ mental health knowledge questionnaire was 60.1%(232/386). The distribution differences of mental health knowledge scores in terms of demographic factors such as place of residence, disposable monthly family income, educational background, and occupation were statistically significant (all P<0.05), while there were no statistically significant differences in the distribution of gender, and marital status (all P>0.05). The most common causes attributed by parents to cases of depression were: high study pressure (66.1%), recent traumatic events (11.9%), and daily conflicts (6.0%). The most common causes of conduct disorder cases were: personality defects (25.6%), problems in childhood (21.5%), and daily conflicts (14.5%). The most common causes of social anxiety cases were: problems in childhood (34.7%), personality defects (32.6%), and high study pressure (6.0%); The most common causes of attention deficit and hyperactivity disorder (ADHD) cases are: problems in childhood (34.5%), personality defects (21.8%), and daily conflicts (9.3%). There were statistically significant differences between the passing score of parents′ mental health knowledge and the attribution of conduct disorders, social anxiety, and ADHD (all P<0.05). Conclusions:The level of mental health knowledge of parents is relatively low and urgently needs to be improved. The place of residence, the disposable monthly income of the family, educational background and occupation are the influencing factors of parents′ awareness rate of mental health knowledge. Parents attribute common mental disorders in children and adolescents to psychosocial factors, ignoring biological factors. Parents have a relatively low competence in maintaining the mental health of children and adolescents.

Objective:To investigate the efficacy and safety of protein A immunoadsorption (PAIA) combined with rituximab (RTX) in highly sensitized patients who underwent haplo-hematopoietic stem cell transplantation (haplo-HSCT) .Methods:The clinical data of 56 highly sensitized patients treated with PAIA and RTX before haplo-HSCT at the First Affiliated Hospital of Soochow University and Soochow Hopes Hematonosis Hospital between March 2021 and June 2023 were retrospectively analyzed. The number of human leukocyte antigen (HLA) antibody types and the mean fluorescence intensity (MFI), humoral immunity, adverse reactions during adsorption, and survival within 100 days before and after adsorption were measured.Results:After receiving the PAIA treatment, the median MFI of patients containing only HLA Ⅰ antibodies decreased from 7 859 (3 209-12 444) to 3 719 (0-8 275) ( P<0.001), and the median MFI of HLA Ⅰ+Ⅱ antibodies decreased from 5 476 (1 977-12 382) to 3 714 (0-11 074) ( P=0.035). The median MFI of patients with positive anti-donor-specific antibodies decreased from 8 779 (2 697-18 659) to 4 524 (0–15 989) ( P<0.001). The number of HLA-A, B, C, DR, and DQ antibodies in all patients decreased after the PAIA treatment, and the differences were statistically significant (A, B, C, DR: P<0.001, DQ: P<0.01). The humoral immune monitoring before and after the PAIA treatment showed a significant decrease in the number of IgG and complement C3 ( P<0.001 and P=0.002, respectively). Forty-four patients underwent HLA antibody monitoring after transplantation, and the overall MFI and number of antibody types decreased. However, five patients developed new antibodies with low MFI, and nine patients continued to have high MFI. The overall survival, disease-free survival, non-recurrent mortality, and cumulative recurrence rates at 100 days post-transplantation were 83.8%, 80.2%, 16.1%, and 4.5%, respectively. Conclusions:The combination of PAIA and RTX has a certain therapeutic effect and good safety in the desensitization treatment of highly sensitive patients before haplo-HSCT.

The clinical practice guidelines of traditional Chinese medicine （TCM） have problems such as limited clinical application and unclear implementation effects， which may be related to the lack of clinical practice evidence. To provide reliable and precise evidence for clinical practice， this article proposes a model of combining TCM guidelines with real-world study， which includes 4 steps. Firstly， during the implementation process of the guidelines， a high-quality research database is established. Secondly， the recommendations in the guidelines are evaluated based on the established database in multiple dimensions， including applicability， effectiveness， safety， and cost-effectiveness， and thus their effectiveness in practical applications can be determined. Thirdly， based on the established database， core prescriptions are identified， and the targeted populations and medication plans are determined. That is， the best treatment regimen is established based on the analysis of abundant clinical data regarding the effects of different medication frequencies， dosages， and duration on efficacy. Fourthly， the guidelines are updated according to the real-world evidence. The research based on this model can provide real-world evidence for ancient and empirical prescriptions， improving their application in clinical practice. Moreover， this model can reduce research costs and improve research efficiency. When applying this model， researchers need to pay attention to the quality of real-world evidence， ensuring that it can truly reflect the situation in clinical practice. In addition， importance should be attached to the clinical application of guideline recommendations， ensuring that doctors can conduct standardized diagnosis and treatment according to the guidelines. Finally， full-process participation of multidisciplinary experts is encouraged to ensure the comprehensiveness and scientificity of the study. In conclusion， the application of this model will contribute to the development of TCM guidelines responsive to the needs of clinical practice and achieve the goal of promoting the homogenization of TCM clinical diagnosis and treatment.

OBJECTIVE To establish a proteomic pre-processing protocol for low input samples (1×104 cells) in order to map the proteomic aging atlas of individual mouse antral follicles and elucidate the aging patterns of mouse antral follicles.METHODS Using cell lines and primary mouse cells,the protocol was developed by optimizing lysis buffers,enzymatic digestion,and ultrasonication for 1 × 104 cells (about 1 μg protein).The sample pre-processing protocol established in this study was evaluated by comparing it with two commercial sample preparation kits:iST kit,EasyPept-Ex (Ex kit),in terms of protein identification overlap,overall grand average of hydropathy (GRAVY),theoretical isoelectric points,and protein molecular weight.The sample suitability of the current sample pretreatment process was assessed using primary spleen and liver cell samples of mice at three different scales:100,1000,and 10000.Using this sample pre-processing approach in conjunction with the highly sensitive timsTOF Pro 2 mass spectrometer,proteome maps of individual antral follicles from young-aged (2 months),middle-aged (12 months),and old-aged (22 months) mice were generated.Differential and time-series analyses identified age-related proteins,and elucidated the aging patterns of mouse antral follicles.RESULTS A proteomic pre-processing protocol for 1 × 104 cell samples was established,requiring only one single-step operation for lysis,reduction,and alkylation,with enzymatic digestion not necessitating ultrasonication.We found that for cell samples on the order of 1 × 104,increasing the concentration of sodium deoxycholate in the lysis buffer from 1％ to 10％ enhanced the number of identified proteins from 4089 to 4389,demonstrating improved lysis efficiency (P＜0.05).The addition of ammonium bicar-bonate buffer (50 mmol·L-1,90 μL) to the lysis solution significantly increased the number of identified proteins from 2579 to 4389 (P＜0.01).Both single trypsin and mixed enzyme (trypsin/Lys-C) treatments yielded similar proteolytic outcomes,identifying approximately 3950 proteins each.Reducing the diges-tion time from overnight to 0.5 hours increased the number of identified proteins from 4299 to 4632 (P＜0.05),thus saving time while achieving higher protein identification yields.Compared to commercial kits,approximately 92.3％of the proteins identified by our protocol could also be identified by the iST kit or Ex kit.Our protocol demonstrated no significant bias in terms of hydrophobicity,theoretical isoelectric points or molecular weight,indicating robust performance.As the number of cells in the sample increased,the variety of identified proteins increased significantly.For instance,in samples containing 100,1000,and 10000 cells,525,1650,and 3210 proteins were identified in primary mouse spleen cells,respectively,compared with 366,1160,and 3590 proteins in primary mouse liver cells (P＜0.05).Finally,using this protocol,proteomic profiling of individual antral follicles from young,middle-aged,and old mice (three follicles per age group) was performed,with each follicle identifying over 7500 proteins on average.Based on this data,principal component analysis was conducted in this study,revealing significant differences in protein expression profiles of antral follicles at different age stages,confirming that age made a big difference to the physiological state of follicles.Additionally,we observed a signifi-cant downregulation of chromosome separation-associated proteins in aging mouse follicles (P＜0.01),suggesting potential disruptions in chromosome segregation and meiotic dysregulation.Further analysis revealed 739 proteins significantly correlated with age,among which 378 exhibited positive correlations and 361 negative correlations.CONCLUSION This study provides a low-cost,easy-to-operate,high-throughput,and highly sensitive proteomic sample pre-processing protocol for low input samples.It has constructed dynamic proteome maps of individual antral follicles at different ages in mice,offering high-quality data resources for basic research on follicular aging and providing new insights for exploring potential therapeutic targets for ovarian aging and the development of drugs to enhance fertility.

OBJECTIVE To establish a proteomic pre-processing protocol for low input samples (1×104 cells) in order to map the proteomic aging atlas of individual mouse antral follicles and elucidate the aging patterns of mouse antral follicles.METHODS Using cell lines and primary mouse cells,the protocol was developed by optimizing lysis buffers,enzymatic digestion,and ultrasonication for 1 × 104 cells (about 1 μg protein).The sample pre-processing protocol established in this study was evaluated by comparing it with two commercial sample preparation kits:iST kit,EasyPept-Ex (Ex kit),in terms of protein identification overlap,overall grand average of hydropathy (GRAVY),theoretical isoelectric points,and protein molecular weight.The sample suitability of the current sample pretreatment process was assessed using primary spleen and liver cell samples of mice at three different scales:100,1000,and 10000.Using this sample pre-processing approach in conjunction with the highly sensitive timsTOF Pro 2 mass spectrometer,proteome maps of individual antral follicles from young-aged (2 months),middle-aged (12 months),and old-aged (22 months) mice were generated.Differential and time-series analyses identified age-related proteins,and elucidated the aging patterns of mouse antral follicles.RESULTS A proteomic pre-processing protocol for 1 × 104 cell samples was established,requiring only one single-step operation for lysis,reduction,and alkylation,with enzymatic digestion not necessitating ultrasonication.We found that for cell samples on the order of 1 × 104,increasing the concentration of sodium deoxycholate in the lysis buffer from 1％ to 10％ enhanced the number of identified proteins from 4089 to 4389,demonstrating improved lysis efficiency (P＜0.05).The addition of ammonium bicar-bonate buffer (50 mmol·L-1,90 μL) to the lysis solution significantly increased the number of identified proteins from 2579 to 4389 (P＜0.01).Both single trypsin and mixed enzyme (trypsin/Lys-C) treatments yielded similar proteolytic outcomes,identifying approximately 3950 proteins each.Reducing the diges-tion time from overnight to 0.5 hours increased the number of identified proteins from 4299 to 4632 (P＜0.05),thus saving time while achieving higher protein identification yields.Compared to commercial kits,approximately 92.3％of the proteins identified by our protocol could also be identified by the iST kit or Ex kit.Our protocol demonstrated no significant bias in terms of hydrophobicity,theoretical isoelectric points or molecular weight,indicating robust performance.As the number of cells in the sample increased,the variety of identified proteins increased significantly.For instance,in samples containing 100,1000,and 10000 cells,525,1650,and 3210 proteins were identified in primary mouse spleen cells,respectively,compared with 366,1160,and 3590 proteins in primary mouse liver cells (P＜0.05).Finally,using this protocol,proteomic profiling of individual antral follicles from young,middle-aged,and old mice (three follicles per age group) was performed,with each follicle identifying over 7500 proteins on average.Based on this data,principal component analysis was conducted in this study,revealing significant differences in protein expression profiles of antral follicles at different age stages,confirming that age made a big difference to the physiological state of follicles.Additionally,we observed a signifi-cant downregulation of chromosome separation-associated proteins in aging mouse follicles (P＜0.01),suggesting potential disruptions in chromosome segregation and meiotic dysregulation.Further analysis revealed 739 proteins significantly correlated with age,among which 378 exhibited positive correlations and 361 negative correlations.CONCLUSION This study provides a low-cost,easy-to-operate,high-throughput,and highly sensitive proteomic sample pre-processing protocol for low input samples.It has constructed dynamic proteome maps of individual antral follicles at different ages in mice,offering high-quality data resources for basic research on follicular aging and providing new insights for exploring potential therapeutic targets for ovarian aging and the development of drugs to enhance fertility.