Objective:To explore the relationships between physical activity and cognitive impairment in older adults aged ≥65 years in longevity areas in China.Methods:A total of 6 081 older adults aged ≥65 years from the Healthy Ageing and Biomarkers Cohort Study in China in 2021 were included in this study. Information about their demographic characteristics, lifestyles, and chronic disease histories were collected, the intensity of physical activity was evaluated by using Physical Activity Scale for the Elderly, and the cognitive function was evaluated by using Mini-Mental State Examination Scale (Chinese version). Multifactorial logistic regression model was used to analyze the associations between different levels and types of physical activity and cognitive impairment in older adults.Results:In the 6 081 older adults, 1 829 (30.1%) had cognitive impairment. After adjusting for confounders, older adults with T2 and T3 levels of physical activity had lower risks for cognitive impairment compared with those with T1 levels of physical activity, with ORs of 0.47 (95% CI: 0.40-0.55) and 0.22 (95% CI: 0.18-0.28). The results of different types of physical activities showed that the ORs in leisure activity T2 and T3 groups were 0.52 (95% CI: 0.44-0.63) and 0.49 (95% CI: 0.41-0.58), and the ORs in housework activity T2 and T3 groups were 0.36 (95% CI: 0.30-0.42) and 0.19 (95% CI: 0.16-0.24). There was no significant association between work-related activity and cognitive impairment. Conclusion:There is a negative association between the intensity level of physical activity and cognitive impairment, and active leisure and household activities might reduce the risk for cognitive impairment.

Sarcopenia is an age-related syndrome characterized by progressive and widespread loss of skeletal muscle mass and/or decline in muscle function.Its incidence increases year by year with aging and is influenced by multiple factors,including genetic background,lifestyle,nutritional status,and chronic diseases.Recent studies have revealed a significant correlation between sarcopenia and chronic coronary syndromes(CCS),not only in terms of the frequency of occurrence but also the se-verity of the conditions.Moreover,sarcopenia and CCS share common pathogenic mechanisms,en-compassing various pathophysiological processes such as chronic inflammation,oxidative stress,apop-tosis,and insulin resistance.This article aimed to review the current research progress on comorbidity relationship between sarcopenia and CCS,explore their shared pathophysiological basis,and discuss their impacts on clinical prognosis.

Objective:To investigate the predictive value of anti-Müllerian hormone (AMH) on the outcome of microscopic testicular sperm extraction (micro-TESE) in patients with non-mosaic Klinefelter syndrome (KS) of the clinical data and to identify effective predictors for successful micro-TESE.Methods:A retrospective case-control study was conducted on the clinical data of 118 non-mosaic KS patients treated at the Center for Reproductive Medicine of the First Affiliated Hospital of Zhengzhou University between May 2018 and September 2023. Patients were divided into two groups based on whether sperm were successfully retrieved via micro-TESE: the sperm retrieved group ( n=45) and the no sperm retrieved group ( n=73). Differences between the two groups were compared, and multivariate logistic regression analysis was used to identify factors influencing sperm retrieval. Changes in testicular volume and sex hormone levels before and after surgery were also assessed. Results:The sperm retrieval rate was 38.1% (45/118). Patients in the sperm retrieved group were significantly younger [(26.93±3.80) years] than those in the no sperm retrieved group [(28.27±3.92) years, P=0.029], and the AMH level was significantly higher [0.44 (0.18, 1.13) μg/L] than that in the no sperm retrieved group [0.10 (0.03, 0.22) μg/L, P<0.001]. AMH was identified as an independent predictor of micro-TESE outcome in non-mosaic KS patients ( OR=7.867, 95% CI: 2.727-27.242, P=0.001). The area under the receiver operating characteristic curve was 0.802 (95% CI: 0.722-0.883), and the optimal reference threshold for AMH was ≥0.265 μg/L. Postoperatively, testosterone levels decreased significantly by a median of 0.27 μg/L ( P=0.019), while luteinizing hormone levels increased by a median of 2.08 U/L ( P=0.049), with a more significant decline in testosterone levels observed in the no sperm retrieved group by a median of 0.29 μg/L ( P=0.022). Conclusion:AMH can predict successful micro-TESE in non-mosaic KS patients, with higher AMH levels indicating a higher likelihood of success.

Objective:To explore whether perioperative oral probiotic therapy reduces infectious complications following pancreaticoduodenectomy (PD), aiming to obtain higher-level evidence for clinical practice.Methods:A total of 81 participants undergoing PD at the Department of Pancreatic and Metabolic Surgery, Nanjing Drum Tower Hospital & Affiliated Hospital of Medical School, Nanjing University, from May 2024 to December 2024 were enrolled in this single-center, prospective, randomized controlled trial. The participants were randomly divided into a probiotic treatment group and a control group (receiving conventional treatment without probiotics) using a random number method. The primary outcomes included the incidence of postoperative infectious complications and intra-abdominal infection, and the secondary outcomes were the recovery of gastrointestinal function, postoperative hospital stay, and duration and costs of antibiotic use. The hematological indicators including inflammation and immune markers on postoperative days (POD) 1, 3, 5, and 7 were also compared between these two groups.Results:Finally 72 cases (39 males and 33 females) were analyzed, with 36 patients in the probiotic treatment group and 36 patients in the control group. Compared to the control group, the probiotic treatment group showed statistically significant reductions in the incidence of infectious complications (33.3% vs. 66.7%, P=0.029), intra-abdominal infection (27.8% vs. 58.3%, P=0.030), and incidence of delayed gastric emptying (0 vs. 16.7%, P=0.033). Also, the probiotic treatment group exhibited significantly faster recovery in postoperative bowel movements and shorter time to defecation, liquid diet, and semi-liquid diet (all P<0.05). Additionally, the probiotic treatment group had significantly shorter hospital stay, reduced duration of antibiotic use, and lower antibiotic costs (all P<0.05). Finally, the probiotic treatment group had significantly higher lymphocyte counts on POD 1 ( P<0.05) and showed a significant downward trend in inflammatory markers such as interleukin-6 on PODs 3 and 5 and C-reactive protein on POD 7 (all P<0.05). Conclusions:Perioperative application of probiotic preparations in PD may reduce the incidence of postoperative infectious complications, especially intra-abdominal infection. Additionally, it can prevent delayed gastric emptying, promote the recovery of postoperative gastrointestinal function, shorten hospital stay, and reduce the use of antibiotics. These benefits may be related to the improvement of postoperative inflammatory status.

Objective To investigate the clinical value of 18F-FDG PET/CT image in assisting CT-guided puncture of pancreatic tumor.Methods One hundred and thirteen patients with pancreatic tumors were selected and then divided into 18 F-FDG PET/CT image-assisted CT-guided group(abbreviation 18F-FDG PET/CT-assisted group)(n=54)and CT-guided group(n=59)according to the different guided puncture methods.The diagnostic efficacy and safety of the two guided puncture biopsy methods were analyzed and compared.Results All patients successfully completed the biopsy.The accuracy(the agreement rate between pathological diagnosis and final clinical diagnosis),sensitivity,and complication rate of the 18F-FDG PET/CT-assisted group were 96.30％(52/54),96.15％(50/52),and 3.70％(2/54);and those of the CT-guided group were 84.75％(50/59),83.64％(46/55),and 15.25％(9/59).Ultimately,it was found that the 18F-FDG PET/CT-assisted group performed better in terms of accuracy and complications than CT-guided group,and the differences were statistically significant(x2=4.280 9,P=0.038 5;x2=5.211 4,P=0.022 4).No serious complications such as hemorrhage,abdominal infection,pancreatic fistula,intestinal fistula and so on occurred in all patients.Conclusion 18F-FDG PET/CT image in assisting CT-guided pancreatic tumor puncture possesses more efficient,precise,and safe characteristics,which is the innovation and expansion of traditional CT image-guided puncture biopsy.However,there is still improvement room in terms of economy and feasibility.

Objective:To investigate the predictive value of anti-Müllerian hormone (AMH) on the outcome of microscopic testicular sperm extraction (micro-TESE) in patients with non-mosaic Klinefelter syndrome (KS) of the clinical data and to identify effective predictors for successful micro-TESE.Methods:A retrospective case-control study was conducted on the clinical data of 118 non-mosaic KS patients treated at the Center for Reproductive Medicine of the First Affiliated Hospital of Zhengzhou University between May 2018 and September 2023. Patients were divided into two groups based on whether sperm were successfully retrieved via micro-TESE: the sperm retrieved group ( n=45) and the no sperm retrieved group ( n=73). Differences between the two groups were compared, and multivariate logistic regression analysis was used to identify factors influencing sperm retrieval. Changes in testicular volume and sex hormone levels before and after surgery were also assessed. Results:The sperm retrieval rate was 38.1% (45/118). Patients in the sperm retrieved group were significantly younger [(26.93±3.80) years] than those in the no sperm retrieved group [(28.27±3.92) years, P=0.029], and the AMH level was significantly higher [0.44 (0.18, 1.13) μg/L] than that in the no sperm retrieved group [0.10 (0.03, 0.22) μg/L, P<0.001]. AMH was identified as an independent predictor of micro-TESE outcome in non-mosaic KS patients ( OR=7.867, 95% CI: 2.727-27.242, P=0.001). The area under the receiver operating characteristic curve was 0.802 (95% CI: 0.722-0.883), and the optimal reference threshold for AMH was ≥0.265 μg/L. Postoperatively, testosterone levels decreased significantly by a median of 0.27 μg/L ( P=0.019), while luteinizing hormone levels increased by a median of 2.08 U/L ( P=0.049), with a more significant decline in testosterone levels observed in the no sperm retrieved group by a median of 0.29 μg/L ( P=0.022). Conclusion:AMH can predict successful micro-TESE in non-mosaic KS patients, with higher AMH levels indicating a higher likelihood of success.

Pancreatic cancer is a highly aggressive malignancy with a poor prognosis,and surgical resection remains the only potentially curative treatment.However,since most patients are diagnosed at a locally advanced or metastatic stage,the feasibility of upfront surgery is limited.In recent years,neoadjuvant and conversion therapy have emerged as crucial strategies for borderline resectable and locally advanced pancreatic cancer,aiming to increase the R0 resection rate and improve survival outcomes.Studies have shown that FOLFIRINOX and gemcitabine plus nab-paclitaxel are commonly used neoadjuvant chemotherapy regimens,with the former being more suitable for patients with good performance status,while the latter is better tolerated across a broader patient population due to its lower toxicity.Additionally,radiotherapy,such as stereotactic body radiotherapy(SBRT),can enhance local tumor control,increase tumor cell eradication,and minimize damage to normal tissues,thereby optimizing overall treatment efficacy.Despite the significant advantages of this approach,challenges remain,including the management of toxic side effects and the optimization of treatment protocols.Future research will focus on personalized precision medicine,integrating genomic sequencing and radiomics to refine neoadjuvant/conversion therapy strategies and exploring the combination of chemotherapy,radiotherapy,immunotherapy,and targeted therapy to improve long-term survival in pancreatic cancer patients.This paper summarizes recent advancements in neoadjuvant/conversion therapy combined with radiotherapy for pancreatic cancer and discusses its potential role in modulating tumor biology and optimizing treatment strategies.

Objective:To explore whether perioperative oral probiotic therapy reduces infectious complications following pancreaticoduodenectomy (PD), aiming to obtain higher-level evidence for clinical practice.Methods:A total of 81 participants undergoing PD at the Department of Pancreatic and Metabolic Surgery, Nanjing Drum Tower Hospital & Affiliated Hospital of Medical School, Nanjing University, from May 2024 to December 2024 were enrolled in this single-center, prospective, randomized controlled trial. The participants were randomly divided into a probiotic treatment group and a control group (receiving conventional treatment without probiotics) using a random number method. The primary outcomes included the incidence of postoperative infectious complications and intra-abdominal infection, and the secondary outcomes were the recovery of gastrointestinal function, postoperative hospital stay, and duration and costs of antibiotic use. The hematological indicators including inflammation and immune markers on postoperative days (POD) 1, 3, 5, and 7 were also compared between these two groups.Results:Finally 72 cases (39 males and 33 females) were analyzed, with 36 patients in the probiotic treatment group and 36 patients in the control group. Compared to the control group, the probiotic treatment group showed statistically significant reductions in the incidence of infectious complications (33.3% vs. 66.7%, P=0.029), intra-abdominal infection (27.8% vs. 58.3%, P=0.030), and incidence of delayed gastric emptying (0 vs. 16.7%, P=0.033). Also, the probiotic treatment group exhibited significantly faster recovery in postoperative bowel movements and shorter time to defecation, liquid diet, and semi-liquid diet (all P<0.05). Additionally, the probiotic treatment group had significantly shorter hospital stay, reduced duration of antibiotic use, and lower antibiotic costs (all P<0.05). Finally, the probiotic treatment group had significantly higher lymphocyte counts on POD 1 ( P<0.05) and showed a significant downward trend in inflammatory markers such as interleukin-6 on PODs 3 and 5 and C-reactive protein on POD 7 (all P<0.05). Conclusions:Perioperative application of probiotic preparations in PD may reduce the incidence of postoperative infectious complications, especially intra-abdominal infection. Additionally, it can prevent delayed gastric emptying, promote the recovery of postoperative gastrointestinal function, shorten hospital stay, and reduce the use of antibiotics. These benefits may be related to the improvement of postoperative inflammatory status.

Objective:To explore the relationships between physical activity and cognitive impairment in older adults aged ≥65 years in longevity areas in China.Methods:A total of 6 081 older adults aged ≥65 years from the Healthy Ageing and Biomarkers Cohort Study in China in 2021 were included in this study. Information about their demographic characteristics, lifestyles, and chronic disease histories were collected, the intensity of physical activity was evaluated by using Physical Activity Scale for the Elderly, and the cognitive function was evaluated by using Mini-Mental State Examination Scale (Chinese version). Multifactorial logistic regression model was used to analyze the associations between different levels and types of physical activity and cognitive impairment in older adults.Results:In the 6 081 older adults, 1 829 (30.1%) had cognitive impairment. After adjusting for confounders, older adults with T2 and T3 levels of physical activity had lower risks for cognitive impairment compared with those with T1 levels of physical activity, with ORs of 0.47 (95% CI: 0.40-0.55) and 0.22 (95% CI: 0.18-0.28). The results of different types of physical activities showed that the ORs in leisure activity T2 and T3 groups were 0.52 (95% CI: 0.44-0.63) and 0.49 (95% CI: 0.41-0.58), and the ORs in housework activity T2 and T3 groups were 0.36 (95% CI: 0.30-0.42) and 0.19 (95% CI: 0.16-0.24). There was no significant association between work-related activity and cognitive impairment. Conclusion:There is a negative association between the intensity level of physical activity and cognitive impairment, and active leisure and household activities might reduce the risk for cognitive impairment.

Pancreatic cancer is a highly aggressive malignancy with a poor prognosis,and surgical resection remains the only potentially curative treatment.However,since most patients are diagnosed at a locally advanced or metastatic stage,the feasibility of upfront surgery is limited.In recent years,neoadjuvant and conversion therapy have emerged as crucial strategies for borderline resectable and locally advanced pancreatic cancer,aiming to increase the R0 resection rate and improve survival outcomes.Studies have shown that FOLFIRINOX and gemcitabine plus nab-paclitaxel are commonly used neoadjuvant chemotherapy regimens,with the former being more suitable for patients with good performance status,while the latter is better tolerated across a broader patient population due to its lower toxicity.Additionally,radiotherapy,such as stereotactic body radiotherapy(SBRT),can enhance local tumor control,increase tumor cell eradication,and minimize damage to normal tissues,thereby optimizing overall treatment efficacy.Despite the significant advantages of this approach,challenges remain,including the management of toxic side effects and the optimization of treatment protocols.Future research will focus on personalized precision medicine,integrating genomic sequencing and radiomics to refine neoadjuvant/conversion therapy strategies and exploring the combination of chemotherapy,radiotherapy,immunotherapy,and targeted therapy to improve long-term survival in pancreatic cancer patients.This paper summarizes recent advancements in neoadjuvant/conversion therapy combined with radiotherapy for pancreatic cancer and discusses its potential role in modulating tumor biology and optimizing treatment strategies.