Objective:To investigate the survival outcomes and prognostic factors in patients undergoing radical resection for pancreatic body and tail cancer.Methods:A retrospective case series study was conducted on 992 patients who underwent radical resection for pancreatic body and tail cancer at the Pancreatic Center of the First Affiliated Hospital of Nanjing Medical University from January 2016 to June 2024. In this study, 577 (58.2%) were male and 415 (41.8%) were female,with an age of (65±9) years (range: 26 to 86 years). Follow-up continued until June 2024. Survival rates were estimated using the Kaplan-Meier method,and prognostic factors were identified using univariate and multivariate Cox proportional hazards models.Results:Among 992 patients,open surgery was the predominant approach (89.1%, 884/992), and radical antegrade modular pancreatosplenectomy (RAMPS) was performed in 317 patients (32.0%). Combined organ resection,venous resection,and arterial resection were performed in 23.5%, 9.3%,and 11.2% of patients,respectively. The rates of R0, R1-1 mm, and R1-direct resections were 49.8% (494/992),41.5% (412/992), and 8.7% (86/992),respectively. Stage ⅡB was the most common TNM stage (32.2%,319/992). A total of 801 patients (80.8%) received adjuvant chemotherapy. The median follow-up period was 32.0(8.8) months(range:3.2 to 105.3 months),during which 508 patients (51.2%) died. The overall median survival (OS) was 26.4 months,with 1-,3-, and 5-year survival rates of 79.0%,40.0%, and 29.0%, respectively. In the recent five years (from 2020 to 2024), the median OS improved significantly to 34.1 months compared to 20.0 months from 2016 to 2019 ( P<0.01). Histological subtype analysis showed that the median OS time was 26.7 months for pancreatic ductal adenocarcinoma (PDAC, n=855),58.9 months for invasive intraductal papillary mucinous carcinoma (IPMC, n=32),and 15.7 months for adenosquamous carcinoma of pancreas (ASCP, n=73) ( P=0.001). Among PDAC patients, adjuvant chemotherapy significantly improved survival (29.1 months vs. 14.4 months, P<0.01);in IPMC patients, adjuvant chemotherapy also extended survival (65.7 months vs. 58.9 months, P=0.047). Although ASCP patients receiving chemotherapy had a longer median OS time than those without (18.8 months vs. 8.9 months),the difference was not statistically significant ( P=0.151). Multivariate Cox regression analysis in PDAC patients indicated that adjuvant chemotherapy, R0 resection, T stage,N stage,and tumor differentiation were independent prognostic factors ( P<0.01). The median OS time by TNM stage was:not reached for stage ⅠA, 51.6 months for ⅠB, 25.5 months for ⅡA, 23.7 months for ⅡB, 23.0 months for Ⅲ, and 14.4 months for Ⅳ. The median OS time for R0,R1-1 mm,and R1-direct resections was 34.1,24.7,and 15.7 months,respectively ( P<0.01). Conclusion:Adjuvant chemotherapy,R0 resection,tumor stage,and differentiation are independent prognostic factors for pancreatic body and tail cancer.

Objective:To investigate the survival outcomes and prognostic factors in patients undergoing radical resection for pancreatic body and tail cancer.Methods:A retrospective case series study was conducted on 992 patients who underwent radical resection for pancreatic body and tail cancer at the Pancreatic Center of the First Affiliated Hospital of Nanjing Medical University from January 2016 to June 2024. In this study, 577 (58.2%) were male and 415 (41.8%) were female,with an age of (65±9) years (range: 26 to 86 years). Follow-up continued until June 2024. Survival rates were estimated using the Kaplan-Meier method,and prognostic factors were identified using univariate and multivariate Cox proportional hazards models.Results:Among 992 patients,open surgery was the predominant approach (89.1%, 884/992), and radical antegrade modular pancreatosplenectomy (RAMPS) was performed in 317 patients (32.0%). Combined organ resection,venous resection,and arterial resection were performed in 23.5%, 9.3%,and 11.2% of patients,respectively. The rates of R0, R1-1 mm, and R1-direct resections were 49.8% (494/992),41.5% (412/992), and 8.7% (86/992),respectively. Stage ⅡB was the most common TNM stage (32.2%,319/992). A total of 801 patients (80.8%) received adjuvant chemotherapy. The median follow-up period was 32.0(8.8) months(range:3.2 to 105.3 months),during which 508 patients (51.2%) died. The overall median survival (OS) was 26.4 months,with 1-,3-, and 5-year survival rates of 79.0%,40.0%, and 29.0%, respectively. In the recent five years (from 2020 to 2024), the median OS improved significantly to 34.1 months compared to 20.0 months from 2016 to 2019 ( P<0.01). Histological subtype analysis showed that the median OS time was 26.7 months for pancreatic ductal adenocarcinoma (PDAC, n=855),58.9 months for invasive intraductal papillary mucinous carcinoma (IPMC, n=32),and 15.7 months for adenosquamous carcinoma of pancreas (ASCP, n=73) ( P=0.001). Among PDAC patients, adjuvant chemotherapy significantly improved survival (29.1 months vs. 14.4 months, P<0.01);in IPMC patients, adjuvant chemotherapy also extended survival (65.7 months vs. 58.9 months, P=0.047). Although ASCP patients receiving chemotherapy had a longer median OS time than those without (18.8 months vs. 8.9 months),the difference was not statistically significant ( P=0.151). Multivariate Cox regression analysis in PDAC patients indicated that adjuvant chemotherapy, R0 resection, T stage,N stage,and tumor differentiation were independent prognostic factors ( P<0.01). The median OS time by TNM stage was:not reached for stage ⅠA, 51.6 months for ⅠB, 25.5 months for ⅡA, 23.7 months for ⅡB, 23.0 months for Ⅲ, and 14.4 months for Ⅳ. The median OS time for R0,R1-1 mm,and R1-direct resections was 34.1,24.7,and 15.7 months,respectively ( P<0.01). Conclusion:Adjuvant chemotherapy,R0 resection,tumor stage,and differentiation are independent prognostic factors for pancreatic body and tail cancer.

Objective To explore the application value of CT fusion navigation technology in Stanford B-type aortic dissection endovas-cular isolation surgery.Methods Nineteen patients who underwent Stanford B-type aortic dissection endovascular isolation surgery were selected.Prior to surgery,all patients underwent chest and abdominal CT plain scan and enhanced scan,and three-dimensional vascular reconstruction was performed at the post-processing workstation;During the operation,a chest(region of interest)digital subtraction angiography(DS A)3D-CT scan was first performed as the intraoperative matching localization image.Then,a thin-layer(1.0 mm)CT enhanced tomographic image of the chest and abdomen was extracted from the picture archiving and communication system(PACS).At the same time,the DSA 3D-CT image and the thin-layer CT enhanced image were opened for overlapping regis-tration of bony landmarks.After registration,the three-dimensional vascular volume rendering(VR)image of the aorta from the thin-layer CT was fused with the DSA 3D-CT,and the positioning and release of the covered stent were guided by the newly fused multimodal real-time image.Results All 19 patients underwent guided surgery with precise positioning of the covered lesions and successful release of the covered stents,with a success rate of 100％ for the guided technique.The intraoperative placement time of the covered stent was(5.4±2.4)s,the exposure time was(12.8±3.2)min,the surgical duration was(53.9±25.3)min,the intraopera-tive contrast agent dosage was(125.8±25.3)mL,the X-ray fluoroscopy dose was(221.3±155.7)mGy,and the total X-ray exposure dose was(1 056.4±330.3)mGy.There were no serious complications during the operation,and all patients received 1-3 months of follow-up which found they all recovered well.Conclusion The use of CT and DSA fusion navigation technology in guiding the treat-ment of Stanford B-type aortic dissection with covered stents provides real-time three-dimensional fusion images for the operator,which can quickly and accurately locate and release the stent,and has certain clinical value.

Objective:To evaluate the clinical efficacy of returning, squeezing, patting and pulling orthopaedic manipulation combined with pelvic fabric tape fixation for the treatment of postpartum pubic symphysis separation.Methods:The clinical data of 80 patients with postpartum pubic symphysis separation from June 2015 to March 2019 were retrospectively analyzed, and all of them were given orthopaedic manipulative therapy using return squeezing and patting and pulling, once a week, for a total of 3 times. After the manipulative treatment, the patients were instructed to brake the pelvic fixation straps for not less than 8 h per day, and digital X-ray (DR) pelvic radiographs or ultrasound tests were performed before and after the treatment to measure the distance between the pubic symphysis. VAS scale was used to assess the degree of pain, and the Oswestry dysfunction index (ODI) was used to assess the degree of dysfunction. The clinical efficacy was evaluated.Results:After treatment of 80 patients, 6 showed significant improvement, 69 showed improvement, and 5 showed no improvement, with a total effective rate of 93.8%. Compared with before group, the inter-pubic symphysis distance [(15.09±3.10) mm, (12.01±4.36) mm, (9.64±0.30) mm, (8.18±1.56) mm vs. (19.35±1.08) mm, F=254.64] were significantly smaller at 1 week, 2 weeks, 3 weeks, and 1 month ( P<0.001); VAS scores (2.90±1.24, 1.29±0.88, 0.84±0.43, 0.56±0.32 vs. 6.11±2.93, F=122.60) were significantly lower than before treatment ( P<0.001); ODI (28.09±4.30, 22.01±4.95, 20.64±0.41, 14.18±1.36 vs. 45.43±4.01, F=734.17) were significantly reduced ( P<0.001). Conclusion:Returning, squeezing, patting and pulling orthopaedic manipulation combined with pelvic fabric tape fixation can quickly restore the separation distance of the pubic symphysis, reduce local pain and improve lumbosacral function.

Objective To predict the potential suitable areas of Cyperus rotundus L.in China;To provide a theoretical basis for the protection of wild resources of Cyperus rotundus L.and its artificial cultivation.Methods The data of 732 sample points were collected,combined with the data of 36 environmental factors,and the feature combination and regularization multiplier parameters were optimized using R 3.6.3.The MaxEnt model and geographic information system software ArcGIS 10.4.1 were used to analyze the distribution of the main environmental factors affecting the distribution of the suitability and the distribution of the suitable areas of Cyperus rotundus L.Results The main environmental factors that significantly affected the distribution of the suitability of Cyperus rotundus L.were minimum temperature of coldest month,precipitation of driest month,mean temperature of wettest quarter,mean temperature of warmest quarter,and precipitation of warmest quarter.The highly suitable areas of Cyperus rotundus L.are mainly located in Hainan,Guangdong,Guangxi,western and southern Taiwan,southern Yunnan,southern Tibet,east-central Hubei,eastern Hunan,northern Anhui,and central Jiangxi.Conclusion The results of this study can provide references for the sustainable development of wild resources,artificial cultivation optimization,planting site selection and management.

Objective To predict the potential suitable areas of Cyperus rotundus L.in China;To provide a theoretical basis for the protection of wild resources of Cyperus rotundus L.and its artificial cultivation.Methods The data of 732 sample points were collected,combined with the data of 36 environmental factors,and the feature combination and regularization multiplier parameters were optimized using R 3.6.3.The MaxEnt model and geographic information system software ArcGIS 10.4.1 were used to analyze the distribution of the main environmental factors affecting the distribution of the suitability and the distribution of the suitable areas of Cyperus rotundus L.Results The main environmental factors that significantly affected the distribution of the suitability of Cyperus rotundus L.were minimum temperature of coldest month,precipitation of driest month,mean temperature of wettest quarter,mean temperature of warmest quarter,and precipitation of warmest quarter.The highly suitable areas of Cyperus rotundus L.are mainly located in Hainan,Guangdong,Guangxi,western and southern Taiwan,southern Yunnan,southern Tibet,east-central Hubei,eastern Hunan,northern Anhui,and central Jiangxi.Conclusion The results of this study can provide references for the sustainable development of wild resources,artificial cultivation optimization,planting site selection and management.

Objective To explore the application value of CT fusion navigation technology in Stanford B-type aortic dissection endovas-cular isolation surgery.Methods Nineteen patients who underwent Stanford B-type aortic dissection endovascular isolation surgery were selected.Prior to surgery,all patients underwent chest and abdominal CT plain scan and enhanced scan,and three-dimensional vascular reconstruction was performed at the post-processing workstation;During the operation,a chest(region of interest)digital subtraction angiography(DS A)3D-CT scan was first performed as the intraoperative matching localization image.Then,a thin-layer(1.0 mm)CT enhanced tomographic image of the chest and abdomen was extracted from the picture archiving and communication system(PACS).At the same time,the DSA 3D-CT image and the thin-layer CT enhanced image were opened for overlapping regis-tration of bony landmarks.After registration,the three-dimensional vascular volume rendering(VR)image of the aorta from the thin-layer CT was fused with the DSA 3D-CT,and the positioning and release of the covered stent were guided by the newly fused multimodal real-time image.Results All 19 patients underwent guided surgery with precise positioning of the covered lesions and successful release of the covered stents,with a success rate of 100％ for the guided technique.The intraoperative placement time of the covered stent was(5.4±2.4)s,the exposure time was(12.8±3.2)min,the surgical duration was(53.9±25.3)min,the intraopera-tive contrast agent dosage was(125.8±25.3)mL,the X-ray fluoroscopy dose was(221.3±155.7)mGy,and the total X-ray exposure dose was(1 056.4±330.3)mGy.There were no serious complications during the operation,and all patients received 1-3 months of follow-up which found they all recovered well.Conclusion The use of CT and DSA fusion navigation technology in guiding the treat-ment of Stanford B-type aortic dissection with covered stents provides real-time three-dimensional fusion images for the operator,which can quickly and accurately locate and release the stent,and has certain clinical value.

【Objective】 To investigate the protective effects of aflexible sleeve penile protection device on reducing postoperative pain and wound edema in patients after circumcision. 【Methods】 A total of 54 patients who underwent circumcision at Yan’an Branch of Peking University Third Hospital during Feb.1 and May 31, 2023 were enrolled.The patients were randomly divided into the experimental group and control group, with 27 patients in either groups.Patients in the experimental group were treated with a flexible sleeve penis protection device after surgery, and patients in the control group were treated with traditional gauze bandage after surgery.Postoperative pain, wound edema and complications were compared between the two groups. 【Results】 In terms of pain, the visual analogue scale of the experimental group was significantly lower at 6 hours [(1.7±0.9) vs.(3.3±1.9), P<0.001] and 2 days [(2.0±1.3) vs.(3.3±1.3), P<0.001] after surgery than that of the control group, but there were no statistically significant differences between the two groups on the 4th and 7th postoperative days (P>0.05).In terms of edema, the edema score of the experimental group was significantly lower than that of the control group on the 2nd postoperative day [(2.0±1.0) vs.(4.0±0.8), P<0.001] , the 4th postoperative day [(1.5±1.2) vs.(2.6±0.9), P<0.001] , and the 7th postoperative day [(0.9±1.3) vs.(2.3±1.5), P<0.001] .There was no statistically significant difference in the incidence of complications between the two groups (P>0.05). 【Conclusion】 The flexible sleeve penile protection device has significant effects of reducing early postoperative pain and reducing edema in patients undergoing circumcision.

Dura mater, rich in vasculature and immune cells, is the outermost layer of the central nervous system, and thus acts as the first barrier to protect brain. Meningeal lymphatic vessels and immune cells are main components of dural immunity, which respond to a variety of central nervous system diseases. Meanwhile, compared with brain parenchyma, dura mater communicates more with peripheral tissues and is more susceptible to medical interventions. Therefore, dura mater is a promising target to prevent, diagnose and treat intracranial diseases. Here dural immunity is clarified based on meningeal lymphatic vessels and dural immune cells, and current researches inquiring the role of dural immunity in infectious and immune diseases of central nervous system are summarized.

Oxalicine B ( 1) is an α-pyrone meroterpenoid with a unique bispirocyclic ring system derived from Penicillium oxalicum. The biosynthetic pathway of 15-deoxyoxalicine B ( 4) was preliminarily reported in Penicillium canescens, however, the genetic base and biochemical characterization of tailoring reactions for oxalicine B ( 1) has remained enigmatic. In this study, we characterized three oxygenases from the metabolic pathway of oxalicine B ( 1), including a cytochrome P450 hydroxylase OxaL, a hydroxylating Fe(II)/α-KG-dependent dioxygenase OxaK, and a multifunctional cytochrome P450 OxaB. Intriguingly, OxaK can catalyze various multicyclic intermediates or shunt products of oxalicines with impressive substrate promiscuity. OxaB was further proven via biochemical assays to have the ability to convert 15-hydroxdecaturin A ( 3) to 1 with a spiro-lactone core skeleton through oxidative rearrangement. We also solved the mystery of OxaL that controls C-15 hydroxylation. Chemical investigation of the wild-type strain and deletants enabled us to identify 10 metabolites including three new compounds, and the isolated compounds displayed potent anti-influenza A virus bioactivities exhibiting IC₅₀ values in the range of 4.0-19.9 μmol/L. Our studies have allowed us to propose a late-stage biosynthetic pathway for oxalicine B ( 1) and create downstream derivatizations of oxalicines by employing enzymatic strategies.