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 analyze the clinical curative effect of protective sleep nursing on neonatal hyperbilirubinemia.Methods:Eight neonates with hyperbilirubinemia who were admitted from April 2019 to August 2019 were enrolled. They were divided into control group (40 cases) and observation group (40 cases) by random digits table method. Both groups were given routine nursing. On basis of control group, observation group was given protective sleep nursing. The clinical effect, sleep time, discomfort reactions and nursing satisfaction were compared between the two groups.Results:After nursing, the sleep time, crying time and bilirubin level were (18.67 ± 1.45) h/d, (0.82 ± 0.12) h/d, (191.58 ± 12.74) μmol/L in the observation group, and (17.63 ± 1.33) h/d, (1.05 ± 0.15) h/d, (202.42 ± 13.08) μmol/L in the control group, there were significant differences between the two groups ( t values were 3.343, 7.573, 3.755, P<0.05). The duration and regression time of jaundice were (5.26±1.24), (8.70±2.12) d in the observation group, and (7.14±1.18), (12.95±2.31) d in the control group, there were significant differences between the two groups ( t values were 6.946, 8.573, P<0.05). The good rate of sleep quality, incidence rates of vomiting, skin damage and needle falling out, and nursing satisfaction rate were 90.00%(36/40), 7.50%(3/40), 5.00%(2/40), 10.00%(4/40), 100.00%(40/40) in the observation group, and 72.50% (29/40), 27.50%(11/40), 22.50%(9/40), 32.50%(13/40), 87.50%(35/40) in the control group, there were significant differences between the two groups ( χ2 values were 4.021-6.050, P<0.05). Conclusions:The application of protective sleep nursing in treatment of neonatal hyperbilirubinemia can effectively prolong their sleep time, improve their sleep quality, which is conducive to improving their symptoms, reducing discomfort reactions.And satisfaction of their family members is relatively higher.

Objective: To investigate the current status and real performance of the detection of RUNX1-RUNX1T1 fusion transcript levels and WT1 transcript levels in China through interlaboratory comparison. Methods: Peking University People’s Hospital (PKUPH) prepared the samples for comparison. That is, the fresh RUNX1-RUNX1T1 positive (+) bone morrow nucleated cells were serially diluted with RUNX1-RUNX1T1 negative (-) nucleated cells from different patients. Totally 23 sets with 14 different samples per set were prepared. TRIzol reagent was added in each tube and thoroughly mixed with cells for homogenization. Each laboratory simultaneously tested RUNX1-RUNX1T1 and WT1 transcript levels of one set of samples by real-time quantitative PCR method. All transcript levels were reported as the percentage of RUNX1-RUNX1T1 or WT1 transcript copies/ABL copies. Spearman correlation coefficient between the reported transcript levels of each participated laboratory and those of PKUPH was calculated. Results: ①RUNX1-RUNX1T1 comparison: 9 samples were (+) and 5 were (-) , the false negative and positive rates of the 20 participated laboratories were 0 (0/180) and 5% (5/100) , respectively. The reported transcript levels of all 9 positive samples were different among laboratories. The median reported transcript levels of 9 positive samples were from 0.060% to 176.7%, which covered 3.5-log. The ratios of each sample’s highest to the lowest reported transcript levels were from 5.5 to 12.3 (one result which obviously deviated from other laboratories’ results was not included) , 85% (17/20) of the laboratories had correlation coefficient ≥0.98. ②WT1 comparison: The median reported transcript levels of all 14 samples were from 0.17% to 67.6%, which covered 2.6-log. The ratios of each sample’s highest to the lowest reported transcript levels were from 5.3-13.7, 62% (13/21) of the laboratories had correlation coefficient ≥0.98. ③ The relative relationship of the reported RUNX1-RUNX1T1 transcript levels between the participants and PKUPH was not always consistent with that of WT1 transcript levels. Both RUNX1-RUNX1T1 and WT1 transcript levels from 2 and 7 laboratories were individually lower than and higher than those of PKUPH, whereas for the rest 11 laboratories, one transcript level was higher than and the other was lower than that of PKUPH. Conclusion The reported RUNX1-RUNX1T1 and WT1 transcript levels were different among laboratories for the same sample. Most of the participated laboratories reported highly consistent result with that of PKUPH. The relationship between laboratories of the different transcript levels may not be the same.

Objective To investigate the impact of sample typeon the detection of c-KIT exon 17 mutation in acute myeloid leukemia (AML) patients. Methods A retrospective study was conducted on 51 bone marrow samples collected from 37 AML patients [17 maleand 20 female, with a median age of 33 (range from 1 to 82)] at diagnosis or after treatment from June 2016 to August 2018. Of the 37 cases of AML, 24 were t(8; 21) AML, 11 were inv(16)/t(16;16) AML and 2 were non-CBF-AML. RNA and DNA were simultaneously extracted from every sample. PCR followed by Sanger sequencing were used to screen c-KIT exon 17 mutation, and the comparisons were made between paired cDNA and DNAsamples. Results (1) Of the 51 paired samples, 14 pairs were simultaneously detected positive for c-KITmutation in both of cDNA and DNA samples, but 17 pairs were detected negative in both, and the remaining 20 pairswere only detected positive for the mutation in cDNA but not in DNA, with an inconsistency rate of 39.2％. The positive rate of detecting c-KITmutation was significantly higher in cDNA than in DNA samples (66.7％vs 27.5％,P=0.000073). (2)Inconsistent mutation results between paired cDNA and DNA samples occurred in t(8;21)AML, inv(16)AML and non-CBF-AML patients with the inconsistency rate of 36.4％(12/33), 27.2％(3/11) and 71.4％ (5/7), respectively. (3)The inconsistency rate was significantly higher in samples collected after treatment compared with those collected at diagnosis (72.7％vs 13.8％, P=0.00003). (4) All 5 serially monitored patients with c-KITmutation had inconsistency in mutation detection between cDNA and DNA samples during follow up. Conclusion cDNA improves the detection of c-KIT exon 17 mutation in AML patients compared with DNA, which is especially common after treatment.

Objective To explore the relationship between the increase of transmural dispersion of repolarization with ventricular arrhythmia,myocardial infarction degree and coronary events in elderly patients with myocardial infarction at T peak-T end interval in order to provide the guidance instruction for the assessment of prognosis of elderly myocardial infarction.Methods One hundred and twenty cases of senile myocardial infarction in the cardiology department of our hospital were selected,including 73 males and 47 females,the average age was (62.37 ± 11.34) years old.In addition,76 elderly cases of other heart disease were selected as the control group,including 42 males and 34 females,the average age was (59.56 ± 12.64) years old.The T peak-T end interval,dispersion and T peak-T end interval and dispersion after correcting the heart ratein different groups were analyzed.Results The T peak-T end interval,dispersion and T peak-T end interval and dispersion after correcting the heart rate had statistical differences between the control group and AMI group at admission and between the acute stage and recovery stage in the AMI group (P＜0.01);the T peak-T end interval and dispersion before and after correcting the heart rate had statistical differences among the patients with different ventricular arrhythmia (P＜0.01);the T peak-T end interval and dispersion before and after correcting the heart rate had statistical differences among the patients with anterior lateral wall,anterior wall,inferior wall,high lateral wall and multiple vessels infarction (P＜0.01);the case death after correcting the heart rate in different degrees and coronary event occurrence at admission had statistical difference (P＜0.01).Conclusion The T peak-T end interval has a close relation with malignant arrhythmia occurrence,which has an important predictive value for the short term prognosis in elderly patients with AMI.

Objective To study the cyclooxygenase (COX-2) ,nuclear factor-κB (NF-κB) and vascular endothelial growth factor (VEGF) expression and clinical significance in triple negative breast cancer .Methods From January 2010 to December 2014 ,breast cancer treatment in our hospital 100 patients for the study ,50 patients with triple negative breast cancer ,50 cases of non-triple neg-ative breast cancer was detected by immunohistochemistry ,100 cases of breast cancer were detected by immunohistochemistry in or-ganizations COX-2 ,NF-κB and VEGF expression of lymphatic vessel invasion and lymph vessel density and D2-40 mark detection , statistical analysis of relevant clinical and pathological information .Results COX-2 in triple negative and non-triple negative breast cancer were 76% ,70% ,the difference was not statistically significant (P>0 .05) ,VEGF triple negative breast cancer and non-triple negative breast lesions in cancerous lesions positive expression rates of 60% and 36% ,respectively ,which had significant difference (P<0 .05) .NF-κB in triple negative breast cancer lesions and non-triple negative breast lesions positive expression rate was 66%and 32% ,respectively ,which had significant difference (P< 0 .05) .Triple negative breast cancer NF-κB and VEGF ,COX-2 and VEGF expression was significantly positively related to breast cancer .Conclusion Radiation and chemotherapy is a major means of triple negative breast cancer postoperative treatment ,while inhibiting the NF-κB ,the expression of VEGF and COX-2 is expected to become the new target for treatment of triple negative breast cancer ,is worth exploring .

Objective To evaluate potentially inappropriate medication (PIM ) use of elderly diabetic patients in the out-patient department .Methods Beers criteria (2012 Edition) was used as the basis for evaluation of prescription in 2 000 elderly diabetic cases of our hospital (≥60 years old) with analysis of PIM use .Results There were on the average of 4 kinds of drugs per patient (mean age 76 year-old) .172 cases (8 .60% ) of the 2 000 cases were related to PIM dependent on medication use .17 (0 .85% ) cases were related to PIM dependent on disease conditions .23 (1 .15% ) cases were related to PIM with cau-tion in elder adults .Conclusion It was indicated a high prevalence of PIM by elderly diabetic patients .Given the potential se-verity of this problem ,further steps need to be implemented to prevent this occurrence .

Objective Ti investigate the applicatiin effect if clinical nursing pathway in cardiac valve replacement.Methods 60 patients with cardiac valve replacement were randimly divided inti experimental griup and cintril griup,with 30 patients in each griup.Clinical nursing pathway was applied thriugh periiperative nursing in the experimental griup,riutine nursing was applied in the cintril griup.Pistiperative hemirrhage,infectiin,pressure ulcer,keratitis,inci-dence if hypithermia cimplicatiin and satisfactiin were cimpared between the twi griups.Results Thriugh the applicatiin if clinical nursing pathway,the incidence if pistiperative cimplicatiins decreased significantly (P <0.05),pistiperative satisfactiin imprived ibviiusly (P <0.01). Conclusion Clinical nursing pathway can imprive nursing quality,reduce cimplicatiins and in-crease patients’satisfactiin,si it is wirthy if clinical applicatiin.

Objective Ti investigate the applicatiin effect if clinical nursing pathway in cardiac valve replacement.Methods 60 patients with cardiac valve replacement were randimly divided inti experimental griup and cintril griup,with 30 patients in each griup.Clinical nursing pathway was applied thriugh periiperative nursing in the experimental griup,riutine nursing was applied in the cintril griup.Pistiperative hemirrhage,infectiin,pressure ulcer,keratitis,inci-dence if hypithermia cimplicatiin and satisfactiin were cimpared between the twi griups.Results Thriugh the applicatiin if clinical nursing pathway,the incidence if pistiperative cimplicatiins decreased significantly (P <0.05),pistiperative satisfactiin imprived ibviiusly (P <0.01). Conclusion Clinical nursing pathway can imprive nursing quality,reduce cimplicatiins and in-crease patients’satisfactiin,si it is wirthy if clinical applicatiin.