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.

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 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 impact of national volume-based procurement policies on the use of medicines in treatment of benign prostatic hyperplasia （BPH） and provide data support for the rational clinical use of medicines in BPH treatment. Methods Data on the use of BPH treatment medications from 2019 to 2023 were extracted from the Chinese Medicine Economic Information Network （CMEI）, covering 892 hospitals （including 645 tertiary hospitals and 247 secondary hospitals）. The changes in various indicators, including the consumption sum, Defined daily doses （DDDs）, Defined daily dose cost （DDDc）, and the ranking ratio （B/A） of these drugs were analyzed and compared. Results From 2019 to 2023, due to the influence of relevant policies, the overall consumption sums of medicines used in the sample hospitals in BPH treatment showed a trend of decreasing first and then rising steadily. The DDDs showed an overall upward trend, while the DDDc demonstrated a gradual decline. Tamsulosin and finasteride consistently ranked first and second in DDDs. The B/A value for tamsulosin was significantly higher than that of other BPH treatment medications. Conclusion The implementation of national centralized drug volume-based procurement policies and other policies from 2019 to 2023 had effectively reduced the economic burden of patients with benign prostatic hyperplasia. Tamsulosin and finasteride, which had the highest B/A in the two categories of α-blockers and 5α-reductase inhibitors, dominated the market for BPH treatment. The clinical use of BPH treatment medications was relatively rational.

Alzheimer's disease(AD)is a preva-lent neurodegenerative disorder,characterized by the accumulation of beta-amyloid plaques,the phosphorylation of Tau proteins,and neuronal loss.As the global population ages,the incidence of AD is rising,and there is currently no effective cure.Herbal monomers have garnered interest due to their multifaceted pharmacological effects and low toxicity.This paper aims to provide a comprehen-sive overview of the mechanisms of Nrf2,NF-κB,PI3K/Akt,MAPK and other signalling pathways in the pathogenesis of AD.It also explores the modu-lation of these pathways by various TCM mono-mers,such as leptomeningine and tanshinone ⅡA,and details the research progress to date.For in-stance,Leptosine has been shown to activate Nrf2,thereby reducing oxidative stress,while Tanshinone ⅡA has been observed to inhibit the NF-κB path-way,leading to a reduction in inflammation.Not-withstanding the encouraging indications for the treatment of AD with TCM monomers,there are several challenges that must be addressed.Firstly,the precise mechanism of action remains to be ful-ly elucidated.Secondly,there are significant chal-lenges related to pharmacokinetics and bioavailabil-ity.Thirdly,the sample size of clinical studies is lim-ited and of variable quality.Fourthly,the quality control process is complex.Finally,interactions with other drugs must be taken into account.

Animal disease models are important biological tools for basic medical research.Establishing an ideal animal model is a critical prerequisite for acquiring reliable experimental data.By enabling molecular-level characterization,omics technologies can enhance the precision of animal model assessments,thereby improving the evaluation criteria.This review summarizes the current applications of omics in evaluating animal disease models,discusses their potential for quality control implementation,and proposes novel frameworks for standardized model validation.

Objective To explore the impact of enteral nutrition formula containing slow-release starch on blood glucose variability and prognosis in patients with severe acute pancreatitis(SAP).Methods A total of 204 SAP patients were enrolled and randomly divided into control group and ob-servation group using a random number table method,with 102 patients in each group.The control group received early enteral nutrition support with a standard enteral nutrition formula,while the ob-servation group received early enteral nutrition support with an enteral nutrition formula containing slow-release starch.Blood glucose variability indicators[largest amplitude of glycemic excursions(LAGE),standard deviation of blood glucose(SDBG),blood glucose coefficient of variation(BGCV),mean blood glucose(MBG),mean amplitude of glycemic excursions(MAGE),and time in range(TIR)]were compared between the two groups after treatment,along with clinical indicators during hospitalization,inflammatory markers[procalcitonin,C-reactive protein,interleukin-6(IL-6),and tumor necrosis factor-α(TNF-α)],and nutritional indicators(albumin,prealbumin)levels.Kaplan-Meier analysis was conducted to assess the prognosis of the two groups,and multivariate Cox regression analysis was performed to identify factors influencing prognosis.Results After treat-ment,the observation group exhibited lower levels of MBG,LAGE,SDBG,BGCV,MAGE,and a higher TIR compared with the control group(P＜0.05).During hospitalization,the observation group had a shorter duration of enteral nutritiontherapy,lower insulin usage,and lower incidence rates of multiple organ failure and infectious pancreatic necrosis compared with the control group(P＜0.05).After treatment,the observation group had lower levels of procalcitonin,C-reactive protein,IL-6,and TNF-α compared with the control group(P＜0.05);however,there were no statistically significant differences in albumin and prealbumin levels between the two groups(P＞0.05).Kaplan-Meier analysis showed that the cumulative mortality rate in the observation group was 12.75％,which was lower than the 17.65％in the control group(Log-rank x2=4.361,P=0.037).Multivariate Cox regression analysis revealed that TIR after treatment(HR=0.920;95％CI,0.869 to 0.974)was an independent protective factor for prognosis in SAPpatients(P＜0.05),while infectious pancreatic necrosis(HR=4.269;95％CI,1.922 to 9.482)was an inde-pendent risk factor for prognosis in SAP patients(P＜0.05).Conclusion Enteral nutrition formu-la containing slow-release starch helps stabilize blood glucose variability,control inflammatory mark-er levels,improve nutritional status,and prognosis in SAP patients.Both TIR and infectious pancre-atic necrosis are closely related to the prognosis of SAP patients.

To investigate the effectiveness of a self-developed intelligent medical record writing assistant in enhancing the efficiency of discharge record writing and improving the quality of discharge records, and to assess physicians' satisfaction with the assistant.

Objective:To analyze the abnormal results of health surveillance for workers exposed to dimethylformamide (DMF), and to provide reference for the formulation of relevant policies and standards.Methods:In April 2024, 11, 224 workers who participated in occupational health examinations in Jiangsu Province in 2023 were selected as the research subjects. Among them, 5, 615 people exposed to DMF were taken as the exposure group, and 5, 609 people not exposed to hepatotoxic chemicals were taken as the control group. By inquiring about related symptoms and combining with the occupational health examination of workers, the abnormal rates of blood pressure, blood routine, urine routine, electrocardiogram, liver function and B-ultrasonography of the survey subjects were statistically analyzed.Results:Compared with the control group, the abnormal detection rates of indicators such as blood pressure, blood routine, urine routine, and electrocardiogram were higher, and the difference was statistically significant P<0.05). The abnormal rates of various liver function indicators in the DMF exposure group were all higher than those in the control group. Among them, the abnormal rates of alanine aminotransferase, total protein, total bilirubin, and liver B-ultrasound in the exposure group were all higher than those in the control group, and the differences were statistically significant ( χ2=34.88, 42.49, 43.07, 55.28, P<0.001). Compared with the control group, the detected values of alanine aminotransferase, total protein and total bilirubin in the DMF exposure group were higher, and the difference was statistically significant ( F=5.367, 29.543, 37.766, P<0.05). In the DMF exposure group, the abnormal rates of liver function, electrocardiogram and liver B-ultrasound in men were much higher than those in women, and the differences were statistically significant ( χ2=185.05, 10.06, 141.94, P<0.001, P=0.002, P<0.001). Grouped by length of service, the abnormal detection rate of liver function was similar in each length of service segment, and the difference was not statistically significant ( χ2=0.34, P>0.05). The abnormal detection rate of electrocardiogram increased with the increase of length of service, among which it was the highest in the 10-20 years of service, and the difference was statistically significant ( χ2=7.26, P=0.026). The abnormal rate detected by liver B-ultrasound significantly increased with the increase of working years, and was the highest in the section of ≥20 years of working years. The difference was statistically significant ( χ2=44.15, P<0.001) . Conclusion:Occupational exposure to DMF can affect the health of workers, especially increasing the detection rate of abnormal liver function and liver B-ultrasound. It is very important to strengthen the occupational health monitoring of personnel exposed to DMF, improve the working environment, and pay attention to the chronic liver damage caused by DMF occupational exposure to workers.

Objective:To systematically analyze the incidence and influencing factors of frailty in elderly patients with hematologic malignancies.Methods:Research on frailty in elderly patients with hematologic malignancies was retrieved from Chinese and English databases such as China National Knowledge Infrastructure, Wanfang Data, PubMed, and Web of Science. The search period was from database establishment to August 23, 2024. Two researchers screened the included studies, conducted quality assessment, and extracted data. Meta-analysis was conducted using Stata 18 and RevMan 5.4.Results:A total of seven studies were included, encompassing 19 076 elderly hematologic malignancy patients, with a frailty incidence of 59% [95% CI (0.48, 0.69) ]. Meta-analysis revealed that age [ MD=4.31, 95% CI (3.67, 4.96) ], gender [ OR=0.88, 95% CI (0.83, 0.93) ], alcohol consumption [ OR=1.67, 95% CI (1.15, 2.44) ], self-care ability [ MD=-1.79, 95% CI (-3.17, -0.41) ], anemia [ OR=6.67, 95% CI (2.94, 15.14) ], infection [ OR=1.81, 95% CI (1.16, 2.84) ], and neuropathy [ OR=2.52, 95% CI (1.38, 4.61) ] were the influencing factors of frailty in elderly patients with hematologic malignancies. Conclusions:The incidence of frailty is high in elderly patients with hematologic malignancies. Elderly patients with hematologic malignancies who are older, female, consume alcohol, have low self-care ability, anemia, infections, and neuropathy are prone to frailty. Healthcare providers can conduct early screening and intervention for high-risk populations of frailty based on risk factors to improve the quality of life for elderly hematologic malignancy patients.