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.

Intravascular large B-cell lymphoma (IVLBCL), a rare subtype of non-Hodgkin lymphoma, is classified as an independent subtype of extranodal diffuse large B-cell lymphoma (DLBCL) in the 2008 World Health Organization (WHO) Classification (Turner et al., 2010). The 5th edition of the World Health Organization (WHO 2022) classification of hematolymphoid tumors retains this subtype (Alaggio et al., 2022). IVLBCL, which is characterized by neoplastic lymphocyte proliferation within the lumen of small blood vessels, tends to invade organs, such as the nervous system, skin, bone marrow (BM), and lung (D'Angelo et al., 2019; Satoh et al., 2019; Vásquez et al., 2019; Fukami et al., 2020).
Humans ; Antineoplastic Combined Chemotherapy Protocols/therapeutic use* ; Lymphoma, Large B-Cell, Diffuse/drug therapy* ; Vascular Neoplasms/therapy*

Objective To investigate the expression levels of microRNA-34a(miR-34a),β-catenin and pro-grammed death receptor-1(PD-L1)in cancer tissues of patients with cervical cancer(CC)and their correla-tion with patients' prognosis.Methods A total of 83 patients with CC admitted to Yuncheng Central Hospital Affiliated to Shanxi Medical University from June 2021 to January 2024 were selected as the research objects.General data,CC tissue and adjacent normal tissue samples of all patients were collected.The mRNA expres-sion levels of miR-34a,β-catenin and PD-L1 in CC tissues and adjacent normal tissues were detected by fluo-rescence quantitative PCR and compared.The expression levels of β-catenin and PD-L1 in CC tissues and adja-cent normal tissues were detected by immunohistochemistry.Multivariate Logistic regression analysis was used to analyze the influencing factors of prognosis in CC patients.Receiver operating characteristic(ROC)curve was used to analyze the predictive value of miR-34a,β-catenin and PD-L1 expression levels in CC pa-tients with poor prognosis.Results Compared with adjacent normal tissues,the expression level of miR-34a of the CC tissues was lower,while the expression levels of β-catenin and PD-L1 were higher(P＜0.05).The positive expression rates of β-catenin and PD-L1 protein in CC tissues were higher than those of adjacent nor-mal tissues(89.16％vs.10.84％,78.31％vs.20.48％,x2=101.807,55.526,P＜0.05).There were no sig-nificant differences in age and body mass index(BMI)between the good prognosis group and the poor progno-sis group(t=1.508,1.820,both P＞0.05),while there were significant differences in International Federa-tion of Gynecology and Obstetrics(FIGO)stage and differentiation degree between the two groups(x2=8.451,9.115,both P＜0.05).Compared with the good prognosis group,the expression level of miR-34a of the poor prognosis group was lower,while the expression levels of β-catenin and PD-L1 were higher(P＜0.05).Multivariate Logistic regression analysis showed that increased expression of miR-34a was an protective factor for poor prognosis in CC patients,while the increased expression levels of β-catenin and PD-L1,Ⅱ a and Ⅱ b FIGO staging and low differentiation were independent risk factors for poor prognosis in CC patients(P＜0.05).ROC curve analysis showed that miR-34a,β-catenin and PD-L1 all had certain predictive value for the poor prognosis of CC patient,and the area under the curve(AUC)of the single detection was 0.765,0.836 and 0.797,respectively.The AUC of the combined detection was 0.914(Z=2.631,2.331,2.571,P=0.009,0.020,0.010).Conclusion The expression levels of miR-34a,β-catenin and PD-L1 mRNA affect the prognosis of CC patients.Increased expression of miR-34a is an protective factor for poor prognosis in CC patients,in-creased β-catenin and PD-L1 expressions are independent risk factors for poor prognosis in CC patients,and all three factors can be used as biomarkers to predict poor prognosis in CC patients,and the combined detection of the three has the highest prognostic value.

Objective To investigate the expression and prognostic value of serum receptor for advanced glycation end products(RAGE)and CXC-chemokine ligand 16(CXCL16)in patients with sepsis complicated with acute respiratory distress syndrome(ARDS).Methods A total of 234 patients with sepsis diagnosed and treated in a hospital from January 2019 to January 2022 were selected as the study subjects,and were divided into 82 patients with sepsis complicated with ARDS(ARDS group)and 152 patients with sepsis without ARDS(non-ARDS group)according to whether the subjects were complicated with ARDS.ARDS group was divided into survival group(n=50)and death group(n=32)according to the survival status within 28 days of admission.Another 60 healthy subjects who underwent physical examination in the same period were se-lected as the control group.Serum RAGE and CXCL16 levels were detected by enzyme-linked immunosorbent assay.Pearson correlation analysis of serum RAGE and CXCL16 levels with sequential organ failure assess-ment(SOFA)score,acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ)score and oxygenation index in patients with sepsis and ARDS.Multivariate Logistic regression analysis of prognostic factors of sep-sis complicated with ARDS.The predictive value of serum RAGE and CXCL16 on the prognosis of sepsis complicated with ARDS patients was analyzed by receiver operating characteristic curve.Results The serum RAGE and CXCL16 levels in ARDS group were higher than those in non-ARDS group and control group,and the serum RAGE and CXCL16 levels in non-ARDS group were higher than those in control group,the differ-ence was statistically significant(P＜0.05).Compared with the survival group,the mechanical ventilation time,intensive care unit stay time,procalcitonin,SOFA score,APACHE Ⅱ score,serum RAGE,CXCL16 lev-els were higher in the death group,and the oxygenation index was lower,with statistical significance(all P＜0.05).The serum RAGE level in patients with sepsis complicated with ARDS was positively correlated with SOFA score and APACHE Ⅱ score(r=0.603,0.671,P＜0.05).Serum CXCL16 levels were positively corre-lated with SOFA score and APACHE Ⅱ score(r=0.655,0.707,P＜0.05).Serum RAGE and CXCL16 were negatively correlated with oxygenation index(r=-0.712,-0.683,P＜0.05).Multi-factor Logistics regres-sion analysis showed that serum RAGE and CXCL16 were independent risk factors for death within 28 days of admission in patients with sepsis complicated with ARDS.The area under the curve(AUC)of combined de-tection of serum RAGE and CXCL16 for predicting death within 28 days of admission in patients with sepsis complicated with ARDS was 0.882,which was higher than that of single index detection of serum RAGE and CXCL16,and the difference was statistically significant(Z=4.450,4.906,P＜0.05).Conclusion The com-bined detection of serum RAGE and CXCL16 is helpful to evaluate the clinical prognosis of sepsis complicated with ARDS patients.

Objective To investigate the changes of OAT expression in bone cells in chronic renal failure(CRF)and involved mechanism,and to explore the effect of OAT expression on bone metabolism.Methods Ra-ndomly divide the rats into a control group(n=6)and a model group(n=6).The model group established a rat chronic renal failure model using"single nephrectomy+adenine gavage"method,and the red blood cell(RBC)and hemoglobin(HGB)of the rat body were measured using a blood routine analyzer;Measure indicators such as creatinine(Cr),urea nitrogen(BUN),uric acid(UA),blood calcium(Ca2+),and blood phosphorus(P3+)using a fully automated biochemical analyzer;Pathological examination of rat kidneys;X-ray examination of rat tibia;Immunohistochemical examination of bone tissue OAT1 level.Results The bone density of the model group rats is lower than that of the control group;The calcium and phosphorus metabolism of rats in the model group was in metabolic disorder,and the OAT1 value of bone tissue binding was much lower than that of the control group(P= 0.0018),which was statistically significant.(P=0.0018)Conclusion Chronic renal failure affected the binding ability of OAT1 in bone tissue,leading to the metabolic disorder for calcium absorption and phosphorus metabolism,thus aggravating renal osteodystrophy(P<0.05).

Objective:To evaluate the predictive value of neutrophil free fatty acid receptor 3 (FFAR3) for secondary infection in patients with severe acute pancreatitis (SAP).Methods:① Biological information analysis: peripheral blood microarray data sets related to acute pancreatitis (GSE194331) were obtained from the Gene Expression Omnibus (GEO), including data from 32 healthy adults, 52 patients with mild acute pancreatitis, 20 patients with moderate-to-severe acute pancreatitis, and 10 patients with SAP. The original data of GSE194331 dataset were downloaded for quality control, pruning, quantification, annotation and difference analysis, and the different genes were obtained. ② Clinical study: a prospective observational study was conducted. Forty-five SAP patients admitted to the critical care medicine department of the Eastern Theater Command General Hospital of the Chinese People's Liberation Army from January to November 2022 were enrolled, and they were divided into infected group and non-infected group according to whether secondary infection occurred during intensive care unit (ICU) stay. At the same time, 10 healthy adult volunteers were enrolled as control. Peripheral blood of subjects in each group was collected, neutrophils were isolated, and FFAR3 mRNA expression was detected by real-time fluorescence quantitative reverse transcription-polymerase chain reaction (RT-PCR). Spearman correlation method was used to analyze the correlation between neutrophil FFAR3 mRNA expression and secondary infection in SAP patients. Multivariate Logistic regression analysis was used to evaluate whether neutrophil FFAR3 mRNA expression was a risk factor for secondary infection in SAP patients. Receiver operator characteristic curve (ROC curve) was plotted to evaluate the predictive value of neutrophil FFAR3 mRNA expression on secondary infection in SAP patients.Results:① Results of biological information analysis: the analysis of GSE194331 dataset showed that 301 genes were differentially expressed in peripheral blood cells between healthy controls and patients with pancreatitis. By biological function analysis, 8 biological functions involved in immune response were obtained, and 44 differential expressed genes were enriched in these 8 biological functions. The results of cell distribution analysis showed that there were 21 differential expressed genes expressions on neutrophils significantly higher than other immune cells, and the gene related to lipid metabolism was FFAR3. These results indicated that FFAR3 expression was closely related to the occurrence and development of SAP. ② Clinical study results: out of the 45 SAP patients, 24 developed into secondary infection during ICU stay, 21 did not develop into secondary infection. The expression of neutrophil FFAR3 mRNA in SAP patients with secondary infection was significantly higher than that in SAP patients without secondary infection and healthy controls [2 -ΔΔCt: 3.8 (3.0, 4.2) vs. 1.4 (1.1, 2.7), 1.0 (0.8, 1.1), both P < 0.05]. Spearman correlation analysis showed that neutrophil FFAR3 mRNA expression was positively correlated with secondary infection in SAP patients ( r = 0.799, P < 0.001). Multivariate Logistic regression analysis showed that increased FFAR3 mRNA expression was an independent risk factor for secondary infection in SAP patients [odds ratio ( OR) = 17.212, 95% confidence interval (95% CI) was 3.004-98.613, P = 0.001]. ROC curve analysis showed that the area under the ROC curve (AUC) of neutrophil FFAR3 mRNA expression for predicting secondary infection in SAP patients was 0.856 (95% CI was 0.750-0.981, P < 0.001). When the optimal cut-off value was 2.37, the sensitivity was 95.83% and the specificity was 76.19%. According to the optimal cut-off value of neutrophil FFAR3 mRNA expression (2.37) for predicting secondary infection in SAP patients obtained by ROC curve analysis, 45 SAP patients were divided into two groups for subgroup analysis. It suggested that the incidence of secondary infection in SAP patients with FFAR3 mRNA expression level ≥2.37 was significantly higher than that in SAP patients with FFAR3 mRNA expression level < 2.37 [82.14% (23/28) vs. 5.88% (1/17)], and the difference was statistically significant ( P < 0.01). Conclusion:The expression of FFAR3 mRNA in neutrophils is closely related to the secondary infection in SAP patients, and monitoring its level can effectively predict the secondary infection in SAP patients.

Abdominal hemorrhage is one of the most severe complications of infected pancreatic necrosis(IPN).Common causes of bleeding include arterial,venous,coagulopathy-related,and iatrogenic factors.The preferred treatment for IPN complicated by abdominal bleeding is digital subtraction angiography(DSA)combined with transcatheter arterial embolization.For patients with repeated negative DSA results,ineffective conservative treatment,or acute bleeding with extremely unstable vital signs,emergency surgery is required.The surgery should follow the principles of damage control.Preventing bleeding in IPN patients is a top priority for future work.This article,based on the diagnostic and treatment experience of the authors'team as well as relevant research findings,shares thoughts and discusses with fellow professionals regarding the diagnosis and treatment of IPN with abdominal hemorrhage.

Background and Aims:The occurrence of duodenal fistula following infected pancreatic necrosis(IPN)in the later stage of treatment for acute necrotizing pancreatitis presents a significant clinical challenge.It often leads to severe complications such as difficulty in administering enteral nutrition,electrolyte imbalances,abdominal bleeding,and worsening infections.This study was performed to explore the efficacy of enteral nutrition combined with step-up drainage in treating IPN complicated by duodenal fistula and to share single-center experience. Methods:The clinical data of 66 patients with IPN complicated by duodenal fistula who underwent enteral nutrition combined with step-up drainage in the Severe Pancreatitis Treatment Center of the Nanjing Eastern Theater General Hospital between January 2018 and December 2020 were retrospectively analyzed. Results:Among the 66 patients,the median time from disease onset to the development of duodenal fistula was 53(32-75)d.In 46 cases(69.7％),suspicious digestive fluid-like discharge was observed from drainage tube or double-lumen tube.The diagnosis and location of the duodenal fistula were confirmed in 49 patients(74.2％)through fistulography,while the remaining cases were confirmed via surgical exploration or endoscopy.The duodenal fistulas were mainly located in the horizontal part(33.3％)or descending part(50.0％)of the duodenum.Nutritional access was safely established through nasojejunal tube in 61 patients(92.4％),while 5 patients(7.6％)required surgery to establish the access.Twenty patients(30.3％)experienced secondary abdominal bleeding,and 14 patients(21.2％)died.Among the 52 patients who recovered,49(94.2％)healed through step-up drainage,while 3(5.8％)required surgery due to delayed healing.Of the 49 patients who underwent non-surgical treatment,10(20.4％)achieved fistula closure through drainage tube,and 39(79.6％)achieved closure through continuous lavage drainage via double-lumen tube.The median healing time for duodenal fistula in non-surgically treated patients was 41(29-80)d. Conclusion:Patients with IPN complicated by duodenal fistula are in a critical condition.Enteral nutrition combined with step-up drainage is an effective treatment for these patients.

Objective:To investigate the clinical characteristics of first-episode and recurrent acute hypertriglyceridemic pancreatitis (HTGP).Methods:The retrospective cohort study was con-ducted. The clinical data of 313 patients with HTGP admitted to 26 medical centers in China in the Chinese Acute Pancreatitis Clinical Research Group (CAPCTG)-PERFORM database from November 2020 to December 2021 were collected. There were 219 males and 94 females, aged 38(32,44)years. Of the 313 patients, 193 patients with first-episode HTGP were allocated into the first-episode group and 120 patients with recurrent HTGP were allocated into the recurrent group. Observation indica-tors: (1) propensity score matching and comparison of general data of patients between the two groups after matching; (2) comparison of severity and prognosis in the course of disease within 14 days between the two groups; (3) the association between recurrent HTGP and the risk of persistent organ failure (POF); (4) follow-up. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the independent sample t test. Measurement data with skewed distribution were represented as M( Q1, Q3), and comparison between groups was conducted using the Wilcoxon rank sum test. Count data were expressed as absolute numbers or percentages, and comparison between groups was conducted using the chi-square test. Comparison of ordinal data was conducted using the Wilcoxon rank sum test. The Kaplan-Meier method was used to plot the cumulative recurrence rate curve and Log-Rank test was used for survival analysis. The Logistic regression model was used for multivariate analysis, and continuous variables were converted into categorical variables according to the mean value or common criteria. Propensity score matching was performed by 1∶1 nearest neighbor matching method, with caliper value of 0.02. Paired t test or Wilcoxon rank sum test and McNemar′s test were used for comparison between matched groups. Results:(1) Propensity score matching and comparison of general data of patients between the two groups after matching. Of the 313 patients,208 cases were successfully matched, including 104 cases in the first-episode group and 104 cases in the recurrent group. After propensity score matching, there was no significant difference in demographic characteristics, severity of illness scores and laboratory test between the two groups ( P>0.05). The elimination of gender, acute physiology and chornic health evaluation (APACHE) Ⅱ score, computed tomography severity index score, systemic inflammatory response syndrome score, sequential organ failure assessment score, apolipoprotein E, C-reactive protein, creatinine, lactic acid dehydrogenase, procal-citonin confounding bias ensured comparability between the two groups. (2) Comparison of severity and prognosis in the course of disease within 14 days between the two groups. There were signifi-cant differences in POF and local complications between the first-episode group and the recurrent group ( P<0.05). (3) The association between recurrent HTGP and the risk of POF. Results of uncor-rected univariate analysis showed that there was no association between recurrent HTGP and the risk of POF ( odds ratio=0.78, 95% confidence interval as 0.46-1.30, P>0.05). Results of multivariate analysis after adjusting for covariates such as gender, age, APACHE Ⅱ score, C-reactive protein, triglyceride and total cholesterol showed that compared with first-episode HTGP, recurrent HTGP was associated with a higher risk of POF ( odds ratio=2.22, 95% confidence interval as 1.05-4.71, P<0.05). Results of subgroup analysis showed that age<40 years was associated with an increased risk of POF ( odds ratio=3.31, 95% confidence interval as 1.09-10.08, P<0.05). (4) Follow-up. Twelve of the 313 patients died during hospitalization, including 9 cases in the first-episode group and 3 cases in the recurrent group. The rest of 301 surviving patients, including 184 cases in the first-episode group and 117 cases in the recurrent group, were followed up for 19.2(15.5, 21.9)months. Results of follow-up showed that for 184 survived patients of the first-episode group, 164 cases were followed up and 24 cases experienced recurrence, for 117 survived patients of the recurrent group,29 cases experienced recurrence, showing a significant difference between the two groups ( χ2=4.67, P<0.05). Conclusion:Compared with first-episode HTGP, patients with recurrent HTGP are more prone to POF and local complications, and are more prone to recurrence after discharge. The risk of POF in recurrent HTGP patients is 2.22 times that of those with first-episode, and the risk is higher in patients with age <40 years.

Objective To quantitatively analyze and evaluate the content of rehabilitation policy for people with disabilities in China. Methods This study focused on ten national policies of disability rehabilitation issued from 2021 to 2023.It employed text mining techniques to process policy texts and constructed a policy modeling consistency index model for dis-ability rehabilitation policies in China.The relevant policies were evaluated and analyzed quantitatively. Results The disability rehabilitation policies in China were relatively comprehensive in terms of policy transparency,op-erational mechanisms and policy nature.However,there was still a need for optimization in terms of policy per-spectives,target groups,incentive mechanisms,and other aspects. Conclusion The overall quality of disability rehabilitation policy texts at the national level in China is relatively good.There is a need to further enhance the predictability of policy objectives,clarify the responsibilities and division of labor among various departments,and improve policy incentive mechanisms in future policy formulation,which will further refine China's disability rehabilitation policy system and contribute to high-quality develop-ment of the disability cause.