Neoadjuvant therapy for pancreatic cancer is undergoing a paradigm shift from conventional chemotherapy to precision medicine. This expert forum discussed cutting-edge issues in pancreatic cancer neoadjuvant therapy from an evidence-based perspective, incorporating the latest clinical research advances. We focused on innovative directions including immunotherapy combination strategies, liquid biopsy applications, artificial intelligence (AI)-assisted decision making, and individualized precision medicine. We proposed forward-looking concepts such as molecular subtyping-guided individualized treatment strategies, multi-omics integrated efficacy prediction models, and standardized multidisciplinary collaborative care systems. These innovative concepts will drive pancreatic cancer neoadjuvant therapy toward more precise and effective directions.

Objective:To investigate the clinical value of adjuvant therapy after conversion resection for pancreatic cancer.Methods:The retrospective cohort study was conducted. The clinicopathological data of 173 patients with pancreatic cancer who underwent surgical resection after neoadjuvant and/or induction therapy in The First Affiliated Hospital of Naval Medical University from January 2019 to December 2021 were collected. There were 107 males and 66 females, aged (59±9)years. Observation indicators: (1) comparison of clinicopathological data between patients with and without adjuvant therapy after conversion resection for pancreatic cancer; (2) analysis of influencing factors for prognosis of pancreatic cancer after conversion resection; (3) follow-up and prognosis; (4) survival benefit of adjuvant therapy in subgroup populations. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the t test. Measurement data with skewed distribution were represented as M( Q1, Q3), and comparison between groups was conducted using the Mann-Whitney U 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 non-parameter rank sum test. The Graphpad prism 8 software was used to draw survival curves, the Kaplan-Meier method was used to calculate survival time and survival rates, and the Log-Rank test was used for survival analysis. The COX proportional hazards regression model was used for univariate and multivariate analyses. Interaction analysis was used to determine the benefit of adjuvant therapy in subgroup populations. Results:(1) Comparison of clinicopathological data between patients with and without adjuvant therapy after conversion resection for pancreatic cancer. Of the 173 pancreatic cancer patients, there were 108 cases with adjuvant therapy after conversion resection and 65 cases without adjuvant therapy after conversion resection, respectively. Age and body mass index were (58±9)years and (23.2±2.8)kg/m 2 in patients with adjuvant therapy, versus (61±8)years and (22.2±2.8)kg/m 2 in patients without adjuvant therapy, showing significant differences in the above indicators between them ( t=-2.036, 2.200, P<0.05). (2) Analysis of influencing factors for prognosis of pancreatic cancer after conversion resection. Results of multivariate analysis showed that CA19-9 normalization, pathological N staging, degree of tumor differentiation and postoperative adjuvant therapy were independent factors influencing overall survival time in pancreatic cancer patients receiving conversion resection ( hazard ratio=1.598, 1.541, 2.004, 2.571, 95% confidence interval as 1.041-2.453, 1.021-2.327, 1.288-3.118, 1.721-3.843, P<0.05). (3) Follow-up and prognosis. All 173 patients were followed up for 24.5(5.0,52.0)months. The postoperative median overall survival time of 173 patients was 28.9(5.7,51.9)months, and the 1-, 2-, 3-year overall survival rates were 90%, 59%, 40%, respectively. Of 2019, 2020, 2021, the proportions of patients receiving adjuvant therapy after conversion resection were 62.8%(27/43), 57.7%(30/52) and 65.4%(51/78) respectively. The postoperative median overall survival time was 42.2(8.8,49.7)months in patients with adjuvant therapy after conversion resection, versus 20.4(5.7,51.9)months in patients without adjuvant therapy after conversion resection, showing a significant difference between them ( χ2=29.893, P<0.05). (4) Survival benefit of adjuvant therapy in subgroup populations. Results of interaction analysis showed that in subgroup populations with CA19-9 normalization, pathological stage N0, pathological stage N1-2, moderate to well differentiated tumors, adjuvant therapy after conversion resection can bring a better survival benefit for patients with pancreatic cancer ( adjustment hazard ratio=0.220, 0.300, 0.410, 0.340, 95% confidence interval as 0.120-0.400, 0.170-0.560, 0.240-0.690, 0.210-0.690). Conclusions:Postoperative adjuvant therapy is an independent factor influencing overall survival time in pancreatic cancer patients receiving conversion resection. Adjuvant therapy after conversion resection can bring additional survival benefits for pancreatic cancer, particularly for patients who respond favorably to neoadjuvant and/or induction therapy.

Objective:To adapt and build Guideline for Management of Antipsychotic Medication Adherence in Schizophrenics which is suitable for China's national conditions. Methods:Guided by the ADAPTE guideline adaptation method, and combined with the current status of antipsychotic medication adherence of schizophrenics in China, we systematically searched the existing antipsychotic medication adherence management guidelines and systematic evaluation, and evaluated, selected, and integrated the best evidence. We conducted usability research on the adapted guidelines, conducted discussions among experts and external evaluations to form the final version of the guideline.Results:A total of 9 guidelines and 14 systematic evaluations were included. The adapted guideline contained 30 pieces of evidence, including 4 themes of policy and decision support, medication adherence assessment, medication adherence management plan, and medication adherence management measures.Conclusions:The adapted guideline for nursing management of antipsychotic medication adherence in schizophrenics can provide evidence support for clinical nursing practice.

Objective:To understand the clinical application status of evidence of foot nursing education in high-risk diabetic patients, analyze the obstacle factors and formulate intervention strategies, so as to provide reference for the transformation of evidence-based evidence into clinical practice.Methods:From April to June 2019, a total of 12 nurses and 49 high-risk diabetic foot patients in Department of Endocrinology in Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine were selected as research objects by the convenient sampling method. A total of 15 pieces of evidence of foot nursing education for high-risk diabetic foot patients were introduced. 10 review indicators were formulated to carry out clinical status review according to the evidence and obstacle factor analysis was carried out according to the review results.Results:The clinical compliance rate of the 10 review indicators was 0-43%, of which the standardized scores of foot care knowledge, belief and behavior in high-risk diabetic foot patients were 68.32%, 61.00% and 59.44%, respectively. The standardized scores of foot nursing knowledge, belief and behavior were 75.97%, 54.17% and 52.78%, respectively. The main obstacle factors included lack of evidence-based nursing practice plan for high-risk diabetic nursing education, lack of introduction of high-risk diabetic foot screening tools, lack of multi-disciplinary foot nursing education, single form of health education, low level of knowledge, faith and practice of nurses' foot nursing education, lack of training and lack of attention by nurses to effect evaluation.Conclusions:Evidence of foot nursing education in high-risk diabetic foot patients has not been effectively translated into clinical practice. Evidence-based practice programs should be constructed according to intervention strategies to shorten the gap between clinical practice and evidence.

Objective:To study on the association between vasoactive-inotropic score(VIS) and mortality of total arch replacement in Stanford type A aortic dissection(TAAD) patients.Methods:Data of TAAD patients admitted from January 2018 to November 2018 were analyzed retrospectively. According to the inclusion and exclusion criteria, 187 patients were finally included in the analysis. 30-day mortality was calculated and the patients were divided into death group(18 cases) and non-death group(169 cases). The VIS at each time point and perioperative indexes of the two groups were compared. The value of VIS in predicting mortality was analyzed.Results:The 30-day mortality was 9.63%(18/187). The operation time, cardiopulmonary bypass time, ventilator assistance time, the incidence of tracheotomy and major postoperative complications in the death group were significantly higher than those in the non-death group( P<0.05). VIS of death group was significantly higher than that of non-death group( P<0.05). At each time point, the area under ROC curve(AUC) of VIS was greater than 0.500( P<0.05), among which AUC of ICU 48 h VIS was the largest(0.817), and the best cut-off point of ICU 48 h VIS was determined to be 9, sensitivity 61.1%, specificity 92.3%. Logistic regression analysis showed that ICU 48 h VIS was an independent risk factor for predicting the death of total arch replacement in TAAD patients( OR=1.465, 95% CI: 1.194-1.796, P<0.001). Conclusion:When ICU 48 h VIS≥9, the risk of death was increased in patients with total arch replacement of TAAD. VIS may be a useful reference index for predicting the mortality of total arch replacement in TAAD patients in the early postoperative period.

Objective To compare Vecchietti′s and Davydov′s laparoscopic techniques for vagino-plasty in patients with Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome. Methods From January 2010 to December 2013, 13 patients underwent the Vecchietti′s laparoscopic procedure (Vecchietti group), and 15 patients underwent the Davydov′s laparoscopic procedure (Davydov group). Intraoperative parameters and postoperative results were compared. Results Both of the two groups were successfully treated. The neovagina in both groups were wide with good elasticity, softness and smoothness. The operation time [(39± 7) versus (73 ± 11) minutes], the intraoperative blood loss [(21 ± 6) versus (63 ± 10) ml], the anal exsufflation time after surgery [(19 ± 5) versus (28 ± 6) hours] and the recovery period of body temperature after surgery [(35 ± 10) versus (46 ± 10) hours] of the Vecchietti group were less than those of the Davydov group (all P<0.05). But the neovagina length [(8.8±0.5) versus (9.6±0.5) cm] was shorter and the Female Sexual Function Index scale score [26.8 ± 2.0 versus 28.5 ± 1.7] was lower in the Vecchietti group than those in the Davydov group (all P<0.05). The postoperation hospital duration didn′t reached statistical difference between the two groups [(7.5 ± 0.9) versus (7.1 ± 0.7) days, P>0.05]. No intraoperative complication occurred. After surgery, 2 patients were found vaginal polyps and 8 patients were suffered from pain in the Davydov group, while all patients were suffered from pain in the Vecchietti group. Conclusions Both Vecchietti′s and Davydov′s laparoscopic techniques are simple, safe and effective surgical methods for vaginal reconstruction. In contrast, the Vecchietti′s procedure is more time efficient and minimally invasive, while the Davydov′s procedure can get less pain, longer vagina and higher sexual satisfaction.

OBJECTIVE To evaluate the detect method of neopterin(Npt) by enzyme-linked immunosorbent assay(ELISA) and discuss the application of Npt in the viral encephalitis.METHODS The Npt was detected by ELISA.The methodology was investigated by sensitivity,precision,rate of recovery,interference and reference value.The npt was detected by ELISA assay in peripheral blood of 50 healthy people,30 cases of cerebrospinal fluid in children with viral encephalitis and 12 cases of cerebrospinal fluid in the control group.RESULTS In this method,within-run CVs were 4.94% and 5.55%;between-run CVs were 5.99% and 6.57%.The sensitivity was 1.08 nmol/L;the rate of recovery was 95.8-107.8%.Various indexes of the methodology coincided with the requirements of clinical laboratory.The reference value of serum Npt was 0-7.84 nmol/L.The Npt of cerebrospinal fluid was(34.09 ? 36.34) nmol/L in the viral encephalitis group,and(4.55 ? 2.89)nmol/L in the control group,and the Npt of cerebrospinal fluid in patient was significantly higher than that in control group(P