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.

In order to explore the application value of the suction connecting tube combined with gastroscope visual blood clot removal device in the blood clot removal surgery of patients with upper gastrointestinal bleeding, the clinical data of 18 patients with upper gastrointestinal bleeding treated with this device at the Department of Gastroenterology, General Hospital of Central Theater Command from January 2023 to June 2024 were retrospectively analyzed to observe its therapeutic effect. The results showed that the operation time of the device for 18 patients ranged 4-16 minutes (8.2±3.1 min). The total volume of blood clots and blood cleared ranged 120-500 mL (221.1±97.1 mL). Blood and blood clots were successfully removed in a single procedure in 17 patients, with a success rate of 94.4% (17/18). Hemostasis was unsuccessful in 1 patient with gastric cancer and bleeding under endoscopy, and subsequent surgical treatment was performed. No serious complication occurred. The suction connecting tube combined with gastroscope visual blood clot removal device can effectively remove blood and blood clots in the digestive tract, with high success rate, which is worth promotion and application.

Objective To investigate the changes of 8 lipid biomarkers,4 complement biomarkers and albu-min(ALB)in serum of patients with colorectal cancer(CRC)and their value in CRC screening.Methods A total of 120 newly diagnosed CRC patients in Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine from August 2022 to January 2024 were selected as the CRC group,and 110 healthy subjects were selected as the healthy control(HC)group.A total of 8 lipid biomarkers including total cholesterol(TC),tri-glyceride(TG),high density lipoprotein cholesterol(HDL-C),low density lipoprotein cholesterol(LDL-C),apolipoprotein(Apo)A1,ApoA2,ApoB and ApoE,4 complement biomarkers including complement C3(C3),complement C4(C4),complement C1q(C1q)and complement C1 inhibitor(C1INH),3 intestinal tumor markers including carcinoembryonic antigen(CEA),carbohydrate antigen(CA)125,CA19-9,and ALB levels were detected in serum of each group.Independent sample t test and Mann-Whitney U test were used for com-parison between groups,and stepwise Fisher discriminant algorithm was used to fit each marker to establish a screening model.Receiver operating characteristic curve was used to analyze the diagnostic efficacy of each marker and the model.Results The serum levels of ApoA1,ApoA2,HDL-C,TC and ALB in CRC group were lower than those in HC group(P<0.05),while the serum levels of C1INH,C4 and CEA were higher than those in HC group(P<0.05).Among the single biomarkers,ALB had the highest diagnostic efficiency,the area under the curve(AUC)was 0.909,the sensitivity was 77.50%,and the specificity was 94.55%.The AUC of the screening model composed of ApoA2,C1INH and ALB was 0.978,the sensitivity was 91.67%,and the specificity was 98.86%.The diagnostic efficacy was higher than any single biomarker.Conclusion ApoA2,C1INH and ALB are abnormally expressed in the serum of CRC patients.The screening model composed of ApoA2,C1INH and ALB can provide reference for CRC screening and clinical auxiliary diagnosis.

OBJECTIVES: To analyze the changes in disease burden and risk factors of atrial fibrillation/atrial flutter (AF/AFL) in China and globally from 1990 to 2021 to provide epidemiological evidence for developing effective preventive measures for AF/AFL in China. METHODS: Based on data from the Global Burden of Disease Study 2021, we analyzed sex- and age-specific AF/AFL burden metrics across 204 countries or territories. Age-standardized incidence rate (ASIR), prevalence, mortality rate (ASMR), and disability-adjusted life-years (DALYs) rate (ASDR) were calculated. Joinpoint regression was employed to compute average annual percentage changes (AAPC) in trends. The risk factors were systematically evaluated and further validated using Mendelian randomization analysis. RESULTS: From 1990 to 2021, China experienced an increase in ASIR of AF/AFL (from 42.63 to 44.93 per 100 000), contrasting with the global decline. While China's ASMR decreased (from 4.93 to 4.33 per 100 000), global ASMR rose slightly (from 4.24 to 4.36 per 100 000). China's ASDR remained stable at 93.29 per 100 000, whereas global ASDR increased marginally (100.81 to 101.40 per 100 000). Significant sex disparities were observed: males showed higher ASIR and ASDR, while females exhibited greater ASMR and ASDR. China had higher incidence and prevalence but lower mortality and DALY rates compared to global averages. In 2021, the key risk factors for AF/AFL included elevated systolic blood pressure, high BMI, smoking, alcohol use, high-sodium diet, and low temperature. Gender-specific patterns emerged: smoking was predominant in males, whereas high BMI disproportionately affected females. CONCLUSIONS AF/AFL incidence and prevalence keep increasing in China, and its large population base and demographic aging pose significant public health challenges. Maintaining healthy lifestyle habits, including smoking cessation, alcohol moderation, and a low-sodium diet can help to lower AF/AFL incidence, and regular screenings is crucial for its early detection and treatment.
Humans ; China/epidemiology* ; Risk Factors ; Atrial Flutter/epidemiology* ; Atrial Fibrillation/epidemiology* ; Mendelian Randomization Analysis ; Male ; Female ; Global Burden of Disease ; Incidence ; Prevalence ; Middle Aged ; Disability-Adjusted Life Years ; Aged

In order to explore the application value of the suction connecting tube combined with gastroscope visual blood clot removal device in the blood clot removal surgery of patients with upper gastrointestinal bleeding, the clinical data of 18 patients with upper gastrointestinal bleeding treated with this device at the Department of Gastroenterology, General Hospital of Central Theater Command from January 2023 to June 2024 were retrospectively analyzed to observe its therapeutic effect. The results showed that the operation time of the device for 18 patients ranged 4-16 minutes (8.2±3.1 min). The total volume of blood clots and blood cleared ranged 120-500 mL (221.1±97.1 mL). Blood and blood clots were successfully removed in a single procedure in 17 patients, with a success rate of 94.4% (17/18). Hemostasis was unsuccessful in 1 patient with gastric cancer and bleeding under endoscopy, and subsequent surgical treatment was performed. No serious complication occurred. The suction connecting tube combined with gastroscope visual blood clot removal device can effectively remove blood and blood clots in the digestive tract, with high success rate, which is worth promotion and application.

Objective:To establish an early clinical prediction model for patients with chronic liver disease who are coinfected with hepatitis E virus (HEV), and quickly evaluate the probability of severe hepatitis in patients.Methods:A retrospective analysis was conducted on 87 patients with chronic liver diseases who were hospitalized at the Third Affiliated Hospital of Sun Yat-sen University from May 2018 to September 2023. Clinical features and laboratory indexes were analyszed and patients were classified to severe (TBIL >171 μmol/L with PTA <40%) and non-severe (TBIL <171 μmol/L with PTA >40%) groups. and Independent factors identified using LASSO regression were incorporated into a novel nomogram to identify patients at high risk of severe hepatitis in the early stages. The performance of the nomogram was evaluated using the area under the curve and the mean absolute error of the calibration curve.Results:Significant difference was observed in the serum total bile acid (TBA) level between the severe group [240.00 (183.30, 268.70) umol/L] and the non-severe group [93.40 (20.10, 271.70) μmol/L, U=269.00, P=0.002]. Additionally, the levels of apolipoprotein A1 (APOA1) [0.32 (0.18, 0.48) g/L] and uric acid (UA) [156.15 (117.00, 202.00) μmol/L] were significantly lower in the severe group compared to the non-severe group (APOA1: [0.77 (0.63, 1.06) g/L, U=71.00, P<0.001]; UA: [334.05 (243.70, 401.00) μmol/L, U=83.00, P<0.001]). The researchers developed a nomogram, which incorporated two independent factors (APOA1 and UA) and an additional variable (TBA), exhibiting a strong predictive ability, with an area under the curve (AUC) of 0.963 (95% confidence interval: 0.927-0.998) and a well-fitted calibration curve. Positive and negative predictive values of 94.0% and 88.2% were calculated, and a nomogram score of 129 or greater was considered indicative of a higher likelihood of developing severe illness. Conclusions:This nomogram offers a rapid and accurate means of evaluating the probability of severe illness in patients with chronic liver disease after overlapping infection with HEV, which can accurately and effectively predict the risk of severe illness in patients.

Cerebral small vessel disease (CSVD) is a series of diseases originating from pathological changes in cerebral microvessels, with a high prevalence in the population of advanced age. CSVD may significantly increase the risk of various neurological disorders, including cognitive impairment and stroke. With the development and application of advanced imaging techniques such as functional magnetic resonance imaging (fMRI) and diffusion tensor imaging (DTI), there has been a deeper understanding of the brain function and microstructural changes in patients with CSVD. This article reviews some new indicators and analysis methods of fMRI and DTI in CSVD research, and elaborates on their correlation with patient clinical manifestations.

In the context of the emphasis on the claims of multiple subjects in fourth-generation educational evaluation, the subjective experience of students has gradually become one of the key contents of educational evaluation. However, there is still a vague understanding of the conceptual source, specific definition, and measurement indicators of the student experience theory, and a more systematic theoretical system has not yet been formed. With the UE user experience thinking in the business field as the core meta-theory, this article integrates value-added evaluation and the idea of three-source flow, elaborates on the core concept connotation of compound student experience teaching evaluation, and builds a five-dimensional evaluation model for student experience with "aesthetic experience, interactive experience, emotional experience, behavioral experience, and discursive experience" as the first-level indicators based on literature research, expert interviews, and multi-round group discussions. It is hoped that student evaluation will force teachers to improve the contents and form of teaching and help to achieve breakthrough reform of the teaching system as a whole.

Objective:To understand the cognition of the family caregivers of terminal cancer patients on digital health intervention, to clarify their actual needs, and to analyze the obstacles to their acceptance of digital health intervention, so as to develop a digital health intervention plan for the family caregivers of terminal cancer patients.Methods:From February 2024 to March 2024, the family caregivers of 16 patients with terminal cancer in Hunan Cancer Hospital Pain Hospice Ward were selected by objective sampling, who met the inclusion and exclusion criteria were interviewed in a semi-structured manner about the cognition and needs of digital health intervention, and the interview contents were sorted and analyzed using the Colaizzi7 step method.Results:A total of 16 family caregivers of terminal cancer patients, 4 males and 12 females, aged 26-55 years, were interviewed. Four themes were distilled from the interview results: family caregivers of terminally cancer patients agree on the importance of digital health interventions; lack of awareness of digital health interventions; expectations of digital health interventions; and possible confounders affecting digital health interventions.Conclusions:The family caregivers of terminal cancer patients had insufficient awareness of digital health intervention, but all showed affirmation of the development of digital health intervention services. It is recommended to actively improve the basic conditions of digital health services, strengthen publicity, raise the level of awareness of the family caregivers, and positively overcome the relevant interfering factors, so as to gradually promote the development of digital health services.