Objective To investigate the short- and long-term prognoses and the risk factors affecting “textbook outcome” (TO) after laparoscopic pancreaticoduodenectomy (LPD) for pancreatic ductal adenocarcinoma (PDAC). Methods The clinical and follow-up data of patients diagnosed with PDAC and treated with LPD from January 2019 to December 2022 were retrospectively analyzed. The prognosis was compared between TO and non-TO groups, and univariate and multivariate logistic regression analyses were used to identify independent prognostic factors for TO. Results A total of 284 patients were enrolled in this study, including 185 cases in the TO group and 99 cases in the non-TO group. The 1-, 3- and 5-year overall survival (OS) rates of the TO and non-TO groups with PDAC were 87.3% vs. 85.9%, 52.5% vs. 38.4%, and 18.0% vs. 4.5%, respectively (P=0.020); the recurrence-free survival (RFS) rates were 74.1% vs. 65.7%, 27.1% vs. 21.0%, and 10.0% vs. 0%, respectively (P=0.042). Multivariate logistic regression analysis showed that operation time >360 min (OR=0.561, 95%CI: 0.321-0.979, P=0.042), intraoperative blood loss >400 ml (OR=0.392, 95%CI: 0.175-0.879, P=0.023), hard or tough texture of pancreas (OR=2.240, 95%CI: 1.247-4.022, P=0.007), and main pancreatic duct diameter >3 mm (OR=1.931, 95%CI: 1.126-3.312, P=0.017) were independent prognostic factors for TO. Conclusion After the learning curve, more than 60% of patients with PDAC can achieve TO after LPD. The chances of achieving TO are significantly reduced when the operation time >360 min, the intraoperative blood loss >400 ml, the texture of pancreas was soft, and the diameter of the main pancreatic duct >3 mm.

BACKGROUND: As an essential part of health services, rehabilitation is of great significance to improve the health and quality of life of the whole population. Accelerating aging calls for a significant expansion of rehabilitation services in China, but rehabilitation needs remain unclear. We conducted the study to explore the rehabilitation needs in China and project the trend of rehabilitation needs from 2020 to 2034. METHODS: The data of health conditions that might potentially benefit from rehabilitation were obtained from Global Burden of Disease (GBD) study. Estimated annual percentage changes (EAPCs) were calculated to quantify the trends of the age-standardized rates. Projections of rehabilitation needs were made until 2034 using Bayesian age-period-cohort analysis (BAPC). RESULTS: Approximately 460 million persons (33.3% of the total population) need rehabilitation in China, contributing to 63 million years lived with disabilities (YLDs) in 2019. The number of prevalent cases that need rehabilitation increased from around 268 (95% uncertainty interval [UI]: 257-282) million in 1990 to almost 460 (95% UI: 443-479) million in 2019, representing an increase of 71.3%. The highest contribution to the need for rehabilitation was musculoskeletal disorders with about 322 (95% UI: 302-343) million persons in seven aggregate disease and injury categories, and hearing loss with over 95 (95% UI: 84-107) million people among 25 health conditions. Based on the projection results, there will be almost 636 million people (45% of the total population) needing rehabilitation services in China by 2034, representing an increase of 38.3%. The rehabilitation needs of neoplasms, cardiovascular diseases, and neurological disorders are expected to increase significantly from 2019 to 2034, with increases of 102.3%, 88.8% and 73.2%, respectively. CONCLUSIONS The need for rehabilitation in China substantially increased over the last 30 years. It is predicted that over two in five people will require rehabilitation by 2034, thus suggesting the need to develop rehabilitation services that meet individuals' rehabilitation needs.
Humans ; China/epidemiology* ; Global Burden of Disease ; Female ; Male ; Musculoskeletal Diseases/epidemiology* ; Rehabilitation/trends* ; Quality of Life ; Middle Aged ; Aged ; Bayes Theorem

Cognitive impairment is the main clinical manifestation of many nervous system diseases such as stroke,multiple sclerosis,and neurodegeneration,and neuroinflammation is one of the key mechanisms for the onset of cognitive disorders.Chemokines are a class of highly conserved small-molecule secretory proteins that bind to the corresponding chemokine receptors located on cell mem-brane,activating downstream signaling pathways and playing an important role in cell migration,proliferation,differentiation,and sur-vival.In the central nervous system,chemokines and their receptors are involved in immune response and can exert a certain regulatory effect on neuroinflammation.This article reviews the research advances in chemokines and their receptors in cognitive disorders,in or-der to provide new insights and targets for the early diagnosis and treatment of related diseases.

Objective To investigate the short-and long-term prognoses and the risk factors affecting"text-book outcome"(TO)after laparoscopic pancreaticoduodenectomy(LPD)for pancreatic ductal adenocar-cinoma(PDAC).Methods The clinical and follow-up data of patients diagnosed with PDAC and treated with LPD from January 2019 to Dec-ember 2022 were retrospectively anal-yzed.The prognosis was compared bet-ween TO and non-TO groups,and uni-variate and multivariate logistic regre-ssion analyses were used to identify independent prognostic factors for TO.Results A total of 284 patients were enrolled in this study,including 185 cases in the TO group and 99 cases in the non-TO group.The 1-,3-and 5-year overall survival(OS)rates of the TO and non-TO groups with PDAC were 87.3%vs.85.9%,52.5%vs.38.4%,and 18.0%vs.4.5%,respectively(P=0.020);the recurrence-free survival(RFS)rates were 74.1%vs.65.7%,27.1%vs.21.0%,and 10.0%vs.0%,respectively(P=0.042).Multivariate logistic regression analysis showed that operation time>360 min(OR=0.561,95%CI:0.321-0.979,P=0.042),intraoperative blood loss>400 ml(OR=0.392,95%CI:0.175-0.879,P=0.023),hard or tough texture of pancreas(OR=2.240,95%CI:1.247-4.022,P=0.007),and main pancreatic duct dia-meter>3 mm(OR=1.931,95%CI:1.126-3.312,P=0.017)were independent prognostic factors for TO.Conclusion After the learning curve,more than 60%of patients with PDAC can achieve TO after LPD.The chances of achieving TO are significantly reduced when the operation time>360 min,the intraoperative blood loss>400 ml,the texture of pancreas was soft,and the diameter of the main pancreatic duct>3 mm.

Polycystic ovary syndrome（PCOS） and its resulting infertility is one of the common diseases of gynecology and reproductive endocrinology. The phosphatidylinositol 3-kinase/protein kinase B（PI3K/Akt） signaling pathway is relatively well-studied in the development of intervention in PCOS， and the experiments on PCOS in rats conducted by traditional Chinese medicine through this signaling pathway is also the main direction of mechanistic research. In this paper， 20 articles published in academic journals in the past 5 years were selected through the corresponding criteria， and the objective situation and existing problems of the selected research projects were analyzed from five aspects， namely， baseline data， modeling and treatment， grouping， evaluative indexes， and pharmacodynamic indexes. It is found that there were different degrees of problems in each research project， such as the observation indicators of modeling， criteria for judging the success of the model， the treatment period， the calculation of dosage of prescription/active ingredients and specific dosage were not clearly defined， which could easily lead the bias of the results or reduce the validity of experimental data. Based on this， the list of PCOS rat experimental research operations was formed， involving five categories of experimental rats， model construction， study implementation， outcome measures and analysis and report with a total of 21 operation lists， with a view to provide a reference for the subsequent PCOS experiments related to scientific research and helping to form high-quality results.

It is believed that there is a pathogenesis of yang deficiency in polycystic ovary syndrome （PCOS） infertility， and it is concluded that warm-yang method has a better effect in improving endometrial abnormality， enhancing the quality of follicles， correcting endocrine disorders， and resolving or alleviating clinical symptoms in PCOS infertility. Based on Yanghe Decoction （阳和汤）， a representative traditional Chinese medicine decoction for warming yang， Yanghe Xiaonang Decoction （阳和消囊汤） was formulated， combining with warm medicinals according to symptoms， and aerobic exercise was also advocated to help generate and develop yang qi， in order to provide ideas for clinical treatments.

Objective:To analyze the feasibility and safety of laparoscopic transhepatic section biliary exploration without T-tube drainage in the treatment of intrahepatic and extrahepatic bile duct stones.Methods:A retrospective analysis was conducted on the clinical data of 200 patients with intrahepatic and extrahepatic bile duct stones who underwent surgical treatment in Ankang Central Hospital from January 2020 to December 2024, including 79 males and 121 females, with the average age of (64.1±6.1) years. Among the 200 patients, 100 underwent laparoscopic hepatectomy and stone removal through transhepatic section cholangiography and choledochoscopy and were included in the observation group. Another 100 patients underwent laparoscopic hepatectomy, common bile duct incision, choledochoscopic exploration and stone removal, and T-tube drainage and were included in the control group. The intraoperative blood loss, operation time, postoperative hospital stay, hospitalization cost, postoperative pain score, time to get out of bed and move around, recovery time of intestinal function, abdominal drainage time, total complication rate, recurrence of stones, biliary tract infection, etc. were compared between the two groups.Results:The operation time, intraoperative blood loss, postoperative hospital stay and hospitalization cost of the observation group (165.8±29.9 min, 158.9±23.7 ml, 8.8±1.8 d and 46, 037.8±312.6 yuan, respectively) were all lower than those of the control group (220.3±37.5 min, 232.5±36.7 ml, 12.5±2.5 d, and 57 006.2±528.5 yuan) and the differences were statistically significant (all P<0.05). The postoperative pain score of the control group was (4.8±1.3) points, the postoperative time to get out of bed for activities was (1.6±0.5) d, the postoperative recovery time of intestinal function was (3.2±0.7) d, and the abdominal drainage time was (5.0±0.8) d. All were higher than those of the observation group (3.2±0.8) points, (0.8±0.2) d, (1.8±0.5) d, and (2.5±0.6) d, and the differences were statistically significant (all P<0.05). The total incidence of complications, recurrence of stones and infection rate of biliary tract in the observation group were 6.0%(6/100), 3.0%(3/100) and 2.0%(2/100) respectively, which were lower than those in the control group at 36.0%(36/100), 11.0%(11/100) and 9.0%(9/100). The differences were all statistically significant (all P<0.05). Conclusion:Laparoscopic transhepatic section biliary exploration without T-tube drainage for the treatment of intrahepatic and extrahepatic bile duct stones is feasible and safe.

This paper interprets the best practice guidelines for Practice Education in Nursing published by the Registered Nurses' Association of Ontario (RNAO), providing a scientific basis and insights for the development and progress of nursing students' practical education in China. The goal is to improve the quality of nursing students' clinical practice and enhance their clinical service capabilities.

Objective To observe the value of contrast-enhanced ultrasound(CEUS)for diagnosing splenic lymphoma.Methods Eighteen patients with pathologically confirmed splenic lymphoma were retrospectively collected.The routine ultrasound and CEUS manifestations of lesions were observed,and the diagnostic accuracy of these two methods for diagnosing splenic lymphoma were compared.Results Among 18 cases,conventional ultrasound showed single lesion in 8(8/18,44.44％)and multiple lesions in 10 cases(10/18,55.56％).The maximum diameter of lesions was(5.43±2.03)cm.For the largest lesion(target lesion)in 18 cases,5(5/18,27.78％)were found with very low echo,11(11/18,61.11％)with low echo and 2(2/18,11.11％)with mixed echo.The internal echo was uneven in 10 lesions(10/18,55.56％)while uniform in 8 lesions(8/18,44.44％),8(8/18,44.44％)shaped regularly but 10(10/18,55.56％)irregularly,15(15/18,83.33％)with clear and 3(3/18,16.67％)with unclear boundaries.CDFI showed blood flow signals in 10(10/18,55.56％)but not in 8 lesions(8/18,44.44％).During CEUS of 18 target lesions,no enhancement was detected in 1 lesion(1/18,5.56％),peripheral to central enhancement,central to peripheral enhancement and synchronous enhancement was observed in 12(12/18,66.67％),2(2/18,11.11％)and 3 lesions(3/18,16.67％),respectively,which at the peak mainly presented as low(8/18,44.44％)or high(7/18,38.89％)enhancement,while no enhancement or equal enhancement was noticed in 1(1/18,5.56％)and 2(2/18,11.11％)lesions,respectively.Uniform and uneven distribution of contrast agents was found in 5(5/18,27.78％)and 12(12/18,66.67％)lesions,respectively,while 1 lesion(1/18,5.56％)without distribution of contrast agents.Annular and dendritic enhancement in peripheral area was observed in 7(7/18,38.89％)and 5 lesions(5/18,27.78％),while nodular enhancement(3/18,16.67％)or no enhancement(3/18,16.67％)was noticed each in 3 lesions.The scope enlarged after enhancement in 1 lesion(1/18,5.56％),while 17 lesions(17/18,94.44％)did not increase significantly.In the late stage of enhancement,16 lesions(16/18,88.89％)showed low enhancement,while 2(2/18 11.11％)showed no enhancement.Among 18 target lesions,CEUS showed blood supply in 17 lesions(17/18,94.44％),while no blood supply was found in 1 lesion(1/18,5.56％).CEUS correctly diagnosed 11 cases of splenic lymphoma,with diagnostic accuracy of 61.11％(11/18),higher than that of conventional ultrasound([4/18,22.22％],P=0.020).Conclusion CEUS had important clinical value for diagnosing splenic lymphoma.

Objective To observe the value of contrast-enhanced ultrasound(CEUS)for diagnosing splenic lymphoma.Methods Eighteen patients with pathologically confirmed splenic lymphoma were retrospectively collected.The routine ultrasound and CEUS manifestations of lesions were observed,and the diagnostic accuracy of these two methods for diagnosing splenic lymphoma were compared.Results Among 18 cases,conventional ultrasound showed single lesion in 8(8/18,44.44％)and multiple lesions in 10 cases(10/18,55.56％).The maximum diameter of lesions was(5.43±2.03)cm.For the largest lesion(target lesion)in 18 cases,5(5/18,27.78％)were found with very low echo,11(11/18,61.11％)with low echo and 2(2/18,11.11％)with mixed echo.The internal echo was uneven in 10 lesions(10/18,55.56％)while uniform in 8 lesions(8/18,44.44％),8(8/18,44.44％)shaped regularly but 10(10/18,55.56％)irregularly,15(15/18,83.33％)with clear and 3(3/18,16.67％)with unclear boundaries.CDFI showed blood flow signals in 10(10/18,55.56％)but not in 8 lesions(8/18,44.44％).During CEUS of 18 target lesions,no enhancement was detected in 1 lesion(1/18,5.56％),peripheral to central enhancement,central to peripheral enhancement and synchronous enhancement was observed in 12(12/18,66.67％),2(2/18,11.11％)and 3 lesions(3/18,16.67％),respectively,which at the peak mainly presented as low(8/18,44.44％)or high(7/18,38.89％)enhancement,while no enhancement or equal enhancement was noticed in 1(1/18,5.56％)and 2(2/18,11.11％)lesions,respectively.Uniform and uneven distribution of contrast agents was found in 5(5/18,27.78％)and 12(12/18,66.67％)lesions,respectively,while 1 lesion(1/18,5.56％)without distribution of contrast agents.Annular and dendritic enhancement in peripheral area was observed in 7(7/18,38.89％)and 5 lesions(5/18,27.78％),while nodular enhancement(3/18,16.67％)or no enhancement(3/18,16.67％)was noticed each in 3 lesions.The scope enlarged after enhancement in 1 lesion(1/18,5.56％),while 17 lesions(17/18,94.44％)did not increase significantly.In the late stage of enhancement,16 lesions(16/18,88.89％)showed low enhancement,while 2(2/18 11.11％)showed no enhancement.Among 18 target lesions,CEUS showed blood supply in 17 lesions(17/18,94.44％),while no blood supply was found in 1 lesion(1/18,5.56％).CEUS correctly diagnosed 11 cases of splenic lymphoma,with diagnostic accuracy of 61.11％(11/18),higher than that of conventional ultrasound([4/18,22.22％],P=0.020).Conclusion CEUS had important clinical value for diagnosing splenic lymphoma.