Objective To explore the risk factors affecting T-tube sinus tract formation after common bile duct exploration and T-tube drainage by spiral computed tomography (SCT)examination.Methods The clinical data of 465 patients undergoing common bile duct exploration and T-tube drainage at the Affiliated Hospital of Youjiang Medical College for Nationalities from May 2011 to December 2013 were retrospectively analyzed.The residual stones and biliary stricture were detected by T-tube cholangiography,and the T-tube sinus tract formation in all the patients was detected by SCT examination at postoperative week 2.The factors affecting sinus tract formation were analyzed,including gender,age,albumin (Alb),C-reactive protein,alanine transaminase (ALT),total bilirubin (TBil),hemoglobin (Hb),surgical method,effusion around T tube,reoperation,diabetes.Univariate analysis was done using the chi-square test.Multivariate analysis was done using the Logistic regression.Results T-tubes of 465 patients were clear without residual stones.T-tube in the 397 patients was removed when the sinus tract formation was confirmed by CT examination at postoperative week 2.T-tubes in other patients were removed when the sinus tract formation was detected by CT reexamination at postoperative week 4.In univariate analysis,Alb,surgery method,effusion around T-tube and diabetes were important factors affecting T-tube sinus tract formation (x2 =50.750,7.671,19.022,15.373,P ＜ 0.05).Alb ＜ 30 g/L,laparoscopic surgery,effusion around T-tube and diabetes were independent risk factors affecting T-tube sinus tract formation in multivariate analysis [Odds ratio =1.135,0.493,0.262,0.363; 95％ confidence interval:1.061-1.214,0.280-0.865,0.104-0.658,0.156-0.843,P ＜ 0.05].Conclusions The T-tube removal is determined according to the sinus tract formation by CT examination at week 2 after common bile duct exploration and T-tube drainage.Alb ＜ 30 g/L,laparoscopic surgery,effusion around T-tube and diabetes are independent risk factors affecting T-tube sinus tract formation.

Objective To analyze the incidence of urinary stone formation in the contralateral kidney of unilateral nephrectomy patients.Methods 1048 patients,including 596 males and 452 females,underwent unilateral nephrectomy from June 2010 to June 2016.Their age ranged from 16-87 years old (mean 58.7 years old).532 patients combined with components of metabolic syndrome and 213 patients with metabolic syndrome.164 patients had a previous history of urolithiasis.The incidence of urinary stone formation in the contralateral kidney after nephrectomy was recorded and analyzed.The urolithiasis incidences in different gender,age,comorbidity and history of urolithiasis patients after uninephrectomy were compared.Results All patients were followed up within 0.5 to 6 years (mean 3.2 years).89 patients suffered from urinary stones in the contralateral kidney after uninephrectomy.The incidence of urinary stone formation in the contralateral kidney was 8.5％ (89/1048),which was higher than that in general population of China.1％-5％.The urolithiasis incidence was 9.1％ (54/596)in male patients and 7.7％ (35/452)in female patients after nephrectomy.The incidence of urinary stone formation was 8.6％ (3/35)in patients aged under 30 years old,12.5％ (34/272) in patients aged 30-49 years old,7.3％ (37/504) in patients aged 50-69 years old,6.3％ (15/237)in patients aged 70 and over.The incidence of urinary stone formation was 12.2％ (65/532) in patients with components of metabolic syndrome after nephrectomy and 19.7％ (42/213) in patients with metabolic syndrome,while the incidence was 4.7％ (24/516)in patients without components of metabolic syndrome.In patients with history of urolithiasis,the incidence was up to 30.5％ (50/164) after nephrectomy,while 4.4％ (39/884)in patients without history of urolithiasis.Conclusions The incidence of urinary stone formation in the contralateral kidney of uninephrectomy patients was higher,especially in patients with metabolic syndrome or urolithiasis history.Patients after unilateral nephrectomy are more vulnerable to urolithiasis.

Objective To monitor the susceptibility of clinical isolates to antimicrobial agents in tertiary hospitals in major regions of China in 2022.Methods Clinical isolates from 58 hospitals in China were tested for antimicrobial susceptibility using a unified protocol based on disc diffusion method or automated testing systems.Results were interpreted using the 2022 Clinical &Laboratory Standards Institute(CLSI)breakpoints.Results A total of 318 013 clinical isolates were collected from January 1,2022 to December 31,2022,of which 29.5％were gram-positive and 70.5％were gram-negative.The prevalence of methicillin-resistant strains in Staphylococcus aureus,Staphylococcus epidermidis and other coagulase-negative Staphylococcus species(excluding Staphylococcus pseudintermedius and Staphylococcus schleiferi)was 28.3％,76.7％and 77.9％,respectively.Overall,94.0％of MRSA strains were susceptible to trimethoprim-sulfamethoxazole and 90.8％of MRSE strains were susceptible to rifampicin.No vancomycin-resistant strains were found.Enterococcus faecalis showed significantly lower resistance rates to most antimicrobial agents tested than Enterococcus faecium.A few vancomycin-resistant strains were identified in both E.faecalis and E.faecium.The prevalence of penicillin-susceptible Streptococcus pneumoniae was 94.2％in the isolates from children and 95.7％in the isolates from adults.The resistance rate to carbapenems was lower than 13.1％in most Enterobacterales species except for Klebsiella,21.7％-23.1％of which were resistant to carbapenems.Most Enterobacterales isolates were highly susceptible to tigecycline,colistin and polymyxin B,with resistance rates ranging from 0.1％to 13.3％.The prevalence of meropenem-resistant strains decreased from 23.5％in 2019 to 18.0％in 2022 in Pseudomonas aeruginosa,and decreased from 79.0％in 2019 to 72.5％in 2022 in Acinetobacter baumannii.Conclusions The resistance of clinical isolates to the commonly used antimicrobial agents is still increasing in tertiary hospitals.However,the prevalence of important carbapenem-resistant organisms such as carbapenem-resistant K.pneumoniae,P.aeruginosa,and A.baumannii showed a downward trend in recent years.This finding suggests that the strategy of combining antimicrobial resistance surveillance with multidisciplinary concerted action works well in curbing the spread of resistant bacteria.