Objective To investigate the distribution and antibiotic resistance of pathogens isolated from inpatients with urinary tract infections.Methods A retrospective analysis was carried out on 1033 strains of pathogens isolated from urine culture in patients with urinary tract infections in Zhejiang Xiaoshan Hospital during January 2009 and December 2011.Urine specimens were cultured with Uricult,and K-B method was used for drug susceptibility test,WHONET 5.6 software was used to analyse drug susceptibility test.Results Among 1033 strains of pathogens,681 (65.9％) were gram-negative bacteria,197 (19.1％) were gram-positive bacteria,and 155 (15.0％) were fungi.The three most prevalent bacteria were Escherichia coli (402 strains,38.9％),Klebsiella pneumoniae (74 strains,7.2％) and Candida albicans (64 strains,6.2％).60.7％ (244/402) of Escherichia coli and 45.9％ (34/74) of Klebsiella pneumoniae were extended-spectrum β-lactamases (ESBLs) positive.Escherichia coli and Klebsiella pneumoniae were susceptible to imipenem,meropenem,cefoperazone/sulbactam,piperacillin/tazobactam and amikacin.Enterococcus and staphylococcus were susceptible to vancomycin,linezolid and furadantin.Candida was sensitive to flucytosine,voriconazole and amphotericin B.Conclusion Gram-negative bacteria mainly E.coli is the predominant pathogen to urinary tract infections in this group of patients.Regular analysis and monitoring of pathogen species and drug resistance is important for rational use of antibiotics.

Intrahepatic cholangiocarcinoma is a highly invasive malignant tumor, and at present, surgical resection is the only effective way for cure. Lymph node metastasis makes it difficult to accurately judge the extent of radical resection, and no international consensus has been reached on the need for routine lymph node dissection and the extent of lymph node dissection. This article summarizes and analyzes the disputes and problems in preventive lymph node dissection for patients without lymph node metastasis before surgery, hoping to provide a reference for radical resection of intrahepatic cholangiocarcinoma.

Objective:To summarize the midterm to long-term outcomes and experiences of endovascular treatment (ET) of spontaneous isolated superior mesenteric artery dissection (SISMAD).Methods:The clinical data of 31 SISMAD patients from Jan 2011 to Dec 2019 treated with ET was retrospectively analyzed.Results:Successful ET was achieved in 29 patients with a technical success rate of 93.5%. A total of 36 self-expandable bare stents were planted in 28 patients and plain old balloon angioplastry (POBA) was performed in 1 patient. Abdominal pain disappeared within 24 hours in 89.3% of the patients after stenting. The rate of perioperative complication was 3.2%. There was no SMA dissection rupture bleeding, nor perioperative death occurred. The mean follow-up time was 53.5 (range, 6 to 110) months. There was no dissecting aneurysm formation, no SMA rupture and bleeding, and no stent rupture during the follow-up. The post ET 1-year, 3-year, and 5-year free from reintervention rate were 100%, 100%, and 91.7%, respectively.Conclusions:ET for SISMAD is safe and effective with satisfactory perioperative and midterm to long-term outcomes.

Intrahepatic cholangiocarcinoma (ICC) is the second most frequently occurring primary liver cancer. It has been reported that the causes of late diagnosis of ICC are a high degree of malignancy, early metastasis, and diffusion. Most patients visit the hospital because of jaundice or discomfort due to the surrounding compression. ICC commonly recurs after resection, and chemotherapy is not sensitive. Therefore, patients have a poor prognosis and a low survival rate. Currently, a multidisciplinary approach based on surgery is recommended for ICC patients who can undergo surgical excision, and local treatment combined with chemotherapy is the main com-prehensive treatment for patients with advanced ICC who cannot undergo surgical resection. In recent years, it has been found that immunotherapy can involve the autoimmune system to remove tumor cells, and molecular-targeted therapy can kill tumor cells by in-hibiting cell membrane surface molecules that promote tumorigenesis and development. At present, these two treatment modalities have become the research focus of ICC therapy, and progress has been made. The research status is reviewed in this paper.