Acute pancreatitis (AP) is a life-threatening gastrointestinal disorder for which no effective pharmacological treatments are currently available. One of the pharmacological targets that merits further research is the neurokinin 1 receptor (NK1R), which is found on pancreatic acinar cells and responds to the neuropeptide substance P (SP) that participates in AP. Although a few studies have stated the involvement of SP/NK1R in neurogenic inflammation in AP development, the regulatory mechanism remains unclear. In this study, we found that following activation of NK1R by SP, β-arrestin1, a scaffold protein of NK1R, down-regulated transcription of Adss, Adsl, and Ampd in the purine nucleotide cycle, thereby inhibiting mitochondrial function through fumarate depletion. Interestingly, we identified magnolol as a new and natural NK1R inhibitor with a non-nitrogenous biphenyl core structure. It exhibited a beneficial effect on AP by restoring purine nucleotide cycle metabolic enzymes and fumarate levels. Our study not only provides new therapeutic strategies, leading compounds, and drug translation possibilities for AP, but also provides important clues for the study of downstream mechanisms driven by SP in other diseases.

Objective:To explore the clinical characteristics of biliary system diseases complicated by severe acute pancreatitis(SAP) and the risk factors.Methods:This is a retrospective cohort study. A retrospective analysis was conducted on the clinical data of 159 SAP patients admitted to the Department of Pancreatic and Biliary Surgery,the First Affiliated Hospital of Harbin Medical University from January 2019 to October 2024. There were 105 male cases, 54 female cases;aged (42.3±10.8)years (range:20 to 71 years). Grouping was performed according to the presence or absence of concurrent acute acalculous cholecystitis (AAC) and biliary stricture. There were 58 cases in the AAC group,including 40 males and 18 females;aged (43.8±10.6) years (range:28 to 71 years);101 cases in the non-AAC group,including 64 males and 37 females;aged (41.5±10.8) years (range:20 to 64 years);there were statistically significant differences between the two groups in terms of admission total bilirubin,Balthazar-CTSI score,fasting time,and the proportions of concurrent shock and sepsis (all P<0.05);the time from onset of SAP to diagnosis of AAC( M (IQR)) was 10.5 (13.3) days (range: 3 to 34 days). There were 15 cases in the biliary stricture group,including 13 males and 2 females;age (46.5±10.0) years (range:33 to 63 years);141 cases in the non-biliary stricture group,including 89 males and 52 females;age (41.9±10.8) years (range: 20 to 71 years); there were statistically significant differences between the two groups in the proportions of infected pancreatic necrosis,pancreatic head necrosis,and lower extremity venous thrombosis (all P<0.05);the time from the onset of SAP to the diagnosis of biliary stenosis in patients with biliary stenosis was 2.0 (3.0) months (range: 1 to 19 months). Univariate analysis was performed using independent sample t-test, Mann-Whitney U test, χ 2 test,or Fisher′s exact probability method,and variables with P<0.05 in univariate analysis were included in multivariate logistic regression analysis. The receiver operating characteristic (ROC) curve was used to analyze the diagnostic and predictive value of the multivariate logistic regression model for AAC and biliary stricture. Results:There were statistically significant differences in fasting time,Balthazar-CTSI score,admission total bilirubin,and the proportions of concurrent shock and sepsis between the AAC group and non-AAC group ( P<0.05). Multivariate logistic analysis showed that admission total bilirubin ( OR=1.033,95% CI: 1.010 to 1.058, P=0.004),Balthazar-CTSI score ( OR=1.276,95% CI: 1.036 to 1.572, P=0.022),fasting time ( OR=1.127,95% CI: 1.044 to 1.216, P=0.002), and sepsis ( OR=4.033, 95% CI: 1.419 to 11.462, P=0.009) were independent risk factors for AAC complicated by SAP. The area under the curve (AUC) of the ROC curve was 0.820 (95% CI: 0.752 to 0.888). There were statistically significant differences in the proportions of infected pancreatic necrosis,pancreatic head necrosis,and lower extremity venous thrombosis between the biliary stricture group and non-biliary stricture group ( P<0.05). Multivariate logistic analysis showed that infected pancreatic necrosis ( OR=7.376,95% CI:1.566 to 37.750, P=0.012) and pancreatic head necrosis ( OR=3.898,95% CI:1.180 to 12.877, P=0.026) were independent risk factors for biliary stricture complicated by SAP. The AUC of the ROC curve was 0.806 (95% CI:0.715 to 0.898). Conclusions:AAC typically occurs in the early stage of SAP,and biliary stricture usually occurs in the late stage of SAP. Admission total bilirubin,Balthazar-CTSI score,fasting duration,and concurrent sepsis are independent risk factors for AAC complicating SAP. Infected pancreatic necrosis and pancreatic head necrosis are independent risk factors for biliary stricture complicating SAP.

Objective:To explore the clinical characteristics of biliary system diseases complicated by severe acute pancreatitis(SAP) and the risk factors.Methods:This is a retrospective cohort study. A retrospective analysis was conducted on the clinical data of 159 SAP patients admitted to the Department of Pancreatic and Biliary Surgery,the First Affiliated Hospital of Harbin Medical University from January 2019 to October 2024. There were 105 male cases, 54 female cases;aged (42.3±10.8)years (range:20 to 71 years). Grouping was performed according to the presence or absence of concurrent acute acalculous cholecystitis (AAC) and biliary stricture. There were 58 cases in the AAC group,including 40 males and 18 females;aged (43.8±10.6) years (range:28 to 71 years);101 cases in the non-AAC group,including 64 males and 37 females;aged (41.5±10.8) years (range:20 to 64 years);there were statistically significant differences between the two groups in terms of admission total bilirubin,Balthazar-CTSI score,fasting time,and the proportions of concurrent shock and sepsis (all P<0.05);the time from onset of SAP to diagnosis of AAC( M (IQR)) was 10.5 (13.3) days (range: 3 to 34 days). There were 15 cases in the biliary stricture group,including 13 males and 2 females;age (46.5±10.0) years (range:33 to 63 years);141 cases in the non-biliary stricture group,including 89 males and 52 females;age (41.9±10.8) years (range: 20 to 71 years); there were statistically significant differences between the two groups in the proportions of infected pancreatic necrosis,pancreatic head necrosis,and lower extremity venous thrombosis (all P<0.05);the time from the onset of SAP to the diagnosis of biliary stenosis in patients with biliary stenosis was 2.0 (3.0) months (range: 1 to 19 months). Univariate analysis was performed using independent sample t-test, Mann-Whitney U test, χ 2 test,or Fisher′s exact probability method,and variables with P<0.05 in univariate analysis were included in multivariate logistic regression analysis. The receiver operating characteristic (ROC) curve was used to analyze the diagnostic and predictive value of the multivariate logistic regression model for AAC and biliary stricture. Results:There were statistically significant differences in fasting time,Balthazar-CTSI score,admission total bilirubin,and the proportions of concurrent shock and sepsis between the AAC group and non-AAC group ( P<0.05). Multivariate logistic analysis showed that admission total bilirubin ( OR=1.033,95% CI: 1.010 to 1.058, P=0.004),Balthazar-CTSI score ( OR=1.276,95% CI: 1.036 to 1.572, P=0.022),fasting time ( OR=1.127,95% CI: 1.044 to 1.216, P=0.002), and sepsis ( OR=4.033, 95% CI: 1.419 to 11.462, P=0.009) were independent risk factors for AAC complicated by SAP. The area under the curve (AUC) of the ROC curve was 0.820 (95% CI: 0.752 to 0.888). There were statistically significant differences in the proportions of infected pancreatic necrosis,pancreatic head necrosis,and lower extremity venous thrombosis between the biliary stricture group and non-biliary stricture group ( P<0.05). Multivariate logistic analysis showed that infected pancreatic necrosis ( OR=7.376,95% CI:1.566 to 37.750, P=0.012) and pancreatic head necrosis ( OR=3.898,95% CI:1.180 to 12.877, P=0.026) were independent risk factors for biliary stricture complicated by SAP. The AUC of the ROC curve was 0.806 (95% CI:0.715 to 0.898). Conclusions:AAC typically occurs in the early stage of SAP,and biliary stricture usually occurs in the late stage of SAP. Admission total bilirubin,Balthazar-CTSI score,fasting duration,and concurrent sepsis are independent risk factors for AAC complicating SAP. Infected pancreatic necrosis and pancreatic head necrosis are independent risk factors for biliary stricture complicating SAP.

Objective To monitor the susceptibility of clinical isolates to antimicrobial agents in healthcare facilities in major regions of China in 2023.Methods Clinical isolates collected from 73 hospitals across China were tested for antimicrobial susceptibility using a unified protocol based on disc diffusion method or automated testing systems.Results were interpreted using the 2023 Clinical & Laboratory Standards Institute (CLSI) breakpoints.Results A total of 445199 clinical isolates were collected in 2023,of which 29.0％ were gram-positive and 71.0％ 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) (MRSA,MRSE and MRCNS) was 29.6％,81.9％ and 78.5％,respectively.Methicillin-resistant strains showed significantly higher resistance rates to most antimicrobial agents than methicillin-susceptible strains (MSSA,MSSE and MSCNS).Overall,92.9％ of MRSA strains were susceptible to trimethoprim-sulfamethoxazole and 91.4％ of MRSE strains were susceptible to rifampicin.No vancomycin-resistant strains were found.Enterococcus faecalis had 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 93.1％ in the isolates from children and and 95.9％ in the isolates from adults.The resistance rate to carbapenems was lower than 15.0％ for most Enterobacterales species except for Klebsiella,22.5％ and 23.6％ of which were resistant to imipenem and meropenem,respectively .Most Enterobacterales isolates were highly susceptible to tigecycline,colistin and polymyxin B,with resistance rates ranging from 0.6％ to 10.0％.The resistance rate to imipenem and meropenem was 21.9％ and 17.4％ for Pseudomonas aeruginosa,respectively,and 67.5％ and 68.1％ for Acinetobacter baumannii,respectively.Conclusions Increasing resistance to the commonly used antimicrobial agents is still observed in clinical bacterial isolates.However,the prevalence of important crabapenem-resistant organisms such as crabapenem-resistant K.pneumoniae,P.aeruginosa,and A.baumannii showed a slightly decreasing trend.This finding suggests that strengthening bacterial resistance surveillance and multidisciplinary linkage are important for preventing the occurrence and development of bacterial resistance.

Objective To monitor the susceptibility of clinical isolates to antimicrobial agents in healthcare facilities in major regions of China in 2023.Methods Clinical isolates collected from 73 hospitals across China were tested for antimicrobial susceptibility using a unified protocol based on disc diffusion method or automated testing systems.Results were interpreted using the 2023 Clinical & Laboratory Standards Institute (CLSI) breakpoints.Results A total of 445199 clinical isolates were collected in 2023,of which 29.0％ were gram-positive and 71.0％ 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) (MRSA,MRSE and MRCNS) was 29.6％,81.9％ and 78.5％,respectively.Methicillin-resistant strains showed significantly higher resistance rates to most antimicrobial agents than methicillin-susceptible strains (MSSA,MSSE and MSCNS).Overall,92.9％ of MRSA strains were susceptible to trimethoprim-sulfamethoxazole and 91.4％ of MRSE strains were susceptible to rifampicin.No vancomycin-resistant strains were found.Enterococcus faecalis had 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 93.1％ in the isolates from children and and 95.9％ in the isolates from adults.The resistance rate to carbapenems was lower than 15.0％ for most Enterobacterales species except for Klebsiella,22.5％ and 23.6％ of which were resistant to imipenem and meropenem,respectively .Most Enterobacterales isolates were highly susceptible to tigecycline,colistin and polymyxin B,with resistance rates ranging from 0.6％ to 10.0％.The resistance rate to imipenem and meropenem was 21.9％ and 17.4％ for Pseudomonas aeruginosa,respectively,and 67.5％ and 68.1％ for Acinetobacter baumannii,respectively.Conclusions Increasing resistance to the commonly used antimicrobial agents is still observed in clinical bacterial isolates.However,the prevalence of important crabapenem-resistant organisms such as crabapenem-resistant K.pneumoniae,P.aeruginosa,and A.baumannii showed a slightly decreasing trend.This finding suggests that strengthening bacterial resistance surveillance and multidisciplinary linkage are important for preventing the occurrence and development of bacterial resistance.

By combing the development of tongue image,this paper analyzes the image features,advantages and disadvantages of different stages,and makes it clear that tongue image is an important carrier of clinical information of tongue diagnosis.It has been regarded as an important way to understand tongue image since the first monograph on tongue diagnosis.The article also analyzes the formation and development of modern digital and standardized tongue image,and explains the role and value of tongue image in the development of TCM tongue diagnosis terminology,providing reference for the formulation of international standards of TCM diagnosis terminology and the consensus reached by international experts.

Objective:Analysis of hepatitis B surface antigen negative donations, initial detection of reactivity followed by subsequent differential tests or repeat the infection status of non-discriminated reactive (NDR) unresponsive blood donors to explore whether different nucleic acid detection systems have differences in the detection of HBsAg -/NDR. Methods:The test result and reactivity rates of blood donor samples received from January 2020 to August 2022 were compared, and some samples were repeated for both nucleic acid testing systems, and the characteristics of the HBsAg -/HBV DNA + blood donors were analyzed. Results:Through the analysis of nucleic acid result from January 2020 to August 2022, repeated nucleic acid detection can improve the detection of HBsAg -/NDR blood donors, and the detection rate is offset in different cycle threshold valve ( Ct value) intervals or different sample absorbance to cut-off absorbance ratio ( S/ CO value) interval. Also grouping of Ct values or S/ CO values revealed that there was variability in detection rates between intervals in the two nucleic acid detection systems (PCR: X2=108.23, P<0.001, TMA: X2=40.95, P<0.001), mainly concentrated in Ct values less than 38.5 or S/ CO values between 10 and 15. And analysis of selected HBsAg -/HBV DNA + blood donor populations revealed that repeat nucleic acid testing was found for donors of different age ( X2=9.38, P=0.025), number of blood donations ( X2=22.52, P<0.001), occupation ( X2=24.92, P=0.002) and education level ( X2=10.37, P=0.016) significant differences, while there was no statistically significant difference for blood donors by gender ( X2=9.38, P>0.05), with far more males (67.50%) than females. Conclusions:For blood donors with a Ct value of less than 38.5, or an S/ CO value between 10 and 15, or a blood donor at the age of 41 to 50 years, another detection technology can be combined to improve the detection rate, reduce the potential risk of virus transmission of HBsAg -/NDR blood donors, and ensure the safety of clinical blood.

Objective:To analyze the situation of hepatitis B enzyme immunoassay-positive but nucleic acid negative infection (HBsAg ELISA(+ )/HBV-DNA(-)) among unpaid blood donors in Zhejiang Blood Center, and to explore the causes of inconsistency between enzyme immunoassay and nucleic acid result.Methods:A single nucleic acid test was performed on blood donors whose routine blood screening result were HBsAg-ELISA(+ )/HBV-DNA(-), and the test result of such blood donors were analyzed.Results:A total of 205 HBsAg-ELISA(+ )/HBV-DNA(-) samples were screened from 114017 blood donors from May to November, 2022. The proportion of male blood donors (0.14%) were significantly lower than that of the female blood donors (0.24%)( χ2= 14.761, P<0.005); the proportion of the first blood donor (0.32%) was significantly higher than that of the second blood donor (0.09%) ( χ2 = 78.781, P<0.005); the difference between different education levels is statistically significant ( χ2 =47.753, P<0.005). After single-person nucleic acid re-detection, the re-detection rate of nucleic acid in ELISA double-reagent positive samples was higher than that in single-reagent positive samples ( χ2=94.378, P<0.005); there was no significant difference between ELISA reagent 1 and reagent 2 in the detection rate of nucleic acid ( χ2 =0.163, P>0.005). There was no significant difference in the positive rate of secondary nucleic acid detection between the two nucleic acid detection systems ( χ2=0.626, P>0.005). Serological supplementary test showed that 11 HBV-DNA(+ ) samples showed two serological combination patterns after chemiluminescence detection, namely HBsAg(+ )/HBeAb(+ ) and HBeAb(+ ), most of which were HBsAg(+ )/HBeAb (+ ), a total of 10 cases, accounting for 90.91%, and only one case was HBeAb (+ ), accounting for 9.09%. The quantitative result of HBsAg showed that most of them were at low HBsAg level. Conclusions:After re-detection by single nucleic acid detection method, HBsAg-ELISA(+ )/HBV-DNA(-) samples of blood donors do have a certain proportion of HBV-DNA(+ ), but most of the samples were still HBV-DNA (-), additional experiments on HBV serological markers and HBV-DNA are needed to determine their true infection status and clarify the reasons for the inconsistency between enzyme immunoassay and nucleic acid test result. In addition, nucleic acid and HBsAg detection reagents with high sensitivity and specificity should be selected as far as possible in blood donor screening to ensure the accuracy of result.

Objective:To observe the effect of local excision under ultrasonography with immediate mammoplasty in granulomatous lobular mastitis.Methods:Fifty-three patients with granulomatous lobular mastitis admitted from Jan 2017 to Jul 2020 were retrospectively analyzed. Combined with sonographic findings and clinical manifestations, patients were divided into four types: type Ⅰ, single mass; Type Ⅱ, single mass located in one quadrant with one or no skin lesion; Type Ⅲ, multi-quadrant involved with one or no skin lesion; Type Ⅳ, multiple abscesses with multiple lesions in the skin. Twenty-five patients underwent wide local excision (control group); Twenty-eight patients underwent local excision under ultrasonography with immediate mammoplasty (experiment group). Patients with erythema nodosum or in type Ⅳ were given antibiotics and corticosteroid therapy preoperatively for 1 week and postoperatively for 5 days. The others went straight to surgery.Results:All patients were followed up for 1 year. In the experiment group, 28 patients had primary wound healing, and 3 patients had poor wound healing after operation (all were of type Ⅳ). The control group had 6 cases of recurrence(were of type Ⅲ and type Ⅳ). There was significant difference of the recurrence rate between the two groups (0 vs. 24%, χ 2=6.033, P=0.014), and the aesthetic effect of local excision under ultrasonography with immediate mammoplasty was better than that of wide local excision(93% vs. 68%, χ 2=5.330, P=0.020). Conclusion:The recurrence rate of local excision under ultrasonography with immediate mammoplasty is low, and with a satisfactory cosmetic effect.

Objective:To examine the effect of“lesion removal plus whole breast exploration and washing plus micro-plastic surgery”in granulomatous lobular mastitis.Methods:A single-center prospective randomized controlled study method was used to enroll patients diagnosed with granulomatous lobular mastitis for whom surgical procedures were projected from March 2017 to September 2019 at Department of Thyroid and Breast Surgery, Zhongnan Hospital of Wuhan University. The sample size is determined by the superiority test. Based on the literatures and the previous work, the two groups require 97 cases. Fifty-two patients underwent“lesion removal+whole breast exploration and washing plus micro-plastic surgery”(observation group). Forty-five cases underwent“empirical breast lesion resection plus fascia tissue flap plasty plus nipple and areola correction”(control group). The primary study endpoint is the recurrence rate, and the secondary study endpoints include surgical complications, incision healing time, and postoperative patient satisfaction. Independent sample t test, Wilcoxon rank-sum test, χ2 test and Fisher exact test were used for comparison between groups. Results:All procedures were completed successful, with no severe complications. All patients were followed up for (15.2±1.9) months (range: 12 to 24 months). There were no significant differences in incidence of postoperative complications (7.7% (4/52) vs. 6.7%(3/45), P=1), drainage time ((8.6±0.6) days vs. (8.4±0.8) days, t=1.921, P=0.053) and hospital stay ((7.7±0.6) days vs. (7.6±0.5) days, t=1.633, P=0.102) between the two groups. The recurrence rate of the observation group was lower significantly than that of the control group (3.8% (2/52) vs. 24.4%(11/45), χ2=8.819, P=0.003). The observation group had better cosmetic effects ( Z=-2.657, P=0.008) and patient satisfaction than control group ( Z=-5.730, P=0.000). Conclusion:The “lesion removal plus whole breast exploration and flushing plus micro-plastic surgery” has a good therapeutic effect and cosmetic value for patients with refractory granulomatous lobular mastitis.