Complications such as pancreatic leakage,biliary leakage and abdominal infection may occur after pancreaticoduodenectomy.Previous surgeons have recommended routine preventive drainage for early detection and treatment of complications.In recent years,with the rise of the idea of accelerated rehabilitation,this view has been questioned and disputed.In this paper,five aspects of drainage tube placement after pancreaticoduodenectomy,drainage mode,drainage placement area,when to remove the drainage tube,and re-catheter drainage after surgery are reviewed.

Objective To explore the impact of the duration of protracted abstinence(PA)treatment on the level of impulsivity among heroin addicts and to analyze the mediating effect of impulsive cognition between abstinence duration and impulsive behavior.Methods Thirty-six heroin addicts undergoing PA treatment(PA group)and forty matched healthy controls(HC)(HC group)were recruited.Demographic information was collected via questionnaires,and impulsive cognition assessments were conducted.Participants completed the GO/NOGO task to collect data on impulsive behavior.Intergroup differences were compared using the independent sample t-test,and multiple linear regression analysis and mediating effect analysis were performed on the PA group.Results The PA group exhibited significantly higher scores on motor impulsivity,non-planning impulsivity,and total impulsivity compared to the HC group.Additionally,the PA group demonstrated significantly increased NOGO error rate during the GO/NOGO task compared to the HC group(P＜0.001).Multiple linear regression analysis revealed that abstinence duration had a significant negative impact on total impulsivity and non-planning impulsivity(P＜0.001).Mediating effect analysis found a partial mediation effect of total impulsivity between abstinence duration and NOGO error rate(P＜0.001).Conclusion The PA treatment has a significant impact on the level of impulsivity among heroin addicts.Impulsive cognition play a partial mediating role between abstinence duration and impulsive behavior.These results provide an important theoretical and practical basis for optimizing PA treatment programs.

Objective To examine the changing prevalence and antimicrobial resistance profiles of Burkholderia cepacia in 52 hospitals across China from 2015 to 2021.Methods A total of 9 261 strains of B.cepacia were collected from 52 hospitals between January 1,2015 and December 31,2021.Antimicrobial susceptibility of the strains was tested using Kirby-Bauer method or automated antimicrobial susceptibility testing systems according to a unified protocol.The results were interpreted according to the breakpoints released in the Clinical & Laboratory Standards Institute(CLSI)guidelines(2023 edition).Results A total of 9 261 strains of B.cepacia were isolated from all age groups,especially elderly patients.The proportion was 11.1％(1 032 strains)in children,significantly lower than the proportion in adults.About half(46.5％,4 310/9 261)of the strains were isolated from patients at least 60 years old and 42.3％(3 919/9 261)of the strains were isolated from young adults.Most isolates(71.1％)were isolated from sputum and respiratory secretions,followed by urine(10.7％)and blood samples(8.1％).B.cepacia isolates were highly susceptible to the five antimicrobial agents recommended in the CLSI M100 document(33rd edition,2023).B.cepacia isolates showed relatively higher resistance rates to meropenem and levofloxacin.However,the resistance rates to ceftazidime,trimethoprim-sulfamethoxazole,and minocycline remained below 8.1％.The percentage of B.cepacia strains resistant to levofloxacin was the highest compared to other antibiotics in any of the three age groups(from 12.4％in the patients＜18 years old to 20.6％in the patients aged 60 years or older).Conclusions B.cepacia is one of the clinically important non-fermenting gram-negative bacteria.Accurate and timely reporting of antimicrobial susceptibility test results and ongoing antimicrobial resistance surveillance are helpful for rational prescription of antimicrobial agents and proper prevention and control of nosocomial infections.

Objective To summarize the changing prevalence of carbapenem resistance in Enterobacterales based on the data of CHINET Antimicrobial Resistance Surveillance Program from 2015 to 2021 for improving antimicrobial treatment in clinical practice.Methods Antimicrobial susceptibility testing was performed using a commercial automated susceptibility testing system according to the unified CHINET protocol.The results were interpreted according to the breakpoints of the Clinical & Laboratory Standards Institute(CLSI)M100 31st ed in 2021.Results Over the seven-year period(2015-2021),the overall prevalence of carbapenem-resistant Enterobacterales(CRE)was 9.43％(62 342/661 235).The prevalence of CRE strains in Klebsiella pneumoniae,Citrobacter freundii,and Enterobacter cloacae was 22.38％,9.73％,and 8.47％,respectively.The prevalence of CRE strains in Escherichia coli was 1.99％.A few CRE strains were also identified in Salmonella and Shigella.The CRE strains were mainly isolated from respiratory specimens(44.23±2.80)％,followed by blood(20.88±3.40)％and urine(18.40±3.45)％.Intensive care units(ICUs)were the major source of the CRE strains(27.43±5.20)％.CRE strains were resistant to all the β-lactam antibiotics tested and most non-β-lactam antimicrobial agents.The CRE strains were relatively susceptible to tigecycline and polymyxins with low resistance rates.Conclusions The prevalence of CRE strains was increasing from 2015 to 2021.CRE strains were highly resistant to most of the antibacterial drugs used in clinical practice.Clinicians should prescribe antimicrobial agents rationally.Hospitals should strengthen antibiotic stewardship in key clinical settings such as ICUs,and take effective infection control measures to curb CRE outbreak and epidemic in hospitals.

Objective To characterize the changing species distribution and antibiotic resistance profiles of respiratory isolates in hospitals participating in the CHINET Antimicrobial Resistance Surveillance Program from 2015 to 2021.Methods Commercial automated antimicrobial susceptibility testing systems and disk diffusion method were used to test the susceptibility of respiratory bacterial isolates to antimicrobial agents following the standardized technical protocol established by the CHINET program.Results A total of 589 746 respiratory isolates were collected from 2015 to 2021.Overall,82.6％of the isolates were Gram-negative bacteria and 17.4％were Gram-positive bacteria.The bacterial isolates from outpatients and inpatients accounted for(6.0±0.9)％and(94.0±0.1)％,respectively.The top microorganisms were Klebsiella spp.,Acinetobacter spp.,Pseudomonas aeruginosa,Staphylococcus aureus,Haemophilus spp.,Stenotrophomonas maltophilia,Escherichia coli,and Streptococcus pneumoniae.Each microorganism was isolated from significantly more males than from females(P＜0.05).The overall prevalence of methicillin-resistant S.aureus(MRSA)was 39.9％.The prevalence of penicillin-resistant S.pneumoniae was 1.4％.The prevalence of extended-spectrum β-lactamase(ESBL)-producing E.coli and K.pneumoniae was 67.8％and 41.3％,respectively.The overall prevalence of carbapenem-resistant E.coli,K.pneumoniae,Enterobacter cloacae,Pseudomonas aeruginosa,and Acinetobacter baumannii was 3.7％,20.8％,9.4％,29.8％,and 73.3％,respectively.The prevalence of β-lactamase was 96.1％in Moraxella catarrhalis and 60.0％in Haemophilus influenzae.The H.influenzae isolates from children(＜18 years)showed significantly higher resistance rates to β-lactam antibiotics than the isolates from adults(P＜0.05).Conclusions Gram-negative bacteria are still predominant in respiratory isolates associated with serious antibiotic resistance.Antimicrobial resistance surveillance should be strengthened in clinical practice to support accurate etiological diagnosis and appropriate antimicrobial therapy based on antimicrobial susceptibility testing results.

Objective:To analyze the APR triangle formed when the right hepatic vein (RHV) passed through the right anterior hepatic pedicle (RAHP) and the right posterior hepatic pedicle (RPHP) by 3D visualization technique.Methods:Clinical data of 100 subjects undergoing liver contrast-enhanced CT scan in the Second Affiliated Hospital of Harbin Medical University from September 2019 to September 2022 were retrospectively analyzed, including 57 males and 43 females, aged (53.2±13.0) years. The CT data were imported into a system for 3D image reconstruction of the liver. The intrahepatic vascular structure was observed, including the portal vein, APR triangle, the angle between the RAHP and RPHP, the distance between RHV and the vertex of angle when it crosses the angle plane of the RAHP and RPHP, the structure and branches of the right posterior branch of portal vein, and the number of branches into the APR triangle from the main trunk of the right anterior and right posterior portal vein.Results:The main type of portal vein was type A (the main portal vein was divided into left and right branches, and the right branch was further divided into right anterior branch and right posterior branch), in 86 cases (86.0%). The APR triangle was observed in 81 cases (81.0%), and the distance between the right hepatic vein and the vertex of the right anterior and right posterior hepatic pedicle was (1.70±0.36) cm, 1.00-2.00 cm was 82.7%(61/81). The angle between right anterior and right posterior hepatic pedicle was 45°-90° in 77 cases (77.0%, 77/100). In 100 subjects, the main branch of the right posterior portal vein accounted for 42.0% (42/100) of typeⅠ (bifurcation type) and 53.0% (arch type) of type Ⅱ (53/100). In 16 cases (19.8%, 16/81), the main right anterior portal vein branched into the APR triangle, with a total of 22 branches. In 9 cases (11.1%, 9/81), the main branch of the right posterior portal vein (branching type) branched into the triangle, with a total of 11 branches. There were 33 cases (40.7%, 33/81) of right posterior portal vein (arch type) main branch branching into the triangle, a total of 41 branches.Conclusion:The APR triangle, composed of the RAHP, RPHP and RHV, has an objective anatomical basis and is affected by the variants of portal vein and RHV. It is more common for the RHV to be within 1.00-2.00 cm of the vertex of the angle between the RAHP and RPHP, and the main trunk of the right anterior and right posterior branches of portal vein are less divided into the triangle, so it is relatively safe to dissect within this area.

The European Society for Medical Oncology Asia Congress 2024 was held in Singapore from December 6 to 8,2024.The conference unveiled several groundbreaking studies in the field of hepatobiliary and pancreatic tumors,covering clinical applications related to neoadjuvant and adjuvant therapies,translational treatments,later-line therapies,and tumor biomarkers.These studies provide new insights into the clinical diagnosis and treatment of hepatobiliary and pancreatic malignancies and drive the development of related fields.This article focuses on the key topics in hepatobiliary and pancreatic malignancies presented at the conference,aiming to interpret the latest advances in the field and explore the hot issues and future directions for development in this area.

Objective To investigate the acceptance and satisfaction of tuberculosis prevention and control personnel in Beijing with the patient management system, and to provide a basis for further improving the patient management model. Methods A survey was conducted on the current usage, satisfaction, willingness to use and system improvement opinions of the patient management system among medical staff involved in the supervision and medication management of pulmonary tuberculosis patients in Beijing. Results A total of 360 medical staff participated in the survey. ^“Patient management^” was the function with the largest number of users, accounting for 96.94%. The proportion of users of each module who believed that the module's design met actual work needs was over 90%. About 94.44% of respondents believed that patient management systems facilitated the transfer and sharing of information between institutions. And 90.83% of respondents thought that the patient management system was easy to operate, and 89.17% of respondents believed that patient management systems reduced workload. About 97.50% of respondents were satisfied with the overall use of the patient management system. The results of the influencing factor analysis showed that those with 3 or less modules designed to meet actual work were less satisfied than those with more than 3 modules, and the difference was statistically significant (P=0.001). Respondents put forward suggestions for improvement on the optimization of operational details such as system response speed, interface design, system login and query statistics. Conclusion Medical staff involved in the follow-up management of pulmonary tuberculosis patients are highly satisfied with their work using the patient management system. During the promotion and use, it is still necessary to continuously optimize the system functions according to work needs so that the system can truly facilitate work.

Objective To investigate the prognosis of patients with negative sentinel lymph nodes(SLN)after neoadjuvant chemotherapy(NAC)for breast cancer who are exempt from axillary lymph node dissection(ALND)and evaluate its safety in clinical treatment.Methods Clinical data of 2,163 patients initially diagnosed with breast cancer and having negative SLNs after NAC were se-lected from the SEER database from 2018 to 2021.Among them,373 patients underwent only SLN biopsy(SLNB group),and 1,790 patients underwent ALND(ALND group).Propensity score matching(PSM)was used to control for confounding factors,and the Kaplan-Meier method was em-ployed to analyze the overall survival rate.Univariate and multivariate Cox regression analyses were conducted to identify prognostic factors influencing the exemption from ALND in patients with negative SLNs after NAC for breast cancer.Results Before PSM,significant differences were observed be-tween the two groups in terms of clinical tumor stage,molecular subtype,estrogen receptor(ER)sta-tus,progesterone receptor(PR)status,human epidermal growth factor receptor 2(HER-2)status,efficacy of NAC,and breast surgery method(P＜0.05).After PSM,363 patients were included in each group.Univariate Cox regression analysis after PSM revealed that age,clinical tumor stage,and ER status were associated with overall survival(OS)of patients(P＜0.05).There was no sig-nificant difference in OS between patients who underwent SLNB and those who underwent ALND(P＞0.05).Multivariate Cox regression analysis indicated that age and clinical tumor stage were independent factors influencing OS in patients with negative SLNs after NAC.Survival curve analysis after PSM showed no statistically significant difference in overall survival rate between the SLNB and ALND groups(P=0.278).Conclusion Exemption from ALND in patients with negative SLNs af-ter NAC is feasible and does not affect the overall survival rate of patients.

Several types of arthritis share the common feature that the generation of inflammatory mediators leads to joint cartilage degradation. However, the shared mechanism is largely unknown. H2BK120ub1 was reportedly involved in various inflammatory diseases but its role in the shared mechanism in inflammatory joint conditions remains elusive. The present study demonstrated that levels of cartilage degradation, H2BK120ub1, and its regulator WW domain-containing adapter protein with coiled-coil (WAC) were increased in cartilage in human rheumatoid arthritis (RA) and osteoarthritis (OA) patients as well as in experimental RA and OA mice. By regulating H2BK120ub1 and H3K27me3, WAC regulated the secretion of inflammatory and cartilage-degrading factors. WAC influenced the level of H3K27me3 by regulating nuclear entry of the H3K27 demethylase KDM6B, and acted as a key factor of the crosstalk between H2BK120ub1 and H3K27me3. The cartilage-specific knockout of WAC demonstrated the ability to alleviate cartilage degradation in collagen-induced arthritis (CIA) and collagenase-induced osteoarthritis (CIOA) mice. Through molecular docking and dynamic simulation, doxercalciferol was found to inhibit WAC and the development of cartilage degradation in the CIA and CIOA models. Our study demonstrated that WAC is a key factor of cartilage degradation in arthritis, and targeting WAC by doxercalciferol could be a viable therapeutic strategy for treating cartilage destruction in several types of arthritis.