Objective:To study the effect of preoperative pancreatic duct stent placement in enucleation (EN) of pancreatic tumor adjacent to the main pancreatic duct (MPD).Methods:Clinical data of 56 patients with benign or borderline pancreatic tumor adjacent to the MPD undergoing EN in the Department of Hepatobiliary Surgery of the Second Hospital of Hebei Medical University from January 2022 to September 2024 were retrospectively analyzed, including 25 males and 31 females, aged (32.0±5.5) years. Among the patients, 35 (62.5%) were solid pseudopapillary neoplasm, 15 (26.8%) were neuroendocrine tumor, and 6 (10.7%) were serous cystic tumor. According to whether the pancreatic duct stent was placed through encoscopic retrograde cholangiopancreatography preoperatively, patients were divided into the stent group ( n=20, observation group) and no-stent group ( n=36, control group). The operation time, intraoperative pancreatic duct injury, tumor enucleation time and blood loss, grade B/C pancreatic fistula and postoperative hospital stay were compared between the two groups. Results:All patients underwent EN successfully. The operation time in the observation group was shorter than that in the control group [150.0 (143.5, 159.0) vs 158.0 (150.0, 180.0) min, Z=-2.08, P=0.031], and the rate of intraoperative MPD injury in the observation group was lower than that in the control group [10.0% (2/20) vs 38.9% (14/36), χ2=5.26, P=0.022]. The tumor enucleation time and blood loss were comparable between the two groups (both P>0.05). The rate of postoperative grade B/C pancreatic fistula in the observation group was lower than that in the control group [15.0% (3/20) vs 41.7% (15/36), χ2=4.19, P=0.041], and the postoperative hospital stay was also shorter in the observation group [(7.9±1.6) vs (9.3±2.1) d, t=-2.57, P=0.014]. Conclusion:Under the premise of matured endoscopic operation, preoperative pancreatic duct stent placement through ERCP in the EN of pancreatic tumor adjacent to the MPD can protect the MPD during operation, reduce the occurrence of postoperative grade B/C pancreatic fistula, and shorten the postoperative hospital stay.

Objective To explore the efficacy and safety of doxycycline in the treatment of Mycoplasmal pneumoniae pneumonia(MPP)in children under 8 years old.Methods A retrospective selection was made of 258 children with MPP under 8 years old who were admitted to Women and Children's Hospital of Ningbo University from July 2023 to June 2024 as the research subjects.The children were divided into the azithromycin group(n=156)and the doxycycline group(n=102)according to the different drugs used.The clinical indicators,inflammation-related indicators,liver function indicators before and after treatment and adverse reactions of two groups of children were compared.Results After treatment,the defervescence time,cough relief time,pneumonia image absorption time and hospital stay in doxycycline group were shorter than those in azithromycin group(P＜0.05),the number of patients who needed to use steroids and bronchoscope intervention,and the number of patients with total hospitalization costs more than 10 000 yuan were less than those in azithromycin group(P＜0.05).The C-reactive protein(CRP),D-dimer(DD),serum ferritin(SF)and lactate dehydrogenase(LDH)in both groups of children were significantly lower than those before treatment in this group(P＜0.05),and the reduction amplitzes of CRP,DD,SF and LDH in doxycycline group were significantly greater than those in azithromycin group(P＜0.05).There were no significant changes in alanine aminotransferase,aspartate aminotransferase and prealbumin between two groups of children before and after treatment(P＞0.05).The adverse reactions of two groups of children were mainly gastrointestinal reactions,and there was no statistically significant difference in the incidence rate(x2=0.254,P=0.204).Conclusion Doxycycline in treatment of MPP in children under 8 years old can effectively relieve clinical symptoms,reduce inflammatory responses,decrease hormone and bronchoscopy interventions,shorten hospital stays and reduce hospitalization costs,and has good safety.

Objective:To develop and validate a diagnostic model for pancreatic benign and malignant tumors using radiomics technology.Methods:A retrospective analysis was conducted on the clinical data of 113 patients with pancreatic tumors who underwent surgical treatment at the Hepatobiliary and Pancreatic Surgery Departments of the Second Hospital and the First Hospital of Hebei Medical University from January 2020 to December 2022. There were 59 male and 54 female patients, aged (55.3±16.8) years. Preoperative enhanced thin-slice computed tomography (CT) data and postoperative pathological diagnosis results were collected. Data from 74 patients at the Second Hospital were selected, and according to the random classification principle of 7∶3, the data of 52 patients were determined as the training set for model construction, while the remaining 22 patients' data served as the internal validation set. Data from 39 patients at the First Hospital of Hebei Medical University were used as the external validation set to assess the generali-zability of the established model. The region of interest in the lesions on CT images was analyzed using three-dimensional radiomics feature extraction, and the top 5 features were selected using feature selection methods. Radiomics models were established for the selected features using 17 classifiers. The performance of the models was evaluated using the area under curve (AUC) of the receiver operating characteristic (ROC).Results:Two hundred and fifty-five models were established with 15 feature selection methods and 17 classifiers. 7 models with the AUC greater than 0.7 were selected, among which the best one was LASSO-K neighbors classifier model, constructed using the LASSO feature selection method and the k-nearest neighbors algorithm, achieving AUC values of 0.933 (95% CI: 0.859-0.984) in the training set, 0.973 (95% CI: 0.896-1.000) in the validation set, and 0.774 (95% CI: 0.624-0.908) in the external validation set, with satisfactoryclassification and generalization ability. Conclusion:The radiomics-based diagnostic model for pancreatic benign and malignant tumors can effectively distinguish the benignancy and malignancy of tumors. The LASSO-K neighbors classifier model demonstrated high accuracy and reliability in this study.

Objective:To construct a nomogram model for predicting the risk factors of gastrointestinal bleeding following laparoscopic pancreaticoduodenectomy (LPD) based on relevant risk factors and evaluate its predictive value.Methods:A retrospective analysis was conducted on 466 patients with periampullary space occupying lesion who underwent LPD at the Department of Hepatobiliary Surgery, the Second Hospital of Hebei Medical University, from January 2021 to December 2024. Among them, there were 284 males and 182 females, aged (59.9±10.7) years. Patients were randomly divided into a training cohort ( n=326) and a validation cohort ( n=140) using a random number table (7: 3 ratio). Based on whether patients suffered gastrointestinal bleeding, the training cohort was further stratified into a gastrointestinal bleeding group ( n=23) and control group ( n=303). Univariate and multivariate logistic regression analyses were performed to identify independent risk factors for gastrointestinal bleeding. A nomogram was constructed based on multivariate results, and its predictive performance was evaluated by receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA). Results:Compared to the control group, the gastrointestinal bleeding group exhibited significantly higher age, higher rates of postoperative pancreatic fistula (POPF) and intra-abdominal infection, along with lower body mass index, and lower levels of fibrinogen and albumin (all P<0.05). Multivariate analysis identified age ( OR=1.065, 95% CI: 1.002-1.132), fibrinogen ( OR=0.486, 95% CI: 0.243-0.969), albumin ( OR=0.840, 95% CI: 0.741-0.953), POPF ( OR=4.299, 95% CI: 1.348-13.716), and postoperative intra-abdominal infection ( OR=6.352, 95% CI: 1.476-27.341) as independent predictors of gastrointestinal bleeding (all P<0.05). The nomogram demonstrated robust discrimination, with an AUC of 0.861 (95% CI: 0.784-0.939), sensitivity of 82.6%, and specificity of 82.2% in the training cohort. In the validation cohort, the AUC was 0.824 (95% CI: 0.675-0.973), with sensitivity and specificity of 80.0% and 83.8%, respectively. Calibration curves indicated excellent agreement between predicted and observed outcomes. DCA revealed superior net clinical benefit of the nomogram over " treat-all" or " treat-none" strategies within threshold probabilities of 0-0.9 (training) and 0-0.75 (validation). Conclusion:The nomogram based on age, fibrinogen, albumin, POPF, and intra-abdominal infection provides accurate prediction of gastrointestinal bleeding after LPD and demonstrates high clinical utility for risk stratification and decision-making in periampullary space occupying lesion patients.

Objective:To explore the safety and feasibility of laparoscopic pancreaticoduodenectomy (LPD) combined with portal vein system resection and reconstruction.Methods:The clinical data of 26 patients with pancreatic head cancer or distal bile duct malignant tumors who underwent reconstructive LPD combined with portal vein resection in the Department of Hepatobiliary Surgery of the Second Hospital of Hebei Medical University from January 2016 to December 2023 were retrospectively analyzed, including 13 males and 13 females, aged 63.0 (57.2, 66.0) years. The clinical data of the patients, including the operation time, intraoperative blood loss and blood transfusion, blood flow interruption time, postoperative complications, intensive care unit (ICU) admission time, and hospital stay were recorded.Results:All 26 patients had completed the operation successfully. The operation time was (483.65±118.00) min, the intraoperative blood loss was 1 100 (625, 2 750) ml, the intraoperative blood transfusion was 600 (438, 1 050) ml, and the portal vein system blockade time was (35.00±6.00) min. There were 5 cases (19.2%, 5/26) with laparotomy, 5 cases (19.2%%, 5/26) with repair after partial resection of the portal vein system, 12 cases (46.1%, 12/26) with end-to-end anastomosis of the portal venous system, and 9 cases (34.6%, 9/26) with artificial vascular replacement. There was 1 case of grade B pancreatic fistula (3.8%, 1/26), 3 cases of bile leakage (11.5%, 3/26), 1 case of gastric paralysis (3.8%, 1/26), 3 cases of intestinal obstruction (11.5%, 3/26), 2 cases of abdominal infection (7.7%, 2/26), 2 cases of postoperative bleeding (7.7%, 2/26), 1 case of secondary surgery (3.8%, 1/26), and 1 case of perioperative death (3.8%, 1/26). The postoperative hospital stay was 14.00 (12.00, 20.75) d, the ICU length of stay was 3.0 (1.0, 6.5) d, the tumor length diameter was 4.00 (3.00, 5.38) cm, and the number of positive lymph nodes was 1.0(0.5, 3.5).Conclusion:LPD reconstructed with portal system resection is a safe and effective treatment of patients with pancreatic head cancer or distal bile duct malignancy.

To investigate the epidemiological characteristics of co-infection involving macrolide-resistant Mycoplasma pneumoniae (MRMP) and non-bacterial pathogens in hospitalized children at Women and Children′s Hospital of Ningbo University from 2021 to 2024, a retrospective cross-sectional study was conducted. Throat swabs were collected from children admitted for respiratory tract infections between January 2021 and December 2024. A total of 22 311 children aged 0-18 years old were included, including 12 021 males and 10 290 females. The median age was 5.00 years and the mean age was (5.02±3.25) years. Real-time fluorescence quantitative polymerase chain reaction (PCR) and multiplex PCR were employed to determine the MP infection rate, the prevalence of MRMP, and the co-infection rates with non-bacterial pathogens across different years. Patients with MRMP were categorized into two groups based on the presence or absence of co-infections: simple infection group and mixed infection group. The differences in age, gender, and onset time between these groups were analyzed, along with the distribution of pathogens in the mixed infection group. Chi-square tests were used for intergroup comparisons. The results showed that the overall positive rate of MP among the 22 311 children was 39.42% (8 794/22 311), with a detection rate of MP drug resistance gene mutations at 70.42% (6 193/8 794). The co-infection rate of MRMP was 24.29% (1 504/6 193). Statistically significant differences were observed in the MP positive rate and the detection rate of drug resistance gene mutations from 2021 to 2024 ( χ2=1 674.420, P<0.05; χ2=67.733, P<0.05), with peak values in 2023 (50.87% and 73.83%, respectively). Among the annual co-infections, the highest rate was in 2024 (28.72%), while the lowest was in 2022 (7.30%). In the age distribution, the rate of mixed infections decreased with increasing age ( χ2=84.742, P<0.05). Seasonally, the infection rates in winter 2023 and the spring, summer, and autumn of 2024 were significantly higher than those in 2022 ( χ2=24.243, 13.101, 26.181, and 10.687, respectively; all P<0.05), with the lowest mixed infection rate observed in winter 2022 over the four-year period. Over the four years, the highest positive rate for rhinovirus was consistently observed in MRMP co-infections each year, particularly in the 3-to 6-year-old age group. The positive rate for mixed infections involving respiratory syncytial virus, human bocavirus, and parainfluenza virus was notably higher in the 0- to 3-year-old age group. Following the removal of non-pharmaceutical interventions (NPIs) in December 2022, the co-infection rate of other respiratory viruses and MRMP increased in Ningbo City. In conclusion, the positive rate of MRMP has shown an upward trend from 2021 to 2023. Post-NPI removal, MRMP mixed infections have become more prevalent in 2023 and 2024, predominantly affecting children aged 0-6 years, with rhinovirus being the most common co-pathogen.

Turning to critical illness is a common stage of various diseases and injuries before death. Patients usually have complex health conditions, while the treatment process involves a wide range of content, along with high requirements for doctor′s professionalism and multi-specialty teamwork, as well as a great demand for time-sensitive treatments. However, this is not matched with critical care professionals and the current state of medical care in China. Telemedicine, which shortens the distance of medical professionals and the gap of disease diagnosis and treatments in various regions through electronic information, can effectively solve the current problem. Therefore, there is an urgent need to develop a standardized, high-quality visualization telemedicine round system .Therefore, experts have been organized to search domestic and foreign literature on telemedicine round for critically ill patients and to form this consensus based on clinical experiences so as to further improve the level of critical care treatments in regions.

To investigate the epidemiological characteristics of co-infection involving macrolide-resistant Mycoplasma pneumoniae (MRMP) and non-bacterial pathogens in hospitalized children at Women and Children′s Hospital of Ningbo University from 2021 to 2024, a retrospective cross-sectional study was conducted. Throat swabs were collected from children admitted for respiratory tract infections between January 2021 and December 2024. A total of 22 311 children aged 0-18 years old were included, including 12 021 males and 10 290 females. The median age was 5.00 years and the mean age was (5.02±3.25) years. Real-time fluorescence quantitative polymerase chain reaction (PCR) and multiplex PCR were employed to determine the MP infection rate, the prevalence of MRMP, and the co-infection rates with non-bacterial pathogens across different years. Patients with MRMP were categorized into two groups based on the presence or absence of co-infections: simple infection group and mixed infection group. The differences in age, gender, and onset time between these groups were analyzed, along with the distribution of pathogens in the mixed infection group. Chi-square tests were used for intergroup comparisons. The results showed that the overall positive rate of MP among the 22 311 children was 39.42% (8 794/22 311), with a detection rate of MP drug resistance gene mutations at 70.42% (6 193/8 794). The co-infection rate of MRMP was 24.29% (1 504/6 193). Statistically significant differences were observed in the MP positive rate and the detection rate of drug resistance gene mutations from 2021 to 2024 ( χ2=1 674.420, P<0.05; χ2=67.733, P<0.05), with peak values in 2023 (50.87% and 73.83%, respectively). Among the annual co-infections, the highest rate was in 2024 (28.72%), while the lowest was in 2022 (7.30%). In the age distribution, the rate of mixed infections decreased with increasing age ( χ2=84.742, P<0.05). Seasonally, the infection rates in winter 2023 and the spring, summer, and autumn of 2024 were significantly higher than those in 2022 ( χ2=24.243, 13.101, 26.181, and 10.687, respectively; all P<0.05), with the lowest mixed infection rate observed in winter 2022 over the four-year period. Over the four years, the highest positive rate for rhinovirus was consistently observed in MRMP co-infections each year, particularly in the 3-to 6-year-old age group. The positive rate for mixed infections involving respiratory syncytial virus, human bocavirus, and parainfluenza virus was notably higher in the 0- to 3-year-old age group. Following the removal of non-pharmaceutical interventions (NPIs) in December 2022, the co-infection rate of other respiratory viruses and MRMP increased in Ningbo City. In conclusion, the positive rate of MRMP has shown an upward trend from 2021 to 2023. Post-NPI removal, MRMP mixed infections have become more prevalent in 2023 and 2024, predominantly affecting children aged 0-6 years, with rhinovirus being the most common co-pathogen.

Objective:To study the effect of preoperative pancreatic duct stent placement in enucleation (EN) of pancreatic tumor adjacent to the main pancreatic duct (MPD).Methods:Clinical data of 56 patients with benign or borderline pancreatic tumor adjacent to the MPD undergoing EN in the Department of Hepatobiliary Surgery of the Second Hospital of Hebei Medical University from January 2022 to September 2024 were retrospectively analyzed, including 25 males and 31 females, aged (32.0±5.5) years. Among the patients, 35 (62.5%) were solid pseudopapillary neoplasm, 15 (26.8%) were neuroendocrine tumor, and 6 (10.7%) were serous cystic tumor. According to whether the pancreatic duct stent was placed through encoscopic retrograde cholangiopancreatography preoperatively, patients were divided into the stent group ( n=20, observation group) and no-stent group ( n=36, control group). The operation time, intraoperative pancreatic duct injury, tumor enucleation time and blood loss, grade B/C pancreatic fistula and postoperative hospital stay were compared between the two groups. Results:All patients underwent EN successfully. The operation time in the observation group was shorter than that in the control group [150.0 (143.5, 159.0) vs 158.0 (150.0, 180.0) min, Z=-2.08, P=0.031], and the rate of intraoperative MPD injury in the observation group was lower than that in the control group [10.0% (2/20) vs 38.9% (14/36), χ2=5.26, P=0.022]. The tumor enucleation time and blood loss were comparable between the two groups (both P>0.05). The rate of postoperative grade B/C pancreatic fistula in the observation group was lower than that in the control group [15.0% (3/20) vs 41.7% (15/36), χ2=4.19, P=0.041], and the postoperative hospital stay was also shorter in the observation group [(7.9±1.6) vs (9.3±2.1) d, t=-2.57, P=0.014]. Conclusion:Under the premise of matured endoscopic operation, preoperative pancreatic duct stent placement through ERCP in the EN of pancreatic tumor adjacent to the MPD can protect the MPD during operation, reduce the occurrence of postoperative grade B/C pancreatic fistula, and shorten the postoperative hospital stay.

Objective To explore the efficacy and safety of doxycycline in the treatment of Mycoplasmal pneumoniae pneumonia(MPP)in children under 8 years old.Methods A retrospective selection was made of 258 children with MPP under 8 years old who were admitted to Women and Children's Hospital of Ningbo University from July 2023 to June 2024 as the research subjects.The children were divided into the azithromycin group(n=156)and the doxycycline group(n=102)according to the different drugs used.The clinical indicators,inflammation-related indicators,liver function indicators before and after treatment and adverse reactions of two groups of children were compared.Results After treatment,the defervescence time,cough relief time,pneumonia image absorption time and hospital stay in doxycycline group were shorter than those in azithromycin group(P＜0.05),the number of patients who needed to use steroids and bronchoscope intervention,and the number of patients with total hospitalization costs more than 10 000 yuan were less than those in azithromycin group(P＜0.05).The C-reactive protein(CRP),D-dimer(DD),serum ferritin(SF)and lactate dehydrogenase(LDH)in both groups of children were significantly lower than those before treatment in this group(P＜0.05),and the reduction amplitzes of CRP,DD,SF and LDH in doxycycline group were significantly greater than those in azithromycin group(P＜0.05).There were no significant changes in alanine aminotransferase,aspartate aminotransferase and prealbumin between two groups of children before and after treatment(P＞0.05).The adverse reactions of two groups of children were mainly gastrointestinal reactions,and there was no statistically significant difference in the incidence rate(x2=0.254,P=0.204).Conclusion Doxycycline in treatment of MPP in children under 8 years old can effectively relieve clinical symptoms,reduce inflammatory responses,decrease hormone and bronchoscopy interventions,shorten hospital stays and reduce hospitalization costs,and has good safety.