Objective:To investigate the safety and efficacy of the artery-first approach pancreaticoduo-denectomy (PD) combined with portal vein/superior mesenteric vein (PV/SMV) resection and reconstruction for pancreatic head malignancies.Methods:A retrospective analysis was conducted on 322 patients who underwent PD with PV/SMV resection and reconstruction at the Hepatobiliary Pancreatic Surgery Department of the First Hospital Affiliated to Naval Medical University between January 2016 and December 2022. Patients were divided into the artery-first approach PD group (AFA-PD group, n=165) and standard PD group (SPD group, n=157) based on surgical approach. Baseline characteristics, surgical outcomes, postoperative outcomes, pathological results and survival data were compared between two groups. Results:Compared to the SPD group, the AFA-PD group exhibited significantly reduced intraoperative blood loss (500 ml vs 600 ml), lower rates of obvious intraoperative blood loss (≥1 000 ml: 25.45% vs 40.13%), and decreased transfusion requirements (26.67% vs 52.87%). Postoperatively, the AFA-PD group demonstrated lower incidence of grade B/C pancreatic fistula (10.30% vs 19.75%) and higher textbook outcome achievement (78.79% vs 66.24%). Pathologically, the AFA-PD group achieved superior lymph node yield (20 nodes vs 18 nodes) and higher R 0 resection rates (79.39% vs 64.33%), particularly at the posterior pancreatic margin (96.97% vs 91.72%, P=0.040), SMA margin (92.07% vs 82.17%), and SMV margin (88.48% vs 78.98%). Multivariate logistic regression identified arterial invasion >180°, venous invasion >180°, lymph node metastasis, and the artery-first approach as independent predictors of R 0 resection. The AFA-PD group showed prolonged median survival (19.17 month vs 15.73 month). All aforementioned differences were statistically significant (all P value <0.05). Conclusions:The artery-first approach PD combined with PV/SMV resection and reconstruction is safe and effective for pancreatic head malignancies, significantly improving R 0 resection rates and patients' survival outcomes.

Objective To explore the epidemiological characteristics and differences in antimicrobial resistance be-tween catheter-associated urinary tract infection(CAUTI)and non-CAUTI of healthcare-associated infection(HAI),and provide scientific basis for precise clinical prevention and control.Methods Based on the regional HAI surveillance platform in Suzhou City,urinary tract infection(UTI)surveillance data reported by 61 member units from January 2020 to December 2024 were analyzed retrospectively.Pathogen distribution,detection rate of multi-drug-resistant organisms(MDROs),and antimicrobial resistance spectrum characteristics of patients in the CAUTI group and non-CAUTI group were compared.Results The incidence of CAUTI in patients in CAUTI group was 0.99‰,the incidence of healthcare-associated UTI in patients in non-CAUTI group was 0.14％.There was statis-tically significant difference in the distribution of UTI pathogens between the two groups(P＜0.05).The patho-gens of the CAUTI group were mainly Gram-negative bacteria(56.1％),with high proportions of Escherichia coli(19.6％)and Klebsiella pneumoniae(15.0％).In the non-CAUTI group,the proportion of Gram-negative bacteria was higher(64.7％).Antimicrobial susceptibility testing results showed that the resistance rates of Escherichia co-li to tobramycin,cephalosporins,and carbapenems in the CAUTI group were all higher than those in the non-CAU-TI group(all P＜0.05).Except for tigecycline,the resistance rates of Klebsiella pneumoniae to other antimicrobial agents in the CAUTI group were all significantly different from the non-CAUTI group(all P＜0.05).The resis-tance rates of Acinetobacterbaumannii to ticarcillin/clavulanic acid,quinolones,most cephalosporins,carbapenems,and aminoglycosides in the CAUTI group were higher than those of the non-CAUTI group(all P＜0.05).The de-tection rates of MDROs were higher in the CAUTI group,especially that of carbapenem-resistant Klebsiella pneu-moniae,accounting for 57.8％.Conclusion There are significant differences in pathogen distribution and antimi-crobial resistance of UTI between the CAUTI group and the non-CAUTI group.It is necessary to establish a re-gional antimicrobial resistance surveillance system for pathogens in UTI,and provide basis for the rational use of an-timicrobial agents in clinical practice.

OBJECTIVE To retrospectively investigate the incidence of surgical site infection(SSI),distribution and drug resistance of pathogens in 53 hospitals of Suzhou area from 2020 to 2023 so as to provide strategies for pre-vention and control of the hospital-associated infections in Suzhou area.METHODS The data regarding the SSI,distribution and drug resistance of pathogens were statistically analyzed through Suzhou City Regional Hospital In-fection Surveillance Platform.RESULTS The incidence of SSI was 0.24％among the 53 hospitals from 2020 to 2023.Staphylococcus aureus,Enterococcus faecalis,Staphylococcus epidermidis,Enterococcus faecium and Staphylococcus haemolyticus ranked the top 5 species of gram-positive bacteria;Escherichia coli,Klebsiella pneumoniae,Pseudomonas aeruginosa,Enterobacter cloacae and Acinetobacter baumannii ranked the top 5 spe-cies of gram-negative bacteria.There were significant differences in the distributions of S.aureus,K.pneumoniae and A.baumannii in the superficial,deep and organ cavities(P＜0.05).The isolation rate of carbapenem-resistant Acinetobacter baumannii(CRAB)was 69.23％,and the isolation rate of methicillin-resistant Staphylococcus au-reus(MRSA)was 42.14％.The drug resistance rate of the S.aureus strains to oxacillin reached up to 40.24％;the drug resistance rates of the A.baumannii to imipenem and meropenem reached up 63.00％and 65.80％,re-spectively.The drug resistance rates of the K.pneumoniae strains to imipenem and meropenem approximated to 30％,and the drug resistance rate to tigecycline was 19.84％.CONCLUSIONS The total incidence of SSI shows a downward trend in the 53 hospitals of Suzhou area.The S.aureus is the major species of pathogens,and some of the pathogens show high drug resistance rates.

OBJECTIVE To investigate the changes of etiological submission rates before the antimicrobial therapy after a series of intervention measures were taken so as to optimize the use and management of antibiotics.METHODS A total of 97,146 patients who were hospitalized and treated with antibiotics in the First Affiliated Hospital of Soochow University from Jul.2021 to Jun.2024 were recruited as the research subjects.Jan.2023 was set as the time node of intervention,the time period from Jul.2021 to Dec.2022 was assigned as the pre-interven-tion group,and the time period from Jan.2023 to Jun.2024 was assigned as the post-intervention group.The etio-logical submission rates before the antimicrobial therapy were observed by interrupted time series before and after the intervention measures were taken.The changes of isolation rates of multidrug-resistant organisms and inci-dence of hospital-associated infections were estimated by chi-square test.RESULTS The etiological submission rates before the antimicrobial therapy,etiological submission rates before combined use of major antibiotics and etiological submission rates relating to diagnosis of hospital-associated infections were higher after the intervention than before the intervention(all P＜0.05).The interrupted time series analysis showed that from the perspective of long-term benefit,the intervention measures could raise the etiological submission rates before the use of re-stricted,special grades of antibiotics and general antibiotics,and the net benefits were 0.85％,0.67％and 0.68％,respectively(all P＜0.05);there was no significant difference in the etiological submission rate before the com-bined use of major antibiotics.After the intervention,the incidence of multidrug-resistant organisms infection de-creased from 0.46％to 0.27％(P＜0.001);the isolation rate of multidrug-resistant organisms was 25.73％after the intervention,27.47％before the intervention,and there was no significant difference.CONCLUSIONS Scientif-ic and reasonable interventions may effectively raise the etiological submission rates before the antimicrobial thera-py,however,the etiological submission rate for combined use of major antibiotics and the isolation rate of multi-drug-resistant organisms are not improved remarkably.It is necessary to further formulate targeted interven-tion measures so as to push forward high-quality development of infection control.

In recent years,the microorganisms residues in endoscopes have frequently resulted in cross transmis-sion or even the outbreak of hospital-associated infections.It is of great importance to carry out standardized bio-logical surveillance of endoscopes,find out the high-risk links of cleaning and disinfection,and take targeted inter-vention measures to reduce the incidence of endoscopy-related infection.Based on the related guidelines in China and abroad as well as the latest clinical practice researches,the biological surveillance sampling and culture for en-doscopes were summarized in the article so as to enhance the surveillance quality,ensure the reprocessing effect and guarantee the endoscopy-related quality and safety.

Neoadjuvant therapy for pancreatic cancer is undergoing a paradigm shift from conventional chemotherapy to precision medicine. This expert forum discussed cutting-edge issues in pancreatic cancer neoadjuvant therapy from an evidence-based perspective, incorporating the latest clinical research advances. We focused on innovative directions including immunotherapy combination strategies, liquid biopsy applications, artificial intelligence (AI)-assisted decision making, and individualized precision medicine. We proposed forward-looking concepts such as molecular subtyping-guided individualized treatment strategies, multi-omics integrated efficacy prediction models, and standardized multidisciplinary collaborative care systems. These innovative concepts will drive pancreatic cancer neoadjuvant therapy toward more precise and effective directions.

Objective To explore the distribution of healthcare-associated infection(HAI)and direct economic burden in neurosurgical patients based on disease diagnosis-related grouping(DRG),providing data support for in-fection prevention and control.Methods Clinical data of neurosurgical patients in a hospital from January to Decem-ber 2023 were retrospectively investigated,the average length of hospital stay and average hospitalization expense of HAI and non-HAI groups of the subgroups of DRG were analyzed.Results A total of 102 cases of HAI occurred among 2 180 neurosurgical patients,with HAI incidence being 4.68％.The main infection sites were lower respira-tory tract and organ space,accounting for 53.92％and 25.49％respectively.HAI patients distributed in 16 DRG subgroups,out of which AH 19 subgroup(invasive ventilator support≥96 hours or extracorporeal membrane oxy-genation[ECMO]or total artificial heart transplantation)had the highest incidence(58.82％),followed by BC19 subgroup(intracranial vascular surgery accompanied with hemorrhage diagnosis)(17.65％)and BB2A subgroup(craniotomy other than trauma,with severe or general complications and comorbidities)(12.81％).There was no statistically significant difference in resource consumption between HAI group and control group of AH19 group(all P＞0.05).HAI in BB2A group increased the average length of hospital stay and average hospitalization expense by 5.00 days and 34 600 Yuan,respectively.HAI in BC19 group increased the average length of hospital stay and ave-rage hospitalization expense by 8.50 days and 42 800 Yuan,respectively.Lower respiratory tract infection had a significant impact on resource consumption,while organ space infection only increased length of hospital stay of pa-tients.Conclusion Analysis of incidence of HAI and resource consumption of major infection sites based on DRG can clarify the focus of infection prevention and control,formulate targeted intervention measures,control medical expense and improve the quality of medical services.

OBJECTIVE To investigate the current status and risk factors of carbapenem-resistant gram-negative or-ganisms(CRO)infections in neurosurgical ICU patients,and to construct and validate their prediction models.METHODS Clinical data and active screening microbiological results of 113 patients admitted to the Neurosurgical Intensive Care Unit(ICU)of The First Affiliated Hospital of Soochow University between Jul.2023 and Jan.2024 were retrospectively collected,and the patients were divided into a CRO-infected group(n=28)and a non-CRO-infected group(n=85).Predictive variables were screened using LASSO regression and logistic regression.Risk prediction models were constructed using random forest(RF)and logistic regression,the performance of the mod-el was evaluated by analyzing the area under the receiver operating characteristic(ROC)curve(AUC),calibration curves,and decision curves,and internal validation was performed using the bootstrap resampling method.RESULTS Among 113 neurosurgical ICU patients,28 cases developed CRO infections,with an infection rate of 24.78％.The highest infection rate was observed in lower respiratory tract infection,with 17 cases(15.04％).The predominant CRO pathogens were carbapenem-resistant Klebsiella pneumoniae(CRKP)and carbapenem-re-sistant Acinetobacter baumannii(CRAB),accounting for 50.00％and 42.86％of cases respectively.The AUC values for the RF prediction model and nomogram prediction modeling groups were 0.881 and 0.787 respectively,with Brier scores of 0.114 and 0.146,and threshold probabilities of net benefit ranging from 10％to 97％and 12％to 62％respectively.The RF prediction model exhibited superior discrimination,calibration,and clinical u-tility.The RF prediction model demonstrated that days of combined use of meropenem and vancomycin,GCS score,intestinal colonization,and hospitalization history were important predictors for CRO infections.CONCLUSION The prediction model for CRO infections in neurosurgical ICU patients established based on random forest algorithm has good predictive performance,and can be intervened with preventive and control measures for important predictive factors.

OBJECTIVE To explore the distribution and drug resistance of the pathogens causing the abdominal(pelvic)soft tissue infections in secondary or above medical institutions of Suzhou so as to provide bases for pre-vention and control of the infections.METHODS The surveillance data of abdominal(pelvic)soft tissue infections that were reported regularly from 58 member institutions of Suzhou from Jan.2020 to Dec.2023 were collected from the regional nosocomial infection surveillance platform by Suzhou nosocomial infection management and qual-ity control center.Totally 26 tertiary hospitals and 32 secondary hospitals were involved.RESULTS Most of the 1178 strains of pathogens were isolated from the tertiary hospitals,the proportion of gram-negative bacteria was the highest;Escherichia coli,Klebsiella pneumoniae and Enterococcus faecium ranked the top 3 species.The constituent ratio of carbapenem-resistant Klebsiella pneumoniae(CRKP)strains the was highest among the mul-tidrug-resistant organisms.The K.pneumoniae and CRKP strains were sensitive to tigecycline;the E.coli strains were highly sensitive to carbapenems,minocycline and piperacillin-tazobactam;Stenotrophomonas maltophilia strains were highly resistant to most of the antibiotics;Enterobacter cloacae strains were highly resistant to ampi-cillin-sulbactam but were highly sensitive to carbapenems;the drug resistance rate of the A.baumannii strains to tigecycline was less than 5％;the drug resistance rate of Pseudomonas aeruginosa strains to ticarcillin-clavulanic acid was highest.CONCLUSIONS The abdominal(pelvic)soft tissue infection is always mixed infections.The pathogens show severe drug resistance.It is necessary to strengthen the surveillance of etiological spectrum and drug resistance and conduct targeted guidance for clinical practice of diagnosis and treatment.

In recent years,the microorganisms residues in endoscopes have frequently resulted in cross transmis-sion or even the outbreak of hospital-associated infections.It is of great importance to carry out standardized bio-logical surveillance of endoscopes,find out the high-risk links of cleaning and disinfection,and take targeted inter-vention measures to reduce the incidence of endoscopy-related infection.Based on the related guidelines in China and abroad as well as the latest clinical practice researches,the biological surveillance sampling and culture for en-doscopes were summarized in the article so as to enhance the surveillance quality,ensure the reprocessing effect and guarantee the endoscopy-related quality and safety.