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.

Objective To study carbapenem-resistant Enterobacterales(CRE)infection in the neurosurgical inten-sive care unit(NS-ICU)under the combination of active screening using anal swabs and bundled intervention mea-sures in environment with high prevalence of CRE infection,and provide scientific basis for healthcare-associated in-fection(HAI)prevention and control.Methods Inpatients in NS-ICU from 2020 to 2021 were selected as the con-trol group,and didn't undergo active anal swab screening.NS-ICU inpatients from 2022 to 2023 were taken as the trial group,and implemented intervention of active anal swab screening.Isolation measures for CRE positive cases in two groups were implemented,and the incidence of CRE HAI between two groups of patients were compared.Results 645 patients were actively screened for CRE,with a total of 912 screenings.The overall screening positive rate was 9.21％,and the rectal CRE colonization rate in NS-ICU patients was 13.02％(84/645),out of which Klebsiella pneumoniae accounted for 92.86％(n=78 strains).The positive screening rates in patients in the trial group within 48 hours after admission as well as on day 3-7,day 8-15,and 16-30 were 3.30％,4.94％,13.68％,and 18.85％,respectively.With prolonged hospitalization time,the positive rate of CRE anal swab screening gradually increased.During the study period,the overall CRE HAI rate was 6.24％(72/1 153).After implementing active screening intervention,the CRE HAI rate in the trial group was lower than that in the control group(3.57％[23/645]vs 9.65％[49/508],P＜0.001).Conclusion In hospital environment with high CRE prevalence,implementing active screening and bundled intervention measures can effectively identify CRE carriers and reduce the risk of infection caused by intestinal colonization.

Objective To compare the efficacy and safety of perioperative chemotherapy regimens based on docetaxel administered in different cycles for locally advanced gastric cancer(LAGC)and gastroesophageal junction cancer(GEJC)through a network Meta-analysis.Methods PubMed,Embase,Cochrane Library,and Web of Science databases were electronically searched to collect randomized controlled trials(RCTs)evaluating docetaxel-based perioperative regimens for the treatment of LAGC and GEJC from inception to February 28,2025.Two researchers independently screened the literature,extracted relevant data,and assessed the risk of bias in the included studies.Subsequently,a network Meta-analysis was performed using R 4.5.0 software.Results A total of 10 RCTs involving 2,064 patients were included.The results of the network Meta-analysis showed that,compared with three cycles of epirubicin,cyclophosphamide,and fluorouracil(ECF regimen)and four cycles of platinum and fluorouracil(PF regimen),both three-cycle and four-cycle docetaxel,platinum,and fluorouracil(TPF regimen)significantly increased the complete tumor resection rate(R0 resection rate).Compared with surgery alone,the three-cycle TPF regimen significantly improved the R0 resection rate.Additionally,the four-cycle TPF regimen significantly improved 3-year and 5-year progression-free survival(PFS)compared with the two-cycle PF regimen,and significantly improved overall survival(OS)at 3 and 5 years compared with the three-cycle ECF regimen.Compared with surgery alone,the three-cycle TPF regimen also significantly increased the pathological complete response rate(pCR rate).Furthermore,compared with the two-cycle TPF and three-cycle ECF regimens,the four-cycle TPF and PF regimens were associated with a lower risk of surgical complications.Conversely,the two-cycle TPF and three-cycle ECF regimens significantly increased the risk of surgical complications compared with surgery alone.No statistically significant differences were observed in the incidence of grade 3 to 4 adverse events among the treatment regimens(P＞0.05).Based on the surface under the cumulative ranking curve(SUCRA)plot and pairwise comparisons,the three-cycle PF regimen appeared to be the most effective in achieving the highest R0 resection rate,the three-cycle TPF regimen appeared to be the most effective in achieving the highest pCR rate,while the four-cycle TPF regimen was associated with the best outcomes in terms of 3-year and 5-year PFS and OS.Conclusion The four-cycle TPF regimen may be associated with the optimal PFS and OS among perioperative chemotherapy regimens.No statistically significant differences were observed between the four-cycle TPF and the three-cycle PF in terms of R0 resection rate,between the four-cycle TPF and the three-cycle TPF in terms of pCR rate,or between the four-cycle TPF and the other seven regimens included in the study in terms of safety assessment.The four-cycle TPF regimen may represent the optimal perioperative chemotherapy regimen for patients with LAGC and GEJC.

Objective:To evaluate the sample preparation proficiency and storage proficiency of 11 clinical biobanks in Beijing through simulated experiments, and to establish an assessment method for the quality comparability of biological samples.Methods:An exploratory research design was adopted. In November 2023, artificial composite serum quality control materials containing six recombinant human protein markers—recombinant human alanine aminotransferase (rhALT), recombinant human aspartate aminotransferase (rhAST), recombinant human creatine kinase (rhCK), recombinant human creatine kinase-MB (rhCK-MB), recombinant human B-type natriuretic peptide (rhBNP), and recombinant human troponin I (rhTNI)—were distributed to 11 clinical biobanks in Beijing City. Sample preparation and storage followed the standardized operating procedures. Proficiency differences were assessed through statistical analysis.Results:Three-way repeated measures ANOVA revealed all six protein markers showed a declining trend over storage time in ultra-low-temperature environments ( F values 11.68-4 179.66, all P<0.01). However, neither long-term/temporary refrigerator types ( F values 0.01-1.23, all P>0.05)nor placement locations within refrigerators significantly affected the stability of these six proteins ( F valus 0.03-1.47, all P>0.05). The biases in detection results for rhALT, rhAST, rhTNI, and rhBNP at different storage time points were within the allowable bias limits for each item, supporting their use as markers for protein stability in biobank samples. All 11 institutions passed the storage proficiency assessment. In the preparation proficiency assessment, deviations were observed in post-preparation sample results, with a notably high out-of-control rate for rhCK (36.36%). Conclusion:Sample preparation proficiency can serve as a quality control metric for clinical biobanks. Future external quality assessment systems for biobanks should focus on sample preparation rather than storage processes.

Objective:To formulate the maintenance and management process of extracorporeal membrane oxygenation (ECMO) equipment for adults and explore its implementation effect, in order to provide reference for clinical nursing.Methods:A historical control study design was used. A total of 60 patients who received ECMO treatment at the Department of Critical Care Medicine of Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, were selected by convenience sampling method as the research subjects. Among them, 30 patients from January to December 2022 were the control group, and 30 patients from 1 to 12 of 2023 were the observation group. The control group received ECMO treatment using routine methods, while the observation group received ECMO treatment according to the maintenance and management process for adult ECMO equipment. The charging time of the ECMO battery, the completeness of the ECMO equipment, the occurrence rate of ECMO equipment failure, the cleanliness rate of the ECMO equipment surface, and the pre-filling time of the ECMO pipeline were compared between the two groups.Results:The control group included 19 males and 11 females, with an age of (51.34 ± 6.85) years. The observation group comprised 21 males and 9 females, with an age of (50.97 ± 5.39) years. In the observation group, the compliance rate of the ECMO battery standby time was observed to be 100.00% (30/30), while the completeness rate of the equipment ready for use was 96.67% (29/30), and the qualification rate of surface cleanliness of ECMO equipment was 93.33% (28/30), all were superior to 76.67% (23/30), 73.33% (22/30), and 63.33% (19/30) in the control group, and the differences were statistically significant ( χ2 = 5.82, 4.71, 7.95, all P<0.05). The incidence rate of ECMO equipment failure in the observation group was 3.33% (1/30), a rate lower than the control group′s 16.67% (5/30), and the difference was statistically significant ( χ2 = 83.18, P<0.001). The pre-filling time of ECMO circuit in the observation group was (9.56 ± 2.20) min, which was less than the control group′s (13.30 ± 2.76) min, and the difference was statistically significant ( t = 5.79, P<0.001). Conclusions:The formulation and implementation of the process help to improve the standardized operation of ECMO in medical care, so that the ECMO equipment and instruments can be well maintained.

Objective To study carbapenem-resistant Enterobacterales(CRE)infection in the neurosurgical inten-sive care unit(NS-ICU)under the combination of active screening using anal swabs and bundled intervention mea-sures in environment with high prevalence of CRE infection,and provide scientific basis for healthcare-associated in-fection(HAI)prevention and control.Methods Inpatients in NS-ICU from 2020 to 2021 were selected as the con-trol group,and didn't undergo active anal swab screening.NS-ICU inpatients from 2022 to 2023 were taken as the trial group,and implemented intervention of active anal swab screening.Isolation measures for CRE positive cases in two groups were implemented,and the incidence of CRE HAI between two groups of patients were compared.Results 645 patients were actively screened for CRE,with a total of 912 screenings.The overall screening positive rate was 9.21％,and the rectal CRE colonization rate in NS-ICU patients was 13.02％(84/645),out of which Klebsiella pneumoniae accounted for 92.86％(n=78 strains).The positive screening rates in patients in the trial group within 48 hours after admission as well as on day 3-7,day 8-15,and 16-30 were 3.30％,4.94％,13.68％,and 18.85％,respectively.With prolonged hospitalization time,the positive rate of CRE anal swab screening gradually increased.During the study period,the overall CRE HAI rate was 6.24％(72/1 153).After implementing active screening intervention,the CRE HAI rate in the trial group was lower than that in the control group(3.57％[23/645]vs 9.65％[49/508],P＜0.001).Conclusion In hospital environment with high CRE prevalence,implementing active screening and bundled intervention measures can effectively identify CRE carriers and reduce the risk of infection caused by intestinal colonization.

Objective To compare the efficacy and safety of perioperative chemotherapy regimens based on docetaxel administered in different cycles for locally advanced gastric cancer(LAGC)and gastroesophageal junction cancer(GEJC)through a network Meta-analysis.Methods PubMed,Embase,Cochrane Library,and Web of Science databases were electronically searched to collect randomized controlled trials(RCTs)evaluating docetaxel-based perioperative regimens for the treatment of LAGC and GEJC from inception to February 28,2025.Two researchers independently screened the literature,extracted relevant data,and assessed the risk of bias in the included studies.Subsequently,a network Meta-analysis was performed using R 4.5.0 software.Results A total of 10 RCTs involving 2,064 patients were included.The results of the network Meta-analysis showed that,compared with three cycles of epirubicin,cyclophosphamide,and fluorouracil(ECF regimen)and four cycles of platinum and fluorouracil(PF regimen),both three-cycle and four-cycle docetaxel,platinum,and fluorouracil(TPF regimen)significantly increased the complete tumor resection rate(R0 resection rate).Compared with surgery alone,the three-cycle TPF regimen significantly improved the R0 resection rate.Additionally,the four-cycle TPF regimen significantly improved 3-year and 5-year progression-free survival(PFS)compared with the two-cycle PF regimen,and significantly improved overall survival(OS)at 3 and 5 years compared with the three-cycle ECF regimen.Compared with surgery alone,the three-cycle TPF regimen also significantly increased the pathological complete response rate(pCR rate).Furthermore,compared with the two-cycle TPF and three-cycle ECF regimens,the four-cycle TPF and PF regimens were associated with a lower risk of surgical complications.Conversely,the two-cycle TPF and three-cycle ECF regimens significantly increased the risk of surgical complications compared with surgery alone.No statistically significant differences were observed in the incidence of grade 3 to 4 adverse events among the treatment regimens(P＞0.05).Based on the surface under the cumulative ranking curve(SUCRA)plot and pairwise comparisons,the three-cycle PF regimen appeared to be the most effective in achieving the highest R0 resection rate,the three-cycle TPF regimen appeared to be the most effective in achieving the highest pCR rate,while the four-cycle TPF regimen was associated with the best outcomes in terms of 3-year and 5-year PFS and OS.Conclusion The four-cycle TPF regimen may be associated with the optimal PFS and OS among perioperative chemotherapy regimens.No statistically significant differences were observed between the four-cycle TPF and the three-cycle PF in terms of R0 resection rate,between the four-cycle TPF and the three-cycle TPF in terms of pCR rate,or between the four-cycle TPF and the other seven regimens included in the study in terms of safety assessment.The four-cycle TPF regimen may represent the optimal perioperative chemotherapy regimen for patients with LAGC and GEJC.

Objective:To evaluate the sample preparation proficiency and storage proficiency of 11 clinical biobanks in Beijing through simulated experiments, and to establish an assessment method for the quality comparability of biological samples.Methods:An exploratory research design was adopted. In November 2023, artificial composite serum quality control materials containing six recombinant human protein markers—recombinant human alanine aminotransferase (rhALT), recombinant human aspartate aminotransferase (rhAST), recombinant human creatine kinase (rhCK), recombinant human creatine kinase-MB (rhCK-MB), recombinant human B-type natriuretic peptide (rhBNP), and recombinant human troponin I (rhTNI)—were distributed to 11 clinical biobanks in Beijing City. Sample preparation and storage followed the standardized operating procedures. Proficiency differences were assessed through statistical analysis.Results:Three-way repeated measures ANOVA revealed all six protein markers showed a declining trend over storage time in ultra-low-temperature environments ( F values 11.68-4 179.66, all P<0.01). However, neither long-term/temporary refrigerator types ( F values 0.01-1.23, all P>0.05)nor placement locations within refrigerators significantly affected the stability of these six proteins ( F valus 0.03-1.47, all P>0.05). The biases in detection results for rhALT, rhAST, rhTNI, and rhBNP at different storage time points were within the allowable bias limits for each item, supporting their use as markers for protein stability in biobank samples. All 11 institutions passed the storage proficiency assessment. In the preparation proficiency assessment, deviations were observed in post-preparation sample results, with a notably high out-of-control rate for rhCK (36.36%). Conclusion:Sample preparation proficiency can serve as a quality control metric for clinical biobanks. Future external quality assessment systems for biobanks should focus on sample preparation rather than storage processes.

Objective:To formulate the maintenance and management process of extracorporeal membrane oxygenation (ECMO) equipment for adults and explore its implementation effect, in order to provide reference for clinical nursing.Methods:A historical control study design was used. A total of 60 patients who received ECMO treatment at the Department of Critical Care Medicine of Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, were selected by convenience sampling method as the research subjects. Among them, 30 patients from January to December 2022 were the control group, and 30 patients from 1 to 12 of 2023 were the observation group. The control group received ECMO treatment using routine methods, while the observation group received ECMO treatment according to the maintenance and management process for adult ECMO equipment. The charging time of the ECMO battery, the completeness of the ECMO equipment, the occurrence rate of ECMO equipment failure, the cleanliness rate of the ECMO equipment surface, and the pre-filling time of the ECMO pipeline were compared between the two groups.Results:The control group included 19 males and 11 females, with an age of (51.34 ± 6.85) years. The observation group comprised 21 males and 9 females, with an age of (50.97 ± 5.39) years. In the observation group, the compliance rate of the ECMO battery standby time was observed to be 100.00% (30/30), while the completeness rate of the equipment ready for use was 96.67% (29/30), and the qualification rate of surface cleanliness of ECMO equipment was 93.33% (28/30), all were superior to 76.67% (23/30), 73.33% (22/30), and 63.33% (19/30) in the control group, and the differences were statistically significant ( χ2 = 5.82, 4.71, 7.95, all P<0.05). The incidence rate of ECMO equipment failure in the observation group was 3.33% (1/30), a rate lower than the control group′s 16.67% (5/30), and the difference was statistically significant ( χ2 = 83.18, P<0.001). The pre-filling time of ECMO circuit in the observation group was (9.56 ± 2.20) min, which was less than the control group′s (13.30 ± 2.76) min, and the difference was statistically significant ( t = 5.79, P<0.001). Conclusions:The formulation and implementation of the process help to improve the standardized operation of ECMO in medical care, so that the ECMO equipment and instruments can be well maintained.

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.