Objective To investigate the risk factors of pancreatic fistula after pancreaticoduodenectomy.Methods The clinical data of 310 patients who received pancreaticoduodenectomy at the Ruijin Hospital of Shanghai Jiaotong University from January 2005 to May 2013 were retrospectively analyzed.The risk factors associated with the interoperative pancreatic fistula were analyzed.The univariate and multivariate analysis were done using the Pearson chi-square test and non-conditional Logistic regression model.Results A total of 134 patients had postoperative complications,including 103 (33.23％) with pancreatic fistula,among them 40 patients developed additional complications.The results of univariate analysis showed that preoperative levels of hemoglobin,total bilirubin,diameter of the pancreatic duct and postoperative level of albumin were risk factors of pancreatic fistula after pancreaticoduodenectomy (x2 ＝ 4.543,6.087,6.265,5.311,P ＜ 0.05).The results of multivariate analysis showed that preoperative level of total bilirubin equal to or above 34.2 μmol/L,the diameter of the pancreatic duct under 3 mm and the level of postoperative albumin under 28 g/L were the independent risk factors of pancreatic fistula (OR =1.806,1.936,1.780; 95％ confidence interval:1.107-2.948,1.170-3.206,1.002-3.165,P ＜ 0.05).Conclusion Preoperative jaundice (the level of total bilirubin ≥ 34.2 umol/L),pancreatic duct diameter ＜ 3 mm and postoperative malnutrition (albumin ＜ 28 g/L) indicate a higher incidence of postoperative pancreatic fistula.

Objective To investigate the predictive role of the intraoperative amylase ( IOA ) from pancreatic stump for postoperative pancreatic fistula. Methods The clinical data of 26 patients who received distal pancreatectomy ( DP) and central pancreatectomy ( CP) in the Shanghai Ruijin Hospital from June 2017 to July 2018 were retrospectively analyzed. IOA and peri-operative potential clinical factors associated with pancreatic fistula were analyzed. Receiver operating characteristics ( ROC) curve was drawn to evaluate the diagnostic efficacy of IOA from pancreatic stump in predicting postoperative pancreatic fistula, and the sensitivity and specificity were calculated. Results Of 26 patients, 19 patients underwent DP and 7 patients underwent CP. 9 patients (34.6％,9/26)had class A pancreatic fistula (biochemical leak) and 11 patients (42. 3％,11/26) had class B pancreatic fistula after surgery, and no class C pancreatic fistula occurred. Univariate analysis showed that IOA from pancreatic stump in clinically relevant pancreatic fistula group was higher than that in clinically irrelevant pancreatic fistula group(7971. 82 ± 4387. 98 vs 1589. 20 ± 1405. 00, P=0. 001). Area under the curve ( AUC) of IOA in predicting the development of clinically relevant pancreatic fistula after surgery was 0. 921 and 95％ confidential interval was 0. 807-1. 000. The optimal cut-off value was 3622 U/L , and the sensitivity and specificity were 90. 9％ and 86. 7％. Conclusions IOA from pancreatic stump could serve as a clinical indicator for predicting the occurrence of postoperative pancreatic fistula.

Objective To investigate the risk factors of early thromboembolism after pancreaticoduodenectomy with vein reconstruction.Methods The results of bedside ultrasonography and clinical data of 90 patients from Ruijin Hospital,Shanghai Jiao Tong University School of Medicine who underwent pancreaticoduodenectomy with vein reconstruction within 7 days after operation between Janurary 2018 and September 2021 were analyzed retrospectively.According to the results of bedside ultrasound examination of the patency of portal vein,the postoperative patients were divided into portal vein pa-tency group and portal vein embolization group.The hemodynamic differences of bedside ultrasound and the influencing factors of postoperative portal vein thromboembolism were compared.Results Among 90 patients underwent bedside ultra-sound,8 patients had portal vein thromboembolism after pancreaticoduodenectomy with vein reconstruction,and the inci-dence rate was 8.89％.Bedside ultrasound showed that the velocity and flow of portal vein in patients with portal vein thromboembolism decreased significantly(P＜0.0O1).Among the perioperative related risk factors,there was a statistically significant difference in the smoking history and alcohol abuse history between the portal vein patency group and portal vein thromboembolism group.Further,previous smoking history was an independent risk factor for portal vein thromboem-bolism(P=0.003).The outcomes showed that the pancreaticoduodenectomy with vein reconstruction was safe and feasible,however early portal vein thromboembolism with severe complications indicated a poor prognosis.Conclusions The history of smoking and alcohol abuse are the high risk factors of portal vein thromboembolism after pancreaticoduodenectomy with vein reconstruction,which should be prevented by preoperative education.Bedside ultrasound can effectively and safely evaluate the patency of portal vein after pancreaticoduodenectomy with vein reconstruction,which contributes to early clini-cal intervention.

Objective To understand the epidemic characteristics and genotype distribution of acute hepatitis B in Tianjin, and to find out the relationship between genotype and epidemic characteristics. Methods The information of acute hepatitis B cases with a local address in Tianjin was collected through the National Infectious Disease Surveillance System in Tianjin from 2018 to 2022. The patient outcomes were followed up through hospital system records and telephone survey, and hepatitis B virus (HBV) genotypes were detected by fluorescent PCR. Results From 2018 to 2022, there were 387 cases of acute hepatitis B with local address reported in Tianjin, with an average annual reported incidence rate of 0.52/100 000, showing a downward trend in general (χ²=28.553，P<0.001). The reported male to female incidence ratio was 1.68. The age distribution was mainly concentrated in the 30-65 age group, with the highest incidence rate (1.22/100 000) reported in the 35-39 age group. 72.87% of cases showed negative HBsAg after 6 months of follow-up following diagnosis. The proportion of cadres and staff who turned negative (92.16%) was significantly higher than that of those who did not turn negative (0%). The median ALT (1508.00 U/L) in the turning negative group was significantly higher than that in the non-turning negative group (976.00 U/L). Among 315 cases with successful genotyping, genotype C accounted for 81.27%, and genotype B accounted for 14.92%, with 47 cases. The median ALT of genotype B patients with acute hepatitis B (1585.00 U/L) was significantly higher than that of genotype C patients (988.00 U/L). Conclusion The reported incidence rate of acute hepatitis B in Tianjin is relatively low, and shows a downward trend. Young and middle-aged men are prone to infect HBV. Genotype C is the main genotype, and genotype B HBV causes more serious liver damage in patients with acute hepatitis B.

Objective To understand the epidemic characteristics and genotype distribution of acute hepatitis B in Tianjin, and to find out the relationship between genotype and epidemic characteristics. Methods The information of acute hepatitis B cases with a local address in Tianjin was collected through the National Infectious Disease Surveillance System in Tianjin from 2018 to 2022. The patient outcomes were followed up through hospital system records and telephone survey, and hepatitis B virus (HBV) genotypes were detected by fluorescent PCR. Results From 2018 to 2022, there were 387 cases of acute hepatitis B with local address reported in Tianjin, with an average annual reported incidence rate of 0.52/100 000, showing a downward trend in general (χ²=28.553，P<0.001). The reported male to female incidence ratio was 1.68. The age distribution was mainly concentrated in the 30-65 age group, with the highest incidence rate (1.22/100 000) reported in the 35-39 age group. 72.87% of cases showed negative HBsAg after 6 months of follow-up following diagnosis. The proportion of cadres and staff who turned negative (92.16%) was significantly higher than that of those who did not turn negative (0%). The median ALT (1508.00 U/L) in the turning negative group was significantly higher than that in the non-turning negative group (976.00 U/L). Among 315 cases with successful genotyping, genotype C accounted for 81.27%, and genotype B accounted for 14.92%, with 47 cases. The median ALT of genotype B patients with acute hepatitis B (1585.00 U/L) was significantly higher than that of genotype C patients (988.00 U/L). Conclusion The reported incidence rate of acute hepatitis B in Tianjin is relatively low, and shows a downward trend. Young and middle-aged men are prone to infect HBV. Genotype C is the main genotype, and genotype B HBV causes more serious liver damage in patients with acute hepatitis B.

Objective To understand the status of depression and anxiety in patients with chronic hepatitis B in Tianjin, and to analyze its influencing factors, so as to provide references for scientific psychological intervention and health education. Methods Chronic hepatitis B cases whose addresses were Tianjin were randomly selected from the report of infectious disease surveillance system from January 2018 to December 2019 as the study subjects. A certain number of healthy people living in Tianjin were selected as the control. A unified mental health questionnaire survey was conducted by telephone follow-up or face-to-face survey. The distribution characteristics of depression and anxiety were described, and influencing factors of depression and anxiety were analyzed by univariate and multivariate logistic regression analysis. Results A total of 825 cases of chronic hepatitis B and 376 cases of healthy people were investigated. The crude SDS and SAS were (35.47±9.34) and (32.33±8.26), respectively, which were higher than those of healthy people ( P <0.05). The rates of depression and anxiety in chronic hepatitis B patients were 25.45% and 20.61%, respectively, which were significantly higher than those in healthy people (15.96% and 11.70%, respectively) (P < 0.001). The analysis of depression influencing factors showed that the OR of high average monthly income was 0.791 ( 95% CI：0.655～0.955 ), the OR of not knowing correct preventive measures was 1.509 (95% CI：1.084～2.102 ), and the OR of feeling discriminated was 1.650 ( 95% CI：1.166～2.335 ). The multifactor analysis of anxiety influencing factors showed that the OR of not knowing correct preventive measures was 1.490 ( 95% CI:1.049～2.117)), while the OR of feeling discriminated was 1.854 ( 95% CI: 1.289～2.666). Conclusion The levels of depression and anxiety of chronic hepatitis B patients were higher than that of general healthy people. Not knowing correct preventive measures and feeling discriminated in daily life were risk factors while high income was a protective factor.