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 find out the present situation of hepatitis B infection or immunity in Tianjin city,and to provide the scientific basis for the hepatitis B control and prevention.Methods 2 594 samples were selected with the methods of different proportionate stratified and cluster sampling,and the hepatitis B infection markers were detected by ELISA.Results The positive rates of HBsAg,anti-HBs,anti-HBc and HBV were 2.62％,46.72％,10.60％ and 51.54％.Conclusion Compared with the results in 1992,the positive rates of HBsAg,anti-HBc and HBV were decreased significantly,while the positive rate of anti-HBs increased significandy,which ascribed to the comprehensive measure with the vaccination against hepatitis B as a main strategy for control hepatitis B.

Objective:To evaluate the infection rate and influencing factors of hepatitis E virus (HEV) among key occupational population in Tianjin, so as to help occupational population to carry out HEV prevention and control.Methods:A combination of stratified random sampling and convenience sampling was carried out for the study in Tianjin in June 2019. The livestock and poultry-related farming workers, slaughtering workers, selling workers, doctors, farmers, seafood sellers, sewage pipeline workers as the key occupational population groups (1036 person) , and non key occupational population as the control group (200 person) , cross-sectional surveys were conducted in the groups. Enzyme-linked immunosorbent assay (ELISA) was used to detect the serum IgG and IgM antibodies to HEV, and logistic regression model was used to analyze the influencing factors of HEV infection.Results:The positive rate of anti-HEV IgG in key occupational group was 26.45% (274/1036) , which was higher than that in control group of 14.50% (29/200) (χ 2=13.41, P<0.01) . The occupations with the highest positive rate of anti-HEV IgG were livestock (swine) , breeding and slaughtering workers, all of which reached 33.96% (18/53) . The difference in infection rates between different occupations was statistically significant (χ 2=22.57, P<0.01) . Multivariate logistic regression analysis showed that the longer working years, high frequency of eating out (3-5, ≥6 times/week) , drinking raw water, eating under-cooked pork or pig liver, and low frequency of washing hands were risk factors for HEV infection in occupational population ( P<0.05) . But the high education is a protective factor for HEV infection ( P<0.05) . Conclusion:There is a high positive rate of anti-HEV IgG in key occupational population in Tianjin. It is necessary to strengthen the monitoring, publicity and education of the high-risk population, pay attention to personal and dietary hygiene.

Objective:To evaluate the infection rate and influencing factors of hepatitis E virus (HEV) among key occupational population in Tianjin, so as to help occupational population to carry out HEV prevention and control.Methods:A combination of stratified random sampling and convenience sampling was carried out for the study in Tianjin in June 2019. The livestock and poultry-related farming workers, slaughtering workers, selling workers, doctors, farmers, seafood sellers, sewage pipeline workers as the key occupational population groups (1036 person) , and non key occupational population as the control group (200 person) , cross-sectional surveys were conducted in the groups. Enzyme-linked immunosorbent assay (ELISA) was used to detect the serum IgG and IgM antibodies to HEV, and logistic regression model was used to analyze the influencing factors of HEV infection.Results:The positive rate of anti-HEV IgG in key occupational group was 26.45% (274/1036) , which was higher than that in control group of 14.50% (29/200) (χ 2=13.41, P<0.01) . The occupations with the highest positive rate of anti-HEV IgG were livestock (swine) , breeding and slaughtering workers, all of which reached 33.96% (18/53) . The difference in infection rates between different occupations was statistically significant (χ 2=22.57, P<0.01) . Multivariate logistic regression analysis showed that the longer working years, high frequency of eating out (3-5, ≥6 times/week) , drinking raw water, eating under-cooked pork or pig liver, and low frequency of washing hands were risk factors for HEV infection in occupational population ( P<0.05) . But the high education is a protective factor for HEV infection ( P<0.05) . Conclusion:There is a high positive rate of anti-HEV IgG in key occupational population in Tianjin. It is necessary to strengthen the monitoring, publicity and education of the high-risk population, pay attention to personal and dietary hygiene.

Objective To investigate the prevalence of hepatitis C in Tianjin,China and major risk factors,and to provide a theoretical basis for the development of scientific prevention and control strategies for hepatitis C.Methods The monitoring system of notifiable infectious diseases was used to establish the database of hepatitis C cases reported from 2004 to 2014 in Tianjin.With reference to the results of serological surveillance and special case-control investigation,a statistical analysis was performed to investigate the epidemiological characteristics and prevalence of hepatitis C in Tianjin,as well as related risk factors.Results The report rate of hepatitis C in Tianjin showed a decreasing trend from 2004 to 2014 (x 2 =150.018,P ＜ 0.01).The group aged 60 years had the highest report rate (9.09/100000),and there were significant differences between this group and other groups (x2 =2540.887,P ＜ 0.01).The six urban districts in Tianjin had the highest report rate (6.54/100000),and there were significant differences between this area and other areas.The multivariate logistic regression analysis showed that a history of surgery (x2 =12.57,P ＜ 0.01),blood transfusion and blood products (x2 =36.67,P ＜ 0.01),hemodialysis (x2 =4.62,P ＜ 0.01),and intravenous drug use (x2 =12.92,P ＜ 0.01) were major risk factors for hepatitis C.Conclusion The epidemic situation of hepatitis C in Tianjin tends to decrease in recent years.Although there is no effective vaccine for hepatitis C,it still can be prevented and treated.The most effective interventions for hepatitis C include strengthening health education and raising the awareness rate of hepatitis C in the whole population,as well as early detection,diagnosis,and treatment.

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.

Objective: To describe the epidemiological characteristics of a cluster of COVID-19 cases reported in Baodi district of Tianjin as of 18 February, 2020, which might be associated with the exposure in a local department store, and provide suggestions for prevention and control strategy development. Methods: The basic characteristics, time and area distributions, clinical manifestations, epidemiological history and transmission mode of the COVID-19 cases associated with the department store exposure were analyzed. Results: A total of 40 COVID-19 cases were associated with the department store exposure, accounting for 75.47% of the total confirmed cases (53 cases) reported in Baodi district. The cases were mainly at the age of 60 years or older (35.00%) and farmers (40.00%). The main clinical manifestations included fever (95.00%), cough (35.00%), and diarrhea (15.00%). The proportion of confirmed severe cases was 32.50%. The incidence curve showed that the incidence peak occurred on 31 January, 2020. Among the 40 cases, 6(15.00%) were department store employees, 19(47.50%) were customers and 15(37.50%) were close contacts (secondary cases). The first case occurred on 21 January, 2020, this case was a department store employee who had a purchasing history at whole sale markets in other provinces and cities before the onset, and 3 employees were still on duty after symptom onsets. The median of the incubation period of customer cases was 6 days, and the median of the interval between onset and medical treatment of customer cases was 7 days. Conclusion This was a cluster epidemic of COVID-19, which might be associated with the exposure in the department store. By now, the current prevention and control measures have achieved satisfied effects.