Objective To analyze the Clavien-Dindo classification and risk factors of complications after pancreaticoduodenectomy and investigate the relationship between the major risk factors and Clavien-Dindo classification of complications.Methods The retrospective case-control study was adopted.The clinical data of 200 patients who underwent pancreaticoduodenectomy at the Third Affiliated Hospital of Inner Mongolia Medical University from January 2010 to June 2015 were collected.The patients underwent Whipple surgery or pylorospreserving pancreaticoduodenectomy according to the tumor location.Observation indicators included:(1)postoperative complications using Clavien-Dindo classification,(2) univariate and multivariate analyses:the basic conditions of patients,surgery-related factors,pancreas-related factors,(3) relationship between independent risk factors and Clavien-Dindo classification of complications after pancreaticoduodenectomy.The univariate analysis and count data were done using the chi-square test.The comparison between groups was done using independent samples nonparametric test (Kolmogorov-Smirnov Z) and multivariate analysis was done using the Logistic regression model.Results (1) Postoperative complication situations:of 200 patients,122 underwent Whipple surgery and 78 underwent pylorus-preserving pancreatico-duodenectomy,including 6 combined with vascular reconstruction and 1 with radiofrequency ablation of liver tumors.Ninety-eight patients had postoperative complications,including 41 patients with 2 or above kinds of complications.Pancreatic fistula was detected in 80patients,including 42 with grade A,28 with grade B and 10 with grade C,wound infection in 29 patients,delayed gastric emptying in 24 patients,postoperative intra-abdominal infection in 16 patients,postoperative intraabdominal hemorrhage in 10 patients including 8 receiving interventional treatment,postoperative biliary leakage in 7 patients and unintended reoperation in 2 patients.Three patients were dead during hospitalization.The incidence of complications in grade Ⅰ,Ⅱ,Ⅲ (Ⅲ a and Ⅲ b),Ⅳ and V of Clavien-Dindo classification was 28.00％(56/200),13.00％ (26/200),5.00％ (10/200),1.50％ (3/200) and 1.50％ (3/200).(2) The univariate and multivariate analyses:the results of univariate analysis showed that body mass index (BMI) and texture of the pancreas were risk factors affecting complications after pancreatico-duodenectomy (x2=6.483,Z =-3.189,P ＜0.05).The results of multivariate analysis showed that BMI ＞ 23.9 kg/m2 and soft pancreas were independent risk factors affecting complications after pancreaticoduodenectomy (OR =2.044,1.649,95 ％ confidence interval:1.212-3.447,1.194-2.275).(3) The relationship between independent risk factors and Clavien-Dindo classification of complications after pancreaticoduodenectomy was analyzed,there were statistically significant differences between BMI or texture of the pancreas and Clavien-Dindo classification of complications after pancreaticoduodenectomy (x2 =13.897,27.077,P ＜ 0.05).Conclusions Clavien-Dindo classification of complications after pancreaticoduodenectomy is in favor of comprehensive comparisons and quality assessments among different studies,the primary classification is grade Ⅰ and Ⅱ.And decreasing BMI and good management of pancreatic stump may affect Clavien-Dindo classification of complications after pancreaticoduodenectomy.

Objective To characterize the clinical manifestations and to evaluate the value of the electrophysio-logical examination in patients with peripheral nerves injuries caused by neurobrucellosis. Methods Electrophysiology examination was conducted in 32 patients with peripheral nerve injuries caused by neurobrucellosis and 32 normal controls who had equivalent age and gender. The results were further statistically analyzed. Results There were sig-nificant difference between patients and healthy control group in distal motor latency (DML), compound motor active potentials (CMAP) amplitude, motor nerve conduction velocity (MCV), sensory nerve action potential latency(SL),senso-ry nerve action potential (SNAP) amplitude and sensory nerve conduction velocity (SCV) ( P﹤0.05). Electrophysiology examination revealed peripheral nerve damage of limbs involving, both sensory nerve and motor nerves, of which sen-sory and motor nerve injuries accounted for 55.47% and 16.80%, respectively. Median and sural nerve injuries were most frequently affected in upper (64) and lower limbs (16). Motor and sensory nerve conduction velocity was delayed in 43 nerves (16.80%) of 256 examined motor nerves and in 142 nerves (55.47%) of 256 examined sensory nerves. The damage of the sensory nerves was more severe than those of the motor nerves and damage of nerves in the upper limbs was more severe than those in the lower limbs. Conclusion Electrophysiologoical examination provides objective basis for the diagnosis of peripheral nerve injuries in neurobrucellosis.

Objective The clinical characteristics of central nervous system neurobrucellosis (NB),such as incidence features,clinical symptoms,laboratory tests and imaging manifestations,are summarized to provide referenced clinical data for improving diagnosis standard.Methods Thirty-two in-patients with central nervous system NB were chosen in our hospital from March 2011 to December 2014.The clinical data were collected after they underwent some supplementary examinations,and then,follow-up was performed after 6 months of treatment.Results (1) The proportion of male and female was 5.5:1,and the average age was 50 years.(2) Twenty-four patients had onset with infectious of the central nervous system;another 8 had onset with cerebrovascular disease.(3) The clinical symptoms included fever,headache,nausea and vomiting and limb weakness;the signs included pathological syndrome,decreased muscle strength,and meningeal irritation sign.(4) All 32 NB patients underwent lumbar puncture,including 15 with normal cerebrospinal fluid pressure,and routine and biochemical examinations,4 with atypical NB cerebrospinal fluid changes,5 with NB early changes,and 6 with NB late changes.(5) Twenty-three patients appeared with positive imaging performance;15 patients were noted having lesions in the cortex,semi oval center,paraventricular and basal ganglia,3 in the spinal canal,one in the cervical spinal cord,two in the thoracic spinal cord,one in the cerebellar hemisphere and one in the dura mater.(6) After systematical treatment,one died,the other 31 recovered,of which 9 had different degrees of sequela.Conclusions NB is a part of the whole of Brucella infection.Its nonspecific clinical manifestations and extensive clinical syndrome bring some difficulties to definite diagnosis.Cerebrospinal fluid and neuroimaging examination are important evidences for the diagnosis.So it is necessary to study and understand these characteristics deeply to provide valuable data for early diagnosis and treatment of the disease.

Objective ToinvestigatethefeasibilityofassessingliverfunctiongradingbyIDEAL-IQsequenceon1.5T MR.Methods The patientswhowereclinicallydiagnosedaslivecirrhosisandunderwent1.5T MRIDEAL-IQsequenceinourhospitalfrom February 2016toDecember2017wereanalyzedretrospectively.TheyweredividedintoA,BandCgradesaccordingtotheChild-Pughgrading standardofliverfunction.Finally,therewere30patientsinChild-PughA,25patientsinChild-PughBand16patientsinChild-Pugh C.ThefatratiomapsandR2?relaxationratemapswereusedtomeasuretheliverfatcontentandironcontentbythetwoobservers onAW4.6workstation,respectively.ThemeanvaluesofthefatfractionsandtheR2?valuesweremeasuredandcomparedbyusing K ruskal-W allis H testamongthethreegroups.Then,thegroupAandBwerecombinedtoestablishthepredictivemodelindiagnosingthegroup Cbyusingthe L o g istic regressionanalysis,whichcombinedthefatfractionandR2?value.TheROCcurvewasdrawntoobtainedtheAUC,and calculatedthesensitivityandthespecificitywiththeoptimalthreshold.Results Thereweregoodconsistencyofmeasurementdata betweenthetwoobserves(ICC>0.8).ThefatfractionandR2?valueincreasedwiththedecreaseoftheliverfunction.Thefatfractionsofthe Child-PughA,BandCgroupwere(3.58±0.91)%,(3.64±1.20)%,(6.87±3.91)%,respectively.TheR2?valuesoftheChild-Pugh A,BandCgroupswere(33.31±11.80)Hz,(38.00±13.31)Hz,(58.98±44.54)Hz,respectively.TheAUCofwhichcombinedfat fractionandR2?valuediagnosingChild-PughCwas0.843.Thesensitivityandthespecificitywere81.8% and81.3%,respectively. Conclusion The1.5T MRIDEAL-IQsequencecanbeusedtoevaluatetheliverreserveunctionoflivercirrhosispatientsaccording ffatfractionandR2?value,especiallyfortheChild-PughCcirrhosis patientswithhighsensitivityandspecificity.

Objective:The study aims to investigate the relationship between the Geriatric Nutritional Risk Index(GNRI)and the risk of all-cause mortality in older adults living in the community.Methods:Using data from the Chinese Longitudinal Healthy Longevity Survey.a community-based population cohort study utilized the Geriatric Nutritional Risk Index(GNRI), which was calculated based on height, weight, and serum albumin levels during baseline surveys conducted in 2012 and 2014.Participants were categorized into normal(GNRI>98), mild malnutrition(92 ≤ GNRI ≤ 98), and moderate/severe malnutrition(GNRI<92)groups.Follow-up of all participants continued until 2018, during which data on death outcomes and survival time were gathered.The study employed Kaplan-Meier curves and Cox proportional hazards regression models to assess the relationship between GNRI levels and the risk of all-cause mortality.Results:A total of 3, 016 older adults were analyzed, with 1, 296(42.97%)identified as having malnutrition.Over a follow-up period of 10, 594.5 person-years, there were 1, 280 deaths recorded.Adjusting for various factors such as sociodemographic characteristics, functional abilities, cognitive function, and chronic diseases, the mild malnutrition group showed a hazard ratio( CI)of 1.35(95% CI: 1.18-1.56)compared to the normal group, while the moderate/severe malnutrition group had a HR of 1.85(95% CI: 1.61-2.12)for all-cause mortality risk.The GNRI's area under the ROC curve for predicting death was 0.70(95% CI: 0.61-0.77), with a sensitivity of 71.3% and specificity of 65.4%.Subgroup analysis revealed a more significant association between malnutrition and mortality risk in men compared to women( P-interaction=0.037). Conclusions:The findings suggest a notable link between malnutrition levels and the risk of all-cause mortality, indicating that GNRI could be a valuable tool for predicting survival outcomes in this population.

Objective:To investigate the correlation between psychological resilience and the risk of all-cause mortality in disabled older individuals.Methods:A total of 8, 089 disabled older adults were selected from the Chinese Longitudinal Healthy Longevity Survey(1998-2018)after screening with the Katz index.Psychological resilience was assessed at baseline using a seven-item self-rating scale.Participants were followed up until 2018, with survival data being recorded.Restricted cubic spline regression and Cox proportional hazard models were employed to analyze the association between psychological resilience and all-cause mortality, as well as to explore the potential interaction between psychological resilience and levels of disability.Results:After adjusting for potential confounding factors, a linearly negative relationship was found between levels of psychological resilience and mortality risk( P-nonlinear 0.781).Stratified analyses by degree of disability revealed that for older adults with mild disability, a 1 standard deviation increase in psychological resilience was associated with a 12% decrease in mortality risk( HR=0.88, 95% CI: 0.83-0.94).However, no significant association was observed between psychological resilience and mortality risk in severely disabled participants.A significant interaction was noted between resilience levels and degree of disability( P-interaction=0.026). Conclusions:This study offers observational evidence supporting the importance of maintaining psychological resilience in reducing mortality risk among disabled older individuals, particularly those with mild disability.The findings highlight the potential benefits of psychological interventions for older adults with varying levels of functional decline.