Objective:To understand the loss to follow-up of children born to pregnant women with HIV infection (HIV-exposed children) and analyze its influencing factors in China in 2019.Methods:The data were collected from the follow-up records of pregnant women with HIV infection and their children reported by the national "Management Information System for the Prevention of HIV, syphilis and Hepatitis B Mother-to-Child Transmission" in 2019. HIV-exposed children were defined as those who were not followed up after birth or who were not followed up at 18 months of age and who were not followed up at 21 months of age. The univariate and multivariate influencing factors of loss to follow-up of children born to HIV-infected pregnant women were analyzed by χ2 test and logistic regression model. SPSS 25.0 software was used for statistical analysis. Results:The number of HIV-infected pregnant women was 5 039, the number of live-born children was 5 035, the number of loss to follow-up children within 18 months of age was 283, and the loss to follow-up rate children was 5.62%(283/5 035). The results of multivariate logistic regression analysis showed that the rate of loss to follow-up of exposed children born to pregnant women who worked as farmers (animal husbandry and fishery) (a OR=0.34, 95% CI: 0.22-0.53), unmarried (a OR=0.47, 95% CI: 0.24-0.93), first marriage (a OR=0.38, 95% CI: 0.22-0.67), remarriage (a OR=0.36, 95% CI: 0.20-0.67) and cohabiting (a OR=0.47, 95% CI: 0.23-0.97), and knew they had HIV infection before this pregnancy (a OR=0.53, 95% CI: 0.40-0.70) was lower. Han nationality (a OR=1.52, 95% CI: 1.09-2.13), primary school (a OR=2.06, 95% CI: 1.10-3.89) and junior middle school (a OR=1.81, 95% CI: 1.03-3.17) educational level, non-use of antiviral drugs (a OR=6.21, 95% CI: 4.32-8.93) and delivery in township (street) level midwifery institutions (a OR=5.72, 95% CI: 1.61-20.27) had higher rates of loss to follow-up among infants born to HIV-infected pregnant women. Conclusions:HIV-exposed children still have a specific rate of loss to follow-up in China in 2019. In order to further reduce the rate of loss to follow-up, it is of great significance to improve the detection rate of HIV before pregnancy and the rate of antiviral drugs used in pregnant women with HIV infection, which is of great significance for the effective implementation of comprehensive intervention measures of prevention of mother-to-child transmission of HIV.

Background Neonicotinoid insecticides (NEOs) are emerging synthetic insecticides that have been used in various pest management regimens worldwide as alternatives to conventional insecticides. Recently, several studies have indicated that humans are widely exposed to NEOs, but limited is known about the levels and associated health risks of NEOs exposure among children. Objective To estimate exposure levels of four kinds of NEOs in urine samples among 5-year-old children from Laizhou Wan, Shandong Province, and to evaluate health risks of single and cumulative exposure to NEOs among children in this area. Methods A total of 205 children who participated in the 5-year-old follow-up in Laizhou Wan Birth Cohort (LWBC) were included. Urinary concentrations of four NEOs [imidacloprid (IMI), acetamiprid (ACE), clothianidin (CLO), and thiamethoxam (THM)] were measured by high-performance liquid chromatography coupled with triple quadrupole mass spectrometry. Based on the detected NEOs concentrations, estimated daily intake (EDI) was calculated, and the health risk of exposure to single NEO was assessed using hazard quotient (HQ, risk threshold=1). A relative potency factor (RPF) approach was used to standardize the concentrations of the four NEOs by IMI to calculate their cumulative concentrations. Then, the health risk of cumulative exposure to the four NEOs was further evaluated based on the HQ method. Results The detection rates of the four NEOs in the 5-year-old children were all above 90%, and their median creatinine-adjusted urinary concentrations were in the order from high to low as follows: CLO (1.373 μg·g⁻¹) > THM (0.628 μg·g⁻¹) > IMI (0.310 μg·g⁻¹) > ACE (0.073 μg·g⁻¹). Of the four NEOs, the median EDI of IMI was 0.035 µg·kg⁻¹·d⁻¹, higher than those of CLO (0.032 µg·kg⁻¹·d⁻¹), THM (0.012 µg·kg⁻¹·d⁻¹), and ACE (0.002 µg·kg⁻¹·d⁻¹). The maximum HQ values of IMI, CLO, THM, and ACE were 0.168, 0.152, 0.055, and 0.022, respectively, which were all far lower than the risk threshold of 1. The median concentration of cumulative exposure to the four NEOs standardized by IMI was 21.241 μg·g⁻¹, and its median EDI was 2.370 µg·kg⁻¹·d⁻¹. The maximum HQ of cumulative exposure to the four NEOs was only 0.694, which also did not exceed the risk threshold of 1. Conclusion NEOs exposure is common among the 5-year-old children in Laizhou Wan, Shandong. Although there is no obvious health risk associated with single and cumulative exposure to NEOs in the children in this area, their exposure levels of NEOs are higher than those in some foreign areas. The adverse health effects of long-term exposure to low dose of NEOs deserve our extensive attention.

Objective:To investigate the risk factors and treatment of postpancreatico-duodenectomy hemorrhage(PPH).Methods:The retrospective case-control study was conducted. The clinical data of 712 patients who underwent pancreaticoduodenectomy in Peking University First Hospital from January 2012 to November 2021 were collected. There were 392 males and 320 females, aged from 16 to 89 years, with a median age of 62 years. Observation indicators: (1) diagnosis of PPH; (2) analysis of influencing factors for PPH; (3) treatment of PPH. Measurement data with skewed distribution were represented as M(range). Count data were described as absolute numbers or percentages. Univariate analysis was performed using the chi-square test or Fisher exact probability, and multivariate analysis was performed using the Logistic regression model. Results:(1) Diagnosis of PPH. Of the 712 patients, 72 cases had PPH and 7 cases died. The incidence of PPH was 10.11%(72/712), and PPH related mortality was 9.72%(7/72). There were 7 cases of early PPH and 65 cases of delayed PPH. There were 23 cases of mild PPH and 49 cases of severe PPH. (2) Analysis of influencing factors for PPH. Results of univariate analysis showed that preoperative serum total bilirubin (TBil), extended surgery, postoperative pancreatic fistula, postoperative biliary fistula, postoperative abdominal infection were related factors for delayed PPH ( χ2=13.17, 3.93, 87.89, 22.77, 36.13, P<0.05). Results of multivariate analysis showed that preoperative serum TBil ≥171 μmol/L, postoperative grade B or C pancreatic fistula, postoperative biliary fistula, postoperative abdominal infection were independent risk factors for delayed PPH ( odds ratio=1.91, 8.10, 2.11, 2.42, 95% confidence interval as 1.09-3.33, 4.62-14.20, 1.06-4.23,1.35-4.31, P<0.05). (3) Treatment of PPH. ① Treatment of early PPH. Of the 7 cases with early PPH, 4 cases had mild PPH and 3 cases had severe PPH. The 4 cases with mild PPH were stanched by conservative treatment. The bleeding location of the 3 cases with severe PPH were the posterior wall of pancreatoenteric anastomosis, the pancreatic uncinate stump and the unintentional puncture of the jejunostomy tube of the left upper abdominal wall vessels and the 3 cases were stanched by reoperation. All the 7 cases were discharged without other complications. ② Treatment of delayed PPH. Of the 65 cases with delayed PPH, 19 cases had mild PPH and 46 cases had severe PPH. Of the 19 cases with mild PPH, 18 cases were stanched by conservative treatment including 2 cases died of pancreatic fistula and abdominal infection, 1 case were stanched by endoscope therapy. Of the 46 cases with severe PPH, 18 cases with stable vital signs and slow bleeding were stanched by conservative treatment including 1 case died of infectious toxic shock and the other 28 cases underwent invasive treatment, including 2 cases undergoing gastroscopy, 20 cases undergoing interventional treatment and 6 cases under-going reoperation as the initial treatment. Of the 22 cases taking endoscope or interventional treatment as the initial treatment, 5 cases underwent rebleeding and 2 cases died, with the reblee-ding rate and mortality as 22.7%(5/22) and 9.1%(2/22), respectively. Of the 6 cases taking reopera-tion as the initial treatment, 3 cases underwent rebleeding and 2 cases died, with the rebleeding rate and mortality as 3/6 and 2/6, respectively. There was no significant difference in the rebleeding rate and mortality in patients taking endoscope or interventional treatment as the initial treatment and patients taking reoperation as the initial treatment ( P>0.05). Of the 28 cases undergoing invasive treatment, 10 cases underwent secondary surgical treatment, including 6 cases taking reoperation and 4 cases taking interventional treatment as the initial treatment for hemorrhage, and 4 cases died with the mortality as 4/10, and the other 18 cases who did not receive secondary surgical treatment survived. There was a significant difference in the mortality between patients with or without secondary surgical treatment ( P<0.05). Conclusions:Preoperative serum TBil ≥171 μmol/L, post-operative grade B or C pancreatic fistula, postoperative biliary fistula, postoperative abdominal infection are independent risk factors for delayed PPH. Surgical treatment should be performed decisively for early severe PPH. For delayed severe PPH patients who undergoing conservative treat-ment without effect, endoscope therapy and interventional treatment should be the first choice, and surgical treatment should be performed if those above procedures not working.

Numerous studies have demonstrated that estrogens may exert multifaceted effects on the cardiovascular system via activating the classical nuclear receptors ERα or ERβ and the novel G protein coupled estrogen receptor (Gper). However, some studies have reported inconsistent cardiovascular phenotypes in Gper-deficient mice. The current study was aimed to reveal the effects of genetic deletion of Gper on the arterial blood pressure (ABP) and heart rate in rats. Gper-deficient Sprague-Dawley rats were generated by utilizing the CRISPR-Cas9 gene-editing technique. ABP of 10-week old male (n = 6) and 12-week old female (n = 6) Gper-deficient rats and age-matched wild type (WT) rats (6 females and 6 males) were measured under awake and restrained conditions through the non-invasive tail-cuff method daily for 8 (females) or 9 days (males). In the male WT rats, ABP and heart rate were slightly higher in day 1 to 4 than those in day 5 to 9, indicative of stress-related sympathoexcitation in the first few days and gradual adaptation to the restrained stress in later days. Gper-deficient rats had significantly higher ABP initially (male: day 1 to day 5; female: day 1 to day 3) and similar ABP in later days of measurement compared with the WT rats. The heart rate of male Gper-deficient rats was consistently higher than that of the male WT rats from day 1 to day 8. Both male and female Gper-deficient rats appeared to show slower body weight gain than the WT counterparts during the study period. Under anesthesia, ABP of Gper-deficient rats was not significantly different from their WT counterparts. These results indicate that Gper-deficient rats may be more sensitive to stress-induced sympathoexcitation and highlight the importance of Gper in the regulation of the cardiovascular function in stressful conditions.

Objective To explore the impact of abdominal situs inversus on the diagnosis and treatment of abdominal diseases.Methods Clinical data and course of 13 abdominal situs inversus cases from January 2012 to December 2016 were retrospectively analyzed.Results A total of 13 cases accounting for 1.5/10 000 of all cases who had abdominal CT were diagnosed situs inversus.6 of them were diagnosed for routine physical examination,4 of them for urinary tract symptoms,and the other 3 for digestive complaints.Conservative treatment or follow-up was prescribed for 8 patients who were asymptomatic and healthy;Five patients received operation,including 2 nephrecctomy,1 pancreatico duodenectomy,1 laparoscopic cholecystectomy,and 1 endoscopic retrograde cholangiopancreatography.All the cases recovered uneventfully.Conclusions Abdominal situs inversus is rare,non-disease entity,usually an incidental finding during clinical examination.It does not affect the therapeutic principle of concurrent primary disease.

Objective To investigate the clinical features and surgical indications of subtypes of intraductal papillary mucinous neoplasm (IPMN) of the pancreas,and analyze its malignant risk factors.Methods The retrospective case-control study was conducted.The clinicopathological data of 77 patients with IPMN of the pancreas who were admitted to the First Hospital of Peking University from January 2008 to December 2016 were collected.The subtypes of IPMN of the pancreas detected by preoperative imaging examination included main-duct type (MD-IPMN) in 46 patients,branch-duct type (BD-IPMN) in 12 patients,mixed type (MT-IPMN) in 19 patients.The surgical indications were consulted from the Guideline for the diagnosis and treatment of pancreatic cystic lesions composed by the Pancreatic Surgery Group of Surgery Branch of China Medical Association.Surgical procedure was selected according to the location and size of the IPMN.Four to 6 cycles of chemotherapy with S-1 and/or Gemcitabine were conducted for patients with malignant IPMN according to the tolerance and baseline characteristics.Observation indicators included:(1) comparison of the clinical features MD-IPMN,MT-IPMN and BD-IPMN;(2) surgical and postoperative conditions;(3) results of postoperative pathological examination and malignant risk factors analysis;(4) accuracy evaluation of Sendai and Fukuoka guidelines for the diagnosis of malignant IPMN of the pancreas;(5) follow-up results and survival.Patients were followed up by outpatient examination and telephone interview till December 2016.The postoperative adjuvant therapy,tumor recurrence and metastasis of malignant IPMN patients and postoperative survival condition of all the patients were collected.Measurement data with normal distribution were expressed as (x)±s or average (range),and pairwise comparison was analyzed by t test.Measurement data with skewed distribution were expressed by median (range).Comparison between count data and univariate analysis were done by chi-square test.Multiple factors analysis was done by Logistic regTession model.The survival curve was drawn and the survival rate were calculated by Kaplan-Meier method.The comparison of survival was done by Log-rank test.Results (1) Comparison of clinical features between MD-IPMN,MT-IPMN and BD-IPMN:The numbers of patients with symptoms,jaundice,those complicated with diabetes and elevated CA19-9 were 55,20,43 and 28 in MD-IPMN and MT-IPMN,and 6,0,3 and 1 in BD-IPMN,with statistically significant difference (x2=5.421,3.516,5.525,3.834,P＜0.05).(2) Surgical and postoperative conditions:the operations for all the 77 patients were successfully done,including pancreaticoduodenectomy with or without preservation of pylorus on 45 patients,resection of head of pancreas with duodenum preservation on 3 patients,distal pancreatectomy on 23 patients,distal pancreatectomy combined with partial resection of spleen and stomach on 2 patients (with greater curvature of stomach involvement),segmental pancreatectomy on 2 patients,total pancreatectomy on 2 patients.A total of 26 surgery-related complications were detected,including pancreatic fistulas (13),delayed gastric emptying (9),wound infection (2),abdominal hemorrhage (2),and all the complications were improved by conservative treatment.There was no perioperative mortality.The mean duration of hospital stay of the 77 patients was 16 days (range,6-68 days).(3) Results of postoperative pathological examination and malignant risk factor analysis:① results of postoperative pathological examination:no residual tumor was detected at the resection margin in all the 77 patients,including 47 with benign IPMN (29 with adenoma and 18 with mid-severe atypical hyperplasia and without lymph node involvement) and 30 with malignant IPMN (all of them were invasive malignancy,including 17 patients with negative lymph node metastasis and 13 with positive lymph node metastasis).② Malignant risk factor analysis of IPMN:multivariate analysis showed that age,jaundice,elevated carcinoembryonic antigen (CEA),elevated CA19-9,tumor diameter,tumor subtypes were associated with malignancy (x2 =6.531,14.755,10.243,12.062,6.416,6.143,P ＜ 0.05).Multivariate analysis showed that jaundice,elevated CEA,elevated CA19-9,tumor diameter ≥3.0 cm,MD-IPMN were independent risk factors influencing the malignancy of IPMN (OR =9.656,42.853,23.243,34.387,69.883,95％ confidence interval:1.392-66.968,2.088-879.674,2.991-180.628,3.313-356.878,1.247-3 915.467,P＜0.05).(4) Accuracy evaluation of the Sendai and Fukuoka guidelines in diagnosis of malignant IPMN.The sensitivity,specificity,positive and negative predictive values were 100.0％(30/30),14.9％ (7/47),42.9％ (30/70) and 100.0％ (7/7) for the Sendai guideline and 86.7％ (26/30),48.9％ (23/47),52.0％ (26/50),85.2％ (23/27) for the Fukuoka guideline in diagnosis of malignant IPMN,with no significant difference in the sensitivity between the 2 guidelines (x2=2.250,P＞0.05),while significant difference in the specificity between the 2 guidelines were detected (x2 =12.500,P＜0.05).(5) Follow-up and survival:Seventy of 77 patients were followed up,including 42 with benign IPMN and 28 with malignant IPMN.The median survival time was 35.0 months (range,6.0-94.0 months).All the malignant IPMN patients received adjuvant therapy.The 1-,3-,5-year overall survival rates of 47 patient with benign IPMN were 100.0％,96.2％and 96.2％,respectively,and 1 patient died of cardiac infarction.The 1-,3-,5-year overall survival rates of 30 patients with malignant IPMN were 96.6％,81.8％,38.6％,respectively,and 11 patients died of tumor recurrence or metastasis with median time of tumor recurrence or metastasis of 20.5 months (6.0-61.6 months).The 1-,3-,5-year overall survival rates of 17 patients with negative lymph node metastasis were 100.0％,100.0％ and 60.0％,respectively,and the 1-,3-,5-year overall survival rates of 13 patients with positive lymph node metastasis were 91.7％,57.1％ and 0,respectively.There was statistically significant difference between patients with benign and malignant IPMN (x2 =12.530,P＜0.05).There was statistically significant difference between patients with negative lymph node metastasis and those with positive lymph node metastasis (x2 =16.977,P＜ 0.05).Conclusions Patients with MD-IPMN or MT-IPMN are more vulnerable to be complicated with diabetes,jaundice,elevated CA19-9 and high malignancy,and thus surgery is recommended.Jaundice,elevated CEA and CA19-9,tumor diameter≥3.0 cm,MD-IPMN are the independent risk factors influencing the malignancy of IPMN.

OBJECTIVETo develop and test a scoring system to predict the risks of postoperative pancreatic fistula (POPF) after pancreaticoduodenectomy(PD).

METHODSClinic data and postoperative complications of the 445 consecutive patients who underwent a PD procedure between January 2008 and April 2015 in Peking University First Hospital were retrospectively collected and analyzed.The patients were randomly selected to modelling and validation sets at a ratio of 3∶1, respectively.The patient data were subjected to univariate and multivariate analysis in the modelling set of patients.A score predictive of POPF was designed and tested in the validation set.

RESULTSPOPF occurred in 88 of 334 patients(26.4%) in the modelling set.The multivariate analysis showed that body mass index (BMI, P<0.01) and pancreatic duct width(P=0.001) are associated with POPF independently.A risk score to predict POPF was constructed based on these factors and successfully tested.The area under the receiver operating characteristic curve were 0.829(95% CI: 0.777-0.881) on the modelling set and 0.885(95% CI: 0.825-0.945) on the validation set, respectively.

CONCLUSIONSBMI and pancreatic duct width were associated with POPF after PD. The preoperative assessment of a patient's risk for POPF is feasible.The present risk score is a valid tool to predict POPF in patients undergoing PD, to make the selection on anastomosis types, and to take precautions against POPF.

Anastomosis, Surgical ; Body Mass Index ; Humans ; Intestines ; surgery ; Multivariate Analysis ; Pancreas ; pathology ; surgery ; Pancreatic Ducts ; pathology ; Pancreatic Fistula ; pathology ; Pancreaticoduodenectomy ; adverse effects ; Postoperative Complications ; Postoperative Period ; ROC Curve ; Retrospective Studies ; Risk Factors

Objective To investigate the surgical procedure selection for chronic pancreatitis.Methods The clinical data of 80 patients with chronic pancreatitis who were admitted to the Peking University First Hospital from January 2000 to August 2013 were retrospectively analyzed.Thirty-eight patients were with or without pancreatic duct stone,and the dilation of the pancreatic duct was above 7 mm,44 patients were with common bile duct dilation,32 patients were with inflammatory mass in the head of the pancreas,and 3 patients were with splenomegaly and esophagogastric varices.Surgical procedures were selected according to the symptoms and results of imaging examination.The remission or recurrence of pain was judged according to the visual analog scales.Patients were followed up via out-patient examination,mail or phone call till December 2013.Results Choledochojejunostomy was done on 27 patients,Partington-Rochelle pancreaticojejunostomy on 24 patients,PartingtonRochelle pancreaticojejunostomy + choledochojejunostomy on 6 patients,pancreaticoduodenectomy on 7 patients,resection of the body and tail of the pancreas on 4 patients,Beger's procedure on 3 patients,splenectomy on 3 patients,Frey's procedure + fenestration of bile duct in the head of the pancreas on 3 patients,Frey's procedure on 2 patients,common bile duct exploration + T tube drainage on 1 patient.The remission rate of abdominal pain was 95.2％ (60/63).One patient died of abdominal infection and multiple organ dysfunction syndrome perioperatively.Three patients were complicated with abdominal infection,2 with pancreatic fistula,1 with biliary fistula and 1 with abdominal bleeding.All the complications were cured by conservative treatment.Seventy-nine patients were followed up,and the mean time of follow-up was 58.6 months (range,4-156 months).Thirty patients had recurrence or new onset of abdominal pain,and the recurrence rate was 38.0％ (30/79).Of the 32 patients with inflammatory mass in the head of the pancreas,17 received choledochojejunostomy,and the recurrence rate of abdominal pain was 9/17 ; the other 15 patients received pancreatoduodenectomy,Beger' procedure or Frey's procedure,and the recurrence rate of abdominal pain was 1/15.Of the 41 patients without inflammatory mass,10 received choledochojejunostomy,and the recurrence rate of abdominal pain was 7/10; 30 received PartingtonRochelle pancreaticojejunostomy,and the recurrence rate of abdominal pain was 33.3％ (10/30).Conclusions Complete drainage could relieve the symptoms for patients with pancreatic duct dilation.Surgical resection or combined surgical procedure is effective for the treatment of patients with inflammatory mass in the head of the pancreas.

Objective To investigate the risks and benefits of different surgical treatments for cystic neoplasms of the pancreas (CNP).Methods The clinical data of 243 CNP patients were reviewed retrospectively.Different surgical treatments were adopted according to the site,size and invasiveness of the tumors.A long term follow-up was carried out for patients with small benign CNP,and a surgical excision is proposed if tumors progressed during the observation.Results 58 outpatients with no evidence of malignancy was followed up and had long-term survival,in which 4 patients received a surgical resection in case of tumor progression,and all of them were confirmed benign tumors.185 cases received surgical treatments,with a resection rate of 97.3％ (180/185),including 127 non-invasive tumors,and 58 cases of invasive tumors.Perioperative mortality was 2/185,and morbidity rate was 41/185.Pancreatic fistula was the most frequent complication,which was significantly associated with tumor site and excision extension.All patients with non-invasive CNP acquired a long term survival after surgical treatments.The postoperative 1,3,5 year survival rates for patients with invasive lesions were 89.6％,52.1％ and 29.2％,respectively.Conclusions Long term follow-up and observation is feasible for asymptomatic patients with benign CNP.A radical resection should be performed for malignancy,and a combined multi-organ resection may improve the prognosis for local advanced tumors.

Objective To determine the value of liver analysis application in liver segmentation and planning of surgery.Methods Thirty patients suspected having hepatic disease were recruited in this study.Contrast-enhanced CT examinations were performed with Philips Brilliance 64-slice CT,and multi-phase images were obtained.The patients were divided into group B(with focal hepatic lesion,15 patients),and group A(without hepatic lesion,15 patients).We use the portal-venous(60-70 s)images to analysis.Liver volume and vessel recognition were edited manually if necessary,then liver segmentation proceeded automatically.All data were analyzed by the t test,chi-square test,Mann-Whitney U analysis,with SPSS 15.0 software.Results There was no significant difference of post-processing procedure between the two groups(P =0.361).The liver volume was(1374.61 ±444.05)cm3 in the group B and(1225.70±272.07)cm3 in the group A(P=0.108).The accuracy of vessel recognition was no significant difference between the two groups(P=0.87).21 vessels were recognized incorrectly include 18 hepatic veins.Conclusion The liver analysis application provides a 3D reconstruction allow vivid observation of liver segmentation and accurate estimation of the liver volume.It has broad prospect in diagnosing and surgical planning of the liver disease.