Hepatitis B is a major global public health issue. Through the implementation of comprehensive prevention and control strategies centered on hepatitis B vaccination， China has achieved remarkable progress in hepatitis B prevention and control， while there are still many issues and challenges. This article reviews the development of hepatitis B vaccination strategies in China， analyzes the goal and advances in vaccination in different populations， and problems and challenges， in order to provide a reference for further optimizing vaccination strategies and improving the levels of prevention and control.

Objective:To analyze the influencing factors of achieving textbook outcome (TO) after pancreaticoduodenectomy (PD) in patients with pancreatic ductal adenocarcinoma, and to construct a nomograph model to explore its predictive value in TO.Methods:The clinical data of 205 patients with pancreatic ductal adenocarcinoma treated by PD in Henan University People's Hospital from January 2019 to December 2022 were analyzed retrospectively, including 88 males and 117 females with the age of (61.3±9.8) years old. Patients were divided into two groups based on whether they achieved TO after surgery: TO group ( n=113) and non-TO group ( n=92). Clinical data such as age, gender, intraoperative blood loss, operation time, blood transfusion volume, pancreatic CT value, and tumor differentiation degree were collected. Logistic regression analysis screened the influencing factors of PD postoperative TO and built a nomogram model. The performance of the nomogram model was evaluated using receiver operating characteristic (ROC) curve, calibration diagram, and decision curve analysis. Results:Multivariate logistic regression analysis showed that the higher the degree of tumor differentiation was in patients with pancreatic ductal adenocarcinoma (high differentiation to medium differentiation: OR=7.20, 95% CI: 1.20-43.28; high differentiation to low differentiation: OR=16.55, 95% CI: 2.01-136.11), CT value>38.45 Hu ( OR=0.29, 95% CI: 0.13-0.65), blood transfusion volume ≤350 ml ( OR=8.05, 95% CI: 2.94-22.01) and operative time ≤407.5 min ( OR=10.88, 95% CI: 3.90-30.41), the easier it was to achieve TO after PD (all P<0.05). Based on the above influencing factors, a nomogram model of the postoperative effect of PD on TO was established, and the consistency index of this column graph model was 0.863 (95% CI: 0.816-0.911). The sensitivity and specificity of ROC curve were 0.804 and 0.752, respectively. The calibration diagram showed that the calibration curve fits well with the ideal curve, and the decision curve showed that the model had obvious positive net benefit. Conclusion:The degree of tumor differentiation, CT value, blood transfusion volume, and operation time are independent influencing factors for the achievement of TO after PD in patients with pancreatic ductal adenocarcinoma, and the nomogram model constructed based on which has good predictive performance for TO.

Objective:To analyze the effect of sarcopenia on the prognosis of patients with hepatocellular carcinoma (HCC) after laparoscopic radical resection.Methods:Clinical data of 165 patients with HCC undergoing laparoscopic radical resection in Henan University People's Hospital from January 2018 to December 2021 were retrospectively analyzed, including 122 males and 43 females, aged (55.5±11.4) years. Patients were divided into sarcopenia group ( n=79) and control group (non-sarcopenia, n=86) according to the skeletal muscle index. The survivals were analyzed using the Kaplan-Meier method, and were compared by the log-rank test. Univariate and multivariate Cox regression were utilized to analyze the effect of sarcopenia on the prognosis of HCC after laparoscopic radical surgery. Results:The 1- and 3-year cumulative survival rates of control group were 96.4% and 81.2%, which were higher than those of the sarcopenia group (83.2% and 48.9%, respectively, χ2=19.67, P<0.001). The 1- and 3-year recurrence-free survival (RFS) rates of control group were 88.4% and 66.1%, which were higher than those of sarcopenia group (70.9% and 37.7%, respectively, χ2=18.80, P<0.001). Multivariate Cox regression analysis showed that the risk of recurrence ( HR=1.35, 95% CI: 1.20-1.59, P<0.001) and the risk of death ( HR=2.21, 95% CI: 1.23-3.41, P=0.001) after laparoscopic radical resection for HCC in patients with sarcopenia rises compared to non-sarcopenic patients. Conclusion:Sarcopenia is a risk factor for the survival and recurrence of HCC after laparoscopic radical surgery.

Objective:To investigate the clinical and pathological features and improve the acknowledgement of intraductal tubulopapillary neoplasm (ITPN) of pancreas.Methods:Six cases with ITPN in the Shandong Provincial Hospital Affiliated to Shandong First Medical University combined with 40 cases from PubMed and CNKI were retrospectively analyzed. There were 25 males and 21 females, aged (58.6±16.0) years. The clinical manifestations, pathological features, treatment and so on were analyzed.Results:All cases were treated with surgery. The main clinical symptoms were upper abdominal pain and discomfort (23 cases, 50.0%), followed by jaundice (9 cases, 19.6%). Seven cases (15.2%) had no clinical symptoms. Three cases (6.5%) had low back discomfort, chills and other rare symptoms, and 4 cases (8.7%) had no clinical symptoms mentioned in the literature. Tumors of 27 cases (58.7%) located in the head of the pancreas, 9 cases (19.6%) in the body and tail, 4 cases (8.7%) in the whole pancreas, 3 cases (6.5%) in the body, 2 cases (4.3%) in ampulla and 1 case (2.2%) in head and body. Most of the tumors located in the main pancreatic duct. Microscopically, back-to-back tubular glands were densely arranged, parts of them with papillary structure, with obvious cell atypia and many mitoses. Twenty-two cases (47.8%) of ITPN were completely confined to the pancreatic duct, and 24 cases (52.2%) were with associated invasive carcinoma. Tumor cells were positive for cytokeratin 7 and mucin 1, but negative for cytokeratin 20, synaptophysin, chromogranin and trypsin. Mucin 2, mucin 5AC and mucin 6 were negative in most cases. Ki-67 ranged from 10% to 70%.Conclusion:Pancreatic ITPNs were mostly located in the pancreatic head, confined to the main pancreatic duct, and were mostly manifested as pain and discomfort in the upper abdomen. Surgery was the main treatment. Tumors cells of ITPN were arranged in tubular and papillary, with severe epithelial atypia and special immunophenotype, parts of cases accompanied with associated invasive carcinoma.

Objective:To study the clinical, imaging and pathological features of duodenal gangliocytic paraganglioma (DGP).Methods:The clinical, imaging and pathological data of patients with DGP treated at the Shandong Provincial Hospital Affiliated to Shandong First Medical University from January 2012 to October 2021 were retrospectively analyzed.Results:Of 8 patients with DGP, there were 7 males and 1 female, with a median age of 52 years (range 37 to 57 years). Five patients were asymptomatic and they were diagnosed on physical examination followed by investigations. Three patients presented with black stools. CT examination showed localized nodular thickening of the duodenum, with enhanced scanning showing obvious progressive contrast enhancement. Endoscopic ultrasonography showed a hypoechoic submucosal lesion in duodenal wall. Histologically, the neoplasm composed of three different cell types which included Schwann cells, epithelioid cells, and ganglioid cells. The Schwann cells expressed NF, NSE and S-100 proteins; the epithelioid cells expressed CK, NSE, Syn and CgA proteins; while the ganglioid cells expressed NSE, Syn, CgA and NF proteins. Endoscopic submucosal dissection was performed in 2 patients and surgical resection was performed in 6 patients.Conclusion:DGP is a rare benign neurogenic tumor which is most commonly found in the duodenum. It has a good prognosis. Imaging and endoscopic examinations demonstrated a submucosal mass. The main treatment are endoscopic resection and local surgical resection.

Objective:To study the rate of capsule contracture after operation of the textured surfaces breast implants and the smooth surfaces breast implants, to provide evidence for plastic surgeons to select the type of breast implants during breast augmentation.Methods:This study started from January 2018 to May 2019. Chinese and English databases including Wanfang Science and Technology Periodical Full-text Database, VIP Chinese Science and Technology Periodical Full-text Database (VIP) and CNKI, PubMed, Cochrane Library, Web of Science, Science Drirect Online were searched by computer. Some relevant studies were collected for this meta-analysis.Results:We identified 9 studies including a total of 13165 subjects for the meta-analysis. The OR value of the study was 0.43 (95% CI: 0.35, 0.51), and the incidence rate of capsule contracture in the experimental group was lower than that in the control group. In cumulative meta-analysis and sensitivity test, the conclusion was stable. And there was no publication bias found by Egger regression test. Conclusions:The textured surfaces breast implants are better than the smooth surfaces breast implants in terms of incidence rate of capsule contracture after augmentation mammoplasty.

Objective:To study the correlation between serum bilirubin and cystatin C in patients with type 2 diabetes mellitus.Methods:A retrospective cohort study was conducted on 750 patients who were in the Affiliated Hospital of Jining Medical University from June 2017 to May 2018. The clinical data were collected, and the correlation between serum total bilirubin, direct bilirubin, indirect bilirubin and cystatin C was analyzed.Results:According to the results of single factor analysis, after adjusting the related confounding factors, the smooth curve fitting showed that there was a U-shaped relationship between the total bilirubin, indirect bilirubin and cystatin C. When the total bilirubin was <15.9 μmol/L, for every increase of 1 μmol/L in total bilirubin, cystatin C decreased 0.008 mg/L ( β = - 0.008, 95% CI - 0.014 to - 0.002, P<0.01); when indirect bilirubin was <11.5 μmol/L, for every increase of 1 μmol/L in indirect bilirubin, cystatin C decreased 0.011 mg/L ( β = - 0.011, 95% CI - 0.018 to - 0.003, P<0.01). When cystatin C was grouped according to the normal range (cystatin C<1.25 mg/L), after adjusting the related confounding factors, the smooth curve fitting showed that there was a U-shaped relationship between the total bilirubin and indirect bilirubin with cystatin C; when total bilirubin was <15.5 mol/L, for every increase of 1 μmol/L in total bilirubin, the risk of cystatin C exceeding the normal value was reduced by 17% ( OR = 0.83, 95% CI 0.71 to 0.96, P<0.01); when total bilirubin was ≥15.5 μmol/L, for every increase of 1 μmol/L in total bilirubin, the risk of cystatin C exceeding the normal value was increased by 12% ( OR = 1.12, 95% CI 1.01 to 1.25, P<0.05); when indirect bilirubin was <11.8 μmol/L, every increase of 1 μmol/L in indirect bilirubin, the risk of cystatin C exceeding the normal value was reduced by 20% ( OR = 0.80, 95% CI 0.67 to 0.95, P<0.01). However there was no significant correlation between direct bilirubin and cystatin C. Conclusions:There is a U-shaped relationship between total bilirubin, indirect bilirubin and cystatin C. At physiological concentrations, the increase of total bilirubin and indirect bilirubin can reduce cystatin C.

Objective To investigate the X-ray,CT and MRI features of chondroblastoma (CB)and to improve diagnostic skills of this disease.Methods The X-ray,CT and MRI imaging of 27 cases with CB which were verified by histopathological examination and the misdiagnosed cases were analyzed retrospectively.Results Accurate diagnosis of preoperative images was made in 10 cases and all 10 cases were located in the epiphysis of long bone.X-ray and CT showed eccentric round and oval osteolytic bone destruction,with sclerotic rim and internal spotted calcification;MRI showed hypointensity on T1 WI and heterogeneous hypo-and hyperintensity on T2 WI,with peripheral regions of marrow edema and adjacent joint effusion.Seventeen cases were misdiagnosed preoperatively,including 8 cases in long bone epiphysis or apophysis,8 cases in short,flat and irregular bones and 1 case in metaphysis of long bone.Twelve cases showed expansive changes and 10 cases with associated aneurysmal bone cyst(ABC)showed fluid-fluid levels.Conclusion The CB shows sandy or stippled calcification,rim sclerosis,extensive surrounding bone marrow edema.CB in unusual sites usually shows expansive bone destruction,peripheral bone marrow edema,secondary aneurysmal bone cyst.Combined utilization of clinic,pathology and imaging features is helpful for the diagnosis.

Objective To analyze the imaging features of solid pseudopapillary neoplasm of pancreas (SPN) in children, and to improve the awareness of the disease. Methods From January 2007 to December 2016, 12 patients with SPN proven pathologically were enrolled in the study,of whom 12 cases underwent CT scanning and 3 cases underwent MRI scanning. The imaging data of SPN were analyzed retrospectively. The tumor parameters included the location, size, shape, margin, capsule, form, inhancement degree, and presence of calcification, biliary obstruction, surrounding, ascites, lymph node metastasis, as well as distant metastasis, which were comparative analyzed with that of pathology. Results CT showed that 3 cases were located in the head of pancreas,7 cases were located in the body/tail of pancreas, and 2 cases were ectopic. Twelve cases were circular tumors, the diameter of which ranged from 28—76 mm (median diameter 48 mm). Capsules were showed in 10 cases, calcification was seen in 4 cases and hemorrhage was seen in 1 case. Three cases were solid, 8 cases were solid and cystic mixed,and 1 case was cystic. The tumors were heterogeneous, and the solid portion of SPN was moderately to obviously enhanced gradually whereas the cystic part remained unenhanced. Nine cases showed that the tumors growed to the outside of pancreas,in which 4 cases covered by the normal pancreas tissue, 1 case located inside of the pancreas. One case caused biliary obstruction and the collateral circulation of splenic arteriovenous was established in 2 cases due to tumor compressed. Ascites was seen in 2 cases. MRI showed that the cystic components of tumor in 3 cases showed low signal in T1WI and high signal in T2WI, with no enhancement. The solid components of the tumor showed equal signal in T1WI and slightly higher signal in T2WI, with obvious enhancement. Capsules were showed in 3 cases with low signal in T1WI and T2WI, which were obviously enhanced in 2 cases and without enhancement in 1 case;hemorrhage was showed high signal in T1WI in 1 case. No lymph node metastasis and distance metastasis were observed in 12 cases. Conclusions The characteristic imaging findings of SPN in children are boundary clear, capsules, calcification, circular pancreas tumors, which grow to the outside of pancreas, with varied degrees of hemorrhage and necrosis. The solid portion of SPN is moderately or obviously enhanced gradually.

Objective To evaluate wall histological abnormalities 2 to 3 cm to the end in high or intermediate anal atresia in order to identify features that explain postoperative bowel dysfunctions.Methods Sixty anal atresia patients treated in the Capital Pediatric Institution between January 2008 and December 2012 were recruited in our study.36 patients were resected the terminal anal segment (3 cm).Compared with those 24 cases who were not.Resected samples were fixed for HE and immuno-histochemical stainings.Clinical data including sacral ratio (SR),age at operation,gender,bowel function were evaluated.Results There was no significant difference in patients' SR value,gender and age at operation between resected group and control group.The median follow-up period was 4.5 years.The rates of voluntary bowel movement,soiling (grade 1,2,3) were similar in both groups,however,the rates of severe constipation in resection group was significantly lower that in control group (3 ％ vs.21％,P ＜ 0.05) In the bowel wall of distal 2 cm anrectal canal,the connective tissue was found to be irregular and abnormally represented.Muscle coat was abnormal in all cases,showing the dysplasia circular and longitudinal layers.The number of enteric nervous system was significant fewer in distal 2cm anrectal canal than that in distal 3 cm(1.6 ±0.9 vs.5.6 ±1.8,t=11.715,P＜0.01).Conclusions Resection of terminal 3 cm at least of the atresia anal canal benefits postoperative bowel defecation function.