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 influencing factors of not achieving textbook outcome (TO) after laparoscopic radical surgery in patients with malignant pancreatic body and tail tumor, and to establish and evaluate a nomogram for predicting the failure to achieve TO.Methods:The clinical data of 111 patients with malignant pancreatic body and tail tumors undergoing laparoscopic radical surgery in the Department of Hepatobiliary and Pancreatic Surgery in Henan Provincial People's Hospital from January 2020 to December 2022 were retrospectively analyzed, including 44 males and 67 females, aged (53.8±14.7) years. All patients were staged TNM I to II, including pancreatic ductal adenocarcinoma ( n=102, 91.9%), pancreatic neuroendocrine tumor ( n=5, 4.5%), and pancreatic intraductal papillary mucinous tumors ( n=4, 3.6%). The patients were randomly divided into a training set ( n=78) and a test set ( n=33) at a ratio of 7∶3. The 78 patients in the training set were further divided into TO group ( n=28) and control group ( n=50, not achieving TO). Based on the univariate and multivariate logistic regression analysis of training set, the influencing factors of failure to achieve TO after laparoscopic radical surgery in patients with pancreatic body and tail tumor were analyzed. A nomogram based on the multi-factors were established to predict the failure to achieve TO. Receiver operating characteristic (ROC) curve, calibration curve, decision curve analysis (DCA) were utilized to evaluate the nomogram. Results:There were significant differences in tumor diameter, positive lymph nodes, operation time and CT value of pancreas between the TO and control groups (all P<0.05). Multivariate logistic regression analysis showed that tumor diameter >4 cm ( OR=9.673, 95% CI: 2.198-42.579), positive lymph node ( OR=5.385, 95% CI: 1.514-19.154), pancreatic CT value ( OR=0.594, 95% CI: 0.392-0.902) were the influencing factors for patients who did not achieve TO (all P<0.05). Based on the results of multiple factors, a nomogram was established to predict the failure to achieve TO after laparoscopic radical surgery. The area under the ROC curve of the nomogram was 0.849 (95% CI: 0.757-0.940) and 0.873 (95% CI: 0.730-1.000) in the training and test sets, respectively. The calibration curve was close to the ideal curve and the predicted results of the nomogram matched well with the actual results. The DCA showed that the nomogram has obvious positive net benefit. Conclusion:The nomogram constructed with tumor diameter > 4 cm, positive lymph nodes and CT value of pancreas for prediction of the patients with pancreatic body and tail malignant tumor after laparoscopic radical surgery did not achieve TO has good performance.

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.

Abstract: Objective　To investigate the treatment outcomes of patients with pulmonary tuberculosis (PTB) in Xinjiang Production and Construction Corps and to explore the risk factors affecting these outcomes, so as to provide a scientific basis for the prevention and treatment of pulmonary tuberculosis in the corps region. Methods　TB patients registered in the Corps from 2016 to 2022 were selected, and the basic demographic and clinical data of the research objects were collected by retrospective method. Log-rank test was used for univariate analysis and the Cox multivariate regression model was used to analyze the influencing factors of treatment outcomes of patients with pulmonary tuberculosis. Results　From 2016 to 2022, a total of 8 838 TB patients were registered in the TB Management Information System of Xinjiang Production and Construction Corps, of which 495 cases were untreated, 43 cases had changed diagnoses, 301 cases had no treatment outcomes, 6 cases were diagnosed as extrapulmonary tuberculosis, 11 cases were diagnosed as tracheobronchial tuberculosis, and finally 7 982 TB patients were included in the study. Of the 7 982 patients, 7 578 (94.94%) were treated successfully, while 404 (5.06%) had adverse outcomes (including 32 cases of failure, 13 cases of TB death, 173 cases of non-TB death, 12 cases lost to follow-up, 94 cases of adverse reactions, 10 cases transferred to multi-drug resistance treatment, and 70 other cases). Multivariate Cox regression analysis showed that the >30 to 60-year-old and >60-year-old age groups (OR=1.565, P=0.009; OR=2.960, P<0.001), belonging to ethnic minorities (OR=1.526, P<0.001), being a patients with diabetes mellitus (OR=1.696, P=0.002), current address being in other areas of the province or patients from other provinces (OR=1.419, P=0.004; OR=1.624, P=0.001), receiving retreatment (OR=1.910, P<0.001), and absence of primary care management (OR=1.351, P=0.003) were the risk factors for unsuccessful treatment outcomes in the corps' pulmonary tuberculosis patients. Conclusions　The treatment success rate of pulmonary tuberculosis patients in the Corps region is relatively high, but there is still a need to strengthen the treatment and management of the elderly, ethnic minorities, diabetes patients, non-local floating population, retreatment patients and patients who did not receive primary management.

Objective:This work aims to investigate the phenotype-characteristics of drug resistance and the possible mechanisms of extensively drug-resistance Klebsiella pneumoniae(XDRKP). Methods:Screened by the previous drug susceptibility results, 116 clinical Klebsiella pneumoniae isolates were collected from Shanxi Bethune Hospital from January 2018 to December 2020. Matrix-assisted laser desorption/ionization time of flight mass spectrometry (MALDI-TOF MS) rapid microbial identification system and VITEK-compact 2 were used. The modified carbapenem inactivation method (mCIM) combining with EDTA carbapenem inactivation method (eCIM) was used to identify the strains′ carbapenemase phenotypes, which were compared with subsequent qPCR results. The qPCR amplification combining with agarose gel electrophoresis were carried out to detect various drug-resistant related genes, including: carbapenemase genes: blaKPC, blaNDM, blaVIM, blaIMP, blaOXA; aminoglycosides resistance genes: ① 16S rRNA methylase genes: rmtA, rmtC, rmtD, rmtG, rmtH, armA, npmA, rmtB, rmtE, rmtF, ② variant of aminoglycosides acetyltransferase gene: aac(6′)-Ib-cr; quinolone resistance genes: DNA gyrase protection protein qnr family: qnrA, qnrB, qnrC, qnrD, qnrS, efflux pump protein gene: oqxAB, qepA, variant of aminoglycoside acetyltransferase gene: aac(6′)-Ib-cr; and tigecycline-resistant Tet protein genes: efflux pump protein gene: tet (A), tet (L), ribosome protection protein gene: tet (M), tigecycline modified enzyme gene: tet (X). Each isolate′s phenotype and resistance gene result were compared and analyzed correspondingly. Results:A total number of 116 XDRKP isolates were collected in 3 years, 115 of which are identified as carbapenem resistant. Both cephalosporins and quinolones resistant rate were 100%, while the resistant rate of aminoglycosides antibiotic gentamicin, tobramycin and amikacin was 95.69% (111/116), 94.83% (110/116), or 88.79% (103/116) respectively. Sulfonamide antibiotics and tigecycline showed a relatively lower resistant rate. Compared with PCR amplification results, mCIM combining with eCIM phenotype testing had a high conformity, up to 95.65% (110/115). Positive rate of each resistance related gene was: blaKPC 90.52% (105/116), blaNDM 10.34% (12/116), rmtB 81.90% (95/116), armA 2.59% (3/116), oqxAB 65.52% (76/116), qnrB 6.03% (7/116), qnrS 12.93% (15/116), aac(6′)-Ib-cr 7.76% (9/116), or tet(A) 21.55% (25/116), respectively. Other resistance related genes were not detected. Corresponding analysis between the resistant phenotypes and resistance related genes indicated that a total of 65 XDRKP didn′t have a matched pairs, i.e. bacteria′s resistance to specific antibiotic could not be interpreted by carrying some associated resistant genes.Conclusions:The wide distribution of resistant genes and multiple-antibiotic-inactivated trait of some genes(such as aac(6′)-Ib-cr and oqxAB) in XDRKP are potential causes of the generation of extensively drug resistant phenotype. Different XDRKP isolates may carry one or more resistant genes in responding to specific antibiotic. In addition, there are some bacteria with an unmatched phenotype-gene feature indicating that both resistance genes′ regulation and some other mechanisms also play a role in development of XDR.

Objective:To understand the iodine content of edible salt in residents of Xinjiang Production and Construction Corps (referred to as Corps), and provide scientific evidence for prevention and treatment of iodine deficiency disorders.Methods:According to the requirements of the "National Iodine Deficiency Disorders Surveillance Program" form 2015 to 2019, in accordance with the principle of random sampling, one regiment from each of the five directions of east, west, south, north and center in the Corps was selected, and four companies were selected from each regiment. Edible salt samples from the homes of 15 residents in each company were collected, and salt iodine content was quantitatively tested and the test results were analyzed.Results:From 2015 to 2019, 21 028 household salt samples were collected, qualified iodized salt were 20 204, non-qualified iodized salt were 712, non-iodized salt were 112, iodized salt coverage rate was 99.47% (20 916/21 028), iodized salt qualified rate was 96.60% (20 204/20 916), qualified iodized salt consumption rate was 96.08% (20 204/21 028). The average salt iodine content was (27.72 ± 4.81) mg/kg. From 2015 to 2019, the iodized salt coverage rates in the whole Corps were all > 95%, and the iodized salt qualified rates and the qualified iodized salt consumption rate were all > 90%. Among the 14 divisions of the Corps, iodized salt coverage rates were all > 95%, except for the 12th and 14th divisions, where the iodized salt qualified rates and qualified iodized salt consumption rates were < 90%, all other divisions were > 90%.Conclusions:Iodized salt coverage rate, iodized salt qualified rate and qualified iodized salt consumption rate have all reached the national standard for eliminating iodine deficiency disorders from 2015 to 2019, however, non-iodized salt exists in some areas, and the qualified iodized salt consumption rate is low. We should strengthen monitoring of iodized salt in key areas and promote health education, consolidate and maintain achievements in eliminating iodine deficiency disorders.

OBJECTIVE: To explore the clinical characteristics and genetic basis for an infant featuring combined pituitary hormone deficiency. METHODS: Clinical data and results of DNA sequencing of the child were analyzed. RESULTS: The 10-month-old male infant presented with recurrent hypoglycemia, extremely poor appetite and constipation, and severe growth retardation from 2 months on, in addition with pituitary hormone deficiency involving growth hormone, thyroid stimulating hormone, and prolactin. Next generation sequencing revealed a novel heterozygous c.767-769del (p.Glu256del) variant of the POU1F1 gene in the patient. CONCLUSION The patient was diagnosed with combined pituitary hormone deficiency due to the POU1F1 gene variant, for which replacement therapy including thyroxine and growth hormone was provided. Hypoglycemia is unusual in patients carrying POU1F1 gene variants and requires close attention in clinical practice. For children with multiple pituitary hormone deficiency, genetic testing should be recommended to determine the cause.

Objective To analyze the impact of reduction of iodine content in iodine salt on iodine nutrition level among children and pregnant women in Xinjiang Production and Construction Corps (hereinafter referred to as the Corps).Methods In 2011 (before adjusting),the population proportional probability sampling (PPS) method was used to select 30 round fields in the Corps,one primary school was selected in each round field,and 40 children aged 8-10 years old (half males and half females) were taken from each primary school,to collect salt samples from their homes,salt iodine level was determined and thyroid examination was performed;among those 40 children,12 children (half males and half females) were selected,and urine samples were collected to test urine iodine level;at the same time,10 pregnant women were selected from the school location,and their urine samples were collected to test urine iodine level.In 2015 (after adjusting),in 14 divisions of the Corps,one round field was selected in each division from each of five directions of east,west,south,north and middle.Four company teams were selected in each round field,and 15 salt samples of households were collected in each company team,salt iodine was detected.One team primary school was selected in each round field,40 children aged 8-10 years old (half males and half females) were taken from each primary school,urine samples were collected to detect urine iodine level,and thyroid examination was performed;20 pregnant women were taken from each round field,and urine samples were collected to detect urine iodine level.A comparative analysis of iodine nutritional status in children and pregnant women in 2011 and 2015 was conducted.Goiter was examined by B-ultrasonography;salt iodine was detected by direct titration;urine iodine was detected by arsenic cerium catalytic spectrophotometry (WS/T 107-2006).Results A total of 1 195 and 4 215 salt samples were collected in 2011 and 2015,the medians of salt iodine were 32.3 and 28.2 mg/kg,respectively;the goiter rates of children were 3.4％ (42/1 220) and 1.0％ (26/2 552),respectively,both were below national standards (5.0％);the medians of urine iodine of children were 235.3 and 217.9 μg/L,respectively,both were more than the appropriate level;the medians of urine iodine of pregnant women were 183.0 and 157.7 μg/L,respectively,both were at appropriate level.Conclusion The reduction of salt iodization has no significant effect on iodine nutritional status in children and pregnant women,the iodine nutrition levels of children and pregnant women are good.

Objective To analyze epidemiological characteristics of brucellosis in Xinjiang Production and Construction Corps and to provide evidences for control and prevention of the disease.Methods Retrospective study method was used to collect the epidemic characteristics of cases and serological surveillance of brucellosis data in Xinjiang Production and Construction Corps from 2013 to 2017,the time,region,population distribution characteristics and laboratory test results of the disease were analyzed.Results In 2013-2017,the Xinjiang Production and Construction Corps reported a total of 3 287 cases of brucellosis,with an average annual incidence of 24.02/100 000,and no death case was reported.During the period,the incidence was 21.11/100 000,29.73/100 000,26.68/100 000,20.10/100 000 and 19.23/100 000,which showed a decline trend in general (linear x2 =23.67,P ＜ 0.01).The largest cumulative numbers of reported cases of the Corps were in five divisions,they were the Eighth Division with 599 cases,the Sixth Division with 470 cases,the Fourth Division with 366 cases,the Tenth Division with 320 cases and the Ninth Division with 313 cases,and they accounted for 62.91％ (2 068/3 287) of the total number of cases in the whole Corps.Brucellosis occurred in each month of the year,the number of cases reported from March to August accounted for 72.59％ (2 386/3 287),the peak incidence occurred in May and June,showing obvious seasonal fluctuation.Of all reported cases,74.78％ (2 458/3 287) were men,and 25.22％ (829/3 287) were women,38.97％ (1 281/3 287) were at the ages of 40-49 years,farmer was the highest occupation which accounted for 47.52％ (1 562/3 287).Totally 24 120 blood samples were collected from high-risk occupation during the period and 457 samples were positive for Brucella antibody,with an average positive rate of 1.89％,of the positive cases,52.30％ (239/457) had symptoms of brucellosis.Conclusions On the whole,the epidemic of brucellosis in Xinjiang Production and Construction Corps is declining year by year.But as the epidemic slowly expands,all departments should strengthen joint prevention and control measures,control and eliminate the source of infection.At the same time,we should strengthen the propaganda,education and behavior intervention for high-risk occupational groups.

Objective To understand the current situation of iodine deficiency disorders of Xinjiang Production and Construction Corps,in order to provide evidence for establishing prevention and control strategies.Methods According to their sub-area positions of east,west,south,north and center,5 units were extracted in each division via the random sampling method,4 companies were sampled in each chosen unit,15 households were selected in each chosen company to detect salt iodine content in 2015;and 1 elementary school was sampled in each chosen unit,40 students aged 8-10 were selected to collect their urine samples in each school to test urinary iodine and determine the goiter.Twenty pregnant women were randomly selected in each unit to test urinary iodine.Salt iodine was tested using direct titration,urinary iodine was determined using arsenic osmium catalytic spectrophotometry,thyroid was examinated using B-ultrasound.Results Totally 3 915 edible salt samples were monitored.The mean of salt iodine was (27.8 ± 5.5) mg/kg,with 99.1％ (3 880/3 915) iodized salt coverage rate,93.2％ (3 617/3 880) iodized salt qualified rate and 92.4％ (3 617/3 915) qualified iodized salt consumption rate.The goiter rate was 1.0％ (26/2 552) and the median of urinary iodine was 217.9 μg/L of 2 552 children aged 8-10,urinary iodine of southern region and northern region was 212.1 and 222.1 μg/L,respectively.The median of urinary iodine of 1 233 pregnant women was 157.7 μg/L.Conclusion The iodine nutrition level of key groups have already reached the national standard for eliminating iodine deficiency disorders,we should pay more attention to lower level urinary iodine of pregnant women.