The global distribution and the risk prediction of relapsing fever group Borrelia: a data review with modelling analysis.

BACKGROUND: The recent discovery of emerging relapsing fever group Borrelia (RFGB) species, such as Borrelia miyamotoi, poses a growing threat to public health. However, the global distribution and associated risk burden of these species remain uncertain. We aimed to map the diversity, distribution, and potential infection risk of RFGB. METHODS: We searched PubMed, Web of Science, GenBank, CNKI, and eLibrary from Jan 1, 1874, to Dec 31, 2022, for published articles without language restriction to extract distribution data for RFGB detection in vectors, animals, and humans, and clinical information about human patients. Only articles documenting RFGB infection events were included in this study, and data for RFGB detection in vectors, animals, or humans were composed into a dataset. We used three machine learning algorithms (boosted regression trees, random forest, and least absolute shrinkage and selection operator logistic regression) to assess the environmental, ecoclimatic, biological, and socioeconomic factors associated with the occurrence of four major RFGB species: Borrelia miyamotoi, Borrelia lonestari, Borrelia crocidurae, and Borrelia hermsii; and mapped their worldwide risk level. FINDINGS: We retrieved 13 959 unique studies, among which 697 met the selection criteria and were used for data extraction. 29 RFGB species have been recorded worldwide, of which 27 have been identified from 63 tick species, 12 from 61 wild animals, and ten from domestic animals. 16 RFGB species caused human infection, with a cumulative count of 26 583 cases reported from Jan 1, 1874, to Dec 31, 2022. Borrelia recurrentis (17 084 cases) and Borrelia persica (2045 cases) accounted for the highest proportion of human infection. B miyamotoi showed the widest distribution among all RFGB, with a predicted environmentally suitable area of 6·92 million km2, followed by B lonestari (1·69 million km2), B crocidurae (1·67 million km2), and B hermsii (1·48 million km2). The habitat suitability index of vector ticks and climatic factors, such as the annual mean temperature, have the most significant effect among all predictive models for the geographical distribution of the four major RFGB species. INTERPRETATION: The predicted high-risk regions are considerably larger than in previous reports. Identification, surveillance, and diagnosis of RFGB infections should be prioritised in high-risk areas, especially within low-income regions. FUNDING: National Key Research and Development Program of China.

Research on equity of medical resource allocation in Yangtze River Economic Belt under healthy China strategy.

Objective: This study aimed to assess the fairness of medical resource allocation in the Yangtze River Economic Belt, based on the Healthy China strategy. It aimed to identify the issues with resource allocation fairness and provide optimization suggestions. Methods: To assess the allocation fairness from a geographical population perspective, the study used the Health Resource Concentration and Entropy Weight TOPSIS methods. Additionally, the study analyzed the allocation fairness from an economic level angle, using the Concentration Curve and Concentration Index. Results: The study found that the downstream area had higher resource allocation fairness than the midstream and upstream areas. The middle reaches had more resources than the upper and lower reaches, based on population concentration. The Entropy Weight TOPSIS method found that Shanghai, Zhejiang, Chongqing, and Jiangsu had the highest comprehensive score index of agglomeration. Furthermore, from 2013 to 2019, the fairness of medical resource distribution gradually improved for different economic levels. Government health expenditure and medical beds were distributed more equitably, while general practitioners had the highest level of unfairness. However, except for medical and health institutions, traditional Chinese medicine institutions, and primary health institutions, other medical resources were mostly distributed to areas with better economic conditions. Conclusion: The study found that the fairness of medical resource allocation in the Yangtze River Economic Belt varied greatly based on geographical population distribution, with inadequate spatial accessibility and service accessibility. Although the fairness of distribution based on economic levels improved over time, medical resources were still concentrated in better economic areas. The study recommends improving regional coordinated development to enhance the fairness of medical resource allocation in the Yangtze River Economic Belt.

[Research progress and maturity assessment of continuous manufacturing of traditional Chinese medicine].

The pharmaceutical manufacturing model is gradually changing from intermittent manufacturing to continuous manufacturing and intelligent manufacturing. This paper briefly reviewed the supervision and research progress in continuous pharmaceutical manufacturing in China and abroad and described the definition and advantages of continuous pharmaceutical manufacturing. The continuous manufacturing of traditional Chinese medicine(TCM) at the current stage was summarized in the following three terms: the enhancement of the continuity of intermittent manufacturing operations, the integration of continuous equipment to improve physical continuity between units, and the application of advanced process control strategies to improve process continuity. To achieve continuous manufacturing of TCM, the corresponding key technologies, such as material property characterization, process modeling and simulation, process analysis technology, and system integration, were analyzed from the process and equipment, respectively. It was proposed that the continuous manufacturing equipment system should have the characteristics of high speed, high response, and high reliability, "three high(H~3)" for short. Considering the characteristics and current situation of TCM manufacturing, based on the two dimensions of product quality control and production efficiency, a maturity assessment model for continuous manufacturing of TCM, consisting of operation continuity, equipment continuity, process continuity, and quality control continuity, was proposed to provide references for the application of continuous manufacturing technology for TCM. The implementation of continuous manufacturing or the application of key continuous manufacturing technologies in TCM can help to systematically integrate advanced pharmaceutical technology elements and promote the uniformity of TCM quality and the improvement of production efficiency.

Innovative accumulative risk assessment strategy of co-exposure of As and Pb in medical earthworms based on in vivo-in vitro correlation.

Recent studies on risks assessment of heavy metal(loid) are usually based on their total concentrations. Nevertheless, such an analysis does not assess their real amounts absorbed by human body. To scientifically assess the health risks, in this study medical earthworms were analyzed for relative bioavailability (RBA) of arsenic (As) and lead (Pb) using a multiple gavage mouse model with liver, kidneys, brain, and leg bones as biomarkers for the first time. Metal(loid) bioaccessibility was determined using in vitro physiologically based extraction (PBET) assay. We are the first to develop a novel accumulative health risk assessment strategy by combinational analyzing bioavailability of heavy metal(loid) levels to calculate target organ toxicity dose (TTD) modification of the HI and total cancer risk (TCR), which has capacity to evaluate the health risks of co-exposure of Pb and As in medical earthworms. As a result, As-RBA ranged from 7.2% to 45.1%, and Pb-RBA ranged from 16.1% to 49.8%. Additionally, As and Pb bioaccessibility varied from 6.7% to 48.3% and 7.8% to 52.5%, respectively. Moreover, strong in vivo-in vitro correlations (IVIVCs) were observed between metal-RBA and bioaccessibility, indicating the robustness of the in vitro PBET assay to predict metal-RBA in medical earthworms. The refined accumulative assessment strategy revealed that when adjusted by heavy metal(loid) bioavailability, the TTD modification of HI method typically exhibited an acceptable health risk caused by the co-exposure of Pb and As for cardiovascular, hematological, neurological, and renal system. The TCR levels associated with exposure to Pb and As due to the ingestion of medical earthworms were also acceptable after adjustment by bioavailability. Collectively, our innovation on accumulative risk assessment based on in vivo-in vitro correlation provides a novel approach engaging in assessing the risks due to co-exposure of As and Pb in medical earthworms.

[Contamination and Probabilistic Health Risk Assessment of Heavy Metals in Agricultural Soils Around a Lead-Zinc Smelter].

In order to identify the contamination and health risks of heavy metals in agricultural soils, a total of 56 surface soil samples (0-20 cm) were collected around a Pb-Zn smelter in Yunnan Province, and six heavy metals (Pb, Cd, Zn, As, Cu, and Hg) and pH were analyzed to assess heavy metal status, ecological risk, and probabilistic health risk. The results revealed that the average contents of six heavy metals (Pb:4413.93 mg·kg-1, Cd:6.89 mg·kg-1, Zn:1672.76 mg·kg-1, As:44.45 mg·kg-1, Cu:47.61 mg·kg-1, and Hg:0.21 mg·kg-1) were higher than their background values in Yunnan Province. Cd had the highest mean geo-accumulation index (Igeo) of 0.24, the highest mean pollution index (Pi) of 30.42, and the greatest average ecological risk index (Er) of 1312.60, indicating that Cd was the primary enriched and highest-ecological risk pollutant. The mean hazard index (HI) through exposure to six HMs was 2.42E-01 and 9.36E-01 for adults and children, respectively, with 36.63% of HI values for children exceeding the risk threshold of 1. Moreover, the mean total cancer risks (TCR) were 6.98E-05 and 5.93E-04 for adults and children, respectively, with 86.85% of TCR values for children exceeding the guideline value of 1E-04. The probabilistic health risk assessment suggested that Cd and As were the main contributors for the non-carcinogenic risks and carcinogenic risks. This work will provide scientific reference for the precise risk management and effective remediation strategy of soil heavy metal pollution in this study area.

Assessment of carbon emission and primary energy input of a gasoline combustion-powered 2.0 T SUV in China.

With the use of vehicles, large amounts of carbon dioxide are emitted by combustion of gasoline and energy consumes in their lifecycle. Therefore, the objective of this study is to evaluate the lifecycle carbon emission and primary energy input of a widely used sport utility vehicle (SUV) in China with the lifecycle assessment method. The results show that total petrol consumption of an SUV in lifetime is 21,300 kg; the CO2 emissions and primary energy input in the manufacturing, assembly, operation, and decommissioning phase are respectively 8857, 443, 54,925, and 443 kg and 123,413, 6171, 12,341, and 6171 MJ. The average CO2 emission intensity and energy input intensity of materials are respectively 2.74 kg/kg and 64.9 MJ/kg. The primary energy input of materials in manufacturing phase occupies 83.3%, and CO2 emission in use phase is 64,267.3 kg (occupied 92.62%), mainly attributed to the combustion of petrol.

Novel Integrated Tiered Cumulative Risk Assessment of Heavy Metals in Food Homologous Traditional Chinese Medicine Based on a Real-Life-Exposure Scenario.

In order to serve population health better, the first integrated tiered decision tree for cumulative risk assessment of co-exposure of Pb-, Cd-, and As-associated health risks in food homologous traditional Chinese medicine (TCM) was designed, after measuring their concentrations by inductively coupled plasma-mass spectroscopy (ICP-MS). Basically, our three-step decision tree involving hazard quotient (HQ), hazard index (HI), and target-organ toxicity dose (TTD) modification of the HI method was developed to evaluate the potential risks of 949 batches of 15 types of food homologous TCM. To acquire a real-life exposure scenario, the cumulative risk assessment model was established by optimizing key parameters, such as ingestion rates, frequency, and duration of exposure to food homologous TCM based on questionnaire data. As a result, the mean concentrations of Pb, Cd, and As in 949 batches of food homologous TCM were 0.896, 0.133, and 0.192 mg/kg, respectively. The HQ values of As for Angelica sinensis (Oliv.) Diels and Houttuynia cordata Thunb. were 1.04 and 1.01, respectively, for females. Other HQs of Pb, Cd, or As in food homologous TCM were lower than 1 for both males and females. However, after rapid screening of the co-exposure health risks of heavy metals by the HI method, cumulative risk assessment results acquired by TTD modification of the HI method implied that the potential health risks associated with the co-exposure of Pb, Cd, and As in Lonicera japonica Thunb. and Houttuynia cordata Thunb. ingested as both TCM and food were of concern in the clinic. Additionally, the cumulative risks of Pb, Cd, and As in Mentha canadensis L., Chrysanthemum indicum L., and Zaocys dhumnades (Cantor) only used as food exceeded the human tolerance dose. Collectively, our innovation on the tiered strategy of decision tree based on a real-life exposure scenario provides a novel approach engaging in the cumulative risk assessment of heavy metals in food homologous TCM. All in all, such effort attempts to scientifically guide the rational use of TCM in the treatment of the complex diseases and the improvement of population health.

[Social Determinants Affecting Changes in Mental Health of Rural-Urban Migrant Population in Chengdu: An Oaxaca-Blinder Decomposition Analysis].

Objective: To investigate the social determinants that influenced the changes in the mental health of the rural-urban migrant population in Chengdu. Methods: Using data from two cross-sectional surveys, one conducted in 2009 and another, in 2018, of the rural-urban migrant population in Chengdu, we analyzed the social determinants of mental health affecting the rural-urban migrant population in Chengdu by multiple linear regression, and analyzed the contribution of changes in social determinants to the disparity in mental health over a decade using the Oaxaca-Blinder decomposition analysis. Results: This study included 3091 cases of rural-urban migrants in Chengdu, with 965 (31.22%) covered in the survey year of 2009 and 2126 (68.78%) covered in 2018. Multiple linear regression models were established with mental component summary (MCS) as the dependent variable, the social determinants of health as the independent variables, and gender, age, and survey year as covariates. The findings showed that being married ( ß=2.33, P<0.001), drinking 1-2 times per week ( ß=-1.42, P<0.05), illness within four weeks ( ß=-2.57, P<0.001), and hospitalization in the past year ( ß=-1.82, P<0.05), wage arrears ( ß=-1.67, P<0.05), job satisfaction ( ß=1.25, P<0.001), monthly housing costs (housing costs below monthly income: ß=-1.55, P=0.001; housing costs above monthly income: ß=-4.59, P=0.001) and housing condition ( ß=0.23, P<0.05) had significant impact on the MCS of the rural-urban migrant population. The results of the Oaxaca-Blinder decomposition method showed that the MCS disparity between the two surveys was -4.7660 points. With 2018 as the base year, the explainable parts accounted for 15.80%. Being married, decrease in the prevalence of illnesses within four weeks, and increased job satisfaction formed positive contribution to the improvement of the mental health, and increase in the proportion of monthly housing expenses formed negative contribution. Conclusion: Between 2009 and 2018, the mental health of the rural-urban migrant population in Chengdu showed improvement, and changes in marital status, illness within four weeks, job satisfaction, and monthly housing costs contributed to improvements in mental health during the period. Future intervention measures to promote the mental health of the floating population can be developed with the perspective of improving the social determinants of health in mind.

[Multiphase Spatial Distribution Characteristics of Cd Morphology in Typical Intertidal Zones in the Guangdong-Hong Kong-Macao Greater Bay Area and Its Influencing Factors].

Simultaneous sampling and observation were conducted at 14 stations in typical intertidal zones of the Guangdong-Hong Kong-Macao greater bay area. The spatial distribution characteristics of Cd morphology in surface water, pore water, suspended matters, and sediments at each sampling site were analyzed, and the influencing factors of Cd morphology changes in each medium were discussed using statistical analyses based on environmental factors. The results showed that the total contents of Cd in surface water, pore water, suspended matters, and sediments in each intertidal zone ranged from 0.41-15.03 µg·L-1, 0.41-27.54 µg·L-1, 0.41-4.88 mg·kg-1, and 0.20-5.30 mg·kg-1, respectively. The contents of Cd in Shajiao Bay were significantly higher than those in other sampling sites, which should be related to the developed electronics and manufacturing industries in Dongguan. The concentration of Cd in surface water was slightly lower than that in pore water, whereas the content of Cd in suspended matter was comparable to that in sediment at the same sampling site. The results of morphological analysis showed that the ionic-state Cd was dominant in both surface water and pore water, accounting for 67.23%-97.56% and 33.33%-97.16%, respectively. In suspended matter and sediment, Cd was mainly in the residual state, accounting for 45.45%-96.36% and 45.80%-97.27%, respectively. Pearson correlation analysis showed that the complex-state Cd in the aqueous phase was negatively correlated with oxidation reduction potential (ORP) and pH and positively correlated with total organic carbon. The bioavailable Cd in solid sediment was significantly positively correlated with the proportion of clay, ORP, and solid organic carbon and significantly negatively correlated with pH. The single factor linear regression analysis showed that ORP had the greatest effect on the complex-state Cd in the aqueous phase, with regression coefficients of 0.864 and 0.824, respectively. The bioavailable Cd in solid sediment at different depths was significantly affected by the proportion of clay, and the regression coefficients were 0.968, 0.980, 0.977, and 0.877, respectively. The above results indicate that the distribution of total Cd content in the typical intertidal environment of the Greater Bay Area was affected by the characteristics of urban economic development, whereas the allocation of Cd morphology was closely related to environmental factors.

Optimization of competitive supply chains with retailers' horizontal cooperation and consumers' green preference.

With the wider recognition of the concept of environmental protection and sustainable development, more and more manufacturers have begun to implement green manufacturing strategies. However, green development is a gradual process, and the coexistence of ordinary and green products is common. This paper examines the competition between ordinary products and green ones based on supply chains, and discusses the impact of retailers' horizontal cooperation on pricing, greenness, market demand, profit, and other related decisions and results. Model solutions and numerical experiments have shown that consumers' green preference (CGP) has a positive impact on the results of green products and negative effects on those of ordinary ones; however, the impact of competition intensity (CI) is more complex, and the trend tends to change if it exceeds a certain critical value. In general, cooperation encourages retailers to raise prices and make manufacturers lower wholesale prices, but the retail and wholesale prices of green products are always higher than the corresponding prices of ordinary ones. Market demand can be reduced due to cooperation, but it is conducive to strengthening green products' greenness. However, if CI exceeds a certain threshold, the greenness will be weakened by cooperation. Both retailers can benefit from cooperation easily and they always reach a win-win situation, but manufacturers suffer badly as a result. Nevertheless, when CI is weak, cooperation will bring a greater profit improvement to the whole chain of ordinary products; in this case, if a retailer is willing to compensate for a manufacturer's profit loss and help it benefit from cooperation, the manufacturer will encourage the retailer to cooperate horizontally with the green retailer, but the green chain will be seriously damaged. When CI is strong, the greenness of green products is not obvious enough, and cooperation can bring some chances to achieve a win-win situation for two chains; if the green retailer can obtain a larger share from cooperation under this scenario, it can also enable its manufacturer to obtain compensation and change the profit increment from negative to positive. From an overall perspective, when CI is very weak or very strong, horizontal cooperation is conducive to improving the profit of the entire supply chain competition system, but when CI is relatively flat, independent operation for each chain is more advantageous; if the competition status is stable and unchanged, independent competition will be superior to horizontal cooperation.

[Heavy Metal Contamination and Health Risk Assessment of Corn Grains from a Pb-Zn Mining Area].

A total of 92 corn grain samples, around the Pb-Zn mining area in Southwest China, were collected to evaluate the contamination and health risk of heavy metals. Heavy metals including Pb, Zn, Cd, Cr, and Ni in samples were analyzed. A single factor pollution index and comprehensive pollution index were calculated to assess the quality of corn grains. The potential health risks to adults and children due to the intake of these heavy metals through consumption of crops were evaluated using the health risk index. The results showed that the average contents of Pb, Zn, Cd, Cr, and Ni in corn grains were 0.30, 23.75, 0.21, 1.33, and 1.15 mg ·kg-1, respectively, Among the metals, the content of Zn, Pb, Cd, Cr, and Ni exceeded the national food hygiene standards. The Nemero index of Pb, Cd, Cr, and Ni ranged from 4.32 to 9.07, indicating an extremely high level, whereas the contamination of Zn reached an alarming level. The assessment results of the comprehensive health risk index for the corn grains indicated that the contamination of heavy metals poses health risks to adults and children by food ingestion; moreover, the children were more sensitive to various heavy metals than the adults. Principle component analysis revealed that the first main component dominated the sources of Pb, Cd, Cr, and Ni, while the second main component, Zn, might have originated from sources different from the other heavy metals. Positive correlations were not observed between the heavy metals in corns and soils.

Sensory attributes of coffee beverages and their relation to price and package information: A case study of Colombian customers' preferences.

Sensory analysis is a powerful tool for creating profiles of food and beverages based on information perceived by the human senses. This paper investigates 18 of the most popular Colombian coffees. Individuals from nine different cities assessed products in two different ways: degree of presence (absence) of sensory properties and degree of acceptance (liking). The results focused on identifying variations in sensory evaluations due to the city, as well as classification of the products according to their degree of acceptance or rejection, and investigating associations between sensory attributes, price, and label-package information. A correspondence analysis allowed us to investigate the variation introduced by the factor city. The most preferred/rejected products were identified through preference mapping. The level of intensity of the smelling sensory attribute positively affects the price and the information presented at the product´s label-package. However, tasting attributes negatively affects price and perceptions of the product´s label-package information. We conclude that smelling sensory attributes has greater impact on purchase intentions than tasting attributes. Decision-makers should manage scent, price, and label-package characteristics wisely because they are part of the first experience of the customer.

Binary code, a flexible tool for diagnostic metabolite sequencing of medicinal plants.

The principle of chromatographic fingerprint is that certain diagnostic metabolites should be always distributed in a given plant and currently, it has been widely accepted as a promising means for medicinal plant authentication. Moreover, the chemical profile is the only evidence to clarify the ingredients of those consumable plant products, e.g. traditional Chinese medicine (TCM) prescriptions. Herein, efforts were made to describe the diagnostic metabolome of medicinal plant or TCM prescription using a binary code sequence. Forty-five well-known medicinal plants along with six relevant prescriptions were employed for concept illustration and proof. Each plant was subjected to chemical characterization, and diagnostic metabolites of all plants were gathered into a chemical pool containing 595 compounds. A robust method enabling the detection of all 595 constituents was then developed using LC coupled to scheduled multiple reaction monitoring. Analyst™ software was responsible for automatically judging the presence (defined as "1") or absence (defined as "0") of each analyte with a defined signal-to-noise threshold (S/N > 100). After converting each medicinal plant to a binary sequence consisting of 595 codes, an in-house database was built by involving all sequences. The potentials of sequence library retrieval towards plant authentication, preliminary chemical characterization, and deformulation of TCM prescriptions were demonstrated after that the diagnostic metabolome of each test sample was translated to a binary code sequence. Above all, binary code is a flexible tool for diagnostic metabolite sequencing of medicinal plants, and it should be an alternative tool of DNA barcoding towards plant authentication.

Preclinical safety assessment of antipyrine combined with lidocaine hydrochloride as ear drops.

This study was designed to assess the preclinical toxicity of antipyrine combined with lidocaine hydrochloride ear drops (ALED) and support the clinical trials of ALED in clinical settings in China. All the experiments including acute toxicity in rodents, skin sensitization toxicity in guinea pigs, skin irritation toxicity in rabbits and chronic toxicity in rats were performed according to China Food and Drug Administration guidelines. The maximum tolerated dose (MTD) of ALED administration for mice and rats was over (400 g antipyrine plus 100 g lidocaine hydrochloride)/kg and (240 g andtipyrine plus 60 g lidocaine hydrochloride)/kg, respectively. No obvious skin sensitization toxicity and skin irritation toxicity were observed. The main changes concentrated in chronic toxicity study in rats. For the chronic toxicity, rats were administrated once a day for 28 consecutive days, and a 14-day recovery period was followed. The side effects of ALED included decreased dietary intake in male rats, increased proportion of reticulocytes, decreased or even inversed granulocyte:erythrocyte ratio, fluctuated alanine aminotransferase and aspartate aminotransferase, and slightly increased relative weight of liver. Conclusively, blood system (especially erythrocyte system) and digestive system, including liver and gastrointestinal tract, might be the toxic targets of ALED.

[Generalized science of Chinese material medica-from preventive treatment of disease to Chinese medicine health industry].

Based on the systematic summary of the results of the fourth general survey of traditional Chinese medicine resources, the cultivation of large varieties of Chinese material medica and the latest research on health industrial development, the novel concepts and scientific connotations of generalized science of Chinese material medica are put forward, and the basic ideas and methods of a new Chinese medicine academic system, the cultivation system of large varieties of Chinese medicinal materials and the application system of the large health industry are constructed. This kind of generalized science of Chinese material medica, rooted in the traditional Chinese culture and the theory of "preventive treatment of disease", can avoid the narrow prospect induced by the increasing specialization and refinement of knowledge of science of Chinese material medica. It will play an important role in the modernization, industrialization, internationalization of traditional Chinese medicine.

The quantification and assessment of depression and anxiety in patients with postoperative gastroparesis syndrome.

BACKGROUND: This study aimed to analyze the stage-situation depression and anxiety as well as independent influential factors in patients with postsurgical gastroparesis syndrome (PGS) and to provide dependent indications for treatment. PATIENTS AND METHODS: The self-rating depression scale (SDS) and self-rating anxiety scale (SAS) were used to test the depression and anxiety of 53 patients with PGS, who were treated in the Department of Gastroenterological Surgery of Gansu Provincial Hospital from January 2012 to October 2016. A comparison between the SDS or SAS scores of patients with PGS and without PGS was undertaken; then, we retrospectively analyzed the factors influencing depression and anxiety in PGS patients. RESULTS: The patients with PGS' mean scores of depression and anxiety were 49.92±11.37 and 50.91±6.57, respectively, which were higher than that of patients without PGS in the Chinese population (P<0.05). The results of multivariate logistic regression analysis indicated that the independent influential factors of depression and anxiety in patients with PGS included course of disease, pancreatic juice leakage, preoperative outflow tract obstruction, postoperative abdominal infection, and anastomotic complication (P<0.05). Patients with a disease course longer than 30 days; with pancreatic juice leakage; and who suffered from preoperative outflow tract obstruction, postoperative abdominal infection, and anastomotic complication had higher ratios of depression and anxiety. CONCLUSION: Depression and anxiety are clearly evident in patients with PGS, and we should pay attention to this phenomenon and provide appropriate treatment.