Objective:To study the iodine nutrition status of key populations in Sichuan Province, so as to provide a basis for scientific supplementation of iodine and adjustment of prevention and control measures.Methods:From 2018 to 2022, the stratified cluster sampling method was used in 21 counties (district) in Sichuan Province. Each county (district) was divided into 5 areas based on east, west, south, north, and center. One township (street) was selected as a monitoring site from each area. Forty children aged 8 - 10 years old and 20 pregnant women, women of childbearing age, lactating women, and their infants and young children (0 - 2 years old) were randomly selected from each monitoring site. Household edible salt and urine samples were collected for salt and urine iodine testing. B-ultrasound method was used for thyroid examination in children.Results:A total of 52 019 samples of edible salt were collected, including 50 084 qualified iodized salt samples. The qualified iodized salt consumption rate was 96.3%, and the median salt iodine was 27.1 mg/kg. A total of 21 021 urine samples from children were tested, with a median urine iodine level of 199.5 μg/L. A total of 10 293 urine samples were taken from pregnant women, and the median urine iodine level was 172.6 μg/L. A total of 10 502 urine samples were taken from women of childbearing age, with a median urine iodine level of 174.4 μg/L. A total of 10 444 urine samples were taken from lactating women, and the median urine iodine level was 164.9 μg/L. There were 10 442 urine samples from infants and young children, and the median urine iodine level was 191.9 μg/L. A total of 21 028 children underwent thyroid examination, with a goiter rate of 1.8% (370/21 028).Conclusion:From 2018 to 2022, the iodine nutrition of key populations in Sichuan Province is at an appropriate level, and the elimination of iodine deficiency disorders continues to be maintained.

Objective:To establish a good model of incomplete ablation of ectopic implanted tumor of liver, and explore the changes in the molecular landscape of residual cancer, cancer in nude mice.Methods:Eight immunodeficient BALB/c nude mice were used to establish an ectopic tumor model with the MHCC97-H hepatoma cell line, and they were randomly divided into experimental group and control group, with 4 mice in each group. The experimental group underwent simulated clinical incomplete ablation, and the control group only underwent false ablation. The differences between the models were evaluated by ultrasonic diagnostic equipment, thermal imaging cameras, HE staining and high-throughput whole transcriptome sequencing.Results:Liver cancer ectopic implantations in nude mices were all successful. The experimental group showed that the temperature of the tumor around the tip of the needle monitored by the thermal imaging camera was at 50-73.9 ℃. Compared with the control group, the HE staining of the experimental group mostly showed the coexistence of necrotic area-degeneration area-tumor cell area. The necrosis area was (23.75±13.77)%, and the degeneration area was 50%(30%). High-throughput whole transcriptome sequencing revealed that there were hundreds of overlapping stable molecular landscapes in the incomplete ablation simulation model both in vivo and in vitro.Conclusions:By establishing an ectopic implantion model of nude mice with incomplete ablation of residual liver cancer, it can provide a basis for studying the biological characteristics of incomplete ablation of residual cancer at the molecular level.

Objective:To explore the effect of physical development on thyroid volume of children aged 8 - 10 years in Sichuan Province, and explore the thyroid volume correction method suitable for school-age children, so as to accurately prevent and control iodine deficiency disorders.Methods:From June to July 2020, Shuangliu District of Chengdu City, Pengshan District of Meishan City, Miyi County of Panzhihua City and Qingchuan County of Guangyuan City were selected as the survey counties (districts). One township (town and street) was selected from each county (district) according to the five directions of East, West, South, North and Middle, one primary school was selected from each township (town and street), and 40 children aged 8 - 10 years (gender and age balanced) were selected as the survey subjects from each primary school, height and weight were measured, the body mass index (BMI) and body surface area (BSA) were calculated. Thyroid volume was measured by B-ultrasound, and the different thyroid volume indexes [height volume index 1 (HVI1), height volume index 2 (HVI2), body mass volume index (BMIV), weight and height volume index (WHVI), body surface volume index (BSAV)] were calculated, respectively. Urine samples of all children were collected, the iodine concentration in urine was measured, and the correlation between different measurement indexes and children's growth and development indexes was analyzed.Results:A total of 805 children aged 8 - 10 years were investigated, including 403 boys and 402 girls. There were 312, 288 and 205 children in the 8-, 9- and 10-year-old groups, respectively. A total of 805 urine samples were collected, and the median urinary iodine was 251.4 μg/L. There was no statistically significant difference in thyroid volume between boys and girls ( Z = - 0.44, P = 0.661), but was statistically significant difference between ages ( H = 64.95, P < 0.001). In all age groups, thyroid volume was positively correlated with height and weight (8-year-old group: r = 0.29, 0.42, P < 0.001; 9-year-old group: r = 0.29, 0.41, P < 0.001; 10-year-old group: r = 0.34, 0.47, P < 0.001). In all age groups, after HVI1 correction, thyroid volume was positively correlated with height and weight (8-year-old group: r = 0.13, 0.32, P < 0.05; 9-year-old group: r = 0.12, 0.30, P < 0.05; 10-year-old group: r = 0.18, 0.37, P < 0.05). In all age groups, there was a positive correlation between thyroid volume and weight after HVI2 correction (8-year-old group: r = 0.20, P < 0.001; 9-year-old group: r = 0.17, P = 0.004; 10-year-old group: r = 0.26, P < 0.001). In the 8- and 10-year-old groups, there was a positive correlation between thyroid volume and height after BMIV correction ( r = 0.20, P < 0.001; r = 0.21, P = 0.003). In all age groups, there was a negative correlation between thyroid volume and height and weight after WHVI correction (8-year-old group: r = - 0.35, - 0.37, P < 0.001; 9-year-old group: r = - 0.38, - 0.39, P < 0.001; 10-year-old group: r = - 0.31, - 0.38, P < 0.001). In the 8-year-old group, there was a positive correlation between thyroid volume and weight after BSAV correction ( r = 0.11, P = 0.045). Conclusions:Thyroid volume is closely related to height and weight. It may be inappropriate to judge goiter in children only based on age. After the preliminary comparison of five correction methods, it is found that BSAV is better.

Objective:To study the safety and efficacy of laparoscopic cholecystectomy (LC) in treatment of T2a and lower stages of gallbladder carcinoma.Methods:A retrospective study was performed on patients who were diagnosed with gallbladder cancer and underwent surgical treatment from January 2016 to January 2021 at Hunan Provincial People's Hospital. These patients were divided into the simple treatment group and the radical treatment group based on the surgical methods used. The simple treatment group consisted of 64 patients who underwent LC for accidental gallbladder cancers. The radical treatment group consisted of 30 patients who underwent laparoscopic radical cholecystectomy (LRC). The baseline characteristic of the two groups of patients were matched in a 1∶1 ratio using propensity score matching. After matching, there were 26 patients in each of the 2 groups. There were 7 males and 19 females in the simple group, with mean ± s. d. age of (60.6±9.6) years. There were 8 males and 18 females, with mean ± s. d. age (60.9±9.1) years in the radical treatment group. Blood loss, operation time, postoperative hospital stay, biliary leakage, acute pulmonary embolism, and incisional infection were compared between the two groups.Results:In the simple group, the operative time was (78.7±62.9) min, intraoperative blood loss was (10.7±11.6) ml and postoperative hospital stay was (4.4±2.6) d. These results were significantly better than those in the radical group with operative time (298.7±101.3) min, intraoperative blood loss (161.9±96.7) ml and postoperative hospital stay (9.9±4.0) d (all P<0.05). There were no significant difference in the postoperative complications and disease free survival rates between the two groups (both P>0.05). Conclusion:LC was safe and effective for treatment of T2a and lower stages of gallbladder cancer, and it could achieve a similar disease-free survival rate as LRC.

Objective:To analyze the causes of postoperative stricture of biliary-enteric anastomotic for congenital choledochal cysts.Methods:These 28 patients underwent salvage operation on an average 15 years (0.2-25 years) after initial surgeries at the Department of Hepatobiliary Surgery, Hunan Provincial People's Hospital from Jan 2014 to Jun 2018.Results:In 26 patients the biliary-enteric anastomotic stenosis was benign, and in 2 the stricture was caused by cancerration. In 26 cases the Roux-en-Y hepaticojejunostomy was redone,among them 8 cases underwent concurrent hepatectomy for a better exposure of the intrahepatic bile duct. In 2 cases the anastomotic stenosis was found to be caused by canceration with extensive intraabdominal metastasis ,an external drainage was adopted. There were no inhospital deaths, and no serious complications. The postoperative follow-up time was 6-67 months. Two cancerated patients died within half a year, and the remaining patients had no long-term complications.Conclusions:Biliary-enteric anastomotic stenosis is one of the serious complications in postoperative patients for congenital choledochal cysts. Hence a wide, tension free biliary-enteric anastomosis performed by a experienced hand is necessary.

Objective:To investigate the clinical efficacy of perihilar surgical techniques for diffuse hepatolithiasis.Methods:The retrospective and descriptive study was conducted. The clinicopathological data of 122 patients with diffuse hepatolithiasis who were admitted to Hunan Provincial People's Hospital from January 2010 to December 2015 were collected. There were 39 males and 83 females, aged from 21 to 82 years, with a median age of 51 years. After perihilar hepatectomy, the first, second and third divisions of hepatic ducts were opened longitudinally. Strictures in the bile ducts were relieved by stricturoplasty and internal bile duct anastomosis, and stones were removed by multiple methods under direct vision. After resection of severe atrophic liver segment along the plane of hepatic atrophy or bile duct stricture, T-tube or hepaticojejunos-tomy was used for internal drainage. Observation indicators: (1) surgical situations; (2) stricture relief and stone removal. (3) Follow-up. Follow-up was conducted by Wechat, telephone interview or outpatient examination. Patients were followed up once every 3 months in the postoperative 1 year through liver function and abdominal B-ultrasound examination. Subsequently, liver function and abdominal B-ultrasound were reexamined once a year. Magnetic resonance cholangiopancreato-graphy and computed tomography were performed when cholangitis or stone recurrence was suspected to analyze stone recurrence and patient survival. The follow-up was up to July 2020. Measurement data with normal distribution were represented as Mean± SD, and measurement data with skewed distribution were represented as M(range). Count data were expressed as absolute numbers or percentages. Results:(1) Surgical situations: for the 122 patients, the operation time, hepatic portal occlusion time, volume of intraoperative blood loss, duration of postoperative hospital stay were (253±71)minutes, 15 minutes(range, 14?38 minutes), 200 mL(range, 100?1 100 mL), (12±5)days. Postoperative complications occurred to 40 of 122 patients. There were 9 cases of incision infection, 8 cases of bile leakage (5 cases of bile leakage at hepatic section, 3 cases of choledochojejunostomy leakage), 8 cases of septicemia, 7 cases of pleural effusion, 5 cases of abdominal abscess, 3 cases of liver failure, 1 case of biliary bleeding. Some patients had multiple complications. Among the 122 patients, 2 cases died after operation, including 1 case of postoperative liver failure and 1 case of disseminated intravascular coagulation caused by biliary-intestinal anastomotic leakage complicated with sepsis. Patients with bile leakage and abdominal abscess were improved after puncture and drainage under the guidance of B-ultrasound. Patients with cholangiojejunal anastomotic bleeding were embolized through the right hepatic artery. The other complications were improved after conservative treatment. (2) Stricture relief and stone removal: 85 of 88 patients with biliary stricture were relieved, with the stricture relief rate of 96.59%(85/88). Among the 122 patients, 103 cases had stones completely removed and 19 cases had residual stones. The immediate stone clearance rate was 84.43%(103/122). Of the 19 patients with residual stones, choledochoscopy was refused in 3 cases and choledochoscope lithotripsy was performed in 16 cases, of which 7 cases were removed and 9 cases were still residual stones. Of the 122 patients, 110 cases were finally removed stones, 12 cases were eventually residual stones, and the final stone clearance rate was 90.16%(110/122). (3) Follow-up: among the 122 patients, 120 cases including 110 cases with find stone removal and 10 cases with residual stones were followed up for (78±14)months. The 1-, 3, 5-year stone recurrence rates of 120 patients were 0.83%(1/120), 6.67%(8/120), 9.17%(11/120), respectively. The 1-, 3-, 5-year stone recurrence rates of 110 patients with final stone removal were 0, 5.45%(6/110), 5.45%(6/110), respectively. The number of cases with stone recurrence at postoperative 1-, 3- and 5-year of 10 patients with residual stones were 1, 2, 5 cases, respectively. Of 120 patients with follow-up, 1 case died of end-stage liver disease, and the other patients had good survival.Conclusion:Perihilar surgical techniques for diffuse hepatolithiasis is safe and effective.

Objective:To explore the relationship between learning motivation and professional identity of nursing students.Methods:A total of 1 538 undergraduate and specialized nursing students from a medical college in Shandong Province were investigated with general information questionnaire, occupational identity scale and learning motivation scale.Results:The total score of professional identity and learning motivation of nursing students was 57.54±12.89 and 119.92 ±22.03 all of which were at the middle level. There was a positive correlation between the total score and each dimension ( r=0.225-0.614, P<0.01). Conclusions:Nursing students' professional identity is positively correlated with their learning motivation. The stronger their learning motivation is, the higher their level of professional identity is. It suggests that nursing education and managers should pay attention to improving their learning motivation and establish a stable professional concept.

Objective:To explore the value of " internal anastomosis" of bile duct , ie intrahepatic duct stricture resection, cholangioplasty and bilioenteric anastomasis, in the treatment of hepatolithiasis with stricture of bile duct orifice.Methods:The clinical data of 74 patients undergoing this procedure from Dec 2017 to Dec 2019 at Hu′nan Provincial Peopole′s Hospital were retrospectively analysed.Results:All 74 patients received intraoperative choledochoscopy lithotomy, and 26 cases had a hepatectomy for atrophic fibrosis. There were 27 cases with orifice stricture of left-lateral bile duct or its major branchs; 22 cases with that of caudate lobe ducts. 3 cases with that of right anterior ducts; 8 cases with that of right posterior bileduct; and 14 cases with that of bilateral multiple bile ducts . The average operation time was (243±31) min (ranging from 180 to 360 min), the average intraoperative blood loss was (150±26) ml (ranging from 100 to 600 ml). The average postoperative hospital stay was (10.0±2.2) d. The occurrence rate of residual stone was 8.1%. 14 cases (18.9%) had postoperative complications , including 2 cases with bleeding, 1 case with bile leakage, 4 cases with wound infection, 13 cases with pleural effusion. All were cured by conservative therapy, and no complications of grading Ⅲa or above happened according to Clavien Dindo grading system. All 74 cases were followed up, the average follow-up time was (10.2±3.6) months (ranging from 6 to 18months) with good result.Conclusion:" internal anastomosis" is an effective method to remove the narrow openings of intrahepatic bile ducts , thus helps to preserve much possible liver parenchyma, while decreasing the rate of residual stone.

Objective: To summarize our clinical experience and management of an anomalous proximal bile duct joining the cystic duct in laparoscopic cholecystectomy (LC). Methods: A retrospective study was conducted on 8 patients who had an anomalous right anterior bile duct joining the cystic duct who were treated at the Hunan Provincial People's Hospital from March 2003 to January 2019. Results: All the 8 patients were diagnosed to have gallstones cholecystitis on preoperative CT, MRI and abdominal ultrasound. There were no suggestions of an anomalous bile duct. A total of 6 patients underwent reoperation after LC due to abdominal pain and biliary peritonitis. These 6 patients were treated with drainage and T-tube insertion. In the other 2 patients, the anomalous bile duct opening which joined the cystic duct were detected during LC. There was one patient converted to open laparotomy with preservation of the cystic duct and underwent common bile duct T-tube drainage. The other patients continued with laparoscopic surgery. The cystic duct was partially resected with removal of gallbladder, followed by common bile duct drainage. The average follow-up period was 3.4 years and the results were satisfactory. Conclusions Biliary duct anomaly is the main cause of iatrogenic proximal bile duct injury during laparoscopic cholecystectomy. It is not uncommon to have the anomaly of insertion of right anterior segmental bile duct to the cystic duct. To avoid iatrogenic biliary tract injury, careful preoperative study of X-ray films, accurate identification of the intraoperative gallbladder triangle anatomical structures. Strict adherence to carry out the three-word procedure of " discrimination, cut, identify" will help to reduce the incidence of biliary tract complications in laparoscopic cholecystectomy.

Objective To explore the value of round ligament approach in the bile duct benign stricture near porta hepatis.Methods Data of 62 patients treated in Hunan Provincial People's Hospital from Mar 2016 to Mar 2018 were retrospectively analyzed.Results Hepatolithiasis was the cause of bile duct benign stricture in 37 cases,followed by iatrogenic injury (12 cases),cholangio-intestinal anastomotic restenosis (7 cases),cystic dilatation of bile duct (4 cases) and bridge-shaped calculus (2 cases).We get access to the strictured bile duct near porta hepatis by way of round ligament,and hilar cholangioplasty and bilioenteric anastomosis was done at the porta hepatis.The surgery lasted an average of 230.3 minutes and with an average 196.8 ml blood loss.By Clavien-Dindo scoring system,there were Grade Ⅰ complications in 32 cases,Grade Ⅱ complications in 3.On follow-up survey,there were 3 patients with reflux cholangitis.Condclsion Round ligament is a gateway to hilar bile duct benign stricture in an attempt to make hilar cholangioplasty.