Objective To explore the application of scenario simulation teaching in the teaching of clinical nursing students,and to explore its role in improving the learning effect and practical ability of nursing students through empirical re-search.Methods A total of 80 nursing students who were interned in a hospital from July 2021 to July 2023 were selected as the research objects,and they were divided into observation group and control group according to the random number table method,with 40 students in each group.Results The scenario simulation method was better than the traditional teaching method(P＜0.05).Conclusion Scenario simulation teaching can effectively improve the learning efficiency,practical ability and compre-hensive quality of clinical nursing students,but its implementation mechanism needs to be further improved and improved.

Objective To observe the CALR mutation in patients with Ph negative chronic myeloproliferative neoplasms(MPNs) and its clinical significance. Methods From January 2012 to January 2015,the clinical data of ninety-seven patients with chronic myeloproliferative neoplasms was retrospectively analyzed and followed up to analyze different types of MPNs, including the clinical characteristics and gene mutation of polycythemia vera(PV),essential thrombocythemia(ET)and primary myelofibrosis (PMF).The hematological parameters and prognosis of patients with different mutation types were compared ( Cox regression model). Results Among the patients,the incidence of JAK2 mutation was the highest,64. 95% (63/97), followed by CALR mutation ( 19. 59% ( 19/97 ) ) and triple negative ( 10. 31% ( 10/97 ) ) . The incidence of MPL mutation was 5. 15% (5/97),which was the lowest and CALR mutations in ET and PMF were 28. 57%(10/35) and 28. 13% (9/32),respectively. The difference was not statistically significant (χ2 =1. 616,P>0. 05);the CALR gene mutation was not detected in PV patients. Compared with the JAK2 mutation, the hemoglobin,leukocyte and neutrophils in the patients with CALR mutation were lower (P<0. 05),PLT levels were lower in CALR-mutant ET patients ( P<0. 017) ,whereas platelet levels in CALR-mutant PMF patients were higher (P<0. 017). The incidence of disease progression in JAK2 and CALR mutation was 47. 62% (30/63)and 31. 58% (6/19) (χ2=1. 525,P>0. 05). The risk of disease progression in patients with CALR mutation was significantly lower than that of JAK2 mutation ( HR=0. 46,95%CI 0. 26-0. 98,P<0. 05) . Conclusion The clinical characteristics of MPNs patients with different gene mutations are different. The prognosis of MPNs patients with CALR mutation is better than that of JAK2 mutation.

Objective To evaluate prospectively the preoperative use of 16-multidetector computed tomography (MDCT) with cholangiography and angiography in determining the resectability of hilar cholangiocarcinoma.Methods From January 2002 to January 2009,75 consecutive patients with hilar cholangiocarcinoma underwent preoperative MDCT with cholangiography and angiography.3D images of the portal vein,hepatic artery,and bile ducts were created and viewed simultaneously.The accuracy of MDCT with cholangiography and angiography was determined by comparison with intraoperative and pathologic findings.Results All patients tolerated the CT imaging well.The sensitivity,specificity,and accuracy rates were 92.9%,100%,and 96%for portal invasion and 83.3%,100 %,and 93.3%for hepatic arterialinvasion.The accuracy rate of longitudinal tumor extension,using the Bismuth-Corlette classification system,was 96 %.The sensitivity,specificity,and accuracy of prediction of resectability were 95.7%,82.1%,and 90.7%,respectively.Conclusion Preoperative MDCT with cholangiography and angiography gave a good assessment of the degree of biliary and vascular involvement of hilar cholangiocarcinoma.It also accurately predicted resectability in patients with hilar cholangiocarcinoma.