Objective:To evaluate the clinical value of lymph node dissection (LND) for intrahepatic cholangiocarcinoma (ICC) after surgical resection.Methods:A retrospective study was conducted on the clinical data of 156 patients who underwent surgery for ICC in Eastern Hepatobiliary Surgery Hospital of Naval Military Medical University from November 2010 to December 2017, including 94 males and 62 females, aged (60.0±9.5) years. Curative surgery was performed in 114 cases. Of 64 cases were in stage Ⅰ according to American Joint Committee on Cancer (AJCC), including 38 cases of non-lymph node dissection (NLND) and 26 cases of LND; 21 cases were in AJCC stage Ⅱ, including 11 cases of NLND and 10 cases of LND; 22 cases were in AJCC stage Ⅲb, including 14 cases of LND and 8 cases of lymph node resection (LNR); 5 cases were in AJCC stage Ⅲa, 2 cases were in AJCC stage Ⅳ. Univariate and multivariate Cox regression analysis were used for the risk factors of ICC prognosis. The log-rank test compared the survival rates of the two groups.Results:Cox multivariate analysis indicated that lymph node metastasis was independent risk factors for prognosis in patients with ICC ( HR=1.96, 95% CI: 1.09-3.55, P=0.026). A total of 114 patients were included in the curative surgery group. The 1-, 3-, and 5-year overall survival (OS) rates of the negative lymph node group ( n=91) were 65.9%, 47.3% and 35.6%, respectively, which were significantly better than those of the positive lymph node group ( n=23) who had 1-, 3-, 5-year OS rates of 56.5%, 17.7% and 0, respectively (χ 2=8.11, P=0.004 ). In stage Ⅰ and Ⅱ patients, there were no significant differences in 1-, 3-, 5-year OS rates between the NLND group and the LND group (both P>0.05 ). In stage Ⅲb patients, the LND group had 1-, 3-, 5-year OS rates of 71.4%, 29.8% and 0, respectively, significantly better than those of the LNR group who had 1-, 3-, 5-year OS rates of 37.5%, 0 and 0, respectively (χ 2=6.45, P=0.011). Conclusions:Lymph node metastasis is an independent risk factor affecting the prognosis of ICC. Lymph node dissection should be performed cautiously in ICC with AJCC stage Ⅰ and Ⅱ, while routine lymph node dissection is recommended in ICC with AJCC stage Ⅲb.

In vitro anticoagulation is a key technique in continuous renal replacement therapy (CRRT), and heparin was once the preferred anticoagulant for CRRT, but its clinical application is limited due to the high risk of bleeding. Citrate, as a new regional anticoagulant, has received more and more attention and recommendation in recent years, but there are still controversies over its application in patients with liver failure. With reference to relevant literature in China and globally, this article reviews the metabolic characteristics and monitoring methods of regional citrate anticoagulation and its safety in CRRT for patients with liver failure.

Objective:To study the iodine nutritional status of pregnant women in Jiangxi Province, and to provide basis for iodine supplementation scientifically.Methods:In 2019, 100 counties (cities, districts, referred to as counties) of 11 cities in Jiangxi Province were selected by systematic sampling. Each county was divided into five sections according to five directions: east, west, south, north and middle. One township (street) was taken in each section, and 20 pregnant women (balanced early, middle and late pregnancy) were taken from each township (street) to detect their family salt iodine and urinary iodine levels in order to compare the levels of salt iodine and urinary iodine of different cities and the distribution of urinary iodine in different stages of pregnancy.Results:A total of 10 000 edible salt samples were collected from the families of pregnant women, the median of salt iodine was 24.53 mg/kg, the consumption rate of qualified iodized salt was 97.05% (9 705/10 000), and the iodized salt coverage rate was 99.80% (9 980/10 000). There was no significant difference in the iodine content of edible salt of pregnant women in different cities ( H = 3.42, P > 0.05). A total of 10 000 urine samples were collected from pregnant women, the median of urinary iodine was 175.58 μg/L. There was a statistically significant difference in the urinary iodine content of pregnant women in different cities ( H = 28.80, P < 0.01). There was no statistically significant difference in urinary iodine distribution of pregnant women in different stages of pregnancy (χ 2 = 5.73, P > 0.05). Conclusion:The iodine nutritional status of pregnant women in Jiangxi Province is in a suitable state, but the distribution of iodine nutritional status of pregnant women in different regions is uneven, iodine nutritional status of pregnant women in key regions should be paid attention to.

Objective: To investigate the efficacy of alternative donor (AD) in the treatment of aplastic anemia (AA) in children. Methods: The clinical data of AA children who received AD HSCT in our center from Apr. 2010 to Dec. 2016 were retrospectively analyzed. The overall survival (OS) rate, implant success rate, incidence of acute and chronic graft-versus-host disease (GVHD) were statistically analyzed. Results: A total of 109 children with acquired AA, including 64 severe AA (SAA) , 32 very severe AA (VSAA) and 13 transfusion dependent non-severe AA (NSAA) , were recruited in this retrospective AD HSCT study, the median age was 6 (0.8-18) years old. Of them, 44 patients with 10/10 matched unrelated donor (MUD) , 44 patients with mismatched unrelated donor (MMUD) and 21 patients with mismatched related donor (MMRD) . All patients did not receive ATG before HSCT and the active infection was excluded. Except 3 patients suffered from a second graft failure (2 of them rescued by second HSCT) , 106/109 (97.2%) were engrafted with neutrophil and platelet recovery occurring at a median of 13 days (range, 9-19) and 16 days (range, 10-81) post-transplant. Until day 100 post transplantation, the incidence was 74.3% (81/109) for acute GVHD (aGVHD) and 39.4% (43/109) for grade Ⅱ-Ⅳ aGVHD, 30.7% (31/101) and 9.9% (10/101) for overall chronic GVHD (cGVHD) and moderate cGVHD, respectively, and nobody developed an extend cGVHD. After median follow up of 39 (0.7-103) months for all patients, 13 of 109 patients died. The estimated 5-year overall survival (OS) of the entire cohort was 88.1% (95%CI 81.1%-91.4%) with no difference among the MUD, MMUD and MMRD cohort (93.2%, 84.1% and 85.7%, respectively, P=0.361) . Conclusion These excellent outcomes suggest that unmanipulated AD PBSC is a good HSCT source for children with SAA. It’s reasonable to consider AD HSCT as first line therapy for SAA children without matched sibling donor. Better strategies are required to prevent GVHD.

Objective: To explore the difference of personality characteristics of physicians, nurses, medical skills and administrative personnel in a general hospital and its influence on job burnout. Methods: Employee entered the hospital before 2018 were enrolled in the current study and the position was classified as physicians, nurses, medical technician and administrative staff. Minnesota Multiphasic Personality Inventory (MMPI) was completed by the employee at the time of entering the hospital. Status of job burnout was assessed in 2018 using the Maslach Burnout Inventory-General Survey (MBI-GS) . Results: Physicians have a higher rate of paranoia than others (P<0.05) , and administrative staff and medical technician have a slightly higher score than the other two categories of people (P<0.05) , and administrators lie at a higher rate than others (P<0.05) . Further analysis found that personality traits did not have a significant association with job burnout at the time of entry. Conclusion The administrative and medical staff is slightly more irritable, the administrative staff lying slightly higher score, the staff after the entry of job burnout is not affected by the personality characteristics of the onboarding.

Objective To explore the effects of improved emergency nursing intervention on complications and clinical prognosis of severe patients with craniocerebral injury accompanied by cerebral hernia, and provide evidence for clinical nursing. Methods The patients with severe craniocerebral injury accompanied by cerebral hernia were enrolled in Dongguan People's Hospital from January 2016 to December 2018. According to the admission time, the patients were divided into routine nursing group (Admission from January 2016 to June 2017) and improved emergency nursing methods group (Admission from July 2017 to December 2018). To analyze the effect of two different nursing methods on the prognosis of patients by improving first aid nursing measures and routine nursing. Both groups of patients underwent craniotomy, the conventional nursing group was treated with routine operating room care, the improved emergency nursing methods group was given improved emergency care interventions based on the conventional nursing, the operation preparation time, operation time, intra-operative blood loss and the incidence of postoperative complications, clinical prognosis of the two groups were observed; the self-made questionnaire was used to evaluate the scores of the patient's satisfaction and compliance. Results The operation preparation time, operation time and intra-operative blood loss of the improved emergency nursing methods group (40 cases) were significantly lower than those in the conventional nursing group [40 cases, operation preparation time (minutes): 25.03±5.47 vs. 36.73±5.83, operation time (minutes): 52.56±10.63 vs. 92.10±10.73, intra-operative blood loss (mL): 218.73±20.74 vs. 402.66±23.70, all P < 0.05]; the clinical good prognosis rate, rate of satisfaction to nursing, treatment compliance score of the improved emergency nursing methods group were significantly higher than those of the conventional nursing group [clinical good prognosis rate: 20.0% (8/40) vs. 12.5% (5/40), rate of satisfaction to nursing: 95.0% (38/40) vs. 82.5% (33/40), treatment compliance scores: 95.83±4.09 vs. 81.27±5.04, all P < 0.05]; the complication rate of the improved emergency nursing methods group was significantly lower than that of the conventional nursing group [32.5% (13/40) vs. 55.0% (22/40), P <0.05]. Conclusion The improved emergency nursing intervention can significantly improve the clinical prognosis and reduce the incidence of complications in patients with severe craniocerebral injury accompanied by cerebral hernia, so that the clinical application value is relatively high.

Vitamin D is mainly produced in the liver, and chronic liver injury caused by various reasons will affect the metabolism of vitamin D, lead to vitamin D deficiency, and accelerate disease progression. Recent studies have confirmed that in patients with liver cirrhosis, the degree of vitamin D deficiency is closely associated with the severity and complications of liver cirrhosis. This article introduces the role of vitamin D and vitamin D receptor in the evaluation and treatment of liver cirrhosis and points out that vitamin D helps to evaluate the severity of liver cirrhosis and may become a new point and an important drug for the treatment of liver cirrhosis.