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Objective:To study the value of imaging features of extrapancreatic nerve plexus in predicting early postoperative recurrence of ductal adenocarcinoma of pancreatic head.Methods:The clinical, imaging and pathological data of patients with ductal adenocarcinoma of pancreatic head undergoing pancreati-coduodenectomy at the Hepatobiliary Pancreatic Center of Beijing Tsinghua Changgung Hospital, Tsinghua University from January 2014 to April 2022 were retrospectively analyzed. A total of 73 patients were included, including 51 males and 22 females, aged (66.1±9.0) years old. The patients were followed up by telephone or outpatient review, who were divided into two groups according to the recurrence within 6 months after surgery: the recurrence group ( n=26) and the non-recurrence group ( n=47). Streaks or soft-tissue densities in the distribution area of extrapancreatic nerve plexus, difference in CT values between the portal and arterial phases of the distribution area of extrapancreatic nerve plexus, maximum tumor diameter, and regional lymph node enlargement were compared between the two groups. Results:The incidences of streaks or soft-tissue densities showing in the distribution area of extrapancreatic nerve plexus were 80.8%(21/26) in the recurrence group and 51.1%(24/47) in the non-recurrence group, respectively. A CT value difference ≥15 HU between the portal and arterial phases of the distribution area of extrapancreatic nerve plexus occurred in 50.0%(13/26) patients of the recurrence group and 25.5%(27/47) of the non-recurrence group, respectively. Maximum tumor diameter ≥25 mm were found in 80.8% (21/26) patients of the recurrence group and 57.4% (27/47) of the non-recurrence group, respectively. ≥3 reginal lymph node enlargement showed in 65.4% (17/26) patients of the recurrence group and 31.9% (15/47) of the non-recurrence group, respectively (all P<0.05). The risk of early postoperative recurrence increased in patients with a CT value difference ≥15 HU between the portal and arterial phases of the distribution area of extrapancreatic nerve plexus ( OR=3.609, 95% CI: 1.099-11.855), and regional lymph node enlargement ≥ 3 ( OR=4.665, 95% CI: 1.400-15.545) (all P<0.05). And these two independent risk factors were combined to predict early postoperative recurrence of ductal adenocarcinoma of pancreatic head with an area under receiver operating characteristic curve of 0.748, sensitivity of 92.3%, and specificity of 48.9% ( P<0.001). Conclusion:≥ 15 HU CT value difference between the portal and arterial phases of the distribution area of extrapancreatic nerve plexus and ≥ 3 regional lymph node enlargement are independent risk factors for the early postoperative recurrence of pancreatic head ductal adenocarcinoma, which could provide more predictive information preoperatively.
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Objective To analyze the relationship between nursing work environment and nurses′work values of tertiary public hospitals in Tianjin ,and provide a scientific basis for the development of nurses′work values. Methods The sample was 1 875 clinical nurses from 7 tertiary public hospitals in Tianjin, and investigated with Practice Environment Scale (PES) and Work Values Scale. Results The score of nurses′ work values and each dimension(material work values, affective work values,cognitive work values) were different in different level of work environment,betterwork environments>mixedwork environments>poorwork environments(F=121.528, 38.555, 86.834, 136.816,P<0.01). The nursing work environment was positively correlated with work values(r=0.127-0.423, P<0.01). Foundation for quality of care and leadership of the head nurse could predict the nurse work values, and could explain 16.9%of the nurse work values(F=191.315,P<0.01). Conclusions By improving nursing work environment, especially in foundation for quality of care and leadership of the head nurse,can promote the development of nurses′work values.
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Clinical death of patients often results in such strong psychological stress as anxiety,fear and depression among the family members.Behavior problems incurred by such negative feelings often lead medical disputes.Early psychological intervention upon death to the families can not only protect their mental health but also effectively prevent medical disputes from happening.An analysis of the psychological response and characteristics of such families presents the principles and practice for psychological counseling.Discussions in this regard may inspire hospital administrators in how to prevent medical disputes so incurred.