Optimal Lymph Node Staging System in Evaluating Prognosis of Gallbladder Carcinoma: A Multi-institutional Study.

BACKGROUND: Lymph node (LN) involvement is a critical prognostic factor in patients with gallbladder carcinoma (GBC). Controversy exists regarding optimal categorization of nodal metastasis status, including anatomical location of positive nodes (AJCC 7th N staging), number of metastatic lymph nodes (NMLN), log odds of metastatic LNs (LODDS), and lymph node ratio (LNR). METHODS: Patients who underwent curative-intent resection for GBC from six Chinese tertiary hospitals between 2008 and 2013 were analyzed retrospectively. The relative discriminative abilities of the different LN staging systems were assessed by different models including the tree-augmented naïve Bayesian (TAN) model, Cox proportional hazards regression model, and binary logistic regression model. RESULTS: A total of 226 patients were involved in this cohort. Based on the TAN model and composite importance measures, the most important factor affecting the prognosis in the different LN staging systems was NMLN. Among the four TAN models which were built with 4 metastatic LN markers and baseline variables, the accuracy of the NMLN-based prognostic model was 88.15%, higher than 7th N staging (86.44%), LNR (87.34%), and LODDS (85.19%). The Cox model based on NMLN (C-index: 0.763, AIC: 1371.62) had a higher fitness than the others (7th N staging C-index: 0.756, AIC: 1375.51; LNR C-index: 0.759, AIC: 1378.82; LODDS C-index 0.748, AIC: 1390.99). The AUCs of different staging binary logistic regression models were NMLN (0.872), LNR (0.872), 7th N staging (0.869) and LODDS (0.856), respectively. CONCLUSIONS: NMLN was the optimal LN staging system in evaluating prognosis of GBC.

Optimizing palliative care education through undergraduate nursing students' perceptions: Application of importance-performance analysis and Borich needs assessment model.

BACKGROUND: With the aging of the population and the increasing trend of chronic illnesses, the demand for palliative care is growing. Undergraduate nursing students will be the main providers of palliative care in the future. Therefore, it's important to enhance their capability for palliative care. OBJECTIVES: The purpose of this study was to optimize palliative care education, based on undergraduate nursing students' perceptions and educational needs through the application of the importance-performance analysis and Borich needs assessment model. DESIGN: A cross-sectional descriptive study. SETTING: Nursing department in Wenzhou, China. PARTICIPANTS: A total of 448 full-time undergraduate nursing students were recruited for the study. METHODS: Importance-performance analysis was used to identify items that obtain high priority for improvement, and the Borich needs assessment model and the Locus for focus model were used to prioritize educational needs. The three methods were integrated to determine the top-priority content to meet undergraduate nursing students' educational needs in palliative care. RESULTS: The items located in Quadrant II of Importance-performance analysis, ranked in the first 10 in Borich needs assessment, and located in Quadrant I of the Locus for focus model were defined as top-priority content. These included: "respiratory symptoms: pleural effusion, superior vena cava syndrome, respiratory difficulty," "Care of terminal symptoms," "Awareness of dying," "Care of remains," "Cooperation between interdisciplinary teams," and "Rights and interests of dying patients." CONCLUSION: Several years of development of palliative care education have made nursing students aware of its importance. However, they have reported that education remains insufficient. A greater focus on palliative care education is needed to ensure they are better prepared. Specific attention should be given to cooperation between interdisciplinary teams, dealing with death and dying, rights and interests of people who were dying.

Endoscopic anatomic characterization of the frontal recess and its implications in frontal sinus surgery.

OBJECTIVE: This study was designed to describe the anatomic features of the frontal recess by transnasal endoscopy (nasoscope), to analyze its implications in endoscopic frontal sinus surgery and to discuss the issues that may be experienced during such operations. MATERIALS AND METHODS: The patients included in this analysis were adults with chronic sinusitis or nasal polyp (n = 301, 562 sides) hospitalized in our hospital from August 1998 to April 2001. Chronic frontal sinusitis was confirmed in 280 cases (479 sides) by coronal and axial CT scan. Patients with a previous surgical history were excluded from the analysis. The surgical outcomes of these patients and CT imaging data were retrospectively reviewed and analyzed. The drainage pattern of the frontal sinus was identified based on CT scans preoperatively. Endoscopic frontal sinus surgery was performed in 250 cases (421 sides). The anatomic features of the frontal recess under nasoscope were classified into 2 types. RESULTS: The coronal CT results confirmed the position of the frontal sinus ostium between the uncinate process and the middle turbinate in 203 sides (48.2%) of all operated patients and the ostium was found to be located between the uncinate process and the lamina papyracea in 218 sides (51.8%). According to the location of the frontal sinus ostium, we grouped the anatomic features of the frontal recess into 2 types. Type I was documented in 203 sides (48.2%) and type II was seen in 218 sides (51.8%). CONCLUSIONS: The anatomic features of the frontal recess under nasoscope and their classification are very important and helpful for endoscopic frontal sinsus surgery. The upper part of the uncinate process is a dependable anatomic landmark for the localization of the frontal sinus ostium in CT scan and endoscopic frontal sinus surgery.

Study on Market Stability and Price Limit of Chinese Stock Index Futures Market: An Agent-Based Modeling Perspective.

This paper explores a method of managing the risk of the stock index futures market and the cross-market through analyzing the effectiveness of price limits on the Chinese Stock Index 300 futures market. We adopt a cross-market artificial financial market (include the stock market and the stock index futures market) as a platform on which to simulate the operation of the CSI 300 futures market by changing the settings of price limits. After comparing the market stability under different price limits by appropriate liquidity and volatility indicators, we find that enhancing price limits or removing price limits both play a negative impact on market stability. In contrast, a positive impact exists on market stability if the existing price limit is maintained (increase of limit by10%, down by 10%) or it is broadened to a proper extent. Our study provides reasonable advice for a price limit setting and risk management for CSI 300 futures.