Objective To explore the efficacy and safety of treatment of intramural ureteral tumors via transurethral resection. Methods A retrospective analysis was conducted on the clinical data of 26 patients with ureteral cancer who underwent transurethral resection of intramural ureteral tumors at the First Affiliated Hospital of Naval Medical University from May 2020 to May 2023. All patients were treated using the “outer-wedge, inner-rotation” resection technique, with ureteral stents placed intraoperatively. Clinical indicators including operation time, intraoperative blood loss, length of postoperative hospital stay, ureteral stent indwelling duration, intraoperative and postoperative complications, postoperative pathological results, and bladder tumor recurrence rate were analyzed. Results All surgeries were successfully completed. The operation time was 45(35, 60) min, intraoperative blood loss was 5(3, 10) mL, length of postoperative hospital stay was 4(3, 5) d, and the ureteral stent indwelling duration was (33.8±9.7) d. All patients did not experience intraoperative complications, the postoperative hydronephrosis rate was 3.8%. Postoperative pathology confirmed urothelial carcinoma in all cases, including 6 cases of stage pT_a, 16 cases of pT₁, and 4 cases of pT_2a. The follow-up period ranged from 12 to 48 months. Intravesical recurrence occurred in 2 patients, and recurrence rate was 7.7%. There were no tumor-related deaths during the follow-up period. Conclusions Transurethral resection of intramural ureteral tumors is minimally invasive, resulting in less blood loss, and has low rates of postoperative complications such as hydronephrosis and hydroureter. It achieves favorable surgical outcomes while better preserving renal function.

Neoadjuvant therapy has become the standard treatment for locally advanced resectable esophageal cancer, significantly improving long-term survival compared to surgery alone. Neoadjuvant therapy has evolved to include various strategies, such as concurrent chemoradiotherapy, chemotherapy, immunotherapy, or targeted combination therapy. This enriches clinical treatment options and provides a more personalized and scientific treatment approach for patients. This article aims to comprehensively summarize current academic research hot topics, review the rationale and evaluation measures of neoadjuvant therapy, discuss challenges in restaging methods after neoadjuvant therapy, and identify the advantages and disadvantages of various neoadjuvant therapeutic strategies.

Objective:To explore the effect of the Nurse-Mini-CEX assessment method combined with PBL teaching mode in the cultivation of core competencies of undergraduate nursing students during ICU internships.Methods:A total of 64 nursing students interning in the ICU of a Third-grade Class-A hospital in Wuhu City from Sep 2022 to Aug 2023 were selected and randomly divided into 8 groups(8 students in each group).Using cluster sampling,4 groups(32 students)were assigned to the experimental group,receiving training via Nursing-Mini-CEX combined with PBL,while the remaining 4 groups(32 students)served as the control group,undergoing traditional clinical teaching.All students completed a 2-month pre-ICU clinical internship,followed by a 4-week ICU internship.Results:Compared to the control group,the experimental group showed significantly higher scores in five dimensions of nursing competency:nursing consultation,nursing physical examination,nursing diagnosis,nursing interventions,and holistic evaluation(P＜0.05).Additionally,the experimental group outperformed the control group in core competencies,including clinical nursing skills,leadership,interpersonal communication,professional development,critical thinking and research ability(P＜0.05).Self-efficacy in learning ability and behavior,as well as scores in personal accomplishment,depersonalization,and emotional exhaustion,were also higher in the experimental group(P＜0.05).Furthermore,the experimental group reported greater satisfaction with training content,teaching effectiveness,clinical skill development,teamwork cultivation,and overall satisfaction(P＜0.05).Conclusions:Nursing-Mini-CEX assessment combined with PBL teaching mode effectively enhances core competencies and self-efficacy,reduces burnout among ICU nursing interns,and achieve good clinical results,providing a theoretical and practical basis for the teaching and training of nursing students in ICU.However,as a single-center study,further validation and broader studies are warranted.

AIM:To explore the mechanism of ac-tion and clinical significance of NLRC4 in multiple myeloma by analyzing the relative expression and clinical significance of NLRC4 mRNA in bone mar-row fluid of patients with multiple myeloma(MM),so as to guide the formulation of disease treatment and the evaluation of clinical prognosis.METHODS:MMRF database and GTEx database were used to compare the expression and survival correlation of inflammatory bodies between myeloma patients and normal controls.Real-time fluorescent quanti-tative polymerase chain reaction(qPCR)was used to detect the expression of inflammatory bodies in bone marrow fluid of 26 newly diagnosed myeloma patients and 19 post-treatment myeloma patients and peripheral blood of 28 normal volunteers ad-mitted to the First Affiliated Hospital of Anhui Medi-cal University from January to September 2023.The mRNA expression differences of each inflammatory body and the correlation between NLRC4 inflamma-tory body expression and clinicopathologic fea-tures,inflammatory factor/chemokine expression of newly diagnosed patients were analyzed.RE-SULTS:Compared with the control group and the treatment group,the expression of inflammasome mRNA in the newly diagnosed group was increased except for NLRP3,and the expression of NLRC4 mRNA was significantly increased(P<0.01).The he-moglobin count,creatinine level and calcium ion level were linearly correlated with NLRC4 mRNA ex-pression level in newly diagnosed patients(P<0.05).The mRNA expression levels of IL-18,CCL-3 and NL-RC4 in newly diagnosed patients were linearly cor-related(P<0.05).CONCLUSION:NLRC4 inflammato-somes are highly expressed in MM,and promote the occurrence and development of tumor by pro-moting the production and release of inflammatory cytokines/chemokines IL-18 and CCL-3,which is of great significance for the formulation of treatment plan and clinical prognosis evaluation of multiple myeloma.

Objective:To explore the effect of the Nurse-Mini-CEX assessment method combined with PBL teaching mode in the cultivation of core competencies of undergraduate nursing students during ICU internships.Methods:A total of 64 nursing students interning in the ICU of a Third-grade Class-A hospital in Wuhu City from Sep 2022 to Aug 2023 were selected and randomly divided into 8 groups(8 students in each group).Using cluster sampling,4 groups(32 students)were assigned to the experimental group,receiving training via Nursing-Mini-CEX combined with PBL,while the remaining 4 groups(32 students)served as the control group,undergoing traditional clinical teaching.All students completed a 2-month pre-ICU clinical internship,followed by a 4-week ICU internship.Results:Compared to the control group,the experimental group showed significantly higher scores in five dimensions of nursing competency:nursing consultation,nursing physical examination,nursing diagnosis,nursing interventions,and holistic evaluation(P＜0.05).Additionally,the experimental group outperformed the control group in core competencies,including clinical nursing skills,leadership,interpersonal communication,professional development,critical thinking and research ability(P＜0.05).Self-efficacy in learning ability and behavior,as well as scores in personal accomplishment,depersonalization,and emotional exhaustion,were also higher in the experimental group(P＜0.05).Furthermore,the experimental group reported greater satisfaction with training content,teaching effectiveness,clinical skill development,teamwork cultivation,and overall satisfaction(P＜0.05).Conclusions:Nursing-Mini-CEX assessment combined with PBL teaching mode effectively enhances core competencies and self-efficacy,reduces burnout among ICU nursing interns,and achieve good clinical results,providing a theoretical and practical basis for the teaching and training of nursing students in ICU.However,as a single-center study,further validation and broader studies are warranted.

AIM:To explore the mechanism of ac-tion and clinical significance of NLRC4 in multiple myeloma by analyzing the relative expression and clinical significance of NLRC4 mRNA in bone mar-row fluid of patients with multiple myeloma(MM),so as to guide the formulation of disease treatment and the evaluation of clinical prognosis.METHODS:MMRF database and GTEx database were used to compare the expression and survival correlation of inflammatory bodies between myeloma patients and normal controls.Real-time fluorescent quanti-tative polymerase chain reaction(qPCR)was used to detect the expression of inflammatory bodies in bone marrow fluid of 26 newly diagnosed myeloma patients and 19 post-treatment myeloma patients and peripheral blood of 28 normal volunteers ad-mitted to the First Affiliated Hospital of Anhui Medi-cal University from January to September 2023.The mRNA expression differences of each inflammatory body and the correlation between NLRC4 inflamma-tory body expression and clinicopathologic fea-tures,inflammatory factor/chemokine expression of newly diagnosed patients were analyzed.RE-SULTS:Compared with the control group and the treatment group,the expression of inflammasome mRNA in the newly diagnosed group was increased except for NLRP3,and the expression of NLRC4 mRNA was significantly increased(P<0.01).The he-moglobin count,creatinine level and calcium ion level were linearly correlated with NLRC4 mRNA ex-pression level in newly diagnosed patients(P<0.05).The mRNA expression levels of IL-18,CCL-3 and NL-RC4 in newly diagnosed patients were linearly cor-related(P<0.05).CONCLUSION:NLRC4 inflammato-somes are highly expressed in MM,and promote the occurrence and development of tumor by pro-moting the production and release of inflammatory cytokines/chemokines IL-18 and CCL-3,which is of great significance for the formulation of treatment plan and clinical prognosis evaluation of multiple myeloma.

Objective To investigate the effect of Dapagliflozin on high glucose-induced podocyte proliferation and apoptosis through p38 mitogen-activated protein kinase(p38 MAPK)pathway.Methods Human glomerular podocytes(HGPC)were divided into control(Con)group,low/medium/high D-glucose(Glu 10,Glu 20,Glu 30)group,high glucose(HG)group,low/medium/high concentration Dapagliflozin(HG+Dap 12.5,HG+Dap 25,HG+Dap 50)group,Dapagliflozin(HG+Dap)group,inhibitor(HG+ SB 203580)group,Dapagliflozin + inhibitor(HG+Dap+SB 203580)group and Dapagliflozin + activator(HG+Dap+C16-PAF)group.After 24 hours of intervention,the cell viability,proliferation rate,apoptosis rate and levels of related factors were tested.Results Compared with Con group,IL-1β,TNF-α,apoptosis rate,Caspase-3 mRNA and protein expression,p53,p-p38 MAPK protein expression were increased(P＜0.05),while cell proliferation rate,Cyclin D1 mRNA and protein expression were decreased in HG group(P＜0.05).Compared with HG group,the proliferation rate,Cyclin D1 mRNA and protein expression were increased(P＜0.05),while IL-1β,TNF-α,apoptosis rate,Caspase-3 mRNA and protein expression,p53,p-p38 MAPK protein expression were decreased in the HG+Dap and HG+SB 203580 groups(P＜0.05).Compared with HG+Dap group,cell proliferation rate,Cyclin D1 mRNA and protein expression were increased(P＜0.05),while IL-1β,TNF-α,apoptosis rate,Caspase-3 mRNA and protein expression,p53,p-p38 MAPK protein expression were decreased in HG+Dap+SB 203580 group(P＜0.05).In HG+Dap+C16-PAF group,IL-1β,TNF-α,apoptosis rate,Caspase-3 mRNA and protein expression,p53,p-p38 MAPK protein expression were increased(P＜0.05),while cell proliferation rate,Cyclin D1 mRNA and protein expression were decreased(P＜0.05).Conclusion Dagagliflozin can promote HGPC proliferation and inhibit apoptosis and inflammation in high D-glucose environment,and its mechanism may be related to the inhibition of p38 MAPK pathway signal transduction.

Objective:To investigate the surgical treatment effect and prognostic factors of hilar cholangiocarcinoma.Methods:This is an ambispective cohort study. From August 2005 to December 2022,data of 510 patients who diagnosed with hilar cholangiocarcinoma and underwent surgical resection at the Hepatobiliary Center of the First Affiliated Hospital of Nanjing Medical University were retrospectively collected. In the cohort,there were 324 males and 186 females,with an age of ( M (IQR)) 63(13)years (range:25 to 85 years). The liver function at admission was Child-Pugh A (343 cases,67.3%) and Child-Pugh B (167 cases,32.7%). Three hundred and seventy-two(72.9%) patients had jaundice symptoms and the median total bilirubin was 126.3(197.6) μmol/L(range: 5.4 to 722.8 μmol/L) at admission. Two hundred and fourty-seven cases (48.4%) were treated with percutaneous transhepatic cholangial drainage or endoscopic nasobiliary drainage before operation. The median bilirubin level in the drainage group decreased from 186.4 μmol/L to 85.5 μmol/L before operation. Multivariate Logistic regression was used to identify the influencing factors for R0 resection,and Cox regression was used to construct multivariate prediction models for overall survival(OS) and disease-free survival(DFS). Results:Among 510 patients who underwent surgical resection,Bismuth-Corlett type Ⅲ-Ⅳ patients accounted for 71.8%,among which 86.1% (315/366) underwent hemi-hepatectomy,while 81.9% (118/144) underwent extrahepatic biliary duct resection alone in Bismuch-Corlett type Ⅰ-Ⅱ patients. The median OS time was 22.8 months, and the OS rates at 1-,3-,5-and 10-year were 72.2%,35.6%,24.8% and 11.0%,respectively. The median DFS time was 15.2 months,and the DFS rates was 66.0%,32.4%,20.9% and 11.0%,respectively. The R0 resection rate was 64.5% (329/510), and the OS rates of patients with R0 resection at 1-,3-,5-and 10-year were 82.5%, 48.6%, 34.4%, 15.2%,respectively. The morbidity of Clavien-Dindo grade Ⅲ-Ⅴ complications was 26.1%(133/510) and the 30-day mortality was 4.3% (22/510). Multivariate Logistic regression indicated that Bismuth-Corlett type Ⅰ-Ⅲ ( P=0.009), hemi-hepatectomy and extended resection ( P=0.001),T1 and T2 patients without vascular invasion (T2 vs. T1: OR=1.43 (0.61-3.35), P=0.413;T3 vs. T1: OR=2.57 (1.03-6.41), P=0.010;T4 vs. T1, OR=3.77 (1.37-10.38), P<0.01) were more likely to obtain R0 resection. Preoperative bilirubin,Child-Pugh grade,tumor size,surgical margin,T stage,N stage,nerve infiltration and Edmondson grade were independent prognostic factors for OS and DFS of hilar cholangiocarcinoma patients without distant metastasis. Conclusions:Radical surgical resection is necessary to prolong the long-term survival of hilar cholangiocarcinoma patients. Hemi-hepatectomy and extended resection,regional lymph node dissection and combined vascular resection if necessary,can improve R0 resection rate.

Objective:To investigate the establishment method, coordination points and safe transport management strategy of vena-arterial extracorporeal membrane oxygenation (VA-ECMO) in patients with downtime difficulties during cardiopulmonary bypass (CPB).Methods:A observation study was conducted. The patients admitted to the department of critical care medicine of the First Affiliated Hospital of Wannan Medical College (Yijishan Hospital) from January 2020 to October 2022 were enrolled. These patients could not be separated from CPB and received VA-ECMO-assisted CPB surgery. The clinical data of the patients were recorded, including the basic information of the patients, the data of VA-ECMO establishment and transport process, the clinical indicators before and after VA-ECMO installation, the operation data of VA-ECMO and clinical outcomes. The experience was summarized from the aspects of extracorporeal membrane oxygenation (ECMO) establishment, transport process, team cooperation, and adverse events during transport. The clinical indicators before and after ECMO operation were compared. According to whether ECMO was successfully weaned, the patients were divided into a successful weaning group and a failure weaning group, and the clinical data between the two groups were compared.Results:Eighteen patients who underwent VA-ECMO-assisted CPB were enrolled, including 10 males and 8 females. The average age was (56.7±12.3) years old. Preoperative left ventricular ejection fraction (LVEF) was 0.46±0.10, and the main reasons for switching to VA-ECMO assistance included right ventricular systolic weakness in 6 cases, total cardiac systolic weakness in 5 cases, left ventricular systolic weakness in 4 cases, high pulmonary arterial pressure in 2 cases, and intractable ventricular fibrillation in 1 case. Among the 18 patients transferred from CPB to VA-ECMO, 10 cases were successfully weaned and 8 cases failed. In ICU, 8 cases survived, 5 cases died, and 5 cases gave up treatment and discharged. The average time for successful CPB to VA-ECMO establishment was (24.6±7.4) minutes, initial blood flow was (3.3±0.4) L/min, and transit time was (8.4±1.5) minutes. ECMO-assisted duration averaged (82.0±69.3) hours. Adverse events occurred in 9 patients during ECMO establishment and transfer. Post-ECMO onboarding for 4 hours, significant improvements were noted in blood lactic acid (Lac), pH value, mean arterial pressure (MAP), central venous oxygen saturation (ScvO 2) as compared with pre-ECMO onboarding [Lac (mmol/L): 10.5±7.0 vs. 15.2±6.8, pH value: 7.38±0.92 vs. 7.26±0.87, MAP (mmHg, 1 mmHg≈0.133 kPa): 74.9±13.7 vs. 58.4±17.0, ScvO 2: 0.678±0.065 vs. 0.611±0.061, all P < 0.01], and vasoactive-inotropic score (VIS) was also decreased (39.8±29.8 vs. 68.9±64.4, P < 0.01). Compared with successful weaning group, the patients in the failed weaning group exhibited higher pre-machine Lac (mmol/L: 18.8±7.8 vs. 12.3±4.3, P < 0.05), longer CPB time [minutes: 238.0 (208.8, 351.2) vs. 200.0 (185.8, 217.0), P < 0.05], and shorter ECMO-assisted time [hours: 19.5 (11.0, 58.8) vs. 94.5 (65.8, 179.8), P < 0.01]. However, there was no statistically significant difference in pre-machine pH value, ScvO 2, MAP, VIS score, and initial blood flow and establishment time of ECMO between the two groups. Conclusions:VA-ECMO is an effective circulatory aid for CPB surgery that cannot be weaned after CPB. The establishment and transfer of CPB "bridge" to ECMO aid depends on multi-disciplinary treatment (MDT) cooperation. The success rate of ECMO weaning is related to the Lac and CPB duration. If it is not possible to detach from the CPB successfully, VA-ECMO should be initiated as early as possible.

Objective:To integrate the best evidence for early rehabilitation of mechanically ventilated ICU-acquired weakness (ICU-AW) patients using evidence-based methods, providing evidence-based basis for standardized evaluation and intervention of early exercise therapy for mechanically ventilated ICU-AW patients.Methods:A systematic search was conducted on the American Thoracic Society (ATS) Clinical Practice Guidelines, Registered Nurses' Association of Ontario (RNAO), Guidelines International Network (GIN), Canadian Medical Association Clinical Practice Guideline Library (CMACPGL), BMJ Clinical Evidence, UpToDate, Scottish Intercollegiate Guidelines Network (SIGN), PubMed, Cochrane Library, National Guideline Clearinghouse (NGC), Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), UM-library, Physiotherapy Evidence Database (PEDro), National Institute for Health and Care Excellence (NICE), New Zealand Guidelines Group (NZGG), Chinese Medical Pulse Guidelines Website, CNKI and Wanfang data and other Chinese and English databases, professional team websites, and guideline websites for expert consensus, guidelines, randomized collected trial (RCT), systematic reviews and other evidence on early exercise rehabilitation for mechanically ventilated ICU-AW patients. The search time limit was from the establishment of the database to December 31, 2023. Literature search, screening, evaluation, information extraction was independently conducted by two evaluators with cross checking, and quality evaluation of the included literature was conducted.Results:A total of 21 literatures were enrolled, including 5 guidelines, 5 systematic reviews, 4 expert consensuses, and 7 RCT, all of which with high evidence level and all were enrolled. They were summarized into seven aspects with assessment screening, exercise safety standards, precautions, setting of exercise time, exercise intensity, exercise sequence, and recommended exercise content as the core, and 32 best evidences.Conclusions:The evidence summarized can provide evidence-based basis for standardized assessment and intervention of early exercise rehabilitation in mechanically ventilated ICU-AW patients. ICU medical practitioners need to combine the actual clinical environment, individual differences and rehabilitation goals of patients, to provide targeted health guidance and intervention for the prevention of ICU-AW in mechanically ventilated patients.