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.

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.

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 value of methyltransferase-like protein 16(METTL16)in the clinical di-agnosis and prognostic prediction of multiple myeloma(MM)patients.Methods The expression level and prog-nostic potential of each gene involved in N6-methyladenosine(m6A)modification in MM were respectively ana-lyzed in the databases of the Multiple Myeloma Research Foundation(MMRF)and the Genotype-Tissue Expression Project(GTEx).Bone marrow specimens from 26 patients with initial diagnosis of MM and 19 patients with MM af-ter treatment with standard regimens and peripheral blood specimens from 24 normal subjects were collected respec-tively,and the expression levels of m6A genes were determined by qRT-PCR.The correlation between METTL16 expression and various laboratory and clinical indexes was analyzed:hemoglobin(Hb),white blood cell count(WBC),platelet count(PLT),blood creatinine(Scr),serum calcium(Ca2+),β-microglobulin(β-MG),bone destruction,ISS stage,type,and overall survival(OS)in the patients with primary diagnosis.The expression lev-els of interleukin(IL)-4,IL-6,IL-10,IL-18 and chemokine ligand 2(CCL2),CCL3,CCL4 in the specimens were further examined and their correlation with the expression of METTL16 was investigated.Results Database a-nalysis suggested that METTL16 expression was significantly higher in MM patient samples compared with normal controls,which was associated with poor prognosis and had certain diagnostic value.qRT-PCR results showed that the expression level of METTL16 in the bone marrow of patients with initial diagnosis of MM was significantly higher than that of treated patients and normal controls.Its expression was positively correlated with hemoglobin,leuko-cytes and stage,and its expression was positively correlated with CCL4 expression.Conclusion METTL16 expres-sion was significantly elevated in patients with MM,and its expression level was correlated with anemia,more bone destruction and worse stage,which might indicate a poor prognosis.The significant correlation between the expres-sion of METTL16 and CCL4 suggests that METTL16 may play a corresponding pathogenic role through the relevant pathway.METTL16 will have significant clinical value in the management of MM.

Objective To explore the correlation between hyponatremia at admission and all-cause mortality within one year after discharge in elderly patients with intestinal obstruction.Methods The 331 cases of elderly patients with intestinal obstruction(aged ≥ 60 years)who visited the General Surgery Department of Nanjing Meishan Hospital from January 2017 to December 2020 were selected as the research objects for retrospective cohort study analysis.According to the patient's blood sodium level at admission,they are divided into two groups:the hyponatremia group(Na＜135 mmol/L)and the non hyponatremia group(Na≥135 mmol/L).Divided into death group and survival group based on whether death occurred within one year after discharge.SPSS 25.0 software was used for statistical analysis.Independent sample t test,x2 test,Kaplan Meier method,and multivariate Cox regression analysis were used to observe the correlation between admission hyponatremia and all-cause mortality within one year after discharge in elderly patients with intestinal obstruction.Results A total of 331 patients were enrolled.The incidence of hyponatremia was 32.3％,and 56 deaths occurred within one year,accounting for 16.92％.The one-year mortality rate in the hyponatremia group was 23.4％(25/107),which was higher than 13.8％(31/224)in the non hyponatremia group.The difference was statistically significant(P＜0.05).The survival analysis(Kaplan Meier)results showed that the survival rate of the hyponatremia group was lower than that of the non hyponatremia group(Log Rank P＜0.05).After adjusting for other confounding factors in multivariate Cox regression analysis,hyponatremia(HR=1.88,95％CI:1.07-3.29)was an independent risk factor for one-year all-cause mortality in elderly patients with intestinal obstruction(P＜0.05).Conclusion Hyponatremia at admission is an independent risk factor for all cause mortality in elderly patients with intestinal obstruction within one year after discharge.

Objective To explore the efficacy and technical points of complete preservation of female reproductive organ in radical cystectomy.Methods In 2020 and 2021,two female patients with bladder cancer undergoing radical cystectomy in The First Affiliated Hospital of Naval Medical University were selected.The clinical conditions of the patients were evaluated before surgery,and the reproductive organs were completely preserved according to the patients'wishes during the operation.The patients were regularly followed up after surgery.The efficacy and prognosis of patients were evaluated.Results The operation was successful and the two patients recovered well without surgery-related complications.The follow-up time for two patients were 22 months and 36 months.During the follow-up period,no tumor recurrence was found,and the scores of sexual function and quality of life were good.One patient was successfully pregnant at 17 months after surgery,and routine prenatal examination and non-invasive fetal DNA testing showed no abnormalities.Conclusions Under the premise of strictly grasping the surgical indications,the complete preservation of female reproductive organs in radical cystectomy can improve patients'quality of life after surgery,especially protect the reproductive function of women of childbearing age.

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.