Objective To analyze the application value of the American Society of Anesthesiologists (ASA) classification in treating patients with percutaneous nephrolithotomy (PCNL) under local anesthesia for upper urinary tract calculi. Methods A total of 80 patients with PCNL under local anesthesia for upper urinary tract calculi were divided into high-risk group (ASA Ⅲ to Ⅳ level) with 36 cases and low-risk group (ASA Ⅰ to Ⅱ level) with 44 cases according to ASA classification, and perioperative indicators (operation time, intraoperative blood loss and hospital stay), stone clearance rate, inflammatory factors[C reactive protein (CRP), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α)], score of the Visual Analogue Scale (VAS) for pain, and the incidence of complications were compared between the two groups. Results Hospital stay in the low-risk group was significantly shorter than that in the high-risk group (P < 0.05); the stone clearance rate was 93.18% in the low-risk group, which was significantly higher than 75.00% in the high-risk group (P < 0.05). Before surgery, the levels of serum CRP, IL-6 and TNF-α in the high-risk group were significantly higher than those in the low-risk group (P < 0.05); one day after surgery, the levels of serum CRP, IL-6 and TNF-α in the high-risk group were significantly higher than those in the low-risk group (P < 0.05). On the first, the third, and the fifth day after surgery, the VAS score in the high-risk and low-risk groups decreased significantly, and the VAS score in the low-risk group was significantly lower than that in the high-risk group (P < 0.05). Incidence rate of complications in the low-risk group was 4.54%, which was significantly lower than 19.44% in the high-risk group (P < 0.05). Conclusion Application of PCNL under local anesthesia in treating patients with upper urinary tract calculi of ASA Ⅰ to Ⅲ has milder inflammation and pain when compared to those of ASA Ⅲ to Ⅳ, and the incidence rate of complications is relatively low.

Objective:To construct a core index system of job responsibilities for specialist trauma nurses tailored to the current trauma care system in China and provide a reference for trauma centers to set up specialist trauma nurses.Methods:Literature review and group discussion were used to develop the first draft of the core index system of job responsibilities for specialist trauma nurses. The Delphi method was used to conduct two rounds of consultation among 15 experts from 7 provinces or cities in China to determine the final draft. The two rounds of expert active coefficient, expert authority coefficient ( Cr), Kendal coefficient (Kendall′s W), and average value of the importance and variation coefficient ( CV) of each indicator were calculated. Results:In both rounds of consultations, the expert active coefficient was 100%, and the Cr was 0.953. In the second round of consultation, the Kendall′s W was 0.188 ( χ2 =155.29, P<0.001), and the average value of the importance of each indicator ranged from 4.27-5.00 points with the CV of less than 0.25 points. The final index system consisted of 7 first-level indicators and 49 second-level indicators. Conclusion:The core index system of job responsibilities for specialist trauma nurses is reasonable and comprehensive, which can provide guidance for setting up positions of specialist trauma nurses in China.

Objective:To analyze the monitoring results of national brucellosis monitoring sites in Jinzhong City, Shanxi Province, and to provide a basis for scientific evaluation of prevention and control effects.Methods:From the "Disease Surveillance Information Report Management System", the surveillance results of national brucellosis surveillance sites (Pingyao County) in Jinzhong City from 2013 to 2021 were summarized and descriptive analysis was carried out.Results:From 2013 to 2021, a total of 996 cases of brucellosis were reported at the national brucellosis monitoring sites in Jinzhong City. A total of 3 538 serum samples were collected from key occupational groups, of which 161 were positive for brucellosis, with a positive rate of 4.55%. Among them, new cases accounted for 55.28% (89/161) and latent infections accounted for 21.74% (35/161). The annual serological test positive rate fluctuated between 1.19% and 20.55%. Except for 2014, the positive rate in all other years was less than 5.00%, and there was a statistically significant difference in positive rates between different years (χ 2 = 222.89, P < 0.001). The monitoring sites covered all townships within the jurisdiction (5 towns and 8 townships), and there was a statistically significant difference in positive rates among different townships (χ 2 = 26.45, P = 0.009). There was a statistically significant difference in positive rates among different occupations (χ 2 = 27.35, P < 0.001), with higher positive rates for veterinarians (5.41%, 2/37) and herders (4.76%, 29/609), respectively. There was a statistically significant difference in positive rates among different age groups (χ 2 = 42.97, P < 0.001), with a higher positive rate of 7.04% (104/1 477) in the 50 to 59 year old group. It can be seen from the scatter plot that the reported incidence rate did not increase linearly with the increase of serological positive rate. Conclusions:Except for 2014, the positive rate of serological tests for brucellosis at the national brucellosis monitoring sites in Jinzhong City, Shanxi Province has remained basically stable in other years. All townships in Pingyao County have an epidemic of brucellosis, and the 50 - 59 year old group and high-risk occupational groups are susceptible to it. The representatives of the monitoring results is not good, and it is recommended that the monitoring sites should strictly control the inclusion of the monitoring objects.

Objective:To develop an online interactive cytopathological training program, and to evaluate it for improving the cytopathological diagnostic ability of endoscopists in endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) of pancreas.Methods:A total of 5 500 cytopathological images were collected from 194 patients with pancreatic solid mass who underwent EUS-FNA in Nanjing Drum Tower Hospital from August 2018 to August 2019. The cell type in each cytopathological picture was labeled by senior cellular pathologists, which was used to build a learning and testing platform for online interactive cytopathological training. Five endoscopists without cytopathological background were invited to participate in this training. Sensitivity, specificity, positive predictive value and negative predictive value of endoscopists in differential diagnosis of cancer and non-cancer before and after training were compared to evaluate the effect of the online interactive cytopathological training program on improving the ability of endoscopists in diagnosis of cytopathology.Results:A cytopathological training platform for endoscopists to learn and take online test was successfully built. Before training, sensitivity, specificity, positive predictive value, negative predictive value and accuracy of diagnosis of cancer and non-cancer for endoscopists were 0.55 (95% CI: 0.53-0.58), 0.32 (95% CI: 0.30-0.35), 0.43 (95% CI: 0.41-0.45), 0.44 (95% CI: 0.41-0.47) and 0.43 (95% CI: 0.42-0.45), respectively. After training, the above indicators were 0.96 (95% CI: 0.95-0.97), 0.70 (95% CI: 0.68-0.73), 0.74 (95% CI: 0.72-0.76), 0.95 (95% CI: 0.94-0.96) and 0.81 (95% CI: 0.80-0.83), respectively, which were significantly improved compared with those before ( P<0.001). Conclusion:The online interactive cytopathological training program can improve the understanding and diagnostic ability of endoscopists in pancreatic cytopathology, help to implement rapid on-site evaluation in the process of EUS-FNA, and improve the diagnostic efficiency of EUS-FNA.

Objective:To explore the molecular mechanism of pathological changes in osteoarthritis (OA) through applying bioinformatics to analyze the miRNA-mRNA regulatory network.Methods:MiRNA expression data from human serum samples were downloaded from the Gene Expression Omnibus database. Differentially-expressed miRNA was identified using the linear modelling package of the Bioconductor software suite. The target differentially-expressed mRNA was predicted using version 2.0 of the miRWalk database. Version 3.7.1 of the Cytoscape software was used to construct the miRNA-mRNA regulatory network for OA. The target genes were analyzed by using gene ontology and the Kyoto Encyclopedia of Genes and Genomes. The protein-protein interaction network was constructed and the core genes in osteoarthritis pathology were screened out.Results:A total of 7 differentially-expressed miRNAs (all down-regulated) and 900 mRNAs were identified, mostly involved in the negative regulation of protein binding, DNA binding, or transcription in the cell cycle. Ten core genes were screened out: MAPK1, TP53, MAPK14, CCND1, EP300, POLR2E, POLR2F, ABL1, RAC1 and SKIV2L2.Conclusions:Multiple miRNAs, target genes and signaling pathways are involved in the development of OA. The miRNA-mRNA regulatory network identified provides new ideas for exploring the molecular mechanism of OA′s pathology and its clinical diagnosis and treatment.

Objectives: To compare the effect of eldecalcitol and alfacalcidol on skeletal microstructure by highresolution peripheral QCT (HR-pQCT). Methods: This was a substudy of a randomized, double-blind, active comparator trial. Five female osteoporotic patients with 1-year 0.75 mg/day eldecalcitol and 5 with 1-year 1.0 mg/day alfacalcidol completed HR-pQCT scans before and after treatment were enrolled. Results: Total vBMD [1.67 ± 1.06% (mean ± SD), P ¼ 0.043 versus baseline] and trabecular vBMD (2.91 ± 1.72%, P ¼ 0.043) at the radius increased in eldecalcitol group, while total, trabecular, and cortical vBMD tended to decrease in alfacalcidol group, with a significant reduction in cortical vBMD at the tibia (0.88 ± 0.62%, P ¼ 0.043). Cortical area (1.82 ± 1.92%, P ¼ 0.043) at the radius and thickness (0.87 ± 1.12%, P ¼ 0.043) at the tibia increased in eldecalcitol group, while these parameters decreased with alfacalcidol at the tibia (1.77 ± 1.72%, P ¼ 0.043 for cortical area; 1.40 ± 2.14%, P ¼ 0.042 for cortical thickness). Trabecular thickness at the radius (1.97 ± 1.93%, P ¼ 0.042) and number at the tibia (3.09 ± 3.04%, P ¼ 0.043) increased by eldecalcitol but did not increase by alfacalcidol. Trabecular separation decreased by eldecalcitol (2.22 ± 2.43%, P ¼ 0.043) but tended to increase by alfacalcidol at the tibia. Conclusions Eldecalcitol has the greater potential to improve cortical and trabecular microstructure at the peripheral bone than alfacalcidol which needs further more studies.

Objective:To investigate the curative efficacy of radical prostatectomy (RP) for T 4 stage prostate cancer invading bladder neck. Methods:The clinical data of 22 patients with T 4 stage prostate cancer invading bladder neck treated with RP from April 2013 to March 2021 were analyzed retrospectively. The mean age of the patients was (64.09±6.33) years, and the preoperative blood PSA was 57.70(39.40, 68.56) ng/ml. Preoperative MRI or PSMA-PET examination revealed bladder neck invasion, including 16 cases (72.73%) of urinary retention. Clinical stage of T 4N 0M 0 accounted for 40.91% (9/22), T 4N 1M 0 accounted for 45.45% (10/22), and T 4N 1M 1 accounted for 13.64% (3/22). Preoperative patients were not treated with neoadjuvant endocrine or chemotherapy. Laparoscopic or robotic assisted laparoscopic radical prostatectomy and pelvic lymph node dissection were performed. Results:The 22 operations were successfully completed without conversion. The operation time was(184.27±34.82) min, the amount of intraoperative bleeding was (210.91±83.03) ml, the retention time of drainage tube was (4.73 ± 1.03) days, the recovery of gastrointestinal function took 3 (2, 3) days, and the postoperative hospital stay was (6.68 ± 1.39) days. Postoperative pathology showed that the Gleason score of 7 points accounted for 4.54% (1/22), 8 points accounted for 13.64% (3/22), and 9 points accounted for 81.82% (18/22). The positive rate of margin was 81.82% (18/22). Pathological stage of T 4N 0M 0 accounted for 22.73% (5/22), T 4N 1M 0 accounted for 63.64% (14/22), and T 4N 1M 1 accounted for 13.64% (3/22), of which extracapsular or seminal vesicle invasion accounted for 90.91% (20/22). The incidence of postoperative complications above grade 3 was 9.09% (2/22), and the rate of urinary control recovery after 3 months of surgery was 90.91% (20/22). 16 patients with preoperative urinary retention were able to urinate normally after operation. All patients were treated with adjuvant androgen deprivation therapy (ADT) with or without antiandrogens, and 13 cases (59.09%) were treated with adjuvant radiotherapy. The postoperative PSA value before adjuvant treatment was 2.53 (0.51, 5.44) ng/ml. The median survival time was not reached. Two patients died of prostate cancer at 71 and 84 months and one patient died of heart disease at 28 months. Conclusions:RP surgery could effectively relieve the condition of urinary retention with low incidence of operative complications. Although the positive rate of surgical margin is high, RP could be used as one of the treatment options for T 4 stage prostate cancer invading bladder neck, while the long-term effect is still needed to be further analyzed.

Objective:To study the safety and efficacy of endoscopic submucosal dissection (ESD) for early gastric cardia cancer (EGCC) in elderly patients.Methods:A retrospective analysis was performed on data of 499 EGCC patients who underwent ESD from January 2011 to June 2018 in Nanjing Drum Tower Hospital. The patients were divided into two groups by age, the young/middle-aged group (<65 years old) and the elderly group (≥65 years old). The baseline data, lesion features, postoperative complications, short-term efficacy and long-term efficacy of the two groups were compared.Results:The elderly group included 272 patients (283 lesions) and the young/middle-aged group included 227 patients (229 lesions). Except that there were significant differences in the age ( P<0.001) and body mass index ( P=0.002) between the elderly group and the young/middle-aged group, there were no significant differences in the baseline data or pathological features between the two groups. The rate of curative resection in the elderly group was 77.0%, lower than that in the young/middle-aged group (84.3%, P=0.045). No significant differences were found in en bloc resection rate (100.0% VS 99.6%, P=1.000), complete resection rate (94.7% VS 93.9%, P=0.705), postoperative complications incidence (6.4% VS 5.7%, P=0.747), operation time (64.02±39.24 min VS 66.16±44.62 min, P=0.566) or hospitalization time (6.76±2.06 d VS 6.47±1.74 d, P=0.092]. After the median follow-up of 47.9 months, 13.4% patients in the elderly group received additional surgery, which was slightly lower than that in the young/middle-aged group ( P=0.891). There were no significant differences in postoperative recurrence, lymph node metastasis, distant metastasis, overall mortality and disease-related mortality between the two groups. The survival analysis showed that five-year overall survival rates were 94.41% and 96.34% in the elderly group and the young/middle-aged group respectively ( P=0.156), and five-year disease-specific survival rate were 99.18% and 99.03% in the two groups respectively ( P=0.858). Conclusion:ESD is safe and effective for EGCC in elderly patients with satisfactory short-term and long-term efficacy.

Objectives: To compare the effect of eldecalcitol and alfacalcidol on skeletal microstructure by highresolution peripheral QCT (HR-pQCT). Methods: This was a substudy of a randomized, double-blind, active comparator trial. Five female osteoporotic patients with 1-year 0.75 mg/day eldecalcitol and 5 with 1-year 1.0 mg/day alfacalcidol completed HR-pQCT scans before and after treatment were enrolled. Results: Total vBMD [1.67 ± 1.06% (mean ± SD), P ¼ 0.043 versus baseline] and trabecular vBMD (2.91 ± 1.72%, P ¼ 0.043) at the radius increased in eldecalcitol group, while total, trabecular, and cortical vBMD tended to decrease in alfacalcidol group, with a significant reduction in cortical vBMD at the tibia (0.88 ± 0.62%, P ¼ 0.043). Cortical area (1.82 ± 1.92%, P ¼ 0.043) at the radius and thickness (0.87 ± 1.12%, P ¼ 0.043) at the tibia increased in eldecalcitol group, while these parameters decreased with alfacalcidol at the tibia (1.77 ± 1.72%, P ¼ 0.043 for cortical area; 1.40 ± 2.14%, P ¼ 0.042 for cortical thickness). Trabecular thickness at the radius (1.97 ± 1.93%, P ¼ 0.042) and number at the tibia (3.09 ± 3.04%, P ¼ 0.043) increased by eldecalcitol but did not increase by alfacalcidol. Trabecular separation decreased by eldecalcitol (2.22 ± 2.43%, P ¼ 0.043) but tended to increase by alfacalcidol at the tibia. Conclusions Eldecalcitol has the greater potential to improve cortical and trabecular microstructure at the peripheral bone than alfacalcidol which needs further more studies.

Objective:To evaluate the safety and efficacy of indwelling cutting with guidewire in treatment of difficult pancreatic duct stricture.Methods:A retrospective study was performed on the data of patients with chronic pancreatitis, who failed to implant pancreatic duct stent by endoscopic retrograde cholangiopancreatography (ERCP) and whose narrow pancreatic duct only allowed the guidewire to pass through, in Nanjing Drum Tower Hospital from November 2017 to April 2019. The dilatation effect of guidewire indwelling on difficult pancreatic duct stenosis was studied. The duration of guidewire indwelling, the success rate of stent re-implantation, the level of postoperative amylase, recent complications, and follow-up results were analyzed.Results:A total of five patients received indwelling guidewire after failure of dilation of pancreatic duct stenosis during ERCP. After 2.4 days of mean indwelling time, all patients received re-ERCP. The narrow pancreatic duct was successfully expanded and the stent was placed. In terms of complications, only one patient suffered from acute pancreatitis after the first ERCP, and was improved after medical treatment.Conclusion:Guidewire indwelling is a new simple, safe, and effective method for dilatation of pancreatic duct stenosis, and has important clinical value in the management of difficult intubation of pancreatic duct in chronic pancreatitis.