Objective:To investigate the expression difference in PD-L1 on mesenchymal infiltrating immune cells between the primary and metastatic breast cancers, and to explore its relationship with clinicopathological parameters.Methods:All cases of primary breast cancer and their matched metastases diagnosed at the Fourth Hospital of Hebei Medical University between January 2010 and December 2018 were included. Immunohistochemistry (IHC) was used to detect the expression of PD-L1 (SP142) in interstitial infiltrating immune cells, and the expression of ER, PR, HER2 and Ki-67 in primary and matched metastases was detected. Statistical software SPSS 24.00 was used for statistical analysis. Kappa test was used for concordance/agreement analysis and McNemar test for difference analysis.Results:Among the 140 identified primary breast cancers, there were 52 cases with matched lymph node metastasis, 88 cases with distant metastasis, including 35 cases with liver metastasis, 21 cases with lung metastasis, 13 cases with chest wall metastasis, 11 cases with bone metastasis, 6 cases with brain metastasis, 1 case with small intestine metastasis, and 1 case with eyeball metastasis. The overall concordance rate of the PD-L1 expression on mesenchymal immune cells between primary breast cancer and paired metastatic breast cancer was 72.9% (κ=0.441). The concordance rate of PD-L1 expression between primary breast cancers and paired lymph node metastases, and that between primary breast cancers and distant metastases were 75.0% (κ=0.472) and 71.6% (κ=0.472), respectively. The inconcordance rate of interstitial immune cell PD-L1 expression between primary breast cancer and matched lung metastasis was 28.6%(6/21), and the difference was statistically significant ( P=0.031). The expression of PD-L1 in mesenchymal immune cells of primary breast cancer was significantly correlated with tumor size, histological grade, vascular invasion, lymph node metastasis, and Ki-67 index ( P<0.05). The PD-L1 expression was independently associated with lymph node metastasis ( P<0.05), while the expression of PD-L1 in metastatic breast cancer interstitial immune cells was significantly related to the expression of ER ( P<0.05). Conclusions:The expression of PD-L1 in the primary breast cancer is moderately concordant with that in paired metastases, but different from that in paired lung metastases. Therefore, the expression of PD-L1 in distant metastasis needs to be re-evaluated to optimize the treatment outcomes of PD-L1 based therapy.

Objective:To analyze the research hotspots and trends of the application of Kirkpatrick model in nursing education through bibliometrics analysis, so as to provides ideas for follow-up researchers to carry out research in related fields.Methods:Relevant literatures in CNKI, Wanfang, VIP and PubMed were retrieved from the establishment of databases until August 27, 2022. CiteSpace software was used to draw the literature topic clustering map, BICOMB was used to generate the co-occurrence matrix of bibliographic data, and gCLUTO software was used to make the visual hill map and analyze the literature hotspots.Results:A total of 230 literatures were included, including 145 in Chinese and 85 in English. Since 2016, the number of published papers had been on the rise. The papers were published in 134 journals at home and abroad, and the coauthor rate was 95.65% (220/230), and the funded papers accounted for 25.65% (59/230). The hot topic of Chinese literature research was the construction of training evaluation index system and training effectiveness evaluation. The research objects mainly included specialized nurses and in-service nurses.The research hotspot of English literature was nursing education and training. The research objects were specialized nurses and undergraduate students.Conclusions:The application of the Kirkpatrick model in the field of specialized nurse training is still in its infancy, and it needs to be extended to more specialist fields in the future. In addition, researchers should further explore the construction and application of a training evaluation index system based on the Kirkpatrick model in the future, and promote the horizontal development of training