Tumor microenvironment(TME)is the living environment of tumor cells.The immune cells contained in TME are reprogrammed into tumor-promoting states due to various factors.Inhibiting this reprogramming effect of TME is an innovative strategy for treating tumors.As an essential factor in spindle assembly,TPX2 is considered to be a gene that promotes cancer cell proliferation and plays a role in cell response to replication stress.Highly expressed TPX2 in tumor cells promotes tumor growth through a variety of pathways,and these pathways can promote the tumor-promoting activity of immune cells in TME.Therefore,TPX2 may be a regulatory gene of TME.This paper discusses the possible mechanism of TPX2 involved in the regulation of TME by discussing the pathway medi-ated by TPX2 and the regulation of immune cells infiltrated in TME,and provides ideas for subsequent research directions.

AIM:To investigate the effects of total flavonoids of Pterocarya hupehensis Skan(PHSTF)on dex-tran sulfate sodium(DSS)-induced ulcerative colitis(UC)mouse model and lipopolysaccharide(LPS)-stimulated RAW264.7 macrophages.METHODS:Thirty-six male C57BL/6J mice(6 to 8 weeks old,SPF grade)were randomly di-vided into 6 groups:negative control(NC)group,3%DSS-induced model group,mesalazine(300 mg·kg-1·d-1)group,and low-dose(62.5 mg·kg-1·d-1),medium-dose(125 mg·kg-1·d-1)and high-dose(250 mg·kg-1·d-1)PHSTF treatment groups,with 6 mice in each group.The mice in NC group received distilled water,while those in other groups were treated with a 3%DSS solution for 7 d to induce the UC model.On the 1st day of DSS administration,the mice in treatment groups received the corresponding agents via oral gavage for 10 d,while those in NC and model groups were gavaged with distilled water.Throughout the study,the effects of PHSTF on body weight,fecal blood,and colon length were measured and recorded daily.Histopathological changes in colon tissues were assessed using hematoxylin-eosin staining.The levels of the pro-inflammatory cytokine interleukin-1β(IL-1β)and the anti-inflammatory cytokine IL-10 in colon tissues were quantified using ELISA.The LPS-induced RAW264.7 macrophage model was employed to evaluate the cellular effects of PHSTF.Cell viability was assessed by CCK-8 assay,and cell morphology was observed under a microscope.The mRNA expression of inflammatory markers[IL-1β,inducible nitric oxide synthase(iNOS),IL-10 and arginase-1(Arg-1)]was measured by RT-qPCR.Western blot and immunofluorescence double labeling were used to detect the protein expression of macrophage polarization markers(iNOS,CD206 and Arg-1).Finally,immunohistochemistry(IHC)was utilized to as-sess protein expression of iNOS in colon tissues.RESULTS:Compared to the DSS-induced UC model group,PHSTF sig-nificantly improved several parameters,including weight loss(P<0.05),rectal bleeding,and colon shortening in DSS-treated mice.PHSTF also reduced histopathological damage and inflammatory cell infiltration in the colon.It decreased IL-1β levels(P<0.05)and increased IL-10 levels(P<0.05)in colon tissues.In LPS-induced RAW264.7 cells,PHSTF reduced the mRNA expression of IL-1β and iNOS(P<0.01),while upregulating the mRNA expression of IL-10 and Arg-1(P<0.01).Additionally,PHSTF decreased iNOS protein expression(P<0.01)and elevated the expression of Arg-1 and CD206 proteins(P<0.01).IHC analysis further confirmed that PHSTF downregulated iNOS protein expression in colon tissues.CONCLUSION:Treatment with PHSTF promotes the polarization of macrophages from the pro-inflammatory M1 phenotype to the anti-inflammatory M2 phenotype,thereby alleviating inflammation in colon tissue and ameliorating ulcer-ative colitis in mice.

Purpose To investigate the distribution characteristics of tumor-associated macrophages(TAM)in different regions of breast cancer with enhanced contrast-enhanced ultrasound(CEUS),and to further explore the relationship between TAM and CEUS indicators and clinicopathology in different regions of breast cancer.Materials and Methods A total of 119 patients with suspected breast cancer admitted to the Cancer Hospital Affiliated to Xinjiang Medical University from March 2021 to March 2023 were prospectively included.CEUS was applied to the tumor,and ultrasound-guided puncture biopsy was also taken.The lesions diagnosed as breast cancer by pathology was outlined the central area,marginal area and normal area next to the cancer,and was obtained the time intensity curves of different areas.The tissues were taken for immunohistochemistry and flow cytometry,and the TAM cells were stained and distinguished.The characteristics of TAM in different regions of breast cancer and its correlation with clinical pathology were analyzed,respectively.Results By immunohistochemistry and flow cytometry,there were significant differences in the number of TAM infiltration in the border area,central area and adjacent area of breast cancer(immunohistochemistry:F=382.326,P<0.05;flow cytometry:F=24.955,P<0.05).The characteristics of CEUS in three different regions showed that the TAM in the central region of breast cancer increased when filling defect appeared(t=2.631,P<0.05),but the TAM in the peripheral region was more(t=2.999,P<0.05).After angiography,lesions showed high perfusion,and there was significantly more TAM in the edge and central area of the lesion than that in normal area next to the cancer(t=5.529,P<0.05;t=2.584,P<0.05).Clinical stage was related to the TAM in three regions.When the clinical stage was high,there were more TAM in all three regions(t=6.658,2.367,2.400,all P<0.05).Histological grading was high,and TAM in all three areas was high(F=101.151,16.922,26.822,all P<0.05).Conclusion There was a decreasing trend of TAM in the marginal area,central area and adjacent tissues of breast cancer during CEUS.The edge region has more malignant CEUS characteristics than that in the central region and the normal region adjacent to cancer;and the number of TAM is more in breast cancer with late clinical grading,poor tissue differentiation and obvious contrast-enhanced ultrasound malignant characteristics.The distribution characteristics of TAM represent the malignant degree and metastatic probability of breast cancer to a certain extent,and TAM is a factor related to the invasion of breast cancer.

Tumor microenvironment(TME)is the living environment of tumor cells.The immune cells contained in TME are reprogrammed into tumor-promoting states due to various factors.Inhibiting this reprogramming effect of TME is an innovative strategy for treating tumors.As an essential factor in spindle assembly,TPX2 is considered to be a gene that promotes cancer cell proliferation and plays a role in cell response to replication stress.Highly expressed TPX2 in tumor cells promotes tumor growth through a variety of pathways,and these pathways can promote the tumor-promoting activity of immune cells in TME.Therefore,TPX2 may be a regulatory gene of TME.This paper discusses the possible mechanism of TPX2 involved in the regulation of TME by discussing the pathway medi-ated by TPX2 and the regulation of immune cells infiltrated in TME,and provides ideas for subsequent research directions.

AIM:To investigate the effects of total flavonoids of Pterocarya hupehensis Skan(PHSTF)on dex-tran sulfate sodium(DSS)-induced ulcerative colitis(UC)mouse model and lipopolysaccharide(LPS)-stimulated RAW264.7 macrophages.METHODS:Thirty-six male C57BL/6J mice(6 to 8 weeks old,SPF grade)were randomly di-vided into 6 groups:negative control(NC)group,3%DSS-induced model group,mesalazine(300 mg·kg-1·d-1)group,and low-dose(62.5 mg·kg-1·d-1),medium-dose(125 mg·kg-1·d-1)and high-dose(250 mg·kg-1·d-1)PHSTF treatment groups,with 6 mice in each group.The mice in NC group received distilled water,while those in other groups were treated with a 3%DSS solution for 7 d to induce the UC model.On the 1st day of DSS administration,the mice in treatment groups received the corresponding agents via oral gavage for 10 d,while those in NC and model groups were gavaged with distilled water.Throughout the study,the effects of PHSTF on body weight,fecal blood,and colon length were measured and recorded daily.Histopathological changes in colon tissues were assessed using hematoxylin-eosin staining.The levels of the pro-inflammatory cytokine interleukin-1β(IL-1β)and the anti-inflammatory cytokine IL-10 in colon tissues were quantified using ELISA.The LPS-induced RAW264.7 macrophage model was employed to evaluate the cellular effects of PHSTF.Cell viability was assessed by CCK-8 assay,and cell morphology was observed under a microscope.The mRNA expression of inflammatory markers[IL-1β,inducible nitric oxide synthase(iNOS),IL-10 and arginase-1(Arg-1)]was measured by RT-qPCR.Western blot and immunofluorescence double labeling were used to detect the protein expression of macrophage polarization markers(iNOS,CD206 and Arg-1).Finally,immunohistochemistry(IHC)was utilized to as-sess protein expression of iNOS in colon tissues.RESULTS:Compared to the DSS-induced UC model group,PHSTF sig-nificantly improved several parameters,including weight loss(P<0.05),rectal bleeding,and colon shortening in DSS-treated mice.PHSTF also reduced histopathological damage and inflammatory cell infiltration in the colon.It decreased IL-1β levels(P<0.05)and increased IL-10 levels(P<0.05)in colon tissues.In LPS-induced RAW264.7 cells,PHSTF reduced the mRNA expression of IL-1β and iNOS(P<0.01),while upregulating the mRNA expression of IL-10 and Arg-1(P<0.01).Additionally,PHSTF decreased iNOS protein expression(P<0.01)and elevated the expression of Arg-1 and CD206 proteins(P<0.01).IHC analysis further confirmed that PHSTF downregulated iNOS protein expression in colon tissues.CONCLUSION:Treatment with PHSTF promotes the polarization of macrophages from the pro-inflammatory M1 phenotype to the anti-inflammatory M2 phenotype,thereby alleviating inflammation in colon tissue and ameliorating ulcer-ative colitis in mice.

Purpose To investigate the distribution characteristics of tumor-associated macrophages(TAM)in different regions of breast cancer with enhanced contrast-enhanced ultrasound(CEUS),and to further explore the relationship between TAM and CEUS indicators and clinicopathology in different regions of breast cancer.Materials and Methods A total of 119 patients with suspected breast cancer admitted to the Cancer Hospital Affiliated to Xinjiang Medical University from March 2021 to March 2023 were prospectively included.CEUS was applied to the tumor,and ultrasound-guided puncture biopsy was also taken.The lesions diagnosed as breast cancer by pathology was outlined the central area,marginal area and normal area next to the cancer,and was obtained the time intensity curves of different areas.The tissues were taken for immunohistochemistry and flow cytometry,and the TAM cells were stained and distinguished.The characteristics of TAM in different regions of breast cancer and its correlation with clinical pathology were analyzed,respectively.Results By immunohistochemistry and flow cytometry,there were significant differences in the number of TAM infiltration in the border area,central area and adjacent area of breast cancer(immunohistochemistry:F=382.326,P<0.05;flow cytometry:F=24.955,P<0.05).The characteristics of CEUS in three different regions showed that the TAM in the central region of breast cancer increased when filling defect appeared(t=2.631,P<0.05),but the TAM in the peripheral region was more(t=2.999,P<0.05).After angiography,lesions showed high perfusion,and there was significantly more TAM in the edge and central area of the lesion than that in normal area next to the cancer(t=5.529,P<0.05;t=2.584,P<0.05).Clinical stage was related to the TAM in three regions.When the clinical stage was high,there were more TAM in all three regions(t=6.658,2.367,2.400,all P<0.05).Histological grading was high,and TAM in all three areas was high(F=101.151,16.922,26.822,all P<0.05).Conclusion There was a decreasing trend of TAM in the marginal area,central area and adjacent tissues of breast cancer during CEUS.The edge region has more malignant CEUS characteristics than that in the central region and the normal region adjacent to cancer;and the number of TAM is more in breast cancer with late clinical grading,poor tissue differentiation and obvious contrast-enhanced ultrasound malignant characteristics.The distribution characteristics of TAM represent the malignant degree and metastatic probability of breast cancer to a certain extent,and TAM is a factor related to the invasion of breast cancer.

Objective:To explore the long-term efficacy of laparoscopic fundoplication for proton pump inhibitor dependent gastroesophageal reflux disease (GERD).Method:Clinical data of proton pump inhibitor dependent GERD patients who underwent fundoplication at the Rocket Force Characteristic Medical Center from Jan to Jun 2012 were analyzed, including GERD symptom score, subjective symptom relief rate, PPI discontinuation rate and surgical satisfaction, as well as recurrence and complications.Result:A total of 160 GERD patients were included in this study, with 64% of patients having respiratory symptoms. Nissen and Toupet fundoplication were performed in 43 and 117 cases, respectively, with a follow-up time of (127±3) months. The postoperative GERD symptom scores of the patients were significantly lower than before treatment (all P<0.001); The subjective relief of overall symptoms in the digestive tract and airway problem was 90% (80%, 100%) and 100%, respectively. The PPI discontinuation rate was 86%, and the overall satisfaction rate of the treatment was 92%, and the satisfaction rate of patients with respiratory symptoms was 89%. 7% of patients experienced varying degrees of symptomatic recurrence, 4% of patients re-underwent endoscopic treatment and/or laparoscopic fundoplication due to symptom recurrence. The incidence of long-term postoperative dysphagia, bloating, belching, increased exhaust, abdominal pain, diarrhea, and constipation were 11.3%, 16.9%, 0, 1.3%, 0, 2.5%, and 5.6%, respectively. Conclusions:Laparoscopic fundoplication has good long-term efficacy in the treatment of GERD. A small number of patients may experience postoperative recurrence, as well as complications such as dysphagia and gas-bloat syndrome. Most recurrent patients can achieve good therapeutic effect by redoing endoscopic treatment or redoing surgery.

Objective:To analyze the new value of gastroscopy in the diagnosis of esophageal hiatal hernia(EHH).Methods:From March 7 to September 24 in 2019, 194 patients with gastroesophageal reflux disease who received endoscopy and high resolution esophageal manometry (HREM) at the Department of Gastroesophageal Surgery, the PLA Rocket Force Medical Center were selected. The transverse diameter of esophageal hiatus and the upward length of esophagogastric junction (EGJ) were measured under endoscopy, and the relevant data of reflux esophagitis (RE) and length and pressure of lower esophageal sphincter (LES) were collected. The value of traditional method under endoscopy and esophageal hiatus transverse diameter (EHTD) method under endoscopy in the diagnosis of EHH was compared. Independent sample- t test, rank sum test and chi-square test were used for statistical analysis. Results:The detection rate of EHH by EHTD method under endescopy was higher than that by traditional method under endoscopy and HREM method (60.8%, 118/194 vs. 14.9%, 29/194 and 37.1%, 72/194), and the detection rate of EHH by HREM method was higher than that by traditional method under endoscopy, and the differences were statistically significant ( χ2=86.75, 21.82, and 24.75; all P<0.001). The proportion of RE, the upward length of EGJ and the transverse diameter of esophageal hiatus of EHH patients diagnosed by traditional method under endoscopy and EHTD method under endoscopy were all higher than those of non-EHH patients (79.3%, 23/29 vs. 28.5%, 47/165; 49.2%, 58/118 vs. 15.8%, 12/76; 2.0 (2.0, 3.0) cm vs. 0.4(0, 0.7) cm, 0.7(0, 1.6) cm vs. 0(0, 0.6) cm; (2.60±0.71) cm vs. (1.88±0.44) cm, (2.30±0.45) cm vs. (1.51±0.29) cm); the minimum resting pressure of LES and resting pressure of LES were both lower than those of non-EHH patients(3.7(0.3, 12.1) mmHg (1 mmHg=0.133 kPa) vs. 9.1(3.3, 14.2) mmHg, 6.4(2.2, 12.5) mmHg vs. 10.8 (4.7, 15.5) mmHg; (9.70±7.92) mmHg vs. (14.92±10.30) mmHg, (11.36±7.79) mmHg vs. (18.44±11.78) mmHg); the length of intraperitoneal LES were shorter than that of non-EHH patients (0(0, 1.4) cm vs. 1.1(0, 1.7) cm, 0.3(0, 1.5) cm vs. 1.3(0.4, 1.8) cm); the length of LES of EHH patients diagnosed by EHTD method under endoscopy was shorter than that of non-EHH patients ((2.83±0.63) cm vs. (3.10±0.66) cm), and the differences were statistically significant ( χ2=26.53 and 22.31, Z=-8.26 and-5.04, t=5.26 and 13.67, Z=-2.14 and-2.71, t=-2.59 and-4.63, Z=-2.58 and-3.60, t=-2.96; all P<0.05). There were no significant differences in gender, LES length, intraperitoneal LES length, minimum resting pressure of LES, resting pressure of LES and residual pressure of LES between EHH patients diagnosed by EHTD method and traditional method under endoscopy (all P>0.05). Conclusions:Endoscopy plays a significant role in the diagnosis of EHH. EHTD method under endoscopy is more accurate in the diagnosis of sliding EHH, which is worthy of clinical reference.

The management of hospital volunteers is one of the main tasks of medical social workers.In practical work,they are often in a dilemma due to ethical problems,which restricts the scientific development of hospital volunteer organizations.Based on the experience of frontline medical social workers in the"Guangji Boat"Volunteer Service Alliance of the Second Affiliated Hospital Zhejiang University School of Medicine,while investigating other public hospitals,this paper summarized and organized ethical issues,analyzed their causes,and proposed improvement strategies.The ethical dilemma of hospital volunteer service was mainly in the conflict between the dual relationship of human emotion and norm,the conflict between incentive mechanism and non-reward value,as well as the conflict between participation motivation and organizational goal.The ethical dilemma in the management of hospital volunteers was attributed to the lack of standardized practical operation systems.Based on the above ethical dilemmas,combined with the development experience of volunteer service in public hospitals,this paper proposed reasonable countermeasures to provide a reference for the management of hospital volunteers.

Objective:To evaluate the safety and efficacy of domestically produced magnetic sphincter augmentation (MSA) for gastroesophageal reflux disease.Method:This study is a prospective cohort study. Patients with typical heartburn and reflux symptoms (at least partial response to proton pump inhibitors), abnormal esophageal acid exposure and normal esophageal peristalsis were included, prospectively in the Department of Gastroesophageal Surgery, Rocket Force Characteristic Medical Center from June 2019 to September 2022. Patients with hiatal hernia >2 cm and severe esophagitis were excluded. The MSA was wrapped around the distal esophagus after esophageal hiatus repair by laparoscopy. A postoperative questionnaire survey was conducted to assess the relief of symptom, complications, the discontinuation rate of proton pump inhibitor, and surgical satisfaction. Gastroscopy, high-resolution esophageal pressure measurement, and pH value impedance monitoring were also reviewed. The pre- and postoperative rates were compared using the McNeinar χ2 test. Result:Currently, 23 patients with gastroesophageal reflux disease were enrolled and underwent MSA surgery. There were 20 males and 3 females, aged ( M (IQR)) 48 (14) years (range: 25 to 64 years). All cases were successfully implanted with MSA. Subjective indicators were followed for 17 (18) months (range: 14 to 53 months), while objective indicators were followed for 17 (1) months (range: 12 to 23 months). The postoperative gastrointestinal and extraesophageal symptom scores showed a significant decrease compared to preoperative levels as follows: the degree of subjective relief of overall digestive symptoms was 90 (20)% (range:0~100%), the degree of subjective relief of overall respiratory symptoms was 100(10)% (range: 10%~100%), the overall satisfaction rate was 83% (19/23), the proton pump inhibitor discontinuation rate was 70% (16/23). The proportion of esophagitis has decreased from 44% (10/23) to 9% (2/23) ( κ=0.169, P=0.039), The Hill grade of gastroesophageal valve morphology improved from 1 case of grade Ⅰ, 5 cases of grade Ⅱ, 10 cases of grade Ⅲ, and 7 cases of grade Ⅲ preoperative to 22, 1, 0, and 0 cases postoperative. The proportion of lower esophageal sphincter pressure below normal has decreased from 70% (16/23) to 35% (8/23) ( κ=0.170, P=0.012). There were 21 patients who restored normal esophageal acid exposure. Eleven patients had mild long-term dysphagia, but it didn′t affect their daily life. No postoperative device migration, erosion, or secondary surgical removal occurred. Conclusions:Laparoscopic implantation of the MSA device was safe and well tolerated. It can effectively control the symptoms of gastroesophageal reflux disease, reduce medication, restore normal cardia morphology and function, and esophageal acid exposure. The main postoperative complication was dysphagia, but it was relatively mild.