OBJECTIVE To evaluate the efficacy and safety of tyrosine kinase inhibitors （TKI） in the treatment of HER2- positive breast cancer in order to provide evidence-based evidence for clinical medication. METHODS Retrieved from CNKI， Wanfang database， VIP， PubMed， Cochrane Library， Embase and Web of Science， randomized controlled trial （RCT） about TKI （trial group） versus drugs excluding TKI （control group） in the treatment of HER2-positive breast cancer were collected from the establishment of the database to April 2023. Meta-analysis and sensitivity analysis were performed by using RevMan 5.4.1 and Stata 17 software. RESULTS Total of 24 RCT studies were included， involving 15 538 HER2-positive breast cancer patients. The meta- analysis results showed that compared with the control group， the progression-free survival （PFS） [HR＝0.91， 95%CI （0.80， 1.02）， P＝0.12]， overall survival （OS） [HR＝0.95， 95%CI （0.89， 1.01）， P＝0.11]， objective response rate （ORR） [OR＝1.21， 95%CI （0.86， 1.69）， P＝0.27]， and pathological complete response rate （pCR） [OR＝1.44， 95%CI （0.91， 2.27）， P＝0.12] had no statistically significant difference in the trial group； among the 3/4 grade ADRs， the trial group had a higher incidence of anemia [OR＝1.77， 95%CI （1.16，2.70）， P＝0.008]， rash [OR＝11.26， 95%CI （7.32，17.31）， P＜0.000 01]， paronychia [OR＝8.67， 95%CI（1.62，46.53）， P＝0.01]， diarrhea [OR＝10.17， 95%CI（5.03，20.58）， P＜0.000 01]， oral mucositis inflammation [OR＝ 9.34， 95%CI （3.13， 27.83）， P＜0.000 1]， elevated aspartate aminotransferase [OR＝2.09， 95%CI （1.13，3.84）， P＝0.02]， and hypokalemia [OR＝2.37， 95%CI （1.31，4.30）， P＝0.005] than that of the control group. Subgroup analysis results showed that compared with the placebo group， TKI could improve OS and ORR （P＜0.05）， while compared with trastuzumab， TKI had no advantage in PFS， OS， ORR， and pCR， and TKI combined with trastuzumab could significantly improve PFS， OS， ORR， and pCR compared with the trastuzumab group （P＜ 0.05）. Sensitivity analysis suggested that the results were relatively robust and the risk of publication bias was low. CONCLUSIONS Compared with trastuzumab， TKI has no advantages in PFS， OS， ORR and pCR in the treatment of HER2- positive breast cancer， but TKI combined with trastuzumab can significantly improve PFS， OS， ORR and pCR； TKI can increase the risk of grade 3/4 anemia， rash， paronychia， diarrhea， oral mucositis， elevated aspartate aminotransferase， and hypokalemia.

Objective To investigate the changes in distribution of Oncomelania hupensis snails in forestlands in Songjiang District, Shanghai Municipality from 2009 to 2023, so as to provide insights into formulation of O. hupensis snail surveillance programs. Methods The reports on O. hupensis snail surveillance in Songjiang District, Shanghai Municipality from 2009 to 2023 were collected, and the snail surveillance data in forestlands were extracted. The trends in the proportion of areas with snails in forestlands in total areas with snails, occurrence of frames with living snails and density of living snails were evaluated using a Joinpoint regression model in Songjiang District from 2009 to 2023, and the annual percent change (APC) and average annual percent change (AAPC). Results A total of 40 sites with snails were found in forestlands in 14 administrative villages of 4 townships, Songjiang District, Shanghai Municipality from 2009 to 2023. A total of 39 065 frames were surveyed for snails in settings covering an area of 609 600 m², and there were 6 084 frames with snails, covering 151 250 m² snail habitats. A total of 22 210 snails were captured, with the highest density of 260.00 snails/0.1 m², and 6 262 snails were dissected, with no Schistosoma japonicum infection identified in snails. The proportion of areas with snails in forestlands in total areas with snails appeared a tendency towards a rise in forestlands in Songjiang District, Shanghai Municipality from 2009 to 2023 (APC = AAPC = 24.9%, P > 0.05); however, there were no turning points in the trend curve, with the highest proportion seen in 2009 (53.81%), the lowest in 2011 and 2023 (both 0) and a mean proportion of 24.81%. The occurrence of frames with living snails appeared a tendency towards a rise from 2009 to 2023 (APC = AAPC = 41.5%, P > 0.05); however, there were no turning points in the trend curve, with the highest occurrence in 2009 (53.81%), the lowest in 2011 and 2013 (both 0), and the mean occurrence of 15.57%. In addition, the density of living snails appeared a tendency towards a rise from 2009 to 2023 (APC = AAPC = 55.0%, P > 0.05); however, there were no turning points in the trend curve, with the highest density in 2023 (0.96 snails/0.1 m²), the lowest in 2011 and 2013 (both 0), and a mean density of 0.57 snails/0.1 m². Conclusions The difficulty in O. hupensis snail control and risk of imported snails appeared a tendency towards a rise in forestlands in Songjiang District, Shanghai Municipality over years from 2009 to 2023. Supervision and assessment prior to seedling transplantation and intensified surveillance post-transplantation are recommended to reduce the risk of O. hupensis snail importation and spread.

ObjectiveTo analyze the monitoring results and trends of Oncomelania in Songjiang District of Shanghai from 2007 to 2023， and to provide reference for future monitoring work. MethodsThe data of snail monitoring in Songjiang District from 2007 to 2023 were collected， including the location of snail spots， the number of survey frames， the area with snails， the number of frames with snails， the total number of snails， etc. The density of living snails and the occurrence rate of living snail frames were calculated. ResultsFrom 2007 to 2023， a total of 158 snail spots were found in 22 administrative villages in 4 towns in Songjiang District， including 131 emerging snail habitats （82.91%） and 27 reemerging snail habitats （17.09%）. The total snail area was 175 980 m²， the number of snail frames was 10 061， and 33 302 snails were captured. The highest density was 260/0.11 m²， and 15 662 snails were dissected. No positive snails were found. The average density of living snails was 0.60/0.11 m² and the average occurrence rate of living snail frames was 17.99%. The snail areas in different areas were Yexie Town 126 000 m² （71.60%）， Maogang Town 26 470 m² （15.04%）， Xinbang Town 17 040 m² （9.68%）， and Shihudang Town 6 470 m² （3.68%）. The average density of living snails in different areas was 0.89/0.11 m² in Yexie Town， 0.65/0.11 m² in Maogang Town， 0.26/0.11 m² in Shihudang Town and 0.24/0.11 m² in Xinbang Town. The snail areas of different snail habitats were as follows： woodland 151 250 m²（85.95%）， river 13 810 m²（7.85%）， ditch 6 910 m²（3.93%）， farmland 4 010 m²（2.28%）. The average density of living snails in different snail habitats： ditch 1.01/0.11 m²， beach 0.86/0.11 m²， woodland 0.57/0.11 m²， river 0.40/0.11 m². The occurrence rate of living snail frames in different regions and different snail environment types showed a downward trend and the difference was statistically significant. ConclusionAlthough the snail monitoring indicators such as snail area， average living snail density and average living snail frame occurrence rate in Songjiang District are still at its historically low level， the average living snail density and average living snail frame occurrence rate are still high compared with other regions or the national average. We should focus on the upper reaches and tributaries of the Huangpu River， especially the key areas of seedling transplantation， and strengthen monitoring and supervision to reduce the risk of snail input.

Objective:To construct the nursing quality evaluation index system for radionuclide wards, so as to provide scientific basis for monitoring the quality of nursing work in radionuclide wards.Methods:With Donabedian's "structure-process-outcome" three-dimensional quality evaluation model as the theoretical framework, literature review, Delphi method and analytic hierarchy process were used to determine the contents and weights of the evaluation index system of nursing quality in radionuclide wards. The enthusiasm of experts was expressed by the effective recovery rate of the questionnaire, the authority coefficient of experts was expressed by the authority coefficient, and the coordination degree of expert opinions was expressed by the coefficient of variation and the Kendall's harmony coefficient.Results:The effective recovery rates of the two rounds of expert correspondence questionnaires were 100.00% (15/15), the expert authority coefficients were 0.880 and 0.900, the coefficient of variation were 0.10-0.26 and 0-0.16 and the Kendall's harmony coefficients were 0.131 and 0.187 ( P<0.01). The final constructed nursing quality evaluation index system for radionuclide wards included three primary indicators, 12 secondary indicators and 56 tertiary indicators. Conclusions:The constructed nursing quality evaluation index system for radionuclide wards is scientific, reliable, practical and specialized, which is close to clinical nursing work and can provide a good evaluation method for nursing quality evaluation in radionuclide wards.

Objective:To explore the polymorphism of the uridine diphosphateglucuronosyl transferase 1A1 ( UGT1A1) gene in children of multiple nationalities with etiology-unknown neonatal hyperbilirubinemia in Qiubei County. Methods:Full-term neonates with unknown cause hyperbilirubinemia were collected.They were admitted to neonatal ward of Qiubei People′s Hospital from September 2017 to June 2018.All of them were performed UGT1A1 gene test. Results:A total of 100 neonates were enrolled in this study.Among them, 53 infants were Han, and others were minorities.Ten mutation sites of UGT1A1 gene were found.Five sites were never reported before and 4 sites could be pathogenic mutations.In addition, c.211G>A.was the most common genetic mutation, and 13 cases of homozygote and 32 cases of heterozygote were revealed by exome sequencing.The bilirubin levels of children with homozygote c. 211G>A were higher than those without the variation in this study and the differences were statistically significant ( t=2.621, P=0.008). The incidence of c. 211G>A mutation was similar between Han and minority nationalities.Among new-found mutations, c.1091C>CA heterozygous mutation was found in 19 children and in several nationalities, suggesting that this was a common UGT1A1 gene mutation in Qiubei County.Besides c. 211G>A and c. 1091C>CA were the most common variants.The incidence of c. 211G>A had no significant difference between Han and minority nationalities (χ 2=0.215, P=0.643). Neither had the incidence difference of c. 1091C>CA between Han and minority nationalities (χ 2=0.017, P=0.897). Conclusion:c. 211G>A and c. 1091C>CA mutations , which are distributed in both Han and minority nationalities, are common UGT1A1 mutations in Qiubei County.The distribution rate of c. 211G>A mutation is high in the population.The homozygous variation of c. 211G>A is associated with neonatal hyperbilirubinemia.

Objective To analyse the risk factors associated with spontaneous intestinal perforation (SIP) in extremely premature infants/extremely low birth weight infants. Method From January 2015 to December 2018, infants with gestational age (GA)<28 weeks or birth weight (BW)<1000 g admitted to our neonatal intensive care unit were enrolled to the retrospective nested case-control study.The clinical data of SIP infants (SIP group) and infants with the same GA but without SIP (control group) were randomly selected and compared. Multivariable Logistic regression was used to analyse the risk factors of SIP. Result A total of 409 extremely premature infants/extremely low birth weight infants were born during the study period. Among them, 25 SIP infants and 55 controls were enrolled. The incidence of SIP in infants with GA 22～25 weeks was 11.8％(16/136), which is higher than infants with GA 26～27 weeks (2.0％, 5/247) (χ2=16.057, P<0.001). The incidence of SIP in infants with BW 400～749 g was 13.0％(14/108), which is higher than infants with BW 750～999 g (3.4％, 8/236) (χ2=11.343, P=0.001). Multivariate Logistic regression analysis showed that twins (OR=4.153, 95％CI 1.392～12.384, P=0.011), umbilical veins catheterization (OR=15.942, 95％CI 1.026～247.789, P=0.048) and ibuprofen use within 3 days after birth (OR=15.387, 95％CI 1.519～155.883, P=0.021) were independent risk factors of SIP. Conclusion The smaller the GA and BW, the higher the incidence of SIP. Twins,umbilical veins catheterization and ibuprofen use early after birth may be independent risk factors of SIP.

Objective: To explore the influence of cluster nursing intervention on inadequate drainage in vacuum sealing drainage (VSD) for inpatients in burn unit. Methods: From October to December 2016, 60 patients, aged (43.6±2.8) years admitted to our department, receiving VSD treatment and conforming to the inclusion criteria, were included in the routine nursing group, and among the patients, 37 cases were male and 23 cases were female. From May to July 2017, 58 patients, aged (44.2±3.2) years admitted to our department, receiving VSD treatment and conforming to the inclusion criteria, were included in the cluster nursing group, and among the patients, 36 cases were male and 22 cases were female. The patients′ medical records were retrospectively analyzed. After VSD treatment, patients in routine nursing group received routine nursing, and patients in cluster nursing group received cluster nursing. A cluster intervention group was formed and headed by a chief surgeon. The cluster nursing plan was formulated and implemented strictly from the following six aspects of material preparation, negative pressure value control and negative pressure mode setting, drainage tube nursing, semi-permeable membrane reinforcement, standardizing changing process and timing of drainage capsule, and health education. During VSD treatment, the incidence of inadequate drainage, reasons of inadequate drainage and the occurrences, occurrences of inadequate drainage of wounds in different types and sites, and satisfaction of patients in two groups were observed and calculated. The patient satisfaction items included procedure of drainage capsule replacement, the method of tube fixation, the content and form of health education. Data were processed with independent sample t test and chi-square test. Results: (1) During VSD treatment, the incidence of inadequate drainage of patients in routine nursing group was 43.33% (130/300), which was significantly higher than 17.24% (50/290) in cluster nursing group (χ²=43.350, P<0.01). (2) During VSD treatment, the incidences of inadequate drainage caused by blockage of drainage tube due to scabbing of drainage, low negative pressure, air leakage of semi-permeable membrane, improper changing process of drainage capsule, shedding, compression, reversal of drainage tube of patients in cluster nursing group were 7.93% (23/290), 4.48% (13/290), 1.72% (5/290), 1.03% (3/290), and 2.07% (6/290), respectively, significantly lower than 16.67% (50/300), 11.67% (35/300), 4.33% (13/300), 4.00% (12/300), and 6.67% (20/300) in routine nursing group (χ²=10.379, 22.951, 4.832, 7.840, 7.399, P<0.05 or P<0.01). (3) During VSD treatment, the incidences of inadequate drainage of burn wounds, trauma wounds, pressure ulcer, venous ulcer in lower limbs, and diabetic foot of patients in cluster nursing group were significantly lower than those in routine nursing group (χ²=17.835, 6.809, 9.478, 4.939, 8.631, P<0.05 or P<0.01). During VSD treatment, the incidences of inadequate drainage of wounds in different types of patients in the same group were close (χ²=0.434, 0.057, P>0.05). (4) During VSD treatment, the incidences of inadequate drainage of wounds in limbs, trunk, buttocks, and sacrococcyx of patients in cluster nursing group were significantly lower than those in routine nursing group (χ²=31.892, 9.588, 4.939, 4.549, P<0.05 or P<0.01). During VSD treatment, the incidences of inadequate drainage of wounds in different wound sites of patients in the same group were close (χ²=0.071, 0.069, P>0.05). (5) The satisfaction scores in changing process of drainage capsule, method of tube fixation, content and form of health education of patients in cluster nursing group after VSD treatment were significantly higher than those in routine nursing group (t=5.166, 4.471, 7.958, 8.975, P<0.01). Conclusions Cluster nursing intervention on patients receiving VSD treatment could reduce the incidences of inadequate drainage of wounds in different types and sites caused by various reasons. It also can improve patient satisfaction.

Objective To explore the correlation between serum lipoprotein-associated phospholipase A2 (Lp-PLA2) level with the occurrence of ischemic stroke and prognosis in the patients with hypertension . Methods Eighty-eight patients with hypertension in this hospital from January 2013 to January 2016 were se-lected ,including 34 cases of simple hypertension and 54 cases of hypertension complicating ischemic stroke . The Lp-PLA2 level was detected .The severity of ischemic stroke was evaluated on 1 ,14 d after admission by adopting the NIHSS .The patients with hypertension complicating ischemic stroke were divided into the good prognosis group and poor prognosis group according to the NIHSS change situation .Moreover the independent predictive factors of prognosis were evaluated by adopting the Logistic multivariate regression .Results The Lp-PLA2 level in the patients with hypertension complicating ischemic stroke was significantly higher than that in the patients with simple hypertension .The Lp-PLA2 level (OR=1 .523 ,95％ CI=1 .323-1 .657) and NIHSS score (OR=3 .275 ,95％ CI=1 .402 -6 .208) at admission were the independent predictive factors of poor prognosis .Conclusion Serum Lp-PLA2 level is closely correlated with the occurrence and prognosis of ische-mic stroke in the patients with hypertension ,which can serve an evaluation index for the occurrence and prognosis of ischemic stroke in the patients with hypertension and provides an objective basis for the clinical therapy .

Objective: To explore the positive rate of intrinsic factor antibody (IFAb) and level of vitamin B₁₂ (VitB₁₂) in normal physical examination population and the possible relation between IFAb, VitB12 and sex, age, number of RBC, HGB and MCV. Methods: A total of 1 427 people who came to Peking Union Medical Colleague Hospital (PUMCH) for physical examination were enrolled. There were 758 males with average age of (52.5±14.5) years-old and 669 females with average age of (50.3±14.3) year-old. Beckman DxI800 automatic biochemical-immune analyzer and corollary reagents were used to analyze the level of serum IFAb and VitB₁₂. The results in different sex, age were documented and their correlation with the value of whole blood cell count was tested later on. Results: Among the 1 427 normal subjects, 66 (4.63%) were positive for IFAb. The positive rate for IFAb in the population≥40 years-old was higher than those<40 years-old (5.66% vs 1.48%, χ²=7.46, P=0.006). The deficiency rate of VitB₁₂ in the population<40 years-old, 40-59 years-old and ≥60 years-old was 2.22%, 2.51% and 5.50%, respectively (χ²=8.55, P=0.014). There were no difference between people with different sex in the positive rate of IFAb (5.15% for males and 4.04% for females, χ²=0.99, P=0.320) or in the deficiency rate of VitB₁2 (3.83% for males and 2.69% for females, χ²=1.44, P=0.230). The results of multiple linear regression showed that HGB level of IFAb positive subjects was 3.05 g/L lower on average than those of IFAb negative, but IFAb had no effect on both RBC and MCV. There was no correlation between VitB₁2 deficiency and HGB, RBC and MCV. Conclusion The positive rate of IFAb and deficiency rate of VitB₁2 increase as age increases. But the presence of VitB₁₂ deficiency is later than the positive findings of IFAb. IFAb showed some effects on the level of HGB, which may compensate the limitations of VitB₁₂ detection to some extent. It is necessary to check the IFAb and level of VitB₁₂ in people with middle or old ages.

SUMMARY Thehumanembryonicstemcells(hESCs)serveasaself-renewable,genetically-healthy, pluripotent and single source of all body cells,tissues and organs.Therefore,it is considered as the good standard for all human stem cells by US,Europe and international authorities.In this study,the standard and healthy human mesenchymal progenitors,ligament tissues,cardiomyocytes,keratinocytes,primary neurons,fibroblasts,and salivary serous cells were differentiated from hESCs.The human cellular health-safety of NaF,retinoic acid,5-fluorouracil,dexamethasone,penicillin G,adriamycin,lead ace-tate PbAc,bisphenol A-biglycidyl methacrylate (Bis-GMA)were evaluated selectively on the standar-dized platforms of hESCs,hESCs-derived cardiomyocytes,keratinocytes,primary neurons,and fibro-blasts.The evaluations were compared with those on the currently most adopted cellular platforms.Parti-cularly,the sensitivity difference of PM2.5 toxicity on standardized and healthy hESCs derived fibroblasts, currently adopted immortalized human bronchial epithelial cells Beas-2B and human umbilical vein endo-thelial cells (HUVECs)were evaluated.The results showed that the standardized hESCs cellular plat-forms provided more sensitivity and accuracy for human cellular health-safety evaluation.