[摘 要] 目的：探究包被蛋白复合体β1亚基（COPB1）在食管鳞状细胞癌（ESCC）中的表达，及其对ESCC细胞恶性生物学行为的影响、作用机制及临床意义。方法：采用2014～2018年间在河北医科大学第四医院生物样本库中82例ESCC组织及癌旁组织，常规培养正常食管鳞状上皮细胞HEEC和食管癌细胞KYSE-150、KYSE-170、Eca109、TE1、KYSE-30、KYSE-450，用转染试剂将pcDNA3.1-vector（空载体）、pcDNA3.1-COPB1载体，si-NC和si-COPB1转染至KYSE-150、TE1细胞中，记为NC、COPB1-OE、si-NC和si-COPB1组。用数据库数据分析COPB1 mRNA在泛癌组织中的表达及其表达与免疫细胞浸润的关系，qPCR法检测ESCC组织和细胞中COPB1、PIK3CB、CD68、CD163、CD206、ARG1、IL-10 mRNA水平表达情况，WB法检测ESCC组织和各组细胞中的COPB1、PI3K、CD68、CD163、CD206、p-AKT蛋白表达，克隆形成实验和MTS实验检测各组细胞的增殖能力，划痕愈合实验和Transwell实验检测各组细胞的迁移和侵袭能力，免疫组织化学染色（IHC）法检测ESCC组织中COPB1和CD206蛋白表达。以人单核细胞白血病细胞（THP-1）构建巨噬细胞模型，用佛波酯（PMA）和IL-3和IL-4和ESCC细胞上清液诱导巨噬细胞转型，用qPCR和WB法检测CD68和CD206m RNA和蛋白的表达。结果：COPB1在泛癌组织和ESCC组织中均呈高表达且与淋巴结转移和TNM分期有关联（均P < 0.01），COPB1高表达的ESCC患者总生存期短（P < 0.05），COPB1是潜在的ESCC的诊断标志物。COPB1在KYSE-150和TE1细胞中也呈高表达（均P < 0.05），过表达或敲减COPB1可明显抑制或促进KYSE-150和TE1细胞的增殖能力、迁移和侵袭能力（均P < 0.05）。COPB1表达变化诱导的差异表达基因主要富集于PI3K/AKT通路（均P < 0.001）, COPB1可促进PI3K/AKT通路的活化（P < 0.05），COPB1高表达可导致M2型巨噬细胞浸润增加（P < 0.05），COPB1高表达促进TAM/M2极化（P < 0.05）。结论：COPB1在ESCC组织中呈高表达，其可激活PI3K/AKT通路及调控肿瘤免疫微环境促进 ESCC发生发展，COPB1有望成为ESCC诊断和预后的生物标志物及治疗靶点。

Objective To investigate the clinical value of matrix-assisted laser desorption/ionization time of flight mass spectrometry(MALDI-TOF MS)in rapid detection of carbapenemase produced by Klebsiella pneumoniae and Pseudomonas aeruginosa.Methods A total of 60 strains of Klebsiella pneumoniae and 80 strains of Pseudomonas aeruginosa isolated from Pizhou People's Hospital affiliated to Xuzhou Medical University from January 2022 to October 2023 were collected,including 30 strains of carbapenem-resistant Klebsiella pneumoniae(CRKP),30 strains of carbapenem-sensitive Klebsiella pneumoniae(CSKP),50 strains of carbapenem-resistant Pseudo-monas aeruginosa(CRPA)and 30 strains of carbapenem-sensitive Pseudomonas aeruginosa(CSPA).Three detection methods were applied,i.e.,modified carbapenem inactivation method(mCIM),colloidal gold immunochromatography and Autof MS 1000 mass spectrometry identification system to evaluate the ability of Autof MS 1000 mass spectrometry identification system in detecting carbape-nase production of Klebsiella pneumoniae and Pseudomonas aeruginosa.Results The results of Autof MS 1000 mass spectrometry iden-tification system were consistent with those of both mCIM and colloidal gold immunochromatography.Carbapenemase was detected in 28 of the 30 CRKP strains,and it was negative in 2 CRKP strains.Carbapenamase was detected in 15 of the 50 CRPA strains and it was negative in 35 CRPA strains.Thirty strains of CSKP and 30 strains of CSPA were all Carbapenemase negative.The coincidence rate of the results of the three methods in the detection for carbapenase was 100％.Conclusion The result of Autof MS 1000 mass spectrome-try identification system has been consistent with those of mCIM and colloidal gold immunochromatography.It not only has the charac-teristics of cost-saving compare with of mCIM method,but also hold the advantages of fast speed and high accuracy of colloidal gold im-munochromatography method.Thus,Autof MS 1000 system can be used for the rapid identification of carbapenemase produced by Kleb-siella pneumoniae and Pseudomonas aeruginosa.

Objective:To investigate the relationship between 21-gene recurrence risk score (21-Gene RS) and the prognosis and clinicopathological features of hormone receptor (HR) positive, HER2-negative early breast cancer patients who did not receive neoadjuvant therapy.Methods:A total of 469 patients with HR positive and HER2-negative early breast cancer who received surgical treatment in the First Affiliated Hospital, Zhejiang University School of Medicine from January 2014 to October 2017 were selected. Their clinicopathological data were retrospectively analyzed. Tumor tissue samples were collected from patients, and the expression of 21-gene was detected by reverse transcription quantitative real-time polymerase chain reaction (RT-qPCR). The 21-Gene RS was calculated according to the Trial Assigning Individualized Options for Treatment (TAILORx) RS grouping and National Surgical Adjuvant Breast and Bowel Project B-20 (NSABP B-20) RS grouping principles. Patients were divided into low (21-Gene RS<11 or 21-Gene RS<18), intermediate (11≤21-Gene RS<26 or 18≤21-Gene RS<31) and high (21-Gene RS≥26 or 21-Gene RS≥31) risk groups, and the clinicopathological features and prognostic differences of patients in different risk groups were compared. Statistical data were compared by chi-square test. Survival analysis was performed using Kaplan-Meier curve analysis and the differences between groups were compared using Log-rank test. Multivariate analysis was conducted by COX regression analysis.Results:Based on TAILORx RS grouping, the proportions of low-risk, intermediate-risk and high-risk groups among the 469 patients were 18.8% (88/469), 48.2% (226/469) and 33.0% (155/469), respectively. Based on NSABP B-20 RS grouping, the proportion of low-risk, intermediate-risk and high-risk groups were 43.1% (202/469), 37.5% (176/469) and 19.4% (91/469), respectively. The association of 21-Gene RS with histological grading, luminal typing, Ki-67 expression, and chemotherapy and treatment modalities were statistically significant ( P<0.05) regardless of TAILORx RS grouping or NSABP B-20 RS grouping. Kaplan-Meier survival curve suggested poor prognosis in high-risk group ( P<0.05, Log-rank test). Multivariate COX regression analysis showed that surgical method and 21-Gene RS were risk factors affecting the prognosis of patients. Conclusions:21-Gene RS is significantly associated with the prognosis of patients with HR-positive, HER2-negative, early-stage breast cancer not receiving neoadjuvant therapy, as well as with their clinicopathological characteristics such as patients′ histologic grade, luminal typing, Ki-67 expression, and whether or not they are treated with chemotherapy or other treatment modalities.The 21-Gene RS threshold of 11 and 26 or 18 and 31 can be used to grade the prognosis in Chinese patients with early-stage breast cancer. More researches are needed to guide the selection of postoperative adjuvant therapy for patients with HR-positive and HER2-negative early-stage breast cancer.

Objective:To explore the focus of ethical governance in the field of artificial intelligence(Al)in medicine.Methods:By comprehensively reviewing relevant literature to compare the relevant laws and regulations of the field of AI in medicine between China and foreign countries,analyze the governance focus of potential ethical issues,and propose the corresponding governance strategies.Results:At present,the laws,regulations,and regulatory systems related to the field of AI in medicine in China need to be improved.The emphasis of ethical governance should focus on core issues such as protecting privacy rights,ensuring the transparency and fairness of algorithms,clarifying the demarcation and allocation of responsibilities,and clarifying public perceptions and attitudes.Conclusion:The government and all sectors of society should actively learn from international legislative experience,and build an omnidirectional and multi-level ethical governance system from the aspects of policy formulation,legal framework,scientific research,and technological research and development by strengthening top-level design,improving policies and regulations,attaching importance to public feedback,and strengthening interdisciplinary cooperation.

Objective:To evaluate the effectiveness of oral-nasal oxygen supply mouth guard in painless gastroscopy for snoring patients.Methods:The snoring patients who underwent painless gastroscopy at two Endoscopy Centers of Shanghai East Hospital, Tongji University in July 2022 were randomly divided into the observation group (using oral-nasal oxygen supply mouth guard) and the control group (using ordinary nasal oxygen tube and mouth guard). Parameters such as the wearing time and the removal time of the mouth guard, lowest pulse oxygen saturation (SpO 2), incidence of hypoxemia, and the satisfaction of medical staff were compared between the two groups. Results:The wearing time of mouth guard was 11.63±0.84 seconds and the removal time was 5.33±0.76 seconds in the observation group ( n=40), which were lower than those in the control group ( n=47) (14.91±1.21 seconds, t=-14.463, P<0.001; 10.38±0.80 seconds, t=-30.095, P<0.001). The wearing satisfaction score was 9.80±0.61, the lowest SpO 2 was (96.70±3.42)%, the removal satisfaction score was 9.75±0.67, and the anesthesiologists' satisfaction score was 9.20±1.42 in the observation group, which were higher than those in the control group [7.70±0.93, t=12.209, P<0.001; (94.06±3.72)%, t=3.417, P=0.001; 7.96±0.98, t=9.803, P<0.001; 8.13±1.35, t=3.615, P=0.001] with significant difference. There was no significant difference in the incidence of hypoxemia [10.00% (4/40) VS 14.89% (7/47), χ2=0.130, P=0.718] and endoscopic physician satisfaction score (9.30±0.97 VS 9.02±1.31, t=1.112, P=0.269) between the two groups. Conclusion:The oral-nasal oxygen supply mouth guard is easy to wear and remove, effectively reducing SpO 2 fluctuations during painless gastroscopy for snoring patients. It can enhance medical staff satisfaction with high clinical value.

Purpose To study the safety and clinical value of adenosine stress myocardial perfusion imaging(MPI)in evaluating myocardial ischemia in children with Kawasaki disease.Materials and Methods A total of 78 children with a history of Kawasaki disease and coronary artery aneurysm confirmed by echocardiography and coronary angiography were prospectively studied in Children's Hospital of Fudan University from August 2019 to February 2021.Adenosine stress MPIs were performed to analyze the safety of adenosine stress test and its sensitivity and specificity in detecting significant coronary artery stenosis(≥75%),and the positive rate of adenosine stress MPIs in different groups of coronary artery stenosis were further compared.Results All 78 children completed adenosine stress test without serious side effects.Among 78 children with adenosine stress imaging,44 patients with negative adenosine stress imaging did not undergo rest imaging,which reduced radiation exposure by 56.4%(44/78).The sensitivity and specificity of adenosine stress MPIs in detecting significant coronary artery stenosis were 66.7%and 60.6%(40/66),respectively.Adenosine stress MPIs were positive in 21 cases(21/52,40.3%)in non-stenosis group,5 cases(35.7%)in mild to moderate stenosis group,and 8 cases(66.7%)in significant stenosis group.There was no significant difference in the positive rate among the three groups(χ2=3.169,P=0.205).Conclusion Adenosine stress test is safe and feasible in children.The stress-first imaging strategy can reduce radiation exposure.Adenosine stress MPI has important clinical value in evaluating and monitoring myocardial ischemia in children with Kawasaki disease complicated with coronary aneurysm.

Objective:To integrate the real experience of spouse caregivers in the process of caring for dementia patients.Methods:Qualitative researches on the caregiving experience, needs, experience and feelings of spouse caregivers for dementia patients was conducted through computer searches of PubMed, Web of Science, Embase, Cochrane Library, Joanna Briggs Institute (JBI) Evidence Based Healthcare Center Database, CINAHL, PsycINFO, China National Knowledge Infrastructure, Wanfang Database, VIP and China Biology Medicine Disc. The search period was from establishment of the databases to May 2023. The literature was evaluated using JBI quality evaluation criteria for evidence-based health care center quality research, and the results of the included literature were integrated and analyzed by aggregative integration method.Results:A total of 17 articles were included, 62 main research results were extracted and summarized into nine new categories, and three integrated results were synthesized, including increased caring burden accompanied by multiple negative emotions, positive coping with illness, experiencing positive emotions and benefits of caring, multiple unmet needs, and desire for support.Conclusions:It is suggested that medical staff should pay attention to the physical, psychological and social burden of spouse caregivers, use the "Internet +"service and multidisciplinary psychological support therapy to help spouses relieve negative emotions in a timely manner, strengthen contact with the community, build a three-level linkage nursing platform of "hospital community family", and give personalized and substantive help.

H 1-antihistamines are widely used in the treatment of various allergic diseases, but there are still many challenges in the safe and rational use of H 1-antihistamines in pediatrics, and there is a lack of guidance on the prescription review of H 1-antihistamines for children.In this paper, suggestions are put forward from the indications, dosage, route of administration, pathophysiological characteristics of children with individual difference and drug interactions, so as to provide reference for clinicians and pharmacists.

The great anti-epidemic spirit is a magic weapon for the Chinese people to fight against the COVID-19. Taking the Dr. Zha’s Diary of Fighting the COVID-19 as an example to explore the practical basis and scientific connotation of the great anti-epidemic spirit is of great significance for telling Chinese stories and transmitting Chinese spirit. The anti-epidemic experience described in the book reflects the professional qualities of medical staff who are people-oriented and life first in the fight against the epidemic, the overall view of respecting science and precise prevention and control by various forces in society, and the overall pattern of national unity and shared destiny in China, vividly interprets the precious connotation of the new era medical and health professional spirit.

【Objective:】 The data of the literature of the research progress on the assisted reproductive technology (ART) ethical issues in China in the past two decades were summarized to explore the research hotspots and frontiers of ethical issues in this field. 【Methods:】 The relevant literature records of China National Knowledge Infrastructure (CNKI) were retrieved from January 1, 2002 to October 30, 2022. CiteSpace 6.1.R2 software was used to visually analyze the authors, institutions, keywords, etc. 【Results:】 A total of 1274 papers were included, and the number of papers was on the rise. The hot topics covered three dimensions: surrogacy, ethics issues and laws of ART, and measures of ART. 【Conclusion:】 The combination of theory and practice on the ethical issues of ART is not close enough, the cooperation network of researchers need to be further strengthened. The relevant research on surrogacy, reproductive rights, gene editing, and embryo ownership has become a major hotspot and difficulty in recent years, which should be given full attention.