Prognostic value of platelet-to-lymphocyte ratio in upper tract urothelial carcinoma patients treated with radical nephroureterectomy:A metaanalysis

Objective:To evaluate the prognostic value of platelet-to-lymphocyte ratio(PLR)in upper tract urothelial carcinoma(UTUC)patients treated with radical nephroureterectomy.Methods:This study was pre-registered in PROSPERO(No.CRD42020186645).Two reviewers independently performed a comprehensive literature search on PubMed,Web of Science,EMBASE,Cochrane Library databases,China Biology Medicine disc(CBM),Wanfang database,and China National Knowledge Infrastructure(CNKI)from inception to May 2021 for prospective or retrospective cohort studies evaluating the prognostic value of PLR.Literature was analyzed with inclusion and exclusion criteria.Data and other useful clinicopathological features were extracted and analyzed with fixed or random-effect models when applicable.Heterogeneity was assessed on the basis of Cochran’s Q test and I2 statistic.Publication bias was assessed with funnel plots and precisely assessed by Egger's tests.Results:A total of ten studies involving 3287 UTUC patients were included.Meta-analysis showed that elevated preoperative PLR was associated with worse overall survival(HR=1.51,95%CI 1.17-1.94,P=0.001),cancer specific survival(HR=1.52,95%CI 1.21-1.90,P<0.001),disease free survival(HR=1.32,95%CI 1.12-1.56,P=0.001),and progression free survival(HR=1.88,95%CI 1.41-2.52,P<0.001).Furthermore,the sensitivity analyses validated the stability and reliability of the results.Conclusion:The present meta-analysis demonstrates a significant association between elevated preoperative PLR and poor prognosis of UTUC patients treated with radical nephroureterectomy.Hence,PLR could be helpful as a potential prognostic biomarker to guide clinical decision-making and select individualized treatment strategies for UTUC patients.However,more prospective and large-scale trials are needed to provide more evidence.

Microglia in brain aging:An overview of recent basic science and clinical research developments

Aging is characterized by progressive degeneration of tissues and organs,and it is positively associated with an increased mortality rate.The brain,as one of the most significantly affected organs,experiences age-related changes,including abnormal neuronal activity,dysfunctional calcium homeostasis,dysregulated mitochondrial function,and increased levels of reactive oxygen species.These changes collectively contribute to cognitive deterioration.Aging is also a key risk factor for neurodegenerative diseases,such as Alzheimer's disease and Parkinson's disease.For many years,neurodegenerative disease investigations have primarily focused on neurons,with less attention given to microglial cells.However,recently,microglial homeostasis has emerged as an important mediator in neurological disease pathogenesis.Here,we provide an overview of brain aging from the perspective of the microglia.In doing so,we present the current knowledge on the correlation between brain aging and the microglia,summarize recent progress of investigations about the microglia in normal aging,Alzheimer's disease,Parkinson's disease,Huntington's disease,and amyotrophic lateral sclerosis,and then discuss the correlation between the senescent microglia and the brain,which will culminate with a presentation of the molecular complexity involved in the microglia in brain aging with suggestions for healthy aging.

Efficient loading of cesium atoms in a magnetic levitated dimple trap

We report a detailed study of magnetically levitated loading of ultracold ^(133)Cs atoms in a dimple trap.The atomic sample was produced in a combined red-detuned optical dipole trap and dimple trap formed by two small waist beams crossing a horizontal plane.The magnetic levitation for the ^(133)Cs atoms forms an effective potential for a large number of atoms in a high spatial density.Dependence of the number of atoms loaded and trapped in the dimple trap on the magnetic field gradient and bias field is in good agreement with the theoretical analysis.This method has been widely used to obtain the Bose–Einstein condensation atoms for many atomic species.

Comparison of conbercept and ranibizumab for the treatment efficacy of diabetic macular edema: a Metaanalysis and systematic review

AIM: To evaluate the efficacy of intravitreal injection of conbercept(IVC) and ranibizumab(IVR) in patients with diabetic macular edema.METHODS: Reviewers have searched 12 databases, including PubMed, Medline, EMBASE, Web of Science, Springer, ScienceDirect, OVID, Cochrane Library, Clinical Trials.gov, cqVIP, WanFangdata and China National Knowledge Infrastructure(CNKI), up to December 28, 2018. Rev Man 5.3(Cochrane Library Software, Oxford, UK) was employed for statistical analysis. Fixed and random effects models were applied to assess heterogeneity. Odds ratio(OR) was applied for dichotomous variables;weighted mean difference(WMD) was applied for continuous variables. The confidence interval(CI) was set at 95%. Central macular thickness(CMT) and best-corrected visual acuity(BCVA) were employed to analyze the improvement of DME patients. Inclusion criteria for picking out studies were retrospective studies and randomized controlled trials(RCTs) that compared IVC and IVR for the treatment of diabetic macular edema.RESULTS: Four retrospective studies and five RCTs were included with a total of 609 patients. No statistically significant difference was observed in mean CMT and mean BCVA in the baseline parameters [BCVA(WMD:-0.48;95%CI:-1.06 to 0.10;P=0.1), CMT(WMD:-0.83;95%CI:-15.15 to 13.49;P=0.91). No significant difference was found in the improvement of BCVA and adverse event(AE) in IVC group, compared with IVR group after treatment of loading dosage [the 1 st month BCVA(WMD: 0.01;95%CI:-0.26 to 0.27;P=0.96), the 3 rd month BCVA(WMD:-0.04;95%CI:-0.14 to 0.06;P=0.46);the 6 th month BCVA(WMD:-0.24;95%CI:-1.62 to 1.14;P=0.73)], AE(OR: 0.84;95%CI: 0.38 to 1.84;P=0.66)]. A slight difference was found in the effectiveness rate(OR: 1.70;95%CI: 0.97 to 2.96;P=0.06), There were statistically significant differences between IVC and IVR treatment in terms of CMT (1 st month CMT(WMD:-19.88;95%CI:-27.94 to-11.82;P<0.001), 3 rd month CMT(WMD:-23.31;95%CI:-43.30 to-3.33;P=0.02), 6 th month CMT(WMD:-74.74;95%CI:-106.22 to-43.26;P<0.001))CONCLUSION: Pooled evidence suggests that both IVC and IVR are effective in the therapy of diabetic macular edema and affirms that IVC presents superiority over IVR therapy in regard of CMT in patients with diabetic macular edema, but no statistically significant difference with regard to visual improvement. Relevant RCTs with longerterm follow-up are necessary to back up our conclusion.

Reliability and validity of an indicator system for assessing the quality of ophthalmic nursing

Objective:The aim of this study was to examine the reliability and validity of an indicator system for assessing the quality of ophthalmic nursing.Methods:A questionnaire-based study was performed for 218 individuals in clinical nursing management using this indicator system.The resulting data were compiled and analyzed using Excel 2003 and SPSS 13.0,and tests of reliability and validity were conducted.Results:The indicator system yielded an overall Cronbach's a value of 0.948,a test-retest reliability of0.793,3-dimensional Cronbach's a values of 0.870-0.930,and a content validity of 0.92.Exploratory factor analysis was then performed to extract three common factors,which generated a cumulative contribution rate of 54.04%.The load range of each factor was 0.43-0.83.Conclusions:The indicator system for evaluating the quality of ophthalmic nursing has favorable reliability and validity,which means that it is a suitable clinical tool for assessing the quality of ophthalmic nursing.

Perioperative nursing principles guided by the concept of enhanced recovery after surgery

Objective:To explore the clinical effect of perioperative nursing guided by the concept of enhanced recovery after surgery and summarize them.Methods:Pubmed,Chinese National Knowledge Infrastructure(CNKI),Chinese Biomedical Literature Database(CBM),Wanfang Database,and VIP Database were searched to obtain the relevant literature involving enhanced recovery after surgery(ERAS)guidance,obtain the effective clinical data,review the reports in literature,and obtain the effective scheme.Results:Compared with the traditional nursing program,perioperative nursing principles guided by the concept of ERAS provide more accurate nursing care to patients and reduce the occurrence of intraoperative stress events through comprehensive nursing measures such as preoperative pre-rehabilitation measures,intraoperative body temperature and fluid management,postoperative analgesia,prevention of nausea and vomiting,early mobilization,catheter nursing,and better out-of-hospital follow-up.Conclusions:Perioperative nursing principles guided by the concept of ERAS can significantly reduce the incidence of perioperative complications,shorten the hospital stay of patients,and promote postoperative rehabilitation of patients.The transformation and implementation of this concept can bring significant benefits to hospitals,medical care,and patients.

The Effect of a Psycho-Educational Intervention on Quality of Life of Patients with Advanced Lung Cancer Undergoing Chemotherapy

Objective: Cancer patients undergoing chemotherapy commonly experience depression and anxiety, which, along with adverse effects of chemotherapy, inevitably compromise quality of life (QOL) of the patients. The aim of this study was to investigate the effect of a psycho-educational intervention on the quality of life (QOL) of patients with advanced lung cancer undergoing chemotherapy. Methods: Two hundred in-patients with unresectable advanced lung cancer undergoing chemotherapy in Shanxi Cancer Hospital from January to October 2013 were randomized into the intervention group (n = 100) and the control group (n = 100). Patients in the intervention group received a purposely designed and nurse-delivered psycho-educational intervention in addition to routine caring and chemotherapy, whereas those in the control group underwent chemotherapy and routine caring only. QOL of patients was assessed according to QOL instrument for lung cancer (QLICP-LU). The impact of the psycho-educational intervention on QOL was analyzed using independent-sample t test and χ2 test. Results: The psychological, physical, and social function, and the overall QOL scores were significantly improved in patients who received the psycho-educational intervention compared with those in the control group. Conclusions: A nurse-delivered psycho-educational intervention is a useful strategy to improve QOL of patients with advanced lung cancer undergoing chemotherapy.

Application of a perioperative nursing strategy in the surgical treatment of elderly patients: a narrative review

With the steady increase of older people in society, a progressively greater number of patients belonging to the geriatric group need surgical treatment. Since elderly patients with reduced physiological reserve and organ failure often have chronic diseases, geriatric syndrome, and other clinical problems, the perioperative nursing of elderly patients is more complicated. Therefore, we need to comprehensively consider clinical issues, such as patients’ preoperative status, surgical risks, and postoperative quality of life and life expectancy, and conduct comprehensive evaluations and holistic, individualized, and continuous nursing and therapy through the participation of interdisciplinary teams to achieve better curative effects. Here, the perioperative nursing of elderly patients is reviewed, including preoperative evaluation and nursing, intraoperative management, and postoperative nursing.

Measurement of central corneal thickness and precorneal tear film thickness of rabbits using the Scheimpflug system

AIM:To measure central corneal thickness(CCT) and pre-corneal tear film thickness using the Galilei dual Scheimpflug analyzer(GSA) in New Zealand White rabbits.METHODS:Ten normal New Zealand White rabbits(20 eyes) were included in this study.With the assistance of 0.1% fluorescein,the pre-corneal tear film can be well visualized.Both eyes of each rabbit were scanned once with the GSA pre- and post-instillation of 1μL 0.1% fluorescein.The difference between the two measurements of CCT(4-mm diameter) was recorded as the pachymetric values of the central tear film.RESULTS:The CCT of pre- and post-instillation was 388.8±9.5μm and 407.0±10.5μm,respectively.After a paired t-test analysis,the central pre-corneal tear film thickness of 4mm diameter was 18.2±5.31μm with a 95% confidence interval of(15.7,20.6)μm(P<0.001).CONCLUSION:GSA can be used to measure CCT and analyze central tear film thickness of rabbits with the help of fluorescein.

Screening and cloning for proteins transactivated by the PS1TP5 protein of hepatitis B virus:A suppression subtractive hybridization study

AIM:To clone and identify human genes transactivated by PS1TP5 by constructing a cDNA subtractive library with suppression subtractive hybridization(SSH)technique.METHODS:SSH and bioinformatics techniques were used for screening and cloning of the target genes transactivated by PS1TP5 protein.The mRNA was isolated from HepG2 cells transfected with pcDNA3.1(-)-myc-his(A)-PS1TP5 and pcDNA3.1(-)-myc-his(A)empty vector,respectively,and SSH technique was employed to analyze the differentially expressed DNA sequence between the two groups.After digestion with restriction enzyme RsaⅠ,small size cDNAs were obtained.Then tester cDNA was divided into two groups and ligated to the specific adaptor 1 and adaptor 2,respectively.The tester cDNA was hybridized with driver cDNA twice and subjected to nested PCR for two times,and then subcloned into T/A plasmid vectors to set up the subtractive library.Amplification of the library was carried out with E.coli strain DH5α.The cDNA was sequenced and analyzed in GenBank with Vector NTI 9.1 and NCBI BLAST software after PCR amplification.RESULTS:The subtractive library of genes transactivated by PS1TP5 was constructed successfully.The amplified library contained 90 positive clones.Colony PCR showed that 70 clones contained 200-1000-bp inserts.Sequence analysis was performed in 30 clones randomly,and the full-length sequences were obtained by bioinformatics technique.Altogether 24 coding sequences were obtained,which consisted of 23 known and 1 unknown.One novel gene with unknown functions was found and named as PS1TP5TP1 after being electronically spliced,and deposited in GenBank(accession number:DQ487761).CONCLUSION:PS1TP5 is closely correlated with immunoregulation,carbohydrate metabolism,signal transduction,formation mechanism of hepatic fibrosis,and occurrence and development of tumor.Understanding PS1TP5 transactive proteins may help to bring some new clues for further studying the biological functions of pre-S1 protein.

Primitive neuroectodermal tumor of the prostate in a 58-year-old man:A case report

BACKGROUND Primitive neuroectodermal tumor(PNET),especially located in the prostate,is a rare tumor that mainly occurs in young men.Bladder or rectum invasion and distant metastasis are strongly associated with a poor prognosis.Combination therapy,including radical surgery,adjuvant chemotherapy,and radiotherapy,is available.We present a case of prostatic PNET and a review of 17 cases identified in the literature.CASE SUMMARY A 58-year-old man was admitted complaining of dysuria for 2 years.Computed tomography and magnetic resonance imaging showed a large cystic-solid mass in the pelvic cavity compressing the surrounding bladder and rectum.The mass was iso-to hyperintense on T1-weighted imaging(WI)and heterogeneously hyperintense on T2WI.Cystic degeneration and necrosis were seen in the tumor,and solid tissues within the mass enhanced on contrast-enhanced scan.The patient underwent robot-assisted laparoscopic pelvic tumor resection.Histologically,the presence of many small round cells that were positive for expression of CD99,vimentin,and synaptophysin established the diagnosis of PNET in the prostate after surgery.The patient underwent adjuvant chemotherapy.During 34 mo of follow-up,the patient had no signs or symptoms of recurrence or residual disease.CONCLUSION We present the case of the oldest prostatic PNET patient,who has a good prognosis.This illustrates how older men with prostatic PNET may also benefit from the combination therapy,like younger adults,and achieve a long-term survival.As always,PNET should be considered in the differential diagnosis of aggressive prostatic tumors in young men.

Bilateral occurrence of sperm granulomas in the left spermatic cord and on the right epididymis:A case report

BACKGROUND Sperm granuloma is a rare disease in clinical andrology and its incidence is still unclear worldwide.According to the existing literature,sperm granuloma often occurs unilaterally.Clinical and ultrasound features are similar to epididymal tuberculosis,chronic epididymitis and other diseases.Sperm granuloma is usually diagnosed based on postoperative histopathological and immunohistochemical examination.CASE SUMMARY A 46-year-old man was admitted to the hospital due to the presence of a left scrotal mass for 3 mo and aggravation of pain for 1 wk.The lesions at both sites were surgically resected.Postoperative pathological examination showed that the left spermatic cord mass and the right epididymal mass were consistent with sperm granuloma.The sperm granulomas then recurred 3 mo after surgery.There is little change in the local mass so far.CONCLUSION The case report is helpful for our understanding of this disease.In clinical diagnosis,it should be distinguished from epididymal tuberculosis,chronic epididymitis and other diseases.Color Doppler ultrasound can be used as a preferred examination method but postoperative pathological examination is still needed for diagnosis.

Intestinal microbiota in the treatment of metabolically associated fatty liver disease

Metabolically associated fatty liver disease (MAFLD) is a common cause ofchronic liver disease, the hepatic manifestation of metabolic syndrome. Despitethe increasing incidence of MAFLD, no effective treatment is available. Recentresearch indicates a link between the intestinal microbiota and liver diseases suchas MAFLD. The composition and characteristics of the intestinal microbiota andtherapeutic perspectives of MAFLD are reviewed in the current study. Animbalance in the intestinal microbiota increases intestinal permeability andexposure of the liver to adipokines. Furthermore, we focused on reviewing thelatest "gut-liver axis" targeted therapy.

Revaluation of Clopidogrel:Let the Data Speak for Themselves

Clopidogrel was believed to be superior to aspirin by the well-known CAPRIE trial.However,no other large clinical trials demonstrated the same results,but all focused on the combination use of clopidogrel with aspirin,and combination therapy in CREDO was called the "Emperor's New Clothes".However,no one overturned the results of these clinical trials by quantitatively analyzing them.We reviewed ten large-scale clinical trials about clopidogrel.On the basis of results of CAPRIE,CREDO and CHARISMA trials,we re-estimated their minimal sample sizes and their powers by three well-established statistical methodologies.From the results of CAPRIE,we inferred that the minimal sample size should be 85 086 or 84 968 but its power was only 30.70%.A huge gap existed.The same was also true of CREDO and CHARISMA trials.Moreover,in CAPRIE trial,0 was included in the 95% confidence interval and 1 was included in the 95% confidence interval for the relative risk.There were some paradoxical data in CAPRIE trial.We are led to conclude that the results in CAPRIE,CREDO,and from the subgroup analysis in CHARISMA trials were questionable.These results failed to demonstrate that clopidogrel was superior to aspirin or that clopidogrel used in combination with aspirin was better than aspirin alone.The cost-effectiveness analyses by some previous studies were not reliable.

Prevention of Autoimmune Diabetes by Pentoxifylline is Associated with Target Tissue Modulation of Cytokines and the Expression of Fas-FasL

The effect of Pentoxifylline (PTX) on type 1 diabetes was investigated by means of the studies on the expressions of cytokine mRNA in pancreas and the Fas-FasL on islet cells of NOD mice. NOD mice were treated with PTX from 4-6?wk, and then from 8-12?wk. After treatment, it was found that the incidence of diabetes in NOD mice at ages of 30?wk was reduced to 25% in group of mice treated with PTX, in comparison to 73.3% in case of mice injected with PBS, and the degree of insulitis in the PTX treated mice was lower than that of the PBS injected mice. RT-PCR analysis revealed down-regulatory effect on the expressions of IFN-γ and TNF-α mRNA in PTX treated mice, but there was no any effect on the expression of IL-10. As to the expression of Fas, there was marked decrease in the mean cytoplasmic integral optical density (IOD) in PTX treated mice, but there was little difference between PTX and PBS groups in the expression of FasL. These results indicated that PTX could prevent the development of diabetes in NOD mice, which might be related to the regulation of Th1/Th2 imbalance and the decreased expression of Fas in islet cells.

Application of Narrow Band Imaging Technology of Electronic Laryngoscope in the Diagnosis of Hypopharyngeal Carcinoma

Objective:To investigate the value of electronic laryngoscope combined with narrow-band imaging(NBI)in the diagnosis of early hypopharyngeal malignant tumors and precancerous lesions.From 2021 to 2022,90 patients with NBI type diphtheria and pharyngeal lesions were examined by endoscopy and endoscopy.The results showed that there was an abnormal relationship between NBI type diphtheria and pharyngeal lesions in our hospital from 2021 to 2022.Results:the sensitivity,specificity,positive predictive value and negative predictive value of NBI endoscopy in the diagnosis of oropharyngeal and hypopharyngeal malignant lesions were 98.8%,89.2%,95.5%and 97.1%,respectively.The results of NBI endoscopy were highly consistent with those of pathological examination(kappa=0.901,P<0.01).The sensitivity,specificity,positive predictive value and negative predictive value of white light endoscopy were 83.7%,86.5%,93.5%and 69.6%respectively.The results of white light endoscopy were consistent with those of pathological examination(kappa=0.657,P<0.01).NBI endoscopy is more accurate than ordinary white light endoscopy in the diagnosis of hypopharyngeal malignant lesions(especially severe dysplasia/carcinoma in situ,P<0.01)and precancerous lesions(P<0.01).There was a significant correlation between NBI classification and pathological examination results of hypopharyngeal lesions(r=0.820,P<0.01).Conclusions:NBI endoscopy can detect hypopharyngeal carcinoma more accurately than white light endoscopy;NBI typing standard can more accurately diagnose precancerous lesions and early hypopharyngeal cancer,and judge the invasion of the latter.It is of great significance for the early diagnosis and minimally invasive treatment of hypopharyngeal cancer and precancerous lesions.

Research Progress on the Roles of Vitamin D3 in Gastrointestinal Cancer

Vitamin D3 is a steroid hormone. Its main functions include regulating calcium and phosphate metabolism, maintaining normal blood calcium levels, regulating bone metabolism, and regulating the physiological functions of many cells. Recent epidemiological studies suggested that vitamin D deficiency correlates with the risk of gastrointestinal cancer and a poor prognosis in cancer patients. Vitamin D3 has demonstrated anti-tumor activities, including reducing tumor cell proliferation, inducing apoptosis, and inducing cell cycle arrest in gastrointestinal cancer. Further studies showed that vitamin D3 can enhance the effects of chemotherapeutic drugs to induce apoptosis and inhibit the proliferation of gastrointestinal cancer cells. Vitamin D3 analogs also exhibit anti-tumor activity, and generally have fewer side effects than vitamin D3. This review describes the molecular characteristics and anti-cancer mechanisms of vitamin D3 and its analogs in gastrointestinal cancer.

Potential mechanisms of non-suicidal self-injury(NSSI)in major depressive disorder:a systematic review

Background Non-suicidal self-injury(NSSI)is a frequent and prominent phenomenon in major depressive disorder(MDD).Even though its prevalence and risk factors are relatively well understood,the potential mechanisms of NSSI in MDD remain elusive.Aims To review present evidence related to the potential mechanisms of NSSI in MDD.Methods According to Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines,articles for this systematic review were searched on Medline(through PubMed),Embase(through Elsevier),PsycINFO(through OVID)and Web of Science databases for English articles,as well as China National Knowledge Infrastructure(CNKI),SinoMed,Wanfang Data,and the Chongqing VIP Chinese Science and Technology Periodical(VIP)Databases for Chinese articles published from the date of inception to 2 August 2022.Two researchers(BW,HZ)independently screened studies based on inclusion and exclusion criteria and assessed their quality.Results A total of 25157 studies were searched.Only 25 of them were ultimately included,containing 3336 subjects(1535 patients with MDD and NSSI,1403 patients with MDD without NSSI and 398 HCs).Included studies were divided into 6 categories:psychosocial factors(11 studies),neuroimaging(8 studies),stress and hypothalamic-pituitary-adrenal(HPA)axis(2 studies),pain perception(1 study),electroencephalogram(EEG)(2 studies)and epigenetics(1 study).Conclusions This systematic review indicates that patients with MDD and NSSI might have specific psychosocial factors,aberrant brain functions and neurochemical metabolisms,HPA axis dysfunctions,abnormal pain perceptions and epigenetic alterations.

Detection and management of perioperative blood glucose abnormalities

Diabetes mellitus is a common chronic disease.With the improvement of living standards,the prevalence of diabetes mellitus in China is increasing.There are now more people with diabetes in China(>100 million)than in any other country.About half of these people with diabetes need to undergo at least one procedure in their lifetime.Diabetic patients have a much higher probability of perioperative dysglycemia than the normal population,which has a great impact on their prognosis.In addition,non-diabetic patients may also have abnormal blood glucose levels due to various reasons during the perioperative period,which will also lead to a series of adverse consequences.This ar ticle reviews the perioperative blood glucose management of patients to provide a reference for improving their health status.

Ferroptosis biomarkers predict tumor mutation burden's impact on prognosis in HER2-positive breast cancer

BACKGROUND Ferroptosis has recently been associated with multiple degenerative diseases.Ferroptosis induction in cancer cells is a feasible method for treating neoplastic diseases.However,the association of iron proliferation-related genes with prognosis in HER2+breast cancer(BC)patients is unclear.AIM To identify and evaluate fresh ferroptosis-related biomarkers for HER2+BC.METHODS First,we obtained the mRNA expression profiles and clinical information of HER2+BC patients from the TCGA and METABRIC public databases.A four gene prediction model comprising PROM2,SLC7A11,FANCD2,and FH was subsequently developed in the TCGA cohort and confirmed in the METABRIC cohort.Patients were stratified into high-risk and low-risk groups based on their median risk score,an independent predictor of overall survival(OS).Based on these findings,immune infiltration,mutations,and medication sensitivity were analyzed in various risk groupings.Additionally,we assessed patient prognosis by combining the tumor mutation burden(TMB)with risk score.Finally,we evaluated the expression of critical genes by analyzing single-cell RNA sequencing(scRNA-seq)data from malignant vs normal epithelial cells.RESULTS We found that the higher the risk score was,the worse the prognosis was(P<0.05).We also found that the immune cell infiltration,mutation,and drug sensitivity were different between the different risk groups.The highrisk subgroup was associated with lower immune scores and high TMB.Moreover,we found that the combination of the TMB and risk score could stratify patients into three groups with distinct prognoses.HRisk-HTMB patients had the worst prognosis,whereas LRisk-LTMB patients had the best prognosis(P<0.0001).Analysis of the scRNAseq data showed that PROM2,SLC7A11,and FANCD2 were significantly differentially expressed,whereas FH was not,suggesting that these genes are expressed mainly in cancer epithelial cells(P<0.01).CONCLUSION Our model helps guide the prognosis of HER2+breast cancer patients,and its combination with the TMB can aid in more accurate assessment of patient prognosis and provide new ideas for further diagnosis and treatment.