Objective To discover the best physical training way including frequency and intensity each day ,and to guide pa‐tients to get the best cure .Methods Totally 60 chicken ,which were randomly divided into 3 groups ,20 for each ,the deep flexor tendon of the third left toes were found ,repairing after cut them off .Flexor tendon proximal were found by making knees incision then indwelling long silk line .External fixation bandage were used .Their left toes were accepted physical training ,Training stand‐ards :6 pulling backs each time ,toe flexion 1/4 arc ,but less than 2 N .For group A ,exercised once a day ,twice a day for group B , three times a day for group C .Right ones were consider as control group weren′t processed after operation .28 days later ,tendon distance was recorded by using 2 N pulling forces at tendon proximal with aspiring balance .Gross specimen was observed and histo‐logical specimens using Tang Jinen classification method to classify adhesions ,and the dates were analyzed by statistics SPSS 19 .0 . Results Group A remaining of 18 ,rate of 5 .56% ,grade Ⅰ of 1 ,Ⅱ of 2 ,Ⅲ of 4 ;Ⅳ of 10 .Group B remaining of 17 ,rate of 5 .88% , grade Ⅰ of 12 ,Ⅱ of 2 ,Ⅲ of 1 ,Ⅳ of 1 .group C remaining of 16 ,15 toes broke again ,fracture rate was 93 .75 % ,grade Ⅰ of 1 ,con‐trol group were grade Ⅳ .Between group A and B there were no significant differences in degree of adhesion(P> 0 .05) .Group A and Cs′ differences were statistically tested (P< 0 .05) .So were group B and C (P< 0 .05) .The average sliding distance for group A was (3 .01 ± 1 .58) mm ,(6 .72 ± 2 .02) mm for group B ,group C only got one sample ,8 .60mm ,and it was out of statistics .Be‐tween group A and B ,difference resulting from its tendon sliding after statistical tests(P< 0 .05) .For fracture rate ,Group A and B no significant difference was found(α′ = 0 .012 5 ,PAB > α′) .Conclusion Physical training can reduce chicken′s tendon adhesion effectively .

Objective:To study the expression level of programmed death ligand 1 (PD-L1) in combined hepatocellular-cholangiocarcinoma (cHCC-CCA) and its correlation with the clinical characteristics and prognosis.Methods:The clinical data of 75 patients with cHCC-CCA undergoing surgery in Tianjin Medical University Cancer Institute and Hospital from January 2011 to December 2019, including 61 males and 14 females, with a median age of 55 years (36 to 77). Immunohistochemistry was conducted to determine the PD-L1 expression in tumor. The status of PD-L1 expression, clinicopathological data and prognosis of patients were analyzed.Results:In low-differentiated cHCC-CCA tissues, the proportion of PD-L1 expression (21.1%, 8/38) was higher than that in moderately to well-differentiated cHCC-CCA tissues (2.70%, 1/37, χ2=4.366, P=0.037). The median disease-free survival (DFS) and overall survival (OS)of PD-L1 positive patients were 12.3 and 15.1 months, respectively, lower than those of PD-L1 negative patients (14.4 and 23.3 months). The difference of DFS was statistically significant ( χ2=4.052, P=0.044). In multivariate analysis, major vascular invasion (DFS: HR=1.965, 95% CI: 1.119-3.450, P=0.019; OS: HR=1.781, 95% CI: 1.022-3.105, P=0.042) and lymph node metastasis (DFS: HR=2.451, 95% CI: 1.1033-5.814, P=0.042; OS: HR=2.652, 95% CI: 1.120-6.279, P=0.027) were identified as independent prognostic factors affecting DFS and OS. Conclusions:The proportion of PD-L1 positive is higher inthe low-differentiated cHCC-CCA tissue compared to that in moderately to well-differentiated cHCC-CCA. The major vascular invasion and lymph node metastasis are independent factors affecting the prognosis of patients with cHCC-CCA.