Objective:To investigate effect and mechanism of mangiferin on regulation of M2-type macrophage polarization tar-geting MMP9 in pancreatic cancer.Methods:In vivo,therapeutic effect of mangiferin on pancreatic cancer was evaluated by drawing tumor growth curves and immunohistochemical staining.M2-type macrophages expression in pancreatic cancer was detected by immu-nofluorescence and ELISA.Effects of mangiferin on expression of MMP9 and downstream M2 macrophage polarization-related signaling pathways were detected by immunofluorescence,ELISA,Western blot and qRT-PCR.In vitro,MTT assay was utilized to detect effect of mangiferin on M2-type macrophage and therapeutic effect of mangiferin on pancreatic cancer.ELISA was used to detect effect of mangiferin on M2-type polarized macrophages.Effects of mangiferin on expression of MMP9 and its downstream signalling pathway were detected by immunofluorescence and Western blot.Results:Mangiferin had potential to inhibit growth of pancreatic cancer in mice pancreatic model,and could prevent expression of M2-polarized macrophages in pancreatic cancer in addition.At the same time,mangiferin could inhibit expression of MMP9 and downstream M2 macrophage polarization related signaling pathways in pancreatic cancer.Mangiferin inhibited proliferation of pancreatic cancer cells in a M2 type polarized macrophage-pancreas cancer cell co-culture model,inhibited macrophage M2 polarization,at the same time,expression of MMP9 and downstream M2 macrophage polarization related signaling pathway was inhibited.Conclusion:Mangiferin can inhibit macrophage M2 polarization by inhibiting MMP9 and its downstream signaling pathway,and play a role in pancreatic cancer therapy.

Pancreatic ductal adenocarcinoma has a high degree of malignancy, an insidious onset, and rapid progression, with no obvious abdominal manifestations and signs in the early stage. Most patients are already in the advanced stage and have distant organ metastasis at the time of diagnosis, and thus surgical treatment, chemoradiotherapy, and targeted drug therapy often have an unsatisfactory clinical effect. Recent studies have shown that transforming growth factor-β (TGF-β) is closely associated with the development and of tumors and plays a key role in the processes of tumor cell proliferation, invasion, migration, and angiogenesis. Although TGF-β signal can exert a powerful inhibitory effect on tumors through SMAD-mediated cell cycle arrest, TGF-β signal can also accelerate the development of pancreatic cancer by enhancing epithelial-mesenchymal transition, fibrosis, and immune escape. In this article, pancreatic cancer specifically refers to pancreatic ductal adenocarcinoma, and this article reviews the role of TGF-β in its signal transduction and the association of TGF-β with related factors and immune response, so as to provide a theoretical basis for targeted therapy for pancreatic cancer in the future.

Objective To investigate the postoperative complications of ex vivo liver resection combined with autologous liver transplantation in the treatment of end-stage hepatic alveolar echinococcosis at high altitude and related prevention and treatment strategies. Methods Surgical data and follow-up data were collected from 11 patients with end-stage hepatic alveolar echinococcosis who underwent autologous liver transplantation in Qinghai People's Hospital from January 2013 to March 2019, and intraoperative and postoperative conditions were analyzed. Results All 11 patients underwent autologous liver transplantation successfully, without intraoperative death, among whom 2(18.18%) underwent hemi-extracorporeal hepatectomy and 9 (81.82%) underwent total extracorporeal hepatectomy. For the reconstruction of the retrohepatic inferior vena cava, 2 patients (18.18%) underwent reconstruction with the autologous great saphenous vein, 4 patients (36.36%) underwent reconstruction with artificial vessels, and the autologous retrohepatic inferior vena cava was preserved in 5 patients (45.45%). For biliary reconstruction, 8 patients (72.73%) underwent choledochoenterostomy and 3 (27.27%) underwent choledochocholedochostomy. The main postoperative complications of the 11 patients included bleeding in 2 patients (18.18%), bile leakage and abdominal infection in 4 patients (36.36%), bilioenteric anastomotic stenosis in 1 patient (9.09%), thrombus in 2 patients (18.18%), pulmonary infection and pleural effusion in 2 patients (18.18%), and echinococcosis recurrence in 1 patient (9.09%). Of all 11 patients, 2 (18.18%) died during the perioperative period, and the other 9 patients (81.82%) were improved and discharged. Conclusion Bleeding, biliary complications, and infection are the main causes of death in patients undergoing autologous liver transplantation at high altitude. An accurate understanding of surgical indication, careful multidisciplinary evaluation before surgery, superb operation during surgery, standardized surgical procedures, and fine perioperative management are the key to reducing perioperative mortality, avoiding and reducing postoperative complications, and achieving good long-term survival in patients undergoing autologous liver transplantation.