Chimeric antigen receptor (Car) T cells, not only have the characteristics of strong specific recognition of tu-mor antigens, but also have destruction and high affinity advantages, thus receiving more attention. Although it has played a lot of advantages in anti-tumor, it still has some shortcomings, which needs to be further optimized to improve the safety of its clinical application. In this study, The cell structure and biological function, treatment process, application development and application risk of Car T cells are reviewed, which provide references for further clinical immunotherapy of Car T.

Objective: To explore the dialectical relationship between immunosuppressed cell expression and TCM inpatients with liver cancer. Methods: The clinical data of 237 HBV-related primary liver cancer patients were collectedand the differences of MDSC expression and clinical BCLC stage and intrahepatic metastasis were analyzed. Peripheralvenous blood was taken for the detection of MDSC (CD33/CDl4/HLA-DR-/low/CDllb) expression in mononuclear cells, helper T cells (Th1, Th2) and interleukin (IL-12, IL-4) ) detection. Results: There was a significant difference betweenliver stagnation and spleen deficiency syndrome (24.21％) and qi stagnation and blood stasis syndrome (5.54％) (Χ2=11.544, P ＜ 0.05) . The expression of MDSC (21.03％) was higher than that of liver-kidney yin deficiency (5.10％) in advanced hepatocellular carcinoma (＞ 5 cm) (Χ2= 8.223, P ＜ 0.005); the expression of Th2 in liver stagnation and spleendeficiency was higher than that of qi stagnation. There was a significant difference between groups in blood stasis group (t = 10.341, P ＜ 0.05) . The expression of Th2 in wet sputum was higher than that in liver and kidney yin deficiency group.There was significant difference between groups (t = 16.307, P ＜ 0.01) . The IL-4 in liver stagnation and spleendeficiency group (76.57 ± 5.01) was higher than that in qi stagnation and blood stasis group (121.70 ± 6.22); There was asignificant difference between groups (t = 21.414, P ＜ 0.05) . There was a significant difference in IL-4 (375.12 ± 5.31) inthe liver-kidney yin deficiency group compared with the group with wet phlegm (115.46 ± 4.15) (t = 12.455, P ＜ 0.05) .Conclusion: MDSC participates in tumor proliferation, invasion and metastasis by regulating Th2 and IL-4, which isclosely related to the dialectical classification of TCM.

Objective To analyze the difference of echocardiography in patients with chronic Keshan disease (CKD) at different altitudes areas,explore the effects of altitude on the structure and functional of right heart in CKD patients,and provide a reference for imaging diagnosis of CKD.Methods According to the three step distribution of the terrain in China,30 cases of CKD patients in the first step (altitude ＞ 4 000 m) of Tibet autonomous region were randomly selected as the Tibetan plateau group.In the second step (altitude:1 000-2 000 m),31 cases were randomly selected in Gansu Province as the Loess plateau group.In the third step (altitude ＜ 500 m),42 cases were randomly selected in Shandong Province as the plain group.Echocardiography was used to analyze the morphology,hemodynamics and function of right heart.Results Right atrial transverse diameter (RATD),right ventricular transverse diameter (RVTD),right ventricular lateral wall thickness (RVWT) and main pulmonary artery diameter (MPAD) of the Tibetan plateau group,the Loess plateau group and the plain group (mm:49.75 ± 8.40,45.64 ± 7.63,43.56 ± 7.34;50.89 ± 7.13,46.56 ± 5.62,43.27 ± 6.01;4.75 ± 1.02,3.53 ± 0.61,3.37 ± 0.51;32.87 ± 3.62,28.93 ± 2.12,28.44 ± 2.71) were significant differences among the three groups (F =5.36,12.91,37.08,23.33,P ＜ 0.01).The above indexes of the Tibetan plateau group were higher than those of the Loess plateau group and the plain group (P ＜ 0.05).RVTD of Loess plateau group was higher than that of plain group (P ＜ 0.05).The fractional area change [FAC,(24.85 ± 2.75)％,(26.26 ± 3.42)％,(26.73 ± 3.14)％],tricuspid annular plane systolic excursion [TAPSE,(12.87 ± 1.12),(14.59 ± 1.63),(14.13 ± 1.31) mm] of the Tibetan plateau group,the Loess plateau group and the plain group were significant differences among the three groups (F =3.36,13.47,P ＜ 0.05 or ＜ 0.01);the above indexes of the Tibetan plateau group were lower than those of the Loess plateau group and the plain group (P ＜ 0.05).Tei index (0.87 ± 0.18,0.78 ± 0.16,0.71 ± 0.14),tricuspid flap diastolic maximum filling speed/tricuspid annulus early diastolic peak velocity (E/E',9.48 ± 1.22,8.64 ± 0.91,8.12 ± 1.13),systolic pulmonary artery pressure [SPAP,(49.58 ± 11.76),(44.35 ± 11.41),(42.67 ± 12.13) mmHg,1 mmHg =0.133 kPa] of the Tibetan plateau group,the Loess plateau group and the plain group were significant differences among the three groups (F =12.89,13.99,3.12,P ＜ 0.01 or ＜ 0.05);the Tei index and E/E'of the Tibetan plateau group were higher than those of the Loess plateau group and the plain group (P ＜ 0.05).Tei index,E/E'of the Loess plateau group were higher than those of the plain group (P ＜ 0.05).Conclusions The right heart structure and function of CKD patients are affected by the altitude of their residence.With the increase of altitude,the right heart is enlarged,the right ventricular systolic and diastolic functions are decreased,and SPAP is increased in CKD patients.