Objective To explore the effects of the perioperative nursing pathway on physiological and mental status, and risk of infection in Tibetan patients with limb fractures. Methods A total of 86 Tibetan patients with limb fractures who were treated in Ganzi Tibetan Autonomous Prefecture People's Hospital in 2016 were collected in this study. The participants were divided into two groups according to the random number table, with 43 cases in each group. Based on the routine treatment, the control group received conventional perioperative nursing pathway. In contrast, the intervention group received modified nursing pathway tailored for Tibetan patients which included faith support, language assistance, and custom acceptance. Hamilton Anxiety Scale (HAMA) and Hamilton Depression Scale (HAMD) were used to evaluate patients' anxiety and depression status at different time (i. e. before the admission, preoperative day, postoperative day, and on the day of discharge). The peripheral blood sample was collected to investigate patients' C-reactive protein level (CPR). The healthcare associated infection (HAI) was compared between two groups. Results The HAMA scores were (21.3±2.1), (15.7±2.5), (13.1±2.4) and (11.8±1.8) for the intervention group, and (20.7±2.3), (18.1±2.0),(15.8±2.0) and (13.4±1.3) for the control group, which significantly decreased in both groups (F=131.511, 82.510; P<0.001). The intervention group had significantly lower HAMA scores at any evaluate time compared with the control group (t=4.916, 5.667, 4.725; P<0.001). The HAMD scores were (28.7±2.8), (23.6±2.4), (18.5±1.8) and (15.6±2.0) in the intervention group, and (28.4±2.3), (25.6±2.7), (22.6±2.2) and (19.4±2.3) in the control group. Both groups had significant reduction (F=153.582, 102.618; P<0.001) and the intervention group had significantly lower HAMD scores at any evaluate time compared with the control group (t=3.630, 9.458, 8.175; P< 0.01). The serum CPR were (10.2±1.3), (7.8±1.5), (31.7±4.2), and (5.4±1.5) mg/L in the intervention group and (10.1±1.5), (9.8±1.2), (39.2±3.8) and (6.8±1.0) mg/L in the control group, which significantly decreased in both groups (F=139.315, 213.158; P<0.001). The intervention group had significantly lower serum CPR at any evaluate time compared with the control group (t=6.747, 8.582, 5.033;P< 0.001). The intervention group had significantly lower incidence rate of HAI (18.6% vs. 39.5%; χ2=4.568,P<0.05) and less infection duration [(6.4±1.1) d vs. (11.5±2.0) d;t=6.701,P<0.001] compared with the control group. Conclusions The modified clinical perioperative nursing pathway can help patients' physiological and mental status, and reduce the risk of HAI in Tibetan patients with limb fractures.

PD-1 and CTLA-4 antibodies offer great hope for cancer immunotherapy. However, many patients are incapable of responding to PD-1 and CTLA-4 blockade and show low response rates due to insufficient immune activation. The combination of checkpoint blockers has been proposed to increase the response rates. Besides, antibody drugs have disadvantages such as inclined to cause immune-related adverse events and infiltration problems. In this study, we developed a cyclic peptide C25 by using Ph.D.-C7C phage display technology targeting LAG-3. As a result, C25 showed a relative high affinity with human LAG-3 protein and could effectively interfere the binding between LAG-3 and HLA-DR (MHC-II). Additionally, C25 could significantly stimulate CD8 T cell activation in human PBMCs. The results also demonstrated that C25 could inhibit tumor growth of CT26, B16 and B16-OVA bearing mice, and the infiltration of CD8 T cells was significantly increased while FOXP3 Tregs significantly decreased in the tumor site. Furthermore, the secretion of IFN- by CD8 T cells in spleen, draining lymph nodes and especially in the tumors was promoted. Simultaneously, we exploited T cells depletion models to study the anti-tumor mechanisms for C25 peptide, and the results combined with MTT assay confirmed that C25 exerted anti-tumor effects CD8 T cells but not direct killing. In conclusion, cyclic peptide C25 provides a rationale for targeting the immune checkpoint, by blockade of LAG-3/HLA-DR interaction in order to enhance anti-tumor immunity, and C25 may provide an alternative for cancer immunotherapy besides antibody drugs.