Objective To investigate the correlationbetween thecarcinoembryonic antigen ( CEA) level and hypoxic status of breast cancer, and itspotential of being a prognostic factor in breast cancer. Methods Breast cancer cell line MDA-MB-231 was cultured under hypoxic or normoxic condition to determine the protein level of CEA using Western blotting.30 breast cancer tissue sections were collected in Tianjin Medical University Cancer Institute and Hospital from April 2013 to June 2015.and were detected the expression of CEA, hypoxia-inducible factor-1α( HIF-1α) and carbonic anhydrase-9 ( CA-9 ) by immunohistochemistry.Serum CEA were detected by immunofluorescence assay of 166 breast cancer patients collected from April 2009 to June 2011.The correlation between the expression levels of CEA and breast cancer patients'clinical data was analyzed by Logistic univariate analysis.Kaplan-Meier method was employed to calculate the progression-free survival of patients with breast cancer. Log-rank test was conducted to compare the difference between groups.Results CEA levels were significantly higher in breast cancer cells under hypoxic condition in a time-dependent manner, compared to normoxiccontrol. Immunohistochemical staining indicated that CEA was coexpressed with HIF-1αand CA-9 in breast cancer and linear regression analysis revealed that CEA expression correlated with HIF-1α( P =0.0096 );Preoperative serum levels of CEA were closely related with tumor size ( P =0.015 ) andLymph node metastasis(P=0.032); CEA positive patients achieved a progression-free survival of 29.85months(versus 39.08 months in CEA negative patients, P=0.003).Conclusions Hypoxia upregulates CEA expression in breast cancer and the levels of preoperative serum CEA is a potential prognostic factor ofbreast cancer.

The role of myeloid-derived suppressor cells (MDSCs)in promoting inflammatory response and immune escape of tumor cells and the mechanism by which MDSCs promote the development and progression of tumors are reviewed.This could provide a new way for the investigation of immunological mechanism of liver fibrosis and liver cancer.Besides,MDSCs may be an effective therapeutic target for liver cirrhosis and liver cancer.

Diabetic retinopathy(DR) is characterized by retinal edema,macular edema,eye sight degeneration,etc.and it can cause blindness .Etiopathogenisis and pathogenesis studies of DR was gradually deep and good curative effects were achieved. The author reviewed by consulting DR relevant treatment literature of traditional Chinese medicine in recent years.In order to provide reference for clinical treatment of DR.

Objective To investigate the 50% inhibition concentration(IC50)of haematoporphyrin derivative(HpD)and hematoporphyrin monomethyl ether(HMME)at the saturated light dose and 50% inhibition energy density(IED50)at saturated photosensitizer dose in order to find out their photocytotoxicity features.Methods Cell culture and MTT technology were utilized to inspect photosensitizers' photocytotoxicity to the endothelial cells of mouse lung vessel.Exponentially growing cells were incubated with varying concentrations of the photosensitizers in DMEM medium(low glucose)in 96-well microliter plate for 4h.The plate was then exposed to copper vapor laser at 510.6nm and 578.2nm wavelength,respectively,for a period of time.Incubation was continued for another 24h in darkness,and the number of surviving cell was analyzed by MTT assay.Results The findings suggested that the IC50 of HMME was 1.31 and 1.24 times of that of HpD in 510.6nm and 578.2nm wavelengths at saturated light dose,respectively.IED50 of HPD was 1.18 and 1.17 times of that of HMME in 510.6nm and 578.2nm wavelengths at saturated photosensitizer dose,respectively.Conclusion HpD has stronger photocytotoxicity than HMME under 510.6nm and 578.2nm wavelength exposure,and the photocytotoxicity is closely related to light dose and wavelength.

Objective To study both therapeutic and adverse effects of photodynamic therapy for cutaneous malignant tumors.Methods The IEAu-3 gold vapor laser(wavelength 627.8nm),manufactured by the Institute of Electronics,Chinese Academy of Sciences,and diode laser(wavelength 630nm),manufactured by DIOMED Ltd.(GB),were employed as the light source.Power density of the both kinds of laser was 100-150mW/cm2,and energy density was 150-300J/cm2.Haematoporphyrin derivative(HpD)was used as pohotosensitizer at dosage of 5mg/kg.The patients' foci were radiated 12-72h after HpD administration.The patients received 1 to 4 courses of photodynamic therapy.The size of patients' focus was measured before and after treatment and the therapeutic effect was appraised 4 weeks later.Results Evaluation of the therapeutic effect in 30 patients showed that 15 patients(50.0%)responded completely(CR),10 patients(33.3%)responded partially(PR),and 5 patients(16.6%)showed no response(NR).No patients showed progression of the lesion(PD).The total response case(CR+PR)was 25.No adverse effect was found in this group.Conclusions Photodynamic therapy is an effective and safe modality for cutaneous malignant tumor especially for basal cell skin cancer and squamous cell skin cancer.

Objective To investigate the clinical effect of selective laparoscopic cholecystectomy (LC) after percutaneous transhepatic gallbladder drainage (PTGD) in the treatment of elderly patients with acute severe cholecystitis,as well as the most appropriate timing for selective operation.Methods A total of 90 patients with acute severe cholecystitis aged above 60 years who were admitted to Department of Hepatobiliary Surgery in The First Hospital of Jilin University from January 2015 to June 2016 were enrolled,and according to the time of selective LC,they were divided into group A (with 2 months),group B (2-4 months),and group C (＞4 months),with 30 patients in each group.The clinical effects of PTGD and selective LC were observed.The t-test was used for comparison of continuous data between two groups,an analysis of variance was used for comparison between three groups,and LSD-t test was used for comparison between any two groups;the chi-square test was used for comparison of categorical data between groups.Results All the patients underwent successful PTGD,and the time to abdominal pain remission was 2.52 ± 0.76 hours.Body temperature returned to normal with 24-72 hours after surgery,and there were significant improvements in laboratory markers (white blood cell count,neutrophil count,and liver function) (all P ＜ 0.05).No patient experienced complications such as bile leakage,hematobilia,pneumothorax,and colon perforation caused by puncture,and there was no case of PTGD after the tube was detached.There were significant differences between the three groups in gallbladder wall thickness before LC (F =8.029,P ＜ 0.001),time of operation (F =24.674,P ＜ 0.001),intraoperative blood loss (F =12.864,P ＜ 0.001),length of hospital stay (F =22.844,P ＜ 0.001),rate of conversion to laparotomy (x2 =12.345,P =0.002),and incidence rate of complications (x2 =8.750,P =0.013).Compared with group A,groups B and C had significantly lower gallbladder wall thickness before LC,intraoperative blood loss,length of hospital stay,rate of conversion to laparotomy,and incidence rate of complications (all P ＜ 0.05),and group B had significantly lower time of operation,intraoperative blood loss,and length of hospital stay than group C (all P ＜ 0.05).Conclusion Selective LC with 2-4 months after PTGD has a marked clinical effect and high safety in the treatment of elderly patients with acute severe cholecystitis.

Objective ToobservetheclinicaleffectandefficacyofprostaglandinE1(PGE1),thedrugformicrocirculationimprovement, inthetreatmentofacutepancreatitis(AP).Methods Atotalof80patientswithmild-to-moderateAPwhowerehospitalizedandtreated in Second Department of Hepatobiliary and Pancreatic Surgery of the First Hospital of Jilin University from May 2014 to January 2015 were enrolled and randomized into two groups.Forty-four patients in control group received the conventional comprehensive therapy for AP,and 36 patients in experiment group received PGE1 in addition to the conventional therapy.The time to disappearance of abdominal symptoms and the time for serum and urine levels of amylase and serum levels of lipase,C-reactive protein (CRP),and procalcitonin (PCT)to re-turn to normal were compared between the two groups.The independent-samples t-test was applied for comparison of continuous data be-tween the two groups,and the chi-square test or Fisher′s exact test was applied for comparison of categorical data between the two groups. Results ThetwogroupshadsignificantdifferencesinthetimeforserumlevelsofamylaseandCRPandpercentageofneutrophilstoreturn to normal and hospital costs (P=0.041,0.030,0.012,and 0.026,respectively).PGE1 quickly relieved abdominal pain and distention, reducedtheserumlevelofamylase,shortenedthelengthofhospitalstay,andreducedhospitalcosts.Conclusion PGE1hasgoodclinical effect and safety in the treatment of AP,and can be applied as an adjuvant drug in the comprehensive therapy for AP.

Thromboembolic diseases are major health problems worldwide,and remain the leading cause of mortality and disabil-ity at present.Bleeding is the most important complication of an-tithrombotic therapy for thromboembolism,therefore research and development of new antithrombotic drugs with lowered bleeding risk is a significant medical need.The data that elevated plasma levels of FXI are associated with thromboembolic diseases,se-vere FXI deficiency reduced incidence of DVT and ischemic stroke,and FXI deficiency or inhibition in animals shows protec-tive effects against thrombus formation supporting FXI as a novel antithrombotic target with lowered bleeding risk.This paper re-views the progress on FXI as a novel antithrombotic target and the inhibitors target FXI.

Objective:To evaluate the impact of laparotomy pancreatoduodenectomy (OPD), laparoscopic pancreatoduodenectomy (LPD) and Da Vinci robot assisted pancreatoduodenectomy (RPD) on the risk of pancreatic fistula in postoperative patients.Methods:The key words were laparoscopic, pancreaticoduodenectomy, robot, DaVinci, Whipple, complication, fistula, pancreaticoduodenectomy, laparoscopy, robot, postoperative complications and pancreatic fistula, and the databases of CNKI, Wanfang, VIP, CBM, Cochrane Library, PubMed, EMBASE and web of science were searched until August 1, 2020 for retrospective cohort studies and randomized controlled trials comparing the efficacy of OPD, LPD and RPD. The articles were screened according to the pre-set inclusion and exclusion criteria, and the quality of the articles was evaluated and the data were extracted. Based on Bayesian framework, R4.0.2, Revman 5.3 and Stata 16.0 software were used to analyze the extracted data for mesh meta analysis.Results:Thirty articles involving 3 428 patients were included, including 26 retrospective cohort studies and 4 randomized controlled studies. Mesh meta-analysis showed that in the incidence of pancreatic fistula, there was no significant difference between LPD and OPD, between LPD and RPD ( OR=0.93, 95% CI 0.63-1.4; OR=1.4, 95% CI 0.87-2.2, P<0.05), but the incidence of postoperative pancreatic fistula was significantly lower than that of OPD ( OR=1.5, 95% CI 1.1-2.1, P<0.05), 95% CI 1.12.1; P>0.05). The risk probability of pancreatic fistula was ranked as RPD (0.00), LPD(0.34) and OPD(0.65), that is, for the risk of postoperative pancreatic fistula, the advantages and disadvantages of the three surgical methods were ranked as RPD, LPD and OPD. Conclusions:Compared with OPD, RPD can significantly reduce the risk of pancreatic fistula after PD and improve the quality of operation; there was no significant difference between LPD and RPD in the incidence of postoperative pancreatic fistula, and both of them were safe and feasible.

Recently,there is a gradual increase in the incidence of hyperlipidemic pancreatitis with high serum triglyceride (TG) levels.The treatments include general measures,lipid-lowering drugs,blood purification,low molecular weight heparin and insulin,traditional medicine,improving microcirculation,surgical therapy and gene therapy.The prevention of recurrence of hyperlipidemic pancreatitis is different from other types of pancreatitis.