Immune checkpoint inhibitors (ICIs) are currently used in the treatment of various tumors and play an important role in tumor treatment, resulting in many adverse reactions related to the immune system. Type 1 diabetes (T1DM) is a rare endocrine system complication, which is rarely reported at present. We report a case of T1DM after using ICIs to treat gastric cancer. The patient was a 34 year old male who developed diabetes ketoacidosis after 206 days of sintilimab monoclonal antibody use, with fasting blood glucose of 15.78 mmol/L and glycosylated hemoglobin of 8.6%. Islet related antibody: Glutamate decarboxylase antibody: 119.2 IU/mL; Insulin antibody:<2 IU/L. Fasting insulin: 0.21 mU/L; Fasting C-peptide: 0.12 μg/L. Through the analysis of patients' clinical data, it aims to improve clinicians' understanding of immune related type 1 diabetes and provide ideas for correct diagnosis and treatment.

Purpose To investigate the relationship between HPV infection and p53,p16,EGFR expression and prognosis in patients with salivary adenoid cystic carcinoma (ACC).Methods Totally 76 cases of adenoid cystic carcinoma specimens were selected,PCR-reverse dot blot hybridization was used to detect infection of HPV and SP immunohistochemical method was adopted to detect the expression of p53,p16,EGFR,Cdc2 in tumor tissues.Clinical data were collected and all the patients were followed up.The Kaplan-Meier method was used to estimate median overall survival and the Log-rank test to compare survival curves.Cox regression model was used for multivariate analyses.Results Infection rate of HPV in adenoid cystic carcinoma tissues was 0(0/76).The expression rate of p53,p16,EGFR,Cdc2 protein in adenoid cystic carcinoma tissues were 76.3％ (58/76),57.9％ (44/76),60.5％ (46/76) and 64.5％ (49/76)respectively.There was no correlation of the expression of p53,p16,EGFR and Cdc2 with gender,age,tumor location,TNM stage and histological type of patient.Kaplan-Meier survival analysis showed that EGFR-positive patients had shorter median overall survival rate (OS) than the negative ones (x2 =19.111,P ＜ 0.001).EGFR-positive patients had shorter median progression-free survival rate (PFS)than the negative ones (x2 =6.621,P ＜ O.01).Cdc2 positive patients had shorter median OS than the negative ones (x2 =3.870,P ＜ 0.05).Cdc2 positive patients had shorter median PFS than the negative ones (x2 =6.755,P ＜0.01).Cox regression analysis showed that expression of EGFR and Cdc2 was independent risk factors for the prognosis of patients with salivary gland ACC (relativerisk=13.417,13.075,P＜0.001).Conclusion There is no HPV infection detected in adenoid cystic carcinoma tissues.p53,p16,EGFR and Cdc2 are positively expressed in most salivary adenoid cystic carcinoma,p16 is unsuitable as a surrogate for HPV infection status of patient with ACC.Expression of EGFR and Cdc2 is independent risk factors in the prognosis of patients with salivary gland ACC.For the EGFR or Cdc2 positive patients should be followed up closely.

Objective: To investigate the efficacy and safety of using pegylated recombinant human granulocyte-colonystimulating factor (PEG-rhG-CSF) in preventing neutropenia in multiple chemotherapy cycles. Methods: A multicenter, prospective, open-label, singlearmstudy was designed. Patients with malignant tumors, such as lung, ovarian, and colorectal cancers, who received multiple cycles of chemotherapy with the prophylactic use of PEG-rhG-CSF for 2-4 consecutive cycles participated in the study. Results: After the prophylactic use of PEG-rhG-CSF, the incidence of grade IV neutropenia decreased from 4.76% (13/273) in the first cycle to 1.83% (5/273), 1.15% (2/174), and 2.08% (2/96) in subsequent cycles. Meanwhile, the incidence of grade III neutropenia decreased from 11.36% (31/ 273) in the first cycle to 6.23% (17/273), 2.87% (5/174), and 3.13% (3/96) in subsequent cycles. The incidence of febrile neutropenia (FN) during the first cycle was 0.73% (2/273). The duration of FN was 2 days in one case and 5 days in another case. FN was not observed during the second, third, or fourth cycle. After the secondary prophylactic use of PEG-rhG-CSF, the incidence of grade IV neutropenia decreased from 25% (7/28) to 3.57% (1/28), 0% (0/28), and 6.67% (1/15) in subsequent cycles. Meanwhile, the incidence of grade III neutropenia decreased from 71.43% (20/28) to 10.71% (3/28), 14.29% (4/28), and 0% (0/15) in subsequent cycles. The proportion of patients who received antibiotic therapy during the entire chemotherapy period was 10.48% (44/420). Conclusion: The application of PEG-rhG-CSF once per chemotherapy cycle can effectively reduce the occurrence of neutropenia in patients under multiple cycles of chemotherapy treatment with good safety.

Objective:To observe the efficacy of Tegafur gimeracil oteracil potassium(Gio) capsules combined with oxaliplatin in the treatment of advanced gastric cancer,and explore its effect on matrix metalloproteinase-9 (MMP-9) expression in cancer tissues. Methods: Totally 120 patients with advanced gastric cancer were randomly divided into the observation group and the control group, and both groups were treated with neoadjuvant chemotherapy for 3 cycles as follows:the observation group was given Gio capsules and oxaliplatin,and the control group was given 5-fluorouracil combined with oxaliplatin. The short term efficacy,adverse reactions and ex-pression of MMP-9 in cancer tissue before and after the chemotherapy were observed in the two groups. Results:After the treatment, the objective response rate in the two groups had no significant difference(P>0.05);the clinical benefit rate of the observation group was significantly higher than that of the control group(P<0.05);the incidence of severe bone marrow suppression and liver and kid-ney dysfunction in the observation group was significantly lower than that in the control group(P<0.05);after the treatment,the pos-itive expression of MMP-9 in the observation group was significantly lower than that in the control group(P<0.05). Conclusion:Gio capsules combined with oxaliplatin can improve the clinical benefit rate of the patients with advanced gastric cancer,and effectively re-duce the expression of MMP-9 in cancer tissue.

Objective To observe the clinical efficacy of the combination of modification ofChaihu Jia Longgu MuliDecoction with psychological intervention in the treatment of post tumor depression.MethodsTotally 122 cases of post tumor depression were divided into treatment group and control group by simple numeration table random method, with 61 cases in each group. The treatment group was given modification ofChaihu Jia Longgu Muli Decoction orally, at the same time psychological intervention was given. The control group was given escitalopram oxalate tablets for 6 weeks. HAMD scale scores of the two groups were observed before and after treatment to evaluate the clinical efficacy. Changes in life quality of two groups were scored with SF-36 scale. The adverse reactions were also observed.ResultsAfter treatment, the HAMD score of treatment group was lower than control group (P<0.05). The total effective rate was 88.52% (54/61) in the treatment group and 72.13% (44/61) in the control group, with statistical significance (P<0.05). The scores of life quality of treatment group were higher than control group (P<0.05), and the incidence of adverse reactions was lower than control group (P<0.05).Conclusion Combination of modification ofChaihu Jia Longgu MuliDecoction with psychological intervention in the treatment of post tumor depression can significantly improve the depressive state and life quality of the patients with post tumor depression, which is better than the control group, without significant adverse reactions.

Purpose To compare the therapeutic effects of CO2 laser resection and traditional split laryngeal surgery on the early laryn-geal cancer, and to examine relationship between the expression of p27 and PTEN and clinical prognosis in early laryngeal squamous cell carcinoma. Methods 85 patients who underwent CO2 laser resection surgery and 46 patients who underwent split laryngeal surger-y were selected and the occurrence rates after surgery were observed. SP immunohistochemical method was uesd to detect the expression of p27 and PTEN in tumor resection marginal and their surgical margine tissues. Clinical data were collected and all patients were fol-lowed up. Results In the more than two-year follow-up study, 14 of 85 patients in CO2 laser treatment group ( recurrent group) pres-ented with local recurrence and the recurrence rate was 16. 5%, while 6 of 46 patients in split laryngeal surgery group presented with local recurrence and the recurrent rate was 13. 0%. There was no statistical significance in recurrence rate between the two groups ( P> 0. 05). 10 of all the none recurrent patients did not follow the doctor’s advice to quit smoking after the operation, while 12 in the recurrent patients did not, the difference between the two groups was statistically significant (P<0. 01). The positive rate of p27 and PTEN in laryngeal carcinoma tissues and the cancer adjacent tissues ( negative surgical margin tissues ) was 43. 5% ( 57/131 ) , 80. 2% (105/131) and 48. 9% (64/131), 83. 2% (109/131), respectively, with a significant difference (P<0. 01). The positive rate of p27 and PTEN in laryngeal carcinoma tissues of the recurrent group and non recurrent group was 20. 0% (4/20), 47. 7% (53/111) and 10. 0% (2/20), 55. 9% (62/111), respectively, with a significant difference (P<0. 05). While the positive rate of p27 and PTEN in tumor resection marginal tissues of the recurrence group and non recurrence group was 50. 0% ( 10/20 ) , 85. 6% ( 95/111) and 40. 0% (8/20), 91. 0% (101/111), the difference was also statistically significant (P<0. 01). Conclusions There was no statistically significant difference in tumor recurrence rate between CO2 laser surgery and traditional split laryngeal surgery. Postoper-ative recurrence is closely related to resume smoking. The recurrence rate of p27 and/or PTEN negative patients was higher than that of the opposite ones which should be followed up closely after treatment.

Purpose To study the expression of p53, p21 and Cdk1/p34cdc2 in the laryngeal cancer and its margin tissues and to ex-plore their relationship with local recurrence of laryngeal cancer. Methods A total of 85 patients with early laryngeal cancer were se-lected randomly during 2004 to 2010 in Tangshan Union Hospital, Hebei, China. SP immunohistochemical method was used to detect the expression of p53, p21 and Cdk1/p34cdc2 in the tumor and margin tissues. Pathological data were collected for follow-up. Results In more than 2 years of follow-up study, 14 of 85 patients with laryngeal cancer presented with recurrence (recurrent group), while 71 patients without recurrence (none recurrent group). The positive rate of p53 protein in laryngeal cancer and its margin tissues was 60. 0% and 36. 5%, respectively, the positive rate of p21 protein in laryngeal cancer and its margin tissues was 38. 8% and 21. 2%, respectively. The positive rate of Cdk1/ p34cdc2 in laryngeal cancer and its margin tissues was 70. 6% and 29. 4%, respectively. p53 protein in the surgical margin of the recurrent group and non recurrent group was 71. 4% and 29. 6% (P = 0. 003), that of p21 was 50. 0% and 15. 5%, (P =0. 004) and Cdk1/ p34cdc2 was 57. 1% and 23. 9% (P =0. 013), respectively. There was no correlation between expression of p53 with p21 protein and Cdk1/ p34cdc2 protein(P > 0. 05). Conclusion p53, p21 and Cdk1/ p34cdc2 may be involved in the occurrence, development and recurrence of laryngeal squamous cell carcinoma. Overexpression of p53, p21 and Cdk1/ p34Cdc2 in the surgical margin is closely related to local recurrence of laryngeal cancer.

Objective To investigate the in vitro effects of quercitrin on the proliferation and the cytotoxicity of human γδT cells.Methods Peripheral blood mononuclear cells (PBMCs) were isolated from healthy subjects and cultured with isopentenyl pyrophosphate and IL -2 to induce human γδT cells.The hu-manγδT cells were cultured with quercitrin at various concentrations for 48 hours.CCK-8 kits were used to analyze the in vitro proliferation and cytotoxic activities of γδT cells.Flow cytometry was performed to meas-ure the expression of granzyme B and perforin in γδT cells.The expression of p-ERK, p-Akt and Bcl-2 at protein level were detected by Western blot .Results The percentage of human γδT cells in PBMCs was in-creased from (2.96±1.83)%to (88.94±2.36)%after 10 days of culture.The quercitrin at concentrations of 10 to 80 μg/ml could promote the growth of γδT cells and up-regulate the expression of granzyme B , per-forin, p-ERK, p-Akt and Bcl-2 in a dose dependent manner .The cytolytic activities of γδT cells against co-lonic carcinoma cells ( HCT116 ) were enhanced by quercitrin .Conclusion Quercitrin could promote the proliferation of γδT cells and enhance the expression of granzyme B and perforin at certain concentrations in vitro.ERK1/2 and Akt signal transduction systems might be involved in the process .

Objective To evaluate the efficacy and survival rate of neoadjuvant chemotherapy with docetaxe and pirarubicin in triple negative breast cancer (TNBC).Methods Total 51 breast cancer patients were divided into TNBC group (n =26,including 16 of stage Ⅱ and 10 of stage Ⅲ patients) and non-TNBC group (n =25,including 14 of stage Ⅱ and 11 of stage Ⅲ patients).All patients received a median of 4 treatment cycles with TAC regimen [docetaxe 75 mg/m2 on day 1,pirarubicin 40 mg/m2 on day 1 and cyclophosphamide (CTX) 500 mg/m2 on day 1 of each 21 day cycle].The efficacy of treatment and survival rate of two groups were evaluated.Results In TNBC group,9 out of 26 (34.62 ％) patients achieved clinical complete response (cCR),and 14 (53.85 ％) had partial response (cPR).Overall,88.46 ％ of TNBC patients had clinical response and 26.92 ％ (7/26) showed pathology complete response (pCR).In non-TNBC group,6 (24.00 ％) patients reached cCR and 8 (32.00 ％) showed cPR.The overall response rate was of 56.00 ％,and 4 (16.00 ％) patients achieved pCR.The overall 3-year survival rates in TNBC and non-TNBC groups were 73.08 ％ and 88.00 ％,respectively,indicating a poorer prognosis of TNBC.The 5-year survival rates of TNBC patients with and without pCR were 88.89 ％ and 47.06 ％,respectively.Conclusion TAC regimen improves the prognosis for locally advanced TNBC,indicating that the neoadjuvant chemotherapy is effective and safe for TNBC patients.

Purpose To explore the relationship between expression of PCNA and COX-2 in the early laryngeal cancer with negative surgical margins and the local recurrence of tumor. Methods Totally 63 patients with early laryngeal cancer were enrolled in this stud-y, CO2 laser surgery was adopted as treatment, the expression of PCNA and COX-2 was detected in the resected tumor tissue and surgi-cal margins, and the survival and tumor recurrence were also observed. Results The positive rate of the expression of PCNA and COX-2 in the 63 patients with early laryngeal cancer tumor tissues were 73. 02% and 71. 43%, while that in the cutting edge were 33. 33% and 30. 16%, respectively. The expression of PCNA and COX-2 in tumor tissue and cutting edge were of all positive in 41 cases and 13 cases, and the positive rate was 65. 08% and 20. 63%, respectively. In the all followed-up patients, 17 cases were detected of local recurrence, the recurrence rate was 26. 98%, and the recurrence rate in the patients with PCNA positive was 71. 43%, while in the patients with COX-2 positive was 73. 68% (P<0. 05). The combined detection of PCNA and COX-2 positive recurrence rate was significantly higher than that of single positive (P<0. 05). Conclusion PCNA and COX-2 in the early laryngeal cancer with negative surgical margins are important biological markers for the evaluation of prognosis of laryngeal cancer patients, and to formulate the subse-quent treatment regimen. The combined detection of two proteins is more reliable for postoperative management.