Pancreatic ductal adenocarcinoma(PDAC)is one of the leading causes of cancer-related mortality worldwide,but current clinical methods lack effective screening and treatment options.Despite the widespread use of gemcitabine as a first-line chemotherapeutic agent in the treatment of PDAC over the past decade,its efficacy is limited by the development of drug resistance,which significantly shortens patient survival.This review systematically elucidates the critical role of the tumor microenvironment in the development of gemcitabine resistance of PDAC cells,highlighting the contributions of the extracellular matrix barrier,hypoxia-induced adaptive changes in cancer cells,and the formation of an immunosuppressive microenvironment as key factors in gemcitabine resistance.Additionally,we also introduce novel strategies for reversing chemoresistance,including advanced drug delivery systems,and provide a comprehensive overview of the current opportunities and challenges.

Chimeric antigen receptor T(CAR-T)cell therapy is a rapidly developing new immunotherapy in recent years.Compared with other therapies,CAR-T has significant advantages for high-risk and relapsed/refractory B cell non-Hodgkin's lymphoma(B-NHL)patients.Currently,a variety of anti-CD19 CAR-T cells have been approved by the FDA for the treatment of B-NHL,such as axicabtagene ciloleucel,tisagenlecucel,lisocababtagene maraleucel and brexucabtagene autoleucel.In addition,many studies are actively exploring and developing different targeted CAR-T cells,which show great potential in B-NHL.This review briefly summarized the latest research progress on the application of CAR-T in common B-NHL.

Objective To investigate knowledge,attitude and practice towards the fertility preservation of female cancer patients among clinical nurses in a cancer hospital,and to analyze influencing factors,so as to provide references for clinical implementation of related nursing services.Methods A self-designed questionnaire was delivered to 336 nurses working at a tertiary oncology hospital in Tianjin.Univariate analysis and multiple linear regression were used to analyze the factors influencing the knowledge,attitude,and practice level of female fertility preservation among nurses in a cancer hospital.Results In October 2022,a total of 291 nurses completed the questionnaires.The score of the knowledge,attitude and practice were(46.13±8.66),31.00(29.00,33.00),12.00(8.00,14.00),respectively,and the total score was(88.08±12.78).Multiple logistic regression analysis showed that education level,position,department types and whether or not getting the knowledge about fertility preservation of female cancer patients were the influencing factors for the total scores of knowledge,attitude and practice(P＜0.05).Conclusion Nurses who work at the cancer hospital have a positive attitude towards fertility preservation for female cancer patients,while their knowledge and practice level need be improved.Nursing administrators should attach importance to improving the knowledge level and practical ability of nurses in cancer hospitals to protect the fertility of female cancer patients,so as to promote the development of onco-fertility nursing in the future.

Immune checkpoint inhibitors have cahnged the management of patients with metastatic bladder cancer, by leading to long-term response and prolonged survival in a subset of patients. Unfortunately, only one in five patients with metastatic bladder cancer responds to immune checkpoint inhibitors. Preclinical and early clinical evidence indicates that radiotherapy not only acts locally, but It also plays a "double-edged sword" role in the immune system. It is hypothesized that combining checkpoint inhibitors with radiotherapy might enhance an anti-tumor immune response and increase response rates. With a review of research progresses in recent years, we believe that immunotherapy combined with radiotherapy may have a good applied perspective and is expected to further change the treatment pattern of metastatic bladder cancer.

Partial nephrectomy (PN) is primarily used to treat small size renal cell carcinoma (RCC), aiming to minimize the impact on kidney function. Although the recurrence rate post-PN is low, vigilance in diagnosing recurrence is crucial to differentiate it from inflammatory pseudotumor (IPT) and therefore prevent unnecessary interventions. In the case of a 56-year-old female patient who underwent PN for RCC of the right kidney, a mass was identified in the original surgical site over a year later, raising concerns of local recurrence based on imaging findings. However, when the patient declined puncture biopsy, a Radical Nephrectomy (RN) was performed instead. Subsequent pathology results revealed the presence of IPT, not tumor recurrence. This case underscores the importance of a comprehensive analysis of imaging features to accurately diagnose postoperative recurrence following PN. Where uncertainty persists, puncture biopsy should be considered to provide a definitive diagnosis. Moreover, emphasizing ongoing training in PN techniques and adherence to established protocols is essential to minimize the likelihood of complications such as trauma and infection, thereby reducing the occurrence of both postoperative PN recurrence and IPT.

Objective:To evaluate the effect of neoadjuvant chemotherapy combined with immunotherapy on the perioperative renal function in patients undergoing radical resection for esophageal cancer.Methods:This was a retrospective cohort study. Clinical data from patients undergoing neoadjuvant chemotherapy combined with immunotherapy for esophageal cancer in Tianjin Medical University Cancer Institute & Hospital and Tianjin University Chest Hospital from January 2020 to April 2022 were retrospectively collected. According to the preoperative treatment regimen, the patients were divided into neoadjuvant chemotherapy group (group nCT) and neoadjuvant chemotherapy combined with immunotherapy group (group nCT+ IT). nCT group underwent neoadjuvant chemotherapy, which included a platinum-based regimen combined with fluorouracil or taxanes. In nCIT+ IT group, programmed cell death protein 1 inhibitors were used for immunotherapy based on neoadjuvant chemotherapy. All the patients underwent 2-3 cycles of therapy, with each cycle lasting 21 days. Surgery was performed 4-6 weeks after the completion of the last therapy. The concentrations of serum creatinine, uric acid and blood urea nitrogen were detected before therapy, at 72 h before surgery and at 72 h after surgery. The acute kidney injury (AKI) diagnosed by the Kidney Disease: Improving Global Outcomes criteria at 72 h before surgery and 72 h after surgery were recorded. The pathological complete response rates, recurrence rate and disease-free survival time after surgery were collected.Results:Compared with group nCT, the serum urea concentration was significantly increased after treatment, the serum uric acid concentrations were increased at 72 h before surgery and 72 h after surgery, the pathological complete response rate was increased, the recurrence rate was decreased, the disease-free survival time was prolonged ( P<0.05), and no statistically significant changes were found in the incidence of AKI at 72 h before surgery and 72 h after surgery in group nCT+ IT ( P>0.05). Conclusions:Although neoadjuvant chemotherapy combined with immunotherapy can raise the pathological complete response rate and disease-free survival rate, it has a certain effect on renal function. Perioperative renal function testing should be strengthened to prevent the occurrence of AKI in the patients undergoing radical resection for esophageal cancer.

Objective:To assess the efficacy and safety of computed tomography (CT)-guided percutaneous cryoablation in treating malignant liver tumors located explicitly at high-risk sites.Methods:Data were collected retrospectively from patients with malignant liver tumors undergoing percutaneous cryoablation at Tianjin Medical University Cancer Hospital between January 2018 and December 2021. In all, 46 patients with malignant liver tumors at non-high-risk sites were matched 1∶1 according to the maximum tumor diameter. Technical success rate, complete ablation rate, and complications at 12 and 24 months post-surgery were evaluated. A statistical analysis of the ablation effect difference between the high-risk site and non-high-risk site groups was conducted. Univariate and multivariate logistic regression analyses were performed to identify risk factors.Results:Both groups demonstrated a 100% intraoperative technical success rate, and no major complications related to cryoablation were observed. The complete ablation rate was 82.6% (38/46) and 71.7% (33/46) in the high-risk group and 84.8% (39/46) and 73.9% (34/46) in the non-high-risk group at 12 and 24 months, respectively. There was no significant difference in complete ablation rates between the two groups ( P>0.05). Multivariate analysis identified the distance between the tumor edge and high-risk site ≤5 mm and preoperative trans-arterial chemoembolization (TACE) treatment as independent risk factors for cryoablation effect. Conclusion:CT-guided percutaneous cryoablation is a safe and effective approach for patients with malignant liver tumor at high-risk sites. Our results emphasize the importance of proper preoperative planning and intraoperative manipulation.

Objective:To study the postoperative complications and its risk factors in patients undergoing breast reconstruction with abdominal flaps.Methods:The clinical data of patients undergoing breast reconstruction with abdominal flaps at Department of Breast Oncoplastic Surgery, Tianjin Medical University Cancer Institute and Hospital from Jan 2011 to Apr 2022 were reviewed.Results:Postoperative complications occurred in 95 of 484 patients (19.6%), 15.5% had flap complications, 5.2% had donor-site complications, and fat necrosis was the most common complication (11.9%). The rate of fat liquefaction decreased significantly through technical improvement (1.7% vs. 7.0%); By univariate analysis, there were statistically significant differences among the groups by reconstructive type, neoadjuvant chemotherapy, BMI, smoking history ( χ2=21.088, P<0.001; χ2=4.385, P=0.036; χ2=14.784, P=0.018; χ2=19.015, P=0.048). Unplanned reoperation statistically related to the timing of reconstruction, and reconstructive type ( χ2=7.316, P=0.007; χ2=17.167, P<0.001). Revision surgery significantly related to the timing of reconstruction and timing of radiation ( χ2=40.785, P<0.001; χ2=18.602, P<0.001);By multivariate analysis, deep inferior epigastric perforator flap, smoking history were independent risk factors for flap necrosis ( OR=0.084, 95% CI:0.022-0.325, P<0.001; OR=41.623, 95% CI:3.241-534.569, P=0.004) . Conclusions:Complications after breast reconstruction with abdominal flaps are related to many factors. The surgical risks should be carefully evaluated and personalized plan should be formulated before surgery.

Objectives:To explore the clinicopathological characteristics and prognostic risk factors in differentiated thyroid cancer (DTC) patients with lung metastasis.Methods:Patients of differentiated thyroid cancer with lung metastasis in Tianjin Medical University Cancer Institute & Hospital were enrolled from Jan 1, 2010 to Dec 31, 2016. The clinicopathological characteristics and risk factors affecting the prognosis were analyzed retrospectively.Results:A total of 65 DTC patients with lung metastasis were collected in this study, including 56 patients with papillary thyroid carcinoma and 9 patients with follicular thyroid carcinoma; 23 patients died and 42 patients survived. Median follow-up time was 99.4 months. There were 18 males, 47 females. Age 14-73 years, median age 51.0 years. High incidence of DTC lung metastasis was 50-59 years for males and 40-49 years for females. Based on AJCC 8th edition TNM staging, there were 37 patients in stage Ⅱ (age <55 years) and 28 patients in stage Ⅳb (age ≥55 years). The number of 131Ⅰ treatments performed ranged from 1 to 13 times, with a mean of 3.9 times. Firty-five patients were with lung metastasis alone, and 10 patients with lung metastasis and distant metastasis in other organs. Eleven patients suffered from hypoparathyroidism after 131Ⅰ treatment. COX multifactorial regression analysis found that age was independent risk factor affecting prognosis, multiple organs distant metastasis and pathologic subtype were relative risk factors affecting prognosis. There was no correlation between gender, number of 131Ⅰ treatments and poor prognosis. Conclusions:DTC has a high survival even with the occurrence of lung metastasis, but the prognosis is poor when combined with multi-organ metastasis. Age and multiple organ distant metastatic are independent risk factors affecting prognosis.

This article analyzes the shortcomings and influencing factors in the current state of hospital performance man-agement.It proposes optimization strategies and suggestions for the management of medical service quality performance,aiming to promote the implementation of a performance management system in a rational and orderly manner.This provides theoretical sup-port and reference for the practice of medical service quality management,and promotes sustainable and positive development in hospitals.