Esophageal squamous cell carcinoma is the main histological type of esophageal cancer in China, which seriously threatens the health of people. The application of immunotherapy, mainly immune checkpoint inhibitors, has greatly improved the prognosis of patients with esophageal squamous cell carcinoma, but the efficacy of treatment is still limited. Tertiary lymphoid structure (TLS) is an ectopic organized lymphoid structure that accumulates in non-lymphoid organs. Previous studies have found that TLS in esophageal squamous cell carcinoma is associated with better patient outcomes and enhanced immunotherapy efficacy. Based on current researches about TLS in esophageal squamous cell carcinoma, this paper reviews the relationship between TLS and the prognosis and immunotherapy of patients. We hope to provide reference for the precise immunotherapy of esophageal squamous cell carcinoma.

Objective To explore the effects of different phenotypes macrophages(Mφs)on the proliferation,mi-gration and osteogenic differentiation of periodontal ligament stem cells(PDLSCs).Methods PDLSCs were isola-ted and cultured by tissue block method.Tohoku Hospital Pediatrics-1(THP-1)cell line was stimulated to activate into unpolarized Mφs(M0),then induced to polarize into type Ⅰ Mφs(M1)and type Ⅱ Mφs(M2).Quantitative real-time PCR(qPCR)detected the inflammatory factors tumor necrosis factor α(TNF-α),interleukin(IL)-1 β,IL-6,IL-10 and transforming growth factor-β(TGF-β)mRNA expression level.After collecting culture superna-tants with different phenotypes,PDLSCs were stimulated,native control(NC)group did not receive the culture su-pernatant of Mφs.The effects of PDLSCs proliferation were assessed via Methylthiazolyldiphenyl-tetrazolium bro-mide(MTT)assay,while scratch assays were employed to evaluate their migration.Western blot was utilized to analyze the protein expression of Runt-related transcription factor 2(RUNX2)and alkaline phosphatase(ALP).Additionally,Alizarin Red staining was performed to investigate the deposition of calcified nodules in PDLSCs.Re-sults qPCR showed the relative expression of TNF-α,IL-1 β and IL-6 in M1 Mφs were higher than those in M0 and M2 Mφs(P＜0.05),and the relative expression of IL-10 and TGF-β in M2 Mφs were higher than those in M0 and M1 Mφs(P＜0.05);Western blot showed the expression of RUNX2 and ALP proteins in PDLSCs in M0 and M2 groups was higher than those in the NC group(P＜0.05),Alizarin Red staining showed increased calcified nodule deposition in PDLSCs in M0,M1 and M2 groups compared to the NC group;MTT assay showed the prolifer-ation of PDLSCs in the M0 and M1 groups was suppressed compared to the NC group(P＜0.05);and scratch ex-periment showed the migratory capacity of PDLSCs in the M1 and M2 groups was stronger than that in the NC group.Conclusion M0 and M1 Mφs inhibit PDLSCs proliferation,M1 and M2 Mφs promote PDLSCs migration,and all types of Mφs promote osteogenic differentiation of PDLSCs.

Objective:To explore the application and practice of "flipped classroom" in the teaching of general surgery interns.Methods:A total of 20 internship groups (3 to 5 people in each group) were randomly selected from the general surgery practice group in the Department of General Surgery of the Second Clinical Medical College of North Sichuan Medical College. They were randomly divided into the flipped group (45 people) and the traditional group (40 people), with 10 subgroups in each group. The flipped group adopted the flipped classroom teaching mode (students' self-study by handing out materials before class, students and teachers' discussion in class, and students and teachers' evaluation after class), while the control group adopted the current conventional teaching mode (students' preview before class, teachers' explanation in class, and teachers' question answering after class). At the end of the teaching, a questionnaire was used to evaluate the participation and completion of each student. The teaching effect was evaluated by medical history collection and case analysis. The participation, completion, and teaching effect between the two groups were compared and analyzed. SPSS 23.0 software was used for t-test and Chi-square test. Results:The participation of the flipped group was better than that of the traditional group [(17.45±1.83) vs. (15.57±1.52)], and the difference was statistically significant ( P < 0.05). There was no statistically significant difference between the flipped group and the traditional group. There was no significant difference in medical history collection scores between the two groups. The case analysis of the flipped group was better than that of the traditional group [(87.30±6.06) vs. (81.50±5.88), P < 0.05]. The questionnaire shows that about 90% of the students think that flipped classroom can improve their interest in learning [96% (43/45)], improve their autonomous learning ability [89% (40/45)], and have better learning effect. At the same time, 78% (35/45) of students think that learning time is too long. Conclusion:The flipped classroom teaching model can improve the teaching participation of general surgery students, improve students' interest in learning, improve their self-learning ability, and improve students' thinking ability of medical record analysis.

Objective:To investigate the risk factors for delirium after intertrochanteric fracture surgery in the elderly.Methods:The data of 423 elderly patients with femoral intertrochanteric fracture were retrospectively analyzed who had been treated by closed reduction and internal fixation with proximal femoral nail antirotation (PFNA) at Department of Orthopedics, The Second Central Hospital of Baoding from December 2010 to April 2018. They were 205 males and 218 females, aged from 70 to 98 years (mean, 78.6 years). By AO classification, 239 fractures were type 31-A1, 141 ones type 31-A2, and 43 ones type 31-A3. Of them, 362 were complicated with disease of internal medicine. The interval from injury to surgery ranged from 4 to 72 hours with an average of 46.6 hours. The incidence of postoperative delirium was recorded. The risk factors were screened by univariate analysis from the hidden blood loss, gender, age, body mass index, complications, anesthesia method, preoperative preparation time and electrolyte disturbance; multivariate logistic regression analysis was used to determine the independent risk factors from the factors with P< 0.05. Results:Post-operative delirium occurred in 49 of the 423 patients (11.58%) (29 cases on the first postoperative day and 20 ones on the second postoperative day). It was not observed in the other 374 (88.42%) patients. Univariate analysis showed significant differences in the interval from injury to surgery, hidden blood loss and electrolyte disturbance between the patients with and without postoperative delirium ( P<0.05). Multivariate logistic regression analysis showed that the interval from injury to surgery >48 hours ( OR=3.386, 95% CI: 1.362 to 6.638), hidden blood loss>600 mL ( OR=10.292, 95% CI: 1.244 to 35.091) and electrolyte disturbance ( OR=4.157, 95% CI: 1.595 to 7.626) were the independent risk factors for postoperative delirium in elderly patients with intertrochanteric fracture. Conclusion:Long preoperative preparation, a large amount of hidden blood loss and postoperative electrolyte disturbance may be the risk factors for post-operative delirium in elderly patients with intertrochanteric fracture afterinternal fixation.

Objective To investigate therapeutic effect for older patients suffering from stroke sequela combined hip fracture and discuss the influence factors of prognosis.Methods The clinical data of 62 older patients suffering from stroke sequela combined with hip fracture were retrospectively analyzed.The therapy approach included the conservative treatment group (12 cases),the joint replacement group (18 cases) and the internal fixation group (32 cases).The data of the American association of anaesthetists (ASA) score,daily life activities ability index (Barthel life index),complications,mini-mental state examination (MMSE) scale score,proximal femur trabecular bone type index (Singh index),complications after fracture (infection,recurrent stroke,bedsore,deep vein thrombosis,heart failure) were collected and analyzed.Results There was no statistical significance in terms of age,gender,ASA grade,and complications among three groups.In the conservative treatment group,the joint replacement group,and the internal fixation group,the Bart index were (52.1 ± 11.4),(74.5 ± 21.3) and (63.8 ± 15.7) respectively,and the cases of postoperative complications were 10,3 and 13.There were significant difference in terms of Bart index and complication rate among the three groups (F =2.45,P ＜ 0.05 ; x2 =9.32,P ＜ 0.05).The differences of Singh index (x2 =11.05,P ＜ 0.05) and MMSE scale score (x2 =7.40,P ＜ 0.05) were statistically significant between the conservative treatment group and the two surgical treatment groups.No significant difference were found regarding of Singh index and MMSE scale score between the two surgical treatment groups.The relationship between ASA score,complication,MMSE scale score,treatment strategies and Bart index after fracture were found (OR =5.726,7.152,0.047,1.221,and 5.312 respectively ;P ＜ 0.05).Conclusion Joint replacement treatment is a preferred choice for older patients suffering from stroke sequela combined hip fracture.The prognosis is strongly influenced by the physical and mental state of patients.Comprehensive evaluation is an indispensable step to choose treatment strategies.

Objective To explore therapy effect of different operational strategy on tuberculosis of cacroiliac joint with anterior-posterior giant abscess.Methods Fifteen cases were selected as our subject,who suffered with tuberculosis of cacroiliac joint with anterior-pesterior giant abscess from Apr.2005 to Oct.2009.Seven cases underwent focus clearance merely through posterior approach whereas the other 8 cases received focus clearance through anterior-posterior combined approach.We followed-up the cases postoperatively and compared the status of ambi-operation period and tuberculosis' turnover.Results In the posterior approach group,operational periods was (1.9 ± 1.3) h,hemorrhage volume was (487 ± 225) ml,of which 3 cases suffered from abscess relapse postoperatively.In the combined approach group,operational periods was (3.6 ± 1.8) h,hemorrhage volume was (765 ± 538) ml,of which I cases suffered from sinus tract formation postoperatively.Conclusion For patient with tuberculosis of cacroiliac joint with anterior-posterior giant abscess,it has the less relapse rate of the anterior-posterior combined approach than posterior approach.