Endometrial cancer(EC)is one of the common malignant tumors of the female reproductive system,and the conventional treatment methods including surgery and radiochemotherapy have a limited therapeutic effect.CD8+T cells are the main effector cells in tumor microenvironment(TME)and are also the main target cells for immunotherapy that have emerged in recent years.This article briefly elaborates on the cytotoxic effect of CD8+T cells in TME through the three pathways of the perforin-granzyme pathway,the FAS pathway,and the secretion of cytokines,and the changes in the peripheral environment of patients with EC may affect the functions of CD8+T cells.This article also summarizes the application of CD8+T cells as the targets for EC treatment,in order to provide new ideas for clinical treatment.

Lynch syndrome (LS) is a common hereditary tumor syndrome. Gynecological malignancy is usually the first tumor of LS in women, and endometrial cancer (EC) is the most closely associated with LS. Most patients with LS are unaware of this risk, and it is possible to cause misdiagnosis. Thus, early diagnosis helps patients to start tumor surveillance timely, as well as a cascade of family surveillance. This paper reviews the progress of LS associated with EC.

【Objective】 To investigate the relationship between the level of thrombin-antithrombin complex (TAT)/α2-plasmin inhibitor-plasmin complex (PIC) and the utilization rate of mechanical ventilation (MV) in critically ill patients. 【Methods】 For the cross-sectional study, adult patients who had been admitted to the intensive care unit (ICU) for one day or longer and had a record of the first four tests for thrombosis were enrolled. Age, gender, the results of TAT and PIC, disseminated intravascular coagulation score, treatment, and diagnostic information were retrospectively collected from the hospital information system and laboratory information system. Logistic regression model was used to explore the relationship between TAT/PIC and the MV utilization rate. Interaction analysis and subgroup analysis were conducted to explore whether there was any difference between patients with different age and gender, patients with/without DIC, and with/without infection. 【Results】 A total of 1 176 patients were enrolled in this study. The median of the first TAT/PIC was 15.84 (8.13-33.11) in all the patients. The multivariable Logistic regression model results showed that for every 5 increase in TAT/PIC, the possibility of using MV increased by 2.9% (OR=1.029, 95% CI: 1.008-1.050), and the possibility of using MV in Q3 patients was 1.566 times than that in Q1 patients (OR=1.566, 95% CI: 1.095-2.239); the possibility of using MV in Q4 patients was 2.457 times than that in Q1 patients (OR=2.457, 95% CI: 1.694-3.563). Interaction results showed that the relationship between the level of TAT/PIC and MV usage was different in patients with and without infection (Pinteraction=0.02). Further subgroup analysis showed that in the infected patients (674 cases), the possibility of using MV increased by 5.9% for every 5 increase in TAT/PIC (OR=1.059, 95% CI: 1.022-1.097, P=0.001), while there was no significant difference between different TAT/PIC and MV usage in non-infected patients (502 cases) (OR=1.012, 95% CI: 0.984-1.040, P=0.405). 【Conclusion】 There is a correlation between the level of TAT/PIC and mechanical ventilation in patients with infection in the ICU.

Objective To study the gradual-onset rate (GOR)mode on human centrifuge G-tolerance determination and the applications in pilot selection and training. Methods Twenty-five pilots were undertaken the G-tolerance examination under centrifuge GOR operating mode and completed high G centrifuge training at +8.0 Gz level for 10 s.The pilots were divided into excellent group (n=1 3),good group (n=7 )and mediocre group (n=5 )by the high G training result.The pilots, G-tolerance under GOR mode and the anti-G effect of performing HP maneuver were analyzed. Results Under GOR mode pilots, strained tolerance (GOR2 )was significantly higher than their relaxed tolerance (GOR1 )(t=1 4.420,P=0.000 ).The differences on GOR1 tolerance and HP maneuver anti-G effect were not significant among different groups (F=2.593,0.1 76,P>0.05).The GOR2 tolerance of excellent group was significantly higher than that of other 2 groups (P<0.05). There was no significant difference on GOR2 tolerance among groups (P>0.05). Conclusions The G-tolerance and the effect of performing anti-G straining maneuver could be precisely and conveniently evaluated with GOR mode.It is necessary to establish the G-tolerance examination method and assessment criterion under centrifuge GOR mode for the G tolerance determination and training of high performance fighter aircraft pilot.

Objective To study the gradual-onset rate (GOR)mode on human centrifuge G-tolerance determination and the applications in pilot selection and training. Methods Twenty-five pilots were undertaken the G-tolerance examination under centrifuge GOR operating mode and completed high G centrifuge training at +8.0 Gz level for 10 s.The pilots were divided into excellent group (n=1 3),good group (n=7 )and mediocre group (n=5 )by the high G training result.The pilots, G-tolerance under GOR mode and the anti-G effect of performing HP maneuver were analyzed. Results Under GOR mode pilots, strained tolerance (GOR2 )was significantly higher than their relaxed tolerance (GOR1 )(t=1 4.420,P=0.000 ).The differences on GOR1 tolerance and HP maneuver anti-G effect were not significant among different groups (F=2.593,0.1 76,P>0.05).The GOR2 tolerance of excellent group was significantly higher than that of other 2 groups (P<0.05). There was no significant difference on GOR2 tolerance among groups (P>0.05). Conclusions The G-tolerance and the effect of performing anti-G straining maneuver could be precisely and conveniently evaluated with GOR mode.It is necessary to establish the G-tolerance examination method and assessment criterion under centrifuge GOR mode for the G tolerance determination and training of high performance fighter aircraft pilot.

Objective To investigate the effects of small interfering RNA (siRNA) CXCR4 gene on proliferation, invasion and epithelial-mesenchymal transition factors including Twist, Slug and E-cadherin (E-cad)in HeLa cells of human cervical carcinoma.Methods HeLa cells were cultured in vitro and CXCR4-siRNA was transfected into HeLa cells. Methyl thiazolyl tetrazolium (MTT) assay was used to detect the changes of cell proliferation. Transwell experiment was used to observe the changes of cell invasion, and the expressions of CXCR4,Twist,Slug and E-cad protein were detected by Western blot.Results Compared with the blank control group and the negative control group,CXCR4-siRNA transfected into HeLa cells significantly inhibited the expression of CXCR4 protein (0.959±0.197, 0.932±0.141 vs. 0.379±0.022 respectively; F=16.286, P =0.004). MTT results showed that the proliferation of HeLa cells was inhibited at 48 h and 72 h (48 h: 0.846 ± 0.034, 0.823 ± 0.025 vs. 0.744 ± 0.039, F = 7.379, P= 0.024; 72 h: 0.996±0.026, 0.964± 0.059 vs. 0.829±0.051, F = 10.425, P= 0.011). Transwell results showed that the invasiveness of HeLa cells in CXCR4-siRNA group was inhibited at 48 h and 72 h(cell membrane number,48 h:37.4±8.1,33.6±6.2 vs.25.4 ±3.2, F = 4.830, P= 0.029. 72 h: 48.4 ±7.6, 43.0 ±5.4 vs. 33.4 ±6.7, F = 6.579, P= 0.012). After transfection for 48 h, the expression of Twist and Slug protein was decreased and E-cad protein was increased in CXCR4-siRNA group (Twist: 0.93±0.11, 1.00±0.17 vs. 0.53±0.07, F = 10.962, P= 0.010; Slug: 0.515± 0.084,0.470±0.055 vs.0.190±0.028,F =25.579,P=0.001;E-cad:0.53±0.04,0.55±0.24 vs.1.11±0.14,F =12.494, P= 0.007). Conclusions Silencing CXCR4 gene can inhibit the proliferation and reduce the invasiveness of HeLa cells. Inhibiting EMT of HeLa cells can be achieved by down-regulating the expressions of Twist and Slug protein,and up-regulating the expression of E-cad.

Objective To investigate the clinical features and treatment of solid pseudopapillary neoplasm (SPN) of the pancreas.Methods The retrospective cross-sectional study was conducted.The clinicopathological data of 69 patients with SPN of the pancreas who were admitted to the Qilu Hospital of Shandong University from January 2012 to July 2017 were collected.Serum tumor markers detection,enhanced computed tomography (CT) and magnetic resonance imaging (MRI) of abdomen were carried out preoperatively for all the patients,and a part of the patients received endoscopic ultrasonography (EUS).Surgery plans were formulated after completion of examinations.Observation indicators:(1) clinical features;(2) treatment situation;(3) results of pathological examination;(4)follow-up.All the patients were followed up via outpatient examination and telephone interview to detect the survival and tumor recurrence and metastasis till July 2017.Measurement data with normal distribution were presented by (x)±s and were compared by Student's t test.Count data were compared by chi-square test.Results (1) Clinical features:① epidemiologic features:the ratio of male to female was 1∶5.9;patients were aged between 9 and 65 years,including 40 under 30 years and 29 above or equal to 30 years.The onset age was (34± 15)years for male patients and (28 ± 11)years for female patients,respectively,with no statistically significant difference (t=1.364,P＞0.05).Of 69 patients,SPN was located at pancreatic uncinate process in 25 patients,at neck of pancreas in 12 patients,body and tail of pancreas in 32 patients.② Medical history:history of acute or chronic pancreatitis and abdominal trauma were denied by all the 69 patients.③ Clinical manifestation:26 patients had no obvious symptoms and were detected by physical examination;31 patients had discomfort in upper abdomen,nausea and vomiting;other patients were admitted to the hospital because of upper abdominal mass (10 patients),jaundice (1 patient) or nausea,constipation (1 patient).④ Laboratory examination:the levels of preoperative carcinoembryonic antigen (CEA) and CA19-9 were normal.⑤ Imaging examination:plane scan of the CT examination showed round or round-like low-density shadows in the 69 patients,including 51 of cystic solid lesion,13 of solid lesion and 5 of cystic lesion.Complete capsules were observed in 64 patients,blurred boundary between pancreas and adjacent viscera in 5 patients,calcified foci in the pancreatic parenchyma and capsules in 14 patients.Ten patients received MRI examination,and the T1-weighted images showed equal or slightly lower signal,T2-weighted images showed slightly higher signal in the plane scan,and T1-weighted and T2-weighted images of the tumor capsule showed continuous or non-continuous ring-like signal.The results of enhanced scan showed slightly heterogeneous enhancement of the capsule and the parenchyma of the pancreas in the arterial phase,and progressive enhancement in the venous and delayed phase,while the enhancement degree was lower than that of the normal pancreas parenchyma.The parenchyma was cloud-,papillaor mural nodule-like enhanced.Obvious enhancement was observed in capsule while not in the cystic components.The boundaries of the tumors in 5 patients were clear under EUS.Hypo-,iso-and hyperechoic regions were found in the masses,and the masses were confirmed as cyst-solidary type.Obvious calcified foci were found in 1 patient.(2) Treatment outcome:twenty-seven patients received laparoscopic surgery,including tumor expiration in 13 patients,distal pancreatectomy with preservation of spleen in 8 patients,distal pancreatectomy combined with splenectomy in 2 patients,middle pancreatectomy in 2 patients,pancreaticoduodenectomy with preservation of pylorus in 1 patient,pancreatic head resection with preservation of duodenum under the assistance of laparoscopy in 1 patient.Forty-two patients received open surgery,including tumor expiration in 12 patients,distal pancreateetomy with preservation of spleen in 10 patients,distal pancreatectomy combined with spleneetomy in 6 patients,middle pancreatectomy in 5 patients,pancreaticoduodenectomy in 7 patients (with preservation of pylorus in 2 patients) and pancreatic head resection combined with preservation of duodenum in 1 patient.One patient with SPN + hepatic metastasis received distal pancreatectomy+ metastatic foci resection in the lesser omental bursa,and then followed by radiofrequency ablation in the hepatic metastatic foci.Postoperative complications:21 of 69patients had postoperative complications,including 17 intestinal fistulas,2 abdominal bleedings,1 incomplete obstruction,1 pleural effusion + atelectasis,and all of them were cured by symptomatic treatment.(3)Pathological examination:the resection margins of 69 patients were negative.The mean diameter of the tumor was (7±4) cm (21 patients with tumor diameter ＜ 5 cm,and 48 with tumor diameter ≥5 cm).The tumor diameters of 4 in 10 male patients were above or equal to 5 cm,and the number was 44 in 59 female patients,with statistically significant difference (x2 =4.828,P＜0.05).The tumor diameters of 32 in 40 patients who aged under 30 years were above or equal to 5 cm,and the number was 16 in 29 patients who were aged above or equal to 30 years,with statistically significant difference (x2=4.895,P＜0.05).Solid,pseudo-papillary and cystic regions in the SPN tissues were seen under the light microscope.Tumor cells were surrounded the blood vessels and were arranged in the nest or sheet shape in the solid region;blood vessels were surrounded by one or multiple layers of tumor cells in the axis or pseudopapillary shape in the pseudopapillary region;large amount of mucus and clusters of blood cells were seen in the cystic regions.The result of immunohistochemistry showed that the positive rates of α1-antitrypsin,vimentin,β-catenin,progesterone receptor,CD10,synaptophysin and chromogranin A were 100.0％ (39/39),96.6％ (28/29),95.7％ (45/47),94.4％ (51/54),92.5％ (49/53),72.9％ (35/48) and 5.6％ (3/54),respectively.(4) Follow-up:63 of 69 patients were followed up for 1-68 months,with median time of 29 months.No SPN recurrence or metastasis was detected.One patient died of lung cancer at postoperative month 35 and other patients survived well.Conclusions SPN of pancreas is mostly detected in young female patients,and it could be solid or cystic.Abdominal enhanced CT or MRI examination could clarify the diagnosis.EUS-fine needle aspiration examination could provide pathological evidence for definitive diagnosis.Typical cellular morphology and pseudopapillary regions may provide hints for the diagnosis of SPN,and the diagnosis could be clarified when combined with the detection of vimentin,α 1-antitrypsin or other indexes.Complete resection of SPN and ensure negative resection margin are fundamental principles of treatment.

Objective To analyze and discuss the status of fighter pilots' centrifuge training,to investigate the pilots' G tolerance and to provide reference for training program improvement.Methods One thousand and one hundred ninety-nine fighter pilots' human centrifuge training data were collected and analyzed by cross-sectional study.Pilots were classified by the training purposes that were for aeromedical qualification and competitive assessment.The up-to-standard rates were compared upon the analysis of pilots' training performance.Results In 877 pilots for aeromedical qualification,594 completed the runs of 8 G for 10 s,106 completed 9 G for 10 s.The qualification rate was 79.1％.In 180 high performance fighter pilots selected for competitive assessment,141 completed the runs of 9 G for 10 s.The qualification rate was 78.3％.In 142 second generation fighter pilots selected for competitive assessment,140 completed the runs of 7 G for 10 s.The qualification rate was 98.6％ which was significantly greater than that of the pilots for aeromedical qualification (x 2 =31.141,P ＜ 0.01) and high performance fighter pilots selected for competitive assessment (x 2 =29.318,P＜0.01).There was no difference on qualification rate between the latter two groups (x2 =0.058,P ＞0.05).The incidence of G-LOC and A-LOC was 5.0％ and 2.7％ respectively.The incidences of G-LOC (x2 =4.983,P＜0.05) and A-LOC (x2 =7.528,P＜0.05) of the pilots selected for competitive assessment were significantly greater than those of the pilots for aeromedical qualification.In 1 199 pilots,only 2 pilots (0.17％) had severe acute lumbar sprain.Conclusions Advanced anti-G methods have been adopted in our centrifuge training.The incidences of G-LOC and spinal injury induced by centrifuge training are low.The training program still needs further development and the training effectiveness should be improved.

Objective To investigate the therapeutic effects of hyperbaric oxygen (HBO) coupled with acupuncture at "Qiansiguan"on the patients with insomnia.Methods Eighty-nine patients with insomnia who received treatment in the hospital from November 2013 to November 2016 were selected as research subjects . The patients were randomly divided into the simple acupuncture group or the control group (n =44) and the combined treatment group (n =45).The simple acupuncture group received acupuncture at "Qiansiguan", while the combined treatment group was treated with HBO , in addition to acupuncture at "Qiansiguan".After 28 days of treatment, therapeutic effects, sleep quality and adverse reactions were compared between the patients of the 2 groups.Results The cure rate (13 /45) and total effective rate (93.3％) of the combined treatment group were significantly higher than those of the control group (3/44, 65.9％), and statistical significance could be noted, when comparisons were made between the 2 groups (P <0.05).After 14 and 28 days of treatment, the total scores of Pittsburgh sleep quality index (PSQI)for the combined treatment group were obviously lower than those of the simple acupuncture group , with statistical significance (P <0.05).Of the PSQI scores for the combined treatment group , the scores of falling asleep time, sleep duration, sleep efficiency, sleep disorder, sleep quality and daytime function for the combined treatment group were all significantly lower than those for the control group , also with statistical significance (P <0.05).There was no statistical significance in the incidence of drowsiness , dizziness, xerostomia, headache and other adverse reactions, when comparisons were made between the 2 groups (P >0.05).Conclusions HBO combined with acupuncture at "Qiansiguan"could produce effective therapeutic results in the treatment of insomnia and obviously improve sleep quality of the patients .For this reason, it was worth further clinical popularization .

Objective To investigate the effects of hyperbaric oxygen (HBO) coupled with electrical stimulation at Neikuan Luo-Connecting point for promotion of conscious recovery in the patients with severe coma.Methods One hundred and twenty-eight cases of severe coma for a month and with Glasgow coma scale (GCS) scores of 3-8 were recruited as study subjects.The patients were divided into the treatment group and the control group in accordance with different treatment methods,each consisting of 64 subjects.The control group received conventional therapy plus electrical stimulation at Neikuan Luo-Connecting point,while the treatment group received conventional therapy and electrical stimulation at Neikuan Luo-Connecting point plus HBO with the therapeutic pressure at 0.2 MPa (2.0 ATA).After 5 consecutive treatment courses,GCS scores were assayed and EEG detections were made in the patients of the 2 groups,and then therapeutic results were evaluated and compared.Results GCS scores for the treatment group and the control group were respectively (11.15 ± 1.52) and (8.95 ± 1.32),and statistical significance could be seen when comparisons were made between the 2 groups (P ＜ 0.05).Conclusions HBO coupled with electrical stimulation at Neikuan LuoConnecting point in the treatment of patients with severe coma could obviously improve brain electrical activity and displayed good effect on the promotion of conscious recovery.