A 63-year-old female patient with esophageal cancer received tislelizumab monotherapy (intravenous infusion of 200 mg once every 21 days) after surgery. The patient had no disease history of chronic liver disease or diabetes mellitus. At day 39 after the fourth cycle of tislelizumab treatment, abnormal liver function was found, with alanine aminotransferase 494 U/L, aspartate aminotransferase 442 U/L, alkaline phosphatase 1 161 U/L, and total bilirubin 21.4 μmol/L. Then no further tislelizumab was given. After excluding liver injury caused by other reasons through liver pathological examination and relevant laboratory tests, it was considered to be related to tislelizumab. After giving methylprednisolone (32 mg/d orally) and liver protective treatments, the patient's liver function was gradually improved. After 2 weeks of treatment, the dose of methylprednisolone was reduced to 16 mg/d, and 2 weeks later, the patient's fasting blood glucose rose to 19.4 mmol/L. The dose of methylprednisolone was reduced to 8 mg/d. After 2 days, the blood glucose rose to 33.7 mmol/L, blood lactate 3.66 mmol/L, and urinary ketone (++++). Diabetic ketoacidosis was diagnosed and methylprednisolone was discontinued. The fasting and 2-hour postprandial serum insulin and C-peptide levels were significantly reduced, suggesting the damage of pancreatic islet function. Type 1 diabetes caused by tislelizumab was considered. After treatments such as insulin supplement and correcting acidosis, the patient's liver function was improved. At 8 months of follow-up, the patient's liver function returned to normal, but long-term insulin supplement was needed to control blood glucose.

A 63-year-old female patient with esophageal cancer received tislelizumab monotherapy (intravenous infusion of 200 mg once every 21 days) after surgery. The patient had no disease history of chronic liver disease or diabetes mellitus. At day 39 after the fourth cycle of tislelizumab treatment, abnormal liver function was found, with alanine aminotransferase 494 U/L, aspartate aminotransferase 442 U/L, alkaline phosphatase 1 161 U/L, and total bilirubin 21.4 μmol/L. Then no further tislelizumab was given. After excluding liver injury caused by other reasons through liver pathological examination and relevant laboratory tests, it was considered to be related to tislelizumab. After giving methylprednisolone (32 mg/d orally) and liver protective treatments, the patient's liver function was gradually improved. After 2 weeks of treatment, the dose of methylprednisolone was reduced to 16 mg/d, and 2 weeks later, the patient's fasting blood glucose rose to 19.4 mmol/L. The dose of methylprednisolone was reduced to 8 mg/d. After 2 days, the blood glucose rose to 33.7 mmol/L, blood lactate 3.66 mmol/L, and urinary ketone (++++). Diabetic ketoacidosis was diagnosed and methylprednisolone was discontinued. The fasting and 2-hour postprandial serum insulin and C-peptide levels were significantly reduced, suggesting the damage of pancreatic islet function. Type 1 diabetes caused by tislelizumab was considered. After treatments such as insulin supplement and correcting acidosis, the patient's liver function was improved. At 8 months of follow-up, the patient's liver function returned to normal, but long-term insulin supplement was needed to control blood glucose.

OBJECTIVE To explore the intestinal absorption characteristics of saikosaponins. METHODS Based on everted intestinal sac model， using accumulative absorption amount （Q） and absorption rate constant （Ka） as indexes， UHPLC-MS/MS technique as a method， the absorption of saikosaponin A， B2， C， D and F from total saponins of Bupleurum chinense （8 g/mL， by crude drug） in the duodenum， jejunum and ileum was detected. RESULTS The correlation coefficients （r） of the regression equations for the absorption of saikosaponins A， B2， C and F in the duodenum， jejunum and ileum were all higher than 0.95， while the r of saikosaponin D in the above intestinal segments was lower than 0.95； compared with the absorption of the same composition in the duodenum， the Q and Ka of saikosaponin A and C circulating in jejunum and ileum for 120 min， as well as the Q and Ka of saikosaponin F circulating in the ileum for 120 min were significantly decreased （P＜0.05）. CONCLUSIONS Saikosaponin A and the other 4 saikosaponins are all absorbed in the duodenum， jejunum and ileum； among them， saikosaponin A， B2， C and F are linearly absorbed， which conforms to the zero-order absorption characteristics， but saikosaponin D shows non- linear absorption.

Objective To study the anatomical characteristics of the medial sural vessels and the clinical effects of treatment for leg skin and soft tissue defect with free flaps.Methods 6 adult lower limbs were treated by latex perfusion and then observed the origin of the blood supply to gastrocnemius muscle,measure the number of the arteries and veins,the length and diameter of the medial sural vessels.From July 2009 to May 2013,15 clinical cases of serious skin and soft tissue defect were repaired by using free flap with medial sural vessels.The areas of wound surface were ranging from 13 cm × 7 cm-24 cm × 12 cm.10 of them were treated by anterolateral thigh flap,the other of them were treated by latissimus dorsi flap.The donor site were directly sutured or repaired by free skin graft.Results The blood supply of gastrocnemius mucle was multifocal.The medial sural arteries and lateral sural arteries were both origin from popliteal artery.The medial sural vessels include 1 artery and 2 veins.With the length 4-7 cm (average,5.4 cm),the arterial diameter of the origin 2.6-2.9 mm (average,2.7 mm) and the entry point 1.9-2.3 mm (average,2.1 mm),the vein diameter of the origin 1.8-2.2 mm (average,2.0 mm)and the entry point 2.7-3.4 mm(average,2.9 mm).Totally 15 cases flaps were survived with primary healing.The mean follow-up period was 16.5 months(range,11-21 months),The flaps had satisfactory appearance,soft texture,good elasticity and achieved protective sensation at the last followed-up.Conclusions The medial sural vessels are with constant anatomical position,deeply position,hardly damage,long pedicle.Thus,the medial sural vessels combine with free flap is an good choice for the reconstruction of leg skin and soft tissue defect.

Objective To study the anatomical characteristics of the medial sural vessels and the clinical effects of treatment for leg skin and soft tissue defect with free flaps.Methods 6 adult lower limbs were treated by latex perfusion and then observed the origin of the blood supply to gastrocnemius muscle,measure the number of the arteries and veins,the length and diameter of the medial sural vessels.From July 2009 to May 2013,15 clinical cases of serious skin and soft tissue defect were repaired by using free flap with medial sural vessels.The areas of wound surface were ranging from 13 cm × 7 cm-24 cm × 12 cm.10 of them were treated by anterolateral thigh flap,the other of them were treated by latissimus dorsi flap.The donor site were directly sutured or repaired by free skin graft.Results The blood supply of gastrocnemius mucle was multifocal.The medial sural arteries and lateral sural arteries were both origin from popliteal artery.The medial sural vessels include 1 artery and 2 veins.With the length 4-7 cm (average,5.4 cm),the arterial diameter of the origin 2.6-2.9 mm (average,2.7 mm) and the entry point 1.9-2.3 mm (average,2.1 mm),the vein diameter of the origin 1.8-2.2 mm (average,2.0 mm)and the entry point 2.7-3.4 mm(average,2.9 mm).Totally 15 cases flaps were survived with primary healing.The mean follow-up period was 16.5 months(range,11-21 months),The flaps had satisfactory appearance,soft texture,good elasticity and achieved protective sensation at the last followed-up.Conclusions The medial sural vessels are with constant anatomical position,deeply position,hardly damage,long pedicle.Thus,the medial sural vessels combine with free flap is an good choice for the reconstruction of leg skin and soft tissue defect.