Programmed death protein 1 (PD-1) and programmed death protein ligand-1 (PD-L1) play pivotal roles in maintaining immune homeostasis and a crucial link in tumour immune evasion. PD-1/PD-L1 inhibitors have achieved significant efficacy in many cancer immunotherapy, but the effect in the treatment of pancreatic cancer is limited, and the effect of monotherapy is suboptimal. The combined therapeatic effect of PD-1/PD-L1 and chemotherapy, radiotherapy, and molecular targeted therapy were explored. This article summarises the advancements in PD-1/PD-L1 inhibitor combination therapy in the treatment of pancreatic cancer.

Objective:To discuss the clinical efficacy of treating lumbar muscle strain(LMS)with Tuina(Chinese therapeutic massage)plus Chinese medication hot compress. Methods:A total of 147 LMS patients were randomized into a Tuina group,a Chinese medication hot compress group,and a combined group,each consisting of 49 cases.The Tuina group received Tuina treatment;the Chinese medication hot compress group received Chinese medication hot compress treatment;and the combined group received the forementioned two therapies alternately.The three groups of patients were assessed using the visual analog scale(VAS)and Oswestry disability index(ODI)before treatment and after 2 weeks of treatment.A 2-month follow-up was also conducted to observe the relapse rate. Results:The VAS and ODI scores dropped significantly after treatment in all three groups compared with their baseline(P<0.05),and the combined group surpassed the other two groups in comparing the ODI score(P<0.05).The 2-month follow-up showed that the combined group had the lowest relapse rate among the three groups(P<0.05). Conclusion:Compared to each therapy used alone,Tuina plus Chinese medication hot compress can relieve pain,improve daily living function,and reduce the short-term relapse rate better in treating LMS patients.

【Objective】 To evaluate the association between prophylactic plasma transfusion and postoperative bleeding rate in critically ill patients undergoing different invasive procedures. 【Methods】 The information of ICU patients who received different invasive procedures from January 2019 to December 2019 in 6 tertiary hospitals in China were retrospectively investigated. The inclusion criteria of patients were as follows: age ≥ 18 years; received invasive procedures; INR ≥ 1.5 within 72 hours before surgery. Exclusion criteria were patients with incomplete case records. The patients finally included in the study were divided into prophylactic plasma transfusion group and non-prophylactic plasma transfusion group according to their plasma transfusion status. The outcome variable was the incidence of invasive procedure-related bleeding within 48 hours after different invasive procedures. 【Results】 A total of 407 patients underwent invasive procedures, and 362 patients were finally included in this study after excluding 45 patients with incomplete case records. The proportions of prophylactic plasma transfusion in different types of invasive procedures were central venous catheterization (46/146, 31.5%), thoracentesis (13/37, 35.1%), bronchoscopy (8/31, 25.8%), tracheal intubation (9/38, 23.7%), arterial catheterization (9/50, 18.0%) and others (13/60, 21.7%). The bleeding rates showed that different invasive procedures presented no statistical difference between the groups received plasma transfusion or not. In the prophylactic plasma transfusion group, the bleeding rate of arterial catheterization (4/9, 44.4%) was the highest, but all were potential bleeding, followed by tracheal intubation (4/10, 40.0%) and central venous intubation (16/46, 34.8%), with a higher rate of significant bleeding. 【Conclusion】 Prophylactic infusion of plasma did not reduce the bleeding rate after different invasive procedures, but prospective studies are needed to further confirm the conclusion; this study also provides a certain data basis for later prospective studies.

Sepsis is divided into sepsis, severe sepsis and septic shock according to the severity. The severe sepsis and septic shock can lead to multiple organ dysfunction syndrome, which is life-threatening. In the early stage of sepsis, catabolism is obviously. Early enteral and parenteral nutrition should actively correct nutrients and vitamin deficiency, and provide the best low protein and moderate amount of non-protein calories. In the recovery period, the body needs enough protein and calories. In different periods of sepsis, patients have different nutritional needs. Therefore, mastering the nutritional support treatment for the sepsis is extremely important for the prognosis of patients.

Objective: To discuss the misdiagnosis of pyriform sinus fistula and to better understand this kind of illness. Methods: The analysis was based on twenty-eight patients with congenital pyriform sinus fistula aged from 11 months to 14 years, with the median age of 5 years, and who were surgically treated from January 2013 to January 2017 in Kunming Children′s Hospital.Twenty patients were misdiagnosed in other hospital.After the routine examination of neck ultrasound and enhanced CT, internal fistula was found by self-retaining laryngoscope, traced by methylene blue, and excised by high ligation. Results: Twenty patients were misdiagnosed.The misdiagnosis time ranged from 6 months to 3 years.Under self-retaining laryngoscope, piriform fossa fistula were found in all patients.Nineteen fistula were found in the left and 1 in the right.The fistula in patients was unilateral.Seven cases were misdiagnosed as suppurative lymphadensitis, undergone abscess incisional drainage many times.Three cases were misdiagnosed as thyroglossal duct cyst and performed excision of thyroglossal duct cyst.One case was treated by extended Sistruck operation again because the doctor considered that excision of middle segment of hyoid bone was not enough and the fistula was not ligated completely.One case was misdiagnosed as second branchial cleft fistula on the right side of the neck.Nine cases were misdiagnosed as hyroid-associated diseases including 2 cases suppurative thyroiditis, 2 cases subacute thyroiditis and 5 cases thyroid neoplasms.Among them, 2 cases underwent partial thyroidectomy.All the patients were treated with high ligation of fistula under general anesthesia.The operation was smooth, and no hoarseness, bucking and pharyngeal fistula occurred after the operation.Postoperative follow-up time ranged from 12 months to 4 years and the median follow-up was 18 months without recurrence.The diagnosis was confirmed pathologically. Conclusions Pyriform sinus fistula in children was uncommon and easily misdiagnosed in clinic.The majority of physician including some otolaryngologists were lack of understanding of the disease.It should be regarded as one of the important differential diagnosis of neck mass in children.Children with recurrent left neck infection and/or abscess should be highly suspected.Self-retaining laryngoscopic examination can make a definite diagnosis and high ligation of the fistula through the external neck approach can achieve good therapeutic effect.

Objective To verify the expression of long non-coding RNA(LncRNA) TCONS_00023867 in pancreatic cancer tissue and cells,and to explore its effects on cell proliferation,invasion and migration in pancreatic cancer cells.Methods The expression of lncRNA TCONS_00023867 in human pancreatic cancer tissues,adjacent non-cancer tissues,pancreatic cancer cells(Capan-2,AsPC-1,BxPC-3,MIAPaCa-2,PANC-1) and pancreatic normal duct epithelial cell (HPDE6c-7) was detected by quantitative real-time PCR (qRT-PCR).LncRNA TCONS_00023867 over-expression plasmid and its control plasmid PEX-3 were transfected in Capan-2 and PANC-1 cells.Then,the abilities of cell proliferation,invasion and migration were determined by using clone formation assay,CCK-8 assay and Transwell assay,respectively.Furthermore,the expression of p53 protein was examined by Western blot.Results The expression of IncRNA TCONS_00023867 in pancreatic cancer tissues was significantly lower than that in the matched adjacent pancreatic cancer tissue(△Ct value 13.64±0.55vs 8.64± 0.38,P＜0.001).Over-expression of TCONS_00023867,the experimental plate clone count of Capan-2 and PANC-1 cells were respectively lower than that in the empty plasmid vector PEX-3 group (181.3±4.667 vs 227.3± 9.207,P=0.011 2),(86.0±4.933 vs 167.2±2.603,P=0.000 1).The proliferation ability of Capan-2 and PANC-1 was significantly reduced compared with that of the empty plasmid vector PEX-3 group.The migration ability of Capan-2 and PANC-1 was significandy reduces compared with that of the group of empty plasmid vector PEX-3 (57.6±6.809 vs 124.6±8.548,P=0.003),(47.40±7.061 vs 105.2±10.28,P=0.001 7).The invasion ability of Capan-2 and PANC-1 was significantly reduced compared with that of the empty plasmid vector PEX-3 group (46.0± 5.033 vs 120.7±7.055,P=0.001),(64±8.327 vs 118.0±11.53,P=0.019 2).Through western blot experiment,the expression of p53 in Capan-2 and PANC-1 was higher than that in the group of empty plasmid vector PEX-3 (2.192± 0.077 3 vs 1.007±0.018 8,P=0.000 1),(1.816±0.163 vs 0.988±0.012 16,P=0.007 2).Conclusions The level of TCONS_00023867 is decreased in pancreatic cancer tissues and cells.Overexpression of TCONS_00023867 decreases cell proliferation,invasion and migration in pancreatic cancer ceils through increasing the level of p53.

Objective To evaluate the safety and efficacy of laparoscopic distal pancreatectomy in treatment of insulinoma.Methods Clinical data of 8 cases of insulinoma treated by laparoscopic distal pancreatectomy from Apr.2015 to Apr.2017 were retrospectively reviewed.Results Locations of the insulinoma in distal pancreas were all identified preoperatively by enhanced CT,MRI or somatostatin receptor scintigraphy (SRS).Laparoscopic distal pancreatectomy was applied to 8 cases,including combined splenectomy to 1 case.The operation time,bleeding volume,and postoperative hospital stay was (159±44) min,(125±119) ml and (5.5±1.4) days,respectively.Grade B fistula happened to one patient after surgery.The level of postoperative blood glucoses was normal in all cases.Conclusion Laparoscopic distal panreatectomy is safe,effective,and less invasive in treating insulinoma,with quick recovery and high efficacy in spleen preservation.

To investigate the changes in the expression levels of scavenger receptor class B member 1 (SCARB 1) in the liver tissues before and after liver xenotransplantation and analyze the relationship between the variations in the SCARB1 expression and coagulation regulating dysfunction in the recipients.Methods The Wuzhishan miniature pig with α-1,3-galactosyltransferase gene-knockout(GTKO) was utilized as the donor and Macaca thibetana was chosen as the recipient.Heterotopic auxiliary liver xenotransplantation models were established.The liver tissue specimen was collected before and after liver xenotransplantation.Primary hepatocytes were extracted from the pig using collagenase digestion method.Human peripheral blood mononuclear cells were obtained by immunomagnetic bead sorting.These two types of cells were co-cultured and supplemented with human plasma to establish cell models with coagulation regulating dysfunction following liver xenotransplantation.Quantitative real-time reverse transcription polymerase chain reaction (qRT-PCR) and Western blot were performed to quantitatively measure and statistically compared the expression levels of messenger ribonucleic acid (mRNA) and protein of SCARB1 in the tissue and cell samples.At the cellular level,the expression of SCARB 1 was interfered by lentiviral vector.The coagulation time was detected to validate the effect upon coagulation function.Results The expression levels of SCARB1 mRNA and protein were significantly down-regulated after liver xenotransplantation (both P＜0.05).In the cell models,the expression levels of SCARB1 mRNA and protein in the porcine hepatocytes co-cultured with human monocytes were significantly down-regulated compared with those in porcine hepatocytes without intervention (both P＜0.05).Compared with the non-intervention group,the coagulation time was significantly prolonged after the expression of SCARB1 was interfered by lentiviral vector (P＜0.05).Conclusions The down-regulated expression of SCARB1 in the liver graft is one of the main causes of mediating coagulation regulating dysfunction.Intervention of SCARB1 expression contributes to resolve the coagulation regulating dysfunction in the recipients after liver xenotransplantation.

Objective To investigate the correlation of CT image features of mesenteric fibromatosis and its pathological characteristics.Methods Data of 12 mesenteric fibromatosis proved histopathologically in PLA General Hospital and Jiangsu Taizhou People's Hospital from March 2006 to March 2015 were retrospectively reviewed.Results There were 5 males and 7 females with ages ranging from 13 to 67.On the CT image,the masses varied from 3.9 cm to 33.0 cm in diameter.8 of them were round or oval well-circumscribed masses,and 4 were irregular with blurry border.10 of 12 cases were totally similar density,which was ranged from 27 HU to 39 HU.Contrast enhanced CT scan showed moderate enhancing masses in l0 of 12 cases.Macroscopic examination of these specimens revealed that the sections of 11 were solid,firm,grey and yellowish,and 1 was solid-cystic.On the histopathology,the masses consisted of homogeneous spindle shaped fibroblasts,myofibroblasts and collagen.Tumor cells were embedded in a collagen network interrupted by fibrotic sections.Immunohistochemical analysis revealed that the tumor cells expressed Vimentin,H-caldesmon and β-catenin.Conclusions Mesenteric fibromatosis is a rare disease with characteristic CT images,which were based on their pathological characteristics.CT images form the basis of preoperative diagnosis of this disease.