Pancreatic cancer is a highly malignant disease in the digestive system.So far,surgical resection is still the primary treatment for pancreatic cancer,but only about 20% of pancreatic cancer patients can be treated with surgery.Even with comprehensive treatment measures such as surgery,radiotherapy and chemotherapy,biological therapy,and targeted therapy,the overall survival rate of pancreatic cancer patients has not been significantly improved in the past ten years.In recent years,immunotherapy has made breakthroughs in tumor treatment.Cancer immunotherapy has now been recognized as the fourth pillar of cancer treatment alongside surgery,radiotherapy,and chemotherapy.There are also many studies in the treatment of pancreatic cancer,but the results are not satisfactory.This article reviews the current status and possible prospects of immunotherapy for pancreatic cancer.

The deficiency disease of 5αreductase 2 is a common genetic disease of AR,which karyotype is 46,XY.As the boy patients were born,some abnormity in various degrees would occur on the majority of their external genitalia.Blurring of external genitalia or being similar to female phenotype is the most common phenomenon.Also,being close to normal external genitalia of male phenotype could be found.Some patients would visit a doctor on account of diminutive penis or maldevelopment of gonad.The boy patients who have the deficiency disease of 5αreductase 2 with diminutive penis would be inclined to be misdiagnosed or never diagnosed.Thus,the time for treatment would always be delayed.The article is a summary of genotype characteristics、pathogenesis、clinical feature、diagnostic basis and progress of treatment in allusion to the deficiency disease of 5αreductase 2 with diminutive penis.

Objective：To explore the diagnosis and treatment of antepartum mastitis.Methods：The clinicopathological，operative and followup data of 23 cases of antepartum mastitis were retrospectively analyzed.Results：The clinical and pathological data of all the 23 patients were complete.All patients had received core biopsy in the outpatient department.Among the 14（60.8%）patients treated with antibiotics alone，4（17.4%）patients had complete response after antibiotic treatment，6（26.1%）patients had abscess  during treatment，2（8.7%）patients had no significant remission，and 2（8.7%）patients underwent radical surgery after symptom aggravation.Abscess formation was found in 9（39.1%）patients at the initial diagnosis，and a total of 15（65.2%）patients underwent abscess incision and drainage with small incision.Postoperative complications such as hemorrhage and recurrent infection were not found in any patients.All patients gave birth normally，without premature birth，abortion，overdue birth，deformed baby，etc.，and the fetus was healthy.The patients were followed up for 2 years，and no recurrence was found.Conclusion：Prenatal mastitis patients，need to consider the safety of the fetus，according to the condition of the choice of the least damage，the best therapeutic regimen.

When the elderly patients with hip fracture receive surgical treatment,they often face a high risk of unfavorable prognosis due to the influence of multiple complications,which reduces their quality of life and also brings certain economic burden to the society.Therefore,minimally invasive treatment techniques for elderly hip fracture have been developing to improve the prognosis of elderly hip fracture patients.Based on the epidemiology of elderly hip fracture and the results of domestic and foreign literature review and expert investigation,this consensus summarizes the classification,surgical path and rehabilitation measures of elderly hip fracture,to provide a reasonable and standard treatment plan for minimally invasive surgical treatment of elderly hip fracture.

Unlike the majority of other tissues,cartilage is low in cellularity and basically avascular in nature,therefore,chondral lesions due to injury commonly result in the development of osteoarthritis,eventually leading to progressive total joint destruction.Current clinical treatment strategies for cartilage defects include microfracture,osteochondral autografts and allografts.Although they are often used clinically,significant drawbacks and limitations still exist.To solve these problems,cartilage tissue engineering has been recommended to promote more effective treatments.In this review,we discuss current clinical approaches for repairing cartilage,as well as cartilage tissue engineering approaches which are currently developing.We also describe potential future directions in cartilage regeneration.

Objective：To summarize the clinical experience of laparoscopic transabdominal preperitoneal hernia repair(TAPP).
Methods：Retrospective analysis was made on the clinical data of 102 inpatients with inguinal hernia who underwent laparoscopic transabdominal preperitoneal hernia repair(TAPP) in the first ward of general Surgery department,the First Affiliated Hospital of Baotou Medical College from November 2016 to November 2019.
Results：All the 102 cases of TAPP were successfully completed without transferring to open surgery.The operative time was(46.87±4.94)min,the intraoperative blood loss was(5.4±1.64)ml,and the postoperative hospital stay was(4.18±1.09)d.Postoperative analgesics were used in 18 patients(17.65%),with pain score(0.93±1.53) and abdominal incision satisfaction score(4.58±0.62).Postoperative followup(6～42 months) showed good recovery and no recurrence.8 cases of postoperative inguinal seroma,accounting for 7.8%,were relieved after treatment.There were no longterm chronic pain,mesh infection,incision infection,intestinal obstruction and other serious complications.TAPP puncture site has small scar,high incision satisfaction,low postoperative pain,and short postoperative hospital stay.Conclusion：Laparoscopic transabdominal preperitoneal hernia repair(TAPP) in the treatment of inguinal hernia is minimally invasive,safe and effective,without obvious scar and other characteristics,is one of the reliable clinical treatment options for inguinal hernia.

晚期胃癌治疗选择有限，易发生化疗耐药。目前，包括免疫检查点抑制剂、过继细胞疗法、肿瘤疫苗、非特异免疫增强剂及细胞因子疗法在内的免疫疗法对胃癌显示出了良好的疗效。载体药物及3D打印技术也在临床前实验中取得了疗效。临床试验采用免疫肿瘤学单一疗法或联合免疫化学疗法来提高胃癌病人的总体生存时间和客观反应率。根据初步证据，我们相信免疫治疗可以积极影响自然病史，改善胃癌病人的预后。

Objective To study the clinical effect of procedures for prolapse and hemorrhoids（PPH）and excision for thrombosed external hemorrhoid in acute incarcerated mixed hemorrhoids. Methods 82 acute incarcerated mixed hemorrhoids patients treated from September 2014 to May 2018 in our hospital were selected and randomly assigned to two groups，41 cases each group.The control group was treated with Milligan-Morgan surgery; the observation group was treated with PPH plus excision for thrombosed external hemorrhoid.The therapeutic effect，operation conditions and complications were probed. Results The total effective rate in the observation group（95.12%）was significantly higher than control group（85.37%）（P＜0.05）; the operation time and bleeding volume showed no significant differences（P＞0.05）; the hospitalization time and wound healing time in the observation group was shorter than control group（P＜0.05）; the incidence rate of complications in the observation group（2.44%）was significantly lower than control group（19.51%）（P＜0.05）.There was no difference in VAS scores between the two groups before operation.The scores of 3 hours，12 hours and 24 hours after operation were significantly lower than those before operation，and the scores of 3 hours，12 hours and 24 hours after operation in the observation group were lower than those in the control group（P＜0.05）. Conclusion The procedures for prolapse and hemorrhoids plus excision for thrombosed external hemorrhoid can remarkably increase the effective rate，shorten the hospitalization time and wound healing time，and reduce the incidence rate of complications.

Objective To retrospectively analyze the incidence and influencing factors of proximal femoral shortening after intertrochanteric fracture surgery. Methods The clinical data of 97 patients with intertrochanteric fracture treated from January 2017 to February 2020 were retrospectively analyzed.There were 31 cases with the dynamic hip screw(DHS),41 cases with the proximal femoral nail antirotation(PFNA),25 cases with Intertan.They were divided into normal group(59 cases) and PFS group(38 cases) according to the shortening of proximal femur after operation.The differences of age,gender,body mass index(BMI),bone mineral density,fracture type,internal fixation method,reduction quality,TAD value and complete weight-bearing time between the two groups were observed.Results In this group,the proportion of proximal femoral shortening was 38/97(39.18%).In PFS group,the shortening of femoral neck main screw was (5.43±1.72)mm,including 2 cases(2.06%) with internal fixation penetrating the femoral head and 5 cases(5.14%) with nonunion； The proportion of type Ⅲ and type Ⅳ fractures in the normal group was 40.68%,and that in the PFS group was 76.32%,the difference was statistically significant(P<0.05).The proportion of PFNA /Intertan was 76.27% in the normal group and 65.79% in the PFS group(P<0.05).There were 26 cases of positive reduction,18 cases of neutral support and 15 cases of negative support in the normal group,while there were 8 cases,13 cases and 17 cases in the PFS group,the difference was statistically significant(P<0.05).The complete weight-bearing time of normal group was (8.54±2.37)weeks,which was significantly later than that of PFS group(4.15±1.83)weeks(P<0.001).Conclusions  Internal fixation,reduction quality and complete weight-bearing time were important factors affecting the proximal femoral shortening after intertrochanteric fracture.

Objective To explore the clinical practice of best evidence-based practice program for nasogastric tube insertion and evaluate its application.
Methods By referencing to Australia JBI model for evidence-based healthcare, we retrieved and summarized the best evidence for preoperative insertion of nasogastric tube, judged the position of nasogastric tube and alleviated the discomfort caused by the nasogastric tube insertion.Then we formed inspection indicators, maded baseline inspections before application of the best evidence on 29 medical staffs and 50 patients who met the inclusion criteria in department of hepatobiliary surgery, took transformative measures to boost application of the best evidence, and made post-application inspections to evlaute the effect.
Results After the application of the best evidence, the routine operation process of gastric tube insertion was improved; the awareness rate of audit indicators in medical staffs, audit indicators implementation rate, and the correct rate of gastric tube implantation were significantly improved (P<0.05 for all).
Conclusion The summarization and application of the best evidence for preoperative nasogastric tube insertion can improve medical staffs' operation level of nasogastric tube insertion,standardize the operation behaviors,reduce the patients' discomfort caused by the nasogastric tube insertion and improve their satisfaction.

At present,the most direct method for preoperative diagnosis of thyroid cancer is ultrasound-guided fine needle biopsy,but it cannot achieve high accuracy.There are many molecular markers in the thyroid,such as BRAF gene,RAS gene,thyroglobulin,thyroid antibody,etc.This article reviewed some studies and found that some common gene mutations or changes in the level of circulating markers are related to the judgment of benign and malignant thyroid nodules,the aggressiveness of thyroid cancer,and even the prognosis,recurrence,or metastasis of thyroid cancer after surgery.We will analyze some common molecular markers in differentiated thyroid cancer,including genetic markers and circulating markers,analyze their value and significance in the diagnosis of disease,and discuss whether these molecular markers can provide different diagnostic methods for patients with thyroid nodule.

Objective  To investigate the characteristics of the three-dimensional gait changes of the knee joint after the single bundle anatomical reconstruction of autologous hamstring tendons after the rupture of the anterior cruciate ligament (ACL) of the knee. Methods  From August 2018 to June 2020，twenty five patients with ACL rupture of the lateral knee joint were selected as the injury group.During the operation,ACL rupture was confirmed by arthroscopy and the autologous hamstring tendon anatomical reconstruction was performed.Then 25 healthy people were selected as the control group.The three-dimensional gait data of normal knee joints were recorded with the three-dimensional motion capture system and compared with the injury group.In addition,the injury group was followed up before and after surgery and Lysholm knee joint function score was performed. Results  In the control group,the flexion and extension angle was - 2 °~66 °,the internal and external rotation angle was - 5 °~9 °,and the internal and external rotation angle was - 4 °~8 °.After ACL injury,the flexion and extension angle is - 5 °~52 °,the internal and external rotation angle is - 3 °~24 °,and the internal and external rotation angle is - 13 °~14 °.Three months after ACL autologous hamstring tendon reconstruction,the flexion and extension angle was - 2 °~47 °,the internal and external rotation angle was - 5 °~9 °,and the internal and external rotation angle was - 6 °~10 °.Six months after ACL reconstruction,the flexion and extension angle was - 2 °~59 °,the internal and external rotation angle was - 4 °~8 °,and the internal and external rotation angle was - 5 °~8 °.Nine months after ACL reconstruction,the flexion and extension angle was - 2 °~64 °,the internal and external rotation angle was - 2 °~9 °,and the internal and external rotation angle was - 2 °~8 °.12 months after ACL reconstruction,the flexion and extension angle was - 2 °~65 °,the internal and external rotation angle was - 1 °~9 °,and the internal and external rotation angle was - 1 °~8 °.After ACL rupture,the variation range of knee joint from flexion to extension,internal and external rotation,and internal and external turnover angle became larger than that of the control group,and there was significant difference in statistics(P<0.05).The angle range of each motion direction of knee joint after reconstruction was significantly improved compared with that before surgery（P＜0.05）,the difference at each time point after reconstruction was statistically significant compared with that before reconstruction(P<0.05).The gait at 9 and 12 months after reconstruction was significantly improved compared with that at 3 months after reconstruction (P<0.05).The Lysholm score increased from (62.35±3.45) before operation to (93.62±3.51) at 12 months after operation,and the difference was significant (P<0.05).  Conclusion  ACL reconstruction surgery has played a role in stabilizing the knee joint and improved the Lysholm knee joint function score,and with the passage of time after the operation,the Lysholm knee joint function score gradually improved,and basically returned to normal 9 months after the operation.

Complex abdominal aortic aneurysms（CAAA）generally refer to shortneck abdominal aortic aneurysms（AAA）or abdominal aortic aneurysms involving visceral branch arteries.The treatment difficulties are mainly reflected in the adequate assessment of the proximal anchoring area of the neck and the revascularization of the visceral arteries.At present，the main techniques are “parallel stent graft”，“fenestrated” and“branched stent”.Parallel stent is represented by “chimney stents”，and it is usually used in highrisk patients in emergency situations or who are unavailable for the fenestrated stents.“Fenestrated stent graft”，as the main method for treatment of CAAA in recent years，has good safety and effectiveness，and gradually develops from a simple fenestration to a “fenestrated+branched”combination.The above technologies have their own advantages and disadvantages.This article will briefly explain various techniques for the treatment of complex abdominal aortic aneurysms，and provide some evidence for the endovascular treatment strategy of CAAA.

   Children and adolescents are increasingly suffering from articular cartilage and osteochondral deficiencies Traumatic incidents often result in damage to the joint surfaces,Surgery is indicated in young patients when conservative measures fail.The operative techniques for articular cartilage injuries traditionally performed in adults may be performed in children,while an individualized approach must be tailored according to patient and defect characteristics.Autologous chondrocyte transplantation has good biological potential,especially for large cartilage defects on the joint surface.In recent years,emerging PRP and tissue engineering technologies have not been reported in children and adolescents.Clear guidelines for defect dimensionassociated techniques have not been reported.Knee joint dimensions must be considered and correlated with respect to the cartilage defect size.In addition,the damage of the subchondral bone can not be ignored.Articular cartilage repair techniques appear to be safe in this cohort of patients,and no differences in complication rates have been reported when compared with adult patients.

Articular cartilage is a major tissue distributed at the joint surface;it plays a role in loadbearing and lubricating.The articular cartilage of the joints in the extremities mainly consists of hyaline cartilage composed of collagen II.Fibrocartilage formation is easily observed when the cartilage is injured or degenerated,which has abundant type I collagen.In this study,a new viewpoint and concept,focusing on the modification of fibrocartilage in situ approach and regeneration of hyaline cartilage,namely “fibrocartilage hyalinization”,was proposed as a practical clinical strategy.We conducted preliminary discussions and prospects on the feasibility and potential mechanisms of fibrocartilage hyalinization.It is hoped that the strategy will be helpful to the development and clinical transformation of cartilage regeneration research.

Cholangiocarcinoma is a malignant tumor originating from the epithelium of the bile ducts,and its incidence is increasing year by year,especially intrahepatic bile duct carcinoma that originates from the bile duct branches above the second level in the liver.Due to the insidious early symptoms and the lack of effective screening methods,most patients have lost the opportunity for radical surgery by the time they present.Over the past few years,several drugs have been developed that target genetic alterations with the detection of the cholangiocarcinoma genome.The molecular targets with clinical significance mainly include fibroblast growth factor receptor(FGFR),isocitric acid dehydrogenase(IDH),RAS-RAF-MEK-ERK,ERBB,VEGF and NTRK.Drugs targeting their targets show encouraging response rates and survival data as second-line therapies,and are characterized by high specificity and low toxicity.Therefore,targeted therapy is gradually emerging in the treatment of cholangiocarcinoma.In this review,we discuss the latest advances in targeted therapies for cholangiocarcinoma.

Objective To explore the technique and clinical application of Fustar combined with disposable biopsy forceps in the recovery of inferior vena cava filter. Methods A retrospective analysis of 117 cases of the inferior vena cava filter recovered from December 2017 to December 2020 in Wangjing Hospital of the Chinese Academy of Chinese Medical Sciences.The Fustar combined with disposable biopsy forceps were used during the operation.The filter was successfully recovered and performed after the operation.Follow-up observation. Results In this study,117 cases of vena cava filters,including 103 cases of Aegisy filter,9 cases of Optease filter,and 5 cases of Günther Tulip filter,were successfully recovered using the Fustar combined with disposable biopsy forceps,and the recovery success rate was 100%.The operation time of grasping the filter under fluoroscopy It was 45 seconds to 12 minutes and 57 seconds,with an average of 2 minutes and 38 seconds.The angiography showed that the inferior vena cava blood flowed smoothly,and there was no extravasation of contrast agent.Observation and removal of the filter was normal,without deformation or damage.The patients were followed up for 1 to 36 months,with an average of 6 months,and there were no complications such as inferior vena cava stenosis or secondary thrombosis. Conclusion The Fustar combined with disposable biopsy forceps in the recovery of the inferior vena cava filter has the characteristics of simple operation,small trauma,accurate positioning,high recovery rate,and short operation time.It can be promoted as the preferred solution for recovery of vena cava filter.

Objective In order to investigate the etiology and drug resistance of vancomycin resistant enterococci after liver transplantation.
Methods We retrospectively analyzed the clinical data of 524 consecutive patients who underwent liver transplantation in Beijing Chaoyang Hospital in January 2015-2019 in December.Incidence rate and etiology of vancomycin resistant enterococci infection after operation were analyzed.Distribution and drug resistance.
Results 109 of the 524 patients underwent abdominal infection after operation,the incidence rate was 20.80%(109/524).Enterococcus infection was 46 cases,all enterococcus faecium,enterococcal infection rate was 8.78%(46/524),enterococcal infection accounted for 42.2%(46/109) of the patients with abdominal infection,accounting for 64.79%(46/71) of gram positive cocci infection,15 cases of vancomycin resistant hair coloring and 15 vancomycin resistance rate of 32.61%(15/46),and drug sensitivity test showed 
vancomycin resistant enterococcus was completely resistant to penicillin, ampicillin, ciprofloxacin, levofloxacin and erythromycin antibiotics;it was also widely resistant to tetracycline, streptomycin, gentamicin and other antibiotics;and the drug resistance rates were 71.43%(15/21),85.71%(18/21),71.43%(15/21),38.10%(8/21) to teicoplanin,and resistant strains to linezolid,the drug resistance rate was 9.52%(2/21).Tecycline is the most sensitive and no resistant bacteria have been detected.
Conclusion Vancomycin resistant Enterococcus is one of the common pathogens in liver transplantation patients.Conventional prophylactic antibiotics are ineffective in the treatment of vancomycin resistant enterococci,and tigecycline and linezolid can be the first choice for the treatment.