Volume 97  ·  Issue 46  ·  2017

Sepsis is an uncontrolled inflammatory response caused by infection, and the release of a large number of inflammatory mediators can cause acute circulatory failure and multiple organ failure (MODS). Since the first edition of the "Guidelines for the Treatment of Severe Sepsis and Septic Shock" was published in 2004, the "clustered" treatment strategies including fluid resuscitation, early anti-infection and circulatory support have been continuously advanced. More and more sepsis patients can survive the early stage of circulatory failure and MODS. 70% of sepsis patients die 3 days after the onset of the disease, and some patients even die after several weeks^[1]。 The rate of late death in patients with septic shock is as high as 62.7%, and the trend is increasing year by year^[2]。 The data showed that nearly half of the pathogens obtained from blood culture and tissue culture of patients with advanced sepsis were fungi and other opportunistic pathogens, suggesting the occurrence of secondary infection. More importantly, secondary infection increases the risk of death in sepsis patients by more than five times, and the absolute mortality rate also increases by nearly 20%^[2,3]。 In view of this, effective prevention and treatment of sepsis secondary infection will help to further reduce the mortality of sepsis patients.

With the progress of medicine, the pregnancy rate of women with chronic kidney disease (CKD) is higher than before, and the overall fetal live birth rate is significantly increased. However, there is still a great risk of pregnancy in patients with CKD: adverse outcomes for pregnant women include aggravation of original kidney damage, acute kidney injury and pregnancy-related kidney disease, increased proteinuria, increased blood pressure, and preeclampsia (PE), etc.; Adverse fetal outcomes include stillbirth, fetal growth restriction (FGR), and preterm birth. With the comprehensive liberalization of the two-child policy in China, the pregnancy problem of CKD patients has increasingly become a common challenge faced by nephrologists and obstetricians. Therefore, in order to reduce the damage of pregnancy to the maternal kidney and mitigate the adverse effects on pregnant women and fetal outcomes, nephrologists and obstetricians need to normally assess the risk of pregnancy in patients with CKD, determine the optimal timing of pregnancy, stabilize the patient's condition, and closely monitor during pregnancy to detect pregnant women and fetal complications early. Chinese experts in the field of nephrology and obstetrics have drawn on the recent clinical research literature on CKD pregnancy at home and abroad and combined with domestic clinical practice to formulate pregnancy guidelines for CKD patients, aiming at guiding pregnancy of CKD patients, strengthening pregnancy management, improving pregnancy success rate, reducing pregnancy complications, improving maternal and infant survival rate, and improving pregnancy outcomes of CKD patients in China.

To analyze the clinical characteristics and prognosis of implanting drug-eluting stents (DES) for unprotected left main (ULM) coronary artery disease patients with left ventricular systolic dysfunction (LVSD).

A total of 511 ULM coronary artery disease patients who underwent DES implantation from January 2005 to January 2012 in Department of Cardiology, Beijing Anzhen Hospital were included in the study. Based on left ventricular ejection fraction (LVEF), the patients were divided into three groups: LVEF≤40% (n=104), 41%≤LVEF≤49% (n=137), and LVEF≥50% (n=270). The clinical characteristics of patients undergoing DES implantation were retrospectively compared, and the effects of LVSD on ULM coronary artery disease were analyzed.

After comparison of clinical baseline data among three different LVEF groups, the incidence of peripheral vascular diseases, old myocardial infarction (OMI), multi-vessel lesions, complete revascularization and chronic total occlusion (CTO) was statistically different (P=0.002, P<0.001,P<0.001,P=0.049, P=0.001, respectively). However, there was no significant difference in the incidence of other clinical characteristics (all P>0.05). In terms of survival analysis, total mortality and cardiac mortality were both remarkably higher in LVEF≤40% group than those in LVEF≥50% group (bothP<0.001). There was no statistical difference of total mortality between 41%≤LVEF≤49% group and LVEF≥50% group (P>0.05), while cardiac mortality was higher in LVEF≥50% group (P=0.027) . Besides, there was no significant difference among three groups in major adverse cardiac and cerebral events (MACCE), myocardial infarction(MI), cerebral infarction and target vessel revascularization (TVR) (all P>0.05). After adjusting for multiple clinical factors, total mortality and cardiac mortality were both remarkably higher in LVEF≤40% group than those in LVEF≥50% group (P=0.002, P<0.001), while there were no statistical differences of total mortality and cardiac mortality between 41%≤LVEF≤49% group and LVEF≥50% group (bothP>0.05). In terms of MACCE, MI, cerebral infarction and TVR, there were also no significant differences among three groups (allP>0.05).

For ULM coronary artery disease patients with LVSD, implanting DES is safe and effective, but for those with severe LVSD (LVEF≤40%), DES implantation showed an increased risk of long-term death and therefore should be selected with great care.

To assess the efficacy and safety of transbronchial cryobiopsy (TBCB) for the etiologic evaluation of diffuse lung disease (DLD).

Between December 2015 to April 2017, a total of 38 patients with DLD met the inclusion criteria for TBCB in the First Affiliated Hospital of Chongqing Medical University, and 35 of them consented to undergo the procedure under rigid or flexible bronchoscopy. On the tissues obtained from the 35 patients, histopathologic and microbiological evaluations were performed, and together with clinical and radiological manifestations, diagnoses were made and the efficacy of TBCB in the diagnosis of DLD was confirmed, and then therapies were planned accordingly. Complications of the biopsy procedures were recorded.

Of the 35 patients who were enrolled, 24 underwent TBCB under rigid bronchoscopy and 11 under flexible bronchoscopy. Another 3 patients refused the procedure due to disinclination to invasive examinations. One single procedure of TBCB took (51.8±19.2) min on average, the median number of tissues obtained was 6 (5, 8), and the median area of tissues was 15 (9, 20) mm².Definite diagnoses were reached in 33 patients, including idiopathic nonspecific interstitial pneumonia (n=8), connective tissue disease-interstitial lung disease (n=8), occupational lung disease (n=4), idiopathic pulmonary fibrosis (n=3), interstitial pneumonia with autoimmune features (n=3), tuberculosis (n=2), cryptogenic organization pneumonia (n=1), acute interstitial pneumonia (n=1), pulmonary infection (n=1), hypersensitivity pneumonia (n=1) and sarcoidosis (n=1). Diagnostic yield was 94.3% (33 out of 35 cases diagnosed). Pneumothorax occurred in 3 patients (1 patients with mild pneumothorax , 1 moderate and 1 severe), and were resolved with thoracic puncture or pleural drainage. Bleeding occurred in all 24 patients who received TBCB under rigid bronchoscopy (11 patients with mild bleeding, 12 moderate and 1 severe) and was controlled after coagulation measures. After one month of treatment according to the diagnoses acquired with cryobiopsy, the condition was cured in 1 patient (3.0%), alleviated in 17 (51.5%), stable in 11 (33.3%), and deteriorated in 4 (12.1%).

TBCB yields reliable diagnoses with a good safety profile.

By summarize the Prevention and Treatment of Horner Syndrome of CT-guided thoracic sympathetic nerve modulation in the treatment of head and face Hyperhidrosis, reduce the occurrence of the complications.

A retrospective analysis was made on 116 patients of CT-guided thoracic sympathetic nerve modulation in the treatment of head and face Hyperhidrosis in The First Hospital of Jiaxing from January 2010 to December 2016. Analysis the reasons of Horner syndrome and external management to sum up the corresponding prevention and treatment measures.

Under the guidance of CT positioning, 116 patients were successfully punctured to the intended target (both sides of the R3 above the rib head), after injection of local anesthetic plus contrast agent, CT scan showed there are 39 sides of the liquid parallel to the outside of pleural (26 sides) or over (13 sides) R1 above the rib head. CT scan again after the injection of anhydrous alcohol, there are 43 sides of the liquid parallel to the outside of pleural (24 sides) or over (19 sides) R1above the rib head.After the operation, 22 sides appeared Horner syndrome, 19 of which immediately give physiological saline 5 ml into the ipsilateral Satellite ganglion.Within 2 hours Horner′s syndrome completely disappeared, while 3 cases were not treated, Horner syndrome lasts for 3 months to 2 years.

The incidence of Horner syndrome relatively high during the CT-guided thoracic sympathetic nerve modulation to treatment of head and face Hyperhidrosis. Injecting 5 ml physiological saline into the ipsilateral Satellite ganglion immediately can completely eliminate this common complications.

To explore the distribution of ABO blood group in the healthy population in the Ali area of Tibet, and to analyze the difference of blood group distribution between the Tibetan population in Ali and the Tibet Tibetan population.

The blood distribution of 509 apparent healthy volunteers of Tueti County and Gal County, Tibet, which were randomly selected from September to November in 2016; 137 Tibetan blood donors, from 2016 September to2017 July and 84 Tibetan blood donors from 2015 August to 2017 July was analyzed retrospectively. The blood type was tested by the slide method. By reviewing the Chinese and foreign language database, seven articles on Tibetan blood group distribution were obtained. And the data of the blood distribution of the Ali area population and the Tibet Tibetan population were compared.

The ABO phenotype frequencies of 507 apparent healthy people, 137 blood donors and 84 recipients were B>O>A>AB. The composition ratio were 36.1%, 34.5%, 21.5 %, 7.9%; 40.1%, 35.0%, 17.5%, 7.3%; 39.3%, 34.5%, 20.2%, 6.0%.There was no statistically significant difference in blood group distribution between the donors and the recipients (P>0.05). And there was no significant difference in the blood group distribution between Ali and Shigatse, Nagqu, Lhasa, Shannan. However, the differences between Ali and Qamdo, Nyingchi areas were statistically significant.

The geographical position of the blood from the west to east, B type shows a downward trend, O type blood composition ratio shows an upward trend.

To evaluate the efficacy of 24 h urinary free cortisol (24 h UFC) in the diagnosis of subclinical Cushing′s syndrome (SCS), and explore the best diagnostic cut-off value.

The clinical data of patients with adrenal incidentaloma in Chinese PLA General Hospital between January 2008 and December 2016 was retrospectively reviewed and analyzed. All SCS patients were diagnosed based on the current Cushing′s syndrome (CS) guidelines and confirmed by histopathology and then treated as study group, and additional patients with non-functional adrenal adenoma (NFA) were enrolled as control group. ROC curve was used to evaluate efficacy of 24 h UFC and 24 h UFC to creatinine ratio (UFCCR), and explore their best cut-off values.

There were 161 patients with NFA, of which contained 84 males and 77 females, with a mean age of (51.02±10.49) years old. There were 88 patients with SCS, of which contained 26 males and 62 females, with a mean age of (51.74±10.29) years old. The 24 h UFC and UFCCR levels were significant higher in SCS group than those in NFA group[510 (363, 698) nmol vs 335 (209, 467) nmol for 24 h UFC, and 7.82(4.79, 12.13) ml vs 4.82(2.41, 6.57)ml for UFCCR, both P<0.05]. ROC analysis showed that the optimal cut-off for 24 h UFC was 480 nmol (AUC 0.716, 95%CI: 0.648-0.784, with a sensitivity of 58.0% and a specificity of 79.4%) and the optimal cut-off for UFCCR was 6.84 ml (AUC 0.729, 95% CI: 0.662-0.796, with a sensitivity of 59.1% and a specificity of 78.7%).

The recommended cut-off points of 24 h UFC and UFCCR for diagnosing SCS in AI patients were 480 nmol and 6.84 ml, respectively.

To investigate the effects of multi-day low dose ketamine infusion for postmastectomy pain syndrome (PMPS) after breast cancer surgery.

This study was a prospective randomized controlled trial. From June 2015 to May 2016 in Affiliated Yiwu Hospital of Wenzhou Medical University, 66 patients with breast cancer surgery were randomly divided into control group (group C) and ketamine group (group K). Patients in group K were infused with 0.5 mg/kg of ketamine mixed in 250 ml of 0.9% normal saline in 1 h daily for 7 days. Patients in group C were infused the same dose of 0.9% normal saline. Anesthesia induction in both groups were given intravenous midazolam, sufentanil, propofol, vecuronium and intermittent positive pressure ventilation after tracheal intubation, anesthesia was maintained with propofol and remifentanil. After awakening, all patients were monitored in postanesthesia care unit (PACU) and given patient-controlled intravenous analgesia(PCIA). Pain scores were assessed using visual analogue scales (VAS) during PACU, 4 h, 24 h and 2-5 d after surgery, simultaneously analgesic requirement were recorded. Patients were evaluated Hospital Anxiety and Depression Scale (HADS) 5 d after surgery . The patients were followed up for 6 months. At 3 m, 6 m after surgery, the incidence of PMPS, the level of pain, pain site and HADS scale were assessed.

The VAS score uring PACU, 4 h, 24 h and 2-5 d after surgery in group K( (2.5±0.8), (2.4±0.5), (2.4±0.5), (2.0±0.4), (1.5±0.5), (1.0±0.4), 1(1), respectively) was lower than those in group C ((2.9±1.0), (2.9±0.6), (2.6±0.5), (2.3±0.5), (1.8±0.6), (1.5±0.5), 1(0), respectively). There was statistically difference between the two groups (all P<0.05). The consumption of analgesics required at each time postoperation in group K were also lower than that of group C(allP<0.05). Followed up for 6 months, 2 lost in group C, 1 lost in group K. The incidence of PMPS in group K at 3 months and 6 months after surgery was significantly lower(25% and 22%) than that in group C(52% and 45%)(χ²=4.729, 3.842, all P<0.05). There were no significant difference in pain level and site between two groups of PMPS patients (allP>0.05). There were no significant difference of HADS scale preoperative and 5 d after surgery between two groups (allP>0.05); and HADS scale in group K at 3 m and 6 m after surgery was significantly lower than that in group C(allP<0.05).

Perioperative continuous multi-day low dose ketamine infusion can effectively reduce the incidence of PMPS after breast cancer surgery.

To validate the usefulness of the supine position in microsurgery for lesions of the cerebellopontine angle (CPA) by the retrosigmoid approach.

Thirty-nine patients with lesions (22 cases of tumor, 11 cases of trigeminal neuralgia and 6 cases of hemifacial spasm) of the CPA underwent tumor resection surgery or microvascular decompression surgery (MVDS). The patients were operated on in the supine position by retrosigmoid approach with the head turned 50 to 60 degrees away from the lesion and with slight forward flexion of the neck.

In the supine position, the surgery spent less time in the preoperative preparation period, and had minimal cerebellar retraction, with no resection of the cerebellum. There was no pressure sore and the brachial plexus injury in these patients. Gross total resection was achieved in 18 of patients, and subtotal resection happened in 4 patients. The vascular structures were separated from the trigeminal nerve or the facial nerve in microvascular decompression and thus the preoperative symptoms alleviated.

In the supine position, the retrosigmoid approach alleviates cerebellar retraction, increases the exposure and gives better access to the CPA lesions. The associated postoperative complications are negligible. The method is more suitable for elder, debilitated or obese patients.

To investigate the renal safety in patients with benign prostatic hyperplasia treated with tamsulosin hydrochloride.

A retrospective analysis of 10 cases of patients, who had renal dysfunction after treatment with long-term tamsulosin hydrochloride.

The average duration of oral medicine was 2 to 24 months with an average of 7.2 months. The serum creatinine after discontinuation of tamsulosin hydrochloride decreased from 132.5 μmol/L (100-208 μmol/L, normal 59-104 μmol/L) to 95.7 μmol/L (73-122 μmol/L, normal: 59-104 μmol/L) ( F=10.385, P=0.000).

Preliminary results show that taking tamsulosin hydrochloride might lead to renal damage in old patients with benign prostatic hyperplasia. Safety is the premise, and the right medicine should be chosen for different side effects in order to protect the safety of patient.

To investigate the effects of oridonin combined with capecitabine on the proliferaction of MDA-MB-231 human breast cancer cells.

Effect of different concentrations(10, 20 and 40 μmol/L)of oridonin, capecitabine and their combination on the proliferation of MDA-MB-231 cells after incubation for 24 or 48 h was studied. Then, the effect of 5 μmol/L of oridonin, capecitabine and their combination on cell colony formation was detected. Finally, influence of 20 μmol/L of oridonin, capecitabine and their combination on morphological alteration of nucleus, cell cycle and apoptosis was explored.

The inhibition rate on MDA-MB-231 cells after incubation with 20 μmol/L oridonin or capecitabine for 48 h was 49.5% and 58.6%, respectively, while the inhibition rate against proliferation of MDA-MB-231 cells reached 94.6% with combination of 20 μmol/L oridonin and capecitabine. Cells incubated with combination of oridonin and capecitabine formed fewer and smaller colonies ( P<0.01). Meanwhile, cells in the combination group arrested at S and G2/M phases at the same time, and combination of two drugs caused more apoptotic cells (P<0.01).

Oridonin combined with capecitabine can synergistically inhibit the proliferation of MDA-MB-231 human breast cancer cells.

To study myocardial damage and rules of calpain change in rats with burn-blast combined injury.

One hundred and twenty-eight male SD rats were randomly divided into control group, burn group, blast group, burn-blast group, with 32 rats in each group. Control group: 37 degrees′ warm water for 12 s; Burn group: 94 degrees′ boiling water for 12 s; Blast group: 5 g cyclonite explode in 75 cm distance from left chest wall of rat; Burn-blast group: burn group and blast group combined modeling method. At 6, 24, 48, 72 h observation points after injury, abdominal aorta blood samples and myocardial specimen were collected. Left ventricular ejection fraction (EF), left ventricular fractional shortening index (FS) were measured through color Doppler ultrasound instrument; Myocardial tissue was stained with hematoxylin-eosin (HE); serum cardiac troponin I (CTnI) and creatine kinase isoenzyme (CK-MB) were detected; detection of cell apoptosis in myocardial tissue was performed by terminal deoxynucleotidyl transferase-mediated dUTP notch labeling technique (Tunel). Expression levels of calpain mRNA level and protein were detected with Real-time fluorescent quantitative polymerase chain reaction (RT-PCR) and Western imprinting method analysis; calpain activity was detected by fluorescence spectrophotometry.

The injury of burn-blast combined injured rats was obvious, including myocardial interstitial edema, large area of myocardial cell degeneration and disintegration and the number of neutrophil infiltration increased. Cardiac function decreased 24 h after injury in burn group, blast group, burn-blast group; both EF and FS were significant lower than those of control group (all P<0.05). FS at 48, 72 h and EF at 72 h in burn-blast group were significantly lower than those of burn group, blast group at the same time points (allP<0.05); the level of cTnI in burn-blast group rose and was higher than control group at all time points, higher than the burn group, blast group at 48 h (allP<0.05). CK-MB in burn-blast group rats increased after injury, lowered at 24 h and rose again at 48 h. The level was significantly higher than control group and burn group (bothP<0.05). Comparing to control group, myocardial apoptosis index in burn group, blast group and burn-blast group were significantly increased (allP<0.05). Those of burn group (25.3±4.0) at 24 h and (28.8±5.3) at 48 h were significantly lowered than burn-blast group (43.3±9.4), (53.3±10.4) at same time points, and burn group (31.9±6.7) at 72 h was significantly higher than blast group (17.3±6.3) (allP<0.05). Compared to control group, Calpain mRNA and protein expression in myocardial tissue were significantly increased in burn-blast group at all time points (allP<0.05). Calpain activity reached the peak at 24 h after injury, then gradually declined, and was significantly higher than control group (allP<0.05).

Calpain expression and activity increase in burn-blast combined injured rats which leads to myocardial damage.

Pulmonary hamartoma is the most common benign lung tumor, accounting for 75% of all benign lung tumors^[1]； According to the site of occurrence, they are divided into intrapulmonary type, intrabronchial type and intrapulmonary combined intrabronchial type. Among them, intrabronchial hamartoma accounts for about 1.4% ~10%^[2]。 The traditional treatment for pulmonary hamartoma is surgical resection, but it is more invasive. With the rapid development of respiratory interventional techniques, snare, argon plasma coagulation (APC), CO can be performed under bronchoscopy₂Many operations such as cryoablation, clamp removal and tumor removal^[3]。 Bronchoscopic treatment is minimally invasive, and is very suitable for the treatment of endobronchial hamartoma. The clinical data of 12 patients with endobronchial hamartoma diagnosed and treated under bronchoscopy since 2007 in the Department of Respiratory and Oncology of Coal General Hospital are summarized and analyzed as follows.

Acute aortic dissection (AAD) is a disease with high mortality and disability rate. Classical AAD mainly takes chest pain and back pain as the first manifestation, but there are many clinical findings that AAD takes neurological defect as the first manifestation. This study summarized the clinical, imaging, treatment and outcome characteristics of 6 patients with AAD with neurological symptoms as the first manifestation, and carried out relevant literature analysis to further improve the understanding of such cases and avoid clinical misdiagnosis and misdiagnosis.

The 27-year-old male was admitted to the 254th Hospital of the People's Liberation Army on February 8, 2017 due to "a tumor in the right adrenal area found in physical examination for 2 months". In late December 2016, the patient was found to have a tumor with a diameter of 3 cm in the right adrenal area during physical examination in the local hospital. During the illness, he had no discomfort such as dizziness, palpitations and hyperhidrosis, and had no symptoms such as purple lines on the skin, full moon face and buffalo back. On February 3, 2017, CT examination of both kidneys in our hospital further confirmed that it was a right adrenal mass and diagnosed as "adrenal mass". During the course of the disease, the patient's spirit, diet and sleep were good, and there was no discomfort such as fever, chest tightness and shortness of breath. The patient was previously in good health. No abnormalities were found in physical examination, and the indexes of adrenal-related laboratory examination were all within the normal reference range. Plasma renin activity: 2.09 μ g/L, angiotensin II: 96.4 ng/L, aldosterone (recumbent position): 33.7 μ g/24 h, blood cortisol: 145 μ g/L, corticotropic hormone: 20.3 ng/L. Enhanced CT showed an oval mass shadow in the medial branch of the right adrenal gland, with smooth outline and clear boundary, patchy high-density shadow and irregular low-density area (Figure 1), no enlarged lymph nodes were seen in the peritoneum and retroperitoneum, and cyst with calcification was considered. The patient's vital signs were stable, and he was given intravenous drip of hydroxyethyl starch and sodium chloride to expand the volume before operation. On February 24, 2017, he underwent laparoscopic adrenal tumor resection under general anesthesia.

Heparin-induced thrombocytopenia (HIT) is a side effect mediated by antibodies during the treatment of heparin drugs (including unfractionated heparin and low molecular weight heparin). It is mainly manifested by a significant reduction in platelet count, and in severe cases it can lead to venous and arterial thrombosis. The incidence of HIT is low, but the clinical consequences are serious. Among hospitalized patients, thrombocytopenia and heparin exposure due to various causes are prevalent, resulting in significantly more suspected HIT patients than confirmed patients. Therefore, how to accurately identify HIT, treat it in a timely and effective manner, and avoid overtreatment has become an important challenge for clinicians^[1,2,3]。 Based on recent evidence-based research evidence (systematic review, meta-study, clinical controlled trials and guidelines, etc.), this paper expounds the research progress of clinical diagnosis and treatment of HIT.

Hepatitis-cirrhosis-liver cancer is the "three steps" of liver disease evolution. Pathology, molecular biology and imaging studies confirmed^[1,2]In the process of malignant transformation of liver cirrhosis-liver cancer, a long process of precancerous lesions of liver cancer will be experienced. Precancerous lesions of liver cancer^[3]Including hepatocytic dysplasia, dysplasia foci, low-grade dysplasia nodules (LGDN), high-grade dysplasia nodules (HGDN), and hepatocellular adenoma (HCA). Precancerous lesions of liver cancer are the transitional stage from benign lesions to malignant lesions. It is a kind of proliferative lesions with atypical cells and abnormal differentiation, and it lasts for a long time. If the cause is removed in time or treated appropriately, this malignant process may be stopped or even recovered.

Hemophagocytic syndrome (HLH) is a macrophage proliferative disease with multiple organ and system involvement and progressive exacerbation with immune dysfunction. Diseases can be divided into primary HLH with abnormal cell function due to gene mutation and secondary HLH secondary to infection, autoimmune diseases, malignant tumors, etc^[1]。 Rivieve et al.^[2]A study of 162 patients with HLH showed that hematological malignancies, especially non-Hodgkin's lymphoma, were the main causes of HLH, accounting for 56% of the subjects studied. It can be seen that malignant tumors, especially lymphoma, are one of the most common causes of HLH. In this paper, the clinical manifestations, laboratory tests, pathogenesis, diagnosis and treatment of LAHS are introduced, which can provide clinical reference.

There are many ways to classify tumors. According to the location of occurrence, they can be divided into lung cancer, breast cancer, gastric cancer, colorectal cancer, pancreatic cancer, etc. According to the disease stage, they can be divided into stages 1, 2, 3 and 4. According to whether it metastasized or not, it is divided into in situ tumors and metastatic tumors. With the popularity of immunotherapy, especially immune checkpoint inhibitors, hot and cold tumors appear in the new classification of tumors. If there are many immune cells around cancer cells that can recognize cancer cells, then the tumor is a hot tumor, otherwise it is a cold tumor. Mechanistically speaking, tumor cells prevent immune cells from killing cancer cells by initiating immunosuppressive mechanisms during evolution. This situation mainly occurs in hot tumors. In response to this situation, emerging immune checkpoint inhibitor therapies or other immunotherapies can specifically activate immune cells (mainly T cells) around tumor cells, thereby inducing an immune response and killing hot tumors. However, in cold tumors, the above-mentioned immune checkpoint inhibitors or immunotherapy are not very effective. It is mainly due to the lack of effective mutant proteins on the cell surface of cold tumors to activate and attract immune cells. Therefore, how to regulate the mutant proteins on the surface of cold tumors, or to strengthen immunotherapy and apply immune checkpoint inhibitors is the key to enhance the sensitivity of tumor immunotherapy, and it is also an important means to transform cold tumors into hot tumors^[1]。