Valor pronóstico del recuento de leucocitos y plaquetas,en tumores testiculares de células germinales

IntroductionThe immune system plays an essential role in the organism's response to cancer. Several haematological markers can influence prognosis and survival of patients. The objective of this study is to determine their prognostic value in testicular germ cell tumours.Material and methodsRetrospective cohort study on 164 patients with germ cell tumours. Clinical, analytical, histological and evolutionary data were collected. The absolute neutrophil and absolute platelet counts, neutrophil-lymphocyte (NLR), platelet-lymphocyte and lymphocyte-monocyte ratios were estimated at diagnosis. The association that these markers can have with the classic prognostic factors, as well as their effect on prognosis and survival, have been analysed.Results17.7% had NLR >4 and 14.6% ANC >8000/μL. These patients presented higher percentages of residual disease and stage II-III tumours. Patients with elevated absolute neutrophil showed also higher percentages of progression and exitus.7.3% presented absolute platelet  >400000/μL. These patients obtained higher rates of residual disease, nonseminomatous and stage III tumours. 28.4% showed platelet-lymphocyte values >150. This data was associated to higher percentages of residual disease, progression, stage II and III tumours and seminomatous tumours.83.3% had an lymphocyte-monocyte  >3. These patients presented: higher tumour markers in normal range, decreased residual disease rates and higher percentages of stage I and II tumours.The mean survival time was shorter in patients with NLR >4 and absolute neutrophil  >8,000/μL.The ROC curves showed significance in the prediction of progression and values of lymphocyte-monocyte  >3, and prediction of survival and values NLR >4.ConclusionOur results indicate that the analysed haematological markers are associated with poor prognoses at diagnosis. Therefore, their use in daily clinical practice can be a valuable tool in the diagnosis and prognosis of patients with testicular germ cell tumours.     

丁苯酞对急性缺血性脑卒中患者淋巴细胞亚群的影响研究

目的 探讨丁苯酞对急性缺血性脑卒中患者淋巴细胞亚群变化情况的影响。方法 选取2017年1月～2018年12月期间在本院就诊的99例急性缺血性脑卒中患者,分为对照组(n=48)和研究组(n=51),对照组接受常规治疗,研究组在常规治疗基础上联合使用丁苯酞软胶囊。于治疗前后测定淋巴细胞亚群变化情况,同时对脑梗死面积、Barthel指数、美国国立卫生研究院脑卒中量表(NIHSS)评分进行比较,计算不良反应发生率。结果治疗后两组CD3+、CD4+、CD4+/CD8+水平较治疗前明显上升(P0.05),且治疗后研究组CD3+、CD4+、CD4+/CD8+水平明显高于对照组(P0.05);治疗后两组脑梗死面积较治疗前均明显变小(P0.05),Barthel指数评分较治疗前均明显增大(P0.05),NIHSS评分较治疗前均明显减小(P0.05),且治疗后研究组脑梗死面积小于对照组(P0.05),Barthel指数评分大于对照组(P0.05),NIHSS评分小于对照组(P0.05);研究组不良反应发生率(1.96%)与对照组不良反应发生率(4.17%)比较,差异无统计学意义(P0.05)。结论 急性缺血性脑卒中使用丁苯酞,则CD3+、CD4+、CD8+水平改善程度更加明显,细胞免疫功能恢复良好,缩小脑梗死面积,改善神经功能缺损,恢复日常生活能力,安全性好。     

术前外周血血小板/淋巴细胞比值与前列腺癌患者临床病理特征及根治术后生存时间的相关性分析

目的 研究术前外周血血小板/淋巴细胞（PLR）比值与前列腺癌患者临床病理特征及根治术后生存时间的相关性，旨在为更好地治疗前列腺癌患者提供有效的理论依据。方法 回顾性分析2007年6月至2012年6月期间在本院行根治性手术切除并经病理诊断明确的164例前列腺癌患者的临床资料，并将其设为观察组，同时选取164例健康居民作为对照组。利用受试者工作特征（ROC）曲线，最终确定PLR的截点值为130，分为高PLR组（PLR≥130）和低PLR组（PLR<130），分析术前PLR比值与前列腺癌患者临床病理特征以及术后生存时间的相关性，并采用Cox回归分析影响前列腺癌患者预后的独立危险因素。结果 术前PLR值与患者年龄、组织类型无明显相关（P>0.05），与Gleason评分、临床分期、淋巴结转移、远处转移、分化程度、浸润深度存在明显的相关性（P<0.05）；术前PLR<130患者在1、3、5年中的无病生存期与总生存期明显高于术前PLR≥130患者（P<0.05）；经单因素分析，Gleason评分、临床分期、淋巴结转移、分化程度、术前PLR值、术后辅助治疗是影响前列腺癌患者预后的因素（P<0.05），而年龄、远处转移、组织类型、浸润深度与前列腺癌患者预后无相关性（P>0.05）；经Cox回归分析显示：Gleason评分、临床分期、术前PLR≥130是影响前列腺癌患者预后的独立危险因素，而术后辅助治疗是提高患者预后生存率的保护因素；PLR联合PSA对前列腺癌患者诊断的灵敏度、特异度、阳性预测值以及阴性预测值明显高于PSA（P<0.05）。结论 术前PLR比值是影响前列腺癌患者预后的独立危险因素，可作为评价前列腺癌患者预后的指标之一，并且PLR联合PSA能提高对前列腺癌的诊断率，两种指标存在一定程度上存在一定的互补性。     

IL-7 Is the Limiting Homeostatic Factor that Constrains Homeostatic Proliferation of CD8+ T Cells after Allogeneic Stem Cell Transplantation and Graft-versus-Host Disease

Immune reconstitution after allogeneic hematopoietic stem cell transplantation relies primarily on homeostatic proliferation (HP) of mature T lymphocytes, but this process is typically impaired during graft-versus-host disease (GVHD). We previously showed that low IL-7 levels combined with lack of dendritic cell (DC) regeneration constrain CD4⁺ T cell HP during GVHD. However, it is not clear whether these alterations to the peripheral CD4⁺ T cell niche also contribute to impair CD8⁺ T cell regeneration during GVHD. We found that IL-7 therapy was sufficient for restoring CD8⁺ T cell HP in GVHD hosts while forcing DC regeneration with Flt3-L had only a modest effect on CD8⁺ T cell HP in IL-7 treated mice. Using bone marrow chimeras, we showed that HP of naïve CD8⁺ T cells is primarily regulated by MHC class I on radio-resistant stromal cells, yet optimal recovery of CD8⁺ T cell counts still requires expression of MHC class I on both radio-resistant and radio-sensitive hematopoietic cells. Thus, IL-7 level is the primary limiting factor that constrains naïve CD8⁺ T cell HP during GVHD, and accessibility of MHC class I on stromal cells explains how IL-7 therapy, as a single agent, can induce robust CD8 ⁺ T cell HP in the absence of DCs.     

口腔癌肿瘤浸润淋巴细胞对人舌癌裸鼠移植瘤的生长抑制作用

目的探讨在体外具有强大细胞毒活性的口腔癌浸润淋巴细胞在体内的抑瘤效果以及化疗药物环磷酰胺（ｃｙｃｌｏｐｈｏｓｐｈａｍｉｄｅ，Ｃｙ）与肿瘤浸润淋巴细胞（ｔｕｍｏｒｉｎｆｉｌｔｒａｔｉｏｎｌｙｍｐｈｏｃｙｔｅ，ＴＩＬ）联合应用治疗口腔癌的可能性。方法将舌鳞癌细胞系Ｔｃａ８１１３注入裸鼠背部皮下建立移植瘤模型，取培养４周的ＴＩＬ联合低剂量Ｃｙ局部注射，观察肿瘤体积变化及肿瘤生长情况。结果①ＴＩＬ＋ｒＩＬ２和ＴＩＬ＋ｒＩＬ２＋Ｃｙ组在３周内抑瘤率较高（分别为：８６１％±０４％和９７７％±０６％），３周后抑瘤作用减弱；②ＴＩＬ＋ｒＩＬ２＋Ｃｙ组抑瘤率较ＴＩＬ＋ｒＩＬ２组高（第８周抑瘤率分别为：２００％±１４％和７５５％±２５％，Ｐ＜００１）。结论口腔癌ＴＩＬ在应用后３周内具较强抑瘤作用，３周后减弱；联合应用Ｃｙ可获得更佳抑瘤效果     

Differential effects of sympathetic nervous system and hypothalamic–pituitary–adrenal axis on systemic immune cells after severe experimental stroke

Infectious complications are the leading cause of death in the post-acute phase of stroke. Post-stroke immunodeficiency is believed to result from neurohormonal dysregulation of the sympathetic nervous system (SNS) and hypothalamic–pituitary–adrenal (HPA) axis. However, the differential effects of these neuroendocrine systems on the peripheral immune cells are only partially understood. Here, we determined the impact of the hormones of the SNS and HPA on distinct immune cell populations and characterized their interactions after stroke.At various time points after cortical or extensive hemispheric cerebral ischemia, plasma cortisone, corticosterone, metanephrine and adrenocorticotropic hormone (ACTH) levels were measured in mice. Leukocyte subpopulations were flow cytometrically analyzed in spleen and blood. To investigate their differential sensitivity to stress hormones, splenocytes were incubated in vitro with prednisolone, epinephrine and their respective receptor blockers. Glucocorticoid receptor (GCR) and beta2-adrenergic receptor (β2-AR) on leukocyte subpopulations were quantified by flow cytometry. In vivo effects of GCR and selective β2-AR blockade, respectively, were defined on serum hormone concentrations, lymphopenia and interferon-γ production after severe ischemia.We found elevated cortisone, corticosterone and metanephrine levels and associated lymphocytopenia only after extensive brain infarction. Prednisolone resulted in a 5 times higher cell death rate of splenocytes than epinephrine in vitro. Prednisolone and epinephrine-induced leukocyte cell death was prevented by GCR and β2-AR blockade, respectively. In vivo, only GCR blockade prevented post ischemic lymphopenia whereas β2-AR preserved interferon-γ secretion by lymphocytes. GCR blockade increased metanephrine levels in vivo and prednisolone, in turn, decreased β2-AR expression on lymphocytes.In conclusion, mediators of the SNS and the HPA axis differentially affect the systemic immune system after stroke. Moreover, our findings suggest a negative-feedback of corticosteroids on the sympathetic axis which may control the post-stroke stress-reaction. This complex interplay between the HPA and the SNS after stroke has to be considered when targeting the neurohormonal systems in the post acute phase of severe stroke.     

Tumor-Associated Inflammatory Cells in Thyroid Carcinomas

The complex interactions between immune cells and tumor cells in cancer play a major role in tumor development and subsequent patient outcomes. Different types of tumor-associated inflammatory cells (TAICs), such as dendritic cells, macrophages, lymphocytes, and mast cells, have been recognized for many years in several tumors; however, the role of TAICs in cancer is still not completely understood. This review article focuses on the major types of TAICs, including their general role in cancer and, more specifically, their role and distribution in thyrocyte-derived carcinomas.     

术后早期炎症指标对胰十二指肠切除术后严重胰瘘的预测作用

目的 探讨胰十二指肠切除术（PD）术后早期炎症指标对严重胰瘘的预测作用。方法 回顾性分析2017年8月至2021年4月在中国科学技术大学附属第一医院普外科行胰十二指肠切除术的共117例病人的临床资料。通过查阅病历收集病人的一般资料,术后第1天和第3天的C反应蛋白（CRP）、降钙素原、中性粒细胞与淋巴细胞比值（NLR）、血小板与淋巴细胞比值（PLR）及术后并发症的发生及处理情况。分析严重胰瘘组和非严重胰瘘组间上述指标的差异,利用受试者操作特征曲线（ROC曲线）分析上述指标对严重胰瘘的预测作用。结果 117例行胰十二指肠切除术的病人中B级胰瘘34例,C级胰瘘2例,严重胰瘘26例。严重胰瘘组和非严重胰瘘组间一般资料比较结果显示,两组在年龄、性别、术前体质量指数（BMI）、术前胆红素水平、手术时间、出血量、术前有无胆道引流、病理方面均差异无统计学意义（均P>0.05）。严重胰瘘组与非严重胰瘘组间术后第1天CRP[(104.12±38.73)mg/L比（70.46±30.85）mg/L],术后第3天CRP[(203.99±59.84)mg/L比（141.08±46.39）mg/L]、NLR...