Programmed cell death ligand 1 (PD-L1) expression on gastric cancer and its relationship with clinicopathologic factors

Background: Targeting the immune checkpoints in solid tumors becomes hot recently. Programmed cell death ligand 1 (PD-L1) is ligand for programmed death 1 (PD-1), which is known to negatively regulate T-cell activation. In the present study, we investigated the expression of PD-L1 in tumor specimens of gastric cancer and its relationships with clinicopathological variables and survival. Methods: The expression of PD-L1 in 132 surgically resected specimens of stage II and III gastric cancer was evaluated by immunohistochemistry in microarray tissue. Results: Expression of PD-L1 was observed in 50.8% (67/132) of gastric cancer tumor specimens. Patients whose tumor size over 5cm had a higher positive rate of PD-L1 expression. There was no relationship between the expression of PD-L1 and other clinicopathological variables including age, gender, clinical stage, location as well as histological differentiation. PD-L1 positive patients had significantly poorer survival than negative patients. The 5-year survival rates was 83.1% in those with PD-L1 negative patients and 50.7% for PD-L1 positive patients (P<0.001). The multivariate analysis indicated that both PD-L1 positive and Tumor-node-metastasis stage were independent prognostic factors in gastric cancer patients (P=0.001 and 0.025, respectively). Conclusions: The expression of PD-L1 was found in half of stages II and III gastric cancer patients. Positive of PD-L1 expression indicated poor survival in Chinese stages II and III gastric adenocarcinoma patients. These results may provide the clue for immunotherapy in the adjuvant treatment setting of gastric cancer patients.     

Tangent function transformation of the Abbreviated Injury Scale improves accuracy and simplifies scoring

Introduction

The Injury Severity Score (ISS) and the New Injury Severity Score (NISS) are widely used for anatomic severity assessments after trauma. We present here the Tangent Injury Severity Score (TISS), which transforms the Abbreviated Injury Scale (AIS) as a predictor of mortality.

Material and methods

The TISS is defined as the sum of the tangent function of AIS/6 to the power 3.04 multiplied by 18.67 of a patient''s three most severe AIS injuries regardless of body regions. TISS values were calculated for every patient in two large independent data sets: 3,908 and 4,171 patients treated during a 6-year period at level-3 first-class comprehensive hospitals: the Affiliated Hospital of Hangzhou Normal University and Fengtian Hospital Affiliated to Shenyang Medical College, China. The power of TISS to predict mortality was compared with previously calculated NISS values for the same patients in each data set.

Results

The TISS is more predictive of survival than NISS (Hangzhou: receiver operating characteristic (ROC): NISS = 0.929, TISS = 0.949; p = 0.002; Shenyang: ROC: NISS = 0.924, TISS = 0.942; p = 0.008). Moreover, TISS provides a better fit throughout its entire range of prediction (Hosmer Lemeshow statistic for Hangzhou NISS = 29.71; p < 0.001, TISS = 19.59; p = 0.003; Hosmer Lemeshow statistic for Shenyang NISS = 33.49; p < 0.001, TISS = 21.19; p = 0.002).

Conclusions

The TISS shows more accurate prediction of prognosis and a linear relation to mortality. The TISS might be a better injury scoring tool with simple computation.     

Overexpression of miR-221 inhibits proliferation and promotes apoptosis of human astrocytoma cells

microRNAs (miRNAs) play tumor-promoting roles in a variety of tumors. This study investigated the expression of miRNA-211 (miR-221) in human astrocytoma, and its effect on proliferation and apoptosis of human astrocytoma cells in vitro. miR-221 expression was detected in 10 astrocytoma tissues and 4 adjacent tissues by real-time quantitative PCR (qRT-PCR). miR-221 expression in situ was significantly higher in astrocytoma tissues than in adjacent tissues (P<0.05). To determine whether the upregulation of miR-221 could be associated with tumor development or progression, a synthetic miR-221 mimic was transiently transfected into U251 astrocytoma cells in vitro. qRT-PCR confirmed that the mimic significantly increased the expression of miR-221 in these cells. An MTT colorimetric assay indicated that proliferation was significantly higher in U251 cells transfected with miR-221 mimic than in scramble-transfected control cells (P<0.05). Further analysis of miR-221 transfected cells by flow cytometry revealed an altered cell cycle progression, with more cells in S and G1 phase, as well as an inhibition of apoptosis (P<0.05). These findings indicate that the upregulation of miR-221 in astrocytoma tissues may be associated with development or progression of these tumors. Thus, miR-221 should be explored as a potential molecular marker for the diagnosis and treatment of astrocytoma.     

十二指肠乳头旁憩室合并胆总管结石的诊治

目的探讨十二指肠乳头旁憩室(Juxtapapillary duodenal diverticulum,JPDD)合并胆总管结石的诊断及治疗。方法回顾分析近12年来我院收治的17例JPDD合并胆总管结石临床资料。结果 17例JPDD合并胆总管结石患者,均有不同程度的腹痛、发热、黄疸或者胆道感染的病史,其中9例复发胆总管结石在第一次手术后0.5~3年(平均为1.2年)即再次出现胆道结石或胆道感染的症状。所有病例均行手术治疗,治愈出院。术后随访率为76.47%(13/17)。中位随访时间为26个月(3~78个月)。胆总管切开取石的4例随访患者中2例恢复良好,2例患者偶有胆管感染症状发作,经消炎、利胆等治疗后缓解。行胆管空肠Roux-en-Y吻合8例随访患者中2例患者偶感上腹部不适,经对症治疗后缓解,其余患者随访情况良好。结论胆总管结石形成、复发与JPDD有密切联系。胆总管结石的诊治过程中应考虑合并存在JPDD的可能,切忌只顾取石而忽视胆管末端狭窄和畸形的处理。对合并存在JPDD的胆总管结石患者行胆囊切除、胆总管空肠Roux-en-Y吻合术可获得较好疗效。     

健康管理对社区慢性阻塞性肺疾病患者治疗效果的影响

目的 探讨健康管理在社区慢性阻塞性肺疾病(COPD)患者治疗中的应用效果,评估其应用价值.方法 收集2011年1月至2014年1月社区COPD患者135例,将患者按照随机数表法分为对照组68例和观察组67例,两组患者均给予相同的临床治疗,观察组患者采取社区健康管理方法管理,对照组给予社区常规定期观察随访,健康管理实施6个月后比较两组患者治疗前后的肺功能指标及生活质量指标等情况.结果 观察组患者在肺功能指标、呼吸疾病问卷评分(SGRQ)、日常生活活动评定量表(ADL)得分以及呼吸困难评分(MMRC)得分等方面均优于对照组,差异均有统计学意义(P<0.05).结论 健康管理应用于社区COPD患者治疗,能有效改善患者肺功能,提高患者生活质量,对治疗效果有积极的影响,值得在社区COPD患者管理中推广应用.     

咳嗽并见背冷症证因特点临床研究

目的观察咳嗽并见背冷症患者的临床表现及中医证候特点,探讨分析其病因病机,为咳嗽的临床诊疗提供依据。方法选取以"咳嗽"为主诉且并见背冷症的患者作为研究对象,就其一般性资料、所患呼吸系统基础疾病、咳嗽及背冷症发生的临床特点、相关因素进行分析,总结其发病特点、病因病机及证候学特点。结果咳嗽并见背冷症临床常见,背冷症与咳嗽症状密切相关,病理要素包含湿热、阳虚、痰饮、风邪等。中医辨证分型可见脾胃湿热证占22.8%、脾胃湿热证兼肺阳虚证占21.3%、肺阳虚证占17.3%、肺脾阳虚证占12.7%等。结论背冷症与咳嗽常相兼而见,可见于不同年龄段、不同肺系疾病中,轻重程度各异,且与季节、气候变化等有关。脾胃湿热证、肺阳虚证及其相兼证为咳嗽并见背冷症的常见证候,湿热邪气阻滞气机及肺脾阳虚、卫阳失布而致肺失宣肃是主要病机。     

MiR-375增加肿瘤坏死因子对人口腔鳞癌细胞杀伤活性及机制研究

目的探讨micro RNA-375(mi R-375)对肿瘤坏死因子(TNF-α)杀伤人口腔鳞癌细胞生物效应的影响。方法将人口腔鳞癌细胞Cal27用mi R-375模拟物转染后用TNF-α治疗,采用MTT法检测治疗后Cal27细胞的增殖情况;通过流式细胞术检测Cal27细胞治疗后的凋亡情况;通过流式细胞术检测Cal27细胞内DNA的含量,测定凋亡特征性sub G1期的细胞比值;定量PCR法检测治疗后Cal27细胞抗凋亡蛋白Bcl-2、Bcl-xl、c IAP2、c FLIPL的表达。结果 mi R-375+TNF-α组对Cal27细胞增殖的抑制率为(37.8±5.2)%,凋亡率为(20.5±3.8)%,TNF-α组分别为(6.2±2.7)%、(1.0±0.3)%,两组比较,差异有统计学意义(P0.05);mi R-375+TNF-α组,Cal27细胞的c IAP2、c FLIPL表达较TNF-α组显著下降(2.15±0.16比6.87±0.42、1.54±0.10比3.98±0.25)(P0.05),Bcl-2,Bcl-xl表达不变。结论 mi R-375降低c IAP2、c FLIPL的表达,提高人口腔鳞癌Cal27细胞对TNF-α的敏感性,提高凋亡率。     

膝关节液中白细胞介素1β、白细胞介素6、白细胞介素8及肿瘤坏死因子α表达与组织病理学的相关性研究

目的 研究患者膝关节液中4种炎性因子（IL-1β、IL-6、IL-8、TNF-α）的表达水平及其与相应组织病理学的关系。方法 在关节外科手术前,抽取31例患者的膝关节液,采用流式细胞小球微阵列术方法检测膝关节液中IL-1β、IL-6、IL-8、TNF-α表达水平,同时分析其滑膜组织病理学特征。所有患者按照组织病理学诊断分为骨关节炎（OA）、假体置换后翻修（RPR）、色素性绒毛结节性滑膜炎（PVNS）和类风湿关节炎（RA）,另根据滑膜组织内含铁血黄素情况分为含铁血黄素沉着组和非含铁血黄素沉着组,根据滑膜组织内炎细胞浸润情况分为炎细胞浸润组和非炎细胞浸润组,按照膝关节液颜色分为血性膝关节液组和非血性膝关节液组。结果 31例患者中男9例、女22例,平均年龄（63.60±9.19）岁,左膝12例、右膝19例,OA 18例,RPR 5例,PVNS 5例,RA 3例。OA组患者膝关节液中4种炎性因子含量均最低,与其他3组比较差异均有统计学意义（P均<0.05）;RA组膝关节液中IL-1β水平高于RPR组和PVNS组,差异均有统计学意义（P均<0.05）,但后两组间差异无统计学意义（P>0.05）;RA组膝关节液中IL-6水平高于PVNS组,但低于RPR组,3组间差异均有统计学意义（P均<0.05）;RA组膝关节液中IL-8水平高于RPR组和PVNS组,3组间差异均有统计学意义（P均<0.05）;RA组膝关节液中TNF-α水平高于RPR组和PVNS组,3组间差异均有统计学意义（P均<0.05）。炎细胞浸润组（11例）膝关节液中4种炎性因子水平均高于非炎细胞浸润组（20例）,差异均有统计学意义（P均<0.05）。含铁血黄素沉着组（7例）膝关节液中4种炎性因子水平均高于非含铁血黄素沉着组（24例）,差异均有统计学意义（P均<0.05）。血性膝关节液组（4例）与非血性膝关节液组（27例）相比,IL-1β差异有统计学意义（P<0.05）,但IL-6、IL-8及TNF-α差异均无统计学意义（P均>0.05）。结论 IL-1β、IL-6、IL-8及TNF-α在多种关节疾病中有表达,且与其病理学特征等有相关性。这一发现有助于进一步研究某些关节疾病的发病和发展,可为临床诊断、治疗和基础研究提供参考。     

靶向治疗时代第1大类肺动脉高压临床资料及预后分析

目的 分析中国肺血管扩张药物上市后第Ⅰ大类肺动脉高压（PAH）患者的临床资料及预后。方法 回顾性分析2012年1月至2019年3月武汉亚洲心脏病医院收治的750例确诊的第Ⅰ大类PAH患者,收集患者基线资料、实验室检查、影像学、心导管检查等,平均随访（2.3±1.7）年,评价第Ⅰ大类PAH的治疗及预后,对比分析中国靶向肺血管扩张药上市前后患者临床资料及预后。结果 第Ⅰ大类PAH患者平均确诊年龄（30.39±17.54）岁,女性占65.6%。心功能Ⅲ或Ⅳ级29.2%,6MWD（422±96）米。第Ⅰ大类PAH中IPAH 12.4%、HPAH 0.7%、CTD-PAH 4.8%,portalHT-PAH 0.5%、CHD-PAH 81.6%。不同亚类PAH性别（c2=24.551,P<0.05）、年龄（F=3.973,P=0.003）、BMI（F=11.005,P<0.05）、6MWD（F=2.537,P=0.041）、SPO2（F=4.129,P=0.003）、尿酸（F=7.654,P<0.05）、总胆红素（F=3.737,P=0.005）、SvO2（F=3.298,P=0.011）、PVRI（F=11.132,P<0.05）、心排指数（F=3.506,P=0.008）、右心室/左心室舒张末内径（F=14.909,P<0.05）差异有统计学意义（P<0.05）补充数据 。PAH中仅基础治疗16.3%,心功能Ⅲ~Ⅳ级联合应用两种肺血管扩张药51.6%。平均随访时间为（2.3±1.7）年,终点事件135例,其中死亡30例。IPAH、HPAH、CTD-PAH、CHD-PAH死亡者分别占8.6%、60.0%、11.1%、2.5%。PAH第1、3年生存率分别为98.8%、96.0%,较非靶向药物治疗时期分别提高30.8%、57.1%。结论 靶向治疗时代我国第Ⅰ大类PAH患者早期生存率较前改善。低龄患者药物选择种类少,早期诊断率有待提高,需提高标准靶向治疗率。