The Effect of Coding Method on Cause-of-Death Rankings

Background: Cause-of-death rankings are often used for planning or evaluating health policy measures. In the European Union, some countries produce cause-of-death statistics by a manual coding of death certificates, while other countries use an automated coding system. The outcome of these two different methods in terms of the selected underlying cause of death for statistics may vary considerably. Therefore, this study explores the effect of coding method on the ranking of countries by major causes of death. Method: Age and sex standardized rates were extracted for 33 European (related) countries from the cause-of-death registry of the European Statistical Office (Eurostat). Wilcoxon’s rank sum test was applied to the ranking of countries by major causes of death. Results: Statistically significant differences due to coding method were identified for dementia, stroke and pneumonia. These differences could be explained by a different selection of dementia or pneumonia as underlying cause of death and by a different certification practice for stroke. Conclusion: Coding method should be taken into account when constructing or interpreting rankings of countries by cause of death.

Anti program death-1/anti program death-ligand 1 in digestive cancers

Human tumors tend to activate the immune system regulatory checkpoints as a means of escaping immunosurveillance. For instance, interaction between program death-1(PD-1) and program death-ligand 1(PD-L1) will lead the activated T cell to a state of anergy. PD-L1 is upregulated on a wide range of cancer cells. Anti-PD-1 and anti-PD-L1 monoclonal antibodies(m Abs), called immune checkpoint inhibitors(ICIs), have consequently been designed to restore T cell activity. Accumulating data are in favor of an association between PD-L1 expression in tumors and response to treatment. A PD-L1 expression is present in 30% to 50% of digestive cancers. Multiple anti-PD-1(nivolumab, pembrolizumab) and anti-PD-L1 m Abs(MPDL3280A, Medi4736) are under evaluation in digestive cancers. Preliminary results in metastatic gastric cancer with pembrolizumab are highly promising and phase Ⅱ will start soon. In metastatic colorectal cancer(CRC), a phase Ⅲ trial of MPDL3280 A as maintenance therapy will shortly be initiated. Trials are also ongoing in metastatic CRC with high immune T cell infiltration(i.e., microsatellite instability). Major challenges are ahead in order to determine how, when and for which patients we should use these ICIs. New radiologic criteria to evaluate tumor response to ICIs are awaiting prospective validation. The optimal therapeutic sequence and association with cytotoxic chemotherapy needs to be established. Finally, biomarker identification will be crucial to selection ofpatients likely to benefit from ICIs.

Pathological Characteristics of Liver Allografts from Donation after Brain Death Followed by Cardiac Death in Pigs

Donation after brain death followed by circulatory death （DBCD） is a unique practice in China. The aim of this study was to define the pathologic characteristics of DBCD liver allografts in a porcine model. Fifteen male pigs （25-30 kg） were allocated randomly into donation after brain death （DBD）, donation after circulatory death （DCD） and DBCD groups. Brain death was induced by aug- menting intracranial pressure. Circulatory death was induced by withdrawal of life support in DBCD group and by venous injection of 40 mL 10% potassium chloride in DCD group. The donor livers were perfused in situ and kept in cold storage for 4 h. Liver tissue and common bile duct samples were col- lected for hematoxylin and eosin staining, TUNEL testing and electron microscopic examination. Spot necrosis was found in hepatic parenchyma of DBD and DBCD groups, while a large area of necrosis was shown in DCD group. The apoptosis rate of hepatocytes in DBD [（0.56±0.30）%] and DBCD [（0.50 ±0.11）%] groups was much lower than that in DCD group [（3.78±0.33）%] （P〈0.05）. And there was no significant difference between DBD group and DBCD group （P〉0.05））. The structures of bile duct were intact in both DBD and DBCD groups, while the biliary epithelium was totally damaged in DCD group. Under electron microscope, the DBD hepatocytes were characterized by intact cell membrane, well-organized endoplasmic reticulum, mild mitochondria edema and abundant glycogens. Broken cell membrane, mild inflammatory cell infiltration and sinusoidal epithelium edema, as well as reduced glycogen volume, were found in the DBCD hepatocytes. The DCD hepatocytes had more profound cell organelle injury and much less glycogen storage. In conclusion, the preservation injury of DBCD liver allografts is much less severe than that of un-controlled DCD, but more severe than that of DBD liver allografts under electron microscope, which might reflect post-transplant liver function to some extent.

Population attributable risks of cigarette smoking for deaths of all causes, all cancers and other chronic diseases among adults aged 40-74 years in urban Shanghai, China

Objective： To evaluate the population attributable risks （PARs） between cigarette smoking and deaths of all causes, all cancers, lung cancer and other chronic diseases in urban Shanghai. Methods： In total, 61,480 men aged 40-74 years from 2002 to 2006 and 74,941 women aged 40-70 years from 1997 to 2000 were recruited to undergo baseline surveys in urban Shanghai, with response rates of 74.0% and 92.3%, respectively. A Cox proportional hazards regression model was used to estimate relative risks （RRs） and 95% confidence intervals （95% CIs） of deaths associated with cigarette smoking. PARs and 95 % CIs for deaths were estimated from smoking exposure rates and the estimated RRs. Results： Cigarette smoking was responsible for 23.9% （95% CI： 19.4-28.3%） and 2.4% （95% Ch 1.6- 3.2%） of all deaths in men and women, respectively, in our study population. Respiratory disease had the highest PAR in men [37.5% （95% CI： 21.5-51.6%）], followed by cancer [31.3% （95% Ch 24.6-37.7%）] and cardiovascular disease （CVD） [24.1% （95% CI： 16.7-31.2%）]. While the top three PARs were 12.7% （95% CI： 6.1-19.3%）, 4.0% （95% CI： 2.4-5.6%）, and 1.1% （95% CI： 0.0-2.3%）, for respiratory disease, CVD, and cancer, respectively in women. For deaths of lung cancer, the PAR of smoking was 68.4% （95% CI： 58.2- 76.5%） in men. Conclusions： In urban Shanghai, 23.9% and 2.4% of all deaths in men and women could have been prevented if no people had smoked in the area. Effective control programs against cigarette smoking should be strongly advocated to reduce the increasing smoking-related death burden.

Advances in immuno-oncology biomarkers for gastroesophageal cancer:programmed death ligand 1,microsatellite instability,and beyond

Blockade of the programmed death ligand 1(PD-L1) and programmed cell death 1(PD-1) receptor axis represents an effective form of cancer immunotherapy. Preclinical evidence initially suggested that gastric and gastroesophageal junction(GEJ) cancers are potentially immunotherapy-sensitive tumors. Early phase clinical trials have demonstrated promising antitumor activity with PD-1/PD-L1 blockade in advanced or metastatic gastric/GEJ cancer. Microsatellite instability(MSI) and PD-L1 expression have been shown to predict higher response to PD-1 inhibitors as highlighted by the recent approvals of pembrolizumab in treatmentrefractory solid tumors with MSI status and the thirdline or greater treatment of PD-L1 positive advanced gastric/GEJ cancers. However, predictive and prognostic biomarkers remain an ongoing need. In this review, we detail the preclinical evidence and early tissue biomarker analyses illustrating potential predictive biomarkers to PD-1/PD-L1 blockade in gastric/GEJ cancer. We also review the clinical development of PD-1/PD-L1 inhibitors in gastric/GEJ cancer and highlight several areas in need of future investigation in order to optimize the efficacy of PD-1/PD-L1 blockade in gastric/GEJ cancer.

Prognostic value of programmed death.1, programmed death-ligand 1, programmed death-ligand 2 expression, and CD8(+) T cell density in primary tumors and metastatic lymph nodes from patients with stage T1.4N+M0 gastric adenocarcinoma

Background: Anti-programmed death-1/programmed death-ligand 1(PD-1/PD-L1) immunotherapy has been proved to be effective on gastric cancer in ongoing clinical trials. However, the value of PD-L1 in predicting responses of patients with gastric cancer to anti-PD-1/PD-L1 immunotherapy is controversial. Some studies suggested that intra-and inter-tumoral heterogeneity of PD-L1 expression might explain the controversy.This study aimed to analyze the expression of PD-L1, PD-L2, and PD-1 as well as CD8(+) T-cell density in primary tumors and lymph nodes from patients with stage T1-4 N+M0 gastric adenocarcinoma to explore the heterogeneity of PD-1 signaling pathway molecules.Methods: In primary tumors and metastatic as well as non-metastatic lymph nodes from patients with stage T1-4 N+M0 gastric adenocarcinoma, we detected PD-L1 and PD-L2 expression with immunohistochemistry. CD8(+)T-cell density in primary tumors and PD-1 expression on CD8(+)T cells were detected with immunofluorescence. Univariate analysis was used to determine the prognostic values of them. Cox proportional hazard regression model was used to identify independent risk factors that affect patients' overall survival and disease-free survival.Results: Among 119 eligible patients who had undergone surgical resection, the positive rate of PD-L1 was higher in metastatic lymph nodes than in primary tumors(45.4% vs. 38.7%, P = 0.005); the positive rate of PD-1 on CD8(+)T cells was significantly higher in primary tumors and metastatic lymph nodes than in tumor-free lymph nodes(both P < 0.001). The intensity of PD-1 expression on CD8(+) T cells in primary tumors and in metastatic lymph nodes were stronger than that in tumor-free lymph nodes from the same patient. Beside, the positive rate of PD-L2 did not show any differences between primary tumors and metastatic lymph nodes. In multivariate analysis, PD-L1 expression,PD-L2 expression, a low density of CD8(+) T cells in primary tumors, and PD-1 expression on CD8(+) T cells in primary tumors were associated with poor prognosis.Conclusion: The expression of PD-L1 is heterogeneous in primary tumors and in metastatic lymph nodes from patients with stageT1-4 N+M0 gastric adenocarcinoma, which might explain the inconsistent results in assessing the prognostic value of PD-L1 expression in previous studies.

Clinical significance of programmed death 1/programmed death ligand 1 pathway in gastric neuroendocrine carcinomas

BACKGROUND Recently, more and more studies have demonstrated the pivotal role of programmed death 1/programmed death ligand 1(PD-1/PD-L1) pathway in the immune evasion of tumors from the host immune system. However, the role of PD-1/PD-L1 pathway in gastric neuroendocrine carcinomas(G-NECs) remains unknown.AIM To investigate the expression of PD-1/PD-L1 and role of PD-1/PD-L1 pathway in G-NECs, which occur rarely but are highly malignant and clinically defiant.METHODS We investigated the expression of PD-L1 on tumor cells and PD-1^+, CD8^+, and FOXP3^+ T cell infiltration by immunohistochemistry in 43 resected G-NEC tissue specimens. The copy number alterations of PD-L1 were assessed by qRT-PCR.RESULTS Most of the G-NECs tumor cells exhibited a near-uniform expression pattern of PD-L1, while some showed a tumor-stromal interface enhanced pattern. Of the 43G-NECs, 21(48.8%) were classified as a high PD-L1 expression group, and the high expression of PD-L1 was associated with poor overall survival(OS). The high expression of PD-L1 was correlated with abundant PD-1^+ tumor infiltrating lymphocytes(TILs) instead of CD8^+ TILs and FOXP3^+ regulatory T cells(Tregs).Our analysis also suggested that the infiltration of CD8^+ TILs tended to be a favorable factor for OS, although the difference did not reach the statistical significance(P = 0.065). Meanwhile, PD-L1 was significantly overexpressed in cases with copy number gain as compared with those without.CONCLUSION Our data demonstrated for the first time that high expression of PD-L1 in GNECs is associated with a poor prognosis, while the high expression may be due to the copy number variation of PD-L1 gene or stimulation of TILs. These results provide a basis for the immunotherapy targeting PD-1/PD-L1 pathway in GNECs.

Community Notification of Maternal, Neonatal Deaths and Still Births in Maternal and Neonatal Death Review (MNDR) System: Experiences in Bangladesh

Objectives: The aim of the study was to examine the process of community maternal, neonatal deaths and still births notification within the Bangladesh government health structure using the Maternal and Neonatal Death Review (MNDR) system. The study also explored the feasibility and acceptance of community death notification in the MNDR system. Methods: The study was under-taken in the Thakurgaon district of Bangladesh during 2010. During the study a mix of both qualitative and quantitative information was collected. A review of the documentation process of community death notification was undertaken and focus group discussions (FGDs) with community members, health care providers and managers in a sub-district were conducted, with in-depth interviews (IDIs) with district heath and family planning managers. Quantitative data were collected from community death notifications in the district during January to December 2010. Results: The death notification process was implemented by the government health care system within the Thakurgaon district. Field level health and family planning staff collected maternal and neonatal death information, recorded the death on the notification form and reported back to the Upazila (sub-district of the district) focal point at the Upazila health complex (primary health care centre). Community people were encouraged to share their death information to field level health staff. The health and family planning managers in the district periodically discussed the maternal and neonatal deaths and prepared remedial action plans in high death notified areas. In 2010, 59 maternal deaths, 739 neonatal deaths and 633 still births were reported in Thakurgaon district. District health and family planning departments performed community death notification as part of their routine daily work and integrated these procedures with other field level activities. Conclusion: Community death notification under the MNDR system was found to be achievable and acceptable at the district level using the existing government health system. The simple death notification process used to capture community level maternal, neonatal deaths and still births provides a guide for planning corrective actions for better health outcomes for the community.

Death certification: issues and interventions

A review of the literature suggests that errors in death certification are common. We reviewed the published literature to clarify what is known and what remains to be learned before evidence-based changes in medical education can be recommended. We searched the National Library of Medicine’s PubMed database for articles that addressed death certificate accuracy and identified 159 articles of interest published from 1996 to 2010. Among these 159 articles, we found 83 that were relevant to our goals and objectives. Cause of death certification has been shown to be problematic and several interventions have been shown to improve its accuracy, especially if the intervention is interactive. However these studies have focused on short term gains rather than on long term retention and performance, leaving a significant data gap. We suggest a study design that could address this data gap.

Jghm rum,ud on the Death-Themed Poems of Emily Dickinson

This paper combines the analytical explanation of Dickinson's death-themed poems with her life experience of religion and death experience to reveal her positive attitude towards life and death.

Causes of Maternal Mortality According to Reports of Maternal Death Audits in the University Teaching Hospital Bogodogo (UTH-B) from January to December 2017

Objective: To study causes of maternal mortality according to reports of maternal death audits in the University Teaching Hospital Bogodogo (UTH-B) of Ouagadougou, Burkina Faso. Materials and Method: This was a prospective study that took place over a year from 1 January to 31 December 2017.? It concerned maternal deaths that occurred during this period in the obstetrics and gynecology department of the University Teaching Hospital Bogodogo (UTH-B). All maternal deaths were systematically audited by the audit committee;interviews with providers and families were sometimes conducted. The record books of all patients were analyzed by the audit committee;if necessary, interviews were conducted with care providers and families. The main information collected were recorded on individual files, entered and analyzed using the software Epi-info 7. Result: During the study period, we recorded 32 maternal deaths i.e., 587 per 100,000 live births. Deceased women under age 20 were the most numerous, followed by women aged 20 to 24. The death occurred in most cases in the puerperium in 69.80% of cases. Complications of pregnancy were the most incriminated causes in maternal deaths. Bleeding was the leading cause, accounting for 34.3%. They are followed by hypertensive disorders of pregnancy (21.8%) and infections (18.8%). In the contributing factors, resource factors were incriminated in 56.2% of cases, social factors in 43.7% of cases and medical factors in 25.4% of cases. Death was non-preventable in 76.2% of cases compared to 23.8% of preventable deaths. Conclusion: Maternal mortality is a major public health problem at the maternity hospital of the university hospital Yalgado Ouedraogo. Hemorrhage is the first cause of death. Hypertensive diseases are more and more worrying. Solutions must be found to improve the practice of audits in the obstetrics and gynecology department of UTH-B.

Research progress regarding programmed cell death 1/programmed cell death ligand 1 inhibitors combined with targeted therapy for treating hepatocellular carcinoma

In recent years,a number of targeted therapeutic agents have achieved success in phase III trials in patients with advanced hepatocellular carcinoma(HCC),including sorafenib,lenvatinib,and regorafenib.Immunotherapy is considered to be an effective treatment for advanced HCC.Immune checkpoint inhibitors targeting programmed cell death 1(PD-1)/programmed cell death ligand 1(PDL1)are important antitumor immunotherapy agents that represent breakthroughs in the treatment of advanced HCC.However,treating advanced HCC is still a great challenge,and the need for new treatments remains urgent.This review briefly summarizes the research progress in the use of PD-1/PD-L1 inhibitors combined with targeted therapy for treating HCC.

Epidemiological characteristics and relative factor of hospital death cases with road traffic trauma

Objective: To investigate the epidemiological characteristics and relative factor about hospital death in patients with road traffic trauma. Methods: The age, sex, road-use category, sites of injury, injury severity scale of 159 hospital death cases in 2436 cases with road traffic trauma were observed, and the relation between the causes of death and time elapsed after injury was also studied with likelihood ratio Chi-square test.

Validation of a pediatric bedside tool to predict time to death after withdrawal of life support

AIM: To evaluate the accuracy of a tool developed to predict timing of death following withdrawal of life support in children. METHODS: Pertinent variables for all pediatric deaths(age ≤ 21 years) from 1/2009 to 6/2014 in our pediatric intensive care unit(PICU) were extracted through a detailed review of the medical records. As originally described, a recently developed tool that predicts timing of death in children following withdrawal of life support(dallas predictor tool [DPT]) was used to calculate individual scores for each patient. Individual scores were calculated for prediction of death within 30 min(DPT30) and within 60 min(DPT60). For various resulting DPT30 and DPT60 scores, sensitivity, specificity and area under the receiver operating characteristic curve were calculated.RESULTS: There were 8829 PICU admissions resulting in 132(1.5%) deaths. Death followed withdrawal of life support in 70 patients(53%). After excluding subjects with insufficient data to calculate DPT scores, 62 subjects were analyzed. Average age of patients was 5.3 years(SD: 6.9), median time to death after withdrawal oflife support was 25 min(range; 7 min to 16 h 54 min). Respiratory failure, shock and sepsis were the most common diagnoses. Thirty-seven patients(59.6%) died within 30 min of withdrawal of life support and 52(83.8%) died within 60 min. DPT30 scores ranged from-17 to 16. A DPT30 score ≥-3 was most predictive of death within that time period, with sensitivity = 0.76, specificity = 0.52, AUC = 0.69 and an overall classification accuracy = 66.1%. DPT60 scores ranged from-21 to 28. A DPT60 score ≥-9 was most predictive of death within that time period, with sensitivity = 0.75, specificity = 0.80, AUC = 0.85 and an overall classification accuracy = 75.8%.CONCLUSION: In this external cohort, the DPT is clinically relevant in predicting time from withdrawal of life support to death. In our patients, the DPT is more useful in predicting death within 60 min of withdrawal of life support than within 30 min. Furthermore, our analysis suggests optimal cut-off scores. Additional calibration and modifications of this important tool could help guide the intensive care team and families considering DCD.

善生与善终:中国生命文化的安宁追求

中国传统生命文化立足于生死一体,有一整套对临终“安宁”的文化叙事。在根本理念上,强调“送死”是比“养生”更重要的人生大事,而能够“善终”则是人的幸福追求。在行为决策上,强调个人自主与家庭协商相结合的家庭自主模式;在策略路径上,主张遵守“礼制”,特别设计出一套临终礼仪,帮助人们走向“善终”;在目标价值上,强调“知生”以“知死”,活得好便可以死得好,由此可以实现生命价值的不朽;在精神信念上,则强调对“生死有命”的接纳,同时将“命限”转化为“使命”,从而升华对“天命”的体悟与认知,并在“生生不息”的信仰中接受死亡。

互动式死亡焦虑舒缓工作坊在肿瘤医院护生死亡教育中的应用

目的探析肿瘤医院护生死亡教育中应用互动式死亡焦虑舒缓工作坊的价值。方法在2021年2月—2022年12月哈尔滨医科大学附属肿瘤医院护生中选取42名配合研究,依据随机数字表法分2组,各21名。对照组以传统教学方法为主,观察组以互动式死亡焦虑舒缓工作坊教学方式实施死亡教育。比较2组死亡焦虑评分、教学满意度、对死亡态度评分。结果干预前2组护生的死亡焦虑评分比较差异无统计学意义(P>0.05),干预后观察组护生的死亡焦虑评分[(6.12±1.35)分]较对照组低,护生对教学满意度95.24%高于对照组66.67%,观察组死亡逃避[(12.32±2.12)分]、死亡恐惧[(18.35±2.12)分]、逃离接受的评分[(12.32±1.23)分]低于对照组,自然接受[(19.98±1.35)分]、趋近接受[(28.35±1.3)分]高于对照组,差异均有统计学意义(P<0.05)。结论互动式死亡焦虑舒缓工作坊应用在肿瘤医院护生死亡教育中的效果明显,可提升护生的参与积极性,改善护生对死亡的焦虑情绪,增强护生面对死亡的态度,其满意此种教学方法,临床上可借鉴。

Experiences of Community Members on Reporting Community Maternal Deaths in Mangochi District of Malawi

The purpose of this study was to explore and describe the experiences of community stakeholders on reporting community maternal deaths to relevant authorities in Mangochi District of Malawi. The study employed qualitative hermeneutic phenomenology approach to data collection, analysis and interpretation. It was conducted in three health zones of Mangochi district which are Monkey-bay, Mangochi boma and Namwera zones. Purposive sampling was used to select major community stakeholders on issues of safe motherhood and these were;Village heads, Health Surveillance Assistants (HSAs), safe motherhood volunteers and members of village health committees (VHCs). A total of eighteen in-depth interviews and three focus group discussions were conducted. Descriptive statistics were computed for the demographic variables and the qualitative data were analysed using modified Colaizzi (1978) method based on Heideggerian and Gademerian philosophy. Findings showed that community maternal deaths were not always reported because there were no records in the district. Most participants lacked knowledge on the process and their role in reporting community maternal deaths despite knowing the importance of reporting such deaths. However, findings indicated a positive perception of participants towards reporting community maternal deaths to authorities. The study recommends that health education be offered to community members and Health Surveillance Assistants regarding reporting maternal deaths to improve the situation.

临床护士死亡应对能力与死亡态度、职业认同的相关性

目的:探讨临床护士死亡应对能力与死亡态度、职业认同的关系。方法:2022年10月—2022年12月,采用便利抽样法抽取河北省13所医院的953名临床护士作为研究对象,采用一般资料调查表、中文版死亡应对量表(CDS)、死亡态度描绘量表(DAP-R)、护士职业认同评定量表(PISN)进行调查。结果:953名临床护士CDS得分为(115.30±31.22)分,DAP-R得分为(95.59±16.41)分,PISN得分为(107.55±23.44)分。护士死亡应对水平与正向死亡态度、职业认同水平呈正相关(P<0.05),与负向死亡态度呈负相关(P<0.05)。回归分析结果显示,年龄、学历、近3个月护理过死亡病人的数量、死亡教育培训及DAP-R、PISN得分为护士死亡应对能力的影响因素(P<0.05)。结论:临床护士死亡应对能力处于中等偏低水平,与死亡态度及职业认同相关。护理管理者可通过培养护士正向死亡态度,加强其对护理职业的认同感,进而提升其死亡应对能力。

口蹄疫病毒感染后猪PD-1及其配体转录水平变化和免疫抑制机制分析

研究猪感染口蹄疫病毒(Foot-and-mouth disease virus,FMDV)后程序性死亡受体-1(Programmed death-1,PD-1)及其配体(PD-L1、PD-L2),细胞因子[IL-2(Interleukin-2)、IL-10(Interleukin-10)、IFN-γ(Interferon-γ)]mRNA转录水平和外周血单个核细胞(Peripheral blood mononuclear cells,PBMCs)增殖能力,探讨PD-1/PD-Ls通路在FMDV引起免疫抑制过程中的作用机制。结果表明,猪感染FMDV后3、7、14、17 d,PD-1的mRNA转录水平显著或极显著升高,感染后7 d达到峰值,之后逐渐降低;感染FMDV后3 d和7 d,PD-L1的mRNA转录水平极显著升高;感染FMDV后3 d,PD-L2的mRNA转录水平显著升高。感染FMDV后3、7 d,IL-2的mRNA转录水平显著下降;感染FMDV后1、3 d,IFN-γ的mRNA转录水平极显著下降,IL-2和IFN-γ的mRNA转录水平与PD-1及其配体mRNA转录水平变化趋势相反;感染FMDV后3、7、14 d,IL-10的mRNA转录水平显著或极显著升高,与PD-1及其配体mRNA转录水平变化趋势相同。感染FMDV后,全血中FMDV的病毒载量随着感染后时间的推进逐渐升高,感染后7 d达到峰值,与PD-1及其配体mRNA转录水平变化趋势总体上相同。感染后7 d,PBMCs的增殖能力明显降低。综上,FMDV感染猪后,总体上上调了PD-1及其配体的mRNA转录水平,是FMDV感染引起机体免疫抑制的重要致病机制。

PD-1在原发性肝细胞癌组织中的表达及意义

目的旨在探讨程序性死亡受体-1(PD-1)在原发性肝细胞癌(HCC)组织中的表达及意义。方法回顾性分析2020年5月—2022年5月于联勤保障部队第980(白求恩国际和平)医院接受诊治的HCC患者70例,所有患者均经过影像学及病理学证实为HCC。术中取肝癌原发病灶处癌组织制作为肝癌标本,取肝癌原发病灶5 cm以外的肝组织作为癌旁正常肝组织标本,对所有标本进行切片处理,通过免疫组化、Western blotting等方法,检测标本组织中PD-1的表达情况;分析癌组织、癌旁组织以及不同分化程度的HCC PD-1的表达情况;分析不同病理特征(年龄、性别、肿瘤大小、HBV阳性与否、是否转移、是否合并腹水)对PD-1表达情况的影响。结果癌组织的PD-1表达水平明显高于癌旁组织,差异均具有统计学意义(P<0.05);中分化型HCC PD-1表达水平明显高于高分化及低分化型HCC,差异均具有统计学意义(P<0.05);高分化型与低分化型相比,差异不具有统计学意义(P>0.05);PD-1阳性表达与HCC患者年龄、性别、HBV是否阳性无关,差异不具有统计学意义(P>0.05);PD-1阳性表达与肿瘤大小、肿瘤是否转移以及有无腹水有关,差异具有统计学意义(P<0.05);肿瘤直径>6 cm、肿瘤发生转移以及合并腹水的HCC患者PD-1阳性表达率较高。另外,通过qPCR及Western blotting测定发现PD-1在Ⅲ~Ⅳ期肝癌表达高于Ⅰ~Ⅱ期肝癌。结论PD-1在癌组织中以及中分化型HCC表达水平较高;且肿瘤分期越高,直径越大,合并转移及腹水时,PD-1表达水平高。因此PD-1有望成为判断HCC分期以及预后的指标之一,为HCC的诊断及治疗提供新策略。