信号分子IRAK1/4在antiβ-2GPI/β2GPI复合物诱导THP-1细胞表达TF中的作用探讨

目的:探讨IRAK1和IRAK4在antiβ-2GPI/β2GPI复合物诱导单核细胞株THP-1表达组织因子(TF)中的作用。方法:利用荧光定量PCR(Real-time PCR)、TF活性试剂盒分别检测THP-1细胞表达TF mRNA及TF活性;Western blot检测anti-β2GPI/β2GPI复合物诱导THP-1细胞表达IRAK1、磷酸化-IRAK1(p-IRAK1)、IRAK4情况;观察IRAK1/4抑制物是否干预anti-β2GPI/β2GPI复合物诱导THP-1表达TF。结果:Antiβ-2GPI/β2GPI复合物(100μg/ml)诱导THP-1细胞表达TF显著增加(P<0.05 vs control);Antiβ-2GPI/β2GPI复合物(100μg/ml)刺激THP-1细胞表达IRAK1、p-IRAK1、IRAK4(蛋白)显著升高(P<0.05 vscontrol);IRAK1/4抑制物(50μmol/L)能够阻断antiβ-2GPI/β2GPI复合物(100μg/ml)诱导THP-1表达TF及IRAK1磷酸化的效应。结论:antiβ-2GPI/β2GPI复合物诱导THP-1细胞表达TF过程中,信号分子IRAK1/4被激活进而发挥重要作用。

血清TLR4、TIMP-1水平与小儿热性惊厥临床特征的关系及对继发癫痫的预测价值

目的分析血清Toll样受体4(TLR4)、基质金属蛋白酶组织抑制剂(TIMP)-1水平与小儿热性惊厥(FC)临床特征的关系及对FC继发癫痫的预测价值。方法选取2019年1月至2022年6月320例FC患儿作为研究组,另选取同期发热无惊厥儿童150例作为发热组,体检健康儿童150例作为对照组。根据FC患儿是否继发癫痫分为癫痫组和无癫痫组。采用酶联免疫吸附试验检测血清TLR4、TIMP-1水平,采用Pearson相关分析TLR4、TIMP-1水平及与临床指标间的相关性。采用受试者工作特征(ROC)曲线分析血清TLR4、TIMP-1预测FC继发癫痫的价值。采用Logistic回归分析FC患儿继发癫痫的影响因素。结果FC患儿、发热无惊厥儿童、体检健康儿童血清TLR4、TIMP-1水平依次降低,且两两比较,差异均有统计学意义(P<0.05)。研究组与发热组围生期异常发生情况、肿瘤坏死因子α(TNF-α)、C-反应蛋白(CRP)、白细胞介素-1β(IL-1β)水平和振幅整合脑电图(AEEG)评分比较,差异均有统计学意义(P<0.05)。癫痫组患儿血清TLR4、TIMP-1水平明显高于无癫痫组(P<0.05)。癫痫组和无癫痫组患儿首次惊厥次数、惊厥持续时间、首次惊厥前发热时间、围生期异常发生情况、TNF-α、CRP、IL-1β水平和AEEG评分比较,差异均有统计学意义(P<0.05)。血清TLR4水平与TIMP-1呈正相关(P<0.05);血清TLR4、TIMP-1水平与TNF-α、CRP、IL-1β呈正相关(P<0.05),与AEEG评分呈负相关(P<0.05)。TLR4、TIMP-1联合预测FC患儿继发癫痫的曲线下面积(AUC)明显高于单项检测的AUC(Z_(TLR4-联合)=3.016,P=0.003;Z_(TIMP-1-联合)=2.232,P=0.026)。Logistic回归分析结果表明,TLR4、TIMP-1、TNF-α、CRP、IL-1β水平升高,AEEG评分降低均为FC继发癫痫的危险因素(P<0.05)。结论血清TLR4、TIMP-1与FC患儿临床特征密切相关,TLR4、TIMP-1可能是FC继发癫痫的影响因素。

GLP-1RA与DPP-4i治疗2型糖尿病的疗效及对患者并发症的影响

目的探讨胰高糖素样肽1受体激动剂(GLP-1RA)与二肽基肽酶4抑制剂(DPP-4i)治疗2型糖尿病(T2MD)的疗效及对患者并发症的影响。方法选取2020年6月至2022年6月邯郸市第一医院收治的110例T2MD随机分为GLP-1RA组和DPP-4i组,每组55例,GLP-1RA组采用利拉鲁肽或艾塞那肽治疗,DPP-4i组采用西格列汀或利格列汀治疗。对比2组临床疗效,治疗前后糖脂代谢指标[空腹血糖(FPG)、糖化血红蛋白(HbA1c)、总胆固醇、三酰甘油]、炎症指标[白介素-6(IL-6)、C反应蛋白(CRP)、中性粒细胞/淋巴细胞(NLR)]、肾功能[尿素氮、肌酐、胱抑素C];观察并统计2组并发症及不良反应。结果2组总有效率、并发症总发生率比较差异均无统计学意义(P>0.05)。治疗18周后,2组FPG、HbA1c、三酰甘油、总胆固醇水平低于治疗前,且GLP-1RA组低于DPP-4i组(P<0.05)。治疗18周后,2组IL-6、CRP、NLR水平低于治疗前(P<0.05),但2组间差异无统计学意义(P>0.05)。2组治疗前和治疗18周后尿素氮、肌酐、胱抑素C水平比较差异均无统计学意义(P>0.05)。GLP-1RA组不良反应总发生率高于DPP-4i组(P<0.05)。结论GLP-1RA与DPP-4i均能改善T2MD患者糖脂水平,减轻炎性反应,保护肾功能,预防并发症发生,但GLP-1RA在控制血糖、调脂方面优于DPP-4i,而DPP-4i耐受性更好。

IRAK1/4抑制剂对结肠炎小鼠肠道屏障功能的影响

目的研究白细胞介素受体相关激酶1/4(interleukin receptor-associated kinase 1/4,IRAK1/4)抑制剂对葡聚糖硫酸钠(dextran sulfate sodium,DSS)诱导结肠炎小鼠肠道屏障功能的保护作用。方法30只雄性C57BL/6小鼠随机分为空白组、DSS组、IRAK1/4抑制剂组,每组10只。DSS组与IRAK1/4抑制剂组小鼠使用质量浓度为30g/L的DSS共7天构建结肠炎模型,每组分别给予相应药物试剂处理。每天同一时间观察记录小鼠生命活力、体质量变化、粪便性状及粪便隐血情况,进行疾病活动指数(disease activity index,DAI)评分,并根据病理切片计算组织病理评分,ELISA法检测结肠组织炎性细胞因子(IL-1β、IL-6、TNF-α、IFN-γ)活性表达水平,Western blot法检测结肠组织屏障功能相关蛋白的表达水平。结果与空白组比较,DSS组结肠组织DAI评分明显增高(P<0.01),炎性细胞因子(IL-1β、IL-6、TNF-α、IFN-γ)、屏障功能相关蛋白(ZO-1、occludin、claudin-1、JAM-A)明显减少(P<0.01);与DSS组比较,IRAK1/4抑制剂组炎性细胞因子明显下调,屏障蛋白下降程度减低(P<0.01)。结论IRAK1/4抑制剂可显著减轻DSS诱导的小鼠肠道炎症,并有效改善肠道屏障功能。

声带癌前病变组织中基质金属蛋白酶抑制剂-1、果蝇母亲DDP同源物4表达水平与术后复发和恶变的相关性研究

目的探讨声带癌前病变组织中基质金属蛋白酶抑制剂-1(tissue inhibitor of metalloproteinases 1,TIMP-1)、果蝇母亲DDP同源物4(drosophila mothers against DDP homolog 4,Smad4)表达水平与术后复发和恶变的相关性。方法回顾性分析2018年8月~2021年8月郑州大学第一附属医院收治的162例声带癌前病变患者的临床和病理资料,收集手术切除癌前病变组织(癌前病变组)及病变旁正常黏膜组织(对照组),采用免疫组织化学法检测组织中TIMP-1、Smad4表达情况。分析TIMP-1、Smad4阳性率与临床病理特征的关系,并采用Kaplan-Meier法和Cox回归分析法分析其对术后复发和恶变的影响。结果与对照组正常黏膜组织比较,癌前病变组的TIMP-1阳性率较高,Smad4阳性率较低(P<0.05)。不同病变范围、是否累及前连合、不同程度上皮异常增生患者的TIMP-1、Smad4阳性率存在差异(P<0.05)。术后随访时间24~60个月,中位随访时间36个月,随访期间失访患者6例,随访率96.30%(156/162),随访期间术后复发35例(21.60%),术后恶变16例(9.88%);Kaplan-Meier生存分析显示,TIMP-1阳性患者术后复发率和恶变率高于TIMP-1阴性患者(P<0.05);Smad4阴性患者术后复发率和恶变率高于Smad4阳性患者(P<0.05)。多因素Cox回归分析显示,喉咽反流、病变范围>1/2、中/重度异型增生、TIMP-1阳性、Smad4阴性是复发的独立危险因素(P<0.05),年龄>60岁、累及前连合、TIMP-1阳性、Smad4阴性是恶变的独立危险因素(P<0.05)。结论声带癌前病变组织中TIMP-1高表达、Smad4低表达,且TIMP-1阳性、Smad4阴性表达者术后复发和恶变风险较高。

Treatment of type 2 diabetes, lifestyle, GLP1 agonists and DPP4 inhibitors

In recent years the treatment focus for type 2 diabetes has shifted to prevention by lifestyle change and to more aggressive reduction of blood sugars during the early stage of treatment. Weight reduction is an important goal for many people with type 2 diabetes.Bariatric surgery is no longer considered a last resort treatment. Glucagon-like peptide-1 agonists given by injection are emerging as a useful treatment since they not only lower blood sugar but are associated with a modest weight reduction. The role of the oral dipeptidyl peptidase 4 inhibitors is emerging as second line treatment ahead of sulphonylureas due to a possible beneficial effect on the beta cell and weight neutrality.Drugs which inhibit glucose re-absorption in the kidney,sodium/glucose co-transport 2 inhibitors, may have a role in the treatment of diabetes. Insulin treatment still remains the cornerstone of treatment in many patients with type 2 diabetes.

Lysine-specific demethylase 1 inhibitor rescues the osteogenic ability of mesenchymal stem cells under osteoporotic conditions by modulating H3K4 methylation

Bone tissue engineering may be hindered by underlying osteoporosis because of a decreased osteogenic ability of autologous seed cells and an unfavorably changed microenvironment in these patients. Epigenetic regulation plays an important role in the developmental origins of osteoporosis; however, few studies have investigated the potential of epigenetic therapy to improve or rescue the osteogenic ability of bone marrow mesenchymal stem cells(BMMSCs) under osteoporotic conditions. Here, we investigated pargyline, an inhibitor of lysine-specific demethylase 1(LSD1), which mainly catalyzes the demethylation of the di- and mono-methylation of H3K4. We demonstrated that 1.5 mmol·Lpargyline was the optimal concentration for the osteogenic differentiation of human BMMSCs. Pargyline rescued the osteogenic differentiation ability of mouse BMMSCs under osteoporotic conditions by enhancing the dimethylation level of H3K4 at the promoter regions of osteogenesis-related genes. Moreover, pargyline partially rescued or prevented the osteoporotic conditions in aged or ovariectomized mouse models, respectively. By introducing the concept of epigenetic therapy into the field of osteoporosis, this study demonstrated that LSD1 inhibitors could improve the clinical practice of MSC-based bone tissue engineering and proposes their novel use to treat osteoporosis.

Repositioning of dipeptidyl peptidase-4 inhibitors and glucagon like peptide-1 agonists as potential neuroprotective agents

Repositioning of dipeptidyl peptidase-4 inhibitors and glucagon like peptide-1 receptor agonists is a breakthrough in the field of neural regeneration research increasing glucagon like peptide-1 bioavailability, hence its neuroprotective activities. In this article, the authors suggest not only crossing blood-brain barrier and neurodegenerative disease as off target for dipeptidyl peptidase-4 inhibitors and glucagon like peptide-1 receptor agonists, but also for ophthalmic preparations for diabetic retinopathy, which may be the latest breakthrough in the field if prepared and used in an appropriate nano-formulation to target the retinal nerves. The relation of neurodegenerative diseases' different mechanisms to the dipeptidyl peptidase-4 inhibitors and glucagon like peptide-1 receptor agonists should be further examined in preclinical and clinical settings. The repositioning of already marketed antidiabetic drugs for neurodegenerative diseases should save the high cost of the time-consuming normal drug development process. Drug repositioning is a hot topic as an alternative to molecular target based drug discovery or therapeutic switching. It is a relatively inexpensive pathway due to availability of previous pharmacological and safety data. The glucagon like peptide-1 produced in brain has been linked to enhanced learning and memory functions as a physiologic regulator in central nervous system by restoring insulin signaling. Intranasal administration of all marketed gliptins(or glucagon like peptide-1 receptor agonists) may show enhanced blood-brain barrier crossing and increased glucagon like peptide-1 levels in the brain after direct crossing of the drug for the olfactory region, targeting the cerebrospinal fluid. Further blood-brain barrier crossing tests may extend dipeptidyl peptidase-4 inhibitors' effects beyond the anti-hyperglycemic control to intranasal spray, intranasal powder, or drops targeting the blood-brain barrier and neurodegenerative diseases with the most suitable formula. Moreover, novel nano-formulation is encouraged either to obtain favorable pharmacokinetic parameters or to achieve promising blood-brain barrier penetration directly through the olfactory region. Many surfactants should be investigated either as a solubilizing agent for hydrophobic drugs or as penetration enhancers. Different formulae based on in vitro and in vivo characterizations, working on sister gliptins(or glucagon like peptide-1 receptor agonists), different routes of administration, pharmacokinetic studies, dose response relationship studies, monitoring of plasma/brain concentration ratio after single and multiple dose, and neurodegenerative disease animal models are required to prove the new method of use(utility) for dipeptidyl peptidase-4 inhibitors as potential neuroprotective agents. Furthermore, investigations of glucagon like peptide-1 receptor agonists' neuroprotective effects on animal models will be considered carefully because they crossed the blood-brain barrier in previous studies, enabling their direct action on the central nervous system. Combination therapy of dipeptidyl peptidase-4 inhibitors or glucagon like peptide-1 receptor agonists with already marketed drugs for neurodegenerative disease should be considered, especially regarding the novel intranasal route of administration.

Macrophage modulation with dipeptidyl peptidase-4 inhibitors:A new frontier for treating diabetic cardiomyopathy?

This editorial introduces the potential of targeting macrophage function for diabetic cardiomyopathy(DCM)treatment by dipeptidyl peptidase-4(DPP-4)inhibitors.Zhang et al studied teneligliptin,a DPP-4 inhibitor used for diabetes management,and its potential cardioprotective effects in a diabetic mouse model.They suggested teneligliptin administration may reverse established markers of DCM,including cardiac hypertrophy and compromised function.It also inhibited the NLRP3 inflammasome and reduced inflammatory cytokine production in diabetic mice.Macrophages play crucial roles in DCM pathogenesis.Chronic hyperglycemia disturbs the balance between pro-inflammatory(M1)and antiinflammatory(M2)macrophages,favoring a pro-inflammatory state contributing to heart damage.Here,we highlight the potential of DPP-4 inhibitors to modulate macrophage function and promote an anti-inflammatory environment.These compounds may achieve this by elevating glucagon-like peptide-1 levels and potentially inhibiting the NLRP3 inflammasome.Further studies on teneligliptin in combination with other therapies targeting different aspects of DCM could be suggested for developing more effective treatment strategies to improve cardiovascular health in diabetic patients.

DPP-4 inhibitors and GLP-1RAs:cardiovascular safety and benefits

Glucagon-like peptide-1 receptor agonists(GLP-1RAs)and dipeptidyl peptidase-4 inhibitors are commonly used treatments for patients with type 2 diabetes mellitus(T2DM).Both anti-diabetic treatments function by playing key modulatory roles in the incretin system.Though these drugs have been deemed effective in treating T2DM,the Food and Drug Administration(FDA)and some members of the scientific community have questioned the safety of these therapeutics relative to important cardiovascular endpoints.As a result,since 2008,the FDA has required all new drugs for glycemic control in T2DM patients to demonstrate cardiovascular safety.The present review article strives to assess the safety and benefits of incretin-based therapy,a new class of antidiabetic drug,on the health of patient cardiovascular systems.In the process,this review will also provide a physiological overview of the incretin system and how key components function in T2DM.

Risk of pancreatic adverse events associated with the use of glucagon-like peptide-1 receptor agonist and dipeptidyl peptidase-4 inhibitor drugs: A systematic review and metaanalysis of randomized trials

AIM: To systematically assess risk of pancreatic adverse events with glucagon-like peptide-1(GLP-1) receptor agonist and dipeptidyl peptidase-4(DPP-4) inhibitor drugs.METHODS: We searched Pub Med, Embase, CINAHL, Cochrane review of clinical trials, pharmaceutical company clinical trials register, United States Food and Drug Administration website, European Medicines Agency website and Clinical Trials.gov for randomized controlled trials from inception to October 2013. Randomized control trial studies were selected for inclusion if they reported on pancreatic complication events and/or changes in pancreatic enzyme levels(serum amylase and serum lipase) as adverse events or as serious adverse events for patients who were on GLP-1 receptor agonist and DPP-4 inhibitor drugs. Two independent reviewers extracted data directly. We performed Peto odds ratio(OR) fixed effect meta-analysis of pancreatic adverse events a, and assessed heterogeneity with the I^2 statistic.RESULTS: Sixty-eight randomized controlled trials were eligible. A total of 60720 patients were included in our analysis of the association of risk of pancreatic complication events with GLP-1 agents. A total of 89 pancreatic related adverse events occurred among the GLP-1 agents compared to 74 events among the controls. There was a statistically significant increased risk of elevation of pancreatic enzymes associated with GLP-1 agents compared with control(Peto OR = 3.15, 95%CI: 1.56-6.39, P = 0.001, I2 = 0%). There was no statistically significant difference in the risk of pancreatic adverse event associated with GLP-1 agent compared with controls(Peto OR = 1.00, 95%CI: 0.73-1.37, P = 1.00, I2 = 0%). There were a total of 71 pancreatitis events in patients on GLP-1 agents and 56 pancreatitis events occurred in the control patients. There were 36 reports of pancreatic cancer in these studies. Of these cases, 2 used linagliptin, 2 used alogliptin, 1 used vildagliptin, 7 used saxagliptin while 6 used sitagliptin. The remaining 18 cases occurred among controls.CONCLUSION: Although GLP-1 based agents are associated with pancreatic enzyme elevation, we were unable to confirm a significant risk of pancreatitis or pancreatic cancer.

A Copper(Ⅱ)Complex Based on N-(4-hydroxybenzyl)-L-serine:Synthesis,Crystal Structure and Inhibitory Activity on PTP1B and TCPTP

A novel copper（II） complex with the reduced Schiff base, [Cu（L）2]·H2O （I, HL = N-（4-hydroxybenzyl）-L-serine）, was prepared in aqueous solution and characterized by elemental analysis, FT-IR, electrospray ionization mass spectrometry and single-crystal X-ray diffraction. Complex I crystallizes in the orthorhombic system, space group P212121, with a = 8.9040（18）, b = 9.1530（18）, c = 24.891（5）A^°, V = 2028.6（7） A^°3, Z = 4, C20H26CuN2O9, Mr = 501.97, Dc = 1.644g·cm^3, μ = 1.135 mm^-1, F（000） = 1044, GOOF = 1.194, the final R = 0.0484 and wR = 0.1420 for 6186 observed reflections （I 〉 2σ（I））. In I, two L^- anions are coordinated to the copper ion in tridentate and bidentate chelating modes, respectively, resulting in the coordinated geometry of copper ion to be a distorted square pyramid. The intermolecular hydrogen bonds between the complexes, complexes and lattice water molecules lead to a 2D supramolecular network. The bioactivity of the complex as a potential PTPs inhibitory agent in vitro was investigated, displaying potent inhibition against PTP1B （IC50, 0.27 μM） and TCPTP （IC50, 0.57 μM） with a moderate selectivity.

PD-1 antibody in combination with chemotherapy for the treatment of SMARCA4-deficient advanced undifferentiated carcinoma of the duodenum:Two case reports

BACKGROUND SMARCA4 is a component of chromatin remodeling of SWItch/sucrose-nonfermenting(SWI/SNF)complexes and plays an essential role in oncogenesis.SMARCA4-deficient malignancies arising from the gastrointestinal tract are rare and have a poor prognosis.There is no standard treatment for advanced and undifferentiated SMARCA4-deficient duodenal malignancies.Programmed death 1(PD-1)antibodies,known as immune checkpoint inhibitor antibodies,potentially play a role in treating gastrointestinal tract malignancies.CASE SUMMARY We present two patients with SMARCA4 deficiency and TP53 gene mutation in advanced undifferentiated carcinomas of the duodenum.For both patients,SMARCA4 deficiency was confirmed by immunohistochemical staining for the BRG1 protein,while TP53 gene mutations were observed via next-generation sequencing.Both patients were administered chemotherapy in combination with an anti-PD-1 antibody.The two patients exhibited completely different responses to treatment and had different prognoses.Case 1 experienced rapid progression after PD-1 infusion and chemotherapy,case 2 experienced a remarkable response after treatment,and the progression-free survival was more than 6 months.CONCLUSION This study described our clinical and pathological observations of SMARCA4-deficient advanced undifferentiated carcinoma of the duodenum.PD-1 combined with chemotherapy showed a certain efficacy in select patients,providing options for treating these highly malignant tumors.Patients with liver metastases had a worse prognosis than did those with only lymph node metastasis.

Synthesis and Crystal Structure of a Novel Ethyl 5-(4-(2-Phenylacetamido)phenyl)-1H-pyrazole-3-carboxylate as an Acrosin Inhibitor

The title compound （ethyl5-（4-（2-phenylacetamido）phenyl）-lH-pyrazole-3-carboxylate, C20H19N3O3） was synthesized by the reaction of Claisen condensation, cyclization, reduction and acylation. The structure was characterized by X-ray diffraction, MS, NMR and IR. It belongs to the monoclinic system, space group C2/c with a = 22.723（9）, b = 9.324（4）, c = 18.890（8） A, β = 114.259（6）°, V = 3649（3） A^3, Dc = 1.272 Mg·m^3, Z = 8, Mr = 349.38, p = 0.087 mm^-1, F（000） = 1472, the final R = 0.0615 and wR = 0.1643. The biological test shows that the title compound has a moderate acrosin inhibition activity.

IRAK4-IN-1对SD大鼠炎症软骨细胞炎症和衰老表型的影响

目的研究IRAK4-IN-1对炎症软骨细胞的炎症、分解代谢、衰老表型的影响及其作用机制。方法利用免疫荧光染色和甲苯胺蓝染色法鉴定SD大鼠的乳鼠原代软骨细胞,使用CCK8法筛选IRAK4-IN-1的安全浓度范围,本实验设置空白对照组(Control)、IL-1β刺激组、IL-1β+IRAK4-IN-1(1、5、10μM)组,通过蛋白免疫印迹法检测炎症因子、基质降解酶、衰老标志物及P65/NF-ĸB通路蛋白的表达。结果IRAK4-IN-1显著抑制IL-1β刺激下炎症因子iNOS、COX2,基质降解酶MMP13、ADAMTS5以及衰老标志物P16蛋白的表达,此外P65/NF-ĸB通路的激活也受到显著抑制。结论IRAK4-IN-1在炎症软骨细胞中具有抗炎、抑制分解代谢和衰老的作用,其可能是通过抑制P65/NF-ĸB通路发挥炎症调控作用。

Combined immune checkpoint inhibitors of CTLA4 and PD-1 for hepatic melanoma of unknown primary origin: A case report

BACKGROUND Melanoma is uncommonly found in lymph nodes,subcutaneous tissue,or visceral organs without a primary lesion,where it is identified as metastatic melanoma with unknown primary(MUP).Hepatic MUP is extremely rare and has a poor prognosis.There is limited information on its pathogenesis,clinical and imaging features,and pathological findings.There are no guidelines for the use of immune checkpoint inhibitors(ICIs)in hepatic MUP,and the treatment outcome has rarely been reported.CASE SUMMARY A 42-year-old woman presented to our hospital with hepatic tumors found incidentally during a routine check-up.Contrast-enhanced abdominal computerized tomography showed multiple mass lesions in the liver.Pathological results revealed melanoma,which was confirmed by immunohistochemical staining for HMB-45(+),Melan-A(+),S-100(+),and SOX10(+).There was no evidence of primary cutaneous,ocular,gastrointestinal,or anal lesion on a comprehensive examination.The patient was diagnosed with hepatic MUP.She received combined antibodies against cytotoxic T-lymphocyte-associated antigen 4(CTLA-4,ipilimumab)and programmed death protein-1(PD-1,nivolumab).She died of hepatic failure 9 mo after hepatic MUP was diagnosed.This the first case of hepatic MUP treated with combined ipilimumab and nivolumab,who showed better outcome than previous cases.CONCLUSIONCombined ICIs of PD-1 and CTLA-4 may be considered as the first-line therapyfor patients with hepatic MUP.

Nogo-A、Adropin、ZO-1、ANGPTL4在急性脑出血患者血清中的 蛋白表达水平及对预后的预测价值

目的探究血清轴突生长抑制因子A(Nogo-A)、能量平衡相关蛋白(Adropin)、紧密连接蛋白1(ZO-1)、血管生成素样蛋白4(ANGPTL4)在急性脑出血患者中的蛋白表达水平及其对预后的预测效能。方法选取2020年4月至2022年5月于该院接受治疗的148例急性脑出血患者作为研究组,另选取同时期来该院行一般体检的150例健康者作为对照组,进行回顾性分析,采用酶联免疫吸附试验(ELISA)分别检测两组受试者血清Nogo-A、Adropin、ZO-1、ANGPTL4的蛋白表达水平并对比;采用Spearman相关系数分析血清Nogo-A、Adropin、ZO-1、ANGPTL4的蛋白表达水平与急性脑出血发生的相关性;绘制受试者工作特征(ROC)曲线分析以上4项指标联合检测对急性脑出血的诊断效能;另外对研究组患者进行为期6个月的随访,并按照预后情况分为良好组(91例)与不良组(57例),对比两组患者血清Nogo-A、Adropin、ZO-1、ANGPTL4的蛋白表达水平;采用ROC曲线验证联合检测对该类患者预后的预测效能。结果相比于对照组,研究组血清Nogo-A、ZO-1、ANGPTL4蛋白表达水平明显升高,而Adropin蛋白表达水平明显降低(P均<0.05);经Spearman相关系数分析显示,血清Nogo-A、ZO-1、ANGPTL4蛋白表达水平与急性脑出血的发生率呈正相关(P<0.05),而Adropin蛋白表达水平则与急性脑出血的发生率呈负相关(P均<0.05);RO C曲线验证显示,Nogo-A、Adropin、ZO-1、ANGPTL4蛋白表达水平联合检测对评估急性脑出血具有较高的诊断效能,灵敏度、特异度分别为92.57%、90.67%;相比于良好组,不良组血清Nogo-A、ZO-1、ANGPTL4蛋白表达水平明显升高,而Adropin蛋白表达水平明显降低(P均<0.05);ROC曲线结果显示,相比于单一检测,Nogo-A、Adropin、ZO-1、ANGPTL4蛋白表达水平联合检测的曲线下面积更大(P<0.05),灵敏度为84.21%、特异度为89.01%。结论Nogo-A、Adropin、ZO-1、ANGPTL4蛋白在急性脑出血患者中均异常表达,并且Nogo-A、Adropin、ZO-1、ANGPTL4蛋白表达水平均与急性脑出血的发生存在密切联系。联合4项指标检测不仅能够辅助临床准确判断是否存在急性脑出血,同时对预测患者预后也具有重要临床价值。

CTLA-4与PD-1/PD-L1免疫检查点抑制剂治疗子宫内膜癌新进展

免疫检查点抑制剂(ICIs)是可调节免疫反应。细胞毒性T淋巴细胞相关抗原4 (CTLA-4)和程序性死亡受体1 (PD-1)/程序性死亡受体配体1 (PD-L1)对应的免疫检查点抑制剂已在临床抗肿瘤中展现出极大优势。免疫检查点抑制剂通过阻断免疫检查点通路,激活免疫细胞识别和杀伤的功能治疗子宫内膜癌,从而达到抗肿瘤效果,应用前景广阔。

血清ITIH4和MCL-1水平与急性缺血性脑卒中患者病情程度及预后的关系

目的探究急性缺血性脑卒中(AIS)患者血清间α胰蛋白酶抑制因子重链4(ITIH4)、髓样细胞白血病因子-1(MCL-1)表达与病情程度及预后的关系。方法纳入2019年7月—2022年7月河南科技大学附属黄河医院神经内科诊治AIS患者128例为AIS组。根据入院时美国国立卫生研究院卒中量表(NIHSS)评分,分为轻度亚组(NIHSS<6分,n=42)、中度亚组(NIHSS 6~<14分,n=52)和重度亚组(NIHSS≥14分,n=34)。根据出院3个月时AIS患者改良Rankins评分,分为预后不良亚组(mRS评分>2分,30例)和预后良好亚组(mRS评分≤2分,98例)。另选取同期医院体检的健康人70例为健康对照组。酶联免疫吸附试验检测血清ITIH4、MCL-1水平。Pearson相关分析血清ITIH4、MCL-1水平与病情程度及预后的相关性;多因素Logistic回归分析影响AIS患者预后的因素;受试者工作特征曲线分析血清ITIH4、MCL-1对AIS患者预后的预测价值。结果AIS组患者血清ITIH4、MCL-1水平显著低于健康对照组(t/P=43.211/<0.001,43.191/<0.001);病情程度越重,AIS患者血清ITIH4/MCL-1水平越低(F/P=107.796/<0.001,297.976/<0.001);预后不良亚组梗死面积、入院24 h NIHSS评分高于预后良好亚组(t/P=9.637/<0.001,9.752/<0.001),血清ITIH4、MCL-1水平及出院3个月简易智能状态量表(MMSE)评分、蒙特利尔认知评估量表(MoCA)评分低于预后良好亚组(t/P=26.723/<0.001,11.709/<0.001,13.674/<0.001,10.782/<0.001);AIS患者血清ITIH4、MCL-1与梗死面积、入院24 h NIHSS评分呈负相关(r/P=-0.705/<0.001,-0.685/<0.001;-0.761/<0.001,-0.619/<0.001),与出院3个月MMSE评分、MoCA评分呈正相关(r/P=0.656/<0.001,0.632/<0.001;0.751/<0.001,0.789/<0.001);出院3个月MMSE评分高、出院3个月MoCA评分高是影响AIS患者预后不良的独立保护因素[0.622(0.446~0.868),0.606(0.427~0.861)],血清ITIH4低、MCL-1低、梗死面积大、入院24 h NIHSS评分高是危险因素[OR(95%CI)=1.467(1.150~1.870),1.415(1.094~1.829),1.605(1.168~2.205),1.765(1.233~2.526)];血清ITIH4、MCL-1及两项联合预测AIS预后不良的AUC分别为0.811、0.835、0.923,两项联合预测AIS预后不良的AUC大于单一指标,差异具有统计学意义(Z=4.258、4.119,P均<0.001)。结论AIS患者血清ITIH4、MCL-1表达下调,两者表达水平与病情严重程度有关,两者联合对AIS患者预后具有较高的预测价值。

3-甲基-1-戊烯-4-炔-3-醇合成工艺的改进

以液氨和金属钙为原料通过氨基化制得氨基钙,经炔化得到乙炔钙,乙炔钙再与甲基乙烯酮反应制得乙炔醇钙盐,经水解、挥发氨、水蒸气蒸馏、萃取、回收溶剂、粗馏、精馏制得3-甲基-1-戊烯-4-炔-3-醇。考察金属试剂、催化剂硝酸高铁投入量、阻聚剂和萃取剂对合成及产物的影响。结果表明,选用金属钙作为金属试剂,催化剂硝酸高铁投入量为金属钙质量的0.8%,改性复合阻聚剂和CH2Cl2萃取剂较为合适。该工艺合成路线得到的3-甲基-1-戊烯-4-炔-3-醇纯度达98%以上,物质的量收率71.0%。