The Impact of Finerenone on Changes in Pulse Wave Velocity, Arterial Pressure and Heart Related Deaths in Hemodialysis Patients—Study Perspective

The description in the abstract lacks clear logic and a comprehensive summary of this study, so please revise and improve it according to the design theme and main content of this study, and describe it in the order of (research background), purpose/aim, method, results and conclusions. The introduction of the abstract and preface is rather lengthy, but the summary of the whole study and the presentation of the research background are not perfect (mainly because the logic of the context is not clear and orderly), so it will appear a bit messy. Hope to be able to modify (this has been mentioned in the preliminary opinion). Cardiovascular events (CVE) pose a significant threat to individuals with end-stage renal disease (ESRD), yet these patients are often excluded from cardiovascular clinical trials, leaving prognostic factors associated with CVE in ESRD patients largely unexplored. Recent human studies have demonstrated elevated circulating aldosterone levels in ESRD patients, correlating with left ventricular hypertrophy. Additionally, animal models have shown improvements in uremic cardiomyopathy with spironolactone therapy, prompting interest in assessing the efficacy of spironolactone or eplerenone in reducing mortality and improving cardiovascular function in dialysis patients. Clinicians have historically been cautious about prescribing mineralocorticoid receptor antagonists (MRAs) to congestive heart failure patients with chronic kidney disease (CKD) due to hyperkalemia risk. However, the emergence of finerenone, a novel MR antagonist with a favorable safety profile and lower hyperkalemia risk, has renewed interest in MRA therapy in this population. Heart disease, including coronary artery disease, hypertension, and left ventricular failure, is alarmingly prevalent in dialysis patients, contributing significantly to elevated mortality rates compared to the general population. Arterial stiffness, as indicated by pulse wave velocity (PWV), progressively worsens with advancing CKD stages, peaking in severity among ESRD patients undergoing dialysis. High PWV serves as a crucial risk stratification tool in ESRD. Elevated NT-proBNP and BNP levels in ESRD patients are well-documented, with significant associations observed between baseline peptide concentrations and cardiovascular morbidity and mortality. By incorporating finerenone into our study, we aim to investigate its potential benefits in reducing arterial stiffness, lowering blood pressure, and ultimately mitigating heart-related mortality among hemodialysis patients. This study holds substantial implications for hypertension and cardiovascular risk management in this vulnerable patient population. Eligible participants must have been on chronic hemodialysis for at least three months, with ACE inhibitors or angiotensin receptor blockers included in their therapy at maximum tolerable doses. Serum potassium levels 5.7 mmol/L, left ventricular ejection fraction 50%, and PWV higher than age-estimated values are also prerequisites for study entry. Randomized allocation will be conducted using a permuted block design, stratified by center, with allocation communicated via signed study forms during initial examinations. All steps of this research will be conducted in accordance with the principles of the Helsinki Declaration.

Programmed cell death-1 inhibitor-related sclerosing cholangitis:A systematic review

BACKGROUND Programmed cell death-1(PD-1)inhibitor has been indicated for many types of malignancies.However,these inhibitors also cause immune-related adverse events.Hepatobiliary disorder is a phenotype of immune-related adverse event affecting 0%–4.5%of patients treated with PD-1 inhibitors.Recent studies have reported PD-1 inhibitor-related sclerosing cholangitis(SC);however,the associated clinical and pathological features are unclear.AIM To evaluate the clinical and pathological features of PD-1 inhibitor-related SC through a systematic review of the literature.METHODS The review,conducted using electronic databases in PubMed,was restricted to the period from January 2014 to September 2019 and focused on case reports/series on PD-1 inhibitor-related SC published in English.We scanned the references of the selected literature to identify any further relevant studies.Six cases previously studied by us,including three that have not yet been published,were included in this review.RESULTS Thirty-one PD-1 inhibitor-related SC cases were evaluated.Median age of patients was 67 years(range,43–89),with a male to female ratio of 21:10.The main disease requiring PD-1 inhibitor treatment was non-small cell lung cancer.Agents that caused PD-1 inhibitor-related SC were nivolumab(19 cases),pembrolizumab(10 cases),avelumab(1 case),and durvalumab(1 case).The median number of cycles until PD-1 inhibitor-related SC onset was 5.5(range,1–27).Abdominal pain or discomfort(35.5%,11/31)was the most frequent symptom.Blood serum tests identified liver dysfunction with a notable increase in biliary tract enzymes relative to hepatic enzymes,and a normal level of serum immunoglobulin G4.Biliary dilation without obstruction(76.9%,20/26),diffuse hypertrophy of the extrahepatic biliary tract(90.5%,19/21),and multiple strictures of the intrahepatic biliary tract(30.4%,7/23)were noted.In 11/23(47.8%)cases,pathological examination indicated that CD8+T cells were the dominant inflammatory cells in the bile duct or peribiliary tract.Although corticosteroids were mainly used for PD inhibitor-related SC treatment,the response rate was 11.5%(3/26).CONCLUSION Some clinical and pathological features of PD-1 inhibitor-related SC were revealed.To establish diagnostic criteria for PD-1 inhibitor-related SC,more cases need to be evaluated.

ANALYSIS OF CLINICAL CHARACTERISTICS AND DEATH RELATED FACTORS OF SEVERE MECONIUM ASPIRATION SYNDROME

Objective To investigate the factors in relation with the case fatality in severe meconium aspiration syndrome (MAS). Methods Eighty-one severe MAS cases intervened by the mechanical ventilation from 9 childrens hospitals were retrospectively analyzed for the risk factors of fatality with SAS software for non-parametric rank sum test and chi-square test. Results In the 81 cases, 49 were survived (death rate 39%). The gestational age (GA), Apgars score at 1min and other complications with MAS were significantly related to the death (P <0.05). There was no difference of death rate between the patients with or without receiving endotracheal intubation and airway suctioning (P>0.05). Conclusion A higher death rate (close to 40%) of severe MAS in the middle of 1990s in major cities of China suggests that it is important to detect the intrauterine hypoxemia as it may indicated by meconium staining amniotic fluid which should be intervened early by adequate termination of pregnancy before 42 weeks. The effects of delivery room suction and conventional ventilation also need to be reevaluated.

Accuracy of Physicians in Diagnosing HIV and AIDS-Related Death in the Adult Population of Addis Ababa, Ethiopia

Background: The lack of cause of death information is the main challenge in monitoring the effectiveness of interventions aimed at reducing HIV and AIDS-related deaths in countries where the majority of deaths occur at home. Objective: To evaluate the accuracy of physician reviewers of verbal autopsies in diagnosing HIV and AIDS-related deaths in the adult population of Addis Ababa, the capital of Ethiopia. Methods: This study was done within the context of a burial surveillance system in Addis Ababa. Trained interviewers completed a standard verbal autopsy questionnaire and an independent panel of physicians reviewed the completed form to assign cause of death. Physicians' review was compared to a reference standard constructed based on prospectively collected HIV-serostatus and patients' hospital record. Sensitivity and specificity were calculated to validate the physicians' verbal autopsy diagnoses against reference standards. Results: Physicians accurately identified AIDS-related deaths with sensitivity and specificity of 0.88 (95% CI: 0.80 - 0.93) and 0.77 (95% CI: 0.64 - 0.87), respectively. Generally, there was high level of agreement (Cohen's Kappa Statistic (K > 0.6) between the first two physicians with some yearly variations. In 2008 and 2009 there was an almost perfect agreement (K > 0.80). Conclusion: This study demonstrated the agreement level between two independent physicians in diagnosing AIDS-related death is very high and thus using a single verbal autopsy coder is practical for programmatic purposes in countries where there is critical shortage of doctors.

Electroacupuncture preconditioning protects against focal cerebral ischemia/reperfusion injury via suppression of dynamin-related protein 1

Electroacupuncture preconditioning at acupoint Baihui （GV20） can reduce focal cerebral ischemia/reperfusion injury. However, the precise protective mechanism remains unknown. Mitochondrial fission mediated by dynamin-related protein 1 （Drp1） can trigger neuronal apoptosis following cerebral ischemia/reperfusion injury. Herein, we examined the hypothesis that electroacupuncture pretreatment can regulate Drp1, and thus inhibit mitochondrial fission to provide cerebral protection. Rat models of focal cerebral ischemia/reperfusion injury were established by middle cerebral artery occlusion at 24 hours after 5 consecutive days of preconditioning with electroacupuncture at GV20 （depth 2 mm, intensity 1 mA, frequency 2/15 Hz, for 30 minutes, once a day）. Neurological function was assessed using the Longa neurological deficit score. Pathological changes in the ischemic penumbra on the injury side were assessed by hematoxylin-eosin staining. Cellular apoptosis in the ischemic penumbra on the injury side was assessed by terminal deoxyribonucleotidyl transferase-mediated dUTP-digoxigenin nick end labeling staining. Mitochondrial ultrastructure in the ischemic penumbra on the injury side was assessed by transmission electron microscopy. Drp1 and cytochrome c expression in the ischemic penumbra on the injury side were assessed by western blot assay. Results showed that electroacupuncture preconditioning decreased expression of total and mitochondrial Drp1, decreased expression of total and cytosolic cytochrome c, maintained mitochondrial morphology and reduced the proportion of apoptotic cells in the ischemic penumbra on the injury side, with associated improvements in neurological function. These data suggest that electroacupuncture preconditioning-induced neuronal protection involves inhibition of the expression and translocation of Drp1.

Relation of phospholipase A2-Ⅴ and indoxam to hippocampal neuronal death

BACKGROUND: Ⅴ secretory phospholipase A2 (sPLA2-Ⅴ) is abundant in many mammal tissues. However, it remains unknown whether sPLA2-Ⅴ causes biological or pathological response in central nervous system. OBJECTIVE: To observe the effect of phospholipase A2-Ⅴ (PLA2-Ⅴ) and its inhibitor (indoxam) on hippocampal neuron survival. DESIGN: A repetitive measurement. SETTING: The Animal Center of South Carolina University. MATERIALS: Sprague-Dawley pregnancy day-7, 14, 21 female rats were selected; Reagents: sPLA2- Ⅴ and indoxam were obtained from the Dennis Research Laboratories METHODS: The experiment was finished at the animal center in South Carolina University from January to December, 2004. 0, 12.5, 25, 50 and 100 μg/L sPLA2-Ⅴ were added to neuron with none-MgCl2 Eagle’s medium at 37 ℃, then changed to normal neuron culture medium after 3 hours. 1, 2.5, 5 and 10 μmol/L indoxam was added at 6 hours after 100 μg/L sPLA2-Ⅴwas put to Day-21 SD rat hippocampal embryonic neurons with none-MgCl2 Eagle’s medium at 37 ℃. After 3 hours in the inhibition experiment, it was changed to normal neuron culture medium. The embryonic hippocampal neurons were primarily cultured, and the neuron survival ratio was detected with morphological method. MAIN OUTCOME MEASURES: Survival ratio of hippocampal neurons. RESULTS: ① Effects of sPLA2-Ⅴon neuron survival: When sPLA2-Ⅴ was 0, 12.5, 25, 50 and 100 μg/L, the neuron survival ratios in embryonic neurons of day-7 SD rats were (95.3±1.1)%, (81.4±3.1)%, (74.2±2.2)%, (62.4±1.7)% and (48.9±1.6)%, those in embryonic neurons of day-14 rats were (93.2±1.4)%, (74.3±1.9)%, (68.1±1.7)%, (56.1±1.4)% and (42.5±1.1)%, and those in embryonic neurons of day-21 rats were (91.2±1.2)%, (69.4±2.1)%, (60.3±2.2)%, (49.1±1.2)% and (35.5±1.9)%. There were significant differences among different concentrations (P < 0.05). ② Effects of indoxam on neuron survival: In case of sPLA2-Ⅴ 100 μg/L, the neuron survival ratios were (58.65±1.4)%, (69.34±1.1)%, (82.11±1.2)% and (95.28±0.9)% when indoxam was 1, 2.5, 5 and 10 μmol/L, respectively. There were significant differences among different concentrations (P < 0.05). CONCLUSION: ① The of neuronal death ratio is in a concentration-dependent manner with sPLA2-Ⅴ, and increases as the embryonic aging. ② Indoxam inhibits the proapoptotic effect of sPLA2-Ⅴ.

The Burden of HIV-Related Admissions and Mortality at Princess Marina Hospital, Botswana in 2000: A Pre-Combination Antiretroviral Therapy Era

Background: human immune virus and acquired immunodeficiency syndrome (HIV/AIDS) have been recognized in Botswana for the last three decades, however, combination anti-retroviral therapy (cART) was only introduced after 2000. Facility-based historical data of the burden of HIV/AIDS- related conditions pre-cART have so far not been analyzed. Objective: To analyze the burden of HIV-related admissions and HIV-related deaths, and identify the socio-demographic factors associated with HIV/AIDS deaths at Princess Marina Hospital (PMH) in the year 2000. Methods: A retrospective review of medical files was carried out between May and June 2014. Nine thousand seven hundred and forty-six (9746) records were analyzed for the year for 2000. Cases were identified as documented HIV/AIDS as per medical notes and/or documentation of any of the conditions listed in sections B20-B24 of the International Classification of Diseases (ICD 10 B20-B24). Outcomes were the percentages of HIV-related admissions and HIV-related deaths out of all admissions and deaths. The in-hospital case fatality rate (CFR) was also calculated. Log-binomial regression models were used to determine the most significant factors associated with HIV-related admission and death. Results: The percentages of HIV-related admissions and HIV-related deaths were 4.1% (403/9746) and 11.3% (80/707), respectively. The in-hospital HIV-CFR was 19.9% (80/403). Adjusted log-binomial models identified the most significant protective factors for HIV-related admission were female sex and cART use while age >15 years old was the most significant risk factor. The se of cART was significant protective factor for HIV-associated death while age older than 15 years was the most significant risk factor. Conclusion: There was a significant burden of HIV-related admissions and deaths in PMH before wide-scale cART use in Botswana. This study highlights the increased risk of hospital admission for HIV-positive patients and underlines the need for cART to prevent deaths. Further studies evaluating the impact of wide-scale cART roll out are needed.

Colorectal carcinogenesis:Insights into the cell death and signal transduction pathways:A review

Colorectal carcinogenesis(CRC) imposes a major health burden in developing countries. It is the third major cause of cancer deaths. Despite several treatment strategies, novel drugs are warranted to reduce the severity of this disease. Adenomatous polyps in the colon are the major culprits in CRC and found in 45% of cancers, especially in patients 60 years of age. Inflammatory polyps are currently gaining attention in CRC, and a growing body of evidence denotes the role of inflammation in CRC. Several experimental models are being employed to investigate CRC in animals, which include the APC^(min/+) mouse model, Azoxymethane, Dimethyl hydrazine, and a combination of Dextran sodium sulphate and dimethyl hydrazine. During CRC progression, several signal transduction pathways are activated. Among the major signal transduction pathways are p53, Transforming growth factor beta, Wnt/β-catenin, Delta Notch, Hippo signalling, nuclear factor erythroid 2-related factor 2 and Kelch-like ECH-associated protein 1 pathways. These signalling pathways collaborate with cell death mechanisms, which include apoptosis, necroptosis and autophagy, to determine cell fate. Extensive research has been carried out in our laboratory to investigate these signal transduction and cell death mechanistic pathways in CRC. This review summarizes CRC pathogenesis and the related cell death and signal transduction pathways.

Correlation of PDCD5 and Apoptosis in Hair Cells and Spiral Ganglion Neurons of Different Age of C57BL/6J Mice

This study examined the expression pattern of programmed cell death 5 (PDCD5) in co-chlear hair cells and spiral ganglion neurons (SGNs) and its association with age-related hearing loss in mice.Sixty C57BL/6J (C57) mice at different ages were divided into four groups (3,6,9 or 12 months).PDCD5 expression was detected by using immunohistochemistry,real-time PCR and Western blot.Morphological change of the cochleae was also evaluated by using immunoassay.The results showed that the expression of PDCD5 had a gradual increase with ageing in both protein and RNA levels in C57 mice,as well as gradually increased apoptosis of cochlear hair cells and SGNs.In addition,we also found that caspase-3 activity was enhanced and its expression was enhanced with ageing.It is implied that overexpression of PDCD5 causes the increase in caspase-3 activity and the subsequent increase of apoptosis in cochlear hair cells and SGNs,and thereby plays a role in the pathogenesis of presbycusis.Thus,PDCD5 may be a new target site for the treatment and prevention of age-related hearing loss.

西藏地区结直肠癌免疫治疗和靶向治疗相关分子标志物的检测及意义

目的研究西藏地区结直肠癌中SWI/SNF相关、基质相关、肌动蛋白依赖性染色质调节因子A亚科成员4(SMARCA4)/Brahma相关基因1、V-raf鼠类肉瘤病毒癌基因同源物B(BRAF)、P53、程序性死亡受体1(PD-1)及程序性死亡配体1(PD-L1)免疫组织化学表达和BRAF、神经营养因子酪氨酸受体激酶(NTRK)基因改变情况,为西藏地区结直肠癌患者的靶向治疗及免疫治疗提供依据。方法收集2015年1月至2021年7月西藏自治区人民医院经手术切除病理确诊为结直肠癌病例64例,全部病例均进行SMARCA4、BRAF、P53、PD-1、PD-L1免疫组织化学染色和NTRK1、NTRK2、NTRK3融合基因荧光原位杂交检测及BRAF V600E基因突变PCR检测。结果64例结直肠癌病例男女比例1.21∶1,平均年龄(56.59±13.27)岁;46例(71.88%)位于结肠,18例(28.12%)位于直肠;60例(93.75%)为腺癌,4例(6.25%)为其他类型;11例(17.19%)为T1或T2期,53例(82.81%)为T3或T4期;24例(37.50%)出现淋巴结转移。免疫组织化学方面,64例中1例(1.56%)SMARCA4部分肿瘤细胞表达减弱或缺失,4例(6.25%)BRAF肿瘤细胞阳性表达,35例(54.69%)P53为突变型表达;45例(70.31%)PD-1肿瘤相关免疫细胞阳性比例分数<10%,19例(29.69%)≥10%;52例(81.25%)PD-L1联合阳性分数<10,12例(18.75%)≥10。64例NTRK1、NTRK2、NTRK3融合基因检测均为阴性;4例(6.25%)检测到BRAF V600E基因突变;1例SMARCA4表达缺失病例未检测到SMARCA4基因改变。PD-L1的表达与错配修复缺陷/高度微卫星不稳定和PD-1的高表达呈显著正相关(χ^(2)=10.223,P=0.001;χ^(2)=11.979,P=0.001)。结论西藏地区结直肠癌中较少出现SMARCA4表达减弱或缺失及NTRK融合基因改变,少数病例有BRAF V600E基因突变,Pan-TRK和BRAF免疫组织化学可作为NTRK融合基因及BRAF基因突变的初筛方法。错配修复缺陷/高度微卫星不稳定的病例中更容易出现PD-L1蛋白高表达,这部分患者有望获益于免疫治疗。P53突变与PD-L1表达无相关性,PD-1的高表达和PD-L1的高表达呈正相关。

铜调节的细胞死亡相关基因与前列腺癌关系分析

目的基于美国癌症肿瘤基因图谱(the cancer genome atlas,TCGA)数据库分析铜调节的细胞死亡相关基因与前列腺癌患者预后和免疫细胞浸润的关系。方法从TCGA数据库下载所有前列腺癌患者的基因数据,其中包括前列腺癌组织501例,正常组织52例。运用R软件提取前列腺癌患者中铜调节的细胞死亡相关基因表达矩阵,进行差异分析、多因素回归分析筛选出预后基因,对预后基因进行生存分析,同时探讨预后相关基因与免疫细胞之间的相关性。结果甘氨酸裂解系统蛋白H(GCSH)与前列腺癌患者的预后显著相关,同时发现其与前列腺癌患者中的树突细胞、CD8^(+)T细胞、浆细胞也显著相关(P<0.05)。结论GCSH基因在前列腺癌的发生、发展中起重要作用,有望成为前列腺癌预后的标志物。

铜过载调控的细胞死亡方式在骨骼肌衰老萎缩中的作用

骨骼肌衰老是机体衰老的相关生物学事件,以质量丢失和功能衰退为显著特征,金属组学尤其是铜金属组学在其中的功能角色正日益得到关注。铜金属组学在衰老状态下表现为铜过载,其触发的毒理效应具有激活骨骼肌细胞中发生凋亡、焦亡、铁死亡、铜死亡及并促进α突触核蛋白聚集的特异性分子潜力,相关的信号级联最终可诱导衰老肌纤维中蛋白质、线粒体和卫星细胞等内容物代谢失衡及裂解丢失,同时可触发神经肌肉接头(neuromuscular junction, NMJ)退化和异常,是骨骼肌衰老萎缩的新型病理生理机制。本综述首次系统地解码骨骼肌衰老萎缩调控网络中铜的分子生物学功能、衰老骨骼肌中铜过载的潜在机制,以及铜过载诱导的多种细胞死亡形式例如凋亡、焦亡、铁死亡及铜死亡的信号转导途径在骨骼肌衰老萎缩中的新角色,为临床上应用铜螯合改善和治疗骨骼肌衰老萎缩提供潜在分子靶点和方案选择。

AR、SKP2、SOX10、PD-L1及TIL表达在三阴性乳腺癌中的意义

目的:探索雄激素受体(androgen receptor,AR)、S期激酶相关蛋白2(S-phase kinase-associated protein 2,SKP2)、性别决定区Y相关的HMG盒含因子10(sry-related HMG box-containing factor 10,SOX10)、程序性死亡配体1(programmed death-ligand 1,PD-L1)及肿瘤浸润性淋巴细胞(tumor infiltrating lymphocyte,TIL)在三阴性乳腺癌(triple negative breast cancer,TNBC)表达与临床病理特征和预后的关系。方法:根据苏木精-伊红染色(hematoxylineosin, HE)染色切片评判109例TNBC瘤巢内TIL的比例,采用Leica Bond-Max全自动免疫组化仪检测TNBC组织中AR、SKP2、SOX10、PD-L1的表达。分析以上各生物指标与临床病理特征间的关系,并采用kaplan-Meier、Log-rank进行生存分析。结果:95例患者获得随访,中位随访时间为48个月,中位无病生存时间(disease-free survival, DFS)为42个月,中位总生存时间(overall survival, OS)48个月。在TNBC中,AR阳性表达与淋巴结转移阴性(P=0.009)、肿瘤最大径<2 cm(P=0.008)相关,TIL高表达与低级别TNBC相关(P=0.007),SKP2阳性表达与神经/脉管侵犯阳性(P=0.011)、高级别TNBC相关(P=0.002),SOX10阳性表达与淋巴结转移阳性(P=0.022)、高级别TNBC(P=0.005)相关,PD-L1阳性表达与淋巴结转移阳性(P=0.020)、神经/脉管侵犯阳性(P=0.006)、高级别TNBC(P=0.042)相关。生存分析显示,SKP2、SOX10阳性表达与更差的DFS(P=0.007、P<0.001)和OS(P=0.013、P<0.001)相关,TIL高表达与更好的DFS(P=0.016)及OS(P=0.004)相关。在生物表志物的联合表达中,AR+/SKP2-、AR+/SOX10-与更好的DFS(P=0.004、P<0.001)及OS(P=0.007、P=0.001)相关,SOX10+/低TIL、PD-L1+/低TIL与更差的DFS(P<0.001、P=0.008)及OS(P=0.001、P=0.002)相关,AR-/低TIL者具有更差的OS(P=0.014)。SKP2(HR=4.143,95%CI为1.578~10.875)、SOX10(HR=7.578,95%CI为2.067~27.782)的阳性表达是影响TNBC患者DFS的独立预后因子,SKP2(HR=3.758,95%CI为1.400~10.084)、SOX10(HR=5.131,95%CI为1.316~20.000)及TIL(HR=0.375,95%CI为0.154~0.917)的阳性表达是TNBC患者OS的独立预后因子(P均<0.05)。结论:在TNBC中,AR阳性、TIL高表达与具有更好预后的临床病理特征相关,SKP2、SOX10和PD-L1与具侵袭性的临床病理特征相关。SKP2、SOX10及TIL表达与TNBC预后相关,提示这些生物指标可能成为TNBC新的预后因子,同时它们也有可能成为潜在的治疗靶点。

PD-1/PD-L1单抗药物抗肿瘤免疫治疗相关不良反应及超进展疾病研究进展

近年来,免疫治疗药物的开发和临床应用取得了突破性进展,其中程序性死亡受体1(PD-1)及其配体(PD-L1)作为第二代免疫检查点抑制剂的临床靶点,已成为新药研发的热点之一。目前,美国食品药品监督管理局和我国国家食品药品监督管理总局已批准多种PD-1/PD-L1单克隆抗体(单抗)药物如纳武利尤单抗、帕博利珠单抗和阿替利珠单抗等上市,用于治疗小细胞肺癌、直肠癌、结肠癌和黑色素瘤等。然而在临床应用中发现,PD-1/PD-L1单抗药物在肺、肝、肾、胃肠道系统、内分泌系统和皮肤等均可引起患者发生不同程度的免疫相关不良反应,甚至出现超进展疾病(hyperprogressive disease)情况。加强对PD-1/PD-L1单抗药物的临床应用进行有效的监测与管理,对症使用相关药物,可改善免疫治疗进程,减少免疫治疗对患者产生的不良反应及超进展疾病的影响。

PD-1/PD-L1抑制剂诱发免疫相关甲状腺功能障碍的影响因素及肿瘤总生存期分析

目的探究程序性死亡受体-1(PD-1)/程序性死亡配体-1(PD-L1)抑制剂诱发免疫相关甲状腺功能障碍(irTD)的影响因素及对肿瘤总生存期(OS)的影响。方法纳入211例PD-1/PD-L1抑制剂治疗的肿瘤患者,比较是否发生irTD组间的差异,并进行亚组分析。采用多因素Logistic回归分析探究irTD的影响因素,生存分析法探究是否发生irTD与OS的关系,组间比较采用log-rank检验,多模型COX回归分析评估irTD对OS的影响。结果irTD的发生率为26.1%,1级发生率13.3%,2级发生率10.0%,3~4级发生率2.8%,发生的中位时间为第9周(IQR:5~25周)。性别、吸烟史、靶向史、基线甲状腺抗体在是否发生irTD组间具有统计学差异(P<0.05)。irTD患者甲状腺球蛋白抗体(TGAb)在第3周开始升高,第6~30周高于基线水平,30周后开始下降并逐渐恢复至基线水平,甲状腺微粒体抗体(TMAb)的变化幅度小于TGAb。亚组分析显示,甲亢组首次接受免疫治疗的年龄较甲减组小(P<0.05),基线促甲状腺激素(TSH)水平低于甲减组(P<0.05)。多因素Logistic回归分析显示,基线甲状腺抗体阳性的患者发生irTD的风险是阴性患者的4.595倍(95%CI:2.286~9.239,P<0.001)。生存分析显示,irTD患者的OS更长。多模型COX回归分析显示:在调整年龄、性别、化疗、肿瘤类型、是否转移等因素后irTD患者的OS更长(HR=0.228,95%CI:0.079~0.656,P=0.006)。结论irTD严重程度以1~2级为主,3~4级少见。基线甲状腺抗体阳性是irTD发生的独立危险因素。发生irTD的患者具有更长的OS,可能是由于irTD患者具有更好的免疫应答。

信迪利单抗联合奥沙利铂和替吉奥治疗贲门腺癌致免疫性心肌炎并文献分析

报道1例64岁女性患者因贲门腺癌行信迪利单抗(200 mg,d1)+奥沙利铂(200 mg,d1)+替吉奥(60 mg,bid,d1~14)的3周治疗方案。患者在第2周期治疗的第7天出现后背疼痛,心肌损伤标志物升高,心电图Ⅲ、aVF导联可见异常Q波,T波低平。经冠脉CT检查后排除冠状动脉粥样硬化所致冠心病,诊断为免疫性心肌炎。停用抗肿瘤药物,给予甲泼尼龙治疗9 d后症状缓解,心肌损伤标志物明显下降。免疫性心肌炎是信迪利单抗罕见且严重的不良反应,临床应用信迪利单抗时应密切监测心肌损伤标志物的变化和患者的症状、体征。

ATG5和PDIA3在宫颈癌组织中的表达及其临床意义

目的:探究免疫原性细胞死亡相关基因——自噬相关基因5(ATG5)和蛋白质二硫键异构酶A3(PDIA3)在宫颈癌组织中的表达及其与患者临床病理特征和预后的相关性、相关信号通路及药物敏感性。方法:收集自2016年1月至2023年12月间青岛大学附属医院60例宫颈癌癌组织标本作为实验组,26例因子宫肌瘤、子宫腺肌症切除的正常宫颈组织标本作为对照组,并收集相应的临床资料。采用免疫组化法检测宫颈癌组织和正常宫颈组织中ATG5、PDIA3蛋白的表达差异,分析其表达与各项临床病理参数之间的关系。基于基因表达水平值的交互式分析平台(GEPIA)在线分析宫颈癌组织中ATG5、PDIA3的表达水平对患者预后的影响,使用基因本体论(GO)、京都基因与基因组百科全书(KEGG)、基因集富集分析(GSEA)探究ATG5和PDIA3基因可能涉及的生物学功能及信号通路,用p RRophetic包分析宫颈癌患者癌组织中ATG5、PDIA3高低表达与患者对化疗药物的敏感性。结果:ATG5、PDIA3在宫颈癌组织中的表达率均显著高于正常宫颈组织(83.3%vs 11.5%,χ^(2)=39.538,P=0.001;75.0%vs 46.2%,χ^(2)=6.753,P=0.009),ATG5的表达水平在肿瘤直径、FIGO分期、淋巴结转移方面的差异显著(均P<0.01);PDIA3的表达水平在肿瘤直径、分化程度、FIGO分期和淋巴结转移方面的差异显著(P<0.05或P<0.01)。ATG5和PDIA3的表达水平呈正相关(r=0.679,P<0.001)。GEPIA在线分析网站预后分析显示,ATG5和PDIA3高表达宫颈癌患者的预后差(均P<0.05)。ATG5和PDIA3主要富集的功能及信号通路包括细胞增殖与分化、抗原加工与提呈、P53结合、Wnt信号通路、MAPK信号通路及mTOR信号通路。结论:ATG5和PDIA3在宫颈癌组织中呈高表达,两者高表达与患者不良预后有关,ATG5和PDIA3参与细胞增殖与分化、抗原加工提呈及多种信号通路,有望成为宫颈癌治疗的潜在靶点。

慢性宫颈炎合并HPV感染140例血清SOX2和PD-L1表达与临床病理特征相关性分析

目的探究慢性宫颈炎合并人乳头状瘤病毒(HPV)感染病人血清性别决定区Y框蛋白2(SOX2)和程序性死亡配体1(PD-L1)表达与临床病理特征相关性。方法选取2020年10月至2022年10月在重庆市江津区中医院就诊治疗的未合并HPV感染慢性宫颈炎病人160例作为慢性宫颈炎组,慢性宫颈炎合并HPV感染病人140例作为合并HPV组,另选取在该院体检健康女性110例作为对照组。采用酶联免疫吸附测定(ELISA)检测研究对象血清SOX2水平,实时荧光定量PCR(qRT-PCR)测定血清PD-L1 mRNA水平,二代杂交捕获实验技术(HC2)检测HPV-DNA。结果对照组、慢性宫颈炎组、合并HPV组血清SOX2、PD-L1mRNA水平呈现逐渐升高的趋势(P<0.05);低危型HPV组、中危型HPV组、高危型HPV组血清SOX2、PD-L1 mRNA水平呈现逐渐升高的趋势(P<0.05);慢性宫颈炎合并HPV病人中单一感染率为45.71%(64/140),多重感染率为54.29%(76/140)(P>0.05),其中慢性宫颈炎合并HPV病人中低危型单一感染与多重感染病例数差异有统计学意义(P<0.05);高水平SOX2与低水平SOX2以及高水平PD-L1 mRNA与低水平PD-L1 mRNA慢性宫颈炎病人合并HPV率差异有统计学意义(P<0.05)。结论慢性宫颈炎合并HPV感染病人血清SOX2、PD-L1 mRNA水平均显著升高,与HPV分型密切相关,且病人血清SOX2、PD-L1 mRNA水平与HPV感染均呈正相关。

阿替利珠单抗不良反应94例文献分析

目的分析阿替利珠单抗发生不良反应(adverse reactions,ADRs)的临床特点与规律,为临床安全用药提供参考。方法搜索中国知网、维普、万方、Web of Science、PubMed数据库,收集关于阿替利珠单抗所致不良反应的报道文献并进行分析,研究时间为2022年4—8月。结果阿替利珠致不良反应报道共94例;其中男性56例(59.57%),女性38例(40.43%),男性占比较高;年龄(62.8±12.0)岁,中老年人居多;多数发生在用药后的90 d内(71例,71.0%);阿替利珠单抗致ADRs累及多个系统/器官,其中以神经系统损害(22例,22.0%)占比最多;3~4级严重ADRs占比最多(64例,64.0%);94例经治疗和(或)停药后,好转或治愈80例,死亡5例。结论阿替利珠单抗所致ADRs涉及不同性别与年龄段病人,累及多个系统/器官,临床使用应随时监测,警惕ADRs的发生,做到及时识别与治疗。

Nrf2/HO-1通路在银屑病中作用的研究进展

银屑病的发病机制复杂,探索其发病机制对于治疗十分重要。核因子E2相关因子2(Nrf2)/血红素加氧酶1(HO-1)通路对细胞具有保护作用,与氧化应激、免疫、血管异常增生、表皮失衡以及细胞死亡等生理病理过程密切相关。目前已有研究证实Nrf2/HO-1通路对银屑病皮损有抑制作用,可能通过多种途径参与银屑病发病。就Nrf2/HO-1通路在银屑病中的作用机制及中医药通过干预该通路治疗银屑病的研究进展进行综述。