Prognostic and predictive role of soluble programmed death ligand-1 in head and neck cancer

Abstract Objectives The aim of the study was to investigate clinical significance of soluble PD-L1 (sPD-L1) serum level in head and neck cancer and to evaluate its role as a possible prognostic and predictive biomarker. Methods A prospective analysis of sPD-L1 levels in 60 patients diagnosed and treated due to malignant and non-malignant lesions in the region of head and neck was performed in peripheral blood by an ELISA test. Results The range of sPD-L1 in the study group was 0.16-1.63 ng/mL, mean 0.64 ± 0.32. There were no differences in the mean sPD-L1 regarding patients' age, sex, and the localization of the lesion. Statistically significant difference was revealed in the average sPD-L1 level (p = 0.006) depending on the histopathological advancement of the lesions, 0.704 ± 0.349 and 0.512 ± 0.177 respectively in the malignant and benign group. The separate analysis of laryngeal lesions confirmed statistical difference in sPD-L1 (p = 0.002) for the malignant lesions (0.741 ± 0.353) compared with the benign (0.489 ± 0.175). The sPD-L1 level of 0.765 ng/mL or higher, revealed 35% sensitivity and 95.5% specificity for the diagnosis of head and neck malignant lesions (AUC = 0.664, 95% CI 0.529‒0.8, p-value = 0.039). The 1-year DFS was 83.3% in the group of patients with low sPD-L1 levels (< 0.765 ng/mL) and 53.8% in patients with high sPD-L1 (≥0.765 ng/mL). The 2-year OS were 68% and 69.2% respectively in both groups. The log-rank test confirmed statistically significant prognostic value of sPD-L1 level for 1-year DFS (p-value = 0.035). Conclusions sPD-L1 is a promising prognostic and early recurrence predictive biomarker for head and neck cancers, most significantly for laryngeal lesions. Level of evidence 3.

Clinical Efficacy and Mechanism of Erzhi Tiangui Prescription in Treatment of Patients with Repeated Implantation Failure of Kidney Deficiency Syndrome Based on sPD-1 and Th17/Treg Cytokines / 中国实验方剂学杂志

ObjectiveTo investigate the clinical efficacy and possible mechanism of Erzhi Tiangui prescription on repeated implantation failure （RIF） of kidney deficiency syndrome. MethodSeventy patients with RIF of kidney deficiency syndrome who underwent natural cycle frozen-thawed embryo transfer （FET） in the Reproductive and Genetic Center of the Affiliated Hospital of Shandong University of Traditional Chinese Medicine were enrolled and randomly divided into a treatment group （35 cases） and a control group （35 cases）. Patients in the treatment group took oral Erzhi Tiangui prescription from the third day of each menstrual cycle two months before the FET cycle and continued to take it until the day of transplantation from the third day of the menstrual cycle in the month of transplantation. Those in the control group did not accept traditional Chinese medicine （TCM）. In addition，10 patients who successfully achieved clinical pregnancy after the first natural cycle FET were screened from the reproductive medical record bank of this hospital and assigned to the normal group. Peripheral blood samples of patients in the three groups on the day of embryo transfer were collected from the specimen bank of the Reproductive and Genetic Center. Serum soluble programmed death molecule-1 （sPD-1），soluble programmed death molecule-ligand 1 （sPD-L1），transforming growth factor-β （TGF-β），interleukin-17 （IL-17）， and interleukin-10 （IL-10） levels were measured by enzyme-linked immunosorbent assay （ELISA）. The changes in kidney deficiency syndrome scores， the final biochemical pregnancy rates， clinical pregnancy rates， and embryo implantation rates of the treatment group and the control group before and after treatment were observed. ResultCompared with the normal group，the model group showed increased serum levels of sPD-1 and IL-17（r=0.347，P<0.05），decreased levels of IL-10 and TGF-β （P<0.01），and non-significant change in sPD-L1 level. Serum sPD-1 was positively correlated with IL-17 （P<0.05） and negatively correlated with IL-10（r=-0.521，P<0.01） and TGF-β（r=-0.457，P<0.01） in RIF patients with kidney deficiency syndrome. After TCM treatment，compared with the control group， the treatment group showed improved TCM syndrome score （P<0.05） and increased clinical pregnancy rate and embryo transfer rate（P<0.05），but there was no statistically significant difference in the biochemical pregnancy rate between the two groups. ConclusionAbnormal expression of sPD-1 in patients with RIF of kidney deficiency syndrome breaks the balance of T helper 17 （Th17）/regulatory T cell （Treg），which is not conducive to embryo implantation and pregnancy maintenance. Erzhi Tiangui prescription，a TCM for tonifying the kidney，can significantly improve the symptoms of kidney deficiency in patients with RIF of kidney deficiency syndrome，reduce the concentrations of sPD-1 and IL-17 in the peripheral serum，increase the levels of TGF-β and IL-10，regulate the peripheral Th17/Treg immune balance，and increase the implantation rate and clinical pregnancy rate，which has a high clinical value.

Information Construction of Hospital Medical Consumables Management Based on SPD Mode / 中国医疗器械杂志

To change the traditional hospital medical supplies rough management mode, the hospitals build an information material management platform which combines suppliers and hospitals, information systems and smart devices, clinical needs and professional operations innovatively. Finally, a lean management system called SPD is formed under the guidance of supply chain integration and supported by supply chain management theory and information technology. It has realized the whole process of consumables circulation information traceability, intelligent service in the hospital, and refined management of consumption settlement. The application of SPD in hospitals effectively improves the informatization level and overall operation efficiency of medical consumables management which is an important part of hospital information construction.

Practice of Refined Management of in Vitro Diagnostic Reagents Based on SPD in Hospital / 中国医疗器械杂志

The management of in vitro diagnostic reagents has always been a concern. This paper describes the application of SPD medical consumables fine management system in our hospital. Relying on the brand-new management mode, the whole process from supplier qualification certificate management, in vitro diagnostic reagent procurement management, secondary warehouse management, and then to the use process traceability was realized. The monthly cost of in vitro diagnostic reagents can be accurately counted, which effectively controls the cost of in vitro diagnostic reagents.

Soluble PD-L1 as a prognostic factor for advanced acral and mucosal melanoma / 中国肿瘤生物治疗杂志

@#[Abstract] Objective: Elevated levels of soluble PD-L1 (sPD-L1) are associated with worse prognosis of renal cell carcinoma and multiple myeloma. However, the regulatory roles and functions of sPD-L1 in advanced melanoma are not fully understood. This study was designed to evaluate the association between circulating sPD-L1 concentrations and prognosis of patients with advanced acral or mucosal melanoma. Methods: A total of 102 untreated patients with advanced acral and mucosal melanoma admitted to Peking University Cancer Hospital between January 2012 and December 2015 were enrolled in this study. In the meanwhile, peripheral blood samples were obtained from 40 healthy donors. Circulating sPD-L1 concentrations were determined using an enzyme-linked immunosorbent assay. Results: The advanced melanoma cohort included 58 acral melanoma patients and 44 mucosal melanoma patients. The pre-treatment concentration of sPD-L1 (2.91±2.23 ng/ml) in plasma of patients group was elevated as compared with that in healthy donors (0.59 ng/ml). The concentration of sPD-L1 in serum was significantly upregulated in 39/102 (38.2%) patients and significantly associated with increased LDH level (P=0.021) and number of Tregs (P=0.017). The overall survival rates of patients with high or low concentrations of sPD-L1 were statistically different (8.5 months [high level] vs 11.6 months [low level], P=0.022). Conclusion: sPD-L1 concentration is elevated in patients with advanced acral or mucosal melanoma, which may play an important role in predicting prognosis.

Research progress on clinical application of soluble PD-1 in anti-tumor therapy / 中国肿瘤生物治疗杂志

@#[摘 要] 程序性死亡蛋白-1（programmed death protein 1，PD-1）是表达在T细胞表面的一种重要的免疫抑制穿膜蛋白，在限制慢性炎症、感染或肿瘤中T细胞的活性方面起重要作用。可溶性PD-1（soluble PD-1，sPD-1）是由PD-1缺失3号外显子的转录剪接体转录翻译而来，无法形成穿膜区，但其具有胞外结构域，具有与配体PD-L1/PD-L2结合的能力，能激活T细胞并促进DC成熟，而发挥抗肿瘤作用。随着免疫疗法及免疫检查点阻断治疗的出现并逐渐成为肿瘤治疗的新兴手段，关于PD-1及其抗体的基础及临床转化研究也成为肿瘤研究的热点之一。不同形式的PD-1被发现，意味着PD-1可能在机体中发挥着更加复杂及多面的功能，因此对于sPD-1的研究也逐渐展开及深入。本文就sPD-1作为肿瘤诊断、疗效预测及预后评估的潜在标志物及联合抗肿瘤免疫治疗中的临床应用研究进展作一综述，以期了解sPD-1在抗肿瘤治疗中的重要作用，为肿瘤免疫治疗提供新思路、新方法和新策略。

Quantification of biogenic amines in fabrication steps of Gorgonzola-type cheese / Quantificação de aminas biogênicas nas etapas de fabricação do queijo tipo Gorgonzola

During the Gorgonzola-type cheese preparation there are proteolysis and lipolysis which may be influenced by the type of starter culture chosen. Six manufacturing steps were selected to identify which of them is most suitable for biogenic amines (BA) formation (1- milk, 2- lactic acid bacterial culture and fungus addition, 3- curd, 4- dry salting, 5- maturation at 30 days and maturation at 60 days); perform research on enterobacteria; accomplish the research of BA-producing bacteria (BAPB); detect and quantify the most abundant BA (putrescine, cadaverine, tyramine, histamine, spermidine and spermine) in the six steps of Gorgonzola cheese production and in bacterial isolates using high performance liquid chromatography and UV-Vis SPD/10AV detector and define if the presence of enterobacteria and BAPB would be correlated with BA production in this cheese. The bacterial culture used increased its log population by 7 log cycles and reached its highest level in batch 2 during cheese maturation. There was a decrease in the enterobacterial population in 2 log cycles after 60 days of maturation in batch 1. Tyramine was the BA with the highest concentration 306.32 mg.Kg-1 quantified in step 6 (60 days maturation) in batch 1. Criterion is requiered in bacterial starter culture selection because it is a quality determinant factor in relation to BA production and more rigor in raw material selection.

Durante a elaboração do queijo tipo Gorgonzola ocorre proteólise a partir das bactérias e dos fungos adicionados ao leite que podem levar a formação de aminas biogênicas (AB) neste tipo de queijo. Portanto, no presente estudo foi feito o acompanhamento com coleta de amostras em seis etapas na fabricação deste queijo paraidentificar em qual delas haveria maior formação de aminas biogênicas (AB). As amostras coletadas em três diferentes lotes foram o leite cru (1), leite pasteurizado adicionado de cultura de bactérias ácido-láticas (2), massa coalhada (3), queijo após a etapa de salga seca (4), queijo após 30 dias de maturação (5) e queijo após 60 dias de maturação (6). Também foram realizadas a pesquisa de enterobactérias e bactérias ácido-láticas com característica capacidade de descarboxilação de aminoácidos e produção de aminas biogênicas (BPAB); detecção e quantificação da AB mais abundante (putrescina, cadaverina, tiramina, histamina, espermidina e espermina) nas seis etapas de fabricação do queijo tipo Gorgonzola e nos isolados bacterianos utilizando cromatografia líquida de alta eficiência e detector UV-Vis SPD/10AV e a verificação se a presença de enterobactérias e BPAB estariam correlacionadas com a produção de AB nesse queijo. A cultura bacteriana utilizada cresceu aumentando em sete ciclos logarítmicos sua população e alcançou seu maior nível no lote 2 na etapa de maturação do queijo. Houve diminuição da população enterobactérias em 2 ciclos logarítmicos após 60 dias de maturação no lote 1. A tiramina foi a AB com concentração mais elevada 306,32 mg.Kg-1 quantificada na etapa 6 (60 dias de maturação) no lote 1. É necessário dar mais atenção em duas etapas na elaboração dos queijos: mais critério na seleção da cultura bacteriana iniciadora por ser um fator determinante na qualidade em relação à produção de AB e mais rigor na seleção da matéria-prima.Palavras chaves: cromatografia, cultura iniciadora, detector SPD/10AV UV­Vis, maturação, tiramina.

Quantification of biogenic amines in fabrication steps of Gorgonzola-type cheese / Quantificação de aminas biogênicas nas etapas de fabricação do queijo tipo Gorgonzola

During the Gorgonzola-type cheese preparation there are proteolysis and lipolysis which may be influenced by the type of starter culture chosen. Six manufacturing steps were selected to identify which of them is most suitable for biogenic amines (BA) formation (1- milk, 2- lactic acid bacterial culture and fungus addition, 3- curd, 4- dry salting, 5- maturation at 30 days and maturation at 60 days); perform research on enterobacteria; accomplish the research of BA-producing bacteria (BAPB); detect and quantify the most abundant BA (putrescine, cadaverine, tyramine, histamine, spermidine and spermine) in the six steps of Gorgonzola cheese production and in bacterial isolates using high performance liquid chromatography and UV-Vis SPD/10AV detector and define if the presence of enterobacteria and BAPB would be correlated with BA production in this cheese. The bacterial culture used increased its log population by 7 log cycles and reached its highest level in batch 2 during cheese maturation. There was a decrease in the enterobacterial population in 2 log cycles after 60 days of maturation in batch 1. Tyramine was the BA with the highest concentration 306.32 mg.Kg-1 quantified in step 6 (60 days maturation) in batch 1. Criterion is requiered in bacterial starter culture selection because it is a quality determinant factor in relation to BA production and more rigor in raw material

Durante a elaboração do queijo tipo Gorgonzola ocorre proteólise a partir das bactérias e dos fungos adicionados ao leite que podem levar a formação de aminas biogênicas (AB) neste tipo de queijo. Portanto, no presente estudo foi feito o acompanhamento com coleta de amostras em seis etapas na fabricação deste queijo paraidentificar em qual delas haveria maior formação de aminas biogênicas (AB). As amostras coletadas em três diferentes lotes foram o leite cru (1), leite pasteurizado adicionado de cultura de bactérias ácido-láticas (2), massa coalhada (3), queijo após a etapa de salga seca (4), queijo após 30 dias de maturação (5) e queijo após 60 dias de maturação (6). Também foram realizadas a pesquisa de enterobactérias e bactérias ácido-láticas com característica capacidade de descarboxilação de aminoácidos e produção de aminas biogênicas (BPAB); detecção e quantificação da AB mais abundante (putrescina, cadaverina, tiramina, histamina, espermidina e espermina) nas seis etapas de fabricação do queijo tipo Gorgonzola e nos isolados bacterianos utilizando cromatografia líquida de alta eficiência e detector UV-Vis SPD/10AV e a verificação se a presença de enterobactérias e BPAB estariam correlacionadas com a produção de AB nesse queijo. A cultura bacteriana utilizada cresceu aumentando em sete ciclos logarítmicos sua população e alcançou seu maior nível no lote 2 na etapa de maturação do queijo. Houve diminuição da população enterobactérias em 2 ciclos logarítmicos após 60 dias de maturação no lote 1. A tiramina foi a AB com concentração mais elevada 306,32 mg.Kg-1 quantificada na etapa 6 (60 dias de maturação) no lote 1. É necessário dar mais atenção em duas etapas na elaboração dos queijos: mais critério na seleção da cultura bacteriana iniciadora por ser um fator determinante na qualidade em relação à produção de AB e mais rigor na seleção da matéria-prima.

Application Study of Medical Consumables Supply Chain Reengineering in Hospitals Based on SPD / 中国医疗器械杂志

The supply chain management of medical consumables in hospitals is an important guarantee for the improvement of clinical diagnosis and treatment. It requires continuous re-engineering and optimization on procurement and supplier management, costs and efficiency of daily operation. Based on the practical case of Shanghai Yueyang Integrated Traditional Chinese Medicine and Western Medicine Hospital, the study discusses the practical path and key points as well as improvement results in hospital medical consumables supply chain re-engineering via SPD model. Also, the research can provide references on medical consumables supply chain management to large and medium-size hospitals.

Improvement Effects of SPD System on the Implementation of “Two-invoice System ”in Drug Procurement in Our Hospital / 中国药房

OBJECTIVE： To provide reference for promoting the implementation of “two-invoice system” for drug purchase in medical institutions. METHODS： The function of confirmation， enquiry， statistics for “two-invoice system” of drug purchase order were added into relevant module of SPD （supply processing distribution） system to realize the management of “two-invoice system” data by means of information technology. By analyzing the data of the “two-invoice system” of Shanxi dayi hospital （our hospital） from Aug. 2017 to Jun. 2018， the effects of SPD system on “two-invoice system” of drug purchase in our hospital were introduced after the application of SPD system. The effects of SPD system were evaluated in respects of work efficiency， accuracy rate and resource saving， etc. RESULTS： SPD system was used for the management of “two-invoice system” to realize the information management of invoices. The time for checking “two-invoice system” information was shortened from 1.5 min/sheet to 0.1 min/sheet； the accuracy rate was increased from 95％ to 100％， and about 40 000 sheets of paper were saved each year. CONCLUSIONS： The application of SPD system in “two-invoice system” of drug purchase can improve the work efficiency， reduce the labor cost and reduce the waste of resources， it effectively improves the level of management in our hospital.

Change of peripheral blood sPD-L1 during chemotherapy in patients with small cell lung cancer and its clinical significance / 中国肿瘤临床

Objective: In tumor microenvironment, immune-related mechanisms up-regulate the expression of programmed death li-gand 1 (PD-L1), which abnormally activates PD-L1 signaling pathway and mediates tumor immune escape. Soluble programmed death ligand 1 (sPD-L1) is a form of PD-L1. It has been confirmed that the expression of sPD-L1 in lung squamous cell carcinoma and adeno-carcinoma is related to disease progression, while small cell lung cancer (SCLC) has a high degree of malignancy, strong invasiveness and few related studies. The purpose of this study was to observe the changes in expression of sPD-L1 in the plasma of SCLC patients and their clinical significance. Methods: A total of 94 patients with SCLC diagnosed by pathological examination in Shanxi Provincial Cancer Hospital from March 2018 to November 2018 were selected as test group, and 17 healthy persons in the same period were se-lected as control group. The dynamic changes of plasma sPD-L1 were compared between the two groups, and the correlations among the expression of sPD-L1 and TNM stage, distant metastasis, and pro-gastrin-releasing peptide (ProGRP) was analyzed. Results: The lev-el of sPD-L1 in the test group was higher than that in the control group (P<0.05 and P<0.01, respectively). In patients with SCLC in the remission stage, the serum sPD-L1 level after chemotherapy was significantly lower than that before chemotherapy (P<0.01); in pa-tients with advanced stage, the serum sPD-L1 level after chemotherapy was significantly higher than that before chemotherapy (P<0.01). The abnormal high expression of sPD-L1 in SCLC patients was significantly correlated with the progression of the disease (P<0.05). The expression of sPD-L1 in serum was positively correlated with the tumor marker ProGRP. Conclusions: The expression of sPD-L1 in peripheral plasma of patients with SCLC is higher than that in healthy individuals and is closely related to the clinical effect.

Analysis on centralized procurement and distribution mode of medical consumables under new situation / 医疗卫生装备

Objective To explore the function of medical consumables integrated bidding procurement and the countermeasures of medical institutions under the background of health care reform. Methods The present situation of integrated bidding procurement was analyzed,and its significance and program were described.It's suggested that the whole-course supervision and feedback evaluation be executed on procurement cycle,transaction price.Some countermeasures were proposed to optimize the distribution mode. Results The implementation of centralized bidding procurement of medical consumables helped to integrate market resources, reduce procurement and distribution costs, strengthen supply chain management and intensify market competition. Conclusion The promotion of centralized bidding procurement and distribution mode of medical consumables nationally is the inevitable trend of medical reform, which is beneficial to the benign development of the industry and ultimately benefits the patients.

Predictive and prognostic evaluation of surfactant protein D, von Willebrand factor and interleukin-8 for sepsis-induced acute respiratory distress syndrome / 临床检验杂志

Objective To select valuable biomarkers for diagnosis and predicting outcome of sepsis-related acute respiratory distress syndrome(ARDS) from D-dimmer (DD),yon Willebrand factor (vWF),platelet (PLT),N terminal-pro brain natriuretic peptide (NT-ProBNP),interleukin-6 (IL-6),interleukin-8 (IL-8) and surfactant protein D (SP-D).Methods A total of 48 sepsis accompanied with ARDS patients and 40 sepsis patients were prospectively studied with comparison.The clinical characteristics of all the patients were recorded in detail.The blood samples were obtained within 24 hours of ICU admission.The concentration or activity of the seven biomarkers was quantitatively assayed and the results were recorded.To select the most valuable biomarkers as clinical indices,diagnosis model and death predictive model were constructed by Logistic regression.Results Among the seven candidate biomarkers,SP-D,vWF and IL-8 showed the most value.Their area under the receiver operator characteristic curve (ROC) were 0.758 (P ＜ 0.01),0.783 (P ＜ 0.01) and 0.747 (P ＜ 0.01) respectively,and raised to 0.847 (P ＜ 0.001) when the three biomarkers were combined.IL-8,age greater than or equal to 60 years and APACHE Ⅱ score greater than or equal to 20 were related to ARDS death with 12.138(lnIL-8)(P=0.022),6.157(P=0.040) and7.415(P=0.014) of OR values respectively.Conclusion SP-D,vWF,IL-8 should be valuable for early prediction of sepsis-induced ARDS and the diagnostic accuracy raised through combined utilization.IL-8 may be predictable for prognosis of sepsis related ARDS and the comprehensive evaluation combining clinical indices with IL-8 should be suggested in clinical practice.

Effectiveness Analysis of Collaboration Application of SPD and HIS in Drug Logistics Management / 中国药房

OBJECTIVE:To study the effects of the collaboration application of hospital information system (HIS) andsmart chaininventory automation management system(SPD)in drug distribution enterprises on drug logistics management,and achieve the centralized distribution of drugs. METHODS:Related countermeasures in achieving the informatization and scientiza-tion of drug inventory management after the collaboration application of HIS and SPD were introduced,and effectiveness analysis was conducted for the inventory management by comparing related indicators before and after collaboration application. RESULTS:Through the establishment ofunified receiving platformsystem and barcode technology that combined with HIS and SPD,drug barcode acceptance was achieved;setting drug fixed package and scanning fixed cards in outer packing in theunified receiving platformsystem can achieve automatic out-and into-storehouse and generating purchase plan;the collaboration application of HIS and SPD achieved drug concentration distribution. Compared with before,monthly inventory amount was decreased 27.07%(P<0.05)in the condition that both drug purchases and sales amount were increased,into-warehouse time of pharmacy acceptance was decreased from 6-12 s in each drug to 10-15 s in each order,pharmacy staff dropped from 2.5 to 2 persons. CONCLUSIONS:The collaboration application of HIS and SPD in drug logistics management has improved efficiency of warehouse,reduced drug inven-tory and achieved the informatization and scientization of drug inventory management.

Research on Internal Control Based on Hospital SPD Procurement Supply Chain Mode / 中国卫生经济

Nowadays,more and more hospitals have introduced Supply,Processing,Distraction (SPD) as a supply chain model,but research on its risks and internal control were still limited.It proposed that hospital must stand on its own characteristics in form of economic operation,also combine the basic and systematic analysis of risk system,to set the selection criteria for SPD suppliers.Before implementing process redesign and optimization,it was important to clarify boundaries of assets,logistics and information within hospital and SPD supplier;enhance the performance appraisal for the implementation of SPD supplier,establish the management countermeasure for the internal control (including retrenchment mechanism),so as to bring economic and social value and benefits to hospital.

Monitoring and its clinical significance of SP-D and interleukin-8 levels in bron-choalveolar lavage fluid of ACOS patients undergoing mechanical ventilation / 中国免疫学杂志

Objective:To investigate the concentration of pulmonary surfactant-associated protein D ( SP-D) and interleukin-8 (IL-8) in the bronchoalveolar lavage fluid (BALF) of ACOS patients undergoing mechanical ventilation (MV). Methods:38 patients with ACOS undergoing MV were involved in the study. According to the APACHEⅡscore, the patients were divided into the remission group (n=20) and the aggravation group (n=18). BALF was collected on the 1st and 5th days after MV. The content of IL-8 and SP-D in BALF was measured by ELISA. The levels of IL-8 and SP-D in BALF of the patients with different severity were compared. Results:The level of SP-D was significantly higher on the 5th day than on the 1st day in the remission group,and it decreased more ob-viously in the worsening group (P<0. 05). The level of IL-8 decreased gradually in the remission group but increased gradually in the worsening group. The level of SP-D was negatively correlated with IL-8 level and APACHEⅡ score. Conclusion:The findings suggest that the levels of SP-D and IL-8 in BALF are correlated with prognosis of ACOS patients undergoing MV,and it may prove to be useful as a guidance of therapy and prognosis.

The diagnostic significance of KL-6, SP-A, SP-D and MMP-7 in IPF and its relationship with pulmonary function / 安徽医科大学学报

Objective To investigate the significance of serum krebs Yon den lungen-6(KL-6), surfactant protein A(SP-A), surfactant protein D(SP-D )and matrix metalloprotease 7(MMP-7) in the diagnosis of idiopathic pul-monary fibrosis (IPF) and its relationship with pulmonary function .Methods Serum levels of KL-6, SP-D, SP-A and MMP-7 were detected by ELISA in 38 patients with IPF and serum from 38 patients with pneumonia and 38 normal controls.Serum levels of markers were further analyzed by operating characteristic curve receiver (ROC), from which the ideal level of each serum marker was obtained , and the follow-up of 6 months in patients with IPF . Explore the significance of the diagnosis of IPF and its correlation with pulmonary function .Results The expres-sion of MMP-7, SP-A, SP-D and KL-6 in serum of IPF patients was higher than that in the control group and healthy control group ( P<0.05) .The optimal cutoff value of KL-6 was 723.0 U/ml, SP-A was 67.2 ng/ml, SP-D was 98.1 ng/ml, and MMP-7 was 10.1 ng/ml.The sensitivity of KL-6 was 71.1% and 98.7%, SP-A was 81.6%and 97.4%, SP-D was 81.6%and 97.4%, MMP-7 was 68.4%and 98.7%.The sensitivity of combined KL-6, SP-A, SP-D and MMP-7 four serum markers was 100%, compared with a single serum index , the P value was less than 0.05, with statistical significance .IPF patients serum SP-A, MMP-7 and forced vital capacity within 6 months were significantly correlated(r1 =-0.574,P1 <0.001;r2 =-0.465,P2 =0.003).Conclusion KL-6, SP-A, SP-D and MMP-7 were highly expressed in serum of patients with IPF , and in the diagnosis of IPF , com-bined detection of 4 serum markers can improve the early diagnosis of IPF patients .Combined serum SP-A and MMP-7 levels can improve the accuracy of the IPF patients with pulmonary function changes , the prediction of dis-ease progression has a certain significance .

The German Social Democratic Party(SPD) and the Debate on the Fertility Decline in the German Empire (1870~1918) / 의사학

This paper aimed to examine the debate over the fertility decline in the German Empire, focusing on the role of the SPD. During the German Empire, the fertility rate dramatically declined and the growing awareness of a continuous decline in the birth rate prompted a massive debate among politicians, doctors, sociologists, and feminist activists. The fertility decline was negatively evaluated and generated consciousness of crisis. However, it was not the only way to face this new phenomenon. Indeed, the use of birth control among the upper class was interpreted as a part of a modernizing process. As the same phenomenon reached the working class, it suddenly became a social problem and was attributed to the SPD. The debate over the fertility decline in imperial German society ridden with a fierce class conflict was developed into a weapon against the SPD. Contrary to the assumption of conservative politicians, the SPD had no clear-cut position on this issue. Except for a few politicians like Kautsky and the doctors who came into frequent contact with the workers, the "birth strike" was not listed as the main interest of the SPD. Even Clara Zetkin, the leader of the Social Democratic women's organization viewed it as a concern of the individual person which could not be incorporated in the party program. The women's organization of the SPD put priority on class conflict rather than issues specific to women. As a result, the debate over the birth rate decline within the SPD was not led by the women themselves. There could have been various means to stimulate the birth rate. Improvement in the welfare system, such as tax relief for large families, better housing conditions, and substantial maternity protection, could have been feasible solutions to the demographic crisis. However, Germany chose to respond to this crisis by imposing legal sanctions against birth control. In addition to paragraphs 218-220 of the German criminal law enacted in 1872 which prescribed penal servitude for anyone who had an abortion or people who helped to practice it, Paragraph 184.3 of the civil code was enacted in order to outlaw the advertising, display, and publicizing of contraceptives with an 'indecent' intention, although selling or manufacturing contraceptives was not forbidden. Such a punitive approach was especially preferred by the government and conservative parties because it was easy to implement and "cheap" in comparison with the comprehensive social welfare program. What made the SPD different from other conservative parties was the fact that the SPD opposed the government's attempt to prohibit contraception by means of strengthening a penal code. According to the SPD, it was not only morally unacceptable, but also technically impossible for the government to intervene in family limitation. Moreover, politicians from the SPD criticized that such a punitive policy targeted the working class because the upper echelon of the society could easily evade the ban on contraceptives. However, the SPD did not proceed to draft comprehensive social welfare measures in order to fight the fertility decline. The miserable condition of working class women remained as an invisible social phenomenon even within the SPD. The German women who could not find the proper means to practice contraception were driven to have abortions. Annually, hundreds of the women were accused of practicing abortion and imprisoned. In sum, German society ran about in confusion and did not know how to properly respond to the unprecedented decline in fertility. By defining the fertility decline just as a social disease due to moral decay and influence of socialism, German society lost a chance to rationalize itself. Given that women, the main actors, had no way to take part in the debate over this issue, it is not surprising that German society fought against the symptom of the disease, not against its root.

Inhibitory effect on pulmonary metastasis of melanoma in mice by soluble PD-1 and its combina-tion with HspT0-B16 antigen peptides / 中华皮肤科杂志

Objective To investigate the blockade effects of soluble PD-1 (sPD-1) expressed in vivo on B7-H1/PD-1 signal transduction,and inhibitory effect in pulmonary metastasis of melanoma with combi- nation of Hsp70-B16 antigen peptides in mice.Methods The pulmonary metastasis model of melanoma was established in mice.Immunohistochemical staining and flow cytometry were utilized to detect the expres- sion of PD-1 and B7-H1 respectively in pulmonary metastasis loci.Four days after the inoculation of tumor cells,forty murine models of pulmonary metastasis were randomly divided to be immunized with normal sodium (group A),empty vector pcDNA3.1 (group B),PDlA plasmid (group C) respectively via tail vein injection,subcutaneous injection of Hsp70-B16 antigen peptides (group D) or with the combination of intra- venous PDlA plasmid and subcutaneous Hsp70-B 16 antigen peptides (group E).The local infiltration with lymphocytes in pulmonary metastasis loci was observed and a series of immunological parameters were assessed 17 days after the inoculation of tumor cells.Results The melanoma pulmonary metastasis model was successfully established.There were a lot of PD-1 positive cells in these loci,and B7-H1 molecule was massively expressed on the surface of B16 cells in metastasis loci.The pulmonary metastasis was inhibited in the mice of group E,and the inhibition rate was 95%,higher than that in other groups (53%,76%,9% in group C,D,B,respectively).The quantity of CD8~+ T cells in pulmonary metastasis loci,cytotoxicity of spleen lymphocytes to tumor cells,and serum concentration of IL-2 and IFN-?were all significantly elevated in the mice of group E as compared with those of other groups (all P

Measurement of Distance from Skin to Pleural Cavity in Interscapular Intercostal Space

OBJECTIVE: The purpose of this study is to measure the skin-pleura distance (SPD) of interscapular intercostal space and to correlated SPD with the individual constitutional data such as body-weight, height, obesity and body mass index (BMI; kg/m2). METHOD: We examined 50 patients (36 men and 14 women) who had no pathological abnormality in interscapular intercostal space. We measured the SPD in chest CT (GE sytec 3000i) study and also measured individual constitutional data of patients. RESULTS: The average age of the subjects was 47.0+/-15.3 years, average weight was 59.0+/-9.7 kg, average height was 167.0+/-8.7 cm, average obesity was 98.4+/-14.9%, average BMI was 21.1+/-3.2 kg/m2 and average SPD was 3.7+/-0.7 cm. There was no correlation of statistical significance between SPD, height and age. But there were statistically significant correlations between SPD, weight, obesity and BMI (p<0.01). Linear regression analysis of these data showed significant correlations between SPD and weight (p<0.01, y=0.109x-2.744), obesity (p<0.01, y=0.092x-5.367) and BMI (p<0.01, y=0.380x-4.301). CONCLUSION: We conclude that the approach considering the correlations between SPD and obesity or BMI will be helpful in reducing pleural puncture during any injection on interscapular intercostal space.