Programmed cell death 1 (PD-1) is an important negative costimulatory molecule discovered in recent years, which is expressed on the surface of T and B cells and plays an important role in the regulation of cellular immune response and immune tolerance.After the combination of PD-1 and its receptor programmed cell death 1 ligand 1 (PD-L1), negative regulatory signals are transmitted to suppress the immune response.Under the activation of stimulating factors, PD-1 and PD-L1 are combined to weaken the conduction of downstream signaling pathways such as PI3K/Akt and ERK through recruitment of phosphorylated SHP2, thereby inhibiting the proliferation of T cells and the production of cytokines, inhibiting the immune response and participating in the occurrence and development of a large number of inflammatory diseases.PD-1 in the field of ophthalmology research is still in its infancy.As far as we know, PD-1 participates in ocular inflammatory diseases such as uveitis, sympathetic ophthalmia, allergic conjunctivitis, also is involved in corneal transplant rejection, optic nerve crush injury and optic myelitis, diabetic retinopathy, thyroid related ophthalmopathy, melanoma and other diseases, thus preventing the interactions between PD-1 and its receptor PD-L1 may become a new potential target for the treatment of ocular tumor, inflammation, autoimmune and neurodegeneration disease.In this article, the latest research progress of PD-1 and its receptor PD-L1 in the pathogenesis of ocular diseases were reviewed.

Objective: To revise and evaluate the Chinese version of the FACT-B. Method: The Chinese version of the FACT-B was translated from the original one, after back-translated and culture adaptation, it was applied to 165 patients with breast cancer. Result: The test-retest reliability of five domains, such as physical well-being, social/family well-being, emotional well-being, functional well-being, additional concerns and the overall scale were 0.82～0.89. The internal consistency alpha for the five domains were 0.61～0.84. After admission to hospital 2-4 weeks, the quality of life of patients showed some change in this scale. Conclusion: The Chinese version of the FACT-B has good psychometric quality and can be used to assess the quality of life of Chinese patients with breast cancer.

Objective To explore the effect of low-dose imfepristone on the endometrial simple hyperplasia.Methods Study group were randomly divided into two groups.43 cases in group mifepristone,43 cases in group norethindrone and control group were 20 cases.The endometrial histopathology and the contents of ER and PR were examined before and after the treatment.The changes of endometrial thickness and hemoglobin were detected,too.Results The endometria were all simple hyperplasia before taking the medicine and turned to proliferative stage after taking mifepristone and norethindrone.There were significant difference compared with taking the medicine before(P＜0.05).However,there were no statistical difference between two groups after taking the medicine(P＞0.05).The endometrial ER and PR were significantly depressed after taking the medicine compared with before in study group(P＜0.05).There were no significant difference between control group and group mifepristone after taking mifepristone(P＞0.05).But there were significant difference between controI group and group norethindrone after taking norethindrone(P＜0.05).The endometrum were significant turned thin and the contents of hemoglobin were significantly risen up after taking the medicine in study group(P＜0.05).But the contents of hemoglobin were significantly risen up after taking the medicine in group mifepristone compared with group norethindrone(P＜0.05).Conclusions Low-dose mifepristone can inhibit endometrial simple hyperplasia and turn the endometria from simple hyperplasia to proliferative stage.Low-dose mifepristone may adjust the endometrial ER and PR for inhibitting endometrial hyperplasia and make the expression of endometrial ER and PR decrease.But the contents of ER and PR were more close to normal after taking mifepristone.Low-dose mifepristone can attenuate the endometria and regain the hemoglobin fast.There are seldom side-effects after taking low-dose mifepristone.

Integrin is an important cellular adhesion molecule,which mediates many biologic actions such as cell-cell adhesion or cell-extracellular matrix adhesion.The relationship between integrin and tumor metastasis,as well as the important role of integrin during tumor progress,is reviewed in this article,which gives us the theoretical base for new pathways of cancer treatment.

Objective To observe the effect of butylphthalide sequential therapy combined with injection of alteplase(injection with recombinant human collagenous tissue plasminogen activator) in the treatment of acute cerebral infarction (ACI).Methods 61 patients with ACI and within 4.5 hours of onset were selected,and they were divided into treatment group(butylphthalide combined with alteplase group,31 cases) and the control group (alteplase only group,30 cases) by random number table.The two groups were given glucose-lowering,statins for maintaining the blood pressure,as well as aspirin enteric tablets or clopidogrel for those without bleeding on the 24 hour review head CT in the acute phase.The treatment group was given alteplase for injection with sequential butylphthalide therapy (butylphthalide injection for 2 weeks followed by an oral administration of butylphthalide soft capsules for 3 months),and the control group was given only alteplase for injection.The National Institute of Health stroke scale (NIHSS) and Barthel index (BI) were used for evaluating the final clinical efficacy.Results The NIHSS scores of the treatment group compared with the control group at 24 hour,14 days and 3.5 months after the treatment had statistically significant differences (t =-0.102,-1.964,-2.444,P =0.037,0.018 and 0.012).The NIHSS scores of the treatment group had decreased 2％,27％ and 41％ compared with the control group at 24 hour,14 days and 3.5 months after the treatment,respectively.The BI score of the treatment group and control group at 3.5 months after treatment had statistically significant difference (t =-1.956,P =0.029).Conclusion The sequential butylphthalide therapy combined with injection of alteplase has good synergistic effect for the patients with onset of ACI less than 4.5 hours,and it is a safe and effective treatment method for ACI within 4.5 h and it is worthy of clinical promotion.

Objective To investigate the efficacy and safety of Tripterygium wilfordii Hook F (TwHF) combined with renin-angiotensin system (RAS) blockers in chronic kidney disease (CKD) stages 2~3 of IgA nephropathy. Methods 109 patients were randomized into the observation group and the control group. On the basis of taking RAS blockers, patients in the observation group received TwHF, and patients in the control group received methylprednisolone. The proteinuria, renal function and adverse effect were observed during treatment. Results At 3, 6, 9 and 12 months of treatment, proteinuria in the two groups was lower than the baseline(P <0.05). During follow-ups, there was no significant difference of eGFR between the two groups and baseline (P >0.05). Besides, there was no significant difference in terms of proteinuria, eGFR and effective rate in the two groups. The occurrence rate of adverse effects was 9.8% vs 27.4% and there was significant difference in the two groups (P < 0.05). Conclusions TwHF combined with RAS blockers can decrease proteinuria, protect renal function and have less adverse effects, and it is a useful therapeutic options for CKD stages 2 ~ 3 of IgAN.

Objective To conduct a prospective,randomly controlled trial,evaluating the combination of tacrolimus,corticosteroids and entecavir for the treatment of adult patients with biopsyproven hepatitis B virus-associated membrane nephropathy (HBV-MN).Methods A total of 38 patients with biopsy-confirmed HBV-MN were randomized to the tacrolimus group (n=19) and the control group (n=19).Patients in tacrolimus group received combination therapy of tacrolimus (0.05 mg·kg-1 · d-1),corticosteroids (prednisone acetate,0.5 mg· kg-1 · d-1) and entecavir (0.5 mg/d),whereas patients in control group received entecavir mono-therapy (0.5 mg/d).The primary end point was the percentage of patients reaching complete remission (CR) or partial remission (PR).Results The probability of remission in the treatment group was 88.89％ and 94.44％ after 6 and 12 months,but only 38.89％ and 58.82％ in the control group,respectively.The decrease in proteinuria was significantly greater in the treatment group.Entecavir was used for the treatment of hepatitis in all patients,which caused the disappearance of serum hepatitis B viral DNA(HBV-DNA) and the normalization of ALT and AST levels in 3 months.Notably,two patients in the control group and one patient in the treatment group reached the secondary end point.One patient in the tacrolimus-treated group showed a relapse during the taper period.Conclusion This treatment protocol not only can control the replication of HBV-DNA but also can reduce proteinuria and preserve renal function,it is one of useful therapeutic options for patients with HBV-MN.

Objective To estimate heart function among patients with diabetic foot ulcer,and to investigate the characteristics of heart failure(HF) before and after treatment of ulcer. Methods Items associated with diabetes and some physiological and biochemical indicators were observed in patients with diabetic foot ulcer(162 cases) and with high risk factors of ulcer(75 cases). Heart function was evaluated at patients′ admission, during ulcer related treatment, and prior to discharge. Left ventricular ejection fraction and other cardiac assessment were measured with ultrasonic scan.Results During hospitalization, 23.6%(56/237) patients underwent HF with normal left ventricular ejection fraction, and it was 27.2%(44/162) in patients with foot ulcers. The prevalence of HF was 8.9%(21/237) in all patients studied on admission, and that was 10.5%(17/162) in patients with foot ulcer, more than that without foot ulcer(P＜0.01). More patients with HF were found, being 14.8%(35/237) during 2-7 days after ulcer related treatment initiated, and peak was on the 4th day. There was statistical difference among different Wagner grades(P＜0.05) about the morbidity rate of HF. All patients with HF were improved and tolerant to ulcer related treatment. Conclusion The prevalence of HF with normal left ventricular ejection fraction was relatively high in patients with diabetic foot ulcer, especially after ulcer treatment.

Objective: To investigate the adrenocortical function changes of patients with advanced solid tumors who received the anti- programmed cell death protein-1 (PD-1) antibody, SHR-1210 therapy. Methods: The clinical data of 98 patients with advanced solid tumors who were enrolled in a prospective phase I trial of SHR-1210 therapy at our institution between April 27, 2016 and June 8, 2017 were collected. The levels of plasma adrenocorticotropic hormone (ACTH) and cortisol were evaluated in 96 patients. The clinical manifestations, laboratory tests and radiologic data were collected to define the immune-related adrenal insufficiency. Results: Until December 14th, 2018, no SHR-1210 related primary adrenal insufficiency occurred, and the incidence of immune-related secondary adrenal insufficiency was 1.0% among the 96 patients, which was identified as grade 2. No patient developed grade 3-4 adrenal insufficiency. The main clinical manifestations of the patient who was diagnosed as secondary adrenal insufficiency were grade 2 fatigue, anorexia and headache.The patient developed fatigue and anorexia at the 267th day after receiving the first dose of SHR-1210, the hypocortisolism occurred on the 279th day, and the headache emerged on the 291th day. The anorexia of patient who treated by physiological replacement doses of glucocorticoid since the 457th day was attenuated.The patient whose cortisol level was still below the normal limit continued to accept the hormone replacement therapy up to 776 days after the initial administration of SHR-1210. Conclusions The incidence of SHR-1210 related adrenal insufficiency of patients with advanced solid tumors is low, and the symptoms can be effectively ameliorated by hormone replacement therapy. The potential adverse outcome of adrenal insufficiency following immunotherapy should be noticed by clinicians to avoid the occurrence of adrenal crisis.

OBJECTIVE: To investigate whether the level of homocysteine in patients with postpartum depression is associated with depression index. METHODS: A total of 43 women with postpartum depression or with potential postpartum depression, who visited the psychological clinic of Maternal and Child Health Hospital of Hunan Province from June, 2012 to April, 2014, were enrolled in this study. They were evaluated by the Edinburgh Postnatal Depression Scale and Hamilton Depression Scale. Chinese Classification of Mental Disorder (the third edition) was used for their diagnosis. The depressive index was calculated by Edinburgh Postnatal Depression Scale, Hamilton Depression Scale, and clinical symptom scores, which was used to assess the level of depressive symptoms. The level of homocysteine in serum was detected by chemoluminescent method. Meanwhile, another 31 women, who visited the hospital without postpartum depression, were used as controls to compare with the 43 patients. RESULTS: The homocysteine level in the women with postpartum depression was significantly higher than that in the control group [(10.09 ± 3.59) μmol/L vs (8.57 ± 1.59) μmol/L, t=12.392, P=0.001]. The depression index was positively correlated with the level of homocysteine (r=0.231, P<0.05). CONCLUSION The level of serum homocysteine is associated with postpartum depression, suggesting that the level of serum homocysteine might be a risk biomarker for postpartum depression.
Asian Continental Ancestry Group ; Case-Control Studies ; Depression, Postpartum ; blood ; Female ; Homocysteine ; blood ; Humans ; Psychiatric Status Rating Scales