Objective Programmed cell death ligand 1 (PD-L1) plays an important role in the treatment of malignant tumors. Thestudy explores the relationship between PD-L1 status and breast cancer radiotherapy and clinical prognosis. Methods Using the Cancer Genome Atlas (TCGA) database analyze the relationshipof PD-L1 expression, radiotherapy and prognosis in breast cancer. 1007 patients were included in the statistical analysis. Based on the median value of CD274 mRNA expression levels in the database, the total sample was divided into a PD-L1 -high state group (503 cases) and a PD-L1-low state group (504 cases). Survival analysis was carried out for patients in the high and low state group with and without radiotherapyrespectively. Results The univariate analysis showed that the overall survival rate was improved in patients with PD-L1high status compared with patients with PD-L1-low status. The difference was statistically significant(P=0.047). InPD-L1-high status group, univariate analysis and multivariate analysis showed no significant difference in the overall survival rate between patients with radiotherapy and without radiotherapy, and the P values were 0.352 and 0.242 respectively. However, the overall survival rate of radiotherapy patients with PD-L1-low status group was significantly improved （HR0.550, 95%CI:0.335～0.904, P=0.017）, and there was still statistical significance after multivariate factors adjustment （HR0.415, 95%CI:0.194～0.872, P=0.025）. Chi-square analysis showed that PD-L1 status was associated with ER status (χ2=18.44，P<0.001), HER2 status （χ2=7.943，P=0.047） and molecular typing (χ2=14.52，P=0.006), but not with age, histological type, surgical treatment, postoperative tissue margin status and PR status. Conclusion The PD-L1 status was associated with the radiosensitivity of breast cancer. The overall survival rate of postoperative radiotherapy in patients with PD-L1⁃low expression was significantly improved.It is speculated that PD-L1 may be a radiosensitivity gene for breast cancer.

OBJECTIVETo examine the effect of icariin (ICA) on the cognitive impairment induced by traumatic brain injury (TBI) in mice and the underlying mechanisms related to changes in hippocampal acetylation level.

METHODSThe modifified free-fall method was used to establish the TBI mouse model. Mice with post-TBI cognitive impairment were randomly divided into 3 groups using the randomised block method (n=7): TBI (vehicle-treated), low-dose (75 mg/kg) and high-dose (150 mg/kg) of ICA groups. An additional sham-operated group (vehicle-treated) was employed. The vehicle or ICA was administrated by gavage for 28 consecutive days. The Morris water maze (MWM) test was conducted. Acetylcholine (ACh) content, mRNA and protein levels of choline acetyltransferase (ChAT), and protein levels of acetylated H3 (Ac-H3) and Ac-H4 were detected in the hippocampus.

RESULTSCompared with the sham-operated group, the MWM performance, hippocampal ACh content, mRNA and protein levels of ChAT, and protein levels of Ac-H3 and Ac-H4 were signifificantly decreased in the TBI group (P<0.05). High-dose of ICA signifificantly ameliorated the TBI-induced weak MWM performance, increased hippocampal ACh content, and mRNA and protein levels of ChAT, as well as Ac-H3 protein level compared with the TBI group (P<0.05).

CONCLUSIONICA improved post-TBI cognitive impairment in mice by enhancing hippocampal acetylation, which improved hippocampal cholinergic function and ultimately improved cognition.

Acetylation ; Acetylcholine ; metabolism ; Animals ; Brain Injuries, Traumatic ; complications ; Choline O-Acetyltransferase ; genetics ; metabolism ; Cognitive Dysfunction ; drug therapy ; etiology ; Flavonoids ; chemistry ; pharmacology ; therapeutic use ; Hippocampus ; pathology ; Histones ; metabolism ; Homeostasis ; drug effects ; Male ; Maze Learning ; drug effects ; Mice ; RNA, Messenger ; genetics ; metabolism

Objectives: To analyze the variations of demography, risk factors and triggering factors in acute myocardial infarction (AMI) patients in Beijing area over recent 40 years from 1970s to 2010s. Methods: Our research included in 2 groups: 1970s group, 1314 patients from Beijing collaborative group of coronary artery disease prevention and treatment from 1972-01 to 1973-12; 2010s group, 2200 patients from China AMI registry in Beijing area from 2013-01-01 to 2014-09-30. Demographic characteristics including gender, age, farmer proportion, risk factors and triggering factors for AMI occurrence were compared between 2 groups. Results: Compared with 1970s group, 2010s group had more patients>70 years of age (15.8% vs 25.6%, P<0.001), more with male gender (68.3% vs 75.6%, P<0.001) and the higher farmer proportion (6.5% vs 14.5%, P<0.001); 2010s group showed more patients with previous histories of stroke (6.2% vs 10.5%), MI (9.5% vs 11.9%) and diabetes mellitus (DM) (6.2% vs 27.6%), all P<0.05; 2010s group presented that less patients were triggered by mental stress (51.1% vs 15.2%, P<0.001), while more were induced by physical stress (40.0% vs 61.1%, P=0.007). Conclusions: There were significant changes in recent 40 years for AMI patients in terms of age, gender, farmer proportion, previous histories of stroke, MI and DM; it appeared as aging, androphany and ruralized trends. Physical stress and unhealthy lifestyle were the major triggering factors for AMI occurrence nowadays, more specific efforts should be conducted for heart disease prevention and education.

Adult ; Altitude ; Craniotomy ; methods ; Follow-Up Studies ; Humans ; Male ; Young Adult

OBJECTIVETo investigate clinical characteristics and predictive factors of refractory Mycoplasma pneumoniae pneumonia (RMPP) in children so as to recognize and treat the disease earlier.

METHODThe data including febrile time, inflammatory markers (WBC, neutrophil, CRP) and radiological features of 213 children hospitalized with Mycoplasma pneumoniae pneumonia (MPP) (72 with refractory MPP and 141 with mild MPP were retrospectively analyzed). The primary diagnostic criteria of refractory MPP: the patient's condition still deteriorates after treatment with macrolides for more than 5 days. The independent variables which had significant difference in univariate analysis was analyzed by multivariate logistic regression analysis. The predictive criteria of RMPP were further applied in 100 other patients prospectively. Kappa test was used to evaluate the accuracy rate.

RESULTRefractory MPP patients: febrile time was more than 10 days, white blood cell (WBC) count was (3.8 - 18.5)×10(9)/L in peripheral blood routine test, CRP was 38 mg/L - > 160 mg/L, large lobar consolidation with high density (> 2/3 pulmonary lobe, CT value 40 - 50 HU, without air bronchogram). Mild MPP patients: febrile time was less than 10 days, CRP was often less than 40 mg/L. Independent risk factors for RMPP were febrile time, CRP, large consolidation area with high density in lungs with or without pleural effusion (OR = 1.586, P = 0.017; OR = 4.344, P = 0.001; OR = 2.660, P = 0.012), CT value 40 - 50 HU which were demonstrated by logistic regression analysis. The specificity, sensitivity and Youden index for this diagnostic test were respectively 0.96, 0.94 and 0.90 at a CRP cut off of 40 mg/L. The sensitivity, specificity, and Kappa value for the above criteria to diagnose RMPP were respectively 0.96, 0.94 and 0.9.

CONCLUSIONThe predictive factors for RMPP are febrile time (> 10 days), CRP (> 40 mg/L), large lobar consolidation with high density (> 2/3 pulmonary lobe, CT value > 40 HU with or without pleural effusion) for the purpose of treating earlier.

Adolescent ; C-Reactive Protein ; analysis ; Child ; Child, Preschool ; Female ; Fever ; Humans ; Infant ; Leukocyte Count ; Lung ; diagnostic imaging ; pathology ; Male ; Pneumonia, Mycoplasma ; diagnosis ; pathology ; Predictive Value of Tests ; Retrospective Studies ; Sensitivity and Specificity ; Tomography, X-Ray Computed

Objective To investigate the impact of cytochrome P450 (CYP) 2C19 681G>A polymorphism on long-term prognosis of clopidogrel-treated Chinese patients after percutaneous coronary intervention (PCI).Methods Between January 1, 2009 and August 31,2009, 267 patients with coronary heart disease who received PCI and treated with clopidogrel for 12 months were enrolled. CYP2C19*2 was detected by MALDI-TOF MS and patients were grouped into CYP2C19*1/*1(n=130) and CYP2C19*2 carriers group (n=137). Follow-up was 12 months. The primary endpoint was angina recurrence, urgent coronary revascularization, acute myocardial infarction, stent thrombosis, death and the combined end points. Results Baseline data were similar between two groups (P>0.05).Urgent coronary revascularization and the combined end points occurred more frequently in CYP2C19*2 carriers than in CYP2C19*1/*1 patients (7.3% vs. 1.5% and 8.0% vs. 2.3% respectively,all P<0.05). But incidence of angina recurrence, acute myocardial infarction, stent thrombosis and death was similar between two groups (all P>0.05).Hazard risk of 1 year cumulative survival of CYP2C19*2 carriers group was significantly higher than CYP2C19*1/*1 group after PCI (HR=3.59, 95%CI: 1.02-12.87, P<0.05). Conclusion CYP2C19 681G>A polymorphism is a determinant of prognosis in coronary heart disease patients receiving chronic clopidogrel treatment after PCI.

Objective To compare the clinical characteristics and clinical outcomes in young (≤45 years) female and male coronary artery disease (CAD) patients undergoing percutaneous coronary intervention (PCI). Methods Angiographic and clinical data from 124 premenopausal female patients who underwent elective PCI from April 2004 to February 2008 were compared to age-matched 430 male patients who underwent elective PCI between 2006 and 2007 in our department. All patients were treated according to guidelines and coronary angiography was repeated after 6 months. One year clinical follow-up were performed in all patients. Results Incidences of dyslipidemia, the history of myocardial infarction and smoking were significantly lower in female patients than in male patients (all P < 0.01 ). Left main, left anterior descending and bifurcation lesions were more common while type C lesion and right coronary lesion were less common in young female CAD group compared to young male CAD group (P <0. 01 -0. 05). The average lesion length in female patients was significantly longer than that in male patients [ (20. 36±13.37)mm vs.( 23.04±13.86) mm, P < 0. 05 ]. The in-hospital and follow-up incidences of major adverse cardiac events,stent thrombosis and in-stent restenosis were similar between young female and male CAD patients.Conclusions CAD risk factors were less and vessel lesions were more likely to be found at left main, left anterior descending and bifurcation in young female CAD patients compared to young male CAD patients.The clinical outcomes were similar between young female and male CAD patients.

Objective To explore the correlation between plasma BNP level and left ventricular dysfunction parameters in patients with acute myocardial infarction (AMI). Methods Plasma BNP level was determined in 230 consecutive inpatients with AMI and 111 normal controls. Patients were grouped according Killip grades, LVEF and LVEDd, respectively. BNP was transformed into lnBNP for the normal distribution. The receiver operator characteristic curve (ROC curve) was drawn to determine the best threshold and criteria for diagnosing heart failure. Results After AMI, lnBNP levels increased significantly in proportion with increasing Killip grades (Ⅰ-Ⅲ), and decreasing LVEF(all P<0.05). lnBNP level was significantly higher in LVEDd 55 mm group than in the LVEDd < 55 mm group (P<0.01). lnBNP, LVEDd and LVEF all linearly correlated with Killip grades (P<0.05) and the best correlation was shown between lnBNP and Killip grades(r=0.53, P<0.05). lnBNP also positively correlated with LVEDd(r=0.17 ,P<0.05) and negatively correlated with LVEF(r=-0.41, P<0.01). Among the parameters, InBNP level presented the largest AUC in their ROC curves(P<0.01)for diagnosing decompensated heart failure and cardiogenic shock. The sensitivity, specifiticity and accuracy rates for diagnosing decompensated heart failure were 84.9%, 45.0% and 70.0% respectively by lnBNP at the cut point of 140 ng/L The sensitivity, negative predicting value and accuracy rate for diagnosing cardiac shock were 82.8% ,66.7% and 67.4% respectively by BNP at the cut point of 400 ng/L. Conclusion lnBNP level in hospitalized patients with AMI was positively correlated with Killip grades and LVEDd,negatively correlated with LVEF and could serve as a parameter for diagnosing the decompensated heart failure and excluding the cardiac shock.

OBJECTIVETo observe the serum B-type natriuretic peptide (BNP) changes post acute myocardial infarction (AMI).

METHODSThe serum BNP level was determined in 230 consecutive patients with AMI admitted to CCU and in 111 normal cases from October 2002 to October 2003 in Fuwai Hospital. The 230 AMI patients were further divided into various subgroups according to first or recurrent AMI, ST elevations myocardial infarction (STEMI) or non-ST elevations myocardial infarction (NSTEMI) group, infarction location, coronary arteries involved, infarction related arteries (IRA), TIMI blood flow of IRA and primary PCI or not. Serum BNP, CK-MB, TnT and heart function were analyzed.

RESULTSThe serum BNP level was significantly increased in patients with AMI (553.7 +/- 735.1) ng/L than that in normal subjects [(26.4 +/- 27.4) ng/L, P < 0.05]. LVEF was significantly lower, and LVEDd, BNP and LnBNP were all significantly higher in the first time AMI group compared to recurrent AMI group (all P < 0.001). The BNP level were significantly higher in AMI patients with single or triple coronary arteries stenosis than those without coronary stenosis (P < 0.05), in TIMI blood flow 0 - 1 and 2 groups than in TIMI 3 group (all P < 0.001). The CK-MB and TnT were significantly increased while BNP significantly decreased in the patients underwent primary PCI group compared with patients did not receive PCI therapy (all P < 0.05 - 0.001).

CONCLUSIONSerum BNP was significantly elevated in patients after AMI but decreased after successful primary PCI in patients with AMI.

Adult ; Aged ; Aged, 80 and over ; Angioplasty, Balloon, Coronary ; Female ; Humans ; Male ; Middle Aged ; Myocardial Infarction ; blood ; therapy ; Myocardium ; enzymology ; Natriuretic Peptide, Brain ; blood ; Troponin I ; blood ; Troponin T ; blood

Adult ; Aged ; Angioplasty, Balloon, Coronary ; Diabetes Complications ; etiology ; Female ; Humans ; Male ; Middle Aged ; Stents ; Treatment Outcome