Safety and feasibility of ultra-early lumbar puncture in patients with aneurysmal subarachnoid hemorrhage

Objective:to evaluate the clinical efficacy and safety of ultra-early lumbar puncture drainage of cerebrospinal fluid(CSF)in patients with aneurysmal subarachnoid hemorrhage(SAH).Methods:patients(n=140)with aneurysmal SAH were randomly divided into observation group(n=70)and control group(n=70).After admission,CSF was drained by ultra-early lumbar puncture in the observation group and intermittent lumbar puncture after aneurysm operation in the control group.The incidences of early aneurysm rupture,acute hydrocephalus and delayed hydrocephalus were compared between the two groups.Results:there was no significant diflerence in the incidence of early-ruptured aneurysm and acute hydrocephalus between the two groups,but the incidence of delayed hydrocephalus in the observation group was significantly lower than that in the control group.Conclusion:ultra-early lumbar puncture drainage of CSF in anexirysmal SAH can effectively reduce the incidence of long-term delayed hydrocephalus and it is a safe and effective treatment.

Comparison of two surgical approaches for petroclinic lesions

Objective:to compare the methods of petrous apical bone removal and to explore the applicable scope of Kawase approach and retrosigmoid sinus-internal auditory canal approach.Methods:one group of cadaveric head specimens simulated Kawase approach to measure the data of“Kawase triangle”,the other group simulated retrosigmoid sinus-internal auditory canal approach to measure the safety range of the grinding bone window.Then we explored the clinical indications of the two surgical approaches.Result:the grinding depth of Kawase triangle was 11.6±0.14 mm,and the range of clival exposed after grinding Kawase triangle was 22.4±1.22 mm,which could effectively expose the ventrolateral brainstem,the midline of clivus and the area above the facial acoustic nerve.The diameter of the anterior and posterior of the grinding bone window in the retrosigmoid sinus-internal auditory canal approach was 21.95±2.23 mm.In front of the exposure area were the internal carotid artery,the cavernous sinus,and the upper trigeminal nerve;the lower part was the connection between the facial acoustic nerve and the abducent nerve.Conclusion:Kawase approach is suitable for lesions of ventrolateral brainstem,middle superior clivus,with or without invasion of middle cranial fossa;the retrosigmoid sinus-superior internal auditory canal approach is suitable for lesions mainly in cerebellopontine angle area and only slightly invading Meckel’s cavity.

Effect of improving prehospital hypotension and hypoxemia on the prognosis of patients with traumatic brain injury

Objective:to investigate the effect of improving prehospital hypotension and hypoxemia on the prognosis of different subgroups of patients with traumatic brain injury(TBI).Methods:medical staff were trained about the prehospital first aid for 2 months to fully master the methods of improving prehospital hypotension and hypoxemia,then the prognosis of TBI patients pre-and post-training for 12 months was collected and recorded.The prognostic differences of different TBI subgroups were discussed through data analysis.Results:after the training,the proportion of prehospital hypotension and hypoxemia in TBI patients decreased by 77%(8.5%vs.1.9%)and 63%(9.9%vs.3.6%,P<0.05),respectively.However,only the prognosis of moderate and severe TBI patients was improved,the proportion of patients with"good prognosis^increased by 14%(61.4%vs.70.5%,respectively)and 62%(35.6%vs.58%),and no significant effect showed in mild and critical TBI patients.Conclusion:reducing the incidence of prehospital hypoxemia and hypotension can improve the prognosis of moderate and severe TBI patients,while no significant effect on mild and critical TBI patients.

Bioengineering of nano metal-organic frameworks for cancer immunotherapy

Immunotherapy techniques,such as immune checkpoint inhibitors,chimeric antigen receptor(CAR)T cell therapies and cancer vaccines,have been burgeoning with great success,particularly for specific cancer types.However,side effects with fatal risks,dysfunction in tumor microenvironment and low immune response rates remain the bottlenecks in immunotherapy.Nano metal-organic frameworks(nMOFs),with an accurate structure and a narrow size distribution,are emerging as a solution to these problems.In addition to their function of temporospatial delivery,a large library of their compositions,together with flexibility in chemical interaction and inherent immune efficacy,offers opportunities for various designs of nMOFs for immunotherapy.In this review,we overview state-of-the-art research on nMOFs-based immunotherapies as well as their combination with other therapies.We demonstrate that nMOFs are predominantly customized for vaccine delivery or tumor-microenvironment modulation.Finally,a prospect of nMOFs in cancer immunotherapy will be discussed.

Nanosystem-mediated lactate modulation in the tumor micro environment for enhanced cancer therapy

Metabolic reprogramming allows tumor cells to prefer aerobic glycolysis as the main energy source,resulting in the massive accumulation of lactate in the tumor microenvironment(TME).It is found that lactate is no longer a waste product produced by glycolysis,but plays an important role in cancer progression.The modulation of lactate in the TME has become a promising target for cancer therapy.Although many small molecular inhibitors modulating the production or transport of lactate have appeared at present,their safety and efficacy have limited their further clinical application due to their non-specific targets and biodistribution.Studies have shown that nanomedicine has unique advantages,improving drug delivery efficiency and treatment efficacy while reducing damage to normal tissues,which greatly promotes the development of the research of nanosystems based on lactate modulation.In this review,we summarize the source and metabolism of lactate,the effect of lactate on the TME and recent advances in nanosystem-mediated strategies of lactate modulation for enhanced cancer therapy,hoping to provide ideas and directions for future research in related fields.

胰岛封装技术及其在胰岛移植中的应用

随着全球糖尿病患者人数逐年增长,临床上亟需一种行之有效的糖尿病治疗方案。胰岛移植可通过植入具有正常功能的胰岛以替代患者体内功能受损的胰岛,从而维持正常血糖水平,有望发展为理想的糖尿病治疗方法。然而,胰岛供体资源短缺,且移植后长期服用免疫抑制剂不仅产生诸多不良反应甚至会有致癌风险。以上瓶颈极大限制了胰岛移植的临床应用。采用天然高分子、合成高分子、无机化合物等生物材料对胰岛进行封装,营造免疫隔离微环境,避免宿主免疫细胞与植入胰岛直接接触,可有效抑制免疫排斥反应。免疫隔离的同时,胰岛的封装不影响胰岛素、葡萄糖、氧气等胰岛必需或输出关键分子的交换,同时确保移植胰岛的正常生理活性及精准控制血糖水平的能力。本文综述了胰岛封装的研究现状,常用材料及设计策略,并初步展望其应用前景。