The effects of irreversible electroporation triggering anti-tumor immunity and the value of its combination with immunotherapy

Recently,interventional ablation techniques have gained prominence in tumor treatment guidelines and complement traditional approaches,such as surgery,chemotherapy,and radiotherapy.Conventional ablation techniques,such as microwave,radiofrequency,and cryoablation,have been used;however,they have certain limitations,including the risk of damaging surrounding normal tissues and the heat sink effect caused by tumor blood flow.1 Irreversible electroporation(IRE),an ablation technology independent of thermal energy,is a promising alternative.2 Clinical studies have demonstrated IRE's efficacy in treating tumors,such as pancreatic and liver tumors.3 Recent research has shown that IRE can elicit specific anti-tumor immune responses in the body.5 IRE also plays a crucial role in eliminating residual tumor cells postoperatively and preventing tumor recurrence.

Shanghai expert consensus on totally implantable access ports 2019

Totally implantable access ports(TIAPs)are used for patients with poor peripheral vascular support requiring central venous access.In recent years,TIAPs have been gradually accepted and promoted by patients,doctors,and nurses owing to their advantages of convenient carrying,a long maintenance period,low complications,and a high quality of life for patients.Currently,medical personnel that handle TIAP implantation and management in China are from different areas of healthcare,including surgery,internal medicine,radiology,nurse anesthesia,vascular access,etc.,and many only handle TIAP as a part of their duties.Therefore,the operating procedures and steps for the diagnosis and treatment of complications of TIAP vary from person to person,resulting in different incidence and treatment methods for complications in the implantation and use of TIAP in different medical units.Based on this,we have updated the Shanghai expert consensus on TIAPs from 2015 and explored the diagnosis and treatment procedures of related complications while continuing to emphasize standardized implantation and maintenance.

Identification of two novel mutations in the GALNT3 gene in a Chinese family with hyperphosphatemic familial tumoral calcinosis

Hyperphosphatemic familial tumoral calcinosis(HFTC) is a rare, autosomal recessive genetic disease.This disease is characterized by the progressive calcification of soft tissues leading to symptoms of pressure and hyperphosphatemia but normal concentrations of serum calcium with or without an elevation of1,25-dihydroxyvitamin D3 levels.HFTC is caused by loss-of-function mutations in the GALNT3, FGF23 or KL genes. Here, we identified two novel mutations in the GALNT3 gene in a Chinese family with HFTC.Identification of a novel genotype in HFTC provides clues for understanding the phenotype–genotype relationships in HFTC and may assist not only in the clinical diagnosis of HFTC but also in the interpretation of the genetic information used for prenatal diagnosis and genetic counseling.

Arterial stimulation with simultaneous venous sampling for localizing insulinomas

Purpose: The present study aimed to assess the accuracies of arterial stimulation with simultaneous venous sampling(ASVS) in preoperative localization of insulinomas. Materials and Methods: A cohort consisting of 6 males and 14 females(median age, 48.5y; range, 28–62y) with pathologically proven insulinomas were included in this study. Selective angiographies were performed with the superior mesenteric artery(SMA), gastroduodenal artery(GDA), proximal splenic artery, and midsplenic artery in all individuals. Then ASVS procedures were followed after angiographies for these arteries. Clinical characteristics of the patient and the tumor number, location, and size were recorded. The accuracy of preoperative localization of insulinomas was tested. Results: A total of 22 tumors were identified by histopathological diagnosis. The mean size of the tumor was 1.40±0.60 cm. Five tumors were in the head/neck region and 17 in the body/tail region. ASVS accurately localized 17/20(85%) cases with only biochemical data and 19/20(95%) cases with biochemical data and angiography images. Variant pancreatic arterial anatomy was revealed in 2 false cases with inferior pancreatic artery replaced by the superior mesenteric artery. Conclusion: ASVS was highly accurate in localizing insulinomas and should be performed in most of the patients with suspected insulinomas before the operation.

Irreversible electroporation treatment of pheochromocytoma at a complex site: A case report

A 24-year-old man was seen 2 years prior for hematuria,hypertension(165/120 mmHg),and palpitations.The plasma normetanephrine(NMN)level was elevated(9812.4 pg/mL).Computed tomography(CT)showed bilateral adrenal tumors(Fig.1).Of the two tumors on the left adrenal gland,the lesion on the head aspect was relatively large,while that on the feet aspect(arrow)was relatively small and adjacent to the left renal artery.There was one lesion on the right adrenal gland.Positron emission tomography(PET)-CT showed increased radioactive tracer uptake in the regions of the bilateral adrenal tumors(Fig.2).The clinical diagnosis was pheochromocytoma.

Balloon-occluded retrograde transvenous obliteration with lauromacrogol sclerosant foam for gastric varices

Objectives:To evaluate the safety and efficacy of balloon-occluded retrograde transvenous obliteration(BRTO)using lauromacrogol sclerosant foam for gastric varices(GVs)with gastrorenal venous shunts.Methods:Data of GV patients treated with BRTO using lauromacrogol sclerosant foam in 2016–2020 were retrospectively analyzed along with procedural success rate,complications,and follow-up efficacy.Results:A total of 31 patients were treated with BRTO.The sclerosant foam was prepared by mixing iodinated oil,lauromacrogol,and air at a 1:2:3 ratio.The BRTO procedure was successfully completed in 93.5%of patients.One patient was allergic to the lauromacrogol injection.A mild postoperative fever occurred in three patients.One patient experienced grand mal seizures after the procedure.There was no significant difference in the median Child-Turcotte-Pugh scores before versus after BRTO.Complete GV resolution was observed in 93.1%of patients.One patient underwent endoscopic treatment for the development of high-risk esophageal varices.Another patient underwent transjugular intrahepatic portosystemic shunt placement for the aggravation of ascites.Conclusions:Lauromacrogol sclerosant foam is safe and effective in patients undergoing BRTO for GV.

Bone marrow mesenchymal stem cells-derived exosomes for penetrating and targeted chemotherapy of pancreatic cancer

Pancreatic ductal adenocarcinoma(PDAC) is one of the most intractable malignancy, with an only 6% 5-year relative survival rate. The dismal therapeutic effect is attributed to the chemotherapy resistance and unique pathophysiology with abundant inflammatory cytokines and abnormal hyperplasia of extracellular matrix(ECM). Based on the theory that bone marrow mesenchymal stem cells(BM-MSCs) can influence the tumorous microenvironment and malignant growth of PDAC, we employed exosomes(Exos) derived from BM-MSCs as PDAC-homing vehicles to surpass the restrictions of pathological ECM and increase the accumulation of therapeutics in tumor site. To overcome chemoresistance of PDAC, paclitaxel(PTX) and gemcitabine monophosphate(GEMP)-an intermediate product of gemcitabine metabolismd-were loaded in/on the purified Exos. In this work, the Exo delivery platform showed superiorities in homing and penetrating abilities, which were performed on tumor spheroids and PDAC orthotopic models. Meanwhile, the favorable anti-tumor efficacy in vivo and in vitro, plus relatively mild systemic toxicity, was found. Loading GEMP and PTX, benefitting from the naturally PDAC selectivity, the Exo platform we constructed performs combined functions on excellent penetrating, anti-matrix and overcoming chemoresistance(Scheme 1). Worth expectantly, the Exo platform may provide a prospective approach for targeted therapies of PDAC.

Experimental investigation of a novel micro gas turbine with flexible switching function for distributed power system

Micro gas turbine(MGT)is widely used in small-scale distributed power systems because of its low emissions and fuel flexibility.However,the under-utilization of its exhaust heat and the low electric efficiency are the main bottlenecks that restrict its application.Additionally,the flexible switching between the power generated by the MGT and the power grid is also a key factor for keeping the secure operation of a distributed power station.Therefore,this paper conducted some experimental investigations of a 30 kW MGT to provide reference solutions for the above issues.This MGT is located at Shanghai Jiao Tong University(SJTU),which is designed by the Gas Turbine Research Institute of SJTU,and is manufactured by a turbo machinery factory in Chongqing,China.The demonstration prototype is mainly composed of a single stage centrifugal compressor,a radial turbine,a combustor,a high-speed pennanent magnet generator,and a control system.The results show that the MGT can achieve steady operation at a low rotational speed from 10000 r/min to 34000 r/min in the case of using oil lubricated bearings,which can greatly reduce the economic cost compared with the use of air bearings.At the same time,the ignition success rate of combustion chamber(CC)reaches 98%at a low rotational speed,and a wide range of stable combustion area can be obtained,because of the novel design method of combustor by referencing the way applied in an axial flow aero-engine.The MGT generating set can achieve functions,such as starting up,ignition,stable operation,loaded operation,grid-connection and stopping.This system also can realize flexibly switching from the start motor mode to the generator mode,and from grid-connected mode to off^grid mode,because the innovative multi-state switching control system is adopted.The above research work can make our state master independent intellectual property rights of micro gas turbine,rather than continue to be subject to the technological monopoly of the developed states,which can provide theoretical and experimental support for the industrialization of MGT in China.