From 1975 through 1990, 199 patients with limited small cell lung cancer (LSCLC) were subjected to multimodality treatment including surgical resection combined with chemotherapy or chemoradiotherapy in our department...From 1975 through 1990, 199 patients with limited small cell lung cancer (LSCLC) were subjected to multimodality treatment including surgical resection combined with chemotherapy or chemoradiotherapy in our department. The median postoperative survival time of the 199 patients was 39 months, and the 5-year survival rate was 26%, which was decreased with increase of tumor-stage. In comparison of the survival time of patients in Stage Ⅰ and those in Stage Ⅲa, there was a significant difference (P<0.01). There were no significant differences in survival rate of 3 and 5 years between the patients receiving chemotherapy prior to or after surgical resection. The improvement in survival was documented by surgical resection combined with chemotherapy or chemoradiotherapy for LSCLC. The effect of multimodality treatment is correlated with tumor P-TNM staging, the involvement of lymph node, especially that of the mediastinal lymph node, is a negative factor influencing the prognosis. Surgical resection as an initial management, followed by chemotherapy or chemoradiotherapy may be indicated in LSCLC patients of Stage Ⅰ, Stage Ⅱ and some Stage Ⅲa as the cancer can be resected completely.展开更多
Patients with locally advanced esophageal cancer have a dismal prognosis when treated exclu- sively by surgery. This fact prompted many investigators to apply neoadjuvant treatment strategies in an e?ort to improve su...Patients with locally advanced esophageal cancer have a dismal prognosis when treated exclu- sively by surgery. This fact prompted many investigators to apply neoadjuvant treatment strategies in an e?ort to improve survival. Results from phase III randomized trials are encouraging however, they revealed 五笔字型计算机汉字输入技术 that only patients with major histopathological response will bene?t from treatment. Therefore, predic- tive molecular markers indicating response or non-response to neoadjuvant treatment would be extremely helpful in selecting patients for current and future treatment protocols. In this paper we review the role of the molecular markers ERCC1 (excision repair cross-complementing 1 gene) and c-erbB-2 (synonym: HER2/neu) in predicting response to radiochemotherapy and outcome for patients with locally advanced resectable esophageal cancers (cT2-4, Nx, M0). The results are promising and it appears that we might expect to unequivocally identify with ERCC1 and c-erbB-2 respectively, approximately up to one third of patients who ful?l the criteria for neoadjuvant treatment for locally advanced esophageal cancer but will not bene?t from our treatment protocol. Integration of such markers in the clinical setting might prevent a substantial number of patients from expensive, non-e?ective and potentially harmful therapies, and could lead to a more individualized type of combined multimodality treatment in the near future.展开更多
BACKGROUND Phelan-McDermid syndrome(PMS)is a rare genetic disorder characterized by intellectual disability,delayed language development,autism spectrum disorders,motor tone abnormalities,and a high risk of psychiatri...BACKGROUND Phelan-McDermid syndrome(PMS)is a rare genetic disorder characterized by intellectual disability,delayed language development,autism spectrum disorders,motor tone abnormalities,and a high risk of psychiatric symptoms,including bipolar disorder.CASE SUMMARY This report presented an 18-year clinical history of a 36-year-old woman with PMS,marked by intellectual disabilities,social withdrawal,and stereotyped behaviors.Diagnosed with bipolar disorder at the age of 18 years old,she encountered significant treatment challenges,including severe adverse reactions to antipsychotic medications in 2022,which led to speech and functional regression.Through rehabilitation and comprehensive therapy,her condition gradually improved.In 2024,after further treatment,her symptoms stabilized,highlighting the complexities and successes of long-term management.CONCLUSION Effective management of PMS requires a thorough clinical history,genetic testing,and long-term supportive care.展开更多
BACKGROUND Hepatocellular carcinoma(HCC)is a leading cause of cancer-related mortality worldwide.Transarterial chemoembolization(TACE)combined with percutaneous radiofrequency ablation(RFA)has emerged as a promising t...BACKGROUND Hepatocellular carcinoma(HCC)is a leading cause of cancer-related mortality worldwide.Transarterial chemoembolization(TACE)combined with percutaneous radiofrequency ablation(RFA)has emerged as a promising treatment strategy for patients with unresectable HCC.AIM To evaluate the effectiveness and safety of TACE combined with RFA compared to TACE alone in the management of primary HCC.METHODS A comprehensive retrospective analysis was conducted at our institution from January 2020 to January 2024,involving 106 patients diagnosed with intermediate to advanced-stage HCC.Patients were divided into two groups:Those receiving TACE alone(n=56)and those undergoing combined TACE and RFA therapy(n=50).Treatment efficacy was assessed based on tumor response rates,serum alphafetoprotein(AFP)levels,and survival outcomes.Statistical analyses,includingχ^(2)tests and Kaplan-Meier survival analysis,were performed to compare the outcomes between the two groups.RESULTS The TACE+RFA group demonstrated significantly higher rates of complete response(15 vs 4,P<0.01)and partial response(23 vs 15,P=0.046)compared to the TACE group.Conversely,the TACE group exhibited higher rates of stable disease(25 vs 7,P<0.01)and progressive disease(12 vs 5,P<0.01).Serum AFP levels decreased over time in the TACE+RFA group,while they increased in the TACE group.Survival analysis revealed superior survival outcomes in the TACE+RFA group,with higher survival rates and a prolonged median survival time compared to the TACE group.CONCLUSION The combination of RFA with TACE could offer enhanced treatment response and prolonged survival in patients with primary HCC compared to TACE alone.These findings might support the adoption of multimodal therapeutic approaches,emphasizing the importance of personalized treatment strategies in the management of HCC.展开更多
This commentary evaluates the case report by Mohammed et al on conservative management of ischiofemoral impingement through a multimodal physical therapy program integrating in-person sessions,telerehabilitation,dry n...This commentary evaluates the case report by Mohammed et al on conservative management of ischiofemoral impingement through a multimodal physical therapy program integrating in-person sessions,telerehabilitation,dry needling,and kinesiology taping.The study demonstrated significant pain reduction and functional improvement,highlighting the feasibility of hybrid care models.However,limitations include short-term follow-up,lack of post-treatment imaging,and single-case design restricting generalizability.Future research should prioritize longitudinal studies,anatomical correlation via imaging,and randomized trials to validate efficacy across diverse populations.While the framework offers promising clinical utility,further investigation is critical to optimize protocols and elucidate biomechanical mechanisms underlying symptom resolution.展开更多
Spinal cord injury(SCI)is a serious traumatic disease of the central nervous system,which can give rise to the loss of motor and sensory function.Due to its complex pathological mechanism,the treatment of this disease...Spinal cord injury(SCI)is a serious traumatic disease of the central nervous system,which can give rise to the loss of motor and sensory function.Due to its complex pathological mechanism,the treatment of this disease still faces a huge challenge.Hydrogels with good biocompatibility and biodegradability can well imitate the extracellular matrix in the microenvironment of spinal cord.Hydrogels have been regarded as promising SCI repair material in recent years and continuous studies have confirmed that hydrogel-based therapy can effectively eliminate inflammation and promote spinal cord repair and regeneration to improve SCI.In this review,hydrogel-based multimodal therapeutic strategies to repair SCI are provided,and a combination of hydrogel scaffolds and other therapeutic modalities are discussed,with particular emphasis on the repair mechanism of SCI.展开更多
Photodynamic therapy(PDT) has been widely investigated for cancer therapy. The intracellular accumulation of reactive oxygen species(ROS)-damaged protein facilitates tumor cell apoptosis. However, there is growing evi...Photodynamic therapy(PDT) has been widely investigated for cancer therapy. The intracellular accumulation of reactive oxygen species(ROS)-damaged protein facilitates tumor cell apoptosis. However, there is growing evidence that the ubiquitin-proteasome pathway(UPP) significantly impedes PDT by preventing the enrichment of ROS-damaged proteins in tumor cells. To tackle this challenge, we report a facile dual-drug nanoassembly based on the discovery of an interesting co-assembly of bortezomib(BTZ, a proteasome inhibitor) and pyropheophorbide a(PPa) for proteasome inhibition-mediated PDT sensitization.The precisely engineered nanoassembly with the optimal dose ratio of BTZ and PPa demonstrates multiple advantages, including simple fabrication, high drug co-loading efficiency, flexible dose adjustment,good colloidal stability, long systemic circulation, favorable tumor-specific accumulation, as well as significant enrichment of ROS-damaged proteins in tumor cells. As a result, the cooperative nanoassembly exhibits potent synergistic antitumor activity in vivo. This study provides a novel dual-drug engineering modality for multimodal cancer treatment.展开更多
A desmoplastic small round cell tumor (DSRCT) is a rare, aggressive mesenchymal neoplasm. Although a DSRCT can develop at various sites, the intraabdominal site is the most common location. These tumors are found most...A desmoplastic small round cell tumor (DSRCT) is a rare, aggressive mesenchymal neoplasm. Although a DSRCT can develop at various sites, the intraabdominal site is the most common location. These tumors are found most commonly among young adolescents and the prognosis is extremely poor. Multimodal treatment with surgery, chemotherapy and radiotherapy is very important for these rare cases, and this treatment can improve patient survival. In this report, we describe the case of an 8-year-old boy diagnosed with DSRCT located in the retroperitoneal space. The patient has undergone surgical resection and adjuvant chemoradiation therapy, and is currently alive without disease recurrence.展开更多
To combine localized drug release with multimodal therapy for malignant tumor, a composite hydrogel as an integrative drug delivery system was facilely prepared. The system contains spinach extract （SE）, reduced gra...To combine localized drug release with multimodal therapy for malignant tumor, a composite hydrogel as an integrative drug delivery system was facilely prepared. The system contains spinach extract （SE）, reduced graphene oxide （rGO） and gold nanocages （AuNCs）. SE conduces to the formation of hydrogel, and also serves as a green material for improving the biocompatibility of hydrogel, and a natural pho- tosensitizer for killing tumor cells under laser radiation （fi60 nm）. AuNts show obvious photothermy and can enhance the generation of cytotoxic singlet oxygen （102）. The composite hydrogel shell on tumor cells exhibits several competitive advantages including enhanced antitumor effect by retaining the high con- centration of drugs around cancer cell, excellent PDT/FFr compatibility as well as high loading and controllable release of fluorouracil （5-FU） for synergetic multimodal treatment. The survival rate of HeLa cells incubated with 5-FU loaded hydrogel under NIR radiation for 10 min sharply decreases to 1.2%, in- dicating remarkably improved antitumor effects. These results demonstrate that the hydrogel is an excellent delivery carrier for localizable, NIR-responsive and combined PTT/PDT/Chemo synergetic antitumor.展开更多
BACKGROUND Laparoscopic duodenojejunostomy(LDJ) has become the standard surgical procedure for superior mesenteric artery syndrome due to its sufficient outcome in terms of safety and symptom relief. However, there ar...BACKGROUND Laparoscopic duodenojejunostomy(LDJ) has become the standard surgical procedure for superior mesenteric artery syndrome due to its sufficient outcome in terms of safety and symptom relief. However, there are only a few reports about LDJ for malignant stenosis and its indication remains uncertain.CASE SUMMARY A 77-year-old woman with a history of pancreatic cancer(PC) treated with distal pancreatectomy with en bloc resection of the transverse colon 7 mo ago was admitted for recurrent vomiting. Imaging upon admission revealed marked distention of the duodenum and a tumor around the duodenojejunal flexure. She was diagnosed with malignant stenosis caused by local recurrence of PC. LDJ was performed with an uneventful postoperative course, followed by chemotherapy which gave her 10 mo overall survival.CONCLUSION We think that LDJ is a valuable method for unresectable malignant stenosis around the duodenojejunal flexure as a part of multimodal therapy.展开更多
Gold nanoparticles have recently been exploited as versatile nanocarriers in diagnostic and therapeutic drug delivery for cancer nanomedicine, owing to their biocompatibility, low biotoxicity, surface modifiability an...Gold nanoparticles have recently been exploited as versatile nanocarriers in diagnostic and therapeutic drug delivery for cancer nanomedicine, owing to their biocompatibility, low biotoxicity, surface modifiability and plasma optical properties. A variety of gold nanoparticles have emerged for drug delivery, mainly including gold nanorods, gold nanocages, gold nanostars, gold solid nanospheres and hollow gold nanospheres (HGNs). Among these, HGNs have widely been studied for their higher photothermal conversion efficiency, wider spectral absorption range and stronger surface-enhanced Raman scattering compared with solid gold nanospheres. Therefore, nowadays, researchers prefer to use HGNs to other metal nanocarriers, which can not only play the role of controlled-release drugs but also act as photothermal agents for tumor therapy and diagnosis, due to their properties of surface modification. Combined with the Au–S bond on the surface of HGNs, the targeted preparation is loaded to achieve precise drug delivery. With the assistance of the photothermal characteristics of HGNs themselves, the efficacy of loaded drugs in HGNs is enhanced. In addition, HGNs also have vital values in the field of bioimaging, which serve as photothermal imaging agents and Raman scattering-guided preparations due to their surface-enhanced Raman scattering properties to assist researchers in achieving the purpose of tumor diagnosis. In this review, we summarize the synthesis methods of HGNs and the recent application of HGNs-based nanomaterials in the field of cancer diagnosis and therapy. In addition, the issues to be addressed were pointed out for a bright prospect of HGNs-based nanomaterials.展开更多
To meet the high requirements of biomedical applications in antimicrobial agents, it is crucial to explore efficient nanoantimicrobialagents with no resistance and good biocompatibility for treating infected wounds. I...To meet the high requirements of biomedical applications in antimicrobial agents, it is crucial to explore efficient nanoantimicrobialagents with no resistance and good biocompatibility for treating infected wounds. In this study, compositenano-antibiotic TPA-Py@AuNCs⊂BSA nanoparticles (TAB NPs) are prepared using hollow mesoporous Au nanocages (AuNCs)loaded with a photosensitizer (namely TPA-Py) with D-π-A structure showing aggregation-induced emission properties. WhenTPA-Py is encapsulated in the cavity of AuNCs, its fluorescence is suppressed. In the presence of photothermal induction, TPA-Pycan be released from the AuNCs, allowing for the restoration of fluorescence illumination and the specific imaging of Grampositivebacteria. TAB NPs demonstrate outstanding antimicrobial activity against a variety of bacteria, and this multimodalantimicrobial property does not lead to the development of bacterial resistance. In vitro experiments show that TAB NPs couldeliminate bacteria and ablate bacterial biofilm. In vivo experiments show that the synergistic antimicrobial effect of TAB NPs has asignificant positive impact on the treatment of infectedwounds, including rapid antibacterial action, promotion of M2 macrophagepolarization, and enhancement of chronic wound healing. This study provides an effective strategy for developing wide-spectrumnano-antibiotics for the ablation of bacterial biofilms and the treatment of infected wounds.展开更多
BACKGROUND Intrahepatic cholangiocarcinoma(ICC)is a highly malignant tumour.Hepatectomy is an effective treatment for early ICC,but postoperative recurrence greatly affects patient survival.Studies on recurrent ICC af...BACKGROUND Intrahepatic cholangiocarcinoma(ICC)is a highly malignant tumour.Hepatectomy is an effective treatment for early ICC,but postoperative recurrence greatly affects patient survival.Studies on recurrent ICC after hepatectomy are lacking.AIM To investigate the clinical characteristics of patients with recurrent ICC after hepatectomy,analyse prognostic factors and explore diagnosis and treatment strategies.METHODS A retrospective analysis was performed on all ICC patients undergoing hepatectomy from January 2013 to August 2021.Patients with postoperative recurrence were selected according to the inclusion and exclusion criteria.Cumulative overall survival was plotted by the Kaplan-Meier method,and differences were assessed by univariate survival analysis using the log-rank test.Multivariate analysis of cumulative survival was performed using the Cox proportional risk model.RESULTS During the 8-year study period,103 patients underwent ICC-related hepatectomy,and 54 exhibited postoperative recurrence.The median disease-free survival(DFS)was 6 mo,the median overall survival(OS)was 9 mo,and the cumulative OS rates at 1,2 and 3 years after the operation were 40.7%,14.8%and 7.4%,respectively.The median OS after recurrence was 4 mo,and the cumulative OS rates at 1,2 and 3 years after recurrence were 16.1%,6.7%and 3.4%,respectively.Multivariate analysis showed that alcohol consumption[hazard ratio(HR)=4.64,95%confidence interval(CI):1.53-14.04,P=0.007]and DFS<6 mo(HR=3.47,95%CI:1.59-7.60,P=0.002)were independent risk factors for the cumulative survival of patients with recurrence,while treatment after recurrence(HR=0.21,95%CI:0.08-0.55,P=0.001)was an independent protective factor.The median OS time of patients receiving multimodality therapy after recurrence of ICC was 7 mo,which was significantly higher than that of patients receiving only local therapy(3 mo),patients receiving systematic therapy(4 mo)and patients receiving the best supportive therapy(1 mo).Patients with recurrent ICC who received multimodality therapy had a significantly better long-term survival after recurrence than those who did not(P=0.026).CONCLUSION The prognosis of patients with recurrence after ICC-related hepatectomy is poor.Alcohol consumption and DFS<6 mo are independent risk factors in terms of the cumulative survival of patients with recurrence,while treatment after recurrence is an independent protective factor.Multimodality therapy can effectively improve the prognosis of patients.展开更多
Objective： Combined small cell lung cancer （C-SCLC） is an uncommon subgroup of small cell lung cancer （SCLC） and few clinical data can be referred. Our study is to investigate the clinical features and prognostic...Objective： Combined small cell lung cancer （C-SCLC） is an uncommon subgroup of small cell lung cancer （SCLC） and few clinical data can be referred. Our study is to investigate the clinical features and prognostic factors of C-SCLC, as well as the role of multimodality treatment.Methods： Between January 2004 and December 2012, patients with histologically diagnosed C-SCLC were retrospectively analyzed. The survivals were evaluated with the Kaplan-Meier method. Univariate and multivariate analyses were used to evaluate potential prognostic factors.Results： One hundred and fourteen patients were enrolled, with a median age of 59 （range： 20-79） years old. The most common combined component was squamous cell carcinoma （52.6%）. Among these patients, the disease was stage I, II, III and IV in 9.6%, 19.3%, 46.5% and 24.6% of the patients, respectively. Eighty patients （70.2%） received at least two of the three modalities containing chemotherapy, radiotherapy and surgery. The median follow-up was 32.5 months. The median time of overall survival （OS） was 26.2 months. On univariate analysis, smoking （P=0.029）, Karnofsky performance score （KPS） 〈80 （P=0.000）, advanced TNM stage （P=0.000）, no surgery （P=0.010）, positive resection margin （P=0.000）, positive lymph nodes ≥4 （P=0.000）, positive lymph node ratio 〉10% （P=0.000） and non-multimodality treatment （P=0.004） were associated with poor OS. Multivariate analysis confirmed that smoking, advanced TNM stage, positive resection margin and positive lymph nodes ratio 〉 10% were poor prognostic features. Conclusions： C-SCLC has a relatively early stage and good prognosis, which may due to the underestimated diagnosis in non-surgical patients. Multimodality therapy is recommended, especially for limited disease. Smoking, advanced TNM stage, positive resection margin and positive lymph nodes ratio 〉10% are poor prognostic factors.展开更多
Patients with esophageal cancer have a poor prognosis because they often have no symptoms until their disease is advanced. There are no screening recommendations for patients unless they have Barrett's esophagitis...Patients with esophageal cancer have a poor prognosis because they often have no symptoms until their disease is advanced. There are no screening recommendations for patients unless they have Barrett's esophagitis or a significant family history of this disease. Often, esophageal cancer is not diagnosed until patients present with dysphagia, odynophagia, anemia or weight loss. When symptoms occur, the stage is often stage Ⅲ or greater. Treatment of patients with very early stage disease is fairly straight forward using only local treatment with surgical resection or endoscopic mucosal resection. The treatment of patients who have locally advanced esophageal cancer is more complex and controversial. Despite multiple trials, treatment recommendations are still unclear due to conflicting data. Sadly, much of our data is difficult to interpret due to many of the trials done have included very heterogeneous groups of patients both histologically as well as anatomically. Additionally, studies have been underpowered or stopped early due to poor accrual. In the United States, concurrent chemoradiotherapy prior to surgical resection has been accepted by many as standard of care in the locally advanced patient. Patients who have metastatic disease are treated palliatively. The aim of this article is to describe the multidisciplinary approach used by an established team at a single high volume center for esophageal cancer, and to review the literature which guides our treatment recommendations.展开更多
Objective: Brain Metastasis (BM) from primary gynecologic cancers is a rare entity. The advances and successes in the treatment of primary gynecologic malignancies, have led to prolonged survival and, a higher inciden...Objective: Brain Metastasis (BM) from primary gynecologic cancers is a rare entity. The advances and successes in the treatment of primary gynecologic malignancies, have led to prolonged survival and, a higher incidence of BM. This study aims to report the experience at our institution in managing these patients, and provide possible data points that may be essential to note as prognostic factors, and see if our findings are consistent with the literature in this subject. We also aim to provide a brief literature review of patients with gynecologic cancers and BM. Methods: This is a small single institution retrospective study of 23 patients with a gynecologic malignancy and BM, identified between the years 2007-2015. Data were collected on variables including patient demographics, disease and treatment. Results: The median overall survival from the primary diagnosis was 28 months. Median time from diagnosis of BM to death was 9 months. Conclusion: The outcomes in our study are similar to what is stated in the current literature with regard to BM from gynecologic malignancies. Our literature search also revealed that the molecular analysis and treatment of the primary tumor remain important to prevent BMs. The tendency of tumors to metastasize varies for one tumor type to another for the same type of tumor. The tendency to develop BM may not only depend on risk factors such as stage, grade, and histology, but also on the genetic profile of the primary tumor. The study suggests that multimodal treatment of BM has better outcomes in managing BM from gynecologic cancers.展开更多
Objective:The objectives of this study were to evaluate the long-term results with multimodality therapy, and to clarify the clinicopathologic of features of patients surviving ≥ 3 years for unresectable hepatocellul...Objective:The objectives of this study were to evaluate the long-term results with multimodality therapy, and to clarify the clinicopathologic of features of patients surviving ≥ 3 years for unresectable hepatocellular carcinoma(HCC).Methods:Between 1999 and 2003, a total of 166 patients underwent multimodality therapy for unresectable HCC.All patients underwent multimodality therapy, such as transarterial chemoembolization(TACE), chemotherapy, local ablative therapy, and/ or Chinese traditional medicine.Thirty-nine(23.5%) patients survival ≥ 1 years, and 10(6.0%) patients survived ≥ 3 years.These 39 patients surviving over 1 year were investigated in this study.Eighteen clinical and biologic variables were assessed using univariate and multivariate analyses.Results:TNM staging and tumor extension were isolated by univariate analysis.Only tumor extension was independent risk factors by multiple regression analysis.Of these, 25.6%(10 of 39) survived over 3 years.These 10 patients surviving over 3 years were investigated further.By the end of June 2004, follow-up varied from 3 years and 2 months to 5 years and 1 month.Six patients were still alive with free of disease.Conclusion:Tumor extension was demonstrated to be prognostic of long-term survivors.Multimodality therapy may make a major contribution to achieving long-term survival in patients with unresectable HCC.展开更多
Background Despite its prevalence,there is ongoing debate regarding the optimal management strategy for chronic subdural hematoma(CSDH),reflecting the variability in clinical presentation and treatment outcomes.This a...Background Despite its prevalence,there is ongoing debate regarding the optimal management strategy for chronic subdural hematoma(CSDH),reflecting the variability in clinical presentation and treatment outcomes.This ambidirectional,nationwide,multicenter registry study aims to assess the efficacy and safety of multimodality treatment approaches for CSDH in the Chinese population.Methods/design A multicenter cohort of CSDH patients from 59 participating hospitals in China's Mainland was enrolled in this study.The treatment modalities encompassed a range of options and baseline demographics,clinical characteristics,radiographic findings,and surgical techniques were documented.Clinical outcomes,including hematoma resolution,recurrence rates,neurological status,and complications,were assessed at regular intervals during treatment,3 months,6 months,1 year,and 2 years follow-up.Result Between March 2022 and August 2023,a comprehensive cohort comprising 2173 individuals who met the criterion was assembled across 59 participating clinical sites.Of those patients,81.1%were male,exhibiting an average age of 70.12±14.53 years.A historical record of trauma was documented in 48.0%of cases,while headache constituted the predominant clinical presentation in 58.1%of patients.The foremost surgical modality employed was the burr hole(61.3%),with conservative management accounting for 25.6%of cases.Notably,a favorable clinical prognosis was observed in 88.9%of CSDH patients at 3 months,and the recurrence rate was found to be 2.4%.Conclusion This registry study provides critical insights into the multimodality treatment of CSDH in China,offering a foundation for advancing clinical practices,optimizing patient management,and ultimately,improving the quality of life for individuals suffering from this challenging neurosurgical condition.展开更多
In older patients with comorbidities,hip fractures are both an important and debilitating condition.Since multimodal and multidisciplinary perioperative strategies can hasten functional recovery after surgery improvin...In older patients with comorbidities,hip fractures are both an important and debilitating condition.Since multimodal and multidisciplinary perioperative strategies can hasten functional recovery after surgery improving clinical outcomes,the choice of the most effective and safest pathway represents a great challenge.A key point of concern is the anesthetic approach and above all the choice of the locoregional anesthesia combined with general or neuraxial anesthesia.展开更多
Recent innovations in nanomaterials inspire abundant novel tumor-targeting CRISPR-based gene therapies.However,the therapeutic efficiency of traditional targeted nanotherapeutic strategies is limited by that the bioma...Recent innovations in nanomaterials inspire abundant novel tumor-targeting CRISPR-based gene therapies.However,the therapeutic efficiency of traditional targeted nanotherapeutic strategies is limited by that the biomarkers vary in a spatiotemporal-dependent manner with tumor progression.Here,we propose a self-amplifying logic-gated gene editing strategy for gene/H_(2)O_(2)-mediated/starvation multimodal cancer therapy.In this approach,a hypoxia-degradable covalent-organic framework(COF) is synthesized to coat a-ZIF-8 in which glucose oxidase(GOx) and CRISPR system are packaged.To intensify intracellular redox dyshomeostasis,DNAzymes which can cleave catalase mRNA are loaded as well.When the nano system gets into the tumor,the weakly acidic and hypoxic microenvironment degrades the ZIF-8@COF to activate GOx,which amplifies intracellular H^(+)and hypoxia,accelerating the nanocarrier degradation to guarantee available CRISPR plasmid and GOx release in target cells.These tandem reactions deplete glucose and oxygen,leading to logic-gated-triggered gene editing as well as synergistic gene/H_(2)O_(2)-mediated/starvation therapy.Overall,this approach highlights the biocomputing-based CRISPR delivery and underscores the great potential of precise cancer therapy.展开更多
文摘From 1975 through 1990, 199 patients with limited small cell lung cancer (LSCLC) were subjected to multimodality treatment including surgical resection combined with chemotherapy or chemoradiotherapy in our department. The median postoperative survival time of the 199 patients was 39 months, and the 5-year survival rate was 26%, which was decreased with increase of tumor-stage. In comparison of the survival time of patients in Stage Ⅰ and those in Stage Ⅲa, there was a significant difference (P<0.01). There were no significant differences in survival rate of 3 and 5 years between the patients receiving chemotherapy prior to or after surgical resection. The improvement in survival was documented by surgical resection combined with chemotherapy or chemoradiotherapy for LSCLC. The effect of multimodality treatment is correlated with tumor P-TNM staging, the involvement of lymph node, especially that of the mediastinal lymph node, is a negative factor influencing the prognosis. Surgical resection as an initial management, followed by chemotherapy or chemoradiotherapy may be indicated in LSCLC patients of Stage Ⅰ, Stage Ⅱ and some Stage Ⅲa as the cancer can be resected completely.
文摘Patients with locally advanced esophageal cancer have a dismal prognosis when treated exclu- sively by surgery. This fact prompted many investigators to apply neoadjuvant treatment strategies in an e?ort to improve survival. Results from phase III randomized trials are encouraging however, they revealed 五笔字型计算机汉字输入技术 that only patients with major histopathological response will bene?t from treatment. Therefore, predic- tive molecular markers indicating response or non-response to neoadjuvant treatment would be extremely helpful in selecting patients for current and future treatment protocols. In this paper we review the role of the molecular markers ERCC1 (excision repair cross-complementing 1 gene) and c-erbB-2 (synonym: HER2/neu) in predicting response to radiochemotherapy and outcome for patients with locally advanced resectable esophageal cancers (cT2-4, Nx, M0). The results are promising and it appears that we might expect to unequivocally identify with ERCC1 and c-erbB-2 respectively, approximately up to one third of patients who ful?l the criteria for neoadjuvant treatment for locally advanced esophageal cancer but will not bene?t from our treatment protocol. Integration of such markers in the clinical setting might prevent a substantial number of patients from expensive, non-e?ective and potentially harmful therapies, and could lead to a more individualized type of combined multimodality treatment in the near future.
基金Supported by the Zhejiang Province Medicine and Health Science and Technology Program,No.2023KY980Hangzhou Municipal Health and Family Planning Commission,No.A20220133.
文摘BACKGROUND Phelan-McDermid syndrome(PMS)is a rare genetic disorder characterized by intellectual disability,delayed language development,autism spectrum disorders,motor tone abnormalities,and a high risk of psychiatric symptoms,including bipolar disorder.CASE SUMMARY This report presented an 18-year clinical history of a 36-year-old woman with PMS,marked by intellectual disabilities,social withdrawal,and stereotyped behaviors.Diagnosed with bipolar disorder at the age of 18 years old,she encountered significant treatment challenges,including severe adverse reactions to antipsychotic medications in 2022,which led to speech and functional regression.Through rehabilitation and comprehensive therapy,her condition gradually improved.In 2024,after further treatment,her symptoms stabilized,highlighting the complexities and successes of long-term management.CONCLUSION Effective management of PMS requires a thorough clinical history,genetic testing,and long-term supportive care.
文摘BACKGROUND Hepatocellular carcinoma(HCC)is a leading cause of cancer-related mortality worldwide.Transarterial chemoembolization(TACE)combined with percutaneous radiofrequency ablation(RFA)has emerged as a promising treatment strategy for patients with unresectable HCC.AIM To evaluate the effectiveness and safety of TACE combined with RFA compared to TACE alone in the management of primary HCC.METHODS A comprehensive retrospective analysis was conducted at our institution from January 2020 to January 2024,involving 106 patients diagnosed with intermediate to advanced-stage HCC.Patients were divided into two groups:Those receiving TACE alone(n=56)and those undergoing combined TACE and RFA therapy(n=50).Treatment efficacy was assessed based on tumor response rates,serum alphafetoprotein(AFP)levels,and survival outcomes.Statistical analyses,includingχ^(2)tests and Kaplan-Meier survival analysis,were performed to compare the outcomes between the two groups.RESULTS The TACE+RFA group demonstrated significantly higher rates of complete response(15 vs 4,P<0.01)and partial response(23 vs 15,P=0.046)compared to the TACE group.Conversely,the TACE group exhibited higher rates of stable disease(25 vs 7,P<0.01)and progressive disease(12 vs 5,P<0.01).Serum AFP levels decreased over time in the TACE+RFA group,while they increased in the TACE group.Survival analysis revealed superior survival outcomes in the TACE+RFA group,with higher survival rates and a prolonged median survival time compared to the TACE group.CONCLUSION The combination of RFA with TACE could offer enhanced treatment response and prolonged survival in patients with primary HCC compared to TACE alone.These findings might support the adoption of multimodal therapeutic approaches,emphasizing the importance of personalized treatment strategies in the management of HCC.
文摘This commentary evaluates the case report by Mohammed et al on conservative management of ischiofemoral impingement through a multimodal physical therapy program integrating in-person sessions,telerehabilitation,dry needling,and kinesiology taping.The study demonstrated significant pain reduction and functional improvement,highlighting the feasibility of hybrid care models.However,limitations include short-term follow-up,lack of post-treatment imaging,and single-case design restricting generalizability.Future research should prioritize longitudinal studies,anatomical correlation via imaging,and randomized trials to validate efficacy across diverse populations.While the framework offers promising clinical utility,further investigation is critical to optimize protocols and elucidate biomechanical mechanisms underlying symptom resolution.
文摘Spinal cord injury(SCI)is a serious traumatic disease of the central nervous system,which can give rise to the loss of motor and sensory function.Due to its complex pathological mechanism,the treatment of this disease still faces a huge challenge.Hydrogels with good biocompatibility and biodegradability can well imitate the extracellular matrix in the microenvironment of spinal cord.Hydrogels have been regarded as promising SCI repair material in recent years and continuous studies have confirmed that hydrogel-based therapy can effectively eliminate inflammation and promote spinal cord repair and regeneration to improve SCI.In this review,hydrogel-based multimodal therapeutic strategies to repair SCI are provided,and a combination of hydrogel scaffolds and other therapeutic modalities are discussed,with particular emphasis on the repair mechanism of SCI.
基金financially supported by the Liaoning Revitalization Talents Program (No. XLYC1907129)the Excellent Youth Science Foundation of Liaoning Province (No. 2020-YQ-06)the China Postdoctoral Science Foundation (No. 2020M670794)。
文摘Photodynamic therapy(PDT) has been widely investigated for cancer therapy. The intracellular accumulation of reactive oxygen species(ROS)-damaged protein facilitates tumor cell apoptosis. However, there is growing evidence that the ubiquitin-proteasome pathway(UPP) significantly impedes PDT by preventing the enrichment of ROS-damaged proteins in tumor cells. To tackle this challenge, we report a facile dual-drug nanoassembly based on the discovery of an interesting co-assembly of bortezomib(BTZ, a proteasome inhibitor) and pyropheophorbide a(PPa) for proteasome inhibition-mediated PDT sensitization.The precisely engineered nanoassembly with the optimal dose ratio of BTZ and PPa demonstrates multiple advantages, including simple fabrication, high drug co-loading efficiency, flexible dose adjustment,good colloidal stability, long systemic circulation, favorable tumor-specific accumulation, as well as significant enrichment of ROS-damaged proteins in tumor cells. As a result, the cooperative nanoassembly exhibits potent synergistic antitumor activity in vivo. This study provides a novel dual-drug engineering modality for multimodal cancer treatment.
文摘A desmoplastic small round cell tumor (DSRCT) is a rare, aggressive mesenchymal neoplasm. Although a DSRCT can develop at various sites, the intraabdominal site is the most common location. These tumors are found most commonly among young adolescents and the prognosis is extremely poor. Multimodal treatment with surgery, chemotherapy and radiotherapy is very important for these rare cases, and this treatment can improve patient survival. In this report, we describe the case of an 8-year-old boy diagnosed with DSRCT located in the retroperitoneal space. The patient has undergone surgical resection and adjuvant chemoradiation therapy, and is currently alive without disease recurrence.
基金supported by the National Natural Science Foundation of China (Nos. 21171001, 51372004, 21571002 and 21371003)the Anhui Province Key Laboratory of Environmentfriendly Polymer Materials+1 种基金the Anhui Provincial College Student Innovation Fund Project (No. 201510375048)Key Project of the Natural Science Foundation of the Provincial Education Department (No. KJ2016A679)
文摘To combine localized drug release with multimodal therapy for malignant tumor, a composite hydrogel as an integrative drug delivery system was facilely prepared. The system contains spinach extract （SE）, reduced graphene oxide （rGO） and gold nanocages （AuNCs）. SE conduces to the formation of hydrogel, and also serves as a green material for improving the biocompatibility of hydrogel, and a natural pho- tosensitizer for killing tumor cells under laser radiation （fi60 nm）. AuNts show obvious photothermy and can enhance the generation of cytotoxic singlet oxygen （102）. The composite hydrogel shell on tumor cells exhibits several competitive advantages including enhanced antitumor effect by retaining the high con- centration of drugs around cancer cell, excellent PDT/FFr compatibility as well as high loading and controllable release of fluorouracil （5-FU） for synergetic multimodal treatment. The survival rate of HeLa cells incubated with 5-FU loaded hydrogel under NIR radiation for 10 min sharply decreases to 1.2%, in- dicating remarkably improved antitumor effects. These results demonstrate that the hydrogel is an excellent delivery carrier for localizable, NIR-responsive and combined PTT/PDT/Chemo synergetic antitumor.
文摘BACKGROUND Laparoscopic duodenojejunostomy(LDJ) has become the standard surgical procedure for superior mesenteric artery syndrome due to its sufficient outcome in terms of safety and symptom relief. However, there are only a few reports about LDJ for malignant stenosis and its indication remains uncertain.CASE SUMMARY A 77-year-old woman with a history of pancreatic cancer(PC) treated with distal pancreatectomy with en bloc resection of the transverse colon 7 mo ago was admitted for recurrent vomiting. Imaging upon admission revealed marked distention of the duodenum and a tumor around the duodenojejunal flexure. She was diagnosed with malignant stenosis caused by local recurrence of PC. LDJ was performed with an uneventful postoperative course, followed by chemotherapy which gave her 10 mo overall survival.CONCLUSION We think that LDJ is a valuable method for unresectable malignant stenosis around the duodenojejunal flexure as a part of multimodal therapy.
基金Financial support from the Science and Technology Plan Project of Wuhan(2023020402010631)the Natural Science Foundation of Beijing(7222262)Opening Project of Key Laboratory of Biomedical Polymers of Ministry of Education at Wuhan University(20230401)was gratefully acknowledged.
文摘Gold nanoparticles have recently been exploited as versatile nanocarriers in diagnostic and therapeutic drug delivery for cancer nanomedicine, owing to their biocompatibility, low biotoxicity, surface modifiability and plasma optical properties. A variety of gold nanoparticles have emerged for drug delivery, mainly including gold nanorods, gold nanocages, gold nanostars, gold solid nanospheres and hollow gold nanospheres (HGNs). Among these, HGNs have widely been studied for their higher photothermal conversion efficiency, wider spectral absorption range and stronger surface-enhanced Raman scattering compared with solid gold nanospheres. Therefore, nowadays, researchers prefer to use HGNs to other metal nanocarriers, which can not only play the role of controlled-release drugs but also act as photothermal agents for tumor therapy and diagnosis, due to their properties of surface modification. Combined with the Au–S bond on the surface of HGNs, the targeted preparation is loaded to achieve precise drug delivery. With the assistance of the photothermal characteristics of HGNs themselves, the efficacy of loaded drugs in HGNs is enhanced. In addition, HGNs also have vital values in the field of bioimaging, which serve as photothermal imaging agents and Raman scattering-guided preparations due to their surface-enhanced Raman scattering properties to assist researchers in achieving the purpose of tumor diagnosis. In this review, we summarize the synthesis methods of HGNs and the recent application of HGNs-based nanomaterials in the field of cancer diagnosis and therapy. In addition, the issues to be addressed were pointed out for a bright prospect of HGNs-based nanomaterials.
基金The authors gratefully acknowledge the Research Foundation of Education Department of Shaanxi Province(23JK0282)fund of Rising Stars of Shaanxi Province(2021KJXX-48)+2 种基金the National Natural Science Foundation of China(52173152 and 21805002)the Scientific and Technological Innovation Team of Shaanxi Province(2022TD-36)the Natural Science Basic Research Program of Shaanxi Province(2024JC-YBQN-0107,2024JC-YBMS-114,and 2024JC-YBQN-0782).
文摘To meet the high requirements of biomedical applications in antimicrobial agents, it is crucial to explore efficient nanoantimicrobialagents with no resistance and good biocompatibility for treating infected wounds. In this study, compositenano-antibiotic TPA-Py@AuNCs⊂BSA nanoparticles (TAB NPs) are prepared using hollow mesoporous Au nanocages (AuNCs)loaded with a photosensitizer (namely TPA-Py) with D-π-A structure showing aggregation-induced emission properties. WhenTPA-Py is encapsulated in the cavity of AuNCs, its fluorescence is suppressed. In the presence of photothermal induction, TPA-Pycan be released from the AuNCs, allowing for the restoration of fluorescence illumination and the specific imaging of Grampositivebacteria. TAB NPs demonstrate outstanding antimicrobial activity against a variety of bacteria, and this multimodalantimicrobial property does not lead to the development of bacterial resistance. In vitro experiments show that TAB NPs couldeliminate bacteria and ablate bacterial biofilm. In vivo experiments show that the synergistic antimicrobial effect of TAB NPs has asignificant positive impact on the treatment of infectedwounds, including rapid antibacterial action, promotion of M2 macrophagepolarization, and enhancement of chronic wound healing. This study provides an effective strategy for developing wide-spectrumnano-antibiotics for the ablation of bacterial biofilms and the treatment of infected wounds.
基金Supported by Medical Science and Technology Project of Henan Province,No.SBGJ2018024。
文摘BACKGROUND Intrahepatic cholangiocarcinoma(ICC)is a highly malignant tumour.Hepatectomy is an effective treatment for early ICC,but postoperative recurrence greatly affects patient survival.Studies on recurrent ICC after hepatectomy are lacking.AIM To investigate the clinical characteristics of patients with recurrent ICC after hepatectomy,analyse prognostic factors and explore diagnosis and treatment strategies.METHODS A retrospective analysis was performed on all ICC patients undergoing hepatectomy from January 2013 to August 2021.Patients with postoperative recurrence were selected according to the inclusion and exclusion criteria.Cumulative overall survival was plotted by the Kaplan-Meier method,and differences were assessed by univariate survival analysis using the log-rank test.Multivariate analysis of cumulative survival was performed using the Cox proportional risk model.RESULTS During the 8-year study period,103 patients underwent ICC-related hepatectomy,and 54 exhibited postoperative recurrence.The median disease-free survival(DFS)was 6 mo,the median overall survival(OS)was 9 mo,and the cumulative OS rates at 1,2 and 3 years after the operation were 40.7%,14.8%and 7.4%,respectively.The median OS after recurrence was 4 mo,and the cumulative OS rates at 1,2 and 3 years after recurrence were 16.1%,6.7%and 3.4%,respectively.Multivariate analysis showed that alcohol consumption[hazard ratio(HR)=4.64,95%confidence interval(CI):1.53-14.04,P=0.007]and DFS<6 mo(HR=3.47,95%CI:1.59-7.60,P=0.002)were independent risk factors for the cumulative survival of patients with recurrence,while treatment after recurrence(HR=0.21,95%CI:0.08-0.55,P=0.001)was an independent protective factor.The median OS time of patients receiving multimodality therapy after recurrence of ICC was 7 mo,which was significantly higher than that of patients receiving only local therapy(3 mo),patients receiving systematic therapy(4 mo)and patients receiving the best supportive therapy(1 mo).Patients with recurrent ICC who received multimodality therapy had a significantly better long-term survival after recurrence than those who did not(P=0.026).CONCLUSION The prognosis of patients with recurrence after ICC-related hepatectomy is poor.Alcohol consumption and DFS<6 mo are independent risk factors in terms of the cumulative survival of patients with recurrence,while treatment after recurrence is an independent protective factor.Multimodality therapy can effectively improve the prognosis of patients.
基金supported by the Capital Health Development Research Grant for Youth Scholars (20114002-05)the Funding for Talents Training Project in Beijing (2012D009008000001)
文摘Objective： Combined small cell lung cancer （C-SCLC） is an uncommon subgroup of small cell lung cancer （SCLC） and few clinical data can be referred. Our study is to investigate the clinical features and prognostic factors of C-SCLC, as well as the role of multimodality treatment.Methods： Between January 2004 and December 2012, patients with histologically diagnosed C-SCLC were retrospectively analyzed. The survivals were evaluated with the Kaplan-Meier method. Univariate and multivariate analyses were used to evaluate potential prognostic factors.Results： One hundred and fourteen patients were enrolled, with a median age of 59 （range： 20-79） years old. The most common combined component was squamous cell carcinoma （52.6%）. Among these patients, the disease was stage I, II, III and IV in 9.6%, 19.3%, 46.5% and 24.6% of the patients, respectively. Eighty patients （70.2%） received at least two of the three modalities containing chemotherapy, radiotherapy and surgery. The median follow-up was 32.5 months. The median time of overall survival （OS） was 26.2 months. On univariate analysis, smoking （P=0.029）, Karnofsky performance score （KPS） 〈80 （P=0.000）, advanced TNM stage （P=0.000）, no surgery （P=0.010）, positive resection margin （P=0.000）, positive lymph nodes ≥4 （P=0.000）, positive lymph node ratio 〉10% （P=0.000） and non-multimodality treatment （P=0.004） were associated with poor OS. Multivariate analysis confirmed that smoking, advanced TNM stage, positive resection margin and positive lymph nodes ratio 〉 10% were poor prognostic features. Conclusions： C-SCLC has a relatively early stage and good prognosis, which may due to the underestimated diagnosis in non-surgical patients. Multimodality therapy is recommended, especially for limited disease. Smoking, advanced TNM stage, positive resection margin and positive lymph nodes ratio 〉10% are poor prognostic factors.
文摘Patients with esophageal cancer have a poor prognosis because they often have no symptoms until their disease is advanced. There are no screening recommendations for patients unless they have Barrett's esophagitis or a significant family history of this disease. Often, esophageal cancer is not diagnosed until patients present with dysphagia, odynophagia, anemia or weight loss. When symptoms occur, the stage is often stage Ⅲ or greater. Treatment of patients with very early stage disease is fairly straight forward using only local treatment with surgical resection or endoscopic mucosal resection. The treatment of patients who have locally advanced esophageal cancer is more complex and controversial. Despite multiple trials, treatment recommendations are still unclear due to conflicting data. Sadly, much of our data is difficult to interpret due to many of the trials done have included very heterogeneous groups of patients both histologically as well as anatomically. Additionally, studies have been underpowered or stopped early due to poor accrual. In the United States, concurrent chemoradiotherapy prior to surgical resection has been accepted by many as standard of care in the locally advanced patient. Patients who have metastatic disease are treated palliatively. The aim of this article is to describe the multidisciplinary approach used by an established team at a single high volume center for esophageal cancer, and to review the literature which guides our treatment recommendations.
文摘Objective: Brain Metastasis (BM) from primary gynecologic cancers is a rare entity. The advances and successes in the treatment of primary gynecologic malignancies, have led to prolonged survival and, a higher incidence of BM. This study aims to report the experience at our institution in managing these patients, and provide possible data points that may be essential to note as prognostic factors, and see if our findings are consistent with the literature in this subject. We also aim to provide a brief literature review of patients with gynecologic cancers and BM. Methods: This is a small single institution retrospective study of 23 patients with a gynecologic malignancy and BM, identified between the years 2007-2015. Data were collected on variables including patient demographics, disease and treatment. Results: The median overall survival from the primary diagnosis was 28 months. Median time from diagnosis of BM to death was 9 months. Conclusion: The outcomes in our study are similar to what is stated in the current literature with regard to BM from gynecologic malignancies. Our literature search also revealed that the molecular analysis and treatment of the primary tumor remain important to prevent BMs. The tendency of tumors to metastasize varies for one tumor type to another for the same type of tumor. The tendency to develop BM may not only depend on risk factors such as stage, grade, and histology, but also on the genetic profile of the primary tumor. The study suggests that multimodal treatment of BM has better outcomes in managing BM from gynecologic cancers.
文摘Objective:The objectives of this study were to evaluate the long-term results with multimodality therapy, and to clarify the clinicopathologic of features of patients surviving ≥ 3 years for unresectable hepatocellular carcinoma(HCC).Methods:Between 1999 and 2003, a total of 166 patients underwent multimodality therapy for unresectable HCC.All patients underwent multimodality therapy, such as transarterial chemoembolization(TACE), chemotherapy, local ablative therapy, and/ or Chinese traditional medicine.Thirty-nine(23.5%) patients survival ≥ 1 years, and 10(6.0%) patients survived ≥ 3 years.These 39 patients surviving over 1 year were investigated in this study.Eighteen clinical and biologic variables were assessed using univariate and multivariate analyses.Results:TNM staging and tumor extension were isolated by univariate analysis.Only tumor extension was independent risk factors by multiple regression analysis.Of these, 25.6%(10 of 39) survived over 3 years.These 10 patients surviving over 3 years were investigated further.By the end of June 2004, follow-up varied from 3 years and 2 months to 5 years and 1 month.Six patients were still alive with free of disease.Conclusion:Tumor extension was demonstrated to be prognostic of long-term survivors.Multimodality therapy may make a major contribution to achieving long-term survival in patients with unresectable HCC.
基金supported by grants from the National Natural Science Foundation of China(via Grant No.82071390 to R Jiang).
文摘Background Despite its prevalence,there is ongoing debate regarding the optimal management strategy for chronic subdural hematoma(CSDH),reflecting the variability in clinical presentation and treatment outcomes.This ambidirectional,nationwide,multicenter registry study aims to assess the efficacy and safety of multimodality treatment approaches for CSDH in the Chinese population.Methods/design A multicenter cohort of CSDH patients from 59 participating hospitals in China's Mainland was enrolled in this study.The treatment modalities encompassed a range of options and baseline demographics,clinical characteristics,radiographic findings,and surgical techniques were documented.Clinical outcomes,including hematoma resolution,recurrence rates,neurological status,and complications,were assessed at regular intervals during treatment,3 months,6 months,1 year,and 2 years follow-up.Result Between March 2022 and August 2023,a comprehensive cohort comprising 2173 individuals who met the criterion was assembled across 59 participating clinical sites.Of those patients,81.1%were male,exhibiting an average age of 70.12±14.53 years.A historical record of trauma was documented in 48.0%of cases,while headache constituted the predominant clinical presentation in 58.1%of patients.The foremost surgical modality employed was the burr hole(61.3%),with conservative management accounting for 25.6%of cases.Notably,a favorable clinical prognosis was observed in 88.9%of CSDH patients at 3 months,and the recurrence rate was found to be 2.4%.Conclusion This registry study provides critical insights into the multimodality treatment of CSDH in China,offering a foundation for advancing clinical practices,optimizing patient management,and ultimately,improving the quality of life for individuals suffering from this challenging neurosurgical condition.
文摘In older patients with comorbidities,hip fractures are both an important and debilitating condition.Since multimodal and multidisciplinary perioperative strategies can hasten functional recovery after surgery improving clinical outcomes,the choice of the most effective and safest pathway represents a great challenge.A key point of concern is the anesthetic approach and above all the choice of the locoregional anesthesia combined with general or neuraxial anesthesia.
基金financially supported by the National Natural Science Foundation of China(21874066,and 82073288)the National Key R&D Program of China(2019YFA0709200)+5 种基金the Key Research and Development Program of Jiangsu Province(BE2021373,China)Jiangsu Provincial Medical Key Discipline Cultivation Unit(JSDW202239,China)the Natural Science Foundation of Jiangsu Province(BK20200336,China)the Fundamental Research Funds for Central Universities(China)the Program for Innovative Talents and Entrepreneur in Jiangsu(China)Postgraduate Research&Practice Innovation Program of Jiangsu Province(KYCX23_0146,China).
文摘Recent innovations in nanomaterials inspire abundant novel tumor-targeting CRISPR-based gene therapies.However,the therapeutic efficiency of traditional targeted nanotherapeutic strategies is limited by that the biomarkers vary in a spatiotemporal-dependent manner with tumor progression.Here,we propose a self-amplifying logic-gated gene editing strategy for gene/H_(2)O_(2)-mediated/starvation multimodal cancer therapy.In this approach,a hypoxia-degradable covalent-organic framework(COF) is synthesized to coat a-ZIF-8 in which glucose oxidase(GOx) and CRISPR system are packaged.To intensify intracellular redox dyshomeostasis,DNAzymes which can cleave catalase mRNA are loaded as well.When the nano system gets into the tumor,the weakly acidic and hypoxic microenvironment degrades the ZIF-8@COF to activate GOx,which amplifies intracellular H^(+)and hypoxia,accelerating the nanocarrier degradation to guarantee available CRISPR plasmid and GOx release in target cells.These tandem reactions deplete glucose and oxygen,leading to logic-gated-triggered gene editing as well as synergistic gene/H_(2)O_(2)-mediated/starvation therapy.Overall,this approach highlights the biocomputing-based CRISPR delivery and underscores the great potential of precise cancer therapy.
