Objective To assess the effect of altitude hypoxia on the elderly patients with coronary artery disease (CAD). Methods Three subject groups were surveyed during their train trip on the highest railroad--the Qinghai-Tibet Railway: 22 elderly individuals with documented CAD, 20 healthy elderly controls, and 20 healthy young controls, all of whom from Beijing near the sea level (76 m). Survey questions addressed clinical features of their healthy conditions and aspects of their coronary disease. The baseline study was performed at Xining at an altitude of 2261 m, and then during acute exposure to altitudes of 2808 m, 4768m, 5072 m and 4257 m by train for 24 hours. Resting pulse rate, blood pressure, oxygen saturation, electrocardiograph (ECG), and cardiac work estimated by the heart rate-blood pressure double product were obtained five times in each subject at different altitudes. Results On arrival to altitudes between 4768 m and 5072 m, the older passengers, especially those with preexisting coronary disease, had higher HR, higher BP, and lower SaO2, as well as more frequent abnormalities on ECG, as compared to the younger healthy subjects. As compared with the healthy elderly controls, incomplete right bundle branch block, left ventricular hypertrophy, and ST segment depression were more frequently seen in the elderly coronary patients (P<0.01). Cardiac work in group 1 was increased by 13% 12 hours after arrival to altitudes between 2808 m and 5072 m. Oxygen saturation decreased significantly with the altitude increasing by train ascent but improved after inhalation of oxygen. Most of the older subjects tolerated their sojourn at high altitude well except one who developed angina repeatedly with a significant ST segment depression. Conclusions Coronary events and ECG signs of myocardial ischemia are rare in elderly individuals with CAD who travel from sea level to moderate altitudes of 1500m to 2800 m. Patients with CAD who are well compensated at sea level generally tolerate this moderate altitude well. However, it would be prudent for patients with CAD going to altitude above 3000 m. The patients should consult their physician before undertaking a trip to such altitude.

Objective To compare the effect of three fixed methods in patients with lumbar catheters continuous drainage.Methods One hundred and twenty patients with lumbar catheters continuous drainage were chosen and divided into three groups according to the random number table, each with 40 cases.Three groups received the shoulder fixation, lumbar fixation and modified lumbar fixation, respectively.The incidence of complication after catheter, the skin injury in the fixed position and the patients’ satisfaction were compared in three groups.Results The cases of patients with pipe slip were respectively 5,4,0 in three groups, and the cases of patients with poor drainage were respectively 7,6,1, and the cases of patients with puncture point infection were respectively 8,8,2, and the cases of patients with cerebrospinal fluid leak were respectively 5,6, 0, the cases of patients with intracranial infection were respectively 7,9,1, and the differences were statistically significant in three groups (χ2 =5.05,5.01,4.71,6.21,7.13, respectively;P <0.05).The number of changing dressings were respectively (10 ±1.78),(10 ±2.28),(3 ±1.13) in three groups, and the difference was statistically significant (F=23.54,P<0.05).The cases of patients with pressure ulcers were respectively 7,5, 0 in three groups, and the cases of patients with satisfaction were respectively 20, 24, 33, and the differences were statistically significant in three groups (χ2 =7.20,9.64, respectively;P <0.05). Conclusions Application of the modified lumbar fixation can reduce the incidence of complication of lumbar catheters continuous drainage, and reduce the skin injury, and increase the patients’ satisfaction, and is worthy of clinical promotion.

Objective To investigate the effects of aluminum lactate exposure on learning and memory and the transportation of amyloid-beta peptides (Aβ) in cerebrospinal fluid in rats.Methods A total of 80 male Sprague-Dawley rats were randomly divided into solvent control (distilled water) group and low-,medium-,and high-dose aluminum poisoning groups (10,30,and 90 mg/kg aluminum lactate),with 20 rats in each group,and the poisoning procedure was performed by gavage for 2 months.The Morris water maze test was used to test the rats' learning and memory,Western blot was used to measure the expression level of low-density lipoprotein receptor protein-1 (LRP-1) in rats' choroid plexus,and enzyme-linked immunosorbent assay (ELISA) was used to measure the content of Aβ in the cerebrospinal fluid and plasma.Results The Morris water maze test showed that in the place navigation test,with the increasing training time,the escape latency was significantly shortened in each group and showed significant differences between any two groups (P＜0.05).In the spatial probe test,the time spent in target quadrant in the medium-and high-dose groups was 11.52±1.56 s and 10.43 ±5.27 s,respectively,which was significantly shorter than that in the control group and the low-dose group (15.81±3.01 s and 13.91±2.17 s)(P＜0.05).The numbers of platform crossings in the medium-and high-dose groups were 2.64± 1.39 and 1.50±0.76,respectively,which were significantly lower than those in the control group and the low-dose group (4.29±0.914 and 3.56±1.38)(P＜0.05).The results of ELISA showed that the medium-and high-dose groups had significant increases in the content of Aβ1-42 in cerebrospinal fluid (320.35±84.82 pg/ml and 327.68±67.51 pg/ml),which was significantlyhigher than that in the control group(203.46±74.36 pg/ml) (P＜0.05).The content of Aβ1-42 in plasma showed no significant difference between any two groups (P＞0.05),and that of Aβ1-40 in cerebrospinal fluid and plasma also showed no significant difference between any two groups (P＞0.05).The results of Western blot showed that the high-dose group had significantly lower protein expression of LRP-1 than the control group and the low-and medium-dose groups(0.57±0.21 vs 1.00±0.00/0.79±0.15/0.95±0.24,P＜0.05).Conclusion Subchronic aluminum exposure may reduce learning and memory in rats,and the accumulation of Aβ in cerebrospinal fluid may be related to the reduced protein expression of LRP-1 in the choroid plexus,suggesting that aluminum affects learning and memory in rats through reducing the protein expression of LRP-1,influencing the transportation of Aβ,and leading to the accumulation of Aβ.

Objective To investigate the impairment in primary cultured rat choroid plexus epithelial cells (CPECs) induced by aluminum.Methods The choroid plexus isolated from Sprague-Dawley rats 14 days old was cut into pieces and digested by trypsin in the sterile area.The obtained single cells were cultured in DMEM with 1％ epidermal growth factor and 20％ fetal calf serum.Five days later,immunohistochemistry with anti-transthyretin antibody was used to identify the purity of cultured cells.The well-grown cells were treated with aluminum lactate at different concentrations (0,100,400,and 1 600 μmol/L for control,low-dose,medium-dose,and high-dose groups).Forty-eight hours later,the cell viability,apoptotic rate,level of reactive oxygen species (ROS),and activity of superoxide dismutase (SOD) were measured in each group to evaluate the impairment in primary cultured rat CPECs by aluminum.Results More than 95％ of the cultured cells were identified as CPECs.The medium-and high-dose groups had significantly lower cell viability than the control group (86.74％±4.03％ vs 100％,P＜0.01;81.90％±9.17％ vs 100％,P＜0.01).The high-dose group had significantly lower cell viability than the low-dose group (81.90％±9.17％ vs 92.92％±8.81％,P＜0.01).The medium-and high-dose groups had significantly higher apoptotic rates than the control group (7.26％±0.99％ vs 1.29％±0.03％,P＜0.01;22.25％±1.55％ vs 1.29％±0.03％,P＜0.01) and the low-dose group (7.26％±0.99％ vs 1.68％±0.27％,P＜0.01;22.25％±1.55％ vs 1.68％±0.27％,P＜0.01).The high-dose group had a significantly higher apoptotic rate than the medium-dose group(22.25％±1.55％ vs 7.26％±0.99％,P＜0.01).The medium-and high-dose groups had significantly higher fluorescence intensity of ROS than the control group (22.23％±0.41％ vs 17.24％±0.09％,P＜0.05;25.10％±1.13％ vs 17.24％±0.09％,P＜0.05) and the low-dose group (22.23％± 0.41％ vs 18.31％±0.21％,P＜0.05;25.10％±1.13％ vs 18.31％±0.21％,P＜0.05).The high-dose group had significantly higher fluorescence intensity of ROS than the medium-dose group (25.10％±1.13％ vs 22.23％± 0.41％,P＜0.05).The low-,medium-and high-dose groups had significantly lower SOD activity than the control group[(28.65±0.74) U/g Hb vs (37.35±1.05) U/g Hb,P＜0.05;(22.75±1.94) U/g Hb vs (37.35±1.05) U/g Hb,P＜0.05;(13.29 ±0.64) U/g Hb vs (37.35 ± 1.05) U/g Hb,P＜0.05].The medium-and high-dose groups had significantly lower SOD activity than the low-dose group [(22.75±1.94) U/g Hb vs (28.65±0.74) U/g Hb,P＜ 0.05;(13.29±0.64) U/g Hb vs (28.65±0.74) U/g Hb,P＜0.05],while the high-dose group had had significantly lower SOD activity than the medium-dose group[(13.29±0.64) U/g Hb vs (22.75±1.94) U/g Hb,P＜0.05].There were no significant differences in cell viability,apoptotic rate,level of ROS,or activity of SOD between any other two groups (P＞0.05).Conclusion Aluminum lactate may induce impairment in primary cultured rat CPECs.It reduces the cell viability,elevates the apoptotic rate,and causes oxidative stress.

Objective:To evaluate the feasibility of PET automatic drug infusion system combined with power peripherally inserted central catheter (PICC) for 18F-FDG injection and PET/CT imaging. Methods:Fifty patients with malignant neoplasms who underwent 18F-FDG PET/CT imaging in Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine between December 2021 to July 2022 were prospectively enrolled. They were equally divided into power PICC group and peripheral venipuncture group. PET automatic drug infusion system was respectively connected with the pre-established channels of power PICC and peripheral venipuncture for 18F-FDG injection. Each patient underwent a routine PET/CT imaging at 1 h post-injection. The blood glucose, body weight, prescription dose and injection dose were recorded, and SUV max in the liver and cavoatrial junction were measured in both groups. The independent-sample t test was performed to compare the differences between 2 groups. The power PICC tip positions after 18F-FDG injection in power PICC group were observed. Results:The liver SUV max in the power PICC group and peripheral group were 2.54±0.50 and 2.57±0.31 ( t=0.37, P=0.716), and the SUV max of cavoatrial junction in the 2 groups were 1.68±0.25 and 1.63±0.22 ( t=-0.78, P=0.441), respectively. No significant differences were found in blood glucose, body weight, prescription dose and injection dose between the 2 groups ( t values: 0.00-0.13, all P>0.05). The ratios of injection dose to prescription dose in the 2 groups were 0.998 3±0.007 3 and 0.997 6±0.016 5, respectively, indicating high injection accuracy of the injection methods. No obvious drug residue was displayed at the end of catheter, resulting in good imaging quality. All the tip positions after injection were between T5 and T8, in line with the standardization management of power PICC. Conclusion:PET automatic drug infusion system combined with power PICC can be safely used for 18F-FDG injection and PET/CT imaging with less injection puncture.

Objective To investigate the effects of aluminum lactate exposure on learning and memory and the transportation of amyloid-beta peptides (Aβ) in cerebrospinal fluid in rats.Methods A total of 80 male Sprague-Dawley rats were randomly divided into solvent control (distilled water) group and low-,medium-,and high-dose aluminum poisoning groups (10,30,and 90 mg/kg aluminum lactate),with 20 rats in each group,and the poisoning procedure was performed by gavage for 2 months.The Morris water maze test was used to test the rats' learning and memory,Western blot was used to measure the expression level of low-density lipoprotein receptor protein-1 (LRP-1) in rats' choroid plexus,and enzyme-linked immunosorbent assay (ELISA) was used to measure the content of Aβ in the cerebrospinal fluid and plasma.Results The Morris water maze test showed that in the place navigation test,with the increasing training time,the escape latency was significantly shortened in each group and showed significant differences between any two groups (P＜0.05).In the spatial probe test,the time spent in target quadrant in the medium-and high-dose groups was 11.52±1.56 s and 10.43 ±5.27 s,respectively,which was significantly shorter than that in the control group and the low-dose group (15.81±3.01 s and 13.91±2.17 s)(P＜0.05).The numbers of platform crossings in the medium-and high-dose groups were 2.64± 1.39 and 1.50±0.76,respectively,which were significantly lower than those in the control group and the low-dose group (4.29±0.914 and 3.56±1.38)(P＜0.05).The results of ELISA showed that the medium-and high-dose groups had significant increases in the content of Aβ1-42 in cerebrospinal fluid (320.35±84.82 pg/ml and 327.68±67.51 pg/ml),which was significantlyhigher than that in the control group(203.46±74.36 pg/ml) (P＜0.05).The content of Aβ1-42 in plasma showed no significant difference between any two groups (P＞0.05),and that of Aβ1-40 in cerebrospinal fluid and plasma also showed no significant difference between any two groups (P＞0.05).The results of Western blot showed that the high-dose group had significantly lower protein expression of LRP-1 than the control group and the low-and medium-dose groups(0.57±0.21 vs 1.00±0.00/0.79±0.15/0.95±0.24,P＜0.05).Conclusion Subchronic aluminum exposure may reduce learning and memory in rats,and the accumulation of Aβ in cerebrospinal fluid may be related to the reduced protein expression of LRP-1 in the choroid plexus,suggesting that aluminum affects learning and memory in rats through reducing the protein expression of LRP-1,influencing the transportation of Aβ,and leading to the accumulation of Aβ.

Objective To investigate the impairment in primary cultured rat choroid plexus epithelial cells (CPECs) induced by aluminum.Methods The choroid plexus isolated from Sprague-Dawley rats 14 days old was cut into pieces and digested by trypsin in the sterile area.The obtained single cells were cultured in DMEM with 1％ epidermal growth factor and 20％ fetal calf serum.Five days later,immunohistochemistry with anti-transthyretin antibody was used to identify the purity of cultured cells.The well-grown cells were treated with aluminum lactate at different concentrations (0,100,400,and 1 600 μmol/L for control,low-dose,medium-dose,and high-dose groups).Forty-eight hours later,the cell viability,apoptotic rate,level of reactive oxygen species (ROS),and activity of superoxide dismutase (SOD) were measured in each group to evaluate the impairment in primary cultured rat CPECs by aluminum.Results More than 95％ of the cultured cells were identified as CPECs.The medium-and high-dose groups had significantly lower cell viability than the control group (86.74％±4.03％ vs 100％,P＜0.01;81.90％±9.17％ vs 100％,P＜0.01).The high-dose group had significantly lower cell viability than the low-dose group (81.90％±9.17％ vs 92.92％±8.81％,P＜0.01).The medium-and high-dose groups had significantly higher apoptotic rates than the control group (7.26％±0.99％ vs 1.29％±0.03％,P＜0.01;22.25％±1.55％ vs 1.29％±0.03％,P＜0.01) and the low-dose group (7.26％±0.99％ vs 1.68％±0.27％,P＜0.01;22.25％±1.55％ vs 1.68％±0.27％,P＜0.01).The high-dose group had a significantly higher apoptotic rate than the medium-dose group(22.25％±1.55％ vs 7.26％±0.99％,P＜0.01).The medium-and high-dose groups had significantly higher fluorescence intensity of ROS than the control group (22.23％±0.41％ vs 17.24％±0.09％,P＜0.05;25.10％±1.13％ vs 17.24％±0.09％,P＜0.05) and the low-dose group (22.23％± 0.41％ vs 18.31％±0.21％,P＜0.05;25.10％±1.13％ vs 18.31％±0.21％,P＜0.05).The high-dose group had significantly higher fluorescence intensity of ROS than the medium-dose group (25.10％±1.13％ vs 22.23％± 0.41％,P＜0.05).The low-,medium-and high-dose groups had significantly lower SOD activity than the control group[(28.65±0.74) U/g Hb vs (37.35±1.05) U/g Hb,P＜0.05;(22.75±1.94) U/g Hb vs (37.35±1.05) U/g Hb,P＜0.05;(13.29 ±0.64) U/g Hb vs (37.35 ± 1.05) U/g Hb,P＜0.05].The medium-and high-dose groups had significantly lower SOD activity than the low-dose group [(22.75±1.94) U/g Hb vs (28.65±0.74) U/g Hb,P＜ 0.05;(13.29±0.64) U/g Hb vs (28.65±0.74) U/g Hb,P＜0.05],while the high-dose group had had significantly lower SOD activity than the medium-dose group[(13.29±0.64) U/g Hb vs (22.75±1.94) U/g Hb,P＜0.05].There were no significant differences in cell viability,apoptotic rate,level of ROS,or activity of SOD between any other two groups (P＞0.05).Conclusion Aluminum lactate may induce impairment in primary cultured rat CPECs.It reduces the cell viability,elevates the apoptotic rate,and causes oxidative stress.

Cancer vaccines represent a promising immunotherapeutic treatment modality. The promotion of cross-presentation of extracellular tumor-associated antigens on the major histocompatibility complex (MHC) class I molecules and dendritic cell maturation at the appropriate time and place is crucial for cancer vaccines to prime cytolytic T cell response with reduced side effects. Current vaccination strategies, however, are not able to achieve the spatiotemporal control of antigen cross-presentation. Here, we report a liposomal vaccine loading the second near-infrared window (NIR-II, 1000-1700 nm) fluorophore BPBBT with an efficient photothermal conversion effect that offers an NIR-light-triggered endolysosomal escape under the imaging guidance. The NIR-II image-guided vaccination strategy specifically controls the cytosolic delivery of antigens for cross-presentation in the draining lymph nodes (DLNs). Moreover, the photothermally induced endolysosomal rupture initiates autophagy. We also find that the adjuvant simvastatin acts as an autophagy activator through inhibiting the PI3K/AKT/mTOR pathway. The light-induced autophagy in the DLNs together with simvastatin treatment cooperatively increase MHC class II expression by activating autophagy machinery for dendritic cell maturation. This study presents a paradigm of NIR-II image-guided light-triggered vaccination. The approach for remote control of antigen cross-presentation and autophagy represents a new strategy for vaccine development.