Objective To analyze the mechanism of acute ischemic stroke in cancer patients. Methods The clinical TOAST type, laboratory examinations results, imaging examination results and pathology reports of the 96 patients with cancer and acute cerebral infarction were collected. Results According to TOAST mechanism, the main subtype was undetermined causes (41.67%, 40/96). Lung cancer took largest proportion (39.58%, 38/96). In the group of undetermined causes, adenocarcinoma was more common type than squamous. The imaging examination results could be classified into large artery type, large artery and small artery in same basin and multiple small arterys in different basins. We found the main type was multiple small arterys in different basins (52.50%, 21/40). The lever of D-dimer was high in our patients, especially in undetermined causes (P < 0.01). Conclusions Tumor-related acute cerebral infarction has its own uinque mechanism. Tumor is one kind of systemic diseases, which can promote thrombosis through increasing the lever of D-dimer. The cancer-related mechanism is the main mechanism underlying cancer- related stroke, and may become one of the most important mechanismsn in the pathogenesis of stroke in the near future.

Objective To study the characteristics of Chinese ischemic stroke subclassification (CISS) in relation with migration to different climatic zones in autumn and winter.Methods Ninety-six subjects who travelled from northeast China,northwest China and north China to Hainan Province from September 2012 to February 2017 and were admitted to our hospital due to cerebral infarction occurred within 3 weeks after they arrived at Hainan were included in this study.Their demographic data,risk factors for cerebrovascular disease,laboratory blood test and imaging parameters were recorded.The patients were classified according to their medical history,auxiliary examination findings and CISS.The recorded data were statistically analyzed.Results CISS showed that penetrating artery disease,large artery atherosclerosis,cardiogenic stroke,and undetermined etiology accounted for 50.0％,38.5％,4.2％,7.3％ respectively.Hypertension (70.8 ％) and abnormal glucose metabolism (61.5％) were the major risk factors for cerebral in farction.Conclusion The incidence of penetrating artery disease is the highest,followed by that of large artery atherosclerosis in cerebral infarction patients.Alert to cerebral infarction should thus be stressed for those with hypertension and abnormal glucose metabolism who are going to travel in autumn and winter.

Objective:To analyze the clinical characteristics of lung cancer associated acute ischemic stroke (LCA-AIS) and atrial fibrillation associated acute ischemic stroke (AFA-AIS).Methods:From January 1, 2014 to December 31, 2018, 46 patients diagnosed with LCA-AIS (LCA-AIS group)in Hainan Hospital of Chinese PLA General Hospital were selected, and 46 patients diagnosed with AFA-AIS (AFA-AIS group) were matched according to age and sex.The general situation, laboratory test results and imaging results of the two groups were analyzed.Results:(1) The neurological deficit symptoms in AFA-AIS group were more serious than those in LCA-AIS group; there was significant difference in National Institutes of Health Stroke Scale (NIHSS) score and the Modified Rankin Scale (mRs) score between the two groups ( P=0.001, P=0.003). (2)The D-D polymer concentration in LCA-AIS group was significantly higher than that in AFA-AIS group ( P<0.001), but the hemoglobin, erythrocyte count and hematocrit were significantly lower than those in AFA-AIS group (all P<0.001). (3)There was no significant difference in imaging classification and the number of infarct basins between LCA-AIS group and AFA-AIS group ( P>0.05). LCA-AIS patients was more likely to have poly-period acute ischemic lesions ( P=0.015), while AFA-AIS had significantly larger infarct diameter and more likely to be complicated with acute hemorrhagic stroke or bleeding ( P<0.001). Conclusions:The clinical characteristics of LCA-AIS and AFA-AIS are similar, so it is necessary to distinguish LCA-AIS from AFA-AIS in combination with neurological impairment, laboratory tests and imaging findings to avoid misdiagnosis.

BACKGROUND:Exosomes play a role in all stages of wound repair,and there is currently a large body of research on exosomes in skin wound repair,which has been shown to have great potential for clinical applications. OBJECTIVE:To summarize and discuss the main mechanisms and clinical applications of exosomes in the treatment of skin wounds,in order to promote the clinical translation of exosomes. METHODS:PubMed,clinicaltrials.gov,China National Knowledge Infrastructure,Food and Drug Administration database,and Chinese Clinical Trial Register were searched from inception to March 2023.The English search terms were"exosomes,wound healing,stem cells,chronic wound,immunoregulation,inflammation,skin,therapeutic use,isolation,characterization,infections".The Chinese search terms were"exosomes,wound healing,stem cells,immunomodulation,clinical applications".A total of 79 articles were included for the summary. RESULTS AND CONCLUSION:(1)Exosomes can improve and accelerate wound healing through inflammation regulation,immune protection,angiogenesis,cell proliferation and migration,and collagen remodeling.(2)Exosomes derived from stem cells have mature preparation techniques and related mechanism research,which is currently the mainstream research direction.Non-stem cell-derived exosomes have the advantages of convenience,economy,and easy production,and can be used as a supplement for clinical applications.(3)The clinical application of exosomes is still in its infancy,but has great potential for application.Various exosome modification techniques have laid the foundation for the future development of clinically personalized services and require further research.(4)The clinical translation of exosomes faces many challenges,such as low yield,high heterogeneity,lack of unified standards for isolation,purification,and quality control,and difficulties in storage.

Radiotherapy (RT) can potentially induce systemic immune responses by initiating immunogenic cell death (ICD) of tumor cells. However, RT-induced antitumor immunologic responses are sporadic and insufficient against cancer metastases. Herein, we construct multifunctional self-sufficient nanoparticles (MARS) with dual-enzyme activity (GOx and peroxidase-like) to trigger radical storms and activate the cascade-amplified systemic immune responses to suppress both local tumors and metastatic relapse. In addition to limiting the Warburg effect to actualize starvation therapy, MARS catalyzes glucose to produce hydrogen peroxide (H₂O₂), which is then used in the Cu⁺-mediated Fenton-like reaction and RT sensitization. RT and chemodynamic therapy produce reactive oxygen species in the form of radical storms, which have a robust ICD impact on mobilizing the immune system. Thus, when MARS is combined with RT, potent systemic antitumor immunity can be generated by activating antigen-presenting cells, promoting dendritic cells maturation, increasing the infiltration of cytotoxic T lymphocytes, and reprogramming the immunosuppressive tumor microenvironment. Furthermore, the synergistic therapy of RT and MARS effectively suppresses local tumor growth, increases mouse longevity, and results in a 90% reduction in lung metastasis and postoperative recurrence. Overall, we provide a viable approach to treating cancer by inducing radical storms and activating cascade-amplified systemic immunity.