Recentyearshavewitnessedmuchprogressinbothbasicresearchandclinicaltrialsregar-ding cancer immunotherapy with chimeric antigen receptor (CAR)-engineered T cells.CAR combine the varia-ble regions of a specific monoclonal antibody (scFv)with the CD3ζendodomain.The extracellular domain of CAR-engineered T cells directly dock to the tumor-associated antigen (TAA).When T cells bind to target anti-gens,they mediated redirected cytotoxicity and secrete a series of cytokines such as Perforin,Granzyme,Inter-feron-γ(IFN-γ)and Tumor necrosis factor-α(TNF-α),which would eventually lead to the necrosis of tumor cells.Although the antitumor response of the CAR-engineered T cells is considered as successful and surpri-sing,it should be noted that some safety issues have been observed in other several basic researches and clinical trials.This overview focuses upon the utility and safety of the CAR-engineered T cells.

The phosphatidylinositide-3-kinase(PI3K)/ protein kinase B(Akt)/ mammalian target of rapamycin(mTOR)pathway is recognized to have an important role in the development and progression of colo-rectal cancer(CRC). The most extensively characterized downstream targets of mTORC1 are ribosomal protein S6 kinase 1(p70S6K1)and eukaryotic translation initiation factor(eIF)4E-binding protein 1(4EBP1),both of which are crucial to the regulation of protein synthesis. The abnormal expression of p70S6K1 and 4EBP1 in CRC has become the focus of attention.

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Objective To evaluate the efficacy of nalbuphine in preventing shivering after neuraxial anesthesia in patients undergoing cesarean section.Methods Eighty American Society of Anesthesiologists physical status Ⅰ or Ⅱ patients,aged 20-35 yr,weighing 55-80 kg,undergoing elective cesarean section under neuraxial anesthesia,were divided into nalbuphine group (group N,n=40) and control group (group C,n=40) using a random number table method.After delivery,nalbuphine 0.1 mg/kg was intravenously injected immediately before clamping the umbilical cord in group N,and the equal volume of normal saline was given instead in group C.Ramsay sedation score was recorded before giving nalbuphine,at 5 min after giving nalbuphine,and at the end of surgery.The development of shivering was recorded from the end of nalbuphine administration until the end of surgery,and the shivering intensity was estimated using Wrench grading.The development of over-sedation,nausea and vomiting,bradycardia,hypotension and dizziness was recorded from the end of nalbuphine administration until the end of surgery.Results Compared with group C,Ramsay sedation scores were significantly increased at 5 min after giving nalbuphine and at the end of surgery,the incidence of shivering was decreased,the shivering intensity was reduced (P＜0.05),and no significant change was found in the incidence of adverse reactions in group N (P＞ 0.05).Conclusion Nalbuphine can prevent the occurrence of shivering after neuraxial anesthesia in patients undergoing cesarean section.

Objective:To investigate the effect of arthroscopic superior capsular reconstruction (ASCR) of irreparable massive rotator cuff tears (RCTs) using the "Sandwich" patch graft (autologous fascia lata + LARS artificial ligament + autologous fascia lata).Methods:The patients with irreparable massive RCTs who underwent ASCR by using "Sandwich" patch graft were retrospectively evaluated between December 2016 and October 2018. All cases were followed up more than two years. The pain and function of the shoulder were evaluated by visual analogue scale (VAS), active forward elevation (aFE), American Shoulder & Elbow Surgeons score (ASES), University of California Los Angeles (UCLA) score, and Constant-Murley score. The acromiohumeral distance (AHD) and patch healing were assessed by shoulder X-ray and MRI scan.Results:Twenty-nine patients (12 males and 17 females) were enrolled for final analysis. The average age was 66.0±5.88 years (range 55-77 years). The average length of follow-up was 35.3±7.20 months (range 24-46 months). The tendon of the subscapularis muscle was intacted in 13 cases and repairable in 16 cases. All patients' teres minor muscles were intact and the function of deltoid muscles was all complete. Based on Hamada classification of massive RCTs, 11 cases with type 2, 14 cases with type 3, and 4 cases with type 4. At the last follow-up visit, the AFE of the surgical shoulder was 158.45°±23.87° (range 70°-180°), which was significantly higher than before the surgery 92.59°±45.99° (range 20°-160°, t=6.190, P<0.001). The ASES score was 92.92±9.08 (range 64-100), UCLA score was 31.62±3.93 (range 19-35), and Constant-Murley score was 85.8±8.44 (range 68-94), which were higher than those before the operation 30.69±12.99 (range 68-95), 10.93±3.43 (range 4-17), 39.62±12.68 (range 14-55). There were significant differences between them, respectively ( t=21.145, P<0.001; t=21.348, P<0.001; t=16.333, P<0.001). The VAS was 0.41±0.57 (range 0-2 points), which was significantly lower than that of 4.90±1.05 (range 3-7 points) before operation ( t=20.267, P<0.001). At the last follow-up visit, MRI showed that the AHD increased from 3.31±1.57 mm (range 1.1-6.6 mm) to 6.94±1.76 mm (range 3.0-10.8 mm) significantly ( t=12.195, P<0.001). Radiological outcomes were evaluated according to MRI, the total healing rate was 89.7% (26/29). There were two cases of complete tears, which including one case of infection and 1 partial tears. Conclusion:ASCR of irreparable massive RCTs using "Sandwich" patch graft showed the high healing rate in the short-term follow-up, which is possible to restore the shoulder functions early. It is an effective method for the treatment of irreparable massive RCTs.

Objective: To investigate the clinical outcomes of arthroscopic bridging reconstruction of irreparable massive rotator cuff tears using autogenous fascia lata. Methods: From July 2015 to July 2017, a total of 10 cases (4 male and 6 female) who were treated with arthroscopic bridging reconstruction for irreparable massive rotator cuff tears using autogenous fascia lata were retrospectively analyzed. The age before surgery was 61.3±2.9 years (range 57-67 years). There were 7 patients with right shoulders and 3 with left shoulders. The dominate sides were involved in 7 cases. The trauma history was documented in 2 shoulders. The duration of preoperative symptoms was 14.0±13.5 months (1-48 months). The case with revision surgery was not included. The patients were examined with magnetic resonance imaging (MRI) to evaluate the healing of fascia lata patch bridging in the joint at one week, six months, one year and two years after operation. The motion range of shoulder and the clinical scores, including visual analogue scale (VAS), University of California Los Angeles (UCLA) score, Constant-Murley score and American Shoulder & Elbow Surgeons (ASES) score, were measured before surgery and at follow-up duration. Results: All cases were reconstructed the horizontal couple. No perioperative complication was occurred and all surgery were completed safely and successfully. At the end of two years, the score of ASES was 92.2±3.5 (range 88.3-98.3), UCLA 31.6±2.0 (range 28-34), Constant-Murley 85.2±5.4 (range 78-93) with significant difference (t=11.254, P=0.000; t=12.111, P=0.000; t=8.948, P=0.00) comparing with that before surgery. The VAS pain score was 0.6±0.5 (range 0-1) which was significantly lower than that preoperatively (t=11.326, P=0.000). At 2 years after operation, MRI shows that fascia lata patches healed well in 9 patients. However, one case was with re-tear and patch absorption. The range of motion of shoulder was significantly improved in all patients but with different degrees of weakness (3-4). Conclusion Arthroscopic bridging reconstruction using autogenous fascia lata could effectively improve shoulder function in patients with irreparable massive rotator cuff tears. The autogenous fascia lata patch can heal with the help of rotator cuff tissue through bridging reconstruction.