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 retrieve and summarize the best evidence of peripherally inserted central catheters (PICC) related bloodstream infection prevention and to evaluate the evidence, so as to provide reference for clinical implementation of preventive measures for catheter-related bloodstream infection.Methods:National Institute for Health and Care Excellence (NICE) , National Guideline Clearinghouse (NGC) , Guidelines International Network (GIN) , Scottish Intercollegiate Guidelines Network (SIGN) , Australian Joanna Briggs Institute (JBI) Evidence-based Health Centre Database, UpToDate, BMJ Best Practice, Cochrane Library, China National Knowledge Infrastructure (CNKI) , Wanfang and related professional websites such as Infusion Nursing Society (INS) , Medlive and official website of the National Health Commission were searched for all clinical decisions, guidelines, expert consensus, evidence summary and systematic reviews related to the prevention of PICC catheter-related bloodstream infections. The retrieval time limit was from the establishment of the databases to May 2021. Four researchers evaluated the quality of the literature, and two researchers extracted and summarized the evidence.Results:A total of 9 articles were included, including 1 clinical decision, 1 standard of practice, 4 guidelines and 3 evidence summaries. Finally, 29 pieces of evidence were included from 5 dimensions, including organization management, infusion tool selection, catheterization maintenance and use, health education and extubation.Conclusions:The summary of the best evidence for the prevention of PICC related bloodstream infection covers a wide range of areas. Managers and clinical medical staff should apply the evidence according to the specific medical situation to reduce the occurrence of clinical PICC catheter-related bloodstream infection.

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.

Objective:To retrieve, evaluate, and summarize the best evidence for peripherally inserted central catheter (PICC) related thrombosis in children.Methods:Guideline websites, relevant society websites, and databases at China and abroad were searched for guidelines, evidence summaries, expert consensuses, and systematic reviews related to thrombosis before and after PICC catheterization in children published up to June 30, 2021 based on evidence-based nursing. The quality of the literature was independently evaluated by 2 researchers with reference to Appraisal of Guidelines for Research and Evaluation InstrumentⅡ and the criteria of the Joanna Briggs Institute (JBI) in Australia (2016) . Data were extracted from the literatures that met the standards through expert demonstration, and the evidence was graded and recommended according to the JBI evidence pre-grading system (2014 edition) .Results:A total of 11 articles were included, including 4 guidelines, 1 systematic review, 1 expert consensus, and 5 evidence summaries. 27 pieces of evidence were summarized from 7 aspects: organizational management, catheter selection, blood vessel selection and puncture, location of catheter tip, physical prevention, drug prevention, and evaluation.Conclusions:This paper summarizes and analyzes the best evidence for PICC-related thrombosis in children and provides an evidence-based reference for the clinical application and practice of PICC-related thrombosis in children.

Objective:To retrieve and summarize the best evidence for nursing of hematopoietic stem cell reinfusion in children.Methods:Clinical decisions, guidelines, recommended practices, evidence summaries, systematic reviews, and expert consensuses on nursing of hematopoietic stem cell reinfusion in children were searched in Chinese and English databases as well as related websites such as British Medical Journal (BMJ) Best Practice, National Institute for Health and Clinical Excellence, National Guideline Clearinghouse, Guidelines International Network, Scottish Intercollegiate Guidelines Network, Joanna Briggs Institute Evidence-Based Health Care Center Database, UpToDate, CINAHL, Embase, PubMed, China National Knowledge Infrastructure, WanFang Data, and VIP. The search period was from database establishment to March 2023. Two researchers independently conducted literature quality evaluation, identified the included literature, extracted evidence item by item, and translated, organized and summarized the evidence.Results:A total of nine articles were included, including two clinical decisions, two expert consensuses, four guidelines, and one evidence summary. 24 pieces of evidence were summarized from six aspects, consisting of child preparation, stem cell preparation, item preparation, nursing during reinfusion, nursing after reinfusion, and evaluation and education.Conclusions:The best evidence for nursing of hematopoietic stem cell reinfusion in children involves a wide range of aspects. Managers, clinical medical and nursing staff should apply evidence based on specific medical situations in order to safely and reasonably perform hematopoietic stem cell reinfusion.

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.