Objective To investigate the clinical features, treatment strategies and outcomes of patients with Moyamoya disease and lenticulostriate artery (LSA) aneurysm rupture. Methods Patients with moyamoya disease and LSA aneurysm rupture admitted to Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medicine School from October 2012 to March 2015 were analyzed retrospectively. They were followed up for 1 year. The modified Rankin Scale (mRS) was used to evaluate the outcomes, and 0-2 was defined as good outcome. The demographic characteristics, image anatomical features, treatment schemes, and outcomes of the patients were summarized. The Pubmed database was used to retrieve other similar studies, which combined with this group of cases for analysis. Results A total of 10 patients were enrolled, 2 males and 8 females, aged 29-72 years, with an average of 43. 6 years. All cases were intracranial hemorrhage, including 3 cases of cerebral hemorrhage, 6 cases of ventricular hemorrhage, and 1 case of subarachnoid hemorrhage. At the time of admission, 7 patients had disturbance of consciousness, and 3 patients underwent emergency extraventricular drainage. Among them, 5 patients received endovascular embolization, 4 had good outcome, 1 had mild neurological deficit (mRS score 3); 2 received surgical treatment, all had good outcome; 3 received conservative treatment, all had re-bleeding, 2 died, and 1 had severe disability (mRS score 4). Fourteen eligible articles were included, and a total of 18 patients were included in the analysis: surgical treatment in 7 cases, endovascular treatment in 6 cases, and conservative treatment in 5 cases (self-healing in 1 case). According to the data of this group of patients and literature reports, the good outcome rate of the patients with early interventional embolization or craniotomy clipping treatment was significantly higher than that of conservative treatment (70. 6％vs. 22. 2％; P = 0. 038). Conclusion There is a certain risk of conservative treatment of Moyamoya disease complicated with LSA aneurysm rupture and requires active treatment. Interventional embolization of the parent artery or surgically clipping of aneurysm can effectively improve the clinical outcome of such patients. Interventional embolization of the parent artery and aneurysm can be selected simultaneously if the condition of the parent artery is allowed. Surgery can be selected when the condition of parent artery is poor and the aneurysm is located in the superficial part.

Immune checkpoints are inhibitory signaling pathways in the immune system that maintain balance with co-stimulatory molecules, maintain tolerance to their own tissues, and avoid autoimmune responses. The development of tumors is accompanied by the upregulation of co-suppressor molecules and related ligands, causing the decline or exhaustion of T cell functions, which makes tumor cells excape immune surveillance. The development of monoclonal antibodies against inhibitory receptors and ligands to regulate T cell activity and improve antitumor immune responses have achieved promising clininal results. Combined treatment of immunomodulatory signaling pathways also showed a certain of synergy. This article summarizes the evaluation of combined tumor immunotherapy strategies and synergies, and outlooks the feasibility of combined immunotherapy and the selection of immunization strategies.

Objective : To determine expression profile of VISTA on lymphocyte and the potential regulatory effects on immune response in a murine model of sepsis. Methods : Expression profile of VISTA on T lymphocytes in the spleen and peripheral blood was examined. Mice wereintravenously injected with an agonistic VISTA mAb(MH5A) or isotype control , and then the survival rate , cytokine expression , bacterial burden and lymphocyte apoptosiswere determined. Results : VISTA was substantially expressed on T cell from the spleen and peripheral blood , septic peritonitis did not induce significant changes in the expression profiles at 24h post surgery(P > 0. 05 in each comparison) . Treatment with MH5A improved the survival of septic mice(8/12 vs 2/12 , P = 0. 01) , accompanied by reduced lymphocyte apoptosis [(30 123 ± 6 400) vs (45 482 ± 8 652) , P = 0. 03] , decreased bacterial burden and lessened cytokines expression , such as TNF⁃α , IL⁃6 , IL⁃1β and IFN⁃γ(P < 0. 05 in each comparison) . Conclusion The present study identified VISTA as a novel immune checkpoint in the regulation of T cell apoptosis and inflammatory response during sepsis. VISTA agonism might offer a promising approach in the immunotherapy for sepsis.