Objective To investigate the clinical effect of rapamycin-eluting vertebral artery stent in the treatment of severe ostial vertebral artery stenosis(OV AS),and to analyze the incidence of postoperative in-stent restenosis(ISR).Methods A total of 96 patients with severe OVAS,who received stenting angioplasty at authors'hospital between November 2020 and May 2022,were retrospectively collected.The patients were divided into the observation group(n=48)and the control group(n=48).For the patients of the observation group implantation of rapamycin-eluting vertebral artery stent was carried out,while for the patients of the control group implantation of peripheral balloon dilatation bare metal stent(BMS)was performed.The perioperative basic data,the incidence of complications during follow-up period,and the postoperative incidence of ISR were compared between the two groups.Results Successful stent implantation was achieved in all patients of both groups.During perioperative period no complications such as transient ischemia attack(TIA),dropping-off or fracture of the stent,vertebral artery or stent-related stroke occurred.No statistically significant differences in the length and the diameter of the implanted stents,in the preoperative vertebral artery stenosis ratio,and in the postoperative residual stenosis ratio existed between the two groups(all P＞0.05).In both groups,the postoperative residual stenosis ratio was＜20％.The patients were followed up for a mean period of(12.33±5.82)months(range of 6-18 months),the incidence of postoperative vertebral artery or stent-related stroke in the observation group and the control group was 0％and 4.17％respectively,the difference between the two groups was not statistically significant(P＞0.05).The improvement of clinical symptoms such as dizziness,vertigo,etc.was observed in 47 patients of the observation group and in 45 patients of the control group,and no recurrent posterior circulation TIA or stent-related thrombotic event occurred.The incidence of postoperative restenosis in the observation group was 10.42％,which was significantly lower than 29.17％in the control group(P＜0.05).Conclusion Rapamycin-eluting vertebral artery stent can safely and effectively treat severe OVAS and reduce the incidence of postoperative ISR.(J Intervent Radiol,2024,33:275-279)

Traumatic supraorbital fissure syndrome (TSOFS) is a symptom complex caused by nerve entrapment in the supraorbital fissure after skull base trauma. If the compressed cranial nerve in the supraorbital fissure is not decompressed surgically, ptosis, diplopia and eye movement disorder may exist for a long time and seriously affect the patients′ quality of life. Since its overall incidence is not high, it is not familiarized with the majority of neurosurgeons and some TSOFS may be complicated with skull base vascular injury. If the supraorbital fissure surgery is performed without treatment of vascular injury, it may cause massive hemorrhage, and disability and even life-threatening in severe cases. At present, there is no consensus or guideline on the diagnosis and treatment of TSOFS that can be referred to both domestically and internationally. To improve the understanding of TSOFS among clinical physicians and establish standardized diagnosis and treatment plans, the Skull Base Trauma Group of the Neurorepair Professional Committee of the Chinese Medical Doctor Association, Neurotrauma Group of the Neurosurgery Branch of the Chinese Medical Association, Neurotrauma Group of the Traumatology Branch of the Chinese Medical Association, and Editorial Committee of Chinese Journal of Trauma organized relevant experts to formulate Chinese expert consensus on the diagnosis and treatment of traumatic supraorbital fissure syndrome ( version 2024) based on evidence of evidence-based medicine and clinical experience of diagnosis and treatment. This consensus puts forward 12 recommendations on the diagnosis, classification, treatment, efficacy evaluation and follow-up of TSOFS, aiming to provide references for neurosurgeons from hospitals of all levels to standardize the diagnosis and treatment of TSOFS.

Developing new therapeutic agents for cancer immunotherapy is highly demanding due to the low response ratio of PD-1/PD-L1 blockade in cancer patients. Here, we discovered that the novel immune checkpoint VISTA is highly expressed on a variety of tumor-infiltrating immune cells, especially myeloid derived suppressor cells (MDSCs) and CD8⁺ T cells. Then, peptide C1 with binding affinity to VISTA was developed by phage displayed bio-panning technique, and its mutant peptide VS3 was obtained by molecular docking based mutation. Peptide VS3 could bind VISTA with high affinity and block its interaction with ligand PSGL-1 under acidic condition, and elicit anti-tumor activity in vivo. The peptide DVS3-Pal was further designed by d-amino acid substitution and fatty acid modification, which exhibited strong proteolytic stability and significant anti-tumor activity through enhancing CD8⁺ T cell function and decreasing MDSCs infiltration. This is the first study to develop peptides to block VISTA/PSGL-1 interaction, which could act as promising candidates for cancer immunotherapy.

Abstract: Objective　To prepare a microparticle delivery system that regulates the release rate of extracellular vesicles (EVs), and to exert long-term enhancement of liver cell proliferation after only one intervention. Methods EVs was extracted by differential centrifugation. The structure of the EVs was observed by transmission electron microscopy and the membrane marker protein of EVs was detected by Western blotting. EVs-PLA microspheres with "core-shell" structure were prepared by emulsion-solvent evaporation method. Scanning and transmission electron microscopy were used to detect the morphology of EVs-PLA microspheres and EVs. The release test detected the release behavior of EVs in EVs-PLA microspheres. Scanning electron microscopy was used to detect the morphological changes of EVs-PLA microspheres at 8 weeks of release. EVs-PLA microspheres were co-cultured with hepatocytes, and Phalloidin/DAPI staining was used to observe the cell morphology and evaluate the cytotoxicity of the microspheres. CCK8-test was used to evaluate the cell proliferation activity. Western blot analysis was used to detect extracellular vesicles membrane marker protein expression. Results Comparing the ability of hepatocyte proliferation in the group treated with EVs-PLA microspheres and the control group, it was found that EVs-PLA microspheres did not cause cell apoptosis and mutation in cell structure, had biocompatibility and no cytotoxicity. The EVs-PLA microspheres with "core-shell" structure regulated the release behavior of EVs, which can continuously release EVs, exerting a continuous biological role in promoting hepatocyte proliferation after a single intervention. Conclusions The EVs-PLA microspheres can control-release EVs and promote hepatocyte proliferation continuously after a single intervention, providing a reference for further exploration of EVs-loaded delivery systems in promoting liver regeneration.

【Objective】 To investigate the recurrence of patients with renal cell carcinoma (RCC) after robot-assisted partial nephrectomy (RAPN), and to explore the related factors of recurrence. 【Methods】 Clinical data of 367 RCC patients who underwent RAPN during 2015 and 2020 in our hospital were retrospectively collected. Patients were divided into recurrence group and non-recurrence group. The related factors of recurrence and 5-year cumulative recurrence rate of RCC and clear cell renal cell carcinoma (ccRCC) in the recurrence group were analyzed. 【Results】 The median follow-up was 48 (IQR:38-60) months. Recurrence occurred in 9 patients, with a 5-year cumulative recurrence rate of 97.5%. For RCC patients, univariate analysis showed that tumor size, T-stage, R. E. N. A. L. score, R value, N value, and operation time were significantly associated with postoperative recurrence (P<0.05), while multivariate analysis showed that N value (HR=15.75, 95%CI:2.00-124.17, P=0.009) was an independent related factor. For ccRCC patients, univariate analysis showed that hypertension, tumor size, T-stage, R. E. N. A. L. score, N value, operation time and WHO/ISUP grade were significantly associated with postoperative recurrence (P<0.05), while multivariate analysis showed that WHO/ISUP grade (HR=4.99, 95%CI:1.04-24.01, P=0.045) was an independent related factor. 【Conclusion】 The 5-year cumulative recurrence rate of RCC patients after RAPN is 2.5%. N value and WHO/ISUP grade are the independent related factor of recurrence of RCC and ccRCC, respectively.

【Objective】 To explore the influencing factors of planned robot-assisted partial nephrectomy (RAPN) converted to radical nephrectomy (RN). 【Methods】 Clinical data and operation records of 488 patients planned for RAPN in our hospital during 2015 and 2020 were retrospectively collected. The patients were divided into converted and unconverted groups, and relevant clinical data of the two groups were compared. The causes and influencing factors for conversion were analyzed. 【Results】 Among the 488 patients, 14 (2.9%) converted to RN. The causes included: ①complicated tumor anatomy and surgical difficulties; ②local advanced renal tumor suspected during operation; ③severe intraoperative hemorrhage. Univariate analysis showed that R. E. N. A. L score (P<0.001), E value (P<0.001), N value (P<0.001), L value (P<0.001), renal hilum position (P<0.001) and T stage (P=0.002) were influencing factors of conversion. 【Conclusion】 Causes for the conversion of RAPN to RN include complicated tumor anatomy, suspected local advanced renal tumor and severe intraoperative hemorrhage. The R. E. N. A. L score, E value, N value, L value, renal hilum position and T stage are influencing factors.

【Objective】 To compare the feasibility, safety, and efficacy of robot-assisted and open radical nephrectomy for complex kidney neoplasm >8 cm in diameter. 【Methods】 Clinical data of 24 patients with large kidney neoplasm undergoing robot-assisted radical nephrectomy (9 cases, 37.5%) and open radical nephrectomy (15 cases, 62.5%) during Nov.2015 and Aug.2019 were retrospectively analyzed. The surgical parameters, perioperative complications and follow-up outcomes were compared between the two groups. 【Results】 All operations were successful. Compared with the robot group, the open group had a higher incidence of clinical symptoms (93.3% vs.44.4%, P=0.015) and larger maximum tumor diameter (124 mm vs.95 mm, P=0.021). There were no significant differences in other preoperative characteristics between the two groups. The robot group had less intraoperative blood loss (100 mL vs.800 mL, P=0.006) and lower blood transfusion rate (0% vs. 60.0%, P=0.007) than the open group. During the median follow-up of 50 (range: 25-67) months, 4 patients in the open group and 1 in the robot group developed new metastases, and 4 patients in the open group died due to advanced tumor stage. 【Conclusion】 Robot-assisted radical nephrectomy is safe in the treatment of complex and large renal tumors, and causes less intraoperative blood loss than open surgery.

Pulmonary blast injury has become the main type of trauma in modern warfare, characterized by externally mild injuries but internally severe injuries, rapid disease progression, and a high rate of early death. The injury is complicated in clinical practice, often with multiple and compound injuries. Currently, there is a lack of effective protective materials, accurate injury detection instrument and portable monitoring and transportation equipment, standardized clinical treatment guidelines in various medical centers, and evidence-based guidelines at home and abroad, resulting in a high mortality in clinlcal practice. Therefore, the Trauma Branch of Chinese Medical Association and the Editorial Committee of Chinese Journal of Trauma organized military and civilian experts in related fields such as thoracic surgery and traumatic surgery to jointly develop the Clinical treatment guideline for pulmonary blast injury ( version 2023) by combining evidence for effectiveness and clinical first-line treatment experience. This guideline provided 16 recommended opinions surrounding definition, characteristics, pre-hospital diagnosis and treatment, and in-hospital treatment of pulmonary blast injury, hoping to provide a basis for the clinical treatment in hospitals at different levels.

γ-aminobutyric acid can be produced by a one-step enzymatic reaction catalyzed by glutamic acid decarboxylase. The reaction system is simple and environmentally friendly. However, the majority of GAD enzymes catalyze the reaction under acidic pH at a relatively narrow range. Thus, inorganic salts are usually needed to maintain the optimal catalytic environment, which adds additional components to the reaction system. In addition, the pH of solution will gradually rise along with the production of γ-aminobutyric acid, which is not conducive for GAD to function continuously. In this study, we cloned the glutamate decarboxylase LpGAD from a Lactobacillus plantarum capable of efficiently producing γ-aminobutyric acid, and rationally engineered the catalytic pH range of LpGAD based on surface charge. A triple point mutant LpGAD^{S24R/D88R/Y309K} was obtained from different combinations of 9 point mutations. The enzyme activity at pH 6.0 was 1.68 times of that of the wild type, suggesting the catalytic pH range of the mutant was widened, and the possible mechanism underpinning this increase was discussed through kinetic simulation. Furthermore, we overexpressed the Lpgad and Lpgad^{S24R/D88R/Y309K} genes in Corynebacterium glutamicum E01 and optimized the transformation conditions. An optimized whole cell transformation process was conducted under 40 ℃, cell mass (OD₆₀₀) 20, 100 g/L l-glutamic acid substrate and 100 μmol/L pyridoxal 5-phosphate. The γ-aminobutyric acid titer of the recombinant strain reached 402.8 g/L in a fed-batch reaction carried out in a 5 L fermenter without adjusting pH, which was 1.63 times higher than that of the control. This study expanded the catalytic pH range of and increased the enzyme activity of LpGAD. The improved production efficiency of γ-aminobutyric acid may facilitate its large-scale production.
Glutamate Decarboxylase/genetics* ; Lactobacillus plantarum/genetics* ; Catalysis ; gamma-Aminobutyric Acid ; Hydrogen-Ion Concentration ; Glutamic Acid

During coronavirus disease 2019 epidemic, the treatment of severe trauma has been impacted. The Consensus on emergency surgery and infection prevention and control for severe trauma patients with 2019 novel corona virus pneumonia was published online on February 12, 2020, providing a strong guidance for the emergency treatment of severe trauma and the self-protection of medical staffs in the early stage of the epidemic. With the Joint Prevention and Control Mechanism of the State Council renaming "novel coronavirus pneumonia" to "novel coronavirus infection" and the infection being managed with measures against class B infectious diseases since January 8, 2023, the consensus published in 2020 is no longer applicable to the emergency treatment of severe trauma in the new stage of epidemic prevention and control. In this context, led by the Chinese Traumatology Association, Chinese Trauma Surgeon Association, Trauma Medicine Branch of Chinese International Exchange and Promotive Association for Medical and Health Care, and Editorial Board of Chinese Journal of Traumatology, the Chinese expert consensus on emergency surgery for severe trauma and infection prevention during coronavirus disease 2019 epidemic ( version 2023) is formulated to ensure the effectiveness and safety in the treatment of severe trauma in the new stage. Based on the policy of the Joint Prevention and Control Mechanism of the State Council and by using evidence-based medical evidence as well as Delphi expert consultation and voting, 16 recommendations are put forward from the four aspects of the related definitions, infection prevention, preoperative assessment and preparation, emergency operation and postoperative management, hoping to provide a reference for severe trauma care in the new stage of the epidemic prevention and control.