Single-cell analysis of phenotypic plasticity could improve the development of more effective therapeutics. Still, the development of tools to measure single-cell heterogeneity has lagged due to difficulties in manipulating and culturing single cells. Here, we describe a single-cell culture and phenotyping platform that employs a starburst microfluidic network and automatic liquid handling system to capture single cells for long-term culture and multi-dimensional analysis and quantify their clonal properties via their surface biomarker and secreted cytokine/growth factor profiles. Studies performed on this platform found that cells derived from single-cell cultures maintained phenotypic equilibria similar to their parental populations. Single-cell cultures exposed to chemotherapeutic drugs stochastically disrupted this balance to favor stem-like cells. They had enhanced expression of mRNAs and secreted factors associated with cell signaling, survival, and differentiation. This single-cell analysis approach can be extended to analyze more complex phenotypes and screen responses to therapeutic targets.

Objective To construct a perioperative blood pressure management plan for patients undergoing carotid artery stenting(CAS)and evaluate its application effectiveness,and to provide references for clinical practice.Methods The relevant literature on perioperative blood pressure management for CAS patients was retrieved from domestic and foreign databases,and a preliminary draft of a perioperative blood pressure management plan for CAS patients was constructed.The preliminary draft was discussed and modified through expert meetings,and 2 rounds of expert inquiries were conducted using the Delphi method from June 2023 to August 2023 to determine the final plan.32 patients who received CAS in the neurology department of a tertiary comprehensive hospital in Zhejiang Province were selected from May to July 2024 as an experimental group,and 33 patients who received CAS in the same ward from January to March 2024 as a control group.The experimental group applied the constructed CAS patient perioperative blood pressure management plan,while the control group applied routine perioperative nursing measures.The incidence of postoperative hypertension,postoperative hypotension,and postoperative adverse events was compared between 2 groups.Results A total of 13 experts completed 2 rounds of inquiries.The effective questionnaire response rate for the second round of inquiry was 100％,with an authority coefficient of 0.897.The coefficients of variation for the importance and feasibility scores of each item were 0～0.19 and 0～0.18,respectively,and the Kendall harmony coefficients were 0.224 and 0.201,respectively(P＜0.05).The final construction plan includes 3 primary indicators,15 secondary indicators,and 40 tertiary indicators.Ultimately,32 cases were included in the experimental group and 33 cases in the control group.The incidence of postoperative hypertension,postoperative hypotension,and adverse events in the experimental group was lower than that in the control group,and the difference was statistically significant(P＜0.05).Conclusion The perioperative blood pressure management plan for CAS patients constructed in this study has good scientificity and practicality,which can improve the stability of patients'perioperative blood pressure and reduce the occurrence of adverse events.

Objective To construct a perioperative blood pressure management plan for patients undergoing carotid artery stenting(CAS)and evaluate its application effectiveness,and to provide references for clinical practice.Methods The relevant literature on perioperative blood pressure management for CAS patients was retrieved from domestic and foreign databases,and a preliminary draft of a perioperative blood pressure management plan for CAS patients was constructed.The preliminary draft was discussed and modified through expert meetings,and 2 rounds of expert inquiries were conducted using the Delphi method from June 2023 to August 2023 to determine the final plan.32 patients who received CAS in the neurology department of a tertiary comprehensive hospital in Zhejiang Province were selected from May to July 2024 as an experimental group,and 33 patients who received CAS in the same ward from January to March 2024 as a control group.The experimental group applied the constructed CAS patient perioperative blood pressure management plan,while the control group applied routine perioperative nursing measures.The incidence of postoperative hypertension,postoperative hypotension,and postoperative adverse events was compared between 2 groups.Results A total of 13 experts completed 2 rounds of inquiries.The effective questionnaire response rate for the second round of inquiry was 100％,with an authority coefficient of 0.897.The coefficients of variation for the importance and feasibility scores of each item were 0～0.19 and 0～0.18,respectively,and the Kendall harmony coefficients were 0.224 and 0.201,respectively(P＜0.05).The final construction plan includes 3 primary indicators,15 secondary indicators,and 40 tertiary indicators.Ultimately,32 cases were included in the experimental group and 33 cases in the control group.The incidence of postoperative hypertension,postoperative hypotension,and adverse events in the experimental group was lower than that in the control group,and the difference was statistically significant(P＜0.05).Conclusion The perioperative blood pressure management plan for CAS patients constructed in this study has good scientificity and practicality,which can improve the stability of patients'perioperative blood pressure and reduce the occurrence of adverse events.

Stimulator of interferon genes (STING) is a cytosolic DNA sensor which is regarded as a potential target for antitumor immunotherapy. However, clinical trials of STING agonists display limited anti-tumor effects and dose-dependent side-effects like inflammatory damage and cell toxicity. Here, we showed that tetrahedral DNA nanostructures (TDNs) actively enter macrophages to promote STING activation and M1 polarization in a size-dependent manner, and synergized with Mn²⁺ to enhance the expressions of IFN-β and iNOS, as well as the co-stimulatory molecules for antigen presentation. Moreover, to reduce the cytotoxicity of Mn²⁺, we constructed a TDN-MnO₂ complex and found that it displayed a much higher efficacy than TDN plus Mn²⁺ to initiate macrophage activation and anti-tumor response both in vitro and in vivo. Together, our studies explored a novel immune activation effect of TDN in cancer therapy and its synergistic therapeutic outcomes with MnO₂. These findings provide new therapeutic opportunities for cancer therapy.

Objective:To explore whether NSBB is suitable for the primary prevention of liver cirrhosis accompanied by CSPH with no or small esophageal varices.Methods:Relevant literatures were retrieved from Cochrane library, PubMed, EMBASE, SinoMed, CNKI and Wanfang databases until December 12, 2020. All randomized controlled trials (RCTs) on NSBB use for primary prevention of cirrhosis accompanied by CSPH with no or small esophageal varices were collected. The literature was strictly screened according to the established inclusion and exclusion criteria, odds ratio (OR), and 95% confidence interval (CI) combined effect size. The development of esophageal varices and the initial upper gastrointestinal bleeding were the primary outcome measures. Death (with a maximum average follow-up of about five years) and adverse events (adverse drug reactions, etc.) were the secondary outcome measures.Results:A total of 9 RCTs with 1396 cases were included. Meta-analysis results showed that, compared with placebo, NSBB significantly reduced the incidence of liver cirrhosis accompanied by CSPH with no or small esophageal varices to large esophageal varices progression ( OR=0.51, 95% CI: 0.29-0.89, P=0.02), and mortality (with maximum average follow-up of about five years) ( OR=0.64, 95% CI: 0.44-0.92, P=0.02); however, there was no statistically significant difference in the initial upper gastrointestinal bleeding rate between the two groups ( OR=0.82, 95% CI: 0.44-1.52, P=0.53). Adverse event incidence was greater in the NSBB than the placebo group ( OR=1.74, 95% CI: 1.27-2.37, P=0.0005). Conclusions:NSBB use cannot reduce the initial upper gastrointestinal bleeding rate or adverse event incidence in patients with liver cirrhosis accompanied by CSPH with no or small esophageal varices, but it can delay the progression of gastroesophageal varices and reduce patient mortality.

Adoptive cell therapy (ACT) is an emerging powerful cancer immunotherapy, which includes a complex process of genetic modification, stimulation and expansion. During these

Objective:To investigate the clinical effect of lateral rectus abdominis approach combined with presacral decompression for surgical treatment of old Denis type II sacral fractures complicated with upper sacral plexus injury.Methods:A retrospective case series study was performed on the clinical data of 9 patients with old Denis type II sacral fractures complicated with upper sacral plexus injury (L 4-S 1) admitted to Zhongnan Hospital of Wuhan University from June 2010 to December 2016. There were 6 males and 3 females, aged (33.1±7.5)years (range, 15-58 years). Embolization of internal iliac artery and preimplantation of abdominal aortic balloon were performed 2 hours before operation under the guidance of digital subtraction angiography (DSA). Surgery was performed using a single lateral rectus abdominis approach combined with presacral decompression. The operation time, intraoperative blood loss and full weight-bearing time were recorded. The visual analogue scale (VAS) and European QOL Five Dimensional health scale (EQ-5D) were compared before and after operation. The Gibbons' impairment scale was used to assess neurological function. X-ray and CT scan were used to observe internal fixation and fracture healing. The complications during and after operation were recorded. Results:The patients were followed up for 24-52 months [(35.2±5.2)months]. The operation time was (2.9±0.6)hours. The intraoperative bleeding was (573±138)ml, and the full weight-bearing time was (11.6±1.2)weeks. X-ray and CT scan showed bone healing in all patients at the latest follow-up. The VAS and EQ-5D scale improved from preoperative (7.8±0.6)points and (0.34±0.07)points to the final follow-up of (0.8±0.3)points and (0.81±0.05)points ( P<0.05). According to Gibbons classification, 8 patients were grade I and 1 patient was grade II one year after operation ( P<0.01). Namely, the radiation pain of lower extremities was significantly improved in all patients, among which 8 patients showed pain disappeared and completely returned to normal and 1 patient showed residual numbness and hypoesthesia of the affected limbs. No major complications (eg, iatrogenic lumbosacral plexus injury, vital blood vessels or pelvic organs injury) occurred during the operation. During the follow-up period, only one patient developed traumatic hip arthritis and underwent total hip arthroplasty 6 months after operation. Fractures of the remaining patients were healed well without complications like infection, pressure ulcer or implant failure. Conclusions:For old Denis type II sacral fractures complicated with upper sacral plexus injury, lateral rectus abdominis approach combined with presacral decompression can fully decompress the upper sacral plexus nerve, relieve pain, and promote functional rehabilitation, with low incidence of complications. It is an alternative surgical method for the treatment of old Denis type II sacral fractures complicated with upper sacral plexus injury.

Objective To compare the lateral rectus abdominis approach versus posteromedian sacrum approach in the surgical treatment of unstable sacral fracture complicated with lumbosacral plexus injury.Methods From June 2010 to December 2014,33 unstable sacral fractures complicated with lumbosacral plexus injury were treated at Department of Orthopaedics,Spinal and Pelvic Surgery Center,Zhongnan Hospital.Of them,24 were fresh and 9 obsolete.The lateral rectus abdominis approach was adopted in 17 patients and the posteromedian sacrum approach in 16.All the patients received surgical treatment within 2 to 12 weeks (average,4.5 weeks) after injury.The 2 groups were compared in terms of operation time,bleeding volume,complications,weight-bearing time,visual analogue scale (VAS),European QOL Five Dimensional health scale (EQ-5D) and lumbosacral injury classification and severity scale (LSICS).Results The 2 groups were compatible due to their insignificant differences in baseline data (P ＞ 0.05).Their follow-up time ranged from 17 to 37 months (average,26.8 months).Perioperatively,infection and necrosis of the lumbosacral incision appeared in 2 patients and iatrogenic injury to the lumbosacral plexus in 3 patients.All the other incisions healed well without major complications like infection,pressure ulcer or implant failure.There were no significant differences between the 2 groups in operation time (235.8± 72.0 minutes versus 318.0 ± 64.7 minutes),intraoperative bleeding volume (558.8 ± 125.7 mL versus 734.0 ±98.0 mL),weight-bearing time (9.4 ±2.4 weeks versus 11.3 ±2.3 weeks),postoperative complications,VAS(1.1 ±0.6 points versus 1.0 ±0.6 points),EQ-5D (0.82 ±0.09 points versus 0.78 ±0.06 points) or LSICS (P ＞ 0.05).The final follow-ups revealed significant improvements in VAS,EQ-5D and LSICS in all the patients (P ＜ 0.05).Conclusion The lumbosacral plexus can be well decompressed via both the lateral rectus abdominis approach and the posteromedian sacrum approach,leading to satisfactory clinical outcomes.

Chimeric antigen receptor T cell (CAR-T cell) therapy is a novel adoptive immunotherapy where T lymphocytes are engineered with synthetic receptors known as chimeric antigen receptors (CAR). The CAR-T cell is an effector T cell that recognizes and eliminates specific cancer cells, independent of major histocompatibility complex molecules. The whole procedure of CAR-T cell production is not well understood. The CAR-T cell has been used predominantly in the treatment of hematological malignancies, including acute lymphoblastic leukemia, chronic lymphocytic leukemia, lymphoma, and multiple myeloma. Solid tumors including melanoma, breast cancer and sarcoma offer great promise in CAR-T cell research and development. CD19 CAR-T cell is most commonly used, and other targets, including CD20, CD30, CD38 and CD138 are being studied. Although this novel therapy is promising, there are several disadvantages. In this review we discuss the applications of CAR-T cells in different hematological malignancies, and pave a way for future improvement on the effectiveness and persistence of these adoptive cell therapies.

With the development of specialization and specialist differentiation of modem medicine,the developing mode of "reducing and specializing" has promoted the explosive growth of medical knowledge.Meanwhile,the medical practice based on medical knowledge is being fragmented,and medical activities are gradually moving away from the'people-oriented'core value.Therefore,current medical modality needs to be transformed into a "holistic medicine" stage,which also requires reforms of medical personnel cultivation,including the emphasizes of holistic view as well as multidisciplinary integration.Medical schools are exploring paths to achieve holistic medicine-oriented education and training of students.Currently,the concept of holistic medicine have begun to permeate in medical curriculum design and teaching method innovationand yet needs to befurther deepened in understanding and practicing the essence of the holistic medical modality in the future.