Glioblastoma (GBM) is an aggressive malignancy and therapeutic options are limited due to the presence of the blood-brain barrier (BBB). RVG-29, a 29-amino-acid polypeptide derived from the rabies virus glycoprotein (RVG), has excellent brain-targeted capacity across the BBB. We reduced the size of this peptide to get a15-amino-acid polypeptide (RVG-15), while retaining its brain-targeted capacity across the BBB. First, we synthesized a novel nanocarrier RVG-15-PEG2000-DSPE. Next, DOX-loaded polymeric micelles (DOX RVG-15-PMs) were prepared in an electrostatic interaction-dependent manner. Finally, we evaluated its antitumor benefits in vitro at the cellular level and in vivo using an in situ tumour-bearing mouse model. MALDI-TOF-MS and FTIR spectra confirmed the successful synthesis of the novel nanocarrier. The prepared DOX RVG-15-PMs displayed even size distribution, a high entrapment efficiency and satisfactory in vitro release behaviour. In vitro blank RVG-15-PMs were excellent, safe and highly biocompatible as drug delivery carriers. DOX-loaded micelles were easily taken up by C6 cells and could effectively inhibit cancer development and metastasis. In vivo, DOX RVG-15-PMs delayed weight loss, prevented cancer cell metastasis and accelerated cancer cell apoptosis in tumour-bearing mice. Our novel brain-targeted nanocarrier is highly feasible, while DOX RVG-15-PMs exert significant antiglioma effects, both in vitro and in vivo.
Objective: To study the clinical characteristics of primary hypoparathyroidism in adults. Methods: The clinical data of 200 cases with adult-onset primary hypoparathyroidism in Peking Union Medical College Hospital during December 1987 to December 2015 were collected and analyzed retrospectively. Among them, 128 cases were followed up for a median period of 3 years. Results: The major manifestations at their first visits were tetany and numbness in the distal extremities(81.5%, 163/200 and 62.0%, 124/200). Thirty-two percent of the cases (62 cases) had history of seizures, and 60.9%(98/161) and 74.4%(96/129) of them were with intracerebral calcifications and cataracts, respectively.Most of subjects(155/200)had more than one year delay in diagnosis. Hypercalciuria occurred in 67.2%(86/128) of the cases during the follow-up. No significant differences in the clinical characteristics and biochemical markers between the hypercalciuria subjects and the non-hypercalciuria subjects. Renal nephrocalcinosis or stones were found in 6.5%(5/77) of the cases, and kidney function decreased in 6.6%(6/91) of the patients. Kidney function was negatively associated with age and duration of disease. Conclusions: The predominant manifestations of primary hypoparathyroidism in adults included tetany and numbness in the distal extremities and seizures. It is often misdiagnosed. Calcium supplement combined with vitamin D or its metabolites effectively relieve clinical symptoms and signs. The serum and urinary calcium levels should be monitored frequently to reduce renal complications.
Abstract Objective: To evaluate the effect of online objective structured clinical examination (OSCE) in critical care teaching. Methods: This is a self-controlled prospective study performed in Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College from 2020 to 2021. Consecutive students came from various surgical departments. Online tests were conducted for each student pre-and post-ICU round. There were three spots in online OSCE including clinical case, electrocardiography and chest X-ray. Results: Twenty-four students completed the tests. The median age is 27 years (24-28) in the cohort. There are 18 males and 6 females. Of twenty-four students, 7 came from department of neurologic or head-neck surgery, 3 from department of thoracic surgery, 12 from department of abdominal surgery, and 2 from others. There was significant difference in scores between pre-round and post-round ICU test in the chest X-ray spot, which was 3.33±4.81 and 6.67±4.81 respectively ( P = 0.029). Scores in the postround ICU test in the electrocardiography spot was higher than that in the pre-round test (5.85±5.05 vs. 8.33±3.80)however no significance was reached ( P = 0.056). There was no significant difference in the scores between pre-round and post-round ICU test in the clinical case spot (63.33±18.33 vs 71.67 ± 13.07, P = 0.116). Lastly, there were significant differences in total scores between pre-round and post-round ICU test (72.50±19.83 vs 86.67±13.40, P = 0.019). Conclusions: Online OSCE was feasible in the teaching evaluation of surgical rotation residents in ICU. Surgery rotation residents in ICU should receive more training in electrocardiography and chest X-ray.
Abstract Background Advances in oncology led to a substantial increase in the number of patients requiring admission to the ICU. It is significant to confirm which cancer critical patients can benefit from the ICU care service like noncancer patients. Methods An observational retrospective cohort study using intensive care unit (ICU) admissions of Medical Information Mart for Intensive Care III from the Beth Israel Deaconess Medical Center in Boston, MA, USA between 2001 and 2012 was conducted. Propensity score matching was used to reduce the imbalance between two matched cohorts. ICU patients with cancer were compared with those without cancer in terms of patients’ characteristics and survival. Results There were 38,508 adult patients admitted to ICUs during the period. The median age was 65 years (IQR, 52-77) and 8,308 (21.8%) had an underlying malignancy diagnosis. The noncancer group had a significant survive advantage at the point of 28-day, 90-day, 365-day and 1095-day after ICU admission compared with cancer group ( P < 0.001 for all) after PSM. Subgroup analysis showed that the diagnosis of malignancy didn’t decrease 28-day and 90-day survive when patients’ age ≥65-year, patients in surgical intensive care unit or cardiac surgery recovery unit or traumatic surgical intensive care unit, elective admission, patients with renal replacement therapy or vasopressor support ( P > 0.05 for all). Conclusions Malignancy is a common diagnosis among ICU patients. Patients without cancer have a survive advantage compared with patients with cancer in the short- and medium-term. However, in selected groups, cancer critical patients can benefit from the ICU care service like noncancer patients in the short-term.
BACKGROUND: Esophagectomy is a very important method for the treatment of resectable esophageal cancer, which carries a high rate of morbidity and mortality.This study was undertaken to assess the predictive score proposed by Ferguson et al for pulmonary complications after esophagectomy for patients with cancer. METHODS:The data of patients who admitted to the intensive care unit after transthoracic esophagectomy at Cancer Hospital of Chinese Academy of Medical Sciences and Peking Union Medical College between September 2008 and October 2010 were retrospectively reviewed.RESULTS: Two hundred and seventeen patients were analyzed and 129 (59.4%) of them had postoperative pulmonary complications.Risk scores varied from 0 to 12 in all patients.The risk scores of patients with postoperative pulmonary complications were higher than those of patients without postoperative pulmonary complications (7.27±2.50 vs. 6.82±2.67;P=0.203).There was no significant difference in the incidence of postoperative pulmonary complications as well as in the increase of risk scores (χ 2 =5.477,P=0.242).The area under the curve of predictive score was 0.539±0.040(95%CI 0.461 to 0.618; P=0.324) in predicting the risk of pulmonary complications in patients after esophagectomy.CONCLUSION: In this study, the predictive power of the risk score proposed by Ferguson et al was poor in discriminating whether there were postoperative pulmonary complications after esophagectomy for cancer patients.
Abstract To investigate the occurrence and 90-day mortality of cancer patients following unplanned admission to the intensive care unit (ICU), as well as to develop a risk prediction model for their 90-day prognosis. We prospectively analyzed data from cancer patients who were admitted to the ICU without prior planning within the past 7 days, specifically between May 12, 2021, and July 12, 2021. The patients were grouped based on their 90-day survival status, and the aim was to identify the risk factors influencing their survival status. A total of 1488 cases were included in the study, with an average age of 63.2 ± 12.4 years. The most common reason for ICU admission was sepsis (n = 940, 63.2%). During their ICU stay, 29.7% of patients required vasoactive drug support (n = 442), 39.8% needed invasive mechanical ventilation support (n = 592), and 82 patients (5.5%) received renal replacement therapy. We conducted a multivariate COX proportional hazards model analysis, which revealed that BMI and a history of hypertension were protective factors. On the other hand, antitumor treatment within the 3 months prior to admission, transfer from the emergency department, general ward, or external hospital, high APACHE score, diagnosis of shock and respiratory failure, receiving invasive ventilation, and experiencing acute kidney injury (AKI) were identified as risk factors for poor prognosis within 90 days after ICU admission. The average length of stay in the ICU was 4 days, while the hospital stay duration was 18 days. A total of 415 patients died within 90 days after ICU admission, resulting in a mortality rate of 27.9%. We selected 8 indicators to construct the predictive model, which demonstrated good discrimination and calibration. The prognosis of cancer patients who are unplanned transferred to the ICU is generally poor. Assessing the risk factors and developing a risk prediction model for these patients can play a significant role in evaluating their prognosis.
Background: The efficacy and safety of tigecycline in the treatment of complicated intra-abdominal infections (cIAIs) is potentially controversial. Here we conducted the non-inferiority study to assess the efficacy and safety of tigecycline versus meropenem in the treatment of postoperative cIAIs.
Abstract Background With progress in tumor treatments, patient survival has been significantly extended; nevertheless, tumors and tumor treatments increase the risk of sepsis. Carrimycin may act as an immune-regulating treatment for tumor-related sepsis. We aimed to evaluate whether carrimycin regulates inflammation and immune function in tumor patients with sepsis. Methods We conducted a multicenter, randomized, placebo-controlled, double-blind clinical trial involving tumor patients with sepsis. The participant inclusion criteria were as follows: 1. age ≥ 18 and ≤ 75 years old; 2. condition consistent with sepsis 3.0 diagnostic criteria; 3. SOFA score of 2–13; and 4. patients with malignant tumors. Enrolled patients were assigned to either carrimycin treatment (400 mg/day) or placebo treatment (400 mg/day) orally once a day for 7 days. The primary outcome was immune-related indicators. Results A total of 120 patients were randomized, of whom 47 were assigned to receive carrimycin and 52 placebo. In immune and inflammation indicators, the HLA-DR and CD8 + T-cell levels showed promising trends, although there was no significant difference between the carrimycin and placebo groups ( P > 0.05). In the CD4 < 38.25 subgroup, the HLA-DR level of the carrimycin group was significantly better than that of the placebo group at 1 day after administration ( P = 0.023). In the CD8 < 25.195 subgroup, the degree of decrease in IL-8 in the carrimycin group was significantly higher than that in the placebo group at 1 ( P = 0.027) and 3 ( P = 0.034) days after administration. The CD8 + T-cell subset level of the carrimycin group was significantly better than that of the placebo group at 3 ( P = 0.027) and 5 ( P = 0.035) days after administration. The levels of SOFA, APACHE II, PCT and CRP were significantly reduced by carrimycin intervention. No serious adverse events were recorded. Conclusions In tumor patients with sepsis, especially those with immunocompromised function, carrimycin regulates the immune status by increasing the HLA-DR level and plays an anti-infective role to improve the severity of the disease but does not affect 28-day all-cause mortality. The trial was registered in the Chinese Clinical Trial Registry (http://www.chictr.org.cn) with the number ChiCTR2000032339 on April 26, 2020.
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