Dual antibody-aided mesoporous nanoreactor for H2O2 self-supplying chemodynamic therapy and checkpoint blockade immunotherapy in triple-negative breast cancer.

Triple-negative breast cancer (TNBC) represents a formidable challenge due to the absence of estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2) expression, rendering it unresponsive to conventional hormonal and targeted therapies. This study introduces the development of mesoporous nanoreactors (NRs), specifically mPDA@CuO2 NRs, as acid-triggered agents capable of self-supplying H2O2 for chemodynamic therapy (CDT). To enhance therapeutic efficacy, these NRs were further modified with immune checkpoint antagonists, specifically anti-PD-L1 and anti-CD24 antibodies, resulting in the formation of dual antibody-aided mesoporous nanoreactors (dAbPD-L1/CD24-mPDA@CuO2 NRs). These NRs were designed to combine CDT and checkpoint blockade immunotherapy (CBIT) for precise targeting of 4T1 TNBC cells. Remarkably, dAbPD-L1/CD24-mPDA@CuO2 NRs exhibited tumor-targeted CDT triggered by H2O2 and successfully activated immune cells including T cells and macrophages. This integrated approach led to a remarkable inhibition of tumor growth by leveraging the collaborative effects of the therapies. The findings of this study introduce a novel and promising strategy for the integrative and collaborative treatment of refractory cancers, providing valuable insights into addressing the challenges posed by aggressive breast cancer, particularly TNBC.

Sore throat may be a clue to the early diagnosis of spontaneous pneumomediastinum.

Spontaneous pneumomediastinum is defined as presence of air in the mediastinum without obvious cause such as esophageal perforation or abscess formation. It is a benign condition and usually resolved by itself in 1 to 2 weeks. The main symptom of spontaneous pneumomediastinum is retrosternal chest pain. Here, we present a young adult who complained about sore throat initially. Marked retropharyngeal emphysema was noted by neck x-ray. Pneumomediastinum was confirmed with chest x-ray and computed tomographic scan later on.We want to emphasize the importance of thorough history taking and lateral soft tissue neck radiograph on retropharyngeal emphysema in real time, which is key to the diagnostic workup for patients who present with persistent sore throat and dysphagia in young adult.

Isolated rotational nystagmus may be the only clue to the early diagnosis of dorsolateral medullary infarction.

The medulla contains complex nervous structures related to motor, sensory, coordination, and visceral autonomic functions. The medullary infarctions cause various symptoms and signs depending on the location of the lesion. Lateral medullary infarction is caused by a vascular event in the territory of the posterior inferior cerebellar artery or the vertebral artery. We report a case of a patient with falling tendency and whirling sensation. He reported no facial drop, arm drift, slurred speech, difficulty of swallowing, or weakness of his limbs. The neurologic examination revealed no decreased muscle power, dysarthria, dysphagia, or other relevant neurologic deficits. Urgent noncontrast brain computed tomography detected no acute hemorrhage or ischemic lesion. On admission, the oculomotor examination revealed conjugated rotational nystagmus with clockwise direction. The magnetic resonance imaging of the brain demonstrated acute infarct in the medulla oblongata approximately 0.8 × 0.5 cm. The infarct appears bright on diffusion-weighted images (Fig.). A diagnosis of dorsolateral medulla infarction was established, and the patient was started on a therapy of 100 mg aspirin once daily. After standard therapies, the patient's recovery was uneventful.

Factors Associated With Emergency Department Visits Among Patients Receiving Publicly-Funded Homecare Services: A Retrospective Chart Review From Southern Taiwan Regional Hospital.

BACKGROUND: The public health strategy of increasing access to comprehensive home or community-based healthcare services and emergency home visits is intent on reducing the overcrowding of emergency departments. However, scientific evidence regarding the association between home-based healthcare services and emergency department uses is surprisingly insufficient and controversial so far. The present retrospective study identified the risk factors for emergency department visits among patients receiving publicly-funded homecare services. METHODS: The personal demographic and medical information, caregiver characteristics, and behaviours related to homecare services and emergency department visits from the medical records and structured questionnaires of 108 patients who were recipients of integrated homecare services in a regional hospital in southern Taiwan between January 1, 2020, and December 31, 2020, were collected. After screening the potential predictor variables using the preliminary univariate analyses, the multivariate logistic regression with best subset selection approach was conducted to identify best combination of determinants to predict unplanned emergency department utilizations. RESULTS: Best subset selection regression analysis showed Charlson Comorbidity Index (odds ratio (OR)=1.33, 95% CI=1.05 to 1.70), male caregiver (OR=0.18, 95% CI=0.05 to 0.66), duration of introducing homecare services (OR=0.97, 95% CI=0.95 to 1.00), working experience of dedicated nurses (OR=0.89, 95% CI=0.79 to 0.99) and number of emergency department utilizations within previous past year before enrollment (OR=1.54, 95% CI=1.14 to 2.10) as significant determinants for unplanned emergency department visits. CONCLUSIONS: The present evidence may help government agencies propose supportive policies to improve access to integrated homecare resources and promote appropriate care recommendations to reduce unplanned or nonurgent emergency department visits among patients receiving homecare services.

Gastric foreign body: a comb.

The ingestion of a foreign body is a common occurrence. Psychiatric patients and prisoners may swallow objects on purpose. Occasionally emergent exploratory laparotomy may be indicated if the diagnosis is uncertain, and emergent removal of the foreign body may be needed to prevent substantial risk of serious complications including perforation, fistula, or gastrointestinal bleeding.