Medicine
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This study aimed to comprehensively assess the optimal regimen for high-dose methotrexate (HD-MTX) in treating primary central nervous system lymphoma (PCNSL). ⋯ Based on the findings of this study, the treatment strategies of MTX are associated with the prognosis and efficacy response of PCNSL patients. The results suggested that the current recommended HD-MTX dosage of 3.5 g/m2 is sufficient for PCNSL to have a favorable treatment response and prognosis. When the number of MTX treatment cycles increases, the therapeutic effect and prognosis of PCNSL patients are improved. The patients treated with MTX-based triplet combination regimens have a better ORR and CR. Although HD-MTX is generally well tolerated, it is necessary to be cautious about the use of multiple therapy that includes cytarabine to prevent potential acute toxicity.
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Review Case Reports
Organized chronic subdural hematoma with cognitive impairment: A case report and literature review.
Organic chronic subdural hematoma is extremely rare in clinical practice, with unclear etiology and pathogenesis. Its clinical manifestations and treatment approaches are diverse, making diagnosis challenging and prone to misdiagnosis or mistreatment, adversely affecting patient care and quality of life. ⋯ Patients with mild or no significant symptoms, such as headaches and dizziness, are advised to undergo regular imaging follow-ups. Surgical intervention is recommended for patients presenting with intracranial hypertension and neurological impairment, with bone flap craniotomy and lesion resection under microscopic guidance being the preferred approach. It is imperative to conduct regular postoperative monitoring to promptly detect potential complications, such as hematoma recurrence.
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Pregnancy-associated atypical hemolytic uremic syndrome (p-aHUS) is a rare, life-threatening condition characterized by microangiopathic hemolytic anemia, thrombocytopenia, elevated liver enzymes, and acute kidney injury. Prompt diagnosis and therapy are crucial due to the high risk of progression to chronic kidney disease (CKD), end-stage kidney disease (ESKD), and dialysis dependency, as well as significant maternal and fetal morbidity and mortality. ⋯ This analysis highlights the severe kidney and pregnancy outcomes associated with p-aHUS. Eculizumab treatment is significantly beneficial in reducing the risk of CKD and ESKD.
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Tumor-associated macrophages (TAMs) are present in and are important components of the tumor microenvironment (TME). TAMs differentiate into 2 functionally distinct morphologies, classically activated (M1)-type TAMs and alternatively activated (M2)-type TAMs, when stimulated by different cytokines. The 2 types of TAMs exhibit distinct properties and functions. ⋯ However, the intracellular signaling pathways involved in the polarization of TAMs are poorly understood. The AKT signaling pathway is an important signaling pathway involved in the polarization, growth, proliferation, recruitment, and apoptosis of TAMs, as well as the action of TAMs on other cells within the TME. This paper reviews the AKT signaling pathway in the polarization of TAMs and the regulation of the TME and provides new ideas for tumor immunotherapy.
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Case Reports
Antegrade horizontal stenting for endovascular coiling of wide-neck aneurysms in the basilar tip: Two case reports.
Endovascular coil embolization for wide-neck intracranial aneurysms is technically challenging and requires supporting devices. Intracranial stents are widely used as a buttress for compact coil filling and preventing coil protrusion into the parent artery. Horizontal stenting has been developed to maximize coil insertion and reduce the risk of thromboembolism. An anterograde route for horizontal stenting could be attempted for basilar tip aneurysms if the posterior communicating artery is not accessible. Here, we report 2 cases of antegrade horizontal stenting (AHS) for wide-neck aneurysm (WNA) in the basilar tip. This approach aims to maximize coil insertion and achieve complete aneurysm occlusion. ⋯ Horizontal stenting via an antegrade route may be an effective strategy for achieving compact coil embolization in selected patients with WNAs at the basilar tip. The Neuroform Atlas stent appears to be a promising tool for AHS owing to its hybrid-cell design. However, the shifting phenomenon of a jailed microcatheter after AHS warrants attention, as it may present potential challenges that require further catheterization.