Xian-Shi Ma

Cell penetrating peptides (CPPs) are usually positive charged peptides and have good cell membrane permeability. Meanwhile, CPPs are facile to synthesize, and can be functionalized to satisfy different demands, such as cyclization, incorporating unnatural amino acids, and lipid conjugation. These properties have made them as efficient drug-delivery tools to deliver therapeutic molecules to cells and tissues in a nontoxic manner, including small molecules, DNA, siRNA, therapeutic proteins and other various nanoparticles. However, the poor serum stability and low tumor targeting ability also hindered their broad application. Besides, inappropriate chemical modification can lead to membrane disruption and nonspecific toxicity. In this paper, we first reviewed recent advances in the CPP applications for cancer therapy via covalent or non-covalent manners. We carefully analyzed the advantages and disadvantages of each CPP modifications for drug delivery. Then, we concluded the recent progress of their clinical trials for different diseases. Finally, we discussed the challenges and opportunities CPPs met to translate into clinical applications. This review presented a new insight into CPPs for drug delivery, which could provide advice on the design of clinically effective systemic delivery systems using CPPs.

Rationale: Duplication of gallbladder is a rare anomaly in humans, as it is very rare for a duplication of gallbladder to be missed during the first cholecystectomy and thus require a second cholecystectomy. Patient concerns: A 42-year-old man came to our hospital with paroxysmal right upper abdominal pain for 10 days. In addition to the pain, he also had transient jaundice. He had undergone laparoscopic cholecystectomy (LC) 1 year ago. Magnetic resonance cholangiopancreatography showed gallstones, intrahepatic bile duct stones with cholangitis, no dilatation of the common bile duct, and a cystic structure was visible in the upper part of common bile duct. The patient underwent LC again, and the intraoperative diagnosis was duplication of gallbladder. Diagnosis: The patient was diagnosed with duplication of gallbladder during surgery. Interventions: The patient underwent LC again. Outcomes: The patient underwent LC again, and was diagnosed with duplicated gallbladder during the operation. The operation was successful and the patient was discharged on the 5th day after the operation without other complications. Lessons: Our case and literature review showed that there are no specific signs of duplicated gallbladders, and ultrasound has a low sensitivity for the diagnosis of double gallbladders, so double gallbladders are easily missed. Patients with double gallbladders may have multiple missed diagnoses during diagnosis and treatment, as in this case. When patients experience upper abdominal pain again after gallbladder removal, we should be alert and consider the possibility of duplicated gallbladders.