Nanomedicine for acute respiratory distress syndrome: The latest application,targeting strategy,and rational design

Acute respiratory distress syndrome (ARDS) is characterized by the severe inflammation and destruction of the lung air–blood barrier, leading to irreversible and substantial respiratory function damage. Patients with coronavirus disease 2019 (COVID-19) have been encountered with a high risk of ARDS, underscoring the urgency for exploiting effective therapy. However, proper medications for ARDS are still lacking due to poor pharmacokinetics, non-specific side effects, inability to surmount pulmonary barrier, and inadequate management of heterogeneity. The increased lung permeability in the pathological environment of ARDS may contribute to nanoparticle-mediated passive targeting delivery. Nanomedicine has demonstrated unique advantages in solving the dilemma of ARDS drug therapy, which can address the shortcomings and limitations of traditional anti-inflammatory or antioxidant drug treatment. Through passive, active, or physicochemical targeting, nanocarriers can interact with lung epithelium/endothelium and inflammatory cells to reverse abnormal changes and restore homeostasis of the pulmonary environment, thereby showing good therapeutic activity and reduced toxicity. This article reviews the latest applications of nanomedicine in pre-clinical ARDS therapy, highlights the strategies for targeted treatment of lung inflammation, presents the innovative drug delivery systems, and provides inspiration for strengthening the therapeutic effect of nanomedicine-based treatment.     

Doppler‐guided haemorrhoidal artery ligation in patients with Crohn’s disease

Aim: The outcome of Doppler‐guided haemorrhoidal artery ligation (DGHAL) was assessed in patients with Crohn’s disease (CD) suffering from grade III haemorrhoids. Method: A retrospective study was carried out of patients with CD and symptomatic Grade III haemorrhoids treated by DGHAL. Perioperative and follow‐up data were retrieved from our database of patients undergoing DGHAL. Results: The study included seven men and six women. The mean age was 34 years old. All had CD without anorectal involvement. The median duration of haemorrhoidal symptoms was 6.3 years. There was no mortality, new incontinence, faecal impaction, urinary retention, abscess formation or persistent pain following the procedure. Mean pain score based on a visual analogue scale (VAS) decreased from 2.4 at 24 h postoperatively to 1.6 on the seventh postoperative day. All patients had completely recovered by the third postoperative day. At 18 months, three (77%) of the patients were asymptomatic and three had recurrent symptoms. Conclusion: Doppler‐guided haemorrhoidal artery ligation is safe and effective in treating Grade III haemorrhoids in patients with CD without rectal involvement.     

瘘管切除合并内口结扎治疗肛瘘临床疗效分析(附74例报告)

目的观察瘘管切除合并内口结扎治疗肛瘘的临床疗效。方法选择74例内口在肛管齿线附近的肛瘘患者,采用将瘘管完全剥离切除,内口盲端结扎的方法手术的临床资料作回顾性分析。结果 74例患者全部一次性治愈,住院时间为12~23d,完全愈合时间为22~47d。痊愈后肛门外观无缺损、移位等改变,生理功能正常。3例患者早期有少许黏液泄漏,8~10周后症状消失,肛门无失禁。结论采用瘘管切除合并内口结扎的手术方法治疗肛瘘彻底,治愈率高,疗效确切,无肛瘘再次复发。     

优质护理在混合痔围手术期患者中的应用价值分析

目的：探讨分析优质的护理在混合痔围手术期患者中的应用价值。方法：选取2013年1月～2014年1月我院接受治疗的68例混合痔患者，随机分为试验组（优质护理组，试验例数为34）和对照组（常规护理组，试验例数为34），利用统计学方法对此两种护理方式下患者的术前精神状态和术后并发症发生率等进行比较分析。结果：试验组通过优质精心的护理，试验组混合痔患者的术前精神状态和并发症发生率明显优于对照组，且术后住院时间也低于对照组，两组对比具有显著差异性（P〈0．05），具有统计学意义。结论：通过优质精心的护理，可有效地促进手术创面的愈合，有利于患者的旱日康复，避免各种并发症的发生，值得在临床上应用和推广。     

康复新在预防食管静脉曲张套扎术后近期再出血中的作用

目的 探讨康复新在预防食管静脉曲张套扎（EVL）术后近期再出血中的作用.方法 56例食管静脉曲张患者根据治疗方法分为对照组20例和治疗组36例.对照组患者EVL术后给予常规抑酸、抗炎、降门脉压治疗;治疗组EVL术后,在常规治疗基础上加用康复新10 mL,tid口服,疗程14 d.比较2组患者EVL术后近期再出血率及EVL术后局部溃疡愈合情况.结果 治疗组EVL术后近期再出血率（2.56％）明显低于对照组（8.89％）（P＜0.05）;套扎局部溃疡愈合情况：治疗组有效率为96.15％,对照组有效率为85.55％,治疗组疗效优于对照组（P＜0.05）.结论 食管静脉曲张EVL术后常规加服康复新能明显促进EVL术后局部溃疡的愈合,减少EVL术后近期再出血风险.     

Prospective randomized multicentre study comparing stapler haemorrhoidopexy with Doppler‐guided transanal haemorrhoid dearterialization for third‐degree haemorrhoids

Aim Doppler‐guided transanal haemorrhoid dearterialization (THD) and stapler haemorrhoidopexy (SH) have been demonstrated to be less painful than the Milligan–Morgan procedure. The aim of this study was to compare the effectiveness of THD vs SH in the treatment of third‐degree haemorrhoids in an equivalent trial. Method One hundred and sixty‐nine patients with third‐degree haemorrhoids were randomized online to receive THD (n = 85) or SH (n = 84) in 10 Colorectal Units in which the staff were well trained in both techniques. The mean follow‐up period was 17 (range 15–20) months. Results Early minor postoperative complications occurred in 30.6% of patients in the THD group and in 32.1% of patients in the SH group. Milder spontaneous pain and pain on defecation were reported in the THD group in the first postoperative week, but this was not statistically significant. Late complications were significantly higher (P = 0.028) in the SH group. Residual haemorrhoids persisted in 12 patients in the THD group and in six patients in the SH group (P = 0.14). Six patients in the SH group and 10 in the THD group underwent further treatment of haemorrhoids (P = 0.34). No differences were found in postoperative incontinence. The obstructed defecation score (ODS) was significantly higher in the SH group (P < 0.02). Improvement in quality of life was similar in both groups. Postoperative in‐hospital stay was 1.14 days in the THD group and 1.31 days in the SH group (P = 0.03). Conclusion Both THD and SH techniques are effective for the treatment of third‐degree haemorrhoids in the medium term. THD has a better cost‐effective ratio and lower (not significant) pain compared with SH. Postoperative pain and recurrence did not differ significantly between the two groups.     

临床路径变异调查与分析

目的分析临床路径变异，以提高临床路径的管理水平。方法以大隐静脉曲张高位结扎剥脱术为例，按照疾病转归、医护、患者、医院和退出路径5方面的因素对临床路径变异进行回顾性调查和统计分析。结果主要的变异因素中患者方面的占36．46％，主要是患者提前出院；医护方面的占31．31％，主要是提前安排手术。结论临床路径变异主要是人的因素，加强变异管理，才能更好的实施临床路径。     

Analysis of pulmonary heme oxygenase-1 and nitric oxide synthase alterations in experimental hepatopulmonary syndrome

BACKGROUND & AIMS: Cirrhosis and portal hypertension due to chronic common bile duct ligation reproduce the features of human hepatopulmonary syndrome, whereas portal hypertension alone due to partial portal vein ligation does not. Nitric oxide contributes to experimental hepatopulmonary syndrome, but the nitric oxide synthase forms involved remain controversial. Recently, increased pulmonary heme oxygenase-1 expression and carbon monoxide production have also been found after common bile duct ligation. Our aim was to explore the role of the heme oxygenase-1/carbon monoxide pathway in the pathogenesis of experimental hepatopulmonary syndrome. METHODS: Pulmonary heme oxygenase-1 expression and distribution were assessed in sham; 3-week partial portal vein ligation; and 1-, 2-, 3-, 4-, and 5-week common bile duct ligation animals by Northern, Western and immunohistochemical analysis relative to endothelial and inducible nitric oxide synthase levels and to hepatopulmonary syndrome development. In vivo heme oxygenase enzyme inhibition with tin protoporphyrin IX in common bile duct ligation animals was used to define effects on intrapulmonary vasodilatation and arterial blood gases. RESULTS: Heme oxygenase-1 expression in pulmonary intravascular monocytes/macrophages and arterial carboxyhemoglobin levels increased progressively from 3 to 5 weeks after common bile duct ligation relative to controls (5-week protein levels were 15.94 +/- 1.75-fold those of sham animals; P < 0.001). Inducible nitric oxide synthase increased transiently in pulmonary intravascular monocytes/macrophages in 3-week common bile duct ligation animals, whereas pulmonary microvascular endothelial nitric oxide synthase increases began at 2 weeks and correlated with the onset of hepatopulmonary syndrome. Tin protoporphyrin treatment normalized carboxyhemoglobin and improved arterial blood gases and intrapulmonary vasodilatation, reflecting partial reversal of hepatopulmonary syndrome. CONCLUSIONS: The heme oxygenase-1/carbon monoxide system is an important contributor to the progression of experimental hepatopulmonary syndrome in addition to alterations in the endothelial nitric oxide synthase/nitric oxide pathway.     

自动体外除颤器临床应用的研究

目的探讨自动体外除颤器（AED）临床应用中对室性心动过速（室速）／心室颤动（室颤）的诊断能力、治疗效果和存在的问题。方法应用Power Heart全自动体外除颤器对入选的21例室速、室颤患者进行监测。结果全组发生需电击的心律失常108次，实施自动电除颤99次，发放的电除颤转复成功率96．97％（96次），无效率3．03％（3次，含1次心房扑动误治疗），误治疗率2．02％（2次）。AED电除颤成功治疗后缓慢性心律失常发生率17．71％（17次）。4例患者AED治疗后出现窦性心动过速和室速、室颤发作频度增加，发作间期缩短的现象。结论AED能够有效地自动诊断和治疗室速、室颤，但临床应用仍有较多问题需注意。     

Detection of K-<Emphasis Type="Italic">ras</Emphasis> mutations in the plasma DNA of pancreatic cancer patients

Background In pancreatic cancers, K-ras mutations have been found frequently (80%–100%), and they could be a good marker to detect tumor DNA in the plasma. Several studies have indicated that polymerase chain reaction/restriction fragment length polymorphism (PCR/RFLP) analysis of K-ras mutation was a useful method for the detection of hepatic and lymph node metastasis of pancreatic cancer. However, this method sometimes exhibited false-positive results, and the rate of K-ras mutation might thus be overestimated in these tissues. To diagnose pancreatic cancer correctly at an early stage, we attempted to detect tumor DNA in the plasma of pancreatic cancer patients using a more sensitive and specific method.Methods We examined 28 pancreatic cancer patients using a sensitive mutation-specific mismatch ligation assay for K-ras gene mutations in primary tumors and paired plasma samples.Results K-ras gene mutations were detected in 26 of the 28 (93%) pancreatic cancers. We also found the same mutations in 9 of these 26 (35%) patients in their plasma DNA. This mutation was found even in the plasma of patients with TNM stage II cancer.Conclusions Genetic alterations present in the tumors of pancreatic cancer patients can be detected in their plasma, and this approach is potentially applicable for cancer screening and the monitoring of this deadly disease.