BACKGROUND: Neurological complications after coronary artery bypass grafting still have a high incidence rate, and the etiology is multiple.OBJECTIVE: To retrospectively investigate the occurrence and relevant factors of severe neurological complications after coronary artery bypass grafting (CABG).METHODS: A total of 761 consecutive patients with undergoing CABG were included in this study from September 2002 to August 2009 at the Nanjing Drumtower Hospital, including 443 males and 318 females, aged from 32-89 years. All patients were grouped according to age(more than or less than 70-year-old) and on pump or off pump coronary surgery. Disclose the relationship between the risk factors and the neurological complications by statistics analysis.RESULTS AND CONCLUSION: Totally 41 patients had serious neurological complications in this study. There was a higher complication incidence in 570-year-old group patients (n=22) than < 70-year-old group (n=19)(14.9% vs. 3.1%, P< 0.001). The neurological complications incidence was similar in on-Pump CABG group (n =7) and off-Pump CABG group (n = 34) (5.3% vs.5.4%, P=0.39). The incidence rate of severe neurological complications was high in carotid artery stenosis > 50% patients. A total of 8 cases died, 2 for massive hemorrhage of gastrointestinal tract; 1 for severe sepsis; 4 for multiple organ dysfunction syndrome;1 for epilepsia gravior postoperatively. Finally, 33 cases survived. The average time of follow up was 3 years, 3 cases died, 3 cases recovery from limitation of limb or hand movement partly, and 1 case had severe mental retardation. Results displayed that elderly patients(= 70 years) undergoing CABG are at higher risk of neurological dysfunction. Carotid artery stenosis is the most risk factor. There are no significant effects on postoperative complications between on-pump CABG and off-pump CABG.

Objective To assess the efficacy of methylprednisolone (MP)pulse therapy in treatment of Hashimoto thyroiditis(HT) complicated with goiter.Methods 30 patients with HT complicated with goiter participated in the study and received MP pulse therapy.The patients had to be euthyroid for at least 3 months before the date of inclusion with plasma concentrations of thyroid hormones within their reference range.The goiter was still obvious and had no improvement.A dose of 250 mg MP was administered intravenously for seven consecutive days,and then treated with oral prednisone 10 mg,three times per day for 6 weeks with the dosage in each week gradually reduced at 5 mg to none.Ultrasonic was used to measure thyroid size before and after MP treatment.Results The treatment was successful at the end of the trial in all of the 30 patients receiving MP.The thyroid size from length,breadth,thickness to isthmus obviously decreased (P ＜ 0.05).The length of the left lobe was (57.42 ± 12.87) mm and (46.37 ± 7.67) mm (t =4.58) before and after treatment; The breadth of the left lobe was(26.68 ±7.71) mm and(22.21 ±6.09) mm(t =4.56) before and after treatment; The thickness of the left lobe was (27.18 ± 6.60) mm and (21.14 ± 5.67) mm(t =7.28) before and after treatment.The length of the right lobe was(58.17 ± 12.32)mm and(49.73 ±9.35) mm(t =3.84) before and after treatment; The breadth of the right lobe was (26.14 ± 7.37)mm and (23.00 ± 6.68) mm(t =3.29) before and after treatment ; The thickness of the right lobe was(27.57 ± 6.42)mm and(22.00 ±5.55)(t =5.88)before and after treatment.The isthmus before and after treatment was(9.94 ±4.15)mm and(6.19 ±2.57)mm(t =6.09).The recurrence rate was 17％ (5/30) after one year.Conclusions MP pulse therapy is an effective treatment for HT complicated with goiter.The recurrence rate is low.

s To compare the clinical effects of intravenously and orally administered aspirin in the treatment for acute coronary syndrome (ACS),and to evaluate the adverse effects of intravenous administration of aspirin.Methods One hundred and twenty-five patients with unstable angina pectoris or acute myocardial infarction were randomized into three groups:group 1 received intravenous aspirin (300mg/d,n =40),while groups 2 (n =42) and 3 (n =43) received orally administered aspirin (100mg/d and 300mg/ d,respectively).The control group included 30 patients with no heart disease or blood disease,and they had never taken aspirin and clopidogrel.Blood samples were taken at 2nd and 7th day of hospitalization.Platelet aggregation and the level ofplatelet activation marker CD62p were measured and compared among the groups.Patients were followed up for 6 months for the occurrence of major adverse cardiovascular events.Results There were no statistically significant differences in the decrease in adenosine diphosphate (ADP)-induced platelet aggregation rate (12.01±10.45%,6.76±14.62% and 9.73±16.72% for group 1,group2 and group 3,respectively),the decrease in arachidonic acid (AA)-induced platelet aggregation rate (6.73±11.34%,6.95±12.45% and 7.57±13.11%,respectively),and the decrease in CD62p level (10.89±18.62%,8.92±11.57% and 7.05±15.67%,respectively).At six months,there were 4 deaths (10%) in group 1,4 deaths (9.5%) in group 2 and 5 deaths (11.6%) in group 3 (P＞0.05).Conclusions Intravenous administration of aspirin provides a new approach as an anti-platelet treatment for ACS patients,especially those who can not tolerate oral administration of aspirin.(J Geriatr Cardiol 2008;5:212-216)

BACKGROUND:Combined radiation and wound injury appeared mainly in patients with tumor radiotherapy and nuclear radiation accidents.The radiation destroys the repair mechanism,resulting in delayed or prolonged wound healing.It still lacks an effective therapeutic strategy currently. OBJECTIVE:To prepare multifunctional wound dressings based on the multiple clinical symptoms of combined radiation and wound injury,which are designed to be antibacteria,promoted healing and analgesics. METHODS:Using levofloxacin,fibroin and lidocaine hydrochloride as raw materials,3D bioprinting technology was applied to prepare the multifunctional wound dressing.(1)The multifunctional dressing was placed on a fixed culture plate coated with Staphylococcus aureus,Escherichia coli and Pseudomonas aeruginosa,and incubated at 37 ℃ overnight to detect the diameter of the antibacterial zone.(2)40 Kunming mice were randomly divided into trauma group,radiation and trauma model group,treatment group and positive drug group,with 10 mice in each group.Mice in the radiation and trauma model group,treatment group and positive drug group were irradiated by 60Co gamma rays.After 1 hour of radiation,a full-layer skin defect wound with a diameter of 1 cm was made on the back of each mouse in the four groups.Normal saline was applied to the wounds of the trauma group and the radiation and trauma model group.Trethanolamine cream was applied to the wounds of the positive drug group.Multifunctional dressing was applied to the wounds of the treatment group.The dressing was changed every 2 days,and the treatment was continued for 14 days.Wound healing rate and serum interleukin-6 level were measured at 3,7 and 14 days after wound modeling.14 days after the wound modeling,the skin tissue of the wound was obtained and received hematoxylin-eosin staining,Masson staining and cytokeratin-14 immunohistochemical staining. RESULTS AND CONCLUSION:(1)3D-printed multifunctional wound dressing had good antibacterial activity.The antibacterial zone diameters against Staphylococcus aureus,Escherichia coli and Pseudomonas aeruginosa were(4.15±0.09),(4.18±0.23)and(4.35±0.13)cm,respectively.(2)With the extension of modeling time,the wound healed gradually.The wound healing rate of the treatment group and the positive drug group was higher than that of the radiation and trauma model group at 3,7 and 14 days after modeling(P<0.01,P<0.001).The wound healing rate of the treatment group was higher than that of the positive drug group.With the extension of modeling time,the serum interleukin level of mice increased first and then decreased.The serum interleukin level in the treatment group at 3,7 and 14 days after modeling was lower than that in the radiation and trauma model group.Hematoxylin-eosin staining and Masson staining exhibited that inflammatory cells infiltrated the granuloma tissue in the trauma group,and the dermal collagen fibers were densely arranged.The normal structure of epidermis and dermis was destroyed and inflammatory cells were infiltrated in the radiation and trauma model group.In the treatment group,normal skin mucosal tissue was observed,the epidermis was arranged closely,and the sweat glands,hair follicles and dermal collagen fibers were arranged regularly.In the positive drug group,the arrangement of epidermal layer was tight,and the arrangement of sweat glands,hair follicles and dermal collagen fibers was regular.Cytokeratin-14 immunohistochemical staining displayed that the epidermal tissue thickness in the treatment group was lower than that in the other three groups(P<0.01,P<0.001).(3)The results confirm that the 3D-printed multifunctional dressing has multiple functions of local anesthesia,anti-infection and promoting healing.

Isovalerylspiramycin (ISP)Ⅰ, as a major component of bitespiramycin (BT), exhibits similar antimicrobial activities with BT and has advantages in quality control and dosage forms. It has been under preclinical studies. The existing ISPⅠ producing strain, undergoing three genetic modifications, carries two resistant gene markers. Thus, it is hard for further genetic manipulation. It is a time-consuming and unsuccessful work to construct a new ISPⅠ strain without resistant gene marker by means of the classical homologous recombination in our preliminary experiments. Fortunately, construction of the markerless ISPⅠ strain, in which the bsm4 (responsible for acylation at 3 of spiramycin) gene was replaced by the Isovaleryltansferase gene (ist) under control of the constitutive promoter ermEp*, was efficiently achieved by using the CRISPR-Cas9 gene editing system. The mutant of bsm4 deletion can only produce SPⅠ. Isovaleryltransferase coded by ist catalyzes the isovalerylation of the SPⅠat C-4" hydroxyl group to produce ISPⅠ. As anticipated, ISPⅠ was the sole ISP component of the resultant strain (ΔEI) when detected by HPLC and mass spectrometry. The ΔEI mutant is suitable for further genetic engineering to obtain improved strains by reusing CRISPR-Cas9 system.
CRISPR-Cas Systems ; Gene Editing ; Genetic Engineering ; Homologous Recombination

Chemotherapy is one of the major approaches for the treatment of metastatic lung cancer, although it is limited by the low tumor delivery efficacy of anticancer drugs. Bacterial therapy is emerging for cancer treatment due to its high immune stimulation effect; however, excessively generated immunogenicity will cause serious inflammatory response syndrome. Here, we prepared cancer cell membrane-coated liposomal paclitaxel-loaded bacterial ghosts (LP@BG@CCM) by layer-by-layer encapsulation for the treatment of metastatic lung cancer. The preparation processes were simple, only involving film formation, electroporation, and pore extrusion. LP@BG@CCM owned much higher 4T1 cancer cell toxicity than LP@BG due to its faster fusion with cancer cells. In the 4T1 breast cancer metastatic lung cancer mouse models, the remarkably higher lung targeting of intravenously injected LP@BG@CCM was observed with the almost normalized lung appearance, the reduced lung weight, the clear lung tissue structure, and the enhanced cancer cell apoptosis compared to its precursors. Moreover, several major immune factors were improved after administration of LP@BG@CCM, including the CD4⁺/CD8a⁺ T cells in the spleen and the TNF-α, IFN-γ, and IL-4 in the lung. LP@BG@CCM exhibits the optimal synergistic chemo-immunotherapy, which is a promising medication for the treatment of metastatic lung cancer.

Radiation therapy is an effective method to kill cancer cells and shrink tumors using high-energy X-ray or γ-ray. Radiation pneumonitis (RP) is one of the most serious complications of radiation therapy for thoracic cancers, commonly leading to serious respiratory distress and poor prognosis. Here, we prepared curcumin-loaded mesoporous polydopamine nanoparticles (CMPN) for prevention and treatment of RP by pulmonary delivery. Mesoporous polydopamine nanoparticles (MPDA) were successfully synthesized with an emulsion-induced interface polymerization method and curcumin was loaded in MPDA via π‒π stacking and hydrogen bonding interaction. MPDA owned the uniform spherical morphology with numerous mesopores that disappeared after loading curcumin. More than 80% curcumin released from CMPN in 6 h and mesopores recovered. CMPN remarkably protected BEAS-2B cells from γ-ray radiation injury by inhibiting apoptosis. RP rat models were established after a single dose of 15 Gy ⁶⁰Co γ-ray radiation was performed on the chest area. Effective therapy of RP was achieved by intratracheal administration of CMPN due to free radical scavenging and anti-oxidation ability, and reduced proinflammatory cytokines, high superoxide dismutase, decreased malondialdehyde, and alleviated lung tissue damages were observed. Inhaled CMPN paves a new avenue for the treatment of RP.

Wound infection is becoming a considerable healthcare crisis due to the abuse of antibiotics and the substantial production of multidrug-resistant bacteria. Seawater immersion wounds usually become a mortal trouble because of the infection of Vibrio vulnificus. Bdellovibrio bacteriovorus, one kind of natural predatory bacteria, is recognized as a promising biological therapy against intractable bacteria. Here, we prepared a B. bacteriovorus-loaded polyvinyl alcohol/alginate hydrogel for the topical treatment of the seawater immersion wounds infected by V. vulnificus. The B. bacteriovorus-loaded hydrogel (BG) owned highly microporous structures with the mean pore size of 90 μm, improving the rapid release of B. bacteriovorus from BG when contacting the aqueous surroundings. BG showed high biosafety with no L929 cell toxicity or hemolysis. More importantly, BG exhibited excellent in vitro anti-V. vulnificus effect. The highly effective infected wound treatment effect of BG was evaluated on mouse models, revealing significant reduction of local V. vulnificus, accelerated wound contraction, and alleviated inflammation. Besides the high bacterial inhibition of BG, BG remarkably reduced inflammatory response, promoted collagen deposition, neovascularization and re-epithelization, contributing to wound healing. BG is a promising topical biological formulation against infected wounds.