Objective: To prepare killer peptide-loaded PLGA nanoparticles which have better effect in treating systemic crypotococcosis. Methods: We adopted a modified double-emulsion method to prepare the killer peptide-loaded PLGA noparticles, and the nanoparticles were characterized by using TEM, SEM, Dynamic Laser Scattering, drug loading analysis, ecapsulation efficacy assessment and in vitro release test. We also evaluated the antifungal activities of killer peptide and killer peptide-loaded PLGA nanoparticles against Cry ptOcoccus neoformans ATCC32609 by plate count method. In the in vivo study, the anticryptococcal efficacies of killer peptide and killer peptide-loaded PLGA nanoparticles were compared by observing the survival and colony-forming in vital organs in a systemic murine cryptococcosis model. Results1 We successfully synthesized killer peptide-loaded PLGA nanoparticles. In vitro anticryptococcal test showed that the killer peptide and killer peptide-loaded PLGA nanoparticles had significantly stronger anticryptococcal effect compared with the normal saline group (P<0.05), and there was no significant difference in the efficacies between free killer peptide and killer peptide-loaded PLGA nanoparticles (P>0.05). In vits test demonstrated that mice treated with killer peptide-loaded PLGA nanoparticles (3 mg/kg or 5 mg/kg) had longer survival period and less fungal burden in vital organs than mice treated with free killer peptide (P<0.05); there was no significant difference in fungal burden and survival period between empty PLGA nanoparticle treated group and normal saline group (P>0.05). Conclusion: The killer peptide-loaded PLGA nanoparticles are more effective in treating systemic murine cryptococcosis.

The quorum sensing commonly exists in procaryote kingdom, regulating various biologic functions. Recently similar phenomenon was also found in fungi world, which affecting both biofilm formation and dimorphism. In this article, we focus on the recent progress on quorum sensing of pathogenic fungi and discuss the possibility of taking quorum sensing molecule as a potential target for antifungl therapy.

Objective To explore the regulation of berberine on the expressions of CDK4 and cyclin D1 in the neurons after the focal cerebral ischemia/reperfusion and the potential protective mechanism of berberine to neurons. Methods Fifty male Wistar rats were randomly divided into berberine-treated group (n=15), normal control group (n=5), sham-operated group (n=15) and vehicle-treated group (n=15). The model of focal cerebral ischemia was constructed using middle cerebral artery occlusion (MCAO) method. At 1, 3, 5 d after 1 hour ofischemia, the expressions and distributions of Bcl-2, cyclin D1 and CDK4 in each group were detected by immunohistochemistry, and morphological changes of brain were observed by HE staining. Results HE staining showed that in the berberine-treated group, the number of neurons was decreased less than that in vehicle-treated group at reperfusion 3 and 5 d. For the result of immunohistochemistry for Bcl-2 positive neurons, there was no obvious difference between berberine-treated group and vehicle-treated group at reperfusion 1 d (P>0.05),however, the number of the Bcl-2 positive cells in berberine-treated group at reperfusion 3 and 5 was significantly increased (P<0.01), and the numbers of cyclin D 1 and CDK4 positive cells were decreased as compared with those in the vehicle-treated group. Conclusions In the rat focal ischemia model,berberine can inhibit the neural expressions of cyclin D1 and CDK4 in the penumbra, that indicates berberine may have the potential of neural protection. The possible mechanism is that berberine can decrease the neural expression ofcyclin D1 and prevent it from entering the nucleus, thereby blocking the cascade reaction and suppressing the apoptosis mediated by cyclin D1.

BACKGROUNDUp to now, locally advanced non-small cell lung cancer simutaneously involving carina, heart and great vessels is still regarded as contraindication for surgical treatment. However, the prognosis is very poor in these patients treated with chemotherapy and/or chemoradiotherapy. The aim of this study is to summarize the clinical experiences of carinoplasty combined with heart and great vessel plasty in the treatment of 84 patients with locally advanced non-small cell lung cancer involving carina, heart and great vessels or both in our hospital.

METHODSFrom March, 1988 to December, 2004, carinal resection and reconstruction combined with heart, great vessel plasty was performed in 84 patients with locally advanced non-small cell lung cancer involving carina, heart and great vessels simutaneously. The operative procedures in this series included as follows: (1) Right upper sleeve lobectomy combined with carinal resection and reconstruction, and right pulmonary artery sleeve angioplasty in 9 patients; (2) Right sleeve pneumonectomy combined with partial resection and reconstruction of left atrium, and superior vena cava resection and Gortex grafts in 3 cases; (3) Left upper sleeve lobectomy combined with carinoplasty, left pulmonary artery sleeve angioplasty and partial resection and reconstruction of left atrium in 3 cases; (4) Right upper sleeve lobectomy combined with carinoplasty, right pulmonary artery sleeve angioplasty and partial resection and reconstruction of left atrium in 10 cases; (5) Left upper sleeve lobectomy combined with carinoplasty and left pulmonary artery angioplasty in 9 cases; (6) Left upper sleeve lobectomy combined with carinoplasty, left pulmonary artery sleeve angioplasty and resection of the aorta arch sheath in 6 cases; (7) Right upper-middle sleeve lobectomy combined with carinoplasty and right pulmonary artery sleeve angioplasty in 3 cases; (8) Left upper sleeve lobectomy combined with carinoplasty, left pulmonary artery angioplasty, resection of the aorta arch sheath and partial resection and reconstruction of left artium in 8 cases; (9) Right upper sleeve lobectomy combined with carinoplasty, right pulmonary artery angioplasty and partial resection and reconstruction of left atrium in 4 cases; (10) Left sleeve pneumonectomy combined with partial resection and reconstruction of left atrium in 3 cases; (11) Right upper-middle sleeve lobectomy combined with carinoplasty, right pulmonary artery angioplasty and superior vena cava resection and reconstruction with Gortex grafts in 23 casese; (12) Right sleeve pneumonectomy combined with partial resection and reconstruction of left atrium in 1 case; (13) Right upper-middle sleeve lobectomy combined with carinoplasty, right pulmonary artery angioplasty and partial resection and reconstruction of left atrium in 1 case; (14) Right upper-middle sleeve lobectomy combined with carinoplasty, right pulmonary artery angioplasty and right inferior pulmonary vein sleeve resection and reconstruction in 1 case.

RESULTSThere were two operative death in this series. The operative mordality was 2.38%. A total of 32 patients had operative complications. The incidence of operative complications was 38.10%. The 1-, 3-, 5-and 10-year survival rate was 81.34%, 59.47%, 31.73% and 24.06% respectively.

CONCLUSIONS(1) It is feasible in technique that carinal resection and reconstruction combined with heart, great vessel plasty in the treatment of locally advanced non-small cell lung cancer involving carina, heart and great vessels simutaneously; (2) Multiple modality therapy based on carinal resection and reconstruction combined with heart and great vessel plasty can remarkably increase the survival rate, and improve the prognosis and quality of life in patients with locally advanced non-small cell lung cancer involving carina, heart and great vessels.

Chronic refractory wound (CRW) is one of the most challengeable issues in clinic due to complex pathogenesis, long course of disease and poor prognosis. Experts need to conduct systematic summary for the diagnosis and treatment of CRW due to complex pathogenesis and poor prognosis, and standard guidelines for the diagnosis and treatment of CRW should be created. The Guideline forthe diagnosis and treatment of chronic refractory wounds in orthopedic trauma patients ( version 2023) was created by the expert group organized by the Chinese Association of Orthopedic Surgeons, Chinese Orthopedic Association, Chinese Society of Traumatology, and Trauma Orthopedics and Multiple Traumatology Group of Emergency Resuscitation Committee of Chinese Medical Doctor Association after the clinical problems were chosen based on demand-driven principles and principles of evidence-based medicine. The guideline systematically elaborated CRW from aspects of the epidemiology, diagnosis, treatment, postoperative management, complication prevention and comorbidity management, and rehabilitation and health education, and 9 recommendations were finally proposed to provide a reliable clinical reference for the diagnosis and treatment of CRW.

Lower extremity deep vein thrombosis (DVT) is one of the main complications in patients with traumatic fractures, and for severe patients, the DVT can even affect arterial blood supply, resulting in insufficient limb blood supply. If the thrombus breaks off, pulmonary embolism may occur, with a high mortality. The treatment and rehabilitation strategies of thrombosis in patients with lower extremity fractures have its particularity. DVT in traumatic fractures patients has attracted extensive attention and been largely studied, and the measures for prevention and treatment of DVT are constantly developing. In recent years, a series of thrombosis prevention and treatment guidelines have been updated at home and abroad, but there are still many doubts about the prevention and treatment of DVT in patients with different traumatic fractures. Accordingly, on the basis of summarizing the latest evidence-based medical evidence at home and abroad and the clinical experience of the majority of experts, the authors summarize the clinical treatment and prevention protocols for DVT in patients with traumatic fractures, and make this consensus on the examination and assessment, treatment, prevention and preventive measures for DVT in patients with different fractures so as to provide a practicable approach suitable for China ′s national conditions and improve the prognosis and the life quality of patients.

Since December 2019, novel coronavirus pneumonia (NCP) has been reported in Wuhan, Hubei Province, and spreads rapidly to all through Hubei Province and even to the whole country. The virus is 2019 novel coronavirus (2019-nCoV), never been seen previously in human, but all the population is generally susceptible. The virus spreads through many ways and is highly infectious, which brings great difficulties to the prevention and control of NCP. Based on the needs of orthopedic trauma patients for emergency surgery and review of the latest NCP diagnosis and treatment strategy and the latest principles and principles of evidence-based medicine in traumatic orthopedics, the authors put forward this expert consensus to systematically standardize the clinical pathway and protective measures of emergency surgery for orthopedic trauma patients during prevention and control of NCP and provide reference for the emergency surgical treatment of orthopedic trauma patients in hospitals at all levels.