RNA-based gene therapy has been widely used for various diseases, and extensive studies have proved that suitable delivery routes greatly help the development of RNA therapeutics. Identifying a safe and effective delivery system is key to realizing RNA therapeutics' clinical translation. Inhalation is a non-invasive pulmonary delivery modality that can enhance the retention of therapeutic agents in the lungs with negligible toxicity, thereby improving patient compliance. Inhaled RNA therapeutics are increasingly becoming an area of focus for researchers; however, only several clinical trials have explored inhaled delivery of RNA for pulmonary diseases. This review presents an overview of recent advances in inhaled delivery systems for RNA therapeutics, including viral and nonviral systems, highlighting state of the art regarding inhalation in the messenger RNA (mRNA) field. We also summarize the applications of mRNA inhalants in infectious and other lung diseases. Simultaneously, the research progresses on small interfering RNAs (siRNAs), antisense oligonucleotides (ASOs), and different types of RNA are also discussed to provide new strategies for developing RNA inhalation therapy. Finally, we clarify the challenges inhaled RNA-based therapeutics face before their widespread adoption and provide insights to help advance this exciting field to the bedside.

Feeding interruption related to airway procedures is a crucial factor contributing to enteral feeding disruption in critically ill patients,and it represents a significant cause of inadequate enteral nutrition delivery.Prolonged or repeated interruptions exacerbate the insufficiency of enteral nutrition,impede patient recovery,and increase the risk of adverse complications.The absence of clear guidelines and standardized protocols has led to variations in clinical practices regarding feeding interruption during airway procedures.This article provides an overview of the clinical importance and current practices associated with feeding interruption during airway procedures in critically ill patients.Additionally,potential avenues for future research are proposed with the aim of enhancing standardization,safety,and efficacy in feeding interruption practices linked to airway procedures for critically ill patients.

To summarize the nursing experience of a patient undergoing laryngeal transplantation due to laryngeal cancer.The case involved the development of a critical care management plan by a multidisciplinary team.By implementing nursing measures such as refined airway care,professional neck wound complication management,precise administration of immunosuppressants,ultrasound monitoring for nutritional management assurance,individualized psychological care,early rehabilitation of swallowing,speech and body function,thyroid function and hyperglycemia monitoring and other measures,the patient stayed in ICU for 23 days post-surgery and discharged after 40 days from admission.

Objective:To learn about the status of iodine deficiency disorders (IDD) in Zhumadian City, Henan Province, and to provide basis for scientific intervention measures.Methods:From 2016 to 2020, monitoring sites were set up in nine counties (districts) of Zhumadian City, and a town/street was selected from each of the five directions of East, West, South, North and Middle at each monitoring site. One primary school was selected from each town/street, 40 non-boarding children aged 8-10 years were selected from each primary school (half male and half female). In addition, 20 pregnant women were selected from each town/street. Urine samples and edible salt samples at home were collected from these children and pregnant women for iodine determination. Some children and pregnant women were selected to investigate the awareness rate of IDD prevention and treatment knowledge. Thyroid B-ultrasound examination was performed in some children. Iodine in drinking water was determined according to the national and provincial requirements of "strengthening scientific iodine supplementation".Results:From 2016 to 2020, a total of 13 500 salt samples were tested, including 12 453 qualified iodized salt samples and 246 non-iodized salt samples. The qualified iodized salt consumption rates of children and pregnant women were 92.26% (8 303/9 000) and 92.22% (4 150/4 500), respectively, and the non iodized salt consumption rates were 1.89% (170/9 000) and 1.69% (76/4 500), respectively. The median urinary iodine concentration of children were 208.91, 179.02, 222.85, 203.50 and 230.50 μg/L, respectively. The median urinary iodine concentration of pregnant women were 182.01, 153.26, 178.72, 196.82 and 178.75 μg/L, respectively. The goiter rate in children was 1.63% (49/3 000), there was no significant difference between different age groups (χ 2 = 0.47, P = 0.790), and between different genders (χ 2 = 0.01, P = 0.912). The awareness rate of IDD prevention and treatment knowledge was 94.68% (11 916/12 585) in children and 91.75% (4 537/4 945) in pregnant women. A total of 27 664 water samples were collected from 1 572 administrative villages, with a median of 12.90 μg/L of water iodine, including 1 383 low-iodine villages, 173 moderately iodine villages and 16 high-iodine villages. Conclusions:Children's iodine nutrition exceeds the appropriate amount, and pregnant women's iodine nutrition is appropriate in Zhumadian City Henan Province. In combination with the results of water iodine monitoring, we will continue to carry out IDD monitoring and consolidate the results of prevention and control.

Objective:To investigate the adherence of patients with chronic airway disease with inhalation therapy and to explore the influencing factors.Methods:A total of 180 outpatients with chronic airway disease were selected by convenient sampling. The general information, adherence of inhalation therapyquestionnaire, asthma knowledge questionnaire, chronic obstructive pulmonary disease (COPD) health literacy questionnaire (COPD-Q) were used to evaluate the general information, adherence of inhalation therapy and disease knowledge level of the patients. The severity of the disease was evaluated by asthma control test (ACT) score and COPD assessment test (CAT) score. ANOVA and t-test were used to analyze the adherence of patients with chronic airway disease, and multivariate linear regression was used to analyze the adherence. Results:The adherence score of asthma patients was 89.74 ± 7.27 and the adherence score of COPD patients was 86.80 ± 9.16, which were in the middle level. The risk factors of non-adherence of inhalation therapy were retirement, living alone and smoking. The effect of inhaled treatment time on the adherence of inhaled therapy is not linear, and the turning point of adherence decline occurs one year after the patients received inhaled therapy. The results of multiple linear regression showed that the effect of course and employment on the adherence of inhalation therapy was statistically significant.Conclusions:The adherence of chronic airway disease patients with inhalation therapy is not ideal, especially for the patients with long course, smoking, retirement and living alone, the medical staff should pay more attention, take appropriate intervention measures to improve the adherence of inhalation therapy.

The clinical application of immune checkpoint inhibitors (ICIs) has significantly improved the prognosis of hepatocellular carcinoma (HCC) patients. With the widespread applica-tion of ICIs in HCC, the management of immune-related adverse events (irAE) gained more and more attention. However, the complicated disease characteristics and various combination therapies in HCC throw out challenges to irAE management. Therefore, the editorial board of the 'Chinese expert consensus on the management of immune-related adverse events of hepatocellular carcinoma treated with immune checkpoint inhibitors (2021 edition)' organizes multidisciplinary experts to discuss and formulate this consensus. The consensus focuses on issues related to HCC irAE manage-ment, and puts forward suggestions, in order to improve standardized and safety clinical medication, so as to maximize the benefits of immunotherapy for patients.

Objective:Anlotinib is an oral multi-target tyrosine kinase inhibitor (TKI) with dual effects of anti-proliferation and anti-angiogenesis. Phase Ⅰ clinical trials showed anlotinib was well tolerated and had therapeutic effects on a variety of tumors. The aim of this study is to explore the safety and efficacy of anlotinib in the treatment of metastatic renal cell carcinoma.Methods:Between January 2014 and November 2015, a single-center data was obtained from a phase Ⅱ clinical study of anlotinib versus sunitinib on advanced renal cell carcinoma and a phase Ⅱ clinical study of anlotinib on advanced renal cell carcinoma which failed to respond to TKI treatment. Kaplan-Meier method was used for survival analysis, while Log-rank test was used to compare the survival rates.Results:A total of 36 patients with advanced renal cell carcinoma were enrolled in this study, including 19 patients without any target drug treatment, 12 patients with sunitinib treatment and 5 patients with sorafenib treatment. The median number of treatment cycle was 16. Partial response (PR) was obtained in 11 patients (30.6%) and stable disease (SD) was obtained in 24 patients (66.7%). The disease control rate (DCR) was 97.2%. The median progression free survival (PFS) was 12.6 months, the 1-year survival rate was 80.6%, and the median survival time was 22.2 months. Up to the follow-up deadline, 3 patients still received treatment, the PFSs were 52.6 months, 65.0 months, and 66.7 months. The most common treatment-related adverse events of grade 3 or 4 included hypertension (19.4%), hand-foot skin reaction (11.1%), proteinuria (5.6%) and anemia (5.6%).Conclusions:Anlotinib shows good anti-tumor activity and is generally well-tolerated in the treatment of advanced renal cell carcinoma. The adverse reactions of anlotinib are milder than sunitinib or pazopanib.

Objective:Anlotinib is an oral multi-target tyrosine kinase inhibitor (TKI) with dual effects of anti-proliferation and anti-angiogenesis. Phase Ⅰ clinical trials showed anlotinib was well tolerated and had therapeutic effects on a variety of tumors. The aim of this study is to explore the safety and efficacy of anlotinib in the treatment of metastatic renal cell carcinoma.Methods:Between January 2014 and November 2015, a single-center data was obtained from a phase Ⅱ clinical study of anlotinib versus sunitinib on advanced renal cell carcinoma and a phase Ⅱ clinical study of anlotinib on advanced renal cell carcinoma which failed to respond to TKI treatment. Kaplan-Meier method was used for survival analysis, while Log-rank test was used to compare the survival rates.Results:A total of 36 patients with advanced renal cell carcinoma were enrolled in this study, including 19 patients without any target drug treatment, 12 patients with sunitinib treatment and 5 patients with sorafenib treatment. The median number of treatment cycle was 16. Partial response (PR) was obtained in 11 patients (30.6%) and stable disease (SD) was obtained in 24 patients (66.7%). The disease control rate (DCR) was 97.2%. The median progression free survival (PFS) was 12.6 months, the 1-year survival rate was 80.6%, and the median survival time was 22.2 months. Up to the follow-up deadline, 3 patients still received treatment, the PFSs were 52.6 months, 65.0 months, and 66.7 months. The most common treatment-related adverse events of grade 3 or 4 included hypertension (19.4%), hand-foot skin reaction (11.1%), proteinuria (5.6%) and anemia (5.6%).Conclusions:Anlotinib shows good anti-tumor activity and is generally well-tolerated in the treatment of advanced renal cell carcinoma. The adverse reactions of anlotinib are milder than sunitinib or pazopanib.

Objective In this paper, the extraction process of Xiaozhong-Zhitong granule (XZG) was investigated. Methods In Process 1, the Panax notoginseng (Burk.) F.H.Chen was extracted with other drugs, and in the process 2, the Panax notoginseng (Burk.) F.H.Chen was crushed and directly used as medicine. Rats were randomly divided into blank group, process 1 group, process 2 group and mixture group.The sample concentration of the process 1 group 1 for the stomach was 2.07 g/ml, and the sample concentration of the process 2 group 1 for the stomach was 1.06 g/ml, and the sample concentration of the mixture group for the stomach was 0.015 g/ml, and blank group gavaged equal volume saline. Anti-inflammatory and analgesic effects of acetic acid writhing test, hot plate test, auricle swelling test and egg white-induced plantar swelling test were evaluated. Results Compared with the blank group after 1, 2, 3, and 4 h after administration, the average writhing number of the mice in the process group 1 and the process 2 group (35.50％ ± 8.06％, 35.00％ ± 7.63％vs. 47.00％ ± 1.45％) significantly decreased (P<0.01), and the auricular swelling degree (46.31％ ± 22.25％, 45.41％ ± 21.43％ vs. 73.89％ ± 15.55％) significantly decreased. And compared with the blank group after 0.5, 1, 2, and 4 h after inflammation, the percentage of pain threshold in the first group and the second group increased (P<0.01). While there was no significant difference in the inhibition rate of paw swelling in each group (P>0.05). Conclusions The design of extraction process of XZG was reasonable; when treating swelling and pain, it was better to put the powder of Panax notoginseng (Burk.) F.H.Chen in XZG.

Objective To study the effects of microemulsion/ethosomes on transdermal absorption properties and efficacy of Huoxue Zhitong Cataplasm. Methods The improved Franz diffusion cells were used for the in-vitro permeation experiment with rat skins as the barriers, which was used to evaluate the transdermal absorption properties. In the erxeriment, the contents of paeonol, eugenol and methyl salicylate were used as markers, and detected by ultra performance liquid chromatography to evaluate the transdermal absorption effects. The anti-inflammatory and analgesia activity were evaluated through the writhing plate experiments. Results The cumulative release rate of paeonol in Huoxue Zhitong Cataplasm, Microemulsion Huoxue Zhitong Cataplasm and Ethosomes Huoxue Zhitong Cataplasm were, in order, 65.30%, 61.30%and 60.20%in 24 h;eugenol were, in order, 51.08%, 54.71% and 55.66% in 24 h; methyl salicylate were, in order, 49.20%, 65.17% and 72.15% in 24 h. Furthermore, Microemulsion Huoxue Zhitong Cataplasm high-dose group and Ethosomes Huoxue Zhitong Cataplasm medium-dose group had good effects on reducing the inflammatory exudate of peritoneal capillary and capillary permeability (P<0.05) in animal models. Conclusion Huoxue Zhitong Cataplasm based on microemulsion/ethosomesnano-technology has good transdermal absorption properties and efficacy.