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.

Objective To discuss the short-term efficacy and safety of primary percutaneous reduction combined with robotic-assisted screw placement for the treatment of Sanders type Ⅲ and Ⅳ calcaneal frac-tures.Methods A total of 52 patients(52 feet)with Sanders type Ⅲ and Ⅳ calcaneal fractures admitted to this hospital from August 2022 to October 2024 were selected as the study subjects.33 patients were treated with robot assisted screw placement(the observation group),including 23 cases of Sanders type Ⅲ patients(4 cases of AC type,16 cases of AB type,3 cases of BC type)and 10 cases of Sanders type Ⅳ patients;19 patients underwent manual screw placement under C-arm X-ray fluoroscopy(the control group),including 14 cases of Sanders type Ⅲ(5 cases of AC type,9 cases of AB type)and 5 cases of Sanders Ⅳ type.The B?hler angle,Gissane angle,calcaneal height,calcaneal width,and calcaneal length were compared between the two groups at 3 and 12 months after surgery.The differences in the time from injury to surgery,intraoperative blood loss,number of intraoperative fluoroscopies,total incision length,operation time,number of screws inserted,num-ber of punctures,hospital stay,fracture healing time,and proportion of tarsal sinus incision-assisted reduction between the two groups were evaluated and compared.The American Orthopedic Foot and Ankle Society(AOFAS)ankle and hindfoot function score,excellent rate of function and visual analog scale(VAS)pain score after surgery were also compared,and the incidence of postoperative complications between the two groups were compared to evaluate safety.Results Both groups of patients were followed up for more than 12 months after surgery.At 3 and 12 months postoperatively,B?hler's angle,Gissane's angle,calcaneal length,calcaneal height,and calcaneal width in both groups showed significant improvements compared to preopera-tive measurements,but there was no statistically significant difference between the two groups(P＞0.05).The intraoperative blooding loss,number of intraoperative fluoroscopies,operation time,and number of punc-tures in the observation group were all lower than those in the control group,and the differences were statisti-cally significant(P＜0.05);There was no statistically significant difference in the time from injury to surger-y,total incision length,number of screws inserted,hospital stay,fracture healing time,proportion of tarsal si-nus incision-assisted reduction,and excellent rate of function between the two groups of patients(P＞0.05).The AOFAS ankle and hindfoot function score of the observation group was higher than that of the control group at 3 months after surgery,and the VAS pain scores in the early postoperative period was lower than that of the control group,the differences were statistically significant(P＜0.05).The incidence of complications such as lower ankle pain,traumatic arthritis,and plantar pain in the observation group was significantly lower than that in the control group,and the difference was statistically significant(P＜0.05).Conclusion Com-pared with manual screw placement,primary percutaneous reduction combined with robotic-assisted screw placement for the treatment of Sanders type Ⅲ and Ⅳ calcaneal fractures is more effective,safe,precise,mini-mally invasive and efficient,with less intraoperative bleeding and lower incidence of complications.

Objective:To investigate the risk factors for postoperative stiffness following rotator cuff repair and to develop a predictive risk assessment model.Methods:A retrospective analysis was conducted on 251 patients (111 males and 140 females) who underwent rotator cuff repair at the Department of Orthopedics, Civil Aviation General Hospital, from June 2016 to December 2022. Patients were divided into two groups based on the time of admission: the modeling group, comprising patients treated from June 2016 to June 2021, was used to construct the risk assessment model, while the validation group, including those treated from July 2021 to December 2022, was used to evaluate the model's effectiveness. In the modeling group, the incidence of postoperative stiffness one year after surgery was assessed. The study collected data on age, sex, body mass index, disease duration, smoking history, diabetes history, preoperative fat infiltration of the rotator cuff muscles, tear size, suturing technique, preoperative stiffness, re-tear rate, visual analogue scale (VAS) scores at two and six weeks postoperatively, Constant-Murley scores at six weeks postoperatively, and both preoperative and postoperative critical shoulder angle (CSA), acromial index (AI), and lateral acromion angle (LAA). Univariate analysis was used to identify potential risk factors for postoperative stiffness, followed by multivariate logistic regression to construct the risk assessment model. The validation group was used to reassess the identified risk factors.Results:Postoperative stiffness occurred in 21 out of 176 patients in the modeling group. Logistic regression analysis revealed that diabetes history, higher fat infiltration of the rotator cuff muscles, larger tear size, preoperative stiffness, higher VAS score at six weeks postoperatively, and lower Constant-Murley score at six weeks postoperatively were significant risk factors for postoperative stiffness. Based on the logistic regression model, a nomogram was created using R software. In the validation group, postoperative stiffness was observed in 11 out of 75 patients. The area under the ROC curve (AUC=0.926) indicated good discriminative ability in predicting postoperative stiffness. The goodness-of-fit test (H-L test: χ 2=2.215, P=0.947) demonstrated moderate calibration of the model. Conclusion:A history of diabetes, high fat infiltration of the rotator cuff muscles, large or massive rotator cuff tears, preoperative stiffness, higher VAS scores at six weeks postoperatively, and lower Constant-Murley scores at six weeks postoperatively are significant risk factors for postoperative stiffness after rotator cuff repair. The risk assessment model shows good discriminative power and calibration, making it a useful tool for predicting the risk of postoperative stiffness following rotator cuff repair.

Objective To explore esomeprazole(EMZ)on acetaminophen(APAP)pharmacokinetics and intestinal microbial balance.Methods A total of 14 rats were randomly allocated into two groups,with 7 rats in each group:acetaminophen group(APAP group),and acetaminophen+esomeprazole combination group(APAP+EMZ group),respectively.Rats in the combination group were fed in the metabolic cage.Equivalent 3.6 mg·kg-1·d-1 esomeprazole was administered intragastrically to the combination group for 14 days;Similarly,an equal volume of 0.9％sodium chloride soution(NaCl)was fed to the APAP group for 14 days.During this period,fecal samples were collected from the rats before and after 14 days of EMZ administration for microbial 16S rRNA sequencing.On the 15th day,both the APAP group and APAP+EMZ groups were administratered an equivalent of 44.82 mg·kg-1 APAP by the same method after the regular EMZ administration.The concentrations of APAP in rat plasma were determined by the UPLC-MS/MS method.Main pharmacokinetic parameters were processed and compared using the software DAS 3.0.1 and SPSS 24.0.Results The pharmacokinetic parameter Cmax of APAP was significantly different between APAP group and APAP+EMZ group(P＜0.05).Compared with APAP group,Cmax increased by 120.38％in the APAP+EMZ group.The pharmacokinetic parameters(AUC(0-∞)、CL、t 1/2、tmax)of APAP showed no statistical differences between APAP group and APAP+EMZ group(P＞0.05).The results of 16SrRNA of intestinal flora showed that the abundance of Lactobacillus,Bacteroides,Clostridium,and Escherichia decreased compared with that before drug administration,while the abundance of Bifidobacterium increased.However,the relative abundance of the above flora showed no prominent differences before and after the EMZ intervention(P＞0.05).Conclusions This study showed that when combining EMZ with APAP,the relative abundance of those related flora,which may influence the β-Glucuronidase,all changed to some extent,but made no difference in statistics.The effect of EMZ on the Cmax of APAP was statistically significant.However,the use of EMZ for two weeks did not alter the other pharmacokinetics of APAP by affecting the gut microbiota.

Objective:To asscentain the 131I activity concentration in 131I treatment workplaces and to explore the method of estimating the internal dose to workers by air sampling and to analyze its influencing factors. Methods:Air sampling method was used to collect aerosols containing radioactivity in 10 randomly selected workplaces in Zhengzhou where 131I therapy was performed. Aactivity concentration of 131I in treatment workplace was measured for gamma emitters by gamma-ray spectrometry. The internal dose due to 131I inhalation was estimated based on measurement result and field investigation result. Results:The activity concentration of 131I in air samples from 19 subpacking rooms ranged from 0.087 to 570 Bq/m 3, with an average of (51.04 ± 128.58) Bq/m 3. Those from 11 wards ranged from 0.162 to 54.6 Bq/m 3, with an average of (7.97 ± 15.89) Bq/m 3. In terms of the work hours recommended by the national standard GBZ 129-2016 Specifications for individual monitoring of occupational internal exposure, the estimated annual effective dose to radiation workers due to the inhalation of 131I ranges from 0.002 to 10 mSv, with an average of (0.61 ± 1.80) mSv, below the dose limit specified in the national standards. Conclusions:The samples with high 131I activity concentration in nuclear medicine workplaces of 10 medical institutions selected in Zhengzhou are mostly distributed in tertiary class hospitals operating large amount of radionuclide with large numbers of thyroid cancer patients adimitted. The result ing internal dose to radiation workers cannot be ignored. Estimating the internal dose based on the measurement result of air samples has a large uncertainty.However, air sampling method can promptly detect radioactive contamination in case of abnormal events or accidents, providing early warning for workers to carry out dose measurement from external exposure and internal exposure assessment.

Objective:To explore the correlation between the anatomical features of shoulder joint and the re-tear rate after surgical repair for small and medium-sized rotator cuff tears.Methods:From June 2017 to June 2019, 55 patients who were diagnosed with small or medium-sized rotator cuff tears and treated with arthroscopic single-row repair were enrolled. Demographics including age, sex, disease course, history of smoking and diabetes mellitus, re-tear rates, Constant-Murley score, University of California, Los Angeles score (UCLA) at 6-month, 1-year, 2-year and 3-year after operation were collected. Postoperative critical shoulder angle (CSA) and acromial index (AI) were measured and calculated based on CT scan. The patients were divided into two groups: patients who got re-tear history during follow-up were included into endpoint re-tear (ER) group, and those who got no re-tear history during follow-up were included into endpoint non-tear (EN) group. One-way Anova was used to compare the CSA\AI among different follow-up point. Fisher's exact test was used to compare sex, morbidity of smoking and diabetes between the ER and EN groups. Two independent samples t-test were used to compare age, disease course, CSA and AI at 1-day after operation, functional scores at each follow-up point between the two groups. Binomial logistic regression analysis was performed to test CSA and AI at 1-day after operation as the risk factors of rotator cuff re-tear at 6-month, 1-year, 2-year and 3-year after operation. The predictive efficacy of CSA and AI at 1-day after operation on re-tear rate at 3-year after operation were evaluated by receiver operating characteristic (ROC) curves, Pearson correlation analysis was used to evaluate the correlation between postoperative CSA/AI and postoperative functional recovery. Results:The CSA and AI of ER group were insignificantly different among all follow-up point ( P>0.05), the CSA and AI of EN group were significantly different among all follow-up point ( F=14.163, P<0.001; F=4.635, P<0.001). The re-tear rates at 6-month, 1-year, 2-year and 3-year after operation were 3.6%, 7.3%, 12.7%, 18.2%. The Constant-Murley score and UCLA scores of ER group at 3-year after operation were 93.60±2.84 and 32.30±1.49, respectively while in EN group, they were 92.11±4.10 and 33.18±1.27, respectively, there were no difference of the Constant-Murley score and UCLA score between ER and EN group at 3-year after operation ( P>0.05). CSA at 1-day after operation was the risk factor to re-tear at 1-year, 2-year and 3-year after operation [ OR=4.622, 95% CI (1.01, 21.06), P=0.048; OR=7.071, 95% CI (1.52, 32.87), P=0.013; OR=3.40, 95% CI (1.42, 8.12), P=0.006]. CSA and AI at 1-day after operation had certain predictive efficacy for rotator cuff re-tear at 3-year after rehabilitation, and CSA was more specific than AI, the optimal cutoff values of CSA and AI at 1-day after operation for predicting rotator cuff re-tear at 3-year after operation were 35.3°and 0.69, the AUC were 0.87 [ OR=3.40, 95% CI (1.42, 8.12), P<0.001]、0.77 [ OR=1.33, 95% CI (0.87, 2.02), P=0.008] respectively. CSA and AI had no relationship with postoperative functional recovery. Conclusion:Greater CSA and AI were predictive factors of small and medium-sized rotator cuff re-tear 1-3 years after surgery with CSA being more specific than AI. However, CSA and AI had no relationship with postoperative functional recovery.

Objective:To investigate the correlation between anatomical features of shoulder joint and postoperative stiffness after rotator cuff repair.Methods:212 patients diagnosed with rotator cuff injury undergoing rotator cuff repair in Civil Aviation General Hospital from March 2016 to December 2021 were enrolled. There were 97 male and 115 female with an average age of 58.87±9.69 years old (range, 41-72). The patients were divided into stiffness group (SG) and non-stiffness group (NG) according to the range of shoulder joint motion at 3-month after operation. Preoperative and postoperative joint anatomical features including critical shoulder angle (CSA), acromial index (AI), lateral acromion angle (LAA) were measured and calculated through CT scan and 3-dimension reconstruction. Age, sex, course of disease, body mass index, tendon fatty infiltration degree, type of rotator cuff injury according to DeOrio & Cofield classification, suture method, and preoperative and 3-month postoperative range of shoulder motion (flexion, abduction, and external rotation), preoperative stiffness condition were collected. All factors between two groups were compared, and binomial logistic regression analysis was performed to find out the risk factors of postoperative joint stiffness. Receiver operating characteristic (ROC) curves were plotted to evaluate the predictive efficacy of postoperative CSA, AI, and LAA for postoperative joint stiffness.Results:43 patients were enrolled in SG and 169 patients were enrolled in NG. Age, sex, course of disease, body mass index, tendon fatty infiltration degree, type of rotator cuff injury according to DeOrio & Cofield classification, suture method, and preoperative range of shoulder motion (flexion, abduction, and external rotation) between two groups were insignificantly different ( P>0.05). The ratio of patients with preoperative stiffness in SG is higher than that in NG (χ 2=40.38, P<0.001). Postoperative CSA and AI of SG were greater than those of NG ( t=5.44, P<0.001; t=4.89, P<0.001), and postoperative LAA of SG was smaller than that of NG group ( t=-5.86, P<0.001). Preoperative stiffness, large postoperative AI and small postoperative LAA were all risk factors of joint stiffness after rotator cuff suture [ OR=9.32, 95% CI(3.44, 25.27), P<0.001; OR=2.39, 95% CI(1.58, 3.62), P<0.001; OR=0.64, 95% CI(0.46, 0.91), P=0.012]. Postoperative CSA, AI and LAA had a certain predictive effect on postoperative joint stiffness (AUC>0.70). LAA was the most sensitive factor and CSA was the most specific factor. The optimal cutoff values of CSA, AI and LAA were 34.4°, 0.70 and 74.5° respectively, and the AUC for predicting postoperative joint stiffness were 0.76 [ OR=0.98, 95% CI(0.69, 0.84), P<0.001]、0.78[ OR=2.39, 95% CI(0.70, 0.84), P<0.001]、0.76[ OR=0.64, 95% CI(0.68, 0.83), P<0.001]. Conclusion:Postoperative CSA, AI and LAA had predictive efficacy on joint stiffness after rotator cuff repair. The greater postoperative CSA and AI or smaller postoperative LAA indicates increased risk of postoperative joint stiffness. LAA was the most sensitive factor and CSA was the most specific factor.

Glioma is the most common primary intracranial central nervous system tumor, and postoperative radiotherapy is an important treatment for glioma. At present, computed tomography (CT) and magnetic resonance imaging (MRI) are widely applied in the delineation of radiotherapy targets for glioma. However, there are still some deficiencies in evaluating tumor scope, recurrence, radiation necrosis and prognosis, etc. Positron emission tomography (PET) / computed tomography (PET-CT) combines the molecular images of PET with the anatomical images of CT, which plays an important role in the diagnosis and differential diagnosis of glioma. With the popularization and application of multimodal imaging technology in radiotherapy, PET-CT molecular imaging, as an important supplement, contributes to the delineation of glioma target volume and the development of accurate radiotherapy, and brings benefits to the prognosis and follow-up of glioma patients. In this article, the application and research progress on PET-CT in the diagnosis, treatment and follow-up for glioma were reviewed.

Objective:To estimate the hospitalization rate of Haemophilus ( H.) influenzae associated community-acquired pneumonia in children under 5 years in Suzhou. Methods:From 2010 to 2014, medical records and bacteriology results of children under 5 years hospitalized with community-acquired pneumonia in Children's Hospital of Soochow University were collected, retrospectively. Detection rate of H. influenzae was describe. The hospitalization rate of H. influenzae associated community-acquired pneumonia was estimated using the number of local children in urban area of Suzhou, which was obtained from the immunization platform of Suzhou Center for Disease Prevention and Control. Results:A total of 28 043 hospitalized pneumonia cases were included from 2010 to 2014, in which 19 526 (69.63%) had bacteriological examination. The overall detection rate of H. influenzae was 11.06% (2 160/19 526), and children aged 12-23 months had the highest positive rate (14.29%, 550/3 850), and the rate was higher during winter-spring than during summer-autumn ( χ 2=455.11, P<0.01). The average hospitalization rate of H. influenzae associated pneumonia in children under 5 years was 760.36/100 000 (95% CI: 733.70/100 000-787.01/100 000), which was higher in winter and spring (898.79/100 000 and 1 249.52/100 000) than in summer and autumn (514.35/100 000 and 359.04/100 000), and the hospitalization rate was higher in boys (942.12/100 000) than in girls (563.76/100 000), the differences were all significant ( P<0.01). The highest hospitalization rate was observed in children aged 1-5 months (2 478.31/100 000) and the hospitalization rate decreased with age ( χ 2=2 129.80, P<0.01). Conclusion:There was a considerable burden of H. influenzae associated community-acquired pneumonia in children under 5 years in Suzhou, especially in children under 6 months.

Objective: To analyze the prevalence of and risk factors for infections in patients with pemphigus, and to evaluate their effect on prognosis. Methods: Clinical data were collected from 182 inpatients with pemphigus in Department of Dermatology, Xijing Hospital, Fourth Military Medical University from May 2011 to May 2017, and retrospectively analyzed. Associations of infection rates with age, disease severity, comorbidities, maximum dose of glucocorticoids, hospitalization duration and costs were analyzed. Statistical analysis was carried out with SPSS 22.0 software by using Logistic regression analysis for analyzing risk factors for concurrent infections in pemphigus patients who were hospitalized for the first time. Results: Among the 182 patients, 82 (45.05%) experienced infections. Additionally, 107 pathogenic strains were cultured from secretions from skin lesions of 77 patients, including 60 strains of Staphylococcus aureus (56.07%) , and 58 Staphylococcus aureus strains were resistant to penicillin (96.67%) . Among the 182 patients, infections were observed in 11 of 14 patients with hypoproteinemia, 69 (41.07%) of 168 patients without hypoproteinemia, 4 (4.81%) of 27 patients with mild pemphigus, 34 (37.7%) of 90 patients with moderate pemphigus and 44 (67.69%) of 65 patients with severe pemphigus. Logistic regression analysis showed that the prevalence rate of infections was significantly higher in the patients with hypoproteinemia than in those without hypoproteinemia (OR = 5.559, 95% CI 1.053-29.347, P = 0.043) . Compared with the patients with mild pemphigus, the prevalence rate of infections significantly increased in the patients with moderate (OR = 4.676, 95% CI 1.276-17.123, P < 0.05) or severe pemphigus (OR = 16.529, 95% CI 4.183-65.314, P < 0.001) . The prevalence of infections in patients with pemphigus was unaffected by gender, types of pemphigus, or the presence of hypertension or diabetes (all P > 0.05) . Among the 145 patients who were followed up, 33 were completely cured, 67 were cured clinically, 23 received improvement, 10 experienced relapse or exacerbation, and 12 died. Of the 12 dead patients, 3 died of pneumonia, 2 died of exacerbated pemphigus and skin infections, and 1 died of sepsis. Conclusions High disease severity and hypoproteinemia are risk factors for infections in patients with pemphigus. Bacterial infection is a common complication in patients with pemphigus, and severe infections are one of the causes of death in patients with pemphigus.