Extracellular vesicles (EVs) are phospholipid bilayer vesicles actively secreted by cells, that contain a variety of functional nucleic acids, proteins, and lipids, and are important mediums of intercellular communication. Based on their natural properties, EVs can not only retain the pharmacological effects of their source cells but also serve as natural delivery carriers. Among them, plant-derived nanovesicles (PNVs) are characterized as natural disease therapeutics with many advantages such as simplicity, safety, eco-friendliness, low cost, and low toxicity due to their abundant resources, large yield, and low risk of immunogenicity in vivo. This review systematically introduces the biogenesis, isolation methods, physical characterization, and components of PNVs, and describes their administration and cellular uptake as therapeutic agents. We highlight the therapeutic potential of PNVs as therapeutic agents and drug delivery carriers, including anti-inflammatory, anticancer, wound healing, regeneration, and antiaging properties as well as their potential use in the treatment of liver disease and COVID-19. Finally, the toxicity and immunogenicity, the current clinical application, and the possible challenges in the future development of PNVs were analyzed. We expect the functions of PNVs to be further explored to promote clinical translation, thereby facilitating the development of a new framework for the treatment of human diseases.

During coronavirus disease 2019 epidemic, the treatment of severe trauma has been impacted. The Consensus on emergency surgery and infection prevention and control for severe trauma patients with 2019 novel corona virus pneumonia was published online on February 12, 2020, providing a strong guidance for the emergency treatment of severe trauma and the self-protection of medical staffs in the early stage of the epidemic. With the Joint Prevention and Control Mechanism of the State Council renaming "novel coronavirus pneumonia" to "novel coronavirus infection" and the infection being managed with measures against class B infectious diseases since January 8, 2023, the consensus published in 2020 is no longer applicable to the emergency treatment of severe trauma in the new stage of epidemic prevention and control. In this context, led by the Chinese Traumatology Association, Chinese Trauma Surgeon Association, Trauma Medicine Branch of Chinese International Exchange and Promotive Association for Medical and Health Care, and Editorial Board of Chinese Journal of Traumatology, the Chinese expert consensus on emergency surgery for severe trauma and infection prevention during coronavirus disease 2019 epidemic ( version 2023) is formulated to ensure the effectiveness and safety in the treatment of severe trauma in the new stage. Based on the policy of the Joint Prevention and Control Mechanism of the State Council and by using evidence-based medical evidence as well as Delphi expert consultation and voting, 16 recommendations are put forward from the four aspects of the related definitions, infection prevention, preoperative assessment and preparation, emergency operation and postoperative management, hoping to provide a reference for severe trauma care in the new stage of the epidemic prevention and control.

Objective    To investigate the use of opioid analgesics during the postoperative hospitalization in patients undergoing lung resection and analyse its influencing factors. Methods    The clinical data of 450 patients undergoing lung resection in Sichuan Cancer Hospital among a multicenter symptom research database (CN-PRO-Lung 1) between November 2017 and January 2020 were analyzed. There were 248 males and 202 females with an average age of 54.7±10.3 years. Results    A total of 448 (99.6%) patients used opioid analgesics. The average daily morphine equivalent dose during the postoperative hospitalization was 48.9 mg. There were statistical differences in postoperative morphine equivalent dose across patients with different sex, age, highest level of education, Charlson Comorbidity Index score, surgical approach, surgical type, operative time, postoperative hospital stay and grade of postoperative complications (all P<0.05). Multivariate analysis showed that sex, surgical approach and postoperative hospital stay were independent influencing factors for morphine use during the postoperative hospitalization in patients undergoing lung resection (all P<0.05). Conclusion    In clinical practice, attention should be paid to postoperative pain for male patients, as well as to promote the application of minimally invasive surgery, and to shorten the length of postoperative hospital stay, in order to ultimately reduce the use of opioids.

Objective:To investigate the clinical features, treatment and prognosis of anti-γ-aminobutyric acid type B receptor (GABA B R) encephalitis. Methods:Retrospective analysis of five patients of anti-GABA BR encephalitis from the Department of Neurology, the University of Hong Kong-Shenzhen Hospital from September 2017 to June 2019 was carried out. Clinical manifestations, auxiliary examination, and treatment were analyzed. The patients were followed up for 3.5-23.0 months to assess their prognosis. Results:Five cases of anti-GABA BR encephalitis (19-81 years old) presented acute onset, with refractory epilepsy as the main clinical manifestation. There were hyperintensive signals on T 2/fluid attenuated inversion recovery in four patients′ temporal lobe and hippocampus. Electroencephalogram showed slow wave or epileptic discharge; Lung mass was found in four patients, and all were small cell lung cancer. Five cases had poor response to first-line immunotherapy (intravenous use of pulse methylprednisolone, high dose immunoglobulin or plasma exchange), then three patients received second-line immunotherapy (rituximab, cyclophosphamide), two of whom with tumor also received tumor chemotherapy. Patients who received second-line treatment and tumor chemotherapy showed better outcome than those who only received first-line treatment. Conclusions:Anti-GABA BR encephalitis present with limbic encephalitis syndromes characterized by refractory epilepsy. For patients with poor response to first-line immunotherapy, initiating second-line immunotherapy as soon as possible can improve the prognosis significantly.

Objective    To study the effect of deep sternal wound infections（DSWIs）treated by the techniques of pectoral major muscular(PM) turnover and non-suture remain after the wound restitution. Method    We retrospectively analyzed the clinical data of 23 patients with DSWIs in our hospital between June 2016 and December 2016. There were 13 males and 10 females at age of 4-73(54.5±19.5) years. There were 8 patients with concomitant diabetes mellitus and 1 patient with chronic obstructive pulmonary disease(COPD) and brain infarction. Eigteen patients were of type Ⅱ, 5 patients of type Ⅲ according to Pairolero’ classification in the DSWIs. Five patients were with remaining abscess cavity in the mediastinum by thoracic compute tomography(CT). Under general anesthesia the DSWIs debrided thoroughly. The PM elevated from the anterior pectoralis major fascia off subcutaneous tissue to lateral to anterior axillary line, the PM cutted off, then made to the muscle flap, turnover PM flap filled and fixed to sternal wound by lighten tensile suture, the subcutaneous tissue and skin sutured by cutting full-thickness. Results    The sternal reconstruction after debridement of the sternal wound was used by bilateral PM flap in the 17 patients, unilateral PM in 6 patients. There were 21(91.3%) patients in stage Ⅰ healing, 2 patients deferment healing of local cut skin without reoperation. There were 22 patients with non-paradoxical breathing during the postoperation. One death resulted from multiple-organ failure of the concomitant disease. The average of hospital day was 10.6 days. The wound healing was good by chest CT at 1 month after the operation. Conclusion    The sternal forming by the technique of the PM flap turnover, without remain of fremde stoffe in wound for DSWIs is distinctive method, evident effect.

Objective: To study the correlation between the empty bottle volume, negative pressure and gas production of the freeze-dried powder in the out-patient pharmacy intravenous admixture center of a children' s hospital in order to provide reference for the drug production. Methods:20 ml Syringes were used to measure the volume of empty bottles, negative pressure and produced gas. The relationship between the theoretical drug dissolution volume and the actual dissolution volume was compared, and the precautions for the drug production were put forward. Results:Among the tested 30 drugs, 6 ones were with the actual dissolution volume half of the theoretical dissolution volume, 8 ones were with negative pressure in the bottles, and 3 ones were with produced gas after dissol-ving. It was appropriate that the empty bottle volume be 4 ml larger than the theoretical dissolution volume, and it was appropriate that the negative pressure volume of drugs was slightly larger than the theoretical dissolution volume. Negative pressure should be still kept in the bottles after the gas production. Conclusion:The design of part of freeze-dried powder injection needle shows defects resulting in drug mixing difficulties to a certain extent.

Objective To investigate the clinic efficacy of proximal humeral internal locking system(PHILOS) in the treatment of Neer Ⅱ and Ⅲ proximal humeral fractures.Methods From January 2013 to December 2015,a total of 47 patients with Neer Ⅱ and Ⅲ proximal humeral fractures was treated with PHILOS fixation in our hospital.The operative time,blood loss in operation,hospital stay,complications,Constant scores and radiography films were retrospectively analyzed.Results All 47 patients were followed up for an average of (19.2 ±9.6) month.The average operative time,the level of average intraoperative blood loss,the mean hospitalization time and the complication rate were(95.6 ±43.1) min,(108 ± 41.6) mL,(11.3 ±3.2) d and 14.7 ％ respectively.The Constant score was improved from(21.74 ± 8.24) preoperatively to(82.83 ± 7.21) at the last follow-up,and the difference was statistically significant(t=-36.57,P＜0.01).Conclusion Fixation with PHILOS is a safe and effective treatment for patients with Neer Ⅱ and Ⅲ proximal humeral fractures.

Objective: To establish the standardized management mode for emergent medicines of inpatient area based on JCI. Methods:The expiry verification data of emergent medicines in hospital wards were collected from 2013 to 2015. The number and the amount of emergent medicines expired in the last three months in each calendar month during the three years were analyzed, the exist-ing problems in the management mode were found out and gradually optimized using PDCA cycle. Results:From 2013 to 2015, the re-placement amount of emergent medicines expired in the next month was 3497. 37 yuan. The number of emergent medicines expired in current month was 62. A total of 420 times of emergent medicines didn' t meet the requires of expiry verification from 2013 to 2015. After the check-in form redesign for emergent medicines and the standardization of replacement process, the number of expired medi-cines in the rescue carts was reduced, and the validity and quantity of drugs in all the rescue vehicles could be clearly shown in the new form. Conclusion:The standardization of emergent medicine management model can guarantee the safety of emergent medicines used in patients.

Objective: To study the dosages of capsules commonly used in children to provide reference for the addition of capsule specification for children.Methods: According to the application situation of capsule dosages commonly used for the inpatients in one children's hospital from January 1, 2013 to September 1, 2016, and combined with the usage rates of various drugs with different dosages, the addition of the minimum dosage of capsules was proposed.Results: Totally 10 species of commonly used capsules were selected from the children's hospital, and among them, 4 ones met the requirements of clinics, and the other 8 ones needed the specification addition, including clostridium butyricum capsules (210 mg) and polysaccharide ferric complex capsules (25 mg).Conclusion: The existing capsule specification can not fully meet the clinical requirements in the children's hospital.Therefore, appropriate dosage adjustments are still needed.

Objective To investigate the dynamic changes of three types of anti-poliovirus neutralizing antibodies and anti-hepatitis A virus (HAV) IgG antibody in children who were immunized with inactivated enterovirus 71 (EV71) vaccine (human diploid cell).Methods Serum samples were collected from the subjects immunized with inactivated EV71 vaccine.Neutralizing antibodies against EV71 and poliovirus were detected by micro-cytopathic effect neutralization test.Enzyme linked immunosorbent assay (ELISA) was used to detect IgG antibody against HAV.Results The geometric mean titers (GMTs) of anti-EV71 neutralizing antibody increased to 4.85 following the first-dose injection of inactivated EV71 vaccine.A significant increase of GMTs (up to 64.37) could be observed 28 days after the second-dose vaccination.Meanwhile, results of the dynamic monitor showed that there were slight fluctuations in the neutralizing antibodies against three types of poliovirus on day 28 (28 days after the first-dose vaccination) compared with those on day 0 (before vaccination) (P<0.05);types Ⅰ and Ⅲ anti-poliovirus neutralizing antibodies on day 56 (28 days after the second-dose vaccination) remained slightly different from those on day 0 (P<0.05), but type Ⅱ anti-poliovirus neutralizing antibody on day 56 had restored to normal level (P>0.05).The level of anti-HAV IgG antibody was stable and no significant difference was found during the observation period (P>0.05).Conclusion This study shows that inactivated EV71 vaccine has no impact on anti-HAV IgG antibody in Children during the two-dose vaccination and in anti-EV71 antibody-producing period, but has slight influence on the anti-poliovirus antibodies.In general, changes in antibody profile do not affect the clinical efficacy of immune response.