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managed with measures against class B infectious diseases since January 8, 2023, the consensus published in 2020 is no longer applicable to the emergency treatment of severe trauma in the new stage of epidemic prevention and control.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 imaging characteristics of uncomplicated acute type B aortic dissection (uATBAD) and the short-term and mid-term outcomes treated with thoracic endovascular aortic repair (TEVAR).Methods:One hundred and forty uATBAD patients treated by TEVAR at Zhejiang Provincial People's Hospital from Jan 2015 to Aug 2021 were retrospectively analyzed. Patients were divided into non-high-risk characteristics group (uATBAD group, 22 cases) and high-risk characteristics group (high-risk uATBAD group, 118 cases) according to the presence or absence of high-risk characteristics. The clinical and follow-up data were analyzed, and the incidence of complications, re-intervention rate, and mortality in the perioperative period and 5-year follow-up were evaluated.Results:The aortic diameter, false lumen diameter and the proportion of laceration in lesser curvature in the high-risk group were higher than those in the non-high-risk group ( P<0.05). There was no significant difference in the incidence of perioperative complications and 30 day mortality between two groups ( P>0.05). The follow-up time ranged from 6 to 83 months (mean 38.3 months). The 5-year mid-term follow-up showed that there was no significant difference in the incidence of aorta-related complications, re-intervention rate, and mortality between two groups ( P>0.05). Conclusions:The imaging characteristics of different typing uATBAD were significantly different. The short- and mid-term clinical effects of TEVAR were similar between the two groups.

Objective:To explore and establish the scoring method of injury assessment in rats with trauma combined with seawater immersion, so as to provide a reference for injury assessment in the special environment of trauma combined with seawater immersion.Methods:Sixty-four SD rats were divided into two groups according to the random number table, including hemorrhagic shock group and compound injury group, with 32 rats per group. Each group was divided into trauma combined with seawater immersion group and simple trauma group, with 16 rats per group. In trauma combined with seawater immersion group, the hemorrhagic shock model was placed in 15℃ seawater for 1 hour to start bleeding, and the blood loss was 30% of the total blood volume. The composite injury model caused 10% Ⅱ degree burns and was incised along the vental midline with a length of about 2 cm, and then placed in 15℃ seawater for 1 hour. The death and survival time were recorded.The survival time significantly longer than 4 hours out of water was recorded as survival, and significantly shorter than 4 hours out of water was recorded as death. Data were observed within 9 hours after injury, including the changes of physiological indexes (respiration, blood pressure, anal temperature) and arterial blood gas (blood glucose, pH value, blood lactic acid, arterial oxygen partial pressure, arterial carbon dioxide partial pressure, bicarbate, sodium ion, chloride ion, calcium ion, potassium ion). Each index were compared between trauma combined with seawater immersion group and simple trauma group. According to the survival situation of all the trauma combined with seawater immersion group at 4 hours out of water, the rats were divided into survival group and death group. The indicators affecting survival were screened, and then the scatter plot of each index corresponding to the mortality rate was established. According to the trend of each index in different interval in the scatter chart, the score table of injury condition was established.Results:The total mortality was 28% (9/32) in trauma combined with seawater immersion group, and was 6% (2/32) in simple trauma group ( P<0.05). The survival time in trauma combined with seawater immersion group [(8.1±3.7)hours] was shorter than that in simple trauma group [(11.3±4.8)hours] ( P<0.05). In trauma combined with seawater immersion group, the respiratory rate[(58.8±2.9)times/min] was slower than that in simple trauma group [(100.4±7.2)times/min], blood pressure [(80.0±25.1)mmHg] was lower than that in simple trauma group [(89.8±18.1)mmHg], and anal temperature [22.4(20.1, 25.0)℃] was significantly lower than that in sample trauma group [31.7(30.5, 33.2)℃], pH value (7.1±0.1) was lower than that in simple trauma group (7.3±0.1), and arterial oxygen partial pressure [(196.3±34.1)mmHg], arterial carbon dioxide partial pressure [45.5(35.1, 51.1)mmHg], serum sodium [145(142, 148)mmol/L], serum chlorine [120(115, 125)mmol/L], serum calcium [(1.3±0.1)mmol/L]as well as serum potassium [(3.6±0.8)mmol/L] were higher than those in simple trauma group [(149.4±22.6)mmHg, 29.7(25.6, 34.5)mmHg, 142(139, 144)mmol/L, 118(114, 121)mmol/L, (1.2±0.1)mmol/L, (3.3±0.6)mmol/L] (all P<0.05). There were no significances in other indexes between the two groups ( P>0.05). In death group, the breathing[36(30, 36)times/min], blood pressure [(43.1±21.8)mmHg], anal temperature [(20.0±1.9)℃], pH value (7.1±0.1), and bicarbonate [(12.3±2.2)mmol/L] were significantly inhibited or suppressed compared with survival group [60(48, 78)times/min, (86.6±19.3)mmHg, (23.0±3.1)℃, 7.2±0.1, (14.6±2.3)mmol/L (all P<0.05). While the two groups showed no significant differences in other indices ( P>0.05). Therefore, the respiration, blood pressure, rectal temperature, pH value and bicarbonate that significantly affect the survival of rats were screened. According to the death rate corresponding to different intervals, a score value was assigned to the interval as the weight of its impact on survival, namely on the severity of the injury, and an injury score table for trauma combined with seawater immersion in rats was established. The injury scoring scale <6 points indicated no death, 6-9 points indicated the mortality of 50%, ≥9 points indicated the mortality of 71%. The 6 points and 9 points were cutoff value of the scale. It can be considered that the scale of <6 points was classified as minor injury, 6-9 points as moderate injury, and ≥9 points as severe injury. Conclusions:The seawater immersion can result in reduced survival time and increased early mortality, manifested as respiratory depression, more serious blood loss, severe hypothermia, severe metabolic acidosis, water and electrolyte disorders (high sodium, high chlorine, high calcium, and high potassium), etc. According to the respiration, blood pressure, anal temperature, pH value and bicarbate, which affect the survival of rats, the injury rating scale of rats with trauma combined with seawater immersion can be established by using the scatter chart. The predicted mortality rate by using the rating scale was roughly consistent with the actual mortality rate, so the injury rating scale basically had a good prediction and hint for the trauma rats combined with seawater immersion.

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 thoracic re-remodeling and therapeutic effect after the bar removal for pectus excavatum corrected by minimal-invasive technique.Methods 145 cases with pectus excavatum,male 115,femal 30;adults in 59,children 86;corrected by minimal-invasive technique improved and performed by the same group surgeon.Bar removed 12-82 months after the procedure,appraising index of curative effects include in chest appearance,thoracic index,thoracic computer tomography(CT) and the distance between the behind of sternum to the anterior border of thoracic spine in the sagittal view.Results The chest shape was good.Thoracic index:before bar removal 2.36 ± 0.32 in children,2.60 ± 0.45 in adults;after that,2.77 ± 0.44 in children,3.04 ± 0.56 in adults.There was all subsidence on the each point of the sternum,descent the maximum at the inferior end of the midsternum,(15.18 ±7.95)mm in children,(14.93 ± 8.81) mm in adults,comparing with bar removal before and after.There was statistical significance.Not the signs of compressing the heart on the CT view.The time interval of the bar removed 3-year in children,5-year in adults without affecting the development of the patients' thorax.Conclusion The sternum descended slightly after bar removal when pectus excavatum corrected to expecting effects.After that,thoracic remodeling again,the chest shape well.

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.

BACKGROUND: Studies on the biomechanical properties in NUSS procedure have obtained some achievements, but the effect of scoliosis surgical correction of scoliosis on thoracic deformity remains unclear.OBJECTIVE: To explore the effect of simultaneous correction of pectus excavatum and scoliosis on thoracic deformity so as to provide reference for designing a rational orthopedic scheme.METHODS: The three-dimensional reconstruction model of the chest was established based on the CT data of the patients with pectus excavatum and scoliosis. The surgical correction of pectus excavatum and scoliosis was simulated by numerical simulation method.RESULTS AND CONCLUSION: (1) Results after correction showed that the bilateral spinous processes at T3-5 segments displaced to the left (X direction) about 1 mm, suggesting that the simultaneous correction is favorable for the correction of scoliosis. (2) Compared with the single NUSS procedure, the displacement at Y direction was increased by 13.358 mm in the simultaneous correction; meanwhile, there was significant difference in the shortest displacement between two methods.(3) In views of Von Mises stress distribution, the stress in the simultaneous correction was decreased by 24.6 MPa compared with the single Nuss procedure, indicating that the simultaneous correction can significantly reduce the Von Mises stress on the chest, which contributes to alleviate the postoperative pain. (4) Our results show that the simultaneous correction cannot only improve scoliosis, but also improve the symptoms of pectus excavatum.

Objective To summarize the experiences in clinical diagnosis and surgical treatment of chest cancers invading the superior vena cava (SVC). Method Retrospective study of 12 cases with chest cancers invading the SVC, SVC and innominate vein were reconstructed with prosthesis in 3 cases, the side wall of the SVC was excised and repaired in 9 cases. Results Complete resection was performed in 10cases,2 cases had incomplete resection. There was no death associated with operation in these patients. All patients were followed up for 1 - 7 years after operation,and 3 cases were lost to follow up,5 of remaining 9cases were dead because of relapse and metastasis, their median survival time was 8 months,other 4 cases lived, their median survival time was 42 months. Conclusions Patients with chest cancers invading the SVC should have surgical treatment of not only tumor resection but also the vessel reconstruction,the prognosis would be better than without surgical treatment. These patients have a high quality of life and live with long-term survival.

Objective To access the alterations of ischemic myocardial regional motion time caused by different extent of coronary artery stenosis by 2D-strain technique. Methods Two-dimensional images were acquired of the standard parasternal and apical (4-chamber,2-chamber and long-axis) views and short-axis views (mitral annulus, papillary muscle and apex) in 140 patients with coronary artery disease. All left ventricular segments were divided into 5 groups according to coronary stenosis seen on angiography:normal,25% -49% ,50% -74% ,75% -99% and 100%. The time to segmental systolic peak strain, systolic peak strain rate, end systolic strain, early diastolic peak strain rate and late diastolic peak strain rate in longitudinal, radial, circumferential directions and the systolic peak rotation, systolic peak rotation rate, early diastolic rotation rate,late diastolic rotation rate were analyzed with EchoPAC offline software. Results In longitudinal direction,compared with normal group,the time to early diastolic peak strain rate of segments with 75% - 99% coronary stenosis increased significantly, the time to systolic peak strain rate, early diastolic peak strain rate of segments with occluded artery were significantly delayed compared with the other 4 groups (P ＜0.05). In radial, circumferential directions, the time to systolic peak strain, systolic peak strain rate,late diastolic peak strain rate of segments with 25% - 49% was shorter than that of normal segments. Those indices for segments with 50% - 74% coronary stenosis were delayed compared with segments with 25% - 49% stenosis, however, those for segments with 75% - 99% coronary stenosis showed some improvement in the comparison with segments with 50% - 74% stenosis. All time indices for segments with occluded arteries were delayed ( P ＜0.05). About rotation, the time to the systolic peak rotation,systolic peak rotation rate,early diastolic peak rotation rate with 25% -49% stenosis was shorter than those of normal segments, the time to systolic peak rotation and early diastolic peak rotation rate for segments with 75% - 99% stenosis improved compared with segments with 50% - 74% stenosis.Conclusions 25% -49% coronary stenosis could lead to alterations of peak myocardial systole and diastole motion time in radial,circumferential and rotation directions,and ≥75% coronary stenosis caused the all 4 directions motion delays. Also the time indices for segments with 75% - 99% coronary stenosis showed some improvement in the comparison with segments with 50% -74% coronary stenosis.