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Advances in Treatment of Liver Metastasis of Colorectal Cancer

Progress in the application of silk fibroin in tissue engineered drug delivery system

ObjectiveThe properties and characteristics of different types of silk fibroin (SF) drug-loaded sustained-release carriers and their effects on the drug release behavior were reviewed, and the existing problems and development prospects of SF drug-loaded sustained-release carriers in tissue engineering drug delivery system were discussed.MethodsThe literatures about drug-loaded SF sustained-release carriers in recent years were extensively consulted, and the types of sustained-release carriers, characteristics of drug release, range of applications, advantages and disadvantages, and solutions were summarized and analyzed.ResultsAt present, the SF drug-loaded sustained-release carriers are mainly divided into SF microparticles, SF scaffolds, SF membranes, SF hydrogels, SF nanofibers, SF sponges, and so on. These types of SF drug-loaded sustained-release carriers have their own advantages and problems, of which the most prominent problem is the burst release of drugs at the initial stage. While, the initial burst release of drugs can be effectively solved by improving the preparation process and adjusting the material ratio. Different types of drug-loaded sustained-release carriers can be prepared by combining different materials to achieve different application scopes and drug release behaviors under different conditions.ConclusionSF is a good drug-loaded carrier for tissue engineering, the burst release of drugs at the initial stage can be solved by improving the preparation process and changing the material structure; through the combination of the advantages of various types of SF drug-loaded sustained-release carriers, it is expected to prepare SF drug-loaded sustained-release carriers that meet different clinical needs.

Multidisciplinary management of acute type A aortic dissection in late pregnancy

ObjectiveTo investigate the multidisciplinary management of patients with acute type A aortic dissection in late pregnancy.MethodsThe clinical data of 3 patients admitted to the Second Affiliated Hospital of Army Medical University from 2018 to 2019 were analyzed. Their age ranged from 27 to 32 years, while gestational age was 34-37 weeks. Sudden chest pain was the main clinical symptom before operation. All 3 patients underwent Bentall surgery after cesarean section under general anesthesia, of whom 2 patients received total arch replacement (TAR) combined with frozen elephant trunk (FET) implantation and 1 received coronary artery bypass grafting (CABG) additionally.ResultsNo patient died during the perioperative period, and all the newborns were delivered successfully and survived healthily. The ICU stay was 3-5 d. The postoperative hospital stay was 15-18 d. The follow-up was 250-751 d. There was no recurrence or death. One patient who developed spontaneous pneumothorax and hydropneumothorax was cured in our center.ConclusionThe multidisciplinary diagnosis and treatment strategy plays a crucial role in saving the life of pregnant patients with acute type A aortic dissection.

小劑量甲潑尼龍對中重度急性呼吸窘迫綜合征患者肺容積及氧合影響的臨床分析

目的探討小劑量甲潑尼龍對中重度急性呼吸窘迫綜合征（ARDS）患者肺容積及氧合的影響。方法收集 2019 年 6 月至 2020 年 6 月錦州醫科大學附屬第一醫院重癥醫學科收治的 50 例中重度 ARDS 機械通氣患者，按照隨機數字表法將患者分為甲潑尼龍試驗組和常規治療對照組，觀察患者治療前后的功能殘氣量（FRC）、氧合指數（PaO2/FiO2）、血清乳酸（cLac）及超敏 C 反應蛋白（hs-CRP）變化及患者預后相關指標；采用 Pearson 法分析 FRC 與 PaO2/FiO2 的相關性。采用受試者工作特征（ROC）曲線評估 FRC 和 PaO2/FiO2 對 ARDS 患者 28 天病死率的預測價值。結果兩組患者治療后第 4、7 天的 FRC、PaO2/FiO2、PaO2、PaCO2、cLac 及 hs-CRP 均較治療前改善（均 P<0.05），而且試驗組在治療后的第 4、7 天的 FRC、PaO2/FiO2、PaO2 顯著高于對照組，cLac、hs-CRP 及 PaCO2 顯著低于對照組（均 P<0.05）。試驗組呼吸機使用時間、住院時間、28 天病死率等均低于對照組（均 P<0.05）。FRC 與 PaO2/FiO2 存在顯著相關性（r=0.731，P<0.05）。ROC 曲線分析顯示，FRC 和 PaO2/FiO2 對中重度 ARDS 患者 28 天病死率均有預測價值，其 ROC 曲線下面積分別為 0.841 和 0.802（均 P<0.05）。結論早期應用小劑量甲潑尼龍可以顯著改善中重度 ARDS 患者 FRC 和 PaO2/FiO2，降低 28 天病死率，療效確切、安全性高，并且通過動態監測 FRC 對于中重度 ARDS 患者預后預測具有較好參考價值。