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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.

小剂量甲泼尼龙对中重度急性呼吸窘迫综合征患者肺容积及氧合影响的临床分析

目的探讨小剂量甲泼尼龙对中重度急性呼吸窘迫综合征（ARDS）患者肺容积及氧合的影响。方法收集 2019 年 6 月至 2020 年 6 月锦州医科大学附属第一医院重症医学科收治的 50 例中重度 ARDS 机械通气患者，按照随机数字表法将患者分为甲泼尼龙试验组和常规治疗对照组，观察患者治疗前后的功能残气量（FRC）、氧合指数（PaO2/FiO2）、血清乳酸（cLac）及超敏 C 反应蛋白（hs-CRP）变化及患者预后相关指标；采用 Pearson 法分析 FRC 与 PaO2/FiO2 的相关性。采用受试者工作特征（ROC）曲线评估 FRC 和 PaO2/FiO2 对 ARDS 患者 28 天病死率的预测价值。结果两组患者治疗后第 4、7 天的 FRC、PaO2/FiO2、PaO2、PaCO2、cLac 及 hs-CRP 均较治疗前改善（均 P<0.05），而且试验组在治疗后的第 4、7 天的 FRC、PaO2/FiO2、PaO2 显著高于对照组，cLac、hs-CRP 及 PaCO2 显著低于对照组（均 P<0.05）。试验组呼吸机使用时间、住院时间、28 天病死率等均低于对照组（均 P<0.05）。FRC 与 PaO2/FiO2 存在显著相关性（r=0.731，P<0.05）。ROC 曲线分析显示，FRC 和 PaO2/FiO2 对中重度 ARDS 患者 28 天病死率均有预测价值，其 ROC 曲线下面积分别为 0.841 和 0.802（均 P<0.05）。结论早期应用小剂量甲泼尼龙可以显著改善中重度 ARDS 患者 FRC 和 PaO2/FiO2，降低 28 天病死率，疗效确切、安全性高，并且通过动态监测 FRC 对于中重度 ARDS 患者预后预测具有较好参考价值。

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.