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Looking retrospectively at the development of humanity, vaccination is an unprecedented medical landmark that saves lives by harnessing the human immune system. During the ongoing coronavirus disease 2019 (COVID-19) pandemic, vaccination is still the most effective defense modality. The successful clinical application of the lipid nanoparticle-based Pfizer/BioNTech and Moderna mRNA COVID-19 vaccines highlights promising future of nanotechnology in vaccine development. Compared with conventional vaccines, nanovaccines are supposed to have advantages in lymph node accumulation, antigen assembly, and antigen presentation; they also have, unique pathogen biomimicry properties because of well-organized combination of multiple immune factors. Beyond infectious diseases, vaccine nanotechnology also exhibits considerable potential for cancer treatment. The ultimate goal of cancer vaccines is to fully mobilize the potency of the immune system as a living therapeutic to recognize tumor antigens and eliminate tumor cells, and nanotechnologies have the requisite properties to realize this goal. In this review, we summarize the recent advances in vaccine nanotechnology from infectious disease prevention to cancer immunotherapy and highlight the different types of materials, mechanisms, administration methods, as well as future perspectives.
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Objective To explore the effect of enteral nutrition (EN) initiation time on the treatment and prognosis of acute respiratory distress syndrome (ARDS) patients with mechanical ventilation. Methods A retrospective study was conducted. 116 adult ARDS patients with mechanical ventilation admitted to the intensive care unit (ICU) of the Sixth Division Hospital of Xinjiang from January 2016 to December 2017 were enrolled. There was no difference in gender, age, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) at admission. Patients were divided into early enteral nutrition group (E-EN group, 66 cases, starting EN within 48 hours) and late enteral nutrition group (L-EN group, 50 cases, starting EN after 7 days later) according to the EN initiation time. Both groups of patients achieved the standard nutrition after 3-5 days of EN. Nutritional indicators [albumin (ALB), pre-albumin (PA)], liver function [total bilirubin (TBIL)], infection index [procalcitonin (PCT)], insulin dosage, respiratory mechanics and pulmonary function [airway peak pressure (PIP), airway plateau pressure (Pplat), mean airway pressure (MPaw), effective static total compliance (Cst), oxygenation index (PaO2/FiO2)], critical scores [APACHEⅡ, multiple organ dysfunction score (MODS), Murray lung injury score, and systemic inflammatory response syndrome (SIRS) score], duration of mechanical ventilation, the length of ICU stay, incidence of multiple organ dysfunction syndrome, 14-day mortality, and ICU hospitalization expenses were collected before treatment and 1, 3, 7, 10, 14 days after treatment. Results There was no difference in biochemical indicators, respiratory mechanics, pulmonary function, or critical scores between the two groups before ICU treatment. Compared with before treatment, ALB and PA were significantly increased, TBIL and MPaw were significantly decreased, insulin dosage was significantly decreased, PIP, Pplat, MPaw were significantly decreased, Cst and PaO2/FiO2were significantly increased, and the critical scores were significantly decreased. Compared with L-EN group, E-EN group had lower TBIL and PCT after treatment [TBIL (μmol/L): 13.21±1.03 vs. 29.02±1.38, PCT (ng/L): 5.36±1.58 vs. 11.33±1.95], lower insulin dose (U: 16.37±1.01 vs. 27.01±1.92), lower PIP, Pplat, MPaw [PIP (cmH2O, 1 cmH2O = 0.098 kPa): 17.7±3.5 vs. 22.5±4.3, Pplat (cmH2O):10.5±1.4 vs. 15.6±1.2, MPaw (cmH2O): 5.5±0.7 vs. 8.2±0.8], higher Cst, PaO2/FiO2[Cst (mL/cmH2O): 128.6±16.5 vs. 93.7±11.9, PaO2/FiO2(mmHg, 1 mmHg = 0.133 kPa): 242.9±27.9 vs. 188.6±25.9, all P < 0.05], however, there was no significant difference in ALB, PA and critical care scores [ALB (g/L): 37.09±1.49 vs. 35.88±1.77, PA (mg/L): 387.29±10.93 vs. 369.27±11.44, APACHEⅡ: 13.9±3.5 vs. 14.5±5.0, Murray: 5.6±0.9 vs. 5.2±1.4, MODS: 1.1±0.4 vs. 1.2±0.3, SIRS: 2.9±0.5 vs. 3.1±0.9, all P > 0.05]. Compared with L-EN group, incidence of multiple organ dysfunction syndrome was significantly decreased in E-EN group [31.8% (21/66) vs. 48.0% (24/50), P < 0.05], duration of mechanical ventilation and the length of ICU stay were significantly shortened (days: 5.5±0.7 vs. 9.2±0.8, 8.6±1.5 vs. 18.3±1.9, both P < 0.05), ICU hospitalization expenses was significantly reduced (10 000 yuan:6.324±0.009 vs. 11.419±0.010, P < 0.05), but there was no significantly difference in 14-day mortality between two groups [15.2% (10/66) vs. 16.0% (8/50), P > 0.05]. Conclusions Early and reasonable application of EN supportive therapy can improve the clinical efficacy of ARDS patients, reduce the incidence of infection, make it easier to control blood sugar, improve lung function, shorten the duration of mechanical ventilation and the length of ICU stay, and reduce hospitalization expenses. However, no significant difference has been found in the prognosis of the recent 14 days.
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OBJECTIVE@#To systematically evaluate the effect of statins on prognosis for patients with cancers. @*METHODS@#Literature on PubMed, EMbase and Cochrane library was screened from the establishment of databases to March, 2015 to find relevant studies. Random-effects models were used to calculate the pooled hazard ratios (HR) and 95% confidence interval (CI) for the association between statin use and all-cause mortality and cancer-specific mortality. @*RESULTS@#A total of 25 studies covered 523 193 patients were identified and included in this Meta-analysis. The pooled effect showed that statin application was associated with a reduction in all-cause mortality in cancer patients (HR, 0.82; 95% CI: 0.76 to 0.89). A significantly decreased mortality in prostate cancer was revealed in subgroup by cancer sites (HR, 0.66; 95% CI: 0.52 to 0.83). In addition, sensitivity analysis demonstrated a weakened association between statin application and all-cause mortality after excluding the studies with shorter follow-up duration (HR, 0.91; 95% CI: 0.75 to 1.10). @*CONCLUSION@#A beneficial effect of statin on all-cause mortality and cancer-specific mortality is presented in patients with cancer. However, further studies are needed to confirm the long term effect.
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Humans , Male , Hydroxymethylglutaryl-CoA Reductase Inhibitors , Therapeutic Uses , Neoplasms , Drug Therapy , Mortality , Prognosis , Prostatic Neoplasms , Drug Therapy , MortalityABSTRACT
Objective To study the optimum combination of orientation parameter of total hip prosthesis and acetabular safe zone on condition that the range of motion for activities of daily living (ADL) is fulfilled.Methods A three-dimensional generic parametric and visually kinematic simulation module of THA was developed.Range of motion ( ROM ) of hip flexion ≥ 110°,internal-rotation ≥30° at 90° flexion,extension ≥30° and external rotation ≥40° were defined as the normal criteria for ADL.ROM of hip flexion ≥ 120°,internal-rotation ≥45° at 90° flexion,extension ≥30° and external rotation ≥40° were as the severe criteria.The ranges of changes in general ratios (GRs) of head-neck,femoral neck antevemion ( FNA ),operative inclination (OI) and anteversion (OA) of acetabulur components were 2.0-2.92,0°-30°,10°-60°,and 0°-70° respectively.Within the limits of the upper two activity criteria,the synchronous OA of acetabulur components was calculated with every 5°change in OI of the cup,and the collodiaphyseal angle ( CDD ) was set as 135°.The safe-zone of combination of acetabulur operative anteversion (OA) and inclination (OI) was defined as the area that fulfilled the two mentioned criteria of ROM without cup-neck impingement.All parameters were analyzed by using SAS 6.12 software.Results The safe zone of acetabdar angle rose with the increase of GRs of head-neck and the safe zone of severe criteria was smaller than that of normal criteria.When the CDD angle was 135°,the sum of average aeetabular OA and acetahular OI plus 0.816 times of the FNA equaled to 84.76° innormal criteria; and the sum of average acetabular OA and acetabular OI plus 0.873 times of the FNA equaled to 92.04° in severe criteria.Conclusions A high GR of head-neck greatly increases the size of safe-zone of acetabular angle.The higher demand of ROM of hip joint requires the smaller safe zone of acetabular angle,as can be corrected by increasing the GR of head-neck.The optimum combination between the sum of average acetabular OA and acetabular OI ( Y) plus FA (X)in the normal criteria and severe criteria can be estimated by using the following formulae:Y1 =-0.816X1 + 84.76 (R2 =0.993 ),Y2 =-0.873X2 + 92.04( R2 =0.999) respectively.
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Objective To discuss biomechanical mechanism of reconstructed joint capsule ligament stabilizing hip joint by means of three-dimensional finite element analysis.Methods A finite element model of total hip arthroplasty(THA)including ischiofemoral ligament reconstruction was construtted by using finite element analysis software Unigraphics NX 2.0 and SolidWorks 2006 to simulate seated leg crossing and obtain peak resisting moment and range of motion prior to impingement.Results The current form of finite element model was characterized by large deformation multi-body contact,large interfacial sliding and high elasticity and could clearly reflect real anatomy and biomechanical behavior of ischiofemoral ligaments.Compared with model with only metal,model of ischiofemoral ligament reconstruction could reduce the peak polyethylene stress at the impingement site and at the head egress site by typically 17%and 31%respectively,increase peak resisting moment by nearly 57%and provide 2.29-fold stability.Conclusions As a discrete structure within the posterior capsule of the hip joint,the ischiofemoral ligament may be the most important contributor to the mechanical integrity of the posterior stability structure.The joint capsule ligament must be reconstructed in hip arthroplasty.
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[Objective]To discuss the method and effectiveness of arthroscopically assisted mini-incision arthrolysis for the stiff knee.[Method]A small lateral suprapatellar incision was made in all 26 patients suffered from stiff knee,and the scissors were introduced the joint to release the adhesive tissues of patellofemoral joint.All adhesive tissues between the medial,lateral retinaculum and the femur,and the between vastus intermedius and femur were released subsequently.After the release of the adherence between the fat pad and femoral condyle,the lateral retinaculum was dissected 1 cm lateral to the patellae,and the dissection of medial retinaculum was applied at the insertion of the vastus medialis.Eventually,arthroscopic debridement and hemostasis combined with manipulative release was applied to remove all remanent adhesive bundles and scar tissues.[Result]Follow-ups were maintained for an average of 19 months(range,from 8-32 months).An increase in the average range of motion of the knee was attained from 32 degrees preoperatively to 113 degrees postoperatively.No complications such as skin necrosis,wound dehiscence,tendon rupture and fracture had occurred during the follow-up period.[Conclusion]The advantages of arthroscopically assisted mini-incision arthrolysis for the stiff knee include simple procedure,minimal trauma,and quick rehabilitation.Otherwise,reservation of the insertion of vastus medialis is of great importance not only for the maintenance of extensive strength and stability of the knee,but also for the functional recovery and the reduction of complications.
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[Objective]To investigate the clinical results and significance and mechanism of early dislocation rate after total hip arthroplasty following the posterolateral approach with posterior capsulotendinous repaired.[Method]The incidence of early dislocation and the prosthetic range of rotation motion among 212 consecutive primary THAs with the posterior capsule and the short external rotators which had been sutured to the medius tendon was reviewed retrospectively,and was compared to the results of 486 consecutive unilateral primary THAs with a complete posterior capsulectomy.[Result]During a 6 months to 5 years(3.7 years in average)following-up,there were significant differences between two groups.In patients with posterior capsulotendinous repair,two of 224 primary total hip arthroplasty(0.9%) had an early posterior dislocation.In patients with a complete posterior capsulectomy,27 of 486 primary total hip arthroplasty(5.6%) had an early dislocation.The difference was statistically significant(x~2=8.51,P