Nanomedicine for acute respiratory distress syndrome: The latest application, targeting strategy, and rational design

Acute respiratory distress syndrome (ARDS) is characterized by the severe inflammation and destruction of the lung air-blood barrier, leading to irreversible and substantial respiratory function damage. Patients with coronavirus disease 2019 (COVID-19) have been encountered with a high risk of ARDS, underscoring the urgency for exploiting effective therapy. However, proper medications for ARDS are still lacking due to poor pharmacokinetics, non-specific side effects, inability to surmount pulmonary barrier, and inadequate management of heterogeneity. The increased lung permeability in the pathological environment of ARDS may contribute to nanoparticle-mediated passive targeting delivery. Nanomedicine has demonstrated unique advantages in solving the dilemma of ARDS drug therapy, which can address the shortcomings and limitations of traditional anti-inflammatory or antioxidant drug treatment. Through passive, active, or physicochemical targeting, nanocarriers can interact with lung epithelium/endothelium and inflammatory cells to reverse abnormal changes and restore homeostasis of the pulmonary environment, thereby showing good therapeutic activity and reduced toxicity. This article reviews the latest applications of nanomedicine in pre-clinical ARDS therapy, highlights the strategies for targeted treatment of lung inflammation, presents the innovative drug delivery systems, and provides inspiration for strengthening the therapeutic effect of nanomedicine-based treatment.

Delivery strategies of amphotericin B for invasive fungal infections

Invasive fungal infections (IFIs) represent a growing public concern for clinicians to manage in many medical settings, with substantial associated morbidities and mortalities. Among many current therapeutic options for the treatment of IFIs, amphotericin B (AmB) is the most frequently used drug. AmB is considered as a first-line drug in the clinic that has strong antifungal activity and less resistance. In this review, we summarized the most promising research efforts on nanocarriers for AmB delivery and highlighted their efficacy and safety for treating IFIs. We have also discussed the mechanism of actions of AmB, rationale for treating IFIs, and recent advances in formulating AmB for clinical use. Finally, this review discusses some practical considerations and provides recommendations for future studies in applying AmB for combating IFIs.

Observation on Uncommon Complications of Acute Pancreatitis.

Acute pancreatitis is a sudden inflammation of pancreas that lasts for a short time. It may range from mild discomfort to a severe, life threatening illness. Abdominal pain which is the major symptom of acute pancreatitis may be accompanied by nausea, vomiting and abdominal distension.1 There may be low grade fever with features of shock which is not unusual.2 Most people with acute pancreatitis recover completely after getting the right treatment. About 80% of cases of acute attack are self-limited and recover spontaneously within a week after the treatment. But in severe cases, acute pancreatitis can result in bleeding into the gland, serious tissue damage, infection and cyst formation. Severe pancreatitis can also harm other vital organs such as heart, lungs and kidneys. Transient hypotension, transient myocardial ischemia reflected by ST-T changes in ECG and associated with diastolic dysfunction and ARDS are uncommon complications of acute pancreatitis. This study was conducted to evaluate their incidence and prognostic significance in acute pancreatitis.METHODSThis study was conducted in Patna Medical College Hospital, Patna, on admitted cases during the period august 2018 – august 2019. A total of 30 cases were included in this study who were diagnosed as acute pancreatitis and gave written consent for the same. Patients with association or history of stroke, head injury, CNS infection, features of demyelination, acute coronary syndrome, cardiogenic pulmonary oedema and established liver disease were excluded.RESULTSThe incidence of transient hypotension, transient myocardial ischemia and ARDS in this study was found to be 13.3%, 6.6% and 6.6% respectively and they were all associated with high mortality.CONCLUSIONSThe commonest risk factor of acute pancreatitis was seen to be Gall Stone followed by Alcoholism, hyperlipidaemia and smoking in this study also. The overall mortality (13.3%) in this study was slightly lower than other studies. and this may be due to small sample size and variation of mortality with time of admission. Transient hypotension, transient myocardial ischemia reflected by ST-T changes in ECG, associated with diastolic dysfunction and ARDS were observed as uncommon complications of acute pancreatitis. Their incidence in this study were 13.3%, 6.6% and 6.6% respectively and they were all associated with high mortality. The clinical significance of their early detection is that the early mortality can be reduced with intensive medical and surgical management.a

Andrographolide sulfonate ameliorates lipopolysaccharide-induced acute lung injury in mice by down-regulating MAPK and NF-κB pathways

Acute lung injury (ALI) or acute respiratory distress syndrome (ARDS) is a severe, life-threatening medical condition characterized by widespread inflammation in the lungs, and is a significant source of morbidity and mortality in the patient population. New therapies for the treatment of ALI are desperately needed. In the present study, we examined the effect of andrographolide sulfonate, a water-soluble form of andrographolide (trade name: Xi-Yan-Ping Injection), on lipopolysaccharide (LPS)-induced ALI and inflammation. Andrographolide sulfonate was administered by intraperitoneal injection to mice with LPS-induced ALI. LPS-induced airway inflammatory cell recruitment and lung histological alterations were significantly ameliorated by andrographolide sulfonate. Protein levels of pro-inflammatory cytokines in bronchoalveolar lavage fluid (BALF) and serum were reduced by andrographolide sulfonate administration. mRNA levels of pro-inflammatory cytokines in lung tissue were also suppressed. Moreover, andrographolide sulfonate markedly suppressed the activation of mitogen-activated protein kinase (MAPK) as well as p65 subunit of nuclear factor-κB (NF-κB). In summary, these results suggest that andrographolide sulfonate ameliorated LPS-induced ALI in mice by inhibiting NF-κB and MAPK-mediated inflammatory responses. Our study shows that water-soluble andrographolide sulfonate may represent a new therapeutic approach for treating inflammatory lung disorders.

Combined Effects of Inhaled Nitric Oxide and a Recruitment Maneuver in Patients with Acute Respiratory Distress Syndrome

No abstract available.