Objective To develop an effective method for delivering VEGF and CD47 double-modified exosomes to treat renal damage induced by heat stroke so as to reduce and repair renal damage. Methods A plasmid fusion-expressing VEGF and CD47 targeting renal injury was constructed, transfected into rat bone marrow derived mesenchymal stem cells (BMMSCs), and then fusion-exosomes were isolated and extracted. Transmission electron microscopy, nanoparticle tracking analysis, and Western blotting were used to identify the obtained exosomes. Rats were intravenously injected with 200 μg of DiD-labeled unmodified exosomes, VEGF-modified exosomes and VEGF-CD47 double-modified exosomes, respectively, through the tail vein, and the effects of exosomes on the kidneys were detected and analyzed using a small animal in vivo imaging instrument. A total of 60 SD rats were randomly divided into 6 groups, with 10 rats in each group, that is, blank control group (group A), heat stroke-induced renal injury model receiving PBS in 12, 24 and 36 h after modelling (group B), empty plasmid group (group C), Exos group (group D), ExosVEGF group (group E) and ExosVEGF-CD47. Kidney tissue and blood samples were collected in 72 h after 3 times of treatment. Pathological changes in kidney tissue were observed at the tissue level and the damage were scored. Changes in serum blood urea nitrogen (BUN) and serum creatinine (Scr) levels were detected to evaluate the therapeutic effect. Western blotting and qRT-PCR were used to analyze the expression of the pro-inflammatory factors TNF-α and NF-κB, the proliferation regulatory signaling molecules Ki67, FGF2, pAMPK and pERK, and the fibrosis regulatory molecule FGF23, in order to comprehensively analyze the effects on proliferation and inhibition of fibrosis. Results BMMSCs and ExosVEGF-CD47 were successfully isolated and characterized, and a rat model of acute kidney injury was effectively constructed. Higher fluorescence intensity was found in the kidney tissue of the ExosVEGF-CD47 group than the Exos-Ctrl group and ExosVEGF group (P<0.05). In 72 h after treatment, the ExosVEGF-CD47 group had significantly lower serum BUN and Scr levels (P<0.0001), and notably lower Tubular casts score (P<0.0001), decreased levels of pro-inflammatory factors TNF-α and NF-κB (P<0.0001), up-regulated Ki67 and FGF2 expression (P<0.05), and down-regulated FGF23 expression (P<0.0001) when compared with the AKI+Exos group and AKI+ExosVEGF group. Conclusion VEGF and CD47 show promise in targeting acute kidney injury induced by heat stroke, effectively mitigate damage and facilitate repair, which may be due to exosome-mediated inhibition of renal tissue inflammation, promotion of proliferation, and inhibition of fibrosis.

自 2019 年 12 月新冠肺炎暴发以来,据 WHO统计截至 2020 年 4 月 8 日全球新冠肺炎病例达1353361 例,死亡 79235 例,中国在此次疫情防控工作中做出了巨大贡献和牺牲.新冠肺炎防控核心是早发现早隔离,临床救治重点是避免患者进展至急性呼吸窘迫综合征 (acute respiratory distress syndrome,ARDS).如果病例发展为 ARDS 可能会根据病情需要进一步行体外膜肺氧合,后续治疗风险可能包括感染、抗凝出血或血栓,治疗的复杂性往往导致预后差.在一些危重型新型冠状病毒肺炎患者救治中,笔者发现新冠肺炎导致的自发性气胸往往导致病情进一步进展,甚至救治失败.本文报道 1 例新冠肺炎导致自发性气胸并文献分析,总结临床治疗经验.

Objective To investigate the Tanreqing injection combined with Budesonide suspen-sion for inhalation on the children with mycoplasma pneumonia. Methods 83 children with mycoplasma pneumonia were included in the department of Pediatrics,The People′s Hospital of Fenyang City,from June 2015 to February 2017. According to the therapeutic method,all patients were divided into the inhalation treatment group(n＝41) and the combined treatment group( n＝42). Patients in the inhalation treatment group were treated by Budesonide suspension for inhalation. Patients in the combined treatment group trea-ted with the Tanreqing injection combined with Budesonide suspension for inhalation. Compared the im-provement of symptoms,the serum levels of solubility intercelluar adhesion molecule-1(sICAM-1)and ser-um monocyte chemoattractant protein-4(MCP-4),lung function(TCL)and forced vital capacity(FVC),the clinical effect,adverse reaction rate and quality of life(SF-36)score. Results The pulmonary rales,asth-ma,cough and fever disappearance time of the combined treatment group[(3.98 ±0.37)d,(3.79 ±1.74)d, (3.06±0.32)d and(4.52 ±0.27)d]were earlier than those of the inhalation treatment group[(6.03 ± 0.64)d,(4.63 ±1.67)d,(5.87 ±1.03)d and(4.94 ±0.39)d],the difference was statistically signifi- cant(P<0. 05). Seven days after treatment,the serum levels of sICAM-1 and MCP-4 of the combined treat-ment group[(181.24 ±18.41)μg/L and(32.39 ±12.28)pg/ml]were lower than those of the inhalation treatment group[(284. 56 ± 24. 53)μg/L and(54. 36 ± 13. 81)pg/ml],the FVC and TLC of the combined treatment group[(3. 09 ±0. 32)L and(2. 46 ±0. 18)L]were higher than those of the inhalation treatment group[(2. 51 ± 0. 28)L and(1. 67 ± 0. 23)L],the SF-36 scores of the combined treatment group(74. 23 ± 10. 08)were higher than those of the inhalation treatment group(65. 51 ± 9. 86),the difference were statisti-cally significant(P<0. 05). Conclusion Tanreqing injection combined with Budesonide Suspension for inhalation is effective in the treatment of children with mycoplasma pneumonia. It can effectively improve the lung function,symptoms and signs,reduce the serum levels of sICAM-1 and MCP-4,improve the quality of life with higher safety.