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Kankala RK, Lin XF, Song HF, Wang SB, Yang DY, Zhang YS, Chen AZ. Supercritical Fluid-Assisted Decoration of Nanoparticles on Porous Microcontainers for Codelivery of Therapeutics and Inhalation Therapy of Diabetes. ACS Biomater Sci Eng 2018; 4:4225-4235. [PMID: 33418821 DOI: 10.1021/acsbiomaterials.8b00992] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The impact of nanotechnology and its advancements have allowed us to explore new therapeutic modalities. To this end, we designed nanoparticles-inlaid porous microparticles (NIPMs) coloaded with small interfering RNA (siRNA) and glucagon-like peptide-1 (GLP-1) using the supercritical carbon dioxide (SC-CO2) technology as an inhalation delivery system for diabetes therapy. siRNA-encapsulating chitosan (CS) nanoparticles were first synthesized by an ionic gelation method, which resulted in particles with small sizes (100-150 nm), high encapsulation efficiency (∼94.8%), and sustained release performance (∼60% in 32 h). These CS nanoparticles were then loaded with GLP-1-dispersed poly-l-lactide (PLLA) porous microparticles (PMs) by SC-CO2-assisted precipitation with the compressed antisolvent (PCA) process. The hypoglycemic efficacy of NIPMs administered via pulmonary route in mice persisted longer due to sustained release of siRNA from CS nanoparticles and the synergistic effects of GLP-1 in PMs, which significantly inhibited the expression of dipeptidyl peptidase-4 mRNA (DPP-4-mRNA). This ecofriendly technology provides a convenient way to fabricate nanoparticle-microparticle composites for codelivery of a gene and a therapeutic peptide, which will potentially find widespread applications in the field of pharmaceutics.
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Affiliation(s)
- Ranjith Kumar Kankala
- Institute of Biomaterials and Tissue Engineering, Huaqiao University, Xiamen 361021, P. R. China.,Fujian Provincial Key Laboratory of Biochemical Technology, Huaqiao University, Xiamen 361021, P. R. China
| | - Xiao-Fen Lin
- Institute of Biomaterials and Tissue Engineering, Huaqiao University, Xiamen 361021, P. R. China.,Fujian Provincial Key Laboratory of Biochemical Technology, Huaqiao University, Xiamen 361021, P. R. China
| | - Hu-Fan Song
- Institute of Biomaterials and Tissue Engineering, Huaqiao University, Xiamen 361021, P. R. China
| | - Shi-Bin Wang
- Institute of Biomaterials and Tissue Engineering, Huaqiao University, Xiamen 361021, P. R. China.,Fujian Provincial Key Laboratory of Biochemical Technology, Huaqiao University, Xiamen 361021, P. R. China
| | - Da-Yun Yang
- Fujian Key Laboratory for Translational Research in Cancer and Neurodegenerative Diseases, Institute for Translational Medicine, School of Basic Medical Sciences, Fujian Medical University, Fuzhou, Fujian 350108, China
| | - Yu Shrike Zhang
- Division of Engineering in Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Cambridge, Massachusetts 02139, United States
| | - Ai-Zheng Chen
- Institute of Biomaterials and Tissue Engineering, Huaqiao University, Xiamen 361021, P. R. China.,Fujian Provincial Key Laboratory of Biochemical Technology, Huaqiao University, Xiamen 361021, P. R. China
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Shin S, Nam B, Soh S, Koo BN. Percutaneous cardiopulmonary support to treat suspected venous air embolism with cardiac arrest during open eye surgery: a case report. Korean J Anesthesiol 2014; 67:350-3. [PMID: 25473466 PMCID: PMC4252349 DOI: 10.4097/kjae.2014.67.5.350] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Revised: 02/17/2014] [Accepted: 02/18/2014] [Indexed: 02/07/2023] Open
Abstract
We report a case of possible venous air embolism (VAE) during trans pars plana vitrectomy with air-fluid exchange of the vitreous cavity. Shortly after initiation of air-fluid exchange, decreases in end-tidal CO2, oxygen saturation, and blood pressure were observed. The patient rapidly progressed to cardiac arrest unresponsive to cardiopulmonary resuscitation, and recovered after the application of percutaneous cardiopulmonary support. Prompt termination of air infusion is needed when VAE is suspected during air-fluid exchange, and extracorporeal life support should be considered in fatal cases. Although the incidence is rare the possibility of VAE during ophthalmic surgery clearly exists, and therefore awareness and vigilant monitoring seem critical.
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Affiliation(s)
- Seokyung Shin
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea. ; Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea
| | - Bokyung Nam
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea
| | - Sarah Soh
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea. ; Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea
| | - Bon-Nyeo Koo
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea. ; Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea
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Campbell J. Recognising air embolism as a complication of vascular access. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2014; 23:S4, S6-8. [PMID: 25158360 DOI: 10.12968/bjon.2014.23.sup14.s4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The insertion and maintenance of advanced vascular access devices is increasingly becoming the remit of advanced nurses. Understanding the potential for air embolism as a complication of this procedure, recognising and managing the signs and symptoms, and being able to apply preventative measures, are imperative to enhance patient safety. A range of outcomes can present from air embolism depending on the rate and volume of air entrained, from sub-clinical to death, so the application of expert knowledge and vigilance is essential to minimise risk. According the the available literature, supplemental oxygen administration appears to be the most effective treatment.
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Im KS, Woo JS, Lee JM. Recurrence of fatal venous air embolism. Korean J Anesthesiol 2014; 67:S111-2. [PMID: 25598879 PMCID: PMC4295953 DOI: 10.4097/kjae.2014.67.s.s111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Kyong Shil Im
- Department of Anesthesiology and Pain Medicine, Uijeongbu St. Mary's Hospital, The Catholic University of Korea College of Medicine, Uijeongbu, Korea
| | - Joon Suk Woo
- Department of Anesthesiology and Pain Medicine, Uijeongbu St. Mary's Hospital, The Catholic University of Korea College of Medicine, Uijeongbu, Korea
| | - Jae Myeong Lee
- Department of Anesthesiology and Pain Medicine, Uijeongbu St. Mary's Hospital, The Catholic University of Korea College of Medicine, Uijeongbu, Korea
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Makino Y, Shimofusa R, Hayakawa M, Yajima D, Inokuchi G, Motomura A, Iwase H. Massive gas embolism revealed by two consecutive postmortem computed-tomography examinations. Forensic Sci Int 2013; 231:e4-10. [PMID: 23806344 DOI: 10.1016/j.forsciint.2013.06.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2012] [Revised: 05/30/2013] [Accepted: 06/01/2013] [Indexed: 01/05/2023]
Abstract
We present a case of unusual gas embolism in a 73-year-old man who was found in a state of cardiopulmonary arrest with an oxygen-supply tube connected to an intravenous catheter inserted into his median cubital vein. Postmortem computed tomography (PMCT) performed 27 h after death showed systemic gas distribution including intravascular gas, pneumothorax, pneumoperitoneum, pneumomediastinum, pneumoretroperitoneum and gastric emphysema. A second PMCT scan performed 116 h after death showed a marked decrease of air inside the body. The current case shows the importance of PMCT for visualization, quantification, and preservation of evidence for establishment of the cause of death in cases with suspected gas embolism. Our findings also indicate that performance of two PMCT examinations may be useful for differentiation of embolized gas from gas produced by putrefaction.
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Affiliation(s)
- Yohsuke Makino
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, Inohana 1-8-1,Chiba City, Chiba Prefecture 260-8670, Japan.
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Sabsovich I, Abel M, Lee CJ, Spinelli AD, Abramowicz AE. Air embolism during operative hysteroscopy: TEE-guided resuscitation. J Clin Anesth 2012; 24:480-6. [DOI: 10.1016/j.jclinane.2012.01.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2011] [Revised: 01/03/2012] [Accepted: 01/16/2012] [Indexed: 01/05/2023]
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Famularo G, Minisola G, Nicotra GC, De Simone C. Massive pulmonary embolism masquerading as pulmonary edema. Am J Emerg Med 2007; 25:1086.e1-2. [DOI: 10.1016/j.ajem.2007.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2007] [Revised: 03/11/2007] [Accepted: 03/12/2007] [Indexed: 10/22/2022] Open
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Stewart RH, Quick CM, Zawieja DC, Cox CS, Allen SJ, Laine GA. Pulmonary Air Embolization Inhibits Lung Lymph Flow by Increasing Lymphatic Outflow Pressure. Lymphat Res Biol 2006; 4:18-22. [PMID: 16569202 DOI: 10.1089/lrb.2006.4.18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Air embolization of the pulmonary vascular tree increases pulmonary microvascular filtration and induces pulmonary edema formation. Flow from cannulated pulmonary lymphatic vessels increases significantly following air embolization. However, in the intact animal, lymph flows into the venous system and the magnitude of lymph flow is directly affected by systemic venous pressure. We hypothesized that pulmonary air embolization would lead to systemic venous hypertension and that this increase in lymphatic outflow pressure would prevent an increase in pulmonary lymph flow. METHODS AND RESULTS Pulmonary air embolization was induced in dogs under general anesthesia. Flow from cannulated pulmonary lymphatic vessels was recorded for lymphatic outflow pressure set equal to atmospheric pressure (Q(LA)) and for outflow pressure set equal to systemic venous pressure (Q(LV)) both before and after embolization. Air embolization resulted in significant increases in systemic venous pressure from 6.4 +/- 0.3 to 12.4 +/- 1.2 mm Hg and in QLA from 48 +/- 9 to 175 +/- 29 microL . min(1). However, embolization did not increase Q(LV) (10 +/- 2 vs. 3 +/- 3 microl . min(1)). CONCLUSIONS Pulmonary air embolization impedes pulmonary lymph flow by increasing systemic venous pressure and, thereby, contributes to pulmonary edema formation.
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Affiliation(s)
- Randolph H Stewart
- Michael E. DeBakey Institute, Texas A&M University, College Station, 77843-4466, USA.
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Bernardo WM, Jatene FB, Demarchi LMMF, Capelozzi VL, Pazetti R, Rivero DHRF, Monteiro R, Oliveira SAD. Análise da remodelação vascular na isquemia pulmonar experimental, nas fases aguda e crônica. J Bras Pneumol 2005. [DOI: 10.1590/s1806-37132005000100006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUÇÃO: Alterações estruturais da circulação pulmonar traduzem processo de remodelação vascular e têm relação provável com variações locais de fluxo e isquemia. OBJETIVO: Definir as alterações histológicas na circulação pulmonar após obstrução experimental da artéria pulmonar. Correlacioná-las com os padrões de redistribuição sangüínea e remodelação vascular. MÉTODO: Foram submetidos à toracotomia esquerda 48 ratos Wistar, alocados aleatoriamente em dois grupos, com ligadura da artéria pulmonar e controle, e sacrificados com 1, 7, 30 e 60 dias. Nos pulmões retirados avaliou-se presença de sinais de injúria no parênquima e mensurou-se diâmetro externo e espessura da parede das arteríolas de bronquíolos terminais, respiratórios e alveolares. Diâmetro interno e porcentagem de espessura da parede foram calculados. RESULTADOS: Só ocorreu infarto, necrose e hemorragia no pulmão isquêmico. No não isquêmico houve aumento mantido dos diâmetros externo e interno das arteríolas, com redução inicial da espessura no 1º dia e valores semelhantes aos do grupo controle no 60º dia. No pulmão isquêmico houve redução transitória nos diâmetros externo e interno das arteríolas de bronquíolos terminais e respiratórios, com aumento, inicial e transitório, na sua espessura. As arteríolas alveolares apresentaram aumento do diâmetro externo e espessura da parede, com redução do diâmetro interno, mantida e progressiva. CONCLUSÃO: Este modelo reproduz arteriopatia distal em pacientes com tromboembolismo pulmonar crônico. A resposta vascular no pulmão não isquêmico é compatível com padrão de remodelação de hiperfluxo; a no pulmão isquêmico com hipofluxo e isquemia. Nas arteríolas de bronquíolos terminais e respiratórios a resposta foi transitória. Nas alveolares foi progressiva e mantida, pela provável ocorrência tardia de hiperfluxo local.
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