干细胞移植联合免疫抑制治疗1型糖尿病的应用前景

背景:最近许多研究报道,干细胞细胞移植联合免疫干预可维持较长的胰岛素非依赖时间并减少糖尿病并发症的发生,但其机制尚不清楚.目的:探讨应用干细胞移植联合免疫抑制治疗1型糖尿病的前景.方法:应用计算机检索了Pubmed数据库(http://www.ncbi.nlm.nih.gov/pubmed/)、CNKI数据库(http://www.cnki.net)、维普数据库(http://www.cqvip.com/index.shtml)、万方数据库(http://g.wanfangdata.com.cn/),检索范围为各数据库中的全部文章,英文检索词为"stem cells,diabetes mellitus,immunosuppression",中文检索词为"干细胞,糖尿病".从检索出的1 676篇文章中选择出文章内容与干细胞移植、免疫抑制治疗1型糖尿病密切相关、较为权威的文章,排除较陈旧文献及重复研究,共纳入中英文文章共29篇进一步分析.结果与结论:就目前干细胞移植联合免疫抑制治疗1型糖尿病的研究现状,对国内外29篇相关文献和报道进行研究总结.结果显示干细胞移植联合免疫抑制治疗1型糖尿病可提高治疗效果,减少并发症的出现,具有良好的应用前景.     

运动性软骨损伤与组织工程化软骨及生物支架材料的修复

背景:篮球运动中造成软骨损伤较为常见.随着组织工程和生物材料的应用发展,利用软骨组织工程化或支架材料修复已成为趋势.目的:对篮球运动中造成软骨损伤的因素进行探讨,重点对组织工程支架材料修复过程中关注的3个要素的研究和运用情况进行概括.方法:由第一作者检索2005-01/2010-10PubMed数据库(http://www.ncbi.nlm.nih.gov/PubMed)及万方数据库(http://www.wanfangdata.com.cn).英文检索词为"crtilage,damage,treatment,biological materials",中文检索词为"组织工程;软骨损伤;修复;生物材料;种子细胞".检索文献量总计120篇,选择文章内容与软骨治疗方法、材料学特点、生物相容性、材料改性、表面修饰及其应用效果相关等方面的文献,排除陈旧及重复实验文章,同一领域文献则选择近期发表或发表在权威杂志的文章,最终纳入30篇符合标准的文献.结果与结论:种子细胞、支架材料和体外培养环境,构成了软骨组织工程学注重的3个要素,3者组成了一个相互促进相互制约的整体,以组织工程技术修复软骨损伤时应注重到3者间的恰当选择和配置.     

药物缓释体抗胶质瘤的效用分析

目的:对药物缓释系统抗胶质瘤中载体材料的类型、材料生物学特点及其应用进行了归纳总结.方法:作者应用计算机检索PubMed(http://www.ncbi.nlm.nih.gov/PubMed)及CNKI数据库(www.cnki.net/index.htm),在标题和摘要中以"聚乳酸,载体,间质内化疗"或"Polylactic acid, vector, interstitial chemotherapy"为检索词进行检索.选择文章与药物缓释体,聚乳酸,载体及其应用效果相关,同一领域文献则选择近期发表或发表在权威杂志文章.共纳入13篇文献.结果:作为药物缓释体的载体应具备良好的生物相容性、高分子聚合物和降解产物均无毒,适当的物理机械性能及可成型性,具有可以调节的降解速度.目前间质内化疗治疗胶质瘤复发,即缓释控释给药系统,不需频繁给药,能在较长时间内维持体内有效的药物浓度,从而可以显著提高药效和降低毒副作用.与静脉化疗药物治疗相比,毒副作用少且疗效好.结论:选择具有良好生物学特性的可降解高分子为载体的化疗缓释体,进行间质内化疗较静脉化疗有明显优势,极具开发潜能.     

肾移植后不同免疫抑制剂抗排斥反应的临床应用及不良反应

背景:如何利用免疫抑制剂之间的协同作用,发挥最佳疗效是肾移植后抗排斥反应的关键所在,如何做到个体化用药,提高疗效避免不良反应的发生显得尤为重要。目的:评价不同免疫抑制剂对肾移植受者和移植肾存活的影响,以便更好地避免药物不良反应。方法:应用计算机检索1999-01/2009-10CNKI数据库相关文献,检索词为"免疫抑制剂,肾移植,排斥反应"。选择文章内容与肾移植免疫抑制剂有关者,同一领域文献则选择近期发表或发表在权威杂志文章,入选25篇文献进行综述。结果与结论:任何一种免疫抑制剂在发挥免疫抑制作用时都会伴有一定毒副作用,临床上应尽量避免不良反应发生。联合用药抗排斥反应已达成共识,事实证明无论采用何种联合方式,均有单一用药无可替代的优势。如何利用免疫抑制药之间的协同作用,发挥最佳疗效是临床关键所在,医生应严密监测患者血药浓度,做到个体化用药,尽可能降低肾移植后排斥反应发生率。     

干细胞在口腔医学中的研究与应用特点

背景:牙髓干细胞、骨髓基质干细胞和牙周膜干细胞属于口腔中的成体干细胞,具有成体干细胞的两大特征:较强的自我更新能力和分化潜能.通过对口腔中多种干细胞的深入研究,有助于人类更加深入地揭示牙齿硬组织形成过程与诱导机制,进而指导临床相关治疗与预防.目的:总结各类口腔成体干细胞的特点及在临床中的应用前景.方法:由第一作者检索1999-01/2009-12 PubMed数据库(http://www.ncbi.nlm.nih.gov/PubMed)及中国知网数据库(http://www.cnki.net).英文检索词为"stem cell,dentistry",中文检索词为"干细胞,口腔医学".检索文献量总计80篇,选择干细胞在口腔医学领域中的基础研究及临床应用,排除陈旧及重复实验文章,最终纳入19篇符合标准的文献.结果与结论:随着研究的深入,口腔特有的成体干细胞将会逐渐被发现,从而建立完整的干细胞库,为口腔各组织的组织工程研究提供可能的细胞来源.     

运动免疫学研究的新进展

目的:运动在增强机体免疫系统某些功能的同时,可使另一些功能受到抑制。研究免疫系统对运动负荷的反应机制,有助于避免运动所致的免疫抑制的发生,为运动健身提供科学依据。资料来源:应用网络检索http://www.ncbi.nlm.nih.gov/PubMed,http://www.highwire.org/,1990-01/2005-02关于运动免疫的相关文献。检索词(限制为标题):免疫(immune),运动(exercise)。资料选择:在检索出的146篇文献中选择运动与感染、运动与免疫抑制、运动与细胞因子、运动与免疫细胞等研究性文献86篇,排除经验总结、个案报告,未排除非盲法研究原著。资料提炼:在86篇文献中,删除21篇内容重复的文献;对65篇文献进行分类整理,其中41篇选用为参考文献。资料综合:营养、机体的状态、年龄、运动的强度、运动的方式等多种因素均可影响机体免疫系统对运动的反应性。大强度运动后上呼吸道感染也许不是发生了新的感染,而是原有感染在运动后的激发;长期有氧运动增加老年人免疫力却得到进一步的实验支持。运动与神经内分泌的研究取得了一些进展,但还是非常局限,结论也有许多矛盾的地方。结论:运动对机体免疫系统的影响是复杂和综合的。运动免疫学的研究还处于初级阶段,任何简单的结论都是不科学的。     

疾病特异诱导多能干细胞距离神经退行性疾病的临床治疗还有多远

背景:各种神经退行性疾病传统的内外科治疗只能缓解症状而不能阻止疾病的进一步发展,细胞替代治疗近年进展迅速,但是干细胞存在的伦理问题及免疫排斥等问题不容忽视,而诱导多能干细胞的产生为这些问题提供了新的解决途径.目的:综述神经退行性疾病的治疗现状以及诱导多能干细胞作为新的细胞来源治疗神经退行性疾病的可能性.方法:应用计算机检索1995/2010 PubMed数据库(http://www.ncbi.nlm.nih.gov/PubMed)及万方数据库(http://www.wanfangdata.com.cn),英文检索词为"induced pluripotent stem cell,PD,ALS,SMA,degenerative disease",中文检索词为"干细胞,帕金森病".初检得到文献374篇,根据纳入标准选择29篇文章进行综述.结果与结论:疾病特异诱导多潜能干细胞可保持疾病特异的基因型,有利于疾病分子机制的进一步阐明,且其拥有与胚胎干细胞类似的多向分化能力;在体外动物模型中可分化为多巴胺能神经元,缓解帕金森病的临床症状,在神经退行性疾病的临床治疗方面具有广泛的应用前景.     

运动性软骨损伤与组织工程化软骨及生物支架材料的修复

背景：篮球运动中造成软骨损伤较为常见。随着组织工程和生物材料的应用发展,利用软骨组织工程化或支架材料修复已成为趋势。目的：对篮球运动中造成软骨损伤的因素进行探讨,重点对组织工程支架材料修复过程中关注的3个要素的研究和运用情况进行概括。方法：由第一作者检索2005-01/2010-10PubMed数据库（http：//www.ncbi.nlm.nih.gov/PubMed）及万方数据库（http：//www.wanfangdata.com.cn）。英文检索词为＂crtilage,damage,treatment,biological materials＂,中文检索词为＂组织工程;软骨损伤;修复;生物材料;种子细胞＂。检索文献量总计120篇,选择文章内容与软骨治疗方法、材料学特点、生物相容性、材料改性、表面修饰及其应用效果相关等方面的文献,排除陈旧及重复实验文章,同一领域文献则选择近期发表或发表在权威杂志的文章,最终纳入30篇符合标准的文献。结果与结论：种子细胞、支架材料和体外培养环境,构成了软骨组织工程学注重的3个要素,3者组成了一个相互促进相互制约的整体,以组织工程技术修复软骨损伤时应注重到3者间的恰当选择和配置。     

经皮主动脉瓣置换的最新研究进展

背景:外科手术是主动脉瓣狭窄的主要治疗方法,但是对于高龄、多重合并症及高手术风险的患者,经皮主动脉瓣置换是最好的选择.目的:总结经皮主动脉瓣置换在在心血管疾病中的应用进展.方法:由第一作者检索2000/2010PubMed数据(http://www.ncbi.nlm.nih.gov/PubMed)及万方数据库(http://www.wanfangdata.com.cn)有关主动脉瓣狭窄外科手术治疗、药物治疗及介入治疗等方面的文献,英文检索词为"aroticstenosis,percutaneous aortic valve replacement,valve stent",中文检索词为"主动脉瓣狭窄;经皮主动脉瓣置换;瓣膜支架;器官移植".排除重复性研究.计算机初检得到63篇文献,根据纳入标准保留25篇进一步归纳总结.结果与结论:自2002 年首例在人体实施经皮主动脉瓣置换手术后,近8年得到了极大的发展,不论是新的心脏瓣膜开发还是手术方式的改善都发展的相当迅速.但是就目前的技术而言还有很多缺陷,比如瓣膜支架不能很好地固定导致瓣膜移位和瓣周漏,血栓形成及主动脉瓣关闭不全也有一定的风险,并且手术操作较复杂在全球范围内普及较低,在中国进行的手术例数更是屈指可数.相信随着手术技术的改良和瓣膜支架的开发以及对手术的更深入研究,经皮主动脉瓣膜置换必将得到更好的发展,使得更多的患者能够获得很好治疗.     

间充质干细胞在再生障碍性贫血治疗中的应用

背景:造血干细胞移植现在仍然是儿童和青年重型再生障碍性贫血的一线治疗选择,但供者来源有限,费用高,且5%~15%的患者因为慢性移植物抗宿主病影响疗效和生活质量.因此尚需探索能提高疗效,减轻不良反应的治疗途径.间充质干细胞易于分离并且增殖力稳定,可以满足临床需求.目的:总结间充质干细胞的研究进展、免疫学特性以及在再生障碍性贫血治疗中的应用情况.方法:由第一作者在2010-06检索PubMed数据库(http://www.ncbi.nlm.nih.gov/PubMed)及中国期刊全文数据库(http://www.cnki.net)1995/2010有关间充质干细胞的研究进展、免疫学特性以及在再生障碍性贫血治疗中应用的文献.英文检索词为"mesenchymal stem cells,aplastic anemia,anemia",中文检索词为"间充质干细胞,再生障碍性贫血,贫血".结果与结论:共收集119篇关于间充质干细胞及再生障碍性贫血的文献,中文85篇,英文34篇,排除因研究目的与课题无关、发表较早、重复及类似研究,纳入30 篇符合标准的文献.目前普遍认为再生障碍性贫血是一种获得性骨髓造血功能衰竭症,再生障碍性贫血的发生、发展与T细胞功能亢进引起的造血组织损伤密切相关.间充质干细胞具有免疫负调节及支持造血双重作用,且具有可移植性和来源广泛的特点.再生障碍性贫血患者和正常人的间充质干细胞在生物学特性上具有差异性,间充质干细胞将会为研究再生障碍性贫血的发病机制和治疗提供新的思路和方法.     

Blood biomarkers of kidney transplant rejection,an endless search?

Introduction: The tailoring of immunosuppressive treatment is recognized as a promising strategy to improve long-term kidney graft outcome. To guide the standard care of transplant recipients, physicians need objective biomarkers that can identify an ongoing pathology with the graft or low intensity signals that will be later evolved to accelerated transplant rejection. The early identification of ‘high-risk /low-risk’ patients enables the adjustment of standard of caring, including managing the frequency of clinical visits and the immunosuppression dosing. Given their ease of availability and the compatibility with a large technical array, blood-based biomarkers have been widely scrutinized for use as potential predictive and diagnostic biomarkers.

Areas covered: Here, the authors report on non-invasive biomarkers, such as modification of immune cell subsets and mRNA and miRNA profiles, identified in the blood of kidney transplant recipients collected before or after transplantation.

Expert commentary: Combined with functional tests, the identification of biomarkers will improve our understanding of pathological processes and will contribute to a global improvement in clinical management.     

Cardiac surgery in solid organ transplant recipients: a clinical challenge

Introduction: Due to continuous improvement of transplant medicine, the number of solid organ transplant recipients in need of cardiac surgery is constantly growing. The objective of this work was to compare different reports on outcomes in patients with previous solid organ transplant after cardiac surgery.

Areas covered: Published studies containing data about solid organ transplant recipients: renal, hepatic, pancreas or combined were identified through med-line research. Reported outcomes were categorized according to short- and long term-follow up and the presence or absence of a match-group. All data reported was analyzed in a retrospective manner. Throughout the studies, authors have reported acceptable short term mortality and morbidity for solid organ transplant recipients, which however was increased when compared to matched population.

Expert commentary: This review summarizes chief findings concerning cardiac surgery in recipients of solid organ transplantations, as reported in current literature, with the aim of highlighting clinical aspects, which play a potential role in the short and long term-outcome of these patients.     

Management of toxoplasmosis in transplant recipients: an update

Introduction. Toxoplasmosis is a life-threatening parasitic disease for hematopoietic stem cell transplant (HSCT) and solid organ transplant (SOT) recipients. The risk of toxoplasmosis in transplant patients mainly depends on the degree of immunosuppression, the tropism of Toxoplasma gondii for the grafted tissue, and the seroprevalence in the general population. Although transplant recipients with toxoplasmosis have a high mortality rate, there are neither well-defined recommendations nor a consensus for the management of this disease in these patients.

Areas covered. This review focuses on the management of toxoplasmosis in transplant recipients and discusses the various strategies for diagnosis, prevention, treatment, and follow-up in clinical practice. The literature search was conducted on publications in English and French using the search terms ‘Toxoplasma gondii,’ ‘organ transplant,’ and ‘transplant recipients.’

Expert commentary. The diagnosis of toxoplasmosis has greatly improved over the last two decades, but it is still a fatal illness. Non-specificity of the symptoms, resulting in a delay before diagnosis, and therapeutic failure are the main causes of death. The development of active treatments against cysts is one of the current challenges that will considerably improve the management of toxoplasmosis in transplant recipients by clearing chronic infection to avoid T. gondii reactivation.     

Current status of mechanical circulatory support for treatment of advanced end-stage heart failure: successes,shortcomings and needs

Introduction: Heart failure (HF) remains a major global burden in terms of morbidity and mortality. Despite advances in pharmacological and resynchronization device therapy, many patients worsen to end-stage HF. Although the gold-standard treatment for such patients is heart transplantation, there will always be a shortage of donor hearts.

Areas covered: A left ventricular assist device (LVAD) is a valuable option for these patients as a bridge measure (to recovery, to candidacy for transplant, or to transplant itself) or as destination therapy. This review describes the current indications for and complications of the most commonly implanted LVADs. In addition, we review the potential and promising new LVADs, including the HeartMate 3, MVAD, and other LVADs. Studies investigating each were identified through a combination of online database and direct extraction of studies cited in previously identified articles.

Expert commentary: The goal of LVADs has been to fill the gap between patients with end-stage HF who would likely not benefit from heart transplantation and those who could benefit from a donor heart. As of now, the use of LVADs has been limited to patients with end-stage HF, but next-generation LVAD therapy may improve both survival and quality of life in less sick patients.     

New drugs and allogeneic hematopoietic stem cell transplantation for hematological malignancies: do they have a role in bridging,consolidating or conditioning transplantation treatment?

Introduction: Novel targeted therapies and monoclonal antibodies can be combined with allogeneic stem cell transplantation (allo-SCT) at different time-points: 1) before the transplant to reduce tumour burden, 2) as part of the conditioning in place of or in addition to conventional agents 3) after the transplant to allow long-term disease control.

Areas covered: This review focuses on the current integration of new drugs with allo-SCT for the treatment of major hematological malignancies for which allo-SCT has been a widely-adopted therapy.

Expert opinion: After having been used as single agent salvage treatments in relapsed patients after allo-SCT or in combination with donor lymphocyte infusions, many new drugs have also been safely employed before allo-SCT as a bridge to transplantation or after it as planned consolidation/maintenance. This era of new drugs has opened new important opportunities to ‘smartly’ combine ‘targeted drugs and cell therapies’ in new treatment paradigms that may lead to higher cure rates or longer disease control in patients with hematological malignancies     

输尿管支架生物降解材料丙交酯-乙交酯共聚物在体外的降解及临床应用

背景:目前不同形式的输尿管支架均有其并发症,因此,如何选择适宜的支架来治疗泌尿系统疾病是目前医学界研究的热点.目的:探讨输尿管支架生物降解材料丙交酯/乙交酯共聚物在体外的降解规律及临床应用前景.方法:由第一作者检索1991-01/2009-12 PubMed数据库(http://www.ncbi.nlm.nih.gov/PubMed)及万方数据库(http://www.wanfangdata.com.cn)有关输尿管支架生物降解材料丙交酯-乙交酯共聚物在体外的降解及临床应用方面的文献,英文检索词为"SR-PLGA;in-vitro degradation;degradalion rate",中文检索词为"丙交酯-乙交酯共聚物;体外降解;降解速率".检索文献量总计135篇,排除陈旧及重复性文章,最终纳入17篇文献进一步分析.结果与结论:高分子降解性输尿管支架材料体内外生物降解性质的研究国外报道较少,国内则未见报道,目前该领域处于基础研究阶段.作为生物降解性高分子材料,降解性质及相容性是此种材料得以应用的首要条件,了解材料的降解及相容性对材料的临床应用具有极其重要的意义.输尿管支架生物降解材料丙交酯-乙交酯共聚物的生物相容性良好,通过调整乙交酯与丙交酯的组分比,可有效调节共聚物的降解速率.     

A successful history: probiotics and their potential as antimicrobials

Introduction: Probiotics are living, non-pathogenic microorganisms (bacteria) that enter through diet in the human body, live during their passage through the gastrointestinal (GI) tract and are beneficial to health. They have become popular in recent years as a way of improving human health through nutrition. This review aims to discuss the efficacy of probiotics for the supportive therapy of certain clinical conditions, especially infectious diseases, as reported in a number of studies, even though some concerns about their safety still remain.

Areas covered: This paper will review the history of probiotics, from ancient ages to date, and the evolution of their use in clinical practice. The study is based on both personal professional experience of the authors and a comprehensive literature analysis, including old documents from libraries, searching the related biological and clinical data on Scopus, Web of Science, PubMed, EMBASE, also using the ‘cited by’ and ‘similar articles’ options available in PubMed.

Expert opinion: Not all researchers agree about the safety and real efficacy of probiotics in common conditions, especially infective diseases. However, the use of probiotics for clinical conditions that may be improved by consumption of these dietary supplements should be considered as a possible supportive therapy in select patients.     

Managing recurrent urinary tract infections in kidney transplant patients

Introduction: Recurrent urinary tract infections (UTI) are a common clinical problem in kidney transplant recipients. Due to the complex urological anatomy derived from the implantation of the kidney graft, the spectrum of the disease and the broad underlying pathophysiological mechanisms. Recurrent UTI worsen the quality of life, decrease the graft survival and increase the costs of kidney transplantation.

Areas covered: In this review, we describe the definitions, clinical characteristics, pathophysiological mechanisms and microbiology of recurrent urinary tract infections in kidney transplantations. The actual published literature on the management of recurrent urinary tract infections is based on case series, observational cohorts and very few clinical trials. In this review, the available evidence is compiled to propose evidence-based strategies to manage these complex cases.

Expert commentary: The management of recurrent urinary tract infections in kidney transplant patients requires a proper diagnosis of the underlying mechanism. Early identification of structural or functional urological abnormalities, potentially amenable for surgical correction, is crucial for a successful management. The use of antibiotics to prevent recurrent infections should be carefully evaluated to avoid side effects and emergence of antibiotic-resistant microorganisms.     

神经干细胞在脊髓损伤中的应用与进展

背景:神经干细胞来源广泛,取材方便,分离培养容易,且神经干细胞易于外源基因的导入和表达,可为基因治疗神经系统的疾病提供良好的载体.目的:对神经干细胞在脊髓损伤中的应用进行回顾性研究.方法:由通讯作者检索2006/2009 PubMed数据(http://www.ncbi.nlm.nih.gov/PubMed)及万方数据库(http://www.wanfangdata.com.cn)有关神经干细胞的培养,鉴定,分化,及其应用于脊髓损伤的组织工程修复等方面的文献,英文检索词为"neural stem cells,spinal cord injury,cellular transplantation",中文检索词为"神经干细胞,脊髓损伤,细胞移植".排除重复性研究.计算机初检得到82篇文献,根据纳入标准保留23篇进一步归纳总结.结果与结论:神经干细胞移植的动物实验已广泛开展.目前神经干细胞在修复脊髓损伤中的应用主要集中以下几方面:一是直接细胞移植进行替代治疗,通过神经干细胞的移植或激活体内的神经干细胞,使其分化为神经元和胶质细胞,并与已经存在的神经细胞结构整合到一起而达到治疗疾病的目的;二是以神经干细胞作为基因载体,携带治疗作用的目的基因进行移植,从而达到细胞替代和基因治疗的双重作用;三是通过对生长因子和细胞因子的研究,诱导自身的神经干细胞分化进行神经自我修复.