mRNA疫苗技术概述及新型冠状病毒肺炎mRNA疫苗的研究进展

mRNA疫苗技术的发展受到分子本身不稳定、自身免疫原性高以及体内递送效率低等因素的限制，经过30多年的研究，近年来随着其稳定性、高效传递系统方面的技术日趋成熟，肿瘤和传染病mRNA疫苗研究进展明显。与传统疫苗技术相比，该技术可诱导机体产生体液免疫和细胞免疫，疫苗生产工艺简单、研发周期短、成本低，便于标准化生产，适用于大流行疾病和传染病暴发流行期间的疫苗开发和生产，是一种应用前景广阔的疫苗。在当前新型冠状病毒肺炎全球大流行的背景下，本文从mRNA疫苗的特征、疫苗递送系统入手，结合新型冠状病毒肺炎mRNA疫苗的研究现状进行了分析和阐述，以期为后续的mRNA疫苗研究开发提供参考依据。     

Migration capacity of human umbilical cord mesenchymal stem cells towards glioma in vivo*

High-grade glioma is the most common malignant primary brain tumor in adults.The poor prognosis of glioma,combined with a resistance to currently available treatments,necessitates the development of more effective tumor-selective therapies.Stem cell-based therapies are emerging as novel cell-based delivery vehicle for therapeutic agents.In the present study,we successfully isolated human umbilical cord mesenchymal stem cells by explant culture.The human umbilical cord mesenchymal stem cells were adherent to plastic surfaces,expressed specific surface phenotypes of mesenchymal stem cells as demonstrated by flow cytometry,and possessed multi-differentiation potentials in permissive induction media in vitro.Furthermore,human umbilical cord mesenchymal stem cells demonstrated excellent glioma-specific targeting capacity in established rat glioma models after intratumoral injection or contralateral ventricular administration in vivo.The excellent glioma-specific targeting ability and extensive intratumoral distribution of human umbilical cord mesenchymal stem cells indicate that they may serve as a novel cellular vehicle for delivering therapeutic molecules in glioma therapy.     

Insulin Use and Smoking Jointly Increase the Risk of Bladder Cancer Mortality in Patients With Type 2 Diabetes

BackgroundWhether insulin use predicts bladder cancer mortality has not been investigated. Furthermore, it is not known whether insulin use and smoking jointly influence the risk.Materials and MethodsA total of 86,939 patients (40,014 men, 46,925 women) with type 2 diabetes mellitus (T2DM) and aged ≥ 25 years in a nationally representative cohort were followed prospectively from 1995 to 2006 for bladder cancer mortality. Cox regression was used considering the following independent variables: age, sex, diabetes duration, body mass index, smoking, insulin use, and area of residence. The models were created for patients aged ≥ 25 and ≥ 65 years, separately; and sensitivity analyses were conducted after excluding (1) patients with duration between onset of diabetes and bladder cancer mortality < 5 years, and (2) patients with diabetes duration at recruitment < 3 years. The joint effect of insulin use and smoking was evaluated.ResultsPatients who died of bladder cancer were characterized by older age, male predominance, longer diabetes duration, smoking, and insulin use. In multivariable Cox models, age, male sex, and insulin use were consistently predictive for bladder cancer mortality in all analyses, whereas the other variables were not. The adjusted hazard ratios for bladder cancer mortality for insulin users vs. nonusers ranged from 1.877 to 2.502 in different models (all P values < .05). Insulin use and smoking jointly increased the adjusted hazard ratio to 3.120 (95% confidence interval, 1.329-7.322).ConclusionsInsulin use is significantly predictive for bladder cancer mortality in patients with T2DM. Insulin use and smoking jointly increase the risk.     

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??OBJECTIVE To introduce the research progress of dosage regimen of piperacillin/tazobactam and its rational offer reference for clinical use.METHODS The domestic and oversea pertinent articles were searched, analyzed and summarized, and the difference between prolonged infusion or continuous infusion and traditional infusionin pharmacodynamics and clinical trials were compared. RESULTS The optimized dosage regimen could achieve higher pharmacodynamics goals, with clinical efficacy and bacterial clearance not inferior to the traditional dosage regimen.CONCLUSION The prolonged or continuous infusion strategy should be recommended for piperacillin/tazobactam in the clinic.     

2020年全国社区医院建设追踪监测分析

背景　社区医院建设是新时期满足群众基本医疗卫生服务需求的重要举措，是推动构建优质高效医疗卫生服务体系的关键环节。自2019年开展社区医院试点工作以来，国家紧密出台相关政策文件推动其发展。截至2020年底，我国已成功创建1 410家社区医院，对其建设情况进行监测、分析十分必要。目的　分析2020年全国社区医院监测数据，针对社区医院建设推进过程中存在的问题与困难，提出进一步推动社区医院建设相关政策建议。方法　利用课题组于2020年12月开展的社区医院追踪监测数据，从社区医院达到推荐标准、业务用房建筑面积、实际开放床位数、科室设置、全科医生配置等方面进行分析，梳理各省份2020年社区医院建设工作进展。结果　截至2020年12月，全国创建社区医院1 410个，73.12%（1 023/1 399）的社区医院达到“优质服务基层行”推荐标准，山西省等9个省份的社区医院全部达到推荐标准。2020年，全国已建成的社区医院平均业务用房面积6 822 m2，较2019年增加347 m2，达到“业务用房面积≥3 000 m2”标准的社区医院占比为96.07%（1 343/1 398）；社区医院平均实际开放床位数为91张，较2019年增加3张，达到“实际开放床位数≥30张”标准的社区医院占比为97.13%（1 355/1 395）；社区医院临床科室设置逐渐齐全，除全科医疗科、康复医学科、中医科外达到“其他10个临床专业科室数≥5个”标准的社区医院占比为89.15%（1 241/1 392），2020年新增临床科室占比较多的依次为发热门诊（18.95%，260/1 372）、康复医学科（9.10%，126/1 384）、精神/心理科（6.55%，89/1 358）；社区医院平均配置全科医生16.15人，较2019年增加1.16人。结论　社区医院推进工作进展顺利，数量翻番，基础设施设备加强，临床科室不断增加，服务能力进一步提升；但各省份社区医院建设数量差距较大，部分省份社区医院对标不够，配套政策应持续完善，人才队伍建设是关键环节。社区医院建设应与各地“十四五”规划相衔接，稳步推进；多部门协同配合，强化社区医院政策保障，推动社区医院高质量发展。     

环状RNA的功能及其在结直肠癌中的研究进展

环状RNAs(circRNAs)是一种具有共价闭合环状的长链非编码RNA。circRNAs广泛存在于真核细胞并且结构稳定。circRNAs可作为微小RNAs(miRNAs)的分子海绵参与基因转录后调控,也可与多种蛋白相互作用,调控基因转录及蛋白翻译等。越来越多的研究表明,circRNA与结直肠癌的发生、发展密切相关,有望为结直肠癌的诊断和治疗提供新的分子标志物和靶点。本文从circRNAs的形成、生物学功能以及在结直肠癌疾病中的研究进展等方面进行简要综述,以期为结直肠癌早期诊断和治疗提供新靶点。     

新中国70年卫生投入回顾与展望

本文基于新中国成立以来卫生投入等相关数据，回顾了70年来卫生投入的基本情况。结合文献分析，从卫生投入的规模与结构、世界排位、卫生投入政策的发展变化等方面，系统总结了卫生投入取得的成绩，着重分析了2009年新医改以来政府主导的多元投入机制的突出特点。分析发现，我国在卫生投入结构、政府卫生投入稳定性与可持续性、个人卫生支出占比等方面还存在一定问题。同时，对新时代下面临的新形势新挑战进行了研判。预测显示，为满足人民群众日益增长的需求，推动卫生系统高质量发展，未来一定时期我国卫生投入仍将继续保持增长趋势，到2030年我国卫生投入规模将达到15.3万亿元，占GDP的比重达到9.2%。为此，建议建立以结果为导向的健康投入机制，从"以治疗为中心"向"以人民健康为中心"转变。     

Assessment of an immunomarking technique for the study of dispersal of Culicoides biting midges

Capture–mark–recapture techniques are used to determine the dispersal and survival of arthropods, including vector groups such as Culicoides. An assumption of these studies is that capture and the subsequent marking process does not impact of the survival and behaviour of the marked individual. The small size of Culicoides means that a significant mortality and disruption of normal behaviour such as host-location can be caused by the process of collection. Here we evaluate a technique, novel to the study of dispersal in vectors, to mark Culicoides directly and indirectly without prior capture. The acquisition and subsequent detection of marker protein by Culicoides exposed to a treated substrate was investigated in the laboratory. The technique was then assessed in a small-scale field trial where a defined section of resting habitat was sprayed with an egg white solution and Culicoides caught within the vicinity were tested for the presence of egg protein. It was found that up to 100% of Culicoides acquired the protein marker in the laboratory with no apparent impact on survival. In the field, pools of Culicoides obsoletus collected next to the treated area were found to be positive for the protein, suggesting that the technique could be used in larger-scale studies. The definition of a behaviourally non-invasive technique for marking Culicoides will greatly increase our understanding of the natural dispersal behaviour of Culicoides and other vectors.     

A multicenter study of the analgesic effects of epidural chloroprocaine after lower limb orthopedic surgery

Study objectiveTo investigate the effects and optimal concentration of chloroprocaine for epidural analgesia after lower limb orthopedic surgery.DesignProspective, randomized, observational, multicenter clinical study.SettingOperating room, postoperative recovery area, university hospital.PatientsOne hundred and twenty patients from 4 hospitals were enrolled and randomized into 5 groups after lower limb orthopedic surgery under epidural anesthesia with lidocaine.InterventionsEpidural chloroprocaine mixed with 0.4 μg/mL fentanyl was administered via a patient-controlled analgesia pump at the concentration of 0.6%, 0.8%, 1.0%, 1.2%, or 1.4% after the surgery.MeasurementsSystolic blood pressure, heart rate, visual analog score at rest and during activity, as well as the Bromage score at 0 minute, 30 minutes, 1 hour, 2 hours, 4 hours, 8 hours, 24 hours, and 48 hours after the surgery were recorded and compared. Use of morphine and incidence of adverse effects were also recorded.Main resultsPatients given 1.2% chloroprocaine showed the lowest visual analog score compared with other groups. There was no significant difference in the Bromage score among 5 groups. The Bromage score returned to 0 in 89.7% of the patients 48 hours after surgery. No difference in postoperative morphine usage, blood pressure, or heart rate was found among 5 groups.ConclusionsEpidural 1.2% chloroprocaine with 0.4 μg/mL fentanyl could generate proper analgesic effects with little influence on mobility in patients undergoing lower limb orthopedic surgery. In addition, it could generate a good sense and movement separation, facilitating the early functional training.     

医药分开综合改革对公立医院药师队伍影响的调查

目的：研究公立医院药师队伍受医药分开综合改革的影响。方法：通过文献回顾法对既往研究成果进行整理和综述，通过专家咨询法设计了针对6个省市药师队伍和管理者的调查问卷和访谈提纲，并以此为工具开展调查。结果：改革对药师队伍的工作内容、工作量、工作心态等维度均存在影响，药师队伍对改革政策也有不同评价，对继续教育和医院、政府的支持政策有较大需求。结论：改革促使医疗机构运营策略与药学服务转型，不仅需要药师队伍内部提升，更需要外部设计。