Extracellular vesicles: Their emerging roles in the pathogenesis of respiratory diseases

Alveoli are the basic structure of the lungs, consisting of various types of parenchymal and bone marrow-derived cells including alveolar macrophages. These various types of cells have several important functions; thus, communication between these cells plays an important role in homeostasis as well as in the pathophysiology of diseases in the lungs. For a better understanding of the pathophysiology of lung diseases, researchers have isolated each type of lung cell to investigate the changes in their gene expressions, including their humoral factor or adhesion molecules, to reveal the intercellular communication among these cells. In particular, investigations during the past decade have focused on extracellular vesicles, which are lipid bilayer delimited vesicles released from a cell that can move among various cells and transfer substances, including microRNAs, mRNAs and proteins, thus, functioning as intercellular messengers. Extracellular vesicles can be classified into three general groups: apoptotic bodies, exosomes, and microparticles. Extracellular vesicles, especially exosomes and microparticles, are attracting increasing attention from pulmonologists as tools for understanding pathogenesis and disease diagnosis. Here, we review studies, including our own, on exosomes and microparticles and their roles in both lung homeostasis and the pathogenesis of lung diseases such as idiopathic pulmonary fibrosis, chronic obstructive lung diseases, and acute respiratory distress syndrome. This review also addresses the roles of extracellular vesicles in COVID-19, the current global public health crisis.     

扶正法治疗精神疾病的心悟

慎察精神疾病患者之症象,准确辨证,若系正气虚匮或不足,予相应之扶正方药、针灸等主治或辅治之,收效颇佳。反之,审证不清,“实而误补,固必增邪”(《顾氏医镜》)。同时,宜鼓励患者多做活动锻炼,增强体质,提高正气,亦可谓一种较好的扶正辅助疗法。     

全国2015-2020年精神科医师转岗培训状况

目的:调查全国精神科医师转岗培训情况,为优化精神科医师转岗培训和制定精神卫生人才培养体系建设提供参考。方法:设计精神科医师转岗培训调查问卷,调查全国31个省(自治区、直辖市)和新疆生产建设兵团2015-2020年转岗培训情况。采用描述性分析方法,对全国精神科医师转岗培训和培训区县覆盖等情况进行分析;采用χ~2检验比较东中西部地区转岗医师中已提供精神科诊疗服务情况。结果:全国共13 388人完成精神科医师转岗培训,9923人变更或加注了精神科执业资质,6538人已提供精神科诊疗服务,无精神卫生资源空白区县数减少85.1%。结论:转岗培训短期内缓解了精神卫生人才紧缺现状,提高了精神卫生服务可及性。     

Methodological considerations for near-infrared spectroscopy to assess mitochondrial capacity after spinal cord injury

Background: Skeletal muscle mitochondrial activity is reduced by?～?50–60% after SCI, resulting in impaired energy expenditure, glucose utilization and insulin sensitivity. Near infra-red spectroscopy (NIRS) is a non-invasive tool that can be used to assess mitochondrial capacity.

Objectives: (1) Highlight methodological limitations impacting data acquisition and analysis such as subcutaneous adipose tissue (SAT) thickness, movement artifacts, inadequate muscle stimulation, light interference, and ischemic discomfort. (2) Provide technical considerations to improve data acquisition and analysis. This may serve as guidance to other researchers and clinicians using NIRS.

Study Design: cross-sectional observational design.

Settings: Clinical research medical center.

Participants: Sixteen men with 1?>?year post motor complete SCI.

Methods: NIRS signals were obtained from right vastus lateralis muscle utilizing a portable system. Signals were fit to a mono-exponential curve.

Outcome Measures: Rate constant and r ² values for the fit curve, indirectly measures mitochondrial capacity.

Results: Only four participants produced data with accepted rate constants of 0.002–0.013?s^?1 and r ² of 0.71–0.87. Applications of studentized residuals ≥2.5 resulted in sparing data from another four participants with rate constants of 0.010–0.018?s^?1and r ² values ranging from 0.86–0.99.

Conclusions: Several limitations may challenge the use of NIRS to assess mitochondrial capacity after SCI. Acknowledging these limitations and applying additional data processing techniques may overcome the discussed limitations and facilitate data sparing.     

各地区中医药预防新型冠状病毒肺炎(COVID-19)方案分析

分析湖北省武汉市新型冠状病毒肺炎(COVID-19)疫情蔓延后各地区发布的中医药预防方案,探究其规律,更好地指导临床用药。收集互联网上发布的新闻和通报,自2019年12月8日官方通报的武汉首例不明原因肺炎发病病例至2020年2月1日北京、天津等地区的13项含中药处方的中医药预防COVID-19的方案。13项预防方案中多用黄芪、玉屏风散等中药和方剂补"正气";由于疫情发于冬季,预防方案体现因时制宜的原则;北方8个地区多使用麦冬、玄参等滋阴润燥中药,南方5个地区多用苍术、藿香等芳香除湿中药,预防方案体现因地制宜的原则;根据人群体质不同采用不同处方,体现因人制宜的原则。此外,还应重视隔离病原、起居有节、调节情志、饮食营养、适当运动等预防措施。COVID-19的中医药预防应注重补正气,根据不同气候、不同地区、不同人群辨证用药,重视综合预防,灵活运用各种措施,达到最佳预防效果。     

伊布利特联合胺碘酮转复持续性房颤的有效性及安全性研究

目的 探讨运用循证护理模式对脑卒中恢复期患者在社区家庭康复中的干预效果。 方法 选取80例首发脑卒中患者作为研究对象，采用随机数字表法分为常规组和观察组各40例。常规组采用常规社区家庭康复护理方法，而观察组实施循证护理模式，即采用循证护理路径制定出适合患者的最佳社区家庭康复护理方案。评估2组患者干预前后的心理状态、神经功能缺损程度、日常生活能力和运动功能，比较2组患者干预后的总有效率、生活质量、疾病复发率和护理满意度。 结果 观察组干预后的总有效率高于常规组（P＜0.05）；观察组干预后的DSI评分、CSS评分、Barthel指数和MAS评分均优于常规组（P＜0.05）；观察组患者干预后的复发率低于常规组，护理满意度高于常规组（P＜0.05）。 结论 在脑卒中恢复期患者的社区家庭康复中，实施循证护理模式能够改善患者的心理状况及运动功 和日常生活能力，降低复发率，提高患者生活质量；能够增进护患间信任及和谐关系。     

Percentage of residual B cells after 2 weeks of rituximab treatment predicts the improvement of systemic sclerosis-associated interstitial lung disease

The benefit of rituximab (RTX) for systemic sclerosis-associated interstitial lung disease (SSc-ILD) has been shown in previous clinical trials. However, predictors of RTX efficacy have not been clarified. We investigated whether B-cell responsiveness to RTX is related to therapeutic effect. Ten SSc-ILD patients treated with RTX in an independent clinical trial (Japan Registry of Clinical Trials, jRCTs031180373) were included in this analysis. Peripheral B-cell counts were examined retrospectively before RTX administration (baseline) and at 2, 4, 12, and 24 weeks after the first RTX administration, along with percent-predicted forced vital capacity (%FVC) before and 24 weeks after RTX treatment. Relative to baseline, the percentage of residual peripheral blood B cells at 2 weeks after RTX was negatively correlated with the %FVC improvement at the 24-week assessment (r = ?0.41, p = 0.04). In the subgroup with less than 5% B-cell persistence at week 2, %FVC at the 24-week assessment was significantly improved compared to baseline (p = 0.02). In another subgroup with more than 5% residual B cells, %FVC was not significantly different after 24 weeks compared to baseline (p = 0.41). In conclusion, the removal rate of B cells after 2 weeks of RTX treatment may be a useful surrogate marker of subsequent SSc-ILD improvement.