Exosomes as novel therapeutic nanodevices

Exosomes are small vesicles (60 to 100 nm) that are released by many cell types. Their heterogeneous protein and lipid compositions, in addition to their enduring physicochemical features have led to the idea of using these natural vesicles as nanodevices for the development of new therapeutic applications. The first exosome-based nanodevices evaluated in the clinic consisted of autologous dexosomes (patient-specific exosomes released by dendritic cells and loaded with tumor antigen-derived peptides). They were tested in two phase I trials as immunotherapeutic regimens for melanoma and nonsmall-cell lung cancer. These studies revealed that dexosome immunotherapy was feasible, safe and led to the induction of both innate and adaptive immune responses, disease stabilization and long-term survival for several patients. The recent steps made towards transforming exosomes into product candidates for immunotherapy are summarized. In addition, recent developments in the field of exosome research that we believe will lead to improved and/or new therapeutic applications are highlighted. For example, a technology known as exosome display can be utilized to develop genetic vaccines that could induce exosome-mediated immunity without requiring the preparation of patient-derived exosomes.     

高脂血症与乳腺癌

<正>近年来随着生活水平和早期诊断水平的提高,乳腺癌发病率呈上升趋势,位居女性恶性肿瘤首位。因此,乳腺癌危险因素受到广泛关注,其中初潮年龄早、绝经年龄晚延长雌激素暴露时间,明确增加了Luminal型乳腺癌的发病风险~([1-2])。血脂代谢是卵巢外雌激素合成的主要途径,因此高脂血症与乳腺癌发病风险的关系引起了广泛关注~([3-4])。早期诊断和治疗水平的提高使乳腺癌人群不     

Medical Cannabis

Medicolegal realities surrounding “medical marijuana” or “medical cannabis” are rapidly evolving in the United States. Clinicians are increasingly being asked by patients to share information about or certify them for medical cannabis. In order to engage in informed discussions with patients or be comfortable certifying them in states with medical cannabis laws, clinicians may benefit from an understanding of the current state of medical knowledge about medical cannabis. Intended for the generalist and subspecialist, this review provides an overview of the legal status, pharmacology, benefits, risks, and abuse liability of medical cannabis along with a general framework for counseling patients.     

Medical Info

上海东方台胞医院开业仪式目前在同济大学附属东方医院南院举行。作为两岸医界交流的盛事,台湾地区八家著名医院的负责人专程来沪参加台胞医院开业仪式,并在“海峡两岸心血管论坛”上进行交流发言。     

Beyond the Medical Model: Thinking Differently about Medical Education and Medical Education Research

Abstract

Issue: In medical education, teaching is currently viewed as an intervention that causes learning. The task of medical education research is seen as establishing which educational interventions produce the desired learning outcomes. This ‘medical model’ of education does not do justice to the dynamics of education as an open, semiotic, recursive system rather than a closed, causal system. Evidence: Empirical ‘evidence’ of ‘what works’ – that is, what is supposed to affect ‘learning’ – has become the norm for medical educational improvements, where generalized summary outcomes of research are often presented as must-follow guidelines for myriad future educational situations. Such investigations of educational processes tend to lack an explicit engagement with the purposes of medical education, which we suggest to understand in terms of qualification (the acquisition of knowledge, skills, and understanding), socialization (becoming a member of the professional group) and subjectification (becoming a thoughtful, independent, responsible professional). In addition, investigations of educational processes tend to rely on causal assumptions that are inadequate for capturing the dynamics of educational communication and interaction. Although we see an increasing acknowledgement of the context-dependency of teaching practices toward educational aims, the currently prevailing view in medical education and educational research limits understanding of what is actually going on when educators teach and students participate in medical education – a situation which seriously hinders advancements in the field. Implications: In this paper, we hope to inform discussion about the practice of medical education by proposing to view medical education in terms of three domains of purpose (professional qualification, professional socialization, and professional subjectification) and with full acknowledgement of the dynamics of educational interaction and communication. Such a view implies that curriculum design, pedagogy, assessment, and evaluation should be reoriented to include and integrate all three purposes in educational practice. It also means that medical education research findings cannot be applied in just any teaching context without carefully considering the value of the suggested courses of actions toward the particular educational aims and teaching setting. In addition, medical educational research would need to investigate all three purposes and recognize the openness, semiotic nature, and recursivity of education in offering implications for teaching practice.     

Medical devices regulations and the Medical Devices Agency

Pansy suffered from a chronic lung condition that required frequent courses of antibiotics. As her veins were poor and cannulation was difficult, a passport was inserted into a vein in her arm in which antibiotics and other solutions were administered. After three courses of antibiotics over the course of several weeks, the nurses had difficulty in administering the medication through the passport but finally succeeded. Subsequently, during a routine X-ray of her lungs, it was discovered that the tube connected with the reservoir had become disconnected and had moved down the vein towards the heart.     

Medical School Ranking and Medical Student Vocational Identity

Phenomenon: Vocational identity may play an important role in physicians' healthy professional development. Allopathic medical students' vocational identity may bear a relationship to the level of emphasis placed on research versus service at their medical school. Approach: Social mission score (SMS) and the US News and World Report (USNWR) research ranking (year 2011) were used as schools' national rankings for service and research, respectively. A questionnaire was sent to 960 3rd-year medical students from 24 allopathic medical schools between January and April 2011. The scale for vocational identity was created using the responses from the Vocational Identity Scale (9 items), and we used an established cutoff from a previous study to categorize those students who had “strong” vocational identity. Findings: After categorizing allopathic medical schools into four groups based on SMS rankings, we found that medical students who attended allopathic medical schools from the two highest SMS ranking groups were more likely to report scores reflecting strong vocational identities—odds ratio [OR] = 2.9, 95% confidence interval (CI) [1.8, 4.7] and OR = 2.5, 95% CI [1.6, 4.0], respectively. In contrast, we did not find any associations between students from allopathic medical schools with high USNWR rankings and likelihood of reporting scores reflecting strong vocational identities. Insights: Social mission scores for allopathic medical schools may potentially serve as predictors of professional and vocational identity development. Further research is needed to better understand these findings, as this is one of the first studies both to examine allopathic medical students' sense of vocational identity and to explore the use of SMS rankings as predictors of medical students' professional development.     

Medical Direction for Operational Emergency Medical Services Programs

Abstract

This is the official position statement of the National Association of EMS Physicians and the National Association of State EMS Officials on medical direction for operational emergency medical services (EMS) programs.     

Medical psychotherapy

Medical psychotherapy is often practiced by family physicians unknowingly. It shares certain features with all other forms of psychotherapy, but it also possesses its own unique qualities. Medical psychotherapy represents combinations of techniques, learned largely by experience, that are useful in treating the patient in crisis, as well as the patient with chronic psychiatric or physical illness. It contributes to higher quality medical care.