干细胞移植治疗心脏疾患存在的问题及其研究进展

干细胞移植给心血管疾病的治疗带来希望,但是同时也存在着许多悬而未决的问题,包括干细胞移植后的安全问题、于细胞的移植途径和移植细胞的选择问题等,本文就干细胞移植进展和存在问题进行综述。     

细胞性心肌成形术对受损心肌的治疗潜能

概述干细胞移植治疗受损心肌的研究进展，着重阐述骨髓来源的三种干细胞系移植的现状以及干细胞移植的优缺点、移植方式及待解决的问题。     

干细胞移植治疗急性心肌梗死的临床研究新进展

干细胞移植已成为治疗心肌梗死的研究热点。大量临床试验已证实干细胞移植能增加左室射血分数,改善心功能等。但要将干细胞移植应用于临床中,仍有许多问题尚未解决。     

干细胞治疗缺血性心力衰竭研究进展

干细胞移植已经被用于治疗如急性心肌梗死、心力衰竭等心脏疾病,其可以提高心功能、促进新生血管的形成和对心脏生理间接影响。被研究的干细胞包括胚胎干细胞、胎儿心肌细胞、骨骼肌肌原细胞、骨髓干细胞、外周血CD34 细胞、内皮祖细胞、心肌祖细胞和成纤维细胞。虽然干细胞治疗心力衰竭是一项革命性进展,但还有许多问题期待解决,比如说何种人群适合做干细胞治疗、移植细胞种类、移植方式、移植细胞数目和疗效的评估等都还没有明确。现从干细胞类型,移植后的效果及移植的方法等方面做一综述。     

干细胞治疗心血管疾病现状及展望

心脏仅有有限的自我再生能力,因此,心肌受损或梗死后的治疗需要外源性的细胞加以修复,目前研究最多的是干细胞治疗。干细胞按来源不同分为胚胎干细胞和成体干细胞。胚胎干细胞研究由于伦理学上的争议,其研究受到困扰,成体干细胞移植成为研究热点。研究表明干细胞移植后,心脏的功能有改善,但其具体机制是移植细胞自身作用,还是细胞旁分泌作用或其他,各研究提供的证据不一。移植本身亦带来了许多问题,如移植手段,移植细胞的纯度、移植后细胞的协调性、机体的排斥、致心律失常作用等,这些都引发了进一步的研究。     

干细胞移植治疗心肌梗死

近几年干细胞移植在心肌梗死方面的应用研究有了较大突破 ,作者对干细胞的基本概念、调控、分离纯化、定向诱导以及胚胎干细胞移植、骨髓干细胞移植、骨骼肌干细胞移植和其它成体干细胞移植治疗心肌梗死研究的最新进展进行综述。     

改善微环境是提高干细胞移植疗效的重要途径

近年来,干细胞的基础和临床研究不断深入,干细胞移植为许多疾病的治疗带来了新的希望,也成为了再生医学蓬勃发展的基础. 大量的基础研究和临床试验已证实干细胞移植治疗心肌梗死是安全可行的,但干细胞治疗还存在一些亟需解决的问题,关键是干细胞移植效果不够理想,干细胞移植对心肌梗死后左心室射血分数的改善在5%左右,长期疗效还有一定争议.     

骨髓间充质干细胞移植治疗脑梗死的作用机制

干细胞移植是近年来医学领域乃至整个生命科学领域的研究热点,也是脑梗死治疗的重点研究方向。由于胚胎干细胞移植存在伦理、法律及取材等方面的问题,在移植治疗中的应用受到很大限制。骨髓间充质干细胞（bone marrow mesenchymal stem cells,BMSCs）是骨髓中存在的一类非造血组织干细胞,有高度增殖和自我更新能力,     

干细胞移植的安全性分析

干细胞移植治疗各种疾病的理论基础是干细胞具有自我更新及分化潜能,可以在体内或体外分化为各种组织细胞,有广阔的发展前景。但是近年一些研究发现干细胞移植可能导致微梗死、血栓性微血管病、肝静脉闭塞症及门静脉血栓形成及肿瘤等并发症。本文就干细胞临床移植可能面临的可行性及安全性问题进行了全面阐述。     

缺血性心脏病干细胞治疗进展

干细胞移植使缺血再灌注中损伤心肌的再生和修复成为可能。研究表明,移植的干细胞活性低且不能存留于心肌组织,所以再生心肌能力有限。优化干细胞移植的各环节成为缺血性心脏病受损心肌干细胞治疗的关键。该文从干细胞来源、体外诱导方法、干细胞预处理、移植方式、移植时机及移植后的监测等方面对心肌干细胞治疗进展作一介绍。     

Multidimensional assessment of quality of life in clinical studies.

Four types of issues in conducting a multidimensional assessment of quality of life in clinical studies are presented: practical issues, measurement issues, data quality issues, and data analysis issues. The various issues are described, and ways of dealing with the issues are discussed. Examples are used from the literature and also from the author's multivariate, longitudinal study on quality of life in cardiac transplant patients. Consideration of these issues and knowing options for dealing with them before the study is conducted is imperative. With a carefully thought out approach to better planning of the study, the clinician/investigator can conduct a scientifically sound study with credible results that will provide meaningful direction for improving the quality of life of clinical populations in the future.     

Which domains of thyroid-related quality of life are most relevant? Patients and clinicians provide complementary perspectives.

OBJECTIVE: To identify how thyroid diseases impact the patients' lives and to select the most relevant quality of life (QoL) issues for a thyroid-specific questionnaire. DESIGN: Fifteen thyroid experts and 80 thyroid outpatients (14 with nontoxic goiter, 12 nodular toxic goiter, 21 Graves' disease, 17 thyroid-associated ophthalmopathy, and 16 primary hypothyroidism) were interviewed. METHODS: The relevance of 138 thyroid disease-related issues was rated during interviews. For each issue, three relevance measures were obtained: a diagnosis-specific patient rating, a diagnosis-specific expert rating, and a combined overall patient/expert rating. The 75 most relevant issues overall and the 15 most relevant issues in each patient category were selected. Results: Based on the above, 92 issues were selected, covering a broad range of clinical and QoL domains. Across patient groups, broader QoL domains were most relevant, especially fatigue and emotional susceptibility. However, when focusing on individual patient groups, diagnosis-related physical symptoms were very relevant too. Patients rated issues about psychosocial problems and impact on daily life as more relevant, whereas clinicians focused on thyroid-characteristic issues. CONCLUSIONS: A broad range of QoL issues and physical symptoms are relevant for thyroid patients, particularly fatigue and emotional susceptibility. Patients and clinicians offer complementary perspectives on relevance.     

Why are clinical trials of glucosamine no longer uniformly positive?

In contrast to earlier industry-funded trials of for knee OA, recent studies have generated negative results. While there will be a tendency to assume that these studies were negative because of the absence of any conflicts of interest, a number of issues must be taken into consideration before drawing such conclusions. These issues include design issues and important differences in sample characteristics. Ultimately, it is clear that more work needs to be done to clarify issues surrounding the efficacy and utility of the various glucosamine compounds.     

PROFESSIONAL PRACTICE WHICH INFORMS EDUCATION

This paper discusses the current practice issues that inform education and promote the need for constant revision and change within gerontological programmes. Current issues that are emerging from the practice area can be identified under the broad headings of service provision, management, emerging technology, ethical decision-making, community involvement and collaborative practice. Each of these issues has generated needs that require a response from education. An examination of the practice issues and possible educational responses is offered.     

Using Prime-Time Animation to Engage Students in Courses on Aging

Prime-time animation is a television genre that frequently reflects on issues that are significant in contemporary society, including aging issues. Using such programs to present aging-related content can be a constructive pedagogical device, offering a means of actively engaging students. This article provides a brief overview of the use of media, popular culture, and prime-time animation in college teaching and addresses specific issues in, as well as examples of, how such programs can be used in college courses, particularly aging courses. The article also reports on a small survey of students who were exposed to such a teaching technique in an undergraduate aging course. Results showed that, in general, students were positive about viewing prime-time animation videos in class and indicated that they found the viewings and associated assignments helpful for learning about concepts and issues in aging.     

Health services research in rheumatology: a great deal accomplished, a great deal left to do

Although rheumatology has been on the cutting edge of health services research for decades, there are many unresolved issues for patients, clinicians, insurers, and policy makers. This article explore three areas in which methodologic controversies present tradeoffs to a health care system that is grappling with larger issues around cost and access to care. Specifically, we examine issues around the use of large databases, the appropriate instruments for measuring patient-centered outcomes, and the questions that are raised from cost effectiveness studies of new treatments for rheumatoid arthritis. The issues are presented in the context of a need to provide better information to those who are providing care and those who are paying for it.     

Issues for the coming age of continuous glucose monitoring

PURPOSE: This article reports the results of a symposium in which diabetes educators considered and discussed issues that are likely to arise when continuous glucose monitoring (CGM) becomes available and readily accessible. METHODS: Fifteen certified diabetes educators and 5 others with complementary expertise participated in a discussion based on their responses to 11 questions designed to elicit perspectives on issues related to CGM. Issues for discussion and debate include those related to patient acceptance and lifestyle, implications for professional practice and reimbursement, concerns about professional liability, use of CGM data by insurers and payers, and CGM data transfer. RESULTS: Educators offered varied and sometimes conflicting responses to CGM-related issues. CONCLUSIONS: Awareness of CGM-related issues will likely become an important part of diabetes professional development and perspectives in practice. Identifying and framing the issues before the new technologies become available allow diabetes educators to participate proactively in structuring the emerging policies, procedures, and standards of care.     

Computer assisted telephone interviewing (CATI) for health surveys in public health surveillance: methodological issues and challenges ahead

This article describes methodological issues, challenges, and a vision for using computer assisted telephone interviewing (CATI) in a comprehensive public health surveillance system in the 21st century. Methodological issues include funding of surveys, survey frequency, sample size considerations, response rates, and types of bias to be considered in questionnaire design. Challenges include the recognition of the merits and limitations of CATI, and the potential for greater use in surveillance of public health issues in health regions requiring rapid and regular data. The vision of a CATI survey-based, rapid, flexible, cost-effective public health surveillance system is described. It is concluded that further discussion and views on improvements with regard to CATI methodological and practical issues will help build a better CATI survey-based public health surveillance system for the future.     

Evidence of a Syndemic Among Young Canadian Gay and Bisexual Men: Uncovering the Associations Between Anti-gay Experiences,Psychosocial Issues,and HIV Risk

Syndemic has become an important theoretical model toward understanding how psychosocial issues may interact to increase HIV acquisition among gay and bisexual men. We measured the extent to which anti-gay experiences are associated with psychosocial issues, which in turn were hypothesized to have an additive effect on HIV risk, in a sample of Canadian young gay and bisexual men. Sixty-eight percent of men reported at least one form of anti-gay experience. For each additional form of anti-gay experience, our data demonstrated increased likelihood of psychosocial issues. Psychosocial issues had an additive effect, increasing the risk of unprotected intercourse in the last 12 months (doubling the risk for those with 3+ issues OR 1.95 [1.39–2.75]). Overall, our findings suggest that a syndemic is occurring among young Canadian gay and bisexual men, highlighting the need to expand HIV prevention efforts beyond sexual risk, to address stigma and gay men’s broader health concerns.     

Regulatory Considerations for Manufacturing and Delivery of Cell-based Therapies for Cardiovascular Indications

Developers of cell-based therapies intended for the treatment of cardiovascular indications must address a number of regulatory issues related to the manufacturing and delivery of living cell products to patients. This article highlights issues that must be considered regarding the cell and tissue source and ancillary materials, the development of a regulatory acceptable manufacturing process, the importance of product characterization as a measure of product quality and clinical site logistics for handling and storing living cell products. Finally, regulatory issues regarding the various delivery systems commonly used for delivery cells to cardiac tissues are touched upon.