Isolation and therapeutic use of human stem cells

Nowadays, adult stem cells are the main target of biological research. Stem cell specific markers allow the extraction in enough quantity and high purity of multipotent cells from organic tissues, and their usage instead of the ethically reprehensible embryonal stem cells in experimental therapeutic purposes is also possible. The key point in the development of a new, stem-cell based therapeutic methodology is the determination of stem cell specific cell surface or cytoplasmatic antigens that makes reliable stem cell identification possible. Bone marrow derived multipotent stem cells can already be suitably identified, and other, more or less organic tissue-derived stem cell specific markers are also available. The first therapeutic interventions have been already done in diseases such as myocardial infarction or diabetes mellitus, and led to promising results.     

The importance of the use of stem cells for public health

Stem cells were elected 'Breakthrough of the Year' by Science(1) magazine in 1999, having shown that stem cells from adult tissues retained the ability to differentiate into other tissue types. During the previous year, the first human embryo stem cell lines were established. Since then, the number of scientific papers on stem cells has been increasing exponentially, establishing new paradigms that are rapidly challenged by subsequent experiments. This paper reviews the stem cell research field, divided into two groups: embryo and adult stem cells. While the differentiation potential of the former is well characterized in mice and humans, their use in cell therapy and research has been hampered by histocompatibility, safety and ethical issues. In contrast, adult stem cells do not present these problems. However, the extent of their plasticity is still under investigation. Nevertheless, numerous clinical trials in humans are under way, mainly with stem cells derived from bone marrow. This paper discusses discuss the importance of working with both classes of human stem cells in order to fulfill the promise of stem cell therapies.     

浅谈部队的蟑螂防治工作

部队营区场所复杂多样,存在很多蟑螂可能孳生与栖息不同于普通公共场所的特殊场所,给蟑螂防治工作提出了更高要求。笔者针对性地对部队蟑螂防治工作的形势与策略进行了讨论。     

对欧美国家医疗器械管理模式的探讨与分析

通过介绍美国医疗器械监管机构即美国食品药品管理局(FDA)和欧盟在医疗器械领域的三个指令即《有源植入性医疗器械指令》(AIMDD)、《医疗器械指令》(MDD)和体外诊断器械指令(IVDD)具体的监管方法,与中国医疗器械监管体系进行比较和分析,提出一些建议和启示。     

异基因造血干细胞移植适应证及疗效

异基因造血干细胞移植(allogeneichematopoiet icstemcelltransplant,Allo-HSCT)是治疗造血系统疾病最有效的方法。根据国际骨髓移植登记处(internationalbonemarrowtransplantregistry,IBMTR)的统计,从1970～2004年,在IBMTR登记的Allo-HSCT病例数已接近5万例,而且每年以近3000例的数量增加;而IBMTR并不包括全世界所有完成的Allo-HSCT病例。我国自上世纪80年代后期由少数几家移植中心开始Allo-HSCT工作到目前除西藏以外所有省、市、自治区均可开展Allo-HSCT工作;在不少地区,该项技术向县、市级医疗机构延伸;随着完成的病例…     

The derivation and potential use of human embryonic stem cells

Human embryonic stem cells lines can be derived from human blastocysts at high efficiency (>50%) by immunosurgical isolation of the inner cell mass and culture on embryonic fibroblast cell lines. These cells will spontaneously differentiate into all the primary embryonic lineages in vitro and in vivo, but they are unable to form an integrated embryo or body plan by themselves or when combined with trophectoderm cells. They may be directed into a number of specific cell types and this enrichment process requires specific growth factors, cell-surface molecules, matrix molecules and secreted products of other cell types. Embryonic stem (ES) cells are immortal and represent a major potential for cell therapies for regenerative medicine. Their use in transplantation may depend on the formation of a large bank of suitable human leucocyte antigen (HLA) types or the genetic erasure of their HLA expression. Successful transplantation may also require induction of tolerance in recipients and ongoing immune suppression. Although it is possible to customize ES cells by therapeutic cloning or cytoplasmic transfer, it would appear unlikely that these strategies will be used extensively for producing ES cells compatible for transplantation. Embryonic stem cell research may deliver a new pathway for regenerative medicine.     

干细胞临床使用有效性和安全性及其对监管的启示

目的分析不同类型干细胞临床使用的有效性和安全性,为政府监管干细胞临床使用提供依据。方法检索国内外6个文献数据库以获取2010年1月—2020年7月的相关研究文献,并进行系统性综述。结果72篇纳入文献涉及干细胞临床使用的有效性与安全性。虽然干细胞临床使用对部分疾病具有一定的治疗效果,但其长期疗效与安全性、尤其是致瘤性等潜在风险仍需进一步评估。结论临床医师应充分权衡干细胞临床使用的获益与风险,政府相关部门应加强对干细胞临床研究与应用的伦理监管和干细胞产品上市的监管,以保障患者权益。     

关于内窥镜目镜罩绝缘水平确定的探讨

本文探讨了确定内窥镜目镜罩的绝缘水平的方法和过程。本文分析的基础是GB9706．1—2007医用电气安全第1部分：安全通用要求。根据该标准中电介质强度的相关要求,通过理论分析内窥镜目镜罩电隔离情况确定出内窥镜目镜罩绝缘的电介质强度的试验电压。根据该标准中漏电流的相关要求,分析了内窥镜所接视频设备隔离类型等情况,结合实验数据得出的绝缘阻抗特性后推导换算出在此电介质强度电压下的电流限。最后本文确定目镜罩绝缘的电介质强度的试验电压为50Hz,1500V,电流限为0．03mA（CF型隔离要求）／0．32mA（BF型隔离要求）。     

药品生产与流通体制改革问题探讨

自2000年7月,国务院办公厅在上海召开了全国城镇职工基本医疗保险制度和医药卫生体制改革工作会议后,医疗保障制度改革终于以全面推进“保、医、药”3项制度配套改革的崭新面貌迈出了可喜的第一步。接着,政府在药品流通领域相继出台了一系列相关政策,目的是切断药品收入与医疗机构及医生的直接经济利益联系,把虚高的药品价格降下来。但是,医和药是相互关联,缺一不可的。药品使用是随着医疗技术的进步而发展变化的,医生劳务价值体现在合理用药、优质的医疗服务中。因此,医药生产与流通体制改革是“3项改革”的重要组成部分,是实现卫生改革总体目标最关键的一个环节。药品生产与流通的品种繁杂、流程长、涉及部门多,经济利益主体复杂,因而,也是改革难度相对较大的一项工作,必须在国家的宏观调控下,加强多部门的合作,以大局为重,协调各方利益,进行一次彻底的深层次的改革。     

关于多排螺旋CT剂量的探讨

随着螺旋CT探测器排数的增加，病人所受辐射剂量也出现了新的变化。本文就多排螺旋CT的剂量表征、测量进行了探讨，对其临床诊断剂量参考水平进行了调研。分析了多排螺旋CT管球对热容量的要求以及其剂量效率的变化。最后提出了在不降低影像质量的情况下如何降低病人剂量的方法。     

The use of therapeutic interchange for biologic therapies

Therapeutic interchange is the practice of switching or dispensing drugs that are chemically distinct but therapeutically similar in terms of their efficacy, safety, and tolerability profiles. The stated goal of therapeutic interchange is to achieve an improved or neutral outcome with the new agent while reducing overall treatment costs. Until recently, most interchange programs have been limited to switches within drug classes, such as angiotensin-converting enzyme (ACE) inhibitors, proton pump inhibitors (PPIs), HMG-CoA reductase inhibitors (statins), and selective serotonin reuptake inhibitors (SSRIs), and generally to drugs that use the same routes of administration. Therapeutic interchange now is being applied to some biologic agents, such as those used to treat psoriasis and rheumatoid arthritis (RA). In some cases, these agents differ in structure and mode of administration. Patients who require a biologic agent are often difficult to manage, and the comorbidities that are prevalent in these patients further complicate management and agent selection. Population-based outcomes among various agents may not appear notably different, but because there is no a priori means to determine the effects of a given biologic agent on any individual patient, therapeutic interchange is inadvisable once a patient receiving RA or psoriasis therapy has been stabilized. However, if a biologic agent has been designated as preferred on a formulary, it is reasonable to initiate treatment with that agent in a patient who is naive to biologic therapy if that agent is not contraindicated. Respectful, two-way communication between health care professionals and managed care organizations (MCOs) will help ensure that a patient receives the appropriate therapy at the right time.     

胎儿淋巴管瘤治疗方法的临床探讨

目的:探讨不同类型淋巴管瘤的治疗方法及其可行性与优越性。方法:选择7例行淋巴管瘤治疗的新生儿,包括产时介入治疗(平阳霉素局部注射)1例,产时手术(子宫外产时处理-EXIT联合产房外科手术)3例,生后第2天行介入治疗3例,对各种治疗方法的适应证及临床效果进行分析并对新生儿的预后进行随访,进一步评价各种治疗方法的可行性与优越性。结果:产时介入治疗1例患儿瘤体局部注射药物后未出现相关并发症,术后3天与其母同时出院,肿瘤明显缩小;术后1个月返院复查,肿瘤局部仅留小结节,未给予再次注射药物;术后半年～1年返院复查肿瘤无复发,生长发育正常。产时手术3例,术后恢复良好,随访2～3年,患儿生长发育正常,其中2例术后1年内瘢痕较明显,术后2年后切口愈合良好,瘢痕几乎看不出。生后第2天行介入治疗3例,术后按期出院,未出现相关并发症,术后半年～1年返院复查,肿瘤无复发,生长发育正常。结论:对于瘤体大、压迫气管会造成新生儿窒息的淋巴管瘤可选择产时手术治疗;对于包绕重要血管神经的囊性淋巴管瘤,介入治疗为其首选治疗方法;产时介入治疗新生儿淋巴管瘤是可行的,最好在手术室有一定条件能完善急检血常规及胸片的前提下完成,以避免相关并发症的发生。对于综合治疗及宫内介入治疗仍需进一步研究。     

Tissue stem cells and cancer stem cells: potential implications for gastric cancer

Gastric cancer remains the second leading cause of death in the world today, making the search for its molecular and cellular basis an important priority. Though recognition of the tight link between inflammation and tumorigenesis is centuries old, only recently are the pieces of the etiological puzzle beginning to fall together. Recent advances in gastric stem cell biology appear to be central to this slowly resolving puzzle. At least two types of stem cells may be important. Resident adult or tissue stem cells may, in a chronically inflamed environment, slowly acquire a series of genetic and epigenetic changes that lead to their emergence as 'cancer stem cells'. This scenario has not yet been proven experimentally, although the first step, prospective recognition of a gastric stem cell has recently been conquered. Alternatively, the setting of chronic inflammatory stress and injury may lead to loss of the indigenous gastric stem cells from their niches; bone marrow derived stem cells may then be recruited to and engraft into the gastric epithelium. Such recruited cells have the potential to contribute to the tumor mass. Indeed, evidence supporting this scenario has been published. Here, we review these recent findings and discuss implications for the future.     

关于医院手术观摩转播系统方案的探讨

本文介绍了建立手术观摩转播系统的必要性，通过模拟视频系统和数字视频系统的优缺点的比较，提出了模拟和数字视频系统相结合的一种方案。     

浅谈新形势下疾病预防控制中心建设

随着社会的不断进步，人类疾病谱和死因顺位正发生巨大的变化，一些新的疾病包括非传染性疾病，如精神卫生、意外伤害、各种中毒等，正成为威胁人类健康的新卫生问题，尤其今春“非典”的爆发，给人类生命和政治经济发展产生负面影响；加入世贸后，我国经济、社会的深刻变革和体制转轨，卫生工作的内、外部环境发生了重大变化；来自境外传染病、新出现传染     

肿瘤热疗中的几个医学工程问题

为提高肿瘤热疗质量，从医学工程学角度，提出几个涉及改善热疗疗效和安全性的问题，如测温、加热剂量数学模型和凋亡模型等。还讨论了热疗在更广泛范围中的应用。     

Human rights for women: the ethical and legal discussion about Female Genital Mutilation in Germany in comparison with other Western European countries

Within Western European countries the number of women and girls already genitally mutilated or at risk, is rising due to increasing rates of migration of Africans. The article compares legislative and ethical practices within the medical profession concerning female genital mutilation (FGM) in these countries. There are considerable differences in the number of affected women and in legislation and guidelines. For example, in France, Great Britain and Austria FGM is included in the criminal code as elements of crime, whereas in Germany and Switzerland FGM is brought to trial as bodily injury. So far trials only in France and Switzerland in connection with FGM resulted in convictions. France and Great Britain as former Colonial countries serve as an example of countries with a comparably great number of African immigrants. These countries have the best possibilities to intervene preventatively, due to legislation and detailed medical guidelines. For instance, an obligation exists in France to inform administrative and medical authorities if FGM is suspected. FGM so far is not explicitly part of the curriculum for medical training in any of the examined countries.     

A Regulatory Take on Cannabis and Cannabinoids for Medicinal use in the European Union

The discovery of the endocannabinoid system has raised public interest in the medicinal use of cannabis, phytocannabinoids, and synthetic cannabinoids, which has always been closely regulated due to their psychotropic effects and potential abuse. The review takes a quick look at the current legal framework in the European Union, which regulates cannabis use and cultivation for medicinal purposes in line with the United Nations Conventions on the production, trade, and use of cannabis, phytocannabinoids, and synthetic cannabinoids. And while the EU legislation precisely defines requirements and marketing authorisation procedures for medicinal products for all EU member states, there is no common regulatory framework for magistral and officinal preparations containing cannabinoids, as they are exempt from marketing authorisation. Instead, their regulation is left to each member state, and it is quite uneven at this point, mainly due to cultural and historical differences between the countries, leading to different access to non-authorised medicinal products. Therefore, to meet great public interest, harmonised approaches on cannabinoid-containing products without marketing authorisation would be welcome to level the playing field in the EU.