存在睡眠呼吸异常的慢病患者呼吸影响心率变异性的初步分析*

目的: 基于整体整合生理学医学理论提出的呼吸引起循环指标变异的假说,分析研究存在睡眠呼吸异常的慢病患者睡眠期间呼吸和心率变异之间的相关关系。方法: 纳入存在睡眠呼吸异常且呼吸暂停低通气指数（AHI）≥15次/小时的慢病患者11例,签署知情同意书后完成标准化症状限制性极限运动的心肺运动试验（CPET）和睡眠呼吸监测,计算分析病人睡眠期间波浪式呼吸（OB）期与正常平稳呼吸期的呼吸鼻气流、心电图R-R间期心率变异的规律。结果: 存在睡眠呼吸异常的慢病患者CPET峰值摄氧量（Peak VO₂）和无氧阈（AT）为（70.8±13.6）%pred和（71.2±6.1）%pred;CPET有5例存在运动诱发的波浪式呼吸（EIOB）,6例为呼吸不稳定,提示整体功能状态低于正常人。本组慢病患者AHI为每小时（28.8±10.0）次,睡眠呼吸异常总时间占睡眠总时间的比值为（0.38±0.25）;OB周期的平均时间长度为（51.1±14.4）s。本组慢病患者正常平稳呼吸期的呼吸周期数与心率变异周期数的比值（B-n/HRV-B-n）为1.00±0.04,每个呼吸周期节律的心率变异平均幅度（HRV-B-M）为（2.64±1.59） bpm,虽然低于正常人（P<0.05）,但却与无睡眠呼吸异常的慢病患者相似（P>0.05）;HRV-B-M的变异度CV（HRV-B-M的SD/x）为( 0.33±0.11）,期间血氧饱和度（SpO₂）虽略低,但并无明显规律性下降与上升。本组慢病患者的OB期间呼吸周期数与心率变异周期数（OB-B-n/OB-HRV-B-n）比值为（1.22±0.18）,OB期每个呼吸周期节律的心率变异平均幅度（OB-HRV-B-M）为（3.56±1.57）bpm及其变异度（OB-CV =OB-HRV-B-M的SD/x）为（0.59±0.28）,每个OB周期节律的心率变异平均幅度（OB-HRV-OB-M）为（13.75±4.25）bpm,OB期间低通气时SpO₂出现明显的下降,OB期间SpO₂平均变异幅度（OB-SpO₂-OB-M）为（4.79±1.39）%,OB期的OB-B-n/OB-HRV-B-n比值、OB-HRV-OB-M比其正常平稳呼吸期对应指标显著增大（P<0.01）。OB-HRV-B-M虽然与正常平稳呼吸期HRV-B-M相比差异无统计学意义（P>0.05）,但其变异度OB-CV却显著增大（P<0.01）。结论: 睡眠呼吸异常的慢病患者OB期的心率变异幅度大于其正常平稳呼吸期,当呼吸模式发生改变时心率变异也发生明显改变,其平稳呼吸期的呼吸周期数与心率变异周期数的比值与正常人以及无睡眠呼吸异常的慢病患者相同,证实心率变异为呼吸源性;而其OB期间心率变异周期数相对于呼吸周期减少直接源于此时的低通气或者呼吸暂停,心率变异也是呼吸源性。     

Large-scale pharmacogenomic studies and drug response prediction for personalized cancer medicine

The response rate of most anti-cancer drugs is limited because of the high heterogeneity of cancer and the complex mechanism of drug action. Personalized treatment that stratifies patients into subgroups using molecular biomarkers is promising to improve clinical benefit. With the accumulation of preclinical models and advances in computational approaches of drug response prediction, pharmacogenomics has made great success over the last 20 years and is increasingly used in the clinical practice of personalized cancer medicine. In this article, we first summarize FDA-approved pharmacogenomic biomarkers and large-scale pharmacogenomic studies of preclinical cancer models such as patient-derived cell lines, organoids, and xenografts. Furthermore, we comprehensively review the recent developments of computational methods in drug response prediction, covering network, machine learning, and deep learning technologies and strategies to evaluate immunotherapy response. In the end, we discuss challenges and propose possible solutions for further improvement.     

Dissolvable Gelatin-Based Microcarriers Generated through Droplet Microfluidics for Expansion and Culture of Mesenchymal Stromal Cells

Microcarriers are synthetic particles used in bioreactor-based cell manufacturing of anchorage-dependent cells to promote proliferation at efficient physical volumes, mainly by increasing the surface area-to-volume ratio. Mesenchymal stromal cells (MSCs) are adherent cells that are used for numerous clinical trials of autologous and allogeneic cell therapy, thus requiring avenues for large-scale cell production at efficiently low volumes and cost. Here, a dissolvable gelatin-based microcarrier is developed for MSC expansion. This novel microcarrier shows comparable cell attachment efficiency and proliferation rate when compared to several commercial microcarriers, but with higher harvesting yield due to the direct dissolution of microcarrier particles and thus reduced cell loss at the cell harvesting step. Furthermore, gene expression and in vitro differentiation suggest that MSCs cultured on gelatin microcarriers maintain trilineage differentiation with similar adipogenic differentiation efficiency and higher chondrogenic and osteogenic differentiation efficiency when compared to MSCs cultured on 2D planar polystyrene tissue culture flask; on the contrary, MSCs cultured on conventional microcarriers appear to be bipotent along osteochondral lineages whereby adipogenic differentiation potential is impeded. These results suggest that these gelatin microcarriers are suitable for MSC culture and expansion, and can also potentially be extended for other types of anchorage-dependent cells.     

Knowledge and attitudes regarding genetic testing among Jordanians: An approach towards genomic medicine

BackgroundThe twenty first century can be called the genomic era referring to the rapid development of genetics, and the beginning of genomic medicine. An initial step towards genomic medicine is to evaluate the knowledge and attitude towards genetic testing among different populations. The aims of this study were to assess the genetic knowledge and attitude towards genetic testing among the Jordanian population and patients with immune diseases. In addition, we evaluated the association between knowledge, attitude and several demographic factors of the population.MethodsThis study was performed using an online questionnaire that was distributed to respondents from different regions of Jordan.ResultsA total of 1149 participants were recruited from the Jordanian population. Overall factual genetic knowledge of the participants was good (65.4%), with education level, working or studying in a health-related field and household average monthly income being significant predictors of factual knowledge scores (P = 0.03, P < 0.001 and P < 0.001, respectively). However, factual knowledge results revealed that scores of questions related to diseases were significantly higher than scores of gene-related scientific facts (P < 0.01). Participants of our study reported to have low perceived knowledge on medical uses (39.5%) and social consequences (23.9%) of genetic testing. Regarding the participants’ attitudes, favorable attitudes towards genetic testing were prevailing (91.5%). Favorable attitudes were more prominent among higher educated participants, and participants with higher scores of factual knowledge.ConclusionDespite the fact that our Jordanian-based study revealed a good level of genetic knowledge as well as a favorable attitude towards genetic testing, we realized an imbalance of knowledge between gene-related scientific facts and disease-related concepts as well as between factual and perceived genetic knowledge, which indicates the necessity of increasing the awareness about genetic testing in order to ensure that individuals can take informed decisions that help in the employment of personalized medicine.     

中药调节肠道菌群防治高血压的研究进展

肠道菌群是人体内环境的重要组成部分,可影响机体的代谢、免疫和炎症反应,与原发性高血压的发生发展密切相关,已成为防治高血压的研究热点。中药在临床用于原发性高血压的治疗且疗效显著。研究表明中药可被肠道菌群分解代谢为易于吸收的活性物质,而这些活性物质又可通过调节肠道菌群结构及其代谢产物防治高血压。本文以肠道菌群作为切入点,通过分析肠道菌群与原发性高血压发生发展的关系和中药在调节原发性高血压肠道菌群方面的研究,总结中药通过调节肠道菌群防治原发性高血压的作用和机制,以期为中药防治高血压及药物研发提供新的研究思路。     

基于新型冠状病毒S蛋白结构及入胞机制的抗体与药物研发

新型冠状病毒肺炎,世界卫生组织命名为“2019冠状病毒病”（corona virus disease 2019, COVID-19）,是一种由2019新型冠状病毒（2019 nCov）感染导致的肺炎。目前新冠肺炎在全球广泛流行,且疫情尚未得到全部控制。由于新型冠状病毒表面的刺突蛋白（spike protein,S）介导病毒与细胞膜受体结合并参与入胞过程,S蛋白在病毒的传播过程中发挥着重要作用。针对S蛋白的研究不仅可以解析病毒相关蛋白质结构与功能,阐释其入胞机制,同时也为新冠肺炎的预防、诊断与治疗提供相关信息,有着重要的应用价值。S蛋白与特异性受体--血管紧张素酶II（angiotensin converting enzyme II, ACE2）结合,相较于SARS病毒,新型冠状病毒S蛋白的RBD区域（receptor binding domain）与ACE2亲和力更高,但其S蛋白与ACE2结合能力整体上弱于SARS病毒。S蛋白结合ACE2受体 介导的新型冠状病毒入胞机制包括胞吞和非胞吞途径。丝氨酸蛋白酶2（transmembrane protease serine 2, TMPRSS2）、溶酶体组织蛋白酶（lysosomal cathepsin）和Furin蛋白酶可切割S蛋白S1和S2亚基间的酶切位点,促进病毒和靶膜的融合。基于S蛋白的结构,本文从抗体的结合位点、来源与类型等方面对靶向新型冠状病毒S蛋白的抗体进行了比较分析,对相关药物作用机制与进展进行了综述。虽然靶向冠状病毒S蛋白的抗体和药物特异性高,治疗效果较好,但部分试剂的作用机制、安全性、适用性和稳定性等性质仍未研究透彻,需要严格评估,因此其研发与应用也存在着一定挑战。     

福建省福州市马尾区药用植物资源研究

依托第四次全国中药资源普查工作,摸清马尾区药用植物资源种类、分布、重点中药材品种以及药材栽培等情况。根据第四次全国中药资源普查要求,通过实地调查、走访以及栽培基地调查等方法对马尾区药用植物资源进行调查,查阅相关资料确定野生药用植物的药用部位、生活型等。马尾区野生药用植物种类共计506种,隶属于132科360属,含2～5种的寡种科占绝对优势地位;草本为主要生活型,药用部位集中在根类和全草类;有福建省重点药材50种、特色药材22种。由于长期受人为干扰,马尾区原生植被破坏严重,药用植物种类较为贫乏。因此,可考虑林下种植中药改善土壤环境,实现中药资源可持续发展。     

Progress of Gastric Cancer Surgery in the era of Precision Medicine

With the development of genomics, the update of modern imaging technology and the advent of artificial intelligence and big data, the surgical treatment of gastric cancer has gradually stepped into precision medicine. Precision surgery treatment of gastric cancer is based on accurate molecular typing and staging using modern molecular diagnostic technology and imaging, and the formulation of precise and individualized surgical treatment plans, with the concept of minimally invasive and accelerated rehabilitation surgery running through it. For intermediate-stage gastric cancer, we have adopted a comprehensive treatment approach including traditional radiotherapy and chemotherapy, targeted therapy and immunotherapy. Utilize artificial intelligence and big data technology to improve the standardization and interconnectivity of specialty data and realize the transformation of evidence-based medicine. Promoting the standardization, standardization and individualization of gastric cancer surgical treatment, providing patients with precise diagnosis and treatment, and further improving patients'' prognosis are the opportunities and challenges in the development of gastric cancer surgery.     

多能干细胞诱导分化为肾脏类器官的研究进展与挑战

用于分化为多种类型细胞的多能干细胞(PSC)体外培养技术已被广泛应用于生物学领域中。由PSC分化而来的肾脏类器官可基本还原生物体内肾脏的组织结构和部分功能,在肾脏疾病模型研究和药物筛选中有重要作用,继续改善肾脏类器官的结构、功能和成熟度将会对肾脏再生治疗提供极大的帮助。研究肾脏类器官的重点在于体外准确模拟体内肾脏的发育过程。本文着重归纳了近十年来对胚胎肾发育过程研究的重点,对肾脏类器官分化技术的几个关键方案进行总结、分析和比较,并探讨肾脏类器官在分化研究和应用中将面临的挑战。