第三类医疗技术取消非行政许可审批后的管理与思考

根据国务院印发的《关于取消非行政许可审批事项的规定》，国家卫生计生委按照《医疗技术临床应用管理办法》，取消了对第三类医疗技术临床准入非行政许可的审批。通过对第三类医疗技术的特性、管理难点与现状及其非行政许可审批制的内涵进行分析，结合近6年来在某三级甲等专科医院的医疗技术管理实践, 在国务院取消第三类医疗技术的非行政许可审批的背景下，提出了强化第三类医疗技术管理的5点建议。     

细胞药物的制备工艺——细胞药物 连载之二

细胞药物制备的质量直接关系到细胞治疗的效果。由于细胞治疗所用细胞是具有生物学效应的,细胞药物的制备技术和应用方案具有多样性、复杂性和特殊性,不像一般生物药物那样有统一的制作标准。细胞药物的制备过程主要包括供者筛查、供者检测、采集、加工、分离纯化、储存等,以造血干细胞、间充质干细胞、肝细胞及树突状细胞为例对其进行简要介绍。     

讲座细胞药物的制备工艺——细胞药物连载之二

细胞药物制备的质量直接关系到细胞治疗的效果。由于细胞治疗所用细胞是具有生物学效应的,细胞药物的制备技术和应用方案具有多样性、复杂性和特殊性,不像一般生物药物那样有统一的制作标准。细胞药物的制备过程主要包括供者筛查、供者检测、采集、加工、分离纯化、储存等,以造血干细胞、间充质干细胞、肝细胞及树突状细胞为例对其进行简要介绍。     

抗胰腺星状细胞药物研究进展

慢性胰腺炎传统治疗方法效果不确定,需要寻找新型有效药物。活化的胰腺星状细胞在胰腺纤维化过程中起了重要的作用,使之成为新的治疗靶点。活化PSC的物质分为三类,即炎症介质、氧化应激和毒素。本文就近年来针对以上不同活化PSC的介质和相关通路的抗星状细胞药物进行综述。     

第三类医疗技术申报及管理的实践与探讨

自卫生部2009年3月印发《医疗技术临床应用管理办法》以来,卫生行政部门规范并加强了对医疗技术临床应用的准入和分级、分类管理。通过对第三类医疗技术的申报和后续管理的实践,对相关法律、法规缺位,从事该技术医疗技术人员动态管理,再评价综合管理模式以及伦理委员会审查等《医疗技术临床应用管理办法》中尚未明确规定的问题,提出探讨与对策。     

抗体偶联药物的研究进展与质量控制

抗体偶联药物（antibody-drug conjugates,ADC）因其良好的靶向性及抗癌活性目前已成为抗肿瘤抗体药物研发的新热点和重要趋势,受到越来越多的关注。ADC药物由单克隆抗体、高效应的细胞毒性物质以及连接臂三部分组成,它将抗体的靶向性与细胞毒性药物的抗肿瘤作用相结合,可以降低细胞毒性抗肿瘤药物的不良反应,提高肿瘤治疗的选择性,还能更好地应对靶向单抗的耐药性问题。与传统单抗药物相比,因其结构复杂,ADC药物质量属性分析方法的建立具有更大的难度和特殊性。对抗体偶联药物的研发现状、质量属性分析方法和挑战以及质量控制要点进行了简要介绍,为ADC药物的研究和质量控制提供参考。     

细胞药物的种类及生物学特性——细胞药物连载之一

细胞药物是以不同细胞为基础的用于疾病治疗的制剂、药物或产品的统称,是继放疗、化疗之后又一种临床有效的治疗手段,可实施个性化治疗。细胞药物的种类很多,按其生物学特性可分为传统体细胞、免疫细胞以及各种不同的干细胞等。经体外操作过的细胞群,如肝细胞、胰岛细胞、软骨细胞、树突状细胞、细胞因子诱导的杀伤细胞、淋巴因子激活的杀伤细胞、体外加工的骨髓或造血干细胞和体外处理的肿瘤细胞(瘤苗)等。细胞药物已在一些难治性疾病中得到应用,包括血液系统疾病、心血管系统疾病、消化系统疾病、神经系统疾病、免疫系统疾病和抗衰老等。细胞治疗涉及的细胞种类很多,且不同细胞或不同治疗方法各有特点。运用不同的细胞药物来修复病变细胞,以重建受损的功能细胞和组织,恢复其生物学功能,为细胞丢失或损伤性疾病的防治提供了崭新的思路。     

细胞药物的研发现状——细胞药物连载之三

近年来,细胞药物的研究受到了国内外重视。特别是干细胞药物,已成为世界各国竞相研究的热点领域,但各国的干细胞药物绝大多数仍处于研究阶段,全球真正上市的干细胞药物很少。目前正在研发的干细胞药物主要集中在治疗慢性疾病（关节炎、糖尿病和癌症等）和心脏相关疾病（心肌梗死、心脏衰竭等）。一些传统体细胞药物（软骨细胞、心肌细胞、胰岛细胞等）和免疫细胞药物已在临床应用。     

细胞分子生物学技术在靶向药物筛选中的应用

随着细胞及分子生物学的发展,新技术方法越来越多地用于新靶点建立和药物筛选研究,为药物设计、靶点的选择和用药方案的确定提供理论依据,同时使药物筛选有了更高的特异性,对药物筛选和药理学研究起到了极大的促进作用. 论述了功能基因的筛选、高通量细胞筛选和高内涵筛选技术、反义核酸技术、转基因/基因敲除技术、基因芯片、蛋白质芯片、组织芯片、酶免疫分析、荧光免疫分析、流式细胞技术等方法在靶向药物筛选中的应用.     

自体DC、CIK细胞在急性髓细胞白血病治疗中的研究进展

树突状细胞(DC)是初级免疫应答的激发者,是最有活力的抗原递呈细胞(APC),可以有效地抑制白血病细胞逃逸。未成熟DC细胞从细胞外捕获各种抗原信息,成熟DC细胞传递各种抗原信息给宿主淋巴结的T细胞,激活抗原相关的主要组织相容性复合体(MHC)限制性特异性免疫应答,另外,亦可通过影响B细胞的增殖,不同程度的活化体液免疫应答。细胞因子诱导的杀伤细胞(CIK)是一组具有细胞毒作用的异质细胞群,是较LAK细胞溶瘤活性更强的一种免疫活性细胞,对包括白血病在内的多种恶性肿瘤具有抗肿瘤效应,具有非MHC限制性的杀瘤特点。二者联合培养及应用又增强了各自的活性。DC细胞与CIK细胞对于白血病的疗效不仅在实验室得以证实,而且已经逐步应用于临床,其在清除微小残留病以及预防造血干细胞移植后复发中取得了良好的效果。随着细胞制备技术的完善和研究的进一步深入,自体DC、CIK细胞治疗急性髓细胞白血病逐渐获得众多专家的认可。中国卫生部已经把自体免疫细胞治疗技术做为第三类医疗技术应用于临床,批准号200984。本文就目前DC、CIK、DC-CIK细胞免疫疗法在急性髓细胞白血病中的应用进展加以综述。     

围产期干细胞库质量管理体系构建

围产期干细胞库质量管理体系（QMS）建设是保障干细胞产品和服务健康发展的基础工作。本文比较分析美国输血协会（AABB）、细胞疗法认证基金会（FACT）和ISO 9001的标准的架构、内容和侧重点,重点论述围产期干细胞库QMS构建的方法、步骤和参考模式。参照权威机构标准建立和运行QMS,能够保障我国围产期干细胞库标准化、规范化和科学化的建设和管理,提升我国干细胞库能力和信任水平。良好的QMS进一步促进干细胞与精准医疗战略性新兴产业升级,为建设健康中国提供动力。     

继续医学教育项目" 过程管理模式" 体会

继续医学教育项目是开展继续医学教育的重要形式之一,是卫生专业技术人员获取新知识、新理论、新技术、新方法的重要途径。项目执行的质量将直接体现继续医学教育质量。因此规范项目管理程序,建立有效的运行体系,建立严格奖罚制度,进行"过程跟踪管理"是保证项目执行质量的有效措施。     

Capturing epidermal stemness for regenerative medicine

The skin is privileged because several skin-derived stem cells (epithelial stem cells from epidermis and its appendages, mesenchymal stem cells from dermis and subcutis, melanocyte stem cells) can be efficiently captured for therapeutic use. Main indications remain the permanent coverage of extensive third degree burns and healing of chronic cutaneous wounds, but recent advances in gene therapy technology open the door to the treatment of disabling inherited skin diseases with genetically corrected keratinocyte stem cells. Therapeutic skin stem cells that were initially cultured in research or hospital laboratories must be produced according strict regulatory guidelines, which ensure patients and medical teams that the medicinal cell products are safe, of constant quality and manufactured according to state-of-the art technology. Nonetheless, it does not warrant clinical efficacy and permanent engraftment of autologous stem cells remains variable. There are many challenges ahead to improve efficacy among which to keep telomere-dependent senescence and telomere-independent senescence (clonal conversion) to a minimum in cell culture and to understand the cellular and molecular mechanisms implicated in engraftment. Finally, medicinal stem cells are expansive to produce and reimbursement of costs by health insurances is a major concern in many countries.     

Stem cells for the treatment of musculoskeletal pain

Musculoskeletal-related pain is one of the most disabling health conditions affecting more than one third of the adult population worldwide. Pain from various mechanisms and origins is currently underdiagnosed and undertreated. The complexity of molecular mechanisms correlating pain and the progression of musculoskeletal diseases is not yet fully understood. Molecular biomarkers for objective evaluation and treatment follow-up are needed as a step towards targeted treatment of pain as a symptom or as a disease. Stem cell therapy is already under investigation for the treatment of different types of musculoskeletal-related pain. Mesenchymal stem cell-based therapies are already being tested in various clinical trials that use musculoskeletal system-related pain as the primary or secondary endpoint. Genetically engineered stem cells, as well as induced pluripotent stem cells, offer promising novel perspectives for pain treatment. It is possible that a more focused approach and reassessment of therapeutic goals will contribute to the overall efficacy, as well as to the clinical acceptance of regenerative medicine therapies. This article briefly describes the principal types of musculoskeletal-related pain and reviews the stem cell-based therapies that have been specifically designed for its treatment.     

应用诱导多能干细胞治疗的进展与挑战

诱导多能干细胞(Induced pluripotent stem cells,i PSCs)是利用特定的转录因子诱导体细胞获得的,像胚胎干细胞一样,可以进行无限的自我更新,并具有分化成三个胚层的能力。iPSC有可能提供无限的自体细胞治疗,目前研究已经证实,不同种类疾病的患者提供的成体细胞诱导后可产生种类繁多的iPSC,这项技术给目前无有效治疗手段的多类疾病带来了治疗的希望,并有可能避免利用胚胎干细胞(embryonic stem cells,ESCs)治疗面临的伦理问题和免疫排斥反应。本文回顾iPSC技术优化过程,着重关注应用i PSC建立细胞模型、进行细胞治疗的进展,并探讨iPSC在基础研究及临床应用中遇到的挑战。     

Identification and classification of chromosomal aberrations in human induced pluripotent stem cells

Because of their somatic cell origin, human induced pluripotent stem cells (HiPSCs) are assumed to carry a normal diploid genome, and adaptive chromosomal aberrations have not been fully evaluated. Here, we analyzed the chromosomal integrity of 66 HiPSC and 38 human embryonic stem cell (HESC) samples from 18 different studies by global gene expression meta-analysis. We report identification of a substantial number of cell lines carrying full and partial chromosomal aberrations, half of which were validated at the DNA level. Several aberrations resulted from culture adaptation, and others are suspected to originate from the parent somatic cell. Our classification revealed a third type of aneuploidy already evident in early passage HiPSCs, suggesting considerable selective pressure during the reprogramming process. The analysis indicated high incidence of chromosome 12 duplications, resulting in significant enrichment for cell cycle-related genes. Such aneuploidy may limit the differentiation capacity and increase the tumorigenicity of HiPSCs.     

Microbial ecology and quality assurance in food fermentation systems. The case of kefir grains application

Fermentation technology has become a modern method for food production the last decades as a process for enhancing product stability, safety and sensory standards. The main reason for this development is the increasing consumers’ demand for safe and high quality food products. The above has led the scientific community to the thorough study for the appropriate selection of specific microorganisms with desirable properties such as bacteriocin production, and probiotic properties. The main food products produced through fermentation activity are bread, wine, beer cheese and other dairy products. The microorganisms conducting the above processes are mainly yeasts and lactic acid bacteria. The end products of carbohydrate catabolism by these microorganisms contribute not only to preservation as it was believed years ago, but also to the flavour, aroma and texture and to the increase of the nutritional quality by thereby helping determine unique product characteristics. Thus, controlling the function of specific microorganisms or the succession of microorganisms that dominate the microflora is therefore advantageous, because it can increase product quality, functionality and value. Throughout the process of the discovery of microbiological diversity in various fermented food systems, the development of starter culture technology has gained more scientific attention, and it could be used for the control of the manufacturing operation, and management of product quality. In the frame of this review the presentation of the quality enhancement of most consumed fermented food products around the world is attempted and the new trends in production of fermented food products, such as bread is discussed. The review is focused in kefir grains application in bread production.     

The generation of GLP-grade human embryonic stem cell banks from four clinical-grade cell lines for preclinical research

The Singapore Stem Cell Bank has generated human embryonic stem cell banks from clinical-grade cell lines ESI-017, ESI-035, ESI-049, and ESI-053. All banks were prepared and characterized according to principles of Good Laboratory Practice for quality assurance. Importantly, each cell line has clearly documented and approved ethical provenance and meets recognized standards for performance and safety. The banks are intended to facilitate the translation of stem cell research to clinical medicine by enabling early phase research and development with high-quality, low-cost cells that are also available as clinical-grade stocks.     

继续医学教育项目”过程管理模式”体会

继续医学教育项目是开展继续医学教育的重要形式之一,是卫生专业技术人员获取新知识、新理论、新技术、新方法的重要途径。项目执行的质量将直接体现继续医学教育质量。因此规范项目管理程序,建立有效的运行体系,建立严格奖罚制度,进行”过程跟踪管理”是保证项目执行质量的有效措施。