新医学是解决人类健康问题的真正钥匙——需“精准”理解奥巴马的“精准医学计划”

2015年年初,美国总统奥巴马在国情咨文中提出了一个预算2.15亿美元的“精准医学计划”,希望以此“引领一个医学时代”。新闻一经发布,“精准医学”立刻成为了媒体和百姓嘴边的热词,受此影响国内亦有不少人士纷纷为美国总统的这一计划点“赞”。有人用“医学革命”来形容它,有人用“开创性”来抬高它,还有一个传闻,受奥巴马“精准医学计划”的影响,中国将在15年内投入600亿元人民币启动并发展中国版的“精准医学计划”。对此,有人提出了质疑,美国版精准医学计划是否符合中国国情?是否存在“水土不服”的可能?直接套用美国总统的智慧能否解决具有中国特色的实际问题?争论由此引发一个让人思考的问题,究竟什么才是现代医学的核心?在盲目堆钱的行动前,我们确实有必要从科学和临床应用的角度来探讨和思考一下现代医学的发展方向。 为了能“精准”地看到问题的实质,我将从当下时髦并且相关的词汇谈起,通过梳理,期待找出解决人类健康问题的真正钥匙。     

“地衣”词考

本文考证了中国先秦时期到清末古籍中对“地衣”的解释;其中有共生学意义的“地衣”一词,是在清代李善兰的《植物学》一书中被提出的。     

中国与“一带一路”参与国家抗击新冠肺炎疫情的国际科技合作现状与展望

2019年底暴发并席卷全球的新型冠状病毒肺炎疫情已经成为需要世界各国共同努力克服的全球重大卫生安全挑战。当前,中国已基本控制国内新冠肺炎疫情,并在疫情相关科学研究及公共卫生产品研发方面取得重大进展,同时加强了与“一带一路”参与国家开展国际科技合作。对中国与“一带一路”参与国家抗击新冠肺炎疫情的基础研究合作、国际科技合作项目等方面进行梳理,可以看到:中国与“一带一路”参与国家形成了领域交叉、节点多样的复杂合作网络,并主要与东南亚、中东欧和西亚各国合作密切;中国与“一带一路”参与国家的科研机构已在防控、流行病学和治疗等领域展开了大量实质研究,合作关系更偏向援助型合作。未来应加强与“一带一路”参与国家的生物技术产业合作与技术转移,发挥“一带一路”区域支点国家的示范效应等方面构建与“一带一路”参与国家更丰富、紧密、务实的科技合作关系。     

“2020年后全球生物多样性框架”的谈判进展以及对我国的建议

“2020年后全球生物多样性框架”是当前《生物多样性公约》谈判的焦点议题, 了解该议题的谈判进展将对我国顺利举办第15次缔约方大会(COP15)产生积极的作用。本文在梳理相关谈判进程的基础上, 分析了各方主要观点, 并就我国应对国际谈判并以东道国身份推进该框架的制定进程提出了建议。各方对制定框架的时间表、程序和一般性原则形成了较为一致的共识, 认为应尽快确定“2020年后全球生物多样性框架”的程序及时间表, 基于“爱知生物多样性目标”的执行经验、科学结论和和广泛的信息来源, 与“可持续发展目标”及其他国际进程衔接, 重视利用情景和模型, 并支持更多利益相关方参与制定过程。同时, 各方认为框架应主要包括土地利用、保护和恢复生物多样性的措施、解决生物多样性丧失的根本原因、主流化、能力建设、资源调动、国家承诺等要素。为应对国际谈判, 建议我国在《公约》谈判会议中适时提出以下观点: 重视实现可持续利用相关的目标; 提升评估指标体系的合理性; 科学制定措施。此外, 建议我国采取以下措施积极推进框架制定进程: 充分利用国际高级别会议, 提升政治重视程度; 积极与主要国际进程协作, 推进该框架深入讨论; 重视调动利益相关方积极性。     

“教学、实践、科研、临床”四位一体的医学遗传学教学体系建设探索与实践

医学遗传学课程介于基础医学和临床医学之间,是一门应用性很强的学科,在现代医学教育体系中有着重要的地位。教学团队在多年的医学遗传学教学实践中,在建设省级精品课程的过程中,构建了“教学、实践、科研、临床”四位一体的医学遗传学教学体系,主要内容包括“课堂教学、社会实践、科学研究、临床应用”四者之间相互渗透、相互补充、相互促进,以课堂教学为基础,用社会实践补充教学,科学研究提升教学,临床应用促进教学。“四位一体”教学体系为基础课程与临床课程的有机整合探索了一条切实可行的路子。实施几年来,课程建设收到了良好效果,学科团队科研水平、社会声誉、医疗服务能力也有明显提高。     

“整合物种概念”和“分化路上的物种”

已有的各个物种概念对物种的认识类似盲人摸象, 只包含了物种的某一个方面; 而一个分化后期的成熟物种应涵盖了所有的物种概念。但是, 尚未到达分化后期的物种往往又已开始新一轮的物种分化; 自然中存在的多数“物种”处于分化路上。这种循环往复连续分化产生的物种, 存在种间生殖隔离不彻底、基因流频繁发生、网状进化突出等现象。此外, 对于不同的物种对, 最早开始分化的基因以及不同物种概念所要求的条件的分化顺序不是统一的, 而是随机的。定义一个适合所有“分化路上的物种”概念存在较大困难。但是, 应采用尽可能多的物种概念来界定分化路上的物种、发表新种和进行分类处理; 也应承认种间可能广泛存在不完全的生殖隔离和有限的基因流, 即有不属于两个物种群体的杂交或回交个体的存在。这样划分的物种比只依据一个物种概念认定的物种具有更高的客观性和科学性。     

野生食用菌“苇菇”的物种多样性及中华美味蘑菇适生区预测

“苇菇”是主产于新疆的野生食用菌,主要分布于我国西北内陆湖泊周边的芦苇或多枝柽柳林内,埋生或半埋生在土壤中。本研究共采集和收集相关标本91份,开展了形态学和分子系统学研究,结果表明这些宏观形态特征相似的“苇菇”标本并非一个物种,而是分属于蘑菇属Bivelares组的大肥蘑菇Agaricus bitorquis、中华美味蘑菇A. sinodeliciosus和亚托柄蘑菇A. subperonatus;及Nigrobrunnescentes组的帕达纳蘑菇A. padanus。本文对“苇菇”形态进行了描述,并提供了它们的分种检索表。其中大肥蘑菇、亚托柄蘑菇和帕达纳蘑菇在我国和欧洲等地均有分布,而中华美味蘑菇仅在我国有报道。据此,依据1950-2000年生物气候数据结合中华美味蘑菇的分布实地调查结果,利用最大熵模型(maximum entropy model,MaxEnt)开展了对中华美味蘑菇分布区的分析和预测,结果表明中华美味蘑菇适生区在我国主要为新疆天山山脉南北两侧、西藏西南部、青海海西州、甘肃西北部以及内蒙古西部地区;预测国外适生区域在中亚的哈萨克斯坦和蒙古国。物种分布模型涉及的环境变量对模型的贡献率显示,最湿月降水量、最暖季度降水量、最冷季度平均温度和最暖月最高温是影响中华美味蘑菇分布的主要环境因子。研究结果表明中华美味蘑菇适生区域狭窄,为狭域种,建议应加强相关资源的保护,并积极拓展其可持续利用途径以降低对野生中华美味蘑菇子实体的过度消耗。     

用青春追逐心中的科研梦想——记第19届“中国青年五四奖章”获得者于黎博士

2015年5月在“五四青年节”来临之际,共青团中央、全国青联联合授予了25 名同志“第19届中国青年五四奖章”的荣誉称号。在这25名获奖者中,我刊编委来自云南大学的于黎研究员作为唯一的女性科学家代表令人瞩目。作为中国优秀青年最高荣誉的获得者,于黎博士无疑成为科研界青年学子学习的又一个榜样。她是如何走上科研的道路,又是如何追逐自己的科研梦想的?带着这些问题,我们一起走进她的世界。     

“超级真菌”耳念珠菌研究进展

耳念珠菌Candida auris也被称为“超级真菌”,是近年来出现的一种人体病原真菌新物种,临床分离株通常具有多重耐药和高致死率等特征。2009年日本首次报道耳念珠菌之后,其感染病例在多个国家呈现出爆发式增长。目前已报道的病例分布在全球五大洲27个国家,包括中国。耳念珠菌感染给临床诊断和防控以及人类健康带来了巨大的挑战。本文从该菌临床分离菌株的生物学、遗传变异分化及耐药特征等方面入手,围绕分子流行病学、基因组特征、毒性因子和耐药性等方面系统地综述了近年来国内外取得的相关进展,并探讨了我国耳念珠菌感染的诊断、治疗和预防的措施。     

“自然对人类的贡献”的实现、发展趋势和启示

生物多样性和生态系统服务政府间科学政策平台(IPBES)的目标是加强科学政策对生物多样性和生态系统服务的影响。为了更好地理解和展示IPBES目标的基本要素及其相互关系, 在千年生态系统评估(MA)的基础上, IPBES融合多种知识体系, 不断完善、创新, 逐步形成了以“自然对人类的贡献” (NCP)为核心的概念框架。本文首先梳理了NCP的发展历程, 论述了NCP与生态系统服务的关系, 指出两者均关注人类福祉, 但与生态系统服务不同的是, NCP涵盖了自然对人类生活的消极影响, 强调社会文化因素、传统知识和土著居民的地位以及人与自然共同作用的重要性。其次, 本文阐述了人与自然共同实现NCP进而影响人类良好生活质量的机制, 并分析了NCP大幅下降的全球趋势, 提出世界各国应不断推动生物多样性保护主流化, 增加国际交流与合作, 致力实现“人与自然和谐共生”的2050年愿景。最后, 本文讨论了NCP在IPBES评估和《生物多样性公约》磋商谈判中的应用前景, 为今后NCP理论研究和实践提供科学支持。     

我国麻类资源的多样性及其保护利用对策

在“七五”、“八五”、“九五”研究的基础上,本文论述了我国麻类资源的种类、数量与分布以及保护利用现状等方面的问题,并提出了多样性的可持续发展和利用对策,为今后我国麻类资源的收集、保存、鉴定、创新和利用提供依据。     

The Characteristics and Trends of Socioeconomic Metabolism in China

China has become the country with the largest resource use and has high levels of waste emissions that pose a great management challenge. To provide more details about environmental problems and to find effective solutions, this article analyzed the scale, structure, and trend of the socioeconomic metabolism in China during the period 1992–2014 based on economy‐wide material flow accounts (EW‐MFA), and predicted resource use during the period of the 13th Five‐Year Plan. The results of this study show that the scale of China's socioeconomic metabolism in China increased more than twofold, during 1992–2014. However, after 2011, with the economic slowdown, the growth rates of total material requirement (TMR), direct material input (DMI), and domestic processed output (DPO) began to decrease. China may reach an inflection point, but this point will probably not be approached before the year 2020. Material recycling (MR) has played an important role in improving resource productivity, improving it by 92.52 renminbi per tonne in 2014. Metallic minerals and fossil fuels are the main sources of hidden flow. Carbon dioxide (CO₂) emissions, construction waste, and agricultural emissions have become the major sources of DPO. Because of the 13th Five‐Year Plan, China may slow the growth rate of DMI and may save 10.26 gigatonnes of resources during 2015–2020. Resource productivity is predicted to increase by 15.91%. Imports and MR may play more important roles. These suggestions are made: (1) strengthening the recycling system; (2) stronger policies, especially in metallic mineral and fossil fuels; (3) developing management systems for CO₂ emissions, construction waste, and agricultural emissions; and (4) adjusting China's economic structure.     

Re‐defining and tackling the emerging challenges in stem cell research and translation: A report of the 10th CSSCR annual meeting

The 10th congress of the Chinese Society for Stem Cell Research was held from 11 to 13 October 2020 at Guiyang International Eco‐Conference Center in Guizhou (Southwest China) with 700 offline participants (and 500 online participants). With a theme adopted from a poem by Mao Zedong during the long march, ‘However difficult it might appear; the challenges will be overcome’, the congress provided opportunities for the fast‐growing field to exchange ideas among people from academia, industry and regulatory authorities, to help accelerate translation. Eight plenary lectures and six concurrent sessions on cell fate decision, stem cell metabolism, neural stem cells and neural regeneration, organoids and disease models, tissue and organ regeneration and clinical translation of stem cell research were covered, including 77 oral presentations and 75 poster presentations. The congress also included special programmes of a youth forum, a lecture award programme, a flagship journal forum and a dedicated networking session. This 3‐day event will significantly boost the stem cell research in an era closing to application.     

Monosomy 7 in donor cell-derived leukemia after bone marrow transplantation for severe aplastic anemia: Report of a new case and review of the literature

Monosomy 7 arises as a recurrent chromosome aberration in donor cell leukemia after hematopoietic stem cell transplantation. We report a new case of donor cell leukemia with monosomy 7 following HLA-identical allogenic bone marrow transplantation for severe aplastic anemia (SAA). The male patient received a bone marrow graft from his sister, and monosomy 7 was detected only in the XX donor cells, 34 months after transplantation. The patient’s bone marrow microenvironment may have played a role in the leukemic transformation of the donor hematopoietic cells.     

Current focus of stem cell application in retinal repair

The relevance of retinal diseases, both in society’s economy and in the quality of people’s life who suffer with them, has made stem cell therapy an interesting topic forresearch. Embryonic stem cells(ESCs), induced pluripotent stem cells(i PSCs) and adipose derived mesenchymal stem cells(ADMSCs) are the focus in current endeavors as a source of different retinal cells, such as photoreceptors and retinal pigment epithelial cells. The aim is to apply them for cell replacement as an option for treating retinal diseases which so far are untreatable in their advanced stage. ESCs, despite the great potential for differentiation, have the dangerous risk of teratoma formation as well as ethical issues, which must be resolved before starting a clinical trial. i PSCs, like ESCs, are able to differentiate in to several types of retinal cells. However, the process to get them for personalized cell therapy has a high cost in terms of time and money. Researchers are working to resolve this since i PSCs seem to be a realistic option for treating retinal diseases. ADMSCs have the advantage that the procedures to obtain them are easier. Despite advancements in stem cell application, there are still several challenges that need to be overcome before transferring the research results to clinical application. This paper reviews recent research achievements of the applications of these three types of stem cells as well as clinical trials currently based on them.     

Regenerative and stem cell-based techniques for facial rejuvenation

This review discusses the most novel ideas and modalities being incorporated into facial rejuvenation. Recent innovative techniques include the use of regenerative stem cell techniques and regeneration supportive modalities such as nano-technology or gene therapies. This review aims to investigate approaches that are less well known and lacking established evidence in order to proactively study these techniques prior to them becoming popularized. These applications and relevant research were reviewed in the context of both surgical and non-surgical modalities in clinical practice. Future directions include the concept of “precision cosmetic medicine” utilizing gene editing and cellular therapies to tailor rejuvenation techniques based on each individual’s genetic make-up and therefore needs.     

Nitric oxide modulation in neuroinflammation and the role of mesenchymal stem cells

Nitric oxide is a versatile mediator formed by enzymes called nitric oxide synthases. It has numerous homeostatic functions and important roles in inflammation. Within the inflamed brain, microglia and astrocytes produce large amounts of nitric oxide during inflammation. Excessive nitric oxide causes neuronal toxicity and death and mesenchymal stem cells can be used as an approach to limit the neuronal damage caused by neuroinflammation. Mesenchymal stem cell therapy ameliorates inflammation and neuronal damage in disease models of Alzheimer’s disease, Parkinson’s disease, and other neuroinflammatory disorders. Interestingly, we have reported that in vitro, mesenchymal stem cells themselves contribute to a rise in nitric oxide levels through microglial cues. This may be an undesirable effect and highlights a possible need to explore acellular approaches for mesenchymal stem cell therapy in the central nervous system.     

Stem cell-derived extracellular vesicle therapy for acute brain insults and neurodegenerative diseases

Stem cell-based therapy is a promising approach for treating a variety of disorders, including acute brain insults and neurodegenerative diseases. Stem cells such as mesenchymal stem cells (MSCs) secrete extracellular vesicles (EVs), circular membrane fragments (30 nm−1 μm) that are shed from the cell surface, carrying several therapeutic molecules such as proteins and microRNAs. Because EV-based therapy is superior to cell therapy in terms of scalable production, biodistribution, and safety profiles, it can be used to treat brain diseases as an alternative to stem cell therapy. This review presents evidences evaluating the role of stem cell-derived EVs in stroke, traumatic brain injury, and degenerative brain diseases, such as Alzheimer’s disease and Parkinson’ disease. In addition, stem cell-derived EVs have better profiles in biocompatibility, immunogenicity, and safety than those of small chemical and macromolecules. The advantages and disadvantages of EVs compared with other strategies are discussed. Even though EVs obtained from native stem cells have potential in the treatment of brain diseases, the successful clinical application is limited by the short half-life, limited targeting, rapid clearance after application, and insufficient payload. We discuss the strategies to enhance the efficacy of EV therapeutics. Finally, EV therapies have yet to be approved by the regulatory authorities. Major issues are discussed together with relevant advances in the clinical application of EV therapeutics.     

Expansion of Multipotent Stem Cells from the Adult Human Brain

The discovery of stem cells in the adult human brain has revealed new possible scenarios for treatment of the sick or injured brain. Both clinical use of and preclinical research on human adult neural stem cells have, however, been seriously hampered by the fact that it has been impossible to passage these cells more than a very few times and with little expansion of cell numbers. Having explored a number of alternative culturing conditions we here present an efficient method for the establishment and propagation of human brain stem cells from whatever brain tissue samples we have tried. We describe virtually unlimited expansion of an authentic stem cell phenotype. Pluripotency proteins Sox2 and Oct4 are expressed without artificial induction. For the first time multipotency of adult human brain-derived stem cells is demonstrated beyond tissue boundaries. We characterize these cells in detail in vitro including microarray and proteomic approaches. Whilst clarification of these cells’ behavior is ongoing, results so far portend well for the future repair of tissues by transplantation of an adult patient’s own-derived stem cells.