Clinical translation

临床翻译
  • 文章类型: Journal Article
    脓毒症被定义为由宿主对感染的反应失调引起的危及生命的器官功能障碍。具有很大的临床异质性,高发病率,和高死亡率。同时,有多种感染源,病理生理学非常复杂,发病机制尚未完全阐明。一个理想的脓毒症动物模型可以准确模拟临床脓毒症,促进脓毒症相关发病机制的发展,治疗方法,和预后。现有的脓毒症模型仍然使用以前的脓毒症2.0建模标准,有一些问题,例如多种感染源,重复性差,无法考虑单因素研究,与临床脓毒症患者差异较大。为了解决这些问题,本研究建立了一种新的脓毒症动物模型。该模型使用静脉尾部注射单个细菌菌株,简化多细菌感染的复杂性,有效地解决了上述问题。
    Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection, with great clinical heterogeneity, high morbidity, and high mortality. At the same time, there are many kinds of infection sources, the pathophysiology is very complex, and the pathogenesis has not been fully elucidated. An ideal animal model of sepsis can accurately simulate clinical sepsis and promote the development of sepsis-related pathogenesis, treatment methods, and prognosis. The existing sepsis model still uses the previous Sepsis 2.0 modelling standard, which has some problems, such as many kinds of infection sources, poor repeatability, inability to take into account single-factor studies, and large differences from clinical sepsis patients. To solve these problems, this study established a new animal model of sepsis. The model uses intravenous tail injection of a single bacterial strain, simplifying the complexity of multibacterial infection, and effectively solving the above problems.
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  • 文章类型: Journal Article
    最近,具有自我推进功能的微型/纳米机器人(MNRs)已成为有前途的智能诊断平台,治疗和治疗应用。尤其是,基于聚合物的MNRs由于其固有的生物相容性和多功能性而引起了极大的关注,使它们积极探索各种医疗应用。由于将MNRs从实验室转化为临床环境势在必行,将适当的聚合物用于MNR是一项关键策略,这可以促使MNR推进到下一阶段。在这次审查中,我们描述了MNRs中的多功能多功能聚合物,以及它们的生物降解性,运动控制,货物装载和释放,附着力,和其他特征。之后,我们回顾了基于聚合物的MNRs在生物成像中的治疗应用,生物传感,药物输送,和组织工程。此外,我们解决了必须克服的挑战,以促进未来的聚合物MNRs的翻译发展。这篇综述将为与聚合物MNRs相关的最新技术提供有价值的见解,并为其进一步临床开发的进展做出贡献。
    Recently, micro/nanorobots (MNRs) with self-propulsion have emerged as a promising smart platform for diagnostic, therapeutic and theranostic applications. Especially, polymer-based MNRs have attracted huge attention due to their inherent biocompatibility and versatility, making them actively explored for various medical applications. As the translation of MNRs from laboratory to clinical settings is imperative, the use of appropriate polymers for MNRs is a key strategy, which can prompt the advancement of MNRs to the next phase. In this review, we describe the multifunctional versatile polymers in MNRs, and their biodegradability, motion control, cargo loading and release, adhesion, and other characteristics. After that, we review the theranostic applications of polymer-based MNRs to bioimaging, biosensing, drug delivery, and tissue engineering. Furthermore, we address the challenges that must be overcome to facilitate the translational development of polymeric MNRs with future perspectives. This review would provide valuable insights into the state-of-the-art technologies associated with polymeric MNRs and contribute to their progression for further clinical development.
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  • 文章类型: Journal Article
    角膜是眼睛的最外层,在我们的视觉系统中起着至关重要的作用。角膜缘上皮干细胞(LESCs),位于高度调节的角膜缘生态位,是角膜上皮再生的主要导体。对LESCs及其生态位的损伤可能导致角膜缘干细胞缺乏(LSCD),一种疾病使眼科医生困惑了这么多年,并可能导致角膜结瘤,新生血管形成,甚至失明。如何恢复LESCs功能是全球眼科科学家和临床医生关注的热点。这篇综述介绍了LESCs和生态位微环境,概述了用于LSCD研究的分离和培养LESCs的各种技术,呈现引起LSCD的常见疾病,并提供了从基础研究到临床治疗的LSCD的诊断和多种治疗方法的全面概述,尤其是基于各种干细胞来源的新兴细胞疗法。此外,我们还创新性地总结了近年来的最新战略,包括外源性药物,组织工程,纳米技术,外泌体和基因治疗,以及最近五年正在进行的治疗LSCD的临床试验。最后,我们强调了LSCD从实验室到床边的挑战,并讨论了LSCD治疗研究的前沿领域.我们希望这篇综述可以为未来治疗LSCD的研究和翻译铺平道路,眼健康领域的关键一步。
    The cornea is the outermost layer of the eye and plays an essential role in our visual system. Limbal epithelial stem cells (LESCs), which are localized to a highly regulated limbal niche, are the master conductors of corneal epithelial regeneration. Damage to LESCs and their niche may result in limbal stem cell deficiency (LSCD), a disease confused ophthalmologists so many years and can lead to corneal conjunctivalization, neovascularization, and even blindness. How to restore the LESCs function is the hot topic for ocular scientists and clinicians around the world. This review introduced LESCs and the niche microenvironment, outlined various techniques for isolating and culturing LESCs used in LSCD research, presented common diseases that cause LSCD, and provided a comprehensive overview of both the diagnosis and multiple treatments for LSCD from basic research to clinical therapies, especially the emerging cell therapies based on various stem cell sources. In addition, we also innovatively concluded the latest strategies in recent years, including exogenous drugs, tissue engineering, nanotechnology, exosome and gene therapy, as well as the ongoing clinical trials for treating LSCD in recent five years. Finally, we highlighted challenges from bench to bedside in LSCD and discussed cutting-edge areas in LSCD therapeutic research. We hope that this review could pave the way for future research and translation on treating LSCD, a crucial step in the field of ocular health.
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  • 文章类型: Journal Article
    目前,关节置换术中骨缺损的治疗是临床实践中的挑战。尽管如此,市售的骨科支架对大型骨缺损的治疗效果有限,特别是对于大量和不规则的缺陷。增材制造多孔钽,特别是,已成为这种支架的有前途的材料,并因其出色的生物相容性而广泛用于骨科,骨诱导,和机械性能。多孔钽在个性化快速制造方面也表现出独特的优势,这允许以低成本和高效率创建具有用于临床应用的复杂几何形状的定制支架。然而,关于增材制造多孔钽的孔结构对骨再生的影响的研究很少。在这项研究中,我们小组通过激光粉末床融合(LPBF)设计并制造了一批孔径为250μm(Ta250)的精密多孔钽支架,450μm(Ta450),650μm(Ta650),和850μm(Ta850)。然后我们进行了一系列体外实验,观察到所有四组都显示出良好的生物相容性。特别是,Ta450表现出最好的成骨性能。之后,我们的团队使用大鼠骨缺损模型来确定体内成骨作用。基于显微计算机断层扫描和组织学,我们确定Ta450表现出最佳的骨向内生长性能。随后,绵羊股骨和髋关节缺损模型用于进一步证实Ta450支架的成骨作用。最后,我们通过Ta450支架的临床应用(7例等待翻修全髋关节置换术的患者)验证了上述体外和体内结果。临床结果证实,直到12个月的随访,Ta450具有令人满意的临床结果。总之,我们的发现表明450μm是多孔钽支架的合适孔径。本研究可能为治疗大量,无法挽回,和关节成形术中的长期骨缺损。
    Currently, the treatment of bone defects in arthroplasty is a challenge in clinical practice. Nonetheless, commercially available orthopaedic scaffolds have shown limited therapeutic effects for large bone defects, especially for massiveand irregular defects. Additively manufactured porous tantalum, in particular, has emerged as a promising material for such scaffolds and is widely used in orthopaedics for its exceptional biocompatibility, osteoinduction, and mechanical properties. Porous tantalum has also exhibited unique advantages in personalised rapid manufacturing, which allows for the creation of customised scaffolds with complex geometric shapes for clinical applications at a low cost and high efficiency. However, studies on the effect of the pore structure of additively manufactured porous tantalum on bone regeneration have been rare. In this study, our group designed and fabricated a batch of precision porous tantalum scaffolds via laser powder bed fusion (LPBF) with pore sizes of 250 μm (Ta 250), 450 μm (Ta 450), 650 μm (Ta 650), and 850 μm (Ta 850). We then performed a series of in vitro experiments and observed that all four groups showed good biocompatibility. In particular, Ta 450 demonstrated the best osteogenic performance. Afterwards, our team used a rat bone defect model to determine the in vivo osteogenic effects. Based on micro-computed tomography and histology, we identified that Ta 450 exhibited the best bone ingrowth performance. Subsequently, sheep femur and hip defect models were used to further confirm the osteogenic effects of Ta 450 scaffolds. Finally, we verified the aforementioned in vitro and in vivo results via clinical application (seven patients waiting for revision total hip arthroplasty) of the Ta 450 scaffold. The clinical results confirmed that Ta 450 had satisfactory clinical outcomes up to the 12-month follow-up. In summary, our findings indicate that 450 μm is the suitable pore size for porous tantalum scaffolds. This study may provide a new therapeutic strategy for the treatment of massive, irreparable, and protracted bone defects in arthroplasty.
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  • 文章类型: Journal Article
    关于虚拟现实(VR)的使用及其融入临床实践的文献很少。鉴于在英国医疗保健中使用VR的兴趣与日俱增,这项调查的目的是探索英国儿科物理治疗师目前在临床实践中的使用情况,确定在临床实践中实施VR的促进因素和障碍,并调查将增强未来使用它的意图的因素。
    使用评估预期接受虚拟现实的决定因素(ADOPT-VR2)的在线调查通过儿科特许物理治疗师协会分发给英国儿科物理治疗师。进行描述性统计和回归分析。
    在128个响应中,81位英国儿科物理治疗师完成了调查。治疗师在国家卫生局工作,在私营部门和教育领域。大多数受访者表示在临床实践中没有使用VR(n=75;93%)。只有7%的受访者表示在临床实践中使用VR。对VR的态度,兼容性,ADOPT-VR2的同伴影响结构均显着预测了使用VR的行为意图(R2=0.612,p=<0.001)。
    这项研究表明,当前VR的使用受到限制。这项研究的结果表明,需要协调多种因素来增强VR的实现。具体来说,治疗师需要有时间,适当的培训,资金和技术支持。利益相关者可能还需要考虑开发实用手册,以确保治疗师一致和正确地实施VR。
    目前VR在临床上的使用非常有限。VR的有限使用不仅仅与缺乏资金有关。物理治疗师需要接受适当的培训,财务和技术支持,以促进VR临床实施。
    UNASSIGNED: The literature is scarce about virtual reality (VR) use and its integration into clinical practice. Given the growing interest toward using VR in healthcare in the UK, the aims of this survey were to explore its current use by paediatric physiotherapists in clinical practice in the UK, identify the facilitators and barriers to VR implementation in clinical practice and investigate the factors that will enhance intentions to use it in the future.
    UNASSIGNED: An online survey using Assessing Determinants of Prospective Take-Up of Virtual Reality (ADOPT-VR2) was distributed to UK paediatric physiotherapists through the Association of Paediatric Chartered Physiotherapists. Descriptive statistics and regression analysis were conducted.
    UNASSIGNED: Out of 128 responses, 81 UK-based paediatric physiotherapists completed the survey. The therapists worked in the National Health Service, in the private sector and education. Most of the respondents reported not using VR in clinical practice (n = 75; 93%). Only 7% of respondents reported using VR in clinical practice. Attitudes toward VR, compatibility, and the peer influence constructs of ADOPT-VR2 all significantly predicted the behavioural intention to use VR (R2 = 0.612, p = <0.001).
    UNASSIGNED: This study shows that the current use of VR is limited. The findings from this study suggest that multiple factors need to be reconciled to enhance VR implementation. Specifically, therapists need to be provided with time, appropriate training, and financial and technical support. Stakeholders may also need to consider developing practical manuals to ensure therapists are implementing VR consistently and correctly.
    The current use of VR in clinic is notably limited.The limited use of VR is not solely related to the lack of funds.Physiotherapists need to be provided with appropriate training, financial and technical support to facilitate VR clinical implementation.
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  • 文章类型: Journal Article
    骨缺损对医疗保健构成重大挑战,每年在全球进行超过200万例骨修复手术。作为骨组织工程领域的新兴力量,3D打印为传统的骨移植手术提供了新的解决方案。然而,目前的3D打印骨支架在材料选择方面仍然面临三个关键挑战,印刷方法,细胞自组织和共同培养,严重阻碍了其临床应用。在这次全面审查中,我们深入研究理想骨支架应具备的性能标准,特别关注3D打印技术在临床翻译过程中面临的三个核心挑战。我们总结了非传统材料和先进印刷技术的最新进展,强调将类似器官的技术与生物打印相结合的重要性。这种组合方法能够更精确地模拟自然组织结构和功能。我们撰写这篇综述的目的是提出有效的策略来应对这些挑战,并促进3D打印支架用于骨缺损治疗的临床翻译。
    Bone defects pose significant challenges in healthcare, with over 2 million bone repair surgeries performed globally each year. As a burgeoning force in the field of bone tissue engineering, 3D printing offers novel solutions to traditional bone transplantation procedures. However, current 3D-printed bone scaffolds still face three critical challenges in material selection, printing methods, cellular self-organization and co-culture, significantly impeding their clinical application. In this comprehensive review, we delve into the performance criteria that ideal bone scaffolds should possess, with a particular focus on the three core challenges faced by 3D printing technology during clinical translation. We summarize the latest advancements in non-traditional materials and advanced printing techniques, emphasizing the importance of integrating organ-like technologies with bioprinting. This combined approach enables more precise simulation of natural tissue structure and function. Our aim in writing this review is to propose effective strategies to address these challenges and promote the clinical translation of 3D-printed scaffolds for bone defect treatment.
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  • 文章类型: Journal Article
    无载体纳米药物具有非凡的活性药物成分(API)负载(甚至100%),可避免的载体诱导毒性,和简单的合成程序被认为是最有希望的候选疾病治疗。大量研究和“无载体”纳米晶体的商业成功已经证明了其强大的临床潜力。然而,他们的实际翻译仍然具有挑战性,并且受到不可预测的装配过程的阻碍,交付效率不足,和不清楚的体内命运。从这个角度来看,我们系统地概述了基于不同API的当代和新兴的无载体纳米药物,以及强调他们在临床翻译中的机遇和挑战。展望未来,进一步改进设计和准备,药物输送,体内功效,无载体纳米药物的安全性对于促进其从工作台到床边的翻译至关重要。
    Carrier-free nanodrugs with extraordinary active pharmaceutical ingredient (API) loading (even 100%), avoidable carrier-induced toxicity, and simple synthetic procedures are considered as one of the most promising candidates for disease theranostics. Substantial studies and the commercial success of \"carrier-free\" nanocrystals have demonstrated their strong clinical potential. However, their practical translations remain challenging and are impeded by unpredictable assembly processes, insufficient delivery efficiency, and an unclear in vivo fate. In this Perspective, we systematically outline the contemporary and emerging carrier-free nanodrugs based on diverse APIs, as well as highlight their opportunities and challenges in clinical translation. Looking ahead, further improvements in design and preparation, drug delivery, in vivo efficacy, and safety of carrier-free nanomedicines are essential to facilitate their translation from the bench to bedside.
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  • 文章类型: Journal Article
    与目前的临床黄金标准系统性免疫抑制相比,用于局部免疫调节的药物递送策略具有巨大的前景,因为它们可以提高挽救生命或增强生命的移植的风险比。这样的策略在较低药物剂量的动物模型中促进了延长的移植物存活,同时使脱靶效应最小化。尽管在临床前动物研究中取得了有希望的结果,这些策略向临床试验的进展面临挑战.对翻译障碍的全面了解是临床验证有效的免疫调节药物递送方案的关键的第一步,该方案在临床前动物模型中被证明具有安全性和耐受性。这篇综述概述了移植局部免疫调节策略的最新技术,并概述了阻碍其临床转化的关键挑战。
    Drug delivery strategies for local immunomodulation hold tremendous promise compared to current clinical gold-standard systemic immunosuppression as they could improve the benefit to risk ratio of life-saving or life-enhancing transplants. Such strategies have facilitated prolonged graft survival in animal models at lower drug doses while minimizing off-target effects. Despite the promising outcomes in preclinical animal studies, progression of these strategies to clinical trials has faced challenges. A comprehensive understanding of the translational barriers is a critical first step towards clinical validation of effective immunomodulatory drug delivery protocols proven for safety and tolerability in pre-clinical animal models. This review overviews the current state-of-the-art in local immunomodulatory strategies for transplantation and outlines the key challenges hindering their clinical translation.
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  • 文章类型: Journal Article
    小胶质细胞,作为中枢神经系统中的免疫细胞,与2型糖尿病(T2D)相关的认知障碍密切相关。初步探索了T2D相关认知障碍与小胶质细胞激活和极化的关系。这篇综述总结了T2D背景下小胶质细胞激活和极化的潜在机制。它讨论了中枢炎症反应,神经元凋亡,淀粉样β沉积,以及小胶质细胞活化和极化介导的Tau蛋白的异常磷酸化,从多个角度探讨小胶质细胞激活和极化与T2D相关认知障碍之间的联系。此外,本综述为未来针对小胶质细胞治疗T2D相关认知障碍及临床转化提供参考。
    Microglia, as immune cells in the central nervous system, are closely related to cognitive impairment associated with type 2 diabetes (T2D). Preliminary explorations have investigated the relationship between T2D-related cognitive impairment and the activation and polarization of microglia. This review summarizes the potential mechanisms of microglial activation and polarization in the context of T2D. It discusses central inflammatory responses, neuronal apoptosis, amyloid-β deposition, and abnormal phosphorylation of Tau protein mediated by microglial activation and polarization, exploring the connections between microglial activation and polarization and T2D-related cognitive impairment from multiple perspectives. Additionally, this review provides references for future treatment targeting microglia in T2D-related cognitive impairment and for clinical translation.
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  • 文章类型: Journal Article
    半月板对于保持膝关节的解剖和功能完整性至关重要。半月板损伤,通常由创伤或退化过程引起,会导致膝关节功能障碍和继发性骨关节炎,而目前对半月板损伤的保守和手术干预效果欠佳。在过去的十年里,半月板组织工程的发展受到了极大的关注,包括孤立的脚手架策略,生物增强,物理刺激,和半月板类器官,改善半月板损伤的预后。尽管临床前结果值得关注,临床前和临床研究之间存在翻译差距和治疗效率不一致。这篇综述全面概述了过去十年半月板组织工程的发展(方案1)。临床前和临床试验结果不一致的原因,以及潜在的策略,以加快翻译的工作台到床边的方法进行了分析和讨论。
    Meniscus is vital for maintaining the anatomical and functional integrity of knee. Injuries to meniscus, commonly caused by trauma or degenerative processes, can result in knee joint dysfunction and secondary osteoarthritis, while current conservative and surgical interventions for meniscus injuries bear suboptimal outcomes. In the past decade, there has been a significant focus on advancing meniscus tissue engineering, encompassing isolated scaffold strategies, biological augmentation, physical stimulus, and meniscus organoids, to improve the prognosis of meniscus injuries. Despite noteworthy promising preclinical results, translational gaps and inconsistencies in the therapeutic efficiency between preclinical and clinical studies exist. This review comprehensively outlines the developments in meniscus tissue engineering over the past decade (Scheme 1). Reasons for the discordant results between preclinical and clinical trials, as well as potential strategies to expedite the translation of bench-to-bedside approaches are analyzed and discussed.
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