Mass Spectrometry-based Proteomics in Acute Respiratory Distress Syndrome： A Powerful Modality for Pulmonary Precision Medicine

Objective：Acute respiratory distress syndrome （ARDS） is an acute and lethal clinical syndrome that is characterized by hypoxemic respiratory failure and diffuse alveolar inflammatory damage.This review aimed to search and discuss the mass spectrometry （MS）-based proteomic studies on different subsets of ARDS patients.Data Sources：Original research articles were collected from the PubMed database published in English up to December 2015.Study Selection：The literature search was done using the term ＂（acute lung injury OR acute respiratory distress syndrome）AND （proteomics OR proteome OR mass spectrum OR differential in-gel electrophoresis OR two-dimensional polyacrylamide gel electrophoresis）＂.Related original research articles were included and were carefully analyzed.Results：Eight original proteomic researches on ARDS patients were found.The common proteomic modalities were two-dimensional （2D）high-performance liquid chromatography-based electronic spray ion-MS/MS and 2D-polyacrylamide gel electrophoresis/differential in-gel electrophoresis-based matrix-assisted laser desorption ionization-time of flight/MS.They compared the proteome between ARDS patients and normal controls and analyzed the dynamic changes ofproteome at different ARDS stages or severity.The disturbed proteome in ARDS patients includes plasma acute-phase proteins,inflammatory/immune-associated proteins,and coagulation proteins.Conclusions：Although several previous studies have provided some useful information about the lung proteome in ARDS patients and gained several interesting disease-associated biomarkers,clinical proteomic studies in ARDS patients are still in the initial stage.An increased cooperation is still needed to establish a global and faithful database containing disease-specific proteome from the largest ARDS subsets.

Extracorporeal blood therapy in sepsis and acute respiratory distress syndrome： the ＂purifying dream＂

Objective To discuss the rationale, hypothesis, modality of extracorporeal blood purification （EBP） techniques for the critically ill animal models or patients, and to summarize the experimental and clinical studies with inconsistent data which explored the EBP＇s efficacy in the areas of critical care medicine. Data sources Articles referred in this review were collected from the database of PubMed published in English up to June 2014. Study selection We had done a literature search by using the term ＂（sepsis OR acute lung injury OR acute respiratory distress syndrome） AND （extracorporeal blood purification OR hemofiltretion OR hemoperfusion OR plasma exchange OR plasmapheresis OR adsorpiton）＂. Related original or review articles were included and carefully analyzed. Results Acute cellular and humoral immune disturbances occur in both sepsis and acute respiratory distress syndrome （ARDS）. Treatments aimed at targeting one single pro-/anti-inflammatory mediator have largely failed with no proven clinical benefits. Such failure shifts the therapeutic rationale to the nonspecific, broad-spectrum methods for modulating the over-activated inflammatory and anti-inflammatory response. Therefore, EBP techniques have become the potential weapons with high promise for removing the circulating pro-/anti-inflammatory mediators and promoting immune reconstitution. Over the years, multiple extracorporeal techniques for the critically ill animal models or patients have been developed, including hemoflltration （HF）, high-volume hemofiltration （HVHF）, high-cutoff hemofiltration （HCO-HF）, hemo-perfusion or -adsorption （HP/HA）, coupled plasma filtration adsorption （CPFA）, and plasma exchange （PE）. These previous studies showed that EBP therapy was feasible and safe for the critically ill animal models or patients. However, data on their efficacy （especially on the clinical benefits, such as mortality） were inconsistent. Conclusions It is not now to conclude that EBP intervention can purify septic or ARDS patients with high clinical efficacy from current experimental and clinical practice. Prospective, randomized controlled, and well-designed clinical or experimental studies and most suitable EBP modalities should be further developed.

Reform direction of medical education in China： implementing ＂competency-based＂ medical education

For over 100 years, medical education has achieved continuous development and progress all over theworld. Flexner＇s report in 1910 brought modern science into the curricula of medical schools. In the 1960s, problem-based learning （PBL） was born in Canada and quickly achieved wide use. From the beginning of the 21 st century, with increasing specialization in medicine, the ＂silo effect＂ has become more apparent. The inequality in healthcare and low efficiency of the entire health system has become prominent problems. These have brought about new challenges for medical education--how to implement accountable medical education so as to rectify the current situation. Therefore, ＂competency-based＂ medical education, as an important feature of the third generation medical education reform, has gradually become the trend. J However, currently in most medical schools in China, PBL is still flourishing, which indicates that we are still at the second generation of medical education reform.