The add-on effect of dengzhan shengmai capsules on secondary prevention of ischemic stroke: A multicentre,randomised, placebo-controlled clinical trial

ObjectiveThe Dengzhan Shengmai (DZSM) capsule is a commercially available type of Chinese herbal medicine frequently administered to improve neurological impairment after stroke. Its ability to prevent recurrent stroke, however, has not been determined. This study therefore evaluated the ability of DZSM as an add-on to conventional secondary preventive agents to prevent recurrent ischemic stroke.MethodsIn this randomised, double-blind, placebo-controlled trial, conducted at 83 hospitals in Mainland China, 3143 patients in 14–180 days after the initial onset of ischemic stroke, were randomly allocated to the DZSM (0.36 g, twice daily for 12 months) or the placebo group. All patients in both groups received standard secondary preventive medications. The primary outcome was the 1-year incidence of stroke. Between group differences were assessed using the Cox proportional hazards model.ResultsIntent-to-treat analysis showed that 58 (3.8%) participants in the DZSM group and 82 (5.4%) in the placebo group experienced new stroke events (hazard ratio = 0.70, 95% confidence interval = 0.50–0.98, P = 0.036). The type and incidence of adverse events were similar in the DZSM and placebo groups.ConclusionsThe addition of DZSM capsules to standard secondary preventive agents provides additional benefits after the initial onset of ischemic stroke, reducing recurrent stroke without increasing severe adverse events. However, further study is needed to elucidate the role of DZSM on the updated practice of conventional secondary prevention for ischemic stroke.     

Mucosa Biology and the Development of Rheumatoid Arthritis: Potential for Prevention by Targeting Mucosal Processes

As the goal in rheumatoid arthritis (RA) management shifts toward the prevention of joint disease, it is important to consider the role of mucosal sites in the pathogenesis of RA because they may be potential targets for preventive interventions. Multiple mucosal sites demonstrate immune dysregulation and inflammation in individuals with classifiable RA as well as, importantly, in individuals with systemic autoimmunity related to RA. The lung, gingival, and gastrointestinal mucosae are most strongly implicated in RA pathogenesis and may be sites where autoimmunity in RA initially develops. Targeting the exact site where the initial immune dysregulation in RA occurs is an appealing approach to prevention because it could avoid unwanted side effects of systemic therapies. However, several challenges must be addressed before mucosa-targeted interventions are a readily available option for RA prevention. Studies are needed to determine whether all RA-related immune dysregulation at mucosal sites will progress to joint disease and whether one or multiple mucosal sites demonstrate dysregulation prior to the development of classifiable RA. These areas of future research are likely to provide crucial pieces in the understanding of RA pathogenesis and ultimately RA prevention.     

Haemochromatosis

Genetic haemochromatosis (GH) is the most common, autosomal recessive disorder in Northern Europe. The studies which led to the identification of the HFE gene are described. In the UK over 90% of patients with GH are homozygous for the C282Y mutation of this gene. This mutation is confined to populations of European origin. The significance of another mutation, H63D, in causing iron overload is less certain. Preliminary studies on the localization of the protein and the effects of the mutations are described. Genetic testing and the measurement of iron status now provide the means to allow for widespread testing for the prevention of iron overload and its consequences. However, questions remain about the clinical penetrance of GH.     

香港防痨工作的过去和展望

过去４０年，香港的防痨工作有显著的成就。目前，结核病的呈报率是每１０万人口中有１１０．４人，死亡率每１０万人口中有６．７人，结核病者平均死亡年龄是６９岁，由于香港初生婴儿卡介苗注射非常成功，历年来接种率都达到差不多百分之百，所以结核病在婴儿或儿童发生的情形已甚为罕见。香港的防痨工作分为三方面进行：①公共卫生──这包括宣传及卫生教育、初生婴儿卡介苗注射、辅导痨病患者及他的家人和痨病调查等。②胸肺科诊疗所服务──香港痨病的治疗大部分是在胸肺科诊疗所提供，现在有１１间全日开放和５间部分开放的胸肺科诊疗所分布全港各区，专门为各种工作时间不同的人士服务。③医院服务──医院服务是主要给严重患者、有并发症或需要住院接受检查和手术的人士。公共卫生和胸肺科诊疗所服务大部分是由卫生署提供。医院治疗是由医院管理局辖下的医院提供，而属于香港防痨心脏及胸病协会的律敦治医院和葛量洪医院则是本港主要的胸肺科医院。香港的防痨工作虽然有此骄人成就，但仍面对很多挑战，中国和香港防痨组织能彼此合作对预防和控制痨病将有帮助。     

Schedule for 1995 annual sgim meeting

PURPOSE: To evaluate the acceptance rate and motivation for acceptance of hepatitis B virus (HBV) vaccine among pre-clinical medical and physician assistant (PA) students in comparison with similar data obtained from resident and staff physicians. METHODS: A cross-sectional survey of all second-year medical and PA students (n=170) at the University of Iowa College of Medicine was conducted in Spring 1992, requesting demographic data, preventive health measure use, and reasons for HBV vaccine acceptance. Responses were compared with data obtained from resident and staff physicians during a concurrent hospital-wide survey. Rates of vaccine acceptance and use of other preventive health measures were compared across the physician groups. Factor analysis was performed to examine reasons for vaccine acceptance among the students. RESULTS: The questionnaire was completed by 162 of the 170 students (95%). Nearly all (99%) of the eligible students had received at least one dose of the HBV vaccine. Vaccine acceptance rates were significantly higher among the students than among either the resident or the staff physicians (p=0.003, p<0.0001, respectively). Influenza vaccine acceptance and seat belt use were significantly higher among the resident and staff physicians than they were among the students. The students attributed their high HBV vaccine acceptance rate to the recommendations of authority figures. Threat of illness and issues of vaccine safety and efficacy were relatively unimportant among the students, though the residents and staff physicians reported threat of illness to be an important motivator for vaccination. CONCLUSIONS: Excellent HBV vaccine acceptance rates may be achieved among preclinical medical and PA students. Recommendations of authority figures are important motivators for HBV vaccine acceptance among students. Presented in part at the annual meeting of the Society for Hospital Epidemiology of America, New Orleans, LA, March 20–22, 1994. Dr. Doebbeling is the recipient of a Special Emphasis Research Career Award (SERCA), grant number 1 KO1 OH00131-01, from the National Institute for Occupational Safety and Health (NIOSH). The contents of this article are solely the responsibility of the authors and do not necessarily represent the official views of NIOSH.