Impact of a multi-component immunization intervention on pneumococcal and herpes zoster vaccinations: A randomized controlled trial of community pharmacies in 2 states

BackgroundThe purpose of this study was to assess the impact of the We Immunize Program on structures, processes, and outcomes of pneumococcal and herpes zoster pharmacy-based immunization services.MethodsPharmacy-technician pairs from 62 Alabama and California community pharmacies participated in a 6-month randomized controlled trial (intervention = 30/control = 32). All received immunization update training; intervention participants also received practical strategies training and monthly telephonic expert feedback. Completion of immunization service structure and process activities were analyzed using Fisher's Exact and one-way Mann-Whitney U tests. The primary outcome, change in number of pneumococcal, herpes zoster, and total vaccine doses administered, was assessed using one-way Wilcoxon signed rank and Mann-Whitney U tests. Associations between program and vaccine doses across time were explored using generalized estimating equations (GEE).ResultsIntervention pharmacies completed more structure (median 12.00 versus 9.00, p = 0.200) and process activities (median 8.00 versus 7.00, p = 0.048) compared to control. Statistically significant increases in the median number of pneumococcal vaccine doses (7.50–12.00 doses, p = 0.007), and total vaccine doses (12.50–28.00 doses, p = 0.014) were seen from baseline to post-intervention within the intervention group. However, these changes were not statistically significant when compared to the control group (pneumococcal p = 0.136, total p = 0.202). Changes in median herpes zoster vaccine doses did not reach significance among intervention (8.50–9.00, p = 0.307) or control (9.00–13.00, p = 0.127) pharmacies.ConclusionsPractical strategies training combined with tailored expert feedback enhanced existing pneumococcal immunization services in community pharmacies.Clinical trial registrationClinicalTrials.gov identifier: NCT02615470.     

银杏酸C17:1衍生物增效达托霉素抗粪肠球菌的发现与机制的初步研究

目的 发现有抗菌活性或是增效活性的银杏酸C17:1衍生物。方法 以银杏酸C17:1为底物，利用一些基团取代苯环上的羧基从而获得银杏酸C17:1衍生物，棋盘法设计试验，测定银杏酸C17:1及其衍生物联合抗生素的增效作用，通过测定Zeta电位、ROS、NPN吸收来探究增效机制。结果 银杏酸C17:1衍生物Ⅱ与达托霉素联合抗粪肠球菌的部分抑菌浓度指数(FICIs)为0.125~0.25，具有明显的协同效应，不仅能产生较高的活性氧，而且能在一定程度改变细胞膜的通透性。结论 银杏酸衍生物Ⅱ对达托霉素体外抗耐药株具有较好的增效作用，可能和ROS的激增以及膜通透性的改变有关。     

微型种植体支抗与口外弓支抗对安氏Ⅱ类1分类错牙合畸形患者的矫治效果对比分析

目的:分析比较微型种植体支抗与口外弓支抗对安氏Ⅱ类1分类错牙合畸形患者的矫治效果。方法:收集笔者医院95例安氏Ⅱ类1分类错牙合畸形患者临床资料,根据其治疗方法将之分为口外弓支抗(MIA组)46例和微型种植体支抗组(HGA组)49例,比较其矫正前后头影测量结果和模型测量结果,矫治时间和不良反应。结果:治疗后,MIA组牙合平面与SN平面夹角(OP-SN)、上颌中切牙牙长轴与SN平面夹角(U1-SN)、上唇突度、下唇突度、上唇最凸点至E线垂直距离(E line-UL)、下唇最凸点至E线垂直距离(E line-LL)、覆牙合(OB)、覆盖(OJ)均小于HGA组(P<0.05),矫治时间短于HGA组(P<0.05),总不良反应发生率与HGA组差异无统计学意义(P>0.05)。结论:对比HGA,MIA对安氏Ⅱ类1分类错牙合畸形患者的矫治效果更佳,且能够缩短矫治时间。     

中西医结合护理干预妊娠晚期合并急性单纯性阑尾炎患者的临床观察

目的:探讨中西医结合护理干预妊娠晚期合并急性单纯性阑尾炎的临床疗效。方法:将2017 年9 月—2018 年12月于我院接受中西医结合保守治疗的31 例妊娠晚期合并急性单纯性阑尾炎患者作为研究对象，按随机数表法随机分为中西医结合护理组(观察组16 例)与常规护理组(对照组15 例)，对照组采取常规护理措施，观察组在对照组的基础上增加中西医结合护理措施，对比两组患者的临床疗效。结果:观察组患者的心理状态变化、新生儿体质状况以及临床疗效等指标等情况均明显优于对照组，且组间对比差异显著有统计学意义(P ＜ 0.05)。结论:中西医结合护理对妊娠晚期合并急性单纯性阑尾炎有较好的临床效果，可减少、甚至避免孕妇因合并急性阑尾炎而造成的打击和创伤。     

The introduction of BCG vaccination to neonates in Northern Sweden, 1927–31: Re-analysis of historical data to understand the lower mortality among BCG-vaccinated children

BackgroundFollowing the introduction of oral Bacille Calmette-Guérin (BCG) a century ago, Albert Calmette suggested that BCG both provided protection against death from tuberculosis (TB) and other causes. The findings were not pursued. Today, there is considerable evidence that intradermal BCG have beneficial non-specific effects (NSEs). We re-analyzed data from BCG’s introduction 1927–1931 in Sweden hypothesizing that BCG reduced infectious deaths.MethodsIn three papers published by Dr Carl Näslund, the progress of oral neonatal BCG rollout provided free-of-charge and the effects on child mortality in the highly TB-prevalent region Norrbotten was sequentially updated. We analyzed cause-specific post-neonatal mortality by vaccination status excluding deaths from congenital conditions. Due to apparent differences in effects during study years, effects were assessed overall and separately in two periods (1927–1929, 1930–1931).ResultsAccording to Näslund, TB households were slightly more likely to accept vaccination; fewer newborns that were sick or had congenital problems were vaccinated. BCG coverage was 28.3% (5659/20,012); 8.7% (1746/20,012) died. The BCG/unvaccinated Risk Ratio (RR) of post-neonatal childhood death was 0.53 (0.45–0.62). BCG was associated with 80% (49–92%) reduced mortality from TB. From 1927 to 29, BCG appeared to protect strongly against deaths from all diseases, including the non-infectious, RR = 0.09 (0.02–0.36), presumably reflecting selection bias. From 1930 to 1931, there was no protection against non-infectious deaths, RR = 0.92 (0.49–1.70) indicating less bias (p = 0.004 for same effect). During 1930–1931, BCG was associated with reductions in non-TB infectious deaths (RR = 0.75 (0.58–0.97)); 2/3 were caused by respiratory infections, against which the BCG/unvaccinated RR was 0.61 (0.43–0.84). Other causes of death were less frequent and provided no clear pattern, except that BCG was associated with more meningitis deaths, RR = 6.85 (2.20–21.4).ConclusionHealthy vaccinee bias, particularly in 1927–1929, resulted in strongly beneficial overall BCG effects. However, the 1930–1931 data provided some support that BCG both protected against TB deaths and deaths from respiratory infections.     

糖皮质激素受体 GRα／GRβ在慢性鼻－鼻窦炎治疗中的作用

目的:探讨糖皮质激素受体GRα/GRβ在慢性鼻-鼻窦炎治疗中的作用。方法:本研究共纳入2013年5月至2015年5月在上海交通大学医学院附属瑞金医院耳鼻咽喉科行鼻内镜手术治疗的慢性鼻-鼻窦炎患者150例,根据治疗效果分为有效组和无效组,通过免疫组织化学方法检测糖皮质激素受体GRα和GRβ在慢性鼻-鼻窦炎鼻息肉组织中的表达情况,同时选取无鼻-鼻窦炎及变应性疾病史患者中鼻甲黏膜作为阴性对照。分析GRα和GRβ表达水平与Lund and Kennedy内镜评分和生活质量评价的相关性。结果:在有效组、无效组和对照组的鼻黏膜(鼻息肉)中均有较高程度的GRα阳性细胞的表达,各组间的GRα积分无统计学意义;另外,有效组和无效组的GRβ积分均明显高于对照组,有效组GRβ积分明显低于无效组,两两比较,其差异均具有统计学意义(P<0.01)。相关性分析显示,将150例患者GRα的表达与Lund and Kennedy内镜评分无明显相关性,而GRβ的表达与Lund and Kennedy内镜评分呈现正相关。另外,GRα的表达与术后VAS评分、SNOT-20评分及SF-36评分之间无明显的相关性,而GRβ的表达与术后VAS评分和SNOT-20评分均呈正相关,而与术后SF-36评分无明显相关性。结论:GRβ的高表达可能是导致慢性鼻-鼻窦炎患者临床疗效不佳的重要因素。     

Relation between active mediation,exposure to Daniel Tiger’s Neighborhood,and US preschoolers’ social and emotional development

This study explored the relationship between active mediation, exposure to Daniel Tiger’s Neighborhood, and key indicators of preschoolers’ social and emotional development. One hundred and twenty-seven children aged 2–6 either watched or did not watch 10 episodes of Daniel Tiger’s Neighborhood over a two-week period. Results revealed that preschoolers who watched the program exhibited higher levels of empathy, self-efficacy, and emotion recognition when their regular TV-watching experiences are frequently accompanied by active mediation. This was especially true for younger preschoolers and preschoolers from low-income families. Implications for policy-makers, parents, producers of prosocial programming, and educators are discussed.