Which children and adults should receive the chickenpox vaccine?

Chickenpox vaccine is safe and effective and elicits long-standing immunity. Primary care physicians caring for children and adults should be aware of its benefits.     

Obesity: Which drug and when?

BACKGROUND: Obesity, with all its consequences, is audaciously confronting medical professionals and health service providers worldwide. Diet and exercise intervention is an essential part of any weight management strategy, but may not succeed in isolation. Effective approaches for routine practice are more likely to involve affordable, efficacious and well-tolerated drug therapy than the more expensive, case selective approach of bariatric surgery. OBJECTIVES AND CONCLUSIONS: Advancement of pharmacotherapy is expanding the battery of available drugs; the clinician is faced with an increasingly complex therapeutic decision. Which drug to use, and when, is influenced by a range of factors, discussed here. There is a large body of high quality evidence in the literature to support the presently available drugs; however, many questions remain unanswered including duration of therapy and whether longer-term goals of improved morbidity and mortality are achievable. Clinician and patient awareness of these issues will provide a more informed therapeutic decision and ultimately improve the potential for reaching the weight management targets.     

Which comes first: the antigen or the adjuvant?

Recent attempts to develop an HIV-1 vaccine indicate that viral replication can be limited by the induction of viral-specific T cell responses; however, recent trials of vaccine candidates designed to target CD8⁺ T cell responses were unsuccessful. In this issue, Sui and colleagues used a nonhuman primate model to investigate the effect of various vaccine adjuvants on the efficacy of SIV immunization. Unexpectedly, Sui et al. discovered that animals given adjuvant alone in the absence of SIV antigen exhibited a pronounced decrease in viral load following viral challenge. Vaccination with viral antigens combined with adjuvant correlated with the expansion of a population of cells with similarity to myeloid-derived suppressor cells (MDSCs) that may have suppressed vaccine-elicited T cell responses. Together, these results suggest that both innate and adaptive vaccine-elicited immune responses will need to be considered in future HIV-1 vaccine development.The HIV-1 vaccine field has debated the importance of eliciting strong functional antibody responses to prevent viral invasion of target cells versus eliciting potent T cell responses to kill virus-infected cells. This debate has converged on the consensus that both arms of the immune response will likely be necessary to achieve effective HIV-1 vaccination (1, 2). Additionally, the field has turned toward investigating TLR agonists and other adjuvants to enhance dendritic cell antigen presentation and augment vaccine-elicited responses (3–8). Despite repeated attempts to produce an efficacious HIV-1 vaccine, our knowledge of the adjuvant-specific impact on both the humoral and cellular arms of vaccine-elicited immune responses is still nascent. Moreover, the necessity of HIV-1 vaccine candidates to engage the innate immune system is an ongoing area of investigation (9, 10).     

Is the way to man's heart (and lung) through the abdomen?

Intra-abdominal hypertension is increasingly recognized to be both prevalent and clinically important in medical and surgical intensive care units. Intra-abdominal pressure (IAP) can impact organ function throughout the body, and it can also complicate standard measurements used in intensive care units. The article by Krebs and colleagues reports the effect of IAP on respiratory function, gas exchange and hemodynamic function. Their results show a relatively small effect of modestly elevated IAP on these variables in their patient population. However, their work raises several questions for clinicians and researchers regarding the pathophysiology and management of IAP.     

Is the scientific publishing of complementary and alternative medicine objective?

Bias expressed by conventional journals against the field of "alternative," "integrative," or "complementary" medicine has been said to drive the appearance of new journals dedicated to this field. We examined two examples of recent articles on complementary and alternative medicine that appeared in two major medical journals in 1998. One is an editorial on the risks of alternative medicine, published in The New England Journal of Medicine and the other is a study on Therapeutic Touch, published in the Journal of the American Medical Association. We evaluated whether information and opinions presented in this editorial and article are objective or not. We found that these examples reflect, at best, misinformation or misunderstanding of the field, or at worst, disingenuousness. We consider the possibility that this apparent bias may be due to the fact that some of the concepts implicit in alternative medicine are outside the current biomedical framework. Yet, it is only by exploring knowledge outside the boundaries of existing dogmas that real (as opposed to incremental) progress can occur.     

Atorvastatin Inhibits the HIF1α-PPAR Axis,Which Is Essential for Maintaining the Function of Human Induced Pluripotent Stem Cells

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Is the combination of remifentanil and propopfol suitable for transsphenoid resection of the hypophysis?

In a multi-center trial, the feasibility of combining remifentanil (RF) and target-controlled infusion of propofol (P) for patients undergoing transsphenoidal resection of the pituitary gland was tested. After IRB approval, 74 patients (29 male/45 female) were included in the study. The concentration of RF and the target concentration of P were recorded as were heart rate (HR) and mean arterial blood pressure (MAP). For intubation the RF dosage was 0.26 +/- 0.06 microgram.kg-1.min-1 and the target concentration of P was 3.16 +/- 0.63 micrograms.ml-1. After induction, HR and MAP decreased significantly. The painful events of the operation were preparation of the nasal mucous membrane and penetration of the sella turcica. By adjusting the RF dose to 0.31 +/- 0.09 microgram.kg-1. min-1 and the target concentration of P to 3.48 +/- 1.49 micrograms.ml-1, an increase of HR and MAP above initial values was avoided at this time. Hypotension and bardycardia were treated in eight patients (10.8%) with a vasopressor, in four patients (5.4%) with atropine and in four more patients (5.4%) with a combination of these drugs. Two patients (2.7%) needed antihypertensive therapy. The average time interval between the end of P-TCI and spontaneous breathing was 6 +/- 3 min (median 6 min) and till patients opened their eyes 9 +/- 4 min (median 9 min). After 13 +/- 4 min (median 13 min) the patients became orientated. The average doses of analgetics were 19.5 +/- 19.9 mg piritramide and 1.8 +/- 1.0 g metamizol during the first 12 hours postoperatively. Eight patients (10.8%) did not need any analgetics. We suggest that the combination of RF and P as a "fast track concept" can supplement the repertoire of anaesthetic managements used for transsphenoidal resection of the pituitary gland.