National decision-making for the introduction of new vaccines: A systematic review, 2010–2020

BackgroundCompeting priorities make using a transparent and evidence-based approach important when deciding to recommend new vaccines. We conducted a literature review to document the processes and frameworks for national decision-making on new vaccine introductions and explored which key features have evolved since 2010.MethodsWe searched literature published on policymaking related to vaccine introduction from March 2010 to August 2020 in six databases. We screened articles for eligibility with the following exclusion criteria: non-human or hypothetical vaccines, the sole focus on economic evaluation or decision to adopt rather than policy decision-making. We employed nine broad categories of criteria from the 2012 review for categorization and abstracted data on the country, income level, vaccine, and other relevant criteria.ResultsOf the 3808 unique references screened, 116 met eligibility criteria and were classified as: a) framework of vaccine adoption decision-making (27), b) studies that analyse empirical data on or examples of vaccine adoption decision-making (45), c) theoretical and empirical articles that provide insights into the vaccine policymaking process (44 + 17 already included in the previous categories). Commonly reported criteria for decision-making were the burden of disease; vaccine efficacy/effectiveness, safety; impact on health and non-health outcomes; economic evaluation and cost-effectiveness of alternative interventions. Programmatic and acceptability aspects were not as often considered. Most (50; 82%) of the 61 articles describing the process of vaccine introduction policymaking highlighted the role of country, regional, or global evidence-informed recommendations and a robust national governance as enabling factors for vaccine adoption.ConclusionsThe literature on vaccine adoption decision-making has expanded since 2010. We found that policymakers and expert advisory committee members (e.g., National Immunization Technical Advisory Group [NITAG]) increasingly value the interventions based on economic evaluations. The results of this review could guide discussions on evidence-informed immunization decision-making among country, sub-regional, and regional stakeholders.     

蚤类的种间杂交及其分类学意义 (一)曲棘新蚤×思博新蚤

作者以曲棘新蚤（ＮｅｏｐｓｙｌａｔｅｒａｔｕｒａＲｏｔｈｓｃｈｉｌｄ，１９１３）和思博新蚤（Ｎ．ｓｉｂｏｉＹｅｅｔＹｕ，１９９３）为亲本进行了杂交试验。亲本蚤自新疆野外采集，在实验室饲养两代以上纯化后用于杂交试验。两种蚤的饲养器具完全分开，采用平皿湿滤纸法培育蚤的裸蛹，并在蛹期即将雌雄分开，以保证同种蚤亲代两性间无交配。设正交、反交、子代自交和回交四种组合。以能产生Ｆ２以上杂种者为杂交可育，否则为杂交不育。以雄性第９腹板后臂鬃的形态、可动突形状及第８腹板后缘鬃序为判定杂交后代归属的形态学特征。杂交结果表明，两亲本蚤杂交可育，产生了Ｆ２以上杂种。在正交Ｆ１和Ｆ２、反交Ｆ１以及回交子代中均出现了两亲本蚤形态特征之间的中间型个体，说明两亲本蚤间并不存在生殖隔离，它们实际上是同一个物种。本次试验的结果提示，目前蚤类分类工作中的传统的方法和标准有待通过遗传学试验及现代生物技术方法加以修正和完善。     

The efficacy and safety of traditional Chinese medicine Guilu Erxian Jiao in the treatment of knee osteoarthritis: A systematic review and meta-analysis

ObjectiveA systematic review was conducted to investigate the efficacy of Guilu Erxian Jiao (GEJ) in the treatment of knee osteoarthritis (OA).MethodsWe searched PubMed, MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, Chinese Electronic Periodical Services, and ClinicalTrials.gov to identify relevant randomized controlled trials or controlled clinical trials, from the inception of each source to April 20, 2021. Primary outcome included overall efficacy, pain score, and Lequesne index score; secondary outcome included adverse events. Methodological quality was assessed using the Cochrane risk of bias tool (RoB 1.0). The meta-analysis was performed based on a random-effects model due to anticipated clinical heterogeneity. The grading of overall evidence was assessed using the GRADE system. The study protocol was registered on PROSPERO (CRD42021233573).ResultsEight studies were included. Compared to controls, GEJ exhibited superior overall efficacy for treating OA (risk ratio (RR) = 1.20; 95% confidence interval (CI) = 1.06–1.35). Regarding pain score, there was no statistical difference between GEJ and controls (standardized mean difference (SMD) = 0.27; 95% CI = −0.91 – 1.46). No significant difference was found in Lequesne score between GEJ and controls (MD = −0.25; 95% CI = −0.52 – 0.01). No statistical difference in adverse reactions was observed between GEJ and controls (risk difference (RD) = −0.01; 95% CI = −0.05–0.03).ConclusionOur findings suggest that GEJ may have positive effects on overall efficacy in treating OA. However, there is insufficient evidence regarding pain score, Lequesne score, and knee joint function score.     

Creative versus repetitive dance therapies to reduce the impact of fibromyalgia and pain: A systematic review and meta-analysis

Background and purposePhysical exercise is one of the most effective interventions to reduce fibromyalgia symptoms. Previous studies have reported benefits of dance-based intervention on the fibromyalgia impact, health-related quality of life and pain, regardless the interventions were based on creative- or repetitive dance. This study aimed to compare the effectiveness of creative and repetitive dance interventions.MethodsPRISMA guidelines were followed in this systematic review. The Cochrane Library, PubMed, Trip, Google Scholar, Web of Science (WOS), Embase and Scopus databases were selected to identify potential articles. Studies were included if they met the following inclusion criteria: to be a clinical trial or a randomized controlled trial, include people with fibromyalgia, have a comparison group and evaluate the impact of the disease, pain or quality of life. Fifteen articles fulfilled the inclusion criteria. The methodological quality of the studies was assessed using the Cochrane Collaboration's tool.ResultsDance-based interventions significantly reduced fibromyalgia impact (standardized mean difference = −0.69), pain (standardized mean difference = −0.70 and increased quality of life (standardized mean difference = 0.43) of people with fibromyalgia. The effectiveness of dance interventions is increased when a creative component is added, since it can lead to higher improvements in pain, impact of the disease and improving quality of life.ConclusionDance-based interventions are significantly effective in reducing the impact of fibromyalgia, pain as well as increasing health-related quality of life. Subgroup analyses suggest that creative dance-based interventions could be more effective than repetitive dance-based interventions to reduce pain and fibromyalgia impact. However, results must be taken with caution due to the large heterogeneity and the small number of articles.     

谷氨酸转运体、谷氨酸/胱氨酸转运体与谷氨酸神经细胞毒作用

谷氨酸转运体与谷氨酸／胱氨酸转运体在脑缺血疾病中起重要作用，谷氨酸转运体的结构或功能改变可使细胞间隙的谷氨酸浓度急剧升高，激活NMDA受体产生一系列的表现，同时抑制谷氨酸／胱氨酸转运体对胱氨酸的摄取，介导谷胱苷肽耗竭、氧自由基升高、胞内钙升高、线粒体损伤、细胞色素c释放等神经细胞毒环节，激活半胱天冬酶诱导凋亡。可进一步加重谷氨酸的神经细胞毒作用。     

从系统性看肿瘤发生与治疗

系统论是当今人们认识事物的重要理论和方法。本文从系统论的基本观点入手，以“基因决定论”为论点，用系统思维、系统方法来分析肿瘤的发生与肿瘤的基因治疗及肿瘤综合治疗，以阐明肿瘤的发生发展是一个多因素、多步骤的过程，是机体各系统功能紊乱、失衡的结果，因此，对肿瘤的治疗必须从系统和整体考虑，以期达到最佳治疗效果。强调系统性思维及方法在医学工作中的重要性。     

微脉冲半导体激光的临床应用现状

微脉冲半导体激光是一种阈下光凝技术 ,它能选择性地作用于视网膜色素上皮细胞 ,避免损伤视网膜神经层 ,在产生治疗作用的同时最大限度地保持视功能 ,对治疗黄斑水肿、中心性浆液性脉络膜视网膜病变 (中浆 )和玻璃膜疣具有较好的疗效。本研究阐述了微脉冲半导体激光的原理、临床应用及激光光凝斑检测等方面的进展。     

运用系统聚类法综合评价农村社区卫生服务中心功能

目的综合评价农村社区卫生服务功能。方法系统聚类分析。结果把58个乡镇分成好、中、差3类。结论转变农村乡镇卫生院服务模式,从社区卫生服务的医疗、预防、康复、保健、健康教育和计划生育指导六位一体功能出发,协调发展,全方位提高农村社区卫生服务功效。     

不同剂量和用药途径对早期妊娠药物流产效果影响的系统评价

目的:用循证医学的方法评价米非司酮配伍米索前列醇不同剂量、不同用药方法终止早孕药物流产的有效性。方法:计算机检索8个数据库、手工检索9种期刊,并追查参考文献,纳入国内外前瞻性临床对照试验,至少由两人独立评估文献质量和资料提取。数据分析采用软件Revman4.2完成。在异质性检验(P=0.05)后,无异质性者采用固定效应模型合并分析;有异质性者则分析异质性原因,并用敏感性分析、亚组分析或随机效应模型处理。结果:米非司酮<150mg组与150～200mg组的完全流产率、流产失败率和孕囊排除时间的差异均无统计学意义;米索前列醇口服组完全流产率低于阴道用药组,不完全流产率和流产失败率高于阴道用药组。结论:进一步减少米非司酮量(150mg)可能可行,需要深入研究米非司酮最低有效剂量。米索前列醇口服比阴道用药流产效果稍差,但口服用药更方便。