Seven-Valent Pneumococcal Conjugate Vaccine and Nasopharyngeal Microbiota in Healthy Children

Seven-valent pneumococcal conjugate vaccine (PCV-7) is effective against vaccine serotype disease and carriage. Nevertheless, shifts in colonization and disease toward nonvaccine serotypes and other potential pathogens have been described. To understand the extent of these shifts, we analyzed nasopharyngeal microbial profiles of 97 PCV-7–vaccinated infants and 103 control infants participating in a randomized controlled trial in the Netherlands. PCV-7 immunization resulted in a temporary shift in microbial community composition and increased bacterial diversity. Immunization also resulted in decreased presence of the pneumococcal vaccine serotype and an increase in the relative abundance and presence of nonpneumococcal streptococci and anaerobic bacteria. Furthermore, the abundance of Haemophilus and Staphylococcus bacteria in vaccinees was increased over that in controls. This study illustrates the much broader effect of vaccination with PCV-7 on the microbial community than currently assumed, and highlights the need for careful monitoring when implementing vaccines directed against common colonizers.     

Effects of writing down the request for help: A randomized controlled trial

Background: Studies investigating interventions, aimed at improving patient satisfaction by exploring the patient's request for help, show conflicting results.

Objectives: To investigate whether writing down the request for help on a request card, prior to the consultation improves patient satisfaction.

Methods: This study was a single-blind randomized controlled trial, in which the patients were blinded to the intervention. Patients were recruited in two rural practices (five GPs) and one urban practice (four GPs) in The Netherlands. Consecutive patients with a new request for help were asked to participate. All patients received general information about patient satisfaction. After randomization, patients in the intervention group were asked to fill in a card with their request(s) for help; the general practitioners started the consultations with these questions. We used the ‘Professional Care’ subscale of the Consultation Satisfaction Questionnaire (CSQ) to examine the effect of the intervention on patient satisfaction. Secondary outcomes were patient satisfaction measured with the patient's VAS score, the GP's VAS score on satisfaction, consultation time, the other subscales of the CSQ, and the number of consultations during follow-up.

Results: There was no difference in patient satisfaction (CSQ, VAS) between both groups. We also did not find any differences between the other subscales of the CSQ.

Conclusion: A beneficial effect of the use of a ‘request card’ by the patient on patient satisfaction of the consultation could not be demonstrated.     

A Randomized Controlled Trial of a Community-Based Nutrition Education Program for Low-Income Parents

ObjectiveAssess effectiveness of the Expanded Food and Nutrition Education Program on nutrition behaviors post-education and longitudinally.DesignSwitching replications randomized experimental design. Participants randomly assigned to immediate education (IE) or delayed education (DE). Participants in IE received intervention the first 8 weeks, and those in DE the second 8 weeks, with no intervention during alternate periods. Data were collected in 3 repeated measures.ParticipantsParents (n = 168 randomized; n = 134 completed) of children in 2 Head Start and 6 low-income schools.InterventionEight weekly workshops, based on Eating Right is Basic-Enhanced adapted to incorporate dialogue approach with experiential learning.Main Outcome MeasuresTen-item self-reported behavior checklist on nutrition, food resource management, food safety, and food security; responses on a 5-point scale reporting frequency of behavior.AnalysisChi-square, analysis of variance, and multiple regression.ResultsGroups were demographically similar. Both groups reported improved behaviors pre- to post-education (P < .05). There was no significant difference between groups at Time 1 (T1) or DE control period (T1 vs T2). Changed IE behavior was retained T2 to T3. A multiple regression model of overall change, controlling for T1 score and educator, showed significant improvement (n = 134, β = 5.72, P < .001).Conclusions and ImplicationsPositive outcomes were supported by this experimental study in a usual program context, with reported behavior changes retained at least 2 months.     

独活寄生汤治疗类风湿性关节炎临床疗效的meta分析

目的系统评价独活寄生汤治疗类风湿性关节炎（RA）的有效性,为临床应用和进一步研究提供参考依据。方法在万方医学网、重庆维普网和中国知网数据库,以＂独活寄生汤＂和＂类风湿关节炎＂为并列检索词,检索应用独活寄生汤治疗RA的随机对照临床试验文献,时间区间设定为1999年1月—2014年4月。按照Cochrane系统评价手册推荐的简单评价法,评价纳入研究的方法学质量,软件版本为Rev Man 5.2,采用优势比指标进行meta分析。结果共有7个应用独活寄生汤治疗RA的随机对照临床试验文献,文献中累计观察类风湿关节炎患者542例。meta分析结果显示,OR值为4.29,95%CI为（2.55,7.20）,整体效果检验Z为5.51,P〈0.01。结论与对照组相比,独活寄生汤治疗RA在治疗效果方面较好,是一种比较安全的药物。受到纳入研究的文献数量和质量的限制,效果评定可能存在小部分偏倚,尚需要高质量的随机双盲试验继续验证。     

硝苯地平和坦索罗新治疗下段输尿管结石的meta分析

目的比较硝苯地平与坦索罗新两种药物在药物排石治疗中的疗效及安全性。方法计算机检索Pubmed、Cochrane和Embase等数据库,查找所有比较硝苯地平与坦索罗新治疗下段输尿管结石的临床随机对照试验（RCT）,检索时限为建库至2014年1月16日。同时手检纳入文献的参考文献。按纳入排除标准由两人独立进行RCT的筛选、资料提取和质量评价后,采用Rev Man 5.2软件进行meta分析,并采用证据质量分级和推荐强度（GRADE）系统进行证据质量评价。结果共纳入5个研究,3 708例患者。meta分析结果显示：1在有效性方面：5个研究均比较了排石率,坦索罗新组排石率高于硝苯地平组,差异有统计学意义（RR为0.77,95%CI为0.75-0.80,P=0.02）。4个研究比较了排石时间（d）,其中1个研究显示两者差异无统计学意义（P=0.2）,另外3个研究均显示两者差异有统计学意义（均P〈0.01）,坦索罗新组排石时间较硝苯地平组短。5个研究均比较了镇痛效果,其中1个研究显示两者双氯芬酸使用剂量差异无统计学意义（P〉0.05）,另外4个研究均显示两者治疗双氯芬酸使用剂量差异有统计学意义（P〈0.01）。2在安全性方面：两组在轻微不良反应发生率和严重不良反应发生率上差异均无统计学意义（RR为1.61,95%CI为0.59-4.38,P=0.35;RR为0.43,95%CI为0.06-2.89,P=0.38）。结论硝苯地平跟坦索罗新相比,坦索罗新组排石率高于硝苯地平组,而两者不良反应发生率相似;此外,坦索罗新组在缩短排石时间和减少镇痛剂使用量方面优于硝苯地平组。下段输尿管结石的药物治疗首选坦索罗新。     

A New Measure for Monitoring Intraoperative Somatosensory Evoked Potentials

ObjectiveTo propose a new measure for effective monitoring of intraoperative somatosensory evoked potentials (SEP) and to validate the feasibility of this measure for evoked potentials (EP) and single trials with a retrospective data analysis study.MethodsThe proposed new measure (hereafter, a slope-measure) was defined as the relative slope of the amplitude and latency at each EP peak compared to the baseline value, which is sensitive to the change in the amplitude and latency simultaneously. We used the slope-measure for EP and single trials and compared the significant change detection time with that of the conventional peak-to-peak method. When applied to single trials, each single trial signal was processed with optimal filters before using the slope-measure. In this retrospective data analysis, 7 patients who underwent cerebral aneurysm clipping surgery for unruptured aneurysm middle cerebral artery (MCA) bifurcation were included.ResultsWe found that this simple slope-measure has a detection time that is as early or earlier than that of the conventional method; furthermore, using the slope-measure in optimally filtered single trials provides warning signs earlier than that of the conventional method during MCA clipping surgery.ConclusionOur results have confirmed the feasibility of the slope-measure for intraoperative SEP monitoring. This is a novel study that provides a useful measure for either EP or single trials in intraoperative SEP monitoring.     

Anti-angiogenesis in prostate cancer： knocked down but not out

Angiogenesis is a very complex physiological process, which involves multiple pathways that are dependent on the homeostatic balance between the growth factors （stimulators and inhibitors）. This tightly controlled process is stimulated by angiogenic factors, which are present within the tumor and surrounding tumor-associated stromal cells. The dependence of tumor propagation, invasion and metastasis on angiogenesis makes the inhibitors of new blood vessel formation attractive drugs for treating the malignancies. Angiogenesis can be disrupted by several distinct mechanisms： by inhibiting endothelial cells, by interrupting the signaling pathways or by inhibiting other activators of angiogenesis. This strategy has shown therapeutic benefit in several types of solid tumors, leading to Food and Drug Administration （FDA） approval of anti-angiogenic agents in the treatment of kidney, non-small cell lung, colon and brain cancers. Although no angiogenesis inhibitors have been approved for patients with metastatic prostate cancer, therapies that target new blood vessel formation are still an emerging and Dromising area of prostate cancer research.     

不同器械经脐单切口与三孔腹腔镜胆囊切除术的前瞻性随机对照研究

目的比较不同器械经脐单切口与三孔腹腔镜胆囊切除术的安全性、手术效果。方法选取2011年9月～2012年6月胆囊切除术150例,随机分为3组：A组行经脐单切口腹腔镜胆囊切除术（可转腕器械）;B组行经脐单切口腹腔镜胆囊切除术（普通器械）;C组行三孔腹腔镜胆囊切除术。比较手术时间、术中出血量、术后疼痛、满意程度、C反应蛋白、免疫球蛋白及T淋巴细胞亚群等损伤指标。结果中位手术时间A组40min和B组37．5min显著长于C组25min（X2=25．165,P=0．000;X2=16．184,P=0．000）,但A、B2组无统计学差异（X2=0．987,P=0．610）。中位术中出血量A组10．0ml和B组10．0ml显著多于C组7．5ml（X2=12．571,P=0．002;X2=13．619,P=0．001）,但A、B2组无统计学差异（X2=0．021,P=0．989）。3组术后疼痛评分、满意程度、创伤及对免疫系统影响均无差异（P〉0,05）。发生并发症4例,其中胆漏3例（B组1例,C组2例）,术中胆道损伤l例（B组）,A组未发生并发症。结论SILC是一种兼顾安全与美观的胆囊切除术式,可转腕器械使SILC更具安全性。     

Early filiform needle acupuncture for poststroke depression: a meta-analysis of 17 randomized controlled clinical trials

OBJECTIVE: To evaluate the effectiveness and safety of filiform needle acupuncture for poststroke depression, and to compare acupuncture with the therapeutic efficacy of antidepressant drugs. DATA RETRIEVAL: We retrieved data from the Chinese National Knowledge Infrastructure(1979–2012), Wanfang(1980–2012), VIP(1989–2012), Chinese Biomedical Literature(1975–2012), PubMed(1966–2012), Ovid Lww(–2012), and Cochrane Library(–2012) Database using the internet. SELECTION CRITERIA: Randomized controlled trials on filiform needle acupuncture versus antidepressant drugs for treatment of poststroke depression were included. Moreover, the included articles scored at least 4 points on the Jadad scale. Exclusion criteria: other acupuncture therapies as treatment group, not stroke-induced depression patients, score 4 points, non-randomized controlled trials, or animal trials. MAIN OUTCOME MEASURES: These were the Hamilton Depression Scale scores, clinical effective rate, Self-Rating Depression Scale scores, Side Effect Rating Scale scores, and incidence of adverse reaction and events. RESULTS: A total of 17 randomized controlled clinical trials were included. Meta-analysis results displayed that after 4 weeks of treatment, clinical effective rate was better in patients treated with filiform needle acupuncture than those treated with simple antidepressant drugs [relative risk = 1.11, 95% confidence interval(CI): 1.03–1.21, P = 0.01]. At 6 weeks, clinical effective rate was similar between filiform needle acupuncture and antidepressant drug groups. At 2 weeks after filiform needle acupuncture, Hamilton Depression Scale(17 items) scores were lower than in the antidepressant drug group(mean difference =-2.34, 95%CI:-3.46 to-1.22, P 0.000,1). At 4 weeks, Hamilton Depression Scale(24 items) scores were similar between filiform needle acupuncture and antidepressant drug groups. Self-Rating Depression Scale scores were lower in filiform needle acupuncture group than in the antidepressant drug group. Side Effect Rating Scale was used in only two articles, and no meta-analysis was conducted. Safety evaluation of the 17 articles showed that gastrointestinal tract reactions such as nausea and vomiting were very common in the antidepressant drug group. Incidence of adverse reaction and events was very low in the filiform needle acupuncture group. CONCLUSION: Early filiform needle acupuncture for poststroke depression can perfectly control depression. Filiform needle acupuncture is safe and reliable. Therapeutic effects of filiform needle acupuncture were better than those of antidepressant drugs.     

定压控制通气模式下有创呼吸机峰值压力差异对重症患者的潜在风险分析

目的：通过测试分析不同品牌型号的有创呼吸机在定压控制通气模式下的气道峰压,揭示其气道峰压的差异以及由此可能对重症患者造成的潜在威胁。方法：利用呼吸阻力和顺应性可调的成人模拟肺作为有创呼吸机的负载,测试各品牌型号呼吸机在定压控制通气模式下的气道峰压。结果：通过分析发现,各品牌型号有创呼吸机其气道峰压在定压控制通气模式下存在差异。结论：对重症患者而言,如果忽视各品牌型号有创呼吸机之间的气道峰压差异,将有可能对重症患者造成潜在威胁。