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Does compulsory vaccination limit personal freedom? Ethical issues 强制接种疫苗会限制人身自由吗?伦理问题
Pub Date : 2018-01-01 DOI: 10.21767/AMJ.2018.3462
M. Paternoster, R. Scotto, Faiza Saleem, A. Buonomo, N. S. Moriello, C. Casella, Emanuele Capasso, S. Nappa, I. Gentile, G. Borgia, V. Graziano
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引用次数: 0
Development of dengue vaccines 登革热疫苗的发展
Pub Date : 2018-01-01 DOI: 10.21767/amj.2018.3451
C. S. Lim, C. Poh
Background: Dengue virus (DENV) causes up to 390 million infections yearly, of which 96 million are clinically manifested. Approximately 500,000 people with severe dengue require hospitalization each year and there are at least 25,000 deaths among children from Asian and Latin American countries. DENV is endemic in more than 100 countries. Chemical and biological controls have been implemented in targeting Aedes aegypti and Aedes albopictus mosquitoes, but these control practices failed to stem the dengue transmission. As a result, dengue vaccine has become a potential option recommended by WHO to be implemented in dengue endemic regions. Currently, several vaccine candidates are being evaluated in clinical studies. Amongst the vaccine candidates, live attenuated vaccines (LAV) are the furthest along the development pipeline. The most advanced vaccine, CYD-TDV (Dengvaxia) has been licensed in 19 countries. Several other live attenuated vaccines, as well as DNA, subunit, inactivated virus, viral-vectored and subunit-based vaccines, are under development and evaluation in preclinical or clinical studies. Each of the live-attenuated vaccine candidates targets on molecular determinants of virulence in DENV, with the emphasis on attenuating the DENV and inducing a balanced tetravalent immune response against all the four dengue serotypes. Aims: This review presents several different vaccine approaches and their construction strategies, providing an insight into the development of future dengue vaccines such as live attenuated vaccines, DNA vaccines, sub-unit protein vaccines and viral vectored vaccines. Methods: Recent development status of dengue vaccine candidates was reviewed based on the published data and an online registry for clinical trials (ClinicalTrials.gov) which is run by the U.S. National Library of Medicine, National Institutes of Health. Results: Increasing burden of dengue necessitates the development of a safe and efficacious tetravalent dengue vaccine. Various vaccine strategies are being developed for disease prevention, each has its own strengths and limitations. Dengvaxia is a licensed dengue vaccine in 19 countries but it has been suspended in the Philippines in December 2017 due to its potential risks in children <9 years of age and seronegative vaccinees. TDV was able to elicit neutralizing antibodies as well as cross protective T cell responses against all four dengue serotypes and protected mice and nonhuman primates against challenge with wild type DENV. Seroconversion was achieved in both seronegative and seropositive adults and children <1.5 years of age with a single dose. TV003/TV005 was able to elicit multifunctional T cell response in addition to the humoral response. Seroconversion in 90 per cent of seronegative adults was observed with a single dose of TV005. However, eliciting a balanced immune response against all the four dengue serotypes remained the major impediment. Conclusion : Dengvaxia has been launched
背景:登革热病毒(DENV)每年导致多达3.9亿人感染,其中9600万人有临床表现。每年约有50万严重登革热患者需要住院治疗,亚洲和拉丁美洲国家的儿童中至少有25 000人死亡。DENV在100多个国家流行。已经针对埃及伊蚊和白纹伊蚊实施了化学和生物控制,但这些控制措施未能阻止登革热的传播。因此,登革热疫苗已成为世卫组织建议在登革热流行地区实施的一种潜在选择。目前,几种候选疫苗正在临床研究中进行评估。在候选疫苗中,减毒活疫苗(LAV)是开发管道中最长的。最先进的疫苗CYD-TDV(登卡夏)已在19个国家获得许可。其他几种减毒活疫苗以及DNA、亚基、灭活病毒、病毒载体和亚基疫苗正在临床前或临床研究中开发和评估。每种候选减毒活疫苗都针对DENV毒力的分子决定因素,重点是减毒DENV并诱导针对所有四种登革热血清型的平衡四价免疫反应。目的:本文综述了几种不同的登革热疫苗方法及其构建策略,为未来登革热疫苗如减毒活疫苗、DNA疫苗、亚单位蛋白疫苗和病毒载体疫苗的开发提供参考。方法:根据已发表的数据和临床试验在线注册表(ClinicalTrials.gov)对登革热候选疫苗的最新发展状况进行审查,该注册表由美国国立卫生研究院国家医学图书馆管理。结果:日益增加的登革热负担要求开发安全有效的登革热四价疫苗。目前正在制定各种预防疾病的疫苗战略,每种战略都有自己的长处和局限性。Dengvaxia是一种已在19个国家获得许可的登革热疫苗,但由于其对9岁以下儿童和血清阴性疫苗接种者的潜在风险,已于2017年12月在菲律宾暂停使用。TDV能够引发针对所有四种登革热血清型的中和抗体和交叉保护性T细胞反应,并保护小鼠和非人灵长类动物免受野生型DENV的攻击。在血清阴性和血清阳性的成人和<1.5岁的儿童中,单剂量均可实现血清转化。除了体液反应外,TV003/TV005还能引发多功能T细胞反应。用单剂TV005观察到90%的血清阴性成人血清转化。然而,激发针对所有四种登革热血清型的平衡免疫反应仍然是主要障碍。结论:Dengvaxia已在11个国家推出,但由于对幼儿的不良影响,它已在菲律宾被撤回。TDV和TV003/TV005等实验性疫苗是目前正在进行第三期临床试验的减毒活疫苗。持续的实地试验将进一步加深我们对保护或风险的免疫相关性的理解。
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引用次数: 5
Intermittent fasting for cardiovascular disease risk factor reduction: A narrative review of current evidence 间歇性禁食减少心血管疾病危险因素:对当前证据的叙述性回顾
Pub Date : 2018-01-01 DOI: 10.21767/AMJ.2018.3485
C. Gavaghan, R. Jayasinghe
Background: The metabolic syndrome (MetSy), which is defined by the spectrum of obesity, insulin resistance and dyslipidaemia, is recognised as a major contributor to the overall risk of developing cardiovascular disease. Intermittent fasting (IF), which encompasses dieting plans with varying schedules of fasting, may be an effective method of reducing the burden of MetSy and the consequent cardiovascular events in the face of a worsening obesity epidemic in the contemporary society. Aims: Despite the widespread public interest there is a serious lack of scientific understanding of the evidence base and the safe, optimal recommendations. This has created a level of public confusion that we endeavour to address by this narrative review of the published literature. Methods: This narrative literature review summarises the current findings and suggests which regimens may be more effective and where future research in this area should be focused. Results: Although the ideal regimen for IF remains unclear, there is promising evidence that alternate day fasting or modified fasting regimens, paired with or without continuous caloric restriction, may be more effective than continuous caloric restriction alone. Conclusion: IF has been shown in the small number of human clinical trials discussed here to be an alternative to continuous caloric restriction in reducing the factors that contribute to the development of cardiovascular disease. Long-term randomised, controlled trials comparing continual caloric restriction and IF are required to objectively assess energy intake, energy expenditure, adherence, disease outcomes and metabolic factors.
背景:代谢综合征(MetSy)被定义为肥胖、胰岛素抵抗和血脂异常,被认为是导致心血管疾病总体风险的主要因素。间歇性禁食(IF),包括不同时间的节食计划,可能是减轻MetSy负担和随之而来的心血管事件的有效方法,面对当今社会日益严重的肥胖流行病。目的:尽管公众有广泛的兴趣,但对证据基础和安全、最佳建议的科学理解严重缺乏。这造成了一定程度的公众困惑,我们试图通过对已发表文献的叙述性回顾来解决这一问题。方法:这篇叙述性文献综述总结了目前的研究结果,并提出了哪些方案可能更有效,以及该领域未来的研究应该集中在哪里。结果:虽然IF的理想治疗方案尚不清楚,但有希望的证据表明,隔日禁食或改进的禁食方案,配合或不配合持续的热量限制,可能比单独持续的热量限制更有效。结论:本文讨论的少量人体临床试验显示,IF在减少导致心血管疾病发展的因素方面可替代持续热量限制。需要进行长期随机对照试验,比较持续热量限制和IF,以客观评估能量摄入、能量消耗、依从性、疾病结局和代谢因素。
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引用次数: 1
Native human dermis versus human acellular dermal matrix: A comparison of biaxial mechanical properties 天然人真皮与人脱细胞真皮基质:双轴力学性能的比较
Pub Date : 2018-01-01 DOI: 10.21767/AMJ.2018.3487
M. Terzini, A. Aldieri, E. Zanetti, D. Massai, A. Audenino, C. Bignardi
Background Human Acellular Dermal Matrices (HADMs), thanks to its mechanical resistance and it’s not immunogenic response, is used in reconstructive surgery such as breast reconstruction procedures and hernia repairs. There is the need to investigate the mechanical response of HADMs when subjected to in vivo-like stresses. Aims In order to supply additional guidance to surgeons, in this work equi-biaxial experimental curves of native and decellularized human dermis are presented because it is essential to investigate the engineered tissue response when subjected to stresses comparable to those that occur in vivo. Methods HADMs specimens were biaxially characterized exploiting a customized biaxial conversion device entirely realized through rapid prototyping methods, and the HADM response to mechanical stimuli comparable to the in vivo deformation state was explored. From the derived data, stress-strain curves were evaluated, and the elastic moduli were extracted from the curve toe-region. As an indication of the fibre rearrangement rate, the slope of the stressstrain curve at higher strains was evaluated in a semi-log plane. Results The mean elastic modulus at low strains for the mediolateral direction (along Langer lines) resulted from 35 per cent to 87 per cent higher than the cranio-caudal one. Furthermore, medio-lateral specimens show lower rearrangement velocities at higher strains. Considering both directions, the decellularization process leads to a deterioration of the mechanical properties of the matrix. Conclusion The tested HADMs maintained the typical anisotropic dermis behaviour, dependent on the collagen network predominantly oriented along the Langer lines. Moreover, comparisons among HADMs and the native human reticular dermis demonstrated the mechanical strength loss at lower strains caused by the decellularization process.
人类脱细胞真皮基质(HADMs)由于其机械阻力和无免疫原性反应,被用于重建手术,如乳房重建手术和疝气修复。有必要研究hadm在受到体内样应力时的机械响应。为了给外科医生提供额外的指导,在这项工作中,我们提出了天然真皮和去细胞人真皮的等双轴实验曲线,因为研究工程组织在受到与体内发生的压力相当的压力时的反应是必不可少的。方法利用完全通过快速成型方法实现的定制双轴转换装置对HADM样品进行双轴表征,并探讨HADM对类似于体内变形状态的机械刺激的响应。根据得到的数据,对应力-应变曲线进行了计算,并从曲线脚趾区提取了弹性模量。作为纤维重排率的指示,在半对数平面上评估了高应变下应力-应变曲线的斜率。结果低应变下中外侧方向(Langer线)的平均弹性模量比颅尾侧高35% ~ 87%。此外,中侧向试样在高应变下表现出较低的重排速度。考虑到这两个方向,脱细胞过程导致基体力学性能的恶化。结论所测hadm保持典型的各向异性真皮行为,依赖于主要沿兰格线取向的胶原网络。此外,与天然网状真皮的比较表明,在较低应变下,由脱细胞过程引起的机械强度损失。
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引用次数: 4
Primary, nodal, marginal zone lymphoma of a woman’s left breast imitated fibroadenoma 女性左乳原发性淋巴结边缘区淋巴瘤,模仿纤维腺瘤
Pub Date : 2018-01-01 DOI: 10.21767/amj.2018.3494
S. Strashilov, A. Yordanov, V. Nanev, M. Mihailova
Background Primary breast lymphoma is a rare malignant neoplastic disease, accounting for around 0.5 per cent of all malignant diseases of that organ, and also 2.2 per cent of extranodal lymphomas. The most common histopathological types are: diffuse large B-cell lymphoma, extranodal B-cell marginal zone lymphoma and MALT lymphoma. The primary affected group is with median age between 55 and 62 years. The clinical manifestation is usually of a tumour process in the affected breast. Case presentation Here we present an extremely rare case of a 68 years old woman with primary, nodal, B-cell, marginal zone lymphoma of the left breast, presenting itself under the mask of a benign tumour process, found accidentally following a histopathological examination of excisional samples. Conclusions Primary, nodal, marginal zone, B-cell lymphoma of the breast is extremely rare. Its clinical and mammographic presentation completely overlaps with those of fibroadenoma, which makes diagnosing it preoperatively practically impossible. Main treatment method here is not surgical, but radiological and chemotherapeutic.
原发性乳腺淋巴瘤是一种罕见的恶性肿瘤疾病,约占该器官所有恶性疾病的0.5%,也占结外淋巴瘤的2.2%。最常见的组织病理类型有:弥漫性大b细胞淋巴瘤、结外b细胞边缘区淋巴瘤和MALT淋巴瘤。主要受影响人群的中位年龄在55岁至62岁之间。临床表现通常是在受影响的乳房肿瘤进程。我们报告一例极为罕见的68岁女性左乳房原发性淋巴结b细胞边缘区淋巴瘤,在良性肿瘤的掩盖下表现出来,在切除样本的组织病理学检查中意外发现。结论乳腺原发性、淋巴结性、边缘带性b细胞淋巴瘤极为罕见。它的临床和乳房x线摄影表现与纤维腺瘤完全重叠,这使得术前诊断几乎不可能。主要的治疗方法不是手术,而是放疗和化疗。
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引用次数: 0
Hemophagocytic syndrome due to infection by H1N1 influenza virus H1N1流感病毒感染引起的噬血细胞综合征
Pub Date : 2018-01-01 DOI: 10.21767/amj.2018.3502
H. Gustavo, Bastidas Alirio, Forero Yency, Martin Daniel, J. Aponte
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引用次数: 0
Spontaneous coronary artery dissection with hypothyroidism in a 45-year-old man: A case report 45岁男性自发性冠状动脉剥离合并甲状腺功能减退1例
Pub Date : 2018-01-01 DOI: 10.21767/amj.2018.3528
Meiqin Wang, Gai-Xia Liu, Guofang Xue, Dong-fang Li, G. Zhu, C. Hölscher
Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndrome in young persons, rarely found in men. There are currently no known direct causes of this condition, although some correlations have been found. We report the case of a 45-year-old man with unstable angina pectoris secondary to spontaneous diffuse spiral dissection in the right coronary artery. In addition, the patient was diagnosed with other autoimmune related diseases, for example hypothyroidism, chronic atrophic gastritis, lung emphysema, which suggesting that autoimmune mechanism is an important mechanism for the
自发性冠状动脉剥离(SCAD)是一种罕见的原因急性冠状动脉综合征的年轻人,很少发现在男性。目前还没有已知的这种情况的直接原因,尽管已经发现了一些相关性。我们报告一例45岁男性不稳定型心绞痛继发于自发性弥漫性螺旋夹层右冠状动脉。此外,患者还被诊断为其他自身免疫性相关疾病,如甲状腺功能减退、慢性萎缩性胃炎、肺气肿等,提示自身免疫机制是其发生的重要机制
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引用次数: 0
Why volubility can predict the success of cochlear implantation 为什么容积率可以预测人工耳蜗植入的成功
Pub Date : 2018-01-01 DOI: 10.21767/amj.2018.3518
Paris Binos, Anna Polemikou, E. Loizou
Background We sought to identify potential communication markers predicting the success of cochlear implantation, that might be observed within the first year of life. According the last ten years literature review volubility can be considered as a potentially important vocal measure predicting later language development. Aims The present review aims to review existing evidence related with: (i) why volubility posits a plausible marker of cochlear implantation success in infancy, and (ii) presents the clinical usefulness of volubility data in predicting later language trajectory. Methods Rate of vocalization or volubility measured in terms of frequency of syllable production and it is clearly affected by parental interactivity. A low percentage of volubility can be predictive of significant communication impairment. Vocalization growth during the first year of life, as demonstrated in publications examining sound production characteristics of normally hearing (NH) and hearing impaired (HI) infants fitted with CI, were reviewed. Results Literature results revealed differences in linguistic performance among NH and CI infants which are typically attributed to auditory deprivation. Infants received late CI, produce fewer syllables (low volubility) and exhibit lateonset babbling, especially those who underwent the procedure as late as the age of 12 months or thereafter. Early recipients (implanted before the age of 12-months) related with more vocalizations, which is thought to stem from CI-initiated auditory feedback. In sum, total syllables produced (volubility) demonstrate the developmental trajectory of language acquisition which in turn is a crucial factor related with the success of cochlear implantation. Conclusion Contemporary findings collectively endorse volubility as a plausible criterion of differentiation between successful and non-successful early CI. It is argued that volubility measures predict language development and, in doing so, carry vast implications on designing efficient clinical assessment and intervention practices.
研究背景:我们试图确定预测人工耳蜗植入成功的潜在交流标记,这些标记可能在出生后一年内观察到。根据近十年的文献综述,口述能力可以被认为是预测后期语言发展的潜在重要的声音测量。本综述的目的是回顾现有的相关证据:(i)为什么说话能力是婴儿人工耳蜗植入成功的一个可信的标志,以及(ii)提出说话能力数据在预测后期语言轨迹方面的临床用途。方法用音节产生的频率来测量幼儿的发声率或发声率,其明显受父母互动的影响。低比例的口齿不清可能预示着严重的沟通障碍。在检查正常听力(NH)和听力受损(HI)婴儿安装CI的声音产生特征的出版物中,对生命第一年的发声增长进行了回顾。结果NH和CI婴儿在语言表现上存在差异,这主要归因于听觉剥夺。婴儿接受晚期CI,产生更少的音节(低语速),并表现出晚发的咿呀学语,特别是那些在12个月或之后接受手术的婴儿。早期接受者(在12个月前植入)与更多的发声有关,这被认为是源于ci发起的听觉反馈。综上所述,所产生的总音节量(口述能力)反映了语言习得的发展轨迹,而语言习得的发展轨迹又是影响人工耳蜗植入成功与否的关键因素。结论:当代的研究结果共同支持易言性作为区分早期CI成功和不成功的合理标准。有人认为,言语能力的测量可以预测语言的发展,在这样做的过程中,对设计有效的临床评估和干预实践有着巨大的影响。
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引用次数: 1
Lid abscess: An unusual presentation of melioidosis 眼睑脓肿:一种不寻常的类鼻疽表现
Pub Date : 2018-01-01 DOI: 10.21767/AMJ.2017.2809
Bhagwati Wadwekar, R. Ninan, S. Bhat, Sheela devi, R. RamyaS, R. Kanungo
Melioidosis caused by Burkholderia pseudomallei (B. pseudomallei), is an emerging infection in India. Clinical manifestation of melioidosis is variable ranging from localized benign infection to fulminant septicemia. Ocular presentation of melioidosis is rare. However, cases of endophthalmitis, keratitis and orbital infections have been reported. We report the isolation of B. pseudomallei in a 40 year old male, presenting with fever and lid abscess. The patient was treated with meropenem during the acute phase and switched to trimethoprim/sulfamethoxazole for eradication phase.
由假假伯克霍尔德菌引起的类鼻疽病是印度的一种新发感染。类鼻疽的临床表现多样,从局部良性感染到暴发性败血症不等。类鼻疽的眼部表现是罕见的。然而,也有眼内炎、角膜炎和眼窝感染的病例报道。我们报告一例40岁男性患者分离出假芽孢杆菌,表现为发热和眼睑脓肿。患者在急性期用美罗培南治疗,根除期改用甲氧苄啶/磺胺甲恶唑。
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引用次数: 2
Bilateral ankyloblepharon filiforme adnatum associated with cardiac defects 与心脏缺陷相关的双侧丝状强直性睑球
Pub Date : 2018-01-01 DOI: 10.21767/amj.2017.3297
Ling Zhu, Ronghui Ju
Ankyloblepharon filiforme adnatum (AFA) is a rare congenital anomaly and its presentation always indicates the possibility of other important anomalies. AFA is classified into four subgroups based on the associated abnormalities. Here we report a case of AFA associated with cardiac defects happened to an in vitro fertilization (IVF) female baby whose mother is elderly parturient (more than 43year-old), and the baby was treated one day after birth.
摘要丝状强直性睑下垂是一种罕见的先天性畸形,它的出现往往预示着其他重要畸形的可能性。根据相关异常将AFA分为四个亚组。我们在此报告一例AFA合并心脏缺陷发生在一个体外受精(IVF)的女性婴儿,其母亲是高龄产妇(超过43岁),婴儿在出生后一天接受治疗。
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引用次数: 1
期刊
Australasian Medical Journal
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