BACKGROUND & AIMS: :The present review gives an updated overview of transfusion transmitted virus (TTV), a novel agent, in relation to its molecular characteristics, epidemiological features, modes of transmission, tissue tropism, pathogenesis, role in various diseases and its eradication from the body. TTV, a DNA virus, is a single stranded, non-enveloped, 3.8 kb long DNA virus with a small and covalently closed circular genome comprising 3852 bases. It was tentatively designated Circinoviridae virus. TTV genome sequence is heterogeneous and reveals the existence of six different genotypes and several subtypes. TTV has been reported to transmit not only via parenteral routes, but also via alternate routes. This virus has been detected in different non-human primates as well. At present, TTV is detected by polymerase chain reaction (PCR) with no other available diagnostic assays. It shows its presence globally and was detected in high percent populations of healthy persons as well as in various disease groups. Initially it was supposed to have strong association with liver disease; however, there is little evidence to show its liver tropism and contribution in causing liver diseases. It shows high prevalence in hemodialysis patients, pointing towards its significance in renal diseases. In addition, TTV is associated with several infectious and non-infectious diseases. Though, its exact pathogenesis is not yet clear, TTV virus possibly resides and multiplies in bone marrow cells and peripheral blood mononuclear cells (PBMCs). Recently, attempts have been made to eradicate this virus with interferon treatment. More information is still needed to extricate various mysteries related to TTV.

背景与目标： : 本综述提供了有关输血传播病毒 (TTV) 的最新概述，该病毒是一种新型药物，涉及其分子特征，流行病学特征，传播方式，组织嗜性，发病机理，在各种疾病中的作用及其从体内根除。TTV是一种DNA病毒，是一种单链、无包膜、3.8 kb长的DNA病毒，具有包含3852碱基的小且共价闭合的环状基因组。暂定为Circinoviridae病毒。TTV基因组序列是异质的，揭示了六种不同基因型和几种亚型的存在。据报道，TTV不仅通过肠胃外途径传输，而且还通过替代途径传输。这种病毒也在不同的非人类灵长类动物中被检测到。目前，TTV是通过聚合酶链反应 (PCR) 检测的，没有其他可用的诊断方法。它显示了其在全球的存在，并在健康人群的高百分比人群以及各种疾病组中被检测到。最初，它应该与肝脏疾病有很强的联系; 但是，几乎没有证据表明其肝向性和在引起肝脏疾病中的贡献。它在血液透析患者中显示出很高的患病率，表明其在肾脏疾病中的重要性。此外，TTV还与几种传染病和非传染病有关。尽管TTV病毒的确切发病机制尚不清楚，但可能在骨髓细胞和外周血单个核细胞 (pbmc) 中存在并繁殖。最近，人们试图用干扰素治疗根除这种病毒。仍然需要更多的信息来解开与台视有关的各种谜团。

BACKGROUND & AIMS: The World Bank in its document under the title 'Investing in Health' (1993) states that the health status of the population, including the working population, and working conditions in individual countries depend essentially on the value of gross national product per capita. The attitudes towards the role and objectives of occupational medicine have changed significantly over the last three decades. A high priority given to primary prevention reflects the mainstream of a new approach to preventive measures. Advancements in technology, production and services, common use of computers and flattening of work organisation structures have brought about the need for workers' active participation in planning of activities and shaping working conditions in own enterprise. At the same time, workers are required to possess much higher qualifications facilitating their participation in applying new technologies and using new information systems, which resulted in a fierce competition on the labour market. In the countries in the political, social and economic transition, the conditions for introducing a new system of sustained development, described by Gustavsen at the 25th International Congress on Occupational Health have not as yet been established. A procedure-based system involving negotiations between employers and workers' representatives failed to be successful in improving working conditions as the roles of the state, employers and trade unions had not been defined precisely. It is expected that further health promotion at the worksites in these countries will depend mainly on the economic progress and the reformed system of education.

背景与目标： 世界银行在其题为 “投资于健康” (1993) 的文件中指出，包括工作人口在内的人口的健康状况和各个国家的工作条件基本上取决于人均国民生产总值。在过去的三十年中，人们对职业医学的作用和目标的态度发生了重大变化。对初级预防的高度重视反映了预防措施新方法的主流。技术，生产和服务的进步，计算机的普遍使用以及工作组织结构的扁平化带来了工人积极参与活动计划和塑造自己企业工作条件的需求。同时，要求工人具有更高的资格，以促进他们参与应用新技术和使用新信息系统，这导致了劳动力市场的激烈竞争。在政治，社会和经济转型的国家中，古斯塔夫森在第25届国际职业健康大会上描述的引入新的可持续发展体系的条件尚未建立。涉及雇主和工人代表之间谈判的基于程序的系统未能成功改善工作条件，因为国家，雇主和工会的作用尚未得到准确定义。预计这些国家工作场所的进一步健康促进将主要取决于经济进步和教育制度的改革。

BACKGROUND & AIMS: INTRODUCTION:Adverse drug reactions (ADRs) occur frequently in hospitals and increase costs of health care; however, few studies have quantified the clinical and economic impact of ADRs in Colombia. OBJECTIVES:These impacts were evaluated by calculating costs associated with ADRs in patients hospitalized in the internal medicine ward of a Level 3 hospital located in Bogotá, Colombia. In addition, salient clinical features of ADRs were identified and characterized. MATERIAL AND METHODS:Intensive follow-ups for a cohort of patients were conducted for a five month period in order to detect ADRs; different ways to classify them, according to literature, were considered as well. Information was collected using the INVIMA reporting format, and causal probability was evaluated with the Naranjo algorithm. Direct costs were calculated from the perspective of payer, based on the following costs: additional hospital stay, medications, paraclinical tests, additional procedures, patient displacement to intermediate or intensive care units, and other costs. RESULTS:Of 836 patients admitted to the service, 268 adverse drug reactions were detected in 208 patients (incidence proportion 25.1%, occurence rate 0.32). About the ADRs found, 74.3% were classified as probable, 92.5% were type A, and 81.3% were moderate. The body system most often affected was the circulatory system (33.9%). Drugs acting on the blood were most frequently those ones associated with adverse reactions (37.6%). The costs resulting from medical care of adverse drug reactions varied from COL dollar 93,633,422 (USD dollar 35,014.92) to COL dollar 122,155,406 (USD dollar 45,680.94), according to insurance type, during the study period. CONCLUSIONS:Adverse drug reactions have a significant negative health and financial impact on patient welfare. Because of the substantial resources required for their medical care and the significant proportion of preventable adverse reactions, active programs of institutional pharmacovigilance are highly recommended.

背景与目标：

BACKGROUND & AIMS: Nodular regenerative hyperplasia (NRH) of the liver is a condition characterized by multiple monoacinar regenerative nodules in the absence of fibrous septa. When these nodules become confluent they may be seen with sonography or CT. The appearance of these pseudotumoral pattern of NRH has been scarcely described with MRI. We present the imaging findings of five patients with NRH and a pseudotumoral form at sonography. Sonography depicted hyperechoic lesions in four patients and hypoechoic lesions in another. Computed tomography showed hypodense lesions with little contrast enhancement in two patients. Three patients showed subtle focal liver lesions on MRIisointense in one, mildly hypointense in another, and minimally hyperintense in a patient with siderosis. The dynamic behavior at MRI was similar to the normal liver parenchyma. Hyperechoic lesions on sonography or hypodense lesions on CT, barely or not seen on MRI, can be indicative of NRH in an appropriate clinical setting.

背景与目标： 肝脏的结节性再生增生 (NRH) 是一种疾病，其特征是在没有纤维间隔的情况下多个单腺泡再生结节。当这些结节汇合时，可以通过超声检查或CT看到它们。MRI几乎没有描述这些NRH假瘤模式的出现。我们在超声检查中介绍了5例NRH和假瘤形式患者的影像学发现。超声检查显示了四名患者的高回声病变，另一名患者的低回声病变。计算机断层扫描显示两名患者的低密度病变几乎没有对比度增强。三名患者在一个mriisointensient上显示出细微的局灶性肝病灶，在另一个患者中显示出轻度低信号，而在患有铁质沉着症的患者中显示出最小高信号。MRI的动态行为与正常肝实质相似。在适当的临床环境中，超声检查中的高回声病变或CT上的低密度病变 (在MRI上几乎看不到或看不到) 可以指示NRH。

BACKGROUND & AIMS: OBJECTIVE:The scholarly dissemination of innovative medical education practices helps broaden the reach of this type of work, allowing scholarship to have an impact beyond a single institution. There is little guidance in the literature for those seeking to publish program evaluation studies and innovation papers. This study aims to derive a set of evidence-based features of high-quality reports on innovations in emergency medicine (EM) education. METHODS:We conducted a scoping review and thematic analysis to determine quality markers for medical education innovation reports, with a focus on EM. A search of MEDLINE, EMBASE, ERIC, and Google Scholar was augmented by a hand search of relevant publication guidelines, guidelines for authors, and website submission portals from medical education and EM journals. Study investigators reviewed the selected articles, and a thematic analysis was conducted. RESULTS:Our search strategy identified 14 relevant articles from which 34 quality markers were extracted. These markers were grouped into seven important themes: goals and need for innovation, preparation, innovation development, innovation implementation, evaluation of innovation, evidence of reflective practice, and reporting and dissemination. In addition, multiple outlets for the publication of EM education innovations were identified and compiled. CONCLUSION:The publication and dissemination of innovations are critical for the EM education community and the training of health professionals. We anticipate that our list of innovation report quality markers will be used by EM education innovators to support the dissemination of novel educational practices.

背景与目标：

BACKGROUND & AIMS: :The cardioprotective drugs used for treatment against ischemia/reperfusion (MI/R) injury have been well evaluated and are considered inadequate. The Chinese herbal medicine formula, Xinji pill (XJP) has been used traditionally for the prevention and treatment of ischemic heart diseases for decades. In the present study, the cardioprotective effects of XJP against MI/R injury were assessed in vivo and its possible mechanism was examined. Male Sprague‑Dawley rats were selected for establishing an MI/R model, which was induced by ischemia for 30 min followed by 24 h reperfusion. Drugs and saline were administered intragastrically from day 14 prior to MI/R. Blood samples were collected for biochemical detection. The rats were then sacrificed and cardiac muscle tissues were harvested. The mRNA expression levels of antioxidant genes were measured by reverse transcription‑quantitative polymerase chain reaction and the protein levels were measured by western blotting. Pretreatment with XJP for 14 days protected the heart against I/R‑induced myocardial function disorder, protected against heart injury, as demonstrated by normalized serum levels of lactate dehydrogenase and creatine kinase, and suppressed oxidative stress. XJP markedly upregulated the expression of antioxidant genes, including superoxide dismutase, catalase, glutathione reductase and glutathione peroxidase, and promoted the protein expression of heme oxygenase‑1 and NFE2‑related factor 2 (Nrf2) in the heart tissues. Furthermore, Akt kinase was confirmed to be upstream of Nrf2 in the XJP treatment. LY294002, a specific inhibitor of Akt, significantly eliminated the cardioprotective effects of XJP. In conclusion, these results demonstrated that XJP exhibited notable cardioprotective properties, in which the Akt/Nrf2 signaling pathway may be involved.

背景与目标： : 用于治疗缺血/再灌注 (MI/R) 损伤的心脏保护药物已得到很好的评估，被认为是不充分的。几十年来，中药配方新基丸 (XJP) 一直用于预防和治疗缺血性心脏病。在本研究中，在体内评估了XJP对MI/R损伤的心脏保护作用，并研究了其可能的机制。选择雄性sprague-dawley大鼠建立MI/R模型，该模型由缺血30分钟然后再灌注24小时诱导。从MI/R开始的第14天开始胃内给药和生理盐水。采集血样进行生化检测。然后处死大鼠并收获心肌组织。通过逆转录定量聚合酶链反应测量抗氧化基因的mRNA表达水平，并通过蛋白质印迹法测量蛋白质水平。用XJP预处理14天可以保护心脏免受I/r诱导的心肌功能障碍，防止心脏损伤，如乳酸脱氢酶和肌酸激酶的标准化血清水平所示，并抑制氧化应激。XJP显着上调了抗氧化基因的表达，包括超氧化物歧化酶，过氧化氢酶，谷胱甘肽还原酶和谷胱甘肽过氧化物酶，并促进了血红素氧合酶-1和NFE2相关因子2 (Nrf2) 在心脏组织中的蛋白表达。此外，在XJP治疗中，Akt激酶被证实是Nrf2的上游。LY294002是一种特殊的Akt抑制剂，显著消除了XJP的心脏保护作用。总之，这些结果表明XJP表现出显着的心脏保护特性，其中可能涉及Akt/Nrf2信号通路。

BACKGROUND & AIMS: BACKGROUND:Regulatory bodies including the European Medicines Agency register medications (formulation, route of administration) for specific clinical indications. Once registered, prescription is at clinicians' discretion. Off-label use is beyond the registered use. While off-label prescribing may, at times, be appropriate, efficacy and toxicity data are often lacking. AIM:The aim of this study was to document off-label use policies (including disclosure and consent) in Australian palliative care units and current practices by palliative care clinicians. DESIGN:A national, cross-sectional survey was conducted online following an invitation letter. The survey asked clinicians their most frequent off-label medication/indication dyads and unit policies. Dyads were classified into unregistered, off-label and on-label, and for the latter, whether medications were nationally subsidised. SETTING/PARTICIPANTS:All Australian palliative medicine Fellows and advanced trainees. RESULTS:Overall, 105 clinicians responded (53% response rate). The majority did not have policies on off-label medications, and documented consent rarely. In all, 236 medication/indication dyads for 36 medications were noted: 45 dyads (19%) were for two unregistered medications, 118 dyads (50%) were for 26 off-label medications and 73 dyads (31%) were for 12 on-label medications. CONCLUSIONS:Off-label prescribing with its clinical, legal and ethical implications is common yet poorly recognised by clinicians. A distinction needs to be made between where quality evidence exists but registration has not been updated by the pharmaceutical sponsor and the evidence has not been generated. Further research is required to quantify any iatrogenic harm from off-label prescribing in palliative care.

背景与目标：

BACKGROUND & AIMS: :In this issue of Blood, Yang et al have demonstrated that the therapeutic activity of a targeted therapy, the tyrosine kinase inhibitor (TKI) dasatinib, unexpectedly depends on antitumor T-cell responses that are strongly potentiated by immunostimulation (agonist anti-OX40).

背景与目标： 在本期《血液》中，Yang等人已经证明了靶向治疗，酪氨酸激酶抑制剂 (TKI) 达沙替尼的治疗活性出乎意料地依赖于免疫刺激强烈增强的抗肿瘤T细胞反应 (激动剂anti-OX40)。

BACKGROUND & AIMS: :The present investigation describes the effect on the isolated rat ileum of methanolic extracts derived from Conyza filaginoides (D. C.) Hieron (Asteraceae), Croton fragilis HBK. (Euphorbiaceae), Dodonaea viscosa Jacq. (Sapindaceae), Gymnosperma glutinosum (Spreng) Less. (Asteraceae), Parthenium tomentosum DC. var. stramonium (Greene) Rollins (Asteraceae), Potentilla thurberi A. Gray (Rosaceae), Pterogonum atrorubens (Englem.) H. Gross (Polygonaceae), Zornia venosa Mohlenbr. (Fabaceae) and Datura lanosa Barclay ex Bye (Solanaceae). In all the cases the extracts inhibited, in a concentration-dependent manner, the spontaneous contraction of the intestinal smooth muscle. The most active extract was that of D. viscosa. These findings tend to support the ethnomedical use of the selected species as spasmolytic agents in Mexican traditional medicine. Additionally, the potential antimicrobial activity of the extracts against pathogenic enterobacteria was investigated. Seven of the nine plants evaluated displayed antibacterial effects.

背景与目标： : 本研究描述了源自Conyza filainoides (d.c.) 的甲醇提取物对分离的大鼠回肠的影响Hieron (菊科)，巴豆脆性HBK。(大戟科)，Dodonaea viscosa Jacq。(无患子科)，裸子植物谷草 (spleng) 较少。(菊科)，多叶parthentosum DC。变种stramonium (Greene) Rollins (菊科)，委陵菜thurberi A.灰色 (蔷薇科)，Pterogonum atrorubens (Englem.) H. Gross (蓼科)，Zornia venosa Mohlenbr。(豆科) 和曼陀罗·拉诺萨·巴克莱 (Solanaceae)。在所有情况下，提取物均以浓度依赖性方式抑制肠平滑肌的自发收缩。最具活性的提取物是粘粘D。这些发现倾向于支持所选物种在墨西哥传统医学中作为解痉剂的民族医学用途。此外，还研究了提取物对致病性肠杆菌的潜在抗菌活性。评估的9种植物中有7种具有抗菌作用。

BACKGROUND & AIMS: :The prevalence of renal diseases is rising and reaching 5-15% of the adult population. Renal damage is associated with disturbances of body homeostasis and the loss of equilibrium between exogenous and endogenous elements including drugs and metabolites. Studies indicate that renal diseases are influenced not only by environmental but also by genetic factors. In some cases the disease is caused by mutation in a single gene and at that time severity depends on the presence of one or two mutated alleles. In other cases, renal disease is associated with the presence of alteration within a gene or genes, but environmental factors are also necessary for the development of disease. Therefore, it seems that the analysis of genetic aspects should be a natural component of clinical and experimental studies. The goal of personalized medicine is to determine the right drug, for the right patient, at the right time. Whole-genome examinations may help to change the approach to the disease and the patient resulting in the creation of "personalized medicine" with new diagnostic and treatment strategies designed on the basis of genetic background of each individual. The identification of high-risk patients in pharmacogenomics analyses will help to avoid many unwarranted side effects while optimizing treatment efficacy for individual patients. Personalized therapies for kidney diseases are still at the preliminary stage mainly due to high costs of such analyses and the complex nature of human genome. This review will focus on several areas of interest: renal disease pathogenesis, diagnosis, treatment, rate of progression and the prediction of prognosis.

背景与目标： : 肾脏疾病的患病率正在上升，并达到成年人口的5-15%。肾脏损害与机体稳态紊乱以及外源性和内源性元素 (包括药物和代谢物) 之间平衡的丧失有关。研究表明，肾脏疾病不仅受环境影响，还受遗传因素影响。在某些情况下，该疾病是由单个基因突变引起的，当时的严重程度取决于一个或两个突变等位基因的存在。在其他情况下，肾脏疾病与一个或多个基因内的改变有关，但环境因素也是疾病发展所必需的。因此，似乎遗传方面的分析应该是临床和实验研究的自然组成部分。个性化医疗的目标是在正确的时间为正确的患者确定正确的药物。全基因组检查可能有助于改变疾病和患者的治疗方法，从而创建具有基于每个个体遗传背景设计的新诊断和治疗策略的 “个性化医学”。在药物基因组学分析中识别高危患者将有助于避免许多不必要的副作用，同时优化单个患者的治疗效果。肾脏疾病的个性化治疗仍处于初步阶段，这主要是由于此类分析的高昂成本和人类基因组的复杂性。这篇综述将集中在几个感兴趣的领域: 肾脏疾病的发病机制，诊断，治疗，进展率和预后预测。

BACKGROUND & AIMS: :This study, conducted over two time periods, aimed to evaluate the effectiveness of the diffusion of data, implementation of correctives measures and updated protocols in reducing time to reperfusion in acute myocardial infarction (AMI) management in the out-of-hospital setting. Mean (SD) time to hospital admission and to arterial puncture improved (58 (13) vs 67 (18) min, p = 0.03; and 82 (16) vs 95 (29) min, p = 0.02). The study, performed according to quality control programme methodology, showed that the chronology of AMI management could be improved by appropriate interventions and monitoring of intervention times.

背景与目标： : 这项研究在两个时间段内进行，旨在评估数据扩散的有效性，纠正措施的实施以及更新的方案在减少医院外急性心肌梗塞 (AMI) 管理中的再灌注时间方面的有效性设置。平均 (SD) 入院和动脉穿刺时间改善 (58 (13) vs 67 (18) 分钟，p = 0.03; 和82 (16) vs 95 (29) 分钟，p = 0.02)。根据质量控制计划方法进行的研究表明，可以通过适当的干预和监测干预时间来改善AMI管理的时间顺序。

BACKGROUND & AIMS: :Widespread interest in global health issues is a common characteristic of students and faculty in schools of public health and schools of medicine. Building on strong university-based and community-based programs in global health, the University of Washington has created a unique Department of Global Health that is housed jointly in its School of Public Health and Community Medicine and its School of Medicine. The creation of this department has generated significant enthusiasm throughout the university and the Seattle community as a new paradigm for addressing global health education, research, and service. Placing the new Department of Global Health in two university schools and finding the appropriate niche for the department among the university's many global health initiatives presented challenges, as well as opportunities. This article describes the goals of the department, the process by which it was created, and what it expects to accomplish.

背景与目标： : 对全球卫生问题的广泛关注是公共卫生学院和医学院的学生和教职员工的共同特征。华盛顿大学以强大的基于大学和社区的全球卫生计划为基础，创建了一个独特的全球卫生部门，该部门位于其公共卫生和社区医学学院及其医学院中。这个部门的创建在整个大学和西雅图社区产生了极大的热情，成为解决全球健康教育，研究和服务的新范式。将新的全球卫生部门安置在两所大学学校中，并在大学的许多全球卫生计划中找到适合该部门的利基市场，带来了挑战和机遇。本文介绍了该部门的目标，创建该部门的过程以及预期实现的目标。

BACKGROUND & AIMS: :7-hydroxymitragynine, a constituent of the Thai herbal medicine Mitragyna speciosa, has been found to have a potent opioid antinociceptive effect. In the present study, we investigated the mechanism of antinociception and the inhibitory effect on gastrointestinal transit of 7-hydroxymitragynine, and compared its effects with those of morphine. When administered subcutaneously to mice, 7-hydroxymitragynine produced antinociceptive effects about 5.7 and 4.4 times more potent than those of morphine in the tail-flick (ED50=0.80 mg/kg) and hot-plate (ED50=0.93 mg/kg) tests, respectively. The antinociceptive effect of 7-hydroxymitragynine was significantly blocked by the mu1/mu2-opioid receptor antagonist beta-funaltrexamine hydrochloride (beta-FNA) and the mu1-opioid receptor-selective antagonist naloxonazine in both tests. Thus, 7-hydroxymitragynine acts predominantly on mu-opioid receptors, especially on mu1-opioid receptors. Isolated tissue studies further supported its specificity for the mu-opioid receptors. Further, 7-hydroxymintragynine dose-dependently (ED50=1.19 mg/kg, s.c.) and significantly inhibited gastrointestinal transit in mice, as morphine does. The inhibitory effect was significantly antagonized by beta-FNA pretreatment, but slightly antagonized by naloxonazine. The ED50 value of 7-hydroxymitragynine on gastrointestinal transit was larger than its antinociceptive ED50 value. On the other hand, morphine significantly inhibits gastrointestinal transit at a much smaller dose than its antinociceptive dose. These results suggest that mu-opioid receptor mechanisms mediate the antinociceptive effect and inhibition of gastrointestinal transit. This compound induced more potent antinociceptive effects and was less constipating than morphine.

背景与目标： : 7-hydroxyymyramynine，泰国草药mitramyna speciosa的一种成分，已被发现具有有效的阿片类药物抗伤害作用。在本研究中，我们研究了7-羟基雌米雌酮的抗伤害感受机制和对胃肠道转运的抑制作用，并将其与吗啡的作用进行了比较。当皮下给药小鼠时，在甩尾 (ED50 = 0.80 mg/kg) 和热板 (ED50 = 0.93 mg/kg) 测试中，7-羟基肌酸产生的抗伤害感受作用比吗啡的作用强约5.7和4.4倍。在两次测试中，mu1/mu2-opioid受体拮抗剂 β-氟曲胺盐酸盐 (β-FNA) 和mu1-opioid受体选择性拮抗剂纳洛酮嗪均显着阻断了7-羟基酪氨酸的抗伤害感受作用。因此，7-羟甲基主要作用于 μ-阿片受体，尤其是mu1-opioid受体。孤立的组织研究进一步支持了其对 μ 阿片受体的特异性。此外，7-羟基喹啉呈剂量依赖性 (ED50 = 1.19 mg/kg，s.C.)，并显著抑制小鼠的胃肠转运，如吗啡。Β-FNA预处理可显着拮抗抑制作用，但纳洛酮嗪可轻微拮抗。7-羟基雌杆菌在胃肠道运输中的ED50值大于其抗伤害感受ED50值。另一方面，吗啡以比其抗伤害感受剂量小得多的剂量显着抑制胃肠道转运。这些结果表明，μ 阿片受体机制介导了抗伤害感受作用和抑制胃肠道转运。与吗啡相比，该化合物可产生更有效的抗伤害感受作用，并且便秘更少。

BACKGROUND & AIMS: :Post-remission therapy in acute myeloid leukemia (AML) remains problematic. It has been demonstrated that younger patients can maintain longer complete remissions (CR) with aggressive post-remission therapies after induction treatment: allogeneic (allo), autologous (auto) stem cell transplantation (SCT), or intensive chemotherapy (ICC). The purpose of our study was to identify the most important randomized and controlled studies comparing these three therapeutic options, in order to draw conclusions and possible suggestions for post-remission therapy of AML, according to the evidence based medicine (EBM) rules. We performed an exhaustive analysis of the literature, searching either in electronic databases or among the references of the identified articles (hand searching). We searched the MEDLINE computer database for reports from 1985 through January 2005 and selected for analysis the clinical trials conducted over adults affected by newly diagnosed AML aged less than 65 years. The study design had to satisfy strict methodological criteria and must consider global mortality and/or disease free survival as primary outcomes. Overall we found 7750 papers; by using the limits "clinical trial" as publication type, "all adults 19+ years", we were able to select 344 papers. Among these, a further selection was made, based on two main clinical queries: 1) is auto-SCT superior to ICC/no other therapy in improving DFS and/or OS in adult AML patients in first CR? 2) is allo-SCT superior to auto-SCT/other therapeutic options in improving DFS and/or OS in adult AML patients in first CR? Concerning the first query, a possible advantage of auto-SCT over ICC was not clearly supported by data from clinical trials; there is no evidence that auto-SCT is superior in terms of OS to chemotherapy. Nevertheless, the reported TRM has been significantly reduced within the past years. Thus, the percentage of patients suitable for auto-SCT in CR has increased. Moreover, the scarce data concerning the comparison between auto-SCT and chemotherapy in different subsets of patients are unable to suggest a differentiated approach in patients with high-risk, standard-risk or low-risk AML. Data from the literature show that patients with unfavorable risk disease are more often addressed to allo-SCT and patients with low-risk disease receive more often intensive consolidation chemotherapy. Concerning the second query, interpretation of data from the main prospective studies about the role of allo-SCT in previously untreated AML is not easy. The first problem is the lack of real randomized clinical trials; in fact, according to the reported studies, AML patients generally receive allo-SCT on the basis of donor availability (the so called "genetic randomization"). The second problem is the frequent absence of intention to treat analysis. Despite methodological limitations, it was possible to compare allo-SCT with auto-SCT on a donor versus no-donor analysis and within risk groups. No overall benefit of allo-grafting on survival was demonstrated by any trial. In conclusion, the EBM approach highlighted the limitations observed in the published studies concerning consolidation therapy in AML; some suggestions, emerging from non-randomized, as well as randomized studies, are adequate, but not conclusive. This point, coupled with the intrinsic complexity to study AML biological heterogeneity, is probably a major obstacle to draw conclusive evidences for consolidation therapy in AML. These observations should plan to address new randomized studies on AML therapy; however, due to the emergence of genetic subgroups and new drugs targeting specific abnormalities, these trials should probably be designed directly focusing on the single entities. In this way, the cure of AML could eventually become the cure of each specific AML subset with its peculiar biological, molecular and prognostic features.

背景与目标： : 急性髓系白血病 (AML) 的缓解后治疗仍然存在问题。已证明，年轻患者在诱导治疗后可以通过积极的缓解后疗法维持更长的完全缓解 (CR): 异体 (allo)，自体 (auto) 干细胞移植 (SCT) 或强化化疗 (ICC)。我们研究的目的是确定比较这三种治疗方案的最重要的随机和对照研究，以便根据循证医学 (EBM) 规则得出结论和可能的AML缓解后治疗建议。我们对文献进行了详尽的分析，在电子数据库中或在已识别文章的参考文献中进行搜索 (手工搜索)。我们在MEDLINE计算机数据库中搜索了通过2005年1月1985年的报告，并选择了针对年龄小于65岁的新诊断AML的成年人进行的临床试验进行分析。研究设计必须满足严格的方法学标准，并且必须将全球死亡率和/或无病生存率作为主要结果。总的来说，我们发现了7750篇论文; 通过使用限制 “临床试验” 作为出版类型，“所有成人19岁”，我们能够选择344篇论文。其中，基于两个主要的临床问题进行了进一步的选择: 1) 在改善首次CR的成年AML患者的DFS和/或OS方面，auto-SCT是否优于ICC/no其他疗法？2) 在改善首次CR的成年AML患者的DFS和/或OS方面，allo-SCT是否优于auto-SCT/其他治疗选择？关于第一个查询，临床试验数据并未明确支持auto-SCT优于ICC的可能优势; 没有证据表明auto-SCT在OS方面优于化疗。然而，在过去几年中，报告的TRM已大大减少。因此，CR中适合auto-SCT的患者百分比增加了。此外，关于不同患者亚组中auto-SCT和化疗之间比较的稀缺数据无法提示高风险，标准风险或低风险AML患者的差异化方法。来自文献的数据表明，患有不利风险疾病的患者更常接受allo-SCT治疗，而低风险疾病的患者更常接受强化强化化疗。关于第二个查询，对来自主要前瞻性研究的有关allo-SCT在先前未经治疗的AML中的作用的数据的解释并不容易。第一个问题是缺乏真正的随机临床试验; 实际上，根据报道的研究，AML患者通常根据供体的可用性接受allo-SCT (所谓的 “遗传随机化”)。第二个问题是经常缺乏治疗分析的意图。尽管方法上有局限性，但可以在供体分析与无供体分析以及风险组中比较allo-SCT与auto-SCT。任何试验都没有证明同种异体移植对生存率的总体益处。总之，EBM方法强调了在已发表的关于AML巩固治疗的研究中观察到的局限性; 从非随机和随机研究中提出的一些建议是足够的，但不是结论性的。这一点，加上研究AML生物异质性的内在复杂性，可能是为AML巩固治疗得出确凿证据的主要障碍。这些观察结果应计划解决有关AML治疗的新的随机研究; 但是，由于遗传亚组的出现和针对特定异常的新药的出现，这些试验可能应直接针对单个实体进行设计。这样，AML的治疗最终可以成为每个特定AML子集的治疗方法，具有其独特的生物学，分子和预后特征。

BACKGROUND & AIMS: :Pharmacotherapies for the behavioural and psychological symptoms of dementia are limited; novel agents for the symptoms are still needed. Herein, we report the case of an 80-year-old male patient with Alzheimer's disease whose severe agitation, insomnia and sexual delusions were successfully treated with a traditional natural Japanese (Kampo) medicine, keishi-ka-ryukotsu-borei-to. We found that administrating keishi-ka-ryukotsu-borei-to increased his serum luteinizing hormone level, which could be inversely associated with his behavioural and psychological symptoms. This report suggests that keishi-ka-ryukotsu-borei-to is a possible alternative treatment for the behavioural and psychological symptoms of dementia, especially sexual delusions.

背景与目标： : 针对痴呆症的行为和心理症状的药物疗法有限; 仍然需要针对这些症状的新型药物。在此，我们报告了一名80岁的男性阿尔茨海默氏病患者，其严重的躁动，失眠和性妄想已成功地用传统的天然日本 (Kampo) 药物keishi-ka-ryukotsu-borei-too治疗。我们发现，服用keishi-ka-ryukotsu-borei-会增加他的血清黄体生成激素水平，这可能与他的行为和心理症状成反比。该报告表明，keishi-ka-ryukotsu-borei-too可能是治疗痴呆症的行为和心理症状，尤其是性妄想的替代疗法。