题目：Older sisters and younger brothers: The impact of siblings on preference for competition
 
Highlights

•The impact of siblings on one’s personality has been long argued in psychology.

•One of the core issues is who rates the participants’ personality traits.

•We go beyond past studies by obtaining competitive trait in economics experiment.

•Having older sisters is negatively associated with men’s competitive preferences.

•Our results support sibling hypotheses from the viewpoint of economics experiment.
 
Abstract

Psychology studies have long argued the possibility that sibling structure, such as birth order and the sex of siblings, shapes one’s personality traits. One of the core issues involved is that of who rates subjects’ personality traits in studies. The present studies (N = 135 in Study 1, N = 232 in Study 2) surpassed the examinations performed in previous studies by obtaining information regarding one of the key personality traits, preference for competition, using a framework developed via experimental economics rather than subjective ratings. Despite the fact that the two studies involved different types of task, we consistently observed that older sisters exerted a significant impact on their younger siblings in both studies. In particular, having an older sister was negatively associated with men’s competitive preferences. We also obtained suggestive evidence that having an older sister was positively associated with women’s competitive preferences. Our results support sibling hypotheses from the perspective of experimental economics.

 
Keywords Sibling competition;Gender;Competition;Personality;Experimental economics
 
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原文出处：http://www.sciencedirect.com/science/article/pii/S0191886915001609 收起阅读 »

标题：Cloud cover-adjusted ultraviolet B irradiance and pancreatic cancer incidence in 172 countries
 
Highlights

•We measured the association between UVB irradiance and pancreatic cancer incidence.

•Higher UVB was associated with lower levels of pancreatic cancer incidence.

•The relationship remained significant after controlling for several confounders.

•The association may be explained through photosynthesis of vitamin D.
 
Abstract
Background

Controversy exists regarding whether vitamin D deficiency could influence the etiology of pancreatic cancer. Several cohort studies have found that high serum 25-hydroxyvitamin D [25(OH)D] concentrations are associated with low risk of pancreatic cancer, while others have not.

Hypothesis

Low ultraviolet B irradiance is associated with high incidence of pancreatic cancer.

Methods

Age-standardized pancreatic cancer incidence rates were obtained from GLOBOCAN in 2008. The association between cloud-adjusted UVB irradiance and age-standardized incidence rates of pancreatic cancer was analyzed using regression.

Results

Overall, the lower the cloud-adjusted UVB irradiance, the higher the incidence rate of pancreatic cancer. Residents of countries with low UVB irradiance had approximately 6 times the incidence rates as those in countries with high UVB irradiance (p < 0.0001 for males and p < 0.0001 for females). This association persisted after adjustment for traditional risk factors of pancreatic cancer (p = 0.0182 for males and p = 0.0029 for females).

Conclusions

There was an inverse association of cloud-adjusted UVB irradiance with incidence of pancreatic cancer that persisted after adjustment. This result is consistent with an inverse association of overall vitamin D deficiency in countries with lower UVB irradiance with risk of pancreatic cancer. Further research on the role of 25(OH)D in reduction of pancreatic cancer in individuals would be desirable to expand the limited avenues available for prevention of this highly fatal disease.

This article is part of a Special Issue entitled ‘17th Vitamin D Workshop’.

 
Keywords Pancreatic cancer;Ultraviolet rays;Incidence;UVB;Vitamin D;Epidemiology;International comparisons
 
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原文出处：http://www.sciencedirect.com/science/article/pii/S0960076015001016
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Men who are losing their hair due to male pattern baldness may be at increased risk of dying from prostate cancer, a new study suggests.Researchers analyzed information from more than 4,000 U.S. men ages 25 to 74, who were assessed by a dermatologist and categorized has having no balding, or minimal, moderate or severe balding.

Men with any degree of balding were 56 percent more likely to die from prostate cancer over a 21-year period, compared with men who were not losing their hair. What's more, those with moderate balding were 83 percent more likely to die from prostate cancer, compared to those with no balding.
 
The findings support the hypothesis that a shared biological process influences both balding and prostate cancer, the researchers said. One theory is that high levels of male hormones (such as testosterone) play a role in both conditions. Men with male pattern baldness have been found to have higher levels of male hormones, and these hormones also fuel the growth of prostate cancer cells.However, it's too soon to make any recommendations about screening men for prostate cancer based on the findings, said study author Cindy Zhou, a postdoctoral fellow at the National Cancer Institute. "We still need future studies to replicate what we observed," Zhou said.

If the findings are confirmed, male pattern baldness might be used as one indicator of a man's risk of developing prostate cancer, which could help scientists determine which men should undergo prostate cancer screening, the researchers said. However, studies would first need to show that taking a man's baldness into account actually improves researchers' ability to predict the man's prostate cancer risk, above and beyond what can be predicted using current risk factors, Zhou said.
 
An earlier study found that men who start to bald in their 20s were at higher risk for prostate cancer than men who don't start to lose their hair until later, but the new study found a link between balding and fatal prostate cancer regardless of age.Interestingly, the new study did not find a link between severe balding and an increased risk of fatal prostate cancer. This could be because there were few men in the study with severe balding, which limited the ability of the study to detect a link, Zhou said.

The study was presented this week at the American Association for Cancer Research meeting in Philadelphia.       
 
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Even casual walking for an extra two minutes each hour may help prolong life.

A new study suggests that engaging in low intensity activities such as standing may not be enough to offset the health hazards of sitting for long periods of time. On the bright side, adding two minutes of walking each hour to your routine just might do the trick. These findings were published in the Clinical Journal of the American Society of Nephrology (CJASN).

Numerous studies have shown that sitting for extended periods of time each day leads to increased risk for early death, as well as heart disease, diabetes and other health conditions. Considering that 80 percent of Americans fall short of completing the recommended amount of exercise, 2.5 hours of moderate activity each week, it seems unrealistic to expect that people will replace sitting with even more exercise.

With this in mind, scientists at the University of Utah School of Medicine investigated the health benefits of a more achievable goal, trading sitting for lighter activities for short periods of time. They used observational data from National Health and Nutrition Examination Survey (NHANES) to examine whether longer durations of low intensity activities (e.g. standing), and light intensity activities (e.g. casual walking, light gardening, cleaning) extends the life span of people who are sedentary for more than half of their waking hours.

They found that there is no benefit to decreasing sitting by two minutes each hour, and adding a corresponding two minutes more of low intensity activities. However, a "trade-off" of sitting for light intensity activities for two minutes each hour was associated with a 33 percent lower risk of dying.

"It was fascinating to see the results because the current national focus is on moderate or vigorous activity. To see that light activity had an association with lower mortality is intriguing," says lead author Srinivasan Beddhu, M.D., professor of internal medicine.

Beddhu explains that while it's obvious that it takes energy to exercise, strolling and other light activities use energy, too. Even short walks add up to a lot when repeated many times over the course of a week. Assuming 16 awake hours each day, two minutes of strolling each hour expends 400 kcal each week. That number approaches the 600 kcal it takes to accomplish the recommended weekly goal of moderate exercise. It is also substantially larger than the 50 kcal needed to complete low intensity activities for two minutes each awake hour over the course of one week.

"Based on these results we would recommend adding two minutes of walking each hour in combination with normal activities, which should include 2.5 hours of moderate exercise each week," says Beddhu. Moderate exercise strengthens the heart, muscles, and bones, and confers health benefits that low and light intensity activities can't.

The study examined 3,243 NHANES participants who wore accelerometers that objectively measured the intensities of their activities. Participants were followed for three years after the data were collected; there were 137 deaths during this period.

"Exercise is great, but the reality is that the practical amount of vigorous exercise that can be achieved is limited. Our study suggests that even small changes can have a big impact," says senior author Tom Greene, Ph.D., director of the Study Design and Biostatistics Center at the Center for Clinical and Translational Science.

Beddhu adds that large, randomized, interventional trials will be needed to definitively answer whether exchanging sitting for light activities leads to better health.

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原文出处：http://www.sciencedaily.com/releases/2015/04/150430170715.htm
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A controversial artificial sweetener is being removed from Diet Pepsi in the US amid consumer concerns about its safety.

Aspartame-free cans of the drink will go on sale from August in America, but not in Britain.

Regulators in the UK and the US insist aspartame is still safe to use in soft drinks.

PepsiCo says its decision is a commercial one - responding to consumer preferences.

Last year, sales in Diet Pepsi fell by more than 5% in the US, latest figures show.
 
Similarly, sales of Diet Coke, which also contains aspartame, decreased by more than 6%.

PepsiCo says it will replace aspartame with another sweetener - sucralose - mixed with acesulfame potassium (Ace-K).

Seth Kaufman, vice-president of Pepsi, said: "Aspartame is the number one reason consumers are dropping diet soda."

In tests, Mr Kaufman said, people still recognised the reformulated drink to be Diet Pepsi but it might have a "slightly different mouth-feel".

There are no plans to change the ingredients in the UK.

A spokesman said: "Consumers in the UK market love Diet Pepsi just as it is today.

"Pepsi uses a variety of approved sweetener options to create great-tasting colas, including aspartame, which remains an important sweetener in some Pepsi beverages around the world, including Diet Pepsi in the UK market."

The change only applies to the US market and will affect all varieties of Diet Pepsi, such as Caffeine Free Diet Pepsi and Wild Cherry Diet Pepsi. It will not apply to other PepsiCo drinks, such as Diet Mountain Dew.
 
Health concerns
Aspartame has sparked controversy since it was first approved for use in the 1980s, despite being one of the most thoroughly tested and studied food additives.

Aspartame, also known as E951, is about 200 times sweeter than sugar but contains very few calories.

Thousands of foods and drinks around the world use it as a sugar substitute, including breakfast cereals and sugar-free chewing gum.

Food safety experts have been keeping its use under close scrutiny since a number of anecdotal reports pointed to potential side-effects.

A study published by the Ramazzini Foundation in Bologna, Italy, in July 2005 claimed to have shown that rats given dosages of aspartame equivalent to those in humans may develop tumours.

But European regulators who assessed this research were not convinced by it and concluded that aspartame could still be used as a food additive.

The US Food and Drug Administration says there are more than 100 studies that support aspartame's safety.

But regulators agree that there should be a limit to how much of the sweetener people consume.

An adult would have to consume 14 cans of a sugar-free drink every day to reach this limit.

There are some people who cannot safely consume aspartame. These are people with an inherited disease called phenylketonuria or PKU.

People with PKU are unable to metabolise a component of aspartame.
 
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原文出处：http://www.bbc.com/news/health-32478203 收起阅读 »

这是门诊病人跟网络上网友偶尔会问到的问题，答案是YES！怀孕时期是可以拍片子甚至做CT的。一般目前所做的X光片或CT，辐射剂量都远远低于家长需要担心的范围，因此对怀孕的影响微不足道。这不是我说的，大多数欧美的文献以及国际上公认的看法也都是如此，以下是美国妇产科医师学会2009年的建议，我简单的介绍一下。

常见的放射科检查包括 X光片，断层扫描（CT），核磁共振（MRI），以及B超（ultrasound).这几项只有X光片以及CT有辐射。

辐射对于怀孕的影响主要是从动物以及核爆的生还者身上观察出来的，辐射的负面影响包括:

1. 导致畸形或智力迟钝
2. 导致癌症
3. 导致生殖细胞的突变因而对下一代可能有基因上的影响

 
怀孕的第8-15周是对辐射最敏感的时期，这段时间如果孕妇曝露到超高剂量辐射的话（20RAD拉德以上），胎儿患有畸形或精神发育迟缓的风险会明显增高，而且剂量越大机会越大。但是如果在这段时期曝露到辐射，不超过5RAD拉德以上的剂量是不会对胎儿有影响的。而怀孕第八周以前还有第25周之后辐射导致畸形的效应是没有科学证明的！

胎儿时期曝露到辐射是否会增加癌症的几率目前没有很明确的答案，但如果有的话可能性也非常小。有些数据显示曝露到1-2RAD（拉德）的胎儿以后罹患血癌的机会会增加1-2倍。换言之一般孩子罹患血癌的机会是大约1/3000，而曝露到辐射的胎儿的机会则约1/2000. 如果为了这个风险而堕胎的话，需要把1999个健康的孩子堕掉才能预防一个血癌，不建议。

Ultrasound 也就是B超是没有辐射的，对胎儿也是安全的

MRI 核磁共振也没有辐射，基本很安全，但有时需要打显影剂好让影像更清楚；而这MRI使用的显影剂在动物实验中有增加流产的几率，但是需要在人体建议用的剂量2-7倍的情况下才可能发生，因此一般做的所谓增强的核磁（需要静脉注射显影剂）在怀孕期间也是安全的。尽管如此，目前还是建议如果可以等到产后才做的话就再等等。

做CT时用的显影剂基本也是安全，但是由于有零星的报导说可能会导致天生的甲状腺功能低，因此如果可以不用的话就不用，或等到产后再做CT。

刚刚提到胎儿怀孕期间曝露到辐射的剂量不超过5RAD拉德的话是很安全的，以下是常做的放射科检查的剂量表。
 
*1 rad = 1000 mrad  (1拉德= 1000 毫拉德）
放射科检查                                           胎儿曝露到的辐射剂量
胸透视 （前后+侧位）                          0.02–0.07 mrad
一张腹部X光片                                     100 mrad
静脉肾盂摄影                                        >=1 rad*
一张髋关节X光片                                  200 mrad
乳腺X光片                                            7–20 mrad
钡剂观察检查                                        2–4 rad
头颅或胸腔的断层扫描                          <1 rad
腹腔或腰椎的断层扫描                          3.5 rad
盆腔断层扫描                                        250 mrad
 
Data from Cunningham FG, Gant NF, Leveno KJ, Gilstrap LC 3rd, Hauth JC, Wenstrom KD. General considerations and maternal evaluation. In: Williams obstetrics. 21st ed. New York (NY): McGraw-Hill; 2001. p. 1143–58.

从这个表可以看出，要达到5拉德可不是件容易的事，如果拍一次胸片算0.1 mrad 的话，要拍5万次胸片才会对胎儿可能有影响。而剂量较高的腹部X光片也得拍个50次才会开始有危险。

断层扫描（CT）相对来说辐射剂量是高了很多，但是即使做一个腹腔CT也还不会超过5拉德这个门槛。
 
总结一下，以下是目前的建议：

1. 妇女应该被告知怀孕期间做任何单项的放射科检查不会对胎儿有影响。更具体的是所曝露的辐射剂量不超过5拉德以上是不会增加胎儿畸形或流产的几率。
2. 不应该因为担心辐射可能造成的影响而不让怀孕妇女做必要的X光检查。但怀孕期间如果合适的话，尽可能考虑用没有辐射的检查如B超或核磁共振代替CT或X光片。
3. 核磁跟B超对胎儿健康没有影响
4. 孕期妇女如果需要做多种或多次有辐射的检查，可以考虑让放射科的专家会诊，帮忙计算判断检查后胎儿可能曝露到的辐射剂量
5. 有放射性的碘的同位素在孕期是不可以在治疗使用的（这是针对某些甲抗患者）
6. 怀孕期间静脉注射显影剂做增强CT或MRI是不太可能对胎儿有任何影响，尽管如此，显影剂应该还是在对诊断跟母亲的健康利多于害的时候才用。

最后，病人也常问男方或女方照了X光之后或者做了CT之后是不是要等一段时间才能怀孕，没有这回事啦，怀孕都能照了，更何况孕前。那哺乳期呢？当然也能,不用因为做了增强CT或核磁来停止哺乳，因为目前使用的显影剂出现在母乳的量非常少，就像大多数妈妈吃的药一样也只有很少剂量会出现在母乳内，因此不必为此停止哺乳。

希望上述这些资料对一些迷惑的准妈妈有帮助。
 
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每逢节假日来临，很多人都会选择结伴出去旅游。除了看看美丽的风景，就是吃各地的美食了，在不知不觉中就对自己的身体和健康进行了一次次的“考验”。这种突然改变日常生活规律和饮食的行为很容易使身体感到不适。

出门在外，无论在豪华宾馆还是小餐馆，你都不难发现，大鱼大肉是人们节假日里餐桌上的“主打菜”。大量的研究已经表明，动物性食物摄入过多会对人们的健康带来不利影响。为此，在任何时候都要注意选择含脂肪低、能量低的食物，同时注意不过量食用。分析发现，猪肉中含的脂肪在30%以上，为牛、羊肉的两三倍，要尽量少吃；内脏口味虽美，但胆固醇含量较高，摄入过多会影响健康，应少吃为宜。鱼、虾、蚌、贝等水产品含脂肪低而富含优质蛋白质，可以适量多吃一些。
 
豆制品品种繁多，如豆腐、豆腐干、豆腐丝、香干、熏干、豆浆和豆腐脑等，这类食物营养丰富，不仅蛋白质含量高，还富含矿物质和维生素。另外，豆制品中的胆固醇含量却远远低于鱼、肉、蛋、奶。所以，在安排旅游中的饮食时，记着至少点一种豆制品，这样既可以改善膳食的营养素供给，还可避免吃肉类过多对健康的不良影响。

新鲜蔬菜富含维生素、矿物质和膳食纤维，可以补充动物性食物的不足。在旅游中的膳食安排中千万别忘了新鲜蔬菜。蔬菜种类繁多，不同品种所含营养成分不尽相同，红、黄、绿等深色蔬菜中维生素含量超过浅色蔬菜，如油菜、芹菜、苋菜、木耳菜、盖菜、雪里蕻、茴香和胡萝卜等。所有的新鲜蔬菜都含有维生素C，如辣椒、绿叶菜等。黄瓜、西红柿等所含维生素C虽然不如深色蔬菜多，如果生吃，维生素C的损失少，所以也是维生素C的一个良好食物来源。在餐桌上伴以翠绿鲜艳的蔬菜，会促进食欲。
 
“无酒不成席”，为了活跃气氛，人们往往要喝酒来表示庆贺，甚至一些平时不喝酒的人也会喝上一点点。喝酒过量有害健康，因为白酒的主要成分是酒精（乙醇），除此以外，几乎不含其他任何营养物质。所以，喝酒一定要适量。《中国居民膳食指南》中建议，每天不超过低度白酒（38度）50毫升（1两）所含的酒精量为适量，约相当于葡萄酒150毫升（1杯），啤酒450毫升（1瓶）。

不喝酒的人在用餐时常喝饮料。大多数饮料中都含有糖，不知不觉中会喝进去较多的能量，应注意适量为佳。建议选用茶（绿茶、红茶），喝茶容易失眠的，可以选用菊花茶、大麦茶、苦荞茶等。

记着，要玩好，更要吃好，寓健康与节日之中。
 
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Major achievements in pediatric research, often taken for granted, have been made possible with federal funding. A recent congressional briefing hosted by the AAP Committee on Pediatric Research highlighted discoveries from the last 40 years from the perspectives of researchers and families.
 From passenger safety laws to the use of surfactant to rotavirus vaccines, pediatric research innovations over the last four decades have led to life-saving discoveries and policy changes that many take for granted.

Despite the importance of these advancements, researchers don’t always do a good job explaining the impact of their work and how it saves lives, said Tina Cheng, M.D., M.P.H., FAAP, chair of the AAP Committee on Pediatric Research (COPR).
 
That’s one reason the committee hosted a congressional briefing in December to present to lawmakers “7 Great Achievements in Pediatric Research” (see sidebar). Researchers and family members impacted by the research spoke to a standing-room-only crowd, focusing on innovations in the members’ lifetimes.

The topics covered immunizations, pediatric cancer, saving premature infants, preventing HIV transmission from mothers to babies, reducing sudden infant death syndrome (SIDS), increasing life expectancy for children with chronic diseases, and saving lives with car seats and seat belts. Forty years ago some of these discoveries may have seemed like science fiction.
 
To help select the topics, COPR surveyed its members along with the boards of the American Pediatric Society, Academic Pediatric Association, Society for Pediatric Research, Federation of Pediatric Organizations and Association of Medical School Pediatric Department Chairs. The groups, along with the Academy, sponsored the briefing.

“We chose the seven because we felt like they were recent successes and they were successes that would resonate with the public,” said Dr. Cheng, who moderated the briefing.
 
SPEAKING FROM THE HEART

Researchers shared their perspectives, but when family members and young people offered their stories about how research changed their lives, it was even more powerful, said neonatologist Scott Denne, M.D., FAAP, past chair of COPR.

Tokunbo Olaniyan, of Columbia, Md., a young woman whose late mother had sickle cell disease, talked about how grateful she was that her mother lived to be old enough to give birth. Forty years ago, sickle cell patients in the United States typically lived to only about 14 years.
 
College student Vikram Siberry, of Olney, Md., told how a seatbelt saved him during a car accident in high school that took the life of his friend who was behind the wheel.

Dr. Denne also shared how the introduction of surfactant to treat premature babies has affected his professional life.

“The difference is as night-and-day as any intervention has ever been,” he said.

“Before surfactant, our primary tools were the ventilator, and premature babies were born and immediately struggled to breathe,” he told the group. “The ventilator caused substantial damage — major ruptures of the lung — so you had to put in chest tubes. Babies needed to stay on ventilators for prolonged periods. Many babies who left the nursery had significant lung disease, and many babies simply didn’t survive.

“A daily event was babies dying … multiple chest tubes being placed … a whole host of rooms dedicated for babies who were going to be on ventilators for months. That was the reality before surfactant,” Dr. Denne said.

Today, many babies come off ventilators more quickly, lung damage is significantly less severe and survival rates have increased substantially, he noted.
 
SIDS was addressed by Marian Willinger, Ph.D., director of the research program in SIDS at the Eunice Kennedy Shriver National Institute for Child Health and Human Development. Dr. Willinger, consultant to the AAP Task Force on SIDS, coordinated much of the research efforts on the Back to Sleep campaign. Since 1994, the overall U.S. SIDS rate has declined by more than half as a result of babies being placed on their backs to sleep.

The briefing included graphs and charts on topics such as the progress made in life expectancy for patients with sickle cell anemia and cystic fibrosis. One chart showed the steep drop in perinatally acquired AIDS in the early 1990s with the introduction of an antiretroviral medication.
 
IMPORTANCE OF FUNDING

All of the stories were designed to help lawmakers and others understand the ongoing need for federal research funding.

“It’s very important for the general public to understand how impactful investing in research can and has been,” said Dr. Denne, who said funding should be maintained or better yet, increased.

Although the seven achievements will be no surprise to any pediatrician, Dr. Cheng said they all are taken for granted sometimes and continued investment is needed.

“All of these discoveries were the result of research funding innovation that led to decreased mortality, increased life expectancy, increased quality of life. There are more research discoveries to be made.”
 
7 Great Achievements in Pediatric Research in the Past 40 Years

Preventing disease with life-saving immunizations
 
Diseases like rotavirus and Haemophilus influenzae type b are now preventable due to vaccines.

Saving premature babies by helping them breathe

Deaths from respiratory distress syndrome have been reduced by two-thirds with the introduction of surfactant.

Reducing sudden infant death syndrome (SIDS) with Back to Sleep

SIDS has declined by half due to research and the Back to Sleep campaign.

Curing a common childhood cancer

More than 90% of children with acute lymphocytic leukemia now survive, compared with 57% in the 1970s.

Preventing human immunodeficiency virus (HIV) transmission from mother to baby

Twenty years ago, one in four mothers with HIV transmitted HIV to their babies. Now the transmission rate is less than 2% due to advances in medications given during pregnancy.

Increasing life expectancy for children with chronic diseases

Life expectancy of patients with sickle cell disease or cystic fibrosis has risen from 14 years to more than 40 years.

Saving lives with car seats and seat belts

Research leading to vehicle safety laws has significantly reduced pediatric motor vehicle deaths.
 
AAP评出40年儿科研究七大成就：1.疫苗接种预防疾病。2.表面活性剂助早产儿呼吸。3.仰卧降低婴儿猝死综合征。4.治愈一种儿童常见癌症（急淋白血病存活率从70年代的57%上升到90%）5.阻断HIV母婴传播（降低至<2%）6.提高慢性疾病儿童预期寿命。7.安全座椅和安全带救了很多孩子性命。
 
中文翻译：
本文地址：http://www.wjbb.com/know/1049
原文出处：http://aapnews.aappublications.org/content/36/5/11.full 收起阅读 »

一款意大利生产的进口药物，却被纳入中国疫苗体系长达八年时间，推荐给无数孩子接种。这起疫苗医疗界的“丑闻”，直接暴露出中国公共卫生体系的管理漏洞
 
“兰菌净疫苗”风波

□本刊记者 高胜科实习生 谢如颖/文

2015年4月，辽宁省沈阳市市民李菲(化名)发现儿子三年前接种的所谓二类疫苗“兰菌净”，实际上却是一款进口药。4月10日，国家卫计委疾病预防与控制局局长于竞进在《中国疾控工作进展(2015)报告》发布会上明确表示，兰菌净不属于疫苗，而是国家药监总局批准的一种“治疗用生物制品”，不能作为疫苗使用。

看到这则新闻后，李菲知道受骗了。2012年8月，“兰菌净”被沈阳市大东区一家医院的防疫保健科作为“二类疫苗”推荐给家长们。一般情况下，家长们手中的预防接种本上，会多次推荐该疫苗，沈阳分别是在孩子1周岁龄、2.5周岁龄时推荐接种，北京则在孩子3月龄、9月龄及1.5周岁龄时共推荐三次。

兰菌净，由意大利贝斯迪药厂(Bruschettini S.R.L，下称贝斯迪)生产，中文名也叫“细菌溶解物”。4月21日，意大利药品监管局(AIFA)在给《财经》记者的邮件回复中称，兰菌净(Lantigen B)是一款口服产品，用于预防呼吸道感染。

2000年，兰菌净经原国家药监局批准在中国上市。2007年，首次被列入中国疾控中心的疫苗管理系统，全国大部分疾控部门和基层预防接种机构将其作为二类疫苗推荐使用。自此，这款意大利生产的进口药物，进入中国疫苗体系长达近八年之久，被推荐给孩子接种。

所谓二类疫苗，为公民自费、自愿接种的疫苗。兰菌净的说明书上写明“禁忌是已知对所含成分过敏者”。但多位家长表示，保健医生推荐兰菌净时并未对此充分告知，并强调感冒患儿与健康者均可使用。

“药物都有禁忌以及注意事项，进入疫苗体系后，就会被忽略。”具有医药管理经验的南京大学法学院教授邱鹭风表示，将药物混入疫苗体系，具有一定的公共安全风险隐患。

3月，江苏、河北等地个别儿童在服用兰菌净后被确诊为川崎病，恐慌情绪随之在家长群体中蔓延。川崎病是一种血管炎综合征，可导致严重心血管病变。不过，导致川崎病的成因复杂，不能简单关联与使用兰菌净的对应关系。

对健康儿童使用一款药物，除违背医学伦理以外，是否会产生毒副作用或不良反应，更为受访专家所忧虑。邱鹭风呼吁，国家卫计委有必要对使用过兰菌净的儿童群体进行普查。

疫苗、药品，两种全然不同的平行流通体系，因为“兰菌净”出现了交集，直接暴露出中国公共卫生体系的管理漏洞，而已然产生的失误该由谁承担，公共卫生行政系统的管理漏洞如何弥补？这是“兰菌净风波”落幕后的遗留问题。

被规避的处方管制

贝斯迪的中文官网上自称，1985年公司利用特有的专利技术，严格按欧盟GMP规范，研发了兰菌净，意大利药品监管局将其划分为其他类别疫苗。该产品1985年在意大利获批销售，意大利药品监管局在邮件中称，兰菌净至今仅在意大利本国销售。

4月17日，欧洲药监局发给《财经》记者的邮件回复称，“很抱歉我们不能给你提供查询信息，因为兰菌净不是一个中央权威认证药物，不过请留意，欧洲药监局对此产品正按中央授权进入一个科学评估程序。”

一位特别研究过兰菌净的中国疾控系统人士指出，兰菌净缺乏足够的临床数据支撑，既没有获得欧洲药监局的注册，也没有取得美国食品药品监督管理局(FDA)的准许。在全球最权威专业著作《疫苗学》中，未列有兰菌净。

意大利药监局在回复中称，兰菌净产品在意大利有严格的处方要求，需有医生处方才能购买，且每次处方不能重复使用，使用时还要严格遵照医嘱。这意味着治疗用途和用药途径必须由处方严格把控。

国内著名儿科专家张思莱也称，兰菌净是口服类型药物，是处方治疗药物，应在医生指导下使用。

但是，在中国疾控体系内，对疫苗没有处方要求，向家长推荐兰菌净时不必开具处方，而且推荐产品的基层保健医疗人员，一部分甚至是不具备处方权的护士。这些医护人员参加由区县级以上的疾控中心每年不定期组织的预防接种业务培训，并取得《预防接种上岗证》即可。

兰菌净受到质疑后，贝斯迪中文官网上发布多篇文章，强调兰菌净具有预防与治疗性的双重作用，并使用“治疗性疫苗”这个名词。今年3月底，两篇从标题到内容高度一致，对兰菌净介绍时也以治疗性疫苗为导向的文章，分别刊载在国家卫计委主管的《健康报》、国家药监总局主管的《中国医药(20.72, 1.21, 6.20%)报》上。

《中国医药报》的文章称，兰菌净是一种人工制备的细菌抗原提取物，是治疗性疫苗的典范。

在中国，预防用生物制品是疫苗，治疗用生物制品属药品广义范畴。兰菌净在中国另注册为“治疗用生物制品7类”，也就是在国外上市销售、但尚未在国内销售的生物制品。

所谓“治疗性疫苗”，现在还停留在新概念层面，“在中国还处于研究阶段，目前没有真正一款治疗性疫苗上市”。中国工程院院士、北京生物制品研究所原所长赵凯说。

临床试验“以药代苗”？

进口药物产品，要完成在中国的注册批准，必须在国内进行三期临床试验。

《财经》记者调查获知，香港铨福发展有限公司(下称香港铨福)帮助兰菌净完成了在国内的三期临床试验和注册，且成为该产品在中国地区销售的第一家总代理商。该公司成立于1994年，主要业务为进口药物在中国地区的注册、市场开发以及各项意大利原装药物的推广。

“把兰菌净引入中国时，我们不会考察它在国外的市场与注册情况，最主要是考虑它的适应症，在中国是否有发展前景。”一位香港铨福人士说。兰菌净由六种细菌处理后提取而成，适应症为上呼吸道细菌感染，如鼻炎、扁桃体炎及支气管炎等疾病。该公司认为，引入中国后会有很大的市场空间。贝斯迪也认同兰菌净更适用于中国等发展中国家。

这名香港铨福公司人士透露，兰菌净在原国家药监局指定的试验基地目录中，选择了北京、上海、广州等三个城市指定医院进行临床试验。当时的临床试验是按照“进口药物”类别进行的，“都是针对成人进行试验，而没有把孩子作为实验对象”。

疫苗与药物的临床试验有本质不同。

首先，疫苗试验是针对健康人群进行预防性试验，而药物通常针对特定疾病的患者进行治疗性试验。其次，疫苗试验对三期试验样本各有要求，每期逐步增加，通常第一期做安全测试只需几十人，第二期要数百人，第三期要扩大范围达到数千人，甚至超过万人。

发表于2001年、2004年的两篇论文《兰菌净对于反复发生呼吸道感染患者血清和唾液SIgA水平影响的临床研究》《多价细菌疫苗舌下滴入预防儿童反复呼吸道感染的双盲随机对照研究》均指出，兰菌净可调节机体免疫功能，减少呼吸道感染。作者来自北京大学人民医院、中日友好医院、上海复旦大学附属中山医院、广州医学院第一附属医院等呼吸科，以及广州呼吸疾病研究所。　　多位业内专家对兰菌净产品的三期临床试验的科学性提出异议，从上述两篇论文中可见，兰菌净在临床试验中选择了患者，而非健康人群，未遵循疫苗试验理论。并且，兰菌净的有效样本量分别为120人与86人，样本量偏少。

兰菌净在中国完成三期临床试验并获批，正是前国家药监局局长郑筱萸执政时期，当时是新药批文高峰期。有的药企仅需花费几万元，便可买到新药注册的全部材料，并以假样品通过药检所的检验，构成新药审批的“中国特色”。

郑筱萸2006年落马之后，要想全部清理他留下的巨量批文“遗产”，十分棘手，重新报批审核，几无可能。

贝斯迪对《财经》记者称，在华出售的兰菌净产品100%由我司生产并原装进口至中国，在华所有的药品注册、渠道销售均符合中国制定的相关法规及标准，我司对该产品具有最终解释权。

疫苗信息系统罗生门

兰菌净在中国获批后，香港铨福拿到中国独家代理权，向全国推广的渠道是医院。市场零售价为188元/支。几年后，代理权易主。

“当时的代理合同还没到期，意大利厂家要求终止合同，重新更换代理商。”上述香港铨福人士说，“对方认为我们在中国市场推广不力，对销量不是很满意。”

贝斯迪则称，公司在全球制定了严格的商业合作政策，会根据市场的变化、品牌销售情况等因素定期评估市场表现，存在商业合作模式调整的可能性。

接手中国区独家代理权的新公司，是重庆煜澍丰医药有限公司。该公司成立于2007年8月，由上海大陆药业有限公司原总经理杨杰另起炉灶而成。

上海医药(27.36, 0.12, 0.44%)集团有限公司原总裁吴建文因受贿等罪名，在2011年被判处死刑缓期两年执行。吴在受审中交代，杨杰在其帮助下，获得了兰菌净在中国的独家代理权，年销售额超过1000万元。为感谢吴并继续寻求支持，杨杰先后六次向吴行贿，共计199万余元人民币和1万美元。

2007年，中国疾控中心将兰菌净纳入中国儿童预防接种信息管理系统，列入“二类疫苗”类别的下拉菜单。二类疫苗的采购权在地方疾控部门。至此，各地预防接种机构陆续使用。

有地方疾控中心辩称，兰菌净出现在管理系统的疫苗菜单中，意即对该产品是疫苗的认定，地方可自行采购、使用。

然而，于竞进称，儿童预防接种信息管理系统的职能之一，是负责收集全国各地的生物制品使用情况，将兰菌净收集在系统中，并不说明它就是疫苗。

负责该管理系统的中国疾控中心免疫规划中心综合办人士也向《财经》记者表示，纳入该系统并不等于对“兰菌净是疫苗”的认定。

但这一说辞也饱受争议。“这个系统到底为收集信息所开发使用的，还是为了对地方有指导作用？官方回应混淆了这两个概念。”一位地方疾控系统人士对此不解，如果只为收集信息，那么为何要向全国使用平台上共享这一信息呢？

该管理系统是2005年由中国疾控中心公开招标，深圳金卫信信息技术有限公司中标并开发的。深圳金卫信公司相关负责人告诉《财经》记者，该公司负责系统在全国的技术和运行、维护工作，以往也经常增加、删减疫苗名目，但必须有中国疾控中心免疫规划中心的授权，并下发文件，才能操作。

此外，中国疾控中心在收集各地的使用信息时，也要经过严格的审核程序，并在发现问题后及时纠正。审核内容包括产品批文、临床试验数据、适应症等基本信息，从程序上要在国家疾控中心内部逐级签字审批，最终组织专家委员会评审。

一位业内人士指出，由此可见，调整系统目录的审核程序时，要么存在主观故意成分，要么则是客观的疏忽等因素造成。总之，这是把关不严造成的管理漏洞。

于竞进表示，上述信息管理系统在2014年已进行过调整，兰菌净不再纳入疫苗信息目录。但一位地方疾控中心人士告诉《财经》记者，调整后的系统，“兰菌净”改成了另一中文名“细菌溶解物”依然存在。

这位人士称，既然国家卫计委已承认兰菌净不是疫苗，那么厂商与各地疾控部门在宣传材料中称之为疫苗就是虚假宣传，应该追责；为了防止兰菌净再流入疾控体系，卫计委还应该明确通报全国接种门诊，今后不得再使用兰菌净。

是否涉嫌“商业贿赂”

国务院2005年颁布实施的《疫苗流通和预防接种管理条例》(下称《疫苗条例》)规定，疫苗生产、批发企业销售疫苗时，应提供药品监管部门依法签发的检验合格或审核批准证明复印件，经营进口疫苗的，还应提供进口药品通关单复印件。

疾控中心、接种单位在接收或购进疫苗时，应索取这些证明文件，并保存至超过疫苗有效期两年备查。

上述地方疾控中心人士判断，地方疾控部门很容易会察觉“兰菌净不是疫苗”的重大缺陷；且根据《疫苗条例》，疫苗都有专门的冷藏链条运输及保存规定，而兰菌净作为药物不用冷链保存，也很容易引起警觉。但是，在地方的采购、销售环节滋生的利益空间，导致这个前提性错误以“擦边球”的方式存在数年。

北京、辽宁、甘肃、湖南等地的基层预防接种门诊均向《财经》记者表示，销售的兰菌净全部由省级疾控中心统一采购，然后经地市级、县区级疾控中心逐级下发，最终到预防接种门诊的防疫保健科。这一程序也符合《疫苗条例》的具体规定。但据《财经》记者调查发现，除了由省级疾控中心统一采购以外，兰菌净的另一流通渠道是由各个地区代理商雇佣的销售代表，直接向基层预防接种部门推销、供应。

如兰州华卫药品生物制品有限责任公司，从中国总代理商重庆煜澍丰医药有限公司手中获得了兰菌净在甘肃地区的二级分销代理权，成为地区代理商。

“我们的销售渠道有两种，一种是疾控部门，另一种是直接面向社区医院等预防接种点。”一位兰州华卫药品公司内部人士说。后一种现象在医药流通领域被称“体外循环”，被严格禁止，因为其脱离了监管，有产品安全质量风险。

兰菌净作为一款“新疫苗”在各地推广，分别有不同的时间表。据《财经》记者的不完全统计，河北引入时间最早，2009年11月进入石家庄市疾控中心。2010年9月引入黑龙江省，2012年进入山东、云南、四川、甘肃等绝大多数地区。截至目前，仅有上海等极个别省级地区未销售过兰菌净。

“(以前)江苏省疾控中心的采购量最大，每月约用数万支。”一位曾代理过兰菌净的人士表示，从全国市场来看，北京销量不多，平均每月仅有数千支。经济相对落后地区，接种使用量也少。

吴建文案发后，多家企业涉案人员因行贿被另案处理。重庆煜澍丰医药有限公司的兰菌净销售业务未受此案影响，据该公司在招聘网站的公开消息，兰菌净自2009年销售以来，借助市场部和销售部强大的专业化推广力度，在全国销量以每年200%的幅度快速增长，总销售额近6亿元人民币。

兰菌净的售价也从最初的医院渠道每支188元一路飙升，全国的预防接种部门零售价在298元至398元之间。据媒体报道，在意大利兰菌净零售价每支14.2欧元，折合人民币90余元。

兰菌净能迅速铺开全国市场，得益于各省二级代理商的“地毯式”上门销售。兰菌净的北京地区代理商为北京亿统凯定生物技术开发有限公司，该公司招聘的“疫苗推广代表”职位上首个要求就是，在辖区区域内向防疫保健科推广，确保指标的完成或超额完成，并按公司要求拜访客户和推广，配合市场部门的计划组织各类活动，不断提高产品的认知度和市场份额。

《财经》记者获悉，该公司具体销售路径是，通过不断拜访客户，在终端环节完成“走量”，各级流通环节分别从中获利。

据业内人士透露，如按省级疾控部门统一采购为例，零售300余元/支的兰菌净，利润分摊体系为：采购成本不足百元；区域代理商环节获利百元左右；从省级疾控中心的采购价到终端零售价之间的透明、合理差价约百元(一般作为运输、人力等成本，零售价由各地物价部门确定)；此外，还有销售人员每支约20元的提成，以及销售人员给予接种门诊医生的每支数十元不等的“定期回扣结算”(通常按月结算)。

在北京个别区域，兰菌净的单支售价从最初的398元，调整为322元，给予终端环节的医生计提的“单支回扣”也从50元调整为30元。“单支回扣”在业内被称为“带金销售”模式。

在邱鹭风看来，持有代理合同的各级经销商，物价局规定的零售价，以及各级疾控部门通过正规采购渠道所产生的差价空间，可视为合法利润。但是，如果厂商或代理商向终端环节给予“回扣”，则涉嫌商业贿赂，违反《反不正当竞争法》中“经营者不得采用财物或其他手段进行贿赂以销售或者购买商品”的规定，以及《国家药品管理法》相关规定。

《财经记者独家获悉，近日，兰菌净在中国区域的总代理商再次易主，接单者为美国最大的医药分销商之一、全球百强企业康德乐公司。其在1993年进入中国市场，如今成为进口药物在华的大型批发销售公司。康德乐公司将兰菌净的在华销售权，转交给2013年收购的下属公司——广州百济新特药业连锁有限公司。

一位广州百济新特药业连锁有限公司人士称，该公司在全国有数十个加盟连锁实体药房。兰菌净目前仅在北京百济新特药房独家销售，未来能否通过连锁药房铺开全国，能否再发展分销代理模式，还要等待公司下一步的市场推广计划。

谁之过？

受利益驱动的医护人员，甚至可能扮演厂商的“基层推销员”。沈阳市民李菲清晰记得，三年前，保健医生强调该产品能有效预防手足口病，“当时电视报道正是手足口病暴发高峰期，因为这种恐慌，我们二话没说就付费了”。手足口病是一种发疹性传染病，与兰菌净适用的呼吸道感染疾病截然不同。

邱鹭风表示，药物兰菌净混迹于疫苗，会对公共利益以及接种者知情权益构成损害。如果兰菌净在医院、药房销售，消费者至少还会有更多同类药品的选择权；而“列入疫苗”后，很容易让接种者有主观的信任感，整个销售过程中带有诱导因素，更让消费者误以为其是疫苗。

“让家长认为它是疫苗，才愿意自费使用。”南开大学法学院教授宋华琳称，“鱼目混珠”改变了公众的预期，构成公共权益的侵犯，同时，也有药品滥用甚至过度医疗的可能。

《疫苗条例》中对“疫苗”的定义就是指预防、控制传染病的发生、流行，用于人体的预防性生物制品。

受访的法学专家认为，兰菌净作为“治疗用生物制品”，适应症又非针对“传染病”，却按照《疫苗条例》进行流通，从法理上，除了违反该条例，还涉嫌构成以下几种违法违规行为。

首先，“冒充疫苗”可能构成行政违法，行政机关可对厂商进行罚款，要求整改。其次，涉嫌违反《国家药品管理法》构成“销售假药、劣药”行为。“这需要司法机关介入调查并认定。”邱鹭风说。

第三，从民事侵权角度，如果认定接种后出现人命或不良的人身损害，接种者可向接种单位和药品厂家要求人身损害赔偿。

第四，“带金销售”模式涉嫌构成商业贿赂。从目前情况来看，生产兰菌净的意大利厂家把法律风险转移至中国的代理公司。“兰菌净在中国的代理商可构成行政违法行为，并涉嫌构成刑事犯罪。刑事犯罪可能涉嫌两部分，一是商业贿赂，另为冒充疫苗出售。”邱鹭风说。

对意大利厂家是否追责，要看其对中国的代理行为是否知情。如果厂家明知违规仍未制止，中国司法机关也可采取“长臂管辖”原则对其追责。

兰菌净混入疫苗事件，暴露出疾控行政管理体系有严重纰漏。邱鹭风以及清华大学公共管理学院教授、社会政策研究所执行所长李等多位专家一致认为，这种行政管理漏洞需要趁早弥补，否则未来还很可能有其他产品混入攸关儿童健康权益的疫苗系统中，“后果不堪设想”。

本刊记者曹凯对此文亦有贡献
 
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初夏将近，这几天气温也是直线飙升，高温袭来，你准备好了吗？一般在高温的情况下，人们容易出汗。出汗就会丢失水分、水溶性维生素及一些电解质。同时，高温还会使人体的消化液分泌减少，和其他季节相比，容易出现食欲下降。

许多人都喜欢吃些清凉的食物来“消暑”，例如凉菜、西瓜、冰激凌、冰镇汽水、啤酒等。但在高温天气的饮食中，我们应该注意“三多三少”。
 
1、 多饮水喝汤，少“冰冷刺激”。

每日应少量多次饮用白开水，也可饮用绿茶水、绿豆汤或酸梅汤等饮料消烦除渴。多喝汤能调节口味，增强食欲。有些人在天热的时候，喜欢来一大碗冰镇啤酒或冰镇饮料一饮而尽，这种“刺激性”降温的行为会刺激脾胃，影响胃液分泌而使食欲减退，造成消化不良、厌食、腹部胀痛、腹泻等胃肠道疾病。此外，冰冷食物虽可暂时缓解燥热，但口腔受冰冷刺激后，容易造成唾液腺及舌部味觉神经、牙周神经迅速降温，有时甚至出现麻痹状态，会刺激咽喉，引起咽炎或牙痛等不良反应。
 
2、 多蔬果，少油腻食物。

在这个时节，蔬菜瓜果种类繁多，营养丰富。市面上常见的苦瓜、冬瓜、番茄、丝瓜、南瓜、黄瓜、西瓜等，有清凉祛暑的作用。尤其是一些深色的果蔬，如胡萝卜、芒果、红黄番茄等，它们含有大量的胡萝卜素及植物化学物质，有助于增强免疫力，补充维生素、矿物质和膳食纤维。吃油腻食物会加重胃肠的负担，人们会感到腹胀，不思饮食、疲倦感加重。因此饮食应以清淡平和为主。
 
3、多熟食，少生冷。

在这个时节，人们往往喜欢生吃瓜果、海鲜等食物。值得注意的是，气温高，各种病菌和寄生虫容易繁殖，如果不注意饮食卫生，特别是到“三无”摊点吃不卫生的食物，很可能会染上疾病。民以食为天，食以安为先！

除了上述的“三多三少”外，还要保持健康的生活方式，包括充足睡眠和多做户外运动等。
 
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