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郴州那家皮肤科好郴州哪个男子医院治疗附睾炎郴州第一医院治疗阳痿多少钱 After 70 years, why aren’t we better at developing flu vaccines?今年的流感疫情非常严峻。从去年秋天至今,已经有数千美国人死于流感,其中包括56名儿童。美国疾病控制与预防中心已经发布了流感预警,而现在我们才刚刚进入二月,也就是流感疫情通常会集中爆发的月份。This year’s influenza season is a serious one. Thousands of Americans — including 56 children — have died from the flu since last fall. The Centers for Disease Control and Prevention (CDC) has labeled the outbreak an epidemic, and we’re barely into February, the month that typically brings the peak of the season.流感疫情如此严重的部分原因是,今年的流感疫苗注射效果是近十年来最弱的一次。这或许也可以解释今年的流感疫情为什么如此早地就达到流行病级别。美国疾病控制与预防中心表示,今年的流感疫苗有效率只有23%,远低于往年50%到60%的水平。Part of the problem is this year’s flu shot has been one of the least effective in a decade, and it may account for why we are seeing the flu reach epidemic levels so early this season. The current flu vaccine is only 23% effective, compared to between 50% and 60% efficacy for a typical seasonal flu vaccine, according to the CDC.流感疫苗并不是一项高新技术,早在1935年,人类就测试了第一流感疫苗。仅仅7年后,也就是1942年,美国就开始在美军基地里进行大规模的流感疫苗研究。那么经过了70多年的研究,为什么我们还没有创造出一种持续有效的流感疫苗呢?The flu vaccine isn’t a newfangled technology. The first human influenza vaccines were tested as early as 1935, and extensive flu vaccine studies were started on U.S. army bases in 1942. So, after more than 70 years of research, why aren’t we better at creating a consistently effective seasonal flu vaccine?分析流感变种Analyzing the strains每年2月,世界卫生组织都会召集全球流感专家进行研讨,以确定下一季流感疫苗所使用的病毒株。全球科学家和医生都在努力收集和分析当前流行的病毒株,希望找到那些有可能演化为新流感的病毒变种。The answer to that question begins in February of every year, when global flu experts and the World Health Organization meet as part of an annual consortium to peg the influenza strains for the following season’s flu vaccine美国疾病控制与预防中心的世卫合作中心负责人杰基o卡茨表示:“这是一个持续不断的过程。一个病毒的变种会衍生出一系列变种。它是一种持续不断的线性进化,但也是很难预测的。想获得一精确的流感疫苗,关键就在于及时获得病毒样本,这样我们才能及时分析,准备下一年的疫苗。”Scientists and doctors from around the world work diligently to collect and analyze the flu strains currently in circulation, looking to pinpoint mutations that could become ground zero for a new epidemic.一旦这些病毒株被确定,专家就会针对其中的三到四种,来研制下一年的疫苗。这些病毒株会被大量生产,然后交给葛兰素史克、诺华和赛诺菲等生产厂家来生产和销售——这个过程需要显著的提前期,才能保疫苗在10月初到达各地的医院。“It’s a constant process,” said Jackie Katz, the head of the CDC’s WHO collaborating center. “One set of mutations will build on another. It’s a constant sort of linear evolution, but it’s one that is very hard to predict. One of the key features to get an accurate vaccine is having the viruses arrive in time, so we can characterize and analyze these viruses for the coming season.”去年二月中旬开始的疫苗研制过程,也和往年没有什么差别。来自美国疾病控制与预防中心、美国食品药品监督(FDA)、美国国家卫生研究院和世界卫生组织和其他国际机构的官员在瑞士日内瓦召开会议,确定了下一年度可能在北半球流行的流感病毒株,然后将它们交给生产厂商。(为了给南半球研制流感疫苗,去年9月也召开了另一场类似的峰会。)Once those strains are identified, the experts choose three to four to include in the next season’s vaccine. Those strains are then produced and handed off to manufacturers, such as GlaxoSmithKline, Novartis and Sanofi, to produce and distribute — a process that requires significant lead time to ensure the doses reach doctor offices by early October.到了去年三月,一种流感病毒的变种突然出现了,科学家们知道它有肆虐的可能,但为时已晚。卡茨表示:“时间是我们研制流感疫苗最大的敌人。”This same process happened in mid-February last year. Officials from the CDC, Food and Drug Administration, National Institute of Health, WHO, and other international bodies, met in Geneva, Switzerland, to pinpoint the strains that would be prevalent in the Northern Hemisphere then handed those off to manufacturers. (A separate but similar summit happens for the Southern Hemisphere in September.)疫苗是如何生产的The problem came in March when a mutation showed up that scientists knew would wreak havoc, but it was too late. “Time is one of our biggest enemies for the flu vaccine,” said Katz.据葛兰素史克公司介绍,最普通的流感疫苗生产方法往往会使用鸡蛋,这个过程会持续5个月。几百万只受精的鸡蛋会被用作流感病毒的培养基,然后病毒会被收集、提纯并装进药瓶。在疫苗正式投放全国之前,生产厂家和FDA会测试它们的效能和安全性。How vaccines are made这个方法从上世纪50年代就开始采用。这是一个缓慢且冗长的过程,尤其是考虑到它面临的挑战。首先,生产过程依赖足够的受精鸡蛋。如果鸡蛋的供给不足,那就会影响免疫血清的产量。其次,有些病毒变种在鸡蛋里成长得并不好,有的还会发生意想不到的变异,从而影响疫苗的效能。The most common vaccine production method useschicken eggs. This process takes about five months, according to GlaxoSmithKline. Millions of fertilized eggs are used as a culture to grow influenza viruses, which are then harvested, purified and packaged into vials. Manufacturers and the FDA then test for potency and safety before shipping the lot releases around the country.约翰霍普金斯大学布隆伯格公共卫生学院教授安德鲁o皮克兹表示:“问题的关键在于要改变疫苗的生产方式,它是制约疫苗精确性的一个重要因素。其实,我们确定这些病毒株的速度是非常快的,尤其考虑到它对细节的要求。”This method has been in practice since the 1950s. It’s slow and tedious, especially given the challenges. Firstly, manufacturing relies on the availability of enough fertilized eggs. If egg supplies were ever compromised it would affect our ability to produce enough serum. Second, some flu strains don’t grow that well in chicken eggs and undergo undesirable mutations that affect the potency of a seasonal vaccine.从2013年1月起,一种新的疫苗生产方式开始进入市场。它的生产速度更快,不需要用鸡蛋作为培养基,而且它的效能可能会更高。这种疫苗被称作“重组蛋白疫苗”,它采用了一种流感病毒蛋白质,这种蛋白质是通过改变一种感染昆虫细胞的病毒的基因而合成的。它可以引发人体的免疫反应,生成保护性抗体。“The question is about changing the way these vaccines are made. It’s the real factor limiting the accuracy,” said Andrew Pekosz, a professor at Johns Hopkins University’s Bloomberg School of Public Health. “The speed at which we can identify these strains, especially given the level of detail, is very rapid.”FluBlok是第一也是首获得FDA认的重组蛋白疫苗。其制造商Protein Sciences公司的女发言人雷切尔o菲尔伯鲍姆指出:“生产出疫苗只需要几个星期,而不是几个月。另外它还含有三倍的抗原,能起到更好的保护效果。有了这项技术,我们基本上避免了时间上的拖延。”As of January 2013, a new vaccine production method hit the market. It’s faster, egg-free and potentially more effective. It’s called a recombinant protein vaccine and uses an influenza virus protein that’s made by genetically altering a virus that infects insect cells. The resulting protein is what triggers the immune response in humans to make protective antibodies.重组蛋白疫苗通常需要6到12周的生产时间。在发生流感大爆发的情况下,Protein Sciences只需要3到6个月的时间,就能向全美提供5000万流感疫苗。而用鸡蛋培养的疫苗要想达到这样的应急产量,则至少需要6个月的时间。“It takes only weeks versus months to produce,” said Rachel Felberbaum, a spokeswoman for Protein Sciences, the maker of FluBlok, the first and only FDA approved recombinant influenza vaccine. “It also has three times the antigens, which helps protect better. We can do that without a time lag because of the technology.”与时间赛跑The recombinant vaccine typically takes between six to 12 weeks to manufacture, and in the case of a pandemic Protein Sciences is y to provide 50 million doses to the U.S. government in as quickly as three to six months. Egg-based vaccines would require at least six months for similar emergency output.重组技术通过基因手段在成长速度更快的昆虫细胞中孵化流感蛋白质,从而可以为科学家节省更多宝贵的时间,更精确地确定下一季可能爆发的流感病毒变种。它必定能够帮助科学家更好地研制今年的疫苗。Vying for time皮克兹表示:“我们只需要花四五个星期的时间,就能信心十足地抓住即将流行的流感病毒变种的长尾巴。”Recombinant technology — which uses genetic modification to incubate the flu proteins in faster-growing insect cells — could help carve out the vital time that scientists need to more accurately target influenza strains that will circulate during the upcoming season. It certainly would have helped scientists better target this year’s vaccine.该技术有可能为我们节省宝贵的时间,但它仍是一项新技术。为了应对今年的流感季节,葛兰素史克公司生产了约2400万基于鸡蛋培养基生产的流感疫苗,在美国还有其他四家公司也在使用鸡蛋培养基技术。相比之下,Protein Sciences公司今年只推出了30万FluBlok流感疫苗。“All we need is to buy four to five weeks to have a high level confidence of catching the long tail of emerging variants,” said Pekosz.目前整个行业都在大力投资重组技术,其中也包括葛兰素史克。不过菲尔伯鲍姆表示,大多数厂商在这项技术上都落后了10到15年。Protein Sciences计划明年将FluBlok疫苗的产量提高到120万,不过对于美国总体的流感疫苗需求量来说,这还只是一个很小的比例。The technology has potential to buy that extra time, but it’s still new. For this year’s flu season, GlaxoSmithKline produced about 24 million vaccine doses using the egg-based method, and it is one of five companies producing traditional egg-based flu vaccines in the U.S. In comparison, Protein Sciences released 300,000 FluBlok doses this season.科学家的终极目标是研制一种能够治愈所有流感变种的疫苗。《财富》记者埃里卡o弗莱正在深入研究科学家们将如何在接下来的大约10年内实现这个目标。The industry as a whole is investing in this recombinant technology, including GlaxoSmithKline GSK -0.09% . However, most manufacturers are still about 10 to 15 years behind, said Felberbaum. Protein Sciences plans to scale up to 1.2 million FluBlok doses for the next flu season, though that’s still a small portion of the overall vaccine quantity needed for the U.S.直到现在,全球科学家还在认真准备今年二月的流感峰会,他们希望在会上精确地确定明年的流感变种——这可能会拯救几万人的生命。Ultimately, scientists hope for a universal vaccine — one shot that would cure all influenza strains.Fortune’s Erika Fry delved into how scientists are working toward that end goal, which remains nearly 10 years off.皮克兹表示:“在大多数年份里,我们的匹配工作都做得很好,这也是我们能够获得进展的情形之一,但这项工作需要各方齐心协力,不只是科学家,生产和监管环节也必须及时跟上才行。”(财富中文网)Until then, scientists around the world are working diligently to be prepared for this February’s influenza summit when they hope to accurately pinpoint next season’s strains — potentially saving tens of thousands of lives.译者:朴成奎“In most years, we have a pretty good match,” said Pekosz. “It’s one of those situations where we could improve, but it takes a really concerted effort. It’s not just science, but manufacturing and regulations.”审校:任文科 /201502/359899郴州治疗前列腺肥大的费用是多少

郴州中医男科医院割包皮“We need a national debate on nicotine,” said Mitch Zeller.“我们需要就尼古丁展开一场全民大讨论,”米奇·泽勒(Mitch Zeller)说。Zeller is the director of the Center for Tobacco Products, a division of the Food and Drug Administration created in 2009 when Congress passed legislation giving the F.D.A. regulatory authority — at long last! — over cigarettes. In addition, the center will soon have regulatory authority over other tobacco products, including electronic cigarettes, which have become enormously controversial even as they have gained in use. Through something called a “deeming rule,” the center is in the process of asserting that oversight over e-cigarettes.泽勒是烟草制品中心(Center for Tobacco Products)主任,这个食品与药品(Food and Drug Administration,简称FDA)下属机构,是国会2009年——终于!——立法授予FDA香烟管制权后成立的。除了香烟,中心不久还会获得其他烟草产品的管制权,包括使用量在增加但争议极大的电子烟。通过一个叫做“推定规则”的条款,烟草中心即将得到监管电子烟的权力。Opponents of electronic cigarettes, which include many public health officials, hope that the center will treat these new devices like it treats cigarettes: taking steps to discourage teenagers from “vaping,” for instance, and placing strict limits on the industry’s ability to market its products.包括许多公共卫生官员在内的电子烟反对者希望烟草中心能把这些新型烟具当成普通香烟一样处理:比如着手抑制电子烟在青少年中的流行,对该产业的产品营销能力进行严格限制。Proponents, meanwhile, hope that the center will view e-cigarettes as a “reduced harm” product that can save lives by offering a nicotine fix without the carcinogens that are ingested through a lit cigarette. In this scenario, e-cigarette manufacturers would be able to make health claims, and adult smokers might even be encouraged to switch from smoking to vaping as part of a reduced harm strategy.与此同时,持者则希望中心把电子烟当做一种“减害”产品,它能让人过尼古丁瘾,但又不会产生燃烧的香烟会有的致癌物。照这个说法,电子烟生产商就可以声称它们的产品有益健康,甚至将之纳入整体的减害策略,提倡成年烟民从吸烟转向吸电子烟。When I requested an interview with Zeller, I didn’t expect him to tip his hat on which direction he wanted the center to go, and he didn’t. Indeed, one of the points he made was that the F.D.A. was conducting a great deal of scientific research — more than 50 studies in all, he said — aimed at generating the evidence needed to better understand where to place e-cigarettes along what he calls “the continuum of risk.”在向泽勒提出采访请求的时候,我并不指望他会透露自己希望中心该走哪条路,他也确实没说。事实上他的其中一项表态是,FDA在做大量的科学研究——据他说在50项以上——希望能充分积累据,以便更好地判断电子烟在他所说的“风险序列”中处于什么位置。Zeller is a veteran of the “tobacco wars” of the 1990s, working alongside then-F.D.A. Commissioner David Kessler, who had audaciously labeled cigarettes a “drug-delivery device” (the drug being nicotine) and had claimed regulatory authority. Zeller left the F.D.A. in 2000, after the Supreme Court ruled against Kessler’s interpretation, and joined the American Legacy Foundation, where he helped create its hard-hitting, anti-tobacco “Truth campaign.” After a stint with a consulting firm, Pinney Associates, he returned to the F.D.A. in early 2013 to lead the effort to finally regulate the tobacco industry.泽勒是参加过1990年代“烟草战争”的老兵,辅佐当时的FDA局长戴维·凯斯勒(David Kessler),后者曾甘冒大不韪将香烟称为“药物递送装置”(药物指的是尼古丁),并为此声称自己拥有监管权。凯斯勒的解释遭到最高法院否决后,泽勒于2000年离开FDA,进入美国遗产基金会(American Legacy Foundation)工作,并在那里策动了强有力的反烟活动“真相运动”(Truth campaign)。之后他在咨询机构Pinney Associates工作过一段时间,于2013年初回到FDA,着手实现对烟草行业的监管。“I am fond of ing Michael Russell,” Zeller said, referring to an important South African tobacco scientist who died in 2009. In the early 1970s, Russell was among the first to recognize that nicotine was the reason people got addicted to cigarettes. “He used to say, ‘People smoke for the nicotine but die from the tar,’ ” Zeller recalled.“我喜欢引用迈克尔·拉塞尔(Michael Russell)的话,”泽勒说,这位南非著名烟草科学家已于2009年去世,他在1970年代初提出尼古丁是人对香烟上瘾的原因,是这一理论的先驱之一。“他说过,‘致人抽烟的是尼古丁,致人死亡的是焦油,’”泽勒说。This is also why Zeller found e-cigarettes so “interesting,” as he put it, when they first came on the market. A cigarette gets nicotine to the brain in seven seconds, he said. Nicotine gum or patches can take up to 60 minutes or longer, which is far too slow for smokers who need a nicotine fix. But e-cigarettes can replicate the speed of cigarettes in delivering nicotine to the brain, thus creating real potential for them to become a serious smoking cessation device.这也是为什么当市场上刚出现电子烟的时候,泽勒会说这是个“有意思的”东西。他说香烟可以在七秒钟内将尼古丁送达大脑。尼古丁咀嚼糖或贴片需要长达60分钟,甚至可能更久,对希望过尼古丁瘾的烟民来说实在太慢。但电子烟的尼古丁递送速度可以和香烟媲美,因此有望成为正经的戒烟手段。But there are still many questions about both their safety and their efficacy. For instance, are smokers using e-cigarettes to quit cigarettes, or they using them to get a nicotine hit at times when they can’t smoke cigarettes? And beyond that there are important questions about nicotine itself, and how it should be dealt with.但人们对它的安全性和功效仍然有很多疑问。比如烟民是在用电子烟戒香烟,还是在不能抽香烟时,用它来过尼古丁瘾呢?除此之外,关于尼古丁本身及其处置方式,也有一些重要的问题尚待解答。“When nicotine is attached to smoke particles, it will kill,” said Zeller. “But if you take that same drug and put it in a patch, it is such a safe medicine that it doesn’t even require a doctor’s prescription.” That paradox helps explain why he believes “there needs to be a rethink within society on nicotine.”“尼古丁和烟尘颗粒在一起,可以致命,”泽勒说。“但同一种药物放到贴片里就安全了,安全到连医生处方都不需要。”正是出于这种困惑,他认为“社会对尼古丁需要有一个重新的认识”。Within the F.D.A., Zeller has initiated discussions with “the other side of the house” — the part of the agency that regulates drugs — to come up with a comprehensive, agency-wide policy on nicotine. But the public health community — and the rest of us — needs to have a debate as well.泽勒在FDA内部已经开始跟“房子那一头的人”——负责药物监管的部门——讨论制定一个全面的、各部门统一的尼古丁政策。但公共卫生领域,以及我们大家,也需要展开讨论。“One of the impediments to this debate,” Zeller said, is that the e-cigarette opponents are focused on all the flavors available in e-cigarettes — many of which would seem aimed directly at teenagers — as well as their marketing, which is often a throwback to the bad-old days of Big Tobacco. “The debate has become about these issues and has just hardened both sides,” Zeller told me.泽勒说,“阻碍这种讨论的其中一个因素”是,电子烟反对者抓住了电子烟的多种口味——其中许多口味是直接迎合青少年的——以及它们的营销方式,时常让人想起穷凶极恶的“大烟草公司”时代。“讨论已经开始围绕这些问题展开,导致双方的态度都强硬起来,”泽勒对我说。It’s not that Zeller believes nicotine is perfectly safe (he doesn’t) or that we should shrug our shoulders if teenagers take up vaping. He believes strongly that kids should be discouraged from using e-cigarettes.这并不表示泽勒相信尼古丁是绝对安全的(他不这么认为),或者我们不需要把青少年吸电子烟太当回事。他坚信应该设法制止青少年使用电子烟。Rather, he thinks there should be a recognition that different ways of delivering nicotine also come with different risks. To acknowledge that, and to grapple with its implications, would be a step forward.他的看法是我们应该认识到,不同的尼古丁递送方法,带来的风险也是不同的。明确这一点,面对它可能带来的后果,就是一种进步。“This issue isn’t e-cigarettes,” said Mitch Zeller. “It’s nicotine.”“问题不在电子烟,”米奇·泽勒说。“在尼古丁。” /201506/380650郴州治疗梅毒需要多少费用 郴州最好的早泄医院

郴州市第一人民医院南院治疗男性不育多少钱 SEOUL, South Korea — South Korea said on Tuesday that it would investigate all hospitalized pneumonia patients to determine whether they had been exposed to Middle East respiratory syndrome, as it struggled to contain an outbreak of the virus that has infected 95 people in the country and killed seven.韩国首尔——韩国周二表示,将对所有入院治疗的肺炎患者进行排查,以确定他们是否曾接触中东呼吸综合征(Middle East Respiratory Syndrome,简称MERS)。目前,韩国正在艰难地控制MERS疫情,这里已有95人受到感染,7人丧生。The outbreak of the virus, known as MERS, in South Korea is the largest reported outside Saudi Arabia, where more than 440 people have died of the disease since it was discovered there in 2012. MERS symptoms are similar to those of pneumonia.据报道,除沙特阿拉伯以外,MERS疫情在韩国最为严重。自2012年在沙特发现这种疾病以来,该国已有逾440人死于MERS。这种疾病的症状与肺炎类似。Although a vast majority of MERS patients in South Korea were infected in two hospitals, cases have also been found in seven other hospitals in Seoul, the capital, and elsewhere.尽管韩国的绝大多数MERS患者是在两家医院受到感染的,但是首都首尔的另外七家医院及其他一些地方,也发现了MERS病例。Nearly 2,900 people who had been near any of the confirmed cases had been isolated as of Tuesday, to be monitored for symptoms by the government. More than 2,200 schools remained closed.截至周二,曾与确诊病例有过较密切接触的近2900人被隔离,接受政府对他们进行的观察,看是否会出现相关症状。有2200多所学校处于停课状态。The government said that on Wednesday it would interview all hospitalized pneumonia patients and also check their medical records to see if they had recently visited any of the hospitals where the infection had been found. South Korea’s first MERS case, a 68-year-old man who had traveled to Saudi Arabia and neighboring countries, was discovered to have the virus on May 20.韩国政府表示将于周三对所有入院治疗的肺炎患者进行询问,并检查他们的医疗记录,看是否曾于近期前往发现感染病例的医院。韩国的首名MERS患者是一名68岁的男子,曾去往沙特阿拉伯及多个邻国。5月20日,他被发现携带这种病毒。Interviewing pneumonia patients is intended “to find any suspected case we have missed and to prevent a further sp of the virus,” the Health Ministry said in a statement. “Once we find a suspected patient, we will move him into a one-bed room and run a DNA test to determine if he carries the MERS virus.”走访肺炎患者是为了“发现我们漏掉的任何疑似病例,阻止病毒进一步传播”,韩国卫生部发表声明称。“一旦发现疑似患者,我们会将他转移至单人病房,并通过DNA测试来判定他是否携带MERS病毒。”The government announced the plan after acknowledging it had failed to isolate some suspected cases soon enough. On Tuesday, four new MERS cases were found in three hospitals that had not been on the government list of infected hospitals.在宣布上述计划之前,政府承认自己没能尽快隔离一些疑似病患。周二,在三家并未列在政府之前公布的感染名单上的医院中,发现了四例新的MERS病例。On Tuesday, Hong Kong issued a “red alert” travel warning for South Korea, while the World Health Organization began work on a joint mission with South Korean doctors and officials to assess the outbreak in the country and review the government response.周二,香港发布了针对韩国的“红色”外游警示,世界卫生组织(World Health Organization)则开始与韩国医疗人员和官员一起开展联合行动,以评估该国的疫情,并审核政府的应对举措。The travel alert “advises Hong Kong residents to avoid nonessential travel to Korea, including leisure travel,” the Hong Kong government said in a statement. It advised those aly in South Korea to “avoid unnecessary visits to health care facilities.”香港政府的声明称,旅游警示“建议市民,如非必要,避免前赴韩国,包括前往当地旅游”。政府还建议身在当地的港人“尽量避免到访当地的医疗机构”。Hong Kong has been sensitive to infectious diseases since the outbreak of SARS in 2003, which killed hundreds of people.自2003年爆发严重急性呼吸综合征(SARS)疫情并导致数百人死亡以来,香港对传染性疾病一直比较敏感。Also on Tuesday, the airline Cathay Pacific, which is based in Hong Kong, and its subsidiary, Dragonair, said they would waive fees for people to rebook travel to South Korea from Hong Kong, given the travel alert.同样在周二,总部位于香港的国泰航空及其子公司港龙航空宣布,鉴于旅游警示,它们将免除乘客更改从香港到韩国的机票所需的费用。 /201506/380094郴州哪个精囊炎医院好郴州第一医院包皮手术怎么样



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