世界経済・社会統計 = World development indicators

4 CLINICAL PARTICULARS 4.1 Therapeutic Indications Trimetazidine is indicated in adults as add-on therapy for the symptomatic treatment of patients with stable angina pectoris who are inadequately controlled by or intolerant to first-line antianginal therapies. 4.2 Posology and method of administration Oral administration. Posology The dose is one tablet of 35mg of trimetazidine twice daily during meals. Special populations Renal impairment In patients with moderate renal impairment (creatinine clearance [30-60] ml/min) (see sections 4.4 and 5.2), the recommended dose is 1 tablet of 35mg in the morning during breakfast. Elderly Elderly patients may have increased trimetazidine exposure due to age-related decrease in renal function (see section 5.2). In patients with moderate renal impairment (creatinine clearance [30-60] ml/min), the recommended dose is 1 tablet of 35mg in the morning during breakfast. Dose titration in elderly patients should be exercised with caution (see section 4.4). Health Products Regulatory Authority

Summary of product characteristics

Streptococcus pneumoniae (pneumococcus) is a major cause of worldwide mortality and morbidity, and to a large extent is vaccine-preventable. Nasopharyngeal carriage of pneumococcus precedes disease and is the source of pneumococcal spread between people. The use of vaccine effect on carriage as part of the vaccine licensure and post-vaccine introduction evaluation could facilitate and expand the licensure of new, life-saving pneumococcal vaccines and enable a comprehensive estimate of population effects after vaccine introduction. The authors provide a review of the evidence supporting pneumococcal carriage at the individual level as an immediate and necessary precursor to pneumococcal disease. Based on such a causal link between carriage and disease, the authors emphasize the role of information on pneumococcal carriage in vaccine trials and in public health decision-making.

The fundamental link between pneumococcal carriage and disease

Summary Background The Finnish Invasive Pneumococcal disease (FinIP) vaccine trial was designed to assess the effectiveness of a pneumococcal vaccine containing ten serotype-specific polysaccharides conjugated to Haemophilus influenzae protein D, tetanus toxoid, and diphtheria toxoid as the carrier proteins (PHiD-CV10) against invasive pneumococcal disease. Methods In this cluster-randomised, double-blind trial, children aged younger than 19 months received PHiD-CV10 in 52 clusters or hepatitis vaccines as control in 26 clusters. Infants aged younger than 7 months at the first vaccination received either a 3+1 or a 2+1 vaccination schedule, children aged 7–11 months received a 2+1 schedule, and those 12–18 months of age received a two-dose schedule. The primary and secondary objectives were to assess vaccine effectiveness against culture-confirmed invasive pneumococcal disease due to any of the ten vaccine serotypes for the 3+1 and 2+1 schedules, respectively, in children who received at least one PHiD-CV10 dose before 7 months of age. Masked follow-up of pneumococcal disease lasted from the first vaccination (from February, 2009, to October, 2010) to January 31, 2012. Invasive disease data were retrieved from data accumulated in the national infectious diseases register. This trial and the nested acute otitis media trial are registered with ClinicalTrials.gov, numbers NCT00861380 and NCT00839254, respectively. Findings 47 366 children were enrolled from February, 2009, to October, 2010. 30 527 participants were assessed for the primary objective. 13 culture-confirmed vaccine-type cases of invasive pneumococcal disease were detected: none in the PHiD-CV10 3+1 group, one in the PHiD-CV10 2+1 group, and 12 in the control groups. The estimates for vaccine effectiveness were 100% (95% CI 83–100) for PHiD-CV10 3+1 and 92% (58–100) for PHiD-CV10 2+1 groups. Two cases of any culture-confirmed invasive disease irrespective of serotype were detected in combined PHiD-CV10 infant cohorts compared with 14 in the corresponding control cohorts (vaccine effectiveness 93%, 75–99). In catch-up cohorts, seven cases of invasive disease were reported, all in the control group: two cases in the children enrolled at 7–11 months of age; and five cases in children enrolled at 12–18 months of age (vaccine effectiveness 100%, 79–100). Non-fatal serious adverse events suspected to be vaccine-related were reported via routine post-immunisation safety surveillance in 18 children. Interpretation This nationwide trial showed high PHiD-CV10 effectiveness against invasive pneumococcal disease when given in different schedules. For the first time, effectiveness of a 2+1 schedule in infants was confirmed in a clinical trial. Funding GlaxoSmithKline Biologicals SA and National Institute for Health and Welfare, Finland.

Effectiveness of the ten-valent pneumococcal Haemophilus influenzae protein D conjugate vaccine (PHiD-CV10) against invasive pneumococcal disease: a cluster randomised trial

The advances in cancer biology and pathogenesis during the past two decades, have resulted in immunotherapeutic strategies that have revolutionized the treatment of malignancies, from relatively non-selective toxic agents to specific, mechanism-based therapies. Despite extensive global efforts, infectious diseases remain a leading cause of morbidity and mortality worldwide, necessitating novel, innovative therapeutics that address the current challenges of increasing antimicrobial resistance. Similar to cancer pathogenesis, infectious pathogens successfully fashion a hospitable environment within the host and modulate host metabolic functions to support their nutritional requirements, while suppressing host defenses by altering regulatory mechanisms. These parallels, and the advances made in targeted therapy in cancer, may inform the rational development of therapeutic interventions for infectious diseases. Although "immunotherapy" is habitually associated with the treatment of cancer, this review accentuates the evolving role of key targeted immune interventions that are approved, as well as those in development, for various cancers and infectious diseases. The general features of adoptive therapies, those that enhance T cell effector function, and ligand-based therapies, that neutralize or eliminate diseased cells, are discussed in the context of specific diseases that, to date, lack appropriate remedial treatment; cancer, HIV, TB, and drug-resistant bacterial and fungal infections. The remarkable diversity and versatility that distinguishes immunotherapy is emphasized, consequently establishing this approach within the armory of curative therapeutics, applicable across the disease spectrum.

Principles of Immunotherapy: Implications for Treatment Strategies in Cancer and Infectious Diseases.

Introduction: Pneumococcal conjugate vaccines (PCVs) have provided a significant clinical and economic impact globally. The majority of countries which have implemented an infant PCV program have o...

Review of vaccine effectiveness assumptions used in economic evaluations of infant pneumococcal conjugate vaccine.

The 13-valent pneumococcal conjugate vaccine (PCV) has been part of routine immunisation in a 2 + 1 schedule (two primary infant doses and one booster during the second year of life) in the UK since 2010 Recently, the UK's Joint Committee on Vaccination and Immunisation recommended changing to a 1 + 1 schedule while conceding that this will increase disease burden; however, uncertainty remains on how much pneumococcal burden - including invasive pneumococcal disease (IPD) and non-invasive disease - will increase We built a dynamic transmission model to investigate this question The model predicted that a 1 + 1 schedule would incur 8777-27 807 additional cases of disease and 241-743 more deaths over 5 years Serotype 19A caused 55-71% of incremental IPD cases Scenario analyses showed that booster dose adherence, effectiveness against carriage and waning in a 1 + 1 schedule had the most influence on resurgence of disease Based on the model assumptions, switching to a 1 + 1 schedule will substantially increase disease burden The results likely are conservative since they are based on relatively low vaccine-type pneumococcal transmission, a paradigm that has been called into question by data demonstrating an increase of IPD due to several vaccine serotypes during the last surveillance year available

/pdf/dynamic-transmission-modelling-to-address-infant-51kzvna2ln.pdf

Dynamic transmission modelling to address infant pneumococcal conjugate vaccine schedule modifications in the UK.

Background: The 13-valent pneumococcal conjugate vaccine (PCV13) is the only PCV licensed to protect against serotype 3 in children. However, conflicting estimates exist of PCV13’s direct and indirect protection vaccine effectiveness (VE) for serotype 3. Objective: Our study examined the of PCV13 for serotype 3 using different assumptions for PCV13 direct and indirect VE to model trends in serotype 3 invasive pneumococcal disease (IPD) and comparing these to observed data from the United Kingdom (UK). Methods: A dynamic transmission model of the spread of pneumococcal carriage and development of IPD was used to fit pre-PCV13–modeled IPD incidence with observed data. To allow for comparison across scenarios, post-PCV13–modeled IPD incidence was fit to observed data using assumptions for three different scenarios: (scenario 1) serotype 3 as a nonvaccine serotype, (scenario 2) VE against serotype 3 IPD of 63.5% based on a recent meta-analysis, and (scenario 3) a model-estimated VE against serotype 3. Results: Post-PCV13 introduction, modeled 2017 and average annual serotype 3 IPD incidence were within 20% and 59% of observed values for scenarios 2 and 3, respectively, but deviated by >100% for scenario 1. For adults aged ≥65 years, modeled 2017 IPD incidence in scenario 1 differed from observed data by 16% versus roughly 8% in scenarios 2 and 3. Conclusions: Observed data do not support a scenario of no serotype 3 VE, but rather a combination of direct protection among vaccinated children and a lower level of indirect protection among older adults. Policymakers should consider transmission dynamics when examining VE against covered serotypes.

/pdf/estimating-the-vaccine-effectiveness-against-serotype-3-for-3d317v4qim.pdf

Estimating the Vaccine Effectiveness Against Serotype 3 for the 13-Valent Pneumococcal Conjugate Vaccine: A Dynamic Modeling Approach

Introduction In November 2015, the Joint Committee on Vaccination and Immunisation (JCVI) recommended against including PCV13 for age based and risk based populations. 1 A principal driver of this recommendation was the incidence of hospitalised pneumococcal pneumonia, reported by Rodrigo et al. 2 Using the Results from the study by Rodrigo et al a simple calculation can be performed to approximate the incidence of vaccine preventable pneumococcal CAP from all cause hospitalised CAP (ACH-CAP). The national Hospital Episodes Statistics (HES) database 3 reports a significantly higher incidence of ACH-CAP which could impact the potential benefit provided by PCV13. Aim To compare the incidence of ACH-CAP reported in the study by Rodrigo et al. 2 with the incidence of ACH-CAP coded in HES in the corresponding population, over a similar period of time. Materials and Methods The study by Rodrigo et al ran from September 2008 for 5 years. Inpatients≥16 years old, with symptoms suggestive of lower respiratory tract, new CXR infiltrates consistent with pneumonia, and treated for CAP, were included. 2 Our HES analysis included patients≥18 years old with (ICD-10) codes J12–J18 4 (April 2008 – March 2013) admitted to the hospitals in Rodrigo’s study (Nottingham University Hospitals NHS Trust – City Campus and Queen’s Medical Centre Campus). Results Rodrigo and colleagues identified 2702 adults while our analysis of HES identified 11 059 across both sites. Conclusion The study by Rodrigo et al was not specifically designed to capture total incidence of ACH-CAP, instead its objective was to report on pneumococcal serotype evolution. 2 Miscoding and misdiagnosis of pneumonia in HES is well-recognised 5 but doesn’t appear to explain the four-fold difference in these numbers. Further investigation to validate HES data against hospital records could be performed. Accurate incidence data would impact cost-effectiveness analyses and facilitate a more informed decision next time the data is reviewed. Please refer to page A257 for declarations of interest in relation to abstract S6. References https://app.box.com/s/iddfb4ppwkmtjusir2tc/1/2199012147/22846051967/1 Rodrigo et al . Eur Respir J 2015;45:1632–1641. http://content.digital.nhs.uk/hes http://www.icd10data.com/ICD10CM/Codes Daniel et al . Thorax 2017;72(4):376–379.

https://thorax.bmj.com/content/thoraxjnl/72/Suppl_3/A7.full.pdf

S6 Establishing the true incidence of hospitalised community acquired pneumonia (cap) in the uk: a hospital episode statistics (hes) analysis

POSC177 Healthcare Utilisation and Inpatient Mortality in Patients Hospitalised with Pneumonia with and without COPD: A Retrospective Cohort Study

Handle everyday research tasks with reliable, citation-backed results

Your personal Research Agent to handle research tasks with citation-backed results

Popular Tasks used by Researchers

How can I help with your research?

Meet SciSpace

Get more enhanced response by uploading the PDFs you want me to reference.

No relevant PDFs in your library

SciSpace is the AI research assistant for academics. Run systematic literature reviews on 280M+ papers, and write papers with cited sources. Trusted by 1M+ students, PhDs & researchers.

SciSpace | AI for Research

Analyze PDFs

Code & Manuscripts

Funding & Grants

Literature & Patents

Medical & Clinical Data

Systematic Review

Visualize & Present

Web & Data

Build a Google Scholar-like website for your research.

Build a website

Create charts and images for your research

Create a Chart

Write a paper for submission to a journal

Draft a manuscript

Patent Search

Design eye-catching scientific posters in minutes.

Scientific Poster Generation

Systematic Literature Review

One task is running at the moment. Your messages will be shown right after.

Drag and drop or click here to browse

Loved by <highlight>1 million+</highlight> researchers

Extract a list of specific topics and their sources from unstructured text

Topics

Compare and analyze relevant papers that matches with your search

Papers

Get insights from PDFs and bookmarked papers from your library

My library

Recent searches

Try searching for:

Catch AI-generated content in scholarly and non-scholarly content

{ai} Detector

Ai Writer

Get PDF Summaries, highlighted text explanations 

Chat with PDF

Effortlessly create in-text citations and bibliographies in APA and 2,500 other formats

Citation generator

Get explanations, summaries, and answers on academic papers

Ease up your research workflow with {scispace}'s cohort of exciting AI tools

Elevate your academic writing skills and convey your ideas the way you want

Paraphraser

Explore our range of reading and writing tools

Your file is being prepared and should be ready in a few minutes. If it's a large file, it might take a bit longer. You can close this window, and we'll email you the file when it's done.

You have reached a maximum limit of <strong>{limit}</strong> columns in the table. Remove at least <strong>1</strong> column to add or create another one.

D Jones

Author Tools

Chat about Author