1、Frozen vs Fresh Fecal Microbiota Transplantation and Clinical Resolution of Diarrhea in Patients With Recurrent Clostridium difficile InfectionA Randomized Clinical Trial1、文章內(nèi)容“艱難”艱難梭菌（Clostridium difficile），又稱難辨梭菌，困難梭菌，艱難梭狀芽胞桿菌產(chǎn)芽胞，糞口傳播，腸道正常菌群專型厭氧，對(duì)氧十分敏感，很難分離培養(yǎng)故得名分離培養(yǎng)艱難，還有更難“艱難”治療艱難芽胞耐熱耐干燥酒精類手消，常規(guī)表明

2、清潔劑無(wú)法殺滅芽胞抗酸性可穿過(guò)胃酸屏障耐藥性（氨芐西林、頭孢菌素、林可霉素、克林霉素、紅霉素、四環(huán)素耐藥）以往臨床治療用萬(wàn)古霉素與四硝唑（metronidazole，商品名滅滴靈）致病性1. 假膜性結(jié)腸炎（pseudomembranous colitis，PMC）：臨床表現(xiàn)為腹瀉、腹痛、伴有全身中毒癥狀，癥狀突然開始，并伴隨血壓低，嚴(yán)重時(shí)能致死。2.抗生素相關(guān)性腹瀉（antibiotic-associated diarrhea)： 在體內(nèi)的潛伏期為5-10天，之后導(dǎo)致大量的棕色或水狀腹瀉，持續(xù)1周左右。糞菌移植FMTFecal microbiota transplantation, FMT將健

3、康人糞便中的功能菌群，移植到患者胃腸道內(nèi)，重建新的腸道菌群，實(shí)現(xiàn)腸道及腸道外疾病的治療食物中毒、腹瀉、發(fā)熱并瀕臨死亡的患者，述“飲糞汁一升，即活”（東晉葛洪肘后備急方）一般通過(guò)鼻胃管、或灌腸劑，也有口服膠囊法上課不要吃東西冷凍 VS 新鮮實(shí)驗(yàn)新鮮 vs 冷凍2、臨床試驗(yàn)設(shè)計(jì)相關(guān)詞匯Randomized, double-blinded, non-inferior trialrandomizationblindinghypothesisSingle-blind 單盲Double-blind 雙盲Triple-blind 三盲Unblinded laboratory technician 非盲化驗(yàn)員

4、Blinded investigator 盲研究員？Blinding盲法Superiority trials 優(yōu)效性試驗(yàn)Superior adj.superiority su,prrt n. Non-inferiority trials 非劣效性試驗(yàn)Inferior adj.inferiority n,frrt n.Equivalence trials 等效性試驗(yàn)Equivalence：(用途、功能、尺寸、價(jià)值等的)相等；等值Equality：（地位、權(quán)利的）平等Equation：等式、方程式、化學(xué)反應(yīng)式Classification by hypothesis假設(shè) Non-inferiorit

5、y trials 非劣效性試驗(yàn)Simple randomization簡(jiǎn)單隨機(jī)化Block randomization區(qū)組隨機(jī)化Stratified randomization分層隨機(jī)化Stratified block randomization分層區(qū)組隨機(jī)化Dynamic randomization動(dòng)態(tài)隨機(jī)化Randomization隨機(jī)StratificationBlock n. 塊；街區(qū)；大廈；障礙物；區(qū)組vt. 阻止；阻塞；限制；封蓋adj. 成批的，大塊的；交通堵塞的Patients were assigned (1:1) to frozen or fresh FMT deliver

6、ed by enema according to a computer generated random number; randomization was performed in blocks, with stratification according to major risk factors for recurrent CDI: age(65 vs 65years),setting(community vs healthcareassociated CDI), and the number of recurrent CDI episodes(2 vs 2).Stratified bl

7、ock randomization分層區(qū)組隨機(jī)化3詞匯詞根TERMINOLOGY& ROOT INTRODUCTION項(xiàng)永波2013030058CDI：艱難梭菌感染Clostridium difficile Infection klstrdmdifsil命名為何艱難？詞根-um （質(zhì)，結(jié)構(gòu)）-ile（的）FMT：糞便微生物移植fecal microbiota transformation糞便Feces fisizStool stul （凳子）Waste 例句Gentleman, I brought a small stool for you, please have a seat. rheum

8、atoid arthritisRehrumat/o-oidarthr/o-itisWaterflow風(fēng)濕Resembling樣的 joint 關(guān)節(jié)inflammation感染、炎癥ru:mtd :rrats 類風(fēng)濕性關(guān)節(jié)炎類風(fēng)濕性關(guān)節(jié)炎(rheumatoid arthritis, RA)病因不明預(yù)后不佳風(fēng)濕性關(guān)節(jié)炎(rheumatic arthritis, RA)病因明確鏈球菌感染自身免疫病rheumatoid arthritisru:mtd :rrats 療效、效益：efficacy，effectiveness，efficiencyefficacy療效療法的自身屬性effectiveness

9、療效真實(shí)療效efficiency效率，效益社會(huì)經(jīng)濟(jì)效益refractory rfrktri生理不應(yīng)期ERP：effective refractory period臨床難治性，頑固性Refractory CDI 頑固性艱難梭菌感染Enema nm灌腸Lavage lv灌洗，洗胃Gastric lavageConstipation k:nstpen便秘morbidity / mortality發(fā)病率/ 死亡率零散醫(yī)學(xué)詞匯4、詞匯的特殊翻譯顏妙名setting set有道：n. 環(huán)境；安裝；布置知網(wǎng)：設(shè)置(5322)整定(1082)設(shè)定(1290)機(jī)構(gòu)：community settingshealt

10、h care settingDESIGN, SETTING, AND PARTICIPANTS: academic medical centers in Canada設(shè)定：Given the potential advantages of providing frozen FMT, its use is a reasonable option in this setting. 波波翻譯成“在本研究的設(shè)定條件下” perturbed ptb有道：adj. 煩躁不安的；受擾動(dòng)的知網(wǎng)：攝動(dòng)(1006)擾動(dòng)(470)紊亂的：Perturbed microbiota may play a role in

11、 facilitating reinfection.blind bland有道：adj. 盲目的；瞎的知網(wǎng)：盲(5888)盲目(449)盲信(229)雙盲：double-blind知情的：an unblinded laboratory technician不知情的：blinded investigatorslogistic ldstk有道：adj. 后勤學(xué)的；數(shù) 符號(hào)邏輯的知網(wǎng)：物流(2159)后勤(708)logistic回歸(4475)物流：The usefulness of this approach may be limited by logistic difficulties in

12、preparing fresh material.resolution rezlu()n有道：n. 物 分辨率；決議；解決；決心知網(wǎng)：分辨率(12823)分辨(2906)拆分(974)療效：clinical resolution 臨床療效The proportion of patients with clinical resolution was 83.5% for the frozen FMT.primary clinical resolution 主要臨床療效relapse rlps有道：n. 復(fù)發(fā)，再發(fā)；故態(tài)復(fù)萌；回復(fù)原狀知網(wǎng)：復(fù)發(fā)(3606)復(fù)吸(241)復(fù)發(fā)的(466)clinica

13、l resolution of diarrhea without relapse recurrent rkr()nt有道：adj. 復(fù)發(fā)的；周期性的，經(jīng)常發(fā)生的知網(wǎng)：復(fù)發(fā)(6582)復(fù)發(fā)性(2444)反復(fù)(1238)recurrent Clostridium difficile Infectionassign san有道：v. 分配；指派；計(jì)數(shù) 賦值知網(wǎng)：分配(404)指派(15)轉(zhuǎn)讓(3)Patients were assigned (1:1) to frozen or fresh FMT delivered by enema according to a computer-generate

14、d random number.allocate lket有道：v. 分配；撥出；使坐落于知網(wǎng)：分配(470)配置(431)劃歸(0)Patients were randomly allocated to receive frozen (n = 114) or fresh (n = 118) FMT via enema.allocation n.5、長(zhǎng)難句臨床2013 201301014 姜晨旦Treatment failure was defined as persistence of diarrhea and a positive C difficile toxin assay or tc

15、dB polymerase chain reaction assay within 5 days of the last FMT or the need for additional therapy for CDI; colectomy; or death directly attributable to CDI at 13 weeks after the last FMT.治療失敗定義為在接受末次 FMT 治療后 5 天內(nèi)持續(xù)腹瀉并呈現(xiàn)艱難梭菌毒素試驗(yàn)或者 tcdB的 PCR 試驗(yàn)陽(yáng)性，又或是需要附加的CDI 治療；結(jié)腸切除術(shù)；或在末次 FMT 后的 13 周內(nèi)因 CDI 導(dǎo)致直接死亡。 A

16、lthough it would have been useful to determine the efficacy of FMT according to the total number of recurrences, this was not feasible because of the prolonged duration of recurrence and the history of multiple recurrences in the majority of patients.雖然根據(jù)復(fù)發(fā)總數(shù)來(lái)確定 FMT 效力本應(yīng)很有用，但由于長(zhǎng)時(shí)間的復(fù)發(fā)時(shí)間和大部分病人的多次復(fù)發(fā)史，這

17、實(shí)際是不可行的。In situations in which a related donors sample was used, the eligible relative donor collected the stool and submitted the stool at least 48 hours prior to the FMT to allow freezing and also in the morning of the scheduled FMT to the laboratory to ensure that the participant received the all

18、ocated FMT and the designated donors stool.在一個(gè)有關(guān)聯(lián)的提供者的樣本被選中時(shí)，此合適提供者在 FMT 執(zhí)行前至少 48 小時(shí)進(jìn)行糞便收集并提交， 以保證有充足的時(shí)間進(jìn)行冷凍；在預(yù)定的 FMT 執(zhí)行的早上提供者也向?qū)嶒?yàn)室提供糞便以保證參與者收到被分配的 FMT 和指定的提供者的糞便。The primary end points were no recurrence of CDI-related diarrhea at 13 weeks after receiving up to 2 FMTs without the need for antibiotics specifically for recurrence and safety.主要的研究終點(diǎn)指標(biāo)是在接受了最多兩次FMT后 在 13 周時(shí)間點(diǎn)上無(wú) CDI 相關(guān)腹瀉的復(fù)發(fā)， 特別是不再需要抗生素的復(fù)發(fā)性和安全性。C