Assessment of the Safety of Aquatic Animal Commodities for International Trade: The OIE Aquatic Animal Health Code

Trading of aquatic animals and aquatic animal products has become increasingly globalized during the last couple of decades. This commodity trade has increased the risk for the spread of aquatic animal pathogens. The World Organisation for Animal Health (OIE) is recognized as the international standard‐setting organization for measures relating to international trade in animals and animal products. In this role, OIE has developed the Aquatic Animal Health Code, which provides health measures to be used by competent authorities of importing and exporting countries to avoid the transfer of agents pathogenic for animals or humans, whilst avoiding unjustified sanitary barriers. An OIE ad hoc group developed criteria for assessing the safety of aquatic animals or aquatic animal products for any purpose from a country, zone or compartment not declared free from a given disease ‘X’. The criteria were based on the absence of the pathogenic agent in the traded commodity or inactivation of the pathogenic agent by the commercial processing used to produce the commodity. The group also developed criteria to assess the safety of aquatic animals or aquatic animal products for retail trade for human consumption from potentially infected areas. Such commodities were assessed considering the form and presentation of the product, the expected volume of waste tissues generated by the consumer and the likely presence of viable pathogenic agent in the waste. The ad hoc group applied the criteria to commodities listed in the individual disease chapters of the Aquatic Animal Health Code (2008 edition). Revised lists of commodities for which no additional measures should be required by the importing countries regardless of the status for disease X of the exporting country were developed and adopted by the OIE World Assembly of Delegates in May 2011. The rationale of the criteria and their application will be explained and demonstrated using examples.     

国际疾病分类体系概述及其对战伤分类信息标识体系设计的启示

国际疾病分类体系（ICD）是由世界卫生组织（WHO）依据疾病特征,按照特定分类规则,对疾病信息以字母和数字代码进行表达的体系。ICD构建了国际统一的疾病分类信息的标准,构成了全球医疗健康数据的基础,推动了全球医疗信息应用,在国际上得到了广泛使用,并根据应用需求不断进行完善升级。与此同时,ICD在军事领域也得到了较为普遍的应用,例如,美军将ICD融入其卫勤保障体系中,在提升战伤救治质量、优化卫勤决策方面发挥了基础性的积极作用。ICD最新版本ICD-11具有先进科学的基础模型系统以及较为完善的内容体系,在军事领域应用方面具有一定的优势。因此,我军应在整合现有成果的基础上,吸收借鉴ICD发展和外军应用实践的经验,针对战伤分类信息标识应用的实际需求,构建完善的战伤分类信息标识体系,提升战伤分类的先进性和科学性,为未来的军事斗争卫勤准备提供有力支撑。     

International survey of cochlear implant candidacy

Background: The goal of this work was to determine international differences in candidacy based on audiometric and speech perception measures, and to evaluate the information in light of the funding structure and access to implants within different countries.

Method: An online questionnaire was circulated to professionals in 25 countries. There were 28 respondents, representing the candidacy practice in 17 countries.

Results: Results showed differences in the funding model between countries. Unilateral implants for both adults and children and bilateral implants for children were covered by national funding in approximately 60% of countries (30% used medical insurance, and 10% self-funding). Fewer countries provided bilateral implants routinely for adults: national funding was available in only 22% (37% used medical insurance and 41% self-funding). Main evolving candidacy areas are asymmetric losses, auditory neuropathy spectrum disorders and electro-acoustic stimulation. For countries using speech-based adult candidacy assessments, the majority (40%) used word tests, 24% used sentence tests, and 36% used a mixture of both. For countries using audiometry for candidacy (70–80% of countries), the majority used levels of 75–85?dB HL at frequencies above 1?kHz. The United Kingdom and Belgium had the most conservative audiometric criteria, and countries such as Australia, Germany, and Italy were the most lenient. Countries with a purely self-funding model had greater flexibility in candidacy requirements.     

Predicting three-month and 12-month post-fitting real-world hearing-aid outcome using pre-fitting acceptable noise level (ANL)

Objective: Determine the extent to which pre-fitting acceptable noise level (ANL), with or without other predictors such as hearing-aid experience, can predict real-world hearing-aid outcomes at three and 12 months post-fitting. Design: ANLs were measured before hearing-aid fitting. Post-fitting outcome was assessed using the international outcome inventory for hearing aids (IOI-HA) and a hearing-aid use questionnaire. Models that predicted outcomes (successful vs. unsuccessful) were built using logistic regression and several machine learning algorithms, and were evaluated using the cross-validation technique. Study sample: A total of 132 adults with hearing impairment. Results: The prediction accuracy of the models ranged from 61% to 68% (IOI-HA) and from 55% to 61% (hearing-aid use questionnaire). The models performed more poorly in predicting 12-month than three-month outcomes. The ANL cutoff between successful and unsuccessful users was higher for experienced (～18 dB) than first-time hearing-aid users (～10 dB), indicating that most experienced users will be predicted as successful users regardless of their ANLs. Conclusions: Pre-fitting ANL is more useful in predicting short-term (three months) hearing-aid outcomes for first-time users, as measured by the IOI-HA. The prediction accuracy was lower than the accuracy reported by some previous research that used a cross-sectional design.     

The International Registry of Acute Aortic Dissections (IRAD) – experiences from the first 20 years

Abstract

An international collaboration on various aspects of acute aortic syndromes, IRAD or The International Registry of Acute Aortic Dissections, is celebrating its 20th anniversary this year (2016). In this paper, we present important lessons learned during these first 20 years.     

弥漫大 B 细胞淋巴瘤患者 Th17细胞及相关细胞因子水平与预后的关系

目的：探讨弥漫大B细胞淋巴瘤（ DLBCL）患者Th17细胞及相关细胞因子水平与预后的关系及其意义。方法将60例DLBCL患者按照国际预后指数（IPI）评分分为低中危组32例和中高危组28例,另选健康者30例作为对照组。采用流式细胞术检测各组外周血中Th17细胞比例,ELISA检测外周血相关细胞因子白细胞介素（ IL）－17、IL－21、IL－23、转化生长因子－β（ TGF－β）的表达水平,分别比较各组之间Th17细胞及相关细胞因子水平的差异,并分析其与IPI评分的相关性;分析随访的54例患者Th17细胞水平与生存率的关系。结果（1）中高危组Th17细胞、IL－17、IL－21均低于对照组和低中危组,IL－23低于对照组,TGF－β高于对照组和低中危组,差异均有统计学意义（P＜0．05）。（2）DLBCL患者Th17细胞、IL－17、IL－21与IPI评分呈负相关,TGF－β与IPI评分呈正相关,相关性有统计学意义（P＜0．05）。（3）高Th17细胞者和低Th17细胞者3年生存率分别为82．1％和45．0％,Th17细胞水平对DLBCL患者生存的影响有统计学意义（P＝0．021）。结论 DLBCL患者Th17细胞及相关细胞因子水平与IPI评分密切相关,Th17细胞与IPI评分呈负相关。 Th17细胞对预后有影响,可能在DLBCL的发生发展中起着抑制作用。     

新一轮药品集中采购价格10省份间对比研究

目的研究我国10省份新一轮药品集中采购药品中标价格差异,为进一步完善我国各省份药品集中采购工作提供参考。方法基于"2015年全国样本医院药品采购排行榜"和各省份新一轮集中采购目录选择15种药品,通过对比研究法对15种药品的省份间价格、国产药与进口药的价格进行分析,在借鉴世界卫生组织/国际卫生行动组织药品价格标准调查法的基础上,将各省份的药品价格与国际参考价格进行对比分析。结果同种药品在各省份的采购价格不相同,福建省价格明显低于其他省份价格,少数进口药价格明显高于国产药价格,部分药品的中位价格比值超过了合理区间。结论建议各省份参考福建在药品集中采购方面的有益经验,完善各自的集中采购方案;各省份应对国产通过一致性评价的仿制药、进口专利或原研药一视同仁,给予两者公平竞价的机会;将国际参考价格纳入限价参考体系中,制定更加合理的限价标准。