以整体观念发展人体功能和康复研究

WHO发布的《国际功能、残疾与健康分类》，为全面理解将损伤的生物医学观点与残疾的社会模式整合在一起的人体功能与康复研究奠定了基础。它提出了在提高研究能力方面面临的一系列新旧挑战。本文将从三个方面概述应对这些挑战的方法：建立深入到不同科学领域的人体功能与康复研究的组织；发展合适的学术培训项目；建立大学研究中心和合作网络。     

Heparin-induced thrombocytopenia

Opinion statement Treatment with heparin is associated with two types of thrombocytopenia. The most worrisome of these is the immune-mediated heparin-induced thrombocytopenia (HIT type II). Suspicion of HIT type II mandates immediate cessation of heparin adminis-tration and consideration of an alternative anticoagulation therapy. Hirudin and argatroban are approved alternative anticoagulants with no cross-reactivity with the HIT antibody. HIT type II is a clinicopathologic syndrome, and therefore diagnosis requires clinical and laboratory confirmation. The laboratory evaluation for HIT type II should also determine whether or not there is HIT-antibody cross-reactivity with danaparoid and low molecular weight heparin. Patients with HIT type II who require coronary artery bypass graft surgery present a particularly difficult situation, as there is no ideal alternative to heparin anticoagulation.     

Pre‐morbid type 2 diabetes mellitus is not a prognostic factor in amyotrophic lateral sclerosis

Introduction: The aim of this study was to determine whether a history of pre‐morbid type 2 diabetes mellitus (DM2) is a prognostic factor in amyotrophic lateral sclerosis (ALS). Methods: The relationship between DM2 and survival was analyzed in a study population consisting of 1,322 participants from 6 clinical trials. Results: Survival did not differ by diabetes status (log‐rank test, P = 0.98), but did differ by body mass index (BMI) (log‐rank test, P = 0.008). In multivariate analysis, there was no significant association between diabetes and survival (P = 0.18), but the risk of reaching a survival endpoint decreased by 4% for each unit increase in baseline BMI (HR 0.96, 95% CI 0.94–0.99, P = 0.001). DM2 was less prevalent among ALS clinical trial participants than predicted. Conclusions: A history of pre‐morbid DM2 is not an independent prognostic factor in ALS clinical trial databases. The low DM2 prevalence rate should be examined in a large, prospective study to determine whether DM2 affects ALS risk. Muscle Nerve 52:339–343, 2015