美国肝病学会和美国移植学会2012年实践指南：成人肝移植成功后的长期管理

1序言 本实践指南经由美国肝病学会和美国移植学会联合批准通过。本指南为已经成功接受了成人肝移植的受体提供了一个基于数据支持的术后长期管理策略。本指南的撰写基于以下几个方面：（1）正式的已经发表的来自世界各国的回顾和分析性文献（通过Medline题目检索获得）;（2）美国医师协会卫生实践评估手册;（3）实践指南,包括美国肝病学会关于发展 和应用的政策性实践指南,以及美国胃肠病学会对实践指南的政策说明;（4）指南作者在专业领域的实践经验。     

肥胖病人体育活动强度

2005年美国发布了肥胖病人体育活动指南,该指南与许多卫生健康组织(慢性病疾病防治中心、CDC、外科总医师报告、美国运动医学学会、医学会、国际肥胖研究协会、美国饮食指南)的指南,内容大致相近.内容如下:     

美国肝病学会发布的2011临床实践指南:对慢性1型丙型肝炎病毒感染的更新治疗

此临床实践指南是由美国肝病学会发布并获得了美国感染病学会、美国胃肠病学会、全国病毒性肝炎委员会的支持. 这些建议提供了制定指南的数据支持,依据如下:(1)对全世界有关这一主题的文献进行全面回顾及分析(检索至2011年6月前的文献);(2)美国大学健康评定及制定实践指南的医师手册;(3)指南方针,包括美国肝脏病研究协会关于发展及运用实践指南的方针以及美国胃肠病学会的医疗实践指南;C4)作者对丙型肝炎的经验.     

ACCF/AHA/HRS植入器械指南中普通起搏器植入适应证解读

自从1958年第一台心脏起搏器问世,人工心脏起搏在世界各地的发展迅速崛起。目前,起搏治疗尤其是普通起搏器的临床应用已经非常普及。为了规范起搏器的临床应用,欧洲、美国以及中国均制定了临床指南,其中以美国制定的指南影响最大。1984年美国制定第一版指南,在1991年、1998年、2002年、2008年、2012年多次更新,其中1998年指南相比之前的两版（1984年,1991年）已经相对完备,随后的指南均在1998年指南的基础上进行更新。目前,普遍采用的是（2012年美国心脏病学会基金会（ACCF）／美国心脏协会（AHA）／美国心律学会（HRS）植入器械指南》。     

美国非酒精性脂肪性肝病诊疗指南解读

正2017年7月17日Hepatology杂志在线发表新版美国《非酒精性脂肪性肝病诊疗指南》,该指南是对2012年版美国肝脏病学会、美国胃肠病学会、美国胃肠病学院联合发布的实践指南的更新~([1,2])。该指南主要依据:(1)对最新发表的非酒精性脂肪性肝病(NAFLD)国际文献(截至2016年8月)的     

美国经皮冠状动脉介入治疗指南(2005年修订版)解读

2006年1月,美国心脏病学院(ACC)/美国心脏病协会(AHA)/心血管造影和介入治疗学会(SCAI)实用指南工作组发表了《经皮冠状动脉介入治疗指南(2005年修订版)》[中文译本参阅:颜红兵等编译.美国经皮冠状动脉介入治疗指南(2005年修订版).中国环境科学出版社,2006年2月]。上一版指南发     

新的饮食指南:指导健康饮食

饮食指南的不断改进,为人们提供了更多、更好的帮助。每五年,美国联邦政府都会为美国人修改一次饮食指南。在进入2011年之后的几个月内,联邦政府制定了2010年版的饮食指南。这次指南,在新的领域有了突破。实际上,在此次指南中它是第一次督促美国人少     

2007年美国肝病学会慢性乙型肝炎防治指南推荐意见介绍

本指南制定的目的在于帮助内科医师和其他保健服务人员识别、诊断、治疗慢性乙型肝炎患者。指南推荐意见为慢性乙肝患者的诊治提供基于循证医学证据的方法。推荐意见主要依据以下几方面制定：1．截至2006年2月Medline数据库发表的有关慢性乙肝防治文献及2003-2005年间会议摘要;2．美国内科医师协会健康评估、指南制定手册;3．指南制定原则,包括美国肝病学会指南完善及使用原则和美国胃肠病学会指南制定的声明;4．作者的临床实践经验。此外,本指南参照2000年、2006年国立卫生研究院“慢性乙肝治疗”大会的会议记要、2002年欧洲肝病学会慢性乙肝防治指南、2005年亚太地区慢性乙肝防治指南。本《指南》只是帮助医生对乙型肝炎诊疗和预防作出正确决策,应灵活应用。本指南的每项建议都基于相关证据。美国肝病学会指南委员会制定了推荐意见所依据证据的等级,并依据证据等级来反映推荐意见的推荐强度（表1）。由于慢性乙型肝炎的研究进展迅速,本《指南》将根据需要不断更新和完善。     

中国医师协会关于我国高血压诊断标准及降压目标科学声明

正2017年11月13日,在美国心脏病年会上,美国心脏病学学会(American College of Cardiology,ACC)、美国心脏协会(American Heart Association,AHA)等多家组织联合发布了美国成人高血压预防、检测、评估和管理指南(美国高血压新指南)~([1])。美国高血压新指南首次将高血压定义修改为血压≥130/80 mm Hg     

美国心脏学会/美国心脏病学学会心血管疾病预防指南4连发

<正>美国心脏学会/美国心脏病学学会(AHA/ACC)近期发布了4项心血管相关疾病预防指南,指南全文发表于2013年11月12日《循环》(Circulation)杂志和《美国心脏病学学会杂志》(JACC)。这4项指南分别为《2013 ACC/AHA心血管风险评估指南》、《2013 ACC/AHA降低心血管风险之生活方式管理指南》、《2013 ACC/AHA降低成人动脉粥样硬化性心血管疾病(ASCVD)风险之血胆固醇治疗指南》和《2013 AHA/ACC/TOS成人超重和肥胖管理指南》。     

Supportive evidence for the validity of the epidemiologic necropsy for gallstones

Objective:The epidemiologic necropsy measures the occurrence of unsuspected disease through the examination of necropsy records of patients who died for other reasons. The estimates of unsuspected disease derived from the epidemiologic necropsy should approximate what actually occurs in the living population. Design/setting:To test this hypothesis, all necropsy records of adult patients at the University of Kansas Medical Center from 1950 to 1984 were examined for the presence of gallstones. Patients with previous cholecystectomy or whose gallstones were diagnosed during life were excluded. The data were stratified by age and race and compared with those of a screening survey from Canada, a surgical series from New York, two screening surveys from Italy, and one from Denmark. The crude necropsy detection rates and the rates from the screening surveys were standardized to the 1970 federal census for Kansas City. Results/conclusions:The standardized occurrence rates were similar and suggest that the epidemiologic necropsy accurately assesses the occurrence of asymptomatic gallstones in the living population, thus strengthening its validity as a research tool. Received from the Division of General and Geriatric Medicine, Department of Medicine, University of Kansas Medical Center, 39th and Rainbow Boulevard, Kansas City, Kansas, and the Division of General Internal Medicine, Department of Medicine, Case Western Reserve University, Cleveland MetroHealth Medical Center, 3395 Scranton Road H-331, Cleveland, OH 44109.     

Hemodynamics Challenges for the Navigation of Medical Microbots for the Treatment of CVDs

Microbots have been considered powerful tools in minimally invasive medicine. In the last few years, the topic has been highly studied by researchers across the globe to further develop the capabilities of microbots in medicine. One of many applications of these devices is performing surgical procedures inside the human circulatory system. It is expected that these microdevices traveling along the microvascular system can remove clots, deliver drugs, or even look for specific cells or regions to diagnose and treat. Although many studies have been published about this subject, the experimental influence of microbot morphology in hemodynamics of specific sites of the human circulatory system is yet to be explored. There are numerical studies already considering some of human physiological conditions, however, experimental validation is vital and demands further investigations. The roles of specific hemodynamic variables, the non-Newtonian behavior of blood and its particulate nature at small scales, the flow disturbances caused by the heart cycle, and the anatomy of certain arteries (i.e., bifurcations and tortuosity of vessels of some regions) in the determination of the dynamic performance of microbots are of paramount importance. This paper presents a critical analysis of the state-of-the-art literature related to pulsatile blood flow around microbots.     

Standards for the diagnosis of chronic pancreatitis and for the evaluation of treatment

Summary The diagnosis of chronic pancreatitis should be based on the characteristic case history and a combination of exocrine pancreatic function tests and morphological examinations. For diagnostic purposes, an indirect pancreatic function test may be sufificient when direct tests are not available. Otherwise, and especially for scientific evaluation of chronic pancreatitis, a direct pancreatic function test is necessary. In each patient, an ultrasound examination of the pancreas should be performed and, if inconclusive, also computed tomography. In a symptomatic patient, that is, a patient suffering from relapsing pain attacks, an ERCP examination is indicated. A score for the severity of chronic pancreatitis using symptoms, results of function tests, and morphological examinations should be developed for a world-wide comparison of studies. Treatment results should be reported not earlier than 2 yr after the initiation of conservative treatment or surgery. The evaluation of treatment should be based on a score (also to be developed) making use of symptoms.     

Higher-order syzygies for the bracket algebra and for the ring of coordinates of the Grassmanian

A Poincaré resolution is given for the supersymmetric ring of brackets over a signed alphabet. As a consequence, a resolution is found for the ring of coordinates of the Grassmanian variety in projective space over any infinite field.     

Guidance for the use of thrombolytic therapy for the treatment of venous thromboembolism

Patients with venous thromboembolism (VTE) are prone to the development of both short-term and long-term complications that can substantially affect their functional capacity and quality of life. Patients with deep vein thrombosis (DVT) often develop recurrent VTE or the post-thrombotic syndrome, whereas patients with pulmonary embolism (PE) can develop long-term symptoms and functional limitations along a broad spectrum extending to full-blown chronic thromboembolic pulmonary hypertension. Clinicians who care for patients showing severe clinical manifestations of DVT and PE are often faced with challenging decisions concerning whether and how to escalate to more aggressive treatments such as those involving the use of thrombolytic drugs. The purpose of this chapter is to provide guidance on how best to individualize care to these patients.     

Early prediction of the need for non-routine discharge planning for the elderly

Successful home return from hospital admission is a key issue to provide quality healthcare in a society with numerous older subjects. Therefore, a screening method for early identification of patients who require intensive, non-routine discharge planning needs to be established. We have developed a 7-item screening sheet (the screening sheet at admission: SSA) and conducted a prospective cohort study to examine its usefulness in predicting the need for non-routine discharge planning. The SSA score yielded an area under receiver operating characteristic curve of 0.82. Moreover, a cutoff score of 2 or higher gave sensitivity, specificity and positive and negative predictive values of 0.82, 0.72, 0.13 and 0.99, respectively. A stepwise logistic regression model demonstrated that age of 75 years or more and impairment in basic activities of daily living (ADL) were significantly associated with requirement for non-routine discharge planning in surgical patients, while living alone or with a spouse aged 75 or older and readmission within 1 month were also significant predictors in medical patients. The SSA score may be useful in identifying patients who need further assessment and planning. While the four items were particularly important predictors, differences between medical and surgical patients should also be considered.