冠状动脉旁路移植术后心脏康复专家共识

冠状动脉旁路移植术(CABG)是治疗冠心病常见的血运重建手段。CABG后心脏康复是一项综合的、整体的全程医疗管理模式,包括运动治疗、二级预防用药、营养支持、心理管理、戒烟等方面,CABG后规范的心脏康复对于降低再住院率,提高患者运动能力和生活质量以及预防心血管不良事件等方面具有积极意义。因此,为了促进我国CABG后心脏康复的规范化发展,国家心血管病中心、CABG后心脏康复专家共识编写委员会在2016年《中西医结合冠状动脉旁路移植术Ⅰ期心脏康复专家共识》的基础上,就CABG后心脏康复相关问题进行深入探讨,制定了我国CABG后心脏康复专家共识。其中,针对CABG后心脏康复的术前评估、围术期营养、早期营养支持、重症监护病房(ICU)期间康复、社会心理因素干预、睡眠管理等重要问题提出了明确建议。     

应用β肾上腺素能受体阻滞剂规范治疗冠心病的中国专家共识

β肾上腺素能受体阻滞剂(β受体阻滞剂)已被证实可降低无禁忌证冠心病患者的全因死亡和心血管死亡风险,而我国冠心病人群中β受体阻滞剂的应用存在明显不规范,主要体现为使用率低、使用剂量不足和长期治疗依从性差。该共识在《β肾上腺素能受体阻滞剂在心血管疾病应用专家共识》基础上,汇总了近年来出现的新证据,进一步细化患者分类,明确了冠心病患者β受体阻滞剂应用应遵循的“BETA”原则,即Beneficial assessment(获益评估)、Enough dosage(足量应用)、Timely usage(及时使用)、Adequate titration(充分滴定),就不同患者人群使用β受体阻滞剂的临床指征、用法用量、治疗目标和疗程给出了明确建议。     

WHO's role in the global health system: what can be learned from global R&D debates?

Recent global debates on the research and development (R&D) of health technologies, such as drugs, diagnostics and vaccines, can be seen as a microcosm of discussions on the role of the World Health Organization (WHO) in the global health system more broadly. The global R&D system has come under heightened scrutiny with the publication of a 2012 report by the WHO Consultative Expert Working Group on Research and Development (CEWG), which made a number of recommendations to more equitably meet global health needs. The CEWG report followed a decade-long process of debate at the WHO on the weaknesses of the global R&D system, which include problems of affordability, limited research where market returns are small or uncertain (such as the ‘neglected diseases’ that predominantly affect the world's poorest), inefficient overlap of research efforts, and overuse of medicines such as antibiotics. The CEWG report called on WHO Member States to develop a global framework to improve monitoring, coordination and financing of R&D efforts through the establishment of a Global Health R&D Observatory and the negotiation of a binding treaty on R&D. While the treaty option has been put on the back-burner for several years, Member States nevertheless agreed at the 2013 World Health Assembly (WHA) on concrete steps towards a global framework. Progress at the 2013 WHA reaffirmed the central role of WHO as a convener, and the WHA's decision to create the Observatory within the WHO Secretariat underscored the organization's role as a source of strategic knowledge in the global health system. However, despite WHO's constitutional mandate as the ‘directing and coordinating authority on international health work’, in reality it faces major challenges in coordinating autonomous R&D actors such as states, firms and foundations in the global system. Strengthening its ability to do so requires, at a minimum, reforming its financing arrangements to provide it with a greater degree of independence from its largest donors. In addition, WHO may seem to be the natural arena for negotiating a binding R&D treaty, but negotiating new global agreements in other arenas such as the WTO, WIPO, or plurilateral fora offer the possibility of more enforceable and stronger public health norms. Nevertheless, no single arena in the existing system of global governance is perfectly suitable for the negotiation of progressive, inclusive, binding, enforceable, global health rules. While tradeoffs are inherent in the choice of any particular arena, leadership from either the multilateral institutions or influential governments can make a key difference in how beneficial any R&D treaty may be for health. In the coming years, global R&D debates will remain a critical issue to watch. The evolution of the global R&D system will be a harbinger not only of WHO's place in a rapidly-changing global health system, but also of our collective capacity to strengthen institutions of global governance for health.     

Optimization of Compound Ranking for Structure‐Based Virtual Ligand Screening Using an Established FRED–Surflex Consensus Approach

The use of multiple target conformers has been applied successfully in virtual screening campaigns; however, a study on how to best combine scores for multiple targets in a hierarchic method that combines rigid and flexible docking is not available. In this study, we used a data set of 59 479 compounds to screen multiple conformers of four distinct protein targets to obtain an adapted and optimized combination of an established hierarchic method that employs the programs FRED and Surflex. Our study was extended and verified by application of our protocol to ten different data sets from the directory of useful decoys (DUD). We quantitated overall method performance in ensemble docking and compared several consensus scoring methods to improve the enrichment during virtual ligand screening. We conclude that one of the methods used, which employs a consensus weighted scoring of multiple target conformers, performs consistently better than methods that do not include such consensus scoring. For optimal overall performance in ensemble docking, it is advisable to first calculate a consensus of FRED results and use this consensus as a sub‐data set for Surflex screening. Furthermore, we identified an optimal method for each of the chosen targets and propose how to optimize the enrichment for any target.     

创面修复科护士职业标准的全国专家共识

创面修复科是一门新兴学科,目前尚没有护士职业标准。为更好地规范和加强创面修复科护士队伍的能力和体系建设,中国老年医学学会烧创伤分会、中国医师协会中国创面修复科标准化建设专家委员会、全国创面修复专科联盟组织国内专家,从术语和定义、通用条件、职业要求、技能要求、培训要求、考试考核及颁证等方面,撰写了创面修复科护士职业标准的全国专家共识,供全国同行参考。     

成人心脏外科术后脑损伤诊治的中国专家共识

背景：脑损伤作为成人心脏外科术后一种严重的并发症,发病率依然较高,是除心功能不全以外导致心脏外科手术患者预后不良的最主要因素之一。 目的：为减少心脏外科手术后脑卒中并发症,建立相关方面的诊治规范。 方法：为了降低成人心脏外科术后脑损伤的发生率,减少神经系统并发症,中国研究型医院学会神经再生与修复专业委员会心脏重症脑保护学组联合神经重症护理与康复学组,组织国内心脏内外科、神经内外科、重症监护、体外循环、麻醉以及急诊等医学专家,参考国内外相关指南,结合中国的实际情况,从成人心脏外科术后脑损伤的表现形式、危险因素、非药物性保护策略、术中神经监测以及药物性保护策略等方面,旨在促进患者脑神经功能康复角度进行撰写,经多次讨论最终成稿,制定该专家共识,以期指导临床工作。 结果与结论：为了降低成人心脏手术后脑损伤的发生率,减少神经系统并发症,需要采用个性化、以患者为中心的方法来管理那些可改变的脑损伤危险因素,采用包括术中栓塞的预防,血压、血糖、体温的管理,以及针对术后神经炎性反应药物治疗等方法,达到改善手术效果、提高患者生活质量的目的。然而,目前仍需要进一步的研究,尤其是高质量的以结果为导向的随机对照试验,以进一步提高脑损伤处理策略的证据支持。 ORCID: 0000-0002-0850-5922(韩宏光) 中国组织工程研究杂志出版内容重点：组织构建;骨细胞;软骨细胞;细胞培养;成纤维细胞;血管内皮细胞;骨质疏松;组织工程