益母草注射液防治产后出血的应用共识(2017)

<正>产后出血发生率居高不下是我国孕产妇死亡的重要原因,子宫收缩乏力是造成产后出血的首要因素,应用快速、安全、有效的子宫收缩剂仍是产科医生处理宫缩乏力的根本手段。目前临床应用的宫缩剂包括垂体后叶素类、前列腺素类和生物碱类,其中缩宫素最为常用,缩宫素虽起效快,但半衰期短、有受体饱和现象、对子宫下段平滑肌作用弱。而源于"经产良药"益母草(Leonurus ja-ponicas Houtt)的现代化纯中药制剂益母草注射     

Specialist Perception of Severe Asthma in Korea: A Questionnaire Survey

The Working Group on Severe Asthma of the Korean Academy of Allergy and Clinical Immunology recently published an expert opinion paper on the management of severe asthma in Korea. When developing a consensus, the working group encountered several diagnostic and treatment issues and decided to perform a questionnaire survey of Korean specialists with regard to severe asthma. An e-mail with a uniform resource locator link to the questionnaire was sent to 121 asthma specialists, of whom 44.6% responded. The most commonly accepted definitions of severe asthma were a history of fatal exacerbation or an asthma-triggered need for mechanical ventilation, 3–4 oral corticosteroid (OCS) bursts/year, and maintenance of OCS therapy for 3–6 months per year. Before diagnosing severe asthma, most physicians contemplate chest computed tomography, seek to control chronic rhinosinusitis, and consider poor inhaler compliance. For patients with uncontrolled severe asthma accompanied by type 2 (T2)-high inflammation, most biologics available in Korea were considered appropriate, but gaps were apparent in terms of T2-low asthma treatments. These findings about specialist perception of diagnosis and treatment of severe asthma will inform the use of emerging new drugs and facilitate personalized therapy.     

Stability analysis of clustering of Norris’ visual analogue scale: Applying the consensus clustering approach

Visual analogue scales are widely used to measure subjective responses. Norris’ 16 visual analogue scales (N_VAS) measure subjective feelings of alertness and mood. Up to now, different scientists have clustered items of N_VAS into different ways and Bond and Lader''s way has been the most frequently used in clinical research. However, there are concerns about the stability of this clustering over different subject samples and different drug classes. The aim of this study was to test whether Bond and Lader''s clustering was stable in terms of subject samples and drug effects. Alternative clustering of N_VAS was tested.Data from studies with 3 types of drugs: cannabinoid receptor agonist (delta-9-tetrahydrocannabinol [THC]), muscarinic antagonist (scopolamine), and benzodiazepines (midazolam and lorazepam), collected between 2005 and 2012, were used for this analysis. Exploratory factor analysis (EFA) was used to test the clustering algorithm of Bond and Lader. Consensus clustering was performed to test the stability of clustering results over samples and over different drug types. Stability analysis was performed using a three-cluster assumption, and then on other alternative assumptions.Heat maps of the consensus matrix (CM) and density plots showed instability of the three-cluster hypothesis and suggested instability over the 3 drug classes. Two- and four-cluster hypothesis were also tested. Heat maps of the CM and density plots suggested that the two-cluster assumption was superior.In summary, the two-cluster assumption leads to a provably stable outcome over samples and the 3 drug types based on the data used.     

专家模糊控制器

本文把人工智能中的专家系统技术引入模糊控制中,构造出了专家模糊控制器。该控制系统能用模式识别的方法对不同的误差信息集合进行特征识别,然后采取相应的控制策略。仿真结果证明该控制方法的可行性和有效性。     

《新型冠状病毒患者标本采集技术专家共识》解读

新型冠状病毒肺炎具有高传染性、长潜伏期、部分临床症状不明显或无症状的特点。确诊或排除新型冠状病毒感染肺炎依赖于对患者生物学标本进行的实验室检测。如何规范、高效、正确、安全地采集新型冠状肺炎相关标本,对提高检测结果的准确率和降低院内感染发生率十分重要,因此本文对《新型冠状病毒患者标本采集技术专家共识》进行解读,以供临床护理人员参考。     

临床评价VITEK2高级专家系统对常见细菌β内酰胺耐药表型的检测和分析

目的 评价VITEK2高级专家系统(AES)对临床常见细菌β内酰胺耐药表型的检测和分析。方法 用VITEK2 AES检测并分析已知耐药表型的葡萄球菌、大肠埃希菌、克雷伯菌和阴沟肠杆菌共124株。结果 VITEK2 AES耐甲氧西林葡萄球菌、大肠埃希菌、肺炎克雷伯菌、产酸克雷伯菌产超广语β内酰胺酶[ESBLs(TEM型、SHV型或CTX—M型)]、阴沟肠杆菌产诱导型AmpC酶或高产AmpC酶、ESBLs均能正确检测。对9株同时产ESBLs和高产AmpC酶阴沟肠杆菌检测，其中1株正确，其余8株只报告高产AmpC酶。结论 VITEK2 AES能够对临床菌株中重要的β内酰胺耐药表型准确检测，并能根据所测耐药表型对某些影响临床抗菌药物治疗的药敏结果进行修订。对阴沟肠杆菌某些耐药表型的分析、判断有待进一步改进。     

José Barzelatto lecture: Vision on unsafe abortion

José Barzelatto first distinguished himself as a leader with a vision in his years as a medical student. Later, principally as Director of the Reproductive Health Program at the World Health Organization and of the Ford Foundation program for women's sexual and reproductive rights, he contributed immensely toward the recognition of women's sexual and reproductive rights as part of their basic human rights. José Barzelatto's vision on abortion reflects his drive to promote social justice and respect individual rights, respect diversity, and promote a social consensus for a peaceful society. He believed that the fetus has moral value and did not accept abortion as a method of fertility control, but understood that abortion is a social phenomenon that cannot be changed with legal or moral condemnation. He accepted that condemning women who abort does not prevent abortion, is unfair, and causes great human suffering at a high social cost. José proposed nine points to form the basis for an overlapping consensus on abortion, on which to base a practical consensus that would allow societies to reduce the number of abortions and minimize their consequences. If we can agree on all or most of those points we would achieve the common objectives of: fewer women confronting the dilemma of how to deal with an unwanted pregnancy; fewer induced abortions; and fewer women suffering the consequences of unsafe abortion.     

A comparison of clinically important differences in health-related quality of life for patients with chronic lung disease, asthma, or heart disease

OBJECTIVE: On the eight scales of the Medical Outcomes Study Short-Form 36-Item Health Survey (SF-36), Version 2, we compared the clinically important difference (CID) thresholds for change over time developed by three separate expert panels of physicians with experience in quality of life assessment among patients with chronic obstructive pulmonary disease (COPD), asthma, and heart disease. STUDY DESIGN: We used a modified Delphi technique combined with a face-to-face panel meeting within each disease to organize and conduct the consensus process among the expert panelists, who were familiar with the assessment and evaluations of health-related quality of life (HRQL) measures among patients with the panel-specific disease. PRINCIPAL FINDINGS: Each of the expert panels first determined the magnitude of the smallest numerically possible change on each SF-36 scale, referred to as a state change, and then built their CIDs from this metric. All three panels attained consensus on the scale changes that constituted small, moderate, and large clinically important SF-36 change scores. The CIDs established by the heart disease panel were generally greater than the CIDs agreed on by the asthma and COPD panels. CONCLUSIONS: These panel-derived thresholds reflect possible differences in disease management among the represented panel-specific diseases, and are all greater than the minimal CID thresholds previously developed for the SF-36 scales among patients with arthritis. If confirmed among patients with the relevant diseases and those patients' physicians, these disease-specific CIDs could assist both researchers and practicing clinicians in the use and interpretation of HRQL changes over time.