《医院处方点评管理规范(试行)》释义与药物临床应用评价

目的:释义《医院处方点评管理规范(试行)》(简称《规范》)。方法:通过对制定《规范》的背景、目的与意义进行分析,深入理解《规范》的主要内容。结果与结论:明确《规范》的主要内容和"专项处方点评"范围、内容与标准,可为有效组织开展处方点评提供依据,促进和提高临床合理用药水平。     

Using probabilistic theory to develop interpretation guidelines for Y-STR profiles

Y-STR profiling makes up a small but important proportion of forensic DNA casework. Often Y-STR profiles are used when autosomal profiling has failed to yield an informative result. Consequently Y-STR profiles are often from the most challenging samples. In addition to these points, Y-STR loci are linked, meaning that evaluation of haplotype probabilities are either based on overly simplified counting methods or computationally costly genetic models, neither of which extend well to the evaluation of mixed Y-STR data. For all of these reasons Y-STR data analysis has not seen the same advances as autosomal STR data. We present here a probabilistic model for the interpretation of Y-STR data. Due to the fact that probabilistic systems for Y-STR data are still some way from reaching active casework, we also describe how data can be analysed in a continuous way to generate interpretational thresholds and guidelines.     

Inter-examiner variability of Transcranial Doppler procedure and reports: a multicenter survey

Objective. To assess the clinical use of Transcranial Doppler (TCD) and the reproducibility of TCD reports. Methods. A multicenter survey involving 45 Italian laboratories (the Italian Transcranial Doppler Group — ITDG) was carried out by investigating the examination procedure, the parameters and normative data, and the interpretation criteria applied to reach diagnostic conclusions. The inter-examiner agreement on 10 TCD reports was computed using Kappa statistics. Results. Investigators consider both qualitative (flow direction, signal detectability) and quantitative measurements (mean flow velocity and pulsatility index values), applying their own normative criteria reference which may differ slightly between centers. TCD reports appear to be highly reproducible when based upon the interpretation of qualitative data (Kappa index: 0.95–1.00), whereas a moderate agreement is obtained when considering alterations in quantitative parameters (Kappa: 0.44–0.81). Conclusions. The application of the same criteria in different laboratories may facilitate the standardization of TCD examinations and support the reproducibility of clinical reports based on TCD parameters.Italian Transcranial Doppler GroupIstituto Malattie del Sistema Nervoso, Ancona (Minciotti P., Ceravolo MG., Provinciali L.); Unità Operativa di Chirurgia Vascolare, Osp. Reg. Aosta (Porta C., Palombo A.); Unità Operativa di Neurologia, Osp. Reg. Aosta (D'Alessandro G., Di Giovanni M.); Unità Operativa di Medicina Interna, Arezzo (Felici M., Ralli L.); Divisione di Neurologia 2^o, Bergamo (Camerlingo M., Casto L., Censori B., Ferraro B.); Divisione di Neurochirurgia 1^o, Bologna (Limoni P., Comani V.); Divisione di Neurochirurgia 2^o, Bologna (Giulioni M., Gaist G.); Divisione di Angiologia, Osp. Malpighi, Bologna (Conti E., Catena G.); Clinica Neurologica, Brescia (Anzola GP.); Unità Operativa di Neurologia, Busto Arsizio (Calloni MV., Porazzi D.); Divisione di Neurologia, Osp. S. Michele, Cagliari (Spissu A., Melis M.); Divisione di Neurochirurgia, Osp. S. Michele, Cagliari (Floris F.); Istituto di Clinica Medica, Cagliari (Manconi E., Meloni GA.); >Clinica Neurologica, Chieti (Aquilone L., Viola S., De Leonardis E., Tenaglia MG., Gambi D.);Divisione Medica, Osp. Maggiore di Crema (Zampini A.);Osp. Geriatrico INRCA, Fermo (Bellagamba G., Assouad C., Pennacchietti L., Postacchini D., Gentili G., Moretti V., Fratalocchi N., Dragonetti G.);Dipartimento Scienze Neurologiche, Firenze (Marinoni M., Ginanneschi A., Inzitari D.); Clinica Medica 1^o, Firenze (Nuzzaci G., Borgioli F., Cavallaro N., Letizio D.);Unità Operativa Medicina Interna, Firenze (Bacalli S., Cencetti S., Cipriani M., Lagi A.);Servizio Neurofisiopatologia, Osp. S. Martino, Genova (Ottonello GA., Brusa G.);Clinica Neurologica, Genova (Finocchi C., Del Sette M.),Divisione di Geriatria, Lanciano (Di Diego E., Marchione F.);Clinica Neurologica, L'Aquila (Totaro R., Prencipe M.);Divisione di Neurochirurgia, Lecce (Cancelliere M., Armenise B.);Unità Operativa di Neurologia, Lucca (Giraldi C., Lunardi V.);Clinica Neurochirurgica, Messina (Iacopino D., Todaro C.);Divisione di Neurologia, Mestre (Pistollato G.);Dipartimento Scienze Neuropsichiche, Osp. S. Raffaele, Milano (Giusti C.); Clinica Neurologica 4^o, Osp. S. Raffaele, Milano (Volonté MA.);Clinica Neurochirurgica, Milano (Granata G.);Clinica Neurologica, Osp. Monza (Apale P., Agostoni E., Santoro P.); Clinica Neurologica 2^o, Padova (Meneghetti G., Marini B., Bozzato G.);Divisione di Neurologia, Osp. Cittadetta, Padova (Garbin E.);Istituto Neurologico C. Mondino, Pavia (Micieli G., Bosone D., Tassorelli C.);Clinica Neurologica, Perugia (Mattelli L., Antonelli CL., Cardaioli G., Preiti N., Trequattrini A., Gallai V.);Divisione di Neurotraumatologia, Perugia (Orvieto P., Nasoni G., Preiti N.);Reparto di Neurologia, Villa Serena, Pescara (Buzzelli S.);Unità Operativa di Angiologia, Spoleto (Flamini F.);Divisione di Neurologia, Terni (Iannone G., Trenta A., Costantini F., Costanti D., Sabatini S.;Neurologia, Osp. Gradenigo, Torino Liboni W., Chianale G.);Divisione di Neurologia, Osp. M. Vittoria, Torino (Giobbe D);Istituto Clinica Medica, Trieste (Tonizzo M., Feruglio FS.);Neurologia, Varallo (Dellasette M.);Divisione di Neurochirurgia, Varese (Falchetti P., Pozzi M., Soldati M.);Unità Operativa di Neurofisiopatologia, Viareggio (Lamorgese N.).     

《2020 EACTS/ELSO/STS/AATS成人心脏术后体外生命支持专家共识》解读

2020年10月,欧洲心胸外科学会(EACTS),国际体外生命支持组织(ELSO),美国胸外科医师协会(STS)和美国胸外科学会(AATS)共同发布了《2020 EACTS/ELSO/STS/AATS成人心脏术后体外生命支持专家共识》,该共识为成人心脏术后体外生命支持的选择、管理和项目建设提供了参考,本文对该共识进行解读。     

La place de la compréhension des proverbes et des métaphores dans la compréhension des troubles du cours de la pensée dans la schizophrénie : apport de l’évaluation clinique,de l’imagerie cérébrale fonctionnelle et de la neurophysiologie

According to Bleuler (1911), language impairments were indicative of thought disorders, a fundamental feature of schizophrenia. The objectives of the present review are twofold: (1) to present the clinical interest of the use of the tests of proverbs and metaphors comprehension for the evaluation of the characteristics of thought disorders in schizophrenia, and to highlight the heterogeneity of the forms of their interpretations; (2) to present the results from neuroimaging and neurophysiological studies of metaphor comprehension in order to identify the neurocognitive mechanisms underlying metaphorical language comprehension of patients with schizophrenic disorders. Results from the reviewed clinical applications of proverbs tests showed that thought disorders in individuals with schizophrenia are illustrated by different forms of proverb interpretations: literal, concrete, idiosyncratic, over-inclusiveness and unconventional. Results from the reviewed brain imaging and neurophysiological studies showed that these different forms of figurative misinterpretations may be related to different neurocognitive mechanisms: concreteness appears to be related to the dysfunction of the left inferior frontal gyrus and inverted brain lateralization during metaphor processing in individuals with schizophrenia compared to healthy individuals. During novel metaphor comprehension, which is highly effortful, individuals with schizophrenia, relative to controls, demonstrate increased activation of the right precuneus, a region that mediates complex and highly integrated functions including retrieval of episodic memory and mental imagery. These results may suggest that individuals with schizophrenia use mental imagery to support comprehension of both literal and metaphoric language. Furthermore, it was demonstrated that over-inclusive thinking, which is exhibited by individuals with schizophrenia during figurative language comprehension, could be related to very early right hemispheric hyper-activation (when a left early activation is expected) and to reduced bilateral brain activity during semantic processing. Such as reversed brain activation may explain why the individuals with schizophrenia are relatively over reliant on early-stage coarse or large semantic processing and may be prone to form meanings that are idiosyncratic and highly unconventional.     

Quand la transformation s’annonce : les rêves initiatiques

Objectives

The clinic in general and the transcultural consultation in particular are constantly faced with new challenges in the relationship between intrapsychic and intersubjective dimensions. This implies continuous innovation in treatment, especially for migrant patients. We consider migrant patients afflicted by an impossible initiation represent a paradigmatic example of the above-mentioned issues. They are stuck in a hopeless paradox: there are unable to return to their country of origin and lack of initiatory rituals with symbolic efficiency in the host society.

AJCC与JSCCR对直肠癌盆腔侧方淋巴结定义演变的解读

侧方淋巴结清扫仍是直肠癌手术治疗的重要术式,但对于直肠癌的盆腔侧方淋巴结是否为区域淋巴结及侧方淋巴结清扫术的意义,欧美与日本专家有不同的观点。对盆腔侧方淋巴结的不同定义会导致直肠癌的分期不同,进而导致不同的治疗决策。不同时期的欧美学者及日本学者对盆腔侧方淋巴结的定义有一个演变过程,笔者根据现有资料对该演变做一解读。由于日本学者对侧方淋巴结研究较多,故重点阐述日本大肠癌研究会对侧方淋巴结的定义演变。     

基于临床实践的中医学神的诠释思路

中医学神的复杂性导致了其难以客观地把握和认识。从临床实践角度揭示中医学的神、五脏、脑之间的生理、病理联系,诊断、治疗机制,是科学诠释中医学神的正确可行途径。诠释神的内容体系包括:相关概念如神明、元神、识神、神志等;生理机制如不同层次、不同类型的神在不同脑区的定位、神经调节路径、各种网络、调节物质等;病理机制如从功能性病理到器质性病变、从微观气化到宏观产物、从五脏功能单位到脑区定位等的具体内容和机制;证候学内容如确立以神的症状为辨证要点引领的症状群、揭示证候实质的科学内涵;疗效作用机制如客观准确评价中药方剂对于脑病的防治效果、阐明中药方剂治疗脑病的作用途径、作用方式和作用靶点等。     

留守儿童解释偏向的跨情境比较研究

目的了解留守儿童在一般同伴和亲密好友社交情境下的解释偏向特点。方法选取320名留守儿童为研究组,276名普通儿童为控制组,施测儿童版两可社交情境解释问卷。结果留守儿童的消极解释偏向显著高于控制组(t=2.52,P<0.05),积极解释偏向显著低于控制组(t=-4.21,P<0.001);留守儿童指向自身的消极解释偏向显著高于控制组(t=2.66,P<0.01;t=3.58,P<0.001);留守儿童在亲密好友情境比在一般同伴情境下更少产生消极解释(t=5.77,P<0.001),更多地产生积极解释(t=-4.19,P<0.001)。结论留守儿童存在明显的消极解释偏向,缺乏积极解释偏向;好友关系在一定程度上抑制消极解释并促进积极解释的产生。