从非酒精性脂肪性肝病到代谢相关脂肪性肝疾病

非酒精性脂肪性肝病（non-alcoholic fatty liver disease,NAFLD）的患病率逐年上升,世界对该疾病的认识也逐渐深入。多年来,在对该领域不断的探索中发现术语NAFLD的局限性,因此国际多名专家经过多年讨论,最终联手提出了新术语“代谢相关脂肪性肝疾病（metabolic associated fatty liver disease, MAFLD）”,然而这一术语在过去几年饱受争议。从NAFLD到MAFLD,给科研及临床工作带来的影响是不容置疑的。因此,该文简要总结了现有的研究结论,通过多方面对比NAFLD和MAFLD,加深临床医师对MAFLD的认识。     

撤销论文对于全球防治学术不端行为的意义和遏制作用

目的 对促进我国学术期刊净化学术信息提供一些帮助。方法 通过研究、分析近年间被撤销的论文和相关数据,了解撤销论文的一些特征,以及了解其对于全球防治学术不端行为的意义和遏制作用。结果 撤销论文是为了降低由学术不端行为或诚实性错误引起的负面影响而采取的处理方式,被国内外出版界普遍采用。但是,现实情况与最初的设想不一样,每年被撤销的论文还在不断增长,借鉴国内外针对撤销论文产生的一些争议性的研究,试探性地提出关于撤销论文在防治学术不端行为的疑问和自己的看法,并给出自己认为有效的建议。结论 撤销论文对于遏制学术不端行为有一定意义和遏制作用。     

Exploring the controversy in child abuse pediatrics and false accusations of abuse

There is a controversy in child abuse pediatrics between an established corps of child abuse pediatricians aligned with hospital colleagues and law enforcement, and a multi-specialty challenger group of doctors and other medical professionals working with public interest lawyers. The latter group questions the scientific validity of the core beliefs of child abuse pediatricians and believes that there are a substantial number of false accusations of abuse occurring. An unproven primary hypothesis, crafted around 1975 by a small group of pediatricians with an interest in child abuse, lies at the foundation of child abuse pediatrics. With no scientific study, it was hypothesized that subdural hemorrhage (SDH) and retinal hemorrhage (RH) were diagnostic of shaking abuse. That hypothesis became the so-called “shaken baby syndrome.” Through the period 1975–1985, in a coordinated manner, these child abuse specialists coalesced under the American Academy of Pediatrics and began working with district attorneys and social workers, informing them of the ways in which their hypothesis could be applied to prosecutions of child abuse and life-altering social service interventions. In a legal context, using then-prevailing evidentiary rules which treated scientific expert testimony as valid if it was “generally accepted” in the field, they represented falsely that there was general acceptance of their hypothesis and therefore it was valid science. As the ability to convict based on this unproven prime hypothesis (SDH and RH equals abuse) increased, some defense attorneys were professionally compelled by their own doubts to reach out to experts from other fields with experience with SDH and RH, trauma, and biomechanics, for second opinions. Medical and legal challenges to the established thinking soon emerged, based on both old and new evidenced-based literature. As the intensity of the controversy increased, the probability of false accusation became more apparent and the need to address the issue more pressing. Since false accusations of child abuse are themselves abusive, efforts to eliminate such false accusations must continue.     

Evidence-making controversies: the case of hepatitis C treatment and the promise of viral elimination

Contested science presents a problem for ‘evidence-based’ public health intervention. Taking a perspective that treats evidence as constituted through the practices which make it, we treat controversies in public health science as events of ‘evidence-making’ intervention. We look back on a recent controversy in evidence-making regarding the curative potential of new treatments for hepatitis C. The controversy concerned the publication of a systematic review conducted by the Cochrane Collaboration. We explore how published responses critical of the review enact their evidence-making. We do this to illuminate how moments of controversy offer useful sites of evidencing-making investigation for public health research. We identify four intersecting objects of evidence-making in the published responses: cure; expertise; hope; and morality. We reflect on how different experts perform evidence differently, how these evidence performances are in friction yet incorporate one another, and how such evidence-making practice fuses together different knowledge forms within and beyond science. Controversy makes visible the multiplicity and fluidity of evidence objects which might otherwise be constituted as singular and robust. A prime matter of concern in this exemplar is ‘cure’ and the protection of curative potential linked to new treatments in the presence of evidence uncertainty. We use our case study to argue for the benefits of an ‘evidence-making intervention’ approach to the study and use of evidence in critical public health research.     

患者经血传播疾病检测对医务人员职业暴露预防的意义

目的探讨患者术前、输血前检测对医务人员职业暴露在医院感染控制中的意义。方法对2003~2004年间10 754例术前、输血前的患者进行乙型肝炎表面抗原(HBsAg)、丙型肝炎抗体(抗-HCV)、艾滋病抗体(抗-HIV)、甲苯胺红不加热血清试验(TRUST)检测分析。结果检出HBsAg阳性1 163例,阳性率10.81%;抗-HCV阳性21例,阳性率0.20%;抗-HIV阳性1例,阳性率0.01%,经省疾病预防控制中心HIV确认实验室确证;TRUST阳性74例,阳性率0.69%,经明胶颗粒凝集试验(TPHA)确证;重叠感染多为HBV和HCV重叠感染及HBV和梅毒的重叠感染;消化科为乙型肝炎的高发科室(χ2=4.77,P<0.05),妇科为潜伏梅毒的高发科室(2χ=6.98,P<0.01)。结论术前、输血前检测经血传播性疾病可事先知悉患者的感染情况,对医务人员职业暴露防治、对医院感染控制、日后减少医患纠纷具有重要的意义。     

Idiopathic clubfoot treatment and heterogeneity of current therapeutic strategies: The Ponseti method versus the French functional method (a systematic review)

BackgroundSince Hippocrates, the treatment of idiopathic clubfoot has undergone many changes, with surgical techniques and conservative approaches evolving over the centuries. Today, a wide variety of practices exist in France and throughout the world; consequently, the treatment of idiopathic clubfoot remains controversial, but the Ponseti method and the functional method seem to stand out. Nevertheless, has one of them demonstrated superiority?MethodsThe purpose of this review is to compare these two methods. Based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2009 recommendations, this research was conducted on Pubmed, Web of Science, and 1Findr. Only articles concerning patients with moderate or severe idiopathic clubfoot (10–17 on the Dimeglio scale) treated early using the Ponseti method or the functional method were eligible.ResultsAfter reviewing 49 studies, seven published between 2008 and 2018 were selected: five prospective cohort studies, one retrospective cohort study, and one meta-analysis. Each method, according to morphological and kinetic criteria, seems to have advantages that the other does not have.ConclusionsAlthough the Ponseti method is becoming the gold standard and appears more appropriate in poor countries, it is impossible to affirm its superiority over the functional method. Therefore, the combination of their advantages deserves attention: a hybrid method could be an appealing prospect for the future.     

Is conservative management of preterm rupture of membranes justified?

The management of preterm rupture of membranes (ROM) is controversial. Some advise immediate delivery and others advocate conservative approach in the hope of decreasing morbidity and mortality rates associated with prematurity. A retrospective review of 75 pregnancies with preterm ROM treated conservatively was performed to delineate the relative risk factors. All patients with preterm ROM were placed at bed rest until either labor or chorioamnionitis prompted delivery. Chorioamnionitis developed in 25% of the cases. The percentage of women developing chorioamnionitis increased with duration of ROM. Fetal morbidity and mortality was not increased in the group with chorioamnionitis. Hyaline membrane disease (HMD) and intra ventricular hemorrhage (IVH) were the major causes of neonatal death in the entire group of preterm ROM. There was a significant relationship between neonatal mortality and birth weight. The smaller the birth weight, the greater the risk of neonatal death. Our data support the conservative approach to preterm ROM especially in the very low birth weight group where extreme caution must be taken before a decision is made to terminate pregnancy.     

Calcium and vitamin D controversies

Controversies regarding appropriate use of vitamin D and calcium are predominately related to the extraskeletal effects. Calcium and vitamin D are essential for bone health. The concerns regarding calcium and cardiovascular complications are inconclusive at best, and do not warrant a change in our approach to supplementation at this time. A growing body of literature exists suggesting that additional vitamin D may have numerous benefits, although more study needs to be done. Further prospective trials would provide insight into the potential advantages that increased vitamin D supplementation could provide.     

复发性自然流产诊治若干问题

复发性自然流产(RSA)是指连续发生2次或2次以上的自然流产,其病因错综复杂,目前比较明确的病因有遗传因素、内分泌因素、免疫因素、血栓前状态(PTS)及解剖因素等,但因为缺乏特异性表现,临床上对其难以做出准确的病因诊断,容易忽略某些相关因素而影响活产率。笔者拟就RSA常见若干问题进行探讨,包括规范诊断流程,选择合理必要的排查项目,并针对抗凝、免疫治疗及宫颈环扎手术等热点问题提出看法。