大数据时代的药品安全主动监测:对照选择的挑战与机遇

电子医疗数据已成为大数据时代开展药品安全主动监测的重要资源。基于此确认药品与不良事件是否存在关联，要回归传统的流行病学研究设计，选取恰当的对照进行对比。本文主要阐述不同对照选取的原理、适用情形，介绍、评价并比较各种对照选取的思路与参数，引入对照选择批量化实现的进展性成果，以期为我国利用电子医疗数据开展上市后药品安全性监测提供方法学参考。     

静脉血栓栓塞症风险评估模型研究进展与启示

通过文献研究，总结国内外静脉血栓栓塞症各类评估工具的优缺点及适用范围。指出我国与欧美国家人群存在种族、疾病谱和遗传因素等方面的差异，国外量表所纳入的危险因素并不一定能准确、完整地反映我国患者的风险状况。应借鉴国外评估工具的构建方法，基于我国VTE患者数据进行多中心、大样本的回顾性研究，从而构建更适合我国人群的、更准确的VTE风险评估模型。     

Claudin-15 overexpression inhibits proliferation and promotes apoptosis of Schwann cells in vitro

Our previous experiments have discovered that Claudin-15 was up-regulated in Schwann cells of the distal nerve stumps of rat models of sciatic nerve injury.However,how Claudin-15 affects Schwann cell function is still unknown.This study aimed to identify the effects of Claudin-15 on proliferation and apoptosis of Schwann cells cultured in vitro and explore the underlying mechanisms.Primary Schwann cells were obtained from rats.Claudin-15 in Schwann cells was knocked down using siRNA(siRNA-1 group)compared with the negative control siRNA transfection group(negative control group).Claudin-15 in Schwann cells was overexpressed using pGV230-Claudin-15 plasmid(pGV230-Claudin-15 group).The pGV230 transfection group(pGV230 group)acted as the control of the pGV230-Claudin-15 group.Cell proliferation was analyzed with EdU assay.Cell apoptosis was analyzed with flow cytometric analysis.Cell migration was analyzed with Transwell inserts.The mRNA and protein expressions were analyzed with quantitative polymerase chain reaction assay and western blot assay.The results showed that compared with the negative control group,cell proliferation rate was up-regulated;p-AKT/AKT ratio,apoptotic rate,p-c-Jun/c-Jun ratio,mRNA expression of protein kinase C alpha,Bcl-2 and Bax were down-regulated;and mRNA expression of neurotrophins basic fibroblast growth factor and neurotrophin-3 were increased in the siRNA-1 group.No significant difference was found in cell migration between the negative control and siRNA-1 groups.Compared with the pGV230 group,the cell proliferation rate was down-regulated;apoptotic rate,p-c-Jun/c-Jun ratio and c-Fos protein expression increased;mRNA expression of protein kinase C alpha and Bax decreased;and mRNA expressions of neurotrophins basic fibroblast growth factor and neurotrophin-3 were up-regulated in the pGV230-Claudin-15 group.The above results demonstrated that overexpression of Claudin-15 inhibited Schwann cell proliferation and promoted Schwann cell apoptosis in vitro.Silencing of Claudin-15 had the reverse effect and provided neuroprotective effect.This study was approved by the Experimental Animal Ethics Committee of Jilin University of China(approval No.2016-nsfc001)on March 5,2016.     

《2014年美国胃肠病学会临床实践指南:肝脏局灶性病变的诊断及管理》推荐意见

2014年美国胃肠病学会发布了关于肝脏局灶性病变(focal liver lesions,FLL)的诊疗指南,在此翻译全文推荐意见以供临床医生参考。推荐强度及证据质量分级参考表1。1实性FLL1.1怀疑为肝细胞癌(HCC)(1)肝硬化且超声显示肝损害1 cm的患者应使用磁共振成像(MRI)或三相CT检查(强烈推荐,证据质量中)。(2)慢性肝病患者,特别是合并肝硬化的实性FLL,患     

基于Watson关怀理论的系统化导师制培训对培养新护士人文关怀品质的效果评价

目的 :评价以Watson关怀理论为基础的系统化导师制培训对培养新护士人文关怀品质的效果。方法 :以便利抽样的方法选取某三级甲等医院2018年新入职的110名护士作为研究对象,随机分为对照组与实验组(每组各55人)。对照组参加医院常规的人文关怀培训,实验组接受以Watson关怀理论为基础的系统化导师制人文关怀培训,使用护士人文关怀品质量表对两组新护士进行培训前后的问卷调查。结果 :培训后实验组人文关怀品质总分以及理念、能力、感知3个维度得分与培训前的差值同对照组比较,差异具有统计学意义(P<0.05)。结论 :以Watson关怀理论为基础的系统化导师制人文关怀培训有助于加强新护士人文关怀品质的培养,尤其在人文关怀理念、能力、感知3个维度效果显著。     

A Novel New Delhi Metallo-β-Lactamase Variant,NDM-14, Isolated in a Chinese Hospital Possesses Increased Enzymatic Activity against Carbapenems

A novel New Delhi metallo-β-lactamase (NDM) variant, NDM-14, was identified in clinical isolate Acinetobacter lwoffii JN49-1, which was recovered from an intensive care unit patient at a local hospital in China. NDM-14, which differs from other existing enzymes by an amino acid substitution at position 130 (Asp130Gly), possesses enzymatic activity toward carbapenems that is greater than that of NDM-1. Kinetic data indicate that NDM-14 has a higher affinity for imipenem and meropenem.