推荐:1月BMJ杂志亮点研究汇总(TOP10)

2017-02-08 MedSci MedSci原创

BMJ

在过去的1月份里面四大医学期刊BMJ杂志又有哪些值得我们关注的重磅研究?梅斯医学小编整理了1月份大家普遍关注的一些亮点研究,包括甲状腺激素在甲减孕妇中的治疗、骨折的检测工具以及其他与医学息息相关的且十分重要的热点研究,与大家分享,希望可以从中学习一些知识。【1】BMJ:心理困扰与部位特异性肿瘤死亡相关吗?近日,顶级杂志BMJ上发表了一篇研究文章,研究人员旨在评估心理困扰(焦虑和抑郁)能否作为部

在过去的1月份里面四大医学期刊BMJ杂志又有哪些值得我们关注的重磅研究?梅斯医学小编整理了1月份大家普遍关注的一些亮点研究,包括甲状腺激素在甲减孕妇中的治疗、骨折的检测工具以及其他与医学息息相关的且十分重要的热点研究,与大家分享,希望可以从中学习一些知识。


近日,顶级杂志BMJ上发表了一篇研究文章,研究人员旨在评估心理困扰(焦虑和抑郁)能否作为部位特异性肿瘤死亡的潜在预测因素。

研究人员将开始于1994-2008年期间的16个前瞻性队列研究各个参与者的数据进行合并。研究人员从英国健康调查(13项研究)和苏格兰健康调查(3项研究)抽取了全国代表性样本。在研究之初纳入了163363名16岁以上的男性和女性参与者,这些参与者最初没有癌症诊断,并且提供了自我报告的心理困扰评分(基于一般健康问卷GHQ-12)以及同意进行健康记录。

该研究收集了平均为9.5年的死亡监测数据,在这期间有16 267人发生死亡(4353例死于癌症)。校正年龄、性别、教育、社会经济地位、体重指数(BMI)、吸烟和酒精的摄入量后,并且考虑反向因果关系(通过左审查)和丢失的数据(通过归责),相对于苦恼最少的人群(GHQ-12评分0-6),苦恼最多的人群(GHQ-12评分7-12)所有部位癌症联合的(多变量调整后的风险比为1.32,95%可信区间为1.18-1.48)和吸烟不相关的癌症的(1.45,1.23-1.71)死亡率都升高了,对于结直肠癌(1.84,1.21-2.78)、前列腺癌(2.42,1.29-4.54)、胰腺癌(2.76,1.47-5.19)、食管癌(2.59,1.34-5.00)和白血病(3.86,1.42-10.5)的死亡率也都一样升高。大肠癌和前列腺癌可以观察到与全范围的困扰分数的逐步相关。

本研究进一步证实了心理困扰可能对特定的癌症有一定的预测能力,除了其他躯体疾病。


近日,顶级杂志BMJ上发表了一篇研究文章,研究人员旨在估计亚临床甲状腺功能减退孕妇甲状腺激素治疗的有效性和安全性。

该研究采用回顾性队列研究设计,研究人员以2010年1月1日至2014年12月31日期间大型美国管理数据库为基础。该研究的参与者为5405名亚临床甲减孕妇,其被定义为未经治疗的促甲状腺激素(TSH)浓度为2.5-10mIU/L。该研究的暴露因素为甲状腺激素治疗。主要结局指标为流产和其他预先指定的孕产妇和胎儿妊娠不良结局。 

在5405名妊娠合并亚临床甲状腺功能减退症的患者中,843名治疗前平均TSH浓度为4.8(SD为1.7)mIU/L的患者进行甲状腺激素治疗,4562例平均基线TSH浓度为3.3(SD为0.9)mIU/L的患者未进行甲状腺激素治疗(P<0.01)。在治疗组流产(n=89;10.6%)比未经治疗组妇女(n=614;13.5%)要显著减少(P<0.01)。相比于未治疗组,治疗组的妇女有较低的调整后流产比率(比值比为0.62,95%可信区间为0.48-0.82)但有较高的早产(1.60,1.14-2.24)、妊娠期糖尿病(1.37,1.05-1.79)和子痫前期(1.61,1.10-2.37)几率;其他妊娠相关的不良结局在两组之间类似。治疗组妇女调整后的流产几率均低于未治疗组的女性如果治疗前TSH浓度为4.1-10mIU/L(比值比为0.45,0.30-0.65),但如果治疗前TSH浓度为2.5-4.0 mIU/L (0.91, 0.65 -1.23)就不是这样(P<0.01)。

由此可见,甲状腺激素治疗与降低亚临床甲状腺功能减退症的妇女流产风险有关,特别是那些治疗前TSH浓度为4.1-10mIU/L的患者。然而,其他妊娠相关的不良结局风险增加需要更多的研究来评估在这个人群中甲状腺激素治疗的安全性。


最近,顶级杂志BMJ上发表了一篇研究文章,研究者旨在评估主要研究者与研究药物生产商之间的财务联系(考虑到研究经费来源)与试验结果之间的关系。 

该研究是对随机对照试验(RCT)进行了横断面研究,研究者以通过Medline确认的于2013年1月1日至2013年12月31日发表在“核心临床期刊”的研究为基础,纳入了研究重点为药物疗效的随机样本。该研究的主要指标为主要调查者的财务关系与研究结果之间的相关性。 

该研究共有190篇论文共报道了195项研究符合纳入标准,主要研究人员和制药行业之间的财务关系在132(67.7%)个研究中都有提及。在397个主要调查者中,有231(58%)人与制药行业有财务关系,而166(42%)人没有。在所有的主要研究者中,156(39%)人报告了顾问/咨询费,81(20%)人报告了讲课费,81(20%)人报告了非特定的财务关系,52(13%)人报告了报酬,52(13%)人报告了雇佣关系,52(13%)人报告了旅行费用,41(10%)人报告了股权,20(5%)人报告有研究药物相关的专利。在阳性研究中主要研究人员和制药行业之间存在财务关系的比例为76%(103/136),而阴性对照研究中为49%(29/59)。在未经调整的分析中,主要研究人员和制药行业之间存在财务关系与阳性研究结果存在相关性(比值比为3.23,95%可信区间为1.7-6.1)。在主要的多元分析中,对资金来源调整后,主要研究人员和制药行业之间存在财务关系与RCT阳性研究结果显著相关(比值比为3.57(1.7-7.7)。次要分析是对RCT其他特点进行控制,这些特点包括研究阶段、样本大小、第一作者国家、专业、注册试验、研究设计、分析类型、对照药和结果指标等。这些特点并没有明显影响财务关系和研究成果之间的相关性(比值比为3.37,1.4-7.9)。
 
由此可见,主要研究者的财务联系与临床试验阳性结果呈独立的相关。这些发现可能暗示了临床证据存在的偏倚。 

【4】BMJ:骨质疏松性骨折的预测工具哪家好? 

最近,顶级杂志BMJ上发表了一篇研究文章,研究者使用电子健康记录数据旨在直接比较骨质疏松性骨折研究最多的三个预测工具QFracture、FRAX和Garvan的性能和外部验证。 

该研究为回顾性队列研究,以以色列医疗机构提供商付款人为基础,研究人员纳入了1054815名年龄在50岁至90岁的参与者对所用预测工具和不同年龄组范围进行比较,针对每个预测工具的开发研究,以及预测工具特定的外部验证。 

主要结局指标为从2010到2014年期间在电子健康记录中记录的首次诊断的主要骨质疏松性骨折(针对QFracture和FRAX工具)和髋部骨折(所有三个工具)。观察的骨折率与2010年回顾性的预测概率进行比较。 

观察的五年髋部骨折率为2.7%,主要骨质疏松性骨折发生率为7.7%。髋部骨折ROC曲线下面积(AUC)的预测分别用QFracture为82.7%,用FRAX为81.5%和用Garvan为77.8%。主要骨质疏松性骨折AUC分别用QFracture为71.2%和用Garvan为71.4%。所有的工具都低估了骨折的风险,但FRAX平均观察的预测比和校准斜坡接近1。预测工具特定的验证分析表明髋部骨折的预测AUC用QFracture为88%(那些年龄在30-100岁之间的参与者),用FRAX为81.5%(50-90岁)和用Garvan为71.2%(60-95岁)。 

由此可见,QFracture和FRAX对髋部骨折的预测有较高的鉴别能力,并且QFracture表现略好。这种性能差距在以前的研究中更明显,可能是由于QFracture验证试验的年龄纳入标准较为广泛。对于髋部骨折的预测简单的FRAX与QFracture表现一样的好,并且如果QFracture需要的输入数据不可用时具有优势。然而,这两种工具在实施之前需要校准。

【5】BMJ:偏头痛患者手术发生缺血性卒中和再入院风险更大 
 
最近,顶级医学期刊 BMJ 上发表了一篇研究文章,研究人员旨在探讨偏头痛患者在围手术期缺血性中风的风险是否会增加,并且这是否会导致再住院率增加。

该研究作为一项前瞻性研究,在2007年1月至2014年8月期间,研究者以马萨诸塞总医院及两座下属校区为基础,共纳入了124,558名进行外科手术的患者作为参与者(平均年龄52.6岁;女性占54.5%)。主要结局指标为无偏头痛先兆和有偏头痛先兆的患者术后30天内发生的围手术期缺血性卒中;次要结局指标为术后30天内再住院情况;探索性结局包括出院后卒中和卒中部位的神经解剖学层次。

研究者发现共有10,179(8.2%)名患者诊断有偏头痛,其中1278(12.6%)名患者为有先兆偏头痛,8901(87.4%)名患者为无先兆偏头痛。771(0.6%)名患者在术后30天内发生围手术期缺血性卒中。

与无偏头痛患者相比,偏头痛患者围术期缺血性卒中风险明显增加(调整后的比值比为1.75,95%可信区间为1.39-2.21)。有先兆偏头痛患者的风险(调整后比值比为2.61,1.59-4.29)也高于无先兆偏头痛患者(1.62,1.26-2.09)。

每1000个手术患者发生围手术期缺血性卒中预测的绝对风险为2.4(2.1-2.8)。而每1000例偏头痛患者预测的绝对风险增加到4.3(3.2-5.3),无先兆偏头痛患者预测的绝对风险为3.9(2.9-5),有先兆偏头痛患者预测的绝对风险为6.3(3.2-9.5),偏头痛患者在出院30天内有较高的再入院率(调整后的比值比为1.31,1.22-1.41)。

有偏头痛的手术患者发生围手术期缺血性卒中的风险增加,并且增加了30天内的再入院率。在围手术期缺血性卒中的风险评估中应考虑偏头痛这一因素。

【6】BMJ:没有心衰的稳定型冠心病患者接受肾素-血管紧张素系统抑制剂治疗疗效如何?

最近,顶级杂志BMJ上发表了一篇荟萃分析文章,研究者旨在对没有心脏衰竭的冠状动脉疾病的患者用肾素-血管紧张素系统抑制剂治疗相比于阳性对照和安慰剂的疗效评估。 

分析共纳入了24个研究包括198275人年的随访。相比于安慰剂组,肾素-血管紧张素系统抑制剂可以降低全因死亡率(比值比为0.84,95%可信区间为0.72-0.98)、心血管死亡率(0.74,0.59-0.94)、心肌梗死(0.82,0.76-0.88)、卒中(0.79,0.70-0.89)、心绞痛、心力衰竭、血管重建的风险;但与阳性对照组比不存在风险降低(全因死亡率比值比为1.05、0.94-1.17;P相互作用为0.006;心血管疾病死亡率比值比为1.08、0.93-1.25 P相互作用<0.001;心肌梗死比值比为0.99,0.87-1.12,P相互作用为0.01;卒中比值比为1.10,0.93-1.31;P相互作用为0.002)。贝叶斯Meta回归分析表明,在全因死亡率和心血管疾病死亡率方面,相比于安慰剂,肾素-血管紧张素系统抑制剂的疗效依赖于对照组事件发生率,如肾素-血管紧张素系统抑制剂在高对照事件发生率的试验中是唯一有益的治疗(每1000病人年>14.10例死亡和>7.65例心血管死亡),而在那些低对照事件发生率的试验中不存在这一效应。 

在没有心衰的稳定型冠心病患者中,只有与安慰剂,而不与阳性对照相比时,肾素-血管紧张素系统抑制剂才可以降低心血管事件和死亡。即使在安慰剂对照的试验中,肾素-血管紧张素系统抑制剂的获益主要是在高对照事件发生率的试验中,而在低对照事件发生率的试验中也不存在。证据不支持在其他阳性对照药物存在的情况下优先选择肾素-血管紧张素系统抑制剂。 


最近,顶级医学期刊BMJ上发表了一篇研究文章,研究人员比较了五种风险评分系统在上消化道出血患者评估中的预测准确性和临床应用价值。

该研究采用国际多中心前瞻性研究,分别在欧洲、北美洲、亚洲和大洋洲的六个大型医院内完成。该研究在12个月内共纳入了3012例连续就诊的上消化道出血患者。研究者比较了内镜前评分(admission Rockall、AIMS65和Glasgow Blatchford评分)和内镜后评分(全Rockall和PNED评分)对预设临床终点的预测能力,预设的临床终点包括:复合终点(输血、内镜治疗、介入、手术或30天死亡率),内镜治疗,30天死亡率,再出血,以及住院时间。研究人员也确定了区分低风险和高风险的患者的最佳评分阈值。

研究结果显示,Glasgow Blatchford评分在预测以医院为基础的干预和死亡率方面具有较高的预测精度。其评分≤1分是引导患者门诊就诊的的最佳阈值。对于其他终点这些评分的AUROCS均低于0.80,因此这些结果的临床效用较为有限。


最近,顶级杂志BMJ上发表了一篇研究文章,研究者比较用软式乙状结肠镜检查对不同性别和年龄段的个体进行结直肠癌筛查的有效性。 

在这个汇总分析中研究人员共纳入了287928名参与者;其中115139名参与者被随机分配接受软式乙状结肠镜筛查,而172789名参与者接受常规筛查。SCORE、NORCCAP和PLCO研究的依从率分别为58%、63%、87%。中位随访时间为10.5至12.1年。软式乙状结肠镜筛查降低了男性(相对风险为0.76;95%可信区间为0.70至0.83)和女性(0.83;0.75至0.92)大肠癌的发病率。而在60岁以下的男性和60岁以上的男性软式乙状结肠镜筛查效果差异无统计学意义。另外,研究者发现软式乙状结肠镜筛查可以降低60岁以下女性大肠癌的发病率(相对危险度为0.71;95%可信区间为0.59至0.84),但在那些年龄在60岁或以上的女性中并不显著(0.90;0.80至1.02)。在年轻和老年男性以及60岁以下的女性中,软式乙状结肠镜筛查可显著降低大肠癌死亡率。软式乙状结肠镜筛查降低大肠癌的发病率与在男性和女性远端结肠的发病率程度类似,但在年龄较大的女性中,近端结肠的筛查对大肠癌发病率没有影响,但发现性别和年龄组之间存在显著的交互作用(P=0.04)。 

由此可见,在男性和年轻女性中,软式乙状结肠镜是大肠癌筛查的有效工具。而对于年龄在60岁以上的女性来说,好处相对较小并且没有统计学意义;对于这些女性来说,应该考虑选择更有效的可以检测出近端肿瘤的替代筛查方法。 

【9】BMJ:预防2型糖尿病筛查和治疗策略的诊断准确性和有效性评价

最近,顶级杂志BMJ上发表了一篇研究文章,旨在评估糖尿病前期患者糖尿病前期筛查试验的诊断准确性和预防2型糖尿病发病的干预措施(生活方式或二甲双胍)的疗效。

研究人员通过系统回顾与荟萃分析来实现。研究人员检索了Medline、Embase、Premedline、Google Scholar等数据库。研究者将研究设计、方法和结果等数据提取到Excel电子表格中;由第二个研究人员对20%的研究样本进行了检查。筛查试验中提取的数据包括诊断准确率和人群患病率。进行了两个荟萃分析,一个分析总结了糖尿病前期筛查试验的准确性(以口服葡萄糖耐量试验为标准);另一个分析评估了进行生活方式或二甲双胍干预后进展为2型糖尿病的风险。研究者纳入了评估糖尿病前期患者筛查试验准确性的实证性研究。对经筛查确定的对照人群进行干预(随机试验和干预性研究),没有语言限制。

研究人员共浏览了2874篇文献,对148篇论文(涵盖了138项研究)进行了全面的审查。最后分析纳入了49个筛查试验(其中5个是患病率的研究)和50个干预试验的研究。尽管不同的研究采用了不同的临界值,对于糖尿病前期的筛查,糖化血蛋白(HbA1c)的平均灵敏度为0.49(95%可信区间为0.40-0.58),特异性为0.79(0.73-0.84)。空腹血糖的平均敏感性为0.25(0.19-0.32)和特异性为0.94(0.92-0.96)。不同的血糖异常指标识别不同的亚群(例如,47%的HbA1c异常患者,其他血糖指标没有异常)。从六个月至六年,生活方式干预可以减少36%(28%-43%)的2型糖尿病的相对风险,在后续的随访中衰减到20%(8%-31%)。

由此可见,HbA1c对于糖尿病前期的筛查既不敏感,也不特异;空腹血糖较为特异但不敏感。对通过筛查确定的糖尿病前期患者进行干预措施可以预防或延缓试验人群中2型糖尿病发病。由于筛查不够准确,许多人会被误诊导致不需要进行干预的人接受干预,而真正需要干预的人反而未接受干预。这些研究结果表明,单独实施“筛查和治疗”的策略不太可能对大量发病2型糖尿病有重大影响。


最近,顶级医学期刊 BMJ 上发表了一篇研究文章,研究者旨在量化全球183个国家为减少钠摄入量相关的政府政策、结合有针对性的产业协议和公共教育的成本效益。
 
该研究作为一项全球性建模研究,共有183个国家参与,纳入了各国人口中的成年人口。仿照最近成功的英国研究计划,“柔性调节”的国家政策包括有针对性的产业协议、政府监督和公共教育,以减少人群钠的摄入量。
 
该研究的主要结局指标为成本效益比值,该比值通过10年期间每DALY节约了美元兑换调整后的购买力(相当于特定国家的购买力为多少美元)来评估。
 
在世界范围内,10年间每个国家钠摄入量减少10%预计每年可以避免大约580万心血管疾病相关的DALYs,在10年的干预期间人口加权的平均成本为人均1.13美元。人口加权的平均成本效益比值约为204美元/DALY。在世界九个地区,钠摄入量的减少的估计成本效益最佳的是南亚(为116美元/DALY);在世界30个人口最多的国家,乌兹别克斯坦(为26.08美元/DALY)和缅甸(为33.30美元/DALY)最佳。成本效益最低的是澳大利亚/新西兰(为880美元/DALY,或0.02×人均国内生产总值(GDP)),但仍远远好于成本效益的标准阈值(<3×人均GDP)或高成本效益(<1×人均GDP)的干预措施。世界上绝大多数(96%)的成年人口生活在这种干预的成本效益比值<0.1×人均GDP的国家,并且99.6%的国家成本效益比值<1×人均GDP。
 
由此可见,即使不考虑潜在的医疗储蓄,以减少人群钠摄入量的、包括有针对性的产业协议、政府监督和公共教育的 “柔性调节”国家政策也预计将在全球范围内获得较高的成本效益.

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    2017-07-29 respect
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    2017-07-26 gaoxiaoe
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    2017-02-10 Dr.jerry

    好好学习

    0

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    2017-02-09 孙文杰

    有意思

    0

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    2017-02-09 1ddf0692m34(暂无匿称)

    紧跟前沿研究

    0

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    2017-02-09 ms8253890721363845

    学习啦,好多营养

    0

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    2017-02-09 为你把脉

    唱唱歌哈哈哈哈几句i

    0

  8. [GetPortalCommentsPageByObjectIdResponse(id=1649822, encodeId=018616498224e, content=<a href='/topic/show?id=f1e41e642cd' target=_blank style='color:#2F92EE;'>#TOP10#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=17642, encryptionId=f1e41e642cd, topicName=TOP10)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=bb7b23929551, createdName=respect, createdTime=Sat Jul 29 19:25:00 CST 2017, time=2017-07-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1848227, encodeId=2367184822e49, content=<a href='/topic/show?id=2977356edc' target=_blank style='color:#2F92EE;'>#BMJ#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3567, encryptionId=2977356edc, topicName=BMJ)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=148754, createdName=gaoxiaoe, createdTime=Wed Jul 26 03:25:00 CST 2017, time=2017-07-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=175376, encodeId=67a61e5376af, content=好好学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cdnapi.center.medsci.cn/medsci/head/2017/04/30/dd6bade062cb598667f9f577194196c4.jpg, createdBy=422e1687020, createdName=Dr.jerry, createdTime=Fri Feb 10 12:18:37 CST 2017, time=2017-02-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=175171, encodeId=84391e5171eb, content=有意思, beContent=null, objectType=article, channel=null, level=null, likeNumber=44, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/y1ZJaAFo7AFqm7Hn2QNVTjOpBV9mRicUEjyBqRMnLADF1oQXJGeIVCpiaY1hJVMd1C40EhFCw4LL8sCKTx8Yuvsw/132, createdBy=af0b1960284, createdName=孙文杰, createdTime=Thu Feb 09 15:44:33 CST 2017, time=2017-02-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=175154, encodeId=96571e515477, content=紧跟前沿研究, beContent=null, objectType=article, channel=null, level=null, likeNumber=48, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220115/46bcf39c32de4aa6b45c5f9d66c8ee77/6cb4a20c55bb4b7691122f47747bfca2.jpg, createdBy=9dad1662329, createdName=1ddf0692m34(暂无匿称), createdTime=Thu Feb 09 12:55:44 CST 2017, time=2017-02-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=175148, encodeId=a7861e5148ec, content=学习啦,好多营养, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=2d5a1812418, createdName=ms8253890721363845, createdTime=Thu Feb 09 12:42:21 CST 2017, time=2017-02-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=175108, encodeId=1fbb1e5108ac, content=唱唱歌哈哈哈哈几句i, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b0171930782, createdName=为你把脉, createdTime=Thu Feb 09 10:15:03 CST 2017, time=2017-02-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=175106, encodeId=b9c11e51061f, content=心情很重要!, beContent=null, objectType=article, channel=null, level=null, likeNumber=19, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1c961986924, createdName=1e196c88m23(暂无匿称), createdTime=Thu Feb 09 10:07:43 CST 2017, time=2017-02-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=175104, encodeId=83331e510418, content=学学!!!!, beContent=null, objectType=article, channel=null, level=null, likeNumber=19, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=078f1661649, createdName=wei834766788, createdTime=Thu Feb 09 09:56:34 CST 2017, time=2017-02-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=175076, encodeId=bb051e507623, content=学习了,长了好多知识,感谢, beContent=null, objectType=article, channel=null, level=null, likeNumber=15, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=/v1.0.0/img/user_icon.png, createdBy=fb781996655, createdName=蓝莓花青素, createdTime=Thu Feb 09 08:38:48 CST 2017, time=2017-02-09, status=1, ipAttribution=)]
    2017-02-09 1e196c88m23(暂无匿称)

    心情很重要!

    0

  9. [GetPortalCommentsPageByObjectIdResponse(id=1649822, encodeId=018616498224e, content=<a href='/topic/show?id=f1e41e642cd' target=_blank style='color:#2F92EE;'>#TOP10#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=17642, encryptionId=f1e41e642cd, topicName=TOP10)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=bb7b23929551, createdName=respect, createdTime=Sat Jul 29 19:25:00 CST 2017, time=2017-07-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1848227, encodeId=2367184822e49, content=<a href='/topic/show?id=2977356edc' target=_blank style='color:#2F92EE;'>#BMJ#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3567, encryptionId=2977356edc, topicName=BMJ)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=148754, createdName=gaoxiaoe, createdTime=Wed Jul 26 03:25:00 CST 2017, time=2017-07-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=175376, encodeId=67a61e5376af, content=好好学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cdnapi.center.medsci.cn/medsci/head/2017/04/30/dd6bade062cb598667f9f577194196c4.jpg, createdBy=422e1687020, createdName=Dr.jerry, createdTime=Fri Feb 10 12:18:37 CST 2017, time=2017-02-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=175171, encodeId=84391e5171eb, content=有意思, beContent=null, objectType=article, channel=null, level=null, likeNumber=44, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/y1ZJaAFo7AFqm7Hn2QNVTjOpBV9mRicUEjyBqRMnLADF1oQXJGeIVCpiaY1hJVMd1C40EhFCw4LL8sCKTx8Yuvsw/132, createdBy=af0b1960284, createdName=孙文杰, createdTime=Thu Feb 09 15:44:33 CST 2017, time=2017-02-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=175154, encodeId=96571e515477, content=紧跟前沿研究, beContent=null, objectType=article, channel=null, level=null, likeNumber=48, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220115/46bcf39c32de4aa6b45c5f9d66c8ee77/6cb4a20c55bb4b7691122f47747bfca2.jpg, createdBy=9dad1662329, createdName=1ddf0692m34(暂无匿称), createdTime=Thu Feb 09 12:55:44 CST 2017, time=2017-02-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=175148, encodeId=a7861e5148ec, content=学习啦,好多营养, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=2d5a1812418, createdName=ms8253890721363845, createdTime=Thu Feb 09 12:42:21 CST 2017, time=2017-02-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=175108, encodeId=1fbb1e5108ac, content=唱唱歌哈哈哈哈几句i, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b0171930782, createdName=为你把脉, createdTime=Thu Feb 09 10:15:03 CST 2017, time=2017-02-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=175106, encodeId=b9c11e51061f, content=心情很重要!, beContent=null, objectType=article, channel=null, level=null, likeNumber=19, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1c961986924, createdName=1e196c88m23(暂无匿称), createdTime=Thu Feb 09 10:07:43 CST 2017, time=2017-02-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=175104, encodeId=83331e510418, content=学学!!!!, beContent=null, objectType=article, channel=null, level=null, likeNumber=19, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=078f1661649, createdName=wei834766788, createdTime=Thu Feb 09 09:56:34 CST 2017, time=2017-02-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=175076, encodeId=bb051e507623, content=学习了,长了好多知识,感谢, beContent=null, objectType=article, channel=null, level=null, likeNumber=15, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=/v1.0.0/img/user_icon.png, createdBy=fb781996655, createdName=蓝莓花青素, createdTime=Thu Feb 09 08:38:48 CST 2017, time=2017-02-09, status=1, ipAttribution=)]
    2017-02-09 wei834766788

    学学!!!!

    0

  10. [GetPortalCommentsPageByObjectIdResponse(id=1649822, encodeId=018616498224e, content=<a href='/topic/show?id=f1e41e642cd' target=_blank style='color:#2F92EE;'>#TOP10#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=17642, encryptionId=f1e41e642cd, topicName=TOP10)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=bb7b23929551, createdName=respect, createdTime=Sat Jul 29 19:25:00 CST 2017, time=2017-07-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1848227, encodeId=2367184822e49, content=<a href='/topic/show?id=2977356edc' target=_blank style='color:#2F92EE;'>#BMJ#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3567, encryptionId=2977356edc, topicName=BMJ)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=148754, createdName=gaoxiaoe, createdTime=Wed Jul 26 03:25:00 CST 2017, time=2017-07-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=175376, encodeId=67a61e5376af, content=好好学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cdnapi.center.medsci.cn/medsci/head/2017/04/30/dd6bade062cb598667f9f577194196c4.jpg, createdBy=422e1687020, createdName=Dr.jerry, createdTime=Fri Feb 10 12:18:37 CST 2017, time=2017-02-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=175171, encodeId=84391e5171eb, content=有意思, beContent=null, objectType=article, channel=null, level=null, likeNumber=44, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/y1ZJaAFo7AFqm7Hn2QNVTjOpBV9mRicUEjyBqRMnLADF1oQXJGeIVCpiaY1hJVMd1C40EhFCw4LL8sCKTx8Yuvsw/132, createdBy=af0b1960284, createdName=孙文杰, createdTime=Thu Feb 09 15:44:33 CST 2017, time=2017-02-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=175154, encodeId=96571e515477, content=紧跟前沿研究, beContent=null, objectType=article, channel=null, level=null, likeNumber=48, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220115/46bcf39c32de4aa6b45c5f9d66c8ee77/6cb4a20c55bb4b7691122f47747bfca2.jpg, createdBy=9dad1662329, createdName=1ddf0692m34(暂无匿称), createdTime=Thu Feb 09 12:55:44 CST 2017, time=2017-02-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=175148, encodeId=a7861e5148ec, content=学习啦,好多营养, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=2d5a1812418, createdName=ms8253890721363845, createdTime=Thu Feb 09 12:42:21 CST 2017, time=2017-02-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=175108, encodeId=1fbb1e5108ac, content=唱唱歌哈哈哈哈几句i, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b0171930782, createdName=为你把脉, createdTime=Thu Feb 09 10:15:03 CST 2017, time=2017-02-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=175106, encodeId=b9c11e51061f, content=心情很重要!, beContent=null, objectType=article, channel=null, level=null, likeNumber=19, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1c961986924, createdName=1e196c88m23(暂无匿称), createdTime=Thu Feb 09 10:07:43 CST 2017, time=2017-02-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=175104, encodeId=83331e510418, content=学学!!!!, beContent=null, objectType=article, channel=null, level=null, likeNumber=19, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=078f1661649, createdName=wei834766788, createdTime=Thu Feb 09 09:56:34 CST 2017, time=2017-02-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=175076, encodeId=bb051e507623, content=学习了,长了好多知识,感谢, beContent=null, objectType=article, channel=null, level=null, likeNumber=15, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=/v1.0.0/img/user_icon.png, createdBy=fb781996655, createdName=蓝莓花青素, createdTime=Thu Feb 09 08:38:48 CST 2017, time=2017-02-09, status=1, ipAttribution=)]
    2017-02-09 蓝莓花青素

    学习了,长了好多知识,感谢

    0

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