国外和国内 医学期刊的 不同之处 照日格图 中华医学杂志英文版(Chin Med J) 总编辑 中国医学论坛报 理事会理事、顾问、前总编辑 美国新英格兰医学杂志(N Engl J Med) 编委 中华儿科杂志 副总编辑 欧洲临床研究杂志(Eur J Clin Invest) 编委

国外的和国内的医学期刊有许多不同 国外不少期刊历史长、经验丰富、办刊质量高、刊登高质量高水平医学论文多、及时反映医学科学研究的进展、收录到国际大型科学文献数据库的多、高影响因子的期刊多。

刊名 创刊年 N Engl J Med 1812 Lancet 1823 BMJ 1840 JAMA 1883 Arch Intern Med 1908 Ann Intern Med 1927 Chest 1935 Chin Med J 1887

国外，特别是西方国家，以及澳大利亚、新西兰和日本的医学期刊，收录到SCI和Medline等大型数据库的很多。我国医学期刊，近几年已有20余部被SCI收录。2007年我国(包括港澳)收录到Medline的期刊87部。

收录到SCI的我国内地医学及 相关学科期刊(原有) Journal Titles Impact factor Chinese Medical Journal (中华医学杂志 英文版) 0.858 Acta Pharmacol Sin (中国药理学报) 1.397 Cell Res (细胞研究) 3.426 Acta Biochim Biophys Sin (中国生物化学生物物理学报) 0.931 Asian J Androl (亚洲男性学) 1.737 Fungal Diversity (真菌多样性) 2.297 Science in China – Series C, Life Sciences 0.533

收录到SCI的我国内地医学及 相关学科期刊(新增，临床医学) 0.524 2.092 0.365

收录到SCI的我国内地医学及 相关学科期刊(新增，基础和综合)

审稿方面的不同 国外很多期刊对审稿工作和审稿人的要求很高、很严格。 要求作到：公平、公正、严格遵守时间要求，保密，有高度负责的精神，认真进行审稿。 有利益冲突时及时向编辑部声明，放弃审阅稿件。

审稿的方式 盲化 单盲 (目前比较多见) 双盲 完全公开

对稿件的总体评价(打分) 有些期刊请审稿人对稿件的创新性、科学性、实用价值等方面用评分的方法作出评价。 多数期刊要求审稿人在写审稿意见时，给编辑部和作者分别写出参考意见，不能混淆。不能将给编辑的意见，特别是关于稿件取舍的意见，写入给作者的意见框内(国内有些审稿人常这样作，这不妥)。

审稿意见： 多数审稿人的审稿意见十分详细、具体。这些都对作者以及其他有关人员有重要的参考价值。 一般国外期刊的审稿意见由以下部分组成： 1、对研究内容的概括，即主要目的和主要结果 2、研究的选题、设计，或其他方面的主要问题 3、文章的结构、表述、语言等方面存在的问题 4、对稿件的处理意见

Reviewer: 1 In this article, the authors present the data on a randomized but not blinded study of oseltamivir, a Chinese herbal combination (CHC), a combination of the two, or placebo in treatment of ... The authors found similar clinical outcomes with oseltamivir or the CHC compared to placebo but no benefit of the combination. Despite the fact that this is both an interesting finding and a novel approach, there are significant challenges that must be addressed by the authors - either by providing additional details or by discussing why they were not done. Specifically:

1. Introduction - some detail about the CHC needs to be included as well as some background data - why was this combination of herbs picked over others (esp since the authors cite other studies of other combinations later)? 2. Methods: A. There were a lot of sites involved - was one IRB approval sufficient? B. How, specifically, was the CHC prepared - how was the solution standardized so that there were comparable amounts of active compounds in each dose? C. Why were the individuals hospitalized? This is not typical for influenza studies in high school students with mild disease?

D. How were symptom scores and symptom alleviation defined D. How were symptom scores and symptom alleviation defined? Since one of the most important endpoints is symptom alleviation, why was this only done at discharge instead of when the patients felt better? E. Was no virology, other than initial swabbing, performed? Virologic outcomes are a critical component and failure to assess this significantly limits the value of this study. F. I am surprised that you had such a round number for two different sample size calculations. G. Symptom score is not standardized and definitions are also not consistent with prior flu studies making comparisons challenging.

3. Results - there's little more than what is presented in the abstract - more - including details about changes in symptom scores over time; clearly virology is needed as well. 4. Discussion: A. Need to discuss better how this compound was picked and why the simpler compound wasn't assessed? What is felt to be the active ingredient? Are there studies planned to define this? B. Since the CHC functions with several proposed mechanisms, why do the authors hypothesize that there was no benefit to the combination? C. There are far more limitations than are listed

Reviewer: 2 Summary 1. Double-blind method is not used, although it was randomized controlled trial. 2. Combination therapy of oseltamivir and other CNS stimulating drugs is potentially harmful and is not recommended as routine therapy for influenza especially otherwise healthy teenagers. 3. It is difficult to understand the reasons why you included patients who presented more than 48 hours (but within 72 hours) after the onset of symptoms. 4. Efficacy primary end point (time to resolution of fever) is not appropriate to evaluate the efficacy of oseltamivir.

5. Medication information other than the study drugs was not available except for acetaminophen and antibiotics. Especially NSAIDs and cough medicines affect the outcome but were not described. 6. there seems some bias in the degree of fever and time from onset of illness to intervention 7. However, proportion of participants with complete recovery at discharge was not significantly different in each study group compared control group. 8. Moreover that of M-MXSGT group (62.4%) is rather lower than control group (69.6%). 9. Reported adverse events are extremely few. Is it the real figure?

Details 1. Double-blind method is not used, although it was randomized controlled trial. This is stated in your discussion in the manuscript. Further explanation may be unnecessary. 2. Combination therapy of oseltamivir and other CNS stimulating drugs is potentially harmful and is not recommended as routine therapy for influenza especially otherwise healthy teenagers. Teenagers are thought susceptible to serious abnormal behaviours leading to accidents even with fatal outcome[1]. . Other neuropsychiatric adverse reactions to oseltamivir including sudden death especially during sleep are reported [1]. 1) Hama R.2008b Fatal neuropsychiatric adverse reactions to oseltamivir: case series and overview of causal relationship. Int J Risk Safety Med: 20: 5-36 [11]

Several animal experiments are also suggesting the causality, especially used in combination with CNS-stimulant such as ephedrine [2, 3] (main ingredient of M-MXSGT is ephedra which is the mixture of ephedrine like substances). 2) Izumi Y, Tokuda K, O'dell KA, Zorumski CF, Narahashi T. 2007. Neuroexcitatory actions of Tamiflu and its carboxylate metabolite. Neurosci Lett. 426(1):54-8. Epub 2007 Sep 1. 3) Izumi Y, Tokuda K, O'Dell K, Zorumski C, Narahashi T. 2008. Synaptic and behavioral interactions of oseltamivir (Tamiflu) with neurostimulants. Hum Exp Toxicol. 27(12):911-7.

3. The reason why you included patients who presented more than 48 hours (but within 72 hours) after the onset of symptoms is not understandable. There has been no proof based on the randomized controlled trials that show the efficacy in reducing time to resolution of symptoms by oseltamivir if it is given after more than 48 hours from the onset of symptoms. So if they include those presented more than 48 hours after the onset of flu symptoms and claim the treatment efficacy of oseltamivir, it is misleading. 4. Efficacy primary end point (time to resolution of fever) is not appropriate to evaluate the efficacy of oseltamivir.

Because unchanged oseltamivir that easily enter the brain through blood brain-barrier (BBB) and has CNS depressing action which lower body temperature [3, 4], decreased time to resolution of fever could easily proved without true efficacy against flu. 4) Ono H, Nagano Y, Matsunami N, Sugiyama S, Yamamoto S, Tanabe M.2008. Oseltamivir, an anti-influenza virus drug, produces hypothermia in mice. Biol Pharm Bull. 31(4):638-42. 5. Medication information other than the study drugs was not available except acetaminophen and antibiotics. Especially NSAIDs and medicines for the improvement of cough affect the outcome [4, 5] but were not described.

M-MXSGT has antipyretic action like NSAIDs M-MXSGT has antipyretic action like NSAIDs. it means in the acute phase it decreased body temperature but in the later phase, it disturb the recovery of flu symptoms. This adverse effect may explain lower tendency in proportion of full recovery in the M-MXSGT arm, though the fever resolution was faster than control arm. 5) Hama R. A/H1N1 flu. NSAIDs and flu. BMJ. 2009 Jun 15;338:b2345. doi: 10.1136/bmj.b2345. 6. There seems some bias in the degree of fever and time from onset of illness to intervention a) Degree of fever: rather lower in control group: per cent of >39 C: 14.0 % in control arm vs 23.5 % in oseltamivir arm, 21,4 % in M-MXSGT arm and 24.5 % in combination arm. Flu patients with high fever tend to recover faster than those with low fever.

9. Reported adverse events are extremely few. It’s unbelievable. b) Time from onset of illness to intervention: rather shorter in control arm (30 hours) than in the study arms (35, 35, 32 respectively). late presenting may recover earlier, so the baseline factor is more favorable in the study arms than the control arm. 7. However, proportion of participants with complete recovery at discharge was not significantly different in each study group compared control group. Proportions of complete recovery were 69.6 %, 72.5 %, 62.1 and 70.6 % respectively. 8. Moreover that of M-MXSGT group (62.4%) is rather lower than control group (69.6%). Considering the favourable baseline factors, this is more noted and seriously considered and discussed. 9. Reported adverse events are extremely few. It’s unbelievable.

In the RCTs of oseltamivir for treatment of seasonal flu done in the western countries or in Japan, percent of participants who had at least one adverse event were report about 40 to 50 %. 10. Please refer the papers which were published recently on the systematic review on neuraminidase inhibitor especially on oseltamivir: as bellow: http://www.bmj.com/cgi/content/full/339/dec07_2/b5106 http://www.bmj.com/cgi/content/full/339/dec10_2/b5405 http://www.bmj.com/cgi/content/full/339/dec08_3/b5351 http://www.bmj.com/cgi/content/full/339/dec08_3/b5387 http://www.bmj.com/cgi/content/full/339/dec07_2/b5164 http://www.bmj.com/cgi/content/full/339/dec07_2/b5248 http://www.bmj.com/cgi/content/full/339/dec08_3/b5364

如此全面、详细而具体的审稿意见，对于作者进一步修改稿件，甚至对以后的科研选题和设计，都有极其重要的参考价值，是十分宝贵的。即使稿件退稿了，但如果作者按照审稿人的意见仔细修改，稿件很有可能被其他期刊录用、刊登。这样的例子已经有不少。

组稿的不同—主动、积极 有些国际期刊的主要负责人亲自组稿。如NEJM总编辑JF Drazen教授在SARS暴发后，以及某一年我国发生流脑暴发后，亲自来电话寻求约稿，在全球医学期刊中最早刊登出关于SARS的学术论文。有一次，他出差在酒店看电视，无意中听到有新闻讲讲英国临床试验造成健康志愿者危及生命的循环衰竭，立即与研究人员联系约稿，刊登出细胞因子风暴的论文，他亲自为该文撰写述评。与大型学术会结合，寻求合适的时机发表文章。

专家参与期刊工作的程度不同 国外期刊高度重视专家参与期刊的工作，创造极好的条件，使专家将期刊工作当做自己的工作来作。以NEJM为例，有9名Associate editors, 他们都是波士顿地区，特别是哈佛大学医学院的教学医院的学术带头人，他们基本保证出席每周一次的总编、副总编审稿会，经认真的讨论，决定刊出哪些文章。

高度重视网站建设 注重网站的更新、改版，吸引读者阅读， 提高影响力，给读者提供大量有临床应用价值的音频、视频等多媒体资料，提高期刊的影响力。如每周一次的“Audio Briefing”音频材料，“Video in Clinical Medicine”的视频材料，“Clinical Practice”全文录音材料，等等。另外还提供个体化的文献服务等。考虑到未来媒体的发展，尽可能多地提供适合于无线媒体、掌上电脑等设备的文献资料，如MP3或MP4等格式的文件资料。

期刊与读者的互动性强 用多种方式与读者互动，包括鼓励刊登通讯文章、在网站上邀请读者参与一些病例的诊断或治疗方法选择，以及定期召开与青年医师的座谈会等。网站上设继续教育项目，提供继续教育学分。

国际期刊对稿件的要求更严格： 1、篇幅相对长 2、要求方法部分的内容更详细、具体 3、对伦理学和统计学的要求更高、更严谨 4、对前瞻性临床试验稿件，要求必须在研究开始 前在规定的网站上注册。 5、要求公开作者的利益冲突或关系 6、对参考文献数目的限制较松，可引用较多文献 7、综合性医学期刊要求稿件有普遍影响力 8、许多国际医学期刊对稿件的处理速度快

我国已有20多部医学期刊进入SCI，也有80多部医学期刊进入Medline。我相信，通过与国际一流医学期刊的交流与合作，通过学习国际一流医学期刊办刊方针、方法等，我国医学和其他科技期刊将会取得更多的进步和成功!

谢 谢 !