网状Meta分析的撰写与报告

网状Meta分析是传统Meta分析的扩展，可以实现同时对三个或者三个以上的干预措施的疗效进行比较。本文介绍了网状Meta分析的定义、基本假设、统计分析及软件、撰写和报告，以期吸引更多研究者关注，进而促进网状Meta分析方法的发展。     

撰写网状Meta分析的先决条件

近年来，网状Meta分析（network Meta-analysis，NMA）发表数量日益增长，但发表NMA检索均存在不同程度的瑕疵，为尽可能避免上述问题，全面、系统收集资料是撰写NMA的基础，为此，本文主要介绍撰写NMA时实施检索步骤及注意的问题，期望为NMA撰写者提供帮助。     

当归多糖抗辐射效果的网状Meta分析

目的：评价当归多糖(angelica polysaccharides,APS)抗辐射的效果。方法：系统检索主要中文数据库,纳入数据库中有关ASP抗辐射的动物实验,采用STAIR清单评价纳入研究质量,ADDIS软件(1.16.5)对ASP抗辐射效果的指标进行合并分析。结果：ASP抗辐射的网状Meta分析结果显示：ASP可以提高受辐射损伤实验动物外周血的血小板、红细胞和白细胞的数量,降低丙二醛的含量,提升超氧化物歧化酶的活性,具有一定的辐射保护作用。结论：ASP具有一定的辐射保护作用。     

姜黄素对A549裸鼠移植瘤影响的网状Meta分析

目的：评价姜黄素对A549裸鼠移植瘤影响。方法：系统检索主要中文数据库,纳入数据库中有关姜黄素对A549裸鼠移植瘤影响的动物实验,采用SYRCLE动物实验风险评估工具评价纳入研究质量,STATA13.0软件对数据进行合并分析。结果：共纳入7个研究,网状Meta分析结果显示,与空白相比姜黄素能够减轻瘤重,缩小肿瘤体积,降低肿瘤微血管密度,在姜黄素基础上,加用顺铂可以增加疗效。结论：姜黄素对A549肺癌细胞裸鼠移植瘤的生长具有明显抑制作用。     

《医学科研方法》书讯

正《医学科研方法》一书系统地阐述了医学科研的思维方法,从选题立项、设计实施,到分析总结的各个程序。本书内容包含了各类临床研究、人群研究、卫生经济分析与评价、社会精神问题的研究、文献的检索与评价、论文的撰写,以及动物实验的基本方法。同时也介绍了循证医学、Meta分析等热点问题,并对     

网状Meta分析优先报告规范简介和案例解读

网状Meta分析(Network Meta-Analysis, NMA)作为循证医学发展的二代方法学,越来越受到各国卫生技术评估组织的认可,然而目前NMA的报告存在严重的问题。最近针对NMA的优先报告规范——PRISMA扩展申明被发表在Annals of Internal Medicine上,本文将PRISMA扩展申明介绍给国内学者,为国内研究人员撰写和报告高质量的NMA提供借鉴和参考。     

网状Meta分析检索实施情况调查分析

目的：调查网状Meta分析(network Meta-analysis,NMA)检索实施情况。方法：检索PubMed、EMBASE.com、Web of Science和Cochrane library等数据库获取NMA,根据预先制定的纳入和排除标准纳入符合条件的NMA,提取检索实施方面的相关条目并输入Excel,采用STATA 12.0进行统计分析。结果：最终纳入391篇NMA,383篇NMA检索频率较高的数据库依次为Medline/PubMed、EMBASE和CENTRAL,辅助检索频率较高的依次为追踪综述、检索在研试验、检索已经发表的Meta分析和追踪会议文献。检索最高的数据库组合为Medline/PubMed CENTRAL,而只有270篇NMA同时检索了Medline/PubMed EMBASE CENTRAL,只有38.12%的NMA同时检索了数据库和已经发表的Meta分析。结论：调查显示目前NMA检索对NMA制作基本数据库检索不够,辅助检索措施尤其是对已发表Meta分析的检索有待加强。希望今后NMA撰写者同时检索基本数据库和已经发表的Meta分析,生产出高质量的NMA。     

2017—2022年国内网状Meta分析的研究主题与合作情况分析

目的:采用可视化的方法分析国内网状Meta分析的研究主题剖析与合作情况。方法:以中国知网、中国生物医学文献数据库为数据来源检索获得网状Meta分析的相关文献,并利用VOSviewer1.6.18软件进行发表时间、期刊、省份、机构、作者及关键词的共现分析并绘制相关图表和可视化图谱。结果和结论:共纳入734篇文献进行可视化分析,并且结果显示网状Meta分析的数量一直呈迅速上升趋势。参与研究网状Meta分析的31个省份中,以北京发文量位居首位(198篇),在273种期刊中以《中国循证医学杂志》发文最多,为44篇。2 989位作者中,以田金徽发文量(40篇)最多,602个机构中发文量以兰州大学(70篇)位居首位。分析机构和作者的合作网络可发现,各团体内部成员之间合作较为紧密,不同团体之间的合作相对较弱,因此需加强不同团体之间的合作。高频关键词聚类分析主要涉及7个主题,主要涵盖了药物(中医药)治疗疾病有效性的研究。     

2017—2022年全球网状Meta分析的研究热点与前沿

目的:本研究旨在通过文献计量学分析探讨网状Meta分析相关研究的发展现状和热点前沿。方法:本文以Pub Med, EMBASE.com, Cochrane library三个全球数据库为数据源检索获得网状Meta分析的相关文献,并借助VOSviewer、Cite Space及R软件对纳入研究的发表时间、国家、机构及作者分布、热点内容与前沿趋势进行剖析。结果:共纳入5 689篇文献进行可视化分析,结果显示网状Meta分析在2017—2022年发文量整体呈稳步增长趋势。包括104个国家的5 581个机构的25 736位作者,其中发文量前3位的国家分别为中国、美国和英国,机构分别为多伦多大学、麦克马斯特大学和四川大学,作者分别为Tu, YK、Salanti, G和Tian, JH。发文量15篇及以上的47位作者之间共形成了7个团体,并且各团体之间的合作强度不一。文献刊载在1 343种期刊上,刊载量排名前3的期刊分别为Medicine、BMJ Open和Frontiers In Pharmacology。共现次数60以上的66个关键词形成了4个聚类。结论:网状Meta分析数量整体呈增长趋势。参...     

静脉活性药物治疗痔术后并发症的系统评价和网状Meta分析

目的:系统评价不同静脉活性药物治疗痔术后并发症的疗效。方法:计算机检索Embase、PubMed、The Cochrane Library、中国知网、万方数据库等文献资料,筛选包含静脉活性药物治疗痔术后并发症的随机对照试验(randomized controlled trial, RCT),检索时间从建库截至2023年12月。由2名研究者按照纳入与排除标准筛选文献、提取资料并评价纳入研究的方法学质量后,应用Stata 16.0软件,利用传统Meta分析和网状Meta分析方法对纳入的RCT研究结果进行合并。结果:共纳入22项RCT研究,包含2 743例患者。传统Meta分析和网状Meta分析均显示联合使用静脉活性药物可显著降低患者术后并发症发生率,缩短并发症持续时间,改善并发症评分,促进伤口愈合,差异有统计学意义(P<0.05)。网状Meta分析结果显示纯化微粒化黄酮在改善术后出血评分、缩短术后出血时间方面疗效最佳;地奥司明在降低术后水肿率和出血率方面疗效最佳;七叶皂苷类药物在缩短术后伤口愈合时间和改善术后并发症总有效率方面最佳;香豆素类药物在缩短术后疼痛时间和水肿时间、降低术后疼...     

我院门诊和老年患者抗生素处方的调查分析

目的:了解门诊患者(包括老年患者)抗生素应用情况,并对其合理性进行分析。方法:回顾性调查一家综合性医院门诊患者抗生素使用情况。结果:4 313张门诊处方中含抗生素的比例为39.8%,其中单用抗生素的占57.8%,两药联用占35.3%,三药联用占6.35%,四药联合用占0.52%。老年患者中含抗生素处方比例为41.4%;其中含抗生素处方中单用率为72.5%,二联用药率为26.7%,三联用药率为0.8%,尚无四联使用情况。常用抗生素类药物有氟喹诺酮类、头孢菌素类、大环内酯类等。结论:该院老年患者抗生素选用基本合理。     

骨松灵对骨质疏松症的药效学研究

目的：以大鼠和小鼠观察骨松灵治疗骨质疏松症的药效。方法：采用小鼠扭体及耳廊肿胀,大鼠内芽肿,小鼠免疫器官及性器官增重,大鼠骨结构及钙磷含量测定等实验方法。结果：骨松灵能明显抑制小鼠耳廊肿胀及大鼠内芽组织增生;减少小鼠扭体次数;增加小鼠免疫器官的重量。减轻雌、雄性小鼠性器官的萎缩及重量减轻程度,能明显阻止髓腔面积增大及小梁骨面积减小;增加动物骨钙含量。结论：骨松灵具明确的抗炎止痛作用,能减轻性器官的萎缩程度;提高机体免疫力;通过调节钙磷代谢,保持骨矿含量,改善骨质疏松的骨结构,起到治疗骨质疏松的作用。     

抗抑郁药物对慢性应激抑郁模型大鼠海马胱天蛋白酶-9表达的影响

目的研究氟西汀与噻萘普汀对慢性应激抑郁模型大鼠海马胱天蛋白酶-9(Caspase-9)表达的影响。方法将大鼠随机分为抑郁模型组、氟西汀组、噻萘普汀组和对照组。模型组、氟西汀组和噻萘普汀组给予21d的应激刺激,此期间对照组正常饲养,刺激期间氟西汀组每天灌胃氟西汀(10mg/kg),噻萘普汀组每天灌胃噻萘普汀(50mg/kg),模型组和对照组每天灌胃等体积的生理盐水。行为学检测应用开场法和液体消耗实验。采用Western blot法检测各组大鼠海马Caspase-9的表达情况。结果模型组水平穿越格数、竖立次数、修饰次数、糖水消耗百分比均显著低于对照组(P<0.01)。氟西汀组水平穿越格数、竖立次数、修饰次数和糖水消耗百分比均高于模型组(P<0.05)。噻萘普汀组糖水消耗百分比高于模型组(P<0.05),水平穿越格数、竖立次数和修饰次数也高于模型组,但差异无统计学意义。慢性应激后模型组大鼠海马Caspase-9的表达水平显著高于对照组(P<0.01);氟西汀组大鼠海马Caspase-9的表达水平低于模型组(P<0.01),高于对照组(P<0.05);噻萘普汀组大鼠海马Caspase-9的表达水平低于模型组(P<0.01),高于对照组(P<0.01)。结论氟西汀和噻萘普汀2种抗抑郁药物均可以逆转慢性应激抑郁模型大鼠海马中Caspase-9表达的升高。     

某专科医院护理人员循证护理认知现状调查及对策

目的了解护理人员对循证护理（EBN）的认知现状，提出相应对策。方法采用自行设计的问卷对某专科医院当班护理人员进行EBN认知状况的调查。结果6．76％的护理人员熟悉EBN知识．21．71％的护理人员对EBN知识有所了解，43．06％的护理人员听说过EBN，28．47％的护理人员从未听说过。54．09％和38．79％的护理人员认为有机会可了解和希望了解EBN的相关知识。仅有8．54％的护理人员经常关注EBN。获得EBN知识的来源：医学讲座占56．94％、医学杂志占58．01％、网络信息占69．40％、高年资护士占46．26％。对EBN信息资源了解：29．18％的护理人员不知道，46．28％的护理人员听说过，21．00％的护理人员有所了解，仅有3．56％的护理人员熟悉。循证技能上，护理人员遇到临床护理问题的解决方法：45．20％的护理人员采用EBN的科学证据、57．65％的护理人员采取查阅文献、32．38％的护理人员凭个人经验解决、61．57％的护理人员采取向高年资护士请教。结论护理教育工作者应改革课程体系，重视、完善护生EBN的基础知识及EBN技能培养。医院应对临床护士给予行政支持，领导要重视EBN，确保EBN的实施。     

Non-reducible cyclic, and azaphenylalanyl6 analogues of somatostatin

SSeven new analogues of somatostatin are described, along with the effects of these analogues on pentagastrin-stimulated gastric acid and pepsin secretion in conscious cats. Replacement of the cystine disulphide bridge of somatostatin with an amide bridge, with or without deletion of the N-terminal dipeptide, resulted in analogues with approximately 20% of the potency of somatostatin. Simultaneous ommision of Lys4 in the amide-bridge analogues reduced the activity of the peptides to approximately 5% of somatostatin. Substitution of Phe6 of somatostatin or an amide-bridged analogue with azaphenylalanyl resulted in peptides with no detectable activity. The results illustrate the possible importance of the basic side-chain of Lys4 for the activity of somatostatin. The lack of activity of azaphenylalanyl6 analogues of somatostatin demonstrate the extreme importance of the orientation of the side-chain of Phe6 for the activity of somatostatin, possibly for the binding to somatostatin receptors.     

Effects of acute and chronic administration of fluoxetine on the activity of serotonergic neurons in the dorsal raphe nucleus of the rat

The gradual recovery of activity of serotonergic neurons following an initial inhibition has been hypothesized to play an important role in the delayed onset of efficacy of selective serotonin reuptake inhibitors. This study explored the clinical relevance of this hypothesis by examining the effects of different doses and routes of administration of fluoxetine on the recovery of activity of serotonergic neurons over the course of a 21-day exposure. Single-unit, extracellular recordings of serotonergic neurons were made in the dorsal raphe nucleus of anesthetized male rats. Acute i.v., s.c. and i.p. administration of fluoxetine inhibited the activity of serotonergic neurons. With chronic administration of fluoxetine, at clinically relevant doses, the activity of serotonergic neurons gradually recovered to baseline levels over the course of 14-21 days. The dose of fluoxetine (5, 10 or 20 mg/kg per day) did not make a significant difference in the time course of the recovery of activity of serotonergic neurons. A significant, non-parallel shift in the dose-response curve of serotonergic neurons to the serotonin-1A (5-HT1A) agonist 8-OH-DPAT occurred over the 21 days of treatment with fluoxetine, indicating a desensitization of the 5-HT1A receptor during this period. The recovery of firing did not correlate with either plasma or cerebrospinal fluid levels of fluoxetine or norfluoxetine. These results indicate that, similar to the effects of dose on the speed of onset of the clinical effects of SSRIs, increasing the dose of fluoxetine does not hasten the recovery of firing of serotonergic neurons during chronic administration. These results support the hypothesis that desensitization of the 5-HT1A receptor and consequent recovery of firing of 5-HT cells in the dorsal raphe nucleus plays a role in the delayed therapeutic onset of fluoxetine.     

Dual action effects of morphine on the electrical activity of the dorsal tegmentum

The midbrain tegmentum has been identified as an important locus for development of negative reinforcement with electrical stimulation of the brain. It also plays a central role in the motivational-affective component of pain, and is a site of the analgesic action of morphine. The present study reports the effects of morphine on the electrical activity of areas of the dorsal tegmentum of rats that were also tested for the aversive effects of brain stimulation. The results of spectral analysis of the EEG indicated that IP injections of 16 mg/kg of morphine significantly depressed intensity of EEG, while 8 mg/kg of morphine tended to increase intensity. The results were interpreted in terms of the dual action hypothesis of morphine action and Winter's model of drug effects of electrical activity of the brain. It was concluded that morphine may produce complementary inhibitory and excitatory effects on the negative and positive reinforcement systems of the brain respectively.     

Biochemical characteristics of the anti-ischemic action of the new structural analog of gamma-butyrobetaine 3-(2,2,2,-trimethylhydrazine)propionate

A structural analogue of gamma-butyrobetaine 3-(2,2,2-trimethylhydrazine)propionate (THP) administered orally in doses of 50 and 150 mg/kg for 10 days prevented isoproterenol-induced increase of the activity of the hepatic isoform of lactate dehydrogenase in the rat blood serum and in a dose of 150 mg/kg prevented an increase of creatine phosphokinase activity. Against a background of the course administration of THP isoproterenol failed to cause the accumulation of acyl-insoluble acylcarnitine in the myocardium. In this case a dose-dependent decrease of free carnitine concentration and accumulation of fatty acids in the myocardium were noted. The cardioprotective effect of THP manifested itself in prevention of a decrease of ATP and ADP concentrations, accumulation of AMP and a reduction of energy charge under the influence of isoproterenol. The ability of THP to decrease the intracellular concentration of free carnitine and to depress as a result carnitine-dependent oxidation of free fatty acids may underlie the anti-ischemic effect of THP.     

Effect of corazole on the dynamics of oxidative-reductive processes in cerebral cortical neurons

By using the complex of techniques on the basis of life-time microscopy and spectrophotometry of the structures of II, III layers of the cat brain motor cortex there was studied the effect of ionophoretically delivered corazole on the dynamics of integral redox-state of pyramidal cells bodies, the surrounding neuropil as compared to the changed bioelectrical activity. The development of the convulsant activity of neurons coincided with the shift of their redox-state towards the accumulation of intracellular reducing equivalents. Both in the bodies of neurons and in the structures of neuropil a stable pronounced increase of restoration of intracellular redox-systems was preceded by the process of wave-like fluctuating changes in the content of reducing equivalents. The role of the revealed disturbances of oxidation-reduction processes in the mechanisms of corazole-induced lesions of neurons is discussed.     

经皮穿钉固定骶髂关节针道参数的解剖学研究

目的:计算经皮穿钉治疗骶髂关节脱位的螺钉针道参数。方法:通过对十具防腐尸体的解剖学研究,确定椎弓根最窄处在髂骨后外侧的投影区,将骶1椎体纵形剖开,自一侧骶1椎体通过椎弓根向投影区逆行穿针,确定闭合打钉时拉力螺钉的置入范围、角度、螺钉长度,根据测量数值自另侧骨盆顺行打钉,验证螺钉针道参数。结果:在所有进行实验的尸体骨盆中椎弓根最窄处在髂骨后外侧投射区相对固定,在骶骨翼及S1锥体置入1根长拉力螺钉达骶1锥体1/2,置入螺钉最小长度为6.99厘米(为骶髂关节穿钉点髂骨最小厚度+骶骨体横径+第1骶椎体上面最大横径的1/2),置入螺钉最大长度为7.71厘米(为骶骨翼前缘耳状面骶1椎体外侧缘间距+骶1椎体横径的1/2+骶髂关节穿钉点髂骨最大厚度)。钉道范围:骶1进针点为以髂后上棘、髂后下棘连线为底的等边三角形的顶点,进针方向与冠状面夹角为20～25度,与水平位夹角为20度。结论:闭合打钉治疗骶髂关节脱位从解剖学研究角度认为是可行的的,但进针点及方向、螺钉长度需要根据椎弓根在骨盆壁体表投影数值及与骶1椎体的夹角确定。在不具备导航系统的情况下,以上参数可供临床参考。