有序多分类重复测量资料的广义估计方程分析

目的 探讨广义估计方程在有序多分类重复测量资料中的应用，为临床试验中的重复测量资料的正确分析提供方法学上的参考。方法 采用SAS软件包的GENMOD语句拟合广义估计方程，进行实例分析，并和独立logistic回归分析结果进行对比。结果 获得了各参数及其标准误的估计值。可以对各因素进行直观的参数估计。广义估计方程各参数估计值标准误普遍大于独立logistic回归估计值的标准误，从而使得检验结果发生了变化。结论 广义估计方程引入工作相关矩阵以处理非独立数据之间的相关性，可以有效地控制层次相关性、重复测量因素及其它混杂因素，为有序多分类重复测量资料提供了一种有效的分析方法。     

高血压病患者左心室重量与QT离散度的相关性研究

目的　研究高血压病患者左心室重量与QT离散度的相关关系。方法　根据超声心动图标准 ,将高血压病患者分为伴左心室肥厚与不伴左心室肥厚 2个亚组 ,分析其标准 1 2导联心电图 ,计算QT离散度 ,对比两个亚组的QT离散度 ,对左心室重量与QT离散度进行线性回归分析。结果　QT离散度与左心室重量呈线性相关 (r =0 .3 ,P <0 .0 0 1 )。高血压病伴左心室肥厚组与不伴左心室肥厚组比较 ,前者QT离散度明显增大。高血压病患者左心室越重 ,QT离散度越大。结论　QT离散度与左心室重量存在线性相关 ,左心室肥厚 ,而不是高血压 ,导致QT离散度增大。     

肺良性肿瘤形态学征象的logistic回归分析

目的应用logistic回归对肺良性肿瘤形态学征象进行分析。方法收集52例肺良性肿瘤及30例恶性肿瘤,对形态学征象进行单因素X2检验及相关因素logistic回归分析,形态学征象包括边缘征、钙化征、胸膜继发改变、肿瘤位置、分叶征、肿瘤形状及囊变征。结果经过单因素X2检验,得到肺良性肿瘤形态学征象中,边缘征、钙化征、胸膜继发改变、肿瘤所在位置、分叶征、肿瘤形状及囊变征的X2值分别为26.801、7.329、0.008、0.444、11.134、11.134及0.596,其中只有边缘征、钙化征、分叶征及肿瘤形状的P值0.05,有统计学差异;进行相关因素logistic回归分析后,得到边缘征的Wald统计量值最大,相伴概率最小,分别为9.779和0.002。结论肺良性肿瘤形态学征象中边缘征、钙化征、分叶征及肿瘤形状对鉴别诊断有影响,其中边缘征影响程度最高。     

成组删除法和多重填补法对随机缺失的二分类变量资料处理效果的比较

目的:评价两种随机缺失的二分类变量资料处理方法。方法:以艾滋病中医症候的调查资料为数据来源,利用SAS9.2对完整数据集随机模拟,构建不同比例的随机缺失数据集,对缺失数据集采用多重填补法中的lo-gistic回归法(MI/logistic)进行填充处理;同时对缺失数据集采用成组删除法进行处理;根据各个数据集建立logis-tic回归模型,与完整数据集进行比较。结果:缺失10%时,成组删除法处理结果与完整数据集更接近;缺失20%～40%时,MI/logistic填补后常数项和x的回归系数明显偏离完整数据集;缺失50%时,MI/logistic填充2次时x的回归系数和标准误更接近于完整数据集;缺失60%时,MI/logistic填充后x的回归系数严重偏离完整数据集,成组删除后x回归系数的标准误明显偏离完整数据集。结论:缺失较少(缺失率<40%)时,成组删除法处理效果较好;缺失50%时,采用MI/logistic回归法填充效果更好;缺失60%以上时,两处理方法均不理想。     

结合Kaplan-Meier法与Bootstrap法处理膳食暴露评估中的未检出值

目的：探讨应用Kaplan-Meier方法与bootstrap方法相结合处理膳食暴露评估中多个检出限存在时的未检出值数据.方法：以大米中的镉残留数据为例,应用Kaplan-Meier方法对数据拟合累积概率分布曲线,并且应用bootstrap方法估计残留值的均数和中位数的标准误以及累积概率的区间.结果：Kaplan-Meier方法处理多个检出限存在时的未检出值简单,便于计算机实现,Bootstrap估计的区间与近似估计区间一致性好.结论：对环境暴露评估中包含未检出值的左截尾数据的处理,结合bootstrap区间估计的Kaplan-Meier方法是值得推荐的有效方法.     

心肌梗死急性期与恢复期QT离散度的变化

目的:观察心肌梗死急性期与恢复期QT离散度(QTd)、心率校正QT离散度(QTcd)、QT离散率(QTr)的变化,以了解心肌梗死急性期时心室肌复极时限差异是否较恢复期增大。作为衡量心肌梗死患者是否度过急性期的指标。方法:分别测量56例心肌梗死急性期与恢复期心电图各导联QT间期,最大QT间期(QTmax)减最小QT间期(QT-min),得QTd;以QTmax/(R-R)~(1/2)减QTmin/(R-R)~(1/2)得心率校正QT离散度QTcd;QTd/(R-R)得QT离散率QTr。并对心肌梗死急性期与恢复期的QTd、QTcd、QTr进行比较。结果:心肌梗死急性期较恢复期QTd、QTcd、QTr明显增加,P值分别<0.01、<0.01、<0.001。结论:心肌梗死急性期心室肌复极时限差异较恢复期增大,QTr是QT离散程度更为客观的指标。     

输尿管结石梗阻继发术前CT图像特征对输尿管镜碎石术后发热性尿路感染的预测价值

目的 探讨输尿管结石患者术前CT继发影像特征对输尿管镜下钬激光碎石患者术后发热性尿路感染(UTI)的预测价值。方法收集因输尿管结石行输尿管镜碎石术（URS）治疗的501例患者进行回顾性分析。根据URS术后出现发热性UTI分为非发热组（A组）与发热组（B组）,其中A组432例,B组69例,统计比较两组间的临床因素、结石因素及结石梗阻的继发CT特征改变。采用多变量logistic回归模型分析URS后发热性UTI的预测因素。结果501例患者中69例出现发热性UTI。在单因素分析中,体质指数（t=3.745,P<0.001）、糖尿病（2= 12.969, P<0.001）、慢性肾功能不全（2=18.427, P<0.001）、结石位置（2＝6.491,P=0.039)、结石大小（t=10.624, P<0.001）、肾积水(2=5.314,P=0.021)、输尿管积水(2=11.108,P=0.001)、肾积水CT值（t=12.401,P<0.001）、肾周脂肪链（2=43.874,P<0.001）、输尿管周围脂肪链（2=21.270,P<0.001）、组织边缘征（2=21.750,P<0.001）、手术时间（t=3.728,P<0.001）差异有统计学意义,而年龄、性别、高血压、既往存在急性肾盂肾炎、既往存在结石手术病史、结石CT值、结石边侧、结石数量、结石清除率差异无统计学意义（P>0.05）。在多因素logistic回归分析中,糖尿病（Wald值7.917,P=0.005）、慢性肾功能不全（Wald值12.570,P<0.001）、结石大小（Wald值11.570,P=0.001）、肾周脂肪链（Wald值23.477,P<0.001）、组织边缘征（Wald值19.644,P<0.001）、肾积水CT值（Wald值5.450,P=0.02）、手术时间（Wald值8.812,P=0.003）是URS术后发热性UTI的独立预测因素。结论继发征象包括术前CT上的肾周脂肪链、组织边缘征、肾积水CT值、结石大小、慢性肾功能不全、糖尿病、手术时间是URS后发热性UTI的独立预测因素。     

急性心肌梗死患者QT离散度与早期恶性心律失常的相关性研究

目的:通过对急性心肌梗死患者QT间期离散度(QTd)的观察,探讨其与早期恶性心律失常的关系.方法:选择符合研究标准的急性心肌梗死患者110例,根据有无恶性心律失常分为观察组和对照组,比较两组间QTd、QTcd的差异,并进行统计学分析.结果:110例AMI患者有34例并发恶性室性心律失常,其平均QTd、QTcd值分别为96.24±7.58毫秒和102.04±6.42毫秒;76例患者未并发恶性室性心律失常,其平均QTd、QTcd值分别为63.76±9.37毫秒和68.21±5.98毫秒,组间比较均有统计学意义(P＜0.01).结论:急性心肌梗死患者QTd、QTcd值增大与恶性心律失常的发生率密切相关,QTd或QTcd值越大发生恶性心律失常的几率越高,QT离散度可作为预测恶性心脏事件的一项重要而敏感指标.     

纵向观测二分类数据的广义线性模型分析

目的：利用广义线性模型对纵向观测二分类数据进行分析,充分考虑纵向观测间的相关性,给出一般分析方法。方法：采用Zeger和提出的广义估计方程,拟合logistic广义线性模型,讨论3种协方差矩阵结构。结果：同时获得回归参数、相关参数的估计,完成了较为实用的运行程序,并进行了实例分析。结论：医学研究和临床试验中经常接触到纵向观测数据,对这类数据需采用特殊的方法进行分析处理,以解决重复观测间的相关性问题。     

长期生存者资料分析中半参数混合模型的应用

目的 介绍长期生存者资料分析的半参数混合模型. 方法 以喉癌和宫颈癌病人数据为例阐述半参数混合模型方法 ,并将长期生存者资料半参数混合模型与Cox回归模型得到的结果进行对比分析. 结果喉癌数据Cox比例风险回归模型仅得到一个协变量有统计学意义;半参数混合模型比例风险回归部分得到两个有意义的协变量,logistic回归部分得到一个协变量有统计学意义.宫颈癌数据Cox比例风险回归模型也仅得到一个协变量有统计学意义;半参数混合模型logistic回归部分得到两个协变量有统计学意义,比例风险回归部分有一个协变量有边缘统计学意义. 结论 在对长期生存者存在的数据分析时,半参数混合模型比Cox比例风险回归模型更具优势,可从多角度提供更多有价值的信息,在实际资料的分析中具有广阔的应用前景.     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

Development on Adjustable Calibration Marker for Shock Wave Focus

Shock wave lithotripsy （SWL） is a treatment of choice for upper urinary stones. However, this procedure is inappropriate for obese patients because the focus is often unable to reach the target owing to the limited focal distance in shock wave source. Although treating such patients in a blast path may increase the application length of shock wave source, it＇s difficult to find this path on the lithotripter monitor. For this reason, we invented an adjustable calibration marker in order to set an effective focus in the shock wave hath.     

Study on the TCM Pathogenesis of Angiopathic Complications of Type II Diabetes

Excess production of reactive oxygen species(ROS)of mitochondrion mediated by hyperglycemia is the common pathogenesis of angiopathic complications of diabetes.TCM holds that the damp from the dysfunction of spleen.kidney and liver is the causative factor of complications of diabetes.This is similar to the mechanism of Ros resulting in angiopathic complications of diabetes.When the angiopathic complications of type II diabetes mellitus(T2DM)are difierentiated as caused by turbid damp in TCM can be explained as ROS.Since the obstruction of pathogenic damp in channels and collaterals is said to be the main pathogenesis,the treating principle should be dissolving the damp to remove the obstruction.     

Leptin, Ghrelin and TNF-α before and after Hypo-caloric Traditional Chinese Diet and Auricular Acupuncture

INTRODUCTION Obesity is a complex emergent problem, which can be possibly solved not only by the diet but also by the life style and promotion of a constant physical exercise. 1, 2 No doubt careful attentions must be given to the nutritional condition of obese people, the dietary habits, the somatic build (i.e. distribution of fat mass) and the organic functions linked to formation of the fat mass. All the parameters should be constantly monitored before, during and after a diet treatment. 3, 4, 5     

Relationship between Dysglycemia and Carotid Atherosclerosis in Tibetan Population

People with dysglycemia are at high risk for atherosclerotic diseases. This study aims at investigating the atherosclerotic vascular damage in dysglycemia and its metabolic origin in Tibetan population.     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.     

Luo Lingjie's Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.     

Dr.Zhang Ren's Experience in the Acupuncture Treatment of Different Diseases with the Same Therapeutic Principle

Dr.Zhang Ren,the chief physician,is the chairman of Shanghai Acupuncture and Moxibustion Association.Having been engaged in medicine for about 40 years,he is experienced in treating various intractable diseases.In his long years of clinical practice,he advocates taking the TCM differentiation as the basis to seek for the acupuncture method for treatment of modern intractable diseases.The author of this essay had the fortune to follow Dr.Zhang in study.The following is a summary of Dr.Zhang's experience in the acupuncture treatment for different intractable diseases with the same therapeutic principle.