复方血竭治疗溃疡性结肠炎的Meta分析

目的评价复方血竭保留灌肠治疗溃疡性结肠炎的临床治疗效果。方法通过计算机及手工检索国内期刊公开发表的复方血竭制剂保留灌肠治疗溃疡性结肠炎的临床试验资料,采用Jadad质量标准对文献进行评价,利用RevMan 5.1.7.0软件对各研究结果的总体效应进行Meta分析,并进行敏感性分析;用漏斗图分析发表性偏倚。结果 6篇文献符合纳入标准,共678例病例,其中3篇文献质量较好,3篇属于低质量文献。Meta分析结果显示:各独立试验间无明显的异质性,合并效应值OR=3.08,95%CI为(1.29,7.40),z=2.52,P<0.05,复方血竭保留灌肠治疗溃疡性结肠炎的临床疗效优于对照组,差异有统计学意义。敏感性分析显示评价结果比较稳定,漏斗图图形不呈现左右对称,考虑存在一定的发表偏倚。结论复方血竭保留灌肠治疗溃疡性结肠炎有一定疗效。     

缺氧诱导因子-1α基因多态性和乳腺癌易感性关系的Meta分析

目的 运用Meta分析方法评价缺氧诱导因子-1α(hypoxia inducible factor-1,HIF-1α)基因多态性与乳腺癌发生的关系。方法 检索PubMed、Cochrane Library、中国期刊全文数据库、万方数据库等数据库中所有关于HIF-1α基因多态性与乳腺癌易感关系的相关文献,合并各研究的OR值进行Meta分析。结果 HIF-1α C1772T基因多态性与乳腺癌发生的研究共纳入9篇文献,乳腺癌患者2 787例,对照组2 686例,G1790A基因多态性与乳腺癌风险的研究共纳入4篇文献,其中乳腺癌患者796例,对照组651例。Meta分析结果表明,C1772T以及G1790A基因型均与乳腺癌发病风险无明显相关。排除了对照组基因分布不符合Hardy-Weinberg遗传平衡定律后,对C1772T基因多态性与乳腺癌关系进行敏感性分析,结果表明显性模型（TT vs CT+CC）以及（TT vs CC）与乳腺癌发生有密切关系[OR=2.61,95%CI(1.32~5.15),P=0.006;OR=2.62,95%CI(1.33~5.16),P=0.005];对G1790A基因多态性研究进行敏感分析,未发现对总体分析结果有明显影响。结论 HIF-1α C1772T基因隐性模型个体发生乳腺癌风险可能增加,但HIF-1α基因多态性与乳腺癌发病风险之间的关系尚不明确。     

β受体阻滞剂影响静息心率与我国急性心肌梗死预后的关系

目的采用Meta分析的方法分析应用β受体阻滞剂降低我国人群静息心率水平对急性心肌梗死(AMI)患者死亡率的影响,为AMI临床急诊治疗的选择提供参考依据。方法全面收集国内发表的有关AMI患者应用β受体阻滞剂降低静息心率与死亡率关系的研究文献,对符合条件的所有研究结果利用Rev Man软件进行固定效应模型的Meta分析。计算应用β受体阻滞剂后AMI患者心率慢组相对心率快组发生死亡的危险(RR),评价心率快慢对AMI患者生存的影响,并用漏斗图分析发表性偏倚。结果符合纳入标准的共17篇文献,总样本量2 911例。其中心率慢组1 561例,死亡77例;心率快组1 350例,死亡217例;合并RR=0.30,95%CI是(0.27⁰.42)。漏斗图分析提示存在发表性偏倚。结论 AMI患者应用β受体阻滞剂控制心率水平与病死率之间存在关联。AMI后心率控制不佳者死亡危险增加,心率可能作为评估AMI患者预后的指标之一。     

中西医结合治疗急性胰腺炎有效率Meta分析

目的系统分析中西医结合治疗急性胰腺炎的临床有效率,并作出客观真实的评价,指导临床中西医结合的合理治疗。方法通过检索CNKI、万方、维普3个数据库,根据严格的纳入和排除标准进行文献检索和筛选,并使用Jadad量表进一步对纳入文献进行评估,通过使用Stata SE 12软件进行定量的系统分析。结果本研究共38篇随机对照文献符合纳入标准,患者共计2 892例。Meta分析结果显示,中西医结合治疗急性胰腺炎较常规西药治疗临床有效率合并效应量OR=4.03,其95%可信区间为(3.17,5.12);合并效应量检验Z=11.38,P<0.01,两组间比较,差异有统计学意义(P<0.01)。结论中西医结合治疗急性胰腺炎可以明显改善临床有效率。     

小切口切除胆囊疗效观察

目的对小切口切除胆囊的临床疗效进行观察。方法选取收治的30例采取胆囊切除术患者,随机将所有患者分成对照组（15）与观察组（15）,对照组采取传统胆囊切除术,观察组采取小切口胆囊切除术,将两组患者手术后有关指标以及发生并发症概率进行对比。结果对照组发生并发症概率为20.00%,观察组发生并发症概率为6.67%,观察组明显低于对照组,P〈0.05,其差异有统计学意义。在住院时间、下床活动时间、手术治疗时间以及术中出血量方面,观察组明显优于对照组,P〈0.05,其差异有统计学意义。结论采取小切口胆囊切除术,手术中以及手术后并发症较少,患者恢复比较快,所造成的创伤小。     

急诊腹腔镜胆囊切除术的治疗

目的：探讨急诊腹腔镜胆囊切除术的应用、处理方法及并发症的防治。方法：回顾分析67例急诊腹腔镜胆囊切除术临床资料及治疗效果。结果：行急诊腹腔镜胆囊切除术67例，66例成功，并发症l例。结论：急诊腹腔镜胆囊切除术所遇情况复杂、多变。随着腹腔镜胆囊切除术经验积累。掌握手术技巧，可降低手术难度，减少手术并发症的发生。     

腹腔镜胆囊切除术与直视微创胆囊切除术的对比研究

目的对腹腔镜胆囊切除术与直视微创胆囊切除术进行对比研究，探讨胆囊切除术适应证患者的理想术式。方法 回顾200例腹腔镜胆囊切除术（laparoscopic cholecystectomy，LC）与200例直视微创胆囊切除术的（mini—incision cholecystectomy，MC）临床资料，从手术通应证、术前准备、麻醉选择、手术创伤、并发症等方面对比分析两者的优缺点。结果两者比较LC创伤小、恢复快、并发症较少而MC并发症较多，术后恢复较慢。结论两种方式均具有微创特点，但是LC仍为适应胆囊切除术患者的首选。     

经脐单孔腹腔镜胆囊切除术的适应证与并发症预防

目的总结经脐单孔腹腔镜胆囊切除术的经验与体会,探讨其应用前景。方法我中心在2009年9月～2010年1月开展经脐单孔腹腔镜胆囊切除术19例,总结手术方法、技巧与临床效果。结果 15例完成经脐单孔手术,术后恢复良好,美容效果好;4例因暴露困难和出血术中转为三孔法完成腹腔镜胆囊切除术。19例术后均恢复满意,无并发症发生。结论经脐单孔腹腔镜胆囊切除术具有良好的美容效果,但相应的技术和器械还不成熟,术中发生困难时应果断改变术式。     

腹腔镜胆囊切除致胆管损伤的预防

目的：提高腹腔镜胆囊切除术至胆管损伤的预防水平。方法：回顾分析2002年至2004年306例腹腔镜胆囊切除术。结果：未发生胆管损伤。结论：深刻认识腹腔镜胆囊切除术致胆管损伤的原因，正规的人员培训，严守手术操作规范是预防腹腔镜胆囊切除术致胆管损伤的关键。     

腹腔镜胆囊切除术中胆囊后三角入路预防胆道损伤探讨

目的探讨腹腔镜胆囊切除术中胆管损伤的预防方法。方法对274例行腹腔镜胆囊切除术患者采用胆囊后三角入路行腹腔镜胆囊切除术,对手术情况进行分析。结果 274例中无1例胆道损伤及其他并发症发生,术后平均住院4.5天,均治愈出院。结论胆囊后三角入路有助于术中辨认肝外胆管的结构及变异,能有效预防胆管损伤。     

The relationship between foot posture and lower limb kinematics during walking: A systematic review

Variations in foot posture, such as pes planus (low-arched foot) or pes cavus (high-arched foot), are thought to be an intrinsic risk factor for injury due to altered motion of the lower extremity. Hence, the aim of this systematic review was to investigate the relationship between foot posture and lower limb kinematics during walking. A systematic database search of MEDLINE, CINAHL, SPORTDiscus, Embase and Inspec was undertaken in March 2012. Two independent reviewers applied predetermined inclusion criteria to selected articles for review and selected articles were assessed for quality. Articles were then grouped into two broad categories: (i) those comparing mean kinematic parameters between different foot postures, and (ii) those examining associations between foot posture and kinematics using correlation analysis. A final selection of 12 articles was reviewed. Meta-analysis was not conducted due to heterogeneity between studies. Selected articles primarily focused on comparing planus and normal foot postures. Five articles compared kinematic parameters between different foot postures – there was some evidence for increased motion in planus feet, but this was limited by small effect sizes. Seven articles investigated associations between foot posture and kinematics – there was evidence that increasing planus foot posture was positively associated with increased frontal plane motion of the rearfoot. The body of literature provides some evidence of a relationship between pes planus and increased lower limb motion during gait, however this was not conclusive due to heterogeneity between studies and small effect sizes.     

Perforation of the small bowel as a complication of laparoscopic cholecystectomy: CT findings

Despite the widespread use of laparoscopic cholecystectomy, technical complications unique to the laparoscopic approach may lead to significant postoperative morbidity and mortality. We report a rare case of small bowel perforation due to trocar injury that led to extensive pneumoperitoneum and pneumomediastinum in a patient who underwent laparoscopic cholecystectomy. Small bowel injuries should be suspected when a large or an increasing amount of free air is detected following this procedure.     

肿瘤学与军事医学关系初探

目的：初步探究肿瘤学与军事医学的关系,以消除军队肿瘤学创新发展的理论障碍。方法基于引文网络的文献证据获取。结果我军及外军都有肿瘤学的应用性研究,包括军队中的淋巴组织肿瘤问题、第二次世界大战中388名何杰金病军队患者的长期存活问题、原西德军队中的白血病问题、军队中的黑色素瘤等。外军还有一些文献特别关注了特种武器装备、特别军事行动、特殊军事环境相关的肿瘤流行病学问题,如核武器试验后的癌症问题,越南战争、海湾战争后的肿瘤发生问题。美国还设有专门的军事癌症研究所,2001～2013年共发表了206篇文献。结论密切肿瘤学与军事医学的关系,应当准确把握军队医学与军事医学的关系,充分借鉴外军发展肿瘤学的有益经验,深入挖掘肿瘤学的军事医学价值。     

Research articles published in clinical radiology journals: trend of contribution from different countries

RATIONALE AND OBJECTIVES: To determine different countries' trend of contribution to clinical radiology journals and its relationship with impact factor. MATERIALS AND METHODS: All the journals, which publish articles on clinical radiology, were selected from the category of Radiology and Nuclear Medicine group of journals, and articles published in these journals between 1991 and 2000 were searched for the authors' affiliation using the Medline database. Then, share of research output of the top-ranking 20 countries was determined along with the trend over time. Also, the relationship of different countries' contribution with the impact factor of journals was examined by cross-sectional time-series linear model. RESULTS: Of total articles (38,359), the United States' share for the selected journals in clinical radiology was 43.2% (16,582 articles) and ranked top in the world, followed by the United Kingdom (9.9%) and Japan (8.0%). The recent increase in the share was statistically significant for Japan, France, Germany, Italy, South Korea, Turkey, Spain, Switzerland, Austria, and China. On the other hand, the United States, United Kingdom, and Canada showed a significant negative trend. Among the top-ranking 10 countries, the US contribution was significantly higher to journals with high-impact factors, whereas the opposite was true for France. CONCLUSION: The United States, United Kingdom, and Canada showed a negative trend over the last decade in terms of proportion of contribution of articles to the clinical radiology journals. However, only the United States published more articles in high-impact factor journals.     

Carcinoma of the male breast: report of a series of 88 cases.

A series of 88 cases of male breast cancer was compared with 241 cases of female breast cancer randomly selected from Departmental records. Cases of male breast cancer differed significantly from control female cases with regard to stage of the disease, age of onset and liability to the development of a second carcinoma. In 11 of the 88 cases (12.5%) of male breast cancer another primary malignant tumour developed. In seven instances the large bowel or rectum was the site of the other carcinoma. When correction was made for age and for the stage of the disease the prognosis of breast cancer in men and women was found to be similar. Only minor histological differences were found between male and female cases. Two of 54 cases examined for X-chromatin proved to be Barr-positive.     

低剂量螺旋CT筛查高危人群早期肺癌的Meta分析

目的用Meta分析综合评价低剂量螺旋CT（LDSCT）筛查高危人群早期肺癌的价值。方法搜集1995年1月至2005年6月国内外公开发表的LDSCT筛查高危人群早期肺癌的文献，对符合条件的原始研究进行质量评估、异质性检验和一致性分析。汇总敏感性和特异性，通过汇总受试者工作特征曲线（ROC）和曲线下面积来综合评价LDSCT筛查高危人群早期肺癌的价值，同时对基础扫描和严密随访至少2年后的结果进行比值比（odds ratio，OR）的合并检验，最后进行敏感性分析。结果15篇文献符合纳入标准，由9个独立研究构成，研究对象共8168人，纳入研究存在异质性。按发现结节（B0）、发现结节直径（d）≥5mm（B5）、发现结节d≥10mm（B10）3个标准基础扫描的Kappa值分别为0．061、0．134、0．460，汇总敏感性分别为0．686、0．721、0．640，汇总特异性分别为0．708、0．815、0．959。ROC曲线下面积分别为0．778、0．949、0．539，B0与B5的曲线下面积差异无统计学意义（P〉0，05），B0与B10及B5与B10的曲线下面积差异有统计学意义（P〈0．05）。B5与B10进行基础扫描和严密随访至少2年后结果的合并检验，OR值分别为1．11和1．66。结论纳入文献质量较好。LDSCT筛查高危人群早期肺癌基础扫描中以发现结节d≥5mm为阳性标准较合理，总的诊断效能较高，严密随访能提高筛查试验的准确性，筛查效果受机会性因素的影响较大，有必要通过设计合理、随访严密的大样本随机对照试验来严格控制机会性因素的影响，进一步证实肺癌筛查试验的有效性。     

用Meta分析法评价FDG PET显像诊断肺单发结节的价值

目的用Meta分析法综合评价^18F-脱氧葡萄糖(FDG)PET显像鉴别诊断肺单发结节(SPNs)良恶性的价值。方法搜索Medline数据库，检索用^18F-FDG PET显像诊断SPNs的文献，摘录相关数据；根据Cochrane工作组推荐的诊断试验的评价标准进行文献的质量方法学评估。数据分析用Sigmaplot软件绘制summary ROC(SROC)，用Cochrane工作组的Revman软件进行Meta分析，得到合并的似然比(OR)，用非配对t检验比较目视法和半定量法鉴别诊断SPNs的价值。结果共检索到文献14篇，文献质量水平为a和b级。仅用半定量法可绘制SROC曲线，曲线下面积为0．91。合并后目视法和半定量法OR值分别为39．05和26．97，差异有显著性(P=0．042)，灵敏度、特异性分别为96％，81％和90％，86％，差异均无显著性(P分别为0．051和0．738)。结论入选文献均有较高的质量水平。SROC显示半定量法诊断SPNs有较高的准确性。^18F-FDG PET显像在SPNs的诊断中有利于阳性病例的检出。     

抗细胞角蛋白单克隆抗体AE_1/AE_3在食管、贲门、胃和大肠癌组织中的反应

应用抗细胞角蛋白单克隆抗体ＡＥ１／ＡＥ３，对食管癌、胃癌和大肠癌的原发组织反应进行了研究。结果表明，４６例癌组织的反应率是９３％，食管癌为１００％，胃癌和大肠癌分别是９４％和７９％；反应强度和反应范围显示，食管癌较胃和大肠癌好。ＡＥ１／ＡＥ３符合做检测食管癌在非上皮组织（淋巴结、骨髓和外周血）中的微小转移的探针，不宜用来检测胃和大肠癌的微小转移，至少不能单独使用。同为胃和大肠来源的腺癌组织可出现阴性反应，说明组织来源完全相同的肿瘤可有不同的ＣＫ亚型。对抗某一个或几个ＣＫ亚型单克隆抗体阴性反应的肿瘤，不能完全除外为上皮来源。鉴别疑难肿瘤的组织来源时，必须应用多个抗ＣＫ的单克隆抗体，并且结合其他标记才更有临床意义。     

2型糖尿病对胃癌发病的危险性分析

目的 探讨2型糖尿病(T2DM)是否为胃癌发病的危险因素.方法 随机选取曾在我院住院的胃癌患者296例(胃癌组),并随机选取住我院的非胃癌患者302例作为对照组.采用病例对照的方法,回顾性分析两组的糖尿病患病情况、胃炎病史、饮酒、吸烟、胃癌家族史的差异.结果 胃癌组中合并糖尿病者59例(19.9%),对照组中合并糖尿病者31例(10.3%),两组差异有统计学意义(P=0.036).胃癌组的男性患2型糖尿病的OR值为9.89,女性患者患2型糖尿病的OR值为8.26,男女间比较无显著性差异.单因素回归分析提示,年龄、吸烟、饮酒、胃炎、胃癌家族史、DM与胃癌的发病有关,最终年龄、饮酒、胃炎、T2DM进入多因素非条件回归模型,其OR值分别是1.357、3.013、4.631和3.962.结论 年龄、饮酒、胃炎和T2DM是胃癌的危险因素.在4种危险因素当中,T2DM危险程度仅次于胃炎,并且这些因素存在相互促进作用.     

Understanding the relationship between risks and odds ratios.

BACKGROUND: Many articles provide only odds ratios (OR) and non relative risks (RR) as the effect estimate. For a variety of important reasons, multiple logistic regression used to adjust for confounders routinely provides only the adjusted OR (ORadj). However, from the clinician's perspective, the ORadj is only easily interpretable when it approximates the adjusted RR (RRadj). In general, the relationship between the OR and RR (adjusted or nonadjusted) is dependent on prevalence of disease in the control group (Po) and has always been presented as nonlinear. Therefore, it is difficult for the clinician to convert the OR to RR when reading the published data. A formula was proposed by Zhang and Yu, but the relationship remains nonlinear. OBJECTIVE: To develop a simple method to convert OR to RR without the use of computer. METHODS: Algebraic manipulation. RESULTS: Through algebraic manipulation, we show that although the OR and RR relationship is nonlinear over the range Po, the ratio OR/RR has a linear relationship with Po with a slope of "OR-1": OR/RR=(OR-1)xPo+1. This makes the prediction of RR on the basis of OR more transparent. It is clear that if Po is small, the RR approximates the OR, but only if the OR is also small. Previous problems with confidence intervals noted with the Zhang and Yu formula remain (ie, they are too narrow under some conditions) and the result should be interpreted with this limitation. Relationships between ORadj and risk difference or number needed to treat remain curvilinear, but some overall approximations can be made. CONCLUSION: A simple relationship exists that allows readers to easily convert ORadj to RRadj. Limitations of the approach remain but seem to be less restrictive than the limitations of not converting ORadj to RRadj.