如何正确运用t检验——两算术均值比较优效性t检验及SAS实现

本文主要介绍临床试验中优效性检验的概念、假设检验、界值设定和样本量的估计以及成组设计一元定量资料优效性t检验的SAS实现。通过实例展示SAS在优效性t检验中的应用,分别基于两种数据结构(原始定量数据和样本含量、均值、标准差数据)进行操作,对结果进行解释并作出结论。     

Effect of electroacupuncture for reducing the frequency of recurrent cystitis: A case report 电针减少复发性膀胱炎发作次数:1例病例报告

IntroductionRecurrent cystitis, defined as at least two episodes within six months or three episodes within one year, presented among about one fifth to one-third of women with history of cystitis or urinary tract infection (UTI) according to previous studies. However, the use of antibiotics can only resolve the urinary symptoms but not reduce the frequency of urinary symptoms recurrence, and meanwhile increasing rates of adverse effect of repetitive antimicrobial therapy and bacterial antimicrobial resistance became clinical concerns. This case report aims to present a case of recurrent cystitis treated by electroacupuncture (EA) in reducing recurrent frequency, amount of antibiotics used and urinary symptoms.Case presentationA 42-year-old woman diagnosed with recurrent cystitis for five years presented mainly with recurrent dysuria, urine frequency and urgency. She received EA treatment 3 to 5 sessions a week and 30 min per session from August 2019 to August 2020 with 3-month suspension due to Coronavirus Disease 2019 (COVID-19). During the treatment, both the frequency of recurrent urinary episode and symptoms were reduced. Although there was some fluctuation, the mean frequencies of daytime voiding reduced dramatically from 17.7 to 8.3, and night-time voiding from 4 to 1, and the number of voiding with moderate urgency was reduced from 17.7 to 2.3, and severe urgency dropped from 2.7 to 0. The patient's scores of overactive bladder symptom score (OABSS) and overactive bladder questionnaire short form (OAB-q SF) were also improved. The postvoid residual urine volume (PVR) reduced from 42 mL to less than 10 mL.ConclusionThis case of individual effect of EA for a woman with frequent recurrent cystitis suggested a plausible benefit of EA on reducing frequency, amount of antibiotics used and symptoms of recurrent cystitis, but further research is necessary to proof the efficacy and effectiveness among a wider population.     

TNF inhibitors – Mechanisms of action,approved and off-label indications

Tumor necrosis factor inhibitors (TNFi) belong to the group of biologic drugs, holding presently top positions on lists of most profitable products for pharmaceutical companies. Although current indications for TNFi include only selected diseases with an established role of immune dysfunction in their pathogenesis, studies on new indications are being carried out all over the world. The most important aspect of TNFi therapy is a targeted therapeutic approach, allowing to avoid a wide range of side effects associated with treatment with nonspecific immunosuppressive agents. Results of the trials on TNFi in the approved indications are widely accessible and analyzed elsewhere, both in primary publications as well as in systematic reviews and meta-analyses. Here we aim to discuss their mechanisms of action, and approved, as well as off-label indications of TNFi. In addition, we present comprehensive evidence on TNFi in treatment of rheumatoid arthritis (RA); the first authorized and probably most extensively developed indication for the majority of TNFi.     

Temperament and one-year outcome of gastric bypass for severe obesity

BackgroundThe role of temperament traits in shaping the outcome of gastric bypass for severe obesity has not been established yet. This study evaluated whether temperament traits influence weight loss 1 year after gastric bypass, controlling for the potential confounding effect of Axis I and II disorders.MethodsForty-nine patients with severe obesity (body mass index = 46.4±6.7) undergoing gastric bypass completed a thorough psychiatric evaluation before surgery, including structured interviews, rating scales, and questionnaire assessing the presence and severity of co-morbid Axis I and II disorders. Temperament was evaluated with the Temperament and Character Inventory (TCI). Weight loss 1 year after surgery was calculated as percent total weight loss (%TWL). Predictors of weight loss were investigated with multivariate linear hierarchical regression.ResultsAfter accounting for psychiatric covariates, higher TCI persistence scores independently predicted 1-year outcome of gastric bypass and explained 40% of the variance in %TWL. Patients with low persistence scores showed a significantly lesser weight loss than patients with high scores.ConclusionTemperament traits denoting the ability to persevere in one’s goals in spite of immediate frustration (persistence) are associated with greater weight loss 1 year after gastric bypass. These data suggest the utility of preoperatively assessing and reinforcing such capacity to optimize surgical outcome. Future research will clarify the behavioral mechanisms mediating this relationship as well as the influence of temperament on weight maintenance.     

山海螺本草考证与临床研究进展简

目的：考证山海螺文献记载,综述其临床研究进展。方法：通过查阅古今文献,考证历代本草学对山海螺的记述,汇总其功效报道。结果：山海螺别名有：羊乳（根）、四叶参、奶党、奶树、白河车等,古代本草著作中作为＂羊乳＂的一种,山海螺为肺经药,兼入肝、脾经,是治疗气虚伴有阴津亏乏、痰结肿疡的良药,有扶正之功,无恋邪之弊,补中可清,清中有宣,润而不腻。结论：中医临床应用山海螺有悠久历史,其功效不断被发掘和完善,特别是治疗肿瘤疾患方面具有广阔应用和开发前景。     

我对韩国火病(Hwa-Byung)的认识

火病(Hwa-Byung)是韩国人很熟悉的心身疾病之一,属于韩国人固有文化相关综合征。反而此韩国火病在中医界并不熟知,本文收集和整理了目前有关火病的内容,介绍韩国火病的实际现状。韩国庆熙医疗中心韩方神经精神科通过使用choseunghun开发软件即"火病认定的标准诊断协议",在2004年5月至11月以门诊患者为主进行研究,确定患者辨火病的辨证类型结果如下,其中最多的辨证类型心阴阳两虚证(15),气血两虚证(5),少阳邪气弥漫三焦证(8),热扰胸膈证(8),痰火扰心证(7)。     

芪明颗粒联合羟苯磺酸钙治疗非增殖性糖尿病视网膜病变有效性及安全性的Meta分析＊

目的 系统评价芪明颗粒联合羟苯磺酸钙治疗非增殖性糖尿病视网膜病变（NPDR）的有效性及安全性。方法 计算机检索CNKI、万方、PubMed、Cochrane Library等数据库，检索时间截止至2021年9月，纳入试验组为芪明颗粒联合使用羟苯磺酸钙治疗NPDR的随机对照试验，应用Revman5.3软件对文献进行分析，系统评价对总有效率、血糖指标、视力、黄斑厚度、视网膜循环时间、血清细胞因子含量以及支链氨基酸含量的影响，同时评价芪明颗粒联合羟苯磺酸钙的用药安全性。结果 最终纳入14篇RCT，共计1299例患者。Meta分析结果示：试验组相对于对照组可以有效提高临床疗效（OR=4.22， 95%CI （3.02， 5.90）， Z=8.41， P<0.01，恢复视力（MD=0.14，95%CI （0.11， 0.16），Z=9.28，P<0.01），降低空腹血糖（MD=-0.17， 95%CI （-0.33， -0.01）， Z=2.07，P<0.05）及糖化血红蛋白（MD=-0.42，95%CI （-0.73， -0.11）， Z=2.68，P<0.01），降低黄斑厚度（MD=-7.30，95%CI （-9.86， -4.74）， Z=5.59，P<0.01），缩短视网膜循环时间（MD=-0.49，95%CI （-0.74， -0.23）， Z=3.73，P<0.01），同时可以调节血清因子含量以及支链氨基酸含量，降低不良反应发生率。结论 芪明颗粒联合羟苯磺酸钙治疗NPDR有良好临床疗效，可以有效改善视力情况及视网膜循环状况，改善体内血清支链氨基酸代谢情况，够抑制NPDR患者视网膜内多种细胞因子所介导的血管新生，降低不良反应，但受纳入文献质量和数量的限制，上述结论仍需更多试验进一步验证。     

丹参对激素性股骨头坏死的疗效及作用机制的研究概述

通过对相关文献归纳总结,从中西医两个方面论述激素性股骨头坏死的机制,介绍丹参的药理学研究,分析其对激素性股骨头坏死(Steroid-induced Avasulat Necrosis of the Fcromal Head)的疗效及作用机制,即疏通微循环、改善血液性能、发挥类雌激素作用等。总结丹参与其他疗法耦合对股骨头坏死的效果。     

《妇科玉尺》治疗月经病学术思想探析

《妇科玉尺》为清代著名医家沈金鳌所撰，是一部颇有影响的临床实用妇科专著。沈氏临床经验丰富，精通内外妇儿各科，特别在妇科治疗方面多有创见。沈氏论述月经诸病证治，平正可法，示人以规矩准绳，提供规范，且有论有方，取舍精当，议论中肯。文章拟对《妇科玉尺》治疗月经病的学术思想进行探讨，以期对临床辨证月经病有所裨益。     

“温润辛金、培本宣通”法治疗过敏性鼻炎临证剖析

李友林教授认为过敏性鼻炎的病机本质是"本虚标实",其病位在以肺脾为核心的肺、脾、肾三脏,其基本病理为寒热虚实错杂,脏腑功能不足是其发生演变的基础。经过多年临床经验,总结出以调理"本虚"为主,以治疗"标实"为辅的"温润辛金、培本宣通"法,取得较好疗效。文章阐述了运用本法治疗过敏性鼻炎的理论基础,并附医案3篇加以说明,阐明李友林教授治疗过敏性鼻炎的辨证及用药特点,以期对临床治疗有所启发。