上海市静安区中小学生肥胖状况2种标准评价比较

目的应用1985年“身高标准体重”和2003年国际生命科学会中国肥胖工作组(WGOC)制定的“中国儿童青少年超重、肥胖BMI分类标准建议”比较静安区中小学生的肥胖状况。方法2002~2004年,静安区营养监测点7~18岁的学生,分别用1985年“身高标准体重”法和WGOC标准筛选肥胖、超重,比较2种标准筛选出的肥胖学生特征。结果(1)用身高标准体重、WGOC标准筛选出的肥胖率分别为16.44%和10.51%,超重率分别为12.90%和15.31%;(2)不同年份、不同年龄、不同性别学生中,用2种标准筛选出的肥胖率和超重率存在明显不一致性;有4.41%(734/16 640)的学生用身高标准体重不能进行筛选,其中男生13~17岁组占91.69%(673/734);(3)2种标准筛选的肥胖学生均表现为小学生高于中学生,男生高于女生。结论随着我国青少年发育的快速变化,1985年身高标准体重已不能客观反映儿童青少年中的肥胖、超重水平,而WGOC标准能很好地区分正常体重、超重、肥胖学生。     

豚鼠血液流变学指标正常参考范围的研究

目的建立豚鼠血液流变学各指标的正常参考范围,供学者及同行作研究或实验时参考。方法用心脏采血法采集豚鼠血液5ml、肝素抗凝,雄性44只、雌性23只;用MVIS-2020全自动血液流变学分析仪检测豚鼠血液流变学各指标。结果豚鼠全血黏度(高切)正常值:雄性(5.17±0.72)mpas,雌性(4.86±0.69)mpas;全血黏度(低切):雄性(10.37±1.59)mpas,雌性(9.34±1.38)mpas;血浆黏度:雄性(1.42±0.15)mpas,雌性(1.40±0.13)mpas;全血还原黏度:雄性(6.28±0.90)mpas,雌性(5.93±0.88)mpas;红细胞压积:雄性0.42±0.03,雌性0.37±0.02。结论动物种系之间血液流变学指标存在差异;豚鼠血液流变学结果与性别有关。     

中医院校图书馆参考咨询员知识结构分析

从医、教、研人员对中医古籍图书的需求、对中医古代专题资料的需求、对现代中医药期刊文献的需求、对特种中医药文献的需求、对中医药数据信息的需求、对中医药课题研究的定性需求等实例出发，对中医院校图书馆参考咨询员的知识结构进行了分析。     

腔内高剂量与低剂量近距离放射治疗中晚期肺癌疗效比较

目的探讨高剂量率后装腔内放疗结合体外放疗治疗中晚期肺癌合适剂量分割与临床疗效。方法61例中晚期肺癌随机分为A组和B组。A组腔内放疗施源器中轴外5～10mm处参考剂量10Gy/次/周×2～3次/2～3周;B组腔内放疗施源器中轴外5～10mm处参考剂量5Gy次/周×4～6次/4～6周。体外放疗两组相同。结果A组1、3、5年局控率分别为74.2%、26.7%和16.7%。B组1、3、5年生存率分别为64.5%、45.2%和20.9%。两组比较,统计学无显著意义(P>0.05)。A组1、3、5年局控率分别为60.0%、33.3%和20.0%。B组1、3、5年局控率分别为74.2%、61.3%和41.9%,两组3、5年局控率有显著意义(P<0.05)。并发症:大咯血、放射性食管炎、气管支气管炎、肺炎、气管及肺纤维化等A组明显高于B组(P<0.01)。结论192铱高剂量率后装腔内放疗低剂量放疗优于高剂量放疗,疗效高,并发症少。结合体外放射腔内放疗合适剂量应以5Gy/次周,总剂量20～30Gy为宜。     

计算机编程建立肝脏移植患者他克莫司的有效血药浓度范围

目的 :为临床合理化使用免疫抑制剂他克莫司 (FK5 0 6 )提供理论依据 ,建立适合中国人肝脏移植受者FK5 0 6的有效血药浓度范围。方法 :用VISUALBASIC 6 .0开发程序 ;程序对用微粒子酶免分析法 (MEIA)测定全血FK5 0 6的血药浓度数据进行处理。结果 :肝脏移植术后 1mo内FK5 0 6理想有效血药浓度范围为 7～ 14 μg·L-1。结论 :该程序是开展治疗药物监测工作非常实用的工具 ,按程序所推荐浓度范围调整给药方案 ,既可获得满意的免疫抑制效果 ,又能减少排斥反应和FK5 0 6毒性     

中国人眼颅压力梯度参考区间的临床研究

目的探讨中国人群眼颅压力梯度参考区间,为建立基于眼颅压力梯度的开角型青光眼诊疗新体系提供理论标准。 方法横断面研究。对2010年8月至2019年8月首都医科大学附属北京同仁医院神经内科需行腰椎穿刺的受试者共200例。其中,男性97例,女性103例,年龄区间12~79岁,平均(47.0±14.7)岁。对受试者进行眼压、颅压及全身基本参数测量。性别资料采用频数和百分比描述;年龄、身高、体重、眼压、颅内压、平均动脉压、体质指数及眼颅压力梯度等连续定量资料采用 ±s描述。对于少量缺失数据,采用马尔科夫链蒙特卡洛模拟(MCMC)对缺失数据进行多重插补。采用95%分位数法确定参考值范围,对于连续定量资料的多组间比较采用单因素方差分析,两两比较采用两独立样本t检验。 结果根据全体受试者测定人群眼压参考区间为9.015 mmHg~20.265 mmHg(1 mmHg＝0.133 kPa)。人群颅压参考区间为6.179 mmHg~14.921 mmHg。人群眼颅压力梯度参考区间为-2.987 mmHg~11.047 mmHg。眼颅压力梯度临床诊疗参考区间为0.423 mmHg~10.508 mmHg。以年龄进行分组,<30岁人群眼颅压力梯度参考区间为-2.968 mmHg~9.028 mmHg;30岁~50岁人群眼颅压力梯度参考区间为-2.466 mmHg~11.606 mmHg;>50岁人群眼颅压力梯度参考区间为-2.466 mmHg~11.606 mmHg。三组间眼颅压力梯度差异无统计学意义(F＝2.041,P>0.05)。以性别进行分组,男性眼颅压力梯度参考区间为-2.769 mmHg~10.089 mmHg;女性眼颅压力梯度参考区间为-3.137 mmHg~11.877 mmHg。两组间眼颅压力梯度的差异无统计学意义(t＝-1.413,P>0.05)。以体质指数(BMI)进行分组,BMI<21 kg/m²的人群眼颅压力梯度参考区间为-1.437 mmHg~11.577 mmHg;21 kg/m²2的人群眼颅压力梯度参考区间为-3.046 mmHg~11.026 mmHg;BMI>23 kg/m²的人群眼颅压力梯度参考区间为-3.947 mmHg~10.087 mmHg。不同BMI分组间,眼颅压力梯度差异有统计学意义(F＝6.109,P<0.05)。 结论眼颅压力梯度临床诊疗参考区间为0.423 mmHg~10.508 mmHg,可作为开角型青光眼临床诊疗的新指标。同时,还为开角型青光眼病因学诊断及个体化治疗的进一步深入研究,提供新的实践基础与研究方向。     

HOW TO ASSESS THE RELATIVE RANGE OF TWO CONSECUTIVE LABORATORY MEASUREMENTS TO MONITOR PATIENTS

An integral part of routine health checkups involves laboratory measurements on various analytes in the blood. It is then common to compare the value of two consecutive measurements sampled at different times from the same patient. A “significant” change requires an action (additional sample and/or clinical action). The current rule is to check whether the relative range of measurement is larger than a certain critical threshold. This rule should guarantee a specified confidence level (e.g., 95%), but its derivation was based on an approximation. We derive the exact distribution and show that it is related to the doubly noncentral F distribution. The currently used threshold values are compared with the exact ones, and some limited power calculations are presented to detect changes in the patient condition.     

Inequalities in enrollment of women and racial minorities in trials testing uric acid lowering drugs

AimsWe investigated sex and racial inequalities in clinical trials testing serum uric acid (SUA) lowering drugs and analyzed the temporal trends of participation among the pre-specified demographic groups.Data were collected from publications of clinical trials testing SUA-lowering drugs. Linear regression analysis was performed to assess the relation between drug approval year and proportion of women and minorities enrolled in clinical studies.Data synthesisThe mean percentage enrollment of women in clinical trials significantly decreased over the time (r = −0.43, P-value = 0.02). Moreover, there was a statistically significant difference in mean percentage enrollment of women among trials testing different SUA-lowering drugs, with the highest representation in rasburicase (71.1%) and the lowest representation of women in dotinurad (0.8%). Over the time, also the mean percentage enrollment of racial minorities decreased, passing from 8.7% to 2.2% in a 10-year period.Women were proportionally underrepresented compared with their share of the population with asymptomatic hyperuricemia, overall (participation-to-prevalence ratio (PPR) = 0.34), in trials testing xanthine oxiase inhibitors (PPR = 0.38) and uricosurics (PPR = 0.29), and in trials with febuxostat, allopurinol, pegloticase, halofenate/arhalofenate, verinurad, lesinurad and dotinurad. Women were proportionally underreppresented also compared with their share of the population with gout, overall (PPR = 0.69) and in trials testing XOIs (PPR = 0.69), uricosurics (PPR = 0.68), and all SUA-lowering drugs excepted for rasburicase, pegloticase and topiroxostat.ConclusionsOur analysis shows that women and racial and ethnical minorities are underrepresented in controlled clinical trials testing SUA-lowering drugs, with similar pattern across drug classes.     

Place and Time Coding of Frequency in the Peripheral Auditory System: Some Physiological Pros and Cons

Evidence for and against classical theories of ‘place’ and ‘period’ mechanisms for the coding of frequency, and the modifications of the theories invoked to account for the pitch of ‘residue’ and other types of stimuli, are examined in the light of physiological data. These include new data on the temporal discharge patterns of cochlear nerve fibres under stimulation with two-tone complexes, harmonic and inharmonic three-tone complexes, and five-tone complexes of differing relative phase. They show, in particular, that certain arguments against ‘period’ coding of ‘residue’ pitch are invalid. The interspike intervals in the discharge patterns of cochlear fibres under these conditions are consistent with the pitches heard. On the other hand, the classical ‘period’ theory needs to be modified to take into account the normally relatively sharp frequency selectivity of cochlear fibres, and requires certain inefficiencies on the part of the central processor for pitch.

Comparison of measures of cochlear fibre frequency selectivity with analogous psychophysical data in man, including those on the ‘existence region’ of ‘residue’ pitch, suggests that ‘residue’-type stimuli judged to be tonal in quality could both: (a) be sufficiently resolved spectrally at the cochlear fibre level to serve as input to any of the current spectral ‘pattern recognition’ mechanisms proposed for the pitch extraction of complex signals, and also, (b) could generate patterns of temporal discharge reflecting enough waveform interaction between the harmonics to convey the pitch heard, because of the shape of the cochlear filters. (This conclusion might have to be qualified in the light of further physiological experiments on the ‘second effect’ of pitch shift.)

The present evidence, both psychophysical and physiological, suggests the following synthesis: musical interval recognition and relatively crude frequency discrimination can be accomplished by trained observers on signals where the frequency appears to be coded exclusively in terms of temporal information. However, the pitch quality of these signals is judged to be poor or absent. Likewise, signals, apparently coded exclusively by ‘place’ mechanisms, while having tonality, allow relatively crude frequency discrimination and judgment of musical intervals. With the possible exception of psychophysical data on the phenomenon of diplacusis, the present evidence cannot exclude the possibility that the central pitch extractor mechanism utilizes both the ‘place’ and ‘period’ cues produced by pure-tone signals (below 5 kHz) and ‘residue’-type signals, both signals evoking strong pitch and fine acuity of frequency discrimination. The degree of salience of a signal's pitch could well depend on the coherence of the two types of cue.

However, the greatest obstacle to the acceptance of ‘place’ coding mechanisms for frequency, particularly of the frequency components of a complex sound, is the restricted dynamic range of the peripheral elements of the auditory nervous system. Because of this, it is not clear how differences in the spectral energy distribution in signals at medium to high sound levels can be established in terms of patterns of mean discharge rate across the cochlear fibre array. At high sound levels, physiological evidence suggests that the discharge rates of the majority of stimulated fibres will be saturated, whereas psychophysical evidence suggests that the coding of the frequency and the relative level of even single-component signals can be carried out over a wide dynamic range in the absence of cues derived from spread of activity across the fibre array. Some new data, however, indicate that this problem may be circumvented at the cochlear nucleus level, but the coding mechanisms involved at the primary neurone level are obscure. One intriguing possibility exists that the auditory nervous system may utilize the fine temporal structure of cochlear fibre discharge patterns for the transmission of ‘place’ information.