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81.
目的探讨Bayesian两变量层次模型的构建及其在诊断试验系统评价中的应用。方法将Bayesian两变量层次模型应用于传统Pap细胞学涂片诊断子宫颈癌准确性评价的历史Meta分析资料,估计相关的效应指标敏感度和特异度及筛查研究比随访研究的相对可信度。结果与经典综合受试者工作特征曲线方法相比,Bayesian两变量层次模型估计得到三个层次的效应指标,其中综合敏感度和特异度均数及95%可信区间分别为0.64(0.56,0.72)和0.74(0.67,0.80),预测敏感度和特异度均数及95%可信区间分别为0.61(0.12,0.96)和0.69(0.21,0.97),筛查研究比随访研究的相对可信度估计为1.3(0.59,2.48)。结论采用Bayesian两变量层次模型进行诊断试验Meta分析,更加灵活、有效,易于实现和解释,值得推广应用。  相似文献   
82.
目的:探讨常规超声心动图对蒽环类化疗药物所致心脏毒性的诊断价值。方法:选取2014年2月至2017年6月在我院接受蒽环类药物化疗的乳腺癌术后患者136例,给予吡柔比星+环磷酰胺+多西他赛方案化疗6个周期。疗程结束后,根据患者是否发生心脏毒性分为心脏毒性组(N=48)和无心脏毒性组(N=76),对比患者化疗前后的超声心动图参数,分析常规超声心动图参数在早期心脏毒性诊断中的价值。结果:心脏毒性组TAPSE、E/A和E/a,值显著低于无心脏毒性组(P0.05)。ROC曲线分析,TAPSE、E/A和E/e'对应的曲线下面积分别为0.917(0.874,0.962)、0.902(0.853,0.957)、0.845(0.823,0.921)。TAPSE的截断值为20.78 mm、E/A的截断值为1.19、E/e'的截断值为8.59,Youden指数分别为0.842、0.761、0.712。结论:常规超声心动图在蒽环类药物心脏毒性诊断中具有一定价值。  相似文献   
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Objective

To investigate the effects of various rehabilitative interventions aimed at enhancing poststroke motor recovery by assessing their effectiveness when compared with no treatment or placebo and their superiority when compared with conventional training program (CTP).

Data Source

A literature search was based on 19 Cochrane reviews and 26 other reviews. We also updated the searches in PubMed up to September 30, 2017.

Study Selection

Randomized controlled trials associated with 18 experimented training programs (ETP) were included if they evaluated the effects of the programs on either upper extremity (UE) or lower extremity (LE) motor recovery among adults within 6 months poststroke; included ≥10 participants in each arm; and had an intervention duration of ≥10 consecutive weekdays.

Data Extraction

Four reviewers evaluated the eligibility and quality of literature. Methodological quality was assessed using the PEDro scale.

Data Synthesis

Among the 178 included studies, 129 including 7450 participants were analyzed in this meta-analysis. Six ETPs were significantly effective in enhancing UE motor recovery, with the standard mean differences (SMDs) and 95% confidence intervals outlined as follow: constraint-induced movement therapy (0.82, 0.45-1.19), electrostimulation (ES)-motor (0.42, 0.22-0.63), mirror therapy (0.71, 0.22-1.20), mixed approach (0.21, 0.01-0.41), robot-assisted training (0.51, 0.22-0.80), and task-oriented training (0.57, 0.16-0.99). Six ETPs were significantly effective in enhancing LE motor recovery: body-weight-supported treadmill training (0.27, 0.01-0.52), caregiver-mediated training (0.64, 0.20-1.08), ES-motor (0.55, 0.27-0.83), mixed approach (0.35, 0.15-0.54), mirror therapy (0.56, 0.13-1.00), and virtual reality (0.60, 0.15-1.05). However, compared with CTPs, almost none of the ETPs exhibited significant SMDs for superiority.

Conclusions

Certain experimented interventions were effective in enhancing poststroke motor recovery, but little evidence supported the superiority of experimented interventions over conventional rehabilitation.  相似文献   
85.

Background

Customized cutting block (CCB) was designed to ensure the accurate alignment of knee prostheses during total knee arthroplasty. Given the paucity of CCB efficacy data, we compare CCB with conventional cutting guide using a randomized controlled trial.

Methods

One hundred eight osteoarthritic knee patients underwent total knee arthroplasty by one experienced surgeon were randomized to receive CCB (n = 54) or conventional cutting instrument (CCI) surgery (n = 54). The primary outcomes were limb alignment, prostheses position, and operative time. The secondary outcomes were hemodynamic alteration after surgery, functional outcomes (modified Western Ontario and McMaster University Osteoarthritis Index) and range of motion at 2 years after surgery.

Results

Mean hip-knee-ankle angle in the CCB group was 179.4° ± 1.8° vs 179.1° ± 2.4° in the CCI group, Δ = 0 (95% confidence interval [CI] ?0.6 to 1.1, P = .55). Mean operative time was faster in the CCB arm: 93 ± 12 vs 104 ± 12 minutes, Δ = 11 (95% CI ?16.7 to ?7.2, P < .0001). There were no differences in hemodynamic parameters, mean blood loss (446 [CCB] vs 514 mL [CCI], Δ = ?68 [95% CI ?138 to 31 mL, P = .21]), postoperative hemoglobin changes, incidence of hypotension (systolic <90 mm Hg), oliguria, and rates of blood transfusion. Functional outcomes and range of motion were also similar.

Conclusion

There was no improvement in alignment, hemodynamic changes, blood loss, and knee functional outcomes. CCB reduced surgical time by 11 minutes in our population. CCB cost-effectiveness should be further investigated.  相似文献   
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88.
目的观察液基薄层细胞学技术(TCT)联合间接免疫荧光染色对尿液中足细胞的染色效果并探讨其临床应用价值。方法收集50例2型糖尿病肾病患者和14例健康对照者晨尿标本,TCT制片与传统离心涂片后均行间接免疫荧光染色,观察足细胞形态。结果 64例标本中TCT制片满意率(85.94%)高于传统离心涂片(50.00%),TCT制片的足细胞检出率(73.47%)高于传统离心涂片(51.02%),差异有统计学意义(P0.05)。2种方法检测足细胞均阳性时,TCT制片的阅片效果优于传统离心涂片。结论较传统离心涂片而言,TCT制片联合间接免疫荧光染色在尿足细胞检测中具有优越性。  相似文献   
89.
Objectives: To analyze the characteristics and the prognostic significance of chromophobe renal cell carcinomas (chRCC). Methods: Data about 2981 patients with non‐metastatic renal cell carcinomas (RCC) at the time of surgery were retrospectively collected from 26 institutions between 1998 and 2008. All patients had undergone partial or radical nephrectomies. Of the 2981 patients, 2602 patients with conventional RCC (cRCC) and 148 with chRCC were studied. Clinical and pathological parameters were determined in all patients. Recurrence‐free survival (RFS) and cancer‐specific survival (CSS) were assessed. Results: Patients with chRCC differed significantly from those with cRCC on the following parameters: younger age (P = 0.026), greater female ratio (P < 0.001), and larger tumor diameter (P < 0.001). Both groups were alike with respect to body mass index (P = 0.943), Eastern Cooperative Oncology Group performance status (P = 0.163), T stage (P = 0.375), and Fuhrman's grade (P = 0.134). The 5‐year RFS rates in patients with chRCC and cRCC were 82.7% and 83.3%, respectively (P = 0.762). The 5‐year CSS rates in patients with chRCC and cRCC were 88.8% and 92.2%, respectively (P = 0.980). Both groups showed equivalent oncological outcomes in terms of RFS and CSS for cases stratified by T stage and Fuhrman's grade. In multivariate analysis, the histological subtype was not retained as an independent prognostic variable (RFS: P = 0.893; CSS: P = 0.729). Conclusions: Despite being significantly different from cRCC in terms of several clinical and pathological parameters, chRCC shows equivalent oncological outcomes.  相似文献   
90.
目的:探讨微生态疗法治疗细菌性阴道病的临床应用。方法:将在我校附院门诊就诊的细菌性阴道病患者随机分成两组:A组64例,B组64例;A组给予常规治疗,B组均常规治疗后加用微生态疗法治疗,观察并比较两组治疗结束后的有效率,并于下次月经干净后复查,观察各组的复发率。结果:治疗结束后,细菌性阴道病的治疗有效率,A组92.2%,B组96.9%,P〉0.25;复发率,A组23.7%,B组1.6%,P〈0.005。结论:微生态疗法联合阴道常规治疗的方法治疗细菌性阴道病,疗效好,而且复发率低。  相似文献   
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