隐蔽分组(分配隐藏)和盲法的概念、实施与报告

“分配隐藏”很容易被误解而被广大临床试验实施者和论文作者所忽略,尤其是常将“分配隐藏”与盲法混淆。分配隐藏实质是产生随机序列者和决定分配序别者不能参与纳入受试者,也不宜参与以后的试验过程,尤其不能参与结果的测量。本文通过实例介绍了正确的分配隐藏和盲法实施过程。最后,还举例介绍了论文写作中方法学的描述。     

氯诺昔康对手术致痛大鼠脊髓背角COX-2表达的影响

目的：研究氯诺昔康对手术致痛大鼠脊髓背角COX-2表达的影响。方法：大鼠随机分为：对照组、模型组,三个氯诺昔康预处理模型组（制作手术致痛模型前20 min腹腔注射1、3、9 mg/kg）。3 h后,取出脊髓,采用免疫组化方法观察脊髓背角COX-2的表达。结果：模型组脊髓背角COX-2表达较强,而氯诺昔康可减少手术致痛引起的COX-2表达,并有量效关系。结论：氯诺昔康能对手术致痛引起脊髓背角COX-2的表达产生剂量依赖性的抑制作用。     

Waitlist mortality in patients with autoimmune liver diseases

Introduction and ObjectivesAutoimmune liver diseases such as autoimmune hepatitis, primary biliary cholangitis, and primary sclerosing cholangitis are the primary indication for ～24% of total liver transplants. The liver transplant allocation system is currently based upon the Model for End-Stage Liver Disease and it often underestimates the severity of autoimmune liver diseases. We aim to compare the rate of adverse waitlist removal among patients with all autoimmune liver diseases and other indications for liver transplant in the Model for End-Stage Liver -Na era.Materials and MethodsUsing the United Network for Organ Sharing database, we identified all patients listed for liver transplant from 2016 to 2019. The outcome of interest was waitlist survival defined as the composite outcome of death or removal for clinical deterioration. Competing risk analysis was used to evaluate the waitlist survival.ResultsPatients with autoimmune hepatitis had a higher risk of being removed from the waitlist for death or clinical deterioration (SHR 1.37, 95% CI 1.08–1.72; P<0.007), followed by primary biliary cholangitis (SHR 1.34, 95% CI 1.07–1.68; P<0.011).ConclusionsHigh waitlist death or removal for clinical deterioration was observed in patients with PBC and AIH when compared to other etiologies. It may be useful to reassess the process of awarding MELD exception points to mitigate such disparity.     

2006-2007年山东省疾病预防控制机构仪器设备状况调查

[目的]了解山东省疾病预防控制体系仪器设备装备情况,为制定疾控体系仪器设备装备规划提供科学依据。[方法]2007年10月,对山东省、市、县三级疾病预防控制机构2006-2007年的仪器设备情况进行调查。[结果]2007年底,按照国家仪器设备装备标准,省级疾控机构仪器设备配置超过国家常规仪器设备标准;按基本职能必须装备的仪器设备种类拥有率为85．47％,数量拥有率为76．14％。市级机构常规与职能仪器设备种类拥有率分别为79．46％、62．05％,数量拥有率分别为71．46％、29．88％。县级机构常规与职能仪器设备种类拥有率分别为73．90％、61．32％,数量拥有率分别为59．97％、34．19％,46．34％的仪器设备为2000年以前配置。[结论]山东省省级疾病预防控制机构仪器设备能满足常规工作开展需要,市、县级机构仪器设备尚不能维持常规工作的开展。     

Secondary Listing for Deceased-Donor Kidney Transplantation Does Not Increase Likelihood of Engraftment at a Large Transplant Center

The supply of donor organs has not increased as fast as has the number of patients awaiting kidney transplantation. Few organs are shared outside the areas of recovery. This trend has caused some ESRD patients to seek listing at multiple centers. We examined UNOS registry data and transplant registry data at the University of Alabama at Birmingham (UAB) for the 576 patients listed at multiple centers over an 8-year span ending December 31, 2005. We identified 72 multilisted patients who received a deceased-donor renal allograft at UAB and reviewed their records for demographics, HLA matching and transfer of listing time. The only predictors for transplantation at UAB were initial listing at UAB or transfer of waiting time. Fifty-one of the 72 patients had listed at UAB first; the other 21 had transferred waiting time. None of the 176 patients who listed elsewhere first and did not transfer waiting time had been transplanted at UAB. Aggregate cost of listing and evaluation for the 176 patients listed elsewhere first who did not transfer waiting time was $1 254 528. Secondary listing at UAB, with a large cohort awaiting transplantation, without transfer of waiting time from another center was an expensive and futile process.     

Current Kidney Allocation Rules and Their Impact on a Pediatric Transplant Center

In 2005, kidney allocation rules in the United States were updated to enhance access to kidneys from young adult deceased donors (DDs) for pediatric recipients. We studied how this rule change affected transplant activity at our pediatric center. We retrospectively compared kidney transplant activity at our center since the rule change (until December 31, 2007) to before the change (n = 36 each), focusing on those recipients directly affected by it, that is, younger than 18 years. There were no significant differences in recipients' age, gender or ethnicity before versus after the rule change. Percentages of preemptive transplants and retransplants were similar in both groups, as was the percentage of sensitized patients. There was a significant decrease in overall, but not DD, mean donor age. Mean wait time for DD kidneys decreased for pediatric recipients. Increases were found in percentage of DD transplants and in mean HLA mismatches after the rule change. Patient and short-term graft survival were not significantly different. These data suggest that the allocation rule change was not only followed by improvement in overall access to kidney transplantation for children, but also by decreases in living donor transplants and HLA matching. Larger studies are needed to evaluate the long-term impact of the change.     

Preventable Death: Children on the Transplant Waiting List

Children, especially those under 5 years of age, have the highest death rate on the transplant waiting list compared to any other age range. This article discusses the concept, supported by OPTN data, that there is an age range of small pediatric donors, which are almost exclusively transplanted into small pediatric transplant candidates. Allocation policies that allow broader sharing of small pediatric donors into small pediatric candidates are likely to decrease death rates of children on the waiting list. As well, although the number of pediatric deceased donors continues to decline, improving consent rates for eligible pediatric donors, and judicious use of pediatric donors after cardiac death, can enhance the pediatric deceased donor supply.     

常州市卫生人力资源配置现状及发展对策

目的调查了解常州市卫生人力资源配置存在的问题，以提出相应对策。方法分析卫生人力的数量和专业、年龄、学历、职称构成，以及近10年卫生人力资源及利用效率的动态变化。结果卫生人力总量充足，城乡差别不大，专业分布不平衡，年龄呈中青年化，结构不尽合理，农村卫生人力素质及利用率较低。结论合理规划卫生人力资源，使各专业协调发展，加强高层次人才培养，进行城乡合理资源调整。     

磁共振成像设备的引进

医疗设备的购置是医院设备管理工作的一个重要环节,磁共振成像是大型精密医疗诊断设备,其结构精密,产品更新换代频繁,选件配置复杂,价格昂贵,本文主要从采购前的效益分析工作、选型的调研工作、磁共振的主要性能指标、引进时需把握的几个原则,人员培养,配套设施,安装验收等方面加以论述。