The Win Ratio: On Interpretation and Handling of Ties

Abstract

To handle composite endpoints, the win ratio has been applied to data analysis and design of clinical trials. Its interpretation, however, is not always clear, and it could handle ties differently. We address these two aspects. First, we express the win ratio as a ratio of two proportions, namely, the proportion of patient-level comparisons in which the experimental treatment “wins” over the control divided by the proportion of “wins” for the control, taking into account the priority order of the components. This equivalent form, the ratio of proportions, can ease communication to clinical trial stakeholders—especially when the win proportions themselves are reported. We recommend such presentations. In some simple cases, we connect the win ratio to the odds ratio, the hazard ratio, the Mann–Whitney U, and the mean difference. In exploring the role of ties, we introduce the win odds, as an extension of the Mann–Whitney odds under the framework of prioritized pairwise comparisons. Finally, we discuss some practical aspects of the win ratio, including rules for defining winners (or losers) and ties, dependence on censoring, win ratio estimands, and benefit-risk assessments, as well as applications to two clinical studies.     

Modification of the Haemodynamic Effects of ACTH by Angiotensin II in Sheep

The study was performed to examine the hypothesis that adrenocorticotrophic hormone (ACTH) induced hypertension in sheep would be enhanced if the blood level of angiotensin II (ANG II), normally suppressed during ACTH administration, was kept at control levels by intravenous infusion of ANG II. Administration of ACTH at 1.0 μg/kg/day for 6 days produced a half maximum rise in mean arterial pressure, Δ 14 mmHg, associated with hypokalaemia and initial urinary sodium retention. A rate of ANG II infusion, (0.9 μg/kg/day) for 6 days, was contrived to produce a small increase in peripheral resistance and mean arterial pressure, Δ 10 mmHg. Pressor responses to concomitant infusion of ACTH and ANG II were additive, Δ 25 mmHg. There was no potentiation of ACTH hypertension by ANG II in the sheep.     

慢性阻塞性肺疾病弥散功能变化及其对运动能力的影响

目的:探讨慢性阻塞性肺疾病(COPD)弥散功能变化及其对运动能力的影响。方法:选择稳定期COPD患者27人(均为男性)。受试者进行静息肺功能检查和心肺运动试验。静息肺通气功能检查指标包括:用力肺活量(FVC)、第一秒用力呼气容积(FEV1)。根据FEV1占预计值%将全部患者分为三组,分别为Ⅰ级组(轻度,n=6)、Ⅱ级组(中度,n=13)、Ⅲ级组(重度,n=8)。单次呼吸法测定静息时不同肺泡气氧分压下的一氧化碳弥散量(DLCO);采用Roughton和Forster的方法计算肺泡毛细血管膜弥散能力(Dm)和肺毛细血管床血容量(Vc)。心肺运动试验检测最大摄氧量(VO2max)、最大二氧化碳排出量(VCO2max)、最大功率(Wmax)、氧脉搏(O2pulse)等。结果:三组患者DLCO及Vc无显著差异。Ⅲ级组Dm显著低于Ⅱ级组(P<0.05)。Ⅲ级组COPD患者的VO2max、VCO2max、Wmax、O2pulse显著低于Ⅰ级组和Ⅱ级组(P<0.05)。COPD患者的DLCO与VCO2max(r=0.450,P<0.05)、VO2max(r=0.526,P<0.01)、Wmax(r=0.565,P<0.01)、O2pulse(r=0.517,P<0.01)呈正相关,Dm与VO2max(r=0.469,P<0.05)、VCO2max(r=0.514,P<0.01)、Wmax(r=0.532,P<0.01)呈正相关。结论:(1)即使是DLCO无明显变化的COPD患者,其Dm也可出现降低;(2)随着病情的加重,COPD患者运动能力下降,且其运动能力与其弥散功能尤其是Dm密切相关。     

经食管超声多普勒与温度稀释法对心输出量测定的相关性研究

目的　研究经食管超声多普勒和温度稀释法在心输出量监测中的相关性。方法　 15例ASA ～ 级 ,择期在全麻下手术的病人 ,其中嗜铬细胞瘤切除术 2例 ,心脏瓣膜置换术 13例 ,采用经食管超声多普勒 ( TED)与温度稀释法 ( TD)同体配对测定心输出量 ,进行两种心输出量测定方法的相关性研究。结果　两种方法监测下 15例病人心输出量具有良好的相关性 ,相关系数为 0 .83 ,回归方程 ( TED) =1.0 8TD- 0 .2 5 ,偏离 ( bias)为 0 .11。心脏瓣膜置换术病人主动脉阻断前两种监测方法的相关系数为 0 .85 ,TDE=1.0 9TD- 0 .16,偏离为 0 .2 3 ,主动脉阻断后两种监测方法的相关系数为0 .77,TED=1.13 TD- 0 .72 ,偏离为 - 0 .0 4。结论　经食管超声多普勒是一种无创、简便、连续的测定心输出量的方法 ,与温度稀释法有良好的相关性。     

“Sleep benefit” in Parkinson's disease: A systematic review

Sleep disorders are common among patients with Parkinson's disease (PD). However, there are also reports of PD patients experiencing a beneficial effect of sleep. Upon awaking in the morning some patients experience good mobility, as if they are in an “on” state induced by medication, contrary to what would be expected after a night without medication. This intriguing phenomenon is known as sleep benefit. Here, we review the available research on sleep benefit in PD, describing its prevalence, clinical effects and determinants. We also discuss the possible mechanisms underlying sleep benefit, and the potential clinical applicability. Finally, we propose a new definition of sleep benefit to allow for improved standardization and homogeneity in future research. Important research targets include the development of objective measures of sleep benefit, as a basis for obtaining a better understanding of sleep benefit, its underlying mechanisms and its potential therapeutic application.     

Subthalamic-thalamic DBS in a case with spinocerebellar ataxia type 2 and severe tremor-A unusual clinical benefit.

This is a single case report of a patient with spinocerebellar ataxia type 2 (SCA2) and severe tremor. Whereas disease progression with prevailing ataxia and dysmetria was slow over the first symptomatic 6 years, 6 months prior to operation were characterized by the development of a severe, debilitating postural tremor rendering the patient unable to independently sit, stand, speak, or swallow. Deep brain stimulation (DBS) at a subthalamic-thalamic electrode position almost completely arrested her tremor. The patient regained the functional state prior to her rapid disease progression allowing a restricted range of daily activities. Her condition has remained approximately stable over the two postoperative years to date. In addition to the efficacy of DBS on cerebellar tremor, the results illustrate a remarkable improvement of the patient's general condition and independence.     

南通工业经济运行中投入与产出结构变动分析

南通工业经济运行中的投入与产出结构变动状况，可从要素投入、产出、投入与产出的关系等方面进行考察与分析。从投入与产出结构变动角度看，近年来南通工业经济运行存在5个方面的特征，即要素投入向优势行业集中，但工业装备质量有所下降；优势行业技术进步速度加快，但一般行业进展较为滞后；产值利税快速增长，但若干重要行业则发展较慢；结构协调效应日趋明显，但不同要素结构变动效益差异较大；工业经济整体运行质量稳步提升，但行业间不平衡现象较为突出。因此，当前在总体思路上应突出5大重点：特别重视工业装备质量的提高；切实加快一般行业的技术进步；大力促进高新技术产业发展；着力协调好扩大就业与提升技术水平的关系；促进工业经济整体运行质量与效益均衡提升。     

社区卫生服务站运营状况调查分析

通过对区医院设立的１２个社区卫生服务站开展有偿和无偿服务的经济效益和社会效益的调查，结果表明：不同站点的业务收入是不同的，但总体上呈赢利状态，其中药品利益收入所占比重偏高，为４３．８０％。发展自身专科特色及方便、就近的服务，显示了社区卫生服务的活力与优势，而政府资金投入不足，相关政策不配套，药品价格及各项服务收费标准尚未理顺，医疗卫生机制缺乏合理规划是影响和制约社区卫生服务可持续发展的主要因素，有