孕期亲密伴侣暴力和孕晚期就寝-晨起规律与小于胎龄儿的关系

目的:探讨孕期亲密伴侣暴力(IPV)与小于胎龄儿(SGA)的关联,并分析孕晚期就寝-晨起规律在其关联中的作用。方法:从2015年3月-2019年6月在合肥市三家医院的产科门诊招募孕妇4908名,使用WHO多国妇女健康和家庭暴力研究小组总结而来的清单式问卷进行调查,并采用多元logistic回归模型进行分析。结果:孕期精神暴力、躯体暴力、性暴力和总IPV发生率分别为9.1%、1.4%、0.9%和9.7%,SGA发生率为7.1%。回归分析结果显示,孕期IPV与SGA正向关联(OR=1.59);分别按就寝时间和晨起时间分层,7∶00后起床、22∶00-23∶00和23∶00后就寝组的IPV与SGA正向关联(OR=2.85、2.18、1.98);按就寝-晨起规律分层,非早睡早起组的IPV和IPV组的非早睡早起与SGA正向关联(OR=2.15、3.32)。结论:孕期遭受IPV(尤其是精神暴力)会增加SGA的风险,而就寝-晨起规律会使IPV与SGA的关联在不同的规律下增强或减弱。     

A novel prognostic scoring model for newly diagnosed FLT3-ITD-positive acute myeloid leukemia

FMS-like tyrosine kinase 3-internal tandem duplication (FLT3-ITD) is one of the most common somatic mutations in acute myeloid leukemia (AML). However, the molecular structure characteristics and widely accepted prognostic factors for FLT3-ITD are still not well described. This study aimed to retrospectively examine 81 patients with FLT3-ITD-positive AML diagnosed and treated at the First Affiliated Hospital of Zhejiang University from December 2013 to March 2018 using the next-generation sequencing 185-gene platform. High variant allele frequency (VAF) [> 0.48, P = 0.0089 for overall survival (OS), P = 0.13 for relapse-free survival (RFS)], multiple ITDs (> 1 ITDs, P = 0.011 for OS, P = 0.033 for RFS) and longer insertion length (> 69 bp, P = 0.14 for OS, P = 0.0078 for RFS) predicted poor survival. The study further proposed an easily applicable scoring model for OS using the Least Absolute Shrinkage and Selector Operation (LASSO) Cox regression model. Also, an independent cohort of 30 patients was used for external model validation. The mode was expressed as follows: 0.659 × FLT3-ITD VAF + 0.375 × FLT3-ITD number + 0.807 × Age + 0.688 × DNMT3A + 1.939 × U2AF1 (FLT3-ITD VAF > 0.48 scored 1; FLT3-ITD number scored 1 if carried 1 ITD, 2 if carried ≥ 2 ITDs; age > 44 years scored 1, the presence of DNMT3A or U2AF1 scored 1; 0 for other conditions). It categorized patients into low-risk (L-R, score < 1, n = 20) and high-risk (H-R, score ≥ 1, n = 61) groups based on the risk score with a significant difference in survival (3-year OS, P < 0.0001; 3-year RFS, P = 0.0005). A prognostic nomogram that integrated these five factors was developed with a concordance index calculation [OS: 0.68, 95% CI (0.64-0.72)].     

Uterine artery ligation at its origin following retroperitoneal space development decreases blood loss during single-port total laparoscopic hysterectomy

ObjectiveThis study aimed to determine risk factors associated with the failure of uterine artery ligation at its origin following development of the retroperitoneal space (UALr) and evaluated its efficacy in decreasing estimated blood loss (EBL) during single-port total laparoscopic hysterectomy (SP-TLH).Materials and methodsThis study includes patient data collected prospectively from May 1st, 2013 to establish a registry for single-port surgery. Data for the present study were collected retrospectively from May 1st, 2013 to August 30th, 2016. Patients who underwent SP-TLH for a symptomatic benign disease. When bilateral UALr was performed successfully, the case was classified as part of the UALr success group. When only unilateral UALr was completed or UALr failed, the case was classified as part of the failure group. We compared patients’ baseline characteristics and surgical outcomes between the two groups.ResultsBilateral UALr was successfully performed in 155 cases and failed in 64 patients. Body Mass Index (BMI) was significantly different between the two groups (24.1 kg/m2 vs. 22.86 kg/m2, p = 0.025). A BMI higher than 23.6 kg/m² was a risk factor for UALr failure in a multivariate analysis (odds ratio = 2.42, p = 0.004). EBL was significantly lower in the UALr success group compared to the UALr failure group (100 [100.0–200.0] vs. 200 [100.0–250.0], p < 0.001), and incidence of Hb decrease of more than 2 g/dl was higher in the UALr failure group (36.1% vs. 54.7%, p = 0.017).ConclusionWe identified higher BMI as a risk factor for UALr failure and demonstrated the safety and efficacy of UALr in reducing blood loss during SP-TLH.     

如何正确运用t检验——线性回归模型中参数与0比较t检验及SAS实现

本文目的是介绍t检验在简单线性回归分析和多重线性回归分析中参数与0之间差异性比较时的理论依据和应用实践。首先介绍线性回归分析中t检验的基本原理和计算公式;然后用SAS程序分别对2个实例进行简单线性和多重线性回归分析,提请读者着重关注输出结果中有关"参数假设检验部分的检验统计量的名称及结果";最后对结果进行解释和讨论。     

生存资料回归模型分析——生存资料参数回归模型分析SAS实现

本文目的是介绍生存资料参数回归模型的SAS实现,包括创建SAS数据集、依据图示法选择模型、拟合参数模型和似然比检验。利用SAS中的LIFEREG过程绘制生存函数关于生存时间的关系图,拟合对应的参数分布回归模型,通过拟合优度检验选择最优的参数回归模型,最后对相关结果进行解释。     

宫颈癌根治术后腹腔间隔综合征一例诊治体会

腹腔间隔综合征(abdominal compartment syndrome,ACS)是开腹手术较为罕见的并发症,死亡率高。结合1例宫颈恶性肿瘤根治术后ACS合并切口裂开的病例,强调对于高危患者准确监测腹内压和及时剖腹手术的重要性。该患者极度肥胖,体质量指数(BMI)=40 kg/m^2,两次新辅助化疗后行宫颈癌根治术(经腹广泛子宫、双侧卵巢、双侧输卵管切除术,盆腔淋巴结切除术),术后第1天,持续腹胀咳嗽;术后第4天出现ACS,行开腹减压术。术后恢复良好,经过10个月的随访,未见并发症。     

Using the clay slip game in art therapy: a sensory intervention

ABSTRACT

The goal of the present study was to achieve a better understanding of the experience of playing with slip and the ways in which participants experience the Clay Slip Game and how they perceive the therapeutic qualities of the material, thus including the potential for art therapists to add the Slip Game to their toolbox. Ten experienced qualified art therapists and 48 art therapy students took part. All participants engaged in the Slip Game during the study and reported their experiences in an interview (therapists) or in written personal reflections (students). Data analysis adhered to the principles of Grounded Theory [Charmaz (2006). Constructing grounded theory: A practical guide through qualitative analysis. London: Sage Publications]. The findings indicate that the experience of the Slip Game is mainly a sensory (tactile), playful, pleasant and calming experience of making without the need to produce an end product. The experience is more internal (meditative) and stimulates feelings of regression. The therapeutic qualities of the material, as discussed by the participants, are related to the regressive and sublimative processes afforded by the material, and as a material that enables sensory, behavioural, emotional, and motor regulation.

Plain-language summary

Art therapy is a type of psychotherapy that uses artistic materials and creative processes in the therapeutic process. Since art materials are the primary tools through which the art therapy processes occur, therapists need to have an in-depth understanding of the art materials they offer to their clients [Moon (2010). Materials & media in art therapy: Critical understandings of diverse artistic vocabularies. New York, NY: Routledge].

Slip is a mixture of water with an additional substance that produces a thick and saline-type paste [De Montmollin (2010). The barbotine game-challenge of creativity. Antwerpen.]. It can be made by diluting and filtering any kind of clay to make it semi-fluid. Playing with slip as a distinct and separate technique was defined as a ‘game’ by Daniel De Montmollin, a ceramicist. De Montmollin created the Slip Game as a way to help people free themselves from internal and external censorship or criticism.

The goal of this study was to understand the participants’ experience of the Slip Game and whether they found the process therapeutic. Forty-eight art therapy students and 10 art therapists took part in the study. After engaging in the Slip Game, the art therapists reported their experiences in an interview and the students wrote personal reflections. These were then analysed using Grounded Theory.

The findings show that the participants experienced the Slip Game as mainly sensory and reported it was pleasant, calming, playful and tactile, a way of ‘making’ without the need to produce an end product. They also found the experience to be meditative, that it stimulated feelings of regression and felt that engaging with slip also improved behaviour, emotional control and fine hand-movement skills.     

Predictors of Patient Satisfaction Following Primary Total Knee Arthroplasty: Results from a Traditional Statistical Model and a Machine Learning Algorithm

BackgroundIt is well-documented in the orthopedic literature that 1 in 5 patients are dissatisfied following total knee arthroplasty (TKA). However, multiple statistical models have failed to explain the causes of dissatisfaction. Furthermore, payers are interested in using patient-reported satisfaction scores to adjust surgeon reimbursement rates without a full understanding of the influencing parameters. The purpose of this study was to more comprehensively identify predictors of satisfaction and compare results using both a statistical model and a machine learning (ML) algorithm.MethodsA retrospective review of consecutive TKAs performed by 2 surgeons was conducted. Identical perioperative protocols were utilized by both surgeons. Patients were grouped as satisfied or unsatisfied based on self-reported satisfaction scores. Fifteen variables were correlated with satisfaction using binary logistic regression and stochastic gradient boosted ML models.ResultsIn total, 1325 consecutive TKAs were performed. After exclusions, 897 TKAs were available with minimum 1-year follow-up. Overall, 85.3% of patients were satisfied. Older age generation and performing surgeon were predictors of satisfaction in both models. The ML model also retained cruciate-retaining/condylar-stabilizing implant; lack of inflammatory conditions, preoperative narcotic use, depression, and lumbar spine pain; female gender; and a preserved posterior cruciate ligament as predictors of satisfaction which allowed for a significantly higher area under the receiver operator characteristic curve compared to the binary logistic regression model (0.81 vs 0.60).ConclusionFindings indicate that patient satisfaction may be multifactorial with some factors beyond the scope of a surgeon’s control. Further study is warranted to investigate predictors of patient satisfaction particularly with awareness of differences in results between traditional statistical models and ML algorithms.Level of EvidenceTherapeutic Level III.