如何正确运用χ~2检验——病例对照设计四格表资料的χ~2检验

本文目的是介绍病例对照设计四格表资料的χ~2检验、优势比的假设检验和区间估计以及使用SAS与R软件实现的方法。针对病例对照设计的特点,重点介绍优势比的概念、假设检验和区间估计方法。对SAS与R软件计算的结果作出解释,并给出统计结论和专业结论。     

Optimize the management of urological tube-related emergencies during the coronavirus disease 2019 (COVID-19) pandemic

BackgroundTo introduce and determine the value of optimized strategies for the management of urological tube-related emergencies with increased incidence, complexity and operational risk during the global spread of coronavirus disease 2019 (COVID-19).MethodsAll emergent urological patients at Tongji Hospital, Wuhan, during the period of January 23 (the beginning of lockdown in Wuhan) to March 23, 2020, and the corresponding period in 2019 were recruited to form this study’s COVID-19 group and control group, respectively. Tongji Hospital has the most concentrated and strongest Chinese medical teams to treat the largest number of severe COVID-19 patients. Patients in the control group were routinely treated, while patients in the COVID-19 group were managed following the optimized principles and strategies. The case incidence for each type of tube-related emergency was recorded. Baseline characteristics and management outcomes (surgery time, secondary complex operation rate, readmission rate, COVID-19 infection rate) were analyzed and compared across the control and COVID-19 periods.ResultsThe total emergent urological patients during the COVID-19 period was 42, whereas during the control period, it was 124. The incidence of tube-related emergencies increased from 53% to 88% (P<0.001) during the COVID-19 period. In particular, the incidence of nephrostomy tube-related (31% vs. 15%, P=0.027) and single-J stent-related problems (19% vs. 6%, P=0.009) increased significantly. The mean surgery times across the two periods were comparable. The number of secondary complex operations increased from 12 (18%) to 14 (38%) (P=0.028) during the COVID 19-period. The number of 2-week postoperative readmission decreased from 10 (15%) to 1 (3%) (P=0.049). No participants contracted during the COVID-19 period.ConclusionsUrological tube-related emergencies have been found to have a higher incidence and require more complicated and dangerous operations during the COVID-19 pandemic. However, the optimized management strategies introduced in this study are efficient, and safe for both urologists and patients.     

某医疗机构核医学工作场所劳务派遣保洁人员的职业健康管理

近几年，"劳务派遣"成了医疗机构终末消毒、保洁、垃圾回收等工作新的用工形式。由于多数用工单位和用人单位不清楚对劳务派遣人员职业健康管理中各自应承担的责任和义务，以至于劳务派遣工在劳动过程中应享有的劳动保护权益未获得切实保障。本文就某医疗机构核医学工作场所劳务派遣保洁人员的职业健康管理监督案例进行讨论。     

T1WI_Star_VIBE_FS序列在头颈部放疗MR定位中扫描方法研究

目的 对比分析T1WI_Star_VIBE_FS序列在头颈部肿瘤患者MR定位中不同扫描方式对图像质量、信噪比、对比噪声比等参数的影响,确定优选扫描方式。方法 回顾性分析 78例头颈部MR定位患者,分别采用组织补偿法(A组 23例)、分段扫描拼接法(B组 18例)和二者结合法(C组 37例)进行增强扫描,对比上述3种扫描方式获取的图像质量、颈前部软组织信噪比(SNR)和对比噪声比(CNR)的差异。结果 C组扫描方式可获取较高的图像质量评分;3种扫描方式获取图像的SNR的平均值分别为 214.70±148.78、91.95±59.26、307.61±127.80;CNR的平均值分别为 208.74±148.27、85.79±59.50、301.58±127.48;C组在图像质量评分、SNR和CNR方面均明显优于A、B组(P<0.01)。结论 推荐使用组织补偿和分段拼接扫描相结合方式作为头颈部肿瘤放疗MR定位的优选扫描方式。     

Bailing Capsule combined with α-ketoacid tablets for stage 3 chronic kidney disease: Protocol of a double-blinded,randomized, controlled trial

Background:Chronic kidney disease (CKD) is a progressive and irreversible loss of kidney function. After stage 3, there will be increased risks of hypertension, heart failure, bone disease, anemia, gastrointestinal symptoms, and progression to end-stage kidney failure without proper intervention and treatment. Compound α-ketoacid tablets (KA) administration plays an important role in clinical CKD adjunctive therapy for patients with restricted protein intake. Bailing Capsule (BC), a commonly used Chinese patent medicine for renal diseases, could regulate human immune function, repair renal tubular epithelial cells, prevent renal tubular atrophy, and reduce kidney damage to improve renal function. In this study, we try to conduct a double-blinded, randomized, controlled trial to observe the efficacy and safety of BC combined with KA in treating patients with stage 3 CKD.Methods:This is a double-blinded, randomized, controlled trial. Patients will be randomly divided into treatment group (BC and KT) and control group (BC-simulation and KT) in a 1:1 ratio according to random number table. The treatment course will be 8 weeks, and the changes of subjective symptoms, patient global assessment (PGA) scale, serum creatinine, cystatin C, and estimated glomerular filtration rate, all related adverse events, vital sign measurements, and physical examinations will be recorded. SPSS 21.0 will be used for data analysis.Conclusions:The results will show whether BC combined with KA could alleviate the symptoms of fatigue, anorexia, halitosis, nausea, itching, and edema, improve kidney function in patients with CKD at stage 3.Trial registration:OSF Registration number: DOI 10.17605/OSF.IO/24AJ7.     

Ultra-High Performance Liquid Chromatography/Ion Mobility-Quadrupole Time-of-Flight Mass Spectrometry and Database-Driven Automatic Peak Annotation for the Rapid Profiling and Characterization of the Multicomponents from Stephaniae Tetrandrae Radix (Fang-Ji)

Quality control of traditional Chinese medicine (TCM) begins with elucidation of its chemical basis. The root of Stephania tetrandra, Stephaniae Tetrandrae radix (STR; Fang-Ji), has long been utilized as an antirheumatic, analgesic, and diuretic TCM. Powerful analytical strategies that would enable a multicomponent characterization of STR are still lacking. In the present study, we established a rapid, reliable, and enhanced profiling approach, using ultra?high performance liquid chromatography coupled with ion mobility/quadrupole time?of?flight mass spectrometry (MS) and automatic peak annotation facilitated by computational matching of an in?house library. This approach was used to characterize the multicomponents of STR. Good chromatographic separation was achieved within 17 min on a reversed-phase BEH C18 column eluted with acetonitrile/0.1% ammonium hydroxide in water, whereas data?independent high?definition MSE in the positive mode was applied to acquire the MS2 data using a Vion? IM?QTOF instrument, which, in theory, could cover all the profiled precursor ions. To overcome the interference of three predominant peaks, a knockout strategy was utilized by automated valve switching. An in?house library of 163 compounds was established and incorporated into the UNIFI? platform. By applying this method, we could identify or tentatively characterize 76 alkaloidsfrom the methanolic extract of STR, including 14 aporphine?type, four morphine?type, 48 bisbenzylisoquinoline?type, seven tetrahydroprotoberberine?type, one protopine?type, one benzylisoquinoline?type, and one other. For each component, four?dimensional information, such as retention time, collision cross-section, high-accuracy MS1, and high-accuracy MS2 data, was utilized to achieve the systematic multicomponent characterization of STR.     

前列腺重复穿刺研究进展

前列腺穿刺存在漏诊前列腺癌的可能,重复穿刺有其必要性。本文对前列腺重复穿刺独立危险因素、穿刺途径选择和穿刺新技术进展方面进行综述,以提高临床医生对前列腺重复穿刺适应证的认识。对符合前列腺重复穿刺的患者,推荐使用mpMRI靶向穿刺,以提高有临床意义前列腺癌的检出率,减少无临床意义前列腺癌的检出率。     

中药黄芪对骨代谢的影响及相关基础研究进展

黄芪(Astragali Radix)为豆科黄芪属植物蒙古黄芪或膜荚黄芪的干燥根。始载于东汉末年的《神农本草经》,具有2000多年的药用史,在《本草纲目》中被列为上品,认为黄芪具有补气升阳、利水消肿、固表止汗、托疮生肌等功效。黄芪化学成分包括:葡聚糖、杂多糖等多糖成分;黄芪苷I、II、III和大豆皂苷等多种皂苷;天冬氨酸、丝氨酸等多种氨基酸;多种微量元素及叶酸、亚油酸、甾醇类等。目前对黄芪的化学成分研究多集中在黄芪多糖、黄芪皂苷或其有效单体成分。现代药理学研究表明,黄芪具抗肿瘤、免疫调节、心血管保护、保肝、改善神经系统功能、抗骨质疏松等生物活性,其中,黄芪对骨细胞代谢具有一定的调节作用。通过对近年来黄芪对骨代谢的影响及相关基础研究的文献汇总,发现黄芪甲苷等黄芪提取物及黄芪制剂大多通过对成骨细胞的促进及破骨细胞的抑制进行骨代谢的调节,亦有通过促进类骨素的分泌、激素水平的调节进行调控,本文综述了黄芪甲苷等黄芪提取物及黄芪制剂对骨代谢的基础、动物模型及临床3个方面近十年的研究内容进行综述,为研究中药黄芪对骨细胞代谢影响提供些许帮助并为防治骨质疏松症提供思路与参考。     

呼吸机相关性肺炎集束化护理方案实施不佳原因的质性研究

目的了解ICU护士预防呼吸机相关性肺炎集束化护理方案临床实施不佳的原因,为护理管理提供参考。方法采用质性研究的现象学方法,对在我中心ICU工作1年以上的19名护理人员进行深入访谈,按现象学研究方法整理分析资料。结果通过阅读、分析、反思、分类,提炼4个主题,包括病情限制不能实施相关护理、低学历低年资护士缺乏业务知识和临床经验、护理任务繁重而人员相对短缺的困扰、医嘱执行中的不规范问题。结论 ICU护士预防呼吸机相关性肺炎集束化护理方案实施不佳的主要原因有多方面,需引起护理管理者的重视,采取有效应对来促进护理质量持续改进。