如何表达与描述定量资料（三）

在医学论文中,如何正确表达与描述定量资料,对于正确选择统计学中的假设检验方法至关重要。当试验涉及两个、三个或多个因素,且这些因素之间依据专业知识和重复试验次数多少认为可以考察其各种关系时,该定量资料就属于可以考察因素之间交互作用的定量资料。根据试验设计类型和专业知识,运用恰当的方法表达和描述可以考察因素之间交互作用的多因素设计（常见的是析因设计和重复测量设计）的定量资料,对科学评价全部因素对观测结果的影响情况有着十分重要的意义。     

如何表达与描述定量资料（四）

在医学论文中,如何正确表达与描述定量资料,对于正确选择统计学中的假设检验方法至关重要。当试验涉及两个、三个或多个因素,且这些因素之间依据专业知识和重复试验次数多少认为可以考察其各种关系时,该定量资料就属于可以考察因素之间交互作用的定量资料。根据试验设计类型和专业知识,运用恰当的方法表达和描述可以考察因素之间交互作用的多因素设计（常见的是多因素析因设计和含区组因素析因设计）的定量资料,对科学评价全部因素对观测结果的影响情况有着十分重要的意义。     

无法考察交互作用的两因素设计（一）

实验中经常遇到涉及两个因素的实验,若两因素有交互作用,则需采用析因设计、正交设计等设计类型,但这些设计通常需要进行较多次实验。若在理论和专业上可以证明实验中涉及到的两个因素不存在交互作用,或交互作用对观测结果的影响无统计学意义,并且特定实验条件（通常为各因素不同水平的一种组合）下实验数据的测定误差在专业上允许的范围之内,则可：果用无重复实验的随机区组设计、无重复实验的平衡不完全随机区组设计、具有一个重复测量的单因素设计、无重复实验双因素设计和两因素嵌套设计。本文结合实例,重点阐明前3种实验设计类型。     

无法考察交互作用的两因素设计（二）

摘要：科研中经常遇到涉及两个因素的实验,若两因素有交互作用,则需采用析因设计、正交设计等设计类型,但这些设计通常需要进行较多次实验。若在理论和专业上可以证明,实验中涉及到的两个因素不存在交互作用,或交互作用对观测结果的影响无统计学意义,并且特定实验条件（通常为各因素不同水平的一种组合）下实验数据的测定误差在专业上允许的范围之内,则可采用无重复实验的随机区组设计、无重复实验的平衡不完全随机区组设计、具有一个重复测量的单因素设计、无重复实验双因素设计和两因素嵌套设计。本文结合实例,重点介绍后两种实验设计类型。关键词：统计学,医学;研究设计;因素分析,统计学     

如何正确处理无法考察交互作用的三因素或四因素设计定量资料

在实际科研工作中，研究者有专业知识为依据可认为多个因素间相互独立（不存在交互作用）或根据研究目的不需要考察多个因素之间的交互作用或受试验条件及样本量等的限制无法考察多因素间的交互作用时，往往需要采用一些比较特殊的试验设计类型。     

样本量估计与检验效能分析（七）

所谓两因素析因设计,是指试验中涉及两个试验因素,不同的试验条件数等于两个试验因素的水平数的乘积,即由试验因素的水平全面组合而成。全部受试对象被完全随机地分配到各试验条件组中去。做试验时,全部试验因素同时施加（即无先后顺序之分）;对资料进行统计分析时,试验因素地位平等（即不存在主次之分,也不存在嵌套关系）。本文向读者介绍采用两因素析因设计一元定量资料方差分析处理定量资料时,在试验之前如何估计样本含量与检验效能。     

可以考察交互作用的多因素试验设计类型

可以考察交互作用的试验设计类型有很多，包括析因设计、含区组因素的析因设计、重复测量设计、正交设计、裂区设计等。在所有可以考察交互作用的试验设计类型中，析因设计是最受研究者青睐的一种试验设计类型。析因设计也称全因子试验设计，即试验中涉及所有因素水平全面组合形成的试验条件，各试验条件下做k次独立重复试验。含区组因素析因设计，比析因设计多考察1个或多个重要非试验因素（即区组因素）对观测结果的影响。本文通过实例具体介绍析因设计及含区组因素的析因设计。     

如何正确识别和处理几种易混淆的多因素设计定量资料（二）

常用的多因素实验设计类型有：析因设计、嵌套设计、裂区设计、重复测量设计。要做到正确处理这几种易混淆的多因素实验设计定量资料，必须掌握以下几个鉴别多因素设计定量资料的关键点。     

如何正确处理正交设计和均匀设计定量资料

1 引言 所有的多因素实验设计都可初分为两大类，其一为“全因子实验”，即全部实验因素的水平全面组合，这种设计被称为“析因设计”（要求在各组合条件下做两次以上独立重复实验）；其二为“部分因子实验”，即仅做析因设计全部实验点中的一部分。当实验涉及的多个实验因素之间的交互作用很复杂且都需要考察时．最好采用析因设计，其优点在于结论比较精确，不但能够检验各因素的主效应，还能全面检验所有因素间的各阶交互作用效应大小。但析因设计也存在着明显的缺点，     

样本量估计与检验效能分析(七)

所谓两因素析因设计,是指试验中涉及两个试验因素,不同的试验条件数等于两个试验因素的水平数的乘积,即由试验因素的水平全面组合而成.全部受试对象被完全随机地分配到各试验条件组中去.做试验时,全部试验因素同时施加(即无先后顺序之分);对资料进行统计分析时,试验因素地位平等(即不存在主次之分,也不存在嵌套关系).本文向读者介绍采用两因素析因设计一元定量资料方差分析处理定量资料时,在试验之前如何估计样本含量与检验效能.     

我国与美国日本对放射技术人才培养模式的比较

由于历史的原因,放射技术形成一门独立且具有比较系统理论的学科,仅有50多年的历史。我国的放射技术随着改革开放有了长足的进步,在高校中已有了培养人才的一席之地。但也不讳言,其水平与发达国家相比还有相当的差距。笔者就我国设有放射技术专业的高校招生状况作过一次调查,并与美国、日本的培养模式作了比较。根据卫生部科技教育司和教育部高等教育司联合下发的题为“关于对中国医学教育改革和发展纲要征求意见的通知”(卫科教规划发[2000]61号文)精神,有下述的思考。1美国和日本的放射技术人才培养模式1.1美国的培养模式根据日本大阪大学医疗技术短期大学的稻本一夫对《美国四年制放射技术教育》调查资料和美国医学物理委员会公布的2001年至2002年的医学物理师任职资格有关资料的分析,美国高校培养的与放射技术人才有关的教育有两种模式。第一种模式是由16所大学设有4年制放射线摄影技术(BS-Rad irgraphy)、4年制核医学技术(BS-Nuc learM ed ic ine)、4年制放射治疗技术(BS-Rad iation Therapy)、4年制超声技术(BS-U ltrasound)、4年制影像诊断技术(BS-D iagnos...     

Aspirin combined with mechanical measures to prevent venous thromboembolism after total knee arthroplasty: a randomized controlled trial

Background Venous thromboembolism （VTE） is an important complication after major orthopedic surgery.Pharmaceutical methods represent the main strategy of VTE prevention.The use of aspirin in VTE prevention is still controversial worldwide,especially in China.The purpose of this study was to evaluate the role of aspirin combined with mechanical measures in the prevention of VTE after total knee arthroplasty （TKA）.Methods Between January 2012 and May 2013 and in accordance with the inclusion criteria,120 patients undergoing TKA were randomly allocated to two groups.To prevent VTE,patients in group A received aspirin combined with mechanical measures postoperatively,while patients in group B received low-molecular-weight heparin （LMWH） sodium and rivaroxaban sequentially in combination with mechanical measures postoperatively.All surgeries were performed by one surgeon using a posterior-stabilized cemented prosthesis.The two groups were followed up and compared for the incidence of deep vein thrombosis （DVT） by duplex ultrasound scan and clinical VTE events.The adverse events,the blood loss index,and the cost of VTE prevention were also compared.Results DVT was detected in 10 of 60 patients in group A （16.7％,95％ CI：7.3％-26.1％） compared with 11 of 60 in group B （18.3％,95％ CI：8.5％-27.8％） （P=0.500）.There is no statistical evidence supporting the inferior effect of aspirin in preventing DVT as compared with the other medications.There were no cases of symptomatic VTE or death during the follow-up period.Area of ecchymosis was lower in group A than in group B,and the differences were statistically significant.Patients in group A had the lower blood loss index as compared with patients in group B.No transfusion cases were found in both groups.The differences were statistically significant.The cost of VTE prevention analysis indicated a cost reduction using aspirin in group A compared with using LMWH and rivaroxaban in group B.Conclusion Aspirin combined with mechanical measu     

卵巢破裂出血误诊为急性阑尾炎18例诊治分析

卵巢滤泡与黄体破裂出血由于缺乏特异症状,且多常发生于右侧,易与急性阑尾炎相混淆。我院1993年1月到2007年12月将卵巢破裂出血误诊为急性阑尾炎而收住外科治疗18例,现报道如下。1临床资料1.1一般情况年龄15岁～52岁,平均年龄27.6岁,25岁以下12例,占66.6%。其中已婚7例,未婚11例。既往有阑尾发作史者5例。1.2临床表现有转移性右下腹痛病史者10例,开始位于右下腹5例,3例为下腹部痛。其腹痛与急性阑尾炎相类似,甚难鉴别。腹痛距上次月经7d～28d不等,平均14.7d,8d～16d14例。腹痛伴有恶心、呕吐12例,有里急后重感9例。入院时体温37.2℃～37.5℃13例,超过37.53例,在正常范围2例。入院时血压110～120/60～90mmHg8例,90～100/50～70mmHg10例,18例均有不同程度的右下腹固定性压痛及反跳痛,反跳痛较压痛剧烈,10例伴轻度腹肌紧张。白细胞>10.0×109/L13例,中性0.55～0.75,血红蛋白75g/L～112g/L。1.3治疗本组18例全部行手术治疗,并经手术证实。其中右侧卵巢破裂17例,左侧卵巢破裂1例。12例卵巢滤泡破裂,8例黄体破裂。...     

肺栓塞18例临床分析

肺栓塞是西方国家的常见病,病死率占全部疾病死因的第3位,仅次于肿瘤和心肌梗死[1]。我国目前尚无发病率的确切统计,但近年来随着临床诊断意识和临床检验手段不断提高,临床工作中肺栓塞的检出率逐渐增多。我院近2年诊断出急性肺栓塞18例,并对其进行溶栓抗凝治疗,效果良好,报道如下。1临床资料1.1一般资料18例为我院2004年5月至2006年10月的住院患者,男性13例,女性5例,年龄27岁～75岁。11例有烟酒嗜好,慢性反复性肺栓塞2例,有深静脉血栓史者7例,高血压9例,冠心病6例,肺源性心脏病5例,风湿性心脏病2例,左下肢骨折1例,胆囊手术1例,肿瘤1例,长期卧床2例。1.2临床表现突然起病14例,缓慢起病4例,其中6例为住院过程中长期卧床而发病。18例均有呼吸困难,10例严重呼吸困难。剧烈胸痛7例,伴压榨感4例,咯血5例、大咯血2例,咳嗽15例,剧烈干咳12例,面色苍白16例,烦躁不安18例,晕厥6例,休克8例。体征:颈静脉怒张7例,叩诊肺部浊音7例,听诊呼吸音减弱14例,两肺闻及湿啰音4例,左肺闻及湿啰音9例,闻及胸膜摩擦音5例,心界向左扩大10例,心动过速10例,肺动脉瓣第二音亢进12例,心尖部闻及收缩期杂...     

Evaluation of diuretic and laxative activity of hydro-alcoholic extract of Desmostachya bipinnata （L,） Stapf in rats

OBJECTIVE： In continuation to the growing evidence for therapeutical potential of Desmostachya bipinnata （Linn） Stapf, the current pharmacological study was carried out to evaluate the diuretic and laxative activity of its hydro-alcoholic extract in rats. METHODS： The hydro-alcoholic extract of D. bipinnata whole plant was prepared by using Sox- hlet extractor and subjected to analysis by standard preliminary phytochemical tests. Evaluation of both diuretic and laxative activity was carried out using standard methods as reported earlier. Frusemide （20 mg/kg） was served as positive control for diuretic activity and sennosides （10 mg/kg） served as negative control for laxative activity. RESULTS： The hydro-alcoholic extract showed significant diuretic activity and was found to be the most potent in increasing the urinary output at 500 mg/kg when the effect was compared with that of the standard frusemide （P〈0.01）. Moreover, this extract was found to be most effective in increasing urinary electrolyte concentration （Na＋, K＋, and Cl-） at both doses tested. Whereas the results for laxative activity showed minimal increase of feces output at the dose of 500 mg/kg and the increase was negligible when compared with that of the standard drug sennosides. CONCLUSION： Altogether, the above significant findings validate and support its folkloric diuretic use and lend pharmacological credence to the ethno-medical use of this plant in traditional system of medicine, which demands further studies to investigate its active constituents, as well as its use and safety.     

Mechanical tests on the reconstructed anterior cruciate ligament fixed with allogenetic cortical bone cross-pin on the femoral side

Background Anterior cruciate ligament reconstruction （ACLR） has developed dramatically in the last century.Now,ACLR has become a reliable and productive procedure.Patients feel satisfied in 〉90% cases.The aim of this study was to evaluate the feasibility of allogenetic cortical bone cross-pin （ACBCP） used as a clinical fixation method in anterior cruciate ligament reconstruction on the femoral side based on biomechanical tests in vitro.Methods The specimens were provided by the bone banks of the First Affiliated Hospital of People＇s Liberation Army of General Hospital from September 2011 to June 2012.Fresh deep frozen human allogenetic cortical bone was machined into cross-pins which is 4.0 mm in diameter and 75.0 mm in length.Biomechanical parameters compared with Rigidfix were collected while cross-pins were tested in double-shear test.The load-to-failure test and cycling test were carried out in a goat model to reconstruct anterior cruciate ligament with Achilles tendon autograft on the femoral side fixed by human 4.0 mm ACBCP and 3.3 mm Rigidfix served as control.Maximum failure load,yield load,and stiffness of fixation in single load-to-failure test were compared between the two groups.Cycle-specific stiffness and displacement at cycles 1,30,200,400,and 1 000 were also compared in between.Results In double-shear test both maximum failed load and yield load of 4.0 mm humanACBCP were （1 236.998±201.940） N.Maximum failed load and yield load of Rigidfix were （807.929±110.511） N and （592.483±58.821） N.The differences of maximum failed load and yield load were significant between ACBCP and Rigidfix,P 〈0.05.The shear strength of ACBCP and Rigidfix were （49.243±8.039） MPa and （34.637±3.439） MPa,respectively,P 〈0.05.In the load-to-failure test ex vivo,yield load and maximum failed load of ACBCP fixation complexity （（867.104±132.856）N,（1 032.243±196.281） N） were higher than those of Rigidfix （（640.935±42.836） N,（800.568±64.890） N,P 〈0.05）.However,s     

阑尾穿孔及周围脓肿切口感染的预防

我院从2000年至2007年收治穿孔性阑尾炎及阑尾周围脓肿84例,按外科治疗并采取综合预防切口感染的治疗措施取得了良好的临床效果,现报告如下。1临床资料1.1一般资料本组84例中男46例,女38例,年龄5岁～70岁,平均年龄43.2岁。阑尾切除83例(98.8%),阑尾周围脓肿切开引流切除阑尾者1例(1.2%)。1.2方法严格手术室空气及手术器械消毒,术前适当用抗生素静脉点滴。术中切开皮肤、皮下组织不做潜行分离,切口认真止血,避免大块结扎,消毒中保护切口,切开腹膜前准备好吸引器,将腹膜切一小口进行吸引,将脓液尽量吸净,然后延长腹膜切口。开腹后用弯血管钳将腹膜拉出,固定在皮缘消毒巾上,保护皮下组织,如腹腔脓液少而腹膜炎局限者,吸拭干净脓液,一般不作腹膜灌洗。对腹腔脓液较多者,先吸净脓液,待阑尾切除后用浓度0.5mg/ml生理盐水庆大霉素溶液,0.2%甲硝唑液各500ml交替腹腔灌洗,再用生理盐水灌洗至液体清亮,吸蘸干净,于原切口外下方另戳孔置硅胶引流管行腹腔引流。腹膜缝合完毕后更换用过的手术器械及手套,拆除消毒巾。切口用上述灌洗液交替冲洗一次,周围皮肤碘伏消毒后逐层缝合各层组织。术毕用纱布滚压挤出切口皮下积气或...     

儿童传染性单核细胞增多症82例诊治分析

传染性单核细胞增多症（infectious mononucleosis,IM）是由EB病毒感染引起的疾病,本病临床表现多样,易误诊、漏诊,为提高对本病的认识,现将荆门市第一人民医院儿科2003年1月至2006年6月收治的资料完整的82例传染性单核细胞增多症病例报道如下。     

Surgical treatment of poor grade middle cerebral artery aneurysms associated with large sylvian hematomas following prophylactic hinged craniectomy

The clinical characteristics of patients who presented in poor clinical grade due to ruptured middle cerebral artery aneurysms （MCAAs） associated with large sylvian hematomas （SylH） were ana- lyzed and an ingenious designed prophylactic hinged craniectomy was introduced. Twenty-eight pa- tients were graded into Hunt-Hess grades IV-V and emergency standard micro-neurosurgeries （aneu- rysm clipping, hematoma evacuation and prophylactic hinged craniectomy） were performed, and their clinical data were retrospectively analyzed. 46.43% of the patients reached encouraged favorable out- comes on discharge. The favorable outcome group and the poor outcome group significantly differed in terms of patients＇ anisocoria, Hunt-Hess grade before surgery, extent of the midline shift and time to the surgery after bleeding （P〈0.05）. There were no significant differences in age, sex, volume and location of the hematoma, size of aneurysm between the favorable and poor groups （P〉0.05）. However, ingen- ious designed prophylactic hinged craniectomy efficiently reduced the patients＇ intracranial pressure （ICP） after surgery. It was suggested that preoperative conditions such as Hunt-Hess grading, extent of the midline shift and the occurrence of cerebral hernia affect the prognosis of patients, but time to the surgery after bleeding and prophylactic hinged craniectomy are of significant importance for optimizing the prognosis ofMCAA oatients 19resenting with large SylH.     

支撑喉镜下声带肿物手术患者的护理

支撑喉镜手术是当今推行的一种耳鼻喉科先进手术方法。手术具有创伤小、痛苦小、出血少、手术时间短、恢复快、效果好等优点。我科于2007年6月至2008年6月为215例声带肿物患者行支撑喉镜下声带肿物手术。分析确定这类疾病发生及术后复发密切相关的危险因素,采取针对性护理和康复教育,是减少发病和术后并发症,促进患者早日康复的重要保证,现报道如下。1临床资料1.1一般资料本组215例,男99例,女116例,年龄5岁~79岁,平均年龄为41.2岁。病种分布:声带息肉145例,声带小结59例,声带囊肿5例,声带癌4例,喉乳头状病2例。病程平均为11个月(2个月~6a),均保守治疗1.5个月以上。病变左侧112例,病变右侧99例,双侧4例。1.2手术方法215例患者均在静脉复合全麻下手术,支撑喉镜暴露声带并固定,用喉外科器械切除病变组织,对切除的肿物均进行病理检查,以病理诊断为病种进行分类。1.3结果215例患者手术均获成功,痊愈出院。术后嘱禁声,予抗生素、激素和超声雾化治疗。术后住院时间为4d~12d,术后住院时间平均为6.8d。术后2个月~3个月门诊复诊,患者嗓音恢复良好。2发病及术后复发危险因素调查分析2.1本组患者职...