脑卒中患者生活自理能力预测研究

目的 预测初发脑卒中患今后生活自理能力。方法 回顾性分析１９７例初发脑卒中中层得,以Ｂａｒｈｅｌ指数评定生活自理能力。按得分多少分为自理组（ＢＩ≥６１分）１２３例,非自理组（ＢＩ≤６０分）７４例,对发病时情况,入院后第１次各项检查结果以及康复治疗等参数进行单因素（ｔ和Ｘ＾２检验）和多元回归分析。结果 单因素分析中,合并多种疾病,入院时神志,认知障碍,尿失禁,肺部感染,高血糖,失语,脑部病灶大小,     

生物信息学在肝细胞癌风险预测中的应用

生物信息学是一门交叉科学,通过综合运用数学、计算机科学和生物学的各种工具,来阐明和理解大量生物数据所包含的生物学意义。随着基因组学测序技术的不断发展,产生大量的生物学数据资源,从大数据中挖掘所蕴藏的生物学意义,已成为了当前亟待解决的主要任务之一。本文主要归纳总结基于特征基因的肝癌风险预测模型,为肝癌的早期检测、预后和治疗方案的优化提供新观点。     

Using newspaper obituaries to “nowcast” daily mortality: Evidence from the Italian COVID-19 hot-spots

Real-time tracking of epidemic helps governments and health authorities make timely data-driven decisions. Official mortality data, whenever reliable and available, is usually published with a substantial delay. We report results of using newspapers obituaries to “nowcast” the mortality levels observed in Italy during the COVID-19 outbreak between February 24, 2020 and April 15, 2020. Mortality levels predicted using obituaries outperform forecasts based on past mortality according to several performance metrics, making obituaries a potentially valid alternative source of information to deal with epidemic surveillance.     

伤口呈色显影用于预测重症肢体缺血患者血管腔内治疗后溃疡愈合的价值初探

目的 探讨伤口呈色显影预测重症肢体缺血患者血运重建术后溃疡愈合的价值.方法 回顾性分析上海交通大学医学院附属仁济医院血管外科2011年6月1日-2014年6月30日收治成功实施Angiosome概念指导腔内血运重建的重症肢体缺血的缺血性溃疡患者临床资料.根据血管腔内血运重建术后伤口呈色显影情况分组,其中伤口呈色(+)组109例,伤口呈色(-)组64例,分别比较患者保肢率,溃疡愈合时间的差异,试分析其作为重症肢体缺血的缺血性溃疡愈合预测因子的价值.采用SPSS 19.0软件进行统计学分析.正态分布计量资料以均数±标准差(x±s)表示,两组比较采用t检验.计数资料以频数和百分比表示,两组比较采用Pearson x2检验或Fisher确切概率法.结果 纳入研究患者共173例(173条患肢),两组患者年龄、性别比例、吸烟史、冠心病、糖尿病、慢性肾功能不全、术前踝肱指数、术后踝肱指数差异均无统计学意义,溃疡愈合时间:伤口呈色(+)组(3.9±1.9)个月低于伤口呈色(-)组(7.9±2.6)个月,差异有统计学意义(P＜0.05).累积保肢率:伤口呈色(+)组(90.2％)高于伤口呈色(-)组(78.0％),差异有统计学意义(P＜0.05).通过Logistic回归分析,校正年龄、性别、吸烟史、高血压异常等因素后,伤口呈色(-)(OR=4.5,P＜0.05)、IRc(间接血供有侧支)血运重建(OR =2.6,P＜0.05)均是溃疡难愈合的独立危险因素.结论 伤口呈色显影阳性显示足部循环较好,可以作为重症肢体缺血的缺血性溃疡愈合的预测因子,而伤口呈色显影阴性是溃疡难愈合的独立危险因素.     

Using time series analysis to forecast the health-related quality of life of post-menopausal women with non-metastatic ER+ breast cancer: A tutorial and case study

BackgroundTime series models are widely used forecasting techniques in health care for long time series and are typically built in commercial statistical packages. However, for short time series data, such as health-related quality of life (HRQoL), guidance on how to select and use appropriate time series models is lacking. This tutorial provides a step-by-step guide adopting a time series analysis framework for HRQoL forecasting.ObjectiveWe walk through a case study examining the forecasting of the effects of adjuvant endocrine therapy on the HRQoL of post-menopausal women with non-metastatic ER + breast cancer using data from the HRQoL sub-protocol of the Tamoxifen arm of the Arimidex, tamoxifen, alone or in combination (ATAC) trial.MethodsThe forecasting of HRQoL consists of four steps: 1) data extraction and accuracy check, 2) forecasting horizon definition and identification of data pattern, 3) forecasting model identification and fitting using five forecasting approaches appropriate for short time series ((i) double exponential smoothing, (ii) double moving average, (iii) fuzzy forecasting, (iv) grey forecasting, and (v) Volterra series), 4) forecasting model selection. A user-friendly visual basic for applications (VBA) Excel add-in is made available to interested users to facilitate the application of the tutorial.ResultsThe Grey method and Volterra series appeared to be good candidates to forecast the effects of adjuvant endocrine therapy on the HRQoL of post-menopausal women with non-metastatic ER + breast cancer enrolled in the ATAC trial.ConclusionIt is feasible to forecast the effects of treatments on HRQOL even when the time series is short.     

如何使小梁切除术后眼压更可控

抗青光眼手术是青光眼治疗的主要方法之一。近年来,抗青光眼手术技术长足发展,微创手术层出不穷,患者及术者对手术预期也日益增高。然而,手术可控性不高导致术后疗效的可预测性不尽如人意。本文针对青光眼房水外引流手术中的小梁切除术,在分析其原理和局限性的基础上,指出手术效果的观察指标及术后眼压的调控方法,以期临床进一步开展相关研究,提高抗青光眼手术的疗效。     

婴幼儿先天性心脏病体外循环术后急性肾损伤早期预警的临床研究

目的 探讨婴幼儿先天性心脏病体外循环术后急性肾损伤的发病情况以及尿中性粒细胞明胶酶相关脂质运载蛋白(NGAL)、白介素18(IL-18)及N-乙酰-β-D氨基葡萄糖苷酶(NAG)、尿微量白蛋白(MA)、α1微球蛋白(α1-MG)在婴幼儿先天性心脏病体外循环术后急性肾损伤中的早期预测价值.方法 本组58例≤3岁的行体外循环手术的先天性心脏病患儿,分别在术前和体外循环开始后4、6、12、24 h留取尿样进行NGAL、IL-18、NAG、MA、α1-MG的检测.根据体外循环术后是否发生急性肾损伤分为急性肾损伤组和非急性肾损伤组,对2组以上指标进行比较.结果 急性肾损伤组和非急性肾损伤组各29例,两组性别、年龄、体重差异无统计学意义.急性肾损伤组术后4、6、12 h的尿NGAL/尿肌酐(UCr)水平(2820.0μg,/g,905.7 μg/g,76.1μg/g)均高于非急性肾损伤组(27.6 μg/g,19.5 μg/g,16.0 μg/g) (P ＜0.01).急性肾损伤组术后4、6、12和24 h的尿IL-18/UCr水平(3768.0 ng/g,1092 ng/g,421.0 ng/g,256.8 ng/g)均高于非急性肾损伤组(511.7 ng/g,304.1 ng/g,207.5 ng/g,100.8 ng/g) (P ＜0.05).急性肾损伤组术后4、6h的尿NAG/UCr水平(1205.5 U/g,294.7 U/g)均高于非急性肾损伤组(176.8 U/g,104.5 U/g) (P ＜0.01).急性肾损伤组术后4、6、12 h的尿MA/UCr水平(1628.0 mg/g,383.7 mg/g,121.2 mg/g)均高于非急性肾损伤组(119.0 mg/g,81.3 mg/g,86.5 mg/g) (P ＜0.05).急性肾损伤组术后4、6、12h的尿α1-MG/UCr水平(804.4 mg/g,384.5 mg/g,104.4 mg/g)高于非急性肾损伤组(154.0 mg/g,84.3 mg/g,37.2 mg/g)(P＜0.01).尿NGAL、IL-18、NAG、MA/UCr和α1-MG/UCr 5个指标均在术后4h预测价值最大.结论 尿生物学标志物NGAL、IL-18、NAG、MA、α1-MG对体外循环术后早期急性肾损伤有较强的预测价值.     

结直肠癌高危人群多因素风险预测模型及评价

结直肠癌的发生是遗传因素和环境因素共同作用的结果。国内外学者已尝试建立多种结直肠癌风险预测模型用于识别危险因素、筛选高危人群及评估发病风险,从而为不同风险人群提供个性化的筛查方案,有效降低结直肠癌的发病率和病死率。现有的典型结直肠癌风险预测模型的建立多基于病例对照研究和队列研究。欧美地区和亚洲地区（除中国外）模型仅纳入常见风险因素;中国的模型在常见风险因素的基础上,还纳入了遗传因素。然而,各模型的建立和验证多基于本地区人群,是否适用于外部人群尚待验证。本文就各种模型的建立、验证和评价进行综述,为进一步建立精确的风险预测模型提供依据。     

Can Oncologists Predict the Efficacy of Treatments in Randomized Trials?

BackgroundDecisions about trial funding, ethical approval, or clinical practice guideline recommendations require expert judgments about the potential efficacy of new treatments. We tested whether individual and aggregated expert opinion of oncologists could predict reliably the efficacy of cancer treatments tested in randomized controlled trials.Materials and MethodsAn international sample of 137 oncologists specializing in genitourinary, lung, and colorectal cancer provided forecasts on primary outcome attainment for five active randomized cancer trials within their subspecialty; skill was assessed using Brier scores (BS), which measure the average squared deviation between forecasts and outcomes.ResultsA total of 40% of trials in our sample reported positive primary outcomes. Experts generally anticipated this overall frequency (mean forecast, 34%). Individual experts on average outperformed random predictions (mean BS = 0.29 [95% confidence interval (CI), 0.28–0.33] vs. 0.33) but underperformed prediction algorithms that always guessed 50% (BS = 0.25) or that were trained on base rates (BS = 0.19). Aggregating forecasts improved accuracy (BS = 0.25; 95% CI, 0.16–0.36]). Neither individual experts nor aggregated predictions showed appreciable discrimination between positive and nonpositive trials (area under the curve of a receiver operating characteristic curve, 0.52 and 0.43, respectively).ConclusionThese findings are based on a limited sample of trials. However, they reinforce the importance of basing research and policy decisions on the results of randomized trials rather than expert opinion or low‐level evidence.Implications for PracticePredictions of oncologists, either individually or in the aggregate, did not anticipate reliably outcomes for randomized trials in cancer. These findings suggest that pooled expert opinion about treatment efficacy is no substitute for randomized trials. They also underscore the challenges of using expert opinion to prioritize interventions for clinical trials or to make recommendations in clinical practice guidelines.     

湖沼地区预测钉螺数量的模型研究

目的探讨并建立湖沼地区钉螺数量的预测模型,为钉螺的定量化研究提供方法学依据。方法在安徽省贵池区秋浦河沿岸随机数字表法随机选择滩地作为研究现场,根据植被类型分层随机抽样,以交叉复核随机抽检法（随机数字表法）调查钉螺,分别用差分GPS仪、T＆D Recorder for Windows、卷尺及烘干称重法收集高程、土壤温度（简称土温）和气温、植被高度、土壤湿度（简称土湿）和植被类型6个环境变量信息。对数据进行预处理,通过偏差量和Akaike信息准则比较不同误差分布和连接函数组合的广义线性模型,确定最佳模型结构,建立并验证预测模型效果。结果建模样本量为162框,变量之间存在着复杂的相关性,钉螺数与植被高度呈正相关（r=0．36）,与土湿呈负相关（r=-0.22）,气温与土温呈正相关（r=0．59）,土温与植被高度呈负相关（r=-0．36）,土湿与土温和气温均呈负相关（r=-0.34和-0．12）。广义线性模型的最佳结构是以gamma分布为误差分布、倒数为连接函数和均数平方为方差函数的模型结构。模型拟合结果显示高程、土湿、土温、植被类型和植被高度对于预测钉螺的数量有统计学意义,t值分别为-3．202,3．124,-1．989,2．668和-2．371,P值分别为0．00166,0．00214,0．04849,0．00846和0．01897,而气温的作用被土温取代没有进入模型。结论广义线性模型可用于建立钉螺的预测模型,为钉螺的定量化研究提供了广阔的研究前景。