阿德福韦酯联合干扰素α-1b治疗HBeAg阳性慢性乙型肝炎疗效研究

目的 探讨阿德福韦酯(ADV)联合IFN α-1b治疗HBeAg阳性慢性乙型肝炎(CHB)患者临床疗效.方法 将120例患者分成3组:单用IFN α-1b组(A组)40例,单用ADV组(B组)40例,ADV和IFN α-1b联合治疗组(C组)40例,疗程48周,分别于治疗12周、24周和48周时查ALT复常率、HBeAg血清转换率、HBV DNA阴转率.其中各组中10人于治疗前及治疗48周行肝穿刺活检术,观察病理改变,根据炎症活动度(G)和纤维化程度(S)进行计分,同时采用纤维化半定量计分系统(SSS)评分.结果 C组24周和48周后的ALT复常率分别为65.0％和87.5％,HBeAg转换率为35.0％和45.0％,HBV DNA阴转率为75.5％和92.5％,均显著高于A组和B组(ALT复常率,24周:x2=7.93、4.81,48周:x2=6.52、3.98,P均＜0.05；HBeAg转换率,24周:x2=4.18、12.26,48周:x2 =4.95、14.58,P均＜0.01；HBV DNA转阴率,24周:x2=9.78、3.75,48周:x2=11.96、6.99,P均＜0.05).组织学肝纤维化各项评分结果联合治疗组均优于单药组,差异有统计学意义(SSS:t=23.27、48.99;G:t=53.89、94.31；S:t =60.01、82.06,P均＜0.01).结论 IFN联合ADV治疗CHB患者可协同抑制HBV复制,明显提高抗HBV疗效,且无明显不良反应,是一种有效的治疗方法.     

Multicenter Validation of the Philadelphia EMS Admission Rule (PEAR) to Predict Hospital Admission in Adult Patients Using Out-of-hospital Data

Objectives:  The objective was to validate a previously derived prediction rule for hospital admission using routinely collected out-of-hospital information.
Methods:  The authors performed a multicenter retrospective cohort study of 1,500 randomly selected, adult patients transported to six separate emergency departments (EDs; three community and three academic hospitals in three separate health systems) by a city-run emergency medical services (EMS) system over a 1-year period. Patients younger than 18 years or who bypassed the ED to be evaluated by trauma, obstetric, or psychiatric teams were excluded. The score consisted of six weighted elements that generated a total score (0–14): age ≥ 60 years (3 points); chest pain (3); shortness of breath (3); dizzy, weakness, or syncope (2); history of cancer (2); and history of diabetes (1). Receiver operator characteristic (ROC) curves for the decision rule and admission rates were calculated among individual hospitals and for the entire cohort.
Results:  A total of 1,102 patients met inclusion criteria. The admission rate for the entire cohort was 40%, and individual hospital admission rates ranged from 28% to 57%. Overall, 34% had a score of ≥4, and 29% had a score of ≥5. Area under the ROC curve (AUC) for the combined cohort was 0.83 for all admissions and 0.72 for intensive care unit (ICU) admissions; AUCs at individual hospitals ranged from 0.72 to 0.85. The admission rate for a score of ≥4 was 77%; for a score of ≥5 the admission rate was 80%.
Conclusions:  The ability of this EMS rule to predict the likelihood of hospital admission appears valid in this multicenter cohort. Further studies are needed to measure the impact and feasibility of using this rule to guide decision-making.     

学校体育教学中“传统教育”与“现代教育”的融合

运用文献研究法,对体育教学发展的两条主线构成的矛盾,即教育理论的支撑学校体育的"传统教育"派与"现代教育"的矛盾,以及作为体育教学和技术支撑部分"体质论"与"技能论"之间的矛盾展开论述,围绕素质教育传授知识、发展个性和创新能力的培养的特点,论述两对矛盾的融合,以期从另一视角阐释现代体育教学发展的特征。     

应用EVIEWS软件预测门诊人次

目的掌握简便的门诊人次预测方法,为医院管理服务。方法使用Eviews软件,采用时间序列分解方法与趋势外推法预测门诊人次。结果 Eviews软件小巧实用,采用时间序列预测方法得到结果误差较小,趋势外推法误差较大。结论 Eviews软件操作简单,界面简洁,值得推广。     

我国医院卫生管理人员发展预测研究?

为加强医院管理人员队伍建设,提高医院管理水平,亟须明确未来医院管理人员队伍发展的目标。本研究采用时间序列指数平滑模型,利用机构预测法预测了2015年和2020年医院所需管理人员数量。结果为:2015年和2020年医院管理人员所需数量分别为25.7万人和27.6万人,且在2011—2015年和2016—2020年间,每年医院管理人员新增数为3 894和3 820人。建议坚持培养和引进两条路径并重原则,逐步提高医院管理人员的素质和管理水平。     

Utility of established cardiovascular disease risk score models for the 10-year prediction of disease outcomes in women

Cardiovascular disease (CVD) is a major cause of mortality globally. In absolute numbers, more women die from CVD than men do. CVD mortality risk differs between genders, reflecting the different distribution of modifiable risk factors and severity of CVD outcomes. This study reviews six established risk score models and their applicability to the female population. These models are assessed against two criteria: discrimination and calibration. Sensitivity, specificity and positive- and negative-predictive values are also examined. The risk score models are found to be limited in applicability, requiring recalibration beyond their study population. Relevant risk factors to predict CVD mortality for women, such as measures of obesity, physical activity, alcohol consumption, use of antihypertensive medication, chronic kidney disease and coronary artery calcium are generally not incorporated in these models.     

Selective screening for high cholesterol in Australian general practice

Objective:To test whether information simply obtained from adults can identify those who are likely to have blood cholesterol levels higher than 6.5 mmol/L (250 mg/dl). Design:Cross-sectional study. Setting:Seven general practices in the lower Hunter Region of Australia. Participants:Of 693 men and women 25 to 65 years old attending the general practices, 616 (89%) participated. Twelve pregnant women and four without blood samples were excluded, leaving 600 subjects (208 men, 392 women). Measurements and main results:Twenty-two percent of subjects had blood cholesterol higher than 6.5 mmol/L (250 mg/dl). In women, high cholesterol was mainly found among those over 40 years of age, but in men high cholesterol was more evenly spread across the different age groups. Stepwise logistic regression identified age, history of hypertension, and a past history of heart attack as significant independent predictors of high cholesterol. A simple model developed from these variables identified 81% of men and women (95% CI=72–90%) with high cholesterol while testing only 49% of the population (95% CI=44–54%). This model was developed in a random subset of 331 of the 600 subjects, and when applied to the remaining 269 subjects, it identified 77% of those with high cholesterol (95% CI=67–87%) after testing 48% (95% CI=42–54%). Conclusions:Selective screening using this simple model can identify adults who are likely to have high blood cholesterol and could complement case-finding or provide an alternative high-risk strategy for communities that cannot afford to screen all individuals. Received from the Centre for Clinical Epidemiology and Biostatistics, Faculty of Medicine, University of Newcastle, Newcastle, NSW, Australia. Supported by an NH & MRC (Australia) Public Health Research and Development Fellowship Award, and Astra Pharmaceuticals (Australia).     

数据挖掘技术在肝癌术后预测分析中的应用初探

目的：考察数据挖掘技术对肝癌患者术后预测的效果。方法：采用数据挖掘技术中的神经网络方法在SAS软件上构建神经网络模型。利用该模型分析我校东方肝胆外科医院1990年1月1日入院至1995年12月31日出院的1457例肝癌患者的临床资料，检测其对肝癌患者术后复发的预测准确率。结果：从56个指标中筛选出有统计学意义的11个指标进入模型，经适当训练后在验证集和测试集上预测准确率均在80％以上。结论：数据挖掘技术可应用于肝癌术后预测分析，效果较为理想。在应用数据掺掘技术时应采用较大样本，同时还应根据资料类型选用适当的方法，反复尝试。     

以填料结构为模型参数的填料塔泛点预测新方法

根据从双膜理论出发由Bernou lli方程得到的液泛气速与液速之间的函数关系,考察了两个与填料有关的模型参数:一个是由填料比表面积a和床层空隙率ε所组成的填料因子a/3ε,另一个是本文定义的填料结构参数。研究表明:拉西环和球形颗粒属于同一类型,其结构参数确定为1.4;而鲍尔环和矩鞍环属于另一类填料,填料结构参数确定为0.9。由于同时考虑了填料结构和填料因子的作用,因此对液泛的预测更有针对性、更加准确。