模拟器训练在实施股动脉穿刺点ExoSealTM封堵止血系统操作的多中心对照研究

背景与目的：介入手术已成为血管外科的主要治疗手段,对于手术直接相关的股动脉穿刺点封堵处理是手术操作收尾的一个重要环节。鉴于国内外目前尚缺乏关于封堵止血系统模拟器训练应用效果的高级别证据,本研究旨在评估模拟器训练在实施股动脉穿刺点ExoSealTM封堵止血系统操作的临床应用效果以及在血管介入操作基础教学培训中的应用价值。 方法：采用前瞻性对照设计,选择2020年5月—2020年10月7个中心的8名血管介入医师分别用两种不同方式进行封堵操作培训。4名血管介入医师通过阅读ExoSealTM说明书和观看视频进行培训（对照组）,另4名血管介入医师的培训方式为在前者基础上增加专业人员指导下的模拟器使用（研究组）。培训结束后,在主诊医师监管下,每名医师对接受血管介入手术,并在股总动脉使用6 F鞘管的患者,采用ExoSealTM封堵止血系统对穿刺点进行封堵。两组医师各操作50例患者,比较两组的操作时间、出血量、器械成功率、股动脉栓塞发生率、二次干预率、24 h内发生血肿率。 结果：研究组在ExoSealTM封堵止血系统操作中,所需的操作时间和出血量均少于对照组（24.50 s vs. 30.00 s,P=0.003;8.60 mL vs. 11.22 mL,P=0.019）。研究组的器械成功率（98.0%）高于对照组（96.0%）,但差异无统计学意义（P=0.558）。两组均无动脉栓塞、二次干预和24 h内发生血肿情况。 结论：ExoSealTM封堵止血系统模拟器的训练能够提高股动脉封堵的安全性和有效性。该模拟器的训练应常规用于血管介入操作的基础教学培训中。     

童年期居住环境卫生对农村居民中老年期慢性病患病的影响研究

目的探讨童年期居住环境卫生对农村居民中老年期慢性病患病的影响, 并检验童年期健康状况在其中的中介效应。方法基于中国健康与养老追踪调查2018年最新调查和2014年生命历程调查共同访问的12 506名农村居民数据, 运用χ2检验、秩和检验、logistic回归分析模型、倾向评分加权法、负二项回归模型和KHB分析法进行分析。结果调整其他混杂因素后, 相比童年期居住环境卫生较好的农村居民, 童年居住环境卫生较差的中老年农村居民患哮喘风险提高23.7%(OR=1.237, 95%CI:1.060～1.445), 患肝脏疾病、肾脏疾病和消化系统疾病的风险增加16.4%(OR=1.164, 95%CI:1.006～1.347)、22.4%(OR=1.224, 95%CI:1.083～1.383)和19.6%(OR=1.196, 95%CI:1.103～1.296), 患血脂异常和心脏病的可能性上升了26.6%(OR=1.266, 95%CI:1.153～1.390)和13.6%(OR=1.136, 95%CI:1.031～1.253)。负二项回归模型分析结果显示, 童年居住环境卫生较差的中老年农村...     

The concept of distinct but voluminous groups of bipolar and unipolar diseases

Summary One hundred and six affective (76 unipolar and 30 bipolar) and 101 schizoaffective patients (45 unipolar and 56 bipolar) were investigated after a long-term course of illness, evaluating sociodemographic and general data, the long-term course of illness, disability and psychosocial alterations according to WHO/DAS, WHO/PIRS and GAS, as well as several social consequences of the illness (living situation at the end of the observation time, downward occupational drift, downward social drift, premature retirement, achievement of the expected social development). Comparing the 30 bipolar affective and 56 bipolar schizoaffective disorders, no differences were found regarding (a) sociodemographic and general data (i.e. sex distribution, age at onset, education and occupation at onset, stable heterosexual relationship, premorbid personality and social interactions, mental illness in the family, broken home, life events, season of birth and social classes) and (b) relevant patterns of the long-term course. Regarding long-term out-come the only difference found concerned the more favourable outcome of the bipolar affective disorders according to WHO/DAS, while using GAS the difference was not statistically significant. No difference was found either between the two bipolar groups in the social consequences of the illness. The combining of both bipolar groups as bipolar diseases is discussed, as well as the use of the terms bipolar disease, affective subtype and bipolar disease, schizoaffective subtype.     

Time course of the effect of intravenous dimetindene maleate

Summary In order to evaluate the time course of its effects, dimetindene maleate has been investigated in a histamine provocation model in man. Eight healthy male volunteers were treated i. v. with 4 mg dimetindene maleate or sodium chloride solution in a double blind, cross over study. Intracutaneous histamine injections were given at –1, 2, 5, 14, 17, 20, 23, 26, and 29 h following drug administration and the areas of flares and wheals were measured after 5, 10, 20, and 30 min. There was strong inhibition of the development both of flares and wheals, which was more pronounced for the former. Baseline adjusted areas under the curve differed significantly following drug and placebo treatment. The maximum effect was observed at 2 h.The mean residence time of the inhibitory effect was calculated to be 13 h compared to the mean residence time of dimetindene in blood of 5 h, which indicates a non-linear relationship between blood level and effect.     

儿科临床研究协调员职业培训现状的调查与需求分析

目的 了解儿科临床研究协调员（clinical research coordinator,CRC）职业培训现状,探讨儿科CRC基地化培训建设,以促进儿科CRC的能力提升。方法 采用匿名问卷调研法,于2023年7月25日至10月16日期间,通过问卷星向调查对象发放自行设计的问卷,以进行儿科CRC职业培训及基地化培训需求相关情况的调查分析。采用Excel对数据进行整理。计数资料以例数或者率表示。结果 回收有效问卷328份。调查结果显示,认为当前CRC培训充分且可以满足实际工作需求的仅为7.62%（25人）,另有4.88%（16人）的人认为没有CRC培训,46.34%（152人）的人认为培训不足以支撑实际工作的要求。87.50%（287人）的人认为CRC需要持续的培训。46.95%（154人）的人选择了有经验的CRC是较为合适的带教人员之一,但是需要3年及以上CRC工作经验。46.95%（154人）选择了CRC合适的培训时长为3个月。培训方式的选择从高到低为：有经验的CRC带教实习（90.85%,298人）、实操技能手把手带教（88.41%,290人）、案例分析讨论（87.20%,286人）、流程模拟（83.23%,273人）、授课（76.52%,251人）。培训后考核方式的选择从高到低为：案例分析（76.52%,251人）、操作模拟（74.09%,243人）、流程模拟（73.17%,240人）、笔试（66.16%,217人）、面试（63.72%,209人）。结论 目前,儿科CRC的培训还不足以满足实际工作需求,急需制定一个符合工作需要的CRC培训体系并进行推广实践,从基础上促进中国儿科临床研究健康生态的构建。     

Reconstructing the life course: health during early old age in a follow-up study based on the Boyd Orr cohort

A method is described for investigating life course influences on health in early old age. The lives of some 300 individuals at present aged 65-75 y have been reconstructed from the archived records of a pre-WWII survey, in which they took part as children, and from lifegrid interviews with the same individuals 60 y later. Despite loss to study at several points those interviewed are shown to be representative of the British population socio-demographically, in comparison with the 1931 and 1991 decennial censuses, and physically, in comparison with the Health Survey for England. Bias is conservative because the most disadvantaged were disproportionately affected by loss to follow-up through death and because non-responders to interview were more disadvantaged as children than the interviewees. Representativeness and conservative bias, it is argued, justify the use of these data for investigating life course influences on health in early old age.     

眶上神经的走行层次及其临床意义

目的探讨眉区和额部不同手术层面眶上神经的保护方法。方法在１５例成人头部标本上,对眶上神经在眉区和额部的行程、走行层次和入肌点的位置进行解剖观测。结果眶上神经出眶上孔后,以５２．８±７．４°角向外上经额肌筋膜附着处入帽状腱膜下隙,达发际附近穿帽状腱膜和额肌至皮下。眶上神经起始部直径１．４±０．３ｍｍ,本干入肌点至眶上孔的直线距离为４０．２±９．１ｍｍ,水平距离和垂直距离分别为３０．５±８．８ｍｍ和３３．８±８．４ｍｍ。结论根据手术层面的不同,额眉区的深层面手术应注意保护眶上神经     

A decade of spontaneous long-term course of psychogenic impairment in a community population sample

Background: Our epidemiological study demonstrates the spontaneous long-term course of predominantly psychosocially influenced (“psychogenic”) disorders (neurotic spectrum disorders, personality disorders, stress reactions and somatoform disorders) in a representative community sample of the normal adult population of Mannheim, an industrial and university town in Germany. The natural spontaneous course of these disorders in a population sample over a long period remains largely unknown. Method: Beginning in 1979 (n _t1 = 600) a random population sample was investigated three times over a mean period of approximately 11 years. The last follow-up study ended in 1994 (n _t3 = 301). The follow-up sample was representative of the t1 sample. Psychodynamically trained and clinically experienced interviewers used a semi-structured interview and standardized clinical and psychometric instruments. Psychogenic impairment was assessed using a standardized expert rating (Impairment Score, IS). Results: The mean sum-score of psychogenic impairment after 11 years exceeded the value at t1. The case rate (point prevalence, ICD diagnosis + clinical cut-off/IS) increased from 21.6% at t1 to 26.2% at t3 in the investigated follow-up sample. Intra-individual correlation of psychogenic impairment between t1 and t3 was high (r = 0.55). We found strong evidence for an unfavorable long-term course of psychogenic impairment and only a weak tendency (23.1%) for spontaneous remission of clinically relevant psychogenic impairment. Within a regression model clinical variables, childhood development conditions and personality traits at t1 predicted psychogenic impairment at t3. Conclusion: All clinical variables conclusively indicate an unfavorable spontaneous long-term course of psychogenic impairment. Together with the well-known high prevalence of psychogenic disorders in the normal population, this underlines the need for early therapeutic and preventive intervention. Accepted: 20 August 1999     

Application of Akaike's information criterion (AIC) in the evaluation of linear pharmacokinetic equations

According to linear pharmacokinetics, the time course of plasma concentration of a drug, C_p,is expressed by a sum of exponential functions, C_p= _i=1 ⁿ a_i .This article describes a statistical technique to estimate the number of exponential terms, n,for the time course of drug by the application of Akaike's information criterion (AIC). Plasma concentrations of ethoxybenzamide, sulfisoxazole, bishydroxycoumarin, and diazepam measured following bolus intravenous injection were used as clinical examples for this method. Selection of models is compared between the AIC method and an Ftest method at significance levels of 5% and 1%.     

前程加速超分割放射治疗食管癌疗效分析

目的 :评价前程加速超分割治疗食管癌放疗疗效及放射反应。方法 :对 96例食管癌随机分为前程加速超分割组 (前超组 )和常规组 ,每组 4 8例 ,全部经病理证实。男性 6 3例 ,女性 33例 ;年龄 4 1岁～ 70岁 ,中位年龄 5 7岁 ;病变部位胸上段 2 1例 ,胸中段 6 3例 ,胸下段 12例。病变长度 :<5cm 2 9例 ,5 0cm～ 7 0cm 5 7例 ,>10cm 10例。全部采用 6MVX线外照射 ,常规组 1次 /天 ,2 0Gy/次 ,5次 /周 ,总剂量 6 4Gy～ 6 8Gy ,4 4～ 4 5天完成。前超组 2次 /天 ,1 5Gy/次 ,间隔 6小时以上 ,总剂量 6 4～ 6 8Gy ,35～ 37天完成。 结果 :随访率 96 9%。 1、3、5年生存率前超组为 81 15 %、4 4 1%和 2 6 8% ,常规组为6 1 7%、2 5 1%和 16 9%。前超组 1、3年生存率高于常规组 (u值为 2 97及 2 6 4 ,P <0 0 1) ,5年生存率无显著意义 (u =1 71,P >0 0 5 )。前超组和常规组放射性食管炎发生率分别为 2 7 16和 16 7% (χ2 =1 5 2 ,P =0 2 0 ) ;放射性气管炎发生率前超组为 18 8% ,常规组为 12 5 % (χ2 =0 71,P =0 4 0 )。结论 :食管癌前程加速超分割治疗的 1年和 3年生存率高于常规组 ,5年生存率无明显差异 ,患者对前超组放疗副作用与常规组相比无明显增加。