改良早期预警评分对转院转运工作影响的临床研究

目的 研究改良早期预警（MEWS）评分对转院转运工作的影响.方法 在转院转运工作中应用MEWS评分系统对患者进行病情评估,对比其应用前（对照组）、应用后（研究组）转院患者转运途中病情恶化的发生率、患者或家属满意度及医生、护士对实施MEWS评分转运管理模式前（对照组）、后（研究组）满意度的变化.结果 转院患者转运途中病情恶化发生率由应用前（对照组）的10.63%降至应用后（研究组）的3.74%,应用前、后比较差异有显著统计学意义（P＜0.01）;患方满意度则由96%提高至99%,医护人员对实施MEWS评分转运管理模式前、后的满意度由应用前的83.3%提高至应用后的95%,应用前、后比较均有显著性意义（P＜0.05）.结论 MEWS评分能对转院患者的病情进行比较客观、准确的评估,提高了医务人员的质量和医疗干预意识,从而有效降低转院患者转运途中的病情恶化发生率和提高院前医患双方的满意度,是转院转运工作中简便、快捷、客观、实用的病情评估方法和模式,值得推广应用.     

MEWS系统在指导院前急性脑血管意外急救的临床应用

目的 探讨应用改良早期预警（MEWS）评分指导急性脑血管意外院前急救的临床价值.方法 将院前急救中临床诊断为急性脑血管意外的患者分为常规病情评估急救组（对照组）和进行现场MEWS评分指导急救组（实验组）,并比较两组患者的病死率及好转出院率.结果 对照组病死率为17.23%,好转出院率为82.77%;实验组病死率为8.76%,好转出院率为91.24%.两组比较,差异有统计学意义（P＜0.05）.结论 急性脑血管意外患者院前应用MEWS评分进行病情评估和指导急救,能降低患者的病死率及提高好转出院率,具有较好的应用价值,值得在院前脑血管意外急救中推广应用.     

An update analysis of two polymorphisms in encoding ribonuclease L gene and prostate cancer risk: involving 13,372 cases and 11,953 controls

Encoding ribonuclease L (RNASEL) is a ubiquitously expressed latent endoribonuclease involved in the mediation of antiviral and pro-apoptotic activities of the interferon-inducible 2-5A system. Although the relationship between RNASEL gene polymorphisms and prostate cancer (PCa) risk has been widely reported, results were somewhat controversial and underpowered. Now, we performed an update analysis of 14 publications evaluating the association between RNASEL R462Q and D541E polymorphisms and PCa risk. We conducted a literature search of PubMed database to identify all eligible articles that examined the association of RNASEL R462Q and D541E polymorphisms with PCa. Odds ratios (OR) with 95% confidence intervals (CI) were estimated to assess these association. R462Q showed a significantly elevated effect on Africans (QQ vs. RR: OR = 2.50, 95% CI = 1.28–4.87, P_{heterogeneity} = 0.231). In addition, PCa men who contain 462Q genotype had a higher Gleason score ≥ 7 (OR = 1.16, 95% CI = 1.05–1.28, P_{heterogeneity} = 0.906). On the other hand, D541E was associated with increased total PCa. In the stratified analysis by race, there was also significantly increased PCa in Africans and Caucasians, as well as in sporadic PCa studies (OR = 1.09, 95% CI = 1.04–1.15, P_{heterogeneity} = 0.078). Our update analysis showed evidence that RNASEL R462Q and D541E polymorphisms were associated with PCa risk. Still more well-designed studies should be performed to clarify the role of these two polymorphisms in the development of PCa.     

Liana co‐occurrence patterns in a temperate rainforest

Questions: Are liana–host interactions structured at the community level? Do liana–host interactions differ between species, growth form guilds or habitats? Location: Otari‐Wilton's Bush, on the southern tip of North Island, New Zealand. The forest contains 75 ha of mature and regenerating conifer–broadleaf forest. Methods: Nine liana species were quantified among 217 trees to test for negative co‐occurrence patterns. We also conducted additional analyses within and among compartments embedded in the community‐level matrix. Liana and host abundance distributions were assessed across two contrasting habitats. Results: Community‐level analyses revealed negative co‐occurrence patterns. Positive, neutral and negative co‐occurrence patterns were found among compartments within the community‐level matrix. Host species compartments were consistent with randomized expectations, while positive co‐occurrence patterns were found within the host species matrix. Negative co‐occurrence patterns were found inconsistently among lianas that share the same region of host space, and those that do not. Conclusions: Overall, results indicate the liana community is structured non‐randomly. Liana–host interactions appear to follow an opportunistic growth strategy and interactions are due mostly to habitat partitioning.     

新生儿缺氧缺血性脑病血清S-100B蛋白与NBNA评分动态监测 的临床研究

目的:观察新生儿缺氧缺血性脑病(hypoxic-ischemicencephalopathy,HIE)血清S-100B蛋白的动态变化规律,探讨其在HIE早期诊断中的价值,以及其浓度变化与病情严重程度及预后的关系。同时研究围产期高危因素以及NBNA评分在HIE发生发展与预后中的作用。方法:30例住院正常新生儿作为对照组,于出生后采血,55例HIE患儿(HIE组)分别于出生后1天、2天、7天采血,采用酶联免疫吸附试验、双抗体夹心法检测。收集并分析两组围产期相关资料。HIE组并于采血同时进行NBNA评分。结果:(1)HIE患儿生后第一天与第二天血清S-100B蛋白浓度明显高于对照组(P<0.05),生后第七天轻度HIE与对照组比较没有统计意义,中、重度HIE与对照组比较有统计学意义。(2)生后第一天与第二天不同病情组HIE患儿NBNA评分相互比较差异具有统计学意义(P<0.05),第七天轻、中和重度患儿NBNA评分<35分的患儿分别占33.3%,47.1%,100%。结论:动态监测HIE患儿血清S-100B蛋白浓度和NBNA评分的变化,对HIE的早期诊断,严重程度的判断以及预后的估计有重要意义。     

Assessing the skill of yes/no predictions

Summary Should healthy, middle‐aged women receive precautionary mammograms? Should trauma surgeons use the popular TRISS score to predict the likelihood of patient survival? These are examples of questions confronting us when we decide whether to use a yes/no prediction. In order to trust a prediction we must show that it is more valuable than would be our best guess of the future in the absence of the prediction. Calculating value means identifying our loss should the prediction err and examining the past performance of the prediction with respect to that loss. A statistical test to do this is developed. Predictions that pass this test are said to have skill. Only skillful predictions should be used. Graphical and numerical methods to identify skill will be demonstrated. The usefulness of mammograms is explored.     

Smooth tests for the zero-inflated poisson distribution

In this article we construct three smooth goodness-of-fit tests for testing for the zero-inflated Poisson (ZIP) distribution against general smooth alternatives in the sense of Neyman. We apply our tests to a data set previously claimed to be ZIP distributed, and show that the ZIP is not a good model to describe the data. At rejection of the null hypothesis of ZIP, the individual components of the test statistic, which are directly related to interpretable parameters in a smooth model, may be used to gain insight into an alternative distribution.     

Estimating mean response as a function of treatment duration in an observational study, where duration may be informatively censored

After a treatment is found to be effective in a clinical study, attention often focuses on the effect of treatment duration on outcome. Such an analysis facilitates recommendations on the most beneficial treatment duration. In many studies, the treatment duration, within certain limits, is left to the discretion of the investigators. It is often the case that treatment must be terminated prematurely due to an adverse event, in which case a recommended treatment duration is part of a policy that treats patients for a specified length of time or until a treatment-censoring event occurs, whichever comes first. Evaluating mean response for a particular treatment-duration policy from observational data is difficult due to censoring and the fact that it may not be reasonable to assume patients are prognostically similar across all treatment strategies. We propose an estimator for mean response as a function of treatment-duration policy under these conditions. The method uses potential outcomes and embodies assumptions that allow consistent estimation of the mean response. The estimator is evaluated through simulation studies and demonstrated by application to the ESPRIT infusion trial coordinated at Duke University Medical Center.     

DNA marker mining of ILSTS035 microsatellite locus on chromosome 6 of Hanwoo cattle

We describe tests for detecting and locating quantitative trait loci (QTL) for traits in Hanwoo cattle. From results of a permutation test to detect QTL for marbling, we selected the microsatellite locus ILSTS035 on chromosome 6 for further analysis. K-means clustering analysis applied to five traits and nine DNA markers in ILSTS035 resulted in three cluster groups. Finally we employed the bootstrap test method to calculate confidence intervals using the resampling method to find major DNA markers. We conclude that the major markers of ILSTS035 locus on chromosome 6 of Hanwoo cattle are markers 235 bp and 266 bp.