浅谈一体化功能手术室

分析了传统手术室的现状与存在问题,提出将手术室设备与医院信息整合,组建一体化功能手术室是医院发展方向。建议对手术室一体化设制制定专门标准。     

Nine-year reciprocal transplant experiment in the gardens of the basin and mountain big sagebrush (Artemisia tridentata: Asteraceae) hybrid zone of Salt Creek Canyon: the importance of multiple-year tracking of f itness

We have studied reciprocal transplant gardens involving the hybrid zone between basin and mountain big sagebrush ( Artemisia tridentata ) in Salt Creek Canyon, Utah, for 9 years. Previously, we showed that the parental taxa and hybrids had superior reproductive and vegetative performance in their native garden. These earlier data supported the Bounded Hybrid Superiority model. Now, after 9 years, we find that the mountain seed source plants have greater relative fitness than middle hybrid zone seed source plants in the middle hybrid zone garden. These results may be due to plant density and climatic factors more conducive to mountain seed source growth than that of either basin or middle hybrid zone seed source plants. On the other hand, these fitness estimates do not take into account the timing of reproduction, which together with the age-specific survival rate, can profoundly affect lifetime fitness. The intrinsic rate of increase ( r ) takes both of these factors into account, providing another estimate of fitness. Middle hybrid zone seed source plants had the greatest rate of increase in both the middle hybrid zone and mountain gardens and a greater rate of increase than either parent in the basin garden. This is most likely due to the greater reproductive performance of middle hybrid zone plants earlier in life than either parental taxon. These results partly support the Bounded Hybrid Superiority model and show the importance of long- term studies of hybrid fitness.  © 2005 The Linnean Society of London, Biological Journal of the Linnean Society , 2005, 86 , 213–225.     

Assessment of a method for cultivar selection based on regional trial data

Summary In this study a method for analyzing regional trial data is investigated for its effectiveness in cultivar selection. The method is a synthesis of three procedures: (1) regression analysis for genotype × environment (GE) interaction, and subsequent cluster analysis for grouping cultivars for similarity of response; (2) superiority measure analysis of cultivar performance based on the distance mean square between the test cultivar and the maximum response; (3) type 4 stability analysis for three-way classification data (cultivar × location × year), to measure a cultivar's stability. Each of these three procedures is aimed at different aspects of the selection problem: the first obtains an overview of the types of cultivar response; the second measures a cultivar's general adaptability within the region; the third assesses a cultivar's ability to withstand unpredictable variation, namely that caused by year effects. Four sets of published data, each originally analyzed by a univariate or a multivariate approach, were used as examples. The results suggest that the present method provides direct and useful information for selection purposes. The superiority measure, which is the core of the method, can be used even if the data do not fit the linear model for GE interaction. Plotting the data with a fixed standard represented by the maximum response provides a simple visual tool for identifying environments where a cultivar performs well.Contribution No. C-035 from Research Program Service, Research Branch, Agriculture Canada, Ottawa, Ontario, K1A 0C6     

On testing simultaneously non-inferiority in two multiple primary endpoints and superiority in at least one of them

In a clinical trial with an active treatment and a placebo the situation may occur that two (or even more) primary endpoints may be necessary to describe the active treatment's benefit. The focus of our interest is a more specific situation with two primary endpoints in which superiority in one of them would suffice given that non-inferiority is observed in the other. Several proposals exist in the literature for dealing with this or similar problems, but prove insufficient or inadequate at a closer look (e.g. Bloch et al. (2001, 2006) or Tamhane and Logan (2002, 2004)). For example, we were unable to find a good reason why a bootstrap p-value for superiority should depend on the initially selected non-inferiority margins or on the initially selected type I error alpha. We propose a hierarchical three step procedure, where non-inferiority in both variables must be proven in the first step, superiority has to be shown by a bivariate test (e.g. Holm (1979), O'Brien (1984), Hochberg (1988), a bootstrap (Wang (1998)), or L?uter (1996)) in the second step, and then superiority in at least one variable has to be verified in the third step by a corresponding univariate test. All statistical tests are performed at the same one-sided significance level alpha. From the above mentioned bivariate superiority tests we preferred L?uter's SS test and the Holm procedure for the reason that these have been proven to control the type I error strictly, irrespective of the correlation structure among the primary variables and the sample size applied. A simulation study reveals that the performance regarding power of the bivariate test depends to a considerable degree on the correlation and on the magnitude of the expected effects of the two primary endpoints. Therefore, the recommendation of which test to choose depends on knowledge of the possible correlation between the two primary endpoints. In general, L?uter's SS procedure in step 2 shows the best overall properties, whereas Holm's procedure shows an advantage if both a positive correlation between the two variables and a considerable difference between their standardized effect sizes can be expected.     

Asymptotical Tests on the Equivalence,Substantial Difference and Non‐inferiority Problems with Two Proportions

Let d = p₂ ? p₁ be the difference between two binomial proportions obtained from two independent trials. For parameter d, three pairs of hypothesis may be of interest: H₁: d ≤ δ vs. K₁: d > δ; H₂: d ? (δ₁, δ₂) vs. K₂: d ∈ (δ₁, δ₂); and H₃: d ∈ [δ₁, δ₂] vs. K₃: d ? [δ₁, δ₂], where H_i is the null hypothesis and K_i is the alternative hypothesis. These tests are useful in clinical trials, pharmacological and vaccine studies and in statistics generally. The three problems may be investigated by exact unconditional tests when the sample sizes are moderate. Otherwise, one should use approximate (or asymptotical) tests generally based on a Z‐statistics like those suggested in the paper. The article defines a new procedure for testing H₂ or H₃, demonstrates that this is more powerful than tests based on confidence intervals (the classic TOST – two one sided tests – test), defines two corrections for continuity which reduce the liberality of the three tests, and selects the one that behaves better. The programs for executing the unconditional exact and asymptotic tests described in the paper can be loaded at http://www.ugr.es/~bioest/software.htm. (© 2004 WILEY‐VCH Verlag GmbH & Co. KGaA, Weinheim)     

Sequential tests for noninferiority and superiority

The problem of simultaneous sequential tests for noninferiority and superiority of a treatment, as compared to an active control, is considered in terms of continuous hierarchical families of one-sided null hypotheses, in the framework of group sequential and adaptive two-stage designs. The crucial point is that the decision boundaries for the individual null hypotheses may vary over the parameter space. This allows one to construct designs where, e.g., a rigid stopping criterion is chosen, rejecting or accepting all individual null hypotheses simultaneously. Another possibility is to use monitoring type stopping boundaries, which leave some flexibility to the experimenter: he can decide, at the interim analysis, whether he is satisfied with the noninferiority margin achieved at this stage, or wants to go for more at the second stage. In the case where he proceeds to the second stage, he may perform midtrial design modifications (e.g., reassess the sample size). The proposed approach allows one to "spend," e.g., less of alpha for an early proof of noninferiority than for an early proof of superiority, and is illustrated by typical examples.     

西北地区无痛支气管镜的临床应用

目的:观察西北地区开展无痛支气管镜检查方法的优越性。方法:将600例患者随机分为A、B两组,A组为观察组,给予异丙酚复合瑞芬太尼静脉麻醉法,经喉罩人工辅助通气,B组为对照组,给予单纯利多卡因表面麻醉,方法为利多卡因氧气加压口鼻面罩雾化,鼻腔、气管内滴药,连续观察患者在支气管镜诊疗前、过程中血压、心率、血氧饱和度变化及术中、术后反应情况。结果:观察组气管镜操作前、中的血氧饱和度无明显改变,心率、血压有所升高,术后舒适度明显高于对照组。结论:无痛支气管镜诊疗时可以获得满意的麻醉效果,优于常规局麻法,值得临床推广应用。