慢性前列腺炎（Ⅱ、Ⅲ型）所致不育症的临床分析

目的观察综合疗法治疗慢性前列腺炎（Ⅱ、Ⅲ型）所致不育症的疗效。方法将120例慢性前列腺炎（Ⅱ、Ⅲ型）所致不育症的患者随机分为A组、B组、C组。A组（综合治疗组）,B组（中西药结合治疗组）,C组（西药治疗组）。观察3组治疗前、后前列腺液、精液各项指标的变化情况。结果 A组治愈26例,显效8例,有效4例,无效2例,总有效率95%;B组分别为14例,8例,6例,12例和70%;C组分别为12例,10例,5例,13例和67.5%。经Ridit分析,A组与B组比较,P〈0.01,与C组比较,P〈0.01;B组与C组比较,P〉0.01。结论综合疗法治疗慢性前列腺炎（Ⅱ、Ⅲ型）所致不育症的效果较好,并能改善精液质量和精子的活动能力,提高受孕率。     

Assessing the Effect of the Best Treatment. A Non-parametric Inference Problem

For patients of a certain type, a number of treatments are available. The effect of each such treatment is assumed to be described by a shift model; it is, however, admitted that there may be an interaction between patient and treatment, meaning in particular that the treatment which is best for one patient is not necessarily best for another. The problem is the following: if each patient is given the treatment which is optimal for that particular patient, will this produce a significant effect and, if so, how large is the effect?     

全膝关节置换术治疗类风湿性关节炎的临床效果分析

目的:探讨全膝关节置换术对类风湿性关节炎的临床疗效。方法:回顾性分析2012年10月至2014年1月在我院接受全膝关节置换术的80例风湿性关节炎患者的临床资料。采用HSS评分标准对膝关节疼痛情况进行评价,根据膝关节活动度(ROM)评价膝关节置换术的临床效果,观察患者术后并发症的发生情况,采用SF-36健康量表评估患者术后的生活质量。结果:患者术后膝关节疼痛评分低于术前(P0.05);患者术后膝关节活动度高于术前,且膝关节伸直和最大屈曲状态均优于术前(P0.05);术后膝关节冠状面和矢状面的畸形率均低于术前,差异具有统计学意义(P0.05);患者术后生存质量明显高于术前,差异具有统计学意义(P0.01)。术后发生感染2例,下肢深静脉血栓3例,膝前区疼痛2例,经对症治疗均获得缓解。结论:全膝关节置换术治疗类风湿性关节炎具有显著的临床效果,值得推广应用。     

改良手术方法治疗耳廓假性囊肿的疗效分析

目的:评价改进耳廓假性囊肿手术方法后治疗耳廓假性囊肿的疗效。方法:选择2011年2月至2012年7月在我科住院治疗耳廓假性囊肿患者56例,并将其随机分为常规手术组和改进手术组,观察和比较两组患者手术治疗后的痊愈率、显效率及总有效率。结果:所有病人经门诊随访半年以上。常规组1例痊愈(4.6%),4例显效(18.2%),16例有效(72.3%),1例无效(4.6%),总有效率95.5%(21/22);改进组24例痊愈(70.6%),9例显效(26.5%),1例有效(2.9%),总有效率100%(34/34),两组的痊愈率比较差异有显著性意义(P0.05),改进手术组的痊愈率显著高于常规手术组;两组的显效率比较差异有显著性意义(P0.05),改进手术组的显效率显著高于常规手术组;两组的总有效率比较差异没有有显著性意义(P0.05)。结论:改进耳廓假性囊肿手术方法后,术后术腔的渗液明显减少,缩短了换药时间,加快了伤口愈合的速度,避免了手术后因反复换药刺激引起耳廓机化、皮肤增厚而导致的耳廓变形。     

Comparison of One‐Step and Two‐Step Meta‐Analysis Models Using Individual Patient Data

The problem of combining information from separate trials is a key consideration when performing a meta‐analysis or planning a multicentre trial. Although there is a considerable journal literature on meta‐analysis based on individual patient data (IPD), i.e. a one‐step IPD meta‐analysis, versus analysis based on summary data, i.e. a two‐step IPD meta‐analysis, recent articles in the medical literature indicate that there is still confusion and uncertainty as to the validity of an analysis based on aggregate data. In this study, we address one of the central statistical issues by considering the estimation of a linear function of the mean, based on linear models for summary data and for IPD. The summary data from a trial is assumed to comprise the best linear unbiased estimator, or maximum likelihood estimator of the parameter, along with its covariance matrix. The setup, which allows for the presence of random effects and covariates in the model, is quite general and includes many of the commonly employed models, for example, linear models with fixed treatment effects and fixed or random trial effects. For this general model, we derive a condition under which the one‐step and two‐step IPD meta‐analysis estimators coincide, extending earlier work considerably. The implications of this result for the specific models mentioned above are illustrated in detail, both theoretically and in terms of two real data sets, and the roles of balance and heterogeneity are highlighted. Our analysis also shows that when covariates are present, which is typically the case, the two estimators coincide only under extra simplifying assumptions, which are somewhat unrealistic in practice.     

Analysis of Crossover Designs with a Categorical Response

In the analysis of two-period crossover designs, one frequently must consider the case of a categorical response with binary as a special case. These circumstances are considered in this paper and the proposed method—an extension of GART'S tests for the binary case—is similar to that of PIKE, CASAGRANDE and SMITH for the analysis of pair-matched case-control studies. The results are illustrated with a numerical example.     

腺样体手术治疗儿童分泌性中耳炎的临床疗效观察

目的：观察腺样体手术治疗儿童分泌性中耳炎的临床效果。方法：选择分泌性中耳炎合并腺样体肥大患儿80例（160耳）,将其随机分为手术组和对照组,每组40例,手术组患儿给予腺样体消融手术治疗,而对照组患儿进行保守治疗,观察和比较两组治疗1个月后的临床疗效。结果：治疗1个月后,手术组治愈72耳,好转6耳,治疗总有效率为97．5％,而对照组治愈8耳,好转20耳,治疗总有效率为35％,较手术组显著降低（P〈0．05）。结论：腺样体切除是治疗分泌性中耳炎的有效途径,治疗中应尽可能避免并发症的发生,恢复和保护咽鼓管的生理功能。     

腺样体手术治疗儿童分泌性中耳炎的临床疗效观察

目的:观察腺样体手术治疗儿童分泌性中耳炎的临床效果。方法:选择分泌性中耳炎合并腺样体肥大患儿80例(160耳),将其随机分为手术组和对照组,每组40例,手术组患儿给予腺样体消融手术治疗,而对照组患儿进行保守治疗,观察和比较两组治疗1个月后的临床疗效。结果:治疗1个月后,手术组治愈72耳,好转6耳,治疗总有效率为97.5%,而对照组治愈8耳,好转20耳,治疗总有效率为35%,较手术组显著降低(P0.05)。结论:腺样体切除是治疗分泌性中耳炎的有效途径,治疗中应尽可能避免并发症的发生,恢复和保护咽鼓管的生理功能。     

Causal diagrams for empirical research

The primary aim of this paper is to show how graphical modelscan be used as a mathematical language for integrating statisticaland subject-matter information. In particular, the paper developsa principled, nonparametric framework for causal inference,in which diagrams are queried to determine if the assumptionsavailable are sufficient for identifying causal effects fromnonexperimental data. If so the diagrams can be queried to producemathematical expressions for causal effects in terms of observeddistributions; otherwise, the diagrams can be queried to suggestadditional observations or auxiliary experiments from whichthe desired inferences can be obtained.     

超滤脱水装置在顽固性心衰患者中的应用

目的:研究探讨超滤脱水装置在顽固性心衰患者治疗中的应用效果。方法:选取我院近3年收治的顽固性心衰患者70例为研究对象,采用超滤脱水装置进行超滤治疗。持续治疗4周以后,对患者的临床疗效进行观察评价,并对患者的治疗前后的基础生理指标包括患者的心率、体重、平均动脉压进行检测比较,以及患者的心功能、肾功能指标的改善情况。结果:(1)本研究中超滤法治疗顽固性心衰患者的临床总有效率为97.14%(68/70),临床疗效显著。(2)治疗后患者的心率、体重、医学研究会呼吸困难量表(medical research council scale,MRC)分别为(94.12±10.21)次/min、(65.97±6.89)Kg、(2.47±1.02)分,显著低于治疗前为(110.67±11.83)次/min、(71.73±7.93)Kg、(3.56±1.21)分,差异有统计学意义(P0.05)。治疗前后患者的平均动脉压(mean arterial pressure,MAP)无显著变化。(3)治疗后患者的心功能指标包括心输出量、左室射血分数(Left ventricular ejection fraction,LVEF)、B型脑钠肽(brain natriuretic peptide,BNP)分别为(5.09±1.14)L/min、(48.92±8.31)%、(1486.34±197.95)pg/mL,显著优于治疗前分别为(2.32±1.01)L/min、(29.76±7.09)%、(3979.35±646.42)pg/mL,差异有统计学意义(P0.05)。(4)患者治疗前后的肾功能指标包括肾小球滤过率(glomerular filtration rate,GFR)、肌酐(creatinine,Cr)、尿素氮(Blood urea nitrogen,BUN)等水平值无统计学差异,提示超滤前后不影响患者的肾功能。结论:应用超滤脱水装置对顽固性心衰患者进行超滤治疗的临床疗效显著,能够迅速缓解患者的症状,改善患者心功能,且操作简便,有较高的临床应用价值。     

白藜芦醇对大鼠局灶性脑缺血再灌注的治疗作用

目的:观察白藜芦醇对大鼠局灶性脑缺血再灌注损伤的治疗作用及可能的机制。方法:将SD大鼠随机分为2组:对照组(n=16),白藜芦醇组(n=16)。对照组再灌注即刻腹腔给予0.5 ml生理盐水,白藜芦醇组再灌注即刻腹腔给予20 mg/kg白藜芦醇。再灌注22小时后,进行神经功能学评分、脑梗死容积测定,用分光光度仪测定脑组织溶浆中SOD、MDA和MPO的含量。结果:再灌注22小时后,白藜芦醇治疗组可以改善大鼠神经功能学评分和降低脑梗死面积(P<0.05),同时可以增加脑组织溶浆中SOD的活性,降低MDA和MPO的含量。结论:白藜芦醇通过减轻白细胞的浸润、提高自由基的清除率对大鼠局灶性脑缺血再灌注损伤发挥治疗作用。     

A Locally Most Powerful Test for Detecting a Treatment Effect in the Presence of Nonresponders

A problem that frequently occurs in many biological experiments is when some subjects in the treatment group may be unaffected by the treatment. For this reason, the distribution of responses in the treatment group is expressed as a two-component mixture, where Lehmann alternatives are used to relate the distributions of affected and unaffected patients. A distribution-free approach is proposed for testing the hypothesis of no treatment effect against the alternative that a subset of the treated subjects respond to the treatment. The test is locally optimal and structured on the basis of the empirical distribution of the untreated subjects. The properties of the test are discussed and the power function is derived. It is shown that the power increases with the proportion of responders in the experiment.     

Too unwell to trust? The effect of mental health on social trust in Europe

Social trust is often thought to be adversely affected by mental health problems. However, rigorous causal evidence required to substantiate this thought is scarce. Here I examine the causal effect of individuals’ mental health on social trust using data from the European Social Survey. Estimating the causal effect, however, is a formidable task since the relationship between mental health and social trust is endogenous due to reverse causality and unmeasured confounding. I circumvent these difficulties by using a recently developed econometric technique that does not rely on valid exclusion restriction for identification. I find strong evidence that mental ill health has a significant negative effect on social trust. Further, I provide suggestive evidence which shows that the adverse effect of mental ill health on social trust arises due to reductions in individuals’ level of optimism and hope, and participation in social networks caused by mental ill health. Overall, the results suggest that for achieving a durable increase in social trust – which often is one of the fundamental objectives of policy makers – interventions to promote mental health of individuals could be extremely useful.     

双囊气压输液袋在失血性休克病人中的应用

目的:评价应用双囊气压输液袋抢救失血性休克病人的疗效.方法:根据纳入/排除标准选择2009年1月至2012年6月收入我科的创伤失血性休克病人40例做为研究对象,分别采用双囊气压输液袋(实验组)或传统注射器配合三通管快速输液(对照组)恢复患者血压,观察和比较两种方法处理的患者输完250 mL液体所需的时间,恢复正常收缩压和正常动脉血氧饱和度的时间,以及连续扩容1000mL后的收缩压值、心率、体温和患者存活率.结果:实验组输注250mL液体所需的时间明显少于对照组(P＜0.01),实验组恢复正常收缩压和正常动脉血氧饱和度的时间少于对照组(P＜0.05),而两组患者在扩容1000 mL后收缩压、心率、体温的平均值的差异无统计学意义(P＞0.05),两组患者的存活率的差异无统计学意义(P＞0.05).结论:应用双囊气压输液袋补液抢救失血性休克病人能更迅速、有效恢复患者的收缩压.     

乌司他丁对急性肺损伤/急性呼吸窘迫综合征的治疗研究

目的研究大剂量乌司他丁在急性肺损伤/急性呼吸窘迫综合征中的治疗效果。方法回顾性分析2006年1月至2010年1月广西医科大学第一附属医院ICU收治的154例ALI/ARDS患者的临床资料,根据治疗方案分为乌司他丁组(UTI组)(n=80),对照组(n=74)。记录两组患者开始治疗、治疗第3天、治疗第7天的生命体征、动脉血气分析、血生化检查结果;记录患者在ICU治疗的转归。应用SPSS 13.0软件对结果进行统计学分析。结果经治疗3天UTI组呼吸频率低于对照组;动脉血气分析提示两组患者PaO2、PaO2/Fi O2、SaO2均有上升,UTI组PaO2/Fi O2略低于对照组(P0.01),而两组患者PaO2、SaO2比较无统计学差异。UTI组与对照组的死亡率比较(UTI组52.5%,对照组52.7%,P=0.980)无统计学差异,机械通气时间UTI组低于对照组[UTI组(14.8±3.9)天,对照组(16.7±4.2)天,P=0.020]。根据ALI/ARDS发生的病因分为肺内源性及肺外源性进行亚组分析(A组:肺内源性ALI/ARDS,使用UTI治疗;B组:肺内源性ALI/ARDS,不使用UTI治疗;C组:肺外源性ALI/ARDS,使用UTI治疗;D组:肺外源性ALI/ARDS,不使用UTI治疗),发现乌司他丁对肺外源性ALI/ARDS患者(C组)的ICU时间、ICU内死亡率及机械通气时间均低于不使用UTI的患者(D组)。结论大剂量乌司他丁用于ALI/ARDS的临床治疗可有效改善患者氧合指数,减少机械通气时间,且高血糖的发生率低,尤其是乌司他丁治疗肺外源性ALI/ARDS患者的预后优于肺内源性的ALI/ARDS。     

Dealing with limited overlap in estimation of average treatment effects

Estimation of average treatment effects under unconfounded orignorable treatment assignment is often hampered by lack ofoverlap in the covariate distributions between treatment groups.This lack of overlap can lead to imprecise estimates, and canmake commonly used estimators sensitive to the choice of specification.In such cases researchers have often used ad hoc methods fortrimming the sample. We develop a systematic approach to addressinglack of overlap. We characterize optimal subsamples for whichthe average treatment effect can be estimated most precisely.Under some conditions, the optimal selection rules depend solelyon the propensity score. For a wide range of distributions,a good approximation to the optimal rule is provided by thesimple rule of thumb to discard all units with estimated propensityscores outside the range [0.1,0.9].