Through collecting and synthesizing the paper concerning the method of dealing with heterogeneity in the meta analysis, to introduce the multi-levels statistical models, such as meta regression and baseline risk effect model based on random effects, and random effects model based on hierarchical bayes, and to introduce their application of controlling the meta analysis heterogeneity. The multi-levels statistical model will decompose the single random error in the traditional model to data structure hierarchical. Its fitting effect can not only make the meta-analysis result more robust and reasonable, but also guide clinical issues through the interpretation of association variable.
ObjectiveTo understand the characteristics of and risk factors for nosocomial infection in a newly built branch of a university teaching hospital, in order to investigate the control measures for prevention and control of nosocomial infection. MethodsA total of 598 cases of nosocomial infection from April 2012 to June 2014 were enrolled in this study. We analyzed statistically such indexes as nosocomial infection rate, infection site, pathogen detection, and use of antibiotics. Meantime, infection point-prevalence survey was introduced by means of medical record checking and bedside visiting. ResultsAmong all the 44 085 discharged patients between April 2012 and June 2014, there were 598 cases of nosocomial infection with an infection rate of 1.36%. Departments with a high nosocomial infection rate included Intensive Care Unit (ICU) (9.79%), Department of Orthopedics (2.98%), Department of Geriatrics (2.62%), and Department of Hematology (1.64%). The top four nosocomial infection sites were lower respiratory tract (45.32%), urinary tract (13.21%), operative incision (8.86%), and blood stream (8.86%). The samples of 570 nosocomial infections were delivered for examination with a sample-delivering rate of 95.32%. The most common pathogens were acinetobacter Baumanii (17.02%), Klebsiella pneumoniae (14.21%), Escherichia coli (13.68%), Pseudomonas aeruginosa (11.93%), and Staphylococcus aureus (9.12%). And urinary tract intubation (42.81%), admission of ICU (28.60%), and application of corticosteroid and immunosuppressive agents (26.42%) were the top three independent risk factors for nosocomial infection. ConclusionGeneral and comprehensive monitoring is an effective method for the hospital to detect high-risk departments, factors and patients for nosocomial infection, providing a theoretical basis for prevention and control of nosocomial infection.
ObjectiveTo investigate the feasibility and clinical effect of controlled hypotension in 3 cm single-port video-assisted thoracoscopic surgery (VATS) for the lymph node group 7 dissection in the left lung resection. MethodsWe retrospectively analyzed the clinical data of 37 patients with lung cancer who underwent 3 cm single-port VATS from May 2015 to August 2015 in Tongji Hospital, and systolic blood pressure of 12 patients (7 males, 5 females, average age of 58.3 years, range 42-69 years) was controlled between 80-90 mm Hg by nitroglycerin or sodium nitroprusside while the pressure of 25 patients (14 males, 11 females, average age of 57.7 years, range 43-68 years) was not controlled when receiving lymph node group 7 dissection. ResultsControlled hypotension in lymphadenectomy achieved satisfactory results. The lymphadenectomy time of 12 patients with controlled hypotension (18.5±4.3 min on average, range 15.6-25.3 min) was shorter than that of 25 patients without controlled hypotension (24.3±5.1 min on average, range 18.2-29.8 min); the difference was statistically significant (P<0.05). ConclusionControlled hypotension is a simple and feasible method that increases the operating space, and reduces the difficulty of cleaning lymph nodes and the risk of bleeding.
Objective To identify and investigate the quality of randomized controlled trials (RCTs) of traditional Chinese medicine (TCM) in 11 non-key Chinese medical journals so as to learn about the current status and problems. Methods Eleven non-key medical journals of TCM from 1995 to 2000 were hand searched to identify the RCT and controlled clinical trials (CCTs). Each identified RCT or CCT was page by page verified by handsearchers based on the criteria developed by the Cochrane Handbook; the RCTs’ design, randomization method description, blind, baseline comparison, inclusion and exclusion criteria, diagnostic criteria,criteria for theraputic effectiveness, sample size, statistical method，described outcome, side effects, and follow up etc. were analyzed. Results In the related journals from 1995 to 2000, a total of 66 volumes and 390 issues were checked. As a result, 22 739 clinical studies were identified, of which 1 416 RCTs, only 24 (1.69%) were done with double blinding. There were 141 CCTs from 1995 to 2000, the total number of RCT increased from 95 to 1 416 and most of studies were on digestives diseases. Most of these studies had no detailed randomization method description, only 38 (2.68%) studies provided a methodology description. In addition, 1 220 (86.16% ) described outcome index, 1 203 (84.96%) used statistical method，934 (65.96%) had baseline comparison，828 (58.47%) described diagnostic criteria, 197 (13.91%) had inclusion and exclusion criteria，finally only 89 (6.29%) reported side effects. Conclusions Although the number of RCT has increased in the 11 non-key medical journals of TCM in the past six years, the quality of these RCTs needs to be improved.
Objective To evaluate the effectiveness of GnRH antagonist on vitro fertilization-embryo transfer (IVF-ET). Methods We searched CBMdisc (1979 to 2010), Wanfang (1994 to 2010), CNKI (1994 to 2010), VIP (1989 to 2010), PubMed (1997 to 2010), PML (1997 to 2010), FMJS (2000-2010), and 9 related journals to identify randomized controlled trials (RCTs) on the comparison between GnRH antagonist (GnRHA) and GnRH agonist (GnRHa). The quality of included trials was critically appraised. RevMan 4.2.7 software was used for statistical analysis. Results Six published RCTs involving 1 208 participants were included. Compared with the GnRHa group, stimulation duration in the GnRHA group was lower (WMD= –1.07, 95%CI –1.38 to –0.76), dose of gonadotrophins (Gns) in the GnRHA group was slightly lower (WMD= –0.49, 95%CI –1.63 to 0.66), endometrial thickness at the time of HCG administration was no significant difference in the two groups (WMD= –0.09, 95%CI –0.42 to 0.24), number of oocytes retrieved in the GnRHA group was lower (WMD= –1.80, 95%CI –2.48 to –1.12), OHSS rate in the GnRHA group was slightly lower (Peto OR= 0.77, 95%CI 0.35 to 1.72), pregnancy rate in the GnRHA group was slightly lower (Peto OR= 0.83, 95%CI 0.65 to 1.05), miscarraige rate as no significant difference in the two groups (Peto OR= 1.49, 95%CI 0.79 to 2.82). Conclusions Compared with GnRHa, GnRHA requires shorter stimulation duration and less Gn, less affected the pregnancy rate, and reduces the incidence of OHSS. The use of GnRHA in clinical practice is relatively flexible with good acceptability. GnRHA for the superovulation IVF-ET offers an alternative treatment. The above conclusion still needs more well-designed, multi-center, and large-scale RCTs to confirm and update.
Brain-computer interface (BCI) can establish a direct communications pathway between the human brain and the external devices, which is independent of peripheral nerves and muscles. Compared with invasive BCI, non-invasive BCI has the advantages of low cost, low risk, and ease of operation. In recent years, using non-invasive BCI technology to control devices has gradually evolved into a new type of human-computer interaction manner. Moreover, the control strategy for BCI is an essential component of this manner. First, this study introduced how the brain control techniques were developed and classified. Second, the basic characteristics of direct and shared control strategies were thoroughly explained. And then the benefits and drawbacks of these two strategies were compared and further analyzed. Finally, the development direction and application prospects for non-invasive brain control strategies were suggested.
With the continuous promotion of China’s medical and health system reform, the problem of unreasonable medical examination has gradually become prominent after the elimination of “raising healthcare by medicine” and “raising healthcare by medical device”, which has become the core of aggravating the economic burden of patients’ diseases. Based on the current situation of medical examination control mechanism in China, this study explores the medical examination control mechanism including institutional restraint mechanism, supervision and management mechanism, quality control mechanism from external regulation and internal control, so as to regulate the medical examination behavior, realize the normalization of supervision and management, promote the continuous improvement of medical examination quality, in order to enhance the rationality of medical examination. It is expected to provide a theoretical basis for health departments to explore and perfect the control mechanism of the medical examination.
ObjectiveTo observe the effect of acute normovolemic hemodilution (ANH) with autologous blood transfusion (ABT) and controlled hypotension (CH) during surgery on allogeneic blood transfusion and blood coagulation function. MethodsSixty patients in our hospital from February 2012 to January 2014 were chosen as our study subjects. They underwent surgeries of grade Ⅲ to Ⅳ, and the estimated amount of bleeding during surgery was more than 400 mL. The patients were randomized into group A (ANH+CH group) and group B (control group), with 30 in each. Patients in group A were first administered a standard endotracheal general anesthesia. Then an invasive arterial blood pressure monitoring was performed and the central venous blood was taken. ANH was implemented, and CH was applied to reduce bleeding. When the procedure was almost completed, ABT was implemented. The value of hematocrit, hemoglobin, platelet, prothrombin time (PT), activated partial thranboplastin time (APTT), fibrinogen, international normalized ratio (INR), heart rate, mean arterial pressure and central venous pressure were measured and recorded at the end of blood volume collection (T1), and before ABT (T2) and after ABT (T3). When hemoglobin was lower than 70 g/L during the surgery, ABT was implemented. After surgery, no allogeneic blood transfusion was performed if hemoglobin was higher than 90 g/L. Patients in group B received routine treatment. ResultsPatients' hemodynamics maintained relatively stable during ANH+ABT+CH. Blood volume collected from patients was (408.3 ±142.1) mL; blood loss volume was (705.4±586.8) mL. Compared with group B, the amount of bleeding was significantly lower, and it was reduced by (549.2±250.2) mL. No organ damage was found. For group A, compared with those values at T0, PT, hematocrit, hemoglobin, fibrinogen, and INR were significantly different at T1 and T2 (P<0.05), but the average value was within the acceptable range which did not affect the blood coagulation function. PT, APTT, platelet, hematocrit, hemoglobin, fibrinogen, and INR were significantly different before and after autologous blood transfusion (P<0.05). Postoperative infection and non-healing wounds rate was not significantly different between the two groups (P>0.05). ConclusionThis technique of acute normovolemic hemodilution with autologous blood transfusion and controlled hypotension is a useful, efficient and cost-effective blood conservation strategy. Moderate hemodilution has no influence on blood coagulation function in patients.
Objective To evaluate the effects of mass immunization campaign on the epidemiological characteristics of measles. Methods Comparison was made between the incidences of measles before and after the mass immunization campaign in 2007 in Shunqing prefecture of Nanchong city. Results The total number of the reported measles cases reached 460 during 2004 to 2007 in Shunqing prefecture of Nanchong city, and the respective annual rates of incidence were 4.04, 23.53, 11.84, and 33.57, respectively per 100 000 heads. Cases reported from April to July accounted to 73.91% of the total (340/460). Children under 15 were reported to have the highest incidence rate and accounted to 83.70% of the total (385/460), of which incidences of children under 1 accounted to 0%, 10.81%, 13.51% and 25.82%, respectively. Only 20.00% of the subjects (92/460) in this study had a definite history of measles vaccination. After the mass immunization campaign in September, 2007, only 10 cases were reported in 2008 and the incidence rate was 1.58 per 100 000 heads, a 95.29% decrease in incidence rate in comparison with that of the last year. Conclusion The mass immunization campaign has achieved substantial results.
Objective To evaluate the applicability of the cut-off points of different versions of the Asthma Control Questionnaire (ACQ) in the Chinese population and their consistency with the symptom control criteria of the Global Initiative for Asthma (GINA), so as to provide strategies for cut-off point selection in clinical practice. Methods Based on baseline data from a multicenter prospective cohort study, asthma patients who completed pulmonary function tests, GINA symptom control assessments, and the ACQ-7 questionnaire were included. Taking the GINA symptom control level as the gold standard, the Receiver Operating Characteristic Curve (ROC) was used to determine the optimal cut-off points of the ACQ for discriminating the GINA symptom control levels, and the consistency was analyzed by kappa statistics. Results Among 399 patients (58.9% female; mean age 44.5 ± 12.8 years), asthma symptom control, partial control, and uncontrolled rates were 61.7%, 27.6%, and 10.8%, respectively. ROC analysis revealed the following optimal cutoffs for identifying symptom control: ACQ-5 (0.5), ACQ-6Res (0.42), ACQ-6PFT (0.92), and ACQ-7 (0.93); for identifying uncontrolled symptoms: ACQ-5 (0.9), ACQ-6Res (1.08), ACQ-6PFT (1.42), and ACQ-7 (1.36). All corresponding areas under the ROC curve (AUC) exceeded 0.9. Consistency between ACQ and GINA symptom control levels was moderate (Fleiss’ κ = 0.453–0.531). Performance characteristics varied between traditional (0.75/1.5) and optimized cutoffs. After optimization, ACQ-5 emerged as the only version achieving balanced sensitivity-specificity (Youden index = 0.75) in dual tasks: ACQ-5 ≤ 0.5 demonstrated sensitivity (91%) and specificity (84%) for symptom control, while ACQ-5 ≥ 0.9 showed sensitivity (95%) and specificity (80%) for uncontrolled status. Conclusions Region-specific calibration of ACQ cutoffs enhances clinical utility in the Chinese population. A stratified application strategy is recommended: high-sensitivity cutoffs for initial screening to reduce underdiagnosis, high-specificity cutoffs for resource-constrained settings to minimize overtreatment, and optimized ACQ-5 cutoffs (≤0.5/≥0.9) for comprehensive management to balance sensitivity and specificity. Flexible combination of cutoff protocols tailored to screening objectives may optimize hierarchical asthma management.