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In medical field, the demand of high-level applied statistical talents is becoming more and more urgent, and the number of medical colleges to train graduate students of Master of Applied Statistics (MAS) is increasing gradually. Taking Chongqing Medical University as an example, this article introduces the objective, orientation and training mode of MAS education, analyzes the main characteristics of MAS professional education and talent training, discusses the problems mainly on training system and teaching base, combined with the interview results of MAS graduate students studying in CMU, and puts forward target suggestions including expanding the enrollment scale, optimizing the "two-tutorial system", advancing the training system and developing new teaching bases, to provide reference and experience for the teaching and training of MAS graduate students in medical colleges.
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OBJECTIVE：To compare the cost-effectiveness of insulin analogues and human insulin in the treatment of type 2 diabetes mellitus ，to reduce economic burden of patients ，and to provide new ideas for non-randomized pharmacoeconomic research. METHODS ：Retrospective data of a Third-grade Class-A hospital were adopted and 533 patients with type 2 diabetes were taken as object to balance the difference between groups through propensity score matching ，and construct net-benefit regression framework so as to analyze the cost-effectiveness of insulin analogues and human insulin in the treatment of type 2 diabetes mellitus. RESULTS ：There was a positive relationship between the efficacy and cost of the two therapeutic schemes ，i.e. insulin analogues were more effective than human insulin ，and the difference of total effective rate between the two schemes was 14.5％. The corresponding treatment cost of insulin analogues was higher than that of human insulin ，and the average total cost difference was 960.3 yuan. The cost of insulin analogues was 66.23 yuan more than that of human insulin for each additional unit of clinical effect （total effective rate ）. Results of net-benefit regression analysis showed that critical value of willingness to pay of therapy plan was 16 947.5 yuan. CONCLUSIONS ：When the willingness to pay is more than 16 947.5 yuan，the insulin analogue scheme is suitable ；on the contrary ，the human insulin analogue scheme is suitable. The propensity scoring technology used for the net-benefit regression analysis can broaden the source of avaliable data for non-randomized pharmacoeconomic evaluation.
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BACKGROUND@#This study aimed to analyse the epidemiological characteristics of bacillary dysentery (BD) caused by Shigella in Chongqing, China, and to establish incidence prediction models based on the correlation between meteorological factors and BD, thus providing a scientific basis for the prevention and control of BD.@*METHODS@#In this study, descriptive methods were employed to investigate the epidemiological distribution of BD. The Boruta algorithm was used to estimate the correlation between meteorological factors and BD incidence. The genetic algorithm (GA) combined with support vector regression (SVR) was used to establish the prediction models for BD incidence.@*RESULTS@#In total, 68,855 cases of BD were included. The incidence declined from 36.312/100,000 to 23.613/100,000, with an obvious seasonal peak from May to October. Males were more predisposed to the infection than females (the ratio was 1.118:1). Children < 5 years old comprised the highest incidence (295.892/100,000) among all age categories, and pre-education children comprised the highest proportion (34,658 cases, 50.335%) among all occupational categories. Eight important meteorological factors, including the highest temperature, average temperature, average air pressure, precipitation and sunshine, were correlated with the monthly incidence of BD. The obtained mean absolute percent error (MAPE), mean squared error (MSE) and squared correlation coefficient (R) of GA_SVR_MONTH values were 0.087, 0.101 and 0.922, respectively.@*CONCLUSION@#From 2009 to 2016, BD incidence in Chongqing was still high, especially in the main urban areas and among the male and pre-education children populations. Eight meteorological factors, including temperature, air pressure, precipitation and sunshine, were the most important correlative feature sets of BD incidence. Moreover, BD incidence prediction models based on meteorological factors had better prediction accuracies. The findings in this study could provide a panorama of BD in Chongqing and offer a useful approach for predicting the incidence of infectious disease. Furthermore, this information could be used to improve current interventions and public health planning.
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Objective To evaluate the impact of chest blast injury on left ventricular function and myocardial strain with speckle tracking imaging (STI).Methods Fifty healthy New Zealand rabbits were randomly divided into 4 groups.Five rabbits without blast injury were used as a normal group,and the other rabbits were placed in specific semi-enclosed blasting environment in accordance with the different distance of the explosion.With instantaneous detonators,slight,medium and heavy chest blast injury animal models were produced and labeled as A,B,and C group (each n=15),respectively.The left ventricular function was measured with conventional echocardiography and STI.The longitudinal strain (LS) of the left ventricle was measured with two-dimensional strain analysis software and statistically analyzed.Results There was no significant difference of ejection fraction (EF) and fractional shortening (FS) in the left ventricle after chest blast injury between group A and normal group (all P＞0.05),while LS of anterior wall,anterior septum wall and lateral wall of group A significantly decreased compared with those of normal group (all P＜0.05).In group B and C,the left ventricular EF,FS and LS of each segment were lower than those of normal group (all P＜0.05).In group C,the left ventricular EF,FS and LS of each segment were lower than those in group A (all P＜0.05).There was no significant difference of EF and FS between group B and group C.In group C,LS of anterior wall and lateral wall of basal segment and middle segment were lower than those of group B (all P＜0.05).Conclusion STI can reflect functional changes of left ventricle in each segment earlier and more sensitively after chest blast injury.
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Age-related macular degeneration (AMD) is a common cause of blindness among people over 65 in developed countries.With the rapidity of population aging process,the prevalence of AMD will be further increased.The application of anti-vascular endothelial factor growth medicine in ophthalmology has made great progress in the therapeutic effect and prognosis of wet AMD.In this context,many countries and regions have successively formulated guidelines for the AMD clinical diagnosis and treatment,especially the United States,Europe and Australia.Through the analysis of AMD clinical guidelines of American Academy of Ophthalmology (AAO) in 2015,and by comparing it with AMD analysis and treatment guidelines of European Society of Retina Specialists (EURETINA) in 2014,this paper provides an accurate,effective and comprehensive diagnosis strategy and lays a foundation for providing AMD patients with quality diagnosis and treatment plans.
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We analyzed the trend of flu incidence in Chongqing,explored the independent influence of low temperature on the incidence of influenza and provided reference for the development of influenza prevention and control measures and strategies.Based on the epidemiological data of influenza from 2010-2015 in Chongqing and the meteorological data in the same period of time,using the temperature as the independent variable and the morbidity rate of daily flu as the dependent variable,we use the propensity value to match the balance of pressure,air flow and other confounding factors,establishing four negative binomial regression models.Confounding meteorological factors were balanced by the propensity score.The negative binomial regression model was better than the corresponding model before matching in Chi-square test,Deviance,Scale deviance,AIC and AICC.The lower the daily minimum temperature,the higher the incidence of influenza.The influence of meteorological factors on the incidence of influenza is lagging,and the use of negative binomial regression to control confounding factors before matching may underestimate the impact of temperature on the incidence of influenza.In addition,low temperature may be an important meteorological factor that leads to an increased incidence of influenza.
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Objective To establish virtual three-dimensional models of interventional devices and individualized surgical area structure in transjugular intrahepatic portosystemic shunt(TIPS)treatment,and to explore the value of virtual models for preoperative simulation in TIPS treatment.Methods Thin slice scan data of 8 patients with supine upper abdomen were obtained,three dimensional structures of bone,liver,portal vein,inferior vena cava and hepatic vein in CT scan area were reconstructed in Mimics software.According to the size of interventional instruments,a virtual RUPS-100 puncture kit and an VIATORR stent were established in 3D MAX software. Computer simulations were performed to evaluate the route from the hepatic vein puncture portal vein using the RUPS-100 puncture kit and VIATORR stent release position.Results ①The establishment of individual three-dimensional model of patients was helpful for doctors to understand the spatial relation of hepatic vein and portal vein.②Through simulation,the puncture parameters of multi angle and multi position are obtained,which was helpful for the doctor to adjust the puncture direction according to the puncture point.③The position of the bare segment of the VIATORR stent in the portal vein was obtained by simulation,which was helpful for evaluating the length of the stent.④The preoperative simulation results included the simulation parameters for each patient puncture into left portal vein,right portal vein and portal vein bifurcation.In the actual operation,we punctured into the portal vein bifurcation in 4 cases,into the right branch in 2 cases and into the left in 2 cases.⑤Preoperative simulations were performed using 8 mm×6 cm×2 cm size VIATORR stent.Howere,the actual operation of the first case was lack of experience,and the stent position was lower,then we released a bare stent at the proximal end of the VIATORR stent.The rest of the cases were the same as the simulation results.Conclusion According to the three-dimensional model of the individual structure of the patient,the preoperative simulations have high fidelity.The simulation results of the parameters of the puncture and the release position of the stent could guide the actual operation more accurately.It is of practical value to improve the success rate of operation and to train residents.
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OBJECTIVE:To provide reference for improving pharmaceutical care in the hospital. METHODS:A total of 712 clinical pharmacists were selected from 38 third grade class A hospitals in 17 provinces and cities by convenient sampling to investi-gate the ability of pharmacectical care and influantial factors. Single and multiple factor Logistic regression analysis were conducted for the results. RESULTS:The single factor analysis showed that there was significant difference in the communication between clinical pharmacists and patients or medical staffs,the listening attitude of the patients,attitude towards job prospects,understand-ing about the connotation of clinical pharmacy,the timeliness of drug supply,smoothness degree of channel,the timeliness of coordi-nation,smooth development of pharmaceutical care(P<0.05). The multiple factor analysis showed that due to good communication with the doctor [OR=1.819,95%CI(1.469,2.253)],pharmacists could understand definition and connotation of pharmaceutical care [OR=2.263,95%CI(1.722,2.973)],and the male pharmacists [OR=0.558,95%CI(0.382,0.813)] with positive attitude to the pharmacists [OR=1.506,95%CI(1.309,1.733)] believed to provide good pharmaceutical care. CONCLUSIONS:This investigation can reflect the present situation of hospital pharmaceutical service in China to a certain extent. It is suggested to improve pharmaceuti-cal care ability of pharmacists through strengthening resource disposition and the cooperation between physicians and pharmacist.
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Scimitar syndrome is a rare congenital cardiopulmonary anomaly,consisting of partial anomalous pulmonary venous return,right lung hypoplasia,and several associated defects.The condition generally has significant morbidity and mortality,but its etiology is poorly understood.Scimitar syndrome has a wide spectrum of clinical presentations ranging from severe respiratory difficulty and high mortality in the perinatal period to asymptomatic and incidental in adulthood.Its diagnosis is mainly dependent on angiocardiography and imging methods.The adult combined with scimitar syndrome are usually given symptomatic treatment.If severe symptoms appears,its primary treatment is surgery to correct anomalous drainage.In the article,the research progress of the pathological anatomy,familial scimitar ayndrome,the clinical diagnosis,clinical therapy and prognosis are reviewed.
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Objective To study the clinical application value of lung ultrasonography (LUS) in adult community acquired pneumonia (CAP).Methods A total of 304 cases of CAP diagnosed by clinic and lung CT in our hospital were performed LUS examination and the results were conducted the comparison.The majority of pneumonia patients detected by ultrasound were performed the ultrasound follow up for observing the disease outcomes.Results Among 301 cases,288 cases were ultrasound examination positive,11 cases were false negative,2 cases were misdiagnosis,the positive rate was 95.6 ％.The main ultrasound signs were pulmonary consolidation,abnormal pleural line,B line and pleural effusion.Among 288 cases of positive ultrasound,lung consolidation was found,in which 193 cases were accompanied by air bronchogram,280 cases had abnormal pleural line,85 cases had pleural effusion,212 cases had B line;the consolidation lesion areas distribution:unilateral lung in 108 cases,bilateral lungs in 180 cases,82cases of single lesion and 206 cases of multiple lesions.Conclusion The lung ultrasound diagnosis of CAP has high accuracy,no radiation,can conduct in bedside,can be repeated for many times,and is worth promoting.
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Objective To study the clinical application value of lung ultrasonography (LUS) in adult community acquired pneumonia (CAP).Methods A total of 304 cases of CAP diagnosed by clinic and lung CT in our hospital were performed LUS examination and the results were conducted the comparison.The majority of pneumonia patients detected by ultrasound were performed the ultrasound follow up for observing the disease outcomes.Results Among 301 cases,288 cases were ultrasound examination positive,11 cases were false negative,2 cases were misdiagnosis,the positive rate was 95.6 ％.The main ultrasound signs were pulmonary consolidation,abnormal pleural line,B line and pleural effusion.Among 288 cases of positive ultrasound,lung consolidation was found,in which 193 cases were accompanied by air bronchogram,280 cases had abnormal pleural line,85 cases had pleural effusion,212 cases had B line;the consolidation lesion areas distribution:unilateral lung in 108 cases,bilateral lungs in 180 cases,82cases of single lesion and 206 cases of multiple lesions.Conclusion The lung ultrasound diagnosis of CAP has high accuracy,no radiation,can conduct in bedside,can be repeated for many times,and is worth promoting.
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OBJECTIVE:To investigate the regularity and characteristics of adverse drug reaction (ADR) in our hospital,to reduce the incidence of ADR,and to provide reference for clinical rational drug use. METHODS:1 731 ADR cases reported by our hospital during Jan. 2002 to Jul. 2015 to national ADR monitoring center through the network system were selected and analyzed statistically in respects of gender,age,related drugs,route of administration,causal relationship evaluation,reporting personnel status,ADR results and drug dosage form organs or systems involved in ADR and manifestation. RESULTS:There were a total of 1 731 ADR patients,among which 640 cases were male,and 1 091 cases were female;patients aged 41-60,≥61 were 676,568 cases;there were 86 cases of severe ADR and 1 645 cases of general ADR,249 cases of new ADR,include 19 cases of severe ADR;causal relationship evaluation of ADR was“impossible”(572 cases) and“very likely”(859 cases) as the vast majority of staff reporting;the most of reporters were doctors (1 290 cases,74.52%),followed by pharmacists (323 cases, 18.66%) and nurses (118 cases, 6.82%);ADR of most patients were improved and recovered. There were 16 routes of administration in ADR cases,among which intravenous infusion and oral administration were the main route of administration, accounting for 92.95%;ADR reports involved 32 kinds of dosage form,which mainly were injection,tablets and capsules, accounting for 86.76%. CONCLUSIONS:Great importance should be attached to ADR monitoring and reporting. We also should reduce the use of intravenous drugs,pay attention to the safety of drug use in elderly patients,promote clinical rational drug use, and ensure the safety of patients.
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Improving medical students' calculation ability in statistics has become the focus and difficulty of medical statistics course teaching, and its application relies heavily on statistical calculation software. In order to explore a new teaching approach which combined the advantages of traditional method and web-based calculation, we intended to build a web computing platform applying the Browser/Server (B/S) mode based on the campus network, and to revise the current syllabus of medical statistics, as well as to create a virtual web-lab containing a typical case library. Practice has proved that the new mode effec-tively improved the practice capability of students and changed the traditional teacher-centered teaching approach.
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Objective To evaluate the image quality of dynamic three-dimensional contrast enhanced ultrasonography(3D-CEUS) in liver tumors.Methods Twenty-five patients were examed with 2D-CEUS and dynamic 3D-CEUS.Contrast-enhanced computed tomography or magnetic resonance imaging(CECT/MRI) were performed early or late.Two readers reviewed the images of both modalities and graded the images according to diagnostic criteria as follows:tumor blood fusion in arterial phase(unclear-score 0,moderate-score 1,clear-score 2),tumor boundry and relationship with periphery tissues (unclear score 0,moderate-score 1,clear-score 2).The concordance between the two modalities for showing liver tumors was evaluated by Kappa test.Results Twenty-three of 25 danymic 3D-CEUS were displayed successfully versus total objects in CECT/ MRI.Among them,for showing blood fusion,16 lesions scored 2,7 lesions scored 1,2 lesions scored 0 in danymic 3D-CEUS,meanwhile 18 lesions scored 2,7 lesions scored 1,0 lesion scored 0 in CECT/MRI,the Kappa value was 0.65.For showing tumor boundry and relationship with peripherytissues,16 lesions scored 2,7 lesions scored 1,2 lesions scored 0 in danymic 3D-CEUS,meanwhile 21 lesions scored 2,4 lesions scored 1,0 lesion scored 0 in CECT/MRI,the Kappa value was 0.52.Conclusions Danymic 3D-CEUS was shown to be useful for displaying tumor blood fusion,boundry and relationship with periphery tissues in single liver tuomor,the concordance between dynamic CEUS and CECT/MRI for single liver tuomor was fair.For huge liver tumor and multi-tumors,3D-CEUS can not give overall information.
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Objective To explore the ultrasonographic characteristics and methodology characteristics of fetal limb deformities . Methods A retrospective analysis was made on 6 336 pregnant women accepting systematic prenatal ultrasonography during the period of May 2010 to May 2012 in the General Hospital of Chengdu Military Region .The long bones of the upper and lower limbs were scanned by using the systematic continuous sequence approach (SCSA) and by adding the arc rotaryprocess for observing the hands and feet ,fetal limbs morphology ,structure ,posture and movement ,etc .were dynamically observed .The suspected position or fetal limb deformities were examined with three-dimensional(3D) ultrasonography as the supplementary .The prenatal ultrasound examination results of fetal limb deformities were analyzed .Results Among 6 336 pregnant women ,20 cases of fetal limb deformi-ties were confirmed by induced labor or after birth ,18 cases were diagnosed by the prenatal ultrsound ,including 5 cases of short limbs deformity ,3 cases of fatal dwarf ,1 case of phocomelia ,1 case of double radiuses absence ,1 case of unilateral hand missing ,1 case of double shank absence ,2 cases of polydactyly ,3 cases of foot varus and 1 case of overlapping finger .2 cases of missed diagno-sis were multiple fingers and overlapping finger .Conclusion The abnormality of terminal fingers(toes) number and posture is easy to be missed diagnosis ,which are the difficulty and the key point of examination .
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Objective To explore the application value of real-time shear wave elastography(SWE) in the liver injury caused by the blast injury.Methods The abdominal mild,moderate and severe blast injury animal models were built,liver and abdominal cavity conventional ultrasound scan and liver SWE measurement were processed before and immediately post-blast,and then the two groups' liver alanine aminotransferase (ALT) and the liver pathology results were compaired.Results The conventional ultrasound scan,immediately after the injury,had found no abnormities of the hepatic tissue in the mild blast injury group,while varying degrees of liver capsular rupture,part of the liver parenchyma regional uneven echo,subcapsular hematoma,obvious liver parenchyma interruption,effusion between the disruption of liver parenchyma and abdominal cavity effusion etc.a series of liver injury had been found in the moderate and severe groups,and the severe blast injury group was more obvious.Three groups' immediately liver elasticity and ALT of post-blast liver injury were increased compared with the pre-blast,the liver elasticity and ALT of each group pre-and post-blast comparing had statistically signifcant (P ＜0.05),and the three groups post-blast immediately liver elasticity and ALT and any two groups' comparing also had statistically significant (P ＜0.05).Conclusions After the blast injury,the changes of liver elasticity were associated with the liver injury degree,the higher elasticity values suggest the heavier damage.Based on conventional ultrasonography,SWE could provide a new evaluation method for the judgement of liver balst injury,especially in the diagnosis of mild liver blast injury.
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Objective To explore the value of the determination of the devitalized tissue area of bullet wounds in the pig extremities by contrast-enhanced ultrasound(CEUS).Methods A model of bullet wounds to the pig limb soft tissue was constructed with a model 53 smoothbore.The sonographic features of the soft tissue of and around the primary traumatic channel of the pig extremities were observed by routine ultrasound and CEUS and compared with the pathological findings.Results The primary traumatic channel of bullet wounds to the pig extremities produced clearer tubular echoes under routine ultrasonic imaging.The echoes from inside the traumatic channel changed with time.Part of tissue close to the periphery of the traumatic channel presented with a filling defect area except the primary traumatic channel after ultrasonic contrast of the traumatogenic area.The pathological examination revealed devitalized necrotic tissues in the filling defect area while the heterogeneous low potentiation of the tissue around and the most peripheral circular high potentiation of the traumatic channel indicated a degenerative tissue change and a small angiectatic change after CEUS.Conclusions Routine ultrasound may determine the run of the primary traumatic channel in the traumatogenic area of bullet wounds to the pig extremities while CEUS may accurately distinguish the devitalized tissue in the traumtogenic area.The combination of both is bound to raise greatly the level of the treatment and cure of bullet wounds.
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Objective To study the geographical distribution of the HIV/AIDS epidemic in C city .Methods Based on the theory of multiple regression analysis ,trend surface regression mathematical model was constructed .The latitude and longitude coordinates of different districts and data of HIV/AIDS were collected in the model and the results by ArcGIS software were got ,the trend sur-face analysis chart was drawed at last .Results HIV/AIDS infection rates trend surface regression mathematical model of C city was statistically significant difference(P< 0 .05) ,its goodness-of-fit was 53 .18% .Regions exsisted abnormal residual value and should be the paid attention to explore protective or risk factors in these regions .Conclusion The method can be used in the analy-sis of C city HIV/AIDS epidemic systematic variation in the geographic distribution and local district ,and provide some clues for the local epidemic prevention and controlling of HIV/AIDS .
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Objective To investigate the value of emergency bedside focused assessment with sonography for trauma (FAST) in combination with regional organ focused ultrasonography in patients with closed abdominal trauma.Methods Two hundred and thirty-seven patients with closed abdominal trauma underwent bedside ultrasonography in the Emergency Department at General Hospital of Chengdu Military Command.In patients with unstable hemodynamics or severe craniocerebral injury,ultrasonography was ended immediately after FAST screening.In patients with stable vital signs,the focused regional organ injury after FAST screening was determined based on the mechanism of trauma,action location and direction of external force,abdominal symptoms,and signs.The results of operation and CT scanning were considered as golden criteria and used to compare with those of ultrasonography.Results (1) The diagnostic sensitivity of FAST to abdominal organ rupture and ascites due to abdominal organ rupture calling for emergency operation was 79.3％ and 100％,respectively.The total specificity of FAST was 98.2％,positive predictive value 93.9％,and negative predictive value 86.7％.(2) The diagnostic accordance rate of single visceral injury examined by regional organ focused ultrasonography was 91.2％ and that of multiple visceral injury was 63.6％.The missed diagnoses were predominantly contusion and microlaceration.Conclusions FAST can quickly screen out the patients with unstable hemodynamics due to abdominal organ rupture calling for emergency management.Regional organ focused ultrasonography can increase the rate of correct diagnosis of visceral injury and decrease the rate of missed diagnosis.
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Objective To explore the value of echo-tracking technique in the detecting the ipsilateral external iliac artery elasticity after gunshot wound in pig limbs.Methods Two-dimensional ultrasound imagings and elasticity parameters of external iliac artery of fifteen pig limbs were obtained respectively,and the results were compared with pre-injury groups.The animals were sacrificed after ultrasonography.Pathological examinations of adjacent external iliac artery of injured pig limbs were analyzed.Results Two-dimensional ultrasound imagings of external iliac arteries had no significant changes post-injury.The changes of elasticity parameters were significiant differences in the injured group comparing with the pre-injured group (P ＜0.05),including the increased stiffness parameter(β),pressure-strain elasticity modulus (Ep)and the decreased arterial compliance(AC).Pathological result showed that the internal elastic lamina of artery detected were flat,endothelial cells came off discontinuously and structure of them were undefined.Conclusions Echo-tracking technique can find the elastic changes of adjacent artery indirect injured by gunshot wound sensitively and which can suggest the occurrence of vascular indirect injury.