孟德尔随机化方法在流行病学病因推断中的应用

目的阐述在观察性流行病学研究中如何运用孟德尔随机化方法进行科学合理的病因推断,以控制混杂因素和反向因果关联对结果的影响.方法以孟德尔独立分配定律为基础,已知不同基因型导致不同的中间表型（即待研究的暴露因素）,用基因-疾病的因果链模拟暴露因素对疾病的作用,推导出暴露对疾病的真实效应值.结果基因-疾病的效应估计值能够反映暴露因素和疾病间的真实联系.由于配子形成时等位基因的随机分配,该效应估计值不会受到传统流行病学研究中的混杂因素的影响.结论孟德尔随机化的应用能够增强观察性流行病学中的病因推断,增进对潜在危险因素的认识,同时可能为研究设计和资料分析提供新思路,具有较大的应用前景.     

陕西省医疗资源分布的聚类分析研究

运用统计学原理和方法对收集的数据进行整理，建立了由7组指标构建的评价体系，定量地评价了2002年陕西省各个地区的医疗资源分布状况，为进一步合理配置陕西省医疗资源提供了依据。     

运用系统聚类法综合评价农村社区卫生服务中心功能

目的综合评价农村社区卫生服务功能。方法系统聚类分析。结果把58个乡镇分成好、中、差3类。结论转变农村乡镇卫生院服务模式,从社区卫生服务的医疗、预防、康复、保健、健康教育和计划生育指导六位一体功能出发,协调发展,全方位提高农村社区卫生服务功效。     

聚类分析方法在我国托幼机构卫生保健工作现状研究中的应用

【目的】丁解我国托幼机构卫生保健工作的整体现状，为促进托幼机构卫生保健工作提供参考。【方法】通过分层整群抽样调查了31个省（自治区、直辖市）8966所托幼机构，采用聚类分析方法对其中27个省（市、自治区）托幼机构卫生保健工作进行分析。【结果】①27个省（市、自治区）的村级以上托幼机构（简称城市园）卫生保健工作整体分为三类：第1类包括6个省份，保健医配备率平均为96．0％（采用中位数）；第2类包括20个省份，保健医配备率平均为68．5％；第3类包括1个省份，保健医配备率为32．0％。②27个省（市、自治区）的村级托幼机构（简称农村园）卫生保健工作整体可分三类。第1类有1个省份，保健医配备率为31．6％；第2类包括24个省份．保健医配备率平均为12．2％；第3类包括2个省份。保健医配备率仅为2．7％。【结论】①1个省份的城市园的卫生保健状况和农村园的卫生保健状况相当。②要重视农村地区的托幼机构卫生保健制度的执行。     

Accuracy of Electrode Position in Sphenopalatine Ganglion Stimulation in Correlation With Clinical Efficacy

IntroductionSphenopalatine ganglion (SPG) stimulation is an efficient treatment for cluster headache. The target for the SPG microstimulator in the pterygopalatine fossa lies between the vidian canal and foramen rotundum, ideally two contacts should be placed in this area. However, placement according to the manufacturers recommendations is frequently not possible. It is not known whether a suboptimal electrode placement interferes with postoperative outcomes.Materials and MethodsSPG stimulation was performed in 13 patients between 2015 and 2018 in a single center. Lead location was determined by intraoperative computed tomography scan and correlated with the planned lead position as well as clinical data and stimulation parameters. Patients with a reduction of 50% or more in pain intensity or frequency were considered responsive.ResultsEleven patients (84.6%) responded to SPG stimulation with eight being frequency responders (61.5%). In seven cases, there were less than two electrodes between vidian canal and foramen rotundum, there was no significant correlation with negative stimulation results (p = 0.91). The mean distance of lead location between pre- and postoperative images did not correlate with clinical outcomes (p = 0.84) and was even bigger in responders (4.91 mm vs. 4.53 mm). The closest electrode contact to the vidian canal was in the stimulation area in all but one patient, regardless of its overall distance to canal. The distance of the closest electrode to the vidian canal was, however, not significantly correlated to the percentage of frequency (p = 0.68) or intensity reduction (p = 0.61).ConclusionThere was no significant correlation regarding aberrations of lead position from the planned position with clinical outcome. However, this study might be underpowered to detect such a correlation. The closest electrode contact to the vidian canal was in the stimulation area in all but one patient in the final programming. This indicates that, overall, the lead location does play a crucial role in SPG stimulation for cluster headache.     

Cluster of Ebola Virus Disease,Bong and Montserrado Counties,Liberia

Lack of trust in government-supported services after the death of a health care worker with symptoms of Ebola resulted in ongoing Ebola transmission in 2 Liberia counties. Ebola transmission was facilitated by attempts to avoid cremation of the deceased patient and delays in identifying and monitoring contacts.     

Genetically predicted insomnia and lung cancer risk: a Mendelian randomization study

BackgroundThe relationship between insomnia and lung cancer is scanty. The Mendelian randomization approach provides the rationale for evaluating the potential causality between genetically-predicted insomnia and lung cancer risk.MethodsWe extracted 148 insomnia-related single-nucleotide polymorphisms (SNPs) as instrumental variables (IVs) from published genome-wide association studies (GWASs). Summary data of individual-level genetic information of participants were obtained from the International Lung Cancer Consortium (ILCCO) (29,266 cases and 56,450 controls). MR analyses were performed using the inverse-variance-weighted approach, MR pleiotropy residual sum and outlier (MR-PRESSO) test, weighted median estimator, and MR-Egger regression. Sensitivity analyses were further performed using Egger intercept analysis, leave-one-out analysis, MR-PRESSO global test, and Cochran's Q test to verify the robustness of our findings.ResultsThe results of the MR analysis indicated an increased risk of lung cancer in insomnia patients (OR = 1.1671; 95% CI 1.0754–1.2666, p = 0.0002). The subgroup analyses showed increased risks of lung adenocarcinoma (OR = 1.1878; 95% CI 1.0594–1.3317, p = 0.0032) and squamous cell lung cancer (OR = 1.1595; 95% CI 1.0248–1.3119, p = 0.0188).ConclusionOur study indicated that insomnia is a causal risk factor in the development of lung cancer. Due to the lack of evidence on both the epidemiology and the mechanism level, more studies are needed to better elucidate the results of the study.     

Magnetic resonance imaging accurately tracks kidney pathology and heterogeneity in the transition from acute kidney injury to chronic kidney disease

1. Download : Download high-res image (366KB)
2. Download : Download full-size image