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Effectiveness of intravenous r- tPA versus UK for acute ischaemic stroke: a nationwide prospective Chinese registry study

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Stroke & Vascular Neurology 2021年第4期6卷 603-609,I0060-I0066页

作者： Xinhong wang Xiaoqiu Li Yuming Xu Runhui Li Qingcheng Yang Yong Zhao Fengyun wang Baoying Sheng Runqing wang Shaoyuan Chen Lihua wang Liying Shen Xiaowen Hou Yu Cui duolao wang Bin Peng Craig S Anderson Huisheng Chen On behalf of INTRECIS Investigators Neurology General Hospital of Northern Theatre CommandShenyangLiaoningChina Neurology The First Affiliated Hospital of Zhengzhou UniversityZhengzhouChina Neurology Central Hospital Affiliated to Shenyang Medical CollegeShenyangChina Neurology The People’s Hospital of Anyang CityAnyangChina Neurology Haicheng Hospital of Traditional Chinese MedicineHaichengChina Neurology Liaocheng People's HospitalLiaochengShandongChina Neurology The First Affiliated Hospital of Jiamusi UniversityJiamusiChina Neurology Zhengzhou Central HospitalZhengzhouChina Neurology The 32183 Military Hospital of PLABaichengChina Neurology The Second Affiliated Hospital of Harbin Medical UniversityHarbinChina Neurology Tieling County Central HospitalTielingChina Clinical Sciences Liverpool School of Tropical MedicineLiverpoolUK Neurology Peking Union Medical College HospitalBeijingChina The George Institute for Global Health SydneyNew South WalesAustralia 不详

Background Intravenous recombinant tissue plasminogen activator(r-tPA)and urokinase(UK)are both recommended for the treatment of acute ischaemic stroke(AIS)in China,but with few comparative outcome data being *** aimed to compare the outcomes of these two thrombolytic agents for the treatment of patients within 4.5 hours of onset of AIS in routine clinical practice in *** A pre-planned,prospective,nationwide,multicentre,real-world registry of consecutive patients with AIS(age≥18 years)who received r-tPA or UK within 4.5 hours of symptom onset according to local decision-making and guideline recommendations during *** primary effectiveness outcome was the proportion of patients with an excellent functional outcome(defined by modified Rankin scale scores 0 to 1)at 90 *** key safety endpoint was symptomatic intracranial haemorrhage according to standard *** logistic regression was used for comparative analysis,with adjustment according to propensity scores to ensure balance in baseline *** Overall,4130 patients with AIS were registered but 320 had incomplete or missing data,leaving 3810 with available data for analysis of whom 2666 received r-tPA(median dose 0.88(IQR 0.78-0.90)mg/kg)and 1144 received UK(1.71(1.43-2.00)×104 international unit per kilogram).There were several significant intergroup differences in patient characteristics:r-tPA patients were more educated,had less history of stroke,lower systolic blood pressure,greater neurological impairment and shorter treatment times from symptom onset than UK ***,in adjusted analysis,the frequency of excellent outcome(OR 1.18,95%CI 1.00 to 1.40,p=0.052)and symptomatic intracranial haemorrhage(OR 0.70,95%CI 0.33 to 1.47,p=0.344)were similar between *** UK may be as effective and carry a similar safety profile as r-tPA in treating mild to moderate AIS within guidelines in *** http://***

关键词： prospective routine nationwide

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Win Ratio法在比较两组间非正态分布数据中的应用

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中国卫生统计 2018年第5期35卷 798-800页

作者：李超康轶君朱妮 Tao Chen duolao wang 颜虹西安交通大学医学部公共卫生学院流行病与卫生统计学系 710061 陕西省疾病预防控制中心卫生信息所 Department of Clinical Sciences Liverpool School of Tropical Medicine

目的介绍Win Ratio法的原理及技术,以及此方法在比较两组间非正态分布数据中的应用。方法以一项随机对照双盲试验为例,采用Win Ratio法比较不符合正态分布的结局变量(孕周)在两组间的差异,并利用Bootstrap法估算相应的置信区间。同时比... 详细信息

目的介绍Win Ratio法的原理及技术,以及此方法在比较两组间非正态分布数据中的应用。方法以一项随机对照双盲试验为例,采用Win Ratio法比较不符合正态分布的结局变量(孕周)在两组间的差异,并利用Bootstrap法估算相应的置信区间。同时比较与传统非参数检验方法结果之间的差异,所有分析均采用SAS 9. 4软件。结果 Win Ratio法估算干预组孕周高于对照组的概率为52. 83%,置信区间为(1. 04,1. 21)。该结果与传统非参数方法一致,但Hodges&Lehmann法估计的置信区间结果中包含0。结论相比传统非参数检验方法,Win Ratio除能够在区间估计的基础上判断组间差异是否具有统计学意义,还可以估计干预效应,同时可保证良好的可靠性和把握度。

关键词： Win Ratio Bootstrap 可信区间干预效应

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Win Ratio法在比较两组生存资料复合终点数据中的应用

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中国卫生统计 2019年第6期36卷 955-958页

作者：李超梁煊怡康轶君朱妮 Tao Chen duolao wang 颜虹西安交通大学医学部公共卫生学院流行病与卫生统计学系 710061 陕西省疾病预防控制中心信息所 Department of Clinical Sciences Liverpool School of Tropical Medicine

目的介绍Win Ratio法在比较两组生存资料复合终点数据的基本原理及方法。方法以一项采用整群随机化双盲对照设计的孕期营养素干预研究为实例,运用Win Ratio法分析比较不同营养素补充对子代两种复合结局"孕28周至分娩后4周死亡"及次要不... 详细信息

目的介绍Win Ratio法在比较两组生存资料复合终点数据的基本原理及方法。方法以一项采用整群随机化双盲对照设计的孕期营养素干预研究为实例,运用Win Ratio法分析比较不同营养素补充对子代两种复合结局"孕28周至分娩后4周死亡"及次要不良结局"低出生体重"的影响,并运用Bootstrap法计算95%CI。比较Win Ratio法及传统Cox风险回归模型计算结果间的差异。结果Win Ratio法与传统Cox风险回归所得结果一致,两组间差异均无统计学意义。Win Ratio法分析结果显示对照组(孕期补充叶酸)的不良结局发生率是干预组(孕期补充多维营养素)的1.07倍,95%CI为(0.85,1.27);传统Cox风险回归模型分析的结果与Win Ratio法相似,即对照组的不良结局发生是干预组的1.04倍,95%CI为(0.83,1.31)。结论相较于传统的生存分析,Win Ratio法在分析多种结局的生存资料时,可考虑结局间的重要性,同时在保证良好的准确性和检验效能的前提下完成对生存资料的区间估计及干预效应的评价。

关键词： Win Ratio Cox回归生存资料

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Win Difference法在临床试验中比较两组间干预效应的应用

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中国卫生统计 2020年第1期37卷 121-123页

作者：梁煊怡 Tao Chen duolao wang 颜虹周自爱李超西安交通大学医学部公共卫生学院流行病与卫生统计学系 710061 Department of Clinical Sciences Liverpool School of Tropical Medicine

目的介绍Win Difference法在临床试验数据分析中比较两组间干预效应的基本原理与技术。方法运用Win Difference法对两组孕期补充不同微量营养素的妇女子代学龄早期智力情况(连续性变量,二分类变量)进行分析,并基于置换检验估算其P值与95... 详细信息

目的介绍Win Difference法在临床试验数据分析中比较两组间干预效应的基本原理与技术。方法运用Win Difference法对两组孕期补充不同微量营养素的妇女子代学龄早期智力情况(连续性变量,二分类变量)进行分析,并基于置换检验估算其P值与95%置信区间。结果Win Difference法分析结果显示:阈值为0时,“孕期补充叶酸加铁”组与“孕期补充叶酸”组子代智力更优率的差值为2.40%(P=0.500;95%CI,-4.42%,9.54%),阈值为5时,“叶酸加铁”组与“叶酸”组子代智力更优率的差值为2.39%(P=0.472;95%CI,-4.30%,8.75%);将智力发育得分转换为二分类变量(<80时判断为智力发育迟缓)后,“叶酸加铁”组与“叶酸”组子代智力更优率的差值为-1.24%(P=0.615;95%CI,3.59%,-6.06%)。以上结果与传统检验方法所得结果均一致,两组间差异均无统计学意义。结论在两组间结局效应比较中,Win Difference法保持了Win Ratio法评估干预效应的优势,并将干预效应的评价指标由基于两组间赢率倍数的R w值转变为基于两组间赢率差值的D w值,结局变量类型均能够保证良好的效度与信度。同时能够通过设定阈值筛选出达到一定程度的组间差异,进一步评价两组间干预措施效果。

关键词： Win Difference 临床试验干预效应置换检验经验分布

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Vaccination against coronavirus disease 2019 in patients with pulmonary hypertension:A national prospective cohort study

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Chinese Medical Journal 2024年第6期137卷 669-675页

作者： Xiaohan Wu Jingyi Li Jieling Ma Qianqian Liu Lan wang Yongjian Zhu Yue Cui Anyi wang Cenjin Wen Luhong Qiu Yinjian Yang Dan Lu Xiqi Xu Xijie Zhu Chunyan Cheng duolao wang Zhicheng Jing Department of Cardiology State Key Laboratory of Complex Severe and Rare DiseasesPeking Union Medical College HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100730China Department of Echocardiography National Center for Cardiovascular DiseasesFuwai HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100037China Department of Pulmonary Circulation Shanghai Pulmonary HospitalTongji University School of MedicineShanghai 200433China Department of Cardiology The First Affiliated Hospital of Zhengzhou UniversityZhengzhouHenan 450052China Department of Clinical Sciences Liverpool School of Tropical MedicineLiverpoolUnited Kingdom

Background:Coronavirus disease 2019(COVID-19)has potential risks for both clinically worsening pulmonary hypertension(PH)and increasing ***,the data regarding the protective role of vaccination in this population are still *** study aimed to assess the safety of approved vaccination for patients with ***:In this national prospective cohort study,patients diagnosed with PH(World Health Organization[WHO]groups 1 and 4)were enrolled from October 2021 to April *** primary outcome was the composite of PH-related major adverse *** used an inverse probability weighting(IPW)approach to control for possible confounding factors in the baseline characteristics of ***:In total,706 patients with PH participated in this study(mean age,40.3 years;mean duration after diagnosis of PH,8.2 years).All patients received standardized treatment for PH in accordance with guidelines for the diagnosis and treatment of PH in *** them,278 patients did not receive vaccination,whereas 428 patients completed the vaccination *** of the participants were infected with COVID-19 during our study ***,398 patients received inactivated severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)vaccine,whereas 30 received recombinant protein subunit *** adjusting for baseline covariates using the IPW approach,the odds of any adverse events due to PH in the vaccinated group did not statistically significantly increase(27/428[6.3%]vs.24/278[8.6%],odds ratio=0.72,P=0.302).Approximately half of the vaccinated patients reported at least one post-vaccination side effects,most of which were mild,including pain at the injection site(159/428,37.1%),fever(11/428,2.6%),and fatigue(26/428,6.1%).Conclusions:COVID-19 vaccination did not significantly augment the PH-related major adverse events for patients with WHO groups 1 and 4 PH,although there were some tolerable side effects.A large-scale randomized controlled trial is warr

关键词： Coronavirus disease COVID-19 Pulmonary hypertension Vaccination

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Secular trend in age at menarche for women born from 1962 to 1994 at high altitudes:a retrospective study in the rural Tibet region of China

Secular trend in age at menarche for women born from 1962 to...

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2017年中国卫生统计学学术年会

作者： Yijun Kang Shaonong Dang duolao wang Lingxia Zeng Qiang Li Leilei Pei Yue Cheng Yuxue Bi Quanli wang Shengbin Xiao Hong Yan School of Public Health Xi'an Jiaotong University Health Science Center Department of Clinical Sciences Liverpool School of Tropical Medicine

＜正＞Background:Age at menarche（AM）is a sensitive indicator of environmental conditions during *** retrospective study examined AM for women in rural Tibet and detected its related ***:AM data were collected retrospectively by questionnaire from 1,556 women who gave informed consent enrolled from October 2007 to May 2011,which were born

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Non-Ischemic, Non-Hypoxic Myocardial Injury, and Long-Term Mortality in Patients with Coronavirus Disease 2019: A Retrospective Cohort Study

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Cardiology Discovery 2022年第2期2卷 77-82页

作者： Fajiu Li Xijie Zhu Ziyang Zhu Yinjian Yang Zhuang Tian duolao wang Shi Chen Xiaoyan Gao Yalin Xu Bo Zhang Wei Yu Min Liu Xiqi Xu Chenghong Li Shuyang Zhang Department of Pulmonary and Critical Care Medicine Affiliated Hospital of Jianghan UniversityWuhanHubei 430015China Department of Cardiology Peking Union Medical College HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100730China Department of Medical Science Research Center Peking Union Medical College HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100730China Department of Clinical Sciences Liverpool School of Tropical MedicineLiverpoolMerseyside L35QAUnited Kingdom Department of Geriatrics Affiliated Hospital of Jianghan UniversityWuhanHubei 430015China Department of Cardiology Affiliated Hospital of Jianghan UniversityWuhanHubei 430015China.

Objective:Cardiac damage is commonly reported in patients with coronavirus disease 2019(COVID-19)but its prevalence and impact on the long-term survival of patients remain *** study aimed to explore the prevalence of myocardial injury and assess its prognostic value in patients with ***:A single-center,retrospective cohort study was performed at the Affiliated Hospital of Jianghan *** from 766 patients with confirmed COVID-19 who were hospitalized from December 27,2019 to April 25,2020 were ***,clinical,laboratory,electrocardiogram,treatment data and all-cause mortality during follow-up were collected and ***:Of the 766 patients with moderate to critically ill COVID-19,86(11.2%)died after a mean follow-up of 72.8 *** injury occurred in 94(12.3%)*** mortality rate was 64.9%(61/94)and 3.7%(25/672)in patients with and without myocardial injury,*** regression showed that myocardial injury was an independent risk factor for mortality(hazard ratio:8.76,95%confidence interval:4.76–16.11,P<0.001).Of the 90 patients with myocardial injury with electrocardiogram results,sinus tachycardia was present in 29,bundle branch block in 26,low voltage in 10,and abnormal T-wave in ***:COVID-19 not only involves pneumonia but also cardiac *** injury is a common complication and an independent risk factor for mortality in COVID-19 patients.

关键词： Coronavirus COVID-19 Mortality Myocardial injury

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论科学健康观

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中国医学伦理学 2005年第2期18卷 30-34页

作者：李恩昌王多劳西安交通大学(医学院)中国医学伦理学编辑部陕西西安710061 伦敦大学卫生与热带病学院

医学模式转变在中国开展以来,中国卫生事业的绩效不增反减。这从侧面提示,卫生事业发展和人民健康水平的提高有其自身的规律性和系统联系性,非一个医学模式所能概括。说明需要有新的理论构架能促进医学的发展———科学健康观。其核心是... 详细信息

医学模式转变在中国开展以来,中国卫生事业的绩效不增反减。这从侧面提示,卫生事业发展和人民健康水平的提高有其自身的规律性和系统联系性,非一个医学模式所能概括。说明需要有新的理论构架能促进医学的发展———科学健康观。其核心是:人民健康是反映社会政治、经济、文化和自然、生态发展的主要综合指标之一,促进人民健康是执政党、政府及全社会的重要责任和共同目标,要通过政治、经济、文化的协调、和谐发展和改革来促进人民健康,寓人民健康于政治、经济、文化发展之中,通过社会的和谐发展,构建健康型社会———促进人民健康。

关键词：科学健康观医学模式转变卫生事业绩效健康型社会

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晶状体糖基化终末产物在糖尿病视网膜病变中的临床应用价值

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中华糖尿病杂志 2022年第7期14卷 696-703页

作者：姚佳舒刘钰桑苗苗李伟袁扬邱山虎王多劳孙子林东南大学附属中大医院内分泌科东南大学糖尿病研究所南京210009 安徽医科大学附属宿州医院(安徽省宿州市立医院)内分泌科宿州234000 东南大学附属中大医院全科东南大学糖尿病研究所南京210009 利物浦热带医学院临床科学系英国利物浦28372

目的:探讨晶状体自发荧光强度比值(LFR)与糖尿病视网膜病变(DR)的关系及其在中国DR人群中的筛查价值。方法:为横断面研究。自2020年5月至2021年1月,从中国8个不同省份的社区居民中筛选糖尿病患者590例,收集上述研究对象的人口学特征、... 详细信息

目的:探讨晶状体自发荧光强度比值(LFR)与糖尿病视网膜病变(DR)的关系及其在中国DR人群中的筛查价值。方法:为横断面研究。自2020年5月至2021年1月,从中国8个不同省份的社区居民中筛选糖尿病患者590例,收集上述研究对象的人口学特征、吸烟史、疾病史,测量收缩压、舒张压、身高、体重,检测空腹血糖、餐后2 h血糖、糖化血红蛋白(HbA 1c)、血脂等指标,并计算体重指数、估算的肾小球滤过率。运用晶状体荧光显微镜测定受检眼LFR,采用基于DR早期治疗研究(ETDRS)评分对眼底图像进行分级。按LFR三分位水平分为3组:LFR最低组( Q1组,LFR<20.20%,196例)、LFR中间组( Q2组,LFR 20.20%~25.88%,198例)和LFR最高组( Q3组,LFR≥25.89%,196例)。采用logistic回归分析探讨LFR与DR之间的关联,并以受试者工作特征曲线(ROC)评价LFR单独或联合HbA 1c筛查DR的效能。结果:随着LFR水平的升高,DR的患病率呈上升趋势[ Q1组5.10%(10/196), Q2组11.62%(23/198), Q3组30.10%(59/196);趋势性 P值<0.001]。以ETDRS评分≥31为参考标准,校正年龄、性别、体重指数、收缩压、舒张压、HbA 1c、空腹血糖、餐后2 h血糖、高密度脂蛋白胆固醇、甘油三酯、估算的肾小球滤过率、吸烟史后,LFR每增加1个标准差,DR患病风险增加2.34倍(95%CI 1.68~3.26)。当以ETDRS评分≥31为参考标准时,LFR筛查DR的曲线下面积(AUC)为0.783,灵敏度为64.15%,特异度为84.36%,将LFR与HbA 1c联合后,AUC提升至0.865,灵敏度提升至94.34%。结论:LFR与DR患病风险正相关,且对于DR筛查表现出较高的AUC及特异度,联合HbA 1c可提高其筛查效能。

关键词：糖尿病并发症糖尿病视网膜病变血红蛋白A 糖基化糖基化终末产物晶状体自发荧光强度比值

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The role of active case finding in reducing patient incurred catastrophic costs for tuberculosis in Nepal

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Infectious Diseases of Poverty 2019年第6期8卷 61-75页

作者： Suman Chandra Gurung Kritika Dixit Bhola Rai Maxine Caws Puskar Raj Paudel Raghu Dhital Shraddha Acharya Gangaram Budhathoki Deepak Malla Jens W.Levy Job van Rest Knut Lonnroth Kerri Viney Andrew Ramsay Tom Wingfield Buddha Basnyat Anil Thapa Bertie Squire duolao wang Gokul Mishra Kashim Shah Anil Shrestha Noemia Teixeira de Siqueira-Filha Birat Nepal Medical Trust KathmanduNepal Department of Clinical Sciences Liverpool School of Tropical MedicineLiverpoolUK KNCV Tuberculosis Foundation The HagueNetherlands Department of Public Health Sciences Karolinska InstitutetStockholmSweden Research School of Population Health Australian National UniversityCanberraAustralia University of St Andrews St AndrewsUK University of Liverpool LiverpoolUK Oxford University Clinical Research Unit KathmanduNepal National Tuberculosis Centre BhaktapurNepal Nick Simons Institute LalitpurNepal Institute for Health Technology Assessment Porto AlegreBrazil

Background:The World Health Organization(WHO)End TB Strategy has established a milestone to reduce the number of tuberculosis(TB)-affected households facing catastrophic costs to zero by *** role of active case finding(ACF)in reducing patient costs has not been determined *** study therefore aimed to compare costs incurred by TB patients diagnosed through ACF and passive case finding(PCF),and to determine the prevalence and intensity of patient-incurred catastrophic costs in ***:The study was conducted in two districts of Nepal:Bardiya and Pyuthan(Province No.5)between June and August *** hundred patients were included in this study in a 1:1 ratio(PCF:ACF,25 consecutive ACF and 25 consecutive PCF patients in each district).The WHO TB patient costing tool was applied to collect information from patients or a member of their family regarding indirect and direct medical and non-medical *** costs were calculated based on the proportion of patients with total costs exceeding 20%of their annual household *** intensity of catastrophic costs was calculated using the positive overshoot *** chi-square and Wilcoxon-Mann-Whitney tests were used to compare proportions and ***,the Mantel Haenszel test was performed to assess the association between catastrophic costs and type of ***:Ninety-nine patients were interviewed(50 ACF and 49 PCF).Patients diagnosed through ACF incurred lower costs during the pre-treatment period(direct medical:USD 14 vs USD 32,P=0.001;direct non-medical:USD 3 vs USD 10,P=0.004;indirect,time loss:USD 4 vs USD 13,P<0.001).The cost of the pre-treatment and intensive phases combined was also lower for direct medical(USD 15 vs USD 34,P=0.002)and non-medical(USD 30 vs USD 54,P=0.022)costs among ACF *** prevalence of catastrophic direct costs was lower for ACF patients for all thresholds.A lower intensity of catastrophic costs was also documented for ACF patients,altho

关键词： Tuberculosis Case finding Cost Catastrophic cost Patient-incurred cost Nepal

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