临床医学试验与生存分析——二者的统计学关系及哲学思考

生存分析是基于临床医学试验中的数据处理问题 ,吸收数理统计的思想发展起来的一门科学。它将数理统计处理完全数据的技巧拓展到处理不完全数据的场合。生存分析不是单纯的数理统计的推广 ,而是一种以现代数学理论为基础的集理论研究与应用相结合的新兴学科。许多方法和理论结果是数理统计中不曾有的。由于这种基于理论与应用一体的特点 ,在许多领域都可找到其应用的地方。当然 ,生存分析的产生应用都离不开马克思主义哲学理论的指导。

PBL教学模式在临床医学科研试验中的应用研究

PBL教学模式是一种新兴的教学模式,与传统的教学模式相比,其更开放、更灵活、更易学生所接受,本文通过探讨PBL教学模式在临床医学科研试验中的应用,发现PBL教学模式不仅能够激发学生的学习兴趣、增强记忆,还有助于提升学生的综合素质,可见PBL教学模式作为一种新的教学模式,在临床医学教学上,具有发展的空间,学校应该合理的给学生们开展一些PBL课程,以此提高教学效率。

Reality of evidence-based practice in palliative care

There has been a paradigm shift in medicine away from tradition, anecdote and theoretical reasoning from the basic sciences towards evidence-based medicine(EBM). In palliative care however, statistically significant benefits may be marginal and may not be related to clinical meaningfulness. The typical treatment vs. placebo comparison necessitated by ‘gold standard' randomised controlled trials(RCTs) is not necessarily applicable. The complex multimorbidity of end of life care involves considerations of the patient's physical, psychological, social and spiritual needs. In addition, the field of palliative care covers a heterogeneous group of chronic and incurable diseases no longer limited to cancer. Adequate sample sizes can be difficult to achieve, reducing the power of studies and high attrition rates can result in inadequate follow up periods. This review uses examples of the management of cancer-related fatigue and death rattle(noisy breathing) to demonstrate the current state of EBM in palliative care. The future of EBM in palliative care needs to be as diverse as the patients who ultimately derive benefit. Non-RCT methodologies of equivalent quality, validity and size conducted by collaborative research networks using a ‘mixed methods approach' are likely to pose the correct clinical questions and derive evidencebased yet clinically relevant outcomes.

The Extraarticular Symptoms Influence ACR Response in the Treatment of Rheumatoid Arthritis with Biomedicine: A Single-blind, Randomized, Controlled, Multicenter Trial in 194 patients

Objective: The extraarticular symptoms are important in the pattern differentiation of traditional Chinese medicine (TCM), and the present study is designed in an attempt to find the associations between the extraarticular symptoms and American College of Rheumatology (ACR) Response in 194 cases of rheumatoid arthritis (RA) treated with biomedicine. Methods: The data were obtained from a randomized clinical trial. One hundred ninety-four RA patients were treated with the biomedical therapy (diclofenec, methotrexate and sulfasalazine). ACR20 response in 24 weeks was used for the efficacy evaluation. Eighteen symptoms (including 13 extraarticular symptoms) that TCM practitioners focus on were collected for exploration on the association between the symptoms and the efficacy of the biomedical therapy with association rules method. Results: After 24 weeks, a total of 135 patients receiving biomedicine had achieved an ACR20 response. The association rules analysis on each symptom showed that soreness in the waist was more associated with ACR20 response, but with lower support (selected sample size based, 20.10% and 14.95% respectively); cold intolerance and cold joint were found to be associated with ACR20 response with higher support (48.97% and 53.61% respectively), and the confidences (predicted effective rate) were 73.08% and 71.23% respectively. The associations between combination of symptoms (among them, there was at least one extraarticular symptom) and ACR20 response indicated that cold intolerance or cold joint with higher confidence and support were the most important extraarticular symptoms. Conclusion: The RA patients with "cold intolerance" and "cold joints", which are the extraarticular symptoms that TCM practitioners focus on, may show higher ACR20 response when treated with the biomedical approach.

Stem cell therapies and regenerative medicine in China

Stem cells are the core of tissue repair and regeneration,and a promising cell source for novel therapies.In recent years,research into stem cell therapies has been particularly exciting in China.The remarkable advancements in basic stem cell research and clinically effective trials have led to fresh insights into regenerative medicine,such as treatments for sweat gland injury after burns,diabetes,and liver injury.High hopes have inspired numerous experimental and clinical trials.At the same time,government investment and policy support of research continues to increase markedly.However,numerous challenges must be overcome before novel stem cell therapies can achieve meaningful clinical outcomes.

Randomized,double-blind,parallel-controlled clinical trial on correspondence of prescriptions and Traditional Chinese Medicine syndrome of ischemic stroke

OBJECTIVE:To investigate the effect of correspondence of prescriptions and the traditional Chinese medicine(TCM) syndrome of ischemic stroke.METHODS:Based on standard syndrome diagnosis and a series of effective formulas,a randomized,double-blind,parallel-controlled clinical trial on correspondence of prescriptions and the TCM syndrome of ischemic stroke was conducted.The formulas were dynamically changed according to the patient's TCM syndrome.RESULTS:The treatment was composed of a series of formulas changed daily according to the TCM syndrome.Treatments which were composed of a series of formulas had similar short-term(1 month after onset) effects in improving mild and moderate neurological deficits compared with treatments composed of only one formula.However,patients treated with a series of formulas showed improved subjective symptoms in the short-term and a decreased risk of stroke recurrence within three months after onset.CONCLUSION:Complete(series of formulas) and incomplete(only one formula) correspondence of prescriptions and TCM syndrome have similar effects on the central clinical manifestation of ischemic stroke,such as neurological deficit and activities in daily living.However,they have significant differences regarding individual dysfunctions,such as subjective symptoms.

Integrated treatment for lower-limb stage Ⅱ thromboangiitis obliterans by interventional therapy and oral administration of Chinese medicine: a randomized controlled clinical trial

OBJECTIVE： To observe if integrated treatment is better than other therapies for lower-limb stage Ⅱ thromboangiitis obliterans （TAO）. METHODS： Ninety lower-limb stage Ⅱ or worse TAO patients were randomly divided into three groups： group A （30 cases） treated by intervention and oral administration of Chinese medicine; group B （30 cases） treated by intervention alone; and group C （30 cases） treated only with oral adminis- tration of Chinese medicine. Therapeutic effects were observed, including the cure rate; the recurrence rate after one month, three months, six months, nine months, and one year; the ankle brachial indexes; the incidence of complications; and the level of C-reactive protein and erythrocyte sedimentation rate.RESULTS： Group A had significantly better clinically curative effects, related indexes, and outcomes during the long-term follow-up survey, than that of groups B and C. CONCLUSION： Integrated treatment is more effective for treating lower-limb stage Ⅱ or worseTAO.