Application Analysis of Nursing Students'Grades in Course Relevance Based on Association Rule Mining Algorithm Apriori

By analyzing the correlation between courses in students’grades,we can provide a decision-making basis for the revision of courses and syllabi,rationally optimize courses,and further improve teaching effects.With the help of IBM SPSS Modeler data mining software,this paper uses Apriori algorithm for association rule mining to conduct an in-depth analysis of the grades of nursing students in Shandong College of Traditional Chinese Medicine,and to explore the correlation between professional basic courses and professional core courses.Lastly,according to the detailed analysis of the mining results,valuable curriculum information will be found from the actual teaching data.

Levels of evidence and grades of recommendation supporting European society for medical oncology clinical practice guidelines

Background:The European Society for Medical Oncology(ESMO)guidelines are among the most comprehensive and widely used clinical practice guidelines(CPGs)globally.However,the level of scientific evidence supporting ESMO CPG recommendations has not been systematically investigated.This study assessed ESMO CPG levels of evidence(LOE)and grades of recommendations(GOR),as well as their trends over time across various cancer settings.Methods:We manually extracted every recommendation with the Infectious Diseases Society of America(IDSA)classification from each CPG.We examined the distribution of LOE and GOR in all available ESMO CPG guidelines across different topics and cancer types.Results:Among the 1,823 recommendations in the current CPG,30%were classified as LOEⅠ,and 43%were classified as GOR A.Overall,there was a slight decrease in LOEⅠ(−2%)and an increase in the proportion of GOR A(+1%)in the current CPG compared to previous versions.The proportion of GOR A recommendations based on higher levels of evidence such as randomized trials(LOEⅠ–Ⅱ)shows a decrease(71%vs.63%,p=0.009)while recommendations based on lower levels of evidence(LOEⅢ–Ⅴ)show an increase(29%vs.37%,p=0.01)between previous and current version.In the current versions,the highest proportion of LOEⅠ(42%)was found in recommendations related to pharmacotherapy,while the highest proportion of GOR A recommendations was found in the areas of pathology(50%)and diagnostic(50%)recommendations.Significant variability in LOEⅠand GOR A recommendations and their changes over time was observed across different cancer types.Conclusion:One-third of the current ESMO CPG recommendations are supported by the highest level of evidence.More well-designed randomized clinical trials are needed to increase the proportion of LOEⅠand GOR A recommendations,ultimately leading to improved outcomes for cancer patients.

Functionally graded structure of a nitride-strengthened Mg_(2)Si-based hybrid composite

The ex-situ incorporation of the secondary SiC reinforcement,along with the in-situ incorporation of the tertiary and quaternary Mg_(3)N_(2) and Si_(3)N_(4) phases,in the primary matrix of Mg_(2)Si is employed in order to provide ultimate wear resistance based on the laser-irradiation-induced inclusion of N_(2) gas during laser powder bed fusion.This is substantialized based on both the thermal diffusion-and chemical reactionbased metallurgy of the Mg_(2)Si–SiC/nitride hybrid composite.This study also proposes a functional platform for systematically modulating a functionally graded structure and modeling build-direction-dependent architectonics during additive manufacturing.This strategy enables the development of a compositional gradient from the center to the edge of each melt pool of the Mg_(2)Si–SiC/nitride hybrid composite.Consequently,the coefficient of friction of the hybrid composite exhibits a 309.3%decrease to–1.67 compared to–0.54 for the conventional nonreinforced Mg_(2)Si structure,while the tensile strength exhibits a 171.3%increase to 831.5 MPa compared to 485.3 MPa for the conventional structure.This outstanding mechanical behavior is due to the(1)the complementary and synergistic reinforcement effects of the SiC and nitride compounds,each of which possesses an intrinsically high hardness,and(2)the strong adhesion of these compounds to the Mg_(2)Si matrix despite their small sizes and low concentrations.

热敏灸治疗颈型颈椎病的Meta分析及GRADE证据等级评价

目的系统评价热敏灸及其综合疗法用于颈型颈椎病的临床效果,为热敏灸治疗颈型颈椎病提供更好的证据来源。方法收集国内外各大数据库热敏灸及其综合疗法用于颈型颈椎病的随机对照试验(RCT),通过Revman 5.3软件进行Meta分析,按照GRADE标准对结局指标进行证据质量评价。结果纳入9篇文献共855例患者,Meta分析结果提示:热敏灸及其综合疗法组在提高总有效率(RR=1.19,P<0.01)和治愈率(RR=1.73,P<0.01)、降低视觉模拟量表(VAS)评分(SMD=-0.73,P<0.01)、简化McGill疼痛问卷(SF-MPQ)评分(SMD=-1.28,P<0.05)以及NPQ颈痛量表评分(SMD=-0.81,P<0.05)方面都优于对照组;GRADE证据等级评价提示:前三者为低质量证据,后二者为极低质量证据。结论热敏灸及其综合疗法用于颈型颈椎病在提高临床效果、镇痛以及改善患者生活质量方面更具优势。

Characterization and comparison of the aroma-active compounds on different grades of sesame-flavor Baijiu by headspace solid-phase microextraction and gas chromatography-olfactometry-mass spectrometry

This study investigated the aroma-active compounds and compared the differences of three different grades of sesame-flavor Baijiu by headspace solid-phase microextraction(HS-SPME)coupled with gas chromatography-olfactometry-mass spectrometry(GC-O-MS).A total of 54 aroma-active compounds were detected.Principal component analysis showed that JZ1,JZ2,and JZ3 were well separated from each other.JZ1 as the premium-grade Baijiu had the highest aroma intensities,concentrations.According to aroma intensities and concentrations,dimethyl trisulfide,butanoic acid,phenylacetaldehyde,2-furylmethanethiol,ethyl hexanoate,2,6-dimethylpyrazine,etc.could be potentially applied as volatile makers to distinguish the three different grades of sesame-flavor Baijiu as their significant difference(P<0.05)in three Baijiu samples.Roasted aroma had the significant difference(P<0.05)in three sample base on aroma profiles.Meanwhile,2-furylmethanethiol,2,6-dimethylpyrazine were related to the roasted aroma,they may be had a significant contribution to the differences of three different grades of sesame-flavor Baijiu.This study has provided a comprehensive understanding of the differences of three different grades of sesame-flavor Baijiu.

刮痧改善腰椎间盘突出疼痛症状的系统评价及GRADE证据质量评价

目的系统评价刮痧干预腰椎间盘突出疼痛症状的疗效与安全性,为其临床治疗提供循证依据。方法计算机检索自建库到2022年8月29日前公开发表在中国知网、万方、维普、中国生物医学文献服务系统、PubMed、Embase、Web of Science、The Cochrane Library数据库,收集关于刮痧干预腰椎间盘突出的随机对照试验(Randomized controlled trial,RCT)。文章由两名研究者独立筛选,根据Cochrane Reviewers Handbook 6.2的偏倚风险评估工具对纳入文献进行质量评价,应用RevMan 5.4软件对纳入文献的结局指标进行Meta分析,并采用GRADE系统对结局指标进行证据质量等级评价。结果最终纳入10篇RCT,共1087例患者。Meta分析结果显示:刮痧试验组治疗腰椎间盘突出患者在疼痛VAS评分[MD=-1.11,95%CI(-1.58,-0.64),P<0.00001]、日本骨科协会(JOA)评分[MD=4.47,95%CI(3.76,5.17),P<0.00001]、临床有效率[relative risk(RR)=1.13,95%CI(1.08,1.19),P<0.00001]和护理满意度[RR=1.21,95%CI(1.09,1.34),P=0.0005]方面,明显优于对照组,差异均有统计学意义(P<0.00001)。本文结局指标的证据质量为极低。结论当前证据表明,刮痧治疗腰椎间盘突出患者的疼痛症状具有良好临床疗效,并有助于提高临床护理满意度。由于部分结局证据质量较低,有待严谨的多中心、大样本随机对照试验来进一步验证其有效性,提升临床证据。

穴位埋线治疗功能性便秘疗效与安全性Meta分析及GRADE评价

目的:系统评价穴位埋线治疗功能性便秘(FC)的疗效和安全性及纳入证据的质量,以期为临床决策提供循证医学证据。方法:检索中国知网(CNKI)、万方知识服务平台(WANFANG)、维普中文期刊数据库(VIP)、中国生物医学文献服务系统(SinoMed)、Embase、PubMed和Cochrane Library数据库,搜集穴位埋线治疗FC的随机对照试验(RCT),检索时间均从建库至2023年10月16日。由2名研究者独立完成文献筛选、资料提取及偏倚风险评估,采用RevMan 5.4软件进行Meta分析,并采用GRADE评价方法对各项结局指标进行证据质量评价。结果:最终共纳入19项RCT,包括1673例患者。Meta分析结果显示,与对照组比较,穴位埋线治疗FC可提高总有效率[RR=1.23,95%CI=(1.17,1.29),P<0.00001],增加完全自发排便(CSBM)次数[MD=0.61,95%CI=(0.11,1.10),P=0.02],改善粪便性状[MD=0.53,95%CI=(0.31,0.76),P<0.00001]及排便困难[MD=-0.71,95%CI=(-1.03,-0.40),P<0.00001],缩短排便时间[MD=-0.50,95%CI=(-0.72,-0.29),P<0.00001],改善便秘生活质量评估量表(PAC-QOL)评分[MD=-7.72,95%CI=(-12.83,-2.61),P<0.003];两组不良反应发生率比较,差异无统计学意义[RR=0.37,95%CI=(0.10,1.38),P=0.14]。GRADE证据级别评价结果显示:总有效率为中级别证据质量,不良反应发生率、粪便性状评分、排便困难评分为低级别证据质量,CSBM次数、排便时间、PACQOL评分为极低级别证据质量。结论:穴位埋线治疗FC具有一定的疗效,可改善便秘相关症状,且未增加不良反应发生率。但纳入研究质量总体偏低,上述结论尚需开展更多高质量的研究予以验证。

腕踝针干预术后疼痛疗效的Meta分析和Grade评价

目的运用循证医学方法对腕踝针干预术后疼痛的疗效和安全性进行系统评价和Grade评价。方法计算机检索中国知网、万方、维普、中国生物医学文献数据库、PubMed、Embase、Web of Science、Cochrane Library中关于腕踝针干预术后疼痛的随机对照试验,检索时限为建库至2023年10月。采用RevMan 5.4软件进行Meta分析。结果纳入23篇文献,共计1968例患者,Meta分析结果显示,与常规治疗相比,腕踝针能够提高术后疼痛患者的总有效率[OR=4.42,95%CI(2.60,7.50),P<0.001],术后镇痛泵药量使用减少[MD=-9.03,95%CI(-12.09,-5.98),P<0.001],术后疼痛评分降低[MD=-1.39,95%CI(-1.68,-1.09),P<0.001],可减少不良反应发生率[RR=0.40,95%CI(0.32,0.48),P<0.001]以及临床满意度[OR=3.94,95%CI(2.40,6.48),P<0.001]。Grade证据分级结果显示:总有效率、不良反应发生率和临床满意度3项结局指标为中等质量证据,VAS评分指标为低质量证据,镇痛泵药量使用指标为极低质量证据。结论腕踝针可提高总有效率,减少术后镇痛药用量,不良反应少,安全性高,为患者提供了一种安全有效的镇痛方式。

医院药学指南制定中的证据与推荐意见GRADE系统评级方法及应用

目前,国际上存在多种证据与推荐意见分级系统,对临床医务工作者阅读指南证据和推荐意见造成困扰。证据推荐分级的评估、制定与评价(GRADE)系统目前是全球使用最为广泛的证据与推荐意见分级系统,本文简单地介绍GRADE系统证据质量评级及影响推荐意见形成的4个主要因素,并结合中国医院药学界发起制定的、在国际上发表的几部药学指南举例阐述,以帮助临床医务工作者了解GRADE系统,以批判性思维运用指南证据和推荐意见指导临床实践行为。

乌梅丸加减治疗帕金森病的Meta分析及GRADE评价

目的 系统评估乌梅丸加减治疗帕金森病(parkinson's disease, PD)的疗效和安全性。方法 计算机检索Cochrane Library、EMBASE、Web of Science、PubMed、CNKI、CBM等中英文数据库及临床试验中心,关于乌梅丸治疗PD的临床随机对照试验(randomized controlled trial, RCT),检索时限从建库至2023年4月。进行资料整理及数据提取等工作后,最终纳入8项研究,治疗组(乌梅丸)和对照组分别纳入226例。使用RevMan 5.3及stata14软件进行荟萃分析,使用GRADEpro GDT评估各项结局指标的证据质量。结果 治疗组降低PD统一评分量表(unified Parkinson's disease rating scale, UPDRS)的各项量表积分较对照组明显,其中在改善UPDRS Ⅰ、Ⅲ、Ⅳ方面具有统计学意义,结果分别为[MD=-0.769,95%CI(-1.213~-0.324),P=0.001]、[MD=-2.211,95%CI(-2.713~-1.708),P=0]、[MD=-0.526,95%CI(-1.041~-0.012),P=0.045]。2组在改善UPDRS总分方面差异无统计学意义[MD=3.964,95%CI(-9.465~17.392),P=0.563]。治疗组能显著提高治疗有效率,差异具有统计学意义[RR=1.709,95%CI(1.361~2.145),P=0]。各项研究均未发现不良事件发生及与治疗有关的检验指标异常。GRADE证据质量分级结果为UPDRS Ⅰ、UPDRS Ⅲ、UPDRS Ⅳ及有效率方面均为中等级别,UPDRS Ⅱ为低等级,UPDRS总分为非常低。结论 乌梅丸加减的应用对PD的治疗有一定效果,且具有良好的安全性。

补肾方剂改善高龄女性自然妊娠结局的Meta分析及GRADE质量评价

目的系统评价补肾方剂改善高龄女性自然妊娠结局的临床疗效和安全性。方法检索中国知网、万方数据库、维普数据库、SinoMed、PubMed、Web of Science、Cochrane Library、Embase等数据库建库至2022年6月收录的补肾方剂改善高龄女性自然妊娠结局的随机对照研究(RCT)。运用偏倚风险工具进行质量评估,使用RevMan软件进行Meta分析。结果共纳入14篇RCT。Meta分析结果显示:补肾方剂联合西药治疗在提高妊娠率[RR=1.71,95%CI(1.45,2.01),P<0.00001]、降低卵泡刺激素(FSH)水平[SMD=-1.63,95%CI(-2.84,-0.43),P=0.008]、提高雌二醇(E_(2))水平[SMD=3.97,95%CI(1.76,6.17),P=0.0004]、增加排卵期子宫内膜厚度[SMD=2.12,95%CI(1.07,3.18),P<0.0001]方面均优于西药组;且补肾方剂单独使用在提高妊娠率[RR=1.94,95%CI(1.31,2.88),P=0.001]、降低FSH水平[SMD=-0.48,95%CI(-0.74,-0.22),P=0.0003]方面也具有显著疗效。结论与西医治疗比较,补肾方剂可以显著改善高龄女性自然妊娠结局,且不良反应较少,但仍需更多高质量、大样本、多中心的RCT予以验证。

温针灸治疗原发性痛经有效性和安全性的系统评价及GRADE评价

目的:评价温针灸治疗原发性痛经的有效性和安全性。方法:根据PRISMA指南进行系统综述和荟萃分析。收集PubMed、Web of Science、EMBASE、Cochrane Library、中国知网、维普、万方、中国生物医学数据库自建库至2023年5月的随机对照试验。使用Review Manager 5.4对所有获得的数据进行分析。结果:温针灸治疗原发性痛经在提高临床疗效{风险比(RR)=1.21,95%置信区间(CI)[1.16,1.25],P<0.00001},改善阻力指数(RI){均数差(MD)=-0.14,95%CI[-0.19,-0.08],P<0.00001}、搏动指数(PI)(MD=-0.55,95%CI[-0.69,-0.40],P<0.00001)、β-内啡肽(β-EP){标准化均数差(SMD)=1.36,95%CI[0.90,1.82],P<0.00001}、痛经证候积分(MD=-1.82,95%CI[-2.77,-0.87],P=0.0002)、疼痛视觉模拟评分法(VAS)评分(MD=-1.16,95%CI[-1.48,-0.83],P<0.00001)方面的作用优于单独的常规治疗,并且在不良反应发生率(P=0.01)方面低于对照组。证据质量等级评价结果显示临床疗效为中级,其他多为低级。结论:温针灸治疗原发性痛经的疗效明确,并且具有一定的安全性。

基于GRADE证据质量评级的小青龙汤治疗过敏性鼻炎系统评价与试验序贯分析

目的:系统评价小青龙汤治疗过敏性鼻炎的临床疗效和安全性,分析证据质量,验证研究结果的可信度。方法:检索中国知网、万方数据库、维普中文期刊服务平台、中国生物医学文献数据库、PubMed、Web of Science、The Cochrane Library等数据库中从建库至2023年7月31日小青龙汤治疗过敏性鼻炎的文献。对所得文献进行筛选、资料提取和评估,使用RevMan5.3软件进行Meta分析,使用Stata 16.0软件进行敏感性分析,使用TSA V0.9软件进行试验序贯分析,使用GRADEpro软件对结局指标进行证据质量评级。结果:纳入20篇随机对照试验(Randomized Controlled Trial,RCT),患者1 723例。Meta分析结果显示,试验组比对照组有更好的临床疗效[相对危险度(RR)=1.19,95%置信区间(CI)(1.14,1.25),P <0.000 01]。试验组在降低半年复发率[RR=0.50, 95%CI (0.32,0.78),P=0.002],降低鼻塞[加权均数差(WMD)=-0.20,95%CI(-0.26,-0.13),P <0.000 01]、流涕[WMD=-0.09,95%CI(-0.15,-0.03),P=0.004]、喷嚏[WMD=-0.21,95%CI(-0.28,-0.13),P <0.000 01]等症状积分及体征积分[WMD=-0.25,95%CI(-0.37,-0.14),P <0.000 1]和血清白细胞介素-4水平[WMD=-4.23,95%CI(-7.22,-1.23),P=0.006]方面均优于对照组。试验序贯分析进一步肯定了小青龙汤治疗过敏性鼻炎的疗效。GRADE证据质量分级显示,临床有效率、不良反应发生率、鼻痒积分为低质量证据,其余均为极低质量证据。结论:小青龙汤治疗过敏性鼻炎安全有效,但需要纳入更高质量的临床研究进一步验证。

Failure Mode and Effects Analysis Based on Z-Numbers and the Graded Mean Integration Representation

Failuremode and effects analysis(FMEA)is a widely used safety assessmentmethod inmany fields.Z-number was previously applied in FMEA since it can take both possibility and reliability of information into consideration.However,the use of fuzzy weighted mean to integrate Z-valuations may have some drawbacks and is not suitable for some situations.In this paper,an improved method is proposed based on Z-numbers and the graded mean integration representation(GMIR)to deal with the uncertain information in FMEA.First,Z-numbers are constructed based on the evaluations of risk factors O,S,D for each failure mode by different experts.Second,weights of the three risk factors and experts are determined.Third,the integration representations of Z-numbers are obtained by a newmethod based on the GMIRmethod.Finally,risk priorities of the failure modes are derived considering the weights of experts and risk factors.Two examples and a case study are given to show the use of the proposed method and comparison with other methods.The results show that the proposed method is more reasonable,universal and simple in calculation.

Spatial and Temporal Distribution of Different Grades of Short-time Precipitation in Xining City

Based on the hourly precipitation data from 4 observation stations of Xining City from June to September during 2005-2011,the temporal and spatial distribution characteristics of short-time precipitation were analyzed.The results show that the precipitation distribution in Xining region exhibited the less-more-less trend from southwest to northeast,while the torrential rain gradually increased from the northwest and southwest to the middle.The hourly general precipitation in Xining region had obviously seasonal characteristics,and its annual distribution showed wavy changes,but the annual variation of short-time heavy precipitation and rainstorm was very obvious.Furthermore,short-time heavy precipitation was concentrated from 18:00 to 24:00,followed by 03:00-07:00 on the following day.The occurrence time of short-time rainstorm accorded with short-time heavy precipitation.It offers a useful reference for the accurate and timely short-term forecast.

Rockburst Intensity Grade Prediction Model Based on Batch Gradient Descent and Multi-Scale Residual Deep Neural Network

Rockburst is a phenomenon in which free surfaces are formed during excavation,which subsequently causes the sudden release of energy in the construction of mines and tunnels.Light rockburst only peels off rock slices without ejection,while severe rockburst causes casualties and property loss.The frequency and degree of rockburst damage increases with the excavation depth.Moreover,rockburst is the leading engineering geological hazard in the excavation process,and thus the prediction of its intensity grade is of great significance to the development of geotechnical engineering.Therefore,the prediction of rockburst intensity grade is one problem that needs to be solved urgently.By comprehensively considering the occurrence mechanism of rockburst,this paper selects the stress index(σθ/σc),brittleness index(σ_(c)/σ_(t)),and rock elastic energy index(Wet)as the rockburst evaluation indexes through the Spearman coefficient method.This overcomes the low accuracy problem of a single evaluation index prediction method.Following this,the BGD-MSR-DNN rockburst intensity grade prediction model based on batch gradient descent and a multi-scale residual deep neural network is proposed.The batch gradient descent(BGD)module is used to replace the gradient descent algorithm,which effectively improves the efficiency of the network and reduces the model training time.Moreover,the multi-scale residual(MSR)module solves the problem of network degradation when there are too many hidden layers of the deep neural network(DNN),thus improving the model prediction accuracy.The experimental results reveal the BGDMSR-DNN model accuracy to reach 97.1%,outperforming other comparable models.Finally,actual projects such as Qinling Tunnel and Daxiangling Tunnel,reached an accuracy of 100%.The model can be applied in mines and tunnel engineering to realize the accurate and rapid prediction of rockburst intensity grade.

PTGD后择期腹腔镜胆囊切除治疗对GradeⅡ急性胆囊炎ACTH、MPO及Cor水平的影响

目的分析PTGD后择期LC治疗对GradeⅡ急性胆囊炎ACTH、MPO及Cor水平的影响。方法选取2021年12月至2023年5月安徽中科庚玖医院收治的急性胆囊炎患者121例,根据治疗方案分为三组,即甲组(急诊行LC治疗,未行PTGD)38例、乙组(PTGD引流管拔出后72 h后行LC,早期)43例和丙组(PTGD引流管拔出后14~30 d后行LC,晚期)40例。对比三组手术情况、炎症因子、肝功能、ACTH、MP、Cor水平及并发症发生率。结果甲组LC手术时长、术后卧床时长及住院天数均长于丙组、乙组,失血量、中转开腹率高于丙组、乙组,差异有统计学意义(P<0.05);丙组LC手术时长、术后卧床时长及住院天数均长于乙组,差异具有统计学意义(P<0.05)。LC术后1 d hs-CRP、PCT、IL-6、ST、ALT、ALP、ACTH、MPO及Cor:甲组>丙组>乙组,差异有统计学意义(P<0.05)。并发症发生率:甲组>丙组>乙组,差异有统计学意义(P<0.05)。结论PTGD后择期LC治疗对GradeⅡ急性胆囊炎ACTH、MPO及Cor水平影响小,且并发症低;而PTGD后早期行LC能有效改善肝功能、炎症因子,且术后应激反应更低,值得临床推广。

Bending and wave propagation analysis of axially functionally graded beams based on a reformulated strain gradient elasticity theory

A new size-dependent axially functionally graded(AFG) micro-beam model is established with the application of a reformulated strain gradient elasticity theory(RSGET). The new micro-beam model incorporates the strain gradient, velocity gradient,and couple stress effects, and accounts for the material variation along the axial direction of the two-component functionally graded beam. The governing equations and complete boundary conditions of the AFG beam are derived based on Hamilton's principle. The correctness of the current model is verified by comparing the static behavior results of the current model and the finite element model(FEM) at the micro-scale. The influence of material inhomogeneity and size effect on the static and dynamic responses of the AFG beam is studied. The numerical results show that the static and vibration responses predicted by the newly developed model are different from those based on the classical model at the micro-scale. The new model can be applied not only in the optimization of micro acoustic wave devices but also in the design of AFG micro-sensors and micro-actuators.

火针治疗神经性皮炎的Meta分析及GRADE证据质量评价

目的:运用Meta分析系统评价火针治疗神经性皮炎的临床疗效。方法:计算机检索中国期刊全文数据库(CNKI)、重庆维普(VIP)、万方数据库(WanFang)、中国生物医学文献数据库(CBM)及Pubmed、Cochrane library等中英文数据库,时限设定为建库-2023年2月28日,检索火针治疗神经性皮炎的随机对照试验(Randomized controlled,RCT)相关文献。运用Cochrane风险偏倚评估工具对纳入研究的文献质量评估,再运用Revman5.4软件进行Meta分析,运用TSA0.9.5.10软件进行试验序贯分析,使用GRADE软件对主要结局指标的证据进行证据质量评级。结果:①共纳入18篇研究,1 662例患者,火针组840例,对照组822例;②Meta分析结果显示:火针组的临床有效率[OR=3.99,95%CI(2.81,5.68),Z=7.71,P<0.00 001]、复发率[OR=0.27,95%CI(0.11,0.68),Z=2.79,P=0.005)]均优于对照组;症状积分[MD=-1.49,95%CI(-2.25,-0.73),Z=3.85,P=0.0 001]、TNF-α水平[MD=-4.26,95%CI(-7.01,-1.51),Z=3.03,P=0.002]、IL-6水平[MD=-7.39,95%CI(-14.36,-0.42),Z=2.08,P=0.04]、IL-4水平[MD=-1.50,95%CI(-1.94,-1.06),Z=6.69,P<0.00 001]方面火针组均低于对照组;③火针组不良反应率整体低于对照组;④试验序贯分析显示:累计Z值穿过了传统界值和TSA界值,表示虽然累计的信息量未达到期望值,但不需要更多的试验,提前得到肯定的结论,结果较为可靠。结论:火针治疗神经性皮炎的具有明确的疗效,在症状积分和TNF-α、IL-6、IL-4水平表达等方面效果均优于对照组,安全性也较高,可为中医外治法治疗神经性皮炎的有效性提供相关证据。但因GRADE证据质量评级显示证据质量不理想,建议后续医务工作者可减少开展火针治疗神经性皮炎相关低质量试验,开展一些多中心、高质量的研究对结果加以佐证,从而避免科研和医疗资源的浪费。

Influence of Online Learning Attitude in the Blended Teaching Model on the Final Grades

The combination of online teaching and traditional offline teaching can maximize the advantages of both.Based on the blended teaching of English Reading course,39 students were selected as the research subjects to study the relationship between their online learning attitudes and their grades in the final examination.Judged from the number of times for each student to download teaching resources,the number of assignments submitted online,and the quality of the submitted assignments,each student’s attitude toward online learning was examined comprehensively,and a correlation analysis was conducted through SPSS Statistics 21.0 to explore the influence of online learning attitude on English reading performance.Through data collection and analysis of the online learning attitudes over a 16-week period,a significant positive correlation was found between the online learning attitudes and the English reading grades,indicating that the online learning attitude in the blended learning model plays a crucial role in improving the English reading skill,and students should maintain a positive attitude toward online teaching in blended learning.