基于数据挖掘的高祥福治疗干燥综合征用药规律研究

目的：通过数据挖掘总结高祥福教授治疗干燥综合征（Sjogren''s syndrome, SS）的用药规律。方法：收集高祥福2019年9月至 2022年2月通过门诊治疗的干燥综合征患者病历数据,建立方药数据库,对数据进行规范化处理。采用Excel 2007、SPSS Modeler 18.0、SPSS Statistic 25.0等软件对药物及其性味归经等进行频数分析,对高频药物进行关联规则分析、聚类分析。结果：纳入有效处方432首,共涉及191味药,累及频次6621次。用药频次位于前5的分别是丹参、麦冬、生地黄、黄芩、黄芪,药性多寒、平,药味多甘、苦、辛,多归肝、肺、脾、胃经,用药以补虚药、清热药、活血化瘀药、利水渗湿药最为多见。麦冬—茵陈、麦冬—石斛、生地黄—青蒿、麦冬—天冬等关联度较高,为常用药对。高频聚类得到6类药物组合。结论：高祥福教授辨治干燥综合征时,以气阴两虚为本,瘀热互结为标,治疗上强调补阴为基本大法,兼顾气阴双补、清热生津、养血活血之法。     

基于数据挖掘探索浙江名中医高祥福治疗强直性脊柱炎的处方用药规律

[目的]通过数据挖掘的方法探究高祥福教授治疗强直性脊柱炎的处方用药规律,以便更好指导和应用于临床。[方法]收集2018年1月至2020年3月于浙江中医药大学附属第三医院高祥福教授门诊就诊的强直性脊柱炎患者资料,运用Excel 2019对使用的中药进行频数分析,包括性味、归经、功效等,并选取使用频次>49次的高频中药,采用SPSS 23.0软件进行分层聚类分析。[结果]符合纳入标准的病案共计340诊次,共使用中药115味,总频次为4766。药物四气前3位为寒、温和平;五味前3位为苦味、甘味和辛味;药物归经前3位是肝经、脾经和肺经;按功效排序,前3位为补虚药、清热药和解表药。高频中药共28味,以补虚药、解表药、活血化瘀药、清热药、祛风湿药和健脾化湿药6大类为主。聚类分析提示高频中药可聚为3类,且聚拢趋势较好,第一类为杜仲、续断、延胡索、防风、山药、生地黄、丹参,第二类为黄芩、黄连、葛根、淫羊藿、薏苡仁、牛膝、苍术、牡丹皮、黄柏、穿山龙、茯苓、川乌、青风藤、佛手,第三类为黄芪、当归、麻黄、附子、桂枝、知母、川芎。[结论]高祥福教授治疗强直性脊柱炎以扶正祛邪为原则,用药上寒温苦辛甘并用,多应用补虚药和解表药,病程中注意活血化瘀,标本兼治,同时配伍清热泻火、祛风除湿中药,从而可起到扶正不留邪、祛邪不伤正的效果。     

基于文献数据探析古代男性不育症用药特点

目的 通过整理、分析古代文献中古代医家治疗男性不育症所用方药,探讨古代治疗男性不育症用药特点.方法 收集古代文献治疗男性不育相关方剂93首,把方剂中所用中药录入Excel表格,进行频数频率统计,对高频次药物功效、归经的分布进行统计分析.结果 93首方剂共215味药物,药物的临床功效共20种;古代男性不育症的病机以虚证为主;其中使用频数在前22位的药物功效主要是补虚药、温里药、收涩药、利水渗湿药、安神药、活血化瘀药、攻毒杀虫止痒药、清热药,入肾药物占91.0％.结论 古代治疗男性不育症用药特点是以补虚药为主,同时攻补兼施、寒热并用、表里兼顾,注重调和阴阳气血平衡及补肾益精.     

基于数据挖掘探讨陈洪宇教授治疗慢性肾衰竭用药规律

目的：基于数据挖掘分析陈洪宇教授治疗慢性肾衰竭的用药规律。方法：收集和整理陈教授治疗慢性肾衰竭的门诊病案228 例,录入Microsoft Excel软件建立数据库,采用 SPSS Modeler 18.0和SPSS Statistics 25.0对医案处方的用药及功效、性味归经进行统计,运用关联规则分析、因子分析、聚类分析对其用药规律进行数据挖掘。结果：纳入处方228首,涉及中药192味,高频药物有莪术、三棱、当归、大枣、积雪草、杜仲、黄芪、丹参、川芎、芡实等;药类多集中于补虚药、清热药、利水渗湿药、活血化瘀药、收涩药。药味以甘、苦、辛为主,药性以寒、平、温为多;处方常用药对有三棱-莪术、金樱子-芡实、当归-黄芪等; 因子分析将药物分为10类,聚类分析将药物分为7组。结论: 陈教授治疗慢性肾衰竭药物性味多以寒、平、温及甘、苦、辛味为主,治疗以健脾益肾、益气养血;以活血化瘀、祛风除湿治标,标本兼顾。     

清代《虚损启微》对“虚劳”治疗的用药规律分析

使用频数表对《虚损启微》治疗虚劳的72首方剂中所列药物的分类、使用频次、有无毒性、归经进行统计分析。分析《虚损启微》的用药规律,探讨虚劳的病机和治法特点。结果表明,虚劳的用药频次以补虚、清热、安神、利水渗湿、收涩药为多,有毒药物使用频次较少,归经以脾胃经、肾膀胱经为多。《虚损启微》一书认为虚劳的基本病机在于气血亏虚兼有阴虚,用药多用补虚佐以清热、安神、利水渗湿、收涩之品,少用有毒药物,并注重补肾健脾益胃。     

吴良村治疗胃癌的用药规律研究

[目的]探讨吴良村教授治疗胃癌的用药规律。[方法]纳入2014年1月1日至2014年12月31日期间吴良村教授在浙江省中医院门诊诊治的胃癌患者116例,采集患者临床信息,建立临床方剂基础数据库,对处方药味、用药频数、药物性味、药物功效进行描述性分析,并对频次10以上的42种药物进行系统聚类分析。[结果]在116例病例中共用药159种,累计用药频次1816,其中用药频次最多者为甘草,其后依次为茯苓、山药、太子参;药物类别使用频次最高的是补虚药(补气药类最多),其次为清热药、消食药、理气药;药性使用频次最多的为平性,药味使用频次最多的为甘味。聚类分析将药物主要分为5大类,涉及方剂四君子汤、二陈汤,涉及药对稻芽与麦芽、鸡内金与猕猴桃根、蛇舌草与仙鹤草等。[结论]吴老治疗胃癌以补气为主,其主方与四君子汤相类,同时注重养阴清热,顾护胃津,并常常辅以消食理气药物通畅中焦,疏利气机。     

基于文献数据挖掘的男性不育症中医用药规律研究

[目的]研究男性不育症中医用药规律。[方法]检索2012年1月至2016年12月中国知网(China National Knowledge Infrastructure,CNKI)收录的中医诊治男性不育症的临床研究和个人经验类文献,提取方药信息,建立用药数据库,应用频数分析、聚类分析和关联规则分析进行数据挖掘。[结果]筛选出的145篇文献中共有215首处方,涉及235味药,18类功效,共计2 644药物频次。使用频次位于前50的药物累积频率达75.55%,使用频率前7位的药物类别依次为补虚药、清热药、活血化瘀药、利水渗湿药、收涩药、解表药、理气药。药性依次以温、平、寒为主,鲜见大寒大热之药;药味以甘味为最,苦、辛次之;归经以肾为最,其次为肝,再次为肺和脾。关联规则分析显示关联性强的主要为五子衍宗丸方中的子类药物组合,其他还有子类药与补虚药的配伍组合。高频药物聚类分析得到10个聚类方,集中体现出中医治疗男性不育症在补益精血的基础上辨证运用泻火坚阴、解毒导浊、活血通精、理气解郁等治法。[结论]中医治疗男性不育症谨守"正虚邪实"的病机本质,用药以补虚为基本组方配伍,包括补肾健脾、滋补肝肾,兼顾清热、解毒、活血、利水、理气等,契合病机。多种数据挖掘技术结合能更全面和客观地反映男性不育症临床用药规律。     

基于数据挖掘分析国医大师治疗消渴病用药规律

目的基于数据挖掘分析国医大师治疗消渴病验案用药规律。方法收集国医大师治疗消渴病验案中符合纳入标准的方剂39首,涉及中药141种。利用Excel2007软件建立方药数据库,并采用频数分析、聚类分析、关联分析等方法进行统计分析。结果频数分析显示国医大师治疗消渴病用药以补益药、清热药、利水渗湿药为主,辅以利水渗湿、收涩、活血化瘀等药,性味以甘、寒为主;药物多归肝脾肺经。通过聚类分析归纳出六味地黄丸和玉液汤为主的核心药物群,具体药物包括:黄芪、山药、知母、牡丹皮、泽泻、熟地黄、山茱萸、丹参、五味子、葛根、天花粉等。结论国医大师治疗消渴病的用药方面具有补虚为主、祛邪实为辅、注重行肝药的使用、注重阴阳平衡、动静结合等鲜明的特点。     

高祥福教授运用二型九证辨治系统性红斑狼疮情志病变的经验

[目的]总结高祥福教授运用二型九证辨治系统性红斑狼疮(systemic lupus erythematosus,SLE)情志病变的经验。[方法]通过跟师临证及收集高祥福教授治疗SLE情志病变的医案,从病因病机及用药规律出发,分析高教授运用二型九证辨治SLE情志病变的经验,并附验案一则。[结果]高教授基于脏腑情志相关理论,系统总结了二型九证辨治方案中各证型存在的情志病变的病机,认为脏腑功能异常、气血阴阳虚衰及病理产物形成均可引起SLE情志病变,并根据各证型情志病变病机,针对性地总结了临证用药规律,临证中重视整体调整,善用安神定志、养肝疏肝法。所举验案证属阴虚内热、毒蕴血络,以滋阴解毒、凉血消斑为法,予青蒿鳖甲汤加减;针对情志病变,兼予疏肝解郁、养阴安神治疗,红斑、关节疼痛症状及情志病变均逐步改善。[结论]高祥福教授在二型九证基础上辨治SLE情志病变,经验丰富,疗效颇著,值得学习借鉴。     

基于数据分析的孟如教授治疗系统性红斑狼疮用药规律*

目的总结全国名中医孟如教授治疗系统性红斑狼疮的用药组方规律。方法基于中医传承辅助平台软件,运用关联规则和复杂熵聚类分析法对孟如教授1997-2018年治疗系统性红斑狼疮病历资料中615首处方进行用药频次、关联规则、复杂熵聚类等数据分析。结果615首处方中用药频次在20以上的药物有82味,其中有补益作用药物28味,有清热作用药物26味,有理气消食、活血化瘀、祛风除湿、化痰利湿等作用药物各占一定比例。关联规则分析得到常用药物组合53组,其中补益药物组合18组,补泻药物组合34组;常用处方为六味地黄丸、二至丸、生脉散。聚类算法分析得出常用药对26对,以“生地黄,水牛角”、“生地黄,青蒿”、“青蒿,鳖甲”等为临床常用。复杂系统熵聚类分析挖掘出核心药物组合9组,得到可能的新处方9个。结论孟如教授治疗系统性红斑狼疮方面具有独到的用药组方规律,应用中医传承辅助平台软件对于传承研究工作能起到一定的帮助和指导作用。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.