基于真实世界数据探讨中医药治疗糖尿病肾病用药规律的研究＊

目的 基于临床信息系统分析总结真实世界的数据，采用数据挖掘的方法探讨中医药治疗糖尿病肾病的用药规律。方法 收集2018年1月-2020年12月上海中医药大学附属曙光医院宝山分院健康信息系统确诊的糖尿病肾病的门诊或住院患者的诊疗信息，建立Excel数据库，采用Excel 2010软件统计高频药物的四气、五味、归经及功效；使用SPSS Modeler 18.0软件中的Apriori算法分析关联规则，采用web节点建构药对关联网状图；运用SPSS 25统计软件进行因子分析。结果 本研究最终纳入477例接受中药饮片治疗的DKD患者，在1203条方剂信息中，涉及中药462种；使用频数排名前5位的中药分别是黄芪、黄精、石斛、山茱萸、麦冬；使用频数前5类的中药类别分别是补气药、补阴药、清热燥湿药、活血调经药、息风止痉药；在30味高频药物中，苦、甘、辛药味最为常见；药性寒、温数量接近；归脾经、肝经、肺经、肾经居多；关联规则提示，药物组合中置信度最高的组合为地龙-当归-僵蚕，因子分析共得到5个有效因子，累积贡献率为47.33%。结论 中医药治疗DKD在补益气血阴阳的同时，兼顾对瘀血、湿邪和痰饮的治疗，结合证型，可考虑使用黄芪、黄精、石斛、山茱萸、麦冬、金蝉花等药物的使用，清热燥湿药物如黄连、黄芩、黄柏可适当加入，为使邪有去处，大黄、车前子或可增添疗效。     

基于复杂网络技术对电针治疗乳腺增生病处方分析

目的基于复杂网络技术分析电针治疗乳腺增生病的核心穴位及配伍穴相关性,并对电针波型进行探讨。方法检索中国期刊全文数据库(CNKI)、万方数据库、维普网数据库(VIP)中从1954年1月1日到2018年12月31日公开发表的电针治疗乳腺增生病的临床中文文献,利用Excel表格工具建立电针治疗乳腺增生病数据库,利用Matlab2014a软件进行节点中心性分析和聚类分析,利用Gephi0.9.1软件制作复杂网络示意图对分析结果进行描述和展示,利用Excel表格工具制作电针治疗乳腺增生病不同波形比例饼状图并分析其规律。结果选定43条电针处方:电针治疗乳腺增生病主穴核心度前三位依次为膻中穴、足三里、肩井穴;配伍穴位核心度前三位依次为太冲穴、太溪穴、脾俞穴;经络核心度前三位依次为足阳明胃经、任脉、足少阳胆经。配伍穴位相关性分析中,相关性频度前三位组合依次为太冲穴-太溪穴、太冲穴-肾俞穴、太冲穴-三阴交。电针波形中以连续波与疏密波常见,均具有较高的临床应用价值。结论电针治疗乳腺增生病处方以足阳明胃经为最多,其次为任脉;电针波型以连续波为主。     

中药复方配伍的研究方法及其进展

中药复方是由2味或2味以上中药遵循中医理论组合而成的方剂。多味中药在合适的剂量配比之下,协同发挥作用,实现中医的整体调节治疗。研究中药复方的配伍对推动中药现代化发展、新药开发以及临床应用有着重要意义。近年来,研究者们在传统的"七情和合"与"君臣佐使"的基础上,运用新技术和新方法对中药复方的成分、药效活性和药代动力学性质等进行了研究,从不同角度探讨了中药复方配伍的科学内涵。同时,多种数理方法和模型的建立、网络药理学和数据挖掘方法的发展与应用,也对中药复方配伍研究提供了很大帮助。研究方法的发展虽促进了中药复方配伍的科学研究,但还需进一步建立适合中药复方配伍复杂关系的研究方法,以阐明中药复方及其成分/组分配伍的内在规律,进而构建新的现代中药复方,这也是目前中药复方配伍研究的重点任务。     

腹腔镜胆囊切除术转开腹可能性评分系统建立和运用

目的　根据术前临床资料建立预测腹腔镜胆囊切除术转开腹可能性的评分系统。方法　对邵逸夫医院 1994年 4月 4日至 2 0 0 1年 6月 30日的 7134例LC的术前临床资料进行单因素分析 ,筛选出中转开腹的危险因素 ,再进行logistic多元回归分析。男性、高龄 (≥ 6 5岁 )、上腹部手术史、糖尿病、总胆红素升高 (≥ 1 2mg/dl)、胆囊壁增厚 (≥ 4cm )、胆总管直径增宽 (≥ 8cm)、急性胆囊炎是转开腹的危险因素并被分别赋值 ,建立预测转开腹可能性的评分系统。计算 7134例LC的综合得分 ,比较不同得分组转开腹率。用ROC曲线评价该评分系统的效能。 2 0 0 1年 7月 1日至 2 0 0 1年 12月 31日 938例LC运用该评分系统 ,比较各得分组转开腹率的差异。结果　 7134例LC中各组得分越高 ,转开腹率越高 ,且多数相邻两组的转开腹率有显著性差异 (P <0 0 1)。ROC曲线以下面积为0 81,标准误为 0 0 1。 938例LC中的各组也是得分越高 ,转开腹率越高 ,且多数相邻两组的转开腹率有显著性差异 (P <0 0 5 )。结论　根据危险因素预测LC转开腹可能性 ,以指导临床工作。     

Comparison and validation of scoring systems in a cohort of patients treated for perforated peptic ulcer

Background and aims The aim of this study is to evaluate the predictive accuracy of different scoring systems on surgery for perforated peptic ulcer referred to an academic department of general surgery in a tertiary reference center. Patients and methods Seventy-five consecutive patients (Male/female ratio = 64:11; mean age, 44 years; range, 16–85) with perforated peptic ulcer disease were investigated. Disease severity scores and mortality predictions were calculated using the collected data during admission. Discrimination and calibration characteristics of each system, namely, the acute physiology and chronic health evaluation II and III, the simplified acute physiology score II, and the mortality probability models (MPM) II, were determined by using the area under receiver operating characteristics curve and the Hosmer–Lemeshow goodness-of-fit test, respectively. Results Among the 75 patients included, there were eight (10.6%) mortalities. All systems had a reliable power of discrimination and calibration. Among the systems tested, MPM II was the best performing as far as discrimination and calibration characteristics were considered. The parameters of MPM II system that were related to systemic perfusion of the patient were significantly positive in patients who died compared to those who survived. Conclusions MPM II that predicted mortality at admission is better than the other systems in predicting mortality. Results also indicate the importance of maintenance of systemic perfusion of the patient at the early phases of peptic ulcer perforation.     

583例小儿肺炎证候病机学关联规则分析

目的：通过数理分析探讨小儿肺炎的证候病机学。方法：运用关联规则分析583例小儿肺炎发病治疗前症状体征。结果：获得668项频繁项集，其中支持度大于80％者4项：肺部呼吸音粗糙、无恶寒、舌质红、咳嗽每咳数声，共获得关联规则6888条，最高支持度80％，最高置信度98％。结论：小儿肺炎48h内的主要症状体征为：咳嗽每咳数声、咳嗽阵作、气促、发热、多痰、舌质红、肺部呼吸音粗糙、无恶寒、无紫绀、无恶心呕吐等，并且咳嗽每咳数声与咳嗽阵作及发热、无恶寒、气促、多痰、舌质红等症状体征常常关联出现。在证候病机上表现：肺气郁阻是小儿肺炎最主要的病机病理。热邪入里，肺热壅盛，肺气郁阻，津蓄为痰为常见的病机病理改变，且热与郁与痰的病机密切关联。     

Developmental aspects of children's behavior and safety while cycling

OBJECTIVE: To examine children's competence while cycling, as demonstrated in mistakes in performance and failure to comply with safety rules. METHODS: Children in three age groups (8, 10, and 12 years) participated in a realistic yet simulated traffic environment. RESULTS: The boys' cycling speed increased steadily with age, while that of the girls increased from 8 to 10 but decreased at age 12. Most children had adequate motor control by age 10, and the youngest compensated for their less developed skills by cycling slowly and braking early at junctions. Serious mistakes, often related to the children's age and gender, consisted of the children failing to stop at signals or stopping too late, especially at short stopping range. CONCLUSIONS: There are considerable individual differences in children's cycling competence that are related to biological factors, such as age and gender, and psychological factors, such as rule compliance and choice of cycling speed.     

A Computer Reconstruction of the Entire Coronary Arterial Tree Based on Detailed Morphometric Data

A rigorous analysis of blood flow must be based on the branching pattern and vascular geometry of the full vascular circuit of interest. It is experimentally difficult to reconstruct the entire vascular circuit of any organ because of the enormity of the vessels. The objective of the present study was to develop a novel method for the reconstruction of the full coronary vascular tree from partial measurements. Our method includes the use of data on those parts of the tree that are measured to extrapolate the data on those parts that are missing. Specifically, a two-step approach was employed in the reconstruction of the entire coronary arterial tree down to the capillary level. Vessels > 40 μm were reconstructed from cast data while vessels < 40 μm were reconstructed from histological data. The cast data were reconstructed one-bifurcation at a time while histological data were reconstructed one-sub-tree at a time by “cutting” and “pasting” of data from measured to missing vessels. The reconstruction algorithm yielded a full arterial tree down to the first capillary bifurcation with 1.9, 2.04 and 1.15 million vessel segments for the right coronary artery (RCA), left anterior descending (LAD) and left circumflex (LCx) trees, respectively. The node-to-node connectivity along with the diameter and length of every vessel segment was determined. Once the full tree was reconstructed, we automated the assignment of order numbers, according to the diameter-defined Strahler system, to every vessel segment in the tree. Consequently, the diameters, lengths, number of vessels, segments-per-element ratio, connectivity and longitudinal matrices were determined for every order number. The present model establishes a morphological foundation for future analysis of blood flow in the coronary circulation.     

我国中老年健康相关行为与抑郁的关联性分析

目的 分析我国中老年人群抑郁症状,探讨健康相关行为与抑郁间的关联性,为改善中老年抑郁干预措施及政策制定提供依据。方法 采用2018年中国健康与养老追踪调查数据,运用关联规则Apriori算法分析健康相关行为与抑郁症状间的关联,并依据支持度、置信度、提升度评价健康行为对抑郁症状的影响。结果 在8 681名调查对象中,抑郁症状的发生率为40.3%;健康相关行为与抑郁症状的关联规则中的强关联规则为无体力活动、睡眠不足、不饮酒的人更易产生抑郁症状;男性中为无体力活动、吸烟、无社交活动的人更易产生抑郁症状;女性中无体力活动、无社交活动、睡眠不足的人更易产生抑郁症状。结论 健康相关行为与抑郁是相互关联的,可通过针对多种行为的联合干预,改善中老年人的抑郁症状。