基于隐结构模型分析的心血管疾病中医问诊证候分类研究

目的探讨心血管疾病的中医问诊证候分类特征,为中医证候诊断标准的建立提供客观依据。方法利用中医心系问诊采集量表,采集大样本心血管疾病临床病例,根据问诊信息的＂有、无＂分别赋值＂1、0＂,建立问诊数据库;基于隐结构分析,找出规律,建立隐结构模型;人机结合,对部分隐变量进行综合聚类分析和类的细分;基于模型结果,分析心血管疾病的临床中医问诊证候分类特征。结果心血管疾病中医问诊证候以心气虚、心阳虚、气阴两虚、痰湿、血瘀、气滞、心火亢盛、津液亏虚为主,并兼见胃气上逆、肾气不固、脾胃虚寒等证,其出现率依次为46%、23%、34%、18%、19%、39%、14%、1.7%、19%、27%、25%,并提示了这些证候与关系密切的各问诊症状之间的相关性（包括出现的概率和互信息）。结论隐结构分析方法能为中医证候的分类提供定性定量依据,并提示综合聚类分析和类的细分方法的应用能进一步明确隐变量与变量之间的定量关系,从而为临床中医证候标准的建立提供依据。     

夏枯草药材高效液相指纹图谱及其模式识别研究

目的:采用反相高效液指纹图谱及其模式识别方法建立夏枯草药材的质量控制方法。方法:色谱柱为Elit SinoChrom ODS-AP柱,采用乙腈-0.01%磷酸溶液进行梯度洗脱,流速1.0mL.min-1,检测波长为203nm。对15批不同产地的夏枯草药材进行检测,通过比较其指纹图谱相似度,运用主成分分析法和聚类分析法对其进行模式识别研究。结果:得到夏枯草药材对照指纹图谱,共有17个共有峰,各批次指纹图谱及对照图谱间相似度高。通过模式识别研究可将15批药材分为3类,与样品的地域归类一致。结论:研究结果表明,该方法先进、简便、稳定性好,且结果直观,并具有代表性,可为夏枯草的质量控制方法研究提供参考。     

Improving the Diagnostic Accuracy of Depression in Older Persons: The Depression in the Aged Female National Evaluation Cluster Randomized Trial

OBJECTIVES: To evaluate whether a training intervention can improve the ability of geriatricians to recognize depression in older persons.
DESIGN: Multicenter, cluster randomized clinical trial.
SETTING: Fourteen geriatric outpatient clinics in Italy, each representing the unit of randomization.
PARTICIPANTS: After training, a total of 1,914 outpatients aged 65 years and older in both arms, not on antidepressant at entry, were blindly evaluated by the clinic geriatrician, in charge of routine clinical management, and by a field researcher, who formally diagnosed depression by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), taken as the criterion standard.
INTERVENTION: After randomization, geriatricians belonging to the intervention arm were assigned to receive a residential 3-day educational program on depression. Those in the control arm received a generic course on disease management in elderly people.
MEASUREMENTS: Sensitivity and specificity of the diagnosis of depression made by geriatricians, compared with the DSM-IV diagnosis.
RESULTS: Sensitivity and specificity were significantly higher in trained than in untrained geriatricians (49 vs 35% and 91 vs 88%, respectively; P =.002 in marginal regression models). Effectiveness of training was confirmed, adjusting for age, sex, and cognitive performance ( P =.02).
CONCLUSION: The ability of geriatricians to diagnose depression in older outpatients can be improved with a specific training intervention. Improvement of diagnostic performance might translate into more-appropriate clinical management.     

5种地锦药材中总黄酮及3个酚酸类成分测定研究

目的建立地锦草药材真伪鉴别标准。方法采用高效液相色谱法及紫外-可见分光光度法对其酚酸类成分及总黄酮进行测定,并用spss软件对数据进行聚类分析。结果建立了地锦草药材3个酚酸类成分(没食子酸、槲皮素、山柰素)的测定方法,使用聚类分析基本可以将其分为四类。结论初步将地锦草药材的两个正品来源和其他3种地锦类植物相互区分开。为地锦类植物的质量评价和开发药材资源,鉴定药用植物真伪提供了技术支持和科学依据。     

免疫2号方对艾滋病免疫重建不全患者临床症状、体征的影响

目的观察中药免疫2号方对艾滋病高效逆转录抗病毒治疗(HAART)后免疫重建不全患者临床症状、体征的影响。方法选择艾滋病HAART治疗1年以上,免疫重建不全患者253例,随机分为对照组(126例)和治疗组(127例),最终完成随访233例,其中治疗组116例,对照组117例。对照组采用安慰剂(每次6.2g,每天2次)联合HAART治疗[齐多夫定(AZT)300mg+拉米夫定(3TC)150mg+奈韦拉平(NVP)200mg,每日2次];治疗组在HAART治疗基础上+免疫2号方(每次6.2g,每日2次)。6个月后比较两组患者治疗前后CD4+细胞绝对计数、免疫重建有效率、症状体征积分及症状体征改善率的变化。结果治疗组免疫重建有效率为34.48%,对照组为21.37%,治疗组明显优于对照组(P<0.05);两组治疗后3个月、6个月CD4+细胞绝对计数均较治疗前明显上升(P<0.05或P<0.01);与对照组同时间点比较,治疗后6个月治疗组CD4+绝对计数上升幅度明显大于对照组(P<0.05);治疗6个月后,两组各项症状、体征均有所改善甚至消失,治疗组在改善患者乏力、肌肉关节痛、皮肤瘙痒、气短等症状时疗效明显优于对照组(P<0.05)。结论免疫2号方能够提高患者CD4+细胞绝对计数,提高免疫重建有效率,改善部分临床症状、体征。     

基于聚类分析的中药复方职务发明专利现状及增长路径研究

该研究运用简单统计与聚类分析的方法,以中药复方职务发明专利权人为研究对象,探究提升中药企业、中医药院校及相关机构的中药复方专利数量与质量同时构建优质高效的专利保护体系之路径.     

聚类分析在丹参质量评价中的应用

目的：探讨聚类分析用于丹参药材质量评价的可行性。方法：采用药典标准对丹参药材进行鉴定,以总灰分、酸不溶性灰分、水溶性浸出物、醇溶性浸出物、丹参酮ⅡA和丹酚酸B含量为指标,对不同产地的10批丹参进行系统聚类分析。结果：将10批丹参分为2类,分析结果同产地、采收时间、储存条件等因素有关。结论：就药典所规定检测指标而言产地对其影响不显著,采收时间、储存条件等因素是主要因素。     

The ParkinsonNet trial: Design and baseline characteristics

The companion paper describes how implementation of professional networks (ParkinsonNet) may improve the quality and efficiency of allied health care in Parkinson's disease (PD). We designed a cluster‐randomized controlled trial to evaluate this ParkinsonNet concept for one allied health discipline, namely physical therapy. Here we describe the study design and baseline characteristics. The design fully complies with the CONSORT criteria. Sixteen regions in the Netherlands were randomly divided into eight experimental regions where a ParkinsonNet was implemented, and eight control regions where the organization of care was left unchanged (usual care). Participating patients were followed for 6 months to evaluate the implementation process, health benefits and costs of the intervention. In the ParkinsonNet regions, 46 therapists were trained and 358 patients were included. In the usual care regions, 341 patients were included. Baseline characteristics of participants in the ParkinsonNet and control clusters were comparable. With 699 participating patients, this is the largest allied health study in PD to date. © 2010 Movement Disorder Society     

Urological symptom clusters and health‐related quality‐of‐life: results from the Boston Area Community Health Survey

OBJECTIVE

To determine whether urological symptom clusters, as identified in previous studies, were associated with health‐related quality‐of‐life (HRQoL) and use of healthcare.

SUBJECTS AND METHODS

The Boston Area Community Health Survey is a population‐based epidemiological study of 2301 male and 3201 female residents of Boston, MA, USA, aged 30–79 years. Baseline data collected from 2002 to 2005 were used in this analysis. Data on 14 urological symptoms were used for the cluster analysis, and five derived symptom clusters among men and four among women were used in multivariate linear regression models (adjusted for age group, race/ethnicity, and comorbidity) to determine their association with physical (PCS‐12) and mental health component scores (MCS‐12) calculated from the Medical Outcomes Study 12‐item Short Form Survey.

RESULTS

For both men and women, being in the most symptomatic cluster was associated with decrements in the PCS‐12 score (men, cluster 5, ?10.42; women, cluster 4, ?9.80; both P < 0.001) and the MCS‐12 score (men, cluster 5, ?9.35; women, cluster 4, ?6.24; both P < 0.001) compared with the asymptomatic groups. Both men and women in these most symptomatic clusters appeared to have adequate access to healthcare.

CONCLUSION

For men and women, those with the most urological symptoms reported poorer HRQoL in two domains after adjusting for age and comorbidity, and despite adequate access to care.     

Classification of adult patients with type 2 diabetes using the Temperament and Character Inventory

Aim:  Adult patients with type 2 diabetes were classified using the Temperament and Character Inventory (TCI). This classification was used to propose effective therapeutic approaches based on subtypes of psychological characteristics.
Methods:  The TCI and various psychological tests were administered to 89 patients (54 men and 35 women). Cluster analysis was performed using three temperament factors of the TCI as variables for subclassification: novelty seeking (NS), harm avoidance (HA) and reward dependence (RD).
Results:  The patients were divided into two clusters based on the TCI results. Cluster 1 had a low NS/high HA/low RD pattern, which indicated resistance to change and lack of cooperativeness, and results of other tests indicated that patients in cluster 1 were obsessional and had weak intention and personality disorder symptoms. In contrast, cluster 2 had a high NS/low HA/high RD pattern, indicating a socially active person who easily becomes dependent on others, and results of other tests indicated that these patients were histrionic and less anxious. In cluster 1 there was a significant negative correlation between hemoglobin A1c (HbA1c) and SD-1 (TCI self-directedness) 'responsibility' and a significant positive correlation between HbA1c and State anxiety of State–Trait Anxiety Inventory. In cluster 2 there was a significant positive correlation between HbA1c and HA-2 'fear of uncertainty'.
Conclusions:  Patients with type 2 diabetes were classified using the TCI into two subgroups. These two groups differed in psychological characteristics and had a different pattern in correlation with glycemic control.