基于数据挖掘探讨鲁科达治疗肾性蛋白尿的用药规律

[目的] 探讨鲁科达教授治疗肾性蛋白尿的用药规律,归纳总结其组方经验,以供临床参考。[方法] 收集2018年1月至2020年12月鲁教授中医门诊的肾性蛋白尿医案,以Microsoft Excel 2019软件将处方信息转化为可分析的结构化数据,并建立相关数据库,利用频次统计分析、关联规则分析、聚类分析对高频药物、四气五味归经、高频药对、核心组方进行数据挖掘。[结果] 共纳入肾性蛋白尿病例691则,处方3 750首,共涉及中药261味,将使用频次前34味的药物作为高频药物,如黄芪、党参、白术、山药、茯苓、山茱萸、甘草、薏苡仁、地黄、川牛膝、青风藤、地龙等。利用关联规则分析得到高频药对20组,通过聚类分析演化得到4个核心组方。[结论] 鲁教授治疗肾性蛋白尿以补肾健脾、清热利湿、消瘀泄浊为主。     

基于数据挖掘和网络药理学探究含黄连方剂治疗溃疡性结肠炎的配伍规律及作用机制

目的基于现代信息技术,分析以黄连Coptidis Rhizoma为核心治疗溃疡性结肠炎(ulcerative colitis,UC)的用药特点及规律,并阐明含黄连核心药物组治疗UC的分子机制,为其实验验证及新型方剂的研发奠定基础。方法运用Apriori关联规则分析用于治疗UC的含黄连方剂,设置同时满足支持度≥0.25,置信度≥0.9且提升度≥1的药对为含黄连核心药物组,利用TCMSP、HERB和TCMID数据库检索活性成分并收集相应靶点,在GeneCard和OMIM数据库中以"ulcerative colitis"为关键词检索疾病靶点,运用Cytoscape 3.7.1软件构建"中药-成分-潜在靶点"网络图,通过STRING11.0构建蛋白-蛋白相互作用(protein-protein interaction,PPI)网络,并利用"微生信在线"网站对潜在靶点进行京都基因与基因组百科全书(Kyoto encyclopedia of genes and genomes,KEGG)通路可视化,采用分子对接软件AUTODOCK 4对关键靶点和成分进行对接验证。结果数据库筛选得到161首目标方剂,主要涉及72味药;关联规则分析结果提示黄连与木香、甘草、白术、茯苓、当归是具有强关联性的5组药对,这6味核心药物一共含有144种成分、潜在靶点165个,其中有83个靶点分布在骨髓和淋巴组织,关键靶点有31个,包括丝氨酸/苏氨酸激酶1(serine/threonine kinase 1,AKT1)、肿瘤蛋白P53(tumor protein P53,TP53)、丝裂原活化蛋白激酶1(mitogen-activated protein kinase 1,MAPK1)、白细胞介素-6(interleukin-6,IL-6)、MAPK8。KEGG分析结果显示磷脂酰肌醇3-激酶(phosphatidylinositol 3-kinase,PI3K)-蛋白激酶B(protein kinase B,Akt)、IL-17、晚期糖基化终产物及其受体(advanced glycation end products-receptor advanced glycation end products,AGE-RAGE)等通路与含黄连核心药物组治疗UC密切相关。分子对接结果显示受体蛋白与中药成分的对接活性好,作用较稳定且与原配体的结合能相近,其中β-谷甾醇与原癌基因JUN具有最低的结合能。结论初步分析了含黄连方剂治疗UC的配伍规律,并且在分子水平揭示了含黄连核心药物组治疗UC的机制,为后续含黄连方剂治疗UC的开发提供了理论基础。     

针灸技术操作规范及编写通则国际需求调查分析

采用电子问卷形式调查《针灸技术操作规范编写通则》(简称《通则》)的国际需求,探讨其在应用过程中可能遇到的问题,为《通则》国际标准的研制提供依据。共回收有效问卷102份,来自18个国家/地区;针灸技术操作规范国际标准研制需求的优先度前7位为毫针、艾灸、电针、拔罐、耳针、头针、刮痧;98.04%(100/102)的国内外专家认为有必要研制《通则》的国际标准;现有《通则》国家标准的知晓率为71.57%,国外专家趋向于认为其"表达欠清晰",而国内专家则趋向于认为其"缺乏实用性";《通则》国际标准的涵盖范围方面国内专家希望突出共性,而国外专家则希望更多地保留个性;针灸技术操作过程中的具体问题在"相关名词术语""施术前准备""不良反应及禁忌"3方面国内外差异比较大。《通则》国际标准研制过程中应充分考虑不同国家的需求,尽可能在提炼"共性问题"与满足"个性需要"之间找到平衡,以提高国际兼容性和适用性。     

明清时期瘟疫治方用药规律的文献挖掘研究

目的通过对《中华医典》中所包含的明清时期瘟疫治方用药的相关文献进行挖掘及整理分析,探索瘟疫用药及组方规律,为瘟疫的中医临床治疗提供理论依据。方法以《中华医典》为检索数据库,以"瘟疫""瘟""疫""时疫""时邪"等关键词进行检索并建立数据库,采用关联规则分析及因子分析对挖掘的数据进行统计分析。结果共纳入药物175味,发掘核心药物16味,核心药对41对,核心药组16组,核心药团21项,核心处方14方。结论瘟疫的病机特点为"风、寒、湿、热、郁、毒",以"湿"为核心,治疗用药多寒温并用,辛开苦降。     

基于数据挖掘技术研究治疗膝骨关节炎肾虚血瘀型方剂的组方配伍规律

目的:基于中医传承辅助平台分析期刊与专利文献中治疗膝骨关节炎肾虚血瘀型方剂的用药配伍规律。方法:筛选2013年1月至2019年1月中国知网、维普、万方、超星、读秀学术、超星汇雅图书、国研等数据库中治疗膝骨关节炎肾虚血瘀型的方剂,通过中医传承辅助平台构建方剂数据库,利用该软件集成的关联规则及熵聚类等数据挖掘算法,总结治疗膝骨关节炎肾虚血瘀型方剂中的用药频次、常用药对、潜在药对及发现新处方。结果:通过对85首治疗膝骨关节炎肾虚血瘀型方剂所含药物的频次统计分析,得到常用药物33味,其中牛膝、川芎、当归、杜仲、甘草、独活的使用频次较高;使用频次较高的药对有26个,其中川芎与牛膝、当归与牛膝位居前2位,杜仲与牛膝、当归与川芎并列第3位;通过熵层次聚类分析法发现关联系数较高的潜在药对44个及潜在新处方10个。结论:治疗膝骨关节炎肾虚血瘀型的方剂多以补益肝肾为主,兼以活血化瘀、通络止痛为辅,挖掘得到的新处方具有潜在的临床应用和新药开发价值。     

基于关联规则研究五味温通除痹胶囊对类风湿关节炎寒湿证患者的影响

目的:研究五味温通除痹胶囊对类风湿关节炎寒湿证患者免疫炎症指标的影响。方法:整理2018年12月至2019年6月安徽中医药大学第一附属医院类风湿关节炎寒湿证住院患者的病例资料。根据是否使用五味温通除痹胶囊将患者分为治疗组(五味温通除痹胶囊+中药)73例,对照组(单纯中药)317例。分析患者的免疫及炎症指标。结果:①2组患者在性别、年龄方面比较,差异无统计学意义(P>0.05)。②治疗后,2组超敏C-反应蛋白(hs-CRP)、类风湿因子(RF)等指标均降低(P<0.05);而治疗组在改善hs-CRP、抗环瓜氨酸肽抗体、免疫球蛋白M方面优于对照组(P<0.05)。③关联规则分析显示,hs-CRP、RF、补体C3等指标的改善均与五味温通除痹胶囊有较强关联,且联合丹参、桂枝等中药指标的改善明显优于单纯中成药。结论:五味温通除痹胶囊能有效改善类风湿关节炎寒湿证患者免疫炎症指标,且联合中药内服与指标的改善存在明显关联关系。     

Home Food Environment in Relation to Children’s Diet Quality and Weight Status

The objective of this cohort study was to explore relationships among the home food environment (HFE), child/parent characteristics, diet quality, and measured weight status among 699 child-parent pairs from King County, WA, and San Diego County, CA. HFE variables included parenting style/feeding practices, food rules, frequency of eating out, home food availability, and parents’ perceptions of food costs. Child dietary intake was measured by 3-day recall and diet quality indicators included fruits and vegetables, sweet/savory snacks, high-calorie beverages, and Dietary Approaches to Stop Hypertension (DASH) score. Individual linear regression models were run in which child BMI z score and child diet quality indicators were dependent variables and HFE variables and child/parent characteristics were independent variables of interest. Fruit and vegetable consumption was associated with parental encouragement/modeling (β=.68, P<0.001) and unhealthful food availability (−0.27, P<0.05); DASH score with food availability (healthful: 1.3, P<0.01; unhealthful: −2.25, P<0.001), food rules (0.45, P<0.01), and permissive feeding style (−1.04, P<0.05); high-calorie beverages with permissive feeding style (0.14, P<0.01) and unhealthful food availability (0.21, P<0.001); and sweet/savory snacks with healthful food availability (0.26, P<0.05; unexpectedly positive). Children's BMI z score was positively associated with parent's use of food restriction (0.21, P<0.001), permissive feeding style (0.16, P<0.05), and concern for healthy food costs (0.10, P<0.01), but negatively with verbal encouragement/modeling (−0.17, P<0.05), and pressure to eat (−0.34, P<0.001). Various HFE factors associated with parenting around eating and food availability are related to child diet quality and weight status. These factors should be considered when designing interventions for improving child health.     

基于中医传承辅助平台探讨张伦忠治疗中老年郁证经验及组方用药规律

目的基于中医传承辅助平台,分析和总结张伦忠教授治疗中老年郁证的组方规律和用药经验。方法收集张伦忠教授治疗中老年郁证的门诊首诊处方122首,运用中医传承辅助平台软件,分析其组方规律和用药经验。结果122首处方中得出12个核心组合和6个新处方。结论张伦忠教授治疗中老年郁证善于从阴阳角度辨焦虑与抑郁,重视肝、脾、肾三脏,治以疏肝解郁、顾护中焦、补肾填精,多以桑麻地黄汤为基础方临证加减,采用复方治疗,标本兼治。     

Does play promote self-regulation in children?

This theoretical paper discusses the role of pretend play and games with rules in fostering children's self-regulation. It proposes several pathways through which play facilitates self-regulation processes. First, in play, children learn to inhibit their impulsive behaviour and follow rules which transform their behaviour from impulsive and spontaneous to mediated and voluntary. Second, play liberates children from situational constraints as children begin to act upon the meanings of objects as opposed to their immediate motivational valence. Third, children develop internal representations which guide their behaviour. Finally, play promotes verbal self-regulation as children are engaged in an ongoing dialogue with their partners in order to resolve differences in perspectives, to reach an agreement about roles, and to invent play rules. The paper further reviews empirical studies which explore the effect of play on inhibition, working memory, and private speech. The current status of play and implications for practice are discussed.     

Validating an ontology-based algorithm to identify patients with Type 2 Diabetes Mellitus in Electronic Health Records

BackgroundImproving healthcare for people with chronic conditions requires clinical information systems that support integrated care and information exchange, emphasizing a semantic approach to support multiple and disparate Electronic Health Records (EHRs). Using a literature review, the Australian National Guidelines for Type 2 Diabetes Mellitus (T2DM), SNOMED-CT-AU and input from health professionals, we developed a Diabetes Mellitus Ontology (DMO) to diagnose and manage patients with diabetes. This paper describes the manual validation of the DMO-based approach using real world EHR data from a general practice (n = 908 active patients) participating in the electronic Practice Based Research Network (ePBRN).MethodThe DMO-based algorithm to query, using Semantic Protocol and RDF Query Language (SPARQL), the structured fields in the ePBRN data repository were iteratively tested and refined. The accuracy of the final DMO-based algorithm was validated with a manual audit of the general practice EHR. Contingency tables were prepared and Sensitivity and Specificity (accuracy) of the algorithm to diagnose T2DM measured, using the T2DM cases found by manual EHR audit as the gold standard. Accuracy was determined with three attributes – reason for visit (RFV), medication (Rx) and pathology (path) – singly and in combination.ResultsThe Sensitivity and Specificity of the algorithm were 100% and 99.88% with RFV; 96.55% and 98.97% with Rx; and 15.6% and 98.92% with Path. This suggests that Rx and Path data were not as complete or correct as the RFV for this general practice, which kept its RFV information complete and current for diabetes. However, the completeness is good enough for this purpose as confirmed by the very small relative deterioration of the accuracy (Sensitivity and Specificity of 97.67% and 99.18%) when calculated for the combination of RFV, Rx and Path. The manual EHR audit suggested that the accuracy of the algorithm was influenced by data quality such as incorrect data due to mistaken units of measurement and unavailable data due to non-documentation or documented in the wrong place or progress notes, problems with data extraction, encryption and data management errors.ConclusionThis DMO-based algorithm is sufficiently accurate to support a semantic approach, using the RFV, Rx and Path to define patients with T2DM from EHR data. However, the accuracy can be compromised by incomplete or incorrect data. The extent of compromise requires further study, using ontology-based and other approaches.