基于“病-药-量”探讨《中华医典》含竹沥中药方剂相应规律的数据挖掘

目的 分析《中华医典》中含有竹沥中药方剂“病-药-量”的相应规律,为竹沥的临床诊疗应用及深入研发提供参考。方法 收集整理《中华医典》中含有竹沥的中药方剂,录入Excel 2016构建临证方药数据库,对其病症、证型、药物使用频次、功效类别、性味归经、剂型及用量等进行统计分析,运用SPSS Statistics 22.0、IBM SPSS Modeler 18.0软件进行关联规则、聚类分析等数据挖掘。结果 共收集含竹沥方剂349首,主治病证分类共99种,其中高频病证（≥20次）主要为“中风”“痰饮”“咳嗽”,治疗“中风”证型以风痰瘀阻为主,“痰饮”以饮停胃肠为主,“咳嗽”以痰热郁肺为主;组方中使用频次≥50次的药物有19味,使用频次较高的有生姜、甘草、茯苓、陈皮等,药物功效种类以化痰止咳平喘药、补虚药、清热药为主;药性使用频次最高的为寒性药,其次为温性药,药味多选用甘、苦、辛味,药物归经以脾、胃、心经为主;高频病症剂型及药物用量分析显示,治疗“中风”时,剂型多为汤剂,竹沥用量多为100 mL,核心药物配伍重用防风以祛风化痰,改善脑络痹阻;治疗“痰饮”时,剂型多为丸剂,竹沥用量为200 mL...     

UPLC指纹图谱多模式识别结合多指标成分测定的清热消炎宁胶囊质量控制研究

目的 建立清热消炎宁胶囊（Qingre Xiaoyanning Capsules,QXC）UPLC指纹图谱及多指标成分定量分析方法,结合化学模式识别技术对多批次制剂进行质量评价。方法 通过优化样品前处理及色谱检测方法,建立合适UPLC指纹图谱和含量测定条件。色谱柱为UPLC HSS T3柱（50 mm×2.1 mm,1.8μm）;乙腈-0.1%甲酸水溶液为流动相梯度洗脱;检测波长280 nm;柱温40℃;体积流量0.5 mL/min。采用层次聚类分析（hierarchical cluster analysis,HCA）、主成分分析（principal component analysis,PCA）、正交偏最小二乘-判别分析（orthogonal partial least squares-discriminant analysis,OPLS-DA）和聚类热图分析对20批清热消炎宁胶囊进行质量评价。结果 清热消炎宁胶囊UPLC指纹图谱及含量测定方法学考察结果均符合测定要求,获得21个共有峰,运用对照品比对方式指认了7个色谱峰;20批样品的相似度均大于0.954,样品间一致性及稳定性良好;...     

基于Heracles NEO超快速气相电子鼻麸炒白术炮制全过程气味变化识别研究

目的 建立麸炒白术Atractylodis Macrocephalae Rhizoma炮制全过程的定性判别模型,筛选出可以表征麸炒白术不同炮制程度的气味成分。方法 制备麸炒白术饮片,不同时间点取样进行分析。采用Heracles NEO超快速气相电子鼻采集气味图谱,与Arochembase数据库对比得到气味成分信息,结合峰面积分析气味成分的变化规律并进行化学计量学分析。结果 通过判别因子分析（discriminant factor analysis,DFA）、正交偏最小二乘-判别分析（orthogonal partial least squaresdiscriminant analysis,OPLS-DA）、层次聚类分析（hierarchical cluster analysis,HCA）等将麸炒白术炮制全过程样品成功分为4类：生品、炮制不及、炮制成品和炮制太过。在炮制过程中,3-甲基十五烷、十二烷基丙酸酯、正辛基环己烷、1,3-二硝基苯、8-甲基十五烷5个气味成分的峰面积占比较高,其中1,3-二硝基苯在炮制全过程中峰面积呈降低趋势;3-甲基十五烷从炮制不及到炮制成品的过程中峰面积呈增加...     

基于指纹图谱和多指标含量测定的蜜远志质量评价

目的 建立指纹图谱和多指标定量的蜜远志质量评价方法。方法 Kromasil 100-5-C₁₈色谱柱（250 mm×4.6 mm,5 μm）为固定相,以乙腈（A）-0.2%磷酸水溶液（B）为流动相进行梯度洗脱,体积流量为1.0 mL/min,检测波长318 nm。对16批蜜远志建立指纹图谱,确定共有峰并进行相似度分析结合化学计量学分析。采用Waters Xbridge Shiled RP C₁₈色谱柱（250 mm×4.6 mm,5 μm）进行同时测定远志（口山）酮III、3,6''-二芥子酰基蔗糖、细叶远志皂苷、远志酸、远志皂苷元的含量。结果 在指纹图谱研究中,标定了27个共有峰,结合对照品和HPLC-Q-TOF-MS共指认8个成分,分别为西伯利亚远志糖A5、西伯利亚远志糖A6、远志（口山）酮IX、远志（口山）酮III、3,6''-二芥子酰基蔗糖、细叶远志皂苷、远志酸、远志皂苷元。聚类分析将16批样品分为3类;经主成分分析,主成分1～3是影响蜜远志质量评价的主要因子。多指标含量测定中远志（口山）酮III、3,6''-二芥子酰基蔗糖、细叶远志皂苷、远志酸、远志皂苷元的质量分数分别为0.027%～0.068%、0.074%～0.798%、1.1%～1.4%、0.15%～0.36%、0.15%～0.37%。经方法学验证,线性关系良好（r≥0.999 6）,平均加样回收率为97.15%～100.9%。结论 所建立的指纹图谱结合多指标含量测定方法准确、高效,特征性强,可为蜜远志饮片的质量评价和临床应用提供有效参考。     

Subtype‐specific differences in transmission cluster dynamics of HIV‐1 B and CRF01_AE in New South Wales,Australia

IntroductionThe human immunodeficiency virus 1 (HIV‐1) pandemic is characterized by numerous distinct sub‐epidemics (clusters) that continually fuel local transmission. The aims of this study were to identify active growing clusters, to understand which factors most influence the transmission dynamics, how these vary between different subtypes and how this information might contribute to effective public health responses.MethodsWe used HIV‐1 genomic sequence data linked to demographic factors that accounted for approximately 70% of all new HIV‐1 notifications in New South Wales (NSW). We assessed differences in transmission cluster dynamics between subtype B and circulating recombinant form 01_AE (CRF01_AE). Separate phylogenetic trees were estimated using 2919 subtype B and 473 CRF01_AE sequences sampled between 2004 and 2018 in combination with global sequence data and NSW‐specific clades were classified as clusters, pairs or singletons. Significant differences in demographics between subtypes were assessed with Chi‐Square statistics.ResultsWe identified 104 subtype B and 11 CRF01_AE growing clusters containing a maximum of 29 and 11 sequences for subtype B and CRF01_AE respectively. We observed a > 2‐fold increase in the number of NSW‐specific CRF01_AE clades over time. Subtype B clusters were associated with individuals reporting men who have sex with men (MSM) as their transmission risk factor, being born in Australia, and being diagnosed during the early stage of infection (p < 0.01). CRF01_AE infections clusters were associated with infections among individuals diagnosed during the early stage of infection (p < 0.05) and CRF01_AE singletons were more likely to be from infections among individuals reporting heterosexual transmission (p < 0.05). We found six subtype B clusters with an above‐average growth rate (>1.5 sequences / 6‐months) and which consisted of a majority of infections among MSM. We also found four active growing CRF01_AE clusters containing only infections among MSM. Finally, we found 47 subtype B and seven CRF01_AE clusters that contained a large gap in time (>1 year) between infections and may be indicative of intermediate transmissions via undiagnosed individuals.ConclusionsThe large number of active and growing clusters among MSM are the driving force of the ongoing epidemic in NSW for subtype B and CRF01_AE.     

Clinical outcomes in pediatric tibial lengthening and deformity correction: a comparison of the Taylor Spatial Frame with the Orthex Hexapod System

PurposeComparison of two hexapod frame systems in paediatric tibial deformity correction; the Taylor Spatial Frame (TSF) and Orthex Hexapod System.MethodsPaediatric patients with congenital and acquired tibial deformities treated with either TSF (between 2014 and 2016) or Orthex (between 2017 and 2019) frames were included in a retrospective comparative study. Outcome measures were healing index, pin infection rate, regenerate quality and density, software residual rate, deformity correction accuracy, strut exchanges and quality of life (QoL).ResultsThe TSF group had 17 patients (18 frames) and the Orthex group had 21 patients (25 frames). The most common indications for tibial deformity correction were fibular hemimelia (14) and septic or traumatic growth arrest (8). The median time in frame was 230 days (TSF) versus 203 days (Orthex) (p= 0.06). The mean lengthening achieved was 54 mm (TSF) and 51 mm (Orthex) (p = 0.41). The healing index was 41 days/cm (TSF) versus 43 days/cm (Orthex) (p = 0.70). Pin site infections occurred more in the TSF cohort (40%) than in the Orthex cohort (18%) (p < 0.001). The regenerate in the Orthex group showed higher density at three months (p = 0.029) and was more homogenous (p = 0.023) at six months after frame application. Strut exchanges were less frequent with the Orthex system (p < 0.0001). QoL measures were similar in both cohorts (p = 0.92).ConclusionsThis is the first study to compare two hexapod designs in paediatric orthopaedics. The Orthex system showed superiority in regenerate quality and a significant reduction in pin site infection rates. Both systems delivered predictable and accurate limb deformity correction.Level of evidenceIII     

Hospital‐based health systems 20 years later: A taxonomy for policy research and analysis

ObjectiveBuilding on the original taxonomy of hospital‐based health systems from 20 years ago, we develop a new taxonomy to inform emerging public policy and practice developments.Data SourcesThe 2016 American Hospital Association''s (AHA) Annual Survey; the 2016 IQVIA Healthcare Organizations and Systems (HCOS) database; and the 2017‐2018 National Survey of Healthcare Organizations and Systems (NSHOS).Study DesignCluster analysis of the 2016 AHA Annual Survey data to derive measures of differentiation, centralization, and integration to create categories or types of hospital‐based health systems.Data CollectionPrincipal components factor analysis with varimax rotation generating the factors used in the cluster algorithms.Principal FindingsAmong the four cluster types, 54% (N = 202) of systems are decentralized (−0.35) and relatively less differentiated (−0.37); 23% of systems (N = 85) are highly differentiated (1.28) but relatively decentralized (−0.29); 15% (N = 57) are highly centralized (2.04) and highly differentiated (0.65); and approximately 9 percent (N = 33) are least differentiated (−1.35) and most decentralized (−0.64). Despite differences in calculation, the Highly Centralized, Highly Differentiated System Cluster and the Undifferentiated, Decentralized System Cluster were similar to those identified 20 years ago. The other two system clusters contained similarities as well as differences from those 20 years ago. Overall, 82 percent of the systems remain relatively decentralized suggesting they operate largely as holding companies allowing autonomy to individual hospitals operating within the system.ConclusionsThe new taxonomy of hospital‐based health systems bears similarities as well as differences from 20 years ago. Important applications of the taxonomy for addressing current challenges facing the healthcare system, such as the transition to value‐based payment models, continued consolidation, and the growing importance of the social determinants of health, are highlighted.     

The geographic distribution of un-immunized children in Ontario,Canada: Hotspot detection using Bayesian spatial analysis

BackgroundIn Ontario, Canada, little is currently known about the extent to which un-immunized children may cluster geographically. Our objectives were to: describe the geographic distribution of fully un-immunized children; identify geographic clusters (hotspots) of un-immunized children; and to characterize the contribution of spatial effects and covariates on hotspots, where found.MethodsOur analytic cohort consisted of Ontario students aged 7–17 years in the 2016–2017 school year. We defined students as un-immunized if they had zero doses of any vaccine and a non-medical exemption recorded in Ontario’s registry. We calculated unadjusted proportions of un-immunized students by Census Subdivision (CSD) and then used a sequential approach to identify hotspots starting first with hotspot identification at the CSD level and then probed identified hotspots further by Dissemination Area (DA) and including covariates. Hotspots were identified using the Besag-York-Mollie Bayesian spatial model and were defined as areas with >95% probability of having two times the proportion of un-immunized students, relative to the province overall.ResultsWe identified 15,208 (0.94%) un-immunized children within our cohort consisting of more than 1.61 million students. Unadjusted proportions of un-immunized students varied greatly by geography, ranging from 0% to 21.5% by CSD. We identified 16 hotspot CSDs which clustered in five distinct areas, all of which were located in southern Ontario. The contribution of covariates and spatial effects on the risk of having un-immunized students varied greatly across hotspot areas.ConclusionsAlthough the provincial proportion (0.94%) of un-immunized students is small, geographical clustering of such students is evident in Ontario and in some areas presents an important risk for future outbreaks. Further qualitative work within these hotspot areas would be a helpful next step to better characterize the factors associated with vaccine refusal in these communities.     

贵州省2015—2018年涂阳肺结核流行及空间分布特征分析

目的 分析2015—2018年贵州省涂阳肺结核发病的流行及空间分布特征,为全省传染性肺结核防治工作提供依据。方法 数据来源于结核病管理信息系统,整理2015—2018年贵州省88个县（市、区）涂阳肺结核患者登记信息和人口数据,采用ArcGIS 10.0软件构建地理信息数据库、结果可视化、空间自相关分析。结果 2015—2018年贵州省共报告涂阳肺结核45 560例,年均发病率为31.93/10万,总体呈下降趋势,居前3位地区为:安顺、毕节、铜仁市,最低为六盘水市;冬、夏季（1—2月、5—8月）为疫情高发时间,男性发病数均高于女性（发病数比为2.01∶1）,农民、年龄≥60岁人群发病数最多;涂阳肺结核报告发病率全局空间自相关Moran’s I介于0.069～0.254之间（2016、2017年P＜0.05）,热点主要在望谟县,冷点地区主要在花溪、观山湖、万山区。结论 贵州省涂阳肺结核发病存在空间聚集,应对农民、男性、老年患者等高风险人群和高发病率及热点地区给予重点关注和政策倾斜,增加肺结核专项经费和人力资源等的投入,加大宣传教育,开展创新模式有效发现和管理患者,从而降低涂阳肺结核发病率。     

用于评价动物社交偏好程度的新方法

目的：利用一种改进的三箱社交装置评价动物的社交偏好程度,并探索该方法的可行性。方法：采用注意力缺陷多动障碍(ADHD)大鼠作为社交障碍模型动物,以同源大鼠（WKY)大鼠和Wistar大鼠作为对照组,模型组采用治疗ADHD的临床常用中成药小儿黄龙颗粒（1.88 g/kg、3.75 g/kg）灌胃给药16 d。利用改进的三箱社交箱,以待测鼠在陌生鼠侧密切交流区的时间、频次、路程及相关比例作为行为学指标,检测该方法对社交行为评价的可行性。结果：与Wistar大鼠组比较,模型组大鼠与WKY组大鼠在密切交流区域及有陌生鼠侧区域的时间显著减少（P<0.01）,其他指标如频次、路程及比例也均有不同程度减少,小儿黄龙颗粒两剂量均能增加模型大鼠上述各指标数值。结论：该方法能准确捕捉动物的社交行为特征,实现对动物社交偏好程度的全面、客观评价。