我国临床路径研究热点分析

以CNKI、万方、维普3个中文数据库为数据源,检索2000-2009年和2010-2015年两个时间段的临床路径相关文献,对去重后的文献集分别进行高频关键词聚类分析和战略坐标分析,总结我国临床路径相关文献的研究热点。     

基于因子分析和聚类分析的维持性血液透析患者2型肠-肾综合征辨证分型研究

目的:通过分析维持性血液透析(MHD)患者2型肠-肾综合征的中医证候特点,以指导辨证分型,为MHD并发2型肠-肾综合征的中医药治疗提供理论依据。方法:多中心纳入MHD并发2型肠-肾综合征患者136例,建立中医四诊证素数据库,采用因子分析和聚类分析等统计方法对120个证候(四诊证素)进行非线性降维研究。结果:共提取出21个公因子,将MHD并发2型肠-肾综合征患者分为6个中医证型:脾气亏虚证、肾阳亏虚证、阴虚津亏证、心肝血虚证、痰浊壅盛证、肝胃气滞血瘀证。结论:因子分析与聚类分析能简化数据、降低维度,对于该综合征中医辨证类型的确立和诊断依据的规范化具有重要意义。     

Box-Behnken响应面法优化彝药蜜酒同制大黄工艺

目的采用Box-Behnken响应面法对蜜酒同制大黄的炮制工艺进行优化。方法以有效成分及浸出物含量结合感官评分为指标,对粉碎粒度、蒸制时长、闷润温度、含水量4个因素进行单因素考察。在单因素试验基础上,利用HPLC法测定蜜酒同制大黄中游离蒽醌、总蒽醌的含量和热浸法测定浸出物的含量,并以上述3种指标含量的总评归一值为考察指标,对蒸制时间、闷润温度、含水量3个因素进行响应面考察,从而优选蜜酒同制大黄的最佳炮制工艺。结果最佳炮制工艺条件为粉碎粒度过100目筛细粉,蒸制时长3.5h,闷润温度33℃,含水量43%。结论优化的炮制工艺简单可行,为规范蜜酒同制大黄的生产工艺提供了科学依据。     

Plackett-Burman设计联用星点设计-响应面法优选大青叶中靛玉红的提取工艺

目的运用Plackett-Burman实验设计联用星点设计-响应面法(CCD-RSM)筛选超声-微波协同提取大青叶中靛玉红的提取工艺。方法运用Plackett-Burman实验设计筛选主要影响因素,采用CCD-RSM优选靛玉红的提取工艺。以乙醇体积分数、料液比、提取时间为自变量,靛玉红提取量为因变量,通过对自变量与因变量的完全2次响应曲面的回归拟合,利用三维曲面图直观分析大青叶中靛玉红提取最佳工艺,并进行预测分析。结果靛玉红的最佳提取工艺为乙醇体积分数为62%,液料比为26,提取时间为9 min。在此最佳条件下,大青叶中靛玉红提取量的最大估计值为4.37 mg/g,实验结果与模型预测值相符。结论利用Plackett-Burman实验设计联用CCD-RSM确定了大青叶中靛玉红的提取工艺,该方法简便,精度更高、重现性好、预测性强。     

《中国药典》三七项下供试品溶液制备方法的改进

目的优选三七含量测定时供试品溶液的制备方法。方法采用HPLC法同时测定三七皂苷R1、人参皂苷Rg1、人参皂苷Rb1,结合Box-Behnken设计-响应面法考察提取溶剂、料液比、提取温度对皂苷类成分提取工艺的影响,优选供试品溶液的制备方法。结果最佳制备方法为采用75%甲醇,回流提取1次,料液比为1∶40,提取温度为100℃。结论优选出的供试品溶液制备方法简单可行,成分提取率较高,为三七含量测定时供试品溶液制备提供参考。     

星点设计-效应面法优化细叶远志皂苷自微乳释药系统

目的 采用星点设计-效应面法优化细叶远志皂苷自微乳处方.方法 配伍试验、绘制伪三元相图进行处方筛选,以溶解度、粒径及乳化时间为指标,星点设计-效应面法优化处方.结果 细叶远志皂苷自微乳的处方配比为油酸乙酯12.93%,RH40 56.30%,1,2-丙二醇30.77%.结论 此方法的预测性良好,适用于细叶远志皂苷自微乳的处方优化.     

Application of Artificial Neural Networks in the Design and Optimization of a Nanoparticulate Fingolimod Delivery System Based on Biodegradable Poly(3-Hydroxybutyrate-Co-3-Hydroxyvalerate)

Formulation of a nanoparticulate Fingolimod delivery system based on biodegradable poly(3-hydroxybutyrate-co-3-hydroxyvalerate) was optimized according to artificial neural networks (ANNs). Concentration of poly(3-hydroxybutyrate-co-3-hydroxyvalerate), PVA and amount of Fingolimod is considered as the input value, and the particle size, polydispersity index, loading capacity, and entrapment efficacy as output data in experimental design study. In vitro release study was carried out for best formulation according to statistical analysis. ANNs are employed to generate the best model to determine the relationships between various values. In order to specify the model with the best accuracy and proficiency for the in vitro release, a multilayer percepteron with different training algorithm has been examined. Three training model formulations including Levenberg-Marquardt (LM), gradient descent, and Bayesian regularization were employed for training the ANN models. It is demonstrated that the predictive ability of each training algorithm is in the order of LM > gradient descent > Bayesian regularization. Also, optimum formulation was achieved by LM training function with 15 hidden layers and 20 neurons. The transfer function of the hidden layer for this formulation and the output layer were tansig and purlin, respectively. Also, the optimization process was developed by minimizing the error among the predicted and observed values of training algorithm (about 0.0341).     

Nurses and electronic health records in a Canadian hospital: examining the social organisation and programmed use of digitised nursing knowledge

Institutional ethnography (IE) is used to examine transformations in a professional nurse's work associated with her engagement with a hospital's electronic health record (EHR) which is being updated to integrate professional caregiving and produce more efficient and effective health care. We review in the technical and scholarly literature the practices and promises of information technology and, especially of its applications in health care, finding useful the more critical and analytic perspectives. Among the latter, scholarship on the activities of economising is important to our inquiry into the actual activities that transform ‘things’ (in our case, nursing knowledge and action) into calculable information for objective and financially relevant decision‐making. Beginning with an excerpt of observational data, we explicate observed nurse‐patient interactions, discovering in them traces of institutional ruling relations that the nurse's activation of the EHR carries into the nursing setting. The EHR, we argue, materialises and generalises the ruling relations across institutionally located caregivers; its authorised information stabilises their knowing and acting, shaping health care towards a calculated effective and efficient form. Participating in the EHR's ruling practices, nurses adopt its ruling standpoint; a transformation that we conclude needs more careful analysis and debate.     

新疆、西藏地区35岁及以上人群身体脂肪率、内脏脂肪指数与心脏代谢性危险因素聚集的关系

目的 探讨我国新疆、西藏地区35岁及以上人群身体脂肪率（BFP）和内脏脂肪指数（VFI）与心脏代谢性危险因素聚集的关系。方法 2015－2016年,采用分层多阶段随机抽样,选取新疆、西藏地区35岁及以上调查对象7 571人,有效数据5 643人。危险因素聚集定义为两种及以上危险因素（高血压、糖尿病、高甘油三酯血症、低高密度脂蛋白胆固醇血症）同时存在。采用logistic回归和受试者工作特征（ROC）曲线进行分析。结果 新疆、西藏地区35岁及以上居民危险因素聚集患病率为9.78%。BFP、VFI按照四分位数分组,调整性别、年龄、民族、吸烟、饮酒、教育程度、职业劳动强度和海拔后,随着BFP或VFI水平升高,BFP或VFI与危险因素聚集关联的OR值增大。以BFP为5.0%～27.0%组OR值为1,BFP为27.1%～31.7%组、31.8%～36.6%组和36.7%～50.0%组OR值（95% CI）分别为1.15（0.86～1.54）、1.48（1.05～2.07）和1.72（1.10～2.68）;以VFI为1～6组OR值为1,VFI为7～9组、10～13组和14～30组OR值（95% CI）分别为1.20（0.81～1.79）、1.91（1.30～2.80）和3.91（2.64～5.77）。BFP、VFI预测危险因素聚集的曲线下面积（AUC）分别为0.55和0.70,差异有统计学意义（P<0.01）。结论 BFP和VFI水平与心脏代谢性危险因素聚集相关,VFI对危险因素聚集的预测价值较好。