基于数据挖掘的膝骨关节炎中药熏洗用药规律研究

目的:基于中医传承辅助平台V2.5(TCMISS V2.5)研究膝骨关节炎中药熏洗处方的用药规律。方法:通过收集中国期刊全文数据库(CJFD)、中国学术期刊数据库(CSPD)、中文科技期刊数据库(CCD)、PubMed数据库建库至2019年11月中药熏洗治疗膝骨关节炎的处方,输入中医传承辅助平台V2.5,分析处方中各种中药的应用频次、性味归经、关联规则和新方分析。结果:对筛选出的372首中药处方进行分析,应用最多的前3位依次为透骨草、红花、伸筋草,归经以肝、心、脾、肾经为主,药性以温为主,药味以辛、苦、甘为主,新方组合11条。结论:中药熏洗治疗膝骨关节炎以海桐皮汤为主方,治法主要是祛湿散寒、化瘀通络,治肝是关键,兼顾心脾肾。     

基于离散小波变换的多模态医学图像融合改进算法的研究

目的：提出一种改进的离散小波变换算法,并将其用于多模态医学图像融合。方法将源图像经过离散小波变换分解为高频和低频子图像;高频部分采用方向绝对值取大,能有效地保存图像的细节信息,低频部分使用区域能量比融合规则,保存了图像的绝大部分信息;用离散小波逆变换将融合子图像重构成融合图像。结果由3组医学图像融合效果比较可知,该算法在主观视觉效果和客观评价指标方面均优于现存的其他算法。结论该医学图像融合算法快速准确,在噪声环境和临床实例中均表现优越,可以获得较高质量的融合图像,具有较高的临床应用价值。     

基于数据挖掘方法的椎动脉型颈椎病用药规律研究

目的:运用中医传承辅助平台分析椎动脉型颈椎病中药处方的用药规律。方法:通过中国知网、重庆维普、万方数据库中收集2010年1月—2014年12月治疗椎动脉型颈椎病的中药处方,采用关联规则算法、复杂系统熵聚类等无监督数据挖掘方法,分析处方中各种药物的使用频次、性味归经、药物之间的关联规则及核心药物组合。结果:对筛选出的118个中药处方进行分析,确定其常用药物频次,发现常用药物关联规则共57个,核心组合30个。结论:椎动脉型颈椎病常用的药物以活血化瘀药、温经通络药和祛风止眩药为主,四气分布以温、平、凉为主,五味分布以甘、辛、苦为主,主要归于肝、脾、心经,使用频次较高的药味为川芎、葛根、当归、天麻、丹参等。     

我国大病医疗保险报销规则研究

大病医疗保险中的道德风险对医疗保险基金的可持续运行带来挑战。本文对能够减少道德风险的大病医保报销模式展开了研究。理论分析表明,在最大化社会总福利的目标下,应对选择低费用治疗方案的消费者提供补贴,对选择高费用治疗方案的消费者设定自付比例。模拟表明这种差异化报销规则相对于单一报销规则,降低了医疗费用和医疗保险费。本文还对模拟所用的参数选择进行了敏感性检验,结果表明,不同的参数选择不会改变本文所揭示的机理。     

血液透析失眠患者的心率变异性与子午流注规律的关系探讨

目的：探讨维持性血液透析（MHD）失眠患者心率变异性的昼夜节律特点以及其与子午流注规律的关系。方法：选取符合失眠标准的MHD患者,分析其心率变异性（HRV）的主要指标,用匹兹堡睡眠评分系统（PSQI）反映患者睡眠情况,取29例性别、年龄相互匹配的健康人（无肾脏病）作为对照组;比较患者心率变异性的时域指标及频域指标与健康人有无统计学差异,描述患者心率变异性随子午流注时辰变化的特点。结果：本研究共纳入患者21例,24h心电图结果提示患者心率变异性时域指标的全程每5min R-R间期平均值的标准差（SDANN,P=0.004)、相邻R-R间期之间差值的均方根（rMSSD,P=0.016）以及频域指标24h频域总功率较健康组有显著的差异（P=0.010）;根据子午流注时辰划分方法,观察患者的HRV可见,患者每个时辰的SDNN平均值都在150以上,最低值出现在寅时（24h计时的3:00-4:00）并开始上升,上升速度十分缓慢,峰值在巳时（24h计时的9:00-10:00）并由此开始逐渐下降,未时（24h计时的13:00-14:00）重新降回夜间水平波动。结论：维持性血液透析失眠患者的HRV 随着子午流注十二时辰的变化表现出一定的节律。     

《中药成方制剂》含山楂方剂用药规律研究

分析《中华人民共和国卫生部药品标准·中药成方制剂》(以下简称《中药成方制剂》)含山楂方剂组方规律,为临床应用及新药研发提供参考。基于中医传承辅助平台(V2.5)软件,对《中药成方制剂》中含山楂方剂收集整理,并构建数据库,采用关联规则、频次统计等数据挖掘方法,对疾病证候、常用药物配伍及组方规律进行分析。含山楂方剂共308首,涉及中药499种,常用药物组合34个,主治疾病18种,选取其中高频药对"山楂-陈皮"、"山楂-茯苓"及2种高频疾病"积滞"、"腹泻"进行药物组合分析,显示山楂不同药对中作用方向大致相同,在不同疾病中治疗作用各异。《中药成方制剂》中含山楂方剂多具有消食导滞之功效,临床应用较为广泛,常与理气健脾药同用,以达到不同的治疗效果;组方规律反应出山楂在治疗不同疾病时的组方特点,为山楂临床科学化应用及健康产品开发提供依据。     

蔡连香妇科临床用药规律初探

目的：采用数据挖掘法分析名老中医蔡连香的妇科临床用药规律。方法选择蔡连香临床医案165例、共计337诊次的处方资料,用Excel建立数据库,使用中医诊疗大数据智能分析系统进行数据分析,得出高频药物及高频药物组合,并与蔡连香学术思想及临床经验相印证。结果总结出高频药物10味,高频药物组合7组,与蔡连香认为妇科疾病病机以精血不足、肝脾肾三脏失调为主,临床治疗以益精养血、调肝健脾补肾为主要法则的学术观点一致。结论运用数据挖掘的方法总结蔡连香老师的妇科用药规律,对临床具有一定的指导意义。     

A simple Bayesian approach to quantifying confidence level of adverse event incidence proportion in small samples

In both clinical development and post-marketing of a new therapy or a new treatment, incidence of an adverse event (AE) is always a concern. When sample sizes are small, large sample-based inferential approaches on an AE incidence proportion in a certain time period no longer apply. In this brief discussion, we introduce a simple Bayesian framework to quantify, in small sample studies and the rare AE case, (1) the confidence level that the incidence proportion of a particular AE p is over or below a threshold, (2) the lower or upper bounds on p with a certain level of confidence, and (3) the minimum required number of patients with an AE before we can be certain that p surpasses a specific threshold, or the maximum allowable number of patients with an AE after which we can no longer be certain that p is below a certain threshold, given a certain confidence level. The method is easy to understand and implement; the interpretation of the results is intuitive. This article also demonstrates the usefulness of simple Bayesian concepts when it comes to answering practical questions.     

Prediction of an unfavourable course of low back pain in general practice: comparison of four instruments

BACKGROUND: Several instruments can be used to identify patients with an unfavourable course of low back pain in general practice. However, it is unclear which instrument is the predictor of outcome. AIM: To compare the predictive performance (that is, calibration and discrimination) of risk estimation by GPs with assessments using the Orebro Musculoskeletal Pain Screening Questionnaire, the Low Back Pain Perception Scale (LBPPS), and a prediction rule developed for this purpose. Design of study: A prospective cohort study with 1-year follow-up. SETTING: General practice in The Netherlands. METHOD: The outcome 'unfavourable course of low back pain' was defined as having no clinically important improvement at minimally 50% of the measurements at 6, 13, 26, and 52 weeks. Logistic regression analyses were used to study associations between potential predictors and outcome. RESULTS: In total, 60 GPs recruited 314 patients to the study (16 patients were excluded from analysis due to missing data on the course of low back pain). Over a third of patients (112/298) showed an unfavourable course of low back pain on follow-up. Risk estimation by GPs, the Orebro questionnaire, the LBPPS, and the prediction rule had discriminative ability (area under the curve) of 0.59 (95% CI [confidence intervals] = 0.52 to 0.66); 0.61 (95% CI = 0.54 to 0.67); 0.59 (95% CI = 0.52 to 0.66); and 0.75 (95% CI = 0.69 to 0.81) respectively. The prediction rule included history of low back pain, self-perceived risk to develop chronic low back pain, no solicitous responses of the patient's partner (as reported by the patient), frequent walking at work, and 'pain catastrophising'. CONCLUSION: Although the prediction rule performed best with regard to calibration and discrimination, it needs to be externally validated. Risk estimation by GPs performs as well as other instruments and, at present, seems to be the best available option.     

论太阳柴胡证与柴胡汤法

小柴胡汤被称为"少阳枢机之剂,和解表里之总方",在《伤寒论》太阳病篇的应用频次仅略少于"经方之首"桂枝汤。其对太阳病及其变证具有突出的治疗优势,堪称是用治太阳病及其变证的主方。孙思邈概括"太阳病用柴胡汤法",列为《伤寒论》太阳病七法之第四法。根据张仲景"伤寒中风,有柴胡证"等病证合参、以病统证的思维模式,提出"太阳病柴胡证"的概念,认为"小柴胡汤实为疏表清里之首方",而不应将其限于"和解少阳"的狭义范畴。此观点为解析小柴胡汤在太阳病篇的主治病证,以及阐释其在现代外感发热性疾病中的治疗优势,提供了更加充分的理论依据。