基于文献挖掘及复杂网络探讨寻常性痤疮常见中医证型及核心用药规律＊

目的 运用文献挖掘及复杂网络方法探讨中医治疗寻常性痤疮常见证型及核心用药规律。方法 收集中国期刊全文数据库（China National Knowledge Infrastructure，CNKI）、维普中文科技期刊全文数据库（VIP Database，VIP）、万方数据库（WanFang）、中国生物医学文献数据库（Sinomed）中近15年已公开发表的中医治疗寻常性痤疮核心期刊，对其进行医案提取及规范化后，运用复杂网络方法进行分析。结果 共纳入文献178篇，医案数据195条，涉及中药184味，药性多以寒、微寒为主，药物归经归肺经最多，其次肝经、胃经、心经，药物功效多以清热解毒、清热燥湿、清热凉血为主，常见中医证型及对应核心加减处方4个。结论 系统总结了寻常性痤疮近年发病的主流证型、核心处方及用药规律，为之后的临床辨证用药提供参考及借鉴。     

周晓虹教授治疗慢性萎缩性胃炎经验总结

周晓虹教授认为脾胃亏虚是慢性萎缩性胃炎发病的病机关键,而寒凝、气郁、血瘀及湿阻等则是重要的发病因素,采用健脾益气的方法治疗主证,兼用温阳、理气、活血、化湿等方法治疗兼证,同时结合辨病,宏观与微观互参,可以收到满意的疗效。     

Impulse control disorders in chronic migraine with medication overuse after onabotulinumtoxinA: A single-center prospective cohort study

Chronic migraine (CM) with medication overuse headache (MOH) is one of the most common and disabling chronic headache disorders associated with both frequencies of use of medication and behavioral alterations, including psychopathology and psychological drug dependence. Several previous studies on large patient samples have demonstrated the efficacy of Onabotulinum toxin A (OnabotA) on physical symptomatology treatment of headache, but effects on behavioral alterations remain still debate. Our study investigated the effects of OnabotA on psychiatric comorbidities and on quality of life of patients with CM and MOH that failed on traditional therapies. OnabotA was injected, according to the PREEMPT paradigm, 40 patients with CM and MOH and data on headache-related impairment, before and after the OnabotA injections were collected from the patient’s headache diaries. Data on depressive, anxiety symptomatology and impulse control disorders also were collected by means of self-report scales and a semi-structured interview. After six months, patients with CM and MOH showed a significant decrease in monthly headache attacks (from 19.3 ± 5.9 to 11.8 ± 8.5, p = 0.003), monthly headache days (from 23 ± 8.9 to 11.1 ± 6.2, p = 0.001), numbers of analgesics used per month (from 18.2 ± 6.3 to 8.5 ± 4.7, p < 0.0001). The anxiety symptomatology (p ≤ 0.003) and impulse control disorders (from 30% to 10%), but not depressive symptomatology (p = 0.81), were significantly reduced from throughout the study. The treatment with OnabotA proved beneficial effects on anxiety symptomatology and on impulse control disorders in our clinical practice with CM and MOH and further studies should shed light in larger patient samples on long-term behavioural effects.     

The association between tic medication therapy and psychiatric comorbidities among patients with Tourette syndrome: A national population-based study in Taiwan

BackgroundTourette syndrome (TS) is often comorbid with attention deficit hyperactivity disorder, obsessive–compulsive disorder, and depression. Medications are the main treatment for TS. Relationships between TS medication therapy and psychiatric comorbidities remain unclear. This study explored the impacts of TS medication on the risk of psychiatric comorbidities using a nationally representative sample of TS in Taiwan.MethodsData from National Health Insurance Research Database in Taiwan was used to identify 997,213 children and adolescents aged 6–18 years who had received a diagnosis of TS based on ICD-9-CM codes in 2000–2010. Cox’s proportional hazard regression analysis was conducted to estimate the risk of comorbidities among subjects with and without tic medication therapy.ResultsWe found that in TS patients, a lower risk of psychiatric comorbidities occurred in the tic medication therapy group (p = 0.012) and the crude hazard ratio (HR) was 0.6 (95% confidence interval (CI) = 0.4–0.8, p < 0.001). After adjusting for potential confounders of gender, age, income, level of care, department visited, brain injury, and the number of suicide attempts, the risk of comorbidities was still significantly lower in the tic medication therapy group (adjusted HR = 0.5, 95% CI = 0.3–0.6, p < 0.001).DiscussionOne limitation was that we did not include all mediations used to treat psychiatric comorbidities among TS patients. This study found the effectiveness of TS medications on improving psychiatric comorbidities.ConclusionsCompared to those without medication, medication therapy appears to have a benefit of decreasing the risk of psychiatric comorbidities. Strategies to improve medication regimens should be considered in clinical settings.     

Psychological factors involved in psychopharmacological medication adherence in mental health patients: A systematic review

BackgroundPsychopharmacological medication adherence is essential for psychiatric patients’ treatment and well-being.ObjectiveThis review aimed to identify psychological factors related to health control that have been linked to psychopharmacological medication adherence in psychiatric patients.MethodsA literature search was performed through the databases Medline, PubMed, PsycINFO, and Google Scholar to identify relevant studies published before October 15th, 2019. Articles published in peer-reviewed journals that analyzed the psychological factors of health belief and health control involved in psychopharmacological medication adherence in a psychiatric population were included.ResultsThe search identified 124 potentially relevant papers, 29 of which met the eligibility criteria. The final sample was 222 adolescents, most with a diagnosis of attention deficit/hyperactivity disorder (ADHD), and 6139 adults diagnosed especially with schizophrenia spectrum disorder, bipolar disorder, or depressive disorder. Results suggested that medication adherence is associated with health beliefs and psychological variables, such as self-efficacy and locus of control. Family support was also positively related to medication adherence.ConclusionPsychopharmacological medication adherence requires a consideration of multicausality, which depends on sociodemographic, clinical, and psychological factors.Practice implicationsThese findings should be considered in the development and implementation of psychological interventions focused on self-control and family support.     

Explore the Application Law of Disperse Stagnation and Purge Heat with Bitter-Acrid Medicinals in Treating Endogenous Cough

内伤咳嗽以肺失宣肃、肺气上逆为基本病机。“苦辛通降助肺法”即借助药物气味的升降作用以使肺气宣降复常的治法，用于治疗内伤咳嗽可通过苦辛配伍来助肺宣降、调节气机。张之文教授为全国温病学泰斗，提出以“苦辛通降助肺法”治疗内伤咳嗽，临床效果显著。本研究以张老医案为基础，通过数据挖掘来管窥“苦辛通降助肺法”治疗内伤咳嗽的应用规律，为内伤咳嗽的治疗提供新的思路和方法。     

基于数据挖掘和网络药理学的血脂异常用药规律和作用机制研究＊

目的 从文献研究的角度出发，运用数据挖掘和网络药理学研究方法，探讨中医药在血脂异常治疗中的组成规律和作用机制研究，为该病的防治提供参考。方法 以1979-2019年“中国知网（CNKI）”、“万方数据”、“维普中文期刊”等数据库中检索到的中药复方治疗血脂异常文献为数据来源，采用中医传承辅助平台对其进行频次分析、关联规则分析和熵聚类方法分析，研究防治血脂异常方药组成规律，并在此基础上采用网络药理学方法，通过KEGG通路和基因本体富集分析，研究高频核心药物的生物信号通路，阐明其作用机制。结果 共计786篇文献符合检索条件，包含314味中药，发现48味高频中药，按照药物使用频次从高到低排序为：活血化瘀药、补虚药（健脾补肾为主）、利水渗湿药、消食化积药；药物性味以温、苦为主，归肝经和脾经最多；进一步关联分析得到高频药对（药组）17个；经过熵聚类分析发现潜在药物组合22个和新方组合11个。应用网络药理学研究方法，对核心药组“山楂、泽泻和决明子”的作用机制进行探索，发现其主要通过作用于包括雌激素受体1（ESR1）、大麻素受体1型（CNR1）、糖皮质激素受体基因（NR3C1）、环氧合酶2（PTGS2/COX2）等潜在靶点，干预三羧酸（TCA）循环、脂质代谢、脂肪酸降解等调节血脂相关的关键信号通路而发挥调节血脂作用。结论 中药治疗血脂异常以健脾补肾治其本，活血化瘀、消痰化积治其标的方法为主，核心药组的作用机制可能是通过干预脂质代谢和基础代谢相关通路发挥治疗作用。