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。     

Trends in Use and Outcomes of Same-Day Discharge Following Elective Percutaneous Coronary Intervention

ObjectivesThe aims of this study were to describe trends and hospital variation in same-day discharge following elective percutaneous coronary intervention (PCI) and to evaluate the association between trends in same-day discharge and patient outcomes.BackgroundInsights on contemporary use of same-day discharge following elective PCI are limited.MethodsIn a sequential cross-sectional analysis of 819,091 patients undergoing elective PCI at 1,716 hospitals in the National Cardiovascular Data Registry CathPCI Registry from July 1, 2009, to December 31, 2017, overall and hospital-level trends in same-day discharge were assessed. Among the 212,369 patients who linked to Centers for Medicare and Medicaid Services data, the association between same-day discharge and 30-day mortality and rehospitalization was assessed.ResultsA total of 114,461 patients (14.0%) were discharged the same day as PCI. The proportion of patients with same-day discharge increased from 4.5% in the third quarter of 2009 to 28.6% in the fourth quarter of 2017. From 2009 to 2017, the rate of same-day discharge increased from 4.3% to 19.5% for femoral-access PCI and from 9.9% to 39.7% for radial-access PCI. Hospital-level variation in the use of same-day discharge persisted throughout (median odds ratio adjusted for year and radial access: 4.15). Risk-adjusted 30-day mortality did not change over time, while risk-adjusted rehospitalization decreased over time and more quickly for same-day discharge (P for interaction <0.001).ConclusionsIn the past decade, a large increase in the use of same-day discharge following elective PCI was not associated with worse 30-day mortality or rehospitalization. Hospital-level variation in same-day discharge may represent an opportunity to reduce costs without compromising patient outcomes.     

Designing a data set for postpartum recall registry of women with gestational diabetes in recent pregnancy and its implementation in Iranian urban health centers

Background and aimsGestational diabetes has serious short and long-term consequences for both mother and child. Designing a standard data set and implementing a recall registry system provides opportunities for early interventions in women with a history of gestational diabetes. The present study aims to draft a data set for the gestational diabetes recall registry and its establishment in urban health centers.MethodsTo design a data set for gestational diabetes postpartum recall registry a qualitative study has been done from April to June of 2019. In this stage, Information need assessment, Identification of data elements, development of registry software, and field-testing were done. Web-based software was designed in NET language and using a Visual Studio programming environment. Implementation of the postpartum recall registry was started in 6 health centers of Ahvaz city from August 2019.ResultsDuring six months 163 women with gestational diabetes in current pregnancy were registered. The final data set for the postpartum recall registry included six main groups, 23 subclasses, and 188 data elements. Mandatory data were included 115 elements.ConclusionA data set was finalized using a standard method and implemented in urban health centers for six months. Implementing a postpartum registry with standard elements can help manage data and plan for future interventions to reduce modifiable risk factors in this population.     

土家医药半结构化数据的功效挖掘及可视化研究＊

目的 利用数据挖掘技术对半结构化数据的土家族医药进行品种规范和常用功效的可视化发现。方法 收集整理《中国民族药辞典》、《土家医方剂学》等土家族代表性医药文献，建立土家族医药原始数据库，包含药物拉丁学名、药用部位、性味、毒性、功效、主治疾病等。借助Visual FoxPro 9.0软件对土家族医药特性进行频次统计和品种规范，主要以法定标准收录；借助TCMISS (V2.5)、Cytoscape3.6.1、Gephi0.9.2等软件对土家药“药物-功效-主治”间的语义关系，进行功效挖掘和可视化展示。结果 筛选土家药共1453味，方剂共771首，其中土家药主要以“寒（凉）、平”性偏多，苦味药频次最高，其次是辛味药、甘味药；清热败毒、赶风除湿等功效出现频次最高；皮肤疮癣、妇科疾病等是关联程度较大的主治病症。结论 土家族医药的品种规范和“药性-药味-功效-主治”隐形关系可视化分析，可为完善土家药信息化研究奠定基础。     

汉代以来著名医家治疗痰饮用药规律的数据挖掘研究＊

目的 探讨汉代以来著名医家治疗痰饮的方剂用药与组方规律，以期对痰饮临床治疗及中药新药研发提供参考。方法 收集整理汉代以来著名医家的痰饮论述与医案共涉及208首方剂，录入中医传承辅助系统（V2.5），采用改进的互信息法、关联规则、复杂系统熵聚类、无监督的熵层次聚类，进行痰饮数据库单药、对药、角药的统计、关联规则分析、提取核心组合与新方发现，进行数据挖掘研究。结果 最常见单药是半夏（117次，占56.25%）；最常见对药是半夏-茯苓（62次，占29.81%）；最常见角药是半夏-陈皮-茯苓（33次，占15.87%）；关联度最高的药物组合是生姜 + 茯苓→半夏（置信度为0.8636）；得到18组3味药的核心组合，核心药物为：半夏、茯苓、陈皮、生姜、甘草、桂枝等；得到治疗痰饮9个新候选处方。结论 提示今后痰饮治疗及新药研发时，单药、对药、角药优先考虑：半夏、陈皮、茯苓；配伍优先考虑：生姜、茯苓配伍半夏；核心方剂优先考虑：杏仁-麻黄-桑白皮；新候选处方优先考虑：杏仁、麻黄、桑白皮、阿胶、款冬花。     

艾灸治疗失眠的临床应用规律分析＊

目的 回顾1959年至2018年发表的灸法治疗失眠的临床文献，总结归纳灸法治疗失眠的临床应用规律。方法 检索《中国针灸信息库》、中国期刊全文数据库（清华同方）、万方数字化期刊（万方）、中文科技期刊全文数据库（维普），按照纳入和排除标准筛选灸法治疗失眠的临床研究文献，进行计量分析、聚类分析和关联性分析。结果 艾灸治疗失眠应用频次较高的穴位依次为百会、三阴交、神门、足三里；足太阳膀胱经穴应用频次最高，其次是督脉穴和肾经穴。下肢部的腧穴使用频次最高，其次为头面部、背部。关联性较高的穴对为内关、足三里、神门、百会和三阴交，关联性较高的治疗方法为艾条灸配合针刺。灸法配合中药的总有效率最高，其次为灸法配合针刺，疗效均优于单纯灸法（均P < 0.05）。对比灸法、灸药并用、灸刺并用疗法治疗前后的PSQI评分，灸法与灸药并用疗法比较差异有统计学意义（P < 0.05），与灸刺并用比较差异无统计学意义（P > 0.05）。结论 灸法治疗失眠的组方中主要穴对为内关、足三里、神门、百会和三阴交。配合疗法中灸刺结合的使用频率最高，但灸法配合中药疗法的有效率最高，对于PSQI评分的改善程度亦最大。     

NI-RADS for head and neck cancer surveillance imaging: What,why, and how

The Neck Imaging Reporting and Data System (NI-RADS) was conceived in 2016 with the objective of standardizing assessment and reporting in surveillance imaging for patients with head and neck squamous cell carcinomas and their subsequent management. The goals are to simplify radiology reports while increasing the consistency and accuracy of the interpretation of cancer surveillance imaging; enable better communication among clinicians and between clinicians and patients; facilitate outcomes research; and ultimately improve patient survival, morbidity, and mortality. The objective of the current study was to provide the background as to why and how NI-RADS was conceived and what it entails in radiology reporting.     

The diagnostic accuracy of 1.5 T versus 3 T non-echo-planar diffusion-weighted imaging in the detection of residual or recurrent cholesteatoma in the middle ear and mastoid

Purpose and backgroundThis study retrospectively compares diagnostic performance of 1.5 T versus 3 T non-echo planar diffusion weighted imaging with or without additional T1 and T2 sequences in the detection of residual and/or recurrent cholesteatoma.MethodsPatients with clinically suspected recurrent cholesteatoma or postoperative routine survey MR who subsequently underwent surgical procedure were retrospectively included (135 patients, 164 operated ears) from a large database. Patients underwent 1.5 T (128 ears) or 3 T MRI (36 ears), with non-echo planar DWI, T1 and T2 acquisitions. Two radiologists independently reassessed the images. Definitive surgical diagnosis was used as gold standard. Sensitivity, specificity and diagnostic odds ratio were evaluated.ResultsAccording to surgical diagnosis a cholesteatoma was present in 124 of 164 ears, corresponding with a prevalence of 75%. Sensitivity and specificity were lower for 3 T compared to 1.5 T, irrespective of whether additional T1 and T2-weighted sequences were used or not. Diagnostic odds ratios were higher for 1.5 T (34 and 12 for reader 1 and 2, respectively) compared to 3 T (3 and 4 for reader 1 and 2, respectively). Adding T1 and T2 sequences lowers sensitivity but increases specificity.ConclusionNon-epi DWI for the detection of residual/recurrent cholesteatoma is preferably performed on 1.5 T scanners over 3 T. The use of additional sequences regarding detection of cholesteatoma is debatable as it lowers sensitivity but increases specificity. However, these sequences may also be of use in diagnosing complications and planning surgical procedures in some hospitals.     

Evaluation of the Effect of Routine Antibiotic Administration after Uterine Artery Embolization on Infection Rates

PurposeTo evaluate the effect of routine administration of post-procedural antibiotics following elective uterine artery embolization (UAE) on infectious complication rates.Materials and MethodsThe charts of patients who underwent UAE between January 2013 and September 2019 were retrospectively reviewed. Prior to January 15, 2016, all patients received post-procedural antibiotics with 500 mg of ciprofloxacin twice a day orally for 5 days. After January 15, 2016, none of the patients received post-procedural antibiotics. All patients in both groups received pre-procedural intravenous antibiotics. The post-procedural antibiotics group included 217 patients (age, 44.7 ± 6 years); the no-antibiotics group included 158 patients (age, 45.4 ± 5.6 years). Patients in the no-antibiotics group had a significantly higher rate of diabetes mellitus (P = .03) but fewer cases of adenomyosis (P = .048). Otherwise, demographic and fibroid characteristics were similar between the groups.ResultsSix infectious complications (6/375, 1.6%) were recorded. No statistically significant difference (P = .66) was observed in the number of infections between the post-procedural antibiotics group (4/217, 1.8%) and the no-antibiotics group (2/158, 1.3%). Three of the 6 infectious complications presented with malodorous vaginal discharge (3/375, 0.8%) and received nominal therapy. The 3 remaining complications (0.8%) were considered major and included 2 patients (0.5%) who underwent hysterectomy and 1 patient (0.3%) who underwent myomectomy. The major infection rate was 0.9% (2/217) in the post-procedural antibiotics group and 0.7% (1/158) in the no-antibiotics group (P = 1). There were no 90-day post-procedural mortalities.ConclusionsDiscontinuation of routine post-procedural antibiotics with ciprofloxacin after elective UAE did not result in increased rates of infectious complications within the first 90 days post procedure.