基于关联规则和熵聚类的中医经方治疗抑郁症用药规律

目的:基于中医传承辅助平台(V2.5)软件,探讨中医经方治疗抑郁症的用药规律。方法:收集中国期刊全文数据库(CNKI),中文科技期刊数据库(VIP)和万方数据库发表的中医经方及其化裁治疗抑郁症的文献资料,时间设定为1986年1月至2016年12月,将所得数据规范完成后,输入中医传承辅助平台(V2.5)软件,建立数据库,运用中医传承辅助系统中的关联规则、改进的互信息法以及复杂系统熵聚类等无监督数据挖掘方法,分析治疗抑郁症经方中常用的药物、核心组合及发现新方。结果:筛选出符合条件的运用中医经方治疗抑郁症的发表文献共461篇,其中包含119首方剂,涉及中药155味,对其进行分析,发现方剂中出现有35味中药高频应用,频次前5位的中药为炙甘草、大枣、柴胡、半夏、白芍。通过关联规则挖掘出核心组合25个,通过聚类分析得到新方3个。结论:通过中医传承辅助平台(V2.5)对治疗抑郁症的中医经方进行分析,发现运用中医经方治疗抑郁症用药频次较高的中药,大多为辛甘温之品,归经于心、脾胃、肝、肾经的药物频率明显较高,其中尤以入心经为最多,这些高频中药大多有益气健脾、宁心安神、行气解郁的功效。经方治疗抑郁症注重通阳气、养心气、疏肝气、健脾气,为临床辨治抑郁症提供了参考。     

What is the association between income loss during the COVID-19 pandemic and children’s dental care?

BackgroundThe degree to which children experience unmet need for dental care during the COVID-19 pandemic and its association with pandemic-related household job or income loss are unknown.MethodsThe authors performed a cross-sectional household survey of 348 families in Pittsburgh, Pennsylvania, from June 25 through July 2, 2020. Unmet need for child dental care and pandemic-related household job or income loss were assessed using caregiver self-report.ResultsCaregivers reported that the greatest unmet child health care need during the COVID-19 pandemic was dental care (16%), followed by medical care for a well visit or vaccination (5%). Approximately 40% of caregivers reported job loss or a decrease in household income due to the COVID-19 pandemic. The authors found a significant association between the probability of unmet child dental care and pandemic-related household job or income loss (P = .022). Losing a job or experiencing a decrease in income due to the COVID-19 pandemic was associated with unmet child dental care (relative risk, 1.77; 95% confidence interval, 1.08 to 2.88).ConclusionsIn this sample, 3 times as many households reported unmet dental care for a child compared with unmet medical care. Unmet child dental care was more common in households where pandemic-related job or income loss occurred.Practical ImplicationsIf unmet dental care continues as a result of the COVID-19 pandemic, nontraditional strategies for delivering dental care can be considered to improve access to dental care for children, such as teledentistry and oral health prevention services in primary care settings.     

HPLC测定不同产地砂仁中原儿茶酸和香草酸的含量

目的:建立高效液相色谱法(HPLC)同时测定砂仁中原儿茶酸和香草酸的含量,并对不同产地砂仁的原儿茶酸和香草酸含量进行比较。方法:采用Phenomenex Luna C_(18)色谱柱(4.6 mm×250 mm,5μm),以甲醇-0.1%甲酸水为统计相进行梯度洗脱,柱温35℃,流速0.8 mL·min~(-1),进样体积15μL,检测波长260 nm。结果:原儿茶酸在0.000 7~0.008 9 g·L~(-1)呈良好的线性关系,平均回收率100.4%(RSD 3.2%);香草酸在0.000 6~0.030 3 g·L~(-1)呈良好的线性关系,平均回收率99.3%(RSD 2.8%)。对24批不同产地砂仁样品的原儿茶酸及香草酸含量测定结果进行聚类分析,结果显示不同产地砂仁样品分为两大类,一类为阳春砂与绿壳砂,另一类为进口壳砂仁、艳山姜伪品及加工方式为生晒的云南产阳春砂。结论:该方法简便、准确、重复性好,可用于不同产地砂仁中原儿茶酸和香草酸含量测定,为鉴别不同产地的砂仁样品提供参考。砂仁中香草酸含量受其加工方式影响含量变化明显。     

Psychological distress in ethnic minority parents of preschool children with burns

BackgroundLiterature indicates that children from ethnic minorities are at increased risk of sustaining burns. Moreover, parents may experience more psychological distress but why this is the case is poorly investigated.MethodsA prospective study including 120 mothers and 106 fathers of preschool children, of which 23 mothers and 24 fathers had an ethnic minority background, investigated levels of parental feelings of guilt, depressive and posttraumatic stress symptoms and compared Dutch parents with parents from different ethnic backgrounds on these outcomes. A qualitative study with 46 parents, 24 Dutch and 22 from different ethnic minority backgrounds, explored how they coped with the consequences of the burns.ResultsResults revealed more symptoms of posttraumatic stress and depression in ethnic minority parents. Ethnic minority fathers also had more guilt feelings. Lower social support, medical communication hampered by language barriers, lower health literacy and passive communication styles, (aspects of) religious coping and barriers to psychosocial care may partly explain the differences.ConclusionsParents with an ethnic minority background are at risk to experience increased distress after their child’s burn injury. By exploring the aforementioned factors, health care professionals may increase the family’s wellbeing. It may provide a starting point to offer tailored help.     

A two-step approach for mining patient treatment pathways in administrative healthcare databases

Clustering electronic medical records allows the discovery of information on healthcare practices. Entries in such medical records are usually composed of a succession of diagnostics or therapeutic steps. The corresponding processes are complex and heterogeneous since they depend on medical knowledge integrating clinical guidelines, the physician's individual experience, and patient data and conditions. To analyze such data, we are first proposing to cluster medical visits, consultations, and hospital stays into homogeneous groups, and then to construct higher-level patient treatment pathways over these different groups. These pathways are then also clustered to distill typical pathways, enabling interpretation of clusters by experts. This approach is evaluated on a real-world administrative database of elderly people in Québec suffering from heart failures.     

Family companions’ involvement during pre-surgical consent visits for major cancer surgery and its relationship to visit communication and satisfaction

Objective

To examine the association between family companion presence during pre-surgical visits to discuss major cancer surgery and patient-provider communication and satisfaction.

Do physicians discuss end-of-life decisions with family members? A mortality follow-back study

Objective

Deaths from chronic illness are often preceded by a potentially life-shortening end-of-life decision (ELD). Involving family in these ELDs may have psychosocial benefits for them and the dying person. This study aims to examine how often ELDs are discussed with relatives of the dying person and which characteristics determine their involvement in those ELDs.

Noxious family environments in relation to adult and childhood caries

BackgroundThe authors tested hypotheses that more noxious family environments are associated with poorer adult and child oral health.MethodsA community sample of married or cohabiting couples (N = 135) and their elementary school–aged children participated. Dental hygienists determined the number of decayed, missing and filled surfaces via oral examination. Subjective oral health impacts were measured by means of questionnaires completed by the parents and children. The parents completed questionnaires about interparental and parent-to-child physical aggression (for example, pushing) and emotional aggression (for example, derision), as well as harsh discipline. Observers rated the couples’ hostile behavior in laboratory interactions.ResultsThe extent of women's and men's caries experience was associated positively with their partners’ levels of overall noxious behavior toward them. The extent of children's caries experience was associated positively with the level of their mothers’ emotional aggression toward their partners.ConclusionsNoxious family environments may be implicated in compromised oral health. Future research that replicates and extends these findings can provide the foundation to translate them into preventive interventions.Practical ImplicationsNoxious family environments may help explain the limitations of routine oral health preventive strategies. Interprofessional strategies that also address the family environment ultimately may prove to be more effective than are single modality approaches.     

Clinical,immunological and genomic characteristics of children with X-linked agammaglobulinemia from Kerala,South India

X-linked agammaglobulinemia (XLA) is an X-linked recessive primary immunodeficiency disorder caused due to a pathogenic variant in the Bruton tyrosine (BTK) gene with an incidence of 1:379,000 live births and 1:190,000 male births. Patients affected with XLA present with recurrent infections of the gastrointestinal and respiratory tracts. Here we report the first case series of 17 XLA patients of 10 South Indian families with a wide spectrum of clinical and genetic features. In our cohort, patients presented mainly with recurrent pneumonia, gastrointestinal infection, otitis media, pyoderma, abscesses, empyema, arthritis, and osteomyelitis. Using next-generation and Sanger sequencing we have identified 10 unique pathogenic and likely pathogenic variants in 17 patients. This encompasses three nonsynonymous, two stop-gain, two frameshifts, two structural, and one splicing variant, out of which two of them are novel. Based on the type of variant, patients had variable clinical features and treatment responses. We have also evaluated Btk protein expression for six patients in comparison to the healthy individuals and determined mosaic Btk expression patterns in four mothers. We have also performed family screening in 6 families using Sanger sequencing and identified 19 carriers for the variant. The diagnosis for the patients led to the proper treatment i.e. 15 patients were on intravenous immunoglobulin (IVIG) and the other two had successful hematopoietic stem cell transplantation (HSCT). Unfortunately, two of our patients died due to sepsis, while on IVIG. We envision the present study could help in better understanding of patients with XLA and help in family screening and prenatal diagnosis. To the best of our knowledge, this is the largest case series of patients affected with XLA from South India.