优质护理干预对肺结核患者用药依从性的作用

目的对优质护理干预对肺结核患者用药依从性的作用进行观察。方法选择本院收治的120例肺结核患者作为本次研究的纳入对象,选取时间段为2017年1月-2018年1月,随机将这些患者划分为两组,甲组60例,乙组60例,采用常规护理方式护理甲组患者,在此基础上,应用优质护理干预的方式护理乙组患者,对两组患者的治疗依从性进行分析和比较。结果在经过精心的护理之后,甲组中23例完全依从,23例部分依从,14例不依从,总依从率达到了76.7%,乙组中37例完全依从,21例部分依从,2例不依从,总依从率达到了96.7%。乙组在总依从率方面相对于甲组而言更高(P <0.05)。结论采用优质护理干预的方式护理肺结核患者具有很好的效果,能够使患者的用药依从性得以显著提升,从而进一步保障患者的治疗效果。     

肾上腺嗜铬细胞瘤的临床病理特征分析

目的探讨肾上腺嗜铬细胞瘤(PCC)的临床病理特征。方法收集22例PCC患者的临床病历资料,分析临床表现、病理特征、免疫组织化学特征、鉴别诊断、治疗和预后。结果患者中位年龄46岁(23~67岁);男性13例、女性9例;临床常见症状包括高血压、腹胀腹痛;Ⅰ期10例、Ⅱ期12例;中位随访时间为72.5个月(14.9~117.7个月),其中1例复发、1例转移,其余患者均未发生复发及转移;CgA、Syn和CD56阳性表达率分别为95.2%、95.2%、100.0%,CK、Melan-A阴性表达率分别为90.5%和100.0%,Ki-67增殖指数低于10%,S100阳性表达率为76.2%。结论肾上腺PCC发病率低,但有转移和复发的可能,需要定期随访。     

Directly observed hepatitis C treatment with opioid substitution therapy in community pharmacies: A qualitative study

BackgroundThe hepatitis C virus (HCV) will only be eliminated through successful engagement with people who inject drugs (PWID), however some of this population experience socioeconomic and individual issues that can lead to poor HCV treatment adherence. A key sub-group of (PWID) are those who receive opioid substitution therapy (OST). In Australia, OST is most often delivered under direct supervision by a community pharmacist every day or multiple times a week. This regular interaction could be an ideal opportunity to enhance direct-acting antiviral (DAA) treatment adherence under directly observed therapy (DOT) by the pharmacist.AimThe aim of this study was to explore the perspectives of OST patients with a lived experience of HCV to understand whether or not dispensing DAAs in the same way as, or simultaneously with OST would benefit HCV treatment.MethodsData collection occurred from June to August 2017. Semi-structured interviews were conducted with a sample of PWID living with HCV and on OST programs (n = 12) in Melbourne, Australia. Interviews were voice recorded and transcribed in verbatim. Interpretive phenomenology guided analysis of the data.ResultsThemes reported by participants that provide insight into the suitability of DOT of DAAs include: Adherence and non-adherence to DAA treatment; Mixed views towards DOT of DAAs; Experiences and perceptions of OST providers; and Perceived stigma in the pharmacy.ConclusionsCommunity pharmacies offering OST may be an effective place for DOT of HCV treatment, but is likely only to benefit people who face significant challenges to adherence. We suggest that a positive pharmacist-patient relationship, high OST adherence, and commitment to reducing stigma in the pharmacy would be necessary for the intervention to be effective. Further research is needed to evaluate the expanded-role of community pharmacies in improving DAA adherence and eliminating HCV.     

《备急千金要方》腑实热病证组方配伍用药特色初探

《备急千金要方》集中体现了唐代初期以前的医学成就,具有很高的临床价值,首开脏腑论治先河,脏腑卷下分列虚实,提示辨证法门,方药罗列其中,以方示法。《备急千金要方》腑实热内容,以寸口脉位定脏腑,以阳实脉象示病性,以关联经脉及脏腑病症为提纲,以热邪充斥,经腑、脏腑同病为病理特征。依据各腑实热的病理特点,结合《千金翼方》本草理论,分析其组方用药特色,随腑实热病性不同有清养、清泻、清宣、清解等功效,视其兼证而用安神、泻下、利水、行气、凉血,解毒散结等药物。其组方配伍思路既可以针对现代疾病如不寐、头痛、乳痈、口疮、便秘、癃闭等提供借鉴,也可为临床新药开发提供方源和创新思路。     

基于“中医传承辅助平台”软件挖掘年莉教授治疗糖尿病肾病的用药规律

[目的] 采用"中医传承辅助平台"软件，探讨年莉教授治疗糖尿病肾病的用药规律。[方法] 将2016年11月-2019年4月年莉教授治疗糖尿病肾病的中药处方信息输入中医传承辅助平台系统，采用频次分析、组方规律分析方法挖掘、探讨年莉教授治疗糖尿病肾病的临床用药特点。[结果] 对年莉教授治疗糖尿病肾病158首处方进行分析，涉及中药207味，使用频次在前10位的药物分别为白芍、川芎、当归、半夏、刺蒺藜、丹参、泽泻、牛膝、厚朴，白术获得9组药对、3组核心药物组合。[结论] 年莉教授治疗糖尿病肾病经验丰富，高频药物的配伍体现了年莉教授多采用平肝疏肝，补血养阴，活血化瘀的治疗原则。期望能为临床治疗和药物研发提供参考，并为糖尿病肾病在泰国的治疗提供新的理念和借鉴。     

肺痿、肺痹与肺间质纤维化证候认识

弥漫性肺间质疾病是一类以弥漫性肺泡炎症和肺间质纤维化为基本病理改变的疾病总称,其中特发性肺间质纤维化是一类慢性进展、预后差、病死率高的特发性间质性肺炎。结缔组织疾病亦可造成肺损伤而出现肺间质纤维化的表现,症状均以咳、痰、喘等为主。现代中医学者认为肺间质纤维化当归属于中医学的肺痹、肺痿、喘证等范畴。古代文献中对肺痿的认识基于《金匮要略》,其证候特点以肺胃气阴两虚为主,亦可见肺气虚冷;肺痹则是尊崇《内经》中"五脏痹"的理论,主要证候特点为肺气闭阻;而肺间质纤维化的现代研究则表明其证候特点多以气虚为本、瘀血为标。因此,二者分别代表了肺纤维化的不同阶段和(或)不同证候特点,即肺纤维化患者表现出气阴两虚、虚热灼肺或肺气虚冷的证候特点可参照肺痿论治,若表现为肺气闭阻之实证特点则当以肺痹论治。     

Radiomics for classification of bone mineral loss: A machine learning study

PurposeThe purpose of this study was to develop predictive models to classify osteoporosis, osteopenia and normal patients using radiomics and machine learning approaches.Materials and methodsA total of 147 patients were included in this retrospective single-center study. There were 12 men and 135 women with a mean age of 56.88 ± 10.6 (SD) years (range: 28–87 years). For each patient, seven regions including four lumbar and three femoral including trochanteric, intertrochanteric and neck were segmented on bone mineral densitometry images and 54 texture features were extracted from the regions. The performance of four feature selection methods, including classifier attribute evaluation (CLAE), one rule attribute evaluation (ORAE), gain ratio attribute evaluation (GRAE) and principal components analysis (PRCA) along with four classification methods, including random forest (RF), random committee (RC), K-nearest neighbor (KN) and logit-boost (LB) were evaluated. Four classification categories, including osteopenia vs. normal, osteoporosis vs. normal, osteopenia vs. osteoporosis and osteoporosis + osteopenia vs. osteoporosis were examined for the defined seven regions. The classification model performances were evaluated using the area under the receiver operator characteristic curve (AUC).ResultsThe AUC values ranged from 0.50 to 0.78. The combination of methods RF + CLAE, RF + ORAE and RC + ORAE yielded highest performance (AUC = 0.78) in discriminating between osteoporosis and normal state in the trochanteric region. The combinations of RF + PRCA and LB + PRCA had the highest performance (AUC = 0.76) in discriminating between osteoporosis and normal state in the neck region.ConclusionThe machine learning radiomic approach can be considered as a new method for bone mineral deficiency disease classification using bone mineral densitometry image features.     

针药并用在早发性卵巢功能不全防治中的价值初探

早发性卵巢功能不全的常规西医治法包括激素替代疗法和辅助生殖技术,但均存在一定局限性。针药并用是在中医理论指导下,综合使用针灸和中药的一种综合治疗模式,在防治早发性卵巢功能不全中具有一定价值,不仅可提高临床疗效,还可为优化治疗方案、提高治疗安全性奠定基础。未来应进一步明确针药并用防治早发性卵巢功能不全的内涵,在中医理论指导下制定规范,深化基础研究,阐述相应机制,不断完善针药并用防治POI的体系。