基于真实世界数据探讨中医药治疗糖尿病肾病用药规律的研究＊

目的 基于临床信息系统分析总结真实世界的数据，采用数据挖掘的方法探讨中医药治疗糖尿病肾病的用药规律。方法 收集2018年1月-2020年12月上海中医药大学附属曙光医院宝山分院健康信息系统确诊的糖尿病肾病的门诊或住院患者的诊疗信息，建立Excel数据库，采用Excel 2010软件统计高频药物的四气、五味、归经及功效；使用SPSS Modeler 18.0软件中的Apriori算法分析关联规则，采用web节点建构药对关联网状图；运用SPSS 25统计软件进行因子分析。结果 本研究最终纳入477例接受中药饮片治疗的DKD患者，在1203条方剂信息中，涉及中药462种；使用频数排名前5位的中药分别是黄芪、黄精、石斛、山茱萸、麦冬；使用频数前5类的中药类别分别是补气药、补阴药、清热燥湿药、活血调经药、息风止痉药；在30味高频药物中，苦、甘、辛药味最为常见；药性寒、温数量接近；归脾经、肝经、肺经、肾经居多；关联规则提示，药物组合中置信度最高的组合为地龙-当归-僵蚕，因子分析共得到5个有效因子，累积贡献率为47.33%。结论 中医药治疗DKD在补益气血阴阳的同时，兼顾对瘀血、湿邪和痰饮的治疗，结合证型，可考虑使用黄芪、黄精、石斛、山茱萸、麦冬、金蝉花等药物的使用，清热燥湿药物如黄连、黄芩、黄柏可适当加入，为使邪有去处，大黄、车前子或可增添疗效。     

约束隐结构研究冠心病痰湿证的定量化辨证规则＊

目前在中医界已发布的冠心病痰湿证辨证标准是以主症、次症形式定性地给出，存在主观性较强的问题。本文引入约束隐结构分析，该方法将主症、次症的语义作为约束条件加入隐结构分析过程，得到含有主症、次症语义约束的定量化中医证候辨证规则。使用该方法对冠心病痰湿证患者556条无标签数据的分析，得到其约束隐结构模型，最后建立定量化痰湿证辨证规则，舌胖边有齿痕（3.16）、苔腻（3.12）、苔白滑（4.72）、胸闷（1.73）、脉濡或滑（6.04）；次症：肢体困重（0.48）、口黏（0.63）、体胖（0.49）、大便粘滞（1.38）、脘腹痞满（0.97）、面色晦浊（0.79）、嗜睡（1.18）、纳差（1.07）。与经典隐结构模型得到规则和中医界已发布的定性化辨证规则相比，约束隐结构得到的规则客观性强，具有可重复性。在证候类大小、规则的量化合理度上较好地反映了主症、次症的特点，得到的规则切合中医实际，为冠心病痰湿证辨证标准的定量化研究提供帮助和参考。     

Update on pediatric corneal diseases and keratoplasty

Managing pediatric corneal disorders is challenging as the prognosis of pediatric keratoplasty depends on several factors. Advancements in the genetic basis of congenital corneal diseases and investigations in congenital corneal conditions provide a better understanding of pediatric corneal conditions. Surgeons performing keratoplasty in children now have a choice of various techniques. Evolving surgical techniques of anterior lamellar and endothelial keratoplasties have expanded the management interventions in these pediatric corneal morbidity conditions; however, considerable concerns still exist in association with corneal transplantation in infants and children. Outcomes in pediatric keratoplasty depend upon the preoperative indications, the timing of surgical intervention, intraoperative and postoperative factors including the patient/care givers’ compliance. Factors such as low scleral rigidity, higher rate of graft failure, need for frequent examinations under anesthesia, and difficulty in optimal visual acuity assessment still remain a considerable challenge in pediatric scenarios. In children, deprivation amblyopia as a result of the corneal opacification can adversely affect visual development, causing dense amblyopia. Outcomes to surgical interventions for management of corneal opacification in children are further compromised by the preexisting amblyopia apart from the concerns of refractive outcome of the graft. Graft rejection, graft infection, amblyopia, and glaucoma continue to be serious concerns. In recent years both anterior and posterior lamellar keratoplasty techniques are being increasingly performed in pediatric eyes, which offer advantages in the form of lower risk of graft rejection. The timing of surgery, careful case selection, cautious intraoperative approach, and optimal postoperative management can improve the anatomical and functional outcome in difficult cases.     

中药复方配伍的研究方法及其进展

中药复方是由2味或2味以上中药遵循中医理论组合而成的方剂。多味中药在合适的剂量配比之下,协同发挥作用,实现中医的整体调节治疗。研究中药复方的配伍对推动中药现代化发展、新药开发以及临床应用有着重要意义。近年来,研究者们在传统的"七情和合"与"君臣佐使"的基础上,运用新技术和新方法对中药复方的成分、药效活性和药代动力学性质等进行了研究,从不同角度探讨了中药复方配伍的科学内涵。同时,多种数理方法和模型的建立、网络药理学和数据挖掘方法的发展与应用,也对中药复方配伍研究提供了很大帮助。研究方法的发展虽促进了中药复方配伍的科学研究,但还需进一步建立适合中药复方配伍复杂关系的研究方法,以阐明中药复方及其成分/组分配伍的内在规律,进而构建新的现代中药复方,这也是目前中药复方配伍研究的重点任务。     

Concussion incidence and time-loss in Australian football: A systematic review

ObjectivesAustralian football is associated with a risk of concussion. However, despite the extensive and varied nature of literature devoted to this issue, concussion incidence has not been systematically evaluated. To address this, we aimed to conduct a meta-analysis of concussion incidence in Australian football.DesignSystematic review. Prospero registration number: CRD42017064290.MethodsA systematic search of 14 databases using the terms ‘concussion’, and ‘Australian football’ (and variations) was used to obtain records that reported concussion incidence per 1000 players hours across age, sex, and level-of-play. Data were grouped based on how time-loss was applied to the concussion definition.ResultsForty-two studies met inclusion criteria. Incidence rates based on a possible time-loss definition per 1000 player hours, ranged from 2.24 to 17.63 at the elite level, and 0.35 to 14.77 at the community/amateur level. Return-to-play details were reported by six studies and only two studies measured head-impacts in real-time. Several limitations were identified with this literature. First, insufficient return-to-play details precluded a meta-analysis of incidence rates. Second, no longitudinal studies across levels-of-play were found. Third, concussion incidence data for junior and female players were notably scarce.ConclusionsThere was limited scope to determine concussion burden (i.e., incidence and severity) and only preliminary data for player exposure to head-impacts. To address these limitations, injury surveillance should capture sufficient information to permit comparisons within and across levels-of-play. This will also help determine the influence of interventions aimed at reducing the frequency and severity of concussive-injuries.     

基于中医传承辅助平台探讨清代方剂专著论述泄泻用药规律＊

目的 基于中医传承辅助平台软件（V2.5）提供的数据分析平台，研究清代方剂专著论述泄泻的用药规律，供现代中医临床辨证用药参考。方法 查阅中华医典（第5版）中的79部清代方剂专著，选择其中10部专门论述“泄泻”的方剂专著，建立数据库，通过中医传承辅助平台软件（V2.5）集成的药物“频次统计”、“规则分析”等功能，对治疗泄泻的用药规律进行分析。结果 本研究共筛选出93首泄泻处方，含药物119味，挖掘出高频（频次 ≥ 5）药物20味，高频（频次 ≥ 13）药物组合12组，演化得到19个核心药物组合和6首新处方。结论 清代方剂专著中治疗泄泻的方剂，多用利水消肿药、补益药，切合本病脾虚湿盛的病机。中医传承辅助平台（V2.5）可实现对于方剂数据的录入、管理、查询和分析，是一个富有价值的辅助中医药研究的工具。     

基于国家专利的中药复方治疗化学性肝损伤用药规律研究

目的分析国家专利治疗化学性肝损伤的组方用药规律,为新药研发及相关专利的申请提供参考。方法以国家知识产权局中国专利公布公告网站收录的授权专利为资料来源,使用Microsoft Excel 2018建立数据库,对中药频次与分类进行统计分析;采用SPSS Statistic 21.0和SPSS Modeler 15.0对高频中药(频次≥10)进行性味归经分析、系统聚类分析、关联度与网络分析。结果纳入专利100项,涉及中药186味,以葛根最为常见;高频中药15味,药味以甘为主,药性以温、平为主,多归脾、肝经;聚类分析得到7组中药组合;二项、三项和四项关联规则分别为6、24、2项,各项组合分别为6、16、2项;核心药物为葛根、五味子、丹参、甘草、山楂、枸杞子、黄芪、柴胡、姜黄和枳椇子。结论中药复方治疗化学性肝损伤常用补虚、解表、化瘀、活血、渗湿及利水药;临证多采用疏肝理气之剂,适当伍以柔润之品。     

基于数据挖掘探讨葛琳仪治疗慢性泄泻用药规律

目的:研究国医大师葛琳仪治疗慢性泄泻的用药规律,总结其相关学术思想。方法:利用Excel收集整理葛琳仪治疗慢性泄泻的处方数据,采用SPSS Clementine12.0进行关联分析,Apriori算法建立数据挖掘模型,用SPSS20.0对数据进行描述性分析及聚类分析。结果:共筛选出329个处方,包含216味中药,用药频次总计5 299次,使用频率较高的药物是陈皮、广木香、枳壳、生白芍、厚朴等,主要为理气药、补虚药、清热药、化湿药、消食药等,挖掘出药对或药物组合8组。结论:葛琳仪治疗慢性泄泻有立足脾胃,调畅气机;培补正气,标本同治;用药轻灵,思辨加减的特点,值得医者学习并传承。