以“四则四法”论治肺间质纤维化

[目的]通过数据挖掘方法,探讨分析宋康教授治疗间质性肺病的中医组方特色和用药规律,总结其临证经验。[方法]收集2014年1月至2018年12月于浙江中医药大学第一附属医院宋康教授门诊治疗的间质性肺病患者病案,提取所有患者处方药物,建立处方数据库;采用关联规则分析、系统聚类分析及中医复杂网络分析等数据挖掘方法进行分析总结,归纳宋康教授辨治间质性肺病的学术经验及用药规律。[结果]本研究共纳入处方1 114首,涉及药物203味。使用频次居前3位的单味药物为浙贝、桔梗、苏子,总结出核心药对3个、药组3组,并得出治疗间质性肺病的核心处方,由前胡、苏子、浙贝、桔梗、半枝莲、半边莲、虎杖、蛇舌草、鱼腥草、紫草、茜草、甘草组成。方中前胡、苏子、浙贝宣肺降气、化痰平喘,桔梗、半枝莲、半边莲、虎杖、蛇舌草、鱼腥草清热解毒散结,紫草、茜草走血分,有解毒祛瘀之功效,甘草调和诸药。[结论]宋康教授在治疗间质性肺病时以"痰""毒""瘀"为切入点,以清热解毒、化痰散瘀、化痰止咳平喘为主,重视固本祛邪、调畅气机,并擅用药对,精于配伍。     

基于数据挖掘的“真实世界”中医糖尿病症药关系研究

目的:利用关联规则,挖掘糖尿病真实临床症状与药物之间的关联关系。方法:通过成都中医药大学数字医药研究所研发的中医大数据平台,提取符合纳入标准的719例"糖尿病"真实临床医案中的症状、用药信息,构建临床病案数据库,采用频数统计及关联规则等数据挖掘方法,挖掘相关症药关系。结果:糖尿病高频症状为乏力、口渴、形体消瘦;常用药物为麦冬、知母、茯苓;挖掘出尿多—知母、形体消瘦—知母、多食易饥—石膏、麦冬等症药强关联规则。结论:应用数据挖掘方法,总结糖尿病真实临床症药分布规律,为糖尿病中医真实临床症药条目构建与优化奠定基础。     

基于数据挖掘的蔡宛如教授治疗咳嗽变异性哮喘用药规律分析

摘要：目的：基于回顾性分析和数据挖掘的方法探寻蔡宛如教授辨治咳嗽变异性哮喘（cough variant asthma, CVA）的用药规律。方法：收集2019年7月1日至2020年7月1日蔡宛如教授治疗CVA的172首处方,运用频数分析、聚类分析和关联规则的方法进行数据挖掘。结果：共涉及中药97味,高频药物为桔梗、防风、柴胡、北沙参、麻黄、蝉衣;药物类别以清热药、补虚药、止咳平喘化痰药为主;药性以寒、温、平为主;药味以甘、苦、辛为主;归经以肺、胃、脾经为主;关联规则分析显示关联性强的主要有以疏风解表、止咳平喘,疏肝理气、燥湿化痰,养阴润肺、补肺健脾为功效的三类药物;高频药物聚类分析得到7组核心药物,体现了祛风止痉、宣肺平喘、化痰止咳、疏肝解郁、降气泄热、敛肺固表、滋阴清热、健脾益气的治法。结论：蔡宛如教授治疗CVA临床经验丰富,用药以寒凉、清补为主,尤其重视滋养肺津,补肺气、疏肝气、益脾气。     

基于真实世界数据挖掘的洪善贻教授辨治晚期肺癌用药规律分析

目的：研究总结洪善贻教授辨治晚期肺癌的用药规律。方法：筛选250例从2014年6月至2019年6月洪善贻教授诊治的晚期肺癌病例及中药处方,借助古今医案云平台(V2.1个人版),录入医案信息,对中药的使用频数、功效、性味及归经、关联规则、聚类进行分析并采用复杂系统熵聚类法提取核心组合。结果：250例病案共应用249味中药,4140药次,频次≥50的有17味中药,药物功效主要集中在补气理气、清热解毒、化痰散结上。性味上甘平药最为常用,大热大寒之药用的最少。归经上肺、肝、脾三经的药物用的最多,关联规则分析显示关联性强的主要为异功散中的组成药物,根据聚类分析及复杂系统熵聚类法提取核心中药组合,可聚为10类,提取6个核心中药组合,主要体现在补肺健脾、清热解毒、化痰散结、疏肝理气、安神宁心、益气养阴。结论：洪善贻教授辨治晚期肺癌补益脾肺最常以异功散为基础方化裁,擅采用调肝健脾以补肺之法,标本兼治。基于真实世界的数据挖掘研究有利于洪善贻教授辨治晚期肺癌学术经验的总结。     

基于数据挖掘探讨沈红权治疗不寐处方的规律

目的 通过数据挖掘技术分析沈红权治疗不寐的用药经验及组方规律。方法 计算机收集并整理2019年12月至2022年12月就诊于上海中医药大学附属普陀医院沈红权主任门诊收治的不寐患者病史资料和医案处方,建立标准化数据库,借助古今医案云平台V2.3.7对处方中药物的性味、归经、应用频次、功效等进行统计分析,并对药味组合进行关联规则及聚类分析,总结处方用药经验和组方规律。结果 共纳入处方245首,涉及210味中药,总结归纳出高频单味中药20味。药性以平、寒、微寒为主,药味以甘、苦、辛为主,归经以肝、脾经为主。药物关联中得出高频药物药对关联规则8条;高频中药角药关联规则7条。药物聚类得出5个聚类处方。核心处方1主要用于肝血不足,虚热内扰证者;核心处方2主要用于伴下焦湿热伴便秘者;核心处方3主要用于气虚伴瘀热内蕴证者;核心处方4主要用于肝胆郁热证者;核心处方5主要用于肝郁脾虚证者。结论 沈红权主任治疗失眠以宁心安神、疏肝解郁为基本治法,实证常配伍清利湿热、凉血活血药物,虚实夹杂证配伍健脾养心、调和肝胃药物,虚证配伍益气养血、扶正安神为主。     

基于数据挖掘研究宋康教授治疗慢阻肺用药规律

目的：探讨宋康教授运用中医施治慢性阻塞性肺疾病（简称慢阻肺）的用药规律。方法：收集宋老师的有效处方,运用现代数据挖掘软件之中医传承辅助平台系统整理成相应的数据库,采用相应的关联规则及统计算法等,详细分析宋老师的处方里面药物使用的频率,药物与药物间的规律,及相应的关联规律。结果：详细分析所获取的200首处方,统计出10个核心药物组合方和5个全新的处方。结论：宋康教授治疗慢阻肺经验丰富,多用开肺降气,止咳平喘,健脾化痰之品。     

刘小虹治疗慢性阻塞性肺疾病用药规律探讨

[目的]采用数据挖掘的方法探讨刘小虹教授辨治慢性阻塞性肺疾病(COPD)的思路及用药规律,以期为临床中医治疗COPD提供参考.[方法]将刘小虹教授门诊治疗COPD的有效病案的处方录入中医传承辅助平台(V2.5),进行药物频次统计、药对组合及关联规则分析、核心药物组合与新方提取.[结果]共纳入处方215首,药物频次居前的...     

基于关联规则探索名老中医治疗心悸的用药规律

目的探索名老中医治疗心悸的用药规律。方法以《当代名老中医典型医案集》为数据源,采用频数分析、关联规则等数据挖掘方法对医案进行数据挖掘,对核心药物、药对规律进行探讨。结果通过对51则医案101诊次的分析,获得205味中药,1 370频次及核心药物38种;获得药对关联规则共22条。结论名老中医治疗心悸善用经方,喜用补气健脾、活血化瘀、补血养阴、清热泻火、养心安神、调畅气机等药物;丹参与诸药组成的药对,五味子与黄芪、五味子与麦冬、桂枝与甘草组成的药对在当代名老中医治疗心悸的医案中应用广泛。     

基于数据挖掘总结国医大师郭诚杰治疗乳腺增生病的用药规律

目的总结国医大师郭诚杰教授治疗乳腺增生病(Mammary gland hyperplasia,MGH)的用药规律。方法收集并整理郭诚杰教授临床辨证论治乳腺增生病处方,进行勘误后建立遣方用药数据库,并运用古今医案云平台系统(V2.2.1)对所选处方进行用药频次统计、用药模式及配伍关联规则分析。结果共纳入门诊病历483份,提取出处方1000份,总用药频次为12 176次,共使用231味药,10味核心药物,其中药物出现频次以补益药及化痰散结药为主,药物归经分布多为脾、肝、胃、肺、心等经,四气分布主要为温、平、微寒、寒等,五味分布主要为辛、甘、苦等。经关联分析后获得常用药物配伍14对。经聚类分析后可将高频药物分为3组。经复杂网络分析后获得10味药物组成的基本方。结论郭诚杰教授治疗MGH以肝脾为本,所采用的药物以养血健脾药、理气活血药、化痰散结药为主,随症加减。     

基于R语言探索宋康教授运用中药辅助吉非替尼辨治肺腺癌的用药规律

[目的]探索宋康教授运用中药辅助吉非替尼辨治肺腺癌的用药规律。[方法]将1246份宋康教授运用中药辅助吉非替尼辨治肺腺癌的中药处方录入Excel 2010建立处方数据库,采用R Language和R studio对处方进行数据挖掘、频数法分析高频药物分布、Gap Statistic法计算最优聚类数,K均值聚类算法进行聚类分析并可视化、因子分析法提取处方公因子、Apriori法分析药对与不良反应间关联度并用Matrix-Bubble可视化,总结宋康教授运用中药辅助吉非替尼辨治肺腺癌的用药规律。[结果]宋康教授运用中药辅助吉非替尼辨治肺腺癌的第一梯队药物1组:半枝莲、半边莲、白花蛇舌草、穿山甲、白毛藤、龙葵、浙贝母、薏苡仁、鱼腥草;第二梯队1组:前胡、炒苏子、枇杷叶、桔梗、射干、炒白术、茯苓、陈皮、太子参。前胡、炒苏子等11种聚类组合,半枝莲-半边莲-白花蛇舌草等13组公因子,太子参-枇杷叶等9组药对缓解吉非替尼不良反应。[结论]宋康教授运用中药辅助吉非替尼治疗肺腺癌,体现了祛邪-扶正-兼顾不良反应的思想,辨病-辨证-辨症相结合,疗效肯定,值得临床推广与应用。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.