中医信息学与表型组学:症状的遗传突变与证候的生物学基础初探

基于中医信息学和表型组学思想的病-证生物学基础研究的理论和方法学框架,解读证候的遗传结构和疾病关联.挖掘中医信息学与表型组学的理论内涵,阐明中医学与表型组学之间具有相互借鉴的重要意义;从病-证关系这一难点问题入手,将证候视为一系列特定症状表型的组合,从理论与方法上探索中医信息学与表型组学的桥接点,结合文献证明这一方向的...     

代谢组学、药物代谢组学与中医药现代化

在探讨复杂生命现象时,代谢组学、药物代谢组学对机体的整体性认识与传统中医药学的思维方法有一定的趋同性。如果在中医药现代化研究中,有效地契合代谢组学研究方法,将能够深化中药的整体疗效评价、证候的内在本质及辨证施治研究,加快传统中医药与现代生命科学技术的结合,推动中医药现代化,为中医药的发展提供新的空间。     

基于代谢组学的中医证候本质研究进展

中医证候本质研究是中医药学基础理论研究的关键科学问题,而证候体系的复杂性使得其难以用还原论指导下的现代医学方法来揭示其科学内涵,代谢组学以其系统性、动态性、综合性的特点与中医证候的整体观、恒动观、辨证论治思维模式有异曲同工之妙,因此在揭示疾病的证候本质方面代谢组学具有巨大优势。本文从临床疾病及亚健康证候的代谢组学研究、病证结合动物模型的代谢组学分析等方面。对近年来中医疾病证候本质研究中的代谢组学应用相关文献进行综述,以期推动代谢组学在中医药学研究领域的应用。     

表型(证候)可塑性与数量性状位点研究

证候的基因组学研究是“后基因组时代”研究中医证候的热点之一 ,其中重点与难点是表型(证候 )的可塑性与数量形状位点之间复杂的关系问题。结合该领域的研究 ,对表型 (证候 )与数量性状位点从概念、研究进展到两者之间存在的复杂关系等方面进行了概述 ,并提出该领域的研究是阐明证候时空特异性的可能方向     

中医证本质研究与代谢组学技术：现状与思考

证候一直是中医药研究的核心问题,其中证本质研究是中医药现代化研究中最主要的攻关对象,但证候本身的复杂性使其很难通过现代医学还原论的方法来阐释。新涌现的代谢组学以其整体、动态、重视功能变化等特点,与中医证候对病理状态的表达理念不谋而合,在揭示证候的本质规律方面,代谢组学显示出较强的优势。本文通过对证本质研究与代谢组学技术在证本质研究中应用的现状进行综述和分析,发掘证本质研究与代谢组学技术之间存在的契合性及尚需解决的问题,并对其中关键问题进行思考,提出几点解决建议。     

中医疾病证候与组学的相关性研究现状

随着后基因组时代的到来,＂组学＂成为生命科学研究领域的热点,并在中医药领域也得到了较为广泛的应用。作者从中医证候的宏观角度出发,对基因组学、蛋白质组学、代谢组学等技术在中医疾病证候分类中的应用进行了系统性、规范性的文献研究,探讨中医疾病证候与组学的相关性及其意义。作者指出证候与组学的相关性研究任重而道远,对实现中医辨证论治的科学化和定量化具有重大的临床意义。     

"证治代谢组学"假说的研究思路与实践

"证候"基础研究是中医药学现代研究的关键问题之一,是证型规范化和客观化的前提,而代谢组学的方法和技术给"证候"基础研究带来了曙光。通过多年中西医结合临床实践发现,病理状态下不同中医证型间及辨证论治前后患者存在体内代谢物差异,因此在充分回顾、分析既往文献的基础上提出"证治代谢组学"的研究设想。"证治代谢组学"假说以冠心病（CHD）为研究载体,以"证"为切入点,主要探讨基于代谢组学的CHD生化代谢谱与其中医证型的相关性。本文主要介绍了"证治代谢组学"假说的概念与内涵、研究背景、研究依据、研究实践、特色及临床意义。     

应用代谢组学技术进行中医药研究探讨

代谢组学作为系统生物学研究领域中最为活跃的分支学科之一,近年来发展迅速,成为国内外研究的热点.由于代谢组学原理与中医理论思维有许多异曲同工之处,为研究复杂的中医理论和中医药现代化提供了新的思路和研究平台.通过论述代谢组学用于中医药研究的优势,及其在中医证候、中药药效、中医藏象、中医体质等方面的应用进展,认为代谢组学技术在中医药研究的应用中具有广阔的前景,有望取得理论上的重大突破.     

代谢组学在中医药领域中研究与应用

目的:介绍近年来基于代谢组学的中医药研究进展。方法:通过检索近年来代谢组学在中医药研究中的应用的文献37篇,对其进行归纳总结。结果:代谢组学是近年来快速发展的“组学”,作为一种系统性、整体性的研究方法,与中医理论整体观、恒动观、辨证论治的研究思路有一定的趋同性,符合中医药多成分、多靶点、整体综合效应的特点。近年来在中医药的研究中得到广泛应用。该文旨在对代谢组学的定义、研究技术、研究方法方面,并从代谢组学在中医证候研究、体质研究、模型的复制、中药作用机制、中药有效物质基础、中药方剂的配伍规律、药物安全性评价、疾病的诊断等方面进行阐述。结论:两者结合将有助于探索出中医药复杂理论体系研究的新方法、新途径,有助于更好的传承和发展中医药。     

基于代谢组学的中医证候研究

证候一直是中医药研究的核心问题,但证候的复杂性使其很难通过现代医学的还原论方法来阐释。代谢组学是新近发展起来的一种组学方法,因其具有整体、动态等特点,与中医思维不谋而合,因此被广泛应用于中医证候的研究,且已显示出一定的优势。     

中医新名词术语发展趋势——《中医新知识辞典》编后记

通过编写《中医新知识辞典》对1840年以来中医药学出现的2000个新概念、新名词术语进行了整理和规范,发现中医新名词术语的发展趋势是:①由经典词汇分化、转化、衍化出新概念;②用现代科学知识和方法研究中医传统概念而形成新词语;③将现代技术手段运用于中医药临床和科研而形成新型技术术语。上述趋势描述出中医药学术发展的现代轨迹。整理中发现的问题是:新名词术语的量不够大;有些概念尚不稳定或存在歧义;中西医结合的理论性概念不多,标示着中西医在理论水平上的融合非常有限;存在着在概念尚未明晰的情况下草率创立和使用新词语的现象。     

Using SNOMED CT to Represent Two Interface Terminologies

Objective

Interface terminologies are designed to support interactions between humans and structured medical information. In particular, many interface terminologies have been developed for structured computer based documentation systems. Experts and policy-makers have recommended that interface terminologies be mapped to reference terminologies. The goal of the current study was to evaluate how well the reference terminology SNOMED CT could map to and represent two interface terminologies, MEDCIN and the Categorical Health Information Structured Lexicon (CHISL).

Design

Automated mappings between SNOMED CT and 500 terms from each of the two interface terminologies were evaluated by human reviewers, who also searched SNOMED CT to identify better mappings when this was judged to be necessary. Reviewers judged whether they believed the interface terms to be clinically appropriate, whether the terms were covered by SNOMED CT concepts and whether the terms' implied semantic structure could be represented by SNOMED CT.

Measurements

Outcomes included concept coverage by SNOMED CT for study terms and their implied semantics. Agreement statistics and compositionality measures were calculated.

Results

The SNOMED CT terminology contained concepts to represent 92.4% of MEDCIN and 95.9% of CHISL terms. Semantic structures implied by study terms were less well covered, with some complex compositional expressions requiring semantics not present in SNOMED CT. Among sampled terms, those from MEDCIN were more complex than those from CHISL, containing an average 3.8 versus 1.8 atomic concepts respectively, p<0.001.

Conclusion

Our findings support using SNOMED CT to provide standardized representations of information created using these two terminologies, but suggest that enriching SNOMED CT semantics would improve representation of the external terms.     

中医学的科学价值与现状和发展

概括了中医学的学科性质和优势及其衰落的主要原因,提出发展中医药的建议,并将阴阳气化从纵深面深入,把阴阳的"抽象"名词改为"科学"名词,简单阐明事物与物质属性阴阳的天然定理,表达中医四诊八纲的科学道理。     

从“经验”到“证据”: 循证医学促进中医药传承创新发展

循证医学被引入中国并传播推广已有20余年, 在中医药研究领域取得了阶段性的成绩, 该文通过对循证中医药学内涵的分析, 简要梳理了循证中医药研究发展的现状、面临的挑战, 总结了目前循证中医药学发展面临着的“四多”“四少”现象。该文结合对循证医学方法学体系(包括方法论和基本研究方法)的重新认识, 提出基于循证实践的中医临床相关研究实施建议, 以期促进中医药从“经验”到“证据”的转化, 发挥中医药原创优势, 助力中医药传承与创新发展。      

罗元恺高等中医教育管理思想研究

介绍罗元恺中医教育管理理念.其躬身亲创的自信自强、融合至上的教育思想和具有中医特色的管理方法至今影响着中医院校的高等教育模式,是我国中医高等教育的宝贵财富,对我国今后的中医教育发展具有深远的启示.     

Consumer Health Concepts That Do Not Map to the UMLS: Where Do They Fit?

Objective

This study has two objectives: first, to identify and characterize consumer health terms not found in the Unified Medical Language System (UMLS) Metathesaurus (2007 AB); second, to describe the procedure for creating new concepts in the process of building a consumer health vocabulary. How do the unmapped consumer health concepts relate to the existing UMLS concepts? What is the place of these new concepts in professional medical discourse?

Design

The consumer health terms were extracted from two large corpora derived in the process of Open Access Collaboratory Consumer Health Vocabulary (OAC CHV) building. Terms that could not be mapped to existing UMLS concepts via machine and manual methods prompted creation of new concepts, which were then ascribed semantic types, related to existing UMLS concepts, and coded according to specified criteria.

Results

This approach identified 64 unmapped concepts, 17 of which were labeled as uniquely “lay” and not feasible for inclusion in professional health terminologies. The remaining terms constituted potential candidates for inclusion in professional vocabularies, or could be constructed by post-coordinating existing UMLS terms. The relationship between new and existing concepts differed depending on the corpora from which they were extracted.

Conclusion

Non-mapping concepts constitute a small proportion of consumer health terms, but a proportion that is likely to affect the process of consumer health vocabulary building. We have identified a novel approach for identifying such concepts.     

文化人类学研究与中医

介绍了文化人类学与中医研究相关的基本概念、具体运用方法和代表性研究。该学科在西方人文科学中有较大影响力 ,但在中国仍属于新鲜学科。作者认为文化人类学研究对中医学具有很大潜力 ,并试探性指出一些新的研究方向     

The UMLS-CORE project: a study of the problem list terminologies used in large healthcare institutions

Objective

To study existing problem list terminologies (PLTs), and to identify a subset of concepts based on standard terminologies that occur frequently in problem list data.

Design

Problem list terms and their usage frequencies were collected from large healthcare institutions.

Measurement

The pattern of usage of the terms was analyzed. The local terms were mapped to the Unified Medical Language System (UMLS). Based on the mapped UMLS concepts, the degree of overlap between the PLTs was analyzed.

Results

Six institutions submitted 76 237 terms and their usage frequencies in 14 million patients. The distribution of usage was highly skewed. On average, 21% of unique terms already covered 95% of usage. The most frequently used 14 395 terms, representing the union of terms that covered 95% of usage in each institution, were exhaustively mapped to the UMLS. 13 261 terms were successfully mapped to 6776 UMLS concepts. Less frequently used terms were generally less ‘mappable’ to the UMLS. The mean pairwise overlap of the PLTs was only 21% (median 19%). Concepts that were shared among institutions were used eight times more often than concepts unique to one institution. A SNOMED Problem List Subset of frequently used problem list concepts was identified.

Conclusions

Most of the frequently used problem list terms could be found in standard terminologies. The overlap between existing PLTs was low. The use of the SNOMED Problem List Subset will save developmental effort, reduce variability of PLTs, and enhance interoperability of problem list data.     

药用动物资源学与动物药学科建设发展现状及展望

动物类中药资源是中药资源的重要组成部分, 在我国有着悠久的应用历史, 且具有独特的生物活性。作为中药资源学的分支学科, 药用动物资源学科建设目前尚处于发展阶段, 亟需加强建设力度, 不断完善学科体系。动物类中药领域的科学研究主要涉及药用动物资源调查、药用动物规范化养殖及质量标准体系、珍稀濒危药用动物新资源寻找与替代等方面。在以往研究成果的归纳整理分析基础上, 提出药用动物资源学学科建设及科学研究进一步研究方向, 以期为动物类中药资源领域的学科建设、人才培养、科学研究、社会服务及产业发展提供借鉴, 为我国动物类中药事业和产业高质量发展提供支撑。      

Standard Protocol Items for Clinical Trials with Traditional Chinese Medicine 2018: Recommendations, Explanation and Elaboration (SPIRIT-TCM Extension 2018)

Traditional Chinese Medicine(TCM) is one of the oldest systems of medicine. More and more attention has been paid to TCM application, but the variable quality of clinical trials with TCM impedes its widespread acceptance. The Standard Protocol Items: Recommendations for Interventional Trials(SPIRIT) 2013 Statement has established guidelines for designing clinical trials to ensure that the trial results are accurate and reliable. However, there are difficulties when applying SPIRIT 2013 Statement to trials with TCM, due to the unique theory and the characteristic of TCM intervention. An Extension to the original SPIRIT was developed to ensure the quality of trial design with TCM. As Chinese herbal formulae, acupuncture and moxibustion are common and representative interventions in TCM practice, the executive working group determined that the SPIRIT-TCM Extension focus on these three interventions. Extension was developed through initiation, 3 rounds of Delphi consensus survey, and finalizing expert meeting. Seven items from the SPIRIT 2013 Statement were modified, namely, "title", "background and rationale", "objectives", "eligibility criteria", "interventions", "outcomes", and "data collection methods". The Extension includes the introduction of the concept of TCM pattern and 3 major TCM interventions, with examples and explanations. The SPIRIT-TCM Extension 2018 provides suggestion for investigators in designing high quality TCM clinical trials. It is expected that wide dissemination and application of this extension ensure continuous improvement of TCM trial quality throughout the world.