基于网络药理学和分子对接技术探讨黄芪干预腹膜纤维化的机制

目的 运用网络药理学方法及分子对接技术探讨黄芪干预腹膜纤维化的可能机制。方法 利用中药系统药理学数据库及分析平台(TCMSP)检索黄芪的主要化学成分及靶点,并补充文献报道相关药理作用的成分作为潜在活性成分。以"peritoneal fibrosis"为关键词分别在OMIM、Genecards获取目前已知的与腹膜纤维化相关的疾病靶点,后取两者的交集靶点;对交集基因通过STRING数据库与Cytoscape 3.7.2软件构建"药物-成分-靶点-疾病"网络及蛋白互作(PPI)网络并筛选核心网络。基于R软件使用Bioconductor生物信息软件对核心靶点进行GO及KEGG富集分析,最终采用AutoDock软件将主要有效成分与核心靶点进行分子对接,得出其结合能力。结果 筛选出20个黄芪活性成分及文献报道有相关药理作用4个, 457药物作用靶点,与674个腹膜纤维化病靶点取交集,得到86个共同靶点。GO功能富集分析提示黄芪拮抗腹膜纤维化主要参与了蛋白激酶B信号转导的调节、细胞对化学的应激反应、炎症反应的调节等通路; KEGG通路富集分析主要涉及调控肿瘤、磷脂酰肌醇-3-羟激酶-蛋白激酶B(PI3K-Akt)、晚期糖基化终末产物/晚期糖基化终末产物受体(AGE-RAGE)、人类巨细胞病毒感染、HIF-1信号通路等;分子对接结果显示关键靶点与活性成分具有较好的结合能力。结论 黄芪治疗腹膜纤维化的分子机制,可能与抑制炎症及氧化应激反应、调节多种信号通路等相关。     

康莱特注射液联合紫杉醇治疗晚期恶性胸腺瘤的疗效观察

目的:比较康莱特注射液联合紫杉醇及紫杉醇单纯化疗治疗晚期恶性胸腺瘤的不良反应和疗效。方法:2013年8月至2017年12月，经病理学和免疫组化确诊为恶性胸腺瘤并在我院肿瘤中心进行姑息性化疗的患者68例。康莱特注射液联合化疗为观察组（37例）；单纯化疗为对照组（31例）。28天为一周期，共化疗4周期。结果:两组患者均无人发生过敏反应。观察组可有效减轻患者化疗不良反应:恶性、呕吐、四肢麻木、关节肌肉酸痛和白细胞下降(P＜0.05)，可以有效减轻患者胸闷症状和全身疼痛(P＜0.05)，在肿瘤控制方面，康莱特联合化疗的疗效较单纯化疗稍好，但均未见有统计学差异(P＞0.05)。结论:康莱特注射液联合紫杉醇治疗晚期胸腺瘤，具有减轻患者疼痛、减轻化疗不良反应，从而提高患者化疗依从性的作用，值得临床进一步推广和研究。     

面肌痉挛微血管减压术中异常肌反应变化特点与术后疗效关系探究

目的探究面肌痉挛患者微血管减压术(MVD)中异常肌反应(AMR)的变化特点与术后疗效的关系。方法回顾性分析73例MVD术中采用AMR全程定量化监测患者的AMR变化特点,减压操作前AMR阈值较基础阈值升高≥1倍为A1组、1倍为A2组,手术结束时AMR完全消失为B1组、未消失为B2组,B2组中AMR阈值较基础阈值升高≥1倍为B2a组、1倍为B2b组,对各组的术后疗效进行对比分析。结果 A1组21例中,19例立即治愈,1例延迟治愈,1例未愈; A2组52例中,35例立即治愈,9例延迟治愈,8例未愈。A1组较A2组疗效好(P=0. 046)。B1组50例中,42例立即治愈,5例延迟治愈,3例未愈; B2组23例中,12例立即治愈,5例延迟治愈,6例未愈。B1组较B2组疗效好(P=0. 003)。B2 a组的治愈比例较B2 b组高(分别为14/16、3/7),差异有统计学意义(P=0. 045)。结论 AMR在术中的变化特点对术者有重要参考意义,AMR在减压前升高、在手术结束时完全消失、未消失但升高较基础阈值≥1倍者术后疗效相对较好。     

内脏利什曼病合并HIV感染患者诊断和治疗研究进展

内脏利什曼病是全球被忽视的传染病之一,危害严重。而利什曼原虫-人类免疫缺陷病毒(human immunodeficiency virus,HIV)合并感染对流行地区造成的威胁更甚。利什曼原虫与HIV存在相互作用,合并感染者在临床表现、诊断及治疗方面具有一定特殊性,其病死率及复发率均高于HIV阴性的内脏利什曼病患者。本文对利什曼原虫-HIV合并感染患者的临床表现、诊断和治疗进展进行综述。     

数据挖掘法探讨周珉教授治疗原发性肝癌用药规律及经验总结

[目的]数据挖掘法分析周珉教授治疗原发性肝癌的中医用药规律,探讨相关病机并进行经验总结。[方法]收集2016年2月—2018年5月周珉教授门诊期间治疗原发性肝癌的方剂,运用"中医传承辅助系统(V2.50)"进行数据挖掘,并结合周珉教授临床经验,进行原发性肝癌病机探讨及用药规律分析。[结果]共收集治疗原发性肝癌方剂176首,涉及中药235种,列出方剂中的高频药物及组合规律。[结论]总结原发性肝癌以"湿热痰毒、气阴两伤"为基础病机,"清热化湿、健脾养阴"治则贯穿原发性肝癌治疗始末,同时,根据疾病不同发展阶段及治疗措施,权衡"扶正"与"祛邪"的主次分配,斟酌应用"攻毒散结""行气化瘀"等治法,以达到改善患者生活质量、延缓疾病进展的目的。     

Assessing perceived quality of primary care under hospital-township health centre integration: A cross-sectional study in China

Since the new round of health care reform in 2009, the vertical integration of hospitals and primary health institutions has become widely implemented in China as an efficient method for improving quality of primary care. This study aimed to answer the following questions: (a) What is the perceived quality of township health centres (THCs) under integration? (B) What differences could be observed among the three typical integration models, namely, private hospital-THC integration, public hospital-THC integration, and loose collaboration? Two rounds of cross-sectional surveys were conducted from November 2016 to June 2018. The Chinese version of the Primary Care Assessment Tool was used to evaluate perceived quality of sample THCs, and 1118 adult patients were interviewed in total. Multiple linear regressions were employed to compare the quality scores between two survey rounds and among different integration models after controlling for potential confounders. The results revealed that the quality of care significantly improved under private hospital-THC integration as observed by comparing two survey rounds, while no change or slight changes were observed in the other two models. The difference observed among the three models was that the perceived quality of THCs integrated with private hospitals was worse than that of THCs integrated with public hospitals and THCs under loose collaboration, while no significant difference was observed between public hospital-THC integration and loose collaboration. Increased attention should be given to highlighting the tight integration between hospitals and THCs and the different roles played by private and public hospitals in the current reform.     

甘肃省和政县农村老年性白内障防盲项目的卫生经济学评价研究

目的 对2014-2016年在甘肃省和政县开展的白内障综合防盲干预项目进行卫生经济学评价。设计 横断面调查。 研究对象 甘肃省和政县2014-2016年老年性白内障手术前407例患者及术后半年109例患者。方法 对所有调查对象进行卫生经济学问卷调查。通过净效益法、成本效益分析法和成本效果分析法评价项目产生的经济效益和总成本。主要指标 直接成本、间接成本、直接经济效益、间接经济效益、总成本、总效益、净效益、成本效益比、成本效果比。结果 2014-2016年项目期间甘肃省和政县白内障所致总体疾病经济负担为2142.28万元。白内障手术产生的总效益为3398424.98元，总成本为2939125.20元，净效益为459299.78元，效益成本比为1.16:1。项目每投入1万元可降低50岁以上白内障患者导致的0.027%的致盲率和0.164%致残率；项目每降低1%的50岁以上白内障患者的盲率，需投入36.47万元；每降低1%50岁以上白内障患者的残率，需投入6.11万元。结论 在甘肃省和政县开展的老年性白内障防盲综合干预项目具有较好的产出回报比和较高的防盲技术效率。（眼科，2020，29： 298-303）     

Quality of oral anticoagulation control in Chinese patients with non-valvular atrial fibrillation: a prospective controlled study

Abstract

Objective

The sex, age, medical history, treatment, tobacco use, race risk (SAMe-TT₂R₂) Score; the sex, age, medical history, treatment, tobacco use, genotype combination (SAMe-TT₂G₂) Score; and the so-called modified SAMe-TT₂R₂ scores have been proposed to predict the anticoagulation quality for patients with non-valvular atrial fibrillation (NVAF). The data from a prospective controlled study is used to validate the SAMe-TT₂R₂ and SAMe-TT₂G₂ scores in Chinese NVAF patients treated with warfarin and to evaluate the association of factors with time in therapeutic range (TTR) to predict the quality of oral anticoagulation control.