基于知识图谱构建和定性访谈法探析张忠德教授辨治间质性肺病临床特征与方药规律＊

目的 构建个性化知识图谱技术和定性访谈法结合，进一步挖掘张忠德教授辨治间质性肺疾病临证特征与用药规律。方法 采用回顾性分析，系统收集张忠德教授广东省中医院门诊2010年8月至2020年8月治疗间质性肺疾病病历，按照诊断标准、纳入标准、排除标准，严格筛选后，通过广东省中医院大数据挖掘团队中医药大数据智能处理与知识服务系统进行数据挖掘分析，并通过多元化视觉定性访谈法，将定量与定性分析有效结合。结果 共筛选出347首方，共141味药物，常用药物频次 ≥ 84次的药物有10味，其中党参、麦芽、黄芪、紫菀、白术等为核心用药，通过症状与药物推理知识地图显示，党参、炒麦芽、黄芪、大枣、太子参、山萸肉、巴戟天等为主要治疗用药；临证遣方用药知识关联分析，得知咳嗽、耳鸣、心悸、水肿、头痛、胸闷、恶寒等为多见，针对咳嗽，首选紫苏子、橘红、桂枝等温肺降气通阳之品等；频繁聚集显示，常用药对炒麦芽-炒白术、黄芪-党参、黄精-菟丝子、前胡-紫菀、炙枇杷叶-浙贝母等；聚类分析结果得到4组关系密切的聚类新药物组合；以脾为中轴，肺肾共扶为主的“平调五脏论”，分期阶梯辨治间质性肺疾病。结论 张忠德教授认为间质性肺疾病，虚实夹杂为多见，应从肺、脾、肾着手，采用平调五脏论分期阶梯辨治，用药配伍精简，以和为贵，以平为期。     

Transcranial Focused Ultrasound Enhances Sensory Discrimination Capability through Somatosensory Cortical Excitation

Low-intensity transcranial focused ultrasound (tFUS) has emerged as a non-invasive brain neuromodulation tool with high spatial specificity. Previous studies attributed tFUS-enhanced sensory performance to the ultrasound-induced inhibitory neural effects. However, to date there is no direct evidence validating the neural mechanism underlying ultrasound-mediated somatosensory enhancement. In this study, healthy human subjects (N = 9) were asked to perform tactile vibration frequency discrimination tasks while tFUS was directed onto the primary somatosensory cortex. During this task, we simultaneously recorded 64-channel electroencephalography (EEG) signals and investigated the brain responses at both EEG sensors and source domains by means of electrophysiological source imaging (ESI). The behavioral results indicated that the subjects' discrimination ability was improved by tFUS with an increased percentage of correct responses. EEG and ESI results revealed that tFUS neuromodulation was able to improve sensory discrimination capability through excitatory effects at the targeted sensory cortex.     

CLCA1在结肠癌组织中的表达及临床意义

目的:探讨CLCA1在结肠癌组织中的表达水平及其与肿瘤进展和预后的关系。方法:随机选取西安交通大学第一附属医院及第四军医大学西京医院行手术切除的临床结肠癌病例239例，应用免疫组织化学方法检测结肠癌组织及癌旁组织中CLCA1的表达情况，使用统计学方法分析CLCA1在结肠癌中的表达与肿瘤临床病理特征及预后的相关性。结果:CLCA1 在肿瘤中的表达较癌旁组织显著降低（P＜0.05），CLCA1在结肠癌中表达与原发肿瘤浸润深度、淋巴转移和肿瘤TNM分期显著相关（P＜0.05），而且CLCA1低表达组患者总体生存期较高表达组显著缩短（P＜0.001），多因素分析显示CLCA1的表达可作为结肠癌的独立预后因素。结论:CLCA1在结肠癌中表达下调，CLCA1的低表达与肿瘤的侵袭转移和临床预后密切相关，有望作为结肠癌个体化治疗靶点。     

甲醛和苯联合染毒对小鼠胚胎发育的影响

目的研究妊娠期甲醛和苯联合染毒对小鼠胚胎发育的影响。方法将妊娠0天的昆明小鼠随机分为对照组、低剂量组、中剂量组、高剂量组,并分别于妊娠第6天开始进行吸入式染毒,连续15 d,甲醛和苯的剂量为国家室内空气标准的0倍、1倍、50倍和100倍。仔鼠出生后,记录正常生产孕鼠数、产仔数、流产孕鼠数及出生24 h后存活的仔鼠数。仔鼠称重后分离肝及脑组织并进行RT-PCR,检测部分脑、肝发育相关基因在组织内的表达情况。取仔鼠肝组织,固定后免疫组化检测IGF-1的表达情况。结果高剂量组的流产孕鼠数高于对照组、低剂量组及中剂量组(P<0.05);高剂量组的产仔数、存活数低于其余各组(P<0.05);中剂量组、高剂量组仔鼠体重低于对照组和低剂量组(P<0.05);高剂量组发育相关基因Peg3和IGF-1的表达强度低于对照组、低剂量组及中剂量组(P<0.05)。免疫组化结果显示仔鼠肝组织中IGF-1表达降低。结论妊娠期接触甲醛与苯混合气体可导致孕鼠流产率上升、产仔数、仔鼠存活数、仔鼠体重下降,同时也会导致胚胎发育过程中重要基因IGF-1和Peg3表达下调。     

血清C反应蛋白及补体C3水平与急性阑尾炎患儿预后相关性

目的：探讨血清中C反应蛋白（CRP）和补体C3水平在急性阑尾炎患儿预后中的关系。方法：筛选我院收治确诊为急性阑尾炎的32例患儿以及28例健康儿童血液样本，检测血清CRP和C3水平。对相关的各检测结果分别进行Pearson直线相关性分析和Logistic回归分析。结果：急性阑尾炎患儿血清CRP升高（P＜0.01），C3含量降低（P＜0.01）；随严重程度升高，CRP增加，C3降低。Pearson分析表明，CRP与C3表达呈负相关（P＜0.05）；Logistic分析表明，CRP和C3均与急性阑尾炎诊断具有显著相关性（P＜0.01）；ROC曲线分析，结果显示CRP和C3在诊断急性阑尾炎中均具有显著的价值（P<0.01）。结论：CRP与C3能够诊断儿童急性阑尾炎，评估发病严重程度，指导临床采取合理治疗措施，改善患儿预后。     

Acupuncture for cerebral palsy: a meta-analysis of randomized controlled trials

OBJECTIVE: To evaluate the efficacy and safety of acupuncture therapy for children with cerebral palsy. DATA SOURCES: We conducted electronic searches of PUBMED(1950/2017), EMBASE(1974/2017), Science Direct(1986/2017), Academic Source Premier(1887/2017), the Cochrane Library(Issue 4, April 2017), Science Citation Index Expanded(1900/2017), China National Knowledge Infrastructure(1915/2017), China Biological Medicine(1990/2017-04), Wan Fang(1980/2017), VIP(1989/2017), and Chinese Science Citation Database(1989/2017). DATA SELECTION: We included randomized controlled trials that aimed to compare the effect of acupuncture plus rehabilitation training versus rehabilitation training alone. Data about functional motor abilities, daily activity/social participation, effective rate, intellectual development, and adverse effects were included. We used Revman 5.2 software for statistical analysis. OUTCOME MEASURES: The primary outcomes included functional motor abilities, daily activity, and effective rate. The secondary outcomes included intellectual development and adverse effects.RESULTS: Twenty-one studies with a total of 1718 participants met the inclusion criteria. The effect size of gross motor function(SMD = 0.64, 95% CI: 0.52 to 0.76, P 0.00001; I~2 = 0%, P = 0.69; in 13 studies with 1144 patients) and the total effective rate(RR = 1.28, 95% CI: 1.20 to 1.37, P 0.00001; I~2 = 18%, P = 0.27; in 12 studies with 1106 patients) suggested that acupuncture plus rehabilitation produced a significant improvement in gross motor function and a high total effective rate. The pooled fine motor function(SMD = 3.48, 95% CI: 2.62 to 4.34, P 0.00001; I~2 = 64%, P = 0.10; in 2 studies with 193 patients), modified Ashworth scale scores(SMD = –0.31, 95% CI: –0.52 to –0.11, P = 0.003; I~2 = 74%, P = 0.004; in 5 studies with 363 patients) and activities of daily living(SMD = 1.45, 95% CI: 1.20 to 1.71, P 0.00001; I~2 = 78%, P = 0.004; in 4 studies with 313 patients) also indicated improvements in children with cerebral palsy. Publication bias was not observed. Only mild adverse events related to acupuncture were reported. CONCLUSION: Acupuncture plus rehabilitation training improved gross motor function, reduced muscle spasms, and enhanced daily life activities in children with cerebral palsy. However, this conclusion should be interpreted with caution due to the small number of randomized controlled trials available and the small sample sizes. More high-quality and large-scale studies are needed.