贵州地区少数民族与汉族茶碱血药浓度与临床疗效对比研究

目的:通过血药浓度检测对比分析贵州地区少数民族与汉族人群茶碱体内代谢与临床疗效特点的差异。方法:分别测定少数民族与汉族患者达稳态血药浓度后的茶碱及其代谢物1,3-二甲基尿酸的血清浓度;使用SPSS 19.0统计软件进行分析,比较2组患者茶碱及其代谢物1,3-二甲基尿酸血药浓度的差异以及2组患者用药前后肺功能检查、血气分析检查等量化指标改变值的差异。结果:少数民族与汉族患者茶碱血药浓度的差异、用药前后肺功能检查中FEV1/FVC的改变值以及用药前后血气分析检查中SpO2的改变值都具有统计学意义,汉族患者组茶碱血药浓度要普遍高于少数民族患者组,且以上临床检查指标的改变值也高于少数民族患者组。结论:贵州地区少数民族与汉族患者使用氨茶碱后临床症状均有改善,但改善程度各有不同,汉族患者的茶碱血药浓度更高,肺通气功能的改善情况更好,能取得更好的临床疗效。提示不同民族人群中茶碱在体内经肝药酶CYP1A2代谢可能存在基因多态性差异。     

I Am Quite Mellow But I Wouldn't Say Everyone Else Is”: How UK Students Compare Their Drinking Behavior to Their Peers'

Background: Excessive drinking is commonplace at UK Universities. Individuals may misperceive how much they drink compared to others and are less likely to think that they will suffer adverse consequences. Young people often distance themselves and their friends from ‘problem drinkers’. Objectives: The aim of the study was to explore how student drinkers compared their own drinking behaviors to the drinking behaviors of others. Methods: An online survey was completed by 416 students aged 18–30 (68.5% female). They were asked ‘how do you think your drinking compares with other people like you?' and ‘how do you think your behavior when you drink compares with other people like you?’ Answers were subjected to thematic analysis. Results: The first main theme was about ‘identification as a ‘good’ drinker’. Participants suggested their own behavior when drinking was similar to their sober behavior. Further, they viewed themselves as more able to maintain a balance between staying in control and having fun while drinking. The second main theme was about ‘distancing from being a ‘bad’ drinker. Participants distanced themselves from negative prototypical drinkers, such compulsive or anti-social drinkers. They also attributed their own drinking behaviors to situational factors, but described other people as intentionally violent or aggressive. Conclusions/Importance: These findings may explain the failure of some health messages to change drinking behaviors. If drinkers perceive that their behavior when they drink is better than other people's then they may discount intervention messages. Targeting these biases could be incorporated into future interventions.     

Multisample adjusted U‐statistics that account for confounding covariates

Multisample U‐statistics encompass a wide class of test statistics that allow the comparison of 2 or more distributions. U‐statistics are especially powerful because they can be applied to both numeric and nonnumeric data, eg, ordinal and categorical data where a pairwise similarity or distance‐like measure between categories is available. However, when comparing the distribution of a variable across 2 or more groups, observed differences may be due to confounding covariates. For example, in a case‐control study, the distribution of exposure in cases may differ from that in controls entirely because of variables that are related to both exposure and case status and are distributed differently among case and control participants. We propose to use individually reweighted data (ie, using the stratification score for retrospective data or the propensity score for prospective data) to construct adjusted U‐statistics that can test the equality of distributions across 2 (or more) groups in the presence of confounding covariates. Asymptotic normality of our adjusted U‐statistics is established and a closed form expression of their asymptotic variance is presented. The utility of our approach is demonstrated through simulation studies, as well as in an analysis of data from a case‐control study conducted among African‐Americans, comparing whether the similarity in haplotypes (ie, sets of adjacent genetic loci inherited from the same parent) occurring in a case and a control participant differs from the similarity in haplotypes occurring in 2 control participants.     

Sequential parallel comparison design with binary and time‐to‐event outcomes

Sequential parallel comparison design (SPCD) has been proposed to increase the likelihood of success of clinical trials especially trials with possibly high placebo effect. Sequential parallel comparison design is conducted with 2 stages. Participants are randomized between active therapy and placebo in stage 1. Then, stage 1 placebo nonresponders are rerandomized between active therapy and placebo. Data from the 2 stages are pooled to yield a single P value. We consider SPCD with binary and with time‐to‐event outcomes. For time‐to‐event outcomes, response is defined as a favorable event prior to the end of follow‐up for a given stage of SPCD. We show that for these cases, the usual test statistics from stages 1 and 2 are asymptotically normal and uncorrelated under the null hypothesis, leading to a straightforward combined testing procedure. In addition, we show that the estimators of the treatment effects from the 2 stages are asymptotically normal and uncorrelated under the null and alternative hypothesis, yielding confidence interval procedures with correct coverage. Simulations and real data analysis demonstrate the utility of the binary and time‐to‐event SPCD.     

In-vivo evaluation of convex array synthetic aperture imaging

This paper presents an in-vivo study of synthetic transmit aperture (STA) imaging in comparison with conventional imaging, evaluating whether STA imaging is feasible in-vivo and whether the image quality obtained is comparable with traditional scanned imaging in terms of penetration depth, spatial resolution, contrast resolution and artifacts. Acquisition was performed using our research scanner RASMUS and a 5.5 MHz convex array transducer. STA imaging was acquired using circular wave emulation by 33-element subapertures and a 20 micros linear FM signal as excitation pulse. For conventional imaging, a 64 element aperture was used in transmit and receive with a 1.5 cycle sinusoid excitation pulse. Conventional and STA images were acquired interleaved, ensuring that the exact same anatomical location was scanned. Image sequences were recorded in real time and processed off-line. Seven male volunteers were scanned abdominally and the resulting images were compared by three medical doctors using randomized blinded presentation. Penetration and image quality were scored and evaluated statistically. Results showed slightly but significantly (0.48 cm, p = 0.008) increased penetration using STA. Image quality was also highly significantly (p < 0.001) increased. Results show that in-vivo ultrasound imaging using STA is feasible for abdominal imaging without severe motion artifacts.     

Subjective intensity of pain during ultrasonic supragingival calculus removal

OBJECTIVE: To assess subjective intensities of pain during supragingival calculus removal employing ultrasonic scaler tips of two different shapes. MATERIAL AND METHODS: Twenty patients were treated using a piezoelectric ultrasonic device (Sirosonic L) and two different scaler tips representing a conventional (Instrument No. 3) and a slim-line style (Perio Pro Line Instrument SI-11) in a split-mouth design. Pain was recorded during calculus removal at intervals of 0.5 s employing an inter-modal intensity comparison. Additionally, a visual analogue scale was used for evaluation directly after the treatment procedure. Treatment time was recorded to assess the efficiency of calculus removal. RESULTS: Pain assessment during treatment showed that the slim-line scaler tip (median pain score: 1.4 [U], maximum: 3.5 [U], minimum: 0 [U]) caused less pain than the conventional device (median pain score: 7.8 [U], maximum: 14.7 [U], minimum: 0 [U]) (p<0.05). These results could be confirmed by the visual analogue scale. Treatment with the slim-line tip took significantly longer than treatment with the conventional tip (p<0.05). CONCLUSIONS: Using slim-line-styled ultrasonic scaler tips for supragingival calculus removal, painful sensations can be reduced compared with conventional ultrasonic devices. Thus, it might be possible to increase the patient's compliance during dental treatment with oscillating instruments.     

Simultaneous detection and quantitation of organic impurities in methamphetamine by ultra‐high‐performance liquid chromatography–tandem mass spectrometry,a complementary technique for methamphetamine profiling

The analysis of organic impurities plays an important role in the impurity profiling of methamphetamine, which in turn provides valuable information about methamphetamine manufacturing, in particular its synthetic route, chemicals, and precursors used. Ultra‐high‐performance liquid chromatography – tandem mass spectrometry (UHPLC – MS/MS) is ideally suited for this purpose due to its excellent sensitivity, selectivity, and wide linear range in multiple reaction monitoring (MRM) mode. In this study, a dilute‐and‐shoot UHPLC – MS/MS method was developed for the simultaneous identification and quantitation of 23 organic manufacturing impurities in illicit methamphetamine. The developed method was validated in terms of stability, limit of detection (LOD), lower limit of quantification (LLOQ), accuracy, and precision. More than 100 illicitly prepared methamphetamine samples were analyzed. Due to its ability to detect ephedrine/pseudoephedrine and its high sensitivity for critical target markers (eg, chloro‐pseudoephedrine, N‐cyclohexylamphetamine, and compounds B and P), more impurities and precursor/pre‐precursors were identified and quantified versus the current procedure by gas chromatography – mass spectrometry (GC – MS). Consequently, more samples could be classified by their synthetic routes. However, the UHPLC – MS/MS method has difficulty in detecting neutral and untargeted emerging manufacturing impurities and can therefore only serve as a complement to the current method. Despite this deficiency, the quantitative information acquired by the presented UHPLC – MS/MS methodology increased the sample discrimination power, thereby enhancing the capacity of methamphetamine profiling program (MPP) to conduct sample‐sample comparisons.     

"六经为川,肠胃为海"内涵探析

基于中医学整体观念,运用取象比类的方法,借自然界"川""海"之象进一步阐释"六经"之经与腑的双重含义,以及"肠胃为海"在气血化生、津液输布、糟粕传化、扶正培本方面的内涵.指出"六经"与"肠胃"在生理上彼此依存、病理上相互影响.在现代肠道研究中,肠道消化吸收营养物质、排泄代谢废物,体现了肠胃为"气血生化之海""津液输布之海""糟粕传化之海".肠道菌群促进肠黏膜免疫系统的发育并参与调节机体免疫,体现了肠胃为"扶正培本之海".肠神经系统与内分泌系统通过脑-肠轴的双向调控,如同六经与肠胃之间的海川循环,彼此依存、生生不息.通过探析"六经为川,肠胃为海"在肠道各功能网络中的内涵,揭示象思维在中西医整合医学发展中的重要作用,为挖掘经典及科研创新开辟思路.     

基于眼部图像特征的肝肾疾病病证比较研究

目的:基于五轮学说及眼部图像特征提取技术,探讨不同证候(湿热内蕴证、肝郁脾虚证、肝肾阴虚证)的肝硬化及慢性肾脏疾病患者眼部图像特征及其差异性,以期从眼部图像特征上为肝硬化临床诊断及证候辨识提供数据支持。方法:选取2017年10月至2018年3月在上海中医药大学附属曙光医院肝硬化科住院的湿热内蕴证、肝郁脾虚证及肝肾阴虚证3种证候的肝硬化患者118例为研究对象,运用眼科裂隙灯采集受试者的眼部图像,并以年龄、性别、体质量指数匹配的非肝病(慢性肾脏疾病)患者115例及健康志愿者112例眼部图像特征为对照进行比较研究。剔除因受到各种因素干扰眼部图像不符合要求的患者,最终3组各纳入60例进行眼部图像分析。基于图像局部二值模式(LBP)特征提取法,将彩色图像转化为共生矩阵,计算图像LBP特征面积百分比。通过方差分析、秩和检验等统计学方法对相关指标进行比较分析,找出组间差异性。结果:肝硬化患者、慢性肾脏疾病患者与健康人3组眼部图像LBP特征面积百分比差异均有统计学意义(P<0.05)。与健康人组相比,在255层面积百分比中,肝硬化组有245层差异有统计学意义(P<0.05),慢性肾脏疾病组有246层差异有统计学意义(P<0.05)。肝硬化组与慢性肾脏疾病组相比,2组共有15层面积百分比差异有统计学意义(P<0.05)。对2种疾病间不同证候的LBP特征频数面积百分比进行比较,慢性肾脏疾病患者湿热内蕴证、肝郁脾虚证及肝肾阴虚证3组证候间共19层差异有统计学意义(P<0.05),而肝硬化组患者3组证候间差异无统计学意义(P>0.05)。比较3种证候不同疾病间的LBP特征频数面积百分比,湿热内蕴证中,肝硬化与慢性肾脏疾病组患者间有54层差异有统计学意义(P<0.05);肝肾阴虚证中共有46层差异有统计学意义(P<0.05);而肝郁脾虚证的2种疾病间差异无统计学意义(P>0.05)。比较湿热内蕴证、肝郁脾虚证与肝肾阴虚证3种证候间频数面积百分比,发现有2层差异存在统计学意义(P<0.05)。结论:基于眼部图像LBP特征发现,肝硬化及慢性肾脏疾病2种疾病间存在明显差异,且2种疾病的相同证候间比较亦有显著性差异,但同一疾病的3种不同证候间比较,仅肾脏病患者在一定程度上有差异,而肝硬化患者各证候间区分不明显。提示运用眼部图像LBP特征提取技术对不同疾病区分的敏感性优于对证候的区分。