中医药治疗系统性红斑狼疮证型及用药规律演变研究

目的:基于文献整理探讨中医药治疗系统性红斑狼疮(Systemic lupus erythematosus,SLE)的证候分类及用药规律演变。方法:检索中国知网(CNKI)、维普中文科技期刊数据库、中国学术期刊数据库中中医药治疗SLE的相关文献,时间限定为从数据库建立至2018年7月。对证型及药物进行分类并统计分析。结果:纳入文献725篇,总结归纳高频证型11个,出现频次最高的五个证型分别为热毒炽盛证、脾肾两(阳)虚证、阴虚内热(火旺)证、肝肾两(阴)虚证、气阴两虚证,累计频率62.11%。1965-2018年间,阴虚内热(火旺)证呈明显增长趋势;热毒炽盛证、脾肾两(阳)虚证及气阴两虚证在1965-2010年间呈增长趋势,在2011-2018年间呈下降趋势;肝郁气滞(脾虚)证在1965-2018年间呈下降趋势;其余证型均呈动态波动。涉及组方1522个,药物309味,使用15910次,总使用频率最高的5味药分别为生地黄、牡丹皮、茯苓、黄芪、甘草,总累计频率16.42%。使用频率最高药类为清热药和补虚药;生地黄、牡丹皮等清热药的使用频率趋势与热毒炽盛证保持一致,不同年份高频用药大致相似,用药频率存在较小差异。结论:SLE在内以阴阳亏虚为主,在外与热毒侵袭相关,属于本虚标实,其发展与生态环境、社会环境、药物使用等紧密相关,治当以清热凉血、活血祛瘀、益气养阴,并结合个人体质及环境变化辨证治疗。     

基于数据挖掘的王笑民教授治疗非小细胞肺癌的用药规律

目的：基于数据挖掘方法,对王笑民教授治疗非小细胞肺癌用药规律进行探究。方法：收集王笑民教授中医药治疗非小细胞肺癌病历资料并建立数据库,采用Excel、SPSS Statistics 25.0、SPSS Modeler18.0统计软件进行频数、聚类及关联规则分析等,对用药规律进行总结。结果：本研究纳入病例168例,男82例,女86例,年龄33～83岁,症状以咳嗽、咳痰、眠差等常见,中医辨证以瘀毒、相火妄动、脾虚等多见。纳入中药处方424首,涉及药物181味,高频中药29味,归经以肺、肝、脾为多,药性以寒、微寒、温为主,药味以甘、苦、辛多见。聚类分析得到5个药组。关联规则分析得到28条,白花蛇舌草-龙葵-白英-半枝莲-车前子,柴胡-法半夏-白芍,生黄芪-防风-炒白术常联合使用。症-证-药关联分析得出非小细胞肺癌患者以瘀毒证最为常见,常用半枝莲、白花蛇舌草、白英、龙葵、车前子。结论：王笑民教授治疗非小细胞肺癌,重在从肺、肝、脾论治,以清肺解毒、活血通滞、疏肝醒脾为治,明确邪正辨证关系及疾病发展的不同阶段,选择合适用药。     

The association between tic medication therapy and psychiatric comorbidities among patients with Tourette syndrome: A national population-based study in Taiwan

BackgroundTourette syndrome (TS) is often comorbid with attention deficit hyperactivity disorder, obsessive–compulsive disorder, and depression. Medications are the main treatment for TS. Relationships between TS medication therapy and psychiatric comorbidities remain unclear. This study explored the impacts of TS medication on the risk of psychiatric comorbidities using a nationally representative sample of TS in Taiwan.MethodsData from National Health Insurance Research Database in Taiwan was used to identify 997,213 children and adolescents aged 6–18 years who had received a diagnosis of TS based on ICD-9-CM codes in 2000–2010. Cox’s proportional hazard regression analysis was conducted to estimate the risk of comorbidities among subjects with and without tic medication therapy.ResultsWe found that in TS patients, a lower risk of psychiatric comorbidities occurred in the tic medication therapy group (p = 0.012) and the crude hazard ratio (HR) was 0.6 (95% confidence interval (CI) = 0.4–0.8, p < 0.001). After adjusting for potential confounders of gender, age, income, level of care, department visited, brain injury, and the number of suicide attempts, the risk of comorbidities was still significantly lower in the tic medication therapy group (adjusted HR = 0.5, 95% CI = 0.3–0.6, p < 0.001).DiscussionOne limitation was that we did not include all mediations used to treat psychiatric comorbidities among TS patients. This study found the effectiveness of TS medications on improving psychiatric comorbidities.ConclusionsCompared to those without medication, medication therapy appears to have a benefit of decreasing the risk of psychiatric comorbidities. Strategies to improve medication regimens should be considered in clinical settings.     

有关吸烟及围术期用药相互作用的护理思考

为保证病人在围术期用药的安全性,本文对吸烟和术前不同用药与麻醉药之间的不良反应和预防措施进行进行了回顾。     

中文版偏头痛患者药物依赖性问卷信度和效度研究

目的评价中文版偏头痛患者药物依赖性问卷的信度和效度。方法选取115例合并药物依赖综合征的偏头痛患者,收集其临床资料并进行中文版偏头痛患者药物依赖性问卷的测试。采用重测信度、内部一致性信度评价分析问卷信度,采用内容效度和结构效度评价分析问卷效度。结果量表的重测信度除条目11和条目16为0.558和0.443以外,其余条目的重测信度均大于0.7。总量表的Cronbach’α系数为0.820,各个维度的Cronbach’α系数均0.7。量表的各条目得分和相应维度总分之间的相关系数在0.595~0.962之间。因子分析共提取7个特征根大于1的因子,可解释总变异的76.3%,在相应项目上均有较强的因子载荷。结论中文版偏头痛患者药物依赖性问卷具有较好的信度和效度,适合临床推广应用。     

模糊数学及其在中医药学中的应用

中医药理论中存在着许多模糊性的现象.如病症诊断、方剂配伍、药材评定等方面.本文先简述模糊数学的概念,然后着重讲述了其在中医药中的应用.     

子宫内膜异位症的治疗

目的了解子宫内膜异位症近年治疗的现状。方法查阅文献,结合临床经验,综合论点。结果子宫内膜异位症治疗大体分为药物治疗和手术治疗。结论子宫内膜异位症的治疗,应根据不同的临床表现及是否有生育要求,采取个性化治疗方案。     

Migraine susceptibility is modulated by food triggers and analgesic overuse via sulfotransferase inhibition

Background/aimCertain constituents in migraine food triggers and non-steroidal anti-inflammatory drugs (NSAIDs) inhibit sulfotransferases (SULTs) that detoxify drugs/chemicals and play role in the metabolism of neurotransmitters. We aimed to dissect SULT1A1 modulation of CSD susceptibility and behavior in an in vivo experimental model using hesperidin, a SULT1A1 inhibitor found in citrus fruits (known migraine triggers) and mefenamic acid (SULT1A1 inhibitor), an NSAID to simulate medication overuse.MethodsHesperidin was used as SULT1A1 inhibitor found in citrus fruits, known migraine triggers and mefenamic acid (NSAID), another SULT1A1 inhibitor, was used to induce MO in rats. The groups were; 1) Hesperidin (ip) or its vehicle-DMSO (ip) 2) Chronic (4 weeks) mefenamic acid (ip) or its vehicle (ip) 3) Chronic mefenamic acid+hesperidin (ip) or DMSO (ip). CSD susceptibility was evaluated and behavioral testing was performed. SULT1A1 enzyme activity was measured in brain samples.ResultsSingle-dose of hesperidin neither changed CSD susceptibility nor resulted in any behavioral change. Chronic mefenamic acid exposure resulted in increased CSD susceptibility, mechanical-thermal hypersensitivity, increased head shake, grooming and freezing and decreased locomotion. Single dose hesperidin administration after chronic mefenamic acid exposure resulted in increased CSD susceptibility and mechanical-thermal hypersensitivity, increased freezing and decreased locomotion. SULT1A1 enzyme activity was lower in mefenamic acid and mefenamic acid+hesperidin groups compared to their vehicles.ConclusionMefenamic acid and hesperidin have synergistic effect in modulating CSD susceptibility and pain behavior. Sulfotransferase inhibition may be the common mechanism by which food triggers and NSAIDs modulate migraine susceptibility. Further investigations regarding human provocation studies using hesperidin in migraine patients with medication overuse are needed.     

Electronic Pharmacopoeia: A Missed Opportunity for Safe Opioid Prescribing Information?

Errors in prescribing of dangerous medications, such as extended release or long acting (ER/LA) opioid forlmulations, remain an important cause of patient harm. Prescribing errors often relate to the failure to note warnings regarding contraindications and drug interactions. Many prescribers utilize electronic pharmacopoeia (EP) to improve medication ordering. The purpose of this study is to assess the ability of commonly used apps to provide accurate safety information about the boxed warning for ER/LA opioids. We evaluated a convenience sample of six popular EP apps available for the iPhone and an online reference for the presence of relevant safety warnings. We accessed the dosing information for each of six ER/LA medications and assessed for the presence of an easily identifiable indication that a boxed warning was present, even if the warning itself was not provided. The prominence of precautionary drug information presented to the user was assessed for each app. Provided information was classified based on the presence of the warning in the ordering pathway, located separately but within the prescribers view, or available in a separate screen of the drug information but non-highlighted. Each program provided a consistent level of warning information for each of the six ER/LA medications. Only 2/7 programs placed a warning in line with dosing information (level 1); 3/7 programs offered level 2 warning and 1/7 offered level 3 warning. One program made no mention of a boxed warning. Most EP apps isolate important safety warnings, and this represents a missed opportunity to improve prescribing practices.