基于“中医传承辅助平台”软件挖掘年莉教授治疗糖尿病肾病的用药规律

[目的] 采用"中医传承辅助平台"软件，探讨年莉教授治疗糖尿病肾病的用药规律。[方法] 将2016年11月-2019年4月年莉教授治疗糖尿病肾病的中药处方信息输入中医传承辅助平台系统，采用频次分析、组方规律分析方法挖掘、探讨年莉教授治疗糖尿病肾病的临床用药特点。[结果] 对年莉教授治疗糖尿病肾病158首处方进行分析，涉及中药207味，使用频次在前10位的药物分别为白芍、川芎、当归、半夏、刺蒺藜、丹参、泽泻、牛膝、厚朴，白术获得9组药对、3组核心药物组合。[结论] 年莉教授治疗糖尿病肾病经验丰富，高频药物的配伍体现了年莉教授多采用平肝疏肝，补血养阴，活血化瘀的治疗原则。期望能为临床治疗和药物研发提供参考，并为糖尿病肾病在泰国的治疗提供新的理念和借鉴。     

Glutathione conjugation of chlorobenzylidene malononitriles in vitro and the biotransformation to mercapturic acids in rats

The glutathione conjugation of 2-chloro-, 3-chloro-, 4-chloro- and 2,6-dichlorobenzylidene malononitrile (chloroBMNs) was investigated in vitro. In incubation mixtures containing rat liver cytosol (9000 g), the decrease in the initial amount of glutathione due to the various chloroBMNs ranged from 40 to 60% and occurred both enzymatically and spontaneously at physiological conditions (37°C, pH7.4). 2,6-DichloroBMN, however, depleted glutathione largely spontaneously (38±3%). The steric hindrance of the two chlorosubstituents probably plays an important role during the glutathione-S-transferase catalyzed reaction.The hydrolysis of the chloroBMNs to the corresponding chlorobenzaldehydes and malononitrile was studied in a mixture of buffer pH 7.4 and ethanol. The rate of hydrolysis of 2,6-dichloroBMN was slower than those of the related chloroBMNs. This means that 2,6-dichloroBMN will be the most stable compound in the presence of water.Only IP administration of 2-chloroBMN (CS) to adult male Wistar rats gave enhancement of urinary thioether excretion. A thioether could be isolated and was identified as the N-acetyl-S-[2-chlorobenzyl]-L-cysteine. The quantity of this benzylmercapturic acid in the urine of rats amounted to 4.4% dose (0.07 mmol/kg, n=12).After IP administration of 2-chloro- and 3-chlorobenzaldehyde to rats benzylmercapturic acid excretion in the urine was found to be 7.6 and 1.1% of the dose, respectively. Administration of the related 4-chloro- and 2,6-dichlorobenzaldehyde, however, resulted in _no urinary mercapturic acid excretion.It is very likely that in rats the initial biotransformation of chloroBMNs is mainly hydrolysis to corresponding chlorobenzaldehydes, leading in the case of 3-chloro-, 4-chloro- and 2,6-dichloroBMN to no mercapturic acid excretion in the urine.Nevertheless, 2,6-dichloroBMN will be the most reactive compound with proteins and therefore the best haptene in comparison with the related chloroBMNs.This work was financially supported by a grant from the Dutch Foundation for Medical Research FUNGO, grant no. 13-28-57     

不同种的金银花中微量生物元素的分布规律

本文报告不同种的金银花中微量生物元素的分布规律:不同种的金银花中微量生物元素含量的对数与其元素的原子序数成线性关系,并呈现周期性。     

Requiring Consent vs. Waiving Consent for Medical Records Research: A Minnesota Law vs. the U.S. (HIPAA) Privacy Rule

The use of medical records in research can yield information that is difficult to obtain by other means. When such records are released to investigators in identifiable form, however, substantial privacy and confidentiality risks may be created. These risks become more common and more serious as medical records move to an electronic format. In 1996, the state of Minnesota enacted legislation with respect to consent requirements for the use of medical records in research. This legislation has been widely criticized because--it is claimed--it creates an unnecessary impediment to research. In this article, we show that these arguments rest upon misinterpretation and/or misrepresentation of the 1996 legislation. A consent requirement had actually been present in Minnesota since 1976 (though codified in a patient rights statute rather than a privacy statute). The 1996 law does not require specific consent, as often claimed, but rather only a general authorization. The campaign against the Minnesota legislation appears to have been motivated by concern with respect to the then impending federal privacy rule. The HIPAA rule, as enacted, is in fact less stringent with respect to consent than the Minnesota consent law. On the other hand, the Minnesota consent law has not been effectively applied or enforced. As we change the way we manage sensitive medical information, new efforts are needed to provide protection against the confidentiality risks in research. Patient consent is an important tool in this regard. New instrumentalities are needed to solicit and document consent.     

广东2003年末SARS患者冠状病毒抗原抗体动态特征分析

目的分析SARS-IgG、SARS-IgM、核壳蛋白-IgG抗体和核壳蛋白抗原的变化特点并探讨其意义。方法采用酶联免疫方法对2003年末至2004年初新发4例SARS病人的系列血清进行上述4项的滴度检测。结果在病人较早期的血清中可以检测到核壳蛋白抗原，随着抗体水平的升高，抗原含量迅速下降。抗体E升下降快，在最高水平维持时间短，并且除第1例外，其余3例的抗体滴度均小于1：100，核壳蛋白抗体变化规律与总的IgG抗体一致，但滴度更低。结论抗体变化规律与前次流行不同，抗体水平变化快，应注意及时采集标本。抗原检测可作为一种实验室诊断依据。核壳蛋白抗体可考虑用于早期诊断。     

Fuzzy rules to predict degree of malignancy in brain glioma

The current pre-operative assessment of the degree of malignancy in brain glioma is based on magnetic resonance imaging (MRI) findings and clinical data. 280 cases were studied, of which 111 were high-grade malignancies and 169 were low-grade, so that regular and interpretable patterns of the relationships between glioma MRI features and the degree of malignancy could be acquired. However, as uncertainties in the data and missing values existed, a fuzzy rule extraction algorithm based on a fuzzy min-max neural network (FMMNN) was used. The performance of a multi-layer perceptron network (MLP) trained with the error back-propagation algorithm (BP), the decision tree algorithm ID3, nearest neighbour and the original fuzzy min-max neural network were also evaluated. The results showed that two fuzzy decision rules on only six features achieved an accuracy of 84.6% (89.9% for low-grade and 76.6% for high-grade cases). Investigations with the proposed algorithm revealed that age, mass effect, oedema, post-contrast enhancement, blood supply, calcification, haemorrhage and the signal intensity of the T1-weighted image were important diagnostic factors.     

C-spine clearance in poly-trauma patients: A narrative review

The incidence of cervical spine injury in patients with polytrauma is 3.7%. Early identification and management of cervical spine injuries in these patients play a crucial role in preventing secondary cervical spine and cord injuries. C-spine clearance assumes a pivotal role in reducing the morbidity and mortality associated with cervical spine injury. Despite the availability of various validated management algorithms and protocols for C-spine clearance, there are several controversies regarding C-spine clearance, such as the ideal protocol and imaging modality, clearance of obtunded patients and management of patients that lie out of the described protocols and rules. The current article aims to provide a comprehensive review of the relevant literature and address the prevalent controversies.     

基于数据挖掘的中医药治疗小儿湿疹组方用药规律研究

目的：通过应用中医传承辅助平台（V 2.5）挖掘中医药治疗小儿湿疹的组方用药规律,并对高频药物、用药模式及治疗思路进行探讨。方法：搜集国家知识基础设施数据库（CNKI）、中国学术期刊数据库（CSPD）及中文科技期刊数据库（CCD）中2000—2021年应用中医药治疗小儿湿疹的相关文献,经过筛选后建立方药数据库,运用中医传承辅助平台（V 2.5）集成的改进互信息法、关联规则Apriori算法、复杂系统熵聚类与无监督熵聚类等算法对药物频次、性味归经、用药模式、规则分析及新处方等结果进行输出,并进行网络可视化展示。结果：纳入处方200首,共涉及206味中药,高频药物包括甘草、白鲜皮、薏苡仁、茯苓、生地黄、金银花、蝉蜕、地肤子、防风、牡丹皮等,药性以寒性（52.76%）居多,药味以甘（38.89%）、苦（33.37%）、辛（21.96%）味为主,归经以胃经（1 138次）、脾经（1 088次）、肝经（1 061次）居多,并且得到药物之间的关联规则,以及新处方6个。结论：小儿湿疹用药以补虚药、利水渗湿药、清热药、清热解毒药、解表药为主,治疗以疏风清热,燥湿健脾,养血活血为主要大法,分析结果与本病诊疗指南较为吻合,可为小儿湿疹的临床治疗及新药开发提供参考。     

基于K-最近邻规则的磁共振颅脑图像分割算法的应用研究

目的　介绍一种简单实用的磁共振颅脑图像分割算法K 最近邻 (简称K NN)规则 ,并利用该算法对磁共振颅脑图像进行分割研究。方法　该方法是一个多步处理过程。首先利用边界跟踪法对磁共振颅脑图像进行预处理 ,剔除颅骨和肌肉等非脑组织 ,只保留大脑结构 ;然后利用K NN规则对大脑结构进行分割 ,从大脑结构中分别提取出白质 (WM)、灰质 (GM)和脑脊液 (CSF)。结果　分割算法在预处理步中能精确地分割出大脑结构 ,在K NN分割步中能很好地从大脑结构中分割出WM、GM和CSF。结论　该算法在磁共振颅脑图像的分割中简单实用 ,具有很强的鲁棒性和稳定性。     

Test chamber exposure of humans to 1,6-hexamethylene diisocyanate and isophorone diisocyanate

An isocyanate generation apparatus was developed and stable isocyanate atmospheres were obtained. At a concentration of 5 g 1,6-hexamethylene diisocyanate (HDI) per m³ the precision was found to be 7% (n = 5). Three volunteers were each exposed to three different concentrations of HDI (11.9, 20.5, and 22.1 g/m³) and three concentrations of isophorone diisocyanate (IPDI) (12.1, 17.7, and 50.7 g/m³), in an exposure chamber. The duration of the exposure was 2 h. Urine and blood samples were collected, and hydrolysed under alkaline conditions to the HDI and IPDI corresponding amines, 1,6-hexamethylene diamine (HDA) and isophorone diamine (IPDA), determined as their pentafluoropropionic anhydride amides (HDA-PFPA and IPDA-PFPA). The HDA-and IPDA-PFPA derivatives were analysed using liquid chromatography mass spectrometry with thermospray monitoring negative ions. When working up samples from the exposed persons without hydrolysis, no HDA or IPDA was seen. The average urinary excretion of the corresponding amine was 39% for HDI and 27% for IPDI. An association between the estimated inhaled dose and the total excreted amount was seen. The average urinary elimination half-time for HDA was 2.5 h and for IPDA, 2.8 h. The hydrolysis condition giving the highest yield of HDA and IPDA in urine was found to be hydrolysis with 3 M sodium hydroxide during 4 h. No HDA or IPDA could be found in hydrolysed plasma (< ca 0.1 g/l).