论著

基于 Python 语言探析《圣济总录》中腰痛病用药规律研究

Study on medication rule of low back pain in Shengji Zonglu based on Python language

:99-105
 
      目的   应用 Python语言对《圣济总录》中腰痛病篇中的中药进行用药规律分析,提取腰痛病治疗方法及用药特色指导临床腰痛病治疗思路。方法   运用 Python语言中的语言提取对《圣济总录》中腰痛篇章中的所有中药方剂识别,提取方剂组成,统计并分析方剂中中药的规律并将其结果可视化呈现。结果   最终共纳入62首方剂,包含药物86味。其中使用频次≥7次、频率≥1.6%的药物共20味,频次频率最高的为桂枝;所用中药四气以温性为主,占56.74%;五味以辛、甘、苦为主,共约占90%,归经以肝肾经为主;药物功效以补虚类为主,占27.13%;关联规则分析显示提升度最高的组合为麻黄-独活,置信度最高的组合为巴戟天-牛膝、牵牛子-牛膝,支持度最高的组合为川芎-当归、川芎-杜仲;通过聚类分析得到3个聚类结果。结论   《圣济总录》治疗腰痛病方面善用通法和补法,强调活血通络,补益肝肾,尤擅长治疗肝肾亏虚或风寒所客等腰痛病证。
       Objective Python language was used to analyze the rules of traditional Chinese medicine in the chapter of low back pain in Shengji Zonglu,and to extract the treatment methods and medication characteristics of low back pain to guide the clinical treatment of low back pain.Methods The language extraction in Python language was used to identify all the Chinese medicine prescriptions in the chapter of low back pain in Shengji Zonglu,extract the composition of the prescription,and analyze the rules of Chinese medicine in the prescription to visually present the results.Results A total of 62 prescriptions were included,including 86 drugs.Among them,with there were 20 kinds of drugs,the frequency of use ≥7 times,the frequency ≥1.6%,and cmnamomi Mmulus highest frequency.Four gas used in traditional Chinese medicine is given priority to with warm,accounted for 56.74%.The five flavors were mainly pungent,sweet and bitter,accounting for about 90%,and the liver and kidney meridians were the main meridians.The drug efficacy was mainly deficiency tonic,accounting for 27.13%.The association  rule analysis showed that the combination with the highest improvement was Ephedrae Herba- Angelicae Pubescentis Radix,the combination with the highest confidence was Morindae Officinalis Radix- Achyranthis Bidentatae Radix,Pharbitidis Semen- Achyranthis Bidentatae Radix.and the combination with the highest support was Chuanxiong Rhizoma- Angelicae Sinensis Radix,Chuanxiong Rhizoma- Eucommiae Cortex.Three clustering result is obtained by cluster analysis.Conclusions In the treatment of low back pain,Shengji Zonglu is good at using both blocking methods and reinforcing methods,emphasizing circulating blood and unblocking meridians supplementing liver and kidney,especially in the treatment of low back pain syndrome caused by liver and kidney deficiency or wind and cold.
综述

评价药源性心脏毒性生物标志物的研究进展

Research progress in evaluating biomarkers of pharmacogenic cardiotoxicity

:48-55
 
       药源性心脏毒性是临床常见的药物不良反应,是药物研发和临床治疗需面临的严峻考验。对药源性心脏毒性的评价是目前研究的重点,基于其机制复杂多样、临床表现不一、影响因素多,早期评价具有困难。生物标志物是评价心脏毒性的重要指标之一,文章总结了目前已经报道的多种心脏毒性标志物及其潜在的生物标志物,希望能从中找到特异性强、敏感性高的标志物,以贡献于药物心脏安全性评价工作。
    As a common clinical adverse reaction,pharmacogenic cardiotoxicity is a severe challenge for drug development and clinical treatment.The evaluation of pharmacogenic cardiotoxicity is the focus of current research,and early evaluation is difficult with its complex and diverse mechanisms,varying clinical manifestations,and numerous influencing factors.Biomarker is an important index to evaluate cardiotoxicity.This article summarizes a variety of cardiotoxicity biomarkers and other potential biomarkers that have been reported so far,hoping to find  biomarkers with strong specificity and high sensitivity,so as tocontribute to the evaluation on cardiac safety of drugs.
眼科专题:近视防控

西藏林芝市 3 ~ 6 年级学生屈光状态及参数相关性研究

Analysis of refractive status and parameter correlations among three to six grade students in Nyingchi,Tibet

:32-41
 
      目的   分析高原地区3~6年级学生屈光状态及屈光参数之间的关系。方法  2023年9月,采用随机抽样方法选取林芝市波密县某两所小学3~6年级535名学生进行校园筛查。计算并记录裸眼远视力(UCVA),非睫状肌麻痹电脑验光下散光及其轴位、等效球镜(SE)、眼轴(AL)、角膜曲率半径(CR)和眼轴/角膜曲率半径轴率比(AL/CR)。采用SPSS 22.00统计软件分析数据。结果  3~6年级学生AL和AL/CR大体趋势为随年级升高而增长,SE随年级升高而降低。3~6年级学生总体筛查性近视患病率为29.91%,且3~6年级筛查性近视患病率分别为20.35%、25.53%、30.53%和51.38%。总体散光患病率为51.59%,其中顺规散光、逆规散光及斜轴散光分别占90.22%、7.61%及2.17%。视力不良者约40.37%。以非睫状肌麻痹验光SE≤-0.50 D同时UCVA<5.0作为筛查性近视的诊断,AL/CR诊断筛查性近视的灵敏度为0.656、特异度为0.887和Youden指数为0.534,曲线下面积(AUC)为0.802,优于AL评估(AUC=0.764)。结论   高原地区3~6年级学生的筛查性近视患病率随年级升高而快速增长,且散光患病率较高,视力不良者较多。AL/CR值对筛查性近视监测具有一定的临床意义。
      Objective  To analyze the  relationship  between  refractive  status and  refractive  parameters of  students in grades three-six in plateau area.Methods  In September,2023,a random sampling method was used to select 535 students from grades three-six of two primary schools in Bomi County,Nyingchi City,for school screening.Distance uncorrected visual acuity(UCVA),astigmatism and its axis position,equivalent spherical(SE),axial length(AL),corneal radius(CR),and axial length/corneal radius ratio(AL/CR)were calculated and recorded.The data was analyzed using the statistical software SPSS 22.00.Results  The general trend of AL and AL/CR for grade three-six students was increased with grade increasing,while SE decreased with grade increasing.The overall prevalence of screening myopia was 29.91%,and the prevalence of screening myopia in grades three to six was 20.35%,25.53%,30.53% and 51.38%,respectively.The overall prevalence rate of astigmatism was 51.59%,including 90.22%,7.61% and 2.17% for astigmatism with the rule,astigmatism against the rule and oblique astigmatism,respectively.About 40.37% of the students had poor vision.Screening myopia was diagnosed using non-cycloplegic optometry with SE ≤-0.50 D combined with UCVA<5.0.The sensitivity and specificity of AL/CR for screening myopia were 0.656 and 0.887,respectively,with a Youden index of 0.534 and an area under the curve(AUC)of 0.802.This was superior to the AL evaluation,which had an AUC of 0.764.Conclusions  The prevalence of screening myopia increased rapidly with the increase of grade in grade 3 to 6 in plateau area.And there were high prevalence of astigmatism and more poor vision.AL/CR value has a certain clinical significance in the monitoring of screening myopia.
眼科专题:近视防控

羽毛球颠球运动对低年级小学生近视影响的研究

Study on the impact of badminton juggling on myopia in lower grade primary school students

:26-31
 
    目的   研究羽毛球颠球运动对低年级小学生近视的改善效果,为制定儿童青少年近视干预方案提供依据。方法   采用方便抽样方法,抽取广州市1个城区1所小学三年级4个班共182名学生作为研究对象。基线调查完成后,以班为单位,采用随机数字表法将4个班分为干预组(2个班,91例)和对照组(2个班,91例),干预组安排羽毛球颠球项目体育活动,对照组按原教学计划安排非球类常规体育活动。比较两组干预前后筛查性近视率、视力不良率和近视进展程度。结果  干预前两组的年龄、性别、筛查性近视率、视力不良率及近视分级比较,差异均无统计学意义(P>0.05)。两组干预后的等效球镜度数(SE)比较,差异无统计学意义(P>0.05);对照组干预后的裸眼远视力(UDVA)低于干预组,△UDVA、△SE均高于干预组,差异均有统计学意义(P<0.05)。对照组新发筛查性近视率29.13%、累积筛查性近视率49.45%、累积视力不良率68.13%及近视进展程度,均高于干预组新发筛查性近视率7.69%、累积筛查性近视率34.07%、累积视力不良率52.74%及近视进展程度,差异均有统计学意义(P<0.05)。结论   羽毛球颠球运动能降低低年级小学生视力不良进展速度,减少近视的发生率及近视程度,学校可结合引起近视的因素进行灵活应用,以预防近视的发生发展。
      Objective  To study the impact of badminton juggling on the myopia of lower-grade primary school students and to provide a basis for developing myopia intervention strategies for children and adolescents.Methods  By using the convenience sampling method,182 third-grade students from four classes in a primary school in a district of Guangzhou were selected as subjects.After completing the baseline survey,the four classes were divided into an intervention group(2 classes,91 students)and a control group(2 classes,91 students)using a random number table.The intervention group was arranged to participate in badminton juggling sports activities,while the control group followed the original teaching plan without ball games.The study compared the screening rate of myopia,the rate of poor vision,and the degree of myopia progression before and after the study in both groups.Results  On baseline,there were no statistically significant differences between the two groups in terms of age,gender,rate of screening myopia,poor vision,and myopia grading(P>0.05).After 12 months,there was no statistically significant difference in the spherical equivalent(SE) comparison between the two groups(P>0.05).However,the uncorrected distance visual acuity(UDVA) of the control group after 12 months was significantly lower than that of the intervention group,and both △UDVA and △SE were significantly higher than those of the intervention group,with all differences being statistically significant(P<0.05).Incidence of screening myopia in the control group (29.13%),the cumulative rate of screening myopia(49.45%),the cumulative rate of poor vision (68.13%),and the degree of myopia progression was significantly higher than those in the intervention group,which had incidence of screening myopia at 7.69%,the cumulative rate of screening myopia at 34.07%,cumulative rate of poor vision at 52.74%.All these differences were statistically significant(P<0.05).Conclusions  Badminton juggling can slow down vision deterioration,reduce the incidence and severity of myopia in lower grade primary school students.Schools can flexibly apply these findings in conjunction with factors that contribute to myopia to prevent its occurrence and development.
眼科专题:近视防控

广州荔湾区 398 例儿童 FTD 和 PPA 与眼轴长相关性研究

Study on the correlation between FTD and PPA with axial length in 398 children from Liwan district,Guangzhou

:18-25
 
       目的   探讨眼底豹纹斑密度(FTD)及视盘旁萎缩弧(PPA)与眼轴长(AL)的相关性,为眼底定量化在儿童近视防控的应用提供科学依据。方法   本研究随机抽取广州市荔湾区两所小学三年级学生作为研究对象,在校园视力筛查的过程中同时采集AL、CR和眼底彩照。使用AI软件对眼底彩照进行量化分析,量化指标包括不同区域和范围的FTD及PPA面积大小,根据眼轴长度分为三组:A组(AL<23 mm);B组(23 mm≤AL<24 mm);C组(24 mm≤AL)。结果   共有398例右眼被纳入统计分析,年龄范围8~11岁,中位数是9岁,男性人数占55.1%。三组组间AL、AL/CR和SE比较均有统计学差异(P<0.05)。A组与B组相比,FTD在后极部整体范围、黄斑中心3 mm区域、黄斑中心3 mm区域上方区域具有统计学差异(P<0.05),C组与B组相比,PPA面积及FTD在后极部整体范围、视盘为中心4.5 mm范围、黄斑为中心直径3 mm和6 mm范围均具有统计学差异(P<0.05),Spearman相关性分析表明,AL与PPA(r=0.443)和FTD(r=0.322)呈正相关(P<0.001)。亚组相关性分析表明,A组仅黄斑为中心直径3 mm上方范围FTD与AL呈正相关(P=0.028),B组PPA、黄斑中心直径3 mm及其上方范围FTD与AL呈正相关(P<0.05),C组仅PPA与AL呈正相关(P=0.005)。结论底定量对于儿童近视防控具有潜在价值,PPA和FTD与AL呈正相关性,不同区域和范围FTD与AL相关性具有一定差异性,黄斑中心直径3 mm范围及其上方范围与眼轴相关性最强。FTD在短眼轴阶段就可以作为生物标记物预测近视严重程度,而PPA主要在长眼轴阶段体现生物标记物的作用。
       Objective  To investigate the correlation between fundus tessellated density(FTD)and peripapillary atrophy(PPA)with axial length(AL), providing a scientific basis for the application of fundus quantification in the prevention and control of myopia in children. Methods  This study randomly selected third-grade students from two primary schools in Liwan District, Guangzhou City, as research subjects. Axial length(AL), corneal radius(CR), and fundus color photographs were collected simultaneously during the school vision screening process. AI software was utilized to perform quantitative analysis on the fundus color photographs, with quantification indicators including the area size of PPA and FTD in different regions and ranges. Subjects were divided into three groups based on axial length:Group A(AL<23 mm); Group B(23 mm≤AL<24 mm); Group C(AL≥24 mm). Results  A total of 398 right eyes were included in the statistical analysis, with an age range of 8 to 11, a median age of 9, and 55.1% were male. There were significant statistical differences in AL, AL/CR, and spherical equivalent(SE)among the three groups(P<0.05). Compared with Group B, Group A showed significant statistical differences in FTD in the overall posterior pole, the 3 mm diameter area centered on the fovea, and the superior area of the 3 mm foveal center(P<0.05). Compared with Group B, Group C showed significant differences in PPA area and FTD in the overall posterior pole, the 4.5 mm diameter area centered on the optic disc, and the 3 mm and 6 mm diameter areas centered on the fovea(P<0.05). Spearman correlation analysis indicated that AL was significantly positively correlated with PPA(r=0.443)and FTD(r=0.322)(P<0.001). Subgroup correlation analysis showed that in Group A, only the FTD in the superior area of the 3 mm diameter centered on the fovea was significantly positively correlated with AL(P=0.028). In Group B, PPA and FTD in the 3 mm diameter and superior area centered on the fovea were significantly positively correlated with AL(P<0.05). In Group C, only PPA was significantly positively correlated with AL(P=0.005). Conclusions  Fundus quantification holds potential value for the prevention and control of myopia in children. PPA and FTD show significant positive correlations with AL, with varying degrees of correlation in different regions and ranges of FTD with AL. The 3 mm diameter area centered on the fovea and its superior area have the strongest correlation with the eye axis. FTD can serve as a biomarker to predict the severity of myopia in the early stages of eye axis elongation, while PPA primarily manifests as a biomarker in the later stages of elongation. 
眼科专题:近视防控

成年人近视的流行病学及其相关危险因素的研究进展

Advances in the epidemiology and risk factors of adult myopia

:11-17
 
      近视是一种常见的屈光不正状态,也是全球范围内普遍存在的视觉健康问题,其特征是在眼部调节放松的状态下,平行光线经眼的屈光系统折射后聚焦在视网膜前,导致视远模糊。近视通常在儿童期发生和发展,但在成年期仍可继续发生和发展。本综述对已发表的关于成年人近视发生和进展的文献进行总结,描述成年人近视的流行病学特征,包括近视率、近视发病率、近视进展率及其近视特征(屈光度及眼轴),总结成年人近视发病和进展的危险因素。了解成年人近视的发展特点和管理方式对于近视防控实践具有重要意义。
   Myopia is a common refractive error and a universal visual health problem in the world. It is characterized by the fact that parallel light rays refract through the refractive system of the eye and focus in front of the retina when the eye accommodatior is relaxed, resulting in distant blurred vision. Myopia usually occurs and develops in childhood, but can continue to occur and develop in adulthood. This review summarizes the published literature on the occurrence and progression of myopia in adults, describes the epidemiological characteristics of myopia in adults, including myopia rate, myopia incidence rate, myopia progression rate, and myopia characteristics(diopter and ocular axis) ; and summarizes the  risk factors for the occurrence and progression of myopia in adults. Understanding the developmental characteristics and management methods of adult myopia is of great significance for myopia prevention and control practice. 

眼科专题:近视防控

户外活动对近视防控作用及其机制的研究进展

Research progress on prevention and control effect and mechanism of outdoor activities on myopia LI Shukui,LENG Yunxia

:4-10
 
       近几十年来,全球近视患病率不断上升,已成为全世界主要的公共卫生问题之一。众多研究表明户外活动能有效控制近视的发生和发展。本文综述了户外活动对近视防控作用的研究进展及其作用机制,以期为近视防控提供新的思路。

     In recent decades, the prevalence of myopia has been increasing globally, becoming one of the major public health issues worldwide. Numerous studies indicate that outdoor activities can effectively control the onset and progression of myopia. This article reviews the research progress on prevention and control effect and mechanism of outdoor activities on myopia, hoping to provide new insights for myopia prevention and control. 
专家述评

乳酸化修饰在肿瘤中的研究进展

The role of lactation modification in tumors

:1237-1245
 
乳酸以往被视为不具备生物学功能的代谢废物。随着人们对乳酸的深入研究,发现乳酸有多种作用。乳酸化修饰是近期发现一种与乳酸有关的蛋白质翻译后修饰过程。乳酸化修饰主要有两种,一种是与乳酸相关的直接修饰,另外一种是与丙酮酸相关的间接修饰。这两种乳酸化修饰均可能受到糖酵解、乳酸转运与堆积、蛋白质串扰以及神经系统等多方面的调控。乳酸化修饰可以通过直接或间接修饰组蛋白或非组蛋白,从而在肿瘤组织的代谢重编程、增殖、迁移及免疫逃逸中发挥着重要作用。乳酸化修饰的深入研究,有望为肿瘤的诊断和治疗开辟新的路径。因此,为了明确乳酸化修饰在肿瘤方面的研究进展,本文就蛋白乳酸化修饰的分子机制及其在肿瘤中作用的研究进展作一综述。
       Lactic acid was previously regarded as a metabolic waste product with no biological function. As lactic acid has been intensively studied, it has been found to have multiple roles. Lactation modification is a recently discovered protein post-translational modification process related to lactic acid. There are two main types of lactation modification:one is direct modification related to lactic acid and the other is indirect modification related to pyruvate. Both types of lactation modification may be regulated by various aspects such as glycolysis, lactate transport and accumulation, protein crosstalk, and the nervous system. Lactation modification can play an important role in metabolic reprogramming, proliferation, migration, and immune escape of tumor tissues by directly or indirectly modifying histones or non-histone proteins. The in-depth study of lactation modification is expected to find new pathways for tumor diagnosis and treatment. Therefore, in order to clarify the research progress of lactation modification in tumors, this paper presents a review on the molecular mechanism of protein lactation modification and the research progress of its role in tumors. 
医院管理

某三甲医院医疗诉求数据分析与对策研究

Data analysis and countermeasure research on medical demands of a primary hospital

:1506-1510
 
       目的  识别医院在医患沟通、服务态度、医疗服务和医疗质量方面存在的问题,研究提升医院医疗质量与安全的对策。方法   通过收集和整理2024年1-6月某三甲医院医患沟通科处理的医疗诉求数据,包括患者投诉、咨询、建议及求助调查结果,采用定性分析和定量分析相结合的方法,对134件医疗诉求数据进行详细分类和统计,深入分析投诉事由,并结合实际有责投诉量与诊疗总人数,计算投诉千人发生率。投诉千人发生率与2023年同期对照。结果   共处理医疗诉求134件,其中投诉116件(占86.56%)、求助11件(8.21%)、咨询5件(3.73%)、建议2件(1.5%)。投诉中,医患沟通不畅和服务态度问题占42%,医疗服务问题32%,医疗质量问题占26%。实际有责投诉量为63件,投诉千人发生率约为0.12‰。通过对诉求数据的深入分析,识别出医疗服务过程中的薄弱环节和改进点。结论   针对分析结果及同期对照,提出相应的对策建议,包括加强医患沟通培训,改善服务态度,优化医疗服务流程,并对投诉高发科室进行特别关注和改进等措施,以提高患者满意度和医院整体医疗质量。

Objective To identify issues in hospital communication, service attitude medical services, and medical  quality and to explore strategies for enhancing hospital medical quality and safety.  Methods  By collecting and organizing medical  appeal data processed by the Medical Communication Department of a tertiary hospital from January to June 2024, including patient  complaints, inquiries, suggestions, and requests for help. A combined qualitative and quantitative analysis was conducted on 134  medical appeal cases. Detailed classification and statistics were performed on these cases, and an in-depth analysis of the  reasons  for complaints was carried out. Furthermore, the actual number of  responsible complaints was compared with the total number of  treated patients to calculate the complaint rate per thousand people. This complaint  rate was then compared with the same period  in 2023.  Results  A total of 134 medical appeals were processed including 116 complaints(accounting for 86. 56%), 11  requests for help(8. 21%), 5 inquiries(3. 73%), and 2 suggestions(1. 5%). Among the complaints, issues  related to poor  communication between doctors and patients and service attitude accounted for 42%, medical service issues accounted for 32%, and  medical quality issues accounted for 26%. The actual number of responsible complaints was 63, and the complaint rate per thousand  people was approximately 0. 12‰. Through in-depth analysis of the appeal data, weak links and improvement points in the medical  service process were identified.  Conclusions Based on the analysis results and comparisons with the same period, corresponding  countermeasures and suggestions are proposed, including strengthening communication training between doctors and patients,  improving service attitude, optimizing medical service processes, and paying special attention to and improving departments with high  complaint rates in order to improve patient satisfaction and overall hospital medical quality. 

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