中医诊断量化研究的现状、问题与对策

本文简要分析了中医诊断量化研究的进程与症结,通过对中医阴阳五行、天人合一理论与人体功能态模型涵义的深入分析与阐述,认为中医诊断量化研究的途径应以中医学本身的方法论与认识论作为基础,所有的中医科学研究要在这个框架内进行,并在此基础上选择合适的现代科学方法。将定性与定量的研究结合起来,并把量化了的每一种信息放进人体功能态模型内进行定性归位,放在整体内去考量,才能和中医的临床相结合,才能符合中医的理法方药,才有临床使用价值。

Depression recognition using functional connectivity based on dynamic causal model

Dynamic casual modeling of functional magnetic resonance imaging（fMRI） signals is employed to explore critical emotional neurocircuitry under sad stimuli. The intrinsic model of emotional loops is built on the basis of Papez＇s circuit and related prior knowledge, and then three modulatory connection models are established. In these models, stimuli are placed at different points, which represents they affect the neural activities between brain regions, and these activities are modulated in different ways. Then, the optimal model is selected by Bayesian model comparison. From group analysis, patients＇ intrinsic and modulatory connections from the anterior cingulate cortex （ACC） to the right inferior frontal gyrus （rlFG） are significantly higher than those of the control group. Then the functional connection parameters of the model are selected as classifier features. The classification accuracy rate from the support vector machine（SVM） classifier is 80.73%, which, to some extent, validates the effectiveness of the regional connectivity parameters for depression recognition and provides a new approach for the clinical diagnosis of depression.

T2DM患者短期胰岛素泵强化治疗后应用不同序贯治疗方案的临床效果

目的探究2型糖尿病(T2DM)患者短期胰岛素泵强化治疗(CSII)后应用不同的序贯治疗方案的效果。方法78例T2DM患者作为研究对象,根据序贯治疗方案不同分为MET组、STG组和LIR组,每组26例。三组患者均给予饮食、运动以及血糖监测等内容指导和CSII治疗,MET组采用二甲双胍进行序贯治疗,STG组采用西格列汀进行序贯治疗,LIR组采用利拉鲁肽进行序贯治疗。比较三组患者临床指标[治疗后0~10 min胰岛素曲线下面积的改变值(ΔAUC_(Ins 0~10 min))、治疗后体质量指数的改变值(ΔBMI)、治疗后糖化血红蛋白的改变值(ΔHbA1c)、治疗后稳态模型胰岛β细胞功能指数的改变值(ΔHOMA-β)、治疗后的稳态模型胰岛素抵抗指数改变值(ΔHOMA-IR)、治疗后0~8 min胰升血糖素曲线下面积的改变值(ΔAUC_(Glu 0~8 min))]及不良反应发生情况。结果MET组患者的ΔBMI、ΔHbA1c、ΔHOMA-IR、ΔAUC_(Ins 0~10 min)、ΔHOMA-β、ΔAUC_(Glu 0~8 min)分别为(-0.2±0.1)kg/m^(2)、(-1.4±0.4)%、(-0.9±0.2)、(15.6±4.3)mU·min、(12.8±6.4)、(-30.3±8.1)μg·min,STG组分别为(-0.1±0.1)kg/m^(2)、(-0.8±0.2)%、(-0.5±0.2)、(52.0±4.9)mU·min、(30.8±7.3)、(-81.5±5.9)μg·min,LIR组分别为(-1.4±0.3)kg/m^(2)、(-1.0±0.4)%、(-1.3±0.3)、(81.2±7.5)mU·min、(48.2±5.6)、(-115.4±8.1)μg·min。LIR组的ΔBMI、ΔHOMA-IR、ΔAUC_(Glu 0~8 min)均低于MET组和STG组,差异具有统计学意义(P<0.05);MET组的ΔBMI和ΔHOMA-IR均低于STG组,ΔAUC_(Glu 0~8 min)高于STG组,差异具有统计学意义(P<0.05)。MET组的ΔHbA1c、ΔAUC_(Ins 0~10 min)、ΔHOMA-β均低于STG组和LIR组,差异具有统计学意义(P<0.05);STG组的ΔHbA1c高于LIR组、ΔAUC_(Ins 0~10 min)和ΔHOMA-β均低于LIR组,差异具有统计学意义(P<0.05)。治疗后,三组患者均无严重不良反应,MET组发生消化道系统症状3例(11.54%),STG组发生消化道系统症状4例(15.38%),LIR组发生消化道系统症状5例(19.23%),三组患者的不良反应发生率对比差异无统计学意义(P>0.05)。结论T2DM患者在CSII后,采用利拉鲁肽等长促胰素药物较二甲双胍以及西格列汀的序贯疗法,在改善T2DM病理生理缺陷方面效果更明显,值得应用与推广。

糖尿病前期患者CTRPs、HOMA-IR及HOMA-β水平与2型糖尿病发生的相关性及其预测价值

目的糖尿病前期患者补体C1q/肿瘤坏死因子相关蛋白(CTRP)、稳态模型评估胰岛素抵抗指数(HOMA-IR)及稳态模型评估胰岛β细胞功能指数(HOMA-β)与2型糖尿病发生的相关性及其预测价值。方法选择2020年1月—2022年12月于新疆维吾尔自治区人民医院内分泌科收治首次诊断2型糖尿病患者60例作为观察组,首次诊断糖尿病前期患者60例作为对照组。检测并比较2组患者补体C1q/肿瘤坏死因子相关蛋白1(CTRP1)、CTRP3、CTRP9及CTRP12,空腹胰岛素(FINS)、空腹血糖(FPG)、HOMA-IR及HOMA-β。采用相关性分析、回归分析筛选2型糖尿病发生的独立危险因素,应用受试者工作特征曲线(ROC)评价各独立危险因素对2型糖尿病的预测价值。结果观察组患者血清CTRP1水平低于对照组,血清CTRP9、FINS、FPG水平及HOMA-IR及HOMA-β均高于对照组患者(t/P=5.365/0.001、4.626/0.001、1.979/0.050、2.330/0.021、8.988/0.001、5.632/0.001);血清CTRP1与FPG、HOMA-IR及HOMA-β呈负相关(r/P=-0.260/0.004、-0.189/0.039、-0.262/0.004),CTRP9与HOMA-IR及HOMA-β呈正相关(r/P=0.282/0.002、0.262/0.004);血清CTRP9水平、HOMA-IR及HOMA-β升高均是2型糖尿病发生的独立危险因素[OR(95%CI)=5.995(1.514~23.747)、151.722(15.385~1496.220)、1.127(1.005~1.265)],而血清CTRP1水平升高是2型糖尿病发生的独立保护因素[OR(95%CI)=0.907(0.846~0.972)];HOMA-IR对2型糖尿病发生的预测价值最高(AUC=0.884,P<0.001)。结论血清升高是独立保护因素,CTRP9水平、HOMA-IR及HOMA-β均是糖尿病前期患者发生2型糖尿病的独立危险因素,其中HOMA-IR独立预测疾病发生的效能最高,对于临床具有重要指导意义。

SGLT2抑制剂联合二甲双胍治疗2型糖尿病的有效性和安全性分析

探讨对2型糖尿病患者采用SGLT2抑制剂+二甲双胍药物进行治疗后获得疗效以及安全性。方法:将我院2018年06月~2020年05月收治的120例2型糖尿病患者依据数字奇偶法分组;联合组(60例):采用SGLT2抑制剂+二甲双胍药物完成糖尿病治疗;单一组(60例):采用二甲双胍药物完成糖尿病治疗;就组间空腹血糖水平、糖化血红蛋白水平、新稳态模型β细胞功能指数、体重、脂联素水平以及不良反应展开对比。结果:联合组2型糖尿病患者空腹血糖水平(8.42±0.35)mmol/L、糖化血红蛋白水平(7.22±0.85)%以及体重(70.45±3.31)kg均低于单一组空腹血糖水平(8.71±0.36)mmol/L、糖化血红蛋白水平(7.61±0.41)%以及体重(75.41±4.02)kg明显(P<0.05);联合组2型糖尿病患者脂联素水平(28.45±3.31)ng/mL以及新稳态模型β细胞功能指数(17.55±3.22)%均高于单一组脂联素水平(25.51±1.61)ng/mL以及新稳态模型β细胞功能指数(15.65±3.21)%明显(P<0.05);两组不良反应集中于恶心、腹泻以及腹痛等方面,均无严重表现。结论:SGLT2抑制剂+二甲双胍药物有效应用,可使2型糖尿病患者空腹血糖水平、糖化血红蛋白水平以及体重获得显著降低,并同时将脂联素水平以及新稳态模型β细胞功能指数显著提升,不会导致不良反应增加,最终实现2型糖尿病患者有效预后。

Seam tracking control for mobile welding robot based on vision sensor

To solve the seam tracking problem of mobile welding robot,a new controller based on the dynamics of mobile welding robot was designed using the method of backstepping kinematics into dynamics.A self-turning fuzzy controller and a fuzzy-Gaussian neural network(FGNN) controller were designed to complete coordinately controlling of cross-slider and wheels.The fuzzy-neural control algorithm was described by applying the Gaussian function and back propagation(BP) learning rule was used to tune the membership function in real time by applying the FGNN controller.To make the tracking more quickly and smoothly,the neural network controller based on dynamic model was designed,which utilized self-learning and self-adaptive ability of the neural network to deal with the partial uncertainty and the disturbances of the parameters of the robot dynamic model and real-time compensate the dynamics coupling.The results show that the selected control input torques make the system globally and asymptotically stable based on the Lyapunov function selected out;the accuracy of the proposed controller tracing is within ±0.4 mm and can satisfy the requirements of practical welding project.

桑枝总生物碱联合高压氧治疗对老年2型糖尿病患者HOMA-IR及HOMA-β等指标的改善作用

目的探讨桑枝总生物碱联合高压氧治疗对改善老年2型糖尿病患者稳态模型胰岛素抵抗指数(HOMA-IR)及稳态模型胰岛β细胞功能指数(HOMA-β)等指标的作用。方法选择老年糖尿病患者为治疗对象,根据患者主观参与意愿分为对照组、高压氧组、生物碱组和联合组。对照组行常规治疗。高压氧组在对照组基础上增加高压氧治疗。生物碱组在对照组基础上口服桑枝总生物碱片治疗。联合组在对照组基础上联合高压氧疗法和桑枝总生物碱片治疗。治疗后,从患者血糖、稳态模型胰岛素抵抗指数(HOMA-IR)、稳态模型胰岛β细胞功能指数(HOMA-β)、C-肽(C-P)、不良反应发生率、治疗效果等方面进行比较。结果联合组空腹血糖(FBG)显著低于对照组、高压氧组和生物碱组(P<0.05)。生物碱组和联合组餐后2 h血糖(2 h BG)显著低于对照组和高压氧组(P<0.05)。生物碱组HOMA-IR低于对照组和高压氧组,联合组HOMA-IR低于对照组、高压氧组和生物碱组,差异均有统计学意义(P<0.05)。生物碱组HOMA-β、C-P高于对照组和高压氧组,联合组HOMA-β、C-P高于对照组、高压氧组和生物碱组,差异均有统计学意义(P<0.05)。联合组治疗总有效率高于对照组,差异有统计学意义(P<0.05)。4组不良反应发生率差异无统计学意义(P>0.05)。结论桑枝总生物碱联合高压氧治疗可有效改善老年2型糖尿病患者HOMA-IR及HOMA-β等指标,提高治疗效果。

Slave-Fermion Mean-Field Theory of Heisenberg Model

A nearly half-filled two-dimensional Heisenberg model is investigated. A slave-fermion method with fermions as the charge carriers and bosons as the spin carriers is proposed. The ground state shows antiferromagnetic long range order at T = 0. The spin-spin correlation and static susceptibility are also obtained.

柴胡消渴汤联合甘精胰岛素治疗糖尿病胰岛素抵抗临床研究

目的:观察柴胡消渴汤联合甘精胰岛素治疗糖尿病胰岛素抵抗的临床疗效。方法:选取69例糖尿病胰岛素抵抗患者,按随机数字表法分成对照组34例及试验组35例。对照组给予甘精胰岛素治疗,试验组给予甘精胰岛素联合柴胡消渴汤治疗,2组均治疗3个月。比较2组治疗前后空腹血糖、餐后2 h血糖,以及稳态模型胰岛素抵抗指数(HOMA-IR)、稳态模型胰岛β细胞功能指数(HOMA-β)、空腹胰岛素(FINS)和胰岛素敏感指数(ISI);比较2组临床疗效及不良反应发生率。结果:治疗后,2组空腹血糖、餐后2 h血糖均较治疗前降低(P<0.05),试验组空腹血糖、餐后2 h血糖均低于对照组(P<0.05)。治疗后,2组HOMA-IR、FINS均较治疗前降低(P<0.05),HOMA-β、ISI均较治疗前升高(P<0.05);试验组HOMA-IR、FINS均低于对照组(P<0.05),HOMA-β、ISI均高于对照组(P<0.05)。试验组总有效率94.29%,高于对照组76.47%(P<0.05)。试验组不良反应发生率11.43%,与对照组8.82%比较,差异无统计学意义(P>0.05)。结论:柴胡消渴汤联合甘精胰岛素治疗糖尿病胰岛素抵抗,可降低患者的血糖水平,改善胰岛素抵抗,且安全性好。

格列齐特联合利格列汀治疗2型糖尿病的临床研究

目的探讨格列齐特缓释片联合利格列汀片治疗2型糖尿病的临床疗效。方法选取2015年6月—2017年4月天津医科大学第二医院内分泌科收治的2型糖尿病患者120例为研究对象,根据随机原则分成对照组和治疗组,每组各60例。对照组口服利格列汀片,5 mg/次,1次/d。治疗组在对照组基础上口服格列齐特缓释片,30 mg/次,1次/d。两组患者均连续治疗12周。观察两组的临床疗效,比较两组的血糖水平、糖化血红蛋白(Hb A1c)、胰岛素抵抗指数(HOMA-IR)和稳态模型评估β细胞功能(HOMA-β)。结果治疗后,对照组和治疗组的总有效率分别为83.33%、96.67%,两组比较差异有统计学意义(P<0.05)。治疗后,两组空腹血糖、餐后2 h血糖和Hb A1c水平均显著下降,同组治疗前后比较差异有统计学意义(P<0.05);且治疗组空腹血糖和Hb A1c水平明显低于对照组,两组比较差异具有统计学意义(P<0.05)。治疗后,两组HOMA-IR显著下降,HOMA-β显著升高,同组治疗前后比较差异有统计学意义(P<0.05);且治疗组HOMA-β明显高于对照组,两组比较差异具有统计学意义(P<0.05)。结论格列齐特缓释片联合利格列汀片治疗2型糖尿病具有较好的临床疗效,可改善胰岛素抵抗和胰岛β细胞功能,安全性较好,具有一定的临床推广应用价值。

Reweighted Nadaraya-Watson estimation of jump-diffusion models

In this paper,we study the nonparametric estimation of the second infinitesimal moment by using the reweighted Nadaraya-Watson (RNW) approach of the underlying jump diffusion model.We establish strong consistency and asymptotic normality for the estimate of the second infinitesimal moment of continuous time models using the reweighted Nadaraya-Watson estimator to the true function.

Delimiting Ecological Space and Simulating Spatial-temporal Changes in Its Ecosystem Service Functions based on a Dynamic Perspective: A Case Study on Qionglai City of Sichuan Province, China

Delimiting ecological space scientifically and making reasonable predictions of the spatial-temporal trend of changes in the dominant ecosystem service functions(ESFs) are the basis of constructing an ecological protection pattern of territorial space, which has important theoretical significance and application value. At present, most research on the identification, functional partitioning and pattern reconstruction of ecological space refers to the current ESFs and their structural information, which ignores the spatial-temporal dynamic nature of the comprehensive and dominant ESFs, and does not seriously consider the change simulation in the dominant ESFs of the future ecological space. This affects the rationality of constructing an ecological space protection pattern to some extent. In this study, we propose an ecological space delimitation method based on the dynamic change characteristics of the ESFs, realize the identification of the ecological space range in Qionglai City and solve the problem of ignoring the spatial-temporal changes of ESFs in current research. On this basis, we also apply the Markov-CA model to integrate the spatial-temporal change characteristics of the dominant ESFs, successfully realize the simulation of the spatial-temporal changes in the dominant ESFs in Qionglai City’s ecological space in 2025, find a suitable method for simulating ecological spatial-temporal changes and also provide a basis for constructing a reasonable ecological space protection pattern. This study finds that the comprehensive quantity of ESF and its annual rate of change in Qionglai City show obvious dynamics, which confirms the necessity of considering the dynamic characteristics of ESFs when identifying ecological space. The areas of ecological space in Qionglai city represent 98307 ha by using the ecological space identification method proposed in this study, which is consistent with the ecological spatial distribution in the local ecological civilization construction plan. This confirms the reliability of the ecological space identification method based on the dynamic characteristics of the ESFs. The results also show that the dominant ESFs in Qionglai City represented strong non-stationary characteristics during 2003–2019,which showed that we should fully consider the influence of the dynamics in the dominant ESFs on the future ESF pattern during the process of constructing the ecological spatial protection pattern. The Markov-CA model realized the simulation of spatial-temporal changes in the dominant ESFs with a high precision Kappa coefficient of above 0.95, which illustrated the feasibility of using this model to simulate the future dominant ESF spatial pattern. The simulation results showed that the dominant ESFs in Qionglai will still undergo mutual conversions during 2019–2025 due to the effect of the their non-stationary nature. The ecological space will still maintain the three dominant ESFs of primary product production, climate regulation and hydrological regulation in 2025, but their areas will change to 32793 ha, 52490 ha and 13024 ha, respectively. This study can serve as a scientific reference for the delimitation of the ecological conservation redline, ecological function regionalization and the construction of an ecological spatial protection pattern.

慢性乙型肝炎患者代谢异常对肝纤维化的影响

目的探讨慢性乙型肝炎患者代谢异常对肝纤维化的影响。方法分析110例慢性乙型肝炎患者HOMA-IR、HOMA-β、糖脂代谢异常以及脂肪肝对肝纤维化的影响。结果 HOMA-IR越高,肝脏弹性值(LSM)越高(F=5.559、P=0.005),各项肝功能指标、TBil水平亦随HOMA-IR增大而有所升高,但组间差异无统计学意义(P>0.05)。HOMA-β越差,LSM越高(t=-2.771、P=0.029),各项肝功能指标、TBil水平亦随HOMA-β降低而有所升高,但组间差异无统计学意义(P>0.05)。糖代谢状态越差,患者LSM、ALP、GGT水平越高,伴发脂肪肝的比例越高(F=4.663、10.171、11.331、6.482,P=0.033、0.002、0.001、0.039),其他肝功能指标、TBil水平亦随糖代谢的恶化而有所升高,但组间差异尚无统计学意义(P>0.05)。脂代谢异常组较脂代谢正常组及有脂肪肝组较无脂肪肝组肝功能指标、TBil、LSM水平亦有所升高,但组间差异无统计学意义(P>0.05)。结论慢性乙型肝炎患者胰岛素抵抗、胰岛β细胞功能减退、糖脂代谢状态的恶化可促进肝纤维化的进程。

奥利司他胶囊联合西格列汀二甲双胍片治疗肥胖型2型糖尿病的临床研究

目的探讨奥利司他胶囊联合西格列汀二甲双胍片治疗肥胖型2型糖尿病的临床疗效。方法选取2016年3月—2017年3月华中科技大学同济医学院附属协和医院收治的141例患者,随机分为对照组(70例)和治疗组(71例)。对照组患者口服西格列汀二甲双胍片,1片/次,2次/d。治疗组在对照组的治疗基础上口服奥利司他胶囊,1粒/次,3次/d。两组患者均连续治疗12周。观察两组患者的临床疗效,比较两组患者治疗前后空腹血糖(FPG)、餐后2 h血糖(2 h PG)、糖化血红蛋白(Hb A1c)、总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、稳态模型胰岛素抵抗指数(HOMA-IR)和稳态模型胰岛β细胞功能指数(HOMA-β)的变化情况。结果治疗后,对照组和治疗组的总有效率分别为84.29%、95.77%。两组比较差异具有统计学意义(P<0.05)。治疗后,两组患者的FPG、2 h PG、Hb A1c、TC、TG、LDL-C、HOMA-IR、体质量指数水平均较治疗前显著降低(P<0.05),HDL-C、HOMA-β水平升高,同组治疗前后比较差异具有统计学意义(P<0.05);治疗后,治疗组患者FPG、2 h PG、Hb A1c、TC、TG、LDL-C、HOMA-IR、体质量指数低于对照组,HDL-C、HOMA-β水平高于对照组,两组比较差异具有统计学意义(P<0.05)。结论奥利司他胶囊联合西格列汀二甲双胍片治疗肥胖型2型糖尿病具有较好的临床疗效,可显著改善患者血糖水平,安全性较高,具有一定的临床推广应用价值。

Prey-predator model with functional response for optimal harvesting incorporating prey refuge

This paper presents a prey-predator model considering the predator interacting with non-refuges prey by class of functional responses. Here we also consider harvesting for only non-refuges prey. We discuss the equilibria of the model, and their stability for hiding prey either in constant form or proportional to the densities of prey population. We also investigate various possibilities of bionomic equilibrium and optimal harvesting policy. Finally we present numerical examples with pictorial presentation of the various effects of the prey predator system parameter.