苦参凝胶治疗外阴阴道假丝酵母菌病(湿热下注证)的药物经济学评价

目的:评价苦参凝胶治疗外阴阴道假丝酵母菌病(VVC,湿热下注证)的经济性。方法:从卫生体系角度出发,基于1项已发表的苦参凝胶治疗VVC的随机对照试验研究,以该研究中的假丝酵母菌转阴率作为效果参数,从米内网数据库获得成本参数,应用TreeAge Pro软件对苦参凝胶治疗VVC(湿热下注证)进行成本-效果分析。结果:决策树模型模拟结果显示,患者用药治疗14 d后,苦参凝胶联合克霉唑阴道片的成本为123.28元,外阴阴道假丝酵母菌转阴率为0.93;单纯使用克霉唑阴道片的成本为86.56元,假丝酵母菌转阴率为0.71。与单纯使用克霉唑阴道片相比,苦参凝胶联合克霉唑阴道片的成本较高,疗效也更好,增量成本-效果比为166.91元,约为2020年我国人均可支配收入(32189元)的0.52%,敏感性分析显示结果较为稳健。结论:基于2020年我国人均可支配收入作为患者意愿支付阈值的假设,苦参凝胶联合克霉唑阴道片治疗VVC比单纯使用克霉唑阴道片更具有经济性。本研究的开展有益于临床医师合理用药或选用经济性更优的方案,同时对于卫生医疗资源配置方面可以提供优化的参考依据。

Constitution identification model in traditional Chinese medicine based on multiple features

Objective To construct a precise model for identifying traditional Chinese medicine(TCM)constitutions;thereby offering optimized guidance for clinical diagnosis and treatment plan-ning;and ultimately enhancing medical efficiency and treatment outcomes.Methods First;TCM full-body inspection data acquisition equipment was employed to col-lect full-body standing images of healthy people;from which the constitutions were labelled and defined in accordance with the Constitution in Chinese Medicine Questionnaire(CCMQ);and a dataset encompassing labelled constitutions was constructed.Second;heat-suppres-sion valve(HSV)color space and improved local binary patterns(LBP)algorithm were lever-aged for the extraction of features such as facial complexion and body shape.In addition;a dual-branch deep network was employed to collect deep features from the full-body standing images.Last;the random forest(RF)algorithm was utilized to learn the extracted multifea-tures;which were subsequently employed to establish a TCM constitution identification mod-el.Accuracy;precision;and F1 score were the three measures selected to assess the perfor-mance of the model.Results It was found that the accuracy;precision;and F1 score of the proposed model based on multifeatures for identifying TCM constitutions were 0.842;0.868;and 0.790;respectively.In comparison with the identification models that encompass a single feature;either a single facial complexion feature;a body shape feature;or deep features;the accuracy of the model that incorporating all the aforementioned features was elevated by 0.105;0.105;and 0.079;the precision increased by 0.164;0.164;and 0.211;and the F1 score rose by 0.071;0.071;and 0.084;respectively.Conclusion The research findings affirmed the viability of the proposed model;which incor-porated multifeatures;including the facial complexion feature;the body shape feature;and the deep feature.In addition;by employing the proposed model;the objectification and intel-ligence of identifying constitutions in TCM practices could be optimized.

真实世界中使用脉血康胶囊的老年人群特征及用药分析

目的:了解真实世界中脉血康胶囊对老年人群特征分析及联合用药情况。方法:基于全国21家大型三甲医院HIS数据库,对4078例使用脉血康胶囊的老年患者进行描述分析,用频数统计的方法分析其基本用药情况,找出使用频次较高的药物进行评价,选取关联规则中Apriori算法建立模型,使用Clementine12.0进行关联分析,分析老年患者人群特征和脉血康胶囊联合用药情况。结果:患者年龄以65~80岁居多,共3093例,占分析人数的75.85%;真实世界中老年人群使用脉血康胶囊应用于一般病情患者较多;住院时间最多在15~28 d;合并西医诊断中以高血压病最多;合并西药以脉血康胶囊+阿司匹林等血管活性药最常见;合并中药以脉血康胶囊+疏血通活血化瘀药最常见。结论:老年患者在治疗心脑血管疾病时常把脉血康胶囊和其药理作用相似的化学药品联合使用。且在真实世界中脉血康胶囊除了多用于有瘀、湿热的实证患者外,也可用于一些气阴两虚、肝肾亏虚等虚证。

基于态势分析法研究ISO中医药国际标准化形势及应对策略

目的:通过态势分析法(S-W-O-T)研究ISO中医药国际标准化形势,提出应对策略。方法:分两轮对62位中医药国际标准化专家进行问卷调查。结果:经过S-W-O-T分析得出ISO中医药国际标准化的内部优势(S)条目7项,子条目19条;内部劣势(W)条目4项,子条目21条;外部机会(O)条目4项,子条目15项;外部威胁(T)条目2项,子条目7项。结论:ISO中医药国际标准化工作机遇与挑战并存,应"内外兼修"。

中医健康管理的五项原则

中医学认为健康是人类在自然和社会环境中所保持的一种“阴平阳秘”的动态平衡状态，而亚临床状态或疾病，均是由于各种原因导致的机体阴阳的偏盛偏衰。对亚临床状态的调治，从“治未病”思想出发，中医学主张防微杜渐，阻止其进一步向疾病方向发展。对于亚临床状态的防治，中医在重视中药治疗的同时，更加重视养生保健方法在促进亚临床状态向健康转化中的作用，强调必须以中医理论为指导，其原则具有以下几个方面：

Meta-analysis of the efficacy and safety of Huanglian Wendan Decoction alone or combined with western medicine in treating insomnia caused by phlegm-heat internal disturbance

Objective To evaluate the efficacy and safety of Huanglian Wendan Decoction(黄连温胆汤,HLWDD)alone or combined with western medicine in treating insomnia caused by phlegm-heat internal disturbance in recent 10 years.Methods The randomized controlled trials of HLWDD alone or combined with western medicine in treating insomnia caused by phlegm-heat internal disturbance from January 1,2012 to April 1,2022 were searched in China National Knowledge Infrastructure(CNKI),China Science and Technology Journal Database(VIP),Wanfang Database,China BioMedical Literature Database(CBM),PubMed,Web of Science,Embase,and Cochrane Library databases.After being screening,the included literature was analyzed to evaluate the effective rate,Pittsburgh Sleep Quality Index(PSQI)score,traditional Chinese medicine(TCM)syndrome score,and adverse reactions of HLWDD on insomnia caused by phlegm-heat internal disturbance.The subgroup analyzed the effect of HLWDD after different treatment courses,and compared the therapeutic effects of HLWDD alone and HLWDD combined with western medicine.Results Twenty-seven randomized controlled trials were finally included,with a total of 2395 patients.The results of the meta-analysis showed that the curative effect of HLWDD alone or combined with the western medicine group was better than that of the western medicine group[RR=1.14,95%CI(1.06,1.22),P=0.000].The PSQI score[SMD=-0.31,95%CI(-0.42,-0.20),P=0.000],TCM syndrome score[SMD=-0.40,95%CI(-0.67,-0.12),P=0.005],and adverse reaction rate[RR=0.21,95%CI(0.15,0.29),P=0.000]of HLWDD alone or combined with western medicine group were significantly reduced compared with the western medicine group.The subgroup’s analysis showed that the curative effect of HLWDD alone or combined with western medicine group of 4 weeks treatment course was better than that of the western medicine group[RR=1.14,95%CI(1.03,1.26),P<0.05].The TCM syndrome score of HLWDD alone or combined with the western medicine group of 4 weeks treatment course decreased more obviously than that of the western medicine group[SMD=-0.60,95%CI(-0.96,-0.25),P<0.05].There were no significant differences between HLWDD alone or combined with western medicine group and western medicine group with different treatment courses based on PSQI score and adverse reaction rate.Based on the effective rate,the comparison between the HLWDD alone group and the western medicine group[RR=1.09,95%CI(1.00,-1.20)P<0.05],and between the HLWDD combined with western medicine group and the western medicine group[RR=1.15,95%CI(1.03,1.29),P<0.05]was the same.PSQI score[SMD=-0.44,95%CI(-0.59,-0.30),P<0.05]and TCM syndrome score[SMD=-1.10,95%CI(-1.59,-0.61),P<0.05]of HLWDD combined with western medicine group were significantly lower than those of the western medicine group.There were no significant differences of adverse reaction rate between HLWDD alone group[RR=0.08,95%CI(0.04,0.17),P<0.05]and HLWDD combined with western medicine group[RR=0.36,95%CI(0.24,0.53),P<0.05].Conclusion HLWDD alone or combined with western medicine is an effective treatment for insomnia caused by phlegm-heat internal disturbance,which has a high effective rate,significantly reduced PSQI score and TCM syndrome score,and favorable safety.The best course of treatment is 4 weeks.

The Mechanism of Action of Qihuang Jiangtang Capsule in the Treatment of Type 2 Diabetes Based on Network Pharmacology and Molecular Docking Technology

Objective Our objective was to investigate the potential mechanism of action of Qihuang Jiangtang capsule(QHJTC)in the treatment of type 2 diabetes mellitus(T2DM)through network pharmacology and molecular docking.Methods The active components of materia medica in the formula of QHJTC were searched on the Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform and Encyclopedia of Traditional Chinese Medicine.The targets related to the active components were obtained via PubChem database.The targets related to T2DM were retrieved through the GeneCards database.The targets corresponding to the active components and diabetes mellitus were uploaded to the Venn diagrams website to get the Venn diagram,and the intersecting targets were the potential targets of QHJTC in treating T2DM.The active components and potential targets were imported into Cytoscape 3.7.2 software to construct the active component–potential target network,and the key compounds and targets were screened by the Network Analyzer module in the Tools module.The potential targets were imported into the STRING database to obtain the interaction relationships,so as to analyze and construct the protein–protein interaction(PPI)network by Cytoscape 3.7.2 software.The intersecting targets were introduced into Metascape for gene ontology(GO)functional enrichment analysis and Kyoto encyclopedia of genes and genomes(KEGG)pathway enrichment analysis.The top 20 signaling pathways obtained by the KEGG pathway enrichment analysis and the related targets and the corresponding targets were analyzed by using Cytoscape 3.7.2 software to construct the“active component–important target-key pathway network”for the intervention of T2DM with QHJTC.The molecular docking of active components and core targets was performed with AutoDock software.Results A total of 237 active components and 281 related targets were obtained from QHJTC,as well as 1362 T2DM targets and 155 potential targets of QHJTC in treating T2DM.There were 32 key components and 49 key targets identified by the active component–potential target network topology analysis.There were 471 terms obtained from GO functional enrichment analysis,among which 248 related to biological processes,125 related to molecular functions,and 98 related to cellular components.There were 299 signaling pathways obtained from KEGG pathway enrichment analysis.The active components of QHJTC were found spontaneously binding to the core targets.Conclusions QHJTC can treat T2DM through multi-components,multi-targets,and multi-pathways.

复方蜥蜴散不同微粒组合剂干预胃癌前病变模型大鼠Wnt通路研究

目的:研究复方蜥蜴散不同微粒组合剂对胃癌前病变(PLGC)Wnt信号通路蛋白表达影响,探讨其干预PLGC机制。方法:120只SPF级SD雄性大鼠随机分为空白对照组(A组)、模型对照组(B组)、复方蜥蜴散80目组(C组)、100目组(D组)、80目100目1∶1混合组(E组)、维酶素对照组(F组)。除A组外,余组均以MNNG溶液,按0.5m L/100g灌胃,1次/d;辅以饥饱失常,情绪刺激等,制作PLGC模型,连续24周。造模成功后,A组给予等量蒸馏水,B组给予等量0.9%氯化钠溶液;C,D,E组分别给予复方蜥蜴散80目、100目、80目100目1∶1混合0.14g/m L混悬液10m L·kg-1·d-1灌胃;F组予0.1g/m L维酶素混悬液10m L·kg-1·d-1。均1次/d,连续12周。观察复方蜥蜴散对模型大鼠胃黏膜细胞Wnt信号通路中Wnt2、β-连环蛋白(β-catenin)影响。结果:治疗前各模型组与空白对照组相比,Wnt2、β-catenin阳性表达比较,有显著差异(P<0.01)。治疗后各治疗组与模型对照组比较,Wnt2、β-catenin阳性表达比较,有显著性差异(P<0.01);复方蜥蜴散各组Wnt2、β-catenin阳性表达与F组比较有显著性差异(P<0.05,P<0.01);与E组比较,有显著性差异(P<0.05)。结论:复方蜥蜴散不同微粒组合剂可降低Wnt2、β-catenin阳性表达,调控细胞增殖和凋亡,逆转PLGC模型大鼠胃黏膜增生肠化,这可能是该方干预PLGC分子机制。

Overview of the systematic reviews of premature ovarian insufficiency treated with acupuncture

Objective:To assess the reliability of the methodological quality and outcome measures of systematic reviews(SR)/meta-analysis of premature ovarian insufficiency(POI) treated with acupuncture.Methods:SR/meta-analysis of POI treated with acupuncture were searched on POI from the databases including PubMed,Web of Science,EMBase,the Cochran Library,Chinese biomedical literature database(SinoMed),China journal full-text database(CNKI),Wanfang data knowledge service platform(Wanfang)and VIP information Chinese periodical service platform(VIP),from inception to 1 st May 2021.Using A Measurement Tool to Assess Systematic Reviews 2(AMSTAR 2) scale and Grades of Recommendations Assessment,Development and Evaluation(GRADE) system,the methodological quality and outcome measures of the included studies were appraised.Results:Ten articles of SR/meta-analysis were included,published from 2015 to 2020.Using AMSTAR 2,5 articles of SR/meta-analysis were rated as critical low quality in methods,3 articles as low quality,and2 articles as moderate quality.The results of GRADE showed that among the 50 outcomes the quality of evidence of 22 outcomes was very low,that of 25 outcomes was low and that of 3 outcomes was moderate.Conclusion:The methodological quality and the reliability of outcome measures were not high in existing SR/meta-analysis on POI treated with acupuncture,which may affect the translation of the SR/metaanalysis findings into clinical practice.It is necessary to further strengthen the methodological quality and reporting standard of SR/meta-analysis,as well as the robustness of design and implementation of randomized controlled trials(RCTs),in order to generate high quality evidences for clinical decision-making and practice.

Analysis on the outcomes in randomized controlled trials of perimenopausal syndrome treated with acupuncture and moxibustion

Objective:To search systematically the application situation of the outcomes in the randomized controlled trials(RCTs) of perimenopausal syndrome treated with acupuncture and moxibustion so as to provide the foundation for the core outcome sets in treatment of periomenopausal syndrome with acupuncture and moxibustion.Methods:The articles of RTCs on perimenopausal syndrome treated with acupuncture and moxibustion were searched in China National knowledge Infrastructure(CNKI),Wanfang Data Knowledge Service Platform(Wanfang),VIP Chinese Journal Service Platform(VIP),Pubmed,Excerpt medica database(Embase)and Cochrane central register of controlled trials(CENTRAL) databases from January 1,2010 to December31,2020.Two reviewers screened the articles,extracted data and analyzed the application of outcomes in the eligible trials independently.Results:A total of 9391 articles were retrieved initially and 79 articles of them were eligible,including 43 articles in English and 36 articles in Chinese.115 outcomes were involved totally and collected according to 7 outcome domains,of which,the effective rate was the outcome with the highest use frequency.35 articles reported adverse events and 17 articles reported the effect in followup.Conclusion:At present,the outcomes of RCTs on perimenopausal syndrome in treatment with acupuncture and moxibustion are big in divergence,absent in normalization and lack of indicators for long-term prognosis and economics outcomes,as well as have the issues on the incomplete reports on the differentiation between the primary and the secondary outcomes,safety indicators and followup outcomes.It needs to construct the core outcome sets in line with the characteristics of acupuncture-moxibustion discipline so as to improve the quality of clinical trials of acupuncture and moxibustion.

International patient registry on acupuncture therapy for premature ovarian insufficiency:Challenges and opportunities

Premature ovarian insufficiency（POI） affects seriously physical and mental health of the patients. Studies show that acupuncture may be promising in treating POI. yet evidence is insufficient. International patient registry, one form of observational study, is designed for evaluating effectiveness and safety of acupuncture in real-world clinical settings. We will face a series of opportunities and challenges. The opportunities are as follows：（1） Interdisciplinary cooperation can improve the effect of acupuncture for POI.（2） The protocol for acupuncture to treat POI has room for improvement.（3） The patient registry study can make up the shortcomings of randomized controlled trials.（4） The patient registry study can collect real-world data and explore responses of different populations to acupuncture and can be the foundation for the successive studies. International patient registry may face technological, ethical and financial challenges, while the established International Patient Registry Platform of Acupuncture-Moxibustion（www.amreg.org：8082/v3） is actively responding to these challenges. Till now there have been more than 300 patients of POI enrolled on this platform.

Transcutaneous auricular vagus nerve stimulation for impaired glucose tolerance:a randomized controlled trial Protocol

Background:impaired glucose tolerance(IGT)is the early stage of diabetes and it would be deteriorated to type 2 diabetes mellitus(T2 DM)easily if no intervention provided.In western medicine,drug therapy assisted with the intervention of lifestyle is predominated.However,drug therapy brings serious side effect and high prices,while lifestyle intervention is difficult to be insisted on by patients.Therefore,a green and effective intervention mode is urgently needed.Transcutaneous auricular vagus nerve stimulation(taVNS)is a noninvasive and green therapeutic method based on the theory of traditional Chinese medicine(TCM),which can regulate glucose metabolism and reduce blood glucose,but the clinical effect of it has not been clarified yet at present.Hence,this randomized controlled trial(RCT)aims at exploring the effectiveness and safety of taVNS in the treatment of IGT.Methods:a total of 158 patients with IGT will be randomized into a taVNS group and a transcutaneous non-auricular vagus nerve stimulation(tnVNS)group,79 cases in each one.In the taVNS group and the tnVNS group,electric stimulation would be applied to Yidan(胰胆pancreas and gallbladder,CO11)and Pi(脾spleen,CO13)on auricular concha and Jian(肩shoulder SF4,5)on auricular rim respectively.The electric stimulation parameters would be the same in the patients of two groups,for 30 min in each treatment,twice a day,6 weeks as one course and 2 courses of treatment required totally.In week 0,6 and 12 of intervention,the effectiveness indicators would be determined,i.e.fasting plasma glucose(FPG),2 h plasma glucose(2 hPG)and glycosylated hemoglobin(HbA1c)successively.On week 0 and 12,body mass index(BMI)would be calculated,respiration,pulse and blood pressure would be recorded separately.Discussion:through observing the regulatory effect of taVNS on FPG,2 hPG,HbAlc and BMI as well as the adverse reactions,the effectiveness and safety of taVNS in treatment of IGT would be evaluated.This study will provide a safe,effective,convenient and nontoxic side effect intervention for clinical treatment of IGT and prevention from the occurrence and development of T2DM.

Psychosomatic skin disease treated by acupuncture and moxibustion

Based on the theory of "regulating body" integrated with "regulating mind",following the principle of "treating the body and mind simultaneously,treating both symptoms and root causes",Prof.Shao-jun WANG adopts flexibly the different techniques,including body acupuncture,wrist-ankle acupuncture,umbilical acupuncture,fire needling,moxibustion,and cupping,etc.for the treatment of psychosomatic skin diseases.According to the manifestations of skin diseases in different stages,she adopts different acupuncture and moxibustion techniques for the comprehensive treatment of psychosomatic skin diseases,including senile pruritus,alopecia areata,neurodermatitis,eczema,urticaria,and acne,on the basis of syndrome differentiation and different acupoint selections,and achieves good results.