目的 分析宁波市鄞州区近年来出生儿童2剂次水痘疫苗(VarV)接种情况及影响因素.方法 宁波市鄞州区2009年1月1日至2016年12月31日出生的所有儿童资料来源于儿童免疫规划信息管理系统,数据记录时间截至2020年3月31日.了解各年2剂次VarV接种情况,分析接种的影响因素.结果 2009—2016年出生儿童2剂次VarV接种率为72.9％.接种率2009年最低(54.5％),2015年最高(81.1％),且逐年升高.影响儿童2剂次VarV接种率的独立危险因素为女性、外地户籍、农村居住.结论 宁波市鄞州区儿童2剂次VarV接种实施较好,仍需适时开展农村地区、外地户籍儿童为重点对象的相关健康干预和查漏补种.

肺炎支原体(mycoplasmapneumoniae,MP)是引起儿童社区获得性肺炎的常见病原体之一,MP感染主要表现为咳嗽、咽痛、发热等呼吸系统症状,常发生于儿童[1].近年来,儿童肺炎支原体肺炎(mycoplas-mapneumoniae pneumonia,MPP)感染率呈逐渐增高趋势,重症MPP病例也随之增多[2].MP感染可导致患儿的免疫功能出现异常,严重者可危及生命[3].MPP在西医中有明确的诊断方法,归属中医"肺炎喘嗽""外感热病"范畴[4].中医在MPP的早期干预、治疗及改善预后等方面有着独特作用[5].MPP的西医诊疗与中医个体化辨证施治相结合,或将可能为MPP的合理诊疗提供新的临床思维[6].连花清瘟颗粒是以络病理论为指导研制的呼吸系统传染病代表性治疗药物[7],以"宣泄肺热、清瘟解毒"为治疗方法,常用于治疗热毒袭肺证[8],目前已有研究证实其对肺炎的患者有确切的疗效[9],然而由于研究样本量小,结局指标不统一,试验设计不规范等原因,连花清瘟对小儿MPP的临床疗效尚存在争议.本文即通过搜集文献利用Meta分析的方法,对连花清瘟治疗小儿MPP的研究进行系统综述.

目的 了解杭州市中高端社区老年群体养老现状及意愿.方法 随机抽取杭州城区中高端社区≥60岁共4652名常住老年人,采用一般情况调查表,基本身体情况调查表及养老意愿与需求调查表对其进行问卷调查.结果 95.1％的调查对象对养老现状满意度较高,81.3％选择在家养老;老年人目前较为担忧的养老问题主要为慢性病、社区设施和自身经济情况;且42.2％拒绝接受额外的养老费用.结论 老年群体对养老方式的选择仍较为保守,家庭经济状况、患病和医疗支出是影响老年人养老现状和未来选择的重要因素.

To systematically evaluate the clinical efficacy and safety of Lianhua Qingwen in the treatment of adult pneumonia. The randomized controlled trial of Lianhua Qingwen combined with conventional Western medicine in the treatment of pneumonia were retrieved from PubMed, EMbase, Wanfang database, VIP database, and CNKI from the establishment of database to March 2020. Two researchers independently conducted literature screening and data extraction, and the third researcher was in charge of arbitration in case of any disagreement. Outcome indicators included total clinical effective rate, symptom improvement time, and incidence of adverse events. R 3.6.1 was used for Meta-analysis, and RevMan 5.3 was used for quality evaluation. Twenty-two studies were included, with a total of 2 007 patients, including 1 017 patients in the experimental group and 990 patients in the control group. The results showed that the total clinical effective rate of the experimental group was higher than that of the control group(RR=1.11, 95%CI[1.08, 1.15], P<0.001), and the antifebrile time(MD=-1.81, 95%CI[-2.42,-1.21], P<0.001), cough duration(MD=-2.32, 95%CI[-2.89,-1.76], P<0.001), rale duration(MD=-2.19, 95%CI[-2.74,-1.63], P<0.001), imaging recovery time(MD=-2.17, 95%CI[-2.76,-1.58], P<0.001) and post-treatment CRP(MD=-4.07, 95%CI[-6.39,-1.75], P<0.001] were all significantly lower than those of the control group. However, it did not proved that the experimental group was safer than the control group(RR=0.84, 95%CI[0.57, 1.24], P=0.382). The results confirmed that Lianhua Qingwen combined with conventional Western medicine in the treatment of pneumonia could improve the clinical treatment efficiency, shorten the time of fever, cough, rale disappearance and imaging recovery, improve CRP index and accelerate the recovery of pneumonia patients. However, the literatures included in this study had a low quality, and the conclusions still need to be further confirmed by more high-quality, multi-center, rigorously designed randomized controlled trial.

目的 基于数据挖掘技术对中医药治疗系统性红斑狼疮(SLE)处方用药规律进行探索和分析.方法 检索中国知网(CNKI)数据库、万方数据(Wanfang Data)知识服务平台、维普(VIP)中文生物医学期刊数据库、中国生物医学(CBM)文献数据库,建立SLE处方数据库.采用书目共现分析软件(BICOMB2.0)提取数据,SPSS 25.0统计分析,并应用社会网络分析软件UCINET 6.0进行复杂网络分析,通过Net-Draw 2.084制作可视化网络图.结果 筛选出符合纳入标准的文献205篇,涉及初诊处方275张,其中包括330味中药,累计用药频次3 791次.对前63味高频中药进行复杂网络分析得出核心基本方的组成为牡丹皮、生地黄、甘草,常用方剂为犀角地黄汤、四妙勇安汤、六味地黄汤.结论 通过数据挖掘技术结合复杂网络分析技术得出的结果与大部分名医专家的观点基本一致,但研究存在一定偏倚,需要进一步收集大数据来证实用药规律.

Objective:To observe the effect of Lingshao-Zaoren Decoction on urodynamics and the expression of Piezo1 if overactive bladder (OAB) rats. Methods:Thirty SPF grade female SD rats were randomly divided into blank group, model group, Tolterodine control group, low-dose and high-dose Lingshao-Zaoren Decoction groups, with 6 rats in each group. The OAB rats were modeled by intraperitoneal injection of Cyclophosphamide. After the successful modeling, Tolterodine control group was given 0.36 mg/kg Tolterodine tartrate, the low-dose and high-dose Lingshao-Zaoren Decoction groups were given 1.59 and 3.18 g/kg Lingshao-Zaoren Mianjian granules by gavage, the blank group and model group were given the same amount of distilled water, once a day for 14 days. After 14 days, the urodynamics of rats in each group were detected. The bladder volume and maximum bladder pressure were observed respectively. The pathological changes of bladder tissue were observed by HE staining. The expression of Piezo1 protein in bladder tissue was detected by immunohistochemistry and Western blot. The expression of Piezo1 mRNA in bladder tissue was detected by qPCR. Results:Compared with the blank group, the body weight, bladder volume and maximum bladder pressure of the model group were significantly reduced ( P<0.01). HE staining result showed that the model group had hyperplasia of urinary tract epithelium, degeneration, necrosis and abscission of epithelial cells, infiltration of a large number of inflammatory cells in stroma, vascular proliferation, thickening of vascular wall, hyperplasia of mucosal smooth muscle, disorder of arrangement, and significant up regulation of Piezo1 protein expression ( P<0.01). Compared with the model group, the weight [(244.83 ± 6.05) g, (233.33 ± 11.76) g vs. (219.00 ± 9.70) g] of rats in the Tolterodine control group and high-dose group of Lingshao-Zaoren Decoction significantly increased ( P<0.01), and the bladder volume [(0.93 ± 0.31) ml, (1.17 ± 0.17) ml, (1.21 ± 0.23) ml vs. (0.50 ± 0.16) ml] and maximum bladder pressure [(42.00 ± 3.03) cmH 2O, (45.83 ± 7.19) cmH 2O, (46.83 ± 8.23) cmH 2O vs. (30.50 ± 5.47) cmH 2O] of rats in the Tolterodine control group, low-dose and high-dose Lingshao-Zaoren Decoction groups were significantly increased ( P<0.01); the bladder epithelial hyperplasia and degeneration degree, interstitial inflammatory cell infiltration degree and vascular hyperplasia degree of rats in the Tolterodine control group, low-dose and high-dose Lingshao-Zaoren Decoction groups significantly increased. The expression of Piezo1 mRNA (1.50 ± 0.04, 2.05 ± 0.08, 1.44 ± 0.10 vs. 2.56 ± 0.11) and protein in the Tolterodine control group, low-dose and high-dose Lingshao-Zaoren Decoction groups were significantly decreased ( P<0.01). Conclusion:Lingshao-Zaoren Decoction can increase the bladder volume and maximum bladder pressure of urinary incontinence caused by detrusor overactivity in rats with overactive bladder, which may be related to reduction of Piezo1 expression.

重症肺炎属肺炎的特殊类型,其病理改变主要为肺部组织炎症性疾病,且病变范围较大,临床表现可见呼吸困难、意识模糊、心率加快,并发全身组织器官损伤[1].脓毒血症和器官衰竭是重症肺炎死亡的主要原因,抗感染、干预炎症是主要的治疗手段[2].但近年来因为抗生素不合理利用,病原体不断变迁[3],病原菌不断出现耐药性[4],且病后感染会造成治疗失控[2],使治疗难度进一步增加.血必净作为一种有解毒、去除炎症介质等功效的中药注射剂,目前有不少临床试验已证实其能有效治疗重症肺炎[5-7],但尚未有对常规西药联合血必净治疗重症肺炎的有效性进行系统性评价.为此,本文选取相关文献进行Meta分析,以期为临床上西药联合血必净治疗重症肺炎提供参考.

Objective:To evaluate the efficacy of Fufang-Xuanju capsule combined with levofloxacin mesylate tablets in the treatment of chronic epididymitis. Methods:A total of 76 patients in the Urology Department of Xiyuan Hospital of China Academy of Chinese Medical Sciences who met the inclusion criteria from December 2016 to February 2019, were divided into treatment group (43 cases) and control group (33 cases). The control group was given levofloxacin mesylate tablets orally. The treatment group was given Fufang-Xuanju capsule based on the control group. Both groups were treated for 4 weeks. Chronic epididymitis symptom index (CESI) was used to evaluate the clinical efficacy by pain score and quality of life score. Results:The total effective rate was 83.7% (36/43) in the treatment group and 63.6% (26/33) in the control group. There was statistically significant difference between the two groups ( χ2=4.020, P=0.045). Compared with baseline, the pain scores, quality of life scores and total scores of both groups at 2, 4 weeks after treatment were significantly lower ( P<0.01). Two weeks after the treatment, the pain scores, quality of life scores and total scores in the treatment group were significantly lower than those of the control group ( F value were 16.132, 9.134 and 23.681, respectively, all Ps<0.01). And 4 weeks after the treatment, the pain scores, quality of life scores and total scores of the treatment group were significantly lower than that of the control group ( F value were 28.741, 74.049, 72.483, respectively, all Ps<0.01). Conclusions:Fufang-Xuanju capsule combined with levofloxacin mesylate tablets can alleviate the pain of patients with chronic epididymitis, improve the quality of life and improve the clinical efficacy.

目的 评价补中益气汤对膀胱活动低下症患者逼尿肌收缩力的影响.方法 回顾性分析2015年12月—2019年10月于中国中医科学院西苑医院泌尿外科就诊的49例膀胱活动低下症患者的临床资料,按治疗方法的不同将其分为治疗组(27例)和对照组(22例).留置导尿管后,对照组口服盐酸坦洛新缓释胶囊,治疗组在对照组的基础上加用补中益气汤,治疗周期为1～6个月.比较两组患者治疗前后的初感尿意量(VFD)、正常尿意量(VND)、最大尿流率(Qmax)、排尿期最大逼尿肌压(Pdet.max)、最大尿流率时逼尿肌压(Pdet.Qmax)、残余尿量(RV)水平.记录两组治疗过程中的不良反应发生情况.结果 治疗后,两组Qmax、Pdet.max、Pdet.Qmax水平均高于治疗前,RV均低于治疗前,差异有统计学意义(P<0.05),但两组VFD、VND与治疗前比较差异均无统计学意义(P>0.05).治疗后,治疗组Qmax、Pdet.max、Pdet.Qmax水平均高于对照组(P<0.05),但治疗后两组VFD、VND、RV比较差异无统计学意义(P>0.05).治疗过程中两组均无明显不良反应发生.结论 补中益气汤治疗膀胱活动低下症效果显著,可有效改善患者逼尿肌活动低下状态.

膀胱过度活动症(overactive bladder,OAB)是常见的泌尿外科疾病,女性多于男性,发病率随着年龄的增长而增加,调查发现北京郊区成年女性OAB发病率高达8.1％[1].国际尿控学会对OAB诊断标准为:临床症状表现为尿急,伴或不伴有急迫性尿失禁,伴有尿频(白天排尿次数＞8次)和夜尿(夜间排尿次数＞1次),无尿路感染或其他明确的病理改变[2].OAB产生的尿频、尿急、夜尿频多、小腹坠胀症状,使患者不能远离洗手间,正常生活受到很大干扰,引起沉重的情感压力和自卑感,久治不愈会导致焦虑、抑郁等精神疾患[3].

为了解中医药院校研究生对样本量估算能力和教改效果,进一步探讨推动教学改革的方法,对浙江某中医药院校2015级和2016级共420名研究生进行了问卷调查.统计分析发现,研究生对样本量的重要性认识度尚可,但在毕业设计和论文发表过程中样本量实际使用情况不佳;经过教学改革后,学生对样本量估算的认知情况良好,应用比例相对增高.由此可见,中医药院校研究生样本量估计能力仍不容乐观,统计学教学应更多地强化统计应用能力,并且突出医学设计中样本量计算的重要地位.

目的 分析新冠肺炎疫情期间居民心理状态的影响因素,探讨食疗养生行为与心理状态的相关性,提出后疫情时代心理健康调适的建议与措施.方法 通过网络随机抽取研究对象,采用自行设计的问卷对居民新冠肺炎疫情期间生活及心理状态、对食疗养生的认知与选择意向进行调查.结果 调查对象的心理状态与居住地、职业、饮食方式相关,对食疗养生预防传染病的认知与居住地、职业、饮食习惯相关,对食疗养生的选择意向与心理状态相关(均P＜0.05).17.40％的被调查对象自觉在新冠肺炎疫情期间存在焦虑情绪,焦虑人群中99.00％认为食疗养生能带来快乐.存在焦虑情绪的人群中最受欢迎的食疗养生方式为药膳,其次为药茶和花茶;最受欢迎的食疗知识为养生保健食谱.结论 浙江省外、非医务工作者、饮食统一派送的人群在新冠肺炎疫情期间易产生焦虑情绪,存在焦虑情绪的人群对食疗养生的选择意向强,在后疫情时代,应加强食疗养生相关内容的健康宣传,满足大众对食疗养生的需求.