Traditional Chinese Medicine Syndromes in Depressive Episodes of Bipolar Disorder Based on Cluster Analysis and Bayesian Network：A Cross-sectional Study / 中医杂志

ObjectiveTo explore the elements， distribution and characteristics of traditional Chinese medicine （TCM） syndromes in depressive episodes of bipolar disorder （BD）. MethodsBasic information， along with the four examination information， the Hamilton Depression Scale and Young Mania Rating Scale scores， were collected from 293 outpatients with BD at Beijing Anding Hospital， Capital Medical University. The four examination information with an occurrence rate greater than 12% were retained. The R language “dist” function was used to calculate the distances between samples using the Euclidean distance method. The hierarchical clustering of the four examination information was performed using the “hclust” function and the squared Euclidean distance method. A team of five researchers was formed to determine the nature and location of the essential elements of TCM syndrome in BD based on the clustering results. The PC algorithm was used to construct a Bayesian network model of the essential elements. The working group combined the essential elements of TCM syndromes in the Bayesian network according to the reference model results， and then extracted common TCM syndromes. The score of each patient based on the essential elements was matched with the common TCM syndromes to determine the syndrome type of each patient. The working group then performs conformity and revision based on this， obtaining the final distribution of TCM syndromes for the patients. ResultsThere were 77 common TCM symptoms in BD with a frequency greater than 12%. The top 15 symptoms with higher frequencies were slippery pulse， mental fatigue and lack of strength， wiry pulse， excessive rumination， preference for solitude， vexation， agitation and irritability， dry mouth， palpitations， profuse dreaming， unwarranted worries， chest oppression， thin white coating， amnesia， frequent sighing， and poor appetite. TCM syndrome elements of BD can be grouped into 11 categories. The nature of disease-related essential elements included fire， qi deficiency， blood deficiency， qi counterflow， yin deficiency， dampness， heat， fire from constraint， and phlegm. The location of disease-related essential elements included heart， liver， spleen， stomach， kidney， bladder channel， and gallbladder. By constructing a Bayesian network model and considering the opinions from the experts， six common syndromes of BD were identified， among which the highest proportion was heart-stomach heat accumulation， accounting for 27.99% （82 cases）， followed by heart-spleen deficiency （55 cases， 18.77%）， non-interaction between the heart and the kidney （49 cases， 16.72%）， liver constraint and blood deficiency （42 cases， 14.33%）， heart qi deficiency （37 cases， 12.63%）， and damp-heat in the liver and gallbladder （28 cases， 9.56%）. ConclusionsThe nature of disease-related elements of BD are predominantly fire and heat， while the location of disease-related essential elements are primarily associated with the heart， liver， and spleen. The most common TCM syndromes are heart-stomach heat accumulation and heart-spleen deficiency.

Perfiles de resiliencia asociados al engagement académico y al apoyo social en estudiantes universitarios / Coping profiles associated with resilience, academic engagement, and social support in university students

Resumen El objetivo de este estudio fue observar los estilos de resiliencia entre estudiantes de pregrado y explorar la forma en la que cada uno de ellos se encontraba asociado al engagement académico y a las redes de apoyo social al inicio de los estudios universitarios. La muestra correspondió a 371 estudiantes de pregrado del Caribe Colombiano evaluados a partir de un análisis estadístico de clústeres, por el método jerárquico aglomerativo. Posteriormente se clasificaron en grupos de acuerdo con sus similitudes en las 12 dimensiones de resiliencia y finalmente se compararon en términos de engagement y redes personales. Los resultados señalaron cuatro perfiles de estudiantes: (1) sujetos con baja-resiliencia, alto engagement y fuertes vínculos relacionales; (2) resilientes-en-proceso, con niveles intermedios de resiliencia, bajo engagement y redes sociales con poca cercanía; (3) resilientes-autónomos con altos puntajes de resiliencia, niveles intermedios de engagementy redes sociales débiles; y (4) resilientes-con-redes, exhibieron altos niveles de resiliencia, con alto engagement y amplias redes de apoyo. Se concluye que la mayor porción de jóvenes que comienzan la universidad muestra perfiles de baja resiliencia; sin embargo, los altos niveles de motivación por los estudios y los recursos sociales como las redes de apoyo de los compañeros son las condiciones que más permiten afrontar los obstáculos de la vida universitaria. Es importante notar que solamente el último perfil integró los elementos de alta resiliencia, alto engagement y fuertes redes de apoyo que permiten confirmar la íntima asociación entre estos constructos. Los otros perfiles representan casos en los cuales los rasgos de resiliencia son independientes de los niveles de engagement y de la composición de las redes de apoyo personal.

Abstract Adjustment of first-year students to university environments, as well as their academic success, is not exclusively related to their academic aptitude; instead, this adjustment is associated with psychological characteristics, personal and even social resources that help students cope with stressors and new circumstances. A comprehensive assessment of the students' adjustment to university environment must transcend preoccupation on academic performance, and instead explore associations among psychological, academic, and social elements that promote adaptation during the initial years of higher education (Marenco-Escuderos et al., 2021). In this line of research, the objective of this work was to inquire how internal characteristics of students (psychological and academic) interplay with external elements in their support systems to promote adaptation in a higher education environment. Associations were explored among resilience, academic engagement, and social support as determining elements in the adjustment to the demands of the university context. The sample consisted of 371 undergraduate students (60 % female), of low socioeconomic status, enrolled in public universities in the Caribbean region of Colombia. Firstly, the resilience of university students was explored, as the ability to respond to obstacles with a positive view of the world, of others, and of one's own abilities to cope with stressors (Saavedra-Guajardo et al., 2019). Second, the level of engagement that drives young students to concentrate their energies on academic activities was reviewed; and third, the role of peers, and friends as the close-support system that facilitates the overcoming of personal and academic difficulties was investigated (Fernández-Martínez et al., 2017). Based on a statistical cluster analysis, by the agglomerative hierarchical method, individuals were classified according to their similarities in the expression of 12 dimensions of resilience (SV-RES scale), and subsequently compared in terms of engagement (UWES-S scale), and personal support networks (UNICET software). The results showed four student profiles: (1) the largest group consisting of students with low-resilience, high engagement and strong support networks; (2) a resilient group with low levels of engagement and support networks with little intimacy; (3) a resilient group with high characteristics of autonomy, intermediate levels of engagement, and support networks with weak structure; and (4) a very resilient group, high engagement, and wide and strong social support networks. The results point out the fact that the greatest proportion of students who start college show profiles of low resilience, however, high levels of motivation for studies and social resources such as peer support networks are the conditions that mostly allow for coping with adversity in the first years of college. These results could point to cultural aspects specific to the Caribbean region, where social networks are of great importance for daily functioning (Marenco-Escuderos et al., 2021). Regarding the association among the studied variables, it is important to note that only the last profile gathered all elements of high resilience, high engagement, and strong support networks that allow for confirming the association among these constructs. The other three profiles represent cases in which the resilience traits are independent of the students' levels of engagement and the composition of their personal support networks. This study is valuable as it provides a differentiating picture of the relationship of resilience with other psychological and social constructs, and in that it allows to better understand resilience in association with other elements that mediate its interpretation. Important gender differences among the profiles are additionally discussed.

Obesogenic behavior clusters associated with weight status among Brazilian students: a latent class analysis / Agrupamentos de comportamentos obesogênicos associados com status de peso em estudantes brasileiros: uma análise de classe latente

Abstract This study aimed to examine the association between clusters of physical activity (PA), diet, and television viewing (TV) with weight status among a representative sample of Brazilian students. Data from the National Health School-based Survey (PeNSE) 2015 were analyzed (n = 16,521; mean age 14.8, standard deviation 0.03 year). PA (minutes/week spent in leisure-time, and commuting to/from school), TV (hours/day), and weekly consumption of deep-fried empanadas, candies, sodas, ultra-processed foods, fast foods, green salads or vegetables, and fruits were self-reported on the validated PeNSE questionnaire. Latent class analysis defined behavior classes, and binary logistic regression assessed the association between clustering and weight status. Six classes' types with positive and negative behaviors were identified. Adolescents belonging to the "low TV time and high healthy diet" class had higher chances of being overweight (including obesity) compared to their peers in the "moderate PA and mixed diet" class. No associations were found in the other clusters. Mixed classes with healthy and unhealthy behaviors characterized adolescents' lifestyles and these profiles were related to weight status.

Resumo O estudo objetivou examinar a associação entre agrupamentos de atividade física (AF), dieta e tempo de televisão (TV) com o status do peso em uma amostra representativa de estudantes brasileiros. Foram analisados ​​dados da Pesquisa Nacional de Saúde do Escolar (PeNSE) 2015 (n = 16.521; idade média 14,8, desvio padrão de 0,03 ano). AF (minutos/semana no lazer e deslocamento para/da escola), assistir televisão (TV) (horas/dia), consumo semanal de doces, refrigerantes, alimentos ultraprocessados/fast-foods, saladas/vegetais e frutas foram coletadas por questionário validado. Análise de classes latentes definiu os perfis de comportamento e a regressão logística binária a associação entre agrupamento e status de peso. Foram identificadas seis classes com comportamentos positivos e negativos. Adolescentes pertencentes à classe "baixo tempo de TV e alta alimentação saudável" apresentaram maior probabilidade de ter sobrepeso/obesidade em comparação com seus pares na classe "AF moderada e dieta mista". Não foram encontradas associações nos outros perfis. Classes com comportamentos saudáveis ​​e não saudáveis ​​caracterizaram o estilo de vida dos adolescentes e estiveram relacionadas com o status de peso.

Cluster de doenças crônicas não transmissíveis e multimorbidade em trabalhadores da atençãoprimária à saúde / Cluster of chronic non-communicable diseases and multimorbidity in primary healthcare workers

Objetivo: Investigar a agregação das DCNT e a sua associação com as características sociodemográficas e os aspectos ocupacionais dos trabalhadores da APS. Métodos: Tratou-se de um estudo epidemiológico transversal que analisou os dados parciais de uma coorte retrospectiva realizada em Vitória da Conquista (BA) e em São Geraldo da Piedade (MG) no mês de janeiro de 2022 com 105 trabalhadores da Estratégia Saúde da Família (ESF), que preencheram um questionário eletrônico específico autoaplicável. As variáveis analisadas foram: sociodemográficas, caracterização do trabalho, presença de DCNT e de multimorbidade. Foram aplicados os seguintes procedimentos estatísticos: análise descritiva, análise de cluster, teste de qui-quadrado de Pearson e regressão logística binária. Resultados:As cinco DCNT mais prevalentes foram a rinite/sinusite (30,5%), a cefaleia/enxaqueca (26,7%), o colesterol alto (26,7%), a gastrite (19,0%) e a hipertensão arterial sistêmica (19,0%). A prevalência de multimorbidade foi de 26,7% e foram encontradas 11 combinações de cluster (34,4%), sendo o maior escore na combinação das cinco doenças mais prevalentes. Foi identificada a associação entre a presença de multimorbidade e o sexo, sendo a prevalência 24% menor entre os homens, e com a escolaridade, sendo a prevalência 26% maior nos indivíduos que não possuem ensino superior. Conclusão: Foram identificadas associações entre a presença de multimorbidade e o sexo feminino, e indivíduos que não concluíram o ensino superior. Observou-se, ainda, uma associação simultânea das cinco principais DCNT deste estudo com o nível de escolaridade (AU).

Objectives: Investigate the aggregation of NCDs and their association with sociodemographic characteristics and occupational aspects in primary healthcare workers. Methods: A cross-sectional study analyzed partial data from a cohort profile conducted in Vitória da Conquista (BA) and in São Geraldo da Piedade (MG) in January 2022 with 105 workers of "Estratégia de Saúde da Família (ESF)" who answered a self-report electronic questionnaire. The variables of this research were: sociodemographic characteristics, job aspects, and the presence of NCDs and multimorbidity. Data were analyzed with descriptive statistics, cluster analysis, chi-square test, and binary logistic regression. Results: The five NCDs more prevalent were: rhinitis/sinusitis (30,5%), headache/migraine (26,7%), hypercholesterolemia (26,7%), gastritis (19,0%), and hypertension (19,0%). The prevalence of multimorbidity was 26,7%, and 11 cluster combinations were found (34,4%) since the higher score was identified in the aggregation of the five more prevalent diseases. There was an association between the presence of multimorbidity and the sex (the prevalence is 24% smaller for men) and between the presence of multimorbidity and the level of education (the prevalence is 26% higher in people without a college degree). Conclusion: The prevalence of multimorbidity was associated with the female sex and with people without a college degree. Furthermore, an association was observed between the five more prevalent NCDs in this study and the level of education (AU).

Os perfis de gamers adultos pagantes: uma análise sobre os valores preferidos em jogos / The profiles of paying adult gamers: an analysis of the preferred values in games

Os indivíduos constantemente tomam decisões de consumo, que também impactam na cadeia que participa direta ou indiretamente para a criação daquele produto ou serviço. Assim, compreender melhor os perfis dos consumidores de jogos digitais auxiliam os desenvolvedores locais a produzir jogos que despertem e mantenham o interesse desses gamers, tornando esse, o principal objetivo desta pesquisa. Para tal, utilizou-se a Análise de Clusters, através do método K-means para variáveis categóricas, onde foram encontradas quatro personas. Os grupos com mais idade e com renda mensal de R$ 2.200,01 a R$ 4.400,00 expressou um comportamento prudente em relação aos gastos com jogos (gastaram de 0 a 100 reais, nos últimos 6 meses). Os outros dois grupos restantes, mais jovens, apresentaram características financeiras distintas: o de menor renda mensal (até R$ 1.100,00) não foi o que menos gastou com jogos eletrônicos nos últimos 6 meses (101 a 250 reais). A pesquisa também concluiu que "autonomia para seguir vários caminhos" foi bastante valorizada pelos 4 perfis, nomeados de "jogador retraído", "jogador apaixonado", "jogador nostálgico" e "jogador vontade", refletindo as características principais de cada perfil.

Individuals constantly make consumption decisions, which impact not only the consumer, but also the entire chain that participates directly or indirectly in the creation of that product or service. Thus, there is a need to better understand the profiles of consumers of digital entertainment games, so that local developers can produce games that arouse and maintain the interest of these gamers, making this the main objective of this research. For this, Cluster Analysis was used, through the K-means method for categorical variables, where four personas were found, which were translated by their reference profiles (detailed in D descriptions), and represented a set of similar profiles in the sample space of the respondents, with homogeneous characteristics to this "focal profile". The groups composed of the oldest age group (31 ­ 40 years old) and with a monthly income of BRL 2,200.01 to BRL 4,400.00 expressed a prudent behavior in relation to spending on games (they spent from BRL 0.00 to BRL 100.00 in the last 6 months). The other two remaining groups, formed by the younger age group (21 ­ 30 years), had different financial characteristics: the one with the lowest monthly income (up to BRL 1,100.00) was not the one who spent the least on electronic games in the last 6 months. (BRL 101.00 to BRL 250.00). The survey also concluded that "autonomy to follow several paths" was highly valued by the 4 profiles, named "withdrawn player", "passionate player", "nostalgic player" and "willing player"" to reflect the main characteristics of each profile.

Clustering of cardiovascular disease risk factors among first-year students at the University of Ibadan, Nigeria: a cross-sectional study

ABSTRACT BACKGROUND: Cardiovascular disease (CVD) is the second leading cause of death in sub-Saharan Africa. Globally, there is substantial evidence that modifiable risk factors for CVD are increasing in adolescents. Unfortunately, there is a paucity of information on the prevalence and clustering of these risk factors in adolescents. OBJECTIVES: This study explores the modifiable risk factors for CVD among first-year students at the University of Ibadan, Nigeria. DESIGN AND SETTING: This cross-sectional study was conducted at the University of Ibadan, Nigeria. METHODS: A total of 546 newly admitted students at the University of Ibadan, Nigeria, were recruited using stratified random sampling. An interviewer-administered questionnaire was used to obtain information from study participants between January and February 2016. RESULTS: The mean age of respondents was 19 ± 2.2 years with a male-to-female ratio of 1:1. The reported risk factors for CVD were smoking (1.6%), abdominal obesity (3.3%), alcohol consumption (3.7%), overweight/obesity (20.7%), unhealthy diet (85.3%), and physical inactivity (94.5%). Clustering of ≥ 2 risk factors was reported in 23.4% of students. Female students were twice as probably overweight/obese as male students (adjusted odds ratio [AOR] = 2.2; confidence interval [CI] = 1.41-3.43). Students whose fathers were skilled workers were 3.5 times more likely to be physically inactive (AOR = 1.7; CI = 0.97-2.96). The clustering of ≥ 2 risk factors was significantly higher among women and Muslims in bivariate analysis, whereas no significant association was found in multivariate analysis. CONCLUSIONS: Public health strategies to prevent CVD risk factors should begin in schools and extend to the entire community.

Comparación de dos tipos de clasificación en dispepsia funcional; distrés postprandial o dolor epigástrico vs. un análisis multidimensional por conglomerados utilizando aprendizaje no supervisado

Los métodos de inteligencia artificial utilizando herramientas de aprendizaje no supervisado pueden apoyar la resolución de problemas al establecer patrones de agrupación o clasificación no identificados, que permiten tipificar subgrupos para manejos más individualizados. Existen pocos estudios que permiten conocer la influencia de síntomas digestivos y extradigestivos en la tipificación dispepsia funcional; esta investigación realizó un análisis de aprendizaje no supervisado por conglomerados basándose en dichos síntomas, para discriminar subtipos de dispepsia y comparar con una de las clasificaciones actualmente más aceptadas. Se realizó un análisis exploratorio de conglomerados en adultos con dispepsia funcional según síntomas digestivos, extradigestivos y emocionales. Se conformaron patrones de agrupación de tal manera que dentro de cada grupo existiera homogeneidad en cuanto a los valores adoptados por cada variable. El método de análisis de conglomerados fue bietápico y los resultados del patrón de clasificación se compararon con una de las clasificaciones más aceptadas de dispepsia funcional. De 184 casos, 157 cumplieron con criterios de inclusión. El análisis de conglomerados excluyó 34 casos no clasificables. Los pacientes con dispepsia de tipo 1 (conglomerado uno), presentaron mejoría al tratamiento en el 100% de los casos, solo una minoría presentaron síntomas depresivos. Los pacientes con dispepsia de tipo 2 (conglomerado dos) presentaron una mayor probabilidad de falla al tratamiento con inhibidor de bomba de protones, padecieron con mayor frecuencia trastornos de sueño, ansiedad, depresión, fibromialgia, limitaciones físicas o dolor crónico de naturaleza no digestiva. Esta clasificación de dispepsia por análisis de clúster establece una visión más holística de la dispepsia en la cual características extradigestivas, síntomas afectivos, presencia o no de trastornos de sueño y de dolor crónico permiten discriminar el comportamiento y respuesta al manejo de primera línea.

Artificial intelligence methods using unsupervised learning tools can support problem solving by establishing unidentified grouping or classification patterns that allow typing subgroups for more individualized management. There are few studies that allow us to know the influence of digestive and extra-digestive symptoms in the classification of functional dyspepsia. This research carried out a cluster unsupervised learning analysis based on these symptoms to discriminate subtypes of dyspepsia and compare with one of the currently most accepted classifications. An exploratory cluster analysis was carried out in adults with functional dyspepsia according to digestive, extra-digestive and emotional symptoms. Grouping patterns were formed in such a way that within each group there was homogeneity in terms of the values adopted by each variable. The cluster analysis method was two-stage and the results of the classification pattern were compared with one of the most accepted classifications of functional dyspepsia. Of 184 cases, 157 met the inclusion criteria. The cluster analysis excluded 34 unclassifiable cases. Patients with type 1 dyspepsia (cluster one) presented improvement after treatment in 100% of cases, only a minority presented depressive symptoms. Patients with type 2 dyspepsia (cluster two) presented a higher probability of failure to treatment with proton pump inhibitor, suffered more frequently from sleep disorders, anxiety, depression, fibromyalgia, physical limitations or chronic pain of a non-digestive nature. This classification of dyspepsia by cluster analysis establishes a more holistic vision of dyspepsia in which extradigestive characteristics, affective symptoms, presence or absence of sleep disorders and chronic pain allow discriminating behavior and response to first-line management.

Study on UPLC fingerprint and content determination of mangiferin of Gentiana rhodantha / 中国药房

OBJECTIVE To provide reference for quality control of Gentiana rhodantha. METHODS Taking 52 batches of G. rhodantha as subject， ultra-high performance liquid chromatography （UPLC） fingerprint was adopted. The similarity of 52 batches of medicinal materials samples was evaluated by the Similarity Evaluation System for Chromatographic Fingerprints of Traditional Chinese Medicine （2004A edition）； the content of mangiferin was determined； chemometric analyses [cluster analysis， principal component analysis （PCA） and orthogonal partial least squares-discriminant analysis （OPLS-DA）] were performed. RESULTS UPLC fingerprints of 52 batches of G. rhodantha were established， 17 common peaks were identified， and 6 of them were identified， which were loganic acid （peak 1）， neomangiferin （peak 3）， swertiamarin （peak 5）， dangyin （peak 6）， mangiferin （peak 7） and isoorientin （peak 9）. The similarities of 52 batches of medicinal materials samples were all greater than 0.9； cluster analysis showed that S1-S46， S48-S52 clustered into one class， and S47 alone； PCA results showed that the cumulative variance contribution rate of the first six principal components was 82.928%； OPLS-DA results showed that the corresponding components of swertiamarin， mangiferin and chemical composition represented by peak 4， 14， 15， 16 were the main iconic components affecting the quality differences of G. rhodantha medicinal materials. The contents of mangiferin in 52 batches of medicinal material samples ranged from 18.2 to 101.0 mg/g， mostly in accordance with 2020 edition of Chinese Pharmacopoeia. CONCLUSIONS The established UPLC fingerprint and chemometric analysis methods combined with content determination method of mangiferin can comprehensively evaluate the quality of G. rhodantha.

Study on medication law of TCM compounds for treatment of blood stasis type vascular dementia / 国际中医中药杂志

Objective:To explore the medication law and core Traditional Chinese Medicine (TCM) compounds in the treatment of blood stasis vascular dementia (VD) based on data mining.Methods:The literature about TCM treatment for blood stasis VD was retrieved from the databases of CNKI, Wanfang, VIP, and CBM from January 2000 to November 2021. Microsoft Office Excel 2019, SPSS Modeler 18.0, SPSS Statistics 25.0, R X64 4.1.2, and Origin 2021 were used to perform medication frequency analysis, frequency analysis of four properties and five tastes of TCM, association rules, clustering analysis, factor analysis and data visualization.Results:A total of 196 articles were included, with 196 TCM prescriptions, involving 200 kinds of Chinese materia medica. High-frequency drugs were for Acori Tatarinowii Rhizoma, Chuanxiong Rhizoma, Salviae Miltiorrhizae Radix et Rhizoma, Polygalae Radix, Carthami Flos. The medicinal properties were mainly warm, mild and cold, the tastes were mainly sweet, bitter and pungent, and the meridians were mainly liver meridian, spleen meridian and heart meridian. A total of 19 association rules were obtained from the analysis of association rules for 2 kinds of Chinese materia medica, and the rules of the representative were Acori Tatarinowii Rhizoma- Polygalae Radix, Chuanxiong Rhizoma- Carthami Flos, Acori Tatarinowii Rhizoma- Curcumae Radix. A total of 4 categories were extracted through clustering analysis. Factor analysis extracted a total of 8 common factors. Conclusion:The core pathogenesis of blood stasis VD is blood stasis blocking brain collaterals, and there were also pathological factors such as qi deficiency, yin deficiency, phlegm turbidity and so on. The basic treatment is promoting blood circulation and removing stasis, and different methods of promoting blood circulation and drugs are selected. The methods of strengthening spleen and reducing phlegm, nourishing yin and blood, inducing resuscitation, tonifying the kidney and spleen, regulating qi, promoting collaterals and so on can also be used based on syndromes and symptoms of the patients.

Medication law of Traditional Chinese Medicine patent compounds in the treatment of Alzheimer disease based on data mining / 国际中医中药杂志

Objective:To analyze the medication law of Traditional Chinese Medicine (TCM) patent compounds for Alzheimer disease (AD) by using data mining method.Methods:The TCM compounds for the treatment of AD in the patent database were screened, and the frequency, clustering and association analysis were carried out with the help of TCM inheritance calculation platform, SPSS Statistics 21.0 and SPSS Modeler 18.0 software. The medication law was analyzed.Results:A total of 220 patent compounds were included, involving 361 kinds of Chinese materia medica; the top 10 high-frequency drugs were Acori Tatarinowii Rhizoma, Polygalae Radix, Ginseng Radix et Rhizoma, Chuanxiong Rhizoma, Astragali Radix, Lycii Fructus, Poria, Rehmanniae Radix PraeparataAngelicae Sinensis Radix, Salviae Miltiorrhizae Radix et Rhizoma; the most frequently used drugs were drugs for tonifying deficiency and promoting blood circulation to remove blood stasis; most of their properties belonged to warm, mild and cold; the tastes were mainly sweet, bitter and pungent; the meridians belonged to the five internal organs. 16 items of association data (4 combinations of two items and 12 combinations of three items) were obtained by association rule analysis, and the strongest correlation group was " Acori Tatarinowii Rhizoma- Polygalae Radix" and " Acori Tatarinowii Rhizoma- Chuanxiong Rhizoma- Polygalae Radix". Cluster analysis showed four prescription combinations and three pairs of drug compatibility, including the addition and subtraction structure of Kaixin Powder, Zuogui Pill, Bazhen decoction and so on. Conclusion:The core treatment principle of TCM patent compound treatment of AD is regulating and tonifying the five internal organs to treat its root, resolving phlegm and removing blood stasis to treat the symptoms, which accords with the theoretical basis of TCM in the treatment of AD, and can provide reference for clinical practice and new drug research and development.

Analysis of the application and combination rules of Sanyinjiao (SP 6) based on data mining / 国际中医中药杂志

Objective:To analyze the application and regularity of acupoint selection of Sanyinjiao (SP 6) based on data mining.Methods:Search for literatures in CNKI, Wanfang, VIP, and Pubmed, the clinical researches of acupuncture on Sanyinjiao (SP 6) point were selected, according to the inclusion and exclusion criteria, and the retrieval period was from database construction to September 30th, 2021. Excel 2016, SPSS Statistics 25.0, SPSS Modeler 18.0 were used to perform descriptive analysis, association analysis and cluster analysis.Results:After literature screening, a total of 261 literatures were included, involving 73 kinds of diseases, mainly including mental and behavioral disorders, genitourinary diseases, endocrine and nutritional metabolism diseases and nervous system diseases. The most frequently used acupoints in Sanyinjiao (SP 6) compatibility are Zusanli (ST 36), Baihui (GV 20), Guanyuan (CV 4) and Taichong (LR 3), most of which focus on stomach meridian, conception channel, governor channel and bladder meridian. Seven categories were extracted among high-frequency acupoints by cluster analysis. The association rule analysis showed that the commonly used combination of Sanyinjiao (SP 6) were Zusanli (ST 36)-Sanyinjiao (SP 6), Baihui (GV 20)-Sanyinjiao (SP 6), and Guanyuan (CV 4)-Sanyinjiao (SP 6).Conclusions:Sanyinjiao (SP 6) is widely used in clinical application, and it is always compatible with stomach meridian, conception vessel, governor channel acupoints, especially those acupoints on the outer and inner meridians and the upper and lower parts. Sanyinjiao (SP 6) combined with other acupoints can treat diseases of multiple systems, such as insomnia, stroke, anxiety and depression, dysmenorrhea, infertility, etc. Clustering and association analysis found the core compatibility law of Sanyinjiao (SP 6), which can be used as a reference for clinical acupoint selection.

Macroscopic Clinical Medication Pattern of Traditional Chinese Medicine for Esophageal Cancer in Recent Ten Years Based on Data Mining / 中国实验方剂学杂志

ObjectiveTo explore the macroscopic medication pattern of traditional Chinese medicine （TCM） in treating esophageal cancer （EC） and provide medication references for the clinical application of TCM in EC treatment. MethodRelevant literature on TCM treatment of EC was retrieved from three major Chinese databases： China National Knowledge Infrastructure （CNKI）， Wanfang Data， and VIP. Information about Chinese herbal medicines was entered into Excel to establish a prescription database for EC. The data were standardized， summarized， and subjected to frequency analysis， association rules， and cluster analysis of medication in the prescriptions. Based on the TCM classification of EC syndromes， clinical indications corresponding to each syndrome were identified， and high-frequency drugs and drug pairs were analyzed correspondingly with syndromes. ResultA total of 136 prescriptions containing 240 Chinese herbal medicines were screened， with a cumulative frequency of 1 853 times. The top 5 frequently used Chinese herbal medicines were Glycyrrhizae Radix et Rhizoma， Poria， Atractylodis Macrocephalae Rhizoma， Astragali Radix， and Pinelliae Rhizoma. In terms of functions， the Chinese herbal medicines were mainly deficiency-tonifying， urination-promoting and dampness-draining， deficiency-tonifying， deficiency-tonifying， and phlegm-resolving and cough and dyspnea-relieving ones. The statistical analysis of flavor， property， and meridian tropism showed that Chinese herbal medicines were mainly bitter and sweet， warm， cold， and neutral， and acted on the spleen， lung， and stomach meridians. Association rule analysis yielded nine potential drug combinations， and cluster analysis of high-frequency drugs resulted in four combination categories. The four TCM syndromes for EC corresponded to respective clinical indications， treatment drugs， and drug pairs. ConclusionTonifying deficiency， reinforcing healthy Qi， descending adverse Qi， resolving phlegm， activating blood， and resolving stasis are the basic principles of TCM treatment for EC， which are supplemented by clearing heat and dissipating mass while focusing on regulating and smoothing the qi movement. The drug combinations obtained from high-frequency drug and association rule analysis provide references for different TCM syndrome treatments of EC， offering valuable insights for clinical medication.

Influência da Gordura do Braço sobre Medida Indireta da Pressão Sanguínea: Uma Abordagem Estatística e de Machine Learning / Influence of Arm Fat on the Indirect Measurement of Blood Pressure: A Statistical and Machine Learning Approach

Resumo Fundamento A mensuração indireta da pressão sanguínea (PS) é sabidamente influenciada por diversos fatores como técnica, observador e equipamento, mas a influência da composição do braço ainda não foi investigada. Objetivo Identificar a influência da gordura do braço sobre a medida indireta da pressão sanguínea, utilizando modelos de inferência estatística e machine learning. Métodos Estudo transversal, com 489 adultos jovens saudáveis de 18 a 29 anos de idade. Foram medidos comprimento (COB), circunferência do braço (CB) e índice de gordura do braço (IGB). A PS foi mensurada em ambos os braços, simultaneamente. Os dados foram processados utilizando-se Python 3.0 e pacotes específicos para análise descritiva, regressão e clusterização. Um nível de significância de 5% foi adotado para todos os cálculos. Resultados A PS e as medidas antropométricas foram diferentes entre os hemicorpos. A pressão sanguínea sistólica (PAS), COB, e IGB foram maiores no braço direito (BD), enquanto CB foi similar em comparação ao braço esquerdo. COB e CB apresentaram correlação positiva com a PAS. Conforme o modelo de regressão, para determinado valor de CB e COB, a leitura da PAS poderá ter uma redução média de 1,80 mmHg no BD, e 1,62 mmHg no braço esquerdo, a cada 10% de aumento na IGB. A clusterização corroborou os resultados da regressão. Conclusão Foi encontrada uma influência significativa do IGB sobre a leitura da PS. A PAS teve correlação positiva com COB e CB, e correlação negativa com IGB, o que sugere a necessidade de mais investigações sobre a relação da PS com as frações de gordura e músculo do braço.

Abstract Background The indirect measurement of blood pressure (BP) is known to be influenced by many factors such as the technique, observer, and equipment; however, the influence of arm composition has not been investigated yet. Objective To identify the influence of arm fat on the indirect measurement of blood pressure using statistical inference and machine learning models. Methods Cross-sectional study, with 489 healthy young adults aged from 18 to 29 years old. Measurements of arm length (AL), arm circumference (AC) and arm fat index (AFI) were taken. BP was measured in both arms simultaneously. Data were processed using Python 3.0 and its specific packages for descriptive analysis, regression and cluster analysis. Significance levels: 5% for all calculations. Results BP and anthropometric measurements were different between the hemi-bodies. In the right arm, systolic blood pressure (SBP), AL and AFI were higher, while AC was similar compared with the left arm. AL and AC showed positive correlation with SBP. According to the regression model, for a fixed value of AC and AL, SBP readings could be reduced by a mean of 1.80 mmHg in the right arm, and 1.62 mmHg in the left arm for every 10% increase in AFI. Clustering analysis corroborated the regression results. Conclusion There was a significant influence of AFI on BP readings. SBP had a positive correlation with AL and AC, and a negative correlation with AFI, suggesting the need for further investigations on the relationship between BP and percentages of arm muscle and fat.

Brazilian National Food and Nutritional Security System: what are the similarities in the decentralization process? / Sistema Nacional de Segurança Alimentar e Nutricional: quais são as semelhanças no processo de descentralização? / Sistema Nacional de Seguridad Alimentaria y Nutricional: ¿cuáles son las similitudes en el proceso de descentralización?

This study aimed to analyze the multiple characteristics of the decentralization of the Brazilian National Food and Nutritional Security System (SISAN) in a period before the institutional dismantling. Data from the 26 Brazilian states were collected in two public information systems, referring to the years 2017/2018. An exploratory and descriptive study was performed using a hierarchical cluster analysis, based on an analysis model with multiple characteristics of the system decentralization. The results indicated the formation of three clusters, showing the similarity among states with greater intersectoral and participatory character, better relationship with municipalities, and allocation of resources. On the other hand, states with less intersectoral and participatory character, linked to the low allocation of resources, execution of food security actions, and municipal support were clustered. These clusters composed mainly of North and Northeastern states, with a lower Gross Domestic Product, average Human Development Index, and a higher occurrence of food insecurity, expressed characteristics that may be related to greater obstacles in the system decentralization process. This information can help in the decision-making about the SISAN in a more equitable manner, supporting the actors involved in its maintenance and defense, at a time when the country presents an austere political and economic situation, marked by the progressive worsening of food insecurity.

Este estudo teve como objetivo analisar as múltiplas características da descentralização do Sistema Nacional de Segurança Alimentar e Nutricional (SISAN) em um período anterior ao desmonte institucional. Dados dos 26 estados brasileiros foram coletados em dois sistemas públicos de informação, referentes aos anos de 2017/2018. Um estudo exploratório e descritivo foi realizado por meio de uma análise de cluster hierárquica baseada em um modelo de análise com múltiplas características de um sistema descentralizado. Os resultados indicaram a formação de três clusters, mostrando a semelhança entre os estados com maior caráter intersetorial e participativo, assim como melhor relação com municípios e alocação de recursos. De forma oposta, os estados com menor caráter intersetorial e participativo foram agrupados, ligados à baixa alocação de recursos, execução de ações de segurança alimentar e de apoio municipal fracos. Os clusters compostos principalmente por estados do Norte e Nordeste, com menor Produto Interno Bruto, Índice de Desenvolvimento Humano médio e maior ocorrência de insegurança alimentar, expressaram características que podem estar relacionadas a maiores obstáculos na descentralização. Essas informações podem auxiliar na tomada de decisão do SISAN de forma mais equitativa, servindo de apoio aos atores envolvidos em sua manutenção e defesa, em um momento em que o país apresenta uma situação política e econômica de austeridade, marcada pela piora progressiva da situação de insegurança alimentar.

Este estudio tuvo como objetivo analizar las múltiples características de la descentralización del Sistema Nacional de Seguridad Alimentaria y Nutricional (SISAN) en el periodo anterior al desmantelamiento institucional. Los datos de los 26 estados brasileños se recolectaron de dos sistemas de información pública referentes al periodo 2017/2018. Se realizó un estudio exploratorio y descriptivo mediante análisis de clúster jerárquico basado en un modelo de análisis con múltiples características de un sistema descentralizado. Los resultados indicaron la formación de tres clústeres, mostrando la similitud entre los estados de mayor intersectorialidad y participación, así como una mejor relación con los municipios y asignación de recursos. Por otro lado, se agruparon los estados de menor carácter intersectorial y participativo, vinculados a la baja asignación de recursos, ejecución de acciones de seguridad alimentaria y débil apoyo municipal. Los clústeres compuestos principalmente por los estados del Norte y Nordeste de Brasil, con menor Producto Interno Bruto, Índice de Desarrollo Humano medio y mayor ocurrencia de inseguridad alimentaria tuvieron características expresadas que pueden estar relacionadas con mayores obstáculos en la descentralización. Estos datos pueden ayudar al SISAN en la toma de decisiones de manera más equitativa y servir de apoyo a los actores involucrados en su mantenimiento y defensa, en momentos en que el país se enfrenta a una situación política y económica de austeridad, marcada por el progresivo empeoramiento de la inseguridad alimentaria.

Noncommunicable chronic diseases clusters in Brazilian adults and older adults: correlations as multimorbidity / Agrupamento de doenças crônicas não transmissíveis em adultos e idosos brasileiros: correlações como multimorbidade

Abstract Background Health has dynamic conditions and overlapping pathophysiological factors. For health prevention and promotion, actions are necessary to understand the most common risk combinations. Objective Describe noncommunicable chronic diseases (NCDs) clusters and investigate specific multimorbidity combinations in Brazilian adults and older adults. Method This study used data from Vigitel 2013 survey held in the Brazilian capitals (52,929 interviews). A self-report of diabetes, dyslipidemia, hypertension, and obesity was used. The analyses were the descriptive cluster of NCDs and an adjusted binary logistic regression (odds ratio [OR]), stratified by age. Results Among adults, the clusters of diabetes, dyslipidemia, hypertension, and obesity (O/E = 18.74) and diabetes, hypertension, and obesity (O/E = 16.83) were higher. There was a higher clustering between diabetes and obesity (O/E = 7.25). Among adults, diabetes was associated with dyslipidemia (OR: 3.04), hypertension (OR: 3.84), and hypertension with obesity (OR: 3.34). In older adults, hypertension was associated with diabetes (OR: 2.79), dyslipidemia (OR: 2.06), and obesity (OR: 2.26). Conclusion Other diseases combined with diabetes and hypertension were more frequent in adults and older adults. It is suggested to combine preventive and control measures for these diseases for the non-occurrence of new diagnoses.

Resumo Introdução A saúde apresenta condições dinâmicas e fatores fisiopatológicos sobrepostos. Para ações de prevenção e promoção da saúde é necessário entender as combinações comuns de risco. Objetivo Descrever os agrupamentos de doenças crônicas não transmissíveis (DCNT) e investigar combinações específicas de multimorbidade em adultos e idosos no Brasil. Método Este estudo utilizou dados da pesquisa Vigitel 2013, realizada nas capitais brasileiras (total de 52.929 entrevistas). Foi utilizado um relato de diabetes, dislipidemia, hipertensão e obesidade. Nas análises foram utilizados o agrupamento descritivo de DCNT e uma regressão logística binária ajustada (razão de odds [RO]), estratificada por idade. Resultados Entre os adultos, os grupos de diabetes, dislipidemia, hipertensão e obesidade (O / E = 18,74), bem como diabetes, hipertensão e obesidade (O / E = 16,83) foram maiores. Nos idosos, houve maior agrupamento entre diabetes e obesidade (O / E = 7,25). Entre os adultos, o diabetes foi associado à dislipidemia (RO: 3,04) e hipertensão (RO: 3,84), enquanto a hipertensão à obesidade (RO: 3,34). Nos idosos, a hipertensão foi associada a diabetes (RO: 2,79), dislipidemia (RO: 2,06) e obesidade (RO: 2,26). Conclusão Os agrupamentos de outras doenças combinadas com diabetes e hipertensão foram mais frequentes em adultos e idosos. Sugere-se que além das medidas existentes de prevenção para essas doenças também sejam propostas medidas de controle para a não ocorrência de novos diagnósticos.

Perfil epidemiológico e distribuição espacial dos casos de hanseníase na Paraíba / Epidemiological profile and spatial distribution of leprosy cases in Paraíba

Resumo Introdução A hanseníase se apresenta de forma heterogênea, o que requer o reconhecimento do perfil e distribuição espacial para a efetivação de ações de controle. Objetivo Descrever o perfil epidemiológico e a distribuição espacial dos casos de hanseníase na Paraíba. Método Estudo ecológico, de base secundária e abordagem quantitativa. Os loci do estudo foram os 223 municípios do estado. Os dados foram coletados no Sistema de Informação de Agravos de Notificação/Hanseníase correspondentes ao período de 2015 a 2019. Utilizou-se de estatística descritiva e análise espacial com auxílio do software R. Resultados Foram analisados 3.218 casos para o perfil epidemiológico e 3.212 para a análise espacial. Verificou-se maior registro no ano de 2019 (n=778;24,2%); no sexo masculino (n=1.783; 55,5%); faixa etária 40 a 59 anos (n=1.236; 38,4%); classificação multibacilar (n=2.095; 65,2%); forma dimorfa (n= 970; 30,2%), e grau de incapacidade física 0 (n=1.611; 50,2%). Identificaram-se 171 (76,7%) municípios que notificaram casos, e houve detecção de conglomerados simples e compostos envolvendo 31 municípios, situados mais ao Leste e Oeste do estado. Conclusão Ressalta-se que a hanseníase permanece com cadeia de transmissão ativa na Paraíba e com distribuição geográfica heterogênea, reafirmando a importância de planejar e executar ações de controle mais resolutivas.

Abstract Background Leprosy presents itself heterogeneously, which requires the recognition of profile and spatial distribution for the effectuation of control actions. Objective To describe the epidemiological profile and the spatial distribution of leprosy cases in the Paraíba, Brazil. Method Ecological study on a secondary basis with a quantitative approach. The study site was the 223 municipalities in the state of Paraíba. The data were collected in the Notifiable Diseases Information System/Leprosy for the period from 2015 to 2019. Descriptive statistics and spatial analysis were used with the aid of the R software. Results 3,218 cases were analyzed for the epidemiological profile and 3,212 for the spatial analysis. There was a greater record in the year of 2019 (n = 778;24.2%); in males (n = 1,783; 55.5%); age group 40 to 59 years (n = 1,236; 38.4%); multibacillary classification (n = 2,095; 65.2%); dysmorphic form (n = 970; 30.2%); and degree of physical disability 0 (n = 1,611; 50.2%). 171 (76.7%) municipalities that reported cases were identified, and simple and compound conglomerates were detected involving 31 municipalities located further east and west of the state. Conclusion It should be noted that leprosy remains an active transmission chain in Paraíba and has a heterogeneous geographic distribution, reaffirming the importance of planning and executing more resolute control actions.

Spatial clusters of diabetes: individual and neighborhood characteristics in the ELSA-Brasil cohort study / Aglomerados espaciais de diabetes: características individuais e de vizinhança no estudo longitudinal ELSA-Brasil / Grupos espaciales de diabetes: características individuales y vecinales en el estudio longitudinal ELSA-Brasil

This study identified spatial clusters of type 2 diabetes mellitus among participants of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) residing in two cities and verified individual and neighborhood socioeconomic environmental characteristics associated with the spatial clusters. A cross-sectional study was conducted with 4,335 participants. Type 2 diabetes mellitus was defined as fasting blood glucose ≥ 126mg/dL (7.0mmol/L), oral glucose tolerance test ≥ 200mg/dL (11.1mmol/L), or glycated hemoglobin ≥ 6.5% (48mmol/L); by antidiabetic drug use; or by the self-reported medical diagnosis of type 2 diabetes mellitus. Neighborhood socioeconomic characteristics were obtained from the 2011 Brazilian census. A spatial data analysis was conducted with the SaTScan method to detect spatial clusters. Logistic regression models were fitted to estimate the magnitude of associations. In total, 336 and 343 participants had type 2 diabetes mellitus in Belo Horizonte, Minas Gerais State (13.5%) and Salvador, Bahia State (18.5%), respectively. Two cluster areas showing a high chance of type 2 diabetes mellitus were identified in Belo Horizonte and Salvador. In both cities, participants living in the high type 2 diabetes mellitus cluster area were more likely to be mixed-race or black and have a low schooling level and manual work; these were also considered low-income areas. On the other hand, participants in the low type 2 diabetes mellitus cluster area of Salvador were less likely to be black and have low schooling level (university degree) and live in a low-income area. More vulnerable individual and neighborhood socioeconomic characteristics were associated with living in clusters of higher type 2 diabetes mellitus occurrence , whereas better contextual profiles were associated with clusters of lower prevalence.

Este estudo identificou aglomerados espaciais de diabetes mellitus tipo 2 entre participantes do Estudo Longitudinal de Saúde do Adulto no Brasil (ELSA-Brasil) em duas cidades e verificou características socioeconômicas ambientais individuais e de vizinhança associadas aos aglomerados espaciais. Se trata de um estudo transversal com 4.335 participantes. Diabetes mellitus tipo 2 foi definido com base em glicemia de jejum ≥ 126mg/dL (7,0mmol/L); teste oral de tolerância à glicose ≥ 200mg/dL (11,1mmol/L); hemoglobina glicada ≥ 6,5% (48mmol/L); uso de drogas antidiabéticas; ou pelo autodiagnóstico médico de diabetes mellitus tipo 2. As características socioeconômicas do bairro foram obtidas a partir do censo brasileiro de 2011. A análise dos dados espaciais foi realizada pelo método SaTScan para detectar os aglomerados espaciais. Os modelos de regressão logística foram ajustados para estimar a magnitude das associações. Um total de 336 e 343 participantes apresentaram diabetes mellitus tipo 2 em Belo Horizonte, Minas Gerais (13,5%) e Salvador, Bahia (18,5%), respectivamente. Foram identificadas duas áreas de aglomerados com alta probabilidade de diabetes mellitus tipo 2 em Belo Horizonte e Salvador. Em ambas as cidades, os participantes residentes nos aglomerados com alta taxa de diabetes mellitus tipo 2 tinham maior probabilidade de relatar cor de pele parda ou preta, baixa escolaridade e ocupação de trabalho manual; essas áreas também foram consideradas de baixa renda. Por outro lado, os participantes do aglomerado com baixa taxa de diabetes mellitus tipo 2 de Salvador tinham menor probabilidade de serem negros e maior probabilidade de terem diploma universitário, além de morarem em áreas de alta renda. Características socioeconômicas individuais e de vizinhança mais vulneráveis estavam associadas à residência em aglomerados de maior ocorrência de diabetes mellitus tipo 2, enquanto o oposto foi observado para perfis contextuais melhores.

Este estudio identificó grupos espaciales de diabetes mellitus tipo 2 entre los participantes del Estudio Longitudinal de Salud del Adulto en Brasil (ELSA-Brasil) en dos ciudades y verificó las características socioeconómicas ambientales individuales y de vecindario asociadas con los grupos espaciales. Se trata de un estudio transversal con 4.335 participantes. La diabetes mellitus tipo 2 se definió en base a glucosa en ayunas ≥ 126mg/dL (7,0mmol/L); prueba de tolerancia oral a la glucosa ≥ 200mg/dL (11,1mmol/L); hemoglobina glicosilada ≥ 6,5% (48mmol/L); uso de medicamentos antidiabéticos; o por autodiagnóstico médico de diabetes mellitus tipo 2. Las características socioeconómicas del barrio se obtuvieron a partir del censo brasileño de 2011. El análisis de datos espaciales se realizó utilizando el método SaTScan para detectar grupos espaciales. Los modelos de regresión logística se ajustaron para estimar la magnitud de las asociaciones. Un total de 336 y 343 participantes presentaron diabetes mellitus tipo 2 en Belo Horizonte, Minas Gerais (13,5%) y Salvador, Bahia (18,5%), respectivamente. Se identificaron dos áreas de grupos con alta probabilidad de diabetes mellitus tipo 2 en Belo Horizonte y Salvador. En ambas ciudades, los participantes que residían en las áreas del grupo con una alta tasa de diabetes mellitus tipo 2 tenían más probabilidades de informar el color de piel pardo o negro, la baja educación y la ocupación del trabajo manual; estas áreas también se consideraron de bajos ingresos. Por el contrario, los participantes en el área del grupo con baja tasa de diabetes mellitus tipo 2 de Salvador tenían menos probabilidades de ser negros y más probabilidades de tener un título universitario, además de vivir en áreas de altos ingresos. Las características socioeconómicas individuales y de vecindario más vulnerables se asociaron con la residencia en grupos de mayor incidencia de diabetes mellitus tipo 2, mientras que se observó lo contrario para mejores perfiles contextuales.

Characteristics of individuals with moderate to severe asthma who better respond to aerobic training: a cluster analysis / Características de indivíduos com asma moderada a grave que melhor respondem a treinamento aeróbio: análise de conglomerados

ABSTRACT Objective: To determine the characteristics of individuals with asthma who are responsive to aerobic training. Methods: This post hoc analysis of pooled data from previous randomized controlled trials involved 101 individuals with moderate to severe asthma who underwent aerobic training. Participants underwent a maximal cardiopulmonary exercise test and completed the Asthma Control Questionnaire and the Asthma Quality of Life Questionnaire before and after a 24-session aerobic training program. Better and worse responders to aerobic training were identified by cluster analysis. Results: Two clusters were identified according to the improvement in peak VO2 after aerobic training (better and worse responders). Characteristics of the better responder group were being older, being female, having higher BMI, and having higher cardiac reserve at baseline when compared with the worse responder group. Also, better responders had worse clinical control, worse quality of life, and lower physical capacity at baseline. After training, worse responders, in comparison with better responders, showed half the improvement in Δpeak VO2 (7.4% vs. 13.6%; 95% CI, −12.1 to −0.92%; p < 0.05) and worse asthma control. A weak, negative, but significant association (r = −0.35; p < 0.05) was observed between clinical control and aerobic fitness only in the better responder group. Both groups showed significant improvement in quality of life. Conclusions: Obese individuals with worse exercise capacity, clinical control, and quality of life showed improvement with aerobic training. Moreover, worse responders also improved with training, but to a lesser extent.

RESUMO Objetivo: Determinar as características de indivíduos com asma responsivos a treinamento aeróbio. Métodos: Esta análise post hoc de dados agrupados provenientes de ensaios clínicos controlados randomizados anteriores envolveu 101 indivíduos com asma moderada a grave submetidos a treinamento aeróbico. Os participantes foram submetidos a um teste de exercício cardiopulmonar máximo e responderam ao Asthma Control Questionnaire e ao Asthma Quality of Life Questionnaire antes e depois de um programa de treinamento aeróbio de 24 sessões. Melhores e piores respondedores ao treinamento aeróbio foram identificados por análise de conglomerados. Resultados: Foram identificados dois conglomerados de acordo com a melhora do VO2 de pico após o treinamento aeróbio (melhores e piores respondedores). As características do grupo melhor respondedor foram maior idade, sexo feminino, IMC mais elevado e maior reserva cardíaca basal em comparação com o grupo pior respondedor. Os melhores respondedores também apresentavam pior controle clínico, pior qualidade de vida e menor capacidade física basal. Após o treinamento, os piores respondedores, em comparação com os melhores respondedores, apresentaram metade da melhora no ΔVO2 de pico (7,4% vs. 13,6%; IC95%: -12,1 a -0,92%; p < 0,05) e pior controle da asma. Observou-se uma associação negativa fraca, mas significativa (r = −0,35; p < 0,05) entre controle clínico e aptidão aeróbia apenas no grupo melhor respondedor. Ambos os grupos apresentaram melhora significativa da qualidade de vida. Conclusões: Os indivíduos obesos com pior capacidade de exercício, controle clínico e qualidade de vida apresentaram melhora com o treinamento aeróbio. Além disso, os piores respondedores também melhoraram com o treinamento, mas em menor grau.

Análise de variáveis com potencial discriminante para classificação de escolas médicas / Analysis of discriminant variables for classification of medical schools

Resumo: Introdução: Este estudo metodológico pretendeu identificar em qual medida um conjunto de variáveis características de escolas médicas possui capacidade discriminante na classificação dos cursos por meio da análise de agrupamento. Nas últimas décadas, houve um aumento expressivo do número de vagas ofertadas para cursos médicos. Esse advento impôs desafios para os programas de avaliação, tanto pela necessidade de expandir o processo como pela necessidade de implantação de novos indicadores de qualidade. Objetivo: Esse estudo teve como objetivo propor técnicas de análise para aprimorar a capacidade discriminante na classificação de cursos médicos mediante variáveis objetivas relacionadas a aspectos estruturais e operacionais que possam ser incorporadas aos métodos já utilizados. Método: Trata-se de um estudo descritivo, analítico-metodológico e quantitativo que utilizou dados dos cursos médicos de São Paulo, em dezembro de 2020. Foi realizada análise por agrupamentos hierárquico e não hierárquico dos cursos para identificar variáveis com capacidade discriminante em busca de padrões que cooperem para a classificação das escolas médicas. As variáveis estudadas foram: início do curso, carga horária, regime letivo, metodologia, hospital universitário, categoria administrativa da instituição e gratuidade. Para a construção dos agrupamentos, adotaram-se o método de Ward e a distância euclidiana para estimar a discriminação entre os grupos. No agrupamento não hierárquico, a definição da quantidade de grupos foi determinada pela análise da diminuição da variância. Avaliou-se a correlação entre as variáveis por meio de mapas de calor. Resultado: As análises de agrupamento mostraram a existência de três grupos de escolas médicas por similaridade: um grupo composto por escolas mais antigas e com maior carga horária, e, nos outros dois, consideraram-se as escolas não gratuitas sem hospital universitário, diferenciando-se pela idade das escolas. Além disso, as correlações reforçaram que as variáveis adotadas cooperavam para a discriminabilidade entre grupos. Há reconhecida heterogeneidade entre os cursos de graduação no Brasil, e esse dado também se aplica aos cursos médicos que impõem desafios metodológicos para os processos de avaliação estabelecidos. Entretanto, a inclusão de variáveis requer métodos capazes de refinar a capacidade discriminante da análise. Conclusão: A análise aqui proposta mostrou-se capaz de identificar grupos de escolas médicas por meio de indicadores objetivos e pode auxiliar o processo de avaliação das escolas médicas.

Abstract: Introduction: This is a methodological study that aims to identify the extent to which a set of variables characteristic of medical schools have a discriminating capacity to classify the courses through cluster analysis. In the last two decades, there has been a significant increase of vacancies in medical courses. This advent has posed challenges for evaluation programs, both because of the need to expand the evaluation process and the need to implement new quality indicators. Objective: To propose analysis techniques to improve the discriminating capacity to classify medical courses through variables related to structural, operational, and objective aspects that can be incorporated into the already used methods. Method: Descriptive, analytical-methodological, quantitative study that used data from existing medical courses in December 2020, in the state of São Paulo. Analysis by hierarchical and non-hierarchical clustering of courses was performed to identify the discriminating elements that provide standards that cooperate for the classification of medical schools. The studied variables were: course start, workload, academic regime, methodology, University-Hospital, administrative category of the institution, gratuity. For the construction of the clusters, the Ward method and the Euclidean distance were used to estimate the discrimination between the groups. In the non-hierarchical clustering, the definition of the number of groups was determined by the analysis of the decrease in variance. The correlation between the variables was also evaluated through heatmaps. Results: The cluster analysis showed the existence of three groups of medical schools by similarity, with one group consisting of older schools with greater workload, and the other two consisting of private schools without a university-hospital, differing by the course time. Furthermore, the correlations reinforced that the adopted variables cooperated for the discriminability between the groups. Discussion: There is a known heterogeneity among undergraduate courses in Brazil and this also applies to medical courses, which poses methodological challenges for the established assessment processes. However, the inclusion of variables requires methods capable of refining the discriminant capacity of the analysis. Conclusion: The analysis proposed here proved to be capable of identifying groups of medical schools through objective indicators that can support the evaluation process of medical schools.

Identification of Dalbergiae Odoriferae Lignum and Its Counterfeits by 1H-NMR Combined with Multivariate Statistical Analysis / 中国实验方剂学杂志

ObjectiveTo establish the identification method of Dalbergiae Odoriferae Lignum（DOL） and its counterfeits by nuclear magnetic resonance hydrogen spectrum（1H-NMR） combined with multivariate statistical analysis. Method1H-NMR spectra of DOL and its counterfeits were obtained by NMR， and the full composition information was established and transformed into a data matrix， and the detection conditions were as follows：taking dimethyl sulfoxide-d6（DMSO-d6） containing 0.03% tetramethylsilane（TMS） as the solvent， the constant temperature at 298 K（1 K=-272.15 ℃）， pulse interval of 1.00 s， spectrum width of 12 019.23 Hz， the scanning number of 16 times， and the sampling time of 1.08 s. Similarity examination and hierarchical cluster analysis（HCA） were performed on the data matrix of DOL and its counterfeits， and orthogonal partial least squares-discriminant analysis（OPLS-DA） was used to analyze the data matrix and identify the differential components between them. In the established OPLS-DA category variable value model， the category variable value of DOL was set as 1， and the category variable value of the counterfeits was set as 0， and the threshold was set as ±0.3， in order to identify the commercially available DOL. The OPLS-DA score plot was used to determine the types of counterfeits in commercially available DOL， and it was verified by thin layer chromatography（TLC）. ResultThe results of similarity analysis and HCA showed that there was a significant difference between DOL and its counterfeits. OPLS-DA found that the differential component between DOL and its counterfeits was trans-nerolidol. The established category variable value model could successfully identify the authenticity of the commercially available DOL. The results of the OPLS-DA score plot showed that there were heartwood of Dalbergia pinnata and D. cochinchinensis in the commercially available DOL， and were consistent with the TLC verification results. ConclusionThere is a phenomenon that heartwood of D. pinnata and D. cochinchinensis are sold as DOL in the market. 1H-NMR combined with multivariate statistical analysis can effectively distinguish DOL and its counterfeits， which can provide a reference for the identification of them.