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Chinese Medicine Pattern Differentiation and Its Implications for Clinical Practice

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Chinese Journal of Integrative Medicine 2011年第11期17卷 818-823页

作者： arthur sá ferreira Agnaldo José Lopes Laboratory of Computational Modeling and simulation in Rehabilitation Program of Rehabilitation science Augusto Motta University Laboratory of Cardiopulmonar Analysis Rehabilitation science Postgraduation Program Augusto Motta University Laboratory of Respiratory Physiology State University of Rio de Janeiro

Chinese medicine practitioners apply the differentiation reasoning for decision-making. The wide scope of Chinese medicine intervention provides coverage of methods and techniques with applications to primary, secondary and tertiary levels of prevention. The rapid evolution of mathematical and computational techniques allowed the implementation of several models for pattern differentiation that were tested for several physiologic systems. Concurrently, it is argued that pattern differentiation might improve the efficacy of either traditional or conventional medical interventions. This article reviewed the influence of pattern differentiation into clinical practice organized by medical field： general pattern differentiation; genitourinary （recurrent cystitis）; cardiovascular （coronary heart disease; arterial hypertension; angina pectoris）; neurology （stroke）; surgery; metabolic （diabetes mellitus）; hepatic （cirrhosis）; gastrointestinal （chronic superficial gastritis）; orthopedic （low back pain; rheumatoid arthritis; cervical spondylosis; elbow arthritis）; oncology （gastric mucosal dysplasia; lung cancer）; gynecologic and obstetric manifestations （nausea and vomiting）. The reviewed studies presented achievements that have contributed to the integration of Chinese medicine and evidence-based medicine in the treatment of many mild and severe diseases. Target diseases considered as major public health problems were also investigated and the results are promising regarding the possibility to treat guided by pattern differentiation.

关键词： Chinese medicine-syndrome differentiation Chinese medicine preventive medicine rehabilitation "health care delivery"

Promoting integrative medicine by computerization of traditional Chinese medicine for scientific research and clinical practice: The suiteTCM Project

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Journal of Integrative Medicine 2013年第2期11卷 135-139页

作者： arthur de sá ferreira Laboratory of Computational simulation and Modeling in Rehabilitation Post-graduation Program of Rehabilitation Science Augusto Motta University Center

BACKGROUND： Chinese and contemporary Western medical practices evolved on different cultures and historical contexts and, therefore, their medical knowledge represents this cultural divergence. Computerization of traditional Chinese medicine （TCM） is being used to promote the integrative medicine to manage, process and integrate the knowledge related to TCM anatomy, physiology, semiology, pathophysiology, and therapy. METHODs： We proposed the development of the suiteTCM software, a collection of integrated computational models mainly derived from epidemiology and statistical sciences for computerization of Chinese medicine scientific research and clinical practice in all levels of prevention. The software includes components for data management （DataTCM）, simulation of cases （simTCM）, analyses and validation of datasets （sciTCM）, clinical examination and pattern differentiation （DiagTCM, TongueTCM, and PulseTCM）, intervention selection （AcuTCM, HerbsTCM, and DietTCM）, management of medical records （ProntTCM）, epidemiologic investigation of sampled data （ResearchTCM）, and medical education, training, and assessment （studentTCM）. DIsCUssION： The suiteTCM project is expected to contribute to the ongoing development of integrative medicine and the applicability of TCM in worldwide scientific research and health care. The suiteTCM 1.0 runs on Windows XP or later and is freely available for download as an executable application.

关键词： traditional Chinese medicine evidence-based practice computer-assisted decision making

simTCM: A human patient simulator with application to diagnostic accuracy studies of Chinese medicine

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Journal of Integrative Medicine 2015年第1期13卷 9-19页

作者： arthur de sá ferreira Antonio Guilherme Pacheco Postgraduation Program in Rehabilitation science Augusto Motta University Center Program of scientific Computing

OBJECTIVE： The aim of this work is to develop and implement the simTCM, an advanced computationa model that incorporates relevant aspects from traditional Chinese medicine （TCM） theory as well as advanced statistical and epidemiological techniques for simulation and analysis of human patients. METHODs： simTCM presents five major attributes for simulation： representation of true and false profiles for any single pattern; variable count of manifestations for each manifestation profile; empirical distributions of patterns and manifestations in a disease-specific population; incorporation of uncertainty in clinical data; and the combination of the four examinations. The proposed model is strengthened by following international standards for reporting diagnostic accuracy studies, and incorporates these standards in its treatment of study population, sample size calculation, data collection of manifestation profiles, exclusion criteria and missing data handling, reference standards, randomization and blinding and test reproducibility. REsULTs： simulations using data from patients diagnosed with hypertension and post-stroke sensory- motor impairments yielded no significant differences between expected and simulated frequencies of patterns （P = 0.22 or higher）. Time for convergence of simulations varied from 9.90 s （9.80, 10.27） to 28.31 s （26.33, 29.52）. The ratio iteration profile necessary for convergence varied between 1：1 and 5：1. CONCLUsION： This model is directly connected to forthcoming models in a large project to design and implement the suite TCM： ProntTCM, sciTCM, DiagTCM, studentTCM, Research TCM, HerbsTCM, AcuTCM, and DataTCM. It is expected that the continuity of the suiteTCM project enhances the evidence-based practice of Chinese medicine.

关键词： medicine, Chinese traditional evidence-based medicine computer-assisted decision making rehabilitation medicine (TCM)

Asserted and neglected issues linking evidence-based and Chinese medicines for cardiac rehabilitation

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World Journal of Cardiology 2014年第5期6卷 295-303页

作者： arthur de sá ferreira Nathalia Gomes Ribeiro de Moura Laboratory of Computation simulation and Modeling in Rehabilitation Postgraduate Program of Rehabilitation Science Centro Universitário Augusto Motta/UNISUAM CEP 21041-010 Rio de Janeiro Brazil

High blood pressure is among the most prevalent chronic disease in adults that impacts on the quality of life of patients, which are often subjected to physical rehabilitation. Chinese medicine intervention in patients with hypertension presents promising albeit inconclu-sive results, mostly due to methodological issues. This paper discusses asserted and neglected issues linking evidence-based and Chinese medicines as related to systemic arterial hypertension, as well as their impact on the physical rehabilitation of those patients. On the one hand, natural history of hypertension, pulse palpa-tion, and herbal therapy are among the asserted issues because of the scientific evidence collected about them, either in favor or against its integration to the current medical practice. On the other hand, anatomical varia-tions of vessels and comparative physiology are among the most commonly neglected issues because previous researches on integrative medicine ignored the pos-sible effects of these issues as related to the study's outcome. The asserted issues highlighted in this paperstimulate the increasing use of Chinese medicine for health care and the continuity of research on integra-tive medicine in the cardiovascular field for rehabilita-tion. The neglected issues poses additional challenges that must not be overlooked in future research on this topic so that the integration of both traditional and cur-rent knowledge may be of benefit to the population with cardiovascular disease.

关键词： Cardiovascular disease Hypertension Chinese medicine Rehabilitation Integrative medicine

Determination of functional prognosis in hospitalized patients following an intensive care admission

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World Journal of Critical Care Medicine 2016年第4期5卷 219-227页

作者： Natália A ferreira Agnaldo José Lopes arthur s ferreira George Ntoumenopoulos Jerffesson Dias Fernando s Guimaraes Rehabilitation sciences Post-Gradua-tion Program Augusto Motta University Centre Physical Therapy Department Barra D’Or Hospital Post-Graduation Program in Medical sciences State University of Rio de Janeiro Graduate school of Health sciences University of Technology Sydney Physical Therapy Department Federal University of Rio de Janeiro

AIM To investigate the factors associated with the functional progress of hospitalized patients following an intensive care *** Retrospective study including data from a cohort of 198 hospitalized patients following an intensive care admission and not requiring mechanical ventilation in a single tertiary referral hospital. A generalized linear model was used to identify the main effects of clinical and demographic variables on the outcomes of functionality(KATZ Index of Independence in Activities of Daily Living) and muscle strength(MRC scale). The covariates identified as independent predictors were analysed using the receiver operating characteristic curves. The analysis differentiated the periods in the intensive care unit(ICU), in the Ward(WARD) and the total time of hospital stay(TOT).REsULTs Considering the functional outcome(ΔKATZ), the variables that significantly contributed to the model(P ssion, age, sepsis(no), and total length of stay(TLs). Regarding the muscle strength outcome model(ΔMRC), the predictors were MRC on admission, simplified Acute Physiology score III, previous stroke, TLs, and sex(female). The variable age(AUC = 0.664) discriminated the ΔKATZICU. The variables age(AUC = 0.712), KATZ in ICU(AUC = 0.590) and on ward admission(AUC = 0.746), and MRC on ward admission(AUC = 0.721) were discriminative for ΔKATZWARD. For ΔKATZTOT the variables KATZ on ICU admission(AUC = 0.621) and TLs(AUC = 0.617) were discriminative. For ΔMRCICU the variables sAPsIII(AUC = 0.661) and MRC on ICU admission(AUC = 0.653) were discriminative. MRC on ICU(AUC = 0.681) and ward admission(AUC = 0.553) were discriminative for ΔMRCWARD. TLs(AUC = 0.649) and MRC on ward admission(AUC = 0.696) discriminative for the Δ*** specific functional, clinical and demographical variables at ICU admission are associated with the functional prognosis during the hospitalization period.

关键词： Muscle strength Intensive care units Activities of daily living Rehabilitation Early mobilization Post-intensive care unit syndrome

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一种单脏腑辨证方法的统计学验证(英文)

中西医结合学报 2008年第11期6卷 1109-1116页

作者： arthur de sá ferreira 奥古斯都莫塔中央大学理疗科理疗研究小组里约热内卢萨尔加多德奥利维拉大学理疗科

目的:提出一种能帮助中医临床医师进行单脏腑辨证的方法,并对其进行验证。方法:收集患者的四诊资料,然后在中医诊断知识数据库中进行检索,获取不同的备选辨证结果(证型),根据其能够解释四诊所得临床表现的多少进行排序,形成假设诊断列表... 详细信息

目的:提出一种能帮助中医临床医师进行单脏腑辨证的方法,并对其进行验证。方法:收集患者的四诊资料,然后在中医诊断知识数据库中进行检索,获取不同的备选辨证结果(证型),根据其能够解释四诊所得临床表现的多少进行排序,形成假设诊断列表,从中确定最终诊断结果。利用从中医诊断知识数据库中获取的96600种模拟证候群对该诊断方法进行验证。利用基于混淆矩阵的统计学方法评估望、闻、问、切等单个诊断手段、二诊(望诊和闻诊)或三诊(望诊、闻诊和问诊)结合及四诊合参的准确性。结果:问诊的准确度(89.7%)最高,其次为望诊(70.7%)、闻诊(59.9%)和切诊(56.1%)。敏感度和阴性预测值的排序相同。各单个诊断方法的特异度和阳性预测值均相近且较高(>99%)。四诊合参的准确度(93.2%)、敏感度(86.5%)和阴性预测值(88.1%)最高,同样,四诊合参亦具有较高的特异度(99.9%)和阳性预测值(99.8%)。与望、闻、问、切等单个诊断手段以及二诊或三诊结合诊断方法相比,四诊合参的诊断性能更高。结论:该证候诊断方法获得了统计学证据支持,可用于帮助中医临床医师依据脏腑理论进行单脏腑辨证诊断。

关键词：诊断中医学敏感性特异性

“徒手针刺影响健康人和中风后遗症患者肱二头肌功能的即时效果的平行随机对照试验”的研究方案(英文)

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中西医结合学报 2012年第3期10卷 303-309页

作者： Ana Paula de sousa Fragoso arthur de sá ferreira Laboratory of Human Movement Analysis Post-graduation Program of Rehabilitation ScienceAugusto Motta University CenterBonsucessoRio de JaneiroBrazil Department of Physical Therapy Salgado de Oliveira UniversityNiteróiRio de JaneiroBrazil

背景:中风作为一种疾病,中医早在2 000多年前即有诸多经典著作对其进行描述。然而,大部分有关针刺对中风后遗症患者功能恢复的疗效的临床对照试验未能得出针刺具有长期疗效的结论。并且,很多试验以表面肌电图测量患者骨骼肌的电活动以... 详细信息

背景:中风作为一种疾病,中医早在2 000多年前即有诸多经典著作对其进行描述。然而,大部分有关针刺对中风后遗症患者功能恢复的疗效的临床对照试验未能得出针刺具有长期疗效的结论。并且,很多试验以表面肌电图测量患者骨骼肌的电活动以评定针刺刺激的即时疗效的结论也不一致。这些研究结果对针刺在神经肌肉水平的作用提出了质疑。本研究旨在比较徒手针刺影响健康人和中风后肌张力亢进患者的肱二头肌功能及力量的即时效果。方法与设计:本研究拟开展含有4个平行对照组的随机单盲临床试验。分别针刺健康受试者及中风后遗症痉挛性轻瘫患者的曲池(LI11)及天泉(PC2)2个穴位。表面肌电图测量针刺对于肌肉功能的即时疗效及肱二头肌的等长张力作为主要结局指标。次要结局指标包括每组中医证候的出现频率及频率分布。讨论:本研究的临床试验设计在方法学上较之前的类似试验有些改善。预计这一研究能够证实针刺刺激对健康人及中风后遗症患者的神经肌肉的作用。临床试验注册:巴西临床试验注册(***,注册号为RBR-5g7xqh).

关键词：针刺疗法中风后遗症运动障碍肌电描计术随机对照试验临床方案

短期针刺足三里对脂多糖诱导的大鼠急性肺损伤的预防作用(英文)

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中西医结合学报 2009年第10期7卷 969-975页

作者： arthur de sá ferreira Januário Gomes Mourāo e LIMA Tatiana Pereira Teixeira ferreira Camila Madeira Tavares LOPEs Rubens MEYER Laboratory of Human Motion Analysis Augusto Motta University Center Laboratory of Morphology Augusto Motta University Center Laboratory of Inflammation Oswaldo Cruz Institute

目的:研究短期手法针刺足三里治疗对脂多糖诱导的实验性大鼠急性肺损伤的预防作用。方法:根据是否进行脂多糖刺激及采用的针刺方法的不同,将32只 Wistar 大鼠随机分为4组,即正常对照组、模型组、假针刺组和针刺组,每组8只。假针刺组和... 详细信息

目的:研究短期手法针刺足三里治疗对脂多糖诱导的实验性大鼠急性肺损伤的预防作用。方法:根据是否进行脂多糖刺激及采用的针刺方法的不同,将32只 Wistar 大鼠随机分为4组,即正常对照组、模型组、假针刺组和针刺组,每组8只。假针刺组和针刺组大鼠行手法针刺治疗,连续治疗4 d,每次 5 min。第4天针刺后采用脂多糖刺激诱导大鼠急性肺损伤。第5天,收集外周血、支气管肺泡灌洗液和骨髓等进行白细胞计数。结果:血细胞计数和支气管肺泡灌洗液细胞计数提示,针刺可减轻急性肺损伤大鼠的炎性反应,假针刺也有轻微的效果。正常对照组和模型组大鼠无明显的炎性反应。与正常对照组比较,模型组肺泡灌洗液中细胞计数增加;与假针刺组比较,针刺组肺泡灌选液中细胞计数减少,但差异没有统计学意义。结论:预防性手法针刺足三里可减轻脂多糖诱导的大鼠急性肺损伤,但其相关免疫机制仍待进一步的研究。

关键词：针刺脂多糖急性肺损伤大鼠

Repeat hepatectomy for recurrent colorectal liver metastases:A comparative analysis of short-and long-term results

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Hepatobiliary & Pancreatic Diseases International 2022年第2期21卷 162-167页

作者： Paulo Figueiredo Costa Fabricio ferreira Coelho Vagner Birk Jeismann Jaime arthur Pirola Kruger Gilton Marques Fonseca Ivan Cecconello Paulo Herman Digestive surgery Brazilian College of Digestive surgery(Colégio Brasileiro de Cirurgia Digestiva-CBCD) São PauloBrazil Digestive surgery Division Department of GastroenterologyUniversity of São Paulo School of MedicineSão PauloBrazil Instituto do Câncer do Estado de são Paulo(ICEsP) São PauloBrazil

Background: Liver recurrence after resection of colorectal liver metastases(CRLM) is frequent. Repeat hepatectomy has been shown to have satisfactory perioperative results. However, the long-term outcomes and the benefts for patients with early recurrence have not been clarifed. The aim of this study was to compare the short-and long-term outcomes of patients undergoing single hepatectomy and repeat hepatectomy for CRLM. Additionally, the oncological outcomes of patients with early( ≤ 6 months) and late recurrence who underwent repeat hepatectomy were compared. Methods: Consecutive adult patients undergoing hepatectomy for CRLM between June 20 0 0 and February 2020 were included and divided into two groups: single hepatectomy and repeat hepatectomy. Results: A total of 709 patients were included: 649 in the single hepatectomy group and 60 in the repeat hepatectomy group. Patients in the repeat hepatectomy group underwent more cycles of preoperative chemotherapy [4(3-6) vs. 3(2-4), P = 0.003]. Patients in the single hepatectomy group more frequently underwent major hepatectomies(34.5% vs. 16.7%, P = 0.004) and had a greater number of lesions resected(2.9 ± 3.6 vs. 1.9 ± 1.8, P = 0.011). There was no increase in operative time, estimated blood loss, length of hospital stay, complications, or mortality in the repeat hepatectomy group. There were no differences in overall survival( P = 0.626) and disease-free survival( P = 0.579) between the two groups. similarly, for patients underwent repeat hepatectomy, no difference was observed between the early and late recurrence groups in terms of overall survival( P = 0.771) or disease-free survival( P = 0.350). Conclusions: Repeat hepatectomy is feasible and safe, with similar short-and long-term outcomes when compared to single hepatectomy. surgical treatment of early liver recurrence offers similar oncological outcomes to those obtained for late recurrence.

关键词： Colorectal cancer Metastasis Hepatectomy Postoperative complications survival analysis