张昱教授运用药对治疗慢性肾炎经验总结

[目的]总结分析张昱教授运用药对治疗慢性肾炎的经验。[方法]通过跟师临证,收集整理临证医案,查阅相关文献资料,总结张师治疗慢性肾炎的常用药对组成、配伍特色以及常用剂量,探讨药对的临床药理机制,并附验案一则加以佐证。[结果]张师认为“虚-风(内风、外风)-瘀-毒”为慢性肾炎的病因病机,临证时以扶正与祛邪为纲,在辨证论治的基础上灵活运用药对组合治疗。对于正气不足者,常用益气固表、健脾益肾等药对扶助正气;属于邪实者,针对风、瘀、毒不同致病因素,分别采用祛风、活血、解毒等药对以祛除邪气。所举医案,患者辨证为气虚血瘀兼风邪热毒,张师治以益气活血、搜风通络、祛风解毒等常用药对,收效甚佳。[结论]张师运用药对组合治疗慢性肾炎,其方药精简,配伍合理,疗效显著,可为临床用药提供新思路。     

刘胜教授治疗三阴性乳腺癌经验

[目的]总结刘胜教授运用健脾补肾、解毒祛风法治疗三阴性乳腺癌的经验,为三阴性乳腺癌的辨证治疗提供新的思路。[方法]通过整理刘胜教授门诊病例资料,探析其个人协定方及用药规律,归纳出五脏亏虚为三阴性乳腺癌的发病之本,风、痰、瘀、毒,邪实胶着为其病机特点,并列举一则医案佐证。[结果]刘师在以往辨证治疗其他类型乳腺癌的基础上,着重阐述了三阴性乳腺癌正虚邪实、痰瘀毒化热、风挟毒邪流窜的病机特点,因此形成了健脾补肾、解毒祛风的治疗方法,并以此组成个人协定方。所举病案中刘胜教授运用健脾补肾、调摄冲任法调和五脏气血,辅以解毒祛风法预防复发转移,使患者在提高生活质量的基础上延长生存期。[结论]刘师以健脾补肾、解毒祛风治疗三阴性乳腺癌能有效改善患者术后症状,提高生活质量,值得临床推广。     

马大正老师治疗带下病经验介绍

[目的]研究总结马大正老师治疗带下病的临证经验。[方法]主以案例分析的方式,从病因病机、治则治法方面论述马老治疗带下病的学术观点和临床经验,并对其基本方药配伍及常用加减化裁的特色予以总结。[结果]马老分别以清热利湿、健脾益气、益肾健脾、清热解毒、清热利水为主要治法治疗湿热型、脾虚型、脾肾阳虚型及湿毒型的带下,临床疗效颇佳,所举案例也取得很好效果。[结论]马老在治疗带下病过程中根据患者的特点,辨证论治,选方用药精准,取得很好疗效,其经验对妇科的临床诊治具有一定指导意义,值得深入学习和体会。     

何若苹教授治疗恶性肿瘤患者化疗后骨髓抑制经验

[目的]总结何若苹教授治疗恶性肿瘤患者化疗后骨髓抑制的学术观点和临床经验。[方法]通过跟师抄方、整理和学习医案及临床观察等方式,探讨何师对化疗后骨髓抑制病因病机的认识以及辨证施治、用药特色方面的临床经验,并通过案例分析进一步阐述何师的治疗特点。[结果]何师认为,恶性肿瘤患者化疗后骨髓抑制的病机多以脾肾两虚为主,虚瘀互因,终致毒、虚、瘀相互交织。在治疗上,何师以健脾益肾、补气养血等扶正方法为主,使气血生化之源健;辅以理气化湿、活血化瘀、清热解毒之法治疗,令气血条畅,有助于新血的生成,临床疗效显著。所举案例效果较好,病情稳定。[结论]何师临床上运用益肾健脾扶正,辅以祛邪的方法辨治化疗后骨髓抑制,临床疗效明显,对临床实践具有启示意义,值得推广应用。     

周恩超治疗糖尿病肾病药对举隅

[目的]总结周恩超教授运用药对治疗糖尿病肾病的经验。[方法]整理周恩超教授临床常用药对,分别从病因病机、辨证论治等方面阐述周教授对糖尿病肾病的学术观点和临床经验,并举案例佐证。[结果]周恩超教授认为糖尿病肾病的病机以气阴两虚为本,标实多为湿浊、风邪、瘀血等,属虚实夹杂之证,临证善用药对如黄芪配山药、生地配玄参、玉米须配丝瓜络、制僵蚕配全蝎、丹参配地龙等辨证治疗糖尿病,常取得较好疗效。所举案例,疗效确切。[结论]周恩超教授运用常用药对治疗糖尿病肾病疗效显著,其经验及用药值得临床推广应用。     

金实教授治疗白塞氏病中医经验介绍

[目的]总结金实教授对于白塞氏病的中医治疗临床经验。[方法]分析金师对白塞氏病的病因病机认识,从辨证论治、经验用药等方面总结老师治疗白塞氏病的学术思想和临证经验,并举验案佐证。[结果]金师认为素体虚弱是白塞氏病发生的内在基础,而外感湿热之邪是本病发生及发展的外在条件,本病的主要病理因素是"湿、热、毒、瘀、虚"。金师注重辨证,从络论治,标本兼顾,针对其病因病机,采用清热利湿、活血解毒、养阴清热、健脾补肾等方法治疗该病,临床应用每收良效。所举医案,具体展示了上述辨证思路和治疗经验。[结论]金实教授"湿、热、毒、瘀、虚"辨治白塞氏病,临证经验丰富,疗效显著,其学术经验值得推广。     

郑小伟教授治疗顽固性咳嗽经验浅析

[目的]总结郑小伟教授治疗顽固性咳嗽的临床经验。[方法]通过门诊抄方、整理医案及查阅相关文献,探讨顽固性咳嗽的病因病机,并运用病案列举兼评析的方法总结郑师治疗顽固性咳嗽的诊治思路及用药经验。[结果]郑师辨治顽固性咳嗽多从肺、脾、肾出发,辨证以风邪滞肺、脾虚湿困、肺肾气虚为主,治以清肺祛风、健脾化痰、补肾固本。郑师治疗顽固性咳嗽,注重审证辨因,标本同治,附举案例中风邪滞肺、宣发不彻者,治以清肺止咳、祛风止痒;脾虚湿困、痰气郁结者,治以健脾祛痰、理气止咳;肺肾气虚者,治以补肾纳气、敛肺止咳,均获良效。[结论]郑师对顽固性咳嗽辨证思路清晰,咽痒而咳从肺论治,痰多而咳从脾论治,虚喘而咳从肾论治,临床疗效显著,值得借鉴学习。     

刘启廷教授健脾益肾化浊汤治疗带下病经验介绍

[目的]总结刘启廷教授运用健脾益肾化浊汤治疗带下病的临床经验。[方法]通过分析刘启廷教授对带下病的病因病机的认识,总结健脾益肾化浊汤在,临床实践中的辨施要点,阐述刘启廷教授运用健脾益肾化浊汤治疗带下病的临床经验,并举案例佐证。[结果]刘启廷教授根据带下痛多因脾肾虚损,湿热毒邪内蕴,致使带脉失约的病因病机,以健脾益肾化浊为治法,运用健脾益肾化浊汤随证加减治疗,临床上取得了很好的疗效。[结论]刘启延教授运用健脾益肾化浊汤治疗带下病临床疗效显著,对带下病的中医治疗具有启示意义。     

张杰教授辨治慢性萎缩性胃炎特色探析

[目的]总结柴可群教授运用四则四法治疗肺间质纤维化的临证经验。[方法]通过随师门诊,整理相关医案,分析柴师对肺间质纤维化病因病机的认识,阐述柴师运用四则四法治疗肺间质纤维化的理论基础和临证用药经验,并附临床案例加以验证。[结果]柴师认为,肺间质纤维化的病因病机主要是肺、脾、肾虚损与气滞、血瘀、湿浊、痰毒等邪实互结,采用扶正为本、祛邪有度、全程调神、随证而治的四则和健脾补肾、化痰解毒、疏肝解郁、温阳通络四法进行辨治,可取得良好的疗效。所举验案中患者辨为肺脾肾虚、痰毒血瘀证,柴师拟补肺益气、健脾益肾、化痰解毒、活血化瘀法随证加减,疗效显著。[结论]柴师运用四则四法治疗肺间质纤维化疗效显著,对临床有较好的指导意义,值得学习和传承。     

透热转气法在系统性红斑狼疮治疗中的应用

[目的]探讨透热转气法治疗系统性红斑狼疮(systemic lupus erythematosus,SLE)的理论依据及临床应用。[方法]通过分析透热转气法的理论内涵,结合SLE的病因病机和发病特点,阐述透热转气法治疗SLE的理论依据和临证应用,并举典型医案佐证。[结果]透热转气法是指通过宣畅气机,使入营之邪透出气分而解的方法,是温病学的重要治法。SLE的病因病机以肾精亏虚、温毒侵袭及瘀血内阻为主,其发病特点与温病有相似之处,根据SLE患者病情活动期和缓解期的特点可灵活运用透热转气法。所举案例一辨证属热伏血分、气阴耗伤,治以清热凉血、养阴透邪;案例二辨证属营分有热、肾精亏虚,治以清营透热、益肾固精,方中均配伍轻清透邪药以条畅气机、清透邪热,取得良好的疗效。[结论]运用透热转气法治疗SLE发挥了中医药治疗SLE的优势,符合临床实际,对于指导临床应用具有重要的意义。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.