糖尿病性勃起功能障碍的中医证候研究

目的 探讨糖尿病性勃起功能障碍(DED)患者中医证候及其与勃起功能的关系.方法 84例DED患者按照国际勃起功能指数表-5(IIEF-5)评分分为轻度勃起功能障碍(ED,17～21分)、轻中度ED(12～16分)、中度ED(8～11分)、重度ED(<7分);中医证候按照气虚证、阴虚证、阳虚证、血瘀证、痰湿证归类,用5级记分法进行量化评分.结果 阴虚证(78.6%)、血瘀证(70.2%)和气虚证(59.5%)出现频率均>50%.常见复合证候为气阴两虚证(25.0%)、阴虚血瘀证(25.0%)、阴虚痰湿证(11.9%)和阳虚血瘀证(11.9%).轻度ED常见证候为气阴两虚证(39.4%)和阴虚痰湿证(21.2%),而重度ED常见证候为阴虚血瘀证(35.3%)和阳虚血瘀证(23.5%).IIEF-5评分与阳虚证和血瘀证积分呈负相关(r1=0.260,P1<0.05;r2=0.433,P2<0.01);阳虚证和血瘀证积分与病程呈正相关(r1=0.288,P1=0.037;r2=0.231,P2=0.034).有糖尿病慢性并发症(DCC)患者阳虚证和血瘀证积分较无DCC者显著升高[(4.37±5.61)分比(1.42±2.42)分、(5.05±3.38)分比(2.91±3.09)分,均P<0.01].结论 DED的中医证候以阴虚证、血瘀证和气虚证为主;常见复合证候为气阴两虚证、阴虚血瘀证、阴虚痰湿证和阳虚血瘀证;轻度ED常见气阴两虚证和阴虚痰湿证,重度ED常见阴虚血瘀证和阳虚血瘀证.DED患者随着病程延长及合并DCC增多,阳虚、血瘀程度加重,ED加重.     

2型糖尿病患者交感神经皮肤反应检测及中医证候研究

目的研究交感神经皮肤反应（SSR）在2型糖尿病（T2DM）周围神经病变中的诊断价值，分析其与中医证候之间的关系。方法检测192例T2DM患者的SSR；按气虚、阴虚、阳虚、血瘀、痰湿进行中医证候归类，用5级记分法进行量化评分。结果SSR总体异常率为73．4％（141／192）；在无周围神经损害症状和自主神经功能损害症状的患者中，SSR异常率分别为71．5％（27／38）和68．8％（11／16）；性别、年龄、病程及有无自主神经功能损害症状对SSR异常率无影响（P均〉0．05）。SSR上肢波幅（Amp）与脂蛋白B（ApoB）、低密度脂蛋白胆固醇（LDL-C）和胆固醇（CHO）呈正相关；下肢潜伏期（Lat）与餐后2h血糖（2hPBG）、舒张压（DBP）均呈正相关；下肢Amp与ApoA1、ApoB、LDL-C和CHO呈正相关（P〈0．05或P〈0．01）。阴虚证、血瘀证出现频率〉50％；〉60岁组阳虚证比例及积分均显著高于≤60岁组（P〈0．05和P〈0．01）；病程长者血瘀证、阳虚证积分均显著增高（P均〈0．01）；有自主神经功能损害症状患者的气虚证和阴虚证积分均显著高于无自主神经功能损害症状者（P均〈0．01）；SSR异常组的阴虚证积分显著低于正常组（P〈0．05）。相关分析显示：SSR的四肢Lat与气虚证积分呈负相关（-0．316〈r值〈-0．157，P〈0．05或P〈0．01）；右上肢Amp与阳虚证、血瘀证积分均呈负相关（阳虚证r=-0．207，P=0．006；血瘀证r=-0．162，P=0．032）。结论SSR有助于发现糖尿病的亚临床神经病变，可作为评价T2DM患者早期自主神经及小纤维神经病变的敏感指标；血糖、血脂和血压可影响SSR参数。DPN患者阳虚、血瘀程度随病程延长和年龄增长渐进加重，气虚、阳虚和血瘀3种证候的病情程度对SSR参数的异常有一定影响。     

2型糖尿病常见慢性并发症的中医辨证特点

目的探讨2型糖尿病常见慢性并发症的中医辨证特点。方法采用5 级记分法对124 例2 型糖尿病伴常见慢性并发症患者进行临床症状评分,按气虚、阴虚、阳虚、血瘀、痰湿5个证候类型判定证型归属。结果各证候频次顺序为阴虚证>血瘀证>气虚证>阳虚证>痰湿证,其中阴虚、血瘀>50%。辨证分型以虚实夹杂证居多(80.5%),位于前3 位的证型是阴阳两虚血瘀(17.7%)、气阴两虚血瘀(16.9%)、阴虚血瘀(16.9%)。不同病程组间辨证分型构成有显著性差异( P <0.05)。病程<5年以下组以典型症状起病者明显减少(39.1%),但高血压、血脂异常的患病率增高(分别为63.0%和87.0%)。结论现阶段2型糖尿病常见慢性并发症的辨证分型以虚实夹杂证为主,阴虚、血瘀证候贯穿于病程始终。     

益气通络贴外敷联合益气通络方熏蒸治疗糖尿病周围神经病变气虚血瘀证的疗效观察

目的观察益气通络贴外敷联合益气通络方熏蒸治疗糖尿病周围神经病变(DPN)气虚血瘀证患者的疗效。方法将2018年1月—2019年12月扬州市中医院收治的118例DPN患者随机分对照组和观察组,每组59例。2组均给予常规治疗,对照组加用α-硫辛酸静脉滴注,观察组在对照组基础上给予益气通络贴外敷联合益气通络方熏蒸治疗。连续治疗4周后,比较2组血糖、血脂、肾功能指标,周围神经传导速度,多伦多临床神经病变评分(TCSS)、气虚血瘀证症状评分、临床疗效。结果治疗后,观察组血糖、血脂、肾功能指标水平以及TCSS和气虚血瘀证评分低于对照组,胫神经、腓总神经的运动神经传导速度(MNCV)和感觉神经传导速度(SNCV)以及总有效率高于对照组,差异均有统计学意义(P 0.05或P 0.01)。2组治疗期间未发生严重不良反应。结论益气通络贴外敷联合益气通络方熏蒸治疗DPN气虚血瘀证的疗效显著,可改善患者血糖、血脂、肾功能指标以及神经传导速度。     

900例不孕症患者中医体质与中医证候及相关因素的相关性分析

目的探究不孕症患者的中医体质类型分布与中医证候特点及相关因素的相关性。方法采用流行病学横断面调查法,结合中医经络检测技术,同时结合中医理论辨证分型对2017年1月至2019年10月就诊于首都医科大学附属北京妇产医院900例不孕症患者进行中医体质、中医证候及相关因素的调查,探讨中医体质类型和证候的相关性。结果900例不孕症患者中气郁质205例(23%)。各类型出现的频率依次为气郁质>痰湿质>平和质>血瘀质>气虚质>阴虚质>湿热质>阳虚质>特禀质。900例不孕症患者中,中医证候出现的频率最高的依次为肝郁肾虚>肾虚血瘀>气滞血瘀。不孕症患者体质类型分布与年龄、不孕类型、饮食偏嗜有关(P<0.05)。900例不孕症患者中医体质与中医证候有相关性,其中平和质、气郁质、痰湿质均以肝郁肾虚证为主;湿热质以湿热瘀滞证主;血瘀质以气滞血瘀证、肾虚血瘀证为主;阳虚质以脾肾阳虚证为主;阴虚质以肝肾阴虚证为主;气虚质以脾肾两虚证为主。结论不孕症患者体质类型以气郁质、痰湿质最为常见,证候特点以肝郁肾虚证最为常见,体质类型与本病临床表现证候具有明显相关性,这些体质和证候的形成可能与年龄、不孕类型、饮食偏嗜有关。     

126例糖尿病神经传导速度检测结果分析

目的 :探讨神经传导速度 (NCV)测定对糖尿病周围神经病变 (DPN)诊断的价值及DPN的临床特点。方法 :对 12 6例糖尿病患者NCV检测结果及临床表现进行回顾性分析。结果 :糖尿病患者NCV的异常率为 63 5 %,全组有 10 7%为单侧异常。临床症状、体征与NCV测定结果的符合率 5 2 4%和 66 7%,无症状、体征的患者中分别有 5 4 2 %、3 9 4%的NCV异常。结论 :DPN病情隐匿 ,NCV检测为此病的诊断提供直接的客观证据。DPN发病有不对称性 ,必要时双侧同时检测 ,以免漏诊     

糖尿病肾病中医证候分布研究

目的:初步探讨糖尿病肾病(DN)的中医证候分布规律,为其中医证候研究提供比较客观可靠的依据。方法:依据Mon-gensen分期标准选取我院门诊或住院DN(III、IV、V期)患者363例,收集其中医症状信息,进行频数统计分析、归纳,总结其中医证候分布特点。结果:DNIII期主要以气阴两虚兼有血瘀、痰湿为主;IV期以气阴两虚兼有血瘀、痰湿为主,但阴虚呈现下降趋势,而阳虚呈现上升趋势;V期则以气虚、阴阳两虚为主,兼有血瘀、痰湿。结论:糖尿病肾病为本虚标实之证。虚证以气阴两虚为多;实证以血瘀、痰湿为多。本病不同发展阶段,病机重点有所不同,但气虚血瘀为其共有病机。     

神经电生理技术在糖尿病周围神经病诊断中的联合应用

目的探讨联合神经电生理技术在糖尿病周围神经病（DPN）中诊断的应用价值。 方法对85例确诊糖尿病患者分别进行定量温度觉阈值（QTT）、交感皮肤反应（SSR）及神经传导速度（NCV）检测,其中QTT检测指标包括冷觉阈值（CST）、热觉阈值（WST）、冷痛觉阈值（CPT）和热痛觉阈值（HPT）。待各项神经电生理检查结束后,对其结果进行统计学分析。 结果入选糖尿病患者QTT、SSR及NCV异常率分别为84.71%、56.47%和31.76%,经统计学比较,发现入选患者QTT异常率显著高于SSR及NCV异常率（均P<0.05）。无DPN症状组和有DPN症状组其QTT异常率（分别为78.85%和93.94%）组间差异无统计学意义（P>0.05）,SSR异常率（分别为48.08%和69.70%）、NCV异常率（分别为19.23%和51.52%）组间差异均具有统计学意义（P<0.05）。短病程组和长病程组QTT异常率（分别为77.77%和89.80%）组间差异无统计学意义（P>0.05）,SSR异常率（分别为44.44%和65.31%）、NCV异常率（分别为19.44%和40.82%）组间差异均具有统计学意义（P<0.05）。 结论与SSR及NCV检测比较,QTT检测糖尿病患者的异常率最高,其异常率结果与患者临床症状及病程无明显相关性,SSR及NCV异常率与临床症状、病程均具有相关性;联合采用QTT、SSR及NCV检测DPN具有更高的敏感性。     

中药熏洗联合针刺治疗糖尿病周围神经病变临床观察

目的:观察中药熏洗联合针刺治疗糖尿病周围神经病变(DPN)的临床疗效。方法:DPN患者98例,随机分为治疗组52例和对照组46例,均西医基础降糖治疗,对照组使用甲钴胺口服,治疗组同时加用中药熏洗及针刺治疗,疗程均2个月。治疗前后分别观察神经病变证候评分,检测神经传导速度。结果:2组神经传导速度均较治疗前有明显改善(P0.05),治疗组在改善临床症状、神经病变证候方面明显优于对照组(P0.05),但在运动神经传导速度改善方面与对照组比较差异无统计学意义(P0.05),感觉神经传导速度改善有统计学意义(P0.05)。结论:中药熏洗联合针刺是治疗DPN的有效方法之一。     

血浆神经降压素与糖尿病周围神经病变的关系

目的:探讨2型糖尿病患者血浆神经降压素(NT)与糖尿病周围神经病变的关系.方法:测定34例糖尿病非周围神经病变组(非DPN组)、37例糖尿病周围神经病变组(DPN组)和30例健康体健者(对照组)血浆NT、空腹血糖(FBG)和糖化血红蛋白(HbAlc),采用肌电图测定胫神经传导速度(NCV).结果:(1)非DPN组与DPN组血浆NT水平均低于对照组(P＜0.01),DPN组较非DPN组也降低(P＜0.01).(2)pearson相关分析显示血浆NT与NCV、HbAlc、病程呈显著相关(相关系数分别为r=0.889,r=-0.829,r=-0.825,P＜0.001).(3)回归分析显示NCV、HbA1c、病程进入回归方程.结论:血浆NT水平的降低可能参与了糖尿病及糖尿病周围神经病变的发生、发展.     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

Prise en charge des entorses externes de cheville : étude clinique préliminaire sur l’efficacité du dispositif Myolux™

Ankle sprains are the most common injury of the musculoskeletal system and are associated with significant societal and economic impacts. It has been proven that classical therapeutic strategies may not be effective in preventing recurrent injuries: the recurrence rates reported in the literature can reach 73%. In order to provide an effective rehabilitation solution, a destabilizing orthosis was developed. This device is equipped with a mechanical articulator reproducing the subtalar mechanics and placed under the heel. In this paper, we present the main results of a preliminary clinical study conducted between 2004 and 2007. All subjects included in this study were treated with the abovementioned orthosis during 10 rehabilitation sessions of 30 minutes each. Data show a relatively low recurrence rate of 12% for the overall population. Moreover, it's of primary importance to note that this satisfactory ratio is largely reduced (3% of recurrence rate) for the 29 patients who performed one training session per month after the 10th initial rehabilitation sessions. Hence, the destabilizing orthosis appears to be an effective solution to prevent recurrent ankle sprains. However, joint protection requires long-term and regular training sessions. This result has motivated the development of a similar device allowing patients to perform training sessions at home. Finally, data obtained in this study are promising awaiting the final results of the comparative, multicentric and independent clinical trials currently managed by the Hospices Civils de Lyon.     

Clinical Trial Updates and Hotline Sessions presented at the European Society of Cardiology Congress 2007

This article provides information and commentaries on trials which were presented at the Hotline and Clinical Trial Update Sessions at the European Society of Cardiology Congress 2007 in Vienna. The key presentations were performed by leading experts in the field with relevant positions in the trials or registries. It is important to note that unpublished reports should be considered as preliminary data, as the analysis may change in the final publications. The comprehensive summaries have been generated from the oral presentation and the webcasts of the European Society of Cardiology and should provide the readers with the most comprehensive information of relevant publications.     

Balance and Boundaries in Grief Counseling: An Intervention Framework for Volunteer Training

Volunteers or paraprofessional counselors are commonly used to provide supportive care to the bereaved. These counselors generally are trained in basic listening skills, providing a generic, nonspecific approach to intervention that remains to be proven effective. The present paper outlines a framework that provides paraprofessionals with a broader model for intervention with the bereaved. Attention to boundaries as a helper and balance in the grief recovery are central to the model. Interventions are described that provide the paraprofessional counselor with more options for tailoring their counseling strategy to the individual. These include techniques that are presumed to be more specific to the enhancement of grief recovery.     

A new method for the simultaneous analysis of unmodified and modified urinary nucleosides and nucleobases by high performance liquid chromatography

Details are given of a new, rapid and simple pre-fractionation method and an isocratic high performance liquid chromatography system suitable for parallel analysis of nucleosides and nucleobases from urine and other biological fluids. The quantitative recovery and excellent reproducibility of the method is demonstrated by analysis of representative standard RNA catabolites. The advantage of this new method for application to biological samples is discussed.     

Adsorption of Charged Non-albumin Bound Drugs by Amorphous Silica

We investigated the in vitro drug adsorption of PQ 10150 sodium silicate gel (AIS, Santa Clara, CA) with particle size of 230 um and surface area of 400 nr/g. We observed 99% to 88% adsorption of gentamicin; a mean 91 % of disopyramide; a mean 89% of quinidine at low concentration, falling to 75% at higher concentration. Insulin was 88% adsorbed at low concentrations but less so (65%) at higher concentrations. We observed a mean 83 % adsorption of procainamide, a mean 84% of N-acetyl procainamide, 74% oflidocaine, 73% of amitriptyline; and 44% of desipramine. We found an average 14% reduction of total digoxin concentration when serum containing digoxin (2 to 33 ng/mL) was exposed to sodium silicate, while the reduction in free digoxin concentration was 16%. Five percent ethosuximide was also removed. The adsorption of theophylline, phenobarbital, acetaminophen, phenytoin, ethylene glycol, methotrexate, salicylate, thiocyanate and diazepam was minimal and not significant. We conclude that significant amounts of charged, non-albumin bound drugs can be removed by PQ 10150 sodium silicate gel.     

自动化酸碱平衡图在急诊社区获得性肺炎诊治中的应用

目的 探讨自动化酸碱平衡图在急诊科社区获得性肺炎(CAP)患者诊断中的价值.方法 根据病史、肺功能测定结果、慢性阻塞性肺疾病(COPD)诊断标准,将111例CAP患者分为单纯CAP组(56例)和COPD合并CAP组[即慢性阻塞性肺疾病急性加重(AECOPD)组,55例].询问患者病史后即刻抽取动脉血测血气并进行自动化酸碱平衡图分析.结果 血气分析结果显示,AECOPD组动脉血二氧化碳分压(PaCO2,kPa)、HCO3- (mmol/L)、剩余碱(BE,mmol/L)均显著高于CAP组(PaCO2:7.714±2.414比5.896±1.308,HCO3-:30.767±7.185比25.014±3.043,BE:4.345±5.371比-0.354±3.180,均P＜0.01).自动化酸碱平衡图分析结果显示,AECOPD组患者酸碱平衡紊乱高达89.1％,CAP组为66.1％.将AECOPD组和CAP组患者中正常(10.9％、33.9％)、急性呼吸性酸中毒(急性呼酸,12.7％、14.3％)、慢性呼吸性酸中毒(慢性呼酸,49.1％、10.7％)、呼吸性碱中毒(呼碱,7.3％、14.3％)、代谢性酸中毒(代酸,12.7％、17.9％)、代谢性碱中毒(代碱,12.7％、8.9％)综合进行x2分析,差异有统计学意义(x2=24.421,P=0.001),而将正常、急性呼酸、呼碱、代酸及代碱进行x2分析,差异无统计学意义(x2=5.280,P=0.260),提示AECOPD患者慢性呼酸的发生率较单纯CAP患者显著增加.结论 自动化酸碱平衡图能帮助急诊科医师快速识别CAP患者是否存在多重酸碱平衡紊乱,并可快速识别急、慢性呼吸系统疾病.