难治性肾病的辨证论治

1难治性肾病的病因病机1．1脾肾两虚是本病的主要内在条件难治性肾病其病程缠绵难愈，病本是虚，《请病源候论·水通身肿候》曰：“水病者，由脾肾俱虚故也。”统计123例难治性肾病最常见的10大症状是：神疲乏力、食欲不振、大便稀清、大便于结、口淡不渴、口干喜饮、腰膝酸痛、腹胀尿少、恶心呕吐、颜面下肢浮肿。皆为脾肾本质虚弱所致。1．2凤寒湿邪乘虚侵袭是主要的外在诱因《内经》中对水肿的产生早有记载，认为与风、湿等外邪乘虚侵袭有关。《素问·水热穴论》说：“勇而劳甚，则肾汗出，逢于风，内不得入于脏腑，外不得越于肌肤，客于…     

林国华治疗偏身舞蹈症并肝硬化腹水医案1则

正糖尿病非酮症性偏身舞蹈症为临床上的难治病之一,属中医颤病范畴,因此治疗上多从肝论治,《黄帝内经》有言“诸风掉眩,皆属于肝”。肝硬化腹水为临床又一难治病,属中医鼓胀范畴,治疗亦从肝入手。本案患者糖尿病及肝硬化病史多年,形体精瘦,久病体弱,脾失运化,水饮内停,风痰相搏,筋脉失养,虚实夹杂,合而发为本病。针对本案患者,用针刺、穴位埋线、隔甘遂灸诸法,使颤病止、鼓胀消,且疗效持久,特此报道此案,以飨同道。     

中医药治疗干燥综合征的作用机制研究进展

干燥综合征是一种慢性自身免疫性疾病,以免疫细胞浸润,唾液腺和泪腺的进行性损伤为主要特征,除了影响泪腺和唾液腺,导致眼睛干涩和口干症状外,还会累及人体心、肺、肾和中枢神经等多个系统,严重影响人体身心健康。虽然近年来西医在该病的诊断和治疗方面有了广泛和深入的研究,但目前还没有针对潜在病因的治疗方法。中医药在整体观的基础上,能够辨证施治,随证遣方,具有多靶点、多层次、多途径的治疗特点。目前随着中医药现代化研究的进展,发现其在治疗本病方面有着独特的优势,在调节免疫、降低炎症反应及上调水通道蛋白等方面有着姣好的作用,既能缓解临床症状,延缓病情,又能够减轻激素等药物的不良反应。通过回顾近年来关于中医药治疗干燥综合征（SS）的相关文献,对其发病机制及中医药作用的相关机理做了进一步的总结,本文拟从调节免疫、上调水通道蛋白及抗氧化应激等方面就中医药治疗本病的相关机制做一研究归纳,以期为相关实验研究及临床提供更多的理论依据。     

A randomized comparison of repeat stenting with balloon angioplasty in patients with in-stent restenosis

OBJECTIVES: This randomized trial compared repeat stenting with balloon angioplasty (BA) in patients with in-stent restenosis (ISR). BACKGROUND: Stent restenosis constitutes a therapeutic challenge. Repeat coronary interventions are currently used in this setting, but the recurrence risk remains high. METHODS: We randomly assigned 450 patients with ISR to elective stent implantation (224 patients) or conventional BA (226 patients). Primary end point was recurrent restenosis rate at six months. Secondary end points included minimal lumen diameter (MLD), prespecified subgroup analyses, and a composite of major adverse events. RESULTS: Procedural success was similar in both groups, but in-hospital complications were more frequent in the balloon group. After the procedure MLD was larger in the stent group (2.77 +/- 0.4 vs. 2.25 +/- 0.5 mm, p < 0.001). At follow-up, MLD was larger after stenting when the in-lesion site was considered (1.69 +/- 0.8 vs. 1.54 +/- 0.7 mm, p = 0.046). However, the binary restenosis rate (38% stent group, 39% balloon group) was similar with the two strategies. One-year event-free survival (follow-up 100%) was also similar in both groups (77% stent vs. 71% balloon, p = 0.19). Nevertheless, in the prespecified subgroup of patients with large vessels (> or =3 mm) the restenosis rate (27% vs. 49%, p = 0.007) and the event-free survival (84% vs. 62%, p = 0.002) were better after repeat stenting. CONCLUSIONS: In patients with ISR, repeat coronary stenting provided better initial angiographic results but failed to improve restenosis rate and clinical outcome when compared with BA. However, in patients with large vessels coronary stenting improved the long-term clinical and angiographic outcome.     

Dietary risk markers that contribute to the aetiology of hypertension in black South African children: the THUSA BANA study

Although clinical hypertension occurs less frequently in children than in adults, ample evidence supports the concept that the roots of essential hypertension extend back to childhood. Since little is available in the literature on causal dietary factors of hypertension in children, this study hypothesised that certain dietary factors can be identified as risk markers that might contribute to the aetiology of hypertension in black children. Children aged 10-15 years were randomly selected from 30 schools in the North West Province from 2000 to 2001. These children comprised 321 black males and 373 females from rural to urbanised communities, of which 40 male and 79 female subjects were identified with high-normal to hypertensive blood pressure. Blood pressure was measured with a Finapres apparatus and data were analysed with the Fast Modelflo software program to provide systolic, diastolic and mean blood pressure. A 24-h dietary recall questionnaire and weight and height measurements were taken. In a stepwise regression analysis, the following variables were significantly associated (P < or = 0.05) with blood pressure parameters of hypertensive males: biotin, folic acid, pantothenic acid, zinc and magnesium. Energy, biotin and vitamin A intakes were significantly associated with blood pressure parameters of hypertensive females. No significant dietary markers were indicated for any of the normotensive groups. Dietary intakes of all of these nutrients were well below the dietary reference intakes. In conclusion, the dietary results coupled with the cardiovascular parameters of this study identified folic acid and biotin as risk markers that could contribute to the aetiology of hypertension in black persons. The low intakes of these nutrients, among others, is a matter of serious concern, as is the increasing tendency towards urbanisation.     

老年男性冠心病患者无症状心肌缺血的研究

目的：探讨老年男性冠心病患者无症状心肌缺血的发作特点及规律。方法：选择老年男性冠心病（Ⅰ组）、冠心病合并高血压病（Ⅱ组）及冠心病同时合并高血压病、2型糖尿病（Ⅲ组）患者各66例，对其进行动态心电图检查。结果：动态心电图检出老年男性冠心病患者心肌缺血主要为无症状心肌缺血（SMI）；SMI发生率Ⅲ组〉Ⅱ组〉Ⅰ组（P〈0．05），Ⅲ组的SMI总次数与Ⅱ组、Ⅰ组比较有显著差异（P〈0．05）；SMI持续时间Ⅲ组与Ⅱ组比较有显著差异（P〈0．05）；三组的发作高峰均在上午。日间SMI发生次数明显多于夜间，夜间SMI发生比例Ⅲ组与Ⅰ组比较有显著差异（P〈0．05），Ⅲ组昼夜SMI平均持续时间有显著差异（P〈0．05）。结论：高血压病、2型糖尿病均可增加老年男性冠心病患者SMI的发生，尤其是夜间的发生：动态心电图是老年男性冠心病，特别是合并高血压、2型糖尿病患者SMI的重要检测手段。     

糖尿病患者胰岛素无针注射操作指引

目的 形成糖尿病患者胰岛素无针注射护理操作指引。 方法 查阅文献资料并结合专家临床经验,列出胰岛素无针注射过程中的护理问题,设计专家函询表,通过德尔菲专家函询法和专家会议法,结合客观证据和专家意见,对各个条目进行修改、完善。 结果 对胰岛素无针注射操作流程、常见问题及处理、质量控制与管理、健康教育四大主题达成共识。结论 糖尿病患者胰岛素无针注射操作指引制订过程科学、内容全面系统,可为临床护理人员实施胰岛素无针注射操作提供一定的参考。     

肛管直肠压力测定的临床研究进展

肛管直肠压力测定是检测肛管直肠功能的重要方法,是对肛管和直肠正常或异常运动的压力变化进行探测和记录,通过图形识别进行定量分析,从而对肛管直肠生理、病理进行研究。它是一种安全、无创的客观检查技术,近年来测压应用范围不断扩大,在肛肠外科领域已经成为一种兼有研究、临床辅助诊断、指导治疗和疗效评估等作用的专门方法。本文就肛管直肠测压的方法、常用指标及临床应用作一综述。     

浅谈新安医家对痛风的辨证施治

新安医学是中国传统医学的重要组成部分,其渊源流长,术精验丰,名医辈出,医著皇皇,专科悉备,建树博深。新安医家在治疗痛风上颇具特色,其治疗痛风主要按痛风的病机、部位以及病程新旧,同时兼顾个人体质来辨证施治,其临床疗效显著。     

膀胱原发性印戒细胞癌二例报告并文献复习

1病例报告例1:患者男,69岁。因间断性肉眼血尿2个月于2008-06入我院就诊,无尿频、尿急和尿痛,无腹痛、里急后重和血便,无发热。体检无阳性体征。B超提示膀胱右侧壁2 cm×3 cm实质性占位,突入膀胱,右肾、输尿管积水;腹部CT示,膀胱右侧壁实质性占位,侵犯肌层,右肾、输尿管积水,肝胆胰脾未见明显异常。血常规、生