论中医“症”描述的准确性与规范化

“症”是中医诊断体系中最具体的要素,症状信息规范化其关键在于明确“症”的认识和理解,文章系统分析中医“症”的内涵,分析目前“症”规范化中存在的主要问题,如缺乏统一标准、各家之言迥异、中西医“症”的混杂等,这些一定程度上阻碍了中医临床与科研,不利于中医学术的交流及中医诊断学的现代化研究。因此提出从明确症名定义、统一规范症名、拆分复合症名、区分症状轻重、避免诊断性症名、纳入客观指征等几个方面对中医“症”的描述进行规范,通过建立系统标准体系,进行“症”的量化分级,规范信息采集过程,借助微观指标辨证等开展中医“症”的规范化研究。     

腹壁下动脉穿支皮瓣在全舌癌缺损修复中的应用效果评价

目的: 评价游离腹壁下动脉穿支皮瓣（deep inferior epigastric perforator,DIEP）用于舌癌术后全舌缺损修复的效果。方法: 2018年1月—2018年7月应用游离DIEP修复13例舌癌患者,手术缺损部位均为全舌或近全舌缺损。术中将腹壁下动脉与甲状腺上动脉或面动脉吻合,伴行静脉与颈外静脉或颈内静脉属支吻合。结果: l3例DIEP皮瓣均修复成功,皮瓣外观满意。术后随访舌形态良好,功能满意。供区直接闭合,其中1例患者皮瓣供区出现感染,经换药后愈合。所有腹部伤口均为线性瘢痕,腹直肌功能未受明显影响,未发现腹壁疝和腹壁隆起等手术并发症。结论: 腹壁下动脉穿支皮瓣组织量丰富、血供可靠、质地柔软,再造舌外形及功能良好,且供区保留了腹直肌和前鞘,损伤小,将供区并发症降到最低限度,是舌癌术后全舌缺损修复新的可靠技术。     

从“木郁克土”角度探讨围绝经期综合征肝郁证大鼠胃肠动力的改变

目的从“木郁克土”角度探讨围绝经期综合征(PPS)肝郁证大鼠胃肠动力的改变。方法选择3月龄SPF级SD雌性大鼠,分为假手术组、PPS组、PPS肝郁组和柴胡疏肝散组,采用去势法结合慢性不可预知性温和应激建立PPS肝郁证大鼠模型,用柴疏疏肝散进行干预,观察大鼠体重增长率、饲料消耗量、胃残留率及肠推进率变化。结果在体重增长率方面,PPS组显著高于假手术组(P<0.01);PPS肝郁组显著低PPS组(P<0.01);柴胡疏肝散组显著高于PPS肝郁组(P<0.01)。在饲料消耗方面,PPS组高于假手术组,PPS肝郁组低于PPS组;柴胡疏肝散组高于PPS肝郁组。在胃残留率方面,PPS肝郁组显著高于假手术组和PPS组(P<0.01);柴胡疏肝散组显著低于PPS肝郁组(P<0.01)。在肠推进率方面,PPS肝郁组显著低于假手术组和PPS组(P<0.01);柴胡疏肝散组显著高于PPS肝郁组(P<0.01)。结论PPS肝郁大鼠的体重和饲料消耗量发生了改变,体重的增长与饲料的消耗量存在一定的联系,且与大鼠胃肠动力有关。从“木郁克土”角度提示其机制可能是肝郁状态影响到了脾胃功能的正常运行。     

Research progress in rehabilitation treatment of stroke patients A bibliometric analysis

BACKGROUND: Stroke presents as a transient or chronic brain dysfunction and is associated with high morbidity and high mortality. The doctors and scientists would like to argue how to enhance the validity of the rehabilitation treatment and how to further improve the level of treatment on stroke. OBJECTIVE: The aim of this study was to quantitatively analyze the current worldwide progress in research on stroke rehabilitation treatment based on Web of Science database and ClinicalTrial.gov in the past 10 years. METHODS: We conducted a quantitative analysis of clinical trial articles regarding stroke rehabilitation published in English from 2003 to 2013 and indexed in the National Institutes of Health Clinical Trials registry and Web of Science databases. Data were downloaded on March 15, 2013. RESULTS: (1) From 2003 to 2013, 2 654 clinical trials investigating stroke were indexed in ClinicalTrials.gov. There were only 58 clinical trials registered in 2003, and there was a marked increase from 2005. A total of 605 clinical trials on the rehabilitation of stroke were conducted in the past 10 years. (2) The analysis showed that most of the trials in the field were registered by North American institutions. With respect to the Asian countries, China and Taiwan area of China also published a reasonable proportion of the trials, but comparatively speaking, the number of trials is really rare. Most of the interventions were drugs, followed by the devices, and behavioral interventions were ranked third. (3) In the past 10 years, there were 4 052 studies on stroke indexed by Web of Science database. CONCLUSION: From perspective of research progress, we found that the number of clinical trials and papers on stroke rehabilitation has increased significantly in the past 10 years, between them a remarkable positive correlation exists.     

芍药苷干预阿尔茨海默病作用机制研究进展

阿尔茨海默病(Alzheimer’sdisease,AD)是造成老龄人口认知能力减退的主要疾病之一。芍药苷是毛茛科(Ranunculaceae)植物芍药Paeonia lactiflora或牡丹Paeonia suffruticosa根皮中提取出的水溶性单萜苷,具有改善认知能力、镇静、抗炎、镇痛、解痉等作用,可以有效调节AD动物及细胞模型异常磷酸化的Tau蛋白和过度沉积的β-淀粉样蛋白(Aβ)水平,恢复乙酰胆碱、神经生长因子、Ca2+、α7烟碱样乙酰胆碱受体和腺苷受体等神经递质及神经受体的平衡状态,降低组织炎症反应和氧化应激反应并减少细胞凋亡的发生。对近10年来国内外有关芍药苷干预AD的研究进展进行综述,为探索中药防治AD研究提供理论依据。     

金铁锁根中2个新的麦芽酚苷类化合物

目的研究金铁锁Psammosilene tunicoides根的化学成分。方法经硅胶、Sephadex LH-20凝胶、ODS反相硅胶等柱色谱方法进行分离,并运用NMR、HR-ESI-MS等波谱学方法进行化合物的结构鉴定。结果从金铁锁根80%乙醇水提取物中分离得到2个麦芽酚苷类化合物,分别鉴定为麦芽酚-3-O-[6-O-(4-O-α-L-吡喃鼠李糖基)-Z-p-香豆酰基]-β-D-吡喃葡萄糖苷(1)和麦芽酚-3-O-[6-O-(4-O-α-L-吡喃鼠李糖基)-E-p-香豆酰基]-β-D-吡喃葡萄糖苷(2)。结论化合物1和2为新的麦芽酚苷类化合物,分别命名为金铁锁酚苷A和B。     

华南区域自然人群慢性非传染性疾病前瞻性队列研究建设概况

随着生活行为方式、自然和社会环境的急剧变化, 我国慢性非传染性疾病(慢性病)的流行现状及相关危险因素也发生了巨大的改变。全国各地各类慢性病的流行特征及其危险因素分布不尽相同, 而华南地区独特的气候、饮食及生活方式对慢性病发生发展的影响至今尚不明确。因此, 亟需通过区域性大型队列的建设, 为区域重大疾病的病因学研究、早期预测和干预策略提供本土化人群证据, 也为国家重大慢性病防治策略的制定提供依据。华南区域自然人群慢性病前瞻性队列于2017年12月正式启动, 覆盖广东省、广西壮族自治区、福建省和海南省, 以35～74岁常住居民为主要研究对象, 包括城市与农村、汉族与以壮族为代表的少数民族多类型自然人群。本队列围绕华南区域常见重大慢性病建立集健康信息和生物样本为一体的精准医学大数据平台, 并开展长期随访。现已建立116 520人的基线数据库, 年龄为(54.9±12.5)岁, 女性71 077人(61.0%)。基线数据库包括问卷调查、体格检查数据以及生物样本。本文对华南区域自然人群慢性病前瞻性队列设计的理念、研究进展和随访设想作简要介绍。     

PREVALENCE AND CHARACTERISTICS OF HIV-ASSOCIATED STROKE IN A TERTIARY HOSPITAL SETTING IN SOUTH AFRICA

Background and AimsAntiretroviral treatment (ART) era HIV-associated stroke data from Sub-Saharan Africa is limited. We determined the prevalence of HIV in patients presenting with acute symptomatic stroke; and compared risk factors, clinical characteristics, and brain imaging with age-matched stroke patients without HIV.MethodsWe conducted a retrospective study of adults presenting with any type of stroke to a South African tertiary hospital in a 12-month period. Patients living with HIV (PLWH) and HIV-uninfected patients (HIV-) were matched on age group (1:2 ratio).ResultsTheacute stroke prevalence of HIV infection was 9.3% (95%CI: 7.4-11.2%) among 884 stroke patients. Mean age at presentation in PLWH was 46 (±11) years compared to 55 (±14) years in HIV- (p<0.001). Hypertension (p=0.011) and dyslipidaemia (p=0.005) were less prevalent in PLWH. Concurrent infection was more prevalent in PLWH (p=<0.001), largely in patients with low CD4 counts. PLWH with higher CD4 counts had traditional risk factors and less concurrent infection. Among PLWH, 39.3% had been started / restarted on ART within 6-months. Basal ganglia infarcts (p=0.014) and multiple vascular territory involvement (p=0.002) was more common in PLWH. Clinical presentation, ischaemic stroke type, and in-hospital outcomes did not differ between groups.ConclusionStroke patients with HIV were younger, had less traditional cardiovascular risk factors, and more concurrent infections than patients without HIV when CD4 count was low. Recent ART initiation or reinitiation rates were high. Significant differences in CT brain imaging findings were seen. Understanding the multifactorial mechanisms underlying increased stroke risk in this population is crucial.