基于脑肠轴及网络药理学探究大黄治疗卒中后抑郁机制

<正>卒中后抑郁(post-stroke depression,PSD)是脑卒中后最常见的一种精神障碍,表现为一系列显著而持久的以情绪低落、消极悲观、兴趣缺失为主要特征的情感障碍综合征^[1]。PSD患者卒中复发时间较无抑郁患者可提前8年^[2],进一步加重了家庭和社会的负担。卒中之痰热腑实证治疗以清热化痰、通腑开窍为主,常用承气汤配合开窍药加减。《神农本草经》言大黄：“主下瘀血,血闭,寒热,破癥瘕积聚、留饮宿食,荡涤肠胃,推陈致新。”恰应痰热腑实的病机特点。现代研究表明,大黄素及大黄素甲醚可改善抑郁症模型大鼠行为学变化,     

从气机升降理论探析清阳出上窍含义及其运用

气机升降理论是中医学重要的理论,其中的升降既包括构成人体生命精微物质的升降,也包括脏腑的升降。清阳出上窍作为气机升降所要达到的目标,其中“清阳”应当包括所有能够上荣于窍的正气,包括了属“阳”的功能方面的阳、气和属“阴”的形质方面的阴、血。气机升降紊乱的病机可分为虚实两端,不通与不荣,因此,要使清阳出上窍,应遵循“通以畅气机,荣以行升降”的治疗原则。     

64层螺旋CT冠状动脉成像与心血管疾病危险分层的相关性

Objective To investigate the relationship between the risk stratification of cardiovascular diseases and the outcome of 64-slice helical computed tomography (MSCT) coronary angiography. Methods A total of 470 cases suspected to have coronary heart disease were enrolled.They all received 64-slice MSCT coronary angiography, and they were divided into groups according to the range of disease, degree of calcium scoring, degree of stenosis and characteristic of plaque. Among them, 80 patients underwent both MSCT and selective coronary angiography (CAG) at one time, and they were grouped according to the range of disease and degree of stenosis. All the 470 cases were classified as five levels according to the risk stratification of cardiovascular diseases. The lesions of coronary artery in different risk stratifications were observed, and the correlations were analyzed.Results In the 80 patients who underwent both MSCT and selective CAG, there were no significant differences in the range of coronary artery diseases(χ2=3.631, P=0.067) and coronary arterystenosis (χ2=1.639, P=0.200) between MSCT and CAG. Along with the increased level of the risk stratification, there were the more ranges of the coronary artery diseases (λvery high risk. multi-vessel disease=1.09,λhigh risk. double-vessel disease=0.91, λlow-risk. single-vessel disease=1.07)and the more degrees of coronary artery stenosis(λvery high risk. severe stenosis=0.96,λhigh risk. moderate stenosis=1.03,λlow-risk. mild stenosis=0.78). The degrees of calcium scoring in different risk stratifications of cardiovascular diseases showed significantly differences (F=256.20,123.76,62.50, 98. 24,52.36,P＜0.01). There was the highest percentage of soft plaque in very high risk patients.Higher percentages of fiber plaque, calcified plaque and mixed plaque were found in moderate risk and low risk patients(λvery high risk. soft plaque=1.01,λlow-risk. calcium plaques=1.17). Conclusions The 64-slice MSCT coronary angiography could provide a basis for assessing risk stratification of cardiovascular diseases. The complicated coronary artery disease, moderate-severe calcification, more severe stenosis, higher percentage of soft plaque are found in the very high risk patients. The lower level of the risk stratification is found in patients with the less range of the coronary artery disease and less severe degree of the coronary artery calcification and stenosis. The calcified plaque and mixed plaque are found in moderate risk and low risk patients.     

64层螺旋CT冠状动脉成像与心血管疾病危险分层的相关性

Objective To investigate the relationship between the risk stratification of cardiovascular diseases and the outcome of 64-slice helical computed tomography (MSCT) coronary angiography. Methods A total of 470 cases suspected to have coronary heart disease were enrolled.They all received 64-slice MSCT coronary angiography, and they were divided into groups according to the range of disease, degree of calcium scoring, degree of stenosis and characteristic of plaque. Among them, 80 patients underwent both MSCT and selective coronary angiography (CAG) at one time, and they were grouped according to the range of disease and degree of stenosis. All the 470 cases were classified as five levels according to the risk stratification of cardiovascular diseases. The lesions of coronary artery in different risk stratifications were observed, and the correlations were analyzed.Results In the 80 patients who underwent both MSCT and selective CAG, there were no significant differences in the range of coronary artery diseases(χ2=3.631, P=0.067) and coronary arterystenosis (χ2=1.639, P=0.200) between MSCT and CAG. Along with the increased level of the risk stratification, there were the more ranges of the coronary artery diseases (λvery high risk. multi-vessel disease=1.09,λhigh risk. double-vessel disease=0.91, λlow-risk. single-vessel disease=1.07)and the more degrees of coronary artery stenosis(λvery high risk. severe stenosis=0.96,λhigh risk. moderate stenosis=1.03,λlow-risk. mild stenosis=0.78). The degrees of calcium scoring in different risk stratifications of cardiovascular diseases showed significantly differences (F=256.20,123.76,62.50, 98. 24,52.36,P＜0.01). There was the highest percentage of soft plaque in very high risk patients.Higher percentages of fiber plaque, calcified plaque and mixed plaque were found in moderate risk and low risk patients(λvery high risk. soft plaque=1.01,λlow-risk. calcium plaques=1.17). Conclusions The 64-slice MSCT coronary angiography could provide a basis for assessing risk stratification of cardiovascular diseases. The complicated coronary artery disease, moderate-severe calcification, more severe stenosis, higher percentage of soft plaque are found in the very high risk patients. The lower level of the risk stratification is found in patients with the less range of the coronary artery disease and less severe degree of the coronary artery calcification and stenosis. The calcified plaque and mixed plaque are found in moderate risk and low risk patients.     

56例IgA肾病CKD 3～4期患者临床与病理分析

IgA肾病（IgAN）是最常见的原发性肾小球肾炎之一[1]。目前其也是导致终末期肾病（ESRD）的主要病因之一[2]。为了探讨慢性肾脏病（CKD）3～4期的IgAN患者临床表现与其病理变化的关系,可为临床医生根据患者临床表现判断肾脏病变程度,从而制定治疗方案提供依据。本文将2007年7月～2009年12月期间在我院经肾活检证实     

新斯的明联合电极贴穴电刺激治疗肛肠术后尿潴留的体会

目的：新斯的明联合电极贴穴电刺激治疗肛肠术后尿潴留的疗效研究。方法：选择符合本试验诊断标准、纳入标准的52例患者,采取随机、对照的方法,将研究对象分为两组,病人例数比为1：1。实验组为一次性电极贴穴及注射1mg甲硫酸新斯的明注射液联合治疗,选取关元、中极、双侧足三里、双侧三阴交等穴,用一次性电极固定后采用疏密波刺激,治疗30分钟;对照组采用常规方法热敷膀胱区及诱导排尿。观察两组患者的疗效,采用SPSS17．0统计软件建立数据库并进行统计分析。结果：本研究纳入的50例患者均全部完成治疗,对治疗前两组的性别、年龄、精神状况、生命体征、手术时间、治疗前症状及体征等进行比较,差异均无统计学意义（P〉0．05）,提示治疗前两组具有可比性。治疗后对两组的排尿情况进行比较：两组排尿例数比较,实验组显效19例,无效6例;对照组显效7例,无效18例,差异有统计学意义（P〈0．05）;研究结果提示新斯的明联合电极贴穴电刺激治疗肛肠术后尿潴留有一定的临床疗效。结论：新斯的明联合电极贴穴电刺激治疗肛肠术后尿潴留的具有一定的临床疗效,能促进术后患者排尿,减少导尿率,提高患者生活质量,而且无明显不良反应,是一种操作简单、经济、安全、有效的治疗方法,临床值得推广应用。     

以长节段脊髓炎为主要临床表现的神经白塞综合征1例

白塞综合征（Behcet’s syndrome,BS）是一种系统性血管炎,可涉及皮肤、黏膜、关节、眼睛、动静脉、神经系统和胃肠道系统等,其临床表现具有高度异质性。伴有神经系统受累的被定义为神经白塞综合征（neuro-Behcet’s syndrome,NBS）,其中以长节段脊髓病变为主要临床表现的较为罕见,预后也相对更差。本文报道1例NBS中出现胸6-腰1长节段的脊髓病变,经糖皮质激素和免疫抑制剂治疗后预后良好的病例,并结合NBS的病因、临床表现、诊断及治疗的相关文献进行分析。     

中脑梗死累及不同神经核团预后初步研究

目的 中脑梗死发病率低,目前相关研究较少,本研究通过临床表现、影像学资料探讨累及不同神经核团中脑梗死的预后情况。方法 回顾性分析浙江中医药大学附属第一医院2014年1月至2021年12月期间15例经头颅MRI证实的中脑梗死病例,对累及不同脑神经核团病例治疗前后NIHSS、mRS评分进行相关性分析。结果 单侧大脑脚与入院NIHSS评分（Spearman’s rho=-0.536,P=0.040）,动眼神经核与出院NIHSS评分（Spearman’s rho=-0.537,P=0.039）,双侧大脑脚与入院mRS评分（Spearman’s rho=-0.570,P=0.026）、入院NIHSS评分（Spearman’s rho=-0.607,P=0.016）、出院NIHSS评分（Spearman’s rho=-0.629,P=0.012）、出院mRS评分（Spearman’s rho=-0.643,P=0.010）存在一定的相关性,差异均具有统计学意义。结论 双侧大脑脚梗死大多临床预后不佳,与椎-基底动脉严重狭窄且侧支循环不足（低灌注）有关。     

基于数据挖掘研究沈一平治疗免疫性血小板减少症用药规律

目的：基于数据挖掘技术研究沈一平教授运用中医药治疗免疫性血小板减少症（ITP） 的用药规 律。方法：选取2002年1月1日—2022年10月25日就诊于浙江省中医院血液内科沈一平教授门诊并符合纳入 标准及排除标准的ITP患者,运用SPSS Modeler 18.0软件进行数据处理,进行药物频数分析、统计中西医疗效; 采用SPSS Modeler 18.0中的Apriori算法进行药物关联规则分析;用SPSS statistics聚类算法对核心药物进行聚类 分析。将分析结果请沈一平教授审阅并访谈。结果：共纳入处方2 575首,药物频数分析结果示,居前10位中 药分别为山药、太子参、无花果、薏苡仁、蒲公英、仙鹤草、防风、白术、黄芪、荆芥。药物归经频次从高到 低依次为肝、脾、肺、胃、肾、心、胆、大肠、膀胱、小肠、三焦、心包。药物四气频次从高到低依次为寒、 平、温、凉、热,其中,寒、平两种药物所占分别为34.48%、33.27%。药物五味频次以甘、苦、辛为主,酸、 涩、淡、咸次之。高频药物关联规则分析结果获得：核心药物组合以止血、清热、疏风、益气、健脾治法为 主。高频药物系统聚类分析,得到5个聚类结果：第1类为益气养阴止血药;第2类为清热疏风止血药;第3类 为清热凉血药;第4类为补肾填精、温阳益气药;第5类为滋水涵木、酸收止血药。结合访谈发现,沈一平教 授运用中医治疗ITP的思路随着时间而有改变,将其分为3个阶段进行观察,随着时间的变化：归肺经药物比 例有一定的上升,而归肝经、肾经药物比例较前下降;辛味药比例稍有下降;逐渐增加疏风药、清热药的使用 比例。结论：沈一平教授治疗ITP总体治则为健脾益气补肾。在此基础上,加强疏风固表,注意兼证,治病防 变,辨病、辨证论治,融合四气五味之理。     

胸部CT瘤周影像组学在非小细胞肺癌精准诊疗中的应用与挑战

影像组学通过提取医学图像中感兴趣区的定量图像特征,并与肿瘤的生物学特征与异质性进行关联,为个性化精准诊疗提供了关键信息和依据。肿瘤周边蕴含了丰富的微观生物学信息,胸部CT瘤周影像组学通过挖掘肿瘤周围组织的深层异质性信息,为非小细胞肺癌患者提供定量的非侵入性评估方法,展现其在未来临床应用的广阔前景。相信随着计算机、医疗大数据的飞速发展,未来多中心、高质量、大样本数据等工作的深入开展,有望实现影像组学研究的规范化、可重复,推动影像组学研究的临床转化和应用,为肺癌患者精准诊断、治疗和随访等方面奠定基础。