《类证治裁》喉症辨治特点浅析

通过整理《类证治裁》的喉症篇，总结林珮琴诊治喉症的特点。以痰火为主要病因病机进行辨证，遣方广博灵活，推崇外治救急，诊治尤分轻重，对于现代中医耳鼻喉科临床有着重要的指导意义。     

《血证论》平衡观初探

探讨《血证论》平衡观思想,认为主要体现在以下4个方面:一是燮理脏腑,二是审度邪正,三是平衡气血,四是平衡升降。唐容川重视以平为期的整体观念和治病求本的治疗思想,对血证中医药临床辨证施治具有重要参考价值。     

中国艾滋病哨点监测系统的建立及1995年监测报告

为了更科学、有效地监测ＨＩＶ流行趋势，为制定艾滋病预防规划提供准确的信息，我国在２３个省的城市中建立了４２个ＨＩＶ监测哨点，于１９９５年始每年两轮对四类高危人群，即性传播疾病（ＳＴＤｓ）门诊就诊者、暗娼、吸毒者和长途卡车司机，开展ＨＩＶ哨点监测。１９９５年首轮检测了３个目标人群共１１０７１人，在北京的ＳＴＤｓ门诊就诊者中发现ＨＩＶ感染者１例；第二轮检测了４个目标人群共１１７２１人，发现ＨＩＶ感染者３例，其中在福建的ＳＴＤｓ门诊就诊者中发现一例，在海南暗娼人群中发现一例，在新疆的吸毒人群中发现一例。与１９９５年第一轮监测结果相经，检出ＨＩＶ阳性者的地区、人群和阳性数均有增加。本ＨＩＶ哨点监测的结果表明，我国被监测地区高危人群中ＨＩＶ感染率仍处于低水平，但已有广泛流行的潜在危险。另外该ＨＩＶ哨点监测系统有待于进一步完善。     

Effects of weight loss medications on mortality and cardiovascular events: A systematic review of randomized controlled trials in adults with overweight and obesity

AimsAdults affected by obesity are at higher risk of premature mortality. Medications can help to lose weight and to maintain weight loss. Aim of this meta-analysis was to assess whether anti-obesity medications affect all-cause mortality, mortality due to cardiovascular events, cardiovascular risk factors and body weight.Data synthesisA Medline search was performed to identify randomized controlled trials (RCTs) of anti-obesity medications in adults with overweight or obesity reporting data on all-cause mortality, cardiovascular mortality or non-fatal cardiovascular events, with a follow-up of at least 6 months. We identified 28 RCTs with 50,106 participants. The median follow-up was 52 weeks. Evidence did not show superiority of anti-obesity medications over placebo in reducing all-cause mortality (risk ratio 1.03, 95%Confidence Interval [CI] 0.87 to 1.21) or cardiovascular mortality (risk ratio 0.92, 95%CI 0.72 to 1.18). All-cause mortality rate was positively associated with weight loss (β = 0.0007; p = 0.045); hence, for each kg of body weight lost there was a 0.07% decrease of all-cause mortality. The pharmacological treatment reduced total-cholesterol (7.15 mg/dl; 95%CI 1.46–12.85), LDL-cholesterol (5.06 mg/dl; 95%CI 1.12–9.00), and triglycerides levels (9.88 mg/dl; 95%CI 5.02–14.75), while it increased HDL-cholesterol (1.37 mg/dl; 95%CI 0.17–2.57). Systolic blood pressure decreased (0.90 mmHg; 95%CI 0.15–1.64).ConclusionsAlthough we were unable to demonstrate a superiority of anti-obesity medications over placebo on mortality, metaregression showed that even a small weight reduction tends to reduce all-cause mortality in obesity. Our data support public health measures to reduce the obesity burden by including the use of anti-obesity medications.Registration number (PROSPERO)CRD42020210329.     

不同剂量辛伐他汀对急性冠状动脉综合征患者组织因子和组织因子途径抑制物的影响

目的观察不同剂量的辛伐他汀对急性冠状动脉综合征患者血浆组织因子和组织因子途径抑制物的影响。方法将88例急性冠状动脉综合征患者分为对照组28例、辛伐他汀20 mg组29例和辛伐他汀40 mg组31例,在入院第2天和在平均治疗8天以后清晨空腹采血,用酶联免疫吸附法测定血浆中的组织因子活性和组织因子途径抑制物的水平。结果辛伐他汀治疗的两个组组织因子活性较治疗前明显降低,分别从0.47±0.58 IU/L下降到0.20±0.30 IU/L和从0.59±0.77 IU/L下降到0.36±0.55 IU/L(P<0.05),对照组组织因子活性无变化;辛伐他汀40 mg组组织因子途径抑制物的水平增高,从263±203μg/L增加到369±279μg/L(P<0.05),但其他两组组织因子途径抑制物水平在治疗前后无差异。结论20 mg和40 mg辛伐他汀短期治疗急性冠状动脉综合征患者均能使组织因子活性降低,40 mg辛伐他汀治疗时使组织因子途径抑制物水平增高,提示他汀对组织因子和组织因子途径抑制物的作用可能是其抗栓机理之一。     

Risks,Benefits, and Effects on Management for Biopsy of the Papilla in Patients With Familial Adenomatous Polyposis

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Different Kinds of Paraneoplastic Syndromes in Childhood Neuroblastoma

Background:

Clinical presentations of paraneoplastic syndromes in neuroblastoma may multiply. Review of the clinical data and the literature on this syndrome may help in the diagnosis of neuroblastoma.

Objectives:

In order to make more accurate diagnosis, we reviewed the clinical data and the literature on this syndrome.

Patients and Methods:

Between April 2007 and April 2012, 68 children were diagnosed with neuroblastoma or ganglioneuroblastoma in our institution, 9 of which presented exclusively with paraneoplastic syndromes and were not treated with chemotherapy prior to diagnosis. After the diagnosis, all patients received chemotherapy and operation on NB97 protocol.

Results:

Among 68 pediatric patients with neuroblastoma or ganglioneuroblastoma, 4 (5.9%) patients suffered from neurological complications at diagnosis, 2 (2.9%) patients had digestive tract disorders, 2 (2.9%) patients had immune diseases, and 1 (1.5%) suffered from hematological disorder (without bone marrow involvement). All paraneoplastic syndrome patients achieved complete remission on paraneoplastic syndrome before completion of chemotherapy.

Conclusions:

Neuroblastoma may present with a range of non-specific neurologic symptoms in addition to the well-known opsoclonus-myoclonus syndrome and cerebellar ataxia. In any case, the presence of unexplained neurologic manifestations and other common clinical presentations such as rash, constipation, diarrhea, and especially immune disorders in an otherwise healthy child had raised the possibility of paraneoplastic syndrome due to the presence of an undiagnosed tumor.     

幽门螺杆菌感染相关胃病证治规律的探讨

本文开展了幽门螺杆菌（ＨＰ）感染相关胃病证治规律的研究。提出了脾胃虚弱是ＨＰ感染的病理基础，气滞血瘀、郁热、湿阻是其主要病理表现；认为扶正（如补益气血）祛邪（如清热、化湿、理气、活血）为治疗本病的基本原则。     

Multiple Muscular Variations in the Neck,Upper Extremity,and Lower Extremity Biased toward the Left Side of a Single Cadaver

Although numerous reports have found accessory or supernumerary muscles throughout the human body, multiple appearances of these variations biased toward one side of body are rare. We report a 76-yr-old male cadaver with an accessory head of the biceps brachii and palmaris profundus, and a muscular slip between the biceps femoris and semitendinosus on the left side in addition to a bilateral accessory belly of the digastric muscle. No remarkable nervous, vascular, or visceral variation accompanied these variations. An interruption of normal somitogenesis or myogenesis may be a cause of these variations.     

SYNTAX评分与GRACE评分对冠状动脉3支病变患者1年预后判断的比较

目的:比较两种不同评分方法(GRACE评分、SYNTAX评分)对冠脉3支病变(3VD)患者1年终点事件(即心源性死亡、再发心梗和需再次血运重建)发生率预测的价值,为临床选择合理治疗方案提供参考。方法:运用SPSS软件对46例2012年3月-2013年2月本院经冠状动脉造影诊断为3支病变的患者进行回顾性分析。根据入院时患者的一般情况、临床生化指标、心电图等结果以及冠脉造影报告,对每例患者分别进行GRACE评分和SYNTAX评分,并依据分值进行相关分组,采用连续校正卡方检验和Fisher’s精确检验比较各组终点事件的发生率。绘制两种不同评分方法受试者工作特征曲线(ROC),并计算曲线下面积(AUC)。分析比较GRACE评分和SYNTAX评分1年终点事件的预测价值。结果:1GRACE评分和SYNTAX评分不同分组间终点事件发生情况差异均有统计学意义(P<0.01)。2GRACE评分和SYNTAX评分两种方法预测3支病变患者1年终点事件的准确度分别是AUC:0.707,95%CI:0.554-0.859和AUC:0.743,95%CI:0.597-0.890。SYNTAX评分在18.2分时预测1年终点事件敏感度和特异度均较好,分别是0.690和0.750。结论:1SYNTAX评分预测1年终点事件的准确度优于GRACE危险评分。GRACE评分能一定程度预测3支病变患者1年发生终点事件可能,但准确度不高。2SYNTAX评分在18.2分时,预测冠脉3支病变1年终点事件敏感度和特异度均较好,兼有准确性和实用性,可用来指导临床,与GRACE评分比较,在临床工作中SYNTAX评分可作为首选辅助工具。