脉络学说营卫理论指导心律失常辨证论治

经脉包括经(气)络和血(脉)络,清代周学海《读医随笔》将气络末端称为"气之细络",脉络末端称为"血之细络"。心之气络涵盖心脏起搏与传导系统等广泛调控机制,心之脉络涵盖冠状动脉循环系统,心之气络与脉络相互协调,营卫相偕而行,共同维持心脏正常功能。各种致病因素导致营卫异常而发为心律失常,基于脉络学说营卫理论"损其心者,调其营卫"(《难经·十四难》)治疗原则指导心律失常辨证论治,同时充分结合现代致病因素和致病特点,分别选用调节卫气营血之方药,标本兼治,以期为临床诊疗提供有益借鉴。     

辛味中药在治疗消渴证中的应用价值及中药五味理论现代研究的思考

辛味是中药五味学说中的重要性味之一,通常具有“发散”“行气”和“行血”的作用,且辛味中药在传统医学临床应用中占有较大比例。结合中药辛味的功效内涵及传统中医理论对消渴证的认识,阐述辛味中药与消渴证治疗之间的内在联系,总结辛味中药对“消渴三消”的治疗意义与价值。并在此基础上,对中药五味理论的现代研究趋势和发展方向进行思考,为同行研究提供参考。     

Charcot hindfoot deformity reconstruction using a hindfoot nail- surgical technique

Various techniques of reconstruction of deformed Charcot hindfoot using different internal fixation devices have been described in the literature. We present our surgical technique using specific principles that has resulted in improved outcomes to allow correction of deformity, obtain stability and allow progression to weightbearing in orthotic shoes. We describe our preoperative evaluation, planning and surgical timing. We also hope to share some technical pearls and details on the finer points to achieve a satisfactory correction and reduce the learning curve.     

EARLY COPD: determinantes de la aparición y progresión de la enfermedad pulmonar obstructiva crónica en adultos jóvenes. Protocolo de un estudio caso-control con seguimiento

Introduction and objectivesDeterminants of chronic obstructive pulmonary disease (COPD) in the early stages of its natural history are not well known. Improving our knowledge of these factors will help to design interventions that can modify prognosis.Study objectives are: a) to characterize a COPD population of young adults aged 35-50 years from a multidimensional point of view; b) to compare these patients with smokers with normal lung function; and c) to create a cohort of young adults aged 35-50 years (smokers or former smokers), with and without COPD, who will be followed in the future to improve understanding of the natural history of the disease.Participants and methodThis is a case-control multicenter study aimed at establishing a well-characterized cohort of young adults, smokers or former-smokers, with and without COPD, for subsequent follow-up.A total of 311 participants (101 cases and 210 controls) were selected from approximately 30 primary care settings and 12 hospitals in 8 Spanish regions. Subjects were smokers or former smokers (> 10 pack-years) aged 35-50 years. Diagnosis of COPD was based on a post-bronchodilator result of FEV1/FVC < 70%.The main study variables were: questionnaires on health, symptoms, exacerbations and daily physical activity, lung function tests, blood and sputum samples, and low-dose computed tomography. In the statistical analysis, COPD patient characteristics will be described and compared with control subjects using a logistic regression analysis.     

基于网络药理学的气滞胃痛颗粒抗炎镇痛活性作用分析

目的通过网络药理学的方法预测气滞胃痛颗粒抗炎镇痛主要活性成分的作用靶点,结合中医方解配伍理论对其多成分-多靶点-多通路的作用进行分析。方法基于TCMSP中药系统生物学分析数据库收集气滞胃痛颗粒中6味中药的主要化学成分,并借助LC-MS技术对所筛成分进行分析,通过TCMSP检索和Pharmmapper软件预测获取各成分主要的作用靶标,并通过DIP数据库,利用蛋白质相互作用信息建立药物靶标与炎症疼痛靶标的关联,构建药物-靶标-疾病网络,通过网络特征分析气滞胃痛颗粒抗炎镇痛的作用靶标,阐释其抗炎镇痛的主要作用机制。结果根据网络分析,共有44个炎症疼痛靶点与气滞胃痛颗粒密切相关,其中直接作用靶点有20个,主要是对环加氧酶-2(COX-2)和诱导型一氧化氮合酶(i NOS)等蛋白酶的作用,作用机制可能与调节肿瘤坏死因子(TNF)信号通路、NOD样受体(NLR)信号通路、血管内皮生长因子(VEGF)信号通路等与炎症疼痛密切相关的信号通路有关。结论气滞胃痛颗粒抗炎镇痛作用体现了中药多成分、多靶点、多途径的作用特点,该研究为深入阐释气滞胃痛颗粒抗炎镇痛作用机制提供科学依据,并且进一步说明了中医药古方配伍理论的科学性。     

产前分娩预演对初产妇自然分娩成功率及产后并发症的影响

[目的]探讨产前分娩预演对初产妇自然分娩成功率和产后并发症的影响.[方法]收集2016年9月至2018年10月在本院妇产科分娩的初产妇86例,按产前分娩教育方式分为观察组(n=42)和对照组(n=44).对照组孕妇产前接受常规产前健康教育课程培训,观察组在对照组的基础上进行分娩预演实践.比较两组自我效能感量表(GSES)、抑郁自评量表(SDS)和焦虑自评量表(SAS)评分及自然分娩成功率和产后并发症发生率等.[结果]与对照组相比,观察组分娩总产程和第一、二、三明显缩短;新生儿窒息率和产后SDS、SAS评分均明显降低;自然分娩成功率、GSES评分均明显提高,其差异均有统计学意义(P<0.05).观察组产后出血、感染、尿潴留、乳汁淤积发生率及总并发症发生率均低于对照组(P<0.05).[结论]采用常规产前健康教育培训结合产前分娩预演实践的产前管理方式,可有效提高初产妇自然分娩成功率,缩短产程,减少产后并发症的发生,值得临床推广应用.     

温病学理论指导下的新型冠状病毒肺炎诊治刍议

基于温病学理论,探讨新型冠状病毒肺炎的中医病因病机与诊治思路。温病学说源于明清之前的历代中医理论积累,经过长期的温热病防治实践而形成,其对于外感热病(包括烈性传染病)的病因病机、证治方药有着较为系统的论述,近年来在我国的新发传染病防治中发挥出积极的作用。温瘟相通,瘟疫病因多为热毒疫邪,表现为热证阳证,可按温病学中的卫气营血或三焦辨证分期论治,或治以吴又可、庞安时等的经方验方,这些因、机、证、治理论可试用于新型冠状病毒肺炎的中医诊疗。且肺与大肠相表里,胃肠道也是新型冠状病毒侵袭或繁殖的部位,采用中医清热通下之法,使邪从肠道而出,可能是减轻体内病毒感染与肺脏炎症的一种途径。     

A mechanism for gratitude development in a child

Most scholars consider gratitude as a moral emotion, with only few seeing it as a character trait. As a result, no systematic mechanism has ever been attempted to develop gratitude in children. Given the social issue of widespread lack of gratitude in the one-child generations of China, this article attempts to outline a mechanism of parental moral education for gratitude development. The mechanism is underpinned by love, induction and discipline; and theoretically justified in accordance with key psychological and sociological theories, such as Piaget's theory of moral development, Kohlberg's moral stages theory, attachment theory, Hoffman's internalisation theory, Rest's social justice theory and Baumrind's parenting styles theory. The benefits and potential risks of each strategy of the mechanism are addressed.     

Conceptual clarification of the playful engagement in social interaction of preschool-aged children with autism spectrum disorder (ASD)

Children with autism spectrum disorder (ASD) demonstrate limited playfulness. Their difficulty engaging in meaningful interaction with others renders playful engagement in social interactions a challenge. Although little direct evidence exists regarding the promotion of these children’s playful engagement, links can be established with many traits cited in play and social interaction studies. This paper presents the results of a conceptual clarification exercise regarding the key behaviours associated with the construct of playful engagement in preschool-aged children with ASD. Behaviours were identified based on hallmark deficits in early social interactions and play of children with ASD. The analysis revealed the following behaviours: positive affect, engagement, imitation, joint attention, initiation of social interaction, social responsiveness, flexibility, child’s laughter in funny situations and giving and reading non-verbal cues. In conclusion, a conceptually coherent stage has been set for exploring the literature regarding interventions to promote the playful engagement of preschool-aged children with ASD.