中医四诊客观化研究面临的主要问题与挑战

中医四诊客观化研究顺应中医药现代化、国际化发展的趋势。通过简要介绍中医四诊客观化技术研究的国内外现状,阐述了其当前面临的主要问题以及局限性;总结了中医四诊客观化需要解决的关键技术以及发展方向。     

正常中晚期孕妇的凝血四项和D-二聚体结果分析及其临床意义

目的检测正常中晚期孕妇的凝血四项及D-二聚体指标,了解正常中晚期孕妇的凝血与纤溶功能状态及临床意义。方法凝血四项测定均为凝固法,D-二聚体为免疫比浊法。在Sysmex CA7000全自动血凝仪上进行检测。结果正常妊娠中晚期孕妇与正常非孕妇女对照组比较,PT、APTT时间明显缩短(P<0.05);FIB显著增高(P<0.01);TT差异不明显(P>0.05);D-二聚体水平差异有统计学意义(P<0.05)。结论妊娠中晚期由于凝血功能增强,抗凝及纤溶功能减弱,出现妊娠期高凝状态,有利于产后快速有效止血。产前凝血功能的检测,对预防产科并发症(如DIC及羊水栓塞等)有重要的临床意义。     

周岱翰教授论治恶性肿瘤学术经验管窥

周岱翰教授平素勤于耕耘,耽嗜典籍,发皇古义,融会新知,拓展中医肿瘤四诊及“温病学”学术内涵;遣方用药,法师《神农本草经》;认病辨证,倡导“带瘤生存”;辨证施食,推崇中医肿瘤食疗学;学验俱丰,衷中参西,身体力行,推动和发展了中医肿瘤学术体系的构建。     

体外冲击波治疗骨不连及骨折延迟愈合的临床疗效观察

目的 探索体外冲击波促进骨折延迟愈合及治疗骨不连的临床疗效.方法 对50例四肢骨折行切开复位内固定术后骨不连及骨折延迟愈合患者分别进行体外冲击波治疗,3次/d,6次为一疗程,两月后再进行第二疗程治疗,观察治疗后骨折断端愈合情况.结果 50例患者中有49例得到随访,第一疗程后,49例中37例骨折愈合良好,第二疗程后2例骨折得到愈合,共计39例患者取得良好治疗效果,治愈率约为79.59％.未治愈10例患者中1例出现局部血肿,治疗中无神经、血管损伤等并发症.结论 体外冲击波治疗骨不连及骨折延迟愈合疗效确切,临床效果满意;同时具有微创,经济,方便,并发症少等优点.     

浅谈咳嗽的四季分治

[目的]浅论四季咳嗽的不同证候特征及辨治要点.[方法]结合历代中医文献的相关记述,运用中医基础理论,对春夏秋冬四季咳嗽的不同证候特征进行辨析,并提出相应的治法方药及注意事项.[结果]春夏秋冬四季均有咳嗽发生：春季多感风温而咳嗽,治以辛凉解表法为主,方当选银翘散合止嗽散加减;夏季易患风热而咳嗽,治以疏风解热、宣肺止咳为主,方选桑菊饮加止嗽散加减;秋季多伤燥邪而咳嗽,且分凉燥和温燥,凉燥治以温润止咳为主辛温疏表为辅,多用杏苏散加减化裁,温燥治当清凉甘润、宣肺润燥,方以桑杏汤加止嗽散加减为主;冬季易感风寒而咳嗽,治当解表散寒、宣肺肃降,方选三拗汤加止嗽散化裁.[结论]咳嗽四季皆有,临证需以辨证论治为总则,因时制宜,依据不同证候特征远方用药,切实提高临证效果.     

Neuromuscular blockade during therapeutic hypothermia after cardiac arrest: Observational study of neurological and infectious outcomes

Introduction

Neuromuscular blockade (NMB) is widely used during therapeutic hypothermia (TH) after cardiac arrest but its effect on patient outcomes is unclear. We compared the effects of NMB on neurological outcomes and frequency of early-onset pneumonia in cardiac-arrest survivors managed with TH.

Methods

We retrospectively studied consecutive adult cardiac-arrest survivors managed with TH in a tertiary-level intensive care unit between January 2008 and July 2013. Patients given continuous NMB for persistent shivering were compared to those managed without NMB. Cases of early-onset pneumonia and vital status at ICU discharge were recorded. To avoid bias due to between-group baseline differences, we adjusted the analysis on a propensity score.

Results

Of 311 cardiac-arrest survivors, 144 received TH, including 117 with continuous NMB and 27 without NMBs. ICU mortality was lower with NMB (hazard ratio [HR], 0.54 [0.32; 0.89], p = 0.016) but the difference was not significant after adjustment on the propensity score (HR, 0.70 [0.39; 1.25], p = 0.22). The proportion of patients with good neurological outcomes was not significantly different (36% with and 22% without NMB, p = 0.16). Early-onset pneumonia was more common with NMB (HR, 2.36 [1.24; 4.50], p = 0.009) but the difference was not significant after adjustment on the propensity score (HR, 1.68 [0.90; 3.16], p = 0.10).

Conclusions

Continuous intravenous NMB during TH after cardiac arrest has potential owns effects on ICU survival with a trend increase in the frequency of early-onset pneumonia. Randomised controlled trials are needed to define the role for NMB among treatments for TH-induced shivering.     

五行、八卦与四元素学说探析

五行学说与易经八卦体系,有着明显的不同：八卦代表的天、地、水、火、山、泽、雷、风属于自然物质,而五行则把人类劳动创造的“金”也纳入了自然万物之中,使人类的活动与自然万物形成了有机的联系,促成了天人一体的整体观.因为没有人的参与,土不能生金,金不能克木,金也不能生水.可以说,五行是改良的八卦,它与元气一元论、阴阳二元论一起,给了中医学摆脱巫术的科学的世界观和方法论,是中医学善于解决复杂问题的根本原因所在.五行学说与西方的四元素学说也有着明显的区别：五行学说创立了万物之间互相联系、互相影响的关系论,是系统科学的胚基;四元素学说,属于构成论,是分析科学的萌芽.     

Bioavailability of Four Different Pharmaceutical Preparations of Carbamazepine

Abstract The bioavailabilities of two tablet brands carbamazepine (CBZ) (Tegretol®, A; Neurotol®, B) were compared with two new experimental preparations (C, D). Formulation A showed a more sustained release nature than did the other formulations. The AUCs_0→∞ gave no significant differences between treatment A and three other treatments. However, if AUC_0→72 was calculated instead of AUC_0→∞, the preparation A gave the significantly lower bioavailability than the other compounds. Formulations A and B are marketed as generically equivalent preparations in Finland. However, their pharmacokinetic parameters after a single dose were different.     

四维超声成像对产前胎儿发育异常的临床应用研究

目的评价四维超声成像诊断技术在产前胎儿发育异常诊断中的作用。方法采用二维及四维彩色超声多普勒超声诊断仪对1230例孕妇进行检查,追踪引产及分娩后胎儿的实际情况,分析四维彩色超声检查的灵敏度、特异度、阳性预测值、阴性预测值及符合率。结果二维超声对胎儿检查的灵敏度为63.6%,特异度为100%,阳性预测值为100%,阴性预测值为99.7%,对胎儿诊断的符合率为99.7%;四维超声灵敏度为90.9%,特异度为100%,阳性预测值为100%,阴性预测值为99.9%,对胎儿诊断的符合率为99.8%。进一步分析二维及四维超声对发育畸形部位的诊断符合率,二维超声诊断符合率为52.4%,四维超声诊断符合率为81.0%。结论四维超声对发育异常胎儿诊断的灵敏度、阴性预测值及病例诊断符合率高于二维超声,对发育异常部位诊断的符合率也优于二维超声。     

尿四项微量蛋白测定在小儿紫癜性肾炎早期诊断中的意义

目的:探讨尿β2微球蛋白(β2-MG)、糖蛋白(THP)、免疫球蛋白G(IgG)、白蛋白(Alb)四项微量蛋白测定早期辅助诊断小儿紫癜性肾炎肾的临床意义。方法:用放射免疫法(RIA)测定74例过敏性紫癜(HSP)患儿尿β2-MG、THP、IgG、Alb四项微量蛋白的水平,并分组进行对比,分析其变化,以判断HSP有无肾损害及其严重程度和临床分型的关系。结果:74例中,62例(83.8%)尿β2-MG升高,22例(29.7%)尿THP升高,32例(43.2%)IgG升高,60例(81.1%)尿Alb升高。26例血清β2-MG、THP均正常。结论:经过对尿四项微量蛋白的监测及分组比较,结果表明监测微量蛋白可早期诊断紫癜性肾炎(HSPN),指导临床尽早治疗,并可监测有无复发,反映病情的严重程度。