“神转不回，回则不转”理论治疗痫证临证探微

[目的] 探求“ 神转不回,回则不转”理论的内涵及其临床治疗痫证的运用。[方法] 通过查阅《黄帝内经》及后世医药典籍等,分析“神转不回,回则不转”理论,依此阐释痫证病机及立法选方,分析典型案例以论述其理论。[结果] 痫证是由神气逆乱、三焦不通而诱发,五脏不平、内生积滞致痫证不愈,神回不转,神机失用,痫证避无可避,方以柴胡加龙骨牡蛎汤为基础,整理三焦枢转五脏神气,荡平五脏积滞并解其标。所举验案为气机阻滞、痰火扰神之证,治以清肝泻火、豁痰醒神之法,方用柴胡加龙骨牡蛎汤合涤痰汤加减,辄收佳效。[结论“] 神转不回,回则不转”说明人之神机、气血阴阳不能逆乱,应当在各脏间一以贯之流转,每脏间如环无端运转;痫证的治疗应以“通”字为法,方以柴胡加龙骨牡蛎汤加减,旨在通调使道,平治五脏,标本兼顾,恢复神机,并以言语宽慰,则可痫定神安。     

IMRT联合腔内后装放疗对宫颈癌靶区、正常组织及肿瘤血管的影响

目的探讨调强放疗(IMRT)联合腔内后装放疗对宫颈癌靶区、正常组织及肿瘤血管的影响。方法前瞻性选取我院收治的82例宫颈癌患者,采用随机数字表法分为对照组和观察组,每组41例。对照组采用常规四野盒式放疗联合腔内后装放疗,观察组采用IMRT联合腔内后装放疗。比较2组患者疗效,血清肿瘤标志物[癌胚抗原(CEA)、鳞状细胞癌抗原(SCCA)、糖链抗原153(CA153)],靶区及正常器官受量,肿瘤血管形成指标[血清血管内皮生长因子(VEGF)、CD31、血管生成素-2(Ang-2)、低氧诱导因子-1α(HIF-1α)],不良反应发生率,中位无进展生存期(PFS),治疗后6个月、1年总生存率。结果观察组治疗有效率、疾病控制率高于对照组(P<0.05)。观察组CTV、PTV、CTV处方剂量覆盖体积、达100%处方剂量的体积(V100)、达90%处方剂量的体积(V90)高于对照组(P<0.05);观察组小肠、直肠、膀胱、股骨头、骨髓中V30、V45、平均剂量低于对照组(P<0.05);观察组股骨头、骨髓中V10、V20高于对照组(P<0.05)。观察组治疗后2周及1个月CEA、SCCA、CA153、CD31、VEGF、Ang-2、HIF-1α均低于对照组(P<0.05)。观察组泌尿系统、血液系统不良反应发生率均低于对照组(P<0.05);观察组中位PFS长于对照组,1年总生存率高于对照组(P<0.05)。结论IMRT联合腔内后装放疗治疗宫颈癌能提高靶区内放疗剂量,减少危及器官的受照剂量,促进病灶消退,抑制肿瘤血管形成,延长中位PFS,提高1年总生存率,降低不良反应发生率,可作为不能手术宫颈癌患者的一种有效疗法。     

Fluctuating asymmetry of dynamic smiles in normal individuals

The aim of this study was to quantify the fluctuating dynamic facial asymmetry during smiling in a group of ‘normal’ adults, using three-dimensional (3D) motion facial capture technology. Fifty-four male and 54 female volunteers were recruited. Each subject was imaged using a passive markerless 3D motion capture system (DI4D). Eighteen landmarks were tracked through the 3D capture sequence. A facial asymmetry score was calculated based on either a clinically derived midline or Procrustes alignment; scores were based on the Euclidean distance between landmark pairs. Facial asymmetry scores were determined at three time points: rest, median, and maximum frame. Based on the clinically derived midline and on Procrustes alignment, the differences between male and female volunteers, as well as those at the three different time points, were not clinically significant. However, throughout a smile, facial and lip asymmetry scores increased over the duration of the smile. Fluctuating facial asymmetry exists within individuals, as well as between individuals. Procrustes superimposition and the clinically derived midline produced similar asymmetry scores and both are valid for symmetrical faces. However, with facial asymmetry, Procrustes superimposition may not be a valid measure, and the use of the clinically derived midline may be more appropriate, although this requires further investigation.     

新常态下基层医疗机构党支部组织生活创新研究

党的组织生活是党的生活的重要内容,还是增强党支部各项组织生活所具有的活力、增强基层党组织自身的凝聚力、吸引力等最为高效的一种方法。该研究以齐贤社区卫生服务中心全体职工为研究对象,从党内外职工两个角度,发现党支部组织生活存在问题,以问题为导向,创建出一支生机勃勃、能力与党性兼备的基层医疗机构。充分发挥新常态下基层党支部的先锋模范及战斗堡垒作用。     

Prediabetes diagnosis criteria,type 2 diabetes risk and dietary modulation: The CORDIOPREV study

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Continuous glucose monitoring in youth with cystic fibrosis treated with lumacaftor-ivacaftor

Background

The effects of lumacaftor-ivacaftor therapy on glycemia have not been thoroughly investigated. Continuous glucose monitoring (CGM) provides detailed information about glycemic patterns and detects glucose abnormalities earlier than traditional screening tools for diabetes.

Point configurations,phylogenetic trees,and dissimilarity vectors

In 2004, Pachter and Speyer introduced the higher dissimilarity maps for phylogenetic trees and asked two important questions about their relation to the tropical Grassmannian. Multiple authors, using independent methods, answered affirmatively the first of these questions, showing that dissimilarity vectors lie on the tropical Grassmannian, but the second question, whether the set of dissimilarity vectors forms a tropical subvariety, remained opened. We resolve this question by showing that the tropical balancing condition fails. However, by replacing the definition of the dissimilarity map with a weighted variant, we show that weighted dissimilarity vectors form a tropical subvariety of the tropical Grassmannian in exactly the way that Pachter and Speyer envisioned. Moreover, we provide a geometric interpretation in terms of configurations of points on rational normal curves and construct a finite tropical basis that yields an explicit characterization of weighted dissimilarity vectors.

In one of the first papers on tropical geometry, Speyer and Sturmfels (1) introduced the tropical Grassmannian and showed that coincides with the space of n-leaf phylogenetic trees, a tropical analogue of the moduli space of stable rational n-pointed curves that plays an important role in genomics. With this Euclidean embedding, each phylogenetic tree is identified with its dissimilarity vector, the n2-tuple of path lengths connecting each pair of the n leaves.Pachter and Speyer (2) generalized this embedding by introducing the higher dissimilarity maps: for each integer r with 2≤r≤n+12 they showed that any phylogenetic tree can be recovered from its r-dissimilarity vector, the nr-tuple recording the sum of edge lengths in the subtree spanned by each subset of r leaves. They also stated two questions concerning the possible tropical geometry of these higher dissimilarity maps: 1) Is the space of r-dissimilarity vectors in Rnr contained in the tropical Grassmannian ? If so, then 2) is there a rational map whose image tropicalizes to yield the space of r-dissimilarity vectors? The first question was answered positively by several authors using distinct methods (3–5), whereas the second question has remained open other than the case r=3 that was confirmed in the original (2). There have been numerous papers studying other aspects of Pachter and Speyer’s higher dissimilarity maps as well (e.g., refs. 6–13).In this paper we resolve the second question of Pachter and Speyer and introduce and study a variant of the higher dissimilarity maps that is more compatible with tropical geometry.