咳嗽病源流考

咳嗽是肺系疾患的一个常见证候,也是备受古今医家重视的常见病证。由于咳嗽病病因多样,病机亦有不同,涉及多个脏腑,治疗之法各异,历代医家也各有心得,见仁见智,众说纷纭。中医学的历代积累为我们提供了宝贵的经验,根据所掌握的医学文献资料,从病名、分类、病因病机、治疗入手,对历代重要医籍中关于咳嗽病的相关论述进行搜集整理研究,寻找其学术脉络和规律,以期对研究本病并对指导临床提供一些有益的启示和借鉴。     

Prevalence and psychosocial correlates of self-reported past suicide attempts among bariatric surgery candidates

BackgroundAlthough research has been limited, suicidal behavior has commonly been identified as a contraindication for bariatric surgery. The present study aimed to determine the prevalence and correlates of past suicide attempts in a bariatric surgery population at an academic medical center.MethodsA retrospective chart review, including the demographic and psychosocial variables, was conducted of 1020 consecutive bariatric surgery candidates presenting during a 32-month period.ResultsOf the 1020 patients, 115 (11.2%) self-reported ≥1 previous suicide attempt. The patients with a positive suicide history were significantly younger (mean 42.9 ± 11.0 years), less educated (mean 13.4 ± 2.4 years), had a greater body mass index (mean 52.3 ± 11.6 kg/m²), and were more predominantly single (32.2% versus 20.9%), female (90.4% versus 74.8%), and receiving disability (45.2% versus 21.8%) compared with patients without a suicide history. A positive suicide history was also significantly associated with a history of psychiatric hospitalization, outpatient psychotherapy and/or psychotropic medication, sexual abuse, and substance abuse.ConclusionAssessing suicide history is an important aspect of the bariatric preoperative assessment. Additional research is needed to evaluate the effects of suicide history on the postoperative outcomes and adherence.     

Travel distance as factor in follow-up visit compliance in postlaparoscopic adjustable gastric banding population

BackgroundDespite the 2008 “American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic and Bariatric Surgery Medical Guidelines for Clinical Practice for the Perioperative Nutritional, Metabolic, and Nonsurgical Support of the Bariatric Surgery Patient,” consensus does not exist for postoperative care in laparoscopic adjustable gastric banding (LAGB) patients (grade D evidence). It has been suggested that regular follow-up is related to better outcomes, specifically greater weight loss. The aim of the present study was to investigate the effects of travel distance to the clinic on the adherence to follow-up visits and weight loss in a cohort of LAGB patients in the setting of a rural, university-affiliated teaching hospital in the United States.MethodsA retrospective chart review was performed of all consecutive LAGB patients for a 1-year period. Linear regression analysis was used to identify the relationships between appointment compliance and the distance traveled and between the amount of weight loss and the distance traveled.ResultsLinear regression analysis was performed to investigate the effect of the travel distance to the clinic on the percentage of follow-up visits postoperatively. This effect was not significant (P = .4). Linear regression analysis was also performed to elucidate the effect of the travel distance to the clinic on the amount of weight loss. This effect was significant (P = .04).ConclusionThe travel distance to the clinic did not seem to be a significant predictor of compliance in a cohort of LAGB patients with ≤1 year of follow-up in a rural setting. However, a weak relationship was found between the travel distance to the clinic and weight loss, with patients who traveled further seeming to lose slightly more weight.     

Transoral gastric volume reduction for weight management: technique and feasibility in 18 patients

BackgroundEndoluminal suturing to reduce the gastric volume might provide an additional option for the treatment of obesity. Potential advantages of a nonoperative endoluminal intervention include less pain, the ability to perform it as an outpatient procedure, and a high level of patient acceptance. The purpose of the present pilot study was to demonstrate the feasibility and procedural safety of transoral gastric volume reduction (TRIM procedure) using the Restore Suturing System in patients with a body mass index of 30–45 kg/m². Successful completion of the procedure and adverse events were evaluated at academic/university hospitals.MethodsThis was a nonrandomized feasibility study performed at 2 institutions. After institutional review board approval, the patients underwent the TRIM endoluminal gastric plication procedure with the Restore Suturing System (Restore device). Gastric plications were completed to approximate the anterior and posterior gastric walls to achieve restriction of the upper stomach. The number and location of successful plications were recorded, and patients were monitored for complications. The present report described the short-term procedural results (≤24 hours after the procedure) of the studied cohort.ResultsA total of 18 patients were enrolled in the present study. The TRIM procedure was successfully completed in all patients, with placement of 4–8 plications (average 6 per patient). The average procedure time was 125 ± 23 minutes, and no serious or significant procedure-related complications occurred. After the procedure, common patient complaints were nausea, vomiting, and abdominal discomfort. The first 10 patients enrolled were kept overnight according to the study protocol, and the remaining 8 patients were discharged on the day of the procedure.ConclusionEndoluminal suturing using the TRIM procedure and the Restore device was technically feasible, and no serious or significant procedure-related complications were reported. Weight loss, co-morbidity improvement, and durability are under assessment.     

公共卫生学科带头人应具有的素质

公共卫生学科带头人是公共卫生领域的学术领袖和核心,直接影响所在学科的科研、工作水平以及竞争和发展能力。现就公共卫生学科带头人应具备的思想品德、科研、创新、公共卫生实践、管理和身心素质作一探讨。     

Data mining and clinical data repositories: Insights from a 667,000 patient data set

Clinical repositories containing large amounts of biological, clinical, and administrative data are increasingly becoming available as health care systems integrate patient information for research and utilization objectives. To investigate the potential value of searching these databases for novel insights, we applied a new data mining approach, HealthMiner, to a large cohort of 667,000 inpatient and outpatient digital records from an academic medical system. HealthMiner approaches knowledge discovery using three unsupervised methods: CliniMiner, Predictive Analysis, and Pattern Discovery. The initial results from this study suggest that these approaches have the potential to expand research capabilities through identification of potentially novel clinical disease associations.     

现代眩晕医案中情志症名的文献分析

目的:检索1949～2010年中国出版的有关眩晕的医案文献,分析规范化后情志失常的研究,为临床病例信息调查表的制作提供可靠的依据。方法:以中国学术期刊网络出版社总库为主要来源,共检索到1 296篇符合描述眩晕症状的医案文献。运用Note Express软件和Excel 2003从医案中截取症状归类排序和频数统计,并运用统一标准的症状术语进行规范化,统计规范化后的有关情志失常的症状。结果:眩晕医案中烦躁、善怒、心烦、健忘、善悲、善忧思等18种症状共累计出现143篇,占医案总篇数13.06%,为眩晕病案中情志失常的症状进行初步症名的规范化,满足科研与临床的实际需要。结论:规范眩晕病案中情志症状名称,有助于提高诊治眩晕的可操作性和辨证论治水平。     

Good practice in reviewing and publishing studies on herbal medicine, with special emphasis on traditional Chinese medicine and Chinese materia medica

Ethnopharmacological relevance

Studies on traditional Chinese medicine (TCM), like those of other systems of traditional medicine (TM), are very variable in their quality, content and focus, resulting in issues around their acceptability to the global scientific community. In an attempt to address these issues, an European Union funded FP7 consortium, composed of both Chinese and European scientists and named “Good practice in traditional Chinese medicine” (GP-TCM), has devised a series of guidelines and technical notes to facilitate good practice in collecting, assessing and publishing TCM literature as well as highlighting the scope of information that should be in future publications on TMs. This paper summarises these guidelines, together with what has been learned through GP-TCM collaborations, focusing on some common problems and proposing solutions. The recommendations also provide a template for the evaluation of other types of traditional medicine such as Ayurveda, Kampo and Unani.

Materials and methods

GP-TCM provided a means by which experts in different areas relating to TCM were able to collaborate in forming a literature review good practice panel which operated through e-mail exchanges, teleconferences and focused discussions at annual meetings. The panel involved coordinators and representatives of each GP-TCM work package (WP) with the latter managing the testing and refining of such guidelines within the context of their respective WPs and providing feedback.

Results

A Good Practice Handbook for Scientific Publications on TCM was drafted during the three years of the consortium, showing the value of such networks. A “deliverable – central questions – labour division” model had been established to guide the literature evaluation studies of each WP. The model investigated various scoring systems and their ability to provide consistent and reliable semi-quantitative assessments of the literature, notably in respect of the botanical ingredients involved and the scientific quality of the work described. This resulted in the compilation of (i) a robust scoring system and (ii) a set of minimum standards for publishing in the herbal medicines field, based on an analysis of the main problems identified in published TCM literature.

Conclusion

Good quality, peer-reviewed literature is crucial in maintaining the integrity and the reputation of the herbal scientific community and promoting good research in TCM. These guidelines provide a clear starting point for this important endeavour. They also provide a platform for adaptation, as appropriate, to other systems of traditional medicine.     

中药命名规律分析

从中草药药名入手,以药名中直接显示功用,暗喻功用,以古今传闻、医话故事来说明功用,从五色、五味、五行来揭示其功用6个方面,对中草药的命名与其功用的内在联系做了认真的分析,从中找出规律,为初学中医中药的人提供借鉴。     

QSAR analysis of 1,3-diaryl-4,5,6,7-tetrahydro-2H-isoindole derivatives as selective COX-2 inhibitors

Quantitative structure-activity relationship (QSAR) analysis was performed on a series of 1,3-diaryl-4,5,6,7-tetrahydro-2H-isoindole for their cyclooxygenase-2 (COX-2) inhibition. QSAR investigations were based on Hansch's extra thermodynamic multi-parameter approach and receptor surface analysis (RSA). QSAR investigations reveal that steric and electrostatic interactions are primarily responsible for COX-2 enzyme-ligand interaction. QSAR model derived from Hansch analysis demonstrated that COX-2 inhibitory activity is correlated with sum of atomic polarizability (Apol), number of hydrogen-bond donor groups (HBD), energy of the highest occupied molecular orbital (HOMO), desolvation free energy for water (F(H(2)O)) and fraction of areas of molecular shadow in the XY and ZX planes over area of enclosing rectangle (Sxyf and Sxzf) with r ranges 0.870-0.904. The best model was obtained from RSA model having r = 0.940 with good predictive ability (predicted compounds in training set and test set within +/- 1.0 unit of pIC(50)) and can be used in designing better selective COX-2 inhibitors among the congeners in future.