降逆与扶正——呃逆治法临床浅析

本文分别通过汤药及针灸治疗呃逆的两例案例,从中药及针灸的不同治疗角度观察呃逆治疗同一性,结合《伤寒论》中旋覆代赭汤治疗呃逆的原文及王绵之教授对旋覆代赭汤方义的介绍,再从针灸配伍选穴出发,总结降逆扶正之法治疗呃逆的思路。     

No effect of forearm band and extensor strengthening exercises for the treatment of tennis elbow: a prospective randomised study

The objective of this prospective randomised study was to analyse the effect of the forearm support band and of strengthening exercises for the treatment of tennis elbow. Twenty-nine patients with 30 tennis elbows were randomised into 3 groups of treatment: (I) forearm support band, (II) strengthening exercises and (III) both methods. The patients had a standardised examination at their first visit, and then after 6 weeks, 3 months and 1 year. At the latest follow-up, there was a significant improvement of the symptoms compared to before treatment (p<0.0001), considering all patients independently of the methods of treatment. However, no differences in the scores were found between the 3 groups of treatment (p=0.27), indicating that no beneficial influence was found either for the strengthening exercises or for the forearm support band. Improvement seems to occur with time, independent of the method of treatment used.     

A qualitative analysis of a progressive resistance exercise programme for people with multiple sclerosis

Purpose. This qualitative study explored the perceptions of adults with multiple sclerosis about the positive and negative effects of a progressive resistance strengthening programme; and identified factors that might facilitate or create barriers to participation.

Methods. Seven women and two men (mean age 45.6 years, SD 10.7) with multiple sclerosis participated in a 10-week gymnasium based progressive resistance strengthening programme held twice a week. Participants were interviewed at the end of the programme. The recorded interviews were transcribed and then independently coded by three researchers. From these codes, the main themes emerged.

Results. Reports about the programme were very positive with physical, psychological and social benefits noted. Most participants said that they had less fatigue as a result of the programme. Few negative outcomes were reported and these were minor such as aches and pains. Key extrinsic factors for programme completion were the leaders' encouragement and knowledge of exercise; and the group aspect of the programme. Key intrinsic factors were enjoyment, determination, seeing the signs of progress, and a previously held positive attitude about the benefits of exercise.

Conclusions. The results of this study suggest that progressive resistance strength training is a feasible fitness option for some people with multiple sclerosis. Factors perceived to be important for programme completion suggest that choosing encouraging leaders with knowledge of exercise, and exercising in a group may contribute to programme success.     

Outcomes of strengthening approaches in the treatment of low-grade spondylolisthesis

Abstract

Background: Historically, spondylolisthesis has been treated by a wide variety of techniques such as flexion exercises, bracing, abdominal stabilizing programs, general strengthening, stretching, and in some cases, motor control exercises. Although surgical treatment of spondylolisthesis has been outlined in current literature, strengthening programs have not been well defined for this population.

Objective: To describe the outcomes in randomized clinical or controlled trials (RCTs) in which either a global or local strengthening approach was assessed against another comparator in conservative treatment of patients with a low-grade spondylolisthesis.

Methods: A systematic review of the literature. This review was formatted using the PRISMA guidelines, a 27-item checklist and four-phase flow diagram. An electronic search strategy targeting randomized controlled and clinical trials that compared conservative treatments for low-grade (I and II) spondylolisthesis that used a local stabilization approach, motor control, and/or a general strengthening program versus a surgical intervention or a control group was used. Physiotherapy Evidence Database (PEDro) was used to critically appraise each study for quality. Outcome measures included changes in pain measured by the visual analog scale (VAS) along with secondary measures of functional disability, working status, and lumbar range of motion.

Results: Although 28 studies went through full text review, only three studies met inclusion criteria. Within the studies, global strengthening exercise programs significantly decreased subjects’ pain as measured using the VAS but did not significantly improve the level of disability. In contrast, local stabilization or motor control exercises demonstrated improvements in both pain and disability. No studies directly compared a global strengthening approach versus a stabilization approach.

Conclusion: Our findings indicate that both exercise training programs of local strengthening/stabilization interventions, as well as general strengthening programs may be beneficial as conservative strengthening management to patients with a low-grade spondylolisthesis. A direct comparison of these approaches is needed for the spondylolisthesis population.     

无锡市医院内镜清洗消毒管理调查

目的 了解无锡市医院内镜清洗消毒状况，发现内镜消毒管理中存在的问题，并提出建议。方法根据《内镜清洗消毒技术操作规范（2004年版）》要求，对医院内镜消毒管理现状进行调查，并对消毒后的内镜采样监测。结果各医院都具备内镜管理的规章制度，人员培训率50．00％，人员防护符合率64．71％，消毒室专用率35．29％，清洗消毒设施到位率41．18％，清洗消毒流程规范率11．76％，内镜保存条件符合率23．53％，内镜使用中消毒液检测合格率100．00％，吸引瓶、清洗槽、酶洗槽、冲洗槽等物体表面消毒合格率100．00％，消毒后使用中的内镜检测合格率50．00％；消毒后保存中内镜检出合格率36．36％。结论我市开展内镜诊疗工作的医院在消毒剂的使用以及对物体表面的消毒规范，存在一定问题，我市医院内镜诊疗和清洗消毒工作有待进一步规范。     

抗癌回生散扶正抗癌临床研究

抗癌回生散是一以扶正和抗肿瘤为主要作用的纯中药胶囊制剂。１９９６年５月至１９９７年８月在１１７例肿瘤患者中进行了临床观察，结果放化疗疗程完成率１００％，放化疗中血象正常率１００％，Ｋａｒｎｏｆｓｋｙ评分和体重改善率９９．１％，减轻消化道反应有效率９４％，肝肾功能和心脏保护作用有效率１００％，各项指标与平消胶囊和常规药物相比有非常显著差异。以症状、体征和影像学指标评价近期辅助抗肿瘤作用，有效率均为１００％，和平消胶囊对比有显著差异，和常规药物相比有非常显著差异。本研究也通过临床药理学分析，探讨了抗癌回生散扶正抗癌作用机理，论证了其在减少手术、放化疗后的复发和转移，以增加远期疗效和改善生存率，以及减少第二原发癌发生方面的应用价值。     

健脾化湿法对脾胃湿证患者血浆SOD/MDA的影响

目的 探讨脾胃湿证不同腻苔患者血浆SOD/MDA的改变及健脾祛湿治疗的影响。方法 选取60例脾胃湿证患者，分为寒湿和湿热两组（各30例），分别检测患者血浆SOD和MDA的水平，并进行健脾化湿治疗观察；MDA检测采用TBA法，SOD采用RIA法。结果 脾胃湿证时，黄、白腻苔患者血浆SOD水平较正常薄白苔降低，MDA明显升高，且与腻苔厚度有一定的平行关系。健脾祛湿治疗对血浆SOD/MDA水平具有改善作用。结论 腻苔的形成与氧自由基损伤有关，健脾祛湿法能有效地改善腻苔和治疗脾胃湿证，其机制可能与其清除氧自由基及抗氧化损伤作用有关。     

益气活血中药干预糖尿病动脉硬化家兔模型血管平滑肌细胞凋亡的研究

目的 观察益气活血中药对糖尿病动脉硬化家兔模型血管平滑肌细胞凋亡及凋亡相关基因Bcl-2表达的影响。方法 静脉注射胰岛β细胞毒剂四氧嘧啶，并以高糖高脂饲料复制家兔糖尿病动脉硬化模型，造模6周后，再给药6周，观察主动脉内膜的病理形态学改变，采用流式细胞术检测凋亡率以及凋亡相关基因Bcl-2表达。结果 益气活血中药能使糖尿病动脉硬化家兔动脉管腔狭窄减轻，斑块稳定，平滑肌细胞凋亡率明显降低，Bcl-2基因蛋白表达上调。结论 益气活血中药通过调节凋亡基因Bcl-2表达，抑制血管平滑肌细胞凋亡，防止斑块形成，对糖尿病血管病变具有防治作用。     

前健脾后补肾对力竭运动大鼠肾功能和肾细胞凋亡的影响

目的研究中药前健脾后补肾对力竭运动大鼠肾功能的影响及其作用机制。方法将24只雄性SD大鼠分为安静对照组、力竭运动组、力竭运动前健脾后补肾组,力竭运动后24小时取材,检测血清尿素氮、肌酐和尿蛋白含量,HE染色观察肾组织细胞,原位末端标记法(TUNEL)检测肾凋亡细胞。结果力竭运动前健脾后补肾组比力竭运动组的血清尿素氮、肌酐、尿蛋白及凋亡指数低(P<0.05),无类似于力竭运动组的肾组织坏死现象。结论力竭运动造成的肾功能降低可能与肾细胞凋亡、病理损害有关,前健脾后补肾能减轻这些变化,起到一定的保护肾功能作用。     

临床技能学技能强化训练的现状与对策

为了提高医学生临床技能学技能操作水平，我院实行了临床专业学生毕业实习前强化训练方案，笔者将近年来技能操作教学的情况中存在的问题进行剖析，同时给出了相应的应对措施，以期在今后的教学过程中借鉴并不断提高。