《临证指南医案》中风证治特色探析

总结《临证指南医案》中风的诊治思路,指出叶天士在"肝肾阴虚,水不涵木,阳化内风"病机认识基础上,临证灵活运用滋养肝肾、潜阳息风的治疗法则,并融入络病理论,创辛润通络、化湿通络、祛痰通络、养血和络等多种和络通络之法,并重视岁时节气对人体的影响,依据时令不同加减用药,临床不囿于成法,辨证施治,对复杂病证处理分标本缓急,又常多法并用,防治中风先兆。     

Dynamics and topography of human temperature regulation in response to thermal and work load

Summary Climatic chamber experiments were carried out with male subjects who were submitted to various rapid temperature changes. All experiments were performed first with the subjects at rest and later at work on a bicycle ergometer. The aims of the study were 1) to obtain quantitative data enabling to determine effects of a) abrupt thermal load, b) abrupt work load, and c) combined load on the topography and the dynamics of temperatures and effectors, and 2) to answer the question whether the effects of combined load may be computed by a linear superposition of pure thermal plus pure work load.Skin temperatures generally respond more directly to abrupt changes of thermal than of work load. This is in contrast to the dynamic behaviour of central temperatures which moreover exhibit the interesting effect of a transient paradoxical respone both to the onset of work and of thermal load.Time constants of the dynamics of metabolic heat production are high in response to changes of thermal load as compared to the time constants at the onset and end of worl. Generally the time constants of skin temperatures are shorter at rest than at work. Temperature topography changes only to a small extent in exercising subjects.The central temperature increase to combined thermal and work load is not significantly different from the added amount of temperature increases due to pure thermal and to pure work load. This suggests a quasi-linear superposition of both thermal effects and confirms, in accordance with further evidence of this and former studies, the hypothesis that work load does not interfere non-linearly with the regulatory processes. However, an input from thermosensitive elements in the muscles should be assumed.Supported by the Deutsche Forschungsgemeinschaft, SFB 114     

Modern screening strategies in analytical toxicology with special regard to new benzodiazepines

Summary Screening procedures for the detection of toxicologically relevant substances have become of ever-increasing importance due to the rapid development of new substances. Identification methods must be simple, sensitive, and practicable. This article describes standardized chromatographical (corrected R _f ^c values, retention indices) and immunological methods (enzyme-multiplied immunoassay technique, fluorescent polarization immunoassay) with special regard to the screening of some newer benzodiazepines, a class of substances that is still expanding. Some of these new compounds may be integrated in well-known screening procedures (via aminobenzophenones and detection by the Bratton-Marshall reagent); others require special concepts for detection. The problems are indicated and discussed, including the use of high-pressure-liquid chromatography and mass spectrometry; recommendations are given.In memoriam Johann Bösche     

A case-control study of psycholotical and psychosocial risk factors for shoulder and neck pain at the workplace

Risk factors associated with work-related shoulder and neck myalgia were investigated in a case-control study with pairs matched for age, gender, and physical exposure. Guided interviews with standardized and self-constructed questionnaires were performed among manual (n = 15 pairs) and office (n = 24 pairs) workers. Perceived general tension was the variable with the strongest association with shoulder and neck pain in both work groups. Otherwise, the results in the two groups were very different, indicating that different risk factors and mechanisms were associated with shoulder and neck pain in the two work groups. The study provides background information for future attempts to establish causal relationships between physical and psychosocial exposure and shoulder and neck pain, which can be more accurately investigated in a longitudinal rather than a cross-sectional experimental design.     

Technetium-99m mercaptoacetyltriglycine clearance values in children with minimal renal disease: can a normal range be determined?

Use of technetium-99m labelled mercaptoacetyltriglycine (^99mTc-MAG3) simplifies and improves the quantification of renal clearance in children by virtue of its permanent availability, good imaging properties and low radiation exposure. Due to the lack of reference values for ^99mTc-MAG3 clearance in children, the Paediatric Task Group of the EANM initiated a multicentre study to evaluate ^99mTc-MAG3 clearance values in children with minimal renal disease. One hundred and twenty-five children aged between 12 months and 17 years, classified as renally healthy using defined diagnostic criteria, were included in the study. ^99mTc-MAG3 clearance was calculated using an algorithm on the basis of a single blood sample taken at any time between 30 and 40 min after tracer injection. In addition, the absolute ^99m-Tc-MAG3 clearance values were normalized to body surface area. For further evaluation the children were classified into several groups according to age. There was a continuous increase in non-corrected ^99mTc-MAG3 clearance values from the age of 1 year up to the age of 17 years (mean value <2 years: 98±57 ml/min; mean value >8 years: 208±66 ml/min). Normal clearance values for adults were achieved by the age of 8 years. Analysis of the relationship between non-corrected clearance and age yielded a correlation coefficient of r=0.7. When these absolute clearance values were normalized to body surface area, we found nearly constant clearance values for all age groups, with a mean clearance value of 315±114 ml/min×1.73 m². The correlation coefficient for the relationship between normalized clearance and age was r=0.28. In conclusion, the clearance of ^99mTc-MAG3 increases continuously throughout childhood into adolescence due to the maturation and growth of the kidney. After normalization of the absolute clearance to body surface area, no correlation between clearance and age could be proven. Received 16 June 1997 and in revised form 1 September 1997     

海拔5200m重体力劳动45天心肺X线改变及对劳动能力的影响

作者对海拔５２００ｍ从事重体力劳动４５天的４８名青年在劳动前后现场摄取Ｘ线胸片。结果：心脏横径、心脏长径、心脏面积、心胸比率较初入高原时显著缩小（Ｐ〈０．０１）；肺动脉干横径、肺动脉段突度、右肺下动脉横径、右肺下动脉与气管横径比值显著增加（Ｐ〈０．０１）；升主动脉和主动脉横径、胸宽和肺面积增加或显著增加（Ｐ〈０．０５或Ｐ〈０．０１）。其中２例诊断为高原性心脏病，３例诊断为高原性肺水肿。在海拔５２０     

A high flow turbine CPAP system

A continuous high flow CPAP system incorporating a turbine blower is described. The system achieves inspiratory flow rates of 150l/min or more by means of reticulated gas flow and inspired oxygen fractions of 0.21–0.95. Positive airway pressure is provided by weighted disc valves and a modified aviationtype CPAP face mask provides electronic communication with the patient. The mobility of the system also enables its use as an intermittent physiotherapy aid. Work of breathing of the system, as assessed by total pressure fluctuations, is at a minimum.     

Reference values of motor unit action potentials obtained with multi-MUAP analysis

We collected reference values of motor unit action potentials (MUAPs) from healthy deltoid, brachial biceps, first dorsal interosseous, lateral vastus, and anterior tibial muscles in 105 subjects between 15 and 86 years. The MUAPs were recorded with a concentric needle electrode and extracted with a decomposition method we call multi-MUAP analysis. The main goal is to identify and extract MUAPs. Also, the firing pattern of the motor units can be followed. No significant changes with age were found for duration, spike duration, thickness, amplitude, area, size index, or number of phases in all muscles studied. We did not find any influence of gender or height. We found higher amplitudes and shorter durations compared with previous studies. This may be due to a higher contraction level that can be used with a decomposition technique. No right-left side differences were found. The coefficient of variation of the parameters in repeated examinations was small, which implies a good reliability of the measurements. Interexaminer variability of four investigators was not greater than in repeated studies. © 1994 John Wiley & Sons, Inc.     

Investigation of the spontaneous modes of breathing of different ventilators

We investigated six ventilator systems which were designed to allow spontaneous breathing. The time delay between initiation of inspiratory effort and the beginning of inspiratory gas flow was measured, as was the amount of negative (to ambient) pressure generated in the airway needed to produce the gas flow. We found that the flow-by program of the Puritan-Bennett 7200 caused minimal time delay and virtually no negative pressure was required to instigate gas flow. This should be contrasted with the other ventilator systems, which caused significant delay and inspiratory effort and hence increased work of breathing.     

On tests for equality of predictive values for t diagnostic procedures

This paper concerns comparisons of the efficiency of several diagnostic tests, as characterized by the measures of sensitivity (xi), specificity (eta) and predictive value (rho). We show that hypotheses concerning the equality of predictive values relate only to hypotheses concerning xi and eta and that we can test these by approximate chi 2 statistics. Data for the cases of t = 2 or 3 diagnostic tests illustrate the method.