中医肿瘤理论传承发展历程——“扶正培本”到“调气解毒”

回顾现代中医肿瘤学科近60年的发展,形成了“扶正培本”理论体系,中医肿瘤理论得以发展,循证和基础研究取得突破,抗肿瘤新药研发问世。在此基础上,我们创新性地将“气机升降”学说应用于中医肿瘤学,立足“扶正培本”学术思想体系,提出“调气解毒”学说,进一步阐发其科学内涵及理论外延,发挥现代中医药防治肿瘤的特色和优势。     

从耳鸣响度看听阈提高的速度

目的　了解神经性渐进性耳鸣、耳聋患者的耳鸣响度与听阈提高速度的关系。方法　对 5 0例 (76耳 )神经性耳鸣并伴听阈提高的患者作纯音听阈及耳鸣响度的测试 ,并根据病程时间计算听阈提高速度。对 2 5耳耳鸣响度在≤ 10 d B听力级 (HL )的患者与 5 2耳耳鸣响度在 >10 d B HL的患者之提高速度进行比较 ,并进行统计学分析。结果　耳鸣响度≤ 10 d B的 2 4耳与 >10 d B的 5 2耳听阈之提高速度在 3 k Hz以上高频区差异有显著性 (P<0 .0 1)。结论　耳鸣响度大小与听阈提高速度有关联。听阈的提高速度随着耳鸣响度的加大而增快     

Characteristics and long-term outcomes of aortico-left ventricular tunnel

Open in a separate window OBJECTIVESAortico-left ventricular tunnel (ALVT) is an extremely rare, abnormal paravalvular communication between the aorta and the left ventricle. Few studies have identified the characteristics and long-term prognosis associated with ALVT. METHODSThe data of 31 patients with ALVT from July 2002 to December 2019 were reviewed. Echocardiography was performed in all patients during the follow-up period.RESULTSThe median age of the patients was 11.5 years. Bicuspid aortic valve and dilatation of the ascending aorta were found in 13 patients, respectively. The aortic orifice in 20 patients showed a close relation to the right sinus and the right–left commissure. Of the 31 patients, 26 were operated on. Mechanical valve replacement was performed in 4 patients and aortic valve repair, in 6 patients. Ascending aortoplasty was performed in 5 patients and aortic replacement was done in 2 patients. One patient died of ventricular fibrillation before the operation. Follow-up of the remaining 30 patients ranged from 1 to 210 months (median 64 months). There were 4 deaths during the follow-up period: 1 had mechanical valve replacement and 3 did not undergo surgical repair. In the 26 patients without aortic valve replacement, 6 had severe regurgitation and 2 had moderate regurgitation. In the 28 patients without replacement of the ascending aorta, 11 had continued dilatation of the ascending aorta, including those who had aortoplasty.CONCLUSIONSThe aortic orifice of ALVT showed an association with the right sinus and the right–left commissure. For patients who did not have surgery, the long-term survival rate remained terrible. Surgical closure should be done as soon as possible after ALVT is diagnosed. The main long-term complications after surgical repair included aortic regurgitation and ascending aortic dilatation.     

Congenital thrombotic occlusion of the ascending aorta and the aortic arch

Summary In a one-day-old male newborn with severe heart failure, the skin of the upper right thorax was pink, whereas the remaining areas were cyanotic. No peripheral pulses were palpable and the blood pressure could not be measured. On cardiac catheterization, systolic and diastolic pressures were elevated in the left ventricle (137/4/12 mmHg), but in the descending aorta, reached via a patent ductus arteriosus, the pressure was only 55/45 mmHg. O₂ saturation was 97% in the left ventricle and 67% in the descending aorta. Angiocardiography showed an extreme obstruction of the ascending aorta and the aortic arch. The infant died on the second day. Postmortem examination revealed a wall-adherent calcified thrombus that totally occluded the lumen. No etiologic explanation could be obtained from the histologic examination, anamnestic data, or clinical findings.     

Measurement of Acute Tolerance to Alcohol in Human Subjects

Acute tolerance can be defined as a decrease in response to alcohol within a single exposure to the drug, which occurs independently of changes in blood alcohol concentrations (BACs). BACs change over time in most human alcohol administration studies, and computational techniques that account for these changes must be used to measure the rate of acute tolerance development. The most widely used acute tolerance measure in human research is often called the Mellanby effect, and involves the comparison of responses at the same BAC on the ascending and descending limbs of the blood alcohol curve. We compared the Mellanby measure with two other measures of acute tolerance: a conceptually similar area under the curve measure, and a slope function approach that used data only from the descending limb of the blood alcohol curve. The measures were intercorrelated and discussed with regard to empirical and conceptual issues. Exploratory comparisons of those with and with-out a family history of alcoholism are reported. Methodological recommendations for the computation of acute tolerance are made. The results suggest new methods for measuring the rate of acquisition of acute tolerance, and suggest areas for future research on tolerance-proneness and risk for alcoholism.     

Cystic degeneration following severe spinal trauma. Clinical observations in 30 patients

Secondary, in most cases ascending neurological deterioration following severe spinal trauma has been known since the beginning of this century. The alterations are caused by cystic cord degeneration and probably are due to venous circulatory disturbances. In a review of the literature 680 cases were found. The present paper describes findings in our 30 patients. Modern diagnostic methods provide exact localization and evaluation of the cysts. These can then be drained microsurgically. Short-term success is good in many cases, long-term developments will be observed carefully. The functional loss of only one segment can, depending on the level of the original lesion, result in dramatic consequences for the patient.     

腔内修复联合旁路手术治疗DeBakeyⅠ型升主动脉夹层

目的探讨腔内修复联合人造血管旁路手术治疗DeBakeyⅠ型升主动脉夹层的临床应用价值。方法分析2005年中山大学附属第一医院血管外科运用腔内修复联合人造血管旁路手术治愈的2例DeBakeyⅠ型升主动脉夹层临床资料。结果腔内修复前先行左锁骨下动脉-左颈总动脉-右颈总动脉人造血管旁路手术,然后从右股总动脉将带膜支架植入升主动脉封闭内膜撕裂口,并同时封闭无名动脉和左颈总动脉,1例术后即时造影和术后2个月随访造影均显示升主动脉夹层消失,无内漏,颈部人造血管旁路血流通畅,病人健康生存;另1例术后2个月随访,一般情况良好。结论对于内膜撕裂口靠近无名动脉和左颈总动脉的DeBakeyⅠ型升主动脉夹层,腔内修复联合人造血管旁路手术是一种安全而有效的治疗方法。     

Undescended testes: early versus late maldescent

A review of 468 orchidopexies was undertaken to ascertain the importance of a complete hernial sac extending to or beyond the testis. A hernial sac was present in 84% (171/202) of testes in patients under 5 years of age, in contrast to 23% (61/266) in patients over 5 years. It seems reasonable to presume that the failure of the hernial sac to close is secondary to failure of normal descent, which in turn is due to antenatal factors and may be classified as early maldescent. In the older age group maldescent is due to failure of the last stage of descent, which should occur in the 5- to 10-year prepubertal age period (late maldescent, or the ascending testis). The cause of late maldescent is not due to a short processus, as this increases in length with age (approximately 0.5 cm/year), unless the persistence of the processus itself is the cause. A classification of early or late maldescent is suggested.     

Intrathecal substance P depresses spinal motor and sensory responses to stimulation of nociceptive afferents — Antagonism by naloxone

Summary The effect of an injection of substance P into the subarachnoid space was studied on a motor and a sensory response elicited by supramaximal stimulation of the sural nerve in spinal rats. Substance P 10 g depressed the reflex activation in the electromyogram recorded from the ipsilateral tibialis anterior muscle; the depression was significant 5 and 10 min after the injection. Substance P 10 g reduced the activity in ascending axons of the spinal cord evoked by stimulation of afferent C fibres; the effect developed slowly, lasted longer than 60 min and was abolished by an i.v. injection of naloxone 0.2 mg/kg. Only half the number of ascending axons tested showed a depression by substance P, and the administration of a higher dose (50 g) did not produce an effect in a greater number of axons. Substance P did not influence the activity evoked in ascending axons by stimulation of afferent A and A fibres. The depression by substance P of ascending nociceptive activity was antagonized by an i.v. injection of naloxone 0.2 mg/kg. When naloxone 0.2 mg/ng i.v. was administered alone, it increased the activity in ascending axons activated by afferent C fibre stimulation. It is concluded that (i) substance P depresses spinal nociceptive activity without the intermediation of endorphinergic neurons, and (ii) naloxone antagonizes tonic inhibition of the spinal nociceptive system mediated by endogenous opioid peptides and, by facilitating excitatory transmission through disinhibition, neutralizes the depression produced by substance P.Supported by the Sonderforschungsbereich 38 Membranforschung     

非体外循环下冠状动脉旁路移植术中升主动脉钙化的处理

目的 探讨非体外循环冠状动脉旁路移植术(OPCAB)中升主动脉钙化的处理方法,总结手术效果,以减少OPCAB后脑血管事件的发生. 方法 回顾分析2004年9月～2007年12月期间,我院连续治疗的236例伴有升主动脉钙化行冠状动脉旁路移植术患者的临床资料,其中4例采用"No-touch"技术,35例采用Enclose辅助完成近端吻合,197例采用Heartstring辅助完成近端吻合.术中监测血流动力学指标,所有移植血管桥均采用瞬时测血流量技术(TTFM)保证吻合口吻合质量. 结果 远端吻合口881个,近端吻合口267个,桥血管血流量16.2±18.7 ml/min,弹力指数(PI)4.9±2.3,近端吻合口吻合前、后血流动力学指标为:平均动脉压(MAP)78.1±10.4 mmHg vs. 80.9±8.1 mmHg,肺毛细血管楔压(PCWP)11.9±3.6 mmHg vs. 10.9±2.1 mmHg,平均肺动脉压(MPAP)17.3±4 3 mmHg vs. 15.3±2 8 mmHg,心排血量(CO)4.2±1.2 L/min vs. 4.5±1.6 L/min,中心静脉压(CVP)9.2±2.3 cmH2O vs. 9.3±1.8 cmH2O,心率(HR)71.4±14.0次/分vs. 73.4±16.5次/分等,其变化差异无统计学意义(P>0 05).2例因术后发生低心排血量死亡,4例患者术后有脑供血不足症状,经内科治疗随访2个月后好转,其余患者无围手术期心肌梗死等重大并发症发生;住院时间10.5±4.2d.185例随访3～24个月,无心血管事件及脑血管意外,心功能改善、心绞痛缓解. 结论 术前及术中充分评估主动脉钙化程度,采用减少升主动脉操作的近端吻合器吻合技术,可减少脑血管意外的发生,取得良好的临床效果.