戴德英教授治疗不同类型子宫内膜异位症经验

[目的]探析戴德英教授临床治疗不同类型子宫内膜异位症的经验。[方法]通过门诊跟师学习,整理相关病例资料,从子宫内膜异位症的临证特点、戴师创制红藤方的思路及针对不同类型内异症的治疗经验三个方面展开,分析戴德英教授运用红藤方治疗不同类型子宫内膜异位症的经验,并附三则验案以验证。[结果]子宫内膜异位症因其表现之"杂"与复发之"勤"而成为妇科疑难病症。戴德英教授究其病因病机为癥积下焦、瘀久化热、瘀热互结、胞脉阻滞,临证注重审证求因,以经方为本,辨证加减,创制红藤方,并根据不同临床表现,结合不同治法,临床每获良效。本文所附三则验案,分别为子宫内膜肺异位,辨证为瘀热内结、肺气不宣;子宫腺肌病,辨证为腑气不通、湿热内结;经行腹痛,辨证为气滞血瘀、蕴而化热,戴师分别予红藤方加减配合调周治疗,中西医结合及中医内外疗法综合治疗,均获良效。[结论]戴德英教授辩证地看待病和证的关系,临床巧用红藤方结合不同治法治疗不同类型子宫内膜异位症,其经验值得后辈学习借鉴。     

何若苹教授运用二苓和安汤治疗肺腺癌经验

[目的]总结何若苹教授运用二苓和安汤治疗肺腺癌的临证经验。[方法]通过跟师侍诊、收集病例,从中医病因病机、汤药方义、随证加减三个方面对何若苹教授运用二苓和安汤治疗肺腺癌的理论及思路进行分析总结,并举隅医案加以佐证。[结果]何若苹教授认为,肺腺癌病机多以肺脾肾三脏不足为本,以气滞、水湿、痰饮搏结为标,故从益气养阴、补肾填精、利水渗湿、清热解毒等四个方面着手,创制二苓和安汤,随证化裁,治疗肺腺癌。对于阴亏与痰浊并存之患者,何教授先以甘露消毒汤祛其标,再对症治疗。所举验案为老年肺腺癌患者,辨证为气阴不足、痰浊内蕴,治以扶正祛邪、养阴利水,方用二苓和安汤,病情缓解,疗效确切。[结论]何若苹教授运用二苓和安汤治疗肺腺癌,体现出中医专病专方、辨病与辨证相结合的治疗特色,值得学习、总结和推广。     

六味地黄方通过上调肠道雌激素受体改善绝经后ApoE-/-小鼠脂代谢异常研究

目的?应用双侧卵巢去势的ApoE-/-小鼠建立绝经后脂代谢异常模型,探究六味地黄方(LW)能否通过调节肠道雌激素受体改善绝经后脂代谢异常。方法?正常饮食的C57/B6小鼠为对照组(n=6),高脂饮食并接受假手术的ApoE-/-小鼠为假手术对照组(n=6),高脂饮食并接受双侧卵巢去势的的ApoE-/-小鼠为模型组(n=6),模型小鼠接受4.5?g/kg (n=6)或9.0?g/kg (n=6)的六味地黄方治疗90?d。生化法检测小鼠血清中总胆固醇（TC）、甘油三酸酯（TG）、低密度脂蛋白（LDL-C）及高密度脂蛋白（HDL-C）水平,HE染色检测小鼠肝脏脂质损伤,油红染色检测小鼠肝脏脂质堆积,免疫荧光染色检测小鼠空肠雌激素受体α（ERα）、雌激素受体β（ERβ）、ABCG5、ABCG8、PI3K p110β及p-AKT的表达水平,免疫化学染色检测小鼠空肠NPC1L1的表达水平,Western blot法检测小鼠空肠NPC1L1、ABCG5及ABCG8的表达水平。结果?六味地黄方可降低模型小鼠血清TC、TG及LDL-C水平,升高HDL-C水平（P<0.05~0.01）;同时,六味地黄方可显著降低模型小鼠的肝脏脂质损伤和脂肪堆积（P<0.05~0.01）。六味地黄方显著增加模型小鼠空肠内降低的ERα和ERβ水平（P<0.05~0.01）。六味地黄方显著降低模型小鼠空肠中NPC1L1的表达水平（P<0.05）,并上调ABCG5和ABCG8的表达水平（P<0.01）。六味地黄方显著增加模型小鼠空肠内PI3K p110β及p-AKT的表达水平（P<0.05~0.01）。结论?六味地黄方可以显著改善绝经后ApoE-/-小鼠脂代谢异常,其机制与六味地黄方调节肠道胆固醇的吸收和外排有关。上调肠道雌激素受体表达和肠道PI3K/AKT信号可能是六味地黄方调节肠道胆固醇吸收和外排的机制。      

芪竹方改善早期胃癌ESD后症状及预防复发的临床观察

目的 观察芪竹方改善早期胃癌胃黏膜剥离术（ESD）后气阴两虚型症状及预防胃癌复发的临床疗效。方法 共84例早期胃癌ESD后气阴两虚证患者随机分成2组,其中脱落6例,纳入治疗组39例,对照组39例。对照组给予胃复春治疗,治疗组予芪竹方治疗,持续治疗1 a。观察2组临床复发率、胃镜像糜烂灶、病理积分、中医证候积分及癌胚抗原（CEA）变化。结果 治疗后,治疗组在复发率方面低于对照组（5.13% vs. 20.51%,P＜0.05）,治疗组可以较好地减少糜烂灶(P＜0.01）,降低病理积分及CEA水平(P＜0.01）,改善临床症状(P＜0.01）,均优于对照组(P＜0.05）。结论 芪竹方可以较好地改善临床症状,减少胃黏膜糜烂、肠化生及异型增生,降低复发率,临床疗效显著。      

中药组方联合盐酸帕罗西汀治疗老年脑卒中后抑郁的近期疗效观察

目的探索中药组方联合盐酸帕罗西汀治疗老年脑卒中后抑郁的近期疗效。方法选取2015年5月—2017年5月就诊于清河县中心医院神经内科162例老年脑卒中后抑郁患者,随机分为对照组和治疗组,对照组给予盐酸帕罗西汀治疗,治疗组给予中药组方联合盐酸帕罗西汀治疗,观察两组治疗后汉密尔顿抑郁量表17项(HAMD-17)、日常生活能力量表(ADL)、抑郁缓解情况及不良反应。结果治疗后治疗组HAMD-17和ADL评分均较对照组低(tHAMD-17=11.571,tADL=2.601,P<0.05);治疗组抑郁缓解总有效率高于对照组(χ2=8.783,P=0.003),不良反应低于对照组(t=18.734,P<0.05)。结论中药组方联合盐酸帕罗西汀可有效改善老年脑卒中后抑郁症状,提高患者日常生活能力,值得临床推广应用。     

金银花配方颗粒评价性抽验结果分析与建议

目的：通过开展金银花配方颗粒评价性抽验,比较分析不同厂家金银花配方颗粒的质量情况,并提出监管建议。方法：收集各企业金银花配方颗粒质量标准,依据企业标准进行法定检验。结果：共抽验117批金银花配方颗粒,涉及9家生产企业。按各自企业标准进行检验,总体合格率为100%。但是各企业之间金银花配方颗粒含量差异较大且每克颗粒相当的药材（饮片）量不同,转移率不同。结论：通过本次抽验发现金银花配方颗粒的整体质量较高,但是不同厂家之间所用原料药材及生产工艺存在一定差异,导致最终产品质量参差不齐。因此,有必要规范中药配方颗粒生产工艺,尽快统一标准,加强监管。     

Method for Approximating Colloid Osmotic Pressure in Long‐Term Hemodialysis Patients

Colloid osmotic pressure (COP) is important in calculating vascular permeability during hemodialysis (HD). However, few reports have directly measured COP in HD patients. Therefore, the currently published formulas may not be clinically optimal for predicting COP for HD patients. Here, the study aims were (i) to directly measure COP in HD patients and compare the measured and predicted COP values using four previously reported formulas, and (ii) to develop a formula for approximating COP using clinical parameters. We obtained 212 measured COP values using an osmometer; the average value was 22.0 ± 0.2 mm Hg. The predicted COP based on the four different formulas was positively correlated with the measured COP (0.87 < r < 0.89), but was significantly overestimated compared to it (P < 0.001). We also performed a stepwise analysis using serum albumin and non‐albumin protein concentrations and obtained the following simple formula for COP approximation: COP (mm Hg) = ?7.91 + 5.64 × albumin (g/dL) + 3.00 × non‐albumin proteins (g/dL). A positive linear correlation was observed between the measured COP and approximated COP using this formula (r = 0.90, P < 0.001). We calculated the mean Kr (plasma‐refilling coefficient) as a marker for determining dry weight in HD patients using the measured COP and approximated COP. No differences were observed between the mean Kr derived from the measured and approximated COP. We report here significant differences between measured and predicted COP values, and have devised a simple formula for COP approximation in HD patients.     

Prolonged Corrected QT Interval in Patients with Myotonic Dystrophy Type 1

Background and Purpose

Sudden cardiac death is one of the leading causes of death in patients with myotonic dystrophy type 1 (DM1). It has been proposed that a prolonged QT interval is associated with sudden cardiac death in several neurological diseases, including multiple system atrophy, idiopathic Parkinson''s disease, and diabetic autonomic neuropathy. However, analyses of the corrected QT (QTc) interval in DM1 patients are rare in the literature. The purposes of this study were to determine the association between the QT interval and DM1, and the affecting factors.

Methods

Thirty-nine patients diagnosed with DM1 through genetic testing were enrolled. The QTc interval (calculated using Bazett''s formula: QTc=QT/√RR) was compared between these patients and 39 normal healthy controls. The clinical and laboratory factors affecting QTc interval in the patient group were investigated.

Results

The QTc interval was significantly longer in the DM1 group (411.2±44.7 msec, mean±SD) than in the normal control group (355.6±20.6 msec). Intragroup analysis revealed that a prolonged QTc interval in DM1 patients was associated with being female and older, having a longer disease duration, and exhibiting abnormal electrocardiography findings.

Conclusions

The higher incidence of sudden cardiac death in the DM1 population is associated with the observed prolonged QTc interval in those patients.     

解毒化瘀方对内毒素血症大鼠肝细胞线粒体氧化损伤的影响

目的:观察解毒化瘀方对内毒素血症( endotoxemia,ETM)大鼠肝细胞线粒体氧化损伤的影响.方法:将56只大鼠随机分为正常对照组及内毒素注射后6小时、12小时、24小时组和解毒化瘀方6小时、12小时、24小时组.眼眶取血,检测大鼠血清肿瘤坏死因子(TNF)-α水平,同时取肝组织分离线粒体,测定其丙二醛(MDA)的含量及超氧化物岐化酶(SOD)、谷胱甘肽过氧化物酶(GSH-Px)的活性.结果:在注射内毒素6小时后,大鼠血清TNF-α水平及线粒体MDA的含量升高,线粒体SOD、GSH-Px活性下降,随着时间的延长,TNF-α水平及MDA的含量进一步升高,SOD、GSH-Px活性明显下降.与对应的内毒素组比较,经解毒化瘀方处理后,TNF-α水平及MDA的含量均降低,SOD、GSH-Px活性均升高.结论:解毒化瘀方对内毒素刺激Kupffer细胞释放TNF-α有抑制作用,同时减少内源性自由基的生成,提高机体的抗氧化损伤能力,具有保护肝细胞的作用.