论中医“证本质”的科学内涵

中医证的本质在我国已经研究了几十年,但至今对于中医证本质的科学内涵却有着不同的认识和理解。根据现代医学理论、哲学原理等,对于中医证本质的科学内涵进行了初步的理论探讨,提出了中医证的本质与单一证候的物质基础是两个不同的概念,并从西医疾病的基本发病学过程等方面探讨了证有本质的科学根据。     

拓展医院发展思路建设创新型医院

21世纪是知识经济时代,在医学科学技术飞速发展的今天,如何引领医院适应新形势的发展,需要拓展思路、创新思维。本文结合实践论述了创新型医院的概念,建设创新型医院的必要性以及建设创新型医院的思路和举措,旨在通过建设创新型医院促进医院整体发展,以提升医院核心竞争力。     

住院医师规范化培训中中医病案内涵缺失问题及对策

目的 通过补充中医病案内涵,提高住院医师规范化培训质量.方法 随机抽取80份由中医标准化培训医师撰写的中医档案,参照中医病历书写的基本规则,逐项进行检查和分析.结果 住院中医病案普遍存在的问题是中医病案内涵不完整、不完善,主要表现在四诊记录、辨证依据、三级查房记录等方面.结论 通过调查,实施一系列提高住院医师规范化培训...     

癌毒病机科学内涵的现代诠释

癌毒病机理论是程海波教授团队创建的中医肿瘤创新病机理论,近年来被广泛应用于指导恶性肿瘤的临床辨治,并取得了较好的临床疗效。癌毒是导致恶性肿瘤的一类特异性致病因子,是恶性肿瘤发生、发展的关键病机。团队长期围绕癌毒病机的科学内涵开展研究,通过探讨癌毒病机理论与肿瘤微环境的关系、癌毒病机与肿瘤微环境中的特异性致病物质的相关性,提出癌毒的科学内涵是肿瘤微环境中影响肿瘤发生、发展的一类特异性致病物质,炎症因子、乳酸、血管生成因子、免疫抑制因子、外泌体非编码RNA等可能是癌毒病机的生物学基础。结合现代肿瘤学研究进展,诠释癌毒病机的科学内涵,为进一步推广癌毒病机理论及临床应用提供科学依据。      

新时代医学教育发展趋势的思考

步入新时代后,科技革命和产业变革兴起,科技创新加速推进,成为未来发展的主导力量。科技革命衍生的新技术以及人类对医学认知的改变,使得现代医学从业者不断探索并逐渐构建起全生命周期的医学模式,医疗服务也将进入全生命周期健康服务和个性化精准诊治并存的新阶段。近年来,我国首先提出了"新医科"的概念,试图回答在未来如何发展医学教育、如何培养新时代的医学人才。这些都是新时代医学教育工作者需要解决的重大问题。因此,本文对新时代医学教育的发展趋势进行分析,从医学发展和科学研究创新方面来思考医学教育的变革以及医学人才的培养发展方向,并提出相应对策。     

Guidelines for Medical Nutrition Therapy in Gestational Diabetes Mellitus: Systematic Review and Critical Appraisal

BackgroundMedical nutrition therapy is the cornerstone of gestational diabetes mellitus treatment. However, guidelines often present contradictory guidance to health care practitioners.ObjectiveTo systematically review and critically appraise medical nutrition therapy guidelines for treating patients with gestational diabetes mellitus.DesignWe searched Medline, the Cochrane Library, Guidelines International Network, and Google Scholar to retrieve clinical practice guidelines (CPGs) for medical nutrition therapy in gestational diabetes mellitus from professional or governmental organizations, published in English, between January 1, 2007, and November 24, 2018. CPGs were reviewed and appraised using the Appraisal of Guidelines, Research, and Evaluation II instrument.ResultsOf 1,286 retrieved articles, 21 CPGs fulfilled the inclusion criteria. CPGs of the Academy of Nutrition and Dietetics, Diabetes Canada, and Malaysia Health Technology Assessment Section received the greatest overall scores and the highest scores concerning rigor of recommendations development. Many CPGs failed to involve multidisciplinary teams in their development, including patients, and often, dietitians. Applicability of the recommendations was low, lacking facilitators and tools to enhance implementation. Many CPGs demonstrated low editorial independence by failing to disclose funding and competing interests. More medical nutrition therapy recommendations were incorporated in the Academy of Nutrition and Dietetics and Malaysia Health Technology Assessment Section CPGs. The Malaysia Health Technology Assessment Section, Diabetes Canada, Academy of Nutrition and Dietetics, and Endocrine Society guidelines were recommended by the review panel herein without modifications. Overall, the CPGs suggested the consumption of adequate protein and the selection of foods with low glycemic index, divided into three main meals and two to four snacks. Weight gain recommendations were mostly based on the Institute of Medicine body mass index thresholds.ConclusionsWith few exceptions, the main developmental limitations of the appraised CPGs involved low rigor of recommendations development, lack of multidisciplinary stakeholder involvement, low applicability, and inadequate editorial independence. This indicates a need for developing more clear, unbiased, practical, and evidence-based CPGs.     

谈方剂学的内涵与外延

探讨界定了方剂学的内涵与外延,提出了方剂学科的分化设置方案,指出随着方剂学的内涵不断丰富与发展,方剂学已显露出分化外延为理论方剂学、实验方剂学、应用方剂学和临床方剂学等三级学科的雏形。认为方剂学的研究模式已由以往以文献归纳为主要方法的释理性研究,发展为集药物化学、药理学、分子生物学、计算机与信息科学等现代多学科交叉渗透的综合工程。     

中风病内生热毒之内涵、演变及特性探析

从中风病之内生热毒的内涵、形成演变及致病特性等方面阐述了内生热毒与中风病的密切关系 ,认为内生热毒乃中风病发生的关键因素。其形成与演变大体经历了隐匿态、显现态、极变态三期 ,其致病具有骤发性、酷烈性、火热性、兼夹性、善变性、顽固性等特点。热毒内炽、痰瘀交阻、相激相助、犯脑损络而发为卒中当为中风病发生的主导病机。     

基于循环肿瘤细胞探讨四藤方对胃癌根治术后患者的精准治疗

目的 观察四藤方对胃癌患者循环肿瘤细胞（Circulating Tumor Cells, CTCs）的表达影响,探讨其解毒功效的现代细胞生物学内涵。 方法 收集2020年9月至2021年9月上海中医药大学附属龙华医院肿瘤五科具有明确病理诊断的Ⅰ/Ⅱ期胃癌根治术后患者60例,按照随机数字表法随机分为2组,四藤方组予以四藤方+中西医结合常规治疗,对照组予以中西医结合常规治疗。抽取两组患者外周血并分离和富集CTCs,采用免疫磁珠阴性富集技术结合荧光原位杂交法,对CTCs进行检测并计数,进行四藤方干预分析。 结果 在60例患者中CTCs检测阳性率达81.67%（CTCs>=1个/3.2ml, 49/60）,对照组阳性率90.00%（CTCs>=1个/3.2ml, 27/30）,四藤方组阳性率73.33%（CTC>=1个/3.2ml, 22/30）;四藤方能显著降低早期胃癌根治术后患者循环肿瘤细胞计数（P < 0.001）。 结论 四藤方能够降低CTCs数目,而CTCs与复发转移密切相关,提示四藤方可能通过作用于CTCs从而产生抑制作用,达到抗胃癌抗转移作用,对临床准确选择个体化中医诊疗方案有一定的指导意义,值得进一步推广。     

Immunogenicity and protection induced by recombinant Toxocara canis proteins in a murine model of toxocariasis

Toxocariasis, a natural helminth infection of dogs and cats caused by Toxocara canis and T. cati, respectively, that are transmitted to mammals, including humans. Infection control is based currently on periodic antihelmintic treatment and there is a need for the development of vaccines to prevent this infection. Materials and Methods: Eight potential vaccine candidate T. canis recombinant proteins were identified by in silico (rTcGPRs, rTcCad, rTcVcan, rTcCyst) and larval proteomics (rTES26, rTES32, rMUC-3 and rCTL-4) analyses. Immunogenicity and protection against infectious challenge for seven of these antigens were determined in a murine model of toxocariasis. C57BL/6 female mice were immunized with each of or combinations of recombinant antigens prior to challenge with 500 T. canis embryonated eggs. Levels of specific antibodies (IgG, IgG1, IgG2a and IgE) in sera and cytokines (IL-5, INF-ɣ and IL-10) produced by antigens-stimulated splenocytes, were measured. Presence of specific antibodies to the molecules was measured in sera of T. canis-seropositive dogs and humans. Results: All seven molecules were immunogenic in immunized mice; all stimulated significantly elevated levels of specific IgG, IgG1 or IgG2a and six were associated with elevated levels of specific IgE; all induced elevated production of IFN- ɣ and IL-10 by splenocytes, but only the in silico-identified membrane-associated recombinants (rTcCad, rTcVcan, and rTcCyst) induced significantly increased IL-5 production. Vaccination with two of the latter (rTcCad and rTcVcan) reduced larval loads in the T. canis challenged mice by 54.3% and 53.9% (P < 0.0001), respectively, compared to unimmunized controls. All seven recombinants were recognized by T. canis-seropositive dog and human sera. Conclusion: The identification of vaccine targets by in silico analysis was an effective strategy to identify immunogenic T. canis proteins capable of reducing larval burdens following challenge with the parasite. Two recombinant proteins, rTcCad and rTcVcan, were identified as promising vaccine candidates for canine toxocariasis.