清瘟解毒汤联合常规治疗对热毒壅滞型细菌性脓毒血症患者的临床疗效

目的考察清瘟解毒汤联合常规治疗对热毒壅滞型细菌性脓毒血症患者的临床疗效。方法94例患者随机分为对照组和观察组,每组47例,对照组给予常规治疗(抗感染、吸氧、早期体液复苏等),观察组在对照组基础上加用清瘟解毒汤,疗程2周。检测临床疗效、CKMB、Scr、ALT、TGF?β1、CHE、SOFA评分、WBC、PCT、CRP、NK细胞、PT、CD4+/CD8+、并发症发生率变化。结果观察组总有效率高于对照组(P<0.05),并发症发生率更低(P<0.05)。治疗后,2组CKMB、Scr、ALT、TGF?β1、SOFA评分、WBC、PCT、TNF?α降低(P<0.05),PT缩短(P<0.05),CHE、NK细胞、CD4+/CD8+升高(P<0.05),以观察组更明显(P<0.05)。结论清瘟解毒汤联合常规治疗可促进热毒壅滞型细菌性脓毒血症患者感染康复,减轻炎症反应,提高免疫力,保护脏器功能,降低并发症发生率。     

How Picky Eating Becomes an Illness—Marketing Nutrient-Enriched Formula Milk in a Chinese Society

The essential adaptive food selection behavior of young children has become increasingly medicalized as a kind of disease—the “picky-eating” syndrome in Hong Kong. The researcher used the multiple case studies approach with data collected from in-depth interviews and advertisements to examine the process of the medicalization of picky-eating disorder, which demonstrates how an essential adaptive human behavior can be redefined by the market and medical system as a deviant, abnormal behavior that needs to be eliminated and how the resulting health risks can be resolved by modern medicine produced by this pharmaceutical nexus.     

Should sleep laboratories have their own predictive formulas for continuous positive airway pressure for patients with obstructive sleep apnea syndrome?

BackgroundSeveral formulas predicting optimal continuous positive airway pressure (CPAP) for obstructive sleep apnea treatment have been developed and diverse parameters selected as predictive factors in different sleep laboratories using different ethnic groups. This study aimed to validate a constructed predictive formula for the study laboratory and to test the hypothesis that sleep laboratories should have their own predictive formulas.MethodsFifty-seven adult subjects with obstructive sleep apnea syndrome (OSAS) were enrolled in the model-building set and underwent two polysomnography (PSG) studies to diagnose OSAS and titrate for optimal CPAP. A predictive formula, derived from anthropometric and polysomnographic variables, was validated together with two other predictive formulas in 30 subjects by comparing the mean predictive CPAP values, rates of successful prediction, and agreements.ResultsRegression analysis showed that apnea–hypopnea index (AHI), SaO_2nadir (nadir of arterial oxyhemoglobin saturation by pulse oximetry), and body mass index (BMI) strongly correlated with optimal CPAP. The derived predictive formula for the study laboratory was: CPAPpred (predictive CPAP) = 6.380 + 0.033 × AHI – 0.068 × SaO_2nadir + 0.171 × BMI (R² = 0.335, adjusted R² = 0.298). In Taiwan, different predictive formulas used by different sleep laboratories with different independent predictors led to similar mean predictive CPAP values to the mean observed optimal CPAP values, rates of successful prediction, and agreements with the observed optimal CPAP. There were significant differences between the mean predictive CPAP values and mean observed optimal CPAP values, lower rates of successful prediction, and negatively skewed 95% confidence interval (CI) when using a predictive formula derived from different ethnic populations.ConclusionA sleep laboratory may not need to have its own predictive formula for determining the optimal effective CPAP but should adopt the one derived from the same ethnicity of OSAS patients as the reference formula.     

柴胡解毒汤联合干扰素治疗慢性乙肝的疗效和对细胞因子的影响及机制

目的:观察柴胡解毒汤在治慢性乙型肝炎方面的临床疗效,并借此探讨该方对细胞因子的影响。方法:选取2015年9月至2016年3月重庆三峡高等专科学校附属医院收治的慢性乙型肝炎患者90例,随机分成对照组和观察组,每组45例。对照组采用干扰素注射,1次/d,连续2周后,再改为隔日1次,连用3个月;观察组在使用干扰素基础上采用中药柴胡解毒汤治疗,2次/d,同样治疗14 d后观察2组治疗的临床疗效、肝功能比较、药物不良反应、血清IL-1β、IL-6、5-HT及TNF-α水平的变化、HBs Ag、HBe A、HBV-DNA阴转率等情况。结果:1)治疗后观察组有效率86.67%,对照组有效率68.89%,2组有效率比较,差异有统计学意义(P0.05);2)2组与治疗前比较,肝功能指标均有明显改善,差异有统计学意义(P0.05);治疗后,观察组ALT、AST及TBIL值均明显低于对照组,差异有统计学意义(P0.05);3)不良反应中,对照组出现10例(33.00%),观察组4例(8.80%),观察组不良反应明显低于对照组,差异有统计学意义(P0.05);4)2组患者在治疗前,检测的血清IL-1β、IL-6、5-HT及TNF-α含量比较,差异无统计学意义(P0.05),而组间治疗后比较,观察组明显低于对照组,治疗后,上述指标均较治疗前下降,但观察组下降更明显,差异有统计学意义(P0.05);5)观察组HBs Ag阴转率为24.4%、HBe Ag阴转率为33.3%、HBV-DNA阴转率为48.8%均明显高于对照组,对照组HBs Ag阴转率为15.5%、HBe Ag阴转率为11.1%、HBV-DNA阴转率为28.9%,2组比较差异有统计学意义(P0.05)。结论:柴胡解毒汤在治疗慢性乙肝方面有显著的临床效果,且不良反应较传统干扰素明显降低,值得推广,同时,该药对细胞因子等指标也有明显降低作用,考虑其可能是通过类似机制起作用。     

Promoting safe infant feeding practices – the importance of structural,social and contextual factors in Southern Africa

There has been significant progress towards the goal of eliminating vertical transmission of HIV by 2015. However, a question that remains is how we can most effectively prevent late postnatal transmission of HIV through infant feeding. Guidelines published by the World Health Organization in 2010 have been widely adopted. These guidelines place strong emphasis on exclusive breastfeeding, in some countries over‐turning a prior emphasis on formula feeding. Where available, provision of antiretroviral treatment for HIV‐positive mothers or prophylaxis for infants offers additional protection against vertical transmission through infant feeding. However, merely changing guidelines is not sufficient to change practice, particularly with regard to culturally sanctioned forms of feeding, such as mixed feeding. This commentary highlights structural, social and contextual barriers to effective implementation of the guidelines and suggests ways to address some of these barriers.     

Accuracy of the Common Predictive Equations for Estimating Resting Energy Expenditure among Normal and Overweight Girl University Students

Objective: The aim of the present study was to determine the accuracy of commonly used predictive formulas of resting metabolic rate (RMR) compared to measured RMR in normal and overweight young females.

Methods: In this cross-sectional study, 98 female university students aged 18–30 years with body mass index 18 to 30 kg/m² were recruited. Anthropometric indices and body compositions were measured. RMR was measured by indirect calorimetry (FitMate, Cosmed, Rome, Italy) and estimated by 11 predictive formulas. The accuracy of the RMR formulas and mean percentage differences between estimated and measured values were calculated. Paired t test was used to compare estimated and measured RMRs.

Result: There were no significant differences between measured and estimated RMR by the 4 commonly used formulas (Mifflin, Cunningham, and World Health Organization [WHO]/Food and Agriculture Organization [FAO]). Among all of the equations, the Mifflin formula showed the lowest bias (?2.97 ± 116.43 kcal/day) at the group level and was the most accurate formula (80.23%) in normal and overweight participants. The over- and underestimated values were about 14% and 5.5%, respectively. In normal and overweight females, Mifflin was the most accurate formula, with 75.51% and 84.61% accuracy, respectively.

Conclusion: Given the current lack of a standardized formula that consistently delivers accurate results, the Mifflin formula can be recommended for estimating energy requirements in normal and overweight females in clinical practice.     

Leonardo da Vinci's “A Skull Sectioned”: Skull and dental formula revisited

What can be learned from historical anatomical drawings and how to incorporate these drawings into anatomical teaching? The drawing “A skull sectioned” (RL 19058v) by Leonardo da Vinci (1452–1519), hides more detailed information than reported earlier. A well‐chosen section cut explores sectioned paranasal sinuses and ductus nasolacrimalis. A dissected lateral wall of the maxilla is also present. Furthermore, at the level of the foramen mentale, the drawing displays compact and spongious bony components, together with a cross‐section through the foramen mentale and its connection with the canalis mandibulae. Leonardo was the first to describe a correct dental formula (6424) and made efforts to place this formula above the related dental elements. However, taking into account, the morphological features of the individual elements of the maxilla, it can be suggested that Leonardo sketched a “peculiar dental element” on the position of the right maxillary premolar in the dental sketch. The fact that the author did not make any comment on that special element is remarkable. Leonardo could have had sufficient knowledge of the precise morphology of maxillary and mandibular premolars, since the author depicted these elements in the dissected skull. The fact that the author also had access to premolars in situ corroborates our suggestion that “something went wrong” in this part of the drawing. The present study shows that historical anatomical drawings are very useful for interactive learning of detailed anatomy for students in medicine and dentistry. Clin. Anat., 2013. © 2012 Wiley Periodicals, Inc.     

经典名方小续命汤的历史沿革及临床应用考证

国家中医药管理局颁布的《古代经典名方目录（第一批）》中小续命汤出自《备急千金要方》卷八·诸风，该文对小续命汤来源的追溯、历史发展、变化的进程及临床应用均进行系统的考证。考证结果表明，续命汤及其类方是唐宋以前治疗中风的主要方剂，延绵七八百年，为治风准绳，其中以小续命汤最具代表性。小续命汤由续命汤衍变而来，方名最早出现于东晋《小品方》，唐代孙思邈将其纳入《备急千金要方》，对其治疗中风的疗效推崇备至，曰“诸风服之皆验”，后经《外台秘要》及多部医著记载，被列为治疗中风第一要方。宋以后，随着医家对中风病机认识的变化及对小续命汤认识的局限性导致其在中风证的临床应用中逐渐减少，近现代以来又被重新认知和应用，期间其临床应用也发生了较大的变迁。其临床应用范围广泛，涉及多种脑部及神经系统相关疾病，包括但不限于①脑卒中及其后遗症，②周围性面瘫，③类风湿关节炎，④高血压，⑤其他运动神经系统疾病等。主治为脑卒中及其后遗症，其次为周围性面瘫，还有其他新的适应证正逐渐被发现，以上为小续命汤的临床定位、新药转化研究提供有效性安全性的参考依据。