复方丹参滴丸和硝酸异山梨酯治疗冠心病147例报告

目的：探讨联用复方丹参滴丸与硝酸异山梨酯治疗冠状粥样硬化性心脏病、心绞痛的临床疗效及对心功能的影响。方法：根据，临床症状、体表、心电图、血液流变性和运动、耐力试验等，观察单用上述两种药物或二者合用对心功能的影响。结果及结论：复方丹参滴丸对冠心病、心绞痛有较好的疗效，与硝酸异山梨酯合用更适合血容量不足，及扩血管药物敏感的心绞痛的老年患者。     

疏风凉血汤辅助治疗激素依赖性皮炎临床观察

目的 观察中药疏风凉血汤治疗激素依赖性皮炎的临床疗效。方法 将116例激素依赖性皮炎患者随机分成两组。对照组单纯予西药对症治疗（口服氯雷他定10 mg，50%葡萄糖20 mL加10%葡萄糖酸钙10 mL、维生素C 3.0 g，静脉推注，每日1次）；治疗组在此基础上加用疏风凉血汤（白茅根30 g生地30 g牡丹皮15 g荆芥穗15 g防风10 g黄芩15 g连翘15 g栀子10 g赤芍10 g僵蚕10 g地肤子15 g茯苓15 g生甘草10 g ）水煎服，每日1剂， 4周为1个疗程。以潮红（红斑）、肿胀、毛细血管扩张、炎症性丘疹、瘙痒及其他不适感（疼痛、灼热、干皱等）为观察指标，分别按其严重程度的不同分4个等级计分，并根据治疗前后病情的积分减少率评定疗效并观察治疗过程中出现的不良反应和复发情况。结果 治疗组愈显率为76.32%，有效率为94.74%；对照组愈显率为42.50%，有效率为77.50%。两组愈显率和有效率比较，差异均有统计学意义（P＜0.01，P＜0.05）。治疗组有5例服药后出现轻度腹泻，有3例服药后出现轻度恶心和上腹部不适感，对照组中有2例服药后出现轻度嗜睡，均未影响正常治疗。随访3个月，治疗组复发率为16.00%，明显低于对照组的42.50%（P＜0.01）。结论 疏风凉血汤治疗激素依赖性皮炎较单纯西药治疗疗效好，复发率低。     

Treatment of PUVA- and retinoid-PUVA-resistant severe psoriasis with systemic cyclosporin A

Twenty patients with severe psoriasis were treated with the oral administration of 5 mg/kg/day of cyclosporin A (CyA) for 12 weeks. These patients had either failed to respond to or had become unresponsive to conventional treatments including PUVA, UVB, or combinations of etretinate and PUVA or UVB. Complete clearance and marked improvement were observed in 12 (60%) and 4 patients (20%), respectively. The average score of the Psoriasis Area and Severity Index (PASI) was 26.2 before treatment, decreasing to 18.3 in 2 weeks, 8.2 in 6 weeks, and 5.1 in 12 weeks of CyA treatment. There was a tendency for patients with lower blood levels of CyA to show smaller decreases in their PASI scores. In four patients who received skin biopsies, histological improvement was noted within 10 days of treatment; epidermal thickness had decreased by 32%, intraepidermal mitoses by 66%, and parakeratosis had disappeared almost completely. No clinical side effects or alterations in laboratory values were observed that required cessation of CyA. Exacerbations of psoriasis occurred in 11 of 16 patients within 6 weeks after stopping treatment. These results suggest that CyA could be the first choice of treatment for resistant severe psoriasis.     

伊犁三道河地区拜虫杀防治蚊虫效果观察

本文报道了对新疆伊犁三道河地区拜虫杀防治蚊虫效果观察。实验表明:该药室内滞留喷洒效果较好,持效2周左右;营院喷洒,由于此地蚊虫密度高,孳生地广泛存在而难以控制,该药虽能有效降低蚊虫密度和刺叮指数,但持效仅4～5天。因此对蚊虫的防制应采取以环境治理、消除孳生地为根本并结合化学防治、生物防治等综合防制措施,但在环境治理困难的情况下,应以室内防治和单兵防护为主。     

Non-investigational antiarrhythmic drugs: long-term use and limitations

Background: Long-term use of antiarrhythmic drugs is less important today as curative catheter ablation often is more appropriate, and the use of implantable cardioverter-defibrillators is an option. Many patients, however, still prefer, or are merely offered drug treatment. Objectives: To review current literature on conventional antiarrhythmic drugs in the intervention and device era, with focus on efficacy, side effects, drug interactions and pro arrhythmic problems in adult patients. Results/conclusion: Antiarrhythmic drugs are still justified in patients who prefer this treatment or who cannot be cured by catheter ablation owing to technical problems or lack of treatment capacity. Another main use of these drugs is adjunctive treatment after unsuccessful catheter ablation or when arrhythmias frequently recur in a patient with an implanted device. Drug interactions owing to treatment for comorbidity represent a serious challenge.     

疏肝益脾颗粒治疗慢性乙型肝炎70例

[目的]评价疏肝益脾颗粒治疗慢性乙型肝炎临床疗效。[方法]将70例轻、中度慢性乙型肝炎随机分为疏肝益脾颗粒组(治疗组)和甘利欣胶囊组(对照组),60天为1个疗程,分别于治疗前后观察两组的临床表现、肝功能、HBV标记物、HBVDNA的变化。[结果]治疗组与对照组比较在降低转氨酶上差异无显著性(P>0.05),但对部分临床症状的改善及黄疸的降低差别有显著性(P<0.01,0.05>P>0.01);对HBV标记物和HBVDNA的影响方面两组治疗前后及两组之间比较差异无显著性(P>0.05)。[结论]疏肝益脾颗粒可作为慢性乙型肝炎护肝、降酶、减轻肝脏炎症、改善临床症状较为理想的药物。更适用于有黄疸患者的治疗。     

经典名方济川煎主治“肾虚便秘”辨惑

济川煎出自明代医家张景岳所著的《景岳全书》，由当归、牛膝、肉苁蓉、泽泻、升麻及枳壳6味药物组成，是国家中医药管理局首批公布的百首经典名方之一。原书载“凡病涉虚损，而大便闭结不通，则硝、黄攻击等剂必不可用，若势有不得不通者，宜此主之。”笔者通过古今文献考证发现济川煎的功效主治存在古今演变，明清及近代医籍中其主治多是以原书记载的“虚性便秘”为根本展开，而现代则多围绕肾（阳）虚便秘、阴亏便秘展开，尤其是现代以来，中医院校规划教材中将济川煎的主治功效描述为肾虚便秘，笔者对此存在疑惑，并积极响应习总书记的号召，加强古典医籍精华的梳理和挖掘，以《景岳全书》为基础，通过原文探析、药物组成、溯源及后世发挥3个方面进行分析论证，得出济川煎是因“虚人便秘，津液亏虚，法当急下”而设，治疗虚人津亏便秘证，而非现代教材所描述的“肾虚便秘”证。济川煎的创立有渊源，后世医家从肝肾角度、土湿木郁来理解济川煎也蕴含一定道理，但还有待临床进一步挖掘和验证。通过对济川煎功效主治的梳理与讨论，可为今后经典名方济川煎的临床应用及现代开发提供理论依据与参考。     

生脉注射液联合厄贝沙坦治疗冠心病慢性心力衰竭的疗效

目的研究生脉注射液联合厄贝沙坦治疗冠心病慢性心力衰竭的疗效。方法选取我院2017年3月—2018年3月收治的100例慢性心力衰竭患者,随机分为两组各50例。对照组患者口服厄贝沙坦片,1片/次,1次/d,治疗组患者在对照组基础上每日给予生脉注射液,将30 mL生脉注射液溶于250 mL 5%葡萄糖注射液中,两组患者均持续治疗30 d。对比两组临床疗效、心功能相关指标、IL-6、CRP和TNF-α水平、临床症状消失时间和不良反应发生率。结果治疗后治疗组治疗有效率较高(P<0.05);两组患者心输出量(cardiac output,CO)、心脏指数(cardiac index,CI)、有效循环血量(effective circulatory volume,ECV)和心肌耗氧量(myocardial oxygen consumption,MVO)水平均低于治疗前(P<0.05);并且治疗组降低程度较大(P<0.05);两组患者左室射血分数(left ventricular ejection fraction,LVEF)、左室舒张末期内径(left ventricular end-diastolic dimension,LVDd)、室间隔厚度(interventricular septal thickness,IVST)、左室后壁厚度(left ventricular posterior wall thickness,LVPWT)改善(P<0.05);并且治疗组改善程度较大(P<0.05);两组患者C反应蛋白(C-reactive protein,CRP)、肿瘤坏死因子α(tumor necrosis factor-α,TNF-α)和白介素-6(Interleukin-6,IL-6)水平低于治疗前(P<0.05);并且治疗组降低程度较大(P<0.05)。结论慢性心力衰竭采用生脉注射液联合厄贝沙坦进行治疗,具有较好的临床疗效。     

Efficacy of fine‐needle aspiration biopsy in diagnosis of breast cancer: A retrospective study of 303 cases in Bahrain

Breast cancer is a leading cause of death in many countries worldwide and breast lesions remain a common diagnostic dilemma. Fine‐needle aspiration biopsy (FNAB) has been suggested as the most important, first line, minimally invasive measure in the management of patients with breast lesions. The aim of this study is to evaluate the efficacy of FNAB in patients with breast lesions by comparing the diagnostic accuracy of cytology results with that of the definitive histological examination outcome and also to investigate the added value of a single aspirator experience to the overall diagnostic precision and compared with the internationally published results. A retrospective study of 303 breast FNAB samples were carried out by a single experienced cytopathologist with complete comparison records. The prevalence of positive cytologic diagnosis for the breast cancer was determined to be 20.4%. The overall diagnostic accuracy of FNAB was 97.9%, with a specificity and sensitivity of 98.3 and 96.5%, respectively. The overall positive and negative predictive values were determined to be 93.2 and 99.2%, respectively. In addition, the sensitivity was comparable in cases that have been attempted by palpation‐guided sampling compared with those aspirations that were carried out under US guidance. Results from this study confirm that FNAB biopsies performed and reported by a dedicated, single, skilled cytopathologist are highly effective in diagnosis of breast lesions and reliable in differentiating benign and malignant breast lesions with an overall high efficacy in a specialized laboratory‐based FNAB clinic. Diagn. Cytopathol. 2009. © 2009 Wiley‐Liss, Inc.