内毒素血症中医病机及治法探讨

内毒素血症是导致重症革兰阴性菌感染转危的重要病理变化,与中医学"温病"、"瘟疫"过程中的一些重症相似.笔者根据文献学习及中医学基本理论提出热毒内盛、瘀血阻滞、气阴两虚是内毒素血症的重要病机,清热解毒、活血化瘀、益气养阴是内毒素血症防治的根本治法,并对该治法的作用进行了阐述,以冀对内毒素血症的治疗有所帮助.     

《内经》与临证(一)

分析《内经》经文“谨守病机,各司其属”,“诸寒收引,皆属于肾”,以及“诸气郁,皆属于肺”,结合临床验案,强调主症与病机之间的相互关系,有利于提高临床辨证论治的水平。     

Critical management in patients with severe enterovirus 71 infection

OBJECTIVE: The aim of this study was to analyze clinical details occurring in children with severe enterovirus 71 (EV71) infection and synthesize the critical care experience for patients with severe EV71 infection. METHODS: A retrospective clinical, laboratory, and hemodynamic study was performed in a pediatric intensive care unit in a university hospital. From March 1998 to April 2000, seven consecutive pediatric patients with severe EV71 infection were retrospectively analyzed as the comparison group. From May 2000 to March 2003, eight consecutive patients with severe EV71 infection who had received the protocol therapy were enrolled as the study group. Detailed information about clinical treatment and pharmacological therapy was collected for comparison. RESULTS: The clinical presentations and laboratory findings between the comparison and the study groups were not significantly different. The amount of intravenous fluid in the first 24 h was significantly higher in the comparison group (9.2+/-5.0 vs 4.9+/-1.3 mL/kg per h). More patients in the study group received low doses of dopamine infusion, patients in the comparison group received more epinephrine, and none of them received milrinone. The acute-stage and long-term survival rates were higher in the study group (100% vs 43%, 87% vs 29%). CONCLUSION: Early cardiopulmonary support may prevent the vicious cycle of cardiopulmonary failure and improve the clinical outcome of severe EV71 infection. Milrinone may be the ideal inotropic agent for these patients. Echocardiography, a central line, and an arterial line could be an alternate method to replace direct intracardiac hemodynamic monitoring for guiding critical management.     

激素依赖型哮喘撤减激素过程中的证候学变化及其治疗特点

探讨激素依赖型哮喘(SDA)撤减激素过程中的证候学变化及其治疗特点,认为在撤减激素的过程中,SDA患者存在着由阴虚火旺(撤前)→阴阳两虚(撤中)→肾阳亏虚(撤后)的病机演变规律,而痰瘀内阻则贯穿于整个激素撤减过程中.根据其证候学变化建立了中药三步序贯撤减激素的新方案,即撤前滋阴血,清虚热,化痰瘀;撤中滋阴养血熄风,益气温阳活血,化痰降逆平喘;撤后温肾阳,和气血,畅气机.由于三步序贯法根据SDA撤减激素过程中的动态变化规律而设计,因而较既往任何一种单一治法更能符合SDA临床发生、发展、变化的全过程,反映了其病机演变的实质特征.     

汪昂医学学术思想研究

通过对汪昂<素问灵枢类纂约注>、<本草备要>、<医方集解>及<勿药玄诠>等医学著作的全面研究,从四个方面系统地论述了汪昂的医学学术思想,即主张要全面掌握医学的理法方药,不可有所偏重;强调人体的平衡协调,治病重在补偏救弊;重视探讨病因病机,做到治病求本;提倡未病先防,注意强身健体.汪昂的医学学术思想与主张,对后世医家产生了重要影响.     

Intrahepatic cholangiocarcinoma: current management and emerging therapies

Introduction: Intrahepatic cholangiocarcinoma (iCCA) is a malignancy with an increasing incidence and a high-case fatality. While surgery offers the best hope at long-term survival, only one-third of tumors are amenable to surgical resection at the time of the diagnosis. Unfortunately, conventional chemotherapy offers limited survival benefit in the management of unresectable or metastatic disease. Recent advances in understanding the molecular pathogenesis of iCCA and the use of next-generation sequencing techniques have provided a chance to identify ‘target-able’ molecular aberrations. These novel molecular therapies offer the promise to personalize therapy for patients with iCCA and, in turn, improve the outcomes of patients.

Area covered: We herein review the current management options for iCCA with a focus on defining both established and emerging therapies.

Expert commentary: Surgical resection remains as an only hope for cure in iCCA patients. However, frequently the diagnosis is delayed till advanced stages when surgery cannot be offered; signifying the urge for specific diagnostic tumor biomarkers and targeted therapies. New advances in genomic profiling have contributed to a better understanding of the landscape of molecular alterations in iCCA and offer hope for the development of novel diagnostic biomarkers and targeted therapies.     

Progress towards the treatment of Ebola haemorrhagic fever

Being highly pathogenic for human and nonhuman primates and the subject of former weapon programmes makes Ebola virus one of the most feared pathogens worldwide today. Due to a lack of licensed pre- and postexposure intervention, the current response depends on rapid diagnostics, proper isolation procedures and supportive care of case patients. Consequently, the development of more specific countermeasures is of high priority for the preparedness of many nations. Over the past years, enhanced research efforts directed to better understand virus replication and pathogenesis have identified potential new targets for intervention strategies. The authors discuss the most promising therapeutic approaches for Ebola haemorrhagic fever as judged by their efficacy in animal models. The current development in this field encourages discussions on how to move some of the experimental approaches towards clinical application.     

Advances in the diagnosis and management of diabetic distal symmetric polyneuropathy

Distal symmetric polyneuropathy (DSPN) is the most common chronic complication of diabetes mellitus. The pathogenesis of DSPN is not fully elucidated, but it is certainly multifactorial in nature and attributable to metabolic and microvessel disorders related to chronic hyperglycemia, diabetes duration, and several cardiovascular risk factors. Early diagnosis and appropriate management are extremely important, since up to 50% of DSPN cases may be asymptomatic, and patients are unaware of foot injury leading to foot ulcers and amputation. Simple, validated tests such as the Neuropathy Disability Score and/or Vibration Perception Threshold may be used to diagnose DSPN. Similarly, neurological dysfunction screening questionnaires should be used to assess the quality and severity of DSPN symptoms. Using both methods enables prediction of the prognosis of diabetic patients with DSPN. No causative treatment of DSPN is known, but the results of clinical trials indicate that several treatment options are highly effective in symptomatic treatment of painful DSPN. The appropriate treatment of DSPN may improve the outcome, preventing or delaying the development of numerous diabetic complications.     

从瘀热辨治子痈的临证思路与经验——周仲瑛教授瘀热病机男科运用

国医大师周仲瑛教授结合多年的临床经验对"瘀热"病机理论进行较为系统的论述。在周仲瑛教授指导下,通过文献分析,结合临床实践,初步探讨子痈瘀热的病机概念、临床表现、辨证思路、组方用药特点,并举案例说明,以更好丰富"瘀热"理论,也为子痈的辨证施治提供新的思路。