规范化开展医院中药临方炮制工作探讨

通过对湖北省内相关的中医医院进行走访,结合医院实际情况,初步探讨医院如何规范化开展中药临方炮制工作。开展中药临方炮制是中医院个性化给药的充分发挥,也是保障中医临床用药的有效性与安全性,促进中医药文化、技术全面传承的重要体现。医院开展中药临方炮制工作需从人员、设备、技术等多方面努力,以促进中药临方炮制的传承与发展。     

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。     

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。     

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.     

肠康方对肠易激综合征内脏高敏感模型大鼠的作用

[目的]探讨肠康方对肠易激综合征(IBS)内脏高敏感模型大鼠的作用.[方法]制备肠易激综合征内脏高敏感模型,将72只Sprague-Dawley大鼠随机分为6组,即模型组,空白对照组,阳性药物对照组,肠康方高、中、低剂量组.在造模第60天开始灌胃给药或0.9％氯化钠溶液共10d,干预后通过腹肌回缩反射(AWR)半定量评分测定大鼠内脏敏感性.[结果]不同压力下模型组AWR评分显著高于空白对照组,肠康方高、中、低剂量组治疗后AWR评分均显著低于模型组(P＜0.05或P＜0.01).[结论]肠康方可通过改善内脏高敏感治疗IBS.     

Applications of the isolated-check visual evoked potential in primary open angle glaucoma with or without high myopia

AIM: To determine whether the different diameters of a specific intraocular lens (IOL) have significantly different optimised SRK/T A constants and whether these new A constants can improve refractive outcomes. METHODS: Data were collected prospectively from Jan 2011 - Dec 2012 on all patients undergoing routine cataract surgery at a district general hospital in the UK. Patients were divided into three groups according to the size of the Akreos AO MI60 IOL used. A constant for the SRK/T formula were optimised according to the size of the IOL. These optimised A constants were then used to select future refractive outcomes. RESULTS: Totally 2398 cataract operations were performed during the study period of which 1131 met the inclusion criteria. The three optimised A constants for the different sized IOLs were 118.98, 119.13 119.32. The difference between them was highly significant (P≤0.0001). Two optimised A constants for three sizes of IOL led to an improvement in refractive outcomes (from 93.4% to 94.6% of refractive outcomes within 1.00 D of predicted spherical equivalent). The optimised A constant for the largest IOL was based on a small number of cases and was not used. CONCLUSION: Optimising the A constant for the three distinct sizes of the Bausch & Lomb Akreos MI60 lens lead to three significantly different A constants. In our practice, using two different optimised A constants for three different sized IOLs give the least refractive error, however, using three optimised A constants may give better results with a larger dataset.     

Response to Sparks and Duncan's “Do No Harm” Critique of the Use of Stimulant Medications to Treat ADHD in Children and Adolescents

The literature on child sexual abuse suggests family functioning and support may be intervening variables which serve to ameliorate the long-term effects of such abuse. We advocate family therapy as effective treatment for extrafamilial child sexual abuse (especially in preschool children), and we present the essential elements of the family treatment process. Our supporting evidence is provided in the clinical evaluation and treatment of 10 children (and their families), ages 2-6 years, who reported sexual abuse in a daycare setting.     

不同生产厂家赤芍配方颗粒中单萜苷类化合物含量比较

目的比较不同厂家生产的赤芍配方颗粒中单萜苷类化合物(吡啶芍药苷、牡丹皮苷F、氧化白芍苷、氧化芍药苷、10-羟基芍药苷、白芍苷、芍药苷、oxypaeonidanin、4-甲氧基-氧化芍药苷、没食子酰基芍药苷、4-甲氧基芍药苷、白芍苷R_1、paeonidanin、苯甲酰氧化芍药苷、苯甲酰芍药苷)的含量差异,为制定统一的质量标准奠定基础。方法采用Zorbax SB-Aq C_(18)色谱柱(250 mm×4.6 mm,5μm);流动相为乙腈和磷酸二氢钾缓冲盐(pH 2.8)溶液,梯度洗脱,体积流量1.0 mL/min,柱温30℃,检测波长260 nm。结果芍药苷、白芍苷和氧化芍药苷是赤芍配方颗粒中含量最高的3种单萜苷类化合物,且不同厂家生产的赤芍配方颗粒中主要单萜苷类化合物的含量差异较大。样品CSPFKL-KRT中芍药苷和氧化芍药苷的含量最高,样品中质量分数分别为73.214mg/g和16.935mg/g,白芍苷的质量分数最低,为2.343mg/g。而样品CSPFKL-XLS中芍药苷和氧化芍药苷的质量分数最低,样品中分别为26.327 mg/g和4.165 mg/g,白芍苷的质量分数最高18.893 mg/g。结论不同厂家生产的赤芍配方颗粒中主要单萜苷类化合物的含量差异较大,可能会对临床应用产生影响。建立统一的质量标准对于赤芍配方颗粒的质量控制具有重要作用。