Professional Steps: The Certification Path

Obtaining certification is a critical step on the road to professionalism. There are many questions to consider in this decision. Included among these are cost, preparation, and return on the investment. Important answers to these questions are discussed.     

熊磊教授基于“脾为痰源”辨治儿童癫痫临证思路探赜

熊磊教授以理脾为本，将治痰贯穿始终。根据小儿脾常不足、肾常虚、肝常有余的生理特点，癫痫发作期治疗主以涤痰开窍，辅以理气健脾，同时配合活血化瘀通窍与平肝息风潜阳。主要选方为柴芍温胆汤、天麻钩藤饮、桃红四物汤加减；缓解期则以补肾养肝为主，兼以健脾化痰，主要选方为杞菊地黄丸合定痫丸加减，取得较好临床疗效。     

What is the impact of zinc deficiency for pancreatectomies in patients with pancreatic ductal adenocarcinoma?

Backgroundand purpose: Zinc is an essential element for human health and plays an important role in metabolic, immunological and other biological processes. The present study was conducted to investigate the association between zinc deficiency (ZD) and the perioperative clinical course in patients with pancreatic ductal adenocarcinoma (PDAC).MethodsOf 216 patients with PDAC who underwent elective pancreatectomy between 2013 and 2017 at our institution, 206 patients with sufficient clinical data were retrospectively reviewed. The perioperative variables were compared and the risk factors associated with infectious complications were identified.ResultsZD was preoperatively present in 36 (17.5%) of 206 patients with PDAC. In the patients of the ZD group, a higher proportion of males, higher preoperative modified Glasgow prognostic scores, a higher neutrophil-to-lymphocyte ratio, and a higher occurrence of postoperative infectious complications after pancreatectomy were observed, compared to the non-ZD group. By a univariate analysis, three risk factors were significantly associated with infectious complications after pancreatectomy: ZD (vs non-ZD: p = 0.002), serum albumin <3.5 g/dl (vs ≥ 3.5 g/dl: p = 0.005), and the procedure of pancreaticoduodenectomy (vs others: p = 0.013). By multivariate logistic regression analysis, the occurrence of infectious complications was significantly associated with ZD (OR 3.430, 95%CI 1.570 to 7.490, p = 0.002) and the procedure of pancreaticoduodenectomy (OR 2.030, 95%CI 1.090 to 3.770, p = 0.025).ConclusionsThe current study newly demonstrated that ZD could serve as a preoperative predictor of infectious complications after pancreatectomies in the patients with PDAC.     

精准医学决策支持知识组织研究

介绍国内外医学知识组织体系，从数据来源、概念抽取、语义关系构建几方面阐述基于精准医学临床决策支持系统的精准医学知识组织体系设计，分析其在门诊和住院场景的应用。     

何廉臣《感症宝筏》手校稿本述考

《感症宝筏》原名《伤寒指掌》,为清代医家吴贞所著,何廉臣重订,体现了清代中后期寒温思想的融合。该稿本为何廉臣出版该书时手校之底本,由其子抄录,内有多处校对、抄录笔迹及校改痕迹。从该稿本的抄写和体例、稿本与通行本之对比、该稿本中的修改符号等几个方面进行论述,探讨其学术与文物价值。     

Clinical Benefit-Risk Profile of Lenalidomide in Patients With Lower-risk Myelodysplastic Syndromes Without del(5q): Results of a Phase III Trial

BackgroundIn the phase III MDS-005 study of patients with lower-risk, non-del(5q) myelodysplastic syndromes, lenalidomide was associated with a higher rate of ≥ 8 weeks red blood cell transfusion independence (RBC-TI) compared with placebo, but also with a higher risk of hematologic adverse events (AEs).Patients and MethodsThis analysis evaluated the ratio of clinical benefit-risk in patients treated with lenalidomide or placebo, and assessed the effect of lenalidomide dose reductions on response. Clinical benefit was a composite endpoint defined as RBC-TI, transfusion reduction ≥ 4 units packed red blood cells, hemoglobin increase ≥ 1.5 g/dL, or cytogenetic response.ResultsThe rate of clinical benefit was higher with lenalidomide than with placebo (31.9% vs. 3.8%). The ratio of response (RBC-TI and clinical benefit) to risk (hematologic AEs) favored lenalidomide over placebo. Patients who underwent ≥ 1 lenalidomide dose reduction had a longer duration of treatment, received a higher cumulative dose, and were more likely to experience clinical benefit versus patients without dose reductions.ConclusionDespite the occurrence of hematologic AEs, the overall benefit-risk profile supported lenalidomide treatment. Appropriate management of hematologic AEs by dose reductions may help patients with myelodysplastic syndromes to remain on treatment and achieve clinical benefit.     

八珍汤对肺癌化疗致白细胞减少症临床疗效及部分机制研究

目的:探究八珍汤对肺癌化疗所致白细胞减少症的疗效及作用机制,有助于精准治疗并提高疗效。方法:选取2017年4月至2018年4月哈尔滨医科大学附属第一医院收治的肺癌化疗所致白细胞减少症患者66例作为研究对象,采用数字随机表法按就诊顺序号,分为对照组和观察组,每组33例。对照组予利血生20 mg口服,3次/d;鲨肝醇100 mg口服,3次/d,升白治疗,观察组在对照组基础上加用八珍汤化裁治疗,均治疗4周,观察不同方法治疗后在白细胞水平含量比较,比较治疗前、治疗末神疲乏力、心悸气短、头晕目眩、面色淡白、畏寒肢冷、纳呆食少中医症候积分和免疫功能指标CD4^+、CD8^+、CD4^+/CD8^+、NK细胞变化情况,治疗过程中收集不良反应情况,结束治疗后观察疗效情况。结果:1)2组治疗1周、2周、3周、4周后白细胞计数菌显著高于治疗前(P<0.05),观察组治疗1周、2周、3周、4周后显著优于对照组(P<0.05);2)2组患者治疗前神疲乏力、心悸气短、头晕目眩、面色淡白、畏寒肢冷、纳呆食少,比较差异无统计学意义(P>0.05),完成治疗方案后,2组患者以上指标较治疗前均显著下降(P<0.05)。治疗末观察组患者以上指标显著低于对照组(P<0.05)。3)2组患者治疗前CD4^+、CD8^+、CD4^+/CD8^+、NK细胞比较,差异无统计学意义(P>0.05),完成治疗方案后,2组患者CD8^+较治疗前均显著下降,CD4^+、CD4^+/CD8^+、NK细胞较治疗前显著升高(P<0.05),治疗末观察组患者以上指标显著优于对照组(P<0.05)。4)完成治疗后观察组患者显效率、总有效率明显高于对照组(P<0.05)。5)2组在不良反应发生率上比较,差异无统计学意义(P>0.05)。结论:八珍汤对肺癌化疗所致白细胞减少症能升高白细胞水平,提高疗效,改善症状。可能和该药能提高机体免疫力,促使骨髓造血功能有关。     

益气养阴解毒方联合环磷腺苷葡胺注射液治疗病毒性心肌炎35例

目的:探讨益气养阴解毒方联合环磷腺苷葡胺注射液对病毒性心肌炎患者心功能及外周血清肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、转化生长因子-β1(transforming growth factor-β1,TGF-β1)和干扰素-γ(interferon-γ,IFN-γ)水平的影响。方法:将70例病毒性心肌炎患者按照随机数字法分为对照组和观察组,每组各35例。两组患者均给予常规治疗,对照组在常规治疗的基础上给予环磷腺苷葡胺注射液静脉滴注,观察组在对照组的基础上联合益气养阴解毒方治疗。比较两组患者的临床疗效及治疗前后左室短轴缩短分数(left ventricular shortening fraction,LVFS)、左心室射血分数(left ventricular ejection fraction,LVEF)、心脏指数(cardiac index,CI)、TNF-α、TGF-β1和IFN-γ水平。结果:观察组有效率为88.57%,对照组有效率为68.57%,两组患者有效率比较,差异有统计学意义(P<0.05)。两组患者治疗后LVEF、LVFS高于本组治疗前,且观察组高于对照组,差异具有统计学意义(P<0.05)。两组患者治疗后TGF-β1、TNF-α水平低于治疗前比较,IFN-γ高于治疗前,且观察组TGF-β1、TNF-α低于对照组,IFN-γ高于对照组,差异均有统计学意义(P<0.05)。两组患者不良反应发生率比较,差异无统计学意义(P>0.05)。结论:益气养阴解毒方联合环磷腺苷葡胺注射液治疗病毒性心肌炎疗效更显著,可减轻机体的炎症反应,恢复患者心功能。     

骨科大手术患者中医体质类型与静脉血栓栓塞症相关性研究

目的:探讨骨科大手术患者中医体质类型分布特点及其与静脉血栓栓塞症(VTE)的相关性。方法:选取220例骨科大手术患者,其中术后3个月内并发VTE患者102例为观察组,术后3个月内未发生VTE患者118例为对照组。对两组患者进行中医体质判定并分析。结果:220例骨科大手术患者中,平和质64例(29.09%),偏颇体质156例(70.91%)。骨科大手术患者最常见体质类型为气虚质、血瘀质、平和质。观察组最常见体质类型为气虚质、血瘀质,对照组最常见体质类型为平和质、气虚质。Logistic回归分析发现气虚质、血瘀质与VTE具有显著相关性(P<0.05,P<0.01)。结论:偏颇体质是骨科大手术患者的中医体质类型特征;气虚质、血瘀质是骨科大手术并发VTE患者的危险因素。