儿童咳嗽变异性哮喘中医证素分布规律研究

[目的]通过问卷调查的形式结合证素辨证方法学探讨儿童咳嗽变异性哮喘的中医病位、病性证素特点及其组合规律,为提高儿童咳嗽变异性哮喘临床辨证论治水平以及制定防治方案提供依据。[方法]以广东省中医院儿科门诊部符合诊断标准的91例患者为研究对象,进行问卷调查,收集四诊资料,根据"证候辨证素"量表找到每一症状对各证素的权值,最后计算各症状对各证素权值之和,超过阈值100分的证素则判断成立,分析病位证素、病性证素以及病位与病性证素组合规律。[结果]咳嗽变异性哮喘中,病位证素共7个,肺为核心病位,其出现的频率(97.80%)明显高于其他病位证素,病位证素表(95.60%)相对常见,其他病位证素依次为脾(57.14%)、胃(29.67%)、肾(3.30%)、心(3.30%)、肝(1.10%)。病位肺、表、脾、胃等4个证素平均积分超过150分。病位证素组合以二病位、三病位、四病位为主,单一病位出现频率较低。病性证素方面,实性病性有9个,虚性病性4个。实性病性中,病性痰(53.85%)出现频率最高,病性外风(45.05%)、寒(40.66%)、湿(27.47%)等相对常见,病性饮(10.99%)、气滞(8.79%)、热(4.40%)、燥(4.40%)、食积(3.30%)等出现频数较低。虚性病性证素依次为气虚、阳虚、血虚、阴虚,出现频率分别为:87.91%、69.23%、50.55%、26.37%,虚性病性气虚、阳虚平均积分超过150,提示为重度病变;病性证素组合中,二病性组合最常见,频数、频率为61例(67.76%),其次为单一病性证素,频数与频率为19例(21.11%)。病位与病性组合形式中,二病位与单一病性组合"肺+表+气虚"出现频数与频率为76例(83.52%),三病位与单一病性证素组合"肺+表+脾+气虚"出现频率为51例(56.04%)。[结论]咳嗽变异性哮喘核心病位在肺,与表、脾相关;其发病虚实互见,气虚、阳虚在本病发生、发展中具有重要意义;痰、风等为主要实性病性,其中痰为主要病理产物,亦是主要病因。     

基于“五行圆运动”,论冠心病之“痰瘀互结”

流行病学研究显示,冠心病的发病率逐年升高,进一步临床研究发现,"痰瘀互结"是冠心病的主要病机。自《圆运动的古中医学》于2007年出版后,"圆运动"学说成为研究热点之一。东方肝木失敷和、中央脾土失备化、西方肺金失审平、北方肾水失静顺,皆可使南方心火失宣通而难升明。五运常性失司,五行圆运不通,故而痰瘀互结于内。基于传统中医理论,笔者试从"五行圆运动"角度浅论冠心病之"痰瘀互结",为该病的中医临床辨治提供新理念。     

多系统萎缩患者的证候规律(167例)

目的:本研究旨在临床观察并分析多系统萎缩(Multiple System Atrophy,MSA)证候规律。方法:采用横断面分析方法,收集所有符合西医诊断标准的MSA患者一般情况及四诊信息,不设定证候类型,辨别每个病例具体证型,提取证候要素。统计证候要素频次,百分比,归纳证候要素组成分布;采用以类型或平均值为界进行证素的分组比较,探讨证候要素与病程、疾病严重程度、疾病分型的相关性。结果:167例MSA患者总体病机虚多实少,寒多热少。P型热证多见,C+P型寒证多见;气虚最多见于C+P型,血虚多见于P型;气虚常与寒证并见,且多见于疾病中晚期,热证常与血虚并见,且多见于疾病早期。肾虚最多见于C+P型,肝病、心病多见于P型,脾虚及胃病多见于C型。痰、湿多见于C+P型和P型,血瘀多见于C+P型,而气陷只见于C+P型。随着病情加重、混合型的出现,虚证与实证并见,正虚和邪实皆增加。结论:MSA核心病机为肾阳虚,总体治则在于温肾助阳。     

五音经络疗法思想探析

《黄帝内经》首将“五音疗疾”引入中医学,五音经络疗法是以阴阳五行学说和中医经络腧穴理论为基础,把五音阶中宫、商、角、徵、羽以音作药,与中医闻诊、针灸等及其他方法相互协调补充,综合预防、诊断和治疗身心疾病的中国传统医疗方式。这种疗法,将五音与五脏经络连属起来,是对音乐与情感及脏腑脏气之间的声音频率和共鸣互动关系的深刻体验和总结。医者根据音变辨病变,取相对应的经络、腧穴来调节,从而达到治疗的目的。     

Trace element concentrations in breast cancer patients

Alterations in the circulating levels of trace elements have been observed in breast cancer (BC) patients. However, the relationships between these alterations and the metabolic and clinical consequences of BC are unknown. The treatment-of-choice of BC is surgery followed by radiation therapy (RT). The present study was aimed at investigating: 1) the concentrations of several trace elements in BC patients, and their relationships with the intrinsic molecular subtypes of tumors; 2) the toxicological effect of RT. We studied 49 women with BC who were scheduled to receive RT following excision of the tumor. Plasma samples were obtained before and after the irradiation procedure. The control group was composed of 49 healthy women. Patients had significantly lower pre-RT concentrations of B, Cu, and Zn, and significantly higher concentrations of Sr than the control group. Irradiation was associated with a striking increase in plasma B concentrations, while Cu, Fe, Sr and Zn concentrations were not significantly different from pre-RT levels, albeit Sr and Zn showed non-significant trends towards increases. The plasma concentrations of B, Cu, Fe, Sr, and Zn were associated with the tumor expression of hormone receptors, epidermal growth factor receptor 2, Ki67 antigen, as well as dermatitis and asthenia, all of which represent the main toxicological responses to RT.     

七制香附丸中无机元素的分析及健康风险评估

目的:建立电感耦合等离子体质谱(inductive coupled plasma mass spectrometer, ICP-MS)测定七制香附丸中23种无机元素含量的方法,并对分析结果进行化学计量学分析,为七制香附丸中无机元素的评价提供参考。方法:30批样品经微波消解后,采用ICP-MS测定23种无机元素的含量并建立无机元素指纹图谱,进行聚类分析、主成分分析和健康风险评估。结果:23种无机元素线性关系良好(r≥0.998 3);精密度和重复性试验的RSD值均小于5%;加样回收率在81.91%～109.4%,RSD值小于13%;对30批七制香附丸和23种无机元素进行层级聚类,30批七制香附丸分为3类,23种无机元素分为2类;主成分分析中Mg、Ca、Cr、Fe、Ni、Zn、As、Se、Cd、Tl元素经旋转后均大于0.8;健康风险评估结果显示Cu、As、Cd、Pb元素的危害指数(HI)分别为0.004 9,0.046 7,0.047 7,0.276 5,HI均小于1。结论:所建立的ICP-MS方法准确、灵敏、快速,可用于七制香附丸中23种无机元素的含量测定,30批次七制香附丸中Cu、As...     

ICP-MS法测定不同产地红参中9种无机元素

目的 考察不同产地红参中铁（Fe）、锰（Mn）、锌（Zn）、铜（Cu）、硒（Se）、铅（Pb）、砷（As）、汞（Hg）和镉（Cd）9种无机元素的含量差异。方法 采用微波消解技术及电感耦合等离子体质谱（ICP-MS）法测定28批不同产地红参中9种无机元素含量,并采用SPSS 22.0软件进行聚类分析。结果 不同产地红参Fe、Mn、Zn含量均较高,Se含量极低,有害元素Pb、As、Hg、Cd、Cu含量均符合《中国药典》限量标准。28批样品聚类为两类。结论 不同产地红参均富含Fe、Mn、Zn,其重金属及有害元素污染程度小,安全性相对较好。不同产地红参Fe、Zn、Cu、Se、As元素含量差异性均较小,Mn、Pb、Hg、Cd元素差异性较大。     

男宝胶囊中重金属及有害元素的残留量测定及风险评估

目的：研究男宝胶囊中重金属及有害元素的残留情况并进行风险评估。方法：采用微波消解-电感耦合等离子体质谱法,测定10个生产单位的80批样品中铅、镉、砷、汞、铜、钒、铬、钴、镍9种元素的残留量,并采用热图及多变异源图对测定结果进行差异性比较,同时对其进行健康风险评估。结果：9种元素线性关系良好,相关系数r ≥ 0.999 9,平均回收率在76.64% ~ 102.49%,RSD为1.09% ~ 6.92%（n = 6）。80批次男宝胶囊样品中铅、镉、砷、汞、铜、钒、铬、钴、镍的残留量分别为0.384 ~ 2.887、0.060 ~ 0.289、0.213 ~ 13.904、0.002 ~ 35.412、2.250 ~ 10.382、0.302 ~ 1.676、0.348 ~ 5.388、0.187 ~ 0.878、1.608 ~ 4.962 mg·kg-1。铬、砷、铅和汞4种元素的残留量存在一定的差异性,其中汞最为显著,分析差异主要是由生产单位原材料质量控制不稳定导致的;风险评估结果表明,有1批次样品的汞残留量高于最大限量理论值和香港中成药注册安全性技术指引中相关规定值,提示此批次样品存在一定的健康风险。结论：本研究可为男宝胶囊重金属及有害元素残留量测定提供参考依据以及为保证用药安全提供基础。     

Effective Enzyme Coimmobilization and Synergistic Catalysis on Hierarchically Porous Inorganic/Organic Hybrid Microbeads Fabricated Via Droplet‐Based Microfluidics

In this paper, a novel and robust droplet‐based microfluidic method to fabricate poly(ε‐caprolactone)/silica (PCL/SiO₂) hybrid microbeads with hierarchically porous architecture is described and their performance as multienzyme carriers for cascade catalysis is further investigated in detail. In addition to the precise control on size and monodispersity of PCL/SiO₂ microbeads enabled by the microfluidic method, the presence of ammonia as a catalyst for the hydrolysis and condensation of tetraethylorthosilicate makes it possible to manipulate the competition between sol–gel process and solvent extraction and thus adjust the surface porosity of hybrid microbeads, which eliminates the use of porogens/templates and also the complicated post‐treatment. Isothiocyanate‐immunoglobulin G/cyanine 3‐bovine serum albumin (FITC‐IgG/Cy3‐BSA) and superoxide dismutase/chloramphenicol acetyltransferase (SOD/CAT) are coimmobilized, respectively onto hierarchically porous PCL/SiO₂ hybrid microbeads via either physical adsorption or covalent binding. Fluorescence intensity of coimmobilized FITC‐IgG/Cy3‐BSA proves that the proteins/enzymes immobilization amount via covalent binding is much higher than physical adsorption. The enhanced enzymatic activity, total antioxidant capacity, and reusability assay reveal that coimmobilized SOD/CAT exhibits better performance compared with the mono‐immobilized ones, mainly due to their mutual synergistic effect. The excellent results achieved in the work indicate that hierarchically porous PCL/SiO₂ hybrid microbeads are very promising carriers for multienzymatic catalysis.