中医治疗脑出血的研究进展

脑出血是指非外伤性脑实质内血管破裂引起的出血,具有高致死率和高致残率的特点。目前,西方医学对脑出血的治疗手段比较单一,多采用脱水降颅压、脑保护等对症治疗。而中医注重整体观和辨证法,对脑出血的治疗有独特的优势。近年来研究表明中医治疗脑出血可促进血肿的吸收,抑制水肿的形成,保护脑神经,改善患者的预后。目前,临床上常用的治法有活血化瘀法、平肝熄风法、活血利水法、通腑法、添精补髓法,对上述疗法做一综述。     

Analysis of Progression Patterns and Failure Sites of Patients With Metastatic Lung Adenocarcinoma With EGFR Mutations Receiving First-line Treatment of Tyrosine Kinase Inhibitors

BackgroundReliable prediction of progression patterns and failure sites for patients with stage IV lung adenocarcinoma is valuable for physicians to deliver personalized tyrosine kinase inhibitor (TKI) treatment.Patients and MethodsWe retrospectively enrolled 266 patients who had stage IV lung adenocarcinoma and received first-line TKI treatment from 2013 to 2017 in Shanghai Chest Hospital. The clinical characteristics at initial diagnosis, progression patterns, and failure sites were analyzed with the attempt to identify some predictive factors for progression patterns and failure sites.ResultsAmong all patients, 62.4% developed systemic progression, and 37.6% developed oligoprogression. Both cohorts had a median progression-free survival (PFS) of 9 months. The percentage of patients who developed original and distant failure was 39.1% and 60.9%, respectively. Patients with oligometastasis at initial diagnosis were more prone to develop oligoprogression (odds ratio [OR], 4.370; 95% confidence interval [CI], 1.881-10.151; P = .001), whereas pulmonary metastasis was negatively correlated with oligoprogression (OR, 0.567; 95% CI, 0.330-0.974; P = .04). Both oligometastasis diagnosis (OR, 2.959; 95% CI, 1.347-6.500; P = .007) and the maximum diameter of the primary lung lesion (threshold 3.25 cm: OR, 3.646; 95% CI, 2.041-6.515; P = .0001) were strong predictive factors for original failures. Osseous metastasis at initial diagnosis might be an indication for distant failure (OR, 0.536; 95% CI, 0.316-0.909; P = .021).ConclusionOver one-half of patients with stage IV lung adenocarcinoma receiving first-line TKI treatment developed systemic progression and distant failure. Metastasis patterns at initial diagnosis was the most important predictive factor for progression patterns and failure sites. The maximum diameter of the primary lung lesion and evidence of osseous metastasis were also found to be significant indicative factors for failure sites.     

TAPP与TEP治疗腹股沟疝的临床对比研究

目的探讨TAPP与TEP治疗腹股沟疝的临床治疗效果。方法选取2015年1月-2017年12月至本院行腹腔镜疝修补手术的单侧腹股沟疝患者134例为观察对象,按手术方式的不同随机分为TEP组及TAPP组两组。对比分析两组的手术时间、手术出血量、住院时间、住院费用、术后24 h急性疼痛评分(VSA)、并发症发生率。结果 TEP组手术时间、住院费用明显短于或少于TAPP组,差异具有统计学意义。术后24 h急性疼痛评分(VSA)两组相比差异无统计学意义。TEP与TAPP在手术出血量、住院时间、并发症发生率方面差异无统计学意义。结论 TAPP并不增加术后早期急性疼痛的发生率,TAPP与TEP均是治疗腹股沟疝的有效方式。     

基于“祛邪为第一要义”从清热化湿论治新型冠状病毒肺炎

结合验案分析,基于"祛邪为第一要义"探讨新型冠状病毒肺炎从清热化湿论治的思路与方法。认为新型冠状病毒肺炎主要是属于"湿热"性质的疫病,治疗应强调清热化湿,以"祛邪为第一要义",辅以扶正。在中医祛邪与扶正理论指导下,通过宣肺平喘、通腑泻热、芳香化湿等治法,祛邪为主,肺肠合治,可以使发热减轻或消退,使大便通畅,从而截断病情进展,避免或减少危重症的发生及死亡的风险;通过清热化湿、疏肝健脾、凉血化瘀等治法,祛邪兼以扶正,肺与肝、脾合调,可以改善肝功能损伤,减少病情加重的风险;通过补气健脾等扶正治法,可以改善患者的精神和体力,促使病毒更快转阴,缩短病程,促进患者早日康复。     

新型冠状病毒肺炎患者死亡影响因素分析

目的分析新型冠状病毒肺炎(COVID-19)患者死亡的影响因素,为临床上减少COVID-19患者的病亡率提供参考。方法回顾性分析本院2020年1月17日—2月25日期间所有COVID-19入院患者的病例资料,收集患者的性别、年龄、住院期间是否服用中药制剂、临床分型、合并症、核酸检测结果、入院时间、出院情况等相关指标进行统计分析。结果 COVID-19疫情期间,本院COVID-19患者的在院人数逐渐增多,最高峰期曾同时收治904名COVID-19患者。在2020年1月17日—2月25日期间本院共收治1305例COVID-19患者,其中男性632例,女性673例,男女比例1∶1.06。年龄分布在7～101岁,中位数为63(51,70)岁。不同性别之间,患者的年龄分布无明显差异。单因素分析结果显示患者的性别、年龄、治疗期间是否服用中药制剂、临床分型、是否合并基础疾病(高血压、冠心病、糖尿病、肿瘤及尿毒症)以及核酸检测结果均可影响患者的病亡率。Logistics多因素回归分析发现,服用中药制剂、临床分型以及是否合并基础疾病是COVID-19患者病亡的独立危险因素。结论 COVID-19患者死亡与多种因素有关,减少危重症的发生,控制基础疾病,稳定血压血糖,积极改善心脑血管条件及稳定肾功能等是提高COVID-19患者治疗效果的主要措施,并且早期应用中药治疗对减少COVID-19病亡率同样具有十分重要的作用。     

Biogenic silver,gold and copper nanoparticles - A sustainable green chemistry approach for cancer therapy

The advent of nanotechnology has revolutionized the way clinicians are treating cancers. Treatment for cancer includes surgery, radiotherapy, hormonal therapy, chemotherapy, and now nano therapy, which could be a possible alternative. This new treatment regime can be beneficial since it shows minimum side effects as compared to other treatment methods. Metallic nanoparticles synthesized through green chemistry by using biological entities minimizes the side effects and enhances the properties of the metal against cancer cells. These green nanoparticles are widely used in research and have shown promising cytotoxic activity against various cancer cell lines. Mechanistically, these nanoparticles can enter the cancer cell and cause cell death by the activation of various molecular pathways such as apoptosis, necrosis and autophagy. This review focuses on the metal nanoparticles (silver, gold and copper) synthesized by the green chemistry approach that have been utilized to study the cancer cell death and we are also discussing the underlying molecular pathways.     

从心肾论治卒中后抑郁

卒中后抑郁(Post-stroke Depression,PSD)是脑卒中后的常见并发症之一,随着人口老龄化的发展,卒中的发生率日益升高,致使卒中后抑郁人数渐渐增多。目前现代医学对本病的治疗周期较长,患者依从性差,容易造成病情迁延,降低患者的生活质量。中医从整体出发,辨证施治,疗效颇佳,本文将从心肾方面阐述本病,为本病的中医临床研究提供新思路。     

小剂量丙戊酸联合拉莫三嗪治疗癫痫的疗效

目的探索小剂量的丙戊酸联合拉莫三嗪治疗癫痫的临床治疗效果。方法进行分组研究,对照组和观察组所选取的研究对象是本院在2018年2月-2019年2月收治的90例癫痫患者,每组患者各45例,观察组采用小剂量的丙戊酸联合拉莫三嗪进行治疗,对照组采用丙戊酸进行治疗,分析两组患者的癫痫发作次数、癫痫持续时间、临床症状好转时间及总有效率。结果观察组患者癫痫发作次数、癫痫持续时间和临床症状好转时间明显均优于对照组,观察组患者比对照组患者总有效率高,观察组总有效率为84.4%,对照组总有效率为62.2%,差异有统计学意义(P <0.05)。结论对癫痫患者的治疗,小剂量的丙戊酸联合拉莫三嗪提高了癫痫患者的治疗总有效率,具有显著疗效。     

数据挖掘法探讨周珉教授治疗原发性肝癌用药规律及经验总结

[目的]数据挖掘法分析周珉教授治疗原发性肝癌的中医用药规律,探讨相关病机并进行经验总结。[方法]收集2016年2月—2018年5月周珉教授门诊期间治疗原发性肝癌的方剂,运用"中医传承辅助系统(V2.50)"进行数据挖掘,并结合周珉教授临床经验,进行原发性肝癌病机探讨及用药规律分析。[结果]共收集治疗原发性肝癌方剂176首,涉及中药235种,列出方剂中的高频药物及组合规律。[结论]总结原发性肝癌以"湿热痰毒、气阴两伤"为基础病机,"清热化湿、健脾养阴"治则贯穿原发性肝癌治疗始末,同时,根据疾病不同发展阶段及治疗措施,权衡"扶正"与"祛邪"的主次分配,斟酌应用"攻毒散结""行气化瘀"等治法,以达到改善患者生活质量、延缓疾病进展的目的。