浅谈脑梗死的中医病因病机与中医药治疗近况

脑梗死是缺血性卒中之一,随着人口老龄化发展趋势,目前已越居我国居民致残和死亡的首要病因。中医药治疗脑梗死有着重要特色和优势,目前在医学领域中仍占着不可动摇的地位,现就针对古代医家及近现代医家对中风病中医病因病机认识,以及中医药治疗方面针对经典方、经验方、中成药、中医外治等方面进行总结综述。     

Une personne SDF sur 10 souffre de troubles cognitifs : que sait-on de ces troubles ? Une revue de littérature sur la cognition des personnes SDF

ObjectivesHomelessness is associated with several issues (psychiatric and neurological disorders, neurodevelopmental difficulties, malnutrition…) which are also risk factors for cognitive disorders. However, little is known about the relationship between the cognition of homeless people and these eventual explicative etiologies. The aim of this work is to complete the results of Depp et al. about cognition in homelessness by proposing a systematic review of the neuropsychological disorders of homeless people associated with an analysis of the etiologies likely to explain these disorders.MethodsWe followed the PRISMA recommendations to build up this work. We analyzed the abstracts of 385 papers found on databases PSYCINFO and PubMed. Twenty-two studies have been selected for respecting our criteria (at least one valid neuropsychological test ; general group of homeless people and not a sub-group of this population ; study published in English). The prevalence quality has been evaluated through the criteria of Loney et al. Cognitive scores and etiological factors have been compared between studies.ResultsThe 22 studies represent only nine countries. More than half of them are considered as having a poor prevalence quality. In total, 4,256 participants have been evaluated. Their mean age was around 40 years, and 85 % of the participants were men. The results show a prevalence of cognitive disorders (MMSE) in 8.77 % of the sample. The mean IQ was 87.47 and the premorbid IQ 94.59. We also notice possible disorders affecting the episodic memory and the executive functions. Mean scores for short-term memory, speech and visuo-spatial functions are relatively low. None of the studies evaluated the praxia, the gnosia or the social cognition. The heterogeneity of studies and the lack of data did not allow us to give general conclusions about the etiology of these disorders. However, we see that around 40 % of the time subjects had histories of brain injuries and 89 % of childhood trauma. Intellectual disability is found in 49 % of the sample of a single study. Also, 70 % of the homeless population have been diagnosed with substance-related disorders and 65 % with psychiatric disorders. It appears that the only factors correlated with cognitive disorders would be the history of brain injuries and childhood traumas.ConclusionsWe confirm that homeless people often suffer from cognitive difficulties, and some of these difficulties (memory, executive functioning) are severe. Yet the etiology of these disorders remain relatively unknown: even if we observe a high prevalence of psychiatric, substance-related, neurodevelopmental and neurological issues by the homeless population, only a few of them (brain injury history and childhood trauma) seem to be correlated with cognition in homelessness. The potential explicative factors have been too rarely explored to bring a powerful explanation of cognitive disorders in homeless people. Further research needs to be done in order to give a more precise neuropsychological profile of the homeless population and to better understand what the disorders are rooted in. Last but not least, all this research and knowledge should be applied more to the care of homeless people by providing neuropsychological assessment and rehabilitation and by training the team to detect cognitive disorders and to support the person with a cognitive disability.     

缺血性脑血管病梗死模式的分类及病因、发病机制研究进展

缺血性脑血管病的梗死模式具有多样性，根据梗死数目可分为无梗死、单发梗死和多发 梗死。单发梗死主要根据病灶的位置和大小进行分类，多发梗死则根据血管的供血范围进行分类。 单发梗死和多发梗死的不同梗死模式分别与不同的病因和发病机制相关。     

鞍山市学生常见病调查及相关因素分析

目的 调查鞍山市学生常见病情况,并对其相关因素进行分析。方法 2018年9～11月选择鞍山市1个城区和1个县(铁东区和千山区),共监测13所学校,其中城区8所学校,县5所学校,其中包含小学到大学,调查学生常见病发生情况,分析不同年级、性别、地区学生常见病差异性。结果 鞍山市学生视力不良检出率最高,占53.77%,其次为恒牙龋齿,占21.11%;随着年级的增长视力不良检出率呈现出升高趋势(P0.05);与城区相比,县级学校视力不良、恒牙龋齿检出率明显偏高,且女性高于男性,差异有统计学意义(P0.05);随着年级增长,营养不良检出率逐渐降低(P0.05)。结论 鞍山市学生健康状况不容乐观,其中视力不良、龋齿以及营养不良等成为影响学生健康的主要卫生问题,应给予高度重视。     

肝阴虚证证候特点及辨证用药规律的文献研究

目的:为进一步深入研究和探讨肝阴虚证候的本质,本文分析和整理肝阴虚证的病因病机、证候表征、证候属性疾病及遣方选药的规律。方法:运用检索文献并进行频数统计的方法,检索查阅1960年9月1日至2019年1月10日中国知网中医临床研究文献。结果:肝阴虚证的病因病机为肝失疏泄,气机郁滞,化火伤阴,阴液亏虚,失于濡养;证候辨证要点主要为脉弦细数,舌红少津,头晕目眩,五心烦热,口咽干燥,两目干涩;证候临床属性疾病有肝炎、肝硬化、肝纤维化、肝癌;临床上治疗肝阴虚证使用处方主要为一贯煎、补肝汤、四物汤、芍药甘草汤,临床高频使用中药为生地黄、白芍、枸杞、当归、麦冬。结论:本文对于肝阴虚证的证候特点以及辨证用药规律做出系统的总结与归纳,将有关肝阴虚证的论述联系起来,形成统一的整体,为揭示肝阴虚证的本质与临床上形成较为成熟的肝阴虚证治疗方案提供参考。     

社区获得性肺炎的中西医治疗研究进展

社区获得性肺炎(Community Acquired Pneumonia,CAP)是比较常见的院外肺部炎性疾病之一,随着细菌、支原体、衣原体等多种病原体的耐药率的上升,以及病患梯度的范围增加,CAP的发病率呈逐年上升的趋势,死亡率日益增高,导致医疗资源消耗巨大。目前临床上CAP的患者主要依靠经验性治疗。正确选择抗生素、减少病原体的耐药率,优化肺部炎症疾病的医疗方案,提高CAP临床治愈率已经成为临床医生当前面临的一项重大挑战。中药制剂具有广谱抗菌、调节免疫、不易耐药、简便价廉等特点,是解决上述难题的一个很好途径。     

规范喉神经损伤的功能评估与治疗

规范喉神经损伤的功能评估与治疗基金项目：第一作者简介：通信作者：肖水芳（目的随着嗓音医学的发展，喉神经损伤近些年逐渐得到重视，尽管如此，国内当前其诊治欠规范且多依赖个人经验。喉神经损伤原因较多，不同类型损伤的症状、体征以及转归亦不完全一致，针对已知特定类型的喉神经损伤，尤其是喉返神经损伤，当前亦无公认的一线治疗方案，现存的治疗手段均存在相对的优势及不足。本文对喉神经损伤的病因、分类、诊断以及现行的治疗方案进行了归纳与评价，以期能为其诊断及治疗选择提供临床参考。     

耳鸣耳聋中医诊疗进展

耳鸣不是外来的声音,而是自身发出的声音,它可发生于单侧,也可发生于双侧,分为客观性耳鸣和主观性耳鸣。耳聋指不同程度的听力减退。耳鸣耳聋是生活中常见、难治的一种疾病,目前发病机理不明。中医学早在《黄帝内经》中就有耳鸣耳聋的记载及病因病机的论述,此后历代医家亦从不同角度探讨其病因病机及治疗方法。近年来,临床工作者在继承中医传统理论基础上试图从脏腑、经络、气血等方面阐明耳鸣耳聋病因病机,探索应用方剂、针灸、按摩导引等方法治疗耳鸣耳聋,取得了一定的疗效。本文详细归纳近年来耳鸣耳聋的病因病机及治疗方法等方面的文献,以期为临床提供一定的参考依据。     

Characteristics and Clinical Manifestations of Pigmented Purpuric Dermatosis

Background

Pigmented purpuric dermatoses (PPD) are a spectrum of disorders characterized by a distinct purpuric rash. Although PPD can be easily diagnosed, the disease entity remains an enigma and a therapeutic challenge.

Objective

The purpose of this study was to investigate the characteristics and clinical manifestations of PPD and to elucidate the relationship between assumed etiologic factors and the clinical manifestations of PPD and treatment responses.

Methods

Retrograde analyses were performed to identify appropriate PPD patients who visited Korea University Medical Center Anam Hospital from 2002 to 2012.

Results

Information on 113 patients with PPD was analyzed, and 38 subjects with skin biopsy were included for this study. Schamberg''s disease was the most frequent clinical type (60.5%). Concomitant diseases included hypertension (15.8%), diabetes (10.5%), and others. Associated medication histories included statins (13.2%), beta blockers (10.5%), and others. Possibly associated etiologic factors were recent upper respiratory infection (5.3%), high orthostatic pressure due to prolonged standing (2.6%), and strenuous exercise (2.6%). A total of 36 patients (94.7%) were treated with one or more treatment methods, including oral antihistamines, pentoxifylline, topical steroids, and/or phototherapy. There was no significant difference in disease progress according to underlying diseases, medications, or association factors (p>0.05).

Conclusion

Our overall results were grossly consistent with the existing literature, excluding several findings. Although a possible relationship between PPD and cardiovascular disease or cardiovascular medication was proposed at the beginning of the study, no statistically significant correlations were found according to the specific clinical types and treatment responses (p>0.05).