《针灸大成》关于气海穴临床应用的文献研究

目的:通过检索《针灸大成》中与气海穴治疗作用相关的文献条文,总结气海穴在治疗各系统疾病中运用频次较高的疾病及其配穴规律,为临床针灸对气海穴的使用提供理论支持。方法:以《中华医典》(第五版)中《针灸大成》作为文献检索来源,将气海穴及气海穴的别称“脖胦”“下肓”“丹田”“肓之原”“肓原”“下言”和“气泽”为检索词,用计算机检索工具及人工检索相结合的方法检索符合要求的文献条文,通过建立本研究的数据库,频次分析、条形统计图比较分析等方法,总结出气海穴在治疗各系统疾病中的运用频次及其配穴规律。结果:在《针灸大成》所涉及的条文中,气海穴尤善治疗内科疾病,在治疗内科疾病中排名前3位的是脾胃系病症、气血津液疾病、肾系病症和妇科疾病,气海穴配穴习惯为上下配穴法,同名经配穴法,以及前后配穴法,其中主要为前后配穴法和同名经配穴法。结论:气海穴《针灸大成》中单穴应用占比最高,而在气海穴众多配穴中,运用了本经配穴法、上下配穴法、前后配穴法,配穴归经主要来自任脉和足太阳膀胱经。同名经配穴法,同气相求,可增加疗效;与气海穴配伍较多的足太阳膀胱经以背腧穴为主,此为前后配穴法,亦称腹背阴阳配穴法,腹部为阴,腰背为阳,前后配穴法可起到“从阳引阴”亦可“从阴引阳”的作用,以达到调节阴阳,调和脏法,调畅经络的目的。     

Pediatric button battery ingestion: A single center experience and risk score to predict severe outcomes

PurposeThe purpose of this study was to analyze the management and outcomes of primary button battery ingestions and their sequelae at a single high-volume center, and to propose a risk score to predict the likelihood of a severe outcome.MethodsThe medical record was queried for all patients under 21 years old evaluated at our institution for button battery ingestion from 2008 to 2021. A severe outcome was defined as having at least one of the following: deep/circumferential mucosal erosion, perforation, mediastinitis, vascular or airway injury/fistula, or development of esophageal stricture. From a selection of clinically relevant factors, logistic regression determined predictors of a severe outcome, which were incorporated into a risk model.Results143 patients evaluated for button battery ingestion were analyzed. 24 (17%) had a severe outcome. The independent predictors of a severe outcome in multivariate analysis were location of battery in the esophagus on imaging (96%), battery size >/ = 2 cm (95%), and presence of any symptoms on presentation (96%), with P < 0.001 in all cases. Predicted probability of a severe outcome ranged from 88% when all three risk factors were observed, to 0.3% when none were present.ConclusionWe report the presentation, management, and complication profiles of a large cohort of BB ingestions treated at a single institution. A risk score to predict severe outcomes may be used by providers initially evaluating patients with button battery ingestion in order to allocate resources and expedite transfer to a center with pediatric endoscopic and surgical capabilities.Level of evidenceLevel IV.Type of studyClinical Research Paper.     

Effects of the loss and reconstruction of molar occlusal support on memory retrieval and hippocampal neuron density in rats

PurposeAnimal experiments have shown that the loss of occlusal support causes impairments in spatial cognition. Many reports have focused on the memory encoding process, and only few studies have investigated the effect on memory retrieval. This study aimed to examine the effects of both the loss and reconstruction of occlusal support on the memory retrieval process and on the number of hippocampal pyramidal cells.MethodsThe experimental animals were divided into a molarless group, in which molars were extracted, a denture-wearing molarless group with experimental dentures inserted after molar extraction, and a control group. Radial maze trials were performed for 20 consecutive days (acquisition phase). The rats were tested on long-term memory retention following the acquisition phase in eight trials every five days, and in an additional trial 20 days later (probe phase).ResultsThe denture-wearing molarless group showed higher levels of spatial learning and memory than the molarless group. There were no significant differences in memory retrieval during the probe phase between the denture-wearing molarless and the control group. The molarless group showed significantly worse spatial learning and memory and had fewer neurons in the hippocampus than the control group.ConclusionsOur results suggest that the loss of occlusal support decreases the number of pyramidal cells in the hippocampus and impairs memory decoding and retrieval. However, this effect is suppressed by the reconstruction of occlusal support.     

Fertility preservation in patients of childbearing age treated for breast cancer: A nationwide cohort study

BackgroundApproximately 7% of breast cancers are diagnosed in women under 40. Question of subsequent fertility has become fundamental. We aimed to evaluate the rate of fertility preservation (FP) by oocyte retrieval (OR) after ovarian stimulation in patients of childbearing age, managed for breast cancer with adjuvant chemotherapy in France, reuse rate of frozen gametes and live births rate (LBR) after treatment.MethodsWe included 15,774 women between 18 and 40 years old, managed by surgery and adjuvant chemotherapy for breast cancer, between January 2011 and December 2020 from a French health registry. Patients with OR after breast surgery and before chemotherapy were considered as FP group; those with no OR as no FP group. To compare LBR with French population independently of age, we calculated Standardized Incidence Rates (SIR) of live births using indirect standardization method.ResultsFP rate increased gradually since 2011, reaching 17% in 2019. A decrease in use was observed in 2020 (13,9%). Among patients with at least 2 years of follow-up, gamete reuse rate was 5,6%. Births after cancer were mostly from spontaneous pregnancies. Among patients with at least 3 years of follow-up, LBR was 19,6% in FP group, 3,9% in second group. SIR of live births was of 1,05 (95% CI = 0.91–1.19) and 0.33 (95% CI = 0.30–0.36) in FP and no FP group respectively.ConclusionOncofertility activity increased until 2019 in France, reaching 17%. Gamete reuse rate was low. Births resulted mainly from spontaneous pregnancies. SIR of live births was lower in no FP group.     

从“湿疫”论治新型冠状病毒肺炎的思考

本文基于中医经典文献及临床实践思考,立足于"湿疫"理论阐释新型冠状病毒肺炎(简称"新冠肺炎")的病因、病机、传变规律及治疗方药。认为新冠肺炎乃湿毒疫邪所致,其病机特点为内外病邪相引,合而致病;本病除遵循卫、气、营、血传变规律外,同时也表现出三焦传变的过程。同时,通过归纳梳理相关中医经典著作中关于湿疫的证治方药,为新冠肺炎的中医诊治提供临床思路。     

后路枕骨髁螺钉技术研究进展

正枕骨、寰椎和枢椎共同构成了枕颈部活动的结构功能单位,即枕颈交界区~([1-2])。炎症、创伤、肿瘤及畸形等因素会导致枕颈交界区失稳,从而引起颈脊髓或神经根的损伤、麻痹及难以忍受的疼痛,甚至危及生命~([3-4])。后路内固定融合技术是治疗枕颈部失稳的重要手段,目前常用术式为枕骨螺钉技术,该技术较钢丝固定技术有更好的生物力学稳定     

小儿推拿“六腑”穴位考

[目的]通过考证相关文献，更全面认识小儿推拿特定穴“六腑”，正确指导临床应用。[方法]通过整理研究小儿推拿经典古籍和现代文献，对六腑的定位、操作、功效、配伍及现代临床应用、机制研究进行详细解析，从多个方面深入了解该穴。[结果]归纳古籍发现六腑的定位和操作存在争议，普遍认为穴性为寒凉，有退热、通腑之效，常与三关配伍合用于寒热、虚实夹杂之证。现代医家认为该穴有通腑、泻热、解毒的作用，临床可用于小儿多系统病变的治疗，尤以肺、脾胃系疾病多见，效果显著，但目前对于作用机制的研究较少，退热机制可能与神经反馈调节、免疫调节等相关，通腑、解毒机制尚未有前人研究。[结论]小儿推拿六腑穴退热、通腑功效卓著，古今广泛用于临床多种小儿疾病的治疗，备受医家推崇。全面了解该穴，正确指导辨证施术，才能发挥其最佳临床疗效。     

过敏性紫癜性肾炎方药规律及中医证候分析

目的：通过对1993年1月至2019年12月CNKI、VIP、WanFang收录的中医治疗过敏性紫癜性肾炎的文献进行整理分析，探讨中医辨证论治本病的证候和方药规律。方法：采用SPSS 25.0统计软件，对文献中证候、方剂以及药物进行统计归类，总结各证候、方剂、药物出现的频次和所占比例，对药物和临床症状进行聚类分析。结果：共纳入文献93篇，通过整理分析得出39个中医证候，其中脾肾两虚、风盛血热、气不摄血、阴虚火旺、气阴两虚等为中医常见证候；证候要素分析：血热、风热、瘀血、湿热为常见实性病机；肾虚、脾虚、阴虚、气虚为常见虚性病机；病位主要在肾、脾、肺、肝四脏；共得方剂145首，其中自拟方53首，成方92首，二者以补益剂、清热剂、理血剂、祛风剂为主；中药206味，分为13类，以生地黄、牡丹皮、赤芍、当归、茯苓等为常用药。结论：过敏性紫癜性肾炎的病位在肾、脾、肺、肝；风、热、湿、毒、瘀、虚为本病的主要病机。在临床用药中以补虚药、活血药、清热解毒药、利水渗湿药为主，兼以应用祛风药；治疗中应采用中医辨证与辨病相结合的方式。