清肝解郁和健脾补肾法在治疗肝火上亢型慢性肾衰合并高血压中的应用

目的:观察清肝解郁和健脾补肾法治疗肝火上亢型慢性肾衰(CRF)合并高血压患者的临床效果。方法:选取2016年6月至2018年6月京东誉美医院收治的肝火上亢型CRF合并高血压患者90例作为研究对象,按照随机数字表法随机分为对照组和观察组,每组45例。对照组给予口服硝苯地平控释片治疗,观察组在对照组治疗基础上给予清肝解郁、健脾补肾汤治疗,每4周为1个疗程,均治疗3个疗程。比较治疗前后中医症状评分、收缩压(SBP)、舒张压(DBP)变化;比较2组临床疗效;比较治疗前后肾功能指标:尿素氮(BUN)、血肌酐(Scr)、24 h尿蛋白定量(24 hPRO);统计治疗期间2组不良反应发生情况。结果:治疗前观察组与对照组中医症状评分、SBP、DBP、BUN、Scr、24 hPRO比较,差异均无统计学意义(P>0.05),治疗后2组患者中医症状评分、SBP、DBP、BUN、Scr、24 hPRO均显著降低(P<0.05),观察组均低于对照组,差异有统计学意义(P<0.05);2组临床疗效比较,差异有统计学意义(P<0.05),且观察组总有效率显著高于对照组,差异有统计学意义(P<0.05);观察组和对照组不良反应发生率分别为2.22%和6.67%,2组比较差异无统计学意义(P>0.05)。结论:清肝解郁、健脾补肾法辅助治疗肝火上亢型CRF合并高血压疗效确切,可较好控制血压,并且可显著改善肾功能,减少不良反应发生情况。     

The Dangerous Middle: Situational Awareness and Worker Perception of Beetle Kill

ABSTRACT

Forest workers, including loggers, foresters, and wildland firefighters, are regularly exposed to some of the most fatal occupational environments in the United States. These hazardous work environments may become even more complex and dynamic when subject to bark beetle outbreaks that have resulted in significant tree mortality. The impacts of tree death from bark beetles are significant, with the cumulative 17-year (2000–2016) footprint for bark beetle caused tree mortality estimated at 54 million acres. However, how workers think about and act in these environments is understudied. This study, therefore, approaches the issue of beetle kill and forest worker safety by examining the perspectives or workers themselves. Its contribution is to leverage ethnographic research to provide insights that can generate new research questions, better inform outreach, and ultimately improve worker safety outcomes. The resulting insights show that beetle kill was understood by workers as a hazard that increased the complexity and dynamism of the work environment, making situational awareness both more necessary and more difficult to maintain. While much research about situational awareness focuses on hazardous situations, it is suggested that building adequate situational awareness should also include broader considerations of organizational communication, as well as training and experience considered over the course of entire careers.     

《素问玄机原病式》学术思想探讨

《素问玄机原病式》一书，发挥《内经》病机学说，弥补了原“病机十九条”过于简略之不足，创造性地继承和发展了《内经》理论，特别是首倡“六气皆从火化”之说；关于“相火”的论述，则为后世相火理论的形成奠定了基础；它还总结了温热病的治疗原则，对后世温病学派的形成产生了重要影响。     

李杲《脾胃论》热中证探析

金元四大家之一李杲创立脾胃学说，认为“百病皆由脾胃衰而生”，脾胃不足则内生火热之邪，即阴火，是由饮食不节，形体劳役，七情内伤所致，这种阴火内盛的病证称为“热中”。后世医家对于热中证及阴火的实质有诸多争议，影响对脾胃学说的进一步理解和运用。根据李杲医著及其他医家论述分析，热中证的实质是由于脾胃内伤，化生风、湿、热、燥邪气，致使经络营卫运行不利而产生；阴火的治疗侧重于培补中气，除热祛邪。     

Lead poisoning in precious metals refinery assayers: A failure to notify workers at high risk

Lead poisoning in a precious metals refinery fire assayer and a routine OSHA inspection prompted an investigation of the index facility, a survey of the industry, and efforts to notify assayers of this previously unrecognized hazard. Air and blood samples were obtained at the index facility. Management personnel from all fire assay laboratories in Rhode Island and southern Massachusetts were interviewed. The industry's trade association, OSHA, NIOSH, trade unions, and the media were asked to assist in a nationwide notification effort. Assayers at the index facility had excessive exposures to lead due to an age-old, lead-based assaying method that remains the industry gold standard. Blood lead levels of the three assayers (mean 61.3 μ/dl, range 48–86 μg/dl) were considerably higher than those of 16 other refinery workers (mean 27.4 μg/dl, range 13–49 μg/dl). The industry survey revealed inadequate knowledge of both the lead hazard and the applicability of the OSHA lead standard. Notification efforts failed in large part due to economic obstacles. The notification of workers at high risk of lead exposure and the eradication of occupational lead poisoning will require greater attention to economic forces. © 1994 Wiley-Liss, Inc.     

火针刺血疗法的临床应用心得

目的:探讨火针刺血疗法在临床的应用价值。方法:对实践经验和临床资料进行分析。结果:火针刺血疗法疗效快无不良反应。结论:火针刺血疗法对寒凝血瘀证疗效较好。     

Fire in the operating theatre. Evacuation pre–planning may save lives

An operating theatre fire and the steps taken to deal with it are described; the difficulties encountered in evacuating anaesthetised patients are highlighted. Measures which might be taken to prevent recurrence of these problems, and recommendations on the institution of fire drills for the safety of patients and staff are given.     

从热、虚、瘀辨证论治小儿过敏性紫癜

从热、虚、瘀三个方面论述了小儿过敏性紫癜的病因病机特点，抓住病因病机的核心，确定了热伤血络、阴虚火旺、气不摄血三个本证证型和风热、热毒、湿热、血瘀四个标证证型。采用本证和标证相结合的方法对小儿过敏性紫癜进行辨证论治，并从理论上探讨了该方法的科学性和实用性。     

In vivo and in vitro comparison of fire ant venom and fire ant whole body extract

Thirty-four patients with a history of immediate hypersensitivity to the sting of the imported fire ant were evaluated in a study designed to compare the diagnostic usefulness of fire ant whole body extract (WBE) preparations with that of fire ant venom (IFAV). Ninety-one percent ($\text{31}\text{34}$) of the hypersensitive patients skin tested with IFAV at a maximal concentration of 1:5 × 10³, $\text{v}\text{v}$, demonstrated a wheat equal to or greater than the histamine control. Fifty-three percent ($\text{18}\text{34}$) of the group were skin test positive to a WBE preparation. When the criteria for a positive skin test were relaxed, 82% of the hypersensitive group could be identified with the IFAWBE. A comparison of skin test results in sensitive patients revealed variability in the sensitivity of the WBE preparations utilized in the study. Leukocyte histamine release demonstrated a dose-response release of histamine with both IFAV and SIWBEa preparations. Specific venom antisera produced in rabbits identified a precipitin line of common identity in a gel-diffusion system containing IFAWBE and IFAV. This finding was verified by the competitive inhibition of IFAWBE with IFAV in a solid-phase radioimmunoassay system. Fire ant WBEs contain venom constituents and are effective diagnostic agents in up to 82% of patients with hypersensitivity to the sting of the imported fire ant. Marked variability in the responsiveness of sensitive patients to different WBE preparations mandates standardization of these diagnostic preparations.     

基于“阴火”理论探讨内皮细胞代谢重塑与肿瘤血管化关系及中医药干预思考

血管内壁的内皮细胞借助调节血管稳态、血管张力、细胞黏附、细胞增殖、凝血抗性、炎症因子等来响应机体的物理和化学信号,进而维持血管处于衡动稳定的状态。血管生成是肿瘤发生发展所需的关键条件,肿瘤血管化的病理模式为瘤体生长提供所需的营养和氧气,以促进其增殖。近年来,内皮细胞参与肿瘤血管渗入,驱动血管生成被认为是促进肿瘤转移的关键环节。血管内皮细胞可通过调控代谢重塑以满足肿瘤血管化过程中对物质和能量的需要,其异常的代谢特征使得其能更好地适应肿瘤微环境的变化,这种代谢的改变常被看作是肿瘤血管化进程的重要基础。中医“阴火”理论源自《黄帝内经》,原指“阴虚生内热”,属内伤之火范畴,后经历代医家推演变化,逐步形成“脾胃气虚-阴火上乘-气火失调”的病机认识。内皮细胞代谢重塑的发病过程是“阴火”病理表征的客观体现,而阴火造化生息、燔灼妄动之性又与肿瘤新生血管增生无制、亢变为害的疾病状态相吻合。脾胃亏虚与气机失衡的改变可致水谷精微不得布散,发生代谢障碍,停久为痰为瘀,与血脉相搏结,致使局部环境异化（肿瘤微环境形成）、脉道不利（内皮细胞代谢失衡）,异变形成肿瘤新生血管。在“阴火”证候要素指导下,围绕气与火的相关性,运用“扶正调气”的治法遣方用药,可调节内皮细胞代谢功能,达到机体相对平衡状态,进而抑制肿瘤血管新生。基于以上认识,该文围绕内皮细胞代谢重塑与阴火相关理论,阐发学术微旨,以期为中医药干预肿瘤血管化进程提供一定的理论支持。