从湿热体质论治脂溢性脱发

中医对于脂溢性脱发，传统多按"血热风燥""血虚风燥""湿热""肝肾不足"等分型论治，虽能取得一定的临床疗效，暂时缓解病情，但难以根治，给患者带来困扰。倪诚教授根据国医大师王琦教授所提出的"肤-体相关论""体质可调论"，认为湿热体质是脂溢性脱发发病的主要土壤，指出瘀浊蛀发是脂溢性脱发的病机要点，治疗上以清利湿热调体治本、凉血活血为主、佐以滋养肝肾，方用茵陈蒿汤合升降散加减配合外洗经验方，从标本兼顾、分期论治、内服外洗等方面治疗脂溢性脱发，在临床上取得良好的疗效。     

中医体质研究40年回顾与展望

文章回顾中医体质研究40年来在6大理论创新、3大技术创新、4大转化应用、2大学术平台方面取得的辉煌成就。展望未来，中医体质研究将积极策应国家需求，进一步发挥其原创优势、深化理论研究、完善技术方法、加快平台建设、提升服务能力，为实施“健康中国”战略作贡献。     

Current therapeutical strategies for allergic rhinitis

Introduction: Allergic rhinitis is a common condition with increasing prevalence and is associated with several comorbid disorders such as bronchial asthma and atopic dermatitis. If allergen avoidance is not possible, allergen-specific immunotherapy is the only causal treatment option.

Areas covered: This review focuses on current treatments and the future outlook for allergic rhinitis. Pharmacotherapy includes mast cell stabilizers, antihistamines, glucocorticosteroids (GCSs), leukotriene receptor antagonists, and nasal decongestants. Nasal GCSs are currently regarded as the most effective treatment and are considered first-line therapy together with non-sedating antihistamines. The new formulation MP29-02 combines the nasal GCS fluticasone propionate with azelastine in one single spray and has achieved greater improvements than those under monotherapy with modern GCSs or antihistamines. Furthermore, this review discusses allergen immunotherapy alone and in combination with modern monoclonal antibodies.

Expert opinion: Despite the variety of medications for allergic rhinitis, ranging from general symptomatic agents like GCSs or decongestants, to more specific ones like histamine receptor or leukotriene blockers, to causal therapy like immunotherapy, many patients still experience treatment failures or unsatisfactory results. The ultimate goal may be to endotype every downstream pathway separately in order to offer patients individualized, targeted therapy with specific antibodies against the respective pathway.     

不同穴位针刺蝶腭神经节深度及方向的研究

目的:观测下关、颧髎、"蝶腭"穴的体表位置,及各穴至蝶腭神经节的针刺深度和针刺方向.方法:15具成年男性尸体,面部左右共30侧,对其面侧区进行由浅入深的解剖.以下关、颧髎、"蝶腭"穴各穴针刺至蝶腭神经节方向为穿刺入路,电动钻带克氏针穿刺延伸至对侧区域,坐标定位法测量各穴的对应穿刺点.结果:①体表位置:"蝶腭"穴与颧髎的体表距离为21 mm,与下关的体表距离为17 mm.②各穴针刺蝶腭神经节的深度:下关为49.9 mm,"蝶腭"穴为46.9 mm,颧髎为46.6 mm.③对应穿刺点坐标定位:下关针刺方向为前内上,对应于对侧的太阳和瞳子髎的中点处附近区域,对应穿刺点距对侧丝竹空的距离为17.6 mm;"蝶腭"穴针刺方向为后内上,对应穿刺点与颧弓水平线的距离为33 mm,与目外眦垂直线的距离为42 mm;颧髎针刺方向为后内上,对应穿刺点与两外耳门连线的距离为28 mm,头部正中线旁开62 mm.结论:了解下关、颧髎、"蝶腭"穴的体表位置、针刺深度、针刺方向,为临床针刺蝶腭神经节提供了依据.     

Allergic fungal sinusitis— A clinico-pathological study

The co-existence of fungal elements in allergic nasal Polyposis, has given rise to a distinct clinical entity known as ‘Allergic fungal sinusitis ’ (AF’S). Many a time, these fungal elements may not be diagnosed pre-operatively by routine diagnostic nasal endoscopy or CT scan of paranasal sinuses, due to the florid presentation of nasal polyps, which usually obscure the underlying fungal pathology. The diagnosis is often made intra-operatively. The post-operative confirmation of AFS is by histopathology, fungal smear, fungal culture, allergic murin study and fungal specific IgE titres. We report a series often such cases done in our institution, which highlight that AFS should be considered as a differential diagnosis in Sinonasal Polyposis cases, for their effective management.     

湖北地区汉族变应性哮喘患儿Tim-3启动子区基因多态性研究

目的 探讨湖北地区汉族儿童T细胞免疫球蛋白黏蛋白域蛋白．3（Tim-3）启动子区1541位C〉T和574位G〉T单核苷酸变异及其与变应性哮喘易感性之间的关系。方法 分别采用聚合酶链反应．限制性片段长度多态性（PCR-RFLP）和引物特异PCR-核酸序列测定技术检测湖北143例哮喘患儿和72名健康儿童Tim-3启动子区1541位C〉T和574位G〉T单核苷酸变异，讣算基因型和等位基因频率。结果 湖北地区健康儿童Tim-3启动子区1541位C／C、C／T和T／T基因型频率分别是0．961、0．039和0，而哮喘患儿频率分别为0．935、0．065、0，其基因型频率与对照组差异无统计学意义（r=0．3825，P=0．5362）；湖北健康儿童中Tim-3启动子区574位G／G、G／T和T／T基因型频率分别为0．992、0．008和0，而哮喘患儿频率分别为0．941、0．059、0，两组基因型频率差异有统计学意义（χ^2=4．134，P=0．042）。结论 湖北汉族儿童Tim-3启动子区存在多态性变异，其中574位G〉T多态性可能与湖北汉族儿童变应性哮喘易感性有关。     

TGF-β and IL-17 serum levels and specific immunotherapy

Two new T cell subsets may be involved in allergic rhinitis (AR) pathogenesis: Th17 and T regulatory cells, mainly producing IL-17 and TGF-β respectively. Successful Sublingual Immunotherapy (SLIT) induces relevant immunological changes, thus the aim of this study was to evaluate serum IL-17 and TGF-β levels in AR patients treated with SLIT for 2 years. Patients' blood samples were collected before initiating SLIT (baseline), three months after the end of the first pre-seasonal SLIT course, and at the end of the second pre-seasonal course. IL-17 was detectable only in the most severe allergic patients. SLIT significantly induced an increase in serum TGF-β levels. There was moreover a significant relationship between TGF-β and symptom severity and drug use at the end of the study. Therefore, this study provides clinically relevant evidence that two pre-seasonal SLIT courses may significantly affect serum TGF-β levels.     

适应性反应对中医药研究的启示

适应性反应是近年医学研究的热点问题之一,利用适应性反应已作为疾病防治的新战略,其核心和精髓是充分调动和激发机体内源性保护机制,增加机体适应性和抗损伤能力,维持机体自稳态.适应性反应的研究表明了机体自身存在着很强的内源性保护机制,其本质是适应性反应诱导了内源性保护物质(保护性蛋白等)的产生,而用药物等途径则可模拟或增强适应性保护作用.适应性反应与中医学的天人相应、正气学说、扶正固本、藏象学说、治未病思想、适应原中药、针灸经络等理论有诸多联系,对中医药研究有一定的启示,对于揭示中医学的科学内涵和实质、发展和弘扬中医理论及促进中西医结合均具有一定参考意义.     

Allergen avoidance in the secondary and tertiary prevention of allergic diseases: does it work?

Although allergen avoidance is widely recommended as part of a secondary and tertiary prevention strategy for allergic diseases, a clear-cut demonstration of its effectiveness is still lacking. Ongoing observational secondary prevention cohorts show that sensitisation to mite can be prevented in the short term by allergen avoidance measures, but further follow-up of these children is needed to show if this effect can be sustained, as well as to ascertain its impact on allergic disease. More well-designed trials are still required before we can give any conclusive advice to our patients. Considering the management of allergy, current evidence suggests that interventions in children (either single or multifaceted) may be associated with some beneficial effect on asthma control, but no conclusive evidence exists regarding rhinitis or eczema. Conversely, there is little evidence to support the recommendation of allergen avoidance methods in adults with asthma and rhinitis. There is a need for an adequately designed trial assessing the effects of a multifaceted intervention in this age group.