从五运六气角度探析己亥年冬瘟

2019年为己亥之年,土运不足,厥阴风木司天,少阳相火在泉。下半年相火淫胜,火气流行,克金、刑水。风木盛则克制土运,土运本不足,致虚者更虚,强者更强,此谓之不相得,不相得则病;且气克运,古称之为天刑,天刑之年多灾害。2019年,冬季主气太阳寒水之上少阳相火客临,致冬不藏反长,天不寒反暖。地气封藏不固,水中阳气不藏,本应该被抑制或杀灭的微生物却因火热而未灭,并得少阳火毒助长而毒性更猛,化生为火疫。2020年为庚子年,主行金运,金克木,可平复2019年偏盛之木运,故瘟毒会被2020年之金运削弱或肃杀。针对此次瘟疫,未病之人预防要点为:虚邪贼风,避之有时;精神内守,病安从来;正气存内,邪不可干;饮食宜忌,尤为重要;避秽化浊,芳香化湿。已病之人的治疗,依据此次瘟疫"少阳火毒夹湿"病机,以咸补之,以甘泻之,以咸耎之,岁谷宜丹,间谷宜豆。此次瘟毒的性质虽为湿热火毒,但患者体质却有寒热虚实之别,感染后症状、病情和预后亦不同,故中医临证时应遵循辨证论治,三因治宜的原则;若体质素有湿热,邪从本气而化,可遵循运气病机施治;若体质本热,湿去而化为火毒,则应以制火为主;若体质本寒,热去而化寒湿,则应温化寒湿,芳香化浊;若体质素虚,出现危重证候,则应在祛邪时,重视固护元气。     

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。     

基于文献分析多囊卵巢综合征的中医证型分布及用药规律

目的:通过文献探析中医治疗多囊卵巢综合征(PCOS)的证型分布及临床用药规律。方法:检索2003年至2018年1月1日中国期刊全文数据库(CNKI)、万方、维普3个中文数据库中相关中医治疗PCOS的临床研究文献,建立中医治疗PCOS的整体证型及临床用药数据库,并对数据进行处理、分析。结果:①共纳入符合标准的文献252篇,方剂284首;②涉及证型共37种,其中常见证型为肾虚血瘀证、痰湿证、肾虚痰瘀证,共占43.31%;③涉及病位要素以肾为主,其次为肝、脾;涉及病性要素以血瘀、痰、湿为主;④涉及药物193味,按功效共分为16类,补虚药占41.44%,活血化瘀药占16.20%,化痰祛湿药占14.90%;⑤中医治疗PCOS药性以温、平为主,药味以甘为主,辛、苦次之。结论:PCOS病因病机复杂,以肾虚为本,血瘀、痰湿为标,治疗以补肾活血、化湿祛痰为主。     

Epidemiology of tick‐borne pathogens in the semi‐arid and the arid agro‐ecological zones of Punjab province,Pakistan

Tick‐borne diseases (TBDs) have a large impact on animal health and the livelihood of livestock owners, particularly in developing countries. Although climatic and ecological conditions in Pakistan may favour the transmission of tick‐borne pathogens (TBPs), only a few systematic studies have been carried out on TBPs and the diseases that they cause in this country. To improve our understanding of the distribution of TBPs, 3,807 ticks were collected from ruminants (n = 369) on 108 livestock farms (semi‐arid zone = 36, arid zone = 72) in Punjab Province. After morphological identification ticks were pooled into 405 pools (Hyalomma anatolicum = 300, Rhipicephalus microplus = 89, Hyalomma dromedarii = 9, Rhipicephalus turanicus = 7) based on their species, locality of collection, and the host. DNA from each pool was screened by a Reverse Line Blot (RLB) hybridization assay for the presence of Anaplasma, Ehrlichia, Rickettsia, Babesia, and Theileria species. DNA from at least one TBP was found in 142 (35.1%) pools. Among the positive pools, 91 (64.1%) had a mixed infection with two or more TBPs, whereas 51 (35.9%) pools were infected with a single TBP. The detected pathogens not only included species that were known to be endemic in Pakistan, such as Theileria annulata (6.7%), Theileria orientalis (3.5%), Anaplasma marginale (5.7%), Anaplasma centrale (2.7%), Anaplasma ovis (1.5%), Babesia bigemina (0.7%), and Babesia bovis (0.2%), but also several TBPs that had not been reported to occur in Pakistan before. This included Ehrlichia minasensis (3.2%), an Anaplasma platys‐like organism (1.2%), Babesia occultans (0.2%), and Rickettsia massiliae (0.2%), as well as two previously uncharacterized species: Ehrlichia sp. Multan (18.0%) and Anaplasma sp. (BL099‐6) (2.22%). The pathogenicity of these novel species remains to be examined. This study shows that a much broader spectrum of TBPs is present in Pakistan than previously thought, including several zoonotic pathogens.     

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Small‐ and medium‐sized mammals play an important role in the life cycle of tick‐borne pathogens in urban habitats. Our aim was to apply the general protocol, DAMA (documentation–assessment–monitoring–action), which is an integrated proposal to build a proactive capacity to understand, anticipate, and respond to the outcomes of accelerating environmental change. Here we tested whether road‐killed carcasses in urban areas are useful sources of tissue and parasite samples to investigate these species’ contribution to the epidemiology of vector‐borne diseases. We collected 29 road‐killed and 6 carcasses with different causes of mortality (23 northern white‐breasted hedgehogs and 12 from seven other mammal species) mainly from Budapest, Hungary. We used quantitative and conventional PCRs to determine pathogens in 90 collected tissues (52 from hedgehogs; 38 from other species) and 417 ticks that were only found on hedgehogs. Tissue samples revealed a wide range of bacteria including human zoonotic pathogens identified as Anaplasma phagocytophilum ecotype I, Borrelia afzelii, B. spielmanii, Borrelia miyamotoi, Rickettsia helvetica, and Bartonella species. Among the 23 collected hedgehog carcasses, 17 (74%) were infected with A. phagocytophilum, 6 (26%) with Borrelia burgdorferi s.l., 12 (52%) with R. helvetica, and 15 (65%) with Rickettsia sp. Furthermore, we report the first detection of Rickettsia sp. infection in European moles and lesser weasel and R. helvetica in stone marten. Through sequencing B. afzelii, R. helvetica, R. monacensis and A. phagocytophilum ecotype I were identified in the ticks removed from the carcasses. We showed that road‐killed urban mammal species are exposed to multiple tick‐borne pathogens but further studies have to clarify whether they, in fact, also have a role in their maintenance and spread. Our study also demonstrates that roadkill can be used in the risk assessment of potential human infection and in the implementation of the DAMA protocol.     

Fluorescence ureteral navigation during laparoscopic surgery for clinically suspected stage T4 colorectal cancer: A cohort study

BackgroundApproximately 15% of patients with colorectal cancer present with locally advanced tumors (T4 stage). Laparoscopic surgery for stage T4 disease has not yet been established.The near-infrared ray catheter fluorescent ureteral catheter (NIRFUC) is a new device that uses near-infrared fluorescence resin.We examined the utility of fluorescence ureteral navigation (FUN) with the NIRFUC during laparoscopic surgery for stage T4 colorectal cancer.Materials and methodsPatients with stage T4 colorectal cancer (n = 143, from January 2017 to March 2021) were divided into a T4FUN + group, in which the NIRFUC was used (n = 21), and a T4FUN- group, in which the NIRFUC was not used (n = 122). Short-term outcomes were compared between the groups.Next, the laparoscopic surgery rate and incidence of ureteral injury from January 2017 to March 2021 were compared between the T4FUN- group and the non-stage T4FUN- group (n = 434, from January 2017 to March 2021), in which fluorescence ureter navigation was not used.ResultsRectal cancer, stage T4b disease, and invasion into the urinary tract were observed more often in the T4FUN + group than in the T4FUN- group.In the comparisons of the T4FUN + versus T4FUN- groups, the operative time was 398 (161–1090) vs. 256 (93–839) minutes, the blood loss was 10 (1–710) vs. 25 (0–1360) ml, and the ratio of laparoscopic surgery to open surgery was 21:0 vs. 79:43. Postoperative complications (Clavien-Dindo grade ≥ III) were present in 2 (10%; 0 ureteral injury) patients in the T4FUN + group and 13 (11%; 2 ureteral injury) patients in the T4FUN- group.In the T4FUN + group, the operative time was longer (p < 0.0001), but the laparoscopic ratio was higher (p = 0.0002), and the blood loss volume and incidence of ureteral injury tended to be lower.In the comparisons of the T4FUN- versus non-stage T4FUN- groups, the ratio of laparoscopic surgery to open surgery was 79:43 vs. 384:50, the incidence of open conversion was 8 (6.6%) vs. 15 (3.5%), and the incidence of ureteral injury was 2 (1.6%) vs. 0 (0%). In the T4FUN- group, the open surgery rate (<0.0001), open conversion rate (p = 0.0205) and incidence of ureteral injury (p = 0.0478) were high, with a significant difference observed between the groups.ConclusionPatients with stage T4 disease have an increased risk of ureteral injury and are more likely to be converted to open surgery.FUN can help to safely increase the laparoscopic surgery rate while safely visualizing the ureter. FUN is recommended for laparoscopic surgery in patients with stage T4 colorectal cancer.Clinical trial registrationExamination of fluorescence navigation for laparoscopic colorectal cancer surgery; Research Ethics Committee of the Kawaguchi Municipal Medical Center (Saitama, Japan) approval number: 2020-3. https://kawaguchi-mmc.org/wp-content/uploads/clinical research-r02.pdf;     

Focal infection of periodontal origin

Periodontology has evolved from a predominantly mechanical to a sophisticated infectious disease‐based discipline. Research has paved the way for a greater understanding of the periodontal microbiome, improvement in periodontal diagnostics and therapies, and the recognition of periodontitis being associated with more than 50 systemic diseases. The etiopathology of progressive periodontitis includes active herpesviruses, specific bacterial pathogens, and proinflammatory immune responses. This article points to a role of periodontal herpesviruses in the development of systemic diseases and proposes treatment of severe periodontitis not only to avoid tooth loss, but also to reduce the risk for systemic diseases. An efficient, safe, and reliable anti‐infective treatment of severe periodontitis is presented, which targets both herpesviruses and bacterial pathogens and which can be carried out in minimal time with minimal cost.     

D-半乳糖联合对氯苯丙氨酸致肾不藏志不寐大鼠下丘脑神经递质和凋亡基因的实验研究

目的:观察D-半乳糖联合对氯苯丙氨酸(PCPA)致肾不藏志不寐大鼠下丘脑神经递质和凋亡基因的变化。方法:40只SD大鼠随机分为对照组、老年组、失眠组、肾不藏志不寐组(模型组),每组10只。老年组大鼠给予D-半乳糖皮下注射,失眠组给予对PCPA腹腔注射,肾不藏志不寐组给予D-半乳糖皮下注射联合PCPA腹腔注射建立模型,对照组给予等剂量生理盐水注射。造模结束后测量各组大鼠体质量、采用水迷宫观察大鼠定位航行探索运动轨迹、采用RT-PCR法检测各组大鼠下丘脑GABAARα1、GABAARβ2、GABAARγ2、Bax、Bcl-2 mRNA的相对表达量。结果:与空白组比较,模型组体质量显著降低(P<0.01);定位航行探索运动轨迹显著延长;模型组下丘脑GABAARα1、GABAARβ2、GABAARγ2、Bcl-2mRNA相对表达量均显著性降低(P<0.05,P<0.05,P<0.01,P<0.05);下丘脑Bax mRNA相对表达量显著性增加(P<0.05)。结论:D-半乳糖联合PCPA致肾不藏志不寐大鼠下丘脑睡眠相关的神经递质和凋亡基因表达发生改变。