辨体-辨病-辨证诊疗模式在慢性病防治中的应用策略

依据中国防治慢性病中长期规划(2017—2025年),按照国医大师王琦教授倡导的"辨体-辨病-辨证诊疗模式",提出慢性病"3+4+3"防治路向:面向三类人群(一般、高危、患病人群),朝向四种状态(无病、病前、病中、病后状态),指向三辨模式(辨体-辨病-辨证诊疗模式)。进而探讨其应用策略:对于一般人群无病状态——辨体养生,固本防病;对于高危人群病前状态——辨体干预,治本救萌;针对患病人群病中状态——"三辨"施治,标本兼顾;针对患病人群病后状态——辨体调理,固本防复。文中结合案例加以佐证,具有临床指导价值。     

The relationship between measurement of in vivo brain glutamate and markers of iron metabolism: A proton magnetic resonance spectroscopy study in healthy adults

Fundamental human studies which address associations between glutamate and iron metabolism are needed. Basic research reports associations between glutamate and iron metabolism. Human studies report sex differences in iron metabolism and glutamate concentrations, which suggest that these relationships may differ by sex. We hypothesised associations would be apparent between in vivo glutamate and peripheral markers of iron metabolism, and these associations would differ by sex. To test this, we recruited 40 healthy adults (20 men, 20 women) and measured (a) standard clinical biomarker concentrations for iron metabolism and (b) an in vivo proxy for glutamate concentration, glutamate with glutamine in relation to total creatine containing metabolites using proton magnetic resonance spectroscopy studies with a two‐dimensional chemical shift imaging slice, with voxels located in bilateral dorsolateral prefrontal cortices, anterior cingulate cortices and frontal white matter. Only the female group reported significant associations between peripheral markers of iron metabolism and Glx:tCr concentration: (a) right dorsolateral prefrontal cortex Glx:tCr associated positively with serum transferrin (r = .60, p = .006) and negatively with transferrin saturation (r = ?.62, p = .004) and (b) right frontal white matter Glx:tCr associated negatively with iron concentration (r = ?.59, p = .008) and transferrin saturation (r = ?.65, p = .002). Our results support associations between iron metabolism and our proxy for in vivo glutamate concentration (Glx:tCr). These associations were limited to women, suggesting a stronger regulatory control between iron and glutamate metabolism. These associations support additional fundamental research into the molecular mechanisms of this regulatory control.     

Excitability of motor and sensory axons in multifocal motor neuropathy

ObjectiveTo assess excitability differences between motor and sensory axons of affected nerves in patients with multifocal motor neuropathy (MMN).MethodsWe performed motor and sensory excitability tests in affected median nerves of 20 MMN patients and in 20 age-matched normal subjects. CMAPs were recorded from the thenar and SNAPs from the 3rd digit. Clinical tests included assessment of muscle strength, two-point discrimination and joint position.ResultsAll MMN patients had weakness of the thenar muscle and normal sensory tests. Motor excitability testing in MMN showed an increased threshold for a 50% CMAP, increased rheobase, decreased stimulus-response slope, fanning-out of threshold electrotonus, decreased resting I/V slope, shortened refractory period, and more pronounced superexcitability. Sensory excitability testing in MMN revealed decreased accommodation half-time and S2-accommodation and less pronounced subexcitability. Mathematical modeling indicated increased Barrett-Barrett conductance for motor fibers and increase in internodal fast potassium conductance for sensory fibers.ConclusionsExcitability findings in MMN suggest myelin sheath or paranodal seal involvement in motor fibers and, possibly, paranodal detachment in sensory fibers.SignificanceExcitability properties of affected nerves in MMN differ between motor and sensory nerve fibers.     

冠心病和牙周病相互关系的临床观察

目的：通过临床问卷调查及体检，初步探讨牙周病与冠心病间的相互关系。方法：选取齐鲁医院内科患者150例作为观察对象，冠心病组76例，对照组74例，两组均进行相同的病史、血液及牙周病检查。比较两组牙周患病率及牙周健康状况（牙龈出血、牙齿松动、牙齿缺失、牙龈萎缩）的差异。结果：冠心病组牙周病患病率（53．01％）高于对照组（33．35％），统计学检验两组差异有显著性（P〈0．01）。结论：牙周病与冠心病之间可能存在一定的相关性。     

Effects of age on the stress-strain and stress-relaxation properties of the rat molar periodontal ligament

OBJECTIVE: We examined the stress-strain and stress-relaxation properties of the periodontal ligament (PDL) in the rat molar at 2, 6, 12, and 24 months of age to elucidate age-related changes in the tooth support function of the PDL. DESIGN: From the dissected left and right mandibles in each rat, a pair of transverse sections (ca. 0.45 mm in thickness) of the first molar was cut at the middle part of the mesial root. We then obtained a load-deformation curve for the PDL, using one of the paired sections. The other section was loaded to as much as 50% of the maximum load as determined from the contralateral section, and keeping the deformation constant for 10 min, a load-relaxation curve was obtained and analysed. RESULTS: The maximum shear stress and tangent modulus decreased between 2 and 24 months of age. As the maximum shear strain increased with age (P < 0.001), the failure strain energy density did not change between 2 and 24 months of age. The stress-relaxation during the 10 min period decreased from 2 to 24 months of age (P < 0.01). The relaxation process of the PDL in each age was well described by a sum of three exponential decay functions. The age-related decrease in the relaxation was found to be mainly due to the increase in the relaxation time for the long-term relaxation component. CONCLUSION: These results indicate that the maximum shear stress and stiffness of the rat molar PDL decrease between 2 and 24 months of age; but its toughness remains unchanged due to an increase in the extensibility. Our findings further indicate that the fluid flow and movements of macromolecules within the stretched PDL fibres during the stress-relaxation decrease with advancing age.     

正中关系与正畸治疗的相关性

正中关系（CR）一直是口腔正畸学、修复学以及学研究的核心内容之一,在重建咬合、改善颌关系等方面具有重要的生理及临床意义。随着口腔医学研究不断深入,CR被多次重新定义,在正畸学中的应用也更加广泛,与正畸治疗前诊断、检查分析、治疗目标等密切相关。本文就CR的定义及其与错颌畸形的关系、在正畸治疗中的应用等方面进行综述。     

A Technique for Improved Maxillary Record Base Adaptation Through Controlled Polymerization of Light-Activated Dental Resins

A technique for the fabrication of light-activated maxillary record bases is described. The use of a segmental polymerization process provides improved palatal adaptation by minimizing the effects of polymerization shrinkage. Utilization of this technique results in record bases that are well adapted to the corresponding master casts.     

Cancer Risk after Cyclophosphamide Treatment in Idiopathic Membranous Nephropathy

Background and objectives

Cyclophosphamide treatment improves renal survival in patients with idiopathic membranous nephropathy. However, use of cyclophosphamide is associated with cancer. The incidence of malignancies in patients with idiopathic membranous nephropathy was evaluated, and the cancer risk associated with cyclophosphamide use was estimated.

Design, setting, participants, & measurements

Patients who attended the clinic were included prospectively from 1995 on. A crude incidence ratio for the occurrence of malignancy was calculated. Incidence ratios were subsequently standardized to potential confounders. Latency between cyclophosphamide therapy and the occurrence of cancer was estimated by stratifying for time since the start of treatment. Finally, Poisson regression was used to obtain a multiple adjusted incidence ratio and investigate the dose–response relationship between cyclophosphamide and cancer.

Results

Data were available for 272 patients; the mean age was 51 years, and 70% of the patients were men. Median follow-up was 6.0 years (interquartile range=3.6–9.5), and 127 patients were treated with cyclophosphamide. Cancer incidence was 21.2 per 1000 person-years in treated patients compared with 4.6 per 1000 person-years in patients who did not receive cyclophosphamide, resulting in crude and adjusted incidence ratios of 4.6 (95% confidence interval, 1.5 to 18.8) and 3.2 (95% confidence interval, 1.0 to 9.5), respectively.

Conclusion

Cyclophosphamide therapy in idiopathic membranous nephropathy gives a threefold increase in cancer risk. For the average patient, this finding translates into an increase in annual risk from approximately 0.3% to 1.0%. The increased risk of malignancy must be balanced against the improved renal survival.     

数字人体微观研究-量子人体与人体的关系

根据量子人体与人体研究方法的区别,本文首先介绍了量子人体与人体的对应原理,然后描述了量子人体谐振子的相干态,最后对量子人体的Rydberg波包,波形的演化与恢复作了阐述,为数字人体微观研究,阐述量子人体与人体的对应关系提供了理论基础.     

设定护士长接待时段 减少护患纠纷

通过开设护士长接待时段,与病人进行面对面的沟通,并对护士长接待时段中存在的问题进行分析,找出诱发护患矛盾的因素,针对存在的问题提出对策,以提高护理服务的质量,认为护士长接待时段为护患沟通开辟了一条新途径。