中医分期辨证联合外治疗法治疗小儿肺炎的多中心临床观察

[目的]多中心观察中医分期辨证结合外治法治疗小儿肺炎的临床疗效。[方法]按随机、对照、多中心方法,将300例小儿肺炎患儿随机分为中医内外合治组、中医内治组和对照组各100例。中医内外合治组予西医基础治疗、中医辨证施治内服及静滴和"小儿敷贴粉"敷贴及穴位微波;中医内治组予西医基础治疗、中医辨证施治内服及静滴;对照组予西医基础治疗。观察三组疾病总疗效和中医证候急性期及恢复期疗效。[结果]总疗效、中医证候急性期和恢复期的愈显率中医内外合治组分别为100%、95%和78%;中医内治组分别为90%、82%和54%;对照组分别为81%、74%和27%。中医内外合治组疗效明显优于中医内治组,中医内治组明显优于对照组,差异均有统计学显著性意义(P<0.01)。[结论]中医分期辨证结合外治法治疗小儿肺炎可显著提高临床疗效。     

运脾开胃方含药血清对HGSMCs中MLC磷酸化水平的调节机制研究

观察运脾开胃方含药血清对人胃窦平滑肌细胞（HGSMCs）内Ca²⁺、MLC、p-MLC的干预作用以及与Ghrelin受体（GHSR）的关系,研究运脾开胃方治疗厌食症的机制。方法 培养HGSMCs,制备低、中、高浓度的运脾开胃方含药血清;采用激光共聚焦、Western blot法检测运脾开胃方含药血清对HGSMCs内Ca²⁺、MLC、p-MLC的影响;阻断HGSMCs表面GHSR并干扰细胞内外Ca²⁺的正常调控,研究运脾开胃方含药血清对HGSMCs内p-MLC的干预机制。结果 低、中、高剂量组运脾开胃方含药血清能在一定时间范围内上调HGSMCs内Ca²⁺的相对荧光强度（P<0.05~0.01）;低、中、高剂量组运脾开胃方含药血清能在10min时显著上调HGSMCs内p-MLC水平（P<0.05~0.01）;(D-Lys3)-GHRP-6、Thapsigargin、D-HBSS液能显著抑制高剂量运脾开胃方含药血清在10min时对p-MLC的上调作用（P<0.01）。结论 运脾开胃方含药血清可能通过激活GHSR提高细胞内Ca²⁺水平来促进MLC磷酸化。     

运脾强生方提高腹膜透析患者生存质量的疗效观察

目的 观察运脾强生方对腹膜透析（PD）患者生存质量（QOL）的影响。方法 共55例患者随机分为2组,治疗组26例,对照组29例。在西医基础治疗与常规PD治疗的前提下,治疗组加用运脾强生方,疗程3个月。观察治疗后KDQOL-SF^TM1.3量表评分、营养指标（Hb、Alb、pre-A、TSF、MAC、MAMC、MQSGA）、代谢指标（TC、TG、Ca²⁺、P³⁺、PTH）及透析相关指标（BUN、Scr、KT/V、Ccr）的变化。结果 ①治疗组能够改善KDQOL-SF^TM1.3量表总体评分,总有效率为83.3%,优于对照组（P<0.01）,尤其在改善患者症状与一般健康状况、改善睡眠、减轻肾病对生活的影响、增强体力方面（P<0.05）。② 治疗组治疗后MQSGA与治疗前比较明显下降（P<0.01）,Hb、Alb、pre-A、TSF上升（P<0.05）,其中MQSGA、Hb、pre-A、TSF的变化优于对照组（P<0.05）。③2组TC、TG、Ca²⁺、P³⁺、PTH组内与组间比较无统计学意义（P>0.05）。④ 治疗组治疗后BUN较治疗前下降（P<0.05）,其下降幅度优于对照组（P<0.05）,2组Scr、KT/V、Ccr组内与组间比较无统计学意义（P>0.05）。结论 运脾强生方有助于提高PD患者的QOL,其作用与该方能够增进食欲,增强胃肠消化吸收能力,调节脏腑整体功能,进而改善患者的营养状况有关。     

运脾开胃方含药血清对HGSMCs中MLC磷酸化水平的调节机制研究

〖H观察运脾开胃方含药血清对人胃窦平滑肌细胞（HGSMCs）内Ca²⁺、MLC、pMLC的干预作用以及与Ghrelin受体（GHSR）的关系,研究运脾开胃方治疗厌食症的机制。方法 培养HGSMCs,制备低、中、高浓度的运脾开胃方含药血清;采用激光共聚焦、Western blot法检测运脾开胃方含药血清对HGSMCs内Ca²⁺、MLC、pMLC的影响;阻断HGSMCs表面GHSR并干扰细胞内外Ca²⁺的正常调控,研究运脾开胃方含药血清对HGSMCs内pMLC的干预机制。结果 低、中、高剂量组运脾开胃方含药血清能在一定时间范围内上调HGSMCs内Ca²⁺的相对荧光强度（P<0.05~0.01）;低、中、高剂量组运脾开胃方含药血清能在10min时显著上调HGSMCs内pMLC水平（P<0.05~0.01）;(DLys3)GHRP6、Thapsigargin、DHBSS液能显著抑制高剂量运脾开胃方含药血清在10min时对pMLC的上调作用（P<0.01）。结论 运脾开胃方含药血清可能通过激活GHSR提高细胞内Ca²⁺水平来促进MLC磷酸化。     

益气化痰方联合化疗对老年晚期非小细胞肺癌气阴两虚证患者的疗效

目的：观察益气化痰方联合化疗对老年晚期非小细胞肺癌（non-small cell lung carcinoma,NSCLC）气阴两虚证患者的疗效。方法：回顾性分析2019年6月至2021年6月该院收治的74例老年晚期NSCLC气阴两虚证患者的临床资料,按照治疗方式不同将其分为对照组和观察组各37例。对照组采用GP化疗方案治疗,观察组在对照组基础上联合益气化痰方治疗。比较两组客观缓解率、治疗前后中医证候积分、T细胞亚群指标（CD3+、CD4+、CD8+、CD4+/CD8+）水平、卡氏评分法（KPS）评分,以及不良反应发生率。结果：治疗后,观察组客观缓解率为78.38%(29/37),高于对照组的54.05%(20/37),差异有统计学意义（P<0.05）;观察组中医证候积分低于对照组,差异有统计学意义（P<0.05）;观察组CD3+、CD4+、CD4+/CD8+水平和KPS评分均高于对照组,CD8+水平低于对照组,差异有统计学意义（P<0.05）;两组不良反应发生率比较,差异无统计学意义（P>0.05）。结论：益气化痰方联合化疗可提高老年晚期NSCLC气阴两虚证患...     

张良英教授验方治疗盆腔炎性疾病后遗症临床经验探究*

目的 探究全国名中医张良英教授验方内服联合灌肠治疗湿热瘀结型盆腔炎性疾病后遗症的有效性及安全性。方法 选取符合盆腔炎性疾病后遗症湿热瘀结证的患者70例，随机分为对照组及治疗组，每组各35例。治疗组采用张良英教授经验方消炎方口服配合灌肠方保留灌肠，对照组口服妇科千金胶囊。2组均连续治疗2个疗程，观察2组的临床疗效及疗程长短，比较2组的治疗后评分的变化情况。结果 治疗组总有效率为91.43%，明显高于对照组的80%（P<0.05），且治疗组在改善患者的临床症状、体征及综合疗效方面，均优于对照组（P<0.05），2组患者治疗期间未出现不良反应。2组组间病情与疗效比较，轻度P=0.16，中度P=0.01，重度P=0.04。结论 张良英教授消炎方口服配合灌肠方保留灌肠内外合治与妇科千金胶囊治疗湿热瘀结型盆腔炎性疾病后遗症均有效，但张老验方消炎方口服配合灌肠方灌肠内外合治法在改善中医症状、体征及综合疗效方面均优于妇科千金胶囊，并且治疗组在治疗中度及重度病情的疗效上均优于对照组。     

温肾化痰配方颗粒对COPD稳定期患者肺功能与生活质量的影响

目的 探讨温肾化痰配方颗粒对慢性阻塞性肺疾病（COPD）稳定期的肺功能与生活质量的影响。方法 将72例COPD稳定期患者随机分为治疗组和对照组,每组各36例,对照组给予常规治疗,治疗组在常规治疗的基础上加用温肾化痰中药配方颗粒治疗,疗程均为60 d,比较2组患者治疗前后的肺功能、生活质量及临床疗效。结果 治疗1个疗程后,治疗组肺功能指标FEV1、FEV1/FVC、FEF75%和6MVT/m明显高于同期对照组水平(P<0.05,P<0.01),疾病影响、活动受限、呼吸症状及总分明显低于同期对照组( P<0.05,P<0.01);治疗组和对照组的临床控显率分别为44.44%和16.67%,2组组间比较差异具有统计学意义( P<0.01)。结论 温肾化痰配方颗粒可以改善COPD稳定期患者的肺功能状态,具有较好临床疗效,值得进一步探讨。     

滋阴化痰方治疗阴虚痰凝型良性甲状腺结节的临床疗效

【目的】探讨滋阴化痰方（由消瘰丸加味组方而成）治疗阴虚痰凝型良性甲状腺结节的临床疗效。【方法】将62例阴虚痰凝型良性甲状腺结节患者随机分为试验组和对照组,每组各31例。2组患者均给予清淡饮食、少食辛辣刺激食物、适当运动和保持心情舒畅等基础治疗,在此基础上,试验组给予滋阴化痰方治疗,对照组给予左甲状腺素钠片治疗,疗程为3个月。观察2组患者治疗前后中医证候积分、甲状腺结节最大直径及甲状腺功能指标的变化情况,并评价2组患者的临床疾病疗效和中医证候疗效。【结果】（1）疾病疗效方面,治疗3个月后,试验组的总有效率为90.32%(28/31),对照组为48.39%(15/31),组间比较,试验组的临床疾病疗效明显优于对照组（P<0.05）。（2）中医证候疗效方面,治疗3个月后,试验组的总有效率为77.42%(24/31),对照组为38.71%(12/31),组间比较,试验组的中医证候疗效明显优于对照组（P<0.01）。（3）中医证候积分方面,治疗后,试验组的中医证候积分较治疗前明显降低（P<0.01）,而对照组无明显降低（P>0.05）;组间比较,试验组对中医证候积分的降低...     

化痰通络方联合穴位推拿按摩对脑梗死后痉挛性偏瘫患者的效果

目的：探讨化瘀通络方联合穴位推拿按摩对脑梗死后痉挛性偏瘫（SH）的效果。方法：选取2020年8月—2022年8月湛江市第二中医医院收治的86例脑梗死后SH患者,按随机数字表法分为两组,各43例。对照组予以常规治疗及康复锻炼治疗,观察组加用化痰通络方联合穴位推拿按摩治疗,两组均持续治疗4周。比较两组临床疗效、肢体痉挛程度、日常生活能力、运动能力、中医症状积分及安全性。结果：观察组总有效率较对照组高,治疗后临床痉挛指数（CSI）评分较对照组低,Barthel指数（BI）评分、Fugl-Meyer运动功能评定量表（FMA）评分均较对照组高,半身不遂、口舌歪斜、手足拘急、肢体麻木积分均低于对照组,差异均有统计学意义（P<0.05）;两组均无明显不良反应。结论：化痰通络方联合穴位推拿按摩应用于脑梗死后SH患者中疗效确切,能减轻肢体痉挛,改善运动能力。     

益气活血运脾方对反复呼吸道感染患儿免疫功能的影响

目的：探讨自拟益气活血运脾方对反复呼吸道感染患儿免疫功能的影响。方法选择我院收治的136例反复患呼吸道感染患儿,随机分为对照组和治疗组,各68例。对照组给予匹多莫德颗粒,0.4 g /次,2次/ d;治疗组则联合给予自拟益气活血运脾方内服,连续治疗1个月。对比2组临床疗效,评价中医证候积分及用药的安全性,统计治疗前后患儿的复发情况。结果治疗组临床疗效91.2%,明显优于对照组的75.0%（P ＜0.05）;咳喘、食少纳呆、少气懒言、汗多等中医证候评分显著低于对照组,且症状的改善时间较对照组显著缩短（P ＜0.05）;治疗组机体免疫力优于对照组,T 细胞亚群 CD3＋、CD4＋、CD4＋/ CD8＋水平明显高于对照组,而 CD8＋水平则显著低于对照组,其血清免疫球蛋白 IgG、IgA、IgM 水平显著高于对照组（P ＜0.05）;治疗组随访1年内的患病次数明显少于对照组,患病病程短于对照组（P ＜0.05）。结论益气活血运脾方治疗反复呼吸道感染患儿疗效肯定,有利于加快临床症状的消退,减少复发,其机制与提高机体免疫功能有一定相关性。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.