对构建德智体美劳全面发展的新医科人才体系的思考

通过分析"新医科"发展趋势以及目前我国医疗供给侧改革的内在需求与人的全面发展之间的紧密联系,提出立德树人、以智启人、以体育人、以美成人、以劳塑人是"新医科"对医学人才培养的主要途径。在此要求之下,医学高等院校应适应全民健康的目标和社会保健服务的需求,坚持本科教育服务地方经济社会的理念,加强大健康教育与全面素质教育,着力培养符合社会需要的、全面发展的新医科人才。     

再论茶文化的起源、发展与功能定位

茶文化在唐代有迅猛的发展,其普及与当时的经济、政治、文化有密切的关系。也由于其含有咖啡因类成分,可以调节精神,而其他别样茶中不含此类成分,茶的普及推广,形成了一枝独秀的局面。内容进一步阐述茶文化的形成过程,作为"茶"用的植物自古以来就呈现多样性,如同维持生命的"食物"用来治疗疾病的"药品"一样,用来预防疾病的"茶"也不是单单一个物品。     

中药现代化研究关键问题与产业发展

中药现代化是推进中药产业发展的必由之路,中药产业的发展应体现现代技术与国际化的思路。虽然近年来我国中药产业取得了显著成绩,但面临的挑战与考验也是严峻的。中药产业要想在可期待的时间里取得突破飞跃,必须注重中药产业链各环节的中药现代化研究。本文分别从现代生物技术与中药农业、中成药开发与产业化、中药产品综合开发与产业辐射、中药质量评价及行业标准发展这四方面对中药现代研究的关键问题与产业发展进行了探讨和分析。     

印度中医药发展现状与分析

印度是位于南亚次大陆的议会共和制国家,其医疗保健工作由州政府负责,拥有世界上最庞大的"免费医疗"服务体系。印度传统医学历史悠久,阿育吠陀(Ayurveda)、自然疗法(Naturopathy)、瑜伽(Yoga)等为其主要代表。公元前2世纪,中医药随宗教交流及贸易活动传入印度并被印度人民熟悉。针灸在印度已取得独立合法地位,其国内拥有多家针灸诊所和针灸协会,但针灸应用仍缺乏系统的行业标准,除针灸外中医药其他疗法在印度尚缺乏发展空间。     

努力开创中药基地建设的新局面

自1999年我国中药现代化科技工作正式启动以来,科技部以省、自治区、直辖市为单位,先后批准建设了17个国家中药现代化科技产业基地、7个国家中药材规范化种植基地、1个生物医药产业基地。许多基地省的中药现代化工作已上升为“一把手”工程,在带动技术创新,推动产业发展,建设服务平面,培养高素质人才等方面成效显著,已成为推动我国中医药现代化工作最为重要的组织形式之一。形式迫切地要求我们广大的科研人员在准确把握科学技术的整体发展趋势和最新前沿发展动态的同时,敏锐地洞察和及时地了解我国科技工作的总体指导思想、工作部署、重点任务以及相关发展态势,以便我们的工作能够始终面向国家战略需求,始终在正确的轨道上前行。为此,我们刊发科技部刘燕华副部长在“第三届全国中药科技产业基地工作总结交流会”的工作报告,希望广大读者从中有所领悟得到启迪。本文言简意赅,数据详实,具有很强的指导意义。     

Antimicrobial, anti-inflammatory, antiparasitic, and cytotoxic activities of Galium mexicanum

Ethnopharmacological relevance

To study the potential benefit of the traditional Mexican medicinal plant Galium mexicanum Kunth (Rubiaceae). Hexane, chloroform, and methanol extracts as well as various fractions from these extracts were tested to determine antibacterial, antifungal, antiparasitic or anti-inflammatory activities in vitro.

Materials and methods

Aerial parts of the plant were extracted with various solvents and fractionated accordingly. Their antibacterial and antifungal activities were assessed on nine bacterial and four fungal strains. Leishmania donovani was used as a protozoan strain for antiparasitic activity. The anti-inflammatory activity of the compounds was investigated by measuring the secretion of interleukin-6 when macrophages were exposed to lipopolysaccharide.

Results

Various extracts and fractions obtained from this plant exhibit antibacterial, antifungal, antiparasitic, and anti-inflammatory activities. Of special interest was the hexane fraction HE 14b, which show antibacterial (ranging between 67 and 666 μg/ml) and antifungal (at concentrations of 333 μg/ml) activities. Also the hexane fraction HE 5 exhibited antiparasitic activity (at concentrations of 260 μg/ml), whereas the methanol fraction ME 13-15 showed a potent anti-inflammatory activity when compared to dexamethasone. Chemical analyses of the chloroform extract show the presence of triterpenes, saponins, flavonoids, sesquiterpene lactones, and glucosides, but no tannins were detected in the assayed extract.

Conclusions

The benefit of Galium mexicanum as a traditional medicinal plant was confirmed using antibacterial and antifungal assays in vitro. We also report for the first time, and to the best of our knowledge, antiparasitic and anti-inflammatory activities of this plant.     

蒙古国中医药发展现状与分析

蒙古国是毗邻我国北部的议会共和制国家。卫生保健主要由国有医疗机构、私营诊所和混合所有制医疗机构三部分构成,覆盖面广但资源不均。由于民风及气候原因,该国消化系统疾患较为常见,导致蒙古国居民死亡的主要疾病是缺血性心脏病、脑卒中、肝癌等。蒙古国与中国地理相近、文化亲缘,中医药文化的发展与传播较其他国家更为民众所接受。蒙古国的传统医学与中医学长期相互交流与影响,互相促进发展,并受到蒙古国法律的保护。目前蒙医的传承、蒙药的研发与保护、非药物疗法的推广等问题是制约蒙中传统医药发展的因素。建议蒙中传统医学通过联合培养高水平医学人才、加大草药研发与保护力度、扩大非药物疗法的应用,共同推进传统医学在世界的发展与传播。     

伊拉克中医药发展现状与分析

伊拉克是位于亚洲西南部、阿拉伯半岛东北部的多民族、多宗教联邦制国家。医疗保险以初级卫生保健模式为主,私营医疗保健为辅。伊拉克的传统医学以伊斯兰医学为主。2000年,在我国政府支持下伊拉克建立了中医中心,但因安全问题,中心的管理与经营存在人员不足、水平有限、后续支持难以持久等问题。目前,中医药尚未纳入伊拉克医疗保险体系,从一定程度上影响了民众的就医选择,阻碍了中医药的发展。建议通过加强现有中医中心建设,提高中医药教育的可及性,加强两国传统医学的合作与交流,以促进中医药在伊拉克的传播与发展。     

中药研发国内外发展趋势的比较研究

目的：从东西方两种不同视角,对国内外中药研发状况予以分析,以期提出合理性建议,对我国中药研发方向的把握有所裨益。方法：运用文献历史回顾性研究、专家咨询和现场调查等方法,通过立足于中药资源、产业现状、产品结构、市场经济、医疗需求等背景,以日本、德国、美国及欧盟为主要着眼点。结果：①中药内涵与外延发生演变;②我国中药研发具有三向走势,包括中医理论指导下注重传统的中药研发方向、天然植物药理念引发的中药研发方向和中药与天然药物有机结合的中药研发方向;③国外植物药与国内中药研发趋势的逆向性趋同,主要体现在周边诸国从中药获利、欧洲将优秀传统与现代技术完美结合,以及美国从西方朝向东方。结论：中药研发属于高科技领域,我们要在“品、质、性、效、用”的关键问题和环节上勇于继承和完善,在政府主导下,全面整合资源,突出中医特色,在继承中借鉴,在创新中发展,迈出我国中药现代化之路。     

血清CEA、CA-125、CA-153、CA-199、CA242联合检测对消化道肿瘤诊断的临床意义

目的：探讨血清CEA、CA-125、CA-153、CA-199、CA242联合检测对消化道肿瘤诊断的临床意义。方法：采用酶联免疫吸附法（ELISA法）检测130例恶性消化道肿瘤患者（食管癌32例、胃癌34例、胰腺癌30例、大肠癌34例）血清CEA、CA-125、CA-153、CA-199、CA242水平。结果：表明上述四种消化道肿瘤的血清CEA、CA-125、CA-153、CA-199、CA242与对照组比较结果统计学上均有显著性差异（P〈0．01）。除胰腺癌之外，其余3种消化道肿瘤五项肿瘤标记物联合检测的阳性率均显著高于单一标志物检测（P〈0．05），分别为食管癌62．5％、胃癌85．2％、大肠癌82．3％。结论：血清CEA、CA-125、CA-153、CA-199、CA242联合检测可以显著提高消化道恶性肿瘤诊断的敏感性。     

分段开窗旷置结合切扩挂线置管引流术治疗复杂性肛瘘的安全性多中心临床研究

目的探讨分段开窗旷置结合切扩挂线置管引流术治疗复杂性肛瘘的安全性。方法采用随机对照、多中心平行试验的设计方法,将240例复杂性肛瘘患者随机分为2组:试验组120例采用分段开窗旷置结合切扩挂线置管引流术治疗,对照组120例采用切开挂线术治疗,比较2组肛门直肠结构和功能改善情况。结果术后试验组肛门失禁和肛门狭窄、移位、变形等发生率低;肛管直肠压力、直肠容量感觉功能和直肠肛管反射强度降低幅度对照组明显大于试验组。结论分段开窗旷置结合切扩挂线置管引流术治疗复杂性肛瘘可控性与安全性好,值得作为肛瘘手术的新规范化术式在临床中推广应用。     

A traditional Chinese herbal preparation, Er-Zhi-Wan, prevent ovariectomy-induced osteoporosis in rats

Ethnopharmacological relevance

Er-Zhi-Wan (EZW), a classic Chinese formulation, which contains Fructus Ligustri Lucidi (FLL) and Herba Ecliptae (HE). EZW is widely used to prevent and treat various kidney diseases for its actions of nourishing the kidney and strengthening tendon and bone. Although recent reports indicate that EZW restrains osteoclastic bone resorption, its effects on the protection against define OVX-induced bone loss in mature rats have not been systematically investigated.

Materials and methods

Sixty 3-month-old female Sprague-Dawley rats were randomly assigned into sham-operated group (Sham) and five OVX subgroups, OVX with vehicle (OVX); OVX with Estradiol Valerate (EV, 0.4 mg/kg body weight/day); OVX with EZW of graded doses (9.0, 4.5, or 2.25 g/kg/day). Daily oral administration of EV and EZW on 5th week for 26 weeks. Bone turnover markers (Serum alkaline phosphatase (ALP), bone-specific alkaline phosphatase (BALP), osteocalcin (OCN), deoxypyridinoline (DPD)), other parameters, including serum calcium (S-Ca), serum phosphorus (S-P), urine calcium (U-Ca), phosphorus (U-P), and bone mineral density (BMD) of the femur, 4th lumbar vertebra and tibia, bone biomechanical properties and trabecular microarchitecture parameters were measured.

Results

Administration of EZW could significantly prevent ovariectomy-induced bone loss, biomechanical reduction, deterioration of trabecular microarchitecture and the body weight gain without affecting the weight of the uterus, and increased S-Ca, S-P levels, decreased level of bone turnover markers and U-Ca, U-P levels in ovariectomized rats.

Conclusion

The present study indicated that EZW had a definite antiosteoporotic effect without hyperplastic effect on uterus, and it might be a potential alternative medicine for treatment of postmenopausal osteoporosis.     

方剂剂量与君臣佐使关系初探

以2 022个方剂为研究对象, 围绕其中中药剂量及君臣信息, 计算中药的相对剂量, 并进行方剂内的中药相对剂量排名, 利用相关关系分析方法, 进行"中药相对剂量排名"与"君臣佐使情况"之间的相关关系假设检验。探讨中药剂量与中药"君、臣、佐、使"之间的关系。中药相对剂量排名与君、臣地位存在相关关系, 且为负相关。中药相对剂量排名与佐、使地位不存在相关关系。某味中药在处方中如果相对剂量高, 越有可能成为该方的主要药物, 而某味中药是否为该方的佐药或使药与相对剂量无关。     

蒿芩麻杏石甘汤治疗肺炎支原体感染所致儿童急性支气管炎和轻症肺炎23例

目的:观察蒿芩麻杏石甘汤治疗肺炎支原体感染所致儿童急性支气管炎和轻症肺炎的临床疗效。方法:选取肺炎支原体感染所致急性支气管炎和轻症肺炎患儿44例,随机分为治疗组23例和对照组21例。治疗组给予蒿芩麻杏石甘汤治疗,对照组给予阿奇霉素治疗。结果:治疗组愈显率优于对照组(P0.05);治疗组治疗后临床症状体征评分优于对照组(P0.05)。结论:蒿芩麻杏石甘汤治疗儿童肺炎支原体感染所致急性支气管炎和轻症肺炎疗效确切。     

Ethnopharmacological survey of medicinal plants used by traditional health practitioners in Thanchi,Bandarban Hill Tracts,Bangladesh

Ethnopharmacological relevance

There is very limited information regarding plants used by traditional healers in Bandarban Hill Tracts (BHT), Bangladesh for treating general as well as complex ailments. Current study provides significant ethnopharmacological information, both qualitative and quantitative on medical plants in BHT. Aim of the study This study aimed to collect, analyze and evaluate the rich ethnopharmacologic knowledge on medicinal plants in Thanchi, BHT and attempted to identify the important species used in traditional medicine. Further analysis was done by comparison of the traditional medicinal use of the plants with the available scientific literature data.

Materials and methods

The field survey was carried out in a period of several years in Thanchi upazilla of Bandarban districts, Bangladesh. A total of 53 Traditional Health Practitioners (THPs) were interviewed through open-ended and semi structured questionnaire. The collected data were analyzed qualitatively and quantitatively. This ethnomedicinal knowledge was compared against the available scientific literature for reports of related uses and studies of phytochemical compounds responsible for respective ailments.

Results

A total of 84 species of plants, mostly herbs, belonging to 42 families were identified for the treatment of 70 types of ailments. These ailments were categorized into 16 categories. Leaves were the most frequently used plant parts and juice is the mode of preparation of major portions of the plant species. The most common mode of administration was oral ingestion and topical application. Informant consensus factor (F_ic) values of the present study reflected the high agreement in the use of plants in the treatment of digestive system and respiratory system disorders among the informants. Diseases of the digestive system had highest use-reports and 3 species of plants, namely Centella asiatica (L.) Urban. (dysentery), Justicia gendarussa L. (asthma) and Ocimum tenuiflorum L. (coughing) had the highest fidelity level (FL) of 100%. Clerodendrum viscosum Vent., Achyranthes aspera L and Justicia gendarussa L. showed the highest relative importance (RI) value of 1.86. According to use value (UV) the most important species were Ocimum tenuiflorum L. (2.24) and Achyranthes aspera L. (2.15).

Conclusion

Priority should be given for further phytochemical investigation to plants that scored highest FL, F_ic, UV or RI values, as such values could be considered as good indicator of prospective plants for discovering new drugs. Since knowledge regarding traditional medicine being vulnerable day by day so traditional medicine in school curricula should be incorporated so that younger people could appreciate its usefulness. Also counseling of THPs and gardening of medicinal plants should be taken into consideration immediately in order to smooth continuance and extension of traditional medical knowledge and practice for ensuring safe and effective therapy.     

Sedative, vasorelaxant, and cytotoxic effects of convolvulin from Ipomoea tyrianthina

Aim of the study

Ipomoea tyrianthina has been used in Mexican traditional medicine as a mild purgative, for the treatment of nervous disorders, and against tumors. In this study, the effect of convolvulin (an ether-insoluble resin glycoside) from the root of Ipomoea tyrianthina on: Central Nervous System; as spasmolytic and vasodilator; cytotoxic against cancer cell lines is evaluated.

Materials and methods

Convolvulin isolated from the root of Ipomoea tyrianthina (IT-EM) was tested on pentylentetrazole induced seizures, pentobarbital-induced hypnosis, release of GABA and glutamic acid, isolated rat aorta and ileum rings, and against Caco-2 and KB cell lines.

Results

IT-EM increased the hypnotic effect induced by pentobarbital and the release of GABA in brain cortex of mice, but did not protect mice against pentylenetetrazole-induced convulsions. IT-EM produced a significant vasodilator effect in concentration- and endothelium-dependent manners on isolated rat aorta, but did not inhibit significantly contractions on rat ileum, colon, and jejune rings. IT-EM showed cytotoxic activity against nasopharyngeal carcinoma KB cell line.

Conclusions

Convolvulin (IT-EM) from Ipomoea tyrianthina has sedative effect, vasorelaxant effect in concentration- and endothelium-dependent manners, and cytotoxic activity against nasopharyngeal carcinoma KB cell line.     

Plants used for treating respiratory infections in rural Maputaland, KwaZulu-Natal, South Africa

Ethnopharmacological relevance

Traditional remedies are frequently used in treating various respiratory ailments, and are very important in the primary health care of the people living in rural Maputaland, KwaZulu-Natal, South Africa. Novel information gathered from surveys like the present study is important in preserving indigenous knowledge.

Aim of the study

To explore the knowledge that the lay people of a rural community in northern Maputaland have about medicinal plants used in the vicinity to treat respiratory infections.

Materials and methods

Interviews were conducted among 80 homestead inhabitants, using structured questionnaires where convenience sampling was used. The focus was on plants used in treating respiratory infections. Some of the main topics discussed during the interviews were vernacular plant names, plant parts used, harvested amounts, preparation methods, dosage forms and quantities, use of plants in combination as well as the related symptomatic relief associated with respiratory infections.

Results

The study documented 30 plant species (18 families) which are used to treat respiratory infections by the rural people in the study area. Decoctions made with these plants are mostly taken orally, combined with the use of steaming. To the best of our knowledge, Acanthospermum glabratum, Aloe marlothii, Krauseola mosambicina, Ozoroa obovata, Parinari capensis and Plectranthus neochilus are recorded for the first time globally as medicinal plants used for treating respiratory infections and related symptoms. The indigenous aromatic shrub, Lippia javanica was by far the most frequently used plant species, followed by Eucalyptus grandis (an exotic), Tetradenia riparia and then Senecio serratulloides. Twenty-four different plant combinations were used where the most frequently used combination encountered was Eucalyptus grandis with Lippia javanica.

Conclusion

The large number of different plant species traditionally used against respiratory infections supports previous research on the importance of traditional medicine in the primary health care of this remote area. The finding of new vernacular plant names and plant uses in the current survey shows the importance of the documentation of such ethnobotanical knowledge.     

Comparative biological study of roots,stems, leaves,and seeds of Angelica shikokiana Makino

Ethnopharmacological relevance

Angelica shikokiana has been used as a health food for its anticancer, anti-inflammatory, antibacterial, antiallergic, and blood vessel dilating effects in Japan. It can also be used to prevent and treat hepatitis, diabetes, hyperlipidemia, and arteriosclerosis.

Aim of the study

The present study was designed to compare the biological activities such as melanin synthesis inhibitory, anti-allergy, anti-lipase, anti-bacterial, anti-oxidant, and neuroprotective activities of different parts of the plant that may justify the use of this plant in folk medicine.

Material and methods

The roots, stems, leaves and, seeds of Angelica shikokiana were separately extracted with water and ethanol. Each extract was examined for melanin synthesis inhibitory and anti-allergy activity on B16-melanoma and RBL-2H3 cells using IgE and A23187 as a stimulant for β-hexosaminidase release, respectively. We also evaluated the inhibition of two enzymes, lipase and acetylcholine esterase, and of the bacterial growth of two species, Escherichia coli and Staphylococcus aureaus. The anti-oxidant activity was determined using oxygen radical anti-oxidant capacity, ORAC assay and its relation to the phenolic content was estimated using the Folin–Ciocalteu method. Besides, the protective effect of the extracts against H₂O₂-induced oxidative stress in mouse neuroblastoma, Neuro-2A cells was investigated.

Results

The most active extract exhibiting melanin synthesis inhibition (63%) and at the same time with low cytotoxicity (15%) was the ethanol extract of roots at 20 µg/ml, followed by the ethanol extract of stems (57% inhibition, 5% cytotoxicity). On the other hand, the highest inhibitions of β-hexosaminidase release were recorded for the ethanol extract of leaves with IC₅₀ value of 6.89 µg/ml followed by the water extract of the seeds and leaves with IC₅₀ value of 78.32 and 88.44 µg/ml, respectively. For anti-lipase assay, ethanol extracts of the stems and roots showed the strongest inhibition with IC₅₀ values of 204.06 and 216.24 µg/ml, respectively. None of the examined extracts showed any activity against Escherichia coli. while the ethanol extract of the roots and stems showed moderate inhibition for Staphylococcus aureus with minimum inhibitory concentration of 400 µg/ml. Ethanol extract of the roots showed only 30% inhibition of acetylcholine esterase enzyme. The results of anti-oxidant, phenolic content and protective effect against H₂O₂-induced cytotoxicity assays showed highly correlated data. Ethanol extract of the stems (ORAC value of 1.08 µmol Trolox/ mg and phenolic content 44.25 μg GAE/mg) increased the cell viability of H₂O₂-treated Neuro-2A cells by 28%.     

A prospective,randomized, double-blind,multicenter comparative study on the safety and efficacy of Celecoxib and GCSB-5, dried extracts of six herbs,for the treatment of osteoarthritis of knee joint

Ethnopharmacological relevance

This prospective, randomized, double-blind, multicenter study compared the efficacy and safety of Celecoxib and GCSB-5, a new product from extracts of six herbs, for the treatment of knee osteoarthritis.

Materials and methods

A total of 198 eligible patients were randomly assigned to the Celecoxib group (n=99 patients) or the GCSB-5 group (n=99 patients) for the 12-week study. The amount of change and percentage of the change in Western Ontario and McMaster Universities (WOMAC) Arthritis Index from the baseline, the change in pain on walking by visual analogue scale (VAS), physician's global assessment on response to therapy (PGART) by five point Likert scale, and the amount of rescue medicine taken were used as parameters for efficacy. Adverse drug reactions (ADRs) were carefully investigated.

Results

The WOMAC score improved in both the Celecoxib group and GCSB-5 group by 20.5 and 21.3 (P=0.79). The percentage of the change in WOMAC score were −42.0% and −38.9% (P=0.54). The pain VAS score decreased by 29.9 and 27.9 (P=0.58). The responders by PGART were 95.3% and 93.8% (P= 0.66), and the median amount of rescue medicine taken were 2.0 and 6.5 tablets (P=0.06). The incidence of ADRs were 31.3% and 21.2% (P=0.11). The most common ADRs were gastrointestinal system related; 17.2% in GCSB-5 group and 22.2% in Celecoxib group. Any severe ADR was not observed in either group.

Conclusions

The result of this study supports that GCSB-5 is comparable to Celecoxib in terms of the efficacy and safety for the treatment of osteoarthritis of knee joint.