罗氏海盘车的化学成分研究

目的研究海洋生物罗氏海盘车(Asterias rollentias Bell)的化学成分.方法采用硅胶柱色谱、凝胶柱色谱、高效液相色谱等手段,利用理化和波谱分析方法,对罗氏海盘车中的化合物进行分离鉴定.结果与结论从罗氏海盘车中分离得到7个甾醇类化合物,分别为4-甲基胆甾-7-烯-3β-醇(1)、4-甲基胆甾-7,24-二烯-3β-醇(2)、胆甾-7-烯-3β-醇(3)、胆甾-7,22-二烯-3β-醇(4)、24-乙基胆甾-7-烯-3β-醇(5)、麦角甾-7,24(28)-二烯-3β-醇(6)、麦角甾-7,22-二烯-3β-醇(7).这些化合物均为首次从罗氏海盘车中分离得到.     

贝尔麻痹的病因学说和治疗方法回顾

贝尔麻痹(简称BP)是临床上不能肯定病因的、不伴有其他症状或体征的单纯性面神经麻痹。由此引起的面神经病变直接导致患侧面瘫。除了引起面瘫的主要症状(如失去眼闭合功能以外),还可引起面部表情障碍和心理障碍,给患者带来巨大的痛苦。贝尔麻痹的发病率为15-40/100,000/年。虽然比较常见,而且贝尔先生早在1821年就详细地描述了本病的临床表现,但至今为止本病的病因仍未查明。文献上最常提到的病因学说主要包括:血管痉挛学说、压迫学说、遗传学说、病毒感染和自身免疫学说。贝尔麻痹的常见治疗方法很多,包括:药物(如:可的松、阿昔洛韦等)治疗、物理疗法、面肌功能训练、手术及某些特殊疗法。本文回顾性的研究了学者们报道的贝尔麻痹的病因学说和治疗方法,希望将来更深入的研究能明确本病的病因并提高疗效。     

解读Banting奖演讲

Banting科学成就奖是美国糖尿病学会科学年会的最高科学奖项,是以胰岛素发现者之一,曾获得诺贝尔奖的科学家Frederick Banting的名字命名的。今年第68届ADA科学年会的Banting奖颁给了来自德克萨斯糖尿病研究所的著名糖尿病学者Ralph A De Fronzo教授。在他的学术演讲中,DeFronzo教授深入浅出地全面阐述和深刻解析了糖尿病患者高血糖以及胰岛B细胞衰竭的形成原因，并提出了全新的临床治疗方案。     

The Bell Commission: ethical implications for the training of physicians

In 1989, the New York State Legislature enacted New York State Code 405 in response to the death of a patient in a New York City hospital. Code 405 was the culmination of a report (the Bell Commission Report) that implicated the training of residents as part of the problem leading to that tragic death. This paper explores the consequences of the regulatory changes in physician training. The sleep deprivation of house officers was considered a major issue requiring correction. There is little evidence to support the claim that sleep deprivation is a serious cause of medical misadventures. Nevertheless, the changes in house officers' working hours and responsibilities have profound implications. Changes in the time allotted to teaching, the ability to learn from patients admitted after a shift is over, and the increasing loss of continuity, all may have a negative impact on physician training. It is not clear that trainees are being realistically prepared for the actual practice of medicine - physicians often work extended hours. The most serious concern that has been raised is the loss of professionalism by physicians. Residents are now viewing themselves as hourly workers, and the State has intervened in an area of training formerly left to the profession to manage. We are now training doctors in New York State who will be comfortable working in an hourly wage setting, but not in the traditional practice of medicine as it has been in the United States during this century. We are concerned that this may sever the bond between doctor and patient - a bond that has been the bedrock of our conception of a physician.     

中西医结合治疗急性Bell麻痹的前瞻性队列研究

目的观察Bell麻痹最佳组织疗法和措施,探索急性Bell麻痹治疗方法的选择、疗效和后遗症的关系。方法使用前瞻性队列研究将150例患者分为观察组(50例)、对照组1(50例)和对照组2(50例)。观察组采用针刺加中药饮片面瘫祛风复正汤(牵正散加减)内服结合西医疗法。对照组1采取纯中医疗法(针刺、面瘫祛风复正汤),对照组2采取纯西医疗法。10 d为1个疗程,三组均治疗至少3个疗程和至少观察3个月。采用面神经功能分级(HB分级)量表、面部残疾指数(FDI)评分量表等指标,分别于治疗前和治疗后第1、2、3个疗程和第2、3个月进行评价。结果治疗1-3个月后,三组均可降低HB分级,提高FDI评分,差异有统计学意义(P<0.01),且治疗后观察组FDIP和FDIS评分优于2个对照组,差异有统计学意义(P<0.05);观察组疗效明显优于2个对照组,差异有统计学意义(P<0.05);观察组治愈率92%(46/50),优于对照组1的76%(38/50)和对照组2的72%(36/50),差异有统计学意义(P<0.05);治疗3个月后,观察组后遗症发生率为4%(2/50),低于对照组1的20%和对照组2的24%,差异均有统计学意义(P<0.05);观察组痊愈患者的平均治疗时间(24.65±9.95)d,少于对照组1的(33.46±11.35)d、对照组2的(35.76±12.46)d,差异均有统计学意义(P<0.01)。结论中西医结合治疗急性Bell麻痹疗效明显优于单纯中医组和单纯西医组,且后遗症发生率低于2个对照组。     

The Bell Tolls for Thee & Thine: Compassion Fatigue & the Overdose Epidemic

Non-fatal and fatal overdoses are traumatic events that have been increasing over the past 20 years and disproportionately impacting rural communities in the United States. The human suffering caused by the opioid epidemic is rarely described in the empirical literature. The purpose of this article is to 1) define individual- and community-level overdose-related compassion fatigue (OCF), 2) review measurement of compassion fatigue (CF) and interventions to reduce CF, 3) discuss strategies that may reduce OCF and 4) briefly discuss policy implications. OCF is distress resulting from knowledge of or exposure to overdose-related harms, which at the community-level may prohibit collaboration and adaptive agency to effectively respond. When OCF occurs at a community-level, it could have negative consequences by eroding support for evidence-based services and fueling stigma-driven policies that blame people who use drugs. Empathy underlies both OCF and vicarious resilience by allowing one to understand the suffering caused by overdose deaths and to witness the joy of addiction recovery. Using the risk environment framework, OCF at the micro- and macro-levels of the social environment, may increase rural communities’ vulnerability to harm by emphasizing individual responsibility for reducing overdoses rather than community-level infrastructure and resource management. Additional research is needed to develop a measure of OCF and to confirm whether OCF is associated with increased stigma and decreased support for harm reduction in rural areas.