周亨德教授治疗胃癌癌前病变的经验

[目的]介绍与总结周亨徳教授治疗胃癌癌前病变的经验。[方法]通过跟随周师门诊抄方，分析归纳其医案，并查阅相关文献资料，总结周师治疗胃癌癌前病变的经验，并举一则验案进行例证。[结果]周师认为胃癌癌前病变的病因以饮食、情志所伤为主，病机关键在于脾虚湿阻，胃失和降，以脾胃亏虚为本。治疗以补益脾胃为本，脾虚夹实证者有湿当先化湿，有食积当先消食化积，同时重视疏肝理气、调畅情志，佐以纠正不良饮食习惯。[结论]周亨徳教授治疗胃癌癌前病变的经验值得学习和推广。     

姚新苗教授防治骨质疏松症的学术思想略谈

[目的]总结姚新苗教授中医药防治骨质疏松症的主要学术思想。[方法]基于姚新苗教授"益骨汤"实验研究与临床观察,根据中医学理论,结合现代医学研究,分析筋与骨、血瘀、脾胃亏虚、肾精亏虚等因素在骨质疏松症病理过程中的主次地位,阐述相应治法的理论及临床依据。[结果]姚新苗教授治疗骨质疏松症,在"筋骨并重"的基础上更重视"筋"的作用,通过针刀治疗、康复锻炼等"理筋为先",实现筋复骨正。基于骨质疏松症病性多属本虚标实,本虚责于脾肾,而标实则多系瘀血等,遣方用药时主张在补肾、健脾的同时,佐以活血化瘀之药,主要学术思想可以归纳为"理筋为先""从瘀论治""健脾为要"和"补肾为本"等四个方面。[结论]姚新苗教授"理筋为先""从瘀论治""健脾为要"和"补肾为本"的学术思想为中医药防治骨质疏松症提供了新思路,值得学习效法。     

AN OUTBREAK OF PELLAGRA IN NANKING A REPORT OF 30 CASES

The first report of pellagra in China was that of Jouvean-Dubrcuil (I), wbo in 1920 0bserved foiir cascs in Szechuan. In 1923 six cases were observed by Tyau in Shanghai (2), one c:ase by Wu in Wuhu (3) Four years later Lambert (4) describcd one case of undoubtcd pellagra he saw in Honan. This was in a girl who had suffercd from a recto- vaginal iistula and dyscnter31 since ~25, the skin eruption appcarcd from that clatc. Foster and Andcrdon commenting on the above paper, rr.entioned this disease they saw in Hunan anci Hong Kong. Jn the same year Mu (5) gave an account of the thirteenth authentic case observed in Peiping. In :r930 0ne of uq (C.S.Y.) (6) described three cases which xvere associated with disea.ies of the gastro-intestinal Lract. It was discussed that the orRanic lesions oi'' the digeitive system may interfere with adequate assimilation of food and absorption of nutrition and thercfore they are of causative importance in the development of this deficiency disease. Many similar cases have been previously iioted by othcr writers, and O''Leary (7) coined the term "secondary pdla:相似文献   

PELLAGRA OR PELLAGROID IN LEPER SET'rLEMENTS IN KOREA

For the past six or seven years we have noted among the inmates of our inStitutions at Soonchun and Fusan a conditiari very similar to pellagra which might be termed PelkWroiet. (Tuberculoid and Such termS are often used in skin diseases). It is''known among the lepers as ''fRed Diseasel" Quite like Cazal who, in 1762, called it "mal de la rosa."     

Evaluation of internet derived patient information for Acute Pancreatitis

INTRODUCTION:Possibly In the UK there are currently over 26,000 patients admitted to hospital for acute pancreatitis per annum and the incidence is rising. 55% of patients consult the internet for information regarding their medical condition. As the number of people using the internet has increased 57% since 2006, it is increasingly important for medical professionals to direct patients to accurate online sources of information. This paper aims to evaluate the quality of information available online for acute pancreatitis.METHODS:The term ‘acute pancreatitis'' was searched using http://www.google.com, http://www.bing.com, and http://www.yahoo.com. The top 10 results of each of these websites were assessed using the University of Michigan consumer health website evaluation checklist.RESULTS:Of the 30 websites found, 4 were excluded from the evaluation. Within the 26 evaluated websites there was high variability in website quality. However, the authors would have used 18 of the websites again for the purpose of finding out information on acute pancreatitis. 15 websites had a named author of which 11 displayed their credentials. 8 of the websites had been updated within the last year. 10 websites displayed a bias or conflict of interest. Generally, the layout and design of websites was good, however 7 of the websites contained distracting graphics and 9 of the websites had no search facility.DISCUSSION:Doctors should give patients the information they want and need. With a high percentage of patients using the internet, medical professionals should recommend good quality websites to their patients. Engaging in this process could improve the consenting process as patients would be better informed. Good quality websites allows patients to explore conditions by themselves, with a re-consultation facilitating further discussion. Failure to engage in internet­based information risks patients making misinformed decisions due to bias and conflict of interest.

There are currently over 26,000 admissions to hospital for acute pancreatitis in the UK and the incidence is rising. Pancreatitis is, most caused by either gallstones or alcohol, one in five patients will develop severe and associated sequelae such as necrosis of the pancreas ^1,2. It is estimated that around 55% of patients will consult the internet for medical information ^3,4 with 60% of patients reporting that they felt that the information was the ‘same as'' or ‘better than'' information from their doctors. The number of patients researching their condition on the internet is likely to increase due to access to the internet increasing by 57% since 2006, 96% of the UK now have access ⁵.The internet can report on the latest updates in medicine before they are incorporated into a textbook or have been peer-reviewed. The wealth of information available online to patients may be more current than a doctor''s knowledge. However, it is provided by a variety of sources such as the National Health Service (NHS), charities, drug companies and private businesses. This has the potential to provide patients with information that may not be accurate or digestible, with Gupte et al demonstrating that 20% of patients found conflicting information on the internet to that given to them by their consultant ⁴.The internet has the potential to be an invaluable resource for medical professionals by providing good quality patient education. Patients may use the internet before a consultation to try to form a diagnosis by themselves, following the consultation for reassurance and afterwards to share their patient experience. It is therefore important that medical professionals can direct patients to accurate online sources of information. This paper aims to evaluate the quality of information available online for acute pancreatitis.     

武维屏教授肺痹-体痹合治验案举隅

基于历代医家提出的"肺痹-体痹"整体观念,文章总结武维屏教授临证经验:间质性肺病(肺痹)常与关节、皮肤病变(体痹)相合,临床患者多病情复杂,症状纷繁多变,多以祛邪通络、宣降肺气、和解表里、调畅气机、通补兼施为立法治则。阐述肺痹和体痹之间的关系与治疗。     

THE DOCTOR, THE MISSIONA.RY, AND THE SCIENTIST*

The harvest truly is plenteOus, but the labourers are few." Jt was twenty years ago when I first read these words. I was appalled and mentally oppressed by my attempt to apply them to conditionsin China. ''The harvest truly iS plenteous'' in every field. but how sadIy few the labourers are! My thought tnrned to the political Revolutiou then going on in China, to social reforms,to eduCation. to literature,to art to scholarship and thinking, and to the scicnccs,-everywhere I turned. I was troubled by the same thought: How few the labourers arel     

“以器官-系统为中心”课程整合实施中的问题及建议

“卓越医生教育培养计划”要求“五年制临床医学人才培养模式改革试点”临床医学专业本科毕业生必须达到科学与学术、临床能力、健康与社会、职业素养等4方面的基本要求。针对教育改革中发现的问题，结合湖北医药学院自身实践特点，采用“以器官-系统为中心”的整合课程教学模式，强化“以学生为中心”的线上、线下混合式授课过程，以形成性评价体系指导学生发展核心素养，提高学生发现并解决实际问题的能力。     

论灵活配伍乌头治诸痛

[目的]探析乌头止痛功效与其峻烈药性之间的辩证关系,总结乌头的不同配伍在痛证治疗方面的应用,为临床灵活运用乌头拓展思路。[方法]通过查阅历代文献医籍,搜集部分医家的学术观点及相关用药经验,从痛证的不同病因病机探讨乌头的配伍应用,并结合现代药理学研究,总结一般规律。[结果]在风、寒、湿、瘀等以实邪结聚,阻滞经络为主要病机的痛证中,多取用乌头辛热发散之药性祛除病因,同时消除湿浊、瘀血、痰饮等病理产物来达到止痛目的;热痛虽为邪实疼痛,但其病机与乌头大辛大热之性不相适宜,治疗应配伍石膏、知母、白芍等与之药性相反的药物,起到"去性存用"的效果;虚痛的治疗应以标本兼治为原则,在补虚扶正的基础上保留或增强乌头的止痛作用",减毒增效"成为其应用的关键;在外伤、麻醉、癌痛等各类杂痛中,重视对乌头药理活性成分及其抗炎镇痛效应的现代研究,并结合历代医家方药,侧重于发挥乌头"对症治疗"的作用。[结论]乌头为止痛之要药,通过准确辨证,合理配伍,各类痛证均可大胆用之。     

桥本病中医命名探讨

基于"浊"特性和致病特点,以及对中医古今文献中"浊"的研究,通过对桥本病病因病机、临床表现、中西医对本病的认识及特效治疗等方面进行分析,探讨桥本病对应较确切的中医命名,进一步探索中医对桥本病的精确治疗。     

以“转氨酶升高”为首发表现的飞行员干燥综合征1例

目的 报告 1 例以“转氨酶升高”为首发表现的飞行员干燥综合征，并讨论体检鉴定及航医工作。方法 报告 1 例以“转氨酶升高”为首发表现的飞行员干燥综合征的诊治过程及后续体检鉴定工作，讨论体检鉴定及航医工作。结果 该飞行员因“常规年度大体检发现转氨酶升高”入院，白细胞总数偏低；肝功能受损，抗“O”偏高、类风湿因子偏高。自身抗体谱：ANA、抗SSA、抗SSB、抗RO-52(+)；EBV壳抗原IgA、IgG(+)：巨细胞病Ig抗体(+)。结合唇腺活检结果，干燥综合征诊断明确，给予“暂时飞行不合格，地面观察1个月”结论。经过规范治疗后，抗“O”及类风湿因子降低，血液指标恢复正常，肝功能恢复正常。规范治疗和健康指导3个月后，血常规、肝肾功能均无异常。考虑其为青年男性，既往体健，飞行意愿强烈，无口干眼干、无腹痛黄疸等症状，予“飞行合格”结论。结论干燥综合征能够引起全身多器官免疫性损伤，早期诊断和治疗存在较多困难，常导致病情迁延难愈，累及各器官系统并造成功能损害，可能影响到飞行员飞行安全。全面的康复指导、细心的病情观察是预防并发症、决定患者预后的关键。规范治疗和健康指导后，若复查血常规、肝肾功能均无异常，无特异性症状，可予“飞行合格”结论。     

桥本病中医命名探讨

基于"浊"特性和致病特点，以及对中医古今文献中"浊"的研究，通过对桥本病病因病机、临床表现、中西医对本病的认识及特效治疗等方面进行分析，探讨桥本病对应较确切的中医命名，进一步探索中医对桥本病的精确治疗。     

THE PARASITOLOGY NUMBER

In these days of intense specialisation one is apt to lose sight of the vital relationship which the science of medicine bears to general biology. The study of parasites and of the diseases they engender in man and animals helps us to keep constantly in mind this relationship. ThiS fact alone is weighty enough to justify the issue of this special number on Parasitology. If another reason is required, it will be the unique position the subject occupies in the field of medicine. Par- asitolooY rivals f)acteriology in its influcnce on the development of preventive medicine and was probably solely responsible for the intro duction of chemotherapy by Ehrlich. Though no longer a virgin field, Cliina still offers an inexhaustible wealth of material for scientific investigat"ons on parasitic diseases. As an eminent American par- asitologist once remarked "China is metaphorically speaking ''riddled'' with parasites."     

Osteoporosis in childhood.

Osteoporosis is defined as ''too little normal bone'', the disorder being rarer in children than adults. The varied forms in childhood can be classified as those secondary to some other disease and primary forms of the disorder which include the genetically determined osteogenesis imperfecta types and idiopathic forms of osteoporosis. A plea is made for greater clinical application in attempting to discriminate differing forms of these primary disorders. Osteogenesis imperfecta it is argued is a heterogeneous condition with the evidence favouring both dominantly and recessively transmitted forms in different kindreds. Another possible osteogenesis imperfecta variant is characterized by dwarfing, scoliosis and peculiar cystic lesions of the proximal humeri. Idiopathic juvenile osteoporosis is a term reserved for the acute osteoporosis beginning in the immediate prepubertal years and may differ in its cause from idiopathic osteoporosis beginning rather earlier in childhood. It is emphasized that immobilization osteoporosis is of very great importance and may become superimposed upon other osseous dysplasias. A complete understanding of these conditions will be helped by elucidation of the basic underlying defects in collagen and other constituents of bone matrix.     

基于循证医学《伤寒杂病论》方对美尼尔氏综合征的研究

[目的]以《伤寒杂病论》方治疗美尼尔氏综合征的文献为研究对象,探索《伤寒杂病论》方在治疗美尼尔氏综合征临床运用规律、特点和优势。[方法]通过计算机检索以"中国知网""维普""万方""中国生物医学数据库"检索为主,辅以天津中医药大学过期期刊库手工检索,设置《伤寒杂病论》方方剂名为关键词或主题词,获取各方治疗的病症(证)谱,并根据ICD-10文件和《中医病证分类与代码》规范病症(证)谱。通过对病症(证)谱的提取,采用Excel2010建立《美尼尔氏综合征个案信息采集表》《美尼尔氏综合征临床信息采集表》。[结果]《伤寒杂病论》方治在疗美尼尔氏综合征临床研究文献中,泽泻汤有频次众多的大样本临床对照试验支持,且其中的中高级质量证据较多。在美尼尔氏综合征的个案研究方剂谱中,苓桂术甘汤、吴茱萸汤、泽泻汤、小柴胡汤等应用频次较多,且医案证据质量偏高。[结论]优势高频方可分为如下两类:1)以治痰饮标实为主的泽泻汤、五苓散、苓桂术甘汤等。2)以治脾胃虚弱兼木火内郁的小柴胡汤、大柴胡汤、柴胡桂枝汤等。     

The management of central post-stroke pain.

Central post-stroke pain (CPSP) used to be known as ''thalamic syndrome''. Early post-mortem studies showed that many cases had extrathalamic lesions, and modern imaging methods have confirmed and extended these findings. CPSP affects between 2 and 6% of stroke patients, ie, there is an annual incidence in the UK of between 2000 and 6000. Most patients with CPSP appear to be younger than the general stroke population, and usually to have relatively mild motor affliction; thus they may live for many years, giving a prevalence perhaps as high as 20,000. True CPSP, characterised by a partial or total deficit for thermal and/or sharpness sensations, is best treated initially with adrenergically active antidepressants. If these do not work, mexiletine may be added in suitable cases. Recent studies suggest that stimulation of the motor cortex or spinal cord by implanted electrodes may help patients resistant to medical treatment. Positive relaxation, as an adjuvant therapy, should be used in nearly all cases. Considerable or even total relief can be achieved in almost two thirds of patients. There is evidence that the sooner antidepressant treatment is begun, the more likely the patient is to respond; time should not be wasted trying conventional analgesics, which rarely have any significant effect.     

THE NATIONAL CHILDREN'S YEAR

In bririging out this Special Number on Paediatrics, the Chinese Medical Association desires, ttuough its ofUcial organ, the Chinese Medical Journal, to associate itself with thC nationwid~ movement to celebrate 1936''aa the children''s year. For.as Dr. H. H. Kung,the Preskknt of the National Child Welfare Association of China, rigbtiy puts: "There is no country to-day that does not realize the importance of child welfare, for the intelligence and good cithenship of the youths of to-e~ay are measured by the amount of energy and time that is spenl in their education and welfare when they are children, and no modern nation can afford to overIook this fact." And let us add that no nation eonsisting of C 3 individuals, crippled in body and maimed in. mind, caii ever hope for equality in the comity of powers ruling the world.     

NOTES ON AN ENDEMIC CENTRE OF KALA-AZAR IN THE PROVINCE OF HUPEH, CENTRAL CHINA

While the larger and more important endemic areas of kala-azar are fairly well defined, the actual extent of these areas westwards''and southwards appears to be extremely vague. In a recent article Hoeppli* states "that although kala-azar may exist in West, Central and South China, the important endemic centres so far have all been ~ound north of the Yangtze Valley." The uncertainty of our knowledge of the ex- tent,rbf the fringes of the endemic areas should constitute a challenge to all working in those places to make a determined effort to prove the presence or, if possible, the absence of the disease. In these notes I propose to record experiences gained dunng 1936-37 in the small city of Anlu (old name: Teian-fu) in Hupeh which indicate that in that district the disease occurs with sufficient frequency to constitute an endemic focus of kala-azar in Central China and only a few miles north of the Yangtze Valley. .     

超声支气管镜引导下针吸活检术在纵隔及肺门]病变诊断中的应用价值

目的探讨超声支气管镜引导下针吸活检术在纵隔及肺门病变诊断中的应用价值。方法选取2017年6月至2021年3月揭阳市人民医院收治的确诊为纵隔及肺门病变患者42例,所有患者均使用超声支气管镜引导下针吸活检术诊断,病理结果作为金标准。分析超声支气管镜引导F针吸活检术诊断结果超声支气管镜引导下针吸活检术诊断纵隔及肺门病变的效能。结果超声支气管镜引导下针吸活检术结果阳性33例,阴性9例:病理金标准的结果为阳性36例,阴性6例。准确度为929%,灵敏度为91.7% ,特异度为10.0%,阳性预测值100.0%,阴性预测值为67%。结论在纵隔及肺门病变诊断中,超声支气管镜引导下针吸活检术诊断效果理想,安全性高,能有效提高医生的诊断效率,临床上应当进一步推广应用。     

The Babinski reflex.

The plantar response is a reflex that involves not only the toes, but all muscles that shorten the leg. In the newborn the synergy is brisk, involving all flexor muscles of the leg; these include the toe ''extensors'', which also shorten the leg on contraction and therefore are flexors in a physiological sense. As the nervous system matures and the pyramidal tract gains more control over spinal motoneurones the flexion synergy becomes less brisk, and the toe ''extensors'' are no longer part of it. The toes then often go down instead of up, as a result of a segmental reflex involving the small foot muscles and the overlying skin, comparable to the abdominal reflexes. With lesions of the pyramidal system, structural or functional, this segmental, downward response of the toes disappears, the flexion synergy may become disinhibited and the extensor hallucis longus muscle is again recruited into the flexion reflex of the leg: the sign of Babinski. A true Babinski sign denotes dysfunction of the pyramidal tract, and should be clearly distinguished from upgoing toes that do not belong to the flexion synergy of the leg. Correct interpretation of the plantar response depends only to a minor degree on the method or site of stimulation of the foot. It is therefore most important to assess the response in the entire leg.