黄建业教授治疗儿童反复呼吸道感染经验

黄建业教授自拟益气上感汤,益气固表汤,补肾益气汤治疗反复呼吸道感染,临床观察１８５例,总有效率９７．２％,强调防治小儿反复呼吸道感染,以恢复和加强复感儿的抗病能力,调节肺,脾,肾功能,使卫外得固为重要措施。     

劳淋的中医病机证治探讨

本文运用中医理论对劳淋的病机、证治进行了论述。劳淋的病机以肾气不足为本,膀胱湿热为标,本虚标实,虚实夹杂。在发作期以膀胱湿热为主,兼肾气不足,邪少虚多,在缓解期以肾气不足为主,兼余邪,邪少虚多。肾虚为劳淋反复发作的病理基础及变证之源。应当把发作期与缓解期联系起来认识,看成是同一疾病的不同表现阶段,而尤其应重视缓解期的病理变化。劳淋的治疗原则以扶正怯邪为主,发作期以清热利湿,解毒通淋为主,略投补肾之品,缓解期以益气补肾为法,少加清利之品。     

范永升教授治疗小儿多形性红斑经验

[目的]总结范永升教授治疗小儿多形性红斑经验。[方法]通过跟师临证和收集整理范永升教授治疗小儿多形性红斑的医案,分析范教授对小儿多形性红斑中医病因病机的认识,总结范教授辨治小儿多形性红斑临床经验,并举案例佐证。[结果]范永升教授认为小儿多形性红斑多以小儿脾气不足、复感外邪所致,病机特点可概括为"虚、热、瘀"。根据感受病邪程度,将本病分为邪犯肺卫、热炽营阴、耗气伤阴等不同阶段,治疗上分别以辛散表邪、宣清郁热,凉血解毒、消瘀散斑,健脾和胃、清气养阴为治则。范教授通过将小儿生理特点与多形性红斑起病转归有机结合的辨治思路,取得满意的临床疗效。[结论]范永升教授从"虚、热、瘀"角度分阶段辨治小儿多形性红斑,其经验值得借鉴和推广。     

补肾固表方对复感儿外周血Th1和Th2型细胞因子表达失衡的调节作用

目的探讨补肾固表方对复感儿外周血T辅助细胞1(Th1)和T辅助细胞2(Th2)型细胞因子表达失衡的调节作用。方法采集20例复感儿治疗前后外周血,采用流式细胞仪分选CD4 T细胞,提取细胞总RNA,应用实时荧光定量PCR术,检测T-bet、GATA-3、干扰素(IFN-γ)、白细胞介素4(IL-4)基因表达量,并与10例健康对照组进行比较。结果复感儿T-bet mRNA和IFN-γmR-NA表达下降,GATA-3 mRNA和IL-4 mRNA表达升高,与正常组相比,有显著性差异(P<0.01或P<0.05)。补肾固表方治疗后T-bet mRNA上调(P>0.05),IFN-γmRNA上调(P<0.01),GATA-3mRNA和IL-4 mRNA下调(P<0.01),与正常组相比,无显著性差异(P>0.05),其中尤以GATA-3mRNA和IL-4mRNA改变程度明显。结论复感儿间歇期存在Th转录因子及细胞因子基因表达失衡,呈Th2优势应答模式。补肾固表方可使T-bet mRNA和IFN-γmRNA表达量增加,GATA-3mRNA和IL-4 mRNA表达量下降,从转录因子及细胞因子基因水平恢复Th平衡。     

补肾固表方对肾阳虚小鼠模型细胞免疫功能的影响

为探讨补肾固表方(主要药物菟丝子、黄芪、党参、白术、防风、黄芩、柴胡、乌梅、麻黄根等)治疗反复呼吸道感染(复感)的机理,将60只C57BL雄性小鼠分为5组,即正常对照组(A)、模型组(B)、补肾固表方组(C)、玉屏风散组(D)、核酪口服液(E).除A组外,其余小鼠予腹腔注射氢化可的松50mg*kg-1*d-1连续14d,以此造成肾阳虚,模拟复感发病环境.第15d起各组小鼠分别以相应药物灌胃,用量分别相当于临床的30倍,连续4周.之后处死小鼠,观察其细胞免疫功能的变化.结果注射氢化可的松后,小鼠胸腺指数、血清皮质醇、CD+2、CD+3、CD+4、CD+8、CD+4/CD+8、NK均降低,用药组后各项指标有不同的程度的升高,其中C组更为明显.提示提高患儿的细胞免疫功能,可能是补肾固表方治疗复感的机理.     

广州地区复感儿非急性感染期的证候规律及防治方案研究

目的对广州地区复感儿非急性感染期的证型、相关发病因素以及两者之间的相关性作一探讨,以期找出广州地区复感儿非急性感染期理想的防治方案.方法对广州地区非急性感染期复感儿的年龄、性别等相关发病因素以及相应的中医证型进行统计学分析.结果及结论肺脾气虚挟湿挟滞型为该地区复感儿的主要证型;发病因素与年龄、居住地、出生情况、喂养方式、饮食偏嗜、调护情况、过敏性疾病情况、抗生素使用情况及合并病有关;饮食因素与RRTI中多种证型,包括肺气虚、脾气虚、肾气(阳)虚、脾阴虚、肺阴虚、挟湿、挟痰等的发生有关,其中与肺气虚、脾气虚及挟湿证的发生密切相关.     

《伤寒论》太阳,阳明喘证辨治

《伤寒论》太阳、阳明篇中关于喘证的论述有13条,现将其归类辨治如下。1 表证误下 气逆微喘 “太阳病,下之微喘者,表未解故也。桂枝加厚朴杏子汤主之”。太阳病,虽经误下,其正气尚能与欲陷之邪气抗争,而为冲逆微喘,说明表证未解有外出之势,所以仍须用桂枝汤辛温解表,但因已有气逆微喘之变证,故治疗中须加厚朴、杏仁以利气降逆定喘。2 宿有喘疾 复感表邪 “喘家作,桂枝汤加厚朴、杏子佳”。素有喘病,又感大阳表邪,触动宿疾而喘作,治疗除以桂枝汤辛温解表治疗新感之邪外,再加厚朴、杏仁宣肺降气治宿喘,使标本兼顾,新感宿喘同愈。     

汪受传从风痰论治小儿过敏性咳嗽

汪受传治疗小儿过敏性咳嗽时重点着眼于"风",认为风痰内蕴、肺失宣肃是本病的病机关键。发作期采用祛风化痰、宣肃肺气止咳之法,擅用祛风药,常用药物为炙麻黄、杏仁、前胡、桑白皮、黄芩、蝉蜕、胆南星、制僵蚕、重楼等。缓解期病机为肺表不固兼有营卫失和,治宜补肺固表、调和营卫,兼以健脾化痰、扶正祛邪,方药以玉屏风散合桂枝龙骨牡蛎汤为主加减。     

阿尔茨海默病的病机及治疗

阿尔茨海默病的病位在脑,病性为本虚标实,以虚为主。治疗上针对肾虚与痰浊瘀血共存的特点,采用标本兼顾的原则,补肾固本,化痰开窍,活血化瘀。可使＂邪尽正复,神明复主＂。     

舒惠荃治疗中老年女性尿路感染经验

湿、热、毒、瘀、虚是老年女性尿路感染发病的关键。其病位以脾肾、膀胱为中心。涉及肝、胆、心、小肠等多个脏腑。湿热瘀毒蕴结与正气亏虚是主要病机,贯穿于淋证整个病程。急性感染期以清热利湿通淋为主辨证加减;缓解期以益气健脾补肾为法扶正固本。强调中西结合,重视行气除湿、活血化瘀。     

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.