范永升教授涤痰开窍法治疗系统性红斑狼疮脑病

[目的]总结范永升教授运用涤痰开窍法治疗系统性红斑狼疮脑病(systemic lupus erythematosus encephalopathy,SLEE)的经验。[方法]通过阅读文献,跟师临诊,收集病案,从病因病机、治法治则探讨范永升教授运用涤痰开窍法治疗系统性红斑狼疮脑病的临证经验,对其遣方用药规律予以总结分析,并附临床医案以佐证。[结果]范永升教授认为狼疮脑病常与痰瘀互结、脑窍痹阻机制有关,临证多用化痰开窍、平肝熄风的方法,常选用涤痰汤、牵正散、天麻钩藤饮等加减进行治疗,常用的药物有石菖蒲、胆南星、钩藤、半夏、竹茹、郁金、远志等。所附病案显示狼疮脑病患者呈明显的痰湿、瘀阻、脑窍受损之神志异常等症状,范永升教授以涤痰开窍法为先,参以息风通络、通腑泄热等为治疗法则,疗效颇好。[结论]范永升教授认为系统性红斑狼疮脑病以痰浊郁闭为标,根据中医"急则治其标"的治疗原则,临床用涤痰开窍法治疗系统性红斑狼疮脑病发作,具有一定疗效,值得学习和推广。     

范永升教授治疗结缔组织病心脏受累学术经验探析

[目的]总结首届全国名中医范永升教授治疗结缔组织病心脏受累的学术经验。[方法]通过整理、回顾、分析范教授诊治结缔组织病心脏受累相关医案，从中医病因病机和治则治法、中西并重应用原则、分期辨病辨证相结合等方面，总结归纳范教授诊治结缔组织病心脏受累的学术经验，并列举医案一则予以佐证。[结果]范教授认为，结缔组织病心脏受累临床并不少见，属中医“胸痹病”“心水病”“心下悸”等范畴，病因主要与禀赋不足、感受外邪、情志不畅等因素有关，病机为正虚邪侵，心脉痹阻。临证应紧抓心气亏虚、心脉痹阻这个根本病机，治以益气养心、活血通络为主，同时需注意根据心脉痹阻的原因，综合运用清热解毒、活血化瘀、行气化痰、温阳散寒、温化水饮等治法，晚期出现心肾阳虚，则须温肾补火。用药特色为中医辨证与西医辨病相结合，在西医辨病的基础上，灵活运用中医辨证，予以扶正祛邪、补益气血、祛瘀通络、温通心阳、温阳利水等治疗。所举医案中患者处于疾病活动期，证属脾肾阳虚、水湿泛滥，治拟温肾健脾、温阳利水，方用真武汤合苓桂术甘汤加减，临床疗效满意。[结论]范教授根据本病的病因病机及临床特点进行辨证论治，临床用药特色鲜明，中西医取长补短，有机结合，...     

全国名中医范永升教授治疗类风湿关节炎合并间质性肺病学术经验总结

[目的]总结全国名中医范永升教授治疗类风湿关节炎合并间质性肺病学术经验。[方法]通过整理医案,从中医病因病机、治则治法、辨证论治、治疗要领等方面,全面总结范永升教授诊治类风湿关节炎合并间质性肺病的学术经验,并列举医案1例予以佐证。[结果]范永升教授治认为类风湿关节炎的病位主要在脾胃和肝肾;正气虚弱是本病发生的根本原因,风寒湿热等病邪是疾病发生的外在因素,痰瘀为病理产物;间质性肺病发生的根本原因是少阳三焦衰弱,因此临证必须紧抓少阳三焦衰弱这个根本病机。本病的治疗原则为扶正祛邪。扶正主要从益气健脾和补益肝肾入手;祛邪则根据风寒湿热以及痰瘀等的夹杂灵活运用祛风、散寒、除湿、清热、化痰以及通络等治法。范教授临证重视扶助正气、强调适时祛邪以及不忘宣利肺气,所列举医案充分佐证了范教授临床灵活应用扶正祛邪的这一治疗原则。[结论]范永升教授运用中医审因辨证治疗类风湿关节炎合并间质性肺病取得了较好的疗效,为临床用药提供了有益参考,其学术经验值得推广应用。     

范永升应用黄芪桂枝五物汤加减治疗硬皮病经验举隅

[目的]总结范永升教授在临床上应用黄芪桂枝五物汤治疗硬皮病的经验,从而更好地指导临床实践。[方法]通过跟师和收集整理范老师应用黄芪桂枝五物汤治疗硬皮病的医案,分析范老师对硬皮病病因病机的认识以及对黄芪桂枝五物汤的方药分析,并列举范老师治疗硬皮病的一则经典案例。[结果]范老师认为硬皮病的病机为阳虚寒凝,肺脾不足,络脉痹阻,终致皮肤失养。选用温阳散寒,益气和血通痹之黄芪桂枝五物汤加减,适时佐以理气、化痰、疏肝解郁之法,切中病机,取得较好的临床效果。所举验案中患者辨证主要为寒凝血瘀之症,经过黄芪桂枝五物汤散寒活血通痹治疗之后,雷诺症状好转,诸证稳定。[结论]范永升教授从硬皮病病机出发,拟定温阳散寒、通络袪瘀、培补肺脾的治法方药,治疗卓有成效,值得深入学习和借鉴。     

范永升教授治疗幼年特发性关节炎经验拾零

[目的] 总结范永升教授治疗幼年特发性关节炎的经验，为临床提供参考。[方法] 通过临证收集和记录门诊病历，整理范永升教授辨证论治幼年特发性关节炎的经验，总结其病因病机及遣方用药规律，并举医案一则加以佐证。[结果] 范永升教授认为，幼年特发性关节炎多由小儿正气不足、复感外邪所致，病机特点可概括为“湿、热、毒、虚”，急性期治以清热利湿、祛风通络，缓解期治以益气健脾、祛风通络。范教授通过将小儿生理特点与幼年特发性关节炎起病转归有机结合的辨治思路，取得满意的临床疗效。所举医案中患儿处于疾病活动期，证属风湿热痹，治以清热利湿、祛风通络，方用白虎加桂枝汤合四妙丸加减，疗效确切。[结论] 范永升教授从“湿、热、毒、虚”角度辨证论治幼年特发性关节炎，疗效明显，其经验值得借鉴和推广。     

范永升教授论治狼疮脑病经验采撷

[目的] 探讨范永升教授运用补肾滋阴、涤痰开窍法治疗系统性红斑狼疮脑病(systemic lupus erythematosus encephalopathy,SLEE)的临床经验。[方法] 通过临证学习和查阅SLEE的病因病机和辨证论治,阐述范永升教授治疗SLEE的临床经验,并附医案一则。[结果] 范永升教授认为,SLEE的主要病因病机以肾阴不足为本,风痰上扰清窍为标。在临床诊疗中应根据患者临床症状和体征判别疾病的轻重和缓解程度,在补肾滋阴或涤痰开窍上有所侧重,兼顾狼疮本病和继发的神经精神系统损害,动态观察疾病的发展过程。在本例医案中,范永升教授运用补肾滋阴、涤痰开窍法治疗SLEE,有效改善了患者的临床症状和实验室指标。[结论] 范永升教授运用补肾滋阴、涤痰开窍法治疗SLEE,理论依据充分,临床疗效显著,值得推广学习。     

范永升教授成人斯蒂尔病中医诊治特色探析

[目的]探析范永升教授运用中医诊治成人斯蒂尔病的特色。[方法]通过多年侍诊,从病名、病因、病机、治疗原则、辨证方法、用药特色等方面出发,整理和分析范永升教授诊治成人斯蒂尔病的中医特色。[结果]范永升教授根据本病的临床特点提出了"热疹痹"的新病名,认为本病的基本病机为风湿热毒,痹阻气血。治疗原则初期应疏风清热、解肌透邪;进展期应清热祛湿、解毒通络,或清营凉血、透热转气;恢复期当养阴清热、散瘀通络。选方用药强调清热解毒,注重祛除湿邪,善用和解法。[结论]范永升教授运用中医特色辨证治疗本病,取得了较好的疗效,为临床用药提供了参考。     

范永升教授诊治系统性红斑狼疮经验

范永升教授认为系统性红斑狼疮的病因病机以肾虚为本,热毒、瘀血为标;在辨病辨证基础上,以解毒祛瘀滋肾为大法并结合西药综合治疗,取得了较好疗效。     

闫小宁教授运用克银汤治疗血瘀型银屑病经验

[目的]总结闫小宁教授运用克银汤治疗血瘀型银屑病的临证经验,提高中医药治疗血瘀型银屑病的临床疗效。[方法]通过侍诊学习,整理、分析闫小宁教授治疗银屑病血瘀证的医案,从病因病机、临证拟方及配伍加减等方面探究闫小宁教授运用克银汤治疗血瘀型银屑病的临证经验,同时以两则验案佐证。[结果]闫小宁教授认为血瘀型银屑病的病因病机为风热毒邪聚结肌肤,或营血亏耗,生风生燥,导致气血凝滞而发病。针对此病因病机,采用凉血活血、解毒化瘀、养血消斑的治疗总则,并自拟克银汤治疗此病。所列两则医案均具体展示了上述辨证思路和用药特色。其中案一患者辨证为血瘀夹湿热证,治以凉血活血、清热利湿之法,投以自拟方克银汤加减治疗,疗效甚好。案二患者为典型血瘀证型银屑病,首诊以凉血活血、通络化瘀为主,经运用克银汤治疗后皮疹基本消退,故续用前方佐以滋阴之品巩固治疗。[结论]闫小宁教授运用克银汤治疗血瘀型银屑病的临床经验和独到的个人见解值得学习推广和深入探讨。     

范永升教授运用青蒿治疗SLE临床经验

[目的] 总结全国名中医范永升教授运用青蒿治疗系统性红斑狼疮(systemic lupus erythematosus,SLE)的临床经验,提高对SLE的认识。[方法] 通过跟师学习,收集范教授诊治的SLE患者的临床资料,以及整理医案、查询相关文献,回顾分析范教授在SLE的不同阶段运用青蒿及并配伍相关药物的临床经验,并以验案佐证。[结果] 范教授通过辨证论治,以青蒿之清热解毒,治疗SLE轻型阴虚兼有热毒证;以青蒿之透邪滋阴,治疗SLE轻型余邪内伏证;以青蒿之清胆理气,治疗SLE重型肝郁血瘀证。所举病案中分别以解毒祛瘀滋阴方及蒿芩清胆汤治疗轻型及重型SLE,治疗后患者症状改善,SLE疾病活动(systemic lupus erythematosus disease activity index,SLEDAI)评分降低。[结论] 范教授针对SLE的不同阶段,运用青蒿清透虚热、凉血除蒸、解暑截疟,并配伍相关药物,疗效显著,其经验值得推广学习。     

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.     

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.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.