续读半部伤寒论后

伤寒論原有二十二篇(根据明代赵开美复刻宋代高保衡等校正本) ,卽:①辨脉法;②平脉法;③伤寒例;④辨痙湿喝病脉証;⑤辨太阳病脉証并治上;⑧辨太阳病脉証并治中;⑦辨太阳病脉証并冶下;⑧辨阳明病脉証并治;⑨辨少阳病脉証并治;⑩辨太阴病脉証并治;(11)辨少阴病脉証并治;(12)辨厥阴病脉証并治;(13)辨霍乱病脉証并治;(14)     

张士卿教授“三因两辨一对症”治疗小儿湿疹经验

张士卿教授根据多年的临床经验,对小儿湿疹的诊治见解独到,认为小儿湿疹的辨治应遵循“三因”“两辨”“一对症”的辨证要领。所谓“三因”,即因人、因时、因地辨治,“二辨”,即辨分期和辨病证;“一对症”,即针对临床主要症状和其他次要症状的对症辨治,如食欲不振、大便秘结等。附案例2则,以资验证。     

急重症经方辨证治验

目的通过在临床实践中应用经方辨治急重症之体会,表明经方辨治急重症具有良好效果。方法举例探讨经方辨治急重症的临床应用。结果经方辨治危急重症同样可取得显著疗效。结论经方或中西医结合辨治危急重症具有广阔的应用前景。     

浅谈辨病与辩证

辨病与辩证,是诊治中的两种方法,这两种方法,既有联系又有区别,又可谓一体。中医学比较注重辩证而忽视辨病,有些人甚至不知道辨病;西医学注重辨病而忽视辩证(对症)治疗。为了正确理解辨病与辩证,从以下几个方面进行探讨1 辨病与辨证的含义中医学有人称之为经验,实际上是指辨病而不辩证。所谓     

由丹红注射液看中药注射剂临床使用的“辨证”与“辨病”

目的:了解丹红注射液在临床中的"辨证"与"辨病"情况,探讨丹红注射液临床使用方法,加强中药注射剂的合理应用。方法:通过收集丹红注射液的集中监测病历资料,提取其临床使用时辨证与辨病情况,并进行统计分析。结果:丹红注射液临床使用中既有辨证使用也有辨病使用,但存在辨证或辨病与说明书不符情况。结论:中药注射剂的说明书中应规范辨证与辨病的书写,并在临床使用中正确辨证与辨病,合理使用中药注射剂。     

闫永彬教授分层辨治小儿咳嗽经验

总结闫永彬教授分层辨治小儿咳嗽的临床经验。闫教授认为小儿咳嗽,证见多端,外感、内伤、五脏六腑密切联系且具有较强层次感。分层辨治是明理的最好方法,明理是把复杂的咳嗽层次化,首辨病性,再辨主（次）证,最后辨兼症。3个层次的辨治,层次以分,机制自明,效果显著。论治以祛邪复常、宣降相宜、注意清肃为主,绝少使用寒凉伏遏之品,不忘久咳健脾、久嗽活血的学术思想。附案例2则,以资验证。     

辩证论治应为辨病辩证论治

作者认为中医学的特点应是整体观念与辨病辩证论治，即是在辨病基础上的辨论论治。其理由有7:1、辨病辩证论治是《伤寒杂病论》的本意；2辨病辩证论治源于《内经》；3、辨病与辩证是《诸病源侯论》探索病源和归纳证侯的方法；4、温病学运用和发展了辨病辩证论治；5、辨病辩证论治是临床实践的需要；6、辨病辩证论治能促进中医对病的认识；7、辨病辩证论治有助于中西医结合。     

辨证加辨病治胃癌——张士舜治癌经验谈

张士舜主任医师提出的“三辨治癌”，是在传统的辨证论治基础上加辨病论治，即辨病理论治与辨病位论治。在此理论指导下，与现代医学、药学相结合，应用中药有效部位提取物，靶向给药抗胃癌，疗效颇佳，值得临床推广。     

李乃庚教授辨治小儿咳嗽经验

李乃庚教授认为小儿咳嗽既可以是一个独立的肺系病证,也可以是由他脏疾病引起的症状.小儿脏腑娇嫩,肺常不足,咳嗽病因虽多,病位多不离于肺,常涉及脾、肝、肾等他脏.临床治疗咳嗽时需审证求因,不可见咳只治咳.治疗时注重辨新咳或久咳、辨病位、辨体质之三辨相结合,用药遵循"立足祛邪、注重护阳益阴"的原则,并随证灵活加减.应用佛耳草...     

高修安主任医师根据“胃不和则卧不安”论治小儿睡眠障碍经验

小儿因脾胃之要,临床"胃不和"多见。高修安主任医师辨治小儿睡眠障碍从"胃不和则卧不安"着手,首辨虚实,次辨脏腑。治疗以补虚泻实、调整脏腑阴阳、固护胃气为原则,临床疗效显著。附案例1则,以资验证。     

Clinical correlates of heavy tobacco use among adolescents

The primary aim of this study was to determine the clinical factors differentiating adolescents with heavy smoking (> or = 10 cigarettes/day) from adolescents with light smoking. This study involved a study group of 812 adolescents recruited from adolescent alcoholism treatment centers and from the community. Logistic regression analyses demonstrated that adolescents with heavy smoking, compared with adolescents with light smoking, were significantly more likely to demonstrate Caucasian American ethnicity, drug-use disorders, alcohol-use disorders, and conduct disorder. Our findings suggest that the clinical correlates of heavy smoking among adolescents are generally similar to those for smoking at any level (vs. nonsmokers), except that heavy smoking is more strongly associated with Caucasian American ethnicity. Also, depressive disorders were associated with smoking at any level in our sample, but depressive disorders were not associated with heavy smoking.     

Clinical characterization of patients with metastatic colorectal cancer depending on the KRAS status

This retrospective study investigated the clinical characteristics of patients with metastatic colorectal cancer (mCRC) depending on the KRAS status, thereby differentiating KRAS exon 2 mutations in codon 12 versus codon 13. In total, 273 patients with mCRC receiving first-line therapy were analyzed. One hundred patients were treated within the FIRE-3 trial (FOLFIRI plus cetuximab or bevacizumab), 147 patients within the AIO KRK-0104 trial (cetuximab plus CAPIRI or CAPOX), and further 26 patients received therapy outside the study. Thirty-eight tumors with KRAS mutation in codon 13, 140 tumors with mutation in codon 12, and 95 tumors with KRAS wild type as a comparison were included in this analysis. Bivariate analyses demonstrated significant differences between KRAS wild-type, codon 12-mutated, and codon 13-mutated tumors with regard to synchronous lymph node metastasis (P=0.018), organ metastasis (76.8% vs. 65.9% vs. 89.5%, P=0.009), liver metastasis (89.5% vs. 78.2% vs. 92.1%, P=0.025), lung metastasis (29.5% vs. 42.9% vs. 50%, P=0.041), liver-only metastasis (48.4% vs. 28.8% vs. 28.9%, P=0.006), and metastases in two or more organs (49.5, 61.4, 71.1, P=0.047). Regression models indicated a significant impact of KRAS mutations in codon 12 versus codon 13 for synchronous organ and nodal metastasis (P=0.01, 0.03). This pooled analysis indicates that mCRC is a heterogeneous disease, which seems to be defined by KRAS mutations of the tumor. Compared with KRAS codon 12 mutations, codon 13-mutated mCRC presents as a more aggressive disease frequently associated with local and distant metastases at first diagnosis.     

临床路径在可摘局部义齿修复游离端牙列缺失患者中的应用价值

摘要:目的 研究临床路径在可摘局部义齿修复游离端牙列缺失患者中的应用价值。方法 选择 130 例肯氏 Ⅰ、 Ⅱ类牙列缺损患者, 按口腔内余留牙和牙槽嵴黏膜条件相近、 肯氏分类及亚类相同的 2 例为一对, 分为 65 对, 均分为临床路径组和传统修复组。比较 2 组的适应期调改次数, 适应期结束后咀嚼是否有力, 咀嚼时游离端基托是否存在肉眼可见活动度、 基牙龋坏、 基齿松动和食物嵌塞情况。结果 临床路径组在适应期调改次数低于传统方法组［1.0 （1.0, 2.0） 次 vs. 3.0 （2.0, 4.0） 次］; 适应期结束后调改后咀嚼有力的比例 （93.85% vs. 76.96%） 高于传统方法组, 出现肉眼可见动度 （0 vs. 15.38%）、 基牙龋坏 （1.54% vs. 13.85%）、 基牙松动 （0 vs. 12.31%） 及食物嵌塞 （1.54% vs. 15.38%）比例均低于传统方法组 （均 P＜0.05）。结论 临床路径可以提高可摘局部义齿的固位和稳定, 遵循临床路径方法制作可摘局部义齿能够减小功能状态下义齿的不稳定性, 具有良好的推广前景。     

胰腺癌与局限性胰腺炎的超声鉴别诊断

目的：评价超声检查对局限性胰腺炎和胰腺癌的鉴别诊断价值。方法收集辽宁中医药大学附属第二医院2008年1月至2013年8月30例胰腺癌和30例局限性胰腺炎患者的病历资料进行回顾性分析，重点分析2组患者超声图像上是否存在病变部位形态、边界、胰管结构、血流信号、肿块内强回声的不同。结果胰腺癌组患者平均年龄为（57±11）岁，局限性胰腺炎组患者平均年龄为（48±9）岁，组间差异有统计学意义（ t ＝-3．53，P＜0．05）。局限性胰腺炎与胰腺癌组患者超声图像有胰管结构者占比[66．7％（20/30）比6．7％（2/30）]和内部强回声斑块者占比[40％（12/30）比0]差异有统计学意义（均P＜0．01）。结论胰腺癌与局限性胰腺炎发病年龄具有明显的不同，内部强回声斑块与胰管形态的超声成像在胰腺癌与局限性胰腺炎患者的鉴别诊断上存在一定的价值。     

血清CRP鉴别诊断小儿社区获得性肺炎的系统评价

目的探讨血清C反应蛋白(C-reactive protein,CRP)鉴别诊断小儿社区获得性肺炎(Community-acquired pneumonia,CAP)的效能和临床应用前景。方法收集有关血清CRP鉴别诊断小儿CAP的临床研究进行Meta分析。结果细菌性肺炎患者血清CRP阳性率高于支原体肺炎患者、病毒性肺炎和正常健康人(均P<0.01);支原体肺炎患者血清CRP阳性率亦明显高于病毒性肺炎和正常健康人(均P<0.01);而病毒性肺炎患者血清CRP阳性率则高于正常健康人(P=0.010)。结论细菌性肺炎患者血清CRP显著高于支原体肺炎患者、病毒性肺炎患者及正常健康人。     

超声弹性成像技术在乳腺良恶性病变鉴别中的临床价值评价

目的：探讨超声弹性成像（ UE）技术对乳腺良、恶性病变鉴别中的临床价值。方法对2011年12月-2013年6月106例（115个病灶）乳腺病变患者进行超声检查及UE技术,并采用5分法对其硬度进行评价。以术后病理诊断结果为标准,评价UE技术的意义。结果弹性成像诊断乳腺良恶性病变的敏感度为92．31％,特异度为92．16％,准确度为92．17％。结论超声弹性成像技术为超声鉴别乳腺良、恶性病变提供了一个新的手段,尤其在一些边界不清病灶的良、恶性鉴别诊断上具有较高的临床应用价值。     

系统性红斑狼疮合并感染的诊断与鉴别的研究进展

系统性红斑狼疮(SLE) 是一种慢性自身免疫性疾病,可累及多个系统。SLE病人具有较高的感染率,可能是因为长期的免疫抑制治疗以及疾病本身造成的免疫系统异常等综合因素所致,但鉴别SLE发热是感染还是病情活动是极其困难的。活动指数对判断狼疮病人疾病活动是有用的,但临床和生物学的异常可能很难区别疾病活动还是合并感染。几种生物标志物被认为是鉴别SLE活动或者感染的潜在工具,如C-反应蛋白和原降钙素。但仅使用一种生物标志物去确认或者否认感染是不可行的,这就需要新的评分包含多种生物标志物,这可能是区分感染和病情活动新的方法,该文综述了近年关于SLE合并感染的诊断与鉴别的研究进展。     

Phytochemical Investigation of Hippeastrum vittatum

The stereochemistry of pancracine, from HIPPEASTRUM VITTATUM, has been fully characterized as free base and as its O, O-di-acetate by means of spectroscopic analyses and CD-data. Carbon magnetic resonance data provide a simple tool in differentiating the contained montanine skeleton from other alkaloid ring systems within the Amaryllidaceae.     

Cerebrospinal fluid biomarkers for diagnosis of Alzheimer's disease: beta-amyloid(1-42), tau, phospho-tau-181 and total protein

Alzheimer's disease is a chronic progressive neurodegenerative disease and it is the most prevalent type of dementia. Diagnostic means, including neuroimaging methods, are continuously improving. Nevertheless, it is still a challenge to increase the sensitivity and specificity of a diagnosis of Alzheimer's disease. Two diagnostic areas are especially challenging: first, differentiating early stages of Alzheimer's disease from mild cognitive impairment and normal aging; and second, increasing diagnostic specificity especially when similar clinical symptoms are shared by various types of dementia. To date, the analysis of beta-amyloid(1-42), total tau and phospho-tau-181 from cerebrospinal fluid (CSF) are the best biological markers to diagnose Alzheimer's disease and differentiate it from other forms of dementia with a high reliability and validity. This article reviews the use of CSF biomarkers and of putative blood-related markers.     

Serum acetylcholinesterase and prognosis of acute organophosphate poisoning

OBJECTIVE: The aim of this study is to investigate the prognostic value of serum acetylcholinesterase levels and their relationship with neurological syndromes (Type 1 syndrome, intermediate syndrome, and delayed polyneuropathy) in acute organophosphate poisoning. MATERIALS AND METHODS: Thirty-two consecutive patients with acute organophosphate poisoning admitted to the Ondokuz Mayis University Emergency Department from June 1999 to January 2001 were evaluated. Patients were assessed according to admission time, symptoms, and results of clinical exams and their serum acetylcholinesterase levels were determined on days 1, 2, 3, 7, and the last day. RESULTS: There was no significant difference between the first-day serum acetylcholinesterase of the patients with severe poisoning (n = 22, 68.75%) and of the patients with mild poisoning (n = 10, 31.25%; NS). There was no discernible difference between the serum acetylcholinesterase obtained on days 1 and 3 after poisoning from the patients with intermediate syndrome (n = 5, 15.6%; means: 0.90 +/- 0.65 vs. 0.88 +/- 0.53, 19.35 vs. 18.92%; NS, sensitivity = 80%; specificity = 87.5%). There was a significant difference between the serum acetylcholinesterase obtained on days 1 and 3 from the patients with nonintermediate syndrome (n = 24, 75%; means: 1.05 +/- 0.24 vs. 1.68 +/- 0.29, 22.58 vs. 36.12%; p < 0.001). There was no discernible significant difference in serum acetylcholinesterase between the patients with organophosphorus-induced delayed polyneuropathy (n = 7, 21.8%) and nonorganophosphorus-induced delayed polyneuropathy. In the patients who died (n = 5, 15.6%), serum acetylcholinesterase showed no discernible increase day 1-the last day (means: 0.50 +/- 0.25 vs. 0.46 +/- 0.26, 10.75 vs. 9.89%; NS). There was a significant difference between the serum acetylcholinesterase levels obtained on days 1 and the last day from the patients who survived (n = 27, 84.3%; means: 1.14 +/- 0.25 vs. 2.32 +/- 0.26, 24.51 vs. 49.89%; p < 0.001). CONCLUSION: In the acute phase of organophosphate poisoning, low serum acetylcholinesterase (> 50% of minimum normal value) supports the diagnosis of organophosphate poisoning but it does not show a significant relationship to the severity of poisoning (NS). The serum acetylcholinesterase activity may be a useful parameter in following the acute prognosis of organophosphate poisoning.