“一则八法”是诊治消渴及并证管控有效机制

目前,我国糖尿病(消渴病)人数已经攀居世界首位,数量日益上升,现已增加到1.1亿人。消渴及并证等中医疑难危重证的管控、防治和教育工作已成为医学界的重要课题。在中医经典理论的指导下,依据《灵枢·师传篇》等多篇中医经典理论,并结合50余年的临床经验,创新性地提出治疗消渴及并证等中医疑难危重证的综合诊疗管控有效机制"一则八法"。临证中强调中医治病必求于本,做到"读经典,跟明师,多临床",谨守一则,活用八法,因时、因地、因人制宜,因证立法,以法统方,按方遣药,治病治本,形成管控疾病的有效机制。     

试论证的形成及转化因素

在评价中医临床治疗效果时,首先要看其识证是否正确.识证,是中医辨证论治体系的重要组成部分,它是中医关于疾病发生、发展过程中,把握疾病某阶段本质的一种概念,是中医认识疾病的终结和论治的前提.识证,除正确掌握四诊方法、全面收集临床资料外,还必须对证的形成因家及证的转化因素有一个全面的了解.     

萎缩性胃炎中医分型影像学观察

目的:观察萎缩性胃炎中医分型的影像学表现差异。方法:应用低张气钡双重造影技术,观察统计135例萎缩性胃炎与中医胃脘痛辨证分型的虚寒证、郁热证、瘀血证的影像学表现。结果:X线诊断轻度萎缩性胃炎与虚寒证符合率为79.07%,X线诊断中度萎缩性胃炎与郁热证符合率为87.09%,X线诊断重度萎缩性胃炎因例数少未统计符合率。结论:萎缩性胃炎X线表现不能完全与中医胃脘痛辨证分型的虚寒证、郁热证、瘀血证相符。     

亚健康状态中医证候研究探讨

结合当前亚健康状态研究实际,对亚健康状态中医证候研究进行了探讨总结,提出了针对亚健康状态中医证候研究的相关建议。认为应依据中医理论据因辨证;深入开展亚健康状态大样本、多中心、标准化流行病学调查研究;理清证候发展的动态脉络,探寻始发证候、核心证候、转归证候等证候发展变化的客观规律;注重证候与体质的关系。     

基于文献研究的难治性癫痫中医证候要素分布

目的对难治性癫痫的中医证候要素进行分析研究,从循证医学角度探讨其中医证候要素分布规律及特点。方法采用"文献归纳分析方法",检索中国生物医学数据库、中国知网、维普、万方数据库中1996-2016年期间发表的难治性癫痫中医证候分型明确的文献,从文章中所涉及的难治性癫痫中医证型、证素、患者例数进行分布规律分析。结果难治性癫痫病位证素包括肝、神、心、脾、肾、经络/脑络;病性证素包括痰、火、气滞、血虚、气虚、血瘀、动风、闭、阴虚、精亏。结论病位证素中肝病位证素出现频率为第一位;病性证素中在发作期以风为主要表现;虚实证素中,实证大于虚证及虚实夹杂证总和,说明难治性癫痫因实动风多于因虚生风。     

老年糖尿病中医证候与并发症相关性初探

目的:探讨老年糖尿病中医证候与其并发症的相关性。方法:对170例患者的病史、一般情况、症状、理化检查等进行调查,按中医证候归类统计。结果:共调查样本170例,发现老年糖尿病患者的中医辨证与传统的消渴病辨证不同,以气阴两虚、肝肾阴虚及瘀血证为主。结论:该研究有助于了解老年糖尿病患者的中医证候特点及其与常见并发症的关系,为制定出因质制宜的防治方案提供参考。     

癌因性疲乏患者的中医证候聚类分析

【目的】探究恶性肿瘤癌因性疲乏(CRF)患者的中医证候分型规律。【方法】采用横断面调查方法,现场调查200例恶性肿瘤具有癌因性疲乏症状的患者,通过问诊和填写调查问卷的方式采集患者一般资料、疾病、治疗相关资料及中医临床资料,并通过CRF量表(即Piper疲乏量表)量化评估患者疲乏情况。采用聚类分析方法对癌因性疲乏患者中医临床症状进行聚类分型,结合临床实际和专业知识确定中医证型。【结果】(1)CRF量表各维度得分从高到低依次为:情感疲乏行为疲乏躯体疲乏认知疲乏。(2)分层聚类分析结果显示选择6分类时各条目分布较为合理,即CRF患者的临床中医证型可分为肾阳虚、肝气郁结、脾胃阴虚、寒湿困脾、肺气亏虚、脾气亏虚等6个证型。(3)200例恶性肿瘤CRF患者中,脾气亏虚证出现率最高(占35.2%),其他依次为肺气亏虚证(占22.7%)、肝气郁结证(占14.47%)、寒湿困脾证(占11.51%)、肾阳虚证(占8.88%),脾胃阴虚证出现率最低(占7.24%)。【结论】本研究初步得出临床上癌因性疲乏患者的中医证候分型规律,可为临床辨证论治提供一定参考。     

中医证候动物模型的复制方法动物选择以及评价标准

自20世纪60年代初肾阳虚证动物模型问世以来，中医证候动物模型的研制经历了40多年的发展，逐步形成了独特的研究方法。如独特的理论体系：“辨证论治”；独特的评价标准：证、病、症；独特的处理措施：中药、针灸、养生措施；独特的观察指标：舌、脉、汗、神、色；独特的认识特色：审证求因等。中医证候动物模型的研究以中医基础学和实验动物学为基础，中医基础学指导着中医证候动物模型研制的实施。因此，可以这样理解，中医证候动物模型学的产生在很大程度上来说是中医基础学与实验动物学有机结合的成果。     

急性阑尾炎术后中医证候聚类研究

目的:探索急性阑尾炎术后中医证型,为术后辩证施治的规范化奠定基础;为急性阑尾炎的中西医结合治疗提供研究依据.方法:对2010年1月～2012年1月在广东省中山市中医院因急性阑尾炎行急诊阑尾切除手术的患者,术后12 h即按照中医望、问、闻、切四诊收集患者的临床资料,对急性阑尾术后的中医证候进行研究.结果:急性阑尾炎术后患者主证为脾胃湿热证,包括热重于湿和湿重于热两型,可合并兼证为气滞证.结论:急性阑尾炎术后中医证候的研究是中西医结合外科发展的必然趋势,有重要的理论意义和应用价值.     

热疮中医辨证治疗分析

目的:中医根据肺胃热盛证、湿热下注证等病症采取中医辨证治疗过热疮的处理方案。方法:选取2015年3月-2016年2月,我院收治的20例因病久脾虚不摄、病菌感染引起的热疮患者,临床根据中医经验实施辩证治疗,根据临床不同病症针对性实施中药内调,总结临床资料。结果:经中医辩证治疗后,因肺胃热盛证、湿热下注证等症,引起的病症均得到控制,20例患者均治愈康复出院,中医内调效果明显,患者无远期后遗症出现,效果满意。结论:中医从辩证角度,从证而治,根据患者自身条件,热疮引起的不同症状,配比最佳内调药方,有效缓解患者症状,临床治疗热疮意义深远。     

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.