中医学习型PBL教师团队建设的思考与实践

从知识的复杂性角度思考中医PBL的本质,探讨PBL教师团队组建的意义、性质和任务,以及团队建设的主要环节,提出PBL教师团队是一种“学习型组织”,有利于培养PBL教师队伍,提高PBL教学水平。     

Circulating Levels of Inflammatory Cytokines in Patients with Psoriasis Vulgaris of Different Chinese Medicine Syndromes

Objective:To investigate whether the serum levels of inflammation-related cytokines might be different between the healthy individuals and the psoriatic patients diagnosed of three varied Chinese medicine(CM) syndromes[blood-stasis syndrome(BSS),blood-dryness syndrome(BDS) and wind-heat syndrome(WHS)].Methods:A total of 62 psoriatic patients were recruited and assigned to 3 groups according to their CM syndromes,including 27 patients of BSS,21 of BDS and 14 of WHS.Another 20 sex- and agematched healthy subjects were enrolled into the control group.Serum concentrations of multiple cytokines,including monocyte chemotactic protein-1(MCP-1),macrophage inflammatory protein-1α(MIP-1α),soluble CD4 O ligand(SCD40L),tumor necrosis factor-α(TNF-α),epidermal growth factor(EGF),interleukin-8(IL-8),interleukin-17(IL-17),interferon γ inducible protein-10(IP-10) and vascular endothelial growth factor(VEGF),were measured by a multiplexed flow cytometric assay.Results:The circulating levels of MIP-1α,TNF-α,IL-8,and IP-10 were significantly increased in the psoriatic patients compared with the healthy controls(P0.01).Male and female patients tended to have higher serum levels of MCP-1 and IP-10,respectively(P0.05).Interestingly,compared with the control group,6 out of the 9 cytokines(MCP-1,MIP-1α,TNF-α,EGF,IL-8 and IP-10) were substantially increased in the BSS group(P0.05 or P0.01),whereas only MIP-1α and IL-8 levels were elevated in the BDS group(P0.05 or P0.01) concurrent with lowered concentrations of SCD40 L and IL-17(P0.05).In the WHS group,MIP-1α was the only cytokine whose level was evidently increased(P0.01),in contrast to IL-17 which was decreased as compared with the control(P0.05).The psoriatic patients overall owned higher levels of MIP-1α and IL-8 in the circulation which were comparable among the 3 groups of CM syndromes(P0.01).In contrast,TNF-α level of the BSS group was the highest among the three(P0.01),followed by the BDS and the WHS groups.Conclusions:The expression profiles of cytokines in the circulation might not be necessarily identical for psoriatic patients with different CM syndromes.Accordingly,the serum concentrations of certain cytokines could potentially be used as the ancillary indices for the clinical classification of psoriatic CM syndromes.     

中医辨证论治心脏X综合征

心脏X综合征有心绞痛的表现,但其预后与冠脉狭窄引起的心绞痛迥然不同。由于现代医学对此病的认识有限,在治疗方面疗效并不理想,而运用中医药在治疗心脏X综合征方面有很突出的特色和优势,经临床验证疗效满意。     

Analysis of the Diagnostic Consistency of Chinese Medicine Specialists in Cardiovascular Disease Cases and Syndrome Identification Based on the Relevant Feature for Each Label Learning Method

Objective:To analyze the diagnostic consistency of Chinese medicine(CM) specialists in patients with cardiovascular disease and to study syndrome classification and identification based on the multi-label learning method.Methods:Using self-developed CM clinical scales to collect cases,inquiry information,complexity,tongue manifestation and pulse manifestation were assessed.The number of cases collected was 2,218.Firstly,each case was differentiated by two CM specialists according to the same diagnostic criteria.The consistency of the diagnosis based on Cohen’s Kappa coefficient was analyzed.Secondly,take the same diagnosis syndromes of two specialists as the results of the cases.According to injury information in the CM scale "yes" or "no" was assigned "1" or "0",and according to the syndrome type in each case "yes" or "no" was assigned "1" or "0".CM information data on cardiovascular disease cases were established.We studied CM syndrome classification and identification based on the relevant feature for each label(REAL) leaming method,and the diagnostic rate of the syndrome was studied using the REAL method when the number of features selected was 5,10,15,20,30,50,70,and 100,respectively.Results:The syndromes with good diagnostic consistency were Heart(Xin)-qi deficiency,Heart-yang deficiency,Heart-yin deficiency,phlegm,stagnation of blood and stagnation of qi.Syndromes with poor diagnostic consistency were heartblood deficiency and blood deficiency of Heart and Liver(Gan).The highest diagnostic rates using the REAL method were Heart-yang deficiency followed by Heart-qi deficiency.A different number of features,such as 5,10,15,20,30,40,50,70,and 100,respectively,were selected and the diagnostic accuracy based on five features showed the highest diagnostic accuracy.The top five features which had a strong correlation with the syndromes were in accordance with the CM theory.Conclnsions:CM syndrome differentiation is strongly subjective and it is difficult to obtain good diagnostic consistency.The REAL method fully considers the relationship between syndrome types and injury symptoms,and is suitable for the establishment of models for CM syndrome classification and identification.This method can probably provide the prerequisite for objectivity and standardization of CM differentiation.     

Key Symptoms Selection for Two Major Syndromes Diagnosis of Chinese Medicine in Chronic Hepatitis B

Objective

To identify key symptoms of two major syndromes in chronic hepatitis B (CHB), which can be the clinical evidence for Chinese medicine (CM) doctors to make decisions.

Methods

Standardization scales on diagnosis for CHB in CM were designed including physical symptoms, tongue and pulse appearance. The total of 695 CHB cases with dampness-heat (DH) syndrome or Pi (Spleen) deficiency (SD) syndrome were collected for feature selection and modeling, another 275 CHB patients were collected in different locations for validation. Key symptoms were selected based on modified information gain (IG), and 5 classifiers were applied to assist with models training and validation. Classification accuracy and area under receiver operating characteristic curves (AUC) were evaluated.

Results

(1) Thirteen DH syndrome key symptoms and 13 SD syndrome key symptoms were selected from original 125 symptoms; (2) The key symptoms could achieve similar or better diagnostic accuracy than the original total symptoms; (3) In the validation phase, the key symptoms could identify syndromes effectively, especially in DH syndrome, which average prediction accuracy on 5 classifiers could achieve 0.864 with the average AUC 0.772.

Conclusion

The selected key symptoms could be simple DH and SD syndromes diagnostic elements applied in clinical directly. (Registration N0.: ChiCTR-DCC-10000759)

     

肿瘤常见症状中医辨治举要

对肿瘤的常见症状中医辨治进行分析和讨论,包括癌性疼痛、癌性发热、癌性出血、癌性贫血、癌性呕吐、癌性泄泻、癌性便秘、癌性肿胀,并举例说明,认为癌体本属局部为实,整体为虚,虚实夹杂之病,延至晚期,整体衰竭,成为败局,既不可攻,又不可补,惟有姑息治疗,以延朝夕,健胃以助受纳。      

信息技术支持下的探究学习模式在中医诊断学《肝腑辨证》课中的应用

文章介绍了信息技术支持下探究式学习模式具有信息性、实践动手能力、学习资源丰富、培养学生的沟通能力、改变学习思维等特点,并通过中医诊断学《肝腑辨证》课程具体探讨了如何应用这一学习模式进行中医课程的教学。从条件的准备、探究问题的提出和具体教学过程的实践都进行了详细的介绍和分析,说明了应用探究式学习模式进行中医教学的特点,为进一步推广应用这一学习模式提供有益的见解。     

2型糖尿病合并原发性高血压证型分析

目的观察2型糖尿病合并原发性高血压患者的中医证候分布和演变规律。方法共收集318例2型糖尿病合并原发性高血压患者的病历资料,对患者的证型进行分析,并按病程分层对证候演变规律进行分析。结果 318例患者中,单纯虚证68例,占21.4%;单纯实证27例,占8.5%;虚实夹杂证223例,占70.1%。病程0～2年者可见以痰(湿)热互结为主的实证,病程2年以上者气阴两虚证最为多见,病程10年以上者多见脾肾阳虚证、阴阳两虚证。随着病程延长,血瘀证逐渐增多。结论随着病程进展,2型糖尿病合并高血压的证型由热盛津伤、痰热互结逐渐向肝肾阴虚、气阴两虚、脾肾阳虚、阴阳两虚证转化,血瘀证、痰浊证是贯穿于整个病程的常见兼夹证。     

2型糖尿病合并原发性高血压证型分析

目的 观察2型糖尿病合并原发性高血压患者的中医证候分布和演变规律.方法 共收集318例2型糖尿病合并原发性高血压患者的病历资料,对患者的证型进行分析,并按病程分层对证候演变规律进行分析.结果 318例患者中,单纯虚证68例,占21.4%;单纯实证27例,占8.5%;虚实夹杂证223例,占70.1%.病程0～2年者可见以痰(湿)热互结为主的实证,病程2年以上者气阴两虚证最为多见,病程10年以上者多见脾肾阳虚证、阴阳两虚证.随着病程延长,血瘀证逐渐增多.结论 随着病程进展,2型糖尿病合并高血压的证型由热盛津伤、痰热互结逐渐向肝肾阴虚、气阴两虚、脾肾阳虚、阴阳两虚证转化,血瘀证、痰浊证是贯穿于整个病程的常见兼夹证.     

儿童足细胞病不同中医证型的临床特点分析

目的分析儿童足细胞病中医证型与临床特点及实验室检查的关系。方法收集我院儿科2008年3月—2011年3月经肾穿刺活检明确肾脏病理的76例足细胞病住院患儿,在肾穿刺活检前24 h内进行中医辨证分型,分析各证型临床和实验室检查结果。结果 76例患儿中,肺脾气虚型21例,脾虚湿困型13例,脾肾阳虚型24例,肝肾阴虚型7例,气阴两虚型11例。其中肺脾气虚型患儿66.7%存在前驱感染,气阴两虚型患儿72.7%无前驱感染;肺脾气虚型患儿病程小于2个月者占71.4%,气阴两虚型患儿病程大于2个月者占81.8%;患儿血清清蛋白肺脾气虚型最高,气阴两虚型最低;血脂指标肺脾气虚型最低,气阴两虚型最高;尿蛋白定量和尿N-乙酰-B-D-氨基葡萄糖苷酶(NAG酶)均以脾肾阳虚型患儿最高,肺脾气虚型最低。结论儿童足细胞病中医证型与有无前驱感染和病程存在相关性;不同证型的血清学、尿液实验室检查指标存在差异。     

肾病综合征中医辨证分型与血清甲状腺激素之间的关系

目的探讨肾病综合征(nephrotic syndrome,NS)患者中医辨证与血清甲状腺激素变化的关系。方法设立正常对照组,采用放射免疫法测定治疗组血浆总T3(TT3)、总T4(TT4)及促甲状腺激素(TSH)的浓度。结果湿热型血清TT3、TT4、TSH与对照组比较差异均不显著(P>0.05);肝肾阴虚型血清TT3、TT4低于正常对照组(P<0.01),TSH高于正常对照组(P<0.01);脾肾阳虚型血清TT3、TT4低于正常对照组(P<0.01),也低于肝肾阴虚型,二者有显著性差异(P<0.01),TSH与正常对照组比较差异不显著(P>0.05),低于肝肾阴虚型(P<0.01)。结论TT3、TT4、TSH的不同水平变化在NS各中医证型间具有差异性,可作为中医证候的客观表现之一。     

安徽脊髓小脑性共济失调患者基因型与中医证型相关性

目的通过探讨脊髓小脑性共济失调(spinocerebellar ataxia,SCA)患者基因型与中医证型的关系,为SCA的辨证客观化提供依据。方法检测59例来自安徽地区的家族性或散发性SCA患者的基因型,以30例无血缘关系的健康人为对照。对这些SCA患者进行辨证分型,分析其基因型与中医证型的相关性。结果本组59例SCA患者有17例检出SCA3基因亚型,有7例检出SCA1基因亚型。上述患者中医证型表现为肾精亏虚型、脾肾两虚型、肝肾阴虚型、肾虚血瘀型4种,且以肾精亏虚型和脾肾两虚型为主。其中SCA3基因亚型患者与脾肾两虚型相关,而SCA1基因亚型患者与上述证型均无相关性。结论研究初步证实,不同基因亚型的SCA患者与中医证型可能存在相关性,SCA患者不同的中医证型应有其相应的分子基础。     

中医辨证论治治疗糖尿病疗效分析

目的:观察中医辨证论治中药治疗糖尿病的临床疗效。方法:54例糖尿病患者,辨证后分为气阴两虚、阴虚热盛、肝肾阴虚、湿热内蕴、阴阳两虚等型,入院时均有不同程度的并发症。入院后,结合现代医学理论及实验室检查结果,对病人进行综合辨证组方,中药内服,每日1剂。结果:除3例未能随访外,42例患者疗效显著,7例有效,2例无效。总显效率达86.49%。结论:中医辨证论治、结合现代医学理论组方服用中药治疗糖尿病疗效显著。     

PBL教学法在中医内科学教学中的应用研究

目的：探讨PBL教学法对中医内科学教学效果的影响。方法：选择本院2008级中医学本科生126人为研究对象,随机分成采取PBL教学法的一班（试验组）和采取LBL教学法的二班（对照组）,采用期末进行闭卷考试的方式进行教学效果评估。结果：两组学生的客观题成绩之间差异无显著性差异（P〉0.05）;而接受了PBL教学法的学生在代表学生理解能力、综合分析判断能力、应用能力的主观题上的成绩明显优于对照组（P〈0.01）。结论：PBL教学法有利于培养学生的理解能力、综合分析判断能力、应用能力,能提高中医内科学教学的质量。     

慢性胃炎的中医常见证型研究

目的:研究慢性胃炎(包括慢性浅表性胃炎CSG和慢性萎缩性胃炎CAG)的中医临床常见证型分布。方法:搜索阅读慢性胃炎证型分布相关的大量医学期刊文章,对其中证型分布归类总结,找出所占比例较大的证型即主要常见证型。结果:肝胃不和型在慢性胃炎的证型分布中所占比例最大,其余主要常见证型是:脾胃虚弱型、脾胃湿热型、脾胃虚寒型和胃阴不足型。     

中医药治疗Luminal型乳腺癌的特色探析

现代医学认为乳腺癌是一个慢性全身性疾病,其中Luminal型乳腺癌占乳腺癌总数的50%以上,该类患者在接受规范内分泌治疗的同时又面临着不良反应多、依从性差、易产生耐药及远期复发转移等几大难点,针对这些难点,可以通过中医药对其进行干预治疗,且有众多的临床研究和实验研究结果均证明了中医药在防治内分泌治疗的不良反应、改善药物耐药、提高患者依从性及降低远期复发转移风险多个方面有显著疗效。      

中药对动物学习记忆功能影响的研究进展

学习和记忆是人类中枢神经系统的高级机能,学习记忆能力下降是老年性痴呆的一个重要表现,近年有关中药及其提取物对动物学习记忆功能影响的研究日益受到重视,文章对近几年来的研究进展进行综述。     

从中西医学的异同探讨中医证候基因组学

中医学与西医学在学科来源、理论体系、诊断思维、治疗模式等方面均存在很大差异,但两者治疗对象与治疗目的是统一的,这就为中医证候基因组学研究提供了依据.笔者认为,要实现将宏现中医“证候”与微观“基因组学”完美交叉,必须在深刻体会中西医差异的基础上,做到整体与局部的统一、经验与实验的统一、治人与治病的统一.     

中西医结合治疗糖尿病多汗症临床疗效观察

目的：观察中医辨证论治结合降糖药治疗糖尿病多汗症的临床疗效。方法：来自我院门诊的84例糖尿病多汗症患者,随机分为治疗组和对照组,对照组42例给予降糖药治疗,治疗组42例在降糖药治疗基础上结合中医辨证论治,观察治疗前后2组临床效果的变化。结果：治疗组临床治愈率28．5％,总有效率90．4％;对照组临床治愈率9．5％,总有效率57．1％。2组临床治愈率及总有效率比较差异明显,P〈0．01,有统计学意义。结论：中医辨证结合西药治疗糖尿病多汗症疗效明显,值得进一步推广。     

中医内科学:脾系病证概要

介绍了中医内科学脾系病证概要,包括脾系的概念、病因病机、辨治要点、病证举要、治法方药和临证要点。脾系病证的病因病机,实为湿盛而阳微,湿困脾运;虚则脾不化湿,阳微湿盛。辨证分气、血、虚、实、寒、热,治疗要点不在补而在运。病证常见有胃痛（胃痞）、腹痛、呕吐、呃逆、噎膈、反胃、泄泻、便秘、吐血、便血、痰饮、脾瘅等。治法有温中燥湿、清热化湿、攻逐水湿、补中益气、健脾运中、益胃养阴、健脾温中、化瘀通络等,兼证治法有健脾舒肝、健脾和胃、疏肝和胃、抑肝扶脾、培土生金等法。临证要点包括虚实寒热常易并见;治脾当祛湿为主;治胃以调气为先;胃腑热证,注意养阴;脾胃与他脏的关系。