周恩超教授从虚、湿、风、瘀论治肾性蛋白尿经验

[目的]介绍周恩超教授辨证论治肾性蛋白尿的临床经验和学术观点。[方法]通过随周恩超教授门诊学习,整理其治疗肾性蛋白尿的病案,并阅读相关典籍、著作以及论文,结合中医理论对"蛋白尿"病因病机的认识,详尽论述周恩超教授治疗肾性蛋白尿的临床经验和学术观点,并举一则验案佐证。[结果]周恩超教授认为肾性蛋白尿病机多为脾肾亏虚,邪气内侵,其中邪气以湿、风、瘀为主,临证应谨守病机,从补肾健脾、清利湿热、祛风活络等方面辨证施治。所举验案以补益脾肾为本,佐以清利、祛风、化瘀,取得良好的疗效。[结论]周恩超教授从虚、湿、风、瘀论治肾性蛋白尿,临床疗效显著,其学术经验值得借鉴和推广应用。     

黄挺教授辨证治疗舒尼替尼相关蛋白尿的经验

[目的]总结黄挺教授辨证治疗舒尼替尼相关蛋白尿的临床经验。[方法]通过跟师学习、整理医案等方式,从病因、病机、治则、方药等方面总结分析黄挺教授辨证治疗舒尼替尼相关蛋白尿的临床经验,并列举具体医案两则予以验证。[结果]黄挺教授根据多年的临床经验,认为舒尼替尼相关蛋白尿共有3个常见的证型,即脾气下陷、脾肾阳虚或脾肾不足、湿浊浸渍,其中以脾肾阳虚、脾肾不足多见。脾气下陷,治以健脾化湿之法;脾肾阳虚或脾肾不足,治以健脾温肾之法;水湿浸渍,治以健脾利湿之法。所举两则医案中患者皆疗效良好。[结论]黄挺教授运用中医思维正确认识舒尼替尼蛋白尿的形成机制,并以中医中药协同西药辨治,疗效显著,副反应少,值得大力传承并予推广。     

黄文政教授治疗顽固性蛋白尿经验总结

顽固性蛋白尿多见于慢性肾炎、肾病综合征等,导师黄文政教授多年来积累了丰富的临床经验,并取得了非常满意的疗效。他认为顽固性蛋白尿多属于本虚标实之证,本虚多为脾虚和肾虚,脾不升清,中气下陷,浊气下流;肾主封藏,肾不藏精,精气外泄;标实多为夹湿热或瘀血。治疗宜健脾补肾,兼以清热利湿或活血化瘀。另外导师还认为蛋白尿可从风论治,外风可祛风胜湿,内风宜熄风解痉,对于长期难愈的蛋白尿多选用虫类药投入群药中,如轻者加用蝉蜕、僵蚕,中等程度者加用地龙、乌蛸蛇,严重者加用全蝎、蜈蚣等,每每取得意想不到的临床效果。     

辛智科教授从虚论治功能性便秘的临床经验

[目的]总结辛智科教授运用中医补虚理论治疗慢性功能性便秘的学术思想及临床经验。[方法]跟随辛智科教授临证学习,收集辛智科教授临床治疗功能性便秘的病例,从理论依据、临床疗效归纳辛智科教授辨证施治的原则及学术经验,并举验案佐证。[结果]辛智科教授从久病多虚、治病求本的角度入手,重视补虚为法治疗慢性功能性便秘,责之肺脾气虚证、脾肾阳虚证、津亏血少证、肝郁气滞证四种常见证型,分别运用补益肺脾之气、滋补脾肾之阳、生津补血、疏肝行气之法,将功能性便秘的免疫机制同中医病因病机、症候分布规律及辨证论治有机结合,不滥用泻下通便之药,不图一时之快,久久为功,丰富了功能性便秘的治法思路。[结论]辛智科教授运用补虚理论治疗功能性便秘,辨证准确、用药精当、思路清晰,疗效确切,值得进一步深入学习和推广应用。     

孙伟教授论治慢性肾衰竭气阴两虚证

[目的]介绍孙伟教授治疗慢性肾衰竭气阴两虚证的辨证思路及临床用药经验。[方法]通过跟随孙伟教授临诊和学习孙伟教授的医案,从慢性肾衰竭的病因病机、辨证特点、治疗大法等方面,探析孙伟教授治疗慢性肾衰竭气阴两虚证的学术思想及临床经验,并附验案一则。[结果]孙伟教授从医多年,临床经验丰富,认为气阴两虚证为慢性肾衰竭常见证型之一,注重从症状、舌、脉、饮食习惯等多方面辨证,病机总以脾肾气阴两亏为本,湿、热、瘀、毒为标,疾病早期以正虚为主,中期正邪相交,晚期邪实偏盛,治疗上当根据不同病期正邪偏盛辨证施治。在验案中体现了孙伟教授治疗慢性肾衰竭气阴两虚证分期辨证、精准用药的特点,治疗效果明显。[结论]孙伟教授辨治慢性肾衰竭气阴两虚证,特色鲜明,用药灵活,疗效较好,对临床辨证用药具有参考价值。     

周郁鸿教授从脾肾论治免疫性血小板减少症的经验总结

[目的]总结周郁鸿教授从脾肾论治免疫性血小板减少症(immune thrombocytopenia,ITP)的辨证诊疗思维和临证拟方用药经验。[方法]通过概述ITP的现代医学认识、历代中医沿革,收集、整理、归纳周郁鸿教授治疗ITP的典型医案,从脾肾论治ITP的理论渊源、加味黄芪建中汤组方阐释及其药理学剖析等方面论述周教授从脾肾论治ITP的学术观点及临证诊疗思维,并举验案一则以佐证。[结果]现代医学认为,ITP是一种获得性自身免疫性疾病,而历代中医则认为ITP是一种血证。周郁鸿教授认为ITP患者常属"脾胃亏虚、肾精不足"之证,应以脾肾为着眼点辨证论治ITP,以"健脾补肾"为基本治则,以温中补虚立法。加味黄芪建中汤健脾补肾,现代药理研究证明其可能通过调节Th17/Treg细胞而有效治疗脾肾阳虚型慢性ITP。所举验案属脾肾阳虚型血证,方用加味黄芪建中汤,温补脾肾、养血止血,取得较好疗效,展示了该病的辨证诊疗思路。[结论]周郁鸿教授从脾肾论治临床上部分难治ITP患者,中医理论依据充分,临床效果显著,值得推广。     

连建伟验案三则赏析

[目的]探讨连建伟教授治疗疑难杂症的临床经验[方法]通过分析连建伟教授治疗内科杂症的临床验案,探究其学术思想,并总结其临证经验。[结果]连教授对于眩晕病,表现为走路歪斜、不能直行者,辨证为阴虚阳亢,以滋阴平阳法治疗获愈;对于微量尿蛋白增高患者,辨证为脾虚湿胜,以运脾利水胜湿法治疗获愈;对于小便频数、前列腺炎患者,辨证为脾肾两虚,以脾肾双补法治疗,补泻兼施而获愈。[结论]连建伟教授治疗疑难杂症强调方从法出,法随证立,坚持辨证审因,脉证互参,依法立方。所举验案亦于平淡中见奇效,值得学习和借鉴。     

叶进治疗儿童矮身材的经验采撷

[目的]探讨叶进教授治疗儿童矮身材的临证经验。[方法]通过探析文献,随诊收集、整理、学习叶师治疗儿童矮身材的病案,从病因病机、治法方药等方面分析归纳总结叶师以脾肾为主治疗儿童矮身材的学术观点和临床经验,并附典型验案一例以佐证。[结果]叶进教授认为儿童矮身材的治疗应坚持明确病因、对因治疗,探讨病机、辨证论治,依法组方、灵活加减的原则,提出先天禀赋不足和后天饮食失调是儿童矮身材的主要病因,其主要病机为脾肾两虚,治宜健脾益肾,主要选用具有补益脾肾作用的药物,并根据小儿具体的临床症状加减用药,以促进小儿长高。[结论]叶进教授治疗儿童矮身材有独到的学术思想和临床经验,健脾益肾治疗儿童矮身材临床疗效良好,值得学习。     

连建伟教授治疗眩晕经验探析

[目的]探析连建伟教授辨证论治眩晕的学术观点和临床经验,以求深入学习并掌握连建伟教授治疗眩晕的经验。[方法]通过门诊抄方并整理连建伟教授治疗眩晕的医案,运用病案列举兼评析法将连教授的治疗经验和观点贯穿其中。[结果]连老认为眩晕常见病因病机为无风不作眩,无痰不作眩,无虚不作眩。临证中对于肝火上扰者,治以平肝熄风法;气血不足者,治以补益气血法;痰湿中阻者,治以导痰法;肝肾不足者,治以滋养肝肾法。连老治疗眩晕强调方从法出,法随证立,坚持辨证审因,脉证互参,依法立方,故多获良效。[结论]连建伟教授从虚、痰、风辨治眩晕的学术观点和临床经验,值得后学者学习和效仿。     

郑小伟教授治疗顽固性咳嗽经验浅析

[目的]总结郑小伟教授治疗顽固性咳嗽的临床经验。[方法]通过门诊抄方、整理医案及查阅相关文献,探讨顽固性咳嗽的病因病机,并运用病案列举兼评析的方法总结郑师治疗顽固性咳嗽的诊治思路及用药经验。[结果]郑师辨治顽固性咳嗽多从肺、脾、肾出发,辨证以风邪滞肺、脾虚湿困、肺肾气虚为主,治以清肺祛风、健脾化痰、补肾固本。郑师治疗顽固性咳嗽,注重审证辨因,标本同治,附举案例中风邪滞肺、宣发不彻者,治以清肺止咳、祛风止痒;脾虚湿困、痰气郁结者,治以健脾祛痰、理气止咳;肺肾气虚者,治以补肾纳气、敛肺止咳,均获良效。[结论]郑师对顽固性咳嗽辨证思路清晰,咽痒而咳从肺论治,痰多而咳从脾论治,虚喘而咳从肾论治,临床疗效显著,值得借鉴学习。     

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.     

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.