中药炮制:反制与反佐制

文章追溯了中药炮制反制与反佐制炮制方法的理论渊源和历史沿革,根据文献记载对反制和反佐制法进行辨析,结合具体方剂实例,探讨了反制与反佐制的本义和实质,并针对中药炮制反制与反佐制的研究现状,提出了一些新的想法和建议。     

Empathic accuracy and cognition in schizotypal personality disorder

Interpersonal dysfunction contributes to significant disability in the schizophrenia spectrum. Schizotypal Personality Disorder (SPD) is a schizophrenia-related personality demonstrating social cognitive impairment in the absence of frank psychosis. Past research indicates that cognitive dysfunction or schizotypy may account for social cognitive dysfunction in this population. We tested SPD subjects and healthy controls on the Empathic Accuracy (EA) paradigm and the Reading of the Mind in the Eyes Test (RMET), assessing the impact of EA on social support. We also explored whether EA differences could be explained by intelligence, working memory, trait empathy, or attachment avoidance. SPD subjects did not differ from controls in RMET, but demonstrated lower EA during negative valence videos, associated with lower social support. Dynamic, multimodal EA paradigms may be more effective at capturing interpersonal dysfunction than static image tasks such as RMET. Schizotypal severity, trait empathy, and cognitive dysfunction did not account for empathic dysfunction in SPD, although attachment avoidance is related to empathic differences. Empathic dysfunction for negative affect contributes to decreased social support in the schizophrenia spectrum. Future research may shed further light on potential links between attachment avoidance, empathic dysfunction, and social support.     

Predicting Complications after Bariatric Surgery using Obesity-Related Co-morbidities

BACKGROUND: To determine which (if any) pre-surgery obesity-related co-morbidities predict complications after bariatric surgery. METHODS: Claims data are analyzed for 1,760 patients aged 18-62 who were covered by one of seven New York State health plans and underwent bariatric surgery during 2002-2005. Data covered 6 months before to 18 months after surgery. Pre-surgery obesity-related comorbidities studied include: diabetes, hyperlipidemia, hypertension, asthma, arthritis, sleep apnea, GERD, and depression. Specific post-surgery complications examined are: stenosis, complications associated with the anastomosis, dumping syndrome, and sepsis. RESULTS: Obesity-related co-morbidities prior to surgery are significantly correlated with the probability of developing complications up to 180 days after bariatric surgery. For example, sepsis was significantly more likely in patients who had diabetes, arthritis, or sleep apnea prior to surgery. An additional pre-surgery comorbidity is associated with a 27.5% higher likelihood of dumping syndrome, 24.5% higher likelihood of complications associated with the anastomosis, and 23.5% higher probability of sepsis in the first 180 days after surgery. Among the individual co-morbidities studied, sleep apnea and GERD are most predictive of complications. CONCLUSION: Patients who exhibit multiple obesity-related co-morbidities prior to bariatric surgery are at significantly elevated risk of post-surgery complications and merit closer monitoring by health care professionals after bariatric surgery. Limitations of this study include nonexperimental data and an unknown degree of under-reporting of pre-surgery co-morbidities in claims data.     

Subfascial endoscopic perforator ligation: An analysis of early clinical outcomes and cost

Purpose: Early results of subfascial endoscopic perforator surgery (SEPS) were examined. Data on ulcer healing, complications, and costs are presented.Methods: Data were prospectively collected for all patients who underwent SEPS at our institution. A concurrent control group was not available because primary open perforator ligation is no longer performed at our hospital. Preoperative assessment included duplex scanning (valve closure times and perforator mapping), plethysmography, and phlebography. Completeness of therapy was assessed with postoperative duplex mapping of perforating veins. Clinical status was monitored after surgery, and actual costs, including equipment, personnel, and facilities management, are reported.Results: Eighteen procedures were performed in 15 patients (mean age, 52 years; range, 42 to 65 years). Two patients underwent bilateral SEPS, and one patient underwent a second procedure on the same leg. Active ulceration (class 6) was present in 14 of 18 limbs (78%), recently healed ulcers (class 5) in two of 18 (11%), and lipodermatosclerosis with edema (class 4) in two. Deep venous insufficiency was present in 14 of 18 (78%). The number of perforating veins ligated per leg ranged from 0 to 12 (mean, 4.3). Follow-up ranged from 3 to 64 weeks (mean, 22 weeks). Complete ulcer healing occurred in eight of 14 limbs (57%) at a mean of 14 weeks. Reduction in ulcer size was noted in four of 14 (29%), and two limbs were not improved. There were no new ulcers. Residual perforating veins were noted in four of 18 limbs. None of the limbs with residual perforating veins had complete healing of ulceration. Operating room costs were higher than those associated with limited-incision open perforator ligation ($2570 vs $1883).Conclusion: These preliminary data suggest that when used as part of a treatment plan to correct deep and superficial venous insufficiency SEPS results in a high rate of wound healing, with no recurrent ulceration in this series. Increased operating room costs associated with longer operations and greater disposable expenses will likely be overcome by shortened length of stay and diminished wound complications. These findings emphasize the importance of ligating all incompetent perforating veins, as ulcer healing was never achieved when residual perforating veins were found at follow-up. (J Vasc Surg 1997;25:995-1001.)     

联合应用氯沙坦和氨氯地平治疗单纯收缩期高血压的疗效

目的观察氨氯地平单用或与氯沙坦联合应用治疗单纯收缩期高血压的疗效及其对靶器官的保护作用。方法将60例中老年原发性高血压病患者随机分为氨氯地平组（A组）和氨氯地平加氯沙坦组（B组），分别予以氨氯地平5mg／d口服和氨氯地平5mg／d加氯沙坦50mg／d口服，观察治疗前、后尿微量蛋白、血钾、血尿素氮、血肌酐、血尿酸及血压的变化。结果治疗8周，两组血压均有明显下降，A组总有效率为53．33％，B组总有效率为83．33％。两组差异有统计学意义（P〈0．05）。两组治疗前、后的尿微量蛋白，肾功能的差异有统计学意义（P〈0．05）。结论CCB（氨氯地平）和ARB（氯沙坦）联合应用可用于单纯收缩期高血压的治疗。     

Deficient attentional modulation of the startle response in patients with schizotypal personality disorder

OBJECTIVE: Attentional deficits have been identified as an abnormality that individuals with schizotypal personality disorder share with schizophrenia patients. The purpose of this study was to examine automatic sensorimotor gating and controlled attentional modulation of the startle eye blink response in unmedicated subjects with schizotypal personality disorder. METHOD: Eighteen unmedicated patients with schizotypal personality disorder and 16 healthy individuals were assessed in an acoustic attention-to-prepulse paradigm. The participants performed a selective attention task involving the presentation of attended, ignored, and novel tones that served as prepulse tones. Acoustic startle probes were presented at short and long lead intervals after the onset of tones and occasionally during the intertone interval. RESULTS: The comparison subjects showed greater prepulse inhibition and prepulse facilitation during the attended than the ignored prepulses, demonstrating early and later attentional modulation of startle eye blink response. In contrast, the subjects with schizotypal personality disorder failed to show this pattern. CONCLUSIONS: Subjects with schizotypal personality disorder have deficits in controlled attentional processing, as indexed by modification of the startle eye blink response, that are similar to those observed in patients with schizophrenia.     

自拟舒胆汤治疗胆道术后综合征临床观察

为观察中西医结合治疗胆道术后综合征的疗效。随机设中西医结合治疗组（治疗组）38例和对照组37例,治疗组以自拟舒胆汤为基本方结合西药抗生素治疗,对照组则以单纯西药抗生素,观察治疗前后腹胀,腹痛,黄疸以及B超检查的变化。结果：治疗组对腹胀,腹痛,黄疸的疗效优于对照组（P＜0．01－0．05）,B超检查变化无显著差异（P＞0．05）,提示中西医结合治疗对胆道术后综合征的疗效优于单纯西药治疗。