仝小林运用生白术、晚蚕砂、神曲治疗腐腻苔经验

腐腻苔是常见的病理舌苔,其临床意义多为脾气亏虚,运化失司,进而产生湿邪、痰浊、食积等病理产物,秽浊之邪上泛所致.脾失健运,气机失调,浊邪凝聚是其主要病机,治疗上以健运脾胃,消导化浊为主要的治法.生白术、晚蚕砂、神曲是仝小林院士临床常用的辨治腐腻苔的靶方,临床各种病证中但见舌苔腐腻者,皆可配伍使用.方中生白术常用剂量为9...     

A comparison of the effects of epinephrine and vagal stimulation upon the refractory periods of the A-V node and the bundle of His

Summary In dog hearts perfused from donor animals, recording and stimulating electrodes were located in the right atrium and in the proximal portion of the bundle of His. The minimal interval between two His responses propagated from the atrium (A-H F.R.P.) was determined, and the recovery of excitability of the bundle was directly measured at the same basic driving frequency.In the absence of autonomic influences the minimal interval between two His responses propagated from the atrium was longer than the total refractory period (absolute plus relative) of the bundle.The possibility that a decrease of the action potential of the lower elements of the node was responsible for long delays or block in the activation of the bundle was tested and found unlikely.During vagal stimulation the recovery of excitability of the bundle and its diastolic threshold were not modified, but the A-H F.R.P. was increased.During epinephrine administration it was possible on occasion to show that the A-H F.R.P. was equal to the H F.R.P. estimated by stimulating the bundle directly with strong electrical shocks.These results suggest that in the absence of autonomic influence and during vagal stimulation the weakest link for propagation is located within the A-V node rather than at the junction of node and bundle. During strong adrenergic influences, the functional refractory period of the bundle may be a limiting factor in the propagation of impulses from atrium to the bundle of His.With 9 Figures in the TextDedicated to Professor Otto Krayer on the occasion of his 65th birthday.Supported in part by grants from the American Heart Association and the New York State Heart Assembly (Oneida County Heart Committee).     

女性冠心病患者冠状动脉介入治疗长期预后

目的:了解女性冠心病患者在接受冠状动脉介入治疗(PCI)后的长期临床疗效.方法:584例经PCI治疗的患者,被分为女性组(122例)和男性组(462例),收集其一般临床资料及PCI治疗情况,并进行长期(3～49个月)临床随访,详细记录患者临床主要不良事件的发生情况.结果:男性患者的全因性死亡率(0:3.03%,P＞0.05)及心因性死亡率(0:2.98%,P＞0.05)有增高趋势,女性患者因心脏病再住院率(15.57%:9.96%,P＜0.05)显著增加,但2组患者其他临床主要不良事件差异无统计学意义.经过校正不匹配因素的偏相关分析显示,男性与心因性死亡(r=0.0874,P＜0.05)及全因性死亡(r=0.0970,P＜0.05)呈正相关.结论:女性患者PCI治疗的长期临床预后良好.     

简单调强放射治疗与同期化疗治疗颈及胸上段食管癌可行性研究及近期疗效分析

背景与目的：对于颈及胸上段食管癌,三维适形放疗（3-dimensional conformal radiation therapy,3D-CRT）并不一定都能满足临床要求,而适形调强放射治疗（intensity modulation radiation therapy,IMRT）又会占用大量的人力物力。中国医学科学院肿瘤医院定义了一种简单调强放疗技术（simplified IMRT,sIMRT）。本研究中我们应用sIMRT联合同期化疗治疗颈及胸上段食管癌,并分析急性放射反应和近期疗效。方法：对30例颈及胸上段食管癌的原发灶和预防照射区进行sIMRT计划设计。定义2个靶区：PTV1,给予64Gy（2.13Gy×30次）的照射;PTV2,给予54Gy（1.8Gy×30次）的剂量,设计等角度5野sIMRT计划。在开始放疗的第1～5天和第29～33天给予顺铂（DDP）＋氟尿嘧啶（5-FU）方案同期化疗2个周期,放疗结束后28天原方案重复2个疗程。结果：患者可在6周内完成治疗计划,5野sIMRT获得了满意的剂量分布,剂量分布和IMRT相似,但明显优于3D-CRT。所有患者完成了治疗计划,治疗中仅1例发生Ⅲ级放射性气管炎,无因放疗反应而中断治疗的患者。食管病灶达完全缓解（completeremission．CR）者27例（90％）,部分缓解（partialremission,PR）3例（10％）,总有效率达100％;淋巴结病灶达CR者13例,PR4例。毒性反应主要为Ⅰ-Ⅱ级白细胞下降。结论：sIMRT较复杂调强计划治疗颈胸上段食管癌剂量分布相似,明显优于3D—CRT,近期疗效满意,急性放射反应可耐受,远期疗效及组织损伤尚有待长期随访观察。     

血管性抑郁症的研究

目的 比较血管性抑郁症和非血管性抑郁症的临床特征和不同药物的治疗疗效.方法 采用自变量表分别对血管性抑郁症组和非血管性抑郁症组60例的发病年龄、起病形式、诱发因素、临床特征进行分析比较;并给予百忧解20 mg qm;30例血管性抑郁症患者联合血管活性药物及脑代谢剂,引用HAMD、MMSE与入院时、4周、8周进行评定,并逐一比较.结果 本研究显示血管性抑郁症患者发病年龄相对高,多数有诱因,睡眠障碍明显,焦虑躯体症状多,有较严重的阻滞及自杀倾向,合并一定认知功能障碍,对血管性抑郁症组中30例应用脑代谢剂,血管活性药物及抗抑郁剂,疗效明显优于血管性抑郁症组中单用抗抑郁药物,与非血管性抑郁症组相似.结论 血管性抑郁症采用血管性药物、脑代谢剂联合抗抑郁药物疗效明确,为临床治疗另辟新途径.     

大鼠骨髓内皮祖细胞的分离、培养和鉴定

目的研究大鼠骨髓内皮祖细胞（EPC）分离、培养并向内皮细胞方向诱导分化的方法和条件。方法从大鼠骨髓中分离单个核细胞．经差速贴壁后取二次贴壁细胞选择性诱导培养2W。以Dil-ac-LDL、FITC-UEA-1双荧光染色法以及vWF、Flk-1免疫荧光染色法鉴定EPC;流式细胞术（FACS）检测EPC纯度;细胞培养液一氧化氮（NO）含量测定分析EPC功能。结果二次贴壁细胞经诱导培养后3d开始伸展,5d形成集落,7～10d增殖加速并出现条索状结构,2W大部分细胞呈多角形。Dil—ac—LDL、FITC-UEA-1双染．vWF及Flk-1免疫荧光染色阳性率均〉70％。FACS检测其中vWF阳性细胞占77．93％．Flk-1阳性细胞占81．50％。二次贴壁并经诱导培养的细胞培养液中NO含量明显高于普通培养的细胞．但低于成熟内皮细胞（P〈0．05）。结论大鼠骨髓富含EPC,体外诱导培养后可以表现出内皮细胞的部分特征。