儒医合璧,以文化人——陈修园《医学三字经》传统文化特性刍议

中医学与中国传统文化有着密切关系。陈修园《医学三字经》巧妙地将中医和儒家思想结合起来，在中医药学术传播中凸显了鲜明的传统文化特性。文章从儒家的"仁"、文韵和尊崇经典特点对这一特性进行简要探讨。     

rFVIIa administered by continuous infusion during surgery in patients with severe congenital FVII deficiency

Summary. The use of recombinant FVIIa (rFVIIa) to control bleed in individuals with FVII deficiency has been proven to be effective. The main problems associated with its use are that it requires frequent bolus injections to counteract its short half‐life and high cost. Our study aimed to evaluate whether any advantage could be gained by providing rFVIIa by continuous infusion during surgery with regard to haemostatic efficacy, safety and cost. The prospective study included 10 patients with severe FVII deficiency, who underwent 25 surgical procedures (13 major and 12 minor procedures) and were treated with rFVIIa administered by continuous infusion. Tranexamic acid was given concomitantly every 8 h. Prothrombin time, FVII:C assay and thrombin generation assay were used to monitor the treatment. The mean total dose given was 10 mg during a major surgery and 4.4 mg during a minor surgery for a mean treatment duration of 7.5 and 4.0 days respectively. This corresponds to a reduction of 70–90% in drug usage and medication cost compared with bolus injections. Except for one major perioperative bleeding, excellent haemostasis was achieved in all procedures. One patient developed a transient inhibitory activity. None of these events affected the postoperative course or prolonged the hospital stay. Our study demonstrated that continuous infusion of rFVIIa during surgery is safe, effective and highly cost effective.     

Predictability of jaw muscle pains from surface electromyograms

summary In seven (88%) of eight healthy subjects, weak to moderate pains were elicited in the masseter muscles through the isometric contractions of maximum voluntary teeth clenching. Integrated surface electromyograms of the right and left masseter muscles were used to quantify the absolute and relative contractile activities of the two muscles. The risk (relative probability) of inducing pain onset in the single masseter muscle generating the larger amount of isometric activity was 2–5 times the risk of eliciting pain onset in the single masseter muscle generating the lesser amount of isometric activity. However, as an aid in the diagnosis of pain onset, the method of masseteric surface electromyography had a false diagnostic ratio of 0.67     

Atelectatic children treated with intrapulmonary percussive ventilation via a face mask: Clinical trial and literature overview

BACKGROUND: Persistent atelectasis in children is lacking a gold standard treatment. Intrapulmonary percussive ventilation (IPV) is presented as a promising chest physiotherapy technique in the treatment of atelectasis. This study aimed to follow the evolution of atelectasis resolution with noninvasive IPV in young children and to detect eventual adverse effects. METHODS: Six children were hospitalized for respiratory distress with suspicion of atelectasis. A 15 min IPV treatment was immediately started at D1 twice a day for 5 days. Children were free of any other treatment. Chest X-Ray (CXR) was performed on the second day (D2) and was repeated 3 days later (D5). After the study, CXR were retrospectively reviewed by three specialists who had no knowledge of the clinical observations of the patients. They were asked to assess atelectasis by a score between 4 (complete collapse) and 0 (complete resolution). A clinical score on a maximum of 4 points was assessed by appetite deterioration, dyspnoea, mucus production and cough presence at D1 and D5 (1 point per symptom present). Paired t-test compared D1 and D5 results. RESULTS: All patients returned home after 5 days IPV. SpO2 normalized (93.2 +/- 0.8 to 95.3 +/- 0.8; P = 0.002) and patients all improved clinically (score, 2.8 +/- 0.9 to 0.8 +/- 0.6; P < 0.05). Out of four patients with radiographic evidence of atelectasis, three improved their atelectasis score. CONCLUSIONS: No side-effect or adverse effect was observed during IPV treatments. IPV was safe and effective in atelectasis resolution in 3/4 of the cases. Patients all recovered a stable clinical state. CXR improved in 4/5 children. They were all discharged home after 5 days of IPV treatment.     

Gastric myoelectrical activity in premature and term infants

Electrogastrography is a non-invasive method for recording gastric myoelectrical activity. The aims of this study were to record gastric myoelectrical activity in newborn infants using electrogastrographic methods and to compare frequency distributions of postprandial electrogastrograms (EGGs) recorded after gavage feedings. Nineteen infants with gestational ages ranging from 28 weeks to term were studied. Group I subjects were studied only after formula feedings (n = 15) and were divided by age into subgroups A, B and C: A (term, n = 4), B (33–36 weeks, n = 4), and C (28–32 weeks, n = 7). Group II infants (32–34 weeks, n = 4) were studied before and after gavage feeding. The percentage of total EGG power was calculated for four frequency ranges: 1–2.4 cpm (bradygastria); 2.5–3.6 cpm (normal range); 3.7–9.9 cpm (tachygastria); and 10–15 cpm (duodenal/respiratory). Results showed no significant differences in postprandial EGG power in these frequency ranges among the Group I infants of different gestational ages. The power in these EGG frequency ranges did not change significantly after gavage feedings in the Group II infants. In conclusion: (a) EGGs may be recorded successfully from preterm and term infants, (b) postprandial gastric myoelectrical activity in all frequency bands is similar among groups of premature and term infants, and (c) gavage feedings in premature infants did not increase 3 cpm EGG activity.     

Myoepithelial carcinoma of the orbit: a clinicopathological and histopathological study

Tran TL, Broholm H, Daugaard S, Fugleholm K, Poulsgaard L, Prause JU, Kennedy SM, Heegaard S. Myoepithelial carcinoma of the orbit: a clinicopathological and histopathological study. APMIS 2010; 118: 324–30. Two cases of invasive myoepithelial carcinoma arising from the paranasal sinuses and invading the orbit are presented. Patient 1, a 53‐year‐old man, had a 3‐month history of proptosis, pain and epiphora of the right eye. The second patient, a 24‐year‐old man, had for a week been complaining of protrusion of his left eye and of orbital pain. Computed tomography scan and magnetic resonance imaging revealed tumour masses in the frontal, ethmoidal and maxillary sinuses with invasion of the orbit and the frontal lobe. Biopsies from both cases showed spindle and epithelioid tumour cells. Mitotic figures were frequent. Immunohistochemical staining showed positive reaction for bcl‐2, calponin, cytokeratins, CD99, S100, muscle‐specific antigen, smooth muscle antigen and vimentin. The Ki‐67 index was between 30–50% and 5–25%, respectively. Ultrastructurally, intermediate filaments, perinuclear tonofilaments and desmosomes were present. Based on these findings, a diagnosis of myoepithelial carcinoma of mixed cell type in both cases was evident. Both patients died shortly after the diagnosis was made even though both underwent radical surgery. Myoepithelial carcinoma of the paranasal sinuses is very rare and only six cases have been reported previously. We present the first two cases of myoepithelial carcinoma in the paranasal sinuses with invasion of the orbit. This is also the first report of myoepithelial carcinoma arising in the ethmoidal sinus.     

EFFECTS OF CALCIUM ENTRY BLOCKERS ON BLOOD PRESSURE AND HEART RATE IN NEUROGENIC HYPERTENSIVE DOGS

The hypotensive and negative chronotropic effects of 5 calcium entry blockers (verapamil 200 micrograms/kg IV; diltiazem 300 micrograms/kg IV; nifedipine 5 micrograms/kg IV; nicardipine 50 micrograms/kg IV; and bepridil 5 mg/kg IV) were compared in control normotensive and acute neurogenic hypertensive anaesthetized dogs. Acute neurogenic hypertension was induced by sino-aortic denervation (SAD). In control normotensive dogs, all drugs (except bepridil) induced a slight and transient decrease in blood pressure. Nifedipine and nicardipine increased heart rate whereas the three other drugs remained ineffective. SAD caused a 2-2.5-fold increase in the hypotensive properties of the 5 drugs in dogs. Moreover, the duration of this induced hypotension was longer than in control normotensive animals. In SAD dogs, all calcium entry blockers significantly decreased heart rate. This study indicates that the direct cardiac inhibitory action of calcium channel blockers is modulated by baroreceptor activity in intact animals. The mechanism of the selective action of calcium entry blockers in hypertensive SAD in contrast to normotensive dogs is discussed.     

Humoral immune response within the lung in HIV-1 infection

In order to study the humoral immune defences in the respiratory tract during HIV-1 infection, we measured the levels, local productions and anti-HIV and antibacterial activities of IgG and IgA in the bronchoalveolar lavage fluid (BALF) and serum of 61 adult patients with severe HIV infection and of 56 HIV⁻ controls. Albumin was used as the serum transudation factor. The increase of immunoglobulin levels in the serum of HIV-infected patients was confirmed. The IgG level was also increased in epithelial lining fluid (ELF), whereas the total IgA level was unchanged and secretory IgA (SIgA) level was decreased. The ELF/serum immunoglobulin ratios suggested that the IgG present in ELF resulted mainly from transudation, in contrast to SIgA, which was synthesized locally in controls but greatly diminished in HIV-infected patients. IgG to HIV-1 could be detected in BALF of all the patients, but IgA to HIV-1 only in 30% of patients. BAL IgG reacted more consistently and with a broader array of HIV-1 antigens than did IgA. BAL IgA, when present in samples, reacted primarily with viral envelope antigens. Because IgA specificities to some HIV-1 antigens were detected more intensively by BAL than by serum immunoglobulins, we conclude that the mucosal immune response is distinct from that in serum. IgG antibody activity to Streptococcus pneumoniae was decreased in HIV-infected patients' sera, and IgA antibody activities to S. pneumoniae and to Pseudomonas aeruginosa were decreased in ELF in HIV-infected patients.