探索经络本质的新途径

作者首先对近20年来我国在经络本质方面的研究工作进行了回顾与评价。指出若长期在宏观(组织解剖学)层面上难以找到经络的物质存在，应努力在多层面、多学科交叉领域系统开展研究；特别是在微观层面，只有充分借助细胞分子生物学、基因组学、生物物理学、生物化学的理论和实验成果，构筑研究平台，方能有所创新和突破。作者强调经络本质的研究重点应放在对调控人体经络生理网络的信息载体上，并且根椐细胞信号转导的理论和相关实验数据指出，当针刺穴位时，细胞所产生的Ca^2 振荡(在胞内)和Ca^2 波(在胞问)的幅频信号中可能蕴含有经络通路和生理功能调节信息；Ca^2 通过与其结合的蛋白(如钙调素CaM等)参与了人体从生殖、代谢、肌缩运动。直至认知、记忆的几乎所有生命过程。因此，作者认为Ca^2 以及配合针刺实现在细胞问Ca^2 波接力传递的三磷酸肌醇(IP3)，可能就是人们长期探寻的调控人体经络网络的信息载体，它们联同在经线上的细胞缝隙连接蛋白，构成了经络的物质基础。作者最后指出了进一步研究的途径和实验方法。     

Simultaneous orthotopic liver and heterotopic pancreas-duodenum transplantation in a diabetic patient with end-stage liver disease]

OBJECTIVE: To study the effect of combined transplantation of the liver and the pancreas in diabetic patients with end-stage liver disease, and explore the optimal surgical procedure. METHODS: Simultaneous orthotopic liver and heterotopic pancreas-duodenum transplantations were performed in a patient diagnosed as having chronic hepatitis B, hepatocirrhosis, hepatic cellular cancer, and insulin-dependent diabetes. Immunosuppression therapy utilized prednisone, tacrolimus (FK506), mycophenolate mofetil (MMF), and simulect. The function of the liver graft, serum amylase and lipase, blood glucose, and C-peptide were monitored after transplantation. RESULTS: Insulin was withdrawn at the 6th day after operation, good liver allograft functional recovery was achieved, without such complications as pancreatitis, thrombosis, and localized infections. CONCLUSION: End-stage liver disease with concomitant insulin-dependent diabetes is the indication for combined liver-pancreas transplantations, for which simultaneous orthotopic liver and heterotopic pancreas-duodenum transplantations may constitute the optimal surgical approaches as the primary choice.     

中西医结合治疗慢性支气管炎40例

笔者于2006年10月～2008年10月，采用中药配合西药常规治疗慢性支气管炎，取得了较满意的临床疗效，现报道如下。     

熔炼铜作业对工人键康的影响

本文调查55名熔炼铜作业工人(车间空气浓度:铜烟平均为0.12mg/m~3,锌烟平均为0.05mg/m~3),发现铜作业工人体内相对高铜低锌。除了眼和上呼吸道刺激症状明显高于对照组外,还发现心血管功能、肝大百分率、肝功能和免疫功能有异常,似乎与体内高铜低锌有关。     

低分子肝素对急性脑梗塞的影响

为了探讨低分子肝素（ＬＭＷＨ）在脑梗塞应用中的安全性及实用性，采用随机单盲对照方法，对３９例急性脑梗塞病人，予ＬＭＷＨ治疗，并与低分子右旋糖酐治疗进行比较。结果显示：ＬＭＷＨ组对不同程度患者的神经功能恢复程度明显优于低右组（Ｐ＜００１），ＬＭＷＨ组头颅ＣＴ扫描脑梗塞体积缩小的范围比对照组明显（Ｐ＜００５），ＬＭＷＨ不减少血小板数量及纤维蛋白量，不引起出血，可改善血液流变学，降低微循环总积分值。总有效率８７１８％。     

Visualization of patent foramen ovale by biplanar transesophageal echocardiography

Summary It is difficult for conventional transthoracic echocardiography (TTE), by which precise and accurate images of interatrial septum (IAS) can not be acquired, to diagnose patent foramen ovale (PFO) clearly. To evaluate the diagnostic value of biplanar transesophageal echocardiography (TEE) for PFO, TTE and biplanar TEE were performed simultaneously in 270 patients. It was found that in 7 patients patent foramen ovale was detected only through longitudinal planes of biplanar TEE. IAS, which consists of primitive septum and membrane of fossa ovalis, can be directly visualized by two-dimensional images of TEE; in patients with PFO, a dull color flow, which shunts from the right atria to the left atria through the gap between primitive septum and fossa ovalis, can be detected by color Doppler flow images. Furthermore, some right-to-left shunting microbubbles through the valve of patent fossa ovalis can be discovered by cardiac acoustic contrast echocardiography. In conclusion, biplanar TEE combined with color Doppler image and cardiac acoustic contrast facilitates a definite diagnosis of patent foramen ovale as the excellent anatomic images of IAS can be obtained from multiple views under this kind of performance.     

几种特殊类型的T细胞淋巴瘤——附17例临床病理学研究

从80多例T细胞淋巴瘤中筛选出17例具有特殊组织学性的肿瘤,分成六个类型:透明细胞型(9例)、大细胞间变型(2例)、嗜碱性免疫母细胞型(2例)、组织细胞样T细胞淋巴瘤(2例)、大无裂细胞样型(1例)、大细胞多叶核型(1例)。我们试从分类和来源问题上,对以上几型争论较大的淋巴瘤进行讨论,提出我们的初步看法。     

小儿感染性腹泻病原与肿瘤坏死因子水平的关系

肿瘤坏死因子是非常重要的炎症介质。本文为观察小儿感染性腹泻时ＴＮＦ水平与病原的关系。对１９９５年６月￣１９９６年８月收治的４６例细菌感染性腹泻，３５例病毒感染性腹泻患儿进行检测，于入院第一天测定ＴＮＦ水平记录当天的最高体温及腹泻次数，同时进行粪便病原学检查，结果表明在两组具有可比性的情况下，细菌性腹泻组较病毒性腹泻组的ＴＮＦ水平显著增高。     

Pharmacokinetics of Controlled Release and Immediate Release Morphine Sulphate Tablets after a Single Dose and Multiple Doses in Chinese Volunteers

健康志愿者１０名，随机交叉口服硫酸吗啡控释片（ＣＲＭＳ）３０ｍｇ（３０ｍｇ×１）和硫酸吗啡普通片（ＩＲＭＳ）２０ｍｇ（１０ｍｇ×２），分别于服药前后各时点取静脉血，用ＧＣＭＳ测定血浆中吗啡含量。以药代软件程序处理，分别求得ＣＲＭＳ和ＩＲＭＳ的Ｃｍａｘ为１９．３８±３．８０和２１．２７±６．２１ｎｇ／ｍｌ；ｔｍａｘ为２．３６±０．３７ｈ和０．５５±０．１６ｈ；ｔ１／２β为３．５３±０．８７ｈ和３．０３±０．７４ｈ，曲线下面积ＡＵＣ为１４５．１５±１７．６５和９３．０８±１６．６５ｎｇ·ｈ／ｍｌ。癌症病人多次口服硫酸吗啡至稳态，ＣＲＭＳ和ＩＲＭＳ的峰浓度分别为２７．４３±０．３３ｎｇ／ｍｌ，２２．６８±０．１６ｎｇ／ｍｌ；谷浓度分别为１９．４５±１．４４ｎｇ／ｍｌ；１８．１４±０．４９ｎｇ／ｍｌ。