细胞蜡块结合免疫组织化学、分子病理在胸腔积液病理诊断中的应用

胸腔积液是一种常见的临床表现,炎性疾病、循环障碍、恶性肿瘤均可引起.有些癌症患者到了晚期无法进行手术,临床多会选择抽取胸腔积液,通过寻找脱落的癌细胞来明确肿瘤性质.目前,常规离心涂片法是最主要的检测手段,但是该方法缺乏组织形态结构或明显增生的间皮细胞,而且有时送检标本细胞成分过少,常给诊断带来困难[1].而细胞蜡块不仅...     

中枢传导通路与姿势控制技术的基础理论及临床应用

中枢传导通路与姿势控制（central pathway and postural control,CPPC）技术是四川大学华西医院康复医学中心研发的神经康复物理治疗技术。该技术以姿势控制的中枢神经传导通路内在机制与外在表现为核心,运用神经科学理论解释与分析患者的功能障碍。临床实践和研究结果显示,CPPC技术具有良好的疗效和应用前景。该文主要阐述了CPPC技术的基本原理和核心理念、常用的评估和治疗方法、近年来取得的成果及应用推广,旨在为该技术的进一步应用与深入研究提供理论参考与指导。     

陈意“调气”理论述要

全国名中医、浙江省首批国医名师陈意教授从医已有六十载，临床诊疗疾病最为重视调理气机，自谓“调气派”，主张“遣方组药，调气为先”“八法增涩，以和统之”“执中致和，务虚求衡”“天人相应，治肝拟童”等，临证处方活用理论，造诣颇深，擅治内科脾胃病、肺系病、不寐病及慢性病、疑难杂症，屡见佳效。陈老积淀诸多验方医案，文后将陈老临证“调气”常用之验方蠲寒化湿汤、疏降和胃汤作一简单介绍，供临床参考。     

肺结核患者结核分枝杆菌利福平基因突变特征及耐药情况

目的 探讨肺结核患者当中的结核分枝杆菌利福平基因发生突变的特征,同时分析其耐药情况,为耐药结核病的预防和治疗提供科学依据。 方法 选取2016年6月—2018年12月杭州师范大学附属医院收治的肺结核患者532例,依据其痰液中的结核分枝杆菌耐药性分为耐药株(218株)及敏感株(314株)。测定2组菌株的rpoB基因序列及最低抑菌浓度(MIC)值水平。 结果 218株耐药菌株中180株为单重突变耐药菌株,rpoB基因结构分析发现,发生比率最高的突变密码子分别为526位(13.2%)、531位(74.4%)。206株(94.5%)耐药菌株出现至少1个突变位点,且均位于耐利福平决定区(RRDR),12株(5.5%)耐药菌株突变位点在RRDR之外。有4株耐药菌株在RRDR之内发生同义突变,4株耐药菌株在RRDR之外发生同义突变。H37Rv密码子未发生任何突变。有8株敏感菌株发生同义突变在RRDR之外。单重突变菌株的RIF平均MIC值水平为(47.34±2.04)μg/mL,显著低于多种突变菌株平均MIC值水平[(118.24±3.95)μg/mL,t=107.636,P<0.001]。526单密码子平均MIC值水平与531单密码子突变菌株的MIC值水平比较差异无统计学意义(P>0.05)。多重密码子突变菌株的MIC值水平为(116.03±5.06)μg/mL高于单重密码子平均MIC值水平[(47.08±1.31)μg/mL,t=85.530,P<0.001]。 结论 利福平耐药性机制可能与rpoB基因的起始端531位、526位等突变相关,rpoB基因序列可用于预测结核分枝杆菌中的利福平耐药情况及表型。      

系统性红斑狼疮误诊15例分析

现将我们2003—01／2007—12收住的系统性红斑狼疮（SLE）误诊15例分析如下。 1临床资料 1．1一般资料本组男2例，女13例，年龄16～63岁，平均28．19岁，病程1个月～5a。本组诊断均符合美国风湿病学会1997年推荐的SLE分类标准的11项≥4项，并排除感染、肿瘤和其他结缔组织病。     

食疗养生药膳方

糖尿病病人的食疗 糖尿病的发病率已越来越高，严重危害人们健康，应引起足够重视。糖尿病的治疗以综合治疗为优，即饮食、药物和体育三大疗法的结合，称为战胜糖尿病的三大法宝。     

兔肢体爆炸伤合并海水浸泡后在不同复温速率及维持浅低体温下机体炎症反应的特征

Objective To investigate effects of different rewarming rates and maintenance of light hypothermia on inflammatory response in rabbits after limb blast injury, coupled with seawater immersion. Methods First, the model of limb blast injury coupled with seawater immersion was reproduced [the animals were immersed to low body temperature of (31.0±0.5℃)]. Then, 24 adult rabbits were randomly divided into group Ⅰ [the rapid rewarming group, n=6, rewarmed to (38±0.5)℃ at a rate of (8.94±0.93)℃/h], group Ⅱ [the slow rewarming group, n=6, rewarmed to (38±0.5)℃ at a rate of (3.88±0.22)℃/h], group Ⅲ [another slow rewarming group, n=6, rewarmed to (38±0.5)℃ at a rate of (2.18±0.12)℃/h], and the H group [the hypothermia group, n =6, rewarmed to (34 - 35)℃ at a rate of (4.49±0.66)℃/h and kept at that temperature till termination of the experiment]. Regulation of ambient temperature and warm transfusion were used to restore body temperature to target levels and maintained there for 6 hours. Blood samples were taken at 5 different times, I.e. Pre-injury time(T0), post-immersion time (T1), the time when rewarming started (T2), 3 h after rewarming (T3), and 6 h after rewarming (T4). Tissue samples from heart, liver, intestinum, lung and kidney were also collected. Levels of TNF-α (tumor necrosis factor-α), IL-1β (interleukin-1β) and IL-6 (interleukin-6) in plasma and MPO (myeloperoxidase) in homogenate were detected. Results Following rewarming, TNF-α, IL-1β, IL-6 concentrations in the plasma of the animals in group Ⅰ and group H were significantly higher when compared with those of the animals in group Ⅱ and group Ⅲ (P<0.05, P<0.01), and MPO activity in homogenate was significantly higher when compared with that of the animals in group Ⅱ and group Ⅲ(P<0.01, P<0.05), and no statistical difference could be seen between group Ⅱ and Ⅲ (P>0.05). Conclusions Rapid rewarming and maintenance of light hypothermia could obviously elevate TNF-α, IL-1β, IL-6 concentrations in plasma and MPO activity in homogenate, following limb blast injury coupled with hypothermia induced by seawater immersion, while slow rewarming (with a rewarming rate of 2-4℃/h) could significantly inhibit TNF-α, IL-1β, IL-6 levels and PMN activity.     

基于量质传递及化学计量学的药食同源名方青龙白虎汤质量控制研究

目的建立HPLC指纹图谱检测方法,探寻青龙白虎汤冻干粉制备过程工艺和量质传递规律,并结合化学计量学构建其质量控制体系。方法制备15批次青龙白虎汤冻干粉,采用HPLC法建立指纹图谱,色谱结果导入《中药色谱指纹图谱相似度评价软件》(2012版)并计算各部分相似度。测定15批样品量质传递过程中没食子酸、原儿茶酸、绿原酸、表儿茶素和鞣花酸的含量,计算转移率和出膏率。结合化学计量学方法进行分析,以挖掘不同产地样品间对质量控制具有显著贡献的主要成分。结果 15批样品指纹图谱相似度均大于0.9,满足规定要求,并标定冻干粉指纹图谱24个共有峰,对其中6种成分进行了指认,分别为没食子酸(1号峰)、原儿茶酸(4号峰)、绿原酸(8号峰)、表儿茶素(14号峰)、东莨菪内酯(19号峰)、鞣花酸(23号峰)。15批冻干粉表儿茶素、没食子酸、鞣花酸、绿原酸、原儿茶酸的质量分数分别为0.724%～1.301%、2.184%～2.840%、0.607%～0.760%、0.061%～0.141%、0.017%～0.079%,转移率分别为78.60%～89.38%、76.98%～89.88%、76.00%～89.78%、76.90%～90.49%、80.02%～90.25%,出膏率为12.87%～15.11%,均未出现离散数据,表明煎煮、浓缩和冻干过程有效成分转移率较稳定。通过化学计量学分析,找到10个对模型贡献较大的成分,其中包括指认的峰14(VIP=2.812)、峰1(VIP=2.804)、峰23(VIP=2.715)、峰8(VIP=1.053)和峰4(VIP=0.887),可进一步深化青龙白虎汤质量控制研究。结论通过HPLC指纹图谱结合多指标成分含量测定,首次建立了药食同源名方青龙白虎汤的质量控制方法,此方法快速简单可行,重复性、稳定性良好,能同时适用于饮片、煎煮液、浓缩液和冻干粉量质传递规律的相关性考察;进一步通过化学计量学为青龙白虎汤的质量控制研究提供了重要参考。     

基于熵权-正态云模型的多产地蓬莪术质量评价研究

目的构建熵权-正态云模型,对不同产地蓬莪术Curcuma phaeocaulis的质量进行评价。方法以不同产地的蓬莪术为研究对象,选取吉马酮、呋喃二烯、莪术醇和姜黄素含量为定量指标,建立评价体系。利用熵权法测定不同指标的信息熵,确定各评价指标权重。结合云模型,利用正向云发生器,将各指标等级的界限转化为云,计算不同产地的蓬莪术平均等级隶属度,根据隶属度矩阵和权重矩阵对不同产地蓬莪术的质量进行综合性评价。结果产地为四川的蓬莪术综合质量评价结果较高,绝大部分分布在Ⅰ级和Ⅱ级,其中,又以产地为四川温江的蓬莪术评价结果最好,为Ⅰ级。广西所产的蓬莪术评价以Ⅲ级为主,制约因素为吉马酮含量。云南蓬莪术质量以Ⅲ级和Ⅳ级为主,主要制约因素为姜黄素和莪术醇含量。结论从数据挖掘和数理统计角度,创新引入熵权-正态云模型评价模型,建立宏观状态的数学模型与物质基础相统一的蓬莪术质量评价体系,可为蓬莪术质量综合评价提供一种新思路。     

兔肢体爆炸伤合并海水浸泡后在不同复温速率及维持浅低体温下机体炎症反应的特征

Objective To investigate effects of different rewarming rates and maintenance of light hypothermia on inflammatory response in rabbits after limb blast injury, coupled with seawater immersion. Methods First, the model of limb blast injury coupled with seawater immersion was reproduced [the animals were immersed to low body temperature of (31.0±0.5℃)]. Then, 24 adult rabbits were randomly divided into group Ⅰ [the rapid rewarming group, n=6, rewarmed to (38±0.5)℃ at a rate of (8.94±0.93)℃/h], group Ⅱ [the slow rewarming group, n=6, rewarmed to (38±0.5)℃ at a rate of (3.88±0.22)℃/h], group Ⅲ [another slow rewarming group, n=6, rewarmed to (38±0.5)℃ at a rate of (2.18±0.12)℃/h], and the H group [the hypothermia group, n =6, rewarmed to (34 - 35)℃ at a rate of (4.49±0.66)℃/h and kept at that temperature till termination of the experiment]. Regulation of ambient temperature and warm transfusion were used to restore body temperature to target levels and maintained there for 6 hours. Blood samples were taken at 5 different times, I.e. Pre-injury time(T0), post-immersion time (T1), the time when rewarming started (T2), 3 h after rewarming (T3), and 6 h after rewarming (T4). Tissue samples from heart, liver, intestinum, lung and kidney were also collected. Levels of TNF-α (tumor necrosis factor-α), IL-1β (interleukin-1β) and IL-6 (interleukin-6) in plasma and MPO (myeloperoxidase) in homogenate were detected. Results Following rewarming, TNF-α, IL-1β, IL-6 concentrations in the plasma of the animals in group Ⅰ and group H were significantly higher when compared with those of the animals in group Ⅱ and group Ⅲ (P<0.05, P<0.01), and MPO activity in homogenate was significantly higher when compared with that of the animals in group Ⅱ and group Ⅲ(P<0.01, P<0.05), and no statistical difference could be seen between group Ⅱ and Ⅲ (P>0.05). Conclusions Rapid rewarming and maintenance of light hypothermia could obviously elevate TNF-α, IL-1β, IL-6 concentrations in plasma and MPO activity in homogenate, following limb blast injury coupled with hypothermia induced by seawater immersion, while slow rewarming (with a rewarming rate of 2-4℃/h) could significantly inhibit TNF-α, IL-1β, IL-6 levels and PMN activity.