《相对穴及临床应用》评介

承德医学院杨志新医师为了学业的深造．曾经多次来往上海。近年，以其学习所得，编写成《相对穴及临床应用》一书，已于2005年9月由人民卫生出版社出版．日前寄来样书．希望我能给以评介。     

Failure of intensive chemotherapy in poor prognosis non-Hodgkin's lymphoma

In an attempt to improve response and survival rates in patients with non-Hodgkin's lymphoma, a relatively intense six drug regimen MATCOP was developed comprising four-weekly cycles of methotrexate (100mg/m², IV_Y day 8), Adriamycin (30mg/m², IV_Y days 1,2), teniposide (75 mg/rn², IV, day 1), cyclophophamide (300 mg/m², po, days one to five), Oncovin (1.4 mg/m², IV: maximum 2 mg, days 8,15) and prednisolone (100 mg, po, days one to five). A randomised trial was conducted comparing MATCOP with the standard CHOP regimen, comprising three-weekly cycles of cyclophosphamide (750 mg/m², IV, day 1), Adriamycin (50 mg/m², IV, day 1), Oncovin (1.4 mg/m² IV: maximum 2 mg, day 1) and prednisolone (100 mg, PO, days two to six). Eighty patients with large cell lymphoma, diffuse mixed small cleaved and large cell lymphoma or diffuse small cleaved cell lymphoma were randomised, 47 to MATCOP and 33 to CHOP. MATCOP patients experienced increased granulocytopenia, thrombocytopenia (p 0.0001), mucositis (p= 0.002) and infections (p= 0.01) compared to CHOP patients. Complete response rates were similar: 66% for MATCOP patients and 61% for CHOP patients. There were no apparent differences in the time to relapse for patients achieving CR, the time to treatment failure or the overall survival time. Thus despite an increase in toxicity, the more intense regimen MATCOP failed to confer any therapeutic benefit compared with the standard CHOP regimen. Survival was not influenced but toxicity was increased by dose intensification. (Aust NZ J Med 1992; 22: 123–128.)     

棉尘及吸烟对肺功能影响的观察

对８３名接触棉尘的健康者作肺功能测定，并与３９名不接触棉尘的健康者对照。其中男性均为吸烟者；女性均为不吸烟者。结果表明，ＭＭＥＦ、ＰＥＦＲ、Ｖ２５％～７５％均明显低于对照组（分别为Ｐ＜０．０１和Ｐ＜０．０５）．在男性吸烟组，ＶＣ，ＭＢＣ，ＦＥＶ１％也有明显下降（Ｐ＜０．０１），作者认为棉尘对人体的危害主要部位在小气道，吸烟者因损害严重可累及大气道。以往对棉尘反应的肺功能评估仅以ＦＥＶ１％为指标，不能反映早期的变化，有必要进一步完善。     

正常人在静态和运动状态下"死腔/潮气"估测值和实测值的比较

目的研究正常人静态及运动状态下死腔/潮气(VD/VT)估测值和实测值的关系.方法23名受试者行心肺运动试验,同步实时测定摄氧量和二氧化碳排出量,分别在运动前及运动高峰时抽取动脉血,根据Bohr的公式,得出VD/VT实测值,同时再用呼气末CO2分压(PetCO2)代替PaCO2,计算VD/VT,得出VD/VT估测值.结果根据病史、体检、肺功能和运动前后的心电图判断23名受试者均为正常受试者.静态时的VD/VT估测值和VD/VT实测值分别为0.359±0.109和0.354±O.106,两者无显著性差异(P=0.710),相关分析显示两者高度相关(r=0.911,P＜0.001).运动高峰时的VD/VT估测值和VD/VT实测值分别为0.234±0.070和0.248±0.094,两者无显著性差异(P=0.748),相关分析表明两者显著相关(r=0.783,P＜0.001).与静态时比较,运动时估测和实测VD/VT均明显下降.结论对于正常成人,无论是在静态或最大运动状态下,可用无创方法计算VD/VT代替VD/VT实测值.     

西藏地区农牧民生活习俗与包囊虫病的关系调查

目的　探讨西藏地区农、牧民生活习俗与包囊虫病的关系。方法　自制问卷对 7个县 2 40个家庭 163 1名成员与包囊虫感染有关的生活习俗进行调查分析。结果　饭前便后洗手的人仅有 16 1%,餐具一般都用天然水洗 ,大部家庭用天然绵羊绒擦洗茶具。大多数人都喝过河溪水 ,池塘水 ,人人都吃半生不熟的肉 ,半数以上的吃生肉和生血肠 ,绝大多数人喝未经消毒的鲜牛、羊奶。 10 0 %家庭养狗 ,所有人员与狗、羊、牛、马接触密切。包囊虫病人占调查人数 0 43 %( 7/ 163 1) ,有典型症状者占 0 67%( 11/ 163 1)。结论　当地居民感染包囊虫与不良生活习俗有关     

杨绍伊先生《考次汤液经序》(续)

广论之惑已明,再辨叔和撰次.<甲乙经·序>又云:"近世太医令王叔和,撰次仲景遗论甚精."①案今本仲景书卷端,即题云"王叔和撰次".以士安言解之:所谓"撰次"者,即撰集仲景遗论,以之次入仲景书中是也.若然,则今本仲景书为任圣之<汤液经>、张仲景之<广论>、王叔和之<仲景遗论撰>三种集合而成.求之叔和撰次书,见<辨太阳病>首篇.     

睾丸网注射法建立转基因小鼠

目的 为了研究睾丸网注射法建立转基因小鼠的可行性。方法 本试验应用显微注射仪将脂质体包裹的质粒pEGFP—N1通过睾丸网注射到4周龄昆明（KM）小白鼠睾丸生精小管内。注射后6周，与自然发情雌鼠交配，用PCR法检测仔鼠基因组中的外源DNA。结果 共注射4只雄性小鼠，3只存活，并且具有交配，受精能力，共获仔鼠63只，其中2只为PCR阳性仔鼠。结论 用睾丸网注射法制备转基因动物是可行的。     

中西医结合影像学前景辉煌

温家宝总理关于“实行中西医结合,发展传统医药学”的题词,表达了新一代党的领导集体坚持中西医结合方针的决心,并对中西医结合的地位和作用给出了科学的、客观的评价,再次确认了中西医结合是发展传统医药学的重要途径。中医学和现代医学是两个不同的医学体系,都蕴藏着诊疗疾病     

Expression of neuron-specific enolase and olfactory marker protein in the developing olfactory mucosa of human fetuses]

OBJECTIVE: To study the expression of neuron-specific enolase (NSE) and olfactory marker protein (OMP) in the developing olfactory mucosa of human fetuses. METHOD: The expression of NSE and OMP in the olfactory mucosa of 6 human fetuses (12, 16, 20, 24, 28 and 34 weeks) was studied using the technique of immunohistochemistry. RESULTS: NSE immunological positive reactions were seen in all 6 fetal mucosa from gestational 12 (G12) to G34, with plenty of positive-stained dual-pole neuron cells. At G12, the positive cells aligned tightly, the cell bodies were localized in the lower portion of olfactory epithelium and the positive-stained area occupied upper 2/3 of fetal nasal mucosa. With the development, the positive cells gradually became multilayer, but the density and the relative area of positive-cells reduced. At G34, the positive cells were located only in upper 1/3 of nasal mucosa. OMP-positive reactions were localized in a few dual-pole neurons at G12, the number was much less than NSE-positive cells in the same fetus. With the development, the OMP-positive cells gradually increased with most of the cell bodies located in the upper portion of epithelium, but number still relatively less than the NSE-positive cells at the same age. CONCLUSION: At G12, there were lots of olfactory neuron in the olfactory mucosa and only a few olfactory neurons had became mature. With the development, the olfactory epithelial area reduced but the number of mature olfactory neurons increased. At the last trimester, fetal olfactory sensor was almost matured.