钱塘医家学派沿革的区域时代背景

明末清初,钱塘(今杭州)麇集了一大批才华横溢的医药学家,他们互相酬唱、研经讲学,钱塘医家学派便应运而生。康乾盛世,该学派事业兴旺发达,在海内外有一定的影响,医学传承到光绪年间,为中医药学的发展鞠躬尽瘁,在中国医学史上留下了不可磨灭的足迹。因此,稽探钱塘医家学派产生、发展和消亡的政治、经济、教育、科技、思想文化诸方面的地域时代背景有一定的意义。     

Electrocardiographic and Echocardiographic Features That Distinguish Anomalous Origin of the Left Coronary Artery from Pulmonary Artery from Idiopathic Dilated Cardiomyopathy

Many authors have reported noninvasive means of diagnosing anomalous left coronary artery from pulmonary artery (ALCAPA) and differentiating ALCAPA from idiopathic dilated cardiomyopathy (DCM). Systematic evaluation using these noninvasive diagnostic modalities is not available. To distinguish between ALCAPA and DCM using a systematic approach, we examined 23 patients with ALCAPA (age 1 month to 23 years, median 7 months) and 23 patients with DCM (age 5 days to 16 years, median 6.6 months). Standard 12-lead electrocardiograms (ECG) and 2-dimensional (2-D) and color Doppler echocardiograms were performed. A logistic regression model was applied using ALCAPA diagnosis as the dependent variable and ECG and echocardiographic findings as independent variables. A scoring system was created to establish the ALCAPA diagnosis based on results from the logistic regression. On the logistic regression, the ECG feature of QT pattern in aVL (Q wave ≥ 3 mm deep with an inverted T wave) and echocardiographic features of right coronary artery diameter to aortic annulus ratio ≥ 0.14, increased papillary muscle echogenicity, and Doppler color flow of LCA from aorta or pulmonary artery were the most significant differentiating features between the ALCAPA and DCM groups. A scoring system was developed using the previous five variables and assigning a score of 1 to each variable (−1 to Doppler color flow of LCA from aorta). The scoring system had sensitivity of 100% and specificity of 91% for ALCAPA diagnosis. Compared with previous reported diagnostic features in differentiating ALCAPA and DCM, the scoring system had a much higher specificity and positive predictive value. In conclusion, we selected the most useful ECG and echocardiographic features to differentiate between ALCAPA and DCM and created a scoring system to aid clinical diagnosis. This scoring system may be useful in evaluating children with acute congestive heart failure.     

新型冠状病毒肺炎临床合理用药专家共识

新型冠状病毒肺炎（coronavirus disease 2019,COVID-19）疫情发生以来,全国医院药学工作者坚持医药协同,在保障药品供应的前提下,积极参与临床救治工作,加强对患者的用药教育和指导,有效提高药物治疗水平,改善临床救治效果。为更好地发挥药学服务在COVID-19疫情防控中的重要作用,中国药学会医院药学专业委员会特组织临床和药学专家,在《新型冠状病毒感染的肺炎诊疗方案（试行第七版）》的基础上,参考国内外最新的诊疗方案和研究成果,并结合国内各地COVID-19患者的救治经验,制定出新型冠状病毒肺炎临床合理用药专家共识。本共识详细阐述COVID-19临床救治的九类用药,内容涵盖药物治疗作用、遴选原则、用法用量、不良反应及注意事项,以期为COVID-19临床用药提供参考。     

三联式沼气池结合人群化疗控制血吸虫病效益评估

目的了解湖沼垸内流行区建沼气池、改厕、改圈、改厨（三联通）和人群化疗措施对控制血吸虫病传播的效果。方法在龙湾镇重疫区选择未控地区郑家湖村为试区,进行三联式沼气池现场调查,检测构筑物指标,总体合格率和寄生虫卵死亡率、大肠菌群值、氯氮及综合治理措施后疫情变化。结果郑家湖沼气池属混凝土现浇园柱型水压式沼气池,总体合体率为95．5％;出料口粪大肠菌值由进料口4×10^-5～4×10^-7至出料口4×10^-3～4×10^-5,氨氮有所提高,保氮率为96．81％;活螺密度及钉螺感染率分别下降42．86％和66．70％;人群感染率下降36．88％、耕牛感染率下降100％。结论三联式沼气池结合人群化疗措施的实施,不仅可以有效控制血吸虫病传播,而且有显著的经济和社会效益。