经典名方中杜仲的本草考证

通过查阅历代本草、医籍、方书并结合近现代文献资料,笔者对杜仲药材的名称、基原、产地、品质评价、采收加工、炮制历史沿革及产地变迁情况进行了系统梳理及考证,以期为含杜仲的经典名方开发提供参考依据。经考证可知,历代本草均以杜仲为正名,基原为杜仲科植物杜仲Eucommia ulmoides的干燥树皮,古今一致;杜仲最早的产地为河南、山西、陕西、四川一带,自明代以来产地扩展至全国大部分地区,且推崇四川、陕西、重庆、贵州、湖北等地为杜仲的道地产区;近代以来总结其品质以皮厚、块大、粗皮刮净、断面多丝、内表面色暗紫为佳;杜仲的古代炮制加工方法主要有去粗皮切制生用和加酥蜜、姜汁、盐水、酒等辅料炮制,近现代以来炮制方法日趋简化,沿用的炮制方法主要为净制后切制生用、盐炙,建议挖掘不同杜仲炮制品的现代科学内涵,通过标准恢复传统主流炮制方法。基于宋代陈自明的三痹汤中杜仲“去皮,切,姜汁炒”的要求,根据考证结果,建议使用姜杜仲,即参考2020年版《中华人民共和国药典》炒法,以姜汁为辅料进行炮制后入药。     

急性ST段抬高型心肌梗死患者提前肝素化的疗效评价及风险观察

目的探讨急性ST段抬高型心肌梗死(STEMI)患者提前肝素化的疗效及风险。方法选取2019年5月至2020年5月我院收治的160例STEMI患者作为研究对象,随机分为两组各80例。治疗组给予提前肝素化PCI术治疗,对照组给予常规肝素化PCI术治疗。比较两组的TIMI血流分级、不良事件发生率以及治疗前后的症状评分、 LVEF。结果术后,治疗组的TIMI血流0~1级率低于对照组,3级率高于对照组(P <0.05)。治疗后,两组的症状评分均低于治疗前,LVEF水平均高于治疗前(P<0.05);治疗组的症状评分低于对照组,LVEF水平高于对照组(P <0.05)。治疗组的不良事件发生率低于对照组(P <0.05)。结论 PCI术提前肝素化可以提高灌注效果,有效缓解STEMI患者的病情,改善患者心功能,改善预后,且具有较高的安全性。     

Correction to: Cichorium intybus L. promotes intestinal uric acid excretion by modulating ABCG2 in experimental hyperuricemia

The study of sex differences in hyperuricemia can provide not only a theoretical basis for this clinical phenomenon but also new therapeutic targets for urate-lowering therapy. In the current study, we aimed to confirm that estradiol can promote intestinal ATP binding cassette subfamily G member 2 (ABCG2) expression to increase urate excretion through the PI3K/Akt pathway. The estradiol levels of hyperuricemia/gout patients and healthy controls were compared, and a hyperuricemia mouse model was used to observe the urate-lowering effect of estradiol and the changes in ABCG2 expression in the kidney and intestine. In vivo and in vitro intestinal urate transport models were established to verify the urate transport function regulated by estradiol. The molecular pathway by which estradiol regulates ABCG2 expression in intestinal cells was explored. The estradiol level of hyperuricemia/gout patients was significantly lower than that of healthy controls. Administering estradiol benzoate (EB) to both male hyperuricemic mice and female mice after removing the ovaries confirmed the urate-lowering effect of estradiol, and hyperuricemia and estradiol upregulated the expression of intestinal ABCG2. Estradiol has been confirmed to promote urate transport by upregulating ABCG2 expression in intestinal urate excretion models in vivo and in vitro. Estradiol regulates the expression of intestinal ABCG2 through the PI3K/Akt pathway. Our study revealed that estradiol regulates intestinal ABCG2 through the PI3K/Akt pathway to promote urate excretion, thereby reducing serum urate levels.     

Use of a Telemedicine Risk Assessment Tool to Predict the Risk of Hospitalization of 496 Outpatients With COVID-19: Retrospective Analysis

BackgroundRisk assessment of patients with acute COVID-19 in a telemedicine context is not well described. In settings of large numbers of patients, a risk assessment tool may guide resource allocation not only for patient care but also for maximum health care and public health benefit.ObjectiveThe goal of this study was to determine whether a COVID-19 telemedicine risk assessment tool accurately predicts hospitalizations.MethodsWe conducted a retrospective study of a COVID-19 telemedicine home monitoring program serving health care workers and the community in Atlanta, Georgia, with enrollment from March 24 to May 26, 2020; the final call range was from March 27 to June 19, 2020. All patients were assessed by medical providers using an institutional COVID-19 risk assessment tool designating patients as Tier 1 (low risk for hospitalization), Tier 2 (intermediate risk for hospitalization), or Tier 3 (high risk for hospitalization). Patients were followed with regular telephone calls to an endpoint of improvement or hospitalization. Using survival analysis by Cox regression with days to hospitalization as the metric, we analyzed the performance of the risk tiers and explored individual patient factors associated with risk of hospitalization.ResultsProviders using the risk assessment rubric assigned 496 outpatients to tiers: Tier 1, 237 out of 496 (47.8%); Tier 2, 185 out of 496 (37.3%); and Tier 3, 74 out of 496 (14.9%). Subsequent hospitalizations numbered 3 out of 237 (1.3%) for Tier 1, 15 out of 185 (8.1%) for Tier 2, and 17 out of 74 (23%) for Tier 3. From a Cox regression model with age of 60 years or older, gender, and reported obesity as covariates, the adjusted hazard ratios for hospitalization using Tier 1 as reference were 3.74 (95% CI 1.06-13.27; P=.04) for Tier 2 and 10.87 (95% CI 3.09-38.27; P<.001) for Tier 3.ConclusionsA telemedicine risk assessment tool prospectively applied to an outpatient population with COVID-19 identified populations with low, intermediate, and high risk of hospitalization.     

基于住院病案首页数据的全国部分医院心血管临床专科评估探索

目的运用“基于住院病案首页数据的心血管临床专科评估框架”,对全国部分医院的心血管临床专科进行评估。方法梳理112所医院心血管专科重点疾病和重点手术操作的编码情况,计算评估框架中的各个指标,根据医院纳入标准,运用基于数据的多指标综合评价方法,对医院进行打分排序。结果112所医院2010—2012年心血管疾病患者出院人次、重点疾病和重点手术/操作缺失数量均呈偏态分布。按照综合评价医院的纳入标准共56所医院纳入排序,前十位是YN05、SD04、BJ14、SH02、ZJ01、HN01、SX09、YN08、SD01、SX08。重点疾病和重点手术操作均完整的医院共12所,其排序是:BJ14、SH02、HN02、BJ01、TJ01、SH05、SC01、NA03、GD02、SH08、YN03、HL01。本研究综合评价的56所医院中,有30所在国家公布的名单之内,26所不在国家公布的名单之内。结论运用“基于住院病案首页数据的心血管临床专科评估框架”进行心血管临床专科评估是科学、可行的,为专科评估方法提供了新的思路,为专科对口支援建设提供了数据支持。     

大气颗粒物浓度对流感样病例发病关联性研究

目的 探讨大气颗粒物浓度对合肥市流感样病例发病情况的影响.方法 对2014-2017年合肥市流感监测流感样发病例数及同期大气颗粒物(PM2.5PM10),应用分布滞后非线性模型分析两者关系及其滞后效应.结果 流感样病例发病与PM2.5PM10呈正相关(r= 0.10,P＜0.001)与湿度呈负相关(r =-0.09,P = 0.001),其中PM2.5浓度对流感样病例人群的滞后3日和4日有显著影响,其超额死亡风险(ER)分别为0.115％(95％CI:0.016％～1.002％)、0.116％(95％CI:0.002％～1.002％),双污染模型中,纳入其他气态污染物后,模型均表现无统计学意义.结论 PM2.5可能是流感样病例发病的重要影响因素.     

新生儿尿布皮炎的影响因素及预防进展

本文就新生儿尿布皮炎发生的危险因素及预防的研究进展,从完善新生儿皮肤监测系统、ABCDE皮肤护理方案的实施和采用家长参与式护理模式等3个方面进行阐述,以期为降低新生儿尿布皮炎的发生率,提高患儿的舒适度,降低医疗花费,为保障新生儿家庭的护理安全提供参考和指导。     

马尾神经根松弛症诊断及治疗研究

目的 :探讨马尾神经根松弛症的诊断及治疗。方法 :对我院开展椎管造影以来 ,发现马尾神经根松弛症9例患者的临床表现、椎管造影及治疗结果进行分析。结果 :9例患者除具有腰椎管狭窄症的一般临床表现之外 ,椎管造影结果显示狭窄节段上方马尾神经根呈波浪状蛇形卷曲 ,甚至“环状”改变 ,9例患者均行手术治疗。经随访 ,除1例患者症状无明显改善外 ,均完全恢复。结论 :椎管造影是诊断马尾神经根松弛症的有效手段 ,手术外围减压及神经根粘连松解是治疗的有效方法