王自立主任医师应用补阳还五汤验案举隅

补阳还五汤为清代医家王清任所创,用于治疗气虚血瘀之半身不遂。而王自立主任医师通过对原文的研究以及自己的临证经验,用该方治疗多种疑难杂症,验证于临床,取得了良好的疗效。     

赵坤教授运用扶正祛瘀法治疗闭塞性细支气管炎经验

闭塞性细支气管炎患儿近年来不断增多,临床治疗较为困难,赵坤教授从医近30年,致力于小儿呼吸系统疾病及急危重症的中西医结合救治的研究,造诣颇深,导师从痰、瘀、虚论治该病,重视解毒祛瘀、扶正益气,临床治疗效果显著,本文重点介绍赵坤教授运用扶正祛瘀法治疗本病的经验。     

489例主动发现的STD患者求医流向分析

目的了解主动监测发现性病患者的求医行为及基本流向,为制定相关政策及干预提供依据.方法对主动监测发现的STD病人进行问卷式调查.结果仅41.3%的病人首诊选择公立医院,非正规就医的比例仍较大(58.7%).若首诊选择了公立医院等正规就医方式,则复诊选择公立的比例就大,经多元logistical回归分析发现居住地、治疗次数、病感体验、广告传媒、治疗效果、社会因素、治疗花费及一些病种分别是决定病人首诊及复诊的影响因素.结论主动监测发现的性病患者虽然正规就医的比例不高,但若能引导他们求医的首诊取向,就可促使他们转变不良求医行为.     

中国儿童肥胖的评估、治疗和预防指南

儿童肥胖已成为我国严峻的公共健康问题.为了制定用于评估、治疗和预防儿童肥胖的临床实践指南,该指南采用GRADE(推荐分级的评估、制定与评价)方法评价证据质量,针对我国儿童肥胖进行了系统评价,并应用了已经发表的系统评价和独立研究证据.儿童肥胖症的筛查应采用分层、合理的方法,以便在出现严重的并发症之前及早发现异常情况.一旦发生肥胖,通过改变生活方式难以获得有效和持久的减重效果,因此应将促进健康的饮食、活动和环境等作为预防儿童肥胖的主要目标.应严格限制减重药物在儿童青少年肥胖症中的应用.对于严重肥胖、影响发育并且通过改变生活方式减重失败的青少年,可以实施减重手术.     

肾衰方治疗慢性肾衰竭疗效分析

目的:探讨肾衰方(叶任高教授的经验方)治疗慢性肾衰竭的疗效。方法:126例慢性肾衰竭患者随机分为对照组和治疗组各63例,对照组用单纯西医方法治疗,治疗组在同样西医治疗的基础上加用肾衰方治疗,治疗3个月为1个疗程,分析治疗后血尿素氮(BUN)及血清肌酐(Scr)的变化,并对血清肌酐浓度的倒数(1/Scr)和时间的关系进行回归分析。结果:治疗组治疗后BUN、Scr明显下降,与治疗前比较有显著差异(P<0.05),1/Scr与时间的回归关系其统计斜率b值为正值;而对照组则相反。结论:以肾衰方为主的中西医结合治疗方法能阻止慢性肾衰竭的进展。     

中度Marcus-Gunn综合征手术治疗1例附文献复习

下颌-瞬目综合征是1883年Marcus-Gunn首先报道的,因此又名Marcus-Gunn综合征,是一种较少见的先天性上睑和下颌的共同运动.常单眼发病,双眼同时发病少见.表现为上睑下垂,并且当患者下颌运动(张口,下颌移向健侧或向前移动)时下垂的上睑可突然提起,甚至超过对侧,故又称为张口提上睑联带运动综合征.     

Neo-adjuvant therapy or definitive chemoradiotherapy can improve laryngeal preservation rates in patients with cervical esophageal cancer. A Japanese nationwide survey

Background

Various options are available to treat cervical esophageal cancer (CEC), including primary resection, neo-adjuvant therapy followed by surgery, and definitive chemoradiotherapy (dCRT). However, whether neo-adjuvant therapy or dCRT can improve larynx preservation rates in patients with CEC is unclear. This study investigated results of CEC treatment in clinical practice by a nationwide survey in Japan.

Patients and methods

We retrospectively investigated results of clinical practices for patients with resectable CEC treated between 2012 and 2014, using a mailed questionnaire as a nationwide survey to 308 institutions recognized by the Japan Esophageal Society and the Japan Broncho-Esophagological Society.

Results

We registered 792 patients from 93 institutions, of whom 11.1 % underwent endoscopic resection, 46.0 % underwent surgery, and 39.2 % underwent dCRT. Among patients with CEC who were considered to be poor candidates for laryngeal preservation at initial diagnosis, 24.5 % of the 139 patients treated with neo-adjuvant therapy, and 47.3 % of the 226 patients treated with dCRT preserved their larynxes.

Conclusions

This questionnaire survey revealed that multimodality treatment for CEC could decrease laryngectomy rates, especially among patients who were not considered to be laryngeal preservation candidates. These treatment strategies can lead to both laryngeal preservation and postoperative quality of life, and should become more widely used.

     

骨质疏松性椎体压缩性骨折的治疗指南

骨质疏松性椎体压缩性骨折已经成为骨质疏松性疾病中常见的疾病之一。在治疗方式上有保守治疗及椎体成形术等手术治疗,并且各有其优缺点。保守治疗主要以药物为主;手术治疗需要考虑患者的病情,结合患者的年龄、身体状态和经济条件等因素选择合适的治疗方式。     

Prediction of the growth response of short prepubertal children treated with growth hormone

The aim of this study was to identify predictors of the growth response to growth hormone (GH) during the first 2 years of GH treatment, using auxological data and the maximum GH response (GH_max) to provocation tests. The patients were 169 prepubertal short children (27F, 142M), with Gmax values ranging from 0 to 65 mU/1. Their mean age (± SD)was8.3 ± 2.4 years (range 3-13 years), mean height SDS –3.0 ± 0.7 (range –1.5 to –6.0SDS) and mean pretreatment height velocity was normal (± 0.0 SDS) (range -1.6 to + 0.9 SDS). The increase in height SDS during the first 2 years of GH treatment (0.1 U/kg/day) varied from 0.10 to 3.75 SDS, with younger children having a better growth response. Individual growth responses correlated (p < 0.001) with GH_max (r =–0.37), age (r= -0.35), 1-year pretreatment delta SDS (r = -0.25), mid-parental height SDS (r = 0.34), height SDS at start of treatment (r =–0.22) and difference between height SDS of an individual child at the onset of GH treatment and mid-parental height expressed in SDS (diff SDS) (r = –0.43). In a multiple stepwise linear regression model, diff SDS and log GH_max were found to be the strongest predictors of the magnitude of the growth response. In the short children in this study who exhibited a broad range of GH_max values, 33% of the growth response during the first 2 years of treatment could be predicted.