以主诉为核心构建中医问诊路径

问诊是医师通过对患者或陪诊者进行有目的的询问,以了解病情的方法.良好的问诊沟通可以提高诊断效率,减少误诊、漏诊,改善医患关系.主诉是患者就诊时最感痛苦的症状、体征及其持续时间.主诉是问诊的第一步,也是问诊最重要的一项内容.获得主诉后,要能够依据疾病的内在关联性,有序地围绕主诉进行客观、系统、规范的问诊,建立一套清晰的问诊思路,把握住疾病的主线,才能辨证准确.     

侧支血管造影在脾破裂动脉栓塞术中的应用价值

目的 探讨侧支血管造影在脾破裂出血脾动脉栓塞中的重要性.方法 回顾性分析2018年1月～2021年1月52例脾破裂出血行脾动脉栓塞术的临床资料,术中同时行胃左动脉、胰十二指肠上动脉、膈肌动脉等周围血管造影,观察有无侧支血管开放,并栓塞侧支供血动脉.结果 52例中9例(17.3％)侧支血管开放参与脾脏供血.术后脾脏出血均...     

EMA-qPCR检测活沙门菌方法研究

目的 为解决荧光定量PCR（qPCR）方法不能区分死菌和活菌的问题,探索一种快速定量检测“活的”沙门菌的技术路线。方法 将不同浓度叠氮溴化乙锭（EMA）作用于不同浓度的死/活沙门菌后,用qPCR检测沙门菌Ct值,确定EMA的最优使用浓度。在混合菌量为10⁶、10⁵、10⁴、10³ CFU/mL,活菌比例为0%、10%、30%、50%、70%、100%条件下,确定EMA处理过的活菌+死菌,未加EMA的活菌+死菌,未加EMA的活菌+生理盐水三组菌的Ct值,研究EMA-qPCR法对死/活沙门菌的区分能力。结果 EMA浓度低于50 μg/mL,EMA处理活菌组与EMA未处理活菌组的Ct值差异无统计学意义。综合考虑,EMA最优使用浓度为10 μg/mL。采用10 μg/mL EMA进行预处理,混合菌量为10⁶、10⁵、10⁴、10³ CFU/mL时得出的结果一致：活菌比例为0%,≤50%,>50%时,EMA处理过的活菌+死菌与未加EMA的活菌+死菌两组Ct值差异（ΔCt）分别为≥5,≥1,<1。同时,除活菌比例0%外,其他活菌浓度下,EMA处理过的活菌+死菌与未加EMA的活菌+生理盐水两组Ct值无明显差异。结论 菌量为10³~10⁶ CFU/mL时,通过10 μg/mLEMA作用,EMA处理过样品与未加EMA处理样品的ΔCt值≥1,可考虑样品中沙门菌活菌比例≤50%。     

Clinical observation on the correlation between moxibustion sensation and distance of moxa stick

Objective

To explore the correlation between moxibustion sensation and distance of moxa stick and provide reference for clinical practice.

Methods

A total of 16 healthy volunteers aged 18-35 years old in college were recruited and given mild moxibustion at Shousanli (LI 10), Zusanli (ST 36), Shenshu (BL 23) and Tianshu (ST 25) with moxa stick, and the occurrence and frequency of moxibustion sensation were recorded at distances of 5 cm, 4 cm, 3 cm and 2 cm. Mild moxibustion scale was used to count the score.

Results

Warm was the main moxibustion sensation, burning pain and soreness decreased with the rise of distance; for the same acupoint, score of mild moxibustion scale increased with the decrease of distance; score ranged between 5.5 and 6.5 at distance 3 cm, which was the most comfortable distance for volunteers.

Conclusion

The distance of 3 cm is the most comfortable distance in mild moxibustion

     

血府逐瘀汤联合西药治疗冠心病Meta分析

目的:评价血府逐瘀汤联合西药治疗冠心病的临床疗效。方法:检索Medline、Pub Med、CNKI、万方数据库、CBM数据库,查找2010~2016年公开发表的血府逐瘀汤联合西药治疗与西医对照治疗冠心病的临床随机对照研究,2位检索员根据纳入与排除标准独立对文献进行筛选,提取资料并对纳入研究的方法学质量进行评价,运用Rev Man 5.3软件进行Meta分析。结果:纳入9项以血府逐瘀汤为主方治疗冠心病的临床随机对照研究。Meta分析显示,血府逐瘀汤对冠心病的临床疗效改善优于对照组[OR=3.84,95%CI(2.56,5.77),P0.00001],心电图改善效果优于对照组[OR=2.83,95%CI(2.05,3.92),P0.00001]。漏斗图显示存在发表偏倚。结论:血府逐瘀汤联合西药治疗冠心病优于西药常规,且具有较高的安全性。     

酸枣仁改善睡眠药理作用及其机制研究

由于来自外界压力的逐渐增加,睡眠障碍已经成为现代人的常见病.中药作为传统的治疗失眠手段,其临床效果已得到广大患者认可,而酸枣仁作为中医临床中常用的镇静催眠药因其在方剂中的配伍作用而获得睡眠方面研究者的关注.本文通过总结酸枣仁及其配伍组方改善睡眠的药理作用和相关机制,发现酸枣仁中皂苷类、黄酮类以及生物碱类成分可以影响大脑...     

光路系统的优化配置在多色流式细胞术实验方案设计中的应用

目的:基于流式细胞仪光路系统的硬件配置情况,探讨多色流式细胞术实验方案的优化设计.方法:选用6～8周B6小鼠的骨髓细胞作为实验材料,在已有流式抗体的基础上,通过变更BD AriaⅢ流式细胞仪中的滤光片,分别检测各荧光通道信号的相对变异系数％rCV和荧光强度中位值(median of fluorescence inten...     

龙葵氯仿提取物对肾透明细胞癌的干预作用研究

目的:探究龙葵氯仿提取物对肾透明细胞癌(CCRCC)细胞增殖和凋亡能力的影响,明确其在CCRCC中作用机制。方法:同步设空白组、顺铂组、龙葵组、抑制剂组、顺铂联合抑制剂组、龙葵联合抑制剂组采用CCK-8法检测CCRCC细胞系的增殖情况,运用AV/PI染色联合流式细胞术检测细胞的凋亡情况,Western Blot法定量检测PI3K/AKT信号通路关键元件的蛋白表达和磷酸化水平。结果:与空白组比较,各组对786-O的增殖均有抑制作用,均能促进细胞凋亡,其中以顺铂联合抑制剂组和龙葵联合抑制剂组最为突出。与空白组比较,各组均能调控PI3K/AKT信号通路,其中龙葵组的p-AKT表达下调最为显著。结论:龙葵氯仿提取物对CCRCC有较好的干预作用,其可能机制与抑制PI3K/AKT信号通路活化有关。     

冠心病痰浊阻塞证临床用药的中医文献研究

目的:探讨中医药治疗冠心病痰浊阻塞证的临床用药规律。方法:检索2009—2019年中国知网(CNKI)收录的国内发表的中医药治疗冠心病痰浊阻塞证的文献,统计分析临床治疗冠心病痰浊阻塞证的处方、药物组成及功效。结果:共纳入106篇文献,出现54种处方名称,组成中药共计100味,总频次1117次;根据中药的功效及分类,使用频次较多的是化痰止咳平喘药、活血化瘀药、补虚药、理气药,涉及药物种类数较多的为补虚药、活血化瘀药、清热药、理气药、化痰止咳平喘药,使用频次前2位的化痰止咳平喘药为半夏、瓜蒌,活血化瘀药为丹参、川芎,补虚药为甘草、白术,理气药为陈皮、薤白。结论:为临床治疗冠心病痰浊阻塞证提供参考依据。     

Influence of different-distance mild moxibustion at Zusanli (ST 36) on functional brain imaging in healthy population

Objective

To explore the beneficial regulatory effect of mild moxibustion from different distances at Zusanli (ST 36) of healthy population on the functions of temperature-related brain regions.

Methods

In 20 recruited healthy subjects, the change of the temperature-related brain regions induced by mild moxibustion from different distances at Zusanli (ST 36) was observed by functional magnetic resonance imaging (fMRI).

Results

In comparison of the values in amplitude of low-frequency fluctuation (fALFF) during and before moxibustion, it has been found that in moxibustion of 2 cm distance, fALFF value increased in the brain regions of the left anterior cingulated cortex and lateral surrounding cerebral regions, and fALFF value decreased in the cerebral regions of the peripheral cortex of the calcarine fissure; in moxibustion of 3 cm distance, fALFF value increased in the brain regions of the right and medial side and paracingulated gyrus, and fALFF value decreased in the cerebral zone of the left middle temporal gyrus; in moxibustion of 4 cm distance, fALFF value increased in the brain regions of the right and medial and paracingulated gyrus; and in moxibustion of 5 cm distance, fALFF value increased in the brain regions of the left hippocampus. In comparison of the value of regional homogeneity (ReHo), it has been found that in moxibustion of 2 cm distance, ReHo value increased in the cerebral zone of the posterior lobe of the right cerebellum, and ReHo value decreased in the cerebral zone of the right occipital lobe; in moxibustion of 3 cm distance, ReHo value increased in the brain regions of the left cerebellar posterior lobe and left frontal lobe, and ReHo value decreased in the cerebral zone of the right inferior temporal gyrus; in moxibustion of 4 cm distance, ReHo value increased in the brain regions of the right superior frontal gyrus and ReHo value decreased in the brain regions of the right parietal lobe and angular gyrus; in moxibustion of 5 cm distance, ReHo value increased in the cerebral zone of the right frontal lobe and ReHo value decreased in the cerebral zone of the right brainstem.

Conclusion

In moxibustion of 3 cm distance, the changes in the brain regions basically conform to the transmission route of body trunk temperature.