Multicenter study of flunisolide aerosol in adult patients with steroid-dependent asthma

Seventy-three adult, steroid-dependent asthmatic patients participated in a 16-wk, double-blind study testing the efficacy of flunisolide aerosol. Forty received flunisolide, and 33 received placebo. The mean daily prednisone requirement of patients receiving flunisolide fell 59.2% during the testing period, and that of the patients receiving placebo fell 19.7%. The median daily prednisone dose dropped 74.4% in the flunisolide group and 4.2% in the placebo group (p = 0.006). In the flunisolide group 75% tapered use of oral steroids 50% or more, and 27.5% stopped taking oral steroids completely. In the placebo group 36% tapered use of oral steroids 50% or more, and only 12% stopped taking them completely. Despite their reduction in systemic steroids, those patients receiving flunisolide achieved significantly greater reduction in the daily severity of wheezing (p = 0.014) and frequency of asthma attacks (p = 0.049) than did those receiving placebo. In the final evaluation of therapeutic response, 70% of patients receiving flunisolide were rated as having a very good or good response, and 30% were rated as having a fair or poor response. In contrast 33% of patients receiving placebo were rated as very good or good, and 67% were rated as fair or poor (p = 0.0009). No serious reactions were reported. Plasma cortisols showed an average increase of 42.9% in the flunisolide group but no change in the placebo group. Flunisolide aerosol is a well-tolerated and effective agent in the treatment of steroid-dependent asthma.     

Influence of fogging lenses and cycloplegia on open-field automatic refraction

PURPOSE: To compare refractive values measured with and without cycloplegia, or with fogging lenses, using an open-field auto-refractor. METHODS: One hundred and forty-two young adults were enrolled from a university population; 96 were female (67.6%) and 46 were male (32.4%), the age range was 18-26 years (mean 22.3 +/- 3.7 years). The refraction measurement was obtained for the right eye of each subject with the Grand Seiko Auto Ref/Keratometer WAM-5500 (GS) under three conditions, always in this sequence: (1) without cycloplegia (GS), (2) without cycloplegia but using a + 2.00 D fogging lens (GS_2D) and (3) with cycloplegia (GS_cycl). RESULTS: When the average values of spherical equivalent were compared, both accommodation control strategies were almost equally successful: GS, M = -0.85 +/- 2.21 D; GC_2D, M = -0.53 +/- 2.10 D and GS_cycl, M = -0.57 +/- 2.24 D (Kruskal-Wallis test, p < 0.001). When the results were analysed separately for different refractive groups, emmetropes and hyperopes show statistically significant differences while myopes did not. When both accommodation strategies were compared there was a trend for more myopic subjects to display more negative values under cycloplegia, while low myopes, emmetropes and hyperopes tend to display more negative values with the +2.00 D fogging lenses, suggesting this was less effective for accommodation control. CONCLUSIONS: Over-refraction through +2.00 D fogging lenses is useful to achieve additional relaxation of the accommodative response in a similar way to cycloplegia when open-field autorefraction is performed in young adults.     

因声求义——《黄帝内经太素》重言词例释三则

重言词为由单音节或双音节字重叠构成的合成复音词,多用于描物摹状,是古汉语中的常见语言现象。古医籍中的重言词由于存在大量的俗写变体,如运用_般的重言词字面求解方法,往往容易造成望文生义、割裂医理的现象。以唐杨上善《黄帝内经太素》中的三则重言词为例,因声求义,通过寻找恰当的音同音近字,求得确切的解释,务求医理文理两相合宜。     

多排螺旋CT对腮腺肿瘤的诊断价值（附13例报告）

目的：提高对腮腺肿瘤的CT诊断与鉴别诊断水平。方法回顾性分析13例腮腺肿瘤的CT表现和病理结果。结果腮腺混合瘤10例（共18个病灶）,黏液表皮样癌1例,非霍奇金淋巴瘤1例,嗜酸性淋巴肉芽肿瘤1例。结论 CT征象可以为腮腺肿瘤的良恶性鉴别诊断提供有价值的依据,位于浅叶、边界清楚、类圆形或椭圆形的腮腺肿瘤多为良性肿瘤;反之,多为恶性肿瘤。     

The safety of a trial of labor after cesarean section in a grandmultiparous population

Background The rate of vaginal birth after a cesarean (VBAC) delivery in the multiparous population has decreased largely in recent years because of maternal and neonatal complications. The clinical management of grand multiparous (GMP) women (>5 births) with a prior cesarean delivery is even less clear. The purpose of the present study was to assess the risks of maternal and neonatal complications associated with VBAC compared to that of repeated elective cesarean section (CS) in the GMP population. Methods A retrospective study of 1,102 GMP women with a singleton gestation and a prior single CS was conducted. Data were retrieved from the database of the Department of Obstetrics and Gynecology at the Soroka University Medical Center, Beer Sheva, Israel. Maternal and neonatal outcomes were compared between women who underwent a successful VBAC attempt, women who had failed in a trial of labor and women who had an elective repeated CS. Results Six hundred and nineteen women (56%) underwent a successful VBAC, 155 (14%) underwent a trail of labor and 328 (30%) had an elective repeated CS. Women who had a successful VBAC required less blood transfusion, and had less puerperal fever diseases (P < 0.001). Induction or augmentation of labor was associated with failure of VBAC (P < 0.001). No significant differences in neonatal complications were observed between the groups. No significant difference in uterine dehiscence, uterine rupture, amnionitis, postpartum hemorrhage, hysterectomy, puerperal fever and thromboembolic diseases was observed between the groups. Conclusions A successful VBAC in the GMP population was not associated with a higher risk of maternal complications in comparison with a repeated elective CS. This work is in satisfaction of E. Kugler M.D. requirements     

岭南针灸发展史概述

砭石、药物、艾灸、毫针、导引等中医治病方法,岐伯在《黄帝内经素问·异法方宜论》中指出灸法起源北方,因"北方者,天地所闭藏之域也,其地高陵居,风寒冰冽,其民乐野处而乳食,脏寒生满病,其治宜灸焫。故灸焫者,亦从北方来。"岭南地理气候湿热,灸法按理不适广泛使用,但是从现存的古代岭南针灸文献中,大都与灸法相关。当今学者对岭南医学的研究,采取"博古约今"取材原则。"博古"即明清以前,五岭之南皆收而录之;"约今"即明清以后,核心部位在广东尤其珠江三角洲,广东称为"岭南"。古代岭南号称"瘴疠"之乡,在其医学漫长的发展过程中形成了独具特色的地域流派,岭南医学。在其针灸学发展过程中,出现过一些有影响的针灸医家,如著名女灸家鲍姑,有的还撰写了不少针灸著述,可惜很多已佚失,现存有关针灸的文献仅有《肘后备急方》《采艾编》《采艾编翼》《幼幼集成》等寥寥数部针灸学专著。本文针对现存的清及清以前岭南针灸医家及其学术成就进行简单梳理,希望为今后岭南针灸学的深入研究助以微薄之力。