基于经典医籍挖掘唐宋以后中风病“外风致中”思想

中风病是中医临床治疗中具有明显优势的疾病之一,早在《内经》时代就有较为系统的阐述。唐宋以前多认为中风病因外风而致,唐宋以后多主张内风致病。外风致病向内风致病理念的转变是对于早期理论的纠错,还是病因病机理论的延伸,一直以来存在着争议。笔者认为这一观念的转变是对于中风病病因病机分析的细化,唐宋以后"外风致中"思想与"内风致中"理论并行。本文通过对历代中医古籍文献的梳理,重点分析唐宋以后"外风致中"思想的相关研究,并通过现代相关实验研究的整理证实该理论的发展,为中风病中医研究与临床治疗提供理论参考。     

踏车运动对恢复期脑卒中患者ADL的影响

目的：探讨踏车运动对恢复期脑卒中患者日常生活活动能力（ADL）的影响。方法：61例有一定行走能力的恢复期脑卒中患者随机分为观察组31例和对照组30例,均采用常规康复训练方法配合治疗,观察组并增加踏车运动,每天1次,30min。结果：经过8周的训练后,与治疗前比较,2组患者的ADL明显提高（P〈0.05）,观察组提高的程度优于对照组（P〈0.05）。结论：踏车运动对提高恢复期脑卒中患者的ADL有积极作用。     

加速康复外科模式对腹腔镜下胰十二指肠切除术后患者肠道黏膜屏障影响的研究

目的研究加速康复外科(ERAS)模式对腹腔镜下胰十二指肠切除术(LPD)术后患者的肠黏膜屏障功能的影响。方法回顾性分析2015年1月至2018年12月接受LPD术的患者145例,根据干预方案不同分为ERAS组78例及传统组67例。数据采用SPSS 24.0进行统计学分析,术后并发症发生率等计数资料采用χ^2检验;围术期各项指标、肠黏膜屏障功能指标以(±s)表示,独立t检验;P<0.05为差异有统计学意义。结果ERAS组术后恢复情况均优于传统组,其中首次排气时间、首次进食时间、引流管拔管时间及术后住院时间差异均有统计学意义(P<0.05);两组术后死亡率差异无统计学意义(P>0.05);ERAS组患者胃排空延迟的发生例数(3例,3.8%)明显少于传统组(5例,7.5%)(P<0.05),其余并发症比较差异无统计学意义(P>0.05);两组患者术后肠黏膜屏障功能指标ERAS组患者优于传统组,但差异无统计学意义(P>0.05)。结论加速康复外科能使LPD术获得更好的临床效果,并可促进LPD患者术后肠黏膜屏障功能的恢复。     

胃癌术后硬膜外镇痛与静脉镇痛对比的系统回顾与Meta分析

目的比较硬膜外与静脉镇痛在胃癌根治性手术中应用的效果。方法对胃癌根治术中硬膜外镇痛与静脉镇痛的随机对照试验进行系统回顾和荟萃分析。主要研究结果为术后24 h疼痛评分,次要结果包括术后并发症发生率、首次排气时间、住院时间。结果有6项随机对照研究共计393例患者纳入研究,其中英文4篇,中文2篇。Meta分析结果显示,与静脉镇痛组相比,硬膜外镇痛组术后24 h静息状态(WMD=-0.74,95%CI:-1.35^-0.13,P=0.02)、运动状态疼痛评分均较低(WMD=-1.5,95%CI:-1.95^-1.05,P<0.001),术后恶心、呕吐(RR=0.32,95%CI:0.18~0.58,P<0.001)及呼吸系统并发症发病率(RR=0.50,95%CI:0.29~0.85,P=0.01)较低,差异均具有统计学意义,术后泌尿系统并发症两组之间差异无统计学意义(RR=0.87,95%CI:0.38~1.96,P=0.73),但低血压的发生高于静脉镇痛组(RR=3.27,95%CI:1.28~8.32,P=0.01),术后首次排气时间(WMD=-14.01,95%CI:-22.85^-5.17,P=0.002)、术后住院时间(WMD=-0.69,95%CI:-0.90^-0.49,P<0.001)均短于静脉镇痛组。结论胃癌根治术患者镇痛的选择,硬膜外镇痛无论是静息还是动态时镇痛效果均优于静脉镇痛,虽会增加术后低血压发病率,但与肺部并发症、恶心呕吐的等并发症减少有关,并且具有促进胃癌术后肠道功能恢复及缩短住院时间的优势。     

Seroprevalence of Rift valley fever in South African domestic and wild suids (1999–2016)

Rift valley fever (RVF) is a vector‐borne viral disease of domestic ruminants, camels and man, characterized by widespread abortions and neonatal deaths in animals, and flu‐like symptoms, which can progress to hepatitis and encephalitis in humans. The disease is endemic in Africa, Saudi Arabia and Yemen, and outbreaks occur after periods of high rainfall, or in environments supporting the proliferation of RVF virus (RVFV)‐infected mosquito vectors. The domestic and wild animal maintenance hosts of RVFV, which may serve as sources of virus during inter‐epidemic periods (IEPs) and contribute to occurrence of sporadic outbreaks, remain unknown, although reports indicate that the African buffalo (Syncerus caffer) may play a role. Due to the close proximity of the habitats of domestic pigs and warthogs to those of known domestic and wild ruminant RVFV maintenance hosts respectively, our study investigated their possible role in the epidemiology of RVF in South Africa by evaluating RVFV exposure and seroconversion in suids. A total of 107 warthog and 3,984 domestic pig sera from 2 and all 9 provinces of South Africa, respectively, were screened for presence of RVFV neutralizing antibodies using the virus neutralization test (VNT). Sero‐positivity rates of 1.87% (95% CI: 0.01%–6.9%) and 0.68% (95% CI: 0.49%–1.04%) were observed for warthogs and domestic pigs, respectively, but true prevalence rates, taking test sensitivity and specificity into account, were lower for both groups. There was a strong association between the results of the two groups (χ² = 0.75, p = .38), and differences in prevalence between the epidemic and IEPs were non‐significant for all suid samples tested (p > .05). This study, which provides the first evidence of probable exposure and infection of South African domestic pigs and warthogs to RVFV, indicates that further investigations are warranted, to fully clarify the role of suids in the epidemiology of RVF.