叶天士《临证指南医案》中鲜药应用的规律及特色探讨

目的 通过对叶天士《临证指南医案》中使用鲜药的规律和特点进行分析,为临床引进及使用鲜药提供学术参考,也为吴门医派鲜药研究提供方法学借鉴。方法 采用Excel软件录入使用鲜药的医案处方,对药物的使用频数、性味、归经等信息进行统计分析,用SPSS Clementine 12.0软件进行病证与药物的关联分析。结果 医案中使用鲜药的病证共79类,以温热病、疫病为主,使用鲜药品种75种,使用频次718次。鲜药性味以甘、寒为主,主入胃、肺经。药物与疾病之间存在一定的关联,如疟证常用生姜、姜汁,吐血用鲜荷叶汁等。鲜药联用以姜汁-竹沥、甜梨汁-甘蔗浆较多。结论 《临证指南医案》记载鲜药多为地产清轻之品,清热养阴生津之效更胜,在温病治疗中占重要地位,高频常用药物及药对可为临床用药提供参考依据。     

Relevance of Pulmonary Alveolar Echinococcosis

BackgroundPulmonary alveolar echinococcosis (PAE) is a chronic disease caused by Echinococcus multilocularis with very low incidence in developed countries.MethodsThis single-center, retrospective study included 34 patients who were diagnosed with PAE between January 2001 and February 2019 (15 males, 19 females, mean age: 52.4 ± 15.8 years, age range: 28–78 years) in Ataturk University Medical School, Erzurum, Turkey.ResultsThe liver was the primary involved organ in all cases. Pulmonary involvement was detected in 13.0% (34/261) of all cases with hepatic alveolar echinococcosis (AE), and three patients (8.8%) had both pulmonary metastasis and brain metastasis. The route of spread to the lungs based on radiological data was hematogeneous in 25 patients (73.5%), transdiaphragmatic in three patients (8.8%) and both hematogeneous and transdiaphragmatic in six patients (17.7%). AE showed bilateral involvement in 19 patients (55.9%), whereas only the right lung was involved in 12 patients (35.3%) and the left lung in three patients (8.8%). Of the patients, five underwent surgery due to PAE and 29 patients received medical therapy with albendazole. A total of three patients died during the follow-up period (2, 5 and 10 years after the diagnosis of PAE), while 31 patients continued with follow-up and treatment for a mean duration of 5.4 ± 3.8 years (1–14 years).ConclusionsPatients with hepatic AE must, as a matter of course, be screened for possible lung involvement. Albendazole therapy may slow down disease progression in patients with widespread pulmonary involvement who are not eligible for surgery.     

miR-144、miR-451在胃癌组织中的表达及其临床意义

目的探究胃癌患者组织中miR-144、miR-451的表达与临床病理参数及预后的关系。方法2013年6月至2014年6月,收集115例胃癌患者的癌组织及癌旁正常组织,采用实时定量PCR检测组织中miR-144、miR-451的表达水平;分析胃癌组织中miR-144、miR-451的表达与患者临床病理参数的关系,采用Kaplan-Meier生存曲线评估miR-144、miR-451的表达与患者预后的关系,并采用Cox回归模型分析胃癌患者预后的影响因素。结果胃癌组织中miR-144相对表达量为0.214±0.069,低于癌旁正常组织的1.124±0.157,miR-451相对表达量为0.354±0.087,低于癌旁正常组织的1.084±0.108,差异均有统计学意义(均P<0.05);miR-144、miR-451的表达均与肿瘤大小、淋巴结转移、远处转移及TNM分期有关(均P<0.05)。Kaplan-Meier生存分析结果表明,与miR-144高表达组、miR-451高表达组相比,miR-144低表达组、miR-451低表达组患者术后5年总生存率较低,术后中位生存时间较短(均P<0.05)。Cox回归模型发现,远处转移、较高TNM分期、miR-144低表达、miR-451低表达是影响胃癌患者预后的危险因素(均P<0.05)。结论胃癌组织中miR-144、miR-451呈低表达,其与患者病情进展和预后有关,检测胃癌组织中miR-144、miR-451的表达可能有利于患者的病情和预后判断。     

Ventricular arrhythmias during coronary angiography in patients with angina pectoris or chest pain syndromes

Of 7,915 patients undergoing coronary angiography from 1978 to 1983, 39 (25 men and 14 women with a mean age of 57 years [range 37 to 79]) had sustained ventricular tachycardia (VT) or ventricular fibrillation (VF) during the procedure. Nine patients had atypical chest pain and 30 had typical angina. Fifteen had had a previous myocardial infarction. One patient had a history of VT or VF. Electrocardiograms taken at rest revealed a prolonged QT interval in 14. A normal ejection fraction was found in 79%. Coronary angiography revealed that 10 patients had 3-vessel disease, 15 had 1- or 2-vessel disease and 14 had normal coronary arteries. The VT or VF was seen with injection of contrast medium into the right coronary artery in 24, the left coronary artery in 10 and vein bypass grafts in 5 patients. Of the episodes of VT or VF, 67% occurred after injection of contrast medium into a minimally diseased coronary artery. In patients in whom VT or VF occurred after injection into a minimally diseased coronary artery, the arrhythmia was preceded by bradycardia, usually with pronounced widening of the QRS and QT intervals. This response was significantly different from that in patients in whom VT or VF occurred after injection into a coronary artery with significant stenosis; in these patients, VT or VF was initiated by a single premature ventricular contraction on a T wave. VT or VF was successfully cardioverted in all instances, without further arrhythmias.     

Mechanisms governing the relative proportions of thyroxine and 3,5,3'-triiodothyronine in thyroid secretion

In subjects with normal thyroid function only a minor part of firculating 3,5,3'-triiodothyronine (T3) originates directly from the thyroid; the majority is produced in the peripheral tissues by deiodination of thyroxine (T4). However, T3 of thyroidal origin constitutes a relatively high fraction of the total T3 produced in many patients with thyroid hyperfunction or hypofunction. Such a relatively high T3 content in the secretion of the thyroid could be caused by a low T4/T3 ratio in thyroglobulin. Severe iodine deficiency is a well-known inducer of a low T4/T3 ratio, but a low T4/T3 ratio can also be produced independent of the iodine content. This is seen in in vitro studies of thyroglobulin iodination when small amounts of DIT are added to the incubation mixture and in vivo in TSH-treated animals and in patients with Graves' disease. Another mechanism for high thyroidal secretion of T3 could be an enhanced fractional deiodination of T4 to T3 in the thyroid. In vitro thyroid perfusion studies have shown that the T3 content of thyroid secretions is higher than would be expected from the T4/T3 ratio of thyroid hydrolysate and that the major mechanism is deiodination of T4 to T3. Thyroxine deiodinases are also present in the human thyroid, and the amount of T4 deiodinase is enhanced in the thyroids from patients with medically treated Graves' disease and in the hyperstimulated thyroids of rats. Other factors of possible importance for the mixture of T3 and T4 secreted by the thyroid are a relatively faster liberation of T3 than of T4 from thyroglobulin during partial hydrolysis (this faster release of T3 is probably the mechanism behind the more "rapid" secretion of T3 than of T4), or some kind of thyroid heterogeneity leading to pinocytosis and hydrolysis of thyroglobulin with a lower T4/T3 ratio than that of average thyroglobulin.     

精准医学决策支持知识组织研究

介绍国内外医学知识组织体系,从数据来源、概念抽取、语义关系构建几方面阐述基于精准医学临床决策支持系统的精准医学知识组织体系设计,分析其在门诊和住院场景的应用。