寻常型银屑病进行期血热证与方药的相关性研究

目的 运用经典统计学方法和联系数学集对分析相结合的方法,分析寻常型银屑病进行期血热证与方药的相关性.方法 研究纳入患者1238例,包括清热凉血中药治疗寻常型银屑病进行期血热证相关文献15篇986例、课题组前期临床数据资料160例以及前瞻性临床研究92例,运用单因素相关系数法分析相关性并剔除无统计学意义的因素,变量分别进入二分类Logistic回归模型和联系数学集对分析.结果 单因素相关系数分析显示,苦参、金银花、重楼、蛇莓、土茯苓、赤芍、白鲜皮、荆芥、牡丹皮、生地黄、水牛角(片)、白芍、蜈蚣、全蝎、凌霄花等中药是寻常型银屑病进行期血热证临床疗效的正相关因素.二分类Logistic回归分析显示,甘草、磁石、牡蛎、赭石、赤芍、菝葜、知母、生地黄、山豆根、全蝎、蜈蚣、重楼为寻常型银屑病进行期血热证临床疗效的影响因素.联系数学集对分析显示,荆芥、白芍、白鲜皮、蜈蚣、全蝎、苦参、金银花、土茯苓、蛇莓、牡丹皮、生地黄、蚤休、赤芍、地肤子用于治疗寻常型银屑病进行期血热证均为强同势.结论 荆芥、赤芍、生地黄、重楼、苦参、白鲜皮、金银花、土茯苓、蛇莓、牡丹皮、知母、山豆根、水牛角片、菝葜、地肤子、磁石、全蝎、蜈蚣、牡蛎、赭石、白芍、甘草等22种中药是寻常型银屑病进行期血热证的相关因素,临床应用疗效较好.     

穴位埋线疗法病谱初探(英文)

目的:初步探讨穴位埋线疗法的临床适用病种,整理并分析穴位埋线疗法病谱。方法:采用文献研究方法及数据挖掘技术,经过对1971年—2011年6月发表的与穴位埋线疗法相关的临床研究论文进行筛选、录入、审核、提取有效信息等环节后,归纳总结穴位埋线疗法病谱。结果:穴位埋线疗法适用于103种疾病,涉及6个科属。内科最多,共50种,占总病谱的48.54%;其余依次是外科、五官科、妇科和皮肤科,分别为15种、12种、11种、11种;儿科最少,共4种。同时,按照效能针灸等级病谱的规则,初步对该疗法治疗的病种进行等级分类,获得穴位埋线疗法Ⅰ级病谱26种,Ⅱ级病谱30种,Ⅲ级病谱8种。结论:穴位埋线疗法临床运用广泛,病谱不断扩大,值得临床推广应用。     

Drainage of retro-parapharyngeal abscess: an additional indication for endoscopic sinus surgery

Deep neck abscesses are life-threatening conditions, in early stages preferably treated by intravenous antibiotic therapy; in advanced stages, surgical drainage is mandatory. We report two cases of retro-parapharyngeal abscess with prevalent retronasopharyngeal extension in two men aged 60 and 82, both of whom underwent transnasal endoscopic drainage. The main surgical steps were incision of the posterior pharyngeal mucosal wall, widening of the incision, drainage of purulent collection and careful dissection and removal of the necrotic tissue. The first patient, with an abscess associated with chronic otitis media and presenting hypoglossal nerve palsy, quickly recovered from pharyngodinia, otalgia and trismus. Twenty-six months after surgery, he is symptom-free, with hemitongue atrophy due to denervation as the only residual sign. The second patient, affected by skull base osteomyelitis secondary to malignant external otitis, after a first successful drainage, underwent a second endoscopic procedure for the reoccurrence of an abscess in the contralateral retroparapharyngeal space. Twelve months after the first surgery, the patient reported an improvement of symptoms, except for persistent dysphonia related to vagal nerve palsy. At follow-up MR, another abscess was detected in the left retro-parapharyngeal space. In selected cases of abscess, transnasal endoscopic drainage may be an effective alternative to external approaches. Minimal morbidity, the absence of cervical or palatal scars and a short hospitalization time can be considered as important advantages in comparison to external approaches. Patients with abscess secondary to skull base osteomyelitis require close imaging surveillance because of the difficulty of definitive control of the disease.     

颅底脊索瘤的临床诊治进展

颅底脊索瘤是一种较少见的胚胎残余组织肿瘤,呈缓慢浸润性生长。以往因其位置深在且对颅底重要神经结构广泛侵犯,颅底脊索瘤的治疗一直是颅底外科的难题之一。近年来随着神经影像学、肿瘤病理学和颅底外科学的发展,颅底脊索瘤的诊断及治疗也取得了长足的进步。本文就该肿瘤的临床表现、病理诊断、分型和手术入路等诊治进展作一综述。     

额眶筛入路切除前中颅底颅鼻眶沟通瘤

目的探讨切除前中颅底、额、筛窦、眶沟通性肿瘤的最佳手术方式,以满足临床需要。方法对13例前中颅底颅鼻眶沟通瘤患者采用额眶筛入路、T型切口,将外鼻下翻,切除部分筛窦、纸板、额骨眶部及额窦后壁,充分暴露肿瘤组织,在手术显微镜下分块或完全切除肿瘤,分离、保护相应解剖部位,如视神经、内动脉、蝶鞍和脑膜等重要解剖结构。将外鼻回复,用钛板钛钉与额骨固定,恢复良好颌面外形。结果13例颅鼻眶沟通瘤手术均获得成功,随访24个月,11例肿瘤无复发,均无脑脊液鼻漏、脑膜脑膨出等并发症。面部外形良好。结论经额眶筛进入、侧下翻鼻骨入路是耳鼻咽喉科切除前中颅底颅鼻眶沟通瘤的一种良好方法。     

对药酸枣仁-合欢花对抑郁模型大鼠行为学及皮质ERK-CREB细胞信号转导通路的影响

目的探讨对药酸枣仁-合欢花对抑郁模型大鼠行为学及皮质细胞外信号调节蛋白激酶(ERK)-环磷腺苷反应元件结合蛋白(CREB)细胞信号传导通路的影响。方法将雄性2月龄SD大鼠75只,按随机数字表法分为正常组、模型组、中药组、西药组、PD184161组,每组15只。采用孤养加慢性不可预知性温和应激(CUMS)复制大鼠抑郁模型,于实验前1d及实验第1、2、3周末用旷场实验、糖水消耗实验观察各组大鼠的行为学改变。采用实时荧光定量聚合酶链式反应(Real-Time PCR)法对皮质CREB、BDNF mRNA行定量分析。蛋白质免疫印迹(Western Blot)法测皮质ERK1/2、p-ERK1/2、p-RSK及p-CREB蛋白表达水平。结果与正常组比较,模型组大鼠旷场实验得分、糖水消耗度下降,从第2周末开始有统计学意义(P<0.05,P<0.01)、皮质CREB、BDNF mRNA水平下降(P<0.05,P<0.01)、ERK1/2、p-ERK1/2、p-RSK、p-CREB蛋白表达降低(P<0.05,P<0.01);与模型组比较,中药组、西药组、PD184161组大鼠旷场实验得分、糖水消耗度提高,从第2周末开始有统计学意义(P<0.05,P<0.01),皮质CREB、BDNF mRNA水平上调(P<0.05),ERK、p-ERK、p-RSK、p-CREB蛋白表达增强(P<0.05,P<0.01);与中药组比较,PD184161组大鼠旷场实验得分、糖水消耗度下降,第3周末有统计学意义(P<0.05),皮质CREB、BDNF mRNA水平下降(P<0.05),ERK、p-ERK、p-RSK、p-CREB蛋白表达降低(P<0.05)。结论对药酸枣仁-合欢花能够改善抑郁模型大鼠的抑郁症状,具有抗抑郁功效,其作用机制可能与激活ERK-CREB信号传导通路,增强通路中关键因子的表达有关。     

中药临床药师培训基地建设与人才培养的探索与实践

目的：探讨中药临床药师培训目标、培训模式以及培训方案,分析人才培养的局限性及不足,为各医院中药临床药师的培养提供参考。方法：梳理首都医科大学附属北京友谊医院中药临床药师培训具体内容,细化综合能力、药学及临床基本知识、临床药学技能培训和中药科研技能培训的方案及内容,强化中医基础知识在中药临床药学中的重要地位,不断完善中药临床药师基地建设和人才培养模式。结果：明确了学员的报名条件和培训目标,突出了药学、中药学和中医基础知识与临床的重要相互作用关系,并分析讨论基地建设与人才培养的局限性和不足。结论：中药临床药师是执行中药临床药学工作的主体,优化基地的培训体系和内容,丰富人才培养方案,解决问题与不足,本基地的工作内容可为中药临床药师的基地建设和人才培养提供参考。     

Venous thromboembolism in patients with liver diseases

Essentials

• Emerging evidence shows that patients with liver disease are not protected from thrombotic events.
• We assessed the risk of venous thromboembolism (VTE) in patients with liver disease.
• The presence of VTE resulted in an increase in mortality for patients with liver disease.
• Hospitalized patients with moderate‐severe liver disease had low risk of VTE during admission.

Summary

Background and Aims

Patients with liver disease were traditionally believed to be protected against development of blood clots, but some studies have shown a potential increased risk of venous thrombotic complications. We assessed the risk of venous thromboembolism (VTE) in patients with liver disease.

Methods

Data in discharge reports of patients with liver disease and control patients without liver disease were analyzed from the national inpatient sample. Incidence of VTE was compared in patients with mild, moderate‐severe or no liver disease, and the impact on in‐hospital mortality and length of stay was calculated.

Results

The overall incidence of VTE for patients with no liver disease, mild liver disease and moderate‐severe liver disease was 2.7, 2.4 and 0.9 per 100 patient discharges, respectively. In the presence of VTE, in‐hospital mortality was 10.8%, 5.8%, and 21.7% for the no liver disease, mild disease and moderate‐severe liver disease, respectively. The presence of VTE resulted in an increase in mortality for patients with no liver disease (OR, 1.16; 95% CI, 1.14–1.18) and moderate‐severe liver disease (OR, 1.63; CI 95%, 1.42–1.88).

Conclusions

Patients with moderate‐severe liver disease have a lower risk of VTE than those without liver disease. Development of thrombosis during admission increased the risk of in‐hospital mortality.

     

Variation near the hepatocyte nuclear factor (HNF)-4α gene associates with type 2 diabetes in the Danish population

Aims/hypothesis The hepatocyte nuclear factor (HNF)-4 is an orphan nuclear receptor, which plays crucial roles in regulating hepatic gluconeogenesis and insulin secretion. The gene encoding HNF-4 (HNF4A) is located on chromosome 20q12–q13 in a region that in several studies has shown linkage with type 2 diabetes. Recently, two independent studies identified single nucleotide polymorphisms (SNPs) in a 90-kb region spanning HNF4A, which showed strong association with type 2 diabetes in the Finnish and Ashkenazi Jewish populations. In an attempt to replicate and extend these findings, we selected four SNPs in the same HNF4A region, which in the Finnish and Ashkenazi Jewish populations were associated with type 2 diabetes, and examined their relationships with type 2 diabetes and prediabetic phenotypes in the Danish Caucasian population.Methods The rs1884614, rs2425637, rs1885088 and rs3818247 were analysed in case-control studies of 1387, 1429, 1417 and 1371 type 2 diabetic patients and 4766, 4727, 4665 and 4748 glucose-tolerant subjects respectively. Genotype–quantitative trait analyses comprised 4430, 4394, 4336 and 4413 middle-aged glucose-tolerant subjects from the population-based Inter99 cohort for the rs1884614, rs2425637, rs1885088 and rs3818247 respectively.Results The risk allele of the rs1884614, which is located 4 kb upstream of the HNF4A P2 promoter, was associated with type 2 diabetes (odds ratio [OR]=1.14, p=0.02) and with a subtle increase in post-OGTT plasma glucose levels in glucose-tolerant subjects (additive model, p=0.05).Conclusions/interpretation Consistent with results from studies of Finnish and Ashkenazi Jewish subjects, variation near the P2 region of HNF4A is associated with type 2 diabetes in the Danish population.