上海市部分空调系统微生物污染状况的初步调查

[目的]了解当前上海地区空调系统微生物污染情况，更好地控制空调环境的卫生状况。[方法]采用多阶段随机抽样方法，对上海市不同类型空调系统进行横断面调查。选取上海市闵行、闸北、浦东、静安、黄浦、长宁6个区中央及非中央两种类型的空调系统，对其过滤网、热交换器、空调冷却循环水中的细菌总数、霉菌总数以及军团菌、溶血性链球菌、金黄色葡萄球菌、芽胞杆菌等项目进行检测。[结果]中央空调冷却循环水在6月～9月份军团菌污染阳性率均在50％以上，10月份呈现明显下降趋势；在各种不同类型的公共场所中，地铁站、医院、商场酒店的军团菌阳性率均在55％以上；不同类型空调系统过滤网、热交换器的细菌总数、霉菌总数及军团菌、溶血性链球菌、金黄色葡萄球菌检出率均较低，而芽胞杆菌检出率高。[结论]上海市中央空调冷却水军团菌污染状况严重，而不同类型空调系统过滤网、热交换器的卫生状况相对较好。     

噪声习服对听觉损伤保护作用

目的探讨噪声习服对听觉损伤的保护作用。方法取健康成年豚鼠40只，随机分为正常对照组、噪声习服组、噪声损伤暴露组和噪声习服后损伤暴露组。建立噪声习服实验动物模型。采用听觉电生理测试和耳蜗基底膜铺片的方法，分别测定听性脑干反应（ABR）阈值及毛细胞缺失率的变化。结果噪声习服暴露对其后强噪声损伤暴露引起的听力损失产生了13dB的保护作用。耳蜗基底膜铺片显示，本实验中暴露引起的毛细胞缺失较明显，习服后损伤暴露组与直接损伤的暴露组相比基底膜第Ⅰ、Ⅱ圈的毛细胞缺失减少。结论采用适宜的噪声暴露参数，噪声习服暴露可对其后强噪声损伤暴露引起的听力损失产生保护作用。噪声暴露引起的毛细胞形态学改变包括细胞缺失和非致死性细胞损伤。噪声习服暴露后减少其后强噪声损伤暴露引起的毛细胞缺失。     

经方临床运用的几个问题

经方为群方之冠 ,是方剂的鼻祖。临床运用经方要掌握几个关键问题 :1.辨识病机 ,不拘病名 ;2 .突出主症 ,参合佐症 ;3.确定病位 ,落实脏腑 ;4 .伤寒治法 ,有常有变 ;5 .深究方规 ,抓住主方 ;6 .化裁经方 ,扩大运用。要真正探讨经方的奥秘 ,还应当深入读好《伤寒论》,在学中用 ,在用中学。     

经典名方中玄参的本草考证

通过查阅历代本草、医籍、方书及近现代文献资料，对经典名方中所用饴糖的名称、品种、原料及制作工艺进行了考证，为含有饴糖的经典名方开发利用提供依据。经考证可知，饴糖之名历代多源于其形态、质地、制法、原料及产地。古代所用饴糖根据质地不同，主要分为软、硬两类，湿软如蜜者称为“饴”或“胶饴”，质硬色白的则称为“饧”“糖”，现代则多称为麦芽糖，入药仅用胶饴，饧则多作食用；历代药用胶饴推崇糯米（来源于Oryza sativa var. glutinosa）为原料，以大麦Hordeum vulgare制蘖，经过发酵、煎煮、浓缩制备而成，而粟米（来源于Setaria italica var. germanica）、黍Panicum miliaceum等其他谷物为原料制成的饴糖品质次之。2020年版《中华人民共和国药典》未收录饴糖，收载了药用辅料麦芽糖，为纯度较高的结晶粉；但国家食品标准与地方炮制规范中收录了饴糖。基于考证结果，建议经典名方开发中所用胶饴可参考GB/T 20883—2017中的麦芽糖浆，并明确以糯米、大麦为原料。     

Distortion-product Otoacoustic Emissions Study of the Noise-induced Toughening Effect in Rats

Objective—To compare the toughening effects in rats induced by pure tones and a broadband noise (BBN). Material and Methods—Sprague–Dawley female albino rats (n=148; 8–10 weeks old) were used. Three experimental groups were established as follows. Toughening only: 38 rats, divided into 3 subgroups, were exposed to different conditioning sounds (2 and 4 kHz and a BBN of 0.25–6 kHz, respectively) at 75–85 dB sound pressure limit (SPL) for 8 h/day for 10 days. Acoustic trauma only: 54 rats, divided into 3 subgroups, were exposed to different conditioning sounds as above for 24 h at 100–110 dB SPL. Toughening plus acoustic trauma: 56 rats, divided into 3 subgroups, were exposed to different conditioning sounds as above, followed 8 h later by traumatic exposure to the conditioning sound at 110 dB SPL for 24 h. 2f1–f2 distortion-product (DP) otoacoustic emission measurements were obtained from the right ear of each animal pre-exposure, immediately post-exposure and after 8 h of the traumatic or conditioning exposure. Results—In our control DPgram response, the maximum amplitude occurred at the highest frequencies (2, 3, 4, 5 and 6 kHz). No statistical differences between the control DPgram and the DP toughening (2 and 4 kHz and BBN) responses were found. Only 2 and 4 kHz frequencies induced a protective effect against traumatic sound exposures to the same frequencies, and this finding was statistically significant. Conclusion—The toughening phenomenon induced using 2 and 4 kHz pure tones and BBN in rats does not modify the DPgram response. Nevertheless, only 2 and 4 kHz frequencies induce a protective effect against traumatic sound exposures to the same frequencies.     

乌梅丸治疗更年期崩漏的临床观察

目的探究乌梅丸治疗更年期崩漏的临床疗效。方法选择2017年3月—2019年11月收治的52例更年期崩漏患者,以随机数字表法分为治疗组和对照组,每组26例。对照组给予乙烯雌酚2 mg/d和醋酸甲羟孕酮片10 mg/d,治疗组给予乌梅丸治疗。观察2组患者治疗效果及治疗前后汉密尔顿焦虑量表(HAMA)及汉密尔顿抑郁量表(HAMD)评分变化情况。结果治疗组的治疗总有效率高于对照组(P<0.05),且治疗组治疗后的HAMA、HAMD评分均低于对照组(P<0.05)。结论乌梅丸可有效改善更年期崩漏患者的临床症状,缓解患者负面情绪,临床应用价值较高,值得推广。     

侯春光主任中医师运用经方治疗小儿情志类疾病经验

侯春光主任中医师善于应用经方治疗小儿情志类疾病,侯老师临证强调审察病机,随证施治,方证对应,附小儿抽动障碍、精神性烦渴症、睡眠障碍、擦腿综合征4则验案,以资验证。     

State of the Art of Drug Treatment of Schizophrenia and the Future Position of the Novel/Atypical Antipsychotics

Summary: Neuroleptic medication is the most important part of the treatment regimen for schizophrenic patients. The efficacy of neuroleptics in the acute and long-term treatment of schizophrenia is very well proven and the effect size is comparatively high. After more than 40 years of clinical practice with the classical neuroleptics, several more or less generally accepted rules for the management of drug treatment in schizophrenia have been established. The paper aims to describe these standards, discussing, among other things, developments which have appeared in the last 10 to 20 years, e.g. the tendency to a lower daily dose during acute treatment and the tendency to alternative strategies during long-term treatment. The paper especially also takes into consideration the benefits of the novel/atypical antipsychotics as compared to the classical neuroleptics, which will change the current treatment standards under several aspects — a change which is already ongoing. The novel/atypical antipsychotics will be much better accepted by patients, thus leading to increased compliance, will be associated with a better quality of life and will possibly change the long-term outcome of schizophrenic patients in a very important manner. It should be considered that the so-called novel/atypical neuroleptics do not constitute a homogeneous group but are a group of individual drugs, each with their own advantages and disadvantages. As was the situation with the classical neuroleptics, the physician also has to choose the most adequate drug under consideration of the risk/benefit profile of each drug in relation to the disposition of the individual patient.