中医药治疗功能性消化不良现状述评

文章从古代著作探讨功能性消化不良（Functional Dyspepsia,FD）的中医病名。FD 的发病与饮食、外邪内居及精神因素有关,病位主要在肝脾胃三脏,肝郁、脾虚及胃气不降为 FD 主要的病机关键,但目前对 FD 的病机演变规律研究深入不足。FD 的治疗有辨证分型、专法专药,以及辨病辨证相结合等,但缺乏严谨有效的评价体系,对患者生活质量也不够重视。     

针刺十宣、小海穴配合功能训练治疗中风后手功能障碍疗效观察

目的观察针刺以十宣、小海穴为主穴治疗中风后患者手功能障碍的临床疗效。方法将165例中风后手指不能活动的患者随机分为治疗组85例和对照组80例。治疗组患者上肢在常规针刺取穴基础上加用十宣、小海两穴,对照组患者上肢采用常规针刺取穴,针刺结束后两组均进行上肢的功能训练,分别于治疗前、3个疗程后采用神经功能缺损评分标准的手指功能（肌力）记分和Fugl-meyer功能量表中手功能的评分进行评估。结果治疗组治疗3个疗程后手指肌力和手功能恢复方面明显优于对照组（均P〈0.05）。结论针刺十宣、小海穴配合功能训练是一种治疗中风后手功能障碍的有效方法。     

学龄儿童功能性腹痛的临床特点分析与治疗

目的：探讨分析学龄儿童功能性腹痛的临床特点与治疗方法及效果。方法选取2012年1月～2013年12月间收治的100例功能性腹痛学龄儿童（6岁～12岁）,随机分为观察组和对照组各50例。观察组给予化积颗粒治疗,对照组给予消旋山莨菪碱片治疗,分析两组患儿的临床特点,观察比较两组患儿的疗效和安全性。结果学龄儿童功能性腹痛的临床特点为男性少于女性（40/60,1∶1.5）,6～7岁患儿多于8～12岁（65/35,1.86∶1）,病程多为2～3个月;观察组治疗后在总有效率、中医症候评分、不良反应发生率方面均明显优于对照组,差异具统计学意义（P＜0.05）。结论学龄儿童功能性腹痛的临床特点为多为女性患儿,年龄在6～7岁患儿,病程在2～3个月。给予化积颗粒治疗的疗效显著,安全性高。     

精神心理因素与功能性消化不良关系的研究进展

功能性消化不良（funtional dyspepsia,FD）是临床常见的疾病,近年来发现精神心理因素与功能性消化不良发病密切相关。本文就对FD与精神心理因素的关系以及FD目前的治疗现状作一简短的综述。     

功能锻炼配合青鹏膏外用治疗轻度肩关节周围炎随机对照研究

目的：观察功能锻炼配合青鹏膏外用治疗轻度肩关节周围炎的疗效。方法：将200例轻度肩周炎患者,随机分为功能锻炼配合青鹏膏外用治疗组和单纯功能锻炼对照组各100例。治疗组在局部外用青鹏膏后,进行双手爬墙、挽背健手拉患手及前屈患手摸对侧耳朵锻炼,2次/d,每次以上3个锻炼动作各作10次,30d为1个疗程。对照组单纯进行锻炼,疗程同治疗组。采用肩关节周围炎疗效评定量表观察治疗前后2组患者的肩关节疼痛评分、肩关节日常活动评分及日常生活能力评分。结果：2组患者肩关节疼痛评分、肩关节活功能评分及日常生活能力评分治疗后均较治疗前提高,差异均有统计学意义（治疗组P〈0.01,对照组P〈0.05）,治疗后组间比较,治疗组较对照组提高更明显,差异亦具有统计学意义（肩关节疼痛评分P〈0.01,肩关节活动功能及日常生活能力评分P〈0.05）。结论：功能锻炼配合青鹏膏外用治疗轻度肩关节周围炎疗效显著。     

音乐声波按摩治疗改善功能性消化不良患者心身症状的临床探讨

目的:探讨音乐声波按摩治疗对功能性消化不良(functional dyspepsia,FD)患者心身症状的改善作用。方法:选取消化内科门诊符合RomaⅡ标准并签署知情同意书的FD患者23例,停药后,采用两周6次的音乐声波按摩治疗进行干预。干预前后应用症状自评量表(SCL-90)和功能性消化不良症状自测量表进行量化评估。结果:治疗后FD症状量表和SCL-90总分显著低于治疗前(P<0.01),FD症状量表的总有效率为82.61%,SCL-90的总有效率为60.87%。除反酸症状外,干预后FD患者其他胃肠道症状评分较干预前明显降低(P<0.01或P<0.05)。SCL-90因子分测评结果显示,除恐惧因子外,干预后FD患者心理症状评分明显低于治疗前(P<0.01或P<0.05)。结论:音乐声波按摩治疗可改善FD患者的心身症状。     

舒胃汤对功能性消化不良大鼠胃排空、血清NO、血浆SP的影响

目的:探讨舒胃汤对功能性消化不良大鼠胃排空、血清一氧化氮(nitric oxide,NO)和血浆P物质(Substance P,SP)的影响。方法:将大鼠随机分为舒胃汤低剂量组(舒低组)、舒胃汤高剂量组(舒高组)、中成药组(木香顺气丸组)、莫沙必利组、空白组、模型组。采用夹尾刺激方法制造FD模型。实验结束后检测胃排空,硝酸还原酶法检测血清NO含量,用放射免疫法检测血浆SP水平。结果:大鼠模型组与空白组比较胃排空延迟,血浆SP含量明显减少而NO明显升高(均P0.05)。给药各组大鼠与模型组比较胃排空(%)改善(均P0.05),NO(μmol/L)降低(均P0.05),SP含量(pg/mg)明显升高(均P0.05);舒高组与中成药组,胃排空改善(P0.05),NO降低(P0.05)。结论:舒胃汤能够促进胃排空,调节血清NO、SP水平的变化,可能是舒胃汤治疗FD恢复胃肠道运动功能的作用机制之一。     

The intergenerational sources of the U-turn in gender segregation

In the early 1970s, the balkanization of the US labor market into “men’s occupations” and “women’s occupations” began to unravel, as women entered the professions and other male-typed sectors in record numbers. This decline in gender segregation continued on for several decades but then suddenly stalled at the turn of the century and shows no signs of resuming. Although the stall is itself undisputed, its sources remain unclear. Using nearly a half-century of data from the General Social Survey, we show that a resurgence in segregation-inducing forms of intergenerational transmission stands behind the recent stall. Far from serving as impartial conduits, fathers are now disproportionately conveying male-typed occupations to their sons, whereas mothers are effectively gender-neutral in their transmission outcomes. This segregative turn among fathers accounts for 47% of the stall in the gender segregation trend (between 2000 and 2018), while the earlier integrative turn among fathers accounts for 34% of the initial downturn in segregation (between 1972 and 1999). It follows that a U-turn in intergenerational processes lies behind the U-turn in gender segregation.

In all late-industrial countries, women and men continue to occupy very different types of jobs, with women concentrated in service and nurturing occupations (e.g., sales clerk and nurse) and men concentrated in manual and analytic occupations (e.g., laborer and computer scientists). The standard sociological account of such segregation treats it as a premodern relic that should gradually disappear as educational opportunities are equalized, egalitarian gender attitudes diffuse, overt and covert forms of employer discrimination are rooted out, and family-friendly workplaces and related labor market reforms are instituted (1, 2). Between 1970 and 1990, these types of institutional reforms indeed seemed to be bearing fruit, with most late-industrial countries experiencing sharp declines in segregation (3).This egalitarian turn proved to be short-lived. By the end of the 20th century, the decline in gender segregation had stalled in many late-industrial countries, including the United States (4–7). In Fig. 1, we present the US trend using the General Social Survey (GSS), the main data source for our analyses (8). The trend lines in Fig. 1 reveal that the downturn stalled well before integration was achieved (and Fig. 1B additionally suggests a resegregative uptick off this already high baseline). To completely eliminate segregation, ∼60% of US workers would have to shift to a different occupation, a stark result given the stated commitment to gender equality and equal opportunity in the United States. This hypersegregation translates into profound gender gaps in pay, authority, working conditions, and much more (9–12). Because occupational segregation generates such a wide range of unequal outcomes, it has become a conventional policy target among those who seek to reduce gender inequality.Open in a separate windowFig. 1.The U-turn in occupational gender segregation shown by (A) the index of dissimilarity and (B) a margin-free measure of the gender-by-occupation association. Analysis is based on the 1972 to 2018 GSS using women and men in the labor force, ages 25 to 64 (inclusive), with nonmissing data on age, gender, and occupation. n = 44,640. Occupations are coded with 1970 Census Occupational Classification (see SI Appendix, Appendixes B and D, for details). Trend is smoothed with locally smoothed regression (LOESS) with the span set at 0.75. For the definition of D and A, see Materials and Methods.The long line of research on the sources of the stall proceeds in part from this widely shared (albeit not universal) commitment to reduce gender inequality. Although far from conclusive or exhaustive, the available research suggests that 1) the persisting double burden of domestic work erodes the willingness or capacity of women to hold jobs that entail long hours or overwork (12–14); 2) the persistence of norms against women outearning their partners (in marriages between women and men) leads to settling and underachievement (15); 3) the persistence of essentialist beliefs about the types of occupations that women and men are qualified to undertake locks in a conventional division of labor (1, 16, 17); and 4) the continuing tendency of employers to discriminate against mothers (18) and those who participate intermittently in the labor force (19, 20) makes it difficult for women to break into male-typed occupations.^* Across these assorted supply-side and demand-side accounts, a common theme is that the easy desegregative gains have been creamed off, that a new equilibrium or natural rate (22) has been reached, and that puncturing this equilibrium may require different or more aggressive countermeasures.This interpretation rests on a distinction between 1) overt and easy-to-attack inequalities and 2) covert and difficult-to-attack inequalities. It is often argued, for example, that overt forms of hiring discrimination against women can be reduced through antidiscrimination law and open hiring practices, whereas subtler or covert forms are not as easy to address, at least with legal remedies. Likewise, the extreme essentialist view that women are utterly lacking in rational faculties was an early casualty of the gender revolution, whereas it has proven more difficult to root out a subtler form of essentialism that presumes that men are more likely than women to be “brilliant” or “geniuses” (23). By this logic, the gender revolution will only be reenergized by developing new interventions that are fine-tuned for the subtler, albeit still very consequential, mechanisms that lie behind gender inequality.This conclusion may well be warranted. It would, however, be premature to adopt this interpretation without a fuller understanding of the institutional sources of the stalling out. It is striking in this regard that none of the foregoing accounts directly features the role of intergenerational processes. To be sure, conventional accounts routinely invoke the segregative effects of gender-biased training, norms, and culture, but the social processes through which gender-biased training is delivered or gender-biased norms and culture are instilled are left unclear and thus may or may not have intergenerational sources. This is an unfortunate omission because it undermines our capacity to remediate well. As it stands, most currently popular interventions do not target intergenerational processes (24), an understandable state of affairs given that relatively little is now known about their role in the stalling out.There is, then, a worrying omission in our research on the gender U-turn. Although this omission might seem surprising, it has to be remembered that the contemporary family is often seen as a prime carrier of new forms of gender egalitarianism and accordingly an unlikely source of the stalling out. The new gender-egalitarian family features mothers who are increasingly likely to work, to commit to bona fide careers, and to espouse liberal attitudes (25). In this conventional characterization of familial change, it is notable that mothers are represented as a main force for change, whereas fathers remain in the background largely carrying on. This raises the possibility that fathers may not always be unfettered agents of egalitarian change and may, to the contrary, be implicated in the stalling out. The purpose of our paper is to explore this segregative-father hypothesis by melding models of segregation and intergenerational transmission.The results will show that the U-turn in the segregation trend is indeed linked to a U-turn in intergenerational processes. As we will discuss, a variety of mechanisms may lie behind the rise of segregative reproduction, yet most of them involve familial processes in some fashion. It follows that insofar as desegregation is a policy objective, it may be strategic to build interventions that address contemporary family processes.The two streams of mobility research upon which our analysis will capitalize are those examining 1) the net effects of mothers and fathers on outcomes and 2) the effects of intragenerational mobility on segregation. The first of these two streams is of course especially relevant when examining the intergenerational sources of segregation (26, 27). In recent decades, there has been a backlash against treating the father’s or “family head’s” occupation as a satisfactory measure of class origins (28), a long-overdue development given that a rising share of children are now growing up in more complicated families with many potential role models (29, 30). This newer line of multiple-parent mobility research has, however, focused mainly on examining the relative size of the effects of mothers and fathers, a type of “horse race” analysis that comes naturally when one seeks to rectify decades of scholarship that ignored mothers altogether. As important and influential as this research is, it cannot directly answer the research question that we are taking on, given that the implications of this horse race for occupational segregation depend on the extent to which class and gender-typing reproduction come together. To understand how intergenerational transmission contributes to gender segregation, we need to know 1) whether mothers are passing on female-typed occupations disproportionately to daughters and 2) whether fathers are passing on male-typed occupations disproportionately to sons. Although the intergenerational transmission of gender-typed aspirations is well understood (31, 32), our research takes the next step of building gendered mobility models that uncover whether actual reproductive practices are affected by the gender of the parent, the gender typing of the occupation, and the gender of the offspring (33).The second stream of mobility research relevant to our analysis examines the effects of intragenerational mobility on gender segregation (34). This line of research, which has a long history (35), examines how women and men move in and out of the labor force over their career, how women and men move in and out of gender-typed occupations over their career, and how such mobility has gendered sources (e.g., sexual harassment, gender discrimination, and the “second shift”). Within this literature, many scholars (36) have examined whether the gender of managers affects hiring and promotion decisions (and hence downstream segregation), a line of questioning that is formally similar to our own interest in whether the gender of the parent affects occupational outcomes. Because parents are engaged in ongoing socialization, aspiration development, human capital investment, and network provisioning, their effects on segregation may well be more consequential than the pinpoint hiring and firing decisions of managers. This is the core rationale for building intergenerational processes into a segregation trend analysis.     

Ethinyl estradiol 20 μg/drospirenone 3 mg 24/4 oral contraceptive for the treatment of functional impairment in women with premenstrual dysphoric disorder

Objective

To determine the effects of ethinyl estradiol (EE)/drospirenone in a 24/4 regimen (24 days of active and 4 days of inactive pills) on functional impairment (affecting work, partnership, and social activities) in women with premenstrual dysphoric disorder (PMDD).

Methods

The present study was a secondary analysis of a double-blind, randomized, parallel-design multicenter trial. Women received EE 20 μg/drospirenone 3 mg (n = 232) or placebo (n = 218) and completed the Daily Record of Severity of Problems (DRSP) scale daily.

Results

The decrease in mean scores for all 3 DRSP functional impairment items (work, partnership, and social activities) from baseline to cycle 3 mirrored changes in the total DRSP symptom score; the greatest decreases were observed in cycle 1 with further small reductions through to cycle 3. The proportional mean decreases from baseline to cycle 1 for the 3 functional items ranged from 47% to 48%. For all 3 functional items, the mean reductions from baseline to cycle 1 (but not from cycle 1 to cycles 2 and 3) were significantly greater with EE/drospirenone than with placebo (P < 0.05).

Conclusion

Ethinyl estradiol 20 μg/drospirenone 3 mg in a 24/4 regimen significantly improved functional impairment in women with PMDD. Symptoms improved in parallel.     

鼻窦可吸收类固醇缓释植入系统在儿童鼻内镜手术中的初步应用

目的观察鼻窦可吸收类固醇缓释植入系统在儿童鼻内镜手术(FESS)中应用的安全性和有效性。方法我科收治的4~13岁慢性鼻窦炎合并鼻息肉患儿20例,均为单侧发病。将其随机分为观察组和对照组,每组各10例,均行FESS。观察组术中于术腔置入鼻窦类固醇药物缓释支架。术后随访半年,采用视觉模拟量表、Lund-Kennedy评分法进行症状和术腔黏膜评估。结果观察组均成功置入药物缓释支架。术后随访至6个月时,观察组所有患儿症状均较术前明显改善(P<0.05),术后介入率较对照组显著降低(P=0.039),均未见复发。所有支架均被完全吸收。结论儿童FESS中应用类固醇缓释植入物安全、有效。