郭为汀运用自拟方治疗痹证经验

郭为汀老师将痹证分为风痹、寒痹、湿痹、湿热痹、气血肝肾亏虚痹、痰瘀痹阻痹六大型,应用自拟经验方,分别以祛风除痹汤、散寒除痹汤、化湿除痹汤、清热利湿宣痹汤、养血补肾除痹汤、龙凤蠲痹汤结合食疗外用方,疗效显著。     

永乐店社区农村妇女乳腺癌和宫颈癌筛查结果分析

目的：分析永乐店社区农村妇女乳腺癌和宫颈癌筛查结果,找出本地区妇女乳腺癌和宫颈癌发病规律。针对高危人群进行早期筛查,早期治疗,早期干预,以进一步降低乳腺癌和宫颈癌的发生率。方法对永乐店社区服务中心2009年～2013年3次两癌筛查的结果分析,将宫颈癌筛查人群分3个年龄段,分别对异常涂片进行统计分析。将乳腺癌筛查人群分为2个年龄段,从乳腺癌患病人数及患病率进行统计分析。结果在宫颈癌筛查中,25～40岁年龄段组,宫颈上皮内瘤变（CIN）平均检出率161.74/10万,宫颈癌平均检出率为0/10万;41～55岁年龄段组, CIN检出率平均为712.17/10万,宫颈癌平均检出率90.77/10万;56～65岁年龄段组,CIN检出率平均为191.62/10万,宫颈癌检出率平均为0/10万;41～55岁年龄段组的检出率明显高于其他年龄段组,差异具统计学意义（P＜0.05）。乳腺癌在35～49岁年龄段组,3次筛查平均检出率20.37/10万;在50～59岁年龄段组,3次筛查平均检出率平均为154.22/10万;50～59岁年龄段组平均检出率明显高于35～49岁年龄段组,差异具有统计学意义（P＜0.05）。结论宫颈癌及CIN在41～55岁为高发年龄段,乳腺癌在50～59岁为高发年龄段。定期对农村妇女进行筛查尤其是高发年龄段的筛查能有效降低两癌的发生率,节约医疗资源。     

宋代陈晔及《家藏经验方》考

南宋官员陈哗,字日华,福州长乐人,约生于宋绍兴年间,卒于端平年间,历任将仕郎、临汀知州、广东提刑、四川总领、删定、书林等职,亦曾于通州、沅州等地任职,著有《古灵先生年谱》1卷、《谈谐》1卷、《诗话》1卷、《金渊利术》8卷、《夷坚志类编》3卷、《（增广）琐碎录》、《家藏经验方》5卷,主持编撰《鄞江志》8卷,刊行方导《家藏集要方》2卷,另有诗词散文等。《家藏经验方》为陈哗所编撰的一部方书。此书已佚,《妇人大全良方》、《寿亲养老书》、《普济方》、《永乐大典》中有其佚文74条。     

高效液相色谱法测定青果丸中芍药苷的含量

目的：建立高效液相色谱法测定青果丸中芍药苷含量的方法。方法：对样品的提取条件和色谱条件进行方法学研究。采用C18柱，流动相为乙腈-0．Olmol／L磷酸水溶液(13：87)，检测滤长为230mm。结果：芍药苷浓度在0．50～2．50μg范围内，峰面积与进样量呈良好线性关系，回归方程Y=157．4X 12．87，r=0．9996，平均回收率为98．78％，RSD=2．43％。结论：本法提取方法简便、准确，可作为该制剂的定量方法。     

青年冠心病患者危险因素与冠状动脉病变程度的关系

目的 :探讨国人 40岁以下冠心病患者危险因素与其冠状动脉 (冠脉 )病变程度之间的关系。方法 :根据冠状动脉造影结果将 10 8例 40岁以下 (含 40岁 )行冠脉造影者分为冠心病组 (6 2例 )和非冠心病组 (4 6例 ) ,进行危险因素调查并加以分析。结果 :男性患者多支病变多于女性 (5 8%vs 2 9% ,P <0 .0 5 ) ,冠脉病变积分高于女性 (12 .84± 5 .47vs 17.5 3± 3.16 ,P <0 .0 5 ) ,Logistic回归分析显著冠心病家族史、血浆总胆固醇水平及男性性别为冠心病的独立危险因素 ,其比值比 (OR)分别为 3.99(95 %CI 1.39～ 11.5 2 ) ,2 .0 9(95CI 1.30～3.48)和 2 .15 (95 %CI 1.16～ 3.86 ) (P =0 .0 11～ 0 .0 0 4) ;冠脉病变积分与冠心病家族史、血总胆固醇水平及男性性别呈正相关 ,r分别为 0 .36 7,0 .416和 0 .391,P均 <0 .0 5。结论 :冠心病家族史、血浆总胆固醇水平及男性性别对青年人冠心病的发生、发展有着重要促进作用。     

Incidence of Interpersonal Violence among Individuals with Drug Addiction Receiving Compulsory Treatment: A Survey at Two Drug Detention Centers in Hunan,China

正Drug dependence is a serious global health problem.To assist individuals with drug addiction,China alone has established 678 Compulsory Detoxification Detention Centers (CDDCs) that treat over300,000i ndividuals who are required by national law to receive compulsory treatment~([1])because community-based outpatient treatment failed.     

郭勇教授中西医配合辨治肠癌经验

目的：近年来,肠癌的发病率逐年上升,严重影响患者生活质量,笔者有幸跟随郭勇教授,将其诊治肠癌经验与临床文献研究进展结合作一个总结探讨。方法：将郭勇教授多年来诊治的肠癌患者病例收集、整理,剖析并归纳其遣方用药特点,并与郭师探讨交流其辨病辨证思想,将其首创的肿瘤中医治疗应遵循“四阶段、一盲区、二弱点”理念深入解析并与肠癌的治疗融合。将中医与西医在肠癌治疗过程中的角色比重与转变作一个深入且系统的归纳。结果：肿瘤从发生、发展、演变直至归宿存在围手术期、辅助治疗期、随访期和姑息治疗期4个不同的阶段。通过对四个阶段疾病侧重的把握,灵活转换中西医治疗的角色比重,从而使肠癌患者阴平阳秘,达到延长生存时间,提高生活质量的最终目的。结论：中医与西医绝不是一个相互对立的关系,而是应该相互配合,相辅相成。在肠癌的治疗中,郭师中西医配合四阶段治疗肠癌的观点取得了显著疗效。     

Development of an Easy-to-Use Visual Aid for the Prediction of Body Fat Based on Waist Circumference and Height in Asian Chinese Adults

BackgroundAdiposity is a major risk factor for metabolic and cardiovascular diseases. Initial prediction equations to estimate adiposity are complex, requiring skinfold measurements that cannot be obtained conveniently by the general population.ObjectiveTo develop simplified prediction equations to estimate body fat percentage (%BF) in Asian Chinese adults, evaluate the validity of the simplified %BF prediction equations, compare the simplified %BF prediction equations with an existing equation, and create visual charts to enable easy assessment of adiposity by the general public.DesignSimplified prediction equations were developed and evaluated for validity using anthropometric measurements obtained from a cross-sectional study.Participants and settingHealthy participants with no major diseases and not taking long-term medications were recruited in a cross-sectional study conducted at Clinical Nutrition Research Centre, Singapore, between June 2014 and October 2017. A total of 439 participants were used for model building (269 women and 170 men) and another 107 participants were used for evaluating validity (62 women and 45 men).Main outcome measuresSimplified but acceptable prediction models and generation of user-friendly charts.Statistical analyses performedSimplified sex-specific %BF prediction equations were developed using stepwise regression and the model-building dataset. The best models were selected using the Akaike information criterion. The models were further simplified and their performance was compared using the validation dataset before choosing the final prediction equations.ResultsThe final selected models for women and men included waist circumference and height with nonsignificant prediction bias in %BF of 0.84%±3.94% (P=0.098, Cohen’s d_z=0.21) and –0.98%±3.65% (P=0.079, Cohen’s d_z=0.27), respectively. The final equations were split into three height categories from which the sex-specific prediction charts were generated.ConclusionsThe sex-specific prediction charts provide a good visual guide for estimating %BF using height and waist circumference values that are easy to obtain by the general public.     

Evaluation of ompK36 allele groups on clinical characteristics and virulence features of Klebsiella pneumoniae from bacteremia

Background/purposeThis study investigated the implications of ompK36 allele groups on clinical and microbiological features of patients with Klebsiella pneumoniae bacteremia.MethodsA total of 80 K. pneumoniae bloodstream isolates were collected and then divided into four ompK36 allele groups. Clinical characteristics, bacterial antibiotic resistance and virulence determinants were analyzed, including resistance and virulence genes, hypermucoviscosity phenotype, K capsule serotypes, biofilm formation, serum killing, neutrophil phagocytosis, and mouse lethality studies.Results78 isolates were classified into four ompK36 variants, designated groups A (34), B (6), C (26), and D (12), respectively; 2 isolate was untypeable. OmpK36 group C isolates carried higher frequencies of K1/K2 capsule serotypes, hypermucoviscosity phenotype, rmpA gene, allS gene, iroB gene, aerobactin gene, or rmpA2 gene than non-C group isolates. OmpK36 group C isolates were significantly more virulent, as higher serum resistance, higher anti-phagocytosis and higher mouse lethality, than OmpK36 non-C group isolates, except for similar biofilm formation capability. The K20 isolates probably has low expression rates of rmpA and rmpA2 for hypermucoviscosity phenotype. The biofilm formation was significantly associated with ESBL production. OmpK36 group C isolates were more frequently detected in patients with community-acquired bloodstream infection. However, significant underlying diseases and prior use of carbapenem were highly prevalent in patients with OmpK36 non-C group isolates infection. ESBL production was apparently higher in non-C group but did not reach statistical significance.ConclusionOur results suggest that the OmpK36 group C K.pneumoniae is more associated with community-acquired infection with a lower frequency of underlying illness, but with significantly more virulence in bloodstream infection. This would give a remind that clinicians should be aware of such clinical impacts of the ompK36 allele group.     

Thrombolysis for atlantoaxial dislocation mimicking acute ischemic stroke

The frequency of stroke mimics among stroke patients has been reported to be up to 30%, and that in patients who receive thrombolytic therapy ranges between 1% and 16%. Atlantoaxial dislocation with myelopathy mimicking stroke is extremely rare. An 83-year-old man with a history of old cerebellar infarction presented to the emergency department with acute left hemiplegia after a chiropractic manipulation of the neck and back several hours before symptom onset. Mild hypoesthesia was observed on his left limbs. No speech disturbance, facial palsy, or neck or shoulder pain was observed. Intravenous thrombolytic treatment was given 238 min after symptom onset. Brown–Sequard syndrome subsequently developed 6 h after thrombolysis with a hypoesthetic sensory level below the right C5 dermatome. An emergent brain magnetic resonance angiography did not reveal an acute cerebral infarct but rather an atlantoaxial dislocation causing upper cervical spinal cord compression. Clinical symptoms did not deteriorate after thrombolysis. He received successful decompressive surgery 1 week later, and his muscle power gradually improved, with partial dependency when performing daily living activities 2 months later. A literature review revealed that only 15 patients (including the patient mentioned here) with spinal disorder mimicking acute stroke who received thrombolytic therapy have been reported. Atlantoaxial dislocation may present as acute hemiplegia mimicking acute stroke, followed by Brown–Sequard syndrome. Inadvertent thrombolytic therapy is likely not harmful for patients with atlantoaxial dislocation-induced cervical myelopathy. The neurological deficits of patients should be carefully and continuously evaluated to differentiate between stroke and myelopathy.