《金匮要略》“身痛如被杖”相关问题探讨

[目的] 分析《金匮要略·阴阳毒》“身痛如被杖”的含义，以更好地理解仲景所述之意。[方法] 通过采用传世文献与出土文物考证相结合的研究方式，结合文字学、历史学角度探讨，并附医案一则。[结果] “身痛如被杖”是时人描述切身体会的生动表达。“杖”可理解“凡可持之物皆曰杖”，“被杖”分皮肤肿起，出现瘀伤；出现损伤；殴打致死这三种情况。痛感可能是外伤(皮肤肌肉)之痛，也可能是内伤(脏腑受伤)之痛。升麻鳖甲汤总以解毒散邪活血为主，气血兼顾。[结论] 在仲景所属时代，“身痛如被杖”有一定的区分度，表现在施杖方式及痛感等的区分。通过文献与文物考证相结合的方式探讨“身痛如被杖”，更能直观体会当时社会背景下仲景所要表达的含义，提供一个学习《金匮要略》的新方式。     

纳米羟基磷灰石/聚酰胺66支撑棒结合同种异体骨治疗ARCOⅢ期股骨头坏死

BACKGROUND: It remains controversial whether patients with ARCO stage III osteonecrosis of the femoral head should be treated with femoreal head preserving surgery, and what the clinical efficacy of femoreal head preserving surgery is.     

Prediabetes

The burden of diabetes is expected to rise from 415 million individuals in 2015 to 642 million individuals by 2040. Most individuals pass through a phase of prediabetes before developing full-blown diabetes. Insulin resistance, impaired incretin action, and insulin hypersecretion are central to the pathophysiology of prediabetes. Individuals older than 40 years of age and other high-risk individuals should be screened for diabetes with fasting plasma glucose and/or hemoglobin A1c. For those diagnosed with prediabetes, the goal of treatment should be restoring euglycemia, because there are data showing that restoring normoglycemia during prediabetes and early diabetes can produce lasting remission. The preferred approach for this is intensive lifestyle intervention, which besides reducing progression to diabetes, has also been shown to reduce all-cause mortality in a long-term follow-up study. The best evidence for a pharmacological approach is with metformin. Other drugs that have shown efficacy include thiazolidinediones, alpha-glucosidase inhibitors, orlistat, basal insulin, and valsartan. However, except for metformin, none of these drugs are currently recommended for this purpose. Newer agents such as glucagon-like peptide-1 agonists and dipeptidyl peptidase 4 (DPP-4) inhibitors also have considerable promise in this area. Bariatric surgery can be offered to patients with metabolic syndrome and body mass index of 30-35.     

关节镜辅助下髓芯减压植入复合自体骨髓的骨诱导材料联合钛棒支撑治疗Ⅱ期股骨头坏死

目的评估微创经皮关节镜辅助下髓芯减压植入复合自体骨髓的骨诱导材料联合钛棒支撑治疗Ⅱ期股骨头坏死可行性和临床疗效。方法将2003～2007年确诊的股骨头坏死国际骨科循环学会(ARCO)分期Ⅱ期38例46髋,Ⅱa期10髋、Ⅱb期22髋、Ⅱc期14髋;在C型臂透视定位及关节镜辅助下,经皮微创有效准确地进行髓芯减压,对髋关节腔内和股骨头内病变组织清除彻底,改善股骨头内外环境,植入复合自体骨髓的骨诱导材料,并用钛棒支撑股骨头软骨下骨质。术后6、12、24、36个月进行随诊,以Harris髋关节评分、X线片观察病变分期稳定性及临床疗效为评价指标。治疗前后比较采用Student成组设计Dunnett-t检验。结果术后除24个月这个时间段与12个月时相比较,评分指数改善不明显外,术后其余各时间段之间前后比较及与相对应的术前比较,差异均有统计学意义(P<0.05);手术前后X线分期比较,术后16～24个月有4例Ⅱb期进展为Ⅱc期,其中2例以后未恶化,另2例由Ⅱc期进展为Ⅲ期;原始Ⅱc期有2例髋术后24个月病变开始进展,股骨头塌陷,30个月后行全髋关节置换术(THA);术后总改善率为80.43%,Ⅱa期病变治疗改善最好(90%)...     

先天性脊柱侧凸术后远期疗效分析

比较先天性脊柱侧凸两种矫治方法术后远期疗效。对１９８５年９月－１９９８年９月本院采用单纯Ｈａｒｒｉｎｇｔｏｎ掌开棒或掌开棒与加压棒同时并用及植骨融合术治疗的５２例先天性脊柱侧凸进行了总结分析。     

Immunohistochemical localization of protein kinase C (PKC) beta I in the pig retina during postnatal development

In order to investigate the expression of protein kinase C (PKC) beta I in the retinas of pigs during postnatal development, we analyzed retinas sampled from 3-day-old and 6-month-old pigs by Western blotting and immunohistochemistry. Western blot analysis detected the expression of PKC beta I in the retinas of 3-day-old piglets and it was increased significantly in the retinas of 6-month-old adult pigs. Immunohistochemical staining showed PKC beta I in the retinas of both groups. Immunohistochemistry of 3-day-old retinas revealed weak PKC beta I reactivity in the ganglion cell layer, inner plexiform layer, inner nuclear cell layer, outer plexiform layer and rod and cone cell layer. In the 6-month-old pig retina, the cellular localization of PKC beta I immunostaining was similar to that of the 3-day-old retina, where PKC beta I was localized in some glial fibrillary acidic protein-positive cells, glutamine synthetase-positive cells, parvalbumin-positive cells, and PKC alpha-positive cells in the retina. This is the first study to show the expression and cellular localization of PKC beta I in the retina of pigs with development, and these results suggest that PKC beta I, in accordance with PKC alpha, plays important roles in signal transduction pathways in the pig retina with development.     

钽棒植入与骨瓣移植治疗成年人早期股骨头坏死的近期疗效对比

目的:比较髓芯减压联合金属钽棒植入术与带血管蒂髂骨瓣转移术治疗成年早期股骨头坏死(osteonecrosis of the femoral head,ONFH)的近期临床疗效.方法:回顾性收集本院2012年1月至2015年2月间收治的83例(97髋)非创伤性ONFH患者病历资料,A组43例52髋行髓芯减压并钽棒植入术,B组40例47髋,行自身带血管蒂髂骨瓣转移术,术后随访1年,比较两组手术参数指标、术后1年Harris髋关节功能评分及手术疗效.结果:A组手术时间(40.7±10.3) min、术中失血量(88.0±27.1) mL、术后镇痛泵应用时间(1.68±0.32)d、拆线天数(12.8±1.5)d均显著低于B组[(82.5±17.2) min,(239.4±45.2) mL,(2.15±0.48)d,(14.2±1.9)d;P＜0.05].两组术后12个月Harris总评分及各项目评分均较术前显著提高(P＜0.0s),A组术后Harris总评分(88.4±5.9)及关节功能评分(41.5±4.8)均显著高于B组[(83.6±5.3),(37.5±6.1);P＜0.05].两组术后12个月髋关节功能优良率均较术前显著提高(P＜0.05),A组术后12个月优良率(92.3％)显著高于B组(76.6％,P＜0.05).B组有1例出现髓塌陷,A组无髓塌陷病例.结论:髓芯减压联合金属钽棒植入术较带血管蒂髂骨瓣转移术治疗早期ONFH手术操作相对简单,近期疗效更为明显.     

A Simple Route to Rod‐Coil Block Copolymers of Oligo‐ and Polythiophenes with PMMA and Polystyrene

A simple and efficient approach for the preparation of rod‐coil block copolymers comprising oligo‐ and polythiophenes blocks together with PMMA or PS blocks is described. The block copolymers were prepared using a two‐step procedure. α,ω‐dicarboxy‐terminated oligothiophenes and carboxy terminated poly(3‐hexylthiophene) were first prepared. These were then reacted with P₄S₁₀ in a second step to generate the α,ω‐thioester terminated oligothiophenes and poly(3‐hexylthiophene)s which were subsequently used in a one‐pot reaction as RAFT polymerization agents with methylmethacrylate and styrene. The di‐ and tri‐block copolymers hence obtained were fully characterized, both in solution and as thin films.