胃安煎剂治疗慢性萎缩性胃炎癌前病变的临床观察

[目的]观察自拟胃安煎剂治疗慢性萎缩性胃炎（CAG）癌前病变的临床疗效。[方法]102例患者随机分为2组。治疗组68例，口服胃安煎剂；对照组34例，口服胃苏颗粒和维酶素片。观察2组治疗前、后临床症状，萎缩、肠上皮化生（IM）、异型增生（Dys）的病理及幽门螺杆菌（Hp）的变化。[结果]治疗组临床有效率为91．18％，对照组为76．47％，2组比较差异有统计学意义（P〈0．05）。病理检查证实治疗组萎缩、IM和Dys有效率分别为66．18％、67．92％和67．74％；对照组为44．12％、42．31％和29．41％。2组病理疗效差异均有统计学意义（均P〈0．05）。治疗组Hp清除率为75．56％，对照组为58．33％（P〉0．05）。[结论]胃安煎剂对CAG癌前病变有确切的临床疗效。     

郭志华从“阴火”论治心悸

阴火理论为李杲所创,其核心内涵为脾胃气弱,气火失调,升降失序。心悸为临床常见病症,临床上多见心悸心慌伴心烦、疲倦乏力、纳差便溏,属心脾虚弱证的病例。郭志华教授为湖湘名医,尤擅治心血管疾病。基于临床实践,郭志华教授认为阴火与心悸的病理关系以元气受损,气火失调,阴火炽盛,心神失养为基础,擅从阴火论治心悸,常以调气为要,健脾为重,补益脾气,充养元气,调畅气机,论治心悸疾患,往往收获佳效。     

孙伟护肾养阴法治疗慢性肾脏病

肾虚是慢性肾脏病发生发展的基础,由于先天不足、过食温燥、劳逸失度、情志内伤、久病迁延等因素,肾阴虚,乃至气阴两虚等证在临证中频频涉及。孙伟教授提出了护肾养阴法,在治疗上强调补益肾阴,兼顾五脏,弥补亏损之元阴。常用药有制黄精、山萸肉、旱莲草、女贞子、石斛、玉竹、黄芪、太子参等,慎用辛热之品以防劫阴太过,损耗肾阴。善用杜仲、川续断、菟丝子等平补肾阳之品,以期阳中求阴,并适当佐以活血化瘀药物,如当归、丹参、益母草、牛膝等,不致滋阴太过加重湿浊内蕴,使得补而不滞,养阴而不助邪。整体上更注重以养为护、养护并重,从而达到阴阳调和、延缓疾病进展的目的。     

Sodium thiosulfate attenuates high phosphorous induced vascular calcification in rats with 5/6 nephrectomy

Objective To observe the expression of Klotho and Na+/Pi cotransporter in high phosphorous-induced rats with 5/6 nephrectomy and its relationship with vascular calcification, as well as to investigate the effect of early intervention by sodium thiosulfate (STS) on the progression of vascular calcification. Methods Either 5/6 nephrectomy (n=21) or sham operation (n=14) was conducted on 35 Sprague Dawley rats, who were then fed with high phosphorus (HP) diet or normal phosphorus (NP) diet for 16 weeks respectively. The rats were divided into 5 groups as follows: (1) remnant kidney rats receiving HP diet (NHP, n=7), (2) remnant kidney rats receiving NP diet (NNP, n=7), (3) sham operation rats receiving NP diet (SNP, n=7), (4) sham operation rats receiving HP diet (SHP, n=7), (5) remnant kidney rats receiving HP diet with STS (THP, n=7). The treatment group was given STS intraperitoneally three times a week for 16 weeks. At the end of the 16th week, rats tail artery blood pressures were tested, serum creatinine (Scr), calcium (Ca2+), phosphorus (P3+), FGF23, iPTH and urine protein were examined. Throacic aorta and kidney were then removed. Vascular calcification was confirmed by Von kossa staining. Klotho and Pit-1 expression in aortas were determined by immunohistochemistry. Renal lesion was determined by PASM-Masson staining. Renal Klotho and NaPi-2a mRNA were determined by real time RT-PCR. Results After 16 weeks, Scr, P3+, FGF23, iPTH, uric protein and blood pressure were significantly higher in NHP than those in SNP rats (all P＜0.05). PASM-Masson staining revealed typical renal pathology of chronic renal failure in NHP group. With the treatment of STS, THP rats showed significant decrease in Scr, P3+, FGF23, iPTH, uric protein and blood pressure by comparison with NHP group (all P＜0.05). Significant vascular calcification was found in NHP group while NNP and SHP group occasionally had vascular calcification; THP group had marked alleviation of vascular calcification. The aorta and renal expression of Klotho decreased remarkably while expression of Pit-1 and NaPi-2a increased significantly in NHP compared with SNP group (all P＜0.05). Accordingly, the aorta and renal expression of Klotho increased and Pit-1 and NaPi-2a decreased significantly in THP compared with NHP group (P＜0.05). Conclusions The early intervention of sodium thiosulfate might regulate Klotho and Na+/Pi cotransporter expression in both aorth and kidney, decreasing serum phosphate, delaying progression of vascular calcification and improving renal function.     

从脾论治甲状腺功能异常

甲状腺功能异常的发病率逐年上升,现已成为危害人类生命健康的重要卫生问题。基于甲状腺与脾脏在生理上的关联及甲状腺功能异常不同类型的疾病特点,探讨从脾论治甲状腺功能异常。明确甲状腺功能亢进症与甲状腺功能减退症发病的基本病机分别为脾阴不足和脾阳亏虚,并分别给予益气养阴、益气温阳两种基本治法。甲状腺功能亢进症治用甘淡平和及甘酸微寒之药,甲状腺功能减退症治用甘温扶正及辛温开散之药。     

胃复春片对功能性消化不良大鼠胃肠功能的影响

目的 考察胃复春片对胃肠动力障碍的改善作用。方法 建立功能性消化不良（functional dyspepsia,FD）大鼠模型;以FD大鼠体质量、进食量、饮水量、胃平滑肌电活动情况、胃液分泌量、胃蛋白酶活性、肝脏与脾脏质量、胃病理情况等考察胃复春的药效。结果 模型组FD大鼠胃平滑肌电活动明显紊乱,体质量、进食量、饮水量明显减少、胃蛋白酶活性明显降低;经胃复春治疗后,上述现象明显缓解,大鼠体质量、进食量、饮水量明显增加,胃蛋白酶活性明显升高。结论 胃复春能改善FD大鼠的一般状况,对FD大鼠胃酸过多有抑制作用,能提高模型大鼠的胃蛋白酶活性。     

“八位一体”的农村卫生人力资源开发与管理新机制

卫生人力资源是卫生资源中最主要的资源[1].农村卫生人力资源的开发与管理能力决定着农村医疗工作的诊疗质量和公共卫生服务水平;整体人力资源的素质则决定着农村卫生事业的兴衰.做好农村基层卫生服务,人才是关键[2].建立一支训练有素、适应性强的医疗卫生专业人才队伍和畅通农村分享城市优良卫生人力资源的渠道是我们亟待解决的问题.自2009年实施卫Ⅺ项目以来,实施“公开招录、竞争上岗、拜师带徒、强化培训、借力助教、鼓励进修、创新平台、严格考核”的“八位一体”的人才系统工程,探索出一条全面提升农村卫生人力资源素质的新路子.