百岁女医谈允贤传奇医传——从《女医杂言》细论前明妇科、性医学的进步

2015年中国女医屠呦呦获得诺贝尔生理学及医学奖后,中医借此大善,于今岁再祭前明女医谈允贤氏。岁首电视剧《女医·明妃传》热映,故事情节虽跌宕,然非历史真实之谈允贤也。1999年中国中医研究院医史文献研究所郑金生撰文《明代女医谈允贤及其医案女医杂言》,第一次向世间介绍了这位著名的明朝女医生。此前该人医事且并不为人知,究为何?《女医杂言》在前明出版两次,今仅以后版(万历年版)存世,经初考似曾另著别"医案"(或医著)存世,而今仍无善本见存,内中缘由深矣。今经较详细考证有关史料,发现女医谈允贤或其家族成员,似于500年前曾卷进一桩被《明史》记为"壬寅宫变"的冤案当中。至于这宗晚明时期的杀医要案,久不查者甚矣,今当昭雪于世界,以彰显为医者之正气!     

Mediastinal Ancient Schwannoma Causing Intrathoracic Bleeding

Spontaneous hemothorax caused by the rupture of a benign schwannoma has rarely been reported. Herein, we present the successful excision of an extremely rare case of mediastinal ancient schwannoma causing intrathoracic bleeding. A 27-year-old man was admitted to our emergency department because of back pain and dyspnea. Computed tomography revealed massive pleural effusion with a posterior mediastinal tumor. We performed a resection of the tumor which had ruptured, and the tumor was diagnosed as an ancient schwannoma.     

Memory and action: an experimental study on normal subjects and schizophrenic patients

Psychologists have shown that recall of sentences describing previously performed actions is enhanced compared to recall of heard-only action-phrases (enactment effect). One interpretation of this effect argues that subjects benefit from a multi-modal encoding where movement plays a major role. In line with this motor account, it is conceivable that the beneficial effect of enactment might rely, at least in part, on procedural learning, thus tapping more directly implicit memory functions. Neuropsychological observations support this hypothesis, as shown by the fact that the enactment effect is quite insensitive to perturbations affecting declarative memories. i.e. Alzheimer disease. Memory for subject performed tasks in patients with Korsakoff syndrome. The present study attempts to evaluate whether pure motor activity is sufficient to guarantee the described memory facilitation or alternatively, whether first-person experience in carrying out the action (i.e. true enactment) would be required. To this purpose, in a first experiment on healthy subjects, we tested whether sentence meaning and content of the executed action should match in order to produce facilitation in recall of enacted action-phrases. In a second experiment, we explored whether the enactment effect is present in patients suffering from psychiatric disorders supposed to spare procedural memory but to alter action awareness (e.g. schizophrenia). We show that better recall for action phrases is found only when the motor component is a true enactment of verbal material. Moreover, this effect is nearly lost in schizophrenia. This latter result, on the one hand, queries the automatic/implicit nature of the enactment effect and supports the role of the experience of having performed the action in the first-person. On the other hand, it questions the nature of the memory impairments detected in schizophrenia.     

基于文献报道中医古方治疗前列腺癌的用药分析

目的基于文献报道,回顾总结中医古方辨证治疗前列腺癌的临床应用情况,为进一步开展古方治疗前列腺癌现代临床应用及其药效学机制研究提供指导。方法通过中国全文期刊数据库(CNKI)、维普中文期刊服务平台、万方数据知识服务平台,将检索时间限定为自建库到2020年7月4日,查阅中医或中西医结合运用古方辨证治疗前列腺癌的相关文献并追溯综述类文章,将涉及的古方与对应证型的名称规范化并按功能分类整理方剂,运用SPSS26.0软件对不同古方治疗前列腺癌的使用频数进行分析,运用Cytoscape软件对古方-功能类别-证型的复杂网络进行可视化分析。结果从3大数据库中共检索到中医古方治疗前列腺癌相关不重复文献共2025篇,依据研究目的共纳入医家经验38篇,病例报道14篇。证型规范后有34种,湿热蕴结证最常见,频率为10.7%,其次是肝肾阴虚证和瘀血内阻证,频率皆为8.4%,气血两虚证频率为7.6%。共得到古方64种,功能类别以补益剂、祛湿剂和理血剂为主,单个古方使用频率由高到低依次为六味地黄丸8.3%、八正散7.7%、知柏地黄丸5.9%、肾气丸4.1%、四君子汤4.1%等。古方-功能类别-证型的网络分析亦证实这一结论,六味地黄丸在网络中的关联程度最高,方剂对应的证型多为肝肾阴虚证、瘀血内阻证、湿热蕴结证等。结论通过对中医古方治疗前列腺癌的临床经验的梳理和总结可为古方治疗前列腺癌现代临床应用提供参考和指导,但其药效学机制仍需深入探究。     

Ancient plant DNA reveals High Arctic greening during the Last Interglacial

Summer warming is driving a greening trend across the Arctic, with the potential for large-scale amplification of climate change due to vegetation-related feedbacks [Pearson et al., Nat. Clim. Chang. (3), 673–677 (2013)]. Because observational records are sparse and temporally limited, past episodes of Arctic warming can help elucidate the magnitude of vegetation response to temperature change. The Last Interglacial ([LIG], 129,000 to 116,000 y ago) was the most recent episode of Arctic warming on par with predicted 21st century temperature change [Otto-Bliesner et al., Philos. Trans. A Math. Phys. Eng. Sci. (371), 20130097 (2013) and Post et al., Sci. Adv. (5), eaaw9883 (2019)]. However, high-latitude terrestrial records from this period are rare, so LIG vegetation distributions are incompletely known. Pollen-based vegetation reconstructions can be biased by long-distance pollen transport, further obscuring the paleoenvironmental record. Here, we present a LIG vegetation record based on ancient DNA in lake sediment and compare it with fossil pollen. Comprehensive plant community reconstructions through the last and current interglacial (the Holocene) on Baffin Island, Arctic Canada, reveal coherent climate-driven community shifts across both interglacials. Peak LIG warmth featured a ∼400-km northward range shift of dwarf birch, a key woody shrub that is again expanding northward. Greening of the High Arctic—documented here by multiple proxies—likely represented a strong positive feedback on high-latitude LIG warming. Authenticated ancient DNA from this lake sediment also extends the useful preservation window for the technique and highlights the utility of combining traditional and molecular approaches for gleaning paleoenvironmental insights to better anticipate a warmer future.

The Arctic is greening as shrub biomass increases and vegetation ranges shift north in response to summer warming (1, 2). This process—one of the clearest terrestrial manifestations of climate change thus far—has major implications both for local ecosystems and for global energy balance and biogeochemical systems (3–5). In particular, taller shrubs darken otherwise snow-covered surfaces, contributing to the albedo feedback (6, 7), and enhanced evapotranspiration is expected to result in a positive greenhouse feedback (8). Shrub cover also impacts soil thermal regime, which may impact permafrost vulnerability (9–11). Because feedbacks related to Arctic greening are complex and potentially large in magnitude, estimating the extent and rate of northward shrub migration is a vital component of predicting future warming.Past warm periods serve as valuable analogs for understanding the extent of Arctic greening under well-constrained climate conditions. The Last Interglacial (LIG; Marine Isotope Stage [MIS] 5e, 129 to 116 ka [thousands of years before present]) was ∼1 °C warmer than the preindustrial period globally, but the Arctic experienced amplified warming due to higher summer insolation anomalies and positive feedbacks at high latitudes (12, 13). The Eastern Canadian Arctic and Greenland, in particular, were likely ∼4 to 8 °C warmer in summer than present (Fig. 1) (14–18). LIG sediment records from this region thus provide an archive of the vegetation response to Arctic warming at levels comparable to predicted 21^st-century climate change (19).Open in a separate windowFig. 1.Map of Baffin Island and Lake CF8 study area. The symbols represent maximum LIG temperature anomalies based on terrestrial proxy records (shape indicates proxy type) from Baffin Island and Greenland (see SI Appendix, Table S1 for metadata). The shaded regions indicate Arctic bioclimate subzones delineations (29), including modern Betula range in subzones D and E. We note that a small outlier population of Betula occurs east of the D/E boundary on Baffin Island (not captured by vegetation map resolution) (38).While most High Arctic lake basins were scraped clean by ice sheet erosion during the last glaciation and thus only contain postglacial sediments, lakes with small, low-relief catchments within regions of cold-based, slow-flowing ice were protected from erosion. Several such sites have been discovered on eastern Baffin Island, Arctic Canada and contain stratified records of multiple interglacials (20–22). Previous work from Lake CF8 on northeastern Baffin Island (Fig. 1 and SI Appendix, Fig. S1) demonstrates that its sediment record spans at least three interglacials (∼200 ka), including a substantially warmer-than-present LIG as indicated by chironomids, diatoms, and geochemical proxies (15, 23).We targeted the multi-interglacial record from Lake CF8 to assess the vegetation response to pronounced warmth during the LIG and moderate warmth during the Holocene. Pollen produced by some key shrubs and trees, including Betula (birch), is efficiently wind-transported and thus present in lake sediments far north of their ranges (24, 25). We therefore analyzed both sedimentary ancient DNA (sedaDNA), which is sourced locally from within the lake catchment and does not include pollen-derived DNA (26), and fossil pollen to generate a robust vegetation record spanning the last ∼130 ka. Taken together, DNA-inferred plant communities and pollen-inferred July air temperatures provide insight into Arctic plant range shifts under strong summer warming.     

Fine-needle aspiration of neurilemoma (schwannoma). A clinicocytopathologic study of 116 patients

The preoperative fine-needle aspiration cytology (FNAC) diagnoses in 116 surgically excised neurilemomas were reviewed and compared with the corresponding histopathologic diagnoses made on surgical specimens and with clinical data. In addition, the utility of adjunctive techniques was analyzed and other spindle-cell lesions in the differential diagnoses were discussed. An unequivocal, benign diagnosis was rendered by FNAC in 80 cases, 67 of which were correctly labelled as neurilemoma in a review of the original cytology reports. There were 6 false-positive malignant diagnoses while 23 smears were considered insufficient and 7 inconclusive as to whether benign or malignant. On reevaluation, the diagnostic smears in most cases contained spindle cells with wavy nuclei embedded in a fibrillar, occasionally collagenous, and/or myxoid matrix and Antoni A/Antoni B tissue fragments. A moderate to abundant admixture of round to oval cells was also frequent. Nuclear palisading was seen in 41 smears with distinctive Verocay bodies in 10. Markedly pleomorphic nuclei were seen in smears from 8 ancient and 6 conventional neurilemomas, and slight to moderate nuclear pleomorphism was observed in 38 additional cases. Thus most neurilemomas have distinct cytomorphologic features that allow correct diagnosis. The major problem in FNAC of neurilemoma is to obtain sufficient material. Furthermore aspirates showing predominantly Antoni A features, nuclear pleomorphism, and/or myxoid changes can easily be confused with other types of benign or malignant soft-tissue tumors.     

The effect of attentional cueing on conscious awareness of stimulus and response

Attending to a cued location in space leads to faster reaction times when a stimulus is presented there. The reasons for this attentional effect, and its specific locus in the information-processing chain between stimulus and response, remain unclear. One suggestion is that attention speeds the conscious detection of stimuli. Surprisingly, this possibility appears not to have been tested directly. To resolve this question, we asked subjects to make simple responses to lateralised targets that followed either a valid, invalid or neutral cue, and to judge the perceived time of the target onset, or of their response, by delayed report of the position of a clock hand. Our results showed that only a small and non-significant part of the attentional effect is due to delayed conscious awareness of the stimulus. The greater part of the attentional effect is localised either subsequent to conscious detection of stimuli or occurs in a separate, parallel processing stream from that which generates the motor response. Electronic Publication     

妊娠期糖尿病合并妊娠期肝内胆汁淤积症母儿结局探讨

目的:探讨妊娠期糖尿病合并妊娠期肝内胆汁淤积症对孕产妇和国产儿结局的影响。方法:分析17例GDM合并ICP患者和85例单纯GDM患者的临床资料。结果:两组间孕妇分娩孕周差异有统计学意义(P<0.05)。两组先兆早产、早产、酮症、胎膜早破、羊水过多、胎盘早剥、剖宫产、产后出血、宫内生长受限、胎儿宫内窘迫、巨大儿、新生儿低血糖、新生儿窒息和呼吸窘迫综合征、胎儿畸形、死胎、死产发生率比较,差异均无统计学意义(P>0.05)。结论:对妊娠期糖尿病合并妊娠肝内胆汁淤积症患者早诊早治,有效控制血糖及胆汁酸,适时终止妊娠可改善围产儿结局。     

Attention bias in earthquake-exposed survivors: An event-related potential study

The Chinese Wenchuan earthquake, which happened on the 28th of May in 2008, may leave deep invisible scars in individuals. China has a large number of children and adolescents, who tend to be most vulnerable because they are in an early stage of human development and possible post-traumatic psychological distress may have a life-long consequence. Trauma survivors without post-traumatic stress disorder (PTSD) have received little attention in previous studies, especially in event-related potential (ERP) studies. We compared the attention bias to threat stimuli between the earthquake-exposed group and the control group in a masked version of the dot probe task. The target probe presented at the same space location consistent with earthquake-related words was the congruent trial, while in the space location of neutral words was the incongruent trial. Thirteen earthquake-exposed middle school students without PTSD and 13 matched controls were included in this investigation. The earthquake-exposed group showed significantly faster RTs to congruent trials than to incongruent trials. The earthquake-exposed group produced significantly shorter C1 and P1 latencies and larger C1, P1 and P2 amplitudes than the control group. In particular, enhanced P1 amplitude to threat stimuli was observed in the earthquake-exposed group. These findings are in agreement with the prediction that earthquake-exposed survivors have an attention bias to threat stimuli. The traumatic event had a much greater effect on earthquake-exposed survivors even if they showed no PTSD symptoms than individuals in the controls. These results will provide neurobiological evidences for effective intervention and prevention to post-traumatic mental problems.     

A pilot investigation of mild hypothermia in neonates receiving extracorporeal membrane oxygenation (ECMO)

OBJECTIVE: To investigate the safety and feasibility of using mild hypothermia in neonates receiving extracorporeal membrane oxygenation (ECMO).Study design A prospective, nonrandomized pilot study of 25 neonates referred for ECMO. Whole body cooling was achieved by adjustment of the temperature of the extracorporeal circuit water bath. Five groups (N=5 per group) were each studied for the first 5 days of ECMO. The first group was maintained at 37 degrees C throughout the study period. Subsequent groups were cooled to 36 degrees C, to 35 degrees C, and, finally, to 34 degrees C, respectively, for 24 hours and the final group to 34 degrees C for 48 hours before being rewarmed to 37 degrees C. Patients were carefully assessed clinically and biologically. In addition to routine laboratory tests, cytokines (IL-6 and IL-8), complement (C3a), and molecular markers of coagulation (thrombin/antithrombin III [TAT], antithrombin III, and plasmin-alpha2plasminogen) were measured. RESULTS: No major clinical or circuit problems were noted during cooling or rewarming. In particular, there were no problems of bleeding or cardiac arrhythmia. No significant difference was found between groups in terms of molecular markers of coagulation, complement, cytokines, and platelet transfusions. CONCLUSIONS: Applying mild hypothermia (34 degrees C) for 24 or 48 hours to neonates receiving ECMO is both feasible and safe.