叶景华运用经方治疗慢性肾脏病经验

恩师叶景华教授执医六稔余,游邃于仲景之法,辨证精密,立法周谨。吾有幸侍诊,窥其治疗慢性肾脏病遵经方,效如桴鼓。今略草于字墨之间,以飨同道。 叶师认为慢性肾脏病系指多种病因和多种发病机制引起的肾脏病变,具有起病缓慢、隐匿的特点。临床多表现为蛋白尿、血尿、水肿、高血压,严重者可出现肾功能不全。叶老倾其毕生将仲景之理论运用于慢性肾功能不全。     

微创神经外科与转化医学

20世纪末美国哈佛大学医学院提出转化医学概念。转化医学打破了基础医学与临床医学之间的屏障,缩短了"从实验台到病床"(bench to bedside)的过程。本文通过回顾百年神经外科历史,纵观转化医学在建立神经外科、催生显微神经外科和推进微创神经外科3个阶段所起的作用,展望了神经外科学前景,提出微创神经外科将成为转化医学的技术平台。     

The Triangle Model for evaluating the effect of health information technology on healthcare quality and safety

With the proliferation of relatively mature health information technology (IT) systems with large numbers of users, it becomes increasingly important to evaluate the effect of these systems on the quality and safety of healthcare. Previous research on the effectiveness of health IT has had mixed results, which may be in part attributable to the evaluation frameworks used. The authors propose a model for evaluation, the Triangle Model, developed for designing studies of quality and safety outcomes of health IT. This model identifies structure-level predictors, including characteristics of: (1) the technology itself; (2) the provider using the technology; (3) the organizational setting; and (4) the patient population. In addition, the model outlines process predictors, including (1) usage of the technology, (2) organizational support for and customization of the technology, and (3) organizational policies and procedures about quality and safety. The Triangle Model specifies the variables to be measured, but is flexible enough to accommodate both qualitative and quantitative approaches to capturing them. The authors illustrate this model, which integrates perspectives from both health services research and biomedical informatics, with examples from evaluations of electronic prescribing, but it is also applicable to a variety of types of health IT systems.     

Beyond faithful conduction: short-term dynamics, neuromodulation, and long-term regulation of spike propagation in the axon

Most spiking neurons are divided into functional compartments: a dendritic input region, a soma, a site of action potential initiation, an axon trunk and its collaterals for propagation of action potentials, and distal arborizations and terminals carrying the output synapses. The axon trunk and lower order branches are probably the most neglected and are often assumed to do nothing more than faithfully conducting action potentials. Nevertheless, there are numerous reports of complex membrane properties in non-synaptic axonal regions, owing to the presence of a multitude of different ion channels. Many different types of sodium and potassium channels have been described in axons, as well as calcium transients and hyperpolarization-activated inward currents. The complex time- and voltage-dependence resulting from the properties of ion channels can lead to activity-dependent changes in spike shape and resting potential, affecting the temporal fidelity of spike conduction. Neural coding can be altered by activity-dependent changes in conduction velocity, spike failures, and ectopic spike initiation. This is true under normal physiological conditions, and relevant for a number of neuropathies that lead to abnormal excitability. In addition, a growing number of studies show that the axon trunk can express receptors to glutamate, GABA, acetylcholine or biogenic amines, changing the relative contribution of some channels to axonal excitability and therefore rendering the contribution of this compartment to neural coding conditional on the presence of neuromodulators. Long-term regulatory processes, both during development and in the context of activity-dependent plasticity may also affect axonal properties to an underappreciated extent.     

Surround suppression sharpens orientation tuning in the cat primary visual cortex

In the primary visual cortex (V1), the response of a neuron to stimulation of its classical receptive field (CRF) is suppressed by concurrent stimulation of the extraclassical receptive field (ECRF), a phenomenon termed 'surround suppression'. It is also known that the orientation tuning of V1 neurons becomes sharper as the size of the stimulus increases beyond the CRF. However, there have been few quantitative investigations of the relationship between sharpening of orientation tuning and surround suppression. We examined this relationship in 73 V1 neurons recorded from anesthetized and paralysed cats using sinusoidal grating patches as stimuli. We found that sharpening of orientation tuning was significantly correlated with the strength of surround suppression for large stimuli that cover both CRF and ECRF. Furthermore, simulation analysis using a variety of tuning widths and most suppressive orientation of orientation-tuned surround suppression demonstrated that broadly orientation-tuned surround suppression sharpens orientation tuning for large gratings without shift in optimal orientation. Our findings suggest that one of the functional roles of surround suppression in V1 is enhancement of orientation discrimination for large and uniformly patterned objects.     

一种利用计算机造字的方法

针对医古文中有大量的生僻字不能在计算机中直接录入及有些人所造的字又不能在所有计算机通用的问题,介绍了一种简便易学的造字方法以及利用计算机造字时应遵循的原则。指出应用该方法造字,不仅简便易学,而且通用于所有的计算机。     

Inhibitory Effects of Isolated Compounds from Black Coloured Rice Bran on the Complement Classical Pathway

The present study evaluated the anticomplement effects of isolated compounds from black coloured rice bran in the classical pathway of the complement system. Using column chromatography, three compounds: oryzafuran, quercetin and protocatechuic acid, were isolated and evaluated for in vitro anticomplement activity. Oryzafuran showed the most potent inhibitory activity against the complement system, with 50% inhibitory concentration (IC₅₀) values of 126.2 µg/mL. This is the first report of anticomplement activity of isolated compounds from black coloured rice bran. Copyright © 2011 John Wiley & Sons, Ltd.     

State of the Art of Drug Treatment of Schizophrenia and the Future Position of the Novel/Atypical Antipsychotics

Summary: Neuroleptic medication is the most important part of the treatment regimen for schizophrenic patients. The efficacy of neuroleptics in the acute and long-term treatment of schizophrenia is very well proven and the effect size is comparatively high. After more than 40 years of clinical practice with the classical neuroleptics, several more or less generally accepted rules for the management of drug treatment in schizophrenia have been established. The paper aims to describe these standards, discussing, among other things, developments which have appeared in the last 10 to 20 years, e.g. the tendency to a lower daily dose during acute treatment and the tendency to alternative strategies during long-term treatment. The paper especially also takes into consideration the benefits of the novel/atypical antipsychotics as compared to the classical neuroleptics, which will change the current treatment standards under several aspects — a change which is already ongoing. The novel/atypical antipsychotics will be much better accepted by patients, thus leading to increased compliance, will be associated with a better quality of life and will possibly change the long-term outcome of schizophrenic patients in a very important manner. It should be considered that the so-called novel/atypical neuroleptics do not constitute a homogeneous group but are a group of individual drugs, each with their own advantages and disadvantages. As was the situation with the classical neuroleptics, the physician also has to choose the most adequate drug under consideration of the risk/benefit profile of each drug in relation to the disposition of the individual patient.     

CBS基因突变致经典型高同型半胱氨酸尿症1例并文献复习

CBS基因缺陷引起的经典型高同型半胱氨酸尿症主要累及心血管系统、神经系统、骨骼及眼部等,确诊需依靠基因检测。文章回顾性分析1例经典型高同型半胱氨酸尿症所致多发性血栓形成患儿的临床资料并复习相关文献,提示对于不明原因的儿童颅脑静脉血栓形成,需高度警惕CBS基因突变的可能,尽早完善基因检查并尽早规范治疗。对于维生素B6无反应的患儿,在严重并发症出现之前,可尽早行肝移植根治。