糖尿病冠心病本虚标实证型分布特征及与病程年龄关系初探

目的:探讨糖尿病冠心病本虚标实证型分布特征及其与病程、年龄的关系。方法:选择91例经冠脉造影确诊的糖尿病冠心病患者,进行中医辨证分型,统计分析其病程、年龄等资料。结果:本虚证集中分布为气阴两虚、气虚、阳气两虚、阳虚4证,其糖尿病平均病程按气阴两虚、气虚、阳气两虚、阳虚的排序递增,平均年龄按气虚、阳气两虚、阳虚的排序递增,阳虚组较其余3组差异显著(P≤0.05)。标实证集中分布为寒凝、痰浊、血瘀、气滞血瘀、寒凝血瘀、痰浊血瘀6证,各证患者平均年龄、平均糖尿病病程无统计学差异(P>0.05)。结论:糖尿病冠心病患者本虚以气虚、阳虚为主,且随年龄增长和病程延长,由气虚向阳虚发展;标实以痰浊、血瘀为主,且贯穿疾病始末。提示临床治疗应益气温阳以扶正,活瘀化痰以祛邪。     

May 2022 acute hepatitis outbreak,is there a role for COVID-19 and other viruses?

There has been an increasing number of reported cases of acute hepatitis of unknown origin in previously healthy children since first reported on March 31,2022.This clinical syndrome is identified by jaundice and markedly elevated liver enzymes with increased aspartate transaminase and/or alanine amino transaminase(greater than 500 IU/L).We conducted an inclusive literature review with respect to acute hepatitis outbreaks in children using the search terms acute hepatitis,outbreak,children,sever...     

Dating the Origin and Estimating the Transmission Rates of the Major HIV-1 Clusters in Greece: Evidence about the Earliest Subtype A1 Epidemic in Europe

Our aim was to estimate the date of the origin and the transmission rates of the major local clusters of subtypes A1 and B in Greece. Phylodynamic analyses were conducted in 14 subtype A1 and 31 subtype B clusters. The earliest dates of origin for subtypes A1 and B were in 1982.6 and in 1985.5, respectively. The transmission rate for the subtype A1 clusters ranged between 7.54 and 39.61 infections/100 person years (IQR: 9.39, 15.88), and for subtype B clusters between 4.42 and 36.44 infections/100 person years (IQR: 7.38, 15.04). Statistical analysis revealed that the average difference in the transmission rate between the PWID and the MSM clusters was 6.73 (95% CI: 0.86 to 12.60; p = 0.026). Our study provides evidence that the date of introduction of subtype A1 in Greece was the earliest in Europe. Transmission rates were significantly higher for PWID than MSM clusters due to the conditions that gave rise to an extensive PWID HIV-1 outbreak ten years ago in Athens, Greece. Transmission rate can be considered as a valuable measure for public health since it provides a proxy of the rate of epidemic growth within a cluster and, therefore, it can be useful for targeted HIV prevention programs.     

Geographical Origin and Level Identification of Frankincense Based on Hyperspectral Image

Background: As the demand for traditional Chinese medicinal materials increases in China and even the world, there is an urgent need for an effective and simple identification technology to identify the origin and quality of the latter and ensure the safety of clinical medication. Mineral element analysis and isotope finger-printing are the two commonly used techniques in traditional origin identification. Both of these techniques require the use of stoichiometric methods in the identification process. Although they have high accuracy and sensitivity, they are expensive and inefficient. In addition, near-infrared spectroscopy is a fast, nondestructive, and widely used identification technique developed in recent years, but its identification results are susceptible to samples’ states and environmental conditions, and its sensitivity is low. Hyperspectral imaging combines the advantages of imaging technology and optical technology, which can simultaneously access the image information and spectral information which reflect the external characteristics, internal physical structure, and chemical composition of the samples. Hyperspectral imaging is widely applied to agricultural product inspection, but research into its application in origin and quality identification of TCM materials is rare. Methods: In this study, the algorithm framework discriminative marginalized least squares regression (DMLSR) was used for feature extraction of frankincense hyperspectral data. The DMLSR with intraclass compactness graph and manifold regularization can efficiently learn the projective samples with higher separability and less redundant information than the original samples. Then, the discriminative collaborative representation with Tikhonov regularization (DCRT) was applied for classifying the geographical origin and level of frankincense. DCRT introducesthe discriminant regularization term and incorporates SID, which is more sensitive to the spectrum as the measurement method and is more suitable for the frankincense spectral data compared with SVM. Results: For the origin classification task, samples of all levels from each origin were, respectively, selected for three?way classification. We used 10-fold cross-validation to select a model parameter in the experiment. When obtaining the optimal parameters, we randomly selected the training set and testing set, where the training set accounts for 70% and the training set for 30%. After repeating this random process 10 times, we obtained the final average classification accuracy, which is higher than 90%, and the standard deviation fluctuation is usually small. For the level classification task, samples of each level from three origins were separately selected for multiclassification. We randomly selected the training set and testing set from each origin. The level classification results of the three origins are good on D4350 data, and the classification accuracy of each level is basically above 80%. Conclusion: Experiments and analysis show that our algorithm framework has excellent classification performance, which is stable in origin classification and has potential for generalization. In addition, the experiments show that in our algorithm framework, different classification tasks need to combine different data sources to achieve better classification and recognition, as the origin classification task uses frankincense’s D3000 data, and level classification task uses frankincense’s D4350 data.     

16个产地地乌药材的系统鉴定及质量评价

目的:构建地乌药材基原物种系统鉴定体系,并对全国16个产地的地乌药材进行综合品质评价,为地乌药材产地选择及临床用药安全奠定基础。方法:使用传统鉴别方法结合DNA条形码核糖体DNA第二内部转录间隔区(ITS2)序列分子鉴定技术快速鉴别地乌药材真伪,并基于HPLC-UV对地乌药材中5个有效成分进行含量测定,采用Welch Ultimate XB-C18色谱柱(4.6 mm×250 mm,5μm),流动相乙腈-0.01%三氟乙酸溶液(30∶70),检测波长210 nm,柱温30℃,流速1.0 mL·min-1。结果:传统鉴别及DNA条形码快速鉴别技术均能准确鉴别地乌药材真伪。BLAST比对分析发现,16个产地地乌药材均与林荫银莲花Anemone flaccida具有最大相似度;基于多指标成分含量测定表明湖北恩施板桥镇的地乌药材中5个三萜皂苷类成分含量之和最高(10.59%),其次为贵州毕节赫章(6.28%)和湖北长阳都镇湾(5.64%)。结论:DNA条形码技术可作为地乌药材传统鉴定技术的有效补充,该鉴别体系可保障地乌药材基原准确及临床用药安全。HPLC多指标成分综合评价及聚类分析结果表明在本研究所涉及的产地中,湖北恩施、长阳、五峰,贵州毕节和重庆金佛山的地乌药材质量较优,可作为地乌药材的重要产地。     

老昌辉从肾论治肺胀临证经验

老昌辉教授认为肺胀病位主要在肺脾肾,病初肺与脾,久虚肺及肾,本病总属本虚标实,以肺肾阳虚为本,痰瘀伏肺为标,屡感外邪而诱发,肺病日久,肺肾阳虚,肾不纳气,则见咳逆上气,动则喘甚。老昌辉教授以中医气血阴阳理论为基点,结合肺胀的发病特点及临床实践经验,认为肺胀稳定期的治疗不应只拘泥于肺,强调肺肾同源,肾为生气之根,久病及肾,临证首当从肾论治,固本培元为要,使肺气得以充养,肾气充沛,摄纳有权,则气畅喘舒,总结得出了补肾培元法治疗肺胀稳定期的特色治疗原则,并创制了院内制剂补肾培元胶囊,广泛应用于临床,疗效显著。     

不同产地五味子种子挥发油中6个成分含量测定及主成分分析

目的：检测不同产地五味子种子挥发油中α-蒎烯、β-蒎烯、月桂烯、柠檬烯、乙酸龙脑酯和榄香烯的含量。方法：采用水蒸气蒸馏法提取挥发油,气相色谱法(GC)测定挥发油中α-蒎烯、β-蒎烯、月桂烯、柠檬烯、乙酸龙脑酯和榄香烯6个成分含量：采用HP-1701石英毛细管色谱柱(30 m×320μm×1μm),氢火焰离子化检测器,进样口温度为230℃,检测器温度为250℃,柱温以60℃为起始温度,以10℃·min^–1升温至125℃,保持5 min,再以10℃·min^–1升至150℃,保持2 min;载气为氮气,流速为0.9 mL·min^–1;分流进样,分流比为10∶1;进样量为1μL。采用SPSSPRO在线数据处理软件,以五味子种子中6个挥发油成分为指标进行综合评价。结果：各产地五味子种子挥发油中6个成分含量差异较大,α-蒎烯为14.378 8～231.394 2μg·g^–1,β-蒎烯为6.559 1～86.622 4μg·g^–1,月桂烯为11.873 4～143.526 3μg·g     

Spatial and temporal expansion of intrahepatic metastasis by molecularly‐defined clonality in multiple liver cancers

Multiple hepatocellular carcinoma (HCC) is divided into two categories: intrahepatic metastasis (IM), which is a true relapse of HCC, and multicentric origin (MO), which is a second primary tumor. Clinical diagnosis of multiple HCC is usually made based on tumor location and/or time to recurrence; however, it is often difficult to distinguish the two types of multiple HCC. Using 41 matched pairs of multiple HCC specimens, we confirmed the accuracy of clinical diagnoses using exome sequence data and investigated the importance of discriminating the type of multiple HCC. Genomic analysis revealed that 18 (43.9%) patients diagnosed as having genomic IM had common mutations in a pair of HCC tumors with the main tumor of these patients being more progressive compared to those with genomic MO. The accuracy of clinical diagnosis based on lobe (Definition 1) and segment (Definition 2) were 68.3% and 78.0%, respectively. Intriguingly, recurrence ≥2 years after initial surgery for 3 patients was IM. The survival of patients with clinical IM was significantly shorter than for those with clinical MO based on both Definition 1 (P = 0.045) and Definition 2 (P = 0.043). However, mean survival was not different between the patients with genomic IM and those with MO (P = 0.364). Taken together, genomic analysis elucidated that liver cancer may spread more extensively and more slowly than previously thought. In addition, distinguishing multiple HCC as IM or MC may have provided biological information but was not of clinical importance with respect to patient prognosis.     

牙周源性牙周牙髓联合病变常见病原菌的分布及其意义

目的研究牙周源性牙周牙髓联合病变常见病原菌分布及其相关性,为临床治疗提供依据。方法选择2018年1月至2020年6月于新疆维吾尔自治区人民医院口腔科就诊的牙周源性牙周牙髓联合病变患者43例43颗牙作为实验组,重度牙周炎患者41例41颗牙作为对照组。分别采集根管内组织和龈下菌斑,构建含有8种待测细菌基因片段的重组质粒,建立定量标准,应用实时荧光定量PCR技术检测福赛斯坦纳菌(Tannerella forsythia,Tf)、牙龈卟啉单胞菌(Porphyromonas gingivalis,Pg)、具核梭杆菌(Fusobacterium nu?cleatum,Fn)、中间普氏菌(Prevotella intermedia,Pi)、齿垢密螺旋体(Treponema denticola,Td)、消化性链球菌(Digestive streptococcus,Ds)、粪肠球菌(Enterococcus faecalis,Ef)、牙髓卟啉单胞菌(Porphyromanus endodontics,Pe)数量。结果实验组根管内组织与其龈下菌斑中Ds、Pe数量差异无统计学意义(Ρ>0.05),其余6种病原菌数量差异均有统计学意义(P<0.05);实验组与对照组龈下菌斑中Ds数量差异无统计学意义(P=0.241),其余7种病原菌数量差异均有统计学意义(P<0.05);实验组根管内组织与其龈下菌斑中Ef、Pe、Pg、Td、Tf细菌数量密切相关,Ef(r=0.347,Ρ<0.05)、Pe(r=0.363,Ρ<0.05)、Pg(r=0.437,Ρ<0.01)、Td(r=0.471,Ρ<0.01)、Tf(r=0.679,Ρ<0.01)。结论牙周源性牙周牙髓联合病变常见病原菌在根管内组织中数量低于龈下菌斑但根管内病原菌数量与龈下菌斑密切相关,临床治疗期间在控制牙周组织感染的同时,还应重视牙髓组织感染的控制。     

儿童不明原因发热137例临床分析

目的 :探讨学龄期儿童不明原因发热 (Feverofunknownorigin ,FUO)的病因及诊断方法。方法 :对不明原因发热患儿的临床资料进行回顾性分析。结果 :137例患儿中 ,明确诊断 12 9例 ,确诊率为 94 .16 % ;未明确诊断 8例 ,占 5 .84 %。明确诊断的 12 9例中感染性疾病 6 5例 ,占 4 7.4 5 % ;结缔组织病 4 1例 ,占 2 9.93% ;肿瘤 13例 ,占9.4 9% ;其他疾病 10例 ,占 7.3%。结论 :根据临床症状、体征和必要的辅助检查可以明确FUO中的大多数的病因诊断 ,感染性疾病、结缔组织疾病及肿瘤是学龄期儿童FUO的主要原因。