活血化瘀法为主治疗痛经31例疗效观察

目的:探讨活血化瘀法为主治疗痛经的临床疗效及其与改善甲襞微循环的关系.方法:31例痛经患者以活血化瘀为基本治法,在治疗前后进行甲襞微循环观察,采用甲襞微循环加权积分法进行分析比较.结果:治疗前总积分值最高,Σ(A×B)属重度异常,说明微循环障碍严重,与健康对照组比较差异有显著性(P＜0.01);治疗后总积分明显下降,Σ(A×B)属轻度异常,说明微循环有较明显改善,与治疗前比较有显著性差异(P＜0.01).随着临床症状的缓解和微循环障碍改善,总积分值随之下降.结论:"不通则痛"的发病机理与微循环障碍有密切关系;对痛经的施治,除了强调辨证外,改善微循环障碍亦是一个重要方面.     

注重基本技能训练提高学生临床实践能力

对临床教学面临的困难及开展基本技能的必要性的进行了思考.结合自身通过遴选临床教学主讲老师,加强师资队伍的培训;建设多功能临床模拟实验室;加强基本功训练,提高学生临床动手能力等方式,开展了临床技能优化训练,并取得了一定的成效.     

Primary chemotherapy in operable breast carcinoma comparing CMF (cyclophosphamide, methotrexate, 5-fluorouracil) with an anthracycline-containing regimen: short-term responses translated into long-term outcomes.

BACKGROUND: The role of anthracyclines has been extensively studied in adjuvant chemotherapy, but much less in the primary chemotherapy of early breast carcinoma. This study, comparing CMF (cyclophosphamide, methotrexate, 5-fluorouracil) with the rotational anthracycline-containing regimen CMFEV (CMF plus epirubicin and vincristine) administered as primary chemotherapy, demonstrated a significant increase in clinical complete response in premenopausal women. We report the long-term results. PATIENTS AND METHODS: Two hundred and eleven patients with stage I or II palpable breast carcinoma and a tumour diameter of >2.5 cm were randomised to receive CMF or CMFEV for four cycles before surgery. After surgery, the patients in both arms received adjuvant CMF for three cycles. RESULTS: In the study population as a whole, there was a non-significant 20% reduction in mortality and relapse rates in the CMFEV arm. However, the effect of the experimental regimen was only found in premenopausal patients, especially in terms of relapse-free survival (P=0.07) and locoregional relapse-free survival (P=0.0009), thus mirroring the effect on response rates. After 10 years, the proportions of premenopausal patients free from locoregional relapse as a first event in the CMF and CMFEV groups were 68% and 97%, respectively. No relevant differences were found in postmenopausal patients. CONCLUSION: The overall results of this study showed that the greater activity of the experimental anthracycline-containing combination over CMF as primary chemotherapy in premenopausal patients translated into long-term effects in the same subgroup.     

Simultaneous equations in ordered discrete responses with regressor-dependent thresholds

Summary The parameters of ordered discrete response (ODR) models are identified only up to a positive scale. In this paper, we examine the identification issue for simultaneous equations with ODR, where the well-known identification problem in simultaneous equations of recovering structural-form parameters from reduced-form parameters is compounded with the ODR identification problem. We allow the thresholds in ODR to be regressor dependent as well as constant; the former is particularly challenging because threshold parameters get mixed with regression parameters, adding one more dimension to the identification problem. We also explore a cross-equation restriction on threshold differences, under which the structural form parameters are fully identified as if the dependent variables are continuously distributed. An empirical example with farm–household joint labour supply is provided to illustrate the identification issues, to show how our proposals work and to apply tests devised for the threshold constancy and cross-equation restrictions.     

格列吡嗪控释片治疗继发性磺脲类降糖药失效2型糖尿病的疗效

目的 :观察格列吡嗪控释片治疗继发性磺脲类降糖药失效 2型糖尿病的疗效。方法 :选取继发性磺脲类降糖药失效的 2型糖尿病患者 6 4例 ,随机分为 2组 ,各 32例。治疗组予格列吡嗪控释片治疗 ,对照组予格列吡嗪速效片治疗 ,观察 8wk(治疗组分成 4wk剂量调整期 ,4wk维持期 )。治疗前后行 2次口服糖耐量试验 (OGTT)和胰岛素释放试验 ,计算胰岛素释放指数 (IRG)和胰岛素敏感指数 (ISI) ;比较 2组治疗前后血糖 ,血胰岛素 ,IRG ,ISI和临床疗效。结果 :与治疗前比较 ,治疗组治疗后血糖水平下降 ,ISI增高 ,P <0 .0 1;但胰岛素水平及IRG与服药前无显著性差异。对照组各指标治疗前后均无显著性差异。治疗组总有效率 (5 6 .2 % )显著高于对照组 (9.3% ) ,P <0 .0 1,且无明显不良反应发生。结论 :格列吡嗪控释片可改善继发性磺脲类降糖药失效的 2型糖尿病患者胰岛素敏感性及血糖控制 ,可作为继发性磺脲类降糖药失效患者的治疗药物     

感冒、水肿、便秘证治体会

结合多年的临床实践，总结了对感冒、水肿和便秘等中医内科疾病的独特认识，并附病案佐证。     

仙人活心胶囊治疗肾阳虚型中老年男性冠心病心绞痛30例

目的 :观察中药制剂仙人活心胶囊治疗肾阳虚型中老年男性冠心病心绞痛的临床疗效。方法 :采用仙人活心胶囊治疗肾阳虚型中老年男性冠心病心绞痛 30例 ,并设西药及安慰剂治疗 2 8例为对照组 ,疗程 6周。结果 :治疗组在缓解心绞痛症状、改善缺血性心电图表现及中医证候疗效、硝酸甘油停减率等方面优于对照组 (P <0 .0 5 )。结论 :仙人活心胶囊治疗冠心病心绞痛疗效确切。     

家具行业苯对作业女工生殖系统的影响

目的了解家具行业苯对作业女工生殖系统影响.方法采用问卷调查、作业场所职业卫生学调查和工人健康体检的方法,对结果进行分析.结果接触组月经异常主要表现为经量过多、月经周期缩短,月经异常率与对照组比较差异有显著性(P＜0.05);已婚女工的妊娠贫血、恶阻等合并症的发生率也显著高于对照组(P＜0.05);神经衰弱综合征、白细胞减少等显著高于对照组(P＜0.05).结论苯作业对女工的生殖系统可能有一定影响,今后应加强这方面的劳动保护和做好工人的职业宣传教育.     

饮用天然矿泉水人群健康调查

目的 调查了解湖南省天然矿泉水饮用人群的健康状况。方法选择长期饮用天然矿泉水人群为观察组，条件相近不饮用矿泉水人群为对照组，对比两组间健康指标的差异。结果 长期饮用天然矿泉水人群平均期望寿命(e^9)为72．04岁，比不饮用天然矿泉水的对照组人群e^0高出2．99岁，平均死亡年龄要高4．15岁，总患病率要低14．3％，人均医疗费用开支要少28．6％；男女小学生生长发育：男生身高高3．06cm，女生身高高4．26cm；男生体重重2．51kg，女生体重重3．40kg；男生胸围大1．62cm，女生胸围大1．81cm。结论长期饮用天然矿泉水人群的健康状况要优于条件相近不饮用矿泉水人群。     

先天性无痛无汗症1例并文献复习

报告2018年10月收治的1例先天性无痛无汗症,患者年龄32 d,采集患儿及其父母外周血进行医学外显子 5 000种疾病筛查,并对候选基因变异进行Sanger测序验证。患儿主要临床表现为无痛、无汗、反复发热。基因分子遗 传学分析结果提示在患儿遗传性感觉和自主神经病4型等疾病相关基因神经营养因子酪氨酸激酶受体1型(neurotrophic tyrosine kinase receptor type 1,NTRK1)中存在复合杂合突变(c.36G>A和c.851-33T>A)。结果显示两个突变分别来自父母 双方。c.851-33T>A为既往已报道致病突变,c.36G>A为未报道的突变,该突变可导致色氨酸转变成终止密码子。对于 无明确致病报道的点突变,进一步参考美国医学遗传学和基因组学学院(ACMG)基因突变解读指南,评估其为致病基 因,生物学危害性为可能有害。先天性无痛无汗症临床罕见,该病为单基因遗传病,基因分子遗传学分析有助于诊 断及发现新的基因突变。