浅谈温病治疗中的“存津液”

“存得一分津液,便有一分生机”是温病学家长期临床实践的经验总结,在温病各个阶段中,由于温邪极易化燥伤津,只有重视保存津液,才能取得满意疗效。本文分别就“何谓‘津液’”、“津液与温病之关系”、“温病伤津之表现”、“顾护津液——温病治疗要领”、“温病保津存阴诸法”等5个方面加以阐述。温病初期阶段,以清邪为主,但应注意避免损耗津液;极期阶段,治疗仍以清邪为主,但还应适当加用养阴生津之品,以补充被损耗之津液;后期阶段,由于津液历受温邪戕害,此时救阴即为急务。即温病的治疗,从初期阶段经极期阶段至后期阶段,用药从清邪为主、存阴为辅渐转为存阴为主、清邪为辅,切实做到护津液于未伤,养阴津于己耗,救真阴于将竭。     

A Prospective Study of Body Dissatisfaction and Concerns in Extremely Obese Gastric Bypass Patients: 6- and 12-Month Postoperative Outcomes

Background: Body image is a multifaceted construct commonly associated with obesity. This study examined changes in body dissatisfaction, and shape and weight concerns in bariatric surgery patients from baseline to 6 and 12 months post-surgery. Methods: 109 extremely obese patients who underwent gastric bypass surgery completed the Body Shape Questionnaire (BSQ), and the Shape and Weight Concern subscales of the Eating Disorder Examination-Questionnaire (EDE-Q) at baseline, and 6 and 12 months post-surgery. Results: Patients experienced substantial weight loss and reported statistically significant reductions in BSQ, and Shape and Weight Concern scores from baseline to 6 and 12 months post-surgery. Improvements on the BSQ and Shape Concern scale were maintained between 6 and 12 months post-surgery, while patients reported continued reductions in weight and Weight Concern scale scores. Moreover, at 6 and 12 months follow-up, over 80% of female patients had body image scores comparable to published norms. Correlations between change in BMI and the body image measures were variable, and degree of weight loss did not predict body image scores 6 or 12 months post-surgery. Conclusions: Results from the present study illustrate significant and immediate post-surgical reductions in body dissatisfaction and concerns, along with weight loss in bariatric patients. Such improvements indicate a normalization of body image-related concerns in these patients, the majority of who remain overweight or obese despite the substantial post-surgical weight losses. Changes in weight and body image relate poorly to each other, suggesting that mediating factors may be involved.     

Body Composition and Muscle Constituents During Weight Loss: Studies in obese patients following gastroplasty

Background: The influence of rapid and prolonged weight loss on body composition and muscle constituents in the obese patient is not well known. There are serious complications related to rapid and prolonged weight loss. It is of general interest to increase the understanding of the mechanisms and consequences of significant weight loss in man. Methods: In 40 obese patients, the body composition and muscle constituents were studied before and during 1 year of weight loss following gastroplasty. The study was undertaken in two groups (A and B) of obese patients, comprising 32 women and eight men, body weight 82-175 kg and aged 24-49 years. Mean BMI in group A and B was 45 (W/H²) and 43 (W/H²) respectively. Body composition was assessed by total body potassium measurements and muscle constituents were determined by analyses of muscle specimens obtained percutaneously. Results: The preoperative body composition was found to be equal parts of lean body mass and body fat. Preoperatively, muscle constituents revealed a higher protein content per cell and a lower potassium concentration related to fat-free solids. The loss of 18-28% body fat and lean body mass occurred in equal proportions during the first 3 post-operative months of rapid weight loss, followed by a continuous decrease of body fat but not of lean body mass.The concentrations of proteins and potassium per muscle cell revealed a reduction during the period of rapid weight loss. The RNA/DNA ratio 1 year after surgery was still reduced, indicating a low protein synthesis rate. Conclusions: Preoperatively mean body fat accounted for 50% of the body weight in obese patients. Following weight loss, body fat, lean body mass and concentrations of proteins were reduced compared to preoperative values. After the period of rapid weight loss, with reduction of lean body mass and body fat in parallel, a progressive reduction of body fat was observed whereas the lean body mass did not decrease further. Protein synthesis rate was still low 12 months after surgery.     

Ultrasound measurement of visceral and subcutaneous fat in morbidly obese patients before and after laparoscopic adjustable gastric banding: comparison with computerized tomography and with anthropometric measurements

Background: There are now a variety of methods to assess body fat distribution, anthropometric (waist circumference and waist/hip W/H ratio), computed tomography (CT), and ultrasound (US) measurements, with CT considered as the reference method. Bariatric surgery leads to a significant and usually durable weight loss in morbidly obese patients; when assessing its results, it is of interest to measure changes of total fat tissue and of body fat distribution. Methods: In this study, we compared anthropometric, US, and CT measurements of body fat distribution under basal conditions and 1 year after laparoscopic adjustable gastric banding (LAGB); 120 morbidly obese patients were considered at baseline, and 40 patients were re-evaluated 1 year after LAGB. Results: Thickness of visceral and subcutaneous fat measured through CT and US methods was superimposable both under basal conditions and 1 year after LAGB, and the highest correlation was found between CT and US data on visceral fat, followed by CT and US data on subcutaneous fat; a fair correlation was also found between CT and US data on visceral fat and waist circumference. Conclusion:We suggest that evaluation of body fat distribution is accomplished by US instead of CT measurement, because of its lower cost and low exposure risk. Waist circumference stands as a reasonable surrogate of both methods, while W/H ratio is poorly correlated with other measures of body fat distribution.     

The Effects of Roux-en-Y Gastric Bypass Surgery on Body Image

Background: Numerous studies examine the physical effects of Roux-en-Y gastric bypass (RYGBP) surgery on morbid obesity. However, the effects of this surgery on psychosocial issues such as body image have not been extensively studied. Methods: This pilot study used a cross-sectional design to examine the effects of RYGBP surgery on patients' perceived body image. Four groups (n=20) were assessed for perceived change in body image at 4 time intervals.These included pre-surgery,1 to 3 weeks post-surgery, 6-months post-surgery, and 1- year post-surgery,with two measures of body image. One-way ANOVA was applied, with body image measures as the dependent variables, and time since surgery (group) as the independent variable. Planned post-hoc t-tests were applied to assess the differences between specific groups (pre vs. 1 week, pre vs. 6 months post, 6 months post vs. 1 year post). Results: Results of the one-way ANOVAs revealed significant improvement on perceptions of body image over time following surgery. Follow-up t-tests revealed that the most significant improvement occurred between pre-surgery and 6 months postsurgery. Although smaller, the change between 6 months post-surgery and 1 year post-surgery was also significant. Conclusion: While RYGBP results in numerous medical and physical benefits, this study reveals that there are also dramatic improvements in perceived body image, demonstrating the impact of this surgery on a patient's psychosocial health.     

Use of a Modified Stroop Task to Examine Appearance-Schematic Information Processing in College Women

A computerized Stroop color-naming task was usedto compare the information processing of 55appearance-schematic and 50 appearance-aschematic women,based on their scores on the Appearance SchemasInventory (ASI). Participants color-named appearancewords (e.g., OVERWEIGHT, LIPSTICK ) and nonappearancewords (e.g., OBNOXIOUS, BRIDEGROOM ) after exposure toeither a neutral condition or a "priming" condition that emphasized their bodysize/appearance. Primed schematic persons exhibitedgreater Stroop interference in color-naming appearanceversus nonappearance words compared to nonprimedschematics and both primed and nonprimed aschematics. Onan incidental recall task, a modest but significantpositive correlation was observed between ASI scores andthe percentage of appearance words among words subsequently recalled. These and other findingsprovide evidence of the construct validity of the ASI ina nonclinical population and offer a foundation on whichto advance the study of cognitive models of body image and clinical body-imagedisturbances.     

血脂、体质量指数与受体双阴性乳腺癌预后关系的临床研究

【目的】观察乳腺癌患者术前血脂、体质量指数（BMI）与乳腺癌预后的关系。【方法】通过随访乳腺癌巩固期受体双阴性患者,比较手术前血脂、BMI正常患者与血脂、BMI异常患者短期复发转移率与病死率的差异。【结果】血脂异常组复发转移率与病死率明显高于血脂正常组（P〈0．05）,BMI≥25的患者复发转移病死率大于BMI〈25的患者（P〈0．05）。【结论】血脂升高及体质量增加与乳腺癌的预后不良存在相关性。     

补肾活血中药对子宫内膜异位症的影响

【目的】观察补肾调经汤内服加活血散结栓塞肛对子宫内膜异位症(简称内异症)体液免疫及异位子宫内膜的影响。【方法】SD大鼠130只,随机分为10组,分别为正常对照组、模型组、丹那唑阳性对照组及不同剂量补肾调经汤灌胃或加用和单独使用活血散结栓塞肛治疗7个组。除正常对照组外,其他组均复制大鼠子宫内膜异位症模型,然后分别给药,治疗4周后检测血清IgG、IgM、IgA抗体和补体C3、C4及谷丙转氨酶(ALT)水平,进行胸腺、卵巢、子宫、异位移植物及肝、肾组织的病理学检查。【结果】大鼠内异症模型手术4周后,异位的子宫内膜生长良好,IgG、C3水平升高,IgM下降,子宫、卵巢增大;中药及丹那唑治疗后均可使异位的内膜萎缩,3倍人用剂量中药灌胃加塞肛或5倍量组IgG值下降,5倍量中药塞肛或加灌胃组C3值下降,5倍量中药灌胃加塞肛组子宫和卵巢缩小;丹那唑对模型动物的性周期有抑制作用,而中药组均无此作用;各给药组均对大鼠的ALT无明显影响。【结论】补肾调经汤内服加活血散结栓塞肛可使内异症模型大鼠的子宫内膜萎缩,改善其体液免疫功能。     

From a Pictogram to a Symbol: Working with a Transgender Patient in an NHS Gender Clinic Using Piera Aulagnier's Theory of Identity Formation

This article presents clinical work with a transgender patient who was attending a regional NHS gender clinic in England. It aims to link aspects of the patient's identity formation with the theoretical framework offered by the French psychiatrist and psychoanalyst Piera Aulagnier. Emphasizing the complexity of (gender) identity and its process of development, the concept of the ‘birth of the body’ is used to situate the development of gender identity as a process of the creation of an individual narrative, with the experience of embodiment based on unconscious fantasy as specifically troubling for transgender individuals. This struggle may be seen in the clinical material presented. Recommendations are made for working with transgender clients who suffer from a disturbance in creating and navigating relationships. By using the concept of the ‘word-bearer’, an exploration may be opened up of the unconscious dynamics between the clinic as an object that offers understanding, and the service user who is seeking meaning and a remedy for subjective suffering.