《医学证治发微》作者及成书年代考

中医古籍《医学证治发微》是一部并不出名的著作,作者对于多数人也很陌生。一直以来所有文献都认为作者名徐澹庵,字扆臣,约成书于清末。笔者用徐澹庵、徐扆臣、医学证治发微、证治发微等检索词,在各种数据库中反复检索,得到《医学证治发微》有效相关文献4条,即工具书的4条记载;徐澹庵有效相关文献9条(含《医学证治发微》4条有效相关文献);徐扆臣有效相关文献4条与《医学证治发微》相同;《证治发微》有效相关文献0条。足见该书相关记录之稀少。文献记载的"徐澹庵"与《医学证治发微》的作者徐扆臣,字澹庵是两个不同的人。之所以有这样的讹误,多半是因为"澹"通"淡""庵"通"安"。且《医学证治发微》所见者寡,而"徐锦,徐淡庵"所知者众。于是误将清康熙雍正乾隆间的海盐人"徐扆臣,徐澹庵"的著作,安给了清乾隆、道光间的江苏长洲名医"徐锦,徐淡庵"。笔者通过查阅原著,考究文献,对讹误进行了分析,认为《医学证治发微》一书作者为清顺治、康熙年间浙江海盐人徐扆臣,字澹庵,该书当成书在康熙年间。     

Photodynamic Cancer Therapy Using Wavelet Based Monte Carlo Computation of Light Absorption with a Genetic Algorithm

Objective: The method to treating cancer that combines light and light-sensitive drugs to selectively destroy tumour cells without harming healthy tissue is called photodynamic therapy (PDT). It requires accurate data for light dose distribution, generated with scalable algorithms. One of the benchmark approaches involves Monte Carlo (MC) simulations. This gives an accurate assessment of light dose distribution, but is very demanding in computation time, which prevents routine application for treatment planning. Methods: In order to resolve this problem, a design for MC simulation based on the gold standard software in biophotonics was implemented with a large modern wavelet based genetic algorithm search (WGAS). Result: The accuracy of the proposed method was compared to that with the standard optimization method using a realistic skin model. The maximum stop band attenuation of the designed LP, HP, BP and BS filters was assessed using the proposed WGAS algorithm as well as with other methods. Conclusion: In this paper, the proposed methodology employs intermediate wavelets which improve the diversification rate of the charged genetic algorithm search and that leads to significant improvement in design effort efficiency.     

急性酒精中毒的治疗进展及趋势探讨

近年来,对急性酒精中毒的更为有效的治疗方法正在不断探索,中药西药各有优势,而中西医结合治疗将具有更加广阔的前景。     

Magnetic Resonance-Guided Percutaneous Cryoablation of Uterine Fibroids: Early Clinical Experiences

Purpose Uterine fibroids (leiomyomas) are the most common tumors of the uterus. The present study evaluated the feasibility and effectiveness of magnetic resonance (MR)-guided percutaneous cryoablation for uterine fibroids as a minimally invasive treatment alternative. Methods From August 2001 to June 2002, MR-guided percutaneous cryoablation was performed on seven uterine fibroids in 6 patients who displayed clinical symptoms related to tumors. Using a horizontal-type open MR system, cryoablation probes were percutaneously placed in fibroids. Fibroids were ablated, and the site and size of ice balls were monitored on MR imaging. Postoperatively, patients completed a questionnaire to assess changes in presenting clinical symptoms, and MR images were obtained for all patients at follow-up. Changes in clinical symptoms and tumor volume were evaluated in each patient. Results All treated patients showed reductions in tumor size. Mean volume reduction rate was 40.3% at 6 weeks postoperatively, and 79.4% at 9–12 months. All patients reported fever after treatment. Surgical drainage was required for abscess in the probe channel in one patient, and transient liver damage occurred in another. Subjective symptoms improved in all patients except one who had multiple tumors, and no patient complained of new symptoms after cryoablation during follow-up. Conclusion MR-guided percutaneous cryoablation represents a feasible and effective treatment for uterine fibroids.     

逐瘀通脉胶囊联合前列地尔治疗下肢静脉炎的临床观察

目的：对逐瘀通脉胶囊联合前列地尔治疗下肢静脉炎的·临床疗效进行观察和分析。方法：选取符合纳入标准的下肢静脉炎患者56例,按照随机数字法分为中西医结合治疗组和西药治疗组,分别给予相应的治疗措施且对其病情进行观察,最后进行统计学处理。结果：逐瘀通脉胶囊联合前列地尔治疗组优于单纯前列地尔组。结论：中西医结合治疗下肢静脉炎的疗效确切。     

Assessing the impact of evolving evidence in renal cell carcinoma treatment: An update of the Renal Cell Carcinoma Appropriateness-based Treatment Toolkit (ReCATT)

The appropriateness of the numerous therapeutic options available for patients with advanced or metastatic renal cell carcinoma (RCC) was evaluated in 2011, using the RAND/University of California, Los Angeles (UCLA) appropriateness methodology to match treatment suitability to a range of patient scenarios. However, the RCC therapeutic area evolves rapidly and a body of new clinical data has accrued in the intervening years; as a result the exercise was repeated in 2013 using the same methodology, expert panel and patient scenarios. The aim of the updated assessment was to update the guidance to clinicians and use it to develop an interactive web-based application, the Renal Cell Carcinoma Appropriateness-based Treatment Toolkit (ReCATT).This round of assessment achieved greater concordance concerning the appropriateness of treatments/interventions for the clinical scenarios tested; this higher level of agreement is likely to reflect the body of scientific evidence accrued since the previous assessment exercise. Many of the areas of disagreement in 2011 related to the suitability of pazopanib or sunitinib treatment; in the 2013 assessment both agents were considered appropriate treatment options for many of the clinical scenarios assessed. Uncertain scenarios often are related to the optimal management of metastatic RCC with clear cell histology. The use of the RAND/UCLA RCC assessment findings to develop the ReCATT support tool will help to disseminate expert opinion concerning best treatment practice and guide the clinical management of RCC patients treated in the community setting.