新疆出土梵文医方集《鲍威尔写本》与中国传统医学的关系

新疆库车出土的梵文桦树皮写本因英属印度陆军中尉鲍威尔在库车购买而名“鲍威尔写本”.该写本后经英国籍德国裔东方学家霍恩勒研究、考释、刊布,共7卷,前3卷为医方集.经考证,其中的“达子香叶散”即现今藏医的“杜鹃大臣散”.经与中医、藏医、蒙医、维医等中国传统医学中的药方相比较,《鲍威尔写本》与藏医、蒙医关系近,与中医、维医关系远,曾影响过中国传统医学.     

Role of parietal pericardium in acute, severe mitral regurgitation in dogs

Mitral regurgitation (MR) resulting from acute disruption of the mitral valve apparatus leads to serious hemodynamic sequelae. The lesion produces major elevation of left atrial (LA) and pulmonary artery pressures and decreases forward cardiac output. Clinical studies have shown hemodynamic patterns in acute MR similar to those seen in constrictive pericardial disease, suggesting that the pericardium serves to importantly limit cardiac filling in this condition. This hypothesis has not been tested in an animal model in which the intrapericardial pressure can be directly measured. In the present study intrapericardial and intracardiac pressures were measured in 8 dogs before and after the production of acute MR. After production of MR, mean LA pressure increased from 8 +/- 3 to 20 +/- 7 mm Hg (p = 0.004) and the peak LA V wave averaged 31 +/- 13 mm Hg. Mean right atrial pressure increased slightly, from 4 +/- 2 to 5 +/- 1 mm Hg (p less than 0.008). Intrapericardial pressure increased in each dog, but the increment was invariably small (1 +/- 2 to 3 +/- 2 mm Hg, p = 0.001) and there was no tendency to equalization of pressure between right- and left-sided cardiac chambers. Thus, the role of the pericardium in the immediate hemodynamic response to acute, severe MR is minor.     

柴胡疏肝散加减治疗慢性萎缩性胃炎肝胃不和证的Meta分析*

目的系统评价柴胡疏肝散加减治疗慢性萎缩性胃炎(CAG)肝胃不和证的临床疗效以及安全性。方法 检索Pubmed,Web of Science,Cochrane Library,CNKI,VIP和万方数据库,纳入所有柴胡疏肝散加减治疗慢性萎缩性胃炎肝胃不和证的临床随机对照试验(RCTs),检索时间为建库至2019年10月1日,采用RevMan5.3软件进行Meta分析。结果 最终纳入11项研究,共1 068例患者。Meta分析结果显示:与常规西药治疗相比,柴胡疏肝散能有效提高肝胃不和型萎缩性胃炎患者的临床总有效率[RR=1.25,95%CI(1.19,1.33),P<0.000 01]、症状疗效总有效率[RR=1.57,95%CI(1.30,1.89）,P<0.000 01]及血清胃泌素G17水平[MD=3.61,95%CI(2.89,4.33),P<0.000 01],并能改善胃粘膜萎缩[MD=-1.53,95%CI(-1.93,-1.12),P<0.000 01]、肠上皮化生[MD=-0.79,95%CI(-0.96,-0.63),P<0.000 01]、异型增生度[MD=-0.69,95%CI(-0.84,-0.55),P<0.000 01]的病理检查积分,2组疗效差异具有统计学意义。结论 柴胡疏肝散加减治疗肝胃不和型慢性萎缩性胃炎疗效优于常规西药治疗。     

Obtaining reliable intraoral digital scans for an implant-supported complete-arch prosthesis: A dental technique

This article describes a technique for obtaining an accurate complete-arch digital scan for an edentulous patient. To achieve this, an auxiliary polymeric device that simulates a denture is designed, fabricated, and placed in the mouth. This device, having the geometry of a typical dental arch, facilitates the digitalization of the edentulous complete arch. This is because the change in radius of the curvature (change of geometry) enables the scanner to perform a more accurate alignment. Initially, the necessary location of the implants is acquired, and then the soft tissue is added. This technique can achieve accurate complete-arch digital scans. Distances between implants are closer to the gold standard when using this auxiliary geometry piece than those obtained without using it.     

经典名方清胃散的研究进展

清胃散方记载于金代李东垣所著《兰室秘藏》,由当归（身）、生地黄（酒制）、黄连、牡丹皮、升麻5味中药组成,是治疗胃火牙痛的常用方剂。近年来,临床研究表明该方应用范围十分广泛。通过查阅文献,从处方来源、功效主治、化学成分、药理研究、临床应用方面进行综述,以期为新药研发提供依据。     

Understanding the underutilization of cervical brachytherapy for locally advanced cervical cancer

PurposeTo understand the reasons behind current low utilization of brachytherapy for locally advanced cervical cancer in the United States.Methods and MaterialsA 17-item survey was e-mailed to the American Brachytherapy Society (ABS) listserv of active members in 2018. Responses of attending physicians in the United States were included in the analysis.ResultsAmong a total of 135 respondents, 81 completed the survey. Eighty-four percent agree/strongly agree that cervical brachytherapy is underutilized, and 46.9% disagree/strongly disagree that residents are receiving adequate training for brachytherapy; 75.3% agree/strongly agree that inadequate maintenance of brachytherapy skills is a major obstacle to brachytherapy use; and 71.6% agree/strongly agree that increased time requirement constitutes a major obstacle. Over 97% will recommend brachytherapy for most patients with cervical cancer if given access/time; 72.8% always perform their own brachytherapy, whereas 29.6% reported some type of barrier exists in performing brachytherapy themselves, with time required to perform brachytherapy (9.9%) being a leading factor. A quarter (24.7%) routinely refer to other radiation oncologists for brachytherapy. Even among ABS members, 37.0% reported that they would perform an intensity-modulated radiation therapy or stereotactic body radiation therapy boost in specific scenarios in potentially curable patients. The most common scenario is inability to place a uterine tandem (56.7%).ConclusionsThe underutilization of brachytherapy in cervical cancer is widely recognized by ABS members with inadequate training during residency and inadequate maintenance of skills being possible major contributing factors. Even among ABS members, there are identifiable barriers. Continued advocacy and future initiatives in enhancing access to brachytherapy training and efficiency are needed.     

真武汤合生脉散治疗慢性充血性心力衰竭28例临床观察

目的:观察真武汤合生脉散治疗慢性充血性心力衰竭的临床疗效。方法:选择56例诊断明确的慢性充血性心力衰竭患者,经知情同意后,随机分为治疗组与对照组,各28例。对照组运用西药常规进行治疗,治疗组在对照组基础上加用真武汤合生脉散水煎剂治疗,疗程4周。结果:治疗组临床症状改善总有效率为82.14%,对照组64.29%;心衰计分治疗组有效率85.71%,对照组有效率67.85%。结论:真武汤合生脉散可较快缓解慢性充血性心力衰竭临床症状,改善心功能。     

四逆散冻干粉改善大鼠睡眠作用机制研究

目的研究四逆散冻干粉改善大鼠睡眠作用机制。方法按照随机数表法将SD雄性大鼠随机分为5组:空白对照组、阴性对照组、阳性对照组、四逆散冻干粉组,混合物组,每组10只。阴性对照组的大鼠灌胃0. 9%Na Cl;阳性对照组的大鼠灌胃盐酸帕罗西汀溶液4. 2 mg·kg^-1;四逆散冻干粉组的大鼠灌胃四逆散冻干粉水煎液2. 41 g·kg^-1;混合物组灌胃混合物(辛弗林-芍药苷-柴胡皂苷C-甘草次酸=8. 5∶1. 0∶1. 5∶6. 5) 206 mg·kg^-1。每日灌胃1次,连续给药1周。用高效液相色谱(HPLC)法测定脑脊液移行成分。结果四逆散冻干粉在脑脊液中除戊巴比妥钠成分外,并无血中移行成分的进入;给予四逆散冻干粉后,脑脊液中成分峰面积约是空白脑脊液峰面积的12. 5倍;血清中四逆散的移行成分(辛弗林、芍药苷、柴胡皂苷C、甘草次酸)均可以使脑脊液中该内源性物质峰面积高于空白脑脊液峰面积,但不如四逆散整方作用;混和物组增高脑脊液中内源性物质峰面积是四逆散组的3. 2倍,该内源性物质是5-羟色胺。结论四逆散冻干粉是通过促进脑脊液中内源性物质5-羟色胺的分泌达到改善睡眠作用的。