“白血”之古籍探微

"白血"一词首次出现在《素问·至真要大论》。通过检索古籍,分析归纳历代医家对"白血"一词的有关论述,归纳针对其本质的探讨,有"肺血""肾精""脾痰"三种观点。对《内经》原文条分缕析,认为"白血"实乃燥气所胜、金实乘木,所吐之"肺血肺阴",并总结历代医家关于"白血"之治法,以丰富对"白血"的认识。     

Apalutamide-induced severe interstitial lung disease: A report of two cases from Japan

Apalutamide, a competitive inhibitor of the androgen receptor, is being increasingly used for the treatment of prostate cancer. There have been few reports of interstitial lung disease in clinical trials of apalutamide. However, two cases of apalutamide-induced interstitial lung disease with respiratory failure in Japanese males, who were successfully treated with high-dose corticosteroids, are presented here. These cases suggest that clinicians should be alert to the potentially life-threatening risk of pulmonary toxicity associated with apalutamide treatment.     

重点肋骨内固定联合机械通气治疗连枷胸伴创伤性湿肺临床疗效

目的分析重点肋骨内固定联合机械通气治疗连枷胸伴创伤性湿肺的临床效果。 方法选取2014年1月至2015年10月江苏省新沂市人民医院胸心外科收治的连枷胸伴创伤性湿肺患者50例作为研究对象，其中男性35例，女性15例；年龄20~68岁，平均(43.40±2.40)岁。所有患者行重点肋骨内固定术并联合机械通气治疗，术后对比患者治疗前后动脉血气指标变化情况，并详细评估患者治疗前后疼痛和呼吸改善情况。 结果术后患者心率(P)、呼吸频率(RR)、收缩压(SBP)、舒张压(DBP)等体征指标及二氧化碳分压(PaCO₂)、动脉血氧分压(PaO₂)、酸碱度(PH)等动脉血气指标均优于术前(P<0.05)；术后所有患者经CT三维成像复查无二次撕裂或移动松脱并发症发生，内固定均牢固。术后疼痛评分及呼吸困难均明显改善。 结论重点肋骨内固定术联合机械通气治疗可改善患者的呼吸循环状况，加速促进患者的康复，值得临床推广使用。     

¿Quién decide qué datos deben constar en la historia clínica en relación con el origen biológico?

There is an increasing request by patients or their representatives not to have some data registered in their clinical history or if such data exists to be deleted. Without doubt, this is so because such clinical data is accessed by various professionals who in most cases are not directly involved in caring for such patients. On the other hand, such data is copied and iteratively and unnecessary reproduced in various discharge reports and others forms. The problem arises when such controversial data refer to particularly sensitive clinical aspects such as assisted reproduction techniques, which invades personal and family privacy. Therefore, the question is who determines what data should be recorded in the medical records and according to what criteria should be taken that decision?     

川芎嗪联合顺铂对Lewis小鼠肺腺癌移植瘤与血管生成的影响

目的研究川芎嗪联合顺铂对Lewis肺腺癌小鼠移植瘤生长及抑制血管生成的作用机制。方法培养Lewis小鼠肺腺癌细胞,建立移植瘤模型。按照体重将成功制备的荷瘤小鼠模型随机分成4组,每组15只:模型组、顺铂组、川芎嗪组、联合组。模型组:0.9% NaCl,顺铂组:2 mg·kg^-1,川芎嗪组:100mg·kg^-1,联合组:两种药物相加。均每次0.2 mL,干预2周。称量瘤重,计算抑瘤率;用免疫组化方法检测每组血管内皮生长因子(VEGF)、血管抑制蛋白(VASH-1)的表达。结果给药后,联合组、顺铂组、川芎嗪组的抑瘤率分别为54.81%,32.36%,18.36%,与模型组(抑瘤率为0)比较,差异均有统计学意义(均P<0.05)。联合组、顺铂组、川芎嗪、模型组的VEGF表达分别为20.37±2.02,28.07±4.29,26.43±4.69,62.14±6.78;这4组的VASH-1表达分别为9.04±1.01,10.10±1.61,11.53±1.96,12.94±1.10,3个给药组与模型组相比,差异均有统计学意义(均P<0.05)。Pearson相关性分析:VEGF与VASH-1成正相关(r=0.664,P<0.05)。结论川芎嗪联合顺铂协同抑制Lewis小鼠移植瘤生长,其作用机制可能为川芎嗪与顺铂可以直接作用癌细胞,同时降低VEGF与VASH-1表达,发挥抗血管生成作用。     

外周血中hnRNP A2/B1含量及其在肺癌诊断中的意义

目的用FQ-RT-PCR技术检测外周血中hnRNPA2/B1表达水平及在肺癌诊断中的意义.方法用FQ-RT-PCR技术定量分别检测18例健康体检者、12例肺部良性疾病和30例肺癌患者外周血中hnRNPA2/B1 mRNA,并用β-actin对hnRNPA2/B1表达水平进行标化.结果 hnRNPA2/B1与β-actin的比值在正常对照组和良性肺部疾病组间差异无显著性(P>0.05),而肺癌组均高于前两组(P<0.05);hnRNPA2/B1基因在低分化鳞癌中的表达水平很低,与其它类型肺癌差异有显著性(P<0.05).结论 hnRNPA2/B1在血中表达水平的差异在肺癌诊断中具有一定临床应用价值,并与肺癌的病理分级有一定相关性.     

Review of the Captain America Graphic Novel ‘TRUTH: Red,White and Black’ Focusing on Parallels with the Infamous USPHS Syphilis Study at Tuskegee

This review presents the first detailed presentation of the parallelism between the Tuskegee Syphilis Study and the Captain America graphic novel ‘TRUTH: Red, White and Black’, published as a graphic novel by Marvel Comics in 2004 as a paperback, and then in 2009 as a hardcover. First written, published and distributed monthly in 2003 as pre-sequel seven comic book series to tell the story of the origins of the WWII superhero Captain America. In 2003, Marvel Comics chose to tell a ‘very dark story’ to explain the origins of Captain America, a half century after the initial introduction of Captain America as a WWII action hero in 1940. By detailing—for the first time—nine parallel aspects between these two storylines, this review demonstrates how Marvel Comics brought the tragic Tuskegee Syphilis Study story into the popular press, thus reaching an audience far beyond traditional bioethics academicians. This review is intended to stimulate and guide classroom discussions on the ethical issues at the core of the infamous Tuskegee Syphilis Study allowing bioethical issues to be made more accessible to the general public, via school curriculums, by the use of graphic novels.