中医门诊申报失眠及非器质性睡眠障碍患者中药方剂用药频率与型态分析

目的：本研究目的为探讨中医门诊申报失眠及非器质性睡眠障碍患者年龄层之分布、处方用药排行、单方及复方排行前20名、医疗费用结构、治疗方式及同一病者连续5年追踪占率等为主要目的。方法：本研究数据源以2005—2009年中央健康保险局台北分局特约中医院所申报全数据为数据库,以门诊申报失眠及非器质性睡眠障碍疾病资料为撷取条件,依中医院所申报ICD-9-CM主、次诊断为ICD-9-CM（780.5及307.40~307.50）之所有患者。结果：2005—2009年中医门诊主、次诊断申报失眠及非器质性睡眠障碍疾病总病人数为637742人;5年间平均就医次数为4.2次。总件数为2689455件。主、次诊断为失眠及非器质性睡眠障碍疾病患者各年龄层分布为20~59岁分布最多,男女的比率为0.45比1;单方药材排名前5名为酸枣仁（16.45%）、夜交藤（16.20%）、合欢皮（8.93%）、远志（8.09%）、茯神（8.03%）;复方前5名分别为加味逍遥散（23.68%）、酸枣仁汤（22.17%）、天王补心丹（15.66%）、柴胡加龙牡汤（12.18%）及甘麦大枣汤（8.88%）;每张处方的用药品项数单方以1~5个品项最多,复方品项数以1~3个品项最多,其中每张处方不分单复方的用药品项数以3~7个品项占最多。治疗的方式以纯内科服药治疗占最多;持续就医5年者追踪占率为26.62%。结论：本研究提供中医师临床治疗失眠及非器质性睡眠障碍疾病的用药频率及型态,从研究中我们无法了解失眠及非器质性睡眠障碍疾病的中医证型分类,但从用药频率分析得知,中医临床治疗失眠及非器质性睡眠障碍疾病的中药方剂是以能疏肝解郁、清热除烦、补心安神、益气和中、行气化痰、调和胆胃、泻肝利湿、行气止痛、滋补肾阴、清虚火为主。对于中医师临床处方用药应有很好的参考价值。至于相关的方剂及药物的作用机转仍有待日后进一步加以阐明。     

中国Rett综合征患儿突变基因的亲源分析

Objective To identify the parental origin of methyl-CpG-binding protein 2 (MECP2)gene mutations in Chinese patients with Rett syndrome. Methods Single nucleotide polymorphisms (SNPs) in intron 3 of the MECP2 gene were analyzed by PCR and sequencing in 115 patients with Rett syndrome.Then sequencing of the SNP region was performed for the fathers of the patients who had at least one SNP,to determine which allele was from the father. Then allele-specific PCR was performed and the products were sequenced to see whether the allele from father or mother harbored the mutation. Results Seventy-six of the 115 patients had at least one SNP. Three hot SNPs were found in these patients. They were: IVS3+22C＞G, IVS3+266C＞T and IVS3+683C＞T. Among the 76 cases, 73 had a paternal origin of MECP2 mutations, and the other 3 had a maternal origin. There were multiple types of MECP2 mutation of the paternal origin, including 4 frame shift, 2 deletion and 67 point (56 C＞T, 6 C＞G, 2 A＞G, 2 G＞T and 1 A＞T) mutations. The mutation types of the 3 ptients with maternal origin included 2 frame shift and 1 point (C＞T) mutation. Conclusion In Chinese RTT patients, the MECP2 mutations are mostly of paternal origin.     

Bringing Up Baby: Developmental Simulation of the Adult Cranial Morphology of Rungwecebus Kipunji

Rungwecebus kipunji is a recently discovered, critically endangered primate endemic to southern Tanzania. Although phenetically similar to mangabeys, molecular analyses suggest it is more closely related to Papio or possibly descended from an ancient population of baboon‐mangabey hybrids. At present, only a single kipunji specimen, an M1‐stage juvenile male, is available for study; thus, the cranial morphology of the adult kipunji is unknown. In this study, we used developmental simulation to estimate the adult kipunji's 3D cranial morphology. We examined variation in cercopithecine developmental vectors, applied selected vectors to the juvenile cranium, and compared the resulting simulated adults to actual adult male papionins. Differences between papionin developmental vectors were small and statistically insignificant. This uniformity suggests conservation of an ancestral papionin developmental program. Simulated kipunji adults were likewise extremely similar. As a group, the simulated adults were morphometrically distinct from other papionins, corroborating the kipunji's generic status. Simulated adults were phenetically most similar to Lophocebus aterrimus but were distinguished from all adult papionins by the same unique traits that characterize the kipunji juvenile: a tall neurocranium, broad face, short nasal bones, concave anteorbital profile, and dorsally rotated palate. This concordance between juvenile and estimated‐adult morphologies confirms that papionin cranial shape is largely established before M1 eruption. The estimated kipunji adult's neurocranium strongly resembles that of Papio, providing the first cranial evidence supporting their phylogenetic relationship. If the kipunji does indeed have a hybrid origin, then its phenetic affinity to L. aterrimus favors Lophocebus as the proto‐kipunji's paternal lineage. Anat Rec, 2010. © 2009 Wiley‐Liss, Inc.     

左冠状动脉起源于肺动脉6例患儿的诊断与治疗

目的分析左冠状动脉起源于肺动脉(ALCAPA)的诊断特点,评估其手术效果。方法本院2006年3月-2007年10月共收治ALCAPA患儿6例。男4例,女2例;年龄6个月～10岁,平均43.5个月。对这6例患儿的临床表现、心电图(ECG)特征、心脏超声、64排螺旋CT及心导管检查资料、手术治疗及转归进行分析。结果ALCAPA5例患儿有不同程度的多汗、烦躁、气促、拒食等临床表现,临床检查示心功能不全。ECG特异表现:4例患儿ECG存在前侧壁异常Q波及ST段改变,1例患儿存在ST段改变,1例患儿ECG大致正常。典型彩色超声心动图表现为:4例患儿出现左室扩大伴左室收缩功能减低;2例患儿存在二尖瓣轻-中量返流,2例患儿为大量二尖瓣返流;2例患儿表现为右冠状动脉扩张。增强CT及心导管检查有特征性改变。其中5例患儿行手术治疗:2例直接移植,3例行左冠状动脉重建术;2例重度二尖瓣返流患儿同时行二尖瓣成形术。1例无症状患儿未行手术治疗。术后患儿症状改善,无死亡病例。结论了解ALCAPA的病变特点及相关辅助检查,可提高ALCAPA的检出率,尽早手术治疗,改善预后。     

息贲病证治考源

＂息贲＂出自《黄帝内经》,现代病名已很少沿用,本文采用文献学研究方法,对古代中医文献中相关记载＂息贲＂之病名、病因病机、病证、治法及预后规律进行分析和总结,以期为现代中医临床诊治提供思路。     

Pefloxacin in the Antibacterial Treatment of Immunodepressed Patients

Summary

Pefloxacin 800 to 1200 mg daily was given for 3 to 20 days, orally or intravenously, to 84 immunocompromised pa-tients. Five patients dropped out because of side effects and 2 for other causes. Treatment efficacy was evaluated in 77 patients, 43 men and 34 women, aged 18 to 80 years. Immunodepression resulted from malignancy in 46 patients, LAS/ARC or AIDS in 28, and from unknown causes in 3. Fifty-eight patients had documented infections (respiratory-tract infections 29, urinary-tract infections 13, septicemia 10, other 6) and 19 had a fever of unknown origin (FUO). Cure or significant improvement of symptoms was achieved in 81% of patients with documented infections and in 74% of patients with FUO. Side effects (mainly gastrointestinal disturbances and skin rash) occurred in 7 patients (8.2%), including dropouts. These results suggest that pefloxacin may be useful for the antibacterial treatment of immunodepressed patients.     

18F-FDG PET/CT对不明原因发热（FUO）疑难病例病因诊断的效果分析

[目的]回顾分析^18F-FDG PET/CT（FDG-PET）对FUO疑难病例病因的诊断价值。[方法]67例FUO患者行FDG-PET检查,病理及随访结果确定病因。[结果 ]FDG-PET对FUO病因诊断的总有效率为40.3%,对肿瘤（90.0%）诊断能力最强,其次为感染（33.3%）和免疫疾病（20.0%）。肿瘤患者脾大发生率明显增高,淋巴结大和脏器（淋巴结、脾和骨髓）代谢增高发生率以及增高程度与感染和免疫疾病组间无差异。FDG-PET有效组患者淋巴结和脾代谢以及血ESR增高程度与无效组有明显差异。[结论]FDG-PET对FUO疑难病例病因诊断有效率低;肿瘤、感染及免疫系统疾病FDG-PET影像表现有重叠;脾大、淋巴结和脾代谢及血ESR增高程度有助于FUO病因诊断。     

运用引火归元法治疗慢性阻塞性肺疾病急性加重期临床研究

目的观察运用引火归元法治疗慢性阻塞性肺疾病(COPD)急性加重患者的临床疗效。方法将72例COPD患者随机分为2组,对照组36例给予常规西药治疗;治疗组36例在对照组基础上加用参附注射液;观察2组在治疗前和治疗后患者的总有效率、症状积分、肺功能FEV1的变化。结果 2组总有效率比较有显著性差异(P<0.05)。2组症状积分及肺功能均明显改善,实验组的改善更为明显(P均<0.05)。2组治疗前后红细胞、血红蛋白、肝功能、肾功能均无明显变化。结论引火归元法可显著提高COPD急性加重期的患者总有效率,改善症状及肺功能,具有良好的研究及临床应用前景。     

敦煌紫苏煎方源及相关医方探析

敦煌医学卷子P．2662V中的紫苏煎为治疗肺病上气咳嗽或吐脓血之证所设,以该方灵活加减化裁治疗日久不愈之咳嗽,效果甚佳,经与传世文献《千金要方》《千金翼方》《外台秘要方》等方书进行对比,发现没有与敦煌紫苏煎组成相同的医方,即使方中含有紫苏或苏子的治疗咳嗽方,药物组成也不相同,其功用也有所不同,这说明紫苏煎是秘藏藏经洞而在传世文献中没有记载的珍贵方药,从紫苏煎中的药物牦牛酥、诃勒皮等组成来看,该方很有可能来源于敦煌西域的医家,也有可能是中原医家经丝绸之路传入西域后经当地医家结合外来药物化裁而成,这两种情况均反映了丝绸之路医药文化中的中原医药文化与敦煌西域医药文化的密切交流。