我国香港、台湾地区护理管理立法可鉴之处一览

中华人民共和国卫生部颁布的《护士管理办法》,自1994年开始实施至今已经十年有余了。随着我国医疗卫生体制改革的推进,随着医疗服务市场的不断发展《,护士管理办法》的内容有待完善和修改。笔者仅以此文,介绍一下我国港台地区在护理管理方面具有特色的一些立法规定,相信会对日后完善内地护理管理工作有益。     

双虎清肝颗粒联合丹田降脂丸治疗脂肪肝肝炎疗效观察

目的探讨双虎清肝颗粒联合丹田降脂丸治疗脂肪肝肝炎的疗效。方法选择2008年12月~2011年12月在本院进行治疗的脂肪肝患者90例作为研究对象,分为对照组和研究组,对照组采用常规的对症治疗,研究组采用双虎清肝颗粒和丹田降脂丸进行治疗,疗程均为2个月,比较两组的治疗效果。结果研究组治疗总有效例数为40例,总有效率为88.89%,对照组总有效例数为28例,总有效率为62.22%,两组患者治疗总有效率比较差异存在统计学意义（P〈0.05）,研究组和对照组治疗前后ALT、γ-GT、TG和TC差异均存在统计学意义（P〈0.05）,治疗后两组患者生化指标比较显示,各种生化指标ALT、γ-GT、TG和TC差异均存在统计学意义（P〈0.05）。结论采用双虎清肝颗粒联合丹田降脂丸治疗脂肪肝肝炎疗效显著,应加强临床推广。     

Chemical form of metals in traditional medicines underlines potential toxicity in cell cultures

Ethnopharmacological relevance

Mercury (Hg) and arsenic (As) are frequently found in traditional medicines as sulfides, such as cinnabar (HgS) and realgar (As₄S₄). There is a general perception that any medicinal use of such metal-containing remedies is unacceptable. An opposing opinion is that different chemical forms of arsenic and mercury have different toxic potentials.

Aim of the study

To clarify this question, cinnabar, realgar, and cinnabar- and realgar-containing traditional medicine An-Gong-Niu-HuangWan (AGNH), were compared to well-known mercurials (HgS, HgCl₂ and MeHg) and arsenicals (As₂S₂, As₂O₃, NaAsO₂, and Na₂HAsO₄) for their cytotoxicity in human and rodent cell lines.

Materials and method

Cultured cells derived from target organs such as brain (HAPI) and liver (Hep3B, HepG2 and TRL1215) were treated with chemicals for 48 h and cytotoxicity was determined by the MTS assay.

Results

MeHg was most toxic with LC₅₀ of 4-20 μM, followed by NaAsO₂ (LC₅₀, 25-250 μM) and HgCl₂ (LC_50, 50-100 μM), Na₂HAsO₄(LC₅₀, 60-400 μM), As₂O₃(LC₅₀, 30-900 μM), and As₂S₂ (LC₅₀, 100-500 μM). In comparison, the LC₅₀ of realgar ranged from 250 to1500 μM; whereas cinnabar or HgS were approximately 20,000 μM and the toxicity of AGNH was in the range of 1500-8000 μM. Approximately 5000-fold differences exist between MeHg and HgS, and over 10-fold differences exist between NaAsO₂ and As₄S₄.

Conclusions

Chemical forms of metals are important factor in determining their toxicity in traditional medicines, both cinnabar and realgar are much less toxic than well-known mercurial and arsenicals.     

Huayu Pill (化瘀丸) Promotes Fluorescent Doxorubicin Delivery to Tumors in Mouse Model of Lung Cancer

Objective: To study the effect and mechanism of Huayu Wan (化瘀丸, HYW) in combination of chemotherapy of tumor treatment. Methods: HYW serum was added in Lewis cells to assess its impact on fluorescent doxorubicin delivery in vitro. Then, Lewis tumor cells was implanted in C57BL/6 mice via xenograft transplantation. Tumor growth was measured and signal intensity corresponding to blood flow was assessed by laser doppler perfusion imaging (LDPI). Finally, the effect of HYW on the efficacy of doxorubicin was studied. Results: HYW can improve the transfer of fluorescent doxorubicin into cells. The blood flow signal in the tumor tissues of the HYW group was higher than that of the control group (P<0.01). Furthermore, HYW improved drug delivery of doxorubicin to tumor tissues, and this activity was associated with HYW-induced microvascular proliferation (P<0.01). Conclusions: HYW can promote microangiogenesis and increase blood supply in tumor tissues, which in turn may increase the risk of metastasis. At the same time, HYW increases drug delivery and improves the efficacy of chemotherapy drugs through vascular proliferation. Therefore, rational judgment must be exercised when considering applying HYW to an antitumor regimen.     

安宫牛黄丸对阻塞性睡眠呼吸暂停低通气综合征患者血中食欲素A、瘦素及神经肽Y的影响

目的 观察安宫牛黄丸对阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者血中食欲素A(Orexin-A)、神经肽Y(NPY)和瘦素(Leptin)的影响.方法 选择经多导睡眠图仪行多导睡眠监测(PSG)确诊的轻、中度OSAHS患者50例,随机分为两组.治疗组25例给予安宫牛黄丸1丸,睡前服,每日1次,治疗30 d;对照组25例不给予任何治疗.治疗前后用放射免疫法和酶联免疫吸附法分别检测血浆食欲素A、NPY和血清瘦素水平,并进行夜间睡眠监测.结果 与对照组比较,治疗组治疗后患者睡眠呼吸暂停低通气指数(AHI)、觉醒指数明显减少[(16.33±3.57)次/h比(22.23±9.98)次/h.(103.58±32.90)次/s比(127.89±42.78)次/s,P<0.01和P<0.05],平均经皮血氧饱和度(MSpO2)和最低经皮血氧饱和度(LSpO2)明显增加(0.950±0.032比0.934±0.048,0.830±0.041比0.826±0.127,P<0.01和P<0.05),Ⅲ Ⅳ期睡眠百分比、鼾声指数和最长呼吸暂停时间均无差异.激素水平测定结果显示,治疗组治疗后食欲素A、瘦素水平较对照组明显降低(P<0.01和<0.05),而NPY无明显差异(P>0.05).相关性分析表明,OSAHS患者食欲素A、瘦素和NPY与AHI(r1=0.445,r2=0.480,r3=0.454)、觉醒指数(r1=0.613,r2=0.510,r3=0.479)均呈正相关(P<0.05或P<0.01),食欲素A与MSpO2和LSpO2呈负相关(r1=0.666,P1<0.01;r2=0.513,P2<0.05).结论 安宫牛黄丸能够降低轻、中度OSAHS患者血食欲素A、瘦素的水平,从而改善OSAHS患者的预后.     

左归丸、右归丸对老年大鼠海马、杏仁核氨基酸类和单胺类神经递质含量变化的影响

目的 观察左归丸、右归丸对老年大鼠海马、杏仁核氨基酸类神经递质Asp、Glu、Gly、GABA和单胺类神经递质5-HT、NE含量变化的影响，探讨老年机体神经元的神经递质的变化，以及左归丸、右归丸延缓老年大鼠神经内分泌调控退化的作用机制。方法 以自然衰老大鼠为动物模型，分设4组：青年对照组、老年对照组、老年左归丸组、老年右归丸组。采用HPLC-荧光法，检测各组大鼠海马、杏仁核Asp、Glu、gly、GABA含量变化；采用ELISA法，检测5-HT、NE含量变化。结果 与青年对照组相比，老年对照组大鼠海马、杏仁核Asp、Glu、Gly、GABA含量有不同程度升高，而与老年对照组相比，两用药组含量有不同程度降低。同时，老年对照组大鼠海马NE含量减少，左归丸组能提高老年大鼠海马NE含量。而各组大鼠5-HT含量无明显差异。结论 左归丸、右归丸通过不同程度地纠正老年大鼠海马和杏仁核脑区氨基酸类和单胺类神经递质的紊乱状态，使兴奋性和抑制性神经递质趋向平衡，从而有助于改善大脑边缘系统，延缓机体衰老。     

六味地黄丸含药血清对椎间盘I型和Ⅱ型胶原表达的影响

背景：胶原纤维是维持椎间盘正常结构与功能的重要物质,椎间盘中胶原的类型及含量的变化,影响整个椎间盘的生理和病理状态,I型及Ⅱ型胶原是椎间盘胶原的主要组分。目的：观察六味地黄丸含药血清对肿瘤坏死因子a致伤兔椎间盘I型、Ⅱ型胶原蛋白和基因表达的影响。方法：将15只新西兰白兔带终板的45个L2-L5椎间盘随机分为空白第1天组、空白第14天组、肿瘤坏死因子a组、中药血清组、肿瘤坏死因子a＋中药血清组。后两种培养液中分别含5ug/L肿瘤坏死因子a和体积分数10％六味地黄丸血清,培养14d后收集髓核和纤维环观察。结果与结论：RT—PCR和WesternBlot检测结果表明,随着培养时间的延长,纤维环中I型胶原及髓核中Ⅱ型胶原蛋白和基因表达明显降低;加入肿瘤坏死因子a可加速这种变化,而含药血清可延缓I,Ⅱ型胶原蛋白和基因表达变化。提示六味地黄丸可通过稳定I,Ⅱ型胶原蛋白和基因表达,对椎间盘细胞外基质具有保护作用。     

Muscle spasm associated with therapeutic use of Cang Er Zi Wan

Introduction.?Cang Er Zi Wan (CEZW) is a herbal medication derived from Xanthium sibiricum that is used to treat allergies and upper respiratory problems. Its toxicity has been described in grazing animals, in experimental studies, and in human overdoses. We describe a case of muscular spasm that was associated with the therapeutic use of CEZW.?Case report.?A 17-year-old female was prescribed CEZW for chronic allergies. Shortly after her second dose of 10 pills BID, she developed intermittent muscular spasms. She was seen in an Emergency Department and had normal vital signs and no significant laboratory abnormalities. Her physical exam was significant only for intermittent spasm of the muscles of the face, neck, and upper extremities. No tremor, fasciculation, dystonia, akisthisia, chorea, bradykinesia, or clonus was noted. She discontinued the CEZW and the symptoms slowly decreased over 4 days. Testing of the product did not detect any other medications or drugs.?Discussion.?CEZW is a herbal medication that contains X. sibiricum. X. sibiricum is a widespread weed that has caused muscular spasm, seizures, and death in animals that graze on it as well as animals experimentally exposed to it. Eleven cases of accidental human ingestion of Xanthium leading to spasm, somnolence, hypoglycemia, renal, and liver toxicity have been described. We describe a unique case of isolated muscular spasms because of the therapeutic use of a CEZW product.     

万托林、普米克令舒、沐舒坦联合雾化吸人治疗毛细支气管炎疗效观察

目的：探讨毛细支气管炎的雾化吸人治疗方法。材料与方法：将70例患儿随机分为两组,观察组给予万托林、普米克令舒、沐舒坦联合雾化吸人,同时静滴抗病毒药物、抗支原体药物及氢化考的松治疗;对照组给予静滴抗病毒药物、抗支原体药物及氢化考的松、氨茶碱治疗。结果：观察组和对照组患儿治疗1h后哮鸣音消失或减少的例数和呼吸困难、哮鸣音、痰鸣音消失的时间差异有显著性。结论：万托林、普米克令舒、沐舒坦联合雾化吸人治疗毛细支气管炎能够迅速改善症状、缩短病程。     

Combinatory effects of current regimens and Guizhi Fuling Wan on the development of endometriosis

ObjectiveEndometriosis, defined as the growth of endometrial glands and stromal cells in a heterotopic location under the cyclic influence of ovarian hormones, is a common gynecological disorder manifested by chronic pelvic pain and infertility. In traditional Chinese medicine, endometriosis is characterized by stagnation of vital energy (qi) and blood stasis. Guizhi Fuling Wan (GFW) was first described in Chinese canonical medicine to treat disorders associated with stagnation of qi and blood stasis, including endometriosis. Therefore, the current study aimed to test the effects of combining GFW with western medicine on the suppression of endometriosis.Materials and methodsEndometriosis was generated by suturing endometrial tissue on the peritoneal wall of C57BL/6JNarl mice. The mice were subsequently treated with either GFW or current hormonal therapies or in combination for 28 days.ResultsEndometriosis development was inhibited by GFW, Gestrinone, Visanne, GFW + Gestrinone or GFW + medroxyprogesterone acetate (MPA). The expression of intercellular adhesion molecule 1 (ICAM-1) was inhibited by GFW, Gestrinone, MPA, Visanne, GFW + Gestrinone, GFW + MPA and GFW + Visanne. Vascular endothelial growth factor (VEGF) expression was inhibited by GFW, Gestrinone, Visanne, GFW + Gestrinone and GFW + MPA. Both ICAM-1- and VEGF-reducing effects of GFW were attenuated by western medicines. Administration of GFW, MPA, Visanne, GFW + MPA and GFW + Visanne also correspondingly reduced macrophage population in peritoneal fluid. GFW, MPA, Visanne, GFW + MPA and GFW + Visanne enhanced B-cell population in peritoneal fluid.ConclusionThe current study reveals the therapeutic effects of GFW on endometriosis. However, the combination of GFW and current hormonal therapies potentially impedes the efficacy of each individual agent in treating endometriosis.