Sequential Therapy Based on Evolvement of Patterns: A New Model for Treatment of Alzheimer’s Disease

In order to solve the problem of long-term (>9 months) efficacy in the treatment of Alzheimer''s disease (AD) by conventional therapy (CT), a staged and multiply-targeted sequential therapy based on the evolvement of patterns (STEP) was developed. Its main innovations include: (1) the time order of evolution of patterns defined by Chinese medicine (CM) in AD was found, that is, "the orderly pattern evolution starting from Shen (Kidney) deficiency, progressing to phlegm, stasis and fire, and worsening to severe toxin as well as functional collapse"; (2) the cascade hypothesis of Shen deficiency in AD and its sequential therapy based on Shen-reinforcing was proposed, that is, "reinforcing Shen in the early stage and throughout the whole process, resolving phlegm, activating blood and purging fire in the middle stage, detoxifying and replenishing vitality to stop the collapse in the advanced stage", and through meta-analysis, clinical drug use was optimized, thus the leap from "inferential selection" to "evidence-based selection" was realized; (3) the STEP regimen combined with CT maintained cognitive and behavioral stability in AD patients for at least 12 months, with cognitive enhancement and behavioral synergy after 9 months, and cognitive benefit was superior to CT at 9, 12, 15, 18, 21, and 24 months, respectively. The 2-year cognitive improvement rate was increased by 25.64% (P=0.020) and the cognitive deterioration rate was decreased by 48.71% (P=0.000). Among them, the cognitive and functional benefits of Shen-reinforcing therapy for very early AD (350 cases) for 1 year were better than the placebo (P<0.001), and the dementia conversion rate was reduced by 8.85% (P=0.002). The behavioral symptomatic relief of patients with vascular dementia received fire-purging therapy (540 cases) was superior to those received CT (P=0.016). These data suggested that the STEP regimen has synergistic effects on CTs at least in terms of cognitive benefit, and the earlier the use, the greater the benefit will have. Therefore, the STEP regimen should be considered as one of the clinical options, particularly for the dearth of effective pharmaceutical or immunological interventions that are currently available for AD.     

钕钇铝石榴石激光治疗后囊混浊（353例）

采用钕钆铝石榴石激光切除白内障囊外摘除术后１０１例后房人工晶体植入后２５２例的后囊混浊共３５３例，激光治疗疗后视力均明显提高，矫正视力＞１．０者占８２．４％，无１例＜０．５。无明显并发症。     

眼球挫伤与锌

从１９９１年１１月到１９９２年８月对５０例眼挫伤的血清锌进行测定，３６例异常占７２％，其中有眼底改变占７５％。视神经视网膜挫伤锌值增高。低锌影响杆细胞及锥细胞代谢致视力低下，低锌影响视色素合成及色素上皮代谢，造成伤后视网膜色紊乱。     

A tumor-targeted and conditionally replicating oncolytic adenovirus vector expressing TRAIL for treatment of liver metastases.

We have constructed a new capsid-modified adenovirus (Ad) vector that specifically replicates in tumor cells and expresses TNF-related apoptosis-inducing ligand (TRAIL). The Ad capsid contains short-shafted fibers derived from Ad serotype 35, which allow for efficient infection of malignant tumor cells, and largely avoids innate toxicity after intravenous application. Replication-dependent homologous recombination in Ad genomes was used to achieve tumor-specific expression of Ad E1a (to mediate viral replication) and TRAIL (to mediate apoptosis and enhance release of progeny virus from infected cells). We demonstrated that our oncolytic vector (Ad5/35.IR-E1A/TRAIL) induced apoptosis in human tumor cell lines derived from colorectal, lung, prostate, and liver cancer. Both in vitro and in vivo tumor models showed efficient intratumoral spread of this vector. In a model for metastatic colon cancer, tail vein infusion of Ad5/35.IR-E1A/TRAIL resulted in elimination of preestablished liver metastases. Intravenous injection of this vector caused a transient elevation of serum glutamic pyruvic transaminase in tumor-bearing mice, which we attributed to factors released from apoptotic tumor cells. Liver histology analyzed at day 14 after virus injection did not show signs of hepatocellular damage. This new oncolytic vector represents a potentially efficient means for gene therapy of metastatic cancer.     

反相高效液相色谱法测定牛黄类中成药中胆汁酸的含量

反相高效液相色谱法测定牛黄类中成药中胆汁酸的含量倪坤仪，王建，陈健，郁建，屠树滋（中国药科大学２１０００９）含牛黄的中成药种类很多，在医疗中具有广泛的用途。中药牛黄中主要成分为胆汁酸和胆红素。本文主要研究用ＨＰＬＣ法测定牛黄以及含牛黄中成药中胆汁酸的...     

氧暴露剂量对人肺呼吸功能的影响

本文对８名受试者在０．２５～０．２７ＭＰａ下进行三种氧剂量暴露后的肺呼吸功能和Ｘ线胸片跟踪观察，目的在于验证整体实验功能结果对本室以往肺表面活性物质（ＰＳ）物理特性测定结果的符合性。结果表明，氧暴露剂量达到１０６０ＵＰＴＤ（肺型氧中毒剂量单位）时，对呼吸道粘膜、肺泡内皮细胞可产生一定程度影响，导致ＦＥＶ１、ＦＥＶ，％、ＭＭＦ、Ｖ１０（呼气流速）显著改变（Ｐ＜０．０５或Ｐ＜Ｏ．０１），但在停止暴露后４—１２ｈ内上述指标完全恢复。以上与本室以往ＰＳ物理特性测定结果相一致。本义肺活量降低程度较Ｗｒｉｇｈｔ（１９７２）报道的小，Ｘ线胸片无异常；因此，间断用氧要达到连续用氧的等效剂量，应对Ｗｒｉｇｈｔ计量法进行一些修正。     

我院病案管理的几个问题及改进建议

病案是医疗工作的综合体现,是医院医护质量、技术水平、管理水平综合评价的重要依据,可为医疗、教学、科研提供丰富的科学资料,并能为医疗事故、纠纷提供可靠的法律依据.因此,我院坚持不懈地采取各种措施加强对病案的管理.病案管理工作是我院实施医院管理,评价医院工作效率,进行工作预测和决策的基础,而且还为我院教学和科研提供可靠的临床资料,随着现代医学的进一步发展,医疗技术水平亦在不断递增,我们要保质保量地完成病案管理的日常事务工作,就有必要探讨提高病案管理工作的新方法.     

大肝癌手术切除探讨（附16例分析）

报告16例大肝癌手术切除治疗效果，癌块直径>7cm。其中巨块型12例，癌块>10cm9例；癌块>14cm3例，均经病理证实。Ⅱ期切除3例，均经肝固有动脉结扎加插管注药化疗，肿块缩小后再手术，术后生存1年4例，2年3例，3年4例，4年1例，全组中位生存期24.1个月，并对大肝癌的手术适应证及术式选择等进行了探讨。     

Therapeutic Effect of Berberine on 60 Patients with Non－Insulin Dependent Diabetes Mellitus and Experimental Research

ＴｈｅｒａｐｅｕｔｉｃＥｆｆｅｃｔｏｆＢｅｒｂｅｒｉｎｅｏｎ６０ＰａｔｉｅｎｔｓｗｉｔｈＮｏｎ－ＩｎｓｕｌｉｎＤｅｐｅｎｄｅｎｔＤｉａｂｅｔｅｓＭｅｌｌｉｔｕｓａｎｄＥｘｐｅｒｉｍｅｎｔａｌＲｅｓｅａｒｃｈＮｉＹａｎ－ｘｉａ（倪艳霞）；ＬｉｕＡｎ－ｑ...     

肺表面活性蛋白A在皮质类固醇调节哮喘小鼠树突细胞共刺激分子表达中的作用

目的 研究皮质类固醇激素调节小鼠哮喘模型树突细胞表面共刺激分子表达的机制，以及肺表面活性蛋白A（SP-A）在其调节中的作用。方法 BALB/c小鼠30只，分为3组：哮喘组，采用卵蛋白（OVA）致敏和激发；对照组，以生理盐水代替OVA；治疗组，每次OVA激发后10min，腹腔注射地塞米松01mg。用免疫组化法检测SP-A在肺内的表达情况。采用Leica DM Snk软件进行图像采集，并用Qwin软件计算小气道内棕色区域面积，取平均值，进行统计分析。分离培养脾脏树突细胞，用流式细胞仪（FACS）检测树突细胞表面共刺激分子CD80的表达变化。结果 哮喘组肺组织表现为嗜酸性细胞及淋巴细胞浸润为主的炎症变化，治疗组和对照组无此变化。哮喘组的SP-A表达明显低于对照组和治疗组（P〈0．01），CD80的表达率明显高于治疗组（P〈0.01）；哮喘组小气道内SP-A表达与树突细胞CD80阳性率呈负相关（r=-0．907，P〈0．01）。结论 皮质类固醇对小鼠哮喘模型的肺表面活性蛋白有明显的保护作用，可通过激发肺表面活性蛋白抑制树突细胞表面共刺激分子CD80的表达。