从温阳透发法论治难治性痤疮

痤疮可辨为阴、阳两证。阳疮者,缘患者劳汗被寒、玄府闭合,汗脂凝聚日久不得外排,蕴热搏结气血而生疮化腐,疮症为热为痛,此为易治;阴疮者,由阳疮转化而来,缘患者外感寒风、内伤生冷,且医者又重用寒凉、失于托透,以至气血冰凝,久不溃脓或溃脓难出,此为难治。根据难治性痤疮临床表现,其多类属于阴疮,以阳虚表郁、邪闭毛窍为致病之关键,其中表郁毛窍、邪闭肌腠为病之标,阳虚阴凝为病之本。治疗当以温阳透发、祛邪外达为法。以麻黄附子细辛汤温阳化阴滞、发阳透毒治其本,待阴邪发越,即用火针强开门户、消疮排脓治其标。标本兼治、针药结合的方法治疗难治性痤疮在临床中能够安全有效地消除痤疮、改善皮损、降低复发率。     

Primary Prevention of Sudden Cardiac Death: Can We Afford the Cost of Cardioverter-Defibrillators? Data from the Search-MI Registry-Italian Sub-study

Background: Large randomized trials show that in appropriately selected patients with left ventricular dysfunction, implantable cardioverter-defibrillators (ICDs) can improve overall survival at 2–5 years. Since direct implementation of the criteria used in the MADIT II and SCD-HeFT will lead to a marked rise in ICD implants, there is a growing fear that increased use of ICDs may cause a dramatic burden to health care systems. The ICD has traditionally been seen as an expensive form of treatment, which is difficult to accept at the first look. This is mainly due to the nonlinear character of the ICD investment, characterized by high initial expenditure, followed by a deferred pay-off in terms of clinical benefits. Cost-effectiveness analysis may help provide a different perspective on the problem of ICD cost, as may estimation of the daily cost of ICD treatment, assuming a time horizon of 5–7 years—a particularly interesting subject for further registry studies.
Methods and Results: Based on real expenditure data from 2002 to 2005, as recorded in the Search-MI Registry-Italian Sub-study of patients implanted on MADIT II indications, we estimated the daily costs associated with the device and leads. Over a 5–7 year time horizon, the average daily cost was estimated to be €4.60–€6.70. Translation of these figures into U.S. market conditions suggests a daily cost of around $7.90–$11.40.
Conclusions: These findings appear useful to help evaluate the affordability of ICD in comparison with other therapeutic options in a context of limited available economic resources.     

膀胱移行细胞癌P16、P15、P14基因5＇CpG岛甲基化检测

目的 探讨P16、P15、P14基因5＇CpG岛在膀胱移行细胞癌中甲基化状态及其临床意义。方法 应用甲基化特异性PCR（methylation—specific PCR，MSP）方法检测40例膀胱移行细胞癌P16、P15、P14基因甲基化程度，χ^2检验分析其甲基化程度与膀胱癌病理分级分期间关系。结果 膀胱移行细胞癌P16、P15、P14 5＇CpG岛甲基化扩增阳性化率分别为27．5％、17．5％、35％，而正常膀胱组织中均未检测到三种基因5＇CpG岛甲基化。P16、P14基因甲基化与膀胱癌病理分级分期有显著性差异（P〈0．05），P15基因则没有显著性差异（P〉0．05）。结论 P16、P15、P14基因在膀胱癌组织中的甲基化率较高，三种抑癌基因5＇CpG岛异常高甲基化，在膀胱癌的发生、发展中具有重要作用。     

Teaching psychiatric ethics

In the last decade, we have witnessed a burgeoning of interest in ethical issues amongst psychiatrists. Teaching of the subject, however, remains at a rudimentary stage. Various approaches to such instruction are available, particularly modelling (students observe their experienced counterpart), the case method (examining specific clinical situations which involve a need for ethical decision-making), and the seminar approach (trainees are exposed to a core body of knowledge, mainly theoretical in nature). Faced with these different teaching models, the University of Oxford Department of Psychiatry has opted for a blend of all three approaches, which incorporates two goals: an increase in the trainees' sensitivity to the many intricate moral dilemmas facing the psychiatric profession; and their familiarity with salient concepts in moral philosophy which constitute a basis for ethical reasoning and which have a bearing on clinical practice. The teaching programme comprises the following: a pair of trainees prepares a presentation on an aspect of psychiatric ethics under the supervision of a senior psychiatrist. A moral philosopher assumes the role of discussant of the ethical problems raised by the trainees; this is followed by a general discussion. Topics have included involuntary hospitalization, dual loyalty, suicide, psychiatric diagnosis, and ethical issues in various spheres of psychiatric practice such as sex therapy, psychotherapy and child psychiatry. The approach has worked effectively and proved rewarding to all participants involved.     

Comparative toxicity of total lymphoid irradiation and immunosuppressive drug treated patients with intractable rheumatoid arthritis

Outcomes were compared between consecutive patients who had received either total lymphoid irradiation (TLI) or immunosuppressant treatment for intractable rheumatoid arthritis (RA). There were 33 TLI and 32 immunosuppressive recipients; all patients had failed standard therapy. Average followup from the start of therapy was 2.7 years for TLI and 5.9 years for immunosuppressive recipients. Final disability levels were the same in both groups; mortality was equal in both groups as well. There were more hospitalizations for infections in the TLI group and the infecting organisms tended to be staphylococcus or gram negative organisms. Apart from infections, there were more adverse effects reported in the immunosuppressive therapy group.     

以太网中交换设备安全性能主要技术分析与对策

交换设备的安全特性直接影响着网络的安全稳定运行和网络的服务质量,无论是传统的交换设备还是目前广泛运用的交换设备都存在着一些安全隐患.本文分析了交换设备的安全性能和交换机数据处理过程中的缺陷和问题,提出了提高交换设备性能和加强交换设备安全的新思路.     

肱桡关节炎的超声诊断与综合治疗

[目的]探讨超声在诊断肱桡关节炎的价值和综合治疗的效果。[方法]应用高频超声探头对34例肱桡关节炎病人进行检查诊断，从超声表现上与“网球肘”相鉴别，并根据超声、临床表现和普通X线片进行临床分期，针对病情采用不同的方法进行治疗。[结果]制动、局部糖皮质激素封闭治疗5例，症状消失，复诊B超关节囊恢复正常。关节腔内注射玻璃酸钠10例，8例症状消失，关节内积液消失，B超检查关节间隙恢复正常。Ⅲ型在关节镜下手术2例，镜下手术包括病变滑膜切除，关节冲洗，病变软骨修整手术开放手术1例，滑膜切除、关节软骨修复桡骨小头切除。随访3个月-2年，开放手术治疗功能恢复效果不如关节镜手术。局部疼痛症状均消失，3例病人有5。左右的旋转功能受限。开放手术桡骨小头切除病例肘关节屈曲5。受限。[结论]超声作为一种无创、精确、简易、经济的检查手段对诊断肱桡关节炎有重要的作用。根据临床分型采取不同综合治疗方法治疗取得了良好的临床效果。