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.     

双胎输血综合征29对临床分析

目的：探讨新生儿双胎输血综合征的临床表现及其合并症等问题。方法：对过去10年间收治的29对双胎输血综合征患儿资料进行回顾性分析。结果：双胎输血综合征患儿有一般双胎儿的临床共性，且双胎输血综合征患儿中受血儿出现病理临床表现及合并症较供血儿多且严重。结论：双胎输血综合征对受血儿危害更大，故临床上一旦确诊为双胎输血综合征，应对受血儿进行严密监护，若出现临床表现，并发生红细胞增多症，应积极采取治疗措施，以减少严重并发症及后遗症的发生。     

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...     

使用自制Ralph刀切光镜用的高质量半薄切片及染色

在1981年,我们设计了BD—8102组织切片刀制刀机。该机能制出宽为25mm及38mm的高质量玻璃刀(Ralph)。借助一个简单刀架把Ralph刀装配到普通切片机上,就可切出用塑料或石蜡包埋的组织大切片。用这种方法可得到光镜用的高质量半薄切片。并报告近几年来用该刀切片和染片技术的体会。     

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。     

吸烟者、慢性阻塞性肺疾病及肺心病患者PEFV曲线与MEFV曲线的对比探讨

目的　了解部分呼气流量 -容积 (PEFV)曲线的临床意义。方法　用 FJD- 80型及 L R- 80型肺功能仪测定了吸烟者、慢性阻塞性肺疾病 (COPD,慢阻肺 )和肺心病患者的 PEFV曲线和最大呼气流量 -容积(MEFV )曲线。结果　代表 PEFV曲线指标的 ·VF RC及 ·VFRC/ FVC,与 ·V75、·V50 、·V2 5的实 /预 (%)的变动 ,具有相同的倾向 ,都是被动吸烟组 >轻度吸烟组 >重度吸烟组 >慢支组 >肺气肿组 >肺心病组 ;且全部 ·VF RC、·VFRC/ FVC以及 ·V50 、·V2 5的实 /预 (%) ,在重度吸烟组都已降到 71%～ 76 %,而 ·V75在重度吸烟组和慢支组仍然大于 80 %。结论与 MEFV曲线相比 ,·VFRC、·VF RC/ FVC仍然是检查小气道功能的敏感指标 ,其下降的程度可反映疾病严重的程度。由于操作 PEFV曲线处于生理状态 ,易为患者接受 ,宜于临床推广应用。     

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.