基于《辅行诀五脏用药法要》探讨乌梅丸论治情志病

乌梅丸载于《伤寒杂病论》厥阴篇,历代医家多认为其有温脏安蛔之功,临床应用范围较为局限,自清代医家柯琴提出其为厥阴病之主方后乌梅丸才被医家重视,其临床应用亦得以拓展。乌梅丸证之成因,实则归于厥阴风木气运失常,阴阳不相顺接,而非仅为蛔虫内扰所致。以《黄帝内经》“开阖枢”理论分析六经之功能,并结合《伤寒杂病论》原文可证“阴枢”实为厥阴,乌梅丸为厥阴病之主方,有顺接阴阳之功,故其可治疗厥阴枢机不利,寒热错杂之证。《辅行诀五脏用药法要》与《伤寒杂病论》二者同源,均参考了《汤液经法》所载内容,《辅行诀五脏用药法要》中补泻诸方及救逆方之组成有规律可寻,均依文中所载“汤液经法图”而成,与五行理论密切相关。该文通过探索“汤液经法图”组方规律及药物五行归属,以“汤液经法图”组方规律剖析乌梅丸,可证乌梅丸主要作用于肝、脾、心三脏,依黄帝内经五脏藏神理论,此三脏与情志调节密切相关,故以乌梅丸论治厥阴枢机不利、寒热错杂所致之情志病有据可循,文末亦列举概述近年乌梅丸治疗情志病的报道。该文为临床应用乌梅丸治疗情志病提供了思路及依据,扩展了其应用范围,古方亦能为今用。     

肥厚型心肌病诊治的辅助检查进展

肥厚型心肌病是一种常染色体显性遗传性心肌疾病,其遗传特性、临床表型、病程和预后存在显著异质性,临床诊治极具挑战性.多普勒组织成像、定量组织速度成像、组织应变率成像、心脏磁共振及延迟钆增强等辅助检查对早期诊断、指导治疗及判断预后起重要作用.该文就肥厚型心肌病在辅助检查方面的进展作一综述.     

The dosimetric impact of respiratory breast movement and daily setup error on tangential whole breast irradiation using conventional wedge,field-in-field and irregular surface compensator techniques

To evaluate the dosimetric impact of respiratory breast motion and daily setup error on whole breast irradiation (WBI) using three irradiation techniques; conventional wedge (CW), field-in-field (FIF) and irregular surface compensator (ISC). WBI was planned for 16 breast cancer patients. The dose indices for evaluated clinical target volume (CTV_evl), lung, and body were evaluated. For the anterior-posterior (AP) respiratory motion and setup error of a single fraction, the isocenter was moved according to a sine function, and the dose indices were averaged over one period. Furthermore, the dose indices were weighted according to setup error frequencies that have a normal distribution to model systematic and random setup error for the entire treatment course. In all irradiation techniques, AP movement has a significant impact on dose distribution. CTV_evlD₉₅ (the minimum relative dose that covers 95 % volume) and V₉₅ (the relative volume receiving 95 % of the prescribed dose) were observed to significantly decrease from the original ISC plan when simulated for the entire treatment course. In contrast, the D₉₅, V₉₅ and dose homogeneity index did not significantly differ from those of the original plans for FIF and CW. With regard to lung dose, the effect of motion was very similar among all three techniques. The dosimetric impact of AP respiratory breast motion and setup error was largest for the ISC technique, and the second greatest effect was observed with the FIF technique. However, these variations are relatively small.     

联合血液学指标和超声建立甲状腺结节术前良恶性鉴别模型

目的 结合大量临床诊断病例的验证分析,寻找术前甲状腺结节相关指标,建立甲状腺结节良恶性鉴别早期辅助诊断模型.方法 研究解放军总医院收治甲状腺结节住院患者并及时收集其术前血液样本用于生化、甲功、血常规等相关指标测定.回顾性验证分析术前病人一般资料、临床血液学数据、超声结果与术后病理诊断的相关性.结果 入选Logistic回归方程指标包括年龄(Age)、血清促甲状腺激素(TSH)、血清高密度脂蛋白(HDL)、中性粒细胞计数(N)、超声结果(Ult)5项,建模方程为Logit(P)=1.673-0.069X1+0.301X3-1.499X8+5.335X10+ 21.182X12,模型组联合ROC曲线下面积为0.882;验证组为0.812.结论 通过模型分析初步建立甲状腺结节术前良恶性鉴别的血液学指标应用基础,联合超声为手术选择提供客观依据.     

The influence of the crutch setup on stability and weight-bearing parameters in post total hip replacement surgery patients during quiet standing

Purpose: The purpose of this study is to evaluate the influence of the crutch setup on standing, in post total hip replacement (THR) surgery patients.

Materials and methods: Thirty patients after THR were randomly assigned to walking with the elbow flexed (EF) or elbow straight (ES) crutch setup. Subjects were asked to stand on a force platform in a comfortable position with the crutch positioned on the unaffected side, facing forward for 10?seconds. Centre of pressure total path and maximal excursion were evaluated in both medio-lateral and anterior–posterior planes. Difference in the asymmetry of left/right acromial height, measured with and without the crutch, was calculated (ACdiff). Percentage of body weight borne by the crutch (Fcr), symmetry (SIload) between operated and healthy limbs loading during the trial, together with shoulder forces and moments were measured.

Results: No significant differences between the two groups (p?>?.05) were found for stability parameters. ACdiff, Fcr and shoulder load increased significantly (p?Conclusions: The present study showed that the ES setup reduced the force borne by the crutch, the load on the shoulder joint and it minimized postural and loading asymmetries when compared to EF setup. Conversely, postural stability was not influenced by the crutch setup.

• Implications for Rehabilitation

• Static posture and weight-bearing parameters are influenced by crutch setup during quiet standing.

• Crutch setup does not influence postural stability.

• Adjusting the crutch according to the elbow straight setup reduces the force borne by the crutch and the asymmetry in lower limbs loading.

• Forces and moments at the shoulder joint were reduced for the elbow straight setup group.

     

胰腺癌患者螺旋断层放疗摆位误差分析

目的：通过兆伏级CT（MVCT）在线测量校正胰腺癌患者螺旋断层放疗的摆位误差,确定临床靶区CTV和计划靶区PTV之间的外放距离。方法：2012年5月至12月,21例接受TomoTherapy治疗的胰腺癌患者,每次治疗前均行靶区部位MVCT扫描。并将扫描后的MVCT图像与定位时千伏级CT（kVCT）图像进行配准,分别记录患者左右x、头脚y、腹背z和横断面旋转Roll四个方向的偏差数值,对其误差值进行统计分析。结果：21例患者共行358次MVCT扫描,其摆位误差值在x、y、z和Roll方向分别为：（-0．14±0．60）mm、（-1．21±0．44）mm、（0．69±0．93）mm和（0．02±0．26）。x、y、z方向CTV和PTV之间的外放距离分别为：5．5mm、7．4mm和3．9mm。结论：胰腺癌患者治疗摆位误差较大,Tomotherapy通过在线摆位校正能有效减小摆位误差。临床上建议胰腺癌患者在x、y、z方向上CTV和PTV之间可分别外扩5mm、7mm和4mm,为精确照射提供必要的质量保证。     

基于数据挖掘对李佃贵教授治疗消化性溃疡的用药特点分析

通过使用中医传承辅助系统软件,对李佃贵教授在治疗消化性溃疡药-证及四气五味归经方面进行整理,分析其内在用药规律,为临床辨证论治提供参考。方法收集整理李佃贵教授门诊治疗消化性溃疡的经验处方,通过将符合标准的150首中药处方依次录入系统中,来探索并分析出消化性溃疡用药规律。结果经分析得出,150首处方中,核心用药为炒白术,其次为黄连、陈皮、茵陈、乌药、砂仁、枳实、茯苓、川芎、厚朴;药性大多为辛、苦、寒,主归脾、胃、肝经,主要证型为胃气壅滞证、湿浊中阻证、浊毒内蕴证、胃络瘀阻证、胃阴不足证、脾胃虚弱证。最常用药类型为清热解毒、健脾芳香化浊、清热化湿和活血化瘀药。结论通过对李教授治疗消化性溃疡用药规律的分析,总结出其善于将芳香药与苦寒药结合使用,芳香以化浊,苦寒以清热;行气药与活血化瘀药相结合,行气可止痛,活血以化瘀。     

体位固定方式和BMI对胸部肿瘤放疗摆位误差的影响

目的探讨胸部肿瘤患者接受放疗时,体位固定方式和身体质量指数(Body Mass Index,BMI)对摆位误差的影响。方法回顾性分析接受调强放疗的132例胸部肿瘤患者的临床资料。根据放疗时患者双手摆放位置的不同分为A、B两组,A组患者(82例)双手十指交叉置于专用臂托上,B组患者(50例)双手置于身体两侧。根据患者的BMI分为1组(偏瘦)、2组(正常)和3组(超重)。首次治疗前行CBCT扫描,使用自动骨性配准结合手动微调,计算出x、y和z轴方向的摆位误差。比较不同体位固定方式和不同BMI的摆位差异。结果B组患者x方向摆位误差小于A组(P<0.05);B3组患者x方向摆位误差小于A3组(P<0.05)。在y和z方向上,A组和B组之间的差异均无统计学意义(P>0.05)。结论胸部肿瘤患者放疗时,患者双手摆放位置对摆位误差有影响,采用双手体侧位固定方式引起的摆位误差较小。患者BMI越大,摆位误差差异越明显,超重患者更宜选用双手体侧位固定方式。     

急性缺血性脑卒中不同品种数辅助药物治疗方案的成本-效果分析

目的观察急性缺血性脑卒中患者应用不同品种数辅助药物治疗方案的成本与效果差异,从中筛选出最为经济、合理的治疗方案,为制定报销政策及实行临床路径和按病种收费提供参考。方法抽取某医院2012-2013年满足条件的急性缺血性脑卒中患者病历,统计辅助药物用药情况;按同时使用辅助药物品种数将治疗方案分为3组,考察其成本、效果,进行药物经济学评价及敏感性分析。结果 3组方案的成本分别为9263.99元、11046.06元和12807.18元,治疗有效率分别为56.0%、81.8%、86.7%。在单药治疗的基础上,每再获得一个单位效果,二联治疗、三联治疗方案所须追加的成本分别为69.07元、115.41元。敏感性分析不影响结果。结论二联治疗为较理想的辅助药物治疗方案。