基于中医古籍文献的升降散应用溯源及探析

通过对中医古籍中有关升降散论述的文献梳理,全面探讨其内涵。本方是在大黄、僵蚕为雏形的基础上增加蝉蜕、姜黄而成方,几经易名,终在杨璿《伤寒瘟疫条辨》中为后人所熟知。本方广泛用于治疗瘟疫,以丸剂、散剂为主,方便携带,便于服用;重用大黄旨在祛邪、逐秽;应用时视人之体质强弱和量其毒之轻重而判断用药多寡,并辅以米酒、生蜜等以顾护正气。杨璿将其由治疗“热疫”的专方扩展为治疗“表里三焦大热”的通用方剂,扩大了本方治疗疾病范围。     

Danish version of the Oswestry disability index for patients with low back pain. Part 2: Sensitivity, specificity and clinically significant improvement in two low back pain populations

In studies evaluating the efficacy of clinical interventions, it is of paramount importance that the functional outcome measures are responsive to clinically relevant change. Knowledge thereof is in fact essential for the choice of instrument in clinical trials and for clinical decision-making. This article endeavours to investigate the sensitivity, specificity and clinically significant improvement (responsiveness) of the Danish version of the Oswestry disability index (ODI) in two back pain populations. Two hundred and thirty three patients with low back pain (LBP) and/or leg pain completed a questionnaire booklet at baseline and 8 weeks follow-up. Half of the patients were seen in the primary (PrS) and half in the secondary sectors (SeS) of the Danish Health Care System. The booklet contained the Danish version of the ODI, along with the Roland Morris Questionnaire, the LBP Rating Scale, the SF36 (physical function and bodily pain scales) and a global pain rating. At follow-up, a 7-point transition question (TQ) of patient perceived change and a numeric rating scale relating to the importance of the change were included. Responsiveness was operationalised using three strategies: change scores, standardised response means (SRM) and receiver operating characteristic (ROC) analyses. All methods revealed acceptable responsiveness of the ODI in the two patient populations which was comparable to the external instruments. SRM of the ODI change scores at 2 months follow-up was 1.0 for PrS patients and 0.3 for SeS (raw and percentage). A minimum clinically important change (MCID) from baseline score was established at 9 points (71%) for PrS patients and 8 points (27%) for SeS patients using ROC analyses. This was dependable on the baseline entry score with the MCID increasing with 5 points for every 10 points increase in the baseline score. We conclude that the Danish version of the ODI has comparable responsiveness to other commonly used functional status measures and is appropriate for use in low back pain patients receiving conservative care in both the primary and secondary sector.     

Searching for archaic contribution in Africa

Abstract

Context: Africa’s role in the narrative of human evolution is indisputably emphasised in the emergence of Homo sapiens. However, once humans dispersed beyond Africa, the history of those who stayed remains vastly under-studied, lacking the proper attention the birthplace of both modern and archaic humans deserves. The sequencing of Neanderthal and Denisovan genomes has elucidated evidence of admixture between archaic and modern humans outside of Africa, but has not aided efforts in answering whether archaic admixture happened within Africa.

Objectives: This article reviews the state of research for archaic introgression in African populations and discusses recent insights into this topic.

Methods: Gathering published sources and recently released preprints, this review reports on the different methods developed for detecting archaic introgression. Particularly it discusses how relevant these are when implemented on African populations and what findings these studies have shown so far.

Results: Methods for detecting archaic introgression have been predominantly developed and implemented on non-African populations. Recent preprints present new methods considering African populations. While a number of studies using these methods suggest archaic introgression in Africa, without an African archaic genome to validate these results, such findings remain as putative archaic introgression.

Conclusion: In light of the caveats with implementing current archaic introgression detection methods in Africa, we recommend future studies to concentrate on unravelling the complicated demographic history of Africa through means of ancient DNA where possible and through more focused efforts to sequence modern DNA from more representative populations across the African continent.     

中文版感知社会支持量表在老年癌症患者中的信效度分析

目的 检验中文版感知社会支持量表（the multidimensional scale of perceived social support, MSPSS）在老年癌症患者中应用的信效度。方法 采用整群抽样的方法,使用中文版感知社会支持量表对老年癌症患者进行调查,并对结果进行信效度检验。结果 共收到有效问卷520份,中文版感知社会支持量表的Cronbach α系数为0.877;探索性因子中共提取出公因子3个,累积方差贡献率为69.5%;通过验证性因子分析得出GFI、CFI、IFI指标范围在0.855～0.921之间。结论 中文版社会支持量表在老年癌症患者中应用具有良好的信效度,可用于评估该人群感知社会支持水平。     

经典名方当归补血汤的古代文献分析与考证

当归补血汤出自金元时期李东垣《内外伤辨惑论卷中·暑伤胃气论》,是一首被历代医家传承发扬的补气生血经典名方,已被收录于2018年国家中医药管理局公布《古代经典名方目录（第一批）》。通过系统梳理古籍文献及现代文献,并结合古代经典名方关键信息考证原则,对经典名方当归补血汤的历史源流、组成、剂量、炮制、制法与煎服法、功效与应用进行考证分析。共收集相关古籍文献信息604条,其中涉及中医古籍186部,其中40部（金元5部,明19部,清16部）中医古籍详细记载了组成、炮制、剂量等内容。有关当归补血汤组成,主要为当归和黄芪;根据古今剂量折算,黄芪37.3~38.1 g,当归7.5~7.6 g;黄芪宜采用蜜炙,当归为酒当归;加入水600 mL,煎至300 mL,饭前温服。该方古籍主要记载功效为血虚发热,证见肌热、燥热,烦渴引饮,目赤面红,昼夜不息,脉洪大而虚,重按无力,是补气生血名方。现代研究表明,当归补血汤常用于治疗各种贫血、糖尿病肾病、肿瘤、心脑血管疾病。上述研究结果为经典名方当归补血汤后期开发研究提供了参考依据。     

The Effect of Functional Pelvic Tilt on the Three-Dimensional Acetabular Cup Orientation in Total Hip Arthroplasty Dislocations

BackgroundAnterior and posterior pelvic tilt appears to play a role in total hip arthroplasty (THA) stability. When changing from the standing to the sitting position, the pelvis typically rotates posteriorly while the hips flex and this affects the femoro-acetabular positions. This case-control study compares changes in 3-D acetabular cup orientation during functional pelvic tilt between posterior THA dislocations vs stable THAs.MethodsStanding and sitting 3-D cup orientation was compared between fifteen posterior dislocations vs 233 prospectively followed stable THAs. 3-D cup orientation was calculated using previously validated trigonometric algorithms on biplanar radiographs. Those algorithms combine the angles in the three anatomical planes (coronal inclination, transverse version, and sagittal ante-inclination) in the standing position with the change in sagittal pelvic tilt from standing to sitting to calculate the 3-D orientation in the sitting position.ResultsThe standing cup orientation of the dislocated THAs was only characterized by a lower coronal inclination (P = .039). Compared with the controls, from standing to sitting, they showed less posterior pelvic tilt (P < .001). This led to a significant lower coronal inclination (P < .001) and sagittal ante-inclination (P < .001) in the sitting position but similar transverse version (P = .366).ConclusionsComparing posterior THA dislocations to stable THAs, there is a lower increase of all three orientation angles from standing to sitting. This leads to a decreased sitting coronal inclination and sagittal ante-inclination which may lead to an increased risk of impingement ensued by THA instability. By contrast, the transverse version was not significantly different in both positions. This confirms the importance of biplanar data on functional cup orientation.Level of EvidenceDiagnostic, Level III.     

小儿夜惊证治溯源

整理了古代文献关于小儿夜惊的资料记载,对于夜惊的含义、病因病机、临床表现、分证论治等进行了论述。探究以客忤为主因,以入寐后惊啼叫扰为果的夜惊证治,旨在阐明客忤致惊的实际意义,系统了解夜惊发病的因果,探讨对夜惊的防治与调护。