“形神并调”论治脑鸣＊

脑鸣是患者自觉头内轰响的一种病证，常持续发作，给患者带来极大痛苦，造成了巨大的心理、社会和经济负担。中医药辨治脑鸣历史悠久，古代医家偏重于从“形”角度进行调治，多从脏腑及气血理论出发，以调节肝脾肾等脏腑功能为主，近现代医家则逐渐认识到调“神”论治脑鸣的重要性。“形与神俱”是中医学养生廖病的准则，脑鸣病位在脑，故笔者结合脑之功能与特性探讨脑髓与脑神的体用关及其在脑鸣发病中的作用，分析“形神并调”论治脑鸣的理论与临床依据，提出脑鸣证治重在“形神并调”的观点，即虚者宜补髓养神止鸣，实者宜祛邪安神止鸣，或可为脑鸣治疗带来新的启发。     

价格补贴和社会网络对在线健康社区用户购买决策的影响

目的:“互联网+医疗健康”背景下,在线健康社区发展迅猛、竞争加剧,需研究价格补贴和社会网络对用户购买决策的影响.方法:基于在线健康社区信任品双边市场特征,使用多Agent仿真模拟用户购买决策演化路径,分析价格补贴和社会网络对用户购买决策的影响.结果:社会网络对用户购买决策有显著影响,能够帮助服务商扩大先发优势;价格补贴正向影响用户购买决策,对首批用户进行价格补贴更有效;社会网络中不同位置节点对用户购买决策影响存在差异.结论:未来在线健康社区在发展过程应重视价格补贴和社会网络对用户购买决策的影响,合理制定发展策略,促进这一新兴医疗服务模式持续发展.     

高通量测序技术联合瞬态诱发性耳声发射技术在新生儿遗传性聋筛查中的应用价值研究

目的 探究高通量测序（NGS）技术联合瞬态诱发性耳声发射（TEOAE）技术在新生儿遗传性聋筛查中的应用价值。方法采用整群随机抽样方法,根据纳入、排除标准选取2018年1月至2020年10月承德市中心医院625例新生儿作为研究对象,均于出生后3～7 d内行新生儿遗传性聋筛查,筛查方法采用NGS技术和TEOAE技术,并于出生后1个月、2个月采用TEO-AE技术进行第1、2次复筛,统计NGS技术、TEOAE技术筛查结果,分析NGS技术联合TEOAE技术筛查新生儿遗传性聋的价值。结果 本组共纳入625例新生儿,NGS技术筛查结果显示6.08%存在耳聋基因异常,主要为GJB2基因（2.40%）、SLC26A4基因（2.72%）异常,0.80%存在≥2个耳聋基因位点异常;TEOAE技术初筛8.48%的新生儿未通过,第1次、2次复筛未通过率分别为6.40%、5.12%;NGS技术、TEOAE技术筛查新生儿遗传性聋的曲线下面积（AUC）分别为0.920、0.880,二者联合筛查的AUC最大,为0.976,联合筛查的灵敏度、特异度分别为95.65%、99.50%。结论 NGS技术、TEOAE技术均为新生...     

骨筋膜室综合征的防治观察和护理

骨筋膜室综合征是由于外伤引起四肢骨筋膜室内压力增高,导致肌肉及神经缺血、坏死.若不及时诊断和处理,可迅速发展为坏死或坏疽,造成肢体残废,甚至危及生命.作者通过对180例四肢伤患者的患肢局部情况进行观察与护理,给患者进行相关医学知识的宣教,取得了满意效果.     

Huoxue Anxin Recipe(活血安心方)Promotes Myocardium Angiogenesis of Acute Myocardial Infarction Rats by Up-Regulating miR-210 and Vascular Endothelial Growth Factor

Objective: To investigate the microR NAs(miR NAs) expression profile of acute myocardial infarction(AMI) rats and the regulating effects of Huoxue Anxin Recipe(活血安心方, HAR) on angiogenesis-related miR NAs and genes. Methods: Forty-five Wistar rats were randomly assigned to 3 groups according to a random number table: sham, AMI, and AMI+HAR groups(15 in each group). AMI rats were established by ligation of the left descending coronary artery. HAR was intragastrically administered to rats of the AMI+HAR group for successive 21 days since modeling, meanwhile the same volume of 0.9% normal saline was administered to rats of the sham and AMI groups. Doppler echocardiography was used for noninvasive cardiac function test. Hematoxylin and eosin staining was used to observe the histopathological change. miR NAs expression profile was detected by quantitative realtime polymerase chain reaction(qR T-PCR). The mR NA and protein expressions of vascular endothelial growth factor(VEGF), and a target gene of miR-210 was further detected by qR T-PCR and Western blot, respectively. The microvessels density of myocardium was evaluated by CD31 immunostaining. Results: Compared with the sham group, ejection fraction(EF) and fractional shortening(FS) values were decreased significantly in the AMI group(P0.01), while the infarction area and the interstitial collagen deposition were increased obviously. As for the AMI+HAR group, EF and FS values were increased significantly(P0.05 vs. AMI group), and the infarction area was reduced and the interstitial collagen deposition were alleviated significantly. Total of 23 miR NAs in the AMI group expressed differently by at least 1.5 folds compared with those in the sham group; 5 miR NAs in the AMI+HAR group expressed differently by at least 1.5 folds compared with those in the AMI group. Among them, miR-210 was low in the AMI group and high in the AMI+HAR group. The relative mR NA and protein expressions of VEGF were decreased significantly in the AMI group(P0.05 vs. sham group), and increased significantly in the AMI+HAR group(P0.01 vs. AMI group). CD31 expression area and optical intensity were decreased significantly in the AMI group(P0.05 vs. sham group), and increased significantly in the AMI+HAR group(P0.01 vs. AMI group). Conclusions: HAR could reduce the infarction area, alleviate the interstitial fibrosis and improve the cardiac function of AMI rats. Those effects could be related to promoting myocardium angiogenesis of HAR by up-regulating miR-210 and VEGF.     

依那普利治疗肾性蛋白尿28例临床观察

为观察依那普利对肾性蛋白尿的疗效,我们对28例慢性肾脏病患者应用依那普利治疗,总结如下。     

口服雷尼替丁致过敏反应1例报告

患者,男,41岁.因突起口唇、舌尖麻木,舌根僵硬10 min伴全身瘙痒、头昏、寒战、恶心来急诊内科就诊.追问病史,患者因上腹隐痛服雷尼替丁胶囊2粒,约1 h后出现上述症状.既往史：患有十二指肠球部溃疡2年,无其它药物过敏史.     

基于"肾"脏象理论从肾论治治疗珠蛋白合成障碍性贫血

目的:探讨基于"肾"脏象理论,从肾论治珠蛋白合成障碍性贫血的证治规律和客观性.方法:采用随机、单盲、安慰剂平行对照的方法,用补肾益髓法的代表方(益髓生血颗粒),在广西高发区治疗地中海贫血(α-,β-型),疗程3个月.结果:对同一中医证侯(肝肾阴虚、精血不足证)的两种地贫(α-,β-型)患者,用补肾益髓法的代表方(益髓生血颗粒)治疗,均取得肯定的疗效,患者临床症状的明显改善与血液指标的提高相一致.研究提出了地中海贫血中医核心病机的假说,验证了它的客观性,并初步揭示了疗效特点和作用环节.结论:基于"肾藏精生髓、髓生血"理论,用补肾填精益髓法从肾论治,辩证治疗珠蛋白合成障碍性贫血是有效的.高发区临床实践和疗效分子机制的深入研究,进一步验证了"肾藏精生髓、髓生血"理论的客观性.研究结果从一个侧面揭示肾脏象理论的科学内涵提供了科学依据.     

溶血磷脂酸及其受体在急性心肌梗死早期大鼠心肌细胞凋亡调控中的作用及活血方药干预的研究

目的:对比观察大鼠心梗后早期不同部位的心脏形态、功能、心肌细胞凋亡及与LPA3种受体亚型的关系,探讨溶血磷脂酸与心肌细胞凋亡的关系以及活血化瘀药物的作用机制。方法:采用结扎大鼠左冠脉前降支建立心肌梗死模型,将大鼠分为假手术组、模型组、血府逐瘀组、三七总皂苷组(简称三七组),在用药治疗48h时,分别采用病理切片、血流动力学测定、TUNEL、PT-PCT方法检测心功能指标、心肌细胞凋亡和溶血磷脂酸3种受体基因的表达。结果:心梗早期48h后,模型组血流动力学LVSP、±dpdt均较假手术组有明显降低(P<0.01),LVEDP显著升高(P<0.01);组上述值除-dpdt外均有较大差异(P<0.01),-dpdt值没有明显差异。各组在不同部位均有大量的心肌细胞凋亡出现(P<0.01),而组有明显减少(P<0.01)。在心梗边缘区,LPA1表达量分别是模型组组显著增高(P<0.01),组显著下降(P<0.01)。在不同部位各组LPA2基因表达均无显著差异;三七组在心梗处出现LPA2表达异常升高(P<0.05)。模型组主要在非心梗区和梗死边缘区出现大量的LPA3受体表达(P<0.05,P<0.01);在不同部位较模型组...