关于中医证候研究的几点想法

中医证候学研究是目前中医药研究工作的前沿领域.近年来,虽从不同的角度取得了一些进展,但就本质而言,依旧没有明显的突破.虽然证候的传统定义是基本清楚的,但证候的宏观(定性)标准不十分规范,证候宏观(定性)标准量化研究方法有待统一.这在很大程度上阻碍了整个中医药现代化的进程,因此,证候的现代研究思路值得进一步探讨.在证候研究过程中,建议:(1)以现代疾病为切入点,从基本证候(单证)着手,逐步向复证研究过渡;(2)以人为研究对象,取得相当成果后再进行动物实验才有意义;(3)不仅要与生命科学接轨,更要与整个的自然科学接轨.     

CO2 laser in cancer surgery of the breast: a comparative clinical study

Review of the literature reveals little to no data regarding the use of the CO2 laser as a surgical modality in the local treatment of breast cancer. This study was undertaken to determine if the CO2 laser is a surgical improvement over the scalpel, influencing patient care during the surgical and postsurgical period. In the author's series, a total of 209 procedures were performed. Within this group, 105 cases were performed with CO2 laser and 104 cases performed with the scalpel. Biopsies were always performed as a separate procedure prior to definitive surgery. This study was not designed to compare cure rates, the medical follow-up period being 1 year. The results of this study demonstrate a significant improvement in patients' postoperative care, surgical technique, and hospital cost-effectiveness.     

Adipokines in cord blood and risk of wheezing disorders within the first two years of life

BACKGROUND: Adipokines are involved in the regulation of many inflammatory processes and are present at very high concentrations in cord blood of term infants. OBJECTIVE: We analysed data of a large prospective birth cohort study to examine whether adiponectin and leptin concentration in cord blood are determinants of wheezing disorders in children within the first 2 years of life. METHODS: Seven hundred and forty mothers and their newborns were included in this analysis. Adiponectin and leptin concentrations were measured in cord blood. The cumulative incidence of physician-reported asthma or obstructive bronchitis was recorded during a 2-year follow-up. RESULTS: During the first 2 years of life, asthma or obstructive bronchitis was reported by the caring paediatricians for 157 (19.6%) of the children. We found a strong interaction of cord blood adiponectin and history of atopic disease in the mother with respect to the risk of physician-reported asthma or obstructive bronchitis (P=0.006). Compared with children with cord blood levels in the middle quintile (reference category), the odds ratios for physician-reported asthma or obstructive bronchitis in the bottom quintile and top quintile were 0.14 [95% confidence interval (CI) 0.02-0.90] and 2.12 (95% CI 0.67-6.66), respectively (P for trend=0.0003), among children of mothers with a history of atopy. This association was independent of other established risk factors. Leptin levels in cord blood were not associated with risk of asthma or obstructive bronchitis. CONCLUSIONS: In children of mothers with a history of atopy, concentrations of adiponectin in cord blood could play an important role in determining risk of wheezing disorders in early childhood.     

Limbus-based versus Fornix-based conjunctival flap in filtering surgery

Summary A randomized prospective study was performed to compare the results of filtering surgery using a Limbusbased versus a Fornix-based conjunctival flap. The wound closure of the Fornix-based flap was performed using a running 10/0 nylon suture at the limbus. No statistical significant difference of IOP regulation was found between the two groups. There was a tendency of reduced occurrence of shallow anterior chamber and of less vascularized filtering blebs in the Fornix-based technique.     

Variations in the use of diagnostic procedures after acute stroke in Europe: results from the BIOMED II study of stroke care

Valid classification of stroke is essential to initiate effective acute management and early secondary prevention strategies. To accurately evaluate stroke subtype a number of diagnostic procedures have to be performed. This study sought to investigate variations in use of diagnostic procedures across selected European hospitals. First-ever stroke patients were sampled over a 1-year period through 11 hospital-based registers across 10 European countries. We defined a diagnostic standard for valid aetiological classification of ischemic stroke including brain imaging, vascular imaging and echocardiography. The impact of socio-demographic, clinical and structural characteristics on performance of the diagnostic standard was assessed using multivariate logistic regression analyses. A total of 1721 patients were included in the study. 83.1% received brain imaging, ranging from 32.8% to 100%. The diagnostic standard was performed in 40.4% of stroke patients, ranging from 0% to 77.2%. Patients with increasing age ( P  < 0.001) and with more severe strokes ( P  = 0.001) were less probably to receive the diagnostic standard. Patients treated in stroke units and neurological departments were more frequently investigated with the diagnostic standard ( P  < 0.001). Less than half of hospitalized stroke patients across Europe underwent diagnostic procedures to allow for aetiological classification of stroke, which may hamper the initiation of effective early management and secondary prevention.     

Association analysis of genes in the renin‐angiotensin system with subclinical cardiovascular disease in families with Type 2 diabetes mellitus: The Diabetes Heart Study

Aims Cardiovascular disease (CVD) is a major complication of Type 2 diabetes mellitus. The renin‐angiotensin system (RAS) and nitric oxide production are both important regulators of vascular function and blood pressure. Genes encoding proteins involved in these pathways are candidates for a contribution to CVD in diabetic patients. We have investigated variants of the angiotensinogen (AGT), angiotensin converting enzyme (ACE), angiotensin type 1 receptor (AT1R) and endothelial nitric oxide synthase (NOS3) genes for association with subclinical measures of CVD in families with Type 2 diabetes mellitus (T2DM). Methods Atherosclerosis was measured by carotid intima‐media thickness and calcification of the carotid and coronary arteries in 620 European Americans and 117 African Americans in the Diabetes Heart Study. Because of the role of these systems in blood pressure regulation, blood pressure was also investigated. Results Compelling evidence of association was not detected with any of the SNPs with any outcome measures after adjustments for covariates despite sufficient power to detect relatively small differences in traits for specific genotype combinations. Conclusions Genetic variation of the RAS and NOS3 genes do not appear to strongly influence subclinical cardiovascular disease or blood pressure in this diabetic population.     

成人护理专科教育护理学基础课堂教学设计的探讨

本文以“健康与疾病”为例，介绍了成人护理专科的护理学基础课堂教学设计。主要包括学生的情况分析、授课计划的制定、教学方法的选择、课程内容的优化、教学媒体和教学案例的运用等。同时，提出了调动学生的学习积极性、学生终身学习意识教育及医德教育等问题，从而使学生既能真正获得有用知识，又尽可能地通过考试取得学历文凭。     

Periodontal conditions in insulin-dependent diabetes mellitus.

In the present investigation, the frequency and severity of periodontal disease was assessed in a group of 71 patients with a mean duration of 16.5 years of insulin-dependent diabetes mellitus (IDD). The diabetics, aged 17-63 years, were under treatment at the diabetic outpatient clinic of the III Department of Medicine, University Central Hospital of Helsinki and at two clinics of the Helsinki Health Centre. Based upon their long-term medical records, 44 individuals were assessed to have a poorly controlled insulin-dependent diabetes mellitus (PIDD). At baseline of the present study, the PIDD group had a mean blood glucose level of 11.8 mmol/l and a mean glycosylated hemoglobin (HBA1) level of 10.7%. 27 subjects were classified as having a controlled insulin-dependent diabetes mellitus (CIDD). For each individual, site-specific recordings were made for the plaque index, gingival index, pocket depth, loss of attachment, bleeding after probing, gingival recession and radiographic loss of alveolar bone. Under similar plaque conditions, adult subjects with a long-term PIDD were found to have lost more approximal attachment and bone than subjects with a CIDD (P = 0.046, P = 0.019). These differences were not equally obvious when the subjects were classified according to the history of medical complications, such as retinopathies, neuropathies and nephropathies.