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.

Ampelopsis grossedentata is a flavonoid-rich healthy tea, traditionally used as a Chinese herbal medicine, that effectively treats T2DM. In the present study, we investigated the anti-diabetic effect of total flavonoids extracted from Ampelopsis grossedentata (AGT) and the underlying mechanisms using 16S rDNA sequencing and metabolomics. The results indicated that after AGT treatment for 6 weeks, the body weight, liver index, fasting blood glucose (FBG), OGTT-AUC, and serum lipid levels were reduced, and pathological injuries of the liver improved significantly in ZDF rats. Meanwhile, AGT increased the abundance and diversity of gut microbiota, especially BSH-active bacteria, which reduced T-beta-MCA and T-alpha-MCA levels and further activate FXR and FGF15. The activation of FXR-FGF15 axis inhibited excessive bile acid accumulation and liver gluconeogenesis upon AGT treatment. Taken together, our results suggested that AGT ameliorated glycolipid metabolism disorder via the "microbiota-gut-liver" axis, indicating that AGT may be a potential therapeutic strategy for treating T2DM.

OBJECTIVE: To observe the effects of the flower of Edgeworthia gardneri(Wall.) Meisn(EWM) on glucose and lipid metabolism in KK/upj-Ay/J(KKAy) mice and investigate the possible mechanism of EWM in the liver of KKAy mice by transcriptome analysis. METHODS: Forty KKAy mice were fed a high-sugar and high-fat diet for 3 weeks to establish the animal model of metabolic syndrome. After 5 weeks of continuous administration of EWM, serum high-density lipoprotein(HDL), low-density lipoprotein(LDL), triglycerides(TG), total cholesterol(TC), and free fatty acids(FFA) were detected by radioimmunoassay. Serum fasting insulin(Fins) and adiponectin levels were measured by enzymelinked immunosorbent assay. Liver tissue fixed with paraformaldehyde was stained with h e m a t o xyl i n-e o s i n and oil red O. Transcriptome analysis was used to evaluate the liver tissue. The expressions of lipoprotein lipase(LPL), peroxisome proliferator-activated receptor-γ(PPARγ), adenosine 5‘-monophosphate-activated protein kinase(AMPK), sterol regulatory element binding protein-1c(SREBP-1c), and fatty acid synthase(Fas) m RNA and protein in liver tissue were detected by reverse transcription-polymerase chain reaction(RT-PCR) and Western blot analysis. RESULTS: EWM slightly reduced FBG and Fins in KKAy mice. Furthermore, EWM was able to downregulate serum LDL, TG, TC, and FFA and upregulate the expression of serum HDL and adiponectin. Transcriptome analysis revealed the following differential pathways: the peroxisome proliferator-activated receptor(PPAR) signaling pathway and the AMPK signaling pathway. RT-PCR and western blot analysis detected the associated genes and proteins. In addition, EWM was able to upregulate the expression of AMPK and downregulate the expression of PPARγ, SREBP1c, and Fas m RNA and protein and upregulate the expression of LPL m RNA. CONCLUSIONS: EWM can alleviate lipid metabolism disorders and to some extent improve glucose metabolism disorders in KKAy mice. These effects may be related to regulating PPARγ/LPL and activating the AMPK/SREBP1c/Fas pathway.

随着互联网时代的发展,网络卫生领域的法律问题不断涌现随之已逐渐具有独特的次生领域法之特性,并具有坚实理论基础、规则基础和理念基础的网络卫生法学并勃兴,使得该学科的科研教学活动也渐趋热络;但由于其仍尚处于起步和探索阶段,有必要实施针对性的改进策略,包括在宏观层面明确其基本定位其特性,在微观层面采取增加资源投入、深化研究内容、拓展研究视野、增设专门课程或培养方向、加强多学科教学融合、加强与国外卫生法学强校的交流合作等措施,以提高互联网时代卫生法学的科研和教学水平.

《黄帝内经》提出"五脏藏神"理论,即心藏神、肺藏魄、肝藏魂、脾藏意、肾藏志.基于此,失眠与焦虑共病的内在病机当为"神不得藏",其中以"心神""肝魂""脾意"为辨治重点.心不藏神则神烦,治当安心神,方选天王补心丹加减;肝不藏魂则惊悸,治当归肝魂,方选一贯煎化裁;脾不藏意则郁结,治当宁脾意,方选归脾汤出入.同时,基于五脏一体观,亦应重视肺、肾二脏的藏神功能.各脏神有所藏,则失眠与焦虑得平.附验案1则以佐证.

目的:了解国外近5年发表的母乳喂养文献研究焦点,为我国母乳喂养实践与研究提供启示与借鉴.方法:检索PubMed 2015年～2019年收录的母乳喂养相关文献,对高频主题词进行词频及共词聚类分析.结果:共纳入5047篇文献,聚类分析总结出4个研究热点.结论:利用质性研究挖掘母乳喂养知信行的深层内容用于母乳喂养支持,重视基于证据的健康教育,开展早产儿母乳喂养的管理模式,可供借鉴.

Background. Cinnamic acid (CA) has been shown to have many beneficial effects including regulating lipid metabolism and reducing obesity. However, its effect on nonalcoholic fatty liver disease (NAFDL) has not been investigated in detail. Thus, we performed this study in order to explore CA’s effect on hepatic lipid metabolism and the underlying mechanisms. Method. Oleic acid (OA) was used to induce lipid accumulation in HepG2 cells. After coincubation with CA, the cells were stained with oil red O and the triglyceride (TG) content was assessed. Key genes in lipogenesis and fatty acid oxidation pathways were tested. Additionally, db/db and wt/wt mice were divided into three groups, with the wt/wt mice representing the normal group and the db/db mice being divided into the NAFLD and CA groups. After 4 weeks of oral treatment, all mice were sacrificed and the blood lipid profile and liver tissues were assessed. Results. CA treatment reduced the lipid accumulation in HepG2 cells and in db/db mouse livers. ACLY, ACC, FAS, SCD1, PPARγ, and CD36 were significantly downregulated, while CPT1A, PGC1α, and PPARα were significantly upregulated. Conclusion. CA’s therapeutic effect on NAFLD may be attributed to its ability to lower hepatic lipid accumulation, which is mediated by suppression of hepatic lipogenesis and fatty acid intake, as well as increased fatty acid oxidation.

病毒性肝炎是由嗜肝病毒感染导致的传染性疾病,是临床的常见病之一,也是西医内科学与传染病学临床教学的重要组成,由于其内容庞杂,典型患者接触机会较少,学生难以理解,给临床教学带来一定困难.而传统教学方法与模式存在局限性.近年来,强调学习主动性、社会性和情境性的建构主义广泛应用于各学科教学,取得一定效果.文章以病毒性肝炎为例,将学习作为学习者主动构建知识的过程,探索建构主义在传染病、西医内科学课堂教学中应用,以期为中医院校传染病、西医内科学临床教学提供新思路.

Objective:To understand the current status of the evidence-based practice program of physical restraint in ICU patients and analyze its influencing factors, formulate and implement an action plan for continuous application of the program, so as to improve the knowledge level and evidence-based nursing ability of nurses, promote the improvement of patient outcomes, and strengthen the organization′s evidence-based cultural atmosphere.Methods:This study selected the program application departments of China Japan Friendship Hospital Surgical ICU as the research object, including all nurses, patients, nursing process, department standard system, etc. To understand the status and influencing factors of the project through observation and interview methods. The "Optimized Version of Evidence-based Practice Program of Physical Restraint in ICU Patients" was formulated and implemented, and a before-and-after comparative study method was used to comprehensively evaluate the implementation effect from the level of patients, nurses and organization.Results:The implementation rate of the 7 review standards of the program application department showed a downward trend; the patient restraint rate and restraint duration increased compared with the previous period; after the implementation of the optimized version program, the implementation of each item had been improved; the physical restraint rate decreased from 34.91% (37/106) before optimization to 28.57% (8/28) ( χ 2 value was 0.40, P>0.05), and the time of physical restraint decreased from 60.93 hours before optimization to 48.09 hours after optimization ( Z value was -0.19, P>0.05). Conclusions:The continuous application of the evidence-based practice project of physical restraint in ICU patients was not very optimistic. The continuity of implementation was affected by many factors. The continuous quality improvement of this evidence-based practice project can promote the improvement of the standard of physical restraint of patients, improve the quality of life of patients, promote the improvement of nurses' knowledge level and the improvement of evidence-based nursing ability; at the same time, it created a better organization′s evidence-based cultural atmosphere.

Objective:To systematically evaluate the real breastfeeding experience in professional women.Methods:Qualitative studies on breastfeeding experience and needs in professional women which were published up to August 20, 2020 were retrieved from English databases such as PubMed, Medline, The Cochrane Library, Embase, Web of Science, Ovid, CINAHL, Joanna Briggs Institute Library, Chinese databases such as CNKI, Wanfang, VIP, SinoMed, and grey literature databases like ProQuest. After literature screening and evaluation, a collection integration method was used to integrate the results.Results:A total of 12 studies were included, and 57 complete research results were extracted, which were summarized into 8 new categories integrated into 3 new results: working mothers benefited from breastfeeding but also had negative experience due to returning to work; their breastfeeding was affected by multiple promotion and obstacles after returning to work; and they dealt with breastfeeding challenges after returning to work through self-management.Conclusions:We should actively pay attention to the breastfeeding experience of professional women, improve the support for breastfeeding of working mothers, and help them improve their self-management ability, in order to promote their breastfeeding behavior after returning to work.

目的:系统评价华佗再造丸治疗缺血性脑卒中的疗效和安全性,旨在为临床治疗用药提供循证参考.方法:检索PubMed、Embase、Cochrane Library、中国知网等数据库,筛选华佗再造丸治疗缺血性脑卒中的临床随机对照试验,文献发表日期限定在从建库开始到2020年12月14日.2名研究者独立进行文献筛选及数据提取.采用Cochrane协作网提供的偏倚风险评估工具评估纳入研究的质量.根据异质性大小选择固定或随机效应模型汇总效应估计值.生成森林图以显示汇总结果,使用TSA0.9软件进行试验序贯分析.结果:共纳入16篇文献,包括1616名受试者,观察组827名,对照组789名.Meta分析结果显示,华佗再造丸组在提高治疗有效率(OR=3.36,95％CI为2.43～4.56,P<0.001)、降低NIHSS评分(MD=-2.72,95％CI为-3.72～-1.73,P<0.001)、提高日常生活能力(MD=8.89,95％CI为4.51～13.26,P<0.001)方面优于对照组;仅6项研究报告了安全性指标,有待更多研究以进一步明确临床用药安全性.TSA结果显示,华佗再造丸组治疗缺血性脑卒中有效率更优的证据确切.结论:当前研究表明华佗再造丸联合基础治疗可显著提高缺血性脑卒中患者的有效率,降低NIHSS评分,提高日常生活能力,但其安全性有待进一步确证.由于本研究纳入的研究方法质量偏低,且样本量小,需进一步进行大规模、高质量的研究验证其疗效和安全性.

Objective:To re-evaluate the methodological quality and quality of evidence of the systematic review of vitamin D in prevention of falls in the elderly.Methods:Cochrane Library, PubMed, Web of Science, Embase, CNKI, WanFang Database, China Biology Medicine Disc and VIP databases were searched by computer to collect systematic reviews or Meta-analysis on vitamin D in prevention of falls in the elderly, and the references included in the literature were searched manually. The time limit was from the construction of the database to March 2020. Two researchers independently screened and extracted data, and they used AMSTAR 2 Scale and Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system to evaluate the methodology and evidence quality of the included studies.Results:A total of 13 systematic reviews or Meta-analysis were included. AMSTAR 2 evaluation results showed that the methodological quality of 11 studies was extremely low, and that of 2 studies was high. Grade evaluation results showed that among the 21 outcome indicators included in the evaluation, 8 were extremely low quality, 7 were low quality, 6 were medium quality, and no evidence was of high quality.Conclusions:Current studies have shown that vitamin D has a certain effect in preventing falls in the elderly, but the methodological quality of most studies is relatively low and the quality of evidence is generally reliable. The adverse reactions of vitamin D supplementation are also quite heterogeneous. Future research still needs to carry out large-scale and high-quality research to clarify the role and adverse effects of vitamin D.

本文回顾了我国基本医疗保险的发展历程,在此基础上结合相关文献的实地调查情况,分析当下我国基本医疗保险政策与中医药"治未病"与"整体观念"的特点是否相互契合的问题,并从发展中医药事业为视角提出立法建议.

From the aspects of the definition and origin,types,characteristics,theoretical foundations,basic steps and methods of action research,this paper reviewed the main content and application status of action research method.In addition,this paper discussed its implications for development of nursing, looking forward to providing reference for clinical nursing personnel and nursing researchers.

The incidence of bronchial asthma in children increases year by year, which seriously affects children's physical and mental health. Intestinal microbial structure and function has been a research hotspot in recent years. Colonization and succession of intestinal microbiota in early life are affected by many factors, and studies have shown that it is closely related to the onset of asthma. Early intervention on intestinal microbiota imbalance can effectively reduce the risk of childhood asthma. This article summarizes the research progress of the above related content.

急性腹泻是消化系统疾病中最常见的一种症状,多是由于细菌、病毒、各种寄生虫进入肠道中引起感染导致.尤其是夏季到来,冰镇饮品、大排档又被我们安排起来,急性腹泻的问题也随之出现.面对快节奏的生活状态及品类繁多的美食诱惑,我们又应该怎么预防急性腹泻呢?

推荐医师制度是《中医药法》规定的中医医术确有专长人员考核制下的全新制度设计,是考核报名要求中重要的一项.为贯彻落实推荐医师制度,国家卫健委、中医药管理局和各省级中医药主管部门相继发布了《暂行办法》和《实施细则》,使推荐医师在考核报名阶段发挥了很好的初步遴选作用.但由于是首次提出推荐医师的报名要求,在推荐医师的资质要求、推荐医师的权利义务、推荐程序、法律责任等方面仍存在一些问题.就这些问题进行分析论证,并提出相应的对策建议.

[目的]系统评价不同约束情况及约束方式的约束效果.[方法]系统检索PubMed、The Cochrane Library、EMBASE、EBSCO、Ovid、中国学术期刊全文数据库、中国生物医学文献数据库、中国科技期刊数据库中关于不同身体约束情况及约束方式的约束效果对比研究,检索时间为建库至2017年8月1日.按照纳入及排除标准筛选文献、提取资料并评价纳入文献的方法学质量.采用RevMan 5.2软件对数据进行分析.[结果]共纳入18项研究,Meta分析结果显示:约束病人非计划性拔管发生率高于非约束病人[OR=2.53,95％CI(1.74,3.67),P<0.00001],改进约束用具病人非计划性拔管发生率[OR=0.14,95％CI(0.08,0.25),P<0.00001]、皮肤受损发生率[OR=0.08,95％CI(0.04,0.15),P<0.00001]、约束松脱发生率[OR=0.21,95％CI(0.06,0.78),P=0.02]低于传统约束用具病人,优化约束流程病人非计划性拔管发生率[OR=0.09,95％CI(0.04,0.20),P<0.00001]、皮肤受损发生率[OR=0.26,95％CI(0.16,0.42),P<0.00001]、血液循环障碍发生率[OR=0.17,95％CI(0.06,0.48),P=0.0007]低于常规约束流程病人.描述性分析结果显示:观察组病人满意度均高于对照组病人(P<0.05).[结论]现有证据表明:与非约束相比,约束并不能有效降低非计划性拔管发生率,但是针对约束病人,改进约束工具、优化约束流程有利于降低病人非计划性拔管发生率、皮肤受损发生率、血液循环障碍发生率及约束松脱发生率,提高病人满意度.

为增大现行基本医疗保障制度中对中医"治未病"的支持力度,加强中医"治未病"方面的服务能力,发挥中医药在自身优势病种领域的服务优势,确保中医药在健康服务领域的地位,使得全民更加平等,公平地享受中医药服务,促进中医药发展,对现存医保提出立法建议加强对"治未病"的报销是十分必要的.

?? [Abstract]? With the increasing aging of the population in China, the falls of the elderly have attracted wide attention. In 2017, the Registered Nurses Association of Ontario (RNAO) in Canada developed the guidelines for clinical practice of Prevent Falls and Reducing Injury From Fall(s Fourth Edition), which provide a reference for clinical work. This guideline describes the identification of high-risk fallers, the assessment of risk factors for falls, the formulation of falls prevention-related nursing plans and post-treatment measures for falls. This guideline is interpreted for domestic nurses and patient caregivers to learn and apply to guide clinical practice.