目的:旨在应用医院信息系统电子医疗数据开展真实世界脉络舒通丸对胃肠功能影响的临床安全性研究,为脉络舒通丸的临床安全应用提供参考.方法:提取我国14家三甲医院电子医疗数据,按照年龄±5岁、性别相同、入院病情相似的原则,匹配后得到共5086例数据,应用GBM倾向性评分法平衡混杂因素,使用2种Logistic回归方法对比分析真实世界中脉络舒通丸是否对患者胃肠功能具有显著影响.将使用脉络舒通丸后立即停药,并且在用药1～3 d后使用护胃药物,但排除联合使用有胃肠刺激性的药物、既往有慢性胃肠道疾病病史患者作为疑似发生胃肠道不良反应的患者.结果:运用倾向性评分平衡混杂因素后,使用Logistic回归的方法对处理后的数据进行分析,结果显示未观察到使用脉络舒通丸对胃肠功能产生显著影响.结论:该研究为脉络舒通丸的安全性研究提供了证据,但鉴于倾向性评分法有其局限性,无法实现对未知混杂因素的平衡,尚需多种安全性研究证据,为脉络舒通丸在临床安全应用方面提供证据.

精液微观辨证在临床上广泛应用,多与宏观症状一同作为辨证依据,但因缺少相关中医理论支持,故无法单独指导临床治疗.笔者从"阳化气,阴成形"理论入手,探讨"阳化气,阴成形"的理论内涵与外延、"阳化气,阴成形"对精液生成的作用及"阳化气,阴成形"功能失调导致精液异常的病机,提出了治疗精液异常时要以微调肾阴肾阳为主,配合调畅气血,同时兼顾五脏六腑寒热虚实,以调整阴阳偏颇,恢复"阳化气,阴成形"功能,为精液微观辨治提供理论支持.

男科疾病往往病情复杂,病因不明,临床疗效不佳.李海松教授临床用药不拘一格,常借鉴内科、妇科等其他学科的用药经验,灵活运用于男科疾病的治疗中.少腹逐瘀汤本用于治疗寒凝血瘀证痛经等妇科疾患,教授取中医异病同治之理,认为男性所属器官解剖位置特殊,且男科疾病发病部位局限,多以少腹部疾患为主,契合少腹逐瘀汤用药病位;从中医认为,男科疾病多滞、多瘀,血瘀病机贯穿男科疾病始终,运用少腹逐瘀汤治疗男科疾病契合本方主治;临床中,常将少腹逐瘀汤用于男科慢性前列腺炎、不射精症、血精症等方面的治疗,并根据患者寒热气血脏腑特点辨证施治,临床上取得了显著疗效.

慢性附睾炎是男性生殖系统非特异性感染中的常见疾病,多由急性附睾炎迁延而来,表现为患侧阴囊睾丸坠胀不适,性生活后加重,附睾局限性硬结.李曰庆教授认为其病因病机为感受寒湿、伤及阳气,或饮食肥甘、湿热下注,或房事不洁、感受邪毒,或跌仆外伤而致阳气受损,邪毒凝聚于肾子.病位主要在肾子,与肝肾密切相关.治疗上,在整体辨证的同时,应结合局部辨证,从发生的部位及疼痛的性质等方面考虑进行处方用药.

京帮炮制是全国主流炮制流派之一,是根据北京地区临床用药需求和区域用药习惯所形成的独具特色的炮制技术体系.从炮制理论和方法、饮片品种和规格、炮制辅料、炮制工艺方面对京帮炮制技术传统特色进行总结.从挖掘整理京帮炮制理论、搭建传承与开发研究平台、开展京帮炮制理论体系研究、建立科学的质量评价模式的角度为京帮炮制技术的传承创新再发展提供思路.

目的:了解海外中医行医资格管理的概况和趋势,为我国中医机构开展国际服务贸易提供借鉴参考.方法:利用自行设计的调查问卷对参加京交会的海外华侨中医进行问卷调查,调查内容包括中医师在海外获取行医执照相关要求以及在当地面临的竞争及限制情况等.共发放问卷150份,回收有效问卷104份,对数据进行统计分析.结果:62.50％受访者的定居地需要通过当地考试取得行医资格执照才能从事中医(针灸);在53.92％受访者的定居地必须先办理移民才能从事中医(针灸);55.45％受访者的定居地从事中医有语言限制.结论:海外对中医(针灸)从业资格管理日渐加强,经考试取得执照的方式将逐步成为主流;身份条件和语言是中医师走向海外的障碍;多数国家和地区都对外来中医机构有着不同程度的准入限制;我国中医师在海外受到西医师和当地中医师的双重竞争.

系统梳理当代中医学界提出的主要辨证方法,归纳当代辨证方法的研究现状:第一,更加凸显病证结合的辨证模式,对疾病的关注更为深入细致,更为关注慢性非传染性疾病、情志病,注重疾病和证的传变规律和临床特征;第二,更为重视辨证规范化;第三,开始关注辨证策略,包括如何收集辨证信息、如何处理和加工辨证信息、从治疗反推辨证、注重辨证的时空变化.在此基础上对未来辨证方法的研究进行了展望:第一,研究对象上,应聚焦到慢性非传染性疾病、情志病、新发传染病的复合证上;第二,研究内容上,应重点关注特异证候临床表征识别及其测量、辨证标准与应用,融合中西医优势,深刻反映中西医病证研究进展,促进基于个体临床表征的精准医学的发展;第三,研究方法上,坚持病证结合,应用复杂性科学、系统生物学等多学科方法.

OBJECTIVE To assess the effect and safety of Jinhua Qinggan Granule (JHG) in treating influenza patients of wind-heat affecting Fei syndrome (WHAFS). METHODS Totally 136 influenza patients of WHAFS were randomized by stratification into 3 groups, the high dose JHG group (44 cases, 10 g each time), the low dose JHG group (45 cases, 5 g JHG + 5 g placebo each time), and the placebo control group (47 cases, 10 g placebo each time). All medication was administered three times daily for 5 days. The fever disappearance time, the fever disappearance rate, efficacy of TCM syndrome, the disappearance rate of main symptoms and physical signs of flu, the negative rate of virus nucleic acid in the pharyngeal secretion, and safety indicators were assessed. RESULTS The median fever disappearance time was 32.8 h (95% CI: 22.5-41.0 h) in the high dose JHG group, 26.0 h (95% CI: 14.5-36.5 h) in the low dose JHG group, 39.5 h (95% CI: 29.0-46.0 h) in the placebo control group. There was statistical difference in the median fever disappearance time between the low dose JHG group and the placebo control group (P = 0.011). Three days after treatment, the markedly effective rate of TCM symptoms in the low dose JHG group was 66.7%, higher than that of the placebo control group (38.3%), and its effective rate was superior to that of the high dose JHG group (P = 0.043). Five days after treatment, the recovery rate of the low dose JHG group (42.2%) was higher than that of the high dose JHG group (25.0%, P = 0.026) and that of the placebo control group (14.9%, P = 0.002). The markedly effective rate of the low dose JHG group (86.7%) was higher than that of the placebo control group (55.3%, P = 0.001). Similar effects were obtained in the low dose JHG group and the high dose JHG group, but slightly poor in partial indicators of the high dose JHG group. There was no statistical difference in adverse reaction among these three groups (P > 0.05). CONCLUSIONS JHG was effective and safe in treating influenza patients of WHAFS. Routinely low dose was the optimal dosage of JHG.

In order to investigate the inhibition of the extracts of prescription of 921 on prostate cancer cell proliferation in vitro and tumor growth in vivo.The authors use the methods as follow:SRB assay was applied to examine the anti-proliferation of the extracts of prescription of 921 in vitro both on human cancer cell DU-145,PC-3m,EJ and mice prostate cancer TRAMP-C2.The experimental implanted tumor mice model Hepatoma(H22),Sarcoma(S180),Prostate cancer(TRAMP-C2) and tumor nude mice model Prostate cancer(PC-3M) were used to evaluate its anti-tumor activity in vivo.Furthermore,it was also observed to enhance therapeutic effect when combined with cyclophosphamide(CTX) on S180.The results were:1) the extracts of prescription of 921 showed proliferation inhibitory activities on DU-145,PC-3M,EJ and TRAMP-C2 cell lines.2) It inhibited mice H22,S180,TRAMP-C2 and naked mice PC-3M when administered i.g.at 3.6～14.3 g/(kg·day) for 9 days.The extracts of prescription of 921 enhanced CTX's therapeutic effect and didn't enhance its toxicity.In summary,the extracts of prescription of 921 showed inhibitory activity on the growth of prostate cancer.

慢性前列腺炎是临床上的常见病和难治病,笔者认为前列腺功能上有类于脏,治疗上则似腑以通为顺、祛邪为先,常将本病分为早、中、后3期,湿热未尽、湿热挟瘀、脾虚湿滞、脾肾两虚或心脾两虚5型诊治,采用内服与肛塞药物相结合,辅以心理调整、改变不良习惯,可取得良好的临床疗效.

Objective:Over expression of HLA DR antigen is implicated in the process of renal allograft rejection.In this study,urinary sediments of renal allograft recipients were collected and mRNA expression of HLA DR antigen determined to explore its relevance with occurrence of acute or chronic rejection. Methodology:56 renal allograft recipients were involved in this study,including 18 with acute rejection,12 with chronic rejection,6 with cyclosporin A nephrotoxicity and 20 with stable functioning allograft. Results:In recipients with acute allograft rejection,16 of 18 were positive for the detection of HLA DR mRNA.In recipients with chronic allograft rejection,2 out of 12 were positive.And in 6 recipients with cyclosporin A nephrotoxicity,non were positive.In 20 recipients with stable functioning allograft,only one was positive for the detection.No correlation was found between the positive expression of HLA DR mRNA and the number of HLA typeing mismatches. Conclusion:Urinary sediment is feasible for the detection of HLA DR antigen expression in renal allograft recipients.Positive expression of HLA DR mRNA is correlated with the occurrence of both acute and chronic rejection,while not the case for cyclosporin A nephrotoxicity.

自1954年首例肾移植成功以来,器官移植成为近半个世纪发展最快的医学领域之一.为数百万器官功能衰竭患者带来了生命的希冀.这些成绩多半应归功于以环孢霉素A(CsA)、强的松、硫唑嘌呤等为代表的免疫抑制剂的良好抗排斥作用.

前列腺癌在欧美国家是一种十分常见的疾病,据2000年统计资料表明在美国男性肿瘤患者中,其发病率占第1位而病死率则排第2位(CA-Cancer J Clin 2000;50∶7-33).在中国的发病率也正在不断上升,并将随着中国经济的发展、生活水平的提高和生活模式的改变,对中国老年男性的健康构成严重威胁.王沛教授对某些晚期前列腺癌患者采用了中医药治疗,在10余年间共诊治了10位患者,其中有2例D期患者存活期超过10年,这对于采取常规疗法D期患者中位存活期为3～5年的现实是有一定意义的.但在这些病例中,由于时间跨度大、治疗多样化和药物不统一等,使得病例疗效难以总结,中药的疗效难以得到确切评价,但采用中医药治疗前列腺癌是有应用前景的.现将积累的经验及思路简述于下.

主治医师:前列腺癌是男性生殖系肿瘤中的一种重要肿瘤.在欧美国家其死亡人数仅居肺癌之后列第二位,且具有上升的趋势.但前几年在我国临床上却不常见,近数年来随着平均寿命延长,诊断方法改善及诊断水平提高,前列腺癌的临床报道越来越多,也越来越受到人们的关注.现就其诊疗问题进行讨论.

例1 女,37岁.因左侧腰背反复胀痛6年入院.既往无排尿异常史.体检:左肾区饱满,扪及一囊性包块,无叩击痛.B超检查发现左肾外上方有一胎儿头大小囊性包块,IVU检查显示左肾向内下方推移,集合系统有受压现象,拟诊为左肾巨大囊肿.行无水乙醇注入治疗(共3次),效果不佳,即行手术探查.术中见正常肾组织肾门外有一正常输尿管,其外上方有一巨大囊性包块,与肾组织紧密相连,且包块下有一明显粗大管状物与囊腔相通.遂切除囊肿与管状物.病理学检查:囊壁为肾单位,管壁为输尿管组织.确诊为左侧重复肾双输尿管畸形伴输尿管梗阻肾积水.