目的:研究分析贺氏三通法改善脑卒中急性期患者日常生活能力及生活质量的临床疗效.方法:采用随机对照单盲法,将符合纳入标准的120例脑卒中急性期患者随机分为治疗组和对照组,每组各60例.治疗组采用贺氏三通法干预,对照组采用常规针刺干预,观察2组入组前后Barthel指数、脑卒中专用生活质量量表(SS-QOL)及美国国立卫生研究院卒中量表(NIHSS)评分改善程度,比较2组临床疗效.结果:治疗12周,2组Barthel指数总分与同组入组前、入组4周比较,差异均有显著性(P<0.05),且治疗组优于对照组,差异有显著性(P<0.05).治疗组SS-QOL评分的变化值在入组12、24周时均优于对照组,差异有显著性(P<0.05);SS-QOL的第4、7单项入组12周时、第5单项入组24周时可观察到治疗组较对照组的优势具有显著性(P<0.05).入组4、12及24周随访,治疗组和对照组NIHSS评分总分均较入组前有显著性降低(P<0.05),但组间比较差异无显著性(P>0.05).结论:贺氏三通法改善脑卒中急性期患者日常生活能力及生活质量的临床疗效优于普通针刺对照组,为临床运用贺氏三通法提供了参考依据.

Objective:To investigate the clinical characteristics, treatment effect and prognosis of children with nearly diploid neuroblastoma (NB).Methods:A retrospective analysis of the general clinical characteristics (including age, Gender, risk grouping, location of primary tumor, etc.), laboratory test results, treatment and recent prognosis of NB children with nearly diploidy in bone marrow chromosomes by G-banding technology who admitted to Beijing Children′s Hospital, Capital Medical University from January 2015 to December 2018. Kaplan- Meier method was adopted to calculate survival rate.Univariate analysis was performed using Log- Rank test, and multivariate analysis was conducted with Cox regression model. Results:A total of 43 patients, including 27 males and 16 females, with diagnosis were included, with 14 cases in the hypodiploid group and 29 cases in the hyperdiploid group, and the median age was 35.5 months.The 43 children were all in the high-risk group of International Neuroblastoma Staging System(INSS)-Ⅳ.The primary tumors were mainly located in the retroperitoneal adrenal region (83.7%, 36/43 cases). The largest diameter of the tumors was more than 10 cm (53.5%, 23/43 cases), and often accompanied by 2 or more metastases at the time of consultation.In terms of chromosome karyotype and chromosome karyotype of 14 children in the hypodiploid group was 41-45, the most common karyotype was 45 chromosomes[9 cases(64.3%)]. Among 29 children in the hyperdiploid group of the 47 chromosome karyotypes, 11 cases were common (37.9%). Tumor markers were as follows: neuron enolase (NSE) increased in 41 cases children (95.3%) at first diagnosis, and 25 cases (58.1%)> 370 μg/L; 42 cases (97.7%)had lactate dehydrogenase (LDH). The LDH of children in the hypodiploid group was all> 500 U/L, with 1 case was> 10 000 U/L.Nine cases (20.9%) of MYCN gene were detected by fluorescence in situ hybridization (FISH). Treatment and prognosis: the total course of chemotherapy for 43 patients was 1-12, 19(44.2%) patients received autologous stem cell transplantation, 21 patients (46.5%) received postoperative or autologous radiotherapy or metaiodobenzylguanidine treatment, 28 children developed or relapsed with a median duration of 13.8 months, and 15 cases (34.9%) died.The median follow-up time of the 14 children in the hypodiploid group was 14.9 months (2-38 months), 12 cases progressed or relapsed, and 7 died.The median follow-up of 29 children in the hyperdiploid group was 20.0 months (8.1-51.6 months), with 16 patients progressed or relapsed and 8 cases died. Kaplan- Meier survival analysis illustrated that the 3-year projected event free survival (EFS) rate of 43 children was 18.4%, of which 17.1% were in the hypodiploid group and 29.8% in the hyperdiploid group. Conclusions:Preliminary analysis reveals that children with nearly diploid NB are mostly in the stage Ⅳ high-risk group over the age of 18 months, and 2 or more metastases at the time of consultation.The 3-year estimated EFS of 43 children was 18.4%, and the prognosis was worse in the hypodiploid group.

目的 探讨针灸治疗偏头痛的选穴特点及规律.方法 计算机检索针灸治疗偏头痛的RCT文献,提取中医四诊信息,经过数据标准化处理并建立数据库,运用SPSS 20.0系统挖掘其选穴规律.结果 共纳入文献94篇,其中涉及配穴方案48例.主穴取穴主要在头部,以胆经穴为多,通过系统聚类得到5组腧穴组合;配穴的选穴主在四肢,以脾经、胃经、肝经、胆经穴为多,通过系统聚类得到6组腧穴组合.结论 针灸治疗偏头痛的主穴取穴注重局部取穴与辨经取穴的有机结合,而重在治痛;配穴取穴强调远部辨经、辨证取穴,而重在扶正祛邪.针灸治疗偏头痛的选穴重在培本祛邪,标本兼顾,为临床治疗提供依据和指导.

“病多气滞,法用三通”是国医大师贺普仁创立的贺氏针灸三通法的核心内容与精髓所在.“气滞”是导致疾病发生的关键因素,其不仅指气机阻滞,同时也包括气机的失调、脏腑功能的失常,而“多”则表示除了“气滞”之外,其他病因也会导致疾病的发生.三通法包括以毫针疗法为代表的微通法,以火针疗法为代表的温通法和以放血疗法为代表的强通法.根据疾病的特点,气机失调的具体情况,采用三类方法来扶正祛邪,通达气血,调和阴阳.

特发性震颤(essential tremor,ET)又称原发性震颤,属于中枢神经系统的退行性病变,是一种典型的动作性或姿势性震颤,主要表现为双上肢震颤(90％～95％),也可表现为其他部位如头部(30％)、双下肢(10％～15％)的震颤以及语音震颤(20％)等[1].约 60％的患者有家族史,多数患者在 65～70 岁前完全外显[2].ET 发病率随年龄的增加而显著增加, 65 岁以上人群患病率为 5％[3-4].笔者采用针药结合治疗 9 例 ET 患者,现报道如下.

经过数千年历史变迁及历代医家的研究与临床实践,火针疗法的适应证从早期的寒证、痹证逐渐扩展到现在的120多个病种,其功效也从简单的温经散寒拓展为以热引热、补虚泻实、“破”“立”平衡等,逐步得以完善.通过梳理历代火针治疗病种以及相关禁忌症的变迁,整理火针功效由局限到逐步完善的历史脉络,为火针的临床应用提供参考.

2019年12月以来,湖北省武汉市出现多例不明原因肺炎病例,陆续有大量病例感染,国家卫生健康委员会将其命名为“新型冠状病毒肺炎”(COVID-19).随着防控力量的加强,方舱医院轻型患者增多,以及大批患者临床治愈出院,轻型和恢复期患者的中西医结合康复方案亟待制定并实施.因此,根据国家卫生健康委员会及相关学会印发的治疗方案,并经肺康复相关专家、中医药及营养学专家的广泛讨论,共同拟定《新型冠状病毒肺炎中西医结合呼吸康复方案(草案)》,以期在后续的疫情防控中发挥一定的积极作用.

通过于书庄教授提出的“临证五明”理论,强调针灸临床须明确辨病、辨证、辨经、选穴及治法;总结于书庄教授“临证五明”应用经验,初步探析其针灸经络诊疗体系及学术思想;结合笔者临床实践,浅谈应用“临证五明”理论诊治疾病的体会.

Objective:To investigate the clinical, ophthalmological and pathological features of primary uveal lymphoma.Methods:Retrospective clinical study. From 2012 to 2018 in Beijing Tongren Eye Cener, 4 cases and 4 eyes of patients with primary uveal lymphoma were included in the study. Among them, 3 cases were male and 1 case was female. The average age was (54 ± 13.58) years old. The average time from initial diagnosis to pathological diagnosis was (18.50 ± 9.29) months. 3 cases were enucleated and 1 case was biopsied. Extranodal marginal zone lymphoma (EMZL) of the mucosa associated lymphoid tissue (MALT) was confirmed by pathological examination. BCVA, fundus color photography, color Doppler ultrasound and orbital MRI were performed in all eyes. UBM, OCT, FFA and ICGA were performed in 2 eyes, 3 eyes, 3 eyes and 2 eyes respectively. The clinical, imaging and pathological changes were observed. Following up time was ≥ 6 months.Results:At the initial diagnosis, BCVA was 0.6, 0.02 and 0.01 in 1, 2 and 1 eye respectively. Choroid, ciliary body and iris were involved in 3 eyes, choroid in 1 eye. The fundus of the eyes showed infiltration of choroid in yellow and white color, and the lesions were beyond the vascular arch to the equator and peripheral areas. Color Doppler ultrasonography showed that choroidal diffuse thickening and extrascleral extension (ESE) which was the corresponding hypoechoic areas behind the sclera. Among them, ESE showed crescent thickening in 1 eye and nodular thickening in 3 eyes. UBM showed that the echo of ciliary body was thicken and the internal echo was decreased with the iris involved. OCT showed that RPE was wavy and local retinal neuroepithelial layer detached. FFA showed that the early lesions were mottled with strong and weak fluorescence, and the late fluorescence leakage. The posterior wall of the eyeball was thickened and enhanced in MRI.Conclusion:The clinical manifestations of uveal lymphoma are various, color Doppler ultrasound has characteristic manifestations and ESE of crescent or nodular thickening is valuable in diagnosis.

介绍采用火针围刺法治疗上臂复发性韧带样纤维瘤患者1例.复发性韧带样纤维瘤可归属中医学“骨瘤”范畴,病性为本虚标实,证属脾肾亏虚、瘀结经络.治疗以温通活血为主,选用火针围刺疗法.火针围刺法能温通经络、行气活血,从而消除肿物,具有对机体损伤小、简单易行的特点.

目的 对比分析半球形与扁平形葡萄膜转移癌的MRI征象,探讨MRI对不同形态葡萄膜转移癌的诊断价值.方法 回顾性收集北京同仁医院2005～2015年经手术病理或临床综合诊断确诊的眼葡萄膜转移癌49例,平均年龄(52.5±12.3)岁,其中男性19例,女性30例,左眼26例,右眼21例,双眼2例,根据病变形态分为扁平形组(36例)和半球形组(13例).比较两组临床表现及MRI征象,包括患者年龄、性别、肿块侧别、部位、形态、边缘、是否伴发视网膜脱离、T1WI和T2WI信号(与脑灰质相比)、T1 WI和T2WI信号均匀度、强化程度、强化均匀度、强化指数、肿块高度、基底径、基底径与高度比值,计数资料采用Pearson卡方检验,计量资料采用独立样本秩和检验.结果 肿块T1WI信号均匀度、增强程度、强化指数在两组间均有显著差异(x2=4.491、5.026、5.914,P=0.034、0.025、0.015),患者性别、侧别、肿块部位、形态、边缘、是否伴发视网膜脱离、T1WI和T2WI信号(与脑灰质相比)、T2WI信号均匀度均无显著性差异(P＞0.05),基底径与高度比值在扁平形组(0.8～11.3mm,中位数2.9mm)和半球形组(1.0 ～ 6.0mm,中位数2.0mm)两组间均有显著差异(Z =-1.998,P=0.046),患者年龄、肿块高度、基底径均无显著性差异(P＞0.05).结论 半球形与扁平形葡萄膜转移癌的MRI征象存在一定差异,半球形葡萄膜转移癌仍具备多数葡萄膜转移癌T1WI、T2WI多呈等信号的特点,MRI对葡萄膜转移癌具有重要价值.

视神经脊髓炎谱系疾病是一种主要累及视神经和脊髓的中枢神经系统炎性脱髓鞘疾病.此病作为中枢神经系统脱髓鞘疾病在亚洲高发,复发率高,临床症状重,预后差,严重影响生活质量,近期成为神经免疫学科中的研究热点.笔者从疾病的中医针灸治疗现状方面进行了总结分析,为中医诊治此病和进一步科学研究提供思路.

相对于药物的固有属性——"药物副作用"而言,针灸算得上是一种绿色疗法.出于养生的目的,一些人尤其是中老年人认为,既然是绿色疗法就可以"经常扎",甚至"天天扎".事实上,随意针灸并不能产生想象中的治疗效果,身体也不会因此更加获益.

相对于药物的固有属性——“药物副作用”而言,针灸算得上是一种绿色疗法.出于养生的目的,一些人尤其是中老年人认为,既然是绿色疗法就可以“经常扎”.事实上,这样针灸的治疗效果并不好,身体也不会因此更加获益.

相对于药物的固有属性——“药物副作用”而言,针灸算得上是一种绿色疗法.出于养生的目的,一些人尤其是中老年人认为,既然是绿色疗法就可以“经常扎”,甚至“天天扎”.事实上,这样针灸并不能产生想象中的“无限叠加”疗效,身体也不会因此获益更多.

相对于药物的固有属性——"药物副作用"而言,针灸算得上是一种绿色疗法.出于养生的目的,一些人尤其是中老年人认为,既然是绿色疗法就可以"经常扎",甚至"天天扎".事实上,这样针灸并不能产生想象中的疗效"无限叠加",身体也不会因此更加获益.

Objective: To summarize the clinical features, treatment and prognosis of retinoblastoma (RB) patients in distant metastasis stage. Methods: Retrospective case series study. Clinical data of 24 cases (30 eyes) with diagnosis of distant metastasis stage RB were collected in pediatrics department of Beijing Tongren Hospital affiliated with Capital Medical University, from September 2005 to December 2013. In these cases, including 11 male cases and 13 female cases, the treatment age ranged from 7 months to 9 years with the median of 26 months. There were 18 unilateral cases (12 cases of right eye and 6 cases of left eye) and 6 bilateral cases. All cases were treated with surgery, chemotherapy and radiotherapy. The adverse reaction, blood routine and biochemical routine were monitored dynamically and regularly during treatment. The clinical manifestations and auxiliary examination were combined to evaluate the therapeutic effect. Determining the prognosis with death and survival, the survival curve and the median survival time were calculated by the product limit method. Results: The results of pathologic examination of 13 cases showed 11 cases of optic nerve involvement, 6 cases of optic nerve and choroid involvement, 1 case of post laminar involvement, 1 case of cornea and conjunctiva involvement. The most common metastatic site was central nerve system (CNS) (23 cases), followed by orbital involvement (10 cases). Other metastatic sites included bone (9 cases), bone marrow (1 case), pleura (1 case) and lymph node (1 case). 23 patients with CNS metastasis underwent systemic chemotherapy and intrathecal injection. The toxicity and side effects of radiotherapy and chemotherapy were evaluated and classified as grade I-II. Those adverse effects were tolerated by all cases. Followed up to December 31, 2015, all patients with CNS metastasis died and the median survival time was 6 months. Only 1 patient without CNS metastasis disease-free survived for 64 months. Conclusions: The most common metastasis site of RB was CNS. The overall prognosis of RB with distant metastasis was poor, in spite of given combined treatment mainly including surgery, chemotherapy and radiotherapy. But the prognosis of RB patients without CNS metastasis in distant metastasis stage was better than with CNS metastasis. (Chin J Ophthalmol, 2017, 53: 121-126).

Conjunctival tumors account for vast majority of keratoconjunctival tumors.The primary cornea tumors are very rare.Common benign tumors are dermoid, melanocytic nevi, and dermolipoma.Common malignant tumors are squamous cell carcinoma, melanoma, and lymphoma.Histopathology examination is the "gold standard" for tumor diagnosis.In recent years, with the development and applications of in vivo confocat microscopy, it can also provide a reference value for determining the nature of the lesion.Observation is a common choice for management of most benign, asymptomatic tumors.If a malignant transition tendency is observed, both surgery and histopathological examinations are needed as soon as possible.For clinical suspected malignant tummors, the most common treatment is local extended resection and cryotherapy.Sometimes, it may need to be combined with radiotherapy, chemotherapy, or even enucleation or evisceration to save the patient's life.

在新医改背景下,北京中医医院积极探索“医疗联盟”的新模式,在全国范围内相继与30多家医院建立了协作与对口支援、院际合作、托管等合作关系,并制定了具体措施来深化和落实合作,取得一定成效.对医疗联盟的模式和成果作出总结,为完善工作模式提供参考.

Objective To investigate current status of use of oral hypoglycemic drugs and insulin among adult patients with type 2 diabetes mellitus (T2DM) in urban community of Beijing.Methods In total,3297 T2DM patients aged more than 20 years from 15 urban communities of Beijing were studied.Their body weight,height,fasting plasma glucose level and glycosylated hemoglobin Alc (HbAlc) were measured.A door-to-door questionnaire survey on use of oral hypoglycemic drugs and insulin was conducted for them.All the T2DM patients surveyed were divided into four groups based on their received intervention.Results ①Of 3279 T2DM patients,454 (13.8％) received lifestyle intervention,971 (29.5％) used only one oral hypoglycemic drug,1179 (35.7％) with combined oral hypoglycemic drugs,and 693(21.0％) with insulin.②There was significant difference in average HbAlc among the four groups of T2DM patients with lifestyle intervention,only one oral hypoglycemic drug,combined oral hypoglycemic drugs,and insulin,with HbAI c of (7.0 ± 1.9) ％,(7.1 ± 1.5) ％,(7.4 ± 1.5 ) ％,and (7.5 ± 1.5 ) ％for them,respectively ( F =15.1,P ＜ 0.01 ).Proportions of the T2DM patients with HbAlc equal to or higher than 7.0％ were 32.2％,39.4％,52.1％ and 59.5％ for the four groups,respectively ( x2 =117.7,P ＜ 0.01 ).③In the T2DM patients with lifestyle intervention,32.2％ (146/454) of them with HbA1 c equal to or higher than 7.0％ were untreated with any oral hypoglycemic drug.In those with only one oral hypoglycemic drug,39.4％ (383/971) of them with HbAlc equal to or higher than 7.0％ were not treated with combined oral hypoglycemic drugs and/or insulin.In those with combined oral hypoglycemic drugs,52.1％ (614/1079) of them with HbAlc equal to or higher than 7.0％ were not received combined insulin treatment.④ Fasting plasma glucose level,treatment strategies,postprandial 2-h blood glucose level and length of the illness were independent risk factors for HbAlc level equal to or higher than 7.0％,with odds ratio (OR) of 1.757,1.256,1.175 and 1.031,respectively.⑤ In 2843 T2DM patients with oral hypoglycemie drugs and/or insulin treatment,1494 (52.6％ ) received biguanides and 693 received (24.4％ )insulin,respectively.Conclusions More than half of adult patients with T2DM do not meet the target of glycemic control of HbAlc less than 7.0％ in urban communities of Beijing,due to not active use of oral hypoglycemic drugs,and not timely adoption of combined use of oral hypoglycemic drugs and insulin therapy.