Objective:To derive the Chinese medicine(CM)syndrome classification and subgroup syndrome characteristics of ischemic stroke patients.Methods:By extracting the CM clinical electronic medical records(EMRs)of 7,170 hospitalized patients with ischemic stroke from 2016 to 2018 at Weifang Hospital of Traditional Chinese Medicine,Shandong Province,China,a patient similarity network(PSN)was constructed based on the symptomatic phenotype of the patients.Thereafter the efficient community detection method BGLL was used to identify subgroups of patients.Finally,subgroups with a large number of cases were selected to analyze the specific manifestations of clinical symptoms and CM syndromes in each subgroup.Results:Seven main subgroups of patients with specific symptom characteristics were identified,including M3,M2,M1,M5,M0,M29 and M4.M3 and M0 subgroups had prominent posterior circulatory symptoms,while M3 was associated with autonomic disorders,and M4 manifested as anxiety;M2 and M4 had motor and motor coordination disorders;M1 had sensory disorders;M5 had more obvious lung infections;M29 had a disorder of consciousness.The specificity of CM syndromes of each subgroup was as follows.M3,M2,M1,M0,M29 and M4 all had the same syndrome as wind phlegm pattern;M3 and M0 both showed hyperactivity of Gan(Liver)yang pattern;M2 and M29 had similar syndromes,which corresponded to intertwined phlegm and blood stasis pattern and phlegm-stasis obstructing meridians pattern,respectively.The manifestations of CM syndromes often appeared in a combination of 2 or more syndrome elements.The most common combination of these 7 subgroups was wind-phlegm.The 7 subgroups of CM syndrome elements were specifically manifested as pathogenic wind,pathogenic phlegm,and deficiency pathogens.Conclusions:There were 7 main symptom similarity-based subgroups in ischemic stroke patients,and their specific characteristics were obvious.The main syndromes were wind phlegm pattern and hyperactivity of Gan yang pattern.

多发性骨髓瘤(multiple myeloma,MM)是第二大最常见的血液系统恶性肿瘤,尽管现代疗法使患者症状得到了显著改善,整体生存率明显提高,但多数患者仍然复发并死亡.嵌合抗原受体T(chimeric an-tigen receptor T,CAR-T)细胞疗法在多种肿瘤治疗特别是血液系统肿瘤治疗中显示出明显疗效,为复发/难治性MM的治疗带来希望.本文主要从CAR-T细胞结构设计、活性优化、安全性控制等方面来阐述CAR-T细胞治疗MM的优化策略新进展.

乳腺癌囊性脑转移是一种症状严重、预后极差的晚期乳腺癌并发症,其发生率低,但致死率高.患者缺乏临床特异性表现,主要以神经系统症状为主,诊断主要依靠颅脑CT及MRI.由于血脑屏障及血脑肿瘤屏障的存在,相关药物疗效不佳,治疗手段有限,故临床医师应引起重视.针对高复发风险,患者应定期复查,若已患病则以放疗、手术治疗为主,并结合患者情况制订个体化方案.本文从该病的临床特征、诊断要点、治疗方法及预后等方面作一综述,以期为临床诊疗提供更多借鉴.

目的 探讨血必净注射液对抗CD19嵌合抗原受体T细胞(CAR-T)体外肿瘤杀伤活性的影响.方法 构建基于单链抗体(scFV)抗CD19靶点的CAR分子,将CAR基因装载于逆病毒载体质粒中,制备逆病毒载体,转导健康人供体T细胞制备抗CD19?CAR-T细胞.以CD19阳性淋巴瘤细胞(Raji)、Raji-荧光素酶(LUC)标记细胞为靶细胞,将未转导的T细胞、CD19?CAR-T细胞分别与靶细胞按1:2、1:4、1:8的效靶比共孵育12?h后,分别采用流式细胞术、荧光素酶报告基因检测法检测CAR-T细胞对靶细胞的杀伤效果.将血必净注射液按1?g/L及10?g/L浓度加入CD19?CAR-T细胞共培养基,采用同样的方法检测不同浓度血必净注射液处理的CD19?CAR-T细胞对肿瘤细胞的杀伤效率.结果 健康人群来源的CD19?CAR-T细胞经过14?d培养后扩增良好,每48?h扩增倍数为2～6倍,阳性率70.17％,提示CD19?CAR-T细胞制备成功.效靶比为1:2、1:4、1:8时,CD19?CAR-T细胞对Raji细胞和Raji-LUC细胞的杀伤效率均显著高于未转导T细胞〔效靶比1:2时Raji细胞(65.57±2.93)％比(13.17±0.69)％,Raji-LUC细胞(49.23±2.11)％比(14.04±2.68)％;效靶比1:4时Raji细胞(44.40±0.80)％比(10.06±2.44)％,Raji-LUC细胞(29.97±1.77)％比(8.60±0.71)％;效靶比1:8时Raji细胞(27.39±1.70)％比(9.05±1.13)％,Raji-LUC细胞(25.40±0.57)％比(7.09±0.44)％,均P<0.001〕.在相应效靶比条件下,经1?g/L和10?g/L血必净注射液处理的CD19?CAR-T细胞对Raji细胞和Raji-LUC细胞的杀伤效率均高于未经处理的CD19?CAR-T细胞,其中以经1?g/L血必净注射液处理的CD19?CAR-T细胞的杀伤效率升高最为显著〔效靶比1:2时Raji细胞(74.53±2.56)％比(71.91±3.25)％、(64.06±0.86)％,Raji-LUC细胞(57.67±0.58)％比(53.33±0.58)％、(49.00±2.00)％;效靶比1:4时Raji细胞(63.96±3.23)％ 比(50.84±5.54)％、(43.95±0.50)％,Raji-LUC细胞(43.33±0.58)％ 比(40.00±1.00)％、(29.67±2.08)％;效靶比1:8时Raji细胞(41.79±3.58)％比(33.79±1.15)％、(27.62±2.07)％,Raji-LUC细胞(36.20±0.53)％比(31.90±0.66)％、(23.13±1.06)％,均P<0.05〕.结论 CD19?CAR-T细胞能有效杀伤CD19阳性肿瘤细胞,血必净注射液可有效提高CD19?CAR-T细胞对肿瘤细胞的杀伤能力.

对于无过错责任在医疗美容损害中的适用范围,以往研究由于研究方法的局限,忽视了对损害事实和归责原则内部关系的探究,未形成统一的结论.以法经济学为视角,运用成本收益理论和激励作用理论,通过对损害事实内部的"预防成本"分析,认为无过错归责原则仅对医疗美容损害关系中的当事人一方具有激励作用,以此为基础探讨无过错责任在医疗美容损害中的适用范围.

Spatial distribution uniformity is the critical quality attribute(CQA) of Ginkgo Leaves Tablets, a variety of big brand traditional Chinese medicine. The evaluation of the spatial distribution uniformity of active pharmaceutical ingredients(APIs) in Ginkgo Leaves Tablets is important in ensuring their stable and controllable quality. In this study, hyperspectral imaging technology was used to construct the spatial distribution map of API concentration based on three prediction models, further to realize the visualization research on the spatial distribution uniformity of Ginkgo Leaves Tablets. The region of interest(ROI) was selected from each Ginkgo Leaves Tablet, with length and width of 50 pixels, and a total of 2 500 pixels. Each pixel had 288 spectral channels, and the number of content prediction data could reach 1×10~5 for a single sample. The results of the three models showed that the Partial Least Squares(PLS) model had the highest prediction accuracy, with calibration set determination coefficient R_(pre)~2 of 0.987, prediction set determination coefficient R_(pre)~2 of 0.942, root mean square error of calibration(RMSEC) of 0.160%, and root mean square error of prediction(RMSEP) of 0.588%. The classical least-squares(CLS) model had a greater prediction error, with the RMSEP of 0.867%. Multivariate Curve Resolution-Alternating Least Square(MCR-ALS) model showed the worst predictive ability among the three models, and it couldn't realize content prediction. Based on the prediction results of PLS and CLS models, the spatial distribution map of APIs concentration was obtained through three-dimensional data reconstruction. Furthermore, histogram method was used to evaluate the spatial distribution uniformity of API. The data showed that the spatial distribution of APIs in Ginkgo Leaves Tablets was relatively uniform. The study explored the feasibility of visualization of spatial distribution of Ginkgo Leaves Tablets based on three models. The results showed that PLS model had the highest prediction accuracy, and MCR-ALS model had the lowest prediction accuracy. The research results could provide a new strategy for the visualization method of quality control of Ginkgo Leaves Tablets.

中药追溯作为中药安全治理体系的重要组成部分具有不可替代的作用和功能.通过梳理中药追溯法律规制现状,发现目前中药追溯法律规制存在主体责任不明确、监管部门职责交叉、追溯法律制度不够完善等问题.应从明确中药追溯主体责任、明晰监管部门职责、完善追溯法律制度等方面加以完善.

三阴性乳腺癌是临床研究的难点与热点,目前西医缺乏针对性的治疗手段,中医在此有一定的特色和优势.万冬桂教授从医30余年,开设三阴性乳腺癌专病门诊8年,积累了较为丰富的临床经验,擅长从痰论治三阴性乳腺癌,并自创了防治三阴性乳腺癌复发转移的专病专方"蒌慈散结方",应用于临床多年,取得了满意的疗效.万冬桂教授认为痰浊内生是三阴性乳腺癌发生发展的重要病机,痰湿质是三阴性乳腺癌的常见体质,痰浊凝结是三阴性乳腺癌复发转移的主要原因,因此以化痰散结为主要治则,分别从郁、从虚论治,治以疏肝健脾、理气化痰,同时注重引经报使,善用疏通乳络、宣肺化痰、祛风通络之品,杜绝生痰之源,改善偏颇体质,以防发展及传变.

脱发是化疗常见的毒副反应之一,也是影响患者生活质量及治疗依从性的主要原因[1],更易使女性患者产生自我形象扭曲及严重的自卑感[2],导致或加重抑郁、焦虑等负面情绪,从而影响治疗效果及预后[3].李佩文教授在化疗毒副反应的防治方面有独特见解与临床经验[4],笔者现将李教授防治化疗性脱发的经验总结如下.

目的:了解新型冠状病毒肺炎(以下简称新冠肺炎)流行期间乳腺癌患者诊疗情况及心理状态,为今后出现类似突发公共卫生事件时有的放矢,为乳腺癌患者诊疗指导及心理干预提供依据.方法:采用问卷调查法,对全国26省市新冠肺炎疫情前正在接受抗肿瘤治疗的乳腺癌患者疫情期间的诊疗情况及心理状态进行线上问卷调查.采用SPSS 22.0对调查结果进行分析.结果:共收集626 份问卷,在被调查的乳腺癌患者中,16.80%的患者西医治疗延迟或中断,其中静脉化疗和靶向治疗受限人数最多;30.85%的患者中医治疗延迟或中断;55.68%的患者复查随访延迟;59.81%的患者西医治疗延迟或中断长达4周及以上.受疫情影响, 28.64%的患者出现焦虑和(或)抑郁,达到需要进行心理专科干预者占被调查总人数的12.32%.且在延迟诊疗人群中焦虑和(或)抑郁比例明显高于非延迟治疗人群(33.50% vs 26.70%,P＜0.05).结论:大部分乳腺癌患者诊疗(包括复查随访和治疗)在疫情期间延迟或中断.此外,乳腺癌患者在疫情期间焦虑抑郁比例明显增高,且与治疗延迟相关.因此,在疫情期间及时为患者提供便捷的诊疗指导及心理疏导有助于帮助患者从容应对疫情,减少心理压力,控制乳腺癌发生发展.

[目的]考察清毒栓提取物对宫颈癌SiHa细胞活性的影响,并基于叉状头/翅膀状螺旋转录因子(Foxp3)探讨其可能的作用机制.[方法]利用脂质体介导转染方法,建立Foxp3过表达人乳头瘤病毒(HPV)感染阳性SiHa细胞株,同时利用pcDNA3.1空载体转染SiHa细胞株作为阴性对照.用蛋白免疫印迹(Western Blot)法检测经空白血清和15％含药血清分别处理的Foxp3过表达质粒组及空白质粒组SiHa细胞中Foxp3蛋白及其下游信号分子水平,并用CCK8法检测4组SiHa细胞活性.[结果]Foxp3过表达载体转染处理可以显著增加SiHa细胞中Foxp3蛋白、Foxp3下游信号分子β-连环蛋白(β-catenin)、c-Myc、细胞周期蛋白D1(cyclinD1)的蛋白含量并增加SiHa细胞活性(P<0.01),而抑制凋亡基因含半胱氨酸的天冬氨酸蛋白水解酶-3(Caspase-3)剪切(P<0.05);清毒栓含药血清可以显著抑制SiHa细胞中Foxp3及其下游信号分子蛋白水平(P<0.05)并抑制SiHa细胞活性(P<0.01),促进Caspase-3剪切(P<0.01).Foxp3过表达质粒可以抑制含药血清诱导的SiHa细胞中Foxp3下调和活性下降,抑制含药血清诱导的β-catenin、c-Myc、cyclinD1含量下调以及Caspase-3剪切增加.[结论]Foxp3可通过激活β-catenin通路来增加SiHa细胞活性,在SiHa细胞中扮演着原癌基因角色,而清毒栓含药血清通过调节Foxp3影响β-catenin通路从而抑制SiHa细胞活性.

As an advanced concept in international pharmaceutical research,quality by design( QbD) can fulfill the strategic requirements of drug quality from testing to design. In this paper,the extraction process of Yanggong Prescription which was the modified Siwu Decoction was optimized based on QbD concept. With the extraction amount of solid matter,the content of ferulic acid and the content of paeoniflorin as critical quality attributes( CQAs),the failure mode and effect analysis( FMEA) was used to screen potential critical process parameters( p CPPs). The mathematical model was established by Box-Behnken experimental design to investigate the interaction between critical process parameters( CPPs) and CQAs. Then the design space for the extraction process of Yanggong Prescription was further established and optimized. Analysis of variance showed that the variance of all models was significant( P<0. 01),and the lack-of-fit value was not significant,indicating that the model was statistically significant. The relationship between various factors and the response values could be functionalized by the established models. Finally,through the optimization of the design space,the optimum extraction process of Yanggong Prescription was obtained as follows: 3 extraction times,122 minutes extraction,and 7 times of water adding. The extraction process of Yanggong Prescription based on the QbD concept was robust and reliable,which would provide guidance for the process development and quality control of its formulations.

目的:从盆腔解剖结构、免疫、内分泌等方面研究温经汤治疗子宫内膜异位症大鼠不孕的作用机制.方法:50只SD大鼠分为空白组,子宫内膜异位症组(模型组),温经汤高剂量组,温经汤低剂量组,达那唑组.结果:①低剂量组:重度粘连率14％.高剂量组:重度粘连率为0.模型组:重度粘连率50％.达那唑组:重度粘连率25％.②模型组、低剂量组CD3、CD4、CD4/CD8均较正常值低,差异有显著性(P＜0.05),高剂量组、达那唑组与模型组相比较CD3、CD4、CD4/CD8均有所提高,差异有显著性(P＜0.05).③模型组血清E2含量明显高于空白对照组,差异有显著性(P＜0.05).与模型组比较,丹那唑组和温经汤高剂量组的E2水平明显降低,P水平明显提高,差异有显著性(P＜0.05).与空白组比较,模型组大鼠血清催乳素水平明显升高,差异有显著性(P＜0.01).与模型组比较,高剂量组和达那唑组的血清催乳素水平明显降低,差异有显著性(P＜0.05).结论:温经汤通过改善盆腔粘连、免疫系统功能紊乱、内分泌紊乱等治疗子宫内膜异位症不孕.

Objective:To observe the effects of Wenjing decoction on endometriosis rats, pregnancy rate of embryo size, the number of embryos,this paper discusses the influence of Wenjing decoction for treating endometriosis.Methods:50 SD rats were divided into a blank group, an endometriosis group ( a model group ) , a Wenjing decoction high -dose group,a Wenjing decoction low-dose group and a danazol group.Results:Compared with the high-dose group, the gestational sac size of the low-dose group was significantly reduced, with a significant difference (P<0.01);the ges-tational sac size of the danazol group was significantly reduced, with a significant difference (P<0.05);the gestational sac size of the blank group was significantly reduced, with a significant difference (P<0.01).Compared with Wenjing decoction low-dose group, the pregnancy number of the danazol group was significantly reduced, with a significant difference ( P<0.05);the pregnancy number of the blank group was significantly reduced, with a significant difference (P<0.05);the pregnancy number of the model group was significantly reduced, with a significant difference ( P<0.05) .Compared with the blank group,the pregnancy rate of Wenjing decoction high-dose group was significantly re-duced, with a significant difference (P<0.05).Conclusion:Wenjing decoction has a very good improving effect on the pregnancy function of endometriosis rat models.

In order to safeguard the legitimate rights and interests of people with mental disorders for the purpose of legislation , after 27years ’ repeated as appropriate , Mental Health Act finally introduced to fill the gaps in the legislation in the field of mental health , as well as the protection of human rights enshrined in the law.The principle of voluntary hospitalization has been established , supplemented by compulsory hospitalization.The occurrence of " been treated as mental patient " reduced.But objection mechanism to compulsory hospitalization is not conducive to safeguarding the rights of people with mental disorders.Draw on the basis of compulsory hospitalization of mental disorders opposition system in other countries and combined with China's national conditions , this article discussed in aspect of opposition subject , opposition department and opposition procedure in order to improve compulsory hospitalization opposition mechanism.

重型胎盘早剥是临床上的危重症，往往伴随着胎儿死亡和子宫卒中，积极有效的抢救措施，及时行剖宫产手术，并且行捆绑式子宫缝合术，对保留住子宫意义很大。

<正>上消化道出血指屈氏韧带以上的消化道出血,含食管、胃、十二指肠或胰、肝等病变引起的出血,胃空肠吻合术后的空肠出血也包括在内。上消化道出血常见临床表现为呕血、腹痛、便血及不同程度的周围循环衰竭等,属临床常见急症,须进行急救。笔者结合20例护理经验,现将护理体会总结如下。1资料与方法1.1一般资料选择我科上消化道出血患者20例,男12例,女8例;年龄24~78岁;其中单纯黑便11例,呕血伴黑便6例,伴休克3例。患者入院主诉均出现上腹部不适,烧灼感,伴

我国许多公立医院曾经或正在引入ISO9000认证,进行构建医院质量管理框架的尝试,少数医院还通过了美国专门针对医疗机构的JCI认证。北京中医药大学附属护国寺中医医院经历过两次引入ISO9000质量管理体系的实践,文章就两次ISO9000质量体系认证实践中的管理工作总结出一些经验,同时也提出一些问题,并进行了分析与思考。

目的利用MMPI对北京中医药大学第三附属医院护士心理个性特征进行研究,探讨我院护士的总体心理状态,保证我院护理工作的顺利开展。方法利用明尼苏达多相个性测量(MMPI)对北京中医药大学第三附属医院128名在护士进行研究。结果与心理状态正常护士比较,心理状态轻中度异常护士在Hs、D、Hy、Pd、Pt、Ma量表有统计学差异(P<0.05~0.001)。结论我院护士的心理异常主要表现有神经衰落、抑郁、偏执、焦虑、情绪紊乱、妄想的个性特征的异常,为今后我院护士心理健康教育提供了重要依据。

The way to dealing the contravention between clinical teaching and protecting patient’s privacy rights, is normativly embodying the will of the patient during the benefit transfer, and asking and using the the patient’s privacy by informing consent in clinic teaching practice. Meantime, there should be a limitation of the patient’s privacy rights, which should be excluded in some special situation.