To reduce the manufacturing cost of the physical prototype during R & D and reduce the testing time. This article establishes a simulation model of variable displacement radial piston motor with inner curve based on AMEsim. The three operating conditions of the hydraulic motor under full displacement, half displacement and their mutual switching are simulated. The results show that under the condition of full displacement and half displacement, the torque and speed of the inner curve radial piston motor can quickly reach stability, indicating that the design meets the requirements and has high reliability. When the working conditions of full and half displacement are switched, the torque and speed fluctuate to a certain extent. It shows that there is an impact at the specific position of the curve, which needs to be further optimized to improve the stability.

高风险患者中侵袭性真菌感染(IFIs)的发病率及死亡率很高.早期诊断和治疗可以有效降低IFIs的死亡率.然而,由于其缺乏特异性的临床症状和体征,早期诊断IFIs通常会很困难.因此即使没有IFIs的确诊证据,对于符合条件的高危患者也仍有必要进行早期抗真菌治疗.本文综述了儿童IFIs的临床症状和体征及诊断方法的相关研究进展,旨在为IFIS的早期诊断、改善疾病的转归、减轻疾病负担提供线索和支持.

国医大师张大宁在50多年的中医临床实践中深刻认识到慢性肾功能衰竭的发生发展规律,并基于现代医学对慢性肾功能衰竭尿毒症期的认识,认为该病是“久病及肾”“久病多瘀”的结果,病机可概括为“肾虚”“血瘀”和“湿毒”.提出“肾虚血瘀论”和“补肾活血法”,此法颇有疗效,是张老临床治疗慢性肾脏病的总治则,可将此法应用于慢性肾脏病的各个阶段并加以临证施治,使邪去正安,病情得以好转.

静脉曲张导致下肢慢性溃疡是临床常见疾病,病情易反复,难以治愈,单纯西医治疗和中医治疗效果都有不足.应用中西医结合治疗静脉曲张导致双下肢慢性溃疡,有见效快,疗效好,疗效维持时间较长等优势,此附临床病例1 则,以供同道参考. 1 临床资料 患者男,83 岁,于2018 年5 月14 日由门诊收入院.患者双下肢溃破、渗液10 余年,加重1 周.患者既往双下肢静脉曲张病史10 余年,于10 年前行双侧小腿曲张静脉切除术后出现双下肢溃破、渗液,时就诊于外院,予派瑞松等药物治疗,未见明显好转,后反复发作.近1 周溃破、渗液情况加重,就诊于我院疮疡科住院治疗.现症:神情,精神可,双下肢大面积溃破、渗液、水肿,皮肤色黑,皮温偏高,见图1.患者平素性格开朗,无精神障碍,因长期静脉曲张破溃渗液,营养稍差.

药物生物药剂学属性(溶解性、渗透性等)在了解药物体内过程、筛选药物、评价给药系统等方面发挥着越来越重要的作用.中药活性成分复杂、结构类型多样,生物药剂学为中药成分体内过程的预测与研究提供了思路与途径.多成分体系是中药与化学药物的主要区别之一,多成分体系下的中药活性成分的生物药剂学分析已成为研究热点之一,笔者对中药多成分体系下生物药剂学分类系统的构建现状和应用情况进行综述,以期为该领域数据整合、理论归纳以及系统构建提供参考,并为中药传统理论研究以及药品的开发提供新思路.

何首乌始载于北宋《开宝本草》,是我国中医临床常用名药.何首乌中含有二苯乙烯类、蒽醌类、磷脂类、黄酮类等多种活性成分,具有抗衰老、降血脂、抗动脉粥样硬化、保肝、免疫调节等多种药理作用.近年来,何首乌肝损伤事件频发,使该药成为业界研究热点.本文从化学成分、药理作用、毒副作用以及配伍研究等方面对何首乌进行综述,以期为该药的基础研究、临床合理应用等提供思路和参考.

总结栗锦迁教授从痰论治眩晕的临床经验.栗教授认为眩晕的病因病机多与痰湿有关,临床采用辨证论治,用苓桂术甘合泽泻汤加减治疗痰湿上蒙型眩晕,用当归芍药散合半夏白术天麻汤加减治疗痰瘀互阻型眩晕,用黄连温胆汤加减治疗痰热上扰型眩晕,皆获良效.

[Objective]To study the inhibition and immune function effects of co-administration of tegafu and Chinese yam on colon cancer. [Methods] The nude mice model of colon cancer HT29 cells was established. The treatment was given in using tegafur (36 mg/kg), Chinese yam extract (125 mg/kg), and combined utilization method. The tumor suppressor situation was observed, and serum CD4+T/CD8+T, contents of interleukin-2 (IL-2), α-tumor cell necrosis factor (TNF-α) and γ-interferon (IFN-γ) were calculated. [Results] After the treatment, the tumor quality of the combined treatment was lower than that of Chinese yam group and tegafur group, while serum CD4+T/CD8+T and contents of IL-2, TNF-α and IFN-γ were significantly higher than those in the two isolated groups. [Conclusion] The synergistic combination of the Chinese yam extract and the tegafur can improve the immunity of the nude mice with colon cancer and shows certain therapeutic effect.

文章以临床医生为主体,依托信息化手段,重点研究精细化管理在绩效管理中的应用,具体方法包括设定精细考核指标﹑人员模块分配﹑制定考核方法和设立反馈机制等,通过在该院医生管理中的实践应用和后期反馈的不断完善,使绩效管理和日常管理相融合,充分调动了每个员工的集体参与感﹑荣誉感和积极性,促进合理诊疗,增加服务质量;同时,彻底改变了传统的收减支的分配模式,建立了新的分配模式,整体取得了很好的效果.

Objective To study the inhibitory effects of Chinese yam combined with tegafu on colon cancer HT-29 cells in vivo and in vitro.Methods The changes of cell morphology were observed by the method of adopting 2×2 factorial designs,after HT-29 colon cancer cells were treated with physiological saline containing dimethyl sulfoxide(blank control), tegafur(36 mg/L)and Chinese yam(125 mg/L).MTT method was used to detect the proliferation of tumor cells,and flow cytometry was used to detect the expression of tumor stem cells(CD133+cells).The nude mouse model of colon cancer HT-29 cells was established. The treatment was given in the above method, and the tumor inhibition rate was calculated. The VEGF positive rate of the tumor was detected by immunohistochemistry. Results The inhibited proliferation of colon cancer HT-29 cells was significantly higher in the synergistic group than that in Chinese yam group and tegafur group,and the inhibitory rates were higher in the three treatment groups than that of blank control group.The proportion of CD133+cells was significantly lower in HT-29 cells in the synergistic group compared with that of the Chinese yam group and the tegafur group,and which was lower in these three groups than that of the blank control group.After the treatment in three treatment groups,the tumor quality and VEGF positive rate were significantly lower than those of the blank control group,and which was lower in the tegafur+Chinese yam group than that of Chinese yam group and the tegafur group. Conclusion Chinese yam combined with tegafu can inhibit the proliferation of colon cancer HT-29 cells and their stem cells.

高端中医在临床应用的实践研究是全面认识中医在特殊医疗环境从系统性入手进行医疗诊治的新视角.中医文化的价值已经在千百年的传承中被国人乃至全世界广泛认知,但是大部分临床案例是基于经验的而非系统的研究,中高端医疗服务对特殊疾病还存在诸多问题.从中医文化价值体系入手,明确当前高端中医在临床实践中存在的问题及意义,探索新的研究方法,以及对中医临床治疗效果的评定标准,寻求高端中医在临床实践中的认同和认知,为中医传承和发展提供新的思路.

通过将国际上的包括建立传统知识保护名录和数据库的三种主要保护方法的优缺点进行对比和成功经验的回顾,以及对天津市在建立传统知识保护名录和数据库为工作目标的工作过程中所取得的实际工作成果数据加以总结和观察,可以得出以下结论:建立传统知识保护名录是一种有效的、可行的且适合我国情况的保护传统中医药传统知识的方法,值得长期深入地推广.

重症肺炎是临床常见的呼吸系统危急重症,近二十年来,尽管对抗生素研究以及肺炎的临床诊断技术取得显著进展,但肺炎的病死率并没有明显下降.流行病学调查重症社区获得性肺炎患者的病死率高达50％,重症医院获得性肺炎患者的死亡率高达70％.因此对重症肺炎进行有效防治,进一步提高本病的救治水平成为医疗中面临的重大挑战,是重症医学亟待解决的问题.近年来,很多应用中西医结合方法治疗该病的临床试验取得了较好的临床疗效,为其治疗开辟了一条新道路,值得进一步研究.本文从中西医学对重症肺炎的认识、西医常规治疗联合中医辨证分型治疗、西医常规治疗联合中药针剂治疗等几个方面对重症肺炎的中西医结合治疗现状做一总结,以为临床治疗提供依据.

Objective To comprehend the necessity of gastrointestinal decompression after operationin domestic digestive system diseases. Methods The VIP,CNKI and CBM were searched,and then the randomized controlled trials( RCT) were selected according to bringing-into and elimination,and finally data was analyzed by RevMan 4. 2. Results7 RCTs were taken,including 551 cases who quit gastrointestinal decompression early( observational group) and 559cases who took gastrointestinal decompression normally( control group). The incidence rate of throat ache in observational group was significantly lower than that in control group( P 0. 01),and the pooled OR value was 0. 08,with a95% confidence interval( 0. 03 ~ 0. 22). Meanwhile,the incidece rate of pneumonia in observational group was siganificantly lower than that in control group( P 0. 01),and the pooled OR value was 0. 27,with a 95% confidence interval( 0. 14 ~0. 52). The difference of anastomotic leak between observational group and control group was not siganificant( P 0. 05),and the pooled OR value was 0. 75,with a 95% confidence interval( 0. 23 ~2. 31). Conclusion Quiting gastrointinal decompression early can reduce the risk of throat ache and pneumonia.

目的 探讨2型糖尿病伴情绪障碍的中医证候学特征.方法 应用自拟“2型糖尿病常见中医证候辨证参考标准”,对236例伴情绪障碍的糖尿病患者进行中医辨证分型,对结果进行分析.结果 伴情绪障碍的2型糖尿病患者证候类型分布:以气滞气逆为主,呈现多脏腑气机失调的特点.结论 2型糖尿病中医证候学特征涉及多脏腑,病性特征以实证最多,虚实夹杂证次之,虚证最少；具体证型以肺气上逆证居首位,与心身疾病多数以肝立论观点有别；验证了工作假说,即心身疾病的基本证候特征是以多脏腑气机紊乱(气滞、气逆为主)和由此产生的瘀血、痰湿等合两为病.

Objective To explore the effect of Dachengqitang on intestinal endotoxemia in acute liver injured rats.Methods40 Wistar rats were randomly divided into 5 groups: normal group(group A),TAA model group(group B),treatment group of Dachengqi Decoction at low dose(group C),treatment group at moderate dose(group D),treatment group at high dose(group E).There were 8 rats in every group.The endotoxin,the levels of plasma D-lactate,TNF and ALT,TBIL were measured,intestinal content was collected for bacteriological study,liver pathology was observed.ResultsCompared with group A,the levels of endotoxin,plasma D-lactate,TNF,ALT,and TBIL in blood were significantly increased in B group(P 0.01),the rats of B group exist intestinal dysbacteriosis.Compared with B group,endotoxin,the level of plasma D-lactate,TNF,ALT,and TBIL were significantly decreased(P0.01,P0.05) in C,D,E groups.,amel intestinal dysbacteriosis were improved significantly(P 0.05).The pathological change of liver in C,D,E groups was significantly allevtiated.ConclusionDachengqitang protects rats from acute liver injury by improving intestinal dysbacteriosis and reducing the level of plasma endotoxin.

AIM: To explore the roles of nuclear factor-kappa B and its downstream factors such as tumor necrosis factor-α (TNF-α) and Bcl-2 in acute hepatic injury and their machanisms METHODS: A total of 90 male Wistar rats were randomly and averagely divided into normal group, TAA (thioacetamide) model group and PDTC (pyrrolidine dithiocarbamate) pretreated group. The rats in each group were killed 6, 24 and 48 h after induction of the model, 10 rats for each time point. Chromogenic substrate limulus amebocyte lysate method was used to examine the level of plasma endotoxin, and radioimmunoassay was performed to detect the level of plasma TNF-α Liver tissues were collected for pathological examination by immunohistochemistry, and the apoptotic index of hepatic cells was also measured. RESULTS: As compared with those in the normal group, the levels of plasma endotoxin (EU/mL) and TNF-α(μg/L) were significantly increased (endotoxin: 0.64±0.08 vs 0.23±0.02, P＜0.01; 0.96±0.14 vs 0.25±0.02, P＜0.01; 1.15±0.17 vs 0.25±0.03, P＜0.01; TNF-α: 5.97±1.07 vs 1.44±0.52, P＜0.01; 12.52±2.09 vs 1.57±0.62, P＜0.01; 10.76±1.95 vs 1.49±0.57, P＜0.01), and the activities of NF-KB and Bcl-2 in liver tissues were enhanced (NF-κB: 87.11%±8.23% vs 4.64%±1.82%, 78.55%±6.82% vs 4.58%±1.91%, 74.27%±6.26% vs 4.73%±1.89%, all P＜0.01; Bcl-2: 51.11%±4.23% vs 6.74%±3.93%, 71.59%±6.82% vs 6.68%±3.88%, 82.19%±8.54% vs 6.81%±4.14%, all P＜0.01) in the TAA group. With prolonging of TAA treatment, the apoptotic index of hepatic cells were increasing, and the pathological changes becoming notable. After the activity of NF-κB was inhibited by PDTC, the pathologcal injury was alleviated. CONCLUSION: TNF-α is activated in TAA-induced acute liver injury, and NF-κB aggravates hepatic injury by regulating its downstream gene expression.

<正>股骨粗隆周围骨折临床常见,约占全身骨折的3%～4%,临床多采用内固定治疗。动力髋(dynamic hip screw,DHS)具有滑动加压、固定牢靠、允许早期功能锻炼等优点,但如果手术适应证选择不当,手术操作失误等均会产生一些手术并发症[1]。为此笔者对1999年6月—2004年1月采用DHS内固定手术治疗股骨粗隆周围骨折78例,探讨DHS治疗股骨粗隆周围骨折失败的原因。

Objective To construct eukaryotic expression vector of RNA interference specific for Smad4,and to explore the significance of Smad4 inhibition in treatment of hepatic fibrosis.Methods Genome sequences of Smad4 gene was retrieved from Genbank and cDNA was designed coding expression of shRNA(small hairpin RNAs) for Smad4 gene.The cDNA was synthesized and inserted into psilencer3.1-H1-hygro which was a eukaryotic expression vector and identified by the restriction map and sequencing.Results The recombinant plasmid of RNA interference specific for Smad4 was identificated by the restriction map and sequencing which was completely coincided with the designs.Conclusions The siRNA eukaryotic expression vector against Smad4 mRNA has been successfully constructed.

<正>椎弓根螺钉(pedicle screw,PS)内固定技术已广泛应用于脊柱外科[1],PS置入多在C臂侧位反复透视下凭借术者经验予以完成,手术失误率较高[2]。为了提高PS置入的安全性、准确性及成功率,笔者研制了一种可调式简易腰椎椎弓根螺