《金匮要略》中"狐惑"两字从传统考据之音韵、训诂探源当为"弧蜮".《说文解字注》指出"狐"并非指狐疑之意,当为"弧"之错讹,为"蜮"的外形特征,指身体呈弧形;"惑"非为疑惑之意,当读"蜮",即江淮水滨之虫.马王堆出土文献《疗射工毒方》对"蜮"的记载突出其具有"射"的功能,符合"蜮"身体呈弧形的外形特征."狐惑"表现出的"状如伤寒""蚀于喉""蚀于阴""面目乍赤乍黑乍白"等症状与恙虫致病之"偶有畏寒,伴有剧烈头痛全身疼痛乏力,食欲不振;腋下、会阴、肛门出现无痛的庁;丘疹眼结膜的充血"等表现十分吻合.针对此"弧蜮"症状与恙虫致病,通过地下出土与现存传世文献"二重证据"相互佐证,运用训诂学方法,推理出"狐"为"弧"之错讹,"惑"与"蜮"同源,明晰"狐惑"之源流.

蛋白质的空间结构分析属于结构生物学范畴,是常用分子生物学实验技术的一种,已经广泛用于医学和生命科学研究领域.但其相关内容在医学院生物化学教学中介绍较少,未能充分体现其在科研领域的重要性.为了在教学过程中更多介绍结构生物学知识,以人民卫生出版社第九版教材《生物化学与分子生物学》中第二十四章"常用分子生物学技术的原理及其应用"第五节"蛋白质的分离、纯化与结构分析"为教学内容,从以下几个方面进行教学设计:明确教学知识、能力、课程思政目标及教学过程中的重点和难点;分析学生学习该内容时的基础知识和薄弱点并预测教学结果;确定案例分析法为核心、引入多媒体辅助教学、提问式教学法、体验式教学法等;确定教学过程中使用的教材、课件、网络资料等;明确学生自学方法,并提供相关资料;对当前教学设计实施过程中存在的不足进行反思和改进.

To investigate the development status of integrated traditional Chinese and Western medicine and people’s acceptance of it. A total of 16 medical institutions were selected from 10 provinces（municipalities directly under the Central Government） in China as the field investigation sample institutions by the stratified random sampling method,and 30 clinical experts and doctors with professional qualifications were selected as the research objects.Relevant questions were set,one-on-one interviews were conducted,and the interview reports and relevant data were summarized and analyzed. The 27 doctors agreed with the integration of traditional Chinese and Western medicine,accounting for 90% of the total;three medical practitioners,accounting for 10% of the total,oppose the integration of traditional Chinese and Western medicine. Generally speaking,the development status of integrated traditional Chinese and Western medicine is relatively good and people have a high acceptance of it,but it is still in the early stage of development. There are still differences in the acceptance of front-line medical personnel,and there are many problems to be solved. This study lists the related problems and puts forward the main solutions.

泄泻又称腹泻,是以排便次数增多,粪质稀溏或完谷不化,甚至水样便为主症的病症.缪希雍为明代医家,著有《神农本草经疏》《先醒斋医学广笔记》《本草单方》等医学著作,他在临床用药轻灵,处处顾护脾胃,认为泄泻与人体气机转运升降密切相关,临床治法以调理人体之气为主,注重安补脾胃,以恢复气机升降之和.其将泄泻病因分内外,外由风寒暑湿侵袭导致,治法包括升散实脾、以风胜湿;内由饮食劳倦不节导致,治法包括益火之源、散寒温补、补气升阳;同时注重久泻不止的辨治.深入挖掘缪希雍辨治泄泻的经验与规律,对辨析缪希雍的学术思想以及现代临床辨治泄泻有积极的意义.

目的 利用两样本孟德尔随机化方法探究211种肠道菌群与偏头痛(migraine)的因果关系.方法 采用公共数据库MiBioGen研究的肠道菌群GWAS数据(n=13 266)和芬兰数据库(The FinnGen Biobank)的偏头痛GWAS数据(n=280 567),根据预设的阈值提取与211种肠道菌群相对丰度显著相关的独立遗传位点作为工具变量(Instrumental variables,Ⅳs).主要采用逆方差加权法进行分析,根据效应指标优势比(Odds ratio,OR)和95％置信区间(Confidence interval,CI)评估结果.使用留一法、异质性检验、水平基因多效性检验来验证结果的稳定性和可靠性.结果 双歧杆菌目(Bifidobacteriales)、双歧杆菌科(Bifidobacteriaceae)、双歧杆菌属(Bifidobacterium)丰度的升高,可以降低偏头痛的患病风险,其优势比与置信区间分别为(OR=0.77,95％CI:0.70～0.83)、(OR=0.77,95％CI:0.70～0.83)和(OR=0.82,95％CI:0.74～0.91).留一法分析显示结果稳定,不存在对结果有强影响的工具变量,且可以剔除异质性和水平基因多效性对因果效应估计产生的影响.结论 双歧杆菌目、双歧杆菌科、双歧杆菌属是偏头痛发生的保护因素,随着菌群丰度的增加能够降低偏头痛的发病与临床用药,益生菌治疗偏头痛可能成为未来趋势.

目的 观察注射用益气复脉（冻干）联合尼麦角林片治疗轻度血管性认知障碍病人的临床疗效。方法 选取轻度血管性认知障碍病人60例，随机分为治疗组与对照组，每组30例。治疗组给予注射用益气复脉（冻干）联合尼麦角林片，对照组给予尼麦角林片，两组疗程均为2周。评价两组治疗前后简易精神状态检查量表（MMSE）、蒙特利尔认知评估量表（MoCA）各项分值与总分变化。结果 治疗后两组MMSE、MoCA评分均较治疗前明显改善（P＜0.05）,且治疗组除记忆力外的MMSE各项评分及除语言、抽象思维能力外的MOCA各项评分明显优于对照组（P＜0.05）。结论 注射用益气复脉（冻干）联合尼麦角林片治疗轻度血管性认知障碍病人疗效优于单独使用尼麦角林片。

对近年来采用不同方法复制的血管性痴呆动物模型进行比较分析.血管性痴呆模型的复制动物主要采用大鼠和C57BL/6品系小鼠.根据模型复制的病理机制可将血管性痴呆动物模型分为慢性脑低灌注动物模型、慢性脑低灌注混合模型、局灶性脑缺血动物模型、缺血再灌注动物模型.慢性脑低灌注动物模型的复制方法有两血管阻断法(2-VO)及改良2-VO、两血管渐进闭塞法(2VGO)、两血管狭窄法(BCAS);慢性脑低灌注混合模型的复制方法有2-VO+腹腔注射硝普钠、2-VO+尾动脉放血、2-VO+β淀粉样蛋白1-42(Aβ1-42)脑室内注射、改良2-VO+双肾双夹法(2K2C);局灶性脑缺血动物模型的复制方法有大脑中动脉梗死法(线栓法、电凝法)、多发性脑梗死栓塞法(如四氧化三铁颅外吸附法);缺血再灌注动物模型的复制方法有大脑中动脉线栓法、结扎法等.血管性痴呆动物模型因制备方法的不同,其病理组织学改变和认知功能损害程度也有所不同,研究者需根据血管性痴呆的亚型和研究目标做出相应的选择.

Objective:To investigate the salvage role of anterior serratus branch of thoracodorsal artery in breast reconstruction with pedicled latissimus dorsi myocutaneous flap.Methods:The anatomical study was conducted from September 2015 to December 2019. Four fresh adult female cadavers were dissected to measure the number, length, diameter and origin of the anterior serratus branch of the thoracodorsal artery. The clinical data of patients who underwent modified radical mastectomy and immediate breast reconstruction with pedicled latissimus dorsi myocutaneous flap from March 2015 to March 2019 were analyzed retrospectively. It was found that the thoracodorsal artery was damaged during the flap dissection and harvestion. The latissimus dorsi myocutaneous flap was harvested pedicled with the anterior serratus branch of the thoracodorsal artery as the pedicle to reconstruct the breast instead. Postoperative flap survival, breast appearance and texture, cancer recurrence and donor site were followed up.Results:A total of 11 branches of anterior serratus muscle were found in 4 specimens (8 sides), with a length of (6.3 ± 1.8) cm and a diameter of (2.4 ± 0.4) mm, including 7 from the trunk of dorsal thoracic artery, 3 from the vertical branch of dorsal thoracic artery and 1 from the horizontal branch of dorsal thoracic artery. A total of 6 female breast cancer patients aged 29-61 years, mean 42.7 years, were included in the clinical cases. The course of disease ranged from 2 to 36 months [(10.7 ± 5.4) months]. The area of secondary breast defect after modified mastectomy was 14 cm×6 cm to 16 cm×7 cm, the area of latissimus dorsi flap was 13 cm×6 cm to 17 cm×6 cm. All flaps survived thoroughly, the appearance of reconstructed breast was good. The follow-up ranged from 9 to 28 months, with an average of 13.7 months. The breast appearance and texture of all patients were satisfactory, there was no local recurrence, only linear scar was left in the donor area, and the shoulder joint activity was not affected.Conclusions:The anatomy of the anterior serratus branch of the thoracodorsal artery is constant, and the anatomical basis of communicating with the thoracodorsal artery can supply blood to the latissimus dorsi muscle. The pedicled latissimus dorsi myocutaneous flap with anterior serratus branch of thoracodorsal artery can effectively ensure the flap blood supply safety, and can be used as a salvage method for breast reconstruction in the case of thoracodorsal artery trunk injury.

易水学派医家对柴胡的药用具有独到的见解,拓宽了柴胡的应用范围.通过研究易水学派代表医家张元素、李东垣对柴胡药理、药性与应用的论述,进而突出其对本草理论的传承与发展.结果如下:张元素发扬引经报使理论,指出柴胡归手足少阳、手足厥阴四经,可引药入少阳、厥阴,强调柴胡善除少阳头痛;并完善药类法象学说,将柴胡列入"风升生"药物,认为其法象自然界风气,具有升散生发之性,可治疗脾胃疾病,启后世临证应用.其弟子李东垣倡其说,发扬"风药",明确提出:柴胡升举少阳之气,引脾胃清气上升,配伍益气药则能补脾胃不足、升下陷之气;依据内经"火郁发之"之理,结合张元素指出的柴胡善去脏腑之火的理论,对柴胡升散之性拓展运用,以柴胡发散中焦郁火;且"风药胜湿",主张在调理脾胃的同时运用风药,胜湿止泻,兼以升清,柴胡疏泄之功又可助脾运化水湿.易水学派临证使用柴胡频率高而剂量较小,以少量取效,但结合时令用药,春季使用柴胡可稍加用量.诸多临证经验皆有鉴于后世.

本文对当前高校图书馆读者服务中的情绪服务进行简要分析，主要从情绪服务最先衍生点以及基本现状作为切入点，了解目前存在的一些问题，提出针对性的措施，尤其是增添一些人性化的服务，以此转变图书馆的读者服务认知，以期提供参考。

目的 对比分析京津冀心内科医师对中西医结合诊疗指南/共识的满意度,并分析影响满意度的影响因素,为指南/共识的推广、宣传以及编写提供参考.方法 本调研检索了2016～2018年我国发布的心内科疾病中西医结合诊疗指南和共识5篇,对京津冀地区的心内科医师进行线下的自填式问卷,收集了受访医师的基本信息及其对指南/共识的使用率和满意度.结果 共收到有效问卷627份,指南总体使用率均达到甚至超过60％;所有类型受访医师对指南/共识满意度评分在43～51分间,满意度高达66.15％～78.46％.结论 大多数心内科受访医师对指南/共识的使用率和满意度较高,同时提示中西医循证证据方法学的研究以及指南/共识在西医医院和基层医院中的推广和普及工作有待加强.

晚清之际,时医用药拘于成方、泥于旧论,且对药物性味、药效、适用证多有不求甚解者.医家周学海针砭时弊,于《读医随笔》列专题为中药应用正误.本文引述原著石膏、秦艽、柴胡、牡丹皮、桔梗、石菖蒲、远志、桂枝等临床常用药物应用失当之处,分别从治法与病证两个方面进行分析,突出周学海重视药证相应,师古不泥的学术特色,为深入研究其学术思想提供依据.

Objective:To explore the classification and harvesting strategy of free lower abdominal flap.Methods:From September of 2015 to January of 2020, the data of breast cancer patients who underwent immediate or delayed breast reconstruction with free lower abdominal flap transplantation in Hu’nan Cancer Hospital and the Affiliated Hospital of Shandong University of Traditional Chinese Medicine were collected and analyzed retrospectively. According to the actual situation of perforating branch, four types of lower abdominal flap were prepared: (1) free full segment rectus abdominis flap; (2) free rectus abdominis flap with medial or lateral segment of rectus abdominis muscle; (3) free rectus abdominis flap with middle segment of rectus abdominis muscle; (4) free deep inferior epigastric artery perforator (DIEP) flap. The intraoperative conditions (flap weight, vascular pedicle length, harvesting time, etc.), appearance of reconstructed breast and complications of various lower abdominal flaps were statistically analyzed. Measurement data are expressed by Mean±SD.Results:A total of 181 patients with breast cancer were included, including 111 stage Ⅰ patients and 70 stage Ⅱ patients. The age of the patients was (38.5±4.8) years old (25-64 years old). A total of 197 free lower abdominal flaps were harvested. Twelve(6.1%) free full segment rectus abdominis flaps were harvested. The weight of the flap was (355.8±16.4) g, the average length of vascular pedicle was (5.7±0.8) cm, and the average harvesting time was (37.4±2.5) min. Forty-one (20.8%)rectus abdominis flaps with medial or lateral rectus abdominis muscle were harvested, the weight of the flap was (357.4±20.5) g, the average length of vascular pedicle was (6.9±0.6) cm, and the average harvesting time was (45.9±4.9) min. Sixty-eight(34.5%) rectus abdominis flaps with middle segment of rectus abdominis muscle were harvested, the weight of the flap was (362.6±24.7) g, the average length of vascular pedicle was (7.2±0.3) cm, the average harvesting time was (49.4±6.3) min. Seventy-six(38.6%) free deep inferior epigastric artery perforator flaps were harvested, the weight of the flap was (368.3±24.0) g, the average length of vascular pedicle was (9.8±0.4) cm, the average harvesting time was (49.7±3.1) min. Hematoma was noted in 3 cases after operation and removed by emergency operation. All the flaps survived completely. Twelve cases received fat lipofilling 6 to 24 months after operation. Patients were followed up for 14 to 60 months, with an average of 37.1 months, and no recurrence of breast cancer occurred. The reconstructed breasts had satisfactory appearance and texture without flap contracture and deformation. There was only linear scar left at the donor site, there was no significant functional deficit of the abdominal wall. Mild abdominal wall hernia occurred in one patient with full segment rectus abdominis flap and one patient with free DIEP flap, which was relieved by further strengthening the anterior sheath of rectus abdominis.Conclusions:The location, size and source of perforating vessels in the lower abdomen and the anatomic variations of vascular pedicle are complex. The safest way of flap harvest must be adopted according to the actual situation. The DIEP flap is not the only choice of free lower abdominal flap.

目的:运用文献数据挖掘方法分析云南名医吴佩衡含附子处方的用药规律.方法:通过检索《吴佩衡医案》,将含附子的处方录入中医传承辅助平台,构建处方数据库,运用关联规则分析等数据分析方法对药物使用频次、剂量与药物配伍进行分析.结果:纳入164首含附子的处方,其中包含107味药物,频次由高到低依次为:附片、甘草、干姜、肉桂、茯苓、细辛等,附子单次使用剂量10～450 g.频次分析结果显示,排前3位的药物组合为:甘草-附子、附子-干姜、附子-肉桂等;关联规则结果显示,排前3位的药物组合为附子-茯苓,附子-茯苓、干姜,附子-肉桂、干姜,附子-肉桂、干姜、甘草.《吴佩衡医案》中常用处方的核心药物与四逆汤、苓桂术甘汤、赤丸三方具有一定的相似性.结论:吴佩衡应用附子多与温补药干姜、肉桂相伍,强调脾肾阳气双补,重视健运脾阳对恢复人体阳气的重要意义,为辨治各种危急重症提供了借鉴.

思维导图又称心智导图,是一种将抽象的知识进行可视化工具,已越来越多地用于大学的课程教学.本文对预防医学专业生物化学与分子生物学课程第一章蛋白质的结构与功能中的"蛋白质的分子结构"为研究对象,将其知识点导人思维导图工具XMind制作知识树,同时附带各知识点对应的图解,制作了一种图文并茂的思维导图,结果学习效果优于传统的PPT.结论思维导图是提高教师教学质量、提升学生学习能力的有力工具.

目的:通过收集和总结文献,探讨中医、西医、中西医结合治疗慢性前列腺炎的方法,从而为进一步研究该病的治疗方法提供帮助.方法:使用计算机搜索中国学术期刊全文数据库(CNKI)、中国生物医学文献数据库(CMCC)、维普中文期刊数据库(VIP)、万方数据资源系统中国内外发表的关于治疗慢性前列腺炎的临床研究文献,整理中医、西医、中西医结合对于不同分型慢性前列腺炎的治疗方法,对中医、西医、中西医结合治疗该病的优缺点进行归纳总结.结果:共收集符合纳入标准的中医和中西医治疗慢性前列腺炎的文献133篇,排除不合格文献97篇,最终纳入36篇.最终分别总结出中医辨证论治法、内治法、外治法和中西医结合疗法4种慢性前列腺炎的治疗方法.结论:中医和西医在治疗慢性前列腺炎方面各有所长,缺点也相对明显.中医治疗和中西医结合治疗是我国特有的诊疗方法,针对慢性前列腺炎的疗效优于单纯中医治疗和西医治疗.但目前中西医结合医学还不成熟,缺乏相应的理论体系来指导中医和西医临床治疗方法的结合.

目的 观察补肾活血中药治疗脑白质疏松症轻度认知障碍(LAMCI)的临床疗效并探讨其作用机制.方法 选取2018年9月—2019年9月山东中医药大学第二附属医院神经内科门诊及住院治疗的LA病人60例,采用随机数字表法分为首乌益智方组(治疗组)、尼莫地平组(对照组),每组30例,治疗组给予首乌益智方治疗,对照组给予尼莫地平等治疗,两组均治疗12周.观察两组治疗前后形状连线测验(STT,包括STT-A和STT-B两部分)、听觉词语学习测验华山版(AVLT-H)、词语流畅性测验(VFT)、画钟测验(CDT)评分及血清超氧化物歧化酶(SOD)、丙二醛(MDA)水平变化.结果 治疗后,两组STT-A及STT-B、AVLT-H延迟回忆及延迟再认测验评分均较治疗前明显改善(P<0.05),治疗组明显优于对照组(P<0.05);两组血清MDA水平均较治疗前明显下降,SOD水平较治疗前明显升高(P<0.05),且治疗组MDA、SOD改善程度优于对照组(P<0.05).结论 补肾活血中药能够改善LAMCI病人的执行功能及记忆力,其作用机制可能与加强机体抗氧化应激能力,减弱自由基对神经细胞的损伤有关.

文章阐述了张大宁教授对中西医结合学科发展的相关观点和经验。首先,中医与西医"术业有专攻",理解并认同中医的文化属性是制约中西医结合的关键因素。其次,临床疗效是中、西医比拼的焦点,也是中西医结合的落脚点。最后,张教授提出的三维坐标诊疗模式取得了显著的疗效,体现了中西医结合的优势。张大宁教授对中西医结合的思考,根植于文化差异,落脚于临床疗效,为中国中西医结合事业的发展指明了方向。

Objective:This study aimed to explore the clinical application methods and outcomes of innervated deep inferior epigastric artery perforator (DIEP) flap for breast reconstruction.Methods:A retrospective analysis was conducted on 12 female patients with unilateral early breast cancer (clinical stage Ⅰ/Ⅱ) who were admitted from October 2015 to February 2017 in Hunan Cancer Hospital and received modified radical surgery and breast reconstruction by using the DIEP flap with sensory nerve repair (the sensory branch of intercostal nerve in the flap was coated with the third intercostal nerve). The patients' age ranged from 33 years to 52 years (mean age, 37.4±3.5 years). In all flap transplantations, the deep inferior epigastric vessels were anastomosed with internal mammary vessels or thoracodorsal vessels in the recipient sites. Each breast was subdivided into four quadrants. One central region with pressure, hot, and cold recognition was tested in every area. Each patient received a questionnaire asking for their subjective opinion about their breast shape outcome, return of sensation, erogenous sensation, and overall satisfaction.Results:The flap had a length of (32.3±0.4)cm, width of (12.7±1.6)cm, and thickness of (3.8±0.4) cm. The length of pedicle was (12.5±0.4) cm, the outer diameter of artery pedicle was (1.7±0.4)mm, and the outer diameter of venae comitant was (2.2±0.7)mm. The length of sensory branch of intercostal nerve was (2.3±0.4)cm. The recipient vessels included internal mammary vessels (seven cases) and thoracodorsal vessel (five cases). All the recipient nerves are the third intercostal nerve. All flaps were successfully implanted. In one flap donor site, fat necrosis occurred and healed with dressing treatment. No other complications were noted. The reconstructed breasts' shape, texture, and elasticity were good, and no flap contracture deformation was noted. Only linear scar was left in the donor sites, and the abdominal function was not affected. All 12 patients were followed up for 12-38 months (averaged 19.6 months) with satisfying results. No local recurrence happened. At 12 months after breast reconstruction, the neurotization of the DIEP flap resulted in the recovery of sensibility. In all 12 cases (100%) of the DIEP flaps with sensory nerve repair, at least protective sensation was present in all five segments of the breast. Responses to cold or warm stimuli were still present.Conclusions:DIEP flap neurotization using the third anterior intercostal nerve is an effective technique to increase the sensory recovery for patients undergoing breast reconstruction.

目的 调查心内科医师对2016-2018年公开发表的4部心血管疾病中西医结合临床诊疗指南和专家共识(简称"指南和共识")的熟知度和对其质量的评价,为心血管疾病中西医结合临床诊疗指南制定工作提供借鉴.方法 借助"问卷星"调查平台,于2018年12月-2019年4月以电子问卷形式调查国内心内科临床医师以自愿作答及不记名回答方式,对指南和共识的熟知度、质量、改进意见等方面进行调研.结果 回收有效问卷2186份(问卷合格率75.7％);受访者的一般特征分布较均衡,对指南和共识的熟知程度与其工作年限、最高学历、职称、就职医院等级呈正相关(P＜0.05).受访者对指南和共识质量的总体评分较高,与受访者的工作年限、最高学历、职称、第一学历专业、所属医院性质有显著相关性(P＜0.01).在对指南和共识的建议中认为应当"提高指南和共识适用性"的受访者最多,达到72.7％.结论 心内科医师对心血管疾病中西医结合临床诊疗指南和共识的总体熟知度较高,对指南和共识的总体质量较满意,但仍存在诸如指南适用性相对不足等问题需要进一步改进.