BACKGROUND:Aberrant activation of the phosphatidlinositol 3-kinase (PI3K)/protein kinase B (AKT)/mammalian target of rapamycin (mTOR) signaling pathway has been shown to play an important role in lung adenocarcinoma (LUAD). The effect of KRAS mutations, one of the important signatures of LUAD, on the PI3K/AKT/mTOR pathway in LUAD remains unclear. METHODS:The Seurat package and principal component analysis were used for cell categorization of single-cell RNA sequencing data of LUAD. The AUCell score was used to assess the activity of the PI3K/AKT/mTOR pathway. Meanwhile, using the gene expression profiles and mutation profiles in the The Cancer Genome Atlas dataset, LUAD patients were categorized into KRAS-mutant (KRAS-MT) and KRAS-wild-types (KRAS-WT), and the corresponding enrichment scores were calculated using gene set enrichment analysis analysis. Finally, the subpopulation of cells with the highest pathway activity was identified, the copy number variation profile of this subpopulation was inscribed using the inferCNV package and the CMap database was utilized to make predictions for drugs targeting this subpopulation. RESULTS:There is higher PI3K/AKT/mTOR pathway activity in LUAD epithelial cells with KRAS mutations, and high expression of KRAS, PIK3CA, AKT1 and PDPK1. In particular, we found significantly higher levels of pathway activity and associated gene expression in KRAS-MT than in KRAS-WT. We identified the highest pathway activity on a subpopulation of GRB2+ epithelial cells and the presence of amplified genes within its pathway. Finally, drugs were able to target GRB2+ epithelial cell subpopulations, such as wortmannin, palbociclib and angiogenesis inhibitor. CONCLUSIONS:The present study provides a basic theory for the activation of the PI3K/AKT/mTOR signaling pathway as a result of KRAS mutations.

目的 探索案例教学(CBL)模式结合小组合作式学习(TBL)模式在中医药循证医学课程的系统评价章节应用的教学效果,为将该教学模式应用于循证医学教学全过程奠定基础.方法 选择2022年4月—2022年6月辽宁中医药大学参加中医药循证医学课程系统评价章节学习的一至三年级的60例本科生作为研究对象,采用随机数表法分为试验组和对照组,每组30例.对照组运用以授课为基础的传统教学(LBL)模式,试验组在此基础上应用CBL结合TBL的教学模式.比较两组学生随堂测试成绩和问卷调查结果.结果 试验组的随堂测试成绩高于对照

目的 基于《黄帝内经》"不荣则痛"理论探讨类风湿关节炎(rheumatoid arthritis,RA)气阴两虚证的基本病机,并通过临床观察明确益气养阴通络方干预的有效性与安全性.方法 120例类风湿关节炎气阴两虚证患者随机分配至试验组或对照组,每组60例.对照组接受益气养阴通络方模拟剂联合甲氨蝶呤,试验组接受益气养阴通络方联合甲氨蝶呤,干预12周.观察指标:美国风湿病学会类风湿关节炎20%、50%、70%改善率标准(ACR20/50/70),症状体征评价,28个关节疾病活动度(DAS28)评分,目测模拟标尺法(VAS)评分,健康状况评估(HAQ)评分,血沉(ESR),C反应蛋白(CRP),中医总有效率评价,中医证候总分,中医证候单项评分及安全性评价.根据试验结果,以"不荣则痛"立论,探讨益气养阴通络方干预RA的意义.结果 临床疗效评价:试验组达到ACR20/50/70改善标准的比例高于对照组(P<0.05),与对照组相比,试验组治疗12周的关节压痛数、肿胀数、晨僵时间改善明显(P<0.05),DAS28评分、VAS评分有所下降(P<0.05),HAQ评分明显降低(P<0.01),ESR、CRP水平均明显下降(P<0.01).中医证候疗效评价:试验组治疗12周的中医证候总有效率明显高于对照组(P<0.01),与对照组相比,试验组治疗12周证候总分明显下降(P<0.01),单项评分(关节肿大、肌肉酸痛、气短乏力、自汗、口干、眼干、盗汗、手足心热)有所下降(P<0.05).安全性评价:试验组不良反应发生率和例次未显著低于对照组(P>0.05).结论 基于"不荣则痛"理论探讨痹证气阴两虚证的关键病机,通过试验,明确了本方可明显提高RA气阴两虚证患者临床治疗达标率,中医证候疗效,控制疾病活动度,改善疾病症状体征和生存质量,且安全性良好.

PD-1抑制剂相关性肺炎是肿瘤内科常见的免疫治疗相关性不良反应.本文从营卫学说角度探讨PD-1抑制剂相关性肺炎的诊治,认为本病源于PD-1抑制剂的热毒之邪,热伤肺络、痰瘀内阻、脾失健运是其核心病机.辨证过程中应着重辨痰饮、查津液、审营卫、分虚实,基本治则以益气养阴、培土生金为基础,合以散热、化痰、祛疲、行气等随证治之,注重培护营卫.调护饮食、睡眠及精神情志也是治疗PD-1抑制剂相关性肺炎不可或缺的部分.

Confused understanding of Bi syndrome and flaccidity disease often occurred in medical books before Eastern Han Dynasty. While the two diseases were not expounded respectively, until the formation of Huangdi Neijing. This paper sorts out the expositions of Bi syndrome and flaccidity disease in Huangdi Neijing to explore their differences in connotation, causes, pathological mechanism, classifications, symptoms, treatment and prognosis. The author thinks that Bi syndrome is different from flaccidity disease, and prolonged Bi syndrome may consequently lead to flaccidity disease. Therefore, the treatment of Bi syndrome and flaccidity disease should be based on proper differentiation. Bi syndrome and flaccidity disease can be manifested in different stages of a disease. Deficiency and heavy sensation indicate flaccidity, while excess and heavy sensation indicate Bi syndrome. In the treatment of Bi syndrome, apart from identifying its patterns, doctors should also pay attention to the tendency of Bi syndrome turning into flaccidity disease. Therefore, when the treatment of Bi syndrome fails to reach favorable effect, doctors should reconsider treating flaccidity disease instead to improve the efficacy.

INTRODUCTION:Quitting smoking, the critical path to reach the global targets of reducing tobacco use, can bring major and immediate health benefits to smokers. Exploring factors that help individuals to quit smoking is of great importance. The present study explored influencing factors on smoking cessation, in order to provide comprehensive reference for tobacco control policies.METHODS:Ex-smokers and current smokers were recruited online in this cross-sectional survey, from 1 October to 31 November 2022, in China. The observational data were collected using a questionnaire to collect information with respect to sociodemographic characteristics of smokers, attitudes towards smoking cessation, details of smoking cessation, and different potential factors related to smoking cessation through open-ended questions.RESULTS:A total of 638 smokers from 30 provinces were recruited as eligible respondents, with a mean age of 37.3 ± 11.7 years and a mean smoking history of 15.9 ± 13.7 years. The percentage of males was 92.3%. Of the 638 respondents, only 3.9% had no intention to stop smoking. Among 155 subjects who had quitted smoking successfully, willpower (55.5%) was considered as the most important contributing factor. Among 365 subjects who tried to quit but failed, lack of willpower (28.2%), tobacco dependence (16.2%), influence of surrounding smokers or smoking environments (15.9%), bad moods (9.9%), stress from work or life (7.9%), habits (7.1%), socialization (4.1%), and easy availability of tobacco (2.7%) were considered as the adverse factors leading to failure in quitting smoking.CONCLUSIONS:Willpower and support from family members were the vital factors that lead to successful smoking cessation. Future tobacco control policies should also focus on addressing withdrawal symptoms and creating smoke-free environments as well as other factors.

目的 基于《黄帝内经》五运六气理论及现代气象学客观指标,分析冠心病发病与气象因素的相关性.方法 回顾性分析2016 年1 月20 日至2021 年1 月19 日长春地区冠心病逐日入院1 080 例资料与同期逐日气象资料.将纳入研究的冠心病住院患者住院日期转换为干支纪年,根据相应的六气时段归纳整理,对冠心病在不同岁运年、不同六气时段及不同客气时段发病率进行描述分析,采用Logistic回归分析影响冠心病发病的因素,采用Spearman等级相关法分析冠心病与同期气象因素相关性.结果 冠心病患者发病率由高至低按岁运年分布依次为:金运太过之岁＞土运不及之岁＞水运太过之岁＞火运太过之岁＞木运不及之岁;冠心病患者在六气主气各时段发病率由高至低分布依次为:终之气＞初之气＞二之气＞五之气＞四之气＞三之气;冠心病患者在不同客气发病率由高至低分布依次为:阳明燥金＞少阳相火＞厥阴风木＞少阴君火＞太阳寒水＞太阴湿土.将冠心病在各岁运年及六气主气发病规律进行Logistic回归分析,结果显示:岁运的金运太过之岁、六气主气的终之气与冠心病发病率存在密切联系(P＜0.05).将冠心病发病在六气中分布及对应气象数据Spearman相关分析结果显示:冠心病发病数与平均气温及平均降水量呈显著负相关(P＜0.05).结论 吉林省长春地区冠心病发病与五运六气气候变化及气象因素相关,临床防治需关注金运太过之岁及主气的终之气即小雪至大寒时段的寒燥天气对冠心病的影响.

文章通过理论研究发现营卫的原始含义是循环之血气,古人为了解释人体气血生化的问题,赋予了"营卫"津液之气,也即血气前身的含义;为了解释人体生理功能和病因病机,古人赋予了"营"以"荣"的意义,从而获得血气的营养功能,又赋予了"卫"卫外固表之功,从与经脉之营伴行的固定模式和路径中拓展开来,承担了阳气、正气的重任;为了更好地将营卫理论用于临床针刺,古人又赋予了营卫表里深浅的含义.理清营卫概念的内涵及其发展有助于中医理论的发展.

该文运用文献学研究手段,考察与梳理《黄帝内经》中的腧穴条文,分析与挖掘腧穴理论.该文认为腧穴并非静态性的,从生理层面上,腧穴对于全身气血具有输注出入的特性,对于人体结构具有内通外联的特性;在病理状态下,不同个体及不同病证的腧穴具有特异性、差异化的表达.腧穴具有结构性、立体性、循经性、调节性、开放性、动态性等特点.针对这些穴位特性,临床取穴施术应注重按压探查,揣定穴位,重视"治神"与"调气",把握医患双方的"神"与"机".

芍药首载于《神农本草经》.张仲景对药物的应用多与《本经》所载功效主治符合.搜集《伤寒论》与《金匮要略》两书中明确提及芍药"去""减"与"加"变化的条文并进行分析,结合注家观点与现代医家研究得出张仲景应用芍药几点法则.首先,芍药应用病位在"腹"不在"胸",主症在"痛"不在"满".其次,芍药影响排便.大便下利、脾胃虚弱者,芍药减量;大便下利,脾胃虚寒者,当去芍药.经验与药理亦证实,芍药有通利大便的作用,最后芍药能够通利小便.治疗水气病病位在膀胱、在里、在下,用桂枝汤去桂留芍加茯苓白术,走里、下行,导水从小便而走;病位在表、在上者,桂枝汤去芍留桂加麻辛附子,取发汗散水之法.

衰老是正常生命活动的自然规律,是随着年龄增长,人体的组织结构、生理功能等发生退行性改变且不可逆转的生命现象.《内经》载"五七,阳明脉衰,面始焦,发始堕……六七,三阳脉衰于上,面皆焦,发始白……"衰老与中医脏腑经络关系密切,"阳明脉衰"或是衰老的始动因素.针灸美颜抗衰可以调补阳明、平衡气血,治经与调腑相结合,有效控制和延缓衰老的进程,具有"年既老而不衰","防衰老于未然"的独特优势.基于"阳明脉衰"理论,试从衰老发病年龄、致衰因素、临床表现、经脉循行、防治养生等方面,探讨衰老与中医脏腑经络之间的联系,以期指导针灸处方用穴,为针灸临床美颜抗衰提供新思路.

基于《黄帝内经》中"结"病机的论述,探讨"结"病机在积聚类疾病中的演化规律,有益于当今临床中多见的肺结节、乳腺结节、甲状腺结节等疾病的防治及其良恶性转化的干预.文章通过对《黄帝内经》及相关古籍中"结"病机内容的整理,并结合现代研究,总结"结"病机在积聚类疾病中的演化规律."结"病机见于《黄帝内经》,为邪气与有形之物相结聚,而致气滞血瘀痰凝阻滞不通."结"病机的实质为邪气与脏腑经络气血胶着难解的病理状态."结"病机是积聚类疾病发生发展的枢机."结"病机在积聚类疾病中的演化规律:"气结"为积聚之始,"气结"致"瘀结""痰结","气结"与"瘀结""痰结"相互交结难解,日久而化生"毒结",而终致气、血、痰、瘀、毒相互胶结难解之积聚.

蒙医学专业是具有悠久历史传统和独特理论、技术方法的民族特色医药专业,虽在长久的学科发展过程中逐步形成了较为成熟的教育教学体系,但当前蒙医学高等教育存在载体明显不足、人才培养模式缺乏创新性等问题,一定程度上阻碍了蒙医学专业的长足发展.此文从生源情况、民族医药培养目标、课程建设、教学组织、职业规划等方面,分析当前我国普通高校蒙医学本科专业建设及发展现状,旨在为促进蒙医学本科专业发展、提升民族医药高等教育人才质量提供参考依据.

《黄帝内经》(以下简称《内经》)中蕴含丰富的时间医学思想和发病学观点,其是在中医"时序"观以及"天人合一"思想的指导下,从整体层面上研究宇宙与人体生命活动的周期性及其关联性.文章整理总结《内经》中时序发病观的相关内容,从时序的概念与内涵、失于时序与发病的关系、时序与《内经》不同发病观之间的联系、时序发病观的临床应用4个方面论述《内经》"天人合一"思想下的时序发病观,以期能够更好地理解中医经典中的理论内涵,探索生命现象的节律性,为临床诊疗以及养生防病提供指导价值.

目的 探寻苦参的潜在功用.方法 在历代本草文献学中挖掘苦参的功用及治疗病证;再通过利用《普济方》数据库管理系统,对苦参古方治疗病证进行归纳总结,并统计治疗病证的古方频数,推测苦参的功用主治;再结合2020版《中华人民共和国药典》(以下简称《药典》)所收录苦参的功效主治,比较古今差异,对差异部分,提供现代实验研究及临床应用研究佐证,推测苦参的潜在功用.结果 由历代本草文献及含苦参古方所提炼而来苦参基本功效主治与《药典》所收录相一致,而在本草学中所挖掘的散结、止痛、泻火生津、泻火安神、明目、补益脏腑等功效及含苦参古方治疗消渴、痛证、眼疾、瘰疬、积聚、狂证、齿病、痉证等病证《药典》尚未收录.现代研究能够为散结、止痛、泻火生津、泻火安神、明目提供佐证,进而证明散结,止痛,泻火生津,泻火安神,明目是苦参的潜在功用.

《内经》设立专篇论述咳病,提出咳病皆"聚于胃,关于肺",为后世医家从肺胃两脏论治咳喘病提供了理论基础.总结《内经》各时期注家对"聚胃关肺"注释,探讨"聚于胃,关于肺"文义.吴昆、张志聪、姚止庵、滑寿等认为"聚胃关肺"是针对"三焦咳"而言,张介宾、高士宗、马莳、汪昂、丹波元简等则认为"聚胃关肺"承接上文,是概括五脏六腑之咳而言,多数注家都强调了肺胃两脏腑在人体生理活动与病变过程中发挥重要作用.在肺与胃的关系上,《黄帝内经》原文多处论述肺胃经脉相连、生化相关,从解剖学上看,肺胃道路相通,从中医基础理论的气机升降、五行生克制化上也关系密切,从而病理上相互影响,导致咳病发生.最后,从《内经》原文出发,联系后世医家著作,从内外合邪、阳明经腑热盛、阳明水饮上逆及肺胃阴伤四方面,论述肺胃两脏病理上相互影响导致咳病的病证分型、方药筛选,列举相关方药治疗肺系疾病的现代动物实验与临床试验研究,以期为临床辨证选方提供佐证.

近年来,临床中肺结节、乳腺结节、甲状腺结节等疾病逐年增多,为更深入认识这些疾病的本质以便为其治疗提供理论依据,本文对《黄帝内经》中"积""聚""结"原文进行了疏理与辨析,总结"积""聚""结"的内涵.作为动词,"聚""结""积"意义相近但程度不同,"聚气可布""结而不通""宿昔而成积";"结"为可见的有形包块;"积""聚"为难治性疾病,"聚"可发展成"积";"结""聚""积"有一个共同的"结"病机,都是由气血痰水等邪气交结而成,现代的肺结节、甲状腺结节、乳腺结节、胃肠息肉等属于"积聚"范畴,无论是良性、恶性、是否为癌前病变,都可以通过"结"病机进行干预治疗.

芍药首载于《神农本草经》,广泛应用于《伤寒杂病论》,《本草经集注》首次提到芍药的赤白之分.主流本草著作多认为芍药是平或微寒之品,药味记载以酸、苦两味为主.至于经方中应用芍药是赤芍还是白芍,历代医家见解不一.作者基于临床实践,发现芍药甘草汤止咳平喘作用明显.文章遂以此为例,从《黄帝内经》药性理论出发,探讨芍药的药味及芍药甘草汤中所用芍药是赤芍还是白芍,并追溯古代文献,结合现代实验研究,分析芍药及芍药甘草汤止咳平喘作用的理论根据.依据《内经》药性理论及文献记载,如果用芍药甘草汤治疗"脚挛急",选用赤芍或白芍均有一定道理:从五味功效、五行系统归属方面来看,芍药甘草汤中的芍药应为酸味、收敛缓急,选用白芍为宜;从升降浮沉理论分析,芍药甘草汤中的芍药应为苦味、走泄活血,选用赤芍为宜.如果拓展芍药甘草汤应用,用以治疗咳喘、疼痛类疾病,取其止咳、止痛、缓解挛急等作用,则选用白芍配伍为佳.

骨伤科疾病多为皮、肉、筋、骨等浅表部位损伤,无论是急性损伤还是慢性劳损,外治方法可直达病所,能有效缓解局部症状.《黄帝内经》(后文简称《内经》)中有关外治法的论述较多,部分与骨伤科疾病的治疗相关.该文从药物外治、器械外治和手法外治出发,对《内经》中关于外治法的理论渊源、作用机制、方法细则等方面进行梳理,并结合后世医家的古籍文献和实践经验,对外治法的临床应用予以深入剖析,以期更好的为骨伤科临床服务.

"手"是人体四肢部位的核心概念,"手"相关术语是人体术语的重要组成部分.本研究在术语学视角下,检讨《黄帝内经》中与"手"相关的术语,选取"腕骨"等17个术语加以考辨.部分术语仍属于专业术语,保留在中医学专业词汇中,可归入"纯术语"中,如"锐骨""本节"等.部分则进入普通词汇,已经渗透到人们的生活中,逐渐和一般词汇相融合,成为"一般术语"或"准术语",如"鱼际""小指"等.研究肢体类术语可以丰富人体术语系统,为准确地描写和阐释中医术语提供借鉴,同时对大型辞书编纂和中医标准化系统建设提供用例补充.