目的:观察在常规疾病管理基础上加用耳穴贴压联合呼吸功能训练治疗稳定期慢性阻塞性肺疾病(COPD)的临床疗效.方法:选取84例稳定期COPD患者,以简单随机法分成对照组和耳穴贴压组各42例.2组均进行常规疾病管理,对照组开展呼吸功能训练,耳穴贴压组在对照组基础上给予耳穴贴压干预,2组均治疗8周.比较2组治疗前后咳嗽积分、肺功能指标[6min步行试验(6MWT)、第1秒用力呼气容积占预计值百分比(FEV1％pred)、第1秒用力呼气容积/用力肺活量(FEV1/FVC)]及圣乔治呼吸问卷(SGRQ)评分.结果:治疗后,2组日间、夜间咳嗽积分均较治疗前降低(P＜0.05),耳穴贴压组日间、夜间咳嗽积分均低于对照组(P＜0.05).治疗后,2组6MWT值均较治疗前增加(P＜0.05),耳穴贴压组6MWT值大于对照组(P＜0.05);2 组 FEV1％pred、FEV1/FVC 均较治疗前升高(P＜0.05),耳穴贴压组 FEV1％pred、FEV1/FVC均高于对照组.治疗后,2组SGRQ评分均较治疗前降低(P＜0.05),耳穴贴压组SGRQ评分低于对照组(P＜0.05).结论:在常规疾病管理基础上加用耳穴贴压联合呼吸功能训练可有效缓解稳定期COPD患者的咳嗽症状,改善其肺功能和提高生活质量.

尿毒症性皮肤瘙痒症是尿毒症常见的并发症之一,主要表现为患者全身或局部不同程度的皮肤瘙痒,偶见皮疹,发作时间长短不一.在维持性血液透析患者中,尿毒症性皮肤瘙痒症的发病率可达70％以上,其中超过40％的患者会遭受不同程度的瘙痒困扰.

目的 探究简化"六字诀"联合体外膈肌起搏在慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)稳定期患者肺康复治疗中的应用效果.方法 选取2017年7月-2019年6月浙江中医药大学附属第三医院收治的120例COPD稳定期患者,按照随机数字表法分为4组,A组给予基础治疗,B组在A组基础上给予简化"六字诀"功法训练,C组在A组基础上给予体外膈肌起搏干预,D组在A组基础上给予简化"六字诀"功法训练联合体外膈肌起搏干预,每组30例,各组干预周期均为3个月.对比4组患者中医证候积分、BODE指数、生活质量、半年内急性加重次数.结果 干预后,4组患者中医证候积分[(6.82±1.57)分、(5.26±1.34)分、(5.63 ±1.28)分、(4.52±1.15)分]、生活质量各维度评分及总分[(44.21±9.07)分、(37.91 ±8.65)分、(39.92±7.83)分、(32.42±8.26)分]、半年内急性加重次数[(4.25±1.26)次、(3.32±0.87)次、(3.86±1.03)次、(2.62±0.79)次]等指标均较干预前降低,D组明显低于A、B、C组,差异有统计学意义(P＜0.05);干预后4组BODE指数均较干预前下降,D组BODE指数[(4.21±1.04)分]均低于A、B、C组[(5.32±1.67)分、(4.84±1.40)分、(5.23±1.35)分],与A、C组比较差异有统计学意义(均P＜0.05).结论 简化"六字诀"联合体外膈肌起搏用于COPD稳定期患者肺康复治疗中可有效缓解患者临床症状,增强肺功能,减少急性发作次数,降低BODE指数,提升生活质量.

尿毒症性皮肤瘙痒症是终末期肾脏病常见并发症,中医药对其治疗疗效显著.陈明教授基于尿毒症性皮肤瘙痒症之"肾燥"病机,认为"辛以润燥"是尿毒症性皮肤瘙痒的重要治法,通过辨证组方、灵活应用辛润中药,临床获益颇丰.本文通过系统阐述辛润药治疗尿毒症性皮肤瘙痒的理论内涵,以期为中医药治疗尿毒症性皮肤瘙痒症提供新思路.

目的 探讨和解抗敏煎对呼吸道合胞病毒(respiratory syncytial virus,RSV)感染诱发哮喘小鼠TLR3及NF-κB/IRF3信号通路的调控作用.方法 将BALB/c小鼠随机分为对照组,模型组,地塞米松组(0.5mg·kg-1),和解抗敏煎低、中、高剂量组(17.5,35.0,70.0g·kg-1),每组10只.RSV诱发合并卵白蛋白致敏建立哮喘小鼠模型.末次激发后24h,乙酰甲胆碱吸入测定气道相对阻力;麻醉小鼠,制备肺泡灌洗液,检测炎症细胞数(巨噬细胞、嗜酸性粒细胞、淋巴细胞、中性粒细胞)和IgE、CD31、IL-4,TNF-α、MPO含量.取肺组织石蜡包埋切片行HE染色观察肺组织炎症浸润,免疫组化染色观察TLR3表达.qRT-PCR检测肺组织TLR3、NF-κB、IRF3 mRNA的表达.结果 与模型组相比,和解抗敏煎各剂量组能有效降低哮喘小鼠气道高反应性,改善肺组织损伤和炎症细胞浸润,降低肺泡灌洗液中巨噬细胞、嗜酸性粒细胞、淋巴细胞、中性粒细胞数量和IgE、CD31、IL-4、TNF-α、MPO的含量,并有效降低肺组织TLR3、NF-κB、IRF3的表达.结论 和解抗敏煎对病毒诱发的支气管哮喘具有治疗效果,且可能与介导TLR3及NF-κB/IRF3信号通路有关.

目的 分析浙江地区小儿性早熟的病因及证候分布.方法 采用调查表临床研究的方法共调查儿童192例,经Spearman检验对调查问卷进行统计分析.结果 性早熟的患儿中女童占95.8％,男童占4.2％.性早熟的发病情况与食用牛初乳、蜂皇浆、蚕蛹等有相关性;与父母青春期发育情况、患儿出生时情况、饮食习惯、生活习惯等多种因素无相关性.186例性早熟儿童中136例属于肾虚火旺型(占73.12％),36例为肝经郁热型(占19.35％),14例为痰湿阻滞型(占7.53％).结论 性早熟以女童多见,病因学分析显示本病发病与使用牛初乳、蜂皇浆、蚕蛹等有相关性,临床中以肾虚火旺型为常见.

[Objective] To study TCM clinical passage of children sexual pecocity.[Method] Take multi-center and big sample clinical research,and integrated differentiation and treatment based on sign identification,make discussion on diagnosis and treatment of children sexual precocity.[Result] There're 50 cases in all,they take TCM decoctions for treatment,the clinical control rate is 68.00%,the improvement rate 20.00%,the course satisfying degree 88.00%,effect satisfying degree 86.00%,acceptance degree 98.00%,the diagnosis and treatment service satisfying degree 98.00%,the aspects above all get parents' affirmation.[Conclusion] TCM treating children sexual precocity is available and operationable.

Objective To establish a rabbit model wiht dry eye syndrome caused by sex hormones decline in peri-menopause,in order to create the conditions for further study of the pathogenesis and experiment of the dry eye syndrome.Methods 12 adult female rabbits were divided into blank control group(A) and model group(B) in which the double oothectomy were operated,all the rabbits were fed for 45 days.The basic tear secretion and the tear film break-up time were measured to observe the changes in tear film stability with Schirmer test and then all of them were killed to detect in morphology with light microscopy,electron microscopy and immunohistochemistry.Results The measured value in B in Schirmer Ⅰ test was significantly lower than that in A and the tear film break-up time was significantly shorter in B than that in A(P0.01);in the lacrimal gland ducts and acinar epithelial cells,expressions of the positive cellsIL-1β,TNF-α,Fas,FasL and Bax in B were significantly higher than that in A(P0.01);there was no TGF-β1 and bcl-2 significant expression in B compared with A(P0.05);and the damage was obvious in B with electron microscope.Conclusion The models,created firstly,can simulate a complete dry eye syndrome the natural pathological process in peri-menopause,which can provide a ideal animal model of dry eye syndrome for the experimental study.