井夫杰教授推拿结合点刺四缝治疗儿童腺样体肥大经验

腺样体肥大(adenoid hypertrophy,AH)是目前儿科及耳鼻喉科常见疾病,近年来发病率逐渐攀升,其临床多表现为鼻塞、流涕、夜间睡眠打鼾、张口呼吸,严重影响患儿身心健康。本病病因及发病机制尚不明确,现代医学多使用激素联合抗组胺药物治疗,或予以腺样体切除术,然药物依赖性高、停药易复发,术后存在多种并发症等,给患儿及家庭造成沉重负担。该文详细介绍了山东省名中医、知名专家井夫杰教授诊治儿童腺样体肥大的经验。其认为本病以热、痰、瘀为标,以肺、脾、肾虚为本,将病因病机归为:(1)肺卫虚弱,邪犯藩篱;(2)脾土未壮,痰湿内生;(3)肾阴易损,虚火灼络三方面,总结出“邪实正虚分两端,三证论治需明鉴”的辨病辨证方法,在“补肺、健脾、滋肾”的基础上,配合“清热、化痰、祛瘀”等治法,通过推拿结合点刺四缝,标本兼治,攻补兼施,同时不忘顾护患儿脾胃,注重饮食调摄,其选穴及操作无不体现着齐鲁小儿推拿流派深厚的文化底蕴,同时在四缝穴的应用上又极具个人特色。

小儿推拿复式手法黄蜂入洞及黄蜂出洞探源

复式操作手法是小儿推拿特有的手法之一。但由于时代的局限性、解剖定位不精确及理论与临床发展需要等原因,历代医家总结创造的复式操作手法,术式繁多,同名异法、异法同名的现象普遍存在。其中,黄蜂入洞与黄蜂出洞最具有代表性,二者仅一字之差,然操作方法、部位截然不同,在临床应用中易被混淆。文章通过梳理总结古今文献,对黄蜂入洞与黄蜂出洞进行详细、全面介绍,以期更好地指导临床。

明清时期推拿治疗小儿便秘的选穴规律研究

目的:分析明清时期小儿推拿著作中治疗便秘选穴相关内容,探索明清时期推拿治疗小儿便秘的选穴规律。方法:对明清时期小儿推拿的代表性著作进行全文阅读,采用SATI、UCINET、NetDraw等数据挖掘软件,计算治疗便秘相关穴位的支持度、中心度,并对穴位进行可视化中心度分析。结果:11本代表性著作中,共有72条(重复40条)与便秘相关的中医处方,所采用的穴位共有49个,退六腑、分阴阳、运内八卦、推三关、补脾土、清肾水、清大肠等手法选穴使用频次最高且居于中心地位,选穴以小儿手部特定穴居多,穴位类别以通便类手法为主,临床治疗多采用泻法。结论:明清时期推拿治疗小儿便秘以小儿掌指部特定穴为主,以退六腑为君,运内八卦、分阴阳、补脾土、清肾水、清大肠为臣,推三关为反佐,且根据不同中医证候表现选用不同手法、穴位,形成了主次清晰的组方配伍关系。

艾炷灸足三里治疗脾胃虚弱型非小细胞肺癌靶向药物相关性腹泻的疗效观察

目的观察艾炷灸足三里治疗脾胃虚弱型非小细胞肺癌靶向药物相关性腹泻的临床疗效。方法将100例脾胃虚弱型非小细胞肺癌靶向药物相关性腹泻患者随机分为治疗组和对照组,每组50例。治疗组采用艾炷灸足三里治疗,对照组采用口服蒙脱石散治疗。观察两组治疗前后中医证候积分的变化,并比较两组的临床疗效。结果治疗组总有效率为88.0%,对照组总有效率为70.0%,两组比较差异具有统计学意义(P<0.05)。两组治疗后中医证候积分与同组治疗前比较,差异均具有统计学意义(P<0.05)。治疗组治疗后腹胀腹痛、肠鸣、脘腹痞满积分与对照组比较,差异无统计学意义(P>0.05),大便泄泻、食欲不振、倦怠乏力、神疲懒言及症状总积分与对照组比较,差异具有统计学意义(P<0.05)。结论艾炷灸足三里治疗脾胃虚弱型非小细胞肺癌靶向药物相关性腹泻具有较好的疗效。

基于微生物-肠-脑轴理论探讨儿童自闭症的发病及治疗进展

儿童自闭症是儿科常见的精神及行为障碍疾病,且发病率逐年增高。近年来,大量研究发现自闭症的发病与肠道微生物的失衡及肠-脑轴的异常具有密切关系。介绍微生物-肠-脑轴理论的现代研究与中医学理论基础,分析脾胃与肠道微生物及心脑的关系,并在微生物-肠-脑轴理论的基础上探讨自闭症的发病机制与治疗进展,以期为临床自闭症的治疗和研究提供新思路。参考文献41篇。

快针浅刺背俞穴治疗原发性失眠疗效观察

目的:观察快针浅刺背俞穴治疗原发性失眠的临床疗效。方法:将62例原发性失眠患者随机均分为治疗组和对照组,其中治疗组给予快针浅刺背俞穴配合常规针刺治疗,对照组给予常规针刺治疗,两组均配合耳针治疗。结果:两组治疗前匹兹堡睡眠质量指数(PSQI)量表总得分差异无统计学意义(P>0. 05),治疗后治疗组愈显率及总有效率分别为77. 42%、93. 55%,对照组愈显率及总有效率分别为58. 06%、83. 87%。两组比较治疗组疗效优于对照组,愈显率及总有效率分别提高了19. 36%、9. 68%,差异具有统计学意义(P<0. 05)。结论:快针浅刺背俞穴能明显提高常规针刺治疗原发性失眠的临床疗效,且操作简便,安全效优,对临床针灸治疗原发性失眠具有重要的参考价值。

基于数据挖掘探讨当代小儿推拿治疗疳积的选穴规律

目的:探索当代小儿推拿著作中治疗疳积的选穴规律。方法:运用数据挖掘技术,对当代小儿推拿的9本著作进行全文阅读,采用数据挖掘方法以及SATI、UCINET、NetDraw等软件,计算疳积相关穴位的支持度、中心度,并对穴位进行可视化中心度分析。结果:9本代表性著作中,共有11个与小儿疳积相关的症状描述推拿处方,涉及选穴52个,操作总频次为133次,其中推四横纹、揉外劳宫、补脾经、运内八卦等手法操作使用的频率较高,依次为90.91%、63.64%、63.64%、63.64%;取穴主要位于掌指部、前臂部、胸腹部;采用最多的手法是推法,其次是揉法、运法。结论:当代小儿推拿治疗疳积,高频操作为推四横纹、揉外劳宫、补脾经、运内八卦,其穴位均为小儿特定穴,根据手法操作的频次、支持度、中心度,形成了主次清晰的君臣佐使组方配伍关系。

井夫杰推拿治疗小儿厌食经验

总结井夫杰推拿治疗小儿厌食的临床经验。井夫杰治疗小儿厌食疗效显著,其谨守小儿厌食脾胃失健,纳化失和的病机,以推拿代药,分期论治小儿厌食,并立足整体,重视肝、肺、肾对脾胃运化的作用,灵活运用针刺、耳穴、艾灸等多种外治方法,使"杂合以治,各得其所宜",并将"标本相得"及"治未病"的思想贯穿于治疗的整个过程。

中医外治法治疗小儿支气管炎概况

小儿支气管炎的外治法主要有推拿疗法、刺血疗法、耳穴疗法、贴敷疗法、中药灌肠疗法、中药外洗疗法、经皮给药疗法、雾化吸入疗法、拔罐疗法、穴位注射疗法及综合疗法。贴敷疗法可清肺化痰、降气定喘,但容易过敏和起泡。中药外洗可使药物直接作用于皮肤,但存在过敏问题且操作较繁琐。耳穴疗法有调和气血、平衡阴阳的作用,但存在耳部揉捏时刺激较大,耳豆容易脱落,按揉刺激穴位不到位的缺点。拔罐疗法具有通络、止咳、行气、降逆等作用,但存在疼痛感较强,患儿依从性较差等问题。中药灌肠疗法具有给药量较大、保留时间较长、无创伤等优点,但存在患儿不适感较强,依从性差等问题。雾化吸入可直接作用于呼吸道和靶器官,但雾气的刺激易引起呼吸频率的改变,造成患儿憋闷等不适。穴位注射疗法可使穴位刺激的时间和强度延长,但患儿疼痛感强,依从性差。推拿疗法可调整患儿机体功能状态,协调脏腑功能,患儿依从性较高。综合疗法则依据小儿支气管炎的特点及不同疗法、不同优势,联合形成综合治疗模式,疗效较好。虽然中医外治法治疗小儿支气管炎的临床报道较多,但现有的报道多为经验总结;实验研究较少,而且由于对作用机制的研究较少,临床研究的科研设计不严谨、不完整,甚至缺乏对照组,降低了数据的可信度,疗程长短不一,缺乏统一的疗效标准、诊断标准、评价标准,不能客观、真实、系统地评价各种外治法的确切疗效。因此,完善现有资料,统一评价标准,为今后进一步客观评价中医外治法的确切疗效提供依据。

Clinical Characteristics of Children with Coronavirus Disease 2019 in Hubei, China

Since December 2019,COVID-19 has occurred unexpectedly and emerged as a health problem worldw ide.Despite the rapidly increasing number of cases in subsequent weeks,the clinical characteristics of pediatric cases are rarely described.A cross-sectional multicenter study was carried out in 10 hospitals across Hubei province.A total of 25 confirmed pediatric cases of COVID-19 were collected.The demographic data,epidemiological history,underlying discascs,clinical mani festations,laboratory and radiological data,treatments,and outcomes were analyzcd.Of 25 hospitalized patients with COVID-19,the boy to girl ratio was 1.27:1.The median age was 3 years.COVID-19 cases in children aged<3 years,3-6 years,and≥6-years patients were 10(40%),6(24%),and 9(36%),respectively.The most common symptoms at onset of ilness were fever(13[52%]),and dry cough(11[44%]).Chest CT images showed essential normal in 8 cases(33.3%),unilateral involvement of lungs in 5 cases(20.8%),and bilateral involvement in 11 cases(45.8%).Clinical diagnoses included upper respiratory tract infection(n=8),mild pneumonia(n=15),and critical cases(n=2).Two critical cases(8%)were given invasive mechanical ventilation,corticosteroids,and immunoglobulin.The symptoms in 24(96%)of 25 patients were alleviated and one patient had been discharged.It was concluded that children were susceptible to COVID-19 like adults,while the clinical presentations and outcomes were more favorable in children.However,children less than 3 years old accounted for majority cases and critical cases lied in this age group,which demanded extra attentions during home caring and hospitalization treatment.

Effects of Hypoxia on Oxidative Stress, Autophagy and Apoptosis in Cardiomyocytes

Coronary heart disease (CHD) is a hypoxia related disease. However, the relationship of the hypoxia-induced oxidative stress, autophagy and apoptosis in cardiomyocyte remains unclear. In this study, we used CoCl2 to mimic hypoxic conditions in H9c2 cardiomyocytes and study the effects of CoCl2-induced hypoxia on oxidative stress, apoptosis and autophagy, as well as the relationships among these processes. Cell viability and levels of ROS, LC3-II, p62, caspase-3 and PARP were assessed. The viability and morphology of cardiomyocytes were affected by hypoxia, and hypoxia enhanced levels of ROS and the levels of the LC3-II, p62, caspase-3 and PARP proteins in H9c2 cells in a dose-dependent manner. ROS levels rise gradually in the presence of hypoxia;however, it shrinks when hypoxia reaches a certain level. Caspase-3 and PARP levels were raised with the increasing of hypoxia level. Enhanced level of LC3 and decreased levels of p62 in hypoxic cells indicate that autophagy levels are in accord with hypoxia. Based on these results, hypoxia induces oxidative stress, apoptosis and autophagy in cardiomyocytes. Autophagy is a double-edged sword. At a low level, autophagy can resist oxidative stress and protect cardiomyocytes from oxidative stress, while high level autophagy can promote apoptosis of cardiomyocytes.

Effect of salvia miltiorrhiza injection adjuvant therapy on systemic inflammatory stress state and nerve injury degree of children with bacterial Encephalitis

Objective:To discuss the effect of salvia miltiorrhiza injection adjuvant therapy on systemic inflammatory stress state and nerve injury degree of children with bacterial meningitis. Methods: 68 cases of children with bacterial meningitis who were treated in our hospital from Feb. 2014 to Jan. 2017 were selected and were divided into control group (34 cases) and observation group (34 cases) based on random number table, and patients in both groups were treated with continuous treatment for 10 d. Differences of inflammatory mediator, oxidative stress index, nerve injury markers content in cerebrospinal fluid in both groups were compared. Results: Before treatment, differences of inflammatory mediator, oxidative stress index, nerve injury markers content in cerebrospinal fluid in both groups had no statistical significance. 10 d after treatment, inflammatory mediator IL-6, PCT, sVCAM-1, CRP content in cerebrospinal fluid of children in observation group was lower than that in control group;oxidative stress index MDA content in cerebrospinal fluid was lower than that in control group, and SOD content was higher than that in control group;nerve injury markers MBP, NSE, GFAP content in cerebrospinal fluid was lower than that in control group.Conclusion: salvia miltiorrhiza injection adjuvant therapy could effectively relieve the systemic inflammatory stress state and reduce the nerve damages of children with bacterial meningitis.

Correlation between SP-D content in cerebrospinal fluid and severity of viral encephalitis

Objective:To detect the content of SP-D in cerebrospinal fluid(CSF) of children with viral encephalitis, evaluate the correlation between SP-D and indexes of brain injury, inflammatory reaction and cellular immune disorder.Methods: 78 cases of viral encephalitis children diagnosed in our hospital during December 2016 to May 2018 were selected as Viral encephalitis group, 51 cases of fever without intracranial infection children were selected as Control group. The cerebrospinal fluid samples of two groups were taken and SP-D, brain injury-related indicators, inflammatory indicators and T lymphocyte subsets were detected. Pearson test was used to analyze the relationship between SP-D content in CSF and above indicators.Results: Content of SP-D in CSF of Viral encephalitis group was lower than that of control group (P<0.05). Contents of MBP, CK-BB, NSE and S100B in CSF of Viral encephalitis group were higher than those of Control group;contents of IL-1β, TNF-αand ICAM-1 in CSF of Viral encephalitis group were higher than those of Control group;distribution proportion of CD3+, CD4+ T lymphocytes and CD4+/CD8+ ratio in CSF were lower than those of Control group, and levels of CD8+ were higher than that of Control group (P<0.05). Correlation analysis showed that, SP-D content in CSF of viral encephalitis children was directly related to brain injury indexes, inflammatory indexes and T lymphocyte subsets distribution levels(P<0.05).Conclusion: Content of SP-D in CSF of viral encephalitis children decreases abnormally, the specific content is directly related to the degree of brain injury, intracranial inflammation and cellular immune dysfunction. It is important to evaluate the severity of the disease.

Correlation of intestinal flora disorder with systemic inflammatory response and stress response in children with severe pneumonia

Objective:To study the correlation of intestinal flora disorder with systemic inflammatory response and stress response in children with severe pneumonia.Methods: The children who were diagnosed with severe pneumonia in Xiangyang No. 1 People's Hospital between April 2014 and December 2017 were selected as the pneumonia group of the study, and the healthy children who received physical examination in Xiangyang No. 1 People's Hospital during the same period were selected as the control group. The feces was collected to determine the number of intestinal flora bifidobacteria and Escherichia coli (E. coli). Besides, the serum was collected to determine the contents of inflammatory cytokines and oxidative stress indexes, and the peripheral blood was collected to determine the expression intensity of inflammatory molecules and oxidative stress molecules.Results:The number of bifidobacteria and the level of Bifidobacterium and E. coli ratio B/E in feces as well as SOD content in serum of pneumonia group were significantly lower than those of control group whereas the number of E. coli in feces, TLR2, TLR4, NOX2, iNOS and FOXP3 expression intensity in peripheral blood as well as G-CSF, sTREM1, TNF-α, LPO and NO contents in serum were significantly higher than those of control group;Pearson correlation analysis showed that B/E level in feces of pneumonia group was negatively correlated with TLR2, TLR4, NOX2, iNOS and FOXP3 expression intensity in peripheral blood as well as G-CSF, sTREM1, TNF-α, LPO and NO contents in serum, and positively correlated with SOD content in serum.Conclusion:The intestinal flora disorder in children with severe pneumonia can aggravate the degree of systemic inflammatory response and stress response in the course of disease.

Detection of serum IgE and Eotaxin in asthma children and its clinical significance

Objective:To detect serum contents of IgE, Eotaxin and explore the relationship between serum IgE, Eotaxin and asthma severity.Methods: 140 cases of asthma children diagnosed in our hospital during January 2017 to March 2018 were chosen as Asthma group, 100 cases of healthy children vaccinated in our hospital at the same time were chosen as Normal control group. Serum contents of IgE, Eotaxin, inflammatory mediators and airway remodeling indexes were detected in two groups. Correlation analysis was used to evaluate the relationship between serum IgE, Eotaxin content and severity of asthma.Results: Serum contents of IgE and Eotaxin in Asthma group were significantly higher than those in Normal control group, and contents of IL-9, IL-17, IL-18 and IL-33 were higher than those in Normal control group, IL-35 was lower than that in Normal control group;serum contents of MMP-2, MMP-9, TGF-β and VEGF in Asthma group were significantly higher than those in Normal control group (P<0.05). Pearson test found that serum contents of IgE, Eotaxin in asthma children were positively correlated with inflammatory mediators such as IL-9, IL-17, IL-18, IL-33, negatively correlated with IL-35;positively correlated with airway remodeling indexes such as MMP-2, MMP-9, TGF-β and VEGF.Conclusion: Serum contents of IgE, Eotaxin in asthma children are significantly higher than those in normal children, and the specific contents were closely related to the degree of systemic inflammatory response and airway remodeling.

牛磺酸颗粒色素含量分析

目的:建立牛磺酸颗粒色素的HPLC测定方法,并评价不同企业生产的牛磺酸颗粒色素含量差异。方法:采用Agilentzorbax SB-C 18 (250 mm×4.6 mm,5 μm)色谱柱,以甲醇为流动相A,0.02 mol/L醋酸铵溶液为流动相B进行梯度洗脱,检测波长为426 nm和486 nm,柱温40 ℃,流速1.0 ml/min。对17家企业的70批牛磺酸颗粒样品进行检测。结果:柠檬黄在0.1~25 μg/ml浓度范围内,峰面积与浓度呈良好线性关系,线性方程为 Y=32.095 X-2.776 5(r = 0.999 9 ),加样回收率为96.42%,RSD为1.96%(n =9);日落黄在0.1~25 μg/ml浓度范围内,峰面积与浓度呈良好线性关系,线性方程 Y=21.257 X-1.665 2(r = 0.999 9),回收率为95.29%,RSD为1.88%(n =9)。不同企业间产品的柠檬黄含量差异较大,在9.5~88.3 μg/g之间;有2个企业共20批样品检出了处方标示之外的日落黄,含量约为1 μg/g。结论:本法测定牛磺酸颗粒色素含量准确性好,灵敏度高,另外目前牛磺酸颗粒色素含量差异较大,且柠檬黄辅料质量参差不齐。

双针温针灸的应用

温针灸,又名烧针灸、针柄灸,是指将针刺入穴位一定深度得气后,把艾炷或艾段固定于针柄上点燃,使艾灸产生的热力通过针体传导至穴位深部,以发挥针刺与艾灸的双重作用。笔者临床应用温针灸疗法时,发现其存在以下不足:①温针灸广泛适用于寒凝经脉和气血痹阻导致的各种寒证(实寒证、虚寒证)和痛证,但阴气偏盛及久病、虚病者,其气沉滞、运行困难,因而得气感较弱,且针感出现较慢^([1]),正如《灵枢·行针》曰:“其气沉而气往难,故数刺乃知也”;②患者在传统温针灸治疗过程中往往只感受到穴位局部及皮肤表面的热感,而感受不到热感的渗透、扩大及传导;③某些穴位进针较浅时,毫针不能承受艾炷的重量而容易发生倾斜导致艾炷脱落,烫伤患者皮肤或引起床单、衣服的燃烧;④艾炷或艾段燃烧时,其温度可达约550℃,甚至高达800℃^([2]),而某些穴位进针较深时,艾炷与穴位部皮肤距离较近,极易造成皮肤烫伤或皮肤坏死^([3])。

齐鲁小儿推拿诊疗特色撷要

以三字经小儿推拿流派、张汉臣小儿推拿流派、孙重三小儿推拿流派为代表的齐鲁小儿推拿历史悠久,底蕴深厚,风格独特,学术特点突出,在小儿推拿领域具有重要的地位。通过查阅相关文献,从诊法、辨证、取穴、手法施术、保健、治未病等多个方面对齐鲁小儿推拿特色进行梳理总结,使之系统化、理论化,以期为小儿推拿临床诊疗提供参考,更好地推动流派学术思想的传承和中医药事业的发展。

A new maximum-likelihood phase estimation method for X-ray pulsar signals

X-ray pulsar navigation(XPNAV) is an attractive method for autonomous navigation of deep space in the future. Currently, techniques for estimating the phase of X-ray pulsar radiation involve the maximization of the general non-convex object functions based on the average profile from the epoch folding method. This results in the suppression of useful information and highly complex computation. In this paper, a new maximum likelihood(ML) phase estimation method that directly utilizes the measured time of arrivals(TOAs) is presented. The X-ray pulsar radiation will be treated as a cyclo-stationary process and the TOAs of the photons in a period will be redefined as a new process, whose probability distribution function is the normalized standard profile of the pulsar. We demonstrate that the new process is equivalent to the generally used Poisson model. Then, the phase estimation problem is recast as a cyclic shift parameter estimation under the ML estimation, and we also put forward a parallel ML estimation method to improve the ML solution. Numerical simulation results show that the estimator described here presents a higher precision and reduces the computational complexity compared with currently used estimators.

情感交叉擦腿综合征案

患儿,女,3岁5个月。初诊日期:2019年10月20日。家长代诉:夹腿、摩擦阴部1月余,加重1周。现病史:1月余前睡前偶出现双腿交叉,不断用力夹紧扭动摩擦阴部,伴有面色潮红,汗出,持续2~3 min后可自行缓解,或转移注意力可使其停止,未接受治疗。近1周发作次数增多至每日3~5次,尤以睡前、醒后起床前为甚,阻止则哭闹不止。刻下症:发育正常,精神可,面色红,平素脾气急躁,爱哭闹,眠欠安,常夜啼,喜甜食,大便干,小便短赤;舌红、少苔,脉弦数,指纹紫滞。查体:外阴轻度充血。实验室检查:尿培养无致病菌,尿常规、粪便常规、脑电图检查未见异常。西医诊断:情感交叉擦腿综合征;中医无相关病名,证型诊断:心肝火旺证。治则:清心平肝泻火,佐以滋肾健脾。