从《医方论》看费伯雄学术思想

费伯雄强调辨证论治,反对滥用方药,无论是察脉辨证,还是立法制方,都是以醇正和缓为基础的。其学术成就同他的醇正和缓思想是紧密地联系在一起的,无论是察脉辨证,还是立法制方,都是以醇正和缓为基础的。他主张医学诊治戒偏戒杂,要"醇正""和治""缓治",以平淡之法而获奇效,不尚矜奇炫耀。

Long-term results of pneumatic dilation for achalasia: A15 years' experience

AIM： Although most patients with achalasia respond to pneumatic dilation, one-third experienced recurrence, and prolonged follow-up studies on parameters associated with various outcomes are scanty. In this retrospective study, we reported a 15-years＇ experience with pneumatic dilation treatment in patients with primary achalasia, and determined whether previously described predictors of outcome remain significant after endoscopic dilation. METHODS： Between September 1989 and September 2004, 39 consecutive patients with primary symptomatic achalasia （diagnosed by clinical presentation, esophagoscopy, barium esophagogram, and manometry） who received balloon dilation were followed up at regular intervals in person or by phone interview. Remission was assessed by a structured interview and a previous symptoms score. The median dysphagia-free duration was calculated by Kaplan-Meier analysis. RESULTS： Symptoms were dysphagia （n = 39, 100%）, regurgitation （n = 23, 58.7%）, chest pain （n = 4, 10.2%）, and weight loss （n = 26, 66.6%）. A total of 74 dilations were performed in 39 patients; 13 patients （28%） underwent a single dilation, 17 patients （48.7%） required a second procedure within a median of 26.7 mo （range 5-97mo）, and 9 patients （23.3%） underwent a third procedure within a median of 47.8 mo （range 37-120 mo）. Post-dilation lower esophageal sphincter （LES） pressure, assessed in 35 patients, has decreased from a baseline of 35.8±10.4- 10.0±7.1 mmHg after the procedure. The median follow-up period was 9.3 years （range 0.5-15 years）. The dysphagia- free duration by Kaplan-Neier analysis was 78%, 61% and 58.3% after 5, 10 and 15 years respectively. CONCLUSION： Balloon dilation is a safe and effective treatment for primary achalasia. Post-dilation LES pressure estimation may be useful in assessing response. 2005 The W.IG Press and Elsevier Inc. All rights reserved.

A systematic review and meta-analysis of the Chinese literature for the treatment of achalasia

AIM: To evaluate the effect of different approaches in the treatment of achalasia in China. METHODS: We performed a systematic review and meta-analysis of Chinese literature by searching the Chinese Biomedical Database and Chinese scientific Journals database (up to March 2008). All cohort studies (controlled or uncontrolled) in which the patients were observed for more than a year were reviewed in detail. Dichotomous outcomes were reported as relative risks (RR) with 95% confidence interval (CI) for controlled trials. The efficacy in uncontrolled trials was assessed by a pooled estimate of response rate with individual studies weighted in proportion to the sample size. RESULTS: Seven controlled trials compared the effect of botulinum toxin injection (BoTx) with pneumatic dilation (PD). PD was superior to BoTx [65.2% vs 45.3%; RR 1.47 (95% CI 1.23-1.77), P < 0.0001], and had a lower clinical relapse rate (BoTx 30.2% vs PD 10%, RR 0.32 (0.16-0.65), P = 0.001). Heller myotomy (HM) had superior remission rate compared to PD [HM 94.0% vs PD 64.1%, RR 1.48 (1.15-1.99), P = 0.002]. In uncontrolled trials, the effectiveness of PD was 86.6% (23.9%) vs 94.8% (10.6%) for HM. The main complications of PD were perforation and gastroesophageal reflux disease. CONCLUSION: HM is the most effective long-term treatment for patients with achalasia in China. In the future, controlled clinical trials on the treatment of achalasia should focus on comparing laparoscopic myotomy with or without antireflux procedure,including different partial and total fundoplication techniques.

Controversies in the treatment of gastroesophageal reflux and achalasia

The immense success of laparoscopic surgery as an effective treatment of gastroesophageal reflux disease （GERD） and achalasia has established minimal invasive surgery as the gold standard for these two conditions with lower morbidity and mortality, shorter hospital stay, faster convalescence, and less postoperative pain. One controversy in the treatment of GERD evolves around laparoscopic antireflux surgery （LAP, S） as the preferred treatmerit for Barrett＇s esophagus and the procedure＇s potential to reduce the risk of adenocarcinoma of the esophagus. GERD has also been associated with respiratory symptoms, asthma and laryngeal injury, and a second controversy prompts discussions about whether total or partial fundoplication is the more appropriate treatment for GERD. A new and promising alternative in the treatment of GERD is endoluminal therapy. Three types of this new treatment option will be discussed： radiofrequency energy delivered to the lower esophageal sphincter, the creation of a mechanical barrier at the gastroesophageal junction, and the direct endoscopic tightening of the lower esophageal sphincter. Laparoscopic surgery is discussed not only as a very effective treatment for GERD but also as permanent cure for achalasia. This review analyzes the three most important treatment options for achalasia： medications, pneumatic dilatation, and surgical therapy. Medications as the only true non-invasive option in the treatment of achalasia are not as effective as LAPS because of their short half-life and variable absorption due to the poor esophageal emptying. The second treatment option, pneumatic dilatation, involves the stretching of the lower esophagus and is still considered the most effective nonsurgical treatment for achalasia. Finally, surgical therapy for achalasia and the two major controversies concerning this laparoscopic treatment are discussed. The first involves the extent to which the myotomy is extended onto the stomach, and the second concerns the necessity and type of antireflux procedure to prevent GERD after myotomy. LAPS and laparoscopic Heller myotomy are the agreed upon as the gold standards for surgical treatment of GERD and achalasia, respectively. In the hands of an experienced laparoscopic surgeon both are safe and effective treatments for patients with excellent subjective and objective long-term results with at least 90% patient satisfaction.

Histone deacetylase inhibitor MS-275 alone or combined with bortezomib or sorafenib exhibits strong antiproliferative action in human cholangiocarcinoma cells

AIM: To investigate the antiproliferative effect of the histone deacetylase (HDAC) inhibitor MS-275 on cholangiocarcinoma cells alone and in combination with conventional cytostatic drugs (gemcitabine or doxorubicin) or the novel anticancer agents sorafenib or bortezomib. METHODS: Two human bile duct adenocarcinoma cell lines (EGI-1 and TFK-1) were studied. Crystal violet staining was used for detection of cell number changes. Cytotoxicity was determined by measuring the release of the cytoplasmic enzyme lactate dehydrogenase (LDH). Apoptosis was determined by measuring the enzyme activity of caspase-3. Cell cycle status reflected by the DNA content was detected by flow cytometry.RESULTS: MS-275 treatment potently inhibited the proliferation of EGI-1 and TFK-1 cholangiocarcinoma cells by inducing apoptosis and cell cycle arrest. MS-275-induced apoptosis was characterized by activation of caspase-3, up-regulation of Bax and down-regulation of Bcl-2. Cell cycle was predominantly arrested at the G1/S checkpoint, which was associated with induction of the cyclin-dependent kinase inhibitor p21Waf/CIP1. Furthermore, additive anti-neoplastic effects were observed when MS-275 treatment was combined with gemcitabine or doxorubicin, while combination with the multi-kinase inhibitor sorafenib or the proteasome inhibitor bortezomib resulted in overadditive anti-neoplastic effects.CONCLUSION: The growth of human cholangiocarcinoma cells can be potently inhibited by MS-275 alone or in combination with conventional cytostatic drugs or new, targeted anticancer agents.

Non-surgical treatment of esophageal achalasia

Esophageal achalasia is an infrequent motility disorder characterized by a progressive stasis and dilation of the oesophagus; with subsequent risk of aspiration, weight loss, and malnutrition. Although the treatment of achalasia has been traditionally based on a surgical approach, especially with the introduction of laparoscopic techniques, there is still some space for a medical approach. The present article reviews the non-surgical therapeutic options for achalasia.

Hypercalcemia Appeared in a Patient with Glucagonoma Treated with Octreotide Acetate Long-acting Release

PABCREATIC neuroendocrine tumours are uncommon neoplasms of the pancreas.They may cause a clinical syndrome due to hormone overproduction.Glucagonoma is a rare kind of pancreatic tumors. Here we report a case of glucagonoma. Hypercalcemia occurred when the patient underwent octreotide acetate long-acting release.

Memory Safety Based on Probabilistic Memory Allocation

Some unsafe languages,like C and C++,let programmers maximize performance but are vulnerable to memory errors which can lead to program crashes and unpredictable behavior.Aiming to solve the problem,traditional memory allocating strategy is improved and a new probabilistic memory allocation technology is presented.By combining random memory allocating algorithm and virtual memory,memory errors are avoided in all probability during software executing.By replacing default memory allocator to manage allocation of heap memory,buffer overflows and dangling pointers are prevented.Experiments show it is better than Diehard of the following aspects:memory errors prevention,performance in memory allocation set and ability of controlling working set.So probabilistic memory allocation is a valid memory errors prevention technology and it can tolerate memory errors and provide probabilistic memory safety effectively.

Survivin ASODN targeted therapy in XWLC-05 cell transplanted nude mice

Objective:The aim of this study was to study the inhibiting effect of survivin mRNA on transplanted XWLC-05 tumor on nude mice.Methods:We established XWLC-05 transplanted nude mice model.44 mice would be divided randomly into 4 groups:control group (blank),Lip group (simple liposome),survivin SODN group (transfected by sense oligonucleotide) and survivin ASODN group (transfected by antisense oligonucleotide).We would study general activities of nude mice in these 4 groups,measure the size of tumor and calculate the tumor inhabiting rate also.Pathological methods were applied in the analysis of the effect of different treatment on heart,kidney and liver of nude mice in these 4 groups.Results:Tumor grew slowly and size,weight of tumor was lower in survivin ASODN group when compared with that of others.Nude mice of survivin ASODN group showed lower growth index and tumor inhabiting rate was significantly higher than that of other groups (P < 0.05).Transplanted tumor on nude mice in control group (blank),Lip group,and survivin SODN group grew bigger as time passed and there was no significance among them (P > 0.05).We found a great deal of tumor cell necrosis in survivin ASODN group.No death of nude mice was observed in all 4 groups and we did not found obvious lesion in vital organs.Conclusion:Survivin ASDON could be used for the inhibitation of subcutaneously transplanted tumor in nude mice without obvious lesion in vital organs.

Care of inflammatory bowel disease patients in remission

Inflammatory bowel disease(IBD)comprises two distinct conditions:ulcerative colitis and Crohn’s disease,both of which are chronic,relapsing disorders carrying significant morbidity,mortality and healthcare costs.With growing attention to coordinated healthcare for patients with chronic systemic diseases,this review focuses on the care of IBD patients in remission,their concerns,quality of life,follow-up,the role of primary care physicians and the IBD-specific aspects of long-term care.We did an extensive PubMed search for articles pertaining to IBD patients in remission and,along with the authors’experience,formulated a comprehensive review.The difficulties faced by IBD patients in remission include but are not limited to education and employment concerns,psychosocial issues,problems related to health insurance,nutrition,fertility and infections.This review also addresses newer treatment modalities,the debatable effects of smoking on IBD and the importance of vaccination.IBD in remission can be a challenge due to its multifaceted nature;however,with a coordinated approach by gastroenterologists and other involved practitioners,several of these issues can be addressed.

Sustained release of isoniazid from polylactide microspheres prepared using solid/oil drug loading method for tuberculosis treatment

Polylactide(PLA) microspheres were prepared using the solid-in-oil(S/O) spray-drying method to achieve the sustained release of a hydrophilic drug for the treatment of tuberculosis, via intratracheal instillation. Isoniazid(IN), a low-molecular-weight hydrophilic drug, was used as a model drug. The effects of various sizes of micronized IN powder, different drug/polymer ratios, spray-drying process parameters, and drug-release characteristics were studied to optimize the manufacturing parameters. A high entrapment efficiency(87.3%) was obtained using this method; furthermore, the microspheres were spherical and smooth. They were individually and homogenously distributed, with a mean diameter of 5.6 μm; furthermore, they showed a satisfactory extended sustained-release phase. After administration of the microspheres to rats, pulmonary drug concentrations were maintained at a relatively stable level for up to 4 weeks.