先秦至隋唐时期“痈”和“疽”的演变

"痈"和"疽"是中医外科学中两个重要的概念,《灵枢·痈疽》所载二者的区别被历代医家奉为圭皋,但后世医家在实际运用中却常混淆不清。通过对先秦至隋唐时期相关医学文献进行整理与分析,梳理"痈""疽"二者概念演变的大致脉络,发现此二者的区别除《灵枢·痈疽》所述内容外,还在于二者词性和字义不同,即"疽"仅用于疾病的名称使用上,均为名词;而"痈"字通过假借的方式使其字义逐渐丰富,除表示病名外,还用于特指某具体病灶、表肿胀、表壅滞和浮肿之意,既可为名词,亦可为形容词。二者在古籍中有着看似混乱,实则规律的运用。

Intracranial hemorrhage in patients treated with bevacizumab:Report of two cases

Treatment with bevacizumab,an antiangiogenic agent,in patients with metastatic or unresectable colorectal cancer was approved less than 4 years ago in Japan.Bevacizumab improves the survival of patients with metastatic colorectal cancer;however,it may lead to complications such as bleeding,which are sometimes fatal.Bevacizumab should be administered only after careful consideration because the potential risks of therapy outweigh its benefits.Therefore,pharma-ceutical companies do not recommend bevacizumab therapy for patients with brain metastases.While some reports support the cautious use of bevacizumab,others report that it is not always necessary to prohibit its use in patients with metastases to the central nervous system(CNS),including the brain.Thus,bevacizumab therapy in colorectal cancer patients with brain metastases is controversial,and it is unclear whether brainmetastases are a risk factor for intracranial hemor-rhage during anti-vascular endothelial growth factor(VEGF)therapy.We report a 64-year-old man and a 65-year-old man with recurrent colorectal cancer with-out brain metastases;these patients developed multifocal and solitary intracranial hemorrhage,respectively,after the administration of bevacizumab.Our findings suggest that intracranial hemorrhage can occur even if the patient does not have brain metastases prior to bevacizumab treatment and also suggest that brain metastases are not a risk factor for intracranial hemor-rhage with bevacizumab treatment.These findings also question the necessity of excluding patients with brain metastases from clinical trials on anti-VEGF therapy.

宋代的枢密院制度

宋承唐、五代之制,在中央机构中设置枢密院,掌管全国军务。唐代宗永泰元年(765),始命宦官任内枢密使。若按正规官制而言,当时的枢密使是内廷之官。然而宦官冠以枢密使者,简直以内廷的宰相自命,与中书门下、翰林学士鼎足而三。'其职掌唯承受表奏。

Intrathecal injection with methotrexate plus dexamethasone in the treatment of central nervous system involvement in systemic lupus erythematosus

Abstract:Objective To investigate the effect of intrathecal injection (IT) with methotrexate (MTX) plus dexamethasone (DXM) in treating central nervous system involvement in systemic lupus erythematosus (CNS lupus). Methods Twenty-four CNS lupus patients that were refractory to conventional steroid therapy were selected for IT with MTX 10-20?mg plus DXM 10-20?mg. The effects and side effects of IT were closely observed. Results The symptoms and signs of 22/24 (91.7%) CNS lupus patients receiving IT improved considerably. Cerebrospinal fluid pressure,protein and WBC levels declined from 201.5±155.4?mm?H2O, 145.2±87.6?mg/dl and 25.1±14.3/mm3 to 128.7±108.1?mm?H2O, 60.8±38.3?mg/dl and 6.8±2.1/mm3 respectively. Transient side effects were observed in 4 patients: 1 with itching sensation of lower limbs, 2 with headache and 1 with incontinence.Conclusion IT with MTX plus DXM is a promising method for treating CNS lupus and deserves further investigation.

西安西郊出土的后唐《张居翰墓志》

一九八九年十月,陕西省博物馆(今西安碑林博物馆)从事文物征集工作的陈安利、马志祥同志从西安西郊车刘村征回后唐墓志一合,据一村民讲,此墓志为村北基建工地施工时所出,遂运回其家。该墓志保存完整,字迹清楚。志长74cm,宽75cm,四侧线刻十二生肖图案,盖为覆斗式,略小于志,四侧线刻四神、云纹图案,盖篆书题:'大唐故内枢密使清河郡张公墓志铭'十五字。

Transoral atlantoaxial reduction plate fixation for irreducible atlantoaxial dislocation

Objective： To design a clinically applicable transoraipharyngeai atlantoaxiai reduction plate （TARP）, introduce the operation procedure, and evaluate its preliminary clinical effects. Methods： A novel TARP system, including butterfly titanium alloy plate, self-locking screws, atlantoaxial reductor and other operational instruments was developed. This system was applied clinically on five patients with irreducible atlantoaxiai dislocation of congenital or traumatic origin. During operation, the reduction was completed by the combined action of the plate and the atlantoaxiai reductor after transoral joint release and cord decompression. Bone graft granules were implanted between the bilateral atlantoaxiai joints and TARP was used to immobilize subsequently the atlas and axis. Results： Clinical application demonstrated that TARP could induce instant reduction and that the method was operationally feasible and its postoperationai effect was satisfactory. Conclusions： The design of TARP is novel. The operational procedure is simple and easy to use. Furthermore, instant reduction can be completed during the operation and the fixation is relatively stable. TARP is an ideal alternative for irreducible atlantoaxiai dislocation and may have excellent prospects for further clinical applications.

Biomechanical evaluation of atlantoaxial transarticular screw fixation technique

Objective: To compare the biomechanical differences among the atlantoaxial transarticular screw fixation (Magerl) and other posterior fixation techniques. Methods: Seven preserved atlantoaxial complex specimens were harvested and fixated with Magerl, Magerl plus Gallie wiring, Magerl plus Brooks wiring, pure Brooks, pure Gallie, and Halifax interlaminar clamping fixation, respectively. The torque for every fixation technique was measured at the point of five degree rotation of the atlantoaxial joint. Results: The torque for Magerl was 6.59 N·m± 1.14 N·m , which was significantly higher than any other pure posterior techniques including Gallie ( 1.74 N·m± 0.31 N·m ). Brooks ( 4.06 N·m± 0.48 N·m) and Halifax ( 3.44 N·m± 0.87 N·m) (P< 0.01 ), but less than Magerl plus brooks ( 9.94 N·m± 1.45 N·m) (P< 0.01 ). No statistically significant difference was found between Magerl and Magerl plus Gallie wiring ( 7.61 N·m± 1.10 N·m) or between Brooks and Halifax. Conclusions: Compared with other pure posterior fixation techniques the atlantoaxial transarticular screw fixation technique provides more torsion resistance capacity. It is also suggested that combined Gallie wiring do not add any biomechanical superiority to this technique.

Comparative study of electroacupuncture and moxibustion in influencing Tianshu(ST 25) regions mast cells in visceral hyperalgesia rats

Objective：To evaluate and compare electroacupunctures（EA） with different parameters and moxibustion at different temperatures influencing the activation of mast cells（MC） in Tianshu（ST 25） regions of visceral hyperalgesia model rats.Methods：Rats（except for model group） respectively accepted 1 m A or 3 m A EA or moxibustion at 43 or 4 to ℃ ℃stimulate Tianshu（ST 25） points after randomization of the fifty visceral hyperalgesia model rats,and then were compared with that in model and normal groups.Number,degranulation numbers,degranulation rates in Tianshu（ST 25） regions MC of rats in each group were observed using toluidine blue staining.Abdominal withdrawl reflex（AWR） score was used to evaluate the rat visceral hyperalgesia reactions.Results：Compared with the normal group and the model group,MC numbers（P〈0.05,P〈0.01,P〈0.01,P〈0.01）,degranulation numbers and degranulation rates（P〈0.01,P〈0.01,P〈0.05,P〈0.01） of Tianshu（ST 25） MC in regions tissues in 43 and 4 moxibustion groups,and 1 m A and 3 m℃ ℃A EA groups all increased significantly.Compared with the model group,AWR scores were significantly lower in 43 and 4 ℃ moxibustion groups,and 1 m A and 3 m℃A EA groups under the stimulation of 20 mm Hg,40 mm Hg,0 mm Hg or 80 mm Hg colorectal distension（CRD）（P〈0.05 in 1 m A and 3 m A EA groups under the stimulation of 20 mm Hg,P〈0.01 in the other groups）.AWR scores in 43 ℃and 4 ℃moxibustion groups under the stimulation of 20 mm Hg,40 mm Hg,0 mm Hg or 80 mm Hg CRD were not significantly different from those in the normal group（all P〈0.05）;AWR scores in 1 m A EA group under the stimulation of 0 mm Hg or 80 mm Hg were significantly higher than that in the normal group（P〈0.01）;AWR score in 3 m A EA group under the stimulation of 0 mm Hg was significantly higher than that in the normal group（P〈0.01）,and AWR scores in 3 m A EA group under the stimulation of 20 mm Hg or 80 mm Hg were also higher than that in the normal group（P〈0.05）.AWR scores were higher in 1 m A EA group under the stimulation of 40 mm Hg or 80 mm Hg than that in 4 moxibustion group（℃ P〈0.05）;AWR score was higher in 3 m A EA group under the stimulation of 40 mm Hg than that in 4 moxibustion group（℃ P〈0.05）.Conclusion：There are differences among EA of different parameters and moxibustion of different temperatures in activating on Tianshu（ST 25） regions MC of visceral hyperalgesia model rats,as well as in improving the visceral hyperalgesia reaction.The effect of 4 moxibustion℃ is the most significant.

Regulatory effect of mild moxibustion on P2X3 receptors in spinal cord,anterior cingulate cortex and thalamic ventral posterolateral nucleus of rats with IBS visceral hyperalgesia

Objective To observe the therapeutic effect of mild moxibustion on irritable bowel syndrome(IBS)visceral hyperalgesia model rats and its regulatory effect on P2X3 receptors in the spinal cord,anterior cingutate cortex(ACC)and thalamic ventral posterolateral nucleus(VPL).Methods Thirty 8-day-old newborn rats were randomly divided into a normal group(n=6)and a modeling group(n=24)according to the completely random number table method.Rats in the normal group were bred routinely,and those in the modeling group were subjected to preparing IBS chronic visceral hyperalgesia model using colorectal distention(CRD)in stimulation method.Rats successfully modelled were re-divided into a model group,a mild moxibustion group,a P2X3 receptor antagonist group,and a normal saline group according to the completely random number table method with 6 rats in each group.Rats in each group received corresponding interventions from the 37-day old,once a day for 7 consecutive days.Immunohistochemistry and Western blot assays were used to detect P2X3 protein expressions in the spinal cord,ACC and VPL of rats.Results Under different intensities of CRD stimulation,the abdominal withdrawal reflex(AWR)scores of the model group were significantly increased versus the normal group(all P<0.05);the AWR scores of the mild moxibustion group and the P2X3 receptor antagonist group were significantly reduced versus the model group(all P<0.01).The P2X3 protein expressions in rat spinal cord,ACC and VPL tissues of the model group were significantly increased versus the normal group(all P<0.01);the P2X3 protein expressions in rat spinal cord,ACC and VPL tissues of the mild moxibustion group and the P2X3 receptor antagonist group were significantly reduced versus the model group(all P<0.01).Conclusion Mild moxibustion can inhibit the P2X3 receptor expressions in the spinal cord,ACC,and VPL tissues of IBS visceral hyperalgesia model rats,which may be the mechanism of mild moxibustion in relieving the central sensitization of rats with IBS visceral hyperalgesia.

Effect of herbal-partitioned moxibustion at Tianshu(ST 25) and Qihai(CV 6) on pain-related behavior and emotion in rats with chronic inflammatory visceral pain

Objective：To observe the effect of herbal-partitioned moxibustion （HPM） on pain-related behavior and emotion in a rat model of chronic inflammatory visceral pain, and to investigate the mechanism. 〈br〉 Methods：Twenty-four male Sprague-Dawley （SD） rats were randomly divided into three groups：a normal group, a model group and an HPM group. Except for the normal group, rats in the other two groups were clystered with mixed liquor of Trinitrobenzene Sulfonic Acid （TNBS） and 50%ethanol to induce the chronic inflammatory visceral pain model. After the models were established successfully, rats in the HPM group were treated with HPM at bilateral Tianshu （ST 25） and Qihai （CV 6）. Rats in the normal group and the model group were only fixed as those in the HPM group without treatment. Abdominal withdrawal reflex （AWR） score, mechanical withdrawal threshold （MWT） and thermal withdrawal latency （TWL） were adopted to detect the visceral and somatic pain;meanwhile, open field test （OFT） and elevated plus maze test （EPMT） were employed to evaluate pain emotions such as depression and anxiety. 〈br〉 Results：Compared with the normal group, AWR scores of the model group were significantly increased under different stimulus expansion pressure level （P〈0.01）, MWT and TWL were significantly decreased （P〈0.05）;in OFT, the values of horizontal activities and vertical activities were significantly decreased （P〈0.01）;in EPMT, the proportion of the number of entry into the open arms （OE%） and that of residence time in the open arms （OT%） significantly decreased （P〈0.01）, indicating that the model was successful. Compared with the model group, the AWR score of the HPM group was decreased significantly （P〈0.05）, MWT and TWL were significantly increased （P〈0.05）, the values of horizontal activities and vertical activities in the model group were significantly increased （P〈0.01）;in OFT and EPMT, OE%and OT%were significantly increased （P〈0.01）. 〈br〉 Conclusion：HPM has analgesic effect on chronic inflammatory visceral pain. It can reduce the visceral and somatic pain in rats and markedly improve the emotions such as anxiety and depression induced by chronic visceral pain.

Effect of moxibustion on CRF and CRFR1 expressions in hypothalamus of TNBS-induced experimental colitis rats

Objective： To observe the effect of moxibustion on the protein and mRNA expressions of corticotropin-releasing factor （CRF） and corticotropin-releasing factor receptor 2 （CRFR1） in hypothalamus of trinitrobenzene sulfonic acid （TNBS）-induced experimental colitis rats, and to explore the central mechanisms of moxibustion in improving visceral pain and the pain-related emotions in experimental colitis rats. Methods： Thirty-six Sprague-Dawley （SD） rats were randomly divided into a normal group （NG）, a model group （MG）, a herb-partitioned moxibustion group （HPMG） and a sham herb-partitioned moxibustion group （SHPMG）. Except the NG, rats in the remaining three groups all received TNBS enema to establish experimental colitis models. The HPMG received herb-partitioned moxibustion （HPM） at bilateral Tianshu （ST 25） and Qihai （CV 6） for intervention; for the SHPMG, the herbal cakes and moxa cones were only placed on the acupoints but not ignited; rats in the MG and NG were only fixed in the same way as those in the HPMG but did not receive any treatment. At the end of the intervention, the abdominal withdrawal reflex （AWR） score, the open field test （OFT） score and the elevated plus maze （EPM） score were observed to measure the changes in visceral pain and pain-related emotions of the rats. The enzyme-linked immunosorbent assay （ELISA） was used to examine the expressions of CRF and CRFR1 proteins in hypothalamus; the fluorescence-based quantitative polymerase chain reaction （PCR） was used to detect the expressions of CRF and CRFR1 mRNAs in hypothalamus. Results： Compared with the NG, the AWR score increased significantly and the OFT and EPM scores dropped significantly in the MG （all P〈0.05）, and the expressions of hypothalamic CRF and CRFR1 proteins and mRNAs increased significantly （all P〈0.01）. Compared with the MG and SHPMG, the AWR score dropped significantly and the OFT and EPM scores increased significantly in the HPMG （all P〈0.01）, and the expressions of hypothalamic CRF and CRFRI proteins and mRNAs decreased significantly （all P〈0.05）. There were no significant differences between the MG and the SHPMG （all P〉0.05）. Conclusion： HPM can down-regulate the abnormally increased expressions of CRF and CRFR1 proteins and mRNAs in hypothalamus of the TNBS-induced experimental colitis rats, which is plausibly one of its action mechanisms in mitigating visceral pain and the pain-related emotions in the experimental colitis rats.