曹操早期图治理念的现代启示——以《对酒歌》《度关山》为例

曹操诗歌无论是写政治理想,还是揭露社会矛盾,反映离乱现实,都能表现出一个政治家的博大胸怀和深刻眼光——这是他与建安时期其他诗人显著不同之处。曹操早期创作的两篇乐府诗《度关山》《对酒》,就真实地反映了一个政治家的治国理想:君明臣贤、尊民固本;严明法纪、廓清吏治;提倡仁礼、除残去秽;重视农业、轻徭薄赋;反对奢侈、倡行节约。这种政治理想和治国方略,在今天仍然具有一定的启示意义。

试论叶天士宗奇经对治脏不应的补救图治

试论叶天士宗奇经对治脏不应的补救图治解浚沅（吉林省伊通满族自治县小孤山镇卫生院１３０７１５）关键词：叶天士；奇经八脉中图法分类号：Ｒ２４９．４９；Ｒ２２４．０；Ｒ２４１．７在清代著名医家叶天士众多医案中，广泛存在着治脏不应转从奇经施治的案例。如《临证...

标本兼图治哮喘

哮喘是一种发作性的痰鸣气喘疾患,以呼吸急促,喉间有哮鸣声为证,中医对哮喘的治疗原则是:发时治标,平时治本。大多宗朱丹溪:“凡喘未发,以扶正为主,已发以散邪为主。”之说。

《脏腑证治图说人镜经》钱雷《附录》及其医学思想

美国国会图书馆藏《脏腑证治图说人镜经·附录》是一部稀见的明代中医著作。"国会本"版本良好,曾出入多位医学、文化界名人之手,流布序列较完整。该"附录"反映了明代宁波籍名医钱雷"良医出儒,以儒为医""以实求事,经世爱人""博采诸家,批判继承"等三方面医药思想。钱雷的医药思想与浙东文化传统、地域士风存在一定互动。通过对"附录"所收《胎元图》的研读及跨文化、跨领域图像学对照分析,可以发现钱雷及以其为代表的部分明代上层医师在解剖性图像绘制方面处于领先水平;有关胎儿的图像精准度高于其他脏器,反映了明代中医妇产(女)科、生育民俗对人体结构的独特认识。

顺治帝历史作用浅析

满清王朝在汉族集聚地之所以能有几百年的发展，顺治帝的奠基之功不可没。首先，改多尔衮的“勤兵黩武”为抚剿并重，为全国的统一奠定了基础。其次，恢复经济，整顿吏治，改善政治，提高国家机器的行政效率，以增强发展自己的实力。再次，顺应历史潮流，实行汉化政策，摆脱“极弊之势”

论康乾盛世的惩贪

在中国历史上，清代是惩贪力度较重的一个王朝，而有清一代的惩贪又以康乾盛世时期最有特色。康熙帝表彰清官、雍正帝实行耗羡归公、高薪养廉、乾隆帝则屡兴大狱，惩治手段绞斩徒流无所不用，涉及犯官之多、打击面之广以此时为最。应承认三帝的惩贪收到了一时之效，保证了盛世的产生和延续。但总的说来是屡禁不止，究其原因，皇权专制造成皇帝执政过久、崇尚奢华、执法不一。专制主义官僚体制造成的官吏无耻、庸碌、拜金，社会风气的虚糜浮华等都影响着惩贪的彻底。康乾盛世不乏惩贪的手段，却缺少相应的防贪的制约机制。总结这一历史，当给人以启迪和借鉴。

天启成都《府治三衢九陌宫室图》研究

《府治三衢九陌宫室图》中的文化景观可分为政治、宗教、文教功能等7种类型,反映出明末成都作为承宣布政使司中心所在地所具备的城市职能。此图的绘制方式与城池布局彰显出中正和谐、等级尊卑和仿生取象的特点,具有明显的刻意塑造,既是国家意志的体现,又反映出自然环境对城市形态的制约。由图可窥成图的年代、公署布局的发展趋势和佛教、道教的演化形势,却未能显示城市经济的发展状况。该图虽未超脱时代局限,也存在一些绘制或标注错讹,但某些特殊标识或可成为今后方志舆图研究的新旨趣。

The Role of Transesophageal Echocardiography for Transcatheter Closure of Atrial Septal Defects with the Amplatzer Septal Occluder

Objective: To evaluate of the role of transesophageal echocardiography (TEE)in percutaneous closure of atrial septal defects (ASD) with the Amplatzer septal occluder. Methods:Sixty- two patients (10 to 55 years of age) were selected for percutaneous closure of ASD bytrans-esophageal echocardiography, which was also used to monitor the procedure, to select theappropriate size of the Amplatzer device, to verify its position, and to access the immediateresults of the procedure. During the follow-up, transthoracic echocardiography (TTE) or TEE was usedto evaluate the presence and magnitude of residual shunt (RS), device position, and right cardiacchamber diameters. Results: The mean ASD diameter by TTE ([19. 1 +- 5. 8] mm) was significantlysmaller (P< 0. 001) than the stretched diameter of the ASD (25. 1 +- 6. 4) mm. There are nosignificant differences between the TEE -measured value (23. 5+_6. 2) mm and the stretched diameterof the ASD (P > 0. 05). Due to proper patient selection all procedures were successful. There wasimmediate and complete closure in 61/62 patients, only one patients had trivial residual shunt.Follow- up was performed using TTE or TEE right after operation, 1 d, 1 month, 3 months, 6 monthsand yearly thereafter. Ail, patients remain asymptomatic without any clinical or technical problems.Conclusion: With the aid of TEE, percutaneous closure of ASD can be performed successfully, safely,and effectively.

天启成都《府治合属郡县总图》研究

《府治合属郡县总图》作为天启《新修成都府志》所附舆图的首图,向世人呈现出晚明成都府的权力架构、政区层级、城池分布、军防要塞、交通道路等区域地理概貌,着重凸显成都府城的核心地位,服务于地方治理,反映了晚明成都府及其所属州县间的密切关联。虽有道路里程支撑,绘图者却并不以准确性作为首要考量,而重在政治和军事信息的“告知”,尤其对卫所和驿站的标注显示了绘图者对晚明成都府地缘格局的战略认知。纵观明代方志地理总图的绘制概况,《府治合属郡县总图》颇具时代典型性。

Portal hypertension: Imaging of portosystemic collateral pathways and associated image-guided therapy

Portal hypertension is a common clinical syndrome, defined by a pathologic increase in the portal venous pressure. Increased resistance to portal blood flow, the primary factor in the pathophysiology of portal hypertension, is in part due to morphological changes occurring in chronic liver diseases. This results in rerouting of blood flow away from the liver through collateral pathways to low-pressure systemic veins. Through a variety of computed tomographic, sonographic, magnetic resonance imaging and angiographic examples, this article discusses the appearances and prevalence of both common and less common portosystemic collateral channels in the thorax and abdomen. A brief overview of established interventional radiologic techniques for treatment of portal hypertension will also be provided. Awareness of the various imaging manifestations of portal hypertension can be helpful for assessing overall prognosis and planning proper management.

Abdominal aortic aneurysm： Treatment options, image visualizations and follow-up procedures

Abdominal aortic aneurysm is a common vascular disease that affects elderly population.Open surgical repair is regarded as the gold standard technique for treatment of abdominal aortic aneurysm,however,endovaseular aneurysm repair has rapidly expanded since its first introduction in 1990s.As a less invasive technique,endovascular aneurysm repair has been confirmed to be an effective alternative to open surgical repair,especially in patients with co-morbid conditions.Computed tomography （CT） angiography is currently the preferred imaging modality for both preoperative planning and post-operative follow-up.2D CT images are complemented by a number of 3D reconstructions which enhance the diagnostic applications of CT angiography in both planning and follow-up of endovascular repair.CT has the disadvantage of high cummulative radiation dose,of particular concern in younger patients,since patients require regular imaging follow-ups after endovascular repair,thus,exposing patients to repeated radiation exposure for life.There is a trend to change from CT to ultrasound surveillance of endovascular aneurysm repair.Medical image visualizations demonstrate excellent morphological assessment of aneurysm and stent-grafts,but fail to provide hemodynamic changes caused by the complex stent-graft device that is implanted into the aorta.This article reviews the treatment options of abdominal aortic aneurysm,various image visualization tools,and follow-up procedures with use of different modalities including both imaging and computational fluid dynamics methods.Future directions to improve treatment outcomes in the follow-up of endovascular aneurysm repair are outlined.

嘉靖《宁波府郡治图》研读

嘉靖《宁波府郡治图》中着重标志出了政治性、宗教性和教育性以及一些比较重要的社会机构,而与民众生活息息相关且占据城市大部分空间的民居、街巷(坊)、集市等却没有标志出来,这背后有着复杂的原因:其一,在传统的官僚社会中,制图者是重官轻民主流政治意识形态的代表,他们有意凸显公家场所的重要性,而有意无意地忽视民众的私人生活空间;其二,这些机构代表着社会秩序,有着积极的社会功能,其重要性不容忽视,因而在地图上得以凸显;其三,这些机构是专制主义中央集权在地方上的代表,他们或是封建政府的重要组成部分,或与政府有密切联系,在地图上不得不予以凸显。

The role of electrocardiography in the elaboration of a new paradigm in cardiac resynchronization therapy for patients with nonspecific intraventricular conduction disturbance

Cardiac resynchronization therapy （CRT） is associated with a favorable outcome only in patients with left bundle branch block （LBBB） pattern and in patients with a QRS duration 〉 150 ms, in patients with non-LBBB pattern with a QRS duration of 120-150 ms usually is not beneficial. After adjusting for QRS duration, QRS morphology was no longer a determinant of the clinical response to CRT. In contrast to the mainstream view, we hypothesized that the unfavorable CRT outcome in patients with non-LBBB and a QRS duration of 120-150 ms is not due to the QRS morphology itself, but to less dyssynchrony and unfavorable patient characteristics in this subgroup, such as more ischemic etiology and greater prevalence of male patients compared with patients with LBBB pattern. Further, the current CRT technique is devised to eliminate the dyssynchrony present in patients with LBBB pattern and inappropriate to eliminate the dyssynchrony in patients with non-LBBB pattern. We also hypothesized that electrocardiography may also provide information about the presence of interventricular and left intraventricular dyssynchrony and the approximate location of the latest activated left ventricular （LV） region. To this end, we devised new ECG criteria to estimate interventricular and LV intraventricular dyssynchrony and the approximate location of the latest activated LV region. Our preliminary data demonstrated that the latest activated LV region in patients with nonspecific intraventricular conduction disturbance （NICD） pattern might be at a remote site from that present in patients with LBBB pattern, which might necessitate the invention of a novel CRT technique for patients with NICD pattern. The application of the new interventricular and LV intraventricular dyssynchrony ECG criteria and a potential novel CRT technique might decrease the currently high nonresponder rate in patients with NICD pattern.

Electrocorticography-Guided Surgical Treatment of Solitary Supratentorial Cavernous Malformations with Secondary Epilepsy

Objective To evaluate the efficacy of electrocorticographic(ECoG) monitoring and the application of different surgical approaches in the surgical treatment of solitary supretentorial cavernous malformations with secondary epilepsy. Methods This study enrolled a consecutive series of 36 patients with solitary supratentorial cavernous malformations and secondary epilepsy who underwent surgery with intraoperative ECoG monitoring in the Department of Neurosurgery between January 2004 and January 2008. The patients were composed of 15 males and 21 females, aged between 8 and 52 years(mean age 27.3±2.8 years) at the time of surgery. Epilepsy history, the type of epilepsy at the presentation, lesion location, the incidence of residual epileptiform discharges, and postoperative outcomes were evaluated. Results Histopathological examination indicated cavernous malformations and hippocampal sclerosis in 36 and 5 cases, respectively. Neuronal degeneration, glial cell proliferation, and neurofibrillary tangles were found in all the resected cerebral tissues of extended lesionectomy of residual epileptic foci. Lesionectomy, anterior temporal lobectomy, anterior temporal lobectomy plus cortical thermocoagulation, extended lesionectomy, extended lesionectomy plus cortical thermocoagulation were performed in 4, 4, 1, 14, and 13 cases, respectively. Residual epileptiform discharges were captured in 9 out of the 14 patients who had additional cortical thermocoagulation. According to Engle class for postoperative outcomes, 27 cases were class I(75.00%), 5 were class II(13.89%), 2 were class III(5.56%), and 2 were class IV(5.56%), thus the total effective rate(class I+class II) was 88.89%. Neither of epilepsy history, the type of epilepsy, and the location of cavernous malformation was significantly related to outcomes(P>0.05). A significant relationship was found between the incidence of residual epileptiform discharges and outcomes(P=0.041). Conclusions Intraoperative ECoG monitoring, the application of different surgical approaches, and the resection of residual epileptic foci could produce good result in the surgical treatment of supratentorial cavernous malformation with secondary epilepsy. Postoperative residual epileptiform discharges could be a useful predictor for evaluating the outcomes.

Advances in alimentary tract imaging

in imaging techniques are changing the way radiologists undertake imaging of the gastrointestinal tract and their ability to answer questions posed by surgeons. In this paper we discuss the technological improvements of imaging studies that have occurred in the last few years and how these help to better diagnosing alimentary tract disease.

Abnormal cortical functional connections in Alzheimer’s disease: analysis of inter-and intra-hemispheric EEG coherence

To investigate inter- and intra-hemispheric electroencephalography (EEG) coherence at rest and during photic stimulation of patients with Alzheimer's disease (AD). Thirty-five patients (12 males, 23 females; 52～64 y) and 33 sex- and age-matched controls (12 males, 21 females; 56～65 y) were recruited in the present study. EEG signals from C3-C4, P3-P4, T5-T6and O1-O2 electrode pairs resulted from the inter-hemispheric action, and EEG signals from C3-P3, C4-P4, P3-O1, P4-O2, C3-O1,C4-O2, T5-O 1 and T6-O2 electrode pairs resulted from the intra-hemispheric action. The influence of inter- and intra-hemispheric coherence on EEG activity with eyes closed was examined, using fast Fourier transformation from the 16 sampled channels. The frequencies of photic stimulation were fixed at 5, 10 and 15 Hz, respectively. The general decrease of AD patients in inter- and intra-hemispheric EEG coherence was more significant than that of the normal controls at the resting EEG, with most striking decrease observed in the alpha-1 (8.0-9.0 Hz) and alpha-2 (9.5-12.5 Hz) bands. During photic stimulation, inter- and intra-hemispheric EEG coherences of the AD patients having lower values in the alpha (9.5-10.5 Hz) band than those of the control group. It suggests that under stimulated and non-stimulated conditions, AD patients had impaired inter- and intra-hemispheric functional connections, indicating failure of brain activation in alpha-related frequency.

Electroencephalogram and evoked potential parameters examined in Chinese mild head injury patients for forensic medicine

Objective To evaluate the usefulness of quantitative electroencephalogram （QEEG）, flash visual evoked potential （F-VEP） and auditory brainstem responses （ABR） as indicators of general neurological status. Methods Comparison was conducted on healthy controls （N=30） and patients with brain concussion （N=60） within 24 h after traumatic brain injury. Follow-up study of patient group was completed with the same standard paradigm 3 months later. All participants were recorded in multi-modality related potential testing in both early and late concussion at the same clinical setting. Glasgow coma scale, CT scanning, and physical examinations of neuro-psychological function, optic and auditory nervous system were performed before electroencephalogram （EEG） and evoked potential （EEG-EP） testing. Any participants showed abnormal changes of clinical examinations were excluded from the study. Average power of frequency spectrum and power ratios were selected for QEEG testing, and latency and amplitude of F-VEP and ABR were recorded. Results Between patients and normal controls, the results indicated： （1） Highly significance （P 〈 0.01） in average power of α1 and power ratios of θ/α1, 0/α2, α1/α2 of EEG recording; （2） N70-P 100 amplitude of F-VEP in significant difference at early brain concussion; and （3） apparent prolongation of Ⅰ～Ⅲ inter-peak latency of ABR appeared in some individuals at early stage after concussion. The follow-up study showed that some patients with concussion were also afflicted with characteristic changes of EEG components for both increments of α1 average power and θ/α2 power ratio after 3 months recording. Conclusion EEG testing has been shown to be more effective and sensitive than evoked potential tests alone on detecting functional state of patients with mild traumatic brain injury （MTBI）. Increments of α1 average power and θ/α2 power ratio are the sensitive EEG parameters to determining early concussion and evaluating outcome of postconcussion symptoms （PCS）. Follow-up study associated with persistent PCS may be consistent with the postulate of substantial biological, rather than psychological origin. The study suggests that combination of EEG and EP parameters can contribute to the evaluation of brain function as a whole for clinical and forensic applications.

Impact of renal transplantation on cardiac morphological and functional characteristics in children and adults

AIM To compare the effects of renal transplantation on cardiac functions in children and adults.METHODS One hundred and ten patients attending the nephrology outpatient clinic were enrolled in this study and were divided into six groups. The first two groups consisted each of 30 renal transplant patients who had a successful renal transplantation more than six months, but less than one year. Group Ⅰ were less than 18 years and group Ⅱ were more than 18 years. The third and fourth groups, each were 20 chronic renal failure patients on regular hemodialysis. Again, group Ⅲ were less than 18 years and group Ⅳ were more than 18 years. Group Ⅴ and Ⅵ(The control Groups) consisted each of 5 subjects below and above 18 years of age, respectively with normal kidney functions. All patients were subjected to history and examination. The kidney functions and the hemoglobin were analyzed. Afterobtaining informed consent, echocardiography was done to all patients.RESULTS There was a statistically significant improvement(P < 0.0001) in all cardiac parameters. A regression in left ventricular end diastolic volume(LVED) both in children(4.7 ± 0.8 to 4.2 ± 0.5) and in adults(5.9 ± 0.7 to 4.9 ± 0.6) were found. There was a regression in left ventricular end systolic volume(LVES) both in children(3.1 ± 0.6 to 2.4 ± 0.4) and in adults(4.1 ± 0.9 to 3.1 ± 0.5). Fractional shortening improves both in children(32.6 ± 5.3 to 41.7 ± 7.6) and in adults(29.0 ± 6.6 to 36.5 ± 4.1). The improvement in ejection fraction(EF) was higher in children(59.7 ± 7.0 to 71.9 ± 6.1) than in adults(52.0 ± 12.5 to 64.8 ± 5.9). However, this degree of improvement(in children: 12.2 ± 5.1) did not show statistical difference(P-value 0.8), when compared to adults(12.7 ± 9.8). CONCLUSION After renal transplantation cardiac functions and morphology(EF/LVED/LVES) do improve markedly and rapidly in both children and adults.

Dialectical Rhetoric and Socrates＇ Treatment of Mimetic Poetry in Book 10 of the Republic

Christopher Janaway＇s recent book on Plato＇s critique of the arts discusses, among other things, Book 10 of the Republic. This paper claims that his comments upon passages in Republic 10 overl Plato＇s ook the Ion and status of the Republic as itself a work of dramatic mimesis, ignore the dialectical form of the work, and miss that in various dialogues, Plato evinces a high view of poetry and the arts and even envisions a techne poietike. The paper defends these claims by constructing a three-stage argument that Plato holds a high view of poetry： （1） It first sketches an outline of a reading of the Ion as a dialogue that, despite being aporetic, nevertheless points ahead to a Socratic philosophizing that is craft-like and open to divine inspiration, and not only recognizes the value of poetry but also sometimes composes poetry; （2） Then, it discusses Socrates＇ use, in his conversational strategies in the Republic, of the techne of rhetoric described in the Phaedrus; and finally, （3） It considers four arguments against mimetic poetry in Republic 10 （598b8-606d7）, and sketches an interpretation of them that takes issue with Janaway＇s. It argues that they are meant to invite readers to a higher dialectical standpoint, from which might come into view the value of mimetic poetry to a community guided by a Basilike techne