中西结合,文医融会——走近中医临床文献大家余瀛鳌

余瀛鳌先生是我国著名中医文献大家,在中医古籍整理,尤其是中医临床文献整理、中医疑难病症诊治等方面颇多建树。他出身中医世家,又师出名门,还毕业于正规西医院校,参加第一届西学中班,这些特殊的成长经历,使其在学习和工作中逐步形成了中医与西医相结合、文献整理与临床实践相结合、继承与创新相结合的学术特色,他的成长见证了百年中医发展之路,他的治学方法为中医文献与中医临床相结合探索出一条切实可行的道路。

民国中医药期刊《文医半月刊》学术特色研究

民国时期中医药期刊以其时效性、广泛性和真实性,承载着近代中医药珍贵文献资料。《文医半月刊》由施今墨先生于1935年12月1日创刊于北京,1937年10月1日停刊,共出版4卷,发刊37期。该刊注重文学与医学的结合,使医学的专业性与文学的艺术性相辅相成;广泛传播中医知识,大力提倡中西医结合,倡导中医走科学化道路;以期刊连载形式,荟萃名家医著,增强期刊影响力;运用传统中药学理论与西医药理学理论对药物进行研究,推广“简、便、验、廉”的验方;针对中医发展所面临的困境,纳医界自由言论,共谋中医生存发展之路;聚焦时事热点,及时向社会宣传中医药界的时事新闻。通过揭示《文医半月刊》的特色与价值,可以为探讨民国时期中医发展状况提供依据,为研究燕京医学特色提供借鉴。

新文科背景下医学院校“文医融通”人才培养体系构建研究

在新技术迭代、新需求提振以及新国情关照的时代背景下,我国“新文科”建设坚持以终为始,嫁接医学院校“为医先为人”的人才培养理念,实现人文精神与科学精神之间的相互影响渗透,有效解决了“文医融通”的学术性失语与国民性失觉,在厚植中国文化软实力的基础上,通过构建涵盖“价值引领性”目标体系、“边界突破性”课程体系、“育人共同体”支持体系与“主体成长性”评价体系的人才培养体系,培育多样化、创新型、高素质复合人才,提高医学院校服务经济社会发展能力。

《中医药文化》40年学术推介与办刊理念之辨

1984年,《医古文知识》在广大青年学子和医学工作者对科学与知识的热切期盼中诞生。在其最初发展的22年中,杂志办刊理念从夯实广大从业人员的医古文基础、提高阅读古代文献的能力,逐步转变为宣传中医药知识、熔文史哲医艺于一炉。2006年,杂志更名为《中医药文化》,致力于发展成具有一定影响力的学术期刊。在杂志社同仁和业界的共同努力下,目前《中医药文化》已经成为学界最为重要的学术推介与交流平台之一。杂志介绍宿儒大家的卓越成果,推荐新人的学术力作,联络各个学科专业的杰出学者,擘画医学人文领域研究的前沿课题,搭建海内外学界沟通的桥梁纽带,营造融洽、热烈的学术研究氛围。杂志为中医药学术的发展、通识教育与科学普及书写了浓墨重彩的一笔,其意义与价值必将铭记在中医药人的心中。

从《医古文知识》到《中医药文化》:笔尖上的40年

1984年《医古文知识》创刊,2006年更名为《中医药文化》,2024年迎来《中医药文化》创刊40周年。通过与创刊主编段逸山教授进行深入访谈,了解创刊背景和创刊初期面临的挑战、期刊发展过程中内容的定位和演变,探讨《中医药文化》学术工作坊的意义及未来发展策略。段逸山教授对《中医药文化》所取得的各种成绩给予肯定,并对《中医药文化》学术影响力的提升和未来的发展方向提出宝贵意见。

疾患的表达及文学治疗的生命力

文章通过论述文学治疗的对象、机制和方法,探讨了文学治疗作为一种医疗手段所存在的价值,疗愈是文学发生的原初功能之一,文学和治疗在科学发展的繁荣表象下被割裂,但在实际的治疗过程中又不可避免地发生合流。文章试图从文学和医学两方面加以阐述和例举,提出"文医"的概念。

提高医学院校学生人文素质的探究

近年来,医学院校忽视对在校学生进行人文素质教育,对此,作者从对医学院校学生进行人文素质教育的必要性、医学院校学生人文素质教育现状和对策三方面给出了切实可行的建议。

Vestibular evoked myogenic potential

Vestibular evoked myogenic potential （VEMP）, is an electromyographic response of vestibular origin evoked by sound, vibration or electrical stimulation. VEMP is widely used as a clinical test of the otolith organs. Now-adays, two kinds of VEMP, cervical VEMP （cVEMP） and ocular VEMP （oVEMP） are clinically used. cVEMP is a test of sacculo-collic refex while oVEMP is a test of utri-culo-ocular refex. Absence of responses, large interau-ral asymmetry of amplitudes, prolonged peak latencies, and abnormal thresholds of responses are regarded as abnormal responses. Clinical application to various diseases of the vestibular system was performed. Using VEMP, a new type of vestibular neuritis, inferior ves-tibular neuritis was established. A prominent feature of VEMP in Meniere’s disease is a shift of a preferred fre-quency in cVEMP. The whole aspects of VEMP fndings in patients with benign paroxysmal positional vertigo are not clarifed yet. Sensitivity of cVEMP to vestibular schwannoma was 80.0%, while specifcity was 52.7%. Concerning diagnosis of superior canal dehiscence syn-drome （SCDS）, oVEMP to air-conducted sound is the most helpful. Augmentation of oVEMP responses is a prominent feature in SCDS. I also presented “idiopathic otolithic vertigo”, which I proposed as a new clinical en-tity based on VEMP fndings. Some patients complained of lateral tilting sensation in the roll plane, or tilting or translational sensation in the pitch plane without rota-tory vertigo. Majority of patients with these symptoms had absent or decreased responses of oVEMP and/or cVEMP. I proposed that these patients could be diag-nosed as having “idiopathic otolithic vertigo”.

Immune response after photodynamic therapy increases anti-cancer and anti-bacterial effects

Photodynamic therapy(PDT) is a clinically approved procedure for treatment of cancer and infections. PDT involves systemic or topical administration of a photosensitizer(PS), followed by irradiation of the diseased area with light of a wavelength corresponding to an absorbance band of the PS. In the presence of oxygen, a photochemical reaction is initiated, leading to the generation of reactive oxygen species and cell death. Besides causing direct cytotoxic effects on illuminated tumor cells, PDT is known to cause damage to the tumor vasculature and induce the release of pro-inflammatory molecules. Pre-clinical and clinical studies have demonstrated that PDT is capable of affecting both the innate and adaptive arms of the immune system. Immune stimulatory properties of PDT may increase its beneficial effects giving the therapy wider potential to become more extensively used in clinical practice. Be-sides stimulating tumor-specific cytotoxic T-cells capable to destroy distant untreated tumor cells, PDT leads to development of anti-tumor memory immunity that can potentially prevent the recurrence of cancer. The immunological effects of PDT make the therapy more effective also when used for treatment of bacterial infections, due to an augmented infiltration of neutrophils into the infected regions that seems to potentiate the outcome of the treatment.

Noise-induced hearing loss in the 21^(st) century: A research and translational update

Millions of people worldwide are exposed to harmful levels of noise daily in their work and leisure environment. This makes noise-induced hearing loss(NIHL) a major occupational health risk globally. NIHL is the second most common form of acquired hearing loss after agerelated hearing loss and is itself a major contributing factor to presbycusis. Temporary threshold shifts, once thought to be relatively harmless and recoverable, are now known to cause permanent cochlear injury leading to permanent loss of hearing sensitivity. This article reviews the current understanding of the cellular and molecular pathophysiology of NIHL with latest findings from animal models. Therapeutic approaches to protect against or to mitigate NIHL are discussed based on their proposed action against these known mechanisms of cochlear injury. Successes in identifying genes that predispose individuals to NIHL by candidate gene association studies are discussed with matched gene knockout animal models. This links to exciting developments in experimental gene therapy to replace and regenerate lost hair cells and post-noise otoprotective therapies currently being investigated in clinical trials. The aim is to provide new insights into current and projected future strategies to manage NIHL; bench to bedside treatment is foreseeable in the next 5 to 10 years.

Role of myeloid-derived suppressor cells in autoimmune disease

Myeloid-derived suppressor cells(MDSCs) represent an important class of immunoregulatory cells that can be activated to suppress T cell functions. These MDSCs can inhibit T cell functions through cell surface interactions and the release of soluble mediators. MDSCs accumulate in the inflamed tissues and lymphoid organs of patients with autoimmune diseases. Much of our knowledge of MDSC function has come from studies involving cancer models, however many recent studies have helped to characterize MDSC involvement in autoimmune diseases. MDSCs are a heterogeneous group of immature myeloid cells with a number of different functions for the suppression of T cell responses. However, we have yet to fully understand their contributions to the development and regulation of autoimmune diseases. A number of studies have described beneficial functions of MDSCs during autoimmune diseases, and thus there appears to be a potential role for MDSCs in the treatment of these diseases. Nevertheless, many questions remain as to the activation, differentiation, and inhibitory functions of MDSCs. This review aims to summarize our current knowledge of MDSC subsets and suppressive functions in tissue-specific autoimmune disorders. We also describe the potential of MDSC-basedcell therapy for the treatment of autoimmune diseases and note some of hurdles facing the implementation of this therapy.

Extended pectoralis major myocutaneous flap in head and neck reconstruction

Although the pectoralis major myocutaneous flap is often used in head and neck reconstruction, the extension of the skin paddle beyond the inferior limits of the muscle has not been well described. We aim to clarify the design and application of this extended flap in head and neck reconstruction. In this retrospective study, consecutive cases of extended pectoralis major myocutaneous flap reconstruction of post-ablative head and neck defects at a single tertiary referral center were included for analysis. In 7 cases an extended pectoralis major flap was utilized, in which the skin paddle was extended beyond the inferior border of the pectoralis major to include the rectus sheath. Skin and soft tissue as well as composite defects of the oral cavity, parotid/temporal region and neck were reconstructed. All flaps healed satisfactorily with no loss of skin viability. The extended pectoralis major myocutaneous flap is robust and has versatile applications for reconstruction of large, high and three dimensionally complex defects in the head and neck region.

Noise-induced cochlear inflammation

Hearing loss is the most common sensory disability with considerable social and economic implications. According to recent World Health Organization estimates,360 million people worldwide suffer from moderate to profound hearing loss. Exposure to excessive noise is one of the major causes of sensorineural hearing loss,secondary only to age-related hearing loss(presbyacusis). Since cochlear tissues have limited abilities of repair and regeneration, this damage can be irreversible, leading to cochlear dysfunction and permanent hearing loss. Recent studies have shown that cochlear inflammation can be induced by noise exposure and contribute to the overall pathogenesis of cochlear injury and hearing loss. The cochlea is separated from the systemic circulation by the blood-labyrinth barrier,which is physiologically similar to the blood-brain barrier of the central nervous system. Because of this feature, the cochlea was originally considered an immunologically privileged organ. However, this postulate has been challenged by the evidence of an inflammatory response in the cochlea in the presence of bacterial or viral pathogens or antigens that can cause labyrinthitis. Although the main purpose of the inflammatory reaction is to protect against invading pathogens, the inflammatory response can also cause significant bystander injury to the delicate structures of the cochlea. The cochlear inflammatory response is characterised by the generation of proinflammatory mediators(cytokines, chemokines and adhesion molecules), and the recruitment of inflammatory cells(leukocytes). Here, we present an overview of the current research on cochlear inflammation, with particular emphasis on noise-induced cochlear inflammation. We also discuss treatment strategies aimed at the suppression of inflammation, which may potentially lead to mitigation of hearing loss.

Hepatic portal venous gas: Physiopathology, etiology, prognosis and treatment

Hepatic portal venous gas (HPVG), an ominous radiologic sign, is associated in some cases with a severe underlying abdominal disease requiring urgent operative intervention. HPVG has been reported with increasing frequency in medical literature and usually accompanies severe or lethal conditions. The diagnosis of HPVG is usually made by plain abdominal radiography, sonography, color Doppler flow imaging or computed tomography (CT) scan. Currently, the increased use of CT scan and ultrasound in the inpatient setting allows early and highly sensitive detection of such severe illnesses and also the recognition of an increasing number of benign and non-life threatening causes of HPVG. HPVG is not by itself a surgical indication and the treatment depends mainly on the underlying disease. The prognosis is related to the pathology itself and is not influenced by the presence of HPVG. Based on a review of the literature, we discuss in this paper the pathophysiology, risk factors, radiographic findings, management, and prognosis of pathologies associated with HPVG.

Current situation on the reporting quality of randomized controlled trials in 5 leading Chinese medical journals

Objective:The Consolidated Standards for Reporting of Trials(CONSORT) statement has already proved to be an efficient standard for reporting quality of randomized controlled trials(RCTs).However,most of the Chinese medical journals have not endorsed the CONSORT statement.The current situation about the reporting quality of RCTs in Chinese medical journals is still unclear.The purpose of the study was to evaluate the reporting quality of RCTs on papers published in 5 leading Chinese medical journals.Methods:We evaluated 232 original RCT papers using a reporting quality scale based on CONSORT statement from 2001 to 2006 in 5 Chinese medical journals(Journal type 1) without adoption of CONSORT and Chinese Journal of Evidence-based Medicine(Journal type 2) which adopted CONSORT in 2004.We measured the inclusion of 26 items for the reporting quality scale and 6 core items of each RCT report,gave score to each item and calculated the total score obtained in each report and the proportion of reports including individual items.The reporting quality of RCT trials from 2001 to 2003(pre-adoption period) was compared with that from 2004 to 2006(post-adoption period).Results:The average reporting quality of RCTs was moderate(mean score,15.18),and the mean score of the 6 core items was low(mean score,1.09) in 5 leading journals.The difference in the total score and the score of the 6 core items between pre-adoption period(2001-2003) and post-adoption period(2004-2006) was statistically significant(P=0.003;P=0.000).Interaction between journal type and period was not significant(F=0.76;P=0.383).We concluded that the change tendency of reporting quality between Journal type 1 and 2 was not different.But as to the core items of sequence concealment and intention-to-treat analysis,the increases were greater for Journal type 2 when evaluated against Journal type 1(P=0.038;P=0.016).Conclusion:The reporting quality of RCT trials in 5 leading Chinese medical journals is improving.However,the lack of important items in RCT trials remains a serious problem.We recommend the endorsement of the Consolidated Standards for Reporting of Trials statement in Chinese medical journals and the continuing education on evidence-based medicine in China.

Why do we have so much trouble treating anal fistula?

Anal fistula is among the most common illnesses affecting man.Medical literature dating back to 400 BC has discussed this problem.Various causative factors have been proposed throughout the centuries,but it appears that the majority of fistulas unrelated to specific causes (e.g.Tuberculosis,Crohn’s disease) result from infection (abscess) in anal glands extending from the intersphincteric plane to various anorectal spaces.The tubular structure of an anal fistula easily yields itself to division or unroofing (fistulotomy) or excision (fistulectomy) in most cases.The problem with this single,yet effective,treatment plan is that depending on the thickness of sphincter muscle the fistula transgresses,the patient will have varying degrees of fecal incontinence from minor to total.In an attempt to preserve continence,various procedures have been proposed to deal with the fistulas.These include: (1) simple drainage (Seton);(2) closure of fistula tract using fibrin sealant or anal fistula plug;(3) closure of primary opening using endorectal or dermal flaps,and more recently;and (4) ligation of intersphincteric fistula tract (LIFT).In most complex cases (i.e.Crohn’s disease),a proximal fecal diversion offers a measure of symptom-atic relief.The fact remains that an "ideal" procedure for anal fistula remains elusive.The failure of each sphincter-preserving procedure (30%-50% recurrence) often results in multiple operations.In essence,the price of preservation of continence at all cost is multiple and often different operations,prolonged disability and disappointment for the patient and the surgeon.Nevertheless,the surgeon treating anal fistulas on an occasional basis should never hesitate in referring the patient to a specialist.Conversely,an expert colorectal surgeon must be familiar with many different operations in order to selectively tailor an operation to the individual patient.

Apoptotic signaling through reactive oxygen species in cancer cells

Reactive oxygen species(ROS) take part in diverse biological processes like cell growth,programmed cell death,cell senescence,and maintenance of the transformed state through regulation of signal transduction. Cancer cells adapt to new higher ROS circumstance. Sometimes,ROS induce cancer cell proliferation. Meanwhile,elevated ROS render cancer cells vulnerable to oxidative stress-induced cell death. However,this prominent character of cancer cells allows acquiring a resistance to oxidative stress conditions relative to normal cells. Activated signaling pathways that increase the level of intracellular ROS in cancer cells not only render up-regulation of several genes involved in cellular proliferation and evasion of apoptosis but also cause cancer cells and cancer stem cells to develop a high metabolic rate. In over the past several decades,many studies have indicated that ROS play a critical role as the secondary messenger of tumorigenesis and metastasis in cancer from both in vitro and in vivo. Here we summarize the role of ROS and anti-oxidants in contributing to or preventing cancer. In addition,we review the activated signaling pathways that make cancer cells susceptible to death.

Laparoscopic fenestration vs open fenestration in patients with congenital hepatic cysts: A meta-analysis

AIM: To determine whether the outcomes of laparoscopic fenestration (LF) were superior to open fenestration (OF) for congenital liver cysts.METHODS: Comparative studies published between January 1991 and May 2010 on Medline (Ovid),Emsco,PubMed,Science Direct;Cochrane Reviews;CNKI;Chinese Biomedical Database,VIP and other electronic databases were searched.Randomized controlled trials (RCTs) and retrospective case-control studies on the management of congenital hepatic cysts were collected according to the pre-determined eligibility criteria to establish a literature database.Retrieval was ended in May 2010.Meta-analysis was performed using RevMan 5.0 software (Cochrane library).RESULTS: Nine retrospective case-control studies involving 657 patients,comparing LF with OF were included for the final pooled analysis.The meta-analysis results showed less operative time [mean difference (MD): -28.76,95% CI: -31.03 to 26.49,P < 0.00001];shorter hospital stay (MD: -3.35,95% CI: -4.46 to -2.24,P < 0.00001);less intraoperative blood loss (MD: -40.18,95% CI: -52.54 to -27.82,P < 0.00001);earlier return to regular diet (MD: -29.19,95% CI: -30.65 to -27.72,P < 0.00001) and activities after operation (MD: -21.85,95% CI: -31.18 to -12.51,P < 0.0001) in LF group;there was no significant difference between the two groups in postoperative complications (odds ratio: 0.99,95% CI: 0.41 to 2.38,P = 0.98) and cysts recurrence rates.CONCLUSION: The short-term outcomes of LF for patients with congenital hepatic cysts were superior to open approach,but its long-term outcomes should be verified by further RCTs and extended follow-up.

Eotaxin-2 blockade ameliorates experimental autoimmune encephalomyelitis

AIM： To study the effect of blocking the eo-2 pathwaon the development and severity of experimental autoimmune encephalomyelitis （EAE）. METHODS： We produced mAb directed against eo-2named D8. MOG35-55 induced-EAE mice were dailintravenously injected with either 25 μg or 100 μg D8or with vehicle control alone [phosphate-buffered saline（PBS）], starting from day 0 post immunization and weremonitored for EAE clinical score （n = 10 in each group）Mice were sacrifced on day 58 and their sera were assessed for the presence of anti-myelin oligodendrocyteglycoprotein （anti-MOG） antibodies autoantibodies, awell as for the profle of pro-infammatory cytokines andchemokines. Histological analysis of brain sections waperformed by hematoxylin and eosin staining.RESULTS： Daily treatment of EAE induced mice with D8 signifcantly decreased the severity of EAE symp-toms. Treatment with both concentrations of D8 ame-liorated EAE symptoms compared to PBS treated mice, starting from day 42 post immunization （0.89 ± 0.35 in D8 25 μg and D8 100 μg treated groups vs 2.11 ± 0.38 in the PBS treated group, P = 0.03）. A signifcant im-provement in EAE clinical score compared to total IgG treated mice was observed with the higher concentra-tion of D8 （0.81 ± 0.38 in D8 100 μg treated group vs 2.11 ± 0.31 in IgG1 treated group, on day 56 post immunization, P = 0.04）. D8 treated mice with EAE did not signifcantly exhibit lower sera levels of anti-MOG autoantibodies compared to IgG-treated mice. How-ever, they expressed lower sera levels of the pro-in-fammatory cytokines： tumor necrosis factor （7.8 ± 0.2 pg/mL in D8 100 μg treated mice vs 19.9 ± 3.4 pg/mL in IgG treated mice, P = 0.005） and interferon-gamma （1.4 ± 0.6 pg/mL in D8 100 μg treated mice vs 3.6 ± 0.4 pg/mL in IgG treated mice, P = 0.02）, as well as reduced levels of the chemokine macrophage che-moattractant protein-1 （27.2 ± 3.1 pg/mL in D8 100 μg treated mice vs 63.7 ± 12.3 pg/mL in IgG treated mice, P = 0.03）. These fndings indicate that blocking the eo-2 pathway in EAE may affect not only eosino-phil infltration into the central nervous system （CNS）, but also have an effect on monocytes and T cells, but not humoral, mediated responses. Histological analysis of the brains of D8 treated mice with EAE support that this treatment decreases immune cells infltrates in the CNS.CONCLUSION： Taken together, these fndings suggest a role for eo-2 in EAE pathogenesis and consequen-tially may support a therapeutic potential of anti-eo-2 neutralizing mAb in multiple sclerosis.

为文只求关教事--略评《中医典籍与文化十讲》

《中医典籍与文化十讲》通过典籍、生命、疾病、养生和本草五个专题,对中医学与中国传统文化的密切关联进行了重点阐发。从中医教育而言,该书具有以下特点:强调中医典籍学习对于全面了解中医知识体系以及中医传承发展的意义所在;以生命观展现中西医学与文化的差异,将中医学的生命观作为理解与把握中医学理论特质的重点与核心;以疾病、养生、本草三个专题为切入点,阐发了医学与人文双重视野对于理解和发展中医的重要性。该书对于弥补现行中医教材体系的部分知识缺失,推动中医教育发展,具有一定的积极意义。