从《金匮要略》论“治冷不尽用温药”

"寒者热之"是治疗以"冷"为特点的临床证候的常用治疗大法,《金匮要略》中常将"冷"症表述为恶寒、寒热、寒痛、振寒、肢厥等。文章对《金匮要略》中明确出现"冷""寒""凉""厥""冰"等描述的条文,及虽述症太简、但从病机推测应具有"冷"症表现的条文进行整理、分析,总结了"阳虚"和"阳遏"两大类致冷因素,提炼出"治冷不尽用温药"的观点,探讨了因外邪、阴邪、瘀血三大致病因素致冷,治疗不尽用温药的情况,阐述了张仲景治疗此类疾病的临床特点和用药经验,有助于完善《金匮要略》中张仲景治疗思路的研究和指导临床的应用,具有一定的现实意义。

伸筋草功效考

伸筋草是石松科石松属植物石松的干燥全草,是典型的"同药异名""异名同药",别名有石松、过山龙等。《本草拾遗》首提伸筋草之名,《滇南草本》对云南本土中医药的独特药性均有阐述,其对伸筋草功效的阐述别具特色。在考证中药典籍与临床验证的基础上,发掘出伸筋草具有善治脚膝疼冷与促排卵独特的药性,临床善治脚膝疼冷与多囊卵巢综合症导致的排卵障碍,其药性可达卵巢,促进卵巢平滑肌的收缩,有助于排卵。

Sequential use of transarterial chemoembolization and percutaneous cryosurgery for hepatocellular carcinoma

AIM: To evaluate the efficacy of sequential use of transarterial chemoembolization (TACE) and percutaneous cryosurgery for unresectable hepatocellular carcinoma (HCC). METHODS: Four hundred and twenty patients were enrolled in this study. The patients, who were considered to have unresectable tumors due to their location or size or comorbidity, were divided into sequential TACE-cryosurgery (sequential) group (n = 290) and cryosurgery alone (cryoalone) group (n = 130). Patients in the sequential group tended to have larger tumors and a greater number of tumors than those in the cryo-alone group. Tumors larger than 10 cm in diameter were only seen in the sequential group. TACE was performed with the routine technique and percutaneous cryosurgery was conducted under the guidance of ultrasound 2-4 wk after TACE. RESULTS: During a mean follow-up period of 42 ± 17 mo (range, 24-70 mo), the local recurrence rateat the ablated area was 17% for all patients, 11% and 23% for patients in sequential group and cryoalone groups, respectively (P = 0.001). The overall 1-, 2-, 3-, 4and 5-year survival rate was 72%, 57%, 47%, 39% and 31%, respectively. The 1and 2-year survival rates (71% and 61%) in sequential group were similar to those (73% and 54%) in cryo-alone group (P = 0.69 and 0.147), while the 4and 5-year survival rates were 49% and 39% in sequential group, higher than those (29% and 23%) in cryo-alone group (P = 0.001). Eighteen patients with large HCC (> 5 cm in diameter) survived for more than 5 years after sequential TACE while no patient with large HCC (> 5 cm in diameter) survived more than 5 years after cryosurgery. The overall complication rate was 24%, and the complication rates were 21% and 26% for the sequential and cryo-alone groups, respectively (P = 0.06). The incidence of hepatic bleeding was higher in cryo-alone group than in sequential group (P = 0.02). Liver crack only occurred in two patients of the cryoalone group. CONCLUSION: Pre-cryosurgical TACE can increase the cryoablation efficacy and decrease its adverse effects, especially bleeding. Sequential TACE and cryosurgery may be the better procedure for unresectable HCC, especially for large HCC.

Effectiveness of impedance monitoring during radiofrequency ablation for predicting popping

AIM： To retrospectively evaluate the effectiveness of impedance monitoring for predicting popping during radiofrequency ablation （RFA） using internally cooled electrodes. METHODS： We reviewed 140 patients （94 males, 46 females; age range 73.0 ＋ 11.1 year） who underwent RFA between February 2006 and November 2008 with a modified protocol using a limited power delivery rather than a conventional one to avoid popping. All the patients provided their written informed consent, and the study was approved by the institutional review board. Intraprocedural impedances were measured for the study subjects, and the tumors were classified into three types according to the characteristics of their impedance curves： increasing, flat, or decreasing. The tumors were further sorted into seven subtypes （A-G） depending on the curvature of the impedance curve＇ s increase or decrease. Relative popping rates were determined for the three types and seven subtypes. A chi-square test was performed to estimate statistical significance.RESULTS： A total of 148 nodules treated by RFA were analyzed. The study samples included 132 nodules of hepatocellular carcinoma, 14 nodules of metastatic liver cancer, and two nodules of intrahepatic cholangio- carcinoma. The numbers of nodules with each imped- ance curve type were as follows： 37 increasing-type nodules, 43 fiat-type nodules, and 68 decreasing-type nodules. Popping occurrence rates were 24.3%, 46.5% and 64.7%, respectively. Flat-type nodules exhibited a significantly higher rate of popping compared to increasing-type nodules （P = 0.039）. Decreasing-type nodules exhibited a significantly higher rate of popping compared to increasing-type nodules （P 〈 0.0001）. No- tably, nodules that showed a sharp decrease in imped- ance in the latter ablation period （subtype E） exhibited a significantly higher rate of popping compared to other subtypes. CONCLUSION： Intraprocedural impedance monitoring can be a useful tool to predict the occurrence of pop- ping during liver tumor RFA performed with internally cooled electrodes.

Tumour seeding after percutaneous cryoablation for hepatocellular carcinoma

AIM:To assess the rate and risk factors for tumour seeding in a large cohort of patients.METHODS:Over an 8-year period,1436 hepatocellular carcinoma(HCC) patients with 2423 tumour nodules underwent 3015 image-guided percutaneous cryoablation sessions [1215 guided by ultrasonography and 221 by spiral computed tomography(CT)].Follow-up CT or magnetic resonance imaging was performed every 3 mo.The detailed clinical data were recorded to analyse the risk factors for seeding.RESULTS:The median follow-up time was 18(range 1-90) mo.Seeding was detected in 11 patients(0.76%) at 1-24(median 6.0) mo after cryoablation.Seeding occurred along the needle tract in 10 patients and at a distant location in 1 patient.Seeded tumours usually showed similar imaging and histopathological features to the primary HCCs.Univariate analyses identified subcapsular tumour location and direct subcapsular needle insertion as risk factors for seeding.Multivariate analysis showed that only direct subcapsular needle insertion was an independent risk factor for seeding(P = 0.017;odds ratio 2.57;95%CI:1.47-3.65).Seeding after cryoablation occurred earlier in patients with poorly differentiated HCC than those with well or moderately differentiated HCC [1.33 ± 0.577 mo vs 11.12 ± 6.896 mo;P = 0.042;95%CI:(-19.115)-(-0.468)].CONCLUSION:The risk of seeding after cryoablation for HCC is small.Direct puncture of subcapsular tumours should be avoided to minimise seeding.

Progress of heat-hazard treatment in deep mines

Based on the urgency of thermal hazard control in deep coal mines,we studied the status of deep thermal damage and cooling technology both at home and abroad,summarized the causes of deep thermal hazard,analysed and compared the control technologies for deep thermal hazards.The results show that the causes of deep thermal damage can be attributed to three aspects,i.e.,climate,geological and mining factors,of which the geological factors are deemed the major reasons for thermal hazards.As well,we compared a number of cooling technologies of domestic and overseas provenance,such as central air conditioning cooling technology,ice cooling technology and water cooling technology,with one other cooling technology,i.e.,the HEMS cooling technology,which has a large and important effect with its unique＂pure air＂cooling technology,realizes the utilizing of heat resources from underground to the ground.This technology makes use of heat obtained underground;thus the technology can promote low-carbon environmental economic development in coal mines,in order to achieve low- carbon coal production in China.

Expressions of MVD, VEGF, Ki67 in Residual Prostate Cancer after Cryoablation

OBJECTIVE To analyze the effects of cryoablation on the mice bearing Rm-I prostate cancer through detecting tumor angiogenesis and cancer cell proliferation in the mice after cryoablation, and to explore the effects of cryoablation on vascular endothelium growth factor （VEGF）, Ki67 protein expression and microvessel density （MVD） in the mice bearing prostate cancer. METHODS Sixty Rm-1 mouse models of prostate cancer were established. Experimental mice were randomized into 2 groups： the cryoablation group （n = 30） and the control group （n = 30）. After file therap）4 tumor tissues of the mice in group A and B were obtained at day 0 （without cryoablation）, 1st, 3rd, 5th, 7th, 14th day, respectivelj6 after cryoablation, and the expressions of MVD, VEGF and Ki67 proteins were detected at the same time points. RESULTS The expressions of MVD, VEGF and Ki67 proteins in group A were decreased. The lowest values of the factors were detected on the 3rd day after cryoablation, and increased slowly after that. The expressions of MVD, VEGF and Ki67 proteins in the control group were not changed. Significant changes of the expressions of MVD, VEGF and Ki67 proteins in the group A were found at different time points. Correlation analysis suggested a positive correlation between the expressions of VEGF and MVD proteins （r = 0.8793）, a positive correlation between the expressions of Ki67 and MVD proteins （r = 0.7614）, and a positive correlation between the expressions of VEGF and ki67 proteins （r = 0.6921）. CONCLUSION After argon-helium cryoablation treatment for the mice bearing prostate cancer, the expressions of MVD, VEGF and Ki67 proteins in local tumor were reduced on the 1st day. The lowest values of the factors were detected on the 3rd day after cryoablation, and then increased after that. Cryoablation combined with other modalities of treatment may effectively improve the treatment effects of cryoablation for prostate cancer.

Research progress in immunotherapy of pancreatic cancer

Pancreatic cancer is among the most lethal malignancies resistant to conventional therapies. The urgent need fornew therapies has turned the spotlights on immunotherapy. In recent years, a growing body of evidence has alreadybeen gathered regarding the efficacy of genetic engineering modified T-cells, checkpoint inhibitors of T-cells, killercells induced by dendritic cells and cytokine in patients with pancreatic cancer. Cryoimmunotherapy in situ andextra-tumor and immunotherapy combined with chemotherapy could also increase the effectiveness. Research ofpancreatic cancer vaccine has made some progress. The immunity enhancing function of some traditional herbshave been reported, such as Ginsenoside Rg3, which could enhance T-cell subsets and NK cell activity inpancreatic cancer patients with chemotherapy.

CT-Monitored Percutaneous Cryoablation of Uterine Fibroids after Uterine Artery Embolization

OBJECTIVE To investigate the effects of percutaneous cryoablation on uterine fibroids using computed tomographic （CT） guidance after uterine artery embolization.METHODS Twelve patients who failed to respond to uterine artery em- bolization were treated using percutaneous cryoablation. All patients had undergone previous uterine artery embolization an average of 1.2 years （0.7-1.6 years） ago. Two cases had abnormal bleeding, and the other 10 suffered from pressure and/or pelvic pain. Myoma diameters were 4 cm to 16.5 cm. By using CT guidance, 2.0, 2.4, 3.0 or 3.8 mm cryoprobes were placed into the fibroid, and two 15-20 rain freezing processes were performed. Hemostasis was achieved only by pressing the incisions for several minutes. MR-imaging was performed before the procedure to measure the size and number of fibroid tumors, and follow- up MR-imaging determined the reduction of the lesions.RESULTS All patients were discharged within 48 h of treatment. Almost no hemorrhage was found in all of the cases. No bladder or bowel injury or significant postsurgery pain was reported. Ice spheres were readily visualized at CT. Beam-hardening artifact from the metal probes was present, but did not interfere with the procedure. Myomas regressed up to 76.3% after 12 months of treatment, and the primary symptoms improved in all treated women.CONCLUSION CT-monitored percutaneous cryoablation is an effective and minimally invasive therapy for symptom relief and fibroid shrinkage after the failure of uterine artery embolization.

Radical treatment of stage Ⅳ pancreatic cancer by the combination of cryosurgery and iodine-125 seed implantation

AIM:To investigate the therapeutic effect of radical treatment and palliative treatment in stage Ⅳ pancreatic cancer patients.METHODS:81 patients were enrolled in the study.Radical treatment was performed on 51 patients,while 30 patients were put under palliative treatment.The procedural safety and interval survival for stage Ⅳ pancreatic cancer(IS-Ⅳ) was assessed by almost 2.5 years of follow-ups.The IS-Ⅳ of patients under the two kinds of treatment,and the effects of treatment timing and frequency on IS-Ⅳ,were compared.RESULTS:The IS-Ⅳ of patients who received radical treatment was significantly longer than those who received palliative treatment(P < 0.001).The IS-Ⅳ of patients who received delayed radical or palliative treatment was longer than those who received accordingly timely treatment(P = 0.0034 and 0.0415,respectively).Multiple treatments can play an important role in improving the IS-Ⅳ of patients who received radical treatment(P = 0.0389),but not for those who received palliative treatment(P = 0.99).CONCLUSION:The effect of radical treatment was significantly more obvious than that of palliative treatment,and multiple radical treatments may contribute more to patients than a single radical treatment.

Clinical Effects of Treatment for Lung Cancer with Double Points Cryoablation through Percutaneous Puncture Guided by Computed Tomography

OBJECTIVE To investigate the clinical effects of the application of double points cryoablation through percutaneous puncture for advanced lung cancer patients. METHODS Forty-one patients diagnosed with stage III-IV pulmonary carcinoma were selected for the study. The patients were found to have from 1 to 3 foci of carcinoma, and in each case the disease was limited to one lung. The study patients were divided randomly into 3 groups. There were 16 cases receiving routine chemotherapy and radiotherapy in group I, 13 cases treated with cryoablation at a single point in group II, and 12 cases treated with cryoablation at 2 points simultaneously in group III. The patients in the 2 cryoablation groups also received the same treatment as the patients did in group I. The clinical effects were evaluated within 6 months after treatment, and the survival rate was followed-up for 3 years. RESULTS The clinical effects were improved significantly after treatment in group II and in group III compared with those in group I （P 〈 0.05）, including an enhanced regressive rate of 21%, postponed tumor progression of 50.58% and a clinical benefit rate of 92%. The effective rate of regression in group III was higher than that in group II, 43.59% （P 〈 0.05）, and the 3-year survival rate was 37.25%. Significant differences in side effects were not found between the 2 cryoablation groups. CONCLUSION Cryosurgery ablation at 2 points, simultaneously, and directed at I foci might improve the effects of treatment and the prognosis of lung cancer patients, when used in combination with routine treatment.

Field experiment on coalmine heat disaster governance using cold source from surface water

Regarding the lack of cold source for underground cooling systems from either mine inflow or return air, field experiments were taken in a high temperature deep coal mine with abundant cold source from surface water. Taking Sanhejian coal mine as an example, this paper introduced the technology scheme of heat disaster governance using surface water cold source. The paper presents the basics of this field experiment at the beginning, following by the design and site layout of the cooling system including the analysis and calculation of cold source. Numerical calculation method is also applied based on the operation parameters to simulate the influence to the surface river ecosystem. The results suggest that the temperature of surface water shall be lower than 34 ℃ after heat exchange, and when more cooling capacities are needed in the future, increasing the water flow is more favorable than increasing the cooling range of water, which is better for the ecological environment protection,

Experimental study on a cryosurgery apparatus

Cryosurgery is an effective way of curing many diseases including tumors and cancers. It can be applied using a variety of systems and cryogens. Cheap, convenient, reliable equipment still needs to be developed so that cryotherapy may be accepted by surgeons and hospitals. This paper presents a cryosurgery apparatus that utilizes an auto-cascade refrigeration system. Refrigerant mixture R50/R23/R600a was selected as the working fluid. The mixture composition was altered to achieve lower temperatures and higher capacity. The lowest temperature at the cryoprobe could be as low as -100℃, and 8 W refrigeration capacity could be obtained at -80 ℃. An ice ball of 11.6 mm diameter could be formed when the cryoprobe was immersed in a water bath at 37 ℃.

Photothermal therapy of tumors in lymph nodes using gold nanorods and near-infrared laser light with controlled surface cooling

Photothermal therapy （PTT） using near-infrared （NIR） laser light and gold nanorods （GNRs） shows promise as a novel cancer treatment modality. However, the laser intensity required to destroy tumor cells located beneath the skin is greater than the threshold intensity that causes skin damage; thus, irradiation with laser light damages the skin as well as the tumor. Here, we show that a temperature control system allows metastatic lymph nodes （LNs） to be treated by PTT using NIR laser light and GNRs, without skin damage. A mouse model of LN metastasis was developed by injection of tumor cells, and the tumor-bearing proper axillary LN was treated with NIR laser light after injection of GNRs. The skin temperature was maintained at 45 ~C during irradiation by using a temperature control system. Bioluminescence imaging revealed that tumor progression was less in LNs exposed to NIR laser light and GNRs than in LNs exposed to NIR laser light alone or controls （no irradiation or GNRs）. Furthermore, the skin and LN capsule were macroscopically intact on day 9 after irradiation with NIR laser light, whereas tumor cells within the LN showed apoptosis. A numerical analysis demonstrated that the high-temperature zone and the LN region showing damage were localized to an area up to 3 mm in depth. The proposed novel PTT technique, using NIR laser light and GNRs with controlled surface cooling, could be applied clinically to treat metastatic LNs located within or outside the area accessible for surgical dissection.

Effect of "Yang-warming and kidney essence-replenishing" herbal paste on cold-related asthma exacerbation

OBJECTIVE: To observe the effect of "Yang-warming and kidney essence-replenishing" herbal paste on cold-related asthma exacerbation. METHODS: One hundred and fifty one patients with moderate to severe persistent asthma were randomly divided into a treatment group (n=74) and a control group (n=69). Both groups were given basic treatment according to the Global Initiative for Asthma scheme. The treatment group was also treated with herbal paste in the winter. The frequency of asthma exacerbation, cold and cold-re-lated asthma exacerbation, scores of the asthma control test (ACT), and kidney-deficiency syndrome during the one-year follow-up in each group were recorded. RESULTS: Compared with the control group, the onset frequencies of catching cold, asthma exacerbation, cold-related asthma exacerbation, and kidney-deficiency syndrome score were significantly reduced. There was no significant difference in scores of ACT between the two groups. CONCLUSION: "Yang-warming and kidney essence-replenishing" herbal paste could reduce cold-related asthma exacerbation.

Exploration of the Relationship between Geographical Environment and Human Diseases in Ancient China

The Yellow Emperor's Classic of Internal Medicine (黄帝内经素问Huangdi Neijing Suwen), created in the Warring States period (475 to 221 BC) described a phenomenon whereby the eastern, western, northern, southern, and central regions were liable to different diseases. It brought forward the principle of treatment in accordance with local conditions. Lv's Spring and Autumn Annals, Huai Nan Tzu (Huainanzi), and the Regiment of Health (Yangshenglun) in the Qin, Han, Wei, Jin, and Southern and Northern Dynasties all describe regional diseases such as goiter (endemic goiter) and yellowish teeth (dental fluorosis) as being caused by geologic and climatic factors. Zhang (miasma), first mentioned in the Han Dynasty, was considered related to the summer heat and dampness particular to the geographical environment of the south. Zhang was further associated with malaria in the Jin Dynasty. General Treatise on the Etiology and Symptomology of Diseases (Zhubingyuanhou Lun), in the Sui Dynasty, held that as a type of poisonous gas, Zhang was the predisposing cause of malaria, seasonal disease, and barbiers, among other conditions. General Guide (Zhinan Zonglun), in the Southern Song Dynasty, regarded Zhang malaria as a separate disease. Healthy Prescription in the Southern Wuling District (Lingnan Weisheng Fang), in the late Song and early Yuan Dynasties, explicitly put forward the concepts of cold Zhang, hot Zhang, and lockjaw Zhang. Guidelines for Treatment of Zhang Malaria (Zhangnue Zhinan), in the Ming Dynasty, maintained that cold Zhang was equivalent to malaria, while hot Zhang and lockjaw Zhang were equivalent to cold damage, the latter of which can be treated by prescriptions for cold damage. Records on Zhang gas and Zhang disease decreased during the Ming and Qing Dynasties.

From the Founding to the Crisis of Mao Zedong and of China Ruling Party： The Identity the Communist Party

Over the course of the epochal 30 years, i.e., from the founding of People＇s Republic of China in 1949 till the launching of Chinese economic reform in 1978, the Communist Party of China （CPC） underwent a tremendous transformation from the founding to the ruling party of the country. The present research examines the historical, social as well as political aspects of the identity crisis and the CPC was suffering from in its adventurous efforts to chart a course for the socialist transformation of China. It was tempted to resume its leadership role in the revolution given the mounting tension generated by the Cold War and the prevailing revolutionary beliefs within the Party. Nevertheless, it was obliged to restore the country＇s social and political order after the sweeping national reform. In search of an adequate interpretation for the various attempts the Party made in exploring its refreshed identity, hence resolving the crisis, the study focuses on a similar crisis which befell the Party leader, Mao Zedong, in his own struggle against the con- fusion caused by his potentially double role as the head of both a founding and a ruling party. The study suggests that Mao＇s misidentification of his own political role inevitably led to the Party＇s dysfunctions, and closer investigation into the leader＇s personal dilemma offers new insight into such tragic events as the Anti- Rightist Movement, the Great Leap Forward, and the Cultural Revolution.