《伤寒杂病论》定量理论中治疗法度思想探微

张仲景的定量思想体现在辨证论治的各个方面,通过对《伤寒杂病论》原文进行仔细研读和深入分析,探究该书治疗中的法度思想以及其中蕴藏的深层涵义及临床价值。总结出其治疗法度思想不仅体现在量化语言描述上,更体现在剂型、治法、方药煎服以及在治疗中充分考虑病位、体质因素等方面。说明张仲景精准把握疾病的治疗法度,加强对该思想的系统分析和总结运用,以期为临床诊治过程中选方用药和剂量的法度把握提供依据和思路来源。

《黄帝内经》量效关系和治疗法度思想探微

通过对《黄帝内经》原文进行认真研读,系统探讨其中能够体现量效关系和治疗法度思想的论述。探讨其深层涵义、后世论述及临床价值。其中不仅有对药用轻重与病位关系的治疗效应论述,也有治疗用药法度的精确把握,还有关于针刺治疗法度及各种影响因素的详细阐释。这些理论具备了鲜明的中医学特色,包涵着浓厚的中医量值理论内涵,体现着典型的中医辨治思维特点。这些论述反映了《黄帝内经》量学思维的精粹,饱含着辩证法的光华。对中医学定量辨证理论研究和运用,对于临证辨治原则、选方用药和剂量把握均具有重要的指导价值。

中医学量效关系和治疗法度名词术语探微

通过对中医学文献进行认真研读,系统探讨中医学中能够体现临床辨治的量效关系和治疗法度的名词术语。探讨这些名词术语(如轻可去实、重可去怯和药过病所等)的渊源、涵义、后世论述及临床价值。这些理论包涵着浓厚的中医思辨内涵,体现着典型的中医思维特色。这些名词术语反映着中医学量学思维的精粹,饱含着辩证法的光华,彼此之间亦可相互联系,启发融汇。这些研究对中医学定量辨证理论研究和运用、对于临证选方用药和剂量把握均具有重要的指导价值。

High prevalence of osteoporosis in patients with gastric adenocarcinoma following gastrectomy

AIM： To evaluate the prevalence and predictive factors of osteoporosis in patients with gastric adenocarcinoma alter gastrectomy.METHODS： The study included 133 patients diagnosed with gastric adenocarcinoma but who did not undergo prior diagnostic work-up for osteoporosis. Bone mineral density （BMD） was measured by dual-energy X-ray absorptiometry （DXA） and vertebral deformity was assessed by plain X-rays. We evaluated the effects of age, sex, body mass index （BMI）, anemia, back pain, vertebral deformity, tumor staging, reconstruction type, and past medical history to determine predictive factors of osteoporosis in these patients.RESULTS： The prevalence of osteoporosis in the lumbar spine was 38.3% （male, 28.9%; female, 54.0%）, and 15.0% in the femoral neck （male, 10.8%; female, 22.0%）. The vertebral deformity rate was 46.6% （male, 43.4%; female, 52.0%）. Age, BMI and hemoglobin correlated with BMD （P 〈 0.01）. In males, anemia and age 〉 64 years were independent predictive factors of osteoporosis in multivariate analysis. In females, back pain was an independent factor for osteoporosis.CONCLUSION： The results of this study revealed that prevalence of osteoporosis and vertebral bone deformity rate were high in gastric cancer patients, regardless of post-gastrectomy duration and operation type. Early diagnosis and a proper management plan must be established in these patients.

Proton-pump inhibitor-induced hypomagnesemia: Current research and proposed mechanisms

Since the early reports nearly a decade ago, proton-pump inhibitor-induced hypomagnesemia （PPIH） has become a well-recognized phenomenon. While many observational studies in the inpatient and outpatient populations have confirmed the association of PPI exposure and serum magnesium concentrations, there are no prospective,controlled studies to support causation. Molecular mechanisms of magnesium transporters, including the pH-dependent regulation of transient receptor potential melastatin-6 transporters in the colonic enterocyte, have been proposed to explain the effect of PPIs on magnesium reabsorption, but may be a small part of a more complicated interplay of molecular biology, pharmacology, and genetic predisposition. This review explores the current state of research in the feld of PPIH and the proposed mechanisms of this effect.

Should we redefi ne large common bile duct stone?

The definition of large stones is not clear ranging from 10 mm to 15 mm and does not include the lower common bile duct (CBD) diameter. Three hundred and four patients who underwent endoscopic retrograde cholangiopancreatography and stone extraction were retrospectively analyzed over a 1-year period. Sixteen patients were different from others in that 10 patients with large stones had stone extraction with a wire basket or a balloon catheter and 6 patients with small stones had stone extraction with mechanical lithotripsy. The defi nition of large stones should include diameter of the lower CBD and any stone in lower CBD with its diameter greater than 2 mm.

Use of a device that applies external kneading-like force on the abdomen for treatment of constipation

AIM: To evaluate the efficacy of a recently developed device that applies kneading-like motion on the abdomen in improving constipation in elderly long-term care patients. METHODS: Thirty constipated elderly patients were randomly selected from two nursing homes. They were instructed to use the device once daily for 20 min. Rate of bowel movements, volume and consistency of stool and the use of laxantia were all recorded during a 3-wk baseline period and for 12-wk treatment period. Colonic transit time (CTT) was measured in 13 patients by radiopaque markers during the baseline and at the end of treatment. RESULTS: Bowel movement rate (BM/week) increased from 1.4±0.4 BM/wk during baseline to 3.9±0.8 BM/wk during treatment (P<5.0×10-7). Stool amount that was 'low' in 30 patients during baseline increased in 21 patients at the end of the study period (x2 = 19.048-P= 1.3×10-5). Stool consistency,that was 'hard' in 25 patients and 'soft' in 5 patients during baseline, ameliorated in 23 patients at the end of the study (only 2 patients referred 'hard' stool) (x2 = 21.043-P= 4.0×10-6). The mean baseline CTT measured was 92.3±32.3 h at baseline and decreased to 49.4±31.3 h during the study period (P = 0.000208). No side effects were observed during the study period. CONCLUSION: External mechanical vibration of the abdomen reduced CTT and helped to relieve severe constipation in elderly constipated patients.

Gait speed and hospitalization among ambulatory hemodialysis patients: USRDS special study data

AIM： To assess the association of measured gait speed with hemodialysis （HD） patients’ hospitalization, in conjunction with, and apart from, recent fall history.METHODS： Gait speed was measured by a standard protocol and falls during the past 12 mo were ascertained for a prevalent multi-center HD cohort （n = 668） aged 20-92. Hospitalization during the past 12 mo was identified in the patient’s clinic records, and the first hospitalization after gait speed assessment （or the competing event of death） was identifed in the 2013 United States Renal Data System Standard Analysis Files.characterized 34.7% of the patients, and 27.1% had experienced a recent fall. Patients with slow gait speed but without a history of recent falls were 1.79 times more likely to have been hospitalized during the past 12 mo （OR = 1.79, 95%CI： 1.11-2.88, P = 0.02）, and patients with slow gait speed and a history of recent falls were over two times more likely to have been hospitalized （OR = 2.10, 95%CI： 1.19-3.73, P = 0.01）, compared with patients having faster gait speed and no recent fall history. Prospective examination of gait speed/fall history status in relation to frst hospitaliza-tion （or death） incurred by the end of follow-up Decem-ber 31, 2011 also showed that slow gait speed was as-sociated with these events in conjunction with a history of falls （HR = 1.54, 95%CI： 1.04-2.30, P = 0.03）.CONCLUSION： The International Task Force on Nutri-tion and Aging reported that gait speed is a powerful predictor for older adults of adverse outcomes such as hospitalization. In our data, gait speed-apart from, as well as in conjunction with, recent fall history-was as-sociated with HD patients’ hospitalization for multiple causes. Gait speed may be a sensitive health indicator among HD patients across the age spectrum.

Levomilnacipran and vortioxetine:Review of new pharmacotherapies for major depressive disorder

Major depressive disorder(MDD) is a common psychiatric disorder with an estimated lifetime prevalence rate in the range of 13% to 16% in the United States population. Patients with MDD often have symptoms such as depressed mood, loss of interest or pleasure in usual activities, changes in eating or sleeping patterns, fatigue, difficulty concentrating and thoughts of suicide. Although many pharmacotherapy treatment options are available for MDD, antidepressants can oftencause adverse effects that could affect adherence to the medication. Additionally, it is estimated that MDD is unremitting in 15% of patients and 35% can have recurrent episodes. Given the high rate of recurrence and the adverse effects associated with existing medications, new treatment options for depression are needed. Both levomilnacipran and vortioxetine are new antidepressants that were approved by the food and drug administration in 2013 for the treatment of MDD in adults. Levomilnacipran is a serotonin norepinephrine reuptake inhibitor that was effective in several short term studies and sustained efficacy and tolerability was demonstrated in a 48-wk extension study. Vortioxetine is a multi-modal antidepressant and it is thought to work via inhibition of the serotonin(5-HT) transporter, 5-HT3 A, 5-HT7 and 5-HT1 D antagonist, a 5-HT1 B partial agonist, and a 5-HT1 A agonist. Vortioxetine was effective in the treatment of MDD in both short-term trials as well as in the prevention of relapse in a 24-36 wk trial. Sustained efficacy and tolerability was demonstrated in several long-term open-label trials. Further studies comparing levomilnacipran and vortioxetine to other currently available antidepressants are needed to establish its place in therapy.

THEORETICAL ANALYSIS ON THE DEPTH OF NEEDLE-INSERTION

In the present paper, the author sums up and analyzes descriptions about needle-insertion depth in Chinese classical medical book Huang Di Nei Jing (《黄帝内经》The Yellow Emperor’s Internal Classic). In many chapters of Nei Jing, the needle-insertion depth is stressed to be various according to 1) the deficiency or excess of syndromes, 2) the patients’ constitution, 3) the severity of disease, 4) the duration of disease, 5) the location of disease, 6) the patient’s age, 7) the location of the needled acupoint, 8) the season, 9) the patient’s temperament, 10) the pulse condition, 11) the state of “Deqi”, and 12) the location of the running course of meridians. In addition, different kinds of diseases and different stages of diseases also need different depths of needle insertion, different manipulating skills and different stimulating quantity.

Regeneration of Spent Activated Carbon by Yeast and Chemical Method

In this study,spent activated carbon(AC) saturated with caramel was regenerated by using yeast and NaOH.The efficiency of regeneration was evaluated under parameters such as amount,treatment time,temperature,pH value,stirring temperature of yeast and NaOH concentration.The optimum condition for AC regeneration was 8 h for yeast treatment time,35 ℃ for 0.075% yeast culture temperature,a pH value of 6 for the yeast dealing with the spent AC,90 ℃ for NaOH stirring temperature of AC and 6% NaOH for washing after the spent AC was treated by yeast.Under these conditions,methylene blue(MB) adsorption was 213 mg·g-1 in comparison with 60 mg·g-1 of spent AC.The micro structure and surface area of the regenerated AC were characterized by scanning electron mi-croscope(SEM) and N2 sorption,respectively.The pore size distributions of virgin and regenerated AC were ana-lyzed by means of H-K equation,resulting in a mean pore diameter of 1.28 nm and a pore volume of 1.13 cm3·g-1.This study provides data for theoretical support of the AC regeneration technology.

Effect of acupuncture on the speech and acoustics levelin patients with dysarthria

Objective To observe the effect of acupuncture combined with speech therapy on dysarthria after stroke or cerebral trauma. Methods Sixty-one cases of dysarthria were randomly divided into two groups. The observation group （30 cases） was treated with speech therapy and acupuncture at major acupoints Lianquan （廉泉 CV 23）, Jinjin （金津 EX-HN 12）, Yuye （玉夜 EX-HN 13）, Fengchi（风池 GB 20）, Yifeng （翳风 TE 17） and Wangu（完骨 GB 12）, and the control group （31 cases） was treated with speech therapy only. The changes of speech and acoustical indices were evaluated after 9 weeks treatment. Results The word articulation and the correct rate of writings in the two groups were significantly increased after treatment （both P〈0.01）. The total effective rate of 96.7%（29/30） in the observation group was superior to that of 67.7%（21/31） in the control group （P〈0.01）. The maximum phonation time （MPT） tested by a phonolaryngeal aeromechanical analyzer was significantly prolonged in both the observation group （12 cases） and the control group （11 cases） （both P〈0.01）, the improvement in the observation group being more obvious （P〈0.01）. Conclusion Acupuncture combined with speech therapy can improve the speech and acoustic level in the patient of dysarthria.

Effect of Wuziyanzong Pill on sperm quality and calcium ion content in oligoasthenospermia rats

OBJECTIVE： To study the effect of Wuziyanzong treatment on the sperm quality and content of cal- cium ions （Ca2＋） in oligoasthenospermia rats. METHODS： A model of oligoasthenospermia was induced in 50 Sprague Dawley rats by treatment with tripterygium glycosides at 30 mg/kg per day for 8 weeks. They were divided randomly into a model group, a positive group （Huangjingzanyu capsule, 3.01 g/kg）, and low, medium and high dose Wuziyanzong treatment groups （2.30, 4.60, 9.20 g/kg crude drug respectively） with 10 in each group. Another 10 rats were used as a control group. The rats in the control and model groups were administered distilled water, while the rats in the remaining groups were administered Wuziyan- zong for 30 d. The epididymides were removed, spermatozoa recovered and the sperm density and viability were measured. The spermatozoa were pu- rified and the contents of Ca2~ in the cytoplasm and mitochondria were detected by flow cytometry and atomic absorption spectrometry, respectively. RESULTS： After 8 weeks of treatment with tripteryg- ium glycosides, the sperm density, sperm activity and the Ca2~ content of spermatozoa in the model rats were all significantly decreased compared with the control group （all P〈O.05）. After 30 d treatment, the sperm density and activity improved and the Ca2＋ content of sperm were increased significantly in the medium and high dose Wuziyanzong treat- ment groups in comparison with the model group （all P〈O.05）. CONCLUSION： The Wuziyanzong treatment in： creased sperm density, improved sperm viability and enhanced the content of Ca2＋ in the sperm cy- toplasm and mitochondria in this rat model of oli- goasthenospermia.