“病-机-方一体,辨兼证(症)加减”慢性乙型病毒性肝炎系列病治疗体系的运用

侯留法主任医师提出慢性乙型病毒性肝炎系列病(包括乙型肝炎病毒携带、慢性乙型病毒性肝炎、代偿期肝硬化、失代偿期肝硬化、肝细胞肝癌)概念,阐明其发病机制,根据病机立法并总结处方和药物,形成“病-机-方一体,辨兼证(症)加减”的治疗体系,制定出五部曲治疗方案。①乙型肝炎病毒携带:重在补肝肾而解瘟毒。②慢性乙型病毒性肝炎:宜疏肝健脾。③代偿期肝硬化:宜柔肝健脾,活血软坚,防止癌变。④失代偿期肝硬化:重健脾,护正气,兼顾通络活血利水。⑤肝癌:分清时期,补益正气,软坚散结,抗癌解毒。探讨该治疗体系的运用,为临床提供指导。

论精神系列病的形成与治疗

精神系列病，即精神分裂、精神活动障碍、失眠、多忘、心神不宁、语言错乱、心悸、癔病躁狂、登高而歌、弃衣奔走等，都属精神系列病的范畴。

中药内服外洗治疗手足口病72例

笔者从2008年6月25日～7月20日用中药内服外洗治疗手足口病，疗效较好，结果报道如下。 1临床资料 1．1一般资料观察病例均为本院住院患者，共72例。男38例，女34例；年龄6月～1岁9例，1^＋-3岁36例，3^＋～5岁18例，5^＋～9岁9例。

精神分裂症患者病耻感人格特征与社会支持的关系

目的了解精神分裂症患者病耻感与其人格特征的关系，探讨社会支持在人格特征与病耻感中的中介作用。方法对170例康复期精神分裂症患者采用病耻感系列量表、艾森克人格问卷和社会支持问卷进行测评分析。结果（1）精神分裂症患者病耻感水平普遍较高，病耻感系列量表的歧视感知、病耻感应对、病耻感情感体验分量表评分与艾森克人格问卷的神经质、精神质维度分呈显著正相关（P〈0．01），与内外倾性维度分、社会支持问卷评分呈显著负相关（P〈0．05或0．01）；神经质、精神质维度分与社会支持问卷评分呈显著负相关（P〈0．01）。（2）精神分裂症患者精神质、内外倾性维度分能够预测病耻感系列量表的歧视一感知、病耻感应对、病耻感情感体验分量表评分，神经质维度分能够预测歧视一感知和病耻感应对分量表评分。（3）社会支持能够部分中介神经质、精神质对精神分裂症患者贬低一歧视感知和病耻感应对的影响，且能够部分中介精神质对患者病耻感情感体验的影响。结论精神分裂症患者病耻感较高，人格特征是其重要影响因素，社会支持在人格特征对病耻感的影响中起部分中介作用。

不同类型干眼患者泪膜脂质层厚度及其与临床特征的关系

目的研究不同类型干眼患者泪膜脂质层厚度（LLT）及其与干眼临床特征的关系。方法采用系列病例观察研究方法，连续纳入2016年4—8月在北京同仁医院就诊的干眼患者306例306眼行眼表疾病指数（OSDI）问卷调查、睑缘及眼表裂隙灯显微镜检查、泪膜LLT测量、泪膜破裂时间（TBUT）测定、Schirmer试验Ⅰ（SⅠt）检测和红外线睑板腺照相，其中OSDI〉12分、睑缘评分≥2分者157例为睑板腺功能障碍（MGD）组，OSDI〉12分、SⅠt〈5 mm/5 min者53例作为水液缺乏性干眼（ADDE）组，OSDI〉12分、SⅠt〈5 mm/5 min且睑缘评分≥2分者96例作为混合型干眼组。采用LipiView？眼表面干涉仪测量干眼患者泪膜LLT的分布，分析其与患者症状、体征间的相关性。结果干眼患者泪膜LLT值平均为（60.41±18.57）nm，呈正态分布。MGD组、ADDE组和混合型干眼组患者泪膜LLT分别为（57.04±18.26）、（63.52±18.44）和（60.26±18.71）nm，总体比较差异有统计学意义（F＝2.347，P＝0.035），其中MGD组患者泪膜LLT明显薄于ADDE组，差异有统计学意义（t＝2.077，P＝0.039）。患者LLT与OSDI问卷评分呈低度负相关（r＝－0.201，P＝0.003），与SⅠt及睑板腺缺失率均呈负相关（r＝－0.146，P＝0.005；r＝－0.156，P＝0.046）。亚组分析显示，MGD组患者LLT与OSDI评分呈负相关（r＝－0.285，P＝0.000），ADDE组和混合型干眼组患者LLT与OSDI评分无明显相关性（均P〉0.05）；3个组患者LLT与SⅠt间均无明显相关性（均P〉0.05）；混合型干眼组及MGD组患者LLT与睑板腺缺失率的相关性均明显大于总体相关性（r＝－0.335、－0.248、－0.156）。患者异物感、眼酸痛、看电视后眼部不适和看计算机后眼部不适与LLT均呈负相关（r＝－0.243、－0.205、－0.223、－0.258，均P〈0.05）。结论不同类型的干眼患者LLT不同，MGD患者LLT偏薄，而ADDE患者LLT偏厚，泪膜呈现油－水互补趋势；异物感、眼酸痛、看电视或计算机引起眼部不适等症状与LLT相关。

Isolation and Characterization of Mlo and NBS-LRR-like Gene Sequences in Wheat

Based on both cDNA sequence of barley powdery mildew resistance control element Mlo and DNA sequence of the known putative disease resistance gene from Triticum monococcum L., we designed some primers to amplify resistant homologous sequences in the near isogenic lines (NILs) of powdery mildew resistance using RT-PCR method. Two expressed cDNA fragments were isolated from wheat genome. One showed 83% homology to the Mlo gene of barley. The other contained two possible open reading frames (ORFs). NBS conservative domains 2, 3 of disease resistance gene and 13 LRR structures similar to rice Pib protein terminal were found respectively in the two ORFs. It indicated that the latter fragment belongs to NBS-LRR-like genes. The obvious difference of RT-PCR products was observed between the before challenged and the challenged for 72 h by Blumeria graminis f. sp. tritici, which, implied that this sequence could be associated with disease resistance of wheat. Using nulli-tetrasomic lines of 'Chinese Spring', the NBS-LRR-like gene had been located on chromosome 1D.

Unusual presentations of eosinophilic gastroenteritis:Case series and review of literature

Eosinophilic gastroenteritis (EG) is an uncommon disease characterized by focal or diffuse eosinophilic infiltration of the gastrointestinal tract, and is usually associated with dyspepsia, diarrhea and peripheral eosinophilia. Diffuse gastrointestinal tract and colonic involvement are uncommon. The endoscopic appearance may vary from normal to mucosal nodularity and ulceration. Gastrointestinal obstruction is unusual and is associated with predominantly muscular disease. We present five unusual cases of EG associated with gastric outlet and duodenal obstruction. Two cases presented with acute pancreatitis and one had a history of pancreatitis. Four cases responded well to medical therapy and one had recurrent gastric outlet obstruction that required surgery. Four out of the five cases had endoscopic and histological evidence of esophagitis and two had colitis. Two patients had ascites. These cases reaffirm that EG is a disorder with protean manifestations and may involve the entire gastrointestinal tract. Gastric outlet and/or small bowel obstruction is an important though uncommon presentation of EG. It may also present as esophagitis, gastritis with polypoid lesions, ulcers or erosions, colitis and pancreatitis and may mimic malignancy.

Close Relationship between the 2009 H1N1 Virus and South Dakota AIV Strains

Although previous publications suggest the 2009 pandemic influenza A (H1N1) virus was reassorted from swine viruses of North America and Eurasia,the immediate ancestry still remains elusive due to the big evolutionary distance between the 2009 H1N1 virus and the previously isolated strains. Since the unveiling of the 2009 H1N1 influenza,great deal of interest has been drawn to influenza,consequently a large number of influenza virus sequences have been deposited into the public sequence databases. Blast analysis demonstrated that the recently submitted 2007 South Dakota avian influenza virus strains and other North American avian strains contained genetic segments very closely related to the 2009 H1N1 virus,which suggests these avian influenza viruses are very close relatives of the 2009 H1N1 virus. Phylogenetic analyses also indicate that the 2009 H1N1 viruses are associated with both avian and swine influenza viruses circulating in North America. Since the migrating wild birds are preferable to pigs as the carrier to spread the influenza viruses across vast distances,it is very likely that birds played an important role in the inter-continental evolution of the 2009 H1N1 virus. It is essential to understand the evolutionary route of the emerging influenza virus in order to find a way to prevent further emerging cases. This study suggests the close relationship between 2009 pandemic virus and the North America avian viruses and underscores enhanced surveillance of influenza in birds for understanding the evolution of the 2009 pandemic influenza.

He-Ne laser acupuncture for 30 cases of unilateral nervous tinnitus

Objective： To observe the clinical effects of the unilateral nervous tinnitus treated by He-Ne laser acupuncture.Methods： A total of 30 patients of unilateral nervous tinnitus were treated with He-Ne laser acupuncture.The disposable filiform needles of 0.40 mm × 25 mm were used. Ermén（耳门 TE 21）, Tīnggōng（听宫 SI 19）,Tinghui（听会 GB 2）, Yìfēng（翳风 TE 17）,Shuàigǔ（率谷 GB 8） and Zhōngzhǔ（中渚 TE 3） were adopted on the affected side. The input and output ends of the fiber-optic catheter of the laser instrument were connected at a pair of acupoints（TE 21 connect to SI 19, GB 2 connect to TE 17, GB 8 connect to TE 3）.Each pair of acupoints was stimulated with He-Ne laser irradiation for 10 min, 8-10 mW in the output power and 6328 A in the wavelength. The needles were retained for 30 min totally. The treatment was given once a day, 5 times a week, continuously for 2 weeks.Results： Of 30 cases, 19 cases were cured clinically, accounting for 63.3%（19/30）; 7 cases effective remarkably, accounting for 23.3%（7/30） and 4 cases failed, accounting for 13.3%（4/30）.Conclusion： He-Ne laser acupuncture achieves the satisfactory effects on treating nervous tinnitus and it is easily accepted by the patients. Hence, this therapy deserves to be promoted in clinical application.

Phylogenetic analysis revealed the central roles of two African countries in the evolution and worldwide spread of Zika virus

Recent outbreaks of Zika virus （ZIKV） infections in Oceania＇s islands and the Americas were characterized by high numbers of cases and the spread of the virus to new areas. To better understand the origin of ZIKV, its epidemic history was reviewed. Although the available records and information are limited, two major genetic lineages of ZIKV were identified in previous studies. However, in this study, three lineages were identified based on a phylogenetic analysis of all virus sequences from GenBank, including those of the envelope protein （E） and non-structural protein 5 （NS5） coding regions. The spatial and temporal distributions of the three identified ZIKV lineages and the recombination events and mechanisms underlying their divergence and evolution were further elaborated. The potential migration pathway of ZIKV was also characterized. Our findings revealed the central roles of two African countries, Senegal and Cote d＇lvoire, in ZIKV evolution and genotypic divergence. Furthermore, our results suggested that the outbreaks in Asia and the Pacific islands originated from Africa. The results provide insights into the geographic origins of ZlKV outbreaks and the spread of the virus, and also contribute to a better understanding of ZlKV evolution, which is important for the prevention and control of ZlKV infections.

Genetic diversity of coronaviruses in Miniopterus fuliginosus bats

Coronaviruses, such as severe acute respiratory syndrome coronavirus and Middle East respiratory syndrome coronavirus, pose significant public health threats. Bats have been suggested to act as natural reservoirs for both these viruses, and periodic monitoring of coronaviruses in bats may thus provide important clues about emergent infectious viruses. The Eastern bent-wing bat Miniopterus fuliginosus is distributed extensively throughout China. We therefore analyzed the genetic diversity of coronaviruses in samples of M. fuliginosus collected from nine Chinese provinces during 2011–2013. The only coronavirus genus found was Alphacoronavirus. We established six complete and five partial genomic sequences of alphacoronaviruses, which revealed that they could be divided into two distinct lineages, with close relationships to coronaviruses in Miniopterus magnater and Miniopterus pusillus. Recombination was confirmed by detecting putative breakpoints of Lineage 1 coronaviruses in M. fuliginosus and M. pusillus(Wu et al., 2015), which supported the results of topological and phylogenetic analyses. The established alphacoronavirus genome sequences showed high similarity to other alphacoronaviruses found in other Miniopterus species, suggesting that their transmission in different Miniopterus species may provide opportunities for recombination with different alphacoronaviruses. The genetic information for these novel alphacoronaviruses will improve our understanding of the evolution and genetic diversity of coronaviruses, with potentially important implications for the transmission of human diseases.