浅谈经方对中医临床的指导意义

张仲景在《伤寒杂病论》中创立了300余首君臣佐使配伍严谨、疗效确凿的方剂,并在因证立法、辨证加减等方面具有重要的临床指导意义,被尊为“诸方之祖”。经方适应病证多,应用领域广,是后世很多医方的组方基础,有效地指导着医疗实践,具有很强的生命力和发展前景。

Total thyroidectomy is safer with identification of recurrent laryngeal nerve

Objective:To investigate the effect of recurrent laryngeal nerve(RLN)identification on the complications after total thyroidectomy and lobectomy.Methods:Total 134 consecutive patients undergoing total thyroidectomy or thyroid lobectomy from January 2003 to November 2004 were investigated retrospectively.Patients were divided into two groups:RLN identified (Group A)or not(Group B).The two groups were compared for RLN injury and hypocalcaemia.Results:The numbers of patients and nerves at risk were 71 and 129 in Group A,and 63 and 121 in Group B,respectively.RLN injury in Group A(0)was sig- nificantly lower than that in Group B(57.9%)patients,75.8%nerves)for the numbers of patients(P=0.016)and nerves at risk (P=0.006).Temporary hypocalcaemia was significantly higher in Group A than in Group B(1424.1%vs 610.3%,P=0.049). Permanent complications in Group B were significantly higher than those in Group A(1320.6%vs 45.6%,P=0.009).Con- clusion:RLN injury was prevented and permanent complications were decreased by identifying the whole course and branches of the recurrent laryngeal nerve during total thyroidectomy.

Clinical experiences with 20 cases of single-direction thoracoscopic lobectomy and systematic lymph node dissection for peripheral NSCLC

Objective: To evaluate the safety, efficacy, feasibility of single-direction thoracoscopic lobectomy for peripheral lung cancer. Methods: From December 2009 to March 2011, 20 patients with peripheral lung cancer were treated with single-direction thoracoscopic lobectomy and systemic lymph nodes dissection. Results: Surgeries were successfully performed. No significant complications occurred perioperatively. The average operation time was 193 min, the average blood loss was 234 ml, the average duration of drainage was 6 d, the postoperative hospital stay was 12 d, and the average number of lymph nodes dissected was 16. Conclusion: Single-direction thoracoscopic lobectomy is feasible and safe in the treatment of peripheral lung cancer and can simplify the surgical procedures.

Classification of epilepsy using computational intelligence techniques

This paper deals with a real-life application of epilepsy classification, where three phases of absence seizure, namely pre-seizure, seizure and seizure-free, are classified using real clinical data. Artificial neural network （ANN） and support vector machines （SVMs） combined with su- pervised learning algorithms, and k-means clustering （k-MC） combined with unsupervised techniques are employed to classify the three seizure phases. Different techniques to combine binary SVMs, namely One Vs One （OvO）, One Vs All （OVA） and Binary Decision Tree （BDT）, are employed for multiclass classification. Comparisons are performed with two traditional classification methods, namely, k-Nearest Neighbour （k- NN） and Naive Bayes classifier. It is concluded that SVM-based classifiers outperform the traditional ones in terms of recognition accuracy and robustness property when the original clinical data is distorted with noise. Furthermore, SVM-based classifier with OvO provides the highest recognition accuracy, whereas ANN-based classifier overtakes by demonstrating maximum accuracy in the presence of noise.

Neurotrophic and metabotrophic potential of nerve growth factor and brain-derived neurotrophic factor: Linking cardiometabolic and neuropsychiatric diseases

One of biggest recent achievements of neurobiology is the study on neurotrophic factors. The neurotrophins are exciting examples of these factors. They belong to a family of proteins consisting of nerve growth fac-tor （NGF）, brain-derived neurotrophic factor （BDNF）, neurotrophin-3 （NT-3）, NT-4/5, NT-6, and NT-7. Today, NGF and BDNF are well recognized to mediate a diz-zying number of trophobiological effects, ranging from neurotrophic through immunotrophic and epitheliotro-phic to metabotrophic effects. These are implicated in the pathogenesis of various diseases. In the same vein, recent studies in adipobiology reveal that this tissue is the body’s largest endocrine and paracrine organ producing multiple signaling proteins collectively termed adipokines, with NGF and BDNF being also produced from adipose tissue. Altogether, neurobio-logy and adipobiology contribute to the improvement of our knowledge on diseases beyond obesity such as cardiometabolic （atherosclerosis, type 2 diabetes, and metabolic syndrome） and neuropsychiatric （e.g. , Alzheimer’s disease and depression） diseases. The present review updates evidence for （1） neurotrophic and metabotrophic potentials of NGF and BDNF linking the pathogenesis of these diseases, and （2） NGF- and BDNF-mediated effects in ampakines, NMDA receptor antagonists, antidepressants, selective deacetylase inhibitors, statins, peroxisome proliferator-activated receptor gamma agonists, and purinergic P2X3 recep-tor up-regulation. This may help to construct a novel paradigm in the feld of translational pharmacology of neuro-metabotrophins, particularly NGF and BDNF.

Apoptosis and endometrial receptivity: Relationship with in vitro fertilization treatment outcome

Apoptosis is an important process in the reconstruction of endometrium within the menstrual cycle. The balance between cell proliferation and apoptosis regulates the periodic repair and shedding of endometrial cells and leads to the menstruation or prepare the mucosal layer of endometrium for the implantation of the embryo. Many factors with pro- and antiapoptotic action, such as B cell lymphoma/leukemia-2 and inhibitors apoptosis proteins families, caspases, tumor necrosis factor receptors, phosphatase and tensin homolog, proliferator-activated receptor gamma, microRNAs and others are differently expressed in the endometrial tissue at phases of menstrual cycle. Receptivity of the endometrium at the period of “window of implantation” is associated with the signifcant increase of apoptosis in endometrium to allow the embryo to be successfully implanted. The impairment of apoptosis regulation in the endometrium at this period often is observed in infertile women with endometriosis, tubal factor, polycystic ovary syndrome, etc .. In many cases the impairment of apoptosis regulation in the endometrium is the main cause of in vitro fertilization （IVF） treat-ment failure in these patients. As of today, the exact mechanisms and factors mediating the apoptotic process in normal endometrium and in infertile women are not fully understood. Herein, the literature data concerning the endometrial apoptosis regulation in general, and in light of the infuence of apoptosis upon IVF treatment outcome are reviewed. The possibility to use some parameters of endometrial apoptosis for prediction of the successful pregnancy achievement in women participating in IVF protocols also is discussed.

Roles of cholinergic receptors during attentional modulation of cue detection

Basal forebrain corticopetal cholinergic neurons are known to be necessary for normal attentional process-ing. Alterations of cholinergic system functioning have been associated with several neuropsychiatric diseases, such as Alzheimer’s disease and schizophrenia, in which attentional dysfunction is thought to be a key contrib-uting factor. Loss of cortical cholinergic inputs impairs performance in attention-demanding tasks. Moreover, measures of acetylcholine with microdialysis and, more recently, of choline with enzyme-coated microelectrodes have begun to elucidate the precise cognitive demands that activate the cholinergic system on distinct time scales. However, the receptor actions following acetyl-choline release under attentionally-challenging condi-tions are only beginning to be understood. The present review is designed to summarize the evidence regarding the actions of acetylcholine at muscarinic and nicotinic receptors under cognitively challenging conditions in order to evaluate the functions mediated by these two different cholinergic receptor classes. Moreover, evi-dence that supports beneficial effects of muscarinic muscarinic-1 receptor agonists and selective nicotinic receptor subtype agonists for cognitive processing will be discussed. Finally, some challenges and limitations of targeting the cholinergic system for treating cognitive defcits along with future research directions will be mentioned. In conclusion, multiple aspects of cholinergic neurotransmission must be considered when attempting to restore function of this neuromodulatory system.

Long-term potentiation in autonomic ganglia:Potential role in cardiovascular disorders

Ganglionic long-term potentiation(gLTP) is an activitydependent,enduring enhancement of ganglionic transmission.This phenomenon may be induced in autonomic ganglia of an organism under certain conditions whererepetitive impulses surge from the central nervous system(CNS) to the periphery.Chronic stress,repetitive epileptic seizure or chronic use of CNS stimulants could induce gL TP,which would result in a long lasting heightening of sympathetic tone to the cardiovascular system causing hypertension and disturbed cardiac rhythm that may lead to sudden cardiac death.These conditions are briefly reviewed in this article.

Protease-activated receptors in neuropathic pain:an important mediator between neuron and glia

Chronic neuropathic pain is a refractory symptom in clinical practice due to nervous injury or inflammation, and affects millions of people all over the world. Although the neuronal functioning of pain pathways has been studied for many years, the induction and maintenance of this non-adaptive, pathological pain is still poorly understood. Recent evidence indicates that protease-activated receptors (PARs) participate in the initiation and maintenance of neuropathic pain and play a key role in mediating the interactions of nerve cells. Firstly, following nerve injury, alterations in neuron and neuron function induce an abnormal increase of some neurotransmitters and neuromodulators, such as substance P (SP), calcitonin gene-related peptide (CGRP), prostaglandins, kinins, and so on. Such abnormal factors can act on neuron reversely and then induce pain sensation directly, or activate glial cells (astrocytes and microglia) mediated by PARs, which trigger and accelerate the progress of neuropathic pain. Secondly, when the noxious factors invade, glial cells are activated as the first barrier of nervous system and secret many neuroinflammatory factors. These inflammatory factors have effects on PARs (especially PAR1 and PAR2) in the neurons around, and then aggravate the status of pain. Thirdly, in the progress of neuroinflammatory pain, microglia is activated first and initiates the status of pain, and then inflammatory factors and complements from microglia activate astrocytes and maintain or make the pain worse. All of these actions is protective to neurons first, but then turns to a kind of nociception and forms the feeling of pain under the continuous noxious stimuli. Conclusively, PARs may play an important role in the formation and maintenance of chronic pain through mediating the interactions among nerve cells, which may be a novel target in the study and control of neuropathic pain. This article focuses on recent developments of PARs in the progress of neuropathic pain, and provides a framework for addressing the major questions for the future.

Folic acid supplementation: The new dawn for postmenopausal women with hot flushes

Hot flushes, experienced by 75% of menopausal women, are associated with estrogen deprivation. Estrogen was shown to ameliorate hot flushes by interacting with monoamine neurotransmitters in the brain; reducing noradrenaline and increasing serotonin. Hormone replacement therapy(HRT), the first treatment option, causes concerns over possible increased risks particularly breast cancer. Folic acid is involved in the biosynthesis of serotonin and nordrenaline, which is responsible for its effects on mood and cognition, and degrees of folate inadequacy, not severe enough to produce megaloblastic anaemia, were found to be associated with depression and cognitive malfunctioning. Also, increased age was observed to relate to reduced serum and cerebrospinal fluid folic acid levels. There is emerging evidence that folic acid supplementation ameliorates hot fl ushes by the same mechanism as estrogen. To explore this hypothesis, a multi-centre, double-blind, placebo-controlled randomized is being set up to compare the effect of 5 mg folic acid vs placebo in reducing the frequency and severity of hot fl ushes in postmenopausal women, and on the blood level of serotonin and noradrenaline. If folic acid supplementation is demonstrated to be effective, this will be a turning point in the clinical practice since it represents a cheap, safe and well-tolerated alternative to HRT.

A randomized,controlled trial of Shutangluo fang in treating painful diabetic peripheral neuropathy

OBJECTIVE:To assess efficacy of Shutangluo fang on painful diabetic peripheral neuropathy(PDPN).METHODS:Adopting stratified randomized and controlled design,82 patients with PDPN were assigned to two groups.Both groups continued conventional therapy.Epalrestat was administered to patients in both groups,and Shutangluo fang was given to patients in the treatment group.The treatment course lasted for 3 months.The changes before and after treatment of symptoms and signs,electrophysiological assessments were observed.RESULTS:The efficacy of the treatment group was better than the control group.The sensory nerve conduction velocity was significantly improved in the treatment group than the control group.CONCLUSIONS:Shutangluo fang is effective on PDPN.

Pharmacological management of neuropathic pain in patients with vestibular schwannomas:Experience of the Atlantic Lateral Skull Base Clinic

Neuropathic pain is chronic pain generated by disorders of the peripheral and central nervous system, including skull base tumours. A skull base tumour can be any type of tumour that forms in the skull base, and this includes vestibular schwannomas which arise from the sheath of the inner ear vestibulocochlear nerve(eighth cranial nerve). Growth of the tumour, surgical resection, and/or stereotactic radiotherapy may result incompression and/or irritation of the fifth cranial nerve(trigeminal nerve) resulting in facial pain and/or numbness. Non-trigeminal afferent input may contribute to the wide constellation of symptoms seen in orofacial pain patients. The purpose of this report was to develop a decision tool to guide the recognition and treatment of neuropathic pain in this specialized population. Recommendations for treatment are based on evidence presented in Canadian and international neuropathic treatment guidelines. Algorithms are included for assessment and treatment of adult patients with agents that are recognized to have analgesic efficacy within the broad context of neuropathic pain.

Severe facial paralysis:early clinical manifestations and treatment

The study explained features of severe facial paralysis of early stage from the level and degree of nerve injury,syndromes and clinical manifestations of peripheral facial paralysis.Treating protocols with acupuncture were worked out concerning its characteristics to acquire the law of treatment,especially on the severe case.Severe facial paralysis is not only known as the focus of the study on acupuncture treatment,but also the key point to approve the effectiveness of acupuncture on peripheral facial paralysis.

Diagnosis and treatment of diffuse axonal injury in 169 patients

To evaluate current diagnosis and therapeutic effect and outcome of diffuse axonal injury （DAI） in 169 patients. Methods ： The data of 169 DAI patients treated in the Second, Sixth, Eighth and Ninth Hospitals of Shenzhen and Shekou Hospital from January 2001 to January 2005 were collected. The imaging features, classification, GCS （Glasgow coma scale）, treatment and outcome of the 169 patients were retrospecti.vely analyzed. Results ： The simpler the imaging features, the closer the focus of DAI to the periphery of hemisphere and the higher the GCS score, the better the prognoses of DAI patients will be. Conclusions： The prognoses of DAI patients are closely related to the imaging features and classification, GCS and clinical treatment.

Effect of human neural progenitor cells on injured spinal cord

To study whether human neural progenitor cells can differentiate into neural cells in vivo and improve the recovery of injured spinal cord in rats. Methods： Human neural progenitor cells were transplanted into the injured spinal cord and the functional recovery of the rats with spinal cord contusion injury was evaluated with Basso-Beattie-Bresnahan （ BBB ） locomotor scale and motor evoked potentials. Additionally, the differentiation of human neural progenitor cells was shown by immunocytochemistry. Results： Human neural progenitor cells developed into functional cells in the injured spinal cord and improved the recovery of injured spinal cord in both locomotor scores and electrophysiological parameters in rats. Conclusions ： Human neural progenitor cells can treat injured spinal cord, which may provide a new cell source for research of clinical application.

Preface

Clinical medicine and experiments have shown that electrophysiological activities on neuronal disease systems such as the epilepsy and Parkinson can exhibit the evolutions of complex dynamical behaviors and their transitions, which are closely related to the generation mechanism of neuronal diseases. Traditionally, electrophysiological activities have been analyzed from the statistical methods. Although some ideal results have been obtained, mechanisms of complex electrophysiological activities in neuronal systems cannot yet be disclosed. Dynamics modelling can help researchers to explore the mechanisms of electro- physiological activities of neuronal disease systems. By constructing reasonable physiological dynamical model, inner relation between the dynamics model and representation behaviors of the neuronal disease systems can be further studied. In addition, based on the constructed network model, we can also explore mechanisms of the evolutions of dynamical behaviors and their transitions of the initiation, propagation and termination of different kinds of the seizures. Finally, we can design the feasible control method to regulate dynamics behaviors of the seizures so as to realize the healthy neuronal firings.