ALI/ARDS患者糖皮质激素的治疗效果和时机

急性肺损伤/急性呼吸窘迫综合征(ALI/ARDS)是临床各科经常遇到的急症,其发病机制主要是中性粒细胞向炎症部位的移动,释放出大量的炎性介质和细胞因子,引起肺泡毛细血管膜通透性增高,弥漫性肺损伤和蛋白性肺泡水肿液聚集等病理生理改变。临床表现为呼吸困难、呼吸窘迫、顽固的低氧血症,虽然使用机械通气和呼气末正压通气(PEEP)后,其病死率有所下降,但仍然维持在50%左右。就糖皮质激素的作用机制,对不同原因引起的ALI/ARDS治疗效果,使用时机作一综述,期望对ALI/ARDS治疗过程中糖皮质激素的使用予以规范。     

急性肺损伤与急性呼吸窘迫综合征的诊断与治疗策略

急性肺损伤（ALI）和急性呼吸窘迫综合征（ARDS）是多个危险因素直接或间接引起肺部损伤的连续病理过程,以表现低氧血症为特征,ARDS是ALI严重末期的表现。低流量、呼气末正压（PEEP）保护性通气的措施可明显改善氧和,减轻机械通气肺损伤,降低病死率,明显优于传统通气方式。     

Is Theory of Mind Understanding Impaired in Males with Fragile X Syndrome?

Males with fragile X syndrome (FXS) have difficulties with social interaction and many show autistic features. This study examined whether the social deficits characteristic of FXS are associated with theory of mind difficulties. Two groups of boys with FXS participated: a group with few autistic features and a group with many autistic features. An intellectual disability control group also participated. In addition to using standard theory of mind tasks, new techniques were used that were able to separate out the various processing demands of the task (e.g., memory, inhibitory control). Overall, the findings indicate that both groups of boys with FXS have difficulty with theory of mind tasks compared to an intellectual disability control group. However, both groups with FXS also performed worse on comparison trials that required working memory but not theory of mind. Theory of mind difficulties are likely to be an important aspect of the FXS clinical profile, but are most likely the result from a more basic difficulty with working memory.     

Differences in visual orienting between persons with Down or fragile X syndrome

The voluntary and reflexive orienting abilities of persons with Down syndrome and fragile X syndrome, at average MA levels of approximately 4 and 7 years, were compared with an RT task. Reflexive orienting abilities appeared to develop in accordance with MA for the participants with Down syndrome but not for those with fragile X syndrome. However, both groups showed delayed voluntary orienting. The group differences in reflexive orienting at the low MA level reinforce the practice of separating etiologies and highlight the contribution of rudimentary attentional processes in the study of individuals with mental retardation.     

系统生物学引导阿尔茨海默病治疗新策略

阿尔茨海默病(AD)是一种发生于中老年期的退行性脑神经变性疾病,临床上以进行性智能衰退,伴有人格改变为主要特征.其发病过程涉及许多途径和靶点.现代医学认为脑内胆碱能递质功能紊乱、β-淀粉样蛋白沉积、tau-蛋白过磷酸化、炎症反应以及基因突变等在其发病过程中起着重要作用.治疗方法从胆碱酯酶抑制剂、神经递质受体阻滞剂到补气活血、益精填髓、化痰开窍等中医药疗法不等.但抑制剂、阻滞剂等药物阻滞疗法,从单一环节阻断发病途径,忽略了AD发病的整体复杂性.中医辨证论治从整体观念出发,在宏观上治疗AD,对AD的发病缺乏微观深入研究.AD治疗需要借助于“系统生物学”理论的指导.中西医结合为AD的治疗提供了较为科学、有效的途径和发展空间.     

中风病简化辨证的哲学思考

中风病分阴证和阳证为纲辨治,不但有是充分的实践依据和理论基础,而且符合哲学的否定之否定定律。从中风病简化辨证的必要性,中风病阴阳辨证的发展,中风病的病因病机、证候属性可从阴阳两方面认识,中风病阴阳为纲辨证方法符合哲学否定之否定定律4方面进行了论述。     

无证可辨浅识及对策

辨证论治是中医学精髓。无证可辨的情况,究其原因,一方面与医者辨证方法和技能有关,另一方面确实存在无证可辨的现象。为提高辨证水平,医者既要重视病性特点、病因、六经病辨证特色;也要积极引入中医“病”的概念和微观辨证,因为中医辨病在特定情况下可弥补辨证的不足,而微观辨证的深入研究则可能为无证可辨提供客观依据。为此,才可在实践中正确处理无证可辨的尴尬,并使中医诊断学内容臻备。     

医学专业研究生扩招对其培养目标与模式的影响

从医学专业研究生招生的现状及目前研究生培养目标和模式中存在问题出发,分析了我国医学专业研究生招生规模不断扩大对研究生教育的影响,并针对以上变化和问题提出针对逐渐膨胀的医学研究生群体,应采取新的管理及教育模式,从而使研究生的质量和水平得到全面的提高,使我国医学研究生教育水平逐渐与世界接轨.     

“病中辨证”是证发展的必然

在疾病的发展过程中,一般存在着病和证的两种演变,相对于病而言,证有着更高层次的组织方式,有自身发展规律,反映的是机体整体状态。这种对证的诠释有利于中西医理论间的接轨,使证研究更容易被现代医学理论所接受,是中医进一步发展的要求,病证二者并不矛盾,而是互补,共同提供了对疾病的完整认识。