清肾颗粒治疗慢性肾脏病合并脂代谢异常湿热证疗效观察

目的 观察清肾颗粒治疗慢性肾脏病（chronic kidney disease,CKD）合并脂代谢异常湿热证患者的疗效。方法 将60例CKD合并脂代谢异常患者随机分为对照组30例和治疗组30例,两组患者均根据具体情况给予常规治疗,治疗组在此基础上加用清肾颗粒口服,8周为1个疗程。采用血清肌酐（serum creatinine,SCr）、血尿素氮（blood urea nitrogen,BUN）、估算的肾小球滤过率（estimated glomerular filtration rate,eGFR）评价治疗前后肾功能改善情况;采用三酰甘油（triglyceride,TG）、高密度脂蛋白（high- density lipoprotein cholesterol,HDL- C）评价患者治疗前后脂代谢相关指标变化,采用同型半胱氨酸（homocysteine,Hcy）、C反应蛋白（C- reactive protein,CRP）评价患者治疗前后血管功能状态及炎症反应,并比较两组中医症状评分及临床疗效。结果 与治疗前比较,两组患者治疗后SCr、BUN、TG、Hcy、CRP水平显著降低,eGFR、HDL- C水平显著升高（P＜0.05）;治疗组患者SCr、BUN、TG、Hcy、CRP降低程度显著大于对照组（P＜0.05）,eGFR、HDL- C升高程度显著大于对照组（P＜0.05）。两组患者治疗后中医症状评分均显著降低（P＜0.05）,且治疗组降低程度大于对照组（P＜0.05）。治疗组临床疗效优于对照组（P＜0.05）。结论 清肾颗粒能够改善CKD患者肾功能、脂代谢及微炎症状态,有利于保护血管,缓解患者临床症状,提高临床疗效。     

睡眠呼吸暂停综合征患者血压结构、夜间睡眠结构的相关性

目的 运用基于时辰的心肺耦合（cardiopulmonary coupling,CPC）睡眠监测技术探讨睡眠呼吸暂停综合征（sleep apnea syndrome,SAS）患者血压结构及夜间睡眠结构的相关性。方法 纳入因睡眠问题就诊的92例患者,采用基于时辰的CPC监测仪和24 h动态血压（ambulatory blood pressure monitoring,ABPM）监测仪,进行同步监测,采集相关数据。根据CPC计算的呼吸紊乱指数（respiratory disturbance index,RDI）,将患者分为非SAS组23例,SAS组69例,分析两组间血压、夜间睡眠结构的差异;并比较不同程度SAS患者血压、夜间睡眠结构的差异;以及SAS患者RDI与夜间子、丑、寅时睡眠结构的相关性。结果 ①SAS组高血压患病率、异常血压节律发生率明显增高;且初入熟睡时间较长,熟睡时间减少,浅睡时间增多。②轻、中、重度SAS患者夜间睡眠结构差异有统计学意义（P<0.05）。③不同程度SAS患者与夜间子、丑、寅时睡眠结构存在部分差异,进一步线性回归分析发现,SAS患者RDI与子时、寅时浅睡眠时间呈正相关。结论 SAS患者高血压患病率、异常血压节律发生率高,存在夜间睡眠结构紊乱;不同程度SAS患者间血压结构差异不明显,睡眠结构的主要差异在于不稳定睡眠增多,而稳定睡眠减少,且SAS严重程度与子、寅时浅睡时间呈正相关。     

试论侦查运动中矛盾性质的异化现象——刑事侦查辩证法研究之十

本文主要从以下几个方面探讨了侦查运动中矛盾性质的异化现象一、异化现象的成因、表现和实质;二、异化现象具有可变性;三、认识和把握异化现象的重要性和必要性.     

Proponents Bear the Burden of Proof

Richard Gardner claimed to be able to diagnose parental alienation among contentious parents disputing custody, and asserted that his "syndrome" is supported by scientific and legal authority. Despite influencing many custody proceedings, Gardner's ideas fail to meet even minimal scientific standards. The burden of proving any new hypothesis falls on its proponents, and given the complete absence of objective replication, parental alienation syndrome (PAS) must be viewed as nothing more than a hypothesis. The lack of clear guidance in the law allows concepts like PAS to gain temporary credibility, as judges look to mental health professionals for help in making decisions under the vague best interests standard.     

Maternal mortality in Slovenia: Case report and the method of identifying pregnancy-associated deaths

We report on the case of fatal intracerebral haemorrhage that followed the development of severe preeclampsia/eclampsia with haemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome in a 22-year-old primipara. Peculiarities of the reported case are abrupt onset of preeclampsia/eclampsia during the delivery, fulminant course of the disease, minimal changes in kidneys and signs of pre-existing accelerated arteriosclerosis. Since very few forensic pathologists have sufficient experience with such cases and the differential diagnosis may be difficult, we consider it necessary that in all maternal deaths the post-mortem examination is performed by a team of two forensic pathologists and the case further analysed in collaboration with expert obstetrician.Maternal deaths are rare in developed countries but extremely important, because they represent the “tip of the iceberg” of severe maternal and neonatal morbidity and because they reflect accessibility and quality of prenatal and obstetric care as well as the health status of reproductive-aged women. Unfortunately, they are often misclassified in death certificates which may lead to insufficient engagement in solving underlying problems. In Slovenia, the method of active search for pregnancy-associated deaths is used in order to enable accurate monitoring of maternal mortality and minimise underreporting. The method is based on the manual revision of death certificates and the computer-based linkage of Mortality Database with birth register and foetal deaths register and has proved to be highly efficient.     

PARENTAL CONFLICT RESOLUTION

Six-, 12-, and 15-month follow-up data are presented evaluating a program for high-conflict parents. Funded by a grant from Health and Human Services, the program's content reflects an extensive review of research literature, including the relevant literature on personality disorders. Introduced in Phoenix, Arizona in October 1999, the program has served more than 1,000 families in several jurisdictions. Whereas other programs for entrenched, high-conflict cases are typically time intensive, involving 2 to 6 months, this is a one-time 4-hour program. As such, the authors are heartened to report a suprisingly positive—and enduring—response from the parents.     

气虚血瘀证局灶性脑缺血再灌注大鼠血浆及脑组织cAMP、cGMP含量动态研究

目的:复制气虚血瘀证局灶性脑缺血再灌注动物模型,探索病证结合动物模型环腺苷酸(cAMP)和环鸟苷酸(cGMP)含量的动态变化特点. 方法:选用Wistar大鼠,采用饥饿、疲劳、寒湿、惊恐、高脂饮食等多因素复合方法复制气虚血瘀证动物模型,采用线栓法阻塞大鼠大脑中动脉复制局部脑缺血再灌注动物模型,缺血2 h分别再灌注1,3,7 d,观察缺血侧额顶叶皮质、海马脑组织及血浆cAMP、cGMP含量变化.结果:模型鼠缺血再灌注后,血浆和脑组织cAMP含量均显著升高,cGMP含量均明显下降,血浆cAMP以3 d最高, 脑组织、血浆cGMP和脑组织cAMP以1 d最低. 结论:气虚血瘀证局灶性脑缺血再灌注病证结合动物模型,基本符合气虚血瘀证特点和现代医学脑缺血再灌注后环核苷酸变化规律.     

Morphometrical investigations into alterations of the wall thickness of small pulmonary arteries after birth and in cases of sudden infant death syndrome (SIDS)

In 1973 Naeye was the first to demonstrate that, in cases of SIDS, the small pulmonary arteries have more smooth muscle than in controls and suggested that this is a consequence of chronic alveolar hypoxia. Seventy-five cases have been investigated morphometrically in order to obtain quantitative data on the alterations of wall thickness of the small pulmonary arteries after birth and in cases of SIDS. The investigations comprise seven cases of stillbirth, 19 cases of newborn, 33 cases of SIDS and 16 controls. In each case the thickness of the media, the external diameter of the artery and the media area have been measured planimetrically for 90 arteries ranging between 50 μm and 500 μm. A media index was calculated as the ratio of the thickness of the media to the diameter of the artery. Using this index a thickening of the media of the small pulmonary arteries, corresponding to the situation in fetal and neonatal life, has been confirmed for cases of SIDS. The normal postnatal changes in the small pulmonary arteries, media thinning and enlargement of the lumen, could not be observed in SIDS cases in the first year of life.     

试论中国古代“母亲”概念的异化——以服母丧的变化为视角

从唐朝到明朝,服母丧的规格不断提高,到明朝时达到与父亲同样的规格,这说明"母亲"的地位在日益提高,而与此形成鲜明对比的是,就在同时,"女子"的地位却在不断下降.这一矛盾现象表明,"母亲"虽然也是"女子",但"母亲"这一概念却在逐渐与"女子"的概念相隔离,也即"母亲"这一概念在逐步异化于"女子"的概念.造成这一现象的原因是多方面的,最主要的是宗法制度日益发展的需要和结果,"母亲"地位的日益上升在本质上反映的是男子统治权的不断加强.     

试论异化劳动逻辑的二重特征和二重效应——读马克思《1844年经济学哲学手稿》

马克思的异化劳动理论具有二重特征与二重效应。所谓二重特征即逻辑演绎的严密性与逻辑前提的思辨性,由此导致了其在青年马克思思想演进过程中的积极效应与消极效应,即虽然批判了国民经济学关于永恒性的论调,发现了历史主体,但却囿于人本主义的局限,未能认识到历史主体的本质,从而未能真正建立科学的唯物史观。