摘 要： 从4个方面对复兴中医药学进行深层思考。
摘 要： 医疗社会史视角下的医生职业形象问题已不是单纯的医疗技术问题，也是事关医德、医疗管理及科学技术发展等诸多领域的问题。受商品经济冲击和世俗名利观影响，文艺复兴时期的医生形象总体不佳，职业道德明显下滑，患者颇有怨言。这种现象折射了西欧医疗服务技术低下、行业自律性不强、国家管理职能缺位等现状。从医疗社会史角度认识医学问题，既能丰富医学史的社会内涵，又能拓宽其研究路径，进而提升其研究层次。
Adrenocortical carcinoma: clinical outcomes and prognosis of 330 patients at a tertiary care center.
Adrenocortical carcinoma (ACC) is a rare malignancy with a poor prognosis. Herein， we describe the clinical features and outcomes for a large series of ACC patients.Retrospective review of ACC patients seen at The University of Texas MD Anderson Cancer Center from 1998 through 2011.A total of 330 patients with median age at diagnosis of 48.5 years; 12 (3.6%) patients were under 18 years. Hormonally functioning tumors represented 41.8% (n=138) of all cases. Surgical resection for the primary tumor was done in 275 (83.3%) patients (45 at MD Anderson (16.4%)). For those who had surgical resection， the median local-recurrence-free time was 1.04 years. Factors associated with local recurrence included positive surgical margins (P=0.007) and advanced disease stage (P=0.026). Median overall survival time for all patients was 3.21 years. Median survival times were 24.1， 6.08， 3.47， and 0.89 years for stages I， II， III， and IV respectively. In multivariable analysis， older age， functioning tumors， and higher disease stage remained significant prognostic factors associated with poor survival.ACC prognosis remains poor with the use of currently available treatments. Older age， functioning tumors， and incomplete resections are clinical factors associated with poor survival. Surgical expertise is important to achieve complete resections and to improve outcome.
正目前，对张仲景的误解很深。 但很多误解是为了突破禁区，发展学术，这种误解、甚至曲解都是善意的。在中西医并存，而非并重的情况下，再加上不规范的医疗市场，中医不断被边缘化。在这 样的严重现实面前，再误解、误读张仲景的学术，就会加重中医事业的损失，或者会延误中医事业的复兴。复兴中医的道路，必须从大处着眼。河北省中医药学会张 仲景学术思想研究会提出的口号是"学仲景、说仲景、用仲景、做仲景"，回归中医原创思维，达到理论自信、疗效自强、传承自觉，中医复兴才会有希望。
Hospital admission for diabetic ketoacidosis or severe hypoglycemia in 31,330 young patients with type 1 diabetes.
ABSTRACT To investigate rates and risk factors of hospital admission for diabetic ketoacidosis (DKA) or severe hypoglycemia in young patients with established type 1 diabetes. 31，330 patients with type 1 diabetes (median age 12.7 years) from the DPV Prospective Diabetes Registry treated between 2011 and 2013 in Germany were included. Admission rates for DKA (pH <7.3 or bicarbonate <15 mmol/l) and severe hypoglycemia (requiring assistance from another person) were calculated by negative binomial regression analysis. Associations of DKA or hypoglycemia with patient and treatment characteristics were assessed by multivariable regression analysis. Mean admission rate for DKA was 4.81 per 100 patient-years (95% CI， 4.51-5.14). Highest DKA rates were observed in patients with HbA1c≥9.0% (15.83 (14.44-17.36))， age 15-20 years (6.21 (5.61-6.88))， and diabetes duration of 2-4.9 years (5.60 (5.00-6.27)). DKA rate was higher in girls than in boys (5.35 (4.88-5.86) versus 4.34 (3.95-4.77)， p=0.002)， and more frequent in migrants than in non-migrants (5.65 (4.92-6.49) versus 4.57 (4.23-4.93)， p=0.008). Mean admission rate for severe hypoglycemia was 1.45 per 100 patient-years (1.30-1.61). Rates were higher in migrants compared to non-migrants (2.13 (1.72-2.65) versus 1.28 (1.12-1.47)， p<0.001)， and highest in individuals with severe hypoglycemia within the preceding year (17.69 (15.63-20.03) versus patients without preceding hypoglycemia 0.42 (0.35-0.52)， p<0.001). Differences remained significant after multivariable adjustment. Identification of at-risk individuals for DKA (patients with high HbA1c， longer diabetes duration， adolescents， girls) and for severe hypoglycemia (patients with preceding severe hypoglycemia， migrants) may facilitate targeted diabetes counselling in order to prevent these complications.
MiR-330-5p regulates tyrosinase and PDIA3 expression and suppresses cell proliferation and invasion in cutaneous malignant melanoma
Increasing evidences has suggested that miR-330-5p can function as a tumor suppressor in different types of cancers. However， the effects andtheunderlying mechanisms of miR-330-5p in the development of cutaneous malignant melanoma (CMM) remain largely unknown. The aim of the present study was to investigate the role of miR-330-5p in CMM and to determine the molecular mechanisms underlying its action. The expression level of miR-330-5p was detected in 26 cases of primary cutaneous malignant melanoma (PCMM) tissues and cell lines by real-time quantitative PCR. We also assessed whether overexpression of miR-330-5p influencein vitrocell proliferation， invasion and migration. Western blotting analysis was used to detect the influence of miR-330-5p on the targets， andPearsonanalysis was used to calculate the correlation between the expression of targets gene and miR-330-5p in CMM tissues. Our study showed that miR-330-5p was downregulated in CMM tissues (p=0.010) and cell lines (p < 0.05)， and patients with high mitotic activity showed lower miR-330-5p expression levels (p = 0.002). Enforced expression of miR-330-5p inhibit malignant CMM cells proliferation and migration， led to downregulation of the TYR and PDIA3 protein. Moreover， the expression level of miR-330-5p in CMM tissues showed inversely relationship with the expression level of TYR and PDIA3 protein. In conclusion， our findings suggested that miR-330-5p represents a potential tumor suppressive-miRNA and plays an important role in CMM progression by suppressing TYR and PDIA3 expression.
摘 要： 中医学特有的文化印记，体现的社会文化特征，对中华传统文化的发展、繁荣、复兴具有重要的作用和价值。试从认识论的启示、道德观的弘扬、方法论的价值等几个方面论述。中医药文化是五千年中华传统文化至今鲜活的印记，是进行中华传统文化宣传与弘扬的重要组成部分。加强中医药文化建设，不但是建设社会主义核心价值体系，建立中华民族共有精神家园的重要内容，而且是推动社会主义文化大发展大繁荣，努力建设社会主义文化强国的根本要求。