Central and peripheral testosterone effects in men with heart failure:An approach for cardiovascular research

Heart failure(HF) is a syndrome recognized as a health problem worldwide. Despite advances in treatment, patients with HF still have increased morbidity and mortality. Testosterone is one of the most researched hormones in the course of HF. Growing interest regarding the effect of testosterone, on a variety of body systems, has increased the knowledge about its mechanisms of action. The terms central and peripheral effects are used to distinguish the effects of testosterone on cardiac and extracardiac structures. Central effects include influences on cardiomyocytes and electrophysiology. Peripheral effects include influences on blood vessels, baroreceptor reactivity, skeletal muscles and erythropoesis. Current knowledge about peripheral effects of testosterone may explain much about beneficiary effects in the pathophysiology of HF syndrome. However, central, i.e., cardiac effects of testosterone are to be further explored.

胆囊癌的临床诊疗现状与挑战

胆囊癌在胃肠道癌症中位居第五位,同时它也是胆道最常见的恶性肿瘤,约占80%~95%。这种肿瘤预后不佳,总体5年生存率低于5%,平均中位生存期〈6个月。因为胆囊癌在进展时可以没有任何症状,所以早期诊断是至关重要。术前诊断为胆囊结石,而术后确诊为胆囊癌的发生率为0.5%~1.5%。如果术前怀疑患者胆囊癌,则不应通过腹腔镜手术。流行病学研究已经确定了胆囊癌的发病率有地理和种族的显著差异：美洲的印第安人高发,东南亚地区也比较高,但在美洲和世界的其他地区发病率较低。环境诱发因素在胆囊癌的发展过程中发挥关键作用,胆石症、胆道和寄生虫感染的慢性炎症是最好的例证。在过去的10年里,改进成像技术和改良根治的手术方法可改善患者的预后,并帮助延长胆囊癌患者的存活时间。对于R0切除的胆囊癌患者,其总体5年生存率为21%~69%。在将来,潜在的诊断标志物的发展将对那些种族易感性或已知胆道解剖异常的人群提供早期筛查诊断的机会。