小议久病有恶疾

久病是临床上的常见病,恶疾属久病之一。诸多久病常经治疗日趋康复,但亦有部分病症,隐匿复杂,病程久长,病情恶化,而成恶疾,无法救治。因此,特别提醒医者、患者及其家属,面对久病,一要密切观察病情;二要注重全面检查;三要辨病辨证施治;以免漏诊、误诊、误治,防范医患纠纷发生。

警惕潜伏在口腔里的恶疾

58岁的杨女士,右侧口腔颊黏膜出现溃疡一个多月,一直好不了。吃的、喷的药都试过了,但就是不好,并且越来越疼……杨女士这才来到了医院。医生取了杨女士口腔里的溃疡组织做了活检,发现这不是一般的溃疡,而是口腔癌。原来,杨女士嘴里有一颗多年的蛀牙,一开始只是蛀了一个洞,后来慢慢牙冠蛀没了,只留下牙根和露在外面的一点点残牙,由于不疼不痒,她也就没有拔掉。而这点残牙,正是导致杨女士口腔癌的罪魁祸首。

三大皮肤恶疾这样治

皮肤病,可能是人们日常生活中的常见疾病。患上皮肤病,轻者难看又难受,重者如一些自身免疫性皮肤病甚至可夺人性命。在临床上,对于一些难治性皮肤病,则内治同时配合外治法,综合运用,互相补充,方可取得显著的临床疗效。以下介绍如何从中医入手,治疗白瘢风、红斑狼疮、脱发等几种皮肤恶疾。

伯牛患恶疾,麻风绝尘缘

《论语·雍也》记云:"伯牛有疾,子问之,自牖执其手,曰:‘亡之,命矣夫!斯人也而有斯疾也。’"伯牛,即冉耕,是春秋时期伟大教育家孔子的学生,很有美德,不幸得了恶疾。孔子去探望他时。

《武威医简》68、86甲乙及唐以前麻风病用药特点讨论

《武威汉代医简》简68所载内容及其与牍86甲、乙的关系,学界鲜有讨论。故结合云梦睡虎地秦简《封诊式》、张家山汉简《脉书》以及《黄帝内经》(以下简称《内经》)等传世文献的相关论述对上述诸简进行了研究,认为简68与牍86甲、乙皆与麻风病的诊治有关。并就简68的内容与牍86甲、乙所载之"恶病大风方",结合《周礼》《本草图经》《备急千金要方》等传世文献对唐以前治疗麻风病的用药特点进行探讨,发现自两汉以迄隋唐运用以石药为主的方剂攻治麻风病是医界通例,为进一步研究《武威汉代医简》和运用古代麻风病的诊治提供了资料借鉴。

Deep learning model based on PET/CT and combination with Cox proportional hazard model for predicting progression of lung invasive adenocarcinoma after surgery

Objective To observe the efficacy of deep learning(DL)model based on PET/CT and its combination with Cox proportional hazard model for predicting progressive disease(PD)of lung invasive adenocarcinoma within 5 years after surgery.Methods The clinical,PET/CT and 5-year follow-up data of 250 patients with lung invasive adenocarcinoma were retrospectively analyzed.According to PD or not,the patients were divided into the PD group(n=71)and non-PD group(n=179).The basic data and PET/CT findings were compared between groups,among which the quantitative variables being significant different between groups were transformed to categorical variables using receiver operating characteristic(ROC)curve and corresponding cut-off value.Multivariant Cox proportional hazard model was used to select independent predicting factors of PD of lung invasive adenocarcinoma within 5 years after surgery.The patients were divided into training,validation and test sets at the ratio of 6∶2∶2,and PET/CT data in training set and validation set were used to train model and tuning parameters to build the PET/CT DL model,and the combination model was built in serial connection of DL model and the predictive factors.In test set,the efficacy of each model for predicting PD of lung invasive adenocarcinoma within 5 years after surgery was assessed and compared using the area under the curve(AUC).Results Patients'gender and smoking status,as well as the long diameter,SUV max and SUV mean of lesions measured on PET images,the long diameter,short diameter and type of lesions showed on CT were statistically different between groups(all P<0.05).Smoking(HR=1.787[1.053,3.031],P=0.031)and lesion SUV max>4.15(HR=5.249[1.062,25.945],P=0.042)were both predictors of PD of lung invasive adenocarcinoma within 5 years after surgery.In test set,the AUC of PET/CT DL model for predicting PD was 0.847,of the combination model was 0.890,of the latter was higher than of the former(P=0.036).Conclusion DL model based on PET/CT had high efficacy for predicting PD of lung invasive adenocarcinoma within 5 years after surgery.Combining with Cox proportional hazard model could further improve its predicting efficacy.

善理疾者绝其源——关于安全生产的思考

实施安全生产 ,必须紧紧把握预防这个主题 ,抓住责任这个根本 。

Selective Effect of Qinghaosu on Different Stages of Plasmodium falciparum in Vitro

Using highly synchronous cultures of Plasmodium falciparum in vitro,the susceptibi- lity of the different stages of the intraerythrocytic parasites to Qinghaosu (QHS) was assessed.The anti- parasitic effect of QHS was measured by comparing the changes of irradiation of^3 H-hypoxanthine in- corporated into the nucleic acids of parasites exposed to various concentrations of QHS at different stages of growth.It was found that the trophozoite stage of the parasite was the most sensitive to QHS, whereas the early ring stage was the least sensitive,and the sensitivities of the late ring and schizont stages fell between those of the early ring and trophozoite stages.The results revealed the correlation of stage-dependent effects of QHS with the blockade of the protein metabolism of the parasite.

勇气

许多年前,我曾在史坦福医院当义工,那时认识了一个叫丽莎的小女孩,她得了一种十分罕见的恶疾,唯一能挽救她的机会,就是接受她五岁弟弟的输血,因为她弟弟也曾罹患此病,后来奇迹般地被治愈,现在体内产生了此种病毒的抗体。医生向这个小男孩解释了情况。

何谓“七出”

七出,是封建时代休弃妻子的七条理由,男子只要有一条理由,就可以休弃妻子。《仪礼·丧服》:“出妻之子为母。”贾公彦疏:“七出者:无子,一也;淫浃,二也;不事舅姑,三也;口舌,四也;盗窃,五也;妒忌,六也;恶疾,七也。”“七出”也叫“七去”。《大戴礼记·本命》中说:“妇有七去:不顾父母去,无子去,淫去,妒去,有恶疾去,多言去,窃盗去。”

烟台市丹叶电器有限公司董事长徐信东 科技防除尘毒 严守呼吸阵地

随着钢铁、石油、冶金、煤炭等行业的飞速发展,尘肺病发病率始终居高不下。尘肺病患者数量在矿产资源丰富的我国更是迅速增长,许多长期在高粉尘环境下工作的工人患上了这种难以治疗的恶疾。据官方统计,我国每年新增尘肺病人约3万人,而这之前约有87万职业性尘肺病例,使总数近百万,甚至超过了世界各国的总和。这让我国尘肺病人群体面临困难的现状。

Tumor angiogenesis and its clinical significance in pediatric malignant liver tumor

AIM: To investigate the expression of vascular endothelial growth factor (VEGF) and microvascular density (MVD) count in pediatric malignant liver tumor and their clinical significances. METHODS: Fourteen children with malignant liver tumors including seven hepatocellular carcinomas (HCCs), five hepatoblastomas, one malignant mesenchymoma and one rhabdomyosarcoma were studied. Twelve adult HCC samples served as control group. All samples were examined with streptavidin-biotin peroxidase (SP) immunohistochemical staining for VEGF expression and MVD count. RESULTS: VEGF positive expression in all pediatric malignant liver tumors was significantly higher than that in adult HCC (0.4971±0.14 vs0.4027±0.03, P<0.05). VEGF expression in pediatric HCC group was also markedly higher than that in adult HCC group (0.5665±0.10 vs0.4027±0.03, P<0.01) and pediatric non-HCC group (0.5665±0.10 vs 0.4276±0.15, P<0.05). The mean value of MVD in pediatric malignant liver tumors was significantly higher than that in adult HCC (33.66±12.24 vs 26.52±4.38, P<0.05). Furthermore, MVD in pediatric HCC group was significantly higher compared to that in adult HCC group (36.94±9.28 vs 26.52±4.38, P<0.05), but there was no significant difference compared to the pediatric non-HCC group (36.94±9.28 vs 30.37±14.61, P>0.05). All 7 children in HCC group died within 2 years, whereas the prognosis in pediatric non-HCC group was better, in which two patients survived more than 5 years. CONCLUSION: Children with malignant liver tumors, especially with HCC, may have extensive angiogenesis that induces a rapid tumor growth and leads to a poor prognosis.

Giant malignant gastrointestinal stromal tumors: Recurrence and effects of treatment with STI-571

AIM: Malignant gastrointestinal stromal tumors (GISTs)are rare. Tumors larger than 10 cm tend to recur earlier:the larger the volume of the tumor, the worse the prognosis.We hypothesized that treatment with imatinib mesylate (Gleevec; STI-571), a c-kittyrosine kinase inhibitor, as palliative therapy would prolong the survival of patients with recurrent giant malignant GISTs after resection.METHODS: We performed a retrospective analysis of the effects of resection on patients with giant GISTs (＞10 cm in diameter) to determine the overall survival and recurrence rates. Twenty-three patients diagnosed with giant GISTs were included from June 1996 to December 2003. STI571 was not available until January 2000. After that time,9 patients received this drug. The factors of age, sex, tumor location, histological surgical margin, and STI-571, tumor size changes and drug side effects were reviewed. We compared the survival rate to determine the prognostic factors and the effects of STI-571 on patients with recurrent malignant gastrointestinal stromal tumor.RESULTS: The positive surgical margin group had a significantly higher recurrence rate than the negative margin group (P = 0.012). A negative surgical margin and palliative treatment with STI-571 were significant prognostic variables (Log-rank test,P＜0.05). Age, sex and tumor location were not significant prognostic variables. The 5-year survival rate of the surgical margin free patients was 80%and the 2-year survival rate of the surgical margin positive patients was 28%. The 5-year survival rate was 80% for the patients given STI-571 and 30% for the patients not given STI-571. The use of STI-571 gave a significant tumor shrinkage (6/9) rate in patients with giant GIST recurrence after resection.CONCLUSION: A negative surgical margin and the use of STI-571 after surgical resection were good prognostic indicators. Achieving a tumor-free surgical margin is still the best primary treatment for patients with such tumors.If STI-571 is used immediately when the surgical margin is positive and the tumor recurs after resection, then the prognosis of patients with giant GISTs can be improved.

Decrease of serum carnitine levels in patients with or without gastrointestinal cancer cachexia

AIM： To evaluate the levels of serum carnitine in patients with cancer in digestive organs and to compare them with other cancers in order to provide new insights into the mechanisms of cachexia. METHODS： Fifthy-five cachectic patients with or without gastrointestinal cancer were enrolled in the present study. They underwent routine laboratory investigations, including examination of the levels of various forms of carnitine present in serum （i.e., long-chain acylcarnitine, short-chain acylcarnitine, free carnitine, and total carnitine）. These values were compared with those found in 60 cancer patients in good nutritional status as well as with those of 30 healthy control subjects. RESULTS： When the cachectic patients with gastrointestinal cancer were compared with the cachectic patients without gastrointestinal cancer, the difference was -6.8 μmol/L in free carnitine （P 〈 0.005）, 0.04 μmol/ L in long chain acylcarnitine （P 〈 0.05）, 8.7 μmol/L in total carnitine （P 〈 0.001）. In the cachectic patients with or without gastrointestinal cancer, the difference was 12.2 μmol/L in free carnitine （P 〈 0.001）, 4.60 μmol/L in short chain acylcarnitine （P 〈 0.001）, and 0.60 μmol/L in long-chain acylcarnitine （P 〈 0.005） and 17.4 μmol/L in total carnitine （P 〈 0.001）. In the cachectic patients with gastrointestinal cancer and the healthy control subjects, the difference was 15.5 μmol/L in free carnitine （P 〈 0.001）, 5.2 μmol /L in short-chain acylcarnitine （P 〈 0.001）, 1.0 μmol/L in long chain acylcarnitine （P 〈 0.001）, and 21.8 μmol/L in total carnitine （P 〈 0.001）. CONCLUSION： Low serum levels of carnitine in terminal neoplastic patients are decreased greatly due to the decreased dietary intake and impaired endogenous synthesis of this substance. These low serum carnitine levels also contribute to the progression of cachexia in cancer patients.

Squamous cell cancer of the rectum

Squamous cell carcinoma of the rectum is a rare malignancy.It appears to be associated with chronic inflammatory conditions and infections.The clear association seen between Human Papilloma Virus and various squamous cancers has not been firmly established for the squamous cell cancer of the rectum. The presentation is nonspecific and patients tend to present with advanced stage disease.Diagnosis relies on endoscopic examination with biopsy of the lesion.Distinction from squamous cell cancer of the anus can be difficult,but can be facilitated by immunohistochemical staining for cytokeratins.Staging of the cancer with endoscopic ultrasound and computed tomography provides essential information on prognosis and can guide therapy.At present,surgery remains the main therapeutic option;however recent advances have made chemoradiation a valuable therapeutic addition. Squamous cell carcinoma of the rectum is a distinct entity and it is of crucial importance for the practicing Gastroenterologist to be thoroughly familiar with this disease.Compared to adenocarcinoma of the rectum and squamous cell cancer of the anal canal,squamous cell carcinoma of the rectum has different epidemiology, etiology,pathogenesis,and prognosis but,most importantly,requires a different therapeutic approach. This review will examine and summarize the available information regarding this disease from the perspective of the practicing gastroenterologist.

Assessment of the psychological distress difficulties in patients with cancer using the national comprehensive cancer network rapid screening measure

Objective Clinical guidelines like National Comprehensive Cancer Network Disease recommend routine psychological distress screening as a common problem among patients with cancer. The purpose of this study was to assess the prevalence of clinically significant emotional distress related to demographic and clinical association by standard distress thermometer (DT) within the patients lived in different regions of Gilan state, Iran.

Expression of telomerase gene and apoptosis related genes in benign and malignant breast lesion

Objective:To analyse the expression of telomerase and apoptosis related protein,and explore the possible mechanism of breast cancer development.Methods:Immunohistochemistry method(SP)was used to detect the expression of hTERT,p53 and bcl-2 in the tissues of 48 cases of human breast cancer and 42 cases of benign lesions in breast.Results: The positive rates of expression of hTERT,p53 and bcl-2 in breast cancer were 87.50%,56.25%and 54.17%,respectively. Compared with the groups of adjacent noncancerous and benign lesions,there was a significant difference among three types of tissues(P<0.05).The positive rates of expression of p53 and bcl-2 in the group with positive expression of hTERT were 64.28%and 61.90%,respectively,and their difference was significant compared with the negative group(P<0.05). Conclusion:There is a correlation between the activation of telomerases and p53 gene mutation in the development of breast cancer,and they are perhaps relation to the down regulation of bcl-2.

Differentiation between malignant and benign nodules in the liver: Use of contrast C^3-MODE technology

AIM: To investigate the value of contrast-enhanced C3-MODE technology in differentiating malignant nodules of liver from the benign ones. METHODS: Forty-six nodules in 36 patients (29 men and 7 women) were studied by contrast-enhanced C3-MODE technology and contrast-enhanced CT in 1 wk before the biopsy or operation. A low MI monitor and a high MI flash imaging were intermittently performed. After the injection of contrast agent, the period from 10 to 30 s and the time later than 100 s were respectively defined as early arterial phase and the late phase. The vascularities of the liver nodules in the two phases were combined for differential diagnosis. Corresponding to the pathological diagnosis, the accuracy, sensitivity and specificity of contrast-enhanced C3-MODE technology were compared to those of contrast-enhanced CT. RESULTS: By C3-MODE technology, 33 of the 46 liver nodules were demonstrated as defected area in the late phase and were diagnosed as malignant tumors. Of them, 28 with hypervascularity in the early arterial phase were assessed as hepatocellular carcinoma, the other five nodules with rim-like enhancement in the early arterial phase were diagnosed as metastatic tumors. Thirteen nodules were shown as iso or hypervascularity in the late phase as well as centripetal filling in the early arterial phase and we made a diagnosis of hemangioma. Corresponding to the pathological results, the sensitivity, specificity and accuracy of contrast-enhanced C3-MODE technology in differentiating malignant and benign nodules in the liver were 97.0%, 92.3% and 95.7%, respectively. With comparison to those of contrast CT (sensitivity, 94.1%; specificity, 91.7%; accuracy, 93.5%), the difference was not significant. CONCLUSION: Contrast-enhanced C3-MODE technology can effectively differentiate malignant liver tumors from the benign nodules. It highly agrees diagnostically with the pathology. We suggest that it provides a new approach for differential diagnosis of liver nodules in addition to contrast-enhanced CT.

Study on the expression and mutation of human telomeric repeat binding factor (hTRF1) in 10 malignant hematopoietic cell lines

Objective： Detecting the expression and mutation of human telomeric repeat binding factor （hTRF1） in 10 malignant hematopoietic cell line cells on the base of determining its genomic structure and its four pseudogenes to clarify ifhTRF1 mutation is one of the factors of the activation of telomerase. Methods： hTRFlcDNA sequences were obtained from GenBank, its genome structure and pseudogenes were forecasted by BLAST and other biology information programs and then testified by sequencing. Real-time RT-PCR was used to detect the expression of h TRFlmRNA in 10 cell line cells, including myelogenous leukemia cell lines K562, HL-60, U-937, NB4, THP-I, HEL and Dami; lymphoblastic leukemia cell lines 6T-CEM, Jurkat and Raji. Telomerase activities of cells were detected by using telomeric repeat amplification （TRAP）-ELISA protocol. PCR and sequencing were used to detect mutation of each exon ofhTRF1 in 10 cell line cells. Results： hTRF1 gene, mapped to 8q13, was divided into 10 exons and spans 38.6 kb. Four processed pseudogenes ofhTRF1 located on chromosome 13, 18, 21 and X respectively, was named as ψhTRFI-13, ψhTRFI-18, ψhTRF1-21 and ψhTRFI-X respectively. All cell line cells showed positive telomerase activity. The expression of hTRF1 was significantly lower in malignant hematopoietic cell lines cells （0.0338, 0.0108-0.0749） than in normal mononuclear cells （0.0493, 0.0369-0.128） （P=0.004）. But no significant mutation was found in all exons of hTRF1 in 10 cell line cells. Four variants were found in part ofintron 1, 2 and 8 ofhTRF1. Their infection on gene function is unknown and needs further studies. Conclusion： hTRF1 mutation is probably not one of the main factors for telomerase activation in malignant hematopoietic disease.

Application of ^(18)F-fluorodeoxyglucose Positron Emission Tomography in Diagnosis of Malignant Diseases

Objective To testify the efficacy of ^18F-fluorodeoxyglucose （^18F-FDG） positron emission tomography （PET） in the diagnosis of cancer. Methods A total of 170 patients with diagnosed cancer or suspicious cancer were enrolled in this study, and underwent ^18F-FDG PET. The standard uptake value （SUV） and diameter for each abnormal region in PET images were analyzed. All data were analyzed by SPSS 11.5. Results PET scan identified a primary cancer in 45.8% （11/24） patients. The sensitivity and specificity of PET scan in differentiating malignant lesions from benign ones were 78.8% （52/66） and 77.1% （27/35） respectively. Twenty-nine out of 68 （42.6%） lesions were detected earlier by PET than by computed tomography. The SHV of primary cancer was significantly higher than that of metastatic lymph nodes （5.84± 3.12 vs. 3.14± 2.24, P〈0.001）. And SLIV of primary lung cancer was also significantly higher than that of metastatic lung cancer （6.30±3.01 vs. 2.86±2.37, P〈0.01）.Conclusion ^18F-FDG PET plays a very important role in cancer diagnosis.