AIM:To investigate the clinicopathological characteristics of late-stage lung cancer patients with gastrointestinal(GI)-tract metastases,focusing on therapeutic options and outcomes.METHODS:Our institution(the Nationa...AIM:To investigate the clinicopathological characteristics of late-stage lung cancer patients with gastrointestinal(GI)-tract metastases,focusing on therapeutic options and outcomes.METHODS:Our institution(the National Taiwan University Hospital) diagnosed 8159 patients with lung cancer between 1987 and 2008,of which 21 developed symptomatic GI metastases.This study reviewed all of the patients' information,including survival data,pathological reports,and surgical notes.RESULTS:The most common histological type of lung cancer was adenocarcinoma,and 0.26% of patients with lung cancer developed GI metastases.The median duration from lung cancer diagnosis to GI metastases was three months(range,0-108 mo),and the average time from diagnosis of GI metastasis to death was 2.8 mo.Most patients with symptomatic gastric and/or duodenal metastases exhibited GI bleeding and were diagnosed by panendoscopy.In contrast,small bowel metastases typically presented as an acute abdomen and were not diagnosed until laparotomy.All patients with small bowel or colonic metastases underwent surgical intervention,and their perioperative mortality was 22%.Our data revealed a therapeutic effect in patients with solitary GI metastasis and a favorable palliative effect on survival when metastases were diagnosed preoperatively.In patients with multiple GI metastases,the presentation varied according to the locations of the metastases.CONCLUSION:Surgical treatment is worthwhile in a select group of patients with bowel perforation or obstruction.Physicians should be more alert to symptoms or signs indicating GI metastases.展开更多
If a patient is dying and still suffering great pain, what is the least harmful alternative? Here we prefer continuous sedation until death (CSD). CSD differs from physician-assisted death (PAD) in many aspects. First...If a patient is dying and still suffering great pain, what is the least harmful alternative? Here we prefer continuous sedation until death (CSD). CSD differs from physician-assisted death (PAD) in many aspects. Firstly, CSD is not used to shorten life or cause death, but instead its intention is to relieve suffering. Secondly, once CSD is associated with a reduction in or suspension of food intake, the duration of sedation is too short to have an impact on survival rate. Thirdly, CSD is titrated while PAD is often overdosed. Fourthly, the sanctity of life could be maintained since sedation is used merely as a means of quelling suffering. Last but no least, for unconscious patients, the same medicines are frequently used for both palliative sedation and standard surgical procedures.展开更多
In this paper, following a previous paper （[32] Permanence and extinction of a non- autonomous HIV-I model with two time delays, preprint） on the permanence and extinc- tion of a delayed non-autonomous HIV-1 within-...In this paper, following a previous paper （[32] Permanence and extinction of a non- autonomous HIV-I model with two time delays, preprint） on the permanence and extinc- tion of a delayed non-autonomous HIV-1 within-host model, we introduce and investigate a delayed HIV-1 model including maximum homeostatic proliferation rate of CD4＋ T- cells and varying coefficients. By applying the asymptotic analysis theory and oscillation theory, we show： （i） the system will be permanent when the threshold value R. 〉 1, and for this case we also obtain the explicit estimate of the eventual lower bound of the HIV-1 virus load; （ii） the threshold value R＊ 〈 1 implies the extinction of the virus. Furthermore, we obtain that the threshold dynamics is in agreement with that of the corresponding autonomous system, which extends the classic results for the system with constant coefficients. Numerical simulations are also given to illustrate our main results, and in particular, some sensitivity test of R. is established.展开更多
Non-smooth system including impulsive strategies at both fixed and unfixed times are analyzed. For the model with fixed impulsive effects, the global stability of pest eradi- cation periodic solution and the dominance...Non-smooth system including impulsive strategies at both fixed and unfixed times are analyzed. For the model with fixed impulsive effects, the global stability of pest eradi- cation periodic solution and the dominance of dynamic behavior are investigated. This indicates that the model with fixed moments has the potential to protect the natural enemies from extinction, but under some conditions may also serve to extinction of the pest. The second model is constructed according to the practices of IPM, that is, when the pest population reaches the economic injury level, a combination of biological, cultural, and chemical tactics that reduce pests to tolerable levels is used. Numerical investigations imply that there are several different types of periodic solutions and their maximum amplitudes are always less than the given economic threshold. The results also show that the time series at which the IPM strategies are applied are quite complex, which means that the application and realization of IPM in practice are very difficult.展开更多
文摘AIM:To investigate the clinicopathological characteristics of late-stage lung cancer patients with gastrointestinal(GI)-tract metastases,focusing on therapeutic options and outcomes.METHODS:Our institution(the National Taiwan University Hospital) diagnosed 8159 patients with lung cancer between 1987 and 2008,of which 21 developed symptomatic GI metastases.This study reviewed all of the patients' information,including survival data,pathological reports,and surgical notes.RESULTS:The most common histological type of lung cancer was adenocarcinoma,and 0.26% of patients with lung cancer developed GI metastases.The median duration from lung cancer diagnosis to GI metastases was three months(range,0-108 mo),and the average time from diagnosis of GI metastasis to death was 2.8 mo.Most patients with symptomatic gastric and/or duodenal metastases exhibited GI bleeding and were diagnosed by panendoscopy.In contrast,small bowel metastases typically presented as an acute abdomen and were not diagnosed until laparotomy.All patients with small bowel or colonic metastases underwent surgical intervention,and their perioperative mortality was 22%.Our data revealed a therapeutic effect in patients with solitary GI metastasis and a favorable palliative effect on survival when metastases were diagnosed preoperatively.In patients with multiple GI metastases,the presentation varied according to the locations of the metastases.CONCLUSION:Surgical treatment is worthwhile in a select group of patients with bowel perforation or obstruction.Physicians should be more alert to symptoms or signs indicating GI metastases.
文摘If a patient is dying and still suffering great pain, what is the least harmful alternative? Here we prefer continuous sedation until death (CSD). CSD differs from physician-assisted death (PAD) in many aspects. Firstly, CSD is not used to shorten life or cause death, but instead its intention is to relieve suffering. Secondly, once CSD is associated with a reduction in or suspension of food intake, the duration of sedation is too short to have an impact on survival rate. Thirdly, CSD is titrated while PAD is often overdosed. Fourthly, the sanctity of life could be maintained since sedation is used merely as a means of quelling suffering. Last but no least, for unconscious patients, the same medicines are frequently used for both palliative sedation and standard surgical procedures.
文摘In this paper, following a previous paper （[32] Permanence and extinction of a non- autonomous HIV-I model with two time delays, preprint） on the permanence and extinc- tion of a delayed non-autonomous HIV-1 within-host model, we introduce and investigate a delayed HIV-1 model including maximum homeostatic proliferation rate of CD4＋ T- cells and varying coefficients. By applying the asymptotic analysis theory and oscillation theory, we show： （i） the system will be permanent when the threshold value R. 〉 1, and for this case we also obtain the explicit estimate of the eventual lower bound of the HIV-1 virus load; （ii） the threshold value R＊ 〈 1 implies the extinction of the virus. Furthermore, we obtain that the threshold dynamics is in agreement with that of the corresponding autonomous system, which extends the classic results for the system with constant coefficients. Numerical simulations are also given to illustrate our main results, and in particular, some sensitivity test of R. is established.
文摘Non-smooth system including impulsive strategies at both fixed and unfixed times are analyzed. For the model with fixed impulsive effects, the global stability of pest eradi- cation periodic solution and the dominance of dynamic behavior are investigated. This indicates that the model with fixed moments has the potential to protect the natural enemies from extinction, but under some conditions may also serve to extinction of the pest. The second model is constructed according to the practices of IPM, that is, when the pest population reaches the economic injury level, a combination of biological, cultural, and chemical tactics that reduce pests to tolerable levels is used. Numerical investigations imply that there are several different types of periodic solutions and their maximum amplitudes are always less than the given economic threshold. The results also show that the time series at which the IPM strategies are applied are quite complex, which means that the application and realization of IPM in practice are very difficult.
