细胞的生理性死亡和病理性死亡

细胞是生命体最小单位,细胞死亡可分为病理性死亡和生理性死亡。病理性死亡是多种因素作用下,引起细胞膜或溶酶体破裂导致细胞死亡,以炎症渗出为特点。细胞生理性死亡是细胞遵循自身的新陈代谢规律正常死亡,没有炎症反应。

细胞程序化死亡

细胞程序化死亡是生物体内普遍存在的，具有特殊生物学意义的一种形式。它在机体发育、病毒感染及肿瘤发生等方面起着十分重要的作用。

细胞凋亡的研究近况

细胞凋亡是受到包括基因在内的多种因素调节的细胞主动死亡的过程,随着对细胞凋亡研究的深入,人们逐渐认识到细胞凋亡与细胞增殖在致病作用中具有重要的意义。文章简述了细胞凋亡的概念,细胞凋亡的形态改变,细胞凋亡的基因调控,细胞凋亡的生理意义及细胞凋亡与疫病的关系。通过对细胞凋亡的研究,为预防、治疗、诊断某些疾病提供新的理论依据及相应对策。

排除健康与长寿的隐患

纵观人类的生命史,谁都逃不了生老病死这一过程,死亡是必然的,但人类都是尽其天年而终的吗?死亡的直接原因是什么?各国生物学家曾对动物、人类的衰老过程进行过大量的研究,发现人类的死亡大都因疾病而造成的,即“病理死亡”而尽天年而终,即“生理死亡”却极为罕见。长生不老只是人类有史以来的一种美好愿望,千岁、万岁、万寿无疆的期望值最终仍是个零,人虽不能长生不老,但长寿尽其天年是可能的。

Incidence and mortality of gastric cancer in China

Gastric cancer is one of the most frequent cancers in the world; almost two-thirds of gastric cancer cases and deaths occur in less developed regions. In China, based on two national mortality surveys conducted in 1970s and 1990s, there is an obvious clustering of geographical distribution of gastric cancer in the country, with the high mortality being mostly located in rural areas, especially in Gansu, Henan, Hebei, Shanxi and Shaanxi Provinces in the middle-western part of China. Despite a slight increase from the 1970s to early 1990s, remarkable declines in gastric cancer mortality were noticed in almost the entire population during the last decade in China. These declines were largely due to the dramatic improvements in the social-economic environment, lifestyle, nutrition, education and health care system after economic reforms started two decades ago. Nevertheless, gastric cancer will remain a significant cancer burden currently and be one of the key issues in cancer prevention and control strategy in China. It was predicted that, in 2005, 0.3 million deaths and 0.4 million new cases from gastric cancer would rank the third most common cancer. The essential package of the prevention and control strategy for gastric cancer in China would focus on controlling Helicobacter pylori （H pylori infection, improving educational levels, advocating healthy diet and anti-tobacco campaign, searching for cost-effective early detection, diagnosis and treatment programs including approaches for curable management and palliative care.

Acute upper gastrointestinal bleeding in octοgenarians:Clinical outcome and factors related to mortality

AIM: To evaluate the aetiology, clinical outcome and factors related to mortality of acute upper gastrointestinal bleeding (AUGIB) in octogenarians. METHODS: We reviewed the records of all patients over 65 years old who were hospitalised with AUGIB in two hospitals from January 2006 to December of 2006. Patients were divided into two groups: Group A (65-80 years old) and Group B (> 80 years old). RESULTS: Four hundred and sixteen patients over 65 years of age were hospitalized because of AUGIB. Group A included 269 patients and Group B 147 patients. Co-morbidity was more common in octogenarians (P = 0.04). The main cause of bleeding was peptic ulcer in both groups. Rebleeding and emergency surgery were uncommon in octogenarians and not different from those in younger patients. In-hospital complications were more common in octogenarians (P = 0.05) and more patients died in the group of octogenarians compared to the younger age group (P = 0.02). Inability to perform endoscopic examination (P = 0.002), presence of high risk for rebleeding stigmata (P = 0.004), urea on admission (P = 0.036), rebleeding (P = 0.004) and presenceof severe co-morbidity (P < 0.0001) were related to mortality. In multivariate analysis, only the presence of severe co-morbidity was independently related to mortality (P = 0.032). CONCLUSION: While rebleeding and emergency surgery rates are relatively low in octogenarians with AUGIB, the presence of severe co-morbidity is the main factor of adverse outcome.

D2 dissection in laparoscopic and open gastrectomy for gastric cancer

AIM: To evaluate the radicalness and safety of laparoscopic D2 dissection for gastric cancer. METHODS: Clinicopathological data from 209 patients with gastric cancer, who underwent radical gastrectomy with D2 dissection between January 2007 and February 2011, were analyzed retrospectively. Among these patients, 131 patients underwent laparoscopyassisted gastrectomy (LAG) and 78 underwent open gastrectomy (OG). The parameters analyzed included operative time, blood loss, blood transfusion, morbidity, mortality, the number of harvested lymph nodes (HLNs), and pathological stage.RESULTS: There were no significant differences in sex, age, types of radical resection [radical proximal gastrectomy (PG + D2), radical distal gastrectomy (DG + D2) and radical total gastrectomy (TG + D2)], and stages between the LAG and OG groups (P > 0.05). Among the two groups, 127 cases (96.9%) and 76 cases (97.4%) had 15 or more HLNs, respectively. The average number of HLNs was 26.1 ± 11.4 in the LAG group and 24.2 ± 9.3 in the OG group (P = 0.233). In the same type of radical resection, there were no signifi cant differences in the number of HLNs between the two groups (PG + D2: 21.7 ± 7.5 vs 22.4 ± 9.3; DG + D2: 25.7 ± 11.0 vs 22.3 ± 7.9; TG + D2: 30.9 ± 13.4 vs 29.3 ± 10.4; P > 0.05 for all comparisons). Tumor free margins were obtained in all cases. Compared with OG group, the LAG group had signifi cantly less blood loss, but a longer operation time (P < 0.001). The morbidity of the LAG group was 9.9%, which was not signifi cantly different from the OG group (7.7%) (P = 0.587). The mortality was zero in both groups. CONCLUSION: Laparoscopic D2 dissection is equivalent to OG in the number of HLNs, regardless of tumor location. Thus, this procedure can achieve the same radicalness as OG.

The vital threat of an upper gastrointestinal bleeding: Risk factor analysis of 121 consecutive patients

AIM： To analyze the importance in predicting patients risk of mortality due to upper gastrointestinal （UGI） bleeding under today＇s therapeutic regimen. METHODS： From 1998 to 2001, 121 patients with the diagnosis of UGI bleeding were treated in our hospital. Based on the patients＇ data, a retrospective multivariate data analysis with initially more than 270 single factors was performed. Subsequently, the following potential risk factors underwent a logistic regression analysis： age, gender, initial hemoglobin, coumarines, liver cirrhosis, prothrombin time （PT）, gastric ulcer （small curvature）, duodenal ulcer （bulbus back wall）, Forrest classification, vascular stump, variceal bleeding, MalloryWeiss syndrome, RBC substitution, recurrent bleeding, conservative and surgical therapy. RESULTS： Seventy male （58%） and 51 female （42%） patients with a median age of 70 （range： 21-96） years were treated. Their in-hospital mortality was 14%. While 12% （11/91） of the patients died after conservative therapy, 20% （6/30） died after undergoing surgical therapy. UGI bleeding occurred due to duodenal ulcer （n = 36; 30%）, gastric ulcer （n = 35; 29%）, esophageal varicosis （n = 12; 10%）, Mallory-Weiss syndrome （n = 8, 7%）, erosive lesions of the mucosa （n = 20; 17%）, cancer （n = 5; 4%）, coagulopathy （n = 4; 3%）, lymphoma （n = 2; 2%）, benign tumor （n = 2; 2%） and unknown reason （n = 1, 1%）. A logistic regression analysis of all aforementioned factors revealed that liver cirrhosis and duodenal ulcer （bulbus back wall） were associated risk factors for a fatal course after UGI bleeding. Prior to endoscopy, only liver cirrhosis was an assessable risk factor. Thereafter, liver cirrhosis, the location of a bleeding ulcer （bulbus back wall） andpatients＇ gender （male） were of prognostic importance for the clinical outcome （mortality） of patients with a bleeding ulcer.CONCLUSION： Most prognostic parameters used in clinical routine today are not reliable enough in predicting a patient＇s vital threat posed by an UGI bleeding.Liver cirrhosis, on the other hand, is significantly more frequently associated with an increased risk to die after bleeding of an ulcer located at the posterior duodenal wall.

Relationship Between Programmed Death-ligand 1 and Clinicopathological Characteristics in Non-small Cell Lung Cancer Patients

Objective To evaluate the correlation between programmed death-ligand 1 （PD-L1） expression in primary lung cancer cells, tumor associated macrophages （TAM） and patients＇ clinicopathological characteristics. Methods From 2008 to 2010, 208 non-small cell lung cancer patients who underwent surgery or CT-guided biopsy were recruited from Huadong Hospital, Fudan University. Immunohistochemistry staining was performed to evaluate the PD-L1 expression in both primary lung cancer cells and CD68 positive TAM.

End-of-life care in a cardiology department： have we improved？

Background End-of-life care is not usually a priority in cardiology departments. We sought to evaluate the changes in end-of-life care after the introduction of a do-not-resuscitate （DNR） order protocol. Methods ＆ Results Retrospective analysis of all deaths in a cardiology department in two periods, before and after the introduction of the protocol. Comparison of demographic characteristics, use of DNR orders, and end-of-life care issues between both periods, according to the presence in the second period of the new DNR sheet （Group A）, a conven- tional DNR order （Group B） or the absence of any DNR order （Group C）. The number of deaths was similar in both periods （n = 198 vs. n = 197）. The rate of patients dying with a DNR order increased significantly （57.1% vs. 68.5%; P = 0.02）. Only 4% of patients in both periods were aware of the decision taken about cardiopulmonary resuscitation. Patients in Group A received the DNR order one day earlier, and 24.5% received it within the first 24 h of admission （vs. 2.6% in the first period; P 〈 0.001）. All patients in Group A with an implantable cardioverter defibrillator （ICD） had shock therapies deactivated （vs. 25.0% in the first period; P = 0.02）. Conclusions The introduction of a DNR order protocol may improve end-of-life care in cardiac patients by increasing the use and shortening the time of registration of DNR orders. It may also contribute to increase ICD deactivation in patients with these orders in place. However, the introduction of the sheet in late stages of the disease failed to improve patient participation.

中外科学家的评论

中国医学科学院基础医学研究所章静被教授认为，细胞凋亡理论的被证实和获奖具有重要的理论和实际意义。在理论上，细胞凋亡确立了细胞的正常生理性死亡和异常病理性死亡的区别。在生命意义上并非死亡就不好，而生存就好。细胞凋亡的实际意义是让我们能更深刻地理解许多疾病和器官发育的原理，从而找到战胜疾病的手段。

21世纪的健康新概念

洪昭光是全国著名心脑血管专家,中央保健局特聘医生,曾为我国中央及各省自治区领导人作过数百场健康讲座,入选2004福布斯中国名人榜。现任中国首席键康教育专家、卫生部心脑血管病专家咨询委员会副主任、首都医科大学附属北京安贞医院教授、主任医师。从本期开始,我们将以连载的形式发表这份讲座文稿,以飨读者。

Tick-Borne Viruses

Ticks are important vectors for the transmission of pathogens including viruses.The viruses carried by ticks also known as tick-borne viruses(TBVs),contain a large group of viruses with diverse genetic properties and are concluded in two orders,nine families,and at least 12 genera.Some members of the TBVs are notorious agents causing severe diseases with high mortality rates in humans and livestock,while some others may pose risks to public health that are still unclear to us.Herein,we review the current knowledge of TBVs with emphases on the history of virus isolation and identification,tick vectors,and potential pathogenicity to humans and animals,including assigned species as well as the recently discovered and unassigned species.All these will promote our understanding of the diversity of TBVs,and will facilitate the further investigation of TBVs in association with both ticks and vertebrate hosts.