Recent research on vasectomy techniques

Vasectomy is a commonly used, highly effective method for the control of fertility in the human male. It is almost always performed as an outpatient procedure, is safer than tubal occlusion and has few side effects. The number of people relying on vasectomy as a method of contraception varies widely from country to country. Though vasectomy is highly effective, failures may occur due to re-canalization of the vas, surgical error, anatomical variants or failure of contraception during the post-operative waiting period. One of the disadvantages of this technique is that sperm are present in the posterior end of the vas following surgery and hence patients have to use alternative methods of contraception for a waiting period of 12 weeks to 15 weeks before relying on a vasectomy for contraception. This review summarizes recent research on vasectomy conducted by Family Health International, USA.

Key elements that determine the efficacy of cupping therapy:A bibliometric analysis and review of clinical studies

Objective:The aim of this review was to identify the possible mechanisms behind cupping therapy by employing an evidence-based approach,and to explore its possible regional and systemic effects in the human body.Methods:We searched six electronic databases and four online trial registries for articles published up to January 1,2020.Clinical studies on the mechanisms of retained cupping,flashing cupping,moving cupping,and vacuum cupping were considered for this review.The methodological qualities of controlled studies were assessed using the National Institute for Clinical Excellence methodology checklist,the Newcastle-Ottawa Scale,and the Cochrane risk of bias tool.Characteristic statistical description and qualitative summary of results were used for data analysis.Results:Thirty-eight studies(37 full texts and one abstract)were included in this study.Due to the clinical heterogeneity among the studies,we could not conduct a meta-analysis.The results showed that the key factors that contribute to the efficacy of cupping therapy are negative pressure and temperature.Cupping therapy mainly causes local and systemic changes in hemodynamics,immune regulation,metabolism,and pain relief.Conclusion:We identified negative pressure as the key element behind cupping therapy.Cupping therapy may cause redistribution of oxygen at the cupping site and in neighboring tissues,thereby inducing a therapeutic effect by increasing regional blood flow.It may also induce metabolic change,immunomodulation,and neuromodulation.However,additional rigorous clinical research needs to be conducted to further clarify the mechanism behind cupping therapy.

三氧化二砷和肿瘤坏死因子相关凋亡诱导配体诱导的髓系恶性细胞系P15^(ink4b)表达

目的:观察骨髓增生异常综合征(MDS)髓系原始细胞系MDS-L及髓系白血病细胞系ML1经不同剂量和不同时间的三氧化二砷(As2O3)和肿瘤坏死因子相关凋亡诱导配体(TRAIL)处理后的抑癌基因P15ink4b变化。并研究DNA甲基化转移酶DNMT1在P15ink4b变化中的可能作用。方法:体外培养的MDS-L和ML1细胞经9种不同浓度的药物处理(As2O31 mmol/L;2 mmol/L;5 mmol/L;TRAIL 100μg/L;300μg/L;500μg/L;As2O31 mmol/L加Trail 100μg/L;As2O32 mmol/L加TRAIL 300μg/L;As2O35 mmol/L加TRAIL 500μg/L),在24 h、48 h和72 h后收获细胞。未经药物处理的细胞和药物处理后收获的细胞均提取总RNA,经半定量RT-PCR检测P15ink4bmRNA表达。对MDS-L细胞还同时检测DNMT1表达;正常人和5例MDS病例的P15ink4b和DNMT1检测作为对照。结果:未经处理的MDS-L和ML1细胞基本不表达P15ink4b,药物处理后P15ink4b表达增强;药物诱导MDS-L细胞表达P15ink4b的作用强于ML1细胞;未经处理的MDS-L和ML1细胞高表达DNMT1,药物处理24 h后DNMT1不同程度下降,但DNMT1表达状况与P15ink4b表达增强不显示相关性。结论:As2O3和(或)TRAIL处理能促进髓系恶性细胞抑癌基因P15ink4b表达,但并非主要通过抑制DNMT1功能而起作用。

Colostomy is a simple and effective procedure for severe chronic radiation proctitis

AIM: To assess the efficacy and safety of diverting colostomy in treating severe hemorrhagic chronic radiation proctitis(CRP). METHODS: Patients with severe hemorrhagic CRP who were admitted from 2008 to 2014 were enrolled into this study. All CRP patients were diagnosed by a combination of pelvic radiation history, clinical rectal bleeding, and endoscopic findings. Inclusion criteria were CRP patients with refractory bleeding with moderate to severe anemia with a hemoglobin level < 90 g/L. The study group included patients who were treated by diverting colostomy, while the control group included patients who received conservative treatment. The remission of bleeding was defined as complete cessation or only occasional bleeding that needed no further treatment. The primary outcome was bleeding remission at 6 mo after treatment. Quality of life beforetreatment and at follow-up was evaluated according to EORTC QLQ C30. Severe CRP complications were recorded during follow-up.RESULTS: Forty-seven consecutive patients were enrolled, including 22 in the colostomy group and 27 in the conservative treatment group. When compared to conservative treatment, colostomy obtained a higher rate of bleeding remission(94% vs 12%), especially in control of transfusion-dependent bleeding(100% vs 0%), and offered a better control of refractory perianal pain(100% vs 0%), and a lower score of bleeding(P < 0.001) at 6 mo after treatment. At 1 year after treatment, colostomy achieved better remission of both moderate bleeding(100% vs 21.5%, P = 0.002) and severe bleeding(100% vs 0%, P < 0.001), obtained a lower score of bleeding(0.8 vs 2.0, P < 0.001), and achieved obvious elevated hemoglobin levels(P = 0.003), when compared to the conservative treatment group. The quality of life dramatically improved after colostomy, which included global health, function, and symptoms, but it was not improved in the control group. Pathological evaluation after colostomy found diffused chronic inflammation cells, and massive fibrosis collagen depositions under the rectal wall, which revealed potential fibrosis formation. CONCLUSION: Diverting colostomy is a simple, effective and safe procedure for severe hemorrhagic CRP. Colostomy can improve quality of life and reduce serious complications secondary to radiotherapy.

Methylation of DAPK and THBS1 genes in esophageal gastric-type columnar metaplasia

AIM: To explore methylation of DAPK, THBS1, CDH-1, and p14 genes, and Helicobacter pylori(H. pylori) status in individuals harboring esophageal columnar metaplasia.METHODS: Distal esophageal mucosal samples obtained by endoscopy and histologically diagnosed as gastric-type(non-specialized) columnar metaplasia, were studied thoroughly. DNA was extracted from paraffin blocks, and methylation status of deathassociated protein kinase(DAPK), thrombospondin-1(THBS1), cadherin-1(CDH1), and p14 genes, was examined using a methyl-sensitive polymerase chain reaction(MS-PCR) and sodium bisulfite modification protocol. H. pylori cag A status was determined by PCR.RESULTS: In total, 68 subjects(33 females and 35 males), with a mean age of 52 years, were included. H. pylori cag A positive was present in the esophageal gastric-type metaplastic mucosa of 18 individuals. DAPK, THSB1, CDH1, and p14 gene promoters were methylated by MS-PCR in 40(58.8%), 33(48.5%), 46(67.6%), and 23(33.8%) cases of the 68 esophageal samples. H. pyloristatus was associated with methylation of DAPK(P = 0.003) and THBS1(P = 0.019).CONCLUSION: DNA methylation occurs in cases of gastric-type(non-specialized) columnar metaplasia of the esophagus, and this modification is associated with H. pylori cag A positive infection.

Diffusion-weighted magnetic resonance imaging to predict response of hepatocellular carcinoma to chemoembolization

AIM: To investigate whether intra-procedural diffusion- weighted magnetic resonance imaging can predict response of hepatocellular carcinoma (HCC) during trans- catheter arterial chemoembolization (TACE). METHODS: Sixteen patients (15 male), aged 59 ±11 years (range: 42-81 years) underwent a total of 21 separate treatments for unresectable HCC in a hybrid magnetic resonance/interventional radiology suite. Ana- tomical imaging and diffusion-weighted imaging (b = 0, 500 s/mm2) were performed on a 1.5-T unit. Tumor enhancement and apparent diffusion coefficient (ADC, mm2/s) values were assessed immediately before and at 1 and 3 mo after TACE. We calculated the percent change (PC) in ADC values at all time points. We compared follow-up ADC values to baseline values using a paired t test (α = 0.05). RESULTS: The intra-procedural sensitivity, specificity, and positive and negative predictive values (%) for detecting a complete or partial 1-mo tumor response using ADC PC thresholds of ±5%, ±10%, and ±15% were 77, 67, 91, and 40; 54, 67, 88, and 25; and 46, 100, 100, and 30, respectively. There was no clear predictive value for the 3-mo follow-up. Compared to baseline, the immediate post-procedure and 1-mo mean ADC values both increased; the latter obtaining statistical significance (1.48 ± 0.29 mm2/s vs 1.65 ± 0.35 × 10-3 mm2/s, P < 0.014). CONCLUSION: Intra-procedural ADC changes of > 15% predicted 1-mo anatomical HCC response with the greatest accuracy, and can provide valuable feedback at the time of TACE.

Taking Care of Her: A Pilot Feasibility Study of a Caregiver Intervention for Women with Advanced Stage Ovarian Cancer

The purpose of this study is to examine the feasibility and short-term impact of a fully manualized, telephone-delivered intervention for spouse caregivers, Taking Care of Her (TCH). A total of 12 study participants from the Pacific NW were enrolled whose wife was diagnosed with Stage III ovarian cancer within 8 months. Feasibility was confirmed by rates of recruitment and retention;the quality of delivery of the intervention by telephone;and through data obtained on program acceptability during follow up exit interviews. Outcomes from the within-group analysis revealed improvements on standardized measures of spouses’ and patients’ depressed mood and anxiety;marital communication about the cancer;caregivers’ skills and confidence to manage the emotional toll of the illness on themselves and wives;and wives’ positive appraisal of spousal support. Study results suggest that the TCH Program has the potential to positively affect both spouse caregiver and patients’ adjustment to recently diagnosed advanced ovarian cancer. Telephone delivery holds promise for sustainability. A future clinical trial with a larger study sample is warranted.

Partial overlap of anti-mycobacterial,and anti-Saccharomyces cerevisiae mannan antibodies in Crohn's disease

AIM:To test whether humoral immune reaction against mycobacteria may play a role in anti-Saccharomyces cerevisiae antibodies(ASCA) generation in Crohn's disease(CD) and/or whether it correlates with clinical subtypes. METHODS:The dominant ASCA epitope was detected by Galanthus nivalis lectin(GNL)-binding assay. ASCA and IgG against mycobacterial lysates(M avium,M smegmatis,M chelonae,M bovis BCG,M avium ssp. paratuberculosis(MAP)] or purified lipoarabinomannans(LAM) were detected by ELISA. ASCA and anti-mycobacterial antibodies were affinity purified to assess cross-reactivities. Anti-mycobacterial IgG were induced by BCG-infection of mice. RESULTS:GNL bound to different extents to mycobacterial lysates,abundantly to purified mannose-capped(Man) LAM from M tuberculosis,but not to uncapped LAM from M smegmatis . Fifteen to 45%of CD patients but only 0%-6% of controls were seropositive against different mycobacterial antigens. Anti-mycobacterial IgG correlated with ASCA(r = 0.37-0.64;P = 0.003-P < 0.001). ASCA-positivity and deficiency for mannan-binding lectin synergistically associated with anti-mycobacterial IgG. In some patients,anti-mycobacterial antibodies represent cross-reactive ASCA. Vice-versa,the predominant fraction of ASCA did not cross-react with mycobacteria. Finally,fistulizing disease associated with antibodies against M avium,M smegmatis and MAP(P = 0.024,0.004 and 0.045,respectively). CONCLUSION:Similar to ASCA,seroreactivity against mycobacteria may define CD patients with complicated disease and a predisposition for immune responses against ubiquitous antigens. While in some patients anti-mycobacterial antibodies strongly cross-react with yeast mannan;these cross-reactive antibodies only represent a minor fraction of total ASCA. Thus,mycobacterial infection unlikely plays a role in ASCA induction.

Hyperuricemia as a Predictor of Progression of Chronic Kidney Disease: A Matched Cohort Analysis

Background: The clinical significance of uric acid (UA) in patients with chronic kidney disease (CKD) has never been elucidated in detail. Objectives: The aim of this study was to elucidate the predictive value of hyperuricemia (HU) in relation to kidney disease progression in CKD patients. Methods: We reviewed data obtained from 201 CKD patients. Renal outcome was assessed by performing the Kaplan-Meier and Cox proportional hazard regression models. The renal outcomes of CKD patients with and without HU were compared by using a propensity score-matched cohort. Results: The results of a multivariate Cox regression analysis showed that HU (UA ≥ 7.1 mg/dL) (P = 0.001), diabetes mellitus (P = 0.003), and a high urine albumin-to-creatinine ratio (P = 0.0005) were significantly associated with a ≥50% eGFR decline or ESRD. The serum UA values were positively correlated with mean blood pressure (P = 0.007), visceral fat area (P = 0.0003), and maximum carotid intima-media thickness (P = 0.0003). The Kaplan-Meier analysis in the propensity score-matched cohort indicated that the renal survival rate of the group of CKD patients with HU was significantly lower than that of the group without HU (log rank, P Conclusion: The results of this study suggest that the serum UA value is a predictor of CKD progression.

Soluble MICB in Plasma and Urine Explains Population Expansions of NKG2D⁺CD4 T Cells Inpatients with Juvenile-Onset Systemic Lupus Erythematosus

Abnormal NKG2D ligand expression has been implicated in the initiation and maintenance of various auto-inflammatory disorders including systemic lupus erythematosus (SLE). This study’s goal was to identify the cellular contexts providing NKG2D ligands for stimulation of the immunosuppressive NKG2D+CD4 T cell subset that has been implicated in modulating juvenile-onset SLE disease activity. Although previous observations with NKG2D+CD4 T cells in healthy individuals pointed towards peripheral B cell and myeloid cell compartments as possible sites of enhanced NKG2DL presence, we found no evidence for a disease-associated increase of NKG2DL-positivity among juvenile-onset SLE B cells and monocytes. However, juvenile-onset SLE patient plasma and matched urine samples were positive by ELISA for the soluble form of the NKG2D ligands MICA and MICB, suggesting that kidney and/or peripheral blood may constitute the NKG2DL positive microenvironments driving NKG2D+CD4 T cell population expansions in this disease.

Changes Induced by Physical Activity, Weight Loss and Calorie Restriction in Body Composition, Lipoproteins and Functional Capacity in Obese Congolese Women

Background. The effects of physical exercises combined with a low-calorie diet on weight loss, body composition, lipoproteins profile, and physical fitness had been well described. However, Central Africa’s studies investigating these kinds of diets and exercise regimens are lacking. Objective. To investigate the effects of adding 14-weeks exercises to a hypocaloric diet on changes in body composition, lipoproteins concentrations, and physical capacities in obese Congolese women. Population and Methods. In total, 34 obese women aged 30 - 39 years (mean age: 33.7 ± 2.4 years) assigned to 14-weeks training program and low energy ketogenic diet. Body composition was assessed using classic methods and impedancemetry. Fasting plasma glucose (FPG) and fasting serum insulin were assessing using enzymatic colorimetric and radioim-munoradiometric methods. HOMA-IR and lipoproteins concentrations were assessed using standardized laboratory methods. VO2peak was measured on a treadmill during a progressive exercise test. Speed, cadence and stride length were measured along the 10-m level walkway. Muscular endurance was measured using the tests of sit-up and inflections-extensions of elbows. All the variables of the study were assessed at the beginning, in the 7-weeks, and in the 14-weeks of training methods. Results. Declines in body weight (16%), percent fat (12.1%), fat weight (26.4%), abdominal fat (34.2%), and waist circumference (10.4%) were found. A significant decrease in FPG (13%), fasting serum insulin (60.9%), HOMA-IR (64.7%), total cholesterol (12.2%), LDL-cholesterol (20.3%), triglycerides (92.8%), and VLDL-triglycerides (17.5%) was shown. In contrast, significant increase in HDL-cholesterol (27.13%) was found. The peak oxygen consumption VO2peak relative to body weight improved more in the 14-weeks training program (13.4%). Obese women exhibited higher values in the 14-weeks training program for speed gait (16.5%), cadence (9.1%), and stride length (15.7%) during normal walk and rapid walk. Weight loss combined with a low-calorie diet and 14-weeks training program improved significantly muscular endurance capacities. Conclusion. Exercise added to hypocaloric diet leads to decreases in body composition, to improve in insulin sensitivity, to enhancement of VO2peak and functional fitness. This may be helpful for the treatment of the metabolic complications of abdominal obesity.

RSPSSL:A novel high-fidelity Raman spectral preprocessing scheme to enhance biomedical applications and chemical resolution visualization

Raman spectroscopy has tremendous potential for material analysis with its molecular fingerprinting capability in many branches of science and technology.It is also an emerging omics technique for metabolic profiling to shape precision medicine.However,precisely attributing vibration peaks coupled with specific environmental,instrumental,and specimen noise is problematic.Intelligent Raman spectral preprocessing to remove statistical bias noise and sample-related errors should provide a powerful tool for valuable information extraction.Here,we propose a novel Raman spectral preprocessing scheme based on self-supervised learning(RSPSSL)with high capacity and spectral fidelity.It can preprocess arbitrary Raman spectra without further training at a speed of~1900 spectra per second without human interference.The experimental data preprocessing trial demonstrated its excellent capacity and signal fidelity with an 88%reduction in root mean square error and a 60%reduction in infinite norm(L__(∞))compared to established techniques.With this advantage,it remarkably enhanced various biomedical applications with a 400%accuracy elevation(ΔAUC)in cancer diagnosis,an average 38%(few-shot)and 242%accuracy improvement in paraquat concentration prediction,and unsealed the chemical resolution of biomedical hyperspectral images,especially in the spectral fingerprint region.It precisely preprocessed various Raman spectra from different spectroscopy devices,laboratories,and diverse applications.This scheme will enable biomedical mechanism screening with the label-free volumetric molecular imaging tool on organism and disease metabolomics profiling with a scenario of high throughput,cross-device,various analyte complexity,and diverse applications.

骨髓增生异常综合征表皮生长因子受体的表达及其与细胞凋亡的关系

目的 探索骨髓增生异常综合征 (MDS)造血细胞中表皮生长因子受体 (EGFR)表达及其与细胞凋亡的关系。方法 取 18例MDS患者骨髓有核细胞经离心涂片机制片 ,用免疫酶标记方法(碱性磷酸酶 抗碱性磷酸酶系统 ,APAAP)及TdT介导的dUTP缺口末端 (荧光素 )标记 (TUNEL)法先后在同一标本上检测EGFR表达和凋亡信号。 9名正常人骨髓作对照。另外 ,18例MDS中有 15例、9名正常人中有 6名经流式细胞仪分选CD3 4+细胞并制备涂片后按上述方法进行EGFR和凋亡检测 ,并分析两者间的关系。结果 ①MDS骨髓细胞EGFR表达 [(38.6± 2 4.6 ) %]高于正常对照 [(18.1±14 0 ) %](P <0 .0 5 ) ;②MDS细胞凋亡主要发生在EGFR阴性细胞 (16 .1%) ,EGFR阳性细胞中凋亡细胞仅占 1.4%(P <0 .0 1) ,EGFR表达与细胞凋亡呈负相关 (r =- 0 .70 1;tr=3.6 0 ;P <0 .0 1) ;③CD3 4+细胞EGFR表达阳性率RAEB RAEB t CMML组高于RA RAS组 ,分别为 (2 0 .6± 2 7.9) %和 (8.9±11 8) %,但差异无显著性 ,细胞凋亡率RAEB RAEB t CMML组低于RA RAS组 ,分别为 (18.2± 12 5 ) %和 (4 5 .2± 2 0 .5 ) %(P <0 .0 5 )。结论 MDS造血细胞过度表达EGFR。EGFR表达增高可能预示MDS的恶性增殖倾向并通过某种途径抑制细胞凋亡。

A Systematic Review of Anticancer Effects of Radix Astragali

Objective： To review the anticancer effects of Radix astragali （RA）, one of the most commonly used herbs to manage cancer in East Asia, and its constituents and to provide evidence of clinical usage through previously performed clinical studies. Methods： Preclinical and clinical studies related to the anticancer effects of RA were searched from inception to November 2013 in electronic databases. Two reviewers independently investigated 92 eligible studies, extracted all the data of studies and appraised methodological quality of clinical trials. The studies were categorized into in vitro and in vivo experimental studies and clinical studies, and analyzed by saponins, polysaccharides, and flavonoids of RA constituents, RA fraction, and whole extract. Results： In preclinical studies, RA was reported to have tumor growth inhibitory effects, immunomodulatory effects, and attenuating adverse effects by cytotoxic agents as well as chemopreventive effects. Saponins seemed to be the main constituents, which directly contributed to suppression of tumor growth through the activation of both intrinsic and extrinsic apoptotic pathway, modulation of intracellular signaling pathway, and inhibition of invasion and angiogenesis. Flavonoids suppressed tumor growth through the similar mechanisms with saponins. Polysaccharides showed immunomodulatory effects, contributing tumor shrinkages in animal models, despite the low cytotoxicity to cancer cells. Most of the clinical studies were performed with low evidence level of study designs because of various limitations. RA whole extracts and polysacchaddes of RA were reported to improve the quality of life and ameliorate myelosuppression and other adverse events induced by cytotoxic therapies. Coaclusion： The polysaccharides, saponins, and flavonoids of RA, and the whole extract of RA have been widely reported with their anticancer effects in preclinical studies and showed a potential application as a adjunctive cancer therapeutics with the activities of irnmunomodulation, anti-proUferation and attenuation of adverse effects induced by cytotoxic therapy.

Diagnostic Indicators for Blood Stasis Syndrome Patients with Gynaecological Diseases

Objective： To investigate the important diagnostic indicators for blood stasis syndrome （BSS） in patients of childbearing age with gynaecological diseases. Methods： A partial least squared-discriminant analysis （PLS-DA） were applied to BSS symptoms data of patients with gynaecological diseases, and the diagnostic indicators used by doctors of Korean medicine （DKMs） among BSS patients with gynaecological diseases were also investigated. Results： A total of 103 patients of childbearing age with gynaecological diseases and 40 healthy controls were enrolled. Among the 103 patients, 63 （61.7%） and 40 （38.8%） were diagnosed with BSS and non-BSS, respectively, and BSS patients exhibited a more severe extent of disease. A score plot of PLS-DA showed clearly different patterns among the 3 groups. Based on the variable importance on projection of PLS-DA model, menstrual pains, dark lumps in the menstrual blood, ileocoecal tenderness and resistance, sharp pains, and sublingual varicosities were selected as the top five most important indicators. Moreover, more than 75% of DKMs chose dark lumps in menstrual blood, menstrual pain, and dark menstrual blood as the diagnostic indicators of BSS in patients with gynaecological diseases, and more than 49% of them also considered sharp pains, dark red tongue, sublingual varicosities, and tendency to bruise easily as diagnostic indicators of BSS. Conclusion： DKMs focused on menstrual symptoms and certain gynaecological symptoms to diagnose BSS patients of childbearing age with female diseases.

Microchimerism in recurrent miscarriage

Maternal-fetal cell exchange during pregnancy results in acquisition of microchimerism, which can durably persist in both recipients. Naturally acquired microchimerism may impact maternal-fetal interaction in pregnancy. We conducted studies to ask whether microchimerism that a woman acquired from her own mother is detectable before or during pregnancy in women with recurrent miscarriage. Fetal microchimerism was also assayed. Women with primary idiopathic recurrent miscarriage （n=23） and controls （n=31） were studied. Genotyping was conducted for probands, their mothers and the fetus, a non-shared polymorphism identified and quantitative polymerase chain reaction performed to measure microchimerismin peripheral blood mononuclear cells. Preconception comparisons were made between recurrent miscarriage subjects and controls, using logistic regression and Wilcoxon rank sum. Longitudinal microchimerism in subsequent pregnancies of recurrent miscarriage subjects was described. There was a trend toward lower preconception detection of microchimerism in recurrent miscarriage versus controls, 6% vs. 19% （1/16 vs. 6/31, P=0.2）. During pregnancy, 3111 （27%） of recurrent miscarriage subjects who went on to have a birth had detection of microchimerism from their own mother, whereas neither of two subjects who went on to miscarry had detection （0/2）. This initial data suggest that microchimerism from a woman＇s own mother, while detectable in women with recurrent miscarriage, may differ from controls and according to subsequent pregnancy outcome. Further studies are needed to determine the cell types,quantities and any potential functional role of microchimerism in recurrent miscarriage.

高危人群肺癌筛查--肿瘤分期转变的早期证据提示真实世界的获益

随机临床研究结果显示,针对高危人群应用低剂量CT进行肺癌筛查可通过早期诊断非小细胞肺癌(non-small cell lung cancer,NSCLC),降低每年肺癌全因死亡率。目前世界范围内肺癌仍然是病死率最高的肿瘤,主要原因为大多数病例被诊断时即为进展期和无法治愈期。筛查高危人群的目标是在较早可治愈阶段诊断癌症,最终预防肺癌死亡。

Recognition of Association Between Blood Stasis Syndrome and Traumatic Injury among Doctors of Korean Medicine:A Cross-Sectional Observation Study

Objective： To investigate the diagnostic indicators and herbal treatments for blood stasis syndrome（BSS） patients with traumatic injuries and to identify the association between BSS and traumatic injury in Korea. Methods： Two-hundred and four patients with traumatic injury were recruited from the Gangnam and Daejeon branches of Jaseng Hospital of Oriental Medicine between June 2014 and December 2014. Two independent doctors of Korean medicine（DKMs） determined the diagnosis of BSS or non-BSS based on the subjects＇ signs and symptoms. The scores assigned to BSS symptoms and DKMs＇ reasons for diagnosing BSS in patients with traumatic injury were investigated. Both medication and herbal prescription records from a 3-month period were collected for all patients diagnosed with BSS by both DKMs. Results： A total of 169 of 204（82.8%） patients received consistent diagnosis related to BSS by two DKMs. Among them, 54.4%（92 cases） were diagnosed with BSS, and 45.6%（77 cases） were not diagnosed with BSS. DKMs most frequently cited symptoms of recent traumatic injury as justifications for BSS diagnoses, and also selected pain-related indicators such as abdominal pain, sharp pain and nocturnal pain as important reasons in diagnosing BSS. In addition, an inconsistency in the pattern identification theory with respect to traumatic injury was observed. Although only 92 cases（54.4%） of patients were diagnosed with BSS, 77.6% of them were prescribed decoctions for BSS. Conclusions： DKMs considered traumatic injury could cause BSS, and utilized decoction for BSS in patients with traumatic injury without confirming a diagnosis of BSS because they assumed the main symptoms or pathologies of traumatic injury to be closely related to BSS.

结直肠癌肝转移的围手术期化疗

对于经过严格筛选的结直肠癌寡转移患者,根治性治疗可以显著改善患者预后。对于单纯肝转移患者,我们通常会予以积极治疗;当然,对于其他部位的转移,也可以谨慎地予以积极治疗。对于是否行根治性手术,首先要考虑肿瘤能否被根治性切除,同时要确保能存留足够的肝功能。对于预计可切除的肝转移灶,新辅助化疗可用以评估肿瘤生物学行为;而对于预计不可切除的转移灶,新辅助化疗有望实现转移灶切除(即所谓的转化化疗)。尽管转化化疗可以改善预后,但选择何种化疗方案仍然是一个复杂且高度个体化的决策。本文讨论了RAS基因状态、原发瘤位置(左半或右半)以及其他影响化疗选择的临床特征。在考虑对结直肠癌肝转移患者行转移灶切除术时,上述临床特征是指导个体化治疗的关键因素。

-lormone levels following surgical and medical castration： defining optimal androgen suppression

Dear Editor, In the 1940s, Charles Huggins discovered that surgical castration produced remarkable palliative benefits for men with advanced prostate cancer, an effect we now understand to be mediated through depriving the androgen receptor （AR） from its ligands （i.e, testicular-derived androgens）.