青年肺癌患者临床特点分析

目的 探讨青年肺癌的临床特点,为其诊治提供参考.方法 回顾性分析84例青年(≤40岁)肺癌患者(青年组)及老年(≥60岁)肺癌患者(老年组)的临床资料,对其首发症状、并存疾病、影像学表现、组织学类型及临床分期、误诊率、治疗情况及生存率等进行比较.结果 与老年组比较,青年组首发症状以胸痛为主、并存疾病少(P＜0.01)、中央型肺癌多(P＜0.05)、腺癌类型较多(P＜0.05)、误诊率高(P＜0.05).结论 青年肺癌患者的临床表现不典型,胸痛比例较高,组织分型以腺癌为主,误诊率较高,确诊时大多处于晚期.     

218例40岁以下青年人肺癌临床特征分析

目的 探讨≤40岁青年人肺癌的临床及病理特征,并与＞40岁的中老年人肺癌进行比较。方法 对218例青年人肺癌(青年组)以及同期的944例中老年人肺癌(中老年组)进行回顾性分析,比较两组临床及病理特征。结果 青年组女性患者比例高(39％ vs 27％,P＜0.001),以腺癌为主要病理类型(50.9％),病理类型构成与中老年组相比有显著差异(P＜0.001)。咳嗽是最常见的症状(73.9％),其他症状的发生率均不高。青年组患者确诊时晚期比例高(76.0％ vs 48.0％,P＜0.001),接受手术治疗比例显著低于中老年组( P＜0.001),接受综合治疗比例也较低(20.2％)。结论 青年人肺癌具有其特殊的临床及病理特征,明显不同于中老年人肺癌,应提高对青年人肺癌的认识。     

青年与老年肺癌患者临床特征回顾性分析

目的探讨现今发病青年与老年肺癌患者的临床特点。方法收集经病理检查明确诊断的≤40岁青年以及≥70岁老年肺癌患者的临床资料,回顾性分析两组患者年龄、性别比例、ECOG评分、症状、病理类型、分子分型、临床分期、转移部位、合并症等。结果两组患者平均年龄分别为34.88岁、74.48岁;青年组男女性别比例为0.93,而老年组男女比例为4.64,两者比较有显著性差异(P0.005);青年组ECOG评分0分患者多于老年组,但绝大多数患者为0-1分,两组无统计学差异;两组患者主要症状均为咳嗽、胸闷、疼痛(P0.1);青年组78.57%为腺癌,老年组小细胞肺癌、鳞状细胞癌占52.48%(74/141);青年组EGFR阳性率达55.36%(31/56),查见驱动基因比例高达64.29%(36/56);青年组0-Ⅱ期患者为25%,而老年组Ⅲ-Ⅳ期患者高达90%,两组有显著性差异(P0.01)。两组均以肺、胸膜转移最为常见,远处转移(M1b)也多见于骨、脑、肝脏、肾上腺;老年组患者合并疾病达52.5%,明显多于青年组。结论两组患者临床表现均无特异性、临床分期多较晚,但行为状态均较好;青年肺癌患者腺癌很常见,且存在驱动基因几率较高,而老年患者男性多见,小细胞肺癌及鳞癌、合并基础疾病常见,值得临床进一步关注其早期诊断、治疗、预后及预防。     

非小细胞肺癌性别差异的临床研究

目的 分析男性和女性非小细胞肺癌(non-small cell lung cancer,NSCLC)患者年龄、吸烟史、组织病理学类型、临床表现、临床分期及治疗方案等方面的不同.方法 回顾性分析上海长征医院2002年1月至2008年6月收治的921例确诊为肺癌的患者,分析男女NSCLC患者上述各方面的差异,统计学方法选用t检验和x2检验.结果 921例NSCLC患者中,男性647例,占70.2％,女性274例,占29.8％.女性确诊NSCLC早于男性[(57.9±11.4)岁vs(60.9±10.9)岁,P＜0.01],且女性腺癌患者的平均年龄亦低于男性腺癌患者[(57.9±11.6)岁vs(59.8±11.1)岁,P=0.041].男性鳞癌的比例明显高于女性(39.6％ vs 7.7％,P＜0.01),而女性中腺癌比例高于男性(88.7％ vs 55.2％,P＜0.01).在各型NSCLC患者中,男性吸烟的比例均高于女性(鳞癌:86.3％ vs 9.5％,P＜0.01;腺癌:68.1％ vs3.7％,P＜0.01；其他类型NSCLC:76.5％ vs 0.0％,P＜0.01),男性患者咯血的发生率高于女性(32.5％vs 18.6％,P=0.027).结论 NSCLC在男性中更为多发.女性发病早于男性,女性腺癌患者的平均年龄低于男性腺癌患者.男性中鳞癌比例高于女性,而女性中腺癌更为常见.各型NSCLC患者中,男性吸烟的比例均高于女性.     

青年人肺癌34例分析

目的分析青年人肺癌的临床特点。方法分析太仓一院近10年确诊的青年肺癌患者的临床资料。结果青年肺癌患者34例,平均年龄（30.4±5.7）岁。主要症状有咳嗽（10例）、无症状肺部占位（22例）;胸部CT表现：青年组周围型肺癌表现者12例,其中肺上叶7例,中央型肺癌表现者10例;青年肺癌：肿瘤分期：Ⅲb期10例,Ⅳ期8例;老年组肺癌：Ⅲb期2例,Ⅳ期25例。病理分类：青年肺癌病理类型腺癌形态者12例,鳞癌10例;气管镜肉眼形态：腔内占位8例。结论青年肺癌表现缺乏特异性,以体检发现无症状肺部占位多见;胸部CT多见周围型肺癌,分布多位于肺上叶,病理类型腺癌居多,气管镜下腔内占位居多。     

青年人结直肠癌的临床病理特征及预后因素分析

目的 分析青年人结直肠癌的临床病理特征及预后因素.方法 回顾性分析144例青年结直肠癌患者(青年组)和142例老年结直肠癌患者(老年组)的临床资料,分析青年人结直肠癌的临床病理特征及影响预后因素.结果 青年结直肠患者临床症状缺乏特异性,易漏诊和误诊;其原发肿瘤部位较低,直肠中下段占60.4％;标本大体类型以溃疡型多见(占83.3％),组织学类型以腺癌多见;分化程度以低、中分化多见,Duke's分期B、C、D期占91.7％.青年组1、3、5年生存率分别为96％、74％、67％,与老年组(87％、65％、55％)比较差异均无统计学意义(P均＞0.05).Duke's分期和年龄是影响预后的重要独立因素(P均＜0.05).结论 青年结直肠癌肿瘤部位较低,其组织学类型、分化程度较差,恶性程度高,预后差.Duke's分期和年龄是影响预后的重要独立因素.     

青年人肺癌195例临床分析

目的探讨青年人肺癌临床病理特点。方法对1996年1月至2006年5月我院收治的资料较完整的195例40岁以下的原发性肺癌患者进行回顾性分析。结果青年人肺癌男女比例为1．71：1，误诊率高达72．3％，病理类型以腺癌最多占（47．2％），其次为鳞癌（36．4％）及小细胞肺癌（5．1％），其它为未分化癌（11．3％）。TNM分期以Ⅲ、Ⅳ期居多占73．4％，手术切除率低。结论青年人肺癌误诊率高，病理类型以腺癌最多，女性发病率相对较高，确诊时多为晚期，预后差。重视青年患者的肺部表现，及时行相应检查，有助于肺癌的早期诊断及治疗。     

青年和老年女性乳腺癌的临床病理特点比较

目的比较青年与老年女性乳腺癌的临床病理特点。方法对病理组织学确诊的青年(≤35岁)女性乳腺癌患者96例及老年女性乳腺癌患者152例的临床病理资料进行分析比较。结果青年组雌激素受体(ER)阴性表达率为31.25%,高于老年组的25.66%;青年组孕激素受体(PR)阴性表达率为35.42%,高于老年组的32.89%,但是两组差异无统计学意义(P0.05)。HER-2/neu的表达率、病理分期、淋巴结转移、脉管侵犯及肿块大小等在青年组与老年组差异无统计学意义(P0.05)。结论 HER-2/neu的表达在青年组和中老年组中之间的差异性存在争议。青年妇女乳腺癌ER阴性率高,生存率、无病生存率低于同期老年患者,但仍有很多生物学指标,预后相关指标的特点需要进一步探讨,年龄可能并不是影响预后的独立因素。     

老年肾综合征出血热患者流行病学、临床特点及预后分析

目的：分析老年肾综合征出血热（ HFRS）患者在流行病学、临床特征、实验室检查以及预后等方面的特点。方法249例HFRS患者,其中≥60岁30例（老年组）,＜40岁83例（青年组）。回顾性分析两组流行病学、临床特征、实验室检查及预后。结果老年组重型、危重型12例（40．00％）,青年组16例（19．28％）,P＜0．05。老年组早期误诊率33．33％,青年组7．23％,P＜0．05。青年组发热期、少尿期及多尿期持续时间均短于老年组（ P均＜0．05）。与青年组比较,老年组肌酐升高、血小板降低（P均＜0．05）,谷草转氨酶、谷丙转氨酶、尿素氮、白细胞等两组间比较差异无统计学意义（P均＞0．05）。在治疗过程中,青年组8例（9．64％）出现并发症,老年组13例（43．33％）,P＜0．05。老年组病死率6．67％,青年组1．20％,P＜0．05。结论与青年HFRS患者比较,老年HFRS患者早期误诊率高,重型、危重型比例高,病程长,并发症多。     

老年与青年肺癌临床对比分析

目的探讨老年肺癌和青年肺癌的不同特点。方法回顾性分析近5年来在我院经病理学证实的肺癌患者的资料，其中老年（≥70岁）组86例，青年（≤40岁）组45例，分别对两组患者的临床症状、并存病、病理、治疗方法及预后等指标进行比较。结果（1）老年组和青年组有胸痛的比例分别是18．6％和53．3％（P〈0．01），有并存病的比例分别是59．3％和13．3％（P〈0．01）；（2）老年组和青年组鳞癌占的比例分别是56．9％和26．6％（P=0．001），腺癌占的比例分别是25．6％和46．6％（P=0．008），晚期肺癌（Ⅲb-Ⅳ期）的比例分别是48．8％和65．7％（P=0．024）；（3）老年组和青年组半年、1年的生存率分别是72．3％和91．1％（P=0．022）、58．1％和75．6％（P=0．027），2年生存率分别是44．2％和51．1％（P=0．066）。结论老年人鳞癌比例较高，并存病多，治疗受限，预后差；青年人腺癌比例较高，并存病少，治疗更积极，预后较好。     

Three layer functional model and energy exchange concept of aging process

Relying on a certain degree of abstraction, we can propose that no particular distinction exists between animate or living matter and inanimate matter. While focusing attention on some specifics, the dividing line between the two can be drawn. The most apparent distinction is in the level of structural and functional organization with the dissimilar streams of ‘energy flow’ between the observed entity and the surrounding environment. In essence, living matter is created from inanimate matter which is organized to contain internal intense energy processes and maintain lower intensity energy exchange processes with the environment. Taking internal and external energy processes into account, we contend in this paper that living matter can be referred to as matter of dissipative structure, with this structure assumed to be a common quality of all living creatures and living matter in general. Interruption of internal energy conversion processes and terminating the controlled energy exchange with the environment leads to degeneration of dissipative structure and reduction of the same to inanimate matter, (gas, liquid and/or solid inanimate substances), and ultimately what can be called ‘death.’ This concept of what we call dissipative nature can be extended from living organisms to social groups of animals, to mankind. An analogy based on the organization of matter provides a basis for a functional model of living entities. The models relies on the parallels among the three central structures of any cell (nucleus, cytoplasm and outer membrane) and the human body (central organs, body fluids along with the connective tissues, and external skin integument). This three-part structural organization may be observed almost universally in nature. It can be observed from the atomic structure to the planetary and intergalactic organizations. This similarity is corroborated by the membrane theory applied to living organisms. According to the energy nature of living matter and the proposed functional model, the decreased integrity of a human body's external envelope membrane is a first cause of the structural degradation and aging of the entire organism. The aging process than progresses externally to internally, as in single cell organisms, suggesting that much of the efforts towards the restoration and maintenance of the mechanisms responsible for structural development should be focused accordingly, on the membrane, i.e., the skin. Numerous reports indicate that all parts of the human body, like: bones, blood with blood vessels, muscles, skin, and so on, have some ability for restoration. Therefore, actual revival of not only aging tissue of the human body's membrane, but the entire human body enclosed within, with all internal organs, might be expected. We assess several aging theories within the context of our model and provide suggestions on how to activate the body's own anti-aging mechanisms and increase longevity. This paper presents some analogies and some distinctions that exist between the living dissipative structure matter and inanimate matter, discusses the aging process and proposes certain aging reversal solutions.     

Unusual responses of nocturnal pineal melatonin synthesis and secretion to swimming: Attempts to define mechanisms

Abstract: The effect of swimming at night on rat pineal melatonin synthesis was compared with that of light exposure at night. Rats were forced to swim at 0030 hr (lights out at 2000 hr) and sacrificed by decapitation 15 and 30 min later, immediately after swimming. Other groups of animals were exposed to white light (650μW/cm²) for 15 and 30 min at same time. Swimming caused a rapid and highly significant drop in the melatonin content in the pineal gland; however, the activity of N-acetyltransferase (NAT), the supposed rate limiting enzyme in the melatonin production, was not changed. Despite the drop in pineal melatonin levels, serum concentrations of the indole remained elevated in the rats that swam. In contrast, melatonin levels in the pineal and serum of light exposed rats fell precipitously, accompanied by a significant suppression of NAT activity. Since we anticipated that the strenuous exercise associated with swimming may induce release of artrial natriuretic peptide (ANP) from the heart, which in turn could cause the release of pineal melatonin, in a second study we injected physiological saline intravenously to stretch the cardiac muscle and release ANP. Three milliliters of normal saline was injected during the day into the jugular vein of anesthetized rats that were pretreated with isoproterenol to stimulate pineal melatonin production. Animals were killed 15 min after the saline injection, and pineal NAT activity and pineal melatonin levels were measured. The saline injections caused no alteration in the elevated levels of either NAT or melatonin. These data suggest that the disparity in pineal NAT activity (which was high) and pineal melatonin (which was low), in animals swum at night, may not be caused by ANP which is released during strenuous exercise such as swimming.     

Melatonin and photoperiodic time measurement: Seasonal breeding in the sheep

Abstract: Well-established circadian physiology supports the view that photoperiodic time measurement utilizes the coincidence between the presence of light and a photosensitive phase of a 'biological clock' to alter reproductive status—the so-called external coincidence model of seasonal breeding. In this review, we examine the mechanism whereby photoperiod interacts with presumed suprachiasmatic nuclei activity to allow endogenous melatonin to normally synchronize reproductive activity to the optimal time of year. The Romney Marsh sheep is particularly explored as an experimental model. It is suggested that the on/off activity of seasonal reproduction may be a robust mechanism able to be predictably manipulated by the judicious use of the light/dark cycle and exogenous melatonin, but firmly based on circadian principles.     

The immunoneuroendocrine role of melatonin

Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ.     

Serological survey of HIV and syphilis in pregnant women in Madagascar

Objectives Peripartal transmission of human immunodeficiency virus (HIV) and Treponema pallidum, the causative agent of syphilis, leads to severe consequences for newborns. Preventive measures require awareness of the maternal infection. Although HIV and syphilis testing in Madagascar could be theoretically carried out within the framework of the national pregnancy follow‐up scheme, the required test kits are rarely available at peripheral health centres. In this study, we screened blood samples of pregnant Madagascan women for HIV and syphilis seroprevalence to estimate the demand for systemic screening in pregnancy. Methods Retrospective anonymous serological analysis for HIV and syphilis was performed in plasma samples from 1232 pregnant women that were taken between May and July 2010 in Ambositra, Ifanadiana, Manakara, Mananjary, Moramanga and Tsiroanomandidy (Madagascar) during pregnancy follow‐up. Screening was based on Treponema pallidum haemagglutination tests for syphilis and rapid tests for HIV, with confirmation of positive screening results on line assays. Results Out of 1232 pregnant women, none were seropositive for HIV and 37 (3%) were seropositive for Treponema pallidum. Conclusions Our findings are in line with previous studies that describe considerable syphilis prevalence in the rural Madagascan population. The results suggest a need for screening to prevent peripartal Treponema pallidum transmission, while HIV is still rare. If they are known, Treponema pallidum infections can be easily, safely and inexpensively treated even in pregnancy to reduce the risk of transmission.     

Response of rat pineal melatonin to calcium, magnesium, and lithium is circadian stage dependent

Abstract: Herein we documented the response of pineal melatonin production to electrolytes known to be effective on pineal function in view of a possible circadian stage dependence. We studied the release of melatonin by perifused rat pineal glands at 2 different circadian stages corresponding to the middle of the light and dark periods, i.e., respectively, 7 and 19 HALO (Hours After Light Onset, L:D = 12:12). The initial efflux rates were, as expected, much higher in the perifusates of glands removed from rats sacrificed during the dark phase than of those removed during the light phase. After 3 hr of perifusion, melatonin release reached similar levels which were found constant up to the 8th hr of perifusion, whatever the circadian stage. Perifusion of the glands with physiological concentrations for the rat of calcium (5.2 mmol/1) and magnesium (1.34 mmol/1) resulted in a stimulatory effect on the pineal glands removed from rats sacrificed in the middle of the dark period (19 HALO), whereas no effects were observed on the pineal glands removed from rats sacrificed during the light (7 HALO). Lithium (0.28 and 0.55 mmol/1) was ineffective on melatonin release in pineal glands removed 7 and 19 HALO. Our results show differences in the initial efflux rates of melatonin and in the response of perifused pineal glands to calcium and magnesium according to the circadian stage.