Hormonal male contraception: progress and prospects for the 21st century

During the second half of the 20 th century, progress in developing novel, practical contraceptive methods for men has lagged significantly behind developments for women. Despite the lack of reliable, reversible methods, men throughout the world continue to be strongly involved in family planning but a greater involvement will require more attractive and reliable contraceptive options for men. The closest to fruition are hormonal methods the features of which are reviewed. Landmark WHO contraceptive efficacy studies have established that hormonally-induced azoospermia provides highly effective and reversible contraception for at least 12 months with minimal short-term side effects. Even among the small subgroup of men who remain oligozoospermic during hormonal suppression, good contraceptive efficacy is achieved. The present goals are to develop improved second generation hormonal regimens which provide more uniform azoospermia to obviate the need for monitoring of sperm output and to develop long-acting depot testosterone formulations used alone or with additional gonadotrophin suppressive agents such as progestins or GnRH antagonists. Significant obstacles to progress are the flight of industry from contraceptive R&D due to the financial deterrent posed by the product liability crisis as well as the low priority accorded male reproductive health. Together these will determine whether the range of contraceptive options available to our children in the 21st century will improve, or whether the historically recent unbalanced increase in reliance on women for family planning will continue.     

21世纪肝癌临床研究面临的挑战

20世纪,建立在病理学基础上以消灭肿瘤为目标的战略,导致肝癌临床的重大进步,但距离攻克还有很大距离,为此21世纪仍面临重大挑战. 1 消灭肿瘤战略功不可没5 20世纪以消灭肿瘤为目标的疗法(手术、放化疗、局部治疗等)取得了有史以来最大的进步;早诊早治又进一步大幅度提高了疗效.美国肝癌人群的统计,5年生存率由1975 ～ 1977年的4％,上升为1999～2005年的14％[1].     

21世纪我国老年医学发展方向

老年人具有基础疾病多、器官功能储备差、起病隐匿、多重用药等特点,老年医学除具有其综合性、全面性和个体化的特点外,还需注重维持老年人的能力和生活质量,对老年人提供全方位的健康服务。在中国,目前老年医学的发展还需要现代观念、政策及资金上的支持,建立独立的老年医学学科有其必要性及合理性。     

The global tuberculosis situation. Progress and problems in the 20th century, prospects for the 21st century

Mycobacterium tuberculosis has been identified in prehistoric remains of humans. Despite references to TB by Hippocrates and Galen, humankind had limited understanding of and few tools to defend itself against TB until the later 19th century. Subsequently, landmark advances in the 20th century provided the means to control and prevent this disease. At the same time, epidemiological developments and fundamental problems related to human behavior, socioeconomic conditions, and political circumstances continue to thwart efforts to diminish the burden of suffering and death caused by TB. This article reviewed some of these issues including the global failure of TB control in the late 20th century, the worldwide emergence of drug-resistant TB, the extensive spread of HIV infection and its impact on TB incidence; and changing health care and political environments. The obstacles to TB control remain and will remain challenges in the coming years. Still, recent developments in immunology, biochemistry, and molecular biology suggest that new knowledge and tools are just around the corner. These will enhance the ability to conquer this microbe by the end of the current century.     

Stopping tuberculosis in the 21st century: Goals and strategies

The Stop TB Strategy and the Global Plan to Stop TB were launched in 2006 to achieve the tuberculosis (TB)‐related Millennium Development Goals and the Stop TB Partnership targets, and to address new challenges such as that of HIV‐associated TB and multi‐drug‐resistant TB. This paper reviews the historical and recent progress in TB control to show what has changed since the introduction of directly observed therapy (DOTS) in the mid‐1990s, why we needed the new strategy and what the global agenda is today. Major progress was seen in most countries in the last two decades. Globally, the estimated rates of TB prevalence and mortality are declining, but not quickly enough to reach the 2015 Stop TB Partnership targets of halving TB prevalence and death rates compared with 1990. In 2007, it was estimated that more than one‐third of TB patients were not detected or properly treated under proper conditions. Enhancing case detection, while maintaining high treatment success rates, is essential to achieve the 2015 targets. The ultimate goal of TB control is the elimination of the disease as a public health problem. The Stop TB Partnership aims at eliminating TB by 2050 by reaching a global incidence of disease of less than one case per million population. This target will not be achieved unless TB control efforts are further intensified and effective and affordable new technologies to prevent both disease and infection are developed and rapidly introduced in all countries worldwide.     

Pediatric chronic pancreatitis: Updates in the 21st century

Pediatric Pancreatitis has gained a lot of attention in the last decade. Updates in medical management include new testing technologies in genetics, function testing and imaging modalities. Updates in surgical management have taken place as well, with total pancreatectomy islet auto transplantation reserved for a specific patient population that meets the clinical criteria. Multidisciplinary team management is needed for patients with chronic pancreatitis to ensure optimal outcomes.     

Asbestos and the lung in the 21st century: an update

The asbestos‐related disorders (ARDs) are currently of significant occupational and public health concern. Asbestos usage has been banned in most developed countries, but asbestos is still used in many developing countries and the number of cases of ARDs worldwide is rising. Many countries are now experiencing an epidemic of ARDs that is the legacy of occupational exposure in the 1960s–1980s because of the long latency period between asbestos exposure and manifestation of disease. It is likely that asbestos‐related mortality and morbidity will continue to increase. Although the most feared complications of asbestos inhalation are the malignant conditions such as mesothelioma and lung cancer, asbestos inhalation more frequently results in benign conditions such as pleural plaques, diffuse pleural thickening, and asbestosis (pulmonary fibrosis due to asbestos exposure). Over recent years, there have been changes in the epidemiology of mesothelioma, in clinical management of ARDs and developments in new techniques for early detection of malignancy. This review provides an update on the respiratory manifestations of asbestos exposure and also considers advances in screening methods that may affect future management in the workplace.     

二十一世纪的胃肠病学:科学与技术大趋势

或许我发言的题目有些不同凡响，似乎我拥有一只水晶球可以预测将来．但我没有．鉴于我从事胃肠病学和肝病学工作４０＋ａ，我受邀就下一世纪胃肠病学及肝病学的发展方向做一推测．回顾半个世纪前至二战结束和中国的解放，胃肠病学发展刚刚起步，现代科学几乎与他无缘，大...     

Endocrinology in the 21st century: unmasking the mysteries of biology

The traditional concept of endocrinology has provided a model, that enabled to understand and treat endocrine diseases. Molecular and (patho)physiological differentiations of this concept will further improve the treatment of complex endocrine and metabolic diseases. Nature has lifted a tip of her veil, reveiling a number of orphan receptors, which may reflect presently unknown physiological pathways and may be important targets for drug development. Although the integrative function of hormones and receptors can be further elucidated by approaches like reverse endocrinology and functional genomics, the structural interaction between bench (basic science) and bedside (clinical endocrinology) will remain instrumental for the progress of endocrinology.     

Liver transplantation in the 21st century: expanding the donor options

Over the past decade, use of ECD organs for OLT has allowed many transplant programs to afford patients access to an otherwise scarce resource and to maintain center volume. Although overall posttransplant outcomes are inferior to results with optimal, whole-liver grafts, aggressive utilization of ECD and DCD organs significantly lowers median wait-times for OLT, MELD score at OLT, and death while awaiting transplantation. It is incumbent on the transplant community to provide continued scrutiny of the many factors involved in ECD organ utilization, evaluate the degree of risk and benefit such allografts may impart on particular recipients, and thereby provide suitable “matching” to maximize favorable outcomes. Transplant caregivers need to provide patients with evidence-based care decisions, be good stewards of a scarce resource, and maintain threshold survival results for their programs. This requires balancing the urgency with which a transplant is needed and the utility of such a transplant. There is a clear necessity to pursue additional donor research to improve use of these marginal grafts and assess interventions that enhance the safety of ECD livers.     

Prevention of alcohol problems in the 21st century: challenges and opportunities

The community is the "new frontier" for alcohol and other drug prevention. New prevention initiatives at the community level suggest that effective strategies will often be quite different from national or state policies and will require a different perspective. Alcohol and other drug use is part of routine community life and must be considered in the context of the community, which is itself a dynamic and self-adapting system. To develop effective community-level interventions, prevention planners and policy makers must understand how various aspects of the community influence alcohol and other drug use and even contribute to alcohol and other drug problems. This paper outlines the basis for a systems approach to community prevention and the policy options that this approach suggests. It also examines the new science of complexity, differentiates between catchment and a systems approach to prevention, describes a public health model within a systems approach, and describes using local policy as a means to produce system changes as well as recent findings from community-based prevention efforts that employed local alcohol policies.     

Orthopaedic surgery of haemophilia in the 21st century: an overview

Close co-operation between haematologists, orthopaedic surgeons, rehabilitation physicians and physiotherapists is essential for obtaining satisfactory results after orthopaedic procedures that are performed on haemophilic patients. Although continuous prophylaxis could avoid the development of the orthopaedic complications of haemophilia that we still see in the 21st century, such a goal has not been achieved so far, not even in developed countries. Therefore, orthopaedic surgeons are still required to carry out many different surgical procedures, such as arthrocentesis, synoviorthesis, synovectomies, tendon lengthening, articular debridements, alignment osteotomies, joint arthroplasties, nerve releases, opening of compartment syndromes, removal of pseudotumours and osteosynthesis of fractures. Furthermore, the emergence of human immunodeficiency virus has meant that immunosuppressed patients in developed countries sometimes require an arthrotomy for the treatment of spontaneous septic arthritis, or the surgical drainage of a spontaneously infected haematoma (abscess). In addition, they have a high risk of postoperative infection after any surgical procedure, particularly a joint arthroplasty.