Invasive pituitary adenoma mimicking meningioma

It is not always possible to differentiate invasive pituitary adenoma from the other parasellar tumours. A case of an invasive pituitary adenoma mimicking a meningioma is reported. The importance of a correct pre-operative diagnosis is emphasized.     

社会心理环境因素对癌症患者疼痛行为的影响

目的:了解湛江地区癌症患者癌痛行为的现况,进一步探讨社会心理环境因素对癌症患者疼痛行为的影响。方法:现场调查工作于2003-06完成。被调查者均为正在湛江中心人民医院接受治疗的住院患者。采用"癌症患者疼痛情况调查表",由主管医生逐一询问并记录填写,最后专人审核;同时应用汉密顿焦虑量表和汉密顿抑郁量表17项以及生活事件量表对所有患者进行情感评估。结果:共完成1197例癌症患者的调查。①无疼痛者152例(12.7%);轻度疼痛者637例(53.3%);中度疼痛者276例(23.01%);重度疼痛者132例(11.0%)。②1197例住院癌症患者中,接受各种类型镇痛治疗者894例(74.86%),中重度疼痛的发生率只有34%,而癌症疼痛患者使用阿片类镇痛药治疗者只有11%。③骨癌、生殖器癌症、脑癌和肝癌等患者癌症疼痛发生率明显较其他类型癌症高,且中重度疼痛发生率更高。④不同的文化背景其疼痛的表现程度差异存在显著性,文化程度与疼痛程度呈正相关(r=0.071,P<0.05);不同的职业其疼痛的表现程度差异存在显著性;家庭收入低者,其疼痛的痛苦体验要重;有负性生活事件者其癌症疼痛程度表现较重;焦虑和抑郁情感障碍越重,其癌症疼痛程度表现亦越重。结论:湛江地区人群的癌症患者疼痛发生率较低,患者的社会文化背景、实施非药物治疗措施、提供情感支持和社会支持对缓解疼痛有一定的影响。     

Use of complementary and alternative medicine by patients with cancer: a cross-sectional study at different points of cancer care

Complementary and alternative medicine (CAM) is widely used by cancer patients. In order to learn more on the usage of CAM, its reasons and motifs as well as sources of information along the trajectory of treatment, we decided to evaluate the prevalence and predictors for the use of CAM by cancer patients while being under active treatment with chemo- or radiotherapy or in aftercare. We distributed a standardized questionnaire among patients attending a department of radio-oncology, an ambulance for oncology and offices of general practitioners (GPs). Five hundred and six patients took part. Most attributed cancer to stress and trauma (23.7 and 16.4 %) or genes (20.8 %). Forty-four percentage reported knowing a physician with competence in CAM, and in all settings, most patients named the GP. Fifty-one percentage admitted using CAM, 35 % informed the oncologist about using CAM, 56 % informed the GP, and 26 % did not inform any physician. Most often used CAM was vitamin D (17 %) and selenium (16 %). Most important goals were to strengthen the immune system (59 %) and become active (52 %). Most patients were satisfied with the CAM methods they used. Yet, with some methods, dissatisfaction was up to 30 %. The GP has an important function concerning CAM in oncology as most patients believe the GP to have best knowledge in CAM. In order to integrate complementary medicine into evidence-based medicine, physicians should be trained on how to communicate on CAM with the patient and with each other. Explaining cancer and cancer therapies in a way lay persons are able to understand may be helpful. Physicians should actively address patients’ needs of involvement not only in decision making, but also actively in the therapy.     

经动脉骨髓干细胞移植结合介入治疗股骨头缺血性坏死

目的:介入治疗有助于增加股骨头缺血性坏死的股骨头血供,干细胞可以促使新生毛细血管形成。实验拟证明经动脉应用骨髓干细胞移植结合常规介入疗法治疗股骨头缺血性坏死的疗效。方法:选择2005-03/2007-05年于新乡新华医院接受治疗的5例股骨头缺血性坏死患者,共8髋,均为男性,年龄(40.1±10.8)岁,5例患者均经临床症状和髋关节影像学检查确诊。所有患者均签署知情同意书,并经医院伦理委员会批准。实验方法:采集患者自体骨髓血制备骨髓干细胞。采用Seldinger穿刺技术,非治疗侧股动脉穿刺成功后,引入Terumo公司5Fcobra导管,通过非治疗侧髂总动脉、腹主动脉至治疗侧髂总动脉,注射非离子造影剂15mL,并电影采集。血管造影,确定股骨头供血动脉和病变程度,导管超选择进入治疗侧旋股内动脉、旋股外动脉及闭孔动脉,再次血管造影证实导管到位后,经导管缓慢灌注尿激酶、丹参、低分子右旋糖酐、罂粟碱等常规介入治疗药物。药物灌注完成后将备用自体骨髓干细胞悬液等量分为3份,缓慢灌注各支血管。双侧病变者,间隔两周行另外一侧治疗。实验评估:治疗完成后1年随访,Harris评分观察股骨头缺血性坏死临床症状改变和髋关节活动度,判定ARCO分期。结果:5例患者8髋均完成1年随访。随访结果显示,患者临床症状明显缓解,髋关节临床症状Harris评分分值显著提高(P<0.05),髋关节活动度无明显改变(P>0.05),ARCO分期进展4髋,稳定4髋,各为50%,5例患者治疗前后未发生严重并发症。结论:经动脉骨髓干细胞移植配合常规介入疗法治疗股骨头缺血性坏死是一种安全有效的方法。但是由于病例样本小和随访时间较短,其长期效果仍然需要进一步观察。     

A novel germ line mutation in SOX9 causes familial campomelic dysplasia and sex reversal

Mutations in the gene SOX9 result in the syndrome of campomelic dysplasia (CD) which includes sex-reversal in 75% of 46,XY affected individuals. These mutations only affect a single allele of SOX9 suggesting a dominant mode of inheritance for this syndrome. Consequently, CD and autosomal sex reversal may result from haploinsufficiency of SOX9. The SOX9 gene maps to the long arm of human chromosome 17 and translocations in this region also result in CD. We report a family in which there were three affected patients, two of whom showed 46,XY sex-reversal. Interestingly, despite all three patients being heterozygous for a familial mutation in SOX9 (Insertion of a cytosine residue at nucleotide position 1096), their gonadal phenotypes varied widely. The proband was found to have 46,XY true hermaphroditism with ambiguous genitalia. The other two sibs were 46,XY and 46,XX, and both had bilateral ovaries with normal female genitalia. The somatic cells in both parents revealed wild-type SOX9 nucleotide sequences. However, mutational analysis of the SOX9 gene in the father's germ cells revealed they were mosaic for mutant and wild-type sequences. This family is particularly informative as it demonstrates that the same SOX9 mutation can produce very different 46,XY gonadal phenotypes. The range of gonadal morphologies observed may be explained by several possible mechanisms such as variable penetrance of the mutation, increased activity of the non-mutant SOX9 allele or stochastic environmental factors. These results also demonstrate that paternal germ cell mosaicism of a mutant SOX9 sequence can result in a CD phenotype amongst his offspring.      

丹参和南丹参及其制剂复方丹参片中丹参酮ⅡA的含量比较

目的：对丹参和南丹参及其制剂复方丹参片中丹参酮ⅡＡ的含量者进行比较。方法：用中国药典ＨＰＬＣ方法对丹参和南丹参药材进行丹参酮ⅡＡ的含量测定;并建立ＨＰＬＣ测定方法对复方丹参片中的丹参酮ⅡＡ进行含量测定。结果：南丹参及其为原料制成的复方丹参片中丹参酮ⅡＡ含量甚低,为南丹参不能作丹参入药提供了依据。     

Stress,social support,and emotional distress in a community sample of pregnant women

Emotional distress in women during pregnancy has been shown to increase the risk of adverse outcomes for women and newborns. Increasingly, assessment and management of mood and anxiety problems during pregnancy entail consideration of life stress and interpersonal relationships with partners, friends, and family members. This study describes cross-sectional relations between life stress, perceived social support, and symptoms of depression and anxiety as well as the mediating influence of social support on relations between stress and symptoms. A community sample of women (N?=?2,052) provided self-report data during their second trimester of pregnancy. Empirical fit was found for a structural equation model that depicted the combined influences of sociodemographic factors (i.e., socioeconomic status, age, parity), stress (partner conflict and life events), and social support on symptoms of depression and anxiety, χ² (df 51)?=?310.65, p?&lt;?.05; CFI?=?.91. Women who reported low levels of social support showed stronger relations between stress and symptoms than women who reported high levels of social support - indicative of a mediating effect of social support. Consistent with previous studies, results suggest that dyadic psychosocial assessment of pregnant women and their partners may facilitate interventions to augment support networks, thereby reducing the risk of emotional distress.