Editor's note for debate Sporadic dementia of Alzheimer type: Role of amyloid in etiology is challenged

Summary Alzheimer's disease is a heterogenous neurodegenerative disorder. Whereas only a minority is due to genetic abnormalities and mostly with early onset, the majority of all Alzheimer cases is sporadic and with late onset. Therefore, in the latter, age-related disturbances in cellular metabolism may come into focus with respect to the etiopathogenesis rather than the primary formation of amyloid. In this Editor's note for debate, the role of amyloid as a causative factor of sporadic Alzheimer's disease is challenged. Instead, as a possible primary abnormal event in sporadic Alzheimer's disease, the perturbations in neuronal glucose metabolism and the subsequent ATP deficit with its impacts on the secondary amyloid formation are discussed to open a new field of research and another aspect for debate.     

Vegetables,fruit, and cancer. II. Mechanisms

The epidemiologic literature on the relationship between vegetable and fruit consumption and human cancer at a variety of sites was reviewed systematically in Part I.¹ It was concluded that consumption of higher levels of vegetables and fruit is associated consistently, although not universally, with a reduced risk of cancer at most sites, and particularly with epithelial cancers of the alimentary and respiratory tracts. Possible mechanisms by which vegetable and fruit intake might alter risk of cancer are addressed here. A large number of potentially anticarcinogenic agents are found in these food sources, including carotenoids, vitamins C and E, selenium, dietary fiber, dithiolthiones, glucosinolates and indoles, isothiocyanates, flavonoids, phenols, protease inhibitors, plant sterols, allium compounds, and limonene. These agents have both complementary and overlapping mechanisms of action, including the induction of detoxification enzymes, inhibition of nitrosamine formation, provision of substrate for formation of antineoplastic agents, dilution and binding of carcinogens in the digestive tract, alteration of hormone metabolism, antioxidant effects, and others. It appears extremely unlikely that any one substance is responsible for all the associations seen. Possible adverse effects of vegetable and fruit consumption are also examined. One way to consider the relationships reviewed here is to hypothesize that humans are adapted to a high intake of plant foods that supply substances crucial to the maintenance of the organism, but only some of which are currently called essential nutrients. Cancer may be the result of reducing the level of intake of foods that are metabolically necessary—it may be a disease of maladaptation.Authors are with the Division of Epidemiology, School of Public Health, University of Minnesota, 1-210 Moos Tower, 515 Delaware Street SE, Minneapolis, MN 55455, USA. Address correspondence to Dr Potter. This work was supported by NIH Grants CA 50305, CA 46618, and CA 09607.     

14例大疱性表皮坏死松解型药疹治疗体会

报告14例大疱性表皮坏死松解型药疹的治疗。以磺胺类药和解热镇痛药引起者居多,各4例。皮损面积按九分法计算,皮损面积80％以上者9例,80％以上者5例,治愈9例,死亡5例,我们认为早期使用足够剂量皮质激素类药物是有效措施。病程中注意防治感染,给予足够的液体以防止水电解质失平衡,局部治疗使用本院中药“五黄油”。     

Squamous Cell Carcinoma and Adenocarcinoma of the Esophagus–Di?erences in Etiology, Epidemiology and Prevention

Incidence of esophageal carcinoma With more than 300 000 new cases per year, cancerof the esophagus, predominantly squamous cell carcinoma(SCC), is one of the 10 most frequently diagnosed tumortypes. Esophageal cancer occurs often in developing coun-tries and shows great regional di?erences[1]. While in re-cent history the incidence of SCC has decreased slightly inregions of high risk and stayed constant in the USA andWestern Europe, the rate of adenocarcinoma of the esoph-agus (AC) has…     

循环式扩张治疗食管化学灼伤后狭窄20例

目的　探讨食管化学灼伤后狭窄的简单、有效治疗方法 .方法　胃造瘘术后 ,食管内置入丝线 ,从鼻腔和胃造瘘口拉出连结 .用自制的食管扩张器 ,在丝线引导下进行扩张 .结果　食管上段狭窄 4例 ,中段 4例 ,下段 2例 ,全程不规则线状狭窄 1 0例 .经 3～ 8m o间断扩张治疗 ,全部顺利通过 1 8mm扩张器 ,进普食顺利 .经 2～ 5 a随访 ,效果良好 .结论　食管化学灼伤后狭窄行循环式扩张治疗是一种简单、有效、安全、经济的好方法 ,值得推广应用     

A Competency-based Model of Child Depression: A Longitudinal Study of Peer, Parent, Teacher, and Self-evaluations

In a two-wave longitudinal study of third and sixth graders ( N = 617), we obtained self-reports of depression and peer, teacher, parent, and self-reports of competence in five domains: academic, social, attractiveness, conduct, and athletic. Competency evaluations by others predicted change in self-perceived competence over time for girls, but not for boys. Depression predicted change in self-perceived competence over time for boys but not for girls. Among girls, the relative importance of parent, teacher, and peer appraisals shifted from third to sixth grade. For both boys and girls, self-perceptions of competence predicted change in depression scores over time. Furthermore, self-perceived competencies mediated the relation between competency appraisals by others and children's self-reported depression. Results are interpreted in light of a competency-based model of child depression.     

Cerebral venous sinus thrombosis: a clinical study of 23 cases

Objective To describe the etiologies, clinical features and diagnosis of cerebral venous sinus thrombosis.
Methods We reviewed the records of 23 patients admitted with a documented diagnosis of c erebral venous sinus thrombosis from 1991 through 1999 in the Beijing Tiantan Hospital.
Results Infection was the major condition associated with cerebral venous sinus thrombos is. Pseudotumor cerebri syndrome was the most common manifestation, while hemip legia, seizure and unconsciousness may occur alone or in association. The diagn ostic sensitivity of computed tomography (CT), magnetic resonance imaging (MRI) and digital subtract angiography (DSA) were 59%, 86% and 100%, respectively. Th e sensitivity of MRI with magnetic resonance angiography (MRA) reached 96%.
Conclusion As the clinical findings were found to be nonspecific, CT combined with DSA, or MRI with MRA turns out to be valuable for the early diagnosis of cerebral venous sinus thrombosis.     

Initial transforming event in myelodysplastic syndromes may be viral: case for cytomegalovirus

Myelodysplastic syndromes (MDS) are clonal hematopoietic disorders which begin in a pluripotential bone marrow (BM) stem cell. This early stem cell is believed to acquire a growth advantage over its neighbors as a result of an initial transforming event, the nature of which has remained obscure. In this paper, we propose that pathogens such as those belonging to the herpesvirus family of DNA viruses may play a role in the initial transformation of the stem cell. The case for cytomegalovirus (CMV) as a representative of this family of viruses is discussed at length and a molecular mechanism which may be involved in the oncogenic activity of CMV is proposed. No proof has been presented to implicate CMV directly in MDS, but circumstantial evidence which supports such a possibility is provided.     

巩膜扣带手术后视物变形的原因分析

目的 探讨巩膜扣带手术后视网膜复位患者视物变形的原因。 方法 对巩膜扣带手术后视网膜成功复位的79例79只眼行临床观察，手术后2周、2、6个月及1年时行Amsler表检查，分为视物变形组和无视物变形组；同时行检眼镜、荧光素眼底血管造影（FFA）和光相干断层扫描（OCT）检查。并对手术后2周视物变形10只眼和正常人10只眼行视盘-中心凹角测量。 结果 79只眼手术后2周51只眼（64.56%）视物变形，视物变形眼和正常眼的视盘-中心凹角无明显差异(P=0.880)。79只眼中44只眼(视物变形组35只眼，无视物变形组9只眼) 手术后2周时检查OCT和FFA ，视物变形组OCT发现黄斑结构异常31只眼(88.57%)，有7种类型，主要为神经上皮层脱离（74.29%）；FFA发现黄斑结构异常6只眼(17.14%)，也主要为神经上皮层脱离(66.67%)。无视物变形组OCT发现神经上皮层脱离和色素上皮层脱离各1只眼，FFA未见异常。手术后2、6个月、1年时随访，各有18只眼（18/28）、5只眼(5/9)和3只眼(3/7)异常黄斑结构好转，视物变形减轻或消失；而黄斑前膜形成后未见明显变化，视物变形严重而持续。 结论 巩膜扣带手术后视物变形的主要原因是黄斑结构异常，手术后早期和晚期视物变形的主要原因分别是神经上皮层脱离和黄斑前膜。（中华眼底病杂志，2004，20：94-97）     

肠梗阻256例临床分析

目的总结12年来肠梗阻的诊治经验及体会，探讨肠梗阻的病因及治疗措施。方法回顾性分析本院外科1994年1月～2005年12月256例肠梗阻病例的诊治经过。结果病因明确228例（89％），原因不明28例（11%）；非手术治疗75例（29．3％），手术治疗181例（70．7％），术后并发症18例（9．9％）；死亡18例（7．03％）。结论粘连、肿瘤、疝分列肠梗阻病因的前三位，分别占35．93％、27．34％、10．55％。12年间肠梗阻以粘连性肠梗阻、肿瘤性肠梗阻最常见。粘连性肠梗阻中85％为手术所致，肿瘤性肠梗阻临床表现有一定特点。肠梗阻的手术指征应根据临床表现、辅助检查资料综合判定；而早期诊断、积极合理的综合治疗能够降低病死率。