Just a sore throat?

A man, 43 years of age, presents to his general practitioner with a 6 day history of sore throat. There are no other symptoms of an upper respiratory tract infection. In passing, the patient mentions that 6 days ago he experienced an episode of exertional chest pain. On further questioning it is found the chest pain was central with no radiation, it lasted 30 minutes, resolved spontaneously and was associated with nausea. He did not seek medical assessment at the time and has no cardiac history. He takes no regular medication and has no allergies. He is an exsmoker with a 15 pack-year history (he quit 7 years ago) but has no other known cardiac risk factors. He does not drink alcohol or take illicit drugs. On examination, he appears well built with a body mass index of 27. He is not in distress apart from a moderate sore throat. He is afebrile. His heart rate is 66 bpm, regular and his blood pressure is 122/80 mmHg. His tonsils and uvula are neither inflamed nor swollen. He has no cervical lymphadenopathy. His lungs are clear on auscultation and his heart sounds are dual with no murmur. His electrocardiogram is shown in Figure 1.     

A case of multiple piloleiomyoma associated with submucosal tumor of the stomach

A patient with disseminated type multiple piloleiomyoma is reported. He showed multiple painful intradermal nodules on the neck, the back, the chest and the back of the left hand. He had a submucosal tumor of the stomach, which was thought to be a leiomyoma. Multiple piloleiomyoma with other leiomyoma except for uterine myoma is unknown and very rare.     

siRNA沉默FOXF2基因对宫颈癌Hela细胞迁移与增殖的影响研究

目的 探究siRNA沉默FOXF2基因对宫颈癌Hela细胞迁移与增殖的影响研究。方法 在该院于2018年1月-2018年12月检测siRNA沉默FOXF2,选择Western Blot、Real Time-PCR法,之后Hela细胞中蛋白表达、FOXF2基因mRNA的变化。siRNA沉默FOXF2后细胞增殖,选择CCK8检测;siRNA沉默FOXF2后细胞迁移选择划痕试验检测。结果 多重对比各组,选择Dunnett T3,结果显示:3条siRNA链沉默FOXF2后,相较于Hela细胞SNC组合Hela细胞,siRNA-FOXF2 mRNA显著降低(65%~85%),对比差异有统计学意义(P<0.05);相较于Hela细胞SNC组及Hela细胞组,Hela细胞FOXF2蛋白表达水平出现显著降低;在siRNA沉默FOXF2基因后,经细胞划痕试验显示,相较于Hela细胞SNC组及Hela细胞组,Hela细胞的迁移能力显著较高;较Hela细胞SNC组及Hela细胞组,siRNA-FOXF21415组增殖率显著较高,对比差异有统计学意义(P<0.05)。结论 宫颈癌患者针对其Hela细胞的迁移与增殖能力,选择SiRNA沉默FOXF2基因有极大的促进作用,具有临床应用价值。     

Alfred Adler,pioneer in prevention of mental disorders

Alfred Adler (1870–1937) one of the four original members of what was to become the Vienna Psychoanalytic Society, was the first to accept a humanistic-educational model of man in contrast to Freud's medical model of man. This was in line with his deep involvement with prevention; in fact his original interest was in medical prevention. The present paper describes how his work touched on all the points of the contemporary field of psychological prevention. He developed a personality theory most suitable for application in prevention, education and brief psychotherapy. He identified various categories of children at risk. He advocated the right to abortion partly to prevent the birth of a child severely at risk by being unwanted. He considered the then existing dominance of the male sex to be damaging to both sexes. He engaged in practical prevention work by addressing general audiences and especially teachers and by the establishment of and participation in Educational Counseling Centers. He felt that the honest psychologist for reasons of prevention is bound to social advocacy, and that a true psychology of mental health merges into a corresponding world philosophy. These points are fully documented with quotations and references.Heinz L. Ansbacher, Ph.D., Emeritus Professor of Psychology, University of Vermont, and Past President of the North American Society of Adlerian Psychology, is Honorary President of the International Association of Individual Psychology. He and his wife, Rowena, have edited and partly translated three volumes of Alfred Adler's writings:The Individual Psychology of Alfred Adler: A Systematic Presentation in Selections from his Writings (1956),Superiority and Social Interest: A Collection of Later Writings (1964),and Cooperation between the Sexes: Writings on Women, Love and Marriage, Sexuality and its Disorders (1978). The have also edited seventeen volumes of theJournal of Individual Psychology (1957–1973). Dr. Ansbacher has, with Dr. Robert F. Antoch, edited three volumes of Adler's writings in German,Psychotherapie und Erziehung. He is also the author of numerous handbook and textbook chapters and encyclopedia articles on Adler, as well as a large number of journal articles dealing with various aspects of Adlerian psychology.     

美国《大都市卫生法案》推动者:斯蒂芬·史密斯

斯蒂芬·史密斯（Stephen Smith，1823-1922）是美国的外科医生，纽约杂志社的编辑，杰出的公共卫生领袖。他创办美国公共卫生协会，以《美国医学时报》为阵地，警醒大众关注和努力改善生活环境。他的不懈努力促成了美国《大都市卫生法案》的出台，他为美国公共卫生立法以及改善公众健康做出巨大贡献。他亦是长寿的代名词，用自己99岁的高龄展现了预防疾病对长寿的重要性。     

Use evidence to expose the unequal distribution of problems and the unequal distribution of solutions

Mark Petticrew argues that we need to increase the size andstrength of the evidence base on policies and programmes toreduce inequalities in health.¹ He cautions us not to be drawnunnecessarily into (ill informed or tangential) debates aboutmethods. He suggests that while our research is proceeding,much can be done with what evidence we have. He is right onall three     

大气细颗粒物致C57BL/6和C3H/He品系小鼠肺损伤过程中信号通路的差异

目的探讨暴露于大气细颗粒物后,C57BL/6和C3H/He两种品系小鼠在肺损伤过程中信号通路是否存在差异。方法采用气管滴注的染毒方法,两种品系的小鼠(C57BL/6小鼠和C3H/He小鼠)均予大气细颗粒物染毒,连续染毒2天,最后一次染毒24小时后,处死小鼠,取肺组织,并且立即置于液氮中保存。然后运用AffymetrixMouse4302.0表达谱基因芯片,分析挖掘在两种品系小鼠肺部有差异的信号通路。结果在染毒前,基因Igh-6、Mmp2、Timp1、Col1a1、Col1a2、C4和Hc的表达在C57BL/6和C3H/He小鼠之间的比值分别为:0.00、-2.40、0.00、-4.42、-4.92、6.65和-1.93,但是在染毒后,比值变为:-2.83、2.15、-2.18、2.40、2.86、4.23和2.18。通过数据挖掘,找到3条有差异的信号通路,包括:炎症反应通路、基质金属蛋白酶通路和经典的补体激活通路。结论3条有差异的信号通路都直接和炎症反应相关,而且最终都表现为在C57BL/6品系小鼠肺部的炎症反应比C3H/He品系小鼠更加剧烈,提示由于遗传背景的不同导致了这种差异的产生。     

Willem Kouwenaar, editor-in-chief of the Dutch Journal of Medicine 1950-1954

Willem Kouwenaar (1891-1954) spent the first part of his career in the Dutch East Indies as a physician of tropical medicine and tropical hygienist. He conducted many comparative epidemiological studies. After returning to The Netherlands in 1946, he became a professor of tropical medicine. Among other accomplishments, he developed a vaccine against yellow fever. In 1950 he became editor-in-chief of the Nederlandsch Tijdschrift voor Geneeskunde (Dutch Journal ofMedicine). He was of the opinion that 'everything that Dutch physicians are dealing with should also be presented for the information of the subscribers to our Journal,' which also applied to the controversial topics of birth control and contraceptive agents. He died in an airplane accident in 1954.     

何振辉教授疗伤手法的学术思想与技术特色

何振辉教授手法疗伤的学术观点和技术特色是:结合病理基础、力学原理、现代汉语法则,对古今手法进行研究,提出手法及手法名称规范化建议。对正骨手法概括为“纵压”和“横挤”;认为肱骨髁上骨折导致近期并发肘内翻的重要因素是折端向外成角畸形愈合,在施以手法整复及固定时,要注意纠正成角;在腰椎间盘突出症治疗,创大回环手法,取得良好的疗效。     

Managing skin cancer below the knee

CASE STUDY: Mr RR, 74 years of age, developed a nodule on his lower right leg in mid 2005. He was offered the option of excision, skin graft and 10 days bed stay with elevation at a private hospital, but declined due to the cost. He was then referred to a major urban cancer institute for opinion. He was advised that the nodule would most likely fall off and that a 'watch and wait' approach was indicated. Presumably there was a clinical diagnosis of keratoacanthoma.     

Recurrent haemoptysis

A man, 56 years of age, presents to his general practitioner after coughing up half a cupful of fresh, bright red blood every day for 1 week. He has no other medical complaints. He reports previous pulmonary tuberculosis 12 years ago treated with 6 months of standard therapy. Routine follow up was discontinued after 5 years after no evidence of reactivation. He is a nonsmoker, does office clerical duties and is not known to have diabetes or hypertension.     

Liver surgery after the millennium

Since 1906 according to the invitation of the Hungarian Surgical Society mainly surgeons have had the honour to give the János Balassa memorial lecture. In accordance with the traditions the first part of the lecture is a commemoration at János Balassa and the second part deals with the work of the invited lecturer. This year the 84th memorial lecture was held. The speaker besides reviewing János Balassa's biographical data pointed out his outstanding characteristics. Balassa was not only the founder of the first surgical school but a prominent intellectual leader in his age. He summarised the two basic conceptions of his oeuvre in the lecture that he held after being appointed to the leader of the surgical department; to raise surgery from the level of bunglers and barbers to the up-to-date surgical standards. His other statement is valid even today: surgery is equivalent with internal medicine among the clinical sciences but he did not intended to split them up. In the second part of the lecture the speaker presented his own work in hepatic surgery. He highlighted the present concerns of the history of hepatic surgery. He summarised separately the change of approaches in the indications of primary and secondary hepatic tumours. He determined the R0 resection as the basic factor of hepatic surgery. In his lecture he reported the alterations and expectations of surgery in hepatocellular carcinoma and metastatic hepatic tumours. He pointed out the increasing radicality in this field. He reviewed the new surgical techniques that give better results. He emphasised the importance of bloodless surgery in his own experience with Baron knack and different hepatic parenchyma separating techniques. He mentioned the role of oncology in connection with hepatic surgery, especially the results of molecular biology. In his lecture it stood out that he holds the long-term survival the most important result of hepatic surgery but he mentioned several other prognostic factors. Finally he gave an overview about the potential future of hepatic surgery.     

Neuropathy in an Artist Exposed to Organic Solvents in Paints: A Case Study

A 61-year-old artist in Israel had been painting for 30 years in his home studio. He had been healthy until he reached the age of 59.5 years, at which time he began complaining of weakness and paresthesia in both hands and legs. He also complained that he had difficulty concentrating, and his memory was impaired. His work was unusual in that he painted large posters (i.e., 2 × 3 m) with different mixtures of organic solvents, including toluene, xylene, benzene, methyl ethyl ketone, toluene diisocyanate, acetone, and thinner. He did not use any protective gloves and did not wear a mask. He was evaluated with several methods and was diagnosed as having peripheral and central neuropathy, including ototoxic hearing loss as a result of long exposures to organic solvents. The authors were unable to find any similar case report in the literature.     

Marius Tausk (1902-1990), influential endocrinologist and producer of medicines; a retrospect to mark the centenary of his birth

Marius Tausk, born in Sarajevo, studied medicine at Graz in Austria. In 1926, he attended a socialist youth rally in Amsterdam. Whilst there, he met Prof. Ernst Laqueur, a pharmacologist in Amsterdam, who offered him a position at Organon, a newly-founded pharmaceutical company in Oss, the Netherlands. He remained in the Netherlands and became the driving force behind this innovative company. Tausk made many contributions to new developments across the field of endocrinology, including the discovery of the adrenal steroids (together with T. Reichstein, Nobel Prize Laureate in 1950), and the development of oral contraceptive pills. He was astute enough to quickly patent the first corticosteroids. He could quickly extract the essential elements from an information source and disseminate this in five languages. His sharp judgment brought him friends and admirers, yet also those who feared him. In 1937 he was appointed as a private lecturer at the Medical Faculty of Utrecht University and in 1956 he was made Special Professor of Theoretical Endocrinology. He was awarded a number of scientific distinctions including two honorary doctorates. In 1949 he was honoured with the Knighthood of the Order of The Netherlands Lion.     

The Innervation of Teeth: (Section of Odontology)

The author, using the staining methods of Bielschowski, Gross, Beckwith, Weigert-Pal and Cajal in frozen and serial paraffin and celloidin sections, has investigated the dental innervations of man, monkey, dog, cat, and guinea-pig in health and disease. He discusses the anatomy and physiology of the dental innervation and the effect of section of the inferior dental nerve on the trophic, vasomotor, protective, and sensory functions, with special reference to the relation between dental disease and neuropathies. He describes the innervation of the tooth germ and the nature of the growing fibrils seen before calcification in the dentinal papilla and draws attention to the innervation of the periodontal membrane. He has found that these nerves anastomose across the crest of the interdental septa with their fellows and demonstrates coiled sub-cemental nerve-endings. He has been unable to find any difference in the eruption and casting of teeth after section of the inferior dental nerve, and does not find degeneration of the nerves of deciduous teeth prior to casting to be inevitable. He discusses the effect of local anæsthesia on the dental pulp, some of the causes of odontalgia and neuralgia and the effect of old age and general disease on the dental innervation. He has failed with lethal or continued sublethal doses of ethyl and methyl alcohol, lead or tetanus and diphtheria toxins, using the oral, gastric, subcutaneous and intravenous route, to produce dental neuronic change. The effects of fracture of teeth and jaws, the introduction of arsenic into the pulp chamber and amputation and extirpation of the pulp are examined. The vital resistance of the pulp and the significance of granulomata as a protective mechanism are discussed. The author has found that after extraction although there is at first degeneration of the nerve-fibres concerned, there may subsequently be regeneration, sometimes in the form of plexiform neuroma. He has produced degenerative changes in both the nerves and the Gasserian ganglia on both the operated and unoperated sides by the introduction of tetanus and diphtheria toxins into extraction sockets, where the neuronic involvement is proportionate to the degree of trauma with which the extraction is effected. The rôle of innervation in tooth movement during eruption and orthodontic correction, and after the extraction of anterior teeth, has been investigated, the latter by roentgencinematography.     

Bill Kane passionate practitioner

William "Bill" M. Kane, PhD, CHES. William "Bill" M. Kane, PhD, CHES, was a man with public health credentials that could impress just about anyone. He served as executive director of both the American College of Preventive Medicine and the Association for the Advancement of Health Education. He was a professor of health education at the University of New Mexico, and taught at several other colleges and universities over the course of his career. He spent time as director of school health programs at ETR Associates, and served on the boards of several nonprofit organizations devoted to public health and health education. He received many honors, and wrote or coauthored over 50 books and curricula focused on health. Bill Kane was undoubtedly a man who got a lot done. But, even more important for those of us who work in public health, he remains a consummate model of how to do this work with passion.     

Neuropathy in an artist exposed to organic solvents in paints: a case study

A 61-year-old artist in Israel had been painting for 30 years in his home studio. He had been healthy until he reached the age of 59.5 years, at which time he began complaining of weakness and paresthesia in both hands and legs. He also complained that he had difficulty concentrating, and his memory was impaired. His work was unusual in that he painted large posters (i.e., 2 x 3 m) with different mixtures of organic solvents, including toluene, xylene, benzene, methyl ethyl ketone, toluene diisocyanate, acetone, and thinner. He did not use any protective gloves and did not wear a mask. He was evaluated with several methods and was diagnosed as having peripheral and central neuropathy, including ototoxic hearing loss as a result of long exposures to organic solvents. The authors were unable to find any similar case report in the literature.     

The contextual nature of decision making near the end of life: hospice patients' perspectives

Mr. C. was diagnosed with lung cancer seven months ago. The cancer then spread to his brain. He was fully aware that the physicians were treating his symptoms, not the disease, however, discussions regarding the goals of treatment did not occur. He continued the treatment regimen of chemotherapy and radiation therapy. While at home one evening, he fell and fractured his femur. His mobility and independence were at once greatly compromised. While recovering in the hospital, he made the decision to opt out of curative treatment. He stated, "I want to go home, play with my cat, smoke cigarettes, and be with my friends when they can visit." What are the processes by which adults with life-threatening conditions make decisions about their care? What is the context of these decisions? The purpose of this study was to describe the process of decision making for adults with a terminal illness.     

Tropical splenomegaly syndrome (T.S.S.) in a European

A case of tropical splenomegaly syndrome in a 66-year-old white man who had lived in Tanzania for 34 years is described. He had taken anti-malarial prophylaxis continuously and regularly. He had had malaria in 1955 but there was no history of alcoholism or jaundice. He was treated with proguanil hydrochloride and, after return to Tanzania, took paludrine as prophylactic. One year later he had no further complaints, the spleen was no longer palpable and the liver only just palpable.     

A 3He counter version of the Thermo Fisher Scientific NRD neutron rem meter

Thermo Fisher Scientific's NRD rem meter has been in production for almost 40 y and is the primary rem meter in use at many U.S. Department of Energy facilities. An upgrade project was initiated at the Los Alamos National Laboratory with the primary goal of increasing the NRD's neutron sensitivity through the substitution of pressurized 3He gas (4 atmospheres) for the stock counter tube's BF3 fill gas. Historically, BF3 counters were far less expensive relative to 3He and were usually chosen on the basis of cost. That is no longer the case, with pricing for both types of counters being similar. Test results have shown that the 3He counter version of the NRD exhibits stable operation at a reasonable bias voltage and good gamma rejection. Sensitivity has been increased by about a factor of four with no penalty in cost.