携手合作在应对危机中实现可持续发展——在国际钢铁协会第43届年会上的讲话

我想借此机会首先向朋友们简单介绍中国工业60年发展所取得的成就，然后介绍应对国际金融危机，中因工业绎济和钢铁工业状况，以及为实现可持续发展的努力。     

Pathology of the eye in sarcoidosis

Comprehensive neurologic and ophthalmologic examinations of 100 patients with morphologically verified sarcoidosis showed the most frequent involvement of optic nerves and less incident lesions of the eye proper and its appendages. Vision disorders were detected in 39.0 patients, chiasmal disorders in 12.0%. Fundus oculi abnormalities were found in 27.0% of patients. A specific feature of vision disorders in sarcoidosis was that almost half of the patients did not feel them, which may be explained by a predominantly chronic latent pattern of these disorders and by the fact that, despite manifest disorders of peripheral vision, central vision with correction remained normal for a longer time.     

Evidence for nodular epileptogenicity and gender differences in periventricular nodular heterotopia

The new synthetic oleanane triterpenoid 2-cyano-3,12-dioxoolean-1,9-dien-28-oic acid (CDDO) is a potent, multifunctional molecule. It induces monocytic differentiation of human myeloid leukemia cells and adipogenic differentiation of mouse 3T3-L1 fibroblasts and enhances the neuronal differentiation of rat PC12 pheochromocytoma cells caused by nerve growth factor. CDDO inhibits proliferation of many human tumor cell lines, including those derived from estrogen receptor-positive and -negative breast carcinomas, myeloid leukemias, and several carcinomas bearing a Smad4 mutation. Furthermore, it suppresses the abilities of various inflammatory cytokines, such as IFN-gamma, interleukin-1, and tumor necrosis factor-alpha, to induce de novo formation of the enzymes inducible nitric oxide synthase (iNos) and inducible cyclooxygenase (COX-2) in mouse peritoneal macrophages, rat brain microglia, and human colon fibroblasts. CDDO will also protect rat brain hippocampal neurons from cell death induced by beta-amyloid. The above activities have been found at concentrations ranging from 10(-6) to 10(-9) M in cell culture, and these results suggest that CDDO needs further study in vivo, for either chemoprevention or chemotherapy of malignancy as well as for neuroprotection.     

Chest pain in the presentation of sarcoidosis

The cases of six patients are reported illustrating that chest pain may be a prominent feature of sarcoidosis. It may be severe and be the chief presenting symptom. In the cases described it was mostly retrosternal and had few consistent aggravating factors. In each case there was bilateral hilar lymph node enlargement and it is suggested that htis was chiefly responsible for this relatively uncommon symptom of sarcoidosis. It is also suggested that undue persisting pain may respond to corticosteroid administration.     

Vertebral sarcoidosis in adolescents

Two cases of vertebral sarcoidosis in pediatric patients are presented. All such patients reported have been black, 13-15 years old, and have a history of back pain. Radiographs of the involved vertebrae show primarily lytic destruction with sclerotic borders in some of the lesions. Fungal infections, tuberculosis, pyogenic osteomyelitis, Hodgkin's disease and metastatic disease must be considered in every patient with vertebral sarcoidosis.     

Renal manifestations in sarcoidosis

Clinically distinct renal disease is said to be rare in sarcoidosis, but autopsy reveals an incidence of renal involvement is 23 or 26% in Japanese studies. There are three categories of renal disease in sarcoidosis: 1) renal changes by abnormal calcium metabolism, 2) interstitial nephritis or granulomatous nephritis and 3) glomerulonephritis. Some investigators add renal angiitis to the three categories. In some patients without clinical renal disorders, renal involvement is discovered by chance at the time of autopsy or renal biopsy. Renal disease may develop during the course of sarcoidosis, preceding the diagnosis of sarcoidosis, or may be found simultaneously with extrarenal involvements at the time of diagnosis. Renal involvement should always be considered for exact diagnosis and appropriate treatment.     

Cutaneous ulcerations in sarcoidosis

We report the case of a 23 year-old Caribbean woman with sarcoidosis who developed specific skin ulcerations. Ulcerative lesions in sarcoidosis are distinctly unusual, generally multiple, painless, with preponderant location on the lower limbs. The diagnosis is difficult. The pathogenesis is discussed. The most successful therapy is hydrochloroquine with corticosteroids.     

Pulmonary sarcoidosis

Sarcoidosis involves the bronchi or lung in more than 90 percent of patients. Intrathoracic manifestations are protean, ranging from asymptomatic bilateral hilar lymphadenopathy to chronic, progressive, (ultimately fatal), respiratory insufficiency. The clinical course is highly variable, and optimal management and treatment are controversial. We review the salient radiographic, physiologic, and histopathologic features of pulmonary sarcoidosis and discuss rare intrathoracic complications (e.g., bronchostenosis, mycetomas, nodular sarcoidosis, necrotizing sarcoid angiitis and granulomatosis, pulmonary vascular and pleural involvement). We discuss the chest radiographic staging system and the role of ancillary diagnostic modalities including high resolution thin section computed tomographic scans (HRCT), bronchoalveolar lavage, radionuclide scan, and serum angiotensin enzyme converting enzyme. Indications for therapy and an overview of therapeutic options are outlined.     

Extrapulmonary sarcoidosis

The clinical manifestations of sarcoidosis are extremely heterogeneous and overlap with a wide gamut of infectious and noninfectious granulomatous disorders. Prognosis of sarcoidosis is highly variable. Spontaneous remissions occur in nearly two thirds of patients, but chronic, progressive disease may result in severe sequelae. Fatalities occur in 1% to 4% of patients. Pulmonary manifestations typically dominate, but any organ can be affected. Skin, eye, and peripheral lymph nodes are each involved in 20% to 30% of patients. Clinically significant involvement of spleen, liver, bone, heart, kidney, or central nervous system occurs in 2% to 6% of patients. Asymptomatic involvement of these organs is far more common. We review the salient extrapulmonary features of sarcoidosis, and compare and contrast specific features that may mimic other etiologies.     

Muscular sarcoidosis

A 57-year-old woman with sarcoid nodules in muscles of the lower leg was reported. A star-shaped low signal intensity in the lesion on MR imaging, supposedly corresponding to fibrous scar, appears characteristic of this condition, although its specificity is still uncertain.     

Focal nodular hyperplasia of the liver

The management of focal nodular hyperplasia (FNH) of the liver requires a systematic approach. After a histologic diagnosis of FNH is obtained, asymptomatic lesions can be observed safely with regular follow-up and treated if they become symptomatic or enlargement occurs. In the case presented here, we have elected follow-up with serial CT scans because our patient is asymptomatic and the lesion has not significantly enlarged. Patients who have symptomatic lesions while taking an oral contraceptive can have conservative follow-up when they stop taking the oral contraceptive, because regression of FNH has been reported to occur after cessation of oral contraceptive use. If the patient remains symptomatic or if the lesion enlarges after discontinuance of oral contraceptive use, surgical resection is warranted. Other symptomatic patients, including those with a previous history of taking oral contraceptives, should be treated by surgical resection or, when resection is not possible, by embolization or ligation of the hepatic artery, because symptomatic patients are at risk for having malignant lesions misdiagnosed as FNH.