Medical Insight

Self-made Audio Programme 51

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http://www.zshare.net/audio/1278266356049aba/

Welcome to Medical Insight , today is May 11, 2008. I’m Dr. Alex Roy. A 46-year-old woman was evaluated because of pain in the right hip and leg. Several months earlier, pain had developed in her right upper medial thigh and had gradually increased in intensity despite treatment with Ibuprofen, Pantoprazole泮托拉唑质子泵抑制剂, and Acetaminophen–codeine对乙酰氨基酚. A diagnosis of Celiac disease乳糜泻had been made 25 years earlier. At the time of presentation, the patient had hypocalcemia, hypophosphatemia, and a dramatic increase in parathyroid hormone, accompanied by Vitamin D deficiency. Laboratory tests showed low serum calcium and elevated alkaline phosphatase levels. The radiographic images showed lytic but enhancing lesions and a salt-and-pepper appearance in the skull, and there was a nodule in the neck that suggested an enlarged parathyroid gland.Are the skeletal lesions a consequence of metabolic bone disease or of a malignant tumor? Osteoporosis does not cause lytic lesions, but other metabolic bone diseases to be considered include Paget’s disease, osteomalacia, and osteitis fibrosa cystica. Imaging studies will be helpful in this differential diagnosis.

 

Medical Insight

Self-made Audio Programme 52

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http://www.zshare.net/audio/12349768fee31b07/

Welcome to Medical Insight , today is May 11, 2008. I’m Dr. Alex Roy. The use of either Efavirenz（依法韦恩茨）or Lopinavir–Ritonavir（洛匹那韦-利托那韦）plus two Nucleoside Reverse-Transcriptase Inhibitors (NRTIs) （eg: 拉米夫定,替比夫定） is recommended for initial therapy for patients with human immunodeficiency virus type 1 (HIV-1) infection, but which of the two regimens has greater efficacy is not known. In this randomized, open-label study, Efavirenz plus two (NRTIs), Lopinavir–ritonavir plus two NRTIs, and Lopinavir–ritonavir plus Efavirenz were compared. At a median follow-up of 112 weeks, the time to virologic failure was longer in the Efavirenz group than in the Lopinavir–Ritonavir group but was not significantly different in the NRTI-sparing group from the time in either of the other two groups. The groups did not differ significantly in the time to discontinuation because of toxic effects. At virologic failure, antiretroviral resistance mutations were more frequent in the NRTI-sparing group than in the other two groups. Virologic failure was less likely in the efavirenz group than in the lopinavir–ritonavir group. The virologic efficacy of the NRTI-sparing regimen was similar to that of the efavirenz regimen but was more likely to be associated with drug resistance.

 

Medical Insight

Self-made Audio Programme 51

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http://www.zshare.net/audio/11801766470a8187/

Welcome to Medical Insight , today is May 11, 2008. I’m Dr. Alex Roy. The increasing use of antiangiogenic drugs for the treatment of cancer has emerged from decades of extensive basic and clinical research. Three antiangiogenic drugs have been approved by the FDA: Bevacizumab(贝伐单抗 a humanized monoclonal antibody directed against vascular endothelial growth factor VEGF), Sorafenib索拉非尼and Sunitinib舒尼替尼which are oral small-molecule-receptor tyrosine kinase inhibitors. The survival benefits of these treatments are relatively modest (usually measured in months). These treatments are also costly and have toxic side effects. Improvements are likely to come from a more thorough understanding of the molecular and cellular mechanisms governing tumor angiogenesis and the response to antiangiogenic therapies. A number of recent advances promise to bring about such improvements. These include new findings in the VEGF and the VEGF-receptor family, and discovery of the notch–Dll4 signaling pathway in tumor angiogenesis, elucidation of the proangiogenic role of circulating bone marrow–derived cells, identification of the mechanisms of resistance to antiangiogenic drugs, and observations that suggest a role of angiogenesis in the survival and growth of cancer stem cells. Many of these discoveries and others suggest strategies for improving the clinical benefits of antiangiogenic therapy. This review discusses the results of recent investigations into tumor angiogenesis and surveys the mechanisms of action of antibodies and drugs that inhibit angiogenesis.

 

Medical Insight

Self-made Audio Programme 51

download Roy audio material at

http://www.zshare.net/audio/11461008057512a6/

Welcome to Medical Insight , today is May 3, 2008. I’m Dr. Alex Roy. A 41-year-old woman was brought by her husband to the emergency department with a history of 72 hours of epigastric pain, nausea, repeated vomiting, and altered mental status. Her blood calcium was found to be 18.9 mg per deciliter (4.7 mmol per liter, normal range 2.25~2.74mmol/L). The physical examination was consistent with the hypovolemic state. The patient’s husband reported that 4 days earlier they had returned from a vacation in Central America, where the patient had consumed “a lot of alcohol.” 3 days earlier, she started having severe abdominal pain, followed by multiple episodes of vomiting. A few months earlier, she had been told by her primary care physician that she had a mildly elevated blood calcium level of 10.9 mg per deciliter. Her physician was reported that her intact parathyroid hormone (PTH) blood level at her last examination was 33.9 pg per milliliter (normal range, 7 to 53). Medications at home included Tums as needed for abdominal pain and a multivitamin. Habitually, she had been drinking 2 to 3 shots of vodka and some wine daily. Hypercalcemia of this degree is a medical emergency. The patient with severe hypercalcemia is invariably dehydrated, and the first line of treatment should be vigorous hydration with intravenous normal saline with close observation of blood electrolytes and renal function. The history of a measurable PTH level in the face of elevated blood calcium suggests that the patient may have primary hyperparathyroidism, the level of hypercalcemia in this case, however, would be extremely rare with primary hyperparathyroidism. Final Diagnosis: hypercalcemia caused by Milk Alkali Syndrome乳碱综合征 &. Acute pancreatitis.

 

http://www.zshare.net/audio/11396897a3441143/

There is no shortage of tipsters around offering 'get-rich-quick' opportunities. But if you are a serious private investor, leave the Las Vegas mentality to those with money to fritter. The serious investor needs a proper 'portfolio' -- a well-planned selection of investments, with a definite structure and a clear aim. But exactly how does a newcomer to the stock market go about achieving that?
Well, if you go to five reputable stock brokers and ask them what you should do with your money, you're likely to get five different answers, -- even if you give all the relevant information about your age age, family, finances and what you want from your investments. Moral? There is no one 'right' way to structure a portfolio. However, there are undoubtedly some wrong ways, and you can be sure that none of our five advisers would have suggested sinking all of your money into Periwigs*.
So what should you do? We'll assume that you have sorted out the basics -- like mortgages, pensions, insurance and access to sufficient cash reserves. You should then establish your own individual aims. These are partly a matter of personal circumstances, partly a matter of psychology.
For instance, if you are older you have less time to recover from any major losses, and you may well wish to boost your pension income. So preserving your capital and generating extra income are your main priorities. In this case, you'd probably construct a portfolio with some shares along with gilts, cash deposits, and perhaps convertibles or the income shares of split capital investment trusts.
If you are younger, and in a solid financial position, you may decide to take an aggressive approach -- but only if you're blessed with a sanguine disposition and won't suffer sleepless nights over share prices. If portfolio, alongside your more pedestrian investments. Once you have decided on your investment aims, you can then decide where to put your money. The golden rule here is spread your risk -- if you put all of your money into Periwigs International, you're setting yourself up as a hostage to fortune.