0°（伸）←30°（屈） 25°（收） ← 30°（展） → →
感觉消失区测定法：触觉边缘标记用断续直线（——————），痛觉边缘标记用锐角（ⅤⅤⅤⅤⅤⅤ），温度觉边缘标记用断续波浪线（ ～～～～～～ ），深感觉边缘标记用圆圈（○○○○○），位置感觉边缘标记用三角（△△△△△）表示。
TOP10: 睫毛膏：一般来说，睫毛膏的最佳使用期是半年，但是很少有人半年就能用完一支;半年以后，画睫毛的时候就容易出现结粒、粘结或者苍蝇腿，而且会损伤睫毛，让我们本来就弥足珍贵的睫毛变得更加稀少，所以有很简单的方法就可以解决： 1.把睫毛膏的口拧紧，在热水中浸泡10分钟左右，取出后发现，睫毛膏就像新的一样，很顺滑。 *注意，此法只适用于干了不太久的，如果已经好几年没用过的，那么不能使用此法。
如果你的电脑关机一直很正常，有一天突然无法关机了，这种情况我也遇过，我怀疑是病毒关系，立刻用杀毒软件对系统进行扫描杀毒。结果，可想而知，能正常关机了。从这点可以看出，病毒也是引起关机困难的原因之一，除此开病毒关系外，不能正常关机，有可能是其控制面板中的电源选项设置不正确，请检查你的设置，保证ACPI和APM能够正常工作。也有的主板系统BIOS中的APM（高级电源管理）和Win XP电源管理设置之间不完全兼容（以AMI BIOS为多），也可能是硬件和APM不兼容，因此不能自动关机。选择关机却变成重新启动系统，在这种情况下只能手动关机了（按下电源开关保持4秒钟后放开，如果少于4秒则无效）。解决问题的根本办法是升级主板的系统BIOS，采用新的版本。
CMOS设置不正确一样也会引起电脑关机问题，大家在电脑启动时可进入CMOS设置页面，重点检查CPU外频、电源管理、病毒检测、IRQ中断开闭、磁盘启动顺序等选项设置是否正确。具体设置方法你可参看你的主板说明书，其上面有很详细的设置说明，如果你对其设置实在是不太懂，建议你直接用厂家出厂默认设置既可。 6.【某些程序阻止你关闭计算】 请你先确定你运行的程序是否已经完全关闭，（例如BT）可以打开进程管理器查看有无可疑进程。如果有，请你先结束进程
1。加快Windows XP系统的关机。 （你可以手动修改注册表 ） 在程序---运行---输入regedit，进入注册 表， 找到HKEY_CURRENT_USER\Control Pane\Desktop键，将WaitToKillTimeout改 为1000-4000，即关闭程序仅等待1秒。将 HungAppTimeout改为200-500，表示程序出 错时仅等待最多0.5秒，将AutoEndTasks设 置为1。 此外还可将 HKEY_LOCAL_MACHINE\System\CurrentContr olset\Control\的 WaitT0killserviceTimeout改为1000-4000 就可以加快关机速度了） 这些修改也可以用优化大师来做 更安全 在磁盘缓存优化中 点优化按钮就可以了
加快Windows XP系统的关机。 2. 利用Shutdown.exe程序关机 Shutdown.exe是一个关机程序，它被保存在C:\Windows\system32文件夹中（C盘为系统盘）。在桌面上为Shutdown.exe建一个快捷方式，点击右键，在弹出的菜单选择“属性”。在属性对话框中的“目标”文本框的路径后添加 “ -s -t10”，其中“-s”代表关闭计算机，当然可以改为“-r”变成重新启动计算机；“-t”表示设定倒计时间，后面的数字“10”表为10秒。读者可根据自己需要进行更改，这样就可以大大减少关机等待时间。 另外还有一个参数是“-c关机显示的提示信息”，即要关机时系统会弹出一个显示自己设定的信息，注意关机提示信息不能超过127个字符。 3. 妙用“任务管理器” 在WindowsXP中按“Ctrl+Alt+Del”调出“任务管理器”窗口，激活菜单“关机”的同时按住“Ctrl”键，然后选择“关机”或“重新启动”菜单项。这时你会发现，WindowsXP的关机速度可以说是瞬间的事
20~25岁：皮肤状态趋于稳定，细腻光洁，富有弹性，既不需去死皮，也无需加营养。这时最要注意的是保护这层“外膜”。 别用含有生物活性成分的面膜。 对策：补水和维生素，尤其是维生素E和C，自己在家中用水果自制就行。另外，这时皮脂腺分泌仍然旺盛，每周进行一次深层清洁面膜护理也很必要。
三再次是爽肤：爽肤的步骤也是很重要的，主要是调整皮肤的PH值。正常情况下，没做面膜时，洗完脸之后的步骤就是爽肤水了。具体用法参照如下：1、 取出一张化妆棉。2、 放在美容指上，用小指以及食指夹住两端，沾取数滴的爽肤水3、 由下往上，斜擦在脸部以及颈部。手势可参考面膜步骤。4、 重复擦拭，直至化妆棉发干没有爽肤水液。四、然后就是润肤步骤了这一步其实就是我们经常在做的抹乳液。也就是美容界说的，给皮肤补充营养。(具体用法参照面膜步骤。)1、 挤出适量乳液于虎口处。(就是手背，拇指以及食指之间的那一小块皮肤就叫虎口)2、 用美容指分布平均点在脸上，点上五点。即：两颊、额头、鼻子、下巴。3、 轻轻以美容指指腹将乳液均匀由下往上，呈斜线型涂抹于脸部以及颈部。切记，要避开眼周围。五、最后就是保护 保护的工具就是粉底乳，也可称之为隔离霜。 有部分人认为抹了粉底对皮肤不好，这种忧虑并不是没有道理的，如果选择了劣质粉底，不仅无法起到保护皮肤的作用，还会堵塞毛孔。所以，化妆品一定要选择好的、对的。这一步因为市面上的种类太多，不好归纳。但抹隔底霜时，务必手势全部向下，从额头开始等，往下均匀地抹开、推开。 至于为什么其他步骤是向上，而这个步骤却要向下？那是因为我们已做完了对皮肤的系列护理，现在是为了让它有一层保护膜。经过清洁、面膜、爽肤、润肤的动作，为了肌肤可以粉好的吸收，所以我们把毛孔的窗口给打开了。而现在我们要做的，就是把毛孔的窗口暂时关闭，这样，灰尘或是污垢等辐射对肌肤的伤害的比率自然就降低了。
第三步 转向另一面，上身从身前划过，手臂辅助，这一步幅度加大，尽量压伸你的腰。 提醒——运动幅度适量，不要一开始就很大（尤其是中年人），整个运动都是由腰发力，下身不动，动作正确后，会感觉腰两侧的肉，有很紧的感觉，做3个来回就有两侧赘肉结实的感觉。
Lung cancer pleural involvement can produce irregular dull pain in the chest; chest wall tumor invasion, oppression or rib intercostal nerve, severe acute chest pain and tenderness are fixed or in part, and with breathing, coughing, body transformation and add to.
1. A small amount of pleural effusion: rib side every angle blunt round;
2. In the amount of pleural effusion: fluid can be seen side-paragraph;
3. A large number of pleural effusion: not affected by pleural barrier imaging.
1. A small amount of pleural effusion: a small amount of fluid can be seen side;
2. In the amount of pleural effusion: side can be seen in the volume of fluid;
3. A large number of pleural effusion: side pleural effusion can be seen filling the chest and lung see pressure on the situation.
CT and magnetic total shock:
1. A small amount of pleural effusion: a small amount of fluid can be seen side;
2. In the amount of pleural effusion: side can be seen in the volume of fluid;
3. A large number of pleural effusion: side pleural effusion can be seen filling the chest and lung see pressure on the situation.
Mesothelioma treatment of specific drugs
Injection pemetrexed disodium Statement
[Drug Name] General: injection pemetrexed disodium trade names: English: ALIMTA Chinese: Thai than English name: Pemetrexed disodium for Injection for the Chinese Phonetic Alphabet: Zhu She Yong Pei Mei Qu Sai Er Na of the main ingredients for chemicals Pemetrexed disodium its chemical name, and structured: a little formula: C20H19N5Na2O6 7H2O molecular weight: 597.49
[Characters] Ben Pinwei white to pale yellow or green yellow solid freeze-drying.
[Pharmaco] pharmacological effects pemetrexed is a structure that contains the core group for the pyrrole pyrimidine anti-folate agents, through the destruction of cells within the normal metabolism of folic acid-dependent process, inhibiting cell replication and thus inhibit tumor生长. In vitro studies have shown that pemetrexed can inhibit thymidylate synthase, dihydrofolate reductase and Gly-nucleotide carbamoyl transferase activity of these enzymes are necessary for folic acid synthesis enzyme involved in Thymidylate and purine nucleotide synthesis of the biological process again, pemetrexed through the delivery of the carrier and folic acid on the cell membrane folate binding protein transport system into the cells. Once pemetrexed into the cells, it leaves at glutamic acid synthase multi-role into the next and more in the form of glutamate. More glutamate remaining in the cells to become thymidylate synthase ammonia and Gan-nucleotide carbamoyl transferase inhibitors. More of glutamic acid present in the tumor cells - the process of concentration-dependent, and in normal Very low concentrations of the organization. Many of glutamic acid metabolite in tumor cells to extend the half-life, which will extend the drug in the tumor cells within the role of the time.
Pre-clinical studies have shown that pemetrexed could mesothelioma cell lines in vitro (MSTO-211H, NCI-H2052) growth. Mesothelioma cell lines MSTO-211H research shows that pemetrexed and cisplatin have synergy.
Pharmacodynamic analysis of the population using the indicators is absolutely neutrophil count; acceptable to the people at this time for single-drug pemetrexed, did not receive folic acid and vitamin B12 supplement treatment. By observing the lowest myeloid hematological toxicity to determine the severity of the occurrence and found the body of their goods with the dose and a negative correlation between. Research also found that patients with baseline inspection cystathionine or high concentrations of homocysteine, its absolute granulocyte count of the decline could be even worse. Folic acid and vitamin B12; can reduce homocysteine cystathionine or both the substrate concentration. After more than pemetrexed treatment cycle, not on the neutrophil accumulation of toxicity.
Pemetrexed body after administration (AUC38.3-316.8μg hr / mL), neutrophil under the lowest point of time is about 8-9.6 days, after the lowest point, the neutrophil count to resume Baseline level of 4.2-7.5 hours of the day.
Toxicology genetic toxicity: in vivo mouse bone marrow micronucleus show determination pemetrexed is broken agent, but the number of in vitro experimental study (Ames determination, CHO cell determination). Mutagenesis did not show.
Reproductive toxicity: pemetrexed in accordance with 0.1mg/kg / day or more doses (equivalent to the amount recommended by the Human 1 / 1666) to give male mice can lead to fertility decline, too little semen and testicular atrophy.
Carcinogenesis: no pemetrexed Walled carcinogenesis.
[Pharmacokinetics] pemetrexed pharmacokinetic evaluation of 426 cases in a variety of tumor types of patients, single-drug treatment, the dose of 0.2-838mg/m2, 10 minutes intravenous administration. Pemetrexed mainly in the form of the original drug from the urinary excretion, drug delivery within 24 hours, 70% -90% of the pemetrexed restored to the original form of the drug from the urine discharge. Pemetrexed overall clearance rate for 91.8mL/min (the elimination of creatinine was 90mL/min), for patients with normal renal function, in vivo half-life of 3.5 hours; as kidney function, the clearance rate will be reduced, but the dose will be增加. With the pemetrexed dose of the increase in area under the curve AUC and maximum plasma concentration (Cmax) will be increased in proportion. Treatment of multi-cycle has not changed pemetrexed pharmacokinetic parameters, pemetrexed showed a steady volume of distribution for 16.1 liters. In vitro studies have shown that pemetrexed plasma protein binding rate is about 81%, and from the kidney function.
Special crowd pemetrexed special populations research pharmacokinetics in patients with a total of 400 cases in a single research group.
One of the elderly - the age group of 26-80 years old, pemetrexed Pharmacokinetics no significant change.
Children - not included in clinical studies in patients with children.
Gender - male and female patients compared with patients pemetrexed Pharmacokinetics non.
A Caucasian ethnic origin and patients of African descent, pemetrexed pharmacokinetics similar. Japan has been on trial in patients with pharmacokinetic study, although there was no Japanese patients and patients in the West between the pharmacokinetic parameters of the statistical norm in the control of the report, but still shows that both doses of the absolute value is similar to the basic , But no significant clinical differences.
Liver dysfunction - aspartate aminotransferase (AST, SGOT), alanine aminotransferase (ALT, SGPT) and total bilirubin increase does not affect the pemetrexed pharmacokinetics. However, no liver damage in patients with pharmacokinetics. (See [Notes] under the "patients with liver dysfunction").
Renal failure - a total of 127 cases of renal failure patients were pemetrexed pharmacokinetics. If the merger at the same time there are cisplatin treatment, with reduced kidney function, pemetrexed plasma clearance rate, and the whole body exposure dose. Will pemetrexed total body exposure (AUC) and creatinine clearance rate of 100mL/min comparison, when the creatinine clearance rate was 45, 50 and 80mL/min, total body exposure (AUC) increased by 65% to 54% And 13%. (See [the amount of usage] and [attention] under the "warning" section)
[Indication] of the goods and cisplatin for the treatment of surgery can not be malignant pleural mesothelioma.
[The amount of usage] of the goods should have anti-tumor chemotherapy application of the experience under the guidance of qualified doctors to use. This product can only be used for intravenous drip, the solution must be prepared in accordance with the "intravenous drip ready" for that.
Malignant pleural mesothelioma: This product combined with cisplatin for the treatment of malignant pleural mesothelioma the recommended dose for infusion of 500mg/m2 every 21 days of the goods more than 10 minutes, the recommended dose of cisplatin 75mg/m2 drip for more than 2 Hours, this should be the end of the goods delivery 30 minutes later to give cisplatin infusion. Cisplatin treatment must accept the program of hydration. Cisplatin can be found in the specific statement.
Pre-service drugs: corticosteroids - did not pre-service corticosteroids in patients with the drug, using this product should be a higher incidence of skin rash. Pre-service dexamethasone (or similar drugs) can reduce the incidence of skin reaction and its severity. Delivery: 4mg oral dexamethasone 2 times a day, 1 day before the goods delivery, delivery and administration of the day after 1 day even served 3 days. Vitamin A supplement in order to reduce the toxicity of this treatment must be at the same time taking low-dose folic acid and other vitamins containing folic acid compound preparations. Take time: for the first time to give the treatment at least 7 days before the start of the next day, taking 5 doses of folic acid has been taken as a whole cycle of treatment, 1 in the final of the goods 21 days after the delivery service can be stopped. Patients also for the first time in the delivery of the goods within 7 days before the intramuscular injection of vitamin B12 once every 3 months after the first injection cycle, after the administration of vitamin B12 with this drug products in the same day. Dose folic acid :350-1000μg, common dose is 400μg: Vitamin B12 dose 1000μg. (See [Notes] under the "warning").
Laboratory monitoring of the recommended dose adjustment deduction: monitoring - all prepared to accept this treatment of patients with drug use before completion of the platelet count, including the examination of blood cells, after the administration of the need to monitor blood cells and the lowest point in recovery, clinical research At the beginning of the period of a week, 8 days and the first 15 days of inspections of the above-mentioned projects. Patients must neutrophils ≥ 1500/mm3, platelets ≥ 100000cells/mm3, creatinine clearance ≥ 45mL/min, this treatment can begin. Week period required for the treatment of liver function and kidney function in biological and chemical examination.
Recommended dose adjustment method based on a previous cycle low blood cell count and the most serious non-hematologic toxicity dose adjustment. If the 21-day cycle in patients yet to recover from the adverse effects, treatment should be delayed. Patients waiting for the restoration, in accordance with Table 1, Table 2, Table 3 of the requirements for treatment.
Table 1: hematology caused by toxic chemicals present (monotherapy or combination) and cisplatin dose adjustments neutrophil lowest <500/mm3 n = "168)" n = "163 ) "> 5% and the" 10%. (This table lists all the adverse reaction rates were reduced to 5% of the subjective rule out the possibility that researchers may be related to pemetrexed and cisplatin-related). n = "265" n = "276"> 5% and the "10%. (This table lists all the adverse reaction rates were reduced to 5% of the subjective rule out the possibility that researchers might be related to pemetrexed). n = "164) in 3 and 4 degrees laboratory toxicity and the incidence of the above listed pemetrexed administration of a separate clinical study of 3 similar, in addition to neutropenia incidence of (respectively For 12.8 percent and 5.3 percent) and alanine aminotransferase increase in the incidence (of 1.9% and 15.2%), mainly caused by the different groups of subjects, as in Phase 2 studies included those with liver metastasis and / Or baseline abnormal liver function abnormalities in patients with breast cancer, some of these patients prior to chemotherapy has not been too many times already, and some chemotherapy. "> 1.5 times the upper limit of normal in patients with non-clinical research into the products: the patients with liver metastasis, Transaminase> 3.0 times the upper limit of normal, non-clinical research into the products; there are patients with liver metastasis, if transaminase in the 3.0 and 5.0 times the upper limit of normal, clinical research into the products. Liver dysfunction in patients with the dose adjustment see table 2. (See [pharmacokinetics] under the "special groups").
The patients with renal insufficiency of the goods, primarily by renal excretion. And compared to patients with normal renal function. Renal failure in patients with the overall clearance rate decreased, AUC increased. With moderate renal failure patients, cisplatin combination products with the security has not yet been determined (see [pharmacokinetics] under the "special groups").
Drug interactions with the laboratory has not yet been determined. There is no research to prove whether or not to serve patients using this product to drive and operate the machines have an impact, however, proved that Ben Pinke can lead to fatigue, if there is such a scenario, the patient should be informed of careless driving and operating machinery.
【Pregnant women and breast-feeding women use pregnancy】: pregnant women to receive this treatment may be harmful to the fetus. Pregnancy 6 days -15 days of the mice, the vein to 0.2mg/kg (0.6mg/m2) or 5mg/kg (15 mg/m2) pemetrexed, fetal toxicity and teratogenicity. 0.2mg/kg dose given to mice (about recommended human dose of 1 / 833) pemetrexed can cause fetal malformation (talus and the first skull of incomplete ossification), 5mg/kg can cause cleft palate (equivalent to Recommended human dose of 1 / 33). Embryo toxicity mainly in the fetal mortality rate increase at the same time embryo growth retardation. Pregnancy does not have information on women's access to treatment in this study, as recommended in patients with contraception. If during pregnancy the use of the goods so that patients using this product during pregnancy should be informed of the fetus may be potentially dangerous. Breast-feeding: or its metabolites in the secretion of milk from whether or not yet determined. But Ben Pinke to suck the breast of the baby has serious potential harm to accept this treatment should stop breast-feeding mothers.
【Use of children】 for children of drug safety and efficacy has not yet been determined.
【Elderly patients with drug】 of all patients in accordance with the dose adjustment methods, no special program (see [pharmacokinetics] in a special part of the population).
【Chemotherapy drug interactions 】- cisplatin does not change pemetrexed pharmacokinetics, pemetrexed are all platinum drugs had no effect on pharmacokinetics. Vitamins - folic acid and at the same time to give oral vitamin B12 injection does not change pemetrexed pharmacokinetics. Cytochrome P450 enzymes of drug metabolism - in vitro liver MG forecast results show that pemetrexed has not led to the adoption of CYP3A enzyme, CYP2D6 enzyme, CYP2C9 enzyme CYP1A2 enzyme and metabolism of the drug reduced the rate of removal. Chapei study did not view the United States side of the music of cytochrome P450 isozymes. Because, according to the schedule recommended by the administration (1 every 21 days), any of the goods-induced no significant role. Aspirin - to give low-to medium-dose (6 hours per 325mg) of aspirin did not affect the pemetrexed pharmacokinetics of high doses of aspirin on the pemetrexed power-generation drugs It was not immediately clear impact on learning. Ibuprofen - in patients with normal renal function, the daily dose of ibuprofen 400mg, 4 times / day, could pemetrexed clearance rate of 20% (AUC, an increase of 20%). The higher dose of ibuprofen pemetrexed pharmacokinetics impact is still unclear. This product mainly through the glomerular filtration and tubular excretion of the role of the original forms of drugs from the urinary tract eliminated from the body. At the same time give to the kidneys against the drug will be delayed clearance of the goods at the same time given the increase in the burden of renal tubular other drugs (such as probenecid) may also delay the removal of the goods. For normal renal function (creatinine clearance rate of patients with ≥ 80ml/min) patients, and to Ben Pinke drug ibuprofen at the same time (400mg, 4 times / day), but there is light to moderate renal insufficiency (creatinine clearance Between 45 to 79ml/min) patients, the goods and the use of ibuprofen at the same time to be careful. There are light to moderate renal failure patients using this product should be in the 2 days before treatment, drug treatment and the day after 2 days, do not use the short half-life of non-steroidal anti-inflammatory drugs. Long half-life of non-steroidal anti-inflammatory drugs with the potential interaction of chemicals, not yet identified. However, using this product should be 5 days before treatment, drug treatment and the day after 2 days, but also interrupted non-steroidal anti-inflammatory drug treatment. If the application must be non-steroidal anti-inflammatory drugs must be closely monitored toxicity, particularly bone marrow suppression, gastrointestinal and renal toxicity.
【Drug overdose】 just a few of the items drug overdose. The major adverse reaction to neutropenia, anemia, thrombocytopenia, mucositis and skin rash. The drug can be expected to have a major overdose of complications of bone marrow suppression, for the performance of neutropenia, thrombocytopenia, and anemia. In addition, it may be accompanied or not accompanied by fever infections, diarrhea and mucositis. In the event of a drug overdose, doctors should be immediately taken under the guidance of the appropriate measures. Clinical studies, if there is more than 4 degrees 3 days or 3 days leukopenia more than 4 degrees neutropenia, folinic acid can be used, if there is 4 degrees or 3 degrees thrombocytopenia thrombocytopenia or bleeding associated 3 / 4 degree of mucositis, should the use of leucovorin. Folinic acid and the recommended dose is: intravenous drug delivery, 1st dose of 100mg/m2, after 50mg/m2, every 6 hours 1, MS 8 days. Dialysis through the lifting of the goods over the role has not yet been determined.
【Specifications】 0.5 g / bottle
【 Key Storage】 This product should be preserved at room temperature. In accordance with the above-mentioned methods of preparation of this solution products, non-anti-bacterial preservatives, micro-organisms from the point of view should be used immediately, do not throw away part. If you do not run out of time, with good products in this solution can be placed in refrigerator (2-8 ℃) or at room temperature preservation (15-30 ℃), no dark, and its physical and chemical properties within 24 hours remained stable. This product is not photosensitive.
【Packaging】 Glass bottle packaging equipment, a bottle box
【Validity】 valid for 24 months
【Drug Registration No.】 H20050441
【manufacturers】 Lilly France SAS Address: rue du Colonel Lilly, 67640 Fegersheim, France
Biological response modifiers ( BRM) is the body's own cells and a number of elements, both inside and outside of the body response to environmental stimuli, and to participate in the maintenance of the stability of the local environment in the body. BRM through the body to mobilize the inherent ability to resist and eliminate the tumor, the treatment of tumors become a new model. With the cell engineering and genetic engineering progress, BRM in the field of cancer therapy has great development potentials. Cytokines interleukin-(IL), interferon (IFN), tumor necrosis factor (TNF), etc. In addition to direct anti-tumor cells, and cancer cells in the body activated, secretory or anti-cancer effects of molecules, cells or maintain the immune response Proliferation and differentiation of functions, the PMM can be used as adjuvant therapy. Adoptive transfer of the collection of immune cells, isolated cancer cells in the ascites, in vitro amplification, and induced activity of the anti-issued lymphokine activated killer (LAK cells), will be injected into the body, anti-tumor cells. At the same time, given IL-2, may enhance the effectiveness of treatment. Tani , and so will the patient's own cells and malignant mesothelioma cells mixed culture, to be anti-CD3 monoclonal antibodies and the activation of IL-2, to generate cytotoxic T cells (CTL). CTL activation of their own malignant mesothelioma cells have a high degree of cytotoxicity. PMM to the author of 2 cases of patients with chemotherapy at the same time, intra-abdominal injection CTL as adjuvant therapy, the results of ascites subsided, the gradual disappearance of tumor mass, and improve the quality of life of patients. PMM rare for the conclusion of peritoneal cancer, has always held that the very poor prognosis, so far there is no standardization of treatment. However, the situation is expected to change. In recent years, mainly to surgery, chemotherapy, radiation, immunotherapy combined therapy has been
PMM chemotherapy drug for moderate and sensitive. Preoperative induction chemotherapy, surgery and postoperative adjuvant chemotherapy could reduce tumor recurrence and improve 3-year survival rate.
PMM effect of the treatment of certain chemical drugs doxorubicin, cisplatin and carboplatin, bleomycin and domestic anti-cancer drug Elemene and so on. Long
The new spring base, fluorouracil, cyclophosphamide, mitomycin C, also worth a try.
Doxorubicin (Adriamycin, ADM) for each adult 30 ~ 60mg/m2, every 3 weeks 1, or intravenous injection, with a total dose of no more than
550mg/m2. Adverse reactions to toxic to the heart, and have accumulated, with the total dose-related; followed by bone marrow suppression, gastrointestinal reactions and hair loss, and so on.
Cisplatin (Cisplatin, DDP, cisplatin) for each adult 80 ~ 120mg/m2, every 3 weeks 1; or 20mg/m2, MS 5 days every 3 weeks
A course of treatment, intravenous injection. There are side effects of renal toxicity, ototoxicity, neurotoxicity, gastrointestinal reactions and bone marrow suppression, and so on. Mannitol can be used to increase
Reduce its accumulation in renal tubular. The drug is also used in intra-abdominal injection, the specific methods below.
Carboplatin (Carboplatin, CBP) for each adult 300 ~ 400mg/m2, 5% glucose or saline solution, to dilute the concentration of
0.5mg/ml of the solution, intravenous drip, every 3 to 4 weeks to repeat; or 100mg / d, 5% glucose solution in 500ml intravenous drip, MS 5 days;
3 to 4 weeks at a repeat. Can also be used for each 300 ~ 500mg intraperitoneal injection once a week.
Bleomycin (Bleomycin, BLM) with adults 15 ~ 30mg, dissolved in saline or 5% of the amount of glucose solution in the deep intramuscular injection, intravenous
Intravenous drip or twice a week; can be changed according to circumstances 1 / d or several times a week. 60mg can also use dissolved into the abdominal cavity slow. Stey with BLM
Intra-abdominal injection, 1 case of the treatment of patients with PMM, the results of the ascites disappeared after the drug did not appear to survive for more than 3 years. However, BLM high-dose intra-abdominal injection
Which can cause pneumonia-like symptoms and even pulmonary fibrosis; In addition, fever, gastrointestinal reactions more common, allergy occurred in individual patients.
Taxol (Paclitaxel) of the goods is extracted from the bark of the yew anti-cancer drug, through the induction and promotion of tubulin polymerization, to prevent the solution
Poly and stability of microtubules, inhibit cell proliferation and mitosis. Taxol can inhibit mitotic microtubule network required for regeneration, prevent mitosis
Spindle lead to the formation of the chromosomes break inhibit the replication of tumor cells. Dose of 135 ~ 175 mg/m2, diluted in normal saline or 5%
Intravenous glucose solution. Repeat every 3 weeks. 12 hours before the medication should be given dexamethasone 20 mg, 30 ~ 60 minutes ago should intravenous diphenhydramine
50 mg and 300 mg cimetidine or ranitidine 200 mg, to prevent allergic reactions. Combined with cisplatin for approximately 66.7 percent of the patients effectively and in tolerance
Its toxicity . There are side effects of bone marrow suppression, allergic reactions, arthralgia, myalgia, gastrointestinal reactions, peripheral neuropathy, syncope, a total of
Economic dislocation and pain at the injection site, and so on.
Elemene (Elemene) for traditional Chinese medicine Ezhu to extract the anticancer substances; chest, abdomen infusion in the treatment of malignant chest, the better ascites
Effect. In addition to pumping as much as possible in the ascites, according to the amount of 200 ~ 400mg/m2 into the abdominal cavity, 1-2 times a week. The incidence of adverse reactions was 20% to 70%, the main
To have fever, chills and pain; such as pre-anesthetic and inject a small amount of hormones, it can prevent it; other allergic reactions, gastrointestinal reactions.
Cyclophosphamide (CTX) for each adult 600 ~ 1200mg, each week one or two, intravenous injection. After the treatment of bone marrow suppression, gastrointestinal reactions
Bleeding and bladder go far higher than common adverse reactions.
Vincristine (VCR) for each adult 2.5 ~ 8mg/m2, at 1 week, intravenous injection, the total amount of 60 ~ 80mg, the main side effect
For bone marrow suppression.
Methotrexate (MTX) for each adult 15 ~ 50mg, a week one or two, muscle or intravenous injection. There are side effects of bone marrow suppression, gastrointestinal reactions,
Stomatitis, liver and kidney dysfunction, and so on, the long-term drug use may be caused by pulmonary fibrosis.
There are two types of chemotherapy.
Systemic chemotherapy given to anti-cancer drug, the peritoneal cavity less drug distribution. Foreign reports, whether single or combination drug, there are systemic chemotherapy
Efficiency 11% to 14%. Combined chemotherapy, including: DDP + ADM, DDP + CTX + VCR, CTX + VCR + BLM, and so on. However, many scholars stressed that the United
And would not improve the efficacy of chemotherapy . Poulain, etc.  In vitro studies of the DDP, CBP and amphotericin B (AmB) for malignant mesothelioma cell line of fine
Cell toxicity. Contact the above cell lines to the drug 2 hours, 6 days later growth - inhibition curve shows that the concentration of 5 ~ 10mg / L of the AmB-min
A sense of resistance or the cell line, CBP can make the DDP and 50% growth - inhibitory concentration (IC50) to reduce 5 ~ 10 times. AmB role may be related to significant
An increase of tumor cell uptake of platinum, platinum increased the concentration of cells, the cells increased platinum-related toxicity. Phosphodiesterase inhibition A
Xanthine-based (phosphodiesterase inhibiting methylxanthines) and AmB have synergy, its low toxicity and can ease
AmB of renal toxicity. But so far no clinical drug combination of the above.
In recent years, that intra-abdominal chemotherapy, intra-abdominal injection drug use may increase the local concentration of drug to reduce the systemic side effects; not only the eradication of surgery
After the residual tumor tissue, to reduce the recurrence; may also lose some surgical patients the opportunity to reduce the mass, ascites reduced the disease under control.
Intra-abdominal and intravenous dosage amount of a similar or slightly higher than the latter; repeated after 1 week. Under the condition can be injected a few weeks in a row. Ito , and so on
1 to the operation failed to remove the patient PMM injection DDP, and the combination of uracil and tegafur, made an unexpected effect:
In the 223 days after abdominal mass and ascites disappeared. However, in the first 8 months after pelvic tumor recurrence; to give DDP and camptothecin, the result was not good.
Ma, and so on  while continuing to use heating abdominal perfusion (continuous hyperthermic peritoneal perfusion, CHPP) combined DDP
Local injection treatment of PPM. The average amount of the initial infusion DDP for 120mg/ml (81 ~ 166mg/ml), perfusion flow 1.5L/min, the average amount of reperfusion
5.1L (4 ~ 7L), reperfusion after 90 minutes, measuring intra-abdominal temperature for 3 41.5 ℃, 40.5 ℃ and 41.1 ℃. DDP curve of the total fluid infusion
Area under (AUC) for plasma DDP AUC's 21 times the plasma concentration of DDP with the body when the drug is similar. The course of treatment had no significant local adverse reactions,
Patients are able to tolerate CHPP. 10-month follow-up, 1 case of non-CHPP as a result of medical treatment. Park, and so on  had a similar report. As things stand,
CHPP as good as treatment for the PMM is an effective way.
PMM less sensitive to the radiation, the radiation effect as pleural mesothelioma. But the operation has not been fully removed lesions or surgery, radiotherapy is still an important therapy. Including external beam radiotherapy and (or) irradiation. External selection of 60Co general or as a 186KV X-ray sources, depending on the scope of diseases to choose full-or partial abdominal irradiation. Medical Oncology at the hospital to the patient the whole abdominal irradiation, 6 to 7 weeks of radiation dose of 24 Gy (Gy), the results of local recurrence rate fell to 11.4 percent, 3-year survival rate increased to 66.7 percent. Radiation can cause radiation enteritis, radiation and radioactive myelitis, such as hepatitis. Intra-abdominal injection or 32P isotope, such as 198Au, through radiation, so that mesothelioma and small hardening of the arteries, and anti-free in the ascites tumor cells, so that short-term disease remission. However, the law required certain equipment, and costly, and can inhibit the bone marrow have been used less.
Surgical removal of cystic mass effect is very good and no post-operative deaths were reported. However, 25% of patients after local recurrence. Van der Klooster, and so on the report of 1 case of multiple cystic mesothelioma patients, with aspiration and occlusion therapy are null and void, a tumor recurrence 5 years, the last to switch to continuous drainage tube through the vagina, it will eventually heal. Surgical removal of cystic mass effect is very good and no post-operative deaths were reported. However, 25% of patients after local recurrence. At present, laparoscopy can be a complete removal of a huge abdominal cystic mesothelioma.
Surgical treatment of malignant peritoneal mesothelioma
For I, Ⅱ period PMM surgical treatment of choice. Including the tumor by surgical operation (cytoreductive surgery), as far as possible can see the removal of the tumor tissue. However, due to difficult surgery, diffuse disease, it is difficult to achieve complete resection. Of recurrence can be re-operation. Obstruction of persons possible palliative operation, ease the symptoms of obstruction.
Diffuse malignant pleural mesothelioma surgery
Diffuse malignant pleural mesothelioma due to the wide range of diseases, difficult to remove completely the current methods are any palliative treatment. Ⅰ period of patients in good health, possible pleural resection or outside the pleural pneumonectomy surgery, postoperative radiotherapy, chemotherapy or immunotherapy will help extend the survival time of patients.
Pleural mesothelioma is a rare tumor, but its incidence in recent years there has been an upward trend year by year. As the skin between the multi-functional differentiation potential of causing a variety of malignant mesothelioma cells, in the light microscope with pleural metastatic adenocarcinoma, reactive mesothelial cells and other spindle cell tumor is not easy to identify, to the clinical and pathological diagnosis work with To the difficulties. In recent years, as a result of pleural mesothelioma awareness and raise the level of electron microscopy, immunohistochemistry technology, so that the diagnosis of pleural mesothelioma level has been greatly improved.
An optical microscope
Due to the diversity of mesothelioma cells, light microscope, histological type of malignant mesothelioma is not uniform. The World Health Organization had diffuse malignant mesothelioma (dMM) into E-, and mixed sarcoma. 1 〔〕 adams, and so on in accordance with pleural dMM autopsy material into the cell-like tumor type, papillary type tubular, sarcoma-like, mucus-like, hard-and fiber-like hybrid. And in the diffuse pleural tumors, such as found in tumor cells produce collagen material can be identified as dMM. Otherwise, should the existence of small intracytoplasmic vacuoles and even light to moderate nuclear / plasma ratio. Key in the country, such as 2〕 According to the arrangement of the tumor cells, the tumor cells and a different tumor cell components account for at least 50% of the tumor is divided into 11 types: tubular-like type, papillary type tubular, undifferentiated , Fibroblast-ring-like cells, mucus-like, myofibroblastic-like cells in lymphoid tissue type, blood vessel cell type, small-cell and hybrid-type cells. And that help from the following aspects of light microscopy diagnosis of the tumor: ① combination of the tumor occurred in the special position; ② search for a two-way tumor differentiation, especially when the suspected tumor should be more based on observation of production; ③ tumor cell migration phenomenon in transition ; ④ a variety of different types of tumor cells mixed exist; ⑤ clinical performance of the critically ill, but the tumor cell nucleus split as rare.
The surface of tumor cells and tumor cells have the inner surface of the thin hair-like microvilli Peng, cytoplasmic actin-rich tension and glycogen granules, or double-layer membrane of intermittent, the tumor cells have more of the bridge DMM tablets for the ultrastructural characteristics of the Key〕 3. Microvilli and, in the middle and the wire inside the cytoplasm of the new triad cavity known as mesothelioma. Adenocarcinoma and microvilli short and thick, with secretory granules in cytoplasm, outside the gland cells form a cavity for the characteristics of the cancer. Key in the country, such as 4〕 dMM study found that the average value of microvilli aspect ratio> 11, metastatic lung cancer and pleura plush aspect ratio average value of <5, put the average value of the microvilli aspect ratio can be used as identification of cancer and dMM An indicator. DMM and pleural pleural metastatic adenocarcinoma of the bridge between the average grain length of the obvious differences, but the number of different pleura dMM desmosome longer than 1.5μ m, and pleural metastatic lung cancer 1 case of no longer than desmosome 1.5μ m. As a result, applications ultrastructure measurement of the length of the bridge tablets dMM diagnosed with pleural pleural metastatic adenocarcinoma of the differential diagnosis must also value.
Immunohistochemical examination dMM differential diagnosis is the most commonly used method diagnosis. However, there is no antibody which of mesothelioma cancer or totally specific, most common cancer there are only Antibodies response. Diagnosis of mesothelioma is built on the basis of negative reaction. Regular combination of several antibodies to reduce the false negative rate. And in recent years has been between the skin-associated antigen, or low specificity, sensitivity or poor, or only to frozen section, it is not widely used. Immunohistochemistry used in the following areas:
E-4.1 malignant mesothelioma cancer and the identification of brown, such as 5 〔〕 study found that the distinction between E-mesothelioma cancer and the best two markers for cEA and b72.3. At the same time positive for adenocarcinoma of the specificity of 100%, sensitivity 88%; at the same time on the negative mesothelioma specificity 99%, 97% sensitivity. cEA, b72.3 and leu-M1 will enable the combined 74% of the cases have been diagnosed. 6, Key ordonez〕 study cEA, leu-M1, b72.3 is the best marker, and ber-EP4 together will enable the application of more than 90% of mesothelioma cancer and a clear diagnosis. riera such as the application of heat 〔〕 7 antigen retrieval methods used antibodies to the re-evaluation found that most of the antibody in the heat after the repair of antigen to increase its sensitivity, and reduce non-specific. And found cEA, bg8 and ber-EP4 for the distinction between E-mesothelioma and adenocarcinoma of the best markers. Three combinations, the order of application, almost all of mesothelioma cancer with the right to distinguish between. Mesothelial-associated antigen hBME-1, thrombom odulin and calretinin sensitivity and specificity of these antibodies than low. However, antibodies and the combination of the above contribute to the diagnosis of mesothelioma.
E-4.2 malignant mesothelioma and adenocarcinoma with the reaction of mesothelial hyperplasia identification of benign and malignant mesothelium cell in the differential diagnosis of pathology is a difficult diagnosis. eMA and p53 〔〕 8 in benign and malignant mesothelium cell differential diagnosis of a certain value. 9 〔〕 wolanski such as the use of thymus membrane biopsy specimens, found in the eMA positive rate of malignant lesions in 73%, and benign lesions in 1 case of non-positive. The cEA, eMA and b72.3 joint application for the distinction between skin cancer and benign hyperplasia of the useful markers. b72.3 in breast cancer, lung cancer, ovarian cancer in the fluid were positive, healthy and free fluid in 1 case of positive 〔〕 10.
4.3 sarcomatoid sarcoma and mesothelioma, the limitations of fibroids and reactive fibrosis serous sarcomatoid mesothelioma differential expression of low-molecular-weight keratin, sarcoma, fibroma and the limitations of the reactive fibrosis serositis did not express any form of angle Protein. With broad-spectrum keratin marker aE1 / aE3 and low-molecular-weight keratin cAM5.2 can sarcomatoid mesothelioma and the limitations of fibroids, desmoid tumor-like mesothelioma and reactive fibrosis distinction between serous. 〔〕 11, and other montag study found 30 cases of sarcomatoid and mixed mesothelioma sarcoma-like areas on both aE1 / aE3 there is response, and 10 types of organizations, 39 spindle cell tumor and tumor-like process were negative, only A small number of spindle cell tumors, such as synovial sarcoma, epithelioid sarcoma, sarcoma carcinoma, sarcoma cancer occasionally positive. Mesothelial-associated antigen (hBME-1, thrombo-modulin, calretinin) in sarcomatoid mesothelioma in the negative, like mesothelioma sarcoma in the differential diagnosis of no value
dMM secretion of hyaluronic acid, dioxin can be blue or glial iron staining. Pre-treated with hyaluronidase negative. The small number of cancer can also be positive, but after dealing with hyaluronidase positive. Lung cancer mucin secretion neutral, pAS-D-positive staining. DMM and as a result of including a large number of glycogen, pAS staining can be positive, but pre-treated with amylase negative. Therefore, staining with dMM in the differential diagnosis of lung cancer in some help. However, hyaluronic acid for the water-soluble, in the fixed specimens, easily lost in the process of dyeing. And more than 50% of lung cancer do not have a neutral mucin. Therefore, staining the high false negative rate will be gradually replaced by immunohistochemistry.
agNOR reflects the proliferation of nuclear activity. Research in recent years that ag-NOR different characteristics (the number, size, distribution) of benign and malignant lesions in the differential diagnosis of a certain value. Wu Xia, such as 12 〔〕 study found that malignant mesothelioma with the reaction of mesothelial hyperplasia as the main difference between the two: ① malignant mesothelioma agNOR particles of the total average 4.26 ± 1.28, reactive proliferation of mesothelial cells to 1.28 ± 0.38; ② malignant mesothelioma cell nucleus containing 1 or 2 particles, an average of 4.42 ± 1.20,2.38 ± 0.38; reactive proliferation of mesothelial cells were 1.28 ± 0.31,1.7 ± 0.48; ③ malignant mesothelioma agNOR particles inside the nucleus Diameter ≥ 2.6μ m, accounting for 84.33 percent, the response of mesothelial hyperplasia accounts for only 0.48 percent. These three indicators can be used as identification of malignant mesothelioma with the reaction of mesothelial hyperplasia of the objective basis. However, benign and malignant mesothelium cell count average agNOR have overlapping areas, such as ag-NOR particles 0.6677μ m2 area as a benign skin between the upper limit, the specific diagnosis of malignant mesothelioma of 100%, 63.8% sensitivity; EMA and combined, the sensitivity can be increased to 95%, and there are very few false positives 〔〕 9. Recently, the use of quantitative image analysis, the method is fast, accurate and objective advantages. As benign and malignant mesothelium cell differential diagnosis of an auxiliary diagnostic method.
dMM are often accompanied by pleural effusion. As a result, pleural effusion cytology is still the most commonly used, the most important method. In malignant pleural mesothelial cells papillary Changcheng, nodular distribution, who was a typical "mulberry-like", with fiber-like core of the blood vessels; were also scattered single cells, or both, there is mixed. Multinucleated giant cells with malignant plasma cells and concentrated into a small peripheral vacuoles useful for the diagnosis of features. Nucleus and nucleolus slightly irregular, but the nuclear / plasma than normal. And other types of cancer cells, the size and shape vary, the size of a malignant cell to another can be several times the size of the malignant cells, the nucleolus, nuclear / plasma ratio increased. However, either of these features are non-specific, and pleural mesothelioma is built on a variety of abnormalities found on the comprehensive evaluation. dMM pleural effusion cytology positive rate low, renshaw comprehensive reports in the literature of 7% to 77%, and to make specific diagnosis of mesothelioma in the sensitivity of 4% to 63%. Therefore, if the clinical suspicion of pleural effusion dMM and cytology-negative, the inspection should be carried out in other ways, such as chest cT, percutaneous pleural biopsy, Thoracoscopy, thoracic, and so on pleural biopsy. Xue Li-fu, and other reports 〔〕 13 Thoracoscopy for the diagnosis of pleural mesothelioma rate of 100%, instead of open heart pleural biopsy.
Cytogenetic be able to check in cloning identify the level of malignant cells and (or) structural abnormalities, and found that there is consistency of mesothelioma cell chromosome abnormalities 〔〕 14, most of which specific chromosome region loss, the most common Loss of chromosome areas for the short arm of chromosome 1,3,9 and the long arm of chromosome 22. 9 chromosome centromere loss of the most common, the incidence rate of 73% ± 3%, lost for just part of the site where the gene mTS1. MTS1 speculated that the missing gene and the occurrence of the relevant dMM. 15 〔〕 granados, and other 10 suspected cases of patients with pleural effusion dMM the inspection cytogenetics and found that in all cases there are one or more of the lost part of the chromosome region. And 6 cases of atypical hyperplasia were not found in mesothelial clonal chromosomal abnormalities. And observe a variety of chromosomal markers and (or) cloning of numerical changes can improve the cell's genetic diagnosis accuracy. Other types of tumor cells, including non-small cell lung cancer can also occur dMM characteristics of the regional loss of chromosomes. DMM but not adenocarcinoma of the nuclear-type nuclear complex and lung cancer more than 10 clonal abnormalities, and in each of the cloned cells contain a number of changes. The malignant mesothelioma cloning is not to change more than 10 kinds, and very little variation between cells. Therefore, the inspection cytogenetics dMM cytology can be used as a useful method of diagnosis, to identify the reactive mesothelial cells and malignant mesothelioma cells, an important value
DMM due to the large number of hyaluronic acid secretion, lung cancer mucin secretion neutral. Therefore, in the pleural dMM contribute to the determination of hyaluronic acid and the identification of lung cancer. However, some benign serous effusion in the concentration of hyaluronic acid can also be increased. Determined by electrophoresis serosal effusion in the concentration of hyaluronic acid than 50mg l-1, 82% are caused by mesothelioma. High performance liquid chromatography of the value of hyaluronic acid 75mg l-1, for the mesothelioma of the specific 100% .
X-ray and CT scan clearly shows that pleural thickening, nodular mass and pleural effusion levy.
There can puncture pleural fluid, pleural effusion, or yellow blood, as a prominent feature of viscous, or even pull into a strip or plug the needle, the diagnosis of pleural biopsy is of great significance.
More difficult to check on a clear diagnosis of the case, that line is more Thoracoscopy, in addition to general observation, cut the specimens feasible histology, immunohistochemistry and electron microscopy in order to clear diagnosis.
In addition to a clear diagnosis and scope of the disease, yet according to the tumor involving the structure of the stage, the development of treatment and prognosis prediction is of great significance. Butchant its recommendations are divided into Ⅳ period (Table 1).
Diffuse malignant pleural mesothelioma staging (Butchant stages law)
Phases involving the structure of the tumor
Phase Ⅰ tumors confined to the lung and pleura of ipsilateral
Phase Ⅱ chest wall tumor or mediastinal organs (esophagus, heart), intrathoracic lymph node metastases
Phase Ⅲ tumor invasion through the diaphragm and abdominal cavity, the opposite pleural involvement, chest lymph node
Phase Ⅳ distant metastasis
Diffuse malignant pleural mesothelioma early have no special clinical symptoms, the disease often unwittingly add.
The main symptoms are cough, chest pain, shortness of breath and suffering from weight loss, may also have fever, clubbed fingers (toe) and hypertrophic arthritis.
Most of the patients have a pleural effusion.
Mesothelioma is the most crowded-borne visceral dislike of the film's extreme and permanent cancer. It is also the provision of only a few high-profile symptoms of cancer, a very subtle form until it becomes extremely advanced. Mesothelioma, said the most common type of pleural mesothelioma. It may lead to allergies or a cold easily mixed shallow breathing short and / or chronic cough. In many cases, when these symptoms in patients with the investigation, mesothelioma was found by accident. Other symptoms of pleural mesothelioma include:
- Chest pain
- Chronic cough that over time the deterioration of the past
- A short shallow breathing
- The provision of blood
- Lung infection
- The swollen lymph nodes
- Loss of appetite and weight loss 75% of all box mesothelioma is pleural mesothelioma. Another said that the type of Peritoneal mesothelioma. Peritoneal mesothelioma in the stomach and the stomach lining internal organs in the vicinity of the impact, and can be dangerous and is fatal. Peritoneal mesothelioma symptoms include: - pain or swelling in the abdomen - weight loss - intestinal obstruction - the blockade in the small / large intestine - anemia - reducing the total number of red blood cells - fever high-risk group such as asbestos and construction workers must be checked frequently to monitor the lead to inter - All skin tumors. Since this is a very deadly cancer, early diagnosis and treatment may help extend the life, but the mortality rate is usually 100% within five years
Diffuse malignant pleural mesothelioma along the pleural surface, can occur in the wall, the visceral pleura and mediastinum. It is difficult to distinguish the origin of lesion site. CHANG tumor interstitial lung direct invasion to form a nodular mass. Mostly gray tumor, as a result of some of the local necrosis and yellow, hard texture. Often transferred to the hilar and mediastinal lymph nodes, blood can also be transferred to the lungs, liver, brain and adrenal gland. As the skin between the histological diversity, and therefore its histological features and more complex classification. Generally be divided into E-, sarcomatoid type (fiber type) and three types of hybrid, often more than skin type. Single-use optical microscopy often difficult to E-malignant pleural mesothelioma and metastatic adenocarcinoma of the lung, and so the distinction. By immunohistochemistry and electron microscopy help to identify. Malignant pleural mesothelioma low-molecular-weight cytokeratin staining positive, can be separated and sarcoma; malignant pleural mesothelioma can not be CEA (CEA) stain, which can be differentiated adenocarcinoma. If the results of immunohistochemistry with the same tumor, electron microscopy can generally be confirmed. Malignant pleural mesothelioma of the most prominent feature of many of the curved microvilli, and adenocarcinoma microvilli short and straight, and the top covered with a layer of polysaccharide protein complex.
Diffuse malignant pleural mesothelioma rare in China, but Europe and the United States in recent years, the incidence has increased significantly. In the age of 50 to 70 years old, more men than women. Cause of its contact with asbestos, the incubation period of up to 20 to 40 years. However, the incidence of this disease and how much quantity of asbestos exposure and no clear relationship between the length of time. In addition yet with the long-term exposure to radiation, the pleural cavity filling the pleural scarring after treatment, idiopathic, and other factors
Peritoneal mesothelioma for the primary and peritoneal mesothelium cell tumor of the organization, clinical rare. Pathology can be divided into adenomatoid mesothelioma , cystic mesothelioma and malignant mesothelioma (peritoneal malignant mesothelioma, PMM). The first two are benign. Cystic mesothelioma was particularly prevalent in women, the cause is unknown, occurred in the surrounding pelvic or annex, was single or multiple cystic masses; patients often palpable abdominal mass and treatment. PMM account for about 30% of malignant mesothelioma; its occurrence and also closely related to asbestos exposure, about 5% of the patients have a history of exposure ; asbestos fiber intake by mouth, through the intestinal wall and translocation to the peritoneal disease . Exposure to asbestos from the diagnosis, the disease incubation period of up to 25 to 40 years. However, from 1951 to 1993, domestic 20 reported 161 cases of PMM in only 1 case has a history of exposure to asbestos. No history of exposure to asbestos in the crowd, the incidence of about 1 / 1 million years, may be related to certain infections and genetic factors [2, 3, 4]. Foreign PMM reported 1 case of a patient more than 40 years ago have come into contact with glial thorium dioxide (Thorotrast) . PMM often occurred in men over the age of 40. Visceral or parietal peritoneum and the incidence may be; direct violation of abdominal tumor, pelvic organs; 50% to 70% of patients with lymphoid and (or) distant metastasis, such as liver, kidney, adrenal gland, lung, bone and lymph nodes, etc. . This lack of specificity of clinical disease, abdominal pain, constipation, bloating, weight loss and other performance obstruction . Physical examination can be found ascites or abdominal mass, and so on. For ascites effusion, as part of the blood. This disease misdiagnosed as tuberculosis peritonitis, recurrent spontaneous peritonitis, inflammation of superior mesenteric or peritoneal metastases, and so on. Ascites hyaluronic acid increased significantly,> 0.8g / L were only found in the PMM. Ascites exfoliated cells are of the value of the check, but often difficult to judge. Serum carbohydrate antigen -125 (CA125) increased to help diagnose this disease [6,7]. CT and ultra-performance of the B variety, are typically irregular thickening of the peritoneum, omentum adhesion was Pie, was superior mesenteric tissue samples; CT can also enhance the display of pancreatic mass-week-or intra-abdominal diffuse large mass substantive And violations of the intestine and mesenteric; or peritoneal nodules, or cystic mass was; more with varying degrees of ascites . Ultrasound or CT-guided biopsy a certain value. PMM diagnostic laparoscopy is a simple and effective method of peritoneal microscope, the retina diffuse plaques and nodules, and biopsy pathology under direct examination. We have given 1 case of 83-year-old male patient, laparoscopy, peritoneal biopsy report of the mesothelial cells, after the Organization immune to chemical and biological inspection confirmed PMM. Butchart, and other PMM will be divided into 4: I, confined to the peritoneal tumor; Ⅱ period, intra-abdominal lymph node tumor; Ⅲ, tumor metastasis to the lymph nodes outside the abdominal cavity; Ⅳ, distant metastasis. The above categories will help to choose treatment. PMM so far no effective standard treatment. Very poor prognosis, the survival period after diagnosis with a median of 1 year, 2-year survival than those less than 20%. The main cachexia or died of intestinal obstruction, and rarely the cause of death related to tumor metastasis.
Pleural pleural mesothelioma is a primary tumor, there are localized (mostly benign) and diffuse (all malignant) of the sub. One type of diffuse malignant mesothelioma is a chest tumor one of the worst prognosis. The first symptom to chest pain, shortness of breath and coughing the most common. To have fever, sweating or joint pain mainly v. symptoms. About more than half of a large number of pleural effusion of patients with severe shortness of breath. A large number of those without pleural effusion often more severe chest pain, weight loss common. Ordinary X-ray revealed pleural effusion, while lung tumor tissue was wrapped, and so on, have advanced cases of pericardial effusion caused by the heart shadow and the expansion of soft tissue damage, such as video and ribs. Suspicious for malignant pleural mesothelioma patients, CT examination of the most useful. Pleural effusion cytology also contribute to the diagnosis. Conventional laboratory tests, some patients may have a number of platelets, serum carcinoembryonic antigen (CEA), and so increased. For routine inspection diagnosis is not entirely clear, can be used to do thoracoscopic pleural biopsy. In general most patients can not obtain a diagnosis.'s Treatment of malignant pleural mesothelioma, is still no effective cure method. Treatment, have surgery, chemotherapy and radiation treatment, the tumor is generally believed that the relatively limited period I patients, so that solution to the problem of pleural pneumonectomy. For Ⅱ, Ⅲ, Ⅳ phase patients, radical surgery has no meaning, only the implementation of palliative operation in the incidence of the majority of patients between the ages of 40-70, more men than women. The cause of mesothelioma is a major cause of mesothelioma patients of asbestos exposure. About 70 - 80% of patients with the diagnosis of mesothelioma in the history of asbestos exposure at work. However, there are some mesothelioma patients and there is no record of asbestos exposure. The asbestos fibers can be a large number of dispersed into the air and minerals. Asbestos was widely used in many industrial products, including cement, brake linings, roof shingles, textiles and insulation materials. If tiny asbestos particles floating in the air, especially in the manufacturing process, they will be inhaled and cause serious health problems. In addition to mesothelioma, the asbestos exposure of the increase in lung cancer, asbestosis (noncancerous, chronic lung disease) risk, and other cancers, such as the throat and kidney cancer. The combination of smoking and asbestos greatly increase the risk of air passage of the risk of disease. Mesothelioma asbestos exposure mesothelioma manufacturers in the early 1970s before the understanding of asbestos exposure can lead to mesothelioma cancer risk, but they will this information as trade secrets with tighter control. On first exposure to asbestos is reported in the mid-60. Even today, asbestos manufacturers still try to hide the fact that the risk of long asbestos. Long-term human exposure to asbestos in the environment caused by inhaling asbestos and mesothelioma risk to increase dramatically, but a recent study found that even very short-term exposure to asbestos can cause the disease. Typically, mesothelioma need 20-40 years before symptoms show, people usually aged between 50-70 who were diagnosed until the disease. Although the reported rate of increase in the past 20 years, mesothelioma is still relatively rare cancer. The United States each year there are about 2,000 new mesothelioma was diagnosed cases.
3、蕃茄蜂蜜美白 这个美白配方可同时作脸及手部美白。特别是暗疮皮肤，能有效去油腻，防止感染，使皮肤白皙细致。 配方：蕃茄半个、蜂蜜适量。 用法：可将蕃茄搅拌成蕃茄汁后加入适量蜂蜜搅至糊状。均匀涂于脸或手部，待约15分钟洗去。建议每星期做1－2次
5、鸡蛋扫斑 鸡蛋如何美白 ？取新鲜鸡蛋一枚，洗净揩干，加入500毫升优质醋中浸泡一个月。当蛋壳溶解于醋液中之后，取一小汤匙溶液掺入一杯开水，搅拌后服用，每天一杯。长期服用醋蛋液，能去斑使皮肤光滑细腻，扫除面部所有黑斑。
8、白芷美白 材料:白芷6克；蛋黄1个；蜂蜜1大匙；小黄瓜汁1小匙；橄榄油3小匙。 做法:（1）先将白芷粉末，装在碗中，加入蛋黄搅均匀。（2）再加入蜂蜜和小黄瓜汁，调匀后涂抹于脸上，约二十分钟后，再用清水冲洗干净。（3）脸洗净后，用化妆棉沾取橄榄油，敷于脸上，约5分钟。（4）然后再以热毛巾覆盖在脸上，此时化妆棉不需拿掉。（5）等毛巾冷却后，再把毛巾和化妆棉取下，洗净脸部即可。
11、香蕉面膜： 将香蕉去皮捣烂成糊状后敷面，15－20分钟后洗去，长期坚持可使脸部皮肤细嫩、清爽，特别适用于干性或敏感性皮肤的面部美容，效果良好。此方法可使皮肤清爽滑润，并可去除脸部痤疮及雀斑。这种方法适合任何一种皮肤，一周一次，可软化角质美白皮肤 12、银耳面膜 银耳、白芷、茯苓、玉竹各50克，共研末过筛，每晚取粉5克，配面粉3克用水调匀涂面，次日清晨洗去。银耳、白芷、玉竹均能滋养肌肤，茯苓能去斑，并引导诸药直入肌肤，但面部患有皮炎的人要慎用。