Li, Anhui, thirty years ago was the first to the coast, Today, the Li family was quite diverted to improve and became a The to a small unit to seek management positions, but also from the migrant workers and the employer shall extract the appropriate commission.
are regarded as skilled workers, work quality and quantity of children. Every day, many came to the construction of our units. Now we have people grouped together, along with a hammer to make, and can also talk about the price of labor units, and can buy a number of other benefits and leave it. > Li said, I, jumped 50 dollars per person per day. According to the present situation, I think the salary will continue to rise a little. Number of employment units to the China Securities News, said that the labor market supply and demand
Construction of a large unit of the China Securities News, Wei Zheng They complained: Now a word to child recruitment, hard! Substantial increase in wages does not say money is often not hire people. We are such real estate projects, left the migrant workers will stop working. Wei Zheng introduced to his second-tier cities where, for example, wages are carpentry 400-500 yuan per person per day, masonry 200-300 yuan per person per day, water, electric and 500-600 yuan per person per day. Among them, the most difficult to recruit skilled carpentry, woodworking tight almost
Since the emergence of And Over the past hundreds or even thousands of people at every turn large services company, gradually became decentralized
Wei Zheng said, market awareness, greatly enhance human rights awareness, knowledge of and the employer shall seek leave a good job would use their
Wei Zheng said that while . Textile enterprises in Fujian Province, director of human resources is also expressed to the China Securities News, on this playing tug of war issues. Labor units of course do not like the migrant peasant workers in this form, once the
It is worth mentioning that in the past only in the eastern coastal area of the The Midwest, Reid's home to Anhui Province, as of the end of 2010, Anhui province lack of work more than 50 enterprises amounted to more than 2,300 households, lack of work a total of 25 million people. In the Service companies dominate the world by the
Many scholars and industry experts believe that migrant workers in this Relevant departments should be more from the policy level, for the migrant peasant workers supporting the security system set up, information channels, the regulatory environment.
Monday, February 28, 2011
Sunday, February 27, 2011
Q & A nine hundred forty-nine focus
The copyright of all content and a blog all along. For the convenience of reading, some letters of the words were appropriate excision, but retained key elements.
Open holes in the trees: moushun@hotmail.com. Select a letter from an open back, please do not involving personal privacy. You just sent me, I will take conceited. Open holes in the trees present a serious backlog of letters required to be boarded three weeks patiently in line blog.
open holes in the trees do not receive more than 500 words long letters. in principle, restricted to the consultant for any reply. series is not A. asked, The future; the second child's should not; can not be an unmarried mother; sexless marriage how to do and do not want a divorce; want a divorce could not bear children; afraid of looking after him apart even worse than he's; man how derailment run; man is nothing but the divorce could not make the hand; older anxious to marry but of underachievement, special circumstances, I must specifically answer, OK, you send private tree holes.
private tree holes: yushunshun@gmail.com. content should not be open long and privacy, as well as open holes in the trees did not answer several types of topics are Please send here. This tree holes received a hard charge fees. privacy holes in trees and there are dedicated to talk phones, such as no time had no desire to write, you can write to yushunshun@gmail.com, find family number. In order to avoid harassment, the phone will refuse to listen to any calls without an appointment. thank you.
no matter which tree holes sent a letter, please do not use attachments. Where a letter sent to the open holes in the trees, usually copied directly into the document, the letter does not appear The mail address and name. So, do a few days after the letter or the board blog, and then asked me to delete a letter or check the source of a letter, I have no energy to look. sorry.
1, when the thought of a people, cool hand from the tip of the heart, this is why?
one, do not you let Zhesi hurt the temper friends. Second, your attitude to be adjusted.
hhhhhhhhhhhhhh
2, I was 25, has been single blind from the age of 23, compared with the no feeling. Earlier this year class reunion, hit my hour crush of boys (like him for 3 years, he did not know that we are rarely the kind of talk), after He joined my QQ, I was a bit agitated, and offered to his phone, he never spoke to me on QQ, and he wanted to declare (for so many years still have feelings). and my friend said, he asked me not to nerve, and now I'm cool with a lot, I think I actually do not know that he, and he estimated that his girlfriend, and, if he knew someone like him for so many years, he must proud Debu okay, if he my classmate said, I Mo Lianxian person (like him these things, nobody knows). hey, intimate activities, and recently, I really want to find like, do not want to casually improvise.
know some people like normal people own for many years, the first feeling of surprise, the second sense of joy, feeling worried about the third, fourth fifth after the first N is possible to feel proud of, so you do not like him so wretched, and without him tell the truth, let the good feelings that point in the past deposited it in the years to come, can not have an idea will become reality. now continue to look for a man blind date, this has not got the idea for the person you hold back of the head, you will get more confident and happy.
hhhhhhhhhhhhhhhhhhhh
3, I work in the county-level city, was admitted to the civil service two years ago, 2 months ago was introduced to one person, references only to the city planning bureau said that he had to go to work, after inadvertently learned that he has only a temporary. when there is a sense of being cheated. He was graduated from college, when I wanted to test public institutions also allocate it, did not think ten days before the exam, he almost did not review. He said all day no fairness in society today, these places must be default. I hate the attitude of his that escape. I said if you pass the test, I do not want you. He hypocritical to say that you can choose others But you must decide by September. was cold in my heart bursts. After all the talk, I forgive him. He said he will work hard words, but less than two hours daily reading time, soon before exams two days even Director of the Office to travel with them to go. call the night before exams, said some apprehension, I said okay, you have a good go. He did not do everything himself said, adding that even these ten days are enough to test into a good review. Results surprisingly he did not plan.
he began his 80% of the students did not assign their officers to give him a lot of overtime or something. well, Shun sister, he almost did not ask me decent meal, each second night out, he is eaten out, and then asked, times, I complained enough to eat, he said, Who told you that you do not want to eat ah. shun sister, should I break up with him?
excuse to give up social injustice who is also not ideal too lazy to struggle, even as he, like the fair society for nothing, without him, unhealthy mentality, go where no future. He is no alternative for you stingy, a number of temporary workers to pay? As for whether or not to break up with him, do not ask me, ask your heart, if you think you can not do without him, even if he is a beggar, and you can call him into your home.
hhhhhhhhhhhhhhhh
4, her boyfriend had terminal cancer, is now only 2 good friends know. He will not let his parents know, afraid of the burden to their parents to find. both of us know a friend's blind date, contact time is not long, each is recognized each other, feeling bad, is determined to marry each other. He check 2 weeks ago out the disease, and now he has low self-esteem, just wait for death. He broke it, I do not want to delay. Now he does not pick up my phone, and he basically can not change things approved. I think as a good friend accompany the side to take care of, happy to accompany him through a. I also want to quietly told his parents, I do not know how I do it? time now hurry, afraid of delays in treatment of disease spread. He is 25 I 27.
have cancer or have to let this thing his parents know that their parents can not stand the sudden death, might as well tell the parents to let their loved ones to accept the reality a little bit. If diagnosed and really late, but his family was very general, the treatment to avoid the bar, keep alive people who were not saved drag on death, love is the real love of his family home, so I understand his approach. but he should be very low self-esteem, you should persuade him to conform to God, to relax the face, in the life Finally, a length of the journey to meet their wishes as much as possible. Do you want to accompany him to finish his last time, no problem, just let him accept your kindness, multi persuade him, even after the departure of breaking up is his thing, now Why hurry to separate it. could die, is our pursuit, try to do it.
hhhhhhhhhhhhhhhh
5, my baby is in May, and I also unemployed, looking for work have to baby to the grandmother's home field, to take care of the baby must stay at home, choose so hard ah. Shun Shun sister If you, how do you choose? Also since my body weight after production has soared by 30 pounds, what weight loss along sister What coup?
grandchildren if the grandmother is willing to accept, then send your good work, and so her children back from kindergarten point. If the grandmother is not very willing to grandchildren, you will find a reliable nanny to look after children, now, women have to go out and work will not affect the status of your family. Speaking of weight, not only 狠招 coup: try to eat less, exercise as much as possible.
hhhhhhhhhhhhhhhh
6, 2005 I had just attended her boyfriend After postgraduate examinations, when the results did not come out, we apply for the same company and became co-workers. did not work in March, he went to school, we also identified the relationship between male and female friends, but his parents do not agree with us, very firm attitude. They I think working in Beijing, his family was not good. boyfriend wanted me to meet the shortfall through increased own. In the encouragement of her boyfriend, and I took the test three times a graduate student studying so hard for three years, did not succeed. postgraduate her boyfriend after graduation, 08 years and was admitted to a national civil service, his parents do not agree that we got married, I feel the pressure of life after marriage we will have a great hope that he find a job stability, Beijing is a good account or family woman. I'm 28, and my parents for my marriage hurry. My boyfriend and I lived together, exchange the years, I have two flows. her boyfriend under the pressure of his parents, very difficult, and I had a big fight with his father. I very much like to hear from you views on this matter!
you and widening the gap between him, for I was his parents, I would not be happy your marriage. you told his father, an argument? for I am his father and mother for, this does not make you the door. his parents pamper their children and did not want his son because his wife was home and personal conditions of drag, which is the normal state of mind for parents, you and replace what he terms it, your parents would object more intense, so you do not hate his parents, but also to hate and hate only did you find a backbone of the men, and you are too stubborn, knowing that people still live or die against Bu Songshou. Now you are asked for the 2nd miscarriage, know and each other's future is uncertain, you told him to continue living together, this is not asked for what is it? now and consider the break up, no parental support and recognition of the marriage, it is difficult to continue to operate the. find a good fit with who you are each other do not mind, live, is the basis for a happy marriage.
hhhhhhhhhhhhhhhh
7, I'm 28, tall good looks. and her husband quarrel too much the last two years, said a lot of harm to each other's words. I want a divorce , but considering the reality, he is about 70 million annual income, we have the year-old children. friends advised me not to impulse, give and take, and I thought hard, and sometimes want to forgive him, and sometimes very angry. He is the kind of mouth does not speak choice of words, it hurt self-esteem, often offend others. We had no deep feelings, because he after me, then he told me well and just like him. when he was working a year tens of thousands, of people long was also very general, family members do not agree. I thought he would have been good to me, but his temper to a decent life are not confused, he repeated temper tantrums and always fierce look absolutely shattered, although not manipulated, but I also Some became hysterical, was feeling very bad. In fact, he is good to me, money is also generous to me with, but did not let me pipe, this is my heart, bought a house years after his income to keep him own account, but also lend friends.
quarreling recently divorced, and he only willing to give about one-fifth of the money. shun sister you said, I continue to be with him, with his money, my days (After the big deal less to meet their play their work,) by the point of gas; or divorced, took so little money to go, plan a happy? or can be a lawsuit, but I do not want to fight this for the money. The most important thing is children, my family no one to help me with, our only pick him to school, and children to him, I can not bear. I live to continue, or a break?
love has broken, barely scrape together and boring. but you now can give a divorce, but could not prepare his day out with people, do not force you to divorce, got hit with sooner or later, as we take the initiative to give up good. marital property is to be divided equally, he does not want to give you the number of you how much more should be on the court for the money, because you have to raise children, money can hire someone to help you kids thing.
hhhhhhhhhhhhhh
8, he was six years older than me (I 29), sixty-seven before the year (when I have a boyfriend), he is my husband's former colleagues, only seen a few faces (can see a good impression on me), no close friends, and then no longer have any contact. half months ago, I mentioned relatives him, I hesitated, but his parents think he in good condition in all aspects, encouraged me to meet, I agreed. afterwards he said that because I know before agreeing to see. for although he is not understood, but the impression has been good, so want to try to make good contacts, perhaps really fate. Today has been a half months along, feeling not very good. from the blind date that day until today, he did not about I've eaten a meal, each about I always had dinner sixty-seven point, for the first time with I rolled to a nearby park, then a few were sitting downstairs in my home area to chat. This is also called a date? Then he asked me, I have an excuse not to go. I think he may be not interested in me not the nerve to say. But he also said short message in a few years ago, like me, because I had a boyfriend did not tell the truth, said cherish this opportunity, and I want to make good contacts, saying that if I could marry him, and he will love I'll never, never change anything.
I get dizzy by him. relations that her mother was a young man before her and divorce and irritation, plus the time is menopause, leading to mental disorders, behavioral radical. because the love his son so that my son must go through the object communication she agreed, before a lot of contacts have been wrecked his mother, but his evaluation of the outside world good. blind date the day his mother also, and I would quite satisfied, but also, and introduced like I said, I hope our good benefits, early marriage. surface, she did not see anything unusual. sister, there is such a mother I can marry it? after the wedding will not be affected ah?
appointments must go Restaurant? I think not. However, if he deliberately points the wrong meals, rather some other time and keep them with you to eat, can only mean that you do not have confidence, do not want to spend a dime on you. The other, a man vows are just words, you can do it personally, but not take it seriously, otherwise you are stupid fork. As for his mother's problems, just see the side, as long as you do not look particularly different, the performance of special arrogance, people will say satisfied, you do not when their own better than other girls, before allowing his family to accept such a cool, his mother, and you really just kind under the introducer. If the legend of his mother with mental illness, and wrecked His love many times, but this can not be easily provoke people, for I will tremble.
hhhhhhhhhhhhhhhh
9, due to past ignorance, did a curettage, and her boyfriend are now very good, exchanges more than a month have marriage plans. I think he can accept I am not at, but surgery will not be accepted. read online that the young man has done this surgery the doctor will see that child, would shun it true? how to deal with such a thing? boyfriend how to say I do not have? I was very self-blame, and along Do not blame me too K, ah.
I'm not a gynecologist for a second house did not scratch, it is difficult to answer this problem. But like I said N times you do not remember a word, it makes me so angry mm whether curettage, is a virgin, that is your personal privacy, why should tell your boyfriend? if he found the marriage, turn, and then to break up too late, not that guy with a pretentious feudal breakup dates can not grasp you, you will sooner or later points when you was not afraid to point out.
hhhhhhhhhhhhhh
10, Male Dr. Reading 33 foreign countries, female 30, housewife, married for five years and a daughter 2 years old. male and female character not and, men and women harshly intolerant of disrespect, bullying, big and small have him call the shots, frequently because of small snapped the woman. When children surface is also angry with impunity and even threw things around. but no man having an affair, love child. Accompanying women quit because of domestic stability, due to professional issues in a foreign country is unlikely to find a job. is suffering women in a dilemma: it can not bear men the spirit of violence, consciously has lost direction in life and fun, leading a difficult life, and worry about the man so long, the adverse mental health of children; but if a divorce with children to return, but also worried about the growth of divorce on children adversely, and future children education, health, houses and other issues. Dear Shun Yes, women go from here?
tell you to read along with the way her mother to see their children go abroad, you first return to work, resulting in de facto separation, or make you think men have the opportunity to Next, you did this So now no mention of divorce, the divorce because you have not prepared well: at least they have to economic self-reliance, personal independence, and to leave the firm.
hhhhhhhhhhhhhh
11, I am 28, her boyfriend than me in January, exchanges 3 years, I gave up my love for his work to his side. His temper is not good, but also less likely to care about people, but a good heart, and other problems similar to ah, and so I do not matter home. But the three exchanges years, he also wants to marry me, I did not feel safe, because he did sell, to drink in the evening to accompany clients to accompany agents, they do not eat at home, always home late, they go places There are Miss, I am particularly sad. He always said it was his job, in fact, I know that he has been accustomed to that kind of life, and I just do not understand the evening sales have to do? While it is also really love a lot of customers play, but I think this is not necessary, but to be honest I do not have much confidence on her boyfriend because he could not restrain myself. He said that Miss KTV is a picture of the skin. I believe his heart filled with me, because at home He was sticking me, but I still can not accept his life, he did not come home, I can not sleep, do not know what he was doing, did not dare to call, after all, a man out socializing, I would always call let him lose face, bored.
every afternoon so I am very nervous at night if he was home, I will be very happy, if not at home, I was entangled. I had also checked his phone records, have my that ambiguous messages and telephone calls, but not a long period of time to contact, for some time gone. Shun Shun sister, I do not like this kind of life, but love him, and he also wants to marry me, urging me several times I now how to do it?
since his work requires frequent visits to the brothels place, you may wish to have him think of stained sludge in the Oil Stick N times as long as you love him, you forget about him love and fate, every time entertainment when he is right to support the tertiary industry, and protective measures you do, do not be transmitted to strike and less like how can he maintain chastity in sensual pleasures. You did not like him work environment, and he brings you the mind, but you like for him, since no ability reluctantly must sell yourself, then adhere to bite it. In addition, no alternative to the Who told you your guts, have to follow He?
hhhhhhhhhhhhhhhhhh
12, hesitated for a long time, the discovery of cheating ex-husband again, the firm divorce, under the impulse of the households selected purification. never puts down his daughter after the divorce, her ex-husband can not do with her. daughter I single-handedly brought up, always wanted to give her a warm home. remarry her ex-husband asked, and begged me to stay home temporarily, to give both sides a chance. Shun Shun sister, you said good Never look back, and both sides hope all friends and relatives to remarry (her ex-husband in the marital good to me and the children, divorce is derailed by her ex-husband) I am confused, how to take the next road?
sincerity make him point out, if you want to continue to live child care at home, then give you the fortune of his own purification from households. How can you Lingzui he derailed the?
hhhhhhhhhhhhhhhhhh
13, I'm 27 female, 26, and she had a relationship. We are university students, junior and began dating, and now the first five years in a row. before the 1 year we get along quite well, whether or live chat, then slowly she seemed aloof to me, she has a very strong post-graduate program to request and I broke up, I am strongly recovered. Later 2 years every time we fight, whether it is her that she was wrong, I always take the initiative to admit mistakes, I think men should let women can fight as long as I do not take the initiative to go after her , she does not find me. And every time she does not leave me back home the basic message to the phone, do not ignore me, but if we met, she and I are all very happy. Now to work, evening telephone SMS is gone, I do not know is broken up with her or what? Shun sister of how she helped me look at our feelings?
this girl now and you two do? If so, you basically had no future. If you city, she also never take the initiative to contact you, or even lose a separate message, it means she has someone else. In short, she is not very optimistic about you, she is currently not a break with you completely, because half past one would Shuaibu Diao you and the man she did not want to give her Zhunxin.
hhhhhhhhhhhhhh
14, an unmarried female colleagues, non-married male looking for friends, a married man's wife notified his family, is invalid. This woman said: is to it! times create conflicts, so that the couple angry. Look here not leave, unmarried women also looking for other men making fake chat, framing his wife married men. After watching her husband, actually believe it. Faced with this rush do not run , tyranny does not matter what the third, how do?
the existence of such a brutal three, but it is still the attitude of men, a man from now on if you no longer pay any attention to her, call screening, net chat stop do not talk to each other to meet, in any case ignored her, how can she toss? problem is that men like you and her brother, sister, ambiguous, and you would not wipe the following sub-men to offend her and she was willing to hurt your feelings So, you want to hate a man to blame is you and blame you hate a man my son. is inseparable from them, then separate it to you and your man, someone very cumbersome management, control their own much easier, and you try your This can take the initiative to put down the dirty men and women do, if, you did not upset the.
hhhhhhhhhhhhhhhh
15, I ran three more than three years of marriage. LG a nice guy, and I love him, he did not understand the romantic , living dull day, go home from work, really boring. now appears in the work of one man, forty years, funny cute. I did not love his sense of his ambiguous nor too seriously, but liked and his chat. very confused, I do not know whether to keep him at distance. prevailing fear of sinking in the hope of coaching me along to look at.
ambiguous and do not want to find colleagues ah, you'd better consider the following consequences: once to the other colleagues know you a little whatever, who will see you high? not Xialiao, the men and women is a talk on the fiery, to avoid really derailed, or exterminate first ambiguous heart is better.
hhhhhhhhhhhhhhhh
16, female 26, Teachers College as a teacher in the secondary cities. a small language, bachelor's degree. The school requires further study, individuals feel that China's ability to enhance the graduate education of little help, no need to read. not to mention teaching the two In addition, individuals can do that for. In this small town, the age for a major, surrounded by married people, and I became heterogeneous. can not be reconciled, that capacity should not be in a small place by fooling around. Now that the working life is a mess. each school day speaking the same content, it is boring, wages are low. dear old problem, do not see eye. Zengyin pressure and try to have a relationship with a male and feel more pain, and finally let go. summarized reasons, the town considered a good income, and then look up, it is difficult, therefore more to leave. This idea has been many people opposed on the grounds that university teachers of the girls is the most suitable job, working hard to find outside, not be able to break out get out; older, married to the most pressing tasks. personal character undecided, so it flies quite painful.
battles if you want to go out, it should further studies Well, with a postgraduate degree, after you have quit benefits. And who is more experienced, the greater the capital when it is more likely to screw up, their battles away from home. graduate school does not delay seeking a partner for marriage run into, do not touch the first one was on Anyway, since the schools require you to studies, you should take the opportunity to fullness under myself.
hhhhhhhhhhhhhhhh
17, I am 32 years old, nothing, done a few years after graduating from foreign trade, not a success, hard work alone outside It is not for me to return home a small town in Jiangxi mm I've tried various jobs, from small hardware store clerk to clerk typist to the factory, I even did the garment workers, but do not long for each work. I thought the problem was not my own, but really can not change themselves, my parents divorced early, stay in the shadow of my heart, and now his mother retired, she has been blaming me for nothing, I have no power to change this She questioned my age in his hometown of the NPC have been married, and now if I find the object in the home, only to find conditions much lower than I am, I really do not know how to do.
your question adhere to finish off is never one thing, no longer of a good report card is very difficult, after all, not everyone is lucky to be able to stand a short time, can also be pie in the sky fall Zazhuo. Now problem solving marital problems did not work, you must first attach importance to matters, work must concentrate on, and must adhere to do one thing well, you just may develop, and development of the direct benefit is that you do not have a good marriage can survive . As for looking for a man, as long as the hit themselves tempted to do stressed conditions, and if the conditions for your own good, you will not be until now Well, not only so, may wish to study only one aspect of a man is not what you need , so much like to marry.
hhhhhhhhhhhhhhhhhh
18, My boyfriend and I just love when he say what words are, like in the future want to marry me, love my life like that. with time, we has been almost a year. Now his work, and I mention those words, he contradicts me. always said previously before this is now. quarreled several times to break up when he said, adding that his focus is now the cause of , in love or not does not matter. afterwards gave me that in a fit of anger about what he can say. Every time I talk about and fight is, no matter who is right. listen to Shun Shun, I did not tell him ML. peacetime He is also very good with me, but how is not a separate. said in the total count will be forgotten. Please Shun Shun taught me how to do to make me re-gain the upper hand in this love, then?
You basically can not possibly gain the upper hand again, because you took him as your whole world, he only take you when he was a small part of, as long as you do not have the courage you have him reduced to a small part of you always no chance to prevail, and let him chase you stick to you. Remember, a man chasing a woman, said that the words are nonsense, a gust of wind came on the wind in, and can not imagine a fart is always shrouded in around you. like love my life, , college graduates have been in the hospital for three years. love for two years, different city, a place in the male female intern. have met with parents, but both parents have not seen. in the male counterparts in the small town can not find the medical work, women home work before graduation, the clinic workers in January. women back, the male parent to incite men, say a place, how to be afraid of the future. women here have been told. women felt they were long hours with not a thing, resign to run It came to the men, said to be diverted, no matter what as long as the two together, you can adhere to the anti-stress. Women have no confidence in the future of marriage, fear of long points, and male and his parents do not mention marriage. F has for the first time to the male, was worried. would like to insist on his way to the marriage. Men think that women have just recently graduated, do not be diverted, or a good doctor, physician license exam next year, consider getting married. women fear this is an excuse for his , nay. Female teachers in here looking for a job, also signed the contract, that the men would not be opposed. but the man insisted she should not stay here diverted to the Bank made her home.
Female very sad, that men in the drive her away. men that just work for her consideration. Women now can not tell he is really good for her, or do not want to charge. women know that their work should be home doing a good job, that is my heart not understand what her boyfriend is not doing everything possible to be together? who first separated it. women are running, and also so cruel to her back. Women think he is selfish and arbitrary. men think women do not understand his ideas, as long as the love that can not be Do not bread, and said all this for you. Soon, you talk sense to me, afraid of such a return, and after his unlikely marriage, and do not want to marry with other people ah.
work is their own , the future is your own, you have to throw your own, partial to him to give you your future, but he promised not afford, but also can not bear, so he had to rush you home. you, the Shade SOUL.
hhhhhhhhhhhhhhhh
20, I know with her boyfriend to live together in 2008, intends to obtain a permit married in 2009, but my heart is very contradictory, because in the end I'm sure he loved me. I 85 his 80's, We know through the network, from the understanding that the plain old married couple now live a day, but I would be flat, I was a heavy feeling, even if he is too proud a man not fun, as long as he loves me, I am willing followed him. just when he was with a few back with the others I found ambiguous, I forgave him because I knew that he did not really like me, has not yet found me, not to mention love, but I hold a state of mind, to do himself, he will fall in love with me. He explained that Internet addiction through the mouth, did not it personally. I believed him, but later he gradually was I found that every time I say to him communication, because I think quarrel not solve the problem, but he choose to escape, and I do not want to take to solve the problem, it is so, it passed no problem, and I, in his mind is a very good woman.
We are now feeling it considered very stable, but he really is a love affair, man, I analyze his occasional but not with others deliberately ambiguous, and he really likes the opportunity to others. In the past he has not found me, I have can understand him, to now he can make the same mistake, but he is getting better for me, I can still feel it. I am very contradictory and would like to confirm whether he really love me, fish along sister, a any way to help me ah?
he is the north, I am Cantonese, I usually wake up before going to bed would have asked him to kiss me about a few months later, he occasionally will forget, and I said, pretending to get angry He did not got the idea, but he complained that they are not popular so that parents generation did not like, do not still came up and said to him every day, is the need to remember that process takes time. I think this is an excuse, I know that he loves his first love. He told me that before he goes to work every day so his girlfriend and then Guangyi Xia, can at me, these have become troublesome.
on the recent, and I found His dialogue with a woman online, he said to the woman he loved no one except no love, he said he was hurt, has been unable to love any person, including the current me. He said in addition to talk about feelings What can be done with her, dating, sex and so on. boyfriend also said to the woman, I am a good woman, he is responsible for me, because my boyfriend work needs to go to Guangzhou for some time, he even called it Nvwang past , anyway, said a lot of hurt me, and said he once knew a woman, lonely when contact is not talking about feelings, and later married the woman no connection to it. Later I asked him how, he explained that only Nonsense, it totally did not mean, anyway, to continue to quibble just a mouth that there was no real action. and I ...
Open holes in the trees: moushun@hotmail.com. Select a letter from an open back, please do not involving personal privacy. You just sent me, I will take conceited. Open holes in the trees present a serious backlog of letters required to be boarded three weeks patiently in line blog.
open holes in the trees do not receive more than 500 words long letters. in principle, restricted to the consultant for any reply. series is not A. asked, The future; the second child's should not; can not be an unmarried mother; sexless marriage how to do and do not want a divorce; want a divorce could not bear children; afraid of looking after him apart even worse than he's; man how derailment run; man is nothing but the divorce could not make the hand; older anxious to marry but of underachievement, special circumstances, I must specifically answer, OK, you send private tree holes.
private tree holes: yushunshun@gmail.com. content should not be open long and privacy, as well as open holes in the trees did not answer several types of topics are Please send here. This tree holes received a hard charge fees. privacy holes in trees and there are dedicated to talk phones, such as no time had no desire to write, you can write to yushunshun@gmail.com, find family number. In order to avoid harassment, the phone will refuse to listen to any calls without an appointment. thank you.
no matter which tree holes sent a letter, please do not use attachments. Where a letter sent to the open holes in the trees, usually copied directly into the document, the letter does not appear The mail address and name. So, do a few days after the letter or the board blog, and then asked me to delete a letter or check the source of a letter, I have no energy to look. sorry.
1, when the thought of a people, cool hand from the tip of the heart, this is why?
one, do not you let Zhesi hurt the temper friends. Second, your attitude to be adjusted.
hhhhhhhhhhhhhh
2, I was 25, has been single blind from the age of 23, compared with the no feeling. Earlier this year class reunion, hit my hour crush of boys (like him for 3 years, he did not know that we are rarely the kind of talk), after He joined my QQ, I was a bit agitated, and offered to his phone, he never spoke to me on QQ, and he wanted to declare (for so many years still have feelings). and my friend said, he asked me not to nerve, and now I'm cool with a lot, I think I actually do not know that he, and he estimated that his girlfriend, and, if he knew someone like him for so many years, he must proud Debu okay, if he my classmate said, I Mo Lianxian person (like him these things, nobody knows). hey, intimate activities, and recently, I really want to find like, do not want to casually improvise.
know some people like normal people own for many years, the first feeling of surprise, the second sense of joy, feeling worried about the third, fourth fifth after the first N is possible to feel proud of, so you do not like him so wretched, and without him tell the truth, let the good feelings that point in the past deposited it in the years to come, can not have an idea will become reality. now continue to look for a man blind date, this has not got the idea for the person you hold back of the head, you will get more confident and happy.
hhhhhhhhhhhhhhhhhhhh
3, I work in the county-level city, was admitted to the civil service two years ago, 2 months ago was introduced to one person, references only to the city planning bureau said that he had to go to work, after inadvertently learned that he has only a temporary. when there is a sense of being cheated. He was graduated from college, when I wanted to test public institutions also allocate it, did not think ten days before the exam, he almost did not review. He said all day no fairness in society today, these places must be default. I hate the attitude of his that escape. I said if you pass the test, I do not want you. He hypocritical to say that you can choose others But you must decide by September. was cold in my heart bursts. After all the talk, I forgive him. He said he will work hard words, but less than two hours daily reading time, soon before exams two days even Director of the Office to travel with them to go. call the night before exams, said some apprehension, I said okay, you have a good go. He did not do everything himself said, adding that even these ten days are enough to test into a good review. Results surprisingly he did not plan.
he began his 80% of the students did not assign their officers to give him a lot of overtime or something. well, Shun sister, he almost did not ask me decent meal, each second night out, he is eaten out, and then asked, times, I complained enough to eat, he said, Who told you that you do not want to eat ah. shun sister, should I break up with him?
excuse to give up social injustice who is also not ideal too lazy to struggle, even as he, like the fair society for nothing, without him, unhealthy mentality, go where no future. He is no alternative for you stingy, a number of temporary workers to pay? As for whether or not to break up with him, do not ask me, ask your heart, if you think you can not do without him, even if he is a beggar, and you can call him into your home.
hhhhhhhhhhhhhhhh
4, her boyfriend had terminal cancer, is now only 2 good friends know. He will not let his parents know, afraid of the burden to their parents to find. both of us know a friend's blind date, contact time is not long, each is recognized each other, feeling bad, is determined to marry each other. He check 2 weeks ago out the disease, and now he has low self-esteem, just wait for death. He broke it, I do not want to delay. Now he does not pick up my phone, and he basically can not change things approved. I think as a good friend accompany the side to take care of, happy to accompany him through a. I also want to quietly told his parents, I do not know how I do it? time now hurry, afraid of delays in treatment of disease spread. He is 25 I 27.
have cancer or have to let this thing his parents know that their parents can not stand the sudden death, might as well tell the parents to let their loved ones to accept the reality a little bit. If diagnosed and really late, but his family was very general, the treatment to avoid the bar, keep alive people who were not saved drag on death, love is the real love of his family home, so I understand his approach. but he should be very low self-esteem, you should persuade him to conform to God, to relax the face, in the life Finally, a length of the journey to meet their wishes as much as possible. Do you want to accompany him to finish his last time, no problem, just let him accept your kindness, multi persuade him, even after the departure of breaking up is his thing, now Why hurry to separate it. could die, is our pursuit, try to do it.
hhhhhhhhhhhhhhhh
5, my baby is in May, and I also unemployed, looking for work have to baby to the grandmother's home field, to take care of the baby must stay at home, choose so hard ah. Shun Shun sister If you, how do you choose? Also since my body weight after production has soared by 30 pounds, what weight loss along sister What coup?
grandchildren if the grandmother is willing to accept, then send your good work, and so her children back from kindergarten point. If the grandmother is not very willing to grandchildren, you will find a reliable nanny to look after children, now, women have to go out and work will not affect the status of your family. Speaking of weight, not only 狠招 coup: try to eat less, exercise as much as possible.
hhhhhhhhhhhhhhhh
6, 2005 I had just attended her boyfriend After postgraduate examinations, when the results did not come out, we apply for the same company and became co-workers. did not work in March, he went to school, we also identified the relationship between male and female friends, but his parents do not agree with us, very firm attitude. They I think working in Beijing, his family was not good. boyfriend wanted me to meet the shortfall through increased own. In the encouragement of her boyfriend, and I took the test three times a graduate student studying so hard for three years, did not succeed. postgraduate her boyfriend after graduation, 08 years and was admitted to a national civil service, his parents do not agree that we got married, I feel the pressure of life after marriage we will have a great hope that he find a job stability, Beijing is a good account or family woman. I'm 28, and my parents for my marriage hurry. My boyfriend and I lived together, exchange the years, I have two flows. her boyfriend under the pressure of his parents, very difficult, and I had a big fight with his father. I very much like to hear from you views on this matter!
you and widening the gap between him, for I was his parents, I would not be happy your marriage. you told his father, an argument? for I am his father and mother for, this does not make you the door. his parents pamper their children and did not want his son because his wife was home and personal conditions of drag, which is the normal state of mind for parents, you and replace what he terms it, your parents would object more intense, so you do not hate his parents, but also to hate and hate only did you find a backbone of the men, and you are too stubborn, knowing that people still live or die against Bu Songshou. Now you are asked for the 2nd miscarriage, know and each other's future is uncertain, you told him to continue living together, this is not asked for what is it? now and consider the break up, no parental support and recognition of the marriage, it is difficult to continue to operate the. find a good fit with who you are each other do not mind, live, is the basis for a happy marriage.
hhhhhhhhhhhhhhhh
7, I'm 28, tall good looks. and her husband quarrel too much the last two years, said a lot of harm to each other's words. I want a divorce , but considering the reality, he is about 70 million annual income, we have the year-old children. friends advised me not to impulse, give and take, and I thought hard, and sometimes want to forgive him, and sometimes very angry. He is the kind of mouth does not speak choice of words, it hurt self-esteem, often offend others. We had no deep feelings, because he after me, then he told me well and just like him. when he was working a year tens of thousands, of people long was also very general, family members do not agree. I thought he would have been good to me, but his temper to a decent life are not confused, he repeated temper tantrums and always fierce look absolutely shattered, although not manipulated, but I also Some became hysterical, was feeling very bad. In fact, he is good to me, money is also generous to me with, but did not let me pipe, this is my heart, bought a house years after his income to keep him own account, but also lend friends.
quarreling recently divorced, and he only willing to give about one-fifth of the money. shun sister you said, I continue to be with him, with his money, my days (After the big deal less to meet their play their work,) by the point of gas; or divorced, took so little money to go, plan a happy? or can be a lawsuit, but I do not want to fight this for the money. The most important thing is children, my family no one to help me with, our only pick him to school, and children to him, I can not bear. I live to continue, or a break?
love has broken, barely scrape together and boring. but you now can give a divorce, but could not prepare his day out with people, do not force you to divorce, got hit with sooner or later, as we take the initiative to give up good. marital property is to be divided equally, he does not want to give you the number of you how much more should be on the court for the money, because you have to raise children, money can hire someone to help you kids thing.
hhhhhhhhhhhhhh
8, he was six years older than me (I 29), sixty-seven before the year (when I have a boyfriend), he is my husband's former colleagues, only seen a few faces (can see a good impression on me), no close friends, and then no longer have any contact. half months ago, I mentioned relatives him, I hesitated, but his parents think he in good condition in all aspects, encouraged me to meet, I agreed. afterwards he said that because I know before agreeing to see. for although he is not understood, but the impression has been good, so want to try to make good contacts, perhaps really fate. Today has been a half months along, feeling not very good. from the blind date that day until today, he did not about I've eaten a meal, each about I always had dinner sixty-seven point, for the first time with I rolled to a nearby park, then a few were sitting downstairs in my home area to chat. This is also called a date? Then he asked me, I have an excuse not to go. I think he may be not interested in me not the nerve to say. But he also said short message in a few years ago, like me, because I had a boyfriend did not tell the truth, said cherish this opportunity, and I want to make good contacts, saying that if I could marry him, and he will love I'll never, never change anything.
I get dizzy by him. relations that her mother was a young man before her and divorce and irritation, plus the time is menopause, leading to mental disorders, behavioral radical. because the love his son so that my son must go through the object communication she agreed, before a lot of contacts have been wrecked his mother, but his evaluation of the outside world good. blind date the day his mother also, and I would quite satisfied, but also, and introduced like I said, I hope our good benefits, early marriage. surface, she did not see anything unusual. sister, there is such a mother I can marry it? after the wedding will not be affected ah?
appointments must go Restaurant? I think not. However, if he deliberately points the wrong meals, rather some other time and keep them with you to eat, can only mean that you do not have confidence, do not want to spend a dime on you. The other, a man vows are just words, you can do it personally, but not take it seriously, otherwise you are stupid fork. As for his mother's problems, just see the side, as long as you do not look particularly different, the performance of special arrogance, people will say satisfied, you do not when their own better than other girls, before allowing his family to accept such a cool, his mother, and you really just kind under the introducer. If the legend of his mother with mental illness, and wrecked His love many times, but this can not be easily provoke people, for I will tremble.
hhhhhhhhhhhhhhhh
9, due to past ignorance, did a curettage, and her boyfriend are now very good, exchanges more than a month have marriage plans. I think he can accept I am not at, but surgery will not be accepted. read online that the young man has done this surgery the doctor will see that child, would shun it true? how to deal with such a thing? boyfriend how to say I do not have? I was very self-blame, and along Do not blame me too K, ah.
I'm not a gynecologist for a second house did not scratch, it is difficult to answer this problem. But like I said N times you do not remember a word, it makes me so angry mm whether curettage, is a virgin, that is your personal privacy, why should tell your boyfriend? if he found the marriage, turn, and then to break up too late, not that guy with a pretentious feudal breakup dates can not grasp you, you will sooner or later points when you was not afraid to point out.
hhhhhhhhhhhhhh
10, Male Dr. Reading 33 foreign countries, female 30, housewife, married for five years and a daughter 2 years old. male and female character not and, men and women harshly intolerant of disrespect, bullying, big and small have him call the shots, frequently because of small snapped the woman. When children surface is also angry with impunity and even threw things around. but no man having an affair, love child. Accompanying women quit because of domestic stability, due to professional issues in a foreign country is unlikely to find a job. is suffering women in a dilemma: it can not bear men the spirit of violence, consciously has lost direction in life and fun, leading a difficult life, and worry about the man so long, the adverse mental health of children; but if a divorce with children to return, but also worried about the growth of divorce on children adversely, and future children education, health, houses and other issues. Dear Shun Yes, women go from here?
tell you to read along with the way her mother to see their children go abroad, you first return to work, resulting in de facto separation, or make you think men have the opportunity to Next, you did this So now no mention of divorce, the divorce because you have not prepared well: at least they have to economic self-reliance, personal independence, and to leave the firm.
hhhhhhhhhhhhhh
11, I am 28, her boyfriend than me in January, exchanges 3 years, I gave up my love for his work to his side. His temper is not good, but also less likely to care about people, but a good heart, and other problems similar to ah, and so I do not matter home. But the three exchanges years, he also wants to marry me, I did not feel safe, because he did sell, to drink in the evening to accompany clients to accompany agents, they do not eat at home, always home late, they go places There are Miss, I am particularly sad. He always said it was his job, in fact, I know that he has been accustomed to that kind of life, and I just do not understand the evening sales have to do? While it is also really love a lot of customers play, but I think this is not necessary, but to be honest I do not have much confidence on her boyfriend because he could not restrain myself. He said that Miss KTV is a picture of the skin. I believe his heart filled with me, because at home He was sticking me, but I still can not accept his life, he did not come home, I can not sleep, do not know what he was doing, did not dare to call, after all, a man out socializing, I would always call let him lose face, bored.
every afternoon so I am very nervous at night if he was home, I will be very happy, if not at home, I was entangled. I had also checked his phone records, have my that ambiguous messages and telephone calls, but not a long period of time to contact, for some time gone. Shun Shun sister, I do not like this kind of life, but love him, and he also wants to marry me, urging me several times I now how to do it?
since his work requires frequent visits to the brothels place, you may wish to have him think of stained sludge in the Oil Stick N times as long as you love him, you forget about him love and fate, every time entertainment when he is right to support the tertiary industry, and protective measures you do, do not be transmitted to strike and less like how can he maintain chastity in sensual pleasures. You did not like him work environment, and he brings you the mind, but you like for him, since no ability reluctantly must sell yourself, then adhere to bite it. In addition, no alternative to the Who told you your guts, have to follow He?
hhhhhhhhhhhhhhhhhh
12, hesitated for a long time, the discovery of cheating ex-husband again, the firm divorce, under the impulse of the households selected purification. never puts down his daughter after the divorce, her ex-husband can not do with her. daughter I single-handedly brought up, always wanted to give her a warm home. remarry her ex-husband asked, and begged me to stay home temporarily, to give both sides a chance. Shun Shun sister, you said good Never look back, and both sides hope all friends and relatives to remarry (her ex-husband in the marital good to me and the children, divorce is derailed by her ex-husband) I am confused, how to take the next road?
sincerity make him point out, if you want to continue to live child care at home, then give you the fortune of his own purification from households. How can you Lingzui he derailed the?
hhhhhhhhhhhhhhhhhh
13, I'm 27 female, 26, and she had a relationship. We are university students, junior and began dating, and now the first five years in a row. before the 1 year we get along quite well, whether or live chat, then slowly she seemed aloof to me, she has a very strong post-graduate program to request and I broke up, I am strongly recovered. Later 2 years every time we fight, whether it is her that she was wrong, I always take the initiative to admit mistakes, I think men should let women can fight as long as I do not take the initiative to go after her , she does not find me. And every time she does not leave me back home the basic message to the phone, do not ignore me, but if we met, she and I are all very happy. Now to work, evening telephone SMS is gone, I do not know is broken up with her or what? Shun sister of how she helped me look at our feelings?
this girl now and you two do? If so, you basically had no future. If you city, she also never take the initiative to contact you, or even lose a separate message, it means she has someone else. In short, she is not very optimistic about you, she is currently not a break with you completely, because half past one would Shuaibu Diao you and the man she did not want to give her Zhunxin.
hhhhhhhhhhhhhh
14, an unmarried female colleagues, non-married male looking for friends, a married man's wife notified his family, is invalid. This woman said: is to it! times create conflicts, so that the couple angry. Look here not leave, unmarried women also looking for other men making fake chat, framing his wife married men. After watching her husband, actually believe it. Faced with this rush do not run , tyranny does not matter what the third, how do?
the existence of such a brutal three, but it is still the attitude of men, a man from now on if you no longer pay any attention to her, call screening, net chat stop do not talk to each other to meet, in any case ignored her, how can she toss? problem is that men like you and her brother, sister, ambiguous, and you would not wipe the following sub-men to offend her and she was willing to hurt your feelings So, you want to hate a man to blame is you and blame you hate a man my son. is inseparable from them, then separate it to you and your man, someone very cumbersome management, control their own much easier, and you try your This can take the initiative to put down the dirty men and women do, if, you did not upset the.
hhhhhhhhhhhhhhhh
15, I ran three more than three years of marriage. LG a nice guy, and I love him, he did not understand the romantic , living dull day, go home from work, really boring. now appears in the work of one man, forty years, funny cute. I did not love his sense of his ambiguous nor too seriously, but liked and his chat. very confused, I do not know whether to keep him at distance. prevailing fear of sinking in the hope of coaching me along to look at.
ambiguous and do not want to find colleagues ah, you'd better consider the following consequences: once to the other colleagues know you a little whatever, who will see you high? not Xialiao, the men and women is a talk on the fiery, to avoid really derailed, or exterminate first ambiguous heart is better.
hhhhhhhhhhhhhhhh
16, female 26, Teachers College as a teacher in the secondary cities. a small language, bachelor's degree. The school requires further study, individuals feel that China's ability to enhance the graduate education of little help, no need to read. not to mention teaching the two In addition, individuals can do that for. In this small town, the age for a major, surrounded by married people, and I became heterogeneous. can not be reconciled, that capacity should not be in a small place by fooling around. Now that the working life is a mess. each school day speaking the same content, it is boring, wages are low. dear old problem, do not see eye. Zengyin pressure and try to have a relationship with a male and feel more pain, and finally let go. summarized reasons, the town considered a good income, and then look up, it is difficult, therefore more to leave. This idea has been many people opposed on the grounds that university teachers of the girls is the most suitable job, working hard to find outside, not be able to break out get out; older, married to the most pressing tasks. personal character undecided, so it flies quite painful.
battles if you want to go out, it should further studies Well, with a postgraduate degree, after you have quit benefits. And who is more experienced, the greater the capital when it is more likely to screw up, their battles away from home. graduate school does not delay seeking a partner for marriage run into, do not touch the first one was on Anyway, since the schools require you to studies, you should take the opportunity to fullness under myself.
hhhhhhhhhhhhhhhh
17, I am 32 years old, nothing, done a few years after graduating from foreign trade, not a success, hard work alone outside It is not for me to return home a small town in Jiangxi mm I've tried various jobs, from small hardware store clerk to clerk typist to the factory, I even did the garment workers, but do not long for each work. I thought the problem was not my own, but really can not change themselves, my parents divorced early, stay in the shadow of my heart, and now his mother retired, she has been blaming me for nothing, I have no power to change this She questioned my age in his hometown of the NPC have been married, and now if I find the object in the home, only to find conditions much lower than I am, I really do not know how to do.
your question adhere to finish off is never one thing, no longer of a good report card is very difficult, after all, not everyone is lucky to be able to stand a short time, can also be pie in the sky fall Zazhuo. Now problem solving marital problems did not work, you must first attach importance to matters, work must concentrate on, and must adhere to do one thing well, you just may develop, and development of the direct benefit is that you do not have a good marriage can survive . As for looking for a man, as long as the hit themselves tempted to do stressed conditions, and if the conditions for your own good, you will not be until now Well, not only so, may wish to study only one aspect of a man is not what you need , so much like to marry.
hhhhhhhhhhhhhhhhhh
18, My boyfriend and I just love when he say what words are, like in the future want to marry me, love my life like that. with time, we has been almost a year. Now his work, and I mention those words, he contradicts me. always said previously before this is now. quarreled several times to break up when he said, adding that his focus is now the cause of , in love or not does not matter. afterwards gave me that in a fit of anger about what he can say. Every time I talk about and fight is, no matter who is right. listen to Shun Shun, I did not tell him ML. peacetime He is also very good with me, but how is not a separate. said in the total count will be forgotten. Please Shun Shun taught me how to do to make me re-gain the upper hand in this love, then?
You basically can not possibly gain the upper hand again, because you took him as your whole world, he only take you when he was a small part of, as long as you do not have the courage you have him reduced to a small part of you always no chance to prevail, and let him chase you stick to you. Remember, a man chasing a woman, said that the words are nonsense, a gust of wind came on the wind in, and can not imagine a fart is always shrouded in around you. like love my life, , college graduates have been in the hospital for three years. love for two years, different city, a place in the male female intern. have met with parents, but both parents have not seen. in the male counterparts in the small town can not find the medical work, women home work before graduation, the clinic workers in January. women back, the male parent to incite men, say a place, how to be afraid of the future. women here have been told. women felt they were long hours with not a thing, resign to run It came to the men, said to be diverted, no matter what as long as the two together, you can adhere to the anti-stress. Women have no confidence in the future of marriage, fear of long points, and male and his parents do not mention marriage. F has for the first time to the male, was worried. would like to insist on his way to the marriage. Men think that women have just recently graduated, do not be diverted, or a good doctor, physician license exam next year, consider getting married. women fear this is an excuse for his , nay. Female teachers in here looking for a job, also signed the contract, that the men would not be opposed. but the man insisted she should not stay here diverted to the Bank made her home.
Female very sad, that men in the drive her away. men that just work for her consideration. Women now can not tell he is really good for her, or do not want to charge. women know that their work should be home doing a good job, that is my heart not understand what her boyfriend is not doing everything possible to be together? who first separated it. women are running, and also so cruel to her back. Women think he is selfish and arbitrary. men think women do not understand his ideas, as long as the love that can not be Do not bread, and said all this for you. Soon, you talk sense to me, afraid of such a return, and after his unlikely marriage, and do not want to marry with other people ah.
work is their own , the future is your own, you have to throw your own, partial to him to give you your future, but he promised not afford, but also can not bear, so he had to rush you home. you, the Shade SOUL.
hhhhhhhhhhhhhhhh
20, I know with her boyfriend to live together in 2008, intends to obtain a permit married in 2009, but my heart is very contradictory, because in the end I'm sure he loved me. I 85 his 80's, We know through the network, from the understanding that the plain old married couple now live a day, but I would be flat, I was a heavy feeling, even if he is too proud a man not fun, as long as he loves me, I am willing followed him. just when he was with a few back with the others I found ambiguous, I forgave him because I knew that he did not really like me, has not yet found me, not to mention love, but I hold a state of mind, to do himself, he will fall in love with me. He explained that Internet addiction through the mouth, did not it personally. I believed him, but later he gradually was I found that every time I say to him communication, because I think quarrel not solve the problem, but he choose to escape, and I do not want to take to solve the problem, it is so, it passed no problem, and I, in his mind is a very good woman.
We are now feeling it considered very stable, but he really is a love affair, man, I analyze his occasional but not with others deliberately ambiguous, and he really likes the opportunity to others. In the past he has not found me, I have can understand him, to now he can make the same mistake, but he is getting better for me, I can still feel it. I am very contradictory and would like to confirm whether he really love me, fish along sister, a any way to help me ah?
he is the north, I am Cantonese, I usually wake up before going to bed would have asked him to kiss me about a few months later, he occasionally will forget, and I said, pretending to get angry He did not got the idea, but he complained that they are not popular so that parents generation did not like, do not still came up and said to him every day, is the need to remember that process takes time. I think this is an excuse, I know that he loves his first love. He told me that before he goes to work every day so his girlfriend and then Guangyi Xia, can at me, these have become troublesome.
on the recent, and I found His dialogue with a woman online, he said to the woman he loved no one except no love, he said he was hurt, has been unable to love any person, including the current me. He said in addition to talk about feelings What can be done with her, dating, sex and so on. boyfriend also said to the woman, I am a good woman, he is responsible for me, because my boyfriend work needs to go to Guangzhou for some time, he even called it Nvwang past , anyway, said a lot of hurt me, and said he once knew a woman, lonely when contact is not talking about feelings, and later married the woman no connection to it. Later I asked him how, he explained that only Nonsense, it totally did not mean, anyway, to continue to quibble just a mouth that there was no real action. and I ...
Thursday, February 24, 2011
Eye on Health 6.6 Sohu Interview
Professor Chen Youxin Sohu Health Channel about age-related macular degeneration prevention
Sohu health: you friends, good afternoon! Welcome to the Sohu interview between healthy.
On June 6 at the National Eye approaching, we Sohu is honored to have a healthy Beijing Union Medical College Hospital, Professor Chen Youxin guest expert interviews, the talk with netizens on the age-related macular degeneration eye disease that terrible.
as the science improves, the more we learn for the eyes and more clear, eye protection and eye diseases are increasingly concerned about the high 70's is our most well-known red eyes, we know the age of 80 cataracts, glaucoma 90 years we have learned, one after another blinding eye disease under control. Now, macular degeneration, eye health has become the main reason affecting the elderly, but the general public awareness of this disease is very limited, on the one hand do not pay attention after the other, I do not know how sick the correct treatment. am very pleased to have invited Professor Chen Youxin between a guest expert interview with netizens talk about prevention and treatment of this disease.
first of Professor Chen with friends to say hello.
Chen Youxin: Honourable friends, good afternoon! very pleased to meet with you friends.
Beijing Union Medical College Hospital Professor Chen Youxin
Sohu health: I simply tell you about Professor Chen Youxin. Professor Chen Youxin as deputy director of Beijing Union Medical College Hospital Department of Ophthalmology, Chinese Medical Association Ophthalmology Branch Secretary of the Chinese Medical Association Ophthalmological Society, vice chairman of the Youth Committee of the Chinese Medical Association Eye Doctor Association member and Director-General. focus on a variety of common and difficult diagnosis and treatment of ocular fundus, such as various retinal vascular diseases such as diabetic retinopathy, central retinal vein occlusion and other laser and surgical treatment of polypoidal choroidal vasculopathy, retinal vascular tumor-like hyperplasia diagnosis and treatment of diseases, age-related macular degeneration photodynamic therapy, intraocular tumor and the diagnosis and treatment of retinal degenerative diseases. photodynamic therapy carried out in recent years as the choroid the treatment of angiogenesis provides a new treatment, and achieved good results.
age-related macular degeneration will be the main cause of blindness
Sohu health: the beginning of interviews, first give us Professor Chen , what is age-related macular degeneration, or age-related macular degeneration is called.
Chen Youxin: Thank Sohu health to provide such a platform, on June 6 at the National Eye draws near, more and more people concerned about the eyes, and I personally think that life outside of visual function is in addition to the second most important function of the human body, if a person lives in darkness, not only their own lives can not take care of themselves, but also troublesome to others, the pain is unimaginable, about 80% of our information is through the visual organ, the eye is obtained, if the information society in the loss of vision, loss is so big.
interview subject today as the ;, the subject is very good, has just introduced the presenters, in the 20th century, before the 80's or 80's, in the case of the Chinese economy is relatively backward, some infectious diseases are more like the past, trachoma, with the social and economic development, has now been well controlled. The second is glaucoma and cataract, particularly cataract, until now, cataract remains the major eye diseases in our country, but the treatment of cataract is developing rapidly these years, we call preventable or curable blindness blind, Why? as long as we go to the hospital, there is capacity to pay, the eye lens can be replaced, they can improve the vision of cataract patients is high.
example, the human body eyes like a camera, and now it can change the lens, but the film, which is now no technical replacement of the retina, such as macular degeneration and other retinal diseases, the retina can not be transplanted, the means of treatment is relatively limited, so age-related macular degeneration has become a major cause of blindness, particularly in Europe and the United States. Although our national age-related macular degeneration is not currently a major cause of blindness, but we should take precautions, prevention is critical, good will from now on attention to this disease.
What is age-related macular degeneration? the name suggests, with the age-related, increase in prevalence with age, increasing year by year, there were reports that people over the age of 50 the prevalence may be a few percent to the age of 60, 70, 80 years old, even to the more than ten per cent, three dozen, so called age-related macular degeneration.
Sohu Health: Can you explain the role of macula in the eye it?
Chen Youxin: the center of a retina of the eye called the macular region, why is it called macular area? because the region which contains a lot of lutein, lutein is yellow, making the region a little yellow color, in particular, In the pathological point of view, so called the macula.
macular center about 500 microns in diameter, the body of the most important part of a visual function. macular degeneration is precisely the center or near the macular region of the degenerative diseases, mainly referring to is bleeding, oozing, edema, scars, etc..
patients with macular degeneration will cause physical and psychological health of the dual pressures of
Sohu: In the event of macular degeneration after which the person will have symptoms? what is the harm?
Chen Youxin: age-related macular degeneration or age-related macular degeneration is called the Western main reason of blindness, so the disease can be blinding, the first symptoms, many patients are visual distortion, and suddenly things do not look straight, look at distorted vision. especially as some elderly people like to read, to see just do not see that word, appears in the middle of the shadow of the visual, the shadow with hemorrhage, edema area relationship, if the area is small, the shadow of the scope of a small, if a large range of bleeding, or edema, scar a large range, and ultimately, blindness, so the damage is very great.
Sohu health: blind since the quality of life will be greatly affected.
Chen Youxin: research in this area in a foreign country is very much lagging behind some of our home, it is mainly because our economy was not as developed countries are now more concerned about the cataract, while the age-related macular degeneration is not too much concern, in fact, the disease impact on quality of life is very large.
first, loss of self-care ability, a lot of elderly people learn to drive, but was more than 60 years of age-related macular degeneration, can not drive, and if children can not help him to more difficult, and even the streets are difficult. at home cooking, and even the label on the bottle condiment see clearly, Kit could not see the word, the morning milk may be poured down on the table, because the want to see to the place just can not see. this regard, we have seen. elderly already osteoporosis, easy to wrestling fractures because not clear, wrestling and fracture more easily.
also psychologically, as we met with some intellectuals, a lifetime reading, now suddenly can not read, a strong psychological sense of loss. It is reported that the elderly macular degeneration macular degeneration than those without the prevalence of depression in the elderly increased significantly.
many young people so we can not feel the pain after the elderly sick, feel, eat drink on the line. this regard, I want to appeal to children and grandchildren or the children do, to understand the parents or grandparents visual health, suffering from macular degeneration if they should be given more help, and even psychological help.
age-related macular degeneration urgent attention
Sohu health: an introduction by Professor Chen, we can understand the age related macular degeneration, or damage caused by a very large, you can not talk about the disease incidence in our country now is how like? is not more easy to get older?
Chen Youxin: In our country, Like diabetes in the sixties and seventies of last century had very little, but now very much, and why? and lifestyle have a certain relationship, and now studies with the diet, eat fewer fruits and vegetables on, coupled with no exercise, obesity, etc. , the incidence rate of high.
age-related macular degeneration is not a disease peculiar to the West, the Chinese people will have, we have a very famous study was done in Guangdong, the early 90s is probably age-related macular degeneration 3% -4%, to 1998 to 8% -9%, equivalent to double, so the problem must be brought to pay attention, the same people with the improvement of living standards among the incidence rates increased, and the large population in China , a small percentage, multiplied by China's 1.3 billion population, is an astronomical figure, so the age-related macular degeneration of the hazards and impact on society must not be ignored.
Sohu health: and as our national social gerontology of the increase, the incidence rate will increase.
Chen Youxin: Of course, our standard of living improves, the level of improved medical care, treatment capacity increase, and now the average life expectancy of the population, our country has entered an aging society, the elderly population increased substantially. coupled with the incidence of macular degeneration is improving, and I believe the number of patients with age-related macular degeneration is increasing year by year.
Sohu health: morbidity and growth rate so high, everyone's perception is still relatively low.
Chen Youxin: I wrote an article published in , Why mention this? as mentioned earlier, the age-related macular degeneration great harm to society in Western countries is the primary cause of blindness in Europe, Australia, the United States, which accounts for medical expenses is fairly large proportion of , alarming figures, it must pay close attention.
more than the population of our country, macular degeneration has gradually increased each year, so we must attach great importance to, and now can cure cataracts, age-related macular degeneration but are difficult to resolve, especially to the in late, so the social awareness must be improved. We have a random survey of 50 people in the clinic, even the eye of the nurse can not tell what is macular degeneration, and its risk factors which can well imagine that our society For ordinary people, age-related macular degeneration, awareness is low, you ask him what is cataract, know, what is glaucoma, know something, know what is macular degeneration? do not know, so we called for urgent improvement To step up publicity efforts.
Sohu health: young people are not sick, is not it relatively small?
Chen Youxin: We are formerly known as age-related macular degeneration, was found to have 50 years of age or 45 years of age will suffer disease, but they are not old, so now it is called age-related macular degeneration, and found that younger age of onset of his trends, like hypertension and myocardial infarction, who have over the past six or seven years old, and now four more than ten years old myocardial infarction, and lifestyle have a certain relationship.
But if a teenager, two-year-old macular hemorrhage occurs, we do not usually referred to as age-related macular degeneration, idiopathic choroidal called foreign neovascularization, we Chinese call central exudative chorioretinopathy (referred to as
Sohu health: but the harm caused is the same.
Chen Youxin: visual impact, or even blindness, this is the same, but also from the treatment point of view, there are also many similarities between
smoking high cholesterol is age-related macular degeneration certainly incentive
Sohu health: disease caused by reasons for the growth now what? what people may have these diseases?
Chen Youxin: just you ask the incidence of age-related macular degeneration causes cause of two points.
the one hand, from 05 onwards, the study of foreign genes and age-related macular degeneration relationship, probably two or three genes found in the relatively positive relationship with macular degeneration, so that if you had macular degeneration, your odds of higher prevalence of family members, especially on the 40 years of age, eyes should check a couple of years, this is a good thing. Secondly, the age-related macular degeneration has a relationship with the race, whites than in yellow, high incidence of some of the black race. There are overseas research, more women than men. the gender, race, heredity, we can not change is inevitable factor.
the other hand, found several important risk factors can be changed. First, smoking, relatively fast paced society today, we sometimes in order to ease the pressure to smoke, but if you smoke, macular degeneration, the probability of illness at least twice the size. A second obesity, high cholesterol, which is more positive. These articles can be controlled by lifestyle changes. There, now advocate a balanced diet, not to say that eating fruits and vegetables all day, but also meat eating species To many, more to be able to ensure intake of various nutrients, in particular, eat more vegetables and fruits, as vegetables, fruits, rich in chlorophyll, zeaxanthin, lycopene, vitamin C, etc., such things have antioxidant function. now there is a theory, age-related macular degeneration is caused by over-oxidation of the macular area of chronic cell injury.
so I do not smoke, balanced diet, eat more fruits and vegetables, not too fat, no high cholesterol, Of course, eye protection should also pay attention all day long at the computer screen, or front of relatively strong light, ten hours sitting down must be bad, so open the computer as a lesson, recess should be rest.
brought photodynamic therapy treatment of macular degeneration in the spring
Sohu health: we've talked about early detection and identification of the problem, then probably we are more concerned about is the present performance of age-related macular changes can not be cured, what treatment do now?
Chen Youxin: In the past there is no good treatment, but did not explore the footsteps of the moment to stop, explore the 80s of last century laser treatment, macular degeneration that would otherwise cause blindness, by laser Vision therapy can be maintained to 0.1 or 0.2 or 0.05, better than the blind. That is what the laser greatest harm? laser is a thermal burns, eyebrows and beard grabbed, the normal tissues and vascular leakage and burned, but only this time kinds of ways.
to 90 years there is a contrast, called indocyanine green angiography, the angiography as a blood vessels nourish the center of the macular area is not, we will cut off the roots, to nourish the blood vessel destruction, extermination, no breeding of blood vessels, neovascularization atrophied. But if the blood vessels nourishing the best in the center of the macular area, damage is relatively large.
to the late 90s, there has been TTT, transpupillary thermotherapy is called, the equivalent of physical therapy, macular laser do not use heat, then increase the temperature slightly, 5 to 10 degrees, inspire some Heat shock protein protection, so that the surrounding normal tissue is protected, and neovascularization gradually destroyed, so they further protect normal tissue, making new blood vessels slowly shrink, eliminate leakage edema, which in turn is a major step forward .
then the 2000, I wrote in 2007 an article called Total rate of photodynamic therapy, which is a milestone, which makes our doctors may exceed the restricted area is a restricted area over the past macula, macular disease in the past that only four words, The mess does not make sense.
now appears photodynamic therapy, can selectively destroy abnormal new blood vessels. abnormal vessels like fake blood, and now we can put this fake After the circulation to the eye, and then use a special laser, this laser does not produce any heat, called cold laser, or called non-thermal laser, when this laser and our neovascularization after the contact interaction of photosensitizer molecules produced photochemical effect, making blood vessels closed, the last generation of vascular thrombosis, some of the methods are more expensive, but there is no way better than good, so we have a way to treatment. We often joke, vision loss is priceless, but no matter how much money, long as they can cure the disease, is always a way, so we are very happy, and now the patients after 2000, in which there has been a lucky misfortune is because of photodynamic therapy.
the safety of photodynamic therapy Note
Sohu sex and health: photodynamic therapy for visual acuity is not affected?
Chen Youxin: photodynamic therapy in our hospital have done 7 years, the biggest advantage is safety, estimates that the do in the world more than 200 million, enough to prove its safety, in addition to elimination of abnormal blood vessels, stable vision, we do clinical trials found that, in addition to be able to maintain stable vision for most patients, there are about 30% of patients will improve visual acuity . This method is safe, no toxic side effects, is a good way.
Sohu health: just talked about some of macular degeneration, new blood vessels out, which is what?
Chen Youxin: abnormal blood vessels is a fake shop is harmful to beneficial.
Sohu health: effect of early treatment is better?
Chen Youxin: or repetition of the phrase, see a doctor to take the early, so we must first have awareness of macular degeneration, the elderly can easily too. Second, the periodic inspections. Third, that to treat the disease early.
I just said that the treatment of the development process, both large and medium cities across the country photodynamic therapy for macular degeneration include high myopia caused in permeability caused by various causes, like disease similar to macular degeneration, can be treated through this therapy to really reduce the swelling proved to be stable, to protect our eyesight.
Sohu health: patients need after treatment Note what?
Chen Youxin: photodynamic therapy is that, less than 20 minutes the entire treatment process, treatment should be prepared the day of sunglasses, long-sleeved clothes, the best hats, gloves, because the photosensitizer to light to decomposition, in particular, a large sun in summer, when sunlight to prevent the occurrence of interaction with the photosensitizer, the skin burns. generally faster down the mountain when the sun do better treatment, done after 48 hours to avoid glare.
Sohu Health : no problem lighting up?
Chen Youxin: general home lighting, incandescent or fluorescent lamps are still possible, but I suggest try a little dark, lamp is better, anyway, two days after a 48 hours to recover. < br> choice of treatment must be clear before Sohu health condition
: Speaking of the treatment of diseases, there are a number of breakthroughs and progress, and also made a relatively good effect, for the treatment of macular degeneration, now what are the problems, there is no it? example, we have emphasized disease, standard treatment.
Chen Youxin: I have to say is relatively simple, although we now have new treatments, but there are some differences between different doctor may get different results, why ? most important indications of the master, more professional and sophisticated macular degeneration, we want to know, I have some articles on the website, we can see.
first diagnosis of clear, clear your disease is age-related macular degeneration, or retinopathy, or retinal vascular proliferation, this must be determined before treatment, and try to figure out is late or early, and macular degeneration have the dry and wet points. the so-called dry macular degeneration, is the fundus also No new blood vessels, no bleeding, edema and scar formation, but there are some yellow macular dot calm things. but dry macular degeneration can develop into the wet. the so-called wet macular area is already bleeding, oozing, edema, or scar formation, and took part in the early wet just bleeding, and has been completely scarred, and not, like, so be sure to clear diagnosis before treatment.
Sohu health: So we have to choose hospital, clinic doctors when the need for more attention to some.
Chen Youxin: In any kind of treatment before the disease really want to find out the other, as the patient must also ask, do not blindly treatment because improper treatment may increase the injury. Now network is very developed, such as Sohu search for anything on a search to, what is age-related macular degeneration, I would like is some of the network. Also where can be treated and how treatment should be clear. So before treatment do some homework is good, do not believe one of the words, in some places called a cure macular degeneration is certainly not credible.
Sohu health: you can go to Professor Chen's personal web site have a look. Here we look at the problems some users it.
Professor Chen Youxin questions for on-site users
User: mother has macular degeneration two years ago, when I had a photodynamic therapy, good results, the disease does not develop, I feel very good, there is no second treatments, but the vision began to decline last year, is a decline in the future to do, or how to?
Chen Youxin: This is a very big problem, is a philosophical proposition, because people now have no control over the aging , the age-related macular degeneration is a disease in the aging process, and age-related, so do not have a way to completely cure, the treatment approach we are not a cure or a treatment table, so there may exist a treatment secondary treatment, three treatment, in a foreign country to do three times the average first year, twice a second year, third year to do it again, but the biggest advantage is that the treatment abroad can be covered by medical insurance. so do not expect everything will be fine once the treatment, which is not correct, we must constantly review, because there may be the first treatment.
friends: a few years ago my mother felt a shadow front sway, the check is cataract, but because of macular degeneration, is not it inoperable?
Chen Youxin: macular degeneration, if it is to late, do nothing approach, but still should be the treatment of cataract, and why? as macular degeneration, central vision loss is mainly done after treatment of cataracts may be slightly better peripheral vision, so I do cataract patients the time if I gave him, one o'clock is a good visual acuity improved slightly.
User: My mother had macular degeneration for three years, initially left eye, right eye and macular degeneration are serious this year, a sharp decline in visual acuity, according to Beijing every spring, have opened a Chinese medicine hospital taking little or no effect, I ask you to carry out photodynamic surgery?
Chen Youxin: First the first point, to be confirmed, some basic hospital because of equipment limitations, with little experience, may be misdiagnosed. it is proposed to go to large hospitals is not confirmed macular degeneration, to find out is dry, or wet the; second, macular degeneration does have a tendency to eyes, eyes can be a front and rear, left eye right eye had also entirely possible to be, just could not take Chinese medicine, especially at the less experienced Chinese medicine, or some other method should be adopted.
friends: I am a high degree of myopia, 500 eyes about some of the recent decline in sensory acuity, and sometimes feel the shadows, do not know if there is no serious problem, this is not need to go to hospital?
Chen Youxin: high myopia, we generally considered to be above 600 degrees is called myopia, high myopia of 500 degrees is not known, but 500 degrees is quite high Even people who forty-five Baidu myopia can sometimes get sick. so the eye shadow in front of fluttering if there is, it may be vitreous opacity, I suggest go to the hospital regularly look up eyes, look around the retina, there is no degeneration area even some patients with cleft, so patients with high myopia, periodic look up eyes.
Professor Chen Youxin recommendations for users their visits time
Moderator: Time is almost up, Professor Chen Youxin conclude our friends some suggestions, tell us about their visits another time.
Chen Youxin: either the patients themselves or relatives of patients or healthy subjects of interest, we must raise awareness of age-related macular degeneration, the disease is more common, so the state must pay close attention, especially at home have relatively large age of the parents, or grandparents aged relatively large, they often want to look up the eyes, hope that early detection, especially over 60 years, the incidence rate may high, it is necessary to raise awareness.
Second, if it is found they have a visual distortion or a front of a shadow, often alternating left and right eye closed, take a look and found that when these symptoms as soon as possible to the relatively large, qualified the hospital for examination, and sometimes not only ophthalmoscopy, but also have the inspection equipment to early detection.
found to be dry if the age-related macular degeneration, our advice is to eat more vegetables, fruits, go out Great to wear dark glasses sun, quit smoking, eat greasy food, maintain proper weight, but also added lutein, which is large-scale tests proved that the United States, if you added lutein, trace elements, vitamins, can a considerable number of people not to late development. for wet macular degeneration in elderly, to go to the hospital to take some formal method of modern technology, formal examination and treatment, such as photodynamic therapy. In addition, you can combine a number of anti-angiogenesis drugs, injection into the vitreous cavity, now more respected combination therapy, so a multi-pronged, often a treatment is not enough, various methods have their own advantages and disadvantages and complement each other, so that the best results .
Here I would like to stress that many elderly people their mobility, only to be filial sons and daughters of the heart, their information is not well-informed, do not know the disease can rule. Today, I tell you, can cure this disease, so Be sure to tell your family, and some people think that age-related macular degeneration can not rule, anyway, have been older, do not read, this is utterly wrong, the elderly but also the quality of life, can not see is very painful, life quality greatly reduced. macular degeneration will be able to treat, as long as the various methods with properly, can keep your vision steady, and this is confidence.
I work at the Beijing Union Medical College Hospital Department of Ophthalmology, every Monday, two, three out of the morning in Beijing Union Medical College Hospital out-patient, we can come to me at this time. In addition we can contact through my personal web page I, www.chenyouxin.haodf.com and chenyouxin010.blog.sohu.com, can leave a message mentioning some problems, as long as I have the time, basically every night, and sometimes even abroad can be answered.
Sohu Health: This concludes today's interview, thank you very much the concern of friends, and Professor Chen Youxin the visit, If you have any specific questions, one can log on Professor Chen Youxin personal website to ask questions, Sohu is also Professor Chen's blog, In addition, you can go to Beijing Union Medical College Hospital to find Professor Chen. Thank you!
Sohu health: you friends, good afternoon! Welcome to the Sohu interview between healthy.
On June 6 at the National Eye approaching, we Sohu is honored to have a healthy Beijing Union Medical College Hospital, Professor Chen Youxin guest expert interviews, the talk with netizens on the age-related macular degeneration eye disease that terrible.
as the science improves, the more we learn for the eyes and more clear, eye protection and eye diseases are increasingly concerned about the high 70's is our most well-known red eyes, we know the age of 80 cataracts, glaucoma 90 years we have learned, one after another blinding eye disease under control. Now, macular degeneration, eye health has become the main reason affecting the elderly, but the general public awareness of this disease is very limited, on the one hand do not pay attention after the other, I do not know how sick the correct treatment. am very pleased to have invited Professor Chen Youxin between a guest expert interview with netizens talk about prevention and treatment of this disease.
first of Professor Chen with friends to say hello.
Chen Youxin: Honourable friends, good afternoon! very pleased to meet with you friends.
Beijing Union Medical College Hospital Professor Chen Youxin
Sohu health: I simply tell you about Professor Chen Youxin. Professor Chen Youxin as deputy director of Beijing Union Medical College Hospital Department of Ophthalmology, Chinese Medical Association Ophthalmology Branch Secretary of the Chinese Medical Association Ophthalmological Society, vice chairman of the Youth Committee of the Chinese Medical Association Eye Doctor Association member and Director-General. focus on a variety of common and difficult diagnosis and treatment of ocular fundus, such as various retinal vascular diseases such as diabetic retinopathy, central retinal vein occlusion and other laser and surgical treatment of polypoidal choroidal vasculopathy, retinal vascular tumor-like hyperplasia diagnosis and treatment of diseases, age-related macular degeneration photodynamic therapy, intraocular tumor and the diagnosis and treatment of retinal degenerative diseases. photodynamic therapy carried out in recent years as the choroid the treatment of angiogenesis provides a new treatment, and achieved good results.
age-related macular degeneration will be the main cause of blindness
Sohu health: the beginning of interviews, first give us Professor Chen , what is age-related macular degeneration, or age-related macular degeneration is called.
Chen Youxin: Thank Sohu health to provide such a platform, on June 6 at the National Eye draws near, more and more people concerned about the eyes, and I personally think that life outside of visual function is in addition to the second most important function of the human body, if a person lives in darkness, not only their own lives can not take care of themselves, but also troublesome to others, the pain is unimaginable, about 80% of our information is through the visual organ, the eye is obtained, if the information society in the loss of vision, loss is so big.
interview subject today as the ;, the subject is very good, has just introduced the presenters, in the 20th century, before the 80's or 80's, in the case of the Chinese economy is relatively backward, some infectious diseases are more like the past, trachoma, with the social and economic development, has now been well controlled. The second is glaucoma and cataract, particularly cataract, until now, cataract remains the major eye diseases in our country, but the treatment of cataract is developing rapidly these years, we call preventable or curable blindness blind, Why? as long as we go to the hospital, there is capacity to pay, the eye lens can be replaced, they can improve the vision of cataract patients is high.
example, the human body eyes like a camera, and now it can change the lens, but the film, which is now no technical replacement of the retina, such as macular degeneration and other retinal diseases, the retina can not be transplanted, the means of treatment is relatively limited, so age-related macular degeneration has become a major cause of blindness, particularly in Europe and the United States. Although our national age-related macular degeneration is not currently a major cause of blindness, but we should take precautions, prevention is critical, good will from now on attention to this disease.
What is age-related macular degeneration? the name suggests, with the age-related, increase in prevalence with age, increasing year by year, there were reports that people over the age of 50 the prevalence may be a few percent to the age of 60, 70, 80 years old, even to the more than ten per cent, three dozen, so called age-related macular degeneration.
Sohu Health: Can you explain the role of macula in the eye it?
Chen Youxin: the center of a retina of the eye called the macular region, why is it called macular area? because the region which contains a lot of lutein, lutein is yellow, making the region a little yellow color, in particular, In the pathological point of view, so called the macula.
macular center about 500 microns in diameter, the body of the most important part of a visual function. macular degeneration is precisely the center or near the macular region of the degenerative diseases, mainly referring to is bleeding, oozing, edema, scars, etc..
patients with macular degeneration will cause physical and psychological health of the dual pressures of
Sohu: In the event of macular degeneration after which the person will have symptoms? what is the harm?
Chen Youxin: age-related macular degeneration or age-related macular degeneration is called the Western main reason of blindness, so the disease can be blinding, the first symptoms, many patients are visual distortion, and suddenly things do not look straight, look at distorted vision. especially as some elderly people like to read, to see just do not see that word, appears in the middle of the shadow of the visual, the shadow with hemorrhage, edema area relationship, if the area is small, the shadow of the scope of a small, if a large range of bleeding, or edema, scar a large range, and ultimately, blindness, so the damage is very great.
Sohu health: blind since the quality of life will be greatly affected.
Chen Youxin: research in this area in a foreign country is very much lagging behind some of our home, it is mainly because our economy was not as developed countries are now more concerned about the cataract, while the age-related macular degeneration is not too much concern, in fact, the disease impact on quality of life is very large.
first, loss of self-care ability, a lot of elderly people learn to drive, but was more than 60 years of age-related macular degeneration, can not drive, and if children can not help him to more difficult, and even the streets are difficult. at home cooking, and even the label on the bottle condiment see clearly, Kit could not see the word, the morning milk may be poured down on the table, because the want to see to the place just can not see. this regard, we have seen. elderly already osteoporosis, easy to wrestling fractures because not clear, wrestling and fracture more easily.
also psychologically, as we met with some intellectuals, a lifetime reading, now suddenly can not read, a strong psychological sense of loss. It is reported that the elderly macular degeneration macular degeneration than those without the prevalence of depression in the elderly increased significantly.
many young people so we can not feel the pain after the elderly sick, feel, eat drink on the line. this regard, I want to appeal to children and grandchildren or the children do, to understand the parents or grandparents visual health, suffering from macular degeneration if they should be given more help, and even psychological help.
age-related macular degeneration urgent attention
Sohu health: an introduction by Professor Chen, we can understand the age related macular degeneration, or damage caused by a very large, you can not talk about the disease incidence in our country now is how like? is not more easy to get older?
Chen Youxin: In our country, Like diabetes in the sixties and seventies of last century had very little, but now very much, and why? and lifestyle have a certain relationship, and now studies with the diet, eat fewer fruits and vegetables on, coupled with no exercise, obesity, etc. , the incidence rate of high.
age-related macular degeneration is not a disease peculiar to the West, the Chinese people will have, we have a very famous study was done in Guangdong, the early 90s is probably age-related macular degeneration 3% -4%, to 1998 to 8% -9%, equivalent to double, so the problem must be brought to pay attention, the same people with the improvement of living standards among the incidence rates increased, and the large population in China , a small percentage, multiplied by China's 1.3 billion population, is an astronomical figure, so the age-related macular degeneration of the hazards and impact on society must not be ignored.
Sohu health: and as our national social gerontology of the increase, the incidence rate will increase.
Chen Youxin: Of course, our standard of living improves, the level of improved medical care, treatment capacity increase, and now the average life expectancy of the population, our country has entered an aging society, the elderly population increased substantially. coupled with the incidence of macular degeneration is improving, and I believe the number of patients with age-related macular degeneration is increasing year by year.
Sohu health: morbidity and growth rate so high, everyone's perception is still relatively low.
Chen Youxin: I wrote an article published in , Why mention this? as mentioned earlier, the age-related macular degeneration great harm to society in Western countries is the primary cause of blindness in Europe, Australia, the United States, which accounts for medical expenses is fairly large proportion of , alarming figures, it must pay close attention.
more than the population of our country, macular degeneration has gradually increased each year, so we must attach great importance to, and now can cure cataracts, age-related macular degeneration but are difficult to resolve, especially to the in late, so the social awareness must be improved. We have a random survey of 50 people in the clinic, even the eye of the nurse can not tell what is macular degeneration, and its risk factors which can well imagine that our society For ordinary people, age-related macular degeneration, awareness is low, you ask him what is cataract, know, what is glaucoma, know something, know what is macular degeneration? do not know, so we called for urgent improvement To step up publicity efforts.
Sohu health: young people are not sick, is not it relatively small?
Chen Youxin: We are formerly known as age-related macular degeneration, was found to have 50 years of age or 45 years of age will suffer disease, but they are not old, so now it is called age-related macular degeneration, and found that younger age of onset of his trends, like hypertension and myocardial infarction, who have over the past six or seven years old, and now four more than ten years old myocardial infarction, and lifestyle have a certain relationship.
But if a teenager, two-year-old macular hemorrhage occurs, we do not usually referred to as age-related macular degeneration, idiopathic choroidal called foreign neovascularization, we Chinese call central exudative chorioretinopathy (referred to as
Sohu health: but the harm caused is the same.
Chen Youxin: visual impact, or even blindness, this is the same, but also from the treatment point of view, there are also many similarities between
smoking high cholesterol is age-related macular degeneration certainly incentive
Sohu health: disease caused by reasons for the growth now what? what people may have these diseases?
Chen Youxin: just you ask the incidence of age-related macular degeneration causes cause of two points.
the one hand, from 05 onwards, the study of foreign genes and age-related macular degeneration relationship, probably two or three genes found in the relatively positive relationship with macular degeneration, so that if you had macular degeneration, your odds of higher prevalence of family members, especially on the 40 years of age, eyes should check a couple of years, this is a good thing. Secondly, the age-related macular degeneration has a relationship with the race, whites than in yellow, high incidence of some of the black race. There are overseas research, more women than men. the gender, race, heredity, we can not change is inevitable factor.
the other hand, found several important risk factors can be changed. First, smoking, relatively fast paced society today, we sometimes in order to ease the pressure to smoke, but if you smoke, macular degeneration, the probability of illness at least twice the size. A second obesity, high cholesterol, which is more positive. These articles can be controlled by lifestyle changes. There, now advocate a balanced diet, not to say that eating fruits and vegetables all day, but also meat eating species To many, more to be able to ensure intake of various nutrients, in particular, eat more vegetables and fruits, as vegetables, fruits, rich in chlorophyll, zeaxanthin, lycopene, vitamin C, etc., such things have antioxidant function. now there is a theory, age-related macular degeneration is caused by over-oxidation of the macular area of chronic cell injury.
so I do not smoke, balanced diet, eat more fruits and vegetables, not too fat, no high cholesterol, Of course, eye protection should also pay attention all day long at the computer screen, or front of relatively strong light, ten hours sitting down must be bad, so open the computer as a lesson, recess should be rest.
brought photodynamic therapy treatment of macular degeneration in the spring
Sohu health: we've talked about early detection and identification of the problem, then probably we are more concerned about is the present performance of age-related macular changes can not be cured, what treatment do now?
Chen Youxin: In the past there is no good treatment, but did not explore the footsteps of the moment to stop, explore the 80s of last century laser treatment, macular degeneration that would otherwise cause blindness, by laser Vision therapy can be maintained to 0.1 or 0.2 or 0.05, better than the blind. That is what the laser greatest harm? laser is a thermal burns, eyebrows and beard grabbed, the normal tissues and vascular leakage and burned, but only this time kinds of ways.
to 90 years there is a contrast, called indocyanine green angiography, the angiography as a blood vessels nourish the center of the macular area is not, we will cut off the roots, to nourish the blood vessel destruction, extermination, no breeding of blood vessels, neovascularization atrophied. But if the blood vessels nourishing the best in the center of the macular area, damage is relatively large.
to the late 90s, there has been TTT, transpupillary thermotherapy is called, the equivalent of physical therapy, macular laser do not use heat, then increase the temperature slightly, 5 to 10 degrees, inspire some Heat shock protein protection, so that the surrounding normal tissue is protected, and neovascularization gradually destroyed, so they further protect normal tissue, making new blood vessels slowly shrink, eliminate leakage edema, which in turn is a major step forward .
then the 2000, I wrote in 2007 an article called Total rate of photodynamic therapy, which is a milestone, which makes our doctors may exceed the restricted area is a restricted area over the past macula, macular disease in the past that only four words, The mess does not make sense.
now appears photodynamic therapy, can selectively destroy abnormal new blood vessels. abnormal vessels like fake blood, and now we can put this fake After the circulation to the eye, and then use a special laser, this laser does not produce any heat, called cold laser, or called non-thermal laser, when this laser and our neovascularization after the contact interaction of photosensitizer molecules produced photochemical effect, making blood vessels closed, the last generation of vascular thrombosis, some of the methods are more expensive, but there is no way better than good, so we have a way to treatment. We often joke, vision loss is priceless, but no matter how much money, long as they can cure the disease, is always a way, so we are very happy, and now the patients after 2000, in which there has been a lucky misfortune is because of photodynamic therapy.
the safety of photodynamic therapy Note
Sohu sex and health: photodynamic therapy for visual acuity is not affected?
Chen Youxin: photodynamic therapy in our hospital have done 7 years, the biggest advantage is safety, estimates that the do in the world more than 200 million, enough to prove its safety, in addition to elimination of abnormal blood vessels, stable vision, we do clinical trials found that, in addition to be able to maintain stable vision for most patients, there are about 30% of patients will improve visual acuity . This method is safe, no toxic side effects, is a good way.
Sohu health: just talked about some of macular degeneration, new blood vessels out, which is what?
Chen Youxin: abnormal blood vessels is a fake shop is harmful to beneficial.
Sohu health: effect of early treatment is better?
Chen Youxin: or repetition of the phrase, see a doctor to take the early, so we must first have awareness of macular degeneration, the elderly can easily too. Second, the periodic inspections. Third, that to treat the disease early.
I just said that the treatment of the development process, both large and medium cities across the country photodynamic therapy for macular degeneration include high myopia caused in permeability caused by various causes, like disease similar to macular degeneration, can be treated through this therapy to really reduce the swelling proved to be stable, to protect our eyesight.
Sohu health: patients need after treatment Note what?
Chen Youxin: photodynamic therapy is that, less than 20 minutes the entire treatment process, treatment should be prepared the day of sunglasses, long-sleeved clothes, the best hats, gloves, because the photosensitizer to light to decomposition, in particular, a large sun in summer, when sunlight to prevent the occurrence of interaction with the photosensitizer, the skin burns. generally faster down the mountain when the sun do better treatment, done after 48 hours to avoid glare.
Sohu Health : no problem lighting up?
Chen Youxin: general home lighting, incandescent or fluorescent lamps are still possible, but I suggest try a little dark, lamp is better, anyway, two days after a 48 hours to recover. < br> choice of treatment must be clear before Sohu health condition
: Speaking of the treatment of diseases, there are a number of breakthroughs and progress, and also made a relatively good effect, for the treatment of macular degeneration, now what are the problems, there is no it? example, we have emphasized disease, standard treatment.
Chen Youxin: I have to say is relatively simple, although we now have new treatments, but there are some differences between different doctor may get different results, why ? most important indications of the master, more professional and sophisticated macular degeneration, we want to know, I have some articles on the website, we can see.
first diagnosis of clear, clear your disease is age-related macular degeneration, or retinopathy, or retinal vascular proliferation, this must be determined before treatment, and try to figure out is late or early, and macular degeneration have the dry and wet points. the so-called dry macular degeneration, is the fundus also No new blood vessels, no bleeding, edema and scar formation, but there are some yellow macular dot calm things. but dry macular degeneration can develop into the wet. the so-called wet macular area is already bleeding, oozing, edema, or scar formation, and took part in the early wet just bleeding, and has been completely scarred, and not, like, so be sure to clear diagnosis before treatment.
Sohu health: So we have to choose hospital, clinic doctors when the need for more attention to some.
Chen Youxin: In any kind of treatment before the disease really want to find out the other, as the patient must also ask, do not blindly treatment because improper treatment may increase the injury. Now network is very developed, such as Sohu search for anything on a search to, what is age-related macular degeneration, I would like is some of the network. Also where can be treated and how treatment should be clear. So before treatment do some homework is good, do not believe one of the words, in some places called a cure macular degeneration is certainly not credible.
Sohu health: you can go to Professor Chen's personal web site have a look. Here we look at the problems some users it.
Professor Chen Youxin questions for on-site users
User: mother has macular degeneration two years ago, when I had a photodynamic therapy, good results, the disease does not develop, I feel very good, there is no second treatments, but the vision began to decline last year, is a decline in the future to do, or how to?
Chen Youxin: This is a very big problem, is a philosophical proposition, because people now have no control over the aging , the age-related macular degeneration is a disease in the aging process, and age-related, so do not have a way to completely cure, the treatment approach we are not a cure or a treatment table, so there may exist a treatment secondary treatment, three treatment, in a foreign country to do three times the average first year, twice a second year, third year to do it again, but the biggest advantage is that the treatment abroad can be covered by medical insurance. so do not expect everything will be fine once the treatment, which is not correct, we must constantly review, because there may be the first treatment.
friends: a few years ago my mother felt a shadow front sway, the check is cataract, but because of macular degeneration, is not it inoperable?
Chen Youxin: macular degeneration, if it is to late, do nothing approach, but still should be the treatment of cataract, and why? as macular degeneration, central vision loss is mainly done after treatment of cataracts may be slightly better peripheral vision, so I do cataract patients the time if I gave him, one o'clock is a good visual acuity improved slightly.
User: My mother had macular degeneration for three years, initially left eye, right eye and macular degeneration are serious this year, a sharp decline in visual acuity, according to Beijing every spring, have opened a Chinese medicine hospital taking little or no effect, I ask you to carry out photodynamic surgery?
Chen Youxin: First the first point, to be confirmed, some basic hospital because of equipment limitations, with little experience, may be misdiagnosed. it is proposed to go to large hospitals is not confirmed macular degeneration, to find out is dry, or wet the; second, macular degeneration does have a tendency to eyes, eyes can be a front and rear, left eye right eye had also entirely possible to be, just could not take Chinese medicine, especially at the less experienced Chinese medicine, or some other method should be adopted.
friends: I am a high degree of myopia, 500 eyes about some of the recent decline in sensory acuity, and sometimes feel the shadows, do not know if there is no serious problem, this is not need to go to hospital?
Chen Youxin: high myopia, we generally considered to be above 600 degrees is called myopia, high myopia of 500 degrees is not known, but 500 degrees is quite high Even people who forty-five Baidu myopia can sometimes get sick. so the eye shadow in front of fluttering if there is, it may be vitreous opacity, I suggest go to the hospital regularly look up eyes, look around the retina, there is no degeneration area even some patients with cleft, so patients with high myopia, periodic look up eyes.
Professor Chen Youxin recommendations for users their visits time
Moderator: Time is almost up, Professor Chen Youxin conclude our friends some suggestions, tell us about their visits another time.
Chen Youxin: either the patients themselves or relatives of patients or healthy subjects of interest, we must raise awareness of age-related macular degeneration, the disease is more common, so the state must pay close attention, especially at home have relatively large age of the parents, or grandparents aged relatively large, they often want to look up the eyes, hope that early detection, especially over 60 years, the incidence rate may high, it is necessary to raise awareness.
Second, if it is found they have a visual distortion or a front of a shadow, often alternating left and right eye closed, take a look and found that when these symptoms as soon as possible to the relatively large, qualified the hospital for examination, and sometimes not only ophthalmoscopy, but also have the inspection equipment to early detection.
found to be dry if the age-related macular degeneration, our advice is to eat more vegetables, fruits, go out Great to wear dark glasses sun, quit smoking, eat greasy food, maintain proper weight, but also added lutein, which is large-scale tests proved that the United States, if you added lutein, trace elements, vitamins, can a considerable number of people not to late development. for wet macular degeneration in elderly, to go to the hospital to take some formal method of modern technology, formal examination and treatment, such as photodynamic therapy. In addition, you can combine a number of anti-angiogenesis drugs, injection into the vitreous cavity, now more respected combination therapy, so a multi-pronged, often a treatment is not enough, various methods have their own advantages and disadvantages and complement each other, so that the best results .
Here I would like to stress that many elderly people their mobility, only to be filial sons and daughters of the heart, their information is not well-informed, do not know the disease can rule. Today, I tell you, can cure this disease, so Be sure to tell your family, and some people think that age-related macular degeneration can not rule, anyway, have been older, do not read, this is utterly wrong, the elderly but also the quality of life, can not see is very painful, life quality greatly reduced. macular degeneration will be able to treat, as long as the various methods with properly, can keep your vision steady, and this is confidence.
I work at the Beijing Union Medical College Hospital Department of Ophthalmology, every Monday, two, three out of the morning in Beijing Union Medical College Hospital out-patient, we can come to me at this time. In addition we can contact through my personal web page I, www.chenyouxin.haodf.com and chenyouxin010.blog.sohu.com, can leave a message mentioning some problems, as long as I have the time, basically every night, and sometimes even abroad can be answered.
Sohu Health: This concludes today's interview, thank you very much the concern of friends, and Professor Chen Youxin the visit, If you have any specific questions, one can log on Professor Chen Youxin personal website to ask questions, Sohu is also Professor Chen's blog, In addition, you can go to Beijing Union Medical College Hospital to find Professor Chen. Thank you!
Wednesday, February 23, 2011
They just do not understand that the Government calculation does not count words in the end - good luck that
Our old neighbor inside the courtyard, there is an elderly couple after they moved in, I heard that in the past to jump the queue in Shaanxi, Bingtui back, can only be assigned to street work in factories, which have no culture (but then, but because the culture (educated youth) to the countryside to receive re-education), they work hard, party and the country so a plain feeling confident that the Communist Party is the people's happiness. Now, the woman retired, a monthly pension 1,000 or so, the men bought out the length of service, (unit went out of business) too difficult to find a job, less than 60 years old, and do not retire to the parking lot to look at cars a day, is not regarded as formal, one month Five, six dollars. ranked insurance crisis solution started, they were happy, I heard that there are different places to move back to room, so that age, a small three-wheeled board with good home showings went to the macro, I heard the new house but also to to pay 15 million, all of a sudden could not take so much money, with the cqb said, wanted a smaller area of 2 bedroom, according to them, I've saved about 10 million (half of them buy more worked for the money), the doctor used to keep the pension, that way to spend the inside, but they still trust the Government, that the Government would listen to nothing wrong with holding a colorful cqb send information, it appears that looked , find the neighbors yard to discuss, that the Government give them a new arm around, and he is a force drawn, (Chongwen District have such a good The old couple juggle, selling old stuff to find temporary accommodation, the results do not say, the sick old man in a gas, and no place to reasoning, have the heart it! Now the couple moved to temporary went to the residence, before leaving and I said: how could this be? they just do not understand that we speak in the end count count?
Tuesday, February 22, 2011
The universe and life on a number of issues (80)
On countries, rich over five generations, more than six generations of the family is not uncommon
.
why there is this difference, which causes what is it?
us first look at the case of America's wealthiest families.
the United States is the implementation of the national estate. When a rich man died, his half-life of wealth to be a
State as taxes, was conscripted to go.
Thus, on the birth of a large number of the emergence of a variety of charitable funds. is rich in these big
before death, under various names, will own half of the property established by the family
managed charitable or nonprofit fund. so you can avoid The estate tax to be levied.
these funds have a common characteristic, that is the principal of the Fund is owned by the public or social
Council, the Fund's management rights and income distribution rights belong to the management of the fund itself machine
institutions.
established that the results of some funds to make the rich man died after the still huge amount of wealth several
can be the descendants of the rich man to manage and use.
then management and use of these funds to make the descendants of their family, what kind of rights
it?
annually in the first extract from the total amount of funds to do a certain amount of money management fees, which these costs will be mainly
to cover the fund manager's compensation. gainers are mostly members of the family
.
us an account balance.
If the total fund of 20 billion U.S. dollars, the annual extraction of the provisions made by the Fund 3% of the total administrative expenses for the Fund to do
, then, the descendants of this family can be a year to get funds from this
:
20 �� x3% = 6000 �� ��Ԫ.
, of course, This part will be used for paying the money needed to hire managers and other management
management overhead, but even so, executives are also responsible for the use by the family.
the charity and public welfare benefits are not without pure investment.
fund start-up has been done specific considerations and arrangements. which a family can get administrators enormous
the interests of space there, because the story of ordinary things, We do not discuss
.
that is, the fund is invested each year a considerable number of benefits in return.
and fund charitable or public welfare because it is basically is exempt from tax. This will
increasing the principal amount of the Fund.
annual income if the funds by a certain percentage of the increase, after so many years
total size of the fund will reach a significant number. So, in this case, the Fund
with the extraction of the management fee is still the original though, as a base, but the total amount of overhead is greatly enhanced in the
.
course, there are also investment fund management and risk management. But If you do
money to invest its own funds for the family, the risk also exists, but also bear a substantial part of national tax
.
we have said earlier, the richest of the United States Rockefeller family, has wealth has
six generations. the continuous stretch of such a process is actually rich.
other hand the rich history of China, their only characteristic that all the wealth to their children and grandchildren to stay
to enjoy .
This raises the question.
we know, gained a life of wealth owned by the German life, the decision set
.
then compare the rich in China and the United States arrangements for the property when death results, we
will find a difference in the nature.
wealthy American life by their own virtue in exchange for the precious wealth has not lost, but in a
wealth in the form exists in the world was. in fact, equivalent to the person in the world
saved a great fortune, he at any time want to spend and when to use, you can use.
friends know which of the contains the true meaning of you?
family, descendants of the rich man, that is, the fund various times later the specific management
manager who has a lot of time, in fact, the rich man himself reborn into the world < br> after themselves in the management and use of this wealth. because of all this is because his German is so much
reason.
and China's rich all the heritage left to future generations, on the one hand that future generations also have the
blessing to enjoy this wealth. In that case, he will come with their own German heritage with this
parents left in exchange.
the other hand, if the successor does not have the ethics, use of the wealth to do
a bad loss, when German-opportunity, made under a lot of industry, the industry, they have to stay
by the estate to his parents under the commitment.
Why? because this is the reason the universe, what you want, you have to go with
their German exchange.
leave a large inheritance that parents, they did not just have one wish do is to let their children
unearned. so good, that really would like to leave a huge legacy
through the form of production was achieved. So, I'm sorry, those evil, evil children are a result ancestry of evil Sun ,
manufacturing industry under these parents also have to bear.
this form that we speak with people in the world, so a single thought, would like to use their own form of
sick, instead of their loved ones sick, really sick would that get him
's.
and a rich man, his own great virtue in this world have the ability to obtain great wealth,
but his son and grandchildren, it is not necessarily the kind of person Tak.
we are not mentioned, the generation of genetic relationships among people, there is a lot of things lifetimes associated
brought up the situation. So, when the German little life, because the world had a reason for what
aid by the rich than when they made the afterlife and his son, now the world's only body
affection that I, only.
in this case, the parents of the Tak has a thought as to make him the virtue of
may not son, inherited their wealth, rich life. but he did not know that what he
son's life, had been killed in a different space of life, living there between
debt to repay.
The result is that Germany and the great men, left to his own virtue is really another world
life, and may have changed the life or karma Germany.
This is why in China, a,
person's looks and their proportion of the relevant German and industry? If life is more than I, that
What is different is the appearance of each world? that if Xiu, the use of which the world's
looks it?
looks in different spaces is different, and yet has a very similar nature of factors
exist. which constitute the virtuous and the proportion of industry, but also life itself in this
given space and a specific environment, which has the composition of the material life of the other.
life state in the world to show people who have facial identification, phrenology, physical phase,
palmistry and other aspects of method, which in fact means to form the overall shape of people have their back
factors after the material existence.
If this constant reincarnation of life in the world, then, and his countenance was
change in the basic form, based on the process due to the constant reincarnation of the material does not constitute life itself off
changes in the form of performance in the world has changed accordingly.
but one and finished as a life in the realm of good looks, but it is very beautiful
good a condition. essentially no major change in appearance, but the day after tomorrow in the world as a result of
karma and other various components to different substances out, so in essence to show excellent form
out.
us to make an example.
If we put one of the most handsome young man, and one of the most beautiful girl as our
the world's standards, you will find them to do different dress and costume, table
emerges is a very big difference.
such as ink you paint them in the face, put them ragged clothing, shaved head
yin and yang. Then you take a look at the handsome and beautiful men and women still exist?
simply do not exist in the.
But if all these external packaging to out, the natural beauty and handsome
will appear in people's line of sight.
Moreover, in the high-level situation in life, compared with the world, there is a huge one order of magnitude is not
existence of the circumstances.
the particles that make up this life, have all been pure space is another fine particles
sub-state, then the differences shown by the appearance of life is not to have people with the world
thinking to understand.
If the employer's way of thinking to understand analogy, then, is a raw
with life, and in the state of the world is stone, and high performance in a more micro-level space < br> where is the diamond.
This is because they constitute the most basic level of life differences between particles, so that they have no
the quality of life and the life of the state, have been unimaginable.
problem II,
abortion count as manufacturing? If you can not give a good growth environment for life to
into the world is not responsible for it not?
talked about this issue, you look at the good friend irresponsible. It is your personal thoughts. not the nature of the matter.
a life in the world, happiness is not happiness, that is parents can decide up! You may give
enormously wealthy man he left, he will therefore be murder. you may have nothing,
he may scratch and win fame and fortune.
but you self-righteous, to deprive the people and life. that is in the killing, in the manufacturing industry,
have to go their own compensation.
good friends I am afraid
life should be like that but at the last minute of practice they retreat of the old couple.
Hui's performance can be a bit extreme and radical, have been interrupted when he had a tooth
Dharma as an act to compensation factors exist, but also the life of the world does not know the existence of other factors
.
left in life for every one for the world the image of life in the world, they are all in this world
a mission, and demonstrated variety of life and human spirit and honor, in fact, is to make the world
see the practice of life to be experienced on different levels and the performance of state.
question II,
's shallow and thin. little to educate the public display supernatural powers, it can be a side
style.
Sakyamuni Buddha era is to do so, because at that time, constitute the material world the purity of life, compared
high. This life is essentially a kind and compassionate
's.
the Buddhist way of life supernatural show to watch, they really admired, is really the heart of practice as
stars In.
but now people, the people have gone bad, the lust and desire for material, has become his
their sinister motives but greed.
If today Buddha Sakyamuni showing the magic world, then, that the world will be a people respected
heart to think about all this it? will not, but with a heart of greed
to go nuts to get this a supernatural power, easy to use in the world to grab the wealth of
.
that case, that the Buddha showing the magic to the world, that is, brought back one of the greatest greed.
is to make the most of a bad thing .
to the three,
down how important it is, how difficult. put it? name, Lee, selfishness, greed, emotion. Oh, this is a process, that is, so I do not know whether we can do that day. to < br> in.
fit the time, will feel hard, and when you really lay down, you will send
is, in fact, is nothing. For if you do not like smoke, do not I like to drink, you
a taste of alcohol and tobacco to smell offensive. this time, tell you that you have to quit drinking,
if you do not quit, then you'll be arrested and brought to justice. You will feel very funny.
so exaggerated it? As so harshly? I do not need to quit!
is actually the case. hobby and addiction are well formed the day after tomorrow. If the world is the root
This would be no sheep there, then how can the only, then you want to have it to stay in the world only
.
question four,
reread the article, not the same feeling.
Yes. because when you read the first pass, the starting point that kind of level, will understand that on
a level.
when you read it, the level has to improve the process. this time, read the second time you come back when
, you will find the time to read before, there are some limitations and understand the differences between the
, now re-understanding, awareness and understanding will find the problems,
will raise up.
when you re- continue reading, level and state has been increased again, and then look back at some of its
articles will discover new knowledge and understanding of differences and limitations, to increase again
.
this is the cultivation process. certainly understand the law, but also the requirements in accordance with legal principles.
do real repair.
We continue later.
blessings friends!
original Reprinted from: Far Bobo off
Sina User 2010-09-24 08:29:16 [Report]
learning.
matathus
Tiger Departed 2010-09-24 10:29:33 [ ,],[is the real repair.
mind.
Mr. Headshake!
city cat 2010-09-24 14:07:02 [Report]
Xiu Xiu 2010-09-24 14:47 : 42 [Report]
another article is open, happy! being Xieyuan Bo
not worry 2010-09-24 20:32:32 [Report]
greetings to President, and see the new stuff, so happy, But you should pay attention to body Yeah.
bloggers reply: 2010-09-25 06:24:07
doing very well. refueling.
Yunjuanyunshu 2010-09-24 22:58:53 [report]
to stay in the world. ahead of others beyond their own referenced in the text. refueling.
blossoming 2010-09-24 23:59:18 [Report]
Mr. greetings ~!
.
why there is this difference, which causes what is it?
us first look at the case of America's wealthiest families.
the United States is the implementation of the national estate. When a rich man died, his half-life of wealth to be a
State as taxes, was conscripted to go.
Thus, on the birth of a large number of the emergence of a variety of charitable funds. is rich in these big
before death, under various names, will own half of the property established by the family
managed charitable or nonprofit fund. so you can avoid The estate tax to be levied.
these funds have a common characteristic, that is the principal of the Fund is owned by the public or social
Council, the Fund's management rights and income distribution rights belong to the management of the fund itself machine
institutions.
established that the results of some funds to make the rich man died after the still huge amount of wealth several
can be the descendants of the rich man to manage and use.
then management and use of these funds to make the descendants of their family, what kind of rights
it?
annually in the first extract from the total amount of funds to do a certain amount of money management fees, which these costs will be mainly
to cover the fund manager's compensation. gainers are mostly members of the family
.
us an account balance.
If the total fund of 20 billion U.S. dollars, the annual extraction of the provisions made by the Fund 3% of the total administrative expenses for the Fund to do
, then, the descendants of this family can be a year to get funds from this
:
20 �� x3% = 6000 �� ��Ԫ.
, of course, This part will be used for paying the money needed to hire managers and other management
management overhead, but even so, executives are also responsible for the use by the family.
the charity and public welfare benefits are not without pure investment.
fund start-up has been done specific considerations and arrangements. which a family can get administrators enormous
the interests of space there, because the story of ordinary things, We do not discuss
.
that is, the fund is invested each year a considerable number of benefits in return.
and fund charitable or public welfare because it is basically is exempt from tax. This will
increasing the principal amount of the Fund.
annual income if the funds by a certain percentage of the increase, after so many years
total size of the fund will reach a significant number. So, in this case, the Fund
with the extraction of the management fee is still the original though, as a base, but the total amount of overhead is greatly enhanced in the
.
course, there are also investment fund management and risk management. But If you do
money to invest its own funds for the family, the risk also exists, but also bear a substantial part of national tax
.
we have said earlier, the richest of the United States Rockefeller family, has wealth has
six generations. the continuous stretch of such a process is actually rich.
other hand the rich history of China, their only characteristic that all the wealth to their children and grandchildren to stay
to enjoy .
This raises the question.
we know, gained a life of wealth owned by the German life, the decision set
.
then compare the rich in China and the United States arrangements for the property when death results, we
will find a difference in the nature.
wealthy American life by their own virtue in exchange for the precious wealth has not lost, but in a
wealth in the form exists in the world was. in fact, equivalent to the person in the world
saved a great fortune, he at any time want to spend and when to use, you can use.
friends know which of the contains the true meaning of you?
family, descendants of the rich man, that is, the fund various times later the specific management
manager who has a lot of time, in fact, the rich man himself reborn into the world < br> after themselves in the management and use of this wealth. because of all this is because his German is so much
reason.
and China's rich all the heritage left to future generations, on the one hand that future generations also have the
blessing to enjoy this wealth. In that case, he will come with their own German heritage with this
parents left in exchange.
the other hand, if the successor does not have the ethics, use of the wealth to do
a bad loss, when German-opportunity, made under a lot of industry, the industry, they have to stay
by the estate to his parents under the commitment.
Why? because this is the reason the universe, what you want, you have to go with
their German exchange.
leave a large inheritance that parents, they did not just have one wish do is to let their children
unearned. so good, that really would like to leave a huge legacy
through the form of production was achieved. So, I'm sorry, those evil, evil children are a result ancestry of evil Sun ,
manufacturing industry under these parents also have to bear.
this form that we speak with people in the world, so a single thought, would like to use their own form of
sick, instead of their loved ones sick, really sick would that get him
's.
and a rich man, his own great virtue in this world have the ability to obtain great wealth,
but his son and grandchildren, it is not necessarily the kind of person Tak.
we are not mentioned, the generation of genetic relationships among people, there is a lot of things lifetimes associated
brought up the situation. So, when the German little life, because the world had a reason for what
aid by the rich than when they made the afterlife and his son, now the world's only body
affection that I, only.
in this case, the parents of the Tak has a thought as to make him the virtue of
may not son, inherited their wealth, rich life. but he did not know that what he
son's life, had been killed in a different space of life, living there between
debt to repay.
The result is that Germany and the great men, left to his own virtue is really another world
life, and may have changed the life or karma Germany.
This is why in China, a,
person's looks and their proportion of the relevant German and industry? If life is more than I, that
What is different is the appearance of each world? that if Xiu, the use of which the world's
looks it?
looks in different spaces is different, and yet has a very similar nature of factors
exist. which constitute the virtuous and the proportion of industry, but also life itself in this
given space and a specific environment, which has the composition of the material life of the other.
life state in the world to show people who have facial identification, phrenology, physical phase,
palmistry and other aspects of method, which in fact means to form the overall shape of people have their back
factors after the material existence.
If this constant reincarnation of life in the world, then, and his countenance was
change in the basic form, based on the process due to the constant reincarnation of the material does not constitute life itself off
changes in the form of performance in the world has changed accordingly.
but one and finished as a life in the realm of good looks, but it is very beautiful
good a condition. essentially no major change in appearance, but the day after tomorrow in the world as a result of
karma and other various components to different substances out, so in essence to show excellent form
out.
us to make an example.
If we put one of the most handsome young man, and one of the most beautiful girl as our
the world's standards, you will find them to do different dress and costume, table
emerges is a very big difference.
such as ink you paint them in the face, put them ragged clothing, shaved head
yin and yang. Then you take a look at the handsome and beautiful men and women still exist?
simply do not exist in the.
But if all these external packaging to out, the natural beauty and handsome
will appear in people's line of sight.
Moreover, in the high-level situation in life, compared with the world, there is a huge one order of magnitude is not
existence of the circumstances.
the particles that make up this life, have all been pure space is another fine particles
sub-state, then the differences shown by the appearance of life is not to have people with the world
thinking to understand.
If the employer's way of thinking to understand analogy, then, is a raw
with life, and in the state of the world is stone, and high performance in a more micro-level space < br> where is the diamond.
This is because they constitute the most basic level of life differences between particles, so that they have no
the quality of life and the life of the state, have been unimaginable.
problem II,
abortion count as manufacturing? If you can not give a good growth environment for life to
into the world is not responsible for it not?
talked about this issue, you look at the good friend irresponsible. It is your personal thoughts. not the nature of the matter.
a life in the world, happiness is not happiness, that is parents can decide up! You may give
enormously wealthy man he left, he will therefore be murder. you may have nothing,
he may scratch and win fame and fortune.
but you self-righteous, to deprive the people and life. that is in the killing, in the manufacturing industry,
have to go their own compensation.
good friends I am afraid
life should be like that but at the last minute of practice they retreat of the old couple.
Hui's performance can be a bit extreme and radical, have been interrupted when he had a tooth
Dharma as an act to compensation factors exist, but also the life of the world does not know the existence of other factors
.
left in life for every one for the world the image of life in the world, they are all in this world
a mission, and demonstrated variety of life and human spirit and honor, in fact, is to make the world
see the practice of life to be experienced on different levels and the performance of state.
question II,
's shallow and thin. little to educate the public display supernatural powers, it can be a side
style.
Sakyamuni Buddha era is to do so, because at that time, constitute the material world the purity of life, compared
high. This life is essentially a kind and compassionate
's.
the Buddhist way of life supernatural show to watch, they really admired, is really the heart of practice as
stars In.
but now people, the people have gone bad, the lust and desire for material, has become his
their sinister motives but greed.
If today Buddha Sakyamuni showing the magic world, then, that the world will be a people respected
heart to think about all this it? will not, but with a heart of greed
to go nuts to get this a supernatural power, easy to use in the world to grab the wealth of
.
that case, that the Buddha showing the magic to the world, that is, brought back one of the greatest greed.
is to make the most of a bad thing .
to the three,
down how important it is, how difficult. put it? name, Lee, selfishness, greed, emotion. Oh, this is a process, that is, so I do not know whether we can do that day. to < br> in.
fit the time, will feel hard, and when you really lay down, you will send
is, in fact, is nothing. For if you do not like smoke, do not I like to drink, you
a taste of alcohol and tobacco to smell offensive. this time, tell you that you have to quit drinking,
if you do not quit, then you'll be arrested and brought to justice. You will feel very funny.
so exaggerated it? As so harshly? I do not need to quit!
is actually the case. hobby and addiction are well formed the day after tomorrow. If the world is the root
This would be no sheep there, then how can the only, then you want to have it to stay in the world only
.
question four,
reread the article, not the same feeling.
Yes. because when you read the first pass, the starting point that kind of level, will understand that on
a level.
when you read it, the level has to improve the process. this time, read the second time you come back when
, you will find the time to read before, there are some limitations and understand the differences between the
, now re-understanding, awareness and understanding will find the problems,
will raise up.
when you re- continue reading, level and state has been increased again, and then look back at some of its
articles will discover new knowledge and understanding of differences and limitations, to increase again
.
this is the cultivation process. certainly understand the law, but also the requirements in accordance with legal principles.
do real repair.
We continue later.
blessings friends!
original Reprinted from: Far Bobo off
Sina User 2010-09-24 08:29:16 [Report]
learning.
matathus
Tiger Departed 2010-09-24 10:29:33 [ ,],[is the real repair.
mind.
Mr. Headshake!
city cat 2010-09-24 14:07:02 [Report]
Xiu Xiu 2010-09-24 14:47 : 42 [Report]
another article is open, happy! being Xieyuan Bo
not worry 2010-09-24 20:32:32 [Report]
greetings to President, and see the new stuff, so happy, But you should pay attention to body Yeah.
bloggers reply: 2010-09-25 06:24:07
doing very well. refueling.
Yunjuanyunshu 2010-09-24 22:58:53 [report]
to stay in the world. ahead of others beyond their own referenced in the text. refueling.
blossoming 2010-09-24 23:59:18 [Report]
Mr. greetings ~!
Monday, February 21, 2011
CT of small peripheral lung cancer diagnosis
A focus on basic pathological basis of CT signs and the analysis of Radiology, PLA General Hospital
Caizu Long
Lung cancer is one of the most common malignant tumor. In recent years, the incidence of lung cancer was significantly increase. Beijing, Shanghai , Tianjin, Jiangsu and Liaoning Province, the city, Yunnan old areas, the incidence of lung cancer and / or mortality accounts for a variety of malignant tumors of the first. more than the time of diagnosis of lung cancer has been to the middle and late, 70 to 80% of patients had lost radical opportunity to improve the five-year survival rate of patients is very important. CT is the most important early peripheral lung cancer, the most reliable screening method.
one routine inspection methods
do first scan, slice thickness 8-10mm to determine the anatomical lesions. and then the line of lesion thickness of 1.5 to 3.0 HRCT scan or continuous scan. such as the spiral, the lesion can be 3mm thick volume scan, then 1 ~ 3mm reconstruction. The scan can be made lesions of the internal structure and its adjacent edge features clearly show the relationship between organizational structure. If there are difficulties in diagnosis who do dynamic enhanced MRI lesions in order to strengthen the situation of the lesions observed.
CT of small peripheral lung cancer characteristics and signs The pathological basis of
1, signs of lung tumor edge features:
(1) lobulation: small peripheral lung cancer is the most common basic signs. hospital 100 cases of small-diameter less than 3cm of lung lobulation rate was 84%. the vast majority of small lung cancer dark leaf, from the long chord distance and the ratio of> 2 / 5. The pathological basis of one edge of each part of the tumor with varying degrees of tumor cell differentiation, the growth rate of the different relevant . Second, the interval of the lung tissue into the tumor's blood vessels, bronchi branch out from the growth of tumor blood vessels and connective tissue can cause tumor growth retardation; have lacunae, thus forming a leaf shape.
( 2) The rough edges: see fine, short spikes, spike-like protrusions or jagged changes. This is a common sign of lung cancer, the occurrence rate of about%, the performance is due to the tumor stroma, blood vessels outside the tumor growth and spread of tumor cells into the surrounding due.
2, the performance characteristics of CT within the tumor: the majority of the density of small peripheral lung cancer than the uniform, may have vacuole sign, thin air bronchogram, ground-glass honeycomb sign and symptoms, a few cases can still see the calcification .
(1) bubble sign: Refers to the small focal nodular area of sexual transmission. The diameter of <5mm, and lung cancer to empty distinction. can be single or multiple. such as the number of dense vesicles gathered in with honeycomb, said honeycomb sign. The pathological basis for the tumor tissue is not occupied �� gas lung tissue; �� not closed or expansion of small bronchi; �� papillary carcinoma gas cavities between the structure; �� along the alveolar wall growth of alveolar carcinoma and melting is not closed, alveolar destruction and enlargement; �� small focal necrosis within the tumor formed after discharge. This levy more common in bronchioloalveolar carcinoma and adenocarcinoma, is also found in squamous cell carcinoma. Sometimes, the vacuoles internal mucus, shedding of tumor cells in the presence of such components can be made higher CT value, approximate density of water. in the lung appear as a small window on the fuzzy low density bubble in the mediastinal window showed a small bubble on the translucent film.
(2) thin air bronchogram: was thin strip, about 1mm diameter, air density shadow, or in a small bubble-like (diameter <1mm = air density shadow, seen for several consecutive adjacent level, pathology for the expansion of the bronchioles. found in bronchioloalveolar carcinoma or adenocarcinoma.
(3) Cellular Characteristics: integration by a number of cellular vesicles, more consistent in size, this sign only in lung cancer. pathology is the growth of cancer cells along the alveolar walls, alveolar space is not closed, so that mucus left over from the expansion chamber.
(4) ground-glass sign: the whole part of the tumor nodule or nodules were ground area density glassy lighter, it does not pulmonary vascular cover texture. lesion state general still clear. The pathological basis of the growth of tumor cells along the alveolar wall, alveolar wall thickening, but did not block the alveolar cavity, a small amount of mucus within the tumor or off, this sign only in lung cancer .
(5) empty: To more than 5mm round or oval-like low density of air, hospital 100 cases of small peripheral lung cancer occurred within the cavity was 4%. a small hole in the wall thickness of lung cancer is not thin are, uneven wall, there are mural nodule. hole was centered or eccentric place. individual cases meager wall. the edge of the tumor was still visible changes in leaf and burr. empty most of the tumor necrosis Department of liquefied bronchial interlinked, formed after discharge.
(6) calcification: within small peripheral lung cancer with calcification. HRCT reported in the literature on the detection of lung cancer calcification rate can reach 15.8%. our hospital report 100 patients with small lung CT scan detected by TLC 3 cases. calcification showed fine gravel-like, small nodular, diffuse, or indulge in the side of the distribution.
calcification mainly seen in squamous cell lung cancer, adenocarcinoma. The pathological basis �� dystrophic calcification. due to tumor blood supply barriers, tumor cell degeneration, necrosis, local calcium level changes, calcium deposits; �� calcification of the tumor had wrapped before, occurred in the pre-existing calcified granuloma; �� calcification of the primary tumor, mainly seen in mucinous adenocarcinoma. < br> 3, the tumor adjacent to the CT signs of structural change (1) vascular accumulation sign: is gathered around the blood vessels to the nodules. vessels in the tumor edge interrupt or through the tumor. artery and vein may be involved. For the good of them involving the pulmonary vein, is important to identify malignant. Despite reports in the literature of benign lesions are also visible signs of vascular accumulation, but our experience gathered benign vascular lesion detection rate is not high, and reach of small lung cancer. (2), pleural indentation: There are three main performance: �� When the recessed center and the level of parallel scan showed pleural indentation mm typical of tumors and adjacent chest wall or between the triangular shadow, said bell, and its tip is connected with the linear opacities; �� When the level of deviation from the depression center, the line shaped into a film by the two or more, sometimes with the tumor gradually reflected in its separate video from a big big triangle into two smaller triangles; �� level of crack and oblique attack showed pleural indentation curves shadow. Zhiyong Zhang reports of small peripheral lung cancer detection rate of pleural indentation 93%. mainly seen in the adenocarcinoma and bronchioloalveolar carcinoma. The pathological basis of the general opinion of the lesions caused by fibrous scar tissue contraction. cicatricial contraction of fiber grid near the tumor passes through to the visceral pleura, the visceral pleura pull to the tumor foci. indentation and the parietal pleura gap between the composition, the liquid filling the living rational.
(3) pleural tumor shadow on fuzzy little piece, there is about 10% for the small signs of bronchial obstruction.
(4) satellite lesions: In addition to individual cases of adenocarcinoma lesions can occur outside the sub, all showed solitary nodules, no satellite lesions, the Court was no case of 100 patients with small lung cancer satellite lesions.
4, the CT enhancement characteristics of lung cancer and benign lesions
between the blood supply and metabolism are very different, so the use of enhanced MRI in differentiating benign and malignant lesions is important.
first foreign scholars Swenson report of 163 nodules enhanced scan results, including 111 malignant nodules (lung cancer and metastases) the median increase was 40HU, (20 ~ 108HU), and 58 benign lesions, the median increase was only 12HU. with 20HU as a threshold for distinguishing benign and malignant tumors was 100% sensitivity, specificity and accuracy were 76.9% and 92.6%. Yama *** a threshold such as the use of 20HU the findings of the study and about the same. Zhang Minming other diameter of 65 <3cm in the determination of solitary pulmonary nodules increased its rate of time-density curve, peak, and flow perfusion and contrast enhancement patterns between benign and malignant tumors vary. Malignant tumors of the curve rises faster than fast curve after the peak remained at high values. inflammation type, vary between benign and malignant tumors. rate of malignant tumors of the curve rises rapidly, peaking after the curve remained at high values. inflammatory mass of the time-density curve rises faster and the peak high peak decreased slightly after the curve, and then increased again. benign tumor of the time density curve low and flat, or almost no increase. malignancies enhanced peak 41.9HU, inflammatory mass of the peak 43.6HU, benign tumors were significantly higher than the peak (13.4HU). malignancies and inflammatory mass of the blood flow was significantly higher than benign tumor blood flow. enhance the way there are also different, 55% of malignant nodules showed significantly enhanced uniform, begins as a 30% increase is not homogeneous, but most of them gradually after the peak tends to increase homogeneity, and inflammatory tumors in the peripheral part of the increased heterogeneity of the main, and mostly benign tumors do not enhance or edge enhanced.
In short, the enhanced features of lung cancer can be summarized as �� enhanced amplitude, over 20HU; �� time density curve rises faster; �� high blood flow; �� 85% of patients ultimately homogeneous enhancement. These characteristics and lung cancer The new small blood vessels and structural features more relevant, and strong on the tumor tissue metabolism.
three different histological types of lung cancer CT of small peripheral performance analysis
some histological types of lung cancer CT manifestations of small certain characteristics, according to these characteristics, can be broadly inferred their histological type.
1, BAC Bronchioalveala Carcionma abbreviated BAC: Case of large numbers in the subpleural or near the leaves of the pleura, irregular shape, were small pieces and can be star, the internal structure of features, the main signs of air-bronchogram, bubble sign, cellular sign, ground-glass sign, the signs appear high. hospital 63 cases of solitary bronchioloalveolar carcinoma incidence of vacuole sign ( 33) 52.38%, air bronchogram in 21 cases (33.33%), ground-glass sign in 12 cases (19.04%). including ground-glass sign with alveolar cell carcinoma-specific symptoms only. of the performance is still seen as the only two cases uniform density, the density was reduced with the increase of grain like mulberry-like changes.
2, adenocarcinoma: leaf, glitches, blood vessels together, depression and other signs of pleural more significant. vacuole sign and air bronchogram are more common. a small number of vacuoles and more than bronchioloalveolar carcinoma. sometimes see multiple foci, the Department developed on the basis several times due to scar; disease that is relatively small shift, but also a feature of large metastases.
3, squamous cell carcinoma: The main signs are deeply divided leaves, small focal necrosis in the formation of vesicles or empty sign, burr and sawtooth sign, pleural indentation, such as adenocarcinoma of the typical vascular aggregation.
4, small cell carcinoma: peripheral Small cell carcinoma of the lack of the cancer, lung cancer, which has a leaf, glitches, such as cavitation and air bronchogram signs, often very small tumors have significant hilar and mediastinal lymph node metastasis and distant metastasis. lesion itself over the edge finishing, no leaf, density of cross-over are exactly like benign tumors. When the detection of brain metastases, and 10 ~ 15%, can also be transferred to the contralateral lung, adrenal gland, liver, etc..
IV lung cancer Diagnosis and differential diagnosis of
1, lung cancer should be aware of the following links
(1) to correctly identify the basic signs of lung cancer, and a deep understanding of the pathological significance of their representatives, this is the premise correct diagnosis of lung cancer.
(3) improve the diagnosis of some special significance signs of awareness. such as ground-glass density, lighter and its symptoms easily misdiagnosed as inflammatory disease. According to our experience, this is very bronchioloalveolar carcinoma diagnosis, low-density and high density granular same lesions in addition to outside BAC not yet seen. pleural side of the fuzzy little piece of film I saw in the cancer nodules.
(4) on the significance of calcification: calcified lesions appear not to exclude the basis of lung cancer, to be combined with lesions to the overall performance of a comprehensive analysis. based only on the calcification within lesions diagnosed as benign lesions is not desirable. I have two cases of hospital based only on the neglect of the other signs of calcification in the analysis was misdiagnosed as tuberculosis.
reasonable application of enhanced scan, according to disease shape, size, edge of the signs, pathological features of the internal structure, is adjacent peritumoral tissue CT, 85% to 90% of small lung cancer should be able to make a diagnosis, without enhancement. but there are a small part of the basic signs of lung cancer cases occur less , the performance is not typical, then the dynamic CT should be enhanced MRI lesions, differential diagnosis can provide useful information. such as dynamic contrast-enhanced scan can not confirm the diagnosis should be made by CT guided percutaneous biopsy or transbronchial lung biopsy , or short-term intervals after treatment. most of peripheral lung cancer in 1 to 3 months may have changed size.
2, the differential diagnosis of
(1) Tuberculosis: the edge of more smooth, clear, no leaf or only shallow leaf, can be a bit like or mottled, patchy calcification, may also have holes, the hole was at risk or crack like most around the lesion with satellite lesions, easily identified by these signs and lung cancer. within a few TB lesions for special treatment after discharge of caseous necrosis can be displayed vacuolar changes need to identify with bronchioloalveolar carcinoma, but the combination of lung cancer and other imaging characteristics of TB in general is not difficult to identify.
(2) hamartoma: a typical Hamartoma of fat and calcification within its symptoms were of the popcorn-like, smooth, sharp edge of the tumor more than a shallow leaf or leaf-free. individual cases neither calcification nor fat density, and leaf dark, at this time misdiagnosed as lung cancer. but occasionally leaf hamartoma can be deeper, the general absence of other malignant characteristics, such as burrs, air bronchogram, small cavities, such as pleural indentation, and no hilar and mediastinal lymph nodes, etc. signs. enhanced scan enhancement is not obvious, CT added value of more than <20HU.
(3) Other benign tumors: lesion density, smooth edge, notch leaf was not obvious, many fine, short spikes and saw no sign and pleural depression and other signs of malignancy.
(4) spherical pneumonia: more in the lower lung field, edge and more fuzzy, peripheral vascular texture increased, thickening, adjacent pleural reaction is more extensive lesions CT value is lower, more in the 20 ~ 25HU, often the clinical history of recent fever, increased white blood cells, the short-term (7 to 10 days) after infection resistance more than a narrow focus.
(5) small bronchogenic cyst: bronchogenic cyst containing fluid in the lungs, can be presented in isolation nodular shadows, CT showed a clear edge mass, density, CT value of 0 ~ 20HU, but when abundant protein components within the cyst, CT values of up to 20HU above, the performance of enhanced scan without enhancement. Sometimes there are lesions air into the gas density affect the formation of vacuoles is required and the identification of bronchioloalveolar carcinoma.
(6) fungal infections:
(7) arteriovenous fistula:
bronchioloalveolar carcinoma Imaging
PLA General Hospital Caizu Long Zhao Shaohong
bronchioloalveolar carcinoma, although still classified as lung cancer, but significantly different from other cancer, has its tissue and morphological characteristics, have different origins, performance and prognosis, and therefore, scholars believe that should the WHO classification of BAC from adenocarcinoma carved out, as lung cancer can exist independently of a type. In recent years, some research data shows that the developed countries, BAC were significantly increased. Barsky statistical analysis of 1955 1990 than 1527 cases of lung cancer constitutes the dynamic changes of various types found that squamous cell carcinoma from 56.1% (1955 to 1960) decreased to 22.2% (1986 to 1990); the same period, adenocarcinoma (including BAC) rose from 14.6% to 46.5%, much higher than squamous cell carcinoma. BAC's growth is particularly significant, from 1955 to 1960, only 5% of lung cancer, 70 years since the rapid rise to 1985 to 1990 reached 24%. squamous cell carcinoma is almost equal. rather than BAC lung cancer did not change significantly, indicating that the rise in lung cancer incidence rate increase was mainly due to BAC. This Auewbach (USA 1991) and Ikeda (*** 1991) of roughly the same results.
a , by gross pathology and clinical pathological
, BAC can be divided into three types: (1) solitary nodule: both in the lung periphery, in the pleura, the diameter of 0.7 ~ 4.5cm, round or slightly sub- lobulated, gray-white cut surface, usually without necrosis; (2) multiple nodules: the formation of nodules, scattered in the lung of the leaf or leaves, or lungs, nodules are still visible between the normal lung tissue; (3) diffuse: the number of cancer often leaves or lung involvement, texture hard, like a lobar pneumonia, it said the pneumonia-like type. section often has translucent material associated with mucus production. The first type of sputum examination was negative, the latter two types are mostly positive.
light microscope, the organizational structure and morphology under different, BAC can be divided into four types: (1) alveolar cell types: well differentiated cancer cells, columnar, along the original growth of the alveolar wall, similar to normal tissue formation and alveolar-like structures, and stromal invasion; (2) papillary type: lung structure essentially remains, but the prominent feature is the formation of many different sizes of nipple stretching alveolar cavity, the nipple is still some branches slender fibrovascular stroma formation of the axis, the above two types, PAS and Oseen blue staining, cells were negative; (3) mucous cell type: the cells lining the alveolar walls high columnar thin mucus can also be spread only a few cells in alveolar walls, in addition found in mucous cells, are also often filled with alveolar; (4) mixed type: the above three types of hybrid.
BAC, or a different tumors, electron microscope, the source of its four types: (1) Most of the cases originated in the terminal bronchioles ciliated Clara epithelial cells; (2) a small number of cells from alveolar type ��; (3) of the bronchioles Health breast epithelial mucin; (4) Mixed type: the existence of various types of cells were mixed.
isolated type BAC, the majority of patients with no symptoms, the examination found that a small number of patients may have cough, sputum, chest pain, etc. General respiratory symptoms chilblains, individual cases may have bloodshot sputum. diffuse BAC, the majority of patients with severe symptoms, mainly cough, sputum slightly white mucus, quantity, may also have bloody sputum, chest tightness, shortness of breath, chest pain, weight loss, clubbing finger and so on. generally do not heat, when the infection can be hot.
II, X-ray
bronchioloalveolar carcinoma has been a lot of X-ray findings reported in the literature, it can be divided into three types. (1) solitary nodule: lesions were round, pale round or sheet film, rough edges, partakers leaves, burrs, may have depression or pleural pleural tail sign, uneven density lesions, visible air bronchogram phase and vacuole sign. (2) inflammatory: lesions were more inflammatory lung segment or lobe-like consolidation, consolidation area density of the majority of high volume part of the enlarged or reduced, split between straight and curved leaf depression or to outside the carina, showing bronchial air like, honeycomb-shaped gas cavity or vacuole sign. (3) diffuse nodules: miliary and diffuse lung nodules dense shadow, ranging in size, uneven distribution of asymmetry, for the lower lung fields in two with some clear edge and some of the more vague, could be fused into a sheet film, and some showed an increase in mesh texture.
addition to the above three types, but still shows the existence of several mixed X-ray findings.
III, CT performance
bronchioloalveolar carcinoma in lung cancer accounts for about 2% ~ 24%, CT can be divided into isolated type, multi-nodular type and diffuse type.
(a ) isolated type: X-ray on the often ambiguous realm of fuzzy short film video, is often misdiagnosed as pulmonary tuberculosis or inflammation, or for lesions smaller and missed, but there are certain characteristics in the CT, the general can make correct diagnosis. According to the PLA General Hospital 63 cases of solitary bronchioloalveolar carcinoma of the CT signs and pathology research, and reported in the literature, isolated alveolar type addition to the general lung cancer CT signs (leaf, glitch, vascular convergence, pleural retraction, etc. ), there are the following characteristics: (1) lesions in the lung or pleural field next week. (2) can be star-shaped or irregular patchy. (3) vacuole sign (false lumen) appears high , BAC's vacuole sign about 52.38% (33/63). The so-called bubble sign is within the small focal nodular area of transmission, the diameter of <5mm, and the lung cavity to different, sometimes including the gas compartment irregular, ranging from the strip and the width was cystic. BAC vacuole sign of the pathological basis of tumor tissue that is not occupied by gas in lung tissue; not closed or expansion of small bronchi; papillary carcinoma of gas between the structure compartment (this is seen in papillary type); growth along the alveolar septum carcinoma bubble chamber is not closed and melting, destruction and expansion of the alveolar cavity, and sometimes internal cavity mucus, shedding of tumor cells in the presence of components can be made CT value is increased, the density similar to water. (4) thin air bronchogram: was thin strips (diameter l1mm) air density shadow, seen for several adjacent level, the pathology for the expansion of the bronchioles. its occurrence have a higher rate, about 33.3% (21/63). (5) cellular sign: the number of vesicles into the cellular concentration, more consistent in size, sometimes very fine vesicles, the lesions showed fine grid to change. (6) ground-glass density: the entire tumor nodule or nodules of the lighter part of the regional density of glassy mill was vague, it does not cover up the texture of pulmonary vascular lesions realm still clear. The pathological basis of the same tumor cells along the alveolar septum growth, alveolar wall thickening, but the alveolar space is not blocked, a small amount of mucus within the tumor cells or shedding. CT showed pathologic lesions of ground-glass density area of non-mucinous BAC, the consolidation of the alveolar region mucinous cancer. a ground-glass density that the Department of bronchioloalveolar carcinoma of the early signs, PET examination often is holiday, indicating that this time the slow tumor growth, metabolism, lower level. (7), pleural indentation rate of 85.91% occurs (54 / 63), the result of tumors located in the subpleural fibrous tissue and tumor characteristics of successful formation of fibrous tissue caused much about. (8) individual cases of disease shows high density and low density white granular change was mulberry-like.
(b ) multiple nodules: a lobe, or the side of the lung or lungs scattered distribution of nodules, nodule size range, shape and isolation of each type of BAC nodules similar.
(c) of the diffuse type: There are two cases: (1) In patients with more than one lung segment violation of a lobe or a few leaves; (2) numerous small nodules or small plaques distributed in both lungs filled with shadow. Since this type of lung cancer, a majority of cases for the mucous cell type, often secrete large amounts of mucus, can produce pulmonary consolidation and air bronchogram images, and blurred the edges of the shadow of consolidation, the boundary is unclear, it is in the film, is often mistaken for pneumonia or tuberculosis. this type BAC of about accounted for 37% of BAC cases, according to lesion morphology can be divided into four types: hive-based, real variant, multifocal, mixed. According to the literature can be grouped into five characteristic CT signs: (1) hive levy: The lesions uniform density region, showing honeycomb-like air chamber, large and small, are round and oval low density (close to the air). The pathological basis of cancer cell growth along the alveolar bronchioles, but does not destroy its basic structure, and its irregular thickening of the alveolar space it exists in varying degrees. This sign and air bronchogram exist, there are qualitative significance. (2) The air bronchogram: acute inflammatory diseases in general is different from its bronchial wall is characterized by irregular, uneven, narrow universality; bronchus was stiff, twisted; mainly large developing bronchi, small bronchi and more can not be displayed, showing dendritic dry, the air bronchography with pneumonia symptoms performance difference. (3) ground-glass signs: involvement of lung tissue was similar to the density of water samples showed a grid-like structure of ground glass appearance, based on the pathological thickening of the alveolar septum involvement within the framework composed of protein full of mucus or other exudate . (4) consolidation of lung segments and angiogram sign: increased visibility before scanning lobe or lung lesions in the distribution segment, showing wedge consolidation, hilar lesions sharp point, attached to the external and pleural; density, uniform, edge straight, can also be slightly convex or concave, without air bronchogram; enhanced low-density region shows uniform enhancement of vascular dendritic film. (5) patchy distribution of both lungs filled with nodules. individual cases, nodular or cystic changes within the cavity, suggesting it may be the cause of nodule central necrosis, is more likely with the terminal bronchioles of the valve obstruction. (6) Observation: There were increasing, increasing .
IV diagnosis and differential diagnosis
(a) Solitary bronchioloalveolar carcinoma: the addition of a solitary pulmonary nodules with CT signs of the general lung cancer: a leaf, glitch, pleural indentation, vascular convergence and other signs of In addition, as CT also has some other features, such as lesions located in peripheral or subpleural, was under the sheet or stellate lesions uneven density, with fine air bronchogram film, bubble sign (false lumen), hive levy, symptoms such as ground glass, generally suggest the diagnosis of BAC. in which symptoms and ground-glass cellular rarely in other types of lung cancer symptoms appear, has high diagnostic value. of the performance is still seen as the only three cases of uneven density, showing particles like high density, surrounded by signs of low density, such signs have not yet isolated in other types of nodules seen, so the importance of the diagnosis of BAC.
isolated type BAC and other isolated lesions need to identify The main consideration should be given the following lesions.
1. TB nodules or tuberculoma: the majority of lesions leaf edges smooth and no glitches, calcified lesions seen in the meticulous manner, the distribution was diffuse or uniform consistency, CT value of the tall in 160Hu, may have marginal empty, showing crack-like or crescent around most of them have satellite lesions, localized pleural thickening more common, generally is not difficult to identify with the BAC. but the individual TB change, caseous necrosis after discharge reduce the density of small bubble formation zone, exactly like the false lumen BAC, can lead to misdiagnosis. at this time whether the BAC should be noted that other features of disease, such as pleural indentation, vascular convergence sign, air bronchogram, etc., no such signs of TB and more.
2. small bronchogenic cyst: bronchogenic cyst containing fluid in the lungs showed a solitary nodule can, CT showed a sharp smooth edges, uniform density, CT value between 0 ~ 20Hu, generally have no difficulty in identification. But when cyst proteins to become rich, the up 30Hu above, the secondary infection, cysts and more individual bronchioles no pleural indentation, vascular sets grams, etc., void as the air density, through the brightness is high, the BAC of the false lumen and the general ( often fluid and cellular components within, CT value is slightly higher than the air) different.
3. metastases: metastases have various forms, usually multiple lesions, different size, shape similarity, as metastases from the lung capillary vein, and therefore no relationship between lesion and bronchial. Solitary metastases, smooth edges, burrs and saw no more sign, air bronchogram and bubble-free sign.
4. spherical pneumonia: mostly round or oval edge less clear and uniform density of solid lesions, peripheral vascular thickening texture (no vascular cluster), adjacent pleural reaction significant short-term review of anti-infection treatment gradually reduced.
5. and can produce changes in ground-glass-like disease identification: the limitations of this type of lesion of lung infection, eosinophilia disease, hemoptysis into the lungs, intestines and pancreas, and lung metastasis. realm of the obscure diseases of pulmonary infection, irrespective of leaf change, and AC disease state more than clear, often accompanied by vacuoles, and many partakers leaves. hemoptysis in patients with pulmonary ground-glass amorphous, no leaf, no other signs of lung cancer. eosinophilia syndrome with focal infection of CT performance similar; blood eosinophilia diagnosis. bowel and pancreas lung metastasis of primary tumor manifestation. In short, on the ground glass can produce pathological changes in addition to attention to morphological identification, the should be closely combined with clinical performance, to analyze and judge, and can be an accurate identification.
(b) of the diffuse type bronchioloalveolar carcinoma (DBAC): DBAC the CT signs of varying degrees of specificity, and each sign both may appear alone, but also exist, several combined can greatly improve the accuracy of diagnosis. hive-like translucent areas, two each with ground-glass air bronchogram sign (dead tree sign) or to review the increase to determine diagnosis. above (1), (2), (3) individual should be highly suspect of the disease. uniform consolidation plus single (6) should think of the possibility of DABC.
because DBAC lung segment or lobe to the distribution of edge blur has air bronchogram and so easy to mistakenly believe that lobar pneumonia with caseous pneumonia, was uniform when the DBAC consolidation with atelectasis similar air bronchogram within the consolidation and lymph node disease in lymphoma fungoides can also be appears to diffuse small nodules performance DBAC resemble miliary tuberculosis, should be careful to distinguish these lesions.
1, lobar pneumonia: typical CT imaging showed signs of bronchial air, the bronchial wall soft, non- rigid sense, the natural branches, bronchial diameter by the coarse to fine, like the liver-like branches, and DBAC the air bronchogram showed a leafless tree is like. lobar pneumonia is not associated with cellular levy levy and ground glass, often significantly history of acute infection.
2. Tuberculous pneumonia: bronchial angiography shows typical air sign, often accompanied by a variety of other lung field tuberculosis, tuberculous intoxication obvious clinical symptoms.
3. lymphomatoid granuloma: air bronchogram may have, it should DBAC identification. The former lesion often has agglomerate density more uniform, state clearly, do not sign with the ground glass with cellular sign, lesion development was slow.
4 . Lymphoma: Can the distribution was segmental and lobar have air bronchogram, and DBAC similarities, but mostly air bronchogram inflatable bronchial tree trunk, bronchial edge smooth, no dead branches like change. is not accompanied by signs and ground glass hive levy.
5. atelectasis: general significantly smaller in size, leaves significant shift between the split and concave arc, compensatory emphysema adjacent lung tissue, and DBAC real variable volume reduced light, leaves were split between the limitations and wavy convex, the adjacent lung tissue was no significant compensatory changes.
6. miliary tuberculosis: diffuse distribution of small nodules, density, even size, uniform issued; edge of the fuzzy segment, showing interstitial distribution. DBAC the size of small nodules often uneven, the edge clearer, distribution to the middle and lower lung field as the combination of clinical, generally can be identified between the two.
more slice spiral CT in the chest, the application of PLA General Hospital Caizu Long
Caizu Long
Lung cancer is one of the most common malignant tumor. In recent years, the incidence of lung cancer was significantly increase. Beijing, Shanghai , Tianjin, Jiangsu and Liaoning Province, the city, Yunnan old areas, the incidence of lung cancer and / or mortality accounts for a variety of malignant tumors of the first. more than the time of diagnosis of lung cancer has been to the middle and late, 70 to 80% of patients had lost radical opportunity to improve the five-year survival rate of patients is very important. CT is the most important early peripheral lung cancer, the most reliable screening method.
one routine inspection methods
do first scan, slice thickness 8-10mm to determine the anatomical lesions. and then the line of lesion thickness of 1.5 to 3.0 HRCT scan or continuous scan. such as the spiral, the lesion can be 3mm thick volume scan, then 1 ~ 3mm reconstruction. The scan can be made lesions of the internal structure and its adjacent edge features clearly show the relationship between organizational structure. If there are difficulties in diagnosis who do dynamic enhanced MRI lesions in order to strengthen the situation of the lesions observed.
CT of small peripheral lung cancer characteristics and signs The pathological basis of
1, signs of lung tumor edge features:
(1) lobulation: small peripheral lung cancer is the most common basic signs. hospital 100 cases of small-diameter less than 3cm of lung lobulation rate was 84%. the vast majority of small lung cancer dark leaf, from the long chord distance and the ratio of> 2 / 5. The pathological basis of one edge of each part of the tumor with varying degrees of tumor cell differentiation, the growth rate of the different relevant . Second, the interval of the lung tissue into the tumor's blood vessels, bronchi branch out from the growth of tumor blood vessels and connective tissue can cause tumor growth retardation; have lacunae, thus forming a leaf shape.
( 2) The rough edges: see fine, short spikes, spike-like protrusions or jagged changes. This is a common sign of lung cancer, the occurrence rate of about%, the performance is due to the tumor stroma, blood vessels outside the tumor growth and spread of tumor cells into the surrounding due.
2, the performance characteristics of CT within the tumor: the majority of the density of small peripheral lung cancer than the uniform, may have vacuole sign, thin air bronchogram, ground-glass honeycomb sign and symptoms, a few cases can still see the calcification .
(1) bubble sign: Refers to the small focal nodular area of sexual transmission. The diameter of <5mm, and lung cancer to empty distinction. can be single or multiple. such as the number of dense vesicles gathered in with honeycomb, said honeycomb sign. The pathological basis for the tumor tissue is not occupied �� gas lung tissue; �� not closed or expansion of small bronchi; �� papillary carcinoma gas cavities between the structure; �� along the alveolar wall growth of alveolar carcinoma and melting is not closed, alveolar destruction and enlargement; �� small focal necrosis within the tumor formed after discharge. This levy more common in bronchioloalveolar carcinoma and adenocarcinoma, is also found in squamous cell carcinoma. Sometimes, the vacuoles internal mucus, shedding of tumor cells in the presence of such components can be made higher CT value, approximate density of water. in the lung appear as a small window on the fuzzy low density bubble in the mediastinal window showed a small bubble on the translucent film.
(2) thin air bronchogram: was thin strip, about 1mm diameter, air density shadow, or in a small bubble-like (diameter <1mm = air density shadow, seen for several consecutive adjacent level, pathology for the expansion of the bronchioles. found in bronchioloalveolar carcinoma or adenocarcinoma.
(3) Cellular Characteristics: integration by a number of cellular vesicles, more consistent in size, this sign only in lung cancer. pathology is the growth of cancer cells along the alveolar walls, alveolar space is not closed, so that mucus left over from the expansion chamber.
(4) ground-glass sign: the whole part of the tumor nodule or nodules were ground area density glassy lighter, it does not pulmonary vascular cover texture. lesion state general still clear. The pathological basis of the growth of tumor cells along the alveolar wall, alveolar wall thickening, but did not block the alveolar cavity, a small amount of mucus within the tumor or off, this sign only in lung cancer .
(5) empty: To more than 5mm round or oval-like low density of air, hospital 100 cases of small peripheral lung cancer occurred within the cavity was 4%. a small hole in the wall thickness of lung cancer is not thin are, uneven wall, there are mural nodule. hole was centered or eccentric place. individual cases meager wall. the edge of the tumor was still visible changes in leaf and burr. empty most of the tumor necrosis Department of liquefied bronchial interlinked, formed after discharge.
(6) calcification: within small peripheral lung cancer with calcification. HRCT reported in the literature on the detection of lung cancer calcification rate can reach 15.8%. our hospital report 100 patients with small lung CT scan detected by TLC 3 cases. calcification showed fine gravel-like, small nodular, diffuse, or indulge in the side of the distribution.
calcification mainly seen in squamous cell lung cancer, adenocarcinoma. The pathological basis �� dystrophic calcification. due to tumor blood supply barriers, tumor cell degeneration, necrosis, local calcium level changes, calcium deposits; �� calcification of the tumor had wrapped before, occurred in the pre-existing calcified granuloma; �� calcification of the primary tumor, mainly seen in mucinous adenocarcinoma. < br> 3, the tumor adjacent to the CT signs of structural change (1) vascular accumulation sign: is gathered around the blood vessels to the nodules. vessels in the tumor edge interrupt or through the tumor. artery and vein may be involved. For the good of them involving the pulmonary vein, is important to identify malignant. Despite reports in the literature of benign lesions are also visible signs of vascular accumulation, but our experience gathered benign vascular lesion detection rate is not high, and reach of small lung cancer. (2), pleural indentation: There are three main performance: �� When the recessed center and the level of parallel scan showed pleural indentation mm typical of tumors and adjacent chest wall or between the triangular shadow, said bell, and its tip is connected with the linear opacities; �� When the level of deviation from the depression center, the line shaped into a film by the two or more, sometimes with the tumor gradually reflected in its separate video from a big big triangle into two smaller triangles; �� level of crack and oblique attack showed pleural indentation curves shadow. Zhiyong Zhang reports of small peripheral lung cancer detection rate of pleural indentation 93%. mainly seen in the adenocarcinoma and bronchioloalveolar carcinoma. The pathological basis of the general opinion of the lesions caused by fibrous scar tissue contraction. cicatricial contraction of fiber grid near the tumor passes through to the visceral pleura, the visceral pleura pull to the tumor foci. indentation and the parietal pleura gap between the composition, the liquid filling the living rational.
(3) pleural tumor shadow on fuzzy little piece, there is about 10% for the small signs of bronchial obstruction.
(4) satellite lesions: In addition to individual cases of adenocarcinoma lesions can occur outside the sub, all showed solitary nodules, no satellite lesions, the Court was no case of 100 patients with small lung cancer satellite lesions.
4, the CT enhancement characteristics of lung cancer and benign lesions
between the blood supply and metabolism are very different, so the use of enhanced MRI in differentiating benign and malignant lesions is important.
first foreign scholars Swenson report of 163 nodules enhanced scan results, including 111 malignant nodules (lung cancer and metastases) the median increase was 40HU, (20 ~ 108HU), and 58 benign lesions, the median increase was only 12HU. with 20HU as a threshold for distinguishing benign and malignant tumors was 100% sensitivity, specificity and accuracy were 76.9% and 92.6%. Yama *** a threshold such as the use of 20HU the findings of the study and about the same. Zhang Minming other diameter of 65 <3cm in the determination of solitary pulmonary nodules increased its rate of time-density curve, peak, and flow perfusion and contrast enhancement patterns between benign and malignant tumors vary. Malignant tumors of the curve rises faster than fast curve after the peak remained at high values. inflammation type, vary between benign and malignant tumors. rate of malignant tumors of the curve rises rapidly, peaking after the curve remained at high values. inflammatory mass of the time-density curve rises faster and the peak high peak decreased slightly after the curve, and then increased again. benign tumor of the time density curve low and flat, or almost no increase. malignancies enhanced peak 41.9HU, inflammatory mass of the peak 43.6HU, benign tumors were significantly higher than the peak (13.4HU). malignancies and inflammatory mass of the blood flow was significantly higher than benign tumor blood flow. enhance the way there are also different, 55% of malignant nodules showed significantly enhanced uniform, begins as a 30% increase is not homogeneous, but most of them gradually after the peak tends to increase homogeneity, and inflammatory tumors in the peripheral part of the increased heterogeneity of the main, and mostly benign tumors do not enhance or edge enhanced.
In short, the enhanced features of lung cancer can be summarized as �� enhanced amplitude, over 20HU; �� time density curve rises faster; �� high blood flow; �� 85% of patients ultimately homogeneous enhancement. These characteristics and lung cancer The new small blood vessels and structural features more relevant, and strong on the tumor tissue metabolism.
three different histological types of lung cancer CT of small peripheral performance analysis
some histological types of lung cancer CT manifestations of small certain characteristics, according to these characteristics, can be broadly inferred their histological type.
1, BAC Bronchioalveala Carcionma abbreviated BAC: Case of large numbers in the subpleural or near the leaves of the pleura, irregular shape, were small pieces and can be star, the internal structure of features, the main signs of air-bronchogram, bubble sign, cellular sign, ground-glass sign, the signs appear high. hospital 63 cases of solitary bronchioloalveolar carcinoma incidence of vacuole sign ( 33) 52.38%, air bronchogram in 21 cases (33.33%), ground-glass sign in 12 cases (19.04%). including ground-glass sign with alveolar cell carcinoma-specific symptoms only. of the performance is still seen as the only two cases uniform density, the density was reduced with the increase of grain like mulberry-like changes.
2, adenocarcinoma: leaf, glitches, blood vessels together, depression and other signs of pleural more significant. vacuole sign and air bronchogram are more common. a small number of vacuoles and more than bronchioloalveolar carcinoma. sometimes see multiple foci, the Department developed on the basis several times due to scar; disease that is relatively small shift, but also a feature of large metastases.
3, squamous cell carcinoma: The main signs are deeply divided leaves, small focal necrosis in the formation of vesicles or empty sign, burr and sawtooth sign, pleural indentation, such as adenocarcinoma of the typical vascular aggregation.
4, small cell carcinoma: peripheral Small cell carcinoma of the lack of the cancer, lung cancer, which has a leaf, glitches, such as cavitation and air bronchogram signs, often very small tumors have significant hilar and mediastinal lymph node metastasis and distant metastasis. lesion itself over the edge finishing, no leaf, density of cross-over are exactly like benign tumors. When the detection of brain metastases, and 10 ~ 15%, can also be transferred to the contralateral lung, adrenal gland, liver, etc..
IV lung cancer Diagnosis and differential diagnosis of
1, lung cancer should be aware of the following links
(1) to correctly identify the basic signs of lung cancer, and a deep understanding of the pathological significance of their representatives, this is the premise correct diagnosis of lung cancer.
(3) improve the diagnosis of some special significance signs of awareness. such as ground-glass density, lighter and its symptoms easily misdiagnosed as inflammatory disease. According to our experience, this is very bronchioloalveolar carcinoma diagnosis, low-density and high density granular same lesions in addition to outside BAC not yet seen. pleural side of the fuzzy little piece of film I saw in the cancer nodules.
(4) on the significance of calcification: calcified lesions appear not to exclude the basis of lung cancer, to be combined with lesions to the overall performance of a comprehensive analysis. based only on the calcification within lesions diagnosed as benign lesions is not desirable. I have two cases of hospital based only on the neglect of the other signs of calcification in the analysis was misdiagnosed as tuberculosis.
reasonable application of enhanced scan, according to disease shape, size, edge of the signs, pathological features of the internal structure, is adjacent peritumoral tissue CT, 85% to 90% of small lung cancer should be able to make a diagnosis, without enhancement. but there are a small part of the basic signs of lung cancer cases occur less , the performance is not typical, then the dynamic CT should be enhanced MRI lesions, differential diagnosis can provide useful information. such as dynamic contrast-enhanced scan can not confirm the diagnosis should be made by CT guided percutaneous biopsy or transbronchial lung biopsy , or short-term intervals after treatment. most of peripheral lung cancer in 1 to 3 months may have changed size.
2, the differential diagnosis of
(1) Tuberculosis: the edge of more smooth, clear, no leaf or only shallow leaf, can be a bit like or mottled, patchy calcification, may also have holes, the hole was at risk or crack like most around the lesion with satellite lesions, easily identified by these signs and lung cancer. within a few TB lesions for special treatment after discharge of caseous necrosis can be displayed vacuolar changes need to identify with bronchioloalveolar carcinoma, but the combination of lung cancer and other imaging characteristics of TB in general is not difficult to identify.
(2) hamartoma: a typical Hamartoma of fat and calcification within its symptoms were of the popcorn-like, smooth, sharp edge of the tumor more than a shallow leaf or leaf-free. individual cases neither calcification nor fat density, and leaf dark, at this time misdiagnosed as lung cancer. but occasionally leaf hamartoma can be deeper, the general absence of other malignant characteristics, such as burrs, air bronchogram, small cavities, such as pleural indentation, and no hilar and mediastinal lymph nodes, etc. signs. enhanced scan enhancement is not obvious, CT added value of more than <20HU.
(3) Other benign tumors: lesion density, smooth edge, notch leaf was not obvious, many fine, short spikes and saw no sign and pleural depression and other signs of malignancy.
(4) spherical pneumonia: more in the lower lung field, edge and more fuzzy, peripheral vascular texture increased, thickening, adjacent pleural reaction is more extensive lesions CT value is lower, more in the 20 ~ 25HU, often the clinical history of recent fever, increased white blood cells, the short-term (7 to 10 days) after infection resistance more than a narrow focus.
(5) small bronchogenic cyst: bronchogenic cyst containing fluid in the lungs, can be presented in isolation nodular shadows, CT showed a clear edge mass, density, CT value of 0 ~ 20HU, but when abundant protein components within the cyst, CT values of up to 20HU above, the performance of enhanced scan without enhancement. Sometimes there are lesions air into the gas density affect the formation of vacuoles is required and the identification of bronchioloalveolar carcinoma.
(6) fungal infections:
(7) arteriovenous fistula:
bronchioloalveolar carcinoma Imaging
PLA General Hospital Caizu Long Zhao Shaohong
bronchioloalveolar carcinoma, although still classified as lung cancer, but significantly different from other cancer, has its tissue and morphological characteristics, have different origins, performance and prognosis, and therefore, scholars believe that should the WHO classification of BAC from adenocarcinoma carved out, as lung cancer can exist independently of a type. In recent years, some research data shows that the developed countries, BAC were significantly increased. Barsky statistical analysis of 1955 1990 than 1527 cases of lung cancer constitutes the dynamic changes of various types found that squamous cell carcinoma from 56.1% (1955 to 1960) decreased to 22.2% (1986 to 1990); the same period, adenocarcinoma (including BAC) rose from 14.6% to 46.5%, much higher than squamous cell carcinoma. BAC's growth is particularly significant, from 1955 to 1960, only 5% of lung cancer, 70 years since the rapid rise to 1985 to 1990 reached 24%. squamous cell carcinoma is almost equal. rather than BAC lung cancer did not change significantly, indicating that the rise in lung cancer incidence rate increase was mainly due to BAC. This Auewbach (USA 1991) and Ikeda (*** 1991) of roughly the same results.
a , by gross pathology and clinical pathological
, BAC can be divided into three types: (1) solitary nodule: both in the lung periphery, in the pleura, the diameter of 0.7 ~ 4.5cm, round or slightly sub- lobulated, gray-white cut surface, usually without necrosis; (2) multiple nodules: the formation of nodules, scattered in the lung of the leaf or leaves, or lungs, nodules are still visible between the normal lung tissue; (3) diffuse: the number of cancer often leaves or lung involvement, texture hard, like a lobar pneumonia, it said the pneumonia-like type. section often has translucent material associated with mucus production. The first type of sputum examination was negative, the latter two types are mostly positive.
light microscope, the organizational structure and morphology under different, BAC can be divided into four types: (1) alveolar cell types: well differentiated cancer cells, columnar, along the original growth of the alveolar wall, similar to normal tissue formation and alveolar-like structures, and stromal invasion; (2) papillary type: lung structure essentially remains, but the prominent feature is the formation of many different sizes of nipple stretching alveolar cavity, the nipple is still some branches slender fibrovascular stroma formation of the axis, the above two types, PAS and Oseen blue staining, cells were negative; (3) mucous cell type: the cells lining the alveolar walls high columnar thin mucus can also be spread only a few cells in alveolar walls, in addition found in mucous cells, are also often filled with alveolar; (4) mixed type: the above three types of hybrid.
BAC, or a different tumors, electron microscope, the source of its four types: (1) Most of the cases originated in the terminal bronchioles ciliated Clara epithelial cells; (2) a small number of cells from alveolar type ��; (3) of the bronchioles Health breast epithelial mucin; (4) Mixed type: the existence of various types of cells were mixed.
isolated type BAC, the majority of patients with no symptoms, the examination found that a small number of patients may have cough, sputum, chest pain, etc. General respiratory symptoms chilblains, individual cases may have bloodshot sputum. diffuse BAC, the majority of patients with severe symptoms, mainly cough, sputum slightly white mucus, quantity, may also have bloody sputum, chest tightness, shortness of breath, chest pain, weight loss, clubbing finger and so on. generally do not heat, when the infection can be hot.
II, X-ray
bronchioloalveolar carcinoma has been a lot of X-ray findings reported in the literature, it can be divided into three types. (1) solitary nodule: lesions were round, pale round or sheet film, rough edges, partakers leaves, burrs, may have depression or pleural pleural tail sign, uneven density lesions, visible air bronchogram phase and vacuole sign. (2) inflammatory: lesions were more inflammatory lung segment or lobe-like consolidation, consolidation area density of the majority of high volume part of the enlarged or reduced, split between straight and curved leaf depression or to outside the carina, showing bronchial air like, honeycomb-shaped gas cavity or vacuole sign. (3) diffuse nodules: miliary and diffuse lung nodules dense shadow, ranging in size, uneven distribution of asymmetry, for the lower lung fields in two with some clear edge and some of the more vague, could be fused into a sheet film, and some showed an increase in mesh texture.
addition to the above three types, but still shows the existence of several mixed X-ray findings.
III, CT performance
bronchioloalveolar carcinoma in lung cancer accounts for about 2% ~ 24%, CT can be divided into isolated type, multi-nodular type and diffuse type.
(a ) isolated type: X-ray on the often ambiguous realm of fuzzy short film video, is often misdiagnosed as pulmonary tuberculosis or inflammation, or for lesions smaller and missed, but there are certain characteristics in the CT, the general can make correct diagnosis. According to the PLA General Hospital 63 cases of solitary bronchioloalveolar carcinoma of the CT signs and pathology research, and reported in the literature, isolated alveolar type addition to the general lung cancer CT signs (leaf, glitch, vascular convergence, pleural retraction, etc. ), there are the following characteristics: (1) lesions in the lung or pleural field next week. (2) can be star-shaped or irregular patchy. (3) vacuole sign (false lumen) appears high , BAC's vacuole sign about 52.38% (33/63). The so-called bubble sign is within the small focal nodular area of transmission, the diameter of <5mm, and the lung cavity to different, sometimes including the gas compartment irregular, ranging from the strip and the width was cystic. BAC vacuole sign of the pathological basis of tumor tissue that is not occupied by gas in lung tissue; not closed or expansion of small bronchi; papillary carcinoma of gas between the structure compartment (this is seen in papillary type); growth along the alveolar septum carcinoma bubble chamber is not closed and melting, destruction and expansion of the alveolar cavity, and sometimes internal cavity mucus, shedding of tumor cells in the presence of components can be made CT value is increased, the density similar to water. (4) thin air bronchogram: was thin strips (diameter l1mm) air density shadow, seen for several adjacent level, the pathology for the expansion of the bronchioles. its occurrence have a higher rate, about 33.3% (21/63). (5) cellular sign: the number of vesicles into the cellular concentration, more consistent in size, sometimes very fine vesicles, the lesions showed fine grid to change. (6) ground-glass density: the entire tumor nodule or nodules of the lighter part of the regional density of glassy mill was vague, it does not cover up the texture of pulmonary vascular lesions realm still clear. The pathological basis of the same tumor cells along the alveolar septum growth, alveolar wall thickening, but the alveolar space is not blocked, a small amount of mucus within the tumor cells or shedding. CT showed pathologic lesions of ground-glass density area of non-mucinous BAC, the consolidation of the alveolar region mucinous cancer. a ground-glass density that the Department of bronchioloalveolar carcinoma of the early signs, PET examination often is holiday, indicating that this time the slow tumor growth, metabolism, lower level. (7), pleural indentation rate of 85.91% occurs (54 / 63), the result of tumors located in the subpleural fibrous tissue and tumor characteristics of successful formation of fibrous tissue caused much about. (8) individual cases of disease shows high density and low density white granular change was mulberry-like.
(b ) multiple nodules: a lobe, or the side of the lung or lungs scattered distribution of nodules, nodule size range, shape and isolation of each type of BAC nodules similar.
(c) of the diffuse type: There are two cases: (1) In patients with more than one lung segment violation of a lobe or a few leaves; (2) numerous small nodules or small plaques distributed in both lungs filled with shadow. Since this type of lung cancer, a majority of cases for the mucous cell type, often secrete large amounts of mucus, can produce pulmonary consolidation and air bronchogram images, and blurred the edges of the shadow of consolidation, the boundary is unclear, it is in the film, is often mistaken for pneumonia or tuberculosis. this type BAC of about accounted for 37% of BAC cases, according to lesion morphology can be divided into four types: hive-based, real variant, multifocal, mixed. According to the literature can be grouped into five characteristic CT signs: (1) hive levy: The lesions uniform density region, showing honeycomb-like air chamber, large and small, are round and oval low density (close to the air). The pathological basis of cancer cell growth along the alveolar bronchioles, but does not destroy its basic structure, and its irregular thickening of the alveolar space it exists in varying degrees. This sign and air bronchogram exist, there are qualitative significance. (2) The air bronchogram: acute inflammatory diseases in general is different from its bronchial wall is characterized by irregular, uneven, narrow universality; bronchus was stiff, twisted; mainly large developing bronchi, small bronchi and more can not be displayed, showing dendritic dry, the air bronchography with pneumonia symptoms performance difference. (3) ground-glass signs: involvement of lung tissue was similar to the density of water samples showed a grid-like structure of ground glass appearance, based on the pathological thickening of the alveolar septum involvement within the framework composed of protein full of mucus or other exudate . (4) consolidation of lung segments and angiogram sign: increased visibility before scanning lobe or lung lesions in the distribution segment, showing wedge consolidation, hilar lesions sharp point, attached to the external and pleural; density, uniform, edge straight, can also be slightly convex or concave, without air bronchogram; enhanced low-density region shows uniform enhancement of vascular dendritic film. (5) patchy distribution of both lungs filled with nodules. individual cases, nodular or cystic changes within the cavity, suggesting it may be the cause of nodule central necrosis, is more likely with the terminal bronchioles of the valve obstruction. (6) Observation: There were increasing, increasing .
IV diagnosis and differential diagnosis
(a) Solitary bronchioloalveolar carcinoma: the addition of a solitary pulmonary nodules with CT signs of the general lung cancer: a leaf, glitch, pleural indentation, vascular convergence and other signs of In addition, as CT also has some other features, such as lesions located in peripheral or subpleural, was under the sheet or stellate lesions uneven density, with fine air bronchogram film, bubble sign (false lumen), hive levy, symptoms such as ground glass, generally suggest the diagnosis of BAC. in which symptoms and ground-glass cellular rarely in other types of lung cancer symptoms appear, has high diagnostic value. of the performance is still seen as the only three cases of uneven density, showing particles like high density, surrounded by signs of low density, such signs have not yet isolated in other types of nodules seen, so the importance of the diagnosis of BAC.
isolated type BAC and other isolated lesions need to identify The main consideration should be given the following lesions.
1. TB nodules or tuberculoma: the majority of lesions leaf edges smooth and no glitches, calcified lesions seen in the meticulous manner, the distribution was diffuse or uniform consistency, CT value of the tall in 160Hu, may have marginal empty, showing crack-like or crescent around most of them have satellite lesions, localized pleural thickening more common, generally is not difficult to identify with the BAC. but the individual TB change, caseous necrosis after discharge reduce the density of small bubble formation zone, exactly like the false lumen BAC, can lead to misdiagnosis. at this time whether the BAC should be noted that other features of disease, such as pleural indentation, vascular convergence sign, air bronchogram, etc., no such signs of TB and more.
2. small bronchogenic cyst: bronchogenic cyst containing fluid in the lungs showed a solitary nodule can, CT showed a sharp smooth edges, uniform density, CT value between 0 ~ 20Hu, generally have no difficulty in identification. But when cyst proteins to become rich, the up 30Hu above, the secondary infection, cysts and more individual bronchioles no pleural indentation, vascular sets grams, etc., void as the air density, through the brightness is high, the BAC of the false lumen and the general ( often fluid and cellular components within, CT value is slightly higher than the air) different.
3. metastases: metastases have various forms, usually multiple lesions, different size, shape similarity, as metastases from the lung capillary vein, and therefore no relationship between lesion and bronchial. Solitary metastases, smooth edges, burrs and saw no more sign, air bronchogram and bubble-free sign.
4. spherical pneumonia: mostly round or oval edge less clear and uniform density of solid lesions, peripheral vascular thickening texture (no vascular cluster), adjacent pleural reaction significant short-term review of anti-infection treatment gradually reduced.
5. and can produce changes in ground-glass-like disease identification: the limitations of this type of lesion of lung infection, eosinophilia disease, hemoptysis into the lungs, intestines and pancreas, and lung metastasis. realm of the obscure diseases of pulmonary infection, irrespective of leaf change, and AC disease state more than clear, often accompanied by vacuoles, and many partakers leaves. hemoptysis in patients with pulmonary ground-glass amorphous, no leaf, no other signs of lung cancer. eosinophilia syndrome with focal infection of CT performance similar; blood eosinophilia diagnosis. bowel and pancreas lung metastasis of primary tumor manifestation. In short, on the ground glass can produce pathological changes in addition to attention to morphological identification, the should be closely combined with clinical performance, to analyze and judge, and can be an accurate identification.
(b) of the diffuse type bronchioloalveolar carcinoma (DBAC): DBAC the CT signs of varying degrees of specificity, and each sign both may appear alone, but also exist, several combined can greatly improve the accuracy of diagnosis. hive-like translucent areas, two each with ground-glass air bronchogram sign (dead tree sign) or to review the increase to determine diagnosis. above (1), (2), (3) individual should be highly suspect of the disease. uniform consolidation plus single (6) should think of the possibility of DABC.
because DBAC lung segment or lobe to the distribution of edge blur has air bronchogram and so easy to mistakenly believe that lobar pneumonia with caseous pneumonia, was uniform when the DBAC consolidation with atelectasis similar air bronchogram within the consolidation and lymph node disease in lymphoma fungoides can also be appears to diffuse small nodules performance DBAC resemble miliary tuberculosis, should be careful to distinguish these lesions.
1, lobar pneumonia: typical CT imaging showed signs of bronchial air, the bronchial wall soft, non- rigid sense, the natural branches, bronchial diameter by the coarse to fine, like the liver-like branches, and DBAC the air bronchogram showed a leafless tree is like. lobar pneumonia is not associated with cellular levy levy and ground glass, often significantly history of acute infection.
2. Tuberculous pneumonia: bronchial angiography shows typical air sign, often accompanied by a variety of other lung field tuberculosis, tuberculous intoxication obvious clinical symptoms.
3. lymphomatoid granuloma: air bronchogram may have, it should DBAC identification. The former lesion often has agglomerate density more uniform, state clearly, do not sign with the ground glass with cellular sign, lesion development was slow.
4 . Lymphoma: Can the distribution was segmental and lobar have air bronchogram, and DBAC similarities, but mostly air bronchogram inflatable bronchial tree trunk, bronchial edge smooth, no dead branches like change. is not accompanied by signs and ground glass hive levy.
5. atelectasis: general significantly smaller in size, leaves significant shift between the split and concave arc, compensatory emphysema adjacent lung tissue, and DBAC real variable volume reduced light, leaves were split between the limitations and wavy convex, the adjacent lung tissue was no significant compensatory changes.
6. miliary tuberculosis: diffuse distribution of small nodules, density, even size, uniform issued; edge of the fuzzy segment, showing interstitial distribution. DBAC the size of small nodules often uneven, the edge clearer, distribution to the middle and lower lung field as the combination of clinical, generally can be identified between the two.
more slice spiral CT in the chest, the application of PLA General Hospital Caizu Long
Subscribe to:
Posts (Atom)