第六普通外科 肝胆移植外科

10 of Today’s Hottest Jobs]What did we look for? Fields of study with grads—both recent grads within the past five years and those well into their careers—who enjoy an attractive combination of big paychecks and abundant employment opportunities. The undergraduate programs that we ranked can take from two to five years to complete.Take a peek at our list of the ten best college majors for your career.1. Pharmacy and PharmacologyThinkstockUnemployment rate: 3.2%Unemployment rate for recent grads: 5.4%Median salary: $105,000Median salary for recent grads: $51,200Projected job growth for this field, 2010–2020: 25%A pharmacy major can be a bit of an investment, since most states require students to earn a post-grad degree to work as a pharmacist. However, pharmacologists, who don’t necessarily require graduate training, can land jobs right out of college. Public and private labs hire recent grads to research drugs and drug interactions. But whether pharmacy undergrads go on to med school, research or some related field, they can expect to earn big salaries fast. Pharmacists stand to make six figures working in hospitals and stores. Both programs involve pharmacology, toxicology and ethics classes—and promise plenty of jobs when class lets out. Even among recent grads, unemployment is a low 5.4%.2. NursingUnemployment rate: 2.2%Unemployment rate for recent grads: 4.0%Median salary: $60,000Median salary for recent grads: $48,000Projected job growth for this field, 2010–2020: 26%Nursing has always made for a steady, well-paid career, but it's looking especially good as baby-boomers age. Demand for nurses is way up, so unemployment, even among new grads, is down. Nursing majors study a predictable list of health care subjects including anatomy, physiology and biology. While you can score an R.N. certification after two years, nurses with bachelor's degrees generally enjoy better salaries, earning potential and advancement opportunities than their less-educated peers.3. Transportation Sciences and TechnologyThinkstockUnemployment rate: 4.4%Unemployment rate for recent grads: N/AMedian salary: $68,000Median salary for recent grads: $53,100Projected job growth for this field, 2010–2020: 5%Head in the clouds? Hardly a bad thing. Aeronautics and aviation technology majors can expect to earn more than $50,000 right out of school—and as much as $90,000 midway through their careers. Most study engineering, mechanics and aerodynamics and work for airplane manufacturers. Depending on the program, transportation sciences can also include fields such as materials engineering and automotive-technology management.4. Treatment Therapy ProfessionsUnemployment rate: 2.6%Unemployment rate for recent grads: 5.4%Median salary: $62,000Median salary for recent grads: $60,400Projected job growth for this field, 2010–2020: 33%While physical therapists typically need a doctorate degree, respiratory, radiation and recreational therapists make the big bucks on a B.A. alone. Recent grads start off at $60,400, one of the highest salaries on our list. Radiation therapists, for example, stand to make $75,000, the national median for that particular therapy field, after a few years. Treatment therapy programs generally include anatomy and physiology courses, as well as chemistry, physics and pharmacology. Regardless of specialty, most therapists work in hospitals or nursing homes.[More from Kiplinger: 5 Advanced Degrees Still Worth the Debt]5. Chemical EngineeringThinkstockUnemployment rate: 3.8%Unemployment rate for recent grads: 7.5%Median salary: $86,000Median salary for recent grads: $64,500Projected job growth for this field, 2010–2020: 6%Chemical engineering majors make more money out of school than any other major on our list. If that's not enough to send you running for the chem lab, consider the fact that, a few years in, the average chemical engineer will make over $30,000 more than his friends in other fields. The work isn't easy. Chemical engineers study chemistry, physics and biology in school. But after graduation, these engineers stand to enjoy high five-figure salaries in labs and offices and a very low unemployment rate.6. Electrical EngineeringUnemployment rate: 5.0%Unemployment rate for recent grads: 7.3%Median salary: $86,000Median salary for recent grads: $57,000Projected job growth for this field, 2010–2020: 6%Electrical engineering isn't for the faint of heart or the mathematically challenged. But if you can survive four years of differential equations and circuit theory, you're on track to make $57,000 a year at your first job. That’s $20,000 more than the median salary for new grads in the top 100 majors. Long-term job growth is modest, with a 10-year projection below the 14% average for all occupations. Still, consistent demand for qualified electrical engineers keeps unemployment in check. Nearly 300,000 electrical engineers design and test components for manufacturers, engineering firms and power plants across the country.7. Medical TechnologiesThinkstockUnemployment rate: 1.4%Unemployment rate for recent grads: 5.4%Median salary: $58,000Median salary for recent grads: $45,100Projected job growth for this field, 2010–2020: 13%Medical technologists are in serious demand—so serious, in fact, that some hospitals try to tempt recent grads with perks such as sign-on bonuses. In addition to the abundance of employment opportunities, medical-technologies majors can look forward to above-average starting salaries. In school, majors study chemistry, biology and clinical laboratory skills; after graduation, they work in hospitals, doctors’ offices and diagnostic labs analyzing patient samples.8. Construction ServicesUnemployment rate: 5.4%Unemployment rate for recent grads: N/AMedian salary: $65,000Median salary for recent grads: $50,200Projected job growth for this field, 2010–2020: 17%Construction services may seem an odd choice in a down economy, when building projects can grind to a halt. Still, there's enough demand for general contractors and construction managers to keep unemployment at a tidy 5.4%. Construction-services majors study project scheduling and construction law and go on to oversee projects ranging from office buildings to power plants. The workplace isn't as glamorous as a swanky office, but new construction services grads make more money than new grads in finance, general engineering and pre-law.[More from Kiplinger: SPECIAL REPORT: New Grad’s Guide to Financial Success]9. Management Information SystemsThinkstockUnemployment rate: 4.2%Unemployment rate for recent grads: 7.4%Median salary: $71,000Median salary for recent grads: $51,000Projected job growth for this field, 2010–2020: 18%Not all computer majors are created equal, contrary to rumor and admissions-office hype. Computer-networking majors, for instance, see 8.2% unemployment and a $37,300 salary upon graduation. But management information systems majors can expect high starting salaries right out of school, and strong job and salary growth after that. The major prepares students to work in IT for big organizations—helping clueless technophobes fix their e-mail, sure, but also building, securing and maintaining a network for an entire company.10. Medical Assisting ServicesUnemployment rate: 2.9% (Average for all grads with a bachelor’s degree: 4.9%)Unemployment rate for recent grads: 5.4% (Average for top 100 majors: 7.7%)Median salary: $51,000 (Median for all grads with bachelor’s: $54,756)Median salary for recent grads: $43,000 (Median for top 100 majors: $37,000)Projected job growth for this field, 2010–2020: 31% (Average: 14%)If you don't mind following doctors' orders, medical assisting is a pretty sweet deal. The average medical assistant with a two-year associate’s degree will enjoy far better job prospects than most grads and earn nearly as much money as a young B.A.-holder. Medical-assisting majors study office administration and basic clinical skills, such as transcription, coding and lab procedures. They generally work in doctors’ offices, taking patient history, performing basic tests, and tracking insurance and other paperwork as needed.

使癌症诊治个体化，研究全球化2010年09月17日 来源： 中国医学论坛报 作者： 金晶 关键词： CSCO2010;个体化 ——访大会开幕式致词外宾、ASCO董事会和基金会主席MartinJ.Murphy教授 □《中国医学论坛报》记者金晶 马丁·默菲（MartinJ.Murphy）教授，《肿瘤学家》（TheOncologist）、《干细胞》（StemCell）杂志创始编委，希普尔（Hipple）癌症研究中心创始人，美国国立卫生研究院（NIH）基金会主席、美国临床肿瘤学会（ASCO）董事会和基金会主席。作为唯一一位在本次CSCO年会开幕式上致词的外国专家，Murphy教授接受了本报记者的专访。 《论坛报》：在如今的肿瘤治疗领域，靶点治疗可谓是炙手可热，您对靶向治疗的看法如何？在这种热度之下，您是否认为我们的患者正处于被过度治疗的状态？ Murphy教授：要回答这些问题，首先要谈谈在我看来，靶向治疗指的是什么。 多年以来，针对癌症的治疗策略基本上是根据肿瘤的类型来设计的，也就是说，对于乳腺癌，应用针对乳腺的药物，对于胃癌，应用多种药物组成的联合方案，人们期待这些药物对肿瘤产生一定作用。 之后，情况发生了改变，我们探索到了分子传导通路的存在，并慢慢了解到在细胞内，分子们通过传导通路相互联系，然后我们便想到通过靶向一条特定的分子通路、对其进行干预，或许能够治疗的就不再仅限于某一特定器官的肿瘤，而是具有这条分子通路的所有肿瘤，也就是说不同的肿瘤可能拥有相同的分子通路，如果能识别出这些靶点，就可以针锋相对地设计出一些分子药物进行干预——这就是在靶点治疗背后的理论，自从第一种靶向药物伊马替尼出现之后，现在有越来越多的靶向药物涌现出来。 至于我们的患者是否被过度治疗，我想这个问题我还回答不了，因为我不了解中国的治疗模式。但你提到，靶向治疗现在非常火，我认为更重要的一点应该是，选择合适的时机，针对合适的患者应用合适剂量的适合药物进行治疗。如果针对某一靶点的治疗不再有用，就应该寻找其他合适的靶点或合适的治疗手段。无论是传统化疗、免疫治疗或是靶向治疗，都可以是最适合的治疗，但必须是在经过深思熟虑后应用，并且要确保用必尽其能。 《论坛报》：您认为癌症的诊断和治疗有何前景？ Murphy教授：这个问题包含了两个非常重要的方面，一是癌症诊断，一是癌症治疗，这两个方面需要被非常小心的联系起来。让我们以乳腺癌为例，来具体谈一谈。 对于乳腺癌，曾经的诊断依据是在乳腺部位发现肿瘤占位性病变，随后用手术最大程度地切除肿瘤病灶和组织，再应用辅助放化疗对付残留病灶。而现在我们知道，肿瘤中存在一些特异性靶点，这是需要我们识别出来的，所以现在下一个诊断必须更加准确，不仅需要明确肿瘤类型，还需明确分子类型。在作出正确和明确的诊断之后，结合分子缺陷，选择应用最恰当的化疗药物、免疫治疗药物和靶向治疗药物或药物联合方案，从分子水平抑制肿瘤进一步发展。 更进一步说，依然以乳腺癌为例，通过了解患者的雌激素受体（ER）、孕激素受体（PR）和人表皮生长因子受体2（HER2）状态，我们发现了一类侵袭性很强、恶性程度很高的乳腺癌，即对大多数常规治疗无反应的三阴性乳腺癌（ER、PR和HER2均为阴性），当我们能从分子水平对此作出诊断时，我们便找到了这类乳腺癌为何如此难治的可能原因之一，随之开发出一些新药，例如，多聚二磷酸腺苷核糖聚合酶（PARP）抑制剂，我们从Ⅱ期临床试验中发现，PARP抑制剂与化疗药物联合治疗可使三阴性乳腺癌患者达到长期缓解，生存期得以显著延长，现在正进行一些Ⅲ期临床试验以验证Ⅱ期研究的结果。可见，制定有效的治疗方案必须建立在能作出更加精准、从分子水平可解释的诊断基础上。我相信，我也希望，将来的癌症诊断能从分子水平明确定音，这也是使癌症治疗个体化的体现，不是针对乳腺癌的个体化，而是针对乳腺癌患者的个体化。 《论坛报》：您对于癌症预防有何看法？ Murphy教授：每个人都有责任使自己免于罹患癌症，他们应该认识到，通过改变自己的生活方式，是可以预防癌症发生的。 3周之前，我到中国的深圳参加了国际抗癌联盟（UICC）举办的世界抗癌领袖峰会。在会上，中国卫生部部长陈竺公布了一些有关中国吸烟人口的数据，我们看到，若将吸烟者和“吸二手烟者”统计在内，每天有超过十亿的中国人将自己暴露在癌症风险之中，这里的风险不仅仅是肺癌风险，而是任何与烟草相关的癌症风险。 这就给了我们一条很强烈的信息：对于癌症，最好的治疗是预防。当然，我并不是说良好的生活方式可以避免癌症发生，但至少可以大大降低癌症患病危险，减轻自己、家人和社会的负担。我、你，我们每一个人都有责任将这个信息和概念传播开去。 《论坛报》：您认为，在全球抗癌大业中，中国应该或已经作出了怎样的贡献？ Murphy教授：这是一个很好的问题。我第一次到中国是1978年，可说与中国有着深厚的渊源。今年，由于第13届中国抗癌协会临床肿瘤学协作专业委员会（CSCO）学术年会的召开，我又回到中国，这是我第22次到中国，而我已经不准备再去计算我会是第几次来中国，因为我把这里当成了我的第二故乡。 在我来往中国的这些年间，我见证了中国科学家们创造出的一个又一个了不起的成绩，无一不在显示着他们在探索、发展和传递科学方面的能力。在这期间，我看到他们与国内、国外不同机构间的合作越来越多、越来越紧密，合作的领域涵盖了生命科学、制药和生物技术领域。我想，中国的肿瘤学家们一定也对而今越来越广泛的全球多中心合作有了深刻的认识，我也深信，一些关于癌症的新发现、新治疗手段和方法正在从中国的实验室、医院、医学院和大的医学中心中萌生出来，中国正以一种持续的、越来越快的步伐来进行这种知识和手段的更新。以我自己为例，我在1个月内到中国2次参加会议，难道你不认为这就是对以上所说快速发展的一个最好体现吗？再没有什么比这更让我感到兴奋、满怀热情和感激了。在此，我要感谢我的中国朋友们，他们总是伸出热情的双手，不仅是欢迎我回家，更是欢迎我与他们合作，给我以莫大的支持，我希望他们也能同我一样兴奋和激情洋溢。同时，我也要感谢你们报纸，给我这样一个机会来阐述这些如此重要的问题，我们需要像你们一样的媒体来向人们传达这些信息，帮助他们了解并且避免癌症发病风险，以此降低癌症发病率，感谢你们为此所做的工作。摘自医学论坛报

内外科共话AJCC胃癌新分期http://www.cmt.com.cn/xshy/zl/csco2010/expertsview/201009/t20100926_266219.html内外科共话AJCC胃癌新分期2010年09月26日 来源： 中国医学论坛报 作者： 廖莉莉 关键词： 胃癌;内科;外科;分期 □《中国医学论坛报》记者廖莉莉 在今年的CSCO年会上，有这么一群医生，他们自己从论坛选题到组织细节无不亲历亲为，目的就是为了给大家带来一场别开生面的“CSCO青年专家论坛”，以展现我国当代青年肿瘤医师的风采。他们，就是CSCO青年沙龙的诸位学子。在这些活跃在当今肿瘤界的青年学者的精心准备下，一场围绕大肠癌肝转移治疗、美国癌症联合委员会（AJCC）胃癌更新热点及乳腺癌治疗的讨论就此展开。现撷取部分内容，整理如下。 北京肿瘤医院消化肿瘤内科张小田就AJCC胃癌分期提出了几点意见。 1.关于T3、T4a和浆膜层 对于内科医师来说，最新版（第7版）国际抗癌联盟（UICC）/AJCC公布的TNM分期中，浆膜下层（Subserosa，SS）可能算是一个新鲜“面孔”。SS是指肿瘤浸润至浆膜下结缔组织且并未侵犯临近结构或浆膜（脏层腹膜）。而大家平时在病理报告中常见的一些描述，如侵及浆膜、侵达浆膜、侵及全层、侵及全层达浆膜外脂肪组织、侵透浆膜等，其实都是属于新版分期中的T4a期，即侵犯或穿透浆膜。 2.活检淋巴结数目对N分期判断的影响 活检淋巴结数目太少是否可以被定义为pN0?新版指南指出，无论切除或检查的淋巴结数目多少，只要为阴性，即为pN0。因此，病理分期N0≠临床分期N0，在诊断时的“N0”期患者，治疗时可能不一定真的能作为“N0”来对待。 3.难以恰当分期时的处理 为了准确判定肿瘤分期，内科医生要学会读手术记录和病理报告。例如，须判断术式及淋巴结清扫是否足够。但是，当术中描述与术后病理报告不相符时，该如何处理？AJCC分期明确指出，如果TNM不能恰当定义，应按照较低分期来定义，以符合整个AJCC分期原则。虽然找不到这句话的明确根据，但我们更愿意理解为，应以一个更加积极的态度去治疗我们的患者。 4.新版分期的临床意义 将T1期细分为T1a及T1b，为早期胃癌是否应进行内镜下治疗提供了明确的适应证。而将N分期细分、将Ⅳ期划分为M0和M1也较合理，原Ⅳ期M0分至ⅡB～ⅢC。但在我国现阶段D2根治术不能做到100%完成的情况下，ⅢA、ⅢB、ⅢC分期是否合理？虽然对单纯卵巢转移、单纯肝转移、腹水细胞学阳性等胃癌较为特殊的转移模式难于进行病理分期，但临床上却有其独特的治疗方式。 北京肿瘤医院普通外科李子禹对新旧版AJCC胃癌分期进行了对比。 1.T分期的变化 与第6版UICC/AJCC分期相比，第7版分期中T分期的变化见表1和图1。 2.N分期的变化 与第6版相比，第7版分期中N分期的变化见表2。 3.M分期的变化 与第6版相比，第7版分期中M分期变化不大，只是取消了Mx的定义（远处转移无法评估）。