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| intern choicesthe swapping system made us all in the monopoly game. each holding their choices, calculating how could their choices could bargain for better choices, then for even better choices... until we could get the placements, in their preferred hospitals, preferred units, in preferred order. then what's the point of the original computer system? and will it really work out after handing in the swapping forms? maybe i'm too insecure/neurotic. i still can't believe that will come true. maybe there'd be some clergical error. maybe... that's part of the intern training. i do think so. =P | | |
| but inside i'm screaming.隨著這本小說的完成, 我也回到了香港. 隨了某些人, 沒有甚麼使我掛念. btw, 我有facebook account 了, add me if you've got it =) andrewnawong@gmail.com hahahaha~ | | |
| 生．命因為都在收拾東西, 翻出了很多的信件. 尤其是女兒們的信. 也許有些早已忘記我了. 不打緊的. 只是我不會輕易忘記你們的臉. 最近收到的一封信, 都是用那種薄得半透明、粗糙如草紙般的信紙寫的. 對, 因為她在那個地方, 沒別的選擇. 但能夠把這封信寄出 (還是英文地址!), 女兒, 我為你驕傲. 你繼續說你的故事. 你媽媽的一點故事. 你和她的故事. 我繼續的聽. 繼續的留心聽. 那LCC level I 算不上甚麼. 從你出生起的每個挑戰, 都比它難上十倍百倍. 加油呀. (因為看見友人的網誌的故事與音樂, 忍不住. 就在離開之前好好的把一切都放下... eeyuim, you must take a look. this is another taiwan boy's story besides the bbts. i love it. though it might be the saddest? toughest?...... i don't know) siuman, i know you won't mind me putting your blog here. if you mind, please let me know =) www.siumanjourney.blogspot.com | | |
| Pain.I remember I've written here about the sensation of pain and its relation to life, after I read the chapter about Dr. Paul Brand and his mission for patients with leprosy. (go and read about leprosy and Dr. Paul Brand, you gotta know about them if you wanna preach about Jesus' love, eh?) then my friend asked me a question, 'what do we call the condition when people are born without the sensation of pain?' i haven't been taught on this. and haven't heard about this. though many different terms came in my mind: Charcot's arthropathy, spinothalamic tract, subacute combined degeneration of cord, tabes dorsalis... so i did a little search on google, and got this. CONGENITAL INSENSITIVITY TO PAIN
WITH ANHIDROSIS
Congenital Insensitivity to Pain with Anhidrosis (lack of sweating) is a rare autosomal-recessive disorder usually manifested in childhood by a history of unrecognized trauma, indifference to pain stimuli or self-mutilation. This disorder is a rare sensory and autonomic neuropathy which is defined as the absence of normal subjective and objective responses to noxious stimuli in patients shown to have normal central and peripheral nervous systems. INTRODUCTION
Patients diagnosed with congenital insensitivity to pain with anhidrosis (CIPA) suffer from abnormal pain and temperature perception, absence of sweating (anhidrosis), mental retardation, fever during hot weather and loss of unmyelinated fibers with a decrease in size of small myelinated fibers. Body temperature is disturbed as a result of the inability to sweat and insensitivity to pain may lead to bone fracture, multiple scars, osteomyelitis, and joint deformities, which may lead to limb amputation, painless injuries of arms, legs and oral structures. This disorder results from a defect in neural crest differentiation and the system responsible for pain and temperature sensation, the first-order afferent system, is lost. Nociceptive neurons in the dorsal root ganglia derive from the neural crest and they can only survive if they are stimulated by the nerve growth factor (NGF) through the TrkA receptor. Mutations in the TrkA gene have shown a correlation with the defective development of the nociceptive neurons.  HOW IS THE BRAIN INVOLVED?
NGF AND TrkA GENEThe survival of neurons during development is largely dependent on neurotrophic factors, the most important being the NGF family. These neurotrophins recognize two different classes of receptors, the TrK family of tyrosine-protein kinases and the low-affinity receptor, p75. Three types of TrK | receptors,such as TrkA, TrkB, and TrkC have been found. TrkA is the receptor that signals NGF, TrkB signals brain-derived neurotrophic factors and neurotrophin-4, and TrkC is the primary receptor for neurotrophin-3. The P75 receptor facilitates the interaction between the signaling receptor TrkA and NGF by increasing the concentration of NGF in the general area of the TrkA receptors. NGF is produced by target cells consisting of gland, muscle or skin cells. NGF stimulates the survival of cells, derived from the neural crest. These cells include nociceptive neurons and cells |  p75 receptor |
of the sypmathetic ganglia. The receptors, TrkA, mediate the effects of NGF and are mainly found on cells derived by the neural crest in the nervous system. Abnormalities found in patients that carry a disruption in NGF, p75, or TrkA genes are similar to the pathological finding in CIPA. NOCICEPTION PATHWAY
 This the pathway that pain takes through the brain: lumbar spinal cord, cervical spinal cord, lower medulla, mid-medulla, mid pons, midbrain, ventral posterior lateral nucleus thalamus, primary somatosensory cortex and cerebrum. MAIN FEATURES OF THE DISORDER
The main features of the disorder are: lack of pain sensation, painless injuries of the arms, legs and oral structures, fever during hot weather because of inablilty to sweat (anhidrosis), mental retardation, infection and scaring of the tongue, lips and gums, chronic infections of bones and joints, bone fractures, multiple scars, osteomyelitis and joint deformities, which may lead to amputation. CASE STUDIES
People with congenital insensitivity to pain go through life in danger of destroying their bodies because they do not realize the harm they are doing. Many die young and for those who don't they go through life experiencing a different sort of pain. Take into consideration a 13-month-old Pakistani boy who was referred to an orthodontist by his physician after experiencing repeated tongue bitting resulting in ulceration and loss of the tip of his tongue. He had recently been diagnosed as having CIPA which means that he could feel pressure and touch but didn't react to noxious stimuli. He showed little or no response to circumcision performed without anesthesia. At six months he developed osteomyelitis and soon after, severly burnt his finger tips by holding a radiator. At this same time he began to bite his tongue.  
Severe burns on finger tips from holding a radiator and extensive lacerations of tongue with loss of the tip.
The orthodontist suggested that they try to maintain the teeth to protect the tissues from futher damage. A mouthguard was constructed and fitted to protect the tongue. However, it was noted that the patient began experiencing sores in his mouth from the mouthguard. Three more mouthguard were introduced to minimize trauma by rotating the guards. This treatment resulted in much resolution of the ulcerations and helped reduce the chewing. The most well documented case of CIPA was Ms. C. She was a young Canadian student who attended school at McGill University in Montreal. Her father was a physician and was aware of her condition. He asked his colleagues in Montreal to examine his daughter. They concluded that Ms. C was normal in every way except that she felt no pain. She had bitten off the tip of her tongue as a child while chewing food and had suffered third-degree burns after keneeling on a hot radiator. When examined by the psychologist, Ms.C reported that she felt no pain when noxious stimuli were presented. Even when parts of her body were subjected to electirc shock, hot water at burning temperatures or a long ice bath she reportedly felt no pain. It was noted that she showed no changes in blood pressure, heart rate, or respiration when exposed to these conditions. Ms. C claimed that she could not remember sneezing or coughing and could only stimulate her gag reflex with much difficulty. The doctors at Montreal put Ms.C through a series of tests such as: inserting a stick up through the nostrils, pinching tendons, or injecting histamines under the skin. All of these tests failed to produce pain. Ms. C had severe medical problems. She exhibited pathological changes in her knees, hips and spine and underwent several operations to fix these problems. Her doctors explained these changes as a lack of protection to her joints usually given by the sensation of pain. She could not shift her weight when standing, turn over in her sleep, or avoid certain postures. In an individual without CIPA, these things prevent inflammation of the joints. Ms. C died at the age of 29 of massive infections that could not be brought under control. During her last month she reportedly complained of discomfort, tenderness and pain. This was unexplained by her physicians.
REFERENCES
Okuda, K., Toshimi, A., Miwa, T., & Hiroki, K., (2000). Anaesthetic management of children with congenital insensitivity to pain with anhidrosis. Pediatric Anaesthesia, 10, 545-548. Indo, Y., & Hayashida, Y., (1996). Mutations in the TrkA/NGF receptor gene in patients with
congenital insensitivity to pain with anhidrosis. Nature Genet, 13, 485-488. Littlewood, S. J., & Mitchell, L., (1998). The dental problems and management of a patient suffering
from congenital insensitivity to pain. International Journal of Pediatric Dentistry, 8, 47-50. Yotsumoto, S., Setoyama, M., Hozumi, H., Mozoguchi, S., Fukumaru, S., Kobayashi, K., Saheki,
T., & Kanzaki, T., (1999). A novel point mutation affecting the tyrosine kinase domain of the
TrkA gene. The Society for Investigative Dermatology, 112, 810-814.
THIS PAGE HAS NOT BEEN REVIEWED OR APPROVED BY WASHINGTON STATE UNIVERSITY AT VANCOUVER. ITS CONTENTS ARE SOLELY THE CREATION AND RESPONSIBILITY OF COURTNEY WOOD. COMMENTS AND QUESTIONS SHOULD BE SENT TO: COCO1680@AOL.COM from http://helium.vancouver.wsu.edu/~woodc/CIPA.html so we should be grateful that we live WITH pain. still grateful though sometimes we live IN pain, eh? | | |
| 明天就要飛走.期待已久. 不. 我根本從不期待驚喜與美麗會在我的生命中出現. 沒有驚. 已是喜了. 但真的「恨」離開香港很久. 去年今天, 我仍在北京, 享受一個人生活的寧靜與自由. 看愛看的書. 選擇自己喜歡的人談話. 到訪從小在書本中看到的地方. 在敏感的日子到敏感的地方. 在明與暗之間看那特別的旗幟在音樂中升起在風中飄揚. 全都是我所懷念的. 但去年在北京首都機場接通的電話, 把我從高空中摔倒, 然後一個人走在陌生的路上, 除了自己沒有人可以依靠, 就這樣. 到了今天. 因此, 我仍然懷疑, 一切太順利. 仍然懷疑, 明天不會飛得起. 沒有刻意安排甚麼行程. 只是買了到布拉格與羅亞爾河谷的機票. 也許那裏的古堡與廣場, 會勾起一些美好的回憶, 並將之延續下去. 就在我要被摔回現實的地獄之前. 離開是為了回來. 對嗎？
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之前轉貼的文章被評為不雅物品. 我的部落格很不雅嗎？ 對. 他們說是就是. 要原因的嗎？ | | |
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