articles about cartilage regeneration

這是 6/28/2012 NEJM 關於軟骨再生的學術文章。還在動物實驗階段 (rat). 這是我一直想讀呂醫師的12 篇在國際期刊發表的文章的原因。沒有什麼比這個更重要的.  我不是要你們讀這文章,只是舉個例子譲你們知道 幾乎所有這類的文章都是這種性質，牽涉到 bio high tech 或 stem cell, 不是做個膝關節鏡手術（arthroscopy) , 軟骨就能再生。「膝關節軟骨再生促進手術」是呂醫師的 注册商標。美國千千萬萬的 orthopedists (骨科外科醫師), 每年做千千萬萬的 arthroscopies, 我還沒看過有人 claimed 他們做的 arthroscopy, 能夠促進軟骨再生。

 (This knee repair about cartilage regeneration is from Scientific American)

美國的骨科學會（American Orthopedic Association) 真是消息不靈通, 要不然呂醫師應到美國（應該是全世界）各地演講, 把他的特別技術傳給大家, a great contribution to humanity.

醫學無國界。兩年多前高雄陳肇隆醫師 (亞洲換肝之父）回來苉城參加 Dr. Thomas Starzl 的90 歲生日宴, 我跟他見面認識他, 我們保持 email 及 用 LINE 聯絡，所以我知道他常常到世界演講. 去年或前年他跟 Dr. James Eason (給 Steve Jobs 換肝的移植外科醫師）在韓國演講. 我太太，Katy, 去年回台灣，有去高雄長庚醫院拜訪他。

Dr. Chen Chao-Long and Dr. James Eason in Korea

 

Katy visiting Dr. Chen Chao-Long

陳肇隆醫師目前是國際際活體肝移植醫學會的 President-Elect; 2019 年的會議 (兩年一次) 將在台灣主辦。像呂醫師一樣，陳醫師也常接受媒體(報紙或電視）的訪問, 但是我希望能看到呂醫師在 professional field 方面的活動，因為在那種情況所說的才是 real stuff (真正的醫學).

Medial plica syndrome and osteoarthritis are different disease entities (不同的毛病)

請不要誤會，我沒有批評呂醫師的 medical practice, 我相信他的 practice (注重預防及好的 physical therapy) 的效果比一般台灣（甚至美國）醫師的好. 我只是不同意他説  退化性關節炎（osteoarthritis—「退化性」已是一個落伍的觀念.  呂醫師的「膝關節軟骨再生促進手術」、這是不負責任的宣傳花樣.

我不是骨科醫師 （orthopedist) 也不是關節炎專家 （rheumatologist), 但是我不同意呂紹睿醫師的説法：

Osteoarthritis 一般叫 degenerative osteoarthritis (退化性關節炎）, 呂醫師說 説「退化性」是一種落伍的觀念。他説 osteoarthritis 是 內側皺襞 （medial plica) 變質硬化引起的。呂醫師還説他是 1995 年做關節鏡（arthroscopy) 無意中發現這個隱藏的原因。其實這個他「無意中發現的病」叫 plica syndrome, 是另一種病, 跟 退化性關節炎（degenerative osteoarthritis) 無關, 也不是 osteoarthritis 的原因。

呂醫師説從來沒有人報告過, 其實關於 plica syndrome 的報告很多.  他説他於 2002 年設立硏究中心.  中正大學機械工程系劉德騏教授說 「世界上就沒有人做這方面的硏究」（很明顯的 劉教授不讀醫學雜志）世界上沒有人説內側皺襞硬化是 osteoarthritis 隐藏的病因倒是真的。

我在4/14/1988 NEJM 看到一篇文章叫「knee injury in sport」其內就有 提到 plica syndrome.

若有膝蓋關節痛或關節炎而做關節鏡 （arthroscopy) 檢查, 發現有 內側皺襞 （medial pelicans) 硬化, 那麼這個病叫 plica syndrome 或 medial plica syndrome, (有各種不同的 plicas, 依其位置而命名, 絕大部分引起毛病的是 medial plica.) 這種情形就不叫 degenerative osteoarthritis. 呂醫師把這兩種不同的疾病混在一起 説 所有的 degenerative osteoarthritis 都是 內側皺襞硬化引起的。所以他才説「退化性」是一種落伍的關念。

呂醫師說 內側皺襞 是胎兒在三個月 關節腔的空腔形成的時候；它沒有完全退開、像衣服一樣皺摺起來叫 plica. 這完全正確。這是胎兒（embryo) 所留下來的 剩餘物 （remnant). 不是每人都有 （為什麼有些人有，有些人沒有；沒人知道。沒有 plica 膝關節功能完全正常。 美國的一個 study 説只有 50% 的人有內側皺襞, 即兩個人就有一個人沒有. 日本的一個報告說 79.9% 的人有內側皺襞。3,563 的病人做了 3,889 關節鏡手術（arthroscopies—-有些人 兩邊都做), 發現20.1% 的人沒有 medial plica.  

根據呂醫師的理論，美國有一半的人 （日本有20% 的人）永遠不會得 osteoarthritis. 因為他説 osteoarthritis 的主因（或惟一的原因) 是 內側皺襞 引起的，那麼沒有 內側皺襞， 不是就不會有 osteoarthritis 了嗎？ 該 YouTube 說每人一出生就有 內側皺襞，那是錯誤的。   

呂醫師的「膝關節軟骨再生促進手術」、這是不負責任的宣傳花樣。如果他真的相信,經他手術後, 軟骨有再生，他應該把他的學術報告公布, 或放在他醫院的網頁。我們都是外行人（yes, including me). 我們沒有能力判斷其 可信度 （merit）。如果在 peer reviewed  的學術性 醫學雜志發表，那至少我們知道他所說的有經過這方面的專家審查通過. 專家辦事，我放心.  呂醫師這個理論已20 多年, 報紙的報導沒有份量（carry no weight). 只有學術上發表的文章才會叫我閉嘴。

（下面那一段來自蘋果日報, 引自聯合報)

「今日出版的《聯合報》報導，呂紹睿指出，膝關節疼痛好發高齡長者，但實際上不少年輕人也有膝關節疼痛問題。他認為，關節疼痛是因關節囊皺襞與關節摩擦導致發炎、變硬，使關節軟骨被破壞而逐漸消失。他建議關節炎輕症患者多休息，嚴重者則以關節鏡手術，清除發炎皺襞及周邊組織。由於不必置換關節，不少患者慕名而來，就算搶到門診號碼牌，首次看診也要等半年後。」

(The following is from UpToDate and other published reports)

 (This report says 79.9% of Japanese have medial plica 內側皺襞)

 (This report shows no cartilage regeneration possible,軟骨不能再生)

Nothing is more absurd than talking about alkaline foods” (鹼性食物）or 鹼性體質

A friend sent me this post about using “強鹼性食品” to cure lung cancer.

這一年來我已經收到了很多關於如何利用食物把我們的身體改變成「鹼性體質」（whatever it means). 所以 you guys can trust me as I consider myself "educated” in this topic.

這種提倡鹼性食物去治療萬病的説法已不是台灣的專利. 連 Tom Brady (Boston Patriots’ 的 quarterback) 也在提倡. 至少 Brady 說的沒有那麼離譜. More to come. 去年九月New York Times 有一篇文章 叫「Tom Brady’s “The TB12 Method” [聽説那本書有三磅重］Is Hefty but Short on Science”.（see attached). NY Times 也會罵人的，比較斯文而已.

這個post 說吃䶨性食物把身體改成䶨性體質可以治癒肺癌。問題在於我不知道什麼是「䶨性體質」。我相信寫這個 post 的人也不知道；因為根本沒有這種東西。

我們的血液確有 pH 値：動脈內的血液其 pH 是維持在 7.36 至 7.44 之間。It is tightly regulated by both kidney and lungs; 分工合作。(靜脈內的血液其pH 値是 0.02 - 0.04 lower). PH 低於 7.36 叫酸中毒 （acidosis); 高於 7.44 叫䶨中毒（alkalosis). 這是很嚴重的疾病導致腎臟跟肺沒有辨法維持正常的 pH 値。也就是說不正常的酸性或鹼性都是疾病，有時會有生命危險。

我們血液的 pH 値一定要在那個narrow range,不酸不鹼；無論是酸性或鹼性都是不正常的。

吃強酸性或強鹼性的食物是不會改變血液的 pH値的。這是由 我們的腎臟跟肺分工合作調整控制的。Our kidney and lungs are very efficient in regulating our PH, it is none of our business, nor can we control it by diet or will.

至於説改成鹼性體質可治癒肺癌；其荒唐（absurd) 的程度，實在不値得浪費筆墨。

這種提倡鹼性食物去治療萬病的説法已不是台灣的專利. 連 Tom Brady (Boston Patriots’ 的 quarterback) 也在提倡. 至少 Brady 說的沒有那麼離譜. More to come. 去年九月New York Times 有一篇文章 叫「Tom Brady’s “The TB12 Method” Is Hefty but Short on Science [聽説那本書有三磅重］”. NY Times 也會罵人的，比較斯文而已.

(from NY Times article)

Tom Brady的 diet 其實是很健康的：No white sugar, no white flour, no dairy, raw olive oil and certain specific greens. 問題出在他說 80% of his calories come from “alkaline foods” (鹼性食物）。他為了要賣書及推銷他的相關企業；利用 pseudoscience; 推銷他的 book, snack bars, apps, and gears. Brady 真是晚節不保（40 歲對一個 football player來説是一個老人的了）。

他的business partner (Alex Guerrero) has been investigated by Federal Trade Commission for falsely presenting himself as a medical doctor, and for promoting bogus nutritional supplements.

Boston Patriots 的教練（Bill Belichick) 禁止 Brady’s business partner (Guerrero) 到 Patriots training camp or football field sideline.

Tom Brady 跟我們嘉義同鄕 陳昭妃博士，都是利用 pseudoscience 而建立一個企業，賺大錢

What’s Epstein-Barr virus got to do with cancer?

I am a history buff, when it comes to medicine; I am naturally fascinated by the history of medicine, having a penchant of wanting to know how things came into being in medicine.

The story of Epstein-Barr virus (EBV) infectious mononucleosis is a good example.  Recently a friend as me about a relationship between mononucleosis and some sort of lymphoma.  I have to tell a story (which is history) to answer this question.

First a few facts:

• Infectious mononucleosis is transmitted by EB virus.
• Burkitt lymphoma is caused by EB virus, mostly in Africa.
• Nasopharyngeal cancer (鼻咽癌）is caused by EB virus, mostly in China,Taiwan
• Some of the stomach cancers are caused by EB virus.
• Mononucleosis may lead to Hodgkin’s lymphoma.

From above facts, one can see EB virus can cause seemingly harmless mononucleosis, but may cause various cancers, including lymphoma.  It should come no surprise that it has been observed that mononucleosis may lead to Hodgkin’s lymphoma.

Dr. Denis Burkitt

The British surgeon (Dr. Denis Burkitt) served in Africa during WWII and he stayed to do missionary medical practice in Uganda after the war.  He observed that many young children were stricken with an aggressive tumor/cancer, and the distribution seemed to be corresponded to the rainy areas with a high year-round temperature.  He suspected it could be caused by some sort of viral infection.  He first reported in the British Journal of Surgery in 1958, the tumor now bears his name.

On March 22, 1961 Dr. Burkitt returned to England and gave a talk about his findings in Africa at a medical school in London, Dr. Michael Anthong Epstein was among the audience.  After the talk Dr. Epstein asked Dr. Burkitt to send him the tumor samples so he could do further research. 

Dr. Michael Anthony Epstein

Dr. Epstein has worked on Rous sarcoma virus.  Dr. Rous was the first one to discover a virus (now bears his name) can cause cancer in chicken, whereas EBV was the first virus known to cause cancer in human.  Dr. Rous was in his 80s when he was awarded a Nobel Prize in 1966, 40 years after his discovery.

Dr. Yvonne Barr joined Dr. Epstein in her PhD study.  There are numerous others, including several distinguished American virologists, made contribution in establishing EBV as the culprit in causing Burkitt lymphoma; an oncogene was also identified.  The intriguing course of discovery is beyond the scope of this writing.

Dr. Yvonne Barr

The virus was christened as Epstein-Barr virus in 1965.  The historical paper was published in Lancet (3/28/1964) with a title of “Virus particles in cultured lymphoblasts from Burkitt Lymphoma”.  Actually, Dr Burt Achong was also the co-author, but, poor Dr Achong, his name was somehow dropped at the naming of the virus and forgotten, except by a history buff like me. Dr Achong was a pathologist, using electron microscope to identify the virus.

There is an article in New England Journal of Medicine (NEJM) with a title of Hodgkin's lymphoma after infectious mononucleosis, in which it states there is casual connection between mononucleosis and Hodgkin’s lymphoma.

The evidence is that 40-50% of the Reed-Sternberg cells (the hallmark of Hodgkin’s lymphoma, 我看連退休或生銹的婦產科醫師都還記得) contain Epstein-Barr virus antigen.  And those patients did have history of mononucleosis.  The median interval between getting mononucleosis and the onset of Hodgkin’s lymphoma is only 4.1 years.

Dr. Burt Achong

Fortunately in this report among the 38,000 patients with mononucleosis, only 29 cases of Hodgkin’s lymphoma discovered.  Still some uncertainty present, as only one third of the adolescents with Hodgkin’s lymphoma with Reed-Sternberg cells containing EBV; so there is still much we don't know.

It is regrettable that none of these four British doctor-scientists was honored with Lasker awards ("American Nobel"), I think this an oversight.

EBV is also implicated in causing chronic fatigue syndrome; that calls for another post.