“Small-for-flow” syndrome: Shifting the “size” paradigm

The “small-for-size” syndrome and “post-hepatectomy liver failure” refers to the development of liver failure (hyperbilirubinemia, coagulopathy, encephalopathy and refractory ascites) resulting from the reduction of liver mass beyond a certain threshold. This complication is associated with a high mortality and is a major concern in liver transplantation involving reduced liver grafts from deceased and living donors as well as in hepatic surgeries involving extended resections of liver mass. The limiting threshold for liver resection or transplantation is currently predicted based on the mass of the remnant liver (or donor graft) in relation to the body weight of the patient, with a ratio above 0.8 being considered safe. This approach, however, has proved inaccurate, because some patients develop the “small-for-size” syndrome despite complying with the “safe” threshold while other patients who surpass the threshold do not develop it.     

Interaction between the severity of the infection by the nematode <Emphasis Type="Italic">Anguillicola crassus</Emphasis> and the tolerance to hypoxia in the European eel <Emphasis Type="Italic">Anguilla anguilla</Emphasis>

An experiment was conducted to test the effect of the infection by the swimbladder nematode Anguillicola crassus on the survival of the European eel Anguilla anguilla when exposed to hypoxic conditions. Forty-four wild caught and naturally infected eels were placed in an aquarium filled with water from the fishing site (Vaccarès Lagoon, French Mediterranean coast). In this confined environment (271), under decreasing oxygen resources, the first eel death occurred after 45 h (O₂ = 0.98 mg l⁻¹) and the last one after 96 h (O₂ = 0.48 mg l⁻¹). After dissection and parasite examination, analyses revealed significant negative correlations between the time to death and various parameters of parasite pressure (e.g., number of lumen worms, parasite mass, health state of the infected organ). It was shown that the severity of damage to the swimbladder rather than the count of living parasites was the major contributing factor in explaining the variation in time to death. These semi-experimental data demonstrating an increased eel mortality rate under severe oxygen stress are discussed for their relevance under field conditions, especially during hot summer months.     

Divergence within the marker region of the <Emphasis Type="Italic">groESL</Emphasis> operon in <Emphasis Type="Italic">Anaplasma phagocytophilum</Emphasis>

Anaplasma phagocytophilum is an obligate intracellular bacterial parasite in human and animal granulocytes. In Europe, A. phagocytophilum is transmitted by Ixodes ticks; Ixodes ricinus is the vector of the parasite in Poland. In terms of epidemiology, the identification of pathogens in ticks increasingly relies on molecular techniques. Polymerase chain reaction (PCR) with species-specific primers is a tool that allows the quick and accurate detection of pathogens in ticks, humans, or animals. DNA was extracted from the blood of Capreolus capreolus and Cervus elaphus, and amplified using the primers HS1/HS6 (external) and HS43/HSVR (internal). For sequencing, six samples from roe deer and two samples from red deer were selected, and the resulting sequences were submitted to GenBank (accession numbers DQ779568, DQ779567, EU157919, EU157920, EU157921, EU157922). These nucleotide sequences were compared with each other and five variants were distinguished in roe deer and one in red deer. A comparison of the sequences of the author’s database revealed 45 polymorphic sites of substitution character (76% transitions and 24% transversions). The homology tree revealed two groups, one with sequences only from roe deer, while the second with sequences isolated mainly from red deer, livestock animals, and humans. These strains of A. phagocytophilum are also present in Poland.     

From the "what" to the "how": Teaching integrative medicine-related skills to medical students during COVID-19

ObjectiveTo examine the impact of an integrative medicine (IM) course on self-perceived IM-related communication and research skills.MethodsA 3-day mandatory "hybrid" (online and in-person) IM course was held within COVID-19 restrictions for 161 pre-clerkship medical students, with workshops facilitated by mentor healthcare professionals (IM and non-IM) and student-directed tasks. Self-perceived levels of 6 IM-related skills were scored (from 1 to 5) for history-taking; communicating with patients with "alternative" health-beliefs; referral to IM consultations; assessing risks/benefits; and working with non-medical IM practitioners.Results137 students (85.1%) completed pre-/post-course questionnaires, with overall scores improving from pre-course (1.98 ± 0.92) to post-course (3.31 ± 0.63; p < 0.0001), for the entire group and student subgroups (with vs. without prior IM experience). Multivariate analysis found no association between age, gender, primary language or prior experience with IM and improvement in skill scores.ConclusionsThe IM course increased self-perceived skill levels, reflecting the course curriculum and workshops. Further research needs to explore the application of these skills during clinical training.Practice implicationsTeaching medical students about IM in a course comprising communication and research skills was shown to be feasible and effective. The application of IM-related skills needs to be evaluated during the clinical clerkship.     

Characterization of the "<Emphasis Type="Italic">deqi</Emphasis>" response in acupuncture

Background  

Acupuncture stimulation elicits deqi, a composite of unique sensations that is essential for clinical efficacy according to traditional Chinese medicine (TCM). There is lack of adequate experimental data to indicate what sensations comprise deqi, their prevalence and intensity, their relationship to acupoints, how they compare with conventional somatosensory or noxious response. The objective of this study is to provide scientific evidence on these issues and to characterize the nature of the deqi phenomenon in terms of the prevalence of sensations as well as the uniqueness of the sensations underlying the deqi experience.     

The evolution of the <Emphasis Type="Italic">Vibrio cholerae</Emphasis> genome during the modern period

A review of the modern data concerning the phenotypical and genetic peculiarities of the recently emerged highly virulent variants of V. cholerae El-Tor biovar (the etiological agent of the current cholera pandemic) is presented. The molecular-genetic mechanisms that are considered to be a basis for V. cholerae genome evolution during the modern period are discussed. The transposon role in the increased expression of cholera toxin genes, which are constituents of the CTXφ prophage genome, is addressed. The need to work out new gene-diagnostic test-systems for the identification of natural altered variants of the cholera etiological agent is shown.     

Correlation between the presence of symptoms and the <Emphasis Type="Italic">Giardia duodenalis</Emphasis> genotype

Clinical manifestations of Giardia duodenalis infection vary from asymptomatic infection to chronic diarrhoea. We study the correlation between the presence of symptoms and the G. duodenalis genotype in 108 patients with giardiasis. Patient age ranged from 2 to 72 years old. We found a correlation between assemblage AII and symptomatic infections, and between assemblage B and asymptomatic infections in the overall patient group and in patients less than five years of age. Nevertheless, if only patients of more than five years of age were considered, no statistically significant relationship between assemblage and symptomatic or asymptomatic Giardia infections was found. In these patients, host factors may affect the presence of clinical manifestations more than Giardia assemblage.     

Avoiding the term ‘obesity’: An experimental study of the impact of doctors’ language on patients’ beliefs

Objective

GPs sometimes use euphemisms rather than medical terms. The present study aimed to explore the relative impact of using the term ‘obese’ compared to GPs’ preferred euphemism on patients’ beliefs about the problem.

Methods

A cross sectional survey followed by an experimental study was used with two conditions: the term ‘obese’ versus the GPs’ preferred euphemism. In the cross sectional survey, GPs’ (n = 19) described their preferred use of term. In the experimental study, patients (n = 449) from one General Practice in West London then completed a set of ratings about their beliefs following a vignette using either the term ‘obese’ or the GPs’ preferred euphemism.

Results

The first stage of the study showed that GPs avoided using the term ‘obese’ and preferred to use a euphemism. The most commonly used euphemism was ‘your weight may be damaging your health’. The second stage showed that the term ‘obese’ made patients believe that the problem had more serious consequences and made them feel more anxious and upset than when the same symptoms were labelled using the euphemism. When analysed according to the patient's own BMI, however, the results showed that the term ‘obese’ had a greater emotional impact than the euphemism only on patients who were not obese; obese patients found the euphemism more upsetting.

Conclusion

GPs avoid using the term ‘obese’ for fear of upsetting patients. This term, whilst making the problem appear more serious is only more upsetting for non-obese patients.

Practice implications

GPs choice of term therefore needs to reflect whether they want the patients to be upset or whether they want them to accept the seriousness of their problem.