“Ventilatory alternans”: A left–right alternation of inspiratory airflow in humans

In a study visualizing ventilation with hyperpolarized ³He magnetic resonance imaging (MRI) in elite breath hold divers, the dynamic MRI images in one subject exhibited an apparent alternation of the image intensity between left and right lung. We hypothesized that the alternation resulted from alternating variations in inspiratory flow rate to left and right lungs. Analysis showed that the alternation was not due to random uncorrelated temporal fluctuations of intensity (p < 0.001). The frequency of alternation was approximately 56 min⁻¹, suggesting a cardiac origin. Similar alternation of ventilation was confirmed retrospectively in 4 of 6 additional subjects. These observations are consistent with previous studies showing cardiogenic mixing of gas in the lung. We speculate that cardiogenic pendelluft, possibly from ballistic lateral motion of the beating heart, could cause alternating variations of inspiratory flow to the lungs.     

Five ways of being “theoretical”: Applications to provider–patient communication research

Objective

Analyzes the term “theoretical” as it applies to the area of provider–patient communication research, in order to understand better at a conceptual level what the term may mean for authors and critics.

Methods

Based on literature on provider–patient communication.

Results

Offers, and discusses, five definitions of the term “theoretical” as it applies to empirical research and its exposition: (1) grounding, (2) referencing, (3) design and analysis, (4) interpretation, and (5) impact. Each of these definitions embodies a different standard for evaluating the theoretical aspects of research.

Conclusion

Although it is often said that research on provider–patient communication is not “theoretical” enough, the term is ambiguous and often applied vaguely. A multidimensional analysis reveals that there are several distinct ways in which empirical research can be strong or weak theoretically.

Practice implications

Researchers, educators, editors, and reviewers could use the “Five Ways” framework to appraise the theory-relevant strengths and weaknesses of empirical research and its exposition.     

“肌间静脉”还是“肌肉静脉”——亟待厘清的概念

小腿部位深静脉血栓形成的诊治,在临床上仍存在较大争议,是近来血栓研究的热点。其中,“肌间静脉”与“肌肉静脉”这两个解剖概念存在意思模糊不清的情况。通过查阅文献发现,“肌间静脉”这一概念的使用已经导致一定的分歧。因此,呼吁学界统一使用“小腿肌肉静脉”或“小腿肌肉静脉丛”的概念。     

“I’m Not Abusing or Anything”: Patient–physician communication about opioid treatment in chronic pain

Objective

To characterize clinical communication about opioids through direct analysis of clinic visits and in-depth interviews with patients.

Methods

This was a pilot study of 30 patients with chronic pain, who were audio-recorded in their primary care visits and interviewed after the visit about their pain care and relationship with their physicians. Emergent thematic analysis guided data interpretation.

Results

Uncertainties about opioid treatment for chronic pain, particularly addiction and misuse, play an important role in communicating about pain treatment. Three patterns of responding to uncertainty emerged in conversations between patients and physicians: reassurance, avoiding opioids, and gathering additional information. Results are interpreted within the framework of Problematic Integration theory.

Conclusion

Although it is well-established that opioid treatment for chronic pain poses numerous uncertainties, little is known about how patients and their physicians navigate these uncertainties. This study illuminates ways in which patients and physicians face uncertainty communicatively and collaboratively.

Practice implications

Acknowledging and confronting the uncertainties inherent in chronic opioid treatment are critical communication skills for patients taking opioids and their physicians. Many of the communication behaviors documented in this study may serve as a model for training patients and physicians to communicate effectively about opioids.     

Obsessive-compulsive disorder: A “sensory-motor” problem?

Obsessive–compulsive disorder (OCD) is a clinically heterogeneous condition. Although its pathophysiology is not completely understood, neurophysiologic and neuroimaging data have disclosed functional abnormalities in the networks linking frontal cortex, supplementary motor and premotor areas, striatum, globus pallidus, and thalamus (CSPT circuits). By means of transcranial magnetic stimulation (TMS) it is possible to test inhibitory and excitatory circuits within motor cortex.     

创面修复“TIME”原则及其意义****◆

背景：随着人们对创面愈合机制研究的深入和创面处理经验的积累,创床的准备对于创面修复的重要性越来越引起人们的高度重视。 目的：全面了解创面愈合的机制,明确影响创面愈合的各种影响因素及其作用。 方法：电子检索中国期刊全文数据库(1994/2011)和 PubMed 数据库(1994/2011),检索词分别为“TIME原则,创面准备,创面愈合”和“TIME principles, wound bed preparation, wound healing”,语言分别设定为中文和英文,分析创面愈合临床应用原则及效果的研究进展。 结果与结论：共检索到文献 498 篇,阅读标题和摘要后,按纳入标准,共纳入22篇。TIME为创面处理过程中创床准备4项原则性的方法的首个英文字母的缩写,即：T指清除创面坏死组织(tissue);I指控制炎症、减轻感染(infection/inflammation);M指保持创面正常的湿度为肉芽组织生长和创面上皮化创造条件(moisture);E 指去除创缘迁移受损的表皮(edge of wound, non migrating)。目前TIME原则作为一个有价值的创面处理指导工具受到临床医生的好评,并应用于临床实践。     

“People power” or “pester power”? YouTube as a forum for the generation of evidence and patient advocacy

Objective

Venoplasty has been proposed, alongside the theory of chronic cerebrospinal venous insufficiency (CCSVI), as a treatment for multiple sclerosis (MS). Despite concerns about its efficacy and safety, thousands of patients have undergone the procedure. This paper analyses YouTube videos where patients have shared their treatment experiences.

Methods

Content analysis on the 100 most viewed videos from over 4000 identified in a search for ‘CCSVI’, and qualitative thematic analysis on popular ‘channels’ demonstrating patients’ experiences.

Results

Videos adopt an overwhelmingly positive stance towards CCSVI; many were uploaded by patients and present pre- and/or post-treatment experiences. Patients demonstrate rather than merely describe their symptoms, performing tests on themselves before and after treatment to quantify improvement. Videos combine medical terminology and tests with personal experiences of living with MS.

Conclusion

Social media technologies provide patients with novel opportunities for advocating for particular treatments; generating alternative forms of ‘evidence’ built on a hybrid of personal experience and medical knowledge.

Practice implications

Healthcare practitioners need to engage with new digital forms of content, including online social media. Instead of disregarding sources not considered ‘evidence-based’, practitioners should enhance their understanding of what ‘experiential-evidence’ is deemed significant to patients, particularly in contested areas of healthcare.     

医学免疫学“课程思政”设计与实践

"课程思政"是高校教师实现"立德树人"根本任务的重要途径。本文基于医学免疫学课程理论性强、涉及面广、知识更新快、内容抽象等特点,深入挖掘课程相关思政元素。通过线上线下相结合和多种学生参与式教学模式,如病例引入式、翻转课堂和角色扮演等,将思政元素与医学免疫学教学有机融合,以"润物细无声"的方式对学生进行"知识传授"和"价值引领"。     

大鼠拟“血管性痴呆”模型的改进

随着社会进入老龄化 ,作为老年病的脑血管病 ,已成为人类三大死亡原因之一。近年来由于医疗水平的提高和防治知识的深入 ,脑血管病死亡率有所下降 ,而脑血管病造成的各种功能和智力障碍却有增高的趋势。血管性痴呆的防治日益受到人们的关注。目前虽建立了数种脑缺血动物模型 ,但脑缺血晚期学习记忆功能障碍的动物模型较少并不够完善 ,在一定程度上影响了对其机理及治疗的研究。本工作在前人实验的基础上加以改进 ,建立了一种拟“血管性痴呆”的动物模型 ,为研究脑缺血后学习、记忆功能障碍的发生机理及防治提供实验基础。材　料　和　方　法…     

“三全育人”理念在临床免疫学检验技术的应用探讨——以“抗体制备” 为例

为响应国家对高等教育的全员、全过程、全方位育人要求,课题组在医学检验技术专业核心课程——临床免疫学检验技术中,通过全程融入思政元素,整合实验模块(深度)、技术新进展汇报(广度)、大学生创新创业训练项目(创新性)等方面设计课程,本文以“抗体制备”章节为例详细说明课程设计,以期通过“三全育人”在高等医学教育中的实践培养更多高职业素养的医学检验技术人才。     

以“动态”的观念进行肾上腺组织学教学

正组织学是研究机体微细结构及其相关功能的科学,是一门形态学课程,主要以描述的方法进行教学。本系对甲状腺、血管内皮、肝、肾等方面的内容开展了动态观念的教学,以肾上腺为例,表述动态观念教学的具体实施。早在1866年,Arnold已根据肾上腺皮质各区域细胞的形态学特征,将肾上腺皮质分为球     

《医学免疫学》的教学“六要素”

医学免疫学内容抽象,难学难懂。作为教师如果做到以下六个方面"巧开篇、明主线、重内涵、接地气、多互动、善总结",可以有效地提高教学水平,增加学生学习兴趣。     

颈椎定点旋转手法“点”的数字化解剖

背景：虽然颈椎定点旋转复位手法效果显著,但其机制一直缺乏深入的研究。临床上对所要实施的推拿力和旋转节段无法做到精确控制,有时会造成手法的医源性损伤。 目的：从颈椎定点旋转手法旋转中心点的角度分析旋转手法的作用途径。 方法：在64排螺旋CT工作平台扫描标本,层距1 mm。在PHILIPS MEDICAL SYSTEMS图像处理功能模块中提取图片中轮廓线数据,进行上颈椎三维结构重建和图像显示。取枢椎棘突顶点(A点)、齿突垂直轴心(B点)以及两者之间连线的中点(C点)为旋转轴心(模拟中的旋转中心点),分别以各点为原点建立球坐标系。观察枢椎棘突顶点与下颌尖旋转前后的连线夹角,以及齿突垂直轴心与下颌尖旋转前后的连线夹角。 结果与结论：做定点手法旋转时其中心并非是施术者利手作用的枢椎棘突顶点,而是枢椎齿突垂直轴心;实际轴心旋转角>术者观察角。提示应建立颈椎定轴旋转的新概念,并掌握颈椎定轴旋转手法的原则,以指导临床正确应用脊柱旋转类手法。     

The Genus Streptococcus – Part II: New Species and Pathogens in the “Miscellaneous” Streptococci and “Viridans” Streptococci Groups

In the second part of this two-part series on an update on the streptococci, new species and emergent human pathogens in the “viridans streptococci” and the “miscellaneous streptococci” groups are discussed. Among the “miscellaneous streptococci,” the most important organism in human infectious diseases is Streptococcus suis. This organism is primarily an agent of disease in swine and other animals and has now emerged as a significant human pathogen, causing bacteremia and meningitis, particularly among populations in Asia and the Far East. While S. suis capsular serotype 2 is the most frequently isolated agent, infections caused by other serotypes are increasingly being reported. In addition, disease caused by S. suis is now being described more frequently in North America in individuals with significant occupational exposure to swine. Among the viridans streptococci, several new species in the mitis-sanguinis group have been described as human pathogens, including Streptococcus pseudopneumoniae, Streptococcus oligofermentans, and Streptococcus tigurinus. Other newly reported viridans group species either comprise part of the human oral microbiome or have been isolated from animals. This article presents information on these bacterial agents, including characteristics for the recognition and identification of the more important clinical isolates in these streptococcal groups.     

“Hearing voices” in schizophrenia: Who’s voices are they?

Paranoid schizophrenia is a subtype within the group of schizophrenia disorders. In the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), delusions and hallucinations are the first and second symptoms required for the diagnosis of schizophrenia. Empirical data and clinical observations allow us to present the hypothesis that paranoid schizophrenia can be divided into two subgroups: (1) Hallucinatory subgroup, patients with prominent hallucinations and delusions influenced by auditory hallucinations, (2) Delusional subgroup, patients with prominently impaired thought content, in which hallucinations are not significant clinical factors. Furthermore, we believe that auditory hallucinations are not disturbances of perception but rather of thought – or “pseudo-perceptions”.     

The Genus Streptococcus – Part I: Emerging Pathogens in the “Pyogenic Cocci” and the “Streptococcus bovis” Groups

In this first part of a two-part update on the streptococci, new and emerging pathogens in the “pyogenic cocci group” and the “Streptococcus bovis group” are addressed. Among the pyogenic cocci, several new species have been described, and some of these are becoming relevant agents of human disease. Streptococcus porcinus and Streptococcus pseudoporcinus are β-hemolytic streptococci that are found in swine and humans, respectively. S. pseudoporcinus has been isolated primarily from the female genital tract and may play a role in genitourinary tract infections, wound infections, and adverse pregnancy outcomes. Streptococcus iniae, Streptococcus hongkongensis, and Streptococcus ictaluri are fish pathogens, and S. iniae, in particular, has been isolated from several human infections in persons who handle raw seafood or experience penetrating injuries from fish spines or crab pincers. Streptococcus gallolyticus subspecies (i.e., the former “S. bovis group”) are well-recognized causes of bacteremia, meningitis, and endocarditis. S. gallolyticus subsp. gallolyticus is known to be associated with colon cancer, and current studies suggest that other S. gallolyticus subspecies (particularly S. gallolyticus subsp. pasteurianus) may also be associated with meningitis and other digestive tract malignancies. In this review, current research on S. gallolyticus subspecies and proposed mechanisms for their involvement in the pathogenesis of colonic carcinoma are also briefly addressed.