Teaching diagnostic approach to a patient through cinema

Films are produced with the aim of entertaining people, but recently there has been increasing use of films to educate medical trainees about various disorders, symptoms of these disorders, patient–therapist interactions, and various other medical and psychiatric issues. Discussions in academic circles have moved from criticism of negative portrayals of mental illness in earlier films to their use in teaching sessions. Films can be used either in full length or clip format to conduct training modules. Use of the film Stigmata to train residents about diagnostic dilemmas and taking a diagnostic approach to patients is discussed.     

RELEARNING TOWARD MOTOR RECOVERY IN STROKE,SPINAL CORD INJURY,AND CEREBRAL PALSY: A COGNITIVE NEURAL SYSTEMS PERSPECTIVE

In stroke, spinal cord injury, and cerebral palsy there is denervation of target neuron centers, which are self-organizing maps (SOMs) within the neuraxis. Compensatory reinnervation occurs within those SOMs by acquiring synaptic sprouts from whatever neurons in the neighborhood. Such reorganizations are more often maladaptive than beneficial. Motor recovery, if any appears, is incomplete and compromised. Cognitive systems studies indicate that motor paralysis is due to loss of learning ? recall balance in those compensated SOMs, which had been locked into a stability ? plasticity dilemma. Treatment/rehabilitation should aim therefore to first restore this learning related balance. The use of botulinum toxin as a neuromotor relearning tool to improve motor recovery is discussed.     

Optimizing antibiotic prescribing: collective approaches to managing a common-pool resource

BackgroundAntimicrobial resistance (AMR) is one of the greatest threats in 21st century medicine. AMR has been characterized as a social dilemma. A familiar version describes the situation in which a collective resource (in this case, antibiotic efficacy) is exhausted due to over-exploitation. The dilemma arises because individuals are motivated to maximize individual payoffs, although the collective outcome is worse if all act in this way.ObjectivesWe aim to outline the implications for antimicrobial stewardship of characterizing antibiotic overuse as a social dilemma.SourcesWe conducted a narrative review of the literature on interventions to promote the conservation of resources in social dilemmas.ContentThe social dilemma of antibiotic over-use is complicated by the lack of visibility and imminence of AMR, a loose coupling between individual actions and the outcome of AMR, and the agency relationships inherent in the prescriber role. We identify seven strategies for shifting prescriber behaviour and promoting a focus on the collectively desirable outcome of conservation of antibiotic efficacy: (1) establish clearly defined boundaries and access rights; (2) raise the visibility and imminence of the problem; (3) enable collective choice arrangements; (4) conduct behaviour-based monitoring; (5) use social and reputational incentives and sanctions; (6) address misalignment of goals and incentives; and (7) provide conflict resolution mechanisms.ImplicationsWe conclude that this theoretic analysis of antibiotic stewardship could make the problem of optimizing antibiotic prescribing more tractable, providing a theory base for intervention development.     

Unsuspected carcinoma of the gallbladder

Laparoscopic cholecystectomy is the treatment of choice for gallstones. A formal contraindication is gallbladder cancer. However, in a great number of cases, this is a previously unsuspected intraoperative finding, and sometimes its first appearance is in acute cholecystitis. We present the case of 67-year-old woman, which presented an unsuspected carcinoma of the gallbladder that developed abdominal wall implants at the umbilical and left hypocondrium site. The success of LC favors the observation of cases similar to that described in this article. Surgeons who operate using laparoscopic techniques should bear this possibility in mind and practice an extemporaneous biopsy at the slightest suspicion of malignancy, and, if it is confirmed, the operation should be continued as an open one.     

Human food choices: an examination of the factors underlying acceptance/rejection of novel and familiar animal and nonanimal foods

Two studies, aimed at increasing our knowledge of the factors that contribute to acceptance of novel foods were conducted. In Study 1, male and female participants were presented with familiar and novel animal and nonanimal foods and were asked to rate these foods on a variety of measures including: beliefs about the foods, feelings to the thought of ingesting the foods, and willingness to try the foods. Results demonstrated that willingness to try familiar nonanimal foods was predicted by beliefs about the negative sensory properties of the foods and joy elicited by the thought of eating them. Willingness to try familiar animal foods was predicted by beliefs about the sensory properties of the foods and beliefs about the anticipated negative consequences of eating them. Conversely, willingness to try novel foods, of both animal and nonanimal origin was predicted by beliefs about the disgusting properties of these foods and the interest evoked at the thought of consuming them. Study 2 used a qualitatively different sample from that used in Study 1 and perfectly replicated the previous results pertaining to the novel foods. Implications for our understanding of food-related disgust rejections are considered.     

Novel,nano-sized,liposome-encapsulated polyamidoamine dendrimer derivatives facilitate tumour targeting by overcoming the polyethylene glycol dilemma and integrin saturation obstacle

Drug delivery systems (DDSs) commonly employ arginine–glycine–aspartic acid (RGD) peptides with polyethylene glycol (PEG)-dependent enhanced permeability and retention (EPR) effect to optimise tumour-targeting. However, the PEG dilemma and integrin saturation obstacle are major challenges. To address these issues, we constructed a novel, nano-sized DDS by encapsulating doxorubicin (DOX)-loaded folic acid derivatives of polyamidoamine dendrimer (PAMAM G5.0) in cyclic RGD-tyrosine-lysine pentapeptide (c[RGDyK])-modified liposomes (RGD-SL[FND/DOX]), prepared using thin-film hydration, film-dispersion and hydration-sonication. The liposomes were PEGylated, sterically stabilised and pH-sensitive. In vitro, RGD-SL[FND/DOX] showed pH-sensitive holistic FND/DOX release, and pH-dependent uptake and cytotoxicity in human cancer KB cells. At pH 7.4, RGD-SL[FND/DOX] demonstrated greater cellular uptake and cytotoxicity than relevant control formulations (except FND/DOX) did, although this advantage disappeared at pH 6.5. In vivo, RGD-SL[FND/DOX] inhibited S180 sarcoma xenografted tumour growth in Kunming mice more effectively than FND/DOX did. These findings demonstrate the feasibility of constructing double-stage tumour-targeting nano-sized DDSs such as RGD-SL[FND/DOX]. c[RGDyK] and the EPR effect, facilitated by the particle size (about 110?nm) and PEGylation, helped to target the DDS to the tumour tissue, while the subsequent pH-dependent release of FND/DOX and folic acid-mediated endocytosis specifically targeted the tumour cells, thereby overcoming the PEG dilemma and integrin saturation obstacle.     

困境家庭儿童亲社会行为影响因素、作用与边际效应分析

目的：探讨困境家庭儿童亲社会行为的影响因素、作用并进行边际效应分析，为家庭、政府、社会有针对性实施促进困境家庭儿童亲社会行为的干预措施提供实证依据。方法：利用“困境家庭儿童健康调查”（2018年）数据，基于社会生态学理论，使用列联分析和卡方检验考察困境家庭儿童和普通家庭儿童亲社会行为的差异；运用有序多分类logistic回归分析环境变量对儿童亲社会行为的影响，采用边际效应分析不同层面的环境因素对困境家庭儿童亲社会行为不同等级的影响。结果：困境家庭儿童更易产生较差的亲社会行为；其认知能力、监护人的养育行为与生活照料的缺失以及朋友质量等因素对亲社会行为的发展产生重要影响；就影响因素作用看，监护人与儿童的沟通情况和朋友质量会加大困境家庭儿童和普通家庭儿童亲社会行为的差异；就亲社会行为处于不同程度的边际效应看，学习成绩优秀、监护人为其提供较好生活照顾、监护人经常与其沟通的困境家庭儿童亲社会行为处于正常范围的概率显著提高，监护人在过去一年打过儿童、朋友质量差的困境家庭儿童亲社会行为处于临界值和异常范围的概率显著增加。结论：社会生态系统中儿童子系统、父母子系统、儿童环境子系统都在不同程度上作用于儿童特别是困境家庭儿童的亲社会行为，政策干预应当综合造成个体行为异质性的各种环境因素，重视困境家庭儿童的心理建设和社会化发展。     

我国妇幼保健机构面临的困境及对策

从妇幼保健机构的特殊职能以及在卫生服务机构中的重要性出发，结合安徽省妇幼保健机构费用测算课题研究中发现的问题，重点强调我国妇幼保健机构在市场经济竞争日益激烈的今天，面临的财政补偿不力，业务收入不足等一系列的困境，详细分析造成这一困境的原因，最后针对这一困境提出几条解决问题的对策，以求使我国妇幼保健机构摆脱面临的困境，满足妇女、儿童不断增长的预防保健需求，从根本上来提高人们的健康水平。     

Epstein–Barr virus mucocutaneous ulcer followed by Hodgkin lymphoma in multiple myeloma patient

Epstein–Barr virus mucocutaneous ulcers (EBV MCU) are B‐cell lymphoproliferative disorders associated with immunosuppression. We report EBV MCU in a multiple myeloma patient on lenalidomide maintenance after stem cell transplant that resolved with decreased immunosuppression. Furthermore, the subsequent development of classical Hodgkin lymphoma suggests an underlying predisposition to EBV‐driven lymphoproliferative disorders.