Concept Of Medicine Research Articles

The circadian neurobiology of reward.

Circadian clocks are important regulators of physiology and behavior. In the brain, circadian clocks have been described in many centers of the central reward system. They affect neurotransmitter signaling, neuroendocrine circuits, and the sensitivity to external stimulation. Circadian disruption affects reward signaling, promoting the development of behavioral and substance use disorders. In this review, we summarize our current knowledge of circadian clock-reward crosstalk. We show how chronodisruption affects reward signaling in different animal models. We then translate these findings to circadian aspects of human reward (dys-) function and its clinical implications. Finally, we devise approaches to and challenges in implementing the concepts of circadian medicine in the therapy of substance use disorders.

Learning to switch gears - Steering palliative care into emergency medicine.

Emergency care is largely seen as synonymous with resuscitation and saving lives. In most of the developing world where Emergency Medicine (EM) is still evolving, the concept of EM palliative care is alien. Provision of palliative care in such settings poses its own challenges in terms of knowledge gaps, socio-cultural barriers, dismal doctor-to-patient ratio with limited time for communication with patients, and lack of established pathways to provide EM palliative care. Integrating the concept of palliative medicine is crucial for expanding the dimension of holistic, value-based, quality emergency care. However, glitches in decision-making processes, especially in high patient volume settings, may lead to inequalities in care provision, based on socio-financial disparities of patients or premature termination of challenging resuscitations. Pertinent, robust, validated screening tools and guides may assist physicians in tackling this ethical dilemma.

An evaluation of Italian medical students attitudes and knowledge regarding forensic medicine

IntroductionThis study aims to assess students' knowledge of forensic medicine concepts and their opinions regarding the course taught during the degree course in Medicine and Surgery in an Italian university. Consequently, the study aims to assess the impact of the course on the students’ knowledge and attitude in choosing a medical residency. Materials and methodsA cross-sectional study was conducted through an anonymous web-based survey of medical students at the Università Cattolica del Sacro Cuore. Descriptive and univariate analysis were conducted. Results1166 students completed the survey. The forensic medicine course appears to be extremely important in providing training in the fundamental concepts of forensic medicine, especially professional liability, defensive medicine, and forensic pathology. Attending autopsies is important during the course, and their number should be more than ten. Additionally, univariate analysis demonstrates that students' awareness of forensic medicine topics, such as the function of the forensic physicians, professional liability, and defensive medicine, improves in the fifth or sixth year of the course. After the course, more students would choose to pursue a nonclinical and nonsurgical specialty, and forensic medicine specifically, for their residency. ConclusionsThe forensic medicine course has the task of defining the duties and responsibilities of forensic physicians, providing indispensable tools for future medical practitioners, regardless of their future specialisation, and limiting the increasing use of defensive medicine. In conclusion, we recommend further multicenter studies to evaluate the role and direct effect of undergraduate forensic medicine courses on students and on the quality of practice.

Call attention to the role of Beijing Vascular Health Stratification in clinical practice of intellectualized and digital heart and vascular health management medical model in China

Early comprehensive assessment and early intervention of vascular disease, and the life-time maintenance of vascular health are the key to effectively preventing death and disability in end-stage of heart, brain, kidney and peripheral vascular events. Based on this concept, it is necessary to establish a professional clinical discipline of "vascular medicine" which is based on the systemic vascular bed, with measures on prevention, treatment, rehabilitation and intellectualized and digital vascular health management throughout the life cycle for different vascular lesions and different degree of vascular injury. The aim of the establishment of Beijing Vascular Health Stratification (BVHS) is to give a comprehensive and dynamic assessment of vascular health based on the concept of vascular medicine, to conduct individualized analysis of the results, to classify the degree of injury on vascular structure and function, to carry out individualized intervention, and eventually achieve targeted precise prevention and management, establish newly intellectualized and digital vascular health management medical model in China, for effectively reducing the incidence of cardiovascular events.

Idiopathic Short Stature: What to Expect from Genomic Investigations

Short stature is a common concern for physicians caring for children. In traditional investigations, about 70% of children are healthy, without producing clinical and laboratory findings that justify their growth disorder, being classified as having constitutional short stature or idiopathic short stature (ISS). In such scenarios, the genetic approach has emerged as a great potential method to understand ISS. Over the last 30 years, several genes have been identified as being responsible for isolated short stature, with almost all of them being inherited in an autosomal-dominant pattern. Most of these defects are in genes related to the growth plate, followed by genes related to the growth hormone (GH)–insulin-like growth factor 1 (IGF1) axis and RAS-MAPK pathway. These patients usually do not have a specific phenotype, which hinders the use of a candidate gene approach. Through multigene sequencing analyses, it has been possible to provide an answer for short stature in 10–30% of these cases, with great impacts on treatment and follow-up, allowing the application of the concept of precision medicine in patients with ISS. This review highlights the historic aspects and provides an update on the monogenic causes of idiopathic short stature and suggests what to expect from genomic investigations in this field.

Assessing patient-level knowledge of precision medicine in a community health center setting.

As precision medicine approaches are implemented, cancer treatment decisions have come to require comprehension of genetic tests and their role in risk stratification and treatment options. Acceptance and implementation of precision medicine requires patient understanding of numeracy, genetic literacy, health literacy, and medical trust. Implementing precision medicine in a US federally qualified community health center (FQCHC) setting has received little attention. Using a mixed-methods approach, we sought to identify patient-level factors influencing the understanding of cancer risk and precision medicine among FQCHC patients. We enrolled 26 English-speaking adults aged 40-79years. Participants enrolled in focus groups and completed surveys to assess patient-level understanding of precision medicine, numeracy, and health literacy. The majority of participants were female (77%) and self-identified as African American (89%). Approximately one-third reported having a high school degree or less. While health literacy was generally high, 42% felt that genes or genetics had little impact on health and most (69%) reported little familiarity with precision medicine. Many participants reported that trust in their providers was extremely or very important when receiving genetic tests. Numeracy levels were moderate, with nearly half reporting some discomfort working with fractions and 38% finding numerical information only occasionally useful. Findings suggest that patients may lack familiarity with precision medicine concepts relevant for understanding cancer treatment decisions. Future educational efforts may help bridge the gap in patient understanding and facilitate equitable opportunities for precision medicine for all patients, including those seeking care from community health centers.

Processing of Real World Data in Traditional Chinese Medicine

Traditional Chinese medicine (TCM) is a unique traditional medicine in China and has been passed down to the present day with its unique theoretical basis and treatment model. The introduction of the concept of evidence-based medicine into traditional Chinese medicine and the scientific evaluation of its clinical efficacy are essential for the better development and transmission of TCM. Randomised controlled trials have always been the "gold standard" of clinical trial evidence due to their strict inclusion and exclusion criteria and strict control of the data collection process, but the specificity of the TCM treatment model, the holistic, ambiguous, diverse and complex nature of the data, and the concomitant events in the research process make it difficult to conduct randomized ontrolled trials in TCM. Real World Study (RWS), which is conducted in actual clinical settings with broad inclusion and exclusion criteria to obtain treatment effects and long-term clinical outcomes as endpoints, can be used for long-term evaluation of treatment measures based on patients' preference. Real world studies allow for the long-term evaluation of treatment measures based on patients' preference, and are able to evaluate the overall effects, adapting to the holistic concept of Chinese medicine and the characteristics of evidence-based treatment. This paper summaries the data characteristics and data processing methods of real world studies in TCM, with a view to providing a reference for real world studies in TCM.

Evaluating the dissemination of evolutionary biology concepts in medicine.

Darwin's theory of evolution, which is based on variation, heredity, and selection, includes all biological fields and spreads to other areas such as philosophy. Medicine is an example of how the evolutionary perspective can greatly improve the understanding of concepts in an area, as human health and pathological conditions are under the effect of evolution. Evolutionary medicine is an emerging paradigm for understanding human heterogeneity, health, and diseases. Nevertheless, there are indications that medical research and practice are only marginally affected by these ideas. Here, we investigate how concepts of biological evolution are employed in medical research. We use a bibliometric approach to look for the presence and frequency of biological evolution-related concepts in medical articles. The distribution of these concepts over the years is analyzed according to the medical specialty and the impact of the journal. Our data showed that: i) only a small percentage of articles in medical journals have an evolutionary perspective; ii) medical journals where these evolution-based articles are published focus on basic science, theoretical medicine, and less frequently, on applied medicine; iii) these articles are mostly from the microbiology, immunology, neurology, psychology, behavior, and oncology fields; and iv) viruses are the most frequently covered microorganisms, followed by bacteria, fungi, and protozoans. The collection of our results, considering the importance of evolutionary medicine in the medical field, highlights the need for a decisive change in perspective in medical research.

The EvMed Assessment: A test for measuring student understanding of core concepts in evolutionary medicine.

Universities throughout the USA increasingly offer undergraduate courses in evolutionary medicine (EvMed), which creates a need for pedagogical resources. Several resources offer course content (e.g. textbooks) and a previous study identified EvMed core principles to help instructors set learning goals. However, assessment tools are not yet available. In this study, we address this need by developing an assessment that measures students' ability to apply EvMed core principles to various health-related scenarios. The EvMed Assessment (EMA) consists of questions containing a short description of a health-related scenario followed by several likely/unlikely items. We evaluated the assessment's validity and reliability using a variety of qualitative (expert reviews and student interviews) and quantitative (Cronbach's α and classical test theory) methods. We iteratively revised the assessment through several rounds of validation. We then administered the assessment to undergraduates in EvMed and Evolution courses at multiple institutions. We used results from the pilot to create the EMA final draft. After conducting quantitative validation, we deleted items that failed to meet performance criteria and revised items that exhibited borderline performance. The final version of the EMA consists of six core questions containing 25 items, and five supplemental questions containing 20 items. The EMA is a pedagogical tool supported by a wide range of validation evidence. Instructors can use it as a pre/post measure of student learning in an EvMed course to inform curriculum revision, or as a test bank to draw upon when developing in-class assessments, quizzes or exams.

Evaluating the validity of the National List of Essential Medicines 2015 for “anesthetic agents” in 2022: An observational cost analysis

BACKGROUND AND AIMS: The concept of essential medicines (EMs) was introduced in 1977 by the World Health Organization. The most recent National List of EMs (NLEM) is the NLEM 2015, comprising 376 drugs. The following study was undertaken due to the lack of similar studies conducted on anesthetic agents and aims at evaluating “Section 1 – anesthetic agents” of NLEM 2015 and the relevance of EMs in India.MATERIALS AND METHODS: The study takes into account the drugs under Section 1 anesthetic agents. Data were collected from MedGuideIndia, a database of medicines marketed in India. Both cost ratio and percentage cost variations were calculated.RESULTS: Under Section 1 – anesthetic agents, atropine 1 ml injection (0.6 mg/1 ml) at 654.72% and lignocaine + adrenaline 30 ml injection has the lowest percentage cost variation at 6.26%. It was identified in the current study that the average percentage cost variation and cost ratio of all the 24 variations of the drugs is 164.51% and 2.64%, respectively. 1.3 – preoperative medication and sedation for short-term procedures have the highest price variation drug, atropine and 1.2 – local anesthetics have the lowest price variation drug, lignocaine + adrenaline.CONCLUSION: This study mainly discusses the large price variations comparing the lower versus the higher priced branded variants under Section 1 anesthetic agents. Appropriate physician education is required and newer pricing regulations require enforcement.

SECONDARY NOMINATION IN THE ENGLISH TERMINOLOGICAL SYSTEM FOR ANIMAL DISEASES

This paper explored the problem of forming a secondary nomination in the English veterinary terminology on the example of terms for animal diseases. The aim of this study is to reveal the secondary nomination as one of the ways to replenish the terminology denoting animal diseases. Methods applied were continuous sampling of language material, classification, definition analysis and a descriptive-analytical method. Based on the collected lexicographical material, selected from the English veterinary dictionaries, the features of metaphorical and metonymic transferences, which serve for the formation of the English terms, nominating animal diseases have been revealed. The thought processes aimed at the formation of the secondary nomination are described. Layers of vocabulary that are sources of metaphorization and metonymization, such as metaphor, types of metonymic constructions, are considered. A conclusion was made about extraordinary activity in the term creation of metaphorization processes based on the use of signs of some subject areas to denote others. Based on the theory of conceptual metaphor, the main donor domains that served as a source of metaphorical nominations denoting animal diseases were identified. Terminological units for the designation of animal diseases arising as a result of metonymy are analyzed; the most productive models of metonymic transpositions are highlighted, which is important for their systematization and standardization. The study of metonymic transpositions in veterinary terminology makes it possible to clarify the specific features of the nomination of new concepts in veterinary medicine. Metonymic reinterpretation, compared to metaphorical, is a less common form of semantic transformation, including veterinary terms. Terminological units arising as a result of secondary nomination constitute a special part of the veterinary terminology vocabulary denoting animal diseases and reveal a close connection between language and thinking in the acts of secondary nomination.

Concepts of Health, Disease, Overdiagnosis and Defensive Medicine in Relation to Clinical Practice

Health, disease, overdiagnosis and defensive medicine are interrelated complex concepts that lack formal definitions and a uniform holistic perspective. Functional definitions of these concepts are context-specific and differ in relation to clinical practice, research, medical science and health insurance. In the context of clinical practice that is the focus of this review, having no clear working definitions of health, disease, overdiagnosis and defensive medicine is essential for distinguishing people who need medical intervention from those who do not, for formulating accurate diagnosis and treatment options, and for improving professional communication between clinicians and between clinicians and their patients. The purpose of this narrative review is to promote the understanding of the concepts of health, disease, overdiagnosis, defensive medicine and their interrelation in the context of clinical practice, with the view of enhancing the quality of healthcare services.

Consciousness of evidence-based medicine in public health emergencies.

Consciousness of evidence-based medicine in public health emergencies.

Role of Surgical Drains in Orthopedics

Abstract Introduction: The use of drains in orthopedic practice has been affected by the concept of evidence-based medicine, which is accepted as the standard of care for all surgical or medical practices. This concept questions all care processes that cannot be backed by evidence to be beneficial to the patient. There have been a large number of multi-center meta-analytical studies that have found drains to be of little or no benefit in trauma and orthopedic surgeries. As a result of these studies, there are few situations where drains are routinely used, such as calcaneal fractures in developed countries. Even major procedures such as total knee and arthroplasties are being performed without drains. We aim to investigate whether similar evidence can be found in our practice. Materials and Methods: This sounds like the description of a prospective randomized controlled trial studying the use of drains in certain types of surgical procedures. The study population consisted of 86 patients matched for sex and type of injury, and they were assigned to either a group that used drains or a group that did not use drains during their operations. The study aimed to observe and compare the rates of complications, such as hematoma, drain migration, infection, and inadvertent drain stitching, between the two groups. Results: Eighty-six major orthopedic operations were studied. There was no evidence of the occurrence of complication arising from nonuse of drains in the undrained group. Those patients whose wounds were drained had no need for drain change, thus making the wound care less eventful. Conclusion: Wound drains can help reduce tissue swelling in the postoperative period, but there is no significant difference in infection rates, hematoma, or seroma formation between drained and undrained wounds.

Reappraising the Queer Falsetto. Magnus Hirschfeld, Sexology, and the Gendered Vocality of Gay “Men”, 1900–1914

Filling a gap in falsetto history, this article unearths several mentions of male high-voice singing in Berlin’s homosexual subculture before World War I. Using the theories of the physician and liberationist activist Magnus Hirschfeld, a contemporary medical explanation for this phenomenon is discussed, especially with regard to Hirschfeld’s attitudes towards the singers’ gendered and queered bodies. His medical approach, which reinforces the singers’ performative agencies, is brought into conversation with more (post-)modern ideas of queer theory and voice studies, the concepts of embodiment, medicine, and gender providing for interesting points of contact between the two.

Hyaluronidase-trigger nanocarriers for targeted delivery of anti-liver cancer compound.

Chemotherapy is recognized as one of the significant treatment methods for liver cancer. The compound celastrol (CSL) could effectively inhibit the proliferation, migration, and invasion of liver cancer cells, which is regarded as a promising candidate to become a mainstream anti-liver cancer drug. However, the application of CSL in liver cancer chemotherapy is limited due to its systemic toxicity, poor water solubility, multidrug resistance, premature degradation, and lack of tumor targeting. Meanwhile, in order to comply with the current concept of precision medicine, precisely targeted delivery of the anti-liver compound CSL was desired. This paper takes into account that liver cancer cells were equipped with hyaluronic acid (HA) receptors (CD44) on their surface and overexpressed. Hyaluronidase (HAase) capable of degrading HA, HAase-responsive nanocarriers (NCs), named HA/(MI)7-β-CD NCs, were prepared based on the electrostatic interaction between HA and imidazole moieties modified β-cyclodextrin (MI)7-β-CD. HA/(MI)7-β-CD NCs showed disassembly properties under HAase stimuli, which was utilized to trap, deliver, and the controllable release of the anti-liver cancer compound CSL. Furthermore, cytotoxicity assay experiments revealed that CSL-trapped HA/(MI)7-β-CD NCs not only reduced cytotoxicity for normal cells but also effectively inhibited the survival for five tumor cells, and even the apoptotic effect of CSL-trapped NCs with a concentration of 5 μg mL-1 on tumor cells (SMMC-7721) was consistent with free CSL. Cell uptake experiments demonstrated HA/(MI)7-β-CD NCs possessed the capability of targeted drug delivery to cancerous cells. HA/(MI)7-β-CD NCs exhibited site-specific and controllable release performance, which is anticipated to proceed further in precision-targeted drug delivery systems.

Research on Risk Factors Affecting Sepsis Outcomes

Sepsis is one of the diseases with a highest mortality rates in the world. The Sepsis 3.0 consensus places more emphasis on host response to infection, and the concept of "heterogeneity" has been introduced in recent years in understanding sepsis. Therefore, more and more scholars began to pay more attention to the patients themselves, trying to find risk factors for adverse sepsis outcomes, so as to optimize clinical treatment plans and improve patient outcomes. This coincides with the concept of Traditional Chinese Medicine, which is an indispensable part of world medicine, and if the risk factors affecting sepsis outcomes are discussed from the perspective of integrated Traditional Chinese and Western medicine, it will be conducive to a better understanding of sepsis, thereby helping to optimize the individualized treatment of sepsis.

Effective common chinese herbal medicines used in treating chronic cholecystitis with liver-gallbladder dampness-heat syndrome: A review of clinical studies in the past 10 years

The objective of the study is to identify the effective common Chinese herbal medicines used in treating chronic cholecystitis with liver-gallbladder dampness-heat syndrome (CCLGDHS) through reviewing relevant clinical studies published in the past 10 years. Data were collected from ScienceDirect and Chinese National Knowledge Infrastructure. Data screening was carried out for the abstracts and full texts of the data. The top 15 Chinese herbal medicines with the highest occurring frequency were selected, statistically analyzed, and classified by their medicinal properties, actions, and indications according to the Chinese Pharmacopoeia 2015 edition. The top 15 effective common Chinese herbal medicines comprise Chai Hu, Huang Qin, Jin Qian Cao, Bai Shao, Yin Chen, Yu Jin, Chuan Lian Zi, Yan Hu Suo, Zhi Shi, Ban Xia, Bai Zhu, Pu Gong Ying, Gan Cao, Zhi Zi, and Qing Pi. The predominant natures were cold, cool, and warm. This combination can clear stagnant heat, warm Yang, and regulate Qi dynamics. In addition, bitter, pungent, and sweet were the predominant flavors. They can clear dampness-heat, regulate Qi dynamics to relieve cramps and pain, as well as tonify the deficiency. Along with entering the liver and gallbladder meridians, these herbal medicines also entered the spleen, stomach, and lung meridians to prevent potential disease transmission. The combinatorial medicinal actions of the effective common Chinese herbal medicine highlight the importance of the holistic concept of traditional Chinese medicine when treating CCLGDHS. In addition, the inclusion of activating blood to promote blood circulation, relieving cramps and alleviating pain, and tonifying the spleen and stomach represents a new finding in the treatment principle for CCLGDHS.

Differentiation and Treatment of Chronic Renal Failure Based on the Theory of "Peace and Balance"

Chronic renal failure is slow, the course of disease is long, and it is difficult to heal. At present, modern medicine is faced with many difficulties in treatment, and it is difficult to break through. The Chinese medicine treats the symptoms according to the whole concept and has obtained good curative effect. Although the pathogenesis of the disease is complicated, in the whole process of onset, deficiency in origin and excess in superficiality is still the most critical. It is often caused by deficiency of spleen and kidney, disorder of liver ascending and lung descending, combined with phlegm-dampness and stasis toxin, and the disturbance of internal and external wind. Consequently. It is necessary to treat multiple viscera at the same time, and treat both manifestation and root cause of disease. The theory of "Peace and Balance" fully interprets the overall concept of Chinese medicine, we advocate "aim for peace" and Incorporate "balance" throughout the entire treatment,to reach the balance of yin and yang. Therefore, this article will discuss the treatment based on syndrome differentiation of Chronic renal failure by the theory of "Peace and Balance".

Modern P4 medicine concept using virtual reality technology in the treatment of cancer chronic pain

Modern P4 medicine concept using virtual reality technology in the treatment of cancer chronic pain