Telemedicine as a Means to an End, Not an End in Itself

Telemedicine (TM)—the management of disease at a distance—has potential usefulness for patients with advanced respiratory disease. Underscoring this potential is the dramatic expansion of its applications in clinical medicine. However, since clinical studies testing this intervention often provide heterogeneous results, its role in the medical management of respiratory disorders remains inconclusive. A major problem in establishing TM’s effectiveness is that it is not a single intervention; rather, it includes a number of divergent diagnostic and therapeutic modalities—and each must be tested separately. Reflecting the discord between the need for further documentation of its approaches and effectiveness and its rapid utilization without this needed information, a major challenge is the lack of international guidelines for its integration, regulation, operational plans, and guidance for professionals. Tailored TM, with increased flexibility to address differing healthcare contexts, has the potential to improve access to and quality of services while reducing costs and direct input by health professionals. We should view TM as a tool to aid healthcare professionals in managing their patients with respiratory diseases rather than as a stand-alone substitute to traditional medical care. As such, TM is a means rather than an end.

The Current Understanding of Precision Medicine and Personalised Medicine in Selected Research Disciplines: Study Protocol of a Systematic Concept Analysis

Introduction. The terms "precision medicine" and "personalised medicine" have become key terms in health-related research, and in science-related public communication. However, the application of these two concepts and their interpretation in various disciplines are heterogeneous, which also affects research translation and public awareness. This leads to confusion regarding the use and distinction of the two concepts. Methods and analysis. Our study aims at using Rodger's concept analysis method to systematically examine and distinguish the current understanding of the concepts "precision medicine" and "personalised medicine" in clinical medicine, biomedicine (incorporating genomics and bioinformatics), health services research; physics, chemistry, engineering; machine learning, and artificial intelligence, and to identify their respective attributes (clusters of characteristics) and surrogate and related terms. We will analyse similarities and differences in definitions in the respective disciplines and across different (sub)disciplines. The analysis procedure will include (1) a concept identification, (2) a setting, sample, and data source selection, (3) data collection, (4) data analysis and data summary, (5) identification of examples, and (6) identification of implications for further concept development. Ethics and dissemination. Following ethical and research standards, we will comprehensively report the methodology for a systematic analysis following Roger's[1] concept analysis method. Our systematic concept analysis will contribute to the clarification of the two concepts and distinction in their application in given settings and circumstances. Such a broader concept analysis will contribute to non-systematic syntheses of the concepts, or occasional systematic reviews on one of the concepts that have been published in specific disciplines, in order to facilitate interdisciplinary communication, translational medical research, and implementation science.

Cancer Stem Cells and Their Vesicles, Together with Other Stem and Non-Stem Cells, Govern Critical Cancer Processes: Perspectives for Medical Development

Stem cells, identified several decades ago, started to attract interest at the end of the nineties when families of mesenchymal stem cells (MSCs), concentrated in the stroma of most organs, were found to participate in the therapy of many diseases. In cancer, however, stem cells of high importance are specific to another family, the cancer stem cells (CSCs). This comprehensive review is focused on the role and the mechanisms of CSCs and of their specific extracellular vesicles (EVs), which are composed of both exosomes and ectosomes. Compared to non-stem (normal) cancer cells, CSCs exist in small populations that are preferentially distributed to the niches, such as minor specific tissue sites corresponding to the stroma of non-cancer tissues. At niches and marginal sites of other cancer masses, the tissue exhibits peculiar properties that are typical of the tumor microenvironment (TME) of cancers. The extracellular matrix (ECM) includes components different from non-cancer tissues. CSCs and their EVs, in addition to effects analogous to those of MSCs/EVs, participate in processes of key importance, specific to cancer: generation of distinct cell subtypes, proliferation, differentiation, progression, formation of metastases, immune and therapy resistance, cancer relapse. Many of these, and other, effects require CSC cooperation with surrounding cells, especially MSCs. Filtered non-cancer cells, especially macrophages and fibroblasts, contribute to collaborative cancer transition/integration processes. Therapy developments are mentioned as ongoing preclinical initiatives. The preliminary state of clinical medicine is presented in terms of both industrial development and future treatments. The latter will be administered to specific patients together with known drugs, with the aim of eradicating their tumor growth and metastases.

Victor Horsley

Sir Victor Horsley (1857–1916) was a pioneer who shaped the development of neurosurgery and the direction of clinical medicine through his work with the British Medical Association, Medical Defence Union, and General Medical Council. Before the nervous system could be imaged, Horsley operated successfully on the brain and spinal cord, and performed palliative procedures on patients dying from brain tumours. Nevertheless, he became a social pariah due to his support for nationalised health insurance, child welfare and women's rights, amongst other causes. In this fascinating biography, leading neurologist Dr Michael J. Aminoff places Horsley's life and work in the context of the society in which he lived and explores his influence on the development of neurosurgery and social policies still in effect. The many underlying themes to the book include the interplay of science and politics, and the responsibility of physicians to themselves and for the welfare of society.

A Polysaccharide of Ganoderma lucidum Enhances Antifungal Activity of Chemical Fungicides against Soil-Borne Diseases of Wheat and Maize by Induced Resistance

Ganoderma lucidum polysaccharide (GLP), which is the primary active ingredient in G. lucidum, has been widely used in functional food and clinical medicine. However, it is rarely reported in the prevention and control of plant diseases. In this study, we found that the GLP can increase the germination rates and seedling heights of maize and wheat. We also found that the combination of GLP and chemical fungicides as a seed coating chemical compound has a control effect of more than 75% on the primary soil-borne diseases of the wheat and maize growing areas in both greenhouse and field trials. Furthermore, the combination of GLP and chemical fungicides prolongs the lasting period and reduces the application dosage of the chemical fungicides by half. In addition, GLP seed dressing could increase the resistance-related gene expression of the TPS and WRKY53 in maize and WMS533, NbPR1a, and RS33 in wheat. The combination of GLP and low-dose chemical fungicides proved to be an effective way to effectively prevent wheat sharp eyespot, root rot, and maize stalk rot in the wheat and maize continuous cropping areas in the North China Plain and to reduce pesticide use and increase crop yield.

The second strategic plan of medical ethics: a national report

Medical ethics faces several challenges in different aspects of education, research, and treatment in medicine and healthcare practice. Design and implementation of a national strategic plan can pave the way for the development of a roadmap in various countries to strengthen ethics and address these challenges. To create a comprehensive plan compatible with the Iranian healthcare system, a multidisciplinary team of main stakeholders compiled a national strategic plan of medical ethics following several focus group discussion sessions and two workshops (2014-2017). Ultimately, the plan was confirmed by the Supreme Council for the Medical Ethics of the Ministry of Health and Medical Education. The current paper is a national report of the process and the medical ethics strategic plan in Iran. We have also tracked signs of progress and achievements in the country. In conclusion, this valuable effort has led to significant success in the implementation of medical ethics in clinical medicine, medical research, and education by using all the resources in our country. The participation of all the stakeholders, especially healthcare professionals in this way is required.

Myocardial Energy Response to Glyceryl Trinitrate: Physiology Revisited

Objective: Although intravenous nitrates are commonly used in clinical medicine, they have been shown to increase myocardial oxygen consumption and inhibit complex IV of the electron transport chain. As such we sought to measure whether myocardial energetics were impaired during glyceryl trinitrate (GTN) infusion.Methods: 10 healthy volunteers underwent cardiac magnetic resonance imaging to assess cardiac function and 31phosphorus magnetic resonance spectroscopy to measure Phosphocreatine/ATP (PCr/ATP) ratio and creatine kinase forward rate constant (CK kf) before and during an intravenous infusion of GTN.Results: During GTN infusion, mean arterial pressure (78 ± 7 vs. 65 ± 6 mmHg, p < 0.001), left ventricular (LV) stroke work (7,708 ± 2,782 vs. 6,071 ± 2,660 ml mmHg, p < 0.001), and rate pressure product (7,214 ± 1,051 vs. 6,929 ± 976 mmHg bpm, p = 0.06) all fell. LV ejection fraction increased (61 ± 3 vs. 66 ± 4%, p < 0.001), with cardiac output remaining constant (6.2 ± 1.5 vs. 6.5 ± 1.4 l/min, p = 0.37). Myocardial PCr/ATP fell during GTN infusion (2.17 ± 0.2 vs. 1.99 ± 0.22, p = 0.03) with an increase in both CK kf (0.16 ± 0.07 vs. 0.25 ± 0.1 s−1, p = 0.006) and CK flux (1.8 ± 0.8 vs. 2.6 ± 1.1 μmol/g/s, p = 0.03).Conclusion: During GTN infusion, despite reduced LV stroke work and maintained cardiac output, there was a 44% increase in myocardial ATP delivery through CK. As PCr/ATP fell, this increase in ATP demand coincided with GTN-induced impairment of mitochondrial oxidative phosphorylation. Overall, this suggests that while GTN reduces cardiac work, it does so at the expense of increasing ATP demand beyond the capacity to increase ATP production.

MECHANISM OF SENSORINEURAL HEARING LOSS CAUSED BY TYPICAL SCLEROSIS OF COCHLEA

It is difficult to measure the cochlea directly because of the ethical problems and the complexity of cochlear structure. Therefore, finite element model (FEM) can be used as an effective alternative research method. An accurate FEM of the human ear can not only help people understand the mechanisms of sound transmission, but also effectively assess the effects of otologic diseases and guide research on the treatment of hearing loss. In this paper, a three-dimensional (3D) FEM of the human normal cochlea is proposed to study the changes in the biomechanical behavior of the cochlear sensory structure caused by the anterior fissure sclerosis and bottom-turn and apex-turn ossification of the cochlear window. The degree and harm of hearing loss caused by diseases are quantitatively predicted, which can deepen the understanding of the biomechanical mechanism of cochlea, and provide theoretical basis for clinical medicine.