Illuminating the Regenerative Properties of Stem Cells In Vivo with Bioluminescence Imaging

Preclinical animal studies are essential to the development of safe and effective stem cell therapies. Bioluminescence imaging (BLI) is a powerful tool in animal studies that enables the real-time longitudinal monitoring of stem cells in vivo to elucidate their regenerative properties. This review describes the application of BLI in preclinical stem cell research to address critical challenges in producing successful stem cell therapeutics. These challenges include stem cell survival, proliferation, homing, stress response, and differentiation. The applications presented here utilize bioluminescence to investigate a variety of stem and progenitor cells in several different in vivo models of disease and implantation. An overview of luciferase reporters is provided, along with the advantages and disadvantages of BLI. Additionally, BLI is compared to other preclinical imaging modalities and potential future applications of this technology are discussed in emerging areas of stem cell research.     

Patterns of Osteoporosis Medications Selection After Drug Holiday or Continued Therapy: A Real-World Experience

ObjectivePublished literature on physicians’ preferences and sequential treatment patterns of osteoporosis therapy is scarce.MethodsA retrospective cohort study of patients who received bisphosphonates, denosumab, and/or raloxifene for at least 3 consecutive years or teriparatide for at least 18 months for osteoporosis. Data collection spanned 10 years, from October 2007 to September 2016, at a tertiary care center in the United States.ResultsIn total, 12 885 patients were identified on the basis of receiving at least 1 treatment at any point in time; 1814 patients were randomly reviewed, and 274 patients met the inclusion criteria. The mean age was 68.8 ± 10.7 years, and women represented 90.9% of all the cases. Primary care physicians and rheumatologists constituted 65.7% and 22.6% of the prescribers, respectively. Before instituting a drug holiday, alendronate was the most common initial treatment (percentage, mean duration ± standard deviation in years: 69%, 5.4 ± 2.4 years) followed by ibandronate (9.5%, 4.9 ± 2.1 years) and raloxifene (9.1%, 5.2 ± 1.6 years). Denosumab was the most common second course of treatment, accounting for 29.3% of 82 patients who were subsequently prescribed another therapy, followed by alendronate (24.4%) and zoledronate (20.7%). Among patients who were placed on a drug holiday and eventually restarted on osteoporosis therapy, denosumab was the most common treatment instituted (n = 21), accounting for 40% of the total patients, followed by alendronate (32%) and zoledronate (16%). There was a progressive decline in osteoporosis therapy over the duration of the study.ConclusionAlendronate was the most common initial therapy. Denosumab was the most common second course of treatment prescribed.     

Fatal collision? Are wireless headsets a risk in treating patients?

Wireless-enabled headsets that connect to the internet can provide remote transcribing of patient examination notes. Audio and video can be captured and transmitted by wireless signals sent from the computer screen in the frame of the glasses. But using wireless glass-type devices can expose the user to a specific absorption rates (SAR) of 1.11–1.46 W/kg of radiofrequency radiation. That RF intensity is as high as or higher than RF emissions of some cell phones. Prolonged use of cell phones used ipsilaterally at the head has been associated with statistically significant increased risk of glioma and acoustic neuroma. Using wireless glasses for extended periods to teach, to perform surgery, or conduct patient exams will expose the medical professional to similar RF exposures which may impair brain performance, cognition and judgment, concentration and attention and increase the risk for brain tumors. The quality of medical care may be compromised by extended use of wireless-embedded devices in health care settings. Both medical professionals and their patients should know the risks of such devices and have a choice about allowing their use during patient exams. Transmission of sensitive patient data over wireless networks may increase the risk of hacking and security breaches leading to losses of private patient medical and financial data that are strictly protected under HIPPA health information privacy laws.     

TRIANGULAR REFLECTIVE EQUILIBRIUM: A CONSCIENCE‐BASED METHOD FOR BIOETHICAL DELIBERATION

Following a discussion of some historical roots of conscience, we offer a systematized version of reflective equilibrium. Aiming at a comprehensive methodology for bioethical deliberation, we develop an expanded variant of reflective equilibrium, which we call ‘triangular reflective equilibrium’ and which incorporates insights from hermeneutics, critical theory and narrative ethics. We focus on a few distinctions, mainly between methods of justification in ethics and the social practice of bioethical deliberation, between coherence in ethical reasoning, personal integrity and consensus formation, and between political and moral deliberation. The ideal of deliberation is explicated as a sharing of conscience within a special commitment to sincerity and openness to persuasion. Personal growth in wisdom is an indirect by‐product of the continuous practice of moral deliberation. This is explicated in the light of Sternberg's balance theory of wisdom and in the context of medicine as a profession embodying altruistic responsibilities of care in democratic and pluralistic societies.     

反向倍增法在生物组织漫射光计算中的应用

本文将反向倍增法和蒙特卡洛法相结合，运用到生物组织漫长反射率和透射率的计算中，并讨论了样品的光学特性以及厚度对计算结果的影响，同时对该方法的使用范围进行了讨论。     

公立医院医疗服务价格动态调整机制的构建

随着医改的不断推进，医药分开已成为深化医改的共识，其中医疗服务价格的适时调整也提上医改议程。文章按照“总量控制、结构调整、有升有降、逐步到位”的原则，探索通过构建医疗服务成本与价格指数模型，监测、比对二者背离程度，结合医院内部加强成本控制的精细化管理和医保基金的分配情况，提出医疗服务价格动态调整的方法和可行性路径。     

Medical Need,Equality, and Uncertainty

Many hold that distributing healthcare according to medical need is a requirement of equality. Most egalitarians believe, however, that people ought to be equal on the whole, by some overall measure of well‐being or life‐prospects; it would be a massive coincidence if distributing healthcare according to medical need turned out to be an effective way of promoting equality overall. I argue that distributing healthcare according to medical need is important for reducing individuals' uncertainty surrounding their future medical needs. In other words, distributing healthcare according to medical need is a natural feature of healthcare insurance; it is about indemnity, not equality.     

我院规范科室质量与安全团队活动的做法

为持续地落实三级综合医院评审标准相关核心条款，以科室质量与安全管理团队为工作抓手，帮助科室建立管理框架、引领科室制定管理计划、梳理管理目标、重视质量与安全、开展团队活动，努力达到《三级综合医院评审标准实施细则》中持续改进的相关要求。     

THE LEBANESE PHYSICIAN: A PUBLIC'S VIEWPOINT

A physician's lack of humanity is a general complaint in public surveys. The physician‐patient relationship is viewed by the public as being reduced to a business relationship where the patient feels that she is merely a ‘client’ and the physician a healthcare ‘practitioner’ instead of a ‘care giver’. This public perception is not a phenomenon that is peculiar to Lebanon. Yet, the problem has been increasing over the years to the extent that patients feel that physicians are becoming inhumane and business oriented. While this might not characterize all physicians of the 21^st century, this might be true of at least some. Responses were collected from a study that was undertaken based on a questionnaire distributed to a pool of 650 participants from different geographical areas and different social and educational backgrounds in Lebanon. Participants were all older than18 years and mentally competent. None were physicians. The questionnaire was open‐ended and initially piloted among a random sample. The physician traits most desired by the public were found to be: moral traits (41%), interpersonal traits (36%), scientific traits (19%) and other (4%). The most unwanted traits/behaviours were a lack of interpersonal traits (57%), a lack of moral traits (40%) and a lack of scientific skills (3%). The physician‐patient relationship was perceived, in general, as being a flawed one. What can be done to remedy the image of the Lebanese physician that has been projected in the minds of the patients and the public at large? Nine major recommendations are presented.     

Screening Rate for Primary Aldosteronism Among Patients With Apparent Treatment-Resistant Hypertension: Retrospective Analysis of Current Practice

ObjectivePrimary aldosteronism (PA) is the most common secondary cause of hypertension. Patients with PA experience significant cardiovascular and other complications compared with patients with primary hypertension with the same degree of blood pressure control as those with PA. Guidelines have recommended screening all patients with resistant hypertension for PA. The objective of this study was to assess the screening rate for PA among patients with apparent treatment-resistant hypertension and determine the rate of positive screening test result among the group screened.MethodsThis was a retrospective chart review of electronic medical record data of all patients with hypertension aged ≥18 years within a single health system in Minnesota from September 2018 to September 2020.ResultsOf 140 734 patients who were aged ≥18 years and had a diagnosis of hypertension, 18 908 (13.4%) met the criteria for apparent treatment-resistant hypertension after those with congestive heart failure were excluded. Only 795 (4.2%) patients with apparent treatment-resistant hypertension underwent screening for PA in our cohort. Of the 795 patients who underwent screening for PA, 134 (16.9%) had a positive screening test result.ConclusionThe screening rate for PA among patients with resistant hypertension was low. Clinical and public health strategies directed at improving the screening rate for PA are vital.