Nationalism, Carrión's disease and medical geography in the Peruvian Andes

During the turn of the 20th century medical geography in Peru concentrated in the study of a native disease (bartonellosis, also known as Carrión's disease and Verruga Peruana) and reinforced the relationship between the country's 'natural' regions (coast, highlands and Amazon) and different patterns of disease. Expert knowledge on these themes was portrayed as important not only for the practice of medicine but also for the development of the country. This knowledge was instrumental for an emergent local medical tradition and for legitimizing the authority, power and prestige of Lima's medical elite. The city was the capital of a country whose population was mainly Indian and rural, and lived in the highlands. This article studies the development of medical geography in Peru emphasizing the role played by Ernesto Odriozola, an influential clinician from Lima trained in Paris.     

基于地理因素的健康中老年(40-65)P_aO_2参考值预测研究

动脉血氧分压(P_aO_2)参考值是医学诊治的重要指标,并随地理因素的变化而变化.鉴于各地参考值的不同,本文从地理因素角度出发,利用各地的各项地理因素指标,与各地的健康中老年动脉血氧分压参考值建立相关分析和回归分析,以此建立较为精确的预测模型,用以验证已知地区和预测未知地区的参考值.其建立的预测模型为医学参考值的制定提供了新的方法,并促进了地理资源的实践发展.     

Health Care in Modern Cuba

An extensively organized, centrally controlled system, aimed at equalizing and improving the distribution and quality of medical services according to population and geography, characterizes the modern Cuban health care complex. Facilities of increasing sophistication are located in urban areas while an expanding series of ambulatory, multipotential polyclinics attempts to provide most health services in both urban and rural settings.Maternal and child care, immunization programs and other forms of preventive medicine represent major priorities for expenditures. Occupational health is increasingly understood as a valuable resource, and medical professionals on all levels are being trained in significant numbers for Cuba and its allies.     

The evolution of Brazilian studies on helminths and the Escola tropicalista bahiana (Bahia Tropical School) (1866-1892)

In the mid nineteenth century, laboratory research in embryology, development, ecology and pathogeny of helminths unexpectedly resulted in a change in the explication of the etiology of some human pathology that was traditionally attributed to environmental factors. The new postulates of the parasitology of helminths put in question the traditional explications as well as the recognized authorities in the fields of clinical medicine, hygiene, and of medical geography, affecting not only the traditional circles where the innovations were discussed, but also the institutions that controlled and validated medical knowledge. From the beginning of the decade of the 1860s, a group of Brazilian medical doctors, initially led by Otto Wucherer, took part in this scientific movement that had an important impact on the area of the domestic and international academic medicine. The causality of known diseases, such as intertropical hypoemia, hematochyluria and elephantiasis, became the focus of intense debate between 1866 and 1892. By the end of this period, the field of helminthic parasitology had available well-established methodological and conceptual criteria and the role of Ankylostomum duodenale and of Wuchereria bancrofti in the production of those diseases was fully accepted.     

The Oslerian Tradition and Changing Medical Education: A Reappraisal

Although only 21 of Sir William Osler''s 45 years in academic medicine were spent in US medical schools (1884 to 1905), he played a major role in shaping modern medical education in this country. The integration of scholarship with patient care, together with the science and art of medicine, was central to Osler''s teaching and writing throughout his career. A classic generalist and a charismatic clinical teacher, he taught by example and was as concerned with the ideals of medicine as with its science and knowledge.Many changes have reshaped the content, process and concerns of American medical education since Osler''s time. Subspecialization and balkanization of medical education and practice have become dominant. Many of the important issues in medicine today do not fit neatly into the domain of any of the established specialties or medical organizations. There is now an urgent need to promote generalist attitudes in medicine, and the Oslerian tradition has much to offer in approaching today''s problems in medical education and practice.     

A pluralist challenge to “integrative medicine”: Feyerabend and Popper on the cognitive value of alternative medicine

This paper is a critique of ‘integrative medicine’ as an ideal of medical progress on the grounds that it fails to realise the cognitive value of alternative medicine. After a brief account of the cognitive value of alternative medicine, I outline the form of ‘integrative medicine’ defended by the late Stephen Straus, former director of the US National Centre for Complementary and Alternative Medicine. Straus’ account is then considered in the light of Zuzana Parusnikova’s recent criticism of ‘integrative medicine’ and her distinction between ‘cognitive’ and ‘opportunistic’ engagement with alternative medicine. Parusnikova warns that the medical establishment is guilty of ‘dogmatism’ and proposes that one can usefully invoke Karl Popper’s ‘critical rationalism’ as an antidote. Using the example of Straus, I argue that an appeal to Popper is insufficient, on the grounds that ‘integrative medicine’ can class as a form of cognitively-productive, critical engagement. I suggest that Parusnikova’s appeal to Popper should be augmented with Paul Feyerabend’s emphasis upon the role of ‘radical alternatives’ in maximising criticism. ‘Integrative medicine’ fails to maximise criticism because it ‘translates’ alternative medicine into the theories and terminology of allopathic medicine and so erodes its capacity to provide cognitively-valuable ‘radical alternatives’. These claims are then illustrated with a discussion of ‘traditional’ and ‘medical’ acupuncture. I conclude that ‘integrative medicine’ fails to exploit the cognitive value of alternative medicine and so should be rejected as an ideal of medical progress.     

Balancing acts: Picturing perspiration in the long eighteenth century

This essay examines the historical fortunes of an image that throughout the seventeenth and eighteenth centuries became a landmark of the medical doctrine and practice of static medicine advanced by the physician Santorio Santorio (1561-1636). The image depicted a man sitting on a large Roman steelyard, which allowed the weighing of bodily discharges and gave guidance on the intake of food. Well into the eighteenth century, the image of the weight-watching man accompanied Santorio's work on the art of static medicine and, most likely, contributed to its success. It appeared in a variety of medical works and navigated across competing medical theories and different medical genres, while remaining largely unscathed. This essay explores the success and the historical agency of this image. Focusing on the history of its copies and variants, it investigates how the image came to symbolize the attempt to transform dietetics into an experimental practice, and accordingly preserve its pivotal significance in the medical world.     

抑郁症治疗的循证医学研究进展

循证医学是近年来国际上临床医学领域迅速发展起来的新学科,已成为当前国际医学研究中的热点之一,是指对病人的诊 断、治疗、预防、康复和其他决策应建立在当前最佳临床研究证据,是遵循证据的临床医学,强调收集最佳证据。其理念的科学性 和有效性迅速渗透到医学领域的众多学科,循证精神卫生也相继提出并发展。抑郁症是由各种原因引起的以抑郁为主要症状的 一组心境障碍或情感性障碍,近几年能够有效运用循证医学方法为治疗抑郁症寻找最佳临床证据,制定循证诊疗指南成为了临 床医生的迫切要求。本文就抑郁症治疗方面的循证医学研究进展做一综述。     

温度和光周期对水稻抽穗期调控的交互作用

光周期和温度是植物开花的2个关键的调控因素,植物成花转变决定于植物对光周期和温度变化的精确测量.作为短日照植物,水稻在长日低温条件下抽穗期推迟,为了阐明温度和光周期对水稻开花时间的调控效应,本文利用1个光周期不敏感的突变体及其野生型,系统地分析了不同温度和光周期处理条件下,调控水稻开花时间几个关键基因（Hd3a,RFT1,Ehd1,Ghd7,RID1/Ehd2/OsId1,Se5）的表达调控模式,结果表明Ehd1-Hd3a/RFT1通路在光周期和温度调控水稻开花途径中保守.Ehd1,Hd3a和RFT1的表达在低温（23℃）条件下急剧下降,表明Ehd1,Hd3a和RFT1表达阻抑是低温条件下水稻开花推迟的主要原因.另外,在长日照条件下,低温（23℃）处理促进了水稻开花抑制子Ghd7的表达,表明低温条件和长日照条件对Ghd7的表达具有协同作用.此外,本文还分析了Hd1与光周期开花调控途径中几个关键基因的调控关系,发现Hd1在长日照条件下负向调控Ehd1的表达而正向调控Ghd7的表达,表明在长日照条件下,Hd1-Ghd7-Ehd1-RFT1通路也是水稻抽穗期调控的一条重要途径.     

Stem cell-based tissue engineering in veterinary orthopaedics

Regenerative medicine is one of the most intensively researched medical branches, with enormous progress every year. When it comes to translating research from bench to bedside, many of the pioneering innovations are achieved by cooperating teams of human and veterinary medical scientists. The veterinary profession has an important role to play in this new and evolving technology, holding a great scientific potential, because animals serve widely as models for human medicine and results obtained from animals may serve as preclinical results for human medicine. Regenerative veterinary medicine utilizing mesenchymal stromal cells (MSC) for the treatment of acute injuries as well as chronic disorders is gradually turning into clinical routine. As orthopaedic disorders represent a major part of all cases in veterinary clinical practice, it is not surprising that they are currently taking a leading role in MSC therapies. Therefore, the purpose of this paper is to give an overview on past and current achievements as well as future perspectives in stem cell-based tissue engineering in veterinary orthopaedics.     

现代生物医学科技前沿与中西医结合交叉

本文讨论了中医现代化和中西医结合的有关问题,指出中医现代化工作可分为三个方面：第一方面,应当培养大批临床上过硬的中医人才,在临床上有所突破,以此为基础进行理论研究;第二方面,将中医理论转换成现代语言;第三方面,中医与包括现代生物医学在内的多学科结合。阐述了现代生物医学科技前沿与中西医结合交叉而产生的新学科一光子中医学。指出光子中医学将为中西医结合提供理论和技术平台,成为多学科研究中医的代表性学科,并将成为中医现代化的一个重要方向,为人类卫生事业作出重大贡献。     

广西壮族自治区县级医疗卫生资源配置的公平性研究

目的 对广西县级医疗卫生资源配置的公平性进行分析。方法 采用洛伦茨曲线和基尼系数等方法,从人口和地理分布对广西91个县域医疗卫生资源(床位、卫生技术人员、医生)的配置公平性进行分析。结果 广西县级医疗卫生资源中床位、卫生技术人员、医生按人口分布的基尼系数分别为0.230 3、0.239 6、0.250 4,按地理分布的基尼系数分别为0.346 1、0.353 4、
0.352 3。结论 广西县级医疗卫生资源配置的公平性较好,其中人口分布优于地理分布,床位分布优于卫生人力资源分布。广西县级医疗卫生资源配置的公平性低于广西总体水平,但优于城区医疗卫生资源的配置。应进一步加大县级医疗卫生资源的投入,不断缩小城乡差距,提高县级医疗卫生资源在人口和地理配置的公平性。     

中医学跨越“卡夫丁峡谷”的可能性

西医学是从自然哲学模式,经近代生物医学模式而发展到现代生物心理社会医学模式的,而中医学仍处于古代自然哲学医学模式的历史阶段,与现代生物-心理-社会医学模式同形而异质。在现代,中医学要么通过生物医学的＂卡夫丁峡谷＂而追随在西方医学之后,要么消解于西方现代医学之中,要么跨越生物医学的＂卡夫丁峡谷＂而直接跃迁至现代医学。而实现跨越的两个基本条件是实现中医学基础理论的创造性转化与中医文化的大众化。     

Precision medicine in human heart modeling

Precision medicine is a new frontier in healthcare that uses scientific methods to customize medical treatment to the individual genes, anatomy, physiology, and lifestyle of each person. In cardiovascular health, precision medicine has emerged as a promising paradigm to enable cost-effective solutions that improve quality of life and reduce mortality rates. However, the exact role in precision medicine for human heart modeling has not yet been fully explored. Here, we discuss the challenges and opportunities for personalized human heart simulations, from diagnosis to device design, treatment planning, and prognosis. With a view toward personalization, we map out the history of anatomic, physical, and constitutive human heart models throughout the past three decades. We illustrate recent human heart modeling in electrophysiology, cardiac mechanics, and fluid dynamics and highlight clinically relevant applications of these models for drug development, pacing lead failure, heart failure, ventricular assist devices, edge-to-edge repair, and annuloplasty. With a view toward translational medicine, we provide a clinical perspective on virtual imaging trials and a regulatory perspective on medical device innovation. We show that precision medicine in human heart modeling does not necessarily require a fully personalized, high-resolution whole heart model with an entire personalized medical history. Instead, we advocate for creating personalized models out of population-based libraries with geometric, biological, physical, and clinical information by morphing between clinical data and medical histories from cohorts of patients using machine learning. We anticipate that this perspective will shape the path toward introducing human heart simulations into precision medicine with the ultimate goals to facilitate clinical decision making, guide treatment planning, and accelerate device design.

     

Doctors Have no Right to Refuse Medical Assistance in Dying,Abortion or Contraception

In an article in this journal, Christopher Cowley argues that we have ‘misunderstood the special nature of medicine, and have misunderstood the motivations of the conscientious objectors’. We have not. It is Cowley who has misunderstood the role of personal values in the profession of medicine. We argue that there should be better protections for patients from doctors' personal values and there should be more severe restrictions on the right to conscientious objection, particularly in relation to assisted dying. We argue that eligible patients could be guaranteed access to medical services that are subject to conscientious objections by: (1) removing a right to conscientious objection; (2) selecting candidates into relevant medical specialities or general practice who do not have objections; (3) demonopolizing the provision of these services away from the medical profession.     

Might there be a medical conscience?

I defend the feasibility of a medical conscience in the following sense: a medical professional can object to the prevailing medical norms because they are incorrect as medical norms. In other words, I provide an account of conscientious objection that makes use of the idea that the conscience can issue true normative claims, but the claims in question are claims about medical norms rather than about general moral norms. I further argue that in order for this line of reasoning to succeed, there needs to be an internal morality of medicine that determines what medical professionals ought to do qua medical professionals. I utilize a constructivist approach to the internal morality of medicine and argue that medical professionals can conscientiously object to providing treatment X, if providing treatment X is not in accordance with norms that would have been constructed, in light of the end of medicine, by the appropriate agents under the appropriate conditions.     

An ethics of enchantment: forming affect and information in experimental paediatric medicine

Science and medicine have been cast as disenchanted arenas of modernity, even as scholars have illustrated the many enchantments of everyday life. Taking these conversations into the context of experimental paediatric medicine, I explore the dis/enchantments produced through the research ethics systems that govern interactions between medical practitioners and patients’ families. Research ethics enact forms of disenchantment, aiming to produce the informed patient-subject who can knowingly submit to the unknowns of experimental medicine. However, by following one young patient's emotive disruption of the consent process, I suggest that we instead consider an ethics of enchantment: one that recognizes the affective logics of patienthood alongside the informatic. Elaborating how ethical practice is both institutionally structured and interpersonally improvised, I develop key conversations from the anthropology of ethics, and highlight the interplay of enchantment and disenchantment that constitutes modern medical subjects.