脑死亡与脑昏迷脑电信号的复杂度研究

脑死亡诊断是有关病人生死的重要问题.许多国家都把脑电平坦列为脑死亡诊断的基本条件,但研究发现并非所有的脑死亡患者均表现为脑电平坦,同时脑昏迷患者在部分情况下也会表现出脑电平坦的现象,从而有可能在临床中造成误判.C0复杂度判断指标能够利用脑电信号中的复杂度特性帮助临床诊断中对于脑死亡和脑昏迷状况的鉴别.运用C0复杂度算法对22位脑死亡和脑昏迷病例进行分析实验,可以发现脑死亡脑电信号的复杂度明显高于脑昏迷脑电信号的复杂度.实验表明C0复杂度可以用来有效地区分脑死亡和脑昏迷脑电信号,具有潜在的重要临床价值.     

Forensic implication of cadaveric behaviors of the Japanese pavement ant (Tetramorium tsushimae Emery) attending to rabbit cadavers

It is noticed by some researchers that ants may cause some forensic confusion in understanding death scenes. In the aspect of relationship between the ant‐animal decomposition, we observed the behavior of ants congregating on dead animals. Amongst various species of ants visiting dead rabbits, Tetramorium tsushimae Emery was noticeable in producing scratched scars, mounds, and nests around dead rabbits and covering them with soils. The behaviors are likely to interfere or to disturb the usual process of decomposition succession lead by maggots. We discussed that a series of cadaveric behaviors of T. tsushimae may be used as a potential forensic hint not to misunderstand death scenes disturbed by the species.     

Stigmatization of patients suffering from schizophrenia

For the general public, but also for healthcare professionals, schizophrenia is still one of those areas of medicine connected with feelings of unease, fear and prejudice. These feelings lead to stigmatization and discrimination which are unjust processes which put patients suffering from mental illnesses into undesirable and unequal positions. Aim of this research was to establish the extent of stigmatization of mentally ill patients among the population of healthcare professionals and future healthcare professionals and if they differ from general population. Results show that stigmatization of schizophrenic patients is high among all included populations. Although there were no statistical differences between groups regarding the assessment of schizophrenic patients, nurses employed in psychiatric wards exhibited a tendency towards higher acceptance of schizophrenic patients, as well as better understanding of that illness. This data emphasizes a growing need for continuous education of general population but also of healthcare professionals.     

Death, democracy and public ethical choice

The Danish Council of Ethics...believed that the brain-death criterion should not be accepted without public education and debate. Following the introduction of a spectrum of educational and related activites, a Gallup poll found that 98% of the survey population was aware of the debate over brain-vs-heart criteria and that 80% favoured the adoption of a supplemental brain-death standard... This raises the fundamental question of decisionmaking in pluralist democratic societies, of the limits of democratic involvement in such choices, and of the role of bodies like the Danish Council of Ethics... It must be part of the mission of a governmental bioethical body to use its peculiar expertise to teach and to lead -- to build a popular consensus out of confusion. But in doing so, such a Commission will be steering a dangerous course....     

Facing decisions about life and death--communication with parents

How can healthcare professionals, most of whom have never personally been confronted with such tragic situations, best help parents and their children make decisions about life and death that will minimize the suffering of children and their parents? Research studies and the professional experience of those attuned to these problems can be instructive. This paper reviews and gives advice about the communication between healthcare professionals and parents and children facing life and death.     

A primatological perspective on death

Some questions that arise from observations of responses to dead and dying individuals by nonhuman primates are discussed, focusing on psychological issues. The phenomenon of transport and care of dead infants is reviewed, along with the consequences of the mother dying for orphaned offspring. It is argued that particular attention should be paid to how the context of a death affects individuals, for example, traumatic accidental or predation-induced death versus peaceful death following illness. Some primates kill others of their own or other species, which raises additional questions about death awareness and empathy. Observations from both the field and captivity can contribute toward a better understanding of the psychological meaning of death for primates. Some aspects of death awareness recognized by developmental psychologists might help guide research efforts in this area.     

The Ethics of Continued Life‐Sustaining Treatment for those Diagnosed as Brain‐dead

Given the long‐standing controversy about whether the brain‐dead should be considered alive in an irreversible coma or dead despite displaying apparent signs of life, the ethical and policy issues posed when family members insist on continued treatment are not as simple as commentators have claimed. In this article, we consider the kind of policy that should be adopted to manage a family's insistence that their brain‐dead loved one continues to receive supportive care. We argue that while it would be ethically inappropriate to continue to devote scarce acute care resources to such patients in a hospital setting, it may not be ethically inappropriate for patients to receive these resources in certain other settings. Thus, if a family insists on continuing to care for their brain‐dead loved at their home, we should not, from a policy perspective, interfere with the family's wishes. We also argue that healthcare professionals should make some effort to facilitate the transfer of brain‐dead patients to these other settings when families insist on continued treatment despite being informed about the lack of any potential for recovery of consciousness. Our arguments are strengthened by the fact that patients in a persistent vegetative state, who, when correctly diagnosed, also have no potential for recovery of consciousness, are routinely transferred from hospitals to nursing homes or long‐term care facilities where they continue to be ventilated, tube fed and to receive other supportive care. We also briefly explore the question of who should be responsible for the costs of such treatment at the long‐term care facility.     

Genetic approaches to molecular mechanisms of programmed cell death in Dictyostelium

Caspase-independent cell deaths have been observed in many species including the human. However, the molecular mechanisms which govern them are largely unknown. Our present work makes use of a model organism, the protist Dictyostelium discoideum, which displays a caspase-independent cell death during its development. In rich medium, Dictyostelium multiplies vegetatively as a unicellular organism, but in starvation conditions, Dictyostelium cells aggregate, differentiate and morphogenize into a multicellular structure, called sorocarp, containing a mass of spores supported by a stalk. Cells in the stalk are considered dead on the basis of non-regrowth in a rich medium and are vacuolized. This programmed cell death is therefore developmental and vacuolar, and in addition, caspase-independent since the Dictyostelium genome does not contain caspases genes. In order to study in detail this cell death without induction of development, an in vitro experimental protocol has been adopted, which enabled us to describe the cascade of morphological events during this cell death. An insertional mutagenesis approach, followed by appropriate selection or screening of mutants potentially resistant to death, attempted at establishing the cascade of molecular events leading to vacuolar death of Dictyostelium cells. A better understanding of alternative death pathways may allow to control different types of cell deaths in the cases of cancers or neurodegenerative diseases. In this short review, we will discuss briefly some generalities about the development of Dictyostelium in starvation conditions, and we will focus on the course of programmed cell death in Dictyostelium and on the genetic tools used to elucidate the corresponding molecular mechanisms.     

The problematic role of 'irreversibility' in the definition of death

Most definitions of death – whether cardiopulmonary, whole brain and brain stem, or just upper brain – include an irreversibility condition. Cessation of function is not enough to declare death. Irreversibility should be limited to an organism's ability to 'restart' itself after vital organs have ceased to function. However, this would mean that every hour people who cannot be revived without the intervention of medical personnel and their technology are coming back from the dead. However, the alternative of irreversibility being dependent upon technology will lead to even more counterintuitive results such as: some people are dead at a particular time and place, but others in more technologically advanced eras and locations are alive despite their being in identical physical states; in the future, millions of cryogenically frozen human beings could spend centuries in a non–dead state because of the future technological breakthroughs; or large numbers of 'frozen' people are dead for aeons but coroners are not able to declare them so because they are unaware of what biological conditions science will never be able to reverse. So death should be defined only in non–relational biological terms with a self–starting condition similar to that once advocated by Lawrence Becker.     

Heparin can liberate high molecular weight DNA from secondary necrotic cells

The borderline between necrosis and apoptosis is indistinct, but that between types of cell death is important because necrosis may lead to local inflammation, whereas apoptosis usually does not. In certain autoimmune disorders, inhibition of cell death is crucial, since macromolecules released from the dead cells may accelerate the autoimmune processes. We have used various cell death inhibitors to block cell death induced by 4HPR [N‐(4‐hydroxyphenil)‐retinamide] the BL41 and U937 cell lines. VD‐FMK, a general caspase inhibitor, inhibited DNA fragmentation induced by 4HPR, but not PI (propidium iodide) uptake and necrosis. Interestingly heparin, a serine‐protease inhibitor, lowered the PI fluorescence of the dead cell population and increased the sub‐G1 population as measured by flow cytometry. Regarding these changes, we found that heparin failed to increase DNA fragmentation, but merely liberated high molecular mass DNA fragments from dead cells. The exact mechanism is unclear, but heparin during secondary necrosis might enter the cells, bind RNPs (ribonucleoproteins), and pull them out with the attached DNA, where they would be sensitive to enzymatic degradation. Thus, the results suggest that heparin treatment helps in the clearance of cell debris and decreases the immunogenity of secondary necrotic cells.     

Metasynthesis of Youth Suicidal Behaviours: Perspectives of Youth,Parents, and Health Care Professionals

BackgroundYouth suicide is a major public health issue throughout the world. Numerous theoretical models have been proposed to improve our understanding of suicidal behaviours, but medical science has struggled to integrate all the complex aspects of this question. The aim of this review is to synthesise the views of suicidal adolescents and young adults, their parents, and their healthcare professionals on the topics of suicidal behaviour and management of those who have attempted suicide, in order to propose new pathways of care, closer to the issues and expectations of each group.ConclusionThe violence of the message of a suicidal act and the fears associated with death lead to incomprehension and interfere with the capacity for empathy of both family members and professionals. The issue in treatment is to be able to witness this violence so that the patient feels understood and heard, and thus to limit recurrences.     

The familiar-strange manifestation of the dead

This article draws on Islamic perspectives that conceive of visions (ru'yā) and nightmares (kābūs) as instances whereby Jamilā, a 13-year-old Syrian refugee girl in Brooklyn, New York, imagines and makes sense of the dead. She uses the Arabic words ma‘rwf (familiar) and gharīb (strange) to describe her dead elderly neighbour, Safiyya, in her visions and nightmares. Jamilā’s familiar-strange experiences imagine the dead both as good (the divine nature of death fundamental to Islamic values) and as evil (the pain and suffering of the departed). These familiar-strange feelings constitute an irresolvable uncertainty about death, shaping an imaginative space for Jamilā to be with Safiyya, who was like a mother to her. The manifestation of the dead consists of dynamic interpretations for the living. This results in a familiar-strange experience granted through the in-between space of what the philosopher Ibn ‘Arabī calls barzakh (‘obstacle’ or ‘separation’), which allows for an understanding of the departed as both blissful and suffering. The vernacular Arabic used by Jamilā in describing her familiar-strange experiences and the Islamic values upheld by her family underscore the importance of knowledge accumulated in the Islamic tradition for understanding the perception of loss and death for an adolescent Syrian refugee.     

Not the doctor’s business: Privacy,personal responsibility and data rights in medical settings

This paper argues that assessing personal responsibility in healthcare settings for the allocation of medical resources would be too privacy-invasive to be morally justifiable. In addition to being an inappropriate and moralizing intrusion into the private lives of patients, it would put patients’ sensitive data at risk, making data subjects vulnerable to a variety of privacy-related harms. Even though we allow privacy-invasive investigations to take place in legal trials, the justice and healthcare systems are not analogous. The duty of doctors and healthcare professionals is to help patients as best they can—not to judge them. Patients should not be forced into giving up any more personal information than what is strictly necessary to receive an adequate treatment, and their medical data should only be used for appropriate purposes. Medical ethics codes should reflect these data rights. When a doctor asks personal questions that are irrelevant to diagnose or treat a patient, the appropriate response from the patient is: ‘none of your business’.     

The balancing of virtues—Muslim perspectives on palliative and end of life care: Empirical research analysing the perspectives of service users and providers

In this paper, I will share findings from a qualitative study that offers a thematic analysis of 76 interviews with Muslim patients and families as well as doctors, nurses, allied health professionals, chaplains and community faith leaders across the United Kingdom. The data show that for many Muslims, Islam—its texts and lived practice—is of central importance when they are deliberating about death and dying . Central to these deliberations are virtues rooted within Islamic theology and ethics, the traditions of adab (virtue) and aqhlaq (proper conduct). Themes analysed include theological and moral understandings around the virtues of hope and acceptance. The study provides an analysis of these themes in relation to the experiences of Muslim patients and families arriving at meaning making around death and dying and how this interfaces with their interaction with biomedicine and healthcare. The study shows that the juxtaposition of different values and moral frameworks require careful negotiation when Muslim patients and families encounter the healthcare system. The study also describes how healthcare professionals and staff of other faiths and no faith encounter Muslim beliefs and practices, and the challenges they face in interpreting virtues and values rooted in faith, especially when these are perceived to be mutually opposed or inconsistent.     

Personifying Objects/Objectifying People: Handling Questions of Mortality and Materiality through the Archaeological Body

Death and the bodies of the dead are managed and handled in contemporary Western society by various professions that include archaeology. The bodies of the dead exist in a variety of material forms, and generate conflicting responses from the archaeologists who work with them. Positioning archaeologists as professionals within a wider society, this article explores the relationship between the physicality of the body, the (de)construction of personhood and the problem of mortality in contemporary Western (British) society.     

The cornified envelope: a model of cell death in the skin

The epidermis functions as a barrier against the environment by means of several layers of terminally differentiated, dead keratinocytes - the cornified layer, which forms the endpoint of epidermal differentiation and death. The cornified envelope replaces the plasma membrane of differentiating keratinocytes and consists of keratins that are enclosed within an insoluble amalgam of proteins, which are crosslinked by transglutaminases and surrounded by a lipid envelope. New insights into the molecular mechanisms and the physiological endpoints of cornification are increasing our understanding of the pathological defects of this unique form of programmed cell death, which is associated with barrier malfunctions and ichthyosis.     

Social responsibility in human genetics – a survey

The potential for molecular biological manipulation of human beings is a challenge to the social responsibility of human geneticists. The concept of individual healthcare is compromised by a reductionist approach to human biology which defines health solely in terms of genetics. The ability of professionals working in the fields of molecular biology and human genetics to understand the wider social context of their work and the effects it may have on individual health is rarely discussed. This is a report of a survey of social attitudes and awareness carried out among molecular biologists and human geneticists in Germany. The results reveal differences in the understanding of health and these perceptions are shown to depend on the age and gender of the professionals involved.     

DEADLY PLURALISM? WHY DEATH‐CONCEPT,DEATH‐DEFINITION,DEATH‐CRITERION AND DEATH‐TEST PLURALISM SHOULD BE ALLOWED,EVEN THOUGH IT CREATES SOME PROBLEMS

Death concept, death definition, death criterion and death test pluralism has been described by some as a problematic approach. Others have claimed it to be a promising way forward within modern pluralistic societies. This article describes the New Jersey Death Definition Law and the Japanese Transplantation Law. Both of these laws allow for more than one death concept within a single legal system. The article discusses a philosophical basis for these laws starting from John Rawls' understanding of comprehensive doctrines, reasonable pluralism and overlapping consensus. It argues for the view that a certain legal pluralism in areas of disputed metaphysical, philosophical and/or religious questions should be allowed, as long as the disputed questions concern the individual and the resulting policy, law or acts based on the policy/law, do not harm the lives of other individuals to an intolerable extent. However, while this death concept, death definition, death criterion and death test pluralism solves some problems, it creates others.     

Attitudes toward Infection Prophylaxis in Pediatric Oncology: A Qualitative Approach

Background

The risks and benefits of infection prophylaxis are uncertain in children with cancer and thus, preferences should be considered in decision making. The purpose of this report was to describe the attitudes of parents, children and healthcare professionals to infection prophylaxis in pediatric oncology.

Methods

The study was completed in three phases: 1) An initial qualitative pilot to identify the main attributes influencing the decision to use infection prophylaxis, which were then incorporated into a discrete choice experiment; 2) A think aloud during the discrete choice experiment in which preferences for infection prophylaxis were elicited quantitatively; and 3) In-depth follow up interviews. Interviews were recorded verbatim and analyzed using an iterative, thematic analysis. Final themes were selected using a consensus approach.

Results

A total of 35 parents, 22 children and 28 healthcare professionals participated. All three groups suggested that the most important factor influencing their decision making was the effect of prophylaxis on reducing the chance of death. Themes of importance to the three groups included antimicrobial resistance, side effects of medications, the financial impact of outpatient prophylaxis and the route and schedule of administration.

Conclusion

Effect of prophylaxis on risk of death was a key factor in decision making. Other identified factors were antimicrobial resistance, side effects of medication, financial impact and administration details. Better understanding of factors driving decision making for infection prophylaxis will help facilitate future implementation of prophylactic regiments.     

Children with 4q-syndrome: the parents' perspective

A questionnaire survey was conducted among the parents of 32 not previously described children with 4q-syndrome, and 4 affected adult relatives. The questions related to the medical condition of the individual child and the interactions between parents and health professionals. The response rate of the survey was 58 %, and the mean age of the patients was 11.2 years. Thirty eight percent of children were diagnosed within the 1st month of life. Most parents felt severely distressed at the time of diagnosis and 66 % complained about a lack of medical information made available to them. However, parental understanding of the genetic aetiology responsible for the 4q-syndrome was overall good. Apart from a multidisciplinary team of healthcare workers, the internet and religion were named as sources of support. In all, 86 % of parents valued the experience of having a child with 4q-syndrome highly despite the difficulties involved.