Tratamiento de la diabetes mellitus tipo 2 en el paciente anciano

The prevalence of type 2 diabetes mellitus (DM2) increases markedly with age. Antidiabetic treatment and the objectives of glycaemic control in elderly patients with DM2 should be individualised according to their biopsychosocial characteristics. In elderly patients for whom the benefits of intensive antidiabetic treatment are limited, the basic objectives should be to improve the quality of life, preserve functionality and avoid adverse effects, especially hypoglycaemia.Treatment of DM2 in the elderly was the subject of a consensus document published in 2012 and endorsed by several Spanish scientific societies. Since then, new therapeutic groups and evidence have emerged that warrant an update to this consensus document. The present document focuses on the therapeutic aspects of DM2 in elderly patients, understood as being older than 75 years or frail.     

Ageism in cardiology

This article supports the argument that ageism exists in health care, particularly on the equity of access to cardiological services. Rates of use of potentially life saving and life promoting interventions and investigations decline as the patient gets older. Higher rates of cardiological interventions occur among younger people, despite the high incidence of the condition among older individuals. Any ageism in clinical medicine and policy is simply a reflection of the presence of ageist attitudes in wider society, where the youth receives a higher priority over age. Ageism in medicine needs to be addressed to preserve or recapture this trust within an aging population. A wide ranging approach is necessary if equity in the provision of health care services is to be ensured which includes improvement of clinical guidelines and more specific monitoring of health care. Educational efforts to raise awareness that age stereotyping and ageist attitudes are unethical should be initiated. Research initiatives, which cover large numbers of older people, should be developed and older people should be empowered to influence choices and standards of treatments. Finally, legislation may be required to eradicate ageism in society.     

Growth of the teleost eye: novel solutions to complex constraints

Synopsis The cichlid fish, Haplochromis burtoni, is highly dependent on vision for survival in its natural habitat. As is true of most teleost fishes, the eyes continue to grow throughout life without any obvious changes in visual capability. In H. burtoni, for example, retinal area may increase by 27 × in just 6 months. During growth, there is no obvious change in the visual sensitivity, visual acuity or lens quality which must all be appropriate for the enlarging eye. This requires that during growth competing constraints be met. For example, to maintain visual acuity, the number of ganglion cells per visual angle subtended on the retina must remain the same as must the convergence ratio of the cones onto those ganglion cells. In contrast, to maintain visual sensitivity, the number of rod photoreceptors per unit retinal area must remain the same. These requirements are in conflict since a larger eye may preserve acuity with fewer cells per unit area in a larger retina. In addition, the lens properties must remain the same as the animal increases in size so that the image available is of similar quality throughout life. Experiments have been performed to reveal the adaptations during growth which allow the fish to preserve its image of the world throughout life.     

"New beginnings": a case study in gay men's changing perceptions of quality of life during the course of HIV infection

This article reports results of an ethnographic study that sought to understand how a cohort of gay men living with HIV infection evaluated and worked to preserve or improve the quality of their lives. Themes of life story narratives are identified, each with an associated stylistic self-orientation to living with HIV infection. Changes in thematic content of a selected participant's life story narratives are discussed, demonstrating how events of his daily life are integrated into the narratives. Resultant concurrent shifting of themes and stylistic orientations is linked to his perception of improved quality of life.     

PRESIDENTIAL ADDRESS: IS THE SANCTITY OF LIFE ETHIC TERMINALLY ILL?

Our growing technical capacity to keep human beings alive has brought the sanctity of life ethic to the point of collapse. The shift to a concept of brain death was already an implicit abandonment of the traditional ethic, though this has only recently become apparent. The 1993 decision of the British House of Lords in the case of Anthony Bland is an even more decisive shift towards an ethic that does not ask or seek to preserve human life as such, but only a life that is worth living. Once this shift has been completed and assimilated, we will no longer need the concept of brain death. Instead we can face directly the real ethical issue: when may doctors intentionally end the life of a patient?     

Is the sanctity of life ethic terminally ill?

Our growing technical capacity to keep human beings alive has brought the sanctity of life ethic to the point of collapse. The shift to a concept of brain death was already an implicit abandonment of the traditional ethic, though this has only recently become apparent. The 1993 decision of the British House of Lords in the case of Anthony Bland is an even more decisive shift towards an ethic that does not ask or seek to preserve human life as such, but only a life that is worth living. Once this shift has been completed and assimilated, we will no longer need the concept of brain death. Instead we can face directly the real ethical issue: when may doctors intentionally end the life of a patient?     

Telomere biology in mammalian germ cells and during development

The development of an organism is a strictly regulated program in which controlled gene expression guarantees the establishment of a specific phenotype. The chromosome termini or so-called telomeres preserve the integrity of the genome within developing cells. In the germline, during early development, and in highly proliferative organs, human telomeres are balanced between shortening processes with each cell division and elongation by telomerase, but once terminally differentiated or mature the equilibrium is shifted to gradual shortening by repression of the telomerase enzyme. Telomere length is to a large extent genetically determined and the neonatal telomere length equilibrium is, in fact, a matter of evolution. Gradual telomere shortening in normal human somatic cells during consecutive rounds of replication eventually leads to critically short telomeres that induce replicative senescence in vitro and probably in vivo. Hence, a molecular clock is set during development, which determines the replicative potential of cells during extrauterine life. Telomeres might be directly or indirectly implicated in longevity determination in vivo, and information on telomere length setting in utero and beyond should help elucidate presumed causal connections between early growth and aging disorders later in life. Only limited information exists concerning the mechanisms underlying overall telomere length regulation in the germline and during early development, especially in humans. The intent of this review is to focus on recent advances in our understanding of telomere biology in germline cells as well as during development (pre- and postimplantation periods) in an attempt to summarize our knowledge about telomere length determination and its importance for normal development in utero and the occurrence of the aging and abnormal phenotype later on.     

Is there a right to access innovative surgery?

Demands for access to experimental therapies are frequently framed in the language of rights. This article examines the justifiability of such demands in the specific context of surgical innovations, these being promising but non‐validated and potentially risky departures from standard surgical practices. I argue that there is a right to access innovative surgery, drawing analogies with other generally accepted rights in medicine, such as the right not to be forcibly treated, to buy contraceptives, and to choose to have an abortion, including a post‐viability abortion where the mother's life or health is threatened by the pregnancy. I argue that we accept these rights because we believe that people are entitled to try to preserve their lives and health and to make choices of an important and intensely personal kind, and I suggest that a person's choice of medical treatment should be seen in the same light. However, since few rights are absolute, I also consider the circumstances in which it may be justifiable to limit the right to access innovative surgery. In discussing this question, I apply the human rights standard of proportionality, comparing the importance of the reasons for limiting the right with the severity of the invasion on liberty.     

Some ethical issues at the population level raised by 'soft' eugenics, euphenics, and isogenics.

It is argued that at the population level there are three central genetic developments raising ethical issues. The first is the emergence of 'soft' eugenics, due primarily to the increasing ability to detect carriers of genetic diseases, to monitor their pregnancies, and to provide the option to abort a fetus predisposed to major genetic disease. The second development is the recognition of the extent to which many serious diseases of adult life are due to a disturbance of ancient genetic homeostatic mechanisms due to changing life style, raising the question of whether a society that increasingly pays the medical bills should attempt to impose healthier standards of living on its members. Such an attempt at 'euphenics' may be thought of as the antithesis to eugenics. The third development relates to recognition of the need to regulate the size of the earth's population to numbers that can be indefinitely sustained; this regulation in a fashion (isogenic) that will preserve existing genetic diversity.     

LIFE-CENTERED ETHICS, AND THE HUMAN FUTURE IN SPACE

In the future, human destiny may depend on our ethics. In particular, biotechnology and expansion in space can transform life, raising profound questions. Guidance may be found in Life‐centered ethics, as biotic ethics that value the basic patterns of organic gene/protein life, and as panbiotic ethics that always seek to expand life. These life‐centered principles can be based on scientific insights into the unique place of life in nature, and the biological unity of all life. Belonging to life then implies a human purpose: to safeguard and propagate life. Expansion in space will advance this purpose but will also raise basic questions. Should we expand all life or only intelligent life? Should we aim to create populations of trillions? Should we seed other solar systems? How far can we change but still preserve the human species, and life itself? The future of all life may be in our hands, and it can depend on our guiding ethics whether life will fulfil its full potentials. Given such profound powers, life‐centered ethics can best secure future generations. Our descendants may then understand nature more deeply, and seek to extend life indefinitely. In that future, our human existence can find a cosmic purpose.     

The Ashley Treatment: Improving Quality of Life or Infringing Dignity and Rights?

The ‘Ashley treatment’ (growth attenuation, removal of the womb and breasts buds of a severely disabled child) has raised much ethical controversy. This article starts from the observation that this debate suffers from a lack of careful philosophical analysis which is essential for an ethical assessment. I focus on two central arguments in the debate, namely an argument defending the treatment based on quality of life and an argument against the treatment based on dignity and rights. My analysis raises doubts as to whether these arguments, as they stand in the debate, are philosophically robust. I reconstruct what form good arguments for and against the treatment should take and which assumptions are needed to defend the according positions. Concerning quality of life (Section 2), I argue that to make a discussion about quality of life possible, it needs to be clear which particular conception of the good life is employed. This has not been sufficiently clear in the debate. I fill this lacuna. Regarding rights and dignity (section 3), I show that there is a remarkable absence of references to general philosophical theories of rights and dignity in the debate about the Ashley treatment. Consequently, this argument against the treatment is not sufficiently developed. I clarify how such an argument should proceed. Such a detailed analysis of arguments is necessary to clear up some confusions and ambiguities in the debate and to shed light on the dilemma that caretakers of severely disabled children face.     

A new short form individual quality of life measure (SEIQoL-DW): application in a cohort of individuals with HIV/AIDS.

Quality of life is an increasingly important outcome measure in medicine and health care. Many measures of quality of life present patients with predetermined lists of questions that may or may not be relevant to the individual patient. This paper describes a brief measure, the SEIQoL-DW, which is derived from the schedule for evaluation of individual quality of life (SEIQoL). The measure allows respondents to nominate the areas of life which are most important, rate their level of functioning or satisfaction with each, and indicate the relative importance of each to their overall quality of life. Given its practicality and brevity, the measure should prove particularly useful in clinical situations where patient generated data on quality of life is important. This article describes the first clinical application of the measure, assessing the quality of life of a cohort of patients with HIV/AIDS managed in general practice.     

In Defense of Prenatal Genetic Interventions

Jürgen Habermas has argued against prenatal genetic interventions used to influence traits on the grounds that only biogenetic contingency in the conception of children preserves the conditions that make the presumption of moral equality possible. This argument fails for a number of reasons. The contingency that Habermas points to as the condition of moral equality is an artifact of evolutionary contingency and not inviolable in itself. Moreover, as a precedent for genetic interventions, parents and society already affect children's traits, which is to say there is moral precedent for influencing the traits of descendants. A veil‐of‐ignorance methodology can also be used to justify prenatal interventions through its method of advance consent and its preservation of the contingency of human identities in a moral sense. In any case, the selection of children's traits does not undermine the prospects of authoring a life since their future remains just as contingent morally as if no trait had been selected. Ironically, the prospect of preserving human beings as they are – to counteract genetic drift – might even require interventions to preserve the ability to author a life in a moral sense. In light of these analyses, Habermas' concerns about prenatal genetic interventions cannot succeed as objections to their practice as a matter of principle; the merits of these interventions must be evaluated individually.     

在“微生物学”课堂教学中立德树人

立德树人是高等教育的中心环节,思想政治工作应贯穿教育教学全过程。微生物学是一门与人类日常生活密切相关的学科。本文通过若干具体案例,介绍如何在"微生物学"课堂教学过程中立德树人。在传授微生物学专业知识的同时不断加强思想政治教育,从而提高学生的思想水平、政治觉悟、道德品质、文化素养,让学生成为德才兼备、全面发展的人才。此外,为其他自然科学类课程教学实现立德树人提供借鉴和参考。     

Extracellular reduction of the ascorbate free radical by human erythrocytes

We investigated the possibility that human erythrocytes can reduce extracellular ascorbate free radical (AFR). When the AFR was generated from ascorbate by ascorbate oxidase, intact cells slowed the loss of extracellular ascorbate, an effect that could not be explained by changes in enzyme activity or by release of ascorbate from the cells. If cells preserve extracellular ascorbate by regenerating it from the AFR, then they should decrease the steady-state concentration of the AFR. This was confirmed directly by electron paramagnetic resonance spectroscopy, in which the steady-state extracellular AFR signal varied inversely with the cell concentration and was a saturable function of the absolute AFR concentration. Treatment of cells N-ethylmaleimide (2 mM) impaired their ability both to preserve extracellular ascorbate, and to decrease the extracellular AFR concentration. These results suggest that erythrocytes spare extracellular ascorbate by enhancing recycling of the AFR, which could help to maintain extracellular concentrations of the vitamin.     

Physical activity and the healthy mind.

Physicians should seek to enhance the quality rather than the quantity of human life. Physical activity programs can increase life satisfaction through an immediate increase of arousal and a long-term enhancement of self-esteem and body image. In the young child competition can cause excessive arousal, but long-term adverse effects are rare. In the adult a reduction of anxiety and stress and a general feeling of well-being reduce the frequency of minor medical complaints, generating important economic benefits. Physical activity programs also help to correct the reactive depression that accompanies conditions such as myocardial infarction. Interest in physical activity should be stimulated from the earliest years of primary school. The allocation of curricular time to physical education does not hamper academic achievement. Rather, through its impact on psychomotor learning, it enhances the total process of intellectual and psychomotor development.     

Human research tissue banks: the ATRA Project for establishing a human research tissue bank in switzerland

A large number of experiments in biomedical research are carried out on tissues, but, even though the results should be applicable to humans, these tissues are mainly of animal origin. The difficulty encountered in obtaining human organs and tissues is an acknowledged problem: not enough human tissues are available to meet research needs. We are introducing the ATRA Project, with the purpose of supporting progress in biomedical research in Switzerland through the establishment of one or more human tissue banks, which will be able to find, treat, preserve and supply human material. Where similar projects have already been launched, concerns have been expressed that donation for research purposes might compete with donation for transplantation, but most organs and tissues are in any case non-transplantable. Surplus surgical tissue is considered "sanitary waste", and must be treated according to specific regulations for collection, packaging, transport, treatment and disposal. A human tissue bank would not only abate the costs of treating sanitary waste, but would actually turn what is now considered waste into a resource which could be used to save human and animal lives.     

Biosafety, biodiversity and significance of Microbial Resource Centers (MRCs) in microbiology education

Summary Interest in the intrinsic behavior of microorganisms has led to the establishment of centers of expertise, known as Microbial Resource Centers (MRCs) built around specialized collections of cultures of microorganisms. Their main function is to accession, preserve and distribute authenticated, viable samples of microorganisms in consultation with the international scientific community for study and application. Microorganisms, which are exceptionally diverse, are found almost everywhere and affect human society in countless ways. Thus, modern microbiology has a great impact on medicine, agriculture, food science, ecology, genetics, biochemistry and many other fields. MRCs appear to be equally important to industry, to academia, and from the elementary to high school science teachers who can order specific educational strains. The basic microbiological knowledge of human society possesses the potential to revolutionize many aspects of human life. MRCs are a key resource to underpin these developments.     

2PN cell donation in Germany. Or: How the German Embryo Protection (Act) undermines itself

In contrast to embryo donation, the permissibility of 2PN cell donation is highly controversial in Germany. This article is based on there being a legal loophole with respect to 2PN cell donation, which results from an inconsistency within the Embryo Protection Act on the normative status of 2PN cells. Following that thesis, the article argues that, on the basis of the normative criterion totipotency (i.e. the capacity to develop into a born human being), 2PN cells should also be considered human embryos within the meaning of the Act and thereby be protected by that Act in the same way as embryos. However, the normative assumption that 2PN cells should already be endowed with human dignity and the right to life has absurd consequences. Moreover, the consistent continuation of the Embryo Protection Act, as well as of the underlying ethical position or argumentation (i.e. the potentiality argument), leads to the even more absurd consequence of having to place every human somatic cell under the protection of human dignity and the right to life. As totipotency or the developmental potential therefore cannot delimit entities considered worthy of protection (i.e. human embryos) from entities considered not worthy of protection (i.e. 2PN cells, gametes, hESC, hiPSC and human somatic cells), it is not a suitable normative criterion. As a paradigmatic case, 2PN cell donation demonstrates that by retaining this normative criterion the now obsolete German Embryo Protection (Act) ultimately undermines itself.