Mitochondria in cardiac myocytes are densely packed to form a cell-wide network of communicating organelles that accounts for about 35% of the myocyte’s volume . The lattice-like arrangement of mitochondria, mostly in long and dense rows parallel to the cardiac myocyte myoflaments, has the structural features of a highly ordered network . This specifc mitochondrial network architecture ensures that the large demand of adenosine triphosphate (ATP) of cardiac myocytes is met and appropriately distributed. Mitochondria synthesize approximately 30 kg of ATP each day to both provide energy for the basic cellular metabolism and to secure basic physiological functions of the cardiovascular system such as the maintenance of pulmonary and systemic blood pressure during heart contractions . Their intracellular position is closely associated with the sarcoplasmic reticulum and the myoflaments to facilitate cellular distribution of ATP . However, the role of mitochondrial structure and function is not only limited to ATP generation; mitochondria participate in and control numerous metabolic pathways and signaling cascades such as the calcium signaling, redox oxidation, β-oxidation of fatty acids, oxidative phosphorylation, the synthesis of aminoacids, heme and steroids, and cellular apoptosis . Their structural and functional diversity thus surpasses any other cellular organelle.
We health professionals speak an arcane language, often inscrutable to the uninitiated. I realized this recently when a neighbor brought me a report from her doctor, a document containing terms like sclerosis, dextroscoliosis, and white matter. She was ﬂummoxed by the clinical argot and concerned that she had some serious disease. I was able to translate the report into plain English and reassure her that what she had was more or less consistent with her age of 93. But in doing so, I felt a little like Samoset, translating for the Pilgrims of Plymouth Colony as they disembarked the Mayﬂower to share land with Native Americans in 1620.
The language of medicine is more or less English, but it is a very specialized subset of English, a sort of scholarly jargon. There are classical allusions, metaphors, similes, eponyms, acronyms, authorisms, and honorisms. And our clinical dialect can, to patients and their families, be mysterious and often fearful. It certainly can be confusing, with some persons believing, for instance, that hypertension is a synonym for anxiety. For those of us in the health profession, knowing word histories can help us use terms precisely. When I wonder about the sense of a word, I fnd it useful to look up the original meaning.
Transfusion‐associated septic events have been reduced by the introduction of improved donor screening and skin disinfection methods, as well as implementation of first aliquot diversion and bacterial testing. Recent reports of septic reactions indicate that bacterial contamination of blood components continues to be the predominant transfusion‐associated infectious risk in Europe and North America . From 2011 to 2015, the US Food and Drug Administration (FDA) reported 14 fatalities caused by blood components contaminated with bacteria . In Canada, the Transfusion Transmitted Injuries Surveillance System Programme Report for 2006–12 described 33 transfusion reactions involving bacterially contaminated blood components . Only one probable transfusion reaction involving a platelet unit contaminated with Staphylococcus aureus has been reported in the UK since universal screening of platelet concentrates using an automated culture method was
implemented in 2011. However, in this period there have been three near misses where bacterial contamination with S. aureus was detected. Transfusion of those units was prevented because the presence of aggregates was noted during visual inspection of the platelet concentrates . Results of platelet screening with automated culture methods have been summarised in a recent review by Benjamin and McDonald and an ISBT Forum on bacterial contamination in platelets . The data were collected from 16 published reports and 18 contributions (from 16 countries), respectively. These studies revealed an incidence of confirmed positive cultures ranging from 0.01% to 0.1%. Septic reactions representing false‐negative culture results were reported at rates of approximately 0.007%.
The chapter discusses ways to understand the notion of philosophy of medicine, with a special focus on the relation between philosophy of medicine and bioethics. Philosophy of medicine has been distinguished from other associations between philosophy and medicine. These conceptual distinctions lead to an account that delineates bioethics from the realm of philosophy of medicine. It has often been argued that medicine itself is a normative practice in that it aims at the good of patients. This undermines a simple account of medicine as a purely empirical, natural science. Yet such a normative account of medicine does not show that philosophy of medicine needs to aim at normative guidance like bioethics.
This chapter discusses the role of physical exercise under normoxic and hyperoxic conditions, as well as the impact of greatly reduced supplies of oxygen. Experimental studies of effect of HBO on hypoxia associated with exercise will also be described. The results of these studies help set the stage for later detailed analyses of the strengths and limits of HBO therapy itself.
The World Health Organization has estimated that by the year 2050, the world’s population over 60 years will double from about 11% in 2015 to 22% . This means that there will be approximately two billion people aged 60 or older living on the planet. Of these, approximately 20% or 400 million will be 80 years or older. In the year 2015, Japan was the only country in the world with 30% or more of the population in the 60 years or older group. The WHO is projecting that by the year 2050, more than 25 countries, including most countries in Europe, will have a population distribution very similar to that of Japan. For example, the percentage of Italians older than 60 years will increase from approximately 20% in 2010 to approximately 33% in the year 2050. This increase in the number of people in older age groups is associated with an increase in life expectancy. For example, in Japan, life expectancy at age 60 is 86 years and in at least 13 other countries life expectancy at age 60 is now 85 years (Table 1.1). Further, the number of centenarians is also increasing, and in several regions of the world, including Sardinia, Italy and Icaria, Greece, there are a disproportionately large number of people in this age group.
This book is a companion volume to The Philosophical Foundations of Modern Medicine (Lee, 2012b), which has been written to clarify the philosophical framework within which Biomedicine is conducted and has to be understood. This book attempts an equivalent exploration of Classical Chinese Medicine (CCM). These two volumes are born out of a common perspective—no scientific activity (including medicine in so far as medicine claims to be scientific) is innocent of philosophy, notwithstanding the claim of positivist philosophy that science is “scientific” only because it has gone beyond the “metaphysical mode” of explanation (Lee, 2012b). One should not be taken in by this piece of blatant positivist propaganda.1 While Modern Medicine/Biomedicine emerges from modern Western philosophy since the seventeenth century in Western Europe, CCM has emerged, it will be argued, from philosophical roots which could be said to be at least two and a half thousand—if not more—years old. It may be presumed as a working hypothesis that modern Western philosophy and ancient Chinese philosophy are radically different in character; the medicines which ensue from their respective frameworks will also be different.2 This volume sets out the philosophical foundations for CCM; another volume to follow (Lee, in progress/forthcoming) will demonstrate why CCM possesses the specific characteristics it does because of such a philosophical framework.3
Te menstrual cycle is the result of an orchestra of hormones. It involves the interaction of many endocrine glands as well as a responsive uterus. Te menstrual cycle remains a complex process where many aspects are still not well understood. In this chapter we will examine the control of the menstrual cycle through the interaction of the central nervous system, namely, the hypothalamus and pituitary, and the ovaries, resulting in the cyclic and ordered sloughing of the uterine endometrial lining. Te frst section of this chapter, Te Menstrual Cycle, will review the phases of the menstrual cycle. In the second section, Anatomy of the Menstrual Cycle, the hypothalamic, pituitary, ovarian, and uterine activities will be reviewed. Te key hormones that play a role in the control of the menstrual cycle include gonadotropin-releasing hormone (GnRH), follicle- stimulating hormone (FSH), luteinizing hormone (LH), estradiol, and progesterone (. Table 1.1). In addition to these key hormones, there are other peptide and non-peptide hormones that play a role in the menstrual cycle that will also be discussed. Tese hormones will be discussed in the third section, Endocrinology of the Menstrual Cycle.
Dr. Lane is a new graduate and has entered into the field of hospital medicine. During her limited time as a hospitalist, it has become clear to Dr. Lane that she has a gap in her working knowledge of the healthcare system as a whole. During residency, she focused most of her attention on patient care and less on understanding the system in which she works. She is also starting to realize the impact the current healthcare system has not only on her patients but on herself as a healthcare provider. Understanding the basics of healthcare and the healthcare systems in which you work is an important aspect of being a successful hospitalist. This chapter will aim to provide a brief overview of the U.S. healthcare system and introduce you to the different aspects of the Affordable Care Act.
Molly Harrod, PhD, is a trained medical anthropologist with the VA Ann Arbor Center for Clinical Management Research. She has been involved in numerous qualitative and mixed-methods studies focusing on such topics as clinician communication and teamwork, behavior change, patient safety, and implementation science. In addition, she has trained other health researchers in qualitative methods including semi-structured interviewing and the use of observation in research.