text
stringlengths 11
320k
| source
stringlengths 26
161
|
|---|---|
Familial amyloid polyneuropathy , also called hereditary transthyretin amyloidosis (hATTR), [ 1 ] [ 2 ] or Corino de Andrade's disease , [ 3 ] is an autosomal dominant [ 4 ] neurodegenerative disease. It is a form of amyloidosis , and was first identified and described by Portuguese neurologist Mário Corino da Costa Andrade , in 1952. [ 5 ] FAP is distinct from senile systemic amyloidosis (SSA), which is not inherited, and which was determined to be the primary cause of death for 70% of supercentenarians who have been autopsied . [ 6 ] FAP can be ameliorated by liver transplantation.
Usually manifesting itself between 20 and 40 years of age, it is characterized by pain , paresthesia , muscular weakness and autonomic dysfunction . In its terminal state, the kidneys and the heart are affected. FAP is characterized by the systemic deposition of amyloidogenic variants of the transthyretin protein , especially in the peripheral nervous system , causing a progressive sensory and motor polyneuropathy . [ citation needed ]
FAP is caused by a mutation of the TTR gene, located on human chromosome 18q12.1-11.2 . [ 7 ] A replacement of valine by methionine at position 30 (TTR V30M) is the mutation most commonly found in FAP. [ 3 ] The transthyretin protein is a tetramer. The tetramer has to dissociate into misfolded monomers to aggregate into a variety of structures including amyloid fibrils. Because most patients are heterozygotes, they deposit both mutant and wild type TTR subnits. [ citation needed ]
FAP is inherited in an autosomal dominant manner. [ 4 ] This means that the defective gene responsible for the disorder is located on an autosome (chromosome 18 is an autosome), and only one copy of the defective gene is sufficient to cause the disorder, when inherited from a parent who has the disorder. [ citation needed ]
Clinical suspicion for FAP is raised on the basis of a family history of neuropathy and physical exam showing signs of neuropathy . Diagnosis can be made using genetic testing to identify mutations in the TTR gene, but may include other corroborative investigation. [ 8 ] Nerve conduction testing typically shows an axonal polyneuropathy, with sensory involvement greater than motor. Superimposed mononeuropathies may also be evident, such as a median mononeuropathy at the wrist ( carpal tunnel syndrome ). Electromyography (EMG) may show evidence of chronic denervation and reinnervation. Autonomic testing, including quantitative sweat testing, can reveal involvement of the autonomic nervous system . [ 9 ] Occasionally, biopsy of skin, nerve, or muscle may be performed, which can show signs of denervation and amyloid deposition with response to anti-TTR antibodies. [ 10 ] Additional testing should be performed to identify involvement of the heart or kidneys. [ 8 ]
Sudomotor function through electrochemical skin conductance may provide a measure of subclinical autonomic involvement. [ 11 ] [ 12 ]
The medication tafamidis has been approved for the treatment of transthyretin familial amyloid polyneuropathy in Europe. [ 13 ] Studies have found that it delays neurological problems when started early. [ 13 ] [ 14 ] The US Food and Drug Administration 's Peripheral and Central Nervous System Drugs Advisory Committee rejected the drug in June 2012, in a 13–4 vote. [ 15 ] The committee stated that there was not enough evidence supporting efficacy of the drug, and requested additional clinical trials. [ 16 ] In May 2019, the FDA approved two tafamidis preparations for the treatment of transthyretin-mediated cardiomyopathy, but has not approved it for the treatment of transthyretin familial amyloid polyneuropathy. [ 17 ]
In August 2018, the FDA approved patisiran , an siRNA -based treatment, at an expected cost of up to $450,000 per year. [ 18 ]
In August 2021 six patients with hereditary ATTR amyloidosis with polyneuropathy were given doses of NTLA-2001, based on a CRISPR gene editing system. Researchers reported mild adverse events and decreases in serum misfolded transthyretin protein concentrations through targeted knockout. [ 19 ]
Eplontersen (Wainua) was approved for medical use in the United States in December 2023. [ 20 ]
In the absence of a liver transplant , FAP is invariably fatal, usually within a decade. The disadvantage of liver transplantation is that approximately 10% of the subjects die from the procedure or complications resulting from the procedure, which is a form of gene therapy wherein the liver expressing wild-type and mutant TTR is replaced by a liver only expressing wild-type TTR. Moreover, transplanted patients must take immune suppressants (medications) for the remainder of their life, which can lead to additional complications. [ citation needed ]
In late 2011, the European Medicines Agency approved the transthyretin kinetic stabilizer Tafamidis or Vyndaqel discovered by Jeffery W. Kelly and developed by FoldRx pharmaceuticals (acquired by Pfizer in 2010) for the treatment of FAP based on clinical trial data. Tafamidis (20 mg once daily) slowed the progression of FAP over a 36-month period and importantly reversed the weight loss and muscle wasting associated with disease progression. [ citation needed ]
This disease is endemic in Portuguese locations Póvoa de Varzim and Vila do Conde ( Caxinas ), with more than 1000 affected people, coming from about 500 families, where 70% of the people develop the illness. All the analysed Portuguese families presented the same haplotype (haplotype I) associated with the Met 30 mutation. In northern Sweden , more specifically Skellefteå (it is locally called Skelleftesjukan , the Skellefteå disease), 1.5% of the population has the mutated gene. There are many other populations in the world who exhibit the illness after having developed it independently. [ citation needed ]
The disease is somewhat prevalent in Cyprus. Mean age of onset was 46 years, and penetrance is estimated to be 28%, both of which differ from the Portuguese and Swedish populations. [ 21 ]
|
https://en.wikipedia.org/wiki/Familial_amyloid_polyneuropathy
|
Familial encephalopathy with neuroserpin inclusion bodies (FENIB) is a progressive disorder of the nervous system that is characterized by a loss of intellectual functioning ( dementia ) and seizures. [ 1 ] At first, affected individuals may have difficulty sustaining attention and concentrating. Their judgment, insight, and memory become impaired as the condition progresses. Over time, they lose the ability to perform the activities of daily living, and most people with this condition eventually require comprehensive care. [ citation needed ]
The signs and symptoms of familial encephalopathy with neuroserpin inclusion bodies vary in their severity and age of onset. In severe cases, the condition causes seizures and episodes of sudden, involuntary muscle jerking or twitching (myoclonus) in addition to dementia. These signs can appear as early as a person's teens. Less severe cases are characterized by a progressive decline in intellectual functioning beginning in a person's forties or fifties. [ citation needed ]
Mutations in the SERPINI1 gene cause familial encephalopathy with neuroserpin inclusion bodies. The SERPINI1 gene provides instructions for making a protein called neuroserpin. This protein is found in nerve cells , where it plays a role in the development and function of the nervous system. Neuroserpin helps control the growth of nerve cells and their connections with one another, which suggests that this protein may be important for learning and memory. Mutations in the gene result in the production of an abnormally shaped, unstable version of neuroserpin. Abnormal neuroserpin proteins can attach to one another and form neuroserpin inclusion bodies or Collins bodies within nerve cells. [ 2 ] Collins bodies form in cortical and subcortical neurons where they disrupt the cells' normal functioning and ultimately lead to cell death. [ 3 ] Progressive dementia results from this gradual loss of nerve cells in certain parts of the brain. Researchers believe that a buildup of related, potentially toxic substances in nerve cells may also contribute to the signs and symptoms of this condition. [ citation needed ]
This condition is inherited in an autosomal dominant pattern, which means one copy of the altered gene in each cell is sufficient to cause the disorder. In many cases, an affected person has a parent with the condition. [ citation needed ]
|
https://en.wikipedia.org/wiki/Familial_encephalopathy_with_neuroserpin_inclusion_bodies
|
Familial hyperaldosteronism is a group of inherited conditions in which the adrenal glands , which are small glands located on top of each kidney , produce too much of the hormone aldosterone . [ 1 ] Excess aldosterone causes the kidneys to retain more salt than normal, which in turn increases the body's fluid levels and causes high blood pressure . [ 1 ] People with familial hyperaldosteronism may develop severe high blood pressure, often early in life. [ 1 ] Without treatment, hypertension increases the risk of strokes, heart attacks, and kidney failure. [ 1 ] There are other forms of hyperaldosteronism that are not inherited. [ 1 ]
This condition is inherited in an autosomal dominant pattern, which means one copy of the altered gene in each cell is sufficient to cause the disorder. [ 1 ] The various types of familial hyperaldosteronism have different genetic causes. [ 1 ]
It is unclear how common these diseases are. [ 1 ] All together they appear to make up less than 1% of cases of hyperaldosteronism.
Familial hyperaldosteronism is categorized into three types, distinguished by their clinical features and genetic causes. [ 1 ]
In familial hyperaldosteronism type I, hypertension generally appears in childhood to early adulthood and can range from mild to severe. [ 1 ] This type can be treated with steroid medications called glucocorticoids , so it is also known as glucocorticoid remediable aldosteronism (GRA). [ 1 ]
In familial hyperaldosteronism type II, hypertension usually appears in early to middle adulthood and does not improve with glucocorticoid treatment. [ 1 ]
In most with familial hyperaldosteronism type III, the adrenal glands are enlarged up to six times their normal size. [ 1 ] These affected have severe hypertension that starts in childhood. [ 1 ] The hypertension is difficult to treat and often results in damage to organs such as the heart and kidneys. [ 1 ] Rarely, individuals with type III have milder symptoms with treatable hypertension and no adrenal gland enlargement. [ 1 ]
This condition is inherited in an autosomal dominant pattern, which means one copy of the altered gene in each cell is sufficient to cause the disorder. The various types of familial hyperaldosteronism have different genetic causes. Familial hyperaldosteronism type I is caused by the abnormal joining together (fusion) of two similar genes called CYP11B1 and CYP11B2, which are located close together on chromosome 8. These genes provide instructions for making two enzymes that are found in the adrenal glands. [ 1 ]
The CYP11B1 gene provides instructions for making an enzyme called 11-beta-hydroxylase. This enzyme helps produce hormones called cortisol and corticosterone. The CYP11B2 gene provides instructions for making another enzyme called aldosterone synthase, which helps produce aldosterone. When CYP11B1 and CYP11B2 are abnormally fused together, too much aldosterone synthase is produced. This overproduction causes the adrenal glands to make excess aldosterone, which leads to the signs and symptoms of familial hyperaldosteronism type I. [ 1 ]
Familial hyperaldosteronism type III is caused by mutations in the KCNJ5 gene. The KCNJ5 gene provides instructions for making a protein that functions as a potassium channel, which means that it transports positively charged atoms (ions) of potassium into and out of cells. In the adrenal glands, the flow of ions through potassium channels produced from the KCNJ5 gene is thought to help regulate the production of aldosterone. Mutations in the KCNJ5 gene likely result in the production of potassium channels that are less selective, allowing other ions (predominantly sodium) to pass as well. The abnormal ion flow results in the activation of biochemical processes (pathways) that lead to increased aldosterone production, causing the hypertension associated with familial hyperaldosteronism type III. [ 1 ]
The genetic cause of familial hyperaldosteronism type II is unknown. [ 1 ]
This article incorporates text from the United States National Library of Medicine ( [1] ), which is in the public domain .
|
https://en.wikipedia.org/wiki/Familial_hyperaldosteronism
|
Familial isolated vitamin E deficiency or Ataxia with vitamin E deficiency (AVED) is a rare autosomal recessive neurodegenerative disease . [ 1 ] [ 2 ] [ 3 ] [ 4 ] Symptoms are similar to those of Friedreich ataxia .
Familial isolated vitamin E deficiency is caused by mutations in the gene for a- tocopherol transfer protein. [ 5 ] Symptoms manifest late childhood to early teens. [ 6 ]
Treatment includes Vitamin E therapy, where lifelong high-dose oral vitamin E supplementation is prescribed to maintain plasma vitamin E concentrations and monitoring vitamin E levels in blood plasma. [ 6 ]
|
https://en.wikipedia.org/wiki/Familial_isolated_vitamin_E_deficiency
|
Family Constellations , also known as Systemic Constellations and Systemic Family Constellations , is a pseudoscientific [ 1 ] therapeutic method which draws on elements of family systems therapy , existential phenomenology and Zulu beliefs and attitudes to family. [ 2 ]
Family Constellations diverges significantly from conventional forms of cognitive , behaviour and psychodynamic psychotherapy . The method has been described by physicists as an example of quantum mysticism , and its founder Bert Hellinger incorporated the existing pseudoscientific concept of morphic resonance into his explanation of it. Positive outcomes from the therapy have been attributed to conventional explanations such as suggestion , empathy , and the placebo effect . [ 1 ] [ 3 ] [ 4 ]
Practitioners claim that present-day problems and difficulties may be influenced by traumas suffered in previous generations of the family, even if those affected are unaware of the original event. Hellinger referred to the relation between present and past problems that are not caused by direct personal experience as systemic entanglements , said to occur when unresolved trauma has afflicted a family through an event such as murder, suicide, death of a mother in childbirth, early death of a parent or sibling, war, natural disaster, emigration, or abuse. [ 5 ] [ 6 ]
A constellation session is a one-time event, with no follow-up. It may take place in front of a large audience. [ 7 ]
The term "Family Constellations" was first used by Alfred Adler in a somewhat different context to refer to the phenomenon that each individual belongs to and is bonded in relationship to other members of his or her family system. One premise of his work is that one can inherit trauma.
The philosophical orientation of Family Constellations were derived through an integration of existential phenomenology , family systems therapy, and elements of indigenous mysticism.
Małgorzata Talarczyk of The Child and Adolescent Psychiatry Clinic, Poznań University of Medical Sciences in Poland has criticized the family constellation method as not meeting many of aspects of the Polish Code of Ethics for Psychiatrists. In particular, she found that it was inadequate in the areas of "the process, contract, diagnosis, supervision, confidentiality, alternativeness." Thus it is difficult to consider it as "psychotherapy". [ 7 ]
|
https://en.wikipedia.org/wiki/Family_Constellations
|
In medicine , a family history ( FH or FHx ) consists of information about disorders of direct blood relatives of the patient. [ 1 ] Genealogy typically includes very little of the medical history of the family , but the medical history could be considered a specific subset of the total history of a family. [ citation needed ] Accurate knowledge of a patient's family history may identify a predisposition to developing certain illnesses, which can inform clinical decisions and allow effective management or even prevention of conditions. [ 2 ] [ 3 ]
Early mentions of family medical histories in medical literature date from the 1840s. Henry Ancell mentioned inquiring about the family history of a patient in a medical case study in 1842, noting that the patient's presenting concern appears to be present in relatives and remarking on the prolific reproduction of her female relatives. [ 4 ] In 1849, W.H. Walshe argued in a lecture at University College London Hospital that in addition to a history of the presenting disease itself, a physician should also collect family history. [ 5 ] Walshe's lecture does not define or justify the family history, which may suggest that taking one was already in common practice. However, later 19th-century physicians did provide a specific apologia for family histories and in some cases explicitly noted that they were not yet being taken routinely.
James Begbie argued that understanding the health of the entire family, including cousins, can help predict otherwise unpredictable illnesses that run in the family. [ 6 ] Begbie's use of the family history for both predictive and normative evaluation of the family anticipated Francis Galton , who championed the routine family history as a eugenic strategy in his 1883 text, Inquiries into Human Faculty and Its Development . Galton writes:
"The investigation of human eugenics—that is, of the conditions under which men of a high type are produced—is at present extremely hampered by the want of full family histories, both medical and general, extending over three or four generations. There is no such difficulty in investigating animal eugenics, because the generations of horses, cattle, dogs, etc., are brief, and the breeder of any such stock lives long enough to acquire a large amount of experience from his own personal observation. A man, however, can rarely be familiar with more than two or three generations of his contemporaries before age has begun to check his powers; his working experience must therefore be chiefly based upon records. Believing, as I do, that human eugenics will become recognised before long as a study of the highest practical importance, it seems to me that no time ought to be lost in encouraging and directing a habit of compiling personal and family histories." [ 7 ]
Galton argued in the early 1900s for the development of eugenic certification based on consulting these histories. [ 8 ] Starting in the 1920s, family medical histories were used by government eugenics bodies to evaluate candidates for compulsory sterilization . [ 9 ] [ 10 ] Eugenics Boards such as the Eugenics Board of North Carolina also considered family medical histories for the issuance of eugenic certificates marking a candidate as fit for marriage and reproduction. [ 11 ] The Disability History Museum includes a mock eugenic certificate from circa 1924 which was intended to be sent as a love note. [ 12 ]
Although sometimes neglected, [ 13 ] many healthcare professionals glean information on family morbidity of particular diseases (e.g. cardiovascular diseases , autoimmune disorders , mental disorders , diabetes , cancer ) to assess whether a person is at risk of developing similar problems.
Family histories may be imprecise because of various possible reasons:
Some medical conditions are carried only by the female line such as X-linked conditions and some Mitochondrial diseases . Tracing female ancestors can be difficult in societies that change the woman's family name when she marries. Death records often give the maiden name of the deceased, and possibly also the deceased's mother's maiden name. Some of the most useful records for tracing women are wills and probate records.
Other medical conditions are carried only by the male line, though these Y-linked conditions are rare owing to the small size of the Y Chromosome. Tracing male ancestors may be impossible if the conception is due to rape or sexual activity outside of marriage.
Attaining the age when family members are diagnosed with a certain disease can also be helpful for screening purposes, like colon and breast cancer.
Not all positive family histories imply a genetic cause. If various members of the same family have been exposed to the same toxin , then they may develop similar symptoms without a genetic cause.
If a patient has a strong family history of a particular disorder (or group of disorders), this will generally lead to a lower threshold for investigating symptoms or initiating treatment. This is seen particularly in cardiac disease, where strong family history is considered a significant cardiovascular risk factor. [ 14 ]
In diseases with a known hereditary component, many otherwise healthy people with a positive family history are tested early, with the aim of an early diagnosis and intervention to prevent the symptoms from developing. This has become accepted in hemochromatosis and various other disorders.
|
https://en.wikipedia.org/wiki/Family_history_(medicine)
|
The Farmacovigilancia Española, Datos de Reacciones Adversas ( FEDRA ), also known as the Spanish Pharmacovigilance Datatabase or Spanish Pharmacovigilance System , is a pharmacovigilance database in Spain which was developed in 1982. [ 1 ]
This medical article is a stub . You can help Wikipedia by expanding it .
This database -related article is a stub . You can help Wikipedia by expanding it .
|
https://en.wikipedia.org/wiki/Farmacovigilancia_Española,_Datos_de_Reacciones_Adversas
|
Farr's law is a law formulated by Dr. William Farr when he made the observation that epidemic events rise and fall in a roughly symmetrical pattern. [ 1 ] The time-evolution behavior could be captured by a single mathematical formula that could be approximated by a bell-shaped curve . [ 2 ]
In 1840, Farr submitted a letter to the Annual Report of the Registrar General of Births, Deaths and Marriages in England . In that letter, he applied mathematics to the records of deaths during a recent smallpox epidemic, proposing that:
"If the latent cause of epidemics cannot be discovered, the mode in which it operates may be investigated. The laws of its action may be determined by observation, as well as the circumstances in which epidemics arise, or by which they may be controlled." [ 3 ]
He showed that during the smallpox epidemic, a plot of the number of deaths per quarter followed a roughly bell-shaped or " normal curve ", [ 4 ] [ 5 ] and that recent epidemics of other diseases had followed a similar pattern. [ 6 ]
This virus -related article is a stub . You can help Wikipedia by expanding it .
This medical article is a stub . You can help Wikipedia by expanding it .
This statistics -related article is a stub . You can help Wikipedia by expanding it .
|
https://en.wikipedia.org/wiki/Farr's_laws
|
Fasciotomy or fasciectomy is a surgical procedure where the fascia is cut to relieve tension or pressure in order to treat the resulting loss of circulation to an area of tissue or muscle . [ 1 ] Fasciotomy is a limb-saving procedure when used to treat acute compartment syndrome . It is also sometimes used to treat chronic compartment stress syndrome. The procedure has a very high rate of success, with the most common problem being accidental damage to a nearby nerve.
Compartment syndrome is one of the conditions where a fasciotomy may be indicated. People who are likely to have injuries needing a fasciotomy include the following:
A delay in performing the procedure can lead to neurovascular complications or lead to the need for amputation of a limb. [ 1 ] Complications can also involve the formation of scar tissue after the operation. A thickening of the surgical scars can result in the loss of mobility of the joint involved. This can be addressed through occupational or physical therapy.
Fasciotomy in the limbs is usually performed by a surgeon under general or regional anesthesia. An incision is made in the skin, and a small area of fascia is removed where it will best relieve pressure.
Plantar fasciotomy is an endoscopic procedure. The physician makes two small incisions on either side of the heel. An endoscope is inserted in one incision to guide the physician. A tiny knife is inserted in the other. A portion of the fascia near the heel is removed. The incisions are then closed.
In addition to scar formation, there is a possibility that the surgeon may need to use a skin graft to close the wound. Sometimes when closing the fascia again in another surgical procedure, the muscle is still too large to close it completely. A small bulge is visible but is not harmful. It takes a much longer time to heal and, in some cases, takes several months.
|
https://en.wikipedia.org/wiki/Fasciotomy
|
Fasting spittle – saliva produced first thing in the morning, before breakfast – was a treatment used in folk medicine in the ancient Mediterranean. Spittle was thought to cure many diseases. Spittle cures were usually considered to be more effective if fasting spittle was used. [ 1 ]
An early reference to the alleged medicinal benefits comes from the Roman author Varro , who mentions it as a cure for epilepsy and snake bites among other ailments. [ 2 ]
Roman natural philosopher Pliny commented in his Natural History that fasting spittle was efficacious in the treatment of ophthalmia , and that the fasting spittle of a woman was particularly beneficial for treating bloodshot eyes. [ 3 ]
The New Testament contains multiple instances of Jesus using spit as a cure. The Gospel of Mark records Jesus spitting directly into the eyes of a blind man, and the Gospel of John records Jesus using a mixture of spit and mud to make a poultice for healing blindness. [ 4 ] [ 5 ]
And they bring unto him [Jesus] one that was deaf, and had an impediment in his speech ... And he took him aside from the multitude, and put his fingers into his ears, and he spit, and touched his tongue; and saith unto him, Ephphatha, that is, Be opened. Mark 7:32–5
When he had thus spoken, he spat on the ground, and made clay of the spittle, and he anointed the eyes of the blind man with the clay. John 9:6
Suetonius , Tacitus and Cassius Dio mention Roman Emperor Vespasian treating blindness in a similar fashion. [ 2 ] Tacitus mentions that Vespasian consulted with physicians before healing the blind man with his spit. Tacitus also gives a natural, medical explanation for the healing, unlike Suetonius and Cassius Dio who ascribe a more supernatural aura to the restoration of the blind man's sight. [ 6 ]
The Talmud also references the alleged medicinal benefits of saliva, particularly that of a first-born son. [ 7 ]
A certain person once came before R. Hanina and said to him, 'I am sure that this man is firstborn'. R. Hanina said to him, 'How do you know?' — The person replied to him: 'Because when people came to his father, he used to say to them: "Go to my son Shikhath, who is firstborn and his saliva heals'. Might he not have been the firstborn of his mother only [but not of his father]? There is a tradition that the saliva of the firstborn of a father heals, but that of the firstborn of a mother does not heal.
|
https://en.wikipedia.org/wiki/Fasting_spittle
|
Fat, Sick and Nearly Dead is a 2010 American documentary film which follows the 60-day journey of Australian Joe Cross across the United States as he follows a juice fast to regain his health under the care of Joel Fuhrman , Nutrition Research Foundation's Director of Research. [ 1 ]
The feature-length film follows Cross, who was depressed, weighed 310 lbs, suffered from a serious autoimmune disease, and was on steroids at the start of the film, as he embarks on a juice fast. [ 2 ] Cross and Robert Mac, co-creators of the film, both serve on the Nutrition Research Foundation's Advisory Board. [ 3 ] [ 4 ] Following his fast and the adoption of a plant-based diet , Cross states in a press release that he lost 100 pounds and discontinued all medications. [ 5 ] [ 6 ] [ 7 ] During his road-trip Cross meets Phil Staples, a morbidly obese truck driver from Sheldon, Iowa , in a truck stop in Arizona and inspires him to try juice fasting. [ 8 ] [ 9 ] [ 10 ] A sequel to the first film, Fat, Sick and Nearly Dead 2 , was released in 2014. [ 11 ] [ 12 ] [ 13 ]
Fat, Sick, and Nearly Dead won the Turning Point Award and shared the Audience Choice Award – Documentary Film at the 2010 Sonoma International Film Festival . [ 14 ]
The film has received mixed reviews with review aggregation website Rotten Tomatoes giving it a rating of 69% "fresh" [ 15 ] and Metacritic having an average score of 45 out of 100, based on 5 reviews. [ 16 ] The Hollywood Reporter called it an "infomercial passing itself off a documentary". [ 17 ] The New York Times stated that the film is "no great shakes as a movie, but as an ad for Mr. Cross's wellness program its now-healthy heart is in the right place". [ 18 ] Journalist Avery Yale Kamila reviewed the film in 2011, reporting Cross planned to continue avoiding junk food and "eating a diet centered around whole food." She reported Cross had created an online community called Reboot Your Life. [ 19 ]
|
https://en.wikipedia.org/wiki/Fat,_Sick_and_Nearly_Dead
|
Fat transfer , also known as fat graft , lipomodelling , or fat injections , [ 1 ] [ 2 ] is a surgical process in which a person's own fat is transferred from one area of the body to another area. The major aim of this procedure is to improve or augment the area that has irregularities and grooves. [ 3 ] Carried out under either general anesthesia or local anesthesia , [ 4 ] the technique involves 3 main stages: fat harvesting (extracting adipose fat), fat processing (processing the extracted fat) and fat injection (reinjecting the purified fat into the area needing improvement). [ 5 ] [ 6 ]
Autologous fat transplantation is a widely used treatment modality because of its biocompatible properties and availability of fat for transplantation. [ 7 ] The technique has become increasingly popular in recent years for soft tissue augmentation and volume replacement in both reconstructive and aesthetic plastic surgery.
Stem cell fat grafting is a new technique. The stem cells from fat tissue can differentiate into a number of structures, which is useful for cosmetic rejuvenation. Very small grafts (nanografts) contain no adipose cells, but their stem cell content remains useful. [ 8 ]
Breast reconstruction is the surgical process of rebuilding the natural shape and look of a breast, using autologous tissue, prosthetic implants, or a combination of both. [ 9 ] The procedure is most commonly performed in women - as part of their treatment - who have had mastectomy or surgery to treat breast cancer . A doctor harvests fat from one or more areas of the patient's body where excess fat is available and grafts it to the breast for breast reconstruction surgery after a mastectomy or lumpectomy . As the procedure uses the patient's own fat, the structural fat grafting for breast reconstruction surgery is a more natural process than implants and creates a smooth, more symmetrical, look. [ 10 ]
Fat transfer breast augmentation is a natural solution to restore shape and volume to the breasts, which may have been lost due to factors such as aging, pregnancy/breast feeding, or weight loss. [ 11 ] Breast asymmetry can be corrected using the fat transfer procedure, and to give the breasts the same shape and size. Breast augmentation and correction of asymmetry using fat transfer is considered to be an overall safe procedure. [ medical citation needed ] Any major weight gain or loss could have an impact of the procedure results because the fat transferred will behave like the fat in any other body part. The procedure is associated with certain risks such as fat necrosis or death of fat cells, a risk related to any type of fat grafting surgeries. Another risk is fat reabsorption, wherein the body may reabsorb the fat used (up to 50%) in the fat transfer augmentation procedure. [ 12 ]
Fat transfer in gluteal augmentation, also known as buttock augmentation with autologous fat grafting or gluteal lift (currently marketed as the "Brazilian butt lift"), represents one of the most rapidly evolving and increasingly popular operations in aesthetic surgery. [ 13 ] This is a "dual-benefit" body contouring procedure, because fat is harvested from areas with surplus body fat to enhance contouring using liposuction . [ 14 ] [ 15 ] This fat is purified and prepared for transplantation into the gluteal region to increase buttock volume. The technique that can be performed under general and local anesthesia can also create an improvement in buttock shape, along with enhancing. [ 16 ]
The regenerative potential of lipofilling and the role of adipose-derived stem cells (ASCs) contribute to good results in facial fat transfer. In traditional techniques for facial rejuvenation, surgery was used involving the excision of muscle, skin, and/or fat. In contrast, modern techniques focus on using fat grafting [ 17 ] to add volume to the "empty" facial compartments. Now, with more comprehensive understanding of facial aging constituents such as fat atrophy and ptosis of the facial compartments, fat grafting is considered a plausible facial rejuvenation technique, especially of the eyelids. [ 18 ]
Structural fat grafting can be an ideal option to treat the signs of aging or other appearance-related issues – such as prominent-looking veins and tendons, loss of fullness, thinning skin, arthritis and wasting of the hand. [ 19 ] The procedure involves manually harvesting fat from one or more locations on the body via liposuction and placing it around the back of the patient's hand, and sculpting it into a smooth, uniform layer for an ideal appearance. [ 20 ] To "fine tune" the results, additional fat transfer or injection of dermal filler products can be performed. [ 21 ] Autologous fat transfer serves as a filler in the hand rejuvenation procedure. Besides, it also rejuvenates the soft tissue and skin on the posterior side of the hands. [ 17 ]
Autologous micro fat transplantation is often used to correct a low dorsum and a short nose. [ 22 ] [ 23 ]
Scars and burns caused due to various reasons such as injuries, chicken pox, acne, sun or radiation exposure, and more can be repaired with structural fat grafting. [ 24 ] The procedure harvests fat from one or more areas of the body and places it anywhere on the body where tissue has been damaged. [ 25 ] Structural fat grafting can improve the quality of aged and scarred skin, reduce pain and itchiness, heal radiation damage, treat chronic ulcers and reduce the appearance of scars on the face and body - including dimpling and deep depressions, resulting in thicker, softer, healthier skin. [ 26 ]
To ensure survivability, the fat graft should not be manipulated too much and it must be quickly reinjected. Possible complications are swelling, bruising, hematoma formation, paresthesia or donor-site pain, hypertrophic scarring , infection, contour irregularities, and injury caused by the cannula to the underlying structures. [ 17 ] [ 3 ] [ 27 ]
|
https://en.wikipedia.org/wiki/Fat_transfer
|
Various individuals have advanced the surgical art and, as a result, have been called the Father of Surgery by various sources.
Sushruta ( IAST : Suśruta), the purported author of the Sanskrit -language Sushruta Samhita (Sushruta's Compendium), has been called the father of surgery [ 1 ] Dating the Sushruta Samhita has been a matter of debate, but a partial manuscript has been dated to 878 CE. [ 2 ] As of 2023, it is generally accepted by scholars that there were several ancient authors collectively called "Suśruta" who contributed to this text. [ 3 ]
The Arab physician Abu al-Qasim al-Zahrawi (936-1013) wrote Al-Tasrif (The Method of Medicine), a 30-part medical encyclopedia in Arabic . In the encyclopedia, he introduced his collection of over 200 surgical instruments, many of which were never used before. [ 4 ] Some of his works included being the first to describe and prove the hereditary pattern behind hemophilia , as well as describing ectopic pregnancy and stone babies . [ 5 ] He has been called the "father of surgery". [ 6 ] [ 7 ]
The 14th century French surgeon Guy de Chauliac quoted Al-Tasrif over 200 times. Abu Al-Qasim's influence continued for at least five centuries after his death, extending into the Renaissance, evidenced by al-Tasrif's frequent reference by French surgeon Jacques Daléchamps (1513-1588). [ 7 ]
The Frenchman Guy de Chauliac (c. 1300–1368) is said by the Encyclopædia Britannica to have been the most eminent surgeon of the European Middle Ages. He wrote the surgical work Chirurgia magna , which was used as a standard text for some centuries. [ 8 ] He has been called the "father of modern surgery". [ 9 ]
The French surgeon Ambroise Paré (1517–1590) worked as a military doctor. He reformed the treatment of gunshot wounds, rejecting the practice, common at that time, of cauterizing the wound, and ligatured blood vessels in amputated limbs. His collected works were published in 1575. He has been called the "father of modern surgery". [ 10 ] [ 11 ] [ 12 ]
The Italian anatomist and surgeon Hieronymus Fabricius (1537–1619) taught William Harvey , and published a work on the valves of the veins. He has been called the "father of ancient surgery". [ 13 ] [ 14 ]
The Scotsman John Hunter (1728–1793) was known for his scientific, experimental approach to medicine and surgery. [ 15 ] He has been called the "father of modern surgery". [ 16 ] [ 17 ]
The American surgeon Philip Syng Physick (1768–1837) worked in Philadelphia and invented a number of new surgical methods and instruments. [ 18 ] He has been called the "father of modern surgery". [ 19 ] [ 20 ]
The Englishman Joseph Lister (1827–1912) became well known for his advocacy of the use of carbolic acid (phenol) as an antiseptic, and was dubbed the "father of modern surgery" as a result. [ 21 ] [ 22 ]
The German Theodor Billroth (1829–1894) was an early user of antisepsis, and was the first to perform a resection of the esophagus, and various other operations. He has been called the "father of modern surgery". [ 23 ] [ 24 ]
The American William Stewart Halsted (1852–1922) pioneered the radical mastectomy , and designed a residency training program for American surgeons. [ 25 ] [ 26 ] He has been called "the most innovative and influential surgeon the United States has produced", and also the "father of modern surgery". [ 27 ] [ 28 ]
The Scottish James Henderson Nicoll (1863–1921) pioneered a surgical cure for Pyloric stenosis and outpatient care of children with Spina bifida , [ 29 ] and was known as the Father of Day Surgery . [ 30 ]
|
https://en.wikipedia.org/wiki/Father_of_surgery
|
Fatima Marouan , also Fatema Marouane , (born 1952) is a Moroccan physician, business executive and politician. From 2002 to 2005, she headed the Endocrinology and Metabolic Diseases unit of the Ibn Rochd University Hospital in Casablanca . [ 1 ] More recently, under the government of Prime Minister Abdelilah Benkirane , from October 2013 to April 2017 she has served as Minister of Crafts and Social Economy as a member of the National Rally of Independents . [ 2 ]
Born in 1952 in Benslimane to the east of Casablanca , Fatima Maroun studied medicine at the University of Lyon . She became a professor and researcher in Casablanca University 's Department of Medicine and Pharmacy. Specializing in endocrinology and nutritional disorders, she headed the Department of Endocrinology, Diabetology and Nutrition at the Ibn Rochd Hospital in Casablanca. Maroun is a member of the Moroccan commission on combating diabetes . [ 3 ] She went on to head Smedian (Société marocaine d’endocrinologie, diabétologie et nutrition). [ 4 ] Fatima Marouan has contributed to several scientific publications. [ 5 ]
On the political front, as a member of the National Rally of Independents party, she took part in the development of health and education plans. From October 2013 to April 2017, she served as Minister of Crafts and Social Economy ( ministre de l’Artisanat, de l’économie sociale et solidaire ). [ 4 ]
Maroun is also a board member of the Casablanca Chicago Sister Cities Association. She is trilingual, speaking Arabic, French and English. [ 6 ] A member of the scientific board of Destination Santé S.A.S, she has also worked for Casablanca's California Cardiology Clinic. [ 1 ]
Fatima Maroun is married and has two children. [ 3 ]
|
https://en.wikipedia.org/wiki/Fatima_Marouan
|
Fatty-replaced breast tissue is a term used in mammography that refers to the replacement of breast tissue with fatty tissue . This commonly occurs as a person ages .
This article incorporates public domain material from Dictionary of Cancer Terms . U.S. National Cancer Institute .
This oncology article is a stub . You can help Wikipedia by expanding it .
|
https://en.wikipedia.org/wiki/Fatty-replaced_breast_tissue
|
Fatty acid oxidation inhibitors are a new potent class of drugs used in treatment of stable angina pectoris and an addition in treatment of chronic heart failure .
|
https://en.wikipedia.org/wiki/Fatty_acid_oxidation_inhibitors
|
The fear-avoidance model (or FA model ) is a psychiatric model that describes how individuals develop and maintain chronic musculoskeletal pain as a result of attentional processes and avoidant behavior based on pain-related fear . [ 1 ] [ 2 ] [ 3 ] Introduced by Lethem et al. in 1983, this model helped explain how these individuals experience pain despite the absence of pathology . [ 3 ] [ 4 ] [ 5 ] If an individual experiences acute discomfort and delays the situation by using avoidant behavior, a lack of pain increase reinforces this behavior. [ 6 ] [ 7 ] Increased vulnerability provides positive feedback to the perceived level of pain and rewards avoidant behavior for removing unwanted stimuli. [ 2 ] [ 8 ] If the individual perceives the pain as nonthreatening or temporary, he or she feels less anxious and confronts the pain-related situation. [ 9 ] [ unreliable medical source? ]
Avoidant behavior is healthy when encouraging the individual to avoid stressing injuries and permitting them to heal. [ 7 ] However, it is harmful when discouraging the individual from activity after the injury is healed. [ 7 ] The resulting hypervigilance and disability restricts normal use of the tissue and deteriorates the individual physically and mentally. [ 8 ] Once the avoidant behavior is no longer reinforced, the individual exits the positive feedback loop. [ 2 ] In 1993, Waddell et al. developed a Fear-Avoidance Beliefs Questionnaire (FABQ) which showed that fear-avoidance beliefs about physical activities are strongly related to work loss. [ 3 ] [ 6 ]
Anxiety sensitivity is the fear of the symptoms of anxiety . An example of the fear-avoidance model, anxiety sensitivity stems from the fear that the symptoms of anxiety will lead to harmful social and physical effects. As a result, the individual delays the situation by avoiding any stimuli related to pain-inducing situations and activities, becoming restricted in normal daily function. [ 2 ]
Chronic pain is another example that can originate from the drastic misinterpretation of pain as a catastrophe. As a result of this misinterpretation, the individual repeatedly avoids the pain-inducing activity and will likely overestimate any future pain from such activity. The excessive sensitivity to pain discourages the individual from exercise and weakens his or her body. [ 8 ]
Research involving the fear-avoidance model has led some to question its accuracy in representing or predicting the actual avoidance of physical activity due to negative reinforcement . In certain cases, the individual completely avoids anxiety-inducing behavior, so that the fear response never becomes directly involved. Other factors affecting the perceived level of danger and spatial awareness further complicate the model. While the fear-avoidance model may be simplistic for every situation involving fear, discomfort, and/or chronic pain, its effectiveness is generally acknowledged for diagnosing and understanding how humans positively or negatively react to fear and anxiety. [ 8 ]
|
https://en.wikipedia.org/wiki/Fear-avoidance_model
|
In histo pathology , feathery degeneration , formally feathery degeneration of hepatocytes , is a form of liver parenchymal cell (i.e. hepatocyte ) death associated with cholestasis . [ 1 ]
Cells undergoing this form of cell death have a flocculant appearing cytoplasm, [ 2 ] and are larger than normal hepatocytes.
Feathery degeneration is somewhat similar in appearance to ballooning degeneration , which is due to other causes (e.g. alcohol , obesity ); it also has cytoplasmic clearing and cell swelling.
This article related to pathology is a stub . You can help Wikipedia by expanding it .
|
https://en.wikipedia.org/wiki/Feathery_degeneration
|
Febrile neutropenia is the development of fever , often with other signs of infection , in a patient with neutropenia , an abnormally low number of neutrophil granulocytes (a type of white blood cell ) in the blood. It is an oncologic emergency, and is the most common serious complication in patients with hematopoietic cancers or receiving chemotherapy for cancer. [ 1 ] The term neutropenic sepsis is also applied, although it tends to be reserved for patients who are less well. In 50% of cases, an infection is detectable; bacteremia (bacteria in the bloodstream) is present in approximately 20% of all patients with this condition. [ 2 ]
Febrile neutropenia or neutropenic fever is a defined as a single oral temperature value of ≥ 38.3 C (101 F) or a temperature ≥ 38 C (100.4 F) for ≥ 1 hour, with an absolute neutrophil count (ANC) < 1500 cell/microliter. [ 1 ] In case of severe neutropenia, the ANC is < 500 cell/microliter. [ 1 ] In profoundly severe neutropenia, the ANC is < 100 cells/microliter. [ 1 ]
Febrile neutropenia can develop in any form of neutropenia, but is most generally recognized as a complication of chemotherapy when it is myelosuppressive (suppresses the bone marrow from producing blood cells). [ citation needed ] Febrile neutropenia is the most common and serious complication in patients with hematopoietic cancers or receiving chemotherapy for cancer. [ 1 ] The condition occurs when a neutropenic patient gets infected by a pathogen. [ 1 ] Approximately 50% of patients with febrile neutropenia develop an infection, of which 20% with profound neutropenia will develop bacteremia. [ 1 ] Gram-positive bacteria are now the most common pathogens causing febrile neutropenia, with many of these infections resulting from long-term central venous catheters . [ 1 ]
The Multinational Association for Supportive Care in Cancer (MASCC) risk index can be used to identify low-risk patients (score ≥21 points) for serious complications of febrile neutropenia (including death, intensive care unit admission, confusion, cardiac complications, respiratory failure , kidney failure , low blood pressure , bleeding , and other serious medical complications). [ 3 ] The score was developed to select patients for therapeutic strategies that could potentially be more convenient or cost-effective. A prospective trial demonstrated that a modified MASCC score can identify patients with febrile neutropenia at low risk of complications, as well. [ 4 ]
In contrast, the Clinical Index of Stable Febrile Neutropenia (CISNE) score is specific of patients with solid tumors and seemingly stable episodes. CISNE is able to discriminate groups of patients who are at low, intermediate, and high risk of complications in this population. With the CISNE, the complication rate was determined to be 1.1% for low-risk patients, 6.2% for intermediate-risk patients, and 36.0% for high-risk patients. [ 5 ] The prime purpose of this model was to avoid complications from an early hospital release. On the contrary, CISNE should not be used so much to select low-risk patients for outpatient treatment. [ 6 ]
Generally, patients with febrile neutropenia are treated with empirical antibiotics until the neutrophil count has recovered (absolute neutrophil counts greater than 500/mm 3 ) and the fever has abated; if the neutrophil count does not improve, treatment may need to continue for two weeks or occasionally more. In cases of recurrent or persistent fever, an antifungal agent should be added. [ citation needed ]
Guidelines issued in 2002 by the Infectious Diseases Society of America recommend the use of particular combinations of antibiotics in specific settings; mild low-risk cases may be treated with a combination of oral amoxicillin-clavulanic acid and ciprofloxacin , while more severe cases require cephalosporins with activity against Pseudomonas aeruginosa (e.g. cefepime ), or carbapenems ( imipenem or meropenem ). [ 2 ] A subsequent meta-analysis published in 2006 found cefepime to be associated with more negative outcomes, and carbapenems (while causing a higher rate of pseudomembranous colitis ) were the most straightforward in use. [ 7 ]
In 2010, updated guidelines were issued by the Infectious Diseases Society of America, recommending use of cefepime, carbapenems (meropenem and imipenem/cilastatin), or piperacillin/tazobactam for high-risk patients and amoxicillin-clavulanic acid and ciprofloxacin for low-risk patients. Patients who do not strictly fulfill the criteria of low-risk patients should be admitted to the hospital and treated as high-risk patients. [ citation needed ]
Research to compare antibiotic treatments currently recommended in consensus guidelines [ 8 ] identified 44 studies comparing different antibiotics. Significantly higher mortality was reported for cefepime compared to all other antibiotics combined. Piperacillin/tazobactam resulted in lower mortality than other antibiotics. Piperacillin/tazobactam might be the preferred antibiotic for the treatment of cancer patients with fever and neutropenia, while cefepime should not be used.
Empiric treatment should be started within 60 minutes of being admitted. Periodic monitoring should be done to see if the empiric treatment is working, or if a more target therapy should be initiated. [ 9 ] [ 10 ]
In people with cancer who have febrile neutropenia (excluding patients with acute leukaemia ), oral treatment is an acceptable alternative to intravenous antibiotic treatment if they are hemodynamically stable, without organ failure, without pneumonia and with no infection of a central line or severe soft-tissue infection. [ 11 ] Furthermore, outpatient treatment for low‐risk febrile neutropenia in people with cancer probably makes little or no difference to treatment failure and mortality compared with the standard hospital (inpatient) treatment and may reduce time that patients need to be treated in hospital. [ 12 ]
|
https://en.wikipedia.org/wiki/Febrile_neutropenia
|
Febrile non-hemolytic transfusion reaction (FNHTR) is the most common type of transfusion reaction . It is a benign occurrence with symptoms that include fever but not directly related with hemolysis . [ 1 ] It is caused by cytokine release from leukocytes within the donor product as a consequence of white blood cell breakdown. [ 2 ] [ 3 ] [ 4 ] These inflammatory mediators accumulate during the storage of the donated blood, [ 5 ] and so the frequency of this reaction increases with the storage length of donated blood. [ 6 ] This is in contrast to transfusion-associated acute lung injury , in which the donor plasma has antibodies directed against the recipient HLA antigens, mediating the characteristic lung damage. [ citation needed ]
Symptoms must manifest within 4 hours of cessation of the transfusion, and should not be due to another cause such as an underlying infection, bacterial contamination of the blood component, or another type of transfusion reaction, e.g. acute hemolytic transfusion reaction . [ 7 ]
Fever must be at least 38 °C/100.4 °F oral and a change of at least 1 °C/1.8 °F from pre-transfusion value OR chills and/or rigors must be present. [ 7 ] [ 8 ]
The UK hemovigilance system ( SHOT ) categorizes the severity of the reaction. [ 9 ]
Fever of at least 38 °C/100.4 °F oral and a change of between 1 and 2 °C from pre-transfusion values but no other symptoms or signs. [ 9 ]
Fever of at least 39 °C, OR a rise in temperature of at least 2 °C from pre-transfusion values AND/OR other symptoms or signs, including chills ( rigors ), painful muscles ( myalgia ), or nausea that are severe enough that the transfusion is stopped. [ 9 ]
Fever of at least 39 °C, OR a rise in temperature of at least 2 °C from pre-transfusion values AND/OR other symptoms or signs, including chills ( rigors ), painful muscles ( myalgia ), or nausea that are severe enough that the transfusion is stopped AND requires immediate medical treatment, admission to hospital, or lengthens the duration of hospital admission. [ 9 ]
Paracetamol has been used in treatment, and leukoreduction of future transfusions is sometimes performed. [ 10 ]
|
https://en.wikipedia.org/wiki/Febrile_non-hemolytic_transfusion_reaction
|
The Feighner Criteria are a set of influential psychiatric diagnostic criteria developed at Washington University in St. Louis between the late 1950s to the early 1970s.
The criteria are named after a psychiatric paper published in 1972 of which John Feighner was the first listed author. [ 1 ] It became the most cited article in psychiatry for some time. [ 2 ] The development of the criteria had been led by a trio of psychiatrists working together on the project for a medical model of psychiatric diagnosis since the late 1950s: Eli Robins , Samuel Guze and George Winokur . [ 3 ] [ 4 ]
Fourteen conditions were defined, including primary affective disorders (such as depression), schizophrenia , anxiety neurosis and antisocial personality disorder .
The criteria were expanded in the publication of the Research Diagnostic Criteria on which many of the criteria of the American Psychiatric Association 's DSM III (1980) were based, which in turn shaped the World Health Organization 's ICD manual. "The historical record shows that the small group of individuals who created the Feighner criteria instigated a paradigm shift that has had profound effects on the course of American and, ultimately, world psychiatry." [ 5 ]
|
https://en.wikipedia.org/wiki/Feighner_Criteria
|
The Feldenkrais Method (FM) is a type of movement therapy devised by Israeli Moshé Feldenkrais (1904–1984) during the mid-20th century. The method is claimed to reorganize connections between the brain and body and so improve body movement and psychological state. [ 1 ] [ 2 ]
There is no conclusive evidence for any medical benefits of the therapy. However, researchers do not believe FM poses serious risks. [ 2 ]
The Feldenkrais Method is a type of alternative movement therapy that proponents claim can repair impaired connections between the motor cortex and the body, so benefiting the quality of body movement and improving wellbeing. [ 1 ] [ 3 ] Practitioners view it as a form of somatic education [ 4 ] "that integrates the body, mind and psyche through an educational model in which a trained Feldenkrais practitioner guides a client (the ‘student’) through movements with hands-on and verbally administered cues," according to Clinical Sports Medicine. [ 5 ]
The Feldenkrais Guild of North America claims that the Feldenkrais method allows people to "rediscover [their] innate capacity for graceful, efficient movement" and that "These improvements will often generalize to enhance functioning in other aspects of [their] life". [ 6 ]
The Oxford Handbook of Music Performance describes FM as "an experiential learning process that uses movement and guided attention to develop and refine self-awareness." It notes that FM is "increasingly used among high-level performers, such as musicians, actors, dancers, and athletes." [ 7 ]
Feldenkrais lessons have two types, one verbally guided and practiced in groups called Awareness Through Movement, and one hands-on and practiced one-to-one called Functional Integration. [ 8 ] Moshé Feldenkrais wrote, "The purpose of these sensorimotor lessons is to refine one’s ability to make perceptual distinctions between movements that are easy and pleasurable and those that are strained and uncomfortable, which results in the discovery of new movement possibilities as well as potential for further improvements." [ 7 ]
FM operates broadly within five principles: [ 7 ]
In 2015, the Australian Government's Department of Health published the results of a review of 17 natural therapies that sought to determine which would continue being covered by health insurance ; the Feldenkrais Method was one of 16 therapies for which no clear evidence of effectiveness was found. [ 9 ] Accordingly in 2017 the Australian government identified the Feldenkrais Method as a practice that would not qualify for insurance subsidy, saying this step would "ensure taxpayer funds are expended appropriately and not directed to therapies lacking evidence". [ 10 ]
Proponents claim that the Feldenkrais Method can benefit people with several medical conditions, including children with autism spectrum disorders , and people with multiple sclerosis . [ 11 ] However, no studies in which participants were identified as having an autism spectrum disorder or developmental disabilities have been presented to back these claims. [ 12 ]
There is limited evidence that workplace-based use of the Feldenkrais Method may help rehabilitate people with upper limb complaints. [ 13 ]
A 2022 report on the effectiveness of the Feldenkrais Method by the German Institute for Quality and Efficiency in Health Care found a "hint" of benefit for people with Parkinson's disease , compared to a passive lecture program. Evidence for helping chronic low back pain was inconsistent. The report found no evidence for long-term benefit of FM, or benefit for other conditions. It concluded, "The question about the benefit of the Feldenkrais method in comparison with active strategies such as extensive physiotherapy generally remains open. Overall, little evidence is available. From an ethical perspective, the absence of evidence from RCTs is problematic for informed decision making but does not constitute evidence of an absent benefit. Only 2 small, ongoing RCTs of questionable relevance were identified, and therefore, the availability of evidence is not expected to change in the short term." [ 14 ]
David Gorski has written that the Method bears similarities to faith healing , is like "glorified yoga ", and that it "borders on quackery ". [ 6 ] Quackwatch places the Feldenkrais Method on its list of "Unnaturalistic methods". [ 15 ]
From the 1950s till his death in 1984, Feldenkrais taught in his home city of Tel Aviv. He gained recognition in part through media accounts of his work with prominent individuals, including Israeli Prime Minister David Ben-Gurion . [ 16 ] [ 17 ] In David Kaetz's biography, Making Connections: Roots and Resonance in the Life of Moshe Feldenkrais (2007), he argues many lines of influence can be found between the Judaism of Feldenkrais's upbringing and the Feldenkrais Method – for instance, the use of paradox as a pedagogical tool. [ 18 ]
Making Connections described Feldenkrais' approach:
Feldenkrais was critical of the appropriation of the term 'energy' to express immeasurable phenomena or to label experiences that people had trouble describing ... He was impatient when someone invoked energy in pseudoscientific 'explanations' that masked a lack of understanding. In such cases, he urged skepticism and scientific discourse. He encouraged empirical and phenomenological narratives that could lead to insights. [ 18 ]
Beginning in the late 1950s, Feldenkrais traveled to teach in Europe and America. Several hundred people became certified Feldenkrais practitioners through trainings he held in San Francisco from 1975 to 1978 and in Amherst, Massachusetts , from 1980 to 1984. [ 19 ] Cybernetics , also known as dynamic systems theory, continued to influence the Feldenkrais Method in the 1990s through the work of human development researcher Esther Thelen . [ 20 ] :1535
|
https://en.wikipedia.org/wiki/Feldenkrais_method
|
Feline hyperthyroidism is an endocrine disorder in which the thyroid gland produces too much thyroid hormone . Hyperthyroidism is the most common endocrinopathy of cats. The complete pathogenesis is not fully understood.
In 1979 the first clinical report of a cat with hyperthyroidism was reported. [ 1 ] More studies and greater awareness would follow and today hyperthyroidism is a common condition in small animal practice. Whether that is due to increased prevalence or better testing is not entirely agreed upon. [ 2 ]
A study in 1987 transplanted thyroid tissue from affected cats into nude mice . The mice were administered levothyroxine , which suppresses thyroid-stimulating hormone . The thyroid cells remained in the hyperthyroid state. This study helped provide evidence for thyroid dysfunction as the cause rather than thyroid stimulation. [ 2 ]
The majority of cases of hyperthyroidism in cats are the result of benign tumours. The most commonly identified abnormalities of the thyroid gland in hyperthyroid cases are follicular cell adenoma and multinodular adenomatous hyperplasia . 1% to 3% of feline hyperthyroid cases are caused by malignant tumours . These are not always able to be distinguished from benign tumours. [ 2 ]
It is believed that the cause of hyperthyroidism is multifactorial . Studies have identified different mutations as causing thyroid cell autonomy. [ 2 ]
Excessive iodine administration has been hypothesised as causing thyrotoxicosis in cats, as it does in humans; however, cats have been shown in multiple long terms studies to be able to regulate their levels of thyroid hormone within safe ranges when administered iodine. Iodide intake and its effects are unknown. [ 2 ]
Iodine amounts in cat food vary by as much as a factor of 30. Low, high, and variable iodine diets have been hypothesised as cause of feline hyperthyroidism. [ 2 ]
Soy is often used in commercial cat food diets as a vegetable protein. In one study more than half of commercial cat foods surveyed contained soy isoflavones . Genistein and daidzein , both of which occur in soybeans, inhibit the enzymes thyroid peroxidase and thyroxine 5-deiodinase . This causes decreased thyroxine and triiodothyronine concentrations. In response to decreased triiodothyronine levels the body will produce more thyroid-stimulating hormone to normalise triiodothyronine levels, this has been shown to result in increased thyroxine levels. In addition these effects are heightened when a cat is suffering from iodine deficiency. However, further research is needed to confirm a link between soy isoflavones and hyperthyroidism. [ 2 ]
Goitrogens are chemicals that disrupt thyroid hormone production. Chemicals such as bisphenol A and polybrominated diphenyl ethers have been shown to exist in indoor cats at heightened levels and are hypothesised to be a potential cause of hyperthyroidism. Bisphenol A is common in canned cat foods, although no association between it and hyperthyroidism has currently been demonstrated. Polybrominated diphenyl ethers (PBDEs) are often used as fire retardants and are known to be a goitrogen; however, levels of these chemicals have been shown to be the same in euthyroid cats as hyperthyroid cats. No association has been proven in a study for the association between PBDEs and hyperthyroidism. [ 2 ]
Hyperthyroidism is a disease that slowly progresses and symptoms are very subtle at first. It can take up to two years from onset of symptoms for a diagnosis of hyperthyroidism to be made. [ 2 ]
The most common symptom is weight loss, occurring in 98% of hyperthyroid cases. Other symptoms that occur more than 50% of the time, include: a palpable thyroid gland (91%); polyphagia (81%), without obesity; restlessness (76%); tachycardia (66%); polydipsia and polyuria (60%); emesis ; and cardiac murmur (53%). [ 2 ]
Less common symptoms include: diarrhoea (33%), increased volume of faeces (31%), anorexia (26%), polypnoea (25%), myasthenia (25%), muscle tremors (18%), congestive heart failure (12%), excessive nail growth (12%), and dyspnoea (11%). [ 2 ]
Systolic hypertension is reported in 10-15% of cats that have been diagnosed with hyperthyroidism. Some normotensive hyperthyroid cats develop hypertension after having their hyperthyroidism treated. The reasons for this are not currently known. [ 2 ]
Cachexia is a possible symptom in hyperthyroid cats but due to improved screening and diagnostics it is less common for a cat to become cachectic before starting treatment. [ 2 ]
Ventroflexion of the head is a rare symptom observed in hyperthyroid cats but the last case report is from 1994. Due to the rarity the pathogenesis behind this is not known. [ 2 ]
Cardiac conditions have become less common over the years in hyperthyroid cats due to earlier diagnosis and improved treatment. The most common cardiovascular issues are tachyarrhythmias , cardiac murmurs , and gallop rhythms . The cause of these conditions is due to how triiodothyronine increases cardiac output . [ 2 ]
Thyroid cysts can occur in cases of adenoma, adenomatous hyperplasia, or carcinoma. These cysts have a high concentration of thyroxine. Cysts should not be treated with radioactive iodine and instead be surgically removed. [ 2 ]
Symptoms of hyperadrenocorticism can occur in hyperthyroid cats. Adrenocorticotropic hormone levels are raised in some hyperthyroid cats and some studies have documented acromegaly in hyperthyroid cats. [ 2 ]
Multiple case control studies have looked at diet and hyperthyroidism. These studies have found associations between commercial diets and hyperthyroidism. Other risk factors identified include non- Siamese related breeds, lack of outdoor access, flea medication, pesticides, certain cat litters, female sex, sleeping on the floor, organic fertiliser, human baby food, carpet cleaners, natural gas , lack of deworming , and a fish diet. [ 3 ] These mixed results suggest a multifactoral cause with diet being having an important role. [ 2 ]
The age of onset has been reported to be between 4–22 years with an average of 13 years, with some individual cases occurring in cats below the age of 4 years. More than 95% of cases occur in cats 8 years and older. [ 2 ]
Testing for hyperthyroidism is routine for elderly cats and standard blood tests that can be performed in clinic allow for measurement of serum thyroxine levels. With this advancement diagnosis is often made before clinical signs are well noticeable and severe. [ 2 ]
Diagnosing hyperthyroid cats is not just to confirm the presence of the condition but also what symptoms are present. For example, more serious cardiac conditions require special treatment compared to a cat without any serious cardiac abnormalities. Cats with hyperthyroidism should have a complete blood count test, a biochemistry profile of blood serum , urinalysis , measurement of thyroxine serum levels, thoracic radiography , and measurement of blood pressure. If heart disease is suspected electrocardiography and echocardiography should be performed. [ 2 ]
Measurement serum thyroxine levels is the best method of confirming hyperthyroidism. Measurement of serum concentrations triiodothyronine are not useful for diagnosing hyperthyroidism and neither is measurement of serum thyroid-stimulating hormone levels. Thyroxine levels on their own should not be used to diagnose hyperthyroidism: if a patient is displaying no symptoms of hyperthyroidism but test results show heightened serum thyroxine levels the possibility of other causes such as an error in the test have to be considered and excluded before establishing a diagnosis. [ 2 ]
Common findings of a complete blood count on a hyperthyroid cat include a small increase in packed cell volume (40-50%), macrocytosis (20%), and Heinz bodies . Anaemia is rare. Increased erythrocyte count is due to thyroid hormone stimulating erythropoietin secretion. Leukocytes and thrombocytes usually have normal results, some changes may occur but these are not specific and are not consistent. [ 2 ]
The most commonly noticed change in serum chemistry is a non-major increase in liver enzymes . More than 90% of hyperthyroid cats have an increase in either serum concentration of alanine aminotransferase and alkaline phosphatase , with more than 75% of cats having an increase in both. These increases are small and typically below 500 IU/L . Higher increases may be due to hepatic disease , although many other conditions can cause an increase in liver enzymes. [ 2 ]
Fructosamine concentrations are lowered by serum protein metabolism, which is increased in hyperthyroid cats. Fructosamine concentrations are significantly lower in hyperthyroid cats, with half of hyperthyroid cats having levels outside the reference range. Following treatment for hyperthyroidism these concentrations rise to normal levels. Diabetes mellitus also affects fructosamine concentration and this should not be relied on in diabetic cats. Hyperglycaemia can occur in hyperthyroid cats independent of diabetes mellitus. Frucotsamine measurement cannot reliably differentiate non-diabetes related hyperglycaemia. [ 2 ]
In roughly 10% of hyperthyroid cats serum creatinine levels are increased to the point of azotaemia . In 10-20% of cats increased serum concentration of blood urea nitrogen is observed. Although the prevalence of hyperthyroid cats with chronic kidney disease is higher than this due to how hyperthyroidism results in an increase to the glomerular filtration rate . Most cats with chronic kidney disease and hyperthyroidism have the kidney disease go undiagnosed until after treatment for hyperthyroidism has begun. Between 15% and 49% of non-azotaemic hyperthyroid cats will develop azotaemia following treatment for hyperthyroidism. Further complicating the diagnosis is the shared symptoms between the conditions. It is not currently known whether the effects of hyperthyroidism cause or worsen renal disease. Chronic kidney disease is not an uncommon condition in elderly cats further complicating determination of a relationship between the two conditions. [ 2 ]
Common abnormalities found during urinalysis of hyperthyroid cats include: decreased urine specific gravity , proteinuria , symptoms of urinary tract infections , and ketonuria . [ 2 ]
Decreases to urine specific gravity are likely not the result of hyperthyroidism but instead due to chronic kidney disease. [ 2 ] In a 2009 study most cats that had been treated for hyperthyroidism with radioactive iodine did not have changes to urine specific gravity levels. [ 4 ]
Proteinuria is reported in 75–80% of cats with hyperthyroidism. Likely causes of this are glomerular hyperfiltration and glomerular hypertension , and structural changes in the glomerular filtration barrier. [ 2 ]
Thoracic radiographs do not help diagnose hyperthyroidism, instead they help diagnose concurrent illnesses like thoracic neoplasia. If respiratory distress , tachypnoea , tachycardia , arrhythmia , or heart murmur are observed then thoracic radiographs should be taken. Congestive heart failure is uncommon. The most common finding is cardiomegaly . [ 2 ]
The most common echocardiographic abnormalities in hyperthyroid cats is hypertrophy of the left ventricular caudal wall and interventricular septum . The effects of thyroid hormone are known and explain most cardiac abnormalities; [ 2 ] however, one study found only 37% of hyperthyroid cats to have an echocardiographic abnormality, with 32% having abnormalities following treatment. [ 5 ]
Multiple clinical signs that support a diagnosis can be observed in hyperthyroid cats during a clinical exam. The most useful symptoms for this is weight loss with concurrent polyphagia and tachycardia . [ 2 ]
A goitre is swelling from an enlarged thyroid gland. This does not occur in all cases of hyperthyroidism, even those caused by adenoma; however it occurs in most cases and is a common way to support a hyperthyroid diagnosis caused by adenoma. Other conditions can cause a cervical mass that may resemble a goitre. [ 2 ]
Following a test for blood serum thyroxine levels thyrotropin-releasing hormone can be administered to cats intravenously and after 4 hours another blood test can be taken to measure thyroxine serum levels. If the thyroxine levels have increased this indicates the cat is euthyroid but if levels remain stagnant it suggests hyperthyroidism. This test is rarely performed due to side effects. The most common side effects being: emesis , tachypnoea , and defecation . [ 2 ]
Scintigraphy helps to show information on the thyroid gland and tumours affecting it. It is useful for identifying the size of the tumour, whether it is unilateral or bilateral, and how much radiation is required for treatment. Iodine-131 , Iodine-123 , and technetium-99m pertechnetate are all used for this. Pertechnetate is the most commonly used due its low cost, quick uptake, and short half-life . Scintigraphy can also be used to confirm hyperthyroidism when clinical symptoms are present but serum thyroxine levels remain within reference. Drugs such as methimazole and anaesthetics can influence results if not discontinued before scintigraphy. [ 2 ]
Ultrasonography is an alternative option to scintigraphy. Ultrasounds provide less information than scintigraphy but is easier and cheaper to conduct. Ultrasonography allows for the state of the thyroid gland to be evaluated and for an estimation of the volume but does not allow for evaluation of tissue. [ 2 ]
Polyphagia and weight loss are two concurrent symptoms that have multiple causes, including: diabetes mellitus , malnutrition , malabsorption , and maldigestion . If these symptoms occur serum thyroxine levels should be tested to confirm or exclude a diagnosis of hyperthyroidism. [ 2 ]
Thyroid carcinoma has largely the same symptoms as benign tumours. Hypercalcaemia may be seen in a patient with carcinoma. Symptoms that may be identified via radiography include: cardiomegaly , signs of congestive heart failure , signs of pulmonary metastasis , and mediastinal masses . The only way to definitively diagnose a thyroid carcinoma is via histopathological examination of the affected tissue. If treatment has failed thyroid carcinoma should be considered as a possibility. [ 2 ]
Hyperthyroidism can be either managed with anti-thyroid drugs or restricting iodine intake, or it can be treated with radioactive iodine or thyroidectomy for a permanent solution. Choice of treatment depends on a multitude of factors including cost, availability of the treatments, and age and health of the patient. In areas where available, radioactive iodine treatment is the preferred method of treating hyperthyroidism due to the low risks and high efficacy. [ 2 ]
Surgery is a cheaper option than radioactive iodine treatment and does not require any equipment not found in a standard veterinary clinic. It also results in a quicker decrease in thyroid hormone levels. Surgery however can be more risky to elderly cats given the increased risk of anaesthetic complication. A bad surgery can result in nerve damage or fail to fully remove all the abnormal tissue. It may also result in iatrogenic hypothyroidism and hypoparathyroidism . [ 2 ]
Surgery has become a less common treatment option with improvement of access to radioactive iodine treatment and due to risks. Risks include: ectopic tissue being leftover, hypothyroidism , hypoparathyroidism . Less often laryngeal nerve damage and Horner's syndrome may occur. These risks can be prevented with a more experienced surgeon and proper imaging of the thyroid gland before removal. [ 2 ]
Thyroidectomy allows for shorter hospitalisation time and for histopathological evaluation of neoplastic tissue. Thyroidectomy is not recommended when the disease is bilateral. [ 2 ]
Alternative treatments should be prioritised in case of cardiac, electrolyte, and renal dyscrasias. [ 2 ]
Rates of hypocalcaemia following bilateral thyroidectomy range from 6–82% depending on the study and technique used. Mild hypocalcaemia often occurs as a result of an oedema and calcium depeletion. This mild hypocalcaemia typically resolves after several weeks. Severe hypocalcaemia is due to iatrogenic hypoparathyroidism and poses a long term risk to patients. Symptoms include: anorexia, restless behaviour, muscle spasms , muscle tremors , tetany , and convulsion . Calcium and dihydrotachysterol can be used to treat hypocalcaemia with quick results. Ergocalciferol is a cheaper alternative that is sometimes used but is not recommended due to risk of hypercalcaemia [ 2 ]
Following unilateral thyroidectomy thyroxine levels may fall into the hypothyroid reference range. Thyroid function will return within 1–3 months and thyroid hormone supplements are not required. Supplementation retards the growth of the thyroid tissue and will prevent the patient from reaching a euthyroid state. [ 2 ]
Whilst iatrogenic hypothyroidism following a bilateral thyroidectomy is more common it does not always occur and should not be treated unless either clinical symptoms of hypothyroidism or signs of renal disease observed, or if it persists more than 3 months after the procedure. [ 2 ]
Thyroidectomy should be used for suspected carcinomata as it allows for histopathological examination of the tissue. Even when all visible neoplastic tissue is removed the carcinoma may reoccur, thus it is imperative to evaluate following the thyroidectomy. If carcinoma reoccurs radioactive iodine treatment should be undertaken. [ 2 ]
Anti-thyroid drugs are a cheap option that does not require any form of hospital treatment as the medication can be given orally at home; however, the drugs must be given b.i.d. , although this can be reduced to q.d. after a month, and success relies on owner compliance. Anti-thyroid drugs do not address the underlying thyroid issues and has several side effects such as anorexia , emesis , lethargy, thrombocytopaenia , granulocytopaenia , and hepatopathy . [ 2 ]
The three main anti-thyroid drugs, known as thioureylenes , are methimazole , carbimazole , and propylthiouracil . Carbimazole is converted to methimazole by the body. These drugs concentrate within the thyroid gland and inhibit the ability of iodide and iodothyronines to form thyroxine and triiodothyronine which prevents thyroid synthesis. These drugs do not affect thyroid hormone that has already been produced. [ 2 ]
Of these drugs propylthiouracil is not recommended due to the common side effects including: anorexia, emesis, lethargy, immune-mediated haemolytic anaemia , and thrombocytopaenia . [ 2 ]
Thioureylenes should not be used in patients with thyroid carcinoma these drugs increase the release of thyroid-stimulating hormone which aggravates growth of the tumour. The drugs themselves do not do anything to control the growth of tumours. The exception to this may be to stabilise symptoms before radioactive iodine treatment or thyroidectomy. [ 2 ]
Methimazole restores thyroxine levels to normal and resolves most hyperthyroid symptoms. This allows for the assessment of renal function before starting permanent treatment of the hyperthyroidism. Methimazole can also be used to stabilise patients with severe hyperthyroidism prior to surgery or radioactive iodine treatment. Methimazole is less effective in cats with more serious goitres and carcinomata. [ 2 ]
Methimazole may also be applied topically to the pinnae . Topical application reduces gastrointestinal side effects but can result in erythema and inflammation of the pinnae, this can be treated with glucocorticoids . Topical methimazole is easier to apply for owners but more expensive than oral methimazole. [ 2 ]
Between 10 and 25% of cats receiving methimazole will have mild side effects. These usually develop within the first 4–8 weeks and rarely develop beyond this. The most common side effects are anorexia, emesis, and lethargy. The side effects typically resolve either on their own or following a decrease in the dosage. Treatment is ceased in the event of gastrointestinal symptoms and not restarted until they have resolved. Gastrointestinal side effects are more common in cats receiving oral rather than topical treatment. Other mild side effects include haematological condition: eosinophilia , leukopaenia , and lymphocytosis occur at rates of 15% for oral and 5% for topical. These mild conditions do not require any cessation of methimazole. [ 2 ]
Less common side effects include self-induced excoriation which occurs in 2–3% of cats receiving oral treatment and rarely in cats receiving topical treatment. Methimazole should be ceased in these cats and alternative treatments should be pursued for these cats. 3–9% of cats experience severe haematological reactions such as severe thrombocytopaenia alongside haemorrhage , and neutropaenia alongside pyrexia , anorexia, and infection. Any serious blood dyscrasia requires treatment to be immediately stopped and alternative treatments need to be considered. Myasthenia gravis is rare and has only been reported in cats treated orally. The understanding of it and its relation to methimazole is unknown but the immunomodulatory effects of the drug have been suspected as a cause. [ 2 ]
Symptoms of hypothyroidism are rare but cats with biochemical levels of thyroid hormone that falls into the hypothyroid range is common. Iatrogenic hypothyroidism presents an increased risk of azotaemia and any cat with iatrogenic hypothyroidism should have doses reduced and close monitoring following this. [ 2 ]
Carbimazole is quickly transformed to methimazole after absorption or in the gastrointestinal tract. No studies compare the two but evidence suggests lower rates of adverse effects with no reports of severe blood disorders. [ 2 ]
Radioactive iodine treatment results in quick decrease of thyroid hormone, does not require any anaesthetic or surgery, and in most cases is a single treatment. The disadvantages of radioactive iodine is the cost, the availability of it, and the local period a cat needs to stay in a specialised hospital as the radioactivity wears off. The success rate of radioactive iodine treatment is very high at around 95%. [ 2 ]
Radioactive iodine is administered either intravenously or subcutaneously . The iodine gets transported to neoplastic and hyperplastic thyroid tissue. 40–90% of the iodine is excreted via defecation and urination. Gamma rays and beta particles are emitted and these particles cause follicular cells to die off. The beta particles do not affect the parathyroid gland or any other part of the body due to their movement being limited to less than 2mm. The atrophied thyroid tissue will return to regular production of thyroid hormone which avoids the risk of iatrogenic hypothyroidism with other treatment options. [ 2 ] In one study after 4 years 84% of cats were euthyroid and 4% were hypothyroid. [ 6 ]
Thyroid carcinomata are uncommon but difficult to diagnose and require higher dosage to treat. Necrosis may occur following treatment if there is a lot of neoplastic tissue. This risk can be mitigated with surgery, although surgery itself carries risk. High radiation dosage often results in permanent hypothyroidism. [ 2 ]
Thioureylenes induce radioresistance in humans which limits the effectiveness of radioactive iodine treatment. There is no evidence to support for this theory in felines; however, it is still recommended that anti-thyroid drugs should be discontinued for a week or two before starting treatment. [ 2 ]
Limiting the iodine intake of a hyperthyroid cat is a cheap and easy way to manage hyperthyroidism and can be done by the owner with ease; however, it is not always effective, cats may refuse food or find other sources of iodine. The long term effects of this treatment are not currently known. [ 2 ]
In one unpublished study 96% of cats being treated with a diet of less than 0.2 mg/kg of iodine were euthyroid by 180 days. Most failures were attributed to cats having an alternative source of iodine. The long term effects of an iodine diet are not currently known. Iodine limited diets present an alternative for owners with financial issues and in cats with concurrent illness that would make other options more dangerous. [ 2 ]
Concurrent renal disease is not uncommon in hyperthyroid cats and renal disease can complicate treatment for hyperthyroidism. The two symptoms may mask the serum levels used to diagnose the other condition. Some estimates have up to 40% of hyperthyroid cats having chronic kidney disease . [ 2 ]
Because of the increased heart rate and decreased vascular resistance in hyperthyroid cats, hyperthyroid cats also have increased renal plasma flow and an increased glomerular filtration rate . When hyperthyroidism is treated these decrease and an increase of serum creatinine often occurs, which may cause azotaemia and in some cases renal failure . [ 2 ] In one study 15% of cats with treated hyperthyroidism developed azotaemia . [ 7 ]
There are ways to try and measure if a cat will develop renal disease following hyperthyroidism but these do not accurately predict azotaemia and renal disease. Thus the best practice is to trial methimazole then measure serum biochemistry and analyse urine before starting permanent hyperthyroid treatment (radioactive iodine and thyroidectomy). [ 2 ]
When cats have renal disease and hyperthyroidism dietary or drug related treatments are used to minimise hyperthyroid symptoms without hastening renal failure. [ 2 ]
Following treatment patients should receive a follow up after 1 month, 3 months, 6 months, and 12 months. A physical examination should be carried out alongside serum biochemistry and measurement of serum thyroxine levels to confirm the cat is no longer hyperthyroid and to diagnose iatrogenic hypothyroidism. [ 2 ]
Between 93 and 95% of cats treated with radioactive iodine become euthyroid without further need for treatment. Reasons for failing to achieve euthyroidism can be due to adenoma, adenomatous hyperplasia, carcinoma, or an error in the administration of the treatment. [ 2 ]
Rarely some cats will redevelop hyperthyroidism up to 6 years after treatment, this is likely due to new foci caused by new mutations in the tissue than any failure of treatment. [ 2 ]
The average age of death for a cat that has received radioactive iodine treatment for hyperthyroidism is 15 years. Studies have found survival times of between 417 days and 2 years for all cats receiving any form of treatment. [ 2 ]
|
https://en.wikipedia.org/wiki/Feline_hyperthyroidism
|
Feline leishmaniosis (FeL) is a parasitic disease caused by protozoa of the genus Leishmania and is transmitted through the bite of a female sand fly. [ 1 ] Although leishmaniosis primarily affects dogs; an increasing number of cases have been reported in cats. Consequently, feline leishmaniosis is now considered an emerging disease, particularly in regions where canine leishmaniosis (CanL) is endemic. [ 2 ]
Leishmaniosis is a disease caused by protozoa of the genus Leishmania . It has been reported that cats have been infected by at least eight Leishmania species worldwide, including L. infantum , L. major , L. tropica , L. mexicana , L. braziliensis , L. amazonensis , L. panamensis and L. guyanensis. [ 2 ] [ 3 ] [ 4 ] This article focuses on L. infantum , the primary species responsible for severe disease in both dogs and cats across Europe, Asia, Africa, and the Americas. [ 5 ]
The vector is a flying insect that belongs to the genus Phlebotomus in the Old World and the genus Lutzomyia in the New World . [ 6 ] The average size of sand flies is 3 mm. Cases of canine and feline leishmaniosis caused by L. infantum are widespread in areas where sand flies coexist.
Leishmania species are parasites that require two hosts to complete their lifecycle: the phlebotomine sand fly and a vertebrate. This lifecycle consists of two phases: an amastigote stage—a small, round, non-flagellated intracellular form that resides within the macrophages of vertebrate hosts—, and a promastigote stage—a flagellated form that develops in the gut of sand fly vectors.
The cycle proceeds as follows: the sand fly carries extracellular promastigotes, which it transmits to a vertebrate host while feeding on its blood. Once inside the host, the promastigotes are quickly phagocytosed by macrophages and transform into amastigotes. Within these immune cells , they replicate inside intracellular vacuoles, evading the host's immune response.When a female sand fly bites an infected vertebrate, it ingests macrophages containing amastigotes. Inside the gut of the fly, the amastigotes transform back into promastigotes, developing their characteristic flagellum, which enables movement. The promastigotes then multiply and migrate to the fly’s proboscis , ready to infect a new vertebrate host during the next blood meal. [ 7 ]
Non-vectorial transmission of L. infantum , such as through blood transfusion, [ 8 ] vertical transmission, [ 9 ] mating, [ 10 ] or aggressive interactions, [ 11 ] has been documented in dogs, but it has not yet been observed in cats.
Leishmaniosis, caused by L. infantum , is endemic in the Mediterranean Basin , including Spain, Portugal, southern France, Italy, Greece, Turkey, and Cyprus, as well as in the Middle East . [ 6 ] [ 12 ] The importation of infected animals can also introduce the disease into non-endemic regions, such as Northern Europe . [ 13 ] In Central and South America and the Middle East, L. infantum coexists with other Leishmania species. [ 6 ] [ 14 ]
Since 1977, natural cases of feline leishmaniosis have been documented worldwide, primarily in Mediterranean countries, but also in the southern USA, Brazil, Central and South America, and Iran. [ 15 ]
Feline leishmaniosis is an emerging disease that has been increasingly reported over the past two decades, especially in endemic regions. [ 12 ] This rise in feline cases may be linked to the use of sand fly repellents in dogs, which forces the sand fly to seek alternative mammalian hosts. [ 16 ] Additionally, the availability of more sensitive and specific diagnostic tests, advancements in feline medicine, and greater awareness among veterinarians may have contributed to the increasing number of reported FeL cases. [ 14 ] [ 17 ]
Over the past 25 years, approximately 100 clinical cases of FeL have been reported in Europe (including Italy, Spain, France, and Portugal), along with a few cases in Switzerland involving cats imported from endemic regions. [ 4 ] The prevalence of Leishmania infection in cats in endemic areas varies significantly, ranging from 0% to 68.5%. [ 15 ] PCR test positivity rates for Leishmania in blood samples range from 0.43% to 61%, while antibody prevalence varies from 3% to 59%. [ 7 ] Despite this, the prevalence of FeL remains lower in cats than in dogs in the same areas. [ 18 ] [ 19 ] [ 20 ] [ 21 ]
Cats that are most susceptible to Leishmania infections are typically short-haired, between 7 and 9 years of age, male, and have access to the outdoors (either as free-roaming or shelter cats). They are more commonly found in urban areas and cohabit with dogs. Unneutered cats are also at higher risk, as are those with concurrent diseases or immunosuppressive conditions, such as a feline immunodeficiency virus (FIV) infection, which is the most common comorbidity. [ 5 ] [ 15 ] [ 18 ]
The L. infantum strains found in cats share the same genetic characteristics as those from humans, dogs, and sand flies. [ 22 ] Leishmaniosis is a zoonotic disease that can affect humans, causing cutaneous, mucocutaneous and visceral leishmaniosis. Visceral leishmaniosis in humans is a life-threatening condition. [ 23 ] Domestic dogs are typically considered the main reservoir of human L. infantum infection, with transmission occurring mainly through the bites of female sand flies. However, in recent years, cats have garnered increasing attention due to their potential role in transmission and are now considered secondary reservoir hosts. Infected cats may therefore represent an additional source of L. infantum transmission, posing a risk to humans, dogs, and other susceptible animals, including cats themselves. [ 24 ] [ 25 ]
Most infected cats remain subclinical, and the incubation period can extend for years, [ 7 ] as seen in cats relocated from endemic to non-endemic areas, with clinical signs appearing long after they move. These signs can range from isolated dermatological lesions to ocular, renal and systemic manifestations. The disease generally follows a chronic, progressive course, with more systemic clinical signs emerging when the cats’ immune system becomes compromised. [ 4 ]
Common manifestations of FeL include cutaneous or mucocutaneous lesions and lymphadenomegaly. Other possible signs are ocular and oral lesions. [ 4 ]
Dermatological lesions are the most common clinical feature of FeL, accounting for more than half of all cases. [ 15 ]
Ocular signs usually appear alongside systemic signs.
The most common oral lesions are nodules on the tongue and gingiva, often presenting as stomatitis, gingivitis, or feline chronic gingivostomatitis syndrome. [ 17 ] [ 18 ]
Comorbidities play a significant role in both susceptibility to L. infantum infection and the onset of clinical signs in cats.
Cats with impaired immune systems are more likely to develop clinical signs of the infection, especially those with pre-existing conditions. Comorbidities affecting the immune system are present in 56% to 73% of cases, with there being a 2.8 times higher risk of developing leishmaniosis when a cat has FIV. [ 28 ] Other contributing factors include immunosuppressive conditions caused by prolonged or high-dose glucocorticoid treatment among others, [ 15 ] neoplasia (such as epidermoid carcinoma and squamous cell carcinoma [ 17 ] ), metabolic disorders like diabetes mellitus, co-infections (including Hepatozoon felis , Candidatus mycoplasma , Toxoplasma gondii , feline leukemia virus (FeLV) , and feline coronavirus (FCov) ), [ 16 ] and immune-mediated diseases (such as pemphigus). [ 5 ] [ 7 ] However, the association between FeL and the majority of these conditions is not well-supported by controlled studies
The diagnosis of FeL requires a combination of clinical, serological, cytological, and molecular techniques.
Since coexisting diseases are common, a thorough investigation is necessary to confirm L. infantum as the cause of clinical signs.
To summarize, a cat is diagnosed with leishmaniosis if the following criteria are met:
There is no specific treatment approved exclusively for cats, and the approach remains empirical, relying on off-label medications that are primarily prescribed for dogs.
The conventional anti- Leishmania treatments in cats are the following:
Not all drugs used to treat CanL can be used in cats, particularly those containing miltefosine (Milteforan®), which contains propylene glycol as an excipient. In cats, propylene glycol induces the formation of Heinz bodies in red blood cells and eventually leads to anemia. Therefore, it is contraindicated in cats. [ 31 ]
In addition to these treatments, supportive care is essential, especially for cats with visceral involvement, such as hepatic failure or chronic kidney disease, given the potential hepatotoxicity and nephrotoxicity of some medications. [ 30 ]
As with dogs, Leishmania parasites may persist in treated cats, resulting in clinical improvement but not the complete elimination of the infection. [ 1 ] [ 4 ]
Due to the lack of controlled studies on the safety and efficacy of treatment protocols, close monitoring of cats is essential to detect potential adverse effects. Follow-up should occur every three months during treatment, with owners encouraged to promptly report any abnormalities. Monitoring during and after treatment is essential to track progress and identify any complications:
Relapses are common after the discontinuation of treatment, with clinical signs and clinicopathological abnormalities potentially differing from those seen previously. Therefore, regular follow-ups every six months is key to detecting potential relapses or complications, even after treatment is completed. [ 4 ]
Subclinical infected cats that are antibody-positive and/or PCR-positive for L. infantum but show no clinical signs or clinicopathological abnormalities should also be closely monitored due to their risk of developing FeL. While treatment is not recommended for these cats, regular follow-up should include: [ 4 ]
However, in most cases of FeL, the spontaneous regression of clinical signs is frequent, which may be due to the Th1 immune response that gives rise to seroconversion followed by clinical resolution. [ 6 ] [ 32 ]
With appropriate management, leishmaniosis can be controlled and lesions often regress. In well-managed cases, the prognosis is generally good, and affected cats, including those that are FIV-positive, can live for several years after diagnosis. [ 4 ] [ 6 ] [ 7 ]
However, the presence of renal disease, other underlying conditions, or complications may shorten life expectancy and lead to a poor prognosis. Factors that significantly affect prognosis include renal issues (such as acute kidney injury), malignant neoplasms (such as nasal squamous cell carcinoma [ 17 ] [ 33 ] ), FIV/FeLV co-infection, and panleukopenia . [ 4 ] [ 15 ] [ 24 ]
The presence of concurrent health conditions plays a crucial role in survival, emphasizing the importance of managing these issues to improve the overall prognosis of the cat.
Since vaccines are currently available only for dogs, [ 34 ] the primary method of preventing leishmaniosis in cats is the use of topical insecticides. Repellents are particularly important for cats living in or traveling to endemic areas. However, most pyrethrin and pyrethroid -based products commonly used in dogs sold as spot-ons or collars (such as permethrin [ 35 ] and deltamethrin [ 36 ] ) are toxic to cats and should be avoided. The only safe and licensed pyrethroid formulation for cats is a collar combining flumethrin (4.5%) and imidacloprid (10%). To date, only a Seresto® brand collar can be used for cats. These collars have shown a 75% efficacy in reducing infection, while also protecting against ticks and fleas. [ 37 ] [ 38 ]
In addition to topical treatments, other preventive measures include keeping cats indoors from dusk to dawn during the sand fly season (April to November in the Mediterranean region [ 39 ] ), using physical barriers around homes and shelters to prevent sand fly from entering [ 40 ] (such as insecticide-impregnated mosquito nets), and spraying approved insecticide solutions like fluralaner in areas where both humans and animals reside. [ 24 ]
The ideal prevention strategy depends on the cat's lifestyle:
To prevent horizontal (non-vectorial) transmission of this infection, regular testing is recommended for cats in breeding programs or those eligible for blood transfusions. Screening should include antibody detection and a PCR. Infected cats must be excluded from breeding and blood donation in order to prevent further spread. [ 7 ] [ 8 ] [ 10 ]
In endemic regions, minimally invasive screening methods, such as serology and blood, lymph node, or conjunctival swabs for PCR, should be used. However, the sensitivity of these tests may be limited. Screening is also crucial before initiating immunosuppressive treatments or relocating cats to non-endemic areas. [ 4 ] [ 41 ]
After returning from endemic regions, thorough clinical evaluation and testing are necessary to identify any potential infections.
Canine leishmaniosis (CanL) and feline leishmaniosis show significant differences in prevalence, susceptibility, and clinical manifestation. Cats appear to be less susceptible to L. infantum infection compared to dogs, even in endemic regions with frequent exposure . [ 20 ] [ 42 ]
This relative resistance to L. infantum infection compared to dogs is likely due to differences in their immune response. Their defense mechanisms include the production of protective antibodies and a strong Th1 immune response, primarily driven by interferon-gamma (IFN-γ) . IFN-γ plays a crucial role in activating macrophages, enhancing their ability to eliminate Leishmania infantum through the production of nitric oxide (NO) . A robust Th1 response, characterized by high IFN-γ levels, is generally associated with better infection control and reduced disease progression. [ 6 ] [ 16 ] Some studies also suggest that the Th2 response in cats may contribute to protection. [ 5 ] Additionally, seropositive cats (those that test positive for the parasite but do not develop disease) may produce higher IFN-γ levels, which helps to regulate the immune system and prevent the disease from progressing. [ 6 ] [ 16 ] In addition, it appears that the complement system may play a role, and the complement system in cats seems to be qualitatively more effective—especially through the lectin pathway—which could contribute to their natural resistance to L. infantum , in contrast to dogs, which are more vulnerable. [ 43 ]
Clinically, the disease manifests differently between species. In dogs, leishmaniosis typically presents as exfoliative dermatitis, often followed by ulcerative and nodular forms. In contrast, cats normally display nodular or ulcerative forms. [ 1 ] Interestingly, it is more common for cats to present with respiratory and oral clinical signs. Additionally, FeL cases are often associated with underlying immunosuppressive conditions, especially feline immunodeficiency virus (FIV) . [ 15 ] As a result, FeL remains relatively uncommon, even in areas where CanL is prevalent.
Feline leishmaniosis, caused by L. infantum , is an emerging disease in regions where canine leishmaniosis is endemic, particularly around the Mediterranean Basin. In these areas, it is crucial to consider FeL as part of the differential diagnosis when cats present with skin, ocular, or other lesions suggestive of Leishmania infection, to avoid misdiagnosis. This is particularly important in immunocompromised cats with systemic disease or with persistent hematological abnormalities despite treatment. [ 15 ] However, there is limited evidence-based knowledge on FeL. The understanding of its transmission, immunopathogenesis, development, management, and prevention remains in its early stages, with treatment approaches primarily based on empirical methods. [ 2 ]
LeishVet is a group of veterinary scientists from academic institutions in Mediterranean and North American countries whose focus is on the clinical and scientific aspects of canine and feline leishmaniosis.
|
https://en.wikipedia.org/wiki/Feline_leishmaniosis
|
Felix Plaut (1877–1940) was a German psychiatrist who was director of the Department of Serology at the Deutsche Forschungsanstalt für Psychiatrie in Munich . In 1935 he was removed from this position by the Nazis, and subsequently emigrated to London . [ 1 ]
Plaut is remembered for his research on the syphilitic origin of general paresis , as well as his work with August von Wassermann (1866-1925) in the development of a serological test for syphilis. Plaut performed extensive research of syphilis and its correlation to psychiatric disorders, and conducted early studies in neuroimmunology involving the brain 's immune reaction to syphilitic infiltration.
This article about a German psychiatrist is a stub . You can help Wikipedia by expanding it .
|
https://en.wikipedia.org/wiki/Felix_Plaut
|
The American College of Surgeons ( ACS ) is a professional medical association for surgeons and surgical team members, founded in 1913. [ 5 ] It claims more than 90,000 members in 144 countries. [ 6 ]
The ACS was founded in 1913 as an outgrowth of the Clinical Congress of Surgeons of North America that had existed since 1910 as an outgrowth of the journal Surgery, Gynecology and Obstetrics , an initiative of ACS Founder Dr. Franklin H. Martin . [ 7 ]
The college is governed by a Board of Regents , a Board of Governors, and a variety of local ACS Chapters. The Board of Regents formulates policy and directs the affairs of the college. The Board of Governors acts as the liaison between the Board of Regents and the Fellows. The local ACS Chapters exert the college's influence at the community level.
Patricia L. Turner began serving as the executive director and chief executive officer of the college in January 2022. She is currently on the faculty in the department of surgery at the University of Chicago Medicine. [ 8 ]
Fellow of the American College of Surgeons (or FACS) is a professional certification for a medical professional who has passed a set of criteria for education, qualification, and ethics required to join the ACS.
FACS is used as a post-nominal title , such as John Citizen, MD, FACS .
This article about a medical organization or association is a stub . You can help Wikipedia by expanding it .
|
https://en.wikipedia.org/wiki/Fellow_of_the_American_College_of_Surgeons
|
The Final FRCA is a postgraduate examination in anaesthesia , more fully called the Final Examination of the Diploma of Fellowship of the Royal College of Anaesthetists . [ 1 ]
Trainee anaesthetists in the United Kingdom are required to pass this examination during ST3-5 (6 months through ST5), otherwise training may be delayed or stopped.
The examination is open to intermediate and higher trainees in anaesthesia, those working in approved training posts, those who have recently left an approved training post, and other doctors on approval of the Royal College of Anaesthetists who have passed the primary FRCA or an equivalent exempting qualification within the last seven years. [ 2 ] There are a maximum of six attempts at this examination, and there is a robust system in place to support candidates in the UK training system before they get to this point.
The exam takes the form of a written Short-Answer Question (SAQ) paper (3 hours, 12 questions), and a Multiple-Choice Question (MCQ) paper (3 hours, 60 five stem questions covering medicine, surgery, intensive care, pain and basic sciences and 30 Single Best Answer clinical questions) [ 3 ] which can be attempted at several regional centres in the UK (such as Edinburgh, Belfast, Birmingham, Cardiff, Manchester and London).
Candidates who pass both the MCQ and the SAQ are invited to the Structured Oral Examination (SOE) (" Viva voce "), in Churchill House, London , the headquarters of the Royal College of Anaesthetists. [ 3 ]
The SOE component of the examination consists of two structured oral examinations: the first (clinical) consists of 10 minutes to review a prepared series of clinical data, followed by 40 minutes of questioning; the second (basic science) consists of 30 minutes of questioning. [ 4 ] [ 5 ]
The examination is now staged into two distinct, separable components. The written paper must be passed prior to attempting the Structured Oral Examination (SOE). In the written paper, the marks from the short answer questions paper and the multiple choice questions and single-best answer questions are considered together. This part of the examination can now be passed independently, leaving the candidate to attempt the SOE without the need to resit the written paper. The marks from the written paper are no longer considered when attempting the SOE.
To pass the examination, the written paper must be passed in full, followed by an independent pass of the structured oral examination (known commonly as the viva) [ 4 ]
The SOE examinations are usually held over a week. At the end of each day of SOE examinations, Successful candidates are listed on a board in the lobby of the college by RCoA reference number.
Approximately half of all candidates pass the examination at each sitting.
Negative marking (the deduction of a point for an incorrect answer) has been removed from the Multiple Choice Question (MCQ) component of the examination from the October 2008 sitting. From October 2010, some MCQ questions will be set according to the "single best answer" format. [ 6 ]
The tone of the examination is predominantly clinical. The syllabus is extensive and covers all aspects of clinical anaesthetic practice. In addition, the entire syllabus of the Primary FRCA examination (which is predominantly basic science) is included. [ 7 ]
Those who pass the examination are admitted as Fellows of the Royal College of Anaesthetists, and are entitled to use the postnominal "FRCA" after their name. [ 8 ] Fellowship may also be bestowed by election from the Council of the College. A ceremony is held annually in London at which new fellows are formally admitted. "Diplomates" are invited to attend, but are admitted as fellows whether or not they do so.
Before the College bestowed its own fellowships, anaesthetists were awarded the FFARCS: Fellowship of the Faculty of Anaesthetists of the Royal College of Surgeons, the forerunner of the Royal College of Anaesthetists.
The following are similar qualifications to the FRCA. They are not necessarily equivalent or interchangeable:
|
https://en.wikipedia.org/wiki/Fellowship_of_the_Royal_College_of_Anaesthetists
|
Feminists have long struggled with Sigmund Freud 's classical model of gender and identity development, which centers on the Oedipus complex . Freud's model, which became integral to orthodox psychoanalysis , suggests that because women lack the visible genitals of the male, they feel they are "missing" the most central characteristic necessary for gaining narcissistic value—therefore developing feelings of gender inequality and penis envy . In his late theory on the feminine, Freud recognized the early and long lasting libidinal attachment of the daughter to the mother during the pre-oedipal stages. Feminist psychoanalysts have confronted these ideas (particularly the female relationship to the real, imaginary and symbolic phallus ) and reached different conclusions. Some generally agree with Freud's major outlines, modifying it through observations of the pre-Oedipal phase. Others reformulate Freud's theories more completely.
Hélène Deutsch (1884–1982) was one of Freud's first female pupils and the first analyst who made an integral, chronological study of woman's psychological development. In short, Deutsch claims that women have a passive-masochistic sexuality, they are born for reproduction and their development must be seen as different from the development of men. [ 1 ]
Deutsch sees the female development as exceedingly difficult and tortuous, because at some point she must transfer her primary sexual object choice from her mother to her father (and males), if she is to attain her expected heterosexual adulthood. [ 2 ] According to Deutsch, the girl blames her father, not her mother, for the lack of a penis; thus, she stops identifying with her father and masculinity. Because of this relationship with her father, she develops libidinous fantasies of being raped. Thus, the rape fantasy is universal and non-pathological, a key part of female sexuality. Meanwhile, the girl identifies herself with her mother through the wish for an " anal child ". When she recognizes her failure, a decline to the pre-genital stage takes place: a wish for the earlier active ( phallic ) clitoris. Masochistic tensions in the girl prevail and she longs to be castrated by her father. The desire for a child also becomes masochistic.
Melanie Klein , originator of the Kleinian school of psychoanalysis, agreed with the basic structure of the Oedipal situation, but argued that it originated at 6 months of life while subsequently continuing to be worked through during the time that Freud had previously articulated. She identified the recognition of triangular relationships as originating during this time with the start of the infant's burgeoning awareness of the mother's relationships with others.
Nancy Chodorow noted that Freud believed that males possess physical superiority and that a woman's personality is inevitably determined by her lack of a penis. Like Freud, but for different reasons, Chodorow emphasizes that the female Oedipal crisis is not resolved completely, unlike the male crisis: a girl cannot and does not completely reject her mother in favour of men, but continues her relationship of attachment to her. The strength and quality of her relationship with her father are completely dependent upon the strength and quality of her relationship with her mother. Chodorow claims that most women are genitally heterosexual, but they have other, equally deep relationships with their children and with other women, as a result of the primary relationship with the mother. [ 3 ] Thus, a girl represses neither her pre-Oedipal nor her Oedipal attachment to her mother nor her Oedipal attachment to her father. This means that she grows up with more ongoing preoccupation with internalized object relationships and with external relationships. Because a girl does not have to repress her pre-Oedipal and Oedipal attachment to father and mother, she reaches a more relational sensibility than boys. Chodorow illustrated this through studies suggesting that men love (and fall in love) romantically, where women love and fall in love sensibly and rationally. [ 4 ]
In Freud 's model there is no place for femininity unless it is related to masculinity . Luce Irigaray , a student of Jacques Lacan , disagrees with the thoughts about the importance of the penis and phallic for women. [ 5 ] She hypothesizes that the reason the penis is privileged in Freud's model is that it is visible. This is also the reason that male sexuality is based, in early Lacanianism, on having (a penis) and female sexuality is based on lack. In Freud's paradigm, female desire is the desire for a baby to substitute for penis, thus female pleasure is derived from reproduction. [ 6 ] Irigaray disagrees: "How can we accept that the entire female sexuality is being controlled by the lack and envy of the penis?" [ 7 ] Female sexuality is not solely related to reproduction, but neither is it less valuable in reproduction, and thus it should not hold less social power. [ 8 ] Furthermore, she says that Freud is forgetting the mother-daughter relationship. [ 9 ] To enter the Oedipus-complex, a girl must hate her mother. Irigaray says this view makes it impossible for a girl to give meaning to the relationship with her mother. [ 10 ]
|
https://en.wikipedia.org/wiki/Feminist_views_on_the_Oedipus_complex
|
In biology and medicine , feminization is the development in an organism of physical characteristics that are usually unique to the females of the species . This may represent a normal developmental process, contributing to sexual differentiation . Feminization can also be induced by environmental factors, and this phenomenon has been observed in several animal species. [ 1 ] [ 2 ] In the case of transgender hormone therapy , it is intentionally induced artificially.
In animals , when feminization occurs in a male , or at an inappropriate developmental age, it is often due to a genetic or acquired disorder of the endocrine system . In humans , one of the more common manifestations of abnormal feminization is gynecomastia , the inappropriate development of breasts which may result from elevated levels of feminizing hormones such as estrogens . [ 3 ] Deficiency or blockage of virilizing hormones ( androgens ) can also contribute to feminization. In some cases, high levels of androgens may produce both virilizing effects (increased body hair , deepened voice , increased muscle mass, etc.) and feminizing effects (gynecomastia) since androgens can be converted to estrogens by aromatase in the peripheral tissues. [ 3 ]
In insects , feminization can occur through inheritance of reproduction-manipulating endosymbionts . This promotes the inheritance of the endosymbionts because the endosymbionts are passed on by mothers to their eggs. [ 4 ] As such, the more endosymbiont-infected females there are in a population, the more the endosymbionts are passed on to the next generation.
|
https://en.wikipedia.org/wiki/Feminization_(biology)
|
Femoral nerve stretch test , also known as Mackiewicz sign, [ 1 ] is a test for spinal nerve root compression, which is associated with disc protrusion and femoral nerve injury .
The femoral nerve stretch test can identify spinal nerve root compression, which is associated with disc protrusion and femoral nerve injury . It can reliably identify spinal nerve root compression for L2 , L3 , and L4 . [ 2 ] It is usually positive for L2-L3 and L3-L4 (high lumbar) disc protrusions, slightly positive or negative in L4–L5 disc protrusions, and negative in cases of lumbosacral disc protrusion. [ 3 ]
To perform a femoral nerve stretch test, a patient lies prone , the knee is passively flexed to the thigh and the hip is passively extended (reverse Lasègues ). [ 2 ] The test is positive if the patient experiences anterior thigh pain . [ 2 ]
|
https://en.wikipedia.org/wiki/Femoral_nerve_stretch_test
|
Popliteal bypass surgery , more commonly known as femoropopliteal bypass (FPB, fem-pop, etc.) or more generally as lower extremity bypass surgery , is a surgical procedure used to treat diseased leg arteries above or below the knee. [ 1 ] It is used as a medical intervention to salvage limbs that are at risk of amputation and to improve walking ability in people with severe intermittent claudication (leg muscle pain) and ischemic rest pain. [ 2 ]
Popliteal bypass surgery is a common type of peripheral bypass surgery which carries blood from the femoral artery of the thigh to the end of the popliteal artery behind the knee . [ 3 ] The femoral artery runs along the thigh and extends to become the popliteal artery which runs posteriorly to the knee and femur . Smaller arteries carry blood supply from the popliteal artery to the calf and into the foot. [ 4 ] Blockages caused by plaque build-up or atherosclerosis in any of these arteries can reduce leg blood circulation, causing leg pain that may interfere with daily life. [ 4 ]
Standard popliteal bypass surgery involves the bypass of the popliteal artery. [ 5 ] During surgery, incisions are made depending on the location of the blockage. [ 3 ] Usually, a healthy vein is located and sewn above and below the blockage to bypass the narrowed or blocked femoral artery. [ 6 ] This allows the blood to be redirected to flow through the new healthy vessel around the blockage. In some cases, synthetic graft materials (such as polytetrafluoroethylene ) are used instead of a vein graft. [ 1 ]
Femoropopliteal bypass surgery is mainly used to treat cases of femoral artery blockage that cause more severe symptoms that restrict completion of daily tasks such as peripheral artery disease and claudication, or cases that have not responded well to other treatment options . Before surgery is considered, adjustments are made to lifestyle habits such as quitting smoking or exercising more, or using medications, to relieve or improve symptoms. [ 7 ]
Claudication refers to pain in the lower limbs that may be felt while exercising, walking, or simply while resting. A blocked femoral artery reduces the blood flow to the areas of the thigh and calf, causing the pain that leads to claudication. [ 8 ] Severe pain caused by claudication can lead to a person having very restricted ability to move, and pain while resting is often a sign that the condition has worsened. Claudication is also considered a symptom of peripheral artery disease. [ 9 ]
Popliteal bypass surgery may be performed on people with the following symptoms and conditions: [ 10 ]
Generally, a vein bypass lasts at least 5 years in 60-70 percent of people. However about one-quarter to one-third of people will need additional procedures and follow-ups to maintain the condition of the graft. [ 11 ] To minimise postoperative complications and a second bypass, correct postoperative care and surgical techniques must be used.
In comparison, synthetic grafts are more likely to become occluded in the future than using the person's blood vessel. [ 1 ] A synthetic graft remains open in 33 to 50 out of 100 people 5 years after Popliteal bypass surgery was carried out, whereas using veins, the bypass remains unobstructed in 66 out of 100 people. [ 12 ] Moreover, the particular vein, great saphenous vein was shown to be more durable over the years after surgery. [ 5 ] Also, when comparing the efficacy of using PTFE or the great saphenous vein in people with claudication and critical limb ischemia, the latter showed better long term results. [ 5 ] [ 12 ]
A second bypass may be required if a blockage forms in the bypass graft later on. Over time, there is a decreasing trend of percentage patency (likelihood a vessel will remain open) in popliteal bypass surgery, 88% in the first year, 79% and 76% at 3 and 5 years respectively. [ 13 ] Environmental conditions and overall patient health may also affect the patency of the graft. [ 4 ]
Since the operation involves multiple cuts being made on the leg, this relatively high risk surgery involves several risks. Some complications are common for all types of leg associated surgery, while some are specific to popliteal bypass surgery. Complications include but not limited to the following:
In the study of 6,007 people carried out popliteal bypass surgery, the overall rate of morbidity and mortality was 36.8% and 2.3% respectively within 30 days post-surgery. [ 14 ] However, there are variations in studies of mortality as one particular study did not find any person deaths. [ 14 ] The pre-existing risk factors in people can affect mortality rates, with common mortality factors being heart failure , myocardial infarction , diabetes mellitus , infection , and stroke . [ 14 ]
Although antibiotics are generally given before and after surgery, people are still susceptible to wound infections and there is a 7.8% incidence of popliteal bypass surgery associated infections. [ 14 ] Infection contraction is common in popliteal bypass surgery because of the poor blood circulation to the area, poor circulation means that the wounds will heal slower and the incision sites will have a higher chance of becoming infected.
The infection of the vascular graft prosthesis occurs in every 1 in 500 people, under such circumstance the removal of the graft is needed. [ 15 ] Graft infection is strongly associated with high morbidity and mortality. An obvious sign of a graft infection is the drainage of the sinus tract . [ 15 ] Diabetes mellitus and redoing of the bypass graft are associated with a higher chance for graft infection. [ 16 ]
Occasionally, there may be leakage of fluid or blood from the incision wound, a study shows that 7.4 percent people are affected within 30 days post operation. [ 14 ] However this normally settles in time and does not indicate a problem with the bypass itself. [ 4 ]
People with peripheral artery disease undergoing popliteal bypass surgery are also more susceptible to myocardial infarction and abnormal heart rhythms , as patients requiring popliteal bypass are more likely to have higher cholesterol levels and higher blood pressure. The excess strain and damage caused by HBP and high cholesterol level can cause atherosclerosis . Over time, the coronary artery narrows and increases the patient's chance of getting a heart attack. [ 17 ] Myocardial infarctions can also be caused by graft failure and hypoperfusion .
The risk of lymphedema exists in 29 percent of patients, where leg swelling typically lasts 2 to 3 months. [ 14 ] Lymphedema can be caused by blockages in the lymphatic system, leading to insufficient lymph drainage and fluid build-up in the leg. Though it is incurable, swelling of the leg is usually temporary. Treatment like compression stockings, meticulous skin care or doing remedial exercises may help ameliorate the symptoms. [ medical citation needed ]
In rare situations when blockages severely disrupt or stop blood circulation, critical limb ischemia occurs. In cases of ischaemia, insufficient blood available for tissues to survive leads to gangrene and rest pain , in which case amputation is required. [ 18 ] The major goals of amputation are to remove dead tissues, relieve pain and promote wound healing. [ medical citation needed ]
With surgery operations such as popliteal bypass, there will be an increased probability of blood clot formation. In rare cases, a part of the clot in the leg breaks free and travels to the lungs, this is also known as a pulmonary embolism . A blockage in the blood vessels of the lung can be formed by pulmonary embolism, and this could cause excess fluid build-up in the lung. [ 6 ] [ 10 ] This condition is also known as pulmonary edema , which is the excess fluid present in the lungs, more specifically, the accumulation of excess fluid in the air sacs of the lung, leading to the impairment of gas exchange and potentially respiratory failure . [ 6 ]
The incidence of early graft thrombosis is between 5-15% for popliteal bypass surgery. [ 19 ] The cause of thrombosis is commonly due to technical errors of the surgery, other causes may include stenosis , narrow vein grafts, a low cardiac output and the compression of the graft. [ 19 ] In such cases, heparin ( anticoagulant ) and thrombectomy can be used to treat graft thrombosis. [ 19 ]
The surgery is generally performed under general anaesthesia. The surgeon makes an incision in the upper leg, and a graft either man-made or the patient's vein is sewn to both ends of the artery. [ 20 ] The graft reroutes the blood flow around the blocked artery, allowing for adequate supply back to the parts of the leg. Generally, it is preferred where possible, a healthy vein is used to make the graft as it has shown to have a better outcome of the procedure. In cases however where a vein can not be used, materials such as polytetrafluoroethylene (PTFE) or Dacron are often used to make the graft. [ 21 ]
Blood vessel grafts often come from the same leg of the bypass site, which are arteries above and below the knee. These grafts can only be removed and prepared during surgery at the time of the bypass. However, in some cases a leg vein is left in place and connected to the artery ( in situ procedure). Under this circumstance, an angioscope (a flexible medical tube with a camera) is used to aid this procedure. [ 3 ]
As mentioned, synthetic graft material like PTFE may be an option if the surgeon does not find suitable veins. PTFE is commonly used in bypasses involving arteries at or above the knee. [ 5 ]
A 2018 Cochrane review found moderate-quality evidence for improved long term success (60 months) for autologous vein grafts when compared to prosthetic materials for above-knee bypasses. [ 2 ] There was low-quality evidence of a small secondary benefit for Dacron over PTFE for above-knee bypass. [ 2 ] For below-knee bypasses the evidence was to uncertain to draw conclusions as to best graft type. [ 2 ]
In order to reduce the risk of complications after surgery, patients should refrain from smoking because it can decrease blood circulation, which makes the graft more likely to fail. Walking is also essential during early recovery periods, it may help reduce swelling to facilitate wound healing and aids collateral artery formation in the leg, which can improve blood flow around blockages. [ 3 ] Often, physiotherapy treatments are given to patients after operation to help the patients ease into walking and other movements to keep the leg muscle flexible. [ 4 ] Other factors such as maintaining a healthy diet and regular exercise may also prevent unnecessary strain on the leg arteries from weight gain. [ 3 ] The above interventions after surgery can improve blood circulation overall and reduce the risks of getting a second bypass. [ medical citation needed ]
In some cases where the blockage is not as severe or limb threatening, alternative procedures that may take place are percutaneous transluminal angioplasty or endarterectomy. These procedures are used when possible as they are considered to be minimally invasive, in turn reducing recovery time and possible complications post-surgery. [ 24 ]
Historically, the first incidence of using a vein to bypass a femoral artery was in 1948 to treat a patient suffering from a foot ulcer . Although the bypass technique was not a new discovery, it was not yet widely used and known. In 1962, a new surgical technique, otherwise known as the in situ procedure was developed and used on veins to improve bypass. It works by increasing the radius of the vein to increase blood flow along the blood vessel. Today, it has now been proved that the in situ procedure is better suited in vein bypasses in the lower leg compared to the upper leg, particularly for treating advanced ischemic disease in the lower leg. [ 25 ]
|
https://en.wikipedia.org/wiki/Femoropopliteal_bypass
|
The Fernström Prize ( Swedish : Fernströmpriset ) is a series of annual awards for prominent Swedish and Nordic scientists in medicine . The prize money is donated by the Eric K. Fernström' Foundation. The prizes are managed by the medical faculty at Lund University . [ 1 ]
There are two versions of the prize, both awarded annually – the main prize and a separate prize for particularly promising young researchers.
The Nordic Fernström Prize ( Nordiska Fernströmpriset ) is awarded annually to an outstanding Nordic scientist in medicine . As of 2023, the prize money is 500,000 krona (approximately €50,000). [ 2 ]
The Swedish Fernström Prize ( Svenska Fernströmpriset ) is awarded annually to six promising Swedish scientists in medicine . The prizes are distributed so that each winner works in one of the six medical faculties in Sweden : [ 13 ]
This science awards article is a stub . You can help Wikipedia by expanding it .
|
https://en.wikipedia.org/wiki/Fernström_Prize
|
The Ferrier Lecture is a Royal Society lectureship given every three years "on a subject related to the advancement of natural knowledge on the structure and function of the nervous system". [ 1 ] It was created in 1928 to honour the memory of Sir David Ferrier , a neurologist who was the first British scientist to electronically stimulate the brain for the purpose of scientific study. [ 1 ]
In its 90-year history, the Lecture has been given 30 times. It has never been given more than once by the same person. The first female to be awarded the honour was Prof. Christine Holt in 2017. The first lecture was given in 1929 by Charles Scott Sherrington , and was titled "Some functional problems attaching to convergence" . [ 2 ] The most recent lecturer was provided by Prof. Christine Holt, who presented a lecture in 2017 titled "understanding of the key molecular mechanisms involved in nerve growth, guidance and targeting which has revolutionised our knowledge of growing axon tips" . [ 3 ] In 1971, the lecture was given by two individuals ( David Hunter Hubel and Torsten Nils Wiesel ) on the same topic, with the title "The function and architecture of the visual cortex" . [ 2 ]
|
https://en.wikipedia.org/wiki/Ferrier_Lecture
|
A ferruginous body is a histopathologic finding in interstitial lung disease suggestive of significant asbestos exposure ( asbestosis ). Asbestos exposure is associated with occupations such as shipbuilding, roofing, plumbing, and construction .
They appear as small brown nodules in the septum of the alveolus . Ferruginous bodies are typically indicative of asbestos inhalation (when the presence of asbestos is verified they are called "asbestos bodies"). In this case they are fibers of asbestos coated with an iron-rich material derived from proteins such as ferritin and hemosiderin . [ 1 ] Ferruginous bodies are believed to be formed by macrophages that have phagocytosed and attempted to digest the fibers.
This article related to pathology is a stub . You can help Wikipedia by expanding it .
|
https://en.wikipedia.org/wiki/Ferruginous_body
|
The Fertility Clinic Success Rate and Certification Act ( FCSRCA ) of 1992 are United States regulatory requirements that mandate all assisted reproductive technology (ART) clinics report pregnancy success rates data to the Centers for Disease Control and Prevention (CDC) in a standardized manner and for the CDC to publish pregnancy success rates . [ 1 ] [ 2 ]
FCSRCA is the primary consumer protection regulation for in-vitro fertilization in the US. [ 3 ] Though participation in FCSRCA is mandatory, there is no penalty for non-participation. [ 3 ] In 2024, approximately 90% of fertility clinics participated, though the results are susceptible to manipulation by cherry picking couples with a higher chance of conception. [ 3 ] [ 4 ] The CDC annually audits a sampling of participating clinics for validity. [ 3 ]
The FCSRCA has been criticized for its lack of enforceability and as being insufficient. [ 5 ] Currently, the fertility industry in the United States is largely self-regulated with voluntary guidelines established by American Society for Reproductive Medicine (ASRM). [ 6 ]
FCSRCA also does not collect embryo data, including how many embryos are created with each IVF cycle, nor how many are discarded, frozen, or implanted. [ 5 ]
This medical article is a stub . You can help Wikipedia by expanding it .
This law -related article is a stub . You can help Wikipedia by expanding it .
|
https://en.wikipedia.org/wiki/Fertility_Clinic_Success_Rate_and_Certification_Act
|
The Fertiprotekt network is a cooperation of university centres, hospitals and practices. It was founded in Germany in 2006. [ 1 ] The network now extends to all German-speaking countries and currently units ca. 100 institutions in Germany, Austria and Switzerland .
The aim of the network is to offer men and women the possibility of seeking advice about scientific information regarding their fertility before and after Chemo- or radiotherapy , and to undergo procedures to protect their fertility . The advice about and the performance of fertility-conserving procedures according to the network’s code of ethics is non-profit oriented. [ 2 ]
As a result of today’s significantly improved prognosis for patients with cancer , quality of life is increasingly important after overcoming treatment of the disease. Fears about fertility preservation play an important role for young men and women. The most common types of cancer diagnosed under the age of 40 years are breast cancer , melanoma , cervical cancer , non-Hodgkin’s lymphoma and leukaemia . One of the biggest problems in women who have to undergo chemo- or radiotherapy is premature ovarian failure (premature ovarian insufficiency) and its associated infertility . [ 3 ] For breast cancer alone, it is assumed that there are ca. 200 patients a year in Germany who wish to conceive. In men, chemotherapy can result in permanent damage to the testicular tissue. Due to advances in reproductive medicine , a variety of fertility-protective methods are now available. These techniques include administration of GnRH-agonists , [ 4 ] ovarian stimulation with cryoconservation of fertilised or unfertilised oocytes , as well as cryoconservation of ovarian tissue . [ 5 ] Relocation of the ovaries by surgically moving them out of the pelvis (ovarian transposition) to protect them from damage caused by radiotherapy is also possible. [ 6 ]
The Fertiprotekt network has carried out international pioneering work in four areas:
Network seminars take place annually. The centres involved are obliged to regularly take part in these annual conferences.
Some methods, such as cryoconservation of sperm and in-vitro fertilisation (IVF) are well established. Others have only been introduced over the last few years, such as cryoconservation of ovarian tissue prior to chemotherapy for later transplantation and the cryoconservation of unfertilized egg cells. These services are therefore not fully covered by statutory health insurance in Germany. [ 12 ]
|
https://en.wikipedia.org/wiki/Fertiprotekt
|
Fetal surgery , also known as antenatal surgery or prenatal surgery , [ 1 ] is a growing branch of maternal-fetal medicine that covers any of a broad range of surgical techniques that are used to treat congenital abnormalities in fetuses who are still in the pregnant uterus . There are three main types: [ 2 ] open fetal surgery, which involves completely opening the uterus to operate on the fetus; minimally invasive fetoscopic surgery, which uses small incisions and is guided by fetoscopy and sonography ; and percutaneous fetal therapy, which involves placing a catheter under continuous ultrasound guidance.
Fetal intervention is relatively new. Advancing technologies allow earlier and more accurate diagnosis of diseases and congenital problems in a fetus.
Fetal surgery draws principally from the fields of surgery , obstetrics and gynecology , and pediatrics - especially the sub-specialties of neonatology (care of newborns), maternal-fetal medicine (care of high-risk pregnancies), and pediatric surgery. It often involves training in obstetrics, pediatrics, and mastery of both invasive and non-invasive surgical techniques. Because of the very high risk and technical complexity of fetal surgery, the procedure is usually performed at specialist centers.
Fetal intervention involves risk to fetus and pregnant patient alike. In addition to the general risks associated with any surgery, there is also a risk that scarring of the uterus will lead to difficulties with future pregnancies. [ citation needed ] This risk is higher than for a typical Cesarean section , for several reasons:
Tocolytics are generally given to prevent labor; [ 3 ] however, these should not be given if the risk is higher for the fetus inside the womb than if delivered, such as may be the case in intrauterine infection, unexplained vaginal bleeding and fetal distress. [ 3 ] An H 2 antagonist is usually given for anaesthesia the evening before and the morning of the operation, and an antacid is usually given before induction to reduce the risk of acid aspiration . [ 3 ] Rapid sequence induction is often used for sedation and intubation. [ 3 ]
Open fetal surgery is similar in many respects to a normal cesarean section performed under general anesthesia, except that the fetus remains dependent on the placenta and is returned to the uterus. A hysterotomy is performed on the pregnant woman, and once the uterus is open and the fetus is exposed, the fetal surgery begins. Typically, this surgery consists of an interim procedure intended to allow the fetus to remain in utero until it has matured enough to survive delivery and neonatal surgical procedures.
Upon completion of the fetal surgery, the fetus is put back inside the uterus and the uterus and abdominal wall are closed up. Before the last stitch is made in the uterine wall, the amniotic fluid is replaced. The mother remains in the hospital for 3–7 days for monitoring. Often [ quantify ] babies who have been operated on in this manner are born pre-term . [ citation needed ]
The main priority is maternal safety, avoiding preterm labor and achieving the aims of the surgery. [ 3 ] The risk of premature labor is increased by concomitant risk factors such as multiple gestation, a history of maternal smoking , and very young or old maternal age . [ 3 ] Risks of fetal surgery, specifically prenatal spina bifida repair, include premature rupture of membranes , uterine rupture in future pregnancies, premature birth and intraspinal inclusion cysts or a tethered cord in the fetus or newborn baby. [ 4 ]
Open fetal surgery has proven to be reasonably safe for the mother. [ 3 ] For the fetus, safety and effectiveness are variable, and depend on the specific procedure, the reasons for the procedure, and the gestational age and condition of the fetus. The overall perinatal mortality after open surgery has been estimated to be approximately 6%, according to a study in the United States 2003. [ 5 ]
All future pregnancies for the mother require cesarean delivery because of the hysterotomy. [ 3 ] Fetal surgery is not thought to decrease maternal fertility. [ 3 ]
Neural tube defects (NTD), which begin to become observable at the 28th day of pregnancy, occur when the embryonic neural tube fails to close properly, the developing brain and spinal cord are openly exposed to amniotic fluid. After birth, exposure of the spinal cord to the outside environment ( myelomeningocele or spina bifida) is associated with several morbidities including weakness or sensory deficits in the lower extremities, bladder dysfunction , fluid buildup in the brain and Type 2 Chiari malformations (herniation of the cerebellar vermis and medulla from the brain into the spinal canal . [ 4 ] Prenatal repair of spina bifida is available in specialty centers. Fetuses treated with prenatal fetal repair have significantly improved outcomes compared to children whose defects are repaired shortly after birth. [ 6 ] Specifically, fetal repair reduces the rate of hydrocephalus, ventriculoperitoneal shunt dependence, and Chiari malformation. Prenatal repair also shows improved motor skills at 30 months and improved mobility, neuropsychological function, and independent functioning between the ages of 5 and 10. [ 7 ] [ 4 ]
Other conditions that potentially are treated by open fetal surgery include [ citation needed ] :
Minimally-invasive fetoscopic surgery has proven to be useful for some fetal conditions.
Fetal surgical techniques were first developed at the University of California, San Francisco , in 1980 using animal models. [ 10 ]
On April 26, 1981, the first successful human open fetal surgery in the world was performed at University of California, San Francisco, under the direction of Dr. Michael Harrison . [ 11 ] [ 12 ] The fetus in question had a congenital hydronephrosis , a blockage in the urinary tract that caused the kidney to dangerously extend. To correct this a vesicostomy was performed by placing a catheter in the fetus to allow the urine to be released normally. The blockage itself was removed surgically after birth. [ 12 ]
Further advances have been made in the years since this first operation. New techniques have allowed additional defects to be treated and for less invasive forms of fetal surgical intervention.
The first two percutaneous ultrasound-guided fetal balloon valvuloplasties , a type of fetal surgery for severe aortic valve obstruction in the heart, were reported in 1991. [ 13 ] Among the first dozen reported attempts at this repair in the 1990s, only two children survived long-term. [ 13 ] [ quantify ] Dr. Oluyinka Olutoye, alongside Darrell Cass, from the Texas Children's Fetal Centre, removed a 23-week-old fetus from her mother's womb in order to perform surgery upon a spinal tumor she had. The girl was placed back in the womb after a five-hour surgery and was born without complications. [ 14 ]
|
https://en.wikipedia.org/wiki/Fetal_surgery
|
A fiberotomy or pericision is an orthodontic surgical procedure designed to sever the gingival fibers around a tooth. It usually reduces the tendency to relapse of tooth rotations corrected by dental braces or other treatments. [ 1 ] The most frequently encountered post-orthodontic problem is the retention of re-established tooth position. Relapse (drifting of the tooth back to its position prior to orthodontic correction) may occur anywhere, but it is often associated with teeth that have undergone rotation (twisting) as part of the orthodontic therapy.
A fiberotomy involves the detachment of the fibers that attach the tooth to the bone via the gum. The fibers act much like twisted rubber bands and releasing the tension between the fibers and the tooth reduces the forces that attempt to pull the tooth back to its original position. It is performed near the completion of the orthodontics and is shown to be effective in preventing the relapse of teeth. To perform this procedure, there is the surgical cutting of disrupted transseptal fibres by making a gingival crevicular incision under local anesthetic after orthodontic alignment. [ 2 ] This procedure is painless as long as the patient takes an analgesic after the numbing has worn off.
This dentistry article is a stub . You can help Wikipedia by expanding it .
|
https://en.wikipedia.org/wiki/Fiberotomy
|
Fibrin degradation products ( FDPs ), also known as fibrin split products, are components of the blood produced by clot degeneration. [ 1 ] Clotting, also called coagulation, at the wound site produces a mass of fibrin threads called a net that remains in place until the cut is healed. As a cut heals, the clotting slows down. Eventually the clot is broken down and dissolved by plasmin . When the clot and fibrin net dissolve, fragments of protein are released into the body. These fragments are fibrin degradation products or FDPs. If your body is unable to dissolve a clot, you may have abnormal levels of FDPs. The most notable subtype of fibrin degradation products is D-dimer .
The levels of these FDPs rise after any thrombotic event.
Fibrin and fibrinogen degradation product (FDP) testing is commonly used to diagnose disseminated intravascular coagulation . [ 2 ]
A tumor marker known as AMDL-ELISA DR-70 (FDP), and now as Onko-Sure, was approved by the US FDA on July 1, 2008 for in vitro diagnostic only and serial testing for monitoring colorectal cancer with more effective by 50 percent than carcinoembryonic antigen (CEA) when CEA values is low. The Onko-Sure blood test can detect also tumors/cancers: of lung, breast, stomach, liver, colon; rectal, ovarian, esophageal, cervical, trophoblastic, thyroid, malignant lymphoma, and pancreatic. [ 3 ] [ 4 ]
This immunology article is a stub . You can help Wikipedia by expanding it .
|
https://en.wikipedia.org/wiki/Fibrin_degradation_product
|
Fibrin glue (also called fibrin sealant ) is a surgical formulation used to create a fibrin clot for hemostasis , cartilage repair surgeries or wound healing . It contains separately packaged human fibrinogen and human thrombin . [ 15 ] [ 16 ] [ 17 ] [ 18 ] [ 19 ] [ 20 ] [ 21 ] [ 22 ] [ 23 ] [ 24 ]
This glue is used as a supportive treatment in surgery (such as liver surgery) for the improvement of hemostasis where standard surgical techniques are insufficient or impractical. [ 13 ] [ 8 ]
It is also used for repairing dura mater tears and bronchial fistulas and for achieving hemostasis after spleen and liver trauma, [ 23 ] in "no sutures " corneal transplantation , pterygium excision with amniotic membrane or conjunctival autograft , and in eye trauma for corneal or conjunctival defects, [ 25 ] [ 26 ] [ 27 ] as well as for skin graft donor site wounds to reduce postoperative pain. [ 28 ]
It can also be used to treat pilonidal sinus disease but it is of unclear benefit as of 2017, due to insufficient research. [ 29 ]
The glue must not get into blood vessels, as this could lead to clotting in the form of thromboembolism or disseminated intravascular coagulation , or to anaphylaxis (a severe allergic reaction). [ 30 ]
Possible adverse effects include bleeding disorder and allergic reactions such as flushing, stinging, generalised urticaria , angioedema , bronchospasm , and anaphylaxis. Other adverse effects in studies occurred in roughly equal proportions in treatment and placebo groups. [ 30 ]
As fibrin glue contains proteins, it may be denatured by ethanol , iodine and heavy metals . These substances are frequently found in antiseptic solutions. [ 30 ]
Thrombin is an enzyme that splits fibrinogen into fibrin monomers in 10 to 60 seconds, which aggregate to form a three-dimensional gel-like structure. Thrombin also activates factor XIII from the human body to factor XIIIa, which then cross-links the fibrin monomers to form a stable clot. Both these processes need calcium to work. As the wound heals, the clot is slowly degraded by the enzyme plasmin . [ 23 ] [ 30 ] [ 31 ]
In rabbit studies, only 1 to 2% of the applied thrombin dose reached the bloodstream. It reached highest blood plasma concentrations after 6 to 8 hours. [ 30 ]
Fibrin glue comes in two vials, respectively containing:
The two components are mixed immediately before application. [ 13 ] [ 32 ] The formulations also contain calcium salts. [ 30 ]
Formulations from different manufacturers may also contain aprotinin , fibronectin , plasminogen , and factor XIII. [ 33 ] [ 34 ]
A formulation with human thrombin was approved for medical use in the United States in March 2003, and in the European Union in October 2008. [ 13 ] [ 32 ] [ 35 ]
|
https://en.wikipedia.org/wiki/Fibrin_glue
|
A fibrin ring granuloma , also known as doughnut granuloma , is a histopathological finding that is characteristic of Q fever . [ 1 ] On hematoxylin-eosin staining , the fibrin ring granuloma consists of a central lipid vacuole (usually washed-out during fixing and staining, leaving only an empty hole) surrounded by a dense red fibrin ring and epithelioid macrophages . Fibrin ring granulomas may also be seen in Hodgkin's disease and infectious mononucleosis . [ 2 ] [ 3 ]
This article related to pathology is a stub . You can help Wikipedia by expanding it .
|
https://en.wikipedia.org/wiki/Fibrin_ring_granuloma
|
A fibroepithelial neoplasm (or tumor ) is a biphasic tumor . They consist of epithelial tissue, and stromal or mesenchymal tissue. They may be benign or malignant . [ 1 ]
Examples include:
Sometimes fibroepithelial polyps (FEPs) of the vulva may be misdiagnosed as cancers. However not much harm is caused because the treatment of both is excision. The consent for removal must however be completely informed. [ 2 ]
This article about a neoplasm is a stub . You can help Wikipedia by expanding it .
This article related to pathology is a stub . You can help Wikipedia by expanding it .
This oncology article is a stub . You can help Wikipedia by expanding it .
|
https://en.wikipedia.org/wiki/Fibroepithelial_neoplasm
|
Fibrosis , also known as fibrotic scarring , is the development of fibrous connective tissue in response to an injury. Fibrosis can be a normal connective tissue deposition or excessive tissue deposition caused by a disease. [ 2 ]
Repeated injuries, chronic inflammation and repair are susceptible to fibrosis, where an accidental excessive accumulation of extracellular matrix components, such as the collagen, is produced by fibroblasts, leading to the formation of a permanent fibrotic scar. [ 1 ] [ 3 ]
In response to injury, this is called scarring , and if fibrosis arises from a single cell line, this is called a fibroma . Physiologically, fibrosis acts to deposit connective tissue, which can interfere with or totally inhibit the normal architecture and function of the underlying organ or tissue. Fibrosis can be used to describe the pathological state of excess deposition of fibrous tissue, as well as the process of connective tissue deposition in healing. [ 4 ] Defined by the pathological accumulation of extracellular matrix (ECM) proteins, fibrosis results in scarring and thickening of the affected tissue — it is in essence a natural wound healing response which interferes with normal organ function. [ 5 ]
Fibrosis is similar to the process of scarring, in that both involve stimulated fibroblasts laying down connective tissue , including collagen and glycosaminoglycans . The process is initiated when immune cells such as macrophages release soluble factors that stimulate fibroblasts. The most well characterized pro-fibrotic mediator is TGF beta , which is released by macrophages as well as any damaged tissue between surfaces called interstitium . Other soluble mediators of fibrosis include CTGF , platelet-derived growth factor (PDGF), and interleukin 10 (IL-10). These initiate signal transduction pathways such as the AKT/mTOR [ 6 ] and SMAD [ 7 ] pathways that ultimately lead to the proliferation and activation of fibroblasts, which deposit extracellular matrix into the surrounding connective tissue. This process of tissue repair is a complex one, with tight regulation of extracellular matrix (ECM) synthesis and degradation ensuring maintenance of normal tissue architecture. However, the entire process, although necessary, can lead to a progressive irreversible fibrotic response if tissue injury is severe or repetitive, or if the wound healing response itself becomes deregulated. [ 5 ] [ 8 ]
Fibrosis can occur in many tissues within the body, typically as a result of inflammation or damage. Common sites of fibrosis include the lungs, liver, kidneys, brain, and heart:
Myocardial fibrosis has two forms:
Fibrosis reversal
Historically, fibrosis was considered an irreversible process. However, several recent studies have demonstrated reversal in liver and lung tissue, [ 15 ] [ 16 ] [ 17 ] and in cases of renal, [ 18 ] myocardial, [ 19 ] and oral-submucosal fibrosis. [ 20 ]
|
https://en.wikipedia.org/wiki/Fibrosis
|
A fibrous tissue neoplasm is a tumor [ 1 ] derived primarily from Fibrous connective tissue .
An example is fibroma .
This oncology article is a stub . You can help Wikipedia by expanding it .
|
https://en.wikipedia.org/wiki/Fibrous_tissue_neoplasm
|
Field hygiene and sanitation are two facets of military medicine that seek to ensure reduction of casualties through avoidance of non-combat related health issues among military personnel, particularly in the prevention of disease. As such, it encompasses prevention of communicable diseases ; promotes personal hygiene ; ensures adequate field water supply; supervises food sanitation ; administers waste disposal ; and controls, prevents, and combats insect-borne diseases transmitted by mosquitoes , louses, flies, fleas, ticks , mites, and other insects. Field hygiene also includes knowledge, avoidance, and control of venomous animals and rodents, as well as mitigation of health problems related to extreme temperature environments.
Lack of field hygiene and sanitation were major contributors to non-combat casualties and deaths in pre-modern field armies, and these remained serious threats to soldier health in modern warfare during the First World War , on the Eastern Front during the Second World War, in the Korean War , the Vietnam War and the Soviet–Afghan War . Inadequate field hygiene and sanitation are also major medical problems and causes of death among refugee populations around the world.
This medical article is a stub . You can help Wikipedia by expanding it .
This military -related article is a stub . You can help Wikipedia by expanding it .
|
https://en.wikipedia.org/wiki/Field_Hygiene_and_Sanitation
|
The field of view ( FOV ) is the angular extent of the observable world that is seen at any given moment. In the case of optical instruments or sensors, it is a solid angle through which a detector is sensitive to electromagnetic radiation . It is further relevant in photography .
In the context of human and primate vision, the term "field of view" is typically only used in the sense of a restriction to what is visible by external apparatus, like when wearing spectacles [ 1 ] or virtual reality goggles. Note that eye movements are allowed in the definition but do not change the field of view when understood this way.
If the analogy of the eye's retina working as a sensor is drawn upon, the corresponding concept in human (and much of animal vision) is the visual field . [ 2 ] It is defined as "the number of degrees of visual angle during stable fixation of the eyes". [ 3 ] Note that eye movements are excluded in the visual field's definition. Humans have a slightly over 210-degree forward-facing horizontal arc of their visual field (i.e. without eye movements), [ 4 ] [ 5 ] [ 6 ] (with eye movements included it is slightly larger, as you can try for yourself by wiggling a finger on the side), while some birds have a complete or nearly complete 360-degree visual field. The vertical range of the visual field in humans is around 150 degrees. [ 4 ]
The range of visual abilities is not uniform across the visual field, and by implication the FoV, and varies between species . For example, binocular vision , which is the basis for stereopsis and is important for depth perception , covers 114 degrees (horizontally) of the visual field in humans; [ 7 ] the remaining peripheral ~50 degrees on each side [ 6 ] have no binocular vision (because only one eye can see those parts of the visual field). Some birds have a scant 10 to 20 degrees of binocular vision.
Similarly, color vision and the ability to perceive shape and motion vary across the visual field; in humans color vision and form perception are concentrated in the center of the visual field, while motion perception is only slightly reduced in the periphery and thus has a relative advantage there. The physiological basis for that is the much higher concentration of color-sensitive cone cells and color-sensitive parvocellular retinal ganglion cells in the fovea – the central region of the retina, together with a larger representation in the visual cortex – in comparison to the higher concentration of color-insensitive rod cells and motion-sensitive magnocellular retinal ganglion cells in the visual periphery, and smaller cortical representation. Since rod cells require considerably less light to be activated, the result of this distribution is further that peripheral vision is much more sensitive at night relative to foveal vision (sensitivity is highest at around 20 deg eccentricity). [ 2 ]
Many optical instruments, particularly binoculars or spotting scopes, are advertised with their field of view specified in one of two ways: angular field of view, and linear field of view. Angular field of view is typically specified in degrees, while linear field of view is a ratio of lengths. For example, binoculars with a 5.8 degree (angular) field of view might be advertised as having a (linear) field of view of 102 mm per meter. As long as the FOV is less than about 10 degrees or so, the following approximation formulas allow one to convert between linear and angular field of view. Let A {\displaystyle A} be the angular field of view in degrees. Let M {\displaystyle M} be the linear field of view in millimeters per meter. Then, using the small-angle approximation :
In machine vision the lens focal length and image sensor size sets up the fixed relationship between the field of view and the working distance. Field of view is the area of the inspection captured on the camera’s imager. The size of the field of view and the size of the camera’s imager directly affect the image resolution (one determining factor in accuracy). Working distance is the distance between the back of the lens and the target object.
In tomography , the field of view is the area of each tomogram. In for example computed tomography , a volume of voxels can be created from such tomograms by merging multiple slices along the scan range.
In remote sensing , the solid angle through which a detector element (a pixel sensor) is sensitive to electromagnetic radiation at any one time, is called instantaneous field of view or IFOV. A measure of the spatial resolution of a remote sensing imaging system, it is often expressed as dimensions of visible ground area, for some known sensor altitude . [ 8 ] [ 9 ] Single pixel IFOV is closely related to concept of ground resolved distance , ground sample distance , modulation transfer function , and resolved pixel size .
In astronomy , the field of view is usually expressed as an angular area viewed by the instrument, in square degrees , or for higher magnification instruments, in square arc-minutes . For reference the Wide Field Channel on the Advanced Camera for Surveys on the Hubble Space Telescope has a field of view of 10 sq. arc-minutes, and the High Resolution Channel of the same instrument has a field of view of 0.15 sq. arc-minutes. Ground-based survey telescopes have much wider fields of view. The photographic plates used by the UK Schmidt Telescope had a field of view of 30 sq. degrees. The 1.8 m (71 in) Pan-STARRS telescope, with the most advanced digital camera to date has a field of view of 7 sq. degrees. In the near infra-red WFCAM on UKIRT has a field of view of 0.2 sq. degrees and the VISTA telescope has a field of view of 0.6 sq. degrees. Until recently digital cameras could only cover a small field of view compared to photographic plates , although they beat photographic plates in quantum efficiency , linearity and dynamic range, as well as being much easier to process.
In photography, the field of view is that part of the world that is visible through the camera at a particular position and orientation in space; objects outside the FOV when the picture is taken are not recorded in the photograph. It is most often expressed as the angular size of the view cone, as an angle of view . For a normal lens focused at infinity, the diagonal (or horizontal or vertical) field of view can be calculated as:
where f {\displaystyle f} is the focal length , here the sensor size and f {\displaystyle f} are in the same unit of length, FOV is in radians.
In microscopy, the field of view in high power (usually a 400-fold magnification when referenced in scientific papers) is called a high-power field , and is used as a reference point for various classification schemes.
For an objective with magnification m {\displaystyle m} , the FOV is related to the Field Number (FN) by
if other magnifying lenses are used in the system (in addition to the objective), the total m {\displaystyle m} for the projection is used.
The field of view in video games refers to the field of view of the camera looking at the game world, which is dependent on the scaling method used.
|
https://en.wikipedia.org/wiki/Field_of_view
|
Field stain is a histological method for staining of blood smears . It is used for staining thick blood films in order to discover malarial parasites. Field's stain is a version of a Romanowsky stain , used for rapid processing of the specimens. [ 1 ]
Field's stain consists of two parts - Field's stain A is methylene blue and Azure 1 dissolved in phosphate buffer solution ; Field's stain B is Eosin Y in buffer solution. Field stain is named after physician John William Field , who developed it in 1941. [ 2 ]
This article related to pathology is a stub . You can help Wikipedia by expanding it .
|
https://en.wikipedia.org/wiki/Field_stain
|
The filamentous haemagglutinin adhesin ( FHA ) is a large, filamentous protein that serves as a dominant attachment factor for adherence to host ciliated epithelial cells of the respiratory tract , called respiratory epithelium . [ 1 ] It is associated with biofilm formation and possesses at least four binding domains which can bind to different cell receptors on the epithelial cell surface . One notable bacterium that produces filamentous haemagglutinin adhesin is Bordetella pertussis , which uses this protein as a virulence factor .
This protein -related article is a stub . You can help Wikipedia by expanding it .
|
https://en.wikipedia.org/wiki/Filamentous_haemagglutinin_adhesin
|
Appendectomy recorded in Geneva in 1929 and entitled "The Operation"
http://imageofsurgery.com/Surgery_history_art.htm
Christian Schad
No
Yes
To illustrate article on author
Not possible
Fair Use Rationale:
Please remember that the non-free content criteria require that non-free images on Wikipedia must not "[be] used in a manner that is likely to replace the original market role of the original copyrighted media. " Use of historic images from press agencies must only be of a transformative nature, when the image itself is the subject of commentary rather than the event it depicts (which is the original market role, and is not allowed per policy). Fair use //en.wikipedia.org/wiki/File:Christian_Schad00.jpg
| |
Dr.Seyed Hossein Rejali
If this is not legally possible:
PD Public domain false false
Any user may perform this transfer; refer to Wikipedia:Moving files to Commons for details.
If this file has problems with attribution , copyright , or is otherwise ineligible for Commons, then remove this tag and DO NOT transfer it; repeat violators may be blocked from editing.
| |
Filip Swirski is a Polish-Canadian-American scientist and educator serving as the Arthur and Janet C. Ross Professor of Medicine, Cardiology and Professor of Radiology at the Icahn School of Medicine at Mount Sinai and is the Director of the Cardiovascular Research Institute. He is also a member of the Biomedical Engineering and Imaging Institute (BMEII), the Marc and Jennifer Lipschultz Precision Immunology Institute (PrIISM), and The Friedman Brain Institutes (FBI) at Mount Sinai. His research partly focuses on innate and inflammatory mechanisms in cardiovascular disease. He is known for his work in cardioimmunology and notably for linking atherosclerosis with blood monocytosis . [ 1 ] [ 2 ] [ 3 ]
Swirski earned his Bachelor of Arts and Science specializing in biochemistry and a Ph.D. in immunology at McMaster University , Hamilton , Canada. He received an honorary MS from Harvard Medical School in 2020 for accomplishing a full professorship. He was professor at the Center for Systems Biology at Massachusetts General Hospital and at Harvard Medical School. [ 4 ] [ 5 ]
Swirski focuses on understanding how leukocytes shape and are shaped by inflammation. His research uses in vivo models of acute and chronic inflammation relevant to cardiovascular, neurodegenerative , infectious, and metabolic diseases. [ 5 ] His writings reflect translational and fundamental cardiovascular and neurodegenerative science research, including cell development , mind-marrow communication, and function. [ 6 ] [ 7 ]
Partial list:
As of 2024, Swirski is credited with 38,923 citations and has an h-index of 95. [ 36 ] His most cited contributions to date are on myocardial infarction, ventricular remodeling, inflammation, stem cell niche, hematopoiesis and hematopoietic stem cells. [ 37 ] Between 2018 and 2019, articles reportedly focused mostly on inflammation (43.72%), bone marrow (17.21%) and immune system (17.21%). [ 38 ]
Five most-cited peer-reviewed publications as of 2024 include: [ 36 ]
|
https://en.wikipedia.org/wiki/Filip_Swirski
|
A filled pause is a non-silent pause in an otherwise fluent speech, where instead of a silent pause there is a filler . The filler can be non-lexical or semiarticulate utterances such as huh , uh , erm , um , or hmm . Fillers may also include words such as well , so , I mean , and like , when used in ways that don't change the meaning of the surrounding speech. [ 1 ]
This particular type of pause is one of several types of speech disfluencies , which also includes silent pauses, "false starts", phrases that are restarted or repeated, and repeated syllables.
|
https://en.wikipedia.org/wiki/Filled_pause
|
Fine-needle aspiration ( FNA ) is a diagnostic procedure used to investigate lumps or masses. In this technique, a thin (23–25 gauge (0.52 to 0.64 mm outer diameter)), hollow needle is inserted into the mass for sampling of cells that, after being stained , are examined under a microscope ( biopsy ). The sampling and biopsy considered together are called fine-needle aspiration biopsy ( FNAB ) or fine-needle aspiration cytology ( FNAC ) (the latter to emphasize that any aspiration biopsy involves cytopathology , not histopathology ). Fine-needle aspiration biopsies are very safe for minor surgical procedures. Often, a major surgical (excisional or open) biopsy can be avoided by performing a needle aspiration biopsy instead, eliminating the need for hospitalization. In 1981, the first fine-needle aspiration biopsy in the United States was done at Maimonides Medical Center . [ 1 ] The modern procedure is widely used to diagnose cancer and inflammatory conditions. Fine needle aspiration is generally considered a safe procedure. Complications are infrequent. [ 2 ]
Aspiration is safer and far less traumatic than an open biopsy; complications beyond bruising and soreness are rare. However, the few problematic cells can be too few (inconclusive) or missed entirely (a false negative ).
This type of sampling is performed for one of two reasons:
When the lump can be felt, the biopsy is usually performed by a cytopathologist or a surgeon . In this case, the procedure is usually short and simple. Otherwise, it may be performed by an interventional radiologist , a doctor with training in performing such biopsies under x-ray or ultrasound guidance. In this case, the procedure may require more extensive preparation and take more time to perform.
Also, fine-needle aspiration is the main method used for chorionic villus sampling , [ 3 ] as well as for many types of body fluid sampling .
It is also used for ultrasound-guided aspiration of breast abscess , [ 4 ] of breast cysts , and of seromas . [ 5 ]
Before the procedure is started, vital signs ( pulse , blood pressure , temperature, etc.) may be taken. Then, depending on the nature of the biopsy, an intravenous line may be placed. Very anxious patients can be sedated through this line, or oral medication ( Valium ) may be prescribed.
The skin above the area to be biopsied is swabbed with an antiseptic solution and draped with sterile surgical towels. The skin, underlying fat , and muscle may be numbed with a local anesthetic , although this is often not necessary with superficial masses. After locating the mass for biopsy, using X-rays or palpation , a special needle of very fine diameter is passed into the mass. The needle may be inserted and withdrawn several times. There are many reasons for this:
After the needles are placed into the mass, cells are withdrawn by aspiration with a syringe and spread on a glass slide. The patient's vital signs are taken again, and the patient is removed to an observation area for three to five hours.
Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is a minimally invasive procedure for acquiring biopsies in gastric regions that are hard to reach otherwise (e.g. the pancreas). Endoscopic ultrasound EUS-FNA of cystic lesions, followed by liquid cell analysis, has been used as a diagnostic tool for differentiating benign, potentially malignant, and malignant pancreatic cysts. [ 6 ] [ 7 ] 'Through-the-needle' cytologic brushes have been developed for increasing the cellular content in the aspirates. [ 8 ] [ 9 ] [ 10 ] [ 11 ]
Rapid on-site evaluation (ROSE) is a real-time service during EUS-FNA interventions, that assesses the adequacy of the collected biopsy samples for diagnostics. Sample adequacy is deemed by the number of target cells that allow for determining tumor malignancy. ROSE reduces the overall number of needle passes required for an appropriate sample and the number of FNA procedures. [ 12 ] ROSE is typically performed in the operating room and starts by transferring an aliquot of the FNA sample onto a glass slide. Then, the sample is manually smeared out to obtain a thin sample layer with cells dispersed along the glass slide. After an air-drying step, the sample is stained, typically with a rapid Romanowky-type stain. Finally, a morphological assessment of the stained cells under a microscope allows us to evaluate the adequacy of the collected FNA sample. [ 13 ] Research focuses, among others, on portable devices for semi-automated sample preparation for ROSE, with the purpose of simplifying the performance of FNA sample preparation and reaching a wider implementation of ROSE. [ 14 ]
As with any surgical procedure, complications are possible, but major complications due to thin-needle aspiration biopsies are fairly uncommon, and when complications do occur, they are generally mild. The kind and severity of complications depend on the organs from which a biopsy is taken or the organs gone through to obtain cells.
After the procedure, mild analgesics are used to control post-operative pain. Aspirin or aspirin substitutes should not be taken for 48 hours after the procedure (unless aspirin is prescribed for a cardiac or neurological condition). Since sterility is maintained throughout the procedure, infection is rare. But should an infection occur, it will be treated with antibiotics . Bleeding is the most common complication of this procedure. A slight bruise may also appear. If a lung or kidney biopsy has been performed, it is very common to see a small amount of blood in sputum or urine after the procedure. Only a small amount of bleeding should occur. During the observation period after the procedure, bleeding should decrease over time. If more bleeding occurs, this will be monitored until it subsides. Rarely, major surgery will be necessary to stop the bleeding.
Other complications depend upon the body part on which the biopsy takes place:
A study published in 2004 showed that in one case, a needle biopsy of a liver tumor resulted in the spread of the cancer along the path of the needle and concluded that needle aspiration was dangerous and unnecessary. The conclusions drawn from this paper were subsequently strongly criticized. [ 15 ]
Lung
Neck
Bone
Risk
|
https://en.wikipedia.org/wiki/Fine-needle_aspiration
|
Joint replacement of the hand is a procedure that was invented by the Scottish scientist, Mitchell McGuire. The procedure was considered a major breakthrough in the medical field at the time. However, it is now considered an almost standard operation. The first successful surgery of this kind was conducted on 21 December 1992, in New York City , US.
This surgical option is reserved for patients with advanced arthritis or with a hand deformity.
Merging of a joint involves removing the joint and surgically "fusing" the joint's end so that the two bones effectively form one solid bone. This surgery stops all movement at that joint and therefore eliminates the pain. [ 1 ] The benefit of fusion is pain relief and the downside is elimination of motion at the fused joint, which can hinder function. Arthritic joint replacements are usually the most effective surgical option in more youthful and active patients. Younger patients may not be candidates for joint replacement because of the increased stress demand on the joints which accompany higher activity levels. This increased stress demand can quickly wear out an artificial joint.
For those with a hand deformity, the surgical procedure varies slightly. Instead of the joint being removed and replaced with a prosthetic hand, a hand from a donor is used [ citation needed ] .
This surgery article is a stub . You can help Wikipedia by expanding it .
This article about biomedical engineering is a stub . You can help Wikipedia by expanding it .
|
https://en.wikipedia.org/wiki/Finger_joint_replacement
|
The Fink effect , also known as "diffusion anoxia ", [ 1 ] "diffusion hypoxia ", [ 2 ] or the "second gas effect", [ 3 ] is a factor that influences the pO 2 (partial pressure of oxygen) within the pulmonary alveoli . When water- soluble gases such as anesthetic agent N 2 O ( nitrous oxide ) are breathed in large quantities they can be dissolved in body fluids rapidly. This leads to a temporary increase [ clarification needed ] in both the concentrations and partial pressures of oxygen and carbon dioxide in the alveoli.
The effect is named after Bernard Raymond Fink (1914–2000), whose 1955 paper first explained it. [ 1 ] [ 4 ] When a patient is recovering from N 2 O anaesthesia , large quantities of this gas cross from the blood into the alveoli (down its concentration gradient ) and so for a short period of time, the O 2 and CO 2 in the alveoli are diluted by this gas. A sufficiently large decrease in the partial pressure of oxygen leads to hypoxia , especially if the patient hypoventilates (which allows more time for evolving nitrous to dilute alveolar oxygen each breath). [ 5 ] Nonetheless, this effect only lasts a couple of minutes and hypoxia can be avoided by increasing the fractional inspired oxygen concentration when recovering from N 2 O administration. [ 6 ] It is for this reason that Entonox , a 50:50 gaseous mixture of nitrous oxide and oxygen , is suitable for use by para-medical staff such as ambulance officers: it provides sufficient nitrous oxide for pain relief with sufficient oxygen to avoid hypoxia. [ 7 ] [ 8 ]
|
https://en.wikipedia.org/wiki/Fink_effect
|
Finney strictureplasty is a procedure in gastroenterology . It is indicated for strictures up to 15 centimetres (5.9 in). The Finney strictureplasty is performed by folding the diseased bowel on itself and creating a large opening between the two loops. This strictureplasty can be used to address longer strictures—greater than 7 centimetres (2.8 in) and not greater than 15 centimetres (5.9 in)—than those manageable with the Heineke-Mikulicz technique (usually performed for strictures up to 7 cm). [ 1 ]
The Finney strictureplasty is named after the Finney pyloroplasty, first described in 1937. [ 2 ] The strictured loop is folded over itself at its midpoint section, forming a U shape. A longitudinal enterotomy is then performed halfway between the mesenteric and the antimesenteric side on the folded loop. The opposed edges of the bowel are sutured together to create a short side-to-side anisoperistaltic enteroenterostomy. Concerns about long-term complications, such as bacterial overgrowth in the bypassed segment, limit the length of the stricture to be addressed by this strictureplasty to less than 15 cm. [ 3 ]
Strictureplasties are categorized into three groups: conventional, intermediate, and complex procedures. The Heineke–Mikulicz strictureplasty is the most common among the conventional stricutreplasties, the Finney strictureplasty is the most common intermediate strictureplasty, and the most common complex strictureplasty is the Michelassi strictureplasty . [ citation needed ]
This surgery article is a stub . You can help Wikipedia by expanding it .
|
https://en.wikipedia.org/wiki/Finney_strictureplasty
|
The firm is a medical team, typically seen in apprenticeship style training in hospital settings. After 2005 in the UK, when trainees started rotating more regularly under the Modernising Medical Careers program, the system of firms in the UK declined. [ 1 ] [ 2 ] [ 3 ] [ 4 ]
This medical article is a stub . You can help Wikipedia by expanding it .
|
https://en.wikipedia.org/wiki/Firm_(medicine)
|
First rib resection is a surgical procedure used in humans to treat thoracic outlet syndrome (TOS) and Paget–Schroetter disease . It involves the surgical removal of a segment of the first rib, which is the rib closest to the head, under the collar bone .
First rib resection is indicated for venous , arterial , and neurogenic TOS. [ 1 ] In all cases, the goal of the operation is to increase the dynamic space between the chest wall and the clavicle , through which the subclavian vein, artery, and the brachial nerve roots pass. [ 2 ]
The first rib may be approached several different ways: from above the clavicle in an inferior direction (infraclavicular), from above the clavicle (supraclavicular), from the posterior neck, and from the armpit medially (transaxillary).
While the operation universally involves removal of the first rib, depending on the indication for the operation, additional maneuvers may be performed. For venous thoracic outlet syndrome , removal of anterior scalene muscle (scalenectomy) and freeing up scar tissue around the subclavian vein (venolysis) are often also performed. If anomalous cervical ribs are present, these may be removed as well.
|
https://en.wikipedia.org/wiki/First_rib_resection
|
In anatomy , a fistula ( pl. : fistulas or fistulae /- l i , - l aɪ / ; from Latin fistula , "tube, pipe") is an abnormal connection (i.e. tube) joining two hollow spaces (technically, two epithelialized surfaces), such as blood vessels , intestines , or other hollow organs to each other, often resulting in an abnormal flow of fluid from one space to the other. [ 2 ] [ 3 ] [ 4 ] An anal fistula connects the anal canal to the perianal skin. An anovaginal or rectovaginal fistula is a hole joining the anus or rectum to the vagina . A colovaginal fistula joins the space in the colon to that in the vagina. A urinary tract fistula is an abnormal opening in the urinary tract or an abnormal connection between the urinary tract and another organ. An abnormal communication (i.e. hole or tube) between the bladder and the uterus is called a vesicouterine fistula , while if it is between the bladder and the vagina it is known as a vesicovaginal fistula , and if between the urethra and the vagina: a urethrovaginal fistula. When occurring between two parts of the intestine, it is known as an enteroenteral fistula, between the small intestine and the skin it is known as an enterocutaneous fistula, and between the colon and the skin as a colocutaneous fistula. [ 3 ]
A fistula can result from an infection, inflammation, injury or surgery. [ 5 ] Many result from complications during childbirth. Sometimes a fistula is deliberately surgically created as part of a treatment, for example in the case of an arteriovenous fistula for hemodialysis . [ 6 ]
The treatment for a fistula varies depending on the type, cause, and severity of the fistula, but often involves surgical intervention combined with antibiotic therapy. In some cases the fistula is temporarily covered using a fibrin glue or plug. A catheter may be required to drain a fistula. [ 3 ]
Globally, every year between 50,000 and 100,000 women are affected by one or more fistulas relating to childbirth. [ 7 ] Typically they are vaginal fistulas, between either the bowel or bladder and the vaginal canal, but uterine and bowel fistulas also occur.
In botany , the term is most common in its adjectival forms, where it is used in binomial names to refer to a species that is distinguished by one or more hollow or tubular structures. Monarda fistulosa , for example, has tubular flowers. [ 8 ]
The term was first used in the 14th century. [ 2 ]
A fistula is an abnormal connection between vessels or organs that do not usually connect. It can be due to a disease or trauma, or purposely surgically created. [ 3 ] [ 5 ]
Various types of fistulas include:
Although most fistulas are in forms of a tube, some can also have multiple branches. [ 9 ]
Types of fistula can be described by their location. Anal fistulas connect between the epithelialized surface of the anal canal and the perianal skin. Anovaginal or rectovaginal fistulas occur when a hole develops between the anus or rectum and the vagina. Colovaginal fistulas occur between the colon and the vagina. Urinary tract fistulas are abnormal openings within the urinary tract or an abnormal connection between the urinary tract and another organ such as between the bladder and the uterus in a vesicouterine fistula, between the bladder and the vagina in a vesicovaginal fistula, and between the urethra and the vagina in urethrovaginal fistula. When occurring between two parts of the intestine, it is known as an enteroenteral fistula, between the small intestine and the skin as an enterocutaneous fistula, and between the small intestine and the colon as a colocutaneous fistula. [ 3 ]
The following list is sorted by the International Statistical Classification of Diseases and Related Health Problems .
Treatment for fistula varies depending on the cause and extent of the fistula, but often involves surgical intervention combined with antibiotic therapy. In some cases the fistula is temporarily covered, using a fibrin glue or plug. Catheters may be required to drain a fistula. [ 3 ]
Surgery is often required to assure adequate drainage of the fistula (so that pus may escape without forming an abscess ). Various surgical procedures are used, most commonly fistulotomy , placement of a seton (a cord that is passed through the path of the fistula to keep it open for draining), or an endorectal flap procedure (where healthy tissue is pulled over the internal side of the fistula to keep feces or other material from reinfecting the channel). [ 19 ]
Management involves treating any underlying causative condition. For example, surgical treatment of fistulae in Crohn's disease can be effective, but if the Crohn's disease itself is not treated, the rate of recurrence of the fistula is very high (well above 50%).
In people with kidney failure , requiring dialysis, a cimino fistula is often deliberately created in the arm by means of a short day surgery in order to permit easier withdrawal of blood for hemodialysis . [ citation needed ]
As a radical treatment for portal hypertension , surgical creation of a portacaval fistula produces an anastomosis between the hepatic portal vein and the inferior vena cava across the omental foramen (of Winslow). This spares the portal venous system from high pressure which can cause esophageal varices, caput medusae , and hemorrhoids. [ citation needed ]
Globally, every year between 50,000 and 100,000 women are affected by fistula relating to childbirth. [ 7 ]
In botany , the term is most common in its adjectival forms, where it is used in binomial names to refer to species that are distinguished by hollow or tubular structures. Monarda fistulosa , for example, has tubular flowers; [ 8 ] Eutrochium fistulosum has a tubular stem; Allium fistulosum has hollow or tubular leaves, and Acacia seyal subsp. fistula is the subspecies with hollow spines. [ citation needed ]
The term was first used in the 14th century. [ 2 ]
A fistula plays a central role in William Shakespeares play All's Well That Ends Well
|
https://en.wikipedia.org/wiki/Fistula
|
Fistulectomy is a surgical procedure where a surgeon completely removes a fistula , an abnormal tract (i.e. tube) that connects two hollow spaces of the body. [ 1 ] [ 2 ] In comparison to other procedural options of treating fistulae such as fistulotomies , where a fistula is cut open (i.e. unroofed) but not completely removed, and seton placement, where a rubber band seton is passed through the tract and left post-operation as a means to allow drainage of the fistula, fistulectomies are considered to be a more radical approach. [ 3 ] [ 2 ] The total removal of a fistula may damage nearby structures in the process. [ 3 ]
In practice, fistulectomies are primarily performed by colorectal surgeons to treat anorectal fistulous tracts, as fistulas commonly emerge in the anorectal region. [ 2 ] In this case, fistulectomies may compromise a patient's anal sphincter , as the removal process may necessitate the surgeon to cut through the muscle. As a result, this may lead to complications such as incontinenece . [ 3 ] For this reason, fistulectomies are no longer considered the "gold standard". [ 3 ]
Based on guidelines published by the American Society of Colon and Rectal Surgery (ASCRS) in 2016, simple and complex anal fistulas were to be treated by fistulotomy or rubber band seton placement with fistulectomies being a secondary option. [ 4 ]
Fistulectomy can be considered in non-anorectal fistulas as well. In these circumstances, a fistulectomy may be the best option for the removal of a patient's diseased soft tissue. [ 5 ]
For anorectal fistulae, the surgeon begins by identifying the internal and external opening of the fistula. The external opening is usually on the patient's skin and can be identified in clinic. [ 6 ] The internal opening is within the anus, and can be found while the surgeon examins the anorectal columns while the patient is under anesthesia. A methalyne blue dye or a peroxide solution may be used to aid with this process. [ 6 ]
Once the openings of the tract are found, a thin metal probe is strung through. Using scissors or electrocautery , the surgeon then cores out the tunneling tract. [ 6 ] At this point, the surgeon inspects the anal sphincters and closes any defects that were made during the procedure. [ 6 ] The wound can then be left open to heal or closed by approximating the tissue back to its anatomic position with sutures. [ 6 ]
As described above, when a fistulectomy is performed to remove an anorectal fistula tract that involves the anal sphincters, a common complication that may occur is fecal incontinence. [ 3 ] The degree of incontinence can be measured using the Wexner score, which can allow surgeons to monitor the progression of incontinence post-operatively. [ 7 ]
As with other surgeries, fistulectomies may also pose other complications such as delayed wound healing and infection. [ 7 ]
This surgery article is a stub . You can help Wikipedia by expanding it .
|
https://en.wikipedia.org/wiki/Fistulectomy
|
A fistulotomy is the surgical opening of a fistulous tract. [ 1 ] They can be performed by excision of the tract and surrounding tissue, simple division of the tract, or gradual division and assisted drainage of the tract in a seton ; a cord passed through the tract in a loop that is slowly tightened over a period of days or weeks.
Fistulas can occur in various areas of the human body, and the location of the fistula influences the necessity of the procedure. Some, such as ano-vaginal and perianal fistulas are chronic conditions, and normally will not heal without surgical intervention. [ citation needed ]
|
https://en.wikipedia.org/wiki/Fistulotomy
|
The five-year survival rate is a type of survival rate for estimating the prognosis of a particular disease, normally calculated from the point of diagnosis. [ 1 ] Lead time bias from earlier diagnosis can affect interpretation of the five-year survival rate. [ 2 ]
There are absolute and relative survival rates, but the latter are more useful and commonly used.
Five-year relative survival rates are more commonly cited in cancer statistics. [ 3 ] Five-year absolute survival rates may sometimes also be cited. [ 4 ]
The fact that relative survival rates above 100% were estimated for some groups of patients appears counterintuitive on first view. It is unlikely that occurrence of prostate cancer would increase chances of survival, compared to the general population. A more plausible explanation is that the pattern reflects a selection effect of PSA screening , as screening tests tend to be used less often by socially disadvantaged population groups, who, in general, also have higher mortality. [ 5 ]
Five-year survival rates can be used to compare the effectiveness of treatments. Use of five-year survival statistics is more useful in aggressive diseases that have a shorter life expectancy following diagnosis, such as lung cancer , and less useful in cases with a long life expectancy, such as prostate cancer . [ citation needed ]
Improvements in rates are sometimes attributed to improvements in diagnosis rather than to improvements in prognosis. [ 6 ]
To compare treatments independently from diagnostics, it may be better to consider survival from reaching a certain stage of the disease or its treatment.
Analysis performed against the Surveillance, Epidemiology, and End Results database (SEER) facilitates calculation of five-year survival rates. [ 7 ] [ 8 ]
|
https://en.wikipedia.org/wiki/Five-year_survival_rate
|
The Five Punishments ( Chinese : 五刑 ; pinyin : wǔ xíng ; Cantonese Yale : ńgh yìhng ) was the collective name for a series of physical penalties meted out by the legal system of pre-modern dynastic China . [ 1 ] Over time, the nature of the Five Punishments varied. Before the Western Han dynasty Emperor Han Wendi ( r. 180–157 BC), [ clarification needed ] the punishments involved tattooing , cutting off the nose , amputation of one or both feet, castration , and death . [ 2 ] [ 3 ] Following the Sui and Tang dynasties (581–907 AD), these were changed to penal servitude , banishment , death, or corporal punishment in the form of whipping with bamboo strips or flogging with a stick. Although the Five Punishments were an important part of Dynastic China's penal system, they were not the only methods of punishment used.
The earliest users of the Five Punishments are believed by some to be the Sanmiao Clan ( 三苗氏 ). Other sources claim they originated with Chiyou , the legendary creator of metalwork and weapons and leader of the ancient Nine Li ( 九黎 ) ethnic group. During the subsequent Xia dynasty (c. 2070 BC – c. 1600 BC), Qi of Xia , son of Yu the Great , the dynasty's founder, adopted the Miao's punishments of amputation of one or both feet ( 刖 ; yuè ), cutting off of the nose ( 劓 ; yì ), chiseling ( 琢 ; zhuó ), tattooing the face or forehead ( 黥 ; qíng ) and other types of punishment. Tattooing, amputation of the nose or feet, removal of the reproductive organs and death became the main five forms of the punishment system during this period. From the Xia Dynasty onwards through the Shang dynasty (1600–1046 BC) and the Zhou dynasty (1046–256 BC). The "Five Punishments for Slaves" were abolished during the reign of Emperor Wen of Han following a petition from a female subject Chunyu Tiying ( 淳于緹縈 ), and were replaced by the "Five Punishments for Serfs".
Apart from the death penalty, the remaining four Punishments for Slaves were designed to bring about damage to their bodies that would mark them for life. [ 4 ] All ordinary citizens were subject to these punishments. [ 5 ] These punishments were for men. The number of crimes to which the punishment was applicable is listed next to each one. [ 6 ]
During the Western Han dynasty , tattooing and amputation were abolished as punishments and in subsequent dynasties, the five punishments underwent further modification. By the Sui dynasty , the five punishments had attained the basic form they would have until the end of the imperial era. This is a brief survey of the five punishments during the Qing dynasty : [ 15 ]
The scale of the remittance payments can be gauged from the fact that at the era of the Qianlong Emperor (1735–1796), the average wage of a construction laborer in Zhili (modern day Hebei ) Province was 0.72 wén or 0.6 troy ounces of silver per day. [ 17 ] It takes 160 years of wage from such a worker to pay for remittance of a death sentence.
The following punishments were applied to women for the same crimes as committed by men: [ citation needed ]
|
https://en.wikipedia.org/wiki/Five_Punishments
|
The fixation reflex is that concerned with attracting the eye on a peripheral object. For example, when a light shines in the periphery, the eyes shift gaze on it. It is controlled by the occipital lobe of the cerebral cortex, corroborated by three main tests:
Older research declares that a motor pathway from the occipital cortex to the brainstem motor neurons was via the superior colliculi . This is the case in lower animals, but in humans, the theory that eye-muscle nuclei ( oculomotor nucleus and Edinger–Westphal nucleus ) aside from the superior colliculi of the midbrain is now generally held.
When an object is focused directly at an object but the eyes drift off their target, the fixation reflex keeps the eyes focused on the original object, albeit moving itself.
This medical article is a stub . You can help Wikipedia by expanding it .
|
https://en.wikipedia.org/wiki/Fixation_reflex
|
Fixing Sex: Intersex, Medical Authority, and Lived Experience , a book by Stanford anthropologist and bioethicist Katrina Karkazis , was published in 2008. Described as "thoughtful", "meticulous", and an "authoritative treatise on intersex", [ 1 ] the book examines the perspectives of intersex people, their families, and clinicians to offer compassionate look at the treatment of people born with atypical sex characteristics.
In a scholarly work, Karkazis draws heavily on interviews with intersex adults, parents, and physicians to explore how intersex is understood and treated. In part 1, she reviews the history of treatment for intersex traits, highlighting the work of John Money and the introduction of the, then new, terms "gender", "gender role" and "gender identity". She explores the events following publication of Milton Diamond 's study of the David Reimer or "John/Joan" case, and the ways in which public opinion impacted on medical treatment. In part 2, Karkazis presents an analysis of current medical approaches to intersex, and the risks involved, in the wake of a 2006 "consensus statement on the management of intersex disorders". [ 2 ] She also reviews the methods utilised to assign a sex of rearing to intersex infants, such as genitals and penis size, chromosomes, fertility, "sexing of the brain", and parental wishes; these impact upon determination whether or not to proceed with early genital surgery. [ 3 ] Part 3 interviews parents of children with complete androgen insensitivity syndrome and congenital adrenal hyperplasia , and adults with intersex experiences. Part 3 also looks at activism by intersex organizations .
The book has been well received by both clinicians and intersex groups. Gary Berkovitz, writing in the New England Journal of Medicine states that Karkazis's analysis is fair, compelling, and eloquent; "Current consensus guidelines recommend early separation of the vagina and urethra for female subjects with abnormalities in the formation of the sex organs... Karkazis presents a compelling argument for the deferment of subsequent surgery until the patient is able to decide." [ 2 ] Elizabeth Reis, reviewing the book in the American Journal of Bioethics , states that the book identifies risk of incontinence, fistulas, scarring and lack of physical sensation arising from surgical intervention, and the psychological harm caused by the knowledge that "one's genitals are 'wrong,' requiring constant medical scrutiny and 'fixing'. It "masterfully examines the concerns and fears of all those with a stake in the intersex debate: physicians, parents, intersex adults, and activists. ... Karkazis’s honest, multi-pronged approach poses critical questions." [ 4 ] Mijeon in the American Journal of Human Genetics writes that the "conclusion is quite fitting", "the history of thinking about the body ... can be highly politicized and controversial". [ 3 ] Kenneth Copeland, former president of the Lawson Wilkins Pediatric Endocrine Society , describes the book as "Masterfully balancing all aspects of one of the most polarizing, contentious topics in medicine... the most recent authoritative treatise on intersex." [ 1 ]
Gayle Rubin describes the book as "meticulous, sensitive, and brilliantly executed". [ 1 ] Arlene Baratz ( Accord Alliance ) describes the book as "a velvet-gloved punch to the gut", "astonishing, a tale told straight from the mouths of affected adults, parents, and physicians in tender and lyrical prose." [ 5 ] Intersex community organization Organisation Intersex International Australia regards the book as "approachable," "compelling and recommended reading". [ 6 ]
The book was referenced by Involuntary or coerced sterilisation of intersex people in Australia, a 2013 report of a committee of the Senate of Australia in 2013. [ 7 ]
The book was nominated for the Margaret Mead Award , 2010, and a finalist for the Lambda Literary Award , 2009. [ 1 ]
|
https://en.wikipedia.org/wiki/Fixing_Sex
|
Flaccid dysarthria is a motor speech disorder resulting from damage to peripheral nervous system (cranial or spinal nerves) or lower motor neuron system. Depending on which nerves are damaged, flaccid dysarthria affects respiration, phonation, resonance, and articulation. It also causes weakness, hypotonia (low-muscle tone), and diminished reflexes. [ 1 ] [ 2 ] Perceptual effects of flaccid dysarthria can include hypernasality, imprecise consonant productions, breathiness of voice, and affected nasal emission . [ 3 ]
Flaccid dysarthria is caused when damage occurs to the motor unit (one or more cranial or spinal nerves). Processes that can cause this include: [ 1 ]
The hallmark of flaccid dysarthria is weakness, affecting different muscles, depending on where the damage has occurred. Some common signs include the following [ 4 ]
Phonation and prosody:
Damage to cranial nerve X can present as changes in voice quality. One or both vocal folds may be effectively paralyzed, or have diminished function. If a vocal fold is stuck in an adducted or closed position, the voice will be harsh and low in volume. A vocal fold stuck in an abducted or open position may cause breathiness and low volume. Listen for vocal flutter and diplophonia. Having both vocal folds stuck in an abducted position creates a breathy voice, with potential inspiratory stridor . Having both vocal folds stuck in an adducted or closed position compromises the airway significantly. In addition to these changes in phonation, someone may have issues changing their pitch or loudness. Or, they may speak in short phrases, as they release more air than normal through their larynx while speaking. [ citation needed ]
Resonance:
Damage to the cranial nerves innervating muscles that control the velum may result in hypernasal speech. This can sound like someone is saying things through their nose, making oral sounds like "b" or "d" sound more like "m" or "n", respectively. Or, there may be air release through the nose that is audible, as in an attempt to say "s".
Articulation:
Damage to the cranial nerves innervating the lips, tongue and other key muscles for making speech sounds may result in inaccurate or imprecise articulation. This may improve with rest.
Other:
Flaccid paralysis can cause muscles to atrophy or lose mass over time. Twitches in the affected muscle fibres (fasciculations) may be present. In the tongue, this resembles worms moving in the tissue. If the muscles of the face are affected (i.e. if there is damage to cranial nerve VII; V for the jaw in mastication), there may be drooping, sagging or drooling. When the tongue moves forward (as in a protrusion exercise), it will move to the stronger side. If the person is asked to move their jaw, it will be opposite (toward the weaker side). Other visible signs that accompany flaccid dysarthria include facial or soft palate droop, or nasal regurgitation with eating (again, if the velum is an affected area). Issues with eating are common, given the shared nature of the muscles for talking and those for chewing and swallowing. These require evaluation alongside any speech difficulties, and if present, may be medically serious (i.e. if material enters the lungs, or if not enough food is able to be eaten). [ citation needed ]
Treatment may be carried out by a range of professionals (i.e. speech-language pathologists/therapists, rehabilitation specialists, or others with training in this area). Treatments may include direct work on the nerves and muscles involved ( see below, organised by affected component of speech ); counselling; partner training (i.e. to improve their ability to understand the affected person, or implement exercises); or, training aimed at helping the person themselves compensate for their condition (i.e. using gestures to supplement a message; using a device to talk; advocating for others to wait while they get their message across). [ 1 ] [ 5 ] Note that treatment should be planned and supervised by a trained professional, and tailored to the individual's specific profile. [ citation needed ]
Phonation and prosody: Behavioural treatments may include turning one's head to the affected side during speech or lateralizing the thyroid cartilage; making an effortful closure of the vocal folds or an abrupt glottal attack; or, producing intense high-level phonation. Medical treatments may include surgery such as medialization laryngoplasty; arytenoid adduction; or, fat/collagen injections. Prosthetic approaches may include artificial larynges; or abdominal binders/corsets (to provide best posture for speech, and support stronger exhalation, if affected muscles include those controlling breathing). [ citation needed ]
Resonance: Behavioural treatments may include use of CPAP machines, supine positioning (lying down, to help train velum closure), or reducing pressure during held consonants (i.e. 's' or 'z' sounds). Again, some medical or prosthetic approaches may be utilised, including palatal lifts, or pharyngeal flap procedures. [ citation needed ]
Articulation: Behavioural treatments may include various speech sound strengthening or accuracy re-training exercises. [ citation needed ]
|
https://en.wikipedia.org/wiki/Flaccid_dysarthria
|
A flail limb (also flail arm or flail leg ) is a medical term which refers to an extremity in which the primary nerve has been severed or ceased to function, resulting in complete lack of mobility and sensation. Although blood typically continues to flow through the limb, it is completely useless and potential for surgical repair is limited. The muscles soon wither away from atrophy , and the limb swings loosely at the side like a "dead weight." [ citation needed ]
Flail limb can occur in cases of traumatic injury to the brachial plexus or in people with motor neuron diseases such as amyotrophic lateral sclerosis . [ 1 ] [ 2 ]
Amputation of the affected limb and replacement with a prosthesis is one option for treatment. Amputation does not reduce pain experienced. [ 1 ] [ 3 ]
This article about a medical condition affecting the nervous system is a stub . You can help Wikipedia by expanding it .
|
https://en.wikipedia.org/wiki/Flail_limb
|
Flap surgery is a technique in plastic and reconstructive surgery where tissue with an intact blood supply is lifted from a donor site and moved to a recipient site. Flaps are distinct from grafts , which do not have an intact blood supply and relies on the growth of new blood vessels. Flaps are done to fill a defect such as a wound resulting from injury or surgery when the remaining tissue is unable to support a graft, wound contraction is to be avoided or to rebuild more complex anatomic structures like breasts or jaws. [ 1 ] [ 2 ] Flaps may also carry with them tissues such as muscle and bone that may be useful in the ultimate reconstruction.
Flap surgery is a technique essential to plastic and reconstructive surgery . A flap is defined as tissue that can be moved to another site and has its own blood supply . This is in comparison to a skin graft which does not have its own blood supply and relies on vascularization from the recipient site. [ 2 ] Flaps have many uses in wound healing and are used when wounds are large, complex, or need tissue of various types and bulk for successful closure and function. [ 2 ]
Flaps can contain many different combination of layers of tissue, from skin to bone (see § Classification ). The main goal of a flap is to maintain blood flow to tissue to maintain survival, and understanding the anatomy in flap design is key to a successful flap surgery. [ 2 ]
Flaps may include skin in their construction. Skin is important for many reasons, but namely its role in thermoregulation , immune function , and blood supply aid in flap survival. [ 2 ] The skin can be divided into three main layers: the epidermis , dermis , and subcutaneous tissue . Blood is mainly supplied to the skin by two networks of blood vessels. The deep network lies between the dermis and the subcutaneous tissue, while the shallow network lies within the papillary layer of the dermis. [ 3 ] The epidermis is supplied by diffusion from this shallow network and both networks are supplied by collaterals , and by perforating arteries that bring blood from deeper layers either between muscles (septocutaneous perforators) or through muscles (musculocutaneous perforators). [ 2 ]
This robust and redundant blood supply is important in flap surgery, [ 2 ] because flaps are cut off from other blood vessels when it is raised and removed from its surrounding native tissue. [ 2 ] The remaining blood supply must then keep the tissue alive until additional blood supply can be formed through angiogenesis . [ 4 ]
The angiosome is a concept first coined by Ian Taylor in 1987. [ 5 ] It is a three-dimensional region of tissue that is supplied by a single artery and can include skin, soft tissue, and bone. [ 5 ] [ 6 ] Adjacent angiosomes are connected by narrower choke vessels, and multiple angiosomes can be supplied by a single artery. Knowledge of these supply arteries and their associated angiosomes is useful in planning the location, size, and shape of a flap. [ 4 ]
Flaps can be fundamentally classified by their mechanism of movement, the types of tissues present, or by their blood supply. [ 2 ] The surgeon generally chooses the least complex type that will achieve the desired effect via a concept known as the reconstructive ladder . [ 7 ] [ 8 ]
Flaps can be classified by the content of the tissue within them.
Classification based on blood supply to the flap:
Anyone who is unstable for surgery should not undergo flap surgery. As with most surgeries, people who are sicker may have more difficulties with wound healing , which include individuals with comorbidities such as diabetes , smoking , immunosuppression , and vascular disease . [ 15 ] [ 16 ]
The risks of flap surgery include infection, wound breakdown , fluid accumulation , bleeding , damage to nearby structures, and scarring . [ 10 ] The most notable risk in this procedure is flap death, where the flap loses blood supply. The loss of blood can be due to many reasons, but is commonly due to tension on the vascular supply and insufficient blood flow to the end segments of the flap. [ 10 ] This can sometimes be fixed with another surgery or using additional methods of healing in the reconstructive ladder. [ 17 ]
As with healing of any wound, healing of a flap maintains the same process of wound healing. There are four stages to wound healing: hemostasis , inflammation , proliferation , and remodeling , all of which can take up to a year to complete. [ 18 ] [ 2 ]
Following flap surgery, the biggest risk in recovery is flap death. Flap failure is an uncommon occurrence but does happen. The reported flap failure rate in free flaps is less than 5%. [ 19 ] The most commonly cause is by venous insufficiency consisting of 54% of all causes. [ 19 ] Venous insufficiency is commonly caused by a venous thrombus within the first 2 days following surgery. [ 19 ] [ 18 ] After the immediate postoperative risk, the flap will continue to heal adhering to the stages of normal wound healing and will take over 3 months for an incision to be at 80% tensile strength compared to normal tissue. [ 18 ]
Skin flaps are an essential part of a surgeon's toolbox in plastic surgery. It is part of the reconstructive ladder. [ 17 ] The first known reports of surgical flaps originated in 600 BC in India by Sushruta where the tilemakers' caste would reconstruct noses using regional flaps due to the practice of nose amputations as a form of legal punishment. [ 20 ] [ 17 ] The next description of flap surgery comes from Celsus, an ancient Roman who described the advancement of skin flaps from 25 BC to 50 AD. [ 20 ] [ 17 ] In the 15th century, Gaspare Tagliacozzi , an Italian surgeon, helped develop the "Italian method" for nasal reconstruction, a delayed pedicle skin graft, where the skin from the arm would be attached to the nose for many months to create the reconstruction, first printed in the 1597 book De Curtorum Chirurgia per Insitionem . [ 21 ] The Italian method was rediscovered in 1800 by German surgeon Carl Ferdinand von Graefe . [ 22 ] Major advancements in modern plastic surgery are mostly attributed to Harold Gillies , who pioneered facial reconstruction during World War I using pedicled tube flaps on patients like Walter Yeo , and the development of the walking-stalk skin flap by Gilles' cousin Archibald McIndoe in 1930. [ 20 ] [ 23 ]
Advancements continued in flap surgery. With the introduction of the operating microscope , microvascular surgery advancements allowed for the anastomosis of blood vessels. [ 12 ] This led to the ability of free tissue transfers, and in 1958 Bernard Seidenberg transferred a part of the jejunum to the esophagus to remove a cancer . [ 12 ] [ 24 ] Modern advancements in flap surgeries have continued since this time and are now commonly used in many procedures. [ 12 ]
|
https://en.wikipedia.org/wiki/Flap_(surgery)
|
Flat forehead is a dysmorphic feature in which the surface of the forehead is unusually flat. [ 1 ] [ 2 ]
Flat forehead is seen in the following conditions and syndromes: [ 1 ]
|
https://en.wikipedia.org/wiki/Flat_forehead
|
A flatline is an electrical time sequence measurement that shows no activity and therefore, when represented, shows a flat line instead of a moving one. It almost always refers to either a flatlined electrocardiogram , where the heart shows no electrical activity [ 1 ] ( asystole ), or to a flat electroencephalogram , in which the brain shows no electrical activity ( brain death ). Both of these specific cases are involved in various definitions of death .
A cardiac flatline is also called asystole . It can possibly be generated by malfunction of the electrocardiography device, but it is recommended to first rule out true asystole because of the emergence of such condition.
Definition:
A cardiac flatline is referred to as asystole. It can be identified by using an ECG/EKG (electrocardiogram) test. Asystole occurs when the electrical and mechanical activities of the heart stop. [ 2 ]
Causes:
ECG/EKG flatline or asystole occurs when the heart's electrical and mechanical activities stop. It also results from other causes such as hypoxia , acidosis , hypokalemia , hyperkalemia , hypovolemia , toxins, pulmonary thrombosis , and coronary thrombosis . Additional causes could also include tension pneumothorax and cardiac tamponade . These conditions should be treated immediately when identified. [ 3 ] [ 2 ]
ECG flat line also occurs when the electrocardiographic (ECG/EKG) leads or recording electrodes are placed incorrectly. It can be caused by malfunction of the electrocardiogram (ECG/EKG) machine. [ 3 ]
Diagnosis:
ECG flatline or asystole is diagnosed when a person, who is in cardiac arrest (the heart stops beating), is experiencing the following conditions:
The electrocardiogram (ECG) test records the heart's electrical activity and will show a flat line if the heart stops beating. [ 2 ]
Definition:
A neurological flatline is referred to as brain death . It can be identified by using an EEG ( electroencephalogram ) test. Brain death is the loss of function of the brain, the cerebrum , that is responsible for thinking and the deep brain or the brain stem that is responsible for the breathing and reflexes such as pupillary light reflex (the constriction of the pupil of the eye in response to light) and gag reflex or pharyngeal reflex (contraction of pharyngeal muscle). [ 4 ]
Causes:
EEG flat line or brain death can result from a head injury that leads to brain damage and bleeding. Brain death also results from a lack of blood flow to the brain because the heart stops beating (cardiac arrest), which is when the ECG imaging shows a cardiac flat line (asystole). [ 4 ]
Diagnosis:
Brain death is diagnosed if a person is experiencing all of the following three conditions:
The electroencephalogram (EEG) records the brain's electrical activity and will show a flat line if the brain is dead. [ 4 ]
In a study published in the New England Journal of Medicine, 631 subjects' end of life was observed. Of the 631 subjects, 480 subjects were analyzed using a computer program that recorded each subject's vitals in order to monitor for return of pulse or heart activity after at least 1 minute of flatlining. The study found that 14% of subjects had a return of heart activity but none regained consciousness. [ 5 ] Neuro flatline or brain death happens after cardiac arrest or cardiac flatline. It can take 2 to 20 seconds after cardiac flatline for the brain to show no activity. [ 6 ]
The definition of death has changed over time, but the loss of cardiac and neurological function have been the main criteria for centuries. The concept of flatlining begins to take form with the invention of technologies for death determination.
It began in 1837 when Professor Manni at the University of Rome offered a cash prize to the doctor who could offer a true test of death. The winner, Dr. Eugene Bouchut used new technology– the stethoscope– to determine death when heart sounds were absent for over two minutes. In 1883 he updated his criteria to require five minutes without heart sounds to qualify cardiac death. [ 7 ]
Then, the standard for viewing cardiac activity changed in 1887 when Augustus Waller recorded the first ECG from the human heart with a mercury capillary electrometer. [ 8 ] This sparked research into modern ECG technology, which was developed from the mercury capillary electrometer by Willem Einthoven. In 1901 to 1905, Einthoven developed the string galvanometer , which could measure and record the heart's electrical activity. Electrodes were place on three points, the “Einthoven leads”, the right and left arms and on the left foot same as today and provided precise recordings of the heart. [ 9 ] This led to Einthoven's Nobel Prize in 1924. [ 10 ] [ 8 ] With the ECG, the characteristics of a dying heart were identified, creating the leading tool for diagnosing death– even to this day. [ 7 ]
However, in the mid 19th century with the invention of the defibrillator and cardioversion, it was realized that the flatline on the ECG did not always mean death. [ 7 ] This instigated research into other ways to determine death, which eventually lead to the idea of brain death.
In 1924, a German physiologist and psychiatrist Hans Berger recorded the first EEG on a human brain. [ 11 ] The machine consisted of steel electrodes that get mounted on the scalp with an EEG cap to visualize and interpret signals. [ 12 ] He noted that the human brain has a specific pattern, called alpha oscillations, and went on to publish this in 1929. [ 13 ] The presence of this technology along with resuscitation technology saw the use of the EEG to determine a time in which the person had reached total death. In 1959, this concept– brain death– was first coined as: "le coma dépassé by Mollaret and Goulon. [ 12 ] They determined that a person reached this state when they were apneic, comatose, without brainstem reflexes, and showed no electroencephalographic (EEG) activity. [ 12 ]
When an individual experiences asystole or cardiac flatline, there is no electrical activity in their heart which is evidenced by the flatline recorded by an ECG. [ 2 ] The lack of electrical activity also means that the individual's heart will stop pumping. Following a cardiac flatline a fast intervention is a priority and can affect individual outcomes and recovery.
Treatment [ 14 ] for cardiac flatline or asystole can involve:
Treatment decisions will depend on where an individual is when they go into asystole. When an individual goes into cardiac arrest providers will start CPR immediately and then try to determine whether the rhythm is shockable. While defibrillation is often portrayed as a common treatment option in popular media, since asystole is an unshockable rhythm defibrillation is not a recommended course of treatment. Successful resuscitation is generally unlikely and is inversely related to the length of time spent attempting resuscitation.
Following a treatment intervention, the individuals who survive may still suffer long-term consequences of their cardiac flatline. [ 16 ]
An individual's cardiac flatline can progress to neurological flatline, which is also referred to as brain death. After an individual's heart stops beating, if providers are unable to successfully intervene within the window, the individual's brain cells will die from this lack of blood and oxygen and this damage is irreversible and permanent. The criteria to diagnose brain death has been outlined in the above sections of this article. While brain death cannot be treated, individuals and their families have several options [ 4 ] available to them:
|
https://en.wikipedia.org/wiki/Flatline
|
A fleam , also flem , flew , flue , fleame , or phleam , was a handheld instrument used for bloodletting .
This name for handheld venipuncture devices first appears in Anglo-Saxon manuscripts around 1000. [ 1 ] The name is most likely derived from phlebotome: phlebos , Greek for blood vessel and tome , meaning to cut. [ 2 ] These instruments are the progression from the early use of fish teeth, sharpened stones, and thorns used to penetrate blood vessels.
The earliest known examples are made of bronze with a myrtle-leaf shape to the blade. In the 17th and 18th centuries, the German Fliete and French flamettes were developed. These devices with their right-angle blades are the earliest forms of what collectors now refer to as the fleam. [ 3 ]
While there are reports of this type of instrument being used in humans, it is more likely that these were reserved for veterinary use, while the common thumb lancet was the instrument of choice for use in people. A survey of 100 fleams found thumb lancets in 6%. [ 4 ] These instruments with their triangular-shaped blades were designed to be placed over the vein (most commonly the jugular or saphenous) and struck with a fleam stick. This would ideally result in rapid penetration of the vein with minimal risk to the operator and minimal dissection of the subcutaneous tissues. The latter point was considered important in minimizing the formation of a dissecting hematoma.
Once the desired blood was drained from the patient, the operator would place a pin through the edges of the incision. A figure eight of tail hair or thread was then placed over the pin to retain closure. [ 5 ] Statements from Mayhew in his 1864 treatise indicate that the perceived benefits of these procedures were coming into great question in the latter half of the 19th century for all conditions except laminitis . [ 5 ]
Early craftsmen often varied the number of blades, the types of materials used for the bolsters, and the types of instruments included in the bolster for patient care. Pictured to the right is a three-blade fleam with a horn handle made in Scotland by the Sanderson craftsmen. This piece has a thumb lancet in one shield of the bolster and a thumb forceps in the other.
Controversy exists among collectors of antique surgical instruments that these types of fleams were made with the lancet so that rural families could bleed the animals and family members alike. Although there are descriptions of the use of thumb lancets in horses for opening the facial vein and for bleeding cats and dogs, the dimensions of the lancets fitted into fleams fit the dimensions of those described by Kirkup for human use. [ 4 ] [ 6 ]
|
https://en.wikipedia.org/wiki/Fleam
|
Flicker vertigo , sometimes called the Bucha effect , is "an imbalance in brain-cell activity caused by exposure to low-frequency flickering (or flashing) of a relatively bright light." [ 1 ] It is a disorientation -, vertigo -, and nausea -inducing effect of a strobe light flashing at 1 Hz to 20 Hz, approximately the frequency of human brainwaves . [ 2 ] [ 3 ] The effects are similar to seizures caused by epilepsy (in particular photosensitive epilepsy ), but are not restricted to people with histories of epilepsy.
This phenomenon has been observed during helicopter flight; a Dr. Bucha identified the phenomenon in the 1950s when called upon to investigate a series of similar and unexplained helicopter crashes. [ citation needed ] Flicker vertigo in a helicopter occurs when the pilot or front passenger looks up through the blades of the main rotor as it turns in the sun causing the light to strobe .
The strobe light effect can cause persons who are vulnerable to flicker vertigo to experience symptoms such as:
These effects are typically very minor and will most often subside within seconds once exposure to the strobe effect has ceased, though residual nausea and minor disorientation may be felt for several minutes.
In extremely rare cases, severe reactions can happen including:
This situation can occur whenever flickering light conditions exist. Examples of this include:
[ 4 ]
According to The US Naval Flight Surgeons Manual, flicker vertigo is a rare occurrence. [ 5 ]
Flicker vertigo has been considered as a principle for various forms of non-lethal weapons . [ 6 ] [ 7 ] A related crowd-control device was invented by Charles Bovill, which "employed a combination of ultra-sonic waves and strobe lights to induce acute discomfort, sickness, disorientation and sometimes epilepsy." [ 8 ]
|
https://en.wikipedia.org/wiki/Flicker_vertigo
|
Flora Murray CBE (8 May 1869 – 28 July 1923) [ 1 ] was a Scottish medical pioneer, and a member of the Women's Social and Political Union suffragettes . [ 2 ] From 1914 to the end of her life, she lived with her partner and fellow doctor Louisa Garrett Anderson . [ 3 ]
Murray was born on 8 May 1869 at Murraythwaite, Dumfries , Scotland, the daughter of Grace Harriet Murray (née Graham) and John Murray, a landowner and Royal Navy captain. [ 4 ] Murray was the fourth of six children.
Murray attended school in Germany and London before attending the London Hospital in Whitechapel in 1890, as a probationer nurse, for a six-month course. Murray decided on her career in medicine and went on to study in the London School of Medicine for Women in 1897. [ 5 ] [ 6 ] She then worked as a Medical assistant for 18 months at an asylum at the Crichton Royal Institution in Dumfriesshire . This experience was crucial in her writing of her MD thesis called 'Asylum Organization and Management' (1905). [ 5 ] She completed her medical education at Durham University , receiving her MB BSc in 1903, and MD in 1905. She received a Diploma in Public Health from the University of Cambridge in 1906. [ 6 ]
During her time in Scotland, Murray lived in Edinburgh with Dr Elsie Inglis , founder of the Scottish Women's Hospitals movement. [ 7 ] Historians such as Hamer and Jennings have argued that Murray had her "first serious lesbian relationship" with Elsie Inglis. [ 8 ] [ 7 ]
In 1905 Murray was a medical officer at the Belgrave Hospital for Children in London and then an anaesthetist at the Chelsea Hospital for Women . In 1905 The Lancet published an article that she authored on the use of anaesthetic in children, titled Ethyl chloride as an anaesthetic for children . [ 9 ]
Murray's hand in women's suffrage first started when she became a participant and activist of Millicent Fawcett 's National Union of Women's Suffrage Societies . She then continued her work in women's suffrage as a supporter of Women's Social and Political Union. She also became a consistent participant in the militant movement, offering her services as a practitioner including at the Pembroke Gardens nursing home for suffragettes recovering from force-feeding, run by Nurses Catherine Pine and Gertrude Townend . [ 10 ] [ 11 ]
She took a leadership role and showed her value as an activist by speaking at public gatherings, becoming a member in the 1911 census protest, and using her medical knowledge and skill to treat her fellow suffragettes who experienced injuries through their work as activists. [ 5 ] She looked after Emmeline Pankhurst and other hunger-strikers after their release from prison and campaigned with other doctors against the forcible feeding of prisoners. [ 12 ]
In 1912 she founded the Women's Hospital for Children at 688 Harrow Road with Louisa Garrett Anderson . It provided health care for working-class children of the area, and gave women doctors their only opportunity to gain clinical experience in paediatrics in London; the hospital's motto was Deeds not Words . [ 12 ]
When the First World War broke out, Murray and her partner Dr Louisa Garrett Anderson founded the Women's Hospital Corps (WHC), and recruited women to staff it. [ 13 ] Believing that the British War Office would reject their offer of help, and knowing that the French were in need of medical assistance, they offered their assistance to the French Red Cross. [ 14 ] The French accepted their offer and provided them the space of a newly built hotel in Paris as their hospital. [ 12 ] Flora Murray was appointed Médecin-en-Chef (chief physician) and Anderson became the chief surgeon. [ 14 ]
Murray reported in her diary that visiting representatives of the British War Office were astonished to find a hospital run successfully by British women, and the hospital was soon treated as a British auxiliary hospital rather than a French one. [ 14 ] In addition to the hospital in Paris, the Women's Hospital Corps also ran another military hospital in Wimereux . [ 12 ]
In January 1915, casualties began to be evacuated to England for treatment. The War Office invited Murray and Anderson to return to London to run a large hospital, the Endell Street Military Hospital (ESMH), under the Royal Army Medical Corps . ESMH treated almost 50,000 soldiers between May 1915 and September 1919 when it closed. [ 12 ]
After the war ended, Murray returned to Harrow Road hospital which was renamed Roll of Honour Hospital, where she continued her work as a private practitioner. Her diary about her experiences of the War became a book titled Women as Army Surgeons: Being the History of the Women's Hospital Corps in Paris (1920) . The book's dedication reads, "To Louisa Garrett Anderson / Bold, cautious, true and my loving companion." [ 8 ]
Lack of funding eventually led to the closure of the Roll of Honour Hospital, and also the retirement of both Murray and Anderson. They moved to a cottage in Paul End, in Penn , Buckinghamshire . [ 5 ]
Murray and Anderson were both appointed to the Order of the British Empire as Commanders (CBE) in August 1917, as part of the first group to receive the honour.
Murray suffered from cancer and died on 28 July 1923, aged 54. Her death occurred shortly after her surgery in a nursing home in Hampstead, London . Her lifelong partner was by her side. [ 12 ] Murray left everything to Anderson in her will. [ 15 ] Murray is buried at the Holy Trinity Church at Penn, Buckinghamshire , near the couple's former home. While Anderson was later cremated and her ashes scattered over the South Downs, a shared tombstone memorialises both women. [ 16 ]
To the dear love of comrades and in memory of
Flora Murray
CBE, MD, BS Durham, DPH. Cambridge
Daughter of Com John Murray RN
Murraythwaite, Dumfriesshire
Born 8 May 1869
Died 26 July 1923
She commanded the military hospital Endall Street London with the rank of Lieutenant Colonel RAMC 1915 -1919
God gave her the strength to lead, to pity and to heal
And of her friend
Louisa Garrett Anderson
C.B.E., M.D., Chief Surgeon Women's Hospital Corps 1914–1919
Daughter of James George Skelton Anderson and Elizabeth Garrett Anderson of Aldeburgh, Suffolk.
Born 28 July 1873
Died 15 November 1943
WE HAVE BEEN GLORIOUSLY HAPPY
In April 2022, it was announced that Murray would appear on the 'reverse side' of the new polymer £100 banknote to be issued by Bank of Scotland to highlight her work in medicine and in women's rights. [ 17 ] The note will feature a portrait of Murray by Francis Dodd . The chief executive of the Royal Free London NHS Foundation Trust noted that "Almost a century since her death, Flora's story is a reminder of the huge debt of gratitude we owe to those early agitators who refused to accept the limitations imposed by a society that didn't believe women could or should be doctors, physicians and surgeons. “Then and now, we embrace the pioneers, the innovators, and the game-changers." [ 18 ]
The banknote came third in the 2023 'world's most beautiful banknote' contest, with the image of Murray on the reverse side, in the foreground and her female stretcher-bearers at Endell Street Hospital in the background. She also appears uniquely in the banknote's front security hologram. [ 19 ]
|
https://en.wikipedia.org/wiki/Flora_Murray
|
A flow diverter is an endovascular prosthesis used to treat intracranial aneurysms . [ 1 ] It is placed in the aneurysm's parent artery, covering the neck, in order to divert blood flow and determine a progressive thrombosis of the sac. [ 2 ] Flow diverting stents consist of structural Cobalt-chrome or Nitinol alloy wires and often a set of radiopaque wires woven together in a flexible braid. [ 3 ]
Flow diverters are treatment for intracranial aneurysms alternative to endosaccular coil embolization, although the techniques can be combined, especially in large/giant aneurysms. It is mainly effective in wide neck unerupted saccular aneurysms , that are difficult to coil because of the tendency of the coils to fill the parent artery (referred to as prolapse). Another situation is fusiform shape or circumferential aneurysms. [ 4 ] Prior to flow diverters many intracranial aneurysms went untreated. [ 5 ] Flow diverters can be placed in the parent vessel or within the aneurysm, which are called intrasaccular flow diverters. [ 6 ] [ 7 ] These devices can be used to treat aneurysms by doing a cerebral angiogram via femoral artery or radial artery access. [ 7 ]
The efficacy of flow diverters can be evaluated using a grading system developed by researchers at Oxford Neurovascular and Neuroradiology Research Unit (Kamran et al. 2011), commonly referred to as flow diverter grading system or Kamran grading system . [ 8 ] After receiving a cerebral flow diverter, patients are placed on dual antiplatelet therapy for an extended period of time to reduce the likelihood of peri-procedural and post-procedural thromboembolic complications. [ medical citation needed ]
The degree of aneurysm occlusion is graded on a five-point scale from 0 (no change in the endoaneurysmal flow) to 4 (complete obliteration of the aneurysm). The patency status of the parent artery is evaluated on a three-point scale, from no change in the parent artery diameter to parent artery occlusion. This grading system is used in clinical practice. It has also been used and adapted by researchers to evaluate and report the effectiveness of flow diverters in general. [ 9 ]
|
https://en.wikipedia.org/wiki/Flow_diverter
|
Fluoride therapy is the use of fluoride for medical purposes. [ 2 ] Fluoride supplements are recommended to prevent tooth decay in children older than six months in areas where the drinking water is low in fluoride. [ 3 ] It is typically used as a liquid, pill, or paste by mouth. [ 4 ] Fluoride has also been used to treat a number of bone diseases . [ 5 ]
Relatively high ingestion of fluoride by babies and children may result in white marks on the teeth known as fluorosis . [ 4 ] Excessive ingestion by babies and children can result in severe dental fluorosis, indicated by a brown or yellow coloring, weakening and brittleness of the teeth, or in severe cases, acute toxicity . Fluoride therapy typically uses the sodium fluoride form, though stannous fluoride may also be used. [ 4 ] [ 5 ] Fluoride decreases breakdown of teeth by acids, promotes remineralisation , and decreases the activity of bacteria . [ 5 ] Fluoride works primarily through direct contact with teeth. [ 3 ] [ 5 ]
Fluoride came into use to prevent tooth decay in the 1940s. [ 6 ] Fluoride is on the World Health Organization's List of Essential Medicines . [ 7 ] In 2021, it was the 291st most commonly prescribed medication in the United States, with more than 600,000 prescriptions. [ 8 ] [ 9 ]
Fluoride therapy has a beneficial effect on the prevention of dental caries . [ 10 ] Fluoride toothpaste, with concentrations of 1000 ppm and above, reduces the risk of dental caries in school-aged children and adolescents. [ 10 ] As primary teeth are being developed, the ingestion of fluoride causes the teeth to form stronger and more resistant to cavities, although this increases the risk of dental fluorosis. [ 10 ] [ 11 ] [ 12 ] Water and milk fluoridation are two forms of systemic fluoride therapy that are effective at preventing dental cavities. [ 13 ]
Fluoride supplementation has been studied for the treatment of postmenopausal osteoporosis , for which it does not appear to be effective. Even though sodium fluoride increases bone density, it does not decrease the risk of fractures. [ 14 ] [ 15 ]
The use of fluoride toothpaste (with concentrations of 1000 ppm and above) and fluoride supplements in children below the age of six years, especially within the first three years of life, is associated with a greater risk of dental fluorosis. [ 10 ] The use of fluoride supplements during the last six months of pregnancy has no significant impact on the incidence of fluorosis in children. [ 16 ] Optimal water fluoridation for the prevention of dental caries increases the prevalence of dental fluorosis by 4 to 5%. [ 13 ] The observed effects are mild to moderate, usually of minimal aesthetic concern. [ 13 ]
Water fluoridation is not linked to the development of osteoporosis or cancer. [ 13 ]
Consumption of large amounts of fluoride can lead to fluoride poisoning and death. The lethal dose for most adult humans is estimated at 5 to 10 grams, equivalent to 32 to 64 mg elemental fluoride per kg of body weight. [ 17 ] [ 18 ] [ 19 ] Ingestion of fluoride can produce gastrointestinal discomfort at doses as low as 0.2 mg/kg, 20 times lower than lethal doses. [ 20 ] Chronic intake and topical exposure may cause dental fluorosis , and excess systematic exposure can lead to skeletal fluorosis . The American Dental Association (ADA) recommends infants primarily consume human milk to reduce fluoride intake and prevent infants developing fluorosis. [ 21 ]
In 1974, a three-year-old child swallowed 45 milliliters of 2% fluoride solution, triple the fatal amount, and died. The fluoride was administered during his first visit to the dentist, and the dental office was later found liable for the death. [ 22 ]
Strictly speaking, fluoride therapy repairs rather than prevents damage to the teeth, causing the mineral fluorapatite to be incorporated into damaged tooth enamel. Fluorapatite is not a natural component of human teeth, although it is found in the teeth of sharks . The main mineral found in natural tooth enamel is hydroxyapatite rather than the fluorapatite created in the presence of fluoride. Even without fluoride, teeth experience alternating increases and decreases in mineral content, depending upon how acidic or alkaline the mouth is, and depending upon the concentration of other substances in the mouth, such as phosphate and calcium.
Fluoride reduces the decay of tooth enamel by the formation of fluorapatite and its incorporation into the dental enamel. The fluoride ions reduce the rate of tooth enamel demineralization and increase the rate of remineralization of teeth at the early stages of cavities. Fluoride exerts these effects by the demineralization and remineralization cycle. [ 23 ] The remineralization cycle, critical to decay prevention, occurs when fluoride is present in the oral cavity. After fluoride is swallowed it has a minimal effect. [ 10 ] [ 24 ] [ 25 ]
Fluoride ions are involved in three principal reactions of remineralization: [ 24 ]
Iso-ionic exchange by the replacement of F − for OH¯ in apatite and crystal growth of fluorapatite from supersaturated solutions are able to occur during exposure to low levels of fluoride (0.01–10 ppm F) over long periods of time. Reaction of apatite dissolution with CaF 2 formation occurs in higher levels of fluoride (100–10,000 ppm F) and the addition of CaF 2 or a CaF 2 containing compound. [ 24 ]
Fluoride's effect on oral microflora and the significance of this effect on fluoride's overall effectiveness against cavities does not currently have a consensus. [ 23 ] [ 24 ] Many studies on bacterial cells in laboratories have shown the fluoride has many effects on them as an antimicrobial agent. The antimicrobial effects require concentrations of fluoride at least 10 ppm F, which only occurs briefly in the mouth with oral fluoride-containing products. [ 23 ] A study looked at fluoride's effects on oral microflora and concluded that fluoride may not solely interact as an antimicrobial agent, acting additionally to reduce bacterial adhesion to teeth, along with the primary action of decreasing demineralization. Further investigation will need to be done to verify these claims. [ 26 ]
Fluoride can be delivered by many chemical methods ( sodium fluoride , stannous fluoride , amine fluoride , monofluorophosphate , and more). The anti-caries performance differences between them have been shown to have less effect than variations in behavior shown by individuals in brushing, using fluoride products and post use behavior. Often the chemical form of fluoride is driven by compatibility with the other elements mixed with, price, and such. [ 23 ]
All fluoridation methods provide low concentrations of fluoride ions in saliva, thus exerting a topical effect on the plaque fluid. [ 27 ] Fluoride does not prevent cavities but rather controls the rate at which they develop, and so repeated exposure throughout the day is essential for its effective function. [ 23 ] The more constant the supply the more beneficial fluoride will be in cavity prevention. [ 23 ] [ 24 ]
Water fluoridation is the controlled addition of fluoride to a public water supply in order to reduce tooth decay. [ 28 ] Its use in the U.S. began in the 1940s, following studies of children in a region where water is naturally fluoridated. In 1945, Grand Rapids, Michigan became the first city in the world to fluoridate its drinking water. The Grand Rapids water fluoridation study was originally sponsored by the U.S. Surgeon General, but was taken over by the NIDR shortly after the institute's inception in 1948. [ 29 ] Fluoridation is now used for about two-thirds of the U.S. population on public water systems [ 30 ] and for about 5.7% of people worldwide. [ 31 ] Although the best available evidence shows no association with adverse effects other than fluorosis, most of which is mild, [ 13 ] water fluoridation has been contentious [ 31 ] and opposition to water fluoridation exists despite its support by public health organizations. [ 32 ] Water fluoridation is the most cost-effective way to induce fluoride, with an estimated cost between US$0.50 and $3.00 per person per year, depending on the size of the community involved. [ 33 ] A dollar spent on fluoridating water is estimated to save $7–42 on dental treatment. [ 33 ]
Most toothpastes contains between 0.22% (1,000 ppm ) and 0.312% (1,450 ppm) fluoride, usually in the form of sodium fluoride , stannous fluoride , or sodium monofluorophosphate (MFP).
Frequent use of toothpaste with 1,100 ppm fluoride content enhances the remineralization of enamel and inhibits the demineralization of enamel and root surfaces. [ 34 ]
Most toothpastes with fluoride contain mild abrasives in order to remove heavier debris and light surface staining. [ 35 ] These abrasives include calcium carbonate, silica gels, magnesium carbonates and phosphate salts. [ 35 ]
Fluoride is available in three forms during toothbrushing. First, it is available as a free ionic fluoride which can react with the tooth structure, interfere with the metabolism of bacteria in plaque, or absorb to the oral mucosa. [ 36 ] Second, it is available as profluoride compounds which can precipitate in the mouth during toothbrushing and release ionic fluoride. [ 36 ] Lastly, fluoride in toothpaste can exist as unavailable fluoride compounds which do not release fluoride ions. This is due to the fluoride ions being swallowed or expelled when spitting. [ 36 ]
High-fluoride content toothpaste generally contains 1.1% (5,000 ppm) sodium fluoride toothpaste. This type of toothpaste is used in the same manner as regular toothpaste. The application of high-fluoride content toothpaste in adults twice daily improves the surface hardness of untreated root decay when compared to toothpaste with regular fluoride content. [ 37 ] [ 38 ]
Fluoridated toothpaste is also available in the form of 0.454% stannous fluoride (SnF 2 with fluoride concentration 1,100 ppm). When combined with the stannous ion (Sn 2+ ), fluoride in toothpaste appears to have a wide range of benefits to oral health.
Toothpastes containing stannous fluoride have been shown to be more effective than other fluoride toothpastes for reducing dental decay , [ 39 ] dental erosion , [ 40 ] [ 41 ] [ 42 ] [ 43 ] gingivitis , [ 44 ] [ 45 ] [ 46 ] [ 47 ] [ 48 ] tooth hypersensitivity , [ 49 ] dental plaque , [ 45 ] [ 48 ] calculus (tartar) [ 50 ] and stains. [ 50 ] A systematic review revealed stabilised stannous fluoride-containing toothpastes caused a reduction of plaque, gingivitis and staining in clinical trials, with a significant reduction in calculus and halitosis compared to other toothpastes. [ 51 ]
Anti-sensitivity toothpastes with fluoride are also available for those who have sensitive teeth. Some anti-sensitivity toothpastes with fluoride on the market contain the ingredients called strontium chloride or potassium nitrate which help to alleviate tooth sensitivity. [ 35 ]
Fluoride mouth rinses can be professionally applied by a dental professional or used at home. The most common fluoride compound used in mouth rinse is neutral sodium fluoride. Fluoride mouth rinses range from 0.05% to 0.2% (225–1,000 ppm) in concentration. [ 52 ] The fluoride rinse with a 0.05% fluoride content is used for daily rinsing, while the rinse with 0.2% fluoride content is used for weekly rinsing and in school-based weekly rinsing programs. [ 53 ] Fluoride at these concentrations is not strong enough for people at high risk for tooth decay. Regular use of a daily (230 ppm) or weekly (900 ppm) fluoride mouth rinse under supervision results into a reduction of tooth decay in children's permanent teeth. [ 54 ] After a fluoride mouthrinse treatment, the fluoride in the mouthrinse is retained in the saliva which helps prevent tooth decay. [ 53 ]
Fluoride mouth rinses are recommended for use in conjunction with other fluoride therapies, but is usually contraindicated for children under six years old as they may swallow the rinse and increase their risk of dental fluorosis. [ 53 ] [ 54 ] In areas without fluoridated drinking water, these rinses are recommended for children.
Many brands of topical fluoride exist. [ 55 ] They are not recommended if a person is drinking water that already contains sufficient fluoride. [ 55 ]
There are several types of professionally applied fluoride gels and foams on the market. The types of professionally applied fluoride gels include 2.0% neutral sodium fluoride and 1.23% acidulated phosphate fluoride. [ 53 ] Acidulated phosphate fluoride (APF) gel or foam comprises a sodium fluoride solution, paste, or powder that has been acidulated with hydrofluoric acid to pH 3 to 4, buffered with a phosphate , and mixed with a gel or foam vehicle such as carboxymethyl cellulose . 1.23% acidulated phosphate fluoride gel or foam is used for patients without tooth-colored restorations, while 2.0% neutral sodium fluoride is used for patients with composites, porcelain, titanium, sealants or sensitivity. [ 56 ]
Professionally applied fluoride gel or foam is applied through the use of a foam mouth tray which is held in the mouth by gently biting down. The application usually lasts for approximately four minutes, and patients should not rinse, eat, smoke, or drink for 30 minutes after application. The reason for this is to allow the teeth to absorb the fluoride into the tooth structure when it is at its highest concentration, without being interrupted. This aids in the repair of microscopic dental decay. [ 57 ] There is no clinical evidence on the effectiveness of one-minute fluoride gel/foam applications. [ 58 ] A specific benefit when using foam is that less product is required during application, which results in a lower fluoride dose and lessens the risk of accidental ingestion. [ 58 ] Additionally, more research regarding the efficacy of fluoride foam is needed as the evidence for its effectiveness is not as strong compared to those of fluoride gels and varnish. [ 58 ]
Some gels are made for home application with the use of a custom tray. A model of a person's teeth can be made by a dental professional, who then uses that to make trays, similar to a sport guard tray, which is put over their teeth. The patient can then use this to hold a fluoride treatment against their teeth overnight or several minutes during the day. The concentration of fluoride in these gels is much lower than in professional products. [ 53 ] The self-applied sodium fluoride gel/foam typically contains 0.5% fluoride and stannous fluoride gel/foam contains 0.15%. [ 53 ]
Head and neck radiation treatment may destroy the cells of the salivary gland which can result in dry mouth. Patients with reduced salivary flow are at an increased risk of tooth decay. The home application of 1.1% fluoride gel with a custom tray is recommended for patients undergoing or are finished with head and neck radiation treatment and patients with decreased salivary flow. [ 59 ]
More research is required regarding the efficacy of fluoride gels in treating initial dental decay lesions. [ 60 ]
Fluoride varnish has practical advantages over gels in ease of application and use of smaller volume of fluoride than required for gel applications. The principle of fluoride varnish is to apply fluoride salt in a very high concentration (approximately 50,000 ppm) onto the surface of the teeth. [ 36 ] Fluoride varnish is a resin-based application that is designed to stay on the surface of the teeth for several hours. As this varnish rests on the tooth's surface, saliva dissolves the fluoride salt, which in turn allows fluoride ions to be released and absorbed by the teeth and soft tissues. [ 36 ] Later, the fluoride is re-released into the oral cavity from these reservoirs which acts as protection for the teeth against cavities. [ 36 ] Currently, there is also no published evidence that indicates that professionally applied fluoride varnish is a risk factor for enamel fluorosis . The varnish is applied with a brush and sets within seconds.
Fluoride varnish has shown to be effective in reducing initial dental decay lesions in both primary and permanent dentition. [ 60 ] Application of fluoride varnish every six months is effective in preventing dental decay in primary and permanent teeth of children and adolescents. [ 58 ]
Devices that slowly release fluoride can be implanted on the surface of a tooth, typically on the side of a molar where it is not visible and does not interfere with eating. The two main types are copolymer membrane and glass bead. These devices are effective in raising fluoride concentrations and in preventing cavities, but they have problems with retention rates, that is, the devices fall off too often. [ 61 ] A 2018 Cochrane review found insufficient evidence to determine the effect of slow-release fluoride glass beads in caries-inhibiting when compared to other types of fluoride therapy. [ 62 ]
Fluoridated lozenges may contain about 1 mg fluoride each, and are meant to be held in the mouth and sucked. The dissolved lozenge is swallowed slowly, so the use of lozenges is both a topical and a systemic therapy. A 1955 study comparing the effects of fluoride lozenges and fluoride pills provided clear evidence early that fluoride acts topically. [ 24 ] [ 63 ]
Medical fluoride supplements in the form of tablets, lozenges, or liquids (including fluoride-vitamin preparations) are used primarily for children in areas without fluoridated drinking water. The evidence supporting the effectiveness of this treatment for primary teeth is weak. The supplements prevent cavities in permanent teeth. A significant side effect is mild to moderate dental fluorosis . [ 10 ] A Cochrane review also found no evidence that daily fluoride supplementation in pregnant women was effective in preventing tooth decay or causing fluorosis in their children. [ 64 ]
|
https://en.wikipedia.org/wiki/Fluoride_therapy
|
Fluoro-jade stain is a fluorochrome derived from fluorescein , and is commonly used in neuroscience disciplines to label degenerating neurons in ex vivo tissue of the central nervous system . The first fluoro-jade derivative was reported by Larry Schmued in 1997 as an alternative method from traditional methods for labeling degenerating neurons such as silver nitrate staining, H&E stain , or Nissl stain . [ 1 ] Fluoro-jade may be preferred to other degenerative stains due to simplicity of staining procedures and visual interpretation, which are common drawbacks of conventional degenerative stains. However, the mechanism by which fluoro-jade labels degenerating neurons is unknown thus creating some controversy to the actual physiological condition of the labeled cells.
Currently, there are three fluoro-jade dyes (fluoro-jade, [ 1 ] fluoro-jade B, [ 2 ] and fluoro-jade C [ 3 ] ), all of which are anionic derivatives of fluorescein and highly acidic . [ 3 ] Specifically, fluoro-jade is a mixture of 5-carboxyfluorescein and 6-carboxyfluorescein disodium salts, whereas fluoro-jade B is a mixture of (1) trisodium 5-(6-hydroxy-3-oxo-3H-xanthen-9yl)benzene, 1,2,4 tricarboxylic acid, (2) disodium 2-(6-hydroxy-3-oxo-3H-xanthen-9yl)-5-(2,4-dihydroxybenzol)terephthalic acid, and (3) disodium 2,5-bis(6-hydroxy-3-oxo-3H-xanthen-9yl)terephthalic acid. [ 4 ] All three fluoro-jade species have similar excitation and emission profiles as fluorescein (excitation: 495 nm; emission:521 nm) and thus can be visualized using a fluorescein/FITC filter. The newer dyes, fluoro-jade B and fluoro-jade C, were developed to improve signal to noise ratio, therefore creating superior compounds for visualizing finer neuronal morphology including dendrites, axons and nerve terminals.
Nearly all processed tissue is compatible with fluoro-jade stain including tissue from rodents (mice and rats), non-human primates and humans. Mounted tissue is stepwise rehydrated with decreasing concentrations of alcohol . Potassium permanganate may be used to decrease background staining and protect tissue from fading and photo bleaching. Fluoro-jade is highly soluble in water and is therefore first dissolved in distilled water . In order to be specific for degenerating neurons, fluoro-jade must be used in an acidic environment, therefore fluoro-jade is further diluted in glacial acetic acid . Additional water washes should be used to rinse tissue before drying and coverslipping. [ 1 ]
Fluoro-jade staining procedures are flexible and therefore can be adapted to be compatible with other staining techniques such as immunohistochemistry . Several modifications to the general procedures can be made such as reducing potassium permanganate incubations to avoid disrupting immunofluorescent labeling. Background can be decreased by alternative methods such as lowering staining temperature or decreasing fluoro-jade concentration, which may be more compatible with other labeling techniques. [ 1 ] Such alterations, however should be determined empirically to optimize specific experimental conditions.
In addition to staining tissue from treated subjects, positive and negative controls should be included to ensure method specificity and validity. Typically tissue from untreated control subjects is included to show specificity for degenerating neurons as fluoro-jade should not stain non-degenerating tissue. Additionally, a positive control is included to ensure validity of staining procedures; to show that degenerating neurons will be stained with fluoro-jade. An acceptable positive control includes neurodegenerative tissue from subjects where fluoro-jade has already been validated, such as kainic acid treated animals.
Fluoro-jade–stained tissue can be visualized under an epifluorescent microscope using a filter system designed for fluorescein or fluorescein isothiocyanate (FITC) (excitation: 495 nm; emission:521 nm). Multiple morphological features can be detected using fluoro-jade stain including cell bodies , dendrites , axons , and axon terminals . [ 1 ] Even though all fluoro-jade derivatives can detect these specific morphological features, the newer derivatives (fluoro-jade B and fluoro-jade C) have greater specificity and resolution and therefore are superior in detecting finer morphological features. [ 3 ] Fluoro-jade is typically quantified in every 6th–12th 40 nm section within the region of interest and expressed as cells/section. Alternatively, stereological procedures may be used to estimate total fluoro-jade positive cells within the defined region.
As the mechanism of fluoro-jade labeling is unknown, correlative analysis with traditional neuronal degeneration stains was used to validate this technique. Initially fluoro-jade staining was compared with H&E and de Olmos's cupric-staining methodologies in a variety of neurotoxic models of neurodegeneration such as injection of kainic acid , MPTP , or multivalent metals. Each of these neurotoxic insults produce brain-region specific neuronal degeneration and thus could be used to the determine specificity of fluoro-jade. Indeed, these studies demonstrated that fluoro-jade consistently reproduced insult specific staining patterns of neuronal degeneration that were identical to H&E and de Olmos's cupric staining patterns after the same neurotoxic insults. These results suggest that fluoro-jade is a reliable marker of neurodegeneration. [ 1 ]
Larry Schmued suggests that a basic "death molecule" is expressed by damaged cells and that the highly anionic and acidic fluoro-jade may be specific for this target. [ 1 ] Further supporting the validity of fluoro-jade stain and this hypothesis is the work of Auer et al. , [ 5 ] who demonstrated that another anionic dye, fuchsine acid , could successfully bind to damaged neurons after a hyperglycemic insult presumably by the same electrostatic mechanism as fluoro-jade. These neurons were characterized by cell death morphology including condensed chromatin , a disrupted plasma membrane , and a disrupted nuclear membrane .
Although fluoro-jade and de Olmos's silver stain have the same pattern of staining in models of neurotoxicity, there are inherent differences between the two methodologies that may have physiological implications. For example, a time course analysis of neuronal degeneration between the two techniques shows that silver stain is evident earlier after a neurotoxic insult which may suggest that fluoro-jade is specific for a later, more committed stage of the degenerative process. [ 6 ]
Traumatic brain injury [ 7 ] [ 8 ]
Spinal cord injury [ 9 ]
Alzheimer's disease [ 10 ]
Aging [ 11 ]
Stroke [ 12 ] [ 13 ]
Epilepsy [ 6 ]
Alcoholism [ 14 ]
Drug abuse [ 15 ]
Fluoro-jade may also be useful for other applications other than labeling degeneration neurons of the brain. Several reports have demonstrated that fluoro-jade is also useful in detecting glia, specifically reactive astroglia [ 16 ] and microglia. [ 17 ] Thus fluoro-jade may be used to assess glial responses associated with neurotoxicity. Additionally, other studies demonstrate that fluoro-jade can also label neurons outside the CNS such as neurons of the dorsal root ganglia. [ 18 ] Finally, fluoro-jade may find use in non-neuronal systems as investigators have reported its use to assess cell death in renal tubular epithelial cells, in vitro [ 19 ] and in vivo. [ 20 ]
|
https://en.wikipedia.org/wiki/Fluoro-jade_stain
|
Fluorosilicate glass ( FSG ) is a glass material composed primarily of fluorine , silicon and oxygen . It has a number of uses in industry and manufacturing, especially in semiconductor fabrication where it forms an insulating dielectric . The related fluorosilicate glass-ceramics have good mechanical and chemical properties.
FSG has a small relative dielectric constant ( low-κ dielectric ) and is used in between metal copper interconnect layers during silicon integrated circuit fabrication process. It is widely used by semiconductor fabrication plants on geometries under 0.25 microns (μ). FSG is effectively a fluorine -containing silicon dioxide (κ=3.5, while κ of undoped silicon dioxide is 3.9). [ 1 ] FSG is used by IBM . [ 2 ] Intel started using Cu metal layers and FSG on its 1.2 GHz Pentium processor at 130 nm complementary metal–oxide–semiconductor ( CMOS ). Taiwan Semiconductor Manufacturing Company ( TSMC ) combined FSG and copper in the Altera APEX.
Fluorosilicate glass-ceramics are crystalline or semi-crystalline solids formed by careful cooling of molten fluorosilicate glass. They have good mechanical properties.
Potassium fluororichterite based materials are composed from tiny interlocked rod-shaped amphibole crystals; they have good resistance to chemicals and can be used in microwave ovens . Richterite glass-ceramics are used for high-performance tableware .
Fluorosilicate glass-ceramics with sheet structure, derived from mica , are strong and machinable. They find a number of uses and can be used in high vacuum and as dielectrics and precision ceramic components. A number of mica and mica- fluoroapatite glass-ceramics were studied as biomaterials . [ 3 ]
This glass material related article is a stub . You can help Wikipedia by expanding it .
This article related to medical technology is a stub . You can help Wikipedia by expanding it .
|
https://en.wikipedia.org/wiki/Fluorosilicate_glass
|
FlyNap is an anesthetic mixture produced by the Carolina Biological Supply Company . The product anesthetizes the Drosophila melanogaster (fruit fly) and other small insects for at least 30 minutes and is commonly used in educational institutes and laboratories for reducing the movement of the fruit flies such that they can be sorted or studied under the microscope or dissecting scope. The liquid is applied to a small brush, which is left in the closed container where the flies are contained until they have ceased moving.
FlyNap consists of a mixture of: [ 1 ]
This product article is a stub . You can help Wikipedia by expanding it .
|
https://en.wikipedia.org/wiki/FlyNap
|
Flynn–Aird syndrome is a rare, hereditary, neurological disease that is inherited in an autosomal dominant fashion. The syndrome involves defects in the nervous, auditory, skeletal, visual, and endocrine systems and encompasses numerous symptoms, bearing striking similarity to other known syndromes of neuroectodermal nature such as: Werner syndrome , Cockayne syndrome and Refsum syndrome . [ 1 ]
The onset of Flynn–Aird syndrome typically occurs between ten and twenty years of age, however, the earliest case was diagnosed at age seven. As the syndrome progresses, initial symptoms tend to intensify and new symptoms become apparent. Unlike related syndromes and despite the intensity of symptoms in the disease progression, Flynn–Aird syndrome does not appear to shorten life expectancy.
The disease is characterized by early-onset dementia , ataxia , muscle wasting , skin atrophy , and eye abnormalities. In addition, patients have the potential of developing a number of other related symptoms such as: cataracts , retinitis pigmentosa , myopia (nearsightedness), dental caries , peripheral neuropathy (peripheral nerve damage), deafness , and cystic bone changes. This syndrome was first discovered in the early 1950s by American neurologists P. Flynn and Robert B. Aird who analyzed one family lineage inheritance pattern of this disease. [ 1 ]
Individuals with this syndrome typically develop normally until reaching the second decade of their lives but the onset of symptoms has been observed as early as age seven. The first defect observed in individuals who have this condition affects the auditory system and is known as bilateral nerve deafness. Another early symptom is the development of myopia (nearsightedness). In addition to bilateral nerve deafness and myopia, other symptoms that plague infected individuals early in disease progression include ataxia, muscle wasting , severe peripheral neuritic pain sometimes accompanied by elevated spinal fluid protein, and joint stiffness . [ 1 ]
The central nervous system (CNS) is affected with deficits in the cerebral cortex which indicate signs of mental retardation even though psychological observations appear relatively normal for individuals studied. Atypical epilepsy is also a common feature of CNS malfunctioning including aphasia expressions, blurred vision, and numbness of the face and limbs. [ 1 ]
In the third decade of the condition, individuals develop further visual problems including retinitis pigmentosa, and bilateral cataracts. Affected individuals experience the restriction of visual fields, night blindness, and eventually severe or complete blindness .
Individuals with this syndrome exhibit many physical deformities including skeletal, epidermal, and subcutaneous abnormalities. The skeletal problems are characterized by scoliosis and muscle weakness indicative of the kyphoscoliotic type which follow muscle wasting and peripheral neuritis (nerve inflammation). Osteoporosis is also observed in many cases. Skin and subcutaneous atrophy is common as well as skin ulcerations due to inability of the skin to heal. One of the final manifestations of disease is baldness . [ 1 ] There is no evidence that the progression of Flynn–Aird syndrome shortens the patient's life-span, but the terrible conditions certainly increase morbidity. [ 1 ]
One family of 68 individuals over 5 generations was studied and the prevalence of disease among the family members suggests that it is indicative of dominant inheritance that is not sexually linked . This is supported by the fact that the disease failed to skip generations even in the absence of intermarriages and that disease incidence was independent of sex. The current findings suggest that the cause of the disease could be narrowed down to one enzymatic defect that is involved in the development of neuroectodermal tissue, however the exact molecular mechanisms are currently unknown. The other symptoms that arise such as bone defects and diabetes may be secondary to this enzymatic defect. [ 1 ]
The exact pathophysiological mechanism of Flynn–Aird syndrome is unknown. However, several theories are in place with regards to the nature of this disease including the presence of a genetically defective enzyme involving a neuroectodermal tissue constituent. This explanation provides evidence for the late onset of the condition, the intricate findings, the varied nature of the disorder, as well as the genetic incidence. In addition, some aspects of the condition may be linked to a suppressing (S) gene due to the fact that only a small amount of stigmata appeared while the defects were still transmitted in the family studied. A suppressing gene down regulates the phenotypic expression of another gene, especially of a mutant gene. Other abnormalities may be due to endocrine system diseases. [ 1 ]
P. Flynn and Robert B. Aird observed this neuroectodermal syndrome after studying one family whose members had a number of neurological symptoms that were consistent from generation to generation. A number of the symptoms overlapped with several known neurological diseases such as Werner syndrome, Refsum syndrome, and Cockayne syndrome, which could be indicative of similar causative origins. However, these syndromes are recessively inherited as opposed to the dominant inheritance seen in the family studied by P. Flynn and Robert B. Aird. About 15% of family members exhibited full-blown symptoms characteristic of the disease while others showed some symptoms that overlapped with the general clinical manifestation of the syndrome. [ 1 ]
|
https://en.wikipedia.org/wiki/Flynn–Aird_syndrome
|
Focal fatty liver (FFL) is localised or patchy process of lipid accumulation in the liver . [ 1 ] It is likely to have different pathogenesis than non-alcoholic steatohepatitis which is a diffuse process. FFL may result from altered venous flow to liver, tissue hypoxia and malabsorption of lipoproteins . The condition has been increasingly recognised as sensitivity of abdominal imaging studies continues to improve. A fine needle biopsy is often performed to differentiate it from malignancy .
This article related to pathology is a stub . You can help Wikipedia by expanding it .
|
https://en.wikipedia.org/wiki/Focal_fatty_liver
|
Focal infection theory is the historical concept that many chronic diseases, including systemic and common ones, are caused by focal infections. In present medical consensus, a focal infection is a localized infection, often asymptomatic, that causes disease elsewhere in the host, but focal infections are fairly infrequent and limited to fairly uncommon diseases. [ 1 ] (Distant injury is focal infection's key principle, whereas in ordinary infectious disease, the infection itself is systemic, as in measles , or the initially infected site is readily identifiable and invasion progresses contiguously, as in gangrene .) [ 2 ] [ 3 ] Focal infection theory, rather, so explained virtually all diseases, including arthritis, atherosclerosis, cancer, and mental illnesses. [ 4 ] [ 5 ] [ 6 ] [ 7 ]
An ancient concept that took modern form around 1900, focal infection theory was widely accepted in medicine by the 1920s. [ 3 ] [ 7 ] [ 8 ] [ 9 ] In the theory, the focus of infection might lead to secondary infections at sites particularly susceptible to such microbial species or toxin. [ 3 ] Commonly alleged foci were diverse—appendix, urinary bladder, gall bladder, kidney, liver, prostate, and nasal sinuses —but most commonly were oral. Besides dental decay and infected tonsils , both dental restorations and especially endodontically treated teeth were blamed as foci. [ 3 ] [ 7 ] The putative oral sepsis was countered by tonsillectomies and tooth extractions, including of endodontically treated teeth and even of apparently healthy teeth, newly popular approaches—sometimes leaving individuals toothless—to treat or prevent diverse diseases. [ 7 ]
Drawing severe criticism in the 1930s, focal infection theory—whose popularity zealously exceeded consensus evidence—was discredited in the 1940s by research attacks that drew overwhelming consensus of this sweeping theory's falsity. Thereupon, dental restorations and endodontic therapy became again favored. [ 3 ] [ 7 ] Untreated endodontic disease retained mainstream recognition as fostering systemic disease. [ 3 ] [ 7 ] [ 10 ] [ 11 ] But only alternative medicine and later biological dentistry continued highlighting sites of dental treatment—still endodontic therapy, but, more recently, also dental implant , and even tooth extraction, too—as foci of infection causing chronic and systemic diseases. [ 12 ] In mainstream dentistry and medicine, the primary recognition of focal infection is endocarditis , if oral bacteria enter blood and infect the heart, perhaps its valves . [ 2 ]
Entering the 21st century, scientific evidence supporting general relevance of focal infections remained slim, yet evolved understandings of disease mechanisms had established a third possible mechanism—altogether, metastasis of infection, metastatic toxic injury, and, as recently revealed, metastatic immunologic injury—that might occur simultaneously and even interact. [ 2 ] [ 13 ] Meanwhile, focal infection theory has gained renewed attention, as dental infections apparently are widespread and significant contributors to systemic diseases, although mainstream attention is on ordinary periodontal disease , not on hypotheses of stealth infections via dental treatment . [ 14 ] [ 15 ] [ 16 ] Despite some doubts renewed in the 1990s by conventional dentistry's critics, dentistry scholars maintain that endodontic therapy can be performed without creating focal infections. [ 3 ] [ 7 ]
Hippocrates , in ancient Greece, had reported cure of an arthritis case by tooth extraction. [ 3 ] Yet focal infection, as such, appeared in modern medicine in 1877, when Karl Weigert reported "dissemination of ' tuberculosis poison' ". [ 17 ] The prior year's breakthrough by Robert Koch , a fellow German, had launched medical bacteriology —a set of laboratory methods to isolate, culture, and multiply a single bacterium of one species [ 18 ] —whereby Koch announced discovery of the " tubercle bacillus " in 1882, fully premising the modern principle of focal infection. [ 6 ] [ 19 ] In 1884, William Henry Welch , tasked to design the medical department at the newly forming Johns Hopkins University , imported the German model, "scientific medince", to America. [ 20 ]
As progressively more diseases drew an infectious hypothesis that led to a pathogen discovery, conjectures grew that virtually all diseases are infectious. [ 21 ] In 1890, German dentist Willoughby D Miller attributed a set of oral diseases to infections, and attributed a set of extraoral diseases—as of lung , stomach, brain abscesses , and other conditions—to the oral infections. [ 6 ] [ 22 ] [ 23 ] [ 24 ] In 1894, Miller became the first to identify bacteria in samples of tooth pulp . [ 25 ] [ 26 ] Miller advised root canal therapy . [ 3 ] [ 6 ] Yet ancient and folk concepts, entrenched as Galenic principles of humoral medicine , found new outlet in medical bacteriology, a pillar of the new "scientific medicine". [ 27 ] Around 1900, British surgeons, still knife-happy, were urging "surgical bacteriology". [ 27 ]
In 1877, French chemist Louis Pasteur adopted Robert Koch's bacteriology protocols, but soon directed them to developing the first modern vaccines, and ultimately introduced rabies vaccine in 1885. [ 28 ] Its success funded Pasteur's formation of the globe's first biomedical research institute, the Pasteur Institute . [ 28 ] In 1886, Pasteur welcomed to Paris the emigration from Russia by international scientific celebrity Elie Metchnikoff —discoverer of phagocytes , mediating innate immunity —whom Pasteur granted an entire floor of the Pasteur Institute, once it opened in 1888. [ 29 ] Later the institute's director and a 1908 Nobelist , Metchnikoff believed, as did his German immunology rival Paul Ehrlich —theorist on antibody , mediating acquired immunity [ 30 ] —and as did Pasteur, too, that nutrition influences immunity. [ 29 ] Metchnikoff brought to France its first yogurt cultures for probiotic microorganisms to suppress the colon's putrefactive microorganisms, which allegedly fostered the colon 's toxic seepage causing degenerative disease, the putative phenomenon termed autointoxication . [ 27 ] [ 29 ] [ 31 ] Metchnikoff reasoned that the colon functions as a "vesitigal cesspool" that stores waste but is unneeded. [ 32 ]
Abdominal surgery's pioneer, Sir Arbuthnot Lane , based in London, drew from Metchnikoff and clinical observation to identify "chronic intestinal stasis"—in lay terms, intractable constipation—presumably, "flooding of the circulation with filthy material". [ 27 ] Reporting surgical treatment in 1908, Lane eventually offered total colon removal , but later favored simply surgical release of colonic "kinks", and in 1925, abandoning surgery, began promoting prevention and intervention by diet and lifestyle, how Lane secured his contemporary reputation as a crank. [ 27 ] [ 31 ] Since 1875, in the American state Michigan, physician John Harvey Kellogg had targeted "bowel sepsis"—an allegedly prime cause of degeneration and disease—at his health resort, Battle Creek Sanitarium . [ 27 ] Having, in fact, coined the term sanitarium , Kellogg yearly received several thousand patients, including US Presidents and celebrities, at his huge resort, advertised as the "University of Health". [ 27 ] But in the 1910s, as North American medical schools emulated the German model—that is, "scientific medicine" [ 33 ] —medical doctors who recognized "focal infection" were hinting a scientific basis versus the older, alleged "health faddists" like medical doctor Kellogg and like minister Sylvester Graham . [ 27 ]
In 1900, British surgeon William Hunter blamed many disease cases on oral sepsis . [ 6 ] [ 34 ] [ 35 ] In 1910, lecturing in Montreal at McGill University , Hunter declared, "The worst cases of anemia, gastritis , colitis , obscure fevers, nervous disturbances of all kinds from mental depression to actual lesions of the cord , chronic rheumatic infections , kidney diseases are those which owe their origin to or are gravely complicated by the oral sepsis produced by these gold traps of sepsis." [ 6 ] Thus, he apparently indicted dental restorations . [ 22 ] Incriminating their execution, rather, his American critics lobbied for stricter requirements on dentistry licensing. [ 6 ] Still, Hunter's lecture—as later recalled—"ignited the fires of focal infection". [ 36 ] Ten years later, he proudly accepted that credit. [ 8 ] And yet, read carefully, his lecture asserts a sole cause of oral sepsis: dentists who instruct patients to never remove partial dentures . [ 36 ] [ 37 ]
Focal infection theory's modern era really began with physician Frank Billings , [ 21 ] based in Chicago, and his case reports of tonsillectomies and tooth extractions that apparently cured infections of distant organs. [ 36 ] Replacing Hunter's term oral sepsis with focal infection , [ 7 ] Billings in November 1911 lectured at the Chicago Medical Society , and published it in 1912 as an article for the American medical community. [ 38 ] In 1916, Billings lectured in California at Stanford University Medical School, this time printed in book format. [ 39 ] Billings thus popularized intervention by tonsillectomy and tooth extraction. [ 6 ] A pupil of Billings, Edward Rosenow held that extraction alone was often insufficient, and urged teamwork by dentistry and medicine. [ 22 ] Rosenow developed the principle elective localization , whereby microorganisms have affinities for particular organs, and also espoused extreme pleomorphism , whereby a bacterium can drastically change form and perhaps evade conventional detection methods. [ 36 ] [ 40 ] [ 41 ]
Since 1889, in the American state Minnesota, brothers William Mayo and Charles Mayo had built an international reputation for surgical skill at their Mayo Clinic , by 1906 performing some 5,000 surgeries a year, over 50% intra-abdominal, a tremendous number at the time, with unusually low mortality and morbidity. [ 27 ] [ 42 ] Though originally distancing themselves from routine medicine and skeptical of laboratory data, they later recruited Edward Rosenow from Chicago to help improve Mayo Clinic's diagnosis and care and to enter basic research via experimental bacteriology. [ 27 ] [ 42 ] Rosenow influenced Charles Mayo, [ 27 ] who by 1914 published to support focal infection theory alongside Rosenow. [ 43 ] [ 44 ] [ 45 ]
At Johns Hopkins University 's medical school, launched in 1894 as America's first to teach "scientific medicine", the eminent Sir William Osler was succeeded as professor of medicine by Llewellys Barker , [ 46 ] who became a prominent proponent of focal infection theory. [ 27 ] Although many of the Hopkins medical faculty remained skeptics, Barker's colleague William Thayer [ 47 ] cast support. [ 27 ] As Hopkins' chief physician, Barker was a pivotal convert propelling the theory to the center of American routine medical practice. [ 27 ] Russell Cecil , [ 48 ] famed author of Cecil's Essentials of Medicine , too, lent support. [ 36 ] In 1921, British surgeon William Hunter announced that oral sepsis was "coming of age". [ 8 ]
Although physicians had already interpreted pus within a bodily compartment as a systemic threat, pus from infected tooth roots often drained into the mouth and thereby was viewed as systemically inconsequential. [ 49 ] Amid focal infection theory, it was concluded that that was often the case—while immune response prevented dissemination from the focus—but that immunity could fail to contain the infection, that dissemination from the focus could ensue, and that systemic disease, often neurological , could result. [ 49 ] By 1930, excision of focal infections was considered a "rational form of therapy" undoubtedly resolving many cases of chronic diseases. [ 5 ] Its inconsistent effectiveness was attributed to unrecognized foci—perhaps inside internal organs—that the clinicians had missed. [ 5 ]
In 1923, upon some 25 years of researches, dentist Weston Andrew Price of Cleveland, Ohio, published a landmark book, [ 3 ] [ 50 ] then a related article in the Journal of the American Medical Association in 1925. [ 51 ] Price concluded that after root canal therapy , teeth routinely host bacteria producing potent toxins. [ 3 ] Transplanting the teeth into healthy rabbits, Price and his researchers duplicated heart and arthritic diseases. [ 3 ] Although Price noted often seeing patients "suffering more from the inconvenience and difficulties of mastication and nourishment than they did from the lesions from which their physician or dentist had sought to give them relief", [ 52 ] his 1925 debate with John P Buckley was decided in favor of Price's position: "practically all infected pulpless teeth should be extracted". [ 53 ] As chairman of the American Dental Association 's research division, Price was a leading influence on the dentistry profession's opinion. [ 54 ] Into the late 1930s, textbook authors relied on Price's 1923 treatise. [ 55 ]
In 1911, the year that Frank Billings lectured on focal infection to the Chicago Medical Society, unsuspected periapical disease was first revealed by dental X-ray. [ 36 ] Introduced by C. Edmund Kells , [ 56 ] dental radiography to feed the "mania of extracting devitalized teeth". [ 57 ] Even Price was cited as an authoritative source espousing conservative intervention at focal infections. [ 58 ] Kells, too, advocated conservative dentistry. [ 56 ] Many dentists were "100 percenters", extracting every tooth exhibiting either necrotic pulp or endodontic treatment , and extracted apparently healthy teeth, too, as suspected foci, leaving many persons toothless. [ 3 ] [ 7 ] A 1926 report published by several authors in Dental Cosmos —a dentistry journal where Willoughby Miller had published in the 1890s—advocated extraction of known healthy teeth to prevent focal infection. [ 59 ] Endodontics nearly vanished from American dental education. [ 3 ] [ 7 ] Some dentists held that root canal therapy should be criminalized and penalized with six months of hard labor . [ 7 ]
Near the turn of the 20th century, psychiatry's predominant explanations of schizophrenia's causation, besides heredity, were focal infection and autointoxication. [ 60 ] In 1907, psychiatrist Henry Andrews Cotton became director of the psychiatric asylum at Trenton State Hospital in the American state New Jersey. [ 61 ] Influenced by focal infection theory's medical popularity, [ 27 ] Cotton identified focal infections as the main causes of dementia praecox (now schizophrenia ) and of manic depression (now bipolar disorder ). [ 61 ] Cotton routinely prescribed surgery not only to clean the nasal sinuses and to extract the tonsils and the teeth, but also to remove the appendix, gall bladder, spleen, stomach, colon, cervix, ovaries, and testicles, while Cotton claimed up to 85% cure rate. [ 61 ]
Despite Cotton's death rate of some 30%, his fame rapidly spread through America and Europe, and the asylum drew influx of patients. [ 61 ] The New York Times heralded "high hope". [ 61 ] Cotton made a European lecture tour, [ 61 ] and Princeton University Press and Oxford University Press simultaneously published his book in 1922. [ 62 ] Despite skepticism in the profession, psychiatrists sustained pressure to match Cotton's treatments, as patients would ask why they were being denied curative treatment. [ 61 ] Other patients were pressured or compelled into the treatment without their own consent. [ 63 ] Cotton had his two sons' teeth extracted as preventive healthcare—although each later committed suicide. [ 61 ] In the 1930s, however, focal infection fell from psychiatry as an explanation, [ 60 ] Cotton having died in 1933. [ 61 ]
Addressing the Eastern Medical Society in December 1918, New York City physician Robert Morris had explained that focal infection theory had drawn much interest but that understanding was incomplete, while the theory was earning disrepute through overzealousness of some advocates. [ 64 ] Morris called for facts and explanation from scientists before physicians continued investing so steeply in it, already triggering vigorous disputes and embittering divisions among clinicians as well as uncertainty among patients. [ 64 ]
In 1919, the American Dental Association 's forerunner, the National Dental Association , held in New Orleans its annual meeting, where C Edmund Kells , the originator and pioneer of dental X-ray, [ 56 ] delivered a lecture, published in 1920 in the association's journal, [ 65 ] largely discussing focal infection theory, which Kells condemned as a "crime". [ 57 ] Kells stressed that X-ray technology is to improve dentistry, not to enhance the "mania of extracting devitalized teeth". [ 57 ] Kells urged dentists to reject physicians' prescriptions of tooth extractions. [ 66 ]
Focal infection theory's elegance suggested simple application, but the surgical removals brought meager "cure" rate, occasional disease worsening, and inconsistent experimental results. [ 6 ] Still, the lack of controlled clinical trials , among present criticism, [ 6 ] was normal at the time—except in New York City. [ 61 ] Around 1920, at Henry Cotton 's claims of up to 85% success treating schizophrenia and manic depression, Cotton's major critic was George Kirby , director of the New York State Psychiatric Institute on Ward's Island . [ 67 ] As colleagues of Kirby, two researchers—bacteriologist Nicolas Kopeloff and psychiatrist Clarence Cheney—ventured from Ward's Island to Trenton, New Jersey, to investigate Cotton's practice. [ 61 ]
In two controlled clinical trials with alternate allocation of patients, Nicolas Kopeloff, Clarence Cheney, and George Kirby concluded Cotton 's psychiatric surgeries ineffective: those who improved were already so prognosed, and others improved without surgery. [ 61 ] [ 68 ] Publishing two papers, the team presented the findings at the American Psychiatric Association 's 1922 and 1923 annual meetings. [ 61 ] [ 69 ] At Johns Hopkins University, Phyllis Greenacre questioned most of Cotton's data, and later helped steer American psychiatry into psychoanalysis . [ 61 ] Antipsychotic colectomy vanished except in Trenton until Cotton—who used publicity and word of mouth, kept the 30% death rate unpublicized, and passed a 1925 investigation by New Jersey Senate—died by heart attack in 1933. [ 61 ]
By 1927, Weston Price 's researches had been criticized for allegedly "faulty bacterial technique". [ 70 ] In the 1930s and 1940s, researchers and editors dismissed the studies of Price and of Edward Rosenow as flawed by insufficient controls, by massive doses of bacteria, and by contamination of endontically treated teeth during extraction. [ 3 ] In 1938, Russell Cecil and D Murray Angevine reported 200 cases of rheumatoid arthritis , but no consistent cures by tonsillectomies or tooth extractions. [ 3 ] [ 71 ] They commented, "Focal infection is a splendid example of a plausible medical theory which is in danger of being converted by its enthusiastic supporters into the status of an accepted fact." [ 6 ] Newly a critic, Cecil alleged that foci were "anything readily accessible to surgery". [ 36 ]
In 1939, E W Fish published landmark findings that would revive endodontics. [ 3 ] Fish implanted bacteria into guinea pigs' jaws, and reported that four zones of reaction consequently developed. [ 3 ] [ 72 ] Fish reported that the first zone was the zone of infection, whereas the other three zones—surrounding the zone of infection—revealed immune cells or other host cells but no bacteria. [ 3 ] Fish theorized that by removing the infectious nidus, dentists would permit recovery from the infection [ 3 ] This reasoning and conclusion by Fish became the basis for successful root-canal treatment. [ 3 ] Still, endodontic therapy of the era indeed posed substantial risk of failure, and fear of focal infection crucially motivated endontologists to develop new and improved technology and techniques. [ 7 ]
The review and "critical appraisal" by Hobart A Reimann and W Paul Havens, published in January 1940, [ 37 ] was perhaps the most influential criticism of focal infection theory. [ 6 ] Recasting British surgeon William Hunter 's landmark pronouncements of 30 years earlier as widely misinterpreted, they summarized that "the removal of infectious dental focal infections in the hope of influencing remote or general symptoms of disease must still be regarded as an experimental procedure not devoid of hazard". [ 59 ] By 1940, Louis I Grossman's textbook Root Canal Therapy flatly rejected the methods and conclusions made earlier by Weston Price and especially by Edward Rosenow. [ 73 ] Amid improvements in endodontics and medicine, including release of sulfa drugs and antibiotics , a backlash to the "orgy" of tooth extractions and tonsillectomies ensued. [ 6 ]
K A Easlick's 1951 review in the Journal of the American Dental Association notes, "Many authorities who formerly felt that focal infection was an important etiologic factor in systemic disease have become skeptical and now recommend less radical procedures in the treatment of such disorders". [ 74 ] A 1952 editorial in Journal of the American Medical Association tolled the era's end by stating that "many patients with diseases presumably caused by foci of infection have not been relieved of their symptoms by removal of the foci", that "many patients with these same systemic diseases have no evident focus of infection", and that "foci of infection are as common in apparently healthy persons as in those with disease". [ 75 ] [ 76 ] Although some support extended into the late 1950s, [ 77 ] [ 78 ] focal infection vanished as the primary explanation of chronic, systemic diseases, [ 15 ] and the theory was generally abandoned in the 1950s. [ 79 ]
Despite the general theory's demise, focal infection remained a formal, if rare, diagnosis, as in idiopathic scrotal gangrene [ 80 ] and angioneurotic edema . [ 81 ] Meanwhile, by way of continuing case reports claiming cures of chronic diseases like arthritis after extraction of infected or root-filled teeth, and despite lack of scientific evidence, "dental focal infection theory never died". [ 7 ] In fact, severe endodontic disease resembles classic focal infection theory. [ 7 ] [ 76 ] In 1986, it was noted that, "in spite of a decline in recognition of the focal-infection theory, the association of decayed teeth with systemic disease is taken very seriously". [ 10 ] Eventually, the theory of focal infection drew reconsideration. [ 79 ] Conversely, attribution of endocarditis to dentistry has entered doubt via case-control study, as the species usually involved is present throughout the human body. [ 82 ]
With the 1950s introduction of antibiotics, attempts to explain unexplained diseases via bacterial etiology seemed all the more unlikely. [ 83 ] By the 1970s, however, it was established that antibiotics could trigger bacteria switch to their L phase . [ 84 ] Eluding detection by traditional methods of medical microbiology , bacterial L forms and the similar mycoplasma —and, later, viruses —became the entities expected in the theory of focal infection. [ 83 ] [ 84 ] Yet until the 1980s, such researchers were scarce, largely due to scarce funding for such investigations. [ 83 ]
Despite the limited funding, research established that L forms can adhere to red blood cells and thereby disseminate from foci within internal organs such as the spleen , [ 85 ] or from oral tissues and the intestines, especially during dysbiosis . [ 86 ] [ 87 ] Perhaps some of Weston Price 's identified "toxins" in endodontically treated teeth were L forms, [ 88 ] thought nonexistent by bacteriologists of his time and widely overlooked into the 21st century. [ 89 ] Apparently, dental infections, including by uncultured or cryptic microorganisms, contribute to systemic diseases. [ 90 ] [ 91 ] [ 92 ] [ 93 ] [ 88 ] [ 87 ]
At the 1990s' emergence of epidemiological associations between dental infections and systemic diseases, American dentistry scholars have been cautious, [ 79 ] some seeking successful intervention to confirm causality. [ 3 ] [ 94 ] Some American sources emphasized epidemiology's inability to determine causality, categorized the phenomena as progressive invasion of local tissues, and distinguished that from focal infection theory—which they assert was evaluated and disproved by the 1940s. [ 3 ] Others have found focal infection theory's scientific evidence still slim, but have conceded that evolving science might establish it. [ 2 ] Yet select American authors affirm the return of a modest theory of focal infection. [ 95 ] [ 96 ]
European sources find it more certain that dental infections drive systemic diseases, at least by driving systemic inflammation, and probably, among other immunologic mechanisms, by molecular mimicry resulting in antigenic crossreaction with host biomolecules, [ 16 ] [ 97 ] [ 98 ] while some seemingly find progressive invasion of local tissues compatible with focal infection theory. [ 98 ] Acknowledging that beyond epidemiological associations, successful intervention is needed to establish causality, they emphasize that biological explanation is needed atop both, and the biological aspect is thoroughly established already, such that general healthcare, as for cardiovascular disease , must address prevalent periodontal disease , [ 97 ] [ 99 ] a stance matched in Indian literature. [ 100 ] Thus, there has emerged the concept periodontal medicine . [ 16 ] [ 79 ]
During the 1980s, dentist Hal Huggins , sparking severe controversy, spawned biological dentistry , which claims that conventional tooth extraction routinely leaves within the tooth socket the periodontal ligament that often becomes gangrenous , then, forming a jawbone cavitation seeping infectious and toxic material. [ 12 ] Sometimes forming elsewhere in bones after injury or ischemia , [ 17 ] jawbone cavitations are recognized as foci also in osteopathy [ 17 ] and in alternative medicine, [ 101 ] but conventional dentists generally conclude them nonexistent. [ 17 ] Although the International Academy of Oral Medicine & Toxicology claims that the scientific evidence establishing existence of jawbone cavitations is overwhelming and even published in textbooks, the diagnosis and related treatment remain controversial, [ 102 ] and allegations of quackery persist. [ 103 ]
Huggins and many biological dentists also espouse Weston Price 's findings on endodontically treated teeth routinely being foci of infection, [ 12 ] although these dentists have been accused of quackery . [ 104 ] Conventional belief is that microorganisms within inaccessible regions of a tooth's roots are rendered harmless once entrapped by the filling material, although little evidence supports this. [ 105 ] A H Rogers in 1976 [ 106 ] and E H Ehrmann in 1977 [ 107 ] had dismissed any relation between endodontics and focal infection. [ 59 ] At dentist George Meinig 's 1994 book, Root Canal Cover-Up , discussing researches of Rosenow and of Price, some dentistry scholars reasserted that the claims were evaluated and disproved by the 1940s. [ 108 ] [ 109 ] Yet Meinig was but one of at least three authors who in the early 1990s independently renewed the concern. [ 59 ]
Boyd Haley and Curt Pendergrass reporting finding especially high levels of bacterial toxins in root-filled teeth. [ 110 ] [ 88 ] Although such possibility appears especially likely amid compromised immunity —as in individuals cirrhotic , asplenic , elderly, rheumatoid arthritic , or using steroid drugs—there remained a lack of carefully controlled studies definitely establishing adverse systemic effects. [ 59 ] Conversely, some if few studies have investigated effects of systemic disease on root-canal therapy's outcomes, which tend to worsen with poor glycemic control, perhaps via impaired immune response, a factor largely ignored until recently, but now recognized as important. [ 59 ] Still, even by 2010, "the potential association between systemic health and root canal therapy has been strongly disputed by dental governing bodies and there remains little evidence to substantiate the claims". [ 59 ]
The traditional root-filling material is gutta-percha , whereas a new material, Biocalex, drew initial optimism even in alternative dentistry, but Biocalex-filled teeth were later reported by Boyd Haley to likewise seep toxic byproducts of anaerobic bacterial metabolism. [ 111 ] [ 112 ] Seeking to sterilize the tooth interior, some dentists, both alternative and conventional, have applied laser technology. [ 112 ] [ 113 ] Although endodontic therapy can fail and eventually often does, [ 105 ] [ 114 ] dentistry scholars maintain that it can be performed without creating focal infections. [ 3 ] And even by 2010, molecular methods had rendered no consensus reports of bacteremia traced to asymptomatic endodontic infection. [ 7 ] In any event, the predominant view is that shunning endodonthic therapy or routinely extracting endodontically treated teeth to treat or prevent systemic diseases remains unscientific and misguided. [ 3 ] [ 109 ] [ 115 ]
|
https://en.wikipedia.org/wiki/Focal_infection_theory
|
Fogarty arterial embolectomy catheter is a device developed in 1961 by Dr. Thomas J. Fogarty to remove fresh emboli in the arterial system . [ 1 ] It consists of a hollow tube with an inflatable balloon attached to its tip. The catheter is inserted into the blood vessel through a clot. The balloon is then inflated to extract the clot from the vessel. [ 2 ] It is available in different lengths and sizes, and is often colour coded by size. [ 3 ] Because it is less invasive than ordinary surgery, it reduces the chance of postoperative complications.
For removal of adherent material or fibrous material, Fogarty adherent clot catheter may be used. [1]
|
https://en.wikipedia.org/wiki/Fogarty_embolectomy_catheter
|
Follicle-stimulating hormone ( FSH ) is a gonadotropin , a glycoprotein polypeptide hormone . [ 1 ] FSH is synthesized and secreted by the gonadotropic cells of the anterior pituitary gland [ 2 ] and regulates the development, growth, pubertal maturation , and reproductive processes of the body. FSH and luteinizing hormone (LH) work together in the reproductive system . [ 3 ]
FSH is a 35.5 kDa glycoprotein heterodimer , consisting of two polypeptide units, alpha and beta. Its structure is similar to those of luteinizing hormone (LH), thyroid-stimulating hormone (TSH), and human chorionic gonadotropin (hCG). The alpha subunits of the glycoproteins LH, FSH, TSH, and hCG are identical and consist of 96 amino acids , while the beta subunits vary. [ 4 ] [ 5 ] Both subunits are required for biological activity. FSH has a beta subunit of 111 amino acids (FSH β), which confers its specific biologic action, and is responsible for interaction with the follicle-stimulating hormone receptor . [ 6 ] The sugar portion of the hormone is covalently bonded to asparagine , and is composed of N-acetylgalactosamine , mannose , N-acetylglucosamine , galactose , and sialic acid .
In humans, the gene for the alpha subunit is located at cytogenetic location 6q14.3. [ 7 ] It is expressed in two cell types, most notably the basophils of the anterior pituitary. The gene for the FSH beta subunit is located on chromosome 11p13, and is expressed in gonadotropes of the pituitary cells, controlled by GnRH , inhibited by inhibin , and enhanced by activin . [ 8 ]
FSH regulates the development, growth, pubertal maturation and reproductive processes of the human body. [ 9 ]
Control of FSH release from the pituitary gland is unknown. Low frequency gonadotropin-releasing hormone (GnRH) pulses increase FSH mRNA levels in the rat, [ 10 ] but is not directly correlated with an increase in circulating FSH. [ 11 ] GnRH has been shown to play an important role in the secretion of FSH, with hypothalamic-pituitary disconnection leading to a cessation of FSH. GnRH administration leads to a return of FSH secretion. FSH is subject to oestrogen feed-back from the gonads via the hypothalamic pituitary gonadal axis.
FSH stimulates the growth and recruitment of immature ovarian follicles in the ovary . In early (small) antral follicles, FSH is the major survival factor that rescues the small antral follicles (2–5 mm in diameter for humans) from apoptosis (programmed death of the somatic cells of the follicle and oocyte). In the luteal-follicle phase transition period the serum levels of progesterone and estrogen (primarily estradiol) decrease and no longer suppress the release of FSH, consequently FSH peaks at about day three (day one is the first day of menstrual flow). The cohort of small antral follicles is normally sufficient in number to produce enough Inhibin B to lower FSH serum levels. [ citation needed ]
In addition, there is evidence that gonadotropin surge-attenuating factor produced by small follicles during the first half of the follicle phase also exerts a negative feedback on pulsatile luteinizing hormone (LH) secretion amplitude, thus allowing a more favorable environment for follicle growth and preventing premature luteinization. [ 13 ]
As a woman nears perimenopause, the number of small antral follicles recruited in each cycle diminishes and consequently insufficient Inhibin B is produced to fully lower FSH and the serum level of FSH begins to rise. Eventually, the FSH level becomes so high that downregulation of FSH receptors occurs and by postmenopause any remaining small secondary follicles no longer have FSH nor LH receptors. [ 14 ]
When the follicle matures and reaches 8–10 mm in diameter it starts to secrete significant amounts of estradiol . Normally in humans only one follicle becomes dominant and survives to grow to 18–30 mm in size and ovulate, the remaining follicles in the cohort undergo atresia . The sharp increase in estradiol production by the dominant follicle (possibly along with a decrease in gonadotrophin surge-attenuating factor) cause a positive effect on the hypothalamus and pituitary and rapid GnRH pulses occur and an LH surge results.
The increase in serum estradiol levels causes a decrease in FSH production by inhibiting GnRH production in the hypothalamus. [ 15 ]
The decrease in serum FSH level causes the smaller follicles in the current cohort to undergo atresia as they lack sufficient sensitivity to FSH to survive. Occasionally two follicles reach the 10 mm stage at the same time by chance and as both are equally sensitive to FSH both survive and grow in the low FSH environment and thus two ovulations can occur in one cycle possibly leading to non-identical ( dizygotic ) twins. [ citation needed ]
FSH stimulates primary spermatocytes to undergo the first division of meiosis , to form secondary spermatocytes. [ citation needed ]
FSH enhances the production of androgen-binding protein by the Sertoli cells of the testes by binding to FSH receptors on their basolateral membranes, [ 16 ] and is critical for the initiation of spermatogenesis .
Follicle-stimulating hormone is typically measured in the early follicular phase of the menstrual cycle, typically day three to five, counted from last menstruation. At this time, the levels of estradiol (E2) and progesterone are at the lowest point of the menstrual cycle . FSH levels in this time is often called basal FSH levels, to distinguish from the increased levels when approaching ovulation. [ 17 ]
FSH is measured in international units (IU). For Human Urinary FSH, one IU is defined as the amount of FSH that has an activity corresponding to 0.11388 mg of pure Human Urinary FSH. [ 18 ] For recombinant FSH, one IU corresponds to approximately 0.065 to 0.075 μg of a "fill-by-mass" product. [ 19 ] The mean values for women before ovulation are around (3.8-8.8) IU/L. After ovulation these levels drop to between (1.8-5.1) IU/L. At the mid of the menstrual cycle it reaches its highest value, between (4.5-22.5) IU/L. During menopause , the values goes up even more, between (16.74-113.59) IU/L.
For men, the mean values are around (1.5-12.4) IU/L. [ 20 ]
FSH levels are normally low during childhood and, in females, high after menopause .
The most common reason for high serum FSH concentration is in a female who is undergoing or has recently undergone menopause . High levels of FSH indicate that the normal restricting feedback from the gonad is absent, leading to an unrestricted pituitary FSH production. FSH may contribute to postmenopausal osteoporosis and cardiovascular disease. [ 21 ]
If high FSH levels occur during the reproductive years, it is abnormal. Conditions with high FSH levels include:
Most of these conditions are associated with subfertility or infertility. Therefore, high FSH levels are an indication of subfertility or infertility.
Diminished secretion of FSH can result in failure of gonadal function (hypogonadism). This condition is typically manifested in males as failure in production of normal numbers of sperm. In females, cessation of reproductive cycles is commonly observed. [ citation needed ] Conditions with very low FSH secretions are:
Isolated FSH deficiency due to mutations in the gene for β-subunit of FSH is rare with 13 cases reported in the literature up to 2019. [ 24 ]
FSH is used commonly in infertility therapy, mainly for ovarian hyperstimulation as part of IVF . In some cases, it is used in ovulation induction for reversal of anovulation as well.
FSH is available mixed with LH activity in various menotropins including more purified forms of urinary gonadotropins such as Menopur , as well as without LH activity as recombinant FSH (Gonapure, Gonal F, Follistim, Follitropin alpha).
Elevated FSH receptor levels have been detected in the endothelia of tumor vasculature in a very wide range of solid tumors. FSH binding is thought to upregulate neovascularization via at least two mechanisms – one in the VEGF pathway, and the other VEGF independent – related to the development of umbilical vasculature when physiological. This presents possible use of FSH and FSH-receptor antagonists as an anti-tumor angiogenesis therapy (cf. avastin for current anti-VEGF approaches). [ 25 ]
|
https://en.wikipedia.org/wiki/Follicle-stimulating_hormone
|
A fomite ( / ˈ f oʊ m aɪ t / ) or fomes ( / ˈ f oʊ m iː z / ) is any inanimate object that, when contaminated with or exposed to infectious agents (such as pathogenic bacteria , viruses or fungi ), can transfer disease to a new host . [ 1 ]
A fomite is any inanimate object (also called passive vector) that, when contaminated with or exposed to infectious agents (such as pathogenic bacteria , viruses or fungi ), can transfer disease to a new host . [ 1 ] [ 2 ] Contamination can occur when one of these objects comes into contact with bodily secretions, like nasal fluid, vomit or feces from toilet plume . Many common objects can sustain a pathogen until a person comes in contact with the pathogen, increasing the chance of infection. The likely objects are different in a hospital environment than at home or in a workplace. [ 3 ] Fomites such as splinters, barbed wire or farmyard surfaces, including soil, feeding troughs or barn beams, have been implicated as sources of virus. [ 4 ]
For humans, common hospital fomites are skin cells , hair, clothing, and bedding. [ 5 ]
Fomites are associated particularly with hospital-acquired infections (HAIs), as they are possible routes to pass pathogens between patients. Stethoscopes and neckties are common fomites associated with health care providers . [ 6 ] It worries epidemiologists and hospital practitioners because of the growing selection of microbes resistant to disinfectants or antibiotics (so-called antimicrobial resistance phenomenon). [ citation needed ]
Basic hospital equipment, such as IV drip tubes, catheters , and life support equipment, can also be carriers, when the pathogens form biofilms on the surfaces. Careful sterilization of such objects prevents cross-infection. [ 7 ] Used syringes, if improperly handled, are particularly dangerous fomites. [ citation needed ]
In addition to objects in hospital settings, other common fomites for humans are cups, spoons, pencils, bath faucet handles, toilet flush levers, door knobs, light switches, handrails, elevator buttons, television remote controls, pens, touch screens, common-use phones, keyboards and computer mice, coffeepot handles, countertops, drinking fountains, and any other items that may be frequently touched by different people and infrequently cleaned. [ 2 ] [ 8 ]
Cold sores , hand–foot–mouth disease , and diarrhea are some examples of illnesses easily spread by contaminated fomites. [ 9 ] The risk of infection by these diseases and others through fomites can be greatly reduced by simply washing one's hands. [ 9 ] When two children in one household have influenza , more than 50% of shared items are contaminated with virus. In 40–90% cases, adults infected with rhinovirus have it on their hands. [ 10 ]
Researchers have discovered that smooth (non-porous) surfaces like door knobs transmit bacteria and viruses better than porous materials like paper money because porous, especially fibrous, materials absorb and trap the contagion, making it harder to contract through simple touch. [ 11 ] Nonetheless, fomites may include soiled clothes, towels, linens, handkerchiefs, and surgical dressings. [ 12 ] [ 13 ]
SARS-CoV-2 was found to be viable on various surfaces from 4 to 72 hours under laboratory conditions. On porous surfaces, studies report inability to detect viable virus within minutes to hours; on non-porous surfaces, viable virus can be detected for days to weeks. [ 2 ] [ 14 ] However, further research called into question the relevance of such tests, instead finding fomite transmission of SARS-Cov-2 in real world settings is extremely rare when standard cleaning procedure are followed. [ 15 ] [ 16 ] [ 17 ] [ 18 ]
Contact with aerosolized virus (large droplet spread) generated via talking, sneezing, coughing, or vomiting, toilet flushing & produced toilet plume [ 19 ] or contact with airborne virus that settles after disturbance of a contaminated fomite (e.g. shaking a contaminated blanket). During the first 24 hours, the risk can be reduced by increasing ventilation and waiting as long as possible before entering the space (at least several hours, based on documented airborne transmission cases), and using personal protective equipment (including any protection needed for the cleaning and disinfection products) to reduce risk. [ 2 ] [ 8 ]
The 2007 research showed that the influenza virus was still active on stainless steel 24 hours after contamination. Though on hands it survives only for five minutes, the constant contact with a fomite almost certainly means catching the infection. [ 20 ] Transfer efficiency depends not only on surface, but mainly on pathogen type. For example, avian influenza survives on both porous and non-porous materials for 144 hours. [ 11 ]
Smallpox was long supposed to be transmitted either by direct contact or by fomites. However A. R. Rao’s careful researches in the 1960s, before smallpox was declared extinct, found little truth in the traditional belief that smallpox can be spread at a distance through infected clothing or bedding. He concluded that it normally invaded via the lungs. [ 21 ] Rao recognized that the virus can be detected on inanimate objects, and therefore might in some cases be transmitted by them, but he concluded that “smallpox is still an inhalation disease ... the virus has to enter through the nose by inhalation". [ 22 ]
In 2002 Donald K. Milton published a review of existing research upon the transmission of smallpox and upon recommendations for controlling its spread in the event of its use in biological war. He agreed, citing Rao, Fenner and others, that “careful epidemiologic investigation rarely implicated fomites as a source of infection”; and broadly agreed with current recommendations for control of secondary smallpox infections, which emphasized transmission via “expelled droplets” upon the breath. He noted that shed scabs (which might be spread via bedsheets or other fomites) often contain “large quantities of virus”, but suggested that the “apparent lack of infectiousness of scab associated virus” might be due to “encapsulation with inspissated pus”. [ 23 ]
Contaminated needles are the most common fomite that transmits HIV . [ 24 ] Fomites from dirty needles also easily spread Hepatitis B . [ 25 ]
The Italian scholar and physician Girolamo Fracastoro appears to have first used the Latin word fomes , meaning " tinder ", in this sense in his essay on contagion, De Contagione et Contagiosis Morbis , published in 1546: [ 26 ] "By fomes I mean clothes, wooden objects, and things of that sort, which though not themselves corrupted can, nevertheless, preserve the original germs of the contagion and infect by means of these". [ 27 ]
English usage of fomes , pronounced / ˈ f oʊ m iː z / , is documented since 1658. [ 28 ] The English word fomite , which has been in use since 1859, is a back-formation from the plural fomites (originally borrowed from the Latin plural fōmĭtēs [ˈfoːmɪteːs] of fōmĕs [ˈfoːmɛs] ). [ 29 ] [ 30 ] Over time, the English-language pronunciation of the plural fomites changed from / ˈ f oʊ m ɪ t iː z / ) to / ˈ f oʊ m aɪ t s / , which led to the creation of a new singular fomite , pronounced / ˈ f oʊ m aɪ t / . [ 30 ] [ 31 ] [ 32 ]
In Latin, fomes (genitive: fomitis , plural fomites , stem fomit- ) is a third-declension T-stem noun. Such nouns, like miles/militis or comes/comitis , typically lose their T (thereby becoming a syllable shorter) in the nominative singular, but retain it in all other cases. In languages derived from Latin, the French fomite, Italian fomite, Spanish fómite and Portuguese fómite or fômite, retain the full stem.
|
https://en.wikipedia.org/wiki/Fomite
|
The Food Additives Amendment of 1958 is a 1958 amendment to the United States' Food, Drugs, and Cosmetic Act of 1938 . It was a response to concerns about the safety of new food additives. The amendment established an exemption from the "food additive" definition and requirements for substances " generally recognized as safe " by scientific experts in the field, based on long history of use before 1958 or based on scientific studies. New food additives would be subject to testing including by the "Delaney clause". The Delaney clause was a provision in the amendment which said that if a substance were found to cause cancer in man or animal, then it could not be used as a food additive .
Generally recognized as safe (GRAS) is a Food and Drug Administration (FDA) designation that a chemical or substance added to food is considered safe by experts, and so is exempted from the usual Federal Food, Drug, and Cosmetic Act (FFDCA) food additive tolerance requirements. [ 1 ] The concept of food additives being "generally recognized as safe" was first described in the Food Additives Amendment of 1958, and all additives introduced after this time had to be evaluated by new standards.
The Delaney Clause is a provision in the amendment named after Congressman James Delaney of New York.
It said:
the Secretary of the Food and Drug Administration shall not approve for use in food any chemical additive found to induce cancer in man, or, after tests, found to induce cancer in animals. [ 2 ]
The Delaney Clause applied to pesticides in processed foods , but only when the concentration of a residue of a cancer-causing pesticide increased during processing; for example when more of a pesticide was present in ketchup than in the raw tomatoes used to make it. (It never applied to pesticides in raw foods.) When the law was passed, "neither advocates nor opponents of the policy, including FDA officials, believed it would have broad application, for only a handful of chemicals had then been shown to be animal carcinogens ." [ 2 ]
The Delaney Clause was invoked in 1959 when Arthur Sherwood Flemming , the Secretary of the Department of Health, Education and Welfare issued a statement advising the public about the possible contamination of substantial quantities of cranberries in Oregon and Washington with the herbicide aminotriazole , which the FDA had recently determined was a carcinogen (see Cranberry scare of 1959 ). Taking place the week of Thanksgiving , the announcement was referred to by many in the cranberry industry as "Black Monday" − sales plummeted, even though many government officials attempted to defuse the scare by declaring their intention to eat cranberries anyway. This episode is regarded as one of the first modern food scares based on a chemical additive.
As analytical chemistry became more powerful and able to detect smaller quantities of chemicals, and as chemicals became more widely used, regulatory agencies had an increasingly difficult time administering the Delaney Clause as it "recognizes no distinctions based on carcinogenic potency and, at least in theory, it applies equally to additives used in large amounts and to those present at barely detectable levels. It thus takes no account of the actual risk a carcinogenic additive might pose." [ 2 ]
The FDA was the first agency to have to confront this problem, with respect to the use of diethylstilbestrol to promote the growth of livestock used in meat production, which remained present in the meat. It addressed the issue by using quantitative risk assessment , declaring that if a carcinogenic food additive creates an excess lifetime cancer risk of less than 1 additional cancer case in every 1,000,000 exposed individuals, the risk is negligible. This standard became known as the " de minimis " exception to the Delaney Rule and was used throughout the FDA and other agencies. [ 2 ]
In 1988 the United States Environmental Protection Agency eased restrictions on several pesticides which posed a "de minimis" risk to humans. This change was challenged by the Natural Resources Defense Council , and overturned in 1992 by the Ninth Circuit Court of Appeals .
Pesticide use was removed from the Delaney Clause in 1996 by an amendment to Title IV of the Food Quality Protection Act of 1996 (P.L. 104-170, Sec. 404).
The Delaney prohibition appears in three separate parts of the FFDCA: Section 409 on food additives; Section 512, relating to animal drugs in meat and poultry; and Section 721 on color additives. The Section 409 prohibition applied to many pesticide residues until enactment of the Food Quality Protection Act of 1996. This legislation removed pesticide residue tolerances from Delaney Clause constraints.
Many foods contain natural substances which are carcinogenic, for example safrole , which occurs in sassafras and sweet basil . Even these substances are covered by the Delaney clause, so that, for example, safrole may not be added to root beer in the United States. [ 3 ]
|
https://en.wikipedia.org/wiki/Food_Additives_Amendment_of_1958
|
Food combining is a nutritional pseudoscientific approach that advocates specific combinations (or advises against certain combinations) of foods. These proposed specific combinations are promoted as central to good health as well as improved digestion and weight loss , despite having no sufficient evidence for these claims. It proposes a list of rules that advocate for eating or not eating certain foods together, including to avoid eating starches and proteins together; always eat fruit before, and not after, a meal; avoid eating fruits and vegetables together in the same meal; and to not drink cold water during a meal. [ 1 ]
Food combining was originally promoted by Herbert M. Shelton in his book Food Combining Made Easy (1951), but the issue had been previously discussed by Edgar Cayce . [ 2 ] The best-known food-combining diet is the Hay Diet , named after William Howard Hay. He lost 30 pounds in 3 months when he implemented his research. In recent years, the food combining diet was popularized in online spaces by social media influencer Kenzie Burke, who promoted and profited from the fad diet through the sale of her "21-Day Reset" program. [ 3 ]
The promotion of food combining is not based on facts, making claims that have no scientific backing and displaying some characteristics of pseudoscience . Kenzie Burke utilizes a multitude of positive testimonials for her 21-Day Reset program that detail various customers' stories of success with the program. [ 4 ] One randomized controlled trial of food combining was performed in 2000, and found no evidence that food combining was any more effective than a "balanced" diet in promoting weight loss. [ 5 ] Besides this study, there is minimal legitimate scientific research on food combining as a diet, and subsequently no sufficient amount of legitimate scientific evidence for any of the diet's claims and any benefits it could potentially have for one's health.
|
https://en.wikipedia.org/wiki/Food_combining
|
Foot and ankle surgery is a sub-specialty of orthopedics and podiatry that deals with the treatment, diagnosis and prevention of disorders of the foot and ankle. Orthopaedic surgeons are medically qualified, having been through four years of college, followed by 4 years of medical school or osteopathic medical school to obtain an M.D. or D.O. followed by specialist training as a resident in orthopaedics , and only then do they sub-specialise in foot and ankle surgery. Training for a podiatric foot and ankle surgeon consists of four years of college, four years of podiatric medical school ( D.P.M. ), 3–4 years of a surgical residency and an optional 1 year fellowship.
The distinction between a podiatric and orthopedic foot and ankle surgeon is: an orthopedic surgeon has a Doctor of Medicine or Doctor of Osteopathic Medicine medical degree or osteopathic medical degree and training that encompasses both orthopedic residency and an optional 6-month to one year of fellowship training specific in techniques of foot and ankle surgery, while the training of a Doctor of Podiatric Medicine consist of a podiatric medical degree and three to four-year residency training specific to foot and ankle medicine and surgery, [ 1 ] with an optional additional 1-year fellowship in foot and ankle trauma, reconstruction, or diabetic limb salvage.
In the UK much controversy exists on the scope of podiatrists practicing surgery and the British Orthopaedic Association , and the British Orthopaedic Foot and Ankle Society produced a position statement on the importance of training and ongoing regulation of podiatrists practising podiatric forefoot surgery after certification and recommended that this should be to the same standard as that of medically qualified trauma and orthopaedic surgeons operating on the foot and ankle. [ 2 ]
Foot and ankle surgeons are trained to treat all disorders of the foot and ankle, both surgical and non-surgical. Additionally, the surgeons are also trained to understand the complex connections between disorders and deformities of the foot, ankle, knee, hip, and the spine. Therefore, the surgeon will typically see cases that vary from trauma (such as malleolar fractures, tibial pilon fractures , calcaneus fractures, navicular and midfoot injuries and metatarsal and phalangeal fractures.) Arthritis care (primarily surgical) of the ankle joint and the joints of the hindfoot (tarsals), midfoot (metatarsals) and forefoot (phalanges) also plays a rather significant role. Congenital and acquired deformities include adult acquired flatfoot, non-neuromuscular foot deformity, diabetic foot disorders, hallux valgus and several common pediatric foot and ankle conditions (such as clubfoot, flat feet, tarsal coalitions , etc.) Patients may also be referred to a foot and ankle surgeon for proper diagnosis and treatment of heel pain (such as a consequence from plantar heel fasciitis), nerve disorders (such as tarsal tunnel syndrome) and tumors of the foot and ankle. Amputation and ankle arthroscopy (the use of a laparoscope in foot and ankle surgical procedures) have emerged as prominent tools in foot and ankle care. In addition, more applications for laser surgery are being found in the treatment of foot and ankle disorders, [ 3 ] including treatment for bunions [ 4 ] and soft tissue lesions. A patient may also be referred to a foot and ankle surgeon for the surgical care of nail problems and phalangeal deformities (such as bunions and bunionettes.)
The vast majority of foot and ankle conditions do not require surgical intervention. For example, several phalangeal conditions may be traced to the type of foot box used in a shoe, and a change of a shoe or shoe box may be sufficient to treat the condition. For inflammatory processes such as rheumatoid arthritis , non-steroidal anti-inflammatory drugs (NSAIDs) and disease-modifying antirheumatic drugs (DMARDS) may be used to manage or slow down the process. Orthotics , or an externally applied device used to modify the structural or functional characteristics of the neuromusculoskeletal system specifically for the foot and ankle, may be used as inserts into shoes to displace regions of the foot for more balanced, comfortable or therapeutic placements of the foot. Physical therapy may also be used to alleviate symptoms, strengthening muscles such as the gastrocnemius muscle (which in turn will pull on the heel, which will then pull on the plantar fascia, thus changing the structure and shape of the foot). [ by whom? ]
Surgery is considered to be a last option when more conservative approaches fail to alleviate symptoms. Techniques such as bunionectomies may be used to surgically remove bunions and other foot and ankle deformalities, arthrodesis (or fusion of joint spaces) for inflammatory processes, and surgical reconstruction (i.e. invasive measures of manipulating neuromusculoskeletal structures) to treat other deformalities. Orthotics, physical therapy, NSAIDs , DMARDs and a change of shoe may act as a complement to surgical intervention, and in most cases will be required for optimal recovery.
The last 50 years has shown high quality research into the etiology and management of foot and ankle deformities. Several publications have been made to act as forums for such research:
|
https://en.wikipedia.org/wiki/Foot_and_ankle_surgery
|
Foot drop is a gait abnormality in which the dropping of the forefoot happens out of weakness, irritation or damage to the deep fibular nerve (deep peroneal), including the sciatic nerve , or paralysis of the muscles in the anterior portion of the lower leg. It is usually a symptom of a greater problem, not a disease in itself. Foot drop is characterized by inability or impaired ability to raise the toes or raise the foot from the ankle ( dorsiflexion ). Foot drop may be temporary or permanent, depending on the extent of muscle weakness or paralysis, and it can occur in one or both feet. In walking, the raised leg is slightly bent at the knee to prevent the foot from dragging along the ground.
Foot drop can be caused by nerve damage alone or by muscle or spinal cord trauma, abnormal anatomy, toxins, or disease. Toxins include organophosphate compounds which have been used as pesticides and as chemical agents in warfare. The poison can lead to further damage to the body such as a neurodegenerative disorder called organophosphorus induced delayed polyneuropathy . This disorder causes loss of function of the motor and sensory neural pathways. In this case, foot drop could be the result of paralysis due to neurological dysfunction. Diseases that can cause foot drop include trauma to the posterolateral neck of fibula, stroke , [ 1 ] [ 2 ] [ 3 ] [ 4 ] amyotrophic lateral sclerosis , muscular dystrophy , poliomyelitis , Charcot–Marie–Tooth disease , multiple sclerosis , cerebral palsy , hereditary spastic paraplegia , Guillain–Barré syndrome , Welander distal myopathy , Friedreich's ataxia , chronic compartment syndrome , and severe nerve entrapment . It may also occur as a result of hip replacement surgery or knee ligament reconstruction surgery.
Foot drop is characterized by steppage gait . [ 5 ] While walking, people suffering the condition drag their toes along the ground or bend their knees to lift their foot higher than usual to avoid the dragging. [ 6 ] This serves to raise the foot high enough to prevent the toe from dragging and prevents the slapping. [ 7 ] [ 8 ] To accommodate the toe drop, the patient may use a characteristic tiptoe walk on the opposite leg, raising the thigh excessively, as if walking upstairs, while letting the toe drop. Other gaits such as a wide outward leg swing (to avoid lifting the thigh excessively or to turn corners in the opposite direction of the affected limb) may also indicate foot drop. [ 9 ]
Patients with painful disorders of sensation ( dysesthesia ) of the soles of the feet may have a similar gait but do not have foot drop. Because of the extreme pain evoked by even the slightest pressure on the feet, the patient walks as if walking barefoot on hot sand. [ citation needed ]
The causes of foot drop, as for all causes of neurological lesions, should be approached using a localization-focused approach before etiologies are considered. Most of the time, foot drop is the result of neurological disorder; only rarely is the muscle diseased or nonfunctional. The source for the neurological impairment can be central (spinal cord or brain) or peripheral (nerves located connecting from the spinal cord to an end-site muscle or sensory receptor). [ citation needed ]
Foot drop is rarely the result of a pathology involving the muscles or bones that make up the lower leg. The anterior tibialis is the muscle that picks up the foot. Although the anterior tibialis plays a major role in dorsiflexion, it is assisted by the fibularis tertius , extensor digitorum longus and the extensor hallucis longus . If the drop foot is caused by neurological disorder all of these muscles could be affected because they are all innervated by the deep fibular (peroneal) nerve , which branches from the sciatic nerve . The sciatic nerve exits the lumbar plexus with its root arising from the fifth lumbar nerve space. [ citation needed ]
Occasionally, spasticity in the muscles opposite the anterior tibialis , the gastrocnemius and soleus, exists in the presence of foot drop, making the pathology much more complex than foot drop. Isolated foot drop is usually a flaccid condition. There are gradations of weakness that can be seen with foot drop, as follows according to MRC: [ citation needed ]
foot slap is a heel strike abnormality, which is the audible slapping of the foot to the floor with each step that occurs when the foot first hits the floor on each step. Sometimes it is not visible and the diagnosis is done by actually hearing the slap.
Treated systematically, possible lesion sites causing foot drop include (going from peripheral to central):
If the L5 nerve root is involved, the most common cause is a herniated disc . Other causes of foot drop are diabetes (due to generalized peripheral neuropathy ), trauma, motor neuron disease (MND), adverse reaction to a drug or alcohol, and multiple sclerosis. [ citation needed ]
Drop foot and foot drop are interchangeable terms that describe an abnormal neuromuscular disorder that affects the patient's ability to raise their foot at the ankle. Drop foot is further characterized by an inability to point the toes toward the body (dorsiflexion) or move the foot at the ankle inward or outward. Therefore, the normal gait cycle is affected by the drop foot syndrome.
The normal gait cycle is as follows:
The drop foot gait cycle requires more exaggerated phases.
Drop Foot is the inability to dorsiflex, evert, or invert the foot. So when looking at the Gait cycle, the part of the gait cycle that involves most dorsiflexion action would be Heel Contact of the foot at 10% of Gait Cycle, and the entire swing phase, or 60-100% of the Gait Cycle. This is also known as Gait Abnormalities. [ citation needed ]
Initial diagnosis often is made during routine physical examination. Such diagnosis can be confirmed by a medical professional such as a physiatrist , neurologist , orthopedic surgeon or neurosurgeon . A person with foot drop will have difficulty walking on his or her heels because
they will be unable to lift the front of the foot (balls and toes) off the ground. Therefore, a simple test of asking the patient to dorsiflex may determine diagnosis of the problem. This is measured on a 0-5 scale that observes mobility. The lowest point, 0, will determine complete paralysis and the highest point, 5, will determine complete mobility. [ citation needed ]
There are other tests that may help determine the underlying etiology for this diagnosis. Such tests may include MRI , MRN , or EMG to assess the surrounding areas of damaged nerves and the damaged nerves themselves, respectively. The nerve that communicates to the muscles that lift the foot is the peroneal nerve . This nerve innervates the anterior muscles of the leg that are used during dorsiflexion of the ankle. The muscles that are used in plantar flexion are innervated by the tibial nerve and often develop tightness in the presence of foot drop. The muscles that keep the ankle from supination (as from an ankle sprain) are also innervated by the peroneal nerve, and it is not uncommon to find weakness in this area as well. Paraesthesia in the lower leg, particularly on the top of the foot and ankle, also can accompany foot drop, although it is not in all instances.
A common yoga kneeling exercise, the Varjrasana has, under the name "yoga foot drop", been linked to foot drop. [ 10 ] [ 11 ]
The underlying disorder must be treated. For example, if a spinal disc herniation in the low back is impinging on the nerve that goes to the leg and causing symptoms of foot drop, then the herniated disc should be treated. If the foot drop is the result of a peripheral nerve injury, a window for recovery of 18 months to 2 years is often advised. If it is apparent that no recovery of nerve function takes place, surgical intervention to repair or graft the nerve can be considered, although results from this type of intervention are mixed. [ citation needed ]
Non-surgical treatments for spinal stenosis include a suitable exercise program developed by a physical therapist, activity modification (avoiding activities that cause advanced symptoms of spinal stenosis), epidural injections, and anti-inflammatory medications like ibuprofen or aspirin. If necessary, a decompression surgery that is minimally destructive of normal structures may be used to treat spinal stenosis. [ citation needed ]
Non-surgical treatments for this condition are very similar to the non-surgical methods described above for spinal stenosis. Spinal fusion surgery may be required to treat this condition, with many patients improving their function and experiencing less pain.
Nearly half of all vertebral fractures occur without any significant back pain. If pain medication, progressive activity, or a brace or support does not help with the fracture, two minimally invasive procedures - vertebroplasty or kyphoplasty - may be options.
Ankles can be stabilized by lightweight orthoses , available in molded plastics as well as softer materials that use elastic properties to prevent foot drop. Additionally, shoes can be fitted with traditional spring-loaded braces to prevent foot drop while walking. Regular exercise is usually prescribed. [ citation needed ]
Functional electrical stimulation (FES) is a technique that uses electrical currents to activate nerves innervating extremities affected by paralysis resulting from spinal cord injury (SCI), head injury, stroke and other neurological disorders. FES is primarily used to restore function in people with disabilities. It is sometimes referred to as neuromuscular electrical stimulation (NMES)
The latest treatments include stimulation of the peroneal nerve, which lifts the foot when you step. Many stroke and multiple sclerosis patients with foot drop have had success with it. Often, individuals with foot drop prefer to use a compensatory technique like steppage gait or hip hiking as opposed to a brace or splint.
FES is applied to lower extremities for improving functional walking in stroke patients; for the correction of foot drop. They have benefited patients by improving gait speed, muscle strength and other functions. [ 12 ]
Treatment for some can be as easy as an underside L-shaped foot-up ankle support ( ankle-foot orthoses ). Another method uses a cuff placed around the patient's ankle, and a topside spring and hook installed under the shoelaces. The hook connects to the ankle cuff and lifts the shoe up when the patient walks.
Both these techniques show significant improvement on usage. [ 12 ]
In December 2021, police in Toronto, Canada said they were looking for a person with a distinctive gait as a suspect in the murder of Barry Sherman and Honey Sherman. Medical professionals quoted by the Toronto Star said that the distinctive gait could be caused by foot drop. [ 13 ]
|
https://en.wikipedia.org/wiki/Foot_drop
|
In the fetal heart , the foramen ovale ( / f ə ˈ r eɪ m ən oʊ ˈ v æ l i , - m ɛ n -, - ˈ v ɑː -, - ˈ v eɪ -/ [ 1 ] [ 2 ] [ 3 ] ), also foramen Botalli or the ostium secundum of Born , allows blood to enter the left atrium from the right atrium. It is one of two fetal cardiac shunts , the other being the ductus arteriosus (which allows blood that still escapes to the right ventricle to bypass the pulmonary circulation ). Another similar adaptation in the fetus is the ductus venosus . In most individuals, the foramen ovale closes at birth. It later forms the fossa ovalis .
The foramen ovale (from Latin ' oval hole ' ) forms in the late fourth week of gestation , as a small passageway between the septum secundum and the ostium secundum. Initially the atria are separated from one another by the septum primum except for a small opening below the septum, the ostium primum . As the septum primum grows, the ostium primum narrows and eventually closes. Before it does so, bloodflow from the inferior vena cava wears down a portion of the septum primum, forming the ostium secundum . Some embryologists postulate that the ostium secundum may be formed through programmed cell death . [ 4 ]
The ostium secundum provides communication between the atria after the ostium primum closes completely. Subsequently, a second wall of tissue, the septum secundum , grows over the ostium secundum in the right atrium. Blood then passes from the right to left atrium only by way of a small passageway in the septum secundum and then through the ostium secundum. This passageway is called the foramen ovale . [ citation needed ]
The foramen ovale often closes at birth. At birth, when the lungs become functional, the pulmonary vascular pressure decreases and the left atrial pressure exceeds that of the right. This forces the septum primum against the septum secundum , functionally closing the foramen ovale. In time the septa eventually fuse, leaving a remnant of the foramen ovale, the fossa ovalis .
A fetus receives oxygen not from its lungs, but from the mother's oxygen-rich blood via the placenta . Oxygenated blood from the placenta travels through the umbilical cord to the right atrium of the fetal heart. As the fetal lungs are non-functional at this time, the blood bypasses them through two cardiac shunts. The first is the foramen ovale (the valve present between them called eustachian valve) which shunts blood from the right atrium to the left atrium. The second is the ductus arteriosus which shunts blood from the pulmonary artery (which, after birth, carries blood from the right side of the heart to the lungs) to the descending aorta. [ citation needed ]
In about 25% of adults the foramen ovale does not close completely, but remains as a small patent foramen ovale ("PFO") . [ 5 ] In most of these individuals, the PFO causes no problems and remains undetected throughout life.
PFO has long been studied because of its role in paradoxical embolism (an embolism that travels from the venous side to the arterial side). This may lead to a stroke or transient ischemic attack . Transesophageal echocardiography is considered the most accurate investigation to demonstrate a patent foramen ovale. A patent foramen ovale may also be an incidental finding.
|
https://en.wikipedia.org/wiki/Foramen_ovale_(heart)
|
Foraminotomy is a medical operation used to relieve pressure on nerves that are being compressed by the intervertebral foramina , the passages through the bones of the vertebrae of the spine that pass nerve bundles to the body from the spinal cord .
A foraminotomy is performed to relieve the symptoms of nerve root compression in cases where the foramen is being compressed by bone, disc, scar tissue, or excessive ligament development and results in a pinched nerve.
The procedure is often performed as a minimally invasive procedure in which an incision is made in the back, the muscle peeled away to reveal the bone underneath, and a small hole cut into the vertebra itself. Through this hole, using an arthroscope , the foramen can be visualized, and the impinging bone or disk material removed. Surgery is typically short in duration, taking around 6 hours. Patients stay in hospital for 5-8 nights, can drive after 8 weeks, perform light duties after 8 weeks and make a full recovery within 18 months.
A foraminotomy that removes a large amount of bone or other material may occasionally be described as a foraminectomy .
This surgery article is a stub . You can help Wikipedia by expanding it .
|
https://en.wikipedia.org/wiki/Foraminotomy
|
Forced Normalization (FN) is a psychiatric phenomenon in which a long term episodic epilepsy or migraine disorder is treated, and, although the electroencephalogram (EEG) appears to have stabilized, acute behavioral, mood, and psychological disturbances begin to manifest. If, or when, treatment for the disorder is halted, the disturbances go away, but the episodic spikes on the EEG reappear. [ 1 ] H. Landolt coined the term 'Forced Normalization' in 1953 in response to a change he witnessed in epileptic EEGs, which monitor electrical activity in the brain. These changes were followed by abrupt behavioral changes in the patient. [ 2 ] Landolt concluded that forced normalization is "the phenomenon characterized by the fact that, with the occurrence of psychotic states , the electroencephalography becomes more normal or entirely normal, as compared with previous and subsequent EEG findings." Forced normalization, as described by Landolt, [ 3 ] was therefore an electrophysiological phenomenon with the electroencephalograph at its helm.
Tellenbach's description of "alternative psychosis" or the reciprocal relationship between abnormal mental states and seizures differed from Landolt's in its clinical rather than EEG description. [ 4 ] Subsequently, this concept was refined by Wolf, [ 5 ] who suggested that the term " paradoxical normalization " was more appropriate and closer to what Landolt intended, wherein both inhibitory processes and epileptic processes (subcortical and restricted) are active at the same time. [ citation needed ]
Researchers have been rallying for the broadening of the FN diagnostic criteria to include more episodic disorders than just epilepsy. It was recently discovered that FN can and has occurred in instances of chronic migraine attacks. [ 6 ] This called into question not only the diagnostic criteria, but also which treatments will treat the most patients the most efficiently.
Forced Normalization was first identified in 1953 and was believed to affect only epileptic patients. Though the converse nature of FN and epilepsy remains puzzling, the link between mental health conditions and epilepsy itself proved unsurprising to scientists. A systematic review compounded data from thousands of instances of FN and each patient's treatment. One of the patterns identified was that the comorbidity of psychiatric symptoms in epilepsy is significantly higher by calling upon the rate of schizophrenia in epilepsy patients, which is double that of the general population. [ 7 ] Furthermore, it found that the concomitance is highly dependent on the type of epilepsy a patient has: temporal lobe and cerebellum central epilepsy tend to be more susceptible to psychiatric behavioral disorders. [ 7 ]
FN in epilepsy patients has historically been treated using pharmacological stimulation, but electrical therapy has been utilized, though uncommon. In more severe cases, pharmacological stimuli improved the induced psychosis. [ 8 ] However, in the systematic review discussed previously, researchers found that pharmacological stimulation proved ineffective in a range of cases. In fact, they the most effective way to stop the psychosis was to completely halt epileptic treatment. [ 7 ] In one study, researchers combined pharmacological and electrical stimulation in an attempt to treat FN patients' psychosis without having to halt antiepileptic treatments. While this method did reduce the frequency and severity of seizures, the psychotic symptoms in the patients worsened. [ 9 ] This led researchers to the conclusion that the pathophysiological antagonism that electrical and pharmacological stimuli are capable of may be too different to combine the methods of treatment for FN.
The occurrence of FN in migraine patients was discovered much more recently, and continues to be the topic of much scholarly debate. The most significant question is whether or not the FN diagnostic criteria should be broadened to include these psychiatric disturbances in any episodic disorder. Antonio Russo et al. were the first researchers to report on an instance of FN in migraine. In this instance, the pattern of episodic disorder remission and abrupt manifestation of psychiatric behaviors that are present in epileptic cases of FN mirrored that of their migraine patient. [ 10 ] These scholars were able to link the disturbance to FN, even though there had never been a case of FN in migraines. This is not only because of similarities in symptoms, but also because of the similarities in neuronal activity these episodic disorders share.
A point of reason to broaden the diagnostic criteria for FN is the similar locations of neuroelectrical activity during the psychosis, regardless of whether a patient suffers from epilepsy or migraines. Thus far, in both migraine and epileptic cases of FN, the psychosis that develops is hypothesized to be rooted largely in non limbic structures of the brain, like the amygdala, cerebrum, and olfactory bulb. [ 9 ] Both antiepileptic drugs (AEDs) and antimigraine medications do not affect these areas and, therefore, do not affect psychiatric activity. Yet, these medications still normalize the episodic activity on the EEG, creating the phenomenon of FN. [ 10 ] This points to the commonalities in the activity of non limbic areas of the brain, rather than the type of episodic disorder of the patient. Migraine researchers believe the primary focus of the diagnosis of FN should be placed on the activity in the cerebral cortex, as well as the psychiatric and behavioral changes that occur in a patient. [ 10 ]
Due to the neuroelectrical similarities of FN in migraines and epilepsy, researchers have begun to theorize about new treatment methods. These new treatments could encompass more instances of FN, rather than cases solely in epilepsy patients. While commonly utilized to treat independent instances of mood disorders and psychosis, electroconvulsive therapy has yet to be used alone to treat FN. Due to pathophysiological similarities in the psychosis caused by FN and nonconcurrent psychosis, researchers have begun to theorize about the success of electrical stimulation alone in treating FN. [ 11 ] In a case study, two patients with debilitating psychosis were followed. Both of the patients had no history of epilepsy or migraines. Yet, the patients each experienced one or more naturally occurring seizures, and their psychosis was largely alleviated after the occurrence of such. [ 11 ] Researchers gathered from this occurrence that the episodic activity in the brain caused by epilepsy may be exactly what wards off psychosis: when patients' seizures go into remission, the psychosis emerges. These researchers hypothesize about the efficiency of electroconvulsive therapy, or some form of clinically induced seizures, to treat the psychosis without having to stop AED or antimigraine therapy. [ 11 ] Furthermore, based on the pathophysiological similarities in both epilepsy and migraines and the regions of the brain the concurrent psychoses effect, a theoretical electrical treatment could be the jumping off point for an all encompassing treatment plan of FN.
|
https://en.wikipedia.org/wiki/Forced_normalization
|
Allegations of forced organ harvesting from Falun Gong practitioners and other political prisoners in China have raised concern within the international community . [ 1 ] [ 2 ] [ 3 ] [ 4 ] According to a report by former lawmaker David Kilgour , human rights lawyer David Matas , and journalist Ethan Gutmann of the US government-affiliated Victims of Communism Memorial Foundation , political prisoners, mainly Falun Gong practitioners, are being executed "on-demand" in order to provide organs for transplant to recipients. [ 1 ] [ 2 ] Reports have shown that organ harvesting has been used to advance the Chinese Communist Party 's persecution of Falun Gong [ 5 ] and because of the financial incentives available to the institutions and individuals involved in the trade. [ 6 ] [ 7 ] A report by The Washington Post has disputed some of the allegations, saying that China does not import sufficient quantities of immunosuppressant drugs , used by transplant recipients, to carry out such quantities of organ harvesting. [ 8 ] Nevertheless, other medical scholars have noted that there are numerous inconsistencies within China's organ transplant data, with misclassifications of non-voluntary organ donations as voluntary. [ 9 ] [ 10 ] [ 11 ]
Reports on systematic organ harvesting from Falun Gong prisoners first emerged in 2006, though the practice is alleged to have started at least six years earlier. [ 12 ] [ 13 ] Several researchers—most notably Matas, Kilgour, and Gutmann—estimate that tens of thousands of Falun Gong prisoners of conscience have been killed to supply a lucrative trade in human organs and cadavers and that these abuses may be ongoing. [ 14 ] These conclusions are based on a combination of statistical analysis; interviews with former prisoners, medical authorities and public security agents; and circumstantial evidence , such as the large number of Falun Gong practitioners detained extrajudicially in China and the profits to be made from selling organs. [ 7 ] [ 6 ]
The Chinese government has long denied all accusations of organ harvesting. [ 8 ] The parliaments of Canada and the European Union , as well as the United States House of Representatives , have adopted resolutions condemning the forced organ harvesting from Falun Gong prisoners of conscience. [ 1 ] United Nations Special Rapporteurs have called on the Chinese government to account for the sources of organs used in transplant practices, and the World Medical Association , the American Society of Transplantation and the Transplantation Society have called for sanctions on Chinese medical authorities. Several countries have also taken or considered measures to deter their citizens from travelling to China for the purpose of obtaining organs. A documentary on organ harvesting from Falun Gong practitioners, Human Harvest , received a 2014 Peabody Award recognizing excellence in broadcast journalism. [ 15 ]
In December 2018, a non-governmental tribunal known as the China Tribunal, chaired by British barrister Sir Geoffrey Nice KC , concluded: "unanimously, and sure beyond a reasonable doubt—that in China forced organ harvesting from prisoners of conscience has been practiced for a substantial period of time involving a very substantial number of victims." [ 16 ] [ 17 ] China eventually admitted that it had engaged in systematic organ harvesting from death row prisoners, [ 8 ] though it denies that such an organ harvesting program is ongoing. [ 1 ]
In August 2024, media outlets reported on the first known survivor of China's forced organ harvesting. [ 18 ] [ 19 ]
China has one of the largest organ transplant programs in the world. Although China does not keep nationwide statistics on transplant volume, Chinese Communist Party -owned China Daily reported that Chinese officials had estimated that as many as 20,000 organ transplants were performed in 2006. [ 20 ] Approximately 9,000 transplants that took place in 2006 were kidney and liver transplants, according to data from the Chinese Ministry of Health . [ 21 ] Some sources said the actual number of transplants is significantly higher, based on detailed analysis of hospital records. [ 22 ] As a matter of culture and custom, however, China has extremely low rates of voluntary organ donation . Between 2003 and 2009, for instance, only 130 people volunteered to be organ donors. [ 23 ] In 2010, the Chinese Red Cross launched a nationwide initiative to attract voluntary organ donors, but only 37 people signed up as of 2011. [ 24 ] Due to low levels of voluntary organ donation, most organs used in transplants are sourced from prisoners. The Chinese government approved a regulation in 1984 to allow the removal of organs from executed criminals, provided they give prior consent or if no one claims the body. [ 25 ]
Despite the absence of an organized system of organ donation or allocation, wait times for obtaining vital organs in China are among the shortest in the world—often just weeks for organs such as kidneys, livers, and hearts. This has made it a destination for international transplant tourism [ 26 ] and a major venue for tests of pharmaceutical anti-rejection drugs . [ 27 ] [ 28 ] [ 29 ] The commercial trade in human organs has also been a lucrative source of revenue for the Chinese medical, military and public security establishments. [ 30 ] [ 31 ] Because there is no effective nationwide organ donation or allocation system, hospitals source organs from local brokers, including through their connections to courts, detention centers and prisons. [ 32 ]
Organ transplant recipients in China are generally not told the identity of the organ donor, nor are they provided with evidence of written consent. In some cases even the identity of the medical staff and surgeons may be withheld from patients. The problem of transparency is compounded by the lack of any ethical guidelines for the transplant profession or system of discipline for surgeons who violate ethical standards. [ 31 ]
By the 1990s, growing concerns about possible abuses arising from coerced consent and corruption led medical groups and human rights organizations to start condemning China's use of prisoner organs. These concerns resurfaced in 2001, when a Chinese military doctor testified before U.S. Congress that he had taken part in organ extraction operations from executed prisoners, some of whom were not yet dead. [ 33 ] In December 2005, China's Deputy Health Minister Huang Jiefu acknowledged that up to 95% of transplant organs from deceased donors, which make up 65% of all transplantations, came from executed prisoners and promised steps to prevent abuse. [ 34 ] [ 35 ] Huang reiterated these claims in 2008 and 2010, stating that over 90% of organ transplants from deceased donors are sourced from prisoners. [ 36 ] [ 37 ] [ 38 ] In 2006, the World Medical Association demanded that China cease harvesting organs from prisoners, who are not deemed able to properly consent. [ 39 ] In 2014, Huang Jiefu said that reliance on organ harvesting from death row inmates was declining, while simultaneously defending the practice of using prisoners' organs in the transplantation system. [ 40 ]
Experts and researchers have also expressed concern that in addition to death-row inmates, prisoners of conscience are also being used to supply the organ transplant industry. These non-death-row inmates may have been imprisoned solely for their political or spiritual beliefs. [ 41 ] [ 42 ]
Falun Gong is a Chinese qigong discipline involving meditation and a moral philosophy rooted in Buddhist tradition. The practice rose to popularity in the 1990s in China, and by 1998, Chinese government sources estimated that as many as 70 million people had taken up the practice. [ 43 ] [ 44 ] Perceiving that Falun Gong was a potential threat to the Party's authority and ideology, Communist Party leader Jiang Zemin initiated a nationwide campaign to eradicate the group in July 1999. [ 45 ]
An extra-constitutional body called the 6-10 Office was created to lead the persecution of Falun Gong, [ 46 ] [ 47 ] and authorities mobilized the state media apparatus, judiciary, police force, army, education system, families, and workplaces to "struggle" against the group. [ 48 ] [ 49 ]
Since 1999, Falun Gong practitioners have been the targets of systematic torture , mass imprisonment , forced labour , and psychiatric abuse , all with the aim of forcing them to recant their beliefs. [ 50 ] [ 51 ] As of 2009, the New York Times reported that at least 2,000 Falun Gong practitioners had been killed amid the persecution campaign; [ 52 ] Falun Gong sources documented over 3,700 named death cases by 2013. [ 50 ] Due to the difficulty in accessing and relaying information from China, however, this may represent only a small portion of actual deaths. [ 50 ]
The first allegations of large-scale organ harvesting from Falun Gong practitioners were made in March 2006 by three individuals claiming knowledge of involuntary organ extractions at the Sujiatun Thrombosis Hospital in Shenyang , Liaoning province. One of the whistleblowers, the wife of a surgeon at the hospital, claimed her husband had performed numerous operations to remove the corneas of Falun Gong practitioners for transplant. [ 31 ]
Representatives of the U.S. State Department were dispatched to the Sujiatun hospital to investigate the claims. They made two visits, first was unannounced and another a tour of the facilities and found no evidence to prove the allegations were true, but said they remained concerned over China's treatment of Falun Gong and the reports of organ harvesting. [ 53 ] [ 54 ] Soon thereafter, in May 2006, the Coalition to Investigate the Persecution of Falun Gong asked former Canadian parliamentarian David Kilgour and human rights lawyer David Matas to investigate the broader allegations of organ harvesting from Falun Gong practitioners in China. Kilgour and Matas agreed to conduct an investigation as volunteers. [ 55 ]
David Kilgour and David Matas released the results of their preliminary investigation on 20 July 2006, in a report titled "Report into Allegations of Organ Harvesting of Falun Gong Practitioners in China" . [ 56 ] Although the pair were denied visas to travel to China, they nonetheless compiled over 30 distinct strands of evidence which were consistent with allegations of organ harvesting from Falun Gong practitioners. These included an analysis of statistics on organ transplantation in China, interviews with former Falun Gong prisoners, and recorded admissions from Chinese hospitals and law enforcement offices about the availability of Falun Gong practitioners' organs. [ 31 ]
In the absence of evidence that would invalidate the organ harvesting allegations—such as a Chinese government registry showing the source of transplant organs—Kilgour and Matas concluded that the Chinese government and its agencies "have put to death a large but unknown number of Falun Gong prisoners of conscience. Their vital organs, including kidneys, livers, corneas and hearts, were seized involuntarily for sale at high prices, sometimes to foreigners, who normally face long waits for voluntary donations of such organs in their home countries." They estimated that from 2000 to 2005, the source for 41,500 organ transplants was unexplained, and that Falun Gong prisoners were the most plausible source for these organs. [ 31 ] [ 57 ] [ 58 ] The authors qualified their report by noting the inherent difficulties in verifying the alleged crimes: no independent organizations are allowed to investigate conditions in China, eyewitness evidence is difficult to obtain, and official information about both organ transplantation and executions is often withheld or is contradictory. [ 31 ] The initial report however received a mixed reception. In the US, a Congressional Research Service report by Thomas Lum stated that the Kilgour–Matas report relied largely on logical inference, without bringing forth new or independently obtained testimony; the credibility of much of the key evidence was said to be questionable. [ 59 ] [ 60 ]
In 2007, Kilgour and Matas presented an updated report under the title " Bloody Harvest: Revised Report into Allegations of Organ Harvesting of Falun Gong Practitioners in China ". The findings were subsequently rewritten as a book released in October 2009. [ 61 ] The reports received international media coverage, and the authors travelled internationally to present their findings to governments and other concerned organizations. [ 62 ]
In 2012, State Organs: Transplant Abuse in China , edited by Matas and Dr. Torsten Trey, was published with essays from Dr. Gabriel Danovitch, Professor of Medicine, Arthur Caplan , Professor of Bioethics, Dr. Jacob Lavee, cardiothoracic surgeon, Dr. Ghazali Ahmad, Professor Maria Fiatarone Singh, Dr. Torsten Trey, Ethan Gutmann and Matas. [ 63 ] [ 64 ] [ 65 ]
Ethan Gutmann , an investigative journalist, author specializing in China, and Research Fellow at the US government–affiliated Victims of Communism Memorial Foundation , initiated his own investigation into the allegations of organ harvesting from Falun Gong practitioners in 2006. [ 66 ] [ 67 ] [ 68 ] Over the span of several years, he conducted interviews with over 100 refugees from China's labor camp and prison system, as well as with Chinese law enforcement personnel and medical professionals. [ 69 ] Based on his research, Gutmann concluded that organ harvesting from prisoners of conscience became prevalent in the north-western province of Xinjiang during the 1990s, when members of the Uyghur ethnic group were targeted in security crackdowns and "strike hard campaigns." [ 70 ] [ 71 ] Enver Tohti, an exiled pro-Uyghur independence activist, claims to have carried out the first live organ transplant on a Uyghur Muslim prisoner in 1995. He said that the first time he performed the transplant procedure, he was taken to a room near the execution ground in Urumqi to remove the liver and kidneys of an executed prisoner. He claimed that the man's heart was still beating as he removed the liver and kidneys. [ 72 ]
By 1999, Gutmann says that organ harvesting in Xinjiang began to decline precipitously, just as overall rates of organ transplantation nationwide were rising. The same year, the Chinese government launched a nationwide suppression of the Falun Gong spiritual group. Gutmann suggests that the new Falun Gong prisoner population overtook Uyghurs as a major source of organs. [ 14 ] He estimated that approximately 65,000 Falun Gong practitioners had been killed for their organs between 2000 and 2008, and notes that this figure is similar to that produced by Kilgour and Matas when adjusted to cover the same time period. [ 14 ] [ 73 ]
Gutmann has also provided testimony on his findings before U.S. Congress and European Parliament, and in August 2014 published his investigation as a book titled The Slaughter: Mass Killings, Organ Harvesting and China's Secret Solution to Its Dissident Problem . [ 74 ]
The Independent Tribunal Into Forced Organ Harvesting of Prisoners of Conscience in China, known as the China Tribunal , [ 75 ] was initiated in 2018 [ 76 ] by the International Coalition to End Transplant Abuse in China. [ 77 ] [ 78 ] The tribunal, based in London , [ 77 ] was made up of a seven-member panel. [ 79 ] [ 80 ] Geoffrey Nice , a Queen's Counsel and the chair of the tribunal, was a prosecutor at the international criminal tribunal for Yugoslavia. [ 77 ] According to an article in the scientific journal Nature , the tribunal does not have any legal authority. [ 79 ] The Chinese government declined an invitation to take part in the tribunal. [ 1 ]
The tribunal heard evidence over a six-month period. [ 75 ] The evidence included analyses of Chinese transplant data, and testimony from ex-prisoners, doctors and human rights workers. [ 79 ] Among the 50 witnesses, who testified either in person or via video link, [ 1 ] were David Kilgour and Jennifer Zeng . [ 77 ] [ 80 ] The tribunal also examined reports from the Committee Against Torture , Freedom House and Amnesty International . [ 1 ] Other submissions included internal Chinese medical records, previous investigations and academic papers. [ 1 ] Covertly recorded phone calls with transplant surgeons and undercover footage inside hospitals were also reviewed. [ 1 ]
In June 2019, the tribunal published their final judgment which unanimously concluded that crimes against humanity had been committed. [ 76 ] The tribunal's report said "forced organ harvesting has been committed for years throughout China on a significant scale and ... Falun Gong practitioners have been one—and probably the main—source of organ supply." [ 76 ] The tribunal estimated between 60,000 and 90,000 transplant operations occurred per year, much more than the official figures of 10,000 from the Chinese government. [ 1 ] [ 77 ] The chair of the tribunal said "there is no evidence of the practice having been stopped and the tribunal is satisfied that it is continuing." [ 77 ]
The tribunal's report included a reference to a research paper, posted on the preprint server SocArXiv , that examined voluntary organ transplant data from 2010 to 2016. [ 81 ] [ 79 ] That paper was later published in BMC Medical Ethics . [ 82 ] The paper's authors said it was difficult to believe the consistent and significant growth in voluntary transplants each year, and they concluded that China's voluntary system probably included non-voluntary donors, likely prisoners. [ 79 ] A statistician commissioned by the tribunal reviewed the paper's analysis and agreed that the data on voluntary transplants appeared to be unreliable. [ 79 ] Francis L. Delmonico , chair of the World Health Organization 's Task Force on Donation and Transplantation of Human Organs and Tissues, told Nature that he was unconvinced by the paper because it did not contain direct evidence of organ harvesting from prisoners. [ 79 ]
Several distinct strands of evidence have been presented to support allegations that Falun Gong practitioners have been killed for their organs in China. [ 83 ] Researchers, human rights advocates and medical advocacy groups have focused in particular on the volume of organ transplants performed in China; the disparity between the number of transplants and known sources of organs; the significant growth in the transplant industry coinciding with the mass imprisonment of Falun Gong practitioners; short wait times that suggest an "on demand" execution schedule; and reports that Falun Gong prisoners are given medical exams in custody to assess their candidacy as organ suppliers. [ 84 ] [ 85 ] [ 86 ]
In August 2024, The Diplomat reported its interview with Cheng Pei Ming, a Falun Gong practitioner, who recounted being subjected to repeated blood tests and a subsequent forced surgery while imprisoned in China. [ 18 ] He later discovered during medical exams in the U.S. that segments of his liver and a portion of his lung had been surgically removed. [ 18 ]
The number of organ transplants performed in China grew rapidly beginning in 2000. [ 87 ] This timeframe corresponds with the onset of the persecution of Falun Gong, when tens of thousands of Falun Gong practitioners were being sent to Chinese labor camps, detention centers and prisons. [ 88 ] [ 89 ]
In 1998, the country reported 3,596 kidney transplants annually. By 2001, overseas organ transportation became marketable, and in 2005 alone, there were hundreds of heart, kidney, and liver transplants, with China reporting over 10,000 kidney transplants in particular. [ 31 ] [ 90 ] Similarly, according to China Daily, the number of liver transplantation centers in China rose from 22 to over 500 between 1999 and 2006. [ 20 ] The volume of transplants performed in these centers also increased substantially in this period. [ 91 ] One hospital reported on its website that it performed 9 liver transplants in 1998, but completed 676 liver transplants in four months in 2005. [ 92 ] The Jiaotong University Hospital in Shanghai recorded seven liver transplants in 2001, 53 in 2002, 105 in 2003, 144 in 2004, and 147 in 2005. [ 31 ]
Kilgour and Matas write that the increase in organ transplants cannot be entirely attributed to improvements in transplant technology: "kidney transplant technology was fully developed in China long before the persecution of Falun Gong began. Yet kidney transplants shot up, more than doubling once the persecution of Falun Gong started...Nowhere have transplants jumped so significantly with the same number of donors simply because of a change in technology." [ 31 ]
Furthermore, they note that during this period of rapid expansion in China's organ transplant industry, there were no significant improvements to the voluntary organ donation or allocation system, and the supply of death row inmates as donors also did not increase. [ 31 ] [ 41 ] The parallel between rapid growth in organ transplants and the mass imprisonment of Falun Gong practitioners is consistent with the hypothesis that Falun Gong practitioners in custody were having their organs harvested. [ 93 ] [ 94 ] [ 95 ] [ 96 ]
In 2015, China was credited with having the world's largest DNA bank, corresponding the investment with the business of organ transport, with the country reporting 60,000 operations per year with kidney operations being the most lucrative. [ 97 ]
According to a US congressional report in 2005, up to 95% of organ transplants in China are sourced from prisoners. [ 34 ] However, China does not perform enough legal executions to account for the large number of transplants that are performed, and voluntary donations are exceedingly rare (only 130 people registered as voluntary organ donors nationwide from 2003 to 2009). [ 23 ]
In 2006, the number of individuals sentenced to death and executed was far fewer than the number of transplants. Based on publicly available reports, Amnesty International documented 1,770 executions in 2006; high-end estimates put the figure closer to 8,000. [ 98 ] Because China lacks an organized organ matching and allocation system, and in order to satisfy expectations for very short wait times, it is rare that multiple organs are harvested from the same donor. [ 99 ] Moreover, many death row inmates have health conditions such as hepatitis B that would frequently disqualify them as organ donors. This suggests the existence of a secondary source for organs. [ 32 ]
In a statement before the U.S. House of Representatives, Damon Noto, a spokesman for Doctors Against Forced Organ Harvesting said "the prisoners sentenced to death cannot fully account for all the transplantations that are taking place in China ... Even if they executed 10,000 and transplanted 10,000 a year, there would still be a very large discrepancy. Why is that? It is simply impossible that those 10,000 people executed would match perfectly the 10,000 people that needed the organs." [ 100 ] David Kilgour and David Matas similarly wrote that traditional sources of transplants such as executed prisoners, donors, and the brain dead "come nowhere near to explaining the total number of transplants across China." [ 101 ] Like Noto, they point to the large number of Falun Gong practitioners in the labor camp and prison system as a likely alternative source for organs. [ 31 ]
Wait periods for organ transplants in China are significantly shorter than elsewhere in the world. According to a 2006 post on the China International Transplantation Assistance Center website, "it may take only one month to receive a liver transplantation, the maximum waiting time being two months. As for the kidney transplantation, it may take one week to find a suitable donor, the maximum time being one month...If something wrong with the donor's organ happens, the patient will have the option to be offered another organ donor and have the operation again in one week." [ 102 ] Other organ transplant centers similarly advertised average wait times of one or two weeks for liver and kidney transplants. [ 31 ] [ 103 ] [ 104 ] This is consistent with accounts of organ transplant recipients, who report receiving organs a matter of days or weeks. [ 26 ] [ 105 ] [ 106 ] By comparison, median wait times for a kidney in developed countries such as the United States, Canada and Great Britain typically range from two years to over four years, despite the fact that these countries have millions of registered organ donors and established systems of organ matching and allocation. [ 107 ] [ 108 ] [ 109 ] [ improper synthesis? ]
Researchers and medical professionals have expressed concern about the implications of the short organ transplant wait times offered by Chinese hospitals. Specifically, they say these wait times are indicative of a pool of living donors whose organs can be removed on demand. [ 41 ] This is because organs must be transplanted immediately after death, or must be taken from a living donor (kidneys must be transplanted within 24–48 hours; livers within 12 hours, and hearts within 8 hours). [ 110 ]
Kirk C. Allison, associate director of the Program in Human Rights and Medicine at the University of Minnesota , wrote that the "short time frame of an on-demand system [as in China] requires a large pool of donors pre-typed for blood group and HLA matching," which is consistent with reports of Falun Gong prisoners having blood and tissue tested in custody. He wrote that China's short organ wait times could not be assured on a "random death" basis, and that physicians he queried about the matter indicated that they were selecting live prisoners to ensure quality and compatibility. [ 110 ] Dr. Jacob Lavee, Director of the Heart Transplant Unit at the Sheba Medical Center in Israel, recounts one of his patients traveling to China for a heart transplant. The patient waited two weeks for a heart, and the surgery was scheduled in advance—meaning the organ could not have been procured on the basis of a random death. [ 111 ] Franz Immer, chairman of the Swiss National Foundation for organ donation and transplantation, reports that during a visit to Beijing in 2007, he was invited by his Chinese hosts to observe a heart transplantation operation: "The organizer asked us whether we would like to have the transplantation operation in the morning or in the afternoon. This means that the donor would die, or be killed, at a given time, at the convenience of the visitors. I refused to participate." [ 14 ]
Editors of the Journal of Clinical Investigation write that "The only way to guarantee transplant of a liver or heart during the relatively short time period that a transplant tourist is in China is to quickly obtain the requisite medical information from prospective recipients, find matches among them, and then execute a person who is a suitable match." [ 41 ] Noto similarly says that China's organ transplant wait times and the ability to schedule transplants in advance can only be achieved by having a large supply of "living donors that are available on demand." Death row inmates alone are not numerous enough to meet this demand. [ 100 ]
Since 1999, hundreds of thousands of Falun Gong practitioners have been detained in re-education through labor camps, prisons, and other detention facilities in China, making them the largest group of prisoners of conscience in the country. [ 112 ] In 2008, the U.S. Department of State cited estimates that half of China's official labor camp population of 250,000 were Falun Gong practitioners, [ 113 ] [ 114 ] and a 2013 report by Amnesty International found that Falun Gong practitioners comprised between 30 and 100 percent of detainees in the labor camps studied. [ 50 ]
Former Chinese prisoners have also reported that Falun Gong practitioners consistently received the "longest sentences and worst treatment" in the camps, and that they are singled out for torture and abuse. [ 50 ] [ 115 ] In 2006, a study by the UN's Special Rapporteur on Torture noted that 66% of reported cases from China involved Falun Gong victims. [ 116 ] Thousands of Falun Gong practitioners have died or been killed in custody, often under disputed circumstances. [ 45 ] [ 50 ] Family members of the deceased have reported being denied an autopsy; [ 117 ] in some instances bodies were summarily cremated without the family's consent. [ 118 ] Analysts and rights groups have pointed to several factors that drive the especially severe treatment against Falun Gong practitioners in custody. These include directives issued from central government or Communist Party authorities; [ 119 ] incentives and quota systems that encourage abuse; [ 50 ] a sense of impunity in the event of deaths in custody; [ 120 ] and the effects of the state propaganda that dehumanizes and vilifies Falun Gong practitioners. [ 49 ] [ 121 ]
The large numbers of Falun Gong prisoners in custody has led researchers to identify them as a likely source for organs. According to Gutmann's research, other marginalized prisoner groups may also have been targeted, including ethnic Tibetans and Uyghurs who reside predominantly in China's western regions. However, for reasons of geographic proximity, Falun Gong practitioners are more likely to be targeted. In addition, because their spiritual practice prohibits smoking or consumption of alcohol, they tend to be comparatively healthy. [ 14 ]
In the context of organ harvesting Kilgour and Matas point to a further source of vulnerability. Namely, in order to protect family members from punishment by security agencies, many detained Falun Gong practitioners refuse to give their names or other personally identifying information to police. "Though this refusal to identify themselves was done for protection purposes, it may have had the opposite effect. It is easier to victimize a person whose whereabouts is unknown to family members than a person whose location the family knows," says their report. Kilgour and Matas wrote that they had yet to meet or hear of any Falun Gong practitioners who were safely released from custody after refusing to identify themselves, despite the prevalence of this practice. [ 31 ] Similarly, Ethan Gutmann reports that in over a hundred interviews with former prisoners, he encountered only one Falun Gong practitioner who had remained nameless while in custody, and "her organs were even more worn out than my own." [ 14 ]
Ethan Gutmann interviewed dozens of former Chinese prisoners, including sixteen Falun Gong practitioners who recalled undergoing unusual medical tests while in detention. Gutmann says some of these tests were likely routine examinations, and some may have been designed to screen for the SARS virus. However, in several cases, the medical tests described were exclusively aimed at assessing the health of internal organs. [ 74 ]
One man, Wang Xiaohua, was imprisoned in a labor camp in Yunnan in 2001 when he and twenty other Falun Gong detainees were taken to a hospital. They had large quantities of blood drawn, in addition to urine samples, abdominal x-rays, and electrocardiogram . Hospital staff did not tend to physical injuries they had suffered in custody. This pattern was repeated in several other interviews. Qu Yangyao, a 30-something Chinese refugee, was taken from a labor camp to a hospital in 2000 along with two other Falun Gong practitioners. She says that hospital staff drew large volumes of blood, conducted chest x-rays and probed the prisoners' organs. There was "no hammer on the knee, no feeling for lymph nodes, no examination of ears or mouth or genitals—the doctor checked her retail organs and nothing else," writes Gutmann. [ 14 ]
Another woman, Jung Tian, recounts comprehensive physical exams and the extraction of large volumes of blood—enough for advanced diagnostics or tissue matching—while in a detention center in Shenyang city. At a women's labor camp in Guangdong province, a former detainee says that 180 Falun Gong prisoners were subject to medical tests in early 2003 and that the tests exclusively focused on internal organs. Another female witness who was held at Masanjia Labor Camp in 2005 said that only young, healthy practitioners had comprehensive medical exams upon arrival at the camp; the old and infirm were given only cursory treatment. [ 14 ]
In addition to Falun Gong practitioners, researcher Jaya Gibson identified three Tibetan prisoners who were subject to "organs-only" medical exams, all of them shortly after 2005. [ 14 ]
In March 2006, immediately after allegations emerged that Falun Gong prisoners were being targeted for organ harvesting, overseas investigators began placing phone calls to Chinese hospitals and police detention centers. The callers posed as prospective transplant recipients or organ brokers and inquired about the availability of Falun Gong organs. In several instances, they obtained recorded admissions that organs could be procured from Falun Gong prisoners. A selection of these conversations were cited as evidence in the report by David Kilgour and David Matas. [ 14 ] [ 31 ]
In one such call to a police detention center in Mishan city, an official said that they had five to eight Falun Gong practitioners under the age of 40 who were potential organ suppliers. When asked for details on the background of these individuals, the official indicated that they were male Falun Gong prisoners from rural areas. [ 122 ]
A doctor at the Minzu hospital in Nanning city said that the hospital did not currently have Falun Gong organs available, but that he had previously selected Falun Gong prisoners for organ harvesting. The doctor also advised the caller to contact a university hospital in neighboring Guangdong province, saying that they had better channels to obtain Falun Gong organs. [ 122 ] At the Zhongshan hospital in Shanghai , a doctor told investigators that all his hospital's organs were sourced from Falun Gong practitioners. During an April 2006 phone call to a military hospital in Guangzhou , a doctor told investigators that he had "several batches" of Falun Gong organs, but that the supply could run dry after 20 May 2006. In another call, investigators posed as an organ broker to call the Jinzhou city people's court. In response to a question about obtaining organs from Falun Gong prisoners, a court official said "that depends on your qualifications ... If you have good qualifications, we may still provide some [organs]." [ 122 ]
Kilgour and Matas concede that in at least some instances, the hospital staff may have been supplying answers that the callers wanted to hear in order to make a sale. The results of these phone calls would also be difficult to replicate; as allegations of organ harvesting from Falun Gong gained attention, hospitals would become more reluctant to candidly discuss their organ sourcing practices. [ 31 ]
This investigative tactic was revived in 2012, when Communist Party officials began investigating Politburo member Bo Xilai for a variety of crimes. Bo had previously been governor of Liaoning province, which researchers believe was a major center for organ harvesting. The "World Organization to Investigate the Persecution of Falun Gong" made phone calls to mid-level and high-level officials with prior connections to Bo, posing as members of the internal Communist Party discipline and inspection group that was building the case against him. They asked questions about the chain of command involved in procuring organs from prisoners, including Falun Gong prisoners. When asked about Bo Xilai's involvement in organ harvesting, one high-ranking member of the Politburo reportedly told investigators that Politburo Standing Committee member and security czar Zhou Yongkang "is in charge of this specifically. He knows it." [ 123 ]
A city-level official in Liaoning province was asked by investigators what direction Bo Xilai may have given regarding removing organs from Falun Gong prisoners. The official replied "I was asked to take care of this task. Party central is actually taking care of this...He [Bo] was involved quite positively, yeah it seemed quite positive. At that time we mainly talked about it during the meetings within the Standing Committee." The official hung up after realizing that he had not confirmed the identity of the caller. [ 123 ]
The growth of a commercial organ trade is linked to economic reforms in the late 1980s and early 1990s that saw a steep decline in government funding to the healthcare system. Healthcare moved toward a more market-driven model, and hospitals devised new ways to grow their revenue. This pattern also applies to military hospitals; since the mid-1980s, the People's Liberation Army has engaged in commercial and profit-making ventures to supplement its budget. [ 31 ] [ 100 ]
In their report on organ harvesting from Falun Gong practitioners, Kilgour and Matas describe transplant hospitals in China that cater to wealthy foreigners who paid upwards of $100,000 for liver, lung, and heart transplants. For instance, the website of the China International Transplantation Network Assistance Center posted the following price list on its website in 2006: Kidney: $62,000; Liver: $98,000–130,000; Liver+kidney: $160,000–180,000; Kidney+pancreas: $150,000; Lung: $150,000–170,000; Heart: $130,000–160,000; Cornea: $30,000. [ 31 ] In a statement before the U.S. House of Representatives, Gabriel Danovitch of the UCLA Medical Center said, "The ease in which these organs can be obtained and the manner that they may be allocated to wealthy foreigners has engendered a culture of corruption." [ 124 ]
Beginning in 2010, Chinese authorities announced that the country would transition away from the use of prisoners as an organ source, and would rely entirely on voluntary donations coordinated through a centralized registry. By 2015, officials asserted that voluntary donors were the sole source for organ transplants in China. However, critics have pointed to evidence of systematic falsification of data related to voluntary organ donations, casting doubt on reform claims. [ 125 ]
In a paper published in the journal BMC Medical Ethics, for instance, researchers analyzed data on voluntary organ transplants from 2010 to 2018. Datasets were drawn from two national sources, several sub-national jurisdictions, and from individual Chinese hospitals. The researchers found compelling evidence of "human-directed data manufacture and manipulation" in the national datasets, as well as "contradictory, implausible, or anomalous data artefacts" in the provincial datasets, which suggests that the data "may have been manipulated to enforce conformity with central quotas." Among the findings was that the purported rate of growth in voluntary donations was derived from a simple quadratic equation, with nearly perfect model parsimony. These findings appear to undermine official claims about the extent of voluntary organ donations in China. [ 6 ] The authors of the BMC Medical Ethics article also note that China's model parsimony is one to two orders of magnitude smoother than any other nation's, even those that have experienced rapid growth in their organ transplantation sector. [ 126 ]
In his book on organ transplant abuse, Ethan Gutmann included a case study centered on China's northeastern Liaoning province. Former Politburo member Bo Xilai served as mayor and party chief of Dalian city, Liaoning in the 1990s, and later was made Governor from 2001 to 2004. The province is known to have a high concentration of Falun Gong practitioners, and leads the country in reported Falun Gong deaths in custody. [ 14 ] Several observers have noted that Bo Xilai pursued an especially intense campaign against Falun Gong in the province, leading to charges of torture and crimes against humanity. [ 127 ] [ 128 ] [ 129 ]
Bo's close associate Wang Lijun was named head of the Public Security Bureau in Jinzhou, Liaoning, in 2003. In this capacity, he ran an organ transplantation facility where he reportedly oversaw "several thousand" organ transplants, leading to concerns that many of the organs were taken from political prisoners. [ 130 ] [ 131 ] During a 2006 award ceremony, Wang told reporters "For a veteran policeman, to see someone executed and within minutes to see the transformation in which this person's life was extended in the bodies of several other people—it was soul-stirring." [ 123 ] Gutmann says it is "extremely unlikely" that all the organs used in these operations were taken from executed death-row prisoners, who would not have been plentiful enough to supply thousands of organ transplants. However, Gutmann notes that Liaoning detained large numbers of Falun Gong practitioners in labor camps and prisons. "It is also germane that both Bo Xilai and Wang Lijun built a large measure of their political power on the repression of Falun Gong," he writes. [ 14 ] [ 123 ]
In addition to organ transplants in Jinzhou, Gutmann notes that security agencies in Dalian city were supplying human cadavers to two major plastination factories, where the bodies are filled with plastics to be sent on display around the world as bodies exhibitions. According to an informant interviewed on the program 20/20, the plastinated cadavers came from executed prisoners. Again, however, Gutmann notes a disparity in the numbers: the body plastination factories operating in Dalian processed thousands of cadavers—far more than could be expected to be donated or taken from legally executed prisoners. The establishment of the body plastination factories coincided with the onset of the persecution of Falun Gong. [ 14 ]
According to a 2017 report from The Washington Post , research and reporting has undercut allegations that China continues to secretly conduct 60,000 to 100,000 organ transplants per year. [ 8 ] Data compiled by American company Quintiles IMS showed China's share of global demand for immunosuppressant drugs, which are necessary to prevent the bodies of patients from rejecting transplanted organs, were approximately in line with the proportion of global transplants China said it performed. [ 8 ] The journal also reported that a lawyer who defended 300 to 400 adepts of the religious organisation said he had "never heard of organs being taken from live prisoners". [ 8 ] In 2016, according to health official Huang Jiefu, China performed a total of 13,238 organ transplant operations. [ 8 ] Xu Jiapeng, an account manager at Quintiles IMS in Beijing, said it was "unthinkable" China operated a clandestine system that the data on immunosuppressants did not pick up. [ 8 ]
However, according to a 2020 scholarly report [ 132 ] by Matthew Robertson, a doctoral researcher who previously published in the BMJ and BMC Medical Ethics on this topic, [ 133 ] [ 134 ] [ 135 ] a group of experts pointed out that the Post article made an "elementary statistical error." The Post reporter calculated a country's drug consumption using sales dollar amounts instead of dosage. [ 136 ] Robertson and the experts argued that this approach was flawed because drug prices vary significantly between countries (e.g., immunosuppressants are 2.5 to 4 times cheaper in China than in the US). Furthermore, both Japan's and the US's shares of global immunosuppressant sales are significantly higher than their shares of global transplants. Since the total global percentage must equal 100%, it means that many other countries would have a much lower share of immunosuppressant sales relative to their share of transplants. [ 136 ] Robertson and the experts also pointed out that the Post 's assumption that a country's share of immunosuppressant sales should match its share of transplants was incorrect. Additionally, the true total number of global transplants is unknown due to the secrecy surrounding China's data. [ 136 ]
Additionally, Robertson and the experts indicated that nearly all Chinese hospitals have two pharmacies: an official one and an unofficial one that operates in a legal gray area to directly generate income for the hospital. The data from these unofficial pharmacies, which handle a substantial amount of business, are not included in IMS figures. Robertson also discovered that IMS did not receive raw data from Chinese hospitals, and instead obtained it through official or semi-official intermediaries that collected data for municipalities. [ 136 ]
Critics have alleged that China's immunosuppressant data would not include foreign transplant tourists but The Washington Post reported that these assertions did not stand up to scrutiny. [ 8 ] Jose Nuñez, head of the World Health Organization 's transplantation program, said the number of foreigners going to China for transplants in 2015 was "really very low" compared with India, Pakistan, the United States as well as China's past. [ 8 ] On the other hand, a documentary by South Korea's TV Chosun contained interview footage showing that a Chinese transplant center, as of late 2017, was accepting foreign patients and providing them and their families with customized services. [ 137 ]
The Chinese government has repeatedly and categorically denied that Falun Gong practitioners have been killed for their organs, and insists that it adheres to World Health Organization standards. Specifically, the government claims that one of the major sources for the transplant figures, Professor Shi Bingyi, later alleged that the Canadian led investigative reports quoting him were fabricated. [ 89 ] However, the government has not refuted the specific points of evidence cited by researchers, nor provided an alternative explanation for the source of organs used in transplants. [ 138 ]
In response to a 2014 resolution on organ harvesting by the U.S. House of Representatives, a Chinese embassy spokesperson said that China requires written consent from organ donors, and declared that "the so-called organ harvesting from death-row prisoners is totally a lie fabricated by Falun Gong". The embassy representative then urged American lawmakers to stop "supporting and conniving" with Falun Gong. [ 139 ]
David Kilgour and David Matas say that the Chinese government's response to their investigation in 2006 contained "a good deal of invective, but no factual information which contradicts or undermines our conclusions or analysis". In particular, the Chinese government response centered on the charge that Falun Gong is an "evil cult"; questioned the motives and independence of the researchers; and noted a captioning error where their report had mislabeled the location of two Chinese cities. The government's response also stated that China prohibits the sale of human organs and requires written consent of the donor—claims which Kilgour and Matas say are belied by the evidence. [ 31 ]
From 2006 to 2008, two UN Special Rapporteurs made repeated requests to the Chinese government to respond to allegations about Falun Gong prisoners and explain the source of organs used in transplant operations. [ 138 ] [ 140 ] The Chinese government's responses did not address these questions or explain the sources of transplant organs. Instead, it wrote China is in compliance with World Health Organization standards, and described the conditions under which organ transplants are permitted under Chinese laws and regulations. It further stated that allegations of organ harvesting "are merely the product of agitation by Falun Gong ... most of them have already been revealed to be unfounded rumours". [ 138 ]
The Chinese government also has sought to prevent public discussion of the issue outside its own borders, and has punished Chinese nationals who have spoken on the subject of organ harvesting. In May 2006, European Parliament Vice President Edward McMillan-Scott went to China on a fact-finding mission to investigate human rights violations. His tour guide, Cao Dong, said he knew of organ harvesting and had seen his Falun Gong practitioner friend's cadaver "in the morgue with holes where body parts had been removed". [ 141 ] Cao Dong was sentenced to five years in prison for speaking with the European Union official. [ 142 ]
In 2007, the Chinese embassy in Canada intervened to cancel the broadcast of a documentary on Falun Gong and organ harvesting, which was scheduled to air on the national broadcast network CBC Television . [ 143 ] The same year, the Chinese embassy in Israel tried unsuccessfully to cancel a talk by researcher David Matas on the subject of organ harvesting, threatening that his testimony would have an adverse impact on China–Israel relations. [ 111 ]
Allegations about organ harvesting from Falun Gong led to renewed focus on China's transplant practices by international medical authorities and professional associations. Medical professionals have raised a number of concerns stemming from the use of prisoner organs, and have debated the ethics of conducting exchanges with Chinese transplant hospitals.
In 2006, the World Medical Association adopted a resolution demanding that China stop using prisoners as organ donors. [ 144 ]
Since 2011, several medical journals have declared that they would cease publishing articles related to organ transplantation operations in China due to concerns about violations of medical ethics. The Journal of Clinical Investigation , a prestigious publication on biomedical research, declared that China's use of organs from executed prisoners "violates basic human rights. It violates core ethical precepts of transplant medicine and medical ethics. Worse still, some of those who are killed may be prisoners whose 'crimes' involve no more than holding certain political or spiritual beliefs." The journal decided that it would no longer accept manuscripts on human organ transplantation "unless appropriate non-coerced consent of the donor is provided and substantiated". [ 41 ] A similar opinion was expressed by authors in the American Journal of Transplantation . [ 145 ]
Writing in The Lancet in 2011, a group of prominent American surgeons and bioethicists called for a boycott of Chinese science and medicine pertaining to organ transplantation. "It is clear from the numbers provided by China that not all of the organs for Chinese citizens and transplant tourists are provided by voluntary consenting donors. The source of many of these organs is executed prisoners whose consent is either non-existent or ethically invalid and whose demise might be timed for the convenience of the waiting recipient", they wrote. [ 146 ] The article's lead author, Dr. Arthur Caplan, later added "Killing prisoners for their parts is unethical on its own", but the practice is even more heinous given that some of the executed prisoners were imprisoned for religious or political beliefs. [ 147 ] [ 148 ]
In contrast, Jeremy Chapman , Australian transplantation surgeon, dismissed Kilgour and Matas's report as "pure imagination piled upon political interest". [ 149 ]
From 2006 to 2008, two UN Special Rapporteurs made repeated requests to the Chinese government to respond to allegations about Falun Gong prisoners and explain the source of organs used in transplant operations. [ 138 ] In a February 2008 report, UN Special Rapporteur on Torture Manfred Nowak noted that in China "there are many more organ transplants than identifiable sources of organs ... It is alleged that the discrepancy between available organs and numbers from identifiable sources is explained by organs harvested from Falun Gong practitioners, and that the rise in transplants from 2000 coincides and correlates with the beginning of the persecution of these persons". [ 140 ] The Chinese government's responses did not address these questions or explain the sources of transplant organs. [ 138 ]
In June 2021, the Special Procedures of the United Nations Human Rights Council voiced concerns over having "received credible information that detainees from ethnic, linguistic or religious minorities may be forcibly subjected to blood tests and organ examinations such as ultrasound and x-rays, without their informed consent; while other prisoners are not required to undergo such examinations." The press release stated that UN’s human rights experts" were extremely alarmed by reports of alleged 'organ harvesting' targeting minorities, including Falun Gong practitioners, Uyghurs, Tibetans, Muslims and Christians, in detention in China." [ 150 ]
Several national governments have held hearings in their national legislatures regarding organ harvesting from Falun Gong practitioners, with some of them subsequently adopting resolutions condemning organ transplant abuses in China or developing legislation to ban transplant tourism.
In July 2014, the Foreign Affairs Subcommittee of the U.S. House of Representatives unanimously adopted a resolution condemning state-sanctioned organ harvesting from Falun Gong prisoners of conscience and members of other minority groups. [ 139 ] [ 151 ] The allegations have also surfaced in reports by the Congressional-Executive Commission on China , [ 152 ] and in the Department of State Country Report on Human Rights for China for 2011. [ 153 ] In January 2015, the White House responded to a petition signed by 34,000 Americans condemning organ harvesting from Falun Gong prisoners. The response noted that:
"China's leaders have announced a pledge to abolish the practice of taking human organs for transplant from executed prisoners, although we are aware of continued reports of such practices. We take such allegations very seriously and will continue to monitor the situation." [ 154 ]
In 2023, several U.S. House representatives introduced legislation and spoke out against organ harvesting in foreign countries. One such bill, the Stop Forced Organ Harvesting Act of 2023, addressed some of these concerns by "imposing sanctions and allowing the State Department to revoke the passports of those convicted of organ trafficking-related crimes." [ 155 ]
In 2024, after multiple hearings, the "Falun Gong Protection Act" (H.R. 4132) was unanimously passed by the U.S. House of Representatives on June 25. The Act focuses on addressing forced organ harvesting in the People's Republic of China, specifically targeting the persecution of Falun Gong practitioners. USA Congressional Bill, H.R.4132 - Falun Gong Protection Act, June 25, 2024
The European Parliament heard testimony about organ harvesting in China during a 6 December 2012 session on human rights in China. One year later, it passed a resolution expressing "deep concern over the persistent and credible reports of systematic, state-sanctioned organ harvesting from non-consenting prisoners of conscience in the People's Republic of China, including from large numbers of Falun Gong practitioners imprisoned for their religious beliefs, as well as from members of other religious and ethnic minority groups." The resolution called for the immediate release of all prisoners of conscience, and urged Chinese authorities to respond to United Nations inquiries about the source of organs used in transplants. [ 156 ] In March 2014, the European Economic and Social Committee in Brussels convened a follow-up event on organ transplant abuses in China. [ 157 ] Participants and speakers at the session endorsed the recommendations of the parliamentary resolution, which recognized that Falun Gong and other minority groups are targets of forced organ harvesting in China. EESC President Henri Malosse called for greater pressure to be put on the Chinese government to end organ transplant abuses. [ 158 ]
In March 2014, the members of the Italian commission on human rights unanimously adopted a resolution calling for the immediate release of Falun Gong practitioners and other prisoners of conscience in China, and urging Italian hospitals to reconsider collaborations with China in the area of organ transplants. [ 159 ] In 2015, the Italian Senate adopted a bill which makes it a crime to traffic in organs from living donors. Individuals found guilty of this offence could face 3–12 years in prison and fines of up to 300,000 Euros (US$350,000). [ 160 ]
In December 2006, the Australian Ministry of Health revealed that two of the country's major organ transplant hospitals had banned training of Chinese surgeons, in response to concerns about organ harvesting from Falun Gong practitioners and other prisoners. [ 161 ] On 21 March 2013, the Australian Senate unanimously passed a motion concerning reports of organ harvesting in China. [ 162 ] [ 163 ] The motion, which was introduced one day after a parliamentary briefing on the subject of organ harvesting from Falun Gong prisoners, called on Australia to adopt strict standards to address the practice of international organ trafficking. [ 164 ] The same year, Green party lawmakers in New South Wales, Australia, proposed legislation to criminalize and create specific offenses related to trafficking in human organs and tissue. [ 165 ]
In 2018, Graham Fletcher , the head of the Department of Foreign Affairs and Trade 's North Asia Division, said "the idea that there is a separate, parallel, hidden, vast network of unspeakable activity where people are essentially killed for their organs, we don't believe that that is happening." Graham's statement was to a parliamentary inquiry into organ trading. [ 1 ]
In 2007, Israel's national legislative body the Knesset adopted new legislation barring insurance companies from providing coverage to Israeli citizens who travel abroad to purchase organs. The move was partly a response to an investigation in which Israeli authorities arrested several men involved in mediating transplants of Chinese prisoners' organs for Israelis. One of the men had stated in an undercover interview that the organs came from "people who oppose the regime, those sentenced to death and from prisoners of the Falun Gong." [ 166 ] In addition to prohibiting citizens from buying organs overseas, the law also imposed criminal charges on organ traffickers. The new rules resulted in a significant decrease in the number of Israeli citizens seeking transplants abroad, while also helping to catalyze an expansion of the voluntary donor registry domestically. [ 111 ]
In 2010, Spain implemented a law prohibiting its nationals from traveling abroad to obtain illegal organ transplants. The legislation was proposed after a Spanish citizen reportedly traveled to Tianjin, China, where he obtained a liver for US$130,000 after waiting for just 20 days. The Spanish legislation makes it a crime to promote or facilitate an illegal organ transplant, punishable with up to 12 years in prison. In addition, any organization found to have participated in illegal organ transplant transactions will be subject to a fine. [ 167 ]
In June 2015, the national legislature of Taiwan passed an amendment to the "Human Organ Transplantation Act" to prohibit the sale or purchase of organs, including from abroad. The law also prohibits the use of organs from executed prisoners. Legislators who supported the bill noted that the amendments were intended to address the problem of Taiwanese citizens traveling to China to purchase organs, some of which were harvested from living donors. [ 168 ]
Similar bills against organ tourism have been proposed in the French national assembly (2010) and in Canadian parliament (2007, 2013). [ 169 ] [ 170 ] [ 171 ]
On 10 December 2018, the S-240 bill – An Act to amend the Criminal Code and the Immigration and Refugee Protection Act (trafficking in human organs), was read the second time in House of Commons of Canada and referred to Canadian House of Commons Standing Committee on Foreign Affairs and International Development . [ 172 ] In the debate, Vice-chair of Foreign Affairs and International Development Subcommittee on International Human Rights (SDIR) MP Ms. Cheryl Hardcastle stated that:
"...the numbers may actually be between 60,000 and 100,000 organ transplants per year... The principal victims of China's organ-harvesting industry was the country's Falun Gong followers... China's organ-harvesting industry developed in tandem with its systematic repression of Falun Gong... Today ... is a profound anniversary marking the UN Convention on the Prevention and Punishment of the Crime of Genocide and Universal Declaration of Human Rights 70 years ago. Those sentiments are inextricably linked after the horrors witnessed in World War II and the conviction of never again. I submit that those sentiments are profoundly linked here as well to Bill S-240. After World War II, the world sought to ensure such madness ensued against humanity never happened again. Organ harvesting and trafficking are a nauseating reality and we must put a stop to them. Canada must act and must start by passing Bill S-240." [ 173 ]
The bill was not passed into law during the 42nd Parliament [ 172 ] or when reconsidered in the 43rd as S-204. [ 174 ] However, the bill was passed by the 44th Parliament as S-223 on 15 December 2022. [ 175 ]
|
https://en.wikipedia.org/wiki/Forced_organ_harvesting_from_Falun_Gong_practitioners_in_China
|
Foreign accent syndrome is a rare medical condition in which patients develop speech patterns that are perceived as a foreign accent [ 1 ] that is different from their native accent, without having acquired it in the perceived accent's place of origin.
Foreign accent syndrome usually results from a stroke , [ 1 ] but can also develop from head trauma, [ 1 ] migraines [ 2 ] or developmental problems. [ 3 ] The condition might occur due to lesions in the speech production network of the brain, or may also be considered a neuropsychiatric condition . [ 4 ] The condition was first reported in 1907, [ 5 ] and between 1941 and 2009 there were 62 recorded cases. [ 3 ]
Its symptoms result from distorted articulatory planning and coordination processes, and although popular news articles commonly attempt to identify the closest regional accent, speakers with foreign accent syndrome acquire neither a specific foreign accent nor any additional fluency in a foreign language. There has been no verified case where a patient's foreign language skills have improved after a brain injury.
To the untrained ear, those with the syndrome sound as though they speak their native languages with a foreign accent ; for example, an American native speaker of American English might sound as though they spoke with a south-eastern British English accent or a native English speaker from Britain might speak with a New York accent . Contrary to popular belief, individuals with FAS do not exhibit their accent without any effort. Instead, these individuals feel as if they have a speech disorder. [ 6 ] More recently, there is mounting evidence that the cerebellum , which controls motor function, may be crucially involved in some cases of foreign accent syndrome, reinforcing the notion that speech pattern alteration is mechanical and thus non-specific. [ 7 ] [ 8 ]
Generally, FAS is not a persisting disorder; it is a temporary stage in recovery from stroke or trauma or potentially a stage of deterioration. FAS mainly affects speech at a segmental or prosodic level. Vowels are more likely to be affected than consonants. Vowel errors include an increase in vowel tensing, monophthongization of diphthongs , and vowel fronting and raising. There is evidence of both vowel shortening and lengthening. Consonantal anomalies include cases of changes in articulation, manner, and voicing. [ 9 ]
On a suprasegmental level, there are changes in intonation and pitch, such as monotonous intonation or exaggerations in pitch height and range. There are also difficulties in using stress accents to indicate pragmatics and meaning. [ 10 ] There is a tendency for FAS patients to switch to syllable-timed prosody when their native language is stress-timed . This perception could be due to changes in syllable durations, and the addition of epenthetic vowels. [ 9 ]
FAS has many similarities to apraxia of speech (AoS), which is another motor speech disorder . Some researchers think that FAS is a mild form of AoS because they are both caused by similar lesions in the brain. FAS differs from AoS in that FAS patients have more control over their speech deficits and their "foreign accent" is a form of compensation for their speech problems. Because there are relatively few differences in the symptoms of FAS and AoS, a listener's perception of the affected speech plays a large role in diagnosis of FAS rather than AoS. The listener has to be familiar with a foreign accent in order to attribute it to the affected speech of someone with FAS. [ 9 ]
The perception of a foreign accent is likely to be a case of pareidolia on the part of the listener. Nick Miller, Professor of Motor Speech Disorders at Newcastle University has explained: "The notion that sufferers speak in a foreign language is something that is in the ear of the listener, rather than the mouth of the speaker. It is simply that the rhythm and pronunciation of speech has changed." [ 11 ]
Foreign accent syndrome is more commonly pronounced in females than it is in males. In a meta-analysis of 112 patients with FAS, 97% were adults, and 67% were female. The typical age range for this disease is around 25–49 years of age. [ 12 ] Only in 12.5% of the cases did the patients have previous exposure to the accent that they later seemed to develop due to FAS. [ 13 ]
The majority of FAS patients develop FAS due to a stroke, but it can also develop as a result of developmental or psychological disorders, trauma, or tumors. Of the patients with neurological damage, the majority had a lesion in the supratentorial left hemisphere. Lesions primarily affected the: premotor cortex , motor cortex , basal ganglia or Broca's area . Lesions are also seen in the cerebellum , which projects to the previous areas. Right hemisphere damage rarely causes FAS. The majority of patients with FAS usually present other speech disorders, such as: mutism , aphasia , dysarthria , agrammatism and apraxia of speech . [ 13 ]
Neurolinguist Harry Whitaker [ 14 ] first coined the term foreign accent syndrome in 1982. He originally proposed some criteria that must be present in order to diagnose someone with FAS; they must be monolingual, they must have damage to their central nervous system that affects their speech, and their speech must be perceived as subjectively sounding foreign by themselves or clinicians. One problem with Whitaker's criteria is that they are based primarily on subjectivity, and therefore acoustic phonetic measurements are rarely used to diagnose FAS. [ 13 ]
Since this syndrome is very rare, it takes a multidisciplinary team to evaluate the syndrome and diagnose it, including: speech-language pathologists , neurolinguists , neurologists , neuropsychologists and psychologists . [ 15 ] In 2010, linguist [ 16 ] Jo Verhoeven and neurolinguist [ 17 ] Peter Mariën [ 18 ] [ 19 ] identified several subtypes of foreign accent syndrome. They described a neurogenic, developmental, psychogenic and mixed variant. Neurogenic FAS is the term used when FAS occurs after central nervous system damage. [ 19 ] Developmental FAS is used when the accent is perceptible as of an early age, e.g. children who have always spoken with an accent. [ 20 ]
Psychogenic FAS is used when FAS is psychologically induced, associated with psychiatric disorder or clear psychiatric traits. [ 21 ] [ 22 ] [ 23 ] The term mixed FAS is used when patients develop the disorder after neurological damage, but the accent change has such a profound impact on the self-perception and identity that they will modify or enhance the accent to make it fit with the new persona. [ 24 ]
Diagnosis, up until today, [ when? ] is generally purely perceptually based. However, in order to find out what subtype the patient has, complementary investigations are necessary. This differentiation is necessary for the clinician to allow for correct therapeutic guidance. Psychological evaluations may be performed in order to rule out any psychiatric condition that may be causing the change in speech, as well as tests to assess reading, writing, and language comprehension in order to identify comorbid disorders . [ 15 ]
One of the symptoms of this syndrome is that the patient moves their tongue or jaw differently while speaking, which creates a different sound, so a recording of the speech pattern is done in order to analyze it. Often, images of the brain are taken with MRI , CT , SPECT [ 20 ] or PET scans. [ 15 ] This is done to see if there is structural and or functional damage in the areas of the brain that control speech and/or rhythm and melody of speech. Electroencephalography is sometimes performed to investigate whether there are disturbances at the electrophysiological level. [ 15 ]
Treatment involves intense speech therapy. Methods such as oromotor exercises, using mirrors, targeting phonetic awareness, reading lists and texts, and using electropalatography are all methods that have been used in the past. Treatment should be developed on a patient by patient basis. About a quarter of FAS patients go through remission after treatment. [ 13 ]
The condition was first described in 1907 by the French neurologist Pierre Marie , [ 5 ] and another early case was reported in a Czechoslovak study in 1919, conducted by German internist Alois Pick [ de ] (1859–1945). [ 25 ] Other well-known cases of the syndrome include one that occurred in Norway in 1941 after a young woman, Astrid L., suffered a head injury from shrapnel during an air-raid . After apparently recovering from the injury, she was left with what sounded like a strong German accent and was shunned by her fellow Norwegians. [ 26 ] [ 27 ]
Cases of foreign accent syndrome often receive significant media coverage, and cases have been reported in the popular media as resulting from various causes including stroke, [ 28 ] [ 29 ] [ 30 ] [ 31 ] [ 32 ] [ 33 ] allergic reaction, [ 34 ] physical injury, [ 33 ] [ 32 ] [ 35 ] [ 36 ] and migraine. [ 37 ] [ 38 ] [ 39 ] [ 40 ] [ 41 ] [ 42 ] [ 43 ] [ 44 ] A woman with foreign accent syndrome was featured on both Inside Edition and Discovery Health Channel 's Mystery ER [ 45 ] in October 2008, and in September 2013 the BBC published an hour-long documentary about Sarah Colwill, a woman from Devon , whose "Chinese" foreign accent syndrome resulted from a severe migraine. [ 46 ] [ 47 ] [ 48 ]
In 2016, a Texas woman, Lisa Alamia, was diagnosed with foreign accent syndrome when, following a jaw surgery, she developed what sounded like a British accent. [ 49 ] [ 50 ] Ellen Spencer, a woman from Indiana who has foreign accent syndrome, was interviewed on the American public radio show Snap Judgment . [ 51 ] The British singer George Michael reported briefly speaking in a West Country accent following his recovery from a three-week long coma in 2012. [ 52 ]
FAS is a very rare disorder. Likewise, there are not very many proposed treatments. Two that may provide relief to patients with FAS in the future include mastery of musical skills and "tongue reading". [ 4 ]
In terms of mastery of music skills, research by Christiner and Reiterer [ non sequitur ] suggests that musicians, both instrumental and vocal, are better at imitating foreign accents than non-musicians. Vocalists are further better than instrumentalists at this task. In this way, individuals with FAS might be able to reimitate their original, lost native accents more easily if they master a musical – especially vocal – skill. [ 4 ]
Pursuing this further, another set of researchers, Banks et al. investigated the role of hearing a foreign accent versus hearing and seeing someone use a foreign accent and which of these may be better for helping an individual replicate a foreign accent. Contrary to the researcher's predictions, "no differences were found in perceptual gains between the two modalities." By contrast, a method that did seem to improve learning of non-native speech sounds was "real-time visual feedback of tongue movements with an interactive 3D visualization system based on electromagnetic articulography." [ 4 ]
Table #1: Cases from developmental FAS (DFAS), Psychogenic FAS (PFAS) and a New Variant of Neurologic FAS [ 4 ]
|
https://en.wikipedia.org/wiki/Foreign_accent_syndrome
|
Forensic dentistry or forensic odontology involves the handling, examination , and evaluation of dental evidence in a criminal justice context. Forensic dentistry is used in both criminal and civil law. [ 1 ] Forensic dentists assist investigative agencies in identifying human remains , particularly in cases when identifying information is otherwise scarce or nonexistent—for instance, identifying burn victims by consulting the victim's dental records. [ 2 ] Forensic dentists may also be asked to assist in determining the age, race , occupation , previous dental history, and socioeconomic status of unidentified human beings.
Forensic dentists may make their determinations by using radiographs , ante- and post-mortem photographs , and DNA analysis. Another type of evidence that may be analyzed is bite marks, whether left on the victim (by the attacker), the perpetrator (from the victim of an attack), or on an object found at the crime scene . However, this latter application of forensic dentistry has proven highly controversial, as no scientific studies or evidence substantiate that bite marks can demonstrate sufficient detail for positive identification and numerous instances where experts diverge widely in their evaluations of the same bite mark evidence. [ 3 ]
Bite mark analysis has been condemned by several scientific bodies, such as the National Institute of Standards and Technology (NIST), [ 4 ] National Academy of Sciences (NAS), [ 3 ] the President's Council of Advisors on Science and Technology (PCAST), [ 5 ] and the Texas Forensic Science Commission . [ 6 ]
In India, certificate courses offered include a modular course by D. Y. Patil Vidyapeeth, Pune , and some other private entities. The Indian Dental Association offers a fellowship program in FO which can be either a classroom program or an online program. Master's degree programs in different forensic disciplines along with M.Sc. Forensic Odontology is offered by National Forensic Sciences University which is the world's only university dedicated to forensic sciences.
It is a 2‑year full‑time course offered at the university's campus at Gandhinagar. [ 7 ]
Postgraduate diploma programs for dentists are available at The University of Melbourne , [ 8 ] The University of Western Australia , [ 9 ] and The University of Adelaide . [ 10 ]
The Belgian university KU Leuven offers a master's in Forensic Odontology.
Following the closure of the MSc course at the University of Glamorgan , one can receive either an MSc in Forensic Dentistry (a one-year programme) or a Masters in Forensic Odontology (a two-year programme) from the University of Dundee in Scotland, which currently has a very limited intake. [ 11 ]
There are two odontology training programs available in the US. One is a Fellowship program at The University of Texas Health Science at San Antonio Center Dental School, and the other is a master's degree program through the University of Tennessee Institute of Agriculture College of Veterinary Medicine.
For undergraduate studies, dental school candidates in Canada are required to complete a BA or at least three years of study in a BA program before completing a dental degree. BA Programs often involve science or biomedical but can include much more, as long as students have completed the basic prerequisites needed. [ 12 ]
There are no graduate study programs for forensic odontology specifically in Canada. Some universities have offered some involvement in forensic science disciples during clinical dental specialty projects, however, they will not graduate with credibility in the forensic odontology discipline.
Dental degrees given by universities in Canada include DDS (doctor of dental science) and DMD (doctor of dental medicine). [ 13 ]
There is no professional certification process for forensic odontologists in Canada currently. It is possible for Canadians to certify for the ABFO, a section of the American Academy of Forensic Science. [ 14 ] This process also includes an examination as well as the candidates must complete a career checklist of accomplishments which will be reviewed. This checklist may include fellowships, working with recognized medicolegal death investigation agencies, completing a minimum level of casework and research, and providing testimony in court cases. [ 12 ] The ABFO and the AAFS often hold scientific sessions which offer workshops including identification, civil litigation, age determination, and bite-mark analysis. These are beneficial in helping prospective forensic practitioners move towards board-eligible status. [ 12 ]
In Ontario, there is a group of 10 forensic dentists that are known as the Province of Ontario Dental Identification Team or better known as PODIT. [ 15 ]
Forensic odontology has played a key role in famous criminal cases:
In 1692, during the Salem Witch Trials , Rev. George Burroughs was accused of witchcraft and conspiring with the Devil , with biting his victims supposedly being evidence of his crimes. His bite marks and the bite marks of other people were compared to the victim's marks. The judges readily accepted the bite marks as evidence and this was the first time in what would become the United States that bite marks were used as evidence to solve a crime. He was later convicted and hanged. About two decades later, he was exonerated by the State, and his children were compensated for the wrongful execution. [ 16 ]
One of the first published accounts involving a conviction based on bite marks as evidence was the “Gorringe case”, in 1948, in which pathologist Keith Simpson used bite marks on the breast of the victim to seal a murder conviction against Robert Gorringe for the murder of his wife Phyllis. [ 17 ] Another early case was Doyle v. State , which occurred in Texas in 1954. The bite mark, in this case, was on a piece of cheese found at the crime scene of a burglary. The defendant was later asked to bite another piece of cheese for comparison. A firearms examiner and a dentist evaluated the bite marks independently and both concluded that the marks were made by the same set of teeth. The conviction, in this case, set the stage for bite marks found on objects and skin to be used as evidence in future cases. [ 18 ]
Another landmark case was People v. Marx , which occurred in California in 1975. [ 19 ] A woman was murdered by strangulation after being sexually assaulted. She was bitten several times on her nose. Walter Marx was identified as a suspect and dental impressions were made of his teeth. Impressions and photographs were also taken of the woman's injured nose. These samples along with other models and casts were evaluated using a variety of techniques, including two-dimensional and three-dimensional comparisons, and acetate overlays. Three experts testified that the bite marks on the woman's nose were indeed made by Marx and he was convicted of voluntary manslaughter.
Several organizations are dedicated to the field of forensic odontology. These organizations include the Bureau of Legal Dentistry (BOLD), the American Board of Forensic Odontology (ABFO), American Society of Forensic Odontology (ASFO) , the International Organization for Forensic Odonto-Stomatology (IOFOS) and the Association Forensic Odontology For Human Rights (AFOHR). Countries have their own forensic Odontological societies, including the British Association for Forensic Odontology (BAFO) and the Australian Society of Forensic Odontology (AuSFO). In 1996, BOLD was created at the University of British Columbia to develop new technology and techniques in forensic odontology. The University of British Columbia program is the only one in North America that provides graduate training in forensic odontology. [ 20 ]
In Canada, The Royal College of Dentists has not recognized forensic odontology therefore there is no organization for Canada, however, there are three well-developed and trained groups for forensic dentistry. These groups include British Columbia, Ontario, and Quebec. [ 12 ] British Columbia has a team called BC Forensic Odontology Response Team (BC_FORT) which is led by six dentists. [ 21 ] They focus on disaster-victim identification work. Ontario has a team of ten forensic dentists called the Province of Ontario Dental Identification Team (PODIT). [ 12 ] Quebec has a team that is run out of McGill University and they offer a well-established forensic dentistry online course that focuses on human bite-mark evidence. [ 22 ] These teams are kept small in order to maintain a relationship between forensic dentists and casework.
The Bureau of Legal Dentistry encourages the use of multiple dental impressions to create a “dental lineup”, similar to a suspect lineup used to identify alleged perpetrators of crime. Currently, dental impressions collected as evidence are compared only to those collected from a given suspect, which may bias the resulting outcome. Using multiple dental impressions in a lineup may enable forensic odontologists to significantly decrease the current bias in matching bite marks to the teeth of a suspect. [ 18 ] The organization BOLD also supports the creation of a database of dental records, which could help in verifying dental uniqueness. [ 19 ] This database could be created using criminal records or possibly all dental patients.
In 1984, the ABFO attempted to diminish the discrepancies and increase the validity of bite mark analysis by creating bite mark methodology guidelines. The guidelines attempt to establish standard terminology in describing bite marks and that reduces the risk of biased results. The ABFO also provides advice on how to effectively collect and preserve evidence. For example, they recommend that the collection of DNA evidence and detailed photographs of bites be taken together at the crime scene. The guidelines also outline how and what a forensic odontologist should record, such as the location, contours, shape, and size of a bite mark. They also provide a system of scoring to assess the degree to which a suspect's dental profile and bite mark match. According to the ABFO, the guidelines are not a mandate of methods to be used, but a list of generally accepted methods. [ 23 ]
The guidelines are intended to prevent potentially useful evidence from being thrown out simply because the forensic odontologist's collection methods were not standardized. Kouble and Craig used a simplified version of the ABFO scoring guidelines in order to retain accuracy with a larger sample of comparisons. A numerical score was assigned to represent the degree of similarity between the bite mark and model/overlay. The higher the score, the greater the similarity. In order to simplify the model, some features that were individually scored in the ABFO guidelines such as arch size and shape were assessed together while certain distinctive features such as spacing between teeth were treated as a separate variable. The authors believe that a simplified version would increase the strength of the comparison process. [ 24 ] In an attempt to improve guidelines used to collect dental evidence, IOFOS developed one of the most recognized systems for the collection of forensic dental evidence [ 25 ] [ 26 ]
There is only one international association promoting humanitarian forensic odontology , called AFOHR. It was inaugurated in 2015 by a group of experts in Lyon during the Interpol DVI annual meeting, following the inspiration of Emilio Nuzzolese, forensic odontologist from Italy. In 2019 the group evolved into Association adopting a by Laws and an elected Board. [ 27 ]
In 2016, an association of civil protection called Dental Team DVI Italia was founded in Bari, Italy , in order to offer pro bono services in the field of human identification and DVI Disaster Victim Identification to support Italian DVI teams. [ 28 ]
A bite mark is defined as a change in a surface's appearance due to the teeth coming into contact with it, leaving behind a dental pattern of the bite. [ 29 ] Studies have been performed in an attempt to find the simplest, most efficient, and most reliable way of analyzing bite marks and comparing them with one another and with suspects' teeth. There are two important notions when it comes to bite mark analysis: every individual has unique dentition that can be identifiable and this uniqueness can be found in a bite mark left in human skin. [ 30 ] The theory behind bite mark analysis has been called into doubt in recent years, with many observers considering the entire field unscientific and invalid and calling for bite mark evidence to be inadmissible in court. [ 31 ] [ 32 ]
Bites can occur on both the victim and the suspect; teeth are used as a weapon by the aggressor and in self-defense by the victim. [ 33 ] Although they are only a small portion of most forensic dentists' caseload, bite marks represent the most challenging aspect of the discipline. In addition to the location of the bite mark, the type of severity of the injury may give investigators clues as to the mental state of the offender. Bite marks may be found on the flesh of victims of a violent attack, particularly on the stomach or buttocks. Bite mark evidence may be the only form of physical evidence found on a body. [ 1 ] Alternatively, they may be found on the suspect, left by the victim during self-defense. Bite marks can be altered through stretching, movement, or change in environment after the bite. Skin is not ideal for holding the shape of a bite mark as it can become distorted due to the viscoelasticity of the skin. [ 34 ] There is also no set standard by which to analyze and compare bite marks.
Factors that may affect the accuracy of bite mark identification include time-dependent changes of the bite mark on living bodies, effects of where the bite mark was found, damage on soft tissue, and similarities in dentition among individuals. Other factors include poor photography, impressions, or measurement of dentition characteristics. [ 35 ]
Most bite mark analysis studies use porcine skin (pigskin), because it is comparable to the skin of a human, and it is considered unethical to bite a human for study in the United States. Limitations to the bite mark studies include differences in properties of pigskin compared to human skin and the technique of using simulated pressures to create bite marks. [ 36 ] Although similar histologically, pigskin and human skin behave in dynamically different ways due to differences in elasticity. [ 24 ] Furthermore, postmortem bites on nonhuman skin, such as those used in the experiments of Martin-de-las Heras et al., display different patterns to those seen in antemortem bite injuries. In recognition of the limitations of their study, Kouble and Craig [ 36 ] suggest using a G-clamp on an articulator in future studies to standardize the amount of pressure used to produce experimental bite marks instead of applying manual pressure to models on pigskin. [ 24 ] Future research and technological developments may help reduce the occurrence of such limitations.
Kouble and Craig compared direct methods and indirect methods of bite mark analysis. In the past, the direct method compared a model of the suspect's teeth to a life-size photograph of the actual bite mark. In these experiments, direct comparisons were made between dental models and either photographs or "fingerprint powder lift models." The "fingerprint powder lift" technique involves dusting the bitten skin with black fingerprint powder and using fingerprint tape to transfer the bite marks onto a sheet of acetate . Indirect methods involve the use of transparent overlays to record a suspect's biting edges. Transparent overlays are made by free-hand tracing the occlusal surfaces of a dental model onto an acetate sheet. When comparing the “fingerprint powder lift” technique against the photographs, the use of photographs resulted in higher scores determined by a modified version of the ABFO scoring guidelines. The use of transparent overlays is considered subjective and irreproducible because the tracing can be easily manipulated. On the other hand, photocopier-generated overlays where no tracing is used are considered to be the best method in matching the correct bite mark to the correct set of models without the use of computer imaging. [ 24 ]
While the photocopier-generated technique is sensitive, reliable, and inexpensive, new methods involving digital overlays have proven to be more accurate. [ 35 ] [ 36 ] Two recent technological developments include the 2D polyline method and the painting method. Both methods use Adobe Photoshop. The use of the 2D polyline method entails drawing straight lines between two fixed points in the arch and between incisal edges to indicate the tooth width. The use of the painting method entails coating the incisal edges of a dental model with red glossy paint and then photographing the model. Adobe Photoshop is then used to make measurements on the image. A total of 13 variables were used in the analysis. Identification for both methods was based on canine-to-canine distance (one variable), incisor width (four variables), and rotational angles of the incisors (eight variables). The 2D polyline method relies heavily on accurate measurements, while the painting method depends on the precise overlaying of the images. Although both methods were reliable, the 2D polyline method gave efficient and more objective results. [ 35 ]
Bite mark analysis has been criticized by the President's Council of Advisors on Science and Technology (PCAST). The PCAST has identified that bite mark analysis is an area which lacks clear standards in regards to the features needed to identify a particular set of dentition as having created a particular mark. [ 37 ] The analysis of bite marks is subjective and is highly criticized. [ 37 ]
So called bite mark analysis has been criticized as largely unscientific based on three pillars of critique: [ 32 ]
Recently, the scientific foundation of forensic odontology, and especially bite mark comparison, has been called into question. A 1999 study by a member of the American Board of Forensic Odontology found a 63% rate of false identifications. [ 38 ] However, the study was based on an informal workshop during an ABFO meeting which many members did not consider a valid scientific setting. [ 39 ] In February 2016, the Texas Forensic Science Commission recommended that bite mark evidence not be used in criminal prosecutions until it had a more firm scientific basis. [ 40 ] That same year, the President's Council of Advisors on Science and Technology declared that bite mark analysis had no scientific validity. [ 41 ]
An investigative series by the Chicago Tribune entitled "Forensics under the Microscope" examined many forensic science disciplines to see if they truly deserve the air of infallibility that has come to surround them. The investigators concluded that bite mark comparison is always subjective and no standards for comparison have been accepted across the field. The journalists discovered that no rigorous experimentation has been conducted to determine error rates for bite mark comparison, a key part of the scientific method . [ 42 ]
Critics of bite mark comparison cite the case of Ray Krone , an Arizona man convicted of murder on bite mark evidence left on a woman's breast. DNA evidence later implicated another man and Krone was released from prison. [ 43 ] Similarly, Roy Brown was convicted of murder due in part to bite-mark evidence, and freed after DNA testing of the saliva left in the bite wounds matched someone else. [ 38 ]
Although bite mark analysis has been used in legal proceedings since 1870, it remains a controversial topic due to a variety of factors. DeVore [ 44 ] and Barbenel and Evans [ 45 ] have shown that the accuracy of a bite mark on the skin is limited at best. Skin is not a good medium for dental impressions; it is liable to several of irregularities present before the imprint that could cause distortion. Also, bite marks can be altered through stretching, movement, or a changing environment during and after the actual bite. Furthermore, the level of distortion tends to increase after the bite mark was made. Both studies suggest that for the bite mark to be accurately analyzed, the body must be examined in the same position it was in when the bite occurred, which can be a difficult if the not impossible task to accomplish. [ 46 ] Bite mark distortion can rarely be quantified. Therefore, bite marks found at the scene are often analyzed under the assumption that they have undergone minimal distortion. [ 19 ] Only limited research has been done in trying to quantify the level of distortion of a bite mark on human skin since the 1970s. The lack of research may largely be because such studies are difficult to organize and are very expensive. [ 46 ]
Bite mark analysis is also controversial because dental profiles are subject to change. The loss of teeth or the alteration of arch configuration through a variety of procedures is common in human populations. The onset of oral diseases such as dental caries has been shown to alter the arch and tooth configuration and must be taken into account when comparing a dental profile to the bite mark after a significant amount of time has passed since the mark was made. [ 19 ]
While the methods behind collecting bite mark evidence at the scene are leading toward greater standardization, the methodology behind analyzing bite marks is extremely variable because it depends upon the preference of the specific odontologist. As discussed earlier, there are several methods used to compare bite marks ranging from life-sized photographs to computer-enhanced three-dimensional imaging. These methods vary in precision and accuracy, and there is no set standard by which to compare or analyze them. [ 46 ] The lack of analytical standards leads to a wide array of interpretations with any bite mark evidence. Some odontologists even disagree on whether or not a mark on the body is the result of a bite. [ 19 ] Therefore, the interpretation of evidence lies largely on the expertise of the forensic odontologist handling the case.
One possible issue facing bite mark analysis is a lack of bite mark uniqueness in any given population. Bite mark analysis is based on the assumption that the dental characteristics of anterior teeth involved in biting are unique amongst individuals, and this asserted uniqueness is transferred and recorded in the injury. [ 46 ] However, there is very little reliable research to support these assumptions. A study performed by MacFarlane et al. [ 47 ] supported the notion of dental uniqueness, but the study revolved around the visual assessment of a cast as opposed to the bite mark that could have been produced by the cast. [ 46 ] In another study conducted by Sognnaes et al., the group tried to find uniqueness between the dental profiles of identical twins in an attempt to prove dental uniqueness in the general population. [ 48 ] However, this study suffered from a small sample size (n=5), with the intent to extrapolate the data to the general population. They also used plaster of Paris as the substrate to simulate skin, yet the two materials have very different properties. [ 46 ] In a review conducted by Strom, he references a study conducted by Berg and Schaidt which suggested that at least four to five teeth need to be present in the mark to ensure its uniqueness and make an identification. [ 49 ] [ 50 ] However, this study was done long before many of the current evaluation methods, and this sheds doubt on how applicable these conclusions are today.
Rawson et al. determined that if five teeth marks can be matched to five teeth, it can be said with confidence that only one person could have caused the bite, and if eight teeth were matched to marks this would be a certainty. However, in this study, the probabilities used to make this claim are based on the assumption that the position of each tooth was independent of all the others. [ 51 ] [ 46 ] This is probably unrealistic because there are several ways that the dental profile can be changed. For example, braces apply force to specific teeth, in order to shift the placement of multiple teeth.
One particular case that highlighted the lack of uniqueness in bite marks involved two suspects accused of attacking a man who had sustained a bite mark injury. [ 52 ] Two separate forensic dentists, one representing the prosecution and one the defense, were brought in to analyze the mark. They reported conflicting results. One found the mark to come from suspect A and the other said it was from suspect B. This disagreement resulted from the fact that even though the two suspects had dental features making them unique, the bite mark itself was not detailed enough to reflect them. Therefore, the mark could have reasonably come from either of the men. [ 52 ] The equivocal outcome demonstrated in the case emphasizes the difficulty in proving uniqueness.
Most of the controversies facing bite mark analysis are due to the lack of empirical supporting evidence. When searching the entire MedLine database from 1960 to 1999, only 50 papers in English were found that related to bite mark analysis. Of these 50 papers, most of which were published in the 1980s, only 8% came from well designed experimentation providing empirical data. The lack of research has led to the continued use of a few outdated and limited studies to support the validity of bite mark analysis. This brings into question whether or not there is enough scientific support for bite mark analysis to be employed in court. [ 52 ]
There have been several instances when forensic dentists have made claims, accusations, and guarantees supported by bite mark evaluation that have been proven incorrect through other forensic sciences. DNA analysis has shed some light on the limitations of bite mark analysis because often the DNA from saliva surrounding the area of the bite mark proves to be a more reliable form of identification. In the case of Mississippi vs. Bourne , the DNA of a suspect excluded them from the crime after a dentist claimed the bite marks on the victim matched the defendant's teeth. [ 18 ] DNA sampling has been included as a task for a forensic odontologist. For a crime scene investigator, taking DNA samples is as common as taking pictures of the scene. [ 53 ] In the case of State vs. Krone , the defendant was sentenced to death, which was overturned. Then Krone was later reconvicted and given life in prison. Both convictions were based largely on bite mark evidence, but ten years later DNA evidence surfaced that identified the real killer and Krone was set free. [ 18 ]
Bite marks were a primary source of evidence in the wrongful convictions of Keith Allen Harward , [ 54 ] [ 55 ] Kennedy Brewer [ 56 ] [ 57 ] and Levon Brooks . [ 58 ] [ 59 ] The role of bite marks in their convictions is told in a Netflix series titled The Innocence Files [ 60 ]
The estimation of an individual's age category becomes crucial in various forensic contexts; such as crime scenes, accidents, mass disasters, and the potential identification of an unknown individual. In determining an approximation of the latter, it is imperative to be aware of the variety of methods utilized in different situations. The most reliable analysis regarding age estimation is a clinical or visual approach. This includes a noninvasive examination of the tooth's eruption rate, as well as the degenerative modifications upon the teeth. These alterations can be present under forms of attrition. The abrasions manufactured from attrition can lead to a proximate age range of the individual. [ citation needed ] Not only can the age of a human specimen be narrowed by evaluating the patterns of tooth eruption and tooth wear, but recent studies also provide evidence that cementum , the mineralized tissue that lines the surface of tooth roots, exhibits annual patterns of deposition. [ 61 ] Aggrawal has presented a comprehensive account. [ 62 ]
In this regard, it should be underlined that age estimation in forensic cases, in contrast to clinical situation, is required to be of optimal accuracy, as potential over- or underestimation of age might lead to a failure of justice. [ 63 ]
Adult dentition can be differentiated from juvenile dentition in bite mark analysis by determining the quantity of teeth. Juvenile teeth are considered primary teeth while adult are considered permanent teeth. [ citation needed ] Twenty teeth will be present by the age of two years old. Thirty-two teeth will be present by the age of twenty-one, with the last ones being the wisdom teeth. [ citation needed ] By analyzing the quantity of teeth in a bite mark, this can assist with determining the age of the individual.
The determination of sex is important in the identification of unknown individuals in both forensic and archaeological contexts. The preferred anatomical methods for sex determination are based on pelvic and cranio-facial morphology. Using these parts of the skeleton, males and females can be correctly classified with over 90% accuracy. [ 64 ] However, these skeletal elements are sometimes recovered in a fragmentary state, rendering sex estimation difficult. Moreover, there is currently no reliable method of sex determination of juvenile or sub-adult remains from cranial or post-cranial skeletal elements since dimorphic traits only become apparent after puberty, and this represents a fundamental problem in forensic investigations. In such situations, teeth are potentially useful in sex determination. Due to their hardness, they are highly resistant to taphonomic processes and are much more likely to be recovered than other parts of the fact, the enamel present on teeth is the hardest biological substance in the human body; [ 65 ] therefore making them extremely sustainable analytical evidence in a forensic context. Moreover, teeth may be particularly useful for sexing immature skeletal remains since both primary and permanent sets of teeth develop before puberty. [ 66 ] [ 67 ]
For several decades research has been conducted into human dental sexual dimorphism, looking at different tooth classes, and using various techniques and measurements, to try to establish the extent of any dimorphism and find criteria or patterns that might enable accurate sexing of unknown individuals. Most of these studies have focused on sexual dimorphism in crown-size dimensions. This research has established that human teeth are sexually dimorphic and, although males and females exhibit overlapping dimensions, there are significant differences in mean values. [ 68 ] [ 69 ] Sexual dimorphism has been observed in both deciduous and permanent dentition, although it is much less in deciduous teeth. [ 70 ] [ 71 ] On average, male teeth are slightly larger than female teeth, with the greatest difference observed in the canine teeth. [ 72 ] [ 73 ] Research using microtomographic scans to look at internal dental tissues has also shown that male teeth consist of significantly greater quantities of dentine than female teeth. [ 74 ] [ 75 ] This results in female teeth having thicker enamel, on average. Researchers have attempted to use statistical techniques such as discriminant functions or logistic regression equations based on these sex differences to estimate the usefulness of such formulae is uncertain because sexual dimorphism in teeth may vary between populations. [ 76 ] [ 75 ] [ 69 ] The advanced methods which amplify the DNA by using Polymerase chain reaction (PCR) give 100% success in sex determination. [ 77 ] Sex estimation based on dentition remains experimental and has yet to gain widespread acceptance. Nevertheless, it offers potentially useful additional techniques that could be used alongside more established methods.
The comparison of antemortem and post-mortem radiographic records can be done to attain a positive identification of an individual. Teeth are used since they are a very durable and resistant to extreme conditions. The radiographs can present dental restorations as well as unique morphology for each individual. [ 78 ] Dental patterns are unique due to the variety of treatments as well as growth for each individual, which creates a benefit in using them for human identification [ 79 ]
Post-mortem radiographs can be taken at the scene or in a laboratory, the antemortem records are collected from dentists’ existing files and are used for comparison with the radiographs taken from the deceased unknown individual. [ 80 ]
It is important that dentists keep all radiographs stored properly since the original dental records will be used during this comparison.
The antemortem and post-mortem radiographs will both be analyzed and transcribed onto Victim Identification forms and loaded into a computer database in order to compare many different antemortem records to the post-mortem in order to obtain a match. [ 81 ]
Radiograph comparison is often a method used in mass fatalities for example natural disasters but It can be used in any case.
Teeth contain a great source of DNA since they are very chemically and physically resistant to extreme conditions. [ 82 ] This method is especially useful in cases where other DNA sources are not accessible, for example in burned victims. Teeth can be used to create a DNA profile in order to identify unknown deceased individuals. Dentin and enamel provide a resistant and protective surface that houses the dental pulp which is located under the enamel and dentin layers in the center of the tooth, which contains the nerves and blood supply as well. [ 82 ] Within the pulp is where genomic and mitochondrial DNA can be extracted. [ 83 ] The teeth should not be completely destroyed using DNA analysis alone, it should be compared with other techniques as well before damaging techniques are used.
In cases where the body is in an advanced stage of decomposition, such as in cases of skeletal remains and charring, and considering the difficulties or impossibility of using fingerprint analysis and the high cost of DNA testing, forensic dentistry can play an important role in identification. [ 84 ] [ 85 ]
The most common means used for ante-mortem comparison are X-rays, dental models, and dental records. However, there are cases where the presumed victim never visited a dentist or the family cannot obtain the aforementioned sources, complicating the odontolegal identification of the victim. Another source of comparison can be photographs of the presumed victim's smile (ante-mortem) compared to photographs of the deceased person's smile (post-mortem), which can highlight the dental characteristics present and, if consistent, confirm the victim's identification. [ 84 ] [ 85 ] [ 86 ] [ 87 ]
However, it is important to pay attention to details that are important in the process, such as the techniques that will be used for the comparison. Two main techniques are generally employed (both of which require the forensic dentist to take photographs of the deceased person's smile, which can then be compared to the ante-mortem photographs): [ 85 ] [ 88 ]
To achieve this, attention must be given to important details, such as: [ 85 ] [ 89 ]
It is important to emphasize that each person's smile is unique, just like fingerprints, palatal rugae, and DNA. Therefore, when properly applied with the necessary scientific rigor, identification through photographs of the smile becomes a reliable method to establish an identification. [ 87 ] [ 90 ] [ 91 ] [ 92 ]
This method of identification involves the analysis and comparison of palatal rugae from the deceased with the palatal rugae of the potential victim. One way to perform this comparison is by creating a mold of the upper arch of the deceased (capturing the palatal rugae) or using a complete upper denture that belonged to the deceased, or on a plaster model for dental purposes, and in an object containing the palatal rugae of the missing person during their lifetime (such as an old complete upper denture in possession of the family). Once the two plaster models are created, they should be scanned/photographed, and a computerized delineation of the palatal rugae should be performed, analyzing each individual ruga and comparing their location, shape, and pattern in each of the photos (of the models). [ 93 ] [ 94 ] [ 95 ]
If there is a match, the victim can be identified. It is important to note that the use of dentures for this identification can be done if the palatal rugae are clearly visible. The impression of palatal rugae in dental prostheses is formed over several years of use by the individual. This method has a significant impact on the identification process, particularly when other methodologies and identification techniques cannot be implemented. [ 93 ]
|
https://en.wikipedia.org/wiki/Forensic_dentistry
|
Forensic entomological decomposition is how insects decompose dead tissue and what that means for timing and information in criminal investigations. Medicolegal entomology is a branch of forensic entomology that applies the study of insects to criminal investigations, and is commonly used in death investigations for estimating the post-mortem interval (PMI). [ 1 ] [ 2 ] One method of obtaining this estimate uses the time and pattern of arthropod colonization. [ 3 ] This method will provide an estimation of the period of insect activity, which may or may not correlate exactly with the time of death. [ 1 ] While insect successional data may not provide as accurate an estimate during the early stages of decomposition as developmental data, it is applicable for later decompositional stages and can be accurate for periods up to a few years. [ 4 ]
Decomposition is a continuous process that is commonly divided into stages for convenience of discussion. [ 5 ] [ 6 ] When studying decomposition from an entomological point of view and for the purpose of applying data to human death investigations, the domestic pig Sus scrofa (Linnaeus) is considered to be the preferred human analogs. [ 2 ] In entomological studies, five stages of decomposition are commonly described: (1) Fresh, (2) Bloat, (3) Active Decay, (4) Advanced or Post-Decay, and (5) Dry Remains. [ 2 ] [ 7 ] While the pattern of arthropod colonization follows a reasonably predictable sequence, the limits of each stage of decomposition will not necessarily coincide with a major change in the faunal community. Therefore, the stages of decomposition are defined by the observable physical changes to the state of the carcass. [ 8 ] A pattern of insect succession results as different carrion insects are attracted to the varying biological, chemical and physical changes a carcass undergoes throughout the process of decay. [ 2 ]
A decaying carcass provides "a temporarily, rapidly changing resource which supports a large, dynamic arthropod community." – M. Grassberger and C. Frank
The fresh stage of decomposition is generally described as the period between the moment of death and when the first signs of bloat are apparent. [ 2 ] [ 6 ] There are no outward signs of physical change, though internal bacteria have begun to digest organ tissues. [ 4 ] No odor is associated with the carcass. [ 2 ] [ 6 ] Early post-mortem changes, used by pathologists as medical markers for early post-mortem interval estimations, have been described by Goff and include livor mortis , rigor mortis and algor mortis .
The first insects to arrive at decomposing remains are usually Calliphoridae , commonly referred to as blow flies. These flies have been reported to arrive within minutes of death or exposure, and deposit eggs within 1–3 hours. Adult flies of the families Sarcophagidae (flesh flies) and Muscidae are also common in this first stage of decomposition. First eggs are laid in or near the natural orifices of the head and anus, as well as at the site of perimortem wounds. [ 2 ] Depending on the rate of decomposition and the development time of particular blowfly species, eggs may hatch and young larvae begin to feed on tissues and liquids while the carcass is still classified in the fresh stage. [ 9 ]
Adult ants may also be seen at a carcass during the fresh stage. Ants will feed both on the carcass flesh as well as eggs and young larvae of first arriving flies. [ 5 ]
The first visible sign of the Bloat Stage is a slight inflation of the abdomen and some blood bubbles at the nose. [ 5 ] Activity of anaerobic bacteria in the abdomen create gases, which accumulate and results in abdominal bloating. [ 2 ] A colour change is observed in the carcass flesh, along with the appearance of marbling. During the bloat stage the odor of putrefaction becomes noticeable. [ 6 ]
Blowflies remain present in great numbers during the bloat stage, and blowflies, flesh flies and muscids continue to lay eggs. Insects of the families Piophilidae and Fanniidae arrive during the bloat stage. Ants continue to feed on the eggs and young larvae of flies. [ 5 ] [ 6 ]
The first species of Coleoptera arrive during the bloat stage of decomposition, including members of the families Staphylinidae (rove beetles), Silphidae (carrion beetles) and Cleridae . These beetles are observed feeding on fly eggs and larvae. [ 2 ] [ 6 ] Beetle species from the families Histeridae may also be collected during this stage, and are often hidden beneath remains. [ 5 ] [ 6 ]
The beginning of active decay stage is marked by the deflation of the carcass as feeding Dipteran larvae pierce the skin and internal gases are released. During this stage the carcass has a characteristic wet appearance due to the liquefaction of tissues. Flesh from the head and around the anus and umbilical cord is removed by larval feeding activity. [ 5 ] A strong odor of putrefaction is associated with the carcass. [ 2 ]
Feeding larvae of Calliphoridae flies are the dominant insect group at carcasses during the active decay stage. [ 2 ] At the beginning of the stage larvae are concentrated in natural orifices, which offer the least resistance to feeding. Towards later stages, when flesh has been removed from the head and orifices, larvae become more concentrated in the thoracic and abdominal cavities. [ 5 ]
Adult calliphorids and muscids decreased in numbers during this stage, and were not observed to be mating. [ 5 ] However, non-Calliphoridae Dipterans are collected from carcasses. [ 2 ] The first members of Sepsidae arrive at the carcass during the active decay stage. Members of Coleoptera become the dominant adult insects at the site of remains. In particular, the numbers of staphylinids and histerids increase. [ 5 ]
Most of the flesh is removed from the carcass during the advanced decay stage, though some flesh may remain in the abdominal cavity. Strong odors of decomposition begin to fade. [ 2 ] [ 5 ]
This stage marks the first mass migration of third instar calliphorid larvae from the carcass Piophilidae larvae may also be collected at this stage. [ 2 ] [ 6 ] Few adult calliphoridae are attracted to carcasses in advanced decay. Adult Dermestidae (skin beetles) arrive at the carcass; [ 6 ] adult dermestid beetles may be common, whereas larval stages are not. [ 2 ]
The final stage of decomposition is dry remains. Payne described a total of six stages of decay, the last two being separate dry and remains. As these stages are nearly impossible to distinguish between, many entomological studies combine the two into a single final stage. Very little remains of the carcass in this stage, mainly bones, cartilage and small bits of dried skin. There is little to no odor associated with remains. [ 2 ] [ 6 ] Any odor present may range from that of dried skin to wet fur. [ 5 ]
The greatest number of species are reported to occur in the late decay and dry stages. [ 2 ] [ 5 ] The dry decay stage is characterized by the movement from previously dominant carrion fauna to new species. [ 5 ] Very few adult calliphorids are attracted to the carcass at this stage, [ 6 ] and adult piophilids emerge. [ 2 ] The dermestid beetles, common in advanced decay, leave the carcass. Non-carrion organisms that commonly arrive at remains in dry decay are centipedes, millipedes, isopods, snails and cockroaches. [ 5 ]
Understanding how a corpse decomposes and the factors that may alter the rate of decay is extremely important for evidence in death investigations. Campobasso, Vella, and Introna consider the factors that may inhibit or favor the colonization of insects to be vitally important when determining the time of insect colonization. [ 10 ]
Low temperatures generally slow down the activity of blow-flies and their colonization of a body. Higher temperatures in the summer favor large maggot masses on the carrion. Dry and windy environments can dehydrate a corpse, leading to mummification. Dryness causes cessation in bacterial growth since there are no nutrients present to feed on.
Access to the body can limit which insects can get to the body in order to feed and lay eggs. Those circumstances that enhance the availability of corpses for arthropod colonization are called "physical barriers". For example, corpses found in brightly lit areas are generally inhabited by Lucilia illustris , in contrast to Phormia regina , which prefers more shaded areas. Darkness, cold, and rain limit the amount of insects that would otherwise colonize the body. A submerged corpse can vary in temperature and is colonized by very few terrestrial insects. Fish, crustaceans , aquatic insects [ 11 ] [ 12 ] and bacteria would be the likely fauna in this case. Bodies that have been buried are harder to get to than freely available bodies which limits the availability of certain insects to colonize. The Coffin fly Megaselia scalaris is one of the few fly species seen on buried bodies because it has the ability to dig up to six feet underground to reach a body and oviposit.
Scavengers and carnivores such as wolves, dogs, cats, beetles, and other insects feeding on the remains of a carcass can make determining the time of insect colonization much harder. This is because the decomposition process has been interrupted by factors that may speed up decomposition. Corpses with open wounds, whether pre or post mortem, tend to decompose faster due to easier insect access. The cause of death likewise can leave openings in the body that allow insects and bacteria access to the inside body cavities in earlier stages of decay. Flies oviposit eggs inside natural openings and wounds that may become exaggerated when the eggs hatch and the larvae begin feeding.
Wraps, garments, and clothing have shown to affect the rate of decomposition because the corpse is covered by some type of barrier. Wraps, such as tight fighting tarps can advance the stages of decay during warm weather when the body is outside. However, loose fitting coverings that are open on the ends may aid colonization of certain insect species and keep the insects protected from the outside environment. This boost in colonization can lead to faster decomposition. Clothing also provides a protective barrier between the body and insects that can delay stages of decomposition. For instance, if a corpse is wearing a heavy jacket, this can slow down decomposition in that particular area and insects will colonize elsewhere. Bodies that are covered in pesticides or in an area surrounded in pesticides may be slow to have insect colonization. The absence of insects feeding on the body would slow down the rate of decomposition.
More fat on the body allows for faster decomposition. This is due to the composition of fat, which is high in water content. Larger corpses with higher percent body fat also tend to retain heat much longer than corpses with less body fat. Higher temperatures favor the reproduction of bacteria inside high nutrient areas of the liver and other organs.
On occasion, drugs that are present in the body at death can also affect how fast insects break down the corpse. Development of these insects can be sped up by cocaine and slowed down by drugs containing arsenic . [ 10 ] [ 13 ]
New research in the related field entomotoxicology is currently studying the effects of drugs on the development of insects who have fed on the decomposing tissue of a drug user. The effects of drugs and toxins on insect development are proving to be an important factor when determining the insect colonization time. It has been shown that cocaine use can accelerate the development of maggots. In one case, Lucilia sericata larvae that fed in the nasal cavity of a cocaine abuser, grew over 8 mm longer than larvae of the same generation found elsewhere on the body. [ 14 ] Other researchers in entomotoxicology are developing techniques to detect and measure drug levels in older fly pupae. This research is useful for determining cause of death for bodies that are found during later stages of decay. To this date, bromazepam , levomepromazine , malathion , phenobarbital , trazolam , oxazepam , alimemazine , clomipramine , morphine , mercury , and copper have been recovered from maggots. [ 15 ]
Understanding the stages of decomposition, the colonization of insects, and factors that may affect decomposition and colonization are key in determining forensically important information about the body. Different insects colonize the body throughout the stage of decomposition. [ 2 ] In entomological studies these stages are commonly described as fresh, bloat, active decay, advanced decay and dry decay. [ 2 ] [ 5 ] Studies have shown that each stage is characterized by particular insect species, the succession of which depends on chemical and physical properties of remains, rate of decomposition and environmental factors. [ 5 ] Insects associated with decomposing remains may be useful in determining post-mortem interval, manner of death, and the association of suspects. [ 15 ] Insect species and their times of colonization will vary according to the geographic region, [ 2 ] and therefore may help determine if remains have been moved. [ 15 ]
|
https://en.wikipedia.org/wiki/Forensic_entomological_decomposition
|
Forensic pathology is pathology that focuses on determining the cause of death by examining a corpse. A post mortem examination is performed by a medical examiner or forensic pathologist, usually during the investigation of criminal law cases and civil law cases in some jurisdictions . Coroners and medical examiners are also frequently asked to confirm the identity of remains.
Forensic pathology is an application of medical jurisprudence . A forensic pathologist is a medical doctor who has completed training in anatomical pathology and has subsequently specialized in forensic pathology. [ 1 ] The requirements for becoming a "fully qualified" forensic pathologist vary from country to country. Some of the different requirements are discussed below (see § Education ).
The forensic pathologist performs autopsies/postmortem examinations with the goal of determining the cause of death as well as the possible manner of death. The autopsy report contains conclusions made relating to the following:
The autopsy also provides an opportunity for other issues raised by the death to be addressed, such as the collection of trace evidence or determining the identity of the deceased. Autopsies are performed when a death occurs, when an unexpected death occurs, when someone dies while not under the care of a physician, to solve criminal cases, when a mass disaster occurs and requires the identification of the victims [ 3 ] and upon request by the family or loved ones of the deceased. Typically, autopsies can cost anywhere from $3,000 to $5,000, however the price can vary from country to country. [ 4 ]
The forensic pathologist examines and documents wounds and injuries, along with the possible causation of those injuries, at autopsy, at the scene of a crime and occasionally in a clinical setting, such as rape investigation or deaths in custody.
Forensic pathologists collect and examine tissue specimens under the microscope ( histology ) to identify the presence or absence of natural disease and other microscopic findings such as asbestos bodies in the lungs or gunpowder particles around a gunshot wound.
They collect and interpret toxicological specimens of body tissues and fluids to determine the chemical cause of accidental overdoses or deliberate poisonings.
Forensic pathologists work closely with the medico-legal authority for the area concerned with the investigation of sudden and unexpected deaths: the coroner (England and Wales), procurator fiscal (Scotland), or coroner or medical examiner (United States).
In mass disaster settings, forensic pathologists will work alongside Forensic Odontologists, Forensics Anthropologists as well as other forensic specialties with the goal of identifying the victims of the disaster. [ 3 ] The process of identification involves the recovery of the victims, the collection of antemortem data, the initial examination along with the collection of any postmortem evidence, and finally the comparison of the antemortem and postmortem data gathered in order to identify those victims. [ 3 ]
They serve as expert witnesses in courts of law testifying in civil or criminal law cases.
In an autopsy , the forensic pathologist is often assisted by an autopsy/mortuary technician (sometimes called a diener in the US).
Forensic physicians sometimes referred to as "forensic medical examiners" or "police surgeons" (in the UK until recently), are medical doctors trained in the examination of, and provision of medical treatment to, living victims of assault, including sexual assault, and individuals who find themselves in police custody. Many forensic physicians in the UK practice clinical forensic medicine part-time, and they also practice family medicine or another medical specialty .
In the United Kingdom , membership of the Royal College of Pathologists is not a prerequisite of appointment as a coroner's medical expert . Doctors in the UK who are not forensic pathologists or pathologists are allowed to perform medicolegal autopsies, as the wording of the Coroners and Justice Act 2009 , which merely stipulates a "registered medical practitioner": anyone on the General Medical Council register.
Forensic pathologists make great contributions to public health and preventative medicine by studying the dead. By using their findings during autopsies , they can use their knowledge to prevent the death of another person. [ 1 ]
Pathologists determine the cause of death through postmortem examination or autopsy. There are three stages of death investigation: examination, correlation, and interpretation. Deaths where there is an unknown cause and those considered unnatural are investigated. In most jurisdictions this is done by a "forensic pathologist", coroner , medical examiner , or hybrid medical examiner-coroner offices.
Forensic pathologists must be trained in several fields to succeed at their job. They utilize a wide variety of methods such as conducting autopsies which in itself has a variety of methods. Some of these methods require various identification techniques, including immunohistological studies, which can be valuable for determining the time of injury and assessing axonal damage resulting from traumatic brain injury [ 5 ] When conducting an autopsy a forensic pathologist may take X-Rays, samples of bodily fluids, samples of tissues, and samples of bacterial culture found within the body. [ 6 ] While conducting the autopsy the forensic pathologist uses the stages of death as another method to inspect both the time of death and the amount of time the body has been deceased. Using the Information received during the autopsy paired with evidence provided by law enforcement provides the basis for the determination of the cause of death.
In some jurisdictions, the title of "Medical Examiner" is used by a non-physician, elected official involved in a medicolegal death investigation. In others, the law requires the medical examiner to be a physician, pathologist, or forensic pathologist.
Similarly, the title "coroner" is applied to both physicians and non-physicians. Historically, coroners were not all physicians (most often serving primarily as the town mortician). However, in some jurisdictions, the topic of "Coroner" is exclusively used by physicians.
In Canada, there was a mix of coroner and medical examiner systems, depending on the province or territory. In Ontario, coroners are licensed physicians, usually but not exclusively family physicians . In Quebec, there is a mix of medical and non-medical coroners, whereas, in British Columbia, there is predominantly a non-physician coroner system. Alberta and Nova Scotia are examples of ME systems [ 7 ] [ 8 ]
In the United States, a coroner is typically an elected public official in a particular geographic jurisdiction who investigates and certifies deaths. The vast majority of coroners lack a Doctor of Medicine degree and the amount of medical training that they have received is highly variable, depending on their profession (e.g. law enforcement, judges, funeral directors, emergency medical technicians, nurses).
In contrast, a medical examiner is typically a physician who holds the degree of Doctor of Medicine (M.D.) or Doctor of Osteopathic Medicine (D.O.). Ideally, a medical examiner has completed both a pathology residency and a fellowship in forensic pathology. In some jurisdictions, a medical examiner must be both a doctor and a lawyer, with additional training in forensic pathology.
Forensic pathology was founded by Rudolf Virchow , a German pathologist, who developed the Virchow method which is one of the main and popular techniques still used by forensic pathologists today. The Virchow method is of doing autopsies as well as instituting cell theory which would shed light on the effects and damage of disease on the human body. Rudolf Virchow began the practice of regulated autopsies where the entire body would be inspected rather than a particular area of interest which would expose additional damage that injuries and ailments inflicted on the human body. [ 9 ] In German-speaking Europe, lectures on forensic pathology were regularly held in Freiburg in the mid 18th century and Vienna in 1804. Scientists like Auguste Ambroise Tardieu , Johann Ludwig Casper and Carl Liman made great efforts to develop forensic pathology into a science based on empirics.
Ambroise Paré is also considered one of the fathers of modern forensic pathology and surgery. His inventions in the early 16th century include surgical instruments and techniques. He pioneered battlefield medicine and treatments of wounds. One technique he used was pouring boiling oil into wounds. [ 10 ]
This history of forensic pathology can be traced all the way back to the fourth century BC in Babylonia but instead of practicing on deceased human bodies, the practice of forensic pathology was strictly practiced on animals. This was said to be done only to animals since humans during this era were believed to be sacred. Later on, in forensic pathology history, forensic pathology would be practiced among those who live in Asia. Muslim doctors would discover infectious diseases and as a result, would operate on deceased bodies; one of those doctors being Ibn Zuhr. Zuhr would go on to performing autopsies on bodies in postmortem and research diseases such as leprosy, mange, and sexually transmitted diseases.
While Zuhr was busy learning about contagious diseases, Yee Siung, a Chinese government official was assembling a group of physicians who were in charge of dissecting criminal murder victims. These victims’ cause of death would be investigated alongside the actual case itself and this would be the first time pathology would be used to help solve criminal cases. [ 11 ]
Forensic pathology was first recognized in the United States by the American Board of Pathology in 1959 after toxicology and pathology had been used to solve thousands of criminal cases worldwide for years. [ 12 ] [ 13 ]
In Canada , it was formally recognized in 2003, [ 14 ] [ 15 ] and a formal training program (a fellowship) is currently being established under the auspices of the Royal College of Physicians and Surgeons of Canada . [ 16 ]
In most English speaking countries, forensic pathology is a subspecialty of anatomical pathology . Training requirements differ from country to country, however, it is common for pathologists to study at a medical school and then go on to study pathology. Many forensic pathologists practice as a histo (hospital) pathologists before moving onto forensic science. Another requirement for forensic pathologists includes having a working knowledge of specific fields of study like toxicology , firearms examination (wound ballistics ), trace evidence , forensic serology and DNA technology. [ 17 ]
There are currently three paths to qualify as a forensic pathologist in Australia. The first is to train solely in forensic pathology (although a significant amount of anatomical pathology knowledge is still required) and pass two examinations for forensic pathology only. The second is to commence training in anatomical pathology, and complete an initial anatomical pathology examination, which takes a minimum of three years; then go on to train solely in forensic pathology and complete a forensic pathology examination, which takes a minimum of two years. The third is to complete a minimum 5 years' training in anatomical pathology to qualify as a fellow in anatomical pathology, then complete a post-fellowship year in forensic pathology (a minimum twelve months further training plus successful completion of an examination). [ citation needed ]
In Canada, [ 18 ] individuals must complete an undergraduate science degree, followed by a doctor of medicine degree from one of the seven medical schools in Canada. After these are completed individuals may enter the Royal College of Physicians and Surgeons (RCPSC) which requires the completion of residency training. [ 19 ] Anatomical pathology is a five-year residency. Residents who wish to become forensic pathologists must then complete a one-year fellowship in forensic pathology. Forensic pathology is a sub-specialty by the RCPSC. As of 2022, there are three schools in Canada that offer the forensic pathology training program. These schools are the University of Alberta, the University of Ottawa [ 20 ] and the University of Toronto. McMaster University ceased their training program in 2019.
Once students have acquired the " Abitur " diploma and completed all the requirements, they can study medicine at a university. Within the medical education system, there are four subdivisions individuals must partake in prior to moving into a specialization.
The first section is a two year preclinical study period where individuals are introduced to the basics. A two month work period at a hospital must be completed between each semester in order to become familiar with everyday life in a hospital. A final exam on the basics concludes this portion.
The second section is a one year clinical period to familiarize the students with the basics of clinical practice. The students complete the first part of the physician's exam at the end of this period.
The third section is another clinical period which lasts for two years, which practices non-surgical, surgical, neurological, ecological and general medicine domains. Here is where forensic medicine is first introduced. Between the first and second clinical sections, four months of medical clerkship are required, which consists of two months in a hospital and two months at any other medical institution. Students complete the second part of the physician's exam at the end of this period.
The final section is a one year practical period where students partake in three 4 month practicums: four months of internal medicine, four months of surgery and four months of clinical practical study of their choice. Students write the final part of the physician's exam before this period and have the oral part afterwards.
Once individuals have completed their medical studies, there is a minimum of six extra years of specialization training for forensic pathology. During this training individuals must complete at least three years and six months working for a legal medicine institution, focusing on clinical forensic pathology training. Then, at least one year of pathology work at a specialized institute is required partaking in autopsy technical training. As well, a minimum of 6 months working with forensic psychiatrists is also required. Finally, a single year of work in any field of medicine or legal medicine must be completed. During these work periods, it is required that these physicians write a number of opinions on their post-mortem examinations, crime scene investigations, crime scene reconstructions and insurance medical cases. There is also a minimum number of reports consisting of their own autopsies, police inquiries, histological investigation and other investigative results. Finally, the practicing physician must complete a certain number of oral court proceedings. Once all of this has been completed, an oral examination, overseen by the Chamber of Physicians (also known as the German Medical Association ) is to be completed which allows individuals to officially become a forensic pathologist upon completion. [ 21 ]
In India, the specialty is commonly referred to as Forensic Medicine and Toxicology, or Legal Medicine. After completion of medical graduation (MBBS), one has to complete three years of study and training including thesis research, which leads to the award of a degree of MD (Forensic Medicine). One can also alternately pass the board examination conducted by the National Board of Examinations Archived 2021-06-03 at the Wayback Machine , leading to awarding of Diplomate of National Board (DNB).
The majority of the specialists are attached to the Department of Forensic Medicine and Toxicology in various medical colleges. The classification of posts includes Assistant Professor (Lecturer), Associate Professor (Reader), and Professor. The work profile of the specialists includes conducting autopsies and clinical forensic examinations; apart from teaching the medical students. They have to regularly appear in the courts as expert witnesses. A typical department in a government institution conducts 100 to 5,000 autopsies a year depending upon the jurisdiction. Apart from this, clinical forensic examinations constitute a major part of the work and the number of cases can run up to ten thousand a year in an average institution.
The largest association of the specialty is Indian Academy of Forensic Medicine [1] (IAFM), which also publishes its quarterly Journal of Indian Academy of Forensic Medicine [2] regularly. This association has a specialist member strength of more than 1000.
In Indonesia, forensic medicine, also known as legal medicine ( "kedokteran kehakiman" ), is a 3-year specialty program that can be taken directly after completing medical school. It is separate from anatomical pathology and clinical pathology. Upon completion of the program, a forensic medicine specialist will obtain the title Spesialis Forensik , or Sp.F . He or she may be addressed in public as Dokter Forensik ("forensic doctor"). Note that there is no pre-medicine program, making the total duration of formal education for one to become a forensic specialist 9 years. It was first introduced through the Dutch colonial criminal justice system in the early twentieth century.
Forensic medicine is also a mandatory round during medical school clerkship. Medical students assist the doctors on autopsies, and they may also be allowed to perform an autopsy under supervision, and to witness in the court.
In Japan, the profession of forensic pathology is not commonly pursued compared to other medical professions such as clinicians and doctors. In Japan, there are 33 of 42 universities that have a department of pathology established on their campuses yet, even so, only 21 of the 42 universities offer residency programs pertaining to forensic pathology. [ 22 ]
To become a forensic pathologist, it requires individuals to pursue a four year undergraduate degree. After completing their undergraduate career, it is then required for individuals to attend medical school to either earn their Masters or Doctorates degree. After completing medical school, individuals are then required to have 2 years of mandatory postgraduate clinical education where they learn important clinical skills such as communication skills, common laboratory procedures such as Gram’s stain and urinalysis. When the two year mandatory clinical training is completed, another 3-4 [ 22 ] years of training is needed to focus more on surgical procedures which is especially for forensic pathologists. During these last 3–4 years of training, forensic pathologists will learn more about specified human anatomy and they will also have the chance to interact with real patients as well as interacting with other forensic pathologists as well. The department of Forensic Medicine at Kyoto University in Japan has a legacy that can be traced back to 1899 when the department of forensic was first founded. The department has been active forces in promoting the significance of forensic medicine through its innovative programs, research, and analysis.
When their training is completed, forensic pathologists in Japan will then have the opportunity to receive their certificate of pathology awarded by the Japanese Society of Pathology [ 23 ]
In the UK, forensic histopathology is a five/five and a half year training programme, consisting of two and half years of histopathology followed by two and half/three years of forensic histopathology. Successful candidates are eligible for inclusion on the specialist register of the General Medical Council (GMC), which is a requirement to work as a consultant forensic pathologist.
Entry to forensic histopathology specialty training requires completion of the UK Foundation Programme , stages A and B of histopathology specialty training, and a pass in the FRCPath Part 1 examination in histopathology. Candidates are in year 3 of specialty training (ST3) when entering forensic histopathology and progress immediately to stage C. Completion of stages C and D, and a pass in the FRCPath Part 2 examination in forensic histopathology allow the candidate to apply for the Certificate of Completion of Training (CCT). [ 24 ]
Another option is to obtain the full FRCPath in general histopathology, followed by another 18–24 months of training in forensic pathology, which will qualify the candidates with either the Diploma of the Royal College of Pathologists in Forensic Pathology (DipRCPath (forensic)) or the Diploma in Medical Jurisprudence (DMJ). In England and Wales, the candidate will also need to be Home Office Accredited, which will require checks of the training portfolio and completion of a security check and the Expert Witness Training Course run by the Forensic Science Service.
Currently approved centres for forensic pathology training in the UK include Belfast, Edinburgh, Liverpool, Leicester, Cardiff, London, Glasgow and Dundee. Not all the posts are currently actively training.
In the United States , forensic pathologists typically complete at least one year of additional training (a fellowship ) after completing an anatomical pathology residency and having passed the "board" examination administered by The American Board of Pathology or The American Osteopathic Board of Pathology ("board-certified"). Becoming an anatomic pathologist in the United States requires completing a residency in anatomic pathology, which is on-the-job training one must perform upon completing medical school before one may practice unsupervised. Anatomic pathology (as it is called) by itself is a three-year residency. Most U.S. pathologists complete a combined residency in both anatomic and clinical pathology , which requires a total of four years.
In the United States, all told, the education after high school is typically 13–15 years in duration (4 years of undergraduate training + 4 years of medical school + 4–5 years of residency [anatomic and clinical pathology combined] + 1–2 years of forensic pathology fellowship). Generally, the biggest hurdle is gaining admission to medical school, although the pass rate for anatomic and forensic pathology board examinations (in the U.S.) is approximately 80-90 and 90-100 percent, respectively. The courts do not require the American Board of Pathology certification in order for a witness to be qualified as an expert in the field of forensic pathology, and there are several "diploma mills" that give online certificates in the field. [ 25 ]
Pathologists often feature in crime fiction. The following television series are listed alphabetically by the character's name:
|
https://en.wikipedia.org/wiki/Forensic_pathology
|
In medicine, a forme fruste ( French , "crude, or unfinished, form"; pl. , formes frustes ) is an atypical or attenuated manifestation of a disease or syndrome, with the implications of incompleteness, partial presence or aborted state. The context is usually one of a well defined clinical or pathological entity, which the case at hand almost — but not quite — fits.
An opposite term in medicine, forme pleine — seldom used by English-speaking physicians — means the complete, or full-blown, form of a disease.
According to gastroenterologist William Haubrich:
A patient may exhibit sudden, intense, epigastric pain and a rigid abdomen . He is thought to have a perforated peptic ulcer . But at operation, only a penetrating ulcer is found, sealed off by adhesion to the omentum or anterior abdominal wall . Such a patient is said to have a forme fruste of acute free perforation as a complication of his peptic ulcer disease. [ 1 ]
The Latin phrase frustra esse means "to be mistaken" or "to be confused". As a technical term in French, the cognate fruste has been used in two related ways. First, as an antiquarian ’s term it refers to a coin, medal or ancient stone on which figures and characters can no longer be recognized due to wear. Secondly, it was employed in natural history to denote mollusk shells whose striations, grooves or tips were worn down. By extension, this sense could be applied to sculpture, pottery, or other objects of great antiquity.
It was in this sense of "indistinctness due to wear or through long use" that the French internist Armand Trousseau (1801–67) first employed the term in connection with an obscured form of Graves' disease , which he described as a "… maladie dite fruste par l’absence du goitre et de l’exophthalmie " ("…disease said to be crude [i.e., indistinct] for its absence of goiter and exophthalmia "). [ 2 ]
The term in medicine has evolved to mean a "not fully developed form of an illness", rather than simply an obscure form. Sigmund Freud (1856–1939) often used the term forme fruste in connection with incomplete or obscured cases of neuroses and psychoses and thus the literature of psychoanalysis is replete with it. (An equivalent term in German is minimalvariante , but Freud used the French version.)
|
https://en.wikipedia.org/wiki/Forme_fruste
|
Formacresol is a mixture consisting of formalin , cresol and glycerine used in dentistry . [ 1 ] It is used for vital pulpotomy of primary teeth and as a temporary intracanal medicament during root canal therapy.
Buckley's solution is a 20% form of formocresol, diluted with glycerine and distilled water . [ 2 ]
The use of formocresol in pediatric dentistry has been deprecated, and ferric sulfate suggested as a substitute. [ 3 ]
This dentistry article is a stub . You can help Wikipedia by expanding it .
|
https://en.wikipedia.org/wiki/Formocresol
|
Formula Comitis Archiatrorum is the earliest known code of medical ethics . [ 1 ] It was written in the 5th century, [ 1 ] during the reign of the Ostrogothic king Theodoric , and is preserved in the works of Cassiodorus . It demands from physicians that they widen and deepen their knowledge and enacts the consultation with other physicians.
This article about a medical book is a stub . You can help Wikipedia by expanding it .
This history of medicine article is a stub . You can help Wikipedia by expanding it .
This article about a book on ethics is a stub . You can help Wikipedia by expanding it .
|
https://en.wikipedia.org/wiki/Formula_Comitis_Archiatrorum
|
Forrest Yoga is a style of yoga as exercise . It was created by and named for Ana T. Forrest in 1982. [ 2 ] It is known for "its long holding of positions, emphasis on abdominal core work, and standing series that can go on for 20 poses on each side". [ 3 ] Reputed for its intensity, the style emphasizes connecting to one's feelings in order to work through physical and emotional trauma. [ 4 ]
Ana Forrest derived her practice from some aspects of Sivananda yoga , along with attention to alignment and use of props found in Iyengar yoga , and the heat and flowing sequences of Ashtanga (vinyasa) yoga . As the style evolved, she created a number of additional poses and sequences adapted to modern society, [ 3 ] [ 5 ] such as wrist stretches to prevent and relieve carpal tunnel syndrome . [ 6 ] She also created shoulder shrugs to relieve tension and loosen the upper back, [ 7 ] abdominal exercises to tone internal organs and strengthen the lower back, and some poses using a folded over and rolled up yoga mat . [ 8 ] Forrest personally practices aspects of Hatha yoga not widely taught in modern yoga as exercise ; her skill at the shatkarma nauli is featured on the Nauli.org site. [ 9 ]
Forrest Yoga classes are conducted in a warm room (85 °F, 29 °C) [ 10 ] and begin with pranayama , then move through seated poses and abdominal muscle exercises before arriving at the "hot part" of the class that might involve sun salutations , standing poses , inversions, backbends and other asanas that build up to the more challenging "apex" poses. The poses are sustained, intensively and contemplatively, sometimes for 10 deep breaths, sometimes for several minutes. [ 11 ]
Forrest Yoga's vision and mission, inspired by the life of Black Elk , a healer and Medicine Man of the Oglala Lakota Sioux , is "to mend the rainbow hoop of the people". [ 2 ] : 257 [ 12 ] [ 2 ] : 171 In this style, healing is meant to extend to the emotional body, directing the breath into affected parts of the body to release emotions. [ 13 ] [ 14 ] Forrest was certified as a yoga teacher when aged 18. She is trained in Native American medicine , reiki , and regression therapy . She has studied alternative healing techniques including homeopathy , naturopathy , reflexology , shiatsu , and chiropractic , all of which, she states, inform her work. [ 15 ]
The style claims to be founded on four principles, or "pillars": [ 11 ]
Forrest Yoga's physical practice uses some "basic moves" in every pose up until Savasana . [ 16 ] Many of these moves resemble those practiced in other yoga styles , such as Ujjayi breath and tucking the tailbone , while others are unique to this style, particularly the practice of relaxing the neck and wrapping the shoulders. Overall emphasis is on breath work and core strengthening. [ 17 ]
|
https://en.wikipedia.org/wiki/Forrest_Yoga
|
Subsets and Splits
No community queries yet
The top public SQL queries from the community will appear here once available.