Medical hypotheses
-
Using fMRI, Menon and Levitin [9] clearly found for the first time that listening to music strongly modulates activity in a network of mesolimbic structures involved in reward processing including the nucleus accumbens (NAc) and the ventral tegmental area (VTA), as well as the hypothalamus, and insula, which are thought to be involved in regulating autonomic and physiological responses to rewarding and emotional stimuli. Importantly, responses in the NAc and VTA were strongly correlated pointing to an association between dopamine release and NAc response to music. Listing to pleasant music induced a strong response and significant activation of the VTA-mediated interaction of the NAc with the hypothalamus, insula, and orbitofrontal cortex. ⋯ In contrast powerful D2 agonists like bromocryptine show a heightened activation of the reward circuitry only in DRD2 A1 allele carriers. If music causes a powerful activation in spite of the DRD2 A1 allele due to a strong DA neuronal release which subsequently impinges on existing D2 receptors, then it is reasonable to assume that music is a strong indirect D2 agonist (by virtue of DA neuronal release in the NAc) and may have important therapeutic applicability in Reward Deficiency Syndrome (RDS) related behaviors including Substance Use Disorder (SUD). Ross et al. [18] found that music therapy appears to be a novel motivational tool in a severely impaired inpatient sample of patients with co-occurring mental illness and addiction.
-
Heart failure is a well-recognized manifestation of organ failure in sepsis and septic shock. The pathophysiology of septic heart failure is complex and currently believed to involve several mechanisms. So far, the contributory role of high plasma catecholamine levels has not been investigated. ⋯ Clinical signs of catecholamine-induced heart failure can present with a wide range of symptoms reaching from subtle histological changes with preserved myocardial pump function to severe heart failure exhibiting a distinctive echocardiographic pattern which became known as "Takotsubo"-like cardiomyopathy or the left ventricular apical ballooning syndrome. In a medical intensive care unit patient population, presence of sepsis was the only variable associated with the development of left ventricular apical ballooning. Since several therapeutic interventions influence catecholamine plasma levels in septic shock patients, treatment strategies aiming at the reduction of endogenous or exogenous catecholamine exposure may protect the heart during septic shock and could facilitate patient survival.
-
In a recent series of polemical editorials in this journal, a scathing and much needed criticism is made of many aspects of current scientific mores, detecting some worrying dysfunctions which threaten the integrity of the whole scientific enterprise. Although the tone is a bit hyperbolic, many important issues are addressed, such as honesty in research, the centrality of truth in science, the role of creativity, just to cite a few. Though agreeing with the overall diagnosis, the discussion still suffers from a lack of a clear and systemic view of science, from which a more precise analysis could be carried out. ⋯ In this paper we address these shortcomings with the aim of contributing to a better understanding of this timely discussion. Though conceding that major structural, historical and cultural shifts might have caused irreversible changes on the way science now evolves, we make some suggestions to counter this trend. These include, among others, the need for an honest and careful dealing with the media and public, to prize and abide by the ethos of science and its underlying values, to cultivate an exact philosophy and to insist that disinterested curiosity and the desire to understand the world are the vital motivations of science.
-
Severe sepsis and septic shock have been part of intensivists' major challenges since the birth of the specialty. This clinical picture is followed by the development of a multiple organ failure syndrome. Our working hypothesis today is that multiple organ failures develop due to a systemic intravascular malignant inflammatory response. ⋯ The disruption of which can lead to multiple organ failure in septic shock. Developing research focusing on the broad hypothalamic and pituitary functions could improve our understanding of metabolic derangements in severe sepsis and septic shock and thus provide new therapeutic options. These new therapies based on hormonal replacement are currently available at low cost and could improve outcomes.
-
Creativity is a complex neuro-psycho-philosophical phenomenon which is difficult to define literally. Fundamentally it involves the ability to understand and express novel orderly relationships. The creative process involves four stages--preparation, incubation, illumination and verification. ⋯ Dopaminergic pathways are involved in the novelty seeking attitude of creative people while norepinephrine levels are depressed during discovery of novel orderly relationships. The relationship between mood and catecholamines and that of creative cognition is often in an inverted U-shaped form. It is hypothesized that that subtle frontal dysfunction is a pre-requisite for creative cognition but here again the relationship is also in an inverted U-form.