Medical hypotheses
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Neurogenic pulmonary edema is an acute life-threatening complication of central nervous system injury. We introduce a hypothesis that early i.v. administration of high-dose atropine can prevent neurogenic pulmonary edema development on the basis of the prevention of baroreflex-induced bradycardia, which was recognized as a major factor in neurogenic pulmonary edema formation. To validate this hypothesis, a clinical trial in patients suffering from subarachnoid haemorrhage should be performed, with atropine administered i.v. immediately after the maintenance of the living functions, intubation and ability to monitor patient.
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Medical practice is increasingly informed by the evidence from randomized controlled trials. When such evidence is not available, clinical hypotheses based on pathophysiological reasoning and common sense guide clinical decision making. ⋯ In this paper, we operationally define this heuristic and discuss its limitations as a rule of thumb for clinical decision making. We review historical and contemporaneous examples of normalization practices as empirical evidence for the normalization heuristic and to highlight its frailty as a guide for clinical decision making.
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Rheumatoid arthritis (RA) is a common, systemic autoimmune disease which leads to destruction of the joint architecture and consequent disability. Although the aetiology of RA remains unknown, accumulating studies have established a strong association between RA and periodontitis (PD). Recently, anti-cyclic citrullinated peptide (anti-CCP) autoantibody and citrullinated peptide have been realized to be involved in the breaking of self-tolerance and development of autoimmune in RA. ⋯ The roles of these immune complexes and inflammatory cells are mediated by a complex cascade involving complement activation. These mechanisms result in a release of mediators of inflammation and joint destruction ultimately leading to the onset of RA. This hypothesis reveals that oral bacterial infection may play a role in peptide citrullination which might be involved in loss of self-tolerance and development of autoimmune in RA.
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Three separate but related ideas build on van Deventer's concept of the "meta-placebo" effect in which placebo effects are hypothesized to help patients even when patients know they are receiving a placebo. First, a method is proposed to experimentally validate the meta-placebo effect without lying to experimental subjects. ⋯ The final section proposes that patients might be able to experience enough placebo- and -curabo-related treatment elements to gain a beneficial effect without either a pill or a doctor. Instead, simply having the knowledge that one can derive medical benefit from placebo, meta-placebo, and -curabo treatments, and without medicine, might in itself suffice to cause some to feel better: the hypothesized meta-meta-placebo and -curabo (or "meta-bo," for short) effect.
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The postmortem diagnosis of drowning continues to be one of the most difficult in forensic pathology because of unspecific autopsy findings. It must be always remembered that disposal of a victim body in water is not unknown in homicide. The most important physiological consequence in fatal drowning is hypoxemia. ⋯ Although some studies reached conclusions to define the mechanisms involved in pathogenesis of mechanical asphyxia and aspiration necessity of additional studies arose. The mechanism of the production of massive aggregates remains to be determined. In the mean time the detection of SP-A (immunohistochemical) as well as biochemical is potentially useful tool in the forensic practice with possible application in daily practice.