Medical hypotheses
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In recent years, the perception has grown that conflicts of interest are having a detrimental effect on medical science as it influences health policy and clinical practice, leading medical journals to enforce self-declaration of potential biases in the attempt to counteract or compensate for the problem. Conflict of interest (CoI) declarations have traditionally been considered inappropriate in pure science since its evaluation systems themselves constitute a mechanism for eliminating the effect of individual biases. Pure science is primarily evaluated by 'peer usage', in which scientific information is 'replicated' by being incorporated in the work of other scientists, and tested by further observation of the natural world. ⋯ But since peer review does not adequately filter-out conflicts of interest in applied medical science, there is a need for the evolution of specialist post-publication institutional mechanisms. The suggested solution is to encourage the establishment of independent 'CoI consultancy' services, whose role would be to evaluate conflicts of interest and other biases in published applied medical science prior to their implementation. Such services would be paid-for by the groups who intend to implement applied medical research.
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The classic explanation that women outlive men solely due to hormonal and lifestyle differences, does not withstand a critical analysis. In developed countries, the average gap in life expectancy between the sexes is 7 years. It has widened over the last decades, despite the trend of women copying the 'unhealthy' lifestyle of men. ⋯ Accordingly, the replicative history of male cells might be longer than that of female cells, resulting in the exhaustion of the regeneration potential and the early onset of age-associated diseases predominantly in large-bodied males. Inherited telomere length variation between unrelated individuals might have obscured a clear correlation between body height and mortality, leading to conflicting results in some studies. Finally, I propose that the secular height increase over the last decades, of about 2.5 cm per generation in the western world, has to be blamed for the widening of the gender gap in life expectancy.
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A model previously presented by Uchida in this journal [Med. Hypotheses 53 (1997) 103] described a mechanism for postoperative delirium. It described an increased level of melatonin resulting in a central "serotonin shortage". ⋯ These findings suggest that this initial paradigm requires modification. We propose that both the agitation seen in hyperactive delirium, and the somnolence associated with the hypoactive form could be explained by a disturbance of central tryptophan homeostasis. It is postulated that intervention in the form of melatonin administration may restore tryptophan levels, and prevent delirium.
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There is growing dissatisfaction regarding the available diagnostic systems for psychiatric disorders (DSM, ICD). Psychiatrists acknowledge that though mental disease reflects brain disorders, the descriptive and symptom based nature of psychiatric diagnosis bears no relation to brain functions. According to Helmut's article published in the October 2003 issue of Science, in the coming decade researchers and psychiatrists will be called upon to propose a basis for the psychiatric diagnostic system of the future. ⋯ Depression and anxiety have been recently linked to alterations of adaptive neuronal plasticity thus reconceptualized as disorders of matching complexity. Finally, psychoses, including schizophrenia spectrum disorders, are reconceptualized as disturbances of neural complexity resulting in altered fast stabilizing plasticity. The new diagnostic system generates testable predictions regarding diagnosis and treatments of mental disorders which may be the future of psychiatry.
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Congenital long QT syndrome (LQTS) is a cardiac electrophysiological disorder due to genetic mutations. Patients with LQTS, if untreated, have a high incidence of ventricular tachycardia and cardiac arrest. Adrenergic activities are believed to play a major role in triggering the onset of cardiac events. ⋯ Its clinical use, however, has been hindered by the complexity of the procedure and complications after the surgery. Video-assisted thoracoscopic sympathectomy has been used to treat patients with palmar and axillary hyperhidrosis. We suggest that the use of the microinvasice thoracoscopic technique may greatly simplify the LSCD procedure, making it the first-line therapy for LQTS.