Medical hypotheses
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Thanks to progress in zinc research, it is now possible to describe in more detail how zinc ions (Zn++) and nitrogen monoxide (NO), together with glutathione (GSH) and its oxidized form, GSSG, help to regulate immune responses to antigens. NO appears to be able to liberate Zn++ from metallothionein (MT), an intracellular storage molecule for metal ions such as zinc (Zn++) and copper (Cu++). Both Zn++ and Cu++ show a concentration-dependent inactivation of a protease essential for the proliferation of the AIDS virus HIV-1, while zinc can help prevent diabetes complications through its intracellular activation of the enzyme sorbitol dehydrogenase (SDH). ⋯ Under the influence of Th1 cells, zinc inhibits the growth of tumours by activating the endogenous tumour-suppressor endostatin, which inhibits angiogenesis. The modern Western diet, with its excess of refined products such as sugar, alcohol and fats, often contains, per calorie, a deficiency of ENs such as zinc, selenium and vitamins A, B, C and E, which results in disturbed immune functions, a shifted Th1/Th2 balance, chronic (viral) infections, obesity, atherosclerosis, autoimmunity, allergies and cancer. In view of this, an optimization of dietary composition would seem to give the best chance of beating (viral) epidemics and common (chronic) diseases at a realistic price.
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Entering both the old dispute (whether fever is adaptive or maladaptive) and its more recent modification (whether hypothermia is protective or detrimental in systemic inflammation), we suggest a new solution. We hypothesize that fever and hypothermia represent two different strategies of fighting systemic inflammation, each developed as an adaptive response to certain conditions, and each beneficial under these conditions. The antimicrobial and immunostimulating benefits of a high body temperature could be easily offset by its high energy cost. ⋯ Hypothermia, on the other hand, constitutes a response aimed at energy conservation and, as such, is beneficial exactly under the conditions of a substantial energy deficit. The two thermoregulatory responses represent two complementary strategies of survival in systemic inflammation: fever ensures the active attack against the pathogen; hypothermia secures the defense of the host's vital systems. The importance of each response's contribution to the whole campaign depends on the severity of the pathogenic insult, premorbid pathology, and current conditions (stress, nutrition, ambient temperature, etc.).
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With spinal anesthesia the level of surgical analgesia is mostly reported without reference to the neuroanatomic map of spinal nerves. The classical maps are variably and inconsistently reported in many textbooks. ⋯ This resulted in a theoretically clinically significant difference of two segments. It is concluded that clear reference should be made to the implemented segmental map in expressing the level of spinal blockade.
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The rationale and specifications for a permanent non-invasive cardiac monitoring device are described, including both an alarm and a device-initiated call (giving patient residence identification) to the emergency services number 911, if cardiac arrest is detected. This device may be useful for high-risk cardiac patients, who incur an unwitnessed cardiac arrest, by providing a prompt call and alarm for early initiation of bystander CPR, cardiac defibrillation (if necessary), advanced cardiac life-support, and early transfer of resuscitated patients to a hospital cardiac care unit. ⋯ With out-of-home unwitnessed cardiac arrest, ACADA-911 specifications also include a cardiac arrest-triggered determination of the patient's location through a commercially inexpensive global positioning system device, whose output is transmitted to EMS via an attached cellular phone/priority call network. A randomized controlled study evaluation of the device is proposed.
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Post-spinal hypotension at cesarean section appears difficult to prevent, despite the three obligatory so-called preventative measures. So far, literature data provide no compelling evidence that expectations have been met in this regard. A critical appraisal of volume preload, ephedrine prophylaxis and left lateral supine position shows that the preventative measures should be re-evaluated. New avenues should be explored aiming at a better prevention and decrease in both the prevalence and magnitude of post-spinal hypotension at cesarean section.