This article reviewed the principles and outcomes of tendon transfer procedures described in the literature to restore function following injuries delivered in a workshop as a way of improving basic science and anatom...This article reviewed the principles and outcomes of tendon transfer procedures described in the literature to restore function following injuries delivered in a workshop as a way of improving basic science and anatomical knowledge in surgical trainees preparing for surgical examinations. Post intervention surveys showed an improvement in trainees’ familiarity with musculoskeletal anatomy and engagement in learning with improved readiness for surgical examinations.展开更多
Aim: To assess FDT perimetry as a screening tool for glaucoma in an optometry practice. Methods: One hundred consecutive patients (mean age 53years) with no previous eye pathology attending a busy optometry practice u...Aim: To assess FDT perimetry as a screening tool for glaucoma in an optometry practice. Methods: One hundred consecutive patients (mean age 53years) with no previous eye pathology attending a busy optometry practice underwent FDT and oculus perimetry, intraocular pressure measurement and optic disc assessment by the same observer. Those patients with an abnormal result on field screening were further assessed with展开更多
Ciliary body ablation with the diode laser is well established as a treatment for neovascular and other refractory glaucomas. Glaucoma secondary to intra-ocular silicone oil for vitreo-retinal surgery is one such glau...Ciliary body ablation with the diode laser is well established as a treatment for neovascular and other refractory glaucomas. Glaucoma secondary to intra-ocular silicone oil for vitreo-retinal surgery is one such glaucoma that can be difficult to control. We reviewed a series of cases where cyclodiode laser is applied for silicone oil-induced glaucoma and demonstrate that it is展开更多
BACKGROUND The deltoid ligament is a key component of ankle fracture stability.Clinical tests to assess deltoid ligament injury have low specificity.In supination externalrotation(SER)type-IV ankle fractures,there is ...BACKGROUND The deltoid ligament is a key component of ankle fracture stability.Clinical tests to assess deltoid ligament injury have low specificity.In supination externalrotation(SER)type-IV ankle fractures,there is either a medial malleolus fracture or deltoid ligament injury.These injuries are often considered unstable,requiring surgical stabilisation.We look to identify the anatomical basis for this instability.This study investigates the anatomical basis for such instability by re-creating SER type ankle fractures in a standardised cadaveric study model,investigating the anatomical basis for such instability.AIM To investigate the anatomical basis for fracture instability in SER type ankle fractures.METHODS Four matched pairs of cadaveric limbs were tested for stability both when axially loaded and under external rotation stress.Four matched pairs of cadaveric limbs(8 specimens)were tested for stability when axially loaded to 750 N with a custom rig.Specimens were tested through increasing stages of SER injury in a stepwise fashion before restoring the lateral side with open reduction and internal fixation(ORIF).Clinical photographs and radiographs were recorded at each step.We defined instability in accordance with well accepted radiological parameters:>4 mm medial clear space opening on a mortise-view radiograph or>7 degrees of talar tilt.RESULTS All specimens with an intact posterior deep deltoid ligament were stable.Once the posterior deep deltoid ligament was sectioned there was instability in all specimens.Stabilisation of the lateral side prevented talar shift,but not talar tilt.CONCLUSION If the posterior deep deltoid ligament is intact then SER fractures can be managed without surgery.If the posterior deep deltoid is incompetent,ORIF and cautious rehabilitation is recommended because the talus can still tilt in the mortise.展开更多
PURPOSE: To document a previously unreported complication after vitrectomy with peeling of the internal limiting membrane (ILM) for idiopathic macular holes. Method: Retrospective review of notes of 232 consecutive pa...PURPOSE: To document a previously unreported complication after vitrectomy with peeling of the internal limiting membrane (ILM) for idiopathic macular holes. Method: Retrospective review of notes of 232 consecutive patients who underwent vitrectomy with peeling of the ILM for idiopathic macular holes from 1996 to 2001. Four patients were found to have eccentric iatrogenic macular holes postoperatively. Optical coherence tomography was used to evaluate these holes. Results: The idiopathic macular holes were graded from stages II to IV preoperatively with visual acuities from 6/18 to 6/60. All patients had surgery within 6 months of presentation. They underwent vitrectomy with complete separation of the posterior cortical vitreous, peeling of the ILM, injection of platelets (0.1ml), and gas tamponade with SF6 20%. Postoperatively the patients postured strictly face down for 10 days. Follow-up ranged from 8 months to 6 years. Iatrogenic eccentric macular holes were noted postoperatively. The holes were located between 3 and 6 o’clock in three patients and at 9 o’clock in the fourth patient, relative to the macula. Optical coherence tomography showed them to be full thickness and completely flat. No further intervention was necessary. No complications have arisen during follow-up. Comment: To our knowledge iatrogenic eccentric full thickness macular holes after macular hole surgery have never been reported. We believe that the location of the holes represents the initial site of ILM elevation. These holes are asymptomatic, have not required any treatment and have not caused any complications in up to 6 years of follow-up.展开更多
Purpose:The majority of acute anterior shoulder dislocations are sustained during sports and wilderness activities.The management of acute dislocations in the pre-hospital setting is currently without guidelines based...Purpose:The majority of acute anterior shoulder dislocations are sustained during sports and wilderness activities.The management of acute dislocations in the pre-hospital setting is currently without guidelines based on the evidence.The study aims to assess the risk of acute complications in pre-hospital shoulder reduction and identify which pre-hospital reduction technique has the highest success rate in the published literature.Methods:The involved databases were Allied and Complementary Medicine,CENTRAL,CINAHL,Cochrane Database of Systematic Reviews,Embase,Europe PMC,Ovid MEDLINE®,Pedro,Proquest,Trip,and World Health Organization International Clinical Trials Registry platform.Only original research of high methodological quality was included,which was defined by the recently developed assessment tooleassessing the methodological quality of published papers(AMQPP)and investigated the management of acute anterior shoulder dislocations in the pre-hospital setting.Results:Two hundred and ninety-eight articles were identified and screened.A full text review was performed on 40 articles.Four articles published between 2015 and 2018 met the inclusion criteria.A total of 181 patients were included with the study duration ranging from 6 to 60 months.All studies reported zero immediate complication following pre-hospital reduction and there were no documented subsequent adverse events regardless of the technique used.Prompt resolution of neurological symptoms was observed following the early and successful pre-hospital reduction.First attempt success rate,when performed by skilled practitioners,ranged from 72.3%to 94.9%.Conclusion:Pre-hospital shoulder reduction appears to be a safe and feasible option when carried out with the appropriate expertise.A novel reduction technique adapted from the mountain medicine diploma course at the University of Paris North was found to have the highest first attempt reduction success rate of 94.9%.Other techniques described in the literature included Hippocratic,Stimson's,Counter-traction and external rotation with the success rates ranging from 54%to 71.7%.展开更多
background and purpose We present the long-term outcome after endovascular treatment of symptomatic intracranial posterior circulation stenoses.Methods 30 patients with symptomatic intracranial posterior circulation s...background and purpose We present the long-term outcome after endovascular treatment of symptomatic intracranial posterior circulation stenoses.Methods 30 patients with symptomatic intracranial posterior circulation stenoses exceeding 70% underwent endovascular treatment between 2006 and 2012.Data regarding presentation,follow-up,procedure details,complications and imaging follow-up were reviewed.All surviving patients underwent a phone interview to establish their current Modified Ranking Scales(MRS).results Stenoses of the intracranial vertebral artery(24 patients)and basilar artery(6 patients)were treated with stents(10 patients),angioplasty alone(13 patients)or both(5 patients).Two procedures failed.One patient(3.3%)died after the procedure,two had stroke(6.6%)and one a subarachnoid haemorrhage without ensuing deficit.Two patients(6.7%)had asymptomatic complications(dissection and pseudoaneurysm).The median clinical follow-up time was 7 years.Of the 29 patients who survived the procedure,6 died due to unrelated causes.Three patients(10%)had recurrent strokes and two(6.7%)a transient ischaemic attack in the posterior circulation.Two patients had subsequent middle cerebral artery strokes.Five(16.7%)patients had recurrent stenoses and three(10%)occlusions of the treated artery.Retreatment was performed in six patients,three(10%)with PTA and three(10%)with stenting.Current MRS scores were as follows:nine MRS 0,eight MRS 1,four MRS 2 and one MRS 4.Conclusions Long-term follow-up after endovascular treatment of high-risk symptomatic intracranial posterior circulation stenoses shows few stroke recurrences.Treatment of intracranial vertebral artery stenosis may be beneficial in appropriately selected patients.展开更多
Without an understanding of functional musculoskeletal system recovery, the translation of knowledge concerning neurological recovery from laboratory discoveries to bedside applications will be incomplete. Because imp...Without an understanding of functional musculoskeletal system recovery, the translation of knowledge concerning neurological recovery from laboratory discoveries to bedside applications will be incomplete. Because improvements in neurological function after cell transplantation are minor and can be easily ignored, this article draws attention to the minimal improvements required to allow a spinal cord injury patient or person to live a relatively independent life. These minimal improvements include(1) the key muscle power required for trunk stability;(2) the key muscle power required to allow a paraplegic to walk; and(3) the key muscle power required for hand usefulness or functionality. The system of muscle power grading promoted by the British Medical Research Council(MRC) is more sensitive and delicate than the ASIA Standards, as the latter only accept the full range of movement of a joint. The MRC system seems to be preferable to the ASIA Standards in clinical trials of cell transplantation, wherein minute improvements in function might result in large differences in the quality of life. The threshold of function is a grade 3 power level. Even if all relevant muscles fail to achieve a power higher than grade 3, the patient can be minimally functional and hence relatively independent. These relevant muscles include the latissimus dorsi, hip flexors, hip abductors, shoulder abductors and flexors, elbow flexors and extensors,and wrist extensors. These muscles are innervated by the C5–7 spinal cord segments except the latissimus dorsi, for which innervation extends to C8.展开更多
生命晚期的患者是否进行心肺复苏抢救是医学实践中一个十分困难而至关重要的决策，放弃心肺复苏是为了患者在生命的最后时刻防止其受到有损尊严的医疗干预，确保患者能够尽可能平静地度过最后的时日。2014年10月，英国抢救复苏委员会 （...生命晚期的患者是否进行心肺复苏抢救是医学实践中一个十分困难而至关重要的决策，放弃心肺复苏是为了患者在生命的最后时刻防止其受到有损尊严的医疗干预，确保患者能够尽可能平静地度过最后的时日。2014年10月，英国抢救复苏委员会 （the Resuscitation Council,UK）、英国医学会（BMA）和英国皇家护理学院（the Royal College of Nursing , RCN）重新评估了医生确定放弃患者心肺复苏的指南。展开更多
Brain function is an extremely active dynamic process. Studing a living organism is essential for explaination of the sophistication of the brain. Although there are progresses in studying living tissues of acute or c...Brain function is an extremely active dynamic process. Studing a living organism is essential for explaination of the sophistication of the brain. Although there are progresses in studying living tissues of acute or cultured slice for prolonged period in vitro, clinicians prefer seeing the lesion directly on an imaging screen or material.Functional MRI(fMRI) is commonly used method to study brain pathology in dynamics.展开更多
With the fast-growing aging population, dementia has become a health priority.However, in the past, medicine was largely dealing with physical disorders, and not enough knowledge and experience have been accumulated f...With the fast-growing aging population, dementia has become a health priority.However, in the past, medicine was largely dealing with physical disorders, and not enough knowledge and experience have been accumulated for mental health. The main and first symptom of this disorder is the loss of memory; hence, understanding the hippocampal formation is the key to tackling dementia. In 2007, a milestone book titled "Hippocampus Book" was published. One of the authors/editors is the 2014 Nobel Laureate in Physiology and Medicine, Professor John O'Keefe. It is a MUST-READ encyclopedia about the hippocampal formation, for those who wish to commit themselves to helping the patients with dementia. The formation consists of the hippocampus,entorhinal cortex, subiculum, presubiculum, parasubiculum, and dentate gyrus. The hippocampus is further divided into CA1, CA2, and CA3. The entorhinal cortex is the gateway of receiving all sensory information from the neocortex, while the subiculum is the exit for the efferent projections to the neocortex. Memory is divided into short-term and long-term memory. The former does not require protein synthesis while the latter does. The electrophysiological activities of creating these memories are short-term potentiation and long-term potentiation respectively. In most cases, the entorhinal cortex is the first structure to be damaged, and even short-term memory cannot be created. However, all except spatial memory are stored in the neocortex. Damage to the hippocampal formation would not affect the storage and retrieval of memories. Hence, past memories may remain intact in the early phases of the disorder. This devastating progressive disease has no cure. However, the highly plastic hippocampal formation may offer us some hope. It is the responsibility of the pharmaceutical industries to develop new drugs. Clinicians should add their efforts to the endeavor. The author would suggest that they explore insulin-like growth factors,brain stimulation, cell transplantation, and animal-assisted therapy to find some innovative solutions to help patients with dementia. As the current status of neuroscience stands, the animal-assisted therapy seems to stand out among all methods. It alleviates symptoms and stabilizes the ailment.展开更多
Geoffrey Raisman was born to a Jewish family in Leeds,England in 1939.His grandparents immigrated from Lithuania over a hundred years ago.This is recorded in his book of family stories(Figure 1).He graduated in medici...Geoffrey Raisman was born to a Jewish family in Leeds,England in 1939.His grandparents immigrated from Lithuania over a hundred years ago.This is recorded in his book of family stories(Figure 1).He graduated in medicine at the University of Oxford,where he taught for 11 years.Later,he moved to the Medical Research Council,equivalent to the Medical Academy in China,where he focused on research.In1989,he was appointed Professor in Anatomy展开更多
Since ancient times medical profession has typically dealt with physical disorders,because they are visible, palpable, and audible. The diagnosis is relatively direct. Mental health problems are hidden in the brain an...Since ancient times medical profession has typically dealt with physical disorders,because they are visible, palpable, and audible. The diagnosis is relatively direct. Mental health problems are hidden in the brain and we did not know what was going on inside the skull. We could only infer, by observing the patient's behaviors and making assumptions. Even now, we have to largely rely on this indirect approach.That is why psychology and psychiatry are classified as behavioral sciences. They are abstract, and we do not understand the structural changes causing the problem,except for obvious vascular or neoplastic lesions. Now, due to the introduction of new technologies, many mental health problems can be visualized through hi-tech equipment, albeit they are not yet palpable or audible. This direct approach has made the diagnosis much more secure. Now, we know that the problem of dementia starts from the hippocampal formation, and we can see it on magnetic resonance imaging(MRI) and functional MRI(f MRI). Therefore, a new era of mental health care is emerging. Dementia has become a burden for the patient, family members,caregivers, and the entire society. With ageing population, the number of patients with dementia will increase sharply not only in the developed but also in the developing world. The care of patients with dementia involves not only biology, but also sociology, including politics, and humanities. In 2012, in collaboration with the UK-based Alzheimer's Disease International, the World Health Organization(WHO)published "Dementia: a public health priority" report. A year later, in 2013, the problem was raised at the G8 summit meeting in London. In 2014, the UK-based Alzheimer's Society estimated that by 2015, there would be 850,000 sufferers of dementia. Finally, in 2015, the First WHO Ministerial Conference on Global Action Against Dementia took place in Geneva and a document calling for action was published. Every UN member state has a responsibility to take action in response to this solemn call to save the human race.展开更多
Clinical translational science:Clinical translational science(CTS)is a new discipline bridging laboratory discoveries and clinical applications.It is normally funded by research grants instead of investment major phar...Clinical translational science:Clinical translational science(CTS)is a new discipline bridging laboratory discoveries and clinical applications.It is normally funded by research grants instead of investment major pharmaceutical companies.It is patient-and populationor community-oriented.Repair of the human展开更多
文摘This article reviewed the principles and outcomes of tendon transfer procedures described in the literature to restore function following injuries delivered in a workshop as a way of improving basic science and anatomical knowledge in surgical trainees preparing for surgical examinations. Post intervention surveys showed an improvement in trainees’ familiarity with musculoskeletal anatomy and engagement in learning with improved readiness for surgical examinations.
文摘Aim: To assess FDT perimetry as a screening tool for glaucoma in an optometry practice. Methods: One hundred consecutive patients (mean age 53years) with no previous eye pathology attending a busy optometry practice underwent FDT and oculus perimetry, intraocular pressure measurement and optic disc assessment by the same observer. Those patients with an abnormal result on field screening were further assessed with
文摘Ciliary body ablation with the diode laser is well established as a treatment for neovascular and other refractory glaucomas. Glaucoma secondary to intra-ocular silicone oil for vitreo-retinal surgery is one such glaucoma that can be difficult to control. We reviewed a series of cases where cyclodiode laser is applied for silicone oil-induced glaucoma and demonstrate that it is
文摘BACKGROUND The deltoid ligament is a key component of ankle fracture stability.Clinical tests to assess deltoid ligament injury have low specificity.In supination externalrotation(SER)type-IV ankle fractures,there is either a medial malleolus fracture or deltoid ligament injury.These injuries are often considered unstable,requiring surgical stabilisation.We look to identify the anatomical basis for this instability.This study investigates the anatomical basis for such instability by re-creating SER type ankle fractures in a standardised cadaveric study model,investigating the anatomical basis for such instability.AIM To investigate the anatomical basis for fracture instability in SER type ankle fractures.METHODS Four matched pairs of cadaveric limbs were tested for stability both when axially loaded and under external rotation stress.Four matched pairs of cadaveric limbs(8 specimens)were tested for stability when axially loaded to 750 N with a custom rig.Specimens were tested through increasing stages of SER injury in a stepwise fashion before restoring the lateral side with open reduction and internal fixation(ORIF).Clinical photographs and radiographs were recorded at each step.We defined instability in accordance with well accepted radiological parameters:>4 mm medial clear space opening on a mortise-view radiograph or>7 degrees of talar tilt.RESULTS All specimens with an intact posterior deep deltoid ligament were stable.Once the posterior deep deltoid ligament was sectioned there was instability in all specimens.Stabilisation of the lateral side prevented talar shift,but not talar tilt.CONCLUSION If the posterior deep deltoid ligament is intact then SER fractures can be managed without surgery.If the posterior deep deltoid is incompetent,ORIF and cautious rehabilitation is recommended because the talus can still tilt in the mortise.
文摘PURPOSE: To document a previously unreported complication after vitrectomy with peeling of the internal limiting membrane (ILM) for idiopathic macular holes. Method: Retrospective review of notes of 232 consecutive patients who underwent vitrectomy with peeling of the ILM for idiopathic macular holes from 1996 to 2001. Four patients were found to have eccentric iatrogenic macular holes postoperatively. Optical coherence tomography was used to evaluate these holes. Results: The idiopathic macular holes were graded from stages II to IV preoperatively with visual acuities from 6/18 to 6/60. All patients had surgery within 6 months of presentation. They underwent vitrectomy with complete separation of the posterior cortical vitreous, peeling of the ILM, injection of platelets (0.1ml), and gas tamponade with SF6 20%. Postoperatively the patients postured strictly face down for 10 days. Follow-up ranged from 8 months to 6 years. Iatrogenic eccentric macular holes were noted postoperatively. The holes were located between 3 and 6 o’clock in three patients and at 9 o’clock in the fourth patient, relative to the macula. Optical coherence tomography showed them to be full thickness and completely flat. No further intervention was necessary. No complications have arisen during follow-up. Comment: To our knowledge iatrogenic eccentric full thickness macular holes after macular hole surgery have never been reported. We believe that the location of the holes represents the initial site of ILM elevation. These holes are asymptomatic, have not required any treatment and have not caused any complications in up to 6 years of follow-up.
文摘Purpose:The majority of acute anterior shoulder dislocations are sustained during sports and wilderness activities.The management of acute dislocations in the pre-hospital setting is currently without guidelines based on the evidence.The study aims to assess the risk of acute complications in pre-hospital shoulder reduction and identify which pre-hospital reduction technique has the highest success rate in the published literature.Methods:The involved databases were Allied and Complementary Medicine,CENTRAL,CINAHL,Cochrane Database of Systematic Reviews,Embase,Europe PMC,Ovid MEDLINE®,Pedro,Proquest,Trip,and World Health Organization International Clinical Trials Registry platform.Only original research of high methodological quality was included,which was defined by the recently developed assessment tooleassessing the methodological quality of published papers(AMQPP)and investigated the management of acute anterior shoulder dislocations in the pre-hospital setting.Results:Two hundred and ninety-eight articles were identified and screened.A full text review was performed on 40 articles.Four articles published between 2015 and 2018 met the inclusion criteria.A total of 181 patients were included with the study duration ranging from 6 to 60 months.All studies reported zero immediate complication following pre-hospital reduction and there were no documented subsequent adverse events regardless of the technique used.Prompt resolution of neurological symptoms was observed following the early and successful pre-hospital reduction.First attempt success rate,when performed by skilled practitioners,ranged from 72.3%to 94.9%.Conclusion:Pre-hospital shoulder reduction appears to be a safe and feasible option when carried out with the appropriate expertise.A novel reduction technique adapted from the mountain medicine diploma course at the University of Paris North was found to have the highest first attempt reduction success rate of 94.9%.Other techniques described in the literature included Hippocratic,Stimson's,Counter-traction and external rotation with the success rates ranging from 54%to 71.7%.
基金WK is supported by the National Institute for Health Research (NIHR) Oxford Biomedical Research Centre (BRC).
文摘background and purpose We present the long-term outcome after endovascular treatment of symptomatic intracranial posterior circulation stenoses.Methods 30 patients with symptomatic intracranial posterior circulation stenoses exceeding 70% underwent endovascular treatment between 2006 and 2012.Data regarding presentation,follow-up,procedure details,complications and imaging follow-up were reviewed.All surviving patients underwent a phone interview to establish their current Modified Ranking Scales(MRS).results Stenoses of the intracranial vertebral artery(24 patients)and basilar artery(6 patients)were treated with stents(10 patients),angioplasty alone(13 patients)or both(5 patients).Two procedures failed.One patient(3.3%)died after the procedure,two had stroke(6.6%)and one a subarachnoid haemorrhage without ensuing deficit.Two patients(6.7%)had asymptomatic complications(dissection and pseudoaneurysm).The median clinical follow-up time was 7 years.Of the 29 patients who survived the procedure,6 died due to unrelated causes.Three patients(10%)had recurrent strokes and two(6.7%)a transient ischaemic attack in the posterior circulation.Two patients had subsequent middle cerebral artery strokes.Five(16.7%)patients had recurrent stenoses and three(10%)occlusions of the treated artery.Retreatment was performed in six patients,three(10%)with PTA and three(10%)with stenting.Current MRS scores were as follows:nine MRS 0,eight MRS 1,four MRS 2 and one MRS 4.Conclusions Long-term follow-up after endovascular treatment of high-risk symptomatic intracranial posterior circulation stenoses shows few stroke recurrences.Treatment of intracranial vertebral artery stenosis may be beneficial in appropriately selected patients.
文摘Without an understanding of functional musculoskeletal system recovery, the translation of knowledge concerning neurological recovery from laboratory discoveries to bedside applications will be incomplete. Because improvements in neurological function after cell transplantation are minor and can be easily ignored, this article draws attention to the minimal improvements required to allow a spinal cord injury patient or person to live a relatively independent life. These minimal improvements include(1) the key muscle power required for trunk stability;(2) the key muscle power required to allow a paraplegic to walk; and(3) the key muscle power required for hand usefulness or functionality. The system of muscle power grading promoted by the British Medical Research Council(MRC) is more sensitive and delicate than the ASIA Standards, as the latter only accept the full range of movement of a joint. The MRC system seems to be preferable to the ASIA Standards in clinical trials of cell transplantation, wherein minute improvements in function might result in large differences in the quality of life. The threshold of function is a grade 3 power level. Even if all relevant muscles fail to achieve a power higher than grade 3, the patient can be minimally functional and hence relatively independent. These relevant muscles include the latissimus dorsi, hip flexors, hip abductors, shoulder abductors and flexors, elbow flexors and extensors,and wrist extensors. These muscles are innervated by the C5–7 spinal cord segments except the latissimus dorsi, for which innervation extends to C8.
文摘生命晚期的患者是否进行心肺复苏抢救是医学实践中一个十分困难而至关重要的决策，放弃心肺复苏是为了患者在生命的最后时刻防止其受到有损尊严的医疗干预，确保患者能够尽可能平静地度过最后的时日。2014年10月，英国抢救复苏委员会 （the Resuscitation Council,UK）、英国医学会（BMA）和英国皇家护理学院（the Royal College of Nursing , RCN）重新评估了医生确定放弃患者心肺复苏的指南。
文摘Brain function is an extremely active dynamic process. Studing a living organism is essential for explaination of the sophistication of the brain. Although there are progresses in studying living tissues of acute or cultured slice for prolonged period in vitro, clinicians prefer seeing the lesion directly on an imaging screen or material.Functional MRI(fMRI) is commonly used method to study brain pathology in dynamics.
文摘With the fast-growing aging population, dementia has become a health priority.However, in the past, medicine was largely dealing with physical disorders, and not enough knowledge and experience have been accumulated for mental health. The main and first symptom of this disorder is the loss of memory; hence, understanding the hippocampal formation is the key to tackling dementia. In 2007, a milestone book titled "Hippocampus Book" was published. One of the authors/editors is the 2014 Nobel Laureate in Physiology and Medicine, Professor John O'Keefe. It is a MUST-READ encyclopedia about the hippocampal formation, for those who wish to commit themselves to helping the patients with dementia. The formation consists of the hippocampus,entorhinal cortex, subiculum, presubiculum, parasubiculum, and dentate gyrus. The hippocampus is further divided into CA1, CA2, and CA3. The entorhinal cortex is the gateway of receiving all sensory information from the neocortex, while the subiculum is the exit for the efferent projections to the neocortex. Memory is divided into short-term and long-term memory. The former does not require protein synthesis while the latter does. The electrophysiological activities of creating these memories are short-term potentiation and long-term potentiation respectively. In most cases, the entorhinal cortex is the first structure to be damaged, and even short-term memory cannot be created. However, all except spatial memory are stored in the neocortex. Damage to the hippocampal formation would not affect the storage and retrieval of memories. Hence, past memories may remain intact in the early phases of the disorder. This devastating progressive disease has no cure. However, the highly plastic hippocampal formation may offer us some hope. It is the responsibility of the pharmaceutical industries to develop new drugs. Clinicians should add their efforts to the endeavor. The author would suggest that they explore insulin-like growth factors,brain stimulation, cell transplantation, and animal-assisted therapy to find some innovative solutions to help patients with dementia. As the current status of neuroscience stands, the animal-assisted therapy seems to stand out among all methods. It alleviates symptoms and stabilizes the ailment.
文摘Geoffrey Raisman was born to a Jewish family in Leeds,England in 1939.His grandparents immigrated from Lithuania over a hundred years ago.This is recorded in his book of family stories(Figure 1).He graduated in medicine at the University of Oxford,where he taught for 11 years.Later,he moved to the Medical Research Council,equivalent to the Medical Academy in China,where he focused on research.In1989,he was appointed Professor in Anatomy
文摘Since ancient times medical profession has typically dealt with physical disorders,because they are visible, palpable, and audible. The diagnosis is relatively direct. Mental health problems are hidden in the brain and we did not know what was going on inside the skull. We could only infer, by observing the patient's behaviors and making assumptions. Even now, we have to largely rely on this indirect approach.That is why psychology and psychiatry are classified as behavioral sciences. They are abstract, and we do not understand the structural changes causing the problem,except for obvious vascular or neoplastic lesions. Now, due to the introduction of new technologies, many mental health problems can be visualized through hi-tech equipment, albeit they are not yet palpable or audible. This direct approach has made the diagnosis much more secure. Now, we know that the problem of dementia starts from the hippocampal formation, and we can see it on magnetic resonance imaging(MRI) and functional MRI(f MRI). Therefore, a new era of mental health care is emerging. Dementia has become a burden for the patient, family members,caregivers, and the entire society. With ageing population, the number of patients with dementia will increase sharply not only in the developed but also in the developing world. The care of patients with dementia involves not only biology, but also sociology, including politics, and humanities. In 2012, in collaboration with the UK-based Alzheimer's Disease International, the World Health Organization(WHO)published "Dementia: a public health priority" report. A year later, in 2013, the problem was raised at the G8 summit meeting in London. In 2014, the UK-based Alzheimer's Society estimated that by 2015, there would be 850,000 sufferers of dementia. Finally, in 2015, the First WHO Ministerial Conference on Global Action Against Dementia took place in Geneva and a document calling for action was published. Every UN member state has a responsibility to take action in response to this solemn call to save the human race.
文摘Clinical translational science:Clinical translational science(CTS)is a new discipline bridging laboratory discoveries and clinical applications.It is normally funded by research grants instead of investment major pharmaceutical companies.It is patient-and populationor community-oriented.Repair of the human
