Medical hypotheses
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In a recent Medical Hypotheses editorial, I suggested the name psychological neoteny (PN) to refer to the widely-observed phenomenon that adults in modernizing liberal democracies increasingly retain many of the attitudes and behaviors traditionally associated with youth. I further suggested that PN is a useful trait for both individuals and the culture in modernizing societies; because people need to be somewhat child-like in their psychology order to keep learning, developing and adapting to the rapid and accelerating pace of change. Thirdly, I put forward the hypothesis that the major cause of PN in modernizing societies is the prolonged duration of formal education. ⋯ However, the economic effect is different in men and women: after parenthood men are more likely to have a job and work more hours while women change in the opposite direction. The conclusion is that psychological neoteny is indeed increasing, and mainly as a consequence of the increasing percentage of school leavers going into higher education. But at present it is unclear whether this trend is overall beneficial or harmful; and the answer may be different for men and women.
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The mechanisms responsible for symptom expression in fibromyalgia (FM) are complex. The most consistently detected objective abnormalities in FM involve pain-processing systems. Up to recently, central nervous system was a primary focus of investigations in FM. ⋯ This paper suggests that patients with FM represent a state of the dysfunction of descending, antinociceptive pathways and low hypothalamic-pituitary-adrenal function. This state is further proposed to result in many skin biopsy findings associated with the disorder, including increased N-methyl-d-aspartate receptors subtype 2D expression, neurogenic inflammation and characteristic electron microscopic findings. Future direction of research would be identification of specific laboratory markers such as skin biopsy for diagnostic and clinical evaluation purposes in FM.
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Postoperative delirium represents a serious complication after major surgery. Patients suffer from anxiety, hallucinations and delusions, and have higher postoperative morbidity and mortality. Generally, the role of acetylcholine deficiency in delirium pathophysiology is widely accepted. ⋯ These morphological changes lead to a decrease of nutritive perfusion and to longer diffusion distance for oxygen. Because acetylcholine synthesis is especially sensitive to low oxygen tension, symptoms of its deficiency readily develop. Therapeutic tools to modulate excessive inflammation are available, therefore new strategies of delirium treatment should be implemented in clinical praxis, as well as in preventive measures.
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Since the launch in 1998 of the anti-impotence drug sildenafil (viagra), the American food and drug administration has identified 50 cases of drug-related blindness, the so-called nonarteritic anterior ischemic optic neuropathy. This, very serious, side effect frequently leads to sudden, mostly irreversible loss of vision, and there is no proven effective treatment to cure patients or to prevent recurrence. ⋯ These data are consistent with the hypothesis that sildenafil, surgery and anesthesia, taken together, could be a potentially dangerous cocktail of risk factors for sudden irreversible loss of vision. To reduce the risk, sildenafil use should be avoided at least one week before surgical operations, since the reported cases of blindness developed 36h after drug ingestion.
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Diabetic foot ulcers (DFUs) consist of an interaction of neuropathy, ischemia and infection. Neuropathy affects sensory, motor and autonomic pathways. Pathogenic factors for neuropathy include hyperglycemia, nonenzymatic glycosylation, oxidative stress, ischemic and hypoxic factors, nerve growth factor anomalies, activation of polyol pathway and immunologic abnormalities. ⋯ In addition, recent in vivo and in vitro investigations have evidenced that statins have a favorable effect on diabetic peripheral neuropathy independent of its lipid-lowering effect by demonstrating restoration or preservation of microcirculation of the sciatic nerve. We hypothesized that statins can be useful for the prevention and treatment of diabetic foot. Possible mechanisms include the reduction of neuropathy and ischemia or through growth factors, the effectiveness of which has been shown for fracture healing in animal models.