Concerns about the application of resistance exercise with blood-flow restriction and thrombosis risk in hemodialysis patients

Background:Hemodialysis(HD)per se is a risk factor for thrombosis.Considering the growing body of evidence on blood-flow restriction(BFR)exercise in HD patients,identification of possible risk factors related to the prothrombotic agent D-dimer is required for the safety and feasibility of this training model.The aim of the present study was to identify risk factors associated with higher D-dimer levels and to determine the acute effect of resistance exercise(RE)with BFR on this molecule.Methods:Two hundred and six HD patients volunteered for this study(all with a glomerular filtration rate of<15 mL/min/1.73 m^(2)).The RE+BFR session consisted of 50%arterial occlusion pressure during 50 min sessions of HD(intradialytic exercise).RE repetitions included concentric and eccentric lifting phases(each lasting 2 s)and were supervised by a strength and conditioning specialist.Results:Several variables were associated with elevated levels of D-dimer,including higher blood glucose,citrate use,recent cardiovascular events,recent intercurrents,higher inflammatory status,catheter as vascular access,older patients(>70 years old),and HD vintage.Furthermore,RE+BFR significantly increases D-dimer after 4 h.Patients with borderline baseline D-dimer levels(400-490 ng/mL)displayed increased risk of elevating D-dimer over the normal range(-500 ng/mL).Conclusion:These results identified factors associated with a heightened prothrombotic state and may assist in the screening process for HD patients who wish to undergo RE+BFR.D-dimer and/or other fibrinolysis factors should be assessed at baseline and throughout the protocol as a precautionary measure to maximize safety during RE+BFR.

Ethics of Human Resources Management in the Cameroonian Health System, Medical Nomadism and the Ineffectiveness of the Fight against High Blood Pressure

Context/objectives: The fight against Chronic Non-Communicable Diseases (NCDs) is a long-term undertaking, which requires available, motivated and well-managed human resources (HR). The administrative management of skills on both qualitative and quantitative levels is one of the essential functions of a health system. To better implement policies of fight against High Blood Pressure (HBP) and other chronic diseases, it is important to establish strategies to retain health personnel. This loyalty requires favorable working conditions and consideration of the contribution-reward couple. Good working conditions are likely to reduce the phenomenon of medical nomadism;conversely, poor HR management can contribute to their exodus towards exotic “green pastures”, thus leading to an additional crisis in the Cameroonian health system. The fight against HBP is a complex, multifaceted and multifactorial reality that requires appropriate management model for all types of resources mainly HR. The main objective of this research is to show the impact of poor management of human resources in Cameroon health system on medical nomadism and the ineffectiveness of the fight against High Blood Pressure. Method: A cross-sectional descriptive survey among five hundred (500) health facilities in the center region of Cameroon has been conducted. A stratified probabilistic technique has been used, and the number of health facilities to be surveyed has been determined using the “sample size estimation table” of Depelteau. The physical questionnaires have been printed and then distributed to data collectors. After data collection, the latter were grouped during processing in Excel sheets. The Chi-square test was used for data with a qualitative value and that of Kolmogorov-Sminorf for data with a quantitative value to assess the normality and reliability of data. The Crochach’s Alpha reliability test allowed us to have a summary of the means and variances and then to search for intragroup correlations between variables. Descriptive analysis was possible with the XLSTAT 2016 software. Results: 43.60% of Health Facilities (HF) managers were unqualified. 82.20% of HF managers have staff in a situation of professional insecurity. They are mainly contractual (49.00), decision-making agents (24.40%), casual agents (08.80). The proportion of unstable personnel is average of 22.00% and very unstable, 12.00%.

Exploring the intersection of the medical metaverse and healthcare ethics:future considerations and caveats

The medical metaverse and digital twin are set to revolutionise healthcare.Like all emerging technologies their benefits must be weighed against their ethical and social,impacts.If we consider the advances of medical technology as an expression of our values,such as the pursuit of knowledge,cures and healing,an ethical study allows us to align our values and steer the technology towards an agreed goal.However,to appreciate the long-term consequents of a technology,those consequences must be considered in the context of a society already shaped by that technology.This paper identifies the technologies currently shaping society and considers the ethical,and social consequences of the medical metaverse and digital twin in that future society.

Mechanisms underlying the role of endoplasmic reticulum stress in the placental injury and fetal growth restriction in an ovine gestation model

Background Exposure to bisphenol A(BPA),an environmental pollutant known for its endocrine-disrupting properties,during gestation has been reported to increase the risk of fetal growth restriction(FGR)in an ovine model of pregnancy.We hypothesized that the FGR results from the BPA-induced insufficiency and barrier dysfunction of the placenta,oxidative stress,inflammatory responses,autophagy and endoplasmic reticulum stress(ERS).However,precise mechanisms underlying the BPA-induced placental dysfunction,and subsequently,FGR,as well as the potential involvement of placental ERS in these complications,remain to be investigated.Methods In vivo experiment,16 twin-pregnant(from d 40 to 130 of gestation)Hu ewes were randomly distributed into two groups(8 ewes each).One group served as a control and received corn oil once a day,whereas the other group received BPA(5 mg/kg/d as a subcutaneous injection).In vitro study,ovine trophoblast cells(OTCs)were exposed to 4 treatments,6 replicates each.The OTCs were treated with 400μmol/L BPA,400μmol/L BPA+0.5μg/m L tunicamycin(Tm;ERS activator),400μmol/L BPA+1μmol/L 4-phenyl butyric acid(4-PBA;ERS antagonist)and DMEM/F12 complete medium(control),for 24 h.Results In vivo experiments,pregnant Hu ewes receiving the BPA from 40 to 130 days of pregnancy experienced a decrease in placental efficiency,progesterone(P4)level and fetal weight,and an increase in placental estrogen(E2)level,together with barrier dysfunctions,OS,inflammatory responses,autophagy and ERS in type A cotyledons.In vitro experiment,the OTCs exposed to BPA for 24 h showed an increase in the E2 level and related protein and gene expressions of autophagy,ERS,pro-apoptosis and inflammatory response,and a decrease in the P4 level and the related protein and gene expressions of antioxidant,anti-apoptosis and barrier function.Moreover,treating the OTCs with Tm aggravated BPA-induced dysfunction of barrier and endocrine(the increased E2 level and decreased P4 level),OS,inflammatory responses,autophagy,and ERS.However,treating the OTCs with 4-PBA reversed the counteracted effects of Tm mentioned above.Conclusions In general,the results reveal that BPA exposure can cause ERS in the ovine placenta and OTCs,and ERS induction might aggravate BPA-induced dysfunction of the placental barrier and endocrine,OS,inflammatory responses,and autophagy.These data offer novel mechanistic insights into whether ERS is involved in BPA-mediated placental dysfunction and fetal development.

On Evaluating University Teachers’ Morality and Ethics in the New Era

University teachers play an important role in promoting moral and political education among university students.Regular and long-term construction of teachers’morality and ethics will contribute to the success of the fundamental task of cultivating talents.The present study proposes that due to the multiple identities of university teachers,it is necessary to evaluate the construction of teachers’morality and ethics in terms of what to evaluate and how to evaluate?It is expected that the attempt will provide useful guidance for the construction of university teachers’morality and ethics.

Levinas on the Ethics of the Other

The traditional mainstream of political philosophy establishes its thoughts on the subjectivity of“I”,which also formats its ethics of justice and freedom on the ground of selfness for itself and by itself.Political philosophers also incline to generalize and neutralize in labelling persons into the abstract concepts which ignore their particularity and diversity;as a result,this led to devastative consequence politically for the other,and also jeopardized the“I”.Hence Emmanuel Levinas provides his solution to this dilemma in an attempt to put the ethics of justice on the ground of the other.Justice for the other is the starting point for the political ethics.The other is the absolute infinity which cannot be encompassed by any conceptual generalization.It is otherness of the other that actually constitutes the selfness of“I”.The freedom of the other guarantees the freedom of“I”.Human being is initially ethical being.Justice for the other is the real foundation in securing justice for“I”.This mutual horizon of the other and I has primitive implication for the genuine ethics.

Exploring the Long-Term Mechanism of the Construction of College Teachers’Ethics in the New Era Under the Concept of“Sanquan Education”

This paper takes the long-term mechanism exploration of the construction of teachers’ethics in the new era under the concept of“Sanquan education,”aiming to explore how to establish a long-term mechanism of the construction to meet the needs of college education development under the background of the new era.A series of targeted measures and suggestions are put forward,including improving the system and mechanism,strengthening the education and training of teachers’ethics,and establishing the evaluation and assessment mechanism.The implementation of these measures can promote the formation of the long-term mechanism of the construction of teachers’ethics in colleges and universities,improve teachers’ethics and behavior quality,and provide strong support for the development of education in colleges and universities.

The Price of Engineering Ethics, a Personal Story

There are costs for doing the right thing,but regret is not one of those costs.I learned this lesson the hard way throughout a 42-year engineering career.As a young engineer,raising a family,I was more adaptable to management mandates,i.e.,I was more willing to be unethical to keep my job to make money and have health insurance for my family.As I grew in age,experience,and stamina,I was less adaptable,i.e.,I was more ethical.This article tells this story through events at various times in my engineering career1.Ethics define how we do the right thing.

Caloric restriction-mimetics for the reduction of heart failure risk in aging heart: with consideration of gender-related differences

The literature is full of claims regarding the consumption of polyphenol or polyamine-rich foods that offer some protection from developing cardiovascular disease(CVD). This is achieved by preventing cardiac hypertrophy and protecting blood vessels through improving the function of endothelium. However, do these interventions work in the aged human hearts? Cardiac aging is accompanied by an increase in left ventricular hypertrophy, along with diastolic and systolic dysfunction. It also confers significant cardiovascular risks for both sexes. The incidence and prevalence of CVD increase sharply at an earlier age in men than women. Furthermore, the patterns of heart failure differ between sexes, as do the lifetime risk factors. Do caloric restriction(CR)-mimetics, rich in polyphenol or polyamine, delay or reverse cardiac aging equally in both men and women? This review will discuss three areas:(1) mechanisms underlying age-related cardiac remodeling;(2) gender-related differences and potential mechanisms underlying diminished cardiac response in older men and women;(3) we select a few polyphenol or polyamine rich compounds as the CRmimetics, such as resveratrol, quercetin, curcumin, epigallocatechin gallate and spermidine, due to their capability to extend health-span and induce autophagy. We outline their abilities and issues on retarding aging in animal hearts and preventing CVD in humans. We discuss the confounding factors that should be considered for developing therapeutic strategies against cardiac aging in humans.

The effect of caloric restriction on genetical pathways

Energy restriction is defined as reducing nutrient intake without dragging the organism into malnutrition. Energy restriction is preferred because it is a non-genetic intervention that increases life expectancy. Nicotinamide adenine dinucleotide(NAD~+)and adenosine monophosphate(AMP)levels, which are the indicators of intracellular energy deficiency, increase with energy restriction. The increase in NAD~+ level stimulates sirtuin(SIRT)enzymes, and the increase in AMP level stimulates AMP-activated protein kinase(AMPK). Various mechanisms are regulated by stimulating these enzymes. By Forkhead box O(FoxO)transcription factors, the ability of resistance to oxidative stress increases, and antioxidant genes, DNA repair, and autophagy genes are stimulated. Apoptosis is induced by stimulation of the p53 protein, and tumor growth is suppressed by the disruption of aging cells. The suppression of phosphoinositide 3-kinase(PI3K)-/-Akt, and therefore mTOR signal stimulates autophagy and mitophagia, and cleanses damaged cells and organelles. Mitochondrial biogenesis is stimulated, antioxidant capacity increases, and inflammatory response decreases. Adipose tissue and lipid metabolism are regulated by the regulation of fatty acid synthesis and oxidation. As a consequence, the effects of caloric restriction on cellular metabolism are regulated through the genetic pathways.

Dietary Vitamin K Restriction and Effectiveness of Vitamin K Antagonists Prescribed at the CNHU-HKM University Cardiology Clinic/BENIN

Introduction: Their efficacy in preventing thrombotic and embolic events has been proven in numerous studies, but their narrow therapeutic index requires particular vigilance, especially in terms of biology. In addition, treatment-related hemorrhagic complications are not uncommon. This study explores the influence of dietary vitamin K restriction on the efficacy of antivitamin K treatment at the University Cardiology Clinic of CNHU-HKM. Methods: Cross-sectional and descriptive study that took place from 25 April to 29 August 2019. Patients’ dietary behaviors and successive INR values were collected. Information on dietary intake was obtained by 2 non-consecutive 24-hour recalls. The effectiveness of VKA treatment was assessed by the “Time in Therapeutic Range” (TTR) of the INR. VKA treatment was considered effective for a TTR greater than 65%. Results: At the end of this study, 40 patients were surveyed. The mean age of the participants was 58.05 years ± 13.32 years, with a sex ratio of 1.35. Complete arrhythmia due to atrial fibrillation was the main indication for VKA treatment (37.50%) and fluindione was the most commonly prescribed drug (77.50%). The duration of treatment was less than or equal to 2 years in 47.5% of the subjects surveyed. Before starting treatment, 85% of patients received advice on restricting vitamin K-rich foods, and 45% of patients reported “food burnout” after a period of compliance with the restriction. The majority of respondents (97.50%) complied with the restriction on vitamin K-rich foods. All respondents had high energy intakes and a poor distribution of macronutrients, with a predominance of carbohydrates and proteins. 2.5% of respondents were on effective anti-vitamin K therapy with a TTR of over 65%. Conclusion: Restriction of vitamin K-rich foods is not conducive to effective treatment with vitamin K antagonists.

Medical Ethics in the Context of the Teachings of V.I.Vernadsky About the Earth’s Biosphere and Living Matter

The subject of medical ethics is usually considered within the binary doctor-patient relationship.In the context of V.I.Vernadsky’s teaching about the Earth’s biosphere and living matter,this relationship turns into a tripartite relationship.The third party is the natural environment around us,primarily the Earth’s biosphere.Thus,the problem of developing and improving medical ethics is connected with entropy-ecological issues.Against the background of this issue,the article draws attention to three issues:the issue of maintaining the chiral purity of living matter,the issue of coexistence and the fight against the world of viruses,and the issue of the danger of degradation of human intelligence under the influence of digitalization and robotization.All three questions relate to the physical and mental health of a person and correspond to what is included in the content of the concept of medical ethics.

The Ethics of Environmental Preservation at the Confluence of the Traditional Approach and Current Challenges

The accumulation of environmental problems,but also the ever-increasing impetuosity with which they manifest,led,starting in 1970,to the need for the emergence and development of a new branch of traditional ethics.Environmental ethics is concerned with finding answers to ethical questions circumscribed to the sphere of human relations with the non-human part of nature.The new field has proven to be an active involvement factor in promoting human values that emphasize the human-environment relationship.Many environmental ethicists believe that the non-human universe has value per se.The article undertakes a theoretical approach that tries to capture the relevant aspects of the efforts by which environmental ethicists combine their activity with other entities,responsible structures,in the collective intervention approach to improve environmental problems.

Reading Toni Morrison’s Home From the Perspective of Medical Relationship Ethics

As the first black women Nobel laureate,Toni Morrison has drawn great attention with her fascinating and deep-thinking novels.Her 10th novel Home vividly shows the racial suffering and the post-war trauma of black veteran Frank,who has drawn critical attention from various perspectives.However,there is hardly any scholarly focus on another major character Cee,whose experience of medical and racial discrimination actually constitutes another important clue throughout the whole story.Therefore,this paper intends to analyze Home from the perspective of ethical relationship ethics,including doctor-patient relationship,doctor-society relationship,patient-society relationship,and patient-family relationship.The analysis indicates that Home not only reveals the history of medical racial discrimination and human experiment ethics problems under the rapid development of medical technology in the 1950s,but also inspire readers’thinking on the ethical problems and ethical dilemmas in the contemporary world.

The Economic Context of Our Time:A Diagnosis in the Light of Transformative Ethics

The following contribution is the attempt to touch upon some fundamental questions for a reliable ethical diagnosis of what can be called the economic context of our epoch.For this purpose,we will consider a well-known concept within the medieval economics in light of its modern reappropriation against the backdrop of transformative ethics:the meant concept is usury;the meant reappropriation is that of Ezra Pound.For reasons of space,the single steps will merely hint at ethical questions that require a much more careful investigation.Within these limits,the essay will therefore analyze certain traits of our current economic context while reconsidering its ethical dimension in the light of the concept of usury.The framework within which this analysis will be conducted is that of transformative ethics.

Study on the Integration of Professional Ethics in Medical Interpretation Course Based on Situational Simulation Teaching Method and Virtual Reality Technology

Based on the theory of situational simulation,the article explores the approach to building the medical interpretation course from three aspects,which are the objective,design,and teaching model.The course aims to cultivate high-quality medical interpreting talents and enhance students’practical interpretation skills,as well as to integrate professional ethics into teaching.Thus,it is necessary for lecturers to change their teaching philosophy,apply information technology,and improve teaching design.Through rich medical interpretation course,lecturers can promote the integration of professional ethics in medical interpretation.

Tackling the Existential Threats from Quantum Computers and AI

Although AI and quantum computing (QC) are fast emerging as key enablers of the future Internet, experts believe they pose an existential threat to humanity. Responding to the frenzied release of ChatGPT/GPT-4, thousands of alarmed tech leaders recently signed an open letter to pause AI research to prepare for the catastrophic threats to humanity from uncontrolled AGI (Artificial General Intelligence). Perceived as an “epistemological nightmare”, AGI is believed to be on the anvil with GPT-5. Two computing rules appear responsible for these risks. 1) Mandatory third-party permissions that allow computers to run applications at the expense of introducing vulnerabilities. 2) The Halting Problem of Turing-complete AI programming languages potentially renders AGI unstoppable. The double whammy of these inherent weaknesses remains invincible under the legacy systems. A recent cybersecurity breakthrough shows that banning all permissions reduces the computer attack surface to zero, delivering a new zero vulnerability computing (ZVC) paradigm. Deploying ZVC and blockchain, this paper formulates and supports a hypothesis: “Safe, secure, ethical, controllable AGI/QC is possible by conquering the two unassailable rules of computability.” Pursued by a European consortium, testing/proving the proposed hypothesis will have a groundbreaking impact on the future digital infrastructure when AGI/QC starts powering the 75 billion internet devices by 2025.

Helping People and Changing the World with CS

What should academic institutions be doing in order to benefit students,the community at large,and society in the new era?Particularly,as computing is impacting all aspects of human society,it also brings many challenges and opportunities for the academic departments of computer science.Some of these challenges include the increasing impact of software on society,issues involving privacy and data abuse,and ethical issues concerning AI.Towards addressing these challenges,the Korea Advanced Institute of Science and Technology(KAIST)leverages its position as an educator in order to train the future computing workforce to be more aware of these issues.To achieve this goal,KAIST mainly adopts three strategies:Combining science&technology and humanities together;putting academy and industry together;training software experts while making them understand people and the world.

Integrating GPT into the Journalism and Communication Industries:The Technological Logic,Ecosystem Reconstruction,and Ethical Chal enges

Generative AI,represented by GPT(Generative Pre-trained Transformer),is now leading the technological revolution and is reconstructing the journalism and communication industries'ecosystems because of its powerful generative capacity and diverse range of outputs.While GPT is busy revolutionizing and innovating the production of news content,working patterns,and operation modes,it has also given rise to ethical concerns in regard to news authenticity,data security,humanistic values,and other related aspects.Therefore,it is imperative to initiate strategies and approaches,such as establishing a mechanism for verifying information authenticity,enhancing data security and privacy regulations,and instituting an ethical supervision and governance framework for AI,in order to facilitate the systematic advancement of AI-based news production while reinstating public trust.

Facing ethical concerns in the age of precise gene therapy:Outlook on inherited arrhythmias

This editorial,comments on the article by Spartalis et al published in the recent issue of the World Journal of Cardiology.We here provide an outlook on potential ethical concerns related to the future application of gene therapy in the field of inherited arrhythmias.As monogenic diseases with no or few therapeutic options available through standard care,inherited arrhythmias are ideal candidates to gene therapy in their treatment.Patients with inherited arrhythmias typically have a poor quality of life,especially young people engaged in agonistic sports.While genome editing for treatment of inherited arrhythmias still has theoretical application,advances in CRISPR/Cas9 technology now allows the generation of knock-in animal models of the disease.However,clinical translation is somehow expected soon and this make consistent discussing about ethical concerns related to gene editing in inherited arrhythmias.Genomic off-target activity is a known technical issue,but its relationship with ethnical and individual genetical diversity raises concerns about an equitable accessibility.Meanwhile,the costeffectiveness may further limit an equal distribution of gene therapies.The economic burden of gene therapies on healthcare systems is is increasingly recognized as a pressing concern.A growing body of studies are reporting uncertainty in payback periods with intuitive short-term effects for insurance-based healthcare systems,but potential concerns for universal healthcare systems in the long term as well.Altogether,those aspects strongly indicate a need of regulatory entities to manage those issues.