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It is also not uncommon for a sive knowledge of the role of these muscles in tension- person to suffer both migraine headaches and severe type headache awaits further research’ order lozol from india arteria musculophrenica. Posture cheap lozol 1.5mg on-line heart attack youtube, chiropractic and migraine The average response of the treatment group (n = 83) showed statistically significant improvement in Analyzing and correcting posture-related muscle migraine frequency (p <0 buy lozol 1.5mg fast delivery hypertension lab tests. Teachers of Alexander technique have perfected a gradual rehabilitation program Massage and migraine and which should ideally be accompanied by treatment (and self-treatment) aimed at stretching and releasing tension-type headache tight muscles and joints, and at toning and balancing Forty-seven migraine sufferers were randomly the body as a whole (Wilson 2002). Massage participants as migraine or not, may be helped by appropriate attended weekly massage sessions during weeks 5–10. Such treat- State anxiety, heart rates and salivary cortisol were ment might involve mobilization or manipulation of assessed before and after the sessions. Perceived stress restricted joints, release of excessive tension in muscles and coping efficacy were assessed at weeks 4, 10 and of the region, or deactivation of trigger points that are 13. Massage and non-migrainous headache Hypertension Quinn et al (2002) investigated the effect of massage Hypertension is one of the most pervasive disease therapy on chronic non-migraine headache. It can lead to target Chronic tension headache sufferers received struc- organ damage, and although there is no one cause of tured massage therapy treatment directed toward primary hypertension, the theory of an unchecked neck and shoulder muscles. Headache frequency, long-term stress response continues to be a valid argu- duration and intensity were recorded and compared ment. It seems to run in The reduction of headache frequency continued for families and is more common in people of African– the remainder of the study (p = 0. Risk factors for the condition of headaches tended to decrease during the massage include stress, a high alcohol intake, a diet high in salt treatment period (p = 0. Chiropractic and hypertension Exercise and headache There have been both negative and positive studies: Evidence suggests that deficits in muscle performance of the deep neck flexor muscles may be linked to cer- • A randomized clinical trial (Goertz et al 2002) vicogenic headache, and that specific exercise pre- compared the effects of chiropractic spinal scription utilizing a pressure biofeedback device may manipulation and diet with diet alone for play an important treatment role, in conjunction with lowering blood pressure in participants with manipulation treatment (Eldridge & Russell 2005). Results showed that for patients health problem in many countries, even in sedentary with high-normal blood pressure or stage I occupations, and that therapeutic exercise can decrease hypertension, chiropractic spinal manipulation the intensity of pain in the neck area (Ylinen et al in conjunction with a dietary modification 2003), Sjögren et al (2005) designed a study to examine program offered no advantage in lowering the effects of a workplace physical exercise program, either diastolic or systolic blood pressure, consisting of light resistance training and guidance, compared to diet alone. The train- hypertensive patients, but no large-scale ing consisted of six dynamic symmetrical movements: controlled studies have been carried out. The training move- from where the nerve supply to the kidneys ments were carried out 20 times with a 30-second emerges, may be of benefit in reducing pause between the training movements. Physical hypertension (Johnston & Kelso 1995, Johnston exercise intervention resulted in a slight, but statisti- et al 1995). Adults who had been diagnosed as aerobic exercise program drop out within 3–6 hypertensive received ten 30-minute massage months and fewer than 20% continue sessions over 5 weeks, or were given exercising after 24 months (Dishman 1994). Sitting diastolic blood pressure There is a major variation in different ethnic decreased after the first and last massage groups, relative to high blood pressure. In the therapy sessions, and reclining diastolic blood first place, black (non-Hispanic) people appear pressure decreased from the first to the last day to have a greater tendency to hypertension of the study. Although both groups reported than whites or Hispanics, although in all less anxiety, only the massage therapy group groups those with ‘higher rates of physical reported less depression and hostility and inactivity’ have higher blood pressure (Bassett showed decreased urinary and salivary stress 2002). The results suggest significantly lower blood pressure after aerobic that massage therapy may be effective in exercise in white women differs markedly from reducing diastolic blood pressure and the response in black women, where it rises, or symptoms associated with hypertension stays the same. In this experimental, known as ‘white coat hypertension’ – pretest/post-test study, a 10-minute back their blood pressure rises when it is tested massage was given to the experimental group by a physician or nurse. The that this tendency improves markedly when control group (n = 6) relaxed in the same regular exercise is taken: ‘12 weeks of exercise environment for 10 minutes, three times a training can result in successful reduction of week for 10 sessions. This • Vigorous exercise and short-term reduction in has now been partially answered by Japanese hypertension: Research has shown that after research. The researchers conclude that their women with mild levels of hypertension results demonstrate that aerobic exercise is exercised vigorously (i. The researchers • Multiple benefits of modified diet, exercise and conclude that: ‘The magnitude and duration of education: A randomized trial (Aldana et al post-exercise hypotension may be sufficient to 2005) has clearly demonstrated improvements normalise the blood pressure of certain in resting heart rate, total cholesterol, low- hypertensive women throughout most of the density lipoprotein cholesterol, and systolic day’ (Pescatello et al 1999). Yoga and hypertension • Hypertensives benefit more from exercise: It is also • Yoga breathing and hypertension: When different known that blood pressure falls more in methods of stress reduction were compared, it hypertensive than in normotensive people. In was found that the fastest and most effective fact, regular exercise lowers blood pressure in way of lowering blood pressure after a stressful 75% of hypertensive people, with average episode was to use simple yoga-type breathing systolic and diastolic reductions of 11 and methods (Sung et al 2000). Exercise can reduce 10- breathing has been shown to be effectual in year cardiovascular risk by at least 25% in the lowering blood pressure in people with mild average hypertensive patient, because of the hypertension, where it can be as effective as effect on blood pressure and other the use of medication (Sydorchuk & Tryniak cardiovascular risk factors (Hagberg et al 2000). Additionally, low-to- measures for hypertension moderate intensities of exercise are as effective • There is limited evidence suggesting manipulation at lowering blood pressure, if not more to be valuable in reducing hypertension. Osteopathic treatment mechanics in a critically ill patient with acute respira- involved 10–20 minutes daily of a standardized pro- tory failure. High-velocity mobilization of cervical tocol, with attending physicians blinded as to group and thoracic dysfunctions has been shown to result in assignment. It may be used on patients with fractures, surgery is accomplished via a median sternotomy as well as on post-surgical patients who have pain at incision, an approach that has been gaining wide- the site of incision. Results are claimed to be lasting and repetitive treat- ment is needed (in hospital settings) only if there is • The soft tissues below the skin are treated with ongoing neurosensory reflex activity or if the condi- diathermy to stem bleeding and the sternum is tion which produced the dysfunction in the first place divided by an electric bone saw, the exposed is repeated or ongoing. Patients were recruited • There are often drainage tubes exiting from and randomly placed into two groups: 28 in the treat- below the xiphoid following surgery. There was no statistical difference sequelae to this trauma are many and varied, and may between groups for age, gender or simplified acute include ‘dehiscence, substernal and pericardial infec- physiology scores. The treatment group had a signifi- tion, non-union of the sternum, pericardial constric- cantly shorter duration of intravenous antibiotic treat- tion, phrenic nerve injuries, rib fractures and brachial ment and a shorter hospital stay. The treatment diately postoperatively, many problems do not emerge group received osteopathic manipulative treatment until later, and these might include structural and on postoperative days 2–5. The main outcome showed functional changes in chest mechanics that do not that, compared to control subjects, the intervention become evident for weeks or months, particularly group negotiated stairs 20% earlier (mean = 4. The intervention group the importance of structural evaluation and treatment, also required less analgesia, had shorter hospital stays both before and after surgery, involving manual thera- and ambulated farther on postoperative days 1, 2 and peutic methods of various types. The conclusion is that patients receiving osteopathic cifically the positional release approaches (Chaitow manipulative treatment in the early postoperative 2007) that are advocated for treating this type of post- period negotiated stairs earlier and ambulated greater surgical trauma (see Chapter 7 for detail of positional distances than did control group patients. In addition, there was extension of muscu- by median sternotomy, and to improve respiratory lar tension from the injured left knee and ankle into function. A prospective, match-controlled postoperative This example highlights the adaptive changes in outcome study spine and thorax that evolved following lower limb As noted above, osteopathic manipulative treatment injury, and how the opportunity to normalize these has been reported to relieve a variety of conditions, changes arose when the knee damage was repaired. Chiropractic treatment seems to • Immune function markers and physical methods: achieve its effect via mediation of the nervous Research evidence suggests that both system. German research showed that the massage therapy (45 minutes of massage five regular (daily) use of a cold shower had a progres- times weekly for 1 month). For with feelings of anxiety, but natural killer cells, 6 months one group took a graduated cold shower and their activity were significantly increased (i. After 6 months those taking the cold shower were Susceptible and healthy children of the same found to be having half the number of colds compared age were used as controls. The cold shower effect of the treatment group was shown to be group’s colds lasted for approximately half as long as significantly better (p <0. Cold were re-examined 3 and 6 months after the showers were avoided during, and for 1 week after, massage intervention. This intervention Otitis media and was performed concurrently with traditional medical chiropractic manipulation management.
Syndromes
As shown in a three-day meeting held in December 1996 at the Council of Europe on the protection of the human embryo lozol 2.5mg fast delivery heart attack 30 year old woman, this essential question is still central buy cheap lozol 2.5 mg on line arterial duplex. The meeting was held a month after the Committee of Ministers of the Council of Europe had approved the text of the Convention for the Protection of Human Rights and Dignity of the Human Being With Regard to the Application of Biology and Medicine (Convention of Human Rights and Biomedicine; (Council of Europe order lozol with a mastercard prehypertension treatments and drugs, 1996)). Controversy over embryo research has been heightened since then by the growing commercial importance of stem cells derived from embryonic and fetal tissue (see Chapter 15). Using the term ‘pre-embryo’ to refer to ‘the stage of the conceptus for the interval from the completion of the process of fertilisa- tion until the establishment of biologic individuation’ (Jones and Schrader, 1992) aroused suspicion that the embryo’s supposed human essence was deliberately ignored or lessened by adding the preWx (Seve, 1994). Even if this utilitarian argument were accepted as uncontroversial – which it is patently not – two further problems arise: the source of embryos, and their fate. If non-viable embryos are to be preferred on the grounds that no harm is done, less good may result – the results may not be easily applicable to viable embryos. In English law any couple cryopreserving surplus embryos must give consent and choose their fate (donation, research or destruction) when the legal time limit for cryopreservation has elapsed. In most cases embryos used for research will in fact be destroyed, as the safety of the potential child who might ensue cannot be assured, and it can actually be argued that it would be unethical to replace such embryos in utero. The availability of cryopreservation makes the creation of embryos purely for research purposes even more controversial, but perhaps more necessary – surplus or supernumerary embryos may be frozen for possible later use, and might only be given for research once the couple have become parents. Shenfield behalf of children below the standards of ‘Gillick competence’ (Gillick v West Norfolk and Wisbech Area Health Authority, 1985), but rather because its destruction is necessarily planned, distancing the embryo from full human status. Where parental consent is recognized, the parent is expected to decide in the best interests of the incompetent child; deciding to destroy the embryo is ipso facto not in its best interests. This leads us to consider the indications for pre-implantation diagnosis, and the notion of ‘severe handicap’, already used in the terminology of legal termina- tion of pregnancy. The most complex ethical question is in fact not so much the current practice of pre-implantation diagnosis, but rather what might be the consequences of its evolving techniques. The questions for consultation centre around, but do not actually mention, the distinction between positive and negative eugenics, perhaps because the terms are so historically tainted (Missa, 1999). No legislation that allows termination of pregnancy on the grounds of a ‘serious’ disorder has actually drawn up a list of the conditions that would qualify. It is thus understandable that the more classical approach (prenatal diagnosis, possibly followed by therapeutic termination of pregnancy) may sometimes be prefer- red by patients. Studies have shown diVerent preferences according to the past experience of the couples concerned and the gender of the potential parent (Chamayou et al. In practice, it is for the time being a matter of rather restricted choice, as the number of units available worldwide for this technique is extremely limited, making it available only to a few prospective parents. The need for long-term surveillance of this particularly ‘precious’ oVspring in turn entails recording the births and follow-up of the children with their speciWc dilemmas already described in detail (Milliez and Sureau, 1997). Another concern in pre-implantation diagnosis is the dilemma between the fundamental principle of conWdentiality for the couple and the right to privacy of the potential child, together with the psychological consequences of intrusion for the children. The problem of conWdentiality with regards to the child sometimes seems insoluble, as it entails a parental, if not sometimes a state, decision, as is the case with non-anonymity of gamete donors in Sweden. In this context it is useful to stress the responsibility that the adults involved, carers as well as putative parents, have towards the vulnerable future third party – the child to be. Fifteen years after implementation of the law in Sweden, 89 per cent of the parents of sperm donor children still have not informed them of their origins (Gottlieb et al. Cryopreservation of reproductive tissues Fragility and vulnerability are also uppermost in issues concerning the cryopreservation of reproductive tissues of adolescents who are suVering from cancer, the treatment of which threatens their future reproductive capacity. However, we are only now starting to address a problem which can only grow larger in view of the increased ability to store successfully testicular or ovarian tissue for future reproduction. In this case the intent, that is the conservation of the reproductive ability of children and adolescents, seems prima facie beneWcent, but that may primar- ily be the parents’ intent, possibly biased by a desire to one day have a grandchild who might remind them of a beloved deceased child. Ovarian biopsy may indeed be a fairly risky procedure in a relatively sick adolescent girl, much more so than sperm donation or testicular biopsy from a boy. Again we face a situation where the intent and the consent of the child or adolescent concerned may not be identical, where one could not be presumed to take place of the other. Could a biopsy be taken, for instance, when the child is unable to consent because he or she is not deemed Gillick competent, or when he or she is so seriously ill that therapeutic privilege is invoked? Cloning and the human embryo Cloning and reproduction, especially cloning the human embryo, made the headlines after the report at one of the American Fertility Society meetings, in 1994, of an experiment describing embryo-splitting. The principle of the creation of identical human beings is thus not a new subject, but the method described by Wilmut and colleagues certainly is (Wilmut et al. Jonas has also stated that the two most awesome kinds of responsibility we may ever face are those of politicians towards society and of parents to their children. This arguably may be extended to future or planned children, the matter Ethical issues in embryo interventions and cloning 155 which concerns us in assisted reproduction. It is indeed because we are responsible, or moral subjects, that we wish to analyse rationally the argu- ments for and against cloning for reproductive purposes. Interestingly, the introduction of the report by the group of advisers to the European Union (European Commission, 1997) states, ‘As there is no dis- crimination against twins per se, it follows that there is no per se objection to genetically identical human beings’. This makes it clear that one must Wnd other arguments than the noumenon (‘thing in itself’) of cloning (its ‘real existence’) in order to counter arguments in favour of human reproductive cloning. The argument of dignity is underlined, using the Kantian categorical precept – ‘to treat each and everyone as an end to themselves and not merely as a means to an end’. Of course we know that a clone obtained by somatic cell nuclear transfer would not be totally identical to the adult donor of the nucleus, because of the recipient cytoplasm bearing the maternal mitochondria; but more im- portantly, the same argument can be used against reproductive cloning by embryo-splitting and transfer to diVerent surrogate mothers at diVerent times. To quote the report: It would be absurd to consider that an adult and his clonal duplicate who must necessarily be born much later, and is bound to have a diVerent life history, could be to any degree presented as two copies of a single and identical person. To believe such a thing would be to fall victim to the reductive illusion which is born of the dismal confusion between identity in the physical sense of sameness (idem) and in the moral sense of selfness (ipse). The report continues: [N]evertheless, although to possess the same genome in no way leads two individuals to own the same psyche, reproductive cloning would still inaugurate a fundamental upheaval of the relationship between genetic identity and personal identity in its 156 F. The uniqueness of each human being, which upholds human autonomy and dignity, is immediately expressed by the unique appearance of body and countenance which is the result of the singularity of each genome. The autonomous human being (who may be deWned as one who is ‘submitted to his or her own laws’) may allegedly be threatened in this very quality by facing his or her relatively identical clones. Can we not argue instead that the best way to counteract discrimination is to accept diVerence as a valuable addition to the rich tapestry of life rather than fear its conse- quences? Indeed if dignity has to be deWned in any essential manner, as it must be if enshrined in international declarations, it is the unique quality of all human beings, also recognized in their diVerences, even if there is a degree of sameness, which gives us dignity. This is obviously absurd, and we have therefore to conclude that even if normal sexual reproduction were a necessary condition for human liberty, it is far from being a suYcient one. It seems reasonable to suppose that the constraints im- posed by the father’s sexual identity would somehow aVect the cloned child; would this be a reduction of the child’s liberty? Ethical issues in embryo interventions and cloning 157 Perhaps feminist psychoanalytical arguments can help us understand the problem of identity – for example, the work of Julia Kristeva (1991) and Luce Irigaray (see Whitford, 1991). Kristeva argues that we cannot respect and accept strangers if we have not accepted our own portion of strangeness, in other words, the stranger within ourselves (Kristeva, 1991). The implication for cloning is that the parent(s) seeking reproductive cloning cannot accept that strangeness carried in the matrix of the gestating mother. In the same analytical vein, one could argue that the fantasy of immortality, or the desire for genetic perpetuation at any cost by those who cannot procreate, seems a more narcissistic venture than the often unconscious choice of a reproductive partner.
Syndromes
A narrow index (as with lithium) suggests that careful prescribing and regular monitoring of levels in appropriate body fluids is required cheap lozol 1.5mg visa blood pressure medication helps ed. Antidepressants are actually system stabilisers and require time to carry out their wanted actions purchase lozol 1.5mg with amex pulse pressure with exercise. Levels of arachidonic acid in the frontal lobes cheap 2.5 mg lozol amex blood pressure normal values, platelet conversion of arachidonic acid to prostaglandins, red cell 766 Perhaps high levels of homocysteine cause cerebrovascular disease and neurotransmitter deficiency, leading to depressed mood. Brain phosphodiester concentration is increased in first episode cases, which may relate to increased breakdown of phospholipase A2. Phosphomonoesters are less plentiful, possibly due to decreased synthesis of phospholipids. Calcium-independent phospholipase A2 activity is increased in schizophrenia, whereas calcium-dependent activity is normal. It is possible that increased phospholipase A2 activity could cause this process to fail. Furthermore, an abnormal gene in schizophrenia for phospholipase A2 has been postulated. Lipid peroxidase and vitamin E concentrations are increased in schizophrenia, more so if patients smoke. In cancer, endogenous reactive oxygen species released during normal respiration damage nucleic acids and lipids. However, supplementation with this last 773 omega-3 fatty acid (Miyamoto ea, 2002, p. Polymeropoulos ea (2009) studied the expression profile of over 12 thousand human genes in a cell treated with various antipsychotic drugs and compared the results to a library of other compounds employed in the treatment of other conditions. There was a common effect of antipsychotics on biosynthesis and regulation of fatty acids and cholesterol leading the authors to wonder if changes in lipid homeostasis might underlie the pathogenesis of schizophrenia: antipsychotics not only activated genes involved in lipid homeostasis but they did so preferentially from all other genes. Polymeropoulos ea (2009) suggested that antipsychotics alter the ratio of polyunsaturated to saturated fatty acids and cholesterol content, which modulates fluidity of neuronal membranes and the membranes of surrounding cells. There is some preliminary evidence that eicosapentaenoic acid may augment antidepressant efficacy in major depression,(Nemets ea, 2002) although dosage may be crucial. According to Stoll ea,(1999) omega-3 fatty acids may have greater antidepressant than antimanic effects in bipolar disorder, and Noaghiul and Hibbeln (2003) suggest that greater seafood consumption reduces the prevalence of bipolar disorder. Frangou ea (2006) reported the effective use of adjunctive ethyl- eicosapentaenoic acid in bipolar depression. Seafood and fish are rich dietary sources of eicosapentaenoic acid and docosahexaenoic acid. Miyake ea (2006) failed to find a clear effect of dietary fish in preventing postpartum depression. Anonymous (2007b) concluded that 775 omega-3 fatty acids should not be used on their own for treating depression , but they might be helpful when added to existing antidepressant medication. Breast milk, but not formula feeds, contains eicosapentaenoic and docosahexaenoic acids, leading Walker ea (1999) to suggest improving nutrition in pregnancy and breast-feeding of the child. The message to do so may be sited at the telomeric end of the chromosome, the latter region shortening each time a cell divides until a crucial length is reached. Hastened by oxidative stress, protein and sugar react to produce glycosylation (protein glycation) with functional and structural damage to the protein. Olive oil The Mediterranean diet involves abundant use of olive oil, a rich source of monounsaturated fatty acids. There is some preliminary evidence that such a diet may help to prevent depression. The apoptotic cell is small, round, and may be surrounded a halo that separate it from other cells; the cytoplasm is eosionophilic and the nucleus contains condensed chromatin. Caspases , cysteine-dependent, aspartate-specific proteases, are involved in apoptosis. These enzymes, which exist as procaspases (latent precursors) before activation, cleave other proteins, e. Neuronal apoptosis is induced by β-amyloid and mutated presenilins in Alzheimer’s disease. Mutant 782 huntingtin protein can cause neuronal apoptosis in Huntington’s disease. The role of apoptosis in 783 conditions such as schizophrenia requires further research. Chronic lithium treatment increases Bcl-2 levels in rat brain and may be neuroprotective. Voluntary muscle fibres have more mitochondrial electron transport problems as the organism ages. Apoptosis (shrinkage of cells), necrosis (swelling of cells), and possibly autophagy (starving cells eat their constituents) are the known modes of cellular demise. Excitotoxicity is involved since injected excitatory amino acids mimic the pathology of Huntington’s disease. Clinical severity varies, the mildest degree consisting of 784 microdysgenesis (neuronal heterotopias , undulating cortical layers, or collections of nerve cells). Hemimegalencephaly is an abnormally big and dysplastic cerebral hemisphere, the opposite hemisphere being compressed. The affected hemisphere shows an enlarged and abnormally shaped lateral ventricle, hypertrophic white matter, and cortical dysgenesis. Classical cases have developmental delay, hemiparesis, and intractable partial seizures from birth or infancy. Other manifestations include neurofibromata, hypomelanosis of Ito, epiloia, and linear nevus syndrome. Hirano bodies are small, eosinophilic rod- or carrot-shaped bodies that may be found in or close to pyramidal nerve cells of the hippocampus. They contain the microfilament protein actin and are numerous in Alzheimer’s disease. Severe cases do not survive but mild cases may be represented by hypertelorism or a single incisor tooth occupying the midline. A number of genetic mutations 786 have been described as underlying sporadic cases. Lewy body Lewy bodies are laminated intracytoplasmic inclusion bodies in melanin containing neurones of the substantia nigra derived from the neuronal cytoskeleton. They are often seen in the remaining cells of the substantia nigra in Parkinson’s disease. They can also be found in the pigmented cells of the locus coeruleus, dorsal vagal nucleus and reticular formation. On haematoxylin and eosin staining, substantia nigra Lewy bodies are pink, often with concentric rings and a surrounding colourless halo. Antibodies to ubiquitin and α-synuclein can be used in postmortem tissue as a method of detecting Lewy bodies. The first genetic cause of Parkinson’s disease was reported in 1997: a mis-sense mutation altering the fifthy-third amino acid of the α-synuclein protein (A53T). Genetic triplication is associated with onset of Parkinson’s disease and dementia with 792 Lewy bodies in the mid-thirties.
