Clinical medicine

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  • Harrison's Internal Medicine Chapter 67. Applications of Stem Cell Biology in Clinical Medicine Applications of Stem Cell Biology in Clinical Medicine: Introduction Organ damage and the resultant inflammatory responses initiate a series of repair processes, including stem cell proliferation, migration, and differentiation, often in combination with angiogenesis and remodeling of the extracellular matrix. Endogenous stem cells in tissues such as liver and skin have a remarkable ability to regenerate the organs, whereas heart and brain have a much more limited capability for self-repair.

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  • Harrison's Internal Medicine Chapter 3. Decision-Making in Clinical Medicine Decision-Making in Clinical Medicine: Introduction To the medical student who requires 2 h to collect a patient's history and perform a physical examination, and several additional hours to organize them into a coherent presentation, the experienced clinician's ability to reach a diagnosis and decide on a management plan in a fraction of the time seems extraordinary.

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  • Harrison's Internal Medicine Chapter 64. The Practice of Genetics in Clinical Medicine Implications of Molecular Genetics for Internal Medicine The field of medical genetics has traditionally focused on chromosomal abnormalities (Chap. 63) and Mendelian disorders (Chap. 62). However, there is genetic susceptibility to many common adult-onset diseases, including atherosclerosis, cardiac disorders, asthma, hypertension, autoimmune diseases, diabetes mellitus, macular degeneration, Alzheimer's disease, psychiatric disorders, and many forms of cancer.

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  • Tham khảo sách 'steroids - from physiology to clinical medicine edited by sergej m. ostojic', y tế - sức khoẻ, y học thường thức phục vụ nhu cầu học tập, nghiên cứu và làm việc hiệu quả

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  • Harrison's Internal Medicine Chapter 65. Gene Therapy in Clinical Medicine Gene Therapy in Clinical Medicine: Introduction Gene transfer is a novel area of therapeutics in which the active agent is a nucleic acid sequence rather than a protein or small molecule. Because delivery of naked DNA or RNA to a cell is an inefficient process, most gene transfer is carried out using a vector, or gene delivery vehicle.

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  • (BQ) Ebook 100 Cases in Clinical Medicine is an indispensable revision tool for medical students preparing for clinical examinations or OSCEs. Using scenarios which mimic daily life, the cases will interest students in clinical problems and help them develop their clinical reasoning skills, with each case presenting details of a patient's medical history and the key findings of a clinical examination, together with initial investigation results for evaluation.

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  • Follow-Up Care after Testing Depending on the nature of the genetic disorder, posttest interventions may include (1) cautious surveillance and appropriate health care screening, (2) specific medical interventions, (3) chemoprevention, (4) risk avoidance, and (5) referral to support services. For example, patients with known pathologic mutations in BRCA1 or BRCA2 are offered intensive screening as well as the option of prophylactic mastectomy and oophorectomy.

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  • Strategies for Stem Cell Replacement Stem cell transplantation is not a new concept and it is already part of established medical practice. Hematopoietic stem cells (HSCs) (Chap. 68) are responsible for the long-term repopulation of all blood elements in bone marrow transplant recipients. HSC transplantation is now the gold standard against which other stem cell transplantation therapies will be measured. Transplantation of differentiated cells is also a clinical reality, as donated organs (e.g., liver, kidney) and tissues (i.e.

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  • Other Organ Systems and the Future The use of stem cells in regenerative medicine has been studied for many other organ systems and cell types, including skin, eye, cartilage, bone, kidney, lung, endometrium, vascular endothelium, smooth muscle, striated muscle, and others. In fact, the potential for stem cell regeneration of damaged organs and tissues is virtually limitless. However, numerous obstacles must be overcome before stem cell therapies can become a widespread clinical reality.

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  • Sources of Evidence: Clinical Trials and Registries The notion of learning from observation of patients is as old as medicine itself. Over the last 50 years, our understanding of how best to turn raw observation into useful evidence has evolved considerably. Case reports, personal anecdotal experience, and small single-center case series are now recognized as having severe limitations to validity and have no role in formulating modern standards of practice. The major tools used to develop reliable evidence consist of the randomized clinical trial and the large observational registry.

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  • Clinical Practice Guidelines According to the 1990 Institute of Medicine definition, clinical practice guidelines are "systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances." This definition provides emphasis to several crucial features of modern guideline development. First, guidelines are created using the tools of EBM. In particular, the core of the development process is a systematic literature search followed by a review of the relevant peer-reviewed literature.

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  • Major Influences on Clinical Decision-Making More than a decade of research on variations in clinician practice patterns has shed much light on forces that shape clinical decisions. The use of heuristic "shortcuts," as detailed above, provides a partial explanation, but several other key factors play an important role in shaping diagnostic hypotheses and management decisions.

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  • Many disorders exhibit the feature of locus heterogeneity, which refers to the fact that mutations in different genes can cause phenotypically similar disorders. For example, osteogenesis imperfecta (Chap. 357), long QT syndrome (Chap. 226), muscular dystrophy (Chap. 382), homocystinuria (Chap. 358), retinitis pigmentosa (Chap. 29), and hereditary predisposition to colon cancer (Chap. 87) or breast cancer (Chap. 86) can each be caused by mutations in distinct genes.

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  • Economic Incentives Economic incentives are closely related to the other two categories of practice-modifying factors. Financial issues can exert both stimulatory and inhibitory influences on clinical practice. In general, physicians are paid on a feefor-service, capitation, or salary basis. In fee-for-service, the more the physician does, the more the physician gets paid. The economic incentive in this case is to do more. When fees are reduced (discounted fee-for-service), doctors tend to increase the number of services billed for.

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  • Evidence-Based Medicine The "art of medicine" is traditionally defined as a practice combining medical knowledge (including scientific evidence), intuition, and judgment in the care of patients (Chap. 1). Evidence-based medicine (EBM) updates this construct by placing a much-greater emphasis on the processes by which the clinician gains knowledge of the most up-to-date and relevant clinical research. The key processes of EBM can be summarized in four steps: 1. Formulating the management question to be answered 2.

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  • The following three examples introduce the subject of clinical reasoning:  A 46-year-old man presents to his internist with a chief complaint of hemoptysis. The physician knows that the differential diagnosis of hemoptysis includes over 100 different conditions, including cancer and tuberculosis. The examination begins with some general background questions, and the patient is asked to describe his symptoms and their chronology.

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  • Statistical Prediction Models Bayes' theorem, as presented above, deals with a clinical prediction problem that is unrealistically simple relative to most problems a clinician faces. Prediction models, based on multivariable statistical models, can handle much more complex problems and substantially enhance predictive accuracy for specific situations. Their particular advantage is the ability to take into account many overlapping pieces of information and assign a relative weight to each based on its unique contribution to the prediction in question.

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  • Indications in gene therapy clinical trials. The chart divides clinical gene transfer studies by disease classification. A majority of trials have addressed cancer, with monogenic disorders and cardiovascular diseases the next largest categories. (Reproduced with permission from J Gene Med. New Jersey, Wiley, 2006.) Gene Transfer for Genetic Disease Gene transfer strategies for genetic disease generally involve gene addition therapy. This approach most commonly involves transfer of the missing gene to a physiologically relevant target cell. ...

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  • People who pursue careers in Internal Medicine are drawn to the specialty by a love of patients, mechanisms, discovery, education, and therapeutics. We love hearing the stories told to us by our patients, linking signs and symptoms to pathophysiology, solving the diagnostic dilemmas, and proposing strategies to prevent and treat illness. It is not surprising given these tendencies that internists prefer to continue their life-long learning through problem solving. This book is offered as a companion to the remarkable 17th edition of Harrison’s Principles of Internal Medicine.

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  • Steroids - From Physiology to Clinical Medicine covers contemporary basic science on steroids research, along with steroids practical application in clinical medicine. We start by describing physiological and pathophysiological roles of steroids, with reference to production and action of gonadal steroids, role of steroid sulfonation, sex specific and steroids-dependent mechanism of hippocampal function, and the hydroxysteroid dehydrogenases for the modulation of tissue glucocorticoid availability.

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