[Application of transbronchial cryobiopsy in the diagnosis of postoperative complications after lung transplantation: a report of 6 cases]

Objective: To investigate the efficacy and safety of transbronchial cryobiopsy (TBCB) after lung transplantation. Methods: The clinical characteristics, TBCB procedure, diagnosis and treatment, and outcomes of lung transplant recipients of 6 patients (all male, aged 33-67 years) with TBCB in China-Japan Friendship Hospital from May to November 2021 were retrospectively analyzed. Results: Among the 6 patients diagnosed by TBCB, there were 2 cases of organizing pneumonia, 1 acute cellular rejection, 1 antibody-mediated rejection, and 1 bronchiolitis obliterans, and 1 diffuse alveolar damage. After the clinical diagnosis was confirmed, the condition improved after adjustment of the treatments followed. There were no serious complications related to the TBCB procedure. Conclusion: TBCB is valuable and relatively safe in the diagnosis of complications after lung transplantation, but the indications need to be strictly controlled.

Circadian nuclear receptor Rev-erbalpha is expressed by platelets and potentiates platelet activation and thrombus formation

Background

Adverse cardiovascular events have day/night patterns with peaks in the morning, potentially related to endogenous circadian clock control of platelet activation. Circadian nuclear receptor Rev-erbα is an essential and negative component of the circadian clock.

Purpose

We aim to investigate the expression profile and biological function of Rev-erbα in platelets.

Methods and results

Here we report the presence and functions of circadian nuclear receptor Rev-erbα in human and mouse platelets. Both human and mouse platelet Rev-erbα showed a circadian rhythm that positively correlated with platelet aggregation. Global Rev-erbα knockout and platelet-specific Rev-erbα knockout mice exhibited defective in hemostasis as assessed by prolonged tail-bleeding times. Rev-erbα deletion also reduced ferric chloride-induced carotid arterial occlusive thrombosis, prevented collagen/epinephrine-induced pulmonary thromboembolism, and protected against microvascular microthrombi obstruction and infarct expansion in an acute myocardial infarction model. In vitro thrombus formation assessed by CD41-labeled platelet fluorescence intensity was significantly reduced in Rev-erbα knockout mouse blood. Platelets from Rev-erbα knockout mice exhibited impaired agonist-induced aggregation responses, integrin αIIbβ3 activation and α-granule release. Consistently, pharmacological inhibition of Rev-erbα by specific antagonists decreased platelet activation markers in both mouse and human platelets. Mechanistically, mass spectrometry and co-immunoprecipitation analyses revealed that Rev-erbα potentiated platelet activation via oligophrenin-1-mediated RhoA/ERM (ezrin/radixin/moesin) pathway.

Conclusion

We provide the first evidence that circadian protein Rev-erbα is functionally expressed in platelets and potentiates platelet activation and thrombus formation. Rev-erbα may serve as a novel therapeutic target for managing thrombosis-based cardiovascular disease.

Funding Acknowledgement

Type of funding sources: Foundation. Main funding source(s): This work was supported by grants from the National Science Fund for Distinguished Young Scholars (81625002), the National Natural Science Foundation of China (81930007).

ERBB2 gene expression silencing involved in ovarian cancer cell migration and invasion through mediating MAPK1/MAPK3 signaling pathway

OBJECTIVE

To explore possible mechanism of ERBB2 gene expression silencing mediating mitogen-activated protein kinase 1/mitogen-activated protein kinase 3 (MAPK1/MAPK3) signaling pathway on proliferation, migration, and invasion of ovarian cancer cells.

PATIENTS AND METHODS

A total of 240 cancer specimens were collected in patients with epithelial ovarian cancer intraoperatively in our hospital from January 2015 to January 2018. Expressions of ERBB2, MAPK1, and MAPK3 in tissues were detected by immunohistochemistry. Following the culture of ovarian cancer cell lines, target cell line with high expression of ERBB2 was screened by qRT-PCR. Cell grouping was performed with four groups after transfection, including Blank group, negative control (NC) group, ERBB2 shRNA group, and ERBB2 overexpression group (shorted as ERBB2 group). The expression levels of ERBB2, MAPK1, MAPK3, vascular endothelial growth factor (VEGF), metalloproteases-2 (MMP-2), and tissue inhibitor of metalloproteases-2 (TIMP-2) were detected by qRT-PCR in different transfection groups, followed by the detection of protein expressions with Western blot. 3-(4,5-Dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay was used to test the proliferation activity of each group after transfection, while transwell assay and scratch test explored cell invasion and migration in each group, respectively.

RESULTS

Immunohistochemistry showed that the positive rates of ERBB2, MAPK1, and MAPK3 in ovarian cancer tissues were significantly increased than those in adjacent normal epithelial tissues. In the cell experiment, ERBB2 gene was highly expressed in SKOV3 ovarian cancer cell line. There was no significant difference in each index between Blank group and NC group (p > 0.05). Compared with Blank group and NC group, the expression levels of ERBB2, MAPK1, MAPK3, VEGF, and MMP-2 in ERBB2 shRNA group decreased significantly, TIMP-2 increased markedly, and proliferation, invasion, and migration abilities of cells decreased markedly after transfection, showing statistically significant differences (All p < 0.05). By contrast, the expression levels of ERBB2, MAPK1, MAPK3, VEGF, and MMP-2 increased remarkably in ERBB2 group, while TIMP-2 decreased significantly, and cell proliferation, invasion, and migration ability increased evidently after transfection, with statistically significant differences (All p < 0.05).

CONCLUSIONS

Silencing ERBB2 gene expression may inhibit the activation of MAPK1/MAPK3 signaling pathway and thus suppress the proliferation, invasion, and migration of ovarian cancer cells. Overexpression of ERBB2 gene can reverse those trends, which in turn support the role of ERBB2 gene expression silencing in molecular targeted therapy of ovarian cancer.

Sweroside ameliorates NAFLD in high-fat diet induced obese mice through the regulation of lipid metabolism and inflammatory response

ETHNOPHARMACOLOGICAL RELEVANCE

Sweroside, an iridoid derived from Traditional Chinese Medicine, is an active component in Swertia pseudochinensis Hara. Swertia pseudochinensis Hara is first recorded in "Inner Mongolia Chinese Herb Medicine"and is considered as a folk medicine for treating hepatitis in northern China.

AIM OF THE STUDY

This study sought to elucidate the role of sweroside in high fat diet induced obesity and fatty liver by using mouse model and investigated the primary molecular mechanism via transcriptomics analysis.

MATERIALS AND METHODS

C57BL/6 mice were fed high-fat diet (HFD) for 14 weeks to induce obesity, hyperglycemia, and fatty liver. These mice were subsequently treated with HFD alone or mixed with sweroside (at a daily dosage of 60 mg per kg of BW, 120 mg per kg of BW and 240 mg per kg of BW) for 6 weeks. BW and food intake was monitored weekly. Biochemical and pathological analysis were conducted to investigate the effect of sweroside on NAFLD. RNA-sequence and RT-qPCR analysis were performed to analyze the potential mechanism.

RESULTS

The mice treated with sweroside were resistant to HFD-induced body weight gain, insulin resistance and hepatic steatosis. Ingenuity pathway analysis (IPA) demonstrated that hepatic gene networks related to lipid metabolism and inflammatory response were down-regulated in the HFD + sweroside group. PPAR-ɑ was located in the center of the hepatic gene network, and the significantly altered genes were CD36 and FGF21, which are related to hepatic inflammation and lipid metabolism. Consistently, upstream-regulators analysis revealed that the main enriched upstream-regulator was PPAR-ɑ.

CONCLUSION

Our results indicate that sweroside may ameliorate obesity with fatty liver via the regulation of lipid metabolism and inflammatory responses. The beneficial effects of sweroside might be closely associated with the regulation of PPAR-α.

Professional and interprofessional identities: a scoping review

Identity development within the interprofessional field is an emerging area of research. This scoping review aims to establish how professional and interprofessional identities are defined, conceptualized, theorized and measured within the interprofessional literature. Six databases were systematically searched for papers focusing on professional and/or interprofessional identities in interprofessional healthcare and education using a scoping review methodology. A total of 84 papers were included. Most papers discussed professional identity only; the minority discussed both identities. There were three key findings. First, no universal definition of interprofessional identity exists. Second, there is no shared understanding of interprofessional identity and its relationship with professional identity. Third, poor alignment between definitions, conceptualizations, theories and measures of interprofessional identity exists. The absence of a psychometrically robust instrument that specifically measures interprofessional identity and the short-term focus of current interprofessional identity research further limits understanding. Research that critically examines professional and interprofessional identity development should be underpinned by clear definitions, concepts, theories and measures of both identities. High-quality research will allow greater understanding of interprofessional identity development and its impact on interprofessional practice.

An integrative investigation on the efficacy of Plantaginis semen based on UPLC-QTOF-MS metabolomics approach in hyperlipidemic mice

Plantaginis semen, the dried mature seed of Plantago asiatica L. or Plantago deprdssa Willd., has a prominent effect on the treatment of obesity, type 2 diabetes and lipid disorders, however, its clinical application is limited due to inadequate in-depth mechanism exploration and incomplete discussion of action targets of its in vivo. Therefore, an untargeted metabolomics approach was firstly applied to study the serum metabolic differences in mice. Metabolomics analysis was performed using ultra performance liquid chromatography quadrupole time of flight mass spectrometry (UPLC-QTOF-MS) together with multivariate statistical data analysis. The results showed that Plantaginis semen can mainly improve blood lipids, some degree in blood glucose and insulin levels in high-fat mice, in addition, the phenotype of liver and fat stained sections demonstrated remarkable results. A total of 22 metabolites involved in arachidonic acid, glycerophospholipid, glycosphingolipid, linoleate, Omega-3 fatty acid, phosphatidylinositol phosphate and tyrosine metabolisms were identified. In further, it was found that the possible mechanisms of Plantaginis semen on hyperlipidemic mice lied in the biosynthesis of thyroxine, biological effects of enzymes of phospholipase A2 activity, glucosylceramide synthase and inositol essential enzyme 1α, genes expressions of fatty acid metabolism and inflammation. Serum metabolomics revealed that Plantaginis semen could cure the organism disease via regulating multiple metabolic pathways which will be helpful for understanding the mechanism of this herb and providing references for better applications of it in clinic, even researches on other TCMs.

Comprehensive metabolite profiling of Plantaginis Semen using ultra high performance liquid chromatography with electrospray ionization quadrupole time-of-flight tandem mass spectrometry coupled with elevated energy technique

Plantaginis Semen is commonly used in traditional medicine to treat edema, hypertension, and diabetes. The commercially available Plantaginis Semen in China mainly comes from three species. To clarify the chemical composition and distinct different species of Plantaginis Semen, we established a metabolite profiling method based on ultra high performance liquid chromatography with electrospray ionization quadrupole time-of-flight tandem mass spectrometry coupled with elevated energy technique. A total of 108 compounds, including phenylethanoid glycosides, flavonoids, guanidine derivatives, terpenoids, organic acids, and fatty acids, were identified from Plantago asiatica L., P. depressa Willd., and P. major L. Results showed significant differences in chemical components among the three species, particularly flavonoids. This study is the first to provide a comprehensive chemical profile of Plantaginis Semen, which could be involved into the quality control, medication guide, and developing new drug of Plantago seeds.

Author Correction: Metabolic Biomarkers for Prognostic Prediction of Pre-diabetes: results from a longitudinal cohort study

A correction to this article has been published and is linked from the HTML version of this paper. The error has been fixed in the paper.

[Diagnostic value of endobronchial ultrasonography with a guide sheath for peripheral pulmonary ground glass opacity]

Objective: To explore the diagnostic value of endobronchial ultrasonography with a guide sheath (EBUS-GS) for peripheral pulmonary ground glass opacity (GGO). Methods: The clinical data of 27 consecutive patients with 27 GGOs diagnosed by EBUS-GS between November 2014 to December 2015 in our Cancer Hospital were retrospectively analyzed. The average age of these 27 patients, including 9 males and 18 females, was 59±11 years. The median lesion size of the 27 GGOs was 2.9±1.2 cm, including 24 mixed GGOs and 3 pure GGOs. EBUS images of all 27 GGOs were evaluated, cytological, histological and combination diagnosis analyzed, and complications observed. Results: Under thin bronchoscope, 2 out of 27 cases showed bronchial stenosis, 1 showed bronchial stenosis with mucosal swelling, and the other 24 did not show abnormalities. Twenty-five out of 27 GGOs were found by EBUS, including 22 cases of mGGO and 3 of pGGO. In these ultrasonic images of 22 mGGOs, 18 showed mixed blizzard sign, 3 showed diffusely heterogeneous acoustic shadow and 1showed blizzard sign. Ultrasonic images of 3 pGGOs all appeared as blizzard sign. Twenty-six cytological specimens were obtained, and 16 were diagnosed clearly. All 27 histological specimens were collected, and 18 were diagnosed clearly. Nineteen of 27 cases were diagnosed by combination of cytological and histological specimens. One complication of EBUS-GS with mild bleeding was observed, and hemorrhage was terminated by conservative treatment. Conclusions: EBUS-GS is valuable for GGO diagnosis with less complications and higher safety. GGO ultrasonic image manifested as mixed blizzard sign, blizzard sign or diffusely heterogeneous acoustic shadow.

Metabolic Biomarkers for Prognostic Prediction of Pre-diabetes: results from a longitudinal cohort study

To investigate the metabolic biomarkers of predicting the transition from pre-diabetes (pre-DM) to normal glucose regulation (NGR) and diabetes (DM) in a longitudinal cohort study. 108 participants with pre-DM were followed up for ten years and divided into 3 groups according to different glycemic outcomes. 20 participants progressed to DM, 20 regressed to NGR, and 68 remained at pre-DM. Alterations in plasma metabolites in these groups were evaluated by untargeted ultra-performance liquid chromatography-quadrupole time-of-flight mass spectrometry (UPLC-QTOF-MS). Twenty three metabolites related to glycerophospholipid metabolism, oxidation and antioxidation were associated with the process from pre-DM to NGR, while twenty two metabolites related to amino acid metabolism, glycerophospholipid metabolism and mitochondrial β-oxidation played important roles in the progression to DM. Results from stepwise logistic regression analysis showed that five biomarkers (20-Hydroxy-leukotriene E4, Lysopc(20:4), 5-methoxytryptamine, Endomorphin-1, Lysopc(20:3)) were good prediction for the restoration to NGR, and five biomarkers (Iso-valeraldehyde, linoleic acid, Lysopc(18:1), 2-Pyrroloylglycine, Dityrosine) for the development of DM. The findings suggest that the combination of these potential metabolites may be used for the prognosis of pre-DM. Targeting the pathways that involved in these prognostic biomarkers would be beneficial for the regression to NGR and the early prevention of DM among pre-DM.

Plantago asiatica L. Seed Extract Improves Lipid Accumulation and Hyperglycemia in High-Fat Diet-Induced Obese Mice

Obesity and its common association with type 2 diabetes, dyslipidemia, and cardiovascular diseases are worldwide epidemics. Currently, to prevent or treat obesity and associated metabolic disorders, herbal dietary supplements or medicines have attracted more and more attention owing to their relative effectiveness with fewer significant side effects. We investigate the therapeutic effects and underlying mechanisms of Plantago asiatica L. seed extract (PSE) on obesity and associated metabolic disorders in high-fat (HF) diet-induced mice. Our results displayed that PSE did not modify food intake or body weight but decreased abdominal white adipose tissue ratio, white/brown adipocyte size, serum total cholesterol, triglyceride (TG), low density lipoprotein cholesterol, free fatty acid, and hepatic TG concentrations when compared with the HF group. The levels of fasting blood glucose and glucose tolerance were improved in the PSE group when compared with the HF group. Furthermore, PSE upregulated mRNA expressions of peroxisome proliferator activated receptors (PPARs) and target genes related to fatty acid metabolism and energy expenditure in liver and adipose tissue of obese mice when compared with the HF group. PSE treatment effectively improved lipid and glucose metabolism in HF diet-induced obese mice. These effects might be attributed to the upregulation of PPAR signaling.

A two-component pre-seeded dermal-epidermal scaffold

We have developed a bilayered dermal-epidermal scaffold for application in the treatment of full-thickness skin defects. The dermal component gels in situ and adapts to the lesion shape, delivering human dermal fibroblasts in a matrix of fibrin and cross-linked hyaluronic acid modified with a cell adhesion-promoting peptide. Fibroblasts were able to form a tridimensional matrix due to material features such as tailored mechanical properties, presence of protease-degradable elements and cell-binding ligands. The epidermal component is a robust membrane containing cross-linked hyaluronic acid and poly-l-lysine, on which keratinocytes were able to attach and to form a monolayer. Amine-aldehyde bonding at the interface between the two components allows the formation of a tightly bound composite scaffold. Both parts of the scaffold were designed to provide cell-type-specific cues to allow for cell proliferation and form a construct that mimics the skin environment.

External auditory canal exostoses in white water kayakers

OBJECTIVE

In this study, the presence and severity of external auditory canal exostoses (EACE) in a group of white water kayakers related to the duration and intensity of kayaking and the number of ear infections reported were identified.

DESIGN

A community-based volunteer cross-sectional study was completed with 92 kayakers (69 men, 23 women; mean (SD) age 29.3 (8.72) years) and 65 control volunteers (37 men, 28 women; mean (SD) age 36.9 (14.9) years). After exclusions, 269 individual ears were examined (154 kayakers and 115 controls). Participants completed a questionnaire and underwent otoscopic examination. Main outcome measures were the presence and severity of EACE, the duration and frequency of kayaking and self-reported ear infections. Exclusion criteria included other cold-water exposure, known ear pathology or poor visualisation of the auditory canal.

RESULTS

The findings demonstrated that 69.5% of kayaker ears and 1.7% of the control group were found to have EACE. Severity of EACE was significantly associated with the duration (p<0.01) and frequency (p<0.05) of kayaking with 90.6% of kayakers that had participated for more than 10 years having evidence of EACE. A significant relationship also existed between the number of self-reported ear infections and the severity of EACE (p<0.01).

CONCLUSION

There is a positive relationship between the duration and frequency of white water kayaking and the presence and severity of EACE and associated ear infections.

Towards a feminist global bioethics: addressing women's health concerns worldwide

In this paper I argue that a global bioethics is possible. Specifically, I present the view that there are within feminist approaches to bioethics some conceptual and methodological tools necessary to forge a bioethics that embraces the health-related concerns of both developing and developed nations equally. To support my argument I discuss some of the challenges that have historically confronted feminists. If feminists accept the idea that women are entirely the same, then feminists present as fact the fiction of the essential "Woman." Not only does "Woman" not exist, -she" obscures important racial, ethnic, cultural, and class differences among women. However, if feminists stress women's differences too much, feminists lose the power to speak coherently and cogently about gender justice, women's rights, and sexual equality in general. Analyzing the ways in which the idea of difference as well as the idea of sameness have led feminists astray, I ask whether it is possible to avoid the Scylla of absolutism (imperialism, colonialism, hegemony) on the one hand and the Charybdis of relativism (postmodernism, fragmentation, Balkanization) on the other. Finally, after reflecting upon the work of Uma Narayan, Susan Muller Okin, and Martha Nussbaum, I conclude that there is a way out of this ethical bind. By focusing on women's, children's, and men's common human needs, it is possible to lay the foundation for a just and caring global bioethics.

Just caring about women's and children's health: some feminist perspectives

This article addresses the issue of women as primary caregivers to children and the concept of "maternal practice." The idea of maternal practice guides mothers as they learn (1) how to meet their child's physical, psychological, and spiritual needs, and (2) how to make their child socially acceptable. Hindrances to maternal practice include severe poverty and disabilities of the mother. The relationship between maternal practice and the quest for health care in the U.S. is discussed. Maintaining adequate health care is more difficult when parents are poorly educated and/or impoverished. Without proper health care, poor children are less likely to be able to compete with rich children in society. Dental care is also a concern, because proper dental care is fundamental in the maintenance of overall health. Dental care is not a "luxury" but medically necessary care. Solutions include increasing the awareness of such programs as CHIP and WIC, extending Medicaid benefits to more children, and compensating health care practitioners for working with Medicaid recipients. In addition, society must think more maternally and increase health and dental care accessibility, particularly to the poor in rural areas. The article concludes with the thought that if society expects mothers to care for their children, then society must care for mothers.

Evidence against oxidative stress as mechanism of endothelial dysfunction in methionine loading model

Endothelial dysfunction reflects reduced nitric oxide (NO) bioavailability due to either reduced production, inactivation of NO, or reduced smooth muscle responsiveness. Oral methionine loading causes acute endothelial dysfunction in healthy subjects and provides a model in which to study mechanisms. Endothelial function was assessed using flow-mediated dilatation (FMD) of the brachial artery in humans. Three markers of oxidative stress were measured ex vivo in venous blood. NO responsiveness was assessed in vascular smooth muscle and platelets. Oral methionine loading induced endothelial dysfunction (FMD decreased from 2.8 +/- 0.8 to 0.3 +/- 0.3% with methionine and from 2.8 +/- 0.8 to 1.3 +/- 0.3% with placebo; P < 0.05). No significant changes in measures of plasma oxidative stress or in vascular or platelet sensitivity to submaximal doses of NO donors were detected. These data suggest that oxidative stress is not the mechanism of endothelial dysfunction after oral methionine loading. Furthermore, the preservation of vascular and platelet NO sensitivity makes a signal transduction abnormality unlikely.

Unmodified supported thiol/lipid bilayers: studies of structural disorder and conducting mechanism by cyclic voltammetry and AC impedance

Supported thiol/lipid bilayer assembly, one of the most spectacular bilayer systems in recent years, has provided a good model to study biomembranes because of its high mechanical stability. In this work, the structural and conducting property of unmodified Au supported octadecanethiol/phosphatidylcholine bilayers were investigated using cyclic voltammetry (CV) and electrochemical impedance spectroscopy (EIS). The forming process of bilayer was monitored by capacitance plane plot. The normalized membrane capacitance of supported bilayer is 0.52 microF cm(-2). Kinetically controlled voltammograms determined by Butler-Volmer equation were obtained for both thiol monolayer and thiol/lipid bilayer in linear sweep voltammetry. Results of EIS experiment indicate that collapsed sites and pinhole defects exist in thiol monolayer and lipid monolayer, respectively. The difference between the values of experimental and theoretical standard electron transfer rate constant indicates that the conducting mechanism of Au supported thiol monolayer is electron tunneling at collapsed sites. The conducting mechanism of Au supported thiol/lipid bilayer is attributed as the following: the electroactive species could diffuse through pinholes in the lipid monolayer and reach collapsed sites in thiol monolayer, where electron transfer occurs via a tunneling process. The fractional coverage of the lipid monolayer measure by EIS experiments is about 0.98 or higher.

Rotation of NMR images using the 2D chirp-z transform

A quick and accurate way to rotate and shift nuclear magnetic resonance (NMR) images using the two-dimensional chirp-z transform is presented. When the desired image grid is rotated and shifted from the original grid due to patient motion, the chirp-z transform can reconstruct NMR images directly onto the ultimate grid instead of reconstructing onto the original grid and then applying interpolation to get the final real-space image in the conventional way. The rotation angle and shift distances are embedded in the parameters of the chirp-z transform. The chirp-z transform implements discrete sinc interpolation to get values at grid points that are not exactly on the original grid when applying the inverse Fourier transform. Therefore, the chirp-z transform is more accurate than methods such as linear or bicubic interpolation and is more efficient than direct implementation of sinc interpolation because the sinc interpolation is implemented at the same time as reconstruction from k-space.

Electron transfer between ferrocene-modified Au/octadecanethiol/lipid BLM electrode and redox couples in solution

Bilayers incorporated with ferrocene consisting of self-assembled octadecanethiol and lipid monolayer on gold substrates were fabricated. Its electrochemical behaviors in solutions containing different redox couples were investigated by cyclic voltammetry and ac impedance. The transmembrane electron transfer reaction across octadecanethiol self-assembled film and an adsorbed phospholipid layer mediated by ferrocene have been observed in the solution of Fe(CN)6(3-/4-). The formal potential difference between mediator in bilayer lipid membrane (BLM) and redox couple in solution has a great impact on the transmembrane electron transfer behavior. The ferrocene-modified BLM electrodes might be useful for constructing a bilayer-based electrochemical current rectifying device.

Two- and three-dimensional image rotation using the FFT

Techniques for rotating two- and three-dimensional (2-D and 3-D) images using fast Fourier transforms (FFT's) are presented. The methods are applications of the multidimensional chirp algorithm. In the 2-D case, one chirp transformation is sufficient, requiring four 2-D FFT's, In the 3-D case, two successive chirp transformations are required, needing six 3-D FFT's.

The ethics of care: a feminist virtue ethics of care for healthcare practitioners

In this paper I seek to distinguish a feminist virtue ethics of care from (1) justice ethics, (2) narrative ethics, (3) care ethics and (4) virtue ethics. I also connect this contemporary discussion of what makes a virtue ethics of care feminist to eighteenth and nineteenth century debates about male, female, and human virtue. In conclude that by focusing on issues related to gender--primarily those related to the systems, structures, and ideologies that create and sustain patterns of male domination and female subordination--we can begin to appreciate that true care and bona-fide virtue can flourish only in societies that treat all persons with equal respect and consideration.

Towards a just, courageous, and honest resolution of the futility debate

This essay discusses the history of the "futility debate" and the motives that sometimes prompt health care professionals, health care providers, patients, and surrogates to take different sides in it. Changes in the health care system, financial responsibility shifts, technical medical advances, and medical care rationing are analyzed as contributors to the futility debate. So too are variations in the definition of futility examined as part of the current controversy. The respective attitudes of professionals, providers, patients, and surrogates in accepting the goals, capabilities, and limits of medicine are also explored. In particular, the lack of honest communication between health care professionals/health care providers on the one hand and patients/surrogates on the other is acknowledged as a major roadblock in the building of care-focused futility policies. Finally, various initial attempts of hospitals to create futility guidelines are evaluated in order to detect problem areas and to suggest lines of improvement.

Blessed are the peacemakers: commentary on making peace in gestational conflicts

The purpose of this commentary on James Nelson's article [1] is to advocate introducing the ethics of care into the arena of gestational conflict. Too often the debate gets stalled in a maternal versus fetal rights headlock. Interventionists stress fetal over maternal rights: they believe education, post-birth prosecution or pre-birth seizure of pregnant women may be permissible. In contrast to interventionists, other philosophers stress that favoring fetal rights treats women like 'fetal containers'. I question whether we should really consider issues of moral/parental obligations to children in terms of rights. Rather, the language of care should guide moral conduct vis-a-vis children/fetuses. The particularity of each woman's story--the particulars of her human relationships--inform her story. An individual's ability to care is largely a function of whether community cares for her. We must care for others to enable them to care for themselves and their loved ones--born or unborn.

The epistemology and ethics of consensus: uses and misuses of 'ethical' expertise

In this paper I examine the epistemology and ethics of consensus, focusing on the ways in which decision makers use/misuse ethical expertise. The major questions I raise and tentative answers I give are the following: First, are the 'experts' really experts? My tentative answer is that they are bona fide experts who often represent specific interest groups. Second, is the experts' authority merely epistemological or is it also ethical? My tentative answer is that the experts' authority consists not only in their command over specific matters of fact and/or value, but also in their ability to achieve 'consensus' about what is 'true'/'false', or 'right'/'wrong'. Third, should the authority of expertise be limited? My tentative answer is that it should be limited in the area of facts but especially in the area of values. Persons who are ethics 'experts' must be particularly careful to practice an ethics of persuasion rather than an ethics of compulsion. Their role is not to force their group consensus upon decision makers' individual moral perceptions and deliberations; rather it is to help decision makers come to their own conclusions about what they ought to do.