3 m diameter) Vegetation analyses were performed during the summ

3 m diameter). Vegetation analyses were performed during the summer of 2011. Soil samples Tanespimycin were collected in the summer of 2008. Linear transects were established in the spruce-Cladina forest and in the reference forest. Subplots were established at 12 stops spaced approximately 20 m apart along each transect. The

depth of the soil humus layer was measured in each subplot and soil humus samples were collected using a 5 cm diameter soil core with the whole humus layer being collected in each sample. Humus bulk density was determined on each of these samples by drying the humus samples at 70 °C, weighing the mass of the sample and dividing that value by the volume of the soil core collected. Humus samples were also measured for total C and N by using a dry combustion analyzer (Leco True Spec, St Joe Michigan). Mineral soil samples were

collected to a depth of 10 cm using a 1 cm diameter soil probe. Each sample was created as a composite of three subsamples with a total of eight samples per stand and 24 for each stand type. Samples were dried at 70 °C, sieved through a 2 mm sieve and analyzed for pH, total C, N, phosphorus (P), potassium (K) and zinc (Zn). Samples were analyzed for available magnesium (Mg) and calcium (Ca) by shaking 10 g sample in 50 ml of 1 M NH4AOc and analyzed on an atomic absorption spectrophotometer. To evaluate concentrations of plant available N and P, ionic resin capsules (Unibest, Bozeman, MT) were buried at the interface of the humus layer and mineral soil in June 2008 and allowed to remain in place until June 2009. Resins were collected from the field and placed in Ku-0059436 in vivo a −20 °C constant temperature cabinet until Glycogen branching enzyme analysis. Resins were extracted by placing the capsules into 10 ml of 1.0 M KCl, shaking for 30 min, decanting, and repeating this process two more times to create a total volume of 30 ml of extractant. Resin extracts were then measured for NH4+-N by using the Bertholet reaction ( Mulvaney, 1996), NO3−-N by a hydrazine method ( Downes, 1978), and phosphate by

molybdate method ( Kuo, 1996) using a 96 well plate counter. Three replicate soil samples (0–5 cm of mineral soil) were collected for charcoal analyses by using a 1 cm diameter soil core with each sample created as a composite of five subsamples. Samples were measured for total charcoal content using a 16 h peroxide, dilute nitric acid digestion in digestion tubes fitted with glass reflux caps ( Kurth et al., 2006). Total C remaining in the digests was determined by dry combustion. Peat samples were collected in the summer of 2011 in an ombrothrophic mire located immediately adjacent to the spruce-Cladina forest at Kartajauratj and east of Lake Kartajauratj, 66°57′48″ N; 19°26′12″ E, by the use of a Russian peat sampler ( Jowsey, 1966). The total peat depth was 125 cm from which the uppermost 40 cm were used for pollen analysis. Samples of 1.

Human pressure on forests, caused by population growth, diffused

Human pressure on forests, caused by population growth, diffused poverty and lack of alternatives, is increasing, leading to extensive forest degradation and deforestation (Rijal and Meilby, 2012). Salerno et al. (2010) assessed an average decrease of 38% in forest biomass between 1992 and 2008 in the Khumbu Valley. Nonetheless, the development of sustainable

management plans, taking into account both ecological and socio-economic issues, is often limited by the lack of knowledge on forest structure and of awareness about human impact on the ecosystem (Rijal and Meilby, 2012). The measured effects of forest exploitation on stand structure and tree species composition confirmed the recent hypothesis that forest degradation has a stronger impact than deforestation in SNPBZ (Stevens, 2003 and Byers, 2005). Trekking VE 821 tourism is still increasing in the SNP and is seriously affecting the Sherpas traditional use of natural resources (Byers, 2009 and Spoon, 2011). Forest degradation and shrub removal (especially Juniperus

wallichiana) are the more evident effects of this socio-cultural change. A land cover change analysis recently performed in the area ( Bajracharya et al., 2010) GDC-0068 research buy revealed that between 1992 and 2006 the most significant shifts were the reduction of mixed forest cover, together with an increase of dwarf shrubs at 3000–4000 m a.s.l. and a reduction of shrubland at higher elevations (4000–5000 m a.s.l.). The overall change in forest and shrub communities was negligible (−4% and −9% respectively) compared to the relevant increase (47%) of dwarf shrubs at 3000–4000 m Sinomenine a.s.l. Prior to 1950, the Sherpa people extensively clearcut woodlands

and converted them into pastures and villages. Land use/cover change is a further driver of erosion risk in Himalayas, a region characterized by heavy rainfalls (Valdiya and Bartarya, 1989, Rawat and Rawat, 1994 and Tiwari, 2000). Soil erosion and mass movement are often related to human activities such as deforestation, overgrazing and building construction in vulnerable sites (Shrestha et al., 2004), but natural disturbances can sometimes override human influence (Bruijnzeel and Bremmer, 1989 and Messerli and Hofer, 1992). In the last decades excessive tree felling without any silvicultural rationale, became the most common forest practice and is still widespread. The prohibition to log living trees inside the national park has caused the increasing removal of green limbs and branches (especially of P. wallichiana) causing severe mechanical damage and growth and survival limitations to the trees ( Gautam, 2001, Gautam and Watanabe, 2002, Bhat et al., 2000 and Pandey and Shukla, 2001). In addition, since the removal of deadwood is still allowed within the park, stems are often purposely injured in order to hasten their death.

Although some endoscopy centers recommend the use of a split-dose

Although some endoscopy centers recommend the use of a split-dose administration of a 2-L homemade solution of Gatorade plus PEG-3350 (Miralax), a meta-analysis has found this regimen to be inferior to standard, split-dose

4-L PEG solutions.39 Two low-volume hyperosmolar solutions that do not contain PEG are available, but both must be taken with sufficient amounts of water to promote adequate cleansing. These solutions include a sulfate solution (Suprep, 3 L, including water) and a magnesium citrate/picosulfate solution (Prepopik, 2.2 L, including water). Because these hyperosmolar solutions may selleck products cause dehydration and electrolyte shifts, they should be used with caution in patients with significant renal or cardiac disease or in patients unable or unlikely to comply with instructions. There are no controlled trials comparing split dosing of low-volume, hyperosmolar solutions and split dosing of standard large-volume 4-L PEG solutions, and hence, it is unknown whether these low-volume options provide comparable outcomes. A trial48 comparing split dosing of a low-volume sulfate-based preparation with split dosing of a low-volume (2 L) PEG solution containing ascorbic acid (MoviPrep) yielded a comparable proportion of good or excellent preparations. Most recently, another

preparation Everolimus (Suclear) has become available, in which a sulfate solution (1 L, including water) is administered the evening before the procedure, and balanced PEG solution (2 L) is administered 4 hours before the procedure. In a controlled trial, split dosing of the sulfate/PEG formulation achieved a similar level of acceptable bowel preparation as split dosing of a low-volume (2 L) PEG/ascorbic acid solution.49 Phosphate-based preparations (tablets and solutions) are still available

but have significant potential for adverse consequences. These preparations Tyrosine-protein kinase BLK can induce mucosal ulcerations that mimic IBD, confusing disease diagnosis and staging. More importantly, several reported cases of severe hyperphosphatemia have occurred (some complicated by mortality) as well as cases of acute phosphate nephropathy. Because of safety concerns as well as the availability of numerous alternative preparation options, phosphate-based solutions should be avoided.50 No studies have compared specific preparation types in patients with IBD. Thus, physicians and endoscopy centers may favor particular agents based on personal experience, reported patient satisfaction, and cost considerations. Based on the extensive body of literature supporting their efficacy and safety, bowel regimens with a split-dose of a full-volume (4 L) balanced PEG solution may be recommended for most patients. The European Society of Gastrointestinal Endoscopy51 specifically recommends use of a PEG formulation in patients with IBD, because alternative formulations can cause mucosal damage.

We measured the precision of Bio-Plex and MILLIPLEX in quantifyin

We measured the precision of Bio-Plex and MILLIPLEX in quantifying spiked cytokine recovery across repeats of biological replicates within each individual assay, which we report as repeatability. Four identical aliquots of three different patient samples were included at different positions on the same plate. The coefficient of variation (%CV) was calculated for each sample and a mean

%CV derived from the Selleckchem Lumacaftor pooled %CV values. In this analysis the %CV was lower with the MILLIPLEX kit for IFNγ (15.4% vs 39.3%) and with the Bio-Plex kit for IL-17 (15.6% vs 21.7%). We also measured the intra-assay precision of these two kits in quantifying cytokine concentrations derived from and included in standard curve calculations. The pooled mean %CV across all IL-17 standards was lower with the Bio-Plex kit (11.8% vs 24.2%) and across all IFNγ standards was lower with the MILLIPLEX kit (14.2% vs 25.1%). We have insufficient data to report on inter-assay precision. Complex

biological samples derived from tissues have not been evaluated by Luminex kit manufacturers and the optimal procedure to prepare our human mucosal tissue samples was not known. Determining the impact of different protocols on cytokine measures could improve the utility of Luminex-based methods to achieve our intended purpose — namely the quantification of endogenous cytokines present at low concentrations in small tissue samples. We compared processing methods and extraction buffers for four pairs of biopsies from each of four patients. Within each pair, biopsies were spiked at 100 pg/mL or spiked with buffer alone (“unspiked”), EPZ015666 order processed and then split into aliquots. Afatinib ic50 Manual sample disruption using a mini pellet pestle with or without homogenisation using a needle and syringe, and automated processing using a TissueLyser LT bead-basher (QIAGEN) were compared, as detailed in Materials and methods. Cytokine spikes were recovered significantly more accurately from

samples processed manually (Fig. 1C). There were no significant differences between processing methods in relation to precision (data not shown) or total protein recovery by BCA assay (mean ± SD for manual 821.8 ± 108.0 μg/mL vs automated 800.3 ± 179.2 μg/mL). We compared manual disruption using pestle alone with additional homogenisation using needle and syringe. Spiked cytokine recovery was usually lower with the latter (Table 2), although this difference was not consistent or statistically significant. We observed that homogenisation with a needle and syringe leads to loss of sample volume, which was retained in equipment dead space. In addition we evaluated if the addition of benzonase to PBS-based extraction buffer improved the performance of manual or automated processing. Benzonase is an endonuclease and digestion of nucleic acids may reduce sample viscosity.

, 2005) Hydrogen sulphide is acutely toxic with fatalities assoc

, 2005). Hydrogen sulphide is acutely toxic with fatalities associated with concentrations in excess of 500 ppm. It has a very low odour threshold (0.008 ppm) but odour perception is lost at concentrations of 150–250 ppm (WHO, 2000), adding to the danger of high level exposures as they may not be recognised, by smell, by the individual. In Europe, there is a workplace exposure limit (8 h TWA) of 5 ppm (HSE, 2011 and SCOEL, 2007) with a

short-term (15-min) exposure limit of 10 ppm. Hydrogen sulphide has previously been reported as a causal agent of unconsciousness and death in a number of occupational exposure incidents (Kage et al., 2002 and Kage et al., 2004). In the UK it has been reported (Costigan, 2003) that around 125,000 workers in the UK are potentially exposed to hydrogen sulphide in work related to the treatment of sewage, effluent waste and farm slurry. this website In the offshore oil and gas industries about 3000 workers are potentially exposed. The UK Health and ABT-199 concentration Safety Executive has investigated several incidents of workplace accidents involving hydrogen sulphide exposure from slurry pits, animal rendering plants and biodigester facilities

in recent years. The increased prevalence of biodigesters and slurry storage may indicate an increased likelihood of further incidents in the future. Here we report three case studies using biological monitoring to determine hydrogen sulphide exposure. Blood or urine thiosulphate determination was carried out according to the method of Kage et al. (1991). Briefly, samples (200 μl) were buffered with ascorbic acid (200 mM, 50 μl) and 5% sodium chloride (50 μl) then derivatised using pentafluorobenzyl bromide (20 mM in acetone, 500 μl) and extracted into iodine ethyl acetate solution (25 mM, 2 ml) to form bis(pentafluorobenzyl)

disulphide. Tribromobenzene was used as an internal standard. Analysis was by gas chromatography–mass spectrometry (positive electron ionisation) using selected ion monitoring (m/z 426 for the thiosulphate derivative). Aliquots (1 μl) were injected (220 °C, splitless) onto a BP-5 equivalent column (30 m × 0.32 mm i.d., 1 μm film) with a helium flow of 1 ml/min. The oven temperature ZD1839 was held at 100 °C for 2 min then ramped at 10 °C/min up to 220 °C, where it was held for 5 min. Calibration standards were prepared in blood or urine, as appropriate, and extracted as per the samples. The calibration curves were linear from 0 to 600 μmol/l (least squares regression > 0.99) and quality control samples were within the expected range showing a coefficient of variation of 12%. The detection limit was 1 μmol/l. Urine samples were also analysed for creatinine content using the alkaline picrate reaction ( Cocker et al.

The average effective topsoil depth is only 15 1 cm in northeast

The average effective topsoil depth is only 15.1 cm in northeast China (against an average of 16.5 cm in China) [7], much smaller than that in North America, which reaches 35 cm on average [7]. The shallow and compacted topsoil not only restricts the root development of plants, but hinders their absorption of nutrients and water. The poor soil properties also reduce their tolerance to abiotic stress, especially resistance against natural disasters [5] and [8]. Subsoil tillage is one of the most effective ways to break up a plow

pan in farming management [9], [10] and [11]. It can break up compacted layers, loosening the soil and deepening the topsoil without inverting it, increasing soil permeability [12]. Cabozantinib As reported by many authors, subsoil tillage can play important roles in efficiently breaking up the plow pan [9] and [13], promoting water storage in the soil [14] and [15], adjusting the proportion of solid, liquid, and gas of soil, improving the structure and characteristics of topsoil [15], [16], [17] and [18], and improving the MEK inhibitor drugs ecological environment for root development and root activities that enhance the anti-stress capacity of plants [19], [20] and [21]. Varsa et al. [22] concluded that deeper tillage could result in higher corn grain yield, especially in dry seasons. Currently, the time and method for subsoil tillage vary in different regions based on local production operations and included inter tillage [23],

[24] and [25], autumn tillage [26] and [27], and spring tillage [26], [27] and [28]. In northeastern China, most farmers are accustomed to inter tillage, which is integrated with fertilizer topdressing at the V6 or V7 stage. Wang et al. [5] developed

a technique of subsoil inter tillage and water conservation in maize production with high yield and high efficiency. Based on this technique, a Alanine-glyoxylate transaminase local standard was established (DB22/T1237-2011). However, most studies have been performed over only one or two years, with subsoil tillage depths mainly around 30 cm, and the results could not accurately reflect the contribution of the technique to grain yield and nutrient accumulation. In the present study, a four-year (2009–2012) experiment in the middle region of northeastern China was conducted to evaluate the impacts of different subsoil tillage depths on soil properties, nutrient (N, P, K) uptake, root morphology, and grain yield of spring maize. The aim was to characterize the effects of subsoil tillage on spring maize and thereby provide useful guidance for soil management coupled with appropriate machinery operations for sustainable crop production in the northeastern region. The experiment was conducted on the research farm of Jilin Academy of Agricultural Sciences, Gongzhuling city, Jilin province (43°29′55″N, 124°48′43″E) during 2009–2012. The field had been under continuous conventional maize management for many years before the experiment.

This effect too is confirmed by the significant decreases in the

This effect too is confirmed by the significant decreases in the proportions of brown rice, milled rice, and Dasatinib datasheet head rice caused by warming in the present study. Significant differences in nighttime warming impacts were found between rice varieties in this study. Warming-led negative effects on rice grain yield and quality were higher for Wuyunjing 7 than

II You 128, suggesting that indica rice possesses greater adaptation capacity to temperature elevation than japonica rice. Japonica rice originates mainly in relatively lower-temperature regions, whereas indica rice originates in higher-temperature regions. After long adaptation to its growing environment, indica rice carries greater adaptation capacity and resistance to warming than japonica rice [19] and [27]. This difference offers an opportunity to adapt to climatic warming by adjusting the spatial distribution of rice varieties. Recently, with the aim of fully investigating warming-induced increases Seliciclib in climatic potential, an ongoing program of alternating indica rice with japonica rice has been conducted in rice–wheat cropping areas in China. On one hand, this alternation may increase rice

yield potential by prolonging the growing cycle, because of the higher resistance of japonica than indica rice to low temperature [20]. On the other hand, our results indicate that this alternation may also decrease rice yield potential, owing to the lower resistance of japonica than indica rice to high temperature. Although the anticipated warming may prolong the rice growth period, it may also increase heat stress to grain filling, especially in rice–wheat cropping areas [28]. Thus, the adjustment of rice variety selection needs to be performed carefully according to the prevailing temperatures in each specific area. Interestingly, greater negative impacts of nighttime warming were found PtdIns(3,4)P2 on the filling rate of inferior than on that of superior grain, especially

for the indica rice II You 128. Previous studies have also shown that the filling rate was significantly higher for superior than for inferior grain [29]. Rice superior grain is characterized by larger vascular bundles in the panicle and stronger filling activity than inferior grain, suggesting greater resistance of superior than of inferior grain to environmental changes such as warming. In addition, post-anthesis warming at nighttime could decrease the grain-filling rate of inferior grain, an effect that may be closely associated with the activities of GS and GOGAT (the key enzymes of protein synthesis) and of ADPG-PPase, SSS and SBE (the key enzymes of starch synthesis) [30]. The significant differences in warming impacts between superior and inferior grain have important implications for super-rice cropping.

Color-singleton presence and color were determined per trial, suc

Color-singleton presence and color were determined per trial, such that each trial had a 75% chance of including a color singleton, and, in singleton present trials, there was a 50% likelihood that the color singleton would be red and a 50% likelihood it would be green. The visual search array was configured such that two of the six possible stimulus positions were located on the vertical meridian of the display. In each trial the target and salient distractor positions were randomly selected with the sole confine check details that these stimuli be presented to different positions.

The search displays were presented on a CRT monitor located 60 cm. away from the participant’s eyes. Each trial began with presentation of fixation point for a random duration of 400 to 1400 ms. This was followed by presentation of the search array, which remained on the screen until 100 ms HKI-272 purchase after response was made (when the next trial began). Participants completed 60 blocks of 30 trials, for a total of 1800 trials. They were instructed to respond as quickly as possible while maintaining an average accuracy of 90% or better, and feedback regarding accuracy and reaction time was provided at the end of each block. They were also instructed to maintain eye fixation throughout the experiment and told that eye movements were being monitored. Prior to beginning the

experiment, each participant completed at least one practice block. EEG and electrooculogram (EOG) were recorded from 134 sintered-AG/AgCl electrodes using the Biosemi ActiveTwo system (Biosemi, Amsterdam, the Netherlands). Horizontal EOG was recorded from electrodes located 1 cm. lateral to the external canthi and vertical EOG was recorded from two electrodes located 2 cm. above and below the right selleck inhibitor eye socket. Electrophysiological signals were digitized at 1024 Hz and resampled offline to 250 Hz. The data were high-pass filtered by convolving each channel with a Hamming-windowed finite

impulse response (FIR) function with half-amplitude attenuation at ~ 0.49 Hz and a 6 dB transition bandwidth of ~ 0.1 Hz, and low-pass filtered with a similar function that resulted in half-amplitude attenuation at 40 Hz and a 6 dB transition bandwidth of 8 Hz. ERP analysis was conducted using a combination of custom scripts for Matlab (Mathworks, Natick, MA) and the EEGLAB toolbox (Delorme and Makeig, 2004). Analysis began with the computation of independent components using the logistic infomax independent component analysis (ICA) algorithm (Bell and Sejnowski, 1995). The primary component associated with eye movements was identified and used to reject epochs in which participants moved their eyes, which resulted in the average rejection of 8.5% of total trials per subject (±3.6% SD). Following this all components associated with blinks, line noise, and other sources of artifact were removed from the data.

7 Mouse studies have proposed several markers for gastric stem ce

7 Mouse studies have proposed several markers for gastric stem cells.4, 8, 9, 10 and 11 Two markers, Lgr5 and Troy, have allowed the identification of cells that have the capacity to self-renew and to generate the different lineages of the stomach in vivo.4 and 11 Research on human gastric stem cells currently is limited. The analysis of spontaneous mutations in the cytochrome c oxidase gene has shown that some, but not all, human gastric units are monoclonal, allowing the conclusion that at

one point in life multipotent stem cells have resided in these units.3 However, direct evidence for the presence selleckchem of multipotent gastric stem cells into adulthood is lacking. One of the Selleckchem Epigenetic inhibitor major functions of the gastrointestinal epithelium is to shield the body from infections and to maintain a peaceful co-existence with the gut commensals. Studies on host–pathogen or host–commensal interactions rely on the use of established model systems such as infection of animals or cancer cell lines,12 but for many pathogens

and commensals, such model systems have not been established yet. The gastric pathogen Helicobacter pylori is one of the most successful pathogens. It uses a range of biological strategies to ensure persistency, which enables it to colonize the stomach of about half of the world’s population. 13 Chronic infection can cause gastric ulcers and gastric cancer. 13 Currently, in vivo experimental studies use rodent models to understand H pylori infection. Although mouse studies certainly are useful, the clinical outcome of infection in mice is usually a mild gastritis that does not progress to ulceration or cancer. Alternatively, the Mongolian gerbil can develop cancer after H pylori infection, but these animals are outbred and the study of host factors therefore would be limited. 12 Other studies use gastric cancer cell lines that typically harbor oncogenic

mutations. Human primary cells would represent the gastric epithelium much more closely, but current techniques are limited to isolation of differentiated (mostly mucous) cells that are not able to self-renew and thus can be maintained for only a few days. 14, 15 and 16 No expanding primary gastric culture system exists that enables new research of primary human gastric cells. Here, we present a gastric culture system that allows indefinite (>1 y) expansion of human gastric cells. The cultures differentiate into the gastric lineages and can be used as a tool to study stem cell biology as well as the response of the epithelium to infection. Human corpus tissue was obtained from 17 patients (12 men, 5 women; age range, 41–87 y) who underwent partial or total gastrectomy at the University Medical Centre Utrecht. Ten patients were diagnosed with gastric cancer and 7 patients were diagnosed with esophageal cancer.

W razie kolizji obowiązków ustawodawca nakazuje stosowanie „odpow

W razie kolizji obowiązków ustawodawca nakazuje stosowanie „odpowiednio” przepisów dotyczących stanu wyższej konieczności. W tego typu sytuacji lekarz może w nagłym przypadku celem udzielenia niezbędnej pomocy medycznej, mając do czynienia z małoletnim pacjentem z zaburzeniami psychicznymi o podłożu somatycznym, zastosować środek przymusu bezpośredniego. Uwzględniając powyższe, opowiadamy się za możliwością zastosowania środków przymusu bezpośredniego określonych w Ustawie o ochronie zdrowia psychicznego w stosunku do małoletniego pacjenta, który z powodu

zaburzeń psychicznych o podłożu somatycznym realizuje zamach na swoje życie lub zdrowie. Niewątpliwie bowiem stany pobudzenia towarzyszące niektórym chorobom Cabozantinib solubility dmso somatycznym wymagają zapewnienia pacjentowi bezpieczeństwa. Przy

czym stosujemy regulacje wynikające z tej ustawy ze wszystkimi konsekwencjami, w tym również obowiązkami wynikającymi z rozporządzenia w sprawie sposobu stosowania i dokumentowania zastosowania przymusu bezpośredniego oraz dokonywania oceny zasadności jego zastosowania. I tak, lekarz może zlecić zastosowanie środka przymusu bezpośredniego w postaci unieruchomienia na czas nie dłuży niż 4 godziny (który może być przedłużony). W określonych sytuacjach, o czym była już mowa wyżej, musi skonsultować jego przedłużenie z lekarzem psychiatrą. Przymus bezpośredni w postaci unieruchomienia stosowany jest w pomieszczeniu jednoosobowym. W przypadku braku możliwości umieszczenia pacjenta w takim pomieszczeniu przymus bezpośredni w formie unieruchomienia click here jest stosowany w sposób umożliwiający oddzielenie tej osoby od innych pacjentów przebywających w

tym samym pomieszczeniu oraz zapewniający poszanowanie jej godności i intymności, w szczególności przez wykonywanie zabiegów pielęgnacyjnych bez obecności innych osób (§ 7 rozporządzenia). Pielęgniarka nie rzadziej niż raz na 15 minut kontroluje, także w czasie snu, stan fizyczny pacjenta. Adnotację o stanie fizycznym niezwłocznie odnotowuje w karcie unieruchomienia (§ 10 rozporządzenia). W czasie tej kontroli pielęgniarka m.in. zapewnia krótkotrwałe, nie rzadziej jednak niż co 4 godziny, częściowe albo całkowite uwolnienie pacjenta od unieruchomienia Nutlin-3 nmr w celu zmiany jego pozycji lub zaspokojenia potrzeb fizjologicznych i higienicznych (§ 11 rozporządzenia). Z całą stanowczością podkreślić należy, że jest to wykładnia, która może znaleźć przeciwników. I to nie tylko, gdy chodzi o małoletnich pacjentów. Ten temat bowiem zawsze będzie budził wątpliwości. Mówimy przecież o stosowaniu środków bez zgody pacjenta, a także wbrew jego woli. W przypadku małoletniego pacjenta chodzi o brak zgody czy sprzeciw przedstawicieli ustawowych. Ponadto kwestia stosowania przymusu bezpośredniego ma zbyt dużą rangę, aby można było pozostawić ją tylko dającej się podważyć wykładni. De lege ferenda w tej mierze postulować należy wprowadzenie, np.