International comparison of the German evidence-based S3-guidelines on the diagnosis and multimodal treatment of early and locally advanced gastric cancer, including adenocarcinoma of the lower esophagus.

BACKGROUND: Clinical guidelines are essential in implementing and maintaining nationwide stage-specific diagnostic and therapeutic standards. In 2011, the first German expert consensus guideline defined the evidence for diagnosis and treatment of early and locally advanced esophagogastric cancers. Here, we compare this guideline with other national guidelines as well as current literature. METHODS: The German S3-guideline used an approved development process with de novo literature research, international guideline adaptation, or good clinical practice. Other recent evidence-based national guidelines and current references were compared with German recommendations. RESULTS: In the German S3 and other Western guidelines, adenocarcinomas of the esophagogastric junction (AEG) are classified according to formerly defined AEG I-III subgroups due to the high surgical impact. To stage local disease, computed tomography of the chest and abdomen and endosonography are reinforced. In contrast, laparoscopy is optional for staging. Mucosal cancers (T1a) should be endoscopically resected "en-bloc" to allow complete histological evaluation of lateral and basal margins. For locally advanced cancers of the stomach or esophagogastric junction (≥T3N+), preferred treatment is preoperative and postoperative chemotherapy. Preoperative radiochemotherapy is an evidence-based alternative for large AEG type I-II tumors (≥T3N+). Additionally, some experts recommend treating T2 tumors with a similar approach, mainly because pretherapeutic staging is often considered to be unreliable. CONCLUSIONS: The German S3 guideline represents an up-to-date European position with regard to diagnosis, staging, and treatment recommendations for patients with locally advanced esophagogastric cancer. Effects of perioperative chemotherapy versus chemoradiotherapy are still to be investigated for adenocarcinoma of the cardia and the lower esophagus.

Multimodal stimulus coding by a gustatory sensory neuron in Drosophila larvae.

Accurate perception of taste information is crucial for animal survival. In adult Drosophila, gustatory receptor neurons (GRNs) perceive chemical stimuli of one specific gustatory modality associated with a stereotyped behavioural response, such as aversion or attraction. We show that GRNs of Drosophila larvae employ a surprisingly different mode of gustatory information coding. Using a novel method for calcium imaging in the larval gustatory system, we identify a multimodal GRN that responds to chemicals of different taste modalities with opposing valence, such as sweet sucrose and bitter denatonium, reliant on different sensory receptors. This multimodal neuron is essential for bitter compound avoidance, and its artificial activation is sufficient to mediate aversion. However, the neuron is also essential for the integration of taste blends. Our findings support a model for taste coding in larvae, in which distinct receptor proteins mediate different responses within the same, multimodal GRN.

Caregiver's interpret infants' early gestures based on shared knowledge about referents

Gestures are the first forms of conventional communication that young children develop in order to intentionally convey a specific message. However, at first, infants rarely communicate successfully with their gestures, prompting caregivers to interpret them. Although the role of caregivers in early communication development has been examined, little is known about how caregivers attribute a specific communicative function to infants' gestures. In this study, we argue that caregivers rely on the knowledge about the referent that is shared with infants in order to interpret what communicative function infants wish to convey with their gestures. We videotaped interactions from six caregiver-infant dyads playing with toys when infants were 8, 10, 12, 14, and 16 months old. We coded infants' gesture production and we determined whether caregivers interpreted those gestures as conveying a clear communicative function or not; we also coded whether infants used objects according to their conventions of use as a measure of shared knowledge about the referent. Results revealed an association between infants' increasing knowledge of object use and maternal interpretations of infants' gestures as conveying a clear communicative function. Our findings emphasize the importance of shared knowledge in shaping infants' emergent communicative skills.

Tracking the source of cerebellar epilepsy: hemifacial seizures associated with cerebellar cortical dysplasia.

Traditionally, subcortical structures such as the cerebellum are supposed to exert a modulatory effect on epileptic seizures, rather than being the primary seizure generator. We report a 14-month old girl presenting, since birth, with seizures symptomatic of a right cerebellar dysplasia, manifested as paroxystic contralateral hemifacial spasm and ipsilateral facial weakness. Multimodal imaging was used to investigate both anatomical landmarks related to the cerebellar lesion and mechanisms underlying seizure generation. Electric source imaging (ESI) supported the hypothesis of a right cerebellar epileptogenic generator in concordance with nuclear imaging findings; subsequently validated by intra-operative intralesional recordings. Diffusion spectrum imaging-related tractography (DSI) showed severe cerebellar structural abnormalities confirmed by histological examination. We suggest that hemispheric cerebellar lesions in cases like this are likely to cause epilepsy via an effect on the facial nuclei through ipsilateral and contralateral aberrant connections.

Prevention and treatment options for postoperative delirium in the elderly.

PURPOSE OF REVIEW: To review recent findings and developments in strategies for prevention and treatment of postoperative delirium. RECENT FINDINGS: Current advances in the field include improved knowledge about predisposing and precipitating factors, evidence for efficacy of multicomponent prevention programmes, refinement of perioperative procedures, and promising pharmacological approaches for prophylaxis and management of postoperative delirium. SUMMARY: Postoperative delirium is a common and serious complication in elderly patients. Preoperative assessment of risk profiles and tailored multimodal prevention approaches proved effective and should be integrated into clinical practice. Despite promising recent findings, at present, the routine use of pharmacological prophylaxis cannot be recommended. Validated and easy-to-use bedside diagnostic tools are available and should be regularly applied for delirium screening in the first days after surgery. In patients developing delirium, causal conditions and contributing factors need to be identified and addressed. Whereas administration of antipsychotics may represent an option for symptomatic treatment, further studies are needed to evaluate the effects of pharmacological approaches on long-term outcomes in elderly patients with delirium.

Le mystère apocryphe : introduction à une littérature méconnue

L' intérêt est vif aujourd'hui pour cette littérature proche de la Bible, faite d' évangiles, d' actes des apôtres et d' apocalypses non retenus dans le canon. Pourquoi ces textes apocryphes, qui ont souvent pour objet des événements évoqués ou des personnages mentionnés dans la Bible, ont-ils été mis à l' écart et largement oubliés dans le passé ? Ont-ils été écrits pour concurrencer les livres du Nouveau Testament ? Quel message religieux véhiculaient-ils ? Le lecteur se voit offrir ici de nombreux extraits de textes et des explications qui en disent la portée, l' intérêt et le charme. Enfin réédité, cet ouvrage est considéré comme un classique dans un domaine suscitant toujours plus d' engouement. Il présente l'Evangile de Thomas, l'Evangile de Nicodème, l'Evangile secret de Marc, les Actes de Paul et les Actes de Philippe. Il accueille également un essai inédit sur l'Evangile de Judas, où est évoquée notamment la filière gnostique à laquelle se rattache cet évangile apocryphe; la trahison de Jésus y est interprétée comme un mystère libérant par la mort le Jésus spirituel.

Les Actes de Paul. Un portrait inhabituel de l'apôtre

(Résumé de l'ouvrage) L'intérêt est vif aujourd'hui pour cette littérature proche de la Bible, faite d' évangiles, d' actes des apôtres et d' apocalypses non retenus dans le canon. Pourquoi ces textes apocryphes, qui ont souvent pour objet des événements évoqués ou des personnages mentionnés dans la Bible, ont-ils été mis à l' écart et largement oubliés dans le passé ? Ont-ils été écrits pour concurrencer les livres du Nouveau Testament ? Quel message religieux véhiculaient-ils ? Le lecteur se voit offrir ici de nombreux extraits de textes et des explications qui en disent la portée, l' intérêt et le charme. Enfin réédité, cet ouvrage est considéré comme un classique dans un domaine suscitant toujours plus d' engouement. Il présente l'Evangile de Thomas, l'Evangile de Nicodème, l'Evangile secret de Marc, les Actes de Paul et les Actes de Philippe. Il accueille également un essai inédit sur l'Evangile de Judas, où est évoquée notamment la filière gnostique à laquelle se rattache cet évangile apocryphe; la trahison de Jésus y est interprétée comme un mystère libérant par la mort le Jésus spirituel.

Matthieu et le judaïsme : une rivalité de frères ennemis

(Résumé de l'ouvrage) La question est souvent posée brutalement : « Le Nouveau Testament est-il anti-juif ? » Comment le message d'amour de Jésus a-t-il pu entraîné et même justifié le mépris, la haine et les violences des chrétiens envers les Juifs, au long des deux millénaires ? Que pensaient exactement les auteurs des évangiles, des Actes des Apôtres et des épîtres ? Comment leurs écrits ont-ils été compris au siècle suivant ? Cinq spécialistes éclairent ces questions en proposant des lectures attentives des divers textes du Nouveau Testament qui parlent des Juifs. Cette étude est fondamentale pour reprendre sur des bases honnêtes et respectueuses le dialogue interrompu dès le 2e siècle. Il y va de notre fidélité à l'Évangile de Jésus-Messie qui réunit et sépare à la fois Juifs et chrétiens.

Juifs et chrétiens selon Luc-Actes : une quête d'identité.

(Résumé de l'ouvrage) La question est souvent posée brutalement : « Le Nouveau Testament est-il anti-juif ? » Comment le message d'amour de Jésus a-t-il pu entraîné et même justifié le mépris, la haine et les violences des chrétiens envers les Juifs, au long des deux millénaires ? Que pensaient exactement les auteurs des évangiles, des Actes des Apôtres et des épîtres ? Comment leurs écrits ont-ils été compris au siècle suivant ? Cinq spécialistes éclairent ces questions en proposant des lectures attentives des divers textes du Nouveau Testament qui parlent des Juifs. Cette étude est fondamentale pour reprendre sur des bases honnêtes et respectueuses le dialogue interrompu dès le 2e siècle. Il y va de notre fidélité à l'Évangile de Jésus-Messie qui réunit et sépare à la fois Juifs et chrétiens.

Le coeur inquiet du christianisme

(Résumé du numéro) Prophéties et visions du futur Notre époque se méfie des prophètes, mais fait confiance aux astrologues, devins et autres voyantes... Y compris dans les plus hautes sphères du pouvoir! Ce surgissement de l'irrationnel dans une société fière de sa "science" laisse perplexe. De telles croyances, dont le caractère païen est parfois souligné, entretiennent dans l'esprit du public une confusion fâcheuse entre prophétie et prédiction. Le prophétisme s'en trouve dévalorisé, alors qu'il a joué à certains moments un rôle décisif dans l'histoire de l'humanité. "L'avez-vous remarqué?", écrivait il y a quelques années Bruno Chenu, "À l'heure actuelle, le thème du prophétisme semble s'être évanoui du paysage, tant social qu'ecclésial. Il n'y a plus grand monde pour se risquer à une interpellation forte, à une mise en cause radicale, à une proposition dérangeante. [...] Nous sommes à l'âge des croyances molles. N'est-il pas grand temps de retrouver, collectivement et personnellement, l'inspiration prophétique?" (1). Le prophète est une figure centrale des religions monothéistes. Il porte la sagesse du message divin que les hommes ne savent pas discerner. Donc, il dérange. Et si sa parole est écoutée, voire sollicitée, dans les périodes d'incertitudes, il devient gênant dès lors que le pouvoir - religieux ou politique - pense avoir repris en main les destinées de la communauté. "L'avenir n'est à personne, sire, l'avenir est à Dieu" rappelle, trop tard!, Victor Hugo à Napoléon 1er. Il est vrai que la condamnation des prophètes est souvent consécutive à une catastrophe déclenchée par de "faux" prophètes. La difficulté à identifier la véritable prophétie a entraîné à plusieurs reprises l'annonce de l'extinction du prophétisme, par les sages juifs au deuxième siècle avant notre ère, ou lorsque le christianisme devient la religion officielle de l'Empire romain. À chaque fois, le prophétisme est réapparu, comme si la religion ne pouvait en faire l'économie. C'est l'une des leçons qui ressort le plus clairement du dossier que nous consacrons au couple tumultueux que constituent prophètes et visions du futur. Le prophète porte aussi les espoirs de l'humanité. Un monde sans prophètes serait-il un monde sans espérance?

L'usage du narratif dans le Testament de Joseph

(Résumé de l'ouvrage) Seventeen innovative studies are collected in this volume which has been produced under the aegis of the Centre for Biblical Studies, University of Manchester, and L'Institut des sciences bibliques, Université de Lausanne. The majority of the studies engage with narrative through providing insightful working examples. Building on the many contributions of recent narratological research, for the most part the studies in this collection avoid the technical language of narratology as they present fresh insights at many levels. Some essays focus more on the implied author, some on the implied reader or hearer, and some on the way particular messages are constructed; some of the studies consider how author, message and reader are all interconnected. There are several creative proposals for refining genre definition, from law and wisdom to gospel and apocryphal writings. Some studies highlight the way in which narratives can contain ethical, religious, and cultural messages. Sensitivity to narrative is also shown by some contributors to expose in intruing ways the redactional processes behind the final form of texts. Students of narrative in the ancient world will find much to consider in this book, and others engaged with literary studies more generally will discover that scholars of the worlds of the Bible and Late Antiquity have much to offer them.

Narrativity in Biblical and Related Texts - La narrativité dans la Bible et les textes apparentés

Seventeen innovative studies are collected in this volume which has been produced under the aegis of the Centre for Biblical Studies, University of Manchester, and L'Institut des sciences bibliques, Université de Lausanne. The majority of the studies engage with narrative through providing insightful working examples. Building on the many contributions of recent narratological research, for the most part the studies in this collection avoid the technical language of narratology as they present fresh insights at many levels. Some essays focus more on the implied author, some on the implied reader or hearer, and some on the way particular messages are constructed; some of the studies consider how author, message and reader are all interconnected. There are several creative proposals for refining genre definition, from law and wisdom to gospel and apocryphal writings. Some studies highlight the way in which narratives can contain ethical, religious, and cultural messages. Sensitivity to narrative is also shown by some contributors to expose in intruing ways the redactional processes behind the final form of texts. Students of narrative in the ancient world will find much to consider in this book, and others engaged with literary studies more generally will discover that scholars of the worlds of the Bible and Late Antiquity have much to offer them.

Brain structure in asymptomatic FMR1 premutation carriers at risk for fragile X-associated tremor/ataxia syndrome.

Fragile X-associated tremor/ataxia syndrome (FXTAS), a late-onset movement disorder affecting FMR1 premutation carriers, is associated with cerebral and cerebellar lesions. The aim of this study was to test whether computational anatomy can detect similar patterns in asymptomatic FMR1 premutation carriers (mean age 46.7 years) with qualitatively normal -appearing grey and white matter on brain MRI. We used a multimodal imaging protocol to characterize brain anatomy by automated assessment of gray matter volume and white matter properties. Structural changes in the hippocampus and in the cerebellar motor network with decreased gray matter volume in lobule VI and white matter alterations of the corresponding afferent projections through the middle cerebellar peduncles are demonstrated. Diffuse subcortical white matter changes in both hemispheres, without corresponding gray matter alterations, are only identified through age × group interactions. We interpret the hippocampal fimbria and cerebellar changes as early alterations with a possible neurodevelopmental origin. In contrast, progression of the diffuse cerebral hemispheric white matter changes suggests a neurodegenerative process, leading to late-onset lesions, which may mark the imminent onset of FXTAS.

The God of the Book of Acts

(Résumé de l'ouvrage) Seventeen innovative studies are collected in this volume which has been produced under the aegis of the Centre for Biblical Studies, University of Manchester, and L'Institut des sciences bibliques, Université de Lausanne. The majority of the studies engage with narrative through providing insightful working examples. Building on the many contributions of recent narratological research, for the most part the studies in this collection avoid the technical language of narratology as they present fresh insights at many levels. Some essays focus more on the implied author, some on the implied reader or hearer, and some on the way particular messages are constructed; some of the studies consider how author, message and reader are all interconnected. There are several creative proposals for refining genre definition, from law and wisdom to gospel and apocryphal writings. Some studies highlight the way in which narratives can contain ethical, religious, and cultural messages. Sensitivity to narrative is also shown by some contributors to expose in intruing ways the redactional processes behind the final form of texts. Students of narrative in the ancient world will find much to consider in this book, and others engaged with literary studies more generally will discover that scholars of the worlds of the Bible and Late Antiquity have much to offer them.