Fever in neutropenic cancer patients : a structured approach

Infectious complications related to acquired neutropenia have become a major medical issue, often requiring intensive care management. These infections may be lethal if empirical broad-spectrum treatment is not rapidly started at the first sign of infection (i.e., fever), and this concept is now widely recognized a standard practice. However, the choice of antibiotics has generated considerable controversy for nearly 25 years. After reviewing some particularities of infection in neutropenic patients, this paper will discuss the options and present comprehensive algorithm for non-infectious diseases specialist, including recent advances about early IV-oral switch and the selection of low risk patients for outpatient management.

Hexyl Aminolevulinate-Guided Fluorescence Cystoscopy in the Diagnosis and Follow-up of Patients with Non-Muscle-invasive Bladder Cancer: A Critical Review of the Current Literature.

CONTEXT: Controversy exists regarding the therapeutic benefit and cost effectiveness of photodynamic diagnosis (PDD) with 5-aminolevulinic acid (5-ALA) or hexyl aminolevulinate (HAL) in addition to white-light cystoscopy (WLC) in the management of non-muscle-invasive bladder cancer (NMIBC). OBJECTIVE: To systematically evaluate evidence regarding the therapeutic benefits and economic considerations of PDD in NMIBC detection and treatment. EVIDENCE ACQUISITION: We performed a critical review of PubMed/Medline, Embase, and the Cochrane Library in October 2012 according to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement. Identified reports were reviewed according to the Consolidated Standards of Reporting Trials (CONSORT) and Standards for the Reporting of Diagnostic Accuracy Studies (STARD) criteria. Forty-four publications were selected for inclusion in this analysis. EVIDENCE SYNTHESIS: Included reports used 5-ALA (in 26 studies), HAL (15 studies), or both (three studies) as photosensitising agents. PDD increased the detection of both papillary tumours (by 7-29%) and flat carcinoma in situ (CIS; by 25-30%) and reduced the rate of residual tumours after transurethral resection of bladder tumour (TURBT; by an average of 20%) compared to WLC alone. Superior recurrence-free survival (RFS) rates and prolonged RFS intervals were reported for PDD, compared to WLC in most studies. PDD did not appear to reduce disease progression. Our findings are limited by tumour heterogeneity and a lack of NMIBC risk stratification in many reports or adjustment for intravesical therapy use in most studies. Although cost effectiveness has been demonstrated for 5-ALA, it has not been studied for HAL. CONCLUSIONS: Moderately strong evidence exists that PDD improves tumour detection and reduces residual disease after TURBT compared with WLC. This has been shown to improve RFS but not progression to more advanced disease. Further work to evaluate cost effectiveness of PDD is required.

Crystal packing modifies ligand binding affinity: the case of aldose reductase.

The relationship between the structures of protein-ligand complexes existing in the crystal and in solution, essential in the case of fragment-based screening by X-ray crystallography (FBS-X), has been often an object of controversy. To address this question, simultaneous co-crystallization and soaking of two inhibitors with different ratios, Fidarestat (FID; K(d) = 6.5 nM) and IDD594 (594; K(d) = 61 nM), which bind to h-aldose reductase (AR), have been performed. The subatomic resolution of the crystal structures allows the differentiation of both inhibitors, even when the structures are almost superposed. We have determined the occupation ratio in solution by mass spectrometry (MS) Occ(FID)/Occ(594) = 2.7 and by X-ray crystallography Occ(FID)/Occ(594) = 0.6. The occupancies in the crystal and in solution differ 4.6 times, implying that ligand binding potency is influenced by crystal contacts. A structural analysis shows that the Loop A (residues 122-130), which is exposed to the solvent, is flexible in solution, and is involved in packing contacts within the crystal. Furthermore, inhibitor 594 contacts the base of Loop A, stabilizing it, while inhibitor FID does not. This is shown by the difference in B-factors of the Loop A between the AR-594 and AR-FID complexes. A stable loop diminishes the entropic energy barrier to binding, favoring 594 versus FID. Therefore, the effect of the crystal environment should be taken into consideration in the X-ray diffraction analysis of ligand binding to proteins. This conclusion highlights the need for additional methodologies in the case of FBS-X to validate this powerful screening technique, which is widely used.

The Social Value of Being Ambivalent: Self-Presentational Concerns in the Expression of Attitudinal Ambivalence

We tested whether individuals can exert control over the expression of attitudinal ambivalence and if this control is exerted with self-presentational concerns. Using the self-presentation paradigm, participants reported more ambivalence about Genetically Modified Organisms ("GMO") in a standard and a self-enhancement (present yourself positively) conditions than in a self-depreciation (present yourself negatively) condition, on both felt (Experiments 1a and 2a) and potential ambivalence, in its cognitive (Experiments 1b and 2b) and affective components (Experiments 1b and 2c). The role of ambivalent attitudes in conveying a positive social value was confirmed by the fact that the above effect was found on a controversial attitude object (GMOs) but the opposite appeared on a non-controversial one (e.g. tooth brushing, a truism; Experiment 3). Such a reversal was obtained by directly manipulating the perception of controversy on GMOs (Experiment 4). Attitudinal ambivalence may thus serve an adaptive function, i.e. achieving a positive social value.

En el corazón de las tinieblas... del Putumayo, 1890-1932. Fronteras, caucho, mano de obra indígena y misiones católicas en la nacionalización de la Amazonía

Objetivo del artículo es reflexionar sobre el llamado «escándalo del Putumayo» estallado en la primera década del siglo XX, en la región objeto de litigio fronterizo entre Perú y Colombia. La denuncia en la prensa internacional de la explotación de los indígenas amazónicos hecha por la empresa «Peruvian Amazon Company», de la que el principal accionista fue el cauchero Julio C. Arana, presentó la región como un nuevo «Congo peruano» y provocó la intervención de Gran Bretaña, Perú, el Vaticano, Colombia y el propio Arana. A partir de repositorios documentales de la cancillería peruana, de los archivos de la Santa Sede, de la folletística y bibliografía publicada por las partes involucradas se plantea una reflexión sobre el escándalo, incidiendo en los argumentos sostenidos por las partes, en particular la peruanización de la región, defendida por Arana y el gobierno peruano.

Avaluació de revistes i avaluació de la recerca en humanitats i ciències socials a Catalunya: aproximació a un problema

The evaluation of the quality and impact of journals as a starting point to systematise the quality of research is an indirect method commonly used for obtaining information for systematic and major evaluation efforts, such as those needed for public tenders to aid projects and research groups. Nevertheless, this method runs into an important obstacle: preparing rankings of journals in the humanities and social sciences is considerably more complex than for those on experimental, biomedical or technological sciences. Cultural, linguistic and territorial components of research in the humanities and social sciences radically question the international rankings. Within this context, the article presents the experience of a study-in-progress whose intention is to evaluate the rankings of journals in the humanities and social sciences published in 1997 by the Generalitat de Catalunya. Even thought an attempt was made to bring this type of titles closer to the Catalan community of researchers, the initiative has been frequently surrounded by controversy and criticism and, at the present, does not enjoy the needed recognition of the Catalan academic sector.

Evaluation of heterogeneity of DNA ploidy in early gastric cancers.

DNA ploidy has been shown to be a predictive parameter for prognosis in various solid tumours. The prognostic value of DNA-ploidy in gastric cancers is still a matter of controversy. A possible explanation for the discrepant results reported in the literature could be sampling error in tumours with multiple stemlines differing in DNA-ploidy. In order to determine whether or not such heterogeneity exists in early gastric carcinoma, we have performed DNA cytophotometry on multiple samples of a group of 17 early gastric carcinomas, of which 8 were pure intramucosal and 9 were infiltrating into the submucosa. We found an aneuploid DNA-stemline in 8 (47%) early gastric cancers, more often in tumours invading into the submucosa (5/9) than in purely mucosal tumours (3/8). Multiple DNA-stemlines were found more frequently in submucosally infiltrating tumours (4/5). These results confirm the presence of DNA-aneuploid early gastric carcinoma which are frequently heterogeneous and suggest that heterogeneity occurs more frequently in tumours invading the submucosa. This heterogeneity is best detected by analysing multiple samples of tumours for DNA-ploidy.

Lessons From the Swiss Medical Board Recommendation Against Mammography Screening Programs

When the US Preventive Services Task Force (USPSTF) in 2009 recommended against universal breast cancer screening with mammography in women aged 40 to 49 years, some scientists, radiologists, politicians, and patients strongly objected. The controversy has been called the "mammography wars." The latest chapter in these wars comes from the Swiss Medical Board, which is mandated by the Conference of Health Ministers of the Swiss Cantons, the Swiss Medical Association, and the Swiss Academy of Medical Sciences to conduct health technology assessments. In a February 2014 report, the Swiss Medical Board stated that new systematic mammography screening programs should not be introduced, irrespective of the age of the women, and that existing programs should be discontinued. The board's main argument was that the absolute reduction in breast cancer mortality was low and that the adverse consequences of the screening were substantial. The absolute risk reduction in breast cancer mortality has been estimated by the board at 0.16% for women screened during 6.2 years and followed-up over 13 years, based on the results of a recent Cochrane Review. The adverse consequences include falsepositive test results, overdiagnosis and overtreatment of patients, and high costs, including the expense of follow-up testing and procedures.

Critères de diagnostic de la fibromyalgie [Fibromyalgia diagnostic criteria].

Fibromyalgia is nowadays an object of controversy. It is the most significant painful and chronic pathology, with a prevalence of 2 to 4% in the general population and a ratio of 3.5% of women for 0.5% of men. Since 1990, fibromyalgia has been defined according to the criteria of the American College of Rheumatology (ACR). The use of these criteria in practice has proved to be controversial and a wide range of studies has shown that an important percentage of patients with fibromyalgia are diagnosed without the criteria of the ACR. This article describes an alternative method for the diagnosis of fibromyalgia.

The Hercynian ore deposits from the Catalonian Coastal Ranges

Many mineralizations, showings and geochemical anomalies have been found in the Hercynian of the Catalonian Coastal Ranges during the last ten years. Many of them are enclosed in the Paleozoic sediments and volcanics and display pre-metamorphic syngenetic characteristics. The lower carboniferous manganese and base meta1 deposits appear to be formed from hydrothermal fluids springing up in the sea floor through active fractures controlling the filling of the basins in a extensional geotectonic setting. Although less evidence and more controversy is available, similar ore forming processes could have taken place in older Paleozoic times. The deformation and metamorphism have not played an important remobilization role, and most epigenetic deposits of Hercynian age are related to the hydrothermal cells induced by the post-metamorphic granitic intrusives.

Tonotopic mapping of human auditory cortex.

Since the early days of functional magnetic resonance imaging (fMRI), retinotopic mapping emerged as a powerful and widely-accepted tool, allowing the identification of individual visual cortical fields and furthering the study of visual processing. In contrast, tonotopic mapping in auditory cortex proved more challenging primarily because of the smaller size of auditory cortical fields. The spatial resolution capabilities of fMRI have since advanced, and recent reports from our labs and several others demonstrate the reliability of tonotopic mapping in human auditory cortex. Here we review the wide range of stimulus procedures and analysis methods that have been used to successfully map tonotopy in human auditory cortex. We point out that recent studies provide a remarkably consistent view of human tonotopic organisation, although the interpretation of the maps continues to vary. In particular, there remains controversy over the exact orientation of the primary gradients with respect to Heschl's gyrus, which leads to different predictions about the location of human A1, R, and surrounding fields. We discuss the development of this debate and argue that literature is converging towards an interpretation that core fields A1 and R fold across the rostral and caudal banks of Heschl's gyrus, with tonotopic gradients laid out in a distinctive V-shaped manner. This suggests an organisation that is largely homologous with non-human primates. This article is part of a Special Issue entitled Human Auditory Neuroimaging.

Blood donor motivation: what is ethical? What works?

The retention of previous donors and the recruitment of new donors is a serious challenge for many blood donation services in their effort to prevent blood shortages. More and more services make use of some sort of donation incentives. However, the use of (material) incentives to motivate blood donors is fiercely controversial and there is a longstanding (ethical) debate about whether it should be allowed that donors receive material rewards. Interestingly, this debate is dealt with in almost complete absence of systematic empirical evidence on the effectiveness of material incentives in encouraging people to donate. In this paper, we argue that the discussion on what is ethical in motivating blood donors should be enriched with empirical evidence based on field experiments. We confront the Titmuss controversy with recent results from an experiment administering lottery tickets as a motivation device. Moreover, we take up a neglected phenomenon in the study of blood donors: many non-donors are not principally against donating blood they have just never made up their mind about becoming active blood donors. We propose active decisions as a mechanism to transform latent prosocial preferences into actual prosocial behavior.

Rapid radiation in spiny lobsters (Palinurus spp) as revealed by classic and ABC methods using mtDNA and microsatellite data

Background: Molecular tools may help to uncover closely related and still diverging species from a wide variety of taxa and provide insight into the mechanisms, pace and geography of marine speciation. There is a certain controversy on the phylogeography and speciation modes of species-groups with an Eastern Atlantic-Western Indian Ocean distribution, with previous studies suggesting that older events (Miocene) and/or more recent (Pleistocene) oceanographic processes could have influenced the phylogeny of marine taxa. The spiny lobster genus Palinurus allows for testing among speciation hypotheses, since it has a particular distribution with two groups of three species each in the Northeastern Atlantic (P. elephas, P. mauritanicus and P. charlestoni) and Southeastern Atlantic and Southwestern Indian Oceans (P. gilchristi, P. delagoae and P. barbarae). In the present study, we obtain a more complete understanding of the phylogenetic relationships among these species through a combined dataset with both nuclear and mitochondrial markers, by testing alternative hypotheses on both the mutation rate and tree topology under the recently developed approximate Bayesian computation (ABC) methods. Results Our analyses support a North-to-South speciation pattern in Palinurus with all the South-African species forming a monophyletic clade nested within the Northern Hemisphere species. Coalescent-based ABC methods allowed us to reject the previously proposed hypothesis of a Middle Miocene speciation event related with the closure of the Tethyan Seaway. Instead, divergence times obtained for Palinurus species using the combined mtDNA-microsatellite dataset and standard mutation rates for mtDNA agree with known glaciation-related processes occurring during the last 2 my. Conclusion The Palinurus speciation pattern is a typical example of a series of rapid speciation events occurring within a group, with very short branches separating different species. Our results support the hypothesis that recent climate change-related oceanographic processes have influenced the phylogeny of marine taxa, with most Palinurus species originating during the last two million years. The present study highlights the value of new coalescent-based statistical methods such as ABC for testing different speciation hypotheses using molecular data.

Genetic variants of the FADS gene cluster and ELOVL gene family, colostrums LC-PUFA levels, breastfeeding, and child cognition

Introduction: Breastfeeding effects on cognition are attributed to long-chain polyunsaturated fatty acids (LC-PUFAs), but controversy persists. Genetic variation in fatty acid desaturase (FADS) and elongase (ELOVL) enzymes has been overlooked when studying the effects of LC-PUFAs supply on cognition. We aimed to: 1) to determine whether maternal genetic variants in the FADS cluster and ELOVL genes contribute to differences in LC-PUFA levels in colostrum; 2) to analyze whether these maternal variants are related to child cognition; and 3) to assess whether children's variants modify breastfeeding effects on cognition. Methods: Data come from two population-based birth cohorts (n = 400 mother-child pairs from INMA-Sabadell; and n = 340 children from INMA-Menorca). LC-PUFAs were measured in 270 colostrum samples from INMA-Sabadell. Tag SNPs were genotyped both in mothers and children (13 in the FADS cluster, 6 in ELOVL2, and 7 in ELOVL5). Child cognition was assessed at 14 mo and 4 y using the Bayley Scales of Infant Development and the McCarthy Scales of Children"s Abilities, respectively. Results: Children of mothers carrying genetic variants associated with lower FADS1 activity (regulating AA and EPA synthesis), higher FADS2 activity (regulating DHA synthesis), and with higher EPA/AA and DHA/AA ratios in colostrum showed a significant advantage in cognition at 14 mo (3.5 to 5.3 points). Not being breastfed conferred an 8- to 9-point disadvantage in cognition among children GG homozygote for rs174468 (low FADS1 activity) but not among those with the A allele. Moreover, not being breastfed resulted in a disadvantage in cognition (5 to 8 points) among children CC homozygote for rs2397142 (low ELOVL5 activity), but not among those carrying the G allele. Conclusion: Genetically determined maternal supplies of LC-PUFAs during pregnancy and lactation appear to be crucial for child cognition. Breastfeeding effects on cognition are modified by child genetic variation in fatty acid desaturase and elongase enzymes.

Tous égaux devant Dieu ? Réflexions sur les logiques d'éligibilité des miraculés

Le pentecôtisme a fait du miracle le coeur de sa théologie et l'élément central de ses activités d'évangélisation. Le catholicisme, par contre, a toujours voulu contrôler l'ensemble des déclarations de manifestations divines. Apparitions et guérisons miraculeuses ont donc systématiquement, et de plus en plus, été soumises à de lentes et rigoureuses procédures d'authentification. Les pentecôtistes voient Dieu comme un être extérieur qui surgit sur la terre pour chasser le mal qui l'envahit. Tous les convertis ont donc droit à la libération et personne ne doit accepter sagement la souffrance. Or, les pèlerins catholiques que nous avons étudiés ne partagent pas ces convictions pentecôtistes. Dieu agit de l'intérieur, non pas en les délivrant, mais en les soutenant dans leurs épreuves quotidiennes. Rare et peu recherchée, la guérison physique cède la place à la guérison spirituelle, accessible à tous. Il nous semble que ces deux types de représentations placent les fidèles dans des dispositions d'esprit très divergentes suscitant, dans un cas ou dans l'autre, des espoirs adaptés à la capacité du groupe à produire des miracles. Pentecostalism placed miracles at the centre of its theology as a key element of its evangelization activities. Catholicism, on the other hand, has always tried to control all declarations of divine demonstrations. Miraculous appearances and recoveries have been more and more systematically subjected to slow and rigorous procedures of verification. The Pentecostals see God as an external force which manifests itself on earth to drive out the evil which invades it. All believers have the right to be free from evil, and nobody should have to accept pain meekly. But the Catholic pilgrims we studied do not share these Pentecostal convictions. God acts from inside, not by delivering them but by supporting them in their daily tests. Physical recovery is rare and not very sought after so it takes second place to spiritual recovery which is accessible to everyone. It seems to us that these two types of representation place believers in very divergent frames of mind giving rise, in one group or the other, to hopes that correspond to the group's capacity to produce miracles.