Impacte d'un programa d'informació sobre l'elaboració del document de voluntats anticipades

Tot i que en el nostre territori comptem des de els anys 80 amb diferents models de Document de Voluntats Anticipades (DVA), aquests continuen essent desconeguts tant per la ciutadania com pels professionals de la salut. Aquesta situació ha fet que ens plantegem com a objectiu d’aquest estudi descriure si existeix la correlació entre el fet de proporcionar informació sobre el DVA i la motivació per la seva realització. En aquest estudi hem agafat com a mostra els usuaris del servei de psicogeriatria de la Fundació Sociosanitaria de Manresa l’Hospital de Sant Andreu de Manresa, tenint en compte les recomanacions del Document Sitges del 2005 i d’altres autors que recomanen fer el DVA en situació de demència lleu o moderada. També s’ha tingut present l’elevada prevalença d’aquesta patologia. S'ha dissenyat un assaig clínic comunitari amb aleatorització de dos consultoris d'un servei de psicogeriatria. Els metges del consultori assignat al grup control feien el tractament habitual en relació al DVA, és a dir, no informar els pacients atesos sobre l'existència i característiques del DVA, i els metges del consultori assignat al grup intervenció donaven informació reglada als seus pacients sobre el DVA. En el moment de la inclusió es registrava informació sociodemogràfica i clínica per poder classificar els participants i, també a tots els subjectes inclosos en l'assaig, al cap de tres setmanes se'ls feia una enquesta telefònica per avaluar l'opinió i el coneixement sobre el DVA. De les respostes de l’enquesta podem extreure com a resultats que més del 90% dels subjectes del grup control no coneixen el DVA. També s’observa de manera significativa com les persones del grup intervenció parlen amb el metge,la infermera i/o la família sobre la dependència i la mort, tenint en compte que la mort i la dependència continuen sent un tema tabú, i que la majoria de la població de l’estudi no planifiquen com volen ser atesos. Tanmateix s’observa com un 2’3 % tenia fet el DVA i un 22’7% manifesten la seva voluntat de realitzar-lo. Amb aquest estudi es conclou que el fet de proporcionar informació sobre el DVA als usuaris del servei de psicogeriatria afavoreix que aquests estiguin motivats per la realització d’aquest document; al mateix temps també afavoreix la planificació de les cures i el parlar sobres temes com la mort i/o la dependència amb la família, el metge la infermera.

Growth Arrest-Specific Gene 6 product modulates innate immunity in sepsis

Background: Growth Arrest-Specific Gene 6 product (Gas6) is, like anticoagulant protein C, a vitamin K-dependent protein. Our aim was to determine whether Gas6 plays a role in sepsis. Materials and methods: We submitted mice lacking Gas6 (Gas6)/)) or one of its receptors (Axl)/), Tyro3)/) or Mertk)/)) to LPS-induced endotoxemia and peritonitis (cecal ligation and puncture (CLP) and inoculation of E. coli). In addition, we measured Gas6 or its soluble receptors in plasma of eight volunteers that received LPS, 13 healthy subjects, 28 patients with severe sepsis, and 18 patients with non-infectious inflammatory diseases. Results: Gas6 and its soluble receptor sAxl raised in mice models and TNF-a was more elevated in Gas6)/) mice than in wild-type (WT). Protein array showed that before and after LPS injection, titers of 62 cytokines were more elevated in plasma of Gas6)/) than WT mice. Endotoxemia-induced mortality was higher in Gas6)/), Axl)/), Tyro3)/) and Mertk)/) compared to WT mice and mortality subsequent to CLP was amplified in Gas6)/) mice. LPS-stimulated Gas6)/) macrophages produced more cytokines than WT macrophages. This production was dampened by recombinant Gas6. Phosphorylation of Akt in Gas6)/) macrophages was reduced, but p38 phosphorylation and NF-jB translocation were increased. In human, Gas6 raised in plasma after LPS (2 ng/kg). Gas6 and sAxl were higher in patients with severe sepsis than in healthy subjects or control patients, and there was a non-significant trend for higher Gas6 in the survival group. Conclusions: Our data point to Gas6 as a major modulator of innate immunity and provide thereby novel insights into the mechanism of sepsis. Thus Gas6 and its receptors might constitute potential therapeutic targets for the development of new immunomodulating drugs.

IDENTITÉ, PROJET, CHANGEMENT : DES REPRÉSENTATIONS SOCIALES AUX LEVIERS DE L'ACTION PUBLIQUE. POUR UN MODE DE GOUVERNANCE AXÉ SUR LE DÉVELOPPEMENT TERRITORIAL. ETUDE DE CAS : CANTON DU JURA (SUISSE)

Thirty years after the Canton of Jura entered sovereignty, it has to be admited that the creation of the newly canton did't fullfill the hopes of economic and demografic growth that many could have expected from political independance. Through a plurality of complementary approaches, the research suggest a closer look at, on one hand, the position of the Canton in its territorial context as well as its structure and dynamics and on the other hand, the representations of the territory and its evolution by the social actors. This in order to formulate a set of social demands (of debate, of openness and of overcoming cleavages) which augurs for a new territoriality regime and testify of a requirement of reflexivity toward the state institutions and actions. The analysis allowed to set in evidence the central role of the couple identity-project in the dynamics of change, and to identifiy three main periods in the recent past of the Canton: a period of territorialization, during which grew a strong collective identity, coupled with a major project of society (the creation of the canton of Jura); then followed a period of deterritorialization, with the fragmentation of the collective identity and the lack of a project of society. Then, the third period, with a paradoxical event, the failure in public vote of the the project Jura open Land (Jura Pays ouvert), which was meant to give a second wind to the Canton. We consider this turning point as the start of a new period (of reterritorialization), with an issue linked with the outlines of a renewed "jurassian" identity and the elaboration of a shared territory project.Trente ans après l'entrée en souveraineté, force est de constater que la création du canton du Jura n'a pas permis de répondre aux espérances de développement économique et démographique que l'indépendance politique devait entraîner dans son sillage. Cette recherche se propose, à travers une pluralité d'approches complémentaires, d'examiner d'une part la position du Canton dans son contexte territorial ainsi que sa structure et sa dynamique; d'autre part, les représentations que se font les acteurs du territoire et de son évolution, pour déboucher sur une série de demandes sociales (de débat, d'ouverture et de dépassement des clivages) qui augurent de la transition vers un nouveau régime de territorialité et témoignent d'une exigence de réflexivité envers les institutions et les actions de l'Etat. L'analyse a permis de mettre en évidence le rôle central du couple identité-projet dans la dynamique de changement et d'identifier trois temps forts dans l'évolution récente du Canton, une phase de territorialisation au cours de laquelle s'est constituée une identité forte doublée d'un projet de société majeur, suivie d'une phase de déterritorialisation avec une fragmentation de l'identité collective et l'absence de projet mobilisateur. Enfin, un moment paradoxal, l'échec du projet Jura Pays ouvert, censé redonner un second souffle au Canton, qui amorce une nouvelle étape (de reterritorialisation) avec un questionnement lié aux contours d'une identité jurassienne renouvelée et à l'élaboration d'un projet de territoire partagé.Les ressorts de la production du territoire et de son développement sont analysés à travers le rôle des représentations sociales dans la constitution identitaire et le projet territorial, à l'exemple du canton du Jura. La mise en évidence du rôle central du couple identité-projet dans la dynamique de changement a permis d'identifier trois temps forts dans l'évolution récente du Canton. Une première phase (la création du canton du Jura), au cours de laquelle s'est constituée une identité forte doublée d'un projet de société majeur, suivie d'une phase au cours de laquelle l'identité collective s'est fragmentée en l'absence de projet mobilisateur (la phase de « gestion » de l'Etat). Puis un moment de rupture (l'échec du projet Jura Pays ouvert) et l'amorce d'une transition vers une nouvelle étape, avec un questionnement lié aux contours d'une identité jurassienne renouvelée, à l'élaboration d'un projet de territoire partagé, et à l'action des pouvoirs publics dans un contexte de repositionnement du Canton.

Que cache l'agenda caché [What is behind the hidden agenda?]

The physicians often forget to ask their patients if they would like to discuss other complaints or topics. It is sometimes quite difficult to explore the patient's complaints; while the physicians tend to focus on the immediate problem, the patients may have not only one, but several hidden agendas during a visit. In a caring relation there is a clear advantage to clarify the implicit. The search for the hidden agenda is to improve the care of i) biomedical problems ii) the social quest presented to the physicians. The sentence "Oh, by the way, doctor..." should not be only understood as an information but also as a relational expression and a reaction to the imminent separation from the physician.

Accions i reflexions en l'organització d'un arxiu monà stic: el monestir de Sant Benet de Montserrat

[eng] The article describes the experience of organising the archive of the monastery of Saint Benedict of Montserrat, an institution that currently holds one of the most important collections of Catalan monastic history: that of the first Clarisses in Barcelona. The author comments about the major phases of the project and then reflects on the context for studying and managing an archive of this type.

Els estudis bibliomètrics basats en l'anà lisi de citacions en à rees d'humanitats en el període 1959-2008

[eng] Objective: To analyse the scientific papers studying citations in the areas of humanities during the period 1959-2008 and to determine the aspects evaluated. The main bibliometric aspects measured were type of study, obsolescence, dispersion, language, theme, author impact and self-citations.Methodology: Broad revision of the international literature in the area of library and information science in the period studied, and detailed analysis of 119 bibliometric studies.Results: Most of the few studies of this area are based on ad-hoc citation compilations. There is a certain predominance of philology. Library quarterly is the journal that has published most papers of this kind. The conclusions of these studies can be as useful as those in the experimental sciences; it would be useful to increase their number.

Isolation and characterization of major histocompatibility complex (MHC) class II B genes in the Barn owl (Aves: Tyto alba)

We isolated major histocompatibility complex class II B (MHCIIB) genes in the Barn owl (Tyto alba). A PCR-based approach combined with primer walking on genomic and complementary DNA as well as Southern blot analyses revealed the presence of two MHCIIB genes, both being expressed in spleen, liver, and blood. Characteristic structural features of MHCIIB genes as well as their expression and high non-synonymous substitution rates in the region involved in antigen binding suggest that both genes are functional. MHC organization in the Barn owl is simple compared to passerine species that show multiple duplications, and resembles the minimal essential MHC of chicken.

Brain-derived neurotrophic factor-like immunoreactivity is localized mainly in small sensory neurons of rat dorsal root ganglia.

Brain-derived neurotrophic factor (BDNF) is a protein capable of supporting the survival and fiber outgrowth of peripheral sensory neurons. It has been argued that histological detection of BDNF has proven difficult because of its low molecular weight and relatively low expression. In the present study we report that rapid removal of dorsal root ganglia (DRG) from the rat, followed by rapid freezing and appropriate fixation with cold acetone, preserves BDNF in situ without altering protein antigenicity. Under these conditions, specific BDNF-like immunoreactivity was detected in DRG both in vivo and in vitro. During DRG development in vivo, BDNF-like immunoreactivity (BDNF-LI) was observed only in a subset of sensory neurons. BDNF-LI was confined to small neurons, after neurons became morphologically distinct on the basis of size. BDNF-L immunoprecipitate was detected only in neuronal cells, and not in satellite or Schwann cells. While in vivo BDNF localization was restricted to small neurons, practically all neurons in DRG cell culture displayed BDNF-LI. Small or large primary afferent neurons exhibited a faint but clear BDNF-LI during the whole life span of cultures. Again, non-neuronal cells were devoid of BDNF-LI. In conclusion, in DRG in vivo, specific BDNF-LI was confined to small B sensory neurons. In contrast, all DRG sensory neurons displayed BDNF-LI in vitro. The finding that BDNF expressed in all DRG neurons in vitro but not in vivo suggests that BDNF expression may be modulated by environmental factors.

Biochemical analysis of the major vaccinia virus envelope antigen.

The major envelope antigen of vaccinia virus is an acylated protein of M(r) 37,000 (p37K) which is required for the formation of extracellular enveloped virions (EEV). Despite its important role in the wrapping process, p37K has not been studied in much detail. In order to better characterize this protein we have undertaken a detailed biochemical analysis. Sodium carbonate treatment showed that p37K is tightly bound to the viral envelope. Its resistance to proteinase K digestion indicates that it is not exposed on the surface of EEV but lines the inner side of the envelope. Since p37K does not contain a signal peptide characteristic of most membrane proteins, we examined the possibility that the protein acquires its membrane affinity through the addition of fatty acids. Indeed, Triton X-114 phase partitioning experiments demonstrated that p37K is hydrophobic when acylated, but hydrophilic in the absence of fatty acids. Three other viral proteins have been shown to be required for virus envelopment and release from the host cell and we therefore tested whether p37K interacts with viral proteins. In EEV and in absence of reducing agents, an 80-kDa complex reacting with an anti-37K antiserum was found. Analysis of this complex showed that it most likely consists of a p37K homodimer. Interestingly, only a small amount of p37K occurs as a complex, most of it is present in the viral envelope as monomers.

Rapid death and regeneration of NKT cells in anti-CD3epsilon- or IL-12-treated mice: a major role for bone marrow in NKT cell homeostasis.

Natural killer T (NKT) cells express a T cell receptor (TCR) and markers common to NK cells, including NK1.1. In vivo, NKT cells are triggered by anti-CD3epsilon MAb to rapidly produce large amounts of IL-4 and by IL-12 to reject tumors. We show here that anti-CD3epsilon MAb treatment rapidly depletes the liver (and partially the spleen) of NKT cells and that homeostasis is achieved 1 to 2 days later via NKT cell proliferation that occurs mainly in bone marrow. Similar results were obtained in mice treated with IL-12. Collectively, our data demonstrate that peripheral NKT cells are highly sensitive to activation-induced cell death and that bone marrow plays a major role in restoring NKT cell homeostasis.

Vascular endothelial growth factor and angiopoietin-2 play a major role in the pathogenesis of vascular leakage in cirrhotic rats.

Background and aims: The extent and molecular mechanisms governing plasma extravasation and formation of ascites in cirrhosis are unknown. Vascular endothelial growth factor-A (VEGF-A) and angiopoietin-2 (Ang-2) are endogenous substances with powerful vascular permeability effects. We assessed regional blood flow, vascular leakage, mRNA and tissular expression of VEGF-A and Ang-2 and vascular permeability following VEGF receptor 2 blockade in control and cirrhotic rats to define the vascular territories showing altered vascular permeability in cirrhosis and to determine whether VEGF-A and Ang-2 are involved in this phenomenon. Methods: Arterial blood flow was analysed with the coloured microsphere method. Vascular leakage was measured and visualised with the dye Evan¿s Blue and colloidal carbon techniques, respectively. VEGF-A and Ang-2 expression were determined by real-time polymerase chain reaction (RT-PCR), immunohistochemistry and western blot. The effect on vascular permeability induced by VEGFR2 blockade was assessed by administration of the receptor inhibitor SU11248. Results: Arterial blood flow was increased in the mesentery, pancreas and small intestine but not in the kidney and spleen of cirrhotic rats as compared to controls. Increased vascular leakage was observed in the mesentery and liver, where colloidal carbon spread from microvessels to the adjacent fibrotic tracts. Increased hepatic and mesenteric expression of VEGF-A and Ang-2 was found in cirrhotic rats as compared to controls. Blockade of VEGFR2 markedly reduced hepatic and mesenteric vascular leakage in cirrhotic rats. Conclusions: Enhanced endothelial permeability is restricted to the hepatic and mesenteric vascular beds in cirrhotic rats with ascites and VEGF-A and Ang-2 are key factors in the signalling pathways regulating this dysfunction.

Recherche de l'iridium à  la limite Permien-Trias du site de Meishan, Changhsing (R. P. Chine).

La forte teneur en elements siderophiles des sediments de la limite Cretace-Tertiaire suggere que les principaJes disparitions d'especes ont ete provoquees par des catastrophes cosmiques. Cette hypothese pourrait etre confirmee par la decouverte d'une anomaJie similaire it la limite Permien-Trias, caracterisee par la plus grave crise biologique du Phanerozoique. L'etude du site de Meishan, en Republique populaire de Chine, n'apporte aucune confirmation de ce scenario. Aucune trace d'iridium, Ie meilleur traceur de la matiere extraterrestre, n'a ete trouvee dans les 18 echantillons preleves au voisinage de la transition Permien-Trias. Toute relation entre la crise biologique du Permien-Trias et une catastrophe cosmique doit donc, pour l'instant, etre consideree comme hypothetique. The presence of siderophile-enriched material at the Cretaceous-Tertiary boundary suggests that the major extinctions of living species could result from cosmic catastrophes. The finding of the same kind of material at the Permian-Triassic boundary would be important to confirm the influence of cosmic phenomena on extinctions. The study of the M eishan section, in China, does not provide any support to this view. Iridium, the best tracer of cosmic material, has not been detected in any of the 18 samples collected around the boundary. A relation between the Permian-Triassic extinction and a cosmic collision therefore remains hypothetical.

Quels nouveaux médicaments a l'horizon pour te traitement du cancer avancé de la prostate [New drugs at the horizon for men with prostate cancer]

Despite major progress in the understanding of biological mechanisms underlying metastatic prostate cancer, the treatment of men with advanced prostate cancer remains challenging. Several randomized controlled trials with promising or positive results are underway or just released. Here we discuss new treatments which might be used in clinic in the near future: hormonal treatments (Abiraterone and MDV3100), a new chemotherapy (Cabazitaxel), a cellular vaccine (Sipuleucel-T), anti-angiogenic drugs (Bevacizumab, Aflibercept), a new radioactive treatment (Alpharadin) and a new bone-protective agent (Deno-sumab).

The bZIP transcription factor Rca1p is a central regulator of a novel CO₂ sensing pathway in yeast.

Like many organisms the fungal pathogen Candida albicans senses changes in the environmental CO(2) concentration. This response involves two major proteins: adenylyl cyclase and carbonic anhydrase (CA). Here, we demonstrate that CA expression is tightly controlled by the availability of CO(2) and identify the bZIP transcription factor Rca1p as the first CO(2) regulator of CA expression in yeast. We show that Rca1p upregulates CA expression during contact with mammalian phagocytes and demonstrate that serine 124 is critical for Rca1p signaling, which occurs independently of adenylyl cyclase. ChIP-chip analysis and the identification of Rca1p orthologs in the model yeast Saccharomyces cerevisiae (Cst6p) point to the broad significance of this novel pathway in fungi. By using advanced microscopy we visualize for the first time the impact of CO(2) build-up on gene expression in entire fungal populations with an exceptional level of detail. Our results present the bZIP protein Rca1p as the first fungal regulator of carbonic anhydrase, and reveal the existence of an adenylyl cyclase independent CO(2) sensing pathway in yeast. Rca1p appears to regulate cellular metabolism in response to CO(2) availability in environments as diverse as the phagosome, yeast communities or liquid culture.