Role of CD44H carbohydrate structure in neuroblastoma adhesive properties.

BACKGROUND: CD44 represents a heterogeneous group of surface glycoproteins involved in cell-cell and cell-matrix interactions. CD44H is the major receptor for hyaluronate, and most if not all CD44H known functions are attributed to its ability to recognize hyaluronate. We have previously demonstrated a lack of CD44 expression in high stages and NMYC-amplified tumors and further have shown that NMYC-amplified cell lines either did not express CD44 at all or expressed a nonfunctional receptor. On the other hand, nonamplified cells constitutively expressed an active receptor, suggesting that absence of CD44-mediated hy aluronate binding could be related to increased malignancy in human neuroblastoma. PROCEDURE: In the present study we have compared the glycosylated structure of CD44 expressed by NMYC amplified vs. nonamplified cell lines in relation to their adhesive properties for hyaluronate. These adhesive properties were measured after modifications of the carbohydrate structure with enzymes and inhibitors of N- or O-linked glycosylation. RESULTS AND CONCLUSIONS: Our results indicate that increased sialylation, defective N-linked glycosylation, and substitution of the CD44 glycoprotein with keratan sulfate glycosaminoglycan might include modifications observed on neuroblastoma cells that could account for the inability of the receptor to bind hyaluronate.

Diagnosis and workup of 522 consecutive patients with neuroendocrine neoplasms in Switzerland.

BACKGROUND: Neuroendocrine neoplasms (NENs) are difficult to diagnose. We used SwissNET data to characterise NEN patients followed in the two academic centres of western Switzerland (WS), and to compare them with patients followed in eastern Switzerland (ES) as well as with international guidelines. METHOD: SwissNET is a prospective database covering data from 522 consecutive patients (285 men, 237 women) from WS (n = 99) and ES (n = 423). RESULTS: Mean ± SD age at diagnosis was 59.0 ± 15.7 years. Overall, 76/522 experienced a functional syndrome, with a median interval of 1.0 (IQR: 1.0-3.0) year between symptoms onset and diagnosis. A total of 51/522 of these tumours were incidental. The primary tumour site was the small intestine (29%), pancreas (21%), appendix (18%) and lung (11%) in both regions combined. In all, 513 functional imaging studies were obtained (139 in WS, 374 in ES). Of these, 381 were 111In-pentetreotide scintigraphies and 20 were 68Ga-DOTATOC PET. First line therapy was surgery in 87% of patients, medical therapy (biotherapy or chemotherapy) in 9% and irradiation in 3% for both regions together. CONCLUSION: Swiss NEN patients appear similar to what has been described in the literature. Imaging by somatostatin receptor scintigraphy (SRS) is widely used in both regions of Switzerland. In good accordance with published guidelines, data on first line therapy demonstrate the crucial role of surgery. The low incidence of biotherapy suggests that long-acting somatostatin analogues are not yet widely used for their anti-proliferative effects. The SwissNET initiative should help improve compliance with ENETS guidelines in the workup and care of NEN patients.

Le psychotique et la psychose à l'épreuve de la réalité

Résumé Qu'est-ce que la psychose, comment apparaît-elle comme «perte du contact avec la réalité», le rapport au réel permet-il de constituer une classe de maladies mentales en soi, d'inférer une structure ou une superstructure commune aux diverses formes cliniques, voilà nos questions de départ, à l'heure où la notion même de psychose est peut-être en train de disparaître de la nosologie psychiatrique contemporaine. Notre travail s'attache, dans sa première partie, à montrer comment est apparu, dans la littérature médicale et psychiatrique du XIXème siècle, le terme de «psychose », pour désigner d'abord l'ensemble des affections mentales telles qu'elles se manifestaient en particulier chez les malades asilaires, dans le cadre plus général des «névroses », c'est-à-dire des affections primaires du système nerveux. Ainsi, la psychose se situe dès l'origine à l'interface du biologique et du psychologique ; s'esquisse aussi de la sorte un champ spécifique au psychiatre, les névroses : « non-psychotiques » relevant plutôt du somaticien. Un premier auteur (H.Schuele) distingue cérébro-psychoses » et « psycho-névroses » dans une acception plus familière au lecteur contemporain : les premières sont des maladies plus sévères, irréversibles, dont l'étiologie est plutôt organique, et les secondes sont moins graves, des maladies « de l'esprit ». Mais c'est avec Freud, qui réunit l'hystérie (la névrose par excellence, d'autant plus qu'elle se manifeste presque exclusivement par des symptômes neurologiques, c'est-à-dire «névrotiques »), les phobies et ce que Kraepelin appelait la Zwangsirresein (la folie de contrainte) sous le terme de psychonévroses de transfert, que vient se constituer durablement le partenaire dialectique qui permettra à la psychose de s'ériger en classe, regroupant la schizophrénie, la maladie maniaco-dépressive, la paranoïa et les psychoses organiques. Freud a situé la problématique spécifique de la psychose comme une perturbation du rapport à la réalité. Cet aspect des psychoses est le plus largement retenu dans le langage «courant » de la psychiatrie clinique, de nos jours encore. Dans sa deuxième partie, ce travail cherche à préciser comment s'élaborent chez Freud les théories de la psychose, plus particulièrement pour ce qui est du rapport à la réalité. On verra alors que ces théories rendent compte pour l'essentiel de la clinique de ce que Freud appelle les paraphrénies, qui rassemblent la schizophrénie et la paranoïa, mais que la maladie maniaco-dépressive semble pour lui d'un registre relativement différent. Il propose même de la ranger dans une catégorie propre, les «névroses narcissiques », reprenant pour l'occasion un terme qu'il utilisait auparavant pour les «psychoses » - comme quoi les questions terminologiques ne sont ni anodines, ni simples. Notre travail s'intéresse enfin à la façon dont la littérature analytique a abordé ces questions, à la suite de Freud. Les auteurs, choisis pour leur renom et leur importance historique ainsi que pour leur intérêt pour les questions soulevées ici, ont chacun des conceptions très diverses des psychoses et de la façon dont l'homme établit un rapport avec la réalité qui l'entoure. D'une façon générale, et comme Freud, ils traitent de la schizophrénie bien plus que de la maladie maniaco-dépressive, et les mécanismes psychopathologiques proposés semblent toujours assez distincts. En définitive, nous n'avons pas trouvé, dans l'histoire de la notion de psychose et chez quelques-uns des auteurs majeurs de la psychanalyse, de justification théorique à la constitution d'une classe en soi de maladies mentales, articulée autour d'un trouble spécifique du rapport à la réalité, qui corresponde à la classe des psychoses. Il n'en reste pas moins que la clinique, qui rapproche souvent la crise schizophrénique et la crise maniaque, appelle assez naturellement l'adjectif «psychotique », comme descriptif de certains symptômes manifestant, le plus souvent, la présence d'une «psychose» sous-jacente.

Macrobii liber Saturnaliorum.

Aurispe opuscula (108). - Pogii liber in ypoçritas (422), oratio ad papam N. (139 v°), liber de nobilitate (149 v°), epistola ad Gregorium Corarium (169 v°). - Luciani dialogua qui inscribitur Caron, jnterprete Rimichio (178). P.P. Vergerii liber de in genuis moribus et liberalibus studiis (202).

Effectiveness of chronic obstructive pulmonary disease-management programs: systematic review and meta-analysis

BACKGROUND: Disease-management programs may enhance the quality of care provided to patients with chronic diseases, such as chronic obstructive pulmonary disease (COPD). The aim of this systematic review was to assess the effectiveness of COPD disease-management programs. METHODS: We conducted a computerized search of MEDLINE, EMBASE, CINAHL, PsychINFO, and the Cochrane Library (CENTRAL) for studies evaluating interventions meeting our operational definition of disease management: patient education, 2 or more different intervention components, 2 or more health care professionals actively involved in patients' care, and intervention lasting 12 months or more. Programs conducted in hospital only and those targeting patients receiving palliative care were excluded. Two reviewers evaluated 12,749 titles and fully reviewed 139 articles; among these, data from 13 studies were included and extracted. Clinical outcomes considered were all-cause mortality, lung function, exercise capacity (walking distance), health-related quality of life, symptoms, COPD exacerbations, and health care use. A meta-analysis of exercise capacity and all-cause mortality was performed using random-effects models. RESULTS: The studies included were 9 randomized controlled trials, 1 controlled trial, and 3 uncontrolled before-after trials. Results indicate that the disease-management programs studied significantly improved exercise capacity (32.2 m, 95% confidence interval [CI], 4.1-60.3), decreased risk of hospitalization, and moderately improved health-related quality of life. All-cause mortality did not differ between groups (pooled odds ratio 0.84, 95% CI, 0.54-1.40). CONCLUSION: COPD disease-management programs modestly improved exercise capacity, health-related quality of life, and hospital admissions, but not all-cause mortality. Future studies should explore the specific elements or characteristics of these programs that bring the greatest benefit.

Chicken BAFF--a highly conserved cytokine that mediates B cell survival.

Members of the tumor necrosis factor (TNF) family play key roles in the regulation of inflammation, immune responses and tissue homeostasis. Here we describe the identification of the chicken homologue of mammalian B cell activating factor of the TNF family (BAFF/BLyS). By searching a chicken EST database we identified two overlapping cDNA clones that code for the entire open reading frame of chicken BAFF (chBAFF), which contains a predicted transmembrane domain and a putative furin protease cleavage site like its mammalian counterparts. The amino acid identity between soluble chicken and human BAFF is 76%, considerably higher than for most other known cytokines. The chBAFF gene is most strongly expressed in the bursa of Fabricius. Soluble recombinant chBAFF produced by human 293T cells interacted with the mammalian cell-surface receptors TACI, BCMA and BAFF-R. It bound to chicken B cells, but not to other lymphocytes, and it promoted the survival of splenic chicken B cells in culture. Furthermore, bacterially expressed chBAFF induced the selective expansion of B cells in the spleen and cecal tonsils when administered to young chicks. Our results suggest that like its mammalian counterpart, chBAFF plays an important role in survival and/or proliferation of chicken B cells.

Nursing: promoting the health of overweight children and adolescents in the school context

The study aimed to analyze the nursing interventions related to the competencies of health promotion of overweight children and adolescents in the school context, in light of the Galway Consensus through an integrative review. Articles published between 1988 and June, 2013 were found in the databases CINAHL, SCOPUS, MEDLINE/PubMed, Cochrane, LILACS and SciELO. A total of 139 publications were obtained from indexed descriptors. Ten articles were selected after reading. The most evident competencies for health promotion were: catalyzing change, needs assessment and impact assessment. The highlights were activities of health education and partnerships with other health professionals and the families of students. It was found that the skills of health promotion developed by nurses can contribute to the adoption of healthy habits by overweight children and adolescents.

Implementação de Sistemas de Gestão da Qualidade: O Caso da Cabo Verde Telecom

A pesquisa tem por objectivo avaliar a implementação do sistema de gestão da qualidade na Cabo Verde Telecom. O tema escolhido justifica-se pela importância do sector das telecomunicações na geração de empregos e rendimentos em Cabo Verde. Tal facto exige que resultados positivos relacionados à melhoria da qualidade sejam alcançados de modo a responder ao ritmo de constante incerteza, actualização no padrão de consumo e busca permanente de melhoria dos serviços prestados. No que se refere à revisão da literatura, faz-se uma resenha histórica da gestão da qualidade, aborda-se as diferentes dimensões da qualidade, a qualidade total, os principais autores, o modelo da EFQM, as normas ISO 9000, a qualidade em serviços e, porque os recursos humanos constituem um factor crítico de sucesso de qualquer sistema de gestão da qualidade, faz-se uma breve referência à gestão da mudança organizacional. O método utilizado é o estudo de caso. A recolha de dados é feita através da observação, da aplicação de questionários e entrevistas semi-estruturadas e do recurso a fontes secundárias – análise documental. A metodologia de análise é descritivo-quantitativa. Os resultados da pesquisa mostram que a implementação do sistema de gestão da qualidade na empresa assenta nos princípios que norteiam a cultura da gestão da qualidade subjacentes às normas ISO 9000:2000. Quanto ao grau de aplicação e adesão aos princípios referidos, pode-se concluir que se verifica uma evolução positiva, mas não na dimensão desejada.

Varatuomari Boris Grünstein 6/6 1962

Kirje

Päätoimittaja Sakari Talvitie 4/4 1962

Kirje