Identification of human T-cell lymphotropic virus infection in a semi-isolated Afro-Brazilian quilombo located in the Marajó Island (Pará, Brazil)

Antibodies to human T-cell lymphotropic virus-1 and 2 (HTLV-1 and 2) were tested in 259 inhabitants (98 males and 161 females) of four villages of the Marajó Island (Pará, Brazil) using enzyme immunoassays (ELISA and Western blot). Types and subtypes of HTLV were determined by nested polymerase chain reaction (PCR) targeting the pX, env and 5´LTR regions. HTLV-1 infection was detected in Santana do Arari (2.06%) and Ponta de Pedras (1%). HTLV-2 was detected only in Santana do Arari (1.06%). Sequencing of the 5´LTR region of HTLV-1 and the phylogenetic analysis identified the virus as a member of the Cosmopolitan Group, subgroup Transcontinental. Santana do Arari is an Afro-Brazilian community and the current results represent the first report of HTLV-1 infection in a mocambo located in the Brazilian Amazon region.

Lifeline Consultation Report - A summary of the feedback to the Public Health Agency's public consultation process on the Lifeline Crisis Response Service

This report is a summary of the feedback from the public consultation process on the current Lifeline contract and future options.

Characterization of the gene expression related to the process of DNA damage tolerance in Schistosoma mansoni

In the course of its complex life cycle, the parasite Schistosoma mansoni need to adapt to distinct environments, and consequently is exposed to various DNA damaging agents. The Schistosoma genome sequencing initiative has uncovered sequences from genes and transcripts related to the process of DNA damage tolerance as the enzymes UBC13, MMS2, and RAD6. In the present work, we evaluate the importance of this process in different stages of the life cycle of this parasite. The importance is evidenced by expression and phylogenetic profiles, which show the conservation of this pathway from protozoa to mammalians on evolution.

Identité et filiation : enfants enlevés-appropriés, adultes restitués dans le contexte de la dernière dictature militaire en Argentine (1976-1983)

Durant la dernière dictature argentine (1976-1983), !a junte militaire organisa le vol de nourrissons, enfants de leurs ennemis, pour qu'ils puissent être élevés dans des familles proches du pouvoir. L'association « Grands-Mères de la Place de Mai » comptabilisa environ 409 vols. Au moment de l'exploration du terrain de récherche, en 2004, une quarantaine avaient été retrouvés dans des familles qui ne connaissaient pas leurs origines tandis qu'une vingtaine étaient dans des familles liées à la junte ; c'est à cette dernière catégorie que s'intéresse ce travail. Durant leur enfance ou à l'âge adulte, ces enfants apprirent un jour la vérité sur leurs origines biologiques et la justice la leur restitua ; c'est pourquoi ils sont dits « restitués ». Cette contribution vise à interroger l'identité individuelle comme une dynamique intime qui s'articule à la filiation et s'insère dans une collectivité, une société. Trois hypothèses l'ont organisée : une première concerne la connaissance des origines biologiques et ses conséquences psychologiques identitaires, qui passe nécessairement par la justice et la société. Une deuxième hypothèse explore les éventelles conséquences traumatiques de l'enlèvement des personnes restituées et de la restitution. Enfin, la troisième hypothèse interroge le rapport de la construction identitaire à la société, qu'elle se fasse par des investissements politiques et associatifs ou par les médias et l'Histoire. Ces hypothèses nourrissent un questionnement sur les liens entre restitution et travail de symbolisation des origines. Sept entretiens semi structurés avec des personnes restituées ont. été menés puis qualitativement analysés dans une perspective que l'on peut référer, de manière large, à une « anthropologique clinique », au croisement d'une psychologie clinique éclairée par la psychanalyse et de l'anthropologie. Au travers d'une analyse approfondie de leur parcours identitaire des personnes enlevées, adoptées et restituées, ce travail se livre à une recherche empirique sur la construction identitaire. Le concept de transmission se trouve mobilisé, qui concerne l'inscription de l'individu dans la subjectivité d'un couple avec le prénom, dans une lignée ou dans un collectif avec le choix professionnel ou les liens avec l'association « Grands-Mères de la Place Mai ». De plus, la thèse apporte une contribution à la compréhension des enjeux du clivage, des blessures primitive et narcissique, des processus d'affiliation et des secrets de famille et propose également de penser, en prolongement, les enjeux de la « défiliation » et de I'« amalgame ». La question du traumatisme, de sa répétition et de son élaboration, ainsi que celle des facteurs de resilience sont également discutées. Ce travail ouvre sur une réflexion plus large du concept d'identité. - During the last dictatorship in Argentina (1976-1983), the military junta organized the kidnapping of infants - children of its enemies - in order to raise them in families close to the authorities. The association "Mothers of the Plaza de Mayo" estimates that approximately 400 children have been kidnapped in this way. During their childhood, or as adults, they have come to learn the truth about their biological origins, restituted to them by justice: They are therefore known as "restituted" children. At the time of the field research in 2004, around 40 children had been found in families unaware of their origins. About 20 other came from families close to the junta. The present work is particularly interested in the latter category. This contribution investigates the individual identity as an intimate dynamics by examining its articulation with filiation and its insertion within a community, a society. It revolves around three hypotheses: the first concerns the knowledge - necessarily transmitted through justice and society - of biological origins and its psychological consequences on the identity. The second explores the eventually traumatic, consequences of kidnapping and restitution among the restituted persons. Finally, the third hypothesis questions the relation between identity construction and society, whether it is made through political and associative involvements, media or History. These hypotheses lead to the examination of affiliations between restitution and symbolization process of the origins. Seven semi-structured interviews with restituted persons have been conducted and qualitatively analyzed in a perspective that can, in a large sense, be referred to as "clinical anthropology": an approach/intersection between clinical psychology, psychoanalysis and anthropology. Through an in-depth analysis of the identity itinerary of the kidnapped, adopted and restituted persons, this work is conducted as an empirical research on identity construction. For that purpose, it uses the concept of transmission to describe an individual's affiliation with the subjectivity of a couple through the first name, with a lineage or a community through professional choices or through his/her connections with the association "Mothers of the Plaza de Mayo". Further, it makes a meaningful contribution to the understanding and implications of the notions of cleavage, of primal and narcissistic wounds, of processes of affiliation and of family secrets. In addition, it also proposes a reflection on and the implication of the notions of "deviation" and "amalgam". The question of trauma, its repetition and elaboration, and of resilience factors are aiso being discussed. This work concludes with results in a iarger consideration of the concept of identity.

Clinical spectrum of uncomplicated malaria in semi-immune Amazonians: beyond the " symptomatic " vs " asymptomatic " dichotomy

We analyzed prospectively 326 laboratory-confirmed, uncomplicated malarial infections (46.3% due to Plasmodium vivax, 35.3% due to P. falciparum, and 18.4% mixed-species infections) diagnosed in 162 rural Amazonians aged 5-73 years. Thirteen symptoms (fever, chills, sweating, headache, myalgia, arthralgia, abdominal pain, nausea, vomiting, dizziness, cough, dyspnea, and diarrhea) were scored using a structured questionnaire. Headache (59.8%), fever (57.1%), and myalgia (48.4%) were the most frequent symptoms. Ninety-six (29.4%) episodes, all of them diagnosed during cross-sectional surveys of the whole study population (96.9% by molecular technique only), were asymptomatic. Of 93 symptom-less infections left untreated, only 10 became symptomatic over the next two months following diagnosis. Fever was perceived as " intense " in 52.6% of 230 symptomatic malaria episodes, with no fever reported in 19.1% episodes although other symptoms were present. We found significant differences in the prevalence and perceived intensity of fever and other clinical symptoms in relation to parasite load at the time of diagnosis and patient's age, cumulative exposure to malaria, recent malaria morbidity, and species of malaria parasite. These factors are all likely to affect the effectiveness of malaria control strategies based on active or passive detection of febrile subjects in semi-immune populations.

The relationship between forensic science and judicial error: a study covering error sources, bias, and remedies

Summary : Forensic science - both as a source of and as a remedy for error potentially leading to judicial error - has been studied empirically in this research. A comprehensive literature review, experimental tests on the influence of observational biases in fingermark comparison, and semistructured interviews with heads of forensic science laboratories/units in Switzerland and abroad were the tools used. For the literature review, some of the areas studied are: the quality of forensic science work in general, the complex interaction between science and law, and specific propositions as to error sources not directly related to the interaction between law and science. A list of potential error sources all the way from the crime scene to the writing of the report has been established as well. For the empirical tests, the ACE-V (Analysis, Comparison, Evaluation, and Verification) process of fingermark comparison was selected as an area of special interest for the study of observational biases, due to its heavy reliance on visual observation and recent cases of misidentifications. Results of the tests performed with forensic science students tend to show that decision-making stages are the most vulnerable to stimuli inducing observational biases. For the semi-structured interviews, eleven senior forensic scientists answered questions on several subjects, for example on potential and existing error sources in their work, of the limitations of what can be done with forensic science, and of the possibilities and tools to minimise errors. Training and education to augment the quality of forensic science have been discussed together with possible solutions to minimise the risk of errors in forensic science. In addition, the time that samples of physical evidence are kept has been determined as well. Results tend to show considerable agreement on most subjects among the international participants. Their opinions on possible explanations for the occurrence of such problems and the relative weight of such errors in the three stages of crime scene, laboratory, and report writing, disagree, however, with opinions widely represented in existing literature. Through the present research it was therefore possible to obtain a better view of the interaction of forensic science and judicial error to propose practical recommendations to minimise their occurrence. Résumé : Les sciences forensiques - considérés aussi bien comme source de que comme remède à l'erreur judiciaire - ont été étudiées empiriquement dans cette recherche. Une revue complète de littérature, des tests expérimentaux sur l'influence du biais de l'observation dans l'individualisation de traces digitales et des entretiens semi-directifs avec des responsables de laboratoires et unités de sciences forensiques en Suisse et à l'étranger étaient les outils utilisés. Pour la revue de littérature, quelques éléments étudies comprennent: la qualité du travail en sciences forensiques en général, l'interaction complexe entre la science et le droit, et des propositions spécifiques quant aux sources d'erreur pas directement liées à l'interaction entre droit et science. Une liste des sources potentielles d'erreur tout le long du processus de la scène de crime à la rédaction du rapport a également été établie. Pour les tests empiriques, le processus d'ACE-V (analyse, comparaison, évaluation et vérification) de l'individualisation de traces digitales a été choisi comme un sujet d'intérêt spécial pour l'étude des effets d'observation, due à son fort recours à l'observation visuelle et dû à des cas récents d'identification erronée. Les résultats des tests avec des étudiants tendent à prouver que les étapes de prise de décision sont les plus vulnérables aux stimuli induisant des biais d'observation. Pour les entretiens semi-structurés, onze forensiciens ont répondu à des questions sur des sujets variés, par exemple sur des sources potentielles et existantes d'erreur dans leur travail, des limitations de ce qui peut être fait en sciences forensiques, et des possibilités et des outils pour réduire au minimum ses erreurs. La formation et l'éducation pour augmenter la qualité des sciences forensiques ont été discutées ainsi que les solutions possibles pour réduire au minimum le risque d'erreurs en sciences forensiques. Le temps que des échantillons sont gardés a été également déterminé. En général, les résultats tendent à montrer un grand accord sur la plupart des sujets abordés pour les divers participants internationaux. Leur avis sur des explications possibles pour l'occurrence de tels problèmes et sur le poids relatif de telles erreurs dans les trois étapes scène de crime;', laboratoire et rédaction de rapports est cependant en désaccord avec les avis largement représentés dans la littérature existante. Par cette recherche il était donc possible d'obtenir une meilleure vue de l'interaction des sciences forensiques et de l'erreur judiciaire afin de proposer des recommandations pratiques pour réduire au minimum leur occurrence. Zusammenfassung : Forensische Wissenschaften - als Ursache und als Hilfsmittel gegen Fehler, die möglicherweise zu Justizirrtümern führen könnten - sind hier empirisch erforscht worden. Die eingestzten Methoden waren eine Literaturübersicht, experimentelle Tests über den Einfluss von Beobachtungseffekten (observer bias) in der Individualisierung von Fingerabdrücken und halbstandardisierte Interviews mit Verantwortlichen von kriminalistischen Labors/Diensten in der Schweiz und im Ausland. Der Literaturüberblick umfasst unter anderem: die Qualität der kriminalistischen Arbeit im Allgemeinen, die komplizierte Interaktion zwischen Wissenschaft und Recht und spezifische Fehlerquellen, welche nicht direkt auf der Interaktion von Recht und Wissenschaft beruhen. Eine Liste möglicher Fehlerquellen vom Tatort zum Rapportschreiben ist zudem erstellt worden. Für die empirischen Tests wurde der ACE-V (Analyse, Vergleich, Auswertung und Überprüfung) Prozess in der Fingerabdruck-Individualisierung als speziell interessantes Fachgebiet für die Studie von Beobachtungseffekten gewählt. Gründe sind die Wichtigkeit von visuellen Beobachtungen und kürzliche Fälle von Fehlidentifizierungen. Resultate der Tests, die mit Studenten durchgeführt wurden, neigen dazu Entscheidungsphasen als die anfälligsten für Stimuli aufzuzeigen, die Beobachtungseffekte anregen könnten. Für die halbstandardisierten Interviews beantworteten elf Forensiker Fragen über Themen wie zum Beispiel mögliche und vorhandene Fehlerquellen in ihrer Arbeit, Grenzen der forensischen Wissenschaften und Möglichkeiten und Mittel um Fehler zu verringern. Wie Training und Ausbildung die Qualität der forensischen Wissenschaften verbessern können ist zusammen mit möglichen Lösungen zur Fehlervermeidung im selben Bereich diskutiert worden. Wie lange Beweismitten aufbewahrt werden wurde auch festgehalten. Resultate neigen dazu, für die meisten Themen eine grosse Übereinstimmung zwischen den verschiedenen internationalen Teilnehmern zu zeigen. Ihre Meinungen über mögliche Erklärungen für das Auftreten solcher Probleme und des relativen Gewichts solcher Fehler in den drei Phasen Tatort, Labor und Rapportschreiben gehen jedoch mit den Meinungen, welche in der Literatur vertreten werden auseinander. Durch diese Forschungsarbeit war es folglich möglich, ein besseres Verständnis der Interaktion von forensischen Wissenschaften und Justizirrtümer zu erhalten, um somit praktische Empfehlungen vorzuschlagen, welche diese verringern. Resumen : Esta investigación ha analizado de manera empírica el rol de las ciencias forenses como fuente y como remedio de potenciales errores judiciales. La metodología empleada consistió en una revisión integral de la literatura, en una serie de experimentos sobre la influencia de los sesgos de observación en la individualización de huellas dactilares y en una serie de entrevistas semiestructuradas con jefes de laboratorios o unidades de ciencias forenses en Suiza y en el extranjero. En la revisión de la literatura, algunas de las áreas estudiadas fueron: la calidad del trabajo en ciencias forenses en general, la interacción compleja entre la ciencia y el derecho, así como otras fuentes de error no relacionadas directamente con la interacción entre derecho y ciencia. También se ha establecido una lista exhaustiva de las fuentes potenciales de error desde la llegada a la escena del crimen a la redacción del informe. En el marco de los tests empíricos, al analizar los sesgos de observación dedicamos especial interés al proceso de ACE-V (análisis, comparación, evaluación y verificación) para la individualización de huellas dactilares puesto que este reposa sobre la observación visual y ha originado varios casos recientes de identificaciones erróneas. Los resultados de las experimentaciones realizadas con estudiantes sugieren que las etapas en las que deben tornarse decisiones son las más vulnerables a lös factores que pueden generar sesgos de observación. En el contexto de las entrevistas semi-estructuradas, once científicos forenses de diversos países contestaron preguntas sobre varios temas, incluyendo las fuentes potenciales y existehtes de error en su trabajo, las limitaciones propias a las ciencias forenses, las posibilidades de reducir al mínimo los errores y las herramientas que podrían ser utilizadas para ello. Se han sugerido diversas soluciones para alcanzar este objetivo, incluyendo el entrenamiento y la educación para aumentar la calidad de las ciencias forenses. Además, se ha establecido el periodo de conservación de las muestras judiciales. Los resultados apuntan a un elevado grado de consenso entre los entrevistados en la mayoría de los temas. Sin embargo, sus opiniones sobre las posibles causas de estos errores y su importancia relativa en las tres etapas de la investigación -la escena del crimen, el laboratorio y la redacción de informe- discrepan con las que predominan ampliamente en la literatura actual. De este modo, esta investigación nos ha permitido obtener una mejor imagen de la interacción entre ciencias forenses y errores judiciales, y comenzar a formular una serie de recomendaciones prácticas para reducirlos al minimo.

Cutting artefacts and cutting process in vitreous sections for cryo-electron microscopy.

Cryo-electron microscopy of vitreous sections (CEMOVIS) has recently been shown to provide images of biological specimens with unprecedented quality and resolution. Cutting the sections remains however the major difficulty. Here, we examine the parameters influencing the quality of the sections and analyse the resulting artefacts. They are in particular: knife marks, compression, crevasses, and chatter. We propose a model taking into account the interplay between viscous flow and fracture. We confirm that crevasses are formed on only one side of the section, and define conditions by which they can be avoided. Chatter is an effect of irregular compression due to friction of the section of the knife edge and conditions to prevent this are also explored. In absence of crevasses and chatter, the bulk of the section is compressed approximately homogeneously. Within this approximation, it is possible to correct for compression by a simple linear transformation for the bulk of the section. A research program is proposed to test and refine our understanding of the sectioning process.

Success of referral for alcohol dependent patients from a general hospital: predictive value of patient and process characteristics.

To assess the effectiveness of a multidisciplinary evaluation and referral process in a prospective cohort of general hospital patients with alcohol dependence. Alcohol-dependent patients were identified in the wards of the general hospital and its primary care center. They were evaluated and then referred to treatment by a multidisciplinary team; those patients who accepted to participate in this cohort study were consecutively included and followed for 6 months. Not included patients were lost for follow-up, whereas all included patients were assessed at time of inclusion, 2 and 6 months later by a research psychologist in order to collect standardized baseline patients' characteristics, process salient features and patients outcomes (defined as treatment adherence and abstinence). Multidisciplinary evaluation and therapeutic referral was feasible and effective, with a success rate of 43%for treatment adherence and 28%for abstinence at 6 months. Among patients' characteristics, predictors of success were an age over 45, not living alone, being employed and being motivated to treatment (RAATE-A score < 18), whereas successful process characteristics included detoxification of the patient at time of referral and a full multidisciplinary referral meeting. This multidisciplinary model of evaluation and referral of alcohol dependent patients of a general hospital had a satisfactory level of effectiveness. Predictors of success and failure allow to identify subsets of patients for whom new strategies of motivation and treatment referral should be designed.

Evaluation of the GlideScope (R) for tracheal intubation in patients with cervical spine immobilisation by a semi-rigid collar

Application of cervical collars may reduce cervical spine movements but render tracheal intubation with a standard laryngoscope difficult if not impossible. We hypothesised that despite the presence of a Philadelphia Patriot (R) cervical collar and with the patient's head taped to the trolley, tracheal intubation would be possible in 50 adult patients using the GlideScope (R) and its dedicated stylet. Laryngoscopy was attempted using a Macintosh laryngoscope with a size 4 blade, and the modified Cormack-Lehane grade was scored. Subsequently, laryngoscopy with the GlideScope was graded and followed by tracheal intubation. All patients' tracheas were successfully intubated with the GlideScope. The median (IQR) intubation time was 50 s (43-61 s). The modified Cormack-Lehane grade was 3 or 4 at direct laryngoscopy. It was significantly reduced with the GlideScope (p < 0.0001), reaching grade 2a in most patients. Tracheal intubation in patients wearing a semi-rigid collar and having their head taped to the trolley is possible with the help of the GlideScope.

PERSONAL(ONTO) : Personalizing the Learning Process in Virtual Environments by means of Adaptive Formative Itineraries based on Reusable Learning Objects and Ontologies TIN2006-15107-C02

Personalization in e-learning allows the adaptation of contents, learning strategiesand educational resources to the competencies, previous knowledge or preferences of the student. This project takes a multidisciplinary perspective for devising standards-based personalization capabilities into virtual e-learning environments, focusing on the conceptof adaptive learning itinerary, using reusable learning objects as the basis of the system and using ontologies and semantic web technologies.

Biological activity of neosergeolide and isobrucein B (and two semi-synthetic derivatives) isolated from the Amazonian medicinal plant Picrolemma sprucei (Simaroubaceae)

In the present study, in vitro techniques were used to investigate a range of biological activities of known natural quassinoids isobrucein B (1) and neosergeolide (2), known semi-synthetic derivative 1,12-diacetylisobrucein B (3), and a new semi-synthetic derivative, 12-acetylneosergeolide (4). These compounds were evaluated for general toxicity toward the brine shrimp species Artemia franciscana, cytotoxicity toward human tumour cells, larvicidal activity toward the dengue fever mosquito vector Aedes aegypti, haemolytic activity in mouse erythrocytes and antimalarial activity against the human malaria parasite Plasmodium falciparum. Compounds 1 and 2 exhibited the greatest cytotoxicity against all the tumor cells tested (IC50 = 5-27 µg/L) and against multidrug-resistant P. falciparum K1 strain (IC50 = 1.0-4.0 g/L) and 3 was only cytotoxic toward the leukaemia HL-60 strain (IC50 = 11.8 µg/L). Quassinoids 1 and 2 (LC50 = 3.2-4.4 mg/L) displayed greater lethality than derivative 4 (LC50 = 75.0 mg/L) toward A. aegypti larvae, while derivative 3 was inactive. These results suggest a novel application for these natural quassinoids as larvicides. The toxicity toward A. franciscana could be correlated with the activity in several biological models, a finding that is in agreement with the literature. Importantly, none of the studied compounds exhibited in vitro haemolytic activity, suggesting specificity of the observed cytotoxic effects. This study reveals the biological potential of quassinoids 1 and 2 and to a lesser extent their semi-synthetic derivatives for their in vitro antimalarial and cytotoxic activities.

Oral cancer treatments and adherence: medication event monitoring system assessment for capecitabine

Background: Oncological treatments are traditionally administered via intravenous injection by qualified personnel. Oral formulas which are developing rapidly are preferred by patients and facilitate administration however they may increase non-adherence. In this study 4 common oral chemotherapeutics are given to 50 patients, who are still in the process of inclusion, divided into 4 groups. The aim is to evaluate adherence and offer these patients interdisciplinary support with the joint help of doctors and pharmacists. We present here the results for capecitabine. Materials and Methods: The final goal is to evaluate adhesion in 50 patients split into 4 groups according to oral treatments (letrozole/exemestane, imatinib/sunitinib, capecitabine and temozolomide) using persistence and quality of execution as parameters. These parameters are evaluated using a medication event monitoring system (MEMS®) in addition to routine oncological visits and semi-structured interviews. Patients were monitored for the entire duration of treatment up to a maximum of 1 year. Patient satisfaction was assessed at the end of the monitoring period using a standardized questionary. Results: Capecitabine group included 2 women and 8 men with a median age of 55 years (range: 36−77 years) monitored for an average duration of 100 days (range: 5-210 days). Persistence was 98% and quality of execution 95%. 5 patients underwent cyclic treatment (2 out of 3 weeks) and 5 patients continuous treatment. Toxicities higher than grade 1 were grade 2−3 hand-foot syndrome in 1 patient and grade 3 acute coronary syndrome in 1 patient both without impact on adherence. Patients were satisfied with the interviews undergone during the study (57% useful, 28% very useful, 15% useless) and successfully integrated the MEMS® in their daily lives (57% very easily, 43% easily) according to the results obtained by questionary at the end of the monitoring period. Conclusion: Persistence and quality of execution observed in our Capecitabine group of patients were excellent and better than expected compared to previously published studies. The interdisciplinary approach allowed us to better identify and help patients with toxicities to maintain adherence. Overall patients were satisfied with the global interdisciplinary follow-up. With longer follow up better evaluation of our method and its impact will be possible. Interpretation of the results of patients in the other groups of this ongoing trial will provide us information for a more detailed analysis.

Existential questionings during the pretransplantation period: A qualitative phenomenological study

Background: Transplantation improves quality of life (kidney transplantation), and saves lives (heart, lung or liver transplantation), but few qualitative studies have explored existential questionings before transplantation. Methods: In this phenomenological qualitative study, patients registered for kidney (n¼30), liver (n¼11), lung (n¼15), or heart (n¼15) transplantation participated in a semi-structured interview. Findings: The following aspects were discussed: The dilemma of choice, the evaluation process, the endorsement of the ''good candidate's role'', the modification of objects, time and space perception, the co-existence of life and death, and the challenge of the body integrity and of the person's identity. Transplantation generates paradoxical situations, and challenges the person's life values. Discussion: Anxiety and distress may arise with awareness of existential questionings and the co-existence different worlds' life values. Transplantation further generates a broader societal and ethical debate as how to accompany existential questionings in a pragmatic medical environment.