Is it worth treating fever in intensive care unit patients? Preliminary results from a randomized trial of the effect of external cooling.

BACKGROUND: Antipyresis is a common clinical practice in intensive care, although it is unknown if fever is harmful, beneficial, or a negligible adverse effect of infection and inflammation. METHODS: In a randomized study, rectal temperature and discomfort were assessed in 38 surgical intensive care unit patients without neurotrauma or severe hypoxemia and with fever (temperature >/=38.5 degrees C) and systemic inflammatory response syndrome. Eighteen patients received external cooling while 20 received no antipyretic treatment. RESULTS: Temperature and discomfort decreased similarly in both groups after 24 hours. No significant differences in recurrence of fever, incidence of infection, antibiotic therapy, intensive care unit and hospital length of stay, or mortality were noted between the groups. CONCLUSIONS: These results suggest that the systematic suppression of fever may not be useful in patients without severe cranial trauma or significant hypoxemia. Letting fever take its natural course does not seem to harm patients with systemic inflammatory response syndrome or influence the discomfort level and may save costs.

Espécies de cigarrinhas (Hemiptera, Cicadellidae, Cicadellinae) em pomares de citros da região de Bebedouro, SP, com descrição de uma espécie nova de Acrogonia Stål

Sharpshooter leafhoppers (Hemiptera, Cicadellidae, Cicadellinae) in citrus groves of the area of Bebedouro, SP, with description of a new species of Acrogonia Stål. Sixteen species of Cicadellidae, subfamily Cicadellinae, were collected and identified: 11 of the tribe Cicadellini and five of the tribe Proconiini. The ten most common species, together with a new species, are characterized based on external morphology and male genitalia: Acrogonia citrina Marucci & Cavichioli sp. nov.; Bucephalogonia xanthophis (Berg, 1879); Dilobopterus costalimai Young, 1977; Ferrariana trivittata (Signoret, 1854); Hortensia similis (Walker, 1851); Macugonalia cavifrons (Stål, 1862); M. leucomelas (Walker, 1851); Oncometopia facialis (Signoret, 1854); Plesiommata corniculata Young, 1977 and P. mollicella (Fowler, 1900). The leafhopper samples were collected in citrus groves and in adjacent habitats (woods, swamp, cultivable plain, spontaneous vegetation of the grove, coffee crop and sugarcane) at the counties of Bebedouro and Monte Azul Paulista and in the district of Turvínia. The collecting methods were: insect net, yellow sticky cards, portable suction trap and Malaise trap. Identification keys were elaborated for the 16 species. There is a great diversity of Cicadellinae species in the citric groves. In the three areas sampled, it was collected a larger number of species of the tribe Cicadellini than of the tribe Proconiini. In the Bebedouro area, the vector species of Xylella fastidiosa, A. citrina sp. nov., B. xanthophis, D. costalimai and O. facialis, were collected in the citrus groves and in all adjacent habitats.

Sistemática, filogenia e distribuição geográfica das espécies sul-americanas de Centris (Paracentris) Cameron, 1903 e de Centris (Penthemisia) Moure, 1950, incluindo uma análise filogenética do "grupo Centris" sensu Ayala, 1998 (Hymenoptera, Apoidea, Centridini)

Systematics, phylogeny and geographical distribution of the South American species of Centris (Paracentris) Cameron, 1903, and Centris (Penthemisia) Moure, 1950, including a phylogenetic analysis of the "Centris group" sensu Ayala, 1998 (Hymenoptera, Apoidea, Centridini). A cladistic analysis with the objective of testing the hypothesis of monophily of Centris (Paracentris) Cameron, 1903, and of studying its phylogenetic relationships with the other subgenera that belong to the Centris group, sensu Ayala, 1998, and the relationships among the species that occur in South America, is presented. Centris (Paracentris) is a group of New World bees of amphitropical distribution, especially diversified in the Andes and in the xeric areas of South and North America. Thirty-one species were included in the analysis, four considered as outgroup, and 49 characters, all from external morphology and genitalia of adult specimens. Parsimony analyses with equal weights for the characters and successive weighting were performed with the programs NONA and PAUP, and analyses of implied weighting with the program PeeWee. The strict consensus among the trees obtained in all the analyses indicates that C. (Paracentris), as previously recognized, is a paraphyletic group. In order to eliminate that condition, the subgenera C. (Acritocentris), C. (Exallocentris) and C. (Xerocentris), all described by SNELLING (1974) are synonymized under C. (Paracentris). The subgenus C. (Penthemisia) Moure, 1950, previously considered a synonym of C. (Paracentris), is reinstated, but in a more restricted sense than originally proposed and with the following species: Centris brethesi Schrottky, 1902; C. buchholzi Herbst, 1918; C. chilensis (Spinola, 1851), C. mixta mixta Friese, 1904, and C. mixta tamarugalis Toro & Chiappa, 1989. Centris mixta, previously recognized as the only South American species of the subgenus C. (Xerocentris), a group supposedly amphitropical, came out as the sister-species of C. buchholzi. The following South American species were recognized under Centris (Paracentris): Centris burgdorfi Friese, 1901; C. caelebs Friese, 1900; C. cordillerana Roig-Alsina, 2000; C. euphenax Cockerell, 1913; C. flavohirta Friese, 1900; C. garleppi (Schrottky, 1913); C. klugii Friese, 1900; C. lyngbyei Jensen-Haarup, 1908; C. mourei Roig-Alsina, 2000; C. neffi Moure, 2000; C. nigerrima (Spinola, 1851); C. toroi sp. nov.; C. tricolor Friese, 1900; C. unifasciata (Schrottky, 1913), and C. vogeli Roig-Alsina, 2000. The relationships among the subgenera of the "Centris group" were: (Xanthemisia (Penthemisia (Centris s. str. - Paracentris))). Centris xanthomelaena Moure & Castro 2001, an endemic species of the Caatinga and previously considered a C. (Paracentris), came out as the sister group of C. (Centris) s. str. A new species of C. (Paracentris) from Chile is described: Centris toroi sp. nov. Lectotypus designations and redescriptions are presented for Centris burgdorfi, C. caelebs, C. lyngbyei, C. tricolor, C. autrani Vachal, 1904 and C. smithii Friese, 1900. New synonyms proposed: C. buchholzi Herbst, 1918 = Centris wilmattae Cockerell, 1926 syn. nov.; C. caelebs Friese, 1900 = Paracentris fulvohirta Cameron, 1903. The female of C. vogeli Roig-Alsina, 2000 and the male of C. xanthomelaena are described.

Revision of the New World bee fly genus Heterostylum Macquart (Diptera, Bombyliidae, Bombyliinae)

The genus Heterostylum Macquart and five Neotropical species (H. ferrugineum (Fabricius, 1805), H. hirsutum (Thunberg, 1827), H. rufum (Olivier, 1789), H. haemorrhoicum (Loew, 1863) and H. pallipes Bigot, 1892) are redescribed. The other species, recently redescribed or described are only diagnosed, except for H. deani Painter, 1930, whose spermathecae are described and illustrated for the first time. The main characters of the external morphology were photographed and the male genitalia and female spermathecae illustrated. An identification key to all included species is also presented.

The small species of Belostoma Latreille (Heteroptera, Belostomatidae). III. A revision of oxyurum group, with a new species from Brazil and description of the male of B. noualhieri Montandon

Species of the oxyurum group (sensu Lauck) consist of five extant Neotropical small species, whose lengths range 15.0 to 20.0 mm. The anterior interocular width about 1.5 times the width of an eye and ventral diverticulum of phallus flattened, circular, and large are, in combination, diagnostic. The small species of the oxyurum group were included in the Lauck´s key to the identification of the species groups, without dealing with the species included in it because many of them are very similar in appearance. Therefore here we redescribe and key the Belostoma species of the oxyurum group. Belostoma oxyurum (Dufour) is newly recorded from Brazil (Paraná and Rio Grande do Sul). Holotype and lectotype are designated for B. oxyurum and B. sanctulum Montandon, respectively. The aspect of the prosternal keel, the ratio between the width of the ventral diverticulum of phallus and its length in ventral view, and the aspect of dorsal arms of ventral diverticulum have proven useful for better species delimitation. Based on specimens from Pará State (N. Brazil), Belostoma carajaensis Ribeiro & Estévez, sp. nov. is described and illustrated. This new species differs from B. sanctulum in having anteoculus shorter than interoculus and the dorsal arms of ventral diverticulum divergent and large. A male specimen of B. noualhieri Montandon was collected in São Paulo State and based mainly on features of male genitalia, this species is here also included under oxyurum group.

Morphological aspects of the genitalia of seven species of Heilus Kuschel (Coleoptera, Curculionidae)

Morphological aspects of the male and female genitalia and their associated sclerites, abdominal tergite and sternite 8, are described, illustrated and discussed for seven species of Heilus Kuschel 1955 of tribe and subtribe Hylobiini-Hylobiina. The seven species are H. faldermanni (Boheman, 1836); H. fasciculatus (Boheman, 1843); H. freyreissi (Boheman, 1836); H. myops (Boheman, 1836); H. pupillatus (Olivier, 1790); H. rufescens (Boheman, 1836) and H. tuberculosus (Perty, 1832).

Contributions to the knowledge of Banasa Stål (Hemiptera, Heteroptera, Pentatomidae): Banasa chaca Thomas

Contributions to the knowledge of Banasa Stål (Hemiptera, Heteroptera, Pentatomidae): Banasa chaca Thomas. The male of Banasa chaca Thomas is described with emphasis on external and internal genitalia and the female internal genitalia is described. Banasa chaca is newly recorded from Buenos Aires Province (Argentina).

Male and female reproductive systems of Stolas conspersa (Germar) (Coleoptera, Chrysomelidae, Cassidinae)

Male and female reproductive systems of Stolas conspersa (Germar) (Coleoptera, Chrysomelidae, Cassidinae). The male and female reproductive systems of Stolas conspersa (Germar, 1824) are described and illustrated for the first time. The male reproductive system shows no difference from the subfamily pattern, which is a tubular well-developed median lobe; "Y", "V" or T-shaped tegmen; reduced pygidium; internal sac membranous and tubular; flagellum generally well developed needle-like structured and gastral spiculum absent. However, the female differs from the pattern proposed for Stolas in two aspects: ovary with 28 ovarioles and a reduced ampulla with indistinct velum.

External irradiation with or without long-term androgen suppression for prostate cancer with high metastatic risk: 10-year results of an EORTC randomised study.

BACKGROUND: We did a randomised phase 3 trial assessing the benefit of addition of long-term androgen suppression with a luteinising-hormone-releasing hormone (LHRH) agonist to external irradiation in patients with prostate cancer with high metastatic risk. In this report, we present the 10-year results. METHODS: For this open-label randomised trial, eligible patients were younger than 80 years and had newly diagnosed histologically proven T1-2 prostatic adenocarcinoma with WHO histological grade 3 or T3-4 prostatic adenocarcinoma of any histological grade, and a WHO performance status of 0-2. Patients were randomly assigned (1:1) to receive radiotherapy alone or radiotherapy plus immediate androgen suppression. Treatment allocation was open label and used a minimisation algorithm with institution, clinical stage of the disease, results of pelvic-lymph-node dissection, and irradiation fields extension as minimisation factors. Patients were irradiated externally, once a day, 5 days a week, for 7 weeks to a total dose of 50 Gy to the whole pelvis, with an additional 20 Gy to the prostate and seminal vesicles. The LHRH agonist, goserelin acetate (3·6 mg subcutaneously every 4 weeks), was started on the first day of irradiation and continued for 3 years; cyproterone acetate (50 mg orally three times a day) was given for 1 month starting a week before the first goserelin injection. The primary endpoint was clinical disease-free survival. Analysis was by intention to treat. The trial is registered at ClinicalTrials.gov, number NCT00849082. FINDINGS: Between May 22, 1987, and Oct 31, 1995, 415 patients were randomly assigned to treatment groups and were included in the analysis (208 radiotherapy alone, 207 combined treatment). Median follow-up was 9·1 years (IQR 5·1-12·6). 10-year clinical disease-free survival was 22·7% (95% CI 16·3-29·7) in the radiotherapy-alone group and 47·7% (39·0-56·0) in the combined treatment group (hazard ratio [HR] 0·42, 95% CI 0·33-0·55, p<0·0001). 10-year overall survival was 39·8% (95% CI 31·9-47·5) in patients receiving radiotherapy alone and 58·1% (49·2-66·0) in those allocated combined treatment (HR 0·60, 95% CI 0·45-0·80, p=0·0004), and 10-year prostate-cancer mortality was 30·4% (95% CI 23·2-37·5) and 10·3% (5·1-15·4), respectively (HR 0·38, 95% CI 0·24-0·60, p<0·0001). No significant difference in cardiovascular mortality was noted between treatment groups both in patients who had cardiovascular problems at study entry (eight of 53 patients in the combined treatment group had a cardiovascular-related cause of death vs 11 of 63 in the radiotherapy group; p=0·60) and in those who did not (14 of 154 vs six of 145; p=0·25). Two fractures were reported in patients allocated combined treatment. INTERPRETATION: In patients with prostate cancer with high metastatic risk, immediate androgen suppression with an LHRH agonist given during and for 3 years after external irradiation improves 10-year disease-free and overall survival without increasing late cardiovascular toxicity.

Ruling out coronary heart disease in primary care: external validation of a clinical prediction rule.

BACKGROUND: The Marburg Heart Score (MHS) aims to assist GPs in safely ruling out coronary heart disease (CHD) in patients presenting with chest pain, and to guide management decisions. AIM: To investigate the diagnostic accuracy of the MHS in an independent sample and to evaluate the generalisability to new patients. DESIGN AND SETTING: Cross-sectional diagnostic study with delayed-type reference standard in general practice in Hesse, Germany. METHOD: Fifty-six German GPs recruited 844 males and females aged ≥ 35 years, presenting between July 2009 and February 2010 with chest pain. Baseline data included the items of the MHS. Data on the subsequent course of chest pain, investigations, hospitalisations, and medication were collected over 6 months and were reviewed by an independent expert panel. CHD was the reference condition. Measures of diagnostic accuracy included the area under the receiver operating characteristic curve (AUC), sensitivity, specificity, likelihood ratios, and predictive values. RESULTS: The AUC was 0.84 (95% confidence interval [CI] = 0.80 to 0.88). For a cut-off value of 3, the MHS showed a sensitivity of 89.1% (95% CI = 81.1% to 94.0%), a specificity of 63.5% (95% CI = 60.0% to 66.9%), a positive predictive value of 23.3% (95% CI = 19.2% to 28.0%), and a negative predictive value of 97.9% (95% CI = 96.2% to 98.9%). CONCLUSION: Considering the diagnostic accuracy of the MHS, its generalisability, and ease of application, its use in clinical practice is recommended.

Le fixateur externe dans les lésions traumatiques graves du bassin: résultats à propos de 20 cas consécutifs [External fixator in severe traumatic injuries of the pelvis: results apropos of 20 consecutive cases]

From August 91 to December 94, 20 external fixators were used for severely injured patients (avg. ISS 25.2). The fractures were essentially open book with or without lateral compression and vertical lesions. The indication for fixation was treatment of shock and stabilization in 8 cases, stabilization alone in 9 cases, and in 3 cases as complementary fixation after internal fixation of posterior lesions. The fixation of the pelvis was effective on the amount of blood loss. One acetabulum fracture required surgery, two patients had internal fixation for loss of reduction and two others for late pubic and posterior pain. The clinical results are good; they are more related to the severity of the initial lesion than to the mode of fixation or the quality of the reduction. No superficial sepsis or osteitis was observed in relation to the pins.

A treatment planning method for sequentially combining radiopharmaceutical therapy and external radiation therapy.

PURPOSE: Effective cancer treatment generally requires combination therapy. The combination of external beam therapy (XRT) with radiopharmaceutical therapy (RPT) requires accurate three-dimensional dose calculations to avoid toxicity and evaluate efficacy. We have developed and tested a treatment planning method, using the patient-specific three-dimensional dosimetry package 3D-RD, for sequentially combined RPT/XRT therapy designed to limit toxicity to organs at risk. METHODS AND MATERIALS: The biologic effective dose (BED) was used to translate voxelized RPT absorbed dose (D(RPT)) values into a normalized total dose (or equivalent 2-Gy-fraction XRT absorbed dose), NTD(RPT) map. The BED was calculated numerically using an algorithmic approach, which enabled a more accurate calculation of BED and NTD(RPT). A treatment plan from the combined Samarium-153 and external beam was designed that would deliver a tumoricidal dose while delivering no more than 50 Gy of NTD(sum) to the spinal cord of a patient with a paraspinal tumor. RESULTS: The average voxel NTD(RPT) to tumor from RPT was 22.6 Gy (range, 1-85 Gy); the maximum spinal cord voxel NTD(RPT) from RPT was 6.8 Gy. The combined therapy NTD(sum) to tumor was 71.5 Gy (range, 40-135 Gy) for a maximum voxel spinal cord NTD(sum) equal to the maximum tolerated dose of 50 Gy. CONCLUSIONS: A method that enables real-time treatment planning of combined RPT-XRT has been developed. By implementing a more generalized conversion between the dose values from the two modalities and an activity-based treatment of partial volume effects, the reliability of combination therapy treatment planning has been expanded.

Ignition of a human body by a modest external source: a case report.

A case of sustained combustion of a human body that occurred in 2006 in Geneva, Switzerland, is presented. The body of a man was discovered at home and found to have been almost completely incinerated between the knees and the mid-chest, with less damage to the head, arms, lower legs and feet. His dog was also found dead just behind the house door. The external source of ignition was most likely a cigarette or a cigar. The chair in which the man had been sitting was largely consumed while other objects in the room exhibited only a brown oily or greasy coating and were virtually undamaged. Toxicological analyses carried out on the blood from the lower legs showed low levels of desalkylflurazepam. Alcohol concentration was 1.10 per thousand, carboxyhaemoglobin levels were 12% and cyanide concentration was 0.05 mg/L. Toxicological analyses carried out on the dog's blood showed carboxyhaemoglobin levels at 65%.

External validation of the ASTRAL score to predict 3- and 12-month functional outcome in the China National Stroke Registry.

BACKGROUND AND PURPOSE: The ASTRAL score was recently introduced as a prognostic tool for acute ischemic stroke. It predicts 3-month outcome reliably in both the derivation and the validation European cohorts. We aimed to validate the ASTRAL score in a Chinese stroke population and moreover to explore its prognostic value to predict 12-month outcome. METHODS: We applied the ASTRAL score to acute ischemic stroke patients admitted to 132 study sites of the China National Stroke Registry. Unfavorable outcome was assessed as a modified Rankin Scale score >2 at 3 and 12 months. Areas under the curve were calculated to quantify the prognostic value. Calibration was assessed by comparing predicted and observed probability of unfavorable outcome using Pearson correlation coefficient. RESULTS: Among 3755 patients, 1473 (39.7%) had 3-month unfavorable outcome. Areas under the curve for 3 and 12 months were 0.82 and 0.81, respectively. There was high correlation between observed and expected probability of unfavorable 3- and 12-month outcome (Pearson correlation coefficient: 0.964 and 0.963, respectively). CONCLUSIONS: ASTRAL score is a reliable tool to predict unfavorable outcome at 3 and 12 months after acute ischemic stroke in the Chinese population. It is a useful tool that can be readily applied in clinical practice to risk-stratify acute stroke patients.

External assessment of the Early Mortality Risk Score in patients with adenocarcinoma undergoing pancreaticoduodenectomy.

BACKGROUND: Pancreaticoduodenectomies (PD) still have a substantial mortality rate. Recently, different scores have been published to predict the mortality risk pre-operatively after PD. This retrospective study was designed to perform an external assessment of an Early Mortality Risk Score (EMRS). METHODS: From 2000 to 2012, all PD cases performed at our institution were documented. Only patients treated for pancreatic head adenocarcinomas were included. Survival time and EMRS (based on age, tumour size, tumour differentiation and comorbidities) were calculated for every patient. Relative risks (RR) of early death 9 and 12 months after PD were then calculated. RESULTS: Of 270 PD for various aetiologies, 120 PD for adenocarcinomas were included. The median follow-up was 37 months, and the overall median survival was 19 months. EMRS of 4 showed a mortality RR of 5.1 at 9 months (P = 0.048) and of 4.5 at 12 months (P = 0.020). CONCLUSIONS: EMRS of 4 is a predictor of tumour-related mortality at 9 and 12 months after PD for adenocarcinoma. The EMRS was externally assessed in our patient cohort and can be implemented in clinical practice. Clinical implications of this score still need to be studied.