Bioethics. 2015 Apr 23. doi: 10.1111/bioe.12160. [Epub ahead of print]

Freedom of Choice About Incidental Findings Can Frustrate Participants' True Preferences.

Viberg J, Segerdahl P, Langenskiöld S, Hansson MG.

Abstract

Ethicists, regulators and researchers have struggled with the question of whether incidental findings in genomics studies should be disclosed to participants. In the ethical debate, a general consensus is that disclosed information should benefit participants. However, there is no agreement that genetic information will benefit participants, rather it may cause problems such as anxiety. One could get past this disagreement about disclosure of incidental findings by letting participants express their preferences in the consent form. We argue that this freedom of choice is problematic. In transferring the decision to participants, it is assumed that participants will understand what they decide about and that they will express what they truly want. However, psychological findings about people's reaction to probabilities and risk have been shown to involve both cognitive and emotional challenges. People change their attitude to risk depending on what is at stake. Their mood affects judgments and choices, and they over- and underestimate probabilities depending on whether they are low or high. Moreover, different framing of the options can steer people to a specific choice. Although it seems attractive to let participants express their preferences to incidental findings in the consent form, it is uncertain if this choice enables people to express what they truly prefer. In order to better understand the participants' preferences, we argue that future empirical work needs to confront the participant with the complexity of the uncertainty and the trade-offs that are connected with the uncertain predictive value of genetic risk information.

Lung. 2015 Apr;193(2):157-71. doi: 10.1007/s00408-015-9697-7. Epub 2015 Feb 19.

Circulating tumor cells in lung cancer: detection methods and clinical applications.

Yu N1, Zhou J, Cui F, Tang X.

Author information

• 1Department of Respiratory Disease, The First Affiliated Hospital of Chongqing Medical University, #1 Youyi Rd., Yu-zhong District, Chongqing, 400016, China.

Abstract

Circulating tumor cells (CTCs) are tumor cells that have disseminated from primary and metastatic sites, and circulate in the bloodstream. Advanced immunological and molecular-based methods can be used to detect and analyze the cells with the characteristics of tumor cells, and can be detected and analyzed in the blood of cancer patients. The most commonly used methods in lung cancer combine the processes of immunomagnetic enrichment and immunocytochemical detection, morphology-based enrichment coupled with reverse transcriptase polymerase chain reaction (RT-PCR), and RT-PCR alone. CTC analysis is considered a liquid biopsy approach for early diagnosis, risk stratification, evaluation of curative efficacy, and early detection of lung cancer relapse. In this review, we discuss the present techniques for analyzing CTCs, and the restrictions of using these methods in lung cancer. We also review the clinical studies in lung cancer and discuss the underlying associations between these studies and their future applications to this disease.

Tuberc Respir Dis (Seoul). 2015 Apr;78(2):64-71. doi: 10.4046/trd.2015.78.2.64. Epub 2015 Apr 2.

Diagnosis of pulmonary tuberculosis: recent advances and diagnostic algorithms.

Ryu YJ1.

Author information

• 1Division of Pulmonary and Critical Care Medicine, Department of Medicine, Ewha Womans University School of Medicine, Seoul, Korea.

Abstract

Pulmonary tuberculosis (TB) persists as a great public health problem in Korea. Increases in the overall age of the population and the rise of drug-resistant TB have reinforced the need for rapid diagnostic improvements and new modalities to detect TB and drug-resistant TB, as well as to improve TB control. Standard guidelines and recent advances for diagnosing pulmonary TB are summarized in this article. An early and accurate diagnosis of pulmonary TB should be established using chest X-ray, sputum microscopy, culture in both liquid and solid media, and nucleic acid amplification. Chest computed tomography, histopathological examination of biopsy samples, and new molecular diagnostic tests can be used for earlier and improved diagnoses, especially in patients with smear-negative pulmonary TB or clinically-diagnosed TB and drug-resistant TB.

Thorac Surg Clin. 2015 May;25(2):161-174. doi: 10.1016/j.thorsurg.2014.12.002. Epub 2015 Feb 15.

Lung Cancer Screening: The European Perspective.

Veronesi G1.

Author information

• 1Lung Cancer Early Detection Unit, European Institute of Oncology, Via Ripamonti 435, 20141 Milan, Italy. Electronic address: giulia.veronesi@ieo.it.

Abstract

European studies have contributed significantly to the understanding of lung cancer screening. Smoking within screening, quality of life, nodule management, minimally invasive treatments, cancer prevention programs, and risk models have been extensively investigated by European groups. Mortality data from European screening studies have not been encouraging so far, but long-term results of the NELSON study are eagerly awaited. Investigations on molecular markers of lung cancer are ongoing in Europe; preliminary results suggest they may become an important screening tool in the future.

Arch Pathol Lab Med. 2015 Apr;139(4):441-4. doi: 10.5858/arpa.2014-0335-ED.

The essential role of pathologists in health care and health policy.

Romano RC1, Allen TC, Blessing MM.

Author information

• 1From the Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota (Drs Romano and Blessing); and the Department of Pathology, University of Texas Medical Branch, Galveston, Texas (Dr Allen).

"Every township, city, county, and state is looking for better health care outcomes with lower costs, and as has been stated countless times in numerous articles and editorials, we, as pathologists, are best positioned to lead this movement."

Study: Half of food ads aimed at kids fall short of nutritional guidelines

“They are packaged for kids, they are marketed to kids, they are put on the grocery store shelf exactly at the height level for kids,” she says.

The heavy promotion of these foods makes it difficult for kids to make smart choices, and tougher for parents to ensure their children eat right.

PLoS One. 2015 Apr 8;10(4):e0124124. doi: 10.1371/journal.pone.0124124. eCollection 2015.

Impact of the CFTR-Potentiator Ivacaftor on Airway Microbiota in Cystic Fibrosis Patients Carrying A G551D Mutation.

Bernarde C1, Keravec M1, Mounier J1, Gouriou S1, Rault G2, Férec C3, Barbier G1, Héry-Arnaud G4.

Author information

• 1EA 3882-Laboratoire Universitaire de Biodiversité et Ecologie Microbienne, Université de Brest, Brest, France.
• 2Centre de Perharidy, CRCM mixte, Roscoff, France.
• 3UMR1078, Institut National de la Santé et de la Recherche Médicale, Brest, France; Laboratoire de Génétique Moléculaire, CHRU Brest, Brest, France; Faculté de Médecine et des Sciences de la Santé, Université de Brest, Brest, France; Etablissement Français du Sang-Bretagne, Brest, France.
• 4EA 3882-Laboratoire Universitaire de Biodiversité et Ecologie Microbienne, Université de Brest, Brest, France; Département de Bactériologie-Virologie, Hygiène et Parasitologie-Mycologie, CHRU Brest, Brest, France.

Abstract

BACKGROUND:

Airway microbiota composition has been clearly correlated with many pulmonary diseases, and notably with cystic fibrosis (CF), an autosomal genetic disorder caused by mutation in the CF transmembrane conductance regulator (CFTR). Recently, a new molecule, ivacaftor, has been shown to re-establish the functionality of the G551D-mutated CFTR, allowing significant improvement in lung function.

OBJECTIVE AND METHODS:

The purpose of this study was to follow the evolution of the airway microbiota in CF patients treated with ivacaftor, using quantitative PCR and pyrosequencing of 16S rRNA amplicons, in order to identify quantitative and qualitative changes in bacterial communities. Three G551D children were followed up longitudinally over a mean period of more than one year covering several months before and after initiation of ivacaftor treatment.

RESULTS:

129 operational taxonomy units (OTUs), representing 64 genera, were identified. There was no significant difference in total bacterial load before and after treatment. Comparison of global community composition found no significant changes in microbiota. Two OTUs, however, showed contrasting dynamics: after initiation of ivacaftor, the relative abundance of the anaerobe Porphyromonas 1 increased (p<0.01) and that of Streptococcus 1 (S. mitis group) decreased (p<0.05), possibly in relation to the anti-Gram-positive properties of ivacaftor. The anaerobe Prevotella 2 correlated positively with the pulmonary function test FEV-1 (r=0.73, p<0.05). The study confirmed the presumed positive role of anaerobes in lung function.

CONCLUSION:

Several airway microbiota components, notably anaerobes (obligate or facultative anaerobes), could be valuable biomarkers of lung function improvement under ivacaftor, and could shed light on the pathophysiology of lung disease in CF patients.

Minerva Med. 2015 Apr 22. [Epub ahead of print]

Surgical options to early-stage lung cancer: can "the less" mean "the safe"?

Cariboni U1, Stella GM.

Author information

• 1UO Chirurgia Toracica, Istituto Clinico Humanitas, Rozzano, Milano, Italy - G.Stella@smatteo.pv.it.

Abstract

Lung cancer is the leading cause of death for solid tumors worldwide. Approximately 5-10% of patients present with an early stage tumor and can undergo radical surgery. There are different kinds of thoracotomies depending on the location of surgical entry and how much lung is removed. At the present, lobectomy is the standard procedure to remove early stage lung cancer. Two options can be performed: i) open lobectomy, through which a lobe of the lungs is removed through a long incision on the side of the chest (thoracotomy); ii) video-assisted thoracoscopic surgical (VATS) procedure which allows the lobe removal through a few small incisions in the chest with the assistance of instruments and a camera. Here we discuss and analyze the findings of a paper by Subroto and colleagues, recently published by the British Medical Journal which compares long term survival after minimally invasive lobectomy and thoracotomy lobectomy, by using a propensity matched approach. Although some methodological limitation, the study findings point out that between the two techniques there are no differences regarding the outcome, but the minor comorbidity associated to VATS. Further investigation in the form of a randomized controlled trial are thus needed to assure to ​VATS wider indications in thoracic oncology.

Calorie-laden diets: The new smoking

Sugar and Carbs, Not Physical Inactivity, Behind Surge in Obesity

Time to bust myth that anyone -- including athletes -- can outrun a bad diet

By BMJ-British Medical Journal | April 23, 2015

"Regular exercise is key to staving off serious disease, such as diabetes, heart disease, and dementia, write the authors, but our calorie laden diets now generate more ill health than physical inactivity, alcohol, and smoking combined."

"...when someone consumes fructose it enters the liver; fructose turns into fat and the fat gets sent into the bloodstream."

By AMY KRAFTCBS NEWSApril 22, 2015, 4:09 PM

High fructose corn syrup raises heart disease risk, study finds

"Stanhope told CBS News that when someone consumes fructose it enters the liver; fructose turns into fat and the fat gets sent into the bloodstream."

Nat Rev Neurosci. 2015 May;16(5):305-12. doi: 10.1038/nrn3939. Epub 2015 Apr 15.

The dopamine theory of addiction: 40 years of highs and lows.

Nutt DJ1, Lingford-Hughes A1, Erritzoe D1, Stokes PR2.

Author information

• 1Centre for Neuropsychopharmacology, Division of Brain Sciences, Burlington Danes Building, Imperial College London, London W12 0NN, UK.
• 21] Centre for Neuropsychopharmacology, Division of Brain Sciences, Burlington Danes Building, Imperial College London, London W12 0NN, UK. [2] Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London SE5 8AF, UK.

Abstract

For several decades, addiction has come to be viewed as a disorder of the dopamine neurotransmitter system; however, this view has not led to new treatments. In this Opinion article, we review the origins of the dopamine theory of addiction and discuss the ability of addictive drugs to elicit the release of dopamine in the human striatum. There is robust evidence that stimulants increase striatal dopamine levels and some evidence that alcohol may have such an effect, but little evidence, if any, that cannabis and opiates increase dopamine levels. Moreover, there is good evidence that striatal dopamine receptor availability and dopamine release are diminished in individuals with stimulant or alcohol dependence but not in individuals with opiate, nicotine or cannabis dependence. These observations have implications for understanding reward and treatment responses in various addictions.

"Despite its importance, little attention has been given to the concept of frailty in family medicine."

Can Fam Physician. 2015 Mar;61(3):227-231.

Frailty: Identifying elderly patients at high risk of poor outcomes.

Lee L1, Heckman G2, Molnar FJ3.

Author information

• 1Family physician at the Centre for Family Medicine Family Health Team in Kitchener, Ont, and Associate Clinical Professor in the Department of Family Medicine at McMaster University in Hamilton, Ont. lee.linda.lw@gmail.com.
• 2Schlegel Research Chair in Geriatric Medicine and Associate Professor in the Faculty of Applied Health Sciences at the University of Waterloo in Ontario.
• 3Medical Director of the Regional Geriatric Program of Eastern Ontario and Assistant Professor in the Department of Medicine at the University of Ottawa in Ontario.

Abstract

OBJECTIVE:

To help family physicians better recognize frailty and its implications for managing elderly patients.

SOURCES OF INFORMATION:

PubMed-MEDLINE was searched from 1990 to 2013. The search was restricted to English-language articles using the following groups of MeSH headings and key words: frail elderly, frail, frailty; aged, geriatrics, geriatric assessment, health services for the aged; and primary health care, community health services, and family practice.

MAIN MESSAGE:

Frailty is common, particularly in elderly persons with complex chronic conditions such as heart failure and chronic obstructive pulmonary disease. Emerging evidence demonstrates the value of frailty as a predictor of adverse outcomes in older persons. While there is currently a lack of consensus as to how best to assess and diagnose frailty in primary care practice, individual markers of frailty such as low gait speed offer a promising feasible means of screening for frailty. Identification of frailty in primary care might provide an opportunity to delay the progression of frailty through proactive interventions such as exercise, and awareness of frailty can guide appropriate counseling and anticipatory preventive measures for patients when considering medical interventions. Recognition of frailty might also help identify and optimize the management of coexisting conditions that might contribute to or be affected by frailty. Further research should be directed at identifying feasible and effective ways to appropriately assess and manage these vulnerable patients at the primary care level.

CONCLUSION:

Despite its importance, little attention has been given to the concept of frailty in family medicine. Frailty is easily overlooked because its manifestations can be subtle, slowly progressive, and thus dismissed as normal aging; and physician training has been focused on specific medical diseases rather than overall vulnerability. For primary care physicians, recognition of frailty might help them provide appropriate counseling to patients and family members about the risks of medical interventions.

Obesity epidemic 'is becoming a US national security issue'

Obesity epidemic 'is becoming a US national security issue', says general who warns that America will soon be too fat to field an army

• General in charge of army recruiting has warned that America's growing obesity epidemic 'is becoming a national security issue'
• Major General Allen Batschelet says 10 percent of young men and women are currently refused because they are too heavy
• Current trends project that the military will be unable to recruit enough qualified soldiers by the end of the decade
• Maximum body fat percentage that the army allows for recruits aged 17-20 is 20 percent for men and 30 percent for females
• 
  

Read more: http://www.dailymail.co.uk/news/article-3050620/Obesity-epidemic-national-security-issue-says-general-warns-HALF-young-Americans-fat-serve-2020.html#ixzz3Y2zioNCe
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Disaster Med Public Health Prep. 2015 Apr;9(2):166-74. doi: 10.1017/dmp.2014.156.

Public Acceptance of Peramivir During the 2009 H1N1 Influenza Pandemic: Implications for Other Drugs or Vaccines Under Emergency Use Authorizations.

Quinn SC1, Hilyard K2, Castaneda-Angarita N3, Freimuth VS4.

Author information

• 11Department of Family Science,School of Public Health,University of Maryland,College Park,Maryland.
• 22School of Public Health,University of Georgia,Athens,Georgia.
• 33Department of Politics and International Relations,University of Southampton,Southampton,United Kingdom.
• 44Southern Center for Communication,Health, and Poverty,University of Georgia,Athens,Georgia.

Abstract

OBJECTIVE:

The Centers for Disease Control and Prevention estimated that up to 88 million H1N1 influenza cases, 398,000 hospitalizations, and up to 18,050 related deaths, including significant racial and ethnic disparities, occurred between April 2009 and March 13, 2010. The Food and Drug Administration (FDA) approved emergency use authorizations (EUAs), which allowed the distribution of unapproved drugs or the off-label use of approved drugs. In late 2009, peramivir was granted an EUA for patients with severe disease. This study examined factors associated with willingness to take peramivir.

METHODS:

In 2010 we conducted a nationally representative survey with 2079 respondents randomly drawn from the Knowledge Networks research panel. Our completion rate was 56%. Respondents received information about peramivir from a fact sheet and then answered questions about their willingness to take the drug.

RESULTS:

Overall, 48% of participants indicated that they would probably or definitely take peramivir. Seventy-nine percent definitely would take the drug if their doctor recommended it and there were no alternative treatments. There were significant racial differences in willingness. The term experimental to refer to the drug decreased willingness to accept peramivir among both whites and blacks.

CONCLUSIONS:

Trust in the FDA was important for peramivir acceptance. Particular care must be taken to ensure that patients and their families understand the complex nature of EUA drugs. Lessons learned can inform communication about future EUAs. 

Family announcement: Steve Byrnes passes away at age 56

Family announcement: Steve Byrnes passes away at age 56

Malar J. 2015 Apr 9;14(1):149. doi: 10.1186/s12936-015-0666-7.

Imported malaria among people who travel to visit friends and relatives: is current UK policy effective or does it need a strategic change?

Behrens RH1, Neave PE2, Jones CO3,4,5.

Author information

• 1Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK. ron.behrens@lshtm.ac.uk.
• 2Department of Public Health, Auckland University of Technology, Auckland, New Zealand. penny.neave@aut.ac.nz.
• 3Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK. CJones@kemri-wellcome.org.
• 4Kemri-Wellcome Trust Research Programme, Kilifi, Kenya. CJones@kemri-wellcome.org.
• 5Nuffield Department of Clinical Medicine, Centre for Tropical Medicine, University of Oxford, Oxford, UK. CJones@kemri-wellcome.org.

Abstract

BACKGROUND:

The proportion of all imported malaria reported in travellers visiting friends and relatives (VFRs) in the UK has increased over the past decade and the proportion of Plasmodium falciparum malaria affecting this group has remained above 80% during that period. The epidemiological data suggest that the strategies employed in the UK to prevent imported malaria have been ineffective for VFRs. This paper attempts to identify possible reasons for the failure of the malaria prevention strategy among VFRs and suggest potential alternatives.

METHODS:

A review of the current UK malaria prevention guidelines was undertaken and their approach was compared to the few data that are available on malaria perceptions and practices among VFRs.

RESULTS:

The current UK malaria prevention guidelines focus on educating travellers and health professionals using messages based on the personal threat of malaria and promoting the benefits of avoiding disease through the use of chemoprophylaxis. While malaria morbidity disproportionately affects VFRs, the mortality rates from malaria in VFRs is eight times, and severe disease eight times lower than in tourist and business travellers. Recent research into VFR malaria perceptions and practices has highlighted the complex socio-ecological context within which VFRs make their decisions about malaria. These data suggest that alternative strategies that move beyond a knowledge-deficit approach are required to address the burden of malaria in VFRs.

DISCUSSION:

Potential alternative strategies include the use of standby emergency-treatment (SBET) for the management of fevers with an anti-malarial provided pre-travel, the provision of rapid diagnostic testing and treatment regimen based in general-practitioner surgeries, and urgent and walk-in care centres and local accident and emergency (A&E) departments to provide immediate diagnosis and accessible ambulatory treatment for malaria patients. This latter approach would potentially address some of the practical barriers to reducing the burden of malaria in VFRs by moving the process nearer to the community.

Zombie allusions: They just keep on coming™: "...not be controlled by government, perhaps encouraged and influenced through programs, but not by taxes."

Your comments on fighting obesity: 'Kids sit like zombies on their iPhones'

Dear Norway:

Dear Norway:

https://www.youtube.com/watch?v=HV3zWSawJiw

Norway to become first nation in world to shut down FM radio

HT:PC

Global Health. 2015 Mar 21;11(1):13.

Health in the sustainable development goals: ready for a paradigm shift?

Buse K1, Hawkes S2.

Author information

• 1Chief, Strategic Policy Directions, UNAIDS, Geneva, Switzerland. busek@unaids.org.
• 2Reader in Global Health, Institute for Global Health, University College London, London, UK. s.hawkes@ucl.ac.uk.

Abstract

The Millennium Development Goals (MDGs) galvanized attention, resources and accountability on a small number of health concerns of low- and middle-income countries with unprecedented results. The international community is presently developing a set of Sustainable Development Goals as the successor framework to the MDGs. This review examines the evidence base for the current health-related proposals in relation to disease burden and the technical and political feasibility of interventions to achieve the targets. In contrast to the MDGs, the proposed health agenda aspires to be universally applicable to all countries and is appropriately broad in encompassing both communicable and non-communicable diseases as well as emerging burdens from, among other things, road traffic accidents and pollution.We argue that success in realizing the agenda requires a paradigm shift in the way we address global health to surmount five challenges: 1) ensuring leadership for intersectoral coherence and coordination on the structural (including social, economic, political and legal) drivers of health; 2) shifting the focus from treatment to prevention through locally-led, politically-smart approaches to a far broader agenda; 3) identifying effective means to tackle the commercial determinants of ill-health; 4) further integrating rights-based approaches; and 5) enhancing civic engagement and ensuring accountability. We are concerned that neither the international community nor the global health community truly appreciates the extent of the shift required to implement this health agenda which is a critical determinant of sustainable development.

"For Hinduism and Buddhism, the cessation of heart, brain and lung function is the beginning of the process of dying-not the end."

Philos Ethics Humanit Med. 2015 Mar 11;10(1):6.

An explanation and analysis of how world religions formulate their ethical decisions on withdrawing treatment and determining death.

Setta SM1, Shemie SD2.

Author information

• 1Department of Philosophy and Religion, Northeastern University, 360 Huntington Ave., Boston, 02115, MA, USA. s.setta@neu.edu.
• 2Division of Pediatric Critical Care, and Medical Director, Extracorporeal Life Support Program at Montreal Children's Hospital, McGill University Health Centre, 2300 Rue Tupper, Montréal, QC, H3H 1P3, Canada. sam.shemie@mcgill.ca.

Abstract

INTRODUCTION:

This paper explores definitions of death from the perspectives of several world and indigenous religions, with practical application for health care providers in relation to end of life decisions and organ and tissue donation after death. It provides background material on several traditions and explains how different religions derive their conclusions for end of life decisions from the ethical guidelines they proffer.

METHODS:

Research took several forms beginning with a review of books and articles written by ethicists and observers of Bön, Buddhism, Christianity, Hinduism, Indigenous Traditions, Islam, Judaism, Shinto and Taoism. It then examined sources to which these authors referred in footnotes and bibliographies. In addition, material was gathered through searches of data bases in religious studies, general humanities, social sciences and medicine along with web-based key word searches for current policies in various traditions.

RESULTS:

Religious traditions provide their adherents with explanations for the meaning and purpose of life and include ethical analysis for the situations in which their followers find themselves. This paper aims to increase cultural competency in practitioners by demonstrating the reasoning process religions use to determine what they believe to be the correct decision in the face of death.

CONCLUSION:

Patterns emerge in the comparative study of religious perspectives on death. Western traditions show their rootedness in Judaism in their understanding of the human individual as a finite, singular creation. Although the many branches of Western religions do not agree on precisely how to determine death, they are all able to locate a moment of death in the body. In Eastern traditions personhood is not defined in physical terms. From prescribing the location of death, to resisting medical intervention and definitions of death, Eastern religions, in their many forms, incorporate the beliefs and practices that preceded them. Adding to the complexity for these traditions is the idea that death is a process that continues after the body has met most empirical criteria for determining death. For Hinduism and Buddhism, the cessation of heart, brain and lung function is the beginning of the process of dying-not the end.

Arch Pathol Lab Med. 2015 Apr 8. [Epub ahead of print]

Comes Digital Pathology.

Allen TC1.

Author information

• 1From the Department of Pathology, University of Texas Medical Branch, Galveston.

"Digital pathology is unlikely to replace glass slides any time soon, but glass slides and digital pathology appear destined to be comites diagnosticus."

Zombie allusions: They just keep on coming™: "...degenerated but functional..."

Front Cell Dev Biol. 2015 Apr 1;3:21. doi: 10.3389/fcell.2015.00021. eCollection 2015.

Atypical centrioles during sexual reproduction.

Avidor-Reiss T1, Khire A1, Fishman EL1, Jo KH1.

Author information

• 1Department of Biological Sciences, University of Toledo Toledo, OH, USA.

Abstract

Centrioles are conserved, self-replicating, microtubule-based, 9-fold symmetric subcellular organelles that are essential for proper cell division and function. Most cells have two centrioles and maintaining this number of centrioles is important for animal development and physiology. However, how animals gain their first two centrioles during reproduction is only partially understood. It is well established that in most animals, the centrioles are contributed to the zygote by the sperm. However, in humans and many animals, the sperm centrioles are modified in their structure and protein composition, or they appear to be missing altogether. In these animals, the origin of the first centrioles is not clear. Here, we review various hypotheses on how centrioles are gained during reproduction and describe specialized functions of the zygotic centrioles. In particular, we discuss a new and atypical centriole found in sperm and zygote, called the proximal centriole-like structure (PCL). We also discuss another type of atypical centriole, the "zombie" centriole, which is degenerated but functional. Together, the presence of centrioles, PCL, and zombie centrioles suggests a universal mechanism of centriole inheritance among animals and new causes of infertility. Since the atypical centrioles of sperm and zygote share similar functions with typical centrioles in somatic cells, they can provide unmatched insight into centriole biology.

Intern Emerg Med. 2015 Apr 1. [Epub ahead of print]

Has evidence-based medicine left quackery behind?

Naudet F1, Falissard B, Boussageon R, Healy D.

Author information

• 1Centre d'Investigation Clinique, CIC-P INSERM 1414, Centre Hospitalier Universitaire de Rennes et Université de Rennes 1, Rennes, France, floriannaudet@gmail.com.

Abstract

Evidence-based medicine (EBM) is generally considered as the most complete paradigm in the practice of clinical medicine. Its application should preclude all kinds of quackery. Therapeutic reformers of the second half of the twentieth century have convinced the medical community that the double-blind randomized controlled trial (RCT) versus placebo is the gold standard in clinical research to establish evidence of treatment usefulness. Nevertheless, this paradigm ignores the importance of non-specific effects in the healing process and can generate misrepresentations. Additionally, because of methodological limitations, RCTs as they are used in practice can give rise to new forms ofquackery by promoting drugs that are not useful for the patients who actually receive them, or are so expensive that their value is open to criticism. This is precisely the case when surrogate outcomes, with questionable clinical significance, are used. These can divert attention from clinically relevant outcomes, such as safety issues that are probably the core of treatment evaluation. The boundaries between quackery and EBM that clinicians are faced with are not so clear-cut. There is a need for doctors to acknowledge their share in quackery and to be continually conscious of the possible pitfalls of their therapeutic practice.