Watchful Eye Prevents Catastrophe in Case of Malignant Hyperthermia: A Case Report.

CASE: A 49-year-old woman presented with a displaced left posterior wall acetabular fracture-dislocation and a left comminuted intra-articular distal radius fracture sustained in a motor vehicle accident. Fifteen minutes after anesthesia induction for operative fixation of the fractures, the patient experienced severe hypertension, increased end-tidal carbon dioxide, and fever. A diagnosis of malignant hyperthermia (MH) was made before incision. The patient was medically stabilized, and her acetabular fracture-dislocation was placed in skeletal traction until she was deemed fit for surgery 4 days later. CONCLUSION: This case report highlights the importance of early recognition of MH and perioperative management.

Mathematics in biological reality: The emergence of natural computation in living systems.

Mathematics is a powerful tool to express the computable part of the reality of the physical world. For living systems, mathematical relations emerge internally as an abstracting capacity in the course of development and adaptation to the external world. All living systems possess internal coding structures which represent their embedded description. They are anticipatory in the sense that the embedded description generates deterministic model of their behavior. If the model does not provide a correct result, they can evolve through the acquisition of new statements inside the embedded description that overcome limitations of the existing model. The newly generated statements acquire meaning in and from the changing environment. The growth of complexity, being a consequence of the internal active adaptation to externality performed by the systems, increases the amount of external work and generates the observed patterns of spatiotemporal structures of evolving systems. In living systems, the symbolic memory constraints are dynamic processes in themselves, co-evolving with the other components of biological systems. Separation of the symbolic memory and the dynamic laws (defined as the epistemic cut), required for self-replication of biological systems, forms the basis for their onto-epistemic relation to reality. In this regard, living systems possess their own internal abstracting capacity and invent mathematics. The digital structure of the genetic code is a manifestation of this mathematics.

The evolutionary dynamics of social systems via reflexive transformation of external reality.

One of the main challenges of the social sciences is to explain metasystem transitions from biological to social systems in the process of evolution. These transitions correspond to the emergence of the structure of the subject in which the external world is internalized as a symbolic image. This structure has the potential of rationally reflecting the external world and encoding it in human language. The structure of the subject was defined by Freud and Lacan within the framework of psychoanalysis and modeled by Vladimir Lefebvre using the algebra of simple relations. In that context, the binary oppositions of the Western (W) and Eastern (E) types of cognitive reflection generate not only opposite types of societies but also form the spatiotemporal pattern within a society as a whole underlying its homeostasis and internal dynamics. This opposition between Western and Eastern types is not identical to, but mirrors the probably genetically determined opposition between individuals with primarily selfish or altruistic behavior. The structure of the reflexive subject represents the basis of a sociotype that can be considered as the third component of biosocial being in addition to genotype and phenotype; it is defined a social form of the individual bonded by the social environment and social interactions. The transition to a different type of social relations and structure is based on an anticipated reflexive choice by an individual that is accompanied by a coherent response from the society. This change is defined as a "social transaction" and can be modeled by the logic of the transactional interpretation of quantum mechanics. In the history of human civilization, social transactions have resulted in the advancement and distribution of new knowledge and technologies, and in the formation, merging, splitting and decline and re-emergence of particular types of societies.

Linking the Tao, biomathics and information through the logic of energy.

The knowledge accumulated in West and East is incomplete in different ways. The mainstream Western approach has contributed the basis for modern science, but indications have appeared in the Western literature that something has been missing in it that Eastern thought could offer. This paper explores the similarities and differences between Eastern and Western approaches to knowledge and whether a trend exists toward their conjunction or convergence. I suggest that a process of conjunction of these different modes of exploration of what the concepts of 'Life and Mind' really entail, at the interface of philosophy and science, is taking place in the areas of information and biomathics. These conjunctions in China and in the West are characterized by scientific and philosophical systems which are holistic rather than reductionist. I argue that a non-standard, non-truth-functional logic of energy, based on the work of Stéphane Lupasco (1900-1988), provides a thread linking these approaches. Grounded in modern physics, it can describe the qualitative changes which are the focus of Chinese thought. In biology, Lupasco showed how the principles of this logic of dynamic relations operate in intra- and inter-cellular processes and at higher levels of organization. This paper supports key, primarily Chinese concepts and critiques the logical and categorial distinctions underlying and restricting the Western world-view. The paper also supports the implicit openness of Integral Biomathics to qualitative Eastern perspectives. Its finality is to find, from the conjunction, "better ideas for better exploration" of the nature of mind and life. This is not an academic exercise but a moral imperative for both Eastern and Western society.

A trade agreement's impact on access to generic drugs.

Millions of people lack access to affordable medicines. The intellectual property rules in the Central America Free Trade Agreement (CAFTA) provide pharmaceutical companies with monopoly protections that allow them to market some drugs without competition by less costly generics. We examined availability of certain drugs in Guatemala and found that CAFTA intellectual property rules reduced access to some generic drugs already on the market and delayed new entry of other generics. Some drugs protected from competition in Guatemala will become open for generic competition in the United States before generic versions will be legally available in Guatemala.

Heavily pretreated ovarian cancer patients treated by single-agent gemcitabine. A retrospective outcome comparison between platinum-sensitive and platinum-resistant patients.

To assess activity and toxicity of gemcitabine treatment in heavily pretreated epithelial ovarian cancer (EOC) patients and compare the outcome between platinum-sensitive and platinum-resistant patients. We conducted a retrospective analysis of 43 women with EOC treated with gemcitabine on Days 1, 8 and 15 every 28 days. Response was evaluated by physical examination and serial CA 125 measurements. The patients (median age 62 years, range 29-87) were previously exposed to a median of 3 (2-8) chemotherapy regimens. A median of 3.5 (1-14) gemcitabine cycles were administered. Eleven (25.6%) patients showed partial response, 19 (44.2%) had stable disease and 13 (30.2%) progressed. Among 22 platinum-sensitive and 21 platinum-resistant patients, the response rate was 45.5% and 4.7% respectively (p = 0.001), and the median time to progression was 5.0 and 2.8 months, respectively (p = 0.0006). The respective median survival was 16.5 and 6.3 months (p = 0.0001). Grade III-IV hematological toxicities included anemia in four (9.3%) patients, thrombocytopenia in four (9.3%) and leucopenia in two (4.7%). The main non-hematological toxicities were grade III fatigue in two patients (4.7%) and nausea and vomiting in two (4.7%). Single agent gemcitabine is an attractive option for heavily pretreated EOC patients. The significant difference between platinum-sensitive and resistant patients' warrants further investigation.

Global trade and public health.

Global trade and international trade agreements have transformed the capacity of governments to monitor and to protect public health, to regulate occupational and environmental health conditions and food products, and to ensure affordable access to medications. Proposals under negotiation for the World Trade Organization's General Agreement on Trade in Services (GATS) and the regional Free Trade Area of the Americas (FTAA) agreement cover a wide range of health services, health facilities, clinician licensing, water and sanitation services, and tobacco and alcohol distribution services. Public health professionals and organizations rarely participate in trade negotiations or in resolution of trade disputes. The linkages among global trade, international trade agreements, and public health deserve more attention than they have received to date.

International trade agreements: hazards to health?

Since the 1980s, neoliberal policies have prescribed reducing the role of governments, relying on market forces to organize and provide health care and other vital human services. In this context, international trade agreements increasingly serve as mechanisms to enforce the privatization, deregulation, and decentralization of health care and other services, with important implications for democracy as well as for health. Critics contend that social austerity and "free" trade agreements contribute to the rise in global poverty and economic inequality and instability, and therefore to increased preventable illness and death. Under new agreements through the World Trade Organization that cover vital human services such as health care, water, education, and energy, unaccountable, secret trade tribunals could overrule decisions by democratically elected officials on public financing for national health care systems, licensing and training standards for health professionals, patient safety and quality regulations, occupational safety and health, control of hazardous substances such as tobacco and alcohol, the environment, and affordable access to safe water and sanitation. International negotiations in 2003 in Cancun and in Miami suggested that countervailing views are developing momentum. A concerned health care community has begun to call for a moratorium on trade negotiations on health care and water, and to reinvigorate an alternative vision of universal access to vital services.

CMF (cyclophosphamide, methotrexate, 5-fluorouracil) versus CNF (cyclophosphamide, mitoxantrone, 5-fluorouracil) as adjuvant chemotherapy for stage II lymph-node positive breast cancer: results by demographic and clinical subgroups.

A multicenter phase III randomized study comparing the efficacies of two adjuvant polychemotherapeutic regimens in 145 patients with stage II node-positive breast cancer: the standard chemotherapy combination, CMF (cyclophosphamide, methotrexate, 5-fluorouracil), and an experimental protocol, CNF (cyclophosphamide, mitoxantrone [Novantrone], 5-fluorouracil) in which mitoxantrone replaced methotrexate. The finding of a significant advantage ( p= 0.04) in the disease-free survival for those receiving mitoxantrone (mean survival 4.4 years for CNF versus 2.7 years for CMF) led the authors to break the data down in subpopulations to determine exactly which groups of women responded more favorably to CNF than CMF. An advantage in disease-free survival was found, most notable in four subgroups: Sephardic women, women less than 45 years of age, premenopausal women, and women with 4 to 10 positive axillary lymph nodes. Although the small numbers of women in each of these subgroups rule out drawing definitive conclusions, the trend merits further study to confirm these observations.