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Contains fulltext : 225781.pdf (Publisher’s version ) (Open Access), BACKGROUND: Invasive fungal diseases (IFDs) remain important causes of morbidity and mortality. The consensus definitions of the Infectious Diseases Group of the European Organization for Research and Treatment of Cancer and the Mycoses Study Group have been of immense value to researchers who conduct clinical trials of antifungals, assess diagnostic tests, and undertake epidemiologic studies. However, their utility has not extended beyond patients with cancer or recipients of stem cell or solid organ transplants. With newer diagnostic techniques available, it was clear that an update of these definitions was essential. METHODS: To achieve this, 10 working groups looked closely at imaging, laboratory diagnosis, and special populations at risk of IFD. A final version of the manuscript was agreed upon after the groups' findings were presented at a scientific symposium and after a 3-month period for public comment. There were several rounds of discussion before a final version of the manuscript was approved. RESULTS: There is no change in the classifications of "proven," "probable," and "possible" IFD, although the definition of "probable" has been expanded and the scope of the category "possible" has been diminished. The category of proven IFD can apply to any patient, regardless of whether the patient is immunocompromised. The probable and possible categories are proposed for immunocompromised patients only, except for endemic mycoses. CONCLUSIONS: These updated definitions of IFDs should prove applicable in clinical, diagnostic, and epidemiologic research of a broader range of patients at high-risk.

Contains fulltext : 226024.pdf (Publisher’s version ) (Closed access), Quantitative real-time PCR (qPCR) is increasingly used to detect Pneumocystis jirovecii for the diagnosis of Pneumocystis pneumonia (PCP), but there are differences in the nucleic acids targeted, DNA only versus whole nucleic acid (WNA), and also the target genes for amplification. Through the Fungal PCR Initiative, a working group of the International Society for Human and Animal Mycology, a multicenter and monocenter evaluation of PCP qPCR assays was performed. For the multicenter study, 16 reference laboratories from eight different countries, performing 20 assays analyzed a panel consisting of two negative and three PCP positive samples. Aliquots were prepared by pooling residual material from 20 negative or positive- P. jirovecii bronchoalveolar lavage fluids (BALFs). The positive pool was diluted to obtain three concentrations (pure 1:1; 1:100; and 1:1000 to mimic high, medium, and low fungal loads, respectively). The monocenter study compared five in-house and five commercial qPCR assays testing 19 individual BALFs on the same amplification platform. Across both evaluations and for all fungal loads, targeting WNA and the mitochondrial small sub-unit (mtSSU) provided the earliest Cq values, compared to only targeting DNA and the mitochondrial large subunit, the major surface glycoprotein or the beta-tubulin genes. Thus, reverse transcriptase-qPCR targeting the mtSSU gene could serve as a basis for standardizing the P. jirovecii load, which is essential if qPCR is to be incorporated into clinical care pathways as the reference method, accepting that additional parameters such as amplification platforms still need evaluation.

Interlaboratory evaluations of Mucorales qPCR assays were developed to assess the reproducibility and performance of methods currently used. The participants comprised 12 laboratories from French university hospitals (nine of them participating in the Modimucor study) and 11 laboratories participating in the Fungal PCR Initiative. For panel 1, three sera were each spiked with DNA from three different species (Rhizomucor pusillus, Lichtheimia corymbifera, Rhizopus oryzae). For panel 2, six sera with three concentrations of R. pusillus and L. corymbifera (1, 10, and 100 genomes/ml) were prepared. Each panel included a blind negative-control serum. A form was distributed with each panel to collect results and required technical information, including DNA extraction method, sample volume used, DNA elution volume, qPCR method, qPCR template input volume, qPCR total reaction volume, qPCR platform, and qPCR reagents used. For panel 1, assessing 18 different protocols, qualitative results (positive or negative) were correct in 97% of cases (70/72). A very low interlaboratory variability in Cq values (SD = 1.89 cycles) were observed. For panel 2 assessing 26 different protocols, the detection rates were high (77-100%) for 5/6 of spiked serum. There was a significant association between the qPCR platform and performance. However, certain technical steps and optimal combinations of factors may also impact performance. The good reproducibility and performance demonstrated in this study support the use of Mucorales qPCR as part of the diagnostic strategy for mucormycosis.

BACKGROUND: Invasive fungal diseases (IFDs) remain important causes of morbidity and mortality. The consensus definitions of the Infectious Diseases Group of the European Organization for Research and Treatment of Cancer and the Mycoses Study Group have been of immense value to researchers who conduct clinical trials of antifungals, assess diagnostic tests, and undertake epidemiologic studies. However, their utility has not extended beyond patients with cancer or recipients of stem cell or solid organ transplants. With newer diagnostic techniques available, it was clear that an update of these definitions was essential. METHODS: To achieve this, 10 working groups looked closely at imaging, laboratory diagnosis, and special populations at risk of IFD. A final version of the manuscript was agreed upon after the groups' findings were presented at a scientific symposium and after a 3-month period for public comment. There were several rounds of discussion before a final version of the manuscript was approved. RESULTS: There is no change in the classifications of "proven," "probable," and "possible" IFD, although the definition of "probable" has been expanded and the scope of the category "possible" has been diminished. The category of proven IFD can apply to any patient, regardless of whether the patient is immunocompromised. The probable and possible categories are proposed for immunocompromised patients only, except for endemic mycoses. CONCLUSIONS: These updated definitions of IFDs should prove applicable in clinical, diagnostic, and epidemiologic research of a broader range of patients at high-risk.

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L’ipotesi che guida il presente contributo è che uno dei modi per migliorare l’utilità clinica sia rendere il formato della nosologia quanto più simile possibile al modo in cui i clinici categorizzano i pazienti – cioè fanno diagnosi –, nell’ambito del rispetto dei vincoli di validità e coerenza interna. In psicologia sperimentale ci sono ricerche in corso sul modo di rappresentare concettualmente i disturbi mentali da parte dei clinici (cioè esperti) nella pratica e in contesti di laboratorio. In questo breve articolo ne illustrerò una parte, suggerendo un possibile utilizzo a miglioramento dell’utilità clinica della nosologia psichiatrica corrente.

La questione dello statuto epistemologico dell’introspezione come metodo di indagine è una delle più controverse in psicologia. La maggiore difficoltà a proposito del metodo introspettivo sembra risiedere nel suo ineliminabile carattere soggettivo e ‘in prima persona’, che lo rende difficilmente valutabile in base ai medesimi criteri di validità utilizzati per considerare gli altri metodi di ricerca psicologica quali, per esempio, l’osservazione del comportamento o gli indici neurofisiologici. Partendo da tali considerazioni, il presente lavoro si propone di affrontare la questione del ruolo dell’introspezione nella ricerca psicologica inserendola all’interno di una problematica più ampia (ma non meno controversa) ovvero quella del rapporto tra psicologia del senso comune e psicologia scientifica. Infatti, se si assume che la soggettività e la prospettiva di prima persona siano a fondamento di tutte le nozioni del senso comune quali credenze, desideri o intenzioni ma non di quelle delle scienze naturali, che mirano a una loro riduzione o addirittura eliminazione, appare evidente come l’introspezione possa avere una rilevanza metodologica solamente nell’ambito una psicologia del senso comune e non nell’ambito di una psicologia che aspira a definirsi scientifica. Per usare la terminologia di Goldman, l’introspezione sembra in grado di fare luce sugli stati consci/soggettivi o macroscopici ma non su quelli inconsci/oggettivi o microscopici (caratterizzati computazionalmente) che sono considerati la reale determinante dei nostri comportamenti e dunque l’oggetto di studio proprio di una psicologia scientifica. Il lavoro si conclude mettendo in discussione la validità di tale proposta e dunque considerando se una psicologia del senso comune rigorosamente definita sia in grado di fornire una spiegazione plausibile del mentale e del comportamento e dunque di esprimere una forma di scientificità alternativa e complementare a quella delle scienze naturali ovvero una s

La psichiatria e, più in generale, la psicopatologia si trovano oggi in pro- fonda trasformazione: un modello medico tradizionale, basato su sintomi e prognosi, si affianca ad approcci alla ricerca e alla diagnosi basati su studi di neuroimaging, genetica ed epigenetica, epidemiologia e farmacologia, e si confronta con modelli fenomenologici, legati alla prospettiva della prima per- sona e del corpo agente, e psicodinamici, che hanno radici storiche ma sono sostenuti da nuove metodologie di indagine sperimentale. In questo quadro, la caratterizzazione del concetto di disturbo mentale e l'individuazione dei vari disturbi mette in gioco scelte teoriche importanti che coinvolgono in maniera essenziale le scienze della mente e la filosofia. Scopo di questo simposio è discutere alcuni aspetti concettuali della psicopatologia con filosofi italiani della scienza cognitiva. In particolare verranno affrontate le seguenti questioni:  è possibile definire la categoria generale di disturbo mentale, e co- me?  quale modello di nosologia è più adeguato per i disturbi mentali, alla luce di una concezione unitaria della mente, in cui il patologico si trova su un continuum con il normale?  Quale concezione del del sé e quale teoria della mente possono spiegare la natura dei disturbi mentali?

My talk is about psychiatric explanation, intended as explanation of ideal syndromes, like Anorexia nervosa or Narcissistic personality disorder. I argue that it should feature three levels, a descriptive-phenomenological what-level, a how-level where a dysfunction is abstractly described as the breakdown of one or more mechanisms, and a where-level in which the mechanisms and their dysfunctions are located in brain areas