Red herrings, circuit-breakers and ageism in the COVID-19 debate.

In their recent paper 'Why lockdown of the elderly is not ageist and why levelling down equality is wrong' Savulescu and Cameron attempt to argue the case for subjecting the 'elderly' to limits not imposed on other generations. We argue that selective lockdown of the elderly is unnecessary and cruel, as well as discriminatory, and that this group may suffer more than others in similar circumstances. Further, it constitutes an unjustifiable deprivation of liberty.

Regulating the Tyrell Corporation: the Emergence of Novel Beings.

Emerging biotechnologies and advances in computer science promise the arrival of novel beings possessed of some degree of moral status, even potentially sentient or sapient life. Such a manifestation will constitute an epochal change, and perhaps threaten Homo sapiens' status as the only being generally considered worthy of personhood and its contingent protections; as well as being the root of any number of social and legal issues. The law as it stands is not likely to be capable of managing or adapting to this challenge. This paper highlights the likely societal ramifications of novel beings and the gaps in the legislation which is likely to be relied upon to respond to these. In so doing, the authors make a case for the development of new regulatory structures to manage the moral issues surrounding this new technological upheaval.

Amplio, Ergo Sum.

This article aims to explore the idea that enhancement technologies have been and will continue to be an essential element of what we might call the "human continuum," and are indeed key to our existence and evolution into persons. Whereas conservative commentators argue that enhancement is likely to cause us to lose our humanity and become something other, it is argued here that the very opposite is true: that enhancement is the core of what and who we are. Using evidence from paleoanthropology to examine the nature of our predecessor species, and their proclivities for tool use, we can see that there is good reason to assume that the development of Homo sapiens is a direct result of the use of enhancement technologies. A case is also made for broad understandings of the scope of enhancement, based on the significant evolutionary results of acts that are usually dismissed as "unremarkable." Furthermore, the use of enhancement by modern humans is no different than these prehistoric applications, and is likely to ultimately have similar results. There is no good reason to assume that whatever we may become will not also consider itself human.

Legally Human? 'Novel Beings' and English Law.

Novel beings-intelligent, conscious life-forms sapient in the same way or greater than are human beings-are no longer the preserve of science fiction. Through technologies such as artificial general intelligence, synthetic genomics, gene printing, cognitive enhancement, advanced neuroscience, and more, they are becoming ever more likely and by some definitions may already be emerging. Consideration of the nature of intelligent, conscious novel beings such as those that may result from these technologies requires analysis of the concept of the 'reasonable creature in being' in English law, as well as of the right to life as founded in the European Convention on Human Rights and the attempts to endow human status on animals in recent years. Our exploration of these issues leads us to conclude that there is a strong case to recognize such 'novel' beings as entitled to the same fundamental rights to life, freedom from inhumane treatment, and liberty as we are.

The Edge of Human? The Problem with the Posthuman as the 'Beyond'.

This article asks whether enhancement can truly lead to something beyond humanity, or whether it is, itself, an inherently human act. The 'posthuman' is an uncertain proposition. What, exactly, would one be? Many commentators suggest it to be an endpoint for the use of enhancement technologies, yet few choose to codify the term outright; which frequently leads to unnecessary confusion. Characterizing and contextualizing the term, particularly its more novel uses, is therefore a valuable enterprise. The abuse of the term 'Human', especially in the context of the enhancement debate and the myriad meanings ascribed to it, could give 'posthuman' very different slants depending on one's assumptions. There are perhaps three main senses in which the term 'human' is employed: the biological, the moral, and the self-idealizing. In the first of these, 'human' is often conflated with Homo sapiens, and used interchangeably to denote species; in the second, 'human' (or 'humanity') generally refers to a community of beings which qualify as having a certain moral value; and the third, the self-idealizing sense, is more descriptive; a label denoting the qualities that make us who we are as beings, or 'what matters about those who matter'. So, what might enhancement make us? A novel species or genus of hominid? Or, perhaps, a morally more valuable being than a regular human? Of course, there's a third option: that a posthuman is a being which embodies our self-ideal more successfully than we do ourselves - one 'more human than human'. Which to choose?

Artificial Intelligence.

It seems natural to think that the same prudential and ethical reasons for mutual respect and tolerance that one has vis-à-vis other human persons would hold toward newly encountered paradigmatic but nonhuman biological persons. One also tends to think that they would have similar reasons for treating we humans as creatures that count morally in our own right. This line of thought transcends biological boundaries-namely, with regard to artificially (super)intelligent persons-but is this a safe assumption? The issue concerns ultimate moral significance: the significance possessed by human persons, persons from other planets, and hypothetical nonorganic persons in the form of artificial intelligence (AI). This article investigates why our possible relations to AI persons could be more complicated than they first might appear, given that they might possess a radically different nature to us, to the point that civilized or peaceful coexistence in a determinate geographical space could be impossible to achieve.

Substance over style: is there something wrong with abandoning the white coat?

In this paper, we address points raised by Stephanie Dancer's article in The BMJ in which she claimed that by 'dressing down', physicians fail to adhere to the dignitas of the medical profession, and damage its reputation. At the beginning of this paper, we distinguish between two different senses in which a person can be, as she terms it, 'scruffy'; and then we address Dancer's three main claims. First, we argue that in regard to the medical profession it is fallacious to assume, as she appears to do, that someone is incompetent or irresponsible when such a judgement is grounded in the fact that a physician is not dressed in a formal way. Second, we argue, contrary to her claim, that the dignified nature of the medical profession is in no coherent way linked to sartorial elegance or lack thereof, but rather, that such dignity is bound to the value of the medical practice in itself, to patients, and to society at large. Third, we examine two ways in which doctors can 'dress down' and show that 'scruffiness' does not necessarily intimates a lack of personal hygiene. Finally, we show that pointing to mere statistical correlation without causation, cannot be used as an argument against scruffiness. We conclude by suggesting that in the medical context, it is more appropriate to educate patients than to chastise practitioners for not following arbitrary cultural mores.

Hot baths and cold minds: neuroscience, mind reading, and mind misreading.

The idea-the possibility-of reading the mind, from the outside or indeed even from the inside, has exercised humanity from the earliest times. If we could read other minds both prospectively, to discern intentions and plans, and retrospectively, to discover what had been "on" those minds when various events had occurred, the implications for morality and for law and social policy would be immense. Recent advances in neuroscience have offered some, probably remote, prospects of improved access to the mind, but a different branch of technology seems to offer the most promising and the most daunting prospect for both mind reading and mind misreading. You can't have the possibility of the one without the possibility of the other. This article tells some of this story.

Endobronchial ultrasound-guided transbronchial needle aspiration prevents mediastinoscopies in the diagnosis of isolated mediastinal lymphadenopathy: a prospective trial.

RATIONALE: Patients with isolated mediastinal lymphadenopathy (IML) are a common presentation to physicians, and mediastinoscopy is traditionally considered the "gold standard" investigation when a pathological diagnosis is required. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is established as an alternative to mediastinoscopy in patients with lung cancer. OBJECTIVE: To determine the efficacy and health care costs of EBUS-TBNA as an alternative initial investigation to mediastinoscopy in patients with isolated IML. METHODS: Prospective multicenter single-arm clinical trial of 77 consecutive patients with IML from 5 centers between April 2009 and March 2011. All patients underwent EBUS-TBNA. If EBUS-TBNA did not provide a diagnosis, then participants underwent mediastinoscopy. MEASUREMENTS AND MAIN RESULTS: EBUS-TBNA prevented 87% of mediastinoscopies (95% confidence interval [CI], 77-94%; P < 0.001) but failed to provide a diagnosis in 10 patients (13%), all of whom underwent mediastinoscopy. The sensitivity and negative predictive value of EBUS-TBNA in patients with IML were 92% (95% CI, 83-95%) and 40% (95% CI, 12-74%), respectively. One patient developed a lower respiratory tract infection after EBUS-TBNA, requiring inpatient admission. The cost of the EBUS-TBNA procedure per patient was £1,382 ($2,190). The mean cost of the EBUS-TBNA strategy was £1,892 ($2,998) per patient, whereas a strategy of mediastinoscopy alone was significantly more costly at £3,228 ($5,115) per patient (P < 0.001). The EBUS-TBNA strategy is less costly than mediastinoscopy if the cost per EBUS-TBNA procedure is less than £2,718 ($4,307) per patient. CONCLUSIONS: EBUS-TBNA is a safe, highly sensitive, and cost-saving initial investigation in patients with IML. Clinical trial registered with ClinicalTrials.gov (NCT00932854).

Lung Decortication With Argon Plasma Energy for the Treatment of Chronic Pleural Empyema.

Lung decortication for the treatment of chronic pleural empyema remains a technically challenging procedure that is associated with bleeding and air leak. The recent advent of pure argon plasma has provided thoracic surgeons with an electrically neutral energy source for dissection and coagulation of pulmonary tissue with minimal depth of necrosis. In this article, we describe the technique of lung decortication with argon plasma energy (PlasmaJet, Plasma Surgical, Roswell, GA, USA) for the treatment of chronic pleural empyema. With appropriate application, the PlasmaJet can facilitate the removal of fibrous cortex with satisfactory hemostasis and aerostasis. Argon plasma energy can potentially be a useful adjunct in lung decortication. Controlled trials are needed to determine its role in the surgical management of advanced pleural empyema.

Alternative and Safe Technique to Tie Down a Biologic Aortic Valve in Small Aortic Roots.

Biologic aortic valves are constructed with 3 stents corresponding to the commissures, which sit in the aortic root. When implanted using interrupted sutures, these stents may make the valve difficult to tie down safely in patients with small, calcified aortic roots. We present an easily reproducible technique to make this valve tie down safer.

Video-thoracoscopic left cardiac sympathetic denervation for long-QT syndrome.

BACKGROUND: Congenital long-QT syndrome represents the most common cardiac channelopathy and manifests as potentially lethal ventricular arrhythmias. Prevention strategies include beta-blockade pharmacotherapy, implantable cardioverter-defibrillators, and left cardiac sympathetic denervation, which can increase the threshold for ventricular fibrillation. Herein, we report our experience with video-assisted thoracoscopic left cardiac sympathetic denervation. METHODS: We performed a retrospective review of the electronic medical records of all patients with congenital long-QT syndrome who underwent video-assisted thoracoscopic left cardiac sympathetic denervation at our institution. RESULTS: From September 2009 to May 2016, 6 patients with a mean age of 30.5 years (range 20-47 years) underwent video-assisted thoracoscopic left cardiac sympathetic denervation for medically refractory long-QT syndrome. All patients had an uneventful recovery and were discharged 1-3 days after the operation. At a median follow-up of 14 months (range 12-60 months), 4 patients had no cardiac events while 2 experienced 1 episode of arrhythmic syncope and 1 episode of appropriate implantable cardioverter-defibrillator shock. Following surgery, the mean annual cardiac events in the study cohort decreased from 2.13 to 0.33 (p = 0.004) and the mean corrected QT interval reduced from 560 ms to 491 ms (p = 0.006). CONCLUSIONS: Video-assisted thoracoscopic left cardiac sympathetic denervation is a safe and effective therapy in patients with congenital long-QT syndrome who continue to suffer from recurrent life-threatening arrhythmias or frequent implantable cardioverter-defibrillator discharges despite maximum tolerated doses of beta blockers.

Advanced bioscience and AI: debugging the future of life.

Scientific advancements lead us towards a future in which Homo sapiens may no longer be the only sapient being. The societal and legal challenges of this potentiality are immense, and it will require traditionally disparate branches of science to recognise their similarities in order to address them effectively.

Biologic Agents in the Treatment of Multicentric Castleman Disease.

Multicentric Castleman disease (MCD) causes an extensive range of systematic symptoms and can be life-threatening if not treated promptly and appropriately. The pathophysiology of the disease remains unclear; however, interleukin 6 (IL-6) pathway and human herpesvirus 8 infection appear to play an important role. As a result, the treatment of MCD remains complex and often insufficient, although a plethora of therapeutic approaches have been used. Between these, biological agents in the form of monoclonal antibodies against specific pathogenic processes of the disease have improved survival rates significantly. In the present study, we review the clinical results of rituximab, which targets B lymphocytes, siltuximab and tocilizumab, which target the IL-6 pathway, bortezomib, which is a selective proteasome inhibitor, and anakinra, which is an interleukin 1 receptor antagonist. The introduction of these biological agents in the treatment of MCD appears to be promising in the first studies performed. However, more clinical trials are required to assess the efficacy and safety of each agent and to form therapeutic strategies that will be widely accepted.

The role of surgical resection in Unicentric Castleman's disease: a systematic review.

INTRODUCTION: Castleman's disease is a rare benign lymphoproliferative disorder of unknown etiology. The disease occurs in two clinical forms with different prognoses, treatments and symptoms: a unicentric form (UCD), which is solitary, localized, and a multicentric form characterized by generalized lymphadenopathy and systemic symptoms. This article aims to review the current literature to consolidate the evidence surrounding the curative potential of surgical treatment to the unicentric type. MATERIAL AND METHODS: A systematic review of English-language literature was performed and databases (Medline, Pubmed, the Cochrane Database and grey literature) were searched to identify articles pertaining to the treatment of unicentric form of Castleman's disease. Each article was critiqued by two authors using a structured appraisal tool, and stratified according to the level of evidence. RESULTS: After application of inclusion criteria, 14 studies were included. There were no prospective randomized control studies identified. One meta-analysis including 278 patients with UCD reported that resective surgery is safe and should be considered the gold standard for treatment. Seven retrospective studies enhance this standpoint. Radiotherapy (RT) has been used in six studies with controversial results. CONCLUSIONS: We conclude that surgical resection appears to be the most effective treatment for Unicentric Castleman's Disease of the thoracic cavity. Radiotherapy can also achieve clinical response and cure in selected patients.