The clinical usefulness of noninvasive measurement of carotid intima media thickness and plaque visualization in the general population is still uncertain.
We evaluated the age-specific incidence ...rates of cerebrovascular events in a cohort of 1348 subjects randomly taken from the census list of San Daniele Township and followed for a mean period of 12.7 years. The association among common carotid intima media thickness, measured at baseline, arterial risk factors, and incidence of ischemic cerebrovascular events was modeled using Poisson regression. The predictive ability of common carotid intima media thickness over arterial risk factors (summarized in the Framingham Stroke Risk Score) was evaluated by receiver operating characteristic curve analysis.
During the follow-up, 115 subjects developed nonfatal ischemic stroke, transient ischemic attack, or vascular death, which were the predefined study end points. After adjustment for age and sex, hypertension, diabetes, common carotid intima media thickness above 1 mm, and carotid plaques were all independent risk factors for development of vascular events. Inclusion of carotid findings (presence of common carotid intima media thickness above 1 mm or carotid plaques) resulted in a predictive power higher than Framingham Stroke Risk Score alone only on for those subjects with a Framingham Stroke Risk Score over 20%.
Although common carotid intima media thickness and presence of carotid plaques are known to be risk factors for the development of vascular events and to be independent from the conventional risk factors summarized in the Framingham Stroke Risk Score, their contribution to individual risk prediction is limited. Further studies will be required to address the role of carotid ultrasonography in the primary prevention of high-risk subjects.
BackgroundIn most low-to-middle-income countries, HIV control at the population level among people who inject drugs (PWID) remains a major challenge. We aimed to demonstrate that an innovative ...intervention can identify HIV-positive PWID in the community who are not treated efficiently, and get them treated efficiently. MethodsBetween 2016 and 2020, we implemented an intervention consisting of mass HIV screening of PWID using three annual respondent-driven sampling surveys (RDSS) and a post-intervention evaluation RDSS in community-based organisation (CBO) sites, coupled with peer support to facilitate/improve access to antiretroviral and methadone therapy in Haiphong, Vietnam. The primary outcome was the proportion of identified uncontrolled HIV-positive PWID who achieved viral control. We also estimated the potential effect of the intervention on the proportion of PWID with HIV RNA >1000 copies/mL among all PWID during the study period. FindingsOver the three RDSS, 3150 different PWID were screened, i.e. two-thirds of the estimated population size. They all injected heroin, their median age was of 39 years, 95% were male, 26.5% were HIV-infected, and 78.6% of the latter had HIV RNA ≤1000 copies/mL. Among the 177 PWID identified with an unsuppressed viral load, 73 (41.2%) achieved viral suppression at the final visit. HIV viremia decreased from 7.2% at baseline to 2.9% at the final RDSS (p<0.001). Up to 42% of this observed reduction may be explained by the intervention, in the absence of any external intervention targeting PWID during the study period. InterpretationMass community-based screening using RDSS coupled with CBO support is a powerful tool to rapidly identify untreated HIV-positive PWID and (re)link them to care. FundingNIDA (USA) and ANRS (France).
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
BACKGROUNDAdvanced hepatocellular carcinoma (HCC) includes a wide spectrum of tumors and patients’ prognosis after treatment is highly variable. Moreover, therapeutic options based on the Barcelona ...Clinic Liver Cancer (BCLC) staging system algorithm are restricted to one systemic therapy.
AIM OF THE STUDYTo refine the stratification among BCLC C HCC patients by establishing a new simple prognostic score.
PATIENTS AND METHODSA regression model based on a BCLC stage C population and validated with an external cohort of BCLC C HCC patients defined the score. It was therefore validated among three external cohorts of BCLC C HCC patients treated with sorafenib.
RESULTSFive variables had independent prognostic valuesthe number of nodules, the infiltrating nature of the HCC, α-fetoprotein serum level, Child–Pugh score, and Eastern Cooperative Oncology Group Performance Status grade. They were integrated into a new score named NIACE ranging from 0 to 7, well correlated with survival. With the use of one threshold value, this score enables defining of two populations with different survivals among BCLC C patients and specifically among those treated with sorafenib.
CONCLUSIONThe NIACE score defines different prognostic subgroups after palliative treatment of HCC. It could be an additional tool for BCLC C HCC before inclusion in clinical trials or for the management of patients. These results must be validated in a prospective study.
BACKGROUNDConventional transarterial chemoembolization (cTACE) with lipiodol is widely performed in patients with hepatocellular carcinoma (HCC) unsuitable for curative treatment. Additional tumor ...parameters such as HCC macroscopic appearance based on imaging might be helpful for transarterial chemoembolization prognostication and management.
PATIENTS AND METHODSA total of 405 patients with HCC who underwent cTACE between 2008 and 2016 from a real-life multicenter French cohort were retrospectively reviewed. Tumors were classified into two macroscopic types according to HCC gross appearance on imagingnodular versus non-nodular. The study population was stratified into two groupsderivation and validation cohorts. Independent prognostic factors of survival based on multivariate cox regression models were determined and then assessed in the validation set. Thereafter, time to progression (TTP) and radiological response rate were investigated for each prognostic factors of survival.
RESULTSMedian overall survival (OS) was 35 months for Barcelona Clinic Liver Cancer (BCLC) stage A, 22 months for BCLC stage B and 12 months for BCLC stage C patients (P < 0.0001). The corresponding TTP for these patients was 12 (7–17) months, 5 (3–6) months and 1.2 (1.2–3) months (P < 0.0001). Multivariate analysis revealed that tumors size and number, non-nodular type, alpha-fetoprotein, aspartate aminotransferase serum levels and impairment of performance status-1 were independent predictors of survival among the study groups. Non-nodular type was the most powerful factor that influences OS, TTP and radiological response rate for the recommended transarterial chemoembolization candidates. TTP was consistent with OS within each stage.
CONCLUSIONHCC macroscopic appearance on imaging is a determinant predictor of outcome after cTACE in a real-life multicenter cohort.
Durante la época de la Resistencia al enemigo y ocupante alemán en 1944 y en los años de la posguerra, hasta 1947, Albert Camus escribió centenares de artículos en el diario Combat. Su compromiso en ...la lucha clandestina y en la gestión de la liberación es evidente. Su voluntad de afirmar principios morales corresponde con la mayor parte de los textos literarios que publicó. Para él hay que asociar lucha ideológica y ética. El análisis de sus colaboraciones periodísticas lo ilustra perfectamente. Camus adoptará una actitud semejante y distinta durante la guerra de Argelia: mantuvo en un primer momento una posición liberal, denunciando ciertas injusticias de la Colonización pero luego, durante el enfrentamiento militar entre Francia y los rebeldes argelinos, se refugió en un silencio dramático, a raíz del fracaso de su llamamiento para una tregua civil. Veremos que en ambas circunstancias históricas, Camus privilegió una actitud profundamente ética.
Los peores enemigos de Francisco Umbral reconocen su capacidad para crear un discurso lingüistico innovador tanto en sus textos autobiográficos, autoficcionales, ficcionales o periodísticos. Entre ...los 14 textos publicados durante la década 2000-2010 por Francisco Umbral, dos solamente pueden considerarse como pertenecientes stricto sensu a la prosa narrativa: son dos novelas, El socialista sentimental (2000) y Los metales nocturnos (2003), a los que hay que añadir, además de las columnas en prensa, un diario íntimo, Un ser de lejanías (2001), y un libro póstumo, Carta a mi mujer, que aparentemente Umbral escribió en los años 80 y que se publicó en 2008. Es precisamente en estos textos supuestamente narrativos donde observamos una marcada tendencia hacia un discurso esencialmente lírico. Nos centraremos esencialmente en este libro póstumo en el cual observamos una gran fuerza poética. En este discurso dirigido a su esposa María España, Umbral da muestra de una gran capacidad de creación en lo que se puede considerar como un testamento que da una imagen muy distinta de la relación del escritor con su esposa.
Cette communication se propose d’aborder l’œuvre d’un des représentants les plus actifs dans la création romanesque espagnole contemporaine à partir des angles suivants : refus du moule traditionnel ...du roman, destruction de la notion de genre, rôle différent de l’auteur, rapport nouveau au réel. Corpus : En Bayona bajo los porches (2002), La flecha del miedo (2000), El corazón de la niebla (2001), La nave de Baco (2004), La isla de Juan Fernández (2005), La calavera de Robinson (2006), Cornejas de Bucarest (2010). Nous fonderons notre analyse sur différents points : la symbolique des titres de ses romans, la représentation d’une ville imaginaire Umbría, incarnation de Pamplona dans des textes qui semblent pourtant si ancrés dans la réalité humaine, sociale, historique du Pays Basque et de la Navarre. Le mythe de Robinson Crusoé et de l’île de Juan Fernández sont significatifs d’une tentation de la marginalité et de la lutte solitaire. La figure de l’écrivain ventriloque, c’est-à-dire voix des autres, atteste cette conception du romancier toujours doublé par un narrateur à la recherche d’un personnage mystérieux. On décèlera ainsi chez Sánchez-Ostiz un refus du réalisme social ou politique au bénéfice d’une littérature qui est avant tout création d’un univers singulier grâce à la suprématie des éléments fictionnels comme l’atteste le véritable manifeste littéraire qui apparaît dans Cornejas de Bucarest (2010). Il y proclame cette revendication selon laquelle tous ses textes sont des romans et son refus du roman historique.
Idiomas cruzados Castellani, Jean– Pierre
El hilo de la fábula,
09/2020
20
Journal Article
Open access
Partimos de la premisa de que cualquier idioma es «otro», comenzando con la lengua materna que comenzamos a escuchar desde la gestación en el útero. La lengua materna es, por lo tanto, la primera ...lengua extranjera que aprendemos. Nos basaremos en las últimas conclusiones del trabajo realizado por investigadores en laboratorios de ciencias cognitivas y psicolingüísticas que subrayan la naturaleza híbrida de este aprendizaje de otros idiomas incluso antes del nacimiento del niño. La familia, la escuela, las diferentes situaciones históricas desarrollarán y modificarán estos logros. Cosmopolitismo, exilio político o económico, las decisiones individuales desempeñarán su papel. Es obvio que los escritores, en su elección voluntaria de escritura, son representantes activosde esas situaciones de doble pertenencia. Este fenómeno está particularmente presente en el caso de Francia con sus colonias y con la francofonía, y de España con la conquista de las Américas y la guerra civil de 1936 a 1939 que provocó un movimiento de exilio o de relación conflictiva con el terreno original. Sin entrar en los detalles de cada uno de estos ejemplos, tomaremos algunos, significativos de esta hibridación.
BACKGROUNDCareful selection of hepatocellular carcinoma (HCC) patients prior to chemoembolization treatment is a daily reality, and is even more necessary with new available therapeutic options in ...HCC. AIMTo propose two new models to better stratify patients and maximize clinical benefit: "6 and 12" and "pre/post-TACE-predict" (TACE, transarterial chemoembolization). METHODSWe evaluated and compared their performance in predicting overall survival with other systems {Barcelona Clinic Liver Cancer (BCLC), Albumin-Bilirubin (ALBI) and NIACE Number of tumor(s), Infiltrative HCC, alpha-fetoprotein, Child-Pugh (CP), and performance status} in two HCC French cohorts of different stages enrolled between 2010 and 2018. RESULTSThe cohorts included 324 patients classified as BCLC stages A/B (cohort 1) and 137 patients classified as BCLC stages B/C (cohort 2). The majority of the patients had cirrhosis with preserved liver function. "Pre-TACE-predict" and "6 and 12" models identified three distinct categories of patients exhibiting different prognosis in cohort 1. However, their prognostic value was no better than the BCLC system or NIACE score. Liver function based on CP and ALBI grades significantly impacted patient survival. Conversely, the "post-TACE-predict" model had a higher predictive value than other models. The stratification ability as well as predictive performance of these new models in an intermediate/advanced stage population was less efficient (cohort 2). CONCLUSIONThe newly proposed "Pre-TACE-predict" and "6 and 12" models offer an interesting stratification into three categories in a recommended TACE population, as they identify poor candidates, those with partial control and durable response. The models' contribution was reduced in a population with advanced stage HCCs.
Background & Aims Transarterial chemoembolization (TACE) is the standard of care for intermediate stage hepatocellular carcinoma (HCC) and it is the most commonly used treatment for HCC worldwide. ...However, no prognostic indices, designed to select appropriate candidates for repeat conventional TACE, have been incorporated in the guidelines. Methods From January 2007 to April 2012, 139 consecutive HCC patients, mainly with an alcohol- or viral-induced disease, were treated with TACE. Using a regression model on the prognostic variables of our population, we determined a score designed to help for repeat TACE and we validated it in two cohorts. We also compared it to the ART score. Results In the multivariate analysis, four prognostic factors were associated with overall survival: BCLC and AFP (>200 ng/ml) at baseline, increase in Child-Pugh score by ⩾2 from baseline, and absence of radiological response. These factors were included in a score (ABCR, ranging from −3 to +6), which correlates with survival and identifies three groups. The ABCR score was validated in two different cohorts of 178 patients and proofed to perform better than the ART score in distinguishing between patients’ prognosis. Conclusions The ABCR score is a simple and clinically relevant index, summing four prognostic variables endorsed in HCC. An ABCR score ⩾4 prior to the second TACE identifies patients with dismal prognosis who may not benefit from further TACE sessions.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
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