Trends in mortality from hepatocellular carcinoma in Europe, 1980-2004.

Upward trends in mortality from hepatocellular carcinoma (HCC) were recently reported in the United States and Japan. Comprehensive analyses of most recent data for European countries are not available. Age-standardized (world standard) HCC rates per 100,000 (at all ages, at age 20-44, and age 45-59 years) were computed for 23 European countries over the period 1980-2004 using data from the World Health Organization. Joinpoint regression analysis was used to identify significant changes in trends, and annual percent change were computed. Male overall mortality from HCC increased in Austria, Germany, Switzerland, and other western countries, while it significantly decreased over recent years in countries such as France and Italy, which had large upward trends until the mid-1990s. In the early 2000s, among countries allowing distinction between HCC and other liver cancers, the highest HCC rates in men were in France (6.8/100,000), Italy (6.7), and Switzerland (5.9), whereas the lowest ones were in Norway (1.0), Ireland (0.8), and Sweden (0.7). In women, a slight increase in overall HCC mortality was observed in Spain and Switzerland, while mortality decreased in several other European countries, particularly since the mid-1990s. In the early 2000s, female HCC mortality rates were highest in Italy (1.9/100,000), Switzerland (1.8), and Spain (1.5) and lowest in Greece, Ireland, and Sweden (0.3). In most countries, trends at age 45-59 years were consistent with overall ones, whereas they were more favorable at age 20-44 years in both sexes. CONCLUSION: HCC mortality remains largely variable across Europe. Favorable trends were observed in several European countries mainly over the last decade, particularly in women and in young adults.

Congenital hydronephrosis: prenatal diagnosis and epidemiology in Europe.

OBJECTIVE: To describe prevalence, prenatal diagnosis and epidemiology of congenital hydronephrosis (CH) in Europe. MATERIAL AND METHOD: Data from a large European database for surveillance of congenital malformations (EUROCAT). The 20 participating registries are all based on multiple sources of information and include information about livebirths, fetal deaths with gestational age >or=20 weeks and terminations of pregnancy after prenatal diagnosis of malformations. Included were all cases with CH and born 1995-2004. RESULTS: There were 3648 cases with CH giving an overall prevalence of 11.5 cases per 10,000 births. The large majority of cases were livebirths (3506, 96% of total) and only 17 cases were fetal deaths and 120 were terminations of pregnancy. Almost all livebirths were alive 1 week after birth. Boys accounted for 72% of all cases. A high proportion of the cases (86%) had an isolated renal malformation. There were large regional differences in prevalence of CH ranging from 2 to 29 per 10,000 births. There was little regional variation in the prevalence of postnatally diagnosed cases while there were large regional differences in prevalence of prenatally diagnosed cases. CONCLUSION: Cases with CH are mainly livebirths, boys and survive the first week after birth. The large difference in prevalence seems to be related to the availability of prenatal screening in the region. The impact of over-diagnosis and potential over-treatment in regions with high prevalence or under-diagnosis with implications for renal function later in life in regions with low prevalence needs further investigation.

Survey of prenatal screening policies in Europe for structural malformations and chromosome anomalies, and their impact on detection and termination rates for neural tube defects and Down's syndrome.

OBJECTIVE: To 'map' the current (2004) state of prenatal screening in Europe. DESIGN: (i) Survey of country policies and (ii) analysis of data from EUROCAT (European Surveillance of Congenital Anomalies) population-based congenital anomaly registers. SETTING: Europe. POPULATION: Survey of prenatal screening policies in 18 countries and 1.13 million births in 12 countries in 2002-04. METHODS: (i) Questionnaire on national screening policies and termination of pregnancy for fetal anomaly (TOPFA) laws in 2004. (ii) Analysis of data on prenatal detection and termination for Down's syndrome and neural tube defects (NTDs) using the EUROCAT database. MAIN OUTCOME MEASURES: Existence of national prenatal screening policies, legal gestation limit for TOPFA, prenatal detection and termination rates for Down's syndrome and NTD. RESULTS: Ten of the 18 countries had a national country-wide policy for Down's syndrome screening and 14/18 for structural anomaly scanning. Sixty-eight percent of Down's syndrome cases (range 0-95%) were detected prenatally, of which 88% resulted in termination of pregnancy. Eighty-eight percent (range 25-94%) of cases of NTD were prenatally detected, of which 88% resulted in termination. Countries with a first-trimester screening policy had the highest proportion of prenatally diagnosed Down's syndrome cases. Countries with no official national Down's syndrome screening or structural anomaly scan policy had the lowest proportion of prenatally diagnosed Down's syndrome and NTD cases. Six of the 18 countries had a legal gestational age limit for TOPFA, and in two countries, termination of pregnancy was illegal at any gestation. CONCLUSIONS: There are large differences in screening policies between countries in Europe. These, as well as organisational and cultural factors, are associated with wide country variation in prenatal detection rates for Down's syndrome and NTD.

Jean-Baptiste Perronneau (ca. 1715-1783). Un portraitiste dans l'Europe des Lumières

Les monographies consacrées à Jean-Baptiste Perronneau (ca 1715-1783) à la fin du XIXe siècle et au début du XXe siècle traduisaient l'engouement pour l'art du XVIIIesiècle qui se déployait dans le Tout Paris de la Belle Époque. Elles rendaient justice au peintre de l'Académie royale de peinture et de sculpture de Paris, et à l'un des peintres favoris des contemporains des Impressionnistes qu'elles présentaient comme un artiste éclipsé de son vivant par son prestigieux aîné, Maurice Quentin Delatour (1704-1788). La première partie de la thèse étudie la carrière parisienne du peintre, ses appuis artistiques et sociaux, ses pratiques au pastel et à l'huile, de l'agrément en 1746 à la réception en 1753 et avant le début de la période des voyages en 1756. La rivalité avec Delatour, mise en scène dans un esprit d'émulation au Salon du Louvre pendant plus de vingt ans, y est largement évoquée. Un même nombre de portraits exposés fait comprendre que Perronneau avait de son vivant la faveur des artistes et du public. Il permet de mesurer les effets de la rivalité avec le peintre de Cour sur sa carrière. Delatour faisait exposer en 1750 son autoportrait à côté de son portrait demandé à Perronneau. Les qualités des deux peintres étaient comparées par la nouvelle critique. Notre étude s'attache à ce qui les rapproche comme à ce qui les sépare. Dans la deuxième partie, les peintres des milieux artistiques qu'il fréquente, Louis Tocqué, Jean-Baptiste Oudry, Charles Nicolas Cochin, pour citer les principaux, sont convoqués pour évaluer l'art de Perronneau dans ce que Cochin appelle la « ressemblance savante ». Les peintres les plus ambitieux s'attachent à son interprétation malgré les difficultés dues aux réactions de leur clientèle. La façon dont procède Perronneau est ici envisagée suivant deux aspects : d'une part, la composition du portrait selon une idée du naturel qui détermine l'attitude et une certaine imitation des défauts ; d'autre part, l'imitation de la nature qui réside dans les qualités de l'art, et donc picturales, appréciées des amateurs avertis. La façon qui lui est propre est de composer un naturel selon des poses variées, fondé sur la noblesse de l'attitude conjuguée à la simplicité, conformément à l'idéal courtois en vigueur depuis le XVIe siècle ; elle reste immuable au long de sa carrière. Dans l'imitation de la nature, sont mis en évidence des aspects cachés du faire lors de la mise en place du relief de la figure, les références aux maîtres anciens, Rembrandt, Van Dyck, la conscience de la distance à laquelle le tableau doit être vu, qui atténue la vigueur de la touche, comme le fait le verre qui sert aussi de vernis au pastel. L'idée de sprezzatura qui régit la distinction légère de la pose se décèle à la surface de ses portraits à travers l'apparence de facilité qu'il s'attache à leur donner, et jusque dans l'inimitable retouche finale. Grâce à la qualité de sa retouche, Perronneau accroît sensiblement dans certaines oeuvres à partir de 1768 l'expression savante et inventive de son sentiment. Afin de peindre comme il l'entend tout en gagnant sa vie et celle de sa famille, le peintre prend le parti de voyager comme l'y autorisait la libéralité de son statut. Dans la troisième partie est étudiée la trame de ses voyages que constituent les recommandations dont il bénéficie. Les identités des quatre cent dix modèles peints en France et en Europe de 1740 à 1782 sont systématiquement étudiées dans le catalogue ainsi que les conditions de leur rencontre avec le peintre. Elles décrivent une clientèle variée représentative de la mobilité des statuts dans l'Europe d'ancien Régime dont la composante nouvelle est la clientèle du monde de la banque internationale et du grand commerce. Leurs portraits peints à l'étranger ou dans les villes de Province que Perronneau présente au Salon irritent et inquiètent l'élite parisienne et donne lieu à de nouvelles tensions avec l'éternel rival, Delatour, au Salon de 1767. Perronneau se sent à juste titre évincé de Paris. Alors que l'on avait pu penser qu'il avait peu souffert des critiques du philosophe qui ne furent publiées qu'après sa mort, il apparaît que sa réputation pâtit de ses jugements diffusés par les nouvelles à la main au-delà des frontières et jusqu'auprès de la prestigieuse clientèle qui lui était acquise. Le travail sur son la carrière et l'oeuvre de Perronneau permet surtout une compréhension nouvelle de l'art du portrait au milieu du siècle, au moment où la représentation individuelle n'a jamais encore touché un aussi large public et où l'Académie ambitionne d'élever cet art au plus haut degré.

An age-period-cohort analysis of gastric cancer mortality from 1950 to 2007 in Europe.

PURPOSE: To analyze the components of the favorable trends in gastric cancer in Europe. METHODS: From official certified deaths from gastric cancer and population estimates for 42 countries of the European geographical region, during the period 1950 to 2007, age-standardized death rates (World Standard Population) were computed, and an age-period-cohort analysis was performed. RESULTS: Central and Northern countries with lower rates in the 2005 to 2007 period, such as France (5.28 and 1.93/100,000, men and women respectively) and Sweden (4.49 and 2.21/100,000), had descending period and cohort effects that decreased steeply from the earliest cohorts until those born in the 1940s, to then stabilize. Former nonmarket economy countries had mortality rates greater than 20/100,000 men and 10/100,000 women, and displayed a later start in the cohort effect fall, which continued in the younger cohorts. Mortality remained high in some countries of Southern and Eastern Europe. CONCLUSIONS: The decrease in gastric cancer mortality was observed in both cohort and period effects but was larger in the cohorts, suggesting that the downward trends are likely to persist in countries with higher rates. In a few Western countries with very low rates an asymptote appears to have been reached for cohorts born after the 1940s, particularly in women.

Prevalence, prenatal diagnosis and clinical features of oculo-auriculo-vertebral spectrum: a registry-based study in Europe.

Oculo-auriculo-vertebral spectrum is a complex developmental disorder characterised mainly by anomalies of the ear, hemifacial microsomia, epibulbar dermoids and vertebral anomalies. The aetiology is largely unknown, and the epidemiological data are limited and inconsistent. We present the largest population-based epidemiological study to date, using data provided by the large network of congenital anomalies registries in Europe. The study population included infants diagnosed with oculo-auriculo-vertebral spectrum during the 1990-2009 period from 34 registries active in 16 European countries. Of the 355 infants diagnosed with oculo-auriculo-vertebral spectrum, there were 95.8% (340/355) live born, 0.8% (3/355) fetal deaths, 3.4% (12/355) terminations of pregnancy for fetal anomaly and 1.5% (5/340) neonatal deaths. In 18.9%, there was prenatal detection of anomaly/anomalies associated with oculo-auriculo-vertebral spectrum, 69.7% were diagnosed at birth, 3.9% in the first week of life and 6.1% within 1 year of life. Microtia (88.8%), hemifacial microsomia (49.0%) and ear tags (44.4%) were the most frequent anomalies, followed by atresia/stenosis of external auditory canal (25.1%), diverse vertebral (24.3%) and eye (24.3%) anomalies. There was a high rate (69.5%) of associated anomalies of other organs/systems. The most common were congenital heart defects present in 27.8% of patients. The prevalence of oculo-auriculo-vertebral spectrum, defined as microtia/ear anomalies and at least one major characteristic anomaly, was 3.8 per 100,000 births. Twinning, assisted reproductive techniques and maternal pre-pregnancy diabetes were confirmed as risk factors. The high rate of different associated anomalies points to the need of performing an early ultrasound screening in all infants born with this disorder.