En finir avec le désir. Michel de Certeau et l'hétérologie des voix

Depuis plusieurs décennies la philosophie, comme la théologie, a trouvé dans la thématique du désir une tentative paradoxale de sauvegarder une pensée de la totalité. A partir de Michel de Certeau, une pensée du multiple pur qui puisse entendre le bris des voix mondaines est possible. Par un parcours en trois temps, les a. tentent d'exposer comment, au niveau des discursivités, l'histoire, opération du deuil et de l'écart, se défie de l'emmurement opéré par la philosophie ; puis, au niveau des singularités, comment la mystique, par l'exemple d'un poème de Jean de la Croix, ne s'exacerbe pas d'un désir porté vers l'absent, mais dévoile la présence sans rassemblement des multiplicités ; enfin, pourquoi cet effondrement de l'un ne verse pas, au niveau ontologique, dans une tautologie de l'être.

Added value of acute multimodal CT-based imaging (MCTI) : a comprehensive analysis

Introduction: MCTI is used to assess acute ischemic stroke (AIS) patients.We postulated that use of MCTI improves patient outcome regardingindependence and mortality.Methods: From the ASTRAL registry, all patients with an AIS and a non-contrast-CT (NCCT), angio-CT (CTA) or perfusion-CT (CTP) within24 h from onset were included. Demographic, clinical, biological, radio-logical, and follow-up caracteristics were collected. Significant predictorsof MCTI use were fitted in a multivariate analysis. Patients undergoingCTA or CTA&CTP were compared with NCCT patients with regards tofavourable outcome (mRS ≤ 2) at 3 months, 12 months mortality, strokemechanism, short-term renal function, use of ancillary diagnostic tests,duration of hospitalization and 12 months stroke recurrence.

European Stroke Organisation (ESO) guidelines for the management of temperature in patients with acute ischemic stroke.

BACKGROUND: Hyperthermia is a frequent complication in patients with acute ischemic stroke. On the other hand, therapeutically induced hypothermia has shown promising potential in animal models of focal cerebral ischemia. This Guideline Document presents the European Stroke Organisation guidelines for the management of temperature in patients with acute ischemic stroke. METHODS: A multidisciplinary group identified related questions and developed its recommendations based on evidence from randomized controlled trials elaborating the Grading of Recommendations Assessment, Development, and Evaluation approach. This Guideline Document was reviewed within the European Stroke Organisation and externally and was approved by the European Stroke Organisation Guidelines Committee and the European Stroke Organisation Executive Committee. RESULTS: We found low-quality evidence, and therefore, we cannot make any recommendation for treating hyperthermia as a means to improve functional outcome and/or survival in patients with acute ischemic stroke and hyperthermia; moderate evidence to suggest against routine prevention of hyperthermia with antipyretics as a means to improve functional outcome and/or survival in patients with acute ischemic stroke and normothermia; very low-quality evidence to suggest against routine induction of hypothermia as a means to improve functional outcome and/or survival in patients with acute ischemic stroke. CONCLUSIONS: The currently available data about the management of temperature in patients with acute ischemic stroke are limited, and the strengths of the recommendations are therefore weak. We call for new randomized controlled trials as well as recruitment of eligible patients to ongoing randomized controlled trials to allow for better-informed recommendations in the future.

La guerre des voix : critique polyphonique et divergences interprétatives dans l'oeuvre de Michel Houellebecq

Cet article vise à explorer la polyphonie des énoncés littéraires et ses effets sur la lecture. Je tenterai de montrer que cette question ne recouvre pas seulement un problème d'attribution, potentiellement insoluble, mais qu'il engage la question fondamentale de la valeur des énoncés fictionnels, que ces valeurs soient esthétiques ou éthiques, ou qu'il s'agisse de la prétention de la fiction à représenter une « vérité », ou du moins un aspect objectif de la réalité. Pour illustrer mon propos, je me servirai d'un court extrait tiré du roman de Michel Houellebecq, La Carte et le territoire. On verra que cette approche implique non seulement le retour de la figure de l'auteur (notamment à travers la prise en compte de sa posture), mais aussi la confrontation entre des lectures programmées par les textes et des lectures concrètes qui, parfois, et même très souvent, divergent des lectures programmées en amont.

International survey of acute stroke imaging used to make revascularization treatment decisions.

BACKGROUND: To assess the differences across continental regions in terms of stroke imaging obtained for making acute revascularization therapy decisions, and to identify obstacles to participating in randomized trials involving multimodal imaging. METHODS: STroke Imaging Repository (STIR) and Virtual International Stroke Trials Archive (VISTA)-Imaging circulated an online survey through its website, through the websites of national professional societies from multiple countries as well as through email distribution lists from STIR and the above mentioned societies. RESULTS: We received responses from 223 centers (2 from Africa, 38 from Asia, 10 from Australia, 101 from Europe, 4 from Middle East, 55 from North America, 13 from South America). In combination, the sites surveyed administered acute revascularization therapy to a total of 25,326 acute stroke patients in 2012. Seventy-three percent of these patients received intravenous (i.v.) tissue plasminogen activator (tPA), and 27%, endovascular therapy. Vascular imaging was routinely obtained in 79% (152/193) of sites for endovascular therapy decisions, and also as part of standard IV tPA treatment decisions at 46% (92/198) of sites. Modality, availability and use of acute vascular and perfusion imaging before revascularization varied substantially between geographical areas. The main obstacles to participate in randomized trials involving multimodal imaging included: mainly insufficient research support and staff (50%, 79/158) and infrequent use of multimodal imaging (27%, 43/158) . CONCLUSION: There were significant variations among sites and geographical areas in terms of stroke imaging work-up used tomake decisions both for intravenous and endovascular revascularization. Clinical trials using advanced imaging as a selection tool for acute revascularization therapy should address the need for additional resources and technical support, and take into consideration the lack of routine use of such techniques in trial planning.