Perioperative antiplatelet therapy.

Aspirin is recommended as a lifelong therapy that should never be interrupted for patients with cardiovascular dis- ease. Clopidogrel therapy is mandatory for six weeks after placement of bare-metal stents, three to six months after myocardial infarction, and at least 12 months after placement of drug-eluting stents. Because of the hypercoagulable state induced by surgery, early withdrawal of antiplatelet therapy for secondary prevention of cardiovascular disease increases the risk of postoperative myocardial infarction and death five- to 10-fold in stented patients who are on continuous dual antiplatelet therapy. The shorter the time between revascularization and surgery, the higher the risk of adverse cardiac events. Elective surgery should be postponed beyond these periods, whereas vital, semiurgent, or urgent operations should be performed under continued dual antiplatelet therapy. The risk of surgical hemorrhage is increased approximately 20 percent by aspirin or clopidogrel alone, and 50 percent by dual antiplatelet therapy. The present clinical data suggest that the risk of a cardiovascular event when stopping antiplatelet agents preoperatively is higher than the risk of surgical bleeding when continuing these drugs, except during surgery in a closed space (e.g., intracranial, posterior eye chamber) or surgeries associated with massive bleeding and difficult hemostasis.

Stem cell transplantation in brain tumors: a new field for molecular imaging?

Neural stem cells have been proposed as a new and promising treatment modality in various pathologies of the central nervous system, including malignant brain tumors. However, the underlying mechanism by which neural stem cells target tumor areas remains elusive. Monitoring of these cells is currently done by use of various modes of molecular imaging, such as optical imaging, magnetic resonance imaging and positron emission tomography, which is a novel technology for visualizing metabolism and signal transduction to gene expression. In this new context, the microenvironment of (malignant) brain tumors and the blood-brain barrier gains increased interest. The authors of this review give a unique overview of the current molecular-imaging techniques used in different therapeutic experimental brain tumor models in relation to neural stem cells. Such methods for molecular imaging of gene-engineered neural stem/progenitor cells are currently used to trace the location and temporal level of expression of therapeutic and endogenous genes in malignant brain tumors, closing the gap between in vitro and in vivo integrative biology of disease in neural stem cell transplantation.

L'Evangile du Sauveur, He 5,7 et la prière de supplication: en quête d'autres traditions sur la prière au Mont des Oliviers

L'Évangile du Sauveur 45-59 rapporte une interprétation peu connue de la prière de Jésus au Mont des Oliviers, comme prière d'intercession pour le peuple d'Israël. Cette interprètation est connue d'Origène, Jérôme et Epiphane. Cet article souhaite montrer que la prise en compte d'une telle tradition permet de reprendre sur une base nouvelle la question de la signification des prières et supplications, avec grand cri et larmes d'He 5,7. En amont de ces deux passages se tient en effet le topos d'une intense prière de supplication, efficace et faisant place aux motions. Evoquée par Justin Martyr et Origène comme d'origine hébraïque, cette prière reçoit dans le cadre du judaïsme hellénistique une tournure caractéristique, quand elle y est associée à la terminologie grecque du suppliant : elle témoigne alors d'un point de contact entre cultures juive et hellénistique. La conclusion souligne que l'Evangile du Sauveur est vecteur à la fois de la mémoire et de l'oubli culturels de la prière de supplication évoquée en He 5,7.