Biomarkers of therapeutic responses in chronic Chagas disease: state of the art and future perspectives

The definition of a biomarker provided by the World Health Organization is any substance, structure, or process that can be measured in the body, or its products and influence, or predict the incidence or outcome of disease. Currently, the lack of prognosis and progression markers for chronic Chagas disease has posed limitations for testing new drugs to treat this neglected disease. Several molecules and techniques to detect biomarkers inTrypanosoma cruzi-infected patients have been proposed to assess whether specific treatment with benznidazole or nifurtimox is effective. Isolated proteins or protein groups from different T. cruzistages and parasite-derived glycoproteins and synthetic neoglycoconjugates have been demonstrated to be useful for this purpose, as have nucleic acid amplification techniques. The amplification of T. cruziDNA using the real-time polymerase chain reaction method is the leading test for assessing responses to treatment in a short period of time. Biochemical biomarkers have been tested early after specific treatment. Cytokines and surface markers represent promising molecules for the characterisation of host cellular responses, but need to be further assessed.

CNS safety at 48-week of switching to ATV/r plus 3TC or two nucleos(t)ides in HIV-suppressed patients on stable ART: the SALT neurocognitive sub-study.

INTRODUCTION Due to their low CNS penetrance, there are concerns about the capacity of non-conventional PI-based ART (monotherapy and dual therapies) to preserve neurocognitive performance (NP). METHODS We evaluated the NP change of aviremic participants of the SALT clinical trial (1) switching therapy to dual therapy (DT: ATV/r+3TC) or triple therapy (TT: ATV/r+2NRTI) who agreed to perform an NP assessment (NPZ-5) at baseline and W48. Neurocognitive impairment and NP were assessed using AAN-2007 criteria (2) and global deficit scores (GDS) (3). Neurocognitive change (GDS change: W48 - baseline) and the effect of DT on NP evolution crude and adjusted by significant confounders were determined using ANCOVA. RESULTS A total of 158 patients were included (Table 1). They had shorter times because HIV diagnosis, ART initiation and HIV-suppression and their virologic outcome at W48 by snapshot was higher (79.1% vs 72.7%; p=0.04) compared to the 128 patients not included in the sub-study. By AAN-2007 criteria, 51 patients in each ART group (68% vs 63%) were neurocognitively impaired at baseline (p=0.61). Forty-seven patients were not reassessed at W48: 30 lost of follow-up (16 DT-14 TT) and 17 had non-evaluable data (6 DT-11 TT). Patients retested were more likely to be men (78.9% vs 61.4%) and had neurological cofounders (9.6% vs 0%) than patients non-retested. At W48, 3 out of 16 (5.7%) patients on DT and 6 out of 21 (10.5%) on TT who were non-impaired at baseline became impaired (p=0.49) while 10 out of 37 (18.9%) on DT and 7 out of 36 (12.3%) on TT who were neurocognitively impaired at baseline became non-impaired (p=0.44). Mean GDS changes (95% CI) were: Overall -0.2 (-0.3 to -0.04): DT -0.26 (-0.4 to -0.07) and TT -0.08 (-0.2 to 0.07). NP was similar between DT and TT (0.15). This absence of differences was also observed in all cognitive tests. Effect of DT: -0.16 [-0.38 to 0.06]) (r(2)=0.16) on NP evolution was similar to TT (reference), even after adjusting (DT: -0.11 [-0.33 to 0.1], TT: reference) by significant confounders (geographical origin, previous ATV use and CD4 cell count) (r(2)=0.25). CONCLUSIONS NP stability was observed after 48 weeks of follow up in the majority of patients whether DT or TT was used to maintain HIV-suppression. Incidence rates of NP impairment or NP impairment recovery were also similar between DT and TT.

The Emergence and Governance of Euroregions: The Case of the Euregio on the Dutch-German Border

Amb una història que data de la dècada de 1950, la EUREGIO és un de les més antigues euroregions a Europa. Es pot considerar com un cas exitós d'una regió transfronterera (CBR) en el sentit que s'ha establert fermament com una agència de fronteres dins del seu tram de la frontera holandesa-alemanya. L'EUREGIO també ha estat una de les protagonistes principals darrere de l'Associació de Regions Frontereres Europees (ARFE), que en les últimes dècades va actuar per difondre el model d'euroregió a tot el territori europeu. Aquest capítol té diversos objectius. En primer lloc, es presenta el cas de la EUREGIO i presenta evidència sobre la seva història, estructura orgànica i polítiques. En segon lloc, s'analitzen les condicions del context en què la EUREGIO ha sorgit i les estructures de govern que es van crear com a resultat. Es fa especial èmfasi en la posició i el paper de l'Euroregió en el context més ampli del marc de governança europea multinivell generat per la política de cohesió de la UE. El capítol conclou amb un intent d'avaluar l'èxit i l'impacte de la EUREGIO i una discussió dels reptes relacionats amb la doble funció de l'EUREGIO com a representant dels interessos de les autoritats locals i les agències de cohesió de la UE posada en pràctica de les polítiques.

The Franco-German motor before the eastern enlargement: the causes of its decline

The Franco-German axis has been a transcendent force behind the European integration ever since the early years of the EEC. Nevertheless, since the fall of the Berlin Wall in November 1989, the perception of a progressive distancing between France and Germany as far as the EU politics is concerned, has increased. There has not been a definitive break in Franco-German relations. However, the influence of the Franco-German axis in the EU has been reduced in the 90s. Finally, in the Nice IGC (December 2000), the misunderstandings of these two “big” states about their weight in the Council, almost caused the failure to conclude the Treaty of Nice, clearing the way for the Eastern enlargement. The traditional balance between France and Germany has been eroded. Germany has consolidated its role of leadership in the EU, and above all towards the candidate countries. The purpose of this paper is to analyse the fifth enlargement as one of the causes of the decline of the Franco-German axis as the motor of the process of European integration.

Reconeixement facial en obres d'art : avaluació del rendiment dels mètodes de l'estat de l'art actual

Aquest paper es divideix en 3 parts fonamentals, la primera relata el que pretén mostrar aquest estudi, que és aplicar els sistemes actuals de reconeixement facial en una base de dades d'obres d'art. Explica quins mètodes s'utilitzaran i perquè es interessant realitzar aquest estudi. La segona passa a mostrar el detall de les dades obtingudes en l'experiment, amb imatges i gràfics que facilitaran la comprensió. I en l'última part tenim la discussió dels resultats obtinguts en l'anàlisi i les seves posteriors conclusions.

Adaptation en français et en allemand d'une échelle de pression des pairs pour jeunes adultes : le Peer Pressure Inventory [Adaptation of a peer pressure scale in French and German: the Peer Pressure Inventory].

BACKGROUND: Peer pressure is regarded as an important determinant of substance use, sexual behavior and juvenile delinquency. However, few peer pressure scales are validated, especially in French or German. Little is known about the factor structure of such scales or the kind of scale needed: some scales takes into account both peer pressure to do and peer pressure not to do, while others consider only peer pressure to do. The aim of the present study was to adapt French and German versions of the Peer Pressure Inventory, which is one of the most widely used scales in this field. We considered its factor structure and concurrent validity. METHODS: Five thousand eight hundred and sixty-seven young Swiss men filled in a questionnaire on peer pressure, substance use, and other variables (conformity, involvement) in a cohort study. RESULTS: We identified a four-factor structure, with the three factors of the initial Peer Pressure Inventory (involvement, conformity, misconduct) and adding a new one (relationship with girls). A non-valued scale (from no peer pressure to peer pressure to do only) showed stronger psychometric qualities than a valued scale (from peer pressure not to do to peer pressure to do). Concurrent validity was also good. Each behavior or attitude was significantly associated with peer pressure. CONCLUSION: Peer pressure seems to be a multidimensional concept. In this study, peer pressure to do showed the strongest influence on participants. Indeed, peer pressure not to do did not add anything useful. Only peer pressure to do affected young Swiss men's behaviors and attitudes and was reliable.

Prescribing practices in German and Swiss psychiatric university and in non-university hospitals : national differences

RÉSUMÉ Il existe dans la pratique de prescription des médicaments de grandes variations entre les hôpitaux. Ces variations sont d'origines multifactorielles, comme par exemple des traditions de prescriptions locales, des considérations pharmato-économiques, la disponibilité d'un médicament, des différences de population, la prévalence d'une maladie, etc. Les études disponibles sur les pratiques de prescription sont souvent réduites à un centre unique, à une région ou à un pays. L'emploi de méthodes et de définitions particulières a jusqu'à pressent limité des comparaisons plus étendues entre les pays et régions. Le but de cette étude est de comparer la pratique de prescription de nouveaux médicaments psychotropes dans des cliniques suisses et allemandes. Cinq hôpitaux psychiatriques ont été sélectionnés, faisant tous partie du projet AMSP, et représentant des cliniques suisses, allemandes, de niveau universitaire ou non. Des données sur 572 patients et 1745 prescriptions ont été collectées durant un jour précis. Les comparaisons ont été ajustées pour l'âge et le sexe. Une différence significative (p <0.001) a été trouvée dans la prescription de nouveaux médicaments antidépresseurs, les cliniciens suisses en donnant en moyenne plus (65.2%) que les allemands (48.3%). Aucune différence significative n'a été démontrée dans la prescription des nouveaux médicaments antipsychotiques atypiques. Il semble en conséquence que les psychiatres suisses ont une propension plus élevée à prescrire des nouveaux médicaments antidépresseurs. Cela semble être dû à des différences de traditions de prescriptions nationales ou régionales. D'autres études sont nécessaires pour investiguer les influences économiques sur la pratique de prescription dans des cliniques suisses et allemandes. SUMMARY Obiective: There are great variations between hospitals in the way drugs are prescribed and these variations may be due to multiple factors such as local prescribing traditions, pharmacoeconomic considerations, drug availability; regional differences of population, disease prevalence etc. Available studies on prescribing habits have, besides studies performed in a unique centre, until now often been restricted to single countries or regions and the comparisons across countries or regions have often been limited by the use of diverse methodologies and definitions. The aim of the present study was to compare drug prescriptions between German and Swiss psychiatric services with regard to their preference of newer psychotropics. Material, method: Five psychiatric hospitals, associated to the AMSP-project, were chosen to represent Swiss and German clinics, university and non-university settings. Data were available from one index day on 572 patients and 1745 prescriptions. The comparisons were adjusted for age and gender. Results: There was a significant difference (p < 0.001) with regard to the prescription of newer antidepressants (NAD), Swiss clinicians giving proportionally more (65.2 %) than the German psychiatrists (48.3 %). No significant difference was, on the other hand, found as to the proportion of atypical antipsychotics, the lack of difference being due to the higher proportion of clozapine among the atypical antipsychotics in Germany. Conclusion: There seems therefore to be a higher propensity for Swiss hospital psychiatrists to prescribe newer antidepressants. This seems to be due to national or regional prescribing traditions. Further studies are needed to investigate the economical influences on antidepressant prescribing in Swiss and German clinics.)