La inversión ontológica de la crítica en Spinoza

El presente trabajo pretende poner de relieve los rasgos esenciales que configuran la sistematización spinozista del racionalismo heredado de Descartes, analizando las diferencias abismales que separan la actitud subjetual y antropológica de la crítica cartesiana, defensora de la categoría de "individualidad", frente a la de "totalidad" preconizada por Spinoza. La tarea se lleva a cabo, concretamente, contraponiendo las nociones de "método","razón" e "ideas", tal como se entienden en uno y otro sistema.

Subjetividad humana y "error" en la filosofía cartesiana

El presente trabajo, continuando la línea investigadora acerca de las nociones derazón, conciencia y subjetividad en Descartes, tal como se ha defendido en otros artículos ya publicados, aporta un nuevo argumento a una línea de trabajo previamente iniciada, poniendo de relieve que el problema gnoseológico del error viene condicionado por la misma noción cartesiana de racionalidad, y que ésta dista mucho de lo que tradicionalmente se ha entendido como una racionalidad abstracta y formal, libre de los imperativos humanos. Por otro lado, y a la inversa, también se intenta mostrar como el hecho del error contribuye, cartesianamente hablando, a definir un modelo de racionalidad profundamentehumanizada. El artículo, tras una introducción, se propone analizar las relaciones entre los conceptos básicos de racionalidad, dogma, y naturaleza, lo que permitirá a continuación dejar constancia de la copertenencia entre racionalidad y error, para acabar viendo como la libertad humana es la vez, y para ambos, su fundamento último.

Del verum-factum al verum-certum [1]

La posición filosófica viquiana en el De Antiquissima ha sido interpretada de forma dominante como escéptica, apoyándose en dos argumentos de desigual carácter. Uno de ellos se alimenta de la crítica del napolitano a Descartes, al ser considerado el filósofo francés como símbolo de la posibilidad de la conquista de la evidencia y como modelo de filosofía antiescéptica.El segundo argumento se inspira en el verum-factum como criterio fundamental de su filosofía. Vico lo formula como alternativa al cartesiano criterio de la claridad y distinción; pero, el efecto del mismo, en su formulación más radical y tópica, lejos de propiciar la conquista de la evidencian más bien parece alejar esta posibilidad respecto a la totalidad del mundo real, sea la naturaleza sea la sociedad, reservándola de forma estricta y exclusiva para el reino fingido de los entes matemáticos. Esto,unido a la falta de una exacta comprensión de la relación del verum-factum con el verum-certum de la Scienza Nuova, simbolizando ésta el momento de fundamentación de una ciencia (en sentido fuerte) del mundo de las naciones, propiciará la tesis de las dos filosofías viquianas, basadas cada una de ellas en sus respectivas epistemologías del verum-factum y del verum-certum.

Manifestations électrocardiographiques de l'hyperkaliémie modérée à sévère

L'hyperpotassémie est un désordre électrolytique, qui dans des situations extrêmes, peut conduire au décès. Les premières études effectuées montraient un lien entre la progression du taux de potassium et l'apparition de modifications électrocardiographiques. Certaines études, plus récentes, ont mis en doute cette hypothèse. Notre étude a pour but de chercher quels sont les facteurs associés à l'apparition d'un pattern électrocardiographique typique, en cas d'hyperpotassémie modérée à sévère (≥7mmol/l), dans une population adulte hospitalière, non sélectionnée. Le 2ème objectif est d'estimer la mortalité liée à ce degré d'hyperkaliémie. Etude au design rétrospectif, sélectionnant les patients adultes avec K : ≥ 7mmol/L, entre 2009 et 2010 au CHUV, ayant un électrocardiogramme à disposition entre -1h et +2h de la prise de sang. Recueil des valeurs de laboratoires et des comorbidités de ces patients et analyse des électrocardiogrammes : fréquence cardiaque, durée QRS, durée QTc, amplitudes ondes T et RS, présence d'un trouble de la conduction, d'une fibrillation ou d'un flutter, d'un rythme jonctionnel. Résultats : Sur les 82 patients sélectionnés, l'analyse statistique a mis en évidence que le taux de potassium n'est corrélé ni à l'apparition de modifications électrocardiographiques typiques, ni à la mortalité. Le seul élément pouvant prédire, sur l'électrocardiogramme, l'apparition d'un pattern typique est le degré d'acidémie. Le risque de décès ou de présenter un arrêt cardiorespiratoire en cas d'hyperkaliémie modérée à sévère est principalement déterminé par la présence d'une acidose métabolique.

Médecine interne: le point de vue du chef de clinique [Internal medicine: the point of view of the chief resident].

Clinical practice in internal medicine has fundamentely changed over the last decade. Our knowledge has dramatically improved and we are facing new types of patients. Their number is increasing, they are older and suffer from increasingly complex medical conditions. The society has evolved as well therefore transforming our daily practice. This implies important modifications of our role and new challenges. We must also develop new aspects of our practice such as recognizing our errors, quality of care, quality of education, ethics, new strategies for taking care of the patient all this in parallel with continuous education. Our role as (general practitioner) is of utmost importance since it enables us to keep the "big pictures" in a more and more specialized environment.

Dynamic impacts of the inhibition of the molecular chaperone hsp90 on the T-cell proteome have implications for anti-cancer therapy.

The molecular chaperone Hsp90-dependent proteome represents a complex protein network of critical biological and medical relevance. Known to associate with proteins with a broad variety of functions termed clients, Hsp90 maintains key essential and oncogenic signalling pathways. Consequently, Hsp90 inhibitors are being tested as anti-cancer drugs. Using an integrated systematic approach to analyse the effects of Hsp90 inhibition in T-cells, we quantified differential changes in the Hsp90-dependent proteome, Hsp90 interactome, and a selection of the transcriptome. Kinetic behaviours in the Hsp90-dependent proteome were assessed using a novel pulse-chase strategy (Fierro-Monti et al., accompanying article), detecting effects on both protein stability and synthesis. Global and specific dynamic impacts, including proteostatic responses, are due to direct inhibition of Hsp90 as well as indirect effects. As a result, a decrease was detected in most proteins that changed their levels, including known Hsp90 clients. Most likely, consequences of the role of Hsp90 in gene expression determined a global reduction in net de novo protein synthesis. This decrease appeared to be greater in magnitude than a concomitantly observed global increase in protein decay rates. Several novel putative Hsp90 clients were validated, and interestingly, protein families with critical functions, particularly the Hsp90 family and cofactors themselves as well as protein kinases, displayed strongly increased decay rates due to Hsp90 inhibitor treatment. Remarkably, an upsurge in survival pathways, involving molecular chaperones and several oncoproteins, and decreased levels of some tumour suppressors, have implications for anti-cancer therapy with Hsp90 inhibitors. The diversity of global effects may represent a paradigm of mechanisms that are operating to shield cells from proteotoxic stress, by promoting pro-survival and anti-proliferative functions. Data are available via ProteomeXchange with identifier PXD000537.

Nouveau programme de formation en médecine interne générale: implications pour les médecins de premier recours [The new postgraduate training program in general internal medicine: implications for the primary care physician].

The Swiss postgraduate training program in general internal medicine is now designed as a competency-based curriculum. In other words, by the end of their training, the residents should demonstrate a set of predefined competences. Many of those competences have to be learnt in outpatient settings. Thus, the primary care physicians have more than ever an important role to play in educating tomorrows doctors. A competency-based model of training requires a regular assessment of the residents. The mini-CEX (mini-Clinical Evaluation eXercise) is the assessment tool proposed by the Swiss institute for postgraduate and continuing education. The mini-CEX is based on the direct observation of the trainees performing a specific task, as well as on the ensuing feedback. This article aims at introducing our colleagues in charge of residents to the mini-CEX, which is a useful tool promoting the culture of feedback in medical education.

Paracentèse abdominale [Abdominal paracentesis]

La paracentèse abdominale est un geste fréquemment réalisé en pratique clinique. Il est indispensable de procéder à ce geste dans un but diagnostique en cas d'ascite nouvellement mise en évidence. Chez un patient connu pour une ascite, chaque détérioration clinique ou des paramètres biologiques nécessite une nouvelle paracentèse. Ce geste peut être également réalisé dans un but thérapeutique en cas d'ascite réfractaire, d'inconfort abdominal ou de dyspnée. Comme pour toute procédure invasive, il convient d'en connaître les indications et contre-indications, le matériel nécessaire ainsi que les complications et leur traitement. Abdominal paracentesis is frequently performed in the clinical setting. Every newly developed ascites need to be investigated by abdominal paracentesis. Any clinical or biological deterioration in patients with chronic ascites also requires a new paracentesis. Therapeutically abdominal paracentesis is performed for refractory or symptomatic ascites. As other invasive procedures, it is critical to master its indications, contra-indications and complications. The aim of this article is to review the basics of abdominal paracentesis in order to help physicians to carry out this technical skill

Geometria a Renato Des Cartes anno 1637 gallice edita, nunc autem cum notis Florimondi de Beaune,... in linguam latinam versa et commentariis illustrata, opera atque studio Francisci a Schooten,...

Comprend : Notae

What treatment for periprosthetic shoulder infection? Results from a multicentre retrospective series.

PURPOSE: Controversy still exists as to the best surgical treatment for periprosthetic shoulder infections. The aim of this multi-institutional study was to review a continuous retrospective series of patients treated in four European centres and to assess the respective eradication rate of various treatment approaches. METHODS: Forty-four patients were available for this retrospective follow-up evaluation. Functional and clinical evaluation of treatment for infection was performed using the Constant-Murley score, visual analogue scale and patient satisfaction Neer score. Erythrocyte sedimentation rate, serum leucocyte count and C-reactive protein were measured and shoulder X-ray examination performed prior to surgery and at the latest follow-up. RESULTS: At a mean follow-up of 41 months (range 24-98), 42 of 44 patients (95.5%) showed no signs of infection recurrence/persistence. Comparable eradication rates were observed after resection arthroplasty (100%; 6/6), two-stage revision (17/17) or permanent antibiotic-loaded spacer implant (93.3%; 14/15). No patient was treated by one-stage revision. On average, both functional and pain scores improved significantly; the worst joint function was observed after resection arthroplasty. CONCLUSIONS: This retrospective analysis conducted on the largest published series of patients to date shows comparable infection eradication rates after two-stage revision, resection arthroplasty or permanent spacer implant for the treatment of septic shoulder prosthesis.