Traitement médicamenteux actuel de l'épiepsie [Current drug treatment for epilepsy]

If one patient is diagnosed with epilepsy, the first treatment line is represented by medications, which allow a seizure control in at least 2/3 of patients. Following the steady development of new compounds, there are currently more than 20 antiepileptic agents on the market, and several more will appear in the near future. This review, focusing on the indications and pitfalls of the most used drugs, with a particular attention to the new ones, aims at improving the orientation among this multitude of options. Since there is almost no difference regarding the efficacy on seizures, it is rather the profile of comorbidities and possible (positive and negative) side effects that will allow to select the best antiepileptic drug for each specific clinical situation, permitting a patient-tailored approach.

On the possible enhancement of oxygen depleton in the coastal waters of Perú between 6ºS and 11ºS

Analiza el balance de oxigeno consumido en las profundidades de las aguas continentales del norte del Perú

Aspects of variability in peruvian coastal waters near 9ºS

Estudia la variabilidad de las aguas costerasen dos transectos cerca de los 8 y 10°S

Current concepts in the pathogenesis of urea cycle disorders.

The common feature of urea cycle diseases (UCD) is a defect in ammonium elimination in liver, leading to hyperammonemia. This excess of circulating ammonium eventually reaches the central nervous system, where the main toxic effects of ammonium occur. These are reversible or irreversible, depending on the age of onset as well as the duration and the level of ammonium exposure. The brain is much more susceptible to the deleterious effects of ammonium during development than in adulthood, and surviving UCD patients may develop cortical and basal ganglia hypodensities, cortical atrophy, white matter atrophy or hypomyelination and ventricular dilatation. While for a long time, the mechanisms leading to these irreversible effects of ammonium exposure on the brain remained poorly understood, these last few years have brought new data showing in particular that ammonium exposure alters several amino acid pathways and neurotransmitter systems, cerebral energy, nitric oxide synthesis, axonal and dendritic growth, signal transduction pathways, as well as K(+) and water channels. All these effects of ammonium on CNS may eventually lead to energy deficit, oxidative stress and cell death. Recent work also proposed neuroprotective strategies, such as the use of NMDA receptor antagonists, nitric oxide inhibitors, creatine and acetyl-l-carnitine, to counteract the toxic effects of ammonium. Better understanding the pathophysiology of ammonium toxicity to the brain under UCD will allow the development of new strategies for neuroprotection.

First host plant records for Iridopsis hausmanni Vargas (Lepidoptera, Geometridae) in the coastal valleys of northern Chile

First host plant records for Iridopsis hausmanni Vargas (Lepidoptera, Geometridae) in the coastal valleys of northern Chile. The trees Haplorhus peruviana Engl. and Schinus molle L. (Anacardiaceae) are mentioned as the first host plant records for the little known native moth Iridopsis hausmanni Vargas, 2007 (Lepidoptera, Geometridae, Ennominae) in the coastal valleys of the northern Chilean Atacama Desert. This is also the first record of Anacardiaceae as host plant for a Neotropical species of Iridopsis Warren, 1894.

Extracção de areia na praia de Calhetona (Ilha de Santiago, Cabo Verde): causas, processos e consequências

A extracção clandestina de areia, nas faixas costeiras e nos leitos das ribeiras, tem sido prática de muitos agregados familiares cabo-verdianos. Nas últimas décadas, a praia de Calhetona (Ilha de Santiago) foi um dos muitos locais que sofreram degradação ambiental significativa, devido à realização desta actividade sem quaisquer planos de extracção e de posterior recuperação das áreas degradadas. Este trabalho, através da conjugação de recolha de dados por inquérito, observação directa e pesquisa documental e bibliográfica, teve como objectivos a caracterização da comunidade (que habita no bairro de Ponta Calhetona) que se dedica à extracção de areia na praia de Calhetona, a descrição da dinâmica da actividade extractiva, a avaliação da percepção que a comunidade tem relativamente às consequências da sua actividade e a descrição do impacte ambiental resultante da extracção de areia. Da análise dos inquéritos, efectuados em Fevereiro de 2012, a 25 chefes de agregados familiares que efectuam a extracção de areia na praia de Calhetona, constata-se que estes são maioritariamente mulheres, predominantemente com idade compreendida entre os 40 e os 59 anos, domésticas, com baixa escolaridade, com famílias numerosas e/ou alargadas a seu cargo e dedicando-se à extração de areia à mais de 10 anos. Os inquiridos, face à situação de vulnerabilidade económica, à falta de emprego e à grande procura de areia para a construção civil, vêem nesta actividade uma fonte de rendimento. Contudo, o proveito obtido desta actividade difícil e potencialmente perigosa é reduzido. Quem efectivamente beneficia são os camionistas que compram a areia a quem procede à extracção e a vendem ao consumidor final pelo dobro do preço. Os inquiridos demonstram uma consciência generalizada dos diversos impactes ambientais negativos resultantes da sua actividade, mas alegam que a extracção de areia é uma das poucas alternativas existentes para providenciar o sustento dos seus agregados familiares. Com base na comparação do estado actual da praia de Calhetona com relatos de habitantes locais, relativos às características da mesma no passado, verifica-se que nos últimos 40-50 anos, desde que se iniciou a intensa extracção de areia nesta praia, o seu aspecto físico se degradou claramente. Essa degradação caracteriza-se principalmente pelo recuo da linha de costa, pela quase ausência de areia e pela salinização dos solos localizados nas proximidades da praia, para além dos consequentes impactes negativos sobre a desova das tartarugas e o turismo balnear.

GUINEA-BISSAU: The Role of Local and International NGOs in Environmental Preservation and Sustainability of the Bijagos Archipelago

Bijagos Archipelago in Guinea-Bissau is at present subject to numerous external impacts that affect its centuries old balance. Since 1975 Guinean society has been using its natural resources in an uncontrolled way over the territory and especially in the coastal area. The archipelago has been increasingly raising interest, most of which is incompatible with the guarantee for a long-term sustainable development. It has also displayed a general impoverishment as far as resource preservation is concerned, due to internal demographic pressure of a population that has doubled since 1981 and to external pressure related to neighboring migrations and consequent depletion of non-renewable resources. This article aims to analyze the actions of local and international NGOs in the preservation and sustainability of the Bijagos Archipelago. We seek through an interdisciplinary approach to analyze the phenomena that are configured within the strategies of NGOs, on the assumption that these issues are articulated in the field of geography and sociology, as well as in politics and international cooperation. It is proposed new challenges to environmental issues, especially in a current situation shaken by constant instability internal and external policies.

Hexyl Aminolevulinate-Guided Fluorescence Cystoscopy in the Diagnosis and Follow-up of Patients with Non-Muscle-invasive Bladder Cancer: A Critical Review of the Current Literature.

CONTEXT: Controversy exists regarding the therapeutic benefit and cost effectiveness of photodynamic diagnosis (PDD) with 5-aminolevulinic acid (5-ALA) or hexyl aminolevulinate (HAL) in addition to white-light cystoscopy (WLC) in the management of non-muscle-invasive bladder cancer (NMIBC). OBJECTIVE: To systematically evaluate evidence regarding the therapeutic benefits and economic considerations of PDD in NMIBC detection and treatment. EVIDENCE ACQUISITION: We performed a critical review of PubMed/Medline, Embase, and the Cochrane Library in October 2012 according to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement. Identified reports were reviewed according to the Consolidated Standards of Reporting Trials (CONSORT) and Standards for the Reporting of Diagnostic Accuracy Studies (STARD) criteria. Forty-four publications were selected for inclusion in this analysis. EVIDENCE SYNTHESIS: Included reports used 5-ALA (in 26 studies), HAL (15 studies), or both (three studies) as photosensitising agents. PDD increased the detection of both papillary tumours (by 7-29%) and flat carcinoma in situ (CIS; by 25-30%) and reduced the rate of residual tumours after transurethral resection of bladder tumour (TURBT; by an average of 20%) compared to WLC alone. Superior recurrence-free survival (RFS) rates and prolonged RFS intervals were reported for PDD, compared to WLC in most studies. PDD did not appear to reduce disease progression. Our findings are limited by tumour heterogeneity and a lack of NMIBC risk stratification in many reports or adjustment for intravesical therapy use in most studies. Although cost effectiveness has been demonstrated for 5-ALA, it has not been studied for HAL. CONCLUSIONS: Moderately strong evidence exists that PDD improves tumour detection and reduces residual disease after TURBT compared with WLC. This has been shown to improve RFS but not progression to more advanced disease. Further work to evaluate cost effectiveness of PDD is required.

Trophic dynamics in the northern Humboldt Current system: insights from stable isotopes and stomach content analyses

The northern Humboldt Current system (NHCS) off Peru is one of the most productive world marine regions. It represents less than 0.1% of the world ocean surface but presently sustains about 10% of the world fish catch, with the Peruvian anchovy or anchoveta Engraulis ringens as emblematic fish resource. Compared with other eastern boundary upwelling systems, the higher fish productivity of the NHCS cannot be explained by a corresponding higher primary productivity. On another hand, the NHCS is the region where El Niño, and climate variability in general, is most notable. Also, surface oxygenated waters overlie an intense and extremely shallow Oxygen Minimum Zone (OMZ). In this context, the main objective of this study is to better understand the trophic flows in the NHCS using both stomach content and stable isotope analyses. The study focuses on a variety of organisms from low trophic levels such as zooplankton to top predators (seabirds and fur seals). The approach combines both long-term and specific studies on emblematic species such as anchoveta, and sardine Sardinops sagax and a more inclusive analysis considering the 'global' food web in the recent years (2008 – 2012) using stable isotope analysis. Revisiting anchovy and sardine we show that whereas phytoplankton largely dominated anchoveta and sardine diets in terms of numerical abundance, the carbon content of prey items indicated that zooplankton was by far the most important dietary component. Indeed for anchovy euphausiids contributed 67.5% of dietary carbon, followed by copepods (26.3%). Selecting the largest prey, the euphausiids, provide an energetic advantage for anchoveta in its ecosystem where oxygen depletion imposes strong metabolic constrain to pelagic fish. Sardine feed on smaller zooplankton than do anchoveta, with sardine diet consisting of smaller copepods and fewer euphausiids than anchoveta diet. Hence, trophic competition between sardine and anchovy in the northern Humboldt Current system is minimized by their partitioning of the zooplankton food resource based on prey size, as has been reported in other systems. These results suggest an ecological role for pelagic fish that challenges previous understanding of their position in the foodweb (zooplanktophagous instead of phytophagous), the functioning and the trophic models of the NHCS. Finally to obtain a more comprehensive vision of the relative trophic position of NHCS main components we used stable isotope analyses. For that purpose we analyzed the δ13C and δ15N stable isotope values of thirteen taxonomic categories collected off Peru from 2008 - 2011, i.e., zooplankton, fish, squids and air-breathing top predators. The δ15N isotope signature was strongly impacted by the species, the body length and the latitude. Along the Peruvian coast, the OMZ get more intense and shallow south of ~7.5ºS impacting the baseline nitrogen stable isotopes. Employing a linear mixed-effects modelling approach taking into account the latitudinal and body length effects, we provide a new vision of the relative trophic position of key ecosystem components. Also we confirm stomach content-based results on anchoveta Engraulis ringens and highlight the potential remarkable importance of an often neglected ecosystem component, the squat lobster Pleuroncodes monodon. Indeed, our results support the hypothesis according to which this species forage to some extent on fish eggs and larvae and can thus predate on the first life stages of exploited species. However, the δ13C values of these two species suggest that anchoveta and squat lobster do not exactly share the same habitat. This would potentially reduce some direct competition and/or predation.

A behavioral ecology of shermen: hidden stories from trajectory data in the Northern Humboldt Current System

This work proposes an original contribution to the understanding of shermen spatial behavior, based on the behavioral ecology and movement ecology paradigms. Through the analysis of Vessel Monitoring System (VMS) data, we characterized the spatial behavior of Peruvian anchovy shermen at di erent scales: (1) the behavioral modes within shing trips (i.e., searching, shing and cruising); (2) the behavioral patterns among shing trips; (3) the behavioral patterns by shing season conditioned by ecosystem scenarios; and (4) the computation of maps of anchovy presence proxy from the spatial patterns of behavioral mode positions. At the rst scale considered, we compared several Markovian (hidden Markov and semi-Markov models) and discriminative models (random forests, support vector machines and arti cial neural networks) for inferring the behavioral modes associated with VMS tracks. The models were trained under a supervised setting and validated using tracks for which behavioral modes were known (from on-board observers records). Hidden semi-Markov models performed better, and were retained for inferring the behavioral modes on the entire VMS dataset. At the second scale considered, each shing trip was characterized by several features, including the time spent within each behavioral mode. Using a clustering analysis, shing trip patterns were classi ed into groups associated to management zones, eet segments and skippers' personalities. At the third scale considered, we analyzed how ecological conditions shaped shermen behavior. By means of co-inertia analyses, we found signi cant associations between shermen, anchovy and environmental spatial dynamics, and shermen behavioral responses were characterized according to contrasted environmental scenarios. At the fourth scale considered, we investigated whether the spatial behavior of shermen re ected to some extent the spatial distribution of anchovy. Finally, this work provides a wider view of shermen behavior: shermen are not only economic agents, but they are also foragers, constrained by ecosystem variability. To conclude, we discuss how these ndings may be of importance for sheries management, collective behavior analyses and end-to-end models.

Propuesta de un sistema de indicadores ambientales y socio económicos en la zona marino costera de Pisco - Paracas

Se presenta un breve diagnóstico de los aspectos ambientales, sociales y económicos del área marino costera de Pisco Paracas, cuya bahía forma parte de la zona de amortiguamiento de la Reserva Nacional de Paracas. A pesar de la importancia y fragilidad del ecosistema, y su proximidad en la zona de amortiguamiento de la Reserva, se ha permitido el asentamiento y desarrollo de diversas actividades extractivas, productivas con el consiguiente incremento en el tráfico marítimo. Diversos programas de vigilancia y seguimiento de entidades públicas o multisectoriales se han realizado en la zona, pero sin un enfoque más integral sobre las interacciones que se dan en un medio tan sui géneris como el medio marino Pisco-Paracas . Se realiza un análisis de la data histórica de los parámetros físico químicos de calidad acuática del período 2000-2010, obtenido principalmente de los programas de seguimiento o evaluación que realiza IMARPE y la empresa PLUS PETROL, contrastándolo con los valores ECA – Categoría 4 (DS 02-2008 – MINAM) a fin de determinar si ellos constituyen indicadores apropiados para determinar el estado real del ecosistema marino costero de Pisco – Paracas. La actual legislación de los recursos hídricos, no es muy clara ni precisa sobre la aplicabilidad para el control de los ECA‟ s en el ámbito marino; esta falta de precisión no contribuye a una vigilancia más eficiente. Con relación a ello, se alcanza una propuesta del sistema de indicadores que incluye parámetro biológico, como la determinación de las floraciones algales nocivas (FAN), episodios recurrentes en Pisco – Paracas; así mismo se introduce el tema de indicadores que midan el cambio en el ecosistema marino, con un enfoque más integral en la zona de Pisco – Paracas tan sujeta a cambios de origen climático

Current variables, definitions and endpoints of the European cardiovascular magnetic resonance registry.

BACKGROUND: Cardiovascular magnetic resonance (CMR) is increasingly used in daily clinical practice. However, little is known about its clinical utility such as image quality, safety and impact on patient management. In addition, there is limited information about the potential of CMR to acquire prognostic information. METHODS: The European Cardiovascular Magnetic Resonance Registry (EuroCMR Registry) will consist of two parts: 1) Multicenter registry with consecutive enrolment of patients scanned in all participating European CMR centres using web based online case record forms. 2) Prospective clinical follow up of patients with suspected coronary artery disease (CAD) and hypertrophic cardiomyopathy (HCM) every 12 months after enrolment to assess prognostic data. CONCLUSION: The EuroCMR Registry offers an opportunity to provide information about the clinical utility of routine CMR in a large number of cases and a diverse population. Furthermore it has the potential to gather information about the prognostic value of CMR in specific patient populations.

Integrating novel agents into multiple myeloma treatment - current status in Switzerland and treatment recommendations.

The treatment of multiple myeloma has undergone significant changes in the recent past. The arrival of novel agents, especially thalidomide, bortezomib and lenalidomide, has expanded treatment options and patient outcomes are improving significantly. This article summarises the discussions of an expert meeting which was held to debate current treatment practices for multiple myeloma in Switzerland concerning the role of the novel agents and to provide recommendations for their use in different treatment stages based on currently available clinical data. Novel agent combinations for the treatment of newly diagnosed, as well as relapsed multiple myeloma are examined. In addition, the role of novel agents in patients with cytogenetic abnormalities and renal impairment, as well as the management of the most frequent side effects of the novel agents are discussed. The aim of this article is to assist in treatment decisions in daily clinical practice to achieve the best possible outcome for patients with multiple myeloma.

Current developments in the radiotherapy approach to elderly and frail patients with glioblastoma multiforme.

The benefit of postoperative radiotherapy (RT) has been demonstrated in elderly patients aged 65 years or older with glioblastoma multiforme. Hypofractionated RT schedules can reduce the time and morbidity of treatment while maintaining comparable survival outcomes to lengthy conventional RT. Current international randomized clinical trials are studying the optimized hypofractionated RT regimens, hypofractionated RT in comparison with temozolomide chemotherapy and hypofractionated RT in comparison with the same RT plus temozolomide. Given the guarded prognosis of the elderly and frail patients, quality of life and side effects of treatment should be closely examined. As more than half of cancers in the world occur in developing countries, hypofractionated RT could be better utilized as a cost-effective treatment for this group of patients.