Algies après cure de hernie inguinale: que faire [Pain after inguinal hernia repair: what to do?]

Hernia repair one of the most frequently performed operations in general surgery. With the introduction of tension-free mesh repair, recurrence rates dropped well below 5% for open and laparoscopic procedures. However, chronic postoperative pain remains a widely neglected complication with a high socio-economic impact. It occurs in about 10-20% of patients after hernia repair. We review the different types of post-herniorrhaphy pain with the typical diagnostic features and we conclude with a pragmatic algorithm based on our clinical experience.

Preoperative hyperfractionated accelerated radiotherapy (HART) and concomitant CPT-11 in locally advanced rectal carcinoma: a phase I study.

PURPOSE: Patients with locally advanced rectal carcinoma are at risk for both local recurrence and distant metastases. We demonstrated the efficacy of preoperative hyperfractionated accelerated radiotherapy (HART). In this Phase I trial, we aimed at introducing chemotherapy early in the treatment course with both intrinsic antitumor activity and a radiosensitizer effect. METHODS AND MATERIALS: Twenty-eight patients (19 males; median age 63, range 28-75) with advanced rectal carcinoma (cT3: 24; cT4: 4; cN+: 12; M1: 5) were enrolled, including 8 patients treated at the maximally tolerated dose. Escalating doses of CPT-11 (30-105 mg/m(2)/week) were given on Days 1, 8, and 15, and concomitant HART (41.6 Gy, 1.6 Gy bid x 13 days) started on Day 8. Surgery was to be performed within 1 week after the end of radiochemotherapy. RESULTS: Twenty-six patients completed all preoperative radiochemotherapy as scheduled; all patients underwent surgery. Dose-limiting toxicity was diarrhea Grade 3 occurring at dose level 6 (105 mg/m(2)). Hematotoxicity was mild, with only 1 patient experiencing Grade 3 neutropenia. Postoperative complications (30 days) occurred in 7 patients, with an anastomotic leak rate of 22%. CONCLUSIONS: The recommended Phase II dose of CPT-11 in this setting is 90 mg/m(2)/week. Further Phase II exploration at this dose is warranted.

Functional plasticity of the LACK-reactive Vbeta4-Valpha8 CD4(+) T cells normally producing the early IL-4 instructing Th2 cell development and susceptibility to Leishmania major in BALB / c mice.

Early production of IL-4 by LACK-reactive Vbeta4-Valpha8 CD4(+) T cells instructs aberrant Th2 cell development and susceptibility to Leishmania major in BALB / c mice. This was demonstrated using Vbeta4(+)-deficient BALB / c mice as a result of chronic infection with MMTV (SIM), a mouse mammary tumor virus expressing a Vbeta4-specific superantigen. The early IL-4 response was absent in these mice which develop a Th1 response to L. major. Here, we studied the functional plasticity of LACK-reactive Vbeta4-Valpha8 CD4(+) T cells using BALB/ c mice inoculated with L. major shortly after infection with MMTV (SIM), i. e. before deletion of Vbeta4(+) cells. These mice fail to produce the early IL-4 response to L. major and instead exhibit an IFN-gamma response that occurs within LACK-reactive Vbeta4-Valpha8 CD4(+) T cells. Neutralization of IFN-gamma restores the production of IL-4 by these cells. These data suggest that the functional properties of LACK-reactive Vbeta4-Valpha8 CD4(+) T cells are not irreversibly fixed.

Identification of a Poor-Prognosis BRAF-Mutant-Like Population of Patients With Colon Cancer.

PURPOSE Our purpose was development and assessment of a BRAF-mutant gene expression signature for colon cancer (CC) and the study of its prognostic implications. Materials and METHODS A set of 668 stage II and III CC samples from the PETACC-3 (Pan-European Trails in Alimentary Tract Cancers) clinical trial were used to assess differential gene expression between c.1799T>A (p.V600E) BRAF mutant and non-BRAF, non-KRAS mutant cancers (double wild type) and to construct a gene expression-based classifier for detecting BRAF mutant samples with high sensitivity. The classifier was validated in independent data sets, and survival rates were compared between classifier positive and negative tumors. Results A 64 gene-based classifier was developed with 96% sensitivity and 86% specificity for detecting BRAF mutant tumors in PETACC-3 and independent samples. A subpopulation of BRAF wild-type patients (30% of KRAS mutants, 13% of double wild type) showed a gene expression pattern and had poor overall survival and survival after relapse, similar to those observed in BRAF-mutant patients. Thus they form a distinct prognostic subgroup within their mutation class. CONCLUSION A characteristic pattern of gene expression is associated with and accurately predicts BRAF mutation status and, in addition, identifies a population of BRAF mutated-like KRAS mutants and double wild-type patients with similarly poor prognosis. This suggests a common biology between these tumors and provides a novel classification tool for cancers, adding prognostic and biologic information that is not captured by the mutation status alone. These results may guide therapeutic strategies for this patient segment and may help in population stratification for clinical trials.

Impact of extracardiac findings during cardiac MR on patient management and outcome.

BACKGROUND: Cardiac magnetic resonance (CMR) is increasingly used to assess heart diseases. Relevant non-cardiac diseases may also be incidentally found on CMR images. The aim of this study was to determine the prevalence and nature of incidental extra-cardiac findings (IEF) and their clinical impact in non-selected patients referred for CMR. MATERIAL/METHODS: MR images of 762 consecutive patients (515 men, age: 56±18 years) referred for CMR were prospectively interpreted by 2 radiologists blinded for any previous imaging study. IEFs were classified as major when requiring treatment, follow-up, or further investigation. Clinical follow-up was performed by checking hospital information records and by calling referring physicians. The 2 endpoints were: 1) non-cardiac death and new treatment related to major IEFs, and 2) hospitalization related to major IEFs during follow-up. RESULTS: Major IEFs were proven in 129 patients (18.6% of the study population), 14% of those being unknown before CMR. During 15±6 month follow-up, treatment of confirmed major IEFs was initiated in 1.4%, and no non-cardiac deaths occurred. Hospitalization occurred in 8 patients (1.0% of the study population) with confirmed major IEFs and none occurred in the remaining 110 patients with unconfirmed/unexplored major IEFs (p<0.001). CONCLUSIONS: Screening for major IEFs in a population referred for routine CMR changed management in 1.4% of patients. Major IEFs unknown before CMR but without further exploration, however, carried a favorable prognosis over a follow-up period of 15 months.

Andorra, història, documentació i arqueologia. Recerca en Època Medieval, dels darrers 30 anys.

Aquest treball de final de grau és una explicació sobre la historiografia del Principat d’Andorra, un petit país dels Pirineus Centrals, entre Espanya i França. La història, l’arqueologia i els reculls documentals que daten d’època medieval, seran l’objecte d’estudi. En aquesta època es posen els fonaments essencials per desenvolupar-se, en un futur com a un Estat. Tot ve configurat per uns pactes del 1278 i del 1288 entre els 2 cosenyors que desenvolupa la seva jurisprudència, la seva activitat econòmica, social i política, converteix els costums i la tradició en els seus valors elementals i es desenvolupa la seva vida quotidiana. I sobre aquestes disciplines s’han fet moltes interpretacions en els últims 30 anys. Saber quin és el seu objectiu, ja sigui per arribar al fet que tots els Andorrans coneguin la seva pròpia historia ,amb la iniciativa de l’Escola Andorrana en els anys 80; o per cercar una base històrica a la naturalesa jurídica i política de les Valls. També explicarem quines són les carències i quines són les recerques més abundants o predominants.

Index fossilium analysibus chemicis examinatorum

Arkit: 1 arkintunnukseton lehti, G3.

L'Univers

1870/11/17 (Numéro 1288).

Ympäristön kunnostustyöt : Pohjois-Savon YTY -projektin toiminta vuonna 2011

Pohjois-Savon YTY -projektin tavoitteena on vahvistaa pitkään työttömänä olleiden henkilöiden sekä syrjäytyneiden alle 25-vuotiaiden henkilöiden työkykyä ja jatkotyöllistymismahdollisuuksia kouluttamalla ja työllistämällä heitä ympäristön kunnostukseen ja hoitoon liittyviin tehtäviin. Projektin rahoituksesta suurin osa tulee Euroopan sosiaalirahastolta (ESR) ja kansallinen rahoitusosuus työ- ja elinkeinoministeriöltä sekä hankkeeseen osallistuvilta kunnilta. Kunnat osoittavat toteutettavat työkohteet ja vastaavat niiden toteuttamiseen tarvittavista materiaalikustannuksista. Projekti käynnistyi 1.3.2008 ja vuonna 2011 mukana oli 17 kuntaa: Iisalmi, Juankoski, Kaavi, Kiuruvesi, Kuopio (aik. Karttula), Leppävirta, Nilsiä, Pielavesi, Rautalampi, Rautavaara, Siilinjärvi, Sonkajärvi, Suonenjoki, Tervo, Tuusniemi, Vesanto ja Vieremä. Projektin tavoitteena on saada vuosittain 75 henkilöä mukaan toimintaan. Projekti järjesti osallistujille kuukauden mittaisen työvoimakoulutuksen, jonka jälkeen he siirtyvät työskentelemään palkkatuella kuntiin. Koulutuksen aikana suoritettiin työelämässä tarvittavat kortit (työturvallisuus-, tulityö-, tieturva1- ja ensiapu1 -kortit), tutustuttiin ATK:n käyttöön työnhaun välineenä ja saatiin tietoa työelämässä tarvittavista tiedoista ja taidoista. Projektin tavoitteena on vahvistaa osallistujien työtaitoja ja työkykyä, jotta he pystyisivät projektin jälkeen toimimaan itsenäisesti vastaavanlaisissa työtehtävissä. Projekti on edistänyt kestävää kehitystä toiminnassaan ja ympäristöön kohdistuvissa töissä. Työkohteissa on suosittu ympäristöystävällisiä toimintatapoja, Vanhojen rakennusten kunnostamisessa on hyödynnetty kierrätysmateriaalia, ympäristöjä on kunnostettu ja elinympäristöjen viihtyvyyttä lisätty edistäen samalla luonnonympäristöjen säilymistä ja hoitoa. Työkauden aikana projekti on ollut aktiivisesti yhteydessä työ- ja elinkeinotoimistoihin (TE-toimistoihin) ja käynyt keskusteluja työvoimaohjaajien kanssa projektissa tehdyistä töistä ja työllistettyjen tilanteesta. Tämän lisäksi työn ohessa on keskusteltu säännöllisesti osallistujien kanssa projektin jälkeiseen työllistymiseen liittyvistä mahdollisuuksista kannustaen heitä omaehtoiseen työnhakuun sekä kouluttautumiseen ammattitaidon kehittämiseksi. Vuonna 2011 projektissa aloitti 74 henkilöä. Miehiä oli 68 ja naisia 6. Osallistujista suurin osa oli yli 45-vuotiaita keski-iän olleessa 45,3 vuotta. Henkilötyöpäiviä kertyi vuoden 2011 loppuun mennessä 9638, koulutuspäiviä 1288 ja työkauden aikaisia ohjauspäiviä 28. Hanke päättyy tammikuussa 2012.

Nekrosìn kyríū Jesoỹ, 2 Cor. IV: 10

Nimekettä edeltää hepreankielinen invokaatio.

Soro urêmico inibe a expressão in vitro da quimiocina SDF-1: possível impacto da toxicidade urêmica na lesão endotelial

Introdução: A disfunção endotelial é importante na patogênese da doença cardiovascular (DCV) relacionada à doença renal crônica (DRC). Stromal cell-derived factor-1 (SDF-1) é uma quimiocina que mobiliza células endoteliais progenitoras (EPC) e em conjunto com a interleucina-8 (IL-8) podem ser usadas como marcadores de reparo e lesão tecidual. Objetivo: Neste trabalho, foi investigado o efeito do meio urêmico na expressão de SDF-1 e IL-8 in vivo e in vitro. Métodos: A inflamação sistêmica foi avaliada por meio da proteína C-reativa (PCR) e interleucina-6 (IL-6). IL-8 e SDF-1 foram avaliados por ELISA como marcadores de disfunção endotelial e reparo tecidual, respectivamente. Os estudos in vitro foram realizados em células endoteliais umbilicais humanas (HUVEC) expostas ao meio urêmico ou saudável. Resultados: Foram incluídos nesse estudo 26 pacientes em hemodiálise (HD) (17 ± 3 meses em diálise, 52 ± 2 anos, 38% homens e 11% diabéticos). As concentrações séricas de PCR, IL-6, SDF-1 e IL-8 foram 4,9 ± 4,8 mg/ml, 6,7 ± 8,1 pg/ml, 2625,9 ± 1288,6 pg/ml e 128,2 ± 206,2 pg/ml, respectivamente. Houve correlação positiva entre PCR e IL-6 (ρ = 0,57; p < 0,005) e entre SDF-1 e IL-8 (ρ = 0,45; p < 0,05). Os resultados in vitro demonstraram que a expressão de SDF-1 pelas HUVEC após 6 horas de tratamento com meio urêmico é menor comparada ao tratamento com meio saudável (p < 0,05). Após 12 horas de tratamento, ocorreu aumento de IL-8 quando as HUVECs foram expostas ao meio urêmico (p < 0,005). Conclusão: Sugerimos que SDF-1 e IL-8 nos pacientes em HD podem ser usados para mensurar a extensão do dano e consequente ativação vascular na uremia.

Le Petit journal. Supplément du dimanche

1915/08/29 (Numéro 1288).

L'Écho de Paris

1887/09/27 (Numéro 1288).

Français 375

Contient : 1° « Apocalipsis », en latin ; 2° Explication de l'Apocalypse, en français ; 3° Prophétie de la sibylle Tiburnica ; 4° « Le Livre de Seneke », traité de Moralité ; 5° Sommaires en vers des poëmes contenus dans le volume, par « PEROS DE NEELE » ; 6° « Li Sieges de Tebes, et d'Ethioclet et de Pollinices » ; 7° Le Roman « de Troies », de « BENEOIT DE SAINTE MORE » ; 8° « Li Sieges d'Ataines », ou Roman d'Athis et Profilias, par « ALEXANDRE » ; 9° « Li Dit JEHAN BODEL », ou le Congé ; 10° Le Roman d'Alixandre, de « LAMBERT LE TORT » et « ALEXANDRE » [de Bernay] ; 11° La Signification de la mort d'Alexandre [de PIERRE DE SAINT-CLOUD] ; 12° La Vengeance d'Alexandre [de GUI, de Cambrai] ; 13° « Des Dus de Normendie », généalogie des comtes de Boulogne ; 14° Le Roman de Rou [de WACE] ; 15° Le Roman « del roi Guillaume d'Engleterre », de « CRESTHEN » [de Troyes] ; 16° Le Roman « de Floire et Blanceflor » ; 17° Le Roman « de Blancandin » ; 18° Le Roman « de Cliget », de « CRESTHEN » [de Troyes] ; 19° « D'Erec et.d'Enide », de « CRESTHEN » [de Troyes] ; 20° « De le Viellete lixun » ; 21° « D'Ysle et de Galeron », de « GAUTIER, d'Arras » ; 22° « De Theophilus » [de GAUTIER, de Coincy] ; 23° « D'Amaldas et de Ydoine » ; 24° « De le Castelaine de Vergi » ; 25° Prose « de saint Estevene », avec la notation ; 26° « Des Vers de le mort », trois cent treize douzains ; 27° « Li Loenge Nostre Dame » ; 28° « De le Viellete » ; 29° Neuf Miracles de Notre-Dame, savoir ; 1 « D'un abé por cui Nostre Dame ouvra en mer » ; 2 « De l'enfant qui son pain offri à l'enfant l'ymage Nostre Dame » ; 3 « D'un moine » ; 4 « D'un clerc » ; 5 « D'un soucrestain » ; 6 « De le soucretaine » ; 7 « D'une grosse feme » ; 8 « D'une ymage Nostre Dame » ; 9 « De la Nativité Nostre Dame »