Prevalence of subfoveal nodules in Coat's disease

Purpose:Coats' disease is a non-hereditary condition characterized by idiopathic retinal telangiectasia, and exudative retinopathy. Although the exudation often spreads from the main areas of telangiectasia, there is a preferential accumulation of exudation in the macular area in Coats' disease. A subfoveal nodule has usually been described in the context of resolution of macular exudates after treatment of peripheral retinal telangiectasis. Nevertheless, a recent reports stressed out an uncommon prominent subfoveal nodule with peripheral exudates as initial presentation of Coats'disease. The purpose of this study was to report the prevalence of this presentation in a cohort of patients. Methods:All consecutive patients with Coats' disease referred to the Jules Gonin Eye Hospital between January 1979 and July 2006 were included. All charts were screened for a clear cut subfoveal circular lesion on fundus photographies at initial presentation. Results:95 patients suffering of Coat's disease were enrolled. 33 out of 95 patients had subtotal or total exudative retinal detachment, which impeded macular examination. 14 out of 62 (22.6%) resting patients presented with a clear cut prominent circular subfoveal lesion at initial presentation. All patients had unilateral disease. Mean age was 5.6 ± 3.5 year old at initial presentation. There were 4 females and 10 males. Pigmentation and size of the nodule were not homogenous. Mean diameter was 1.1 ± 0.5 optic disc diameter. Conclusions:The present study shows that subfoveal nodule is not such a rare primary presentation of Coats' disease in contrast to what it has been previously reported in the literature. Thus the initial finding of prominent subfoveal nodule associated with peripheral retinal findings made the diagnosis of Coats' disease highly likely.Physicians should be aware that a proeminent subfoveal nodule is a common initial presentation of Coats' disease as it can be confused clinically with Retinoblastoma.

Transcranial direct current stimulation for the treatment of focal hand dystonia.

The treatment of writer's cramp, a task-specific focal hand dystonia, needs new approaches. A deficiency of inhibition in the motor cortex might cause writer's cramp. Transcranial direct current stimulation modulates cortical excitability and may provide a therapeutic alternative. In this randomized, double-blind, sham-controlled study, we investigated the efficacy of cathodal stimulation of the contralateral motor cortex in 3 sessions in 1 week. Assessment over a 2-week period included clinical scales, subjective ratings, kinematic handwriting analysis, and neurophysiological evaluation. Twelve patients with unilateral dystonic writer's cramp were investigated; 6 received transcranial direct current and 6 sham stimulation. Cathodal transcranial direct current stimulation had no favorable effects on clinical scales and failed to restore normal handwriting kinematics and cortical inhibition. Subjective worsening remained unexplained, leading to premature study termination. Repeated sessions of cathodal transcranial direct current stimulation of the motor cortex yielded no favorable results supporting a therapeutic potential in writer's cramp.

Mouvements anormaux et accident vasculaire cérébral [Movement disorders in stroke]

Dyskinesias are infrequent presentations in acute stroke (1%). They can be found more frequently as delayed presentations after a stroke, but the prevalence is not available from the literature. The full spectrum of hyper- and hypo-akinetic syndromes has been described, but three main pictures are rather specific of an acute stroke: limb shaking, hemichorea-hemiballism and unilateral asterixis. Besides limb shaking, that seems to reflect a transient diffuse ischemia of the frontosubcortical motor pathway, lesions are described at all levels of the frontosubcortical motor circuit including the sensorimotor frontoparietal cortex, the striatum, the pallidum, the thalamic nuclei, the subthalamic nucleus, the substantia nigra, the cerebellum, the brainstem and their interconnecting pathways, as ischemic or hemorrhagic strokes. The preferentially late development of dyskinesia could reflect the return to a more ancestral motor control level, the most functional possible with the remaining configuration of structures, elaborated by brain plasticity after stroke.

Mutations in ALDH1A3 represent a frequent cause of microphthalmia/anophthalmia in consanguineous families.

Anophthalmia or microphthalmia (A/M), characterized by absent or small eye, can be unilateral or bilateral and represent developmental anomalies due to the mutations in several genes. Recently, mutations in aldehyde dehydrogenase family 1, member A3 (ALDH1A3) also known as retinaldehyde dehydrogenase 3, have been reported to cause A/M. Here, we screened a cohort of 75 patients with A/M and showed that mutations in ALDH1A3 occurred in six families. Based on this series, we estimate that mutations in ALDH1A3 represent a major cause of A/M in consanguineous families, and may be responsible for approximately 10% of the cases. Screening of this gene should be performed in a first line of investigation, together with SOX2.

Endogenous angiotensin II induces atherosclerotic plaque vulnerability and elicits a Th1 response in ApoE-/- mice.

Rupture of vulnerable plaques is the main cause of acute cardiovascular events. However, mechanisms responsible for transforming a stable into a vulnerable plaque remain elusive. Angiotensin II, a key regulator of blood pressure homeostasis, has a potential role in atherosclerosis. To study the contribution of angiotensin II in plaque vulnerability, we generated hypertensive hypercholesterolemic ApoE-/- mice with either normal or endogenously increased angiotensin II production (renovascular hypertension models). Hypertensive high angiotensin II ApoE-/- mice developed unstable plaques, whereas in hypertensive normal angiotensin II ApoE-/- mice plaques showed a stable phenotype. Vulnerable plaques from high angiotensin II ApoE-/- mice had thinner fibrous cap (P<0.01), larger lipid core (P<0.01), and increased macrophage content (P<0.01) than even more hypertensive but normal angiotensin II ApoE-/- mice. Moreover, in mice with high angiotensin II, a skewed T helper type 1-like phenotype was observed. Splenocytes from high angiotensin II ApoE-/- mice produced significantly higher amounts of interferon (IFN)-gamma than those from ApoE-/- mice with normal angiotensin II; secretion of IL4 and IL10 was not different. In addition, we provide evidence for a direct stimulating effect of angiotensin II on lymphocyte IFN-gamma production. These findings suggest a new mechanism in plaque vulnerability demonstrating that angiotensin II, within the context of hypertension and hypercholesterolemia, independently from its hemodynamic effect behaves as a local modulator promoting the induction of vulnerable plaques probably via a T helper switch.

Oculopalatal tremor: variations on a theme by Guillain and Mollaret.

BACKGROUND: Oculopalatal tremor (OPT) is a delayed complication of a brainstem lesion, characterized by involuntary contractions of the soft palate associated with a synchronized ocular pendular nystagmus. MRI reveals inferior olivary nucleus hypersignal/hypertrophy (IONH). Our objective was to refine the clinical profile of patients with OPT and to report a few oddities in both presentation and evolution. METHODS: We performed a retrospective study of patients diagnosed with OPT and a literature search. RESULTS: From our database, we retrieved 5 men and 3 women with a diagnosis of OPT. Eighty-two patients with OPT were retrieved from the literature and were compiled with our series. The average age was 54 years and there was a male predominance. Brainstem vascular lesion was the most common etiology (80%). Prominent vertical pendular nystagmus was found in 90%. Dissociated nystagmus was mostly associated to unilateral contralateral IONH on MRI, while bilateral symmetrical nystagmus was due to a bilateral IONH in the majority of cases. Three oddities were found amongst our 8 patients: prominent nystagmus ipsilateral to IONH; disappearance of IONH on MRI despite persisting nystagmus, and asymptomatic OPT. CONCLUSION: The clinical profile of OPT is rather stereotyped. Rarely do patients deviate from the classical description of OPT.

Role of JNK isoforms in the development of neuropathic pain following sciatic nerve transection in the mouse.

ABSTRACT: BACKGROUND: Current tools for analgesia are often only partially successful, thus investigations of new targets for pain therapy stimulate great interest. Consequent to peripheral nerve injury, c-Jun N-terminal kinase (JNK) activity in cells of the dorsal root ganglia (DRGs) and spinal cord is involved in triggering neuropathic pain. However, the relative contribution of distinct JNK isoforms is unclear. Using knockout mice for single isoforms, and blockade of JNK activity by a peptide inhibitor, we have used behavioral tests to analyze the contribution of JNK in the development of neuropathic pain after unilateral sciatic nerve transection. In addition, immunohistochemical labelling for the growth associated protein (GAP)-43 and Calcitonin Gene Related Peptide (CGRP) in DRGs was used to relate injury related compensatory growth to altered sensory function. RESULTS: Peripheral nerve injury produced pain-related behavior on the ipsilateral hindpaw, accompanied by an increase in the percentage of GAP43-immunoreactive (IR) neurons and a decrease in the percentage of CGRP-IR neurons in the lumbar DRGs. The JNK inhibitor, D-JNKI-1, successfully modulated the effects of the sciatic nerve transection. The onset of neuropathic pain was not prevented by the deletion of a single JNK isoform, leading us to conclude that all JNK isoforms collectively contribute to maintain neuropathy. Autotomy behavior, typically induced by sciatic nerve axotomy, was absent in both the JNK1 and JNK3 knockout mice. CONCLUSIONS: JNK signaling plays an important role in regulating pain threshold: the inhibition of all of the JNK isoforms prevents the onset of neuropathic pain, while the deletion of a single splice JNK isoform mitigates established sensory abnormalities. JNK inactivation also has an effect on axonal sprouting following peripheral nerve injury.

Shoulder pathology: estimating dominant upper-limb activity using 3D kinematic sensors.

Introduction. Quantification of daily upper-limb activity is a key determinant in evaluation of shoulder surgery. For a number of shoulder diseases, problem in performing daily activities have been expressed in terms of upper-limb usage and non-usage. Many instruments measure upper-limb movement but do not focus on the differentiations between the use of left or right shoulder. Several methods have been used to measure it using only accelerometers, pressure sensors or video-based analysis. However, there is no standard or widely used objective measure for upper-limb movement. We report here on an objective method to measure the movement of upper-limb and we examined the use of 3D accelerometers and 3D gyroscopes for that purpose. Methods. We studied 8 subjects with unilateral pathological shoulder (8 rotator cuff disease: 53 years old ± 8) and compared them to 18 control subjects (10 right handed, 8 left handed: 32 years old ± 8, younger than the patient group to be almost sure they don_t have any unrecognized shoulder pathology). The Simple Shoulder Test (SST) and Disabilities of the Arm and Shoulder Score (DASH) questionnaires were completed by each subject. Two modules with 3 miniature capacitive gyroscopes and 3 miniature accelerometers were fixed by a patch on the dorsal side of the distal humerus, and one module with 3 gyroscopes and 3 accelerometers were fixed on the thorax. The subject wore the system during one day (8 hours), at home or wherever he/she went. We used a technique based on the 3D acceleration and the 3D angular velocities from the modules attached on the humerus. Results. As expected, we observed that for the stand and sit postures the right side is more used than the left side for a healthy right-handed person(idem on the left side for a healthy left-handed person). Subjects used their dominant upper-limb 18% more than the non-dominant upper-limb. The measurements on patients in daily life have shown that the patient has used more his non affected and non dominant side during daily activity if the dominant side = affected shoulder. If the dominant side affected shoulder, the difference can be showed only during walking period. Discussion-Conclusion. The technique developed and used allowed the quantification of the difference between dominant and non dominant side, affected and unaffected upper-limb activity. These results were encouraging for future evaluation of patients with shoulder injuries, before and after surgery. The feasibility and patient acceptability of the method using body fixed sensors for ambulatory evaluation of upper limbs kinematics was shown.

Beyond Conditionality versus Cooperation: Power and Resistance in the Case of EU Mobility Partnerships and Swiss Migration Partnerships

Migration partnerships (MPs) have become a key instrument in global migration governance. In contrast to traditional unilateral approaches, MPs emphasize a more comprehensive and inclusive tackling of migration issues between countries of origin, transit, and destination. Due to this cooperation-oriented concept, most of the existing studies on MPs neglect power questions within partnerships in line with the official discourse, reflecting a broader trend in the international migration governance literature. Others take an instrumentalist view in analysing the power of partnerships or focus on soft power. Illustrated with the examples of the European Mobility Partnerships (EU MPs) and the Swiss Migration Partnerships (CH MPs), we conduct an analysis based on a concept of productive power drawing on post-structural and post-colonial insights. Our main argument is that in contrast to their seemingly consent-oriented and technical character, MPs are sites of intense (discursive) struggles, and (re-)produce meanings, subjects, and resistances. A productive power analysis allows us to move beyond the dichotomy in the literature between coercion and cooperation, as well as between power and resistance more broadly.

Horizontal vestibulo-ocular reflex dynamics in acute vestibular neuritis and viral labyrinthitis: evidence of otolith-canal interaction.

OBJECTIVE: To evaluate the dynamic properties of the horizontal vestibulo-ocular reflex (h-VOR) in the acute stage of two common labyrinthine diseases that provoke severe attacks of vertigo with spontaneous nystagmus: vestibular neuritis (vestibular loss alone) and viral labyrinthitis (cochleovestibular loss). MATERIAL AND METHODS: Sixty-three patients were investigated: 42 were diagnosed with vestibular neuritis and 21 with viral labyrinthitis. The h-VOR function was evaluated by conventional caloric and impulsive testing. A simplified model of vestibular function was used to analyze the vestibulo-ocular response to rotational stimulation. RESULTS: The results showed a significant difference in h-VOR characteristics between the two pathologies. Patients with vestibular neuritis exhibited a strong horizontal semicircular canal deficit, but no h-VOR asymmetry between the two rotational directions. In contrast, patients with viral labyrinthitis demonstrated moderate canal paresis and a marked h-VOR deficit in rotation toward the affected ear. CONCLUSION: These findings support the hypothesis that the h-VOR dynamic asymmetry that occurs after an acute unilateral inner ear lesion is not due to canal dysfunction alone, but involves complex adaptive changes in the central VOR that may implicate the otolith system. Based on histopathologic and clinical differences in the two pathologies reported in the literature, we postulate that this otolith-canal interaction is mainly linked to the loss of saccular function.

Origin of the relative afferent pupillary defect in optic tract lesions.

OBJECTIVE: To determine the percent decussation of pupil input fibers in humans and to explain the size and range of the log unit relative afferent pupillary defect (RAPD) in patients with optic tract lesions. DESIGN: Experimental study. PARTICIPANTS AND CONTROLS: Five patients with a unilateral optic tract lesion. METHODS: The pupil response from light stimulation of the nasal hemifield, temporal hemifield, and full field of each eye of 5 patients with a unilateral optic tract lesion was recorded using computerized binocular infrared pupillography. Six stimulus light intensities, separated by 0.5-log unit steps, were used; 12 stimulus repetitions were given for each stimulus condition. MAIN OUTCOME MEASURES: For each stimulus condition, the pupil response of each eye was characterized by plotting the mean pupil contraction amplitude as a function of stimulus light intensity. The percentage of decussating afferent pupillomotor input fibers was calculated from the ratio of the maximal pupil contractions elicited from each eye. The RAPD was determined pupillographically from full-field stimulation to each eye. RESULTS: In all patients, the pupil response from the functioning temporal hemifield ipsilateral to the tract lesion was greater than that from the functioning contralateral nasal hemifield. This temporal-nasal asymmetry increased with increasing stimulus intensity and was similar in hemifield and full-field stimuli, eventually saturating at maximal light intensity. The log unit RAPD did not correlate with the estimated percentage of decussating pupil fibers, which ranged from 54% to 67%. CONCLUSIONS: In patients with a unilateral optic tract lesion, the pupillary responses from full-field stimulation to each eye are the same as comparing the functioning temporal field with the functioning nasal field. The percentage of decussating fibers is reflected in the ratio of the maximal pupil contraction amplitudes resulting from stimulus input between the two eyes. The RAPD that occurs in this setting reflects the difference in light sensitivity between the intact temporal and nasal hemifields. Its magnitude does not correlate with the difference in the number of crossed and uncrossed axons, but its sidedness contralateral to the side of the optic tract lesion is consistent with the greater percentage of decussating pupillomotor input.

Fatal intrahepatic hemorrhage after nadroparin use for total hip arthroplasty.

Low-molecular-weight heparins have become the predominant choice for deep venous thrombosis prophylaxis and treatment. However, their use may cause bleeding complications. Intrahepatic bleeding is exceptional and only very few cases have been described. The authors present a unique case of fatal intrahepatic hematoma complicating nadroparin use in a 65-year-old woman with a hepatic cyst who was admitted to hospital for unilateral total hip arthroplasty. At autopsy, hemoperitoneum (2,000 ml of blood and clots) was evident. A ruptured sub-capsular hematoma involving the right lobe of the liver was observed. The hemorrhage within the cyst induced by the nadroparin use was likely responsible for the subsequent hepatic hematoma, liver rupture, and death. This case highlights the need for pathologists and surgeons to be aware of the possibility of intrahepatic hematoma in patients who have received low-molecular-weight heparins, undergone major surgery and present postoperative hemodynamic instability, especially in those with preoperative diagnosis of hepatic cyst.

Subtelomeric 6p deletion: clinical and array-CGH characterization in two patients

We report on two patients with de novo subtelomeric terminal deletion of chromosome 6p. Patient 1 is an 8-month-old female born with normal growth parameters, typical facial features of 6pter deletion, bilateral corectopia, and protruding tongue. She has severe developmental delay, profound bilateral neurosensory deafness, poor visual contact, and hypsarrhythmia since the age of 6 months. Patient 2 is a 5-year-old male born with normal growth parameters and unilateral hip dysplasia; he has a characteristic facial phenotype, bilateral embryotoxon, and moderate mental retardation. Further characterization of the deletion, using high-resolution array comparative genomic hybridization (array-CGH; Agilent Human Genome kit 244 K), revealed that Patient 1 has a 8.1 Mb 6pter-6p24.3 deletion associated with a contiguous 5.8 Mb 6p24.3-6p24.1 duplication and Patient 2 a 5.7 Mb 6pter-6p25.1 deletion partially overlapping with that of Patient 1. Complementary FISH and array analysis showed that the inv del dup(6) in Patient 1 originated de novo. Our results demonstrate that simple rearrangements are often more complex than defined by standard techniques. We also discuss genotype-phenotype correlations including previously reported cases of deletion 6p.

Poètiques del desig. Alteritat i escriptura a l’obra de Gabriel Ferrater, Maria-Mercè Marçal i Enric Casasses

[cat] La present investigació parteix de la urgència de revisar la poesia catalana contemporània des dels paràmetres de la teoria literària que abracen la representació del desig. Partint de l’estreta vinculació entre aquest marc teòric i les noves formulacions del subjecte líric postmodern, hem proposat l’estudi de tres grans poètiques que han marcat, cada una d’elles en el seu context socioliterari, un punt d’inflexió a la poesia catalana des d’aquest quadre teòric: Gabriel Ferrater, Maria-Mercè Marçal i Enric Casasses. Per aquest motiu, l’objectiu central de la tesi és demostrar, a través de la categoria del desig, com l’alteritat eroticoamorosa és un dels centres de representació i experimentació dels límits del subjecte poètic i quins efectes té en la construcció de la identitat textual i en el que hem anomenat matèria-emoció. La tesi no pretén ser un estudi comparatiu dels tres autors, sinó que, capturant les tres trajectòries en paral•lel, situa cada poètica en un punt de no retorn respecte al desig i la seva representació. Atès això, és, metafòricament, el signe desig, en els seus tres plans, el que unifica els tres paradigmes que hem sotmès a anàlisi: Gabriel Ferrater com a referent, Maria-Mercè Marçal en qualitat de significat i Enric Casasses, portador del significant. El primer capítol va més enllà de la ruptura moderna entre escriptura i exaltació d’una subjectivitat única i monolítica, per comprendre en què consisteix la dissolució del jo líric en tant que fonament de l’enunciació del subjecte en el vers. És una proposta metodològica que, prenent com a centre l’intent de construcció d’una teoria del poema basada en l’expansió del jo cap a l’Altre, analitza algunes de les variables retòriques i ontològiques que coparticipen en la formulació teòrica de subjecte líric incomplet o fragmentat en el moment d’enunciar-se. D’aquesta manera, amb una voluntat de teixir uns ítems teòrics per on circuli el concepte de jo líric versus l’Altre (poesia de l’alteritat, “llei de l’assentiment”, “apropiació” de l’enunciat o, sobretot, matèria-emoció), l’escriptura poètica es concep com un joc de forces entre la performativitat del subjecte líric i la recerca de la seva pròpia subjectivitat. Aquesta crisi del subjecte i la impossibilitat de restituir una relació unilateral respecte a l’Altre, cobren una especial rellevància quan el motor o força que activa la relació d’alteritat és el moviment que impulsa el jo fora de les seves pròpies estructures per atènyer l’altre/a (subjecte desitjat) o absorbir-lo: el desig. La segona part del primer capítol està destinada a definir les aproximacions teòriques sobre la representació del desig —encercades en un posicionament postestructuralista conjuminat amb la crítica literària feminista—, que ens permeten assentar les coordenades interpretatives per portar a terme l’estudi de la formalització de tres subjectes lírics que cerquen en l’escriptura el seu propi esdevenir com a subjectes desitjants. Així és que al llarg del segon capítol hem interrogat les tres poètiques resseguint els espais comuns erigits en la nostra proposta de marc interpretatiu. Per fer-ho, ens hem centrat en Les dones i els dies de Gabriel Ferrater, amb especial èmfasi a “Teoria dels cossos”. En el cas de Maria-Mercè Marçal, hem estudiat exhaustivament el primer poemari que inaugura l’escriptura del desig lèsbic, Terra de Mai, tot establint una contigüitat temàtica amb “Sang presa” (dins de La germana, l’estrangera). I, finalment, hem resseguit la poesia d’Enric Casasses d’una forma transversal, a partir de les obres més significatives entorn al subjecte de recerca, com ara La cosa aquella, “Alquímia d’amor” (dins de Començament dels començaments i ocasió de les ocasions), D’equivocar-se així, Calç i, sobretot, Do’m. Drama en tres actes. Primer de tot, hem definit les coordenades del subjecte desitjant en relació amb el subjecte del desig, la qual cosa ens ha exigit l’anàlisi de l’enunciació del jo líric, respectivament. La recerca de les directrius fundacionals de les subjectivitats líriques —actives des del moment en què sorgeix la demanda del desig (implícita o explícita)―, han fet palesa, progressivament, la problemàtica suficiència ontològica del subjecte que deriva, al seu torn, de l’encontre amb l’altre/a. Així hem arribat a mesurar la distància inexorable que separa el jo del tu, amb resultats ben diferents. Ferrater, que anihila sorprenentment el subjecte líric, ha estat el primer port d’una singladura que, en arribar a Marçal, ens ha permès conèixer la continuïtat del ser: el despertar del desig és l’origen de la individuació dels subjectes agents del plaer en detriment de la compleció identitària. I hem navegat, finalment, fins a Casasses, qui defensa al llarg de la seva obra una individuació com a centre ètic de l’acte amorós. En una segona part, hem estudiat la representació de l’altre/a en cada corpus poètic. En el cas de Ferrater, les dones no només activen l’alteritat eroticoamorosa concreta en cada poema, sinó que, des d’un punt de vista metapoètic, esdevenen constitutives de la subjectivitat lírica en la recerca de la identitat que té lloc al llarg de Les dones i els dies. Partint de la figura de “Teseu”, poema que emmiralla i significa el procés d’escriptura poètica, hem explorat la formalització del desig en funció de les diferents representacions de la dona en paral•lel amb les posicions enunciatives del jo líric. Al llarg d’aquest recorregut, la representació del cos del desig (la fragmentació, la carícia, la mirada, etc.) i l’espai on aquest cos s’esdevé (la cambra), han estat els dos epicentres mitjançant els quals hem conclòs que la dona es presenta com un cos resistent que guia el jo líric a negar, paradoxalment, el mateix desig. La impossibilitat de satisfer el desig es manifesta, així, amb una reformulada pèrdua dels límits del subjecte desitjant. En els versos marçalians el desig emergeix com un gran torrent que arrossega al jo líric a mesurar-se en la distància que la separa de l’altra. A partir de l’altra especular, les primeres sextines de Terra de mai obren un nou ordre del jo i del tu en el discurs amorós: l’equivalència física dels cossos amants/amats extrema la fusió tant física com amorosa que es convertirà en l’acció transformadora i afirmativa de la identitat. Amb això, Marçal desarticula la gestió fal•logocèntrica del desig i l’ubica com una categoria des de la qual emprèn la construcció d’una subjectivitat lírica femenina i lèsbica. En aquest sentit, mitjançant la presència nítida d’una exploració i reconstrucció del cos de dona albirat des del desig homoeròtic, la poeta desplega la renovació d’una simbologia eròtica que configura un cosmos corporal totalment nou: cossos d’aigua i sang. Marçal busca en els fluids corporals femenins (l’aigua, la sang menstrual, la sang del trau o, fins i tot, el vòmit), la transposició dels marges corporals als textuals, convertint el poema no en un paral•lel verbal de l’experiència del desig sinó en un paral•lel corporal. En un primer moment, la representació de l’altra és indissociable de les imatges especulars (aigua o mirall). Aquesta és la fase de continuïtat, de la compleció identitària a través de l’experiència de la jouissance, i està constituïda per tres eixos: la confusió dels límits entre el jo i la seva altra, la fusió de les dues subjectivitats i l’afirmació de la unicitat amb el verb “som”. A continuació, hem resseguit com aquest “ser u” es trenca a mesura que el jo poètic es va singularitzant. Aquest segon moment és on el desig irromp al llenguatge del plaer i es converteix en una passió altament destructiva. La dissimilació amb el tu i la nostàlgia de la “fal•laç utopia d’una fusió absoluta” bolquen el poema cap a un jo poètic mutilat, que cerca un cos absent i l’espai de plenitud d’un subjecte líric que es troba irreparablement ferit (“Sang presa”). La poesia de Casasses trava la representació de l’altre amorós en la modalitat dialògica dels versos (el parlar). El fenomen de l’enunciació poètica casassiana s’emmarca en unes estructures poemàtiques que invoquen, des de l’origen, el Tu, apel•lant, així, al problema estrictament postmodern de la unicitat del jo líric i de la identitat en el procés d’escriptura. Atès això, el poema es convertirà en un dir ofert a l’Altre com a demanda del llenguatge, motiu pel qual el desig emergeix com a motor de l’escriptura poètica. Abans d’endinsar-nos específicament a l’eclosió del Tu en tant que altre amorós, ha calgut esclarir les coordenades generals del Tu en majúscules per esbossar els trets fonamentals de la significació poètica. Així, doncs, hem analitzat com es despleguen els diferents tu en l’enunciació, ja sigui quan aquest refereix al lector o a la poesia (recursos metapoètics), quan correspon a l’amor/desig (governador del subjecte de l’escriptura) i, finalment, quan el tu condensa l’altre amorós (amor particular). En aquest darrer cas, hem proposat una possible escala de transcendència del tu respecte al jo líric: d’un tu amorós totalitzador (la lluna) fins al subjecte del desig, la dona. Paral•lelament, la representació de l’amada és indissociable del concepte d’emoció lírica creada a través de la modelització del dir del jo poètic. Per aquest fet, hem classificat la irrupció del subjecte desitjat en diferents graus de referencialitat: el “tu” present, el “tu” absent i el “tu” de destinació. En un tercer apartat, hem intentat respondre a una de les grans problemàtiques que giren entorn a les escriptures del desig: és possible la seva representació? Ferrater ens enfronta davant de l’indicible. La poètica ferrateriana se situa en un distanciament deliberat de les emocions, la qual cosa circumscriu l’expressió del desig en el marc d’allò incomunicable de l’experiència. Consegüentment, hem abordat la formalització del desig a través del concepte d’imaginació tot analitzant com el poeta aconsegueix elevar l’energia emotiva del llenguatge a partir de les relacions entre la paraula i els seus absents, i com això ens permet parlar del poema en tant que matèria-emoció. Així mateix, hem conclòs que Ferrater captura l’indicible en el text jugant amb els límits representatius del llenguatge. Per abordar les escriptures del desig marçaliana i casassiana hem recorregut als plecs de la matèria-emoció encarats a l’écart: la fractura de l’epidermis del poema causada per l’erupció de la vida corporal, pulsional i afectiva del subjecte de l’escriptura. El ritme pulsional del desig (escena d’escriptura i escena amorosa) i la veu (poiesis) es converteixen en els fonaments de la construcció d’unes subjectivitats líriques que s’inscriuen en una posició femenina, allà on el cos amb estat d’apetència cerca la continuïtat en l’escriptura. Concretament, hem resseguit la formalització de l’absència de l’altra en els versos de Marçal, la qual recorre a figuracions com l’espera, el buit, la desfeta del mirall, l’assassinat dels cossos en plenitud, entre altres imatges que activen el salt de l’eros al thanatos; així com, també, les estructures interrogatives que signifiquen la impossibilitat d’experimentar el desig del desig de l’altra. Respecte a l’obra de Casasses, el poeta troba en la forma dramàtica el mitjà idoni per experimentar les possibilitats de la representació del desig: Do’m. Mitjançant una exegesi detallada del drama, hem pogut concloure que, tal com postula Barthes, l’única construcció textual possible d’allò amorós es troba en formular el que té d’intractable, i això només es pot representar a partir de l’acció mateixa. Talment, Casasses porta a l’extrem la modalitat dialògica pròpia de la seva poesia per escenificar l’encontre amorós i la construcció in progress del subjecte desitjant a través del dir-se l’amor. Finalment, la investigació intenta oferir una resposta al voltant de la conjunció desig, subjectivitat lírica i identitat. Aquestes tres coordenades ens permeten elevar les diferents representacions del desig a l’alçada de les millors poètiques contemporànies. L’ètica i l’estètica ferrateriana es congreguen en l’espai de l’erotisme moral. Ferrater concep el vers com un mètode fenomenològic a través del qual inscriu una actitud poètica que no es pot pensar sense la formalització del subjecte desitjant. Atès això, amb Les dones i els dies s’inaugura la categoria del desig en relació amb els límits d’expressió del subjecte líric. Marçal obre les portes a l’espai literari femení i lèsbic amb una escriptura poètica creadora de nous àmbits per a l’expressió del desig. La cerca d’un nou ordre simbòlic en el llenguatge poètic està estretament vinculada amb la construcció d’una subjectivitat tant política com poètica, un dels trets principals de la qual és la reivindicació i afirmació del plaer sexual femení. D’aquesta manera, el desig a l’obra de la poeta és portador d’una actitud i praxi política que troba la seva màxima expressió en la conquesta d’una llengua abolida. Per acabar, Casasses invoca l’espai de la paraula viva per articular l’acompliment de la funció poètica. A través de la poesia recitada, ja sigui des d’un punt de vista teòric com en la seva performance escènica, construeix una nova i fundacional experiència poètica que troba el seu paral•lel amb l’experiència amorosa. En aquest nou espai de circulació de la paraula poètica hi situa una subjectivitat lírica fundada en el moviment ètic cap a l’altre encarnat en el cos, la veu i el ritme.

A new ambulatory system for comparative evaluation of the three-dimensional knee kinematics, applied to anterior cruciate ligament injuries

The aim of this study was to develop an ambulatory system for the three-dimensional (3D) knee kinematics evaluation, which can be used outside a laboratory during long-term monitoring. In order to show the efficacy of this ambulatory system, knee function was analysed using this system, after an anterior cruciate ligament (ACL) lesion, and after reconstructive surgery. The proposed system was composed of two 3D gyroscopes, fixed on the shank and on the thigh, and a portable data logger for signal recording. The measured parameters were the 3D mean range of motion (ROM) and the healthy knee was used as control. The precision of this system was first assessed using an ultrasound reference system. The repeatability was also estimated. A clinical study was then performed on five unilateral ACL-deficient men (range: 19-36 years) prior to, and a year after the surgery. The patients were evaluated with the IKDC score and the kinematics measurements were carried out on a 30 m walking trial. The precision in comparison with the reference system was 4.4 degrees , 2.7 degrees and 4.2 degrees for flexion-extension, internal-external rotation, and abduction-adduction, respectively. The repeatability of the results for the three directions was 0.8 degrees , 0.7 degrees and 1.8 degrees . The averaged ROM of the five patients' healthy knee were 70.1 degrees (standard deviation (SD) 5.8 degrees), 24.0 degrees (SD 3.0 degrees) and 12.0 degrees (SD 6.3 degrees for flexion-extension, internal-external rotation and abduction-adduction before surgery, and 76.5 degrees (SD 4.1 degrees), 21.7 degrees (SD 4.9 degrees) and 10.2 degrees (SD 4.6 degrees) 1 year following the reconstruction. The results for the pathologic knee were 64.5 degrees (SD 6.9 degrees), 20.6 degrees (SD 4.0 degrees) and 19.7 degrees (8.2 degrees) during the first evaluation, and 72.3 degrees (SD 2.4 degrees), 25.8 degrees (SD 6.4 degrees) and 12.4 degrees (SD 2.3 degrees) during the second one. The performance of the system enabled us to detect knee function modifications in the sagittal and transverse plane. Prior to the reconstruction, the ROM of the injured knee was lower in flexion-extension and internal-external rotation in comparison with the controlateral knee. One year after the surgery, four patients were classified normal (A) and one almost normal (B), according to the IKDC score, and changes in the kinematics of the five patients remained: lower flexion-extension ROM and higher internal-external rotation ROM in comparison with the controlateral knee. The 3D kinematics was changed after an ACL lesion and remained altered one year after the surgery