Medida y caracterización de las propiedades mecánicas tisulares y su aplicación a la medicina guiada por imágenes

[ES] Es un hecho bien conocido que las propiedades mecánicas de los tejidos patológicos difieren de las de los tejidos que los rodean. La práctica médica tradicional de la palpación lo ilustra con claridad. Durante los últimos años han surgido nuevos métodos que tratan de estimar la elasticidad de los tejidos para el diagnóstico de patologías, independientemente de la subjetividad del método médico tradicional. Una técnica en particular, la elastografía por ultrasonidos, fácilmente adaptable a los equipos de ultrasonido tradicionales, con seguridad se convertirá en una herramienta de diagnóstico médico importante, por su utilidad en la detección y caracterización de tumores de próstata y mama, así como en la detección de arterias dañadas, entre otras muchas aplicaciones. en el siguiente artículo se revisan brevemente las bases teóricas y prácticas de la elastografía por ultrasonido.

Una modernidad excéntrica: individuo, multitud y libertad en Spinoza

Este estudio se propone indagar el problema de la relación entre individuo, multitud y libertad en la obra de Spinoza, problema que, es nuestra hipótesis, permite echar luz sobre las alternativas fundamentales que se pusieron en juego en el debate teórico-político de la primera modernidad, y consecuentemente, en la formación de los órdenes políticos secularizados contemporáneos. ¿Cómo es posible la fundación y la conservación de un orden político en estas condiciones de incertidumbre? Más aún: ¿cómo hacer de esta incertidumbre no ya una amenaza, sino la fuerza motriz de un orden político? Estas son algunas de las preguntas que Spinoza responde a partir de una política y una filosofía de la inmanencia y que presentan, para nosotros, el doble interés de una interrogación “histórica” que busca en los orígenes de la modernidad sus posibilidades no transitadas, y “teórico política” en tanto busca en la ontología política spinoziana una forma de interrogar, desde las posibilidades inscriptas en su origen, las encrucijadas de la política moderna. Para llevar adelante esta investigación tomaremos como punto de partida la noción spinoziana de individualidad, buscando comprender sus determinaciones, su especificidad y el modo en que, a partir de ella, resulta posible pensar la "naturaleza humana" y las condiciones de la vida en común. Esta noción de individualidad, sostendremos, implica una crítica moderna de las categorías centrales del proyecto moderno, cuya clave se encuentra justamente en una crítica radical de la concepción moderna de la subjetividad (ya sea en su dimensión individual, como concepción del hombre, o en su dimensión política, como concepción del sujeto soberano). A partir de este desarrollo, daremos tratamiento a la concepción spinoziana de la política, y del que se revela en sus últimos escritos como su actor fundamental: la multitud. Para ello, hemos pretendido poner de relieve la distancia de Spinoza respecto del paradigma de la soberanía estatal desarrollado por Hobbes (y continuado en toda la tradición filosófica del derecho natural, pasando por Locke, Rousseau y Kant) y las consecuencias históricas, políticas e institucionales de tal distancia, así como las posibilidades abiertas a un pensamiento político a partir del registro conceptual abierto por Spinoza.

Bildung in Medienwelten?: Eine biografieanalytische Studie zu Lern- und Bildungsprozessen bei Homosexuellen im Internet

Innerhalb der vorliegenden Untersuchung geht es um die Verknüpfung von Medienbildung, homosexueller Sozialität und der Methodik der Biografieanalyse. Ausgangsbasis ist eine sozialkonstruktivistische Sichtweise auf Geschlecht und (Homo-) Sexualität, wobei eine sozio-historische Kontextualisierung von Homosexualität unter Berücksichtigung von Diskriminierung erfolgt. Im Fokus steht der Coming-out-Prozess, der zwischen Zeigen und Verstecken changiert und mittels des Mediums Internet einen Raum findet, indem neue Bestimmungen homosexueller Identitäten und Formen homosexueller Sozialität möglich werden. Kommunikative Aspekte des Internets werden ausführlich expliziert und durch die strukturelle Medienbildungstheorie nach Marotzki (2009) ergänzt, um mögliche verbundene Bildungsprozesse zu beschreiben. Innerhalb dieser Theorie werden vier kritische Reflexionshorizonte (Wissensbezug, Handlungsbezug, Grenzbezug, Biografiebezug) entfaltet und auf die Artikulations- und Präsentationsmöglichkeiten des Internets bezogen. Deutlich wird, dass das Internet Spielräume für Identitäten bietet, denen Potenziale für reale Identitätskonstruktionen inneliegen. Fassbar werden diese Potenziale durch das medienpädagogische Konstrukt der Medienbiografie, sowie Konzepte der erziehungswissenschaftlichen Biografieforschung (Konstrukt Bildung nach Marotzki, 1990a; Konstrukt Sexualbiografie nach Scheuermann, 1999; 1995). Empirisch orientiert sich die Studie an Methodologie und Methodik der Biografieforschung, Grounded Theory (Glaser/Strauss, 1967) und dem narrationsstrukturellen Verfahren nach Schütze (1984, 1983). Konkret wird auf folgende Forschungsfragen referiert: Wie gestalten sich Lern- und Bildungsprozesse für männliche Homosexuelle in digitalen Medienwelten? Welche Möglichkeiten und Gestaltungschancen gibt es für die Repräsentation des (sexuellen) Selbst im Medium Internet? Welche Auswirkungen haben diese virtuellen Prozesse auf die real gelebte Biografie und das Selbst- und Weltverhältnis der einzelnen Homosexuellen? Durch Rekonstruktion von vier Fallbeispielen werden Möglichkeiten des Internets für die Repräsentation und Identitätsgestaltung von männlichen Homosexuellen präsentiert, bei denen die Gestaltbarkeit von Konstruktionen sexueller Identität und die Problematik der Subjekt-Umwelt-Relation deutlich werden. Im weiteren erfolgt ein kontrastierender Vergleich der Einzelfälle (Dimensionen: Familie, Peer Group, sexualbiografische Entwicklung, Medienbildungsprozesse, biografische Fallstruktur), die einer anschließenden Konstruktion von vier idealtypischen Prozessvarianten der sexualbiografischen Identitätsentwicklung zugeführt werden. Vier verschiedene Möglichkeiten des Internets als Präsentationstraum der eigenen Sexualität und Konstruktionen homosexueller Identität lassen sich somit skizzieren (Virtualitätslagerung, Zweckorientierung, reflexive Balancierung, periodische Selbstaktualisierung). Tentative Bildungs- und Identitätsprozesse sind also in der Virtualität des Internets möglich und können rekursiv-zirkulär auf reale Identitätsentwicklungen und reale Zugänge zu spezifischen sozialen Gruppen einwirken.

Rap et homosexualite: retranchement homophobe ou changement de cap?

With the advent of the law about same-sex marriage in France, the aim of this dissertation is to analyse the relationship between homosexuality and rap music in the country and to determine to which degree this musical genre can influence people on this matter. Islam has flavoured rap from its beginnings because the vast majority of rappers has a Muslim culture. It is true that, Islam goes beyond the mere disapproval of homosexuality affirming that it is a vile fornication punishable by death. This leads rappers to a rejection of homosexuality in their songs. And, thanks to mass media, these songs contributed to the spreading of the stigma of homophobia upon the “mainstream”. Nevertheless, since 2009, a growing crop of rappers began to support the LGBT community with their work. Rap songs became in this way the anthem of the LGBT campaigns, out from the classic mass media. The result of this dissertation is that rap can have a strong influence upon population and can help them change their mind upon certain subjects, as it was the case for the homosexual cause.

L’Orientalismo tra vocazione imperialista, suggestioni esotiche e omoerotiche. Le rappresentazioni storiche del passaggio tra l’epoca omayyade e abbaside.

Lo studio si tratta di mettere in evidenza il cambiamento che ha subito il termine Oriente nel secolo XX in alcuni testi della letteratura italiana contemporanea. L’opera di Edward Said, L’Orientalismo è un testo di riferimento per i nostri studi. Nel quale abbiamo focalizzato l’attenzione su alcuni aspetti salienti: il concetto di orientalismo; l’interesse nei confronti dell’Oriente sul piano politico, scientifico, letterario; l’impossibilità di separare lo studioso dalle circostanze biografiche e sociali. Siamo riusciti, quindi, a stabilire che il cambiamento dell’immagine orientale dipende da tre fattori: lo scrittore (emittente), il soggetto (la fonte) ed il lettore (destinatario), dai quali si origina l’oggetto (il testo). Basandoci su questi tre elementi abbiamo cercato di inquadrare l’interesse letterario per l’Oriente vista da una triplice prospettiva: imperialismo, fascino ed erotismo. Per studiare le prime due prospettive, abbiamo scelto due opere. La prima presenta l’immagine dell’imperialismo, si tratta di Sanya, La moglie egiziana e il Romanzo dell’Oriente Moderno (1927) di Bruno Corra. La seconda prospettiva dove troviamo l’immagine dell’Oriente fascinoso è nello scritto di Annie Vivanti, La terra di Cleopatra (1925). Il punto centrale della tesi si tratta di studiare Annie Messina (1910-1996), è una scrittrice che ha uno stile peculiare ed un approccio tutto suo al tema dell’Oriente. I testi studiati sono : "Il mirto e la rosa" (1982), "Il banchetto dell'emiro" (1997) e "La principessa e il wâlî" (1996), tutti pubblicati dalla casa editrice Sellerio.L’unico pubblicato da Mondadori è "La palma di Rusafa" (1989). L’ultima parte del lavoro abbiamo esposto un profilo storico e socio-religioso della letteratura erotica araba. In cui abbiamo rintracciato le origini dell’immagine erotico dell’Oriente e il tema dell’omosessualità, mettendo a confronto il testo omosessuale di Messina con la letteratura italiana contemporanea.

Relationship Repair After Infidelity: Looking at Other Perspectives

Prior research examining relationship repair after infidelity scenarios tends to focus primarily on heterosexual relationships, and often does not take into consideration the nuance between emotional and sexual infidelity, which, according to evolutionary psychology theories, tends to be salient to individuals based on their reproductive challenges. This research intended to rectify that dearth, hypothesizing that non-heterosexual participants would be more likely to repair a relationship where a partner has committed sexual infidelity than they would be to repair a relationship where a partner has committed an emotional infidelity. As well, based on prior research, there were expectations for sex differences in the likelihood of repairing a relationship after infidelity by a partner for participants in committed relationships, with female participants likely to repair emotional infidelity and male participants likely to repair sexual infidelity. In a survey of volunteers online, likelihood of repair for relationships after sexual or emotional infidelity was related to the sexual orientation of participants. Homosexual/other individuals were equally likely to repair their relationship after an emotional or sexual infidelity was committed by a partner and were more likely to repair a relationship after a partner committed a sexual infidelity than heterosexual individuals were. A qualitative question component obtained more information about the participants¿ logic behind their reconciliation choices, and these results along with the quantitative results are discussed and interpreted using themes from earlier research.

Estimating Patterns of CD4+ Lymphocyte Decline Using Data from a Prevalent Cohort of HIV Infected Individuals

In natural history studies of chronic disease, it is of interest to understand the evolution of key variables that measure aspects of disease progression. This is particularly true for immunological variables in persons infected with the Human Immunodeficiency Virus (HIV). The natural timescale for such studies is time since infection. However, most data available for analysis arise from prevalent cohorts, where the date of infection is unknown for most or all individuals. As a result, standard curve fitting algorithms are not immediately applicable. Here we propose two methods to circumvent this difficulty. The first uses repeated measurement data to provide information not only on the level of the variable of interest, but also on its rate of change, while the second uses an estimate of the expected time since infection. Both methods are based on the principal curves algorithm of Hastie and Stuetzle, and are applied to data from a prevalent cohort of HIV-infected homosexual men, giving estimates of the average pattern of CD4+ lymphocyte decline. These methods are applicable to natural history studies using data from prevalent cohorts where the time of disease origin is uncertain, provided certain ancillary information is available from external sources.

[Bisexuality and AIDS. Implications for heterosexual HIV infections in women]

One of the possible pathways into heterosexual population is the transfer of HIV-virus from bisexual men to their female partners. Therefore sexual behaviour of HIV-positive and -negative bisexual men (n = 31) before and after Aids-disease was analysed. Prior to the Aids-epidemic promiscuous behavior towards male partners (about one female partner per year versus 10 male partners per year). Relatively common contacts to woman occurred within steady relationships. After contact with HIV-test and personal counselling sexual practice became significantly different. The number of female and male contacts was markedly reduced, especially female chance acquaintances were avoided; safer sex was preferred and readiness to inform female partners about bisexuality was increased. This study suggests that reduction of risk for HIV-infection of female partners by homosexual men can be achieved by means of a HIV-test and personal counselling, a possibility that should be considered in preventive concepts.

Low current and nadir CD4+ T-cell counts are associated with higher hepatitis C virus RNA levels in the Swiss HIV cohort study

BACKGROUND: The aim of this study was to evaluate the effect of CD4+ T-cell counts and other characteristics of HIV-infected individuals on hepatitis C virus (HCV) RNA levels. METHODS: All HIV-HCV-coinfected Swiss HIV Cohort Study participants with available HCV RNA levels and concurrent CD4+ T-cell counts before starting HCV therapy were included. Potential predictors of HCV RNA levels were assessed by multivariate censored linear regression models that adjust for censored values. RESULTS: The study included 1,031 individuals. Low current and nadir CD4+ T-cell counts were significantly associated with higher HCV RNA levels (P = 0.004 and 0.001, respectively). In individuals with current CD4+ T-cell counts < 200/microl, median HCV RNA levels (6.22 log10 IU/ml) were +0.14 and +0.24 log10 IU/ml higher than those with CD4+ T-cell counts of 200-500/microl and > 500/microl. Based on nadir CD4+ T-cell counts, median HCV RNA levels (6.12 log10 IU/ml) in individuals with < 200/microl CD4+ T-cells were +0.06 and +0.44 log10 IU/ml higher than those with nadir T-cell counts of 200-500/microl and > 500/microl. Median HCV RNA levels were also significantly associated with HCV genotype: lower values were associated with genotype 4 and higher values with genotype 2, as compared with genotype 1. Additional significant predictors of lower HCV RNA levels were female gender and HIV transmission through male homosexual contacts. In multivariate analyses, only CD4+ T-cell counts and HCV genotype remained significant predictors of HCV RNA levels. Conclusions: Higher HCV RNA levels were associated with CD4+ T-cell depletion. This finding is in line with the crucial role of CD4+ T-cells in the control of HCV infection.

Delayed diagnosis of HIV infection and late initiation of antiretroviral therapy in the Swiss HIV Cohort Study

OBJECTIVES: To investigate delayed HIV diagnosis and late initiation of antiretroviral therapy (ART) in the Swiss HIV Cohort Study. METHODS: Two sub-populations were included: 1915 patients with HIV diagnosis from 1998 to 2007 and within 3 months of cohort registration (group A), and 1730 treatment-naïve patients with CD4>or=200 cells/microL before their second cohort visit (group B). In group A, predictors for low initial CD4 cell counts were examined with a median regression. In group B, we studied predictors for CD4<200 cells/microL without ART despite cohort follow-up. RESULTS: Median initial CD4 cell count in group A was 331 cells/microL; 31% and 10% were <200 and <50 cells/microL, respectively. Risk factors for low CD4 count were age and non-White race. Homosexual transmission, intravenous drug use and living alone were protective. In group B, 30% initiated ART with CD4>or=200 cells/microL; 18% and 2% dropped to CD4 <200 and <50 cells/microL without ART, respectively. Sub-Saharan origin was associated with lower probability of CD4 <200 cells/microL without ART during follow-up. Median CD4 count at ART initiation was 207 and 253 cells/microL in groups A and B, respectively. CONCLUSIONS: CD4<200 cells/microL and, particularly, CD4<50 cells/microL before starting ART are predominantly caused by late presentation. Earlier HIV diagnosis is paramount.

Cochleovestibular Deficit as First Manifestation of Syphilis in a HIV-Infected Patient

We report the detailed documented case of a 57-year-old homosexual HIV-positive man with bilateral cochleovestibular deficits as a first symptom of syphilis infection in early stage II disease. As a morphological substrate, a strong enhancement of both inner ears and vestibulocochlear nerves were found on gadolinium-enhanced MR scans. The serological tests identified an active infection with Treponema pallidum. After a high-dose treatment with penicillin G and prednisolone, the auditory and vestibular functions and the MR morphology of the vestibulocochlear nerves and inner ears on both sides returned to normal.

Emergence of extensively drug-resistant Haemophilus parainfluenzae in Switzerland

Two homosexual men were colonized in the urethra with Haemophilus parainfluenzae nonsusceptible to ampicillin (MIC, 8 μg/ml), amoxicillin-clavulanate (MIC, 4 μg/ml), cefotaxime (MIC, 1.5 μg/ml), cefepime (MIC, 3 μg/ml), meropenem (MIC, 0.5 μg/ml), cefuroxime, azithromycin, ciprofloxacin, tetracycline, and chloramphenicol (all MICs, ≥ 32 μg/ml). Repetitive extragenic palindromic PCR (rep-PCR) showed that the strains were indistinguishable. The isolates had amino acid substitutions in PBP3, L4, GyrA, and ParC and possessed Mef(A), Tet(M), and CatS resistance mechanisms. This is the first report of extensively drug-resistant (XDR) H. parainfluenzae.

Risk Factors and Outcomes for Late Presentation for HIV-Positive Persons in Europe: Results from the Collaboration of Observational HIV Epidemiological Research Europe Study (COHERE)

Background Few studies have monitored late presentation (LP) of HIV infection over the European continent, including Eastern Europe. Study objectives were to explore the impact of LP on AIDS and mortality. Methods and Findings LP was defined in Collaboration of Observational HIV Epidemiological Research Europe (COHERE) as HIV diagnosis with a CD4 count <350/mm3 or an AIDS diagnosis within 6 months of HIV diagnosis among persons presenting for care between 1 January 2000 and 30 June 2011. Logistic regression was used to identify factors associated with LP and Poisson regression to explore the impact on AIDS/death. 84,524 individuals from 23 cohorts in 35 countries contributed data; 45,488 were LP (53.8%). LP was highest in heterosexual males (66.1%), Southern European countries (57.0%), and persons originating from Africa (65.1%). LP decreased from 57.3% in 2000 to 51.7% in 2010/2011 (adjusted odds ratio [aOR] 0.96; 95% CI 0.95–0.97). LP decreased over time in both Central and Northern Europe among homosexual men, and male and female heterosexuals, but increased over time for female heterosexuals and male intravenous drug users (IDUs) from Southern Europe and in male and female IDUs from Eastern Europe. 8,187 AIDS/deaths occurred during 327,003 person-years of follow-up. In the first year after HIV diagnosis, LP was associated with over a 13-fold increased incidence of AIDS/death in Southern Europe (adjusted incidence rate ratio [aIRR] 13.02; 95% CI 8.19–20.70) and over a 6-fold increased rate in Eastern Europe (aIRR 6.64; 95% CI 3.55–12.43). Conclusions LP has decreased over time across Europe, but remains a significant issue in the region in all HIV exposure groups. LP increased in male IDUs and female heterosexuals from Southern Europe and IDUs in Eastern Europe. LP was associated with an increased rate of AIDS/deaths, particularly in the first year after HIV diagnosis, with significant variation across Europe. Earlier and more widespread testing, timely referrals after testing positive, and improved retention in care strategies are required to further reduce the incidence of LP.

Social Meets Molecular: Combining Phylogenetic and Latent Class Analyses to Understand HIV-1 Transmission in Switzerland

Switzerland has a complex human immunodeficiency virus (HIV) epidemic involving several populations. We examined transmission of HIV type 1 (HIV-1) in a national cohort study. Latent class analysis was used to identify socioeconomic and behavioral groups among 6,027 patients enrolled in the Swiss HIV Cohort Study between 2000 and 2011. Phylogenetic analysis of sequence data, available for 4,013 patients, was used to identify transmission clusters. Concordance between sociobehavioral groups and transmission clusters was assessed in correlation and multiple correspondence analyses. A total of 2,696 patients were infected with subtype B, 203 with subtype C, 196 with subtype A, and 733 with recombinant subtypes (mainly CRF02_AG and CRF01_AE). Latent class analysis identified 8 patient groups. Most transmission clusters of subtype B were shared between groups of gay men (groups 1-3) or between the heterosexual groups "heterosexual people of lower socioeconomic position" (group 4) and "injection drug users" (group 8). Clusters linking homosexual and heterosexual groups were associated with "older heterosexual and gay people on welfare" (group 5). "Migrant women in heterosexual partnerships" (group 6) and "heterosexual migrants on welfare" (group 7) shared non-B clusters with groups 4 and 5. Combining approaches from social and molecular epidemiology can provide insights into HIV-1 transmission and inform the design of prevention strategies.