Blood pressure treatment in acute ischemic stroke: a review of studies and recommendations.

PURPOSE OF REVIEW: Elevated blood pressure (BP) is frequent in patients with acute ischemic stroke. Pathophysiological data support its usefulness to maintain adequate perfusion of the ischemic penumba. This review article aims to summarize the available evidence from clinical studies that examined the prognostic role of BP during the acute phase of ischemic stroke and intervention studies that assessed the efficacy of active BP alteration. RECENT FINDINGS: We found 34 observational studies (33,470 patients), with results being inconsistent among the studies; most studies reported a negative association between increased levels of BP and clinical outcome, whereas a few studies showed clinical improvement with higher BP levels, clinical deterioration with decreased BP, or no association at all. Similarly, the conclusions drawn by the 18 intervention studies included in this review (1637 patients) were also heterogeneous. Very recent clinical data suggest a possible beneficial effect of early treatment with some antihypertensives on late clinical outcome. SUMMARY: Observational and interventional studies of management of acute poststroke hypertension yield conflicting results. We discuss different explanations that may account for this and discuss the current guidelines and pathophysiological considerations for the management of acute poststroke hypertension.

Functional avidity of tumor antigen-specific CTL recognition directly correlates with the stability of MHC/peptide multimer binding to TCR.

Avidity of Ag recognition by tumor-specific T cells is one of the main parameters that determines the potency of a tumor rejection Ag. In this study we show that the relative efficiency of staining of tumor Ag-specific T lymphocytes with the corresponding fluorescent MHC class I/peptide multimeric complexes can considerably vary with staining conditions and does not necessarily correlate with avidity of Ag recognition. Instead, we found a clear correlation between avidity of Ag recognition and the stability of MHC class I/peptide multimeric complexes interaction with TCR as measured in dissociation kinetic experiments. These findings are relevant for both identification and isolation of tumor-reactive CTL.

« Recueil de diverses genealogies ».

Contient : « Genealogie des comtes de Lyon et de Forests par Mr le chevalier GUICHENON, avec l'epitaphe d'Artaud, evesque de Belley » ; « Memoires touchant les comtes de Bar sur Seyne », dressés dans une lettre de M. « De VILLEPROUVEE », écrite « à Troyes, ce 4 febvrier 1653 » et adressée au P. J. Vignier ; « Contrele testament de Gerard de Roussillon » ; « Genealogies des maisons de Soissons, de Neelle et autres, par le R. Père JACQUES VIGNIER, de la Compagnie de Jésus » ; « Genealogie de la maison de Grandprey, avec des memoires la concernants » ; Genealogie de la maison de Choiseul par M. le marquis « DE LANQUES » : Notes adressées au R. P. Jacques Vignier, par lettres datées du 4 et du 9 février 1661. Epitaphes de différents membres de la famille de Choiseul, la première relevée à Metz par M. le marquis de Lanques, et les autres par le Père Vignier en l'eglise d'Aigremont et en l'abbaye de Morimond ; Lettre du comte D'HAUSSONVILLE au P. Vignier, concernant les sépultures de la maison de Choiseul à Morimond. « A Choiseul, ce 16 aoust 1658 » ; « Memoires de monseigneur DU CANGE, concernant la maison de Beaujeu » ; « Origine de la maison de Pontaillier ou Pontaillé », par le Père J. Vignier. A la suite : « genealogie de la maison de Pontaillier, suivant les lettres de madame la marquise de Rinel, en 1658 » et « Esclaircissements envoyés au P. J. Vignier de la Cie de Jésus, sur la genealogie de la maison de Pontaillier, descendue des comtes de Champagne » ; « Genealogie de la maison Dessalles de Rorté » adressée dans une lettre datée de Toul, 16 mars 1660, au P. J. Vignier par un descendant de cette famille « LOUYS DESSALLES DE RORTE » ; « Genealogie de la maison de Bourlemont », accompagnee d'une lettre au P. Vignier du Sr DE THUMERY, lettre datée de Bourlemont, le 23 octobre, sans désignation d'année ; « Memoires des seigneurs de Plancy » en Champagne, accompagnés d'une lettre de M. « DE VILLEPROUVEE » au P. J. Vignier ; « Memoires de la maison de Montbel » ; Lettre du Sr « DE VILLEPROUVEE » au P. J. Vignier sur les comtes de Champagne, la maison de Ravenel, les seigneurs de Sablonnière. « Troyes, ce premier de febvrier 1659 » ; Lettre du sieur « DE BEURVILLE » sur le même sujet. Cette lettre, adressée au P. J. Vignier, porte au dos 2 cachets de cire rouge aux armes des Srs de Beurville ; « Lettre de Mr DU LION, Sgr DE POINSSON » au P. J. Vignier, concernant la « genealogie de la maison du Lion ou de Lyon », dont l'auteur de la lettre était issu. Poinsson, 2 janvier 1664 ; Lettre du Sr « DE GAND » concernant sa famille, audit Père. « Dijon, 12 avril 1662 » ; « Genealogie de la maison de Fontetes... prez de St-Seine » ; « Mémoires de la maison de messieurs le Grand » ; « Eloge et genealogie de Jean Mercier, professeur royal en l'Université de Paris » ; Notes, qui semblent autographes, concernant le mariage et la naissance des enfants de JOSIAS MERCIER, seigneur DE GRIGNY etc ; Nouveau tableau généalogique avec blasons relatifs à cette famille ; Lettre autographe signée de PIERRE, « NEVELET DE DOSCHE », audit Père. Chaumont, 11 juin 1662 ; « Genealogie de messieurs de Beze » depuis Guyot de Beze, bourgeois de Cosne, vers le milieu du XVe siècle, jusqu'à Theodore de Beze, qui résigna le prieuré de Villeselve en 1548

Hommes et femmes: sommes-nous tous égaux face à la douleur [Are there differences between men and women with pain?].

An increasing number of articles are published on the differences about pain in men and women. These differences seem to be due to the sex, the biological dimension of the person, and to the gender, which is the role given to that person in a given social and culture environment. The pain prevalence is higher in women, its threshold and tolerance are lower. The pain interpretation, its perception and the coping is also different in men and women. Finally doctors translate and treat pain differently. This article proposes some explanations on these differences which should help us to treat this frequent and noxious symptom for the quality of life in a better way.

Position statement--altitude training for improving team-sport players' performance: current knowledge and unresolved issues.

Despite the limited research on the effects of altitude (or hypoxic) training interventions on team-sport performance, players from all around the world engaged in these sports are now using altitude training more than ever before. In March 2013, an Altitude Training and Team Sports conference was held in Doha, Qatar, to establish a forum of research and practical insights into this rapidly growing field. A round-table meeting in which the panellists engaged in focused discussions concluded this conference. This has resulted in the present position statement, designed to highlight some key issues raised during the debates and to integrate the ideas into a shared conceptual framework. The present signposting document has been developed for use by support teams (coaches, performance scientists, physicians, strength and conditioning staff) and other professionals who have an interest in the practical application of altitude training for team sports. After more than four decades of research, there is still no consensus on the optimal strategies to elicit the best results from altitude training in a team-sport population. However, there are some recommended strategies discussed in this position statement to adopt for improving the acclimatisation process when training/competing at altitude and for potentially enhancing sea-level performance. It is our hope that this information will be intriguing, balanced and, more importantly, stimulating to the point that it promotes constructive discussion and serves as a guide for future research aimed at advancing the bourgeoning body of knowledge in the area of altitude training for team sports.

Predicting the evolution of Kaposi sarcoma, in the highly active antiretroviral therapy era.

BACKGROUND: The outcome of Kaposi sarcoma varies. While many patients do well on highly active antiretroviral therapy, others have progressive disease and need chemotherapy. In order to predict which patients are at risk of unfavorable evolution, we established a prognostic score. METHOD: The survival analysis (Kaplan-Meier method; Cox proportional hazards models) of 144 patients with Kaposi sarcoma prospectively included in the Swiss HIV Cohort Study, from January 1996 to December 2004, was conducted. OUTCOME ANALYZED: use of chemotherapy or death. VARIABLES ANALYZED: demographics, tumor staging [T0 or T1 (16)], CD4 cell counts and HIV-1 RNA concentration, human herpesvirus 8 (HHV8) DNA in plasma and serological titers to latent and lytic antigens. RESULTS: Of 144 patients, 54 needed chemotherapy or died. In the univariate analysis, tumor stage T1, CD4 cell count below 200 cells/microl, positive HHV8 DNA and absence of antibodies against the HHV8 lytic antigen at the time of diagnosis were significantly associated with a bad outcome.Using multivariate analysis, the following variables were associated with an increased risk of unfavorable outcome: T1 [hazard ratio (HR) 5.22; 95% confidence interval (CI) 2.97-9.18], CD4 cell count below 200 cells/microl (HR 2.33; 95% CI 1.22-4.45) and positive HHV8 DNA (HR 2.14; 95% CI 1.79-2.85).We created a score with these variables ranging from 0 to 4: T1 stage counted for two points, CD4 cell count below 200 cells/microl for one point, and positive HHV8 viral load for one point. Each point increase was associated with a HR of 2.26 (95% CI 1.79-2.85). CONCLUSION: In the multivariate analysis, staging (T1), CD4 cell count (<200 cells/microl), positive HHV8 DNA in plasma, at the time of diagnosis, predict evolution towards death or the need of chemotherapy.