More than 10 years survival with sequential therapy in a patient with advanced renal cell carcinoma: a case report

Although radical nephrectomy alone is widely accepted as the standard of care in localized treatment for renal cell carcinoma (RCC), it is not sufficient for the treatment of metastatic RCC (mRCC), which invariably leads to an unfavorable outcome despite the use of multiple therapies. Currently, sequential targeted agents are recommended for the management of mRCC, but the optimal drug sequence is still debated. This case was a 57-year-old man with clear-cell mRCC who received multiple therapies following his first operation in 2003 and has survived for over 10 years with a satisfactory quality of life. The treatments given included several surgeries, immunotherapy, and sequentially administered sorafenib, sunitinib, and everolimus regimens. In the course of mRCC treatment, well-planned surgeries, effective sequential targeted therapies and close follow-up are all of great importance for optimal management and a satisfactory outcome.

Bilateral repetitive transcranial magnetic stimulation for treatment-resistant depression: a systematic review and meta-analysis of randomized controlled trials

There has been concern regarding the use of controversial paradigms for repetitive transcranial magnetic stimulation (rTMS) to manage treatment-resistant depression (TRD). This meta-analysis assessed the efficacy of bilateral rTMS compared with unilateral and sham rTMS in patients with TRD. PubMed, Embase, CENTRAL, PsycINFO, Web of Science, EAGLE and NTIS databases were searched to identify relevant studies, and randomized controlled trials (RCTs) on bilateral rTMS for TRD patients were included. The response was defined as the primary outcome, and remission was the secondary outcome. Ten RCTs that included 634 patients met the eligibility criteria. The risk ratio (RRs) of both the primary and secondary outcomes of bilateral rTMS showed non-significant increases compared to unilateral rTMS (RR=1.01, P=0.93; odds ratio [OR]=0.77, P=0.22). Notably, the RR of the primary bilateral rTMS outcome was significantly increased compared to that for sham rTMS (RR=3.43, P=0.0004). The results of our analysis demonstrated that bilateral rTMS was significantly more effective than sham rTMS but not unilateral rTMS in patients with TRD. Thus, bilateral rTMS may not be a useful paradigm for patients with TRD.

Impacts of capacity remunerative mechanisms on cross-border trade

The European ambitious targets to increase the share of renewable generation pose a challenge to the generation adequacy. Many European member states are concerned that energy-only markets alone might not be able to deliver sufficient capacity required to meet the future electricity demand and back up shortfalls of energy from renewable energy sources (RES) during periods of low wind and sun. Many EU members consider to re-design their energy-only markets and establish different forms of capacity remunerative mechanisms (CRMs) to maintain the security of supply. There is a certain concern that market design changes at the level of EU member countries might conflict with the European goal of a single market. As soon as many European markets are highly interconnected, uncoordinated CRMs might create negative crossborder effects and hinder the achievement of the Internal Electricity Market in Europe. The pros and cons of capacity markets are well examined at the national level. However, the cross-border effects of capacity markets within the European market aiming at higher integration have received less attention. This doctoral dissertation examines the cross-border effects of unilateral implementation of CRMs applying both theoretical and case study analyses. The results show that capacity remunerative mechanisms (CRMs) may cause negative cross-border effects, especially if they are implemented unilaterally.

Feocromocitoma e gravidez: Relato de caso e revisão atualizada

Resumo O feocromocitoma é um tumor da adrenal produtor de catecolaminas, sendo causa rara de hipertensão arterial na gravidez. Sua prevalência em hipertensos é de 0,2%, e em 0,002% das gestações. Acompanhamos gestante hipertensa de 24 anos, branca, tercigesta, admitida na 33ª semana com emergência hipertensiva, indicada cesárea devido a sofrimento fetal, evoluindo com edema agudo de pulmão no pós-parto imediato. Submetida à videolaparoscopia após 13 dias por dor abdominal aguda, sem achado significativo. No pós-operatório, devido à hipertensão arterial grave e refratária, suspeitou-se de feocromocitoma, confirmado por exames bioquímicos e de imagem. Realizada adrenelectomia unilateral com cura da hipertensão. A anatomia patológica e a imunohistoquímica confirmaram o diagnóstico. Concluímos que casos atípicos de hipertensão na gravidez devem ser precocemente investigados e diferenciados da pré-eclâmpsia. Apesar da baixa prevalência, o feocromocitoma na gravidez aumenta consideravelmente a morbimortalidade materno-fetal e o seu reconhecimento e tratamento precoces mudam drasticamente o seu desfecho.

Competitive Effects of Non-Controlling Minority Acquisitions – Sufficient to merit further EU merger regulation?

Partial ownership interests are a widespread phenomenon in modern corporate environment. Unless minority shareholding affords the target to exercise control over the target, they do currently not have to be notified to the European Commission under EU merger regime. However, economic research has long suggested that when linking competing or non-horizontally positioned undertakings particularly in industries with few competitors, minority shareholdings even far below the majority of shares or voting rights could lead to higher prices or lower output volumes to the detriment of consumers. The Commission has recognized this issue and proceeded to suggest an extension of the merger regime to catch also certain non-controlling minority acquisitions. Horizontal non-controlling minority shareholdings create a positive correlation between the sales revenues of the partial acquirer and target. Through the equity interest the acquirer will internalise a fraction, proportional to the financial rights attached to the shareholding, of the profit of the target. This will incentivise the acquirer to contribute to increasing the target’s business profits by increasing its own sales price (horizontal unilateral effects). When a minority stake is held in a vertically related or a conglomerate company, the minority acquirer could be allowed to hamper or eliminate the target’s rivals’ access either to inputs (input foreclosure) or customers (customer foreclosure), depending on which level of the supply chain the parties are (vertical unilateral effects). Under certain circumstances minority share acquisitions could also lessen competition because they facilitate collusion between companies active in the market (coordinated effects). Economic theory confirms that non-controlling minority shareholdings may under certain circumstances create anti-competitive effects that are unlikely to be remedies by pro-competitive effects. However, they are likely to be of less significant nature than anticompetitive effects created by full mergers. This derives fore mostly from the fact that a minority share acquirer carries all the costs associated with its unilateral action but will internalise only a fraction of the lost profits. This is likely to limit the acquirer’s incentive to raise price and the profitability of such behavior. Having in mind that the number of potentially problematic cases is expected to be next to negligible, the limited potential competitive effects of non-controlling minority share acquisitions cannot be seen to clearly merit extension of the scope of the EUMR. The system suggested by the Commission is particularly ill-fitted for such purpose given the clear lack of legal certainty and considerable administrative burden associated with it.

Political economy of preferential trade agreement: the case of bilateral asymmetric negotiation

The purpose of this paper is to analyse the political economy of preferential trade agreements based on a sequential non-cooperative Stackelberg political game between a large economy and a small one, in which the political dispute of rival lobby groups defines the unilateral stance of both governments in the first stage; and the Stackelberg "coalition-proof" equilibrium defines the free trade agreement format in the second stage. Finally, a few modifications in the initial game structure are discussed in order to enhance the small economy's negotiation power. The political economy model is applied to FTAA case.

Herbert Marcuse - anticapitalismo e emancipação

Marcuse teve no Brasil na década de 1970 uma recepção unilateral, sendo visto unicamente como guru da contra-cultura. Contra esse equívoco o artigo mostra a relação intrínseca entre teoria e prática na filosofia de Marcuse, caracterizada como uma filosofia política cuja preocupação central é a transformação radical da sociedade capitalista.

O direito real de Kant

No direito real, Kant investiga a propriedade privada de uma substância (o solo e os objetos localizados nele). No estado de natureza, somente ocorre a posse física ou empírica de um objeto externo, a partir do postulado jurídico da razão prática como uma lei permissiva, pois, do contrário, as coisas utilizáveis seriam em-si ou res nullius, mas a posse jurídica ou inteligível depende da posse comum originária do solo (que não se confunde com o comunismo primitivo), para evitar que a propriedade seja uma relação entre pessoas e coisas, como acontece na teoria do trabalho, porque todo direito exige um dever correspondente. Todavia, coisas não podem ter deveres com relação a pessoas, condição seguida da vontade unilateral do primeiro ocupante de querer o objeto e do advento de uma vontade unificada a priori do provo, que só se torna efetiva no estado civil, a única capaz de gerar uma obrigação recíproca entre todos; por isso, a posse inteligível somente é possível no estado civil, embora a posse empírica do estado de natureza tenha a presunção de tornar-se jurídica, quando ocorrer a entrada no estado jurídico e vale por comparação na espera e preparação daquele estado.

Resolución N° 25 del 26 de febrero de 2007 ¿Cuáles son los los requisitos que evalúa la Cámara de Comercio respecto de la convocatoria?

Servicios registrales

L'exécution des décisions de la Cour internationale de Justice : faiblesses et malentendus

"Mémoire présenté à la Faculté des études supérieures en vue de l'obtention du grade de Maîtrise en droit international (LL.M)"

L'accord de Cotonou et les contradictions du droit international : l'intégration des règles de l'Organisation mondiale du commerce et des droits humains dans la coopération ACP-CE

"Thèse présentée à la Faculté des études supérieures de l'Université de Montréal en vue de l'obtention du grade de Docteur en Droit (LL.D.) Et à A la faculté de droit Jean Monnet en vue de l'obtention du doctorat en Sciences Juridiques"

La circoncision des femmes en Afrique : repenser les politiques de santé

Section des étudiants / Student's section

Implications fonctionnelles du collicule inférieur chez l'humain

Le rôle du collicule inférieur dans les divers processus auditif demeure à ce jour méconnu chez l’humain. À l’aide d’évaluations comportementales et électrophysiologiques, le but des études consiste à examiner l’intégrité fonctionnelle du système nerveux auditif chez une personne ayant une lésion unilatérale du collicule inférieur. Les résultats de ces études suggèrent que le collicule inférieur n’est pas impliqué dans la détection de sons purs, la reconnaissance de la parole dans le silence et l’interaction binaurale. Cependant, ces données suggèrent que le collicule inférieur est impliqué dans la reconnaissance de mots dans le bruit présentés monauralement, la discrimination de la fréquence, la reconnaissance de la durée, la séparation binaurale, l’intégration binaurale, la localisation de sources sonores et, finalement, l’intégration multisensorielle de la parole.

Diminution de la performance motrice du membre ipsilatéral au site de l’accident vasculaire cérébral lors de tâches bilatérales

Suite à un accident vasculaire cérébral (AVC), des déficits au membre controlatéral et ipsilatéral à la lésion cérébrale sont observés chez les personnes avec un AVC. La performance du membre ipsilatéral est déterminée par l’importance de la sévérité clinique du membre controlatéral ainsi que par l’adéquation du traitement bihémisphérique des informations sensori-motrices. L’objectif de la présente étude est de comparer la performance motrice de la main ipsilatérale lors de diverses tâches nécessitant un niveau plus ou moins complexe de traitement de l’information chez une clientèle hémiplégique ayant une faible sévérité clinique. Les résultats démontrent que les forces de pinces entre le pouce et l’index du membre ipsilatéral sont modulées et anticipées adéquatement chez les personnes avec un AVC ayant une faible sévérité clinique tel que démontré par des scores de cinq ou plus au Chedoke-McMaster Stroke Assessment (modules bras et main). La performance motrice du membre ipsilatéral lors de l’exécution d’une tâche de coordination bilatérale est comparable à celle du membre dominant des sujets sains lorsque la tâche est réalisée sans interaction entre les membres supérieurs (deux objets) et elle est perturbée lorsqu’elle implique une action coordonnée et réciproque des membres supérieurs sur un même objet. Ces personnes, ayant une bonne récupération motrice, ont donc une problématique centrale d’intégration et de traitement de l’information sensori-motrice lorsqu’il y a une complexification de la tâche à réaliser. Ces résultats suggèrent donc que les cliniciens devraient porter une attention plus particulière aux activités unilatérales et de coordination bilatérales lors le l’exécution de tâches complexes nécessitant un niveau d’intégration sensori-motrice élevé.

Modulation du cytochrome P450 dans un modèle murin d'insuffisance rénale chronique

Introduction : Les modèles murins sont grandement utilisés dans l’étude des maladies rénales et des pathologies associées. La concentration de la créatinine sérique est un bon indicateur de la filtration glomérulaire et en présence d’insuffisance rénale chronique (IRC), les concentrations de créatinine sérique (et la clairance) reflètent la sévérité de l’IRC. De plus, il a été démontré que l’IRC modifie le métabolisme des médicaments en diminuant l’activité et l’expression des enzymes hépatiques du cytochrome P450 (CYP450). Afin d’étudier la modulation du P450 par l’IRC avec un modèle murin et de confirmer nos résultats chez le rat, nous devons 1) développer un modèle d’IRC chez la souris, 2) mettre au point une technique de dosage des marqueurs de l’IRC et, 3) évaluer l’expression protéique du CYP450 en présence IRC. Matériel et Méthode : Trois modèles chirurgicaux d’IRC chez la souris ont été développés. Une méthode du dosage de la créatinine par chromatographie liquide à haute performance (CLHP) a été mise au point chez la souris et l’expression protéique du P450 a été mesurée par immunobuvardage de type Western. Résultats : Plusieurs paramètres de CLHP comme le pH, la concentration et le débit de la phase mobile modifient le pic d’élution et le temps de rétention de la créatinine. Concernant le modèle expérimental, on observe une perte de poids et une augmentation de la concentration plasmatique de la créatinine chez les souris avec une IRC. De plus, l’expression protéique de plusieurs isoformes du cytochrome P450 est modulée par l’IRC. Nous observons une diminution du CYP 2D de 42% (p < 0,01), du CYP 3A11 de 60% et du CYP 1A de 37% (p <0,01) par rapport aux souris témoins. On ne dénote aucun changement significatif au niveau de l’isoforme 2E1. Conclusion : Il est possible d’induire une insuffisance rénale chronique chez la souris suite à une néphrectomie. La technique de dosage de la créatinine par CLHP est précise et exacte et permet de caractériser la sévérité de l’IRC chez la souris. L’expression protéique du CYP450 est régulée à la baisse dans le foie des souris atteintes d’IRC.