Subclinical Hypothyroidism and the Risk of Stroke Events and Fatal Stroke: An Individual Participant Data Analysis.

OBJECTIVE: The objective was to determine the risk of stroke associated with subclinical hypothyroidism. DATA SOURCES AND STUDY SELECTION: Published prospective cohort studies were identified through a systematic search through November 2013 without restrictions in several databases. Unpublished studies were identified through the Thyroid Studies Collaboration. We collected individual participant data on thyroid function and stroke outcome. Euthyroidism was defined as TSH levels of 0.45-4.49 mIU/L, and subclinical hypothyroidism was defined as TSH levels of 4.5-19.9 mIU/L with normal T4 levels. DATA EXTRACTION AND SYNTHESIS: We collected individual participant data on 47 573 adults (3451 subclinical hypothyroidism) from 17 cohorts and followed up from 1972-2014 (489 192 person-years). Age- and sex-adjusted pooled hazard ratios (HRs) for participants with subclinical hypothyroidism compared to euthyroidism were 1.05 (95% confidence interval [CI], 0.91-1.21) for stroke events (combined fatal and nonfatal stroke) and 1.07 (95% CI, 0.80-1.42) for fatal stroke. Stratified by age, the HR for stroke events was 3.32 (95% CI, 1.25-8.80) for individuals aged 18-49 years. There was an increased risk of fatal stroke in the age groups 18-49 and 50-64 years, with a HR of 4.22 (95% CI, 1.08-16.55) and 2.86 (95% CI, 1.31-6.26), respectively (p trend 0.04). We found no increased risk for those 65-79 years old (HR, 1.00; 95% CI, 0.86-1.18) or ≥ 80 years old (HR, 1.31; 95% CI, 0.79-2.18). There was a pattern of increased risk of fatal stroke with higher TSH concentrations. CONCLUSIONS: Although no overall effect of subclinical hypothyroidism on stroke could be demonstrated, an increased risk in subjects younger than 65 years and those with higher TSH concentrations was observed.

Veränderung von Inzidenz und Mortalität von Kopf-Hals-Malignomen in Rheinland-Pfalz, 2000-2009 [Changes in Incidence and Mortality Trends of Head and Neck Cancer in Rhineland-Palatinate, 2000-2009].

BACKGROUND: Epidemiological data on HNC are often reported aggregated despite their anatomical and histological heterogeneity. In Germany, few studies have analyzed incidence and mortality trends separately for specific anatomic sites. Furthermore, little is known about whether the incidence of HPV-associated tumour entities of the head and neck region has increased. METHODS: Based on cancer registry data from Rhineland-Palatinate from 2000 to 2009, age-standardized incidence and mortality rates were calculated for all HNC sites and localisation groups that might be HPV-associated according to the literature. Trends were analyzed by Joinpoint regression and reported as the annual percentage change (APC). RESULTS: Throughout the study period, 8 055 incident cases and 3 177 deaths were identified. The incidence rates of overall HNC increased among women (APC:+2.2%) and declined slightly among men (- 0.9%). Significantly increasing incidence rates among women were seen for tumours of the oral cavity (+2.7%) and the oropharynx (+3.6%). Among men, a significant decrease in incidence rates for tumours of the hypopharynx (-3.4%) and the larynx (-2.7%) are noteworthy. Cancers at HPV-associated sites showed increased incidence rates in men (+3.3%) and women (+4.3%). A decrease in mortality was found for tumours of the larynx in both sexes (-5.8% men,-9.1% women). CONCLUSIONS: A detailed analysis by localisation of HNC showed significant and often opposing trends for men and women regarding incidence and mortality.

Non-invasive prenatal testing for aneuploidy and beyond: challenges of responsible innovation in prenatal screening.

This paper contains a joint ESHG/ASHG position document with recommendations regarding responsible innovation in prenatal screening with non-invasive prenatal testing (NIPT). By virtue of its greater accuracy and safety with respect to prenatal screening for common autosomal aneuploidies, NIPT has the potential of helping the practice better achieve its aim of facilitating autonomous reproductive choices, provided that balanced pretest information and non-directive counseling are available as part of the screening offer. Depending on the health-care setting, different scenarios for NIPT-based screening for common autosomal aneuploidies are possible. The trade-offs involved in these scenarios should be assessed in light of the aim of screening, the balance of benefits and burdens for pregnant women and their partners and considerations of cost-effectiveness and justice. With improving screening technologies and decreasing costs of sequencing and analysis, it will become possible in the near future to significantly expand the scope of prenatal screening beyond common autosomal aneuploidies. Commercial providers have already begun expanding their tests to include sex-chromosomal abnormalities and microdeletions. However, multiple false positives may undermine the main achievement of NIPT in the context of prenatal screening: the significant reduction of the invasive testing rate. This document argues for a cautious expansion of the scope of prenatal screening to serious congenital and childhood disorders, only following sound validation studies and a comprehensive evaluation of all relevant aspects. A further core message of this document is that in countries where prenatal screening is offered as a public health programme, governments and public health authorities should adopt an active role to ensure the responsible innovation of prenatal screening on the basis of ethical principles. Crucial elements are the quality of the screening process as a whole (including non-laboratory aspects such as information and counseling), education of professionals, systematic evaluation of all aspects of prenatal screening, development of better evaluation tools in the light of the aim of the practice, accountability to all stakeholders including children born from screened pregnancies and persons living with the conditions targeted in prenatal screening and promotion of equity of access.

De temperamento

Invocatio: KREIKKAA Alpha, omega.

L'Univers

1871/04/21 (Numéro 1438).

Att tala om det osägbara : Nicolaus Cusanus cirkulära filosofi i verket De coniecturis med särskild hänsyn till Nelson Pikes tankar om unio mystica

In my dissertation called Speaking of the unsayable: The circular philosophy of Nicholas of Cusa in his work De coniecturis, I presuppose an internal (conceptual) relation between the personal experience of God of Nicholas of Cusa (1401-64) in 1438 and, on the other hand, his philosophy. I hence try to describe the precise character of this relation. Referring to the Norwegian scholars Egil Wyller and Viggo Rossvær, I assume that there is a circularity in Cusanus’ philosophy which appears as self-references (= a sentence refers to itself: A is explained by B and B is explained by A). Wyller finds three phases in the thought of Cusanus (1. De docta ignorantia I-III, 2. De coniecturis I-II, 3. all subsequent works). Rossvær finds it impossible to presuppose certain phases, as the philosophy of Cusanus continuously proceeds and remains open to new ideas. As Cusanus however treats his experience of God far more consciously in his second work De coniecturis than in De docta ignorantia, I find it possible to distinguish between the earlier Cusanus (De docta ignorantia including his earlier works) and the later Cusanus (De coniecturis, about 1444, as well as the following works). Cusanus creates a philosophy of language in outline expressed in De coniecturis, in which he presents two concepts of necessity, i.e. absolute necessity and logical, or reasonable, necessity. These are interrelated in the sense that the mind, or the self, logically affirms the absolute, or unsayable, necessity, which shows itself in the mind and which the mind affirms conjecturally. The endeavour conceptually to understand absolute necessity implies intuitive (or intellectual) contemplation, or vision (investigatio symbolica), in which the four mental unities (the absolute, the intellectual, the rational and the sensuous) work together according to the rules described in De coniecturis. In De coniecturis Cusanus obviously turns from a negative concept of the unsayable to a paradigmatic, which implies that he looks for principles of speaking of the unsayable and presents the idea of a divine language (divinaliter). However, he leaves this idea behind after De coniecturis, although he continues to create new concepts of the unsayable and incomprehensible. The intellectual language of absolute seeing is expressed in the subjunctive, i.e. conditionally. In order to describe the unsayable, Cusanus uses tautologies, the primary one of which is a concept of God, i.e. non aliud est non aliud quam non aliud (the non-other is non-other than the nonother). Wyller considers this the crucial point of the philosophy of Cusanus (De non aliud), described by the latter as the definition of definitions, i.e. the absolute definition. However, this definition is empty regarding its content. It demonstrates that God surpasses the coincidence of opposites (coincidentia oppositorum) and that he is “superunsayable” (superineffabilis), i.e. he is beyond what can be conceived or said. Nothing hence prevents us from speaking of him, provided that he is described as unsayable (= the paradigmatic concept of the unsayable). Here the mode of seeing is decisive. Cusanus in this context (and especially in his later literary production) uses modalities which concern possibility and necessity. His aim is to conduct any willing reader ahead on the way of life (philosophia mentalis). In De coniecturis II he describes the notion of human self-consciousness as the basis of spiritual mutuality in accordance with the humanistic tradition of his time. I mainly oppose the negatively determined concept of Christian mysticism presented by the German philosopher Kurt Flasch and prefer the presentation of Burkhard Mojsisch of the translogical and conjectural use of language in De coniecturis. In particular, I take account of the Scandinavian research, basically that of Johannes Sløk, Birgit H. Helander, Egil Wyller and Viggo Rossvær, who all consider the personal experience of God described by Cusanus a tacit precondition of his philosophy.

The effect of a low dose of clenbuterol on rat soleus muscle submitted to joint immobilization

The aim of the present study was to evaluate the effect of joint immobilization on morphometric parameters and glycogen content of soleus muscle treated with clenbuterol. Male Wistar (3-4 months old) rats were divided into 4 groups (N = 6 for each group): control, clenbuterol, immobilized, and immobilized treated with clenbuterol. Immobilization was performed with acrylic resin orthoses and 10 µg/kg body weight clenbuterol was administered subcutaneously for 7 days. The following parameters were measured the next day on soleus muscle: weight, glycogen content, cross-sectional area, and connective tissue content. The clenbuterol group showed an increase in glycogen (81.6%, 0.38 ± 0.09 vs 0.69 ± 0.06 mg/100 g; P < 0.05) without alteration in weight, cross-sectional area or connective tissue compared with the control group. The immobilized group showed a reduction in muscle weight (34.2%, 123.5 ± 5.3 vs 81.3 ± 4.6 mg; P < 0.05), glycogen content (31.6%, 0.38 ± 0.09 vs 0.26 ± 0.05 mg/100 mg; P < 0.05) and cross-sectional area (44.1%, 2574.9 ± 560.2 vs 1438.1 ± 352.2 µm²; P < 0.05) and an increase in connective tissue (216.5%, 8.82 ± 3.55 vs 27.92 ± 5.36%; P < 0.05). However, the immobilized + clenbuterol group showed an increase in weight (15.9%; 81.3 ± 4.6 vs 94.2 ± 4.3 mg; P < 0.05), glycogen content (92.3%, 0.26 ± 0.05 vs 0.50 ± 0.17 mg/100 mg; P < 0.05), and cross-sectional area (19.9%, 1438.1 ± 352.2 vs 1724.8 ± 365.5 µm²; P < 0.05) and a reduction in connective tissue (52.2%, 27.92 ± 5.36 vs 13.34 ± 6.86%; P < 0.05). Statistical analysis was performed using Kolmogorov-Smirnov and homoscedasticity tests. For the muscle weight and muscle glycogen content, two-way ANOVA and the Tukey test were used. For the cross-sectional area and connective tissue content, Kruskal-Wallis and Tukey tests were used. This study emphasizes the importance of anabolic pharmacological protection during immobilization to minimize skeletal muscle alterations resulting from disuse.

Le Petit journal. Supplément du dimanche

1918/07/14 (Numéro 1438).

L'Écho de Paris

1888/02/27 (Numéro 1438).

La Revue judiciaire : revue mensuelle : réforme, droit pratique, comptes-rendus

1909/12/25 (A2,N12).

La Revue judiciaire : revue mensuelle : réforme, droit pratique, comptes-rendus

1911/10/25 (A4,N10).

La Revue judiciaire : revue mensuelle : réforme, droit pratique, comptes-rendus

1909/09/25 (A2,N9).

La Revue judiciaire : revue mensuelle : réforme, droit pratique, comptes-rendus

1912/10/25 (A5,N10).