D’une guerre à l’autre en Méditerranée. D’un possible à l’autre ?

Dans le bassin méditerranéen, la guerre connaît une permanence tout au long de l’histoire. C’est une zone de grandes tensions qui pendant le XXe siècle en plus des deux guerres mondiales, a connu des conflits fratricides, cruels et barbares : guerre d’Espagne, guerre d’Algérie et guerre de Yougoslavie. De plus en son sein est localisé un des plus dangereux foyers de guerre de la planète : la Palestine. Le véritable événement serait que la guerre ne soit plus conçue comme le centre de la politique.War has been permanent during all history of the Mediterranean sea : first and second world wars, numerous and long crisis (war of Spain, decolonisation of Algeria, conflict in Yougoslavia...). In this sea world, exists one of the most dangerous places of conflicts : Palestine. Anyway, the real important event is that war will not be anymore the principal motivation of politic

Influence of cigarette smoking on rate of reopening of the infarct-related coronary artery after myocardial infarction: A multivariate analysis

AbstractObjectives. This study sought to determine whether the reopening of the infarct-related vessel is related to clinical characteristics or cardiovascular risk factors, or both.Background. In acute myocardial infarction, thrombolytic therapy reduces mortality by restoring the patency of the infarct-related vessel. However, despite the use of thrombolytic agents, the infarct-related vessel remains occluded in up to 40% of patients.Methods. We studied 295 consecutive patients with an acute myocardial infarction who underwent coronary angiography within 15 days (mean [±SD] 6.7 ± 3.2 days) of the onset of symptoms. Infarct-related artery patency was defined by Thrombolysis in Myocardial Infarction trial flow grade ≥ 2. Four cardiovascular risk factors—smoking, hypertension, hypercholesterolemin and diabetes mellitus—and eight different variables—age, gender, in-hospital death, history of previous myocardial infarction, location of current myocardial infarction, use of thrombolytic agents, time interval between onset of symptoms, thrombolytic therapy and coronary angiography—were recorded in all patients.Results. Thrombolysis in current smokers and anterior infarct location on admission were the three independent factors highly correlated with the patency of the infarct-related vessel (odds ratios 3.2, 3.0 and 1.9, respectively). In smokers, thrombolytic therapy was associated with a higher reopening rate of the infarct vessel, from 35% to 77% (p < 0.001). Nonsmokers did not benefit from thrombolytic therapy, regardless of infarct location.Conclusions. These observational data, if replicated, suggest that in patients with acute myocardial infarction, thrombolytic therapy may be most effective in current smokers, whereas non-smokers and ex-smokers may require other management strategies, such as emergency percutaneous transluminal coronary angioplasty

Comparison of accuracy of fibrosis degree classifications by liver biopsy and non-invasive tests in chronic hepatitis C

<p>Abstract</p> <p>Background</p> <p>Non-invasive tests have been constructed and evaluated mainly for binary diagnoses such as significant fibrosis. Recently, detailed fibrosis classifications for several non-invasive tests have been developed, but their accuracy has not been thoroughly evaluated in comparison to liver biopsy, especially in clinical practice and for Fibroscan. Therefore, the main aim of the present study was to evaluate the accuracy of detailed fibrosis classifications available for non-invasive tests and liver biopsy. The secondary aim was to validate these accuracies in independent populations.</p> <p>Methods</p> <p>Four HCV populations provided 2,068 patients with liver biopsy, four different pathologist skill-levels and non-invasive tests. Results were expressed as percentages of correctly classified patients.</p> <p>Results</p> <p>In population #1 including 205 patients and comparing liver biopsy (reference: consensus reading by two experts) and blood tests, Metavir fibrosis (F_M) stage accuracy was 64.4% in local pathologists vs. 82.2% (p < 10^-3) in single expert pathologist. Significant discrepancy (≥ 2F_Mvs reference histological result) rates were: Fibrotest: 17.2%, FibroMeter^2G: 5.6%, local pathologists: 4.9%, FibroMeter^3G: 0.5%, expert pathologist: 0% (p < 10^-3). In population #2 including 1,056 patients and comparing blood tests, the discrepancy scores, taking into account the error magnitude, of detailed fibrosis classification were significantly different between FibroMeter^2G(0.30 ± 0.55) and FibroMeter^3G(0.14 ± 0.37, p < 10^-3) or Fibrotest (0.84 ± 0.80, p < 10^-3). In population #3 (and #4) including 458 (359) patients and comparing blood tests and Fibroscan, accuracies of detailed fibrosis classification were, respectively: Fibrotest: 42.5% (33.5%), Fibroscan: 64.9% (50.7%), FibroMeter^2G: 68.7% (68.2%), FibroMeter^3G: 77.1% (83.4%), p < 10^-3(p < 10^-3). Significant discrepancy (≥ 2 F_M) rates were, respectively: Fibrotest: 21.3% (22.2%), Fibroscan: 12.9% (12.3%), FibroMeter^2G: 5.7% (6.0%), FibroMeter^3G: 0.9% (0.9%), p < 10^-3(p < 10^-3).</p> <p>Conclusions</p> <p>The accuracy in detailed fibrosis classification of the best-performing blood test outperforms liver biopsy read by a local pathologist, i.e., in clinical practice; however, the classification precision is apparently lesser. This detailed classification accuracy is much lower than that of significant fibrosis with Fibroscan and even Fibrotest but higher with FibroMeter^3G. FibroMeter classification accuracy was significantly higher than those of other non-invasive tests. Finally, for hepatitis C evaluation in clinical practice, fibrosis degree can be evaluated using an accurate blood test.</p

Obeticholic acid for the treatment of non-alcoholic steatohepatitis: interim analysis from a multicentre, randomised, placebo-controlled phase 3 trial

Background Non-alcoholic steatohepatitis (NASH) is a common type of chronic liver disease that can lead to cirrhosis. Obeticholic acid, a farnesoid X receptor agonist, has been shown to improve the histological features of NASH. Here we report results from a planned interim analysis of an ongoing, phase 3 study of obeticholic acid for NASH. Methods In this multicentre, randomised, double-blind, placebo-controlled study, adult patients with definite NASH,non-alcoholic fatty liver disease (NAFLD) activity score of at least 4, and fibrosis stages F2–F3, or F1 with at least oneaccompanying comorbidity, were randomly assigned using an interactive web response system in a 1:1:1 ratio to receive oral placebo, obeticholic acid 10 mg, or obeticholic acid 25 mg daily. Patients were excluded if cirrhosis, other chronic liver disease, elevated alcohol consumption, or confounding conditions were present. The primary endpointsfor the month-18 interim analysis were fibrosis improvement (≥1 stage) with no worsening of NASH, or NASH resolution with no worsening of fibrosis, with the study considered successful if either primary endpoint was met. Primary analyses were done by intention to treat, in patients with fibrosis stage F2–F3 who received at least one dose of treatment and reached, or would have reached, the month 18 visit by the prespecified interim analysis cutoff date. The study also evaluated other histological and biochemical markers of NASH and fibrosis, and safety. This study is ongoing, and registered with ClinicalTrials.gov, NCT02548351, and EudraCT, 20150-025601-6. Findings Between Dec 9, 2015, and Oct 26, 2018, 1968 patients with stage F1–F3 fibrosis were enrolled and received at least one dose of study treatment; 931 patients with stage F2–F3 fibrosis were included in the primary analysis (311 in the placebo group, 312 in the obeticholic acid 10 mg group, and 308 in the obeticholic acid 25 mg group). The fibrosis improvement endpoint was achieved by 37 (12%) patients in the placebo group, 55 (18%) in the obeticholic acid 10 mg group (p=0·045), and 71 (23%) in the obeticholic acid 25 mg group (p=0·0002). The NASH resolution endpoint was not met (25 [8%] patients in the placebo group, 35 [11%] in the obeticholic acid 10 mg group [p=0·18], and 36 [12%] in the obeticholic acid 25 mg group [p=0·13]). In the safety population (1968 patients with fibrosis stages F1–F3), the most common adverse event was pruritus (123 [19%] in the placebo group, 183 [28%] in the obeticholic acid 10 mg group, and 336 [51%] in the obeticholic acid 25 mg group); incidence was generally mild to moderate in severity. The overall safety profile was similar to that in previous studies, and incidence of serious adverse events was similar across treatment groups (75 [11%] patients in the placebo group, 72 [11%] in the obeticholic acid 10 mg group, and 93 [14%] in the obeticholic acid 25 mg group). Interpretation Obeticholic acid 25 mg significantly improved fibrosis and key components of NASH disease activity among patients with NASH. The results from this planned interim analysis show clinically significant histological improvement that is reasonably likely to predict clinical benefit. This study is ongoing to assess clinical outcomes

La guerre mise au musée et le tourisme de mémoire

De la guerre, comme activité singulière, on connaît les nombreuses traces mémorielles qu’elle a laissées, que ce soient des lieux (Verdun), des cimetières (Colleville-Omaha), des ruines (Oradour), des noms (Auschwitz), des œuvres d’art (Les désastres de la guerre de Goya, Guernica de Picasso), des monuments (Mont Valérien), des dates commémoratives (11 novembre), des administrations d’État (ONACVG), et de très nombreux récits. Le paysage des champs de bataille est souvent jalonné de tombes, d..

La mémoire comme trace des possibles

« Seules les traces font rêver » René Char Evoquer les traces, c’est se référer à ce qui subsiste d’un passé. Ces survivances, ces vestiges, ces ruines, peuvent témoigner d’un climat, d’un événement, d’une filiation, d’une activité humaine, d’une culture. Ces traces ont toujours intéressé les hommes dans la mesure où elles matérialisent ce qui a disparu, lui donnent une image, permettent de se le représenter, de l’étudier, de se souvenir, de commémorer, de montrer une évolution en remontant l..

L’événement, la mémoire, la politique et le musée

Le siècle a-t-il eu lieu ? Cette question vient à l’esprit en visitant le « musée de l’Ancien-Évêché » à Grenoble. Attiré par la réputation du « Musée dauphinois », il m’a semblé logique de visiter ce musée, récemment inauguré, et qui entend traiter de l’histoire du Dauphiné comme province, en proposant « un regard nouveau sur l’histoire et le patrimoine du département de l’Isère ». Dès l’entrée dans la salle consacrée au xxe siècle, sous le titre « La traversée du siècle », un texte indique ..

Bousquet, Papon, Vichy, la République et les autres

Boursier Jean-yves. Bousquet, Papon, Vichy, la République et les autres. In: Raison présente, n°102, 2e trimestre 1992. Ville et Société. pp. 121-130

Musées de guerre et mémoriaux : Politiques de la mémoire

La France, comme d'autres pays d'Europe, porte encore dans son paysage et sa mémoire les blessures des nombreux conflits armés du xxe siècle. La Seconde Guerre mondiale, en particulier, y a engendré de nombreux « lieux de mémoire » : villages-martyrs, lieux de massacre par les nazis, camps d'internement vichystes, lieux de combats de la Résistance... Ces traces ont suscité la création de musées et de mémoriaux dont l'existence, en tant qu'institutions, ne laisse pas d'être problématique quant aux choix des thèmes et aux modes d'exposition des événements concernés. Dans ses thèses relatives à la muséologie, Georges-Henri Rivière parle ainsi d'une « ponctuation de l'espace adéquate à l'organisation idéologique du message à transmettre ». Que transmettre ? La guerre et la politique peuvent-elles devenir un patrimoine ? Telle sont les questions centrales posées par ces musées qui participent de stratégies mémorielles de groupes, de collectivités territoriales ou d'État, questions que reprennent à leur compte les auteurs du présent ouvrage pour engager une réflexion critique et stimulante sur les politiques de transmission de la mémoire

D’une guerre à l’autre en Europe

La guerre, la politique et la présentification de l’événement Après l’euphorie engendrée par la chute du « Mur de Berlin », le xxe siècle européen trouva son achèvement tragique dans les guerres de décomposition de la Yougoslavie. Débutant sous le signe de l’expansion économique et coloniale, par la « Belle Époque », il avait déjà connu les « guerres balkaniques » de 1912-1913, et dans l’intervalle, deux guerres mondiales. Lors de la première, « la Grande Guerre » de 1914-1918, les principale..