A cosmopolitan temptation

For some, the transnationalization of political action and communicative space in the European Union heralds an emergent cosmopolitan order. Need that be so? There are supranational institutions in the EU as well as transnational political and cultural spaces and cross-border communicative flows. However, the Union's member states remain key controllers of citizenship rights and purveyors of collective identities. And for many purposes they still maintain strongly bounded national public spheres. Because the EU's overall character as a polity remains unresolved, this has consequences for the organization of communicative spaces. The EU is a field of tensions and contradictions that is inescapably rooted in institutional realities. Wishful thinking about cosmopolitanism can get in the way of clear analysis

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Multidisciplinary Management of Lung Cancer: How to Test Its Efficacy?

The multidisciplinary management of lung cancer has been universally accepted. In France, the multidisciplinary approach for cancer patients is established by law. However, the efficacy of this approach remains theoretical, given that no evaluation criteria have been made available and no previous reports have been published on the prospective follow-up of these patients. The Groupe d' Oncologie Thoracique Azuréen carried out a 1-year prospective study on patients discussed during its multidisciplinary weekly meetings, to analyze the concordance between the proposed and administered treatment, the delay of treatment, and the 1-year actuarial survival. Of the 344 patients discussed during the period considered, the therapeutic decision was chemotherapy in 183 patients, surgery in 93, radiochemotherapy in 42, radiotherapy in 14, and supportive care 12. Therapeutic discordance between the planned and the administered treatment was recorded in 15 cases (4.4%), mainly for patient's refusal (seven cases) or poor performance status (five cases). The median delay of treatment was 20 days, shorter for chemotherapy (16 days), and longer for radiotherapy (27 days). The overall 1-year survival rate was 51.4%: 80.4% for stage I, 50.3% for stage II, 37.5% for stage III, and 27.2% for stage IV. For patients for whom discordance of treatment was recorded, a lower survival rate was recorded, without reaching statistical significance (0.07). In conclusion, the efficacy of the Groupe d' Oncologie Thoracique Azuréen multidisciplinary management was confirmed, as we believe that a discordant rate of less than 5% and a delay of treatment of 4 weeks can be considered acceptable. Furthermore, a periodic survival evaluation of the population as a whole could provide additional useful information for multidisciplinary groups

EVOLUTION DES GONADOTROPHINES ET DE LA PROGESTéRONE SéRIQUES AU COURS D'UNE HYPERPROLACTINéMIE INDUITE PAR LE SULPIRIDE (DOGMATIL R) PENDANT LA PHASE LUTéALE DU CYCLE MENSTRUEL

info:eu-repo/semantics/publishe

Estimativa do Balanço de Radiação via sensoriamento remoto na Amazônia Ocidental

The changes in Amazonian landscape are determinants and able to result in significant implications in physical processes, biota and regional climate, therefore, evaluate the aspects concerning the flows on the surface in different regions of this biome is essential to understanding the possible effects of changes in land use. However, due to its vast extent, measures of surface at various points of the Amazon are hampered, requiring a tool more viable and less costly. Thus, aiming to validate a methodology for determination of microclimatic parameters and support future applications in studies of impacts of land use change in the Amazon region, this study estimated the radiation balance in a forest area located in Southwest Amazonia, through Surface Energy Balance Algorithm for Land - SEBAL which uses remote sensing techniques and some data of surface. The measurements in surface were performed by instruments installed in micrometeorological towers of Large-Scale Biosphere-Atmosphere Experiment in Amazonia - LBA Program. The determination of the errors of the data estimated by the algorithm denoted that the SEBAL determined satisfactorily the albedo, the balance of short waves and net radiation, with errors that varied from 3 to 7%. For the balance of long waves the errors were more expressive, around 30%.Pages: 1893-189

Utilização da levedura desidratada (Saccharomyces cerevisiae) para leitões na fase inicial Dried yeast (Saccharomyces cerevisiae) utilization for piglets in the initial phase

Foi conduzido um experimento com o objetivo de avaliar o efeito da adição de diferentes níveis de levedura (Saccharomyces cerevisiae) desidratada na ração sobre o desempenho e a morfologia intestinal de leitões na fase inicial. Foram utilizados 280 leitões (fêmeas e machos castrados) de uma linha genética comercial de suínos, desmamados com 21 dias de idade e distribuídos em 20 baias, de acordo com o delineamento em blocos ao acaso, com 5 repetições e 4 tratamentos experimentais (0, 5, 10 e 15% de adição de levedura). Aos 45 dias de idade, três leitões de cada tratamento foram abatidos e colhidas amostras do duodeno e do jejuno para estudo da morfologia intestinal. Os níveis crescentes de levedura desidratada nas rações não afetaram (P>0,05) o ganho de peso, o consumo de ração e a conversão alimentar dos leitões. Com relação à morfologia do duodeno e do jejuno, também não houve efeito (P>0,05) dos níveis de levedura estudados sobre a altura das vilosidades, das profundidades das criptas e da relação vilosidade/cripta. Os resultados permitiram concluir que a levedura desidratada pode ser adicionada em até 15% nas rações de suínos na fase inicial.<br>An experiment was conducted to evaluate the effect of different levels of dried yeast (Saccharomyces cerevisiae) in diets about performance and intestinal morphology of piglets at initial phase. They used 280 piglets (females and castrated males) from genetic lines, weaned with 21 days of age, allocated in 20 pens in randomized design blocks, with 5 replications and 4 treatments (0, 5, 10 and 15% dried yeast addition). Samples of duodenum and jejunum of 3 piglets slaughtered at 45 days of age were collected from each treatment to study intestinal morphology. The increasing levels of dried yeast in rations did not affect significantly the weight gain, feed intake and feed conversion. In relation of duodenum and jejunum there was no significative effect (P>0.05) of dried yeast increased levels on villous height, crypt depth and villous crypt ratio. The results allowed to conclude that dried yeast can be added up to 15% in initial phase piglets diets

Baseline metabolic tumor volume as a strong predictive and prognostic biomarker in patients with non-small cell lung cancer treated with PD1 inhibitors: a prospective study

International audienc

Long term efficacy and toxicity after stereotactic ablative reirradiation in locally relapsed stage III non-small cell lung cancer

Abstract Background In stage III non-small cell lung cancer (NSCLC) treated with concomitant chemoradiotherapy, there is a high rate of relapse. Some of these relapses are only local and can be treated by stereotactic ablative radiation therapy (SABR). Previous studies reporting outcome after SABR reirradiation of the thorax consisted of a heterogeneous population of various lung cancer stages or even different types of cancer. The purpose of study is to evaluate toxicity and outcome of this strategy in locally relapsed stage III NSCLC only. Methods From February 2007 to November 2015, 46 Stage III NSCLC patients treated with SABR, for lung recurrence following conventionally fractionated radiation therapy (CFRT), were retrospectively analyzed. Results Median follow-up was 47.3 months (1–76.9). The 2 and 4-year progression-free survival (PFS), and overall survival (OS) were of 25.5%/8.6 and 48.9%/30.8%, respectively. Highest presenting toxicity in patients (grade 1 through 5) was: 13 (28.3%), 7 (15.2%), 1 (2.2%), 0 and 2 (4.4%), with deaths due to hemoptysis (n = 1) and alveolitis (n = 1). Although the Biological Effective Dose (at Planning Tumor Volume isocenter) was lower for central tumors treated for an in-field relapse (n = 21, 116 Gy versus 168 Gy, p = 0.005), they had no significant difference in OS than the remaining cohort, but with a higher rate of grade 2–5 toxicities (OR = 0.22, [0.06–0.8], p = 0.02). Conclusion Reirradiation with SABR for local relapse in patients previously treated for stage III NSCLC, is feasible and associated with good outcome. This is also true for central tumors treated for an in-field relapse, but should be radiated with caution to mitigate toxicity