Prenatal ultrasound screening for fetal anomalies and outcomes in high-risk pregnancies due to maternal HIV infection : a retrospective study

Objective: To assess the prevalence of prenatal screening and of adverse outcome in high-risk pregnancies due to maternal HIV infection. Study design: The prevalence of prenatal screening in 330 pregnancies of HIV-positive women attending the department for prenatal screening and/or during labour between January 1, 2002 and December 31, 2012, was recorded. Screening results were compared with the postnatal outcome and maternal morbidity, and mother-to-child transmission (MTCT) was evaluated. Results: One hundred of 330 women (30.5%) had an early anomaly scan, 252 (74.5%) had a detailed scan at 20–22 weeks, 18 (5.5%) had a detailed scan prior to birth, and three (0.9%) had an amniocentesis. In seven cases (2.12%), a fetal anomaly was detected prenatally and confirmed postnatally, while in eight (2.42%) an anomaly was only detected postnatally, even though a prenatal scan was performed. There were no anomalies in the unscreened group. MTCT occurred in three cases (0.9%) and seven fetal and neonatal deaths (2.1%) were reported. Conclusion: The overall prevalence of prenatal ultrasound screening in our cohort is 74.5%, but often the opportunity for prenatal ultrasonography in the first trimester is missed. In general, the aim should be to offer prenatal ultrasonography in the first trimester in all pregnancies. This allows early reassurance or if fetal disease is suspected, further steps can be taken

Advances in Sympathetic Nerve Recording in Humans

In humans, sympathetic activity is commonly assessed by measuring the efferent traffic in the peroneal nerve. The firing activity is the sum of several active neurons, which have the tendency to fire together in a bursting manner. While the estimation of overall sympathetic nervous activity using this multiunit recording approach has advanced our understanding of sympathetic regulation in health and disease no information is gained regarding the underling mechanisms generating the bursts of sympathetic activity. The introduction of single-unit recording has been a major step forward, enabling the examination of specific sympathetic firing patterns in diverse clinical conditions. Disturbances in sympathetic nerve firing, including high firing probabilities, high firing rates or high incidence of multiple firing, or a combination of both may impact on noradrenaline release and effector response, and therefore have clinical implications with regards to the development and progression of target organ damage. Understanding the mechanisms and consequences of specific firing patterns would permit the development of therapeutic strategies targeting these nuances of sympathetic overdrive

: Volume 5

La mise en place effective d'un « espace de liberté, de sécurité et de justice » nesaurait faire l'économie d'une réflexion sur l'harmonisation des sanctions pénales.Réflexion indispensable mais encore neuve, ce qui impliquait davantage une mise enquestions que la recherche de solutions.Mise en questions réalisée en trois temps : le Constat, tout d'abord, des droits internesen matière de sanctions encourues, prononcées et exécutées ; les Enjeux et débats, ensuite,ceux de la faisabilité, de l'opportunité et de la légitimité d'une harmonisation ; lesProspectives, enfin, de voies susceptibles de conduire à l'harmonisation, non seulement dansle but de permettre la reconnaissance mutuelle des décisions pénales mais encore de dessinerdes principes communs de sanction, participant ainsi du renforcement d'une communauté dedroits en Europe

Fabio Mauri: Erinnerung und Ideologie. Die Aufarbeitung von Faschismus und Shoah in den Werken des italienischen Performancekünstlers

Sind die Gewalttaten der Nationalsozialisten und die Shoah in der Kunst darstellbar, oder sollte es gar ein Darstellungsverbot geben? Diese Frage bewegt seit Adorno Theoretiker und Kunstschaffende. Eine Antwort auf die Frage steht noch aus, doch zeugt eine wachsende Produktion von Publikationen und Kunstwerken für das immerwährende Bedürfnis, sich mit der Menschheitskatastrophe zu konfrontieren. Ein Beispiel der künstlerischen Annäherung in Italien findet sich in Fabio Mauris OEuvre. Im Jahr 1926 in Rom geboren, greift er in seinen Performances und Installationen der 1970er bis 1990er Jahre als Zeitzeuge den Schrecken aber auch die Faszination auf, die vom faschistischen und nationalsozialistischen System ausgegangen sind. Auf der Grundlage eigener Erfahrungen entwickelt der Künstler ein "Erinnerungstheater", in das er historische Materialien integriert und das Publikum mit der Ideologie und Propaganda der damaligen Zeit konfrontiert. In einer Art Tableau vivante greift er die Schrecken der Shoah auf und konstruiert eine kühle Installation, die das Grauen spürbar macht. Dabei hofft Mauri durch die Kunst das individuelle und gesellschaftliche Trauma überwinden zu können. Sein Kunstschaffen kann mit dem Schlagwort "Gesamtkunstwerk" belegt werden, da er die Grenzen der Gattungen verwischt und bewusst überschreitet. Neben Theater und Film rezipiert er die Philosophie der Zeit, vor allem Martin Heidegger. In der italienischen Kunstszene verband Mauri eine besondere Freundschaft mit Pier Paolo Pasolini, den er in seiner Jugend in faschistischer Zeit kennen lernte. Beide Intellektuelle thematisierten in ihrer Kunst die gemeinsame Vergangenheit und brachen damit in den 1970er Jahren gesellschaftliche Tabus. Im Vergleich mit Arbeiten ausgewählter deutscher Künstler - Joseph Beuys, Hans Haacke, Anselm Kiefer - werden die Unterschiede und Gemeinsamkeiten der Aufarbeitung der Geschichte in Italien und Deutschland evident, die auch auf die differierenden geschichtlichen Erfahrungen und das Selbstverständnis der beiden Nationen zurückgeführt werden kann

L’exécution des décisions des juridictions internationales des droits de l’homme: vers une harmonisation des systèmes régionau

This article, which compares the legal monitoring procedures of the judgments of the European and Inter-American Court of Human Rights, states that these regimes were initially thought of in very diverse terms. Indeed the political approach at the European level is opposed to the judicial approach adopted by the Inter-American system. This study demonstrates how through evolution, which has already occurred in Europe but is still in preparation in America, both regional systems are moving closer together towards a mixed system (judicial and political) involving several organs, at the international and national levels. Facing similar cases of noncompliance (for either technical or political reasons), both systems try to reply through non punitive measures.Este artículo, que compara el régimen de ejecución de las sentencias de las cortes regionales de derechos humanos, demuestra que el enfoque estuvo concebido inicialmente de manera muy distinta. Al modelo judicial de ejecución de sentencias (modelo interamericano) se opone el modelo europeo de tipo político. Este estudio revela que la evolución, ya realizada a nivel europeo y apenas en gestación a nivel del continente latinoamericano, debería operar hacia un acercamiento en favor de un régimen mixto (cambiando el enfoque judicial con el político) y pluriinstitucional, asociando varios órganos, tanto a nivel regional como nacional. Frente a las resistencias semejantes de los Estados en cuanto a la ejecución de las sentencias (de naturaleza técnica y/o política), la respuesta única dada hasta hoy por todos los modelos ha sido de tipo no coercitiv

El Tribunal Europeo de Derechos Humanos y la técnica de las sentencias piloto: una pequeña revolución en marcha en Estrasburgo.

En el caso Broniowski contra Polonia, referente a un problema de compatibilidad con el Convenio Europeo de Derechos Humanos de un proyecto legislativo que afectaba a un gran número de personas (en torno a las 80.000), el Tribunal Europeo declaró por vez primera la existencia de una violación sistemática; de este modo, dejaba claro que podían imponerse medidas generales a nivel nacional para ejecutar una sentencia, y que dichas medidas debían tomar en consideración la gran cantidad de personas afectadas, así como remediar una deficiencia sistemática puesta de manifiesto por el Tribunal Europeo al constatar la correspondiente violación. El Tribunal Europeo observó asimismo que dichas medidas debían prever el modo de restablecer en sus derechos a las personas afectadas por la violación del Convenio Europeo. Esta especie de nuevo enfoque del Tribunal Europeo al enjuiciar problemas sistemáticos o estructurales en el ordenamiento nacional, conocido como el «procedimiento de la sentencia piloto», ha sido adoptado otros casos desde 2004. Si el objetivo oficial de este nuevo enfoque radica en facilitar una más rápida y eficaz ejecución de las sentencias del Tribunal Europeo y, por ende, evitar el planteamiento de casos repetitivos ante él, esta nueva política consistente en indicar con mayor frecuencia las medidas generales a adoptar por el Estado es, según la autora, parte de un plan más general que apunta a la transformación del Tribunal Europeo de Derechos Humanos en un Tribunal Supremo; algunas de las medidas contenidas en el Protocolo núm. 14, cuya entrada en vigor se produce este mismo año 2007, así como la nueva prioridad conferida por el Tribunal al artículo 46 frente al artículo 41 del Convenio Europeo, revela alguno de esos cambios fundamentales que se están produciendo en Estrasburgo

Effects of Renal Denervation on Sympathetic Activation, Blood Pressure, and Glucose Metabolism in Patients with Resistant Hypertension

Increased central sympathetic drive is a hallmark of several important clinical conditions including essential hypertension, heart failure, chronic kidney disease, and insulin resistance. Afferent signaling from the kidneys has been identified as an important contributor to elevated central sympathetic drive and increased sympathetic outflow to the kidney and other organs is crucially involved in cardiovascular control. While the resultant effects on renal hemodynamic parameters, sodium and water retention, and renin release are particularly relevant for both acute and long term regulation of blood pressure, increased sympathetic outflow to other vascular beds may facilitate further adverse consequences of sustained sympathetic activation such as insulin resistance, which is commonly associated with hypertension. Recent clinical studies using catheter-based radiofrequency ablation technology to achieve functional renal denervation in patients with resistant hypertension have identified the renal nerves as therapeutic target and have helped to further expose the sympathetic link between hypertension and insulin resistance. Initial data from two clinical trials and several smaller mechanistic clinical studies indicate that this novel approach may indeed provide a safe and effective treatment alternative for resistant hypertension and some of its adverse consequences

Evidence for a trap-and-flip mechanism in a proton-dependent lipid transporter

Transport of lipids across membranes is fundamental for diverse biological pathways in cells. Multiple ion-coupled transporters participate in lipid translocation, but their mechanisms remain largely unknown. Major facilitator superfamily (MFS) lipid transporters play central roles in cell wall synthesis, brain development and function, lipids recycling, and cell signaling. Recent structures of MFS lipid transporters revealed overlapping architectural features pointing towards a common mechanism. Here we used cysteine disulfide trapping, molecular dynamics simulations, mutagenesis analysis, and transport assays in vitro and in vivo, to investigate the mechanism of LtaA, a proton-dependent MFS lipid transporter essential for lipoteichoic acids synthesis in the pathogen Staphylococcus aureus. We reveal that LtaA displays asymmetric lateral openings with distinct functional relevance and that cycling through outward- and inward-facing conformations is essential for transport activity. We demonstrate that while the entire amphipathic central cavity of LtaA contributes to lipid binding, its hydrophilic pocket dictates substrate specificity. We propose that LtaA catalyzes lipid translocation by a trap-and-flip mechanism that might be shared among MFS lipid transporters