Les relations internationales des Länder allemands et 679 l'évolution du système fédéral dans l'Union européenne : le cas du Bade-Wurtemberg

On remarque que les relations internationales des Länder allemands (états fédérés allemands) se sont, dans une grande mesure, différenciées et diversifiées au cours de ces quelque vingt dernières années. Sur le plan des relations supranationales qui s'inscrivent dans le contexte de l'intégration européenne, les Länder ont acquis, en matière de prise de décision au sein de l'Union, des droits de participation considérables dans le processus législatif de la République fédérale. Ils ont également développé des moyens directs de négociation et de représentation à Bruxelles. Sur le plan des relations transnationales, ils ont modifié des régimes déjà existants et ont amorcé de nouvelles formes de coopération interrégionale et internationale qui ont contribué au processus d'intégration européenne. Si l'on regarde au-delà des frontières de l'Union européenne, on remarque qu'ils ont établi des relations internationales bilatérales avec des gouvernements des pays d'Europe centrale et d'Europe de l'Est, avec de nombreux pays en voie de développement en Asie, en Afrique et en Amérique du Sud ainsi qu'avec leurs partenaires aux États-Unis et en Asie de l'Est. Le cas du Bade-Wurtemberg montre que ce processus de différenciation et de complexification des institutions peut mener à une adaptation fructueuse des Länder à la mondialisation. C'est grâce à l'aspect coopératif du système fédéral allemand que les Länder sont en mesure d'agir de la sorte.We can see the international relations of the Germon Länder (German federal states) have become, to a considerable extent, more differenciated and diverse in less than 20 years. From the point of view of supranational relations in the context of European integration the Länder have gathered substantial rights of participation in the legislative process of the Federal Republic concerning decision-making in the EU. They have developed direct patterns of negotiation and political representation at Bruxelles, too. From the point of view of transnational relations they have modified already existing regimes and initiated new forms of interregional and cross border cooperation which have contributed to the European integration process. Looking beyond the EU they have taken up bilateral international relations with Central and Eastern European governments, with an array of developing countries in Asia, Africa and South-America and with their partners in the USA and in East-Asia. The case of Baden-Württemberg shows that this process of institutional differenciation and complexity can lead to a successful adaption of the Länder to the globalization process. And it is the cooperative character of the German Federal System that enables the Länder to do so

The minerals in the clay fractions of a black cotton soil and a red earth from Hyderabad, Deccan State, India

RESP

Severe inflammatory reaction induced by peritoneal trauma is the key driving mechanism of postoperative adhesion formation

<p>Abstract</p> <p>Background</p> <p>Many factors have been put forward as a driving mechanism of surgery-triggered adhesion formation (AF). In this study, we underline the key role of specific surgical trauma related with open surgery (OS) and laparoscopic (LS) conditions in postoperative AF and we aimed to study peritoneal tissue inflammatory reaction (TIR), remodelling specific complications of open surgery (OS) versus LS and subsequently evaluating AF induced by these conditions.</p> <p>Methods</p> <p>A prospective randomized study was done in 80 anaesthetised female Wistar rats divided equally into 2 groups. Specific traumatic OS conditions were induced by midline incision line (MIL) extension and tissue drying and specific LS conditions were remodelled by intraperitoneal CO₂insufflation at the 10 cm of water. TIR was evaluated at the 24^th, 72^nd, 120^thand 168^thhour by scoring scale. Statistical analysis was performed by the non-parametric t test and two-way ANOVA using Bonferroni post-tests.</p> <p>Results</p> <p>More pronounced residual TIR was registered after OS than after LS. There were no significant TIR interactions though highly significant differences were observed between the OS and LS groups (p < 0.0001) with regard to surgical and time factors. The TIR change differences between the OS and LS groups were pronounced with postoperative time p < 0.05 at the 24^thand 72^nd; p < 0.01 - 120^thand p < 0.001 - 168^thhrs. Adhesion free wounds were observed in 20.0 and 31.0% of cases after creation of OS and LS conditions respectively; with no significant differences between these values (p > 0.05). However larger adhesion size (41.67 ± 33.63) was observed after OS in comparison with LS (20.31 ± 16.38). The upper-lower 95% confidential limits ranged from 60.29 to 23.04 and from 29.04 to 11.59 respectively after OS and LS groups with significant differences (p = 0.03). Analogous changes were observed in adhesion severity values. Subsequently, severe TIR parameters were followed by larger sizes of severe postoperative adhesions in the OS group than those observed in the LS group.</p> <p>Conclusions</p> <p>MIL extension and tissue drying seem to be the key factors in the pathogenesis of adhesion formation, triggering severe inflammatory reactions of the peritoneal tissue surrounding the MIL resulting in local and systemic consequences. CO₂insufflation however, led to moderate inflammation and less adhesion formation.</p

Design and Organization of the Dexamethasone, Light Anesthesia and Tight Glucose Control (DeLiT) Trial: a factorial trial evaluating the effects of corticosteroids, glucose control, and depth-of-anesthesia on perioperative inflammation and morbidity from major non-cardiac surgery

<p>Abstract</p> <p>Background</p> <p>The perioperative period is characterized by an intense inflammatory response. Perioperative inflammation promotes postoperative morbidity and increases mortality. Blunting the inflammatory response to surgical trauma might thus improve perioperative outcomes. We are studying three interventions that potentially modulate perioperative inflammation: corticosteroids, tight glucose control, and light anesthesia.</p> <p>Methods/Design</p> <p>The DeLiT Trial is a factorial randomized single-center trial of dexamethasone vs placebo, intraoperative tight vs. conventional glucose control, and light vs deep anesthesia in patients undergoing major non-cardiac surgery. Anesthetic depth will be estimated with Bispectral Index (BIS) monitoring (Aspect medical, Newton, MA). The primary outcome is a composite of major postoperative morbidity including myocardial infarction, stroke, sepsis, and 30-day mortality. C-reactive protein, a measure of the inflammatory response, will be evaluated as a secondary outcome. One-year all-cause mortality as well as post-operative delirium will be additional secondary outcomes. We will enroll up to 970 patients which will provide 90% power to detect a 40% reduction in the primary outcome, including interim analyses for efficacy and futility at 25%, 50% and 75% enrollment.</p> <p>Discussion</p> <p>The DeLiT trial started in February 2007. We expect to reach our second interim analysis point in 2010. This large randomized controlled trial will provide a reliable assessment of the effects of corticosteroids, glucose control, and depth-of-anesthesia on perioperative inflammation and morbidity from major non-cardiac surgery. The factorial design will enable us to simultaneously study the effects of the three interventions in the same population, both individually and in different combinations. Such a design is an economically efficient way to study the three interventions in one clinical trial vs three.</p> <p>Trial registration</p> <p><b>This trial is registered at </b>Clinicaltrials.gov <b>#</b>: NTC00433251</p

Peritoneal changes due to laparoscopic surgery

Item does not contain fulltextBACKGROUND: Laparoscopic surgery has been incorporated into common surgical practice. The peritoneum is an organ with various biologic functions that may be affected in different ways by laparoscopic and open techniques. Clinically, these alterations may be important in issues such as peritoneal metastasis and adhesion formation. METHODS: A literature search using the Pubmed and Cochrane databases identified articles focusing on the key issues of laparoscopy, peritoneum, inflammation, morphology, immunology, and fibrinolysis. Results : Laparoscopic surgery induces alterations in the peritoneal integrity and causes local acidosis, probably due to peritoneal hypoxia. The local immune system and inflammation are modulated by a pneumoperitoneum. Additionally, the peritoneal plasmin system is inhibited, leading to peritoneal hypofibrinolysis. CONCLUSION: Similar to open surgery, laparoscopic surgery affects both the integrity and biology of the peritoneum. These observations may have implications for various clinical conditions.1 januari 201

Rod-shaped clay particles

RESP-217