L'écrivain et l'imprimeur

Le livre est un objet manufacturé : la reconnaissance de ce fait invite à intégrer pleinement les apports de l’histoire du livre dans le domaine de l’histoire des textes et de l’histoire littéraire. Et à examiner tout particulièrement la relation entre l’écrivain et l’imprimeur, car elle engage d’abord la définition du « produit livre » par le biais duquel se donne à lire le texte, interroge ensuite le statut de l’auteur, et éclaire enfin la réalité des processus de fabrication et de réception. Ce volume réunit les travaux d’un colloque international qui s’est tenu à l’université du Maine en octobre 2009 ; il propose un large parcours depuis le XVe siècle jusqu’à la période la plus récente ; grâce à des études de cas concrets, appliquées à des auteurs très différents (Balzac ou Vercors, Galilée ou Mallarmé, Brant ou Rousseau), il dévoile les liens souvent étroits établis entre les écrivains et les ateliers typographiques. Le degré d’intervention des auteurs dans le travail de publication, les choix effectués par tel imprimeur, les auxiliaires et intermédiaires qui aident ou brouillent la relation entre l’auteur et l’imprimeur, l’humeur de certains écrivains, la qualification typographique de certains autres, les conditions matérielles en général, sont parfois décisifs dans la mise en page comme dans la mise au jour d’un livre. L’écrivain et l’imprimeur restitue le tempo des gestations particulières, tout en proposant une réflexion globale sur le statut du livre et de son auteur. L’ouvrage révèle combien le temps de l’écriture ne désigne pas un moment clos, mais fonctionne à la manière d’un processus complexe de rédaction, de récriture, de correction, intégrant les étapes de l’impression et de l’édition. Il montre nombre d’auteurs écrivant en fonction de la forme matérielle du livre, et quelques-uns assimilant même les jeux d’épreuves à un manuscrit pour achever le processus d’écriture. Il atteste la permanence de certaines techniques, comme celle du couper-coller, nullement attachée à la disponibilité des médias informatiques. L’auteur, censé être à l’origine du texte, n’est pas le seul à intervenir, et les conditions d’écriture, d’impression, de publication, voire l’histoire des éditions, témoignent de l’importance des contraintes matérielles. On voit ainsi le texte se départir de son abstraction pour s’ancrer dans le temps et l’espace de son élaboration

Photocoagulation or sham laser in addition to conventional anti-VEGF therapy in macular edema associated with TelCaps due to diabetic macular edema or retinal vein occlusion (TalaDME): a study protocol for a multicentric, French, two-group, non-commercial, active-control, observer-masked, non-inferiority, randomized controlled clinical trial

Abstract Background Macular edema (ME) results from hyperpermeability of retinal vessels, leading to chronic extravasation of plasma components into the retina and hence potentially severe visual acuity loss. Current standard of care consists in using intravitreal injections (IVI), which results in a significant medical and economic burden. During diabetic retinopathy (DR) or retinal vein occlusion (RVO), it has recently been shown that focal vascular anomalies (capillary macro-aneurysms, also termed TelCaps) for telangiectatic capillaries may play a central role in the onset, early recurrence, and/or persistence of ME. Since targeted photocoagulation of TelCaps may improve vision, identification, and photocoagulation of TelCaps, it may represent a way to improve management of ME. Objective The Targeted Laser in (Diabetic) Macular Edema (TalaDME) study aims to evaluate whether ICG-guided targeted laser (IGTL), in association with standard of care by IVI, allows reducing the number of injections during the first year of treatment compared with IVI only, while remaining non-inferior for visual acuity. Methods TalaDME is a French, multicentric, two-arms, randomized, sham laser-controlled, double-masked trial evaluating the effect of photocoagulation of TelCaps combined to IVI in patients with ME associated with TelCaps. Patients with vision loss related to center involved ME secondary to RVO or DR and presenting TelCaps are eligible. Two hundred and seventy eyes of 270 patients are randomized in a 1:1 ratio to standard care, i.e., IVI of anti-VEGF solely (control group) or combined with IGTL therapy (experimental group). Stratification is done on the cause of ME (i.e., RVO versus diabetes). Anti-VEGF IVI are administered to both groups monthly for 3 months (loading dose) and then with a pro re nata regimen with a monthly follow-up for 12 months. The primary endpoint will be the number of IVI and the change in visual acuity from baseline to 12 months. Secondary endpoints will be the changes in central macular thickness, impact on quality of life, cost of treatment, and incremental cost-utility ratio in each groups. Key safety Rare but severe AE linked to the use of IVI and laser, and previously described, are expected. In the sham group, rescue laser photocoagulation may be administered by the unmasked investigator if deemed necessary at month 3. Discussion The best management of ME associated with TelCaps is debated, and there have been no randomized study designed to answer this question. Given the fact that TelCaps may affect 30 to 60% of patients with chronic ME due to DR or RVO, a large number of patients could benefit from a specific management of TelCaps. TalaDME aims to establish the clinical and medico-economic benefits of additional targeted laser. The results of TalaDME may raise new recommendations for managing ME and impact healthcare costs. Trial registration EudraCT: 2018-A00800-55/ NCT03751501. Registration date: Nov. 23, 2018

Additional file 1 of Photocoagulation or sham laser in addition to conventional anti-VEGF therapy in macular edema associated with TelCaps due to diabetic macular edema or retinal vein occlusion (TalaDME): a study protocol for a multicentric, French, two-group, non-commercial, active-control, observer-masked, non-inferiority, randomized controlled clinical trial

Additional file 1

Whole-body MR imaging in suspected physical child abuse: comparison with skeletal survey and bone scintigraphy findings from the PEDIMA prospective multicentre study

International audienceObjectives: To assess the contribution of whole-body magnetic resonance imaging (WBMRI) and bone scintigraphy (BS) in addition to skeletal survey (SS) in detecting traumatic bone lesions and soft-tissue injuries in suspected child abuse.Methods: In this prospective, multicentre, diagnostic accuracy study, children less than 3 years of age with suspected physical abuse were recruited. Each child underwent SS, BS and WBMRI. A blinded first review was performed in consensus by five paediatric radiologists and three nuclear medicine physicians. A second review investigated discrepancies reported between the modalities using a consensus result of all modalities as the reference standard. We calculated the sensitivity, specificity and corresponding 95% confidence interval for each imaging modality (SS, WBMRI and BS) and for the combinations [SS + WBMRI] and [SS + BS].Results: One hundred seventy children were included of which sixty-four had at least one lesion. In total, 146 lesions were included. The sensitivity and specificity of each examination were, respectively, as follows: 88.4% [95% CI, 82.0-93.1] and 99.7% [95% CI, 99.5-99.8] for the SS, 69.9% [95% CI, 61.7-77.2] and 99.5% [95% CI, 99.2-99.7] for WBMRI and 54.8% [95% CI, 46.4-63.0] and 99.7% [95% CI, 99.5-99.9] for BS. Sensitivity and specificity were, respectively, 95.9% [95% CI, 91.3-98.5] and 99.2% [95% CI, 98.9-99.4] for the combination SS + WBMRI and 95.2% [95% CI, 90.4-98.1] and 99.4% [95% CI, 99.2-99.6] for the combination SS + BS, with no statistically significant difference between them.Conclusion: SS was the most sensitive independent imaging modality; however, the additional combination of either WBMRI or BS examinations offered an increased accuracy.Key points: • SS in suspected infant abuse was the most sensitive independent imaging modality in this study, especially for detecting metaphyseal and rib lesions, and remains essential for evaluation. • The combination of either SS + BS or SS + WBMRI provides greater accuracy in diagnosing occult and equivocal bone injuries in the difficult setting of child abuse. • WBMRI is a free-radiation technique that allows additional diagnosis of soft-tissue and visceral injuries