243 research outputs found
La persona como creatura
No full textInternational audienceEmmanuel Housset's paper is an effort to revitalize the concept of 'person' for contemporary philosophy and phenomenology To this end the author looks to show how little by little the understanding of 'person' took on a different meaning to that of 'character' or "right bearing individual". It is in authors such as St. Augustine and St. Thomas Aquinas that a different approach is found, one that puts emphasis on the relational and responsive character of a person, rather than on the autonomous and auto telic dimension. According to Housset, such a dimension appears together with the idea of the person as a creation, and in opposition to the idea of the rational individual, that is his own master. The emotional dimension and the personality that is awoken by the many figures of alterity are some of the dimensions of the person that the author analyzes, based on examining the flesh, passions, memory historicity and love.El artículo de Emmanuel Housset implica un esfuerzo de rehabilitación del concepto «persona» para la filosofía contemporánea y la fenomenología. Para ello el autor busca mostrar cómo poco a poco «persona» tomó otra significación que la de «personaje» o sujeto de derecho. Es en autores como san Agustín y santo Tomás de Aquino que se halla un acceso diferente que pone el énfasis más bien en su carácter relacional y responsivo de la persona, antes que en su dimensión autónoma y autotélica. Tal dimensión aparece, según Housset, junto con la idea de persona como creatura y en oposición a la de individuo racional dueño de sí. La dimensión afectiva, la personalidad despertada por las diversas figuras de la alteridad son algunas de las dimensiones de la persona que examina el autor a partir del examen de la carne, las pasiones, la memoria, la historicidad y el amor alteridad
Permissiveness of human biliary epithelial cells to infection by hepatitis C virus.
No full textThe cellular tropism of hepatitis C virus (HCV) is an important but much debated issue. Permissivity to HCV of biliary cells has never been demonstrated. In this context, we used gallbladder epithelial cells (GBEC) as a model of the more proximal biliary epithelium. These cells were isolated from HCV-positive and -negative individuals and cultured for up to 40 days. Biliary cells from HCV-negative subjects were infected in vitro with various inocula. The retention of GBEC functional characteristics was assessed by the expression of cystic fibrosis transmembrane conductance regulator (CFTR). All 12 GBEC tested from HCV-negative patients were successfully infected by HCV. This was assessed by: 1) the detection of HCV-RNA positive and negative strands; 2) the detection of the viral capsid by immunofluorescence; and 3) the combination of single-strand conformation polymorphism (SSCP) and HVR1 sequence analysis demonstrating the distinct majoritary HCV genomes in serum and in GBEC. The level of HCV RNA in cell extracts and supernatants was low, but HCV infection was highly reproducible. Our results expand those showing the cellular tropism of HCV, and demonstrate the sensitivity of biliary cells to HCV infection. This might have an important impact in terms of pathogenesis and pathological features of HCV infection. In addition, given the easy access to these cells and the high reproducibility of in vitro infection, they should constitute an important tool for studies aimed at analyzing the issue of HCV penetration and neutralizing antibodies
[The diagnostic contribution of complementary tests].
No full textInternational audienceThe increasing number of complementary examinations in pneumology often makes it difficult to choose the appropriate tests for optimal investigation. After specifying the conditions in which reference values are established, the authors discuss the general principles of decisional analysis, i.e. sensitivity and specificity, probability ratios, the role of the disease prevalence in interpreting results (Bayes' theorem) and the odds ratio. Practical applications of these principles with regard to diagnosis and therapy in pneumology are also discussed
[Demography of lung specialists in France].
No full textInternational audienceINTRODUCTION: This article analyses the medical demography data in France, particularly the situation concerning lung specialists. METHODS: Study of the published data, particularly institutional reports (Ministry of Health, Sickness Insurance). RESULTS: The demography is characterised by important differences between specialties, regions, and salaried and private practice, as well as the effects of ageing and the increasing numbers of female practitioners. Lung specialists are, on average, younger and more evenly distributed between the different types of practice. Nevertheless they risk experiencing the same difficulties as other specialties in responding to the needs of the French population. The principle proposals of the public authorities concern the restriction of numbers, the regulation of established specialists and new methods of access to the speciality. CONCLUSIONS: Medical demography has a major role in the future of the French health care system
[Diagnostic strategies of pulmonary pneumocystis infection in patients with HIV infection. Decision analysis and medico-economic consequences].
No full textInternational audienceP. carinii pneumonia is one of the most frequent opportunistic infections in HIV-infected patients. Clinical and radiological manifestations are non-specific and reference diagnostic procedure remains broncho-alveolar lavage which is costly and invasive. Alternative diagnostic strategies have been proposed. We report here our experience as well as literature date in this field with the purpose to show the usefulness of decision analysis techniques in choosing an optimal cost-effective strategy
Up-regulation of miR-34b/c by JNK and FOXO3 protects from liver fibrosis
No full textα1-Antitrypsin (AAT) deficiency is a common genetic disease presenting with lung and liver diseases. AAT deficiency results from pathogenic variants in the SERPINA1 gene encoding AAT and the common mutant Z allele of SERPINA1 encodes for Z α1-antitrypsin (ATZ), a protein forming hepatotoxic polymers retained in the endoplasmic reticulum of hepatocytes. PiZ mice express the human ATZ and are a valuable model to investigate the human liver disease of AAT deficiency. In this study, we investigated differential expression of microRNAs (miRNAs) between PiZ and control mice and found that miR-34b/c was up-regulated and its levels correlated with intrahepatic ATZ. Furthermore, in PiZ mouse livers, we found that Forkhead Box O3 (FOXO3) driving microRNA-34b/c (miR‐34b/c) expression was activated and miR-34b/c expression was dependent upon c-Jun N-terminal kinase (JNK) phosphorylation on Ser574. Deletion of miR-34b/c in PiZ mice resulted in early development of liver fibrosis and increased signaling of platelet-derived growth factor (PDGF), a target of miR-34b/c. Activation of FOXO3 and increased miR-34c were confirmed in livers of humans with AAT deficiency. In addition, JNK-activated FOXO3 and miR-34b/c up-regulation were detected in several mouse models of liver fibrosis. This study reveals a pathway involved in liver fibrosis and potentially implicated in both genetic and acquired causes of hepatic fibrosis
Performance and limitations of steatosis biomarkers in patients with nonalcoholic fatty liver disease
No full textBackground Several steatosis biomarkers are available with limited independent validation.Aim To determine diagnostic value and limitations of several steatosis biomarkers using liver biopsy as reference standard in a large cohort of patients with suspected NAFLD.Methods Three hundred and twenty-four consecutive liver biopsies were included. Histological steatosis was categorised as none (<5%), mild (5-33%), moderate (33-66%) and severe (>66%). Five steatosis biomarkers were measured: fatty liver index (FLI), NAFLD liver fat score (NAFLD-LFS), hepatic steatosis index (HSI), visceral adiposity index (VAI) and triglyceride × glucose (TyG) index.Results Steatosis grades prevalence was: none 5%, mild 39%, moderate 30% and severe 27%. Except for VAI, the steatosis biomarkers showed a linear trend across the steatosis grades. However, their correlation with the histological amount of steatosis was only weak-moderate. All steatosis biomarkers had an adequate diagnostic accuracy for the presence of steatosis: AUROCs for FLI, LFS, HSI, VAI and TyG were 0.83, 0.80, 0.81, 0.92 and 0.90. However, their ability to quantify steatosis was poor: none of them distinguished between moderate and severe steatosis and the AUROCs for predicting steatosis >33% were 0.65, 0.72, 0.65, 0.59 and 0.59 for FLI, LFS, HSI, VAI and TyG. Both fibrosis and inflammation significantly confounded the association between steatosis biomarkers and steatosis. The steatosis biomarkers were all correlated with HOMA-IR, independent from histological steatosis.Conclusions All five steatosis biomarkers can diagnose steatosis and are correlated with insulin resistance. They are confounded by fibrosis and inflammation, and do not accurately quantify steatosis; this may limit their clinical utility. More research is needed to identify truly independent and quantitative markers of steatosis
[Filarial eosinophilic lung. Apropos of a case].
No full textInternational audiencePulmonary eosinophilia due to filariasis is a form of filarial infection which is frequent in endemic zones but very much rarer in Europe where it is always "imported". In this case report the authors specify the clinical characteristics and pathophysiology of this disease
[The cost components of the management strategies for lung cancer in France].
No full textInternational audienceINTRODUCTION: To evaluate the average cost of therapeutic strategies for the management of lung cancer in relation to histological type and diagnostic staging and of the individual components of the management strategy. METHODS: Samples were taken between 1 September 1998 and 30 June 1999 from centres with sufficient numbers of lung cancer (LC) cases. All events over an 18 Month period were collected from a retrospective analysis of the records. A Markov model was constructed based on decision branches for localised and diffuse small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC). Several components of management were identified: first line treatment, second line treatment, observation, terminal care and death. RESULTS: The average cost of LC was 22,006 Euro (10,631-36,296) for one year and 25,643 Euro (10,631-46,191) for two years. For SCLC the average annual costs were 22,420 Euro for diffuse disease and 27,098 for localised disease. For NSCLC the totals ranged from 19,543 Euro for inoperable stage I and II tumours to 39,424 for operable tumours. The cost for stage IV tumours was 24,383 Euro. The cost components over two Years varied according to the tumour type. The cost of diagnosis ranged from 6-14%, the cost of management and of terminal care from 33-45% of the total. Analyses of sensitivity confirmed that whatever the histological type or diagnostic staging the percentage of patients initially treated actively (that is to say not by palliative care) had the greatest effect on the total cost, greater than the costs of terminal care and of two courses of chemotherapy. CONCLUSIONS: This model has allowed for the first time the calculation of the contributions of the different therapeutic components to the total cost of the management of lung cancer in France. In the future it will allow analysis of the economic impact of new methods of treatment
Cost-analysis of four diagnostic strategies for Pneumocystis carinii pneumonia in HIV-infected subjects.
No full textInternational audienceThe aim of this study was to analyse the cost-effectiveness ratio of four diagnostic strategies for Pneumocystis carinii pneumonia (PCP) in patients infected with human immunodeficiency virus (HIV). Two hundred and ten HIV-infected patients with suspected PCP underwent induced-sputum (IS) followed, if negative, by bronchoalveolar lavage (BAL); 85 of these patients were able to undergo an exercise test (ET), prior to induced sputum and BAL. The following strategies were analysed: BAL strategy (BAL whenever PCP is suspected); IS strategy (induced sputum followed by BAL if negative); exercise test (ET) strategy, (ET followed by BAL if the results are abnormal); and the ES (exercise sputum) strategy (i.e. BAL only after abnormal ET and negative IS). The cost of each strategy was calculated by taking into account only direct costs; the conditions in which two given strategies would be cost-equivalent were also evaluated. The prevalence of PCP in this population was 31%; IS had 100% specificity and 71% sensitivity, whilst ET had 100% sensitivity and 77% specificity. The costs of BAL, IS, ET and ES strategies were 210,000, 191,940, 140,700 and 112,700 FF, respectively. The ES strategy is, thus, most suitable for our unit. The most economic strategy depends not only on the cost and characteristics of the procedures, but also on the prevalence of PCP in the test population. In conclusion, we developed a model for use by diagnostic centres in choosing the most suitable strategy, on the basis of the local prevalence of PCP
- …
