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Background & aims: Current guidelines recommend immunosuppressive treatment (IT) in patients with primary sclerosing cholangitis (PSC) and elevated aminotransferase levels more than five times the upper limit of normal and elevated serum IgG-levels above twice the upper limit of normal. Since there is no evidence to support this recommendation, we aimed to assess the criteria that guided clinicians in clinical practice to initiate IT in patients with previously diagnosed PSC.
Methods: This is a retrospective analysis of 196 PSC patients from seven German hepatology centers, of whom 36 patients had received IT solely for their liver disease during the course of PSC. Analyses were carried out using methods for competing risks.
Results: A simplified autoimmune hepatitis (AIH) score >5 (HR of 36, p<0.0001) and a modified histological activity index (mHAI) greater than 3/18 points (HR 3.6, p = 0.0274) were associated with the initiation of IT during the course of PSC. Of note, PSC patients who subsequently received IT differed already at the time of PSC diagnosis from those patients, who did not receive IT during follow-up: they presented with increased levels of IgG (p = 0.004) and more frequently had clinical signs of cirrhosis (p = 0.0002).
Conclusions: This is the first study which investigates the parameters associated with IT in patients with PSC in clinical practice. A simplified AIH score >5 and a mHAI score >3, suggesting concomitant features of AIH, influenced the decision to introduce IT during the course of PSC. In German clinical practice, the cutoffs used to guide IT may be lower than recommended by current guidelines.
The main purpose of the paper is to explain the divergent paths of development of ethno-territorial protest movements in modern democratic political systems. By focusing on the interaction between these movements and the state, the different systems of accommodation between the relevant regional and central elites will be analyzed. The study concentrates on the case studies of Québec (Canada) and Corsica (France). The paper is divided into three parts. The first part describes the traditional systems of accommodation in France and Canada. The second part is focused on the process of socio-economic modernization in the 1950s and 1960s in those countries that threatened the established patterns of elite accommodation. The third part deals with the consequences for the established patterns of elite-accommodation and new concepts of territorial management that the central states tried to establish. By looking at the different degrees of centralization and decentralization in the mentioned political systems, the question of access to the political system by new social and political actors will be discussed in detail.
Since the early 1960s ethno-territorial movements have increasingly challenged established patterns of political integration in western democracies. The purpose of this paper is to compare the formation and different paths of development of such nationalist movements in Quebec (Canada) and Corsica (France). The paper presents a brief outline of an argument more fully developed in a study on the two cases. After a short introduction I will first discuss theoretical aspects of minority nationalism. Secondly, I will try to give an overview over major findings and conclusions of my study.