Suchergebnisse

A finales del siglo XV, principio del XVI, se llevó a cabo en Europa la formación de los estados nacionales y apareció el Derecho internacional moderno. Dos fenómenos coexistentes, inseparables el uno del otro. Esta dualidad explica la doble legitimidad en la que se inserta el poder político estatal de los Estados nacionales. Cada uno establece el suyo propio aunque reconoce un orden superior que enlaza a todos los elementos nacionales. Pero en el caso de la UE, hay otra línea de legitimidad más clara y eficaz. Ha sido el genio creador de una generación de hombres clarividentes el que puso en marcha en Europa occidental hace medio siglo, un fenómeno de integración política que puede culminar en una Unión Política desde la diversidad de soberanías estatales insolidarias. Esta singularidad se manifiesta de modo multiforme: en los propios tratados comunitarios, en la naturaleza y características del Derecho comunitario y de modo muy especial en la relación entre el Derecho de la Unión y el particular de sus Estados miembros en la que prevalece el primero de ellos. Es así como la dinámica de integración y el correspondiente Derecho que las conduce han entrado en un proceso de aceleración que puede llevar lejos. ________________________________________At the end of the Fifteen century and beginning of the Sixteenth, national estates were created in Europe and modern International Law appeared. These are two coexisting and inseparable phenomena. This duality explains why the political power of national Estates is based on a double legitimacy: each Estate sets its own political power, but a the same time it recognises a higher system that binds all the national elements. Regarding the European Union, however, there is a clearer and more efficient legitimacy. Half a century ago, the creative talent of a generation of clear-sighted men was the driving force of the start in Western Europe of a political integration phenomenon that can culminate in a Political Union in spite of the differences between the several national estates. The singularity of this process becomes evident in different ways: in the community treaties, in the nature and features of Community Law and especially in the relationship between Community Law and the law of the different Member Estates. In this relationship is Community Law the one that prevails. Integration dynamics and its corresponding law have entered an acceleration process that may go far.

[Background and objective] We aimed to evaluate the safety and outcomes of thrombectomy in anterior circulation acute ischaemic stroke recorded in the SITS–International Stroke Thrombectomy Register (SITS-ISTR) and compare them with pooled randomized controlled trials (RCTs) and two national registry studies. ; [Methods] We identified centres recording ≥10 consecutive patients in the SITS-ISTR with at least 70% of available modified Rankin Scale (mRS) at 3 months during 2014–2019. We defined large artery occlusion as intracranial internal carotid artery, first and second segment of middle cerebral artery and first segment of anterior cerebral artery. Outcome measures were functional independence (mRS score 0-2) and death at 3 months and symptomatic intracranial haemorrhage (SICH) per modified SITS-MOST. ; [Results] Results are presented in the following order: SITS-ISTR, RCTs, MR CLEAN Registry and German Stroke Registry (GSR). Median age was 73, 68, 71 and 75 years; baseline NIHSS score was 16, 17, 16 and 15; prior intravenous thrombolysis was 62%, 83%, 78% and 56%; onset to reperfusion time was 289, 285, 267 and 249 min; successful recanalization (mTICI score 2b or 3) was 86%, 71%, 59% and 83%; functional independence at 3 months was 45.5% (95% CI: 44–47), 46.0% (42–50), 38% (35–41) and 37% (35–41), respectively; death was 19.2% (19–21), 15.3% (12.7–18.4), 29.2% (27–32) and 28.6% (27–31); and SICH was 3.6% (3–4), 4.4% (3.0–6.4), 5.8% (4.7–7.1) and not available. ; [Conclusion] Thrombectomy in routine clinical use registered in the SITS-ISTR showed safety and outcomes comparable to RCTs, and better functional outcomes and lower mortality than previous national registry studies. ; SITS (Safe Implementation of Treatment in Stroke) is financed directly and indirectly by grants from Karolinska Institutet, Stockholm County Council, the Swedish Heart-Lung Foundation, the Swedish Order of St. John, Friends of Karolinska Institutet and private donors, as well as from an unrestricted sponsorship from Boehringer Ingelheim. SITS has previously received grants from the European Union Framework 7, the European Union Public Health Authority, Ferrer International and EVER Pharma. SITS is currently conducting studies supported by Boehringer Ingelheim and Biogen, as well as in collaboration with Karolinska Institutet, supported by Stryker, Covidien and Phenox. N Ahmed is supported by grants provided by the Stockholm County Council and the Swedish Heart-Lung Foundation. S Holmin is supported by grants provided by the Söderberg Foundations, the Stockholm County Council, the Erling Persson Foundation, VINNOVA and HMT. Irene Escudero-Martínez has received a grant from 'Fundación Progreso y Salud, Junta de Andalucía' (grant EF-0437-2018). RM has been supported by the project no. LQ1605 from the National Program of Sustainability II (MEYS CR). RH has been supported by the grants no. DRO–UHHK 00179906 from the Ministry of Health of the Czech Republic and no. PROGRES Q40 from Charles University, Czech Republic. ; Peer reviewed