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Impacts des substances psychoactives sur la déglutition : vers un questionnement des troubles de l’ usage chez nos patients adultes : élaboration d'une plaquette d'information pour les orthophonistes en libéral
No full textIntroduction: this work explores the link bewteen substance use disorders (SUDs) and swallowing disorders. This study has two main goals: to assess private practice speech-language pathologists’ (SLPs) perceived knowledge and anamnesis habits regarding substance use, and offer a concise prevention tool.The introduction provides an overview of the documented effects of cannabis, cocaïne and opioids on the mechanisms of swallowing, and highlights the lack of training courses on this topic, despite its clinical relevance.Material and Methods: an informational leaflet was created and distributed to 50 private-practise SLPs working with dysphagic patients. A two-part questionnaire was administered and used to assess perceived knowledge and current practices (before reading), and then to gather feedback and evaluate the leaflet’s impact on the respondents’ intentions to change their practice (after reading).Results: findings show that 92% of respondents had little to no self-perceived knowledge on the topic, and that only 16% systematically questioned substance use during their swallowing-related anamnesis. Illicit substances such as cocaïne, heroin and cannabis were particularly under-investigated. The leaflet was positively received; 74% of respondents reported learning new informations, and 84% intended to modify their clinical practice, especially by incorporating more targeted questions into their anamnesis.Discussion: this study highlights a significant lack of training and epidemiological data on SUDs in the field of speech-language pathologies. Further research and the inclusion of this topic in the training of SLPs are necessary.Introduction : ce mémoire explore les liens entre troubles de l’usage de substances psychoactives (TUS) et troubles de la déglutition. L’objectif est double : évaluer les connaissances perçues et les pratiques anamnestiques des orthophonistes libéraux face à ces consommations, et proposer un outil de sensibilisation synthétique.L’introduction propose une synthèse des effets recensés du cannabis, de la cocaïne et des opioïdes sur les mécanismes de la déglutition et souligne le manque de formation orthophonique sur cette thématique, malgré des enjeux cliniques importants.Matériel et Méthodes : une plaquette d’information a été élaborée puis diffusée auprès de 50 orthophonistes libéraux prenant en soin des patients dysphagiques. Un questionnaire en deux temps a permis d’évaluer les connaissances perçues et pratiques initiales (avant lecture), puis d’analyser les retours et l’impact de la plaquette sur les intentions de modification des pratiques (après lecture).Résultats : les résultats montrent que 92 % des répondants se sentent peu ou pas informés sur le sujet, et que seuls 16 % interrogent systématiquement les consommations lors de leurs anamnèses de déglutition. Les substances illicites, comme la cocaïne, l’héroïne ou le cannabis, sont notamment peu questionnées. La plaquette a été perçue positivement ; après lecture, 74 % des répondants déclarent avoir appris de nouveaux éléments et 84 % souhaitent modifier leur pratique, principalement en intégrant des questions spécifiques en anamnèse.Discussion : ce travail met en évidence un manque de formation et de données épidémiologiques sur les TUS en orthophonie. Une recherche approfondie dans ce domaine et son intégration dans la formation des orthophonistes sont nécessaires
Archéologie médiévale et moderne : des nouvelles du terrain
No full textDix ans après notre précédent numéro consacré à l’archéologie en Haute-Marne, il était temps de faire le point sur les dernières découvertes de nos amis archéologues. Sans doute aurons nous même l’occasion, à l’avenir, d’y consacrer encore quelques numéros, car notre département est certainement encore loin d’avoir livré tous ses secrets. Quant à l’intérêt qu’il suscite, aussi bien chez les professionnels que chez les simples curieux, il ne s’est pas démenti durant la dernière décennie, bien au contraire ! La meilleure preuve en est le nombre exceptionnel de contributeurs à ce présent numéro : ce ne sont pas moins de quinze spécialistes qui ont répondu à l’invitation de M. Nicolas Delferrière, Mme Anne-Laure Edme et Mme Emeline Retournard. De Saint-Dizier à Langres, en passant par Joinville, Andelot, Chaumont et Morimond, ils vous serviront de guides en ces terrains (mieux) connus : un grand merci à eux tous, et bonne lecture à vous
Early Biological Therapy Within 12 Months of Diagnosis Leads to Higher Transmural Healing Rates in Crohn’s Disease
No full textInternational audienceTransmural healing (TH) is emerging as a potential Crohn's disease (CD) treatment target. Early biological treatment seems to be associated with improved disease outcomes, but its impact on TH remains unclear. We aimed to assess the impact of early biological treatment initiation on TH and its influence on CD prognosis. Methods: This multicenter retrospective study included adult patients with CD starting biological therapy. TH was assessed using magnetic resonance enterography (MRE) at 12 +/- 6 months post-therapy initiation, with radiological examinations reviewed by blinded expert radiologists. TH was defined as complete normalization of all MRE parameters. Timing of biological therapy initiation was analyzed as a continuous variable, with optimal cutoff determined using the Youden index and clinical relevance. Logistic regression with propensity score-adjusted analysis was used to assess the association between early biological therapy initiation and TH. Long-term outcomes (bowel damage progression, CD-related surgery, CD-flare hospitalization, and therapy escalation) were evaluated. Results: Among 154 patients with CD, early biological therapy initiation within 12 months of diagnosis was associated with significantly higher TH rates (adjusted odds ratio [aOR], 3.23; 95% confidence interval [CI], 1.36-7.70; P < .01), which persisted after adjusting for previous biological therapy use (aOR, 2.82; 95% CI, 1.13-7.06; P = .03). Time-to-event analysis demonstrated that TH was significantly associated with reduced risk of bowel damage progression (adjusted hazard ratio [aHR], 0.28; 95% CI, 0.10-0.79; P = .02), CD-related surgery (aHR, 0.21; 95% CI, 0.05-0.88; P = .03) and therapy escalation (aHR, 0.35; 95% CI, 0.14-0.88; P = .02), independently of early biological therapy. Conclusions: Early initiation of biological therapy within 12 months of diagnosis significantly increases TH rates, leading to improved long-term outcomes in patients with CD
A Soil Washing Approach to Remediation of Lead-Contaminated Soil with Amino Acid Ionic Liquid [Met][NO3]
No full textInternational audienceAgainst the challenge of extreme lead (Pb) contamination (>15,000 ppm) in industrial polluted soils, where conventional agents fail to disrupt stable Pb–soil complexes—this study extends our prior cadmium (Cd) remediation research to validate amino acid ionic liquids (AAILs) for highly recalcitrant metals. Fifteen AAILs were screened via batch washing, with [Met][NO3] (methionine-based) demonstrating the highest Pb removal efficiency. Single-factor optimization revealed that under the conditions of 0.8 mol/L, 6:1 liquid–soil ratio, 60 min, 85.4% Pb was removed from severely contaminated soil by [Met][NO3]. Kinetic analysis using four common models showed that the second-order kinetic equation provided the best fit, indicating that Pb removal was predominantly driven by chemical reactions such as complexation or ion exchange. After washing, the contents of various Pb species were significantly reduced, thereby mitigating environmental risks. Notably, no substantial changes in soil texture were observed. However, a marked increase in organic matter content was detected, accompanied by decreases in soil pH and mineral element concentrations. Analysis of soil mineral composition, functional groups, and chemical speciation revealed that [Met][NO3] primarily facilitated Pb removal through ion-exchange and coordination reactions. This study establishes [Met][NO3] as a green agent with dual efficacy: it achieves high-efficiency remediation of severely Pb-contaminated soil while ensuring environmental sustainability, thus highlighting its potential for practical application
Study of the release kinetics of dalbavancin from bone allografts
No full textInternational audienceBone infections are common and difficult to treat, and secondary bone defects, which are often observed, may require a bone allograft. In this case, the surgeon will add antibiotics (usually vancomycin) in direct contact with the bone graft during the procedure, in order to allow in-situ release after implantation in the operating site. Dalbavancin is a novel antibiotic indicated for treating acute bacterial infections resistant to vancomycin. Its modified chemical structure grants it an increased half-life that could modify its release kinetics from the bone allograft. The aim of this study was to determine the release kinetics of dalbavancin from bone grafts after they were immersed in a dalbavancin solution. The study was conducted using a Design of Experiments (DoE) protocol. Decellularized and delipidated allograft bone cubes were preliminarily characterized and put into contact with dalbavancin solutions. The parameters that were studied where the allograft mass, initial dalbavancin concentration and contact time. The samples were then transferred into the release media, which was sampled over time and dalbavancin was quantified using a high pressure liquid chromatography with diode array detector method that was developed for the occasion. Our results showed that on average, dalbavancin was fully released after 5 min for the lower mass bone grafts, but after 60 min for the high mass and high concentration conditions. Contact time had no impact, thus indicating a fast loading process of dalbavancin into the allograft. Although our study revealed the possible benefits of using dalbavancin in bone grafting, an in-vivo study is required to confirm our hypotheses
PhenolQuest: a new reference FFQ for a more precise and comparable assessment of (poly)phenol intake in Europe
No full textInternational audience(Poly)phenols represent a large class of bioactive compounds present in our diet. An increasing number of epidemiological, clinical and pre-clinical studies are demonstrating the beneficial effects of (poly)phenols on various health parameters, parlicularly in relation to the prevention of cardiometabolic diseases. However, fully understanding their potential in preventive nutrition requires significant improvements in the assessment of individuals' exposure to a variety of (poly)phenols. One of the current limitations is the use of standard Food Frequency Questionnaires (FFQs) that are not specifically designed for that purpose and as a consequence lack precision and accuracy for the assessment of (poly)phenol intake. We developed the FFQ PhenolQuest, specially designed to assess with a high level of details the dietary intake of 120 (poly)phenols belonging to all main families, in populations following a European-style diet. It includes 188 foods with a number of additional variations (n = 75). Special effort was made to optimize the questionnaire's design and usability. In particular, the consumption frequency options were expanded compared to the standard FFQ and tailored to the different food groups. An application test conducted on a French population panel of 110 subjects demonstrated PhenolQuest's ability to capture the diversity of (poly)phenol source consumption patterns. PhenolQuest is shared in integrality for free use and further validation by the community. This article presents the challenges and strategies used for its development, as well as its scope of use
