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Les lieux de haute justice et d’exclusion à Troyes durant le Moyen Âge (XIIIe-XVIe siècles).
No full textImpaired endotoxin inactivation, rather than gut translocation, is associated with organ injury in cardiac surgery with cardiopulmonary bypass
No full textInternational audienceBACKGROUNDS In patients with cardiac surgery under cardiopulmonary bypass (CPB), postoperative inflammation is a driver of adverse outcomes. Endotoxaemia is one of the factors thought to trigger this inflammatory response. The mechanism behind high endotoxin activity (increased translocation vs. reduced inactivation capacity) has never been elucidated and may imply different therapeutic candidates. OBJECTIVES We aimed to evaluate, in patients with cardiac surgery with prolonged CPB, mechanisms and consequences of endotoxaemia and the efficacy of haemo-adsorption to reduce the endotoxin burden. DESIGN Ancillary analysis of a randomised controlled trial. Patients scheduled for cardiac surgery with prolonged CPB were assigned to receive either intra-operative haemo-adsorption or standard of care. Endotoxin mass and activity were measured before surgery, at the end of CPB, 6, 24 and 48 h after the end of surgery. SETTING Operating room, Amiens University Hospital. PATIENTS Adults scheduled for cardiac surgery under CPB with an expected CPB time more than 90 min. INTERVENTION Patients were randomised to receive either haemo-adsorption or standard care during CPB. MAIN OUTCOME MEASURES Endotoxin activity. RESULTS Two hundred and ninety-five samples from 66 patients were analysed. Following CPB, we observed a reduction in endotoxin mass accompanied by a relative increase in endotoxin activity. High postoperative endotoxin activity was associated with intra-operative dobutamine requirement, increased postoperative inflammatory biomarkers and organ injury. Endotoxin plasma concentration and activity were not lower in patients treated with haemo-adsoprtion. CONCLUSION The capacity of individuals to inactivate endotoxin rather than raw endotoxin mass (i.e. Quantity) seemed to be a determinant of endotoxin noxious effect in cardiac surgery and CBP. Haemo-adsorption was not associated with a reduction of endotoxin plasma mass or activity in patients with cardiac surgery under CPB. TRIAL REGISTRATION ClinicalTrials.gov, NCT04201119NCT0420111
A randomized phase III trial of structured tumour response surveillance and shared decision‐making for organ preservation in rectal cancer – PRODIGE 101‐ GRECCAR 20‐ EVAREC trial protocol
No full textInternational audienceAbstract Aim Standard management with chemoradiotherapy (CRT) or total neoadjuvant therapy (TNT) followed by total mesorectal excision (TME) reduces local recurrence but often is associated with significant long‐term functional impairment. Organ preservation (OP) has become a key therapeutic goal in rectal cancer to reduce surgery‐related morbidity without compromising oncological outcomes. Three main OP strategies have been developed: Watch and Wait (W&W) strategy, Local Excision (LE) and Contact X‐ray Brachytherapy (CXB), both applicable in patients showing a favourable tumour response after neoadjuvant therapy. The current challenge is defining the optimal timing and modalities for response assessment to accurately identify complete clinical response while balancing oncological control, functional outcomes and patient preferences. This trial evaluates whether a structured tumour response surveillance program combined with shared decision‐making (SDM) can safely increase OP rates. Methods GRECCAR 20 is a multicentre, randomized, open‐label, phase III trial enrolling patients with cT2‐T3N0‐1 rectal adenocarcinoma ≤ 8 cm from the anal verge and ≤ 4 cm in length, without involvement of the anal canal. Across the French GRECCAR and PRODIGE network, 270 patients will be recruited over 36 months. After neoadjuvant treatment (CRT or induction chemotherapy followed by CRT), participants are randomized to either a structured tumour response surveillance strategy with SDM over 8 to 24 weeks (experimental arm) or standard response assessment without SDM at 8 weeks (control arm). In the experimental arm (Arm A), reassessments at 2‐, 4‐ and 6‐month post‐treatment will guide management decisions—W&W, LE, CXB or TME—through a collaborative process between patient and clinician. In the control arm (Arm B), treatment decisions at 2 months will be made solely by the clinician, between LE or TME, based on clinical, endoscopic and radiological assessment. The primary outcome is the OP rate at 2 years. Secondary endpoints include disease‐free survival, TME‐free survival, functional outcomes, quality of life (QoL) and patient‐reported outcome measures (PROMs). Conclusion GRECCAR 20 is the first randomized trial to assess a structured tumour response surveillance program incorporating SDM in rectal cancer. By prioritizing patient values and QoL, this trial aims to improve OP rates without compromising oncological safety, potentially establishing a new standard of personalized, patient‐centred care
First line intensities of the ν 3 + ν 6 band of methyl fluoride
No full textInternational audienceInfrared spectra of CH 3 F were recorded in the 2200 cm -1 region using a Fourier transform spectrometer in Reims, France, with a resolution of 0.003 cm -1 . The measurements were conducted using a White-type cell with a path length of 8.26 m at different pressure of CH 3 F between 1 and 15 mbar. This spectral region corresponds to the ν 3 + ν 6 band, which is measured for the first time in this work. Experimental line positions and intensities were determined using the Voigt lineshape as a model in mono-spectrum fitting. The band assignment was carried out up to J = 45 and K = 15 using our home-made Spec-traMatcher computer code, resulting in more than 1800 measured lines. Strong intensity perturbations were observed, explained by a strong Coriolis coupling for 2ν 3 and ν 3 + ν 6 bands. The square of the transition dipole moments was determined for each line, resulting in the determination of the vibrational transition moment and the Herman-Wallis coefficients of each band using the Watson model
"PULSE FICTION" : Développement d'aliments et de recettes à base de légumineuses peu transformées afin de répondre aux besoins des consommateurs, des agriculteurs et d'améliorer la durabilité alimentaire
No full textInternational audiencePulses offer significant nutritional and environmental benefits and are useful components of healthier, more sustainable diets and global food security. However, their consumption in France remains low and below the world average. Farmers face economic and technical challenges in diversifying crops, and current domestic production is insufficient to meet this low demand, resulting in continued reliance on imports. Production and consumption are closely linked: low consumer demands limit incentives for farmers to expand cultivation, while limited availability can also constrain uptake. One of the major barriers to consumption relates to preparation and processing. While consumers generally view raw or minimally processed pulses positively, they often avoid using them because they perceive them as time‐consuming to prepare or associate them with undesirable sensory attributes (e.g., bitterness and astringency). It also might be difficult for consumers to categorize pulses according to their level of processing. Although pulse processing makes them more convenient for users, former studies suggest that consumers are suspicious about the processing of pulses, and that they may even confuse processing with ultra‐processing. This suspicion could sometimes lead to rejection by consumers. The process should thus remain moderate. Encouraging the use of minimally processed pulses, which balance convenience and acceptance, is crucial for wider adoption. The aim of the PULSE FICTION project is to develop minimally processed pulse products with pulses as the main ingredient that align with consumer preferences, farmer constraints and sustainability goals. A key innovation will be the selection of intermediate food products (IFPs) on the basis of consumer and farmer input and chef‐developed easy‐to‐make recipes. These products will be evaluated for their nutritional and sensory qualities, satiety, consumer acceptance and environmental impact. Beyond product development, PULSE FICTION explores the cognitive and sensory factors influencing consumer acceptability and designs effective communication strategies for all stakeholders to facilitate consumer adoption of pulse‐based foods
Impact of the physico-chemical properties of commercial pea proteins concentrate and isolate on the quality of meat analogs
No full textInternational audiencePlant proteins extracted from soys and peas, have been identified as potential functional ingredients for plantbased meat analogs producted by high moisture extrusion cooking (HMEC). However, the extraction process (dry for concentrate and wet for isolate) can have an impact on the primary structure of the proteins, affecting their technical and functional properties. This study aims to compare the impact of two fractionation process on pea proteins (structure, fractions, flowing index) and their ability to create a network, which can mimic the fiber structure found in meat, within moisture extrusion. Pea protein concentrates (PPC) obtained by dry fractionation, and pea protein isolate (PPI) by isoelectric precipitation were characterized in terms of functional and flow properties. Results showed that PPI have a higher aggregation, lower solubility and water-holding capacity than PPC, and no thermal event was highlighted by differential scanning calorimetry, indicating proteins denaturation of PPI. Denaturation of proteins before the heating step in extruder barrel contrasts with the current model described in the literature. However, treating with HMEC, PPC is less suitable than PPI where better results in term of flow properties (respectively with flowability indexes of 27.33 and 56.17) and anisotropic structure. In that way, it appears that proteins concentration (55 % and 70 % respectively for PPC and PPI) is the most important parameter for creating a meat like texture in the conditions of the experiment
Vers une évaluation hyper-moderne des politiques publiques
No full textNational audienceDepuis son origine en contexte public, l’évaluation des politiques a connu différentes formes. D’abord, une évaluation qualifiée d’« administrative », inscrite dans une logique hiérarchique et centrée sur la conformité procédurale. Ensuite, une évaluation « managériale » portée par les principes du New Public Management (NPM), valorisant la performance, la responsabilisation individuelleet l’usage d’indicateurs quantitatifs. Enfin, une évaluation plus « collaborative et ouverte », intégrant la réflexivité, la participation et la prise en compte du contexte social et territorial de l’action publique, en intégrant des approches post-NPM, plus récentes. Pourtant, malgré ces évolutions, l’évaluation des politiques publiques est actuellement critiquée, que cela soit sur le plan conceptuel ou sur celui plus pratique. Une évaluation renouvelée semble alors nécessaire !
Severity of complications is associated with impaired health‐related quality of life in people with type 1 diabetes
No full textInternational audienceAims Health‐related quality of life (HRQoL) assessment is increasingly integrated into type 1 diabetes (T1D) monitoring to promote a holistic approach. To investigate HRQoL in adults with T1D and to assess the impact of the severity of complications on HRQoL. Materials and Methods This is a cross‐sectional analysis of baseline characteristics of adults living with T1D included in Société Francophone du Diabète – Cohorte Diabète de Type 1 (SFDT1), a French longitudinal cohort study. HRQoL was assessed using generic (EuroQol 5‐Dimensions 5‐Level questionnaire [EQ‐5D‐5L]) and diabetes‐specific (Audit of Diabetes‐Dependent Quality of Life) instruments. The severity of diabetes complications was measured using an adapted Diabetes Complication Score Index (DCSI) ranging from 0 to 14. We used multiple imputations to deal with missing data. Results We included 1892 adults, 48% women, with a median (interquartile range [IQR]) age of 38 (28; 51) years. The mean overall EQ‐5D‐5L HRQoL score was 71.1 ± 17.7 (maximum 100), with the following number of participants negatively impacted for each domain: 271 (14%) for mobility, 94 (5%) for self‐care, 378 (19%) for usual activities, 853 (45%) for pain/discomfort and 983 (52%) for anxiety/depression. The median (IQR) DCSI was 1 (0; 2). In multivariable models, a one‐step increase in DCSI was associated with a 1.5% decrease in overall EQ‐5D‐5L HRQoL. DCSI was also inversely associated with all domains of the generic scale except anxiety/depression and 17 domains of the diabetes‐specific scale. Conclusions We observed an inverse association between the severity of complications and overall HRQoL and most of its dimensions. Our results highlight the need to reinforce the prevention of complications to improve the overall well‐being of people with T1D
Towards approaches that respect human health and ecosystems in agricultural practices
No full textPlant protection products used in agriculture contain molecules specifically designed to be toxic to target organisms. However, their use can also have unintended effects, posing potential risks to ecosystems and non-target organisms, including humans. Research has deepened our understanding of the links between exposure to these substances and the effects observed in the environment. In particular, studies have highlighted how even low levels of exposure can cause chronic effects on non-target organisms and disrupt ecosystems. These findings underscore the importance of quantifying and characterising these exposures in order to better assess their potential impacts on human health and the environment.International audienceThe roundtable discussion held on 6 February 2025 at ONIRIS in Nantes, co-organised by “Carrefours de l’Innovation INRAE” and “ECOPHYTO recherche & innovation”, revisited and expanded upon the presentation of the effects of plant protection products (PPPs) on human health and ecosystems. PPPs, designed to target pests and diseases, also affect non-target organisms, leading to human illnesses (cancers, neurological and respiratory diseases) and ecological imbalances. Robust research, including an INSERM report, has established the strength of the links between exposure to PPPs and various pathologies, particularly among agricultural workers, but also among children exposed in utero. On the environmental front, an INRAE-Ifremer study highlights widespread contamination, with serious impacts on biodiversity (bees, birds, invertebrates) and even the marine environment. The concept of “symbiotoxicity” underscores the disruption of organisms’ microbiomes, exacerbating their vulnerability. Research still lacks data on PPP degradation products and their combined effects (“cocktail effects”). Training programmes such as the One Health Master’s degree aim to prepare professionals capable of addressing these challenges in a systemic way. Since 2020, a compensation fund has been supporting PPP victims, including children exposed before birth. Specialised paediatric consultations are emerging to provide better support for families. Taken together, this body of work clearly calls for a rapid and widespread agroecological transition, implying far-reaching changes in farming practices. However, current policy orientations appear to favour a gradual approach, based on pragmatic actions that can be implemented without disrupting the foundations of the existing agricultural model
A Carta Portuguesa de 1826 ou o laboratório dum “religioso constitucionalismo”
No full textInternational audiencePor trás da figura paradoxal de D. Pedro, improvável encontro entre um rei/imperador liberal e um monarca absoluto, o artigo expõe o destino singular da Carta Portuguesa de 1826, laboratório de um constitucionalismo outorgado, onde Deus, a história e os costumes disputam com o rei todo o poder criador. Da lenda das leis de Lamego às convulsões positivistas de 1910, tece-se a fábula de uma monarquia católica que pretende educar a nação pelo «poder moderador», antes que a utopia de uma constituição vivida, entre costumes e graça, se desfaça com o duplo regicídio e a chegada da república