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Would you board a plane if the pilot had never trained on a flight simulator?
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Spironolactone in patients on chronic haemodialysis at high risk of adverse cardiovascular outcomes (ALCHEMIST): a multicentre, double-blind, randomised, placebo-controlled trial and updated meta-analysis
No full textInternational audienceNo pharmacological therapy has been shown with certainty to improve the cardiovascular prognosis in patients with kidney failure on chronic haemodialysis. We aimed to investigate the effects of the steroidal mineralocorticoid receptor antagonist spironolactone on cardiovascular outcomes in patients on haemodialysis who are at high risk of cardiovascular events.MethodsALCHEMIST was an investigator-initiated, multicentre, double-blind, randomised, placebo-controlled, event-driven trial conducted at 64 university hospitals, general hospitals, and non-profit or private practice dialysis centres in France, Belgium, and Monaco. Adult patients aged 18 years and older with kidney failure on chronic haemodialysis with at least one cardiovascular comorbidity or risk factor were enrolled into a 4-week run-in period on open-label oral spironolactone 25 mg every other day. Participants were randomly assigned (1:1) to oral spironolactone titrated to 25 mg per day or placebo. The randomisation sequence was computer generated and stratified by centre in blocks of 4 or 6, and permutation of treatments within each block. The random assignment was double-blinded. The primary endpoint was time to first major adverse cardiovascular event (cardiovascular death, non-fatal myocardial infarction, acute coronary syndrome, stroke, or hospitalisation for heart failure) and was analysed in the intention-to-treat population. We also performed an updated meta-analysis of double-blind, randomised controlled trials of mineralocorticoid receptor antagonists in patients on haemodialysis incorporating data from ALCHEMIST. The study was registered with ClinicalTrials.gov, NCT01848639.FindingsBetween June 13, 2013, and Nov 24, 2020, 1442 patients were locally screened for eligibility. 823 patients were included in the trial and 794 entered the run-in period. 644 patients were randomly assigned to spironolactone (n=320) or placebo (n=324). 444 (69%) patients were men and 200 (31%) were women. The trial was stopped prematurely due to lack of funding from the sponsor. Median follow-up was 32·6 months (IQR 17·3–48·4). The primary endpoint occurred in 78 (24%) of 320 patients in the spironolactone group (10·66 per 100 patient-years [95% CI 8·54–13·31]) and 79 (24%) of 324 patients in the placebo group (10·70 per 100 patient-years [8·59–13·35]; hazard ratio [HR] 1·00 [95% CI 0·73–1·36]; p=0·98). Hyperkalaemia above 6 mmol/L was reported in 135 (42%) patients in the spironolactone group and 134 (41%) in the placebo group (HR 1·12 [95% CI 0·88–1·43]). In the meta-analysis, mineralocorticoid receptor antagonists did not reduce all-cause or cardiovascular mortality or non-fatal cardiovascular events and did not increase the odds of hyperkalaemia events (serum potassium concentration >6 mmol/L).InterpretationIn patients with kidney failure on haemodialysis and with high risk of adverse cardiovascular outcomes, spironolactone did not reduce the incidence of major cardiovascular events. The updated meta-analysis shows that mineralocorticoid receptor antagonists did not reduce all-cause or cardiovascular mortality. Therefore, off-label use of spironolactone in this setting is not supported by available evidence
Shoulder Musculoskeletal Disorder Rehabilitation Using a Robotic Device Based on Electromyography (EMG) Biofeedback: A Retrospective Cohort Study
No full textInternational audienceBackground and Objectives: While shoulder injuries represent the musculoskeletal disorders (MSDs) most encountered in physical therapy, there is no consensus on their management. In attempts to provide standardized and personalized treatment, a robotic-assisted device combined with EMG biofeedback specifically dedicated to shoulder MSDs was developed. This study aimed to determine the efficacy of an 8-week rehabilitation program (3 sessions a week) using a robotic-assisted device combined with EMG biofeedback (RA-EMG group) in comparison with a conventional program (CONV group) in patients presenting with shoulder MSDs. Materials and Methods: This study is a retrospective cohort study including data from 2010 to 2013 on patients initially involved in a physical rehabilitation program in a private clinic in Chicoutimi (Canada) for shoulder MSDs. Shoulder flexion strength and range of motion were collected before and after the rehabilitation program. Forty-four patients participated in a conventional program using dumbbells (CONV group), while 73 completed a program on a robot-assisted device with EMG and visual biofeedback (RA-EMG group); both programs consisted of two sets of 20 repetitions at 60% of maximal capacity. Results: We showed that the RA-EMG had significantly greater benefits than the CONV group for shoulder flexion strength (4.45 [2.6;6.15] kg vs. 2.3 [0.90;4.775] kg, U = 761, p = 0.013) and for normalized strength (77.5 [51.3;119.1] % vs. 39.1 [16.6;89.2] %, U = 755, p = 0.016). In addition, the RA-EMG group showed a trend to greater absolute gain of ROM than the CONV group (10.0 [0;24.3] degrees vs. 5.5 [0;12.0] degrees, U = 1931, p = 0.067), and a greater benefit in normalized ROM was observed for the RA-EMG (7.4. [0;17.7] %) than the CONV group (4.6 [0;10.8], U = 1907, p = 0.046). Conclusions: The current retrospective cohort study showed that a specific and tailored 8-week rehabilitation program with constant effort by automatic adjustment of the level of resistance by EMG feedback induced greater benefits for shoulder flexion strength and a trend to improve range of motion compared to conventional rehabilitation in patients with shoulder MSDs. Future research should be pursued to determine the added potential of this approach for abduction and external rotation with a randomized controlled design
Les savoirs traditionnels face aux enjeux du futur : d'un héritage culturel à une source d'innovation
No full textInternational audienceLes activités traditionnelles, telles que les métiers d’art et patrimoniaux, certaines professions agricoles et culinaires, ainsi que diverses pratiques ancestrales, représentent aujourd’hui des enjeux socio-économiques majeurs. Face aux transformations rapides des écosystèmes économiques et écologiques, mais également des systèmes culturels et sociaux, les savoirs anciens se trouvent confrontés à des problématiques inédites, notamment en matière de sauvegarde, de transmission et de valorisation. Dans ce contexte, il apparaît nécessaire d’interroger les approches émergentes en faveur d’une gestion durable de ces savoirs.Cet ouvrage collectif s’appuie sur un cycle de séminaires ayant réuni, pendant quatre années, de nombreux professionnels et universitaires issus de champs disciplinaires variés. La question des savoirs traditionnels y est abordée selon une pluralité de perspectives : économique, historique, pédagogique, financière, institutionnelle, technologique et managériale, à partir d’expériences concrètes menées dans plusieurs pays et régions françaises.Les savoirs traditionnels face aux enjeux du futur, à la fois nourri de témoignages de terrain et de réflexions prospectives, propose une mise en perspective originale entre héritage culturel et innovation. Il offre ainsi aux chercheurs, praticiens et décideurs une lecture renouvelée du potentiel que recèlent les savoirs traditionnels dans un monde en mutation
Ultra-High-Frequency-Dielectrophoresis Microfluidic Biosensor to Detect the Transformation Potential of Extracellular Vesicles Derived from Cancer Stem Cells
No full textInternational audienceCancer stem cells (CSCs) remain challenging to isolate and characterize because of their plastic phenotype. To overcome this issue, we used a microfluidic lab-on-a-chip analysis approach based on ultra-high frequency dielectophoresis (UHF-DEP) to measure the dielectrophoretic signature of colorectal cancer cells. We demonstrated that CSCs exhibit a distinct and lower frequency signature than differentiated cancer cells. Extracellular vesicles (EVs) released by tumor cells are implicated in tumor progression and metastasis. As CSC-derived EVs carry a more aggressive cargo, we hypothesized that treating differentiated colorectal cancer cells with these vesicles might affect their phenotype which would be detected by our lab on a chip. Indeed, the dielectrophoretic signature of cells treated with those EVs was altered in comparison to untreated cells, even in cases where no detectable biological changes were observed. Compared to conventional approaches using biomarkers to characterize CSCs, this UHF-DEP lab on a chip is a label-free method providing rapid and relevant results. Such a method could be useful in the clinic for the early detection of CSCs in the tumor mass, as well as for monitoring CSC-derived EVs in the bloodstream in order to study responses to therapy and prevent relapses.</div
Les projets parentaux construits a posteriori et la création de liens de filiation : les États-Unis
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Instituer la pluriparenté ab initio dans le cadre d’un projet parental à plusieurs : les États-Unis
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Approche comparée de la réglementation des plateformes Europe/États-Unis
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Implémentation des données probantes issues des sciences infirmières
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Les étudiant·e·s sénégalais·e·s en France et le cumul études-emplois : quel prix à payer pour aller au bout des études universitaires ?
No full textInternational audienceThis article examines the meaning and effects of Senegalese students combining study with work while studying in France. The objective conditions under which they perform their precarious ‘odd jobs’ entail significant risks to the smooth running of their studies and a real threat, in the short or medium term, to their physical and mental health. This apparent contradiction raises the question: why do these international migrant students, whose living and working conditions are often precarious and constrained, persist with their studies? Or do they simply have no choice but to ‘make do’? Changes of the political and administrative framework governing Senegalese students’ stays in France, as well as the deterioration of their financial resources, appear to significantly hinder their project to complete their university studies.Cet article interroge le sens et les effets du cumul études-emplois par des étudiant·e·s sénégalais·e·s en cours d’études en France. Les conditions objectives d’exercice de leurs « petits boulots » précaires impliquent des risques importants pour le bon déroulement de leurs études et une menace réelle, à court ou moyen termes, pour leur santé physique et mentale. Pourtant, la majorité affirme ne rencontrer aucune difficulté à mener à bien leurs études. Cette apparente contradiction amène à s’interroger : pourquoi ces étudiant·e·s en migration internationale, dont les conditions de vie et de travail relèvent souvent de la précarité et de la contrainte, persistent-ils dans leurs études ou n’ont-ils d’autre choix que de « faire avec » ? Il apparaît que l’évolution du cadre politique et administratif de séjour des étudiant·e·s sénégalais·e·s en France ainsi que la dégradation de leurs conditions financières constituent de fortes entraves à leur projet d’études universitaires