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Bile Duct Replacement in Hepatobiliary Surgery: A Systematic Review
No full textInternational audienceBackground Roux‐en‐Y hepaticojejunostomy (RYHJ) is currently the standard surgical technique for reestablishing biliary continuity, but it exposes the patient to serious biliary complications, such as anastomosis stricture and ascending cholangitis. Methods The literature on biliary replacement using vein grafts as autologous substitutes according to the different stages of the IDEAL framework was reviewed. Results Innovative biliary replacement techniques using bile duct substitutes have yet to reach stage 2a (development) of the IDEAL framework. Vein grafts are the most frequently used substitutes in animals and human studies. Twenty‐three patients have undergone bile duct reconstruction using four different substitutes: vein grafts ( n = 13), omentum/round ligament ( n = 5), jejunum ( n = 4), and Teflon ( n = 1). Biliary replacement using an autologous vein graft ( n = 13) was performed for bile duct injury following cholecystectomy ( n = 12) or hepatectomy ( n = 1). The 90‐day mortality rate was zero. Morbidity occurred within 90 days in two patients (15.4%). Twelve patients were alive at the last follow‐up. Conclusions Autologous venous graft as a substitute for biliary replacement may be an appealing alternative to RYHJ in hepatobiliary surgery, but this technique is still being developed
Lipid/protein interplay in membrane formation and remodeling during plant autophagy
No full textInternational audienceAutophagy is an intracellular degradation and recycling process which promotes plant acclimation and survival to a wide range of environmental stresses. During autophagy, the formation and maturation of specialized membrane vesicles, named autophagosomes, ensure cargo recognition, sequestration and trafficking to the lytic vacuole. Fusion of the autophagosomes with the vacuole delivers in its lumen a vesicle called autophagic body, which membrane is rapidly broken down thus releasing cargo for degradation. The whole dynamic process of autophagy thus relies on an orchestrated series of membrane remodeling events which underlying molecular mechanisms remain poorly understood. As essential components of biological membranes, lipids have the potential to functionally contribute to several steps of the autophagy pathway. To unravel the nature of lipids and pathways related to lipid dynamics during autophagy, we isolated autophagy compartments and established their molecular cartography. Our data highlighted the singular composition of autophagy structures compared to other endomembranes identifying novel potential determinants of membrane formation, architecture and remodeling during autophagy. Notably, we found a soluble lipid-modifying enzyme associating with all compartments of the autophagy pathway: phagophore, autophagosome and autophagic bodies. Upon autophagy inducing conditions, this enzyme which is mostly active at acidic pH, relocalizes from the cytosol to the vacuolar lumen using autophagy as trafficking system. Integrating biochemistry, cell biology and genetics, we unraveled this protein and its closest homolog as the very first actors involved in the vacuolar stages of autophagy in plant cells. Together, our results establish a model proposing that these proteins mediate the disruption of autophagic bodies as the same rate as their delivery, thus efficiently instructing the antepenultimate step of the autophagy pathway
Berry cuticular and secondary compounds changes following heat stress contribute to resistance against Botrytis cinerea in grapevine
No full textInternational audienceVineyards are facing an increase in annual heat waves due to climate change which can interfere with grapevine diseases, and thus with wine quality and/or production. In addition, common practices, notably leaf removal, expose bunches to higher temperatures, particularly during fruit ripening. Such temperature rises modify berry metabolism and potentially the susceptibility to grapevine fungal diseases, such as gray mold caused by Botrytis cinerea (Bc). This fungus, by infecting berries in post-veraison stages, can reduce severely both yield and wine quality. Our research on fruiting cuttings endeavors to elucidate the intricate interplay between heat stress (HS; + 10°C) and tolerance to subsequent Bc infection. To reproduce vineyard microclimate, HS was applied focusing onto the bunch only, at herbaceous stage in Cabernet Sauvignon (CS) and Merlot (M). In vitro test, on detached berries inoculated 22 days post-HS, revealed an enhanced tolerance for CS berries stressed. However M berries, more tolerant than CS ones, were not affected significantly by HS. These results highlight a clear berry response to infection depending on both genetic background and the HS exposure. Based on the major result that fruit ripening (mid-veraison onset, sugar accumulation) and physiology (berry weight and volume) were unaltered significantly following HS, we investigated further the accumulation of preformed defense compounds and fruit physical barriers. We performed berry cuticle composition analyses (i.e. waxes and cutins), skin antifungal tannins assessment and entire-berry metabolomics, assuming that the compounds quantified could potentially account for the heat-induced tolerance. Although a clear difference in metabolites content between CS and M, we highlighted within CS the potential key role of both cutin monomers and skin condensed tannins in the heat-induced tolerance against Bc. Moreover, untargeted metabolomics revealed a range of unfamiliar compounds whose accumulation were potentially contributing to an increased resistance to the pathogen
État des lieux des pratiques de prescription des inhibiteurs sélectifs de la recapture de la sérotonine en soins primaires ambulatoires : étude quantitative transversale descriptive menée par observation des médecins maitres de stage en situation réelle de soins par les internes de phase socle en 2022 (étude AquISRS)
No full textIntroduction: SSRIs are at the forefront of treating the most common psychiatric conditions in primary care, such as MDD and anxiety disorders. However, questions are emerging in the medical literature, particularly regarding non-compliant prescribing durations and practices, as well as a questioned safety. In this context, the AquISRS study was created to conduct a comprehensive assessment of SSRI prescriptions in general practice in the Aquitaine region. Methods: this was a cross-sectional, quantitative, descriptive, multicenter, real-time study. Data were collected by general practice interns at the level 1 practitioner stage, observing SSRI prescriptions from their university internship supervisor. Results: we analyzed 386 data collection sheets. SSRI prescriptions were compliant with do-sages, but less so with indications, with 62 patients treated for mild MDD and 22 patients treated off-label. 18% of the initial prescription group was off-label in terms of duration, and 33% of the renewal group exceeded two years of treatment. Co-prescription of psychotropic drugs accounted for 31% and 38% of these two groups, respectively, with benzodiazepines largely dominating. Adverse effects were reported by 63% of practitioners for initial prescrip-tions and sought by 27% for renewals. Conclusion: three main issues emerge: very long prescription durations, relatively frequent co-prescription of psychotropic drugs, and insufficient information from practitioners about adverse effects. These issues contribute to the chronicity of treatments, an increased risk of polypharmacy, and poor patient compliance. There therefore appear to be areas for improving SSRI prescription practices in general medicine.Introduction : les ISRS sont au premier plan dans le traitement des pathologies psychiatriques les plus rencontrées en soins primaires telles que l’EDC et les troubles anxieux. Cependant, des questionnements apparaissent dans la littérature concernant notamment des durées et des pratiques de prescription non conformes ainsi qu’une innocuité remise en question. Dans ce contexte, l’étude AquISRS a été créée afin de réaliser un état des lieux global des prescriptions d’ISRS en médecine générale dans le territoire aquitain. Matériel et méthodes : il s’agissait d’une étude transversale, quantitative, descriptive, multicentrique, en temps réel. Les données ont été recueillies par des internes de médecine générale en stade de praticien niveau 1, en observant les prescriptions d’ISRS de leurs MSU. Résultats : nous avons analysé 386 fiches de recueil de données. Les prescriptions d’ISRS étaient conformes pour les posologies, moins pour les indications avec 62 patients traités pour un EDC léger et 22 patients traités hors-AMM. 18% du groupe primo-prescription était hors recommandations en termes de durée et 33% du groupe renouvellement dépassait les 2 ans de traitement. La co-prescription de psychotropes représentait respectivement 31% et 38% de ces deux groupes, largement dominée par les benzodiazépines. Les effets indésirables étaient annoncés par 63% des praticiens pour la primo-prescription et recherchés par 27% pour le renouvellement. Conclusion : trois problématiques principales ressortent : des durées de prescription très longues, une co-prescription de psychotropes relativement fréquente ainsi qu’une information par les praticiens sur les effets indésirables encore insuffisante. Ces problématiques participent à la chronicisation des traitements, à un risque accru de polymédication et à une mauvaise observance des patients. Il semble donc exister des axes d’amélioration des pratiques de prescription des ISRS en médecine générale
Biomimetic metal-phenolic network-coated elastin-like polypeptide micelles as an immunogenic cell death inducer for orthotopic glioma sonodynamic-chemodynamic-immune therapy
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Optimisation de la micronutrition pour la performance, la récupération et la santé des traileurs : une approche intégrée
No full textThis thesis analyzes the complex interplay between performance and health in trail running, a demanding discipline characterized by prolonged exertion, varied terrain, and often extreme envi-ronmental conditions. The main objective is to demonstrate how the physiological adaptations specific to trail running create an increased need for micronutrients, which are essential for optimizing perfor-mance and protecting the body. The first part of this work highlights the fundamental role of micronutrients, vitamins, minerals, and trace elements, which are often underestimated compared to macronutrients. These elements actively participate as cofactors in metabolic processes essential for prolonged effort. The second part deepens this perspective by detailing the involvement of micronu-trients in energy production, oxygen transport, muscle contraction, and defense against oxidative stress, all of which are crucial during a trail run. The third part offers a pragmatic framework for sup-porting athletes, based on rigorous classifications such as that of the australian institute of sport, in order to guide personalized, safe, and tailored supplementation for the specific needs induced by the physiology of trail running. Although this study relies on a bibliographic review with limitations (lack of trail-specific data), it underscores the importance of prevention and health counseling. In conclusion, this thesis positions micronutrition as a key lever for combining performance and long-term health in trail runners, while also opening up prospects for future research aimed at better understanding and supporting the specific physiological needs of this practice.Cette thèse analyse la complexité de la performance et de la santé dans le trail running, discipline exigeante caractérisée par des efforts prolongés, des terrains variés et des conditions environnementales souvent extrêmes. L’objectif principal est de démontrer comment les adaptations physiologiques spécifiques au trail génèrent des besoins accrus en micronutriments, indispensables à l’optimisation de la performance et à la protection de l’organisme. La première partie met en lumière le rôle fondamental des micronutriments, vitamines, minéraux et oligoéléments, souvent sous-estimés par rapport aux macronutriments. Ces éléments participent activement en tant que cofacteurs dans les processus métaboliques essentiels à l’effort prolongé. La deuxième partie approfondit cette perspective en détaillant l’implication des micronutriments dans la production énergétique, le transport de l’oxygène, la contraction musculaire et la défense contre le stress oxydatif, toutes cruciales lors d’une course en trail. La troisième partie propose un cadre pragmatique d’accompagnement des athlètes, basé sur des classifications rigoureuses telles que celle de l’australian institute of sport, afin d’orienter une supplémentation personnalisée, sécurisée et adaptée aux besoins spécifiques induits par la physiologie de l’effort en trail. Bien que cette étude s’appuie sur une revue bibliographique comportant des limites (manque de données spécifiques au trail), elle souligne l’importance de la prévention et du conseil en santé. En conclusion, cette thèse positionne la micronutrition comme un levier essentiel pour allier performance et santé durable chez le trailer, tout en ouvrant des perspectives pour des recherches futures visant à mieux comprendre et soutenir les besoins physiologiques spécifiques à cette pratique
Frontières et mobilités dans les processus de conservation transfrontalière de la nature : approche comparative entre le parc transfrontalier du Grand Limpopo (Afrique du Sud-Mozambique) et le parc européen Alpi Marittime-Mercantour (France-Italie)
No full textAgainst a backdrop of multiple environmental crises, including the observed decline in biodiversity, and the globalization of the nature conservation sector, many contiguous protected areas on either side of international borders are the subject of cross-border cooperation between at least two states and at different scales. These are referred to as transboundary protected areas, which are the spatial and political outcomes of transboundary conservation processes. This geography thesis examines the territorial effects of these processes by analyzing the dynamics and interactions between borders, protected areas and the mobility practices of a wide range of stakeholders (local populations, tourists, conservationists). More specifically, this research mobilizes a comparative approach between two transboundary protected areas: the Great Limpopo Transfrontier Park in southern Africa, in its part shared between South Africa with the Kruger National Park and Mozambique with the Limpopo National Park; and the European Alpi Marittime-Mercantour Park located in the southern Alps between France and Italy. This work is based on an approach that blends border studies and environmental geography. It is also based on a review of scientific literature focusing on the environmental dimension of borders and cross-border issues, and on the challenges associated with biodiversity conservation. Finally, this research relies on the collection of data from multi-site surveys (South Africa, Mozambique, France and Italy), during which semi-structured interviews were conducted with local populations, tourists and people involved in the conservation sector.Dans un contexte de crises environnementales multiples, parmi lesquelles le déclin observé de la biodiversité, et de globalisation du secteur de la conservation de la nature, de nombreuses aires protégées contiguës de part et d’autre de frontières internationales font l’objet de coopération transfrontalière entre au moins deux États et à différentes échelles. On parle, pour les désigner, d’aires protégées transfrontalières qui sont les résultantes spatiales et politiques de processus de conservation transfrontalière. Cette thèse en géographie s’intéresse aux effets territoriaux de ces processus à travers l’analyse des dynamiques et des interactions entre frontières, aires protégées et pratiques de mobilité d’une pluralité d’acteur·rices (populations locales, touristes, acteur·rices de la conservation). Cette recherche mobilise plus spécifiquement une approche comparative entre deux aires protégées transfrontalières : le parc du Grand Limpopo en Afrique australe, dans sa partie partagée entre l’Afrique du Sud avec le parc national Kruger et le Mozambique avec le parc national du Limpopo ; et le parc européen Alpi Marittime-Mercantour situé dans les Alpes du Sud entre la France et l’Italie. Ce travail se base sur une approche qui mêle border studies et géographie environnementale ainsi que sur la revue d’une littérature scientifique axée sur la dimension environnementale des frontières et du transfrontalier, et sur les enjeux associés à la conservation de la biodiversité. Cette recherche s’appuie en outre sur la constitution de données à partir d’enquêtes menées sur des terrains multi-situés (Afrique du Sud, Mozambique, France et Italie) où cours desquelles des entretiens semi-directifs ont été réalisés auprès de populations locales, de touristes et de personnes impliquées dans le secteur de la conservation
White wine lees as a source of antioxidants: Insights into their chemical profile
No full textInternational audienceWhite wine lees are known to enhance the oxidative stability of white wine, but the complete set of compounds responsible for this property remain unidentified. Furthermore, due to matrix variability, the studies on the overall composition of lees are not exhaustive. In order to bring new insights, phytochemical constituents of 41 white wine lees samples were characterised, including tartaric acid, lipids, proteins, polysaccharides, polyphenols, and total sulfhydryl compounds. Targeted quantification of polyphenols (phenolic acids, flavanols, flavonols, stilbenoids) and glutathione was performed using UHPLC-HRMS, and correlated with measured antiradical activity (DPPH method). Results revealed significant variability in composition and antioxidant capacity among lees. Correlation analysis showed positive impact of polyphenols, particularly hydroxycinnamic acids, and total sulfhydryl compounds on antioxidant potential. The absence of correlation with glutathione suggests that other sulfhydryl compounds may contribute to antiradical activity. These findings offer valuable insights into the bioactivity and antioxidant potential of white wine lees.</div
Exploring the role of climate in esca disease incidence through 20 years of large-scale vineyard monitoring in France
No full textInternational audienceDieback, caused by biotic and abiotic factors, reduces productivity and increases mortality inperennial plants. Grapevines are particularly affected, notably by wood diseases andincreasingly frequent droughts and heat waves. Among wood diseases, esca is particularlydamaging and is characterised by the expression of leaf symptoms in vineyards during thesummer. However, the factors influencing esca incidence remain poorly understood.Modelling the role of climatic factors, on large spatial and temporal scales, would help toimprove our understanding of the risk factors for this disease. To study the intra-seasonal andinter-annual variation in the incidence of esca expression in relation to climate in France, twotypes of approach were used with SAFRAN climate indicators estimated on 8x8km grids. Thefirst, based on 50 plots in the south-west and 11 grape varieties monitored weekly between2003 and 2021, analysed the impact of climate on the weekly incidence of esca. The second,on 493 plots in six wine-growing regions and 10 grape varieties (2003-2022), explored theeffect of climate and vine phenology (via ecoclimatic indicators) on the annual incidence ofsymptoms. Our results show that a warmer climate before the expression of esca symptomsleads to earlier symptoms during the season and increases the weekly proportion ofsymptomatic vines, except in the case of drought, as esca is inhibited by low soil humidity.Annual incidence depends on the climate during the growing season of each grapevinevariety. Overall, the incidence of esca is correlated with rising temperatures over the year,but is inhibited by factors limiting plant transpiration, such as a high VPD (vapour pressuredeficit). These results offer prospects for a better understanding of the interactions betweenplants, climate and diseases, and thus for anticipating the risk of grapevine dieback
