Equipes infirmières somatiques en soins aigus et infirmier en psychiatrie de liaison : quelle collaboration ?

Deux ans après la création du poste d'infirmier au sein du Service de psychiatrie de liaison du Centre hospitalier universitaire de Lausanne (CHUV), nous rendons compte ici de cette nouvelle pratique. En portant un regard extérieur sur les équipes infirmières, il s'agit de définir l'implication des difficultés relationnelles qu'elles peuvent rencontrer auprès d'un malade. Ce vécu difficile peut être influencé par des facteurs de stress liés au contexte des soins somatiques aigus, ceux-ci pouvant se surajouter à une problématique relationnelle ou psychiatrique. Nous postulons que l'infirmier en psychiatrie de liaison, de par sa position particulière (tiers extérieur, thérapeute, médiateur-traducteur) que nous définissons dans cet article, permet d'offrir des espaces intermédiaires de réflexions quant à une recherche de compréhension d'une relation soignant-soigné et de proposer des outils spécifiques aux équipes infirmières.

Collaboration entre cliniciens et chercheurs autour de la "consultation systémique": double regard sur un cas clinique

Cet article vise à montrer comment chercheurs et cliniciens peuvent collaborer et s'enrichir mutuellement en utilisant la «consultation systémique», en deux séances, dont le but est l'évaluation des interactions familiales, avec mise en lumière des ressources comme des difficultés de la famille. Lors d'une première rencontre, les questions qui motivent les parents et/ou le(s) thérapeute(s) à consulter sont formulées et la famille est invitée à faire des jeux familiaux semi-standardisés qui sont filmés. Lors d'une deuxième rencontre réunissant les mêmes personnes, un visionnement d'extraits des films sert de base aux réponses des chercheurs et à une discussion commune. Une vignette clinique, concernant des violences intrafamiliales, illustrera la richesse et l'utilité de ces consultations et montrera qu'une collaboration entre chercheurs et cliniciens est fructueuse pour toutes les parties concernées.

Coculture of bladder urothelial and smooth muscle cells on small intestinal submucosa: potential applications for tissue engineering technology.

PURPOSE: Small intestinal submucosa is a xenogenic, acellular, collagen rich membrane with inherent growth factors that has previously been shown to promote in vivo bladder regeneration. We evaluate in vitro use of small intestinal submucosa to support the individual and combined growth of bladder urothelial cells and smooth muscle cells for potential use in tissue engineering techniques, and in vitro study of the cellular mechanisms involved in bladder regeneration. MATERIALS AND METHODS: Primary cultures of human bladder urothelial cells and smooth muscle cells were established using standard enzymatic digestion or explant techniques. Cultured cells were then seeded on small intestinal submucosa at a density of 1 x 105 cells per cm.2, incubated and harvested at 3, 7, 14 and 28 days. The 5 separate culture methods evaluated were urothelial cells seeded alone on the mucosal surface of small intestinal submucosa, smooth muscle cells seeded alone on the mucosal surface, layered coculture of smooth muscle cells seeded on the mucosal surface followed by urothelial cells 1 hour later, sandwich coculture of smooth muscle cells seeded on the serosal surface followed by seeding of urothelial cells on the mucosal surface 24 hours later, and mixed coculture of urothelial cells and smooth muscle cells mixed and seeded together on the mucosal surface. Following harvesting at the designated time points small intestinal submucosa cell constructs were formalin fixed and processed for routine histology including Masson trichrome staining. Specific cell growth characteristics were studied with particular attention to cell morphology, cell proliferation and layering, cell sorting, presence of a pseudostratified urothelium and matrix penetrance. To aid in the identification of smooth muscle cells and urothelial cells in the coculture groups, immunohistochemical analysis was performed with antibodies to alpha-smooth muscle actin and cytokeratins AE1/AE3. RESULTS: Progressive 3-dimensional growth of urothelial cells and smooth muscle cells occurred in vitro on small intestinal submucosa. When seeded alone urothelial cells and smooth muscle cells grew in several layers with minimal to no matrix penetration. In contrast, layered, mixed and sandwich coculture methods demonstrated significant enhancement of smooth muscle cell penetration of the membrane. The layered and sandwich coculture techniques resulted in organized cell sorting, formation of a well-defined pseudostratified urothelium and multilayered smooth muscle cells with enhanced matrix penetration. With the mixed coculture technique there was no evidence of cell sorting although matrix penetrance by the smooth muscle cells was evident. Immunohistochemical studies demonstrated that urothelial cells and smooth muscle cells maintain the expression of the phenotypic markers of differentiation alpha-smooth muscle actin and cytokeratins AE1/AE3. CONCLUSIONS: Small intestinal submucosa supports the 3-dimensional growth of human bladder cells in vitro. Successful combined growth of bladder cells on small intestinal submucosa with different seeding techniques has important future clinical implications with respect to tissue engineering technology. The results of our study demonstrate that there are important smooth muscle cell-epithelial cell interactions involved in determining the type of in vitro cell growth that occurs on small intestinal submucosa. Small intestinal submucosa is a valuable tool for in vitro study of the cell-cell and cell-matrix interactions that are involved in regeneration and various disease processes of the bladder.

Metabolic engineering of plants for the synthesis of polyhydroxyalkanoates

Synthesis of polyhydroxyalkanoates (PHAs) in crop is viewed as an attractive approach for the production of this family of biodegradable plastics in large quantities and at low costs. Synthesisof PHAs containing various monomers has so far been demonstrated in the cytosol, plastids, and peroxisomes of plants. Several biochemical pathways have been modifies to achieve this, including the isoprenois pathway, the fatty acid biosynthetic pathway, and the fatty acid

Chemical Functionalization of Bioceramics To Enhance Endothelial Cells Adhesion for Tissue Engineering.

To control the selective adhesion of human endothelial cells and human serum proteins to bioceramics of different compositions, a multifunctional ligand containing a cyclic arginine-glycine-aspartate (RGD) peptide, a tetraethylene glycol spacer, and a gallate moiety was designed, synthesized, and characterized. The binding of this ligand to alumina-based, hydroxyapatite-based, and calcium phosphate-based bioceramics was demonstrated. The conjugation of this ligand to the bioceramics induced a decrease in the nonselective and integrin-selective binding of human serum proteins, whereas the binding and adhesion of human endothelial cells was enhanced, dependent on the particular bioceramics.

Etude romande sur le jeu: une collaboration entre IUMSP et ISPA sur mandat du Programme Intercantonal de Lutte contre la Dépendance au Jeu (PILDJ)

En Suisse, l'offre en matière de jeu est très importante. Que ce soit pour les loteries ou les casinos, les revenus bruts des jeux (RBJ) ont augmenté considérablement au cours de ces dix dernières années. Une offre de prévention et de traitement s'est développée en Suisse romande et le nombre de joueurs qui consultent ne cesse d'augmenter. Toutefois, il n'en reste pas moins qu'il s'agit là d'une petite proportion des joueurs problématiques qui font appel aux services d'aide. Le Programme intercantonal de lutte contre la dépendance au jeu (PILDJ) vise en premier lieu à sensibiliser la population au problème du jeu excessif. Il prévoit pour cela, notamment, de faciliter l'accès à l'information et au traitement. Par ailleurs, il a aussi pour objectif de sensibiliser les professionnels, afin d'améliorer la détection et la prise en charge des joueurs pathologiques. Le PILDJ entend finalement centraliser les informations relatives aux actions menées dans les cantons afin d'améliorer l'échange d'expériences. La coordination de ce Programme a été confiée au Groupement romand d'études des addictions (GREA). Le PILDJ comprend la mise sur pied de 4 modules parmi lesquels figure l'Etude romande sur le jeu. Ce rapport présente les résultats des volets couverts par l'Etude romande sur le jeu. [résumé, p. 5]

Collaboration entre médecin de famille et psychiatre pour les problèmes de santé mentale [Family physicians and psychiatrists' collaborative care for mental health problems].

The burden of disease linked to mental disorders represents more than one-fifth of years lived with disability in the world. Less than half of people suffering from mental disorders are adequately treated. Three quarter of those who receive treatment are followed by primary care. Collaborative care aims to increase the efficiency of direct general practitioner's treatment. Main components are sustainable and individualized consultation-liaison relationship (1/2 day of psychiatrist by 15 days for 10-15 general practitioners), and support of a clinical case manager for complex situations. Collaboration is bidirectional: early or crisis access to specialist care and long-term followup by general practitioner. This model is a challenge for the doctor-patient dual relationship and requires incentives in a public health perspective.

Preimplantation genetic diagnosis (PGD) for HLA typing: bases for setting up an open international collaboration when PGD is not available.

In severe forms of Diamond-Blackfan anemia, preimplantation genetic diagnosis (PGD) of histocompatibility leukocyte antigen-compatible embryos for enabling the next sibling in the family to be a stem-cell transplantation donor constitutes the sole lasting cure capable of terminating the enduring need for iterative transfusions. We report here an open collaboration between two renowned institutions to provide a family desiring this treatment even though they resided where the preimplantation genetic diagnosis procedure is banned.

Engineering tolerance into transplanted beta cell lines.

In this paper we explore the possibility of improving, by genetic engineering, the resistance of insulin-secreting cells to the metabolic and inflammatory stresses that are anticipated to limit their function and survival when encapsulated and transplanted in a type 1 diabetic environment. We show that transfer of the Bcl-2 antiapoptotic gene, and of genes specifically interfering with cytokine intracellular signaling pathways, greatly improves resistance of the cells to metabolic limitations and inflammatory stresses.

IL-17F co-expression improves cell growth characteristics and enhances recombinant protein production during CHO cell line engineering.

The generation of a high productivity cell line is a critical step in the production of a therapeutic protein. Many innovative engineering strategies have been devised in order to maximize the expression rate of production cells for increased process efficiency. Less effort has focused on improvements to the cell line generation process, which is typically long and laborious when using mammalian cells. Based on unexpected findings when generating stable CHO cell lines expressing human IL-17F, we studied the benefit of expressing this protein during the establishment of production cell lines. We demonstrate that IL-17F expression enhances the rate of selection and overall number of selected cell lines as well as their transgene expression levels. We also show that this benefit is observed with different parental CHO cell lines and selection systems. Furthermore, IL-17F expression improves the efficiency of cell line subcloning processes. IL-17F can therefore be exploited in a standard manufacturing process to obtain higher productivity clones in a reduced time frame.