Exposition des enfants à la fumée passive: le point sur des campagnes de sensibilisation

Enfants de moins de 10 ans fumant passivement 14 cigarettes ! D'avril 2010 à avril 2011, l'exposition de 148 enfants (81 garçons et 67 filles) a été testée: 10 enfants de moins d'un an, 25 de 1 à 5 ans, 19 de 5 à 10 ans, 30 de 10 à 15 ans et 64 de 15 à 18 ans. 10 d'entre eux sont des fumeurs et la plus jeune de 14 ans fume 10 cigarettes par jour. Leurs parents, ou parfois des jeunes eux-mêmes, ont commandé de manière volontaire, via les sites Internet des CIPRET Valais, Vaud et Genève, un badge MoNIC gratuit. Les résultats quant à l'exposition de ces enfants interpellent et méritent l'attention.Pour l'ensemble des enfants, la concentration moyenne de nicotine dans leur environnement intérieur mesurée via les dispositifs MoNIC est de 0,5 mg/m3, avec des maximums pouvant aller jusqu'à 21 mg/m3. Pour le collectif d'enfants âgés de moins de 10 ans (26 garçons et 28 filles; tous non-fumeurs), la concentration de nicotine n'est pas négligeable (moyenne 0,069 mg/m3, min 0, max 0,583 mg/m3). En convertissant ce résultat en équivalent de cigarettes inhalées passivement, nous obtenons des chiffres allant de 0 à 14 cigarettes par jour* avec une moyenne se situant à 1.6 cig/j. Encore plus surprenant, les enfants de moins d'un an (4 garçons et 6 filles) inhalent passivement, dans le cadre familial, en moyenne 1 cigarette (min 0, max 2.2). Pour les deux autres collectifs: 10-15 ans et 15-18 ans, les valeurs maximales avoisinent les 22 cigarettes. Notons cependant que ce résultat est influencé, ce qui n'est pas le cas des enfants plus jeunes, par le fait que ces jeunes sont également parfois des fumeurs actifs.* Quand la durée d'exposition dépassait 1 jour (8 heures), le nombre d'heures a toujours été divisé par 8 heures. Le résultat obtenu donne l'équivalent de cigarettes fumées passivement en huit heures. Il s'agit de ce fait d'une moyenne, ce qui veut dire que durant cette période les enfants ont pu être exposés irrégulièrement à des valeurs supérieures ou inférieures à cette moyenne. [Auteurs]

Fas (CD95/APO-1) limits the expansion of T lymphocytes in an environment of limited T-cell antigen receptor/MHC contacts.

Fas-deficient mice (Fas(lpr/lpr)) and humans have profoundly dysregulated T lymphocyte homeostasis, which manifests as an accumulation of CD4(+) and CD8(+) T cells as well as an unusual population of CD4(-)CD8(-)TCRαβ(+) T cells. To date, no unifying model has explained both the increased T-cell numbers and the origin of the CD4(-)CD8(-)TCRαβ(+) T cells. As Fas(lpr/lpr) mice raised in a germ-free environment still manifest lymphadenopathy, we considered that this process is primarily driven by recurrent low-avidity TCR signaling in response to self-peptide/MHC as occurs during homeostatic proliferation. In these studies, we developed two independent systems to decrease the number of self-peptide/MHC contacts. First, expression of MHC class I was reduced in OT-I TCR transgenic mice. Although OT-I Fas(lpr/lpr) mice did not develop lymphadenopathy characteristic of Fas(lpr/lpr) mice, in the absence of MHC class I, OT-I Fas(lpr/lpr) T cells accumulated as both CD8(+) and CD4(-)CD8(-) T cells. In the second system, re-expression of β(2)m limited to thymic cortical epithelial cells of Fas(lpr/lpr) β(2)m-deficient mice yielded a model in which polyclonal CD8(+) thymocytes entered a peripheral environment devoid of MHC class I. These mice accumulated significantly greater numbers of CD4(-)CD8(-)TCRαβ(+) T cells than conventional Fas(lpr/lpr) mice. Thus, Fas shapes the peripheral T-cell repertoire by regulating the survival of a subset of T cells proliferating in response to limited self-peptide/MHC contacts.

Sepsis liées aux accès vasculaires : mise au point, développements récents et prévention [Catheter-related infections : owerview and lipdate]

Les infections liées aux accès vasculaires sont l'une des causes principales des infections nosocomiales. Elles englobent leur colonisation par des micro-organismes, les infections du site d'insertion et les bactériémies et fongémies qui leur sont attribuées. Une bactériémie complique en moyenne 3 à 5 voies veineuses sur 100, ou représente de 2 à 14 épisodes pour 1000 jour-cathéters. Cette proportion n'est que la partie visible de l'iceberg puisque la plupart des épisodes de sepsis clinique sans foyer infectieux apparent associé sont actuellement considérés comme secondaires aux accès vasculaires. Les principes thérapeutiques sont présentés après une brève revue de leur physiopathologie. Plusieurs approches préventives sont ensuite discutées, y compris des éléments récents sur l'utilisation de cathéters imprégnés de désinfectants ou d'antibiotiques.

A single point mutation in the pore region of the epithelial Na+ channel changes ion selectivity by modifying molecular sieving.

The epithelial Na+ channel (ENaC) belongs to a new class of channel proteins called the ENaC/DEG superfamily involved in epithelial Na+ transport, mechanotransduction, and neurotransmission. The role of ENaC in Na+ homeostasis and in the control of blood pressure has been demonstrated recently by the identification of mutations in ENaC beta and gamma subunits causing hypertension. The function of ENaC in Na+ reabsorption depends critically on its ability to discriminate between Na+ and other ions like K+ or Ca2+. ENaC is virtually impermeant to K+ ions, and the molecular basis for its high ionic selectivity is largely unknown. We have identified a conserved Ser residue in the second transmembrane domain of the ENaC alpha subunit (alphaS589), which when mutated allows larger ions such as K+, Rb+, Cs+, and divalent cations to pass through the channel. The relative ion permeability of each of the alphaS589 mutants is related inversely to the ionic radius of the permeant ion, indicating that alphaS589 mutations increase the molecular cutoff of the channel by modifying the pore geometry at the selectivity filter. Proper geometry of the pore is required to tightly accommodate Na+ and Li+ ions and to exclude larger cations. We provide evidence that ENaC discriminates between cations mainly on the basis of their size and the energy of dehydration.

Probing the role of point mutations in the cyp51A gene from Aspergillus fumigatus in the model yeast Saccharomyces cerevisiae.

Azole-resistant strains of Aspergillus fumigatus have been detected and the underlying molecular mechanisms of resistance characterized. Point mutations in the cyp51A gene have been proved to be related to azole resistance in A. fumigatus clinical strains and with different resistance profiles depending on the amino acid change (G54E, G54V, G54R, G54W, M220V, M220K, M220T, M220I). The aim of this work was to express A. fumigatus cyp51A genes in the yeast Saccharomyces cerevisiae in order to better assess the contribution of each independent amino acid substitution to resistance. A tetracycline regulatable system allowing repression of the endogenous essential ERG11 gene was used. The expression of Aspergillus cyp51A alleles could efficiently restore the absence of ERG11 in S. cerevisiae. In general, S. cerevisiae clones expressing. A. fumigatus cyp51A alleles from azole-resistant isolates showed higher MICs to all azoles tested than those expressing alleles from susceptible isolates. The azole susceptibility profiles obtained in S. cerevisiae upon expression of specific cyp51A alleles recapitulated susceptibility profiles observed from their A. fumigatus origins. In conclusion this work supports the concept that characteristics of specific A. fumigatus cyp51A alleles could be investigated in the heterologous host S. cerevisiae.

Médecine interne: le point de vue du chef de clinique [Internal medicine: the point of view of the chief resident].

Clinical practice in internal medicine has fundamentely changed over the last decade. Our knowledge has dramatically improved and we are facing new types of patients. Their number is increasing, they are older and suffer from increasingly complex medical conditions. The society has evolved as well therefore transforming our daily practice. This implies important modifications of our role and new challenges. We must also develop new aspects of our practice such as recognizing our errors, quality of care, quality of education, ethics, new strategies for taking care of the patient all this in parallel with continuous education. Our role as (general practitioner) is of utmost importance since it enables us to keep the "big pictures" in a more and more specialized environment.

Increased tender point counts before and after total hip arthroplasty are associated with poorer outcomes but are not individually predictive.

In a prospective study, total hip arthroplasty (THA) patients were assessed preoperatively and postoperatively (n = 95) to determine if tender points (TPs) are associated with poor THA outcomes. Patients with high follow-up TP counts had higher visual analog scale (VAS) for pain and sleep, higher follow-up Western Ontario and McMaster Universities Arthritis Index (pain, stiffness, function), lower Health Assessment Questionnaire, Harris Hip, and Short Form 36 (physical functioning, bodily pain, physical component summary) scores. High follow-up TP were associated with increased pain, pain not relieved by surgery, poor function, and poor sleep. Visual analog scale pain and sleep, Short Form 36 (physical functioning, bodily pain), Western Ontario and McMaster Universities Arthritis Index, Health Assessment Questionnaire, and Harris hip scores improved significantly after THA; TP scores did not. Higher preoperative TP were predictive of higher follow-up TP but were poorly predictive of poor outcome measures after surgery in individual patients, suggesting that preoperative TPs are contraindicative for THA.

Dépistage de l'athérosclérose: point de la situation en 2006. [Screening for atherosclerosis: 2006 update].

In recent years, several screening tests for subclinical atherosclerosis have been developed. The aim of these tests is to be able to better target preventive therapies to patients at high cardiovascular risk. However, the validity of these screening tests has not been well established for wide use in clinical practice. Being aware of these tests results might also enhance patient motivation to change unhealthy behaviors, such as smoking. However, the effectiveness of such strategy has been poorly studied. Early therapy of atherosclerosis has not been shown to improve clinical outcomes yet. Moreover, potential harms of such screening, such as induced anxiety, have been poorly studied. Although promising, such screening should be validated by clinical trials before routine use in clinical practice.

Le projet "SYNAPSY": un point de rencontre entre clinique et neurosciences [The "SYNAPSY" project: where psychiatrists and neuroscientists meet].

The National Center of Competence in Research project "SYNAPSY" aims at identifying certain mechanisms of psychiatric and cognitive disorders, in order to improve the understanding and the genesis of such pathologies, and to promote the development of better diagnostic tools and of new therapeutic approaches. It provides an excellent opportunity for clinical psychiatrists and neuroscientists to develop a synergic mode of collaboration. On the basis of questions stemming from clinical practice and in the frame of patients cohorts, various research projects in neuroscience should lead to progresses that may have a considerable impact on clinical practice.

Evaluation de deux structures à bas seuil de la ville de Lausanne : Le Passage et le Point d'eau

[Table des matières] 1. Méthodes d'évaluation. 2. Le Passage et le Point d'eau. 2.1. Historique et objectifs. 2.2. Etapes de la mise en route. 3.1. Professionnels salariés. 3.2. Bénévoles professionnels. 3.3. Bénévoles d'accueil. 4.1. Activités de la structure. 4.2. Accueil (animations, repas, collations). 4.3. L'offre socio-éducative. 4.4. L'offre sanitaire. 4.5. La distribution du matériel stérile. 5.1. Prestations d'hygiène. 5.2. Soins somatiques. 5.3. Activité sportive. 6.1. Profil des usagers. 6.2. Indicateurs socio-démographiques et d'intégration sociale. 6.3. Etat de santé perçu. 6.4. Fréquentation du réseau (dispositif bas seuil et autre) et de Point d'eau. 7. Consommation de drogues illégales. 8. Fréquentation de la structure. 9.1. Méthodes d'évaluation utilisées. 9.2. Evaluation du Passage et du Point d'eau.

Kinship, ritual kinship and political milieus in an alpine Valley in 19th century

In my paper I will present some results about ritual kinship and political mobilization of popular groups in an alpine Valley: the Val de Bagnes, in the Swiss canton of Valais. There are two major reasons to choose the Val de Bagnes for our inquiry about social networks: the existence of sharp political and social conflicts during the 18th and the 19th century and the availability of almost systematic genealogical data between 1700 and 1900. The starting point of my research focuses on this question: what role did kinship and ritual kinship play in the political mobilization of popular groups and in the organization of competing factions? This question allows us to shed light on some other uses and meanings of ritual kinship in the local society. Was ritual kinship a significant instrument for economic cooperation? Or was it a channel for patronage or for privileged social contacts? The analysis highlights the importance of kinship and godparentage for the building of homogeneous social and political networks. If we consider transactions between individuals, the analysis of 19th century Val de Bagnes gives the impression of quite open networks. Men and women tried to diversify their relations in order to avoid strong dependency from powerful patrons. Nevertheless, when we consider the family networks, we can notice that most relations took place in a structured social space or a specific "milieu", were intense contacts enhanced trust, although political allegiances and social choices were not fully predictable on the basis of such preferential patterns. In a politically conflictual society, like 19th century Bagnes, ritual kinship interacted with kinship solidarities and ideological factors shaping dense social networks mostly based on a common political orientation. Such milieus sustained the building of political factions, which show surprising stability over time. In this sense, milieus are important factors to understand political and religious polarization in 19th century Switzerland.