273 research outputs found

    Airway remodeling and its reversibility in equine asthma

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    Despite effective therapies for controlling its clinical manifestations, human asthma remains an incurable disease. It is now recognized that inflammation induced structural changes (remodeling) of the airways are responsible for the progressive loss of lung function in asthmatic patients. However, the peripheral airways, where most of the remodeling occurs in severe asthmatic patients, cannot be safely sampled in humans, and therefore, little is known of the effects of current therapies at reversing the established asthmatic remodeling, especially those occurring in the peripheral airways.Animal models have been studied to unravel etiological, immunopathological, and genetic attributes leading to asthma. However, experiments in which the disease is artificially induced have been shown to have limited translational potential for humans. To the contrary, horses naturally suffer from an asthma-like condition which shares marked similarities with human asthma making this model unique to investigate the kinetics, reversibility, as well as the physiological consequences of tissue remodeling (Bullone and Lavoie 2015).We reported an increased deposition of smooth muscle, collagen and elastic fibers in the peripheral airways of affected horses, which was correlated with the lung function (Herszberg et al., 2006; Setlakwe et al., 2014). The airway subepithelial collagen depositions were almost completely reversed with 6 to 12 months of treatment with either antigen avoidance or inhaled corticosteroids (ICS) administration, and there was a modest (30% on average) decrease in airway smooth muscle (Leclere et al., 2011). A recent study also found that ICS combined with long-acting ß2-agonists drugs (LABA) and ICS monotherapy similarly induced a 30% decrease of the airway smooth muscle mass at 3 months (Buollone, 2017). However, only ICS/LABA and antigen avoidance decreased airway luminal neutrophilia.The findings indicate the enhance therapeutic effect of ICS/LABA over ICS monotherapy at controlling asthma exacerbations in humans may be due to their anti-remodeling and anti-inflammatory effects. However, airway smooth muscle remodeling is only partially reversible with current anti-asthma medications

    De I'URSS à la Russie : les institutions internationales de sécurité au service d'une superpuissance en chute libre

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    Constatant que sa puissance diminuait à vue d'oeil, la Russie, tout comme VURSS à la veille de sa dissolution, a recouru aux us afin de préserver ses prérogatives d'une grande puissance menacées par les grands bouleversements géopolitiques. L'article montre à travers trois études de cas combien VURSS durant la crise du Golfe s'efforça à grand-peine de sauvegarder ses intérêts sérieusement entamés ; expérience que la Russie connaîtra avec l'élargissement de I'OTAN vers les pays de l'Europe centrale et orientale. Seule au Conseil de sécurité la puissance grandement amoindrie de la Russie paraît être à l'abri. L'article conclut que la Russie est placée constamment dans des contraintes institutionnelles qui lui échappent malgré ses tentatives d'employer les us existantes pour arrêter l'hémorragie de son influence historique mondiale.Aware that its power was diminishing rapidly, Russia, in the same way as the Soviet Union at the eve of its dissolution, resorted to its in order to preserve its great-power prerogatives threatened as they were by major geopolitical reversals. Through three case studies, this article shows to what extent the Soviet Union during the Gulf Crisis sought with considerable difficulty to forestall the downgrading of its power; an experience repeated by Russia in the NATO enlargement issue. Only at the Security Council does Russia's power seem to be in a relatively safe place. The article concludes that Russia finds itself constantly placed under institutional constraints despite its efforts to stop the downfall of its world historical influence

    Le partenariat professionnel – famille dans les soins aux personnes âgées. Un enjeu de reconnaissance

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    L’État québécois, à l’instar d’autres dans le monde, appelle au partenariat entre l’État et la famille. Ce partenariat toutefois se construira dans le quotidien des échanges entre intervenants et aidants, et exige une certaine congruence entre ces deux groupes sur le plan des attentes mutuelles et des responsabilités attribuées à l’autre. Quatre études menées par les auteurs indiquent plutôt des normes quant à la responsabilité familiale dans les soins et des attentes divergentes. Elles expliqueraient les tensions relevées entre les deux groupes et soulèvent des enjeux de reconnaissance de part et d’autre. Une reconnaissance mutuelle apparaît comme fondamentale dans l’instauration d’une relation partenariale entre intervenants et aidants.The Quebec government, like others around the world, is calling for a partnership between the state and the family in order to provide for the vulnerable elderly. However, this partnership will be built through daily exchanges between formal and informal carers, and will require some agreement between the two groups with respect to what they expect of each other and the responsibilities they attribute to each other. Four studies by the authors provide indications of norms for family responsibility in caring and divergent expectations. They would appear to explain the tension noted between the two groups and raise recognition issues on both sides. Mutual recognition seems to be fundamental to the establishment of a true partnership between formal and informal carers

    L’aide apportée par des tiers et les réactions des aidantes naturelles à la prise en charge de personnes âgées en perte d’autonomie

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    Cet article s'intéresse à la relation entre, d'une part, l'aide apportée par des tiers et, d'autre part, le fardeau ressenti et la dépression pour les aidantes principales de personnes âgées souffrant de problèmes physiques ou cognitifs. Les auteurs avancent l'hypothèse que le soutien social ne constitue pas une entité homogène et que les différents types d'aide apportée sont susceptibles d'avoir des effets différents sur les réactions adverses à la prise en charge. Les données proviennent d'une étude menée en 1990, dans la région de Montréal, auprès de 159 aidantes co-résidant avec la personne aidée et demandeurs de services de la part du réseau formel et le réseau informel. Les analyses de régression hiérarchique montrent le rôle restreint des variables d'aide apportée par le réseau dans l'explication des niveaux de dépression et de fardeau et confirment l'hypothèse d'un spectre d'action étroit de ces variables.This article is about the relation between, on the one hand, support provided by third parties and, on the other, the burden and the depression experienced by the main female supporters who care for the elderly suffering from physical or cognitive problems. The authors examine the hypothesis that social support is not homogeneous accross the board and that the different types of support are likely to have different effects on elders with adverse reactions to the caring process. Data originates from a study that was conducted in the Montréal area in 1990 with 159 female supporters living with an elder requiring care who requested support services from formal and informal networks. Hierarchical regression analyses show that the variables in connection with care dispensed by the network play a limited role in attempting to explain the depression and burden levels. Furthermore, these analyses confirm the hypothesis of the variables' narrow range of influence

    Revisiting the Role of Neighbourhood Change in Social Exclusion and Inclusion of Older People

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    Objective. To explore how older people who are “aging in place” are affected when the urban neighbourhoods in which they are aging are themselves undergoing socioeconomic and demographic change. Methods. A qualitative case study was conducted in two contrasting neighbourhoods in Montréal (Québec, Canada), the analysis drawing on concepts of social exclusion and attachment. Results. Participants express variable levels of attachment to neighbourhood. Gentrification triggered processes of social exclusion among older adults: loss of social spaces dedicated to older people led to social disconnectedness, invisibility, and loss of political influence on neighbourhood planning. Conversely, certain changes in a disadvantaged neighbourhood fostered their social inclusion. Conclusion. This study thus highlights the importance of examining the impacts of neighbourhood change when exploring the dynamics of aging in place and when considering interventions to maintain quality of life of those concerned

    Vieilliront-ils un jour ? Les baby-boomers aidants face à leur vieillissement

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    Au Québec, un nombre grandissant de personnes aidantes sont issues du baby-boom. Au cours d’entrevues portant sur leur expérience d’aidant, nous les avons questionnées sur leur perception de la vieillesse et du vieillissement, afin de faire ressortir plus spécifiquement leur discours au sujet de leur propre vieillissement, les façons dont elles s’y préparent et les exigences énoncées envers les services de santé et, plus particulièrement, les services publics, pour les accompagner dans un vieillissement qu’elles souhaitent radicalement différent de celui de leurs parents.In Quebec, baby boomers are increasingly becoming carers. In interviews about their experiences as carers, we asked them about their perceptions of old age and aging, to find out specifically what they have to say about their own aging, what they are doing to get ready for it and what this means in terms of demands on health care and, especially, public services to help and assist them in an aging process that they want to be radically different from that of their own parents

    Assessment of pulmonary vascular smooth muscle remodeling in severe equine asthma

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    Severe equine asthma (SEA) is characterized by reversible airway obstruction and hypoxemia. Pulmonary hypoxic vasoconstriction occurs during SEA exacerbation, inducing pulmonary hypertension (PH). However, PH is only partially reversed by oxygen administration, and other etiological factors are uninvestigated (Dixon 1978). In rodent asthma models, airway inflammation is associated with pulmonary artery (PA) remodeling (Rydell-Tormanen, Uller et al. 2009), that could contribute to PH, as known in human chronic obstructive pulmonary disease (Barbera, Peinado et al. 2003). We investigated the presence of PA remodeling in SEA, the involvement of vascular smooth muscle (VSM) alterations and their reversibility following long-term antigen avoidance or inhaled corticosteroids. Using histomorphometry, the PA wall was measured on sections stained with hematoxylin-eosin saffron, collected post-mortem from different lung regions of 12 asthmatic horses and 6 controls. Pulmonary vascular smooth muscle (VSM) mass was measured on sections stained for α-smooth muscle actin collected with in vivo thoracoscopy or post-mortem peripheral lung biopsy from 5 controls, 6 asthmatic horses in remission, and 11 asthmatic horses while exacerbation and after 1 year of antigen avoidance alone (5 horses) or treatment with fluticasone (6 horses). Data were compared using unpaired t test with Welch correction or paired t test (p<0.05). PA wall surface percentage was increased in apical (p=0.003) and caudo-dorsal (p=0.03) lung regions (respectively 50,66±13,16% and 50,56±15,02) of asthmatic horses, when compared to controls (respectively 35,38±7,06% and 38,13±10,18). Similarly, VSM mass percentage was increased (p=0.03) in asthmatic horses (47,77±3,17%), compared to controls (41,07±6,22%). A tendency for normalization of the VSM mass was observed after treatment with antigen avoidance (p=0.05; 39,64±4,02%), but not with fluticasone (p=0.27; 45,35±14,98%). Remodeling of the PA occurs in SEA and the increase in VSM could lead to lumen narrowing and enhance hypoxic vasoconstriction, contributing to PH during exacerbation. VSM mass normalization is more effectively obtained by antigen avoidance than by corticosteroids
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