Comparaison de l’utilisation des urgences du CHUV entre les usagers fréquents des urgences requérants d’asile et non requérants d’asile

Contexte : Une des explications du nombre important de consultations aux urgences sont les visites récurrentes des usagers fréquents (UF) des urgences, qui ont été définis comme revenant 5 fois et plus aux urgences sur une période de 12 mois. Plusieurs caractéristiques communes entre les usagers fréquents des urgences et les requérants d’asiles nous ont poussé à nous intéresser à un potentiel lien dans leurs parcours au sein du service des urgences. L’objectif de cette étude est de déterminer quelle est l’utilisation des urgences des usagers fréquents requérants d’asile (UF-RDA), en comparaison aux usagers fréquents des urgences non requérants d’asile (UF-NRDA), en s’appuyant de facteurs sociodémographiques et médicaux. Par la suite, nous essaierons d’expliquer l’origine et les conséquences des différences d’utilisation des urgences constatées entre les UF-RDA et les UF-NRDA. Méthodologie : Nous avons effectué une étude comparative de la totalité des usagers fréquents des urgences du 1er août 2016 au 31 juillet 2019. Des statistiques descriptives ont été faites pour les facteurs socio-démographiques en utilisant le test de Wilcoxon-Mann-Whitney et le test du χ2. Concernant l’analyse des visites, qui sont des facteurs nichés par patients, nous avons utilisé un modèle de régression linéaire ajusté pour l’âge et le sexe. . Résultats : Nous avons étudié un total de 1260 patients majeurs, avec 1167 UF non requérants d’asile et 93 UF requérants d’asile, et 8248 visites durant la période allant du 1er août 2016 au 31 juillet 2019. Ainsi, 7.38% des usagers fréquents des urgences sont des requérants d’asile durant ce temps déterminé. Le nombre de visites par patient entre les deux groupes est semblable, avec une moyenne de 6,57 visites par an pour les UF-RDA et de 6,53 visites pour les UF-NDRA. Concernant les variables qui attestent de la capacité de communication des patients, les UF-RDA parlent une autre langue que le français dans 67,74% des cas et le recours à l’interprétariat a été notifié dans 9,68% des patients UF- DRA. Cependant, le recensement des langues parlées manque dans 38,89% des cas. Concernant les visites, les UF-RDA tendent à venir moins la nuit que les UF-NRDA (OR=0.78), plutôt pour des degrés de triage moins urgents que les UF-NRDA (OR=0.56) et l’orientation des UF-RDA suite à l’admission aux urgences est considérablement faite vers la PMU-Unisanté (policlinique médicale universitaire) en comparaison aux UF-NRDA (OR=2.68). Aucune différence significative n’apparait entre les UF-RDA et UF-NRDA quant à la provenance des patients aux urgences ou dans leur motif de consultation. Nous avons également constaté que le recensement de la douleur était significativement moins effectué pour les UF-RDA. . Conclusion : Dans cette étude, nous constatons que seulement 7,8% des UF sont des requérants d’asile, mais cela consiste en une surreprésentation comparée au pourcentage de requérants d’asile dans la population vaudoise. Cela peut s’expliquer en partie par l’utilisation des urgences par les requérants d’asile pour des pathologies avec un degré de triage significativement moins urgent que les UF-NRDA. Nous avons émis l’hypothèse que cela est dû en partie à une méconnaissance du système de santé et à une culture des soins différente dans leur pays d’origine. Cela expliquerait également le fait que les patients UF-RDA soient plus souvent redirigés vers la PMU-Unisanté que les non-requérants d’asile au vu de leur pathologie non urgente. De plus, au vu du manque de maîtrise du français, cela peut les mener à une incompréhension de leur maladie, des possibles traitements, et du suivi, ce qui peut entraîner les requérants d’asile à venir plus souvent aux urgences et ainsi à devenir un usager fréquent des urgences

Differential Expression of the Demosponge (Suberites domuncula) Carotenoid Oxygenases in Response to Light: Protection Mechanism Against the Self-Produced Toxic Protein (Suberitine)

The demosponge Suberites domuncula has been described to contain high levels of a proteinaceous toxin, Suberitine, that displays haemolytic activityIn the present study this 7–8 kDa polypeptide has been isolated and was shown to exhibit also cytotoxic effects on cells of the same species. Addition of retinal, a recently identified metabolite of β-carotene that is abundantly present in S. domuncula was found to reduce both the haemolytic and the cell toxic activity of Suberitine at a molar ratio of 1:1. Spectroscopic analyses revealed that the interaction between β-carotene and Suberitine can be ascribed to a reversible energy transfer reaction. The enzyme that synthesises retinal in the sponge system is the β,β-carotene-15,15′-dioxygenase [carotene dioxygenase]. In order to clarify if this enzyme is the only β-carotene-metabolizing enzyme a further oxygenase had been identified and cloned, the (related) carotenoid oxygenase. In contrast to the dioxygenase, the carotenoid oxygenase could not degrade β-carotene or lycopene in Escherichia coli strains that produced these two carotenoids; therefore it had been termed related-carotenoid oxygenase. Exposure of primmorphs to light of different wavelengths from the visible spectrum resulted after 3 days in a strong upregulation of the dioxygenase in those 3D-cell aggregates that had been incubated with β-carotene. The strongest effect is seen with blue light at a maximum around 490 nm. It is concluded that the toxin Suberitine is non-covalently modified by retinal, the cleavage product from β-carotene via the enzyme carotene dioxygenase, a light inducible oxygenase. Hence, this study highlights that in S. domuncula the bioactive metabolite, retinal, has the property to detoxify its homologous toxin

Adhesion of platelets to colon cancer cells is necessary to promote tumor development in xenograft, genetic and inflammation models

Platelets represent the linkage between tissue damage and inflammatory response with a putative role in tumorigenesis. Given the importance of the microenvironment in colon cancer development, we elucidated the eventual role of platelets‐cancer cells crosstalk in in vivo colon cancer models. To evaluate the involvement of platelets in intestinal tumorigenesis, we first analyzed if the ablation of β‐integrin P‐selectin that drives platelets‐cell adhesion, would contribute to platelets‐colon cancer cell interaction and drive cancer progression. In a xenograft tumor model, we observed that when tumors are inoculated with platelets, the ablation of P‐selectin significantly reduced tumor growth compared to control platelets. Furthermore, in genetic models, as well as in chronic colitis‐associated colorectal carcinogenesis, P‐selectin ablated mice displayed a significant reduction in tumor number and size compared to control mice. Taken together, our data highlights the importance of platelets in the tumor microenvironment for intestinal tumorigenesis. These results support the hypothesis that a strategy aimed to inhibit platelets adhesion to tumor cells are able to block tumor growth and could represent a novel therapeutic approach to colon cancer treatment

Volatile compared with total intravenous anaesthesia in patients undergoing high-risk cardiac surgery: a randomized multicentre study

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Benzo-dipteridine derivatives as organic cathodes for Li- and Na-ion batteries

Organic-based electrodes for Li- and Na-ion batteries present attractive alternatives to commonly applied inorganic counterparts which can often carry with them supply-chain risks, safety concerns with thermal runaway, and adverse environmental impact. The ability to chemically direct the structure of organic electrodes through control over functional groups is of particular importance, as this provides a route to fine-tune electrochemical performance parameters. Here, we report two benzo-dipteridine derivatives, BF-Me2 and BF-H2, as high-capacity electrodes for use in Li- and Na-ion batteries. These moieties permit binding of multiple Li-ions per molecule while simultaneously ensuring low solubility in the supporting electrolyte, often a precluding issue with organic electrodes. Both display excellent electrochemical stability, with discharge capacities of 142 and 182 mAh g–1 after 100 cycles at a C/10 rate and Coulombic efficiencies of 96% and ∼ 100% demonstrated for BF-Me2 and BF-H2, respectively. The application of a Na-ion cell has also been demonstrated, showing discharge capacities of 88.8 and 137 mAh g–1 after 100 cycles at a C/2 rate for BF-Me2 and BF-H2, respectively. This work provides an encouraging precedent for these and related structures to provide versatile, high-energy density, and long cycle-life electrochemical energy storage materials

Meromorphic traveling wave solutions of the complex cubic-quintic Ginzburg-Landau equation

We look for singlevalued solutions of the squared modulus M of the traveling wave reduction of the complex cubic-quintic Ginzburg-Landau equation. Using Clunie's lemma, we first prove that any meromorphic solution M is necessarily elliptic or degenerate elliptic. We then give the two canonical decompositions of the new elliptic solution recently obtained by the subequation method.Comment: 14 pages, no figure, to appear, Acta Applicandae Mathematica

Overcoming the mobility penalty introduced by dipole disorder in small-molecule HTM films

The importance of the hole-transport material (HTM) in perovskite solar cells (PSCs) is now very well-established, with state-of-the-art materials such as Spiro-OMeTAD attracting significant attention in the last decade. The high cost of such materials still limits the commercialisation of these HTMs. To tackle this, the amide linker has recently been introduced into HTM systems via EDOT-Amide-TPA, utilising condensation chemistry as a cheap and effective route to HTMs. EDOT-Amide-TPA is capable of a variety of intermolecular interactions such as dipole-dipole interactions and hydrogen bonding, both of which are beneficial for enhancing the film morphology and improving charge transport. However, the interplay between these different interactions is not trivial, and understanding how they affect each other is paramount to inform new HTM designs whilst minimising material waste. To date, studies investigating the combined effects of different intermolecular interactions within the HTL on the charge transport properties of these materials are lacking. Furthermore, dipole disorder within the film introduces a mobility ‘penalty’: mobility decreases with stronger overall dipole due to energetic disorder within the film, which hinders charge hopping. In this work, we investigate three amide-based HTM analogs with differing intermolecular interaction capabilities, and show that this penalty can be compensated by a preferentially increased dipole ordering, likely achieved through intermolecular hydrogen bonding. This effectively cancels out the dipole disorder while retaining the beneficial effects on the molecular packing. Our aim is that this work provides a good foundation for navigating the complex interplay between hydrogen bonding, dipole moments, conductivity, and film formation in small-molecule HTM

On elliptic solutions of the cubic complex one-dimensional Ginzburg-Landau equation

The cubic complex one-dimensional Ginzburg-Landau equation is considered. Using the Hone's method, based on the use of the Laurent-series solutions and the residue theorem, we have proved that this equation has neither elliptic standing wave nor elliptic travelling wave solutions. This result amplifies the Hone's result, that this equation has no elliptic travelling wave solutions.Comment: LaTeX, 12 page

Digital PCR methods improve detection sensitivity and measurement precision of low abundance mtDNA deletions

Mitochondrial DNA (mtDNA) mutations are a common cause of primary mitochondrial disorders, and have also been implicated in a broad collection of conditions, including aging, neurodegeneration, and cancer. Prevalent among these pathogenic variants are mtDNA deletions, which show a strong bias for the loss of sequence in the major arc between, but not including, the heavy and light strand origins of replication. Because individual mtDNA deletions can accumulate focally, occur with multiple mixed breakpoints, and in the presence of normal mtDNA sequences, methods that detect broad-spectrum mutations with enhanced sensitivity and limited costs have both research and clinical applications. In this study, we evaluated semi-quantitative and digital PCR-based methods of mtDNA deletion detection using double-stranded reference templates or biological samples. Our aim was to describe key experimental assay parameters that will enable the analysis of low levels or small differences in mtDNA deletion load during disease progression, with limited false-positive detection. We determined that the digital PCR method significantly improved mtDNA deletion detection sensitivity through absolute quantitation, improved precision and reduced assay standard error

Enterocyte superoxide dismutase 2 deletion drives obesity

Compelling evidence support an involvement of oxidative stress and intestinal inflammation as early events in the predisposition and development of obesity and its related comorbidities. Here, we show that deficiency of the major mitochondrial antioxidant enzyme superoxide dismutase 2 (SOD2) in the gastrointestinal tract drives spontaneous obesity. Intestinal epithelium-specific Sod2 ablation in mice induced adiposity and inflammation via phospholipase A2 (PLA2) activation and increased release of omega-6 polyunsaturated fatty acid arachidonic acid. Remarkably, this obese phenotype was rescued when fed an essential fatty acid-deficient diet, which abrogates de novo biosynthesis of arachidonic acid. Data from clinical samples revealed that the negative correlation between intestinal Sod2 mRNA levels and obesity features appears to be conserved between mice and humans. Collectively, our findings suggest a role of intestinal Sod2 levels, PLA2 activity, and arachidonic acid in obesity presenting new potential targets of therapeutic interest in the context of this metabolic disorder