Dossier. Les 25 ans d'Hôpital Plus.

Hôpital plus a fêté les 14 et 15 octobre 2010 ses 25 ans. A cette occasion, l'EHESP et l'ADH, et à travers elle les anciens membres de MH+souhaitaient "créer l'évènement" afin de rappeler combien cette formation est importante pour les dirigeants du monde hospitalier, comme en témoigne la transformation des six modules d'une semaine en diplôme d'établissement, parachevant ainsi un processus qui relie la pratique professionnelle à la réflexion académique. Hôpital Plus représente en effet un temps de respiration essentiel, temps dans lequel on partage ses doutes et une volonté de construire ensemble l'hôpital public de demain. Cadre de référence pour l'identification des termes du management hospitalier, cette formation constitue aussi un véritable tremplin pour rebondir vers de nouvelles perspectives de carrière et/ou pour renforcer ses capacités de direction. Lors de cet anniversaire, le temps s'est suspendu pour la centaine d'anciens stagiaires qui ont marqué une "pause" dans leur exercice quotidien imposant la décision à la minute et le management action/réaction. Le JADH espère que la restitution de ces réflexions sous forme de récit apportera le même bénéfice à ses lecteurs

Long term management of water in the Central Levant: the Hawran case (Syria).

International audienceApart from hydraulic systems linked to major rivers, the control of water in the Near East passes by the exploitation of complementary seasonal resources: springs and river floods. Southern Syria preserves many traces of this exploitation. The principal techniques of water catchment and storage were elaborated during the 4th millennium BC. The waterworks of the two following millennia constituted the basic and sustainable infrastructure of the water supply of the area. The technical innovations and the political reorganizations of the Roman, Byzantine and Umayyad times built a second layer of structures. All these systems were in use until the first half of the 20th century. One can thus follow over six millennia the processes of technical innovation, the periods of collective investment in large scale waterworks, and the reasons of the resilience or the disappearance of the technical systems and their attached social organization

Interleukin 17, a nitric oxide-producing cytokine with a peroxynitrite-independent inhibitory effect on proteoglycan synthesis.

International audienceOBJECTIVE:To compare the potency of 2 cytokines, interleukin 17 (IL-17) and IL-1beta, on rat cartilage proteoglycan synthesis with special attention to nitric oxide (NO) and peroxynitrite formation.METHODS:Chondrocytes in alginate beads were stimulated with human recombinant (rh) IL-17 (0.03 to 300.0 ng/ml) and/or rhIL-1beta (0.25 to 25.0 ng/ml) in the presence or not of L-NMMA or CuDips. Alternatively, rats were injected with either IL-17 (10.0 micro g) or IL-1beta (1.0 micro g) into each knee joint. NO concentrations were determined by a spectrofluorimetric assay, proteoglycan synthesis by 35SO4-2 incorporation, peroxynitrite generation by immunostaining for 3-nitrotyrosine, and IL-1beta mRNA expression by reverse transcription-polymerase chain reaction.RESULTS:IL-17 inhibited proteoglycan synthesis and increased NO production, both in vitro and in vivo, without inducing expression of IL-1beta mRNA in cartilage. Additive effects were observed when IL-17 was combined with low concentrations of IL-1. Surprisingly, a similar NO synthesis between IL-1 and IL-17 led to a less suppressive effect of IL-17 on cartilage anabolism than with IL-1. Both in vitro and in vivo, peroxynitrite formation was extensive with IL-1beta, but negligible or nonexistent with IL-17. L-NMMA and CuDips completely corrected the suppressive effect of IL-1beta on proteoglycan synthesis, unlike with IL-17.CONCLUSION:These data showed that NO is weakly involved in the IL-17 mediated inhibition of proteoglycan synthesis in rat. NO overload may not be predictive of any inhibitory effect on cartilage anabolism, but instead superoxide is a key regulator of NO contribution to chondrocyte dysfunction. Since IL-17 is a NO-producing cytokine with additive effects when combined with IL-1, it may play a pivotal role in cartilage destruction during rheumatoid arthritis, for which infiltrating cells produce high levels of superoxide and proinflammatory cytokines

Cornaline de l’Inde

Les sites archéologiques de la vallée de l'Indus en témoignent : l'artisanal des perles en cornaline remonte à plusieurs millénaires. De nos jours, il se pratique encore dans quelques rares endroits comme en Inde dans la ville de Cambay (Gujarat) qui offre au chercheur une occasion unique de construire des référentiels. Dans ce but, des méthodes d'enquête appropriées ont été élaborées. Elles aboutissent à des régies interprétatives portant sur les processus techniques, les habiletés de taille, le techno-système. Il s'ensuit une interprétation des perles de l'Indus et de la Mésopotamie en termes de production et de réseaux de distribution. Interprétations fondées qui permettent de nouvelles hypothèses sur la fonction de certaines perles et sur les conditions de leur apparition. L'ouvrage est accompagné d'un cédérom (Mac-PC). La totalité des constructions scientifiques y est présentée selon un mode d'édition qui permet une lecture rapide des résultats ainsi que la consultation d'une très importante base de données (photos, films, graphiques, tableaux).The archaeological sites of the Indus Valley show that the craft of carnelian bead-making goes back several thousands of years. 'Ibday it is still racticed in a few rare places, such as the Indian city of Cambay (Gujarat), ofiering a unique opportunity for researchers to construct a modern reference base. With this objective in mind, appropriate investigative methods were developed. They have resulted in interpretative rules relating to technical processes, knapping skills, and the teclmo-system. These rules enable us to interpret the beadsfrom Indus and Mesopotamia in terms of production and distribution networks. These welltfounded interpretations allow the formulation of new hypotheses concerning thefitnction of certain beads and the conditions of their appearance. This book comes with a PC /Mac compatible CD-Rom. Scientific constntcts are presented in aformalized wayfin quick access to the main results as well as easy consultation of the large-size scientific data base (photos,films, graphics)

Same-day testing with initiation of antiretroviral therapy or tuberculosis treatment versus standard care for persons presenting with tuberculosis symptoms at HIV diagnosis: A randomized open-label trial from Haiti.

BackgroundSame-day HIV testing and antiretroviral therapy (ART) initiation is being widely implemented. However, the optimal timing of ART among patients with tuberculosis (TB) symptoms is unknown. We hypothesized that same-day treatment (TB treatment for those diagnosed with TB; ART for those not diagnosed with TB) would be superior to standard care in this population.Methods and findingsWe conducted an open-label trial among adults with TB symptoms at initial HIV diagnosis at GHESKIO in Haiti; participants were recruited and randomized on the same day. Participants were randomized in a 1:1 ratio to same-day treatment (same-day TB testing with same-day TB treatment if TB diagnosed; same-day ART if TB not diagnosed) versus standard care (initiating TB treatment within 7 days and delaying ART to day 7 if TB not diagnosed). In both groups, ART was initiated 2 weeks after TB treatment. The primary outcome was retention in care with 48-week HIV-1 RNA <200 copies/mL, with intention to treat (ITT) analysis. From November 6, 2017 to January 16, 2020, 500 participants were randomized (250/group); the final study visit occurred on March 1, 2021. Baseline TB was diagnosed in 40 (16.0%) in the standard and 48 (19.2%) in the same-day group; all initiated TB treatment. In the standard group, 245 (98.0%) initiated ART at median of 9 days; 6 (2.4%) died, 15 (6.0%) missed the 48-week visit, and 229 (91.6%) attended the 48-week visit. Among all who were randomized, 220 (88.0%) received 48-week HIV-1 RNA testing; 168 had <200 copies/mL (among randomized: 67.2%; among tested: 76.4%). In the same-day group, 249 (99.6%) initiated ART at median of 0 days; 9 (3.6%) died, 23 (9.2%) missed the 48-week visit, and 218 (87.2%) attended the 48-week visit. Among all who were randomized, 211 (84.4%) received 48-week HIV-1 RNA; 152 had <200 copies/mL (among randomized: 60.8%; among tested: 72.0%). There was no difference between groups in the primary outcome (60.8% versus 67.2%; risk difference: -0.06; 95% CI [-0.15, 0.02]; p = 0.14). Two new grade 3 or 4 events were reported per group; none were judged to be related to the intervention. The main limitation of this study is that it was conducted at a single urban clinic, and the generalizability to other settings is uncertain.ConclusionsIn patients with TB symptoms at HIV diagnosis, we found that same-day treatment was not associated with superior retention and viral suppression. In this study, a short delay in ART initiation did not appear to compromise outcomes.Trial registrationThis study is registered with ClinicalTrials.gov NCT03154320

Same-day testing with initiation of antiretroviral therapy or tuberculosis treatment versus standard care for persons presenting with tuberculosis symptoms at HIV diagnosis: A randomized open-label trial from Haiti.

BackgroundSame-day HIV testing and antiretroviral therapy (ART) initiation is being widely implemented. However, the optimal timing of ART among patients with tuberculosis (TB) symptoms is unknown. We hypothesized that same-day treatment (TB treatment for those diagnosed with TB; ART for those not diagnosed with TB) would be superior to standard care in this population.Methods and findingsWe conducted an open-label trial among adults with TB symptoms at initial HIV diagnosis at GHESKIO in Haiti; participants were recruited and randomized on the same day. Participants were randomized in a 1:1 ratio to same-day treatment (same-day TB testing with same-day TB treatment if TB diagnosed; same-day ART if TB not diagnosed) versus standard care (initiating TB treatment within 7 days and delaying ART to day 7 if TB not diagnosed). In both groups, ART was initiated 2 weeks after TB treatment. The primary outcome was retention in care with 48-week HIV-1 RNA ConclusionsIn patients with TB symptoms at HIV diagnosis, we found that same-day treatment was not associated with superior retention and viral suppression. In this study, a short delay in ART initiation did not appear to compromise outcomes.Trial registrationThis study is registered with ClinicalTrials.gov NCT03154320