De « l’Affaire du siècle » au « casse du siècle » ?

L’ambition des associations requérantes de « l’Affaire du siècle » était de faire reconnaître l’insuffisance des actions de l’État en matière climatique et d'obtenir du juge administratif qu’il lui enjoigne de prendre toutes mesures utiles pour réduire les émissions de gaz à effet de serre (GES) à un niveau compatible avec le maintien du réchauffement planétaire en deçà d’1,5 °C. Le jugement avant-dire droit lu le 3 février 2021 par le tribunal administratif de Paris rejoint la liste des « grandes affaires climatiques » rendues dans le monde. Il reconnaît une obligation générale de lutte contre le changement climatique, l’imputation à l’État d’une responsabilité en matière de réduction des émissions de gaz à effet de serre et la recevabilité des demandes en indemnisation du préjudice écologique

Verbal fluency functional magnetic resonance imaging detects anti-seizure effects and affective side effects of perampanel in people with focal epilepsy

Perampanel, a noncompetitive antagonist of the postsynaptic a-amino-3-hydroxy-5-methyl-4-isoxazolepropionic (AMPA) receptor, is effective for controlling focal to bilateral tonic-clonic seizures but is also known to increase feelings of anger. Using statistical parametric mapping-derived measures of activation and task-modulated functional connectivity (psychophysiologic interaction), we investigated 14 people with focal epilepsy who had verbal fluency functional magnetic resonance imaging (fMRI) twice, before and after the add-on treatment of perampanel. For comparison, we included 28 people with epilepsy, propensity-matched for clinical characteristics, who had two scans but no change in anti-seizure medication (ASM) regimen in-between. After commencing perampanel, individuals had higher task-related activations in left orbitofrontal cortex (OFC), fewer task-related activations in the subcortical regions including the left thalamus and left caudate, and lower task-related thalamocaudate and caudate-subtantial nigra connectivity. Decreased task-related connectivity is observed between the left OFC and precuneus and left medial frontal lobe. Our results highlight the brain regions associated with the beneficiary therapeutic effects on focal to bilateral tonic-clonic seizures (thalamus and caudate) but also the undesired affective side effects of perampanel with increased anger and aggression (OFC)

The Impact of Temporal Lobe Epilepsy Surgery on Picture Naming and its Relationship to Network Metric Change

Background: Anterior temporal lobe resection (ATLR) is a successful treatment for medically-refractory temporal lobe epilepsy (TLE). In the language-dominant hemisphere, 30%- 50% of individuals experience a naming decline which can impact upon daily life. Measures of structural networks are associated with language performance pre-operatively. It is unclear if analysis of network measures may predict post-operative decline. Methods: White matter fibre tractography was performed on preoperative diffusion MRI of 44 left lateralised and left resection individuals with TLE to reconstruct the preoperative structural network. Resection masks, drawn on co-registered pre- and post-operative T1-weighted MRI scans, were used as exclusion regions on pre-operative tractography to estimate the post-operative network. Changes in graph theory metrics, cortical strength, betweenness centrality, and clustering coefficient were generated by comparing the estimated pre- and post-operative networks. These were thresholded based on the presence of the connection in each patient, ranging from 75% to 100% in steps of 5%. The average graph theory metric across thresholds was taken. We incorporated leave-one-out cross-validation with smoothly clipped absolute deviation (SCAD) least absolute shrinkage and selection operator (LASSO) feature selection and a support vector classifier to assess graph theory metrics on picture naming decline. Picture naming was assessed via the Graded Naming Test preoperatively and at 3 and 12 months post-operatively and the outcome was classified using the reliable change index (RCI) to identify clinically significant decline. The best feature combination and model was selected using the area under the curve (AUC). The sensitivity, specificity and F1-score were also reported. Permutation testing was performed to assess the machine learning model and selected regions difference significance. Results: A combination of clinical and graph theory metrics were able to classify outcome of picture naming at 3 months with an AUC of 0.84. At 12 months, change in strength to cortical regions was best able to correctly classify outcome with an AUC of 0.86. Longitudinal analysis revealed that betweenness centrality was the best metric to identify patients who declined at 3 months, who will then continue to experience decline from 3-12 months. Both models were significantly higher AUC values than a random classifier. Conclusion: Our results suggest that inferred changes of network integrity were able to correctly classify picture naming decline after ATLR. These measures may be used to prospectively to identify patients who are at risk of picture naming decline after surgery and could potentially be utilised to assist tailoring the resection in order to prevent this decline

The Impact of Temporal Lobe Epilepsy Surgery on Picture Naming and its Relationship to Network Metric Change

BackgroundAnterior temporal lobe resection (ATLR) is a successful treatment for medically-refractory temporal lobe epilepsy (TLE). In the language-dominant hemisphere, 30%- 50% of individuals experience a naming decline which can impact upon daily life. Measures of structural networks are associated with language performance pre-operatively. It is unclear if analysis of network measures may predict post-operative decline.MethodsWhite matter fibre tractography was performed on preoperative diffusion MRI of 44 left lateralised and left resection individuals with TLE to reconstruct the preoperative structural network. Resection masks, drawn on co-registered pre- and post-operative T1-weighted MRI scans, were used as exclusion regions on pre-operative tractography to estimate the post-operative network. Changes in graph theory metrics, cortical strength, betweenness centrality, and clustering coefficient were generated by comparing the estimated pre- and post-operative networks. These were thresholded based on the presence of the connection in each patient, ranging from 75% to 100% in steps of 5%. The average graph theory metric across thresholds was taken.We incorporated leave-one-out cross-validation with smoothly clipped absolute deviation (SCAD) least absolute shrinkage and selection operator (LASSO) feature selection and a support vector classifier to assess graph theory metrics on picture naming decline. Picture naming was assessed via the Graded Naming Test preoperatively and at 3 and 12 months post-operatively and the outcome was classified using the reliable change index (RCI) to identify clinically significant decline. The best feature combination and model was selected using the area under the curve (AUC). The sensitivity, specificity and F1-score were also reported. Permutation testing was performed to assess the machine learning model and selected regions difference significance.ResultsA combination of clinical and graph theory metrics were able to classify outcome of picture naming at 3 months with an AUC of 0.84. At 12 months, change in strength to cortical regions was best able to correctly classify outcome with an AUC of 0.86. Longitudinal analysis revealed that betweenness centrality was the best metric to identify patients who declined at 3 months, who will then continue to experience decline from 3-12 months. Both models were significantly higher AUC values than a random classifier.ConclusionOur results suggest that inferred changes of network integrity were able to correctly classify picture naming decline after ATLR. These measures may be used to prospectively to identify patients who are at risk of picture naming decline after surgery and could potentially be utilised to assist tailoring the resection in order to prevent this decline

Influência de diferentes protocolos de exercício e da dieta hiperlipídica sobre o sistema endocanabinóide de ratos

The objective of the study was to investigate the effects of the hyperlipid diet and the training of swimming and force on the adipose tissue, lipid profi le and endocannabinoid system of exogenous obese rats. For this, we used sixty adult male rats divided into six groups: Sedentary Standard (SP); Sedentary Hyperlipid (SH); Standard Swimming (NP); Hyperlipid Swimming (NH); Standard Force (FP); Hyperlipid Force (FH). After three weeks receiving standard or hyperlipidic diet, the animals started the exercise protocols. The NP and NH groups swam 60 minutes/day, 5 days/week with 5% body weight binding to the body, in 50x30 cm tanks, for 8 weeks. The FP and FH groups performed ladder climbing exercises with weights tied to their tails, once every three days, for 8 weeks. Animals from the SP and SH groups remained sedentary and fed their respective diets. The hyperlipid diet increased body weight gain, relative weight of adipose (epididimal, retroperitoneal, visceral and subcutaneous) and adipocyte (epididimal, retroperitoneal and visceral) areas. It also increased the fat percentage of all adipose tissues and liver, in addition to increasing the gene expression of the CB1 receptor. The trained groups had lower values of adipocyte area, improvement of lipid profi le, lower values in fat percentage of adipose tissues and liver, lower gains of body mass, and lower gene expression of CB1 receptor. Thus our results indicate the potential benefi  ts of strength and swimming training as non-pharma-cological alternatives to control the deleterious effects of the hyperlipidic diet on adipose tissue, lipid profi le, lipid content and control of the imbalance of the endocannabinoid system caused by the hyperlipidic diet.O objetivo do estudo foi investigar os efeitos da dieta hiperlipídica e do treinamento de natação e força sobre o tecido adiposo, perfil lipídico e sistema endocanabinóide de ratos obesos exógenos. Para isso, utilizamos sessenta ratos adultos machos divididos em seis grupos: Sedentário Padrão (SP); Sedentário Hiperlipídico (SH); Natação Padrão (NP); Natação Hiperlipídica (NH); Força Padrão (FP); Força Hiperlipídica (FH). Após três semanas recebendo dieta padrão ou hiperlipídica, os animais iniciaram os protocolos de exercício. Os grupos NP e NH nadaram 60 minutos/dia, 5 dias/semana com carga de 5% do peso corporal atada ao corpo, em tanques de 50x30 cm, durante 8 semanas. Os grupos FP e FH realizaram exercício de subida em escada com pesos atados às suas caudas, uma vez a cada três dias, durante 8 semanas. Os animais dos grupos SP e SH continuaram sedentários e alimentados com suas respectivas dietas. A dieta hiperlipídica aumentou o ganho de massa corporal, peso relativo dos tecidos adiposos (epididimal, retroperitoneal, visceral e subcutâneo) e área de adipócitos (epididimal, retroperitoneal e visceral). Também aumentou o percentual de gordura de todos os tecidos adiposos e fígado, além de aumentar a expressão gênica do receptor CB1. Os grupos treinados apresentaram menores valores de área de adipócitos, melhora do perfil lipídico, menores valores no percentual de gordura dos tecidos adiposos e fígado, menores ganhos de massa corporal, além de menores expressão gênica do receptor CB1. Assim nossos resultados indicam os potenciais benefícios do treinamento força e natação, como alternativas não farmacológicas para controlar os efeitos deletérios da dieta hiperlipídica sobre o tecido adiposo, perfil lipídico, conteúdo lipídico e controle do desequilíbrio do sistema endocanabinóide provocado pela dieta hiperlipídica

Extracorporeal Membrane Oxygenation for Severe Acute Respiratory Distress Syndrome associated with COVID-19: An Emulated Target Trial Analysis.

RATIONALE: Whether COVID patients may benefit from extracorporeal membrane oxygenation (ECMO) compared with conventional invasive mechanical ventilation (IMV) remains unknown. OBJECTIVES: To estimate the effect of ECMO on 90-Day mortality vs IMV only Methods: Among 4,244 critically ill adult patients with COVID-19 included in a multicenter cohort study, we emulated a target trial comparing the treatment strategies of initiating ECMO vs. no ECMO within 7 days of IMV in patients with severe acute respiratory distress syndrome (PaO2/FiO2 <80 or PaCO2 ≥60 mmHg). We controlled for confounding using a multivariable Cox model based on predefined variables. MAIN RESULTS: 1,235 patients met the full eligibility criteria for the emulated trial, among whom 164 patients initiated ECMO. The ECMO strategy had a higher survival probability at Day-7 from the onset of eligibility criteria (87% vs 83%, risk difference: 4%, 95% CI 0;9%) which decreased during follow-up (survival at Day-90: 63% vs 65%, risk difference: -2%, 95% CI -10;5%). However, ECMO was associated with higher survival when performed in high-volume ECMO centers or in regions where a specific ECMO network organization was set up to handle high demand, and when initiated within the first 4 days of MV and in profoundly hypoxemic patients. CONCLUSIONS: In an emulated trial based on a nationwide COVID-19 cohort, we found differential survival over time of an ECMO compared with a no-ECMO strategy. However, ECMO was consistently associated with better outcomes when performed in high-volume centers and in regions with ECMO capacities specifically organized to handle high demand. This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License 4.0 (http://creativecommons.org/licenses/by-nc-nd/4.0/)

Une protection en peau de chagrin. Le Conseil constitutionnel et les conflits du vivant

Lorsque l’utilisation d’infrastructures produisant, par exemple, de l’énergie renouvelable met en danger les conditions de vie de telle espèce sur un territoire donné, le Conseil constitutionnel s’appuie sur une méthode bien spécifique pour arbitrer entre des intérêts protégés à part égale par le bloc de constitutionnalité. L’analyse de quelques décisions rendues en la matière révèle une approche bien pusillanime de sa mission de protection du vivant, qui ne prémunit qu’en apparence des risques d’atteinte à l’environnement ou d’extinction des espèces

L’Etat ir(responsable)

Le 3 février 2021 est une date qui restera dans l’histoire, déjà longue, des procès climatiques. Pour la première fois, en France, le juge administratif reconnaissait que l’État est tenu par l’obligation de lutter contre le changement climatique et qu’il n’avait pas respecté cette obligation, commettant par là-même une faute de nature à engager sa responsabilité. Connue sous le nom de l’« Affaire du siècle », ce procès a donc renvoyé l’État à sa responsabilité juridique en matière de lutte contre le dérèglement climatique. Il faut dire que la reconnaissance du rôle de l’État dans l’engagement de la transition écologique est indiscutable et s’incarne dans un ensemble d’instruments de planification. Cette planification a permis l’affirmation de la responsabilité juridique de l’État tout en révélant les failles du pilotage politique de cette politique publique

L'expropriation sans indemnisation : le cas de l'article L. 318-3 du code de l'urbanisme

International audienc