Système rénine-angiotensine et perturbation des fonctions endothéliales dans un modèle de sepsis

Les perturbations des fonctions physiologiques de l'endothélium participent à la physiopathologie du sepsis et d'un nombre important de maladies cardiovasculaires. Or, les inhibiteurs de l'enzyme de conversion de l'angiotensine (IECA) maintiennent l'intégrité de l'endothélium dans le cas des maladies cardiovasculaires, phénomène qui explique en partie l'effet bénéfique de ces médicaments sur la mortalité reliée à ces maladies. Nous avons étudié l'effet d'un IECA sur l'intégrité fonctionnelle de l'endothélium dans un modèle de sepsis par injection de lipopolysaccharide (LPS) chez le rat. Dans un premier temps nous avons démontré que l'endotoxine (LPS) a un effet hyperperméabilisant sur l'aorte. L'administration de périndopril augmente cet effet. Ensuite, nous avons documenté l'impact du LPS sur l'activité myéloperoxydase (MPO) dans différents tissus, reflet de la quantité de leucocytes polymorphonucléaires séquestrés dans les tissus. Nous avons constaté que le LPS augmente rapidement l'activité MPO dans les poumons (1 h) alors que l'augmentation enregistrée dans la rate est plus tardive (8 h) et est absente dans le coeur. Cet effet du LPS n'est pas modulé par l'administration de périndopril. Finalement, nous avons observé les effets hémodynamiques de l'endotoxine et du périndopril sur le rein. Globalement nous avons constaté que le périndopril a un effet vasodilatateur systémique et rénal qui n'entrave pas les fonctions hémodynamiques normales du rein. Cet effet vasodilatateur est potentiellement salutaire dans la mesure où nous avons observé de surcroît que le périndopril prévient la hausse de la lactatémie observée suite à l'injection de LPS. Accessoirement, la diminution des décomptes leucocytaire et plaquettaire enregistrée respectivement 1 h et 24 h après l'administration d'endotoxine n'a pas été influencée par l'administration de périndopril. Ces résultats nous ont permis de conclure que cet IECA influence les fonctions de l'endothélium dans un modèle de sepsis. Cet impact varie en fonction de l'organe ainsi que de la fonction spécifique à l'étude. Nous suggérons par conséquent que cette classe de médicaments pourrait améliorer le pronostic d'un stress endotoxinique en tant que syndrome, principalement en raison de leur effet vasodilatateur, et moyennant des études subséquentes de validation

Nature of fatty acids in high fat diets differentially delineates obesity-linked metabolic syndrome components in male and female C57BL/6J mice

<p>Abstract</p> <p>Background</p> <p>Adverse effects of high-fat diets (HFD) on metabolic homeostasis are linked to adipose tissue dysfunction. The goal of this study was to examine the effect of the HFD nature on adipose tissue activity, metabolic disturbances and glucose homeostasis alterations in male mice compared with female mice.</p> <p>Methods</p> <p>C57BL/6J mice were fed either a chow diet or HFD including vegetal (VD) or animal (AD) fat. Body weight, plasmatic parameters and adipose tissue mRNA expression levels of key genes were evaluated after 20 weeks of HFD feeding.</p> <p>Results</p> <p>HFD-fed mice were significantly heavier than control at the end of the protocol. Greater abdominal visceral fat accumulation was observed in mice fed with AD compared to those fed a chow diet or VD. Correlated with weight gain, leptin levels in systemic circulation were increased in HFD-fed mice in both sexes with a significant higher level in AD group compared to VD group. Circulating adiponectin levels as well as adipose tissue mRNA expression levels were significantly decreased in HFD-fed male mice. Although its plasma levels remained unchanged in females, adiponectin mRNA levels were significantly reduced in adipose tissue of both HFD-fed groups with a more marked decrease in AD group compared to VD group. Only HFD-fed male mice were diabetic with increased fasting glycaemia. On the other hand, insulin levels were only increased in AD-fed group in both sexes associated with increased resistin levels. VD did not induce any apparent metabolic alteration in females despite the increased weight gain. Peroxisome Proliferator-Activated Receptors gamma-2 (PPARγ2) and estrogen receptor alpha (ERα) mRNA expression levels in adipose tissue were decreased up to 70% in HFD-fed mice but were more markedly reduced in male mice as compared with female mice.</p> <p>Conclusions</p> <p>The nature of dietary fat determines the extent of metabolic alterations reflected in adipocytes through modifications in the pattern of adipokines secretion and modulation of key genes mRNA expression. Compared with males, female mice demonstrate higher capacity in controlling glucose homeostasis in response to 20 weeks HFD feeding. Our data suggest gender specific interactions between the diet's fatty acid source, the adipocyte-secreted proteins and metabolic disorders.</p

Barriers to supportive care during the Ebola virus disease outbreak in West Africa: Results of a qualitative study

© 2018 Loignon et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Background During the 2013–2016 West Africa Ebola outbreak, supportive care was the only non-experimental treatment option for patients with Ebola virus disease (EVD). However, providing care that would otherwise be routine for most clinical settings in the context of a highly contagious and lethal pathogen is much more challenging. The objective of this study was to document and deepen understanding of barriers to provision of supportive care in Ebola treatment units (ETUs) as perceived by those involved in care delivery during the outbreak. Methods This qualitative study consisted of 29 in-depth semi-structured interviews with stakeholders (decision-makers, physicians, nurses) involved in patient care delivery during the outbreak. Analysis consisted of interview debriefing and team-based transcript coding in NVivo10 software using thematic analysis. Findings Participants emphasized three interconnected barriers to providing high-quality supportive care during the outbreak: 1) lack of material and human resources in ETUs; 2) ETU organizational structure limiting the provision of supportive clinical care; and 3) delayed and poorly coordinated policies limiting the effectiveness of global and national responses. Participants also noted the ethical complexities of defining and enacting best clinical practices in low-income countries. They noted tension between, on one hand, scaling up minimal care and investing in clinical care preparedness to a level sustainable in West Africa and, on the other, providing a higher level of supportive care, which in low-resource health systems would require important investments. Conclusion Our findings identified potentially modifiable barriers to the delivery of supportive care to patients with EVD in West Africa. Addressing these in the inter-outbreak period will be useful to improve patient care and outcomes during inevitable future outbreaks. Promoting community trust and engagement through long-term capacity building of the healthcare workforce and infrastructure would increase both health system resilience and ability to handle other outbreaks of emerging diseases

Consensus group sessions: a useful method to reconcile stakeholders’ perspectives about network performance evaluation

Background: Having a common vision among network stakeholders is an important ingredient to developing a performance evaluation process. Consensus methods may be a viable means to reconcile the perceptions of different stakeholders about the dimensions to include in a performance evaluation framework. Objectives: To determine whether individual organizations within traumatic brain injury (TBI) networks differ in perceptions about the importance of performance dimensions for the evaluation of TBI networks and to explore the extent to which group consensus sessions could reconcile these perceptions. Methods: We used TRIAGE, a consensus technique that combines an individual and a group data collection phase to explore the perceptions of network stakeholders and to reach a consensus within structured group discussions. Results: One hundred and thirty-nine professionals from 43 organizations within eight TBI networks participated in the individual data collection; 62 professionals from these same organisations contributed to the group data collection. The extent of consensus based on questionnaire results (e.g. individual data collection) was low, however, 100% agreement was obtained for each network during the consensus group sessions. The median importance scores and mean ranks attributed to the dimensions by individuals compared to groups did not differ greatly. Group discussions were found useful in understanding the reasons motivating the scoring, for resolving differences among participants, and for harmonizing their values

Co-design knowledge mobilization tools for universal accessibility in municipalities

IntroductionModern research teams are re-evaluating conventional methods with the aim of improving the usefulness of knowledge for users, focusing on the role of knowledge users in shaping innovation. In disability field, encouraging participatory research inherently involves diverse perspectives and inclusion, which aligns with the principles of universal accessibility. By actively involving individuals with various backgrounds, abilities, and needs in the research process, we can better understand and address the challenges faced in adopting universal accessibility. This approach ensures that solutions are more comprehensive, inclusive, and effectively cater to the needs of all individuals, fostering a more equitable and accessible environment for everyone. Despite municipal organizations mandating universal accessibility action plans, they lack tools for efficient implementation. The aim of this study was to develop knowledge mobilization tools tailored to a specific municipal context in Quebec, Canada, to facilitate the implementation of universal accessibility measures by municipal employees.MethodsThe co-design process employed in this study was organized into four distinct stages, following the Morales model: (1) Exploration (2) Co-Design (3) Validation (4) Development.ResultsStages one and two highlighted the employees' lack of awareness about universal accessibility issues and their need to have more information and resources about how universal accessibility is encountered in their work. A steering committee co-designed three video vignettes about universal accessibility, the city's action plan and measures included in it.DiscussionThe co-design approach used in this study allowed us to observe the non-linear nature of partnership research with an organization as complex as a municipality. Our study shows significant advantages of collaboration between the municipal sector and research

Tendon normal

peer reviewedLe tendon a été associé au nerf pendant plus de 15 siècles. Ce dogme n'a été rompu qu'en 1745 par les travaux d'Albrecht Von Haller. Embryologiquement, il provient du mésoderme paraxial, du mésoderme de la lame latérale et de l'ectoderme. Il permet la transmission des forces générées par le muscle et est principalement composé de faisceaux de collagène de type I, de glycoprotéines, de protéoglycans, d'eau, de ténocytes et de ténoblastes. L'enthèse, jonction entre l'os et le tendon, peut être fibreuse ou fibrocartilagineuse. La jonction myotendineuse, quant à elle, représente une unité avec des liaisons entre les myocytes et les faisceaux de collagène. Sa vascularisation varie en fonction de la localisation du tendon et s'altère avec l'âge, l'intensité de l'effort, la compression, la friction et la torsion. Il est innervé par des nerfs sensoriels dont les fibres afférentes proviennent des troncs cutanés, musculaires et péritendineux. Sa courbe de déformation permet de comprendre sa biomécanique. En effet, ce tissu est viscoélastique. La mécanotransduction est un processus physiologique par lequel les cellules tissulaires détectent et produisent une réponse biochimique à un stimulus mécanique. L'entraînement favorise la synthèse de collagène de type I et dans une moindre mesure sa dégradation. L'immobilisation, par contre, entraîne une diminution de son poids, de sa rigidité et de sa résistance à la traction. Dans le cas d'une lésion aiguë, la cicatrisation tendineuse s'étend sur un peu plus de 10 semaines et est composée de trois phases : inflammation, réparation et remodelage. Le vieillissement tendineux entraîne un risque plus important de lésions tendineuses. Une diminution de la quantité de collagène et de protéine est alors observée. L'échographie voire l'imagerie par résonance magnétique (IRM) sont les examens d'imagerie médicale de choix en cas de suspicion de tendinopathie

Municipalities’ strategies to implement universal accessibility measures: A scoping review

An accessible built environment is an important catalyst of participation. However, people living with disabilities face daily barriers to in their built environment. Many stakeholders are involved in the implementation of accessible built environment for all, such as municipalities. The implementation of such universal accessibility measures is therefore complex for municipal employees. Integration of such measures into regular activities requires individual (employees) and organizational (municipalities) change. Different implementation strategies are helpful to guide municipalities in the creation of tools and to facilitate the operationalization and implementation of the measures. The aim was to explore what are the implementation strategies used by municipalities to implement universal accessibility measures. To answer this question, (1) identified the different strategies used by municipalities in implementing universal accessibility measures, (2) explored the perceived influence of these strategies, and (3) identified facilitators and barriers to the use of the different strategies to implement universal accessibility measures. We conducted a scoping review following the PRISMA-SR guidelines. We analyzed the data according to the type of strategy and to the Consolidated Framework for Implementation Research (CFIR). Of 1328 articles identified by the search strategy, six studies met the inclusion criteria. The strategies were identified as dissemination, process, integration, or capacity-building strategy. Involvement of all stakeholders was the most frequently mentioned facilitator, while lack of awareness was the most reported barrier. The results show that there is no consensus on which implementation strategies are appropriate and effective to use in this context. Also, there are no measures of effectiveness of pre-post design of these strategies. This shows that implementation strategies in municipal context regarding universal accessibility are still in an exploratory phase. However, it is possible to make links with the different implementation domains of the CFIR. We also observed that the identification of facilitators and obstacles to implementation is important to identify needs and to better plan the different stages of implementation.Un environnement bâti accessible est un important catalyseur de participation. Cependant, les personnes handicapées sont confrontées à des obstacles quotidiens dans leur environnement bâti. De nombreux acteurs sont impliqués dans la mise en oeuvre d’un environnement bâti accessible à tous, tel que les municipalités. La mise en oeuvre de telles mesures d’accessibilité universelle est donc complexe pour les employés municipaux. L’intégration de telles mesures dans les activités régulières nécessite des changements individuels (employés) et organisationnels (municipalités). Différentes stratégies de mise en oeuvre sont utiles pour guider les municipalités dans la création d’outils et pour faciliter l’opérationnalisation et la mise en oeuvre des mesures. L’objectif était d’explorer les stratégies de mise en oeuvre utilisées par les municipalités pour mettre en oeuvre des mesures d’accessibilité universelle. A cette fin, l’ont, (1) a identifié les différentes stratégies utilisées par les municipalités pour mettre en oeuvre des mesures d’accessibilité universelle, (2) exploré l’influence perçue de ces stratégies et (3) identifié les facilitateurs et les obstacles à l’utilisation des différentes stratégies de mise en oeuvre de l’accessibilité universelle des mesures d’accessibilité. Nous avons mené une étude de cadrage conformément aux lignes directrices PRISMA-SR. Nous avons analysé les données selon le type de stratégie et selon le Consolidated Framework for Implementation Research (CFIR). Des 1 328 articles identifiés par la stratégie de recherche, six études répondaient aux critères d’inclusion. Les stratégies ont été identifiées comme étant une stratégie de diffusion, de processus, d’intégration ou de renforcement des capacités. La participation de toutes les parties prenantes était le facilitateur le plus fréquemment mentionné, tandis que le manque de sensibilisation était l’obstacle le plus signalé. Les résultats montrent qu’il n’y a pas de consensus sur les stratégies de mise en oeuvre appropriées et efficaces à utiliser dans ce contexte. De plus, il n’existe aucune mesure de l’efficacité de la conception pré-post design de ces stratégies. Cela montre que les stratégies de mise en oeuvre dans le contexte municipal en matière d’accessibilité universelle sont encore en phase exploratoire. Il est cependant possible de faire des liens avec les différents domaines de mise en oeuvre du CFIR. Nous avons également observé que l’identification des facilitateurs et des obstacles à la mise en oeuvre est importante pour identifier les besoins et mieux planifier les différentes étapes de mise en oeuvre