INDUCTION DE TOLERANCE IN UTERO ET ALLOTRANSPLANTATION D'HEPATOCYTES CHEZ LE MOUTON

RENNES1-BU Santé (352382103) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Innovation et participation dans une politique municipale des vieillissements ? La mise en œuvre du programme Villes Amies des Aînés (VADA) à Brest

With the lengthening of life expectancy and arrival at retirement age of the large baby boomer’s generations, supporting elderly populations has become a truly primordial stake of public policies. In such context, the Age-friendly Cities program initiated by the World Health Organization (WHO), is an attempt to address the challenge of true inclusion of elderly people in society. It encourages active ageing and puts forward the question of the adaptation of urban environment (built and social). In this perspective, involving the elderly is essential to identify necessary adaptations for the development of a society for people of all ages. In 2016, in the continuity of a policy stance centred on prevention called "ageing well", the city of Brest joined the WHO program. It has thus committed to improving the quality of life for elderly people, by reinforcing its action on the adaptation of the city, developing inclusive policies and setting up a participative governance model. This research work offers an analysis of the conditions of emergence of the Brest municipality’s endorsement of the Age-friendly Cities program. It also dwells on the issue of the implementation of an ambitious, transverse and participative approach in the context of budget constraints and sectoral organization of public action.Avec l’allongement de l’espérance de vie et l’arrivée à l’âge de la retraite des générations nombreuses du baby-boom, l’accompagnement des vieillissements est devenu un véritable enjeu primordial des politiques publiques. Dans un tel contexte, le programme Villes amies des Aînés (VADA), initié par l’organisation mondiale de la santé (OMS), tente de répondre au défi d’une véritable inclusion des aînés dans la société. Il encourage le vieillissement actif et pose la question de l’adaptation de l’environnement urbain (bâti et social). Dans cette perspective, la participation des aînés est essentielle pour identifier les adaptations nécessaires au développement d’une société pour tous les âges. En 2016, dans la continuité d’une politique centrée sur la prévention et une démarche baptisée « bien vieillir », la ville de Brest a adhéré à ce programme. Elle s’engage ainsi à améliorer la qualité de vie des aînés, en renforçant son action sur l’adaptation de la ville, en développant une politique inclusive et une forme de gouvernance participative. Cette recherche action se propose d’analyser les conditions d’émergence de l’adhésion au programme VADA de la municipalité de Brest. Elle interroge aussi la mise en œuvre d’une démarche transversale et participative ambitieuse dans un contexte de restriction budgétaire et d’une action publique organisée de façon sectorielle

An easy-to-follow algorithm to improve pre-operative diagnosis for appendicitis in children.

International audienceGoal: To evaluate physician compliance with use of a diagnostic algorithm for appendicitis in children. Our secondary objective was to determine the impact of the algorithm on diagnostic accuracy and morbidity. Methods: We conducted a clustered randomized trial in eight centers. A total of 866 patients were included and, depending on the period of randomization at particular centers, 543 patients were managed before the formal institution of the diagnostic algorithm; their diagnostic management was compared to that of the subsequent 323 patients. Results: There was a 29.1% mean increase in the use of imaging studies included in the algorithm after algorithm set-up, rising from 50.8 to 79.9% (P < 0.02). When we used a composite endpoint of ‘‘poor results’’ (grouping patients with incorrect diagnoses and/or post-operative complications), no statistically significant difference was found between the two periods (85/543 (15.6%) before vs. 45/323 (13.9%) after set-up, P = 0.5). But when the number of incorrect diagnoses of appendicitis made without the use of the algorithm was compared to that of patients who took advantage of the algorithm, the difference was highly significant (67/332 [20.2%] vs. 63/534 [11.8%], P < 0.001), and the rate of unnecessary appendectomy decreased from 11.9 to 5.3% (P < 0.01). Conclusions: Our diagnostic algorithm improved the adherence to good practice for the diagnosis of appendicitis in children, reducing the rates of unnecessary appendectomy and morbidity. This strategy, combining laboratory tests and imaging, should permit pediatric surgeons to adapt their therapeutic approaches to specific cases

Importance of urinary flow studies after hypospadias repair: A systematic review

A systematic review was performed of publications relating to the results of urinary flow studies after hypospadias repair dating back to 1978, when what appears to be the first publication on this topic was found. The literature search was performed using the key words "hypospadias" combined with "urinary flow", "urine flow", "uroflow", "uroflowmetry", and "long-term". We also reviewed the abstracts and full-length articles cited in the reference list of selected articles. Criteria for inclusion in the present systematic review included descriptions of patient selection, surgical technique, the severity of disease (proximal vs distal), and the method used to determine uroflow, as well as a definition of urethral obstruction. In all, 339 article titles were found. Of these, 25 abstracts appeared relevant and the full text of these articles were reviewed, with 22 of the papers included in this review. Sixteen reports had appeared in the literature since 2001, compared with six between 1978 and 2000, suggesting an increasing interest in this topic. On the basis of the results of the present systematic review, we recommend that asymptomatic children operated on for hypospadias in infancy should have one flow study after toilet training, with that study repeated if the results are abnormal. It appears that early abnormal flows improve spontaneously, so that children operated on after toilet training who are asymptomatic should undergo their first uroflow measurement 1 year after surgery. Children with obstructed flow parameters or borderline flows should be followed until adulthood, until long-term follow up studies clarify the significance of abnormal flow parameters. Given the present findings, we anticipate that in the next two decades urologists will need to treat a number of men with strictures resulting from hypospadias repairs performed in childhood