Table ronde Librairies et publics : quelles actions et quels dispositifs ?

International audienc

Table ronde Librairies et publics : quelles actions et quels dispositifs ?

International audienc

Connexin 43 Is a Promising Target for Pulmonary Hypertension due To Hypoxemic Lung Disease

International audienc

Marquer la prééminence sociale

L’objectif principal du programme SAS (Signs and States) est de construire une sémiologie de l’État et c’est en fonction de cet objectif qu’ont été choisis les thèmes traités dans le cadre des conférences qui ont déjà été organisées : rituels, connotations, langages, poids de l’implicite, vérité, valeurs…, toutes notions qui, à l’exception toutefois de la première, ne sont que rarement au premier plan des préoccupations des historiens. Il s’agit pour nous d’appliquer l’un des principes qui irrigue l’œuvre de Saussure, à savoir que le langage est avant tout un système de signes : bien sûr, au premier chef, les signes linguistiques, mais aussi tous les systèmes de signes permettant la communication entre les êtres humains. Ils doivent tous être étudiés avec la même attention, non seulement en tant que tels, mais aussi dans leurs combinaisons multiples, puisqu’ils interagissent évidemment entre eux et s’articulent pour produire du sens. Analyser le politique à partir de la lettre seule du texte politique (qu’il soit pratique ou théorique) est insuffisant puisqu’il ne s’agit là que d’un seul système de signes alors même que, si l’on veut satisfaire aux exigences de l’analyse du discours, d’autres systèmes qui fonctionnent simultanément doivent être pris en compte, telles que la position sociale ou intellectuelle de l’émetteur, les conditions matérielles de production du discours, les spécificités de la prononciation ou la gestique de l’émetteur lorsqu’il s’agit d’une parole. D’où la volonté de se tourner vers des structures dont la portée en tant que système de signes est plus rarement analysée, comme le marquage de l’espace urbain et les marqueurs de la distinction sociale. Tous ces systèmes concourent pourtant à produire cette légitimité implicite dont l’anthropologie politique permet de vérifier qu’elle est bien au cœur de la construction du consensus de la société politique, qu’il prenne la forme d’une véritable acceptation ou qu’il s’agisse seulement de l’intériorisation des limites apportées à l’expression du dissensus, qui assure la stabilité de la domination politique. Il faut déchiffrer ces systèmes et, à partir de là, la façon dont ils interagissent les uns sur les autres. Pour cela, nous avons largement fait appel aux concepts développés par le sociologue Pierre Bourdieu. Mais encore faut-il pour les utiliser à bon escient les adapter au contexte chronologique et spatial de nos recherches : c’est ce qui explique la démarche suivie et la présentation de ce volume

Comparison of Outcomes and Mortality in Patients Having Left Ventricular Assist Device Implanted Early -vs- Late After Diagnosis of Cardiomyopathy

International audienceLVAD implantation in patients with a recently diagnosed cardiomyopathy has been poorly investigated. This work aims at describing the characteristics and outcomes of patients receiving a LVAD within 30 days following the diagnosis of cardiomyopathy. Patients from the ASSIST-ICD study was divided into recently and remotely diagnosed cardiomyopathy based on the time from initial diagnosis of cardiomyopathy to LVAD implantation using the cut point of 30 days. The primary end point of the study was all-cause mortality at 30-day and during follow-up. A total of 652 patients were included and followed during a median time of 9.1 (2.5 to 22.1) months. In this population, 117 (17.9%) had a recently diagnosed cardiomyopathy and had LVAD implantation after a median time of 15.0 (9.0 to 24.0) days following the diagnosis. This group of patients was significantly younger, with more ischemic cardiomyopathy, more sudden cardiac arrest (SCA) events at the time of the diagnosis and were more likely to receive temporary mechanical support before LVAD compared with the remotely diagnosed group. Postoperative in-hospital survival was similar in groups, but recently diagnosed patients had a better long-term survival after hospital discharge. SCA before LVAD and any cardiac surgery combined with LVAD implantation were identified as 2 independent predictors of postoperative mortality in recently diagnosed patients. In conclusion, rescue LVAD implantation for recently diagnosed severe cardiomyopathy is common in clinical practice. Such patients experience a relatively low postoperative mortality and have a better long-term survival compared with remotely diagnosed patients

Current results of left ventricular assist device therapy in France: the ASSIST-ICD registry

International audienceOBJECTIVES: Our goal was to provide a picture of left ventricular assist device (LVAD) activity in France between 2007 and 2016 based on the multicentric ASSIST-ICD registry.METHODS: We retrospectively collected 136 variables including in-hospital data, follow-up survival rates and adverse events from 671 LVAD recipients at 20 out of 24 LVAD implant centres in France. The average follow-up time was 1.2 years (standard deviation: 1.4); the total follow-up time was 807.5 patient-years.RESULTS: The included devices were the HeartMate II®, HeartWare LVAS® or Jarvik 2000®. The overall likelihood of being alive while on LVAD support or having a transplant (primary end point) at 1, 2, 3 and 5 years postimplantation was 65.2%, 59.7%, 55.9% and 47.7%, respectively, given a cumulative incidence of 29.2% of receiving a transplant at year 5. At implantation, 21.5% of patients were on extracorporeal life support. The overall rate of cardiogenic shock at implantation was 53%. The major complications were driveline infection (26.1%), pump pocket or cannula infection (12.6%), LVAD thrombosis (12.2%), ischaemic (12.8%) or haemorrhagic stroke (5.4%; all strokes 18.2%), non-cerebral haemorrhage (9.1%) and LVAD exchange (5.2%). The primary end point (survival) was stratified by age at surgery and by the type of device used, with inference from baseline profiles. The primary end point combined with an absence of complications (secondary end point) was also stratified by device type.CONCLUSIONS: The ASSIST-ICD registry provides a real-life picture of LVAD use in 20 of the 24 implant centres in France. Despite older average age and a higher proportion of patients chosen for destination therapy, survival rates improved compared to those in previous national registry results. This LVAD registry contrasts with other international registries because patients with implants have more severe disease, and the national policy for graft attribution is distinct. We recommend referring patients for LVAD earlier and suggest a discussion of the optimal timing of a transplant for bridged patients (more dismal results after the second year of support?)

Les patients âgés de plus de 70 ans implantés d’une assistance cardiaque ventriculaire gauche à flux continue ont des résultats et une survie similaires que les patients de moins de 70 ans

International audienceBackground: Left ventricular assist device (LVAD) implantation may be an attractive alternative therapeutic option for elderly patients with heart failure who are ineligible for heart transplantation.Aim: We aimed to describe the characteristics and outcomes of elderly patients (i.e. aged ≥ 70 years) receiving an LVAD.Methods; This observational study was conducted in 19 centres between 2006 and 2016. Patients were divided into two groups–younger (aged < 70 years) and elderly (aged ≥ 70 years), based on age at time of LVAD implantation.Results: A total of 652 patients were included in the final analysis, and 74 patients (11.3%) were aged ≥ 70 years at the time of LVAD implantation (maximal age 77.6 years). The proportion of elderly patients receiving an LVAD each year was constant, with a median of 10.6% (interquartile range 8.0–15.4%) per year, and all were implanted as destination therapy. Elderly and younger patients had similar durations of hospitalization in intensive care units and total lengths of hospital stays. Both age groups experienced similar rates of LVAD-related complications (i.e. stroke, bleeding, driveline infection and LVAD exchange), and the occurrence of LVAD complications did not impact survival in the elderly group compared with the younger group. Lastly, when compared with younger patients implanted as destination therapy, the elderly group also exhibited similar mid-term survival.Conclusion:This work strongly suggests that selected elderly adults can be scheduled for LVAD implantation.Contexte: L’implantation d’une assistance cardiaque de longue durée (LVAD) peut être une séduisante alternative thérapeutique pour les patients insuffisants cardiaques âgés non éligible à une transplantation cardiaque.Objectif: Dans cette étude, nous décrivons les caractéristiques et résultats de l’implantation d’une assistance cardiaque mono-ventriculaire gauche chez des patients âgés de plus de 70 ans.Méthodes: Les patients implantés d’un LVAD dans 19 centres français entre 2006 et 2016 ont été inclus et divisés en deux groupes suivant l’âge à l’implantation (≥ 70 ou < 70 ans).Résultats: Un total de 652 patients ont été inclus et 74 (11,3 %) étaient âgés de plus de 70 ans à l’implantation du LVAD (maximal à 77,6 ans). La proportion de patients ayant ≥ 70 ans implanté d’un LVAD est constante chaque année avec une médiane de 10,6 % (8,0–15,4 %). Les 74 patients ont tous été implantés en thérapie définitive. Les deux groupes ont une durée d’hospitalisation (en réanimation et totale) similaire et développent un pourcentage identique de complications en lien avec le LVAD (accidents ischémiques, saignement, infection de câble, changement de LVAD). Le survenue d’une complication n’impact pas la survie chez les patients ≥ 70 ans par rapport au groupe < 70 ans. Enfin, parmi le sous-groupe de patients implantés en thérapie définitive, les deux populations (≥ 0 ou < 70 ans) ont une survie identique.Conclusion: Ce travail suggère que des patients insuffisants cardiaques âgés de plus de 70 ans et bien sélectionnés peuvent être de bons candidats à l’implantation d’un LVAD

Human immunodeficiency virus continuum of care in 11 european union countries at the end of 2016 overall and by key population: Have we made progress?

Background. High uptake of antiretroviral treatment (ART) is essential to reduce human immunodeficiency virus (HIV) transmission and related mortality; however, gaps in care exist. We aimed to construct the continuum of HIV care (CoC) in 2016 in 11 European Union (EU) countries, overall and by key population and sex. To estimate progress toward the Joint United Nations Programme on HIV/AIDS (UNAIDS) 90-90-90 target, we compared 2016 to 2013 estimates for the same countries, representing 73% of the population in the region. Methods. A CoC with the following 4 stages was constructed: number of people living with HIV (PLHIV); proportion of PLHIV diagnosed; proportion of those diagnosed who ever initiated ART; and proportion of those ever treated who achieved viral suppression at their last visit. Results. We estimated that 87% of PLHIV were diagnosed; 92% of those diagnosed had ever initiated ART; and 91% of those ever on ART, or 73% of all PLHIV, were virally suppressed. Corresponding figures for men having sex with men were: 86%, 93%, 93%, 74%; for people who inject drugs: 94%, 88%, 85%, 70%; and for heterosexuals: 86%, 92%, 91%, 72%. The proportion suppressed of all PLHIV ranged from 59% to 86% across countries. Conclusions. The EU is close to the 90-90-90 target and achieved the UNAIDS target of 73% of all PLHIV virally suppressed, significant progress since 2013 when 60% of all PLHIV were virally suppressed. Strengthening of testing programs and treatment support, along with prevention interventions, are needed to achieve HIV epidemic control. © The Author(s) 2020