La précarité sanitaire vue par les médecins

Maria Melchior et Christophe Adam, copilotes de ce dossier, ont interrogé quatre de leurs collègues médecins. Pratique médicale et difficultés quotidiennes, réflexions personnelles et initiatives « engagées » se mêlent. Chacun livre son témoignage, son ressenti sur ce que rester fidèle au serment d’Hippocrate veut dire dans un contexte de dégradation de l’offre de soins

Enhanced muscle mixed and mitochondrial protein synthesis rates after a high-fat or high-sucrose diet

International audienceOBJECTIVE: Obesity and insulin resistance are associated with muscle mitochondrial dysfunction, which might be related to impairment of mitochondrial protein synthesis. This study aimed at investigating mixed and mitochondrial protein synthesis in skeletal muscle in response to dietary manipulations. RESEARCH METHODS AND PROCEDURES: High-sucrose (SU) and high-fat, high-sucrose (F) diets were provided for 6 weeks to Wistar rats at standard (N) and high (H) energy intakes and compared with controls. Fractional synthesis rates of mixed (FSRPT) and mitochondrial (FSRm) proteins within the oxidative (soleus) and glycolytic (tibialis) muscles were measured using stable isotope flooding dose technique using L-[13C]-valine. Carbonyl content, citrate synthase, and cytochrome c oxidase activities were assayed spectrophotometrically on isolated mitochondria. RESULTS: In the soleus, FSRPT was increased by 40% in the NSU and NF groups and by 65% in the HSU and HF groups (p<0.001 vs. control). FSRm was increased with high-fat diets (NF, +16%; HF, +32%; p<0.01). In the tibialis, FSR(PT) was enhanced in all experimental groups (+31% to 37%, p<0.05 vs. control). FSRm was augmented in the NSU, NF, and HF groups (+28% to 32%, p<0.01). Cytochrome c oxidase activity was significantly decreased in all experimental groups in the soleus (p<0.001). DISCUSSION: Muscle mixed and mitochondrial protein FSR are enhanced after short-term dietary intervention known to induce insulin resistance and obesity. Adaptations are muscle type specific and may not explain alterations in mitochondrial oxidative capacity but might contribute to maintain mitochondrial functioning

"Fast proteins" with a unique essential amino acid content as an optimal nutrition in the elderly: Growing evidence

Adequate protein intake is crucial to maintain body protein content in elderly subjects, but quality of dietary proteins should be also considered since amino acid composition and rate of protein digestion modulate amino acid availability. This study investigates whether the efficacy of optimal protein intake levels for protein retention in the elderly is influenced by protein quality

Fast-digestive protein supplement for ten days overcomes muscle anabolic resistance in healthy elderly men

The authors thank all the members of the Human Nutrition Laboratory, and are grateful to Françoise Morel-Laporte, Noëlle Mathieu, Marion Brandolini and Guy Manlhiot for their skilfultechnical assistance. The authors especially thank the volunteers who participated in this studyBackground/objective: Adequate protein intake is crucial to maintain muscle protein content in elderly subjects, but quality of dietary proteins should be considered. The aim was to determine whether soluble milk protein offers an original strategy to increase muscle anabolism in elderly subjects via a synergistic effect of fast-digesting proteins together with a unique essential AA content. Design: We investigated the effect of a 10-day adequate-protein (AP) or high-protein (HP) diet together with the protein source as caseins (CAS) or soluble milk proteins (PRO) on specific muscle protein fractional synthesis rates (FSRs) in healthy elderly men (71.8 +/- 2.4 yr, n = 31). The isotopic study consisted of two periods of 4 h each: a post-absorptive and a postprandial period. The fed state was defined by consumption of either 15 g or 30 g of PRO or CAS, given fractionally every 20 min for 4 h. Soluble milk proteins are produced using a membrane process directly from pasteurized milk. Measurements: Specific muscle protein FSRs were measured during both postabsorptive and postprandial period using a continuous infusion of L-[1-C-13]leucine. Results: FSR of sarcoplasmic muscle proteins and actin did not increase significantly in the postprandial state compared to postabsorptive state, whereas myosin FSR rate was increased by feeding whatever the protein source in HP groups (0.024 +/- 0.005 vs 0.053 +/- 0.011% h(-1), P < 0.05 and 0.026 +/- 0.004 vs 0.050 +/- 0.005% P < 0.004 for PRO HP and CAS HP) but only with the PRO meal in the AP groups (0.031 +/- 0.003 vs 0.062 +/- 0.009% h(-1), P < 0.03 for PRO AP). Mitoehondrial muscle protein FSR was also increased by feeding, irrespective of the protein quantity, but only in PRO meal groups (P < 0.02). Conclusion: Fast-digesting soluble milk proteins improved postprandial muscle protein synthesis, especially mitochondrial muscle proteins and myosin fractional synthesis rates, in elderly subjects. (C) 2015 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserve

KRACH SANITAIRE : la crise, à quel prix ?

Aujourd’hui, notre système de protection sociale est malade. Ce ne sont plus seulement les populations auxquelles une association comme Médecins du Monde apporte assistance chaque jour qui sont concernées. A côté des migrants, des sans-logements, des travailleurs du sexe ou encore des usagers de drogues, c’est de plus en plus la population générale qui rencontre des difficultés d’accès aux soins. Prendre la mesure de l’évolution de la précarité chez certaines populations, décrire les tensions et difficultés actuelles auxquelles sont exposés certains dispositifs, comme l’Aide médicale d’Etat ou le Droit au séjour pour maladie, tels sont les objectifs de ce numéro. Il réunit les représentants de structures qui assurent aujourd’hui le « filet de sécurité sociale », des observateurs de cette exclusion sanitaire montante et des acteurs qui innovent au quotidien. Avec eux, dans le contexte de crise économique et financière que nous connaissons, et alors que se dessine une tendance à l’individualisation des risques, il s’agit d’obtenir des éléments de réponse à la question qui surplombe ces problématiques : quel système de santé solidaire souhaitons-nous construire