392 research outputs found
Intimité et sexualité des patientsPoint de vue du personnel hospitalier
Quotidiennement, les soignants entrent dans la sphère intime du patient. De plus, ils ont à se position- ner à propos de questions difficiles, telles que la place à laisser à la sexualité du patient, la réaction à avoir face à des comportements «inadéquats», etc. Comment vivent-ils cette confrontation à l'inti- mité ? Quelles sont leurs ressources en termes de savoir-faire, formation, directives ? Quelles sont les différentes approches de la sexualité et l'intimité parmi les soignants ?
Douze soignants ont participé à des entretiens semi-dirigés. Ces entretiens ont été analysés afin de faire ressortir les manières de réagir des soignants face à l'intimité. De plus, des experts ont répondu à des questions concernant le contenu de la formation ou les directives des hôpitaux.
Beaucoup de réflexions qui permettent aux soignants de vivre au mieux la confrontation à l'intimité ont été dégagées. Voici deux exemples de réflexions importantes : de quelle manière et dans quel but exposer ou parler de l'intimité du patient ? Comment ajuster la distance thérapeutique en fonction du patient et de la situation ? Quatre manières d'aborder la sexualité ont été identifiées : inexpérimentée et fragile chez le «stagiaire» ; médicale et factuelle chez le «technicien» ; pudique, comme un sujet privé chez le «décent» ; et finalement attentive chez le «compréhensif». Actuellement, il n'existe pas de directives spécifiques au sujet de l'intimité et la sexualité des patients dans nos hôpitaux. En ce qui concerne la formation, le sujet souvent abordé est la protection de la pudeur lors des soins. Le sujet qui fait défaut est la gestion des situations complexes ou liées à la sexualité.
Chaque soignant aborde la sexualité de manière très différente. Il est difficile d'élaborer des directives qui correspondent à chaque soignant et à chaque nouvelle situation. C'est pourquoi il faut se concen- trer sur la formation et la sensibilisation des soignants à cette problématique. Ceci leur permet de se préparer à la confrontation à l'intimité en y réfléchissant à l'avance
Transcriptional silencing of the Dickkopfs-3 (Dkk-3) gene by CpG hypermethylation in acute lymphoblastic leukaemia
Dkk-3 is a newly characterised mortalisation-related gene and an antagonist of the Wnt oncogenic signalling pathway whose
expression is decreased in a variety of cancer cell lines, suggesting that the Dkk-3 gene, located at chromosome 11p15.1, functions as
a tumour suppressor gene. Although 11p15 is a ‘hot spot’ for methylation in acute lymphoblastic leukaemia (ALL), the role of Dkk-3
abnormalities has never been evaluated in this disease. We analysed CpG island methylation of the Dkk-3 promoter in six ALL cell
lines and 183 ALL patients. We observed Dkk-3 hypermethylation in all cell lines and in cells from 33% (60/183) of ALL patients.
Moreover, Dkk-3 methylation was associated with decreased Dkk-3 mRNA expression and this expression was restored after
exposure to the demethylating agent 5-AzaC. Clinical features did not differ between hypermethylated and unmethylated patients.
Estimated disease-free survival (DFS) and overall survival at 10 and 11 years, respectively, were 49.8 and 45.6% for normal patients
and 10.5 and 15.1% for hypermethylated patients (P¼0.001 and 0.09). Multivariate analysis demonstrated that Dkk-3 methylation
was an independent prognostic factor predicting DFS (P¼0.0009). Our data suggest that Dkk-3 methylation occurs at an early stage
in ALL pathogenesis and probably influences the clinical behaviour of the disease
Evidence for Pleistocene gene flow through the ice-free corridor from extinct horses and camels from Natural Trap Cave, Wyoming
Natural Trap Cave (Bighorn Mountains, Wyoming) preserves an abundance of fossil remains from extinct Late Pleistocene fauna and is situated near a past migration route that likely connected populations in Eastern Beringia and the contiguous US—the ice-free corridor between the Cordilleran and Laurentide icesheets. Some palaeontological evidence supports a correspondingly high affinity between fauna recorded in Natural Trap Cave and Eastern Beringia versus elsewhere in the contiguous US, but this hypothesis has not yet been extensively tested using genetic data. In the present study, we analysed 16 horse specimens and one camel specimen from Natural Trap Cave. Of the horse specimens we analysed, we obtained 10 unique and previously unreported mitochondrial haplotypes belonging to two distinct (extinct) genetic clades—two haplotypes corresponded to a caballine horse (Equus sp.) and eight corresponded to the stilt-legged horse (Haringtonhippus francisci). With only one exception, it appears these newly sequenced individuals all shared a common ancestor more recently with Eastern Beringian individuals than with others from the contiguous US. In addition, mitochondrial data from a specimen assigned to Camelops sp. revealed that it shares a closer affinity with specimens from the Yukon Territory than those from Idaho or Nevada, though all appear to belong to a single species (“yesterday''s camel”; Camelops cf. hesternus). Together, these results are consistent with a high level of genetic connectivity between horse and camel populations in the Bighorn Mountains and Eastern Beringia during the Pleistocene. © 2021 Elsevier Ltd and INQU
Promoter hypermethylation of cancer-related genes: a strong independent prognostic factor in acute lymphoblastic leukemia
Promoter hypermethylation plays an important
role in the inactivation of cancerrelated
genes. This abnormality occurs
early in leukemogenesis and seems to be
associated with poor prognosis in acute
lymphoblastic leukemia (ALL). To determine
the extent of hypermethylation in
ALL, we analyzed the methylation status
of the CDH1, p73, p16, p15, p57, NES-1,
DKK-3, CDH13, p14, TMS-1, APAF-1,
DAPK, PARKIN, LATS-1, and PTEN genes
in 251 consecutive ALL patients.Atotal of
77.3% of samples had at least 1 gene
methylated, whereas 35.9% of cases had
4 or more genes methylated. Clinical features
and complete remission rate did not
differ among patients without methylated
genes, patients with 1 to 3 methylated
genes (methylated group A), or patients
with more than 3 methylated genes (methylated
group B). Estimated disease-free
survival (DFS) and overall survival (OS) at
11 years were 75.5% and 66.1%, respectively,
for the nonmethylated group; 37.2%
and 45.5% for methylated group A; and
9.4% and 7.8% for methylated group B
(P < .0001 and P .0004, respectively).
Multivariate analysis demonstrated that
the methylation profile was an independent
prognostic factor in predicting DFS
(P < .0001) and OS (P .003). Our results
suggest that the methylation profile may
be a potential new biomarker of risk prediction
in AL
Methylation status of Wnt signaling pathway genes affects the clinical outcome of Philadelphia-positive acute lymphoblastic leukemia
The clinical significance of aberrant promoter methylation of the
canonical Wnt pathway antagonist genes (sFRP1, sFRP2, sFRP4,
sFRP5, Wif1, Dkk3, and Hdpr1) and also putative tumor-suppressor
gene Wnt5a, belonging to the non-canonical Wnt signaling pathway,
was investigated in a large series of 75 patients with Philadelphia
chromosome-positive acute lymphoblastic leukemia by methylationspecific
polymerase chain reaction. At least one methylated gene
was observed in cells from 66% (49/75) of patients (methylated
group). Disease-free survival and overall survival at 9 years were 51
and 40%, respectively, for the unmethylated group and 3 and 2%,
respectively, for the methylated group (both P < 0.0001). Multivariate
analysis demonstrated that the Wnt methylation profile was an
independent prognostic factor predicting disease-free survival
(P = 0.007) and overall survival (P = 0.039). Abnormal DNA methylation
of promoter-associated CpG islands in the Wnt signaling pathway is
very common in Philadelphia chromosome-positive acute lymphoblastic
leukemia and potentially defines subgroups with distinct
clinical characteristics
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