La décision partagée en médecine générale (quelle représentation en ont les praticiens ?)

L'objet de cette recherche est d'explorer la représentation que les médecins généralistes ont de la décision partagée, à partir de la définition de ce concept dans la littérature. Dans un premier temps, nous avons donc fait une revue de la littérature sur la notion de décision partagée, en situant ce modèle dans le temps par rapport à deux grands modèles décisionnels, le modèle " paternaliste " et le modèle " informatif". Dans un deuxième temps, nous avons réalisé une étude qualitative auprès d'un échantillon de 40 médecins généralistes maîtres de stage des départements de Loire-Atlantique et de Vendée dans le but de savoir comment ils conçoivent personnellement la décision partagée, en partant de l'exemple de la décision de prescription d'un traitement hormonal substitutif de ménopause. Les éléments de divergence mis en évidence entre le concept de décision partagée et la représentation qu'en ont les médecins inclus dans notre étude aboutissent à un questionnement sur les difficultés d'implication du patient dans les décisions qui le concernent dans le domaine de la santé. Ce sont autant de voies de recherche pour la médecine générale.NANTES-BU Médecine pharmacie (441092101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Protéines LAP : de nouvelles clés de voûte de l’architecture épithéliale

La polarité, une des propriétés les plus importantes des épithéliums, se manifeste par la formation de deux domaines membranaires distincts, apical et basolatéral, dont les fonctions sont spécialisées. La formation, le maintien et les fonctions des tissus épithéliaux sont assurés par un canevas de protéines de surface connectées à des réseaux intracellulaires de molécules de structure et de signalisation organisant la polarité spécialisée du tissu, et contrôlant ses relations avec le milieu extérieur. Au sein de ces échafaudages moléculaires, les protéines à domaines PDZ (PSD95/Dlg/ZO-1) tiennent une place prépondérante en assurant l’assemblage et la distribution subcellulaire des acteurs de l’homéostasie épithéliale. Parmi celles-ci, les protéines de la famille LAP (LRR and PDZ) occupent le devant de la scène en raison de leur implication dans les étapes-clés de la différenciation épithéliale. De plus, l’étude de modèles génétiques invertébrés et vertébrés a notamment permis de mettre en exergue leur rôle central au cours du développement embryonnaire et de dévoiler, pour certaines protéines LAP, un rôle potentiel de suppresseur de tumeur.Cell proliferation and cell differentiation are balanced processes required for the correct development and maintenance of tissues, including epithelial tissues. Disruption of this balance by downregulation or loss of function of gatekeepers of epithelial homeostasis may unleash tumor suppressing activities leading ultimately to tumorigenesis. Among the newcoming actors involved in epithelial cell polarity, recent data shed light on the crucial role played by the LAP (LRR And PDZ) protein family. LAP proteins assemble receptors, cytoplasmic adaptors and enzymes in multimolecular networks important for the different steps of epithelial differentiation : adhesion, building of tight junctions and trafficking of proteins along the secretory pathway. Furthermore, genetic studies in invertebrates and vertebrates have installed LAP proteins not only as crucial determinants for epithelial integrity but also as key regulators of cell proliferation and embryonic development

Basolateral targeting by leucine‐rich repeat domains in epithelial cells

The asymmetric distribution of proteins to basolateral and apical membranes is an important feature of epithelial cell polarity. To investigate how basolateral LAP proteins (LRR (for leucine-rich repeats) and PDZ (for PSD-95/Discs-large/ZO-1), which play key roles in cell polarity, reach their target membrane, we carried out a structure–function study of three LAP proteins: Caenorhabditis elegans LET-413, human Erbin and human Scribble (hScrib). Deletion and point mutation analyses establish that their LRR domain is crucial for basolateral membrane targeting. This property is specific to the LRR domain of LAP proteins, as the non-LAP protein SUR-8 does not localize at the basolateral membrane of epithelial cells, despite having a closely related LRR domain. Importantly, functional studies of LET-413 in C. elegans show that although its PDZ domain is dispensable during embryogenesis, its LRR domain is essential. Our data establish a novel paradigm for protein localization by showing that a subset of LRR domains direct subcellular localization in polarized cells

Etude de l'implication d'Erbin, une protéine de la famille LAP, dans l'établissement de la polarité épithéliale

AIX-MARSEILLE2-BU Sci.Luminy (130552106) / SudocSudocFranceF

France, Anthropology in

International audienceAnthropology developed late in France, though the country had cradled its premises during the Enlightenment and the first elaborations of the social sciences happened after the French Revolution of 1789. Dominated by racial and natural history paradigms during the nineteenth century, ethnology got new recognition with the advent of sociology but remained in the framework of museums. After World War II, social anthropology eventually experienced a rapid expansion with the development of research institutions. Conventional readings of the history of French anthropology usually have an emphasis on structuralism and Marxism but they miss the importance of dynamic anthropology and the contribution of many other critical currents of thought that contributed to the reconsideration of the epistemological and methodological bases of the discipline. The reevaluation of ethnological inquiry, in particular since the 1980s, engendered the detraditionalization and de-exoticization of social anthropology and a growing diversification of its fields of research

Cancer Induces a Stress Ileopathy Depending on beta-Adrenergic Receptors and Promoting Dysbiosis that Contributes to Carcinogenesis

Gut dysbiosis has been associated with intestinal and extraintestinal malignancies, but whether and how carcinogenesis drives compositional shifts of the microbiome to its own benefit remains an open conundrum. Here, we show that malignant processes can cause ileal mucosa atrophy, with villous microvascular constriction associated with dominance of sympathetic over cholinergic signaling. The rapid onset of tumorigenesis induced a burst of REG3γ release by ileal cells, and transient epithelial barrier permeability that culminated in overt and long-lasting dysbiosis dominated by Gram-positive Clostridium species. Pharmacologic blockade of β-adrenergic receptors or genetic deficiency in Adrb2 gene, vancomycin, or cohousing of tumor bearers with tumor-free lit-termates prevented cancer-induced ileopathy, eventually slowing tumor growth kinetics. Patients with cancer harbor distinct hallmarks of this stress ileopathy dominated by Clostridium species. Hence, stress ileopathy is a corollary disease of extraintestinal malignancies requiring specific therapies. SIGNIFICANCE: Whether gut dysbiosis promotes tumorigenesis and how it controls tumor progression remain open questions. We show that 50% of transplantable extraintestinal malignancies triggered a β-adrenergic receptor–dependent ileal mucosa atrophy, associated with increased gut permeability, sustained Clostridium spp.–related dysbiosis, and cancer growth. Vancomycin or propranolol prevented cancer-associated stress ileopathy

Cancer Induces a Stress Ileopathy Depending on β-Adrenergic Receptors and Promoting Dysbiosis that Contributes to Carcinogenesis

International audienceAbstract Gut dysbiosis has been associated with intestinal and extraintestinal malignancies, but whether and how carcinogenesis drives compositional shifts of the microbiome to its own benefit remains an open conundrum. Here, we show that malignant processes can cause ileal mucosa atrophy, with villous microvascular constriction associated with dominance of sympathetic over cholinergic signaling. The rapid onset of tumorigenesis induced a burst of REG3γ release by ileal cells, and transient epithelial barrier permeability that culminated in overt and long-lasting dysbiosis dominated by Gram-positive Clostridium species. Pharmacologic blockade of β-adrenergic receptors or genetic deficiency in Adrb2 gene, vancomycin, or cohousing of tumor bearers with tumor-free littermates prevented cancer-induced ileopathy, eventually slowing tumor growth kinetics. Patients with cancer harbor distinct hallmarks of this stress ileopathy dominated by Clostridium species. Hence, stress ileopathy is a corollary disease of extraintestinal malignancies requiring specific therapies. Significance: Whether gut dysbiosis promotes tumorigenesis and how it controls tumor progression remain open questions. We show that 50% of transplantable extraintestinal malignancies triggered a β-adrenergic receptor–dependent ileal mucosa atrophy, associated with increased gut permeability, sustained Clostridium spp.–related dysbiosis, and cancer growth. Vancomycin or propranolol prevented cancer-associated stress ileopathy. This article is highlighted in the In This Issue feature, p. 87