La musique bassari : un parcours obligé

« Il n’est aucun des procédés, aucune des qualités que nous croirions propres à une musique douée d’écriture qui ne se retrouve un peu dans une musique de tradition orale. Mais en dernière analyse, ce qui oppose ces sortes de musiques serait peut-être moins ce que l’une a et l’autre n’a pas que ce que l’une n’a plus et l’autre a encore ».André Schaeffner En milieu bassari, la musique se dissout entièrement à l’intérieur de contextes qui l’englobent et lui donnent sa raison d’être. Son rôle s’..

Hepatocyte and keratinocyte growth factors and their receptors in human lung emphysema

BACKGROUND: Hepatocyte and keratinocyte growth factors are key growth factors in the process of alveolar repair. We hypothesized that excessive alveolar destruction observed in lung emphysema involves impaired expression of hepatocyte and keratinocyte growth factors or their respective receptors, c-met and keratinocyte growth factor receptor. The aim of our study was to compare the expression of hepatocyte and keratinocyte growth factors and their receptors in lung samples from 3 groups of patients: emphysema; smokers without emphysema and non-smokers without emphysema. METHODS: Hepatocyte and keratinocyte growth factor proteins were analysed by immunoassay and western blot; mRNA expression was measured by real time quantitative polymerase chain reaction. RESULTS: Hepatocyte and keratinocyte growth factors, c-met and keratinocyte growth factor receptor mRNA levels were similar in emphysema and non-emphysema patients. Hepatocyte growth factor mRNA correlated negatively with FEV1 and the FEV1/FVC ratio both in emphysema patients and in smokers with or without emphysema. Hepatocyte and keratinocyte growth factor protein concentrations were similar in all patients' groups. CONCLUSION: The expression of hepatocyte and keratinocyte growth factors and their receptors is preserved in patients with lung emphysema as compared to patients without emphysema. Hepatocyte growth factor mRNA correlates with the severity of airflow obstruction in smokers

Participation des fibroblastes et des fibrocytes aux mécanismes de réparation pulmonaire au cours des agressions alvéolaires aiguës

Le syndrome de détresse respiratoire aiguë (ARDS) est la forme la plus sévère d'agression alvéolaire aiguë (ALI) Il est caractérisé par un dommage alvéolaire diffus suivi d'une phase de réparation nécessaire à la guérison. Bien que les fibroblastes pulmonaires soient des acteurs essentiels de cette réparation, leurs caractéristiques et leurs fonctions restent mal connues chez l'homme au cours des ALI/ARDS. L hypothèse défendue par cette thèse est qu une réparation alvéolaire harmonieuse nécessite un recrutement adapté des fibroblastes et de leur précurseur, les fibrocytes, vers le poumon, ainsi qu' une fine régulation de leurs fonctions par l'environnement inflammatoire de l'alvéole. Les principaux résultats de nos travaux ont permis : 1) d établir que le liquide de lavage alvéolaire (LBA) recueilli lors des ALI/ARDS stimule la production de facteurs de réparation épithéliaux comme l'Hepatocyte Growth Factor (HGF) et le Keratinocyte Growth Factor (KGF) par les fibroblastes. Cette production est principalement induite par l'IL-1ß via une boucle autocrine COX2/PGE2. 2) de montrer que les fibroblastes alvéolaires cultivés à partir des LBA d'ALI/ARDS présentent un phénotype activé, caractérisé par une production augmentée de collagène 1 et une capacité de migration majorée. La détection de fibroblastes dans les cultures de cellules du LBA est associée à une diminution des marqueurs de l'inflammation et à une réduction de la durée de ventilation des patients concernés. 3) D analyser l effet des LBA d'ALI/ARDS sur la migration des fibroblastes et de monter l existence d un équilibre entre activation et inhibition de la migration via une modulation de le voie du PDGF. La forme soluble du récepteur a au PDGF (PDGF-sRa) est un des inhibiteurs présent dans le LBA. Une augmentation de la capacité chimiotactique des LBA de patients en ALI/ARDS est associée à une augmentation de la mortalité.4) De démontrer la présence de fibrocytes, précurseurs mésenchymateux circulants d'origine hématopoïétique, dans les LBA de patients en ALI/ARDS et de mettre en évidence que leur recrutement excessif, est associé à un mauvais pronostic. Ainsi, après ajustement sur les covariables cliniques et biologiques (modèle de COX), un pourcentage de fibrocyte supérieur à 6% de la population cellulaire totale du LBA est associé à une durée de ventilation prolongée et à une mortalité augmentée. L ensemble de ces travaux démontrent pour la première fois que les fibroblastes et les fibrocytes sont directement associés au pronostic lors des ALI/ARDS, que leur rôle est indispensable à la guérison mais que leur recrutement excessif pourrait impacter défavorablement le pronostic des patients. Les données physiopathologiques obtenues pourraient contribuer à l identification de nouvelles cibles thérapeutiques et à proposer de nouveaux marqueurs biologiques dans la prise en charge des ALI/ARDSAcute Respiratory Distress Syndrome (ARDS) is the most severe form of Acute Lung Injury (ALI) and is characterized by diffuse alveolar damage followed by a phase of alveolar repair necessary to recovery. Although lung fibroblasts are key players in this repair process, their characteristics and functions remain poorly understood in humans during ALI/ARDS. The hypothesis of our studies was that effective alveolar repair requires a regulated recruitment of fibroblasts and fibrocytes (circulating mesenchymal precursors of hematopoietic origin) to the lung, as well as a tight regulation of their functions by the alveolar inflammatory environment. The main results of our works have shown that: 1) The alveolar lavage fluid (BAL) from ALI/ARDS patients stimulated the production of Hepatocyte Growth Factor (HGF) and Keratinocyte Growth Factor (KGF) by fibroblasts, both of which were involved in epithelial repair. This production was mainly induced by IL-1ß via an autocrine COX2/PGE2 dependant loop. 2) The alveolar fibroblasts cultured from BAL fluids of ALI/ARDS patients demonstrated an activated phenotype, characterized by an increase of both collagen 1 production and ability to migrate. A positive BAL fibroblast cell culture was associated with reduced markers of inflammation and reduced ventilation duration of ALI/ARDS patients. 3) BAL fluids from ALI/ARDS patients modulated fibroblast migration. This effect was related to a balance between activation and inhibition of migration involving the PDGF signaling pathway. The soluble form of the PDGF a receptor (PDGF-sRa) participated in the BAL inhibitory chemotactic activity. An increased chemotactic ability of BAL from ALI/ARDS patients was associated with higher mortality. 4) Excessive recruitment of fibrocytes is associated with poor prognosis. After adjustment of clinical and biological covariates (Cox model), a percentage of fibrocytes higher than 6% of total BAL cells is associated with a prolonged ventilation duration and an increased mortality. Taken together, our works demonstrate for the first time that fibroblasts and fibrocytes are directly associated with prognosis in ALI/ARDS. Fibroblasts are essential to lung healing, but their excessive recruitment may have a negative impact on prognosis. The data presented in this thesis may help identify new therapeutic targets and suggest new biomarkers to consider in the management of ALI/ARDSPARIS-EST-Université (770839901) / SudocSudocFranceF

Réponse inflammatoire induite par la chirurgie cardiaque sous circulation extra-corporelle (rôle des catécholamines)

PARIS-BIUP (751062107) / SudocSudocFranceF

Assessment of salivary amylase as a stress biomarker in pregnant patients.: Salivary alpha-amylase: a stress biomarker in pregnant patients

International audienceBACKGROUND: Chronic stress during pregnancy has been associated with worsened maternal and fetal outcomes. Acute stress immediately before spinal anaesthesia for caesarean section may contribute to hypotension. Therefore objective measures of acute stress may help identify women at risk of adverse outcomes. Salivary alpha-amylase is a stress biomarker that has so far been poorly investigated during pregnancy. The reference change value is the difference between two sequential results that must be exceeded for a change to be considered clinically relevant. Our first aim was to determine if salivary alpha-amylase increased in pregnant patients when subjected to the stress of transfer to the operating room. Our second aim was to determine if changes in salivary alpha-amylase were likely to be clinically significant by measuring reference change value in healthy volunteers. METHODS: In 15 pregnant patients undergoing planned caesarean section under spinal anaesthesia, salivary alpha-amylase, systolic blood pressure, heart rate, and immediate anxiety were measured on the morning of surgery on the ward and again in the operating room. The reference change value was calculated from 18 healthy volunteers. RESULTS: A median 220% increase in salivary alpha-amylase activity (P=0.0015) and a 17% increase in systolic blood pressure (P=0.0006) were observed between the ward and operating room. No changes of immediate anxiety or heart rate were observed. Reference change value was ±76% in volunteers and 13 of the 15 pregnant patients had a salivary alpha-amylase increase greater than the reference change value. CONCLUSION: When pregnant women are taken to the operating room, a clinically and statistically significant increase in salivary alpha-amylase was observed. Further studies are required to define its clinical usefulness

Postoperative Cardiac Troponin I Thresholds Associated With 1-Year Cardiac Mortality After Adult Cardiac Surgery: An Attempt to Link Risk Stratification With Management Stratification in an Observational Study

International audienceObjectives: Cardiac troponin (cTn) concentrations are measured routinely in some centers after cardiac surgery as part of risk stratification, but there are no data on how increased cTn concentrations could change patients' management. The aim of this study was to estimate relevant cTnI thresholds and identify potential interventions (additional monitoring/therapeutic interventions) that could be part of management changes of patients with cTnI greater than relevant thresholds.Design: Retrospective, single-center, observational study.Setting: Bichat-Claude Bernard Hospital, Paris, France, between January 1, 2009, and December 31, 2012.Participants: Consecutive adult patients undergoing cardiac surgery.Measurements and main results: cTnI was measured on the 20th postoperative hour. Causes of death and possible interventions were determined by analysis of individual medical records. cTnI thresholds for 1-year cardiac mortality with a specificity >80% were calculated. For this study, 3,228 procedures were analyzed; 129 deaths occurred (4%), 83 of which (2.6%) were cardiac deaths. Threshold cTnI values were 4.2 µg/L for coronary artery bypass grafting (95% confidence interval [CI] 3.9-4.5) and 10.7 µg/L for non-coronary artery bypass grafting (95% CI 10.0-11.3). In multivariable analysis, the EuroSCORE II (odds ratio 1.1 [95% CI 1.06-1.13]; p < 0.001) and cTnI concentrations greater than the thresholds (odds ratio 5.62 [95% CI 3.37-9.37]; p < 0.001) were associated with significantly increased risk of death. The additive and absolute Net Reclassification Index were 0.288% and 14.1%, respectively, for a logistic model including cTnI and EuroSCORE II (area under the curve C-index 0.82 [95% CI 0.77-0.87]) compared with a model including only EuroSCORE II (area under the curve C-index 0.80 [95% CI 0.75-0.84]). Fifty-three of the 83 patients who experienced cardiac death (64%) had a cTnI concentration greater than the threshold, and an intervention was deemed possible in 47 of those 53 (89%) (mostly patients with mild postoperative cardiac dysfunction). For noncardiac deaths, 28% of patients had a cTnI concentration greater than the threshold and no interventions were deemed possible.Conclusions: In an attempt to evolve from risk to management stratification, this study's results identified a subgroup of patients with mild cardiac dysfunction and a cTnI concentration greater than the threshold who could be the target for interventions in future validation studies concerning changes in patient management

Obstructive Sleep Apnoea Modulates Airway Inflammation and Remodelling in Severe Asthma.

BACKGROUND:Obstructive sleep apnoea (OSA) is frequently observed in severe asthma but the causal link between the 2 diseases remains hypothetical. The role of OSA-related systemic and airway neutrophilic inflammation in asthma bronchial inflammation or remodelling has been rarely investigated. The aim of this study was to compare hallmarks of inflammation in induced sputum and features of airway remodelling in bronchial biopsies from adult patients with severe asthma with and without OSA. MATERIALS AND METHODS:An overnight polygraphy was performed in 55 patients referred for difficult-to-treat asthma, who complained of nocturnal respiratory symptoms, poor sleep quality or fatigue. We compared sputum analysis, reticular basement membrane (RBM) thickness, smooth muscle area, vascular density and inflammatory cell infiltration in bronchial biopsies. RESULTS:In total, 27/55 patients (49%) had OSA diagnosed by overnight polygraphy. Despite a moderate increase in apnoea-hypopnoea index (AHI; 14.2 ± 1.6 event/h [5-35]), the proportion of sputum neutrophils was higher and that of macrophages lower in OSA than non-OSA patients, with higher levels of interleukin 8 and matrix metalloproteinase 9. The RBM was significantly thinner in OSA than non-OSA patients (5.8 ± 0.4 vs. 7.8 ± 0.4 μm, p<0.05). RBM thickness and OSA severity assessed by the AHI were negatively correlated (rho = -0.65, p<0.05). OSA and non-OSA patients did not differ in age, sex, BMI, lung function, asthma control findings or treatment. CONCLUSION:Mild OSA in patients with severe asthma is associated with increased proportion of neutrophils in sputum and changes in airway remodelling