Réflexions méthodologiques et épistémologiques sur l’intervention en immersion : comparaison de deux terrains

International audienceTwo immersion interventions at a specific, long-term site are set out and described : the first was ergonomic and was carried out in conjunction with the polar expedition to ensure the operation of the Concordia scientific station in the Antarctic ; the second, which involved providing psychological assistance, concerned the French sailing team during training and competitions spread over two Olympics, including the events at two Olympic sites. At a remove from these two interventions, their frameworks and intervention rationales were compared, as were their methodological models and the procedures used, and the modalities and constraints of the expertise brought in. A final discussion will try to contrast and compare these two paradigms and the ethical benchmarks of researchers.Se esbozan y describen dos intervenciones específicas de inmersión en el campo a largo plazo: uno, de tipo ergonómico, se realizó con el raid polar, implementado para asegurar el funcionamiento de la estación científica Concordia, en el continente antártico ; la otra, de apoyo psicológico, se hizo con el equipo olímpico francés de vela, durante los entrenamientos y competiciones repartidos en dos olimpiadas y que incluían pruebas en dos sedes olímpicas. A distancia de estas dos intervenciones, se comparan sus marcos y lógicas de intervención, los modelos metodológicos y los procedimientos utilizados, así como las modalidades y las limitaciones de la pericia aportada. Un debate final pretende comparar y contrastar estos dos paradigmas y examinar los puntos de referencia deontológicos de los participantes.Deux interventions en immersion sur un terrain spécifique, de longue durée, sont exposées et décrites : l’une, de type ergonomique, a été effectuée auprès du raid polaire, mis en œuvre pour assurer le fonctionnement de la station scientifique Concordia, sur le continent antarctique ; l’autre, de type accompagnement psychologique, concernait l’équipe de France de voile olympique, lors d’entraînements et compétitions étalés sur deux olympiades et incluant les épreuves sur deux sites olympiques. À distance de ces deux interventions, sont confrontés leurs cadres et logiques d’intervention, les modèles méthodologiques et les procédures utilisées, les modalités et contraintes de l’expertise apportée. Une discussion finale vise à confronter, rapprocher… ces deux paradigmes et à examiner les repères déontologiques des intervenants

Selective propensity of bovine jugular vein material to bacterial adhesions: An in-vitro study

International audienceBACKGROUND: Percutaneous pulmonary valve implantation (PPVI) using Melody valve made of bovine jugular vein is safe and effective. However, infective endocarditis has been reported for unclear reasons. We sought to assess the impact of valvular substrates on selective bacterial adhesion. METHODS: Three valved stents (Melody valve, homemade stents with bovine and porcine pericardium) were tested in-vitro for bacterial adhesion using Staphylococcus aureus and Streptococcus sanguinis strains. RESULTS: Bacterial adhesion was higher on bovine jugular venous wall for S. aureus and on Melody valvular leaflets for S. sanguinis in control groups and significantly increased in traumatized Melody valvular leaflets with both bacteria (traumatized vs non traumatized: p=0.05). Bacterial adhesion was lower on bovine pericardial leaflets. CONCLUSION: Selective adhesion of S. aureus and S. sanguinis pathogenic strains to Melody valve tissue was noted on healthy tissue and increased after implantation procedural steps

A multicenter, randomized trial of increased mycophenolic acid dose using enteric-coated mycophenolate sodium with reduced tacrolimus exposure in maintenance kidney transplant recipients.

International audienceMycophenolic acid (MPA) dose is frequently reduced in tacrolimus-treated kidney transplant patients, but alternatively the recommended MPA dose can be maintained with reduced tacrolimus exposure. In a 6-month, multicenter, randomized, openlabel study, maintenance kidney transplant patients receiving MPA (mycophenolate mofetil 1g/d or enteric-coated mycophenolate sodium (EC-MPS) 720 mg/d) and tacrolimus were randomized to convert to EC-MPS 1,440 mg/d with reduced tacrolimus (n = 46), or receive EC-MPS 720 mg/d with unchanged tacrolimus (n = 48). Mean estimated GFR (eGFR, aMDRD) at Month 6 was 49.1 ± 11.1 and 44.7 ± 11.5 ml/min/1.73 m2 in the EC-MPS 1,440 mg and 720 mg groups, respectively (p = 0.07). The primary endpoint, change in eGFR from Day 0 to Month 6, was 2.48 ± 0.95 ml/min/1.73 m2 with EC-MPS 1,440 mg and -0.48 ± 0.93 ml/min/1.73 m2 with EC-MPS 720 mg (difference 2.96 ml/min/1.73 m2; 95% CI 0.32 - 5.60; p = 0.028). There were no deaths, graft losses or acute rejections. Adverse events were more frequent with EC-MPS 1,440 mg than 720 mg (66.7% vs. 44.7%, p = 0.034). Adverse events with suspected relation to EC-MPS occurred in 26.7% and 21.3% of patients, respectively (p = 0.59). Conversion of kidney transplant patients to increased MPA dosing using EC-MPS 1,440 mg/d, with reduced tacrolimus exposure, appears an effective immunosuppression strategy and may improve renal function. Adverse events overall, but not those with a suspected relation to EC-MPS, were higher with ECMPS 1,440 mg/d

The DESCARTES-Nantes survey of kidney transplant recipients displaying clinical operational tolerance identifies 35 new tolerant patients and 34 almost tolerant patients

Kidney recipients maintaining a prolonged allograft survival in the absence of immunosuppressive drugs and without evidence of rejection are supposed to be exceptional. The ERA-EDTA-DESCARTES working group together with Nantes University launched a European-wide survey to identify new patients, describe them and estimate their frequency for the first time.status: publishe