Soil contamination following an industrial accident : towards efficient investigations and assessment

International audienceWhen an industrial accident occurs, e.g. the explosion or the fire of a chemical facility, soil investigations and subsequent risk mitigation generally need to be decided and performed rapidly. This requires specific organisation and tools: Procedures for an immediate and coordinated intervention of relevant actors: industrials, administrations for industrial facilities, emergency and health, local authorities, environmental consultants and laboratories, NGOs. Models and input data on emission, atmospheric transfer and deposition on soil, for an accidental source; investigation plans and adequate soil quality references, guidelines... But the European Seveso legislation, and its application in France and probably in Europe, is focused on the prevention of immediate impacts on health and constructions; and the Integrated Pollution Prevention and Control (IPPC) legislation deals with the chronic impacts of operating facilities. Thus, post-accidental impacts of industrial accidents are hardly dealt with, the specific organisation and tools are lacking, and when accidents occur, the industrials and administrations concerned are largely unprepared for managing their delayed impacts, first of them on soils

Spontaneous Dissection of Right Coronary Artery Manifested with Acute Myocardial Infarction

Spontaneous coronary artery dissection is a rare cause of acute ischemic coronary events and sudden cardiac death. It usually occurs in young women without traditional risk factors for coronary artery disease during pregnancy or postpartum period. However, it has also been reported in patients with atherosclerotic coronary disease. We present a case of spontaneous right coronary artery dissection in a 48-year male with recent myocardial infarction and previous percutaneous coronary intervention

Effects of statins on plaque rupture assessed by optical coherence tomography in patients presenting with acute coronary syndromes: insights from the optical coherence tomography (OCT)-FORMIDABLE registry

Aims Chronic pre-treatment with statins may reduce mortality and morbidity in patients experiencing acute coronary syndromes (ACS), but mechanisms accounting for these findings are not completely understood. Methods and results The optical coherence tomography (OCT)-Formidable registry retrospectively enrolled 285 consecutive patients with ACS undergoing OCT in 9 European centres. Mean age was 60.4 ± 12.8 years, 148 (51.9%) patients had hyperlipemia, 45 (15.8%) diabetes mellitus and 142 (49.8%) presented with ST Segment Elevation Myocardial Infarction (STEMI). Patients were stratified according to statin prescription: 150 (52.6%) were on chronic pre-treatment with statins before ACS and were more likely to present with non-ST segment elevation acute coronary syndromes (NSTE-ACS) at admission (111, 74%) rather than STEMI, while the opposite was observed for patients not on statins. The primary end-point of ruptured plaque at OCT occurred significantly less frequently in the patients on chronic pre-treatment with statins [odds ratio (OR) 0.375, 95% confidence interval (CI) 0.185-0.759, P = 0.006]. The secondary end-point of thin-cap fibro-atheroma (TCFA) at any site was significantly less frequent in the statin group (OR 0.423, 95%CI 0.213-0.840, P = 0.014). No differences were observed for the secondary end-point of not-ruptured TCFA as the culprit lesion. Pre-specified sensitivity analysis was conducted according to the pattern of ACS: the reported differences were confirmed for NSTE-ACS patients, with a trend towards less plaque rupture and a significant reduction of TCFA at any site with statins, but not for STEMI. Conclusions Chronic pre-treatment with statins is associated with a reduced prevalence of ruptured plaques in patients presenting with ACS, particularly in those with NSTE-ACS. Statins bear hence the potential to reduce morbidity during the acute phase of ACS

Association of the PHACTR1/EDN1 genetic locus with spontaneous coronary artery dissection

Background: Spontaneous coronary artery dissection (SCAD) is an increasingly recognized cause of acute coronary syndromes (ACS) afflicting predominantly younger to middle-aged women. Observational studies have reported a high prevalence of extracoronary vascular anomalies, especially fibromuscular dysplasia (FMD) and a low prevalence of coincidental cases of atherosclerosis. PHACTR1/EDN1 is a genetic risk locus for several vascular diseases, including FMD and coronary artery disease, with the putative causal noncoding variant at the rs9349379 locus acting as a potential enhancer for the endothelin-1 (EDN1) gene. Objectives: This study sought to test the association between the rs9349379 genotype and SCAD. Methods: Results from case control studies from France, United Kingdom, United States, and Australia were analyzed to test the association with SCAD risk, including age at first event, pregnancy-associated SCAD (P-SCAD), and recurrent SCAD. Results: The previously reported risk allele for FMD (rs9349379-A) was associated with a higher risk of SCAD in all studies. In a meta-analysis of 1,055 SCAD patients and 7,190 controls, the odds ratio (OR) was 1.67 (95% confidence interval [CI]: 1.50 to 1.86) per copy of rs9349379-A. In a subset of 491 SCAD patients, the OR estimate was found to be higher for the association with SCAD in patients without FMD (OR: 1.89; 95% CI: 1.53 to 2.33) than in SCAD cases with FMD (OR: 1.60; 95% CI: 1.28 to 1.99). There was no effect of genotype on age at first event, P-SCAD, or recurrence. Conclusions: The first genetic risk factor for SCAD was identified in the largest study conducted to date for this condition. This genetic link may contribute to the clinical overlap between SCAD and FMD

N° 85. — Interactions interfaciales entre l’acide désoxycholique, le cholestérol et la lécithine

L’interaction interfaciale entre l’acide désoxycholique, le cholestérol et la lécithine a été étudiée par la méthode des films mixtes étalées à l’interface eau/air. De plus, la théorie, élaborée récemment par l’un d’entre nous, permettant de décrire le comportement superficiel d’un mélange de tensides a été appliquée à l’interface solution/phase huileuse (heptane ou tétrachlorure de carbone). Ces expériences faites aux interfaces eau/air et eau/heptane ou tétrachlorure de carbone indiquent si les interactions sont dues aux forces Van der Waals ou non. Il en suit que l’interaction entre les films étalés de la lécithine et l’acide désoxycholique en absence des ions calciques, observée à l’interface eau/air, serait due aux forces de Van der Waals. En présence des ions calciques, pourtant une interaction se manifeste aussi à l’interface eau/phase huileuse indiquant que les ions calciques forment un complexe entre les groupes carboxyliques et phosphorylés. L’interaction entre le cholestérol et l’acide désoxycholique se manifeste aussi bien à l’interface eau/air qu’à l’interface eau/phase huileuse. Il y a aussi un effet de pH, mais le rôle des ions calciques est peu important

Impact des attentats du 13 novembre 2015 sur les enfants des civils exposés et sur les relations parents–enfants

International audienceIntroductionSanté publique France carried out a web-based epidemiological survey (ESPA 13 Novembre) between 8 and 12 months after the terrorist attacks of the 13 November 2015. This was done in order to explore the post-traumatic psychological impact of the attacks on the directly exposed civilians and responders as well as their use of healthcare services. The survey took the form of a series of closed-ended questions as well as several open-ended questions. We present here an analysis of the responses of civilians to the following specific question: “If you have children, can you tell us whether you think the experience you went through had an effect on them, or on your relationship with them? Can you explain?”.ObjectiveTo find out about the impact of the attacks on the children of exposed civilians and on parent–child relationships, something that has never been studied in the context of mass attacks.MethodWe carried out a thematic analysis of civilians’ responses to this specific question, building up general themes by data reduction.ResultsThe analyses revealed four main themes which relate to the impact of the exposure to terrorist attacks on parent-child relationships, the changes experienced in their role as parents, their children's reactions and, finally, the ways in which they tried to protect their children.DiscussionThe parents highlighted the psychological changes that operated in them, their unease, their fear of the outside world, and their concern for their children's safety. They discussed the consequences of the attacks on their children in terms of stress, insecurity, psychological disturbances, and even of the emergence of real disorders. The parents have tried to fulfil their protective role in a variety of ways, sometimes with a feeling of powerlessness reinforced for some by the difficulty of finding suitable care spaces. Attachment bonds have, for the most part, tightened in these families demonstrating their reassuring function within the group. It seems essential to care for children, and the family as a whole, alongside their parents, in order to re-establish secure attachment bonds which are a factor in resilience.IntroductionL’Enquête de Santé publique post-attentats du 13 novembre 2015 (ESPA 13 novembre) est une enquête épidémiologique réalisée par Santé publique France, dans le cadre du programme 13 novembre. Le première phase a été réalisée en 2016. Elle interroge les personnes civiles et les intervenants (professionnels et bénévoles) exposés aux attaques afin d’explorer l’impact post-traumatique des attentats sur leur santé ainsi que leur recours aux soins. L’enquête se présente sous la forme d’une série de questions fermées ainsi que de plusieurs questions ouvertes. Nous exposons ici l’analyse des réponses des civils, rédigées entre 8 et 12 mois après les attentats, à la question spécifique suivante : « Si vous avez des enfants, pouvez-vous nous dire si vous pensez que l’expérience que vous avez vécue a eu un effet sur eux, ou sur la relation avec eux ? Pouvez-vous nous expliquer ? ».ObjectifIl s’agit de connaître l’impact des attentats sur les enfants des civils exposés et sur les relations parents–enfants, ce qui a été peu étudié dans le cadre d’attentats de masse.MéthodeNous avons procédé à une analyse thématique des réponses des civils à la question spécifique concernant leurs enfants, en constituant les thématiques générales par réduction de données.RésultatsL’analyse thématique laisse apparaître quatre thèmes principaux qui concernent l’impact des attentats sur les relations parents–enfants, les changements vécus dans leur rôle de parent, les réactions des enfants et enfin, la manière dont ils ont tenté de protéger leurs enfants.DiscussionQuelques mois après les attentats de novembre 2015, une partie des participants à l’enquête mettent en avant les changements psychiques qui se sont opérés chez eux : mal-être, peur du monde extérieur, inquiétude concernant la sécurité de leurs enfants. Ils relèvent d’existence de difficultés chez leurs enfants termes de stress, d’insécurité, de perturbations psychiques jusqu’à l‘émergence de véritables troubles. S’ils ont tenté de mobiliser leur fonction de protection de multiples façons, une partie d’entre eux indiquent se sentir impuissant et avoir des difficultés à trouver des espaces de soins adaptés. Les enfants de leur côté peuvent également se montrer très protecteur avec leurs parents. Pour certains, cette inquiétude mutuelle a provoqué un resserrement des liens familiaux qui a pour fonction la réassurance du groupe