Carbone des sols en Afrique

Les sols sont une ressource essentielle à préserver pour la production d’aliments, de fibres, de biomasse, pour la filtration de l’eau, la préservation de la biodiversité et le stockage du carbone. En tant que réservoirs de carbone, les sols sont par ailleurs appelés à jouer un rôle primordial dans la lutte contre l’augmentation de la concentration de gaz à effet de serre. Ils sont ainsi au centre des objectifs de développement durable (ODD) des Nations unies, notamment les ODD 2 « Faim zéro », 13 « Lutte contre le changement climatique », 15 « Vie terrestre », 12 « Consommation et production responsables » ou encore 1 « Pas de pauvreté ». Cet ouvrage présente un état des lieux des sols africains dans toute leur diversité, mais au-delà, il documente les capacités de stockage de carbone selon les types de sols et leurs usages en Afrique. Il propose également des recommandations autour de l’acquisition et de l’interprétation des données, ainsi que des options pour préserver, voire augmenter les stocks de carbone dans les sols. Tous les chercheurs et acteurs du développement impliqués dans les recherches sur le rôle du carbone des sols sont concernés par cette synthèse collective. Fruit d’une collaboration entre chercheurs africains et européens, ce livre insiste sur la nécessité de prendre en compte la grande variété des contextes agricoles et forestiers africains pour améliorer nos connaissances sur les capacités de stockage de carbone des sols et lutter contre le changement climatique

ARIA digital anamorphosis: Digital transformation of health and care in airway diseases from research to practice

Digital anamorphosis is used to define a distorted image of health and care that may be viewed correctly using digital tools and strategies. MASK digital anamorphosis represents the process used by MASK to develop the digital transformation of health and care in rhinitis. It strengthens the ARIA change management strategy in the prevention and management of airway disease. The MASK strategy is based on validated digital tools. Using the MASK digital tool and the CARAT online enhanced clinical framework, solutions for practical steps of digital enhancement of care are proposed

Augmentation rapide de la dose de clozapine chez un patient avec trouble psychotique réfractaire fuguant à répétition

Objectifs : Présenter un cas d’augmentation rapide des doses de clozapine chez un patient avec trouble psychotique réfractaire, déterminer les suivis pertinents et définir le type de patient pouvant bénéficier de cette pratique. Résumé du cas : Un homme de 31 ans, ayant un trouble psychotique traité par la clozapine, avait l’habitude de fuguer à répétition pendant plus de 48 heures. Cela nécessitait de réintroduire graduellement la clozapine après chaque fugue, engendrant des périodes de contrôle sous-optimal. Une augmentation par tranche de 100 mg par jour en quatre prises a été tentée. La dose de 400 mg a été atteinte en cinq jours, puis modifiée pour une prise uniquotidienne au jour 8. Cette augmentation a été bien tolérée. Discussion : La clozapine est un antipsychotique de deuxième génération indiqué chez les patients avec schizophrénie réfractaire. On retrouve peu de données dans la littérature scientifique pour soutenir une augmentation rapide de la dose. Une augmentation graduelle permet de limiter les effets secondaires dépendant de la dose et de la vitesse d’ajustement, soit la sédation, l’hypotension, les convulsions, le risque de myocardite et les changements à l’électrocardiogramme. Autrement, le fractionnement de la dose réduit l’intensité des concentrations plasmatiques et les effets secondaires associés. Conclusion : Ce cas présente une augmentation rapide et bien tolérée des doses de clozapine. Une telle pratique s’applique à un nombre restreint de patients. En raison de la variabilité interindividuelle du métabolisme de la clozapine, un suivi étroit pour ajuster l’augmentation des doses selon la tolérance du patient est nécessaire. Abstract Objectives: To present a case involving a rapid increase in clozapine doses in a patient with a refractory psychotic disorder, to determine the relevant follow-ups and to define the type of patient who might benefit from this practice. Case summary: A 31-year-old male with a psychotic disorder treated with clozapine had the habit of repeatedly running away for more than 48 hours. This required a gradual reintroduction of clozapine after each runaway event, which resulted in periods of suboptimal control. An increase of 100 mg per day in four doses was attempted. The 400 mg dose was reached in 5 days and was switched to once-daily administration on Day 8. This increase was well tolerated. Discussion: Clozapine is a second-generation antipsychotic indicated in patients with refractory schizophrenia. There is little data in the scientific literature to support rapid dose escalation. A gradual increase limits the dose- and speed of adjustment-dependent adverse effects, namely, sedation, hypotension, convulsions, the risk of myocarditis, and electrocardiographic changes. In other words, dose splitting reduces the peak plasma concentrations and their associated adverse effects. Conclusion: This case involves a rapid and well-tolerated increase in clozapine doses. This practice applies to a small number of patients. Because of interindividual variability in clozapine metabolism, close monitoring is necessary in order to adjust the dose increase according to the patient’s tolerance

Utilisation des tableaux de bord en pharmacie hospitalière : une revue narrative

Objectif : L’objectif principal est de recenser les données relatives à la conception et à la diffusion de tableaux de bord de gestion auprès des équipes de pharmacie. L’objectif secondaire est de situer la pratique au sein des départements de pharmacie du Québec.  Mise en contexte : Il s’agit d’une revue de la littérature scientifique. Une recherche a été effectuée dans PubmedMD, EmbaseMD, Google ScholarMD et dans la littérature grise. Ont été inclus les articles en français ou en anglais décrivant l’utilisation réelle de tableaux de bord de gestion dans les départements de pharmacie en établissement de santé. De plus, un courriel a été envoyé aux 31 chefs de départements de pharmacie en fonction en établissement de santé au Québec au 1er mai 2021, afin d’évaluer l’état de la situation entourant l’utilisation de tableaux de bord en pharmacie.  Résultats : Concernant la revue de littérature, nous avons trouvé 929 articles. Cependant, la recherche est peu concluante, puisque seuls 12 articles décrivent de telles initiatives, principalement aux États-Unis. De plus, ces études nous renseignent peu sur l’impact de ces outils. Notre enquête auprès des chefs de département de pharmacie du Québec confirme que la diffusion de tableaux de bord et d’indicateurs aux membres du département de pharmacie est encore limitée.  Conclusion : Il existe peu de données sur l’utilisation de tableaux de bord en pharmacie hospitalière, mais elle pourrait être utile à la rétroaction, à la comparaison et à l’amélioration des pratiques. D’autres travaux, menés notamment auprès de pharmaciens cliniciens, sont nécessaires afin d’en mesurer l’impact. Abstract  Objective: The primary objective of this study is to identify data concerning the creation of management dashboards and their dissemination to pharmacy teams. The secondary objective is to situate the practice in Quebec pharmacy departments.  Background: This study involved a review of the scientific literature. A search was conducted in Pubmed®, Embase®, Google Scholar®, and the grey literature. Articles in French or English describing the actual use of management dashboards in institutional pharmacy departments were included. In addition, an e-mail was sent to the 31 pharmacy department heads serving in Quebec’s health-care facilities as at May 1, 2021, to assess the situation regarding the use of management dashboards in their pharmacies.  Results: The literature review yielded 929 articles. However, the search was inconclusive, as only 12 articles describe such initiatives, mainly in the United States. Furthermore, these studies provide little information on the impact of these tools. Our survey of Quebec pharmacy department heads confirms that the dissemination of dashboards and indicators to pharmacy department staff is still limited.  Conclusion: There is little data on the use of dashboards in hospital pharmacies, but their use could be helpful for feedback and for comparing and improving practices. Further work, particularly with clinical pharmacists, is needed to measure its impact.

A randomized double-blind feasibility study comparing cetirizine and diphenhydramine in the prevention of paclitaxel-associated infusion-related reactions : the PREMED-F1 study

Purpose. Cetirizine is a less sedative alternative to diphenhydramine for the prevention of infusion-related reactions (IRR) to paclitaxel. However, its use remains controversial. In this study, we assessed feasibility for a future definitive non-inferiority trial comparing cetirizine to diphenhydramine as premedication to prevent paclitaxel-related IRR. Methods. This was a single center randomized prospective feasibility study. Participants were paclitaxel-naive cancer patients scheduled to start paclitaxel chemotherapy. They were randomly assigned to receive either intravenous diphenhydramine 50 mg + oral placebo (control) or intravenous placebo + oral cetirizine 10 mg (intervention) for their first two paclitaxel treatments. The percentage of eligible patients completing a first paclitaxel treatment and the recruitment rate were assessed (feasibility outcomes). Drowsiness was measured at baseline and at selected time points using the Stanford Sleepiness Scale (SSS) (safety outcome). IRR events were also documented (efficacy outcome). Results. Among 37 eligible patients, 27 were recruited and randomized (control 13; intervention 14) and 25 completed the study. The recruitment rate was 4.8 participants/month, meeting the primary feasibility target. Drowsiness was the main adverse effect associated with the premedication. The increase in drowsiness compared to baseline (ΔSSS) was greater in the diphenhydramine group compared to the cetirizine group (median ΔSSS 2 (IQR 3.25) vs median ΔSSS 0 (IQR 1), p < 0.01) when measured one hour after the premedication administration. One participant had an IRR and no unexpected serious adverse event occurred. Conclusion. The trial methods were feasible in terms of recruitment, retention and safety. Cetirizine was significantly less sedating than diphenhydramine. IRR were infrequent and a larger trial is warranted to confirm non-inferiority for IRR prevention

Inhibition of Vascular Endothelial Cadherin Cleavage Prevents Elastic Fiber Alterations and Atherosclerosis Induced by Intermittent Hypoxia in the Mouse Aorta

International audienceIntermittent hypoxia (IH), the major feature of obstructive sleep apnea syndrome (OSAS), induces atherosclerosis and elastic fiber alterations. VE-cadherin cleavage is increased in OSAS patients and in an IH-cellular model. It is mediated by HIF-1 and Src-tyr-kinases pathways and results in endothelial hyperpermeability. Our aim was to determine whether blocking VE-cadherin cleavage in vivo could be an efficient strategy to inhibit deleterious IH-induced vascular remodeling, elastic fiber defects and atherogenesis. VE-cadherin regulation, aortic remodeling and atherosclerosis were studied in IH-exposed C57Bl/6J or ApoE-/-mice treated or not with Src-tyr-kinases inhibitors (Saracatinib/Pazopanib) or a HIF-1 inhibitor (Acriflavine). Human aortic endothelial cells were exposed to IH and treated with the same inhibitors. LDL and the monocytes transendothelium passage were measured. In vitro, IH increased transendothelium LDL and monocytes passage, and the tested inhibitors prevented these effects. In mice, IH decreased VE-cadherin expression and increased plasmatic sVE level, intima-media thickness, elastic fiber alterations and atherosclerosis, while the inhibitors prevented these in vivo effects. In vivo inhibition of HIF-1 and Src tyr kinase pathways were associated with the prevention of IH-induced elastic fiber/lamella degradation and atherogenesis, which suggests that VE-cadherin could be an important target to limit atherogenesis and progression of arterial stiffness in OSA

Chronic intermittent hypoxia, a hallmark of obstructive sleep apnea, promotes 4T1 breast cancer development through endothelin-1 receptors

International audienceThe association between obstructive sleep apnea (OSA) and cancer is still debated and data are scarce regarding the link between OSA and breast cancer progression. Since conclusive epidemiological studies require large sample sizes and sufficient duration of exposure before incident cancer occurrence, basic science studies represent the most promising approach to appropriately address the topic. Here we assessed the impact of intermittent hypoxia (IH), the major hallmark of OSA, on the development of breast cancer and explored the specific involvement of the endothelin signaling pathway. Original in vitro and in vivo models were used where 3D-spheroids or cultures of murine 4T1 breast cancer cells were submitted to IH cycles, and nude NMRI mice, orthotopically implanted with 4T1 cells, were submitted to chronic IH exposure before and after implantation. The role of the endothelin-1 in promoting cancer cell development was investigated using the dual endothelin receptor antagonist, macitentan. In vitro exposure to IH significantly increased 4T1 cell proliferation and migration. Meta-analysis of 4 independent in vivo experiments showed that chronic IH exposure promoted tumor growth, assessed by caliper measurement (overall standardized mean difference: 1.00 [0.45-1.55], p < 0.001), bioluminescence imaging (1.65 [0.59-2.71]; p < 0.01) and tumor weight (0.86 [0.31-1.41], p < 0.01), and enhanced metastatic pulmonary expansion (0.77 [0.12-1.42]; p = 0.01). Both in vitro and in vivo tumor-promoting effects of IH were reversed by macitentan. Overall, these findings demonstrate that chronic intermittent hypoxia exposure promotes breast cancer growth and malignancy and that dual endothelin receptor blockade prevents intermittent hypoxia-induced tumor development

Fontenelle. Digression sur les Anciens et les Modernes : et autres textes philosophiques

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