Discours multilatéraliste, leadership réaliste : l'évolution de la conduite institutionnelle de sécurité des États-Unis sous Clinton

Cet article analyse le rôle et l'influence des institutions internationales de sécurité à travers l'étude du comportement des États-Unis envers la réforme du Conseil de sécurité des Nations Unies, la consolidation de la paix en Bosnie, et l'élargissement de I'OTAN. L'analyse des trois cas démontre que l'administration Clinton a graduellement diminué l'importance accordée aux institutions internationales dans le maintien de la sécurité internationale. Les États-Unis ont accentué leur leadership au sein des institutions afin de définir l'agenda de sécurité en fonction de leurs intérêts. La poursuite des objectifs américains a été davantage influencée par les débats au sein du gouvernement et les demandes des acteurs extérieurs que par les institutions internationales. Celles-ci ont généralement servi de complément aux pratiques souhaitées par les États-Unis et ne se sont pas substituées au rôle que la superpuissance s'attribuait en sécurité internationaleThis article assesses the role and influence of international security institutions through analysis of the United States' behavior towards the reform of the Security Council, peacebuilding in Bosnia, and NATO enlargement. The study demonstrates that the Clinton Administration gradually came to grant less importance to international institutions in ensuring the world's security. The United States intensified its leadership within the institutions in order to define the security agenda in terms of its interests. The pursuit of American interests was more influenced by debates within the government and demands from external actors than by international institutions. Institutions assisted the desired behavior of the US, and did not serve as a substitute for the role the superpower saw for it self in world politics

Vagus Nerve Stimulation Modulates Inflammation in Treatment-Resistant Depression Patients: A Pilot Study

Vagal neurostimulation (VNS) is used for the treatment of epilepsy and major medical-refractory depression. VNS has neuropsychiatric functions and systemic anti-inflammatory activity. The objective of this study is to measure the clinical efficacy and impact of VNS modulation in depressive patients. Six patients with refractory depression were enrolled. Depression symptoms were assessed with the Montgomery–Asberg Depression Rating, and anxiety symptoms with the Hamilton Anxiety Rating Scale. Plasmas were harvested prospectively before the implantation of VNS (baseline) and up to 4 years or more after continuous therapy. Forty soluble molecules were measured in the plasma by multiplex assays. Following VNS, the reduction in the mean depression severity score was 59.9% and the response rate was 87%. Anxiety levels were also greatly reduced. IL-7, CXCL8, CCL2, CCL13, CCL17, CCL22, Flt-1 and VEGFc levels were significantly lowered, whereas bFGF levels were increased (p values ranging from 0.004 to 0.02). This exploratory study is the first to focus on the long-term efficacy of VNS and its consequences on inflammatory biomarkers. VNS may modulate inflammation via an increase in blood–brain barrier integrity and a reduction in inflammatory cell recruitment. This opens the door to new pathways involved in the treatment of refractory depression