Compréhension des perturbations accidentelles du mouvement dans l’activité dans une perspective de prévention

Les lésions consécutives à un heurt, une glissade, un coincement ou toute autre perturbation accidentelle du mouvement volontaire représentent au moins 200 000 accidents du travail avec arrêt chaque année. Cet article est basé sur le croisement de connaissances relatives au risque d’accident avec perturbation du mouvement (APM), au mouvement dans l’activité et aux régulations opératives dans la perspective de mieux comprendre aussi bien la performance du contrôle du mouvement que son échec en situation de travail. Le mouvement, indissociable de l’activité dans laquelle il s’inscrit, émerge, comme l’activité, des interactions en situation de travail. Son contrôle vise en même temps et de manière également indissociable la réalisation de la tâche et l’évitement des perturbations accidentelles du mouvement. Tout d’abord le risque d’APM est caractérisé, puis est présenté le contrôle du mouvement dans l’activité. Sont ensuite abordés la diversité des situations à risque et son effet sur la prévention ainsi que les variabilités en situations de travail, variabilités auxquelles répondent les régulations et desquelles émergent les APM. Puis la gestion du temps en lien avec le risque d’APM est illustrée à partir d’analyses de cas d’accidents. Enfin, un cadre d’analyse de ce risque centré sur l’activité est proposé pour étudier le mouvement dans l’activité en situation habituelle et en situation accidentelle.Injuries resulting from a collision, a slip, a jam or any other accidental disturbance of voluntary movement represent more than 200,000 occupational accidents (OA) with days lost each year. This article is based on the combination of knowledge relating to occupational risk of accident with movement disturbance (AMD), movement in the activity and operational regulations with a view to understanding both the performance and the failure of movement control in the activity. Movement, inseparable from the activity of which it is a part, emerges from interactions in the occupational situation, just like activity. Its control simultaneously and inseparably targets the performance of the task and the avoidance of accidental movement disturbances. First of all the risk of AMD is characterized; the control of movement in the activity is then presented. The diversity of risk situations and its effect on prevention are then discussed, as are the variabilities in work situations, variabilities to which the regulations respond and from which the AMDs emerge. Time management in relation to the AMD risk is then illustrated using accident analyses. Finally, a framework focusing on the activity is proposed for analyzing movement in the activity in both usual and accidental situations

Innate lymphoid cells in the upper airways : importance of CD117 and IL-1RI expression

Although type 1, 2 and 3 innate lymphoid cells (ILC1s, ILC2s and ILC3s, respectively) are emerging as important cell populations regulating tissue homeostasis, remodelling and inflammation, a vast majority of our knowledge stems from in vitro and murine experiments, and requires thorough confirmation in human diseases. Relative levels of ILCs were evaluated by means of flow cytometry in freshly resected human upper airways mucosa of patients with chronic rhinosinusitis without nasal polyps (CRSsNP) and with nasal polyps (CRSwNP), taking into account the patient's clinical parameters and disease comorbidities. We report that the CD117 and interleukin-receptor type I (IL-1RI) expression status of human ILC2s depends on the local tissue environment. Only CD117(+) IL-1RI(+) ILC2s, exclusively present in CRSwNP, possess an interrelationship with type 2 T-helper cell cytokine and eosinophil levels in human upper airway mucosa. In CRSsNP, mainly CD117(-)IL-1RI(-) ILC2s are increased, yielding lower eosinophilia in this disease despite the high levels of ILC2s. These data unveil that the CD117(-) and CD117(+) fractions within the native human ILC2 population are not a random phenomenon, in contrast to what could be concluded from in vitro data, and that the IL-1RI expression is not ubiquitous in ILC2s in vivo in humans, which cannot be assessed via in vitro and murine experiments

Avancée dans la prévention des « chutes de plain-pied » au travail

La chute de plain-pied reste un accident du travail fréquent et grave. La terminologie qualifiant ces accidents est variée, relativement imprécise et n’intègre pas la diversité des accidents rencontrés sous les différentes appellations. L’intérêt de considérer une catégorie d’accidents du travail avec perturbation du mouvement (APM) est tout d’abord mis en évidence à partir de divers extraits de récits d’accidents. Un modèle est ensuite proposé pour les APM montrant que, dans ces cas particuliers d’accident la blessure est souvent la conséquence de l’association fortuite entre l’énergie du mouvement perturbé de la victime et un élément matériel rendu blessant de par ses propriétés et appelé a posteriori un « danger circonstanciel ». Enfin, le raisonnement qui sous-tend la classification de ces accidents est explicité. Il apparaît notamment que la prévention ciblant les causes immédiates de la blessure est difficile voire impossible dans les cas d’APM en raison principalement des exigences inhérentes au travail et de contraintes que ferait peser sur l’entreprise l’application de cette prévention. La prévention à la source du risque tend alors à devenir la seule possible. Ainsi, de banal, l’APM devient un révélateur de dysfonctionnements au sein du système de production.Falls on the same level remain frequent and serious occupational accidents. The terminology used to describe these accidents is varied and somewhat imprecise. Moreover it does not integrate the variety of accidents with different names. The advantage of considering an occupational accident category with motion perturbation (MPA) is demonstrated, based on extracts from various occupational accident accounts. A model is then proposed for MPAs that shows that in these specific cases of accidents, the injury often results from a fortuitous association between the victim’ perturbed motion energy and a physical element that causes injury due to its properties and subsequently called a “circumstantial hazard”. Finally, the reasoning behind the MPA classification is explained. In particular, it appears that prevention that focuses on the immediate causes of the injury is difficult, even impossible, in MPA cases, essentially because of requirements inherent in the work and the constraints on the enterprise to implement this prevention. Prevention implemented at the source of the risk therefore seems to be the only feasible solution. From commonplace accidents, MPAs reveal dysfunctions within the production system.Las caídas al mismo nivel continúan siendo un accidente laboral frecuente y grave. La terminología usada para describir estos accidentes es variada, relativamente imprecisa y no integra la diversidad de accidentes encontrados bajo diferentes apelaciones. En un inicio, el interés de considerar una categoría de accidentes con una perturbación del movimiento (APM) es puesto en evidencia a partir de diversos extractos de relatos de accidentes laborales. A continuación, un modelo es propuesto para los APM, mostrando que en estos accidentes la lesión resulta a menudo de una asociación fortuita entre la energía del movimiento perturbado de la víctima y un elemento material, convertido en agresor por sus propiedades y subsecuentemente llamado un « peligro circunstancial ». Finalmente, el razonamiento detrás de la clasificación de estos accidentes es explicado. En particular, parece ser que la prevención enfocada en las causas inmediatas de la lesión es difícil, incluso imposible en los casos de APM, debido esencialmente a las exigencias inherentes al trabajo y a las dificultades que pesarían en la empresa para la implantación de esta prevención. La prevención realizada en la fuente del riesgo tiende entonces a convertirse en la única posibilidad. Así pues, los APM pasan de ser accidentes banales a ser reveladores de las disfunciones dentro de un sistema de producción

Expression of the inhibitory Ly49E receptor is not critically involved in the immune response against cutaneous, pulmonary or liver tumours

Natural killer (NK) lymphocytes are part of the innate immune system and are important in immune protection against tumourigenesis. NK cells display a broad repertoire of activating and inhibitory cell surface receptors that regulate NK cell activity. The Ly49 family of NK receptors is composed of several members that recognize major histocompatibility complex class I (MHC-I) or MHC-I-related molecules. Ly49E is a unique inhibitory member, being triggered by the non-MHC-I-related protein urokinase plasminogen activator (uPA) in contrast to the known MHC-I-triggering of the other inhibitory Ly49 receptors. Ly49E also has an uncommon expression pattern on NK cells, including high expression on liver DX5-NK cells. Furthermore, Ly49E is the only Ly49 member expressed by epidermal gamma delta T cells. As gamma delta T cells and/or NK cells have been shown to be involved in the regulation of cutaneous, pulmonary and liver malignancies, and as uPA is involved in tumourigenesis, we investigated the role of the inhibitory Ly49E receptor in the anti-tumour immune response. We demonstrate that, although Ly49E is highly expressed on epidermal gamma delta T cells and liver NK cells, this receptor does not play a major role in the control of skin tumour formation or in lung and liver tumour development

Ly49E Expression on CD8αα-expressing intestinal intraepithelial lymphocytes plays no detectable role in the development and progression of experimentally induced inflammatory bowel diseases

The Ly49E NK receptor is a unique inhibitory receptor, presenting with a high degree of conservation among mouse strains and expression on both NK cells and intraepithelial-localised T cells. Amongst intraepithelial-localised T cells, the Ly49E receptor is abundantly expressed on CD8 alpha alpha-expressing innate-like intestinal intraepithelial lymphocytes (iIELs), which contribute to front-line defense at the mucosal barrier. Inflammatory bowel diseases (IBDs), encompassing Crohn's disease and ulcerative colitis, have previously been suggested to have an autoreactive origin and to evolve from a dysbalance between regulatory and effector functions in the intestinal immune system. Here, we made use of Ly49E-deficient mice to characterize the role of Ly49E receptor expression on CD8 alpha alpha-expressing iIELs in the development and progression of IBD. For this purpose we used the dextran sodium sulphate (DSS)- and trinitrobenzenesulfonic-acid (TNBS)-induced colitis models, and the TNF Delta ARE ileitis model. We show that Ly49E is expressed on a high proportion of CD8 alpha alpha-positive iIELs, with higher expression in the colon as compared to the small intestine. However, Ly49E expression on small intestinal and colonic iIELs does not influence the development or progression of inflammatory bowel diseases

A murine intestinal intraepithelial NKp46-negative innate lymphoid cell population characterized by group 1 properties

The Ly49E receptor is preferentially expressed on murine innate-like lymphocytes, such as epidermal V gamma 3 T cells, intestinal intraepithelial CD8 alpha alpha(+) T lymphocytes, and CD49a(+) liver natural killer (NK) cells. As the latter have recently been shown to be distinct from conventional NK cells and have innate lymphoid cell type 1 (ILC1) properties, we investigated Ly49E expression on intestinal ILC populations. Here, we show that Ly49E expression is very low on known ILC populations, but it can be used to define a previously unrecognized intraepithelial innate lymphoid population. This Ly49E-positive population is negative for NKp46 and CD8 alpha alpha, expresses CD49a and CD103, and requires T-bet expression and IL-15 signaling for differentiation and/or survival. Transcriptome analysis reveals a group 1 ILC gene profile, different from NK cells, iCD8 alpha cells, and intraepithelial ILC1. Importantly, NKp46(-)CD8 alpha alpha(-)Ly49E(+) cells produce interferon (IFN)-gamma, suggesting that this previously unrecognized population may contribute to Th1-mediated immunity

Cytogénétique des carcinomes rénaux [Cytogenetics profiles of renal carcinoma]

National audienc

The transcription factor ETS1 is an important regulator of human NK cell development and terminal differentiation

Natural killer (NK) cells are important in the immune defense against tumor cells and pathogens, and regulate other immune cells by cytokine secretion. Whereas murine NK cell biology has been extensively studied, knowledge about transcriptional circuitries controlling human NK cell development and maturation is limited. By generating ETS1-deficient human embryonic stem cells (hESC) and by expressing the dominant-negative ETS1 p27 isoform in cord blood (CB) hematopoietic progenitor cells (HPCs), we show that the transcription factor ETS1 is critically required for human NK cell differentiation. Genome-wide transcriptome analysis determined by RNA-sequencing combined with chromatin immunoprecipitation-sequencing (ChIP-seq) analysis reveals that human ETS1 directly induces expression of key transcription factors that control NK cell differentiation, i.e. E4BP4, TXNIP, TBET, GATA3, HOBIT and BLIMP1. In addition, ETS1 regulates expression of genes involved in apoptosis and NK cell activation. Our study provides important molecular insights into the role of ETS1 as an important regulator of human NK cell development and terminal differentiation

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Prevention of so-called “accidents on the level” in occupational situations: A research project

International audienceAccidents on the level occurring in occupational situations are of concern in France and abroad. INRS (French national research and safety institute) has integrated these accidents into its research and study program. In this paper, we propose a definition of targeted accidents and detail a number of obstacles to their prevention. We go on to describe the main factors governing the problem of preventing these accidents and we detail the two main lines defined in the research and study field: systemic analysis of contexts involving falls on the level in occupational situations and study of adjustment strategies for confronting the risk of falling or balance disturbance in these situations. Finally, we recall the methodological tools used at the start of this research project to meet its objectives.Les chutes de plain-pied qui se produisent en situation professionnelle constituent une préoccupation en France et en dehors de ses frontières. L'INRS a inscrit la prévention de ces accidents dans son programme d'étude et recherche. Cet article propose une définition des accidents ciblés et énonce plusieurs freins à leur prévention. Ensuite les principaux éléments de la problématique de prévention de ces accidents sont exposés et les deux axes définis dans le champ des études et recherches sont développés : l'analyse systémique des contextes de chute de plain-pied en situation professionnelle et l'étude des stratégies de régulation pour faire face au risque de chute ou au déséquilibre dans ces situations. Enfin sont évoqués les outils méthodologiques utilisés au début de ce projet de recherche pour répondre à ses objectifs