Bien-être spirituel et qualité de vie chez les patients atteints d'un cancer pulmonaire avancé : une étude exploratoire

Objectifs Plusieurs études démontrent une corrélation positive entre bien-être spirituel et qualité́ de vie chez les patients oncologiques. Cependant, celles-ci font défaut chez les patients atteints d’un cancer pulmonaire avancé. Les objectifs principaux de ce travail étaient d’évaluer la faisabilité́ et l’acceptabilité́ d’une étude portant sur le bien-être spirituel et son impact sur la qualité́ de vie chez cette population de patients. Méthodologie Cette étude exploratoire, monocentrique, a été conduite au sein de la clinique THOR du service d’oncologie ambulatoire du CHUV par questionnaires dans le cadre d’entretiens semistructurés. Les patients, atteints de cancer pulmonaire stade III ou IV, ont été recrutés par les médecins assistants du service d’oncologie. Différents facteurs, tels que degré de spiritualité et religiosité, bien-être spirituel, qualité de vie, symptômes physiques, psychologiques et de dépression ont été évalués par questionnaires. La faisabilité (nombre de patients répondant aux critères d’inclusion, nombre de patients enrôlés) ainsi que l’acceptabilité (taux et motifs de refus des participants, satisfaction globale à l’égard de l’entretien, impact émotionnel et temps alloué à l’entretien) ont été analysés. Résultats L’étude s’est déroulée d’avril à août 2018. Onze patients y ont participé, tous recrutés au cours des deux derniers mois et demi de l’étude. Diverses hypothèses peuvent expliquer ce recrutement tardif, telles que la charge de travail des médecins oncologues, le nombre élevé de recherches menées en parallèle dans le service et une information insuffisante sur l’étude. La présence de l’investigatrice principale lors des consultations dès juin 2018 a permis de pallier à ces difficultés de recrutement. Tous les patients à qui l’étude a été proposée ont accepté d’y participer. 90% des patients se sont dits plutôt satisfaits ou très satisfaits de l’entretien. Celui-ci n’a suscité aucun impact émotionnel négatif. Les questions ont été compréhensibles pour la grande majorité d’entre eux et le temps alloué à l’entretien a été jugé adéquat. Conclusion Ce travail démontre la bonne acceptabilité́ d’une étude portant sur le bien-être spirituel et son impact sur la qualité́ de vie des patients atteints d’un cancer pulmonaire avancé et suivis ambulatoirement. Elle révèle également en terme de faisabilité la nécessité d’un coinvestigateur impliqué quotidiennement dans le recrutement de ce type de patients

Cigarette smoking during pregnancy and adverse perinatal outcomes: a cross-sectional study over 10 years.

It has been shown that active exposure to tobacco is associated with adverse pregnancy outcomes including, but not limited to, intrauterine fetal death, reduced fetal weight, and higher risk of preterm birth. We want to investigate these effects in a high-income country. This cross-sectional study examined 20,843 pregnant women who delivered over 10 years at the Maternity Hospital of the Centre Hospitalier Universitaire Vaudois (CHUV) in Lausanne, Switzerland. The objective was to evaluate a dose-response relationship between daily cigarette use during pregnancy and possible adverse perinatal outcomes. The social and clinical characteristics as well as obstetric and neonatal outcomes were compared between the smoking and the non-smoking groups. Adjusted odds ratios (aOR) and trend analyses (p <sub>trend</sub> ) were calculated. Nineteen thousand five hundred fifty-four pregnant women met the inclusion criteria and 2,714 (13.9%) of them were smokers. Even after adjusting for confounding factors, smoking during pregnancy was associated with preterm birth, birthweight < 2500 g, intrauterine growth restriction, neonatal respiratory and gastrointestinal diseases, transfer to the neonatal intensive care unit, and neonatal intensive care unit admissions > 7 days. Intrauterine death and neonatal infection were associated with heavy smoking (≥ 20 cigarettes/day). Smoking appeared to be a protective factor for pre-eclampsia and umbilical cord arterial pH below 7.1. A significant trend (p <sub>trend</sub> < 0.05) was identified for preterm birth, intrauterine growth restriction, birthweight < 2500 g, umbilical cord arterial pH below 7.1, transfers to our neonatal intensive care unit, and neonatal intensive care unit admissions more than 7 days. Cigarette smoking is associated with several adverse perinatal outcomes of pregnancy with a dose-dependent effect

In the search for stroke genes: a long and winding road

In spite of a significant improvement in control of numerous predisposing risk factors, stroke remains a major health problem and a common cause of death and disability in our societies. Genetic predisposition to stroke development exists and has been documented in both animal models and in humans. However, a precise definition of genetic factors responsible for common forms of stroke is still lacking, mainly due to its complex nature, the confounding presence of other predisposing risk factors, and the genetic heterogeneity of human populations. In contrast, important breakthroughs have been reached for monogenic forms of stroke, such as cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL). An animal model of stroke, the stroke-prone spontaneously hypertensive rat, has provided valuable information on genetic factors involved in stroke predisposition. Among them, the gene-encoding atrial natriuretic peptide has been identified as a stroke gene in both the stroke-prone spontaneously hypertensive rat and, subsequently, in two different human populations. In particular, structural alterations of the gene are consistently present in diseased individuals, suggesting an important role of mutation-dependent mechanisms in stroke predisposition. Finally, the recent use of intermediate disease phenotypes provides a reductionist approach that may contribute to important accumulating information on genes contributing to cerebrovascular accidents. (C) 2004 American Journal of Hypertension, Ltd

The renin-angiotensin system as a risk factor and therapeutic target for cardiovascular and renal disease.

The renin-angiotensin system (RAS) plays an important homeostatic role in BP regulation, water and salt balance, and tissue growth control under physiologic conditions. On the other hand, a pivotal involvement of the RAS in the pathophysiology of cardiovascular and renal disease is extensively supported by both basic and clinical evidence. In particular, it is today recognized that angiotensin II (AngII), the biologic effector of the RAS, may prompt a number of relevant structural and functional abnormalities through the activation of a complex of cellular effects mostly mediated via its binding with the AT(1) subtype receptors. The key role of these AngII-linked mechanisms of disease is strongly corroborated by large interventional studies. In fact, pharmacologic interference with RAS activity, by both preventing AngII formation with angiotensin-converting enzyme inhibitors or antagonizing its binding to cell membrane receptors by selective antagonists, is associated with highly beneficial outcomes in major disease conditions (hypertension, diabetes, renal failure, heart failure, myocardial infarction, stroke, and others). This article briefly reviews the current views on the biologic organization of RAS evidence supporting a pathogenic role of the RAS activity in promoting cardiac, vascular, and renal disease, and finally provides the basis for considering inhibition of RAS activity a major target for therapeutic interventions in these conditions

Atrial natriuretic peptide gene Polymorphisms and risk of ischemic stroke in humans

Background and Purpose-A precise definition of genetic factors responsible for common forms of stroke is still lacking. The purpose of the present study was to investigate the contributory role of the genes encoding atrial natriuretic peptide (ANP) and type A natriuretic peptide receptor (NPRA) in humans' susceptibility to develop ischemic stroke. Methods-Allele and genotype frequencies of ANP and NPRA were characterized in an Italian case-control study with patients affected by vascular disease or risk factors. Subjects were recruited from the island of Sardinia (206 cases, 236 controls). Results-A significant association between the ANP/TC2238 polymorphic site and stroke occurrence was found when a recessive model of inheritance was assumed. The risk conferred by this mutant genotype, when estimated by multivariate logistic regression analysis, was 3.8 (95% confidence interval, 1.4 to 10.9). A significantly increased risk of stroke recurrence was observed among cases carrying the ANP/CC2238 genotype compared with cases carrying the ANP/TT2238 genotype (P = 0.04). No direct association of NPRA with stroke occurrence was detected. However, a significant epistatic interaction between the ANP/CC2238 genotype and an allelic variant of NPRA led to a 5.5-fold increased risk of stroke (95% confidence interval, 1.5 to 19.4). Conclusions-Our findings support a direct contributory role of ANP to stroke in humans. A significant interaction between ANP and NPRA on stroke occurrence was found