Exploring and contextualizing public opposition to renewable electricity in the United States

This article explores public opposition to renewable power technologies in the United States. It begins by discussing the genesis of environmental ethics, or how some Americans have come to place importance on the protection of the environment and preservation of species, ecosystems, and the biosphere. As result, renewable power systems have become challenged on ethical and environmental grounds and are occasionally opposed by local communities and environmentalists. The article finds that, however, such concern may be misplaced. Renewable electricity resources have many environmental benefits compared to power stations fueled by coal, oil, natural gas, and uranium. Opposition towards renewable resources can at times obscure the true costs and risks associated with electricity use and entrench potential racial and class-based inequalities within the current energy system

Thrombotic microangiopathy associated with anticancer and immune system targeting drugs: New insights from real-world data using the WHO pharmacovigilance database

International audienceAbstract Background The worldwide development of immune system targeting/anticancer drugs has revolutionized immuno‐oncology, but their implication in thrombotic microangiopathy syndromes (TMA) is increasingly suspected. Using real‐world data, the aim of this study was to identify drugs associated with TMA reporting and to describe the evolution of TMA reporting over time with a focus on these drugs. Methods A global disproportionality study was performed using the individual case safety reports (ICSRs) extracted from the World Health Organization (WHO) pharmacovigilance database (VigiBase) from its inception (1968) to April 30, 2022. Results Of the 31,251,040 ICSRs, 6946 cases of suspected drug‐induced TMA were included from 55 countries. The outcome was fatal in 18.2% of cases. A total of 72 immune system targeting/anticancer drugs were associated with significant overreporting, including 17 drugs with a potential new safety concern for TMA. Although the rate of TMA reporting per million of ICSRs has remained fairly stable, an absolute increase in reported cases of suspected drug‐induced TMA has been observed over the last decade. The pattern of drugs reported in TMA has evolved with a substantial increase in the proportion of cases involving immune system‐targeting drugs/anticancer drugs from 47.3% (205/433) in the period 1992–2001 to 80.7% (3819/4730) in the period 2012–2021. Conclusion Several recently marketed immune system targeting/anticancer drugs have been identified as potential new drugs associated with TMA, which will require confirmatory studies. The number of drugs associated with TMA reporting markedly increased within the past 10 years, primarily due to innovative anticancer drugs

Ischémie aiguë de membre inférieur et diabète chez un patient traité par anticorps monoclonal anti-PD1 pour mélanome métastatique

International audienceWe recommend thromboembolism prevention in cases of pre-existing diabetes, and particularly as regards ketoacidosis, in patients under pembrolizumab therapy

Combination of Targeted Therapies for Colorectal Cancer Treatment

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Thrombotic microangiopathies after kidney transplantation in modern era: nosology based on chronology

International audienceBackground: Thrombotic microangiopathies (TMAs) are rare but can be severe in kidney transplant. recipients (KTR). Methods: We analysed the epidemiology of adjudicated TMA in consecutive KTR during the. 2009–2021 period. Results: TMA was found in 77/1644 (4.7%) KTR. Early TMA (n = 24/77 (31.2%); 1.5% of all KTR) occurred during the first two weeks ((median, IQR) 3 [1–8] days). Triggers included acute antibody-mediated rejection (ABMR, n = 4) and bacterial infections (n = 6). Graft survival (GS) was 100% and recurrence rate (RR) was 8%. Unexpected TMA (n = 31/77 (40.2%); 1.5/1000 patient-years) occurred anytime during follow-up (3.0 (0.5–6.2) years). Triggers included infections (EBV/CMV: n = 10; bacterial: n = 6) and chronic active ABMR (n = 5). GS was 81% and RR was 16%. Graft-failure associated TMA (n = 22/77 (28.6%); 2.2% of graft losses) occurred after 8.8 (4.9–15.5) years). Triggers included acute (n = 4) or chronic active (n = 14) ABMR, infections (viral: n = 6; bacterial: n = 5) and cancer (n = 6). 15 patients underwent transplantectomy. RR was 27%. Atypical (n = 6) and typical (n = 2) haemolytic and uremic syndrome, and isolated CNI toxicity (n = 4) were rare. Two-third of biopsies presented TMA features. Conclusions: TMA are mostly due to ABMR and infections; causes of TMA are frequently combined. Management often is heterogenous. Our nosology based on TMA timing identifies situations with distinct incidence, causes and prognosis. © 2023, BioMed Central Ltd., part of Springer Nature

Characteristics of patients with systemic sclerosis suffering from a lower limb amputation: Results of a French collaborative study

International audienceObjective:Systemic sclerosis mainly affects the microvascular network. However, macrovascular manifestations have been reported. We aimed to investigate the characteristics of systemic sclerosis patients with an amputation of a lower limb segment.Methods:We designed a retrospective, case-control, multicentric study on systemic sclerosis patients with amputation of a lower limb segment secondary to critical ischemia via the French Research Group on Systemic Sclerosis. For each case, a control (systemic sclerosis patient without lower limb symptom) was matched with sex, age (+/- 5 years), and cutaneous subset of systemic sclerosis.Results:In total, 26 systemic sclerosis patients (mean age of 67.2 +/- 10.9 years, 20 females, 21 limited cutaneous forms) with a lower limb amputation and 26 matched controls (mean age of 67.3 +/- 11.2 years, 20 females, 22 limited cutaneous forms) were included. At the time of amputation, the mean disease duration was 12.8 (+/- 8.6) years. In comparison to controls, systemic sclerosis patients with amputation had more digital ulcers (p = 0.048), history of digital ulcers (p = 0.026), and a higher prevalence of pulmonary arterial hypertension (p = 0.024). Systemic sclerosis patients with amputation were more often smokers (p = 0.008) and under corticosteroids (p = 0.015). In the multivariate model, pulmonary arterial hypertension, smoking status, and corticosteroids were independent markers associated with lower limb amputation in systemic sclerosis. In the follow-up, 10 patients (38.5%) had recurrent ischemia requiring a new limb amputation, and five patients (19.2%) had an amputation of the contralateral limb.Conclusion:This study identifies some markers associated with lower limb amputation in systemic sclerosis such as digital ulcers and pulmonary arterial hypertension and points out the high risk associated with tobacco consumption and corticosteroid use

The writings of Henry David Thoreau.

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