Traiter les bidonvilles hier et aujourd’hui. Le relogement entre permanence et provisoire

International audienceEn comparant les dispositifs de relogement des bidonvilles dans les années 1960 et 2000 à Saint-Denis, cet article aborde un volet du traitement de la vulnérabilité résidentielle. Il s'agit de comprendre le rapport qui a pu s'établir entre des épisodes d'extension de la zone de vulnérabilité et des processus de transformation urbaine sous des formes urgentes et provisoires. Il apparaît qu'il existe des permanences dans ces dispositifs de relogement, tant concernant la forme d'habitat produit, le public identifié que les acteurs concernés. Cela rend compte de la relation existante entre la vulnérabilité résidentielle et la création d'une urbanité de l'entre-deux

Increases in bioactive IGF do not parallel increases in total IGF-I during growth hormone treatment of children born SGA.

BACKGROUND: Some children born small for gestational age (SGA) experience supra-physiological insulin-like growth factor-I (IGF-I) concentrations during GH treatment. However, measurements of total IGF-I concentrations may not reflect the bioactive fraction of IGF-I which reaches the IGF-I receptor at target organs. We examined endogenous IGF-bioactivity using an IGF-I kinase receptor activation (KIRA) assay that measures the ability of IGF-I to activate the IGF-IR in vitro. AIM: To compare responses of bioactive IGF and total IGF-I concentrations in short GH treated SGA children in the North European Small for Gestational Age Study (NESGAS). RESULTS: Bioactive IGF increased with age in healthy pre-pubertal children (n=94). SGA children had low-normal bioactive IGF levels at baseline (-0.12 (1.8 SD), increasing significantly after one year of high-dose GH treatment to 1.1 (1.4) SD, p2SD (mean IGF-I 2.8 SDS), whereas only 15% (n=15) had levels of bioactive IGF slightly above normal reference values. At baseline, bioactive IGF (SDS) was significantly correlated to height (SDS) (r=0.29, p=0.005), in contrast to IGF-I (SDS) (r=0.17, p=0.10). IGF-I (SDS) was inversely correlated to delta height (SDS) after one year of high-dose GH treatment (r=-0.22, p=0.02). CONCLUSION: In contrast to total IGF-I concentrations, bioactive IGF stayed within the normal reference ranges for most SGA children during the first year of GH treatment

Inferring within-flock transmission dynamics of highly pathogenic avian influenza H5N8 virus in France, 2020.

Following the emergence of highly pathogenic avian influenza (H5N8) in France in early December 2020, we used duck mortality data from the index farm to investigate within-flock transmission dynamics. A stochastic epidemic model was fitted to the daily mortality data and model parameters were estimated using an approximate Bayesian computation sequential Monte Carlo (ABC-SMC) algorithm. The model predicted that the first bird in the flock was infected 5 days (95% credible interval, CI: 3-6) prior to the day of suspicion and that the transmission rate was 4.1 new infections per day (95% CI: 2.8-5.8). On average, ducks became infectious 4.1 h (95% CI: 0.7-9.1) after infection and remained infectious for 4.3 days (95% CI: 2.8-5.7). The model also predicted that 34% (50% prediction interval: 8%-76%) of birds would already be infectious by the day of suspicion, emphasizing the substantial latent threat this virus could pose to other poultry farms and to neighbouring wild birds. This study illustrates how mechanistic models can help provide rapid relevant insights that contribute to the management of infectious disease outbreaks of farmed animals. These methods can be applied to future outbreaks and the resulting parameter estimates made available to veterinary services within a few hours

The source of dietary fat influences anti-tumour immunity in obese mice

Obesity increases the risk of many cancers and impairs the anti-tumour immune response. However, little is known about whether the source or composition of dietary fat affects tumour growth or anti-tumour immunity in obesity. Here, we show that high-fat diets (HFDs) derived from lard, beef tallow or butter accelerate tumour growth in a syngeneic model of melanoma, but HFDs based on coconut oil, palm oil or olive oil do not, despite equivalent obesity. Using butter-based and palm oil-based HFDs as examples, we find that these dietary fat sources differentially regulate natural killer and CD8 T cell infiltration and function within the tumour microenvironment, governed by distinct effects on the plasma metabolome and intracellular metabolism. We identify diet-related lipid intermediates, namely long-chain acylcarnitine species, as immunosuppressive metabolites enriched in mice fed butter compared to palm oil HFD. Together, these results highlight the significance of diet in maintaining a healthy immune system and suggest that modifying dietary fat may improve cancer outcomes in obesity.</p

Neurological manifestations of COVID-19 in adults and children

Different neurological manifestations of coronavirus disease 2019 (COVID-19) in adults and children and their impact have not been well characterized. We aimed to determine the prevalence of neurological manifestations and in-hospital complications among hospitalized COVID-19 patients and ascertain differences between adults and children. We conducted a prospective multicentre observational study using the International Severe Acute Respiratory and emerging Infection Consortium (ISARIC) cohort across 1507 sites worldwide from 30 January 2020 to 25 May 2021. Analyses of neurological manifestations and neurological complications considered unadjusted prevalence estimates for predefined patient subgroups, and adjusted estimates as a function of patient age and time of hospitalization using generalized linear models. Overall, 161 239 patients (158 267 adults; 2972 children) hospitalized with COVID-19 and assessed for neurological manifestations and complications were included. In adults and children, the most frequent neurological manifestations at admission were fatigue (adults: 37.4%; children: 20.4%), altered consciousness (20.9%; 6.8%), myalgia (16.9%; 7.6%), dysgeusia (7.4%; 1.9%), anosmia (6.0%; 2.2%) and seizure (1.1%; 5.2%). In adults, the most frequent in-hospital neurological complications were stroke (1.5%), seizure (1%) and CNS infection (0.2%). Each occurred more frequently in intensive care unit (ICU) than in non-ICU patients. In children, seizure was the only neurological complication to occur more frequently in ICU versus non-ICU (7.1% versus 2.3%, P &lt; 0.001). Stroke prevalence increased with increasing age, while CNS infection and seizure steadily decreased with age. There was a dramatic decrease in stroke over time during the pandemic. Hypertension, chronic neurological disease and the use of extracorporeal membrane oxygenation were associated with increased risk of stroke. Altered consciousness was associated with CNS infection, seizure and stroke. All in-hospital neurological complications were associated with increased odds of death. The likelihood of death rose with increasing age, especially after 25 years of age. In conclusion, adults and children have different neurological manifestations and in-hospital complications associated with COVID-19. Stroke risk increased with increasing age, while CNS infection and seizure risk decreased with age

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Remodelage cardiaque dans la ville la plus haute du monde‎ : effets de l'altitude et du mal chronique des montagnes

Background: Despite unique adaptations to chronic hypoxic exposure, Andeans highlanders frequently develop a maladaptive syndrome , termed chronic mountain sickness (CMS), characterised by a combination of hypoxaemia, excessive erythrocytosis and various non specific symptoms. The aim of this study was to evaluate cardiac remodelling and pulmonary circulation at rest and during exercise in healthy lowlanders and highlanders and in CMS patients living in the highest city in the world La Rinconada, 5 100 m, Peru). Methods: 98 males were evaluated: 18 healthy lowlanders, 23 healthy highlanders living at 3 800 m, and 55 highlanders living at 5 100 m, among which 17 were asymptomatic (no CMS), 14 reported mild CMS and 24 reported moderate severe CMS. Cardiac remodelling was quantified by rest echocardiography. Pulmonary artery pressure (PAP) and pulmonary vascular resistance (TVR) were measured at rest and during submaximal cycling exercise. Total blood volume and haemoglobin mass were determined using the carbon monoxide rebreathing technique. Result: Heart remodelling, predominantly of the right heart, together with an elevation of resting PAP and an impairment in systolic function progressively occurred with the increase in altitude of residency. The left heart exhibited a progressive concentric remodelling with diastolic dysfunction but without systolic dysfunction. Those modifications were emphasised in moderate severe CMS patients at 5 100 m. Mean PAP was higher both at rest and during exercise in healthy highlanders at 5 100 m albeit without significant difference in TVR. On another hand, the moderate severe CMS subjects had a higher TVR at rest and a larger increase in mPAP during exercise. The right heart remodelling was significantly correlated with resting and exercise m PAP, total blood volume and arterial oxygenation. Conclusions: In the highest city in the world, healthy dwellers exhibit right heart dilatation in response to a chronically increased afterload and a left ventricle concentric remodelling with diastolic dysfunction. Those modifications are accentuated in moderate-severe CMS subjects and may enhance the risk of heart failure.Introduction : Malgré des adaptations uniques à l'hypoxie chronique, les andéens vivant en haute altitude développent fréquemment un syndrome de maladaptation, appelé mal chronique des montagnes (CMS), caractérisé par l'association d'une hypoxémie et de plusieurs symptômes aspécifiques. Le but de cette étude était d'évaluer le remodelage cardiaque et l'hémodynamique pulmonaire au repos et à l'effort chez les habitants de la ville la plus haute du monde (La Rinconada, 5100m, Pérou). Méthodes : 98 sujets ont été évalués : 18 sujets vivant en basse altitude, 23 sujets vivant à 3800m d'altitude et 55 sujets vivant à 5100m d'altitude (17 sans CMS,14 avec un CMS léger, 24 avec un CMS modéré à sévère). Le remodelage cardiaque était quantifié par une échocardiographie. Les pressions artérielles pulmonaires (PAP) et les résistances vasculaires pulmonaires (RVP) étaient mésurées au repos et lors d'un exercice submaximal à vélo. Le volume sanguin total et la masse d'hémoglobine étaient déterminés en utilisant le test de CO rebreathing. Résultats : Un remodelage cardiaque, principalement du coeur droit, associé à une élévation des PAP au repos et à une altération de la fonction systolique se développent progressivement avec l'augmentation de l'altitude de résidence. Le coeur gauche présente un remodelage concentrique progressif avec une dysfonction diastolique, mais sans dysfonction systolique. Ces modifications étaient augmentées chez les sujets souffrant d'un CMS modéré à sévère à 5 100 m. Les PAP moyennes était plus élevées au repos et à l'effort chez les habitants vivant à 5100 m. D'un autre côté, les sujets avec un CMS modéré à sévère avaient des RVP plus élevées au repos et une augmentation plus importante des PAP à l'effort. Le remodelage du ceur droit était significativement corrélé avec les PAP au repos et à l'effort, le volume sanguin total et l'oxygénation artérielle. Conclusions : Dans la ville la plus haute du monde, les habitants présentent une dilatation du ceur droit en réponse à une augmentation chronique de la post-charge et un remodelage concentrique du ventricule gauche avec une dysfonction diastolique. Ces modifications sont accentuées chez les sujets souffrant d'un CMS modéré à sévère, et peuvent augmenter le risque d'insuffisance cardiaque

Traiter les bidonvilles hier et aujourd’hui. Le relogement entre permanence et provisoire

This paper aims at analyzing the treatment of residential vulnerability by comparing slum relocation schemes in the 1960s and the 2000s. We seek to understand the links between some episodes of extension of the area of vulnerability and processes of urban transformation in both urgent and provisional forms. We show a certain continuity in slum relocation processes, wich are characterized by their tentative and precarious nature, dedicated to an identified population, and managed by specific actors. It shows the relationship between residential vulnerability and an intermediate urbanity.En comparant les dispositifs de relogement des bidonvilles dans les années 1960 et 2000 à Saint-Denis, cet article aborde un volet du traitement de la vulnérabilité résidentielle. Il s’agit de comprendre le rapport qui a pu s’établir entre des épisodes d’extension de la zone de vulnérabilité et des processus de transformation urbaine sous des formes urgentes et provisoires. Il apparaît qu’il existe des permanences dans ces dispositifs de relogement, tant concernant la forme d’habitat produit, le public identifié que les acteurs concernés. Cela rend compte de la relation existante entre la vulnérabilité résidentielle et la création d’une urbanité de l’entre-deux.Costil Mathilde, Roche Élise. Traiter les bidonvilles hier et aujourd’hui. Le relogement entre permanence et provisoire. In: Les Annales de la recherche urbaine, N°110, 2015. Ville et vulnérabilités. pp. 64-73

Construire la ville acceptable en réponse aux bidonvilles

International audienc

Construire la ville acceptable en réponse aux bidonvilles

International audienc