Éditeur(s) : HAL CCSD International Medical Press
Résumé : International audience
Background: Although the role of clinical/biological factors associated with mortality has already been explored in HIV-infected patients on antiretroviral therapy (ART), to date little attention has been given to the potential role of social vulnerability. This study aimed to construct an appropriate measure of social vulnerability and to evaluate whether this measure is predictive of increased mortality risk in ART-treated patients followed up in the ANRS CO8 APROCO-COPILOTE cohort.Methods: The cohort enrolled 1,281 patients initiating a protease inhibitor-based regimen in 1997–1999. Clinical/laboratory data were collected every 4 months. Self-administered questionnaires collected psycho-social/behavioural characteristics at enrolment (month [M] 0), M4 and every 8–12 months thereafter. A multiple correspondence analysis using education, employment and housing indicators helped construct a composite indicator measuring social vulnerability. The outcome studied was all-cause deaths occurring after M4. The relationship between social vulnerability and mortality, after adjustment for other predictors, was studied using a shared-frailty Cox model, taking into account informative study dropout.Results: Over a median (IQR) follow-up of 7.9 (3.0–11.2) years, 121 deaths occurred among 1,057 eligible patients, corresponding to a mortality rate (95% CI) of 1.64 (1.37, 1.96)/100 person-years. Leading causes of death were non-AIDS defining cancers (n=26), AIDS (n=23) and cardiovascular diseases (n=12). Social vulnerability (HR [95% CI] =1.2 [1.0, 1.5]) was associated with increased mortality risk, after adjustment for other known behavioural and bio-medical predictors.Conclusions: Social vulnerability remains a major mortality predictor in ART-treated patients. A real need exists for innovative interventions targeting individuals cumulating several sources of social vulnerability, to ensure that social inequalities do not continue to lead to higher mortality.
ISSN: 1359-6535

hal-01299300
https://hal-univ-rennes1.archives-ouvertes.fr/hal-01299300
https://hal-univ-rennes1.archives-ouvertes.fr/hal-01299300/document
https://hal-univ-rennes1.archives-ouvertes.fr/hal-01299300/file/Twelve-year%20mortality%20in%20HIV-infected%20patients_accepted.pdf
DOI : 10.3851/IMP2960

Éditeur(s) : HAL CCSD Wiley
Résumé : International audience
Clin Microbiol Infect 2012; 18 (Suppl. 4): 4043 Abstract In order to study complex microbial communities and their associated mobile genetic elements, such as the human gut microbiome, evolutionists could explore their genetic diversity with shared sequence networks. In particular, the detection of remarkable structures in gene networks of the gut microbiome could serve to identify important functions within the community, and would ease comparison of data sets from microbiomes of various sources (human, ape, mouse etc.) in a single analysis.
ISSN: 1198-743X

hal-01544804
https://hal.archives-ouvertes.fr/hal-01544804
DOI : 10.1111/j.1469-0691.2012.03856.x

Éditeur(s) : HAL CCSD Elsevier
Résumé : International audience
Rh (Rhesus) is a major blood group system in man, which is clinically significant in transfusion medicine. Rh antigens are carried by an oligomer of two major erythroid specific polypeptides, the Rh (D and CcEe) proteins and the RhAG glycoprotein, that shared a common predicted structure with 12 transmembrane a-helices (M0 to M11). Non erythroid homologues of these proteins have been identified (RhBG and RhCG), notably in diverse organs specialized in ammonia production and excretion, such as kidney, liver and intestine. Phylogenetic studies and experimental evidence have shown that these proteins belong to the Amt/Mep/Rh protein superfamily of ammonium/methylammonium permease, but another view suggests that Rh proteins might function as CO2 gas channels. Until recently no information on the structure of these proteins were available. However, in the last two years, new insight has been gained into the structural features of Rh proteins (through the determination of the crystal structures of bacterial AmtB and archeaebacterial Amt-1. Here, models of the subunit and oligomeric architecture of human Rh proteins are proposed, based on a refined alignment with and crystal structure of the bacterial ammonia transporter AmtB, a member of the Amt/Mep/Rh superfamily. This alignment was performed considering invariant structural features, which were revealed through Hydrophobic Cluster Analysis, and led to propose alternative predictions for the less conserved regions, particularly in the N-terminal sequences. The Rh models, on which an additional Rh-specific, N-terminal helix M0 was tentatively positioned, were further assessed through the consideration of biochemical and immunochemical data, as well as of stereochemical and topological constraints. These models highlighted some Rh specific features that have not yet been reported. Among these, are the prediction of some critical residues, which may play a role in the channel function, but also in the stability of the subunit structure and oligomeric assembly. These results provide a basis to further understand the structure/function relationships of Rh proteins, and the alterations occurring in variant phenotypes.
ISSN: 1246-7820

hal-00112914
https://hal.archives-ouvertes.fr/hal-00112914
DOI : 10.1016/j.tracli.2006.02.001

Éditeur(s) : HAL CCSD Cambridge University Press (CUP)
Résumé : International audience
Upper Triassic volcanic and sedimentary rocks of the Mamonia Complex in southwestern Cyprus are exposed in erosional windows through the post-Cretaceous cover, where the Mamonia Complex is tectonically imbricated with the Troodos and Akamas ophiolitic suites. Most of these Upper Triassic volcanic rocks have been considered to represent remnants of Triassic oceanic crust and its associated seamounts. New Nd and Pb isotopic data show that the whole Mamonia volcanic suite exhibits features of oceanic island basalts (OIB). Four rock types have been distinguished on the basis of the petrology and chemistry of the rocks. Volcanism began with the eruption of depleted olivine tholeiites (Type 1) and oceanic island tholeiites (Type 2) associated with deep basin siliceous and/or calcareous sediments. The tholeiites were followed by highly phyric alkali basalts (Type 3) interbedded with pelagic Halobia-bearing limestones or white reefal limestones. Strongly LREE-enriched trachytes (Type 4) were emplaced during the final stage of volcanic activity. Nd and Pb isotopic ratios suggest that tholeiites and mildly alkali basalts derived from partial melting of heterogeneous enriched mantle sources. Fractional crystallization alone cannot account for the derivation of trachytes from alkaline basalts. The trachytes could have been derived from the partial melting at depth of mafic material which shares with the alkali basalts similar trace element and isotopic compositions. This is corroborated by the rather similar isotopic compositions of the alkali basalts and trachytes. The correlations observed between incompatible elements (Nb, Th) and {varepsilon}Nd and Pb isotopic initial ratios suggest that the Mamonia suite was derived from the mixing of a depleted mantle (DMM) and an enriched component of High µ (µ = 238U/204Pb, HIMU) type. Models using both Nd and Pb isotopic initial ratios suggest that the depleted tholeiites (Type 1) derived from a DMM source contaminated by an Enriched Mantle Type 2 component (EM2), and that the oceanic tholeiites (Type 2), alkali basalts (Type 3) and trachytes (Type 4) were derived from the mixing of the enriched mantle source of the depleted tholeiites with a HIMU component. None of the Mamonia volcanic rocks show evidence of crustal contamination. The Upper Triassic within-plate volcanism likely erupted in a small southerly Neotethyan basin, located north of the Eratosthenes seamount and likely floored by oceanic crust.
ISSN: 0016-7568

insu-00353657
https://hal-insu.archives-ouvertes.fr/insu-00353657
DOI : 10.1017/S0016756806002937

Éditeur(s) : HAL CCSD Springer
Résumé : International audience
Numerous methods have been proposed in order to perform clustering from social networks. While significant works have been carried out on the design of new approaches, able to search for various kinds of clusters, a major challenge concerns the scalability of these approaches. Indeed, given the mass of data that can now be collected from online social networks, particularly from social platforms, it is important to have efficient methods for exploring and analyzing these very large amount of data. One of the recent social network clustering approaches is the extraction of conceptual links, a new approach that performs link clustering by exploiting both the structure of the network and attributes of nodes to identify strong links between groups of nodes in which nodes share common attributes. In this paper, we focus on the optimization of the search for conceptual links. In particular, we propose PALM, a parallel algorithm that aims to improve the efficiency of the extraction by simultaneously exploring several areas of the search space. For this purpose, we begin by demonstrating that the solution space forms a concept lattice. Then, we propose an approach that explores in parallel the branches of the lattice while reducing the search space based on various properties of conceptual links. We demonstrate the efficiency of the algorithm by comparing the performances with the original extraction approach. The results obtained show a significant gain on the computation time.
28th International Conference on Database and Expert Systems Applications (DEXA)
Lyon, France

hal-01637554
https://hal.archives-ouvertes.fr/hal-01637554
DOI : 10.1007/978-3-319-64471-4_21

Résumé : Les espaces naturels protégés sont aujourd’hui à l‘échelle mondiale l’une des principales politiques publiques mises en œuvre pour faire face à la destruction des écosystèmes. Leur nombre a beaucoup augmenté ces dernières années et les modes d’action qu’ils recouvrent se sont considérablement diversifiés. Pour autant, les écosystèmes continuent à se dégrader, et l’efficacité de ces dispositifs est souvent remise en cause. Cette thèse vise à analyser les facteurs influant sur l’efficacité des espaces protégés pour la conservation d’écosystèmes amazoniens encore peu dégradés. Elle étudie pour cela la mise en œuvre de dispositifs relevant de doctrines de gestion de l’environnement différentes, basées sur (i) la limitation réglementaire maximale des activités humaines impactantes pour les écosystèmes, (ii) la gestion des ressources par des populations locales ou traditionnelles ou (iii) la mise en place d’une gestion forestière durable sur des terres publiques. Nous nous plaçons dans une posture comparative entre la Guyane (France) et l’Amapá (Brésil), territoires partageant une frontière commune, principalement matérialisée par le fleuve Oyapock. La comparaison internationale entre ces deux régions présentant une couverture exceptionnelle en espaces protégés, dans des conditions écologiques et géographiques relativement similaires, nous permet d’observer l’influence du contexte historique et sociopolitique sur les modes de prise en charge de la gestion de l’environnement par les aires protégées. Nous nous sommes basés sur une approche constructiviste, appuyée sur une production de données principalement qualitatives (entretiens semi-directifs, analyse de documents, observation participante…). Nous avons ainsi procédé à une déconstruction critique des dispositifs « aires protégées », permettant de mettre en lisibilité les enjeux environnementaux qu’ils portent, et d’analyser l’efficacité environnementale des stratégies mises en œuvre. Cette analyse s’est articulée autour d’une lecture à la fois diachronique et multiscalaire des processus de gestion.Nous montrons que la mise en place des espaces protégés de Guyane et d’Amapá a été portée par des coalitions d’acteurs structurées autour de doctrines de gestion, c’est à dire de conceptions partagées des conditions de mise en œuvre d’une « bonne gestion environnementale ». Les dispositifs créés ont hérité des ressources stratégiques d’action et de la légitimité de ces coalitions. Les coalitions porteuses de la création des espaces protégés en Amapá sont fortement articulées aux mouvements sociaux et environnementaux plus généraux de l’Amazonie brésilienne, notamment pour les revendications socio-environnementales émergeant à la sortie de la période dictatoriale. En Guyane française, les espaces naturels protégés sont principalement la résultante de compromis entre d’une part une volonté d’exemplarité de l’action de la France en Amazonie, et d’autre part une recherche de minimisation des conflits avec les acteurs politiques locaux.
Nowadays, natural protected areas are one of the main public policies implemented at the international level in order to prevent the destruction of ecosystems. During the last decades, they became very numerous, and mobilized more and more diversified modes of action. However, natural ecosystems continue to deteriorate, and the effectiveness of protected areas is often questioned. The aim of this thesis was to analyse the factors influencing the effectiveness of protected areas in a context of Amazonian ecosystems that are still well preserved. We observed the implementation of environmental management arrangement (protected areas) that are based on various doctrines: (i) the strong limitation of all harmful human activities through legislation; (ii) the management of resources by local or traditional populations; and (iii) the implementation of sustainable forest management on public lands. We adopted a comparative approach between Guyana (France) and Amapá (Brazil), territories that share a common border, mainly identifiable by the Oyapock River. These two territories present quite similar ecological and geographical conditions, and both have an exceptional coverage of protected areas. Therefore this international comparison allowed us to observe the influence of the historical and socio-political context on the implementation of protected areas. We used a constructivist approach, mainly based on qualitative data (semi-structured interviews, document analysis, participant observation...). We effected a critical deconstruction of "protected areas" management arrangements in order to make their environmental objectives intelligible, and we analysed the environmental effectiveness of the strategies implemented. This analysis was based on a diachronic and multiscalar lecture of management processes. We show that the establishment of protected areas in Guiana and Amapá was led by coalitions of actors structured around management doctrines, i.e. shared conceptions of "good environmental management". Management arrangements created inherited the strategic resources of action and the legitimacy of these coalitions. In Amapá, coalitions were strongly articulated with wider social and environmental movements of the Brazilian Amazon, especially in the case of socio-environmental claims rising at the end of the dictatorship. In French Guiana, the natural protected areas are mainly the result of compromise between the French willingness to serve as an example in the Amazon region, and the minimisation of conflicts with local politicians.

http://www.theses.fr/2014AGUY0744/document

Éditeur(s) : HAL CCSD
Résumé : 1 p.
International audience
The 12th May 2008 Wenchuan earthquake in the Longmen Shan occurred on a large thrust fault largely inherited from an Indosinian structure itself probably controlled by an older structural heritage of the South China block continental margin. Within the whole northeast Tibet region, such a structural inheritance has had a major impact on the Tertiary deformation. It appears of primary importance to assess the pre-Tertiary tectonic evolution of the main blocks involved to understand the actual deformation in the eastern edge of Tibet. Over the past decades, the Proterozoic to Cenozoic tectonic, metamorphic and geochronologic history of the Longmen Shan and Songpan Garzê area have been largely studied. We present a synthesis of the tectonic evolution of the Songpan Garzê fold and thrust belt from Triassic to present. The Songpan-Garzê belt was formed during closure of a wide oceanic basin ?lled with a thick (5 to 15 km) sequence of Triassic ?yschoid sediments. Closure of the basin due to Triassic subduction involved strong shortening, intense folding and faulting of the Triassic series. A large-scale décollement, that presently outcrops along the eastern boundary of the belt (Danba area), allowed the growth of a wide and thick accretionary wedge. It develops in the Paleozoic and Triassic series and separates the accretionary prism from an autochthonous crystalline basement which shares many similarities with the basement of the Yangtze Craton (0.7-0.9 Ga). To the north and northwest, below the thickened Triassic series of the belt, the composition (oceanic or continental) of the basement remains unknown. During the Indosinian orogeny the emplacement of orogenic granites (220 - 150 Ma) was associated to crustal thickening. The isotopic composition of granitoids shows that their magma source were predominantly derived from melting of the proterozoic basement with varying degrees of sedimentary material and negligible mantle source contribution. In the Danba area, the décollement outcrops in a large tertiary antiform with a NNW-SSE axis. It has been exhumed too in the hanging wall of the NE-SW faults of the Tertiary Longmen-Shan belt that marks the present day transition from the Tibetan plateau to the Sichuan basin. These faults have episodically absorbed signi?cant shortening since the Late Triassic. The amount and precise timing of post-triassic deformation are dif?cult to constrain especially because of the dif?culty to isolate the tertiary thermochronological signal from the protracted late Triassic - Cretaceous thermal history. Nonetheless it is generally accepted that Jurassic - Cretaceous tectonism did not modi?ed the general Triassic architecture of eastern Tibet contrarily to the Tertiary deformation. The long-term cooling histories obtained on Mesozoic granites and on the metamorphic series of the Danba dome are very similar showing a very slow and regular cooling during Jurassic andCretaceous, con?rming the absence of major tectonic event between c.a. 150 and 30 Ma. Low temperature thermochronology data indicate that ?nal exhumation and cooling occurred in theTertiary with an acceleration between 10 and 5 Ma along the major tectonic structures. Within the Longmen Shan range, a total denudation of 7 to 10 km is estimated for the late Cenozoic period. Similar amounts of late Tertiary denudation have been estimated along an east-west section across the Xianshuihe fault
Asian climate and tectonics seminar
Utrecht, Netherlands

insu-00610298
https://hal-insu.archives-ouvertes.fr/insu-00610298
DOI : 10.1016/j.jseaes.2010.03.008

Éditeur(s) : HAL CCSD BioMed Central
Résumé : International audience
BACKGROUND: The TGF-β transforming growth factor is the most pleiotropic cytokine controlling a broad range of cellular responses that include proliferation, differentiation and apoptosis. The context-dependent multifunctional nature of TGF-β is associated with complex signaling pathways. Differential models describe the dynamics of the TGF-β canonical pathway, but modeling the non-canonical networks constitutes a major challenge. Here, we propose a qualitative approach to explore all TGF-β-dependent signaling pathways. RESULTS: Using a new formalism, CADBIOM, which is based on guarded transitions and includes temporal parameters, we have built the first discrete model of TGF-β signaling networks by automatically integrating the 137 human signaling maps from the Pathway Interaction Database into a single unified dynamic model. Temporal property-checking analyses of 15934 trajectories that regulate 145 TGF-β target genes reveal the association of specific pathways with distinct biological processes. We identify 31 different combinations of TGF-β with other extracellular stimuli involved in non-canonical TGF-β pathways that regulate specific gene networks. Extensive analysis of gene expression data further demonstrates that genes sharing CADBIOM trajectories tend to be co-regulated. CONCLUSIONS: As applied here to TGF-β signaling, CADBIOM allows, for the first time, a full integration of highly complex signaling pathways into dynamic models that permit to explore cell responses to complex microenvironment stimuli.
ISSN: 1752-0509

inserm-00978313
http://www.hal.inserm.fr/inserm-00978313
http://www.hal.inserm.fr/inserm-00978313/document
http://www.hal.inserm.fr/inserm-00978313/file/1752-0509-8-30.pdf
DOI : 10.1186/1752-0509-8-30

Éditeur(s) : HAL CCSD
Résumé : International audience
The aim was to identify patterns of work organization characteristics using data from epidemiological surveillance program of musculoskeletal disorders (MSD) implemented in the Pays de la Loire region between 2002 and 2005. A total of 3710 workers were included and completed a administered questionnaire including 16 organizational variables. Ascendant hierarchical clustering (AHC) of organizational variables and AHC of workers had identified five patterns of work organization characteristics: technical constraints and weak decision latitude; internal/external demand and mean decision latitude; weak pace constraints and mean decision latitude; internal/external demand and high decision latitude; weak pace constraints and high decision latitude. Relationships with MSD diagnosed by occupational physicians were then studied.
The specific health programs (SHP) are one of the four mechanisms of prevention planned by the Health and Safety at work Law in the province of Quebec. If the Law appoints only a responsible doctor, it is in reality Health at work teams (HWT) that develop these SHP. In this communication, based on the model of the working situation and the diagram of inter professional practices of collaboration, we study the practices of inter professional collaboration (CIP) in the HWT. The observed practices vary between independent practices, in parallel, of consultation, of dialogue and in shared services. Formalization of the teams, coordination of communication, leadership, respect and professional identities influence particularly the practices of CIP.
L’objectif était d’identifier des patterns de caractéristiques d'organisation du travail à partir des données du programme de surveillance épidémiologique des troubles musculo-squelettiques (TMS) mis en œuvre dans les Pays de la Loire entre 2002 et 2005. Au total, 3 710 salariés ont été inclus et ont répondu à un questionnaire comportant notamment 16 variables organisationnelles. Une classification ascendante hiérarchique (CAH) des variables organisationnelles puis une CAH des salariés ont permis d’identifier cinq patterns de caractéristiques d’organisation du travail : contraintes techniques et faible latitude décisionnelle ; demande interne/externe et latitude décisionnelle moyenne ; faibles contraintes de rythme et latitude décisionnelle moyenne ; demande externe/interne et forte latitude décisionnelle ; faibles contraintes de rythme et forte latitude décisionnelle. Les associations avec les TMS diagnostiqués par des médecins du travail ont ensuite été étudiées.
Actes du 50ème congrès de la Société d'Ergonomie de Langue Française
Paris, France

halshs-01307785
https://halshs.archives-ouvertes.fr/halshs-01307785

Éditeur(s) : HAL CCSD Elsevier
Résumé : International audience
This article summarizes the geodynamic evolution of the Variscan to Mesozoic Tethyan subduction history, based on a review of geochronological data from Eastern Anatolia and the Lesser Caucasus, and new isotopic ages for the Georgian crystalline basements. The geological history of the basements of Georgia (Transcaucasus) and NE Turkey (eastern Pontides) appears to be similar and provides evidence for a continuously active continental margin above a north-dipping subduction since at least the Lower Jurassic. New La-ICPMS U-Pb ages from the Georgian basement provide further evidence for the derivation of the Transcaucasus and its western continuation (the eastern Pontides) from Gondwana. A migmatized granodiorite provides preserved magmatic zircon cores with an age of 474 ± 3 Ma, while the age of migmatization is constrained by its 343 ± 2 Ma metamorphic rims. Metamorphism is synchronous with widespread I-type granites that were emplaced at 335 ± 8 Ma in the neighbouring Dzirula massif, and in the eastern Pontides. These U-Pb ages are in close agreement with recently obtained Ar/Ar ages from biotites and muscovites from metamorphic schists and U-Pb ages ranging from 340 to 330 Ma in the Georgian basement. The narrow range of ages suggests that the Variscan LP-HT metamorphic event in the eastern Pontides and Georgia was of short duration and likely related to mantle-derived intrusives. Furthermore, we suggest that (1) rifting of the Pontides-Transcaucasus block (PTB) from Gondwana at 450–350 Ma could have been driven by roll-back of the south-dipping Rheic slab, (2) that the main metamorphic and coeval magmatic events are related to the accretion of the PTB to the Eurasian margin at c. 350 Ma, while the source of magmatism is ascribed to slab detachment of the south-dipping slab at 340 Ma and that (3) three subduction zones may have been contemporaneously active in the Tethyan domain during the Jurassic: (i) the Lesser Caucasus South Armenian Block (SAB) shares a similar Gondwana affinity, but bears younger ages for its MP-MT metamorphic evolution and calc-alkaline magmatism bracketed from 160 to 123 Ma; (ii) north-dipping subduction below the PTB from c. 210 Ma to 150 Ma; (iii) northward intra-oceanic subduction bracketed from 180 to 90 Ma between the SAB and the PTB.
ISSN: 0264-3707

hal-01347761
https://hal.archives-ouvertes.fr/hal-01347761
DOI : 10.1016/j.jog.2016.03.003

Éditeur(s) : HAL CCSD Wiley
Résumé : [b]Aim[/b][br/] [br/] The phylogeographical history of Neotropical species can be difficult to reconstruct because of superimposed Neogene and Quaternary histories, and because of taxonomic uncertainty. We analysed range-wide genetic diversity in a widespread pioneer tree species, Jacaranda copaia (Aubl.) D. Don, to characterize phylogeographical structure, date the evolutionary relationships among lineages, and evaluate the role of dispersal and vicariance in establishing the present geographical range.[br/] [br/] [br/] [b]Location[/b][br/] [br/] Guiana Shield; central, southern and western Amazon Basin; Chocó region; Central America.[br/] [br/] [br/] [b]Methods[/b][br/] [br/] We analysed nine nuclear simple sequence repeat loci (nuSSR), eight chloroplast SSRs (cpSSR), and two cpDNA intergenic sequences in 341 adult trees. Genetic differentiation at nuSSRs was inferred using Bayesian clustering. Dating of chloroplast lineage divergence was obtained using a range of published mutation rates and Bayesian coalescence analyses. Population divergence dating was performed using an isolation-with-migration model for eight loci (one cp sequence and seven nuSSRs).[br/] [br/] [br/] [b]Results[/b][br/] [br/] Nuclear SSR variation identified three geographically overlapping clusters (nu-1, nu-2, nu-3). Twelve cpDNA haplotypes were clustered into two haplogroups (cp-1, cp-2) with the central Amazon harbouring the highest diversity. Molecular dating analysis suggests that cpDNA haplotype diversification started around the end of the Pliocene (2.61 Ma on average), whereas population divergence was more recent and occurred during the mid-Quaternary (point estimates between 357 and 436 ka).[br/] [br/] [br/] [b]Main conclusions[/b][br/] [br/] The genetic variation of J. copaia in the Neotropics was shaped mainly by Pleistocene events. Chloroplast diversity did not display the expected cis/trans Andean disjunction, indicating recent dispersal. Nuclear variation revealed that separate regions share a recent history, with a centre of diversity in the central Amazon Basin. The geographical pattern of diversity is congruent with the distribution of the two subspecies, J. copaia copaia and J. copaia spectabilis, and evidence of nuSSR admixture between the two taxa supports their classification as subspecies.
ISSN: 0305-0270

hal-01032410
https://hal.archives-ouvertes.fr/hal-01032410
DOI : 10.1111/j.1365-2699.2012.02797.x

Résumé : L’objet de cette thèse est de présenter les spécificités épidémiologiques, étiologiques et thérapeutiques de la pathologie neurovasculaire dans la population noire spécifique que constitue la population martiniquaise. En 1998, l’étude ERMANCIA I a permis de mettre en évidence une surincidence des accidents vasculaires cérébraux (AVC) en Martinique d’environ 40% par rapport à la métropole avec une haute prévalence de l’hypertension artérielle et du diabète. Ces résultats ont participé à la création en 2003 de la 1ère unité neurovasculaire aux Antilles. Le suivi à 5 ans des patients ERMANCIA I a révélé que la moitié était décédée et que 50% des survivants présentaient une démence vasculaire (soit le double des cohortes métropolitaines), probablement favorisé par une microangiopathie cérébrale sous-jacente souvent sévère amplifiant l’impact cognitif de l’AVC. Ce suivi a également permis d’identifier les faiblesses de la prévention secondaire en Martinique avec près de 80% des hypertendus qui restent mal équilibrés justifiant la création en 2006 d’un réseau de prévention. L’efficacité de ce réseau a été évaluée montrant un taux élevé de bon contrôle tensionnel (74% vs 39%, p=0,01) et une morbi-mortalité vasculaire moindre à 2,5 ans (8,3% vs 24%, p<0,001) que chez les patients contrôles. En 2012, ERMANCIA II a permis de révéler une diminution majeure (en moyenne 30%) de l’incidence des AVC dans la population martiniquaise et de la mortalité à 1 mois pour les patients ≤55 ans (20% vs 8%, p=0,03) probablement en raison d’une meilleure implémentation des mesures de prévention primaire et de la prise en charge en UNV respectivement. Nos données ont également permis de décrire certaines spécificités étiologiques des AVC chez les Martiniquais : grande fréquence de l’athérome intracrânien (pour lequel nous apportons des arguments en faveur d’une nouvelle classification), infarctus choroïdiens antérieurs dont nous décrivons le profil évolutif particulier, infarctus lacunaires multiples sévères. Deux étiologies plus « classiques » comme la drépanocytose et les IC sur morsure de serpent sont devenues anecdotiques. En revanche, une dysplasie carotidienne focale, étiologie déjà décrite mais supposée rare , pourrait être responsable d’un tiers des infarctus carotidiens d’origine indéterminée chez les Afro-Caribéens ≤55 ans exposant à un risque élevé de récidive sous traitement antiagrégant (28% à 14 mois), contre aucun pour les patients traités par endartériectomie. Sur le plan thérapeutique, nos résultats sont en faveur d’un surrisque hémorragique de la thrombolyse standard chez les patients martiniquais les plus âgés, probablement en rapport avec un cumul de lésions microangiopathiques plus important. En l’absence de neuroradiologie interventionnelle en Martinique, nos travaux montrent que certains patients avec occlusion artérielle proximale résistante à la thrombolyse IV standard peuvent bénéficier d’un complément de thrombolytique (0,1mg/Kg de tenecteplase). Une étude randomisée est prévue afin de mieux mesurer le potentiel thérapeutique de cette stratégie. Pour conclure, l’intérêt de ces données est que la population martiniquaise partage très probablement beaucoup de ses « particularités » avec d’autres populations noires encore peu décrites et pour lesquelles l’occidentalisation progressive du mode de vie risque d’accentuer le fardeau représenté par les AVC.
Our work presented herein aimed to describe the epidemiological, etiological and therapeutic features of the stroke pathology in the Martinican Afro-Caribbean population. In 1998, the first population-based epidemiological study, ERMANCIA I, showed a 40% greater firstever stroke incidence in Martinique compared to those observed in continental France, with a high prevalence of hypertension and diabetes. These results contributed to the creation, in 2003, of the first stroke unit in the Caribbean area. In the 5_year follow-up study, we found that half of the patients had died and that 50% of survivors were affected from vascular dementia (twice compared with continental French cohorts): this figure was probably favored by severe underlying cerebral microangiopathy that amplified the cognitive impact of stroke. We also identified a failure in the secondary prevention in Martinique, certified by nearly 80% of hypertensive patients still insufficiently controlled. As a result, in 2006, we developed a well-structured stroke prevention network. The efficiency of this network was attested by the high rate of good blood pressure control (74% vs. 39%, p=0.01) and the reduced vascular morbidity and mortality rate (8.3% vs. 24%, p <0.001) after a 30-month period of activity, in comparison with control “historic” patients. In 2012, ERMANCIA II study revealed a 30% reduction of first-ever stroke incidence and a reduced mortality rate at 1 month for patients ≤55 years (8% vs. 20%, p = 0.03), compared to these observed in ERMANCIA I, likely due to improvement of primary stroke prevention and the best stroke unit management at the acute phase, respectively. Based on our etiological data, we underline: 1) the relatively high frequency of symptomatic intracranial atherosclerosis, for which we propose a new definition; 2) the clinic-radiological features of stroke in the anterior choroidal artery; 3) the atypical picture of “malignant” multilacunar syndrome. On the other hand, stroke due to sickle cell disease or “trigonocephale” snakebite were only anecdotal. However, we found that carotid-bulb atypical fibromuscular dysplasia (CAFD), a very unusual previously described cause of stroke, could be responsible for up to the third of carotidterritory stroke of so-called undetermined etiology among patients ≤55 years. In addition, the relatively high rate of recurrence under antiplatelet (28% at 14 months), was dramatically reduced by endarterectomy in patients with CAFD. From a therapeutic point of view, our results showed an excess rate of post-thrombolysis symptomatic intracerebral hemorrhages in older patients, a figure probably linked to the severe underlying hypertension-triggered cerebral microangiopathy. Owing to the lack of neurointerventionnal option in Martinique, we tested a new therapeutic strategy in patients with a proximal arterial occlusion not responsive to standard IV thrombolysis, consisting in an additional administration of IV tenecteplase, 0.1mg/kg. Our preliminary results were promising, leading us to plan a randomized study. Finally, most of the characteristics of stroke in this Afro-Caribbean population are probably shared by the majority of black people. Thus, our results could have a universal impact in the understanding of stroke burden in blacks.

http://www.theses.fr/2015AGUY0909/document

Éditeur(s) : HAL CCSD
Résumé : International audience
BACKGROUND: Worrying trends regarding human reproductive endpoints (e.g. semen quality, reproductive cancers) have been reported and there is growing circumstantial evidence for a possible causal link between these trends and exposure to endocrine disrupting chemicals (EDCs). However, there is a striking lack of human data to fill the current knowledge gaps. To answer the crucial questions raised on human reproductive health, there is an urgent need for a reproductive surveillance system to be shared across countries. METHODS: A multidisciplinary network named HUman Reproductive health and Global ENvironment Network (HURGENT) was created aiming at designing a European monitoring system for reproductive health indicators. Collaborative work allowed setting up the available knowledge to design such a system. Furthermore we conducted an overview of 23 potential indicators, based upon a weight of evidence (WoE) approach according to their potential relation with EDC exposure. RESULTS: The framework and purposes of the surveillance system are settled as well as the approach to select suitable reproductive indicators. The indicators found with the highest scores according to the WoE approach are prostate and breast cancer incidence, sex ratio, endometriosis and uterine fibroid incidence, indicators related to the testicular dysgenesis syndrome, precocious puberty incidence and reproductive hormone levels. CONCLUSION: Not only sentinel health endpoints, but also diseases with high burdens in public health are highlighted as prior indicators in the context of EDC exposure. Our work can serve as a basis to construct, as soon as possible, the first multi-country reproductive monitoring system
European Journal of Public Health

hal-01197348
https://hal-univ-rennes1.archives-ouvertes.fr/hal-01197348
DOI : 10.1093/eurpub/ckv153
PUBMED : 26330492