Actualités dans la physiopathologie de la sclérodermie systémique : vers de nouvelles opportunités thérapeutiques

Systemic sclerosis is a rare connective tissue disease characterized by skin and several internal organ fibrosis, systemic vasculopathy and immune abnormalities. Even if fibroblasts and endothelial cells dysfunction, as well as lymphocytes and other immune cells implication are now well described, the exact origin and chronology of the disease pathogenesis remain unclear. Oxidative stress, influenced by genetic and environmental factors, seems to play a key role. Indeed, it seems to be implicated in the early phases of fibrosis development, vasculopathy and in immune tolerance abnormalities shared by all patients, although disease expression is heterogeneous. To date, no curative treatment is available. Even if immunosuppressive treatment or drugs acting on vascular system are proposed for some patients, overall, treatment efficiency remains modest. Only autologous hematopoietic stem cells transplantation, reserved for patients with severe or rapidly progressive fibrosis, has recently demonstrated efficiency, with lasting regression of fibrosis. Nevertheless, this treatment can expose to important, life-threatening toxicity. In the last decade, new mechanisms implicated in the pathogenesis of systemic sclerosis have been unraveled, bringing new therapeutic opportunities. In this review, we offer to focus on recent insights in the knowledge of systemic sclerosis pathogenesis and its implication in current and future medical care.     

Identification des facteurs associés à la réussite aux examens cliniques objectifs et structurés dans la faculté de médecine de Rouen

ContextObjective structured clinical examination (OSCE) became a national exam at the end of medical studies in France. The aim of this study was to identify the predictive factors for success at OSCEs.MethodsAurvey query after the OSCEs was completed by fifth-year medicine students at Rouen Uuniversity.. Data on continuous variables were compared using the Mann-Whitney test. Data on quantitative variables were compared using the Spearman's correlation.ResultsTwo hundred and thirty-nine students, i.e., 98.7 % of the students, responded to the query. The median (IQR 25–75) OSCE score was 13.6/20 (12.5–14.2). Students’ personal factors significantly associated with a higher OSCE performance were female sex (median score of 13.7 versus 13.4; P = 0.03) and good health during the clerkship (median score of 13.6 versus 12.6; P = 0.02). A higher OSCE performance was associated with an increased number (≥6)  of medicine clerkships  (median score of 13.8 versus 13.3; P = 0.02) and a decreased number (<3) of surgery clerkships (median score of 13.7 versus 12.9; P = 0.009). There was no correlation between the OSCE score and medical school performance (Spearman's correlation, r = 0.24).ConclusionHomogenization of student's clerkships, assistance to students with health problems seem to be teaching approaches to promote success at OSCEs.     

L’enseignement par discipline de la sémiologie en deuxième année de médecine améliore l’acquisition des compétences. Exemple de la sémiologie neurologique

Introduction

Since 2014–2015, practical teaching of clinical observation skills for 2^nd year medical students at our faculty has been discipline-based; previously, each clinical lecturer had to cover all medical fields. We assessed the impact of this teaching reform on the neurological examination skills of medical students in a before-and-after study.