Médecine interne hospitalière: l'année 2009 en revue (1). La perspective des chefs de clinique [Hospital based internal medicine: the year 2009 in review (I). The perspective of chief residents]

Internists must regularly adjust their patients care according to recent relevant publications. The chief residents from the Department of Internal Medicine of a university hospital present some major themes of internal medicine treated during the year 2009. Emphasis will be placed primarily on changes in the daily hospital practice induced by these recent studies. This variety of topics illustrates both the broad spectrum of the current internal medicine, and the many uncertainties associated with modern medical practice based on evidence.

Tearing and folding of the retinal internal limiting membrane associated with macular epiretinal membrane

PURPOSE: To describe the clinical and histologic features of a particular form of macular epiretinal membrane. METHODS: The charts of all patients operated for macular epiretinal membrane by a single surgeon (E.H.B.) between June 2001 and January 2005 were retrospectively reviewed. Patients with macular epiretinal membrane associated with tearing and folding of the internal limiting membrane (ILM) were identified and the following parameters were recorded when available: age, gender, best-corrected visual acuity before and after vitrectomy; optical coherence tomography; pre-, intra-, and postoperative macular status; intraoperative staining by indocyanine green; histology. RESULTS: Twenty-three of 268 eyes (8.6%) with macular epiretinal membrane were associated with tearing and folding of the ILM, forming a whitish prominent band on the surface of the retina. The mean age of the patients was 68.6 years with a significant female predominance (78.3%). The vitreous was completely detached in 21 eyes. After surgical peeling, the mean visual gain was 3.2 Early Treatment Diabetic Retinopathy Study lines. No recurrence was observed. CONCLUSION: Tearing and folding of the ILM was associated with macular epiretinal membranes in 8.6% of cases. The ILM was probably torn during posterior hyaloid detachment, but the pathogenesis has not been clearly elucidated. The surgeon should begin to peel the macular epiretinal membrane by grasping the folded ILM to ensure complete removal of the ILM together with the epiretinal membrane. The postoperative visual prognosis was good

Audit report on Internal Control over Financial Reporting of the State University of Iowa as of and for the year ended June 30, 2011

Audit report on Internal Control over Financial Reporting of the State University of Iowa as of and for the year ended June 30, 2011

Independent auditor’s report of the State of Iowa on internal control over financial reporting and on compliance and other matters based on an audit of financial statements performed in accordance with government auditing standards for the year ended June 30, 2011

Independent auditor’s report of the State of Iowa on internal control over financial reporting and on compliance and other matters based on an audit of financial statements performed in accordance with government auditing standards for the year ended June 30, 2011

Perturbing Hele-Shaw flow with a small gap gradient

A controlled perturbation is introduced into the Saffman-Taylor flow problem by adding a gradient to the gap of a Hele-Shaw cell. The stability of the single-finger steady state was found to be strongly affected by such a perturbation. Compared with patterns in a standard Hele-Shaw cell, the single Saffman-Taylor finger was stabilized or destabilized according to the sign of the gap gradient. While a linear stability analysis shows that this perturbation should have a negligible effect on the early-stage pattern formation, the experimental data indicate that the characteristic length for the initial breakup of a flat interface has been changed by the perturbation.

Involvement of gap junctional intercellular communication in the pathophysiology of inflammation

SUMMARY Inflammation has evolved as a mechanism to defend the body against invading microorganisms and to respond to injury. It requires the coordinated response of a large number of cell types from the whole organism in a time- and space-dependent fashion. This coordination involves several cell-cell communication mechanisms. Exchange of humoral mediators such as cytokines is a major one. Moreover, direct contact between cells happens and plays a primordial role, for example when macrophages present antigens to lymphocytes. Contact between endothelial cells and leucocytes occurs when the latter cross the blood vessel barrier and transmigrate to the inflammatory site. A particular way by which cells communicate with each other in the course of inflammation, which at this time starts to gain attention, is the intercellular communication mediated by gap junctions. Gap junctions are channels providing a direct pathway (i.e. without transit through the extracellular space) for the diffusion of small molecules between adjacent cells. This process is known as gap junctional intercellular communication (GJIC). The general aim of this thesis was to study a possible involvement of GJIC in the pathophysiology of inflammation. A first part of the work was dedicated to study the implication of GJIC in the modification of vascular endothelial function by inflammation. In a second part, we were interested in the possible role of GJIC in the transmigration of neutrophil polymorphonuclear leucocytes through the endothelium. The main positive finding of this work is that acute inflammation preferentially modulates the expression of connexin 40 (Cx40), a gap junction protein specifically expressed in vascular endothelium. The modulation could be towards overexpression (aortic endothelium of septic rats) or towards downregulation (acutely inflamed mouse lung). We put a lot of efforts in search of possible functions of these modulations, in two directions: a potential protective role of Cx40 increased expression against sepsis-induced endothelial dysfunction, and a facilitating role of Cx40 decreased expression in neutrophil transmigration. To pursue both directions, it seemed logical to study the impact of Cx40 deletion using knock-out mice. Concerning the potential protective role of Cx40 overexpression we encountered a roadblock as we observed, in the aorta, a Cx40 downregulation in wild type mouse whereas Cx40 was upregulated in the rat. Regarding the second direction and using an in vivo approach, we observed that pulmonary neutrophil transmigration was not affected by the genetic deletion of Cx40. In spite of their negative nature, these results are the very first ones regarding the potential implication of GJIC concerning leucocyte transmigration in vivo. Because this process involves such tight cell-cell physical contacts, the hypothesis for a role of GJIC remains attractive.

Effects of fou8/fry1 mutation on sulfur metabolism: is decreased internal sulfate the trigger of sulfate starvation response?

The fou8 loss of function allele of adenosine bisphosphate phosphatase FIERY1 results in numerous phenotypes including the increased enzymatic oxygenation of fatty acids and increased jasmonate synthesis. Here we show that the mutation causes also profound alterations of sulfur metabolism. The fou8 mutants possess lower levels of sulfated secondary compounds, glucosinolates, and accumulate the desulfo-precursors similar to previously described mutants in adenosine 5'phosphosulfate kinase. Transcript levels of genes involved in sulfate assimilation differ in fou8 compared to wild type Col-0 plants and are similar to plants subjected to sulfate deficiency. Indeed, independent microarray analyses of various alleles of mutants in FIERY1 showed similar patterns of gene expression as in sulfate deficient plants. This was not caused by alterations in signalling, as the fou8 mutants contained significantly lower levels of sulfate and glutathione and, consequently, of total elemental sulfur. Analysis of mutants with altered levels of sulfate and glutathione confirmed the correlation of sulfate deficiency-like gene expression pattern with low internal sulfate but not low glutathione. The changes in sulfur metabolism in fou8 correlated with massive increases in 3'-phosphoadenosine 5'-phosphate levels. The analysis of fou8 thus revealed that sulfate starvation response is triggered by a decrease in internal sulfate as opposed to external sulfate availability and that the presence of desulfo-glucosinolates does not induce the glucosinolate synthesis network. However, as well as resolving these important questions on the regulation of sulfate assimilation in plants, fou8 has also opened an array of new questions on the links between jasmonate synthesis and sulfur metabolism.

Jonctions communicantes et sécrétion [Gap junctions and secretion]

The emergence of multicellular organisms has necessitated the development of mechanisms for interactions between adjacent and distant cells. A consistent feature of this network is the expression of gap junction channels between the secretory cells of all glands so far investigated in vertebrates. Here, we reviewed the distribution of the gap junctions proteins, named connexins, in a few mammalian glands, and discussed the recent evidence pointing to the participation of these proteins in the functioning of endocrine and exocrine cells. Specifically, available data indicate the importance of gap junctions for the proper control of glucose-induced insulin secretion. Understanding the functions of beta-cell connexins are crucial for the engineering of surrogate cells, which is necessary for implementation of a replacement cell therapy in diabetic patients.

Equilibrium and nonequilibrium gap-state distribution in amorphous silicon

A general and straightforward analytical expression for the defect-state-energy distribution of a-Si:H is obtained through a statistical-mechanical treatment of the hydrogen occupation for different sites. Broadening of available defect energy levels (defect pool) and their charge state, both in electronic equilibrium and nonequilibrium steady-state situations, are considered. The model gives quantitative results that reproduce different defect phenomena, such as the thermally activated spin density, the gap-state dependence on the Fermi level, and the intensity and temperature dependence of light-induced spin density. An interpretation of the Staebler-Wronski effect is proposed, based on the ''conversion'' of shallow charged centers to neutrals near the middle of the gap as a consequence of hydrogen redistribution.

Bubbles in Kaluza-Klein theories with spacelike or timelike internal dimensions

region to the other. We also present a C-type solution that describes neutral bubbles in uniform acceleration, and we use it to construct an instanton that mediates the breaking of a cosmic string by forming bubbles at its ends. The rate for this process is also calculated. Finally, we argue that a similar solution can be constructed for magnetic bubbles, and that it can be used to describe a semiclassical instability of the two-timing vacuum against production of massless monopole pairs.

Internal and external fluctuations around nonequilibrium steady states in one-dimensional heat-conduction problems

Thermal fluctuations around inhomogeneous nonequilibrium steady states of one-dimensional rigid heat conductors are analyzed in the framework of generalized fluctuating hydrodynamics. The effect of an external source of noise is also considered. External fluctuations come from temperature and position fluctuations of the source. Contributions of each kind of noise to the temperature correlation function are computed and compared through the study of its asymptotic behavior.

Cross-cultural adaptation, reliability, internal consistency and validation of the Spinal Function Sort (SFS) for French- and German-speaking patients with back complaints.

Introduction Functional subjective evaluation through questionnaire is fundamental, but not often realized in patients with back complaints, lacking validated tools. The Spinal Function Sort (SFS) was only validated in English. We aimed to translate, adapt and validate the French (SFS-F) and German (SFS-G) versions of the SFS. Methods Three hundred and forty-four patients, experiencing various back complaints, were recruited in a French (n = 87) and a German-speaking (n = 257) center. Construct validity was estimated via correlations with SF-36 physical and mental scales, pain intensity and hospital anxiety and depression scales (HADS). Scale homogeneities were assessed by Cronbach's α. Test-retest reliability was assessed on 65 additional patients using intraclass correlation (IC). Results For the French and German translations, respectively, α were 0.98 and 0.98; IC 0.98 (95% CI: [0.97; 1.00]) and 0.94 (0.90; 0.98). Correlations with physical functioning were 0.63 (0.48; 0.74) and 0.67 (0.59; 0.73); with physical summary 0.60 (0.44; 0.72) and 0.52 (0.43; 0.61); with pain -0.33 (-0.51; -0.13) and -0.51 (-0.60; -0.42); with mental health -0.08 (-0.29; 0.14) and 0.25 (0.13; 0.36); with mental summary 0.01 (-0.21; 0.23) and 0.28 (0.16; 0.39); with depression -0.26 (-0.45; -0.05) and -0.42 (-0.52; -0.32); with anxiety -0.17 (-0.37; -0.04) and -0.45 (-0.54; -0.35). Conclusions Reliability was excellent for both languages. Convergent validity was good with SF-36 physical scales, moderate with VAS pain. Divergent validity was low with SF-36 mental scales in both translated versions and with HADS for the SFS-F (moderate in SFS-G). Both versions seem to be valid and reliable for evaluating perceived functional capacity in patients with back complaints.

INTERNAL STRUCTURE OF A VERMICULAR IRONSTONE AS DETERMINED BY X-RAY COMPUTED TOMOGRAPHY SCANNING

Ironstones or petroplinthites are common materials in soils under humid tropical climate, generally defined as the result of Fe oxide accumulation in areas where the water table oscillates, and may exhibit considerable morphological variability. The aim of this study was to examine the internal structure and porosity of an ironstone fragment from a Petroferric Acrudox in Minas Gerais, Brazil, by computed tomography (CT) and conventional techniques. The sample analyzed had total porosity of 59.5 %, with large macropores in the form of tubular channels and irregular vughs, the latter with variable degrees of infilling by material released from the ironstone walls or the soil matrix. The CT scan also showed that the ironstone has wide variation in the density of the solid phase, most likely due to higher concentrations or thick intergrowths of hematite and magnetite/maghemite, especially in its outer rims. The implications of these results for water retention and soil formation in ironstone environments are briefly discussed.