Diabétologie : nouveautés en médecine 2007 [Trends in diabetes]

Une méta-analyse concernant l'utilisation de la rosiglitazone chez les diabétiques de type 2 a révélé une augmentation significative du risque d'infarctus du myocarde et une tendance à la surmortalité cardiovasculaire. La méthodologie de cette étude ainsi que ses conclusions ont été beaucoup critiquées. Cette étude montre les limites des méta-analyses auxquelles on prête un rang manifestement trop élevé dans la hiérarchie des niveaux de preuve. L'étude 4T a évalué trois schémas d'insuline dans le traitement du diabète de type 2. Les résultats à un an montrent que seule une minorité des patients atteignent les objectifs. Post-Steno 2 a été présenté au congrès européen du diabète. Ces nouvelles données confirment que le traitement intensifié de tous les facteurs de risque cardiovasculaire permet une réduction majeure de la mortalité cardiovasculaire après 13,3 ans. A recent meta-analysis on the rosiglitazone in the treatment of type 2 diabetes revealed a significant increased risk of myocardial infarction and a trend to a higher cardiovascular mortality. In the following month after this publication, the methodology as its conclusions were criticized. This study shows the limits of the meta-analyses to which one lends a row obviously too high in the hierarchy of the levels of evidence. The study 4T evaluated 3 insulin strategies in the treatment of the type 2 diabetes. The results at one year show that only a minority of the patients achieve the goals. Post-Steno 2 was presented at the European congress diabetes. These new data confirm that the intensified treatment of all cardiovascular factors risk allows a major reduction of cardiovascular mortality after 13.3 years

Morphological and molecular characterisation of Heliconema hainanensis sp. nov. (Spirurina: Physalopteridae) from congers in the South China Sea, with a key to the species of Heliconema

Heliconema hainanensis sp. nov. collected from Uroconger lepturus (Richardson) (Anguilliformes: Congridae), Muraenesox cinereus (Forsskål) and Congresox talabonoides (Bleeker) (Anguilliformes: Muraenesocidae) in the South China Sea was described using light and scanning electron microscopy. The new species differs from its congeners by the following morphology: pseudolabia, the number and arrangement of caudal papillae (4 pairs of pedunculate precloacal papillae arranged in 2 groups of 2 and 2 pairs and 6 pairs of pedunculate postcloacal papillae arranged in 4 groups of 1, 2, 1 and 2 pairs), the length of spicules [left spicule 0.51-0.69 mm, right spicule 0.20-0.27 mm, spicule (right:left) ratio 1:2.20-2.69] and the morphology of the female tail tip. In addition, specimens of the new species collected from the three different hosts and specimens of an unidentified species of Heliconema collected from U. lepturus were characterised using molecular methods by sequencing the internal transcribed spacer (ITS) of ribosomal DNA. Analyses and comparison of the ITS sequence of H. hainanensis sp. nov. with Heliconema sp. support the validity of the new species based on morphological observations. An identification key to the species of Heliconema is also provided.

Adaptaciones de puestos de trabajo de centros de salud en trabajadores especialmente sensibles a riesgos laborales

An overview was conducted of work-person adjustments engaged in workers classified as especially sensitive for certain occupational risks in health sector. The purpose of this research was to provide workplace accommodations featuring because of some disability or health limitation associated with impairments from the tasks performance. During 2012 in the community health centers of a primary care district, 46 workers were catalogued especially sensitive that received an average of 3,2 adjustment measure in workplace. The findings showed a wide variety of accommodations including modifications in working arrangement, in the way to performance of the tasks, and in a lesser extent, changes in near environmental factors to the workplace and/or workstation. All prevention efforts were setting on provide to maintain continuity of working life inside compatible-limits with health and safety of workers. Our results offer a first approach to the knowledge of health limitations management that hamper responsiveness to demand of tasks.

Analyse comparée de régimes institutionnels de gestion des réseaux urbains de l'eau en station touristique de montagne : les cas de Crans-Montana (Suisse) et de Morzine-Avoriaz (France)

La station touristique représente un espace urbain consacré principalement au tourisme, tout en comprenant également une population résidente permanente. Du point de vue de la gestion des réseaux urbains de l'eau, cette caractéristique induit pour ce type de lieu des usages propres à tout espace urbain mais également des spécificités liées à la forte fluctuation saisonnière de la population résidente ou encore à la présence d'usages particuliers tels que l'irrigation des golfs, la production de neige artificielle ou le thermalisme. Dès lors, la planification de l'approvisionnement est délicate et peu prévisible. Ces difficultés sont renforcées par le fait que les concentrations temporelles de la demande coïncident généralement avec des périodes de stress hydrique notable. Dans le cas de stations balnéaires, les pics de fréquentation interviennent en général durant l'été lorsque la ressource en eau est peu disponible. Le problème est similaire dans les stations touristiques de montagne où l'eau est généralement indisponible car stockée sous forme de neige durant les mois de forte fréquentation. De plus, ces difficultés sont souvent renforcées par la localisation géographique des stations touristiques, fréquemment situées dans des espaces sensibles du point de vue de la ressource en eau, avec des situations de pénuries temporelles, voire structurelles. Ces problématiques propres à la plupart des stations touristiques mènent souvent à de fortes rivalités entre, d'une part, les différents usages touristiques de la ressource, et d'autre part, les usages autochtones et touristiques. Les particularités liées au tourisme tendent ainsi à renforcer les rivalités entre différents types de secteurs d'activité (approvisionnement en eau potable, tourisme, hydroélectricité, enneigement artificiel, irrigation, etc.). Ces différents usages de la ressource mis en concurrence nécessitent dès lors la mise en oeuvre de réglementations structurées à travers des politiques publiques ainsi que des droits de propriété et selon des composantes nationales, régionales et locales ; soit un cadre institutionnel que nous proposons d'appeler Régime Institutionnel de Ressource (RIR) (Knoepfel et al. 2001, 2007). A travers cette thèse de doctorat, nous répondons à différentes questions de recherche. Nous tentons d'abord de comprendre comment ces différents RIR sont-ils mis en oeuvre dans le cadre d'espaces touristiques ? Comment ceux-ci sont-ils concrétisés par les acteurs et quels sont leurs effets en termes de durabilité technique, environnementale, sociale et économique des réseaux urbains de l'eau ? Nous questionnons ensuite les effets du tourisme sur la gestion des infrastructures de réseau à l'échelle de la station touristique et de son bassin versant et nous interrogeons sur les effets du tourisme en termes de gestion des eaux urbaines. Nous portons notre attention sur deux stations touristiques situées dans deux contextes institutionnels différents (Crans-Montana en Suisse et Morzine-Avoriaz en France) et y étudions trois types de régimes institutionnels en particulier : la régie directe (gestion publique), l'affermage (gestion déléguée) et la gestion privée des infrastructures. Les résultats de cette thèse de doctorat indiquent tout d'abord dans quelle mesure le tourisme modifie de façon significative la perception et les modalités de gestion de la ressource en eau et des infrastructures. Ils montrent ensuite que l'espace fonctionnel de la gestion de ces infrastructures correspond rarement aux limites du réseau hydrographique naturel et quelles en sont les implications en termes de durabilité. Enfin, la comparaison de différents régimes institutionnels révèle les forces et les faiblesses de chaque modèle de gestion dans le cas spécifique des stations touristiques et également les différentes solutions adoptées localement pour la mise en oeuvre d'un arrangement institutionnel permettant un usage plus ou moins durable des infrastructures de réseau et du réseau hydrographique naturel. - Tourism resort represents an urban area mainly dedicated to tourism while including at the same time a permanent residential population. From the point of view of urban water networks, this characteristic induces a strong seasonal fluctuation of residential population and involves special water uses such as golf irrigation, production of artificial snow or functioning of thermal baths. Therefore, water supply planning can be tricky and difficult to predict. These difficulties are reinforced by the fact that temporary concentrations of water demand coïncidé generally with periods of water stress. In the case of seaside resorts, frequenting peaks arise in general during summer when water resource is less available. The problem is similar in mountainous tourist resorts where water is generally unavailable as it is stored as snow during months of highest frequenting. Furthermore, these difficulties are often reinforced by resorts' geographical localisations, which are often situated in sensitive areas in terms of temporary or structural water shortages. These problematic issues often lead to strong rivalries between tourists' water uses on the one hand, and between locals and tourists uses on the other hand. Thus, features of tourism tend to reinforce rivalries between different sectors of activity (supply of drinking water, tourism, hydroelectricity, artificial snow, irrigation, etc.). These different and competing water uses need the implementation of rules structured through public policies and property rights and through national, regional and local legal components; We propose to call this framework as an Institutional Resource Regime (IRR) (Knoepfel et al. 2001, 2007, 2009). Through this PhD thesis, we answer different research questions. We firstly aim to understand how those different IRR are implemented within tourism spaces? How do actors materialize them and what are their effects in term of technical, environmental, social and economical sustainability of urban water networks? We then, investigate effects of tourism on water networks infrastructures' management at the scale of the tourist resort and its river basin. We focus our attention on two tourist resorts situated within two different institutional contexts (Crans-Montana, Switzerland and Morzine-Avoriaz, France) and study three types of institutional regime in particular: public, delegated and private management of infrastructures. Results of this PhD thesis indicate firstly how tourism modifies in a significant way the perception and management modalities of water resource and infrastructures. Results also show that functional space of infrastructures management rarely matches with the limits of the natural river basin and indicates what it means in terms of sustainability. Finally, the comparison of different institutional regimes reveals the strengths and weakness of each management model in the specific case of tourist resorts and shows the different solutions in locally implementing an institutional arrangement for a more or less sustainable management of network infrastructures and natural water system.

Sharing competences in strategic alliances: a case study of the Cosan and Shell biofuel venture

In a competitive world, the way a firm establishes its organizational arrangements may determine the enhancement of its core competences and the possibility of reaching new markets. Firms that find their skills to be applicable in just one type of market encounter constraints in expanding their markets, and through alliances may find a competitive form of value capture. Hybrid forms of organization appear primarily as an alternative to capturing value and managing joint assets when the market and hierarchy modes do not present any yields for the firm's competitiveness. As a result, this form may present other challenging issues, such as the allocation of rights and principal-agent problems. The biofuel market has presented a strong pattern of changes over the last 10 years. New intra-firm arrangements have appeared as a path to participate or survive among global competition. Given the need for capital to achieve better results, there has been a consistent movement of mergers and acquisitions in the Biofuel sector, especially since the 2008 financial crisis. In 2011 there were five major groups in Brazil with a grinding capacity of more than 15 million tons per year: Raízen (joint venture formed by Cosan and Shell), Louis Dreyfus, Tereos Petrobras, ETH, and Bunge. Major oil companies have implemented the strategy of diversification as a hedge against the rising cost of oil. Using the alliance of Cosan and Shell in the Brazilian biofuel market as a case study, this paper analyses the governance mode and challenging issues raised by strategic alliances when firms aim to reach new markets through the sharing of core competences with local firms. The article is based on documentary research and interviews with Cosan's Investor Relations staff, and examines the main questions involving hybrid forms through the lens of the Transaction Cost Economics (TCE), Agency Theory, Resource Based View (RBV), and dynamic capabilities theoretical approaches. One focal point is knowledge "appropriability" and the specific assets originated by the joint venture. Once the alliance is formed, it is expected that competences will be shared and new capabilities will expand the limits of the firm. In the case studied, Cosan and Shell shared a number of strategic assets related to their competences. Raízen was formed with economizing incentives, as well to continue marshalling internal resources to enhance the company's presence in the world energy sector. Therefore, some challenges might be related to the control and monitoring agents' behavior, considering the two-part organism formed by distinctive organizational culture, tacit knowledge, and long-term incentives. The case study analyzed illustrates the hybrid arrangement as a middle form for organizing the transaction: neither in the market nor in the hierarchy mode, but rather a more flexible commitment agreement with a strategic central authority. The corporate governance devices are also a challenge, since the alignment between the parent companies in the joint ventures is far more complex. These characteristics have led to an organism with bilateral dependence, offering favorable conditions for developing dynamic capabilities. However, these conditions might rely on the partners' long-term interest in the joint venture.

Effective stiffening of DNA due to nematic ordering causes DNA molecules packed in phage capsids to preferentially form torus knots.

Observation that DNA molecules in bacteriophage capsids preferentially form torus type of knots provided a sensitive gauge to evaluate various models of DNA arrangement in phage heads. Only models resulting in a preponderance of torus knots could be considered as close to reality. Recent studies revealed that experimentally observed enrichment of torus knots can be qualitatively reproduced in numerical simulations that include a potential inducing nematic arrangement of tightly packed DNA molecules within phage capsids. Here, we investigate what aspects of the nematic arrangement are crucial for inducing formation of torus knots. Our results indicate that the effective stiffening of DNA by the nematic arrangement not only promotes knotting in general but is also the decisive factor in promoting formation of DNA torus knots in phage capsids.

The fetal membranes of the otter shrews and a synapomorphy for afrotheria.

The otter shrews of mainland Africa are the closest relatives of the Madagascar tenrecs. We sought for similarities in placentation between the two groups and, in a wider context, with other mammals of the Afrotheria clade. Specimens of the Nimba otter shrew (Micropotamogale lamottei) were obtained from the Ivory Coast and examples of the giant otter shrew (Potamogale velox) from the Hill Collection. The Nimba otter shrew has a central haemophagous organ similar to that in tenrecs. The labyrinth of the Nimba otter shrew, however, is endotheliochorial with syncytial trophoblast enclosing the maternal vessels. On the other hand tenrecs have cellular haemomonochorial placentae and an associated spongy zone, which is not present in the Nimba otter shrew. The placenta of the giant otter shrew is also endotheliochorial. The central region of its placenta is particularly interesting, since the juxtafetal portion is clearly a haemophagous region whereas the labyrinth feeding this region is endotheliochorial. Thus there is considerable variation in placental morphology within Tenrecidae. Importantly, however, both otter shrews have a large allantoic sac divided into four intercommunicating lobes by two pairs of septal folds. A similar arrangement has been described for representatives of each of the remaining five orders within Afrotheria. This is significant because previous anatomical studies have failed to establish a single synapomorphy in support of Afrotheria.

Select-divide-and-conquer method for large-scale configuration interaction

A select-divide-and-conquer variational method to approximate configuration interaction (CI) is presented. Given an orthonormal set made up of occupied orbitals (Hartree-Fock or similar) and suitable correlation orbitals (natural or localized orbitals), a large N-electron target space S is split into subspaces S0,S1,S2,...,SR. S0, of dimension d0, contains all configurations K with attributes (energy contributions, etc.) above thresholds T0={T0egy, T0etc.}; the CI coefficients in S0 remain always free to vary. S1 accommodates KS with attributes above T1≤T0. An eigenproblem of dimension d0+d1 for S0+S 1 is solved first, after which the last d1 rows and columns are contracted into a single row and column, thus freezing the last d1 CI coefficients hereinafter. The process is repeated with successive Sj(j≥2) chosen so that corresponding CI matrices fit random access memory (RAM). Davidson's eigensolver is used R times. The final energy eigenvalue (lowest or excited one) is always above the corresponding exact eigenvalue in S. Threshold values {Tj;j=0, 1, 2,...,R} regulate accuracy; for large-dimensional S, high accuracy requires S 0+S1 to be solved outside RAM. From there on, however, usually a few Davidson iterations in RAM are needed for each step, so that Hamiltonian matrix-element evaluation becomes rate determining. One μhartree accuracy is achieved for an eigenproblem of order 24 × 106, involving 1.2 × 1012 nonzero matrix elements, and 8.4×109 Slater determinants

Direct visualization of the trimeric structure of the ASIC1a channel, using AFM imaging.

There has been confusion about the subunit stoichiometry of the degenerin family of ion channels. Recently, a crystal structure of acid-sensing ion channel (ASIC) 1a revealed that it assembles as a trimer. Here, we used atomic force microscopy (AFM) to image unprocessed ASIC1a bound to mica. We detected a mixture of subunit monomers, dimers and trimers. In some cases, triple-subunit clusters were clearly visible, confirming the trimeric structure of the channel, and indicating that the trimer sometimes disaggregated after adhesion to the mica surface. This AFM-based technique will now enable us to determine the subunit arrangement within heteromeric ASICs.

Experimental and computational study on the synthesis and characterization of self-assembling meso/macroporous materials in highly concentrated emulsions

Report for the scientific sojourn carried out at Massachusetts General Hospital Cancer Center-Harvard Medical School, Estats Units, from 2010 to 2011. The project aims to study the aggregation behavior of amphiphilic molecules in the continuous phase of highly concentrated emulsions, which can be used as templates for the synthesis of meso/macroporous materials. At this stage of the project, we have investigated the self-assembly of diblock and triblock surfactants under the effect of a confined geometry being surrounded by the droplets of the dispersed phase. These droplets limit the growth of the aggregates, deeply modify their orientation and hence alter their spatial arrangement as compared to the self-assembly taking place far enough from any boundary surface, that is in the bulk. By performing Monte Carlo simulations, we have showed that the interface between the dispersed and continuous phases as well as its shape has a significant impact on the structural order of the resulting aggregates and hence on the potential applications of highly concentrated emulsions as reaction media, drug delivery systems, or templates for meso/macroporous materials. Due to the combined effect of symmetry breaking and morphological frustration, very intriguing structures, such as square columnar liquid crystals, twisted X-shaped aggregates, and helical phases of cylindrical aggregates, never observed in the bulk for the same model surfactant, have been found. The presence of other more conventional structures, such as micelles and cubic and hexagonal liquid crystals, formed at low and high amphiphilic concentrations, respectively, further enhance the interest on this already rich aggregation behavior.

The effects of walking while working on productivity and health: a field experiment

Lack of physical activity can cause health problems and diminish organizational productivity. We conducted a 12-months long field experiment in a financial services company to study the effects of slow-moving treadmills outfitted for office work on employee productivity and health. 43 sedentary volunteers were assigned randomly to two groups to receive treadmill workstations 7 months apart. Employees could opt at will for standard chair-desk arrangement. Biometric measurements were taken quarterly and weekly online performance surveys were administered to study participants and to more than 200 non-participants and their supervisors.In this study we explore three questions concerning the effects of the introduction of treadmills in the workplace. (1) Does it improve overall physical activity? (2) Does it improve health measures? (3) Does it improve performance? The answers are as follows. (1) Yes (net effect of almost half an hour a day). (2) Yes (small gains, one minor decline). (3) No and yes (initial decline followed by increase to recover to initial level within one year) – based on weekly employee self reports.

The Four Different Types of Internal Hernia Occurring After Laparascopic Roux-en-Y Gastric Bypass Performed for Morbid Obesity: Are There Any Multidetector Computed Tomography (MDCT) Features Permitting Their Distinction?

BACKGROUND: Four different types of internal hernias (IH) are known to occur after laparoscopic Roux-en-Y gastric bypass (LRYGBP) performed for morbid obesity. We evaluate multidetector row helical computed tomography (MDCT) features for their differentiation. METHODS: From a prospectively collected database including 349 patients with LRYGBP, 34 acutely symptomatic patients (28 women, mean age 32.6), operated on for IH immediately after undergoing MDCT, were selected. Surgery confirmed 4 (11.6%) patients with transmesocolic, 10 (29.4%) with Petersen's, 15 (44.2%) with mesojejunal, and 5 (14.8%) with jejunojejunal IH. In consensus, 2 radiologists analyzed 13 MDCT features to distinguish the four types of IH. Statistical significance was calculated (p < 0.05, Fisher's exact test, chi-square test). RESULTS: MDCT features of small bowel obstruction (SBO) (n = 25, 73.5%), volvulus (n = 22, 64.7%), or a cluster of small bowel loops (SBL) (n = 27, 79.4%) were inconsistently present and overlapped between the four IH. The following features allowed for IH differentiation: left upper quadrant clustered small bowel loops (p < 0.0001) and a mesocolic hernial orifice (p = 0.0003) suggested transmesocolic IH. SBL abutting onto the left abdominal wall (p = 0.0021) and left abdominal shift of the superior mesenteric vessels (SMV) (p = 0.0045) suggested Petersen's hernia. The SMV predominantly shifted towards the right anterior abdominal wall in mesojejunal hernia (p = 0.0033). Location of the hernial orifice near the distal anastomosis (p = 0.0431) and jejunojejunal suture widening (p = 0.0005) indicated jejunojejunal hernia. CONCLUSIONS: None of the four IH seems associated with a higher risk of SBO. Certain MDCT features, such as the position of clustered SBL and hernial orifice, help distinguish between the four IH and may permit straightforward surgery.

RecA-DNA helical filaments in genetic recombination.

Paul Howard-Flanders et al proposed a molecular model of RecA-mediated recombination reaction six years ago. How does this model stand at present? In answering this question, we focus on two leading ideas of the original model, namely the proposal of the coaxial arrangement of the aligned DNA molecules within helical RecA filaments and the proposal of the ATP independence of the pairing stage of the recombination reaction. Results obtained after the model was proposed are reviewed and compared with these original assumptions and postulates of the model. EM visualization of recombining DNA molecules, studies of the energetics of the RecA-mediated recombination reaction and biochemical analysis of deproteinized joint molecules are fully consistent with a triple-stranded DNA arrangement during the RecA-mediated recombination reaction and demonstrate the ATP independence of the pairing stage of the reaction.

Integration of olfactory information in a spatial representation enabling accurate arm choice in the radial arm maze

The aim of the present study was to determine whether and how rats can use local olfactory cues for spatial orientation. Rats were trained in an eight-arm radial maze under different conditions as defined by the presence or absence of supplementary olfactory cues marking each arm, the availability of distant visuospatial information, and the illumination of the maze (light or darkness). The different visual conditions were designed to dissociate among the effects of light per se and those of visuospatial cues, on the use of olfactory cues for accurate arm choice. Different procedures with modifications of the arrangement of olfactory cues were used to determine if rats formed a representation of the spatial configuration of the olfactory cues and if they could rely on such a representation for accurate arm choice in the radial maze. The present study demonstrated that the use of olfactory cues to direct arm choice in the radial arm maze was critically dependent on the illumination conditions and implied two different modes of processing of olfactory information according to the presence or the absence of light. Olfactory cues were used in an explicit manner and enabled accurate arm choice only in the absence of light. Rats, however, had an implicit memory of the location of the olfactory cues and formed a representation of the spatial position of these cues, whatever the lighting conditions. They did not memorize the spatial configuration of the olfactory cues per se but needed these cues to be linked to the external spatial frame of reference.

Conserved chromosomal clustering of genes governed by chromatin regulators in Drosophila

BACKGROUND: The trithorax group (trxG) and Polycomb group (PcG) proteins are responsible for the maintenance of stable transcriptional patterns of many developmental regulators. They bind to specific regions of DNA and direct the post-translational modifications of histones, playing a role in the dynamics of chromatin structure. RESULTS: We have performed genome-wide expression studies of trx and ash2 mutants in Drosophila melanogaster. Using computational analysis of our microarray data, we have identified 25 clusters of genes potentially regulated by TRX. Most of these clusters consist of genes that encode structural proteins involved in cuticle formation. This organization appears to be a distinctive feature of the regulatory networks of TRX and other chromatin regulators, since we have observed the same arrangement in clusters after experiments performed with ASH2, as well as in experiments performed by others with NURF, dMyc, and ASH1. We have also found many of these clusters to be significantly conserved in D. simulans, D. yakuba, D. pseudoobscura and partially in Anopheles gambiae. CONCLUSION: The analysis of genes governed by chromatin regulators has led to the identification of clusters of functionally related genes conserved in other insect species, suggesting this chromosomal organization is biologically important. Moreover, our results indicate that TRX and other chromatin regulators may act globally on chromatin domains that contain transcriptionally co-regulated genes.