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See detailDes statines pour le cerveau. Le point en 2008.
Scheen, André ULg; Radermecker, Régis ULg; Sadzot, Bernard ULg

in Revue Médicale de Liège (2008), 63(5-6), 287-92

Statins are essential drugs for the prevention of coronary artery disease. There is now evidence that they can also prevent ischemic stroke. The protective effect is related to the reduction in total and ... [more ▼]

Statins are essential drugs for the prevention of coronary artery disease. There is now evidence that they can also prevent ischemic stroke. The protective effect is related to the reduction in total and LDL cholesterol levels and the clinical benefit is especially high in secondary prevention patients with previous stroke and/or transient ischemic accident. The favourable role of statins is less well documented during an acute stroke than during an acute coronary syndrome, and certainly deserves further studies. Besides their specific cholesterol-lowering effect, statins exert various pleiotropic effects, which probably contribute to vascular protection. Furthermore, statins are able to reduce the formation of beta-amyloid peptide, which plays a key-role in the pathogenesis of Alzheimer disease. However, currently available results are heterogeneous and could not firmly support a protective effect of statins in dementia in general, neither in Alzheimer disease more specifically, nor in the reduction of cognitive function in the elderly. Several ongoing trials should confirm or not confirm this new potential indication of statins in a near future. [less ▲]

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See detailLe cerveau, un organe gluco-dependant. Effets deleteres de l'hypoglycemie et de l'hyperglycemie.
Radermecker, Régis ULg; Philips, Jean-Christophe ULg; Jandrain, Bernard ULg et al

in Revue Médicale de Liège (2008), 63(5-6), 280-6

Glucose is almost the only energy substrate for the brain. Such glucose dependence explains why any large variation of plasma glucose levels could lead to cerebral dysfunction, which may be severe and ... [more ▼]

Glucose is almost the only energy substrate for the brain. Such glucose dependence explains why any large variation of plasma glucose levels could lead to cerebral dysfunction, which may be severe and progress to a coma. Hypoglycaemic coma, the most common one, has a pure metabolic origin (neuroglucopenia) whereas hyperglycaemic coma is more complex and mainly due to osmotic disturbances. Besides acute changes of plasma glucose concentrations, it is generally recognized that more subtle chronic or recurrent glucose abnormalities could also result in brain dysfunction. However, such clinical consequences are more difficult to assess in clinical practice. Nevertheless, learning perturbations in young patients with type 1 diabetes and memory losses, sometimes severe and subject to progress to dementia ("diabetic encephalopathy") in older type 1 or type 2 diabetic patients, have been reported, although with some controversy. The present paper summarizes the current knowledge of both acute and chronic cerebral dysfunctions following perturbations of blood glucose levels in diabetic patients. [less ▲]

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See detailEtude clinique du mois. ONTARGET: protection comparable du telmisartan et du ramipril et absence de benefice de la combinaison chez des patients a haut risque vasculaire.
Scheen, André ULg; Krzesinski, Jean-Marie ULg

in Revue Médicale de Liège (2008), 63(4), 213-9

ONTARGET ("ONgoing Telmisartan Alone and in combination with Ramipril Global Endpoint Trial") compared the angiotensin converting enzyme inhibitor ramipril (10 mg/day), the angiotensin-receptor blocker ... [more ▼]

ONTARGET ("ONgoing Telmisartan Alone and in combination with Ramipril Global Endpoint Trial") compared the angiotensin converting enzyme inhibitor ramipril (10 mg/day), the angiotensin-receptor blocker telmisartan 80 mg/day, and the combination of the two drugs in 25,620 patients with vascular disease or high-risk diabetes. After a median follow up of 56 months, no significant differences were observed between the three groups neither in the primary composite outcome (death from cardiovascular causes, myocardial infarction, stroke, or hospitalization for heart failure), nor in each of its components, total mortality and other secondary outcomes. Telmisartan was equivalent to ramipril (non inferiority criterion), but was better tolerated (less cough and angioedema). The combination of the two drugs in this population (without congestive heart failure and proteinuric nephropathy) did not bring increased benefit (no superiority), but was associated with more adverse events (hypotension, syncope and renal dysfunction). In this population, the choice of the molecule in monotherapy remains optional and the use of a dual blockade is not justified in order to have a better cardiovascular protection. [less ▲]

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See detailMedications in the kidney.
Scheen, André ULg

in Acta Clinica Belgica (2008), 63(2), 76-80

Patients with chronic kidney disease (CKD) constitute a population at high risk for adverse drug reactions and/or drug-drug interactions. Renal dysfunction-induced pathophysiological changes may alter ... [more ▼]

Patients with chronic kidney disease (CKD) constitute a population at high risk for adverse drug reactions and/or drug-drug interactions. Renal dysfunction-induced pathophysiological changes may alter both medication pharmacodynamics and handling. Most pharmacokinetic parameters are adversely affected by impaired kidney function, among which reduced glomerular filtration and altered tubular secretion and reabsorption lead to the most specific alterations. Dosages of drugs cleared by the kidney should usually be adjusted according to creatinine clearance. Recommended methods for maintenance dosing adjustments are dose reductions, lengthening the dosing interval, or both. Appropriate drug selection and dosing in patients with CKD is imperative to avoid drug adverse events and to ensure optimal patient outcomes. [less ▲]

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See detailBelgian expert opinion: how to reduce the residual risk in atherogenic dyslipidaemic patients: place of fibrates.
Ducobu, Jean; Scheen, André ULg; Van Gaal, Luc et al

in Acta Cardiologica (2008), 63(2), 235-48

The demographics of dyslipidaemia have changed towards a more complex atherogenic dyslipidaemia involving increased levels of LDL-C, in particular highly atherogenic small dense particles ... [more ▼]

The demographics of dyslipidaemia have changed towards a more complex atherogenic dyslipidaemia involving increased levels of LDL-C, in particular highly atherogenic small dense particles, hypertriglyceridaemia and low HDL, together with increased levels of markers of cardiovascular inflammation, thrombogenesis and endothelial dysfunction. Statins were shown to significantly lower cardiovascular morbidity and mortality, but there still remains a high residual risk in dyslipidaemic patients, in particular with metabolic syndrome, type 2 diabetes, or low HDL levels. Fibrates have been shown to reduce plasma triglycerides and increase HDL-C, while improving inflammation, thrombogenesis and endothelial dysfunction. Clinical trials with fibrates have demonstrated their potential to reduce cardiovascular morbidity and mortality too, often through other mechanisms than these of statins. Combination trials of statins with fibrates have shown a more complete improvement of lipid profile and risk markers than each class separately. In contrast with gemfibrozil, fenofibrate does not interact significantly with the pharmacokinetics of statins, and up to now its combination with statins has been shown to have a low risk of muscular side effects or liver toxicity. The ACCORD outcome trial is exploring the possible benefits of the combination of fenofibrate with statins on morbidity and mortality of patients with atherogenic dyslipidaemia. [less ▲]

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See detailCB1 receptor blockade and its impact on cardiometabolic risk factors: overview of the RIO programme with rimonabant.
Scheen, André ULg

in Journal of Neuroendocrinology (2008), 20 Suppl 1

Rimonabant, the first selective CB(1) receptor antagonist in clinical use, has been extensively investigated in the Rimonabant in Obesity (RIO) programme, comprising four 1-2 year placebo-controlled ... [more ▼]

Rimonabant, the first selective CB(1) receptor antagonist in clinical use, has been extensively investigated in the Rimonabant in Obesity (RIO) programme, comprising four 1-2 year placebo-controlled randomised clinical trials recruiting more than 6600 overweight/obese patients with or without co-morbidities. Rimonabant 20 mg daily consistently reduced body weight, waist circumference, triglycerides, blood pressure, insulin resistance and C-reactive protein levels, and increased HDL cholesterol concentrations in both non-diabetic and type-2 diabetic overweight/obese patients. Adiponectin levels were increased, an effect that correlated with HDL cholesterol augmentation, while small dense LDL cholesterol levels were decreased in patients receiving rimonabant 20 mg compared with those receiving placebo in RIO Lipids. Furthermore, in RIO Diabetes, a 0.7% reduction in glycated haemoglobin (HbA1c) levels was observed in metformin- or sulphonylurea-treated patients with type-2 diabetes, an effect recently confirmed in the 6-month SERENADE (Study Evaluating Rimonabant Efficacy in drug-NAive DiabEtic patients) trial in drug-naive diabetic patients. Almost half of metabolic changes occurred beyond weight loss, in agreement with direct peripheral effects. The positive effects observed after 1 year were maintained after 2 years. Rimonabant was generally well-tolerated, but with a slightly higher incidence of depressed mood disorders, anxiety, nausea and dizziness compared with placebo. In clinical practice, rimonabant has to be prescribed to the right patient, i.e. overweight/obese subjects with cardiometabolic risk factors and with no major depressive illness and/or ongoing antidepressive treatment, in order to both maximise efficacy and minimise safety issues. New trials are supposed to confirm the potential role of rimonabant in patients with abdominal adiposity, atherogenic dyslipidaemia and/or type-2 diabetes, i.e. at high cardiometabolic risk. [less ▲]

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See detailLong-term effect of CB1 blockade with rimonabant on cardiometabolic risk factors: two year results from the RIO-Europe Study.
Van Gaal, Luc F; Scheen, André ULg; Rissanen, Aila M et al

in European Heart Journal (2008), 29(14), 1761-71

AIMS: Rimonabant, the first selective cannabinoid type 1 receptor blocker, has been shown to produce weight loss and improvements in several cardiometabolic risk factors over 1 year. We report the 2 year ... [more ▼]

AIMS: Rimonabant, the first selective cannabinoid type 1 receptor blocker, has been shown to produce weight loss and improvements in several cardiometabolic risk factors over 1 year. We report the 2 year efficacy and tolerability data of rimonabant. METHODS AND RESULTS: Patients with a body mass index > or =30 or >27 kg/m(2) with treated/untreated hypertension, dyslipidaemia, or both, were randomized to double-blind treatment with placebo, rimonabant 5 or 20 mg once daily plus a calorie-restricted diet for 2 years. Weight loss from baseline to 2 years in the intention-to-treat population was significantly greater with rimonabant 20 mg (mean +/- SD: -5.5 +/- 7.7 kg; P < 0.001) and 5 mg (-2.9 +/- 6.5 kg; P = 0.002) than placebo (-1.2 +/- 6.8 kg). Rimonabant 20 mg produced significantly greater improvements than placebo in waist circumference, high-density lipoprotein cholesterol, triglycerides, fasting glucose and insulin levels, insulin resistance, and metabolic syndrome prevalence. Rimonabant 20 mg produced clinically meaningful improvements in all Impact of Weight on Quality of Life-Lite questionnaire domain scores at 2 years. Rimonabant was generally well tolerated and rates of adverse events, including depressed mood disorders and disturbances were similar to placebo during year 2. Proportions of patients with clinically significant depression (Hospital Anxiety and Depression Scale score >11) were similar in all treatment groups. CONCLUSION: Rimonabant 20 mg over 2 years promoted clinically relevant and durable weight loss and improvements in cardiometabolic risk factors. [less ▲]

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See detailLe medicament du mois. Sitagliptine (Januvia): incretinopotentiateur indique comme insulinosecretagogue dans le traitement du diabete de type 2.
Scheen, André ULg; Van Gaal, L. F.

in Revue Médicale de Liège (2008), 63(2), 105-9

Sitagliptin (Januvia) is the first selective antagonist of dipeptidylpeptidase-4, an enzyme that degrades glucagon-like peptide-1 (GLP-1). This hormone is mainly secreted by ileal L cells and this ... [more ▼]

Sitagliptin (Januvia) is the first selective antagonist of dipeptidylpeptidase-4, an enzyme that degrades glucagon-like peptide-1 (GLP-1). This hormone is mainly secreted by ileal L cells and this secretion is abnormally low in patients with type 2 diabetes. Sitagliptin increases post-meal insulin secretion ("incretin effect) by enhancing the postprandial GLP-1 response ("incretin enhancer"), in a glucose-dependent manner. It improves glycaemic control (HbA1c) in type 2 diabetic patients treated by diet alone, by metformin, by sulfonylurea, by glitazone or by a metformin-sufonylurea combined therapy. The glucose-lowering effect is similar to that of glipizide, but with the advantage of no weight gain and no hypoglycaemic episodes. The tolerance to sitagliptin is excellent. Treatment is simple, with 100 mg once daily, without need of titration or home blood glucose monitoring. In Belgium, sitagliptin is currently reimbursed in patients with type 2 diabetes not adequately controlled with diet and metformin monotherapy. [less ▲]

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See detailThe future of obesity: new drugs versus lifestyle interventions.
Scheen, André ULg

in Expert Opinion on Investigational Drugs (2008), 17(3), 263-7

BACKGROUND: Obesity causes serious medical complications and impairs quality of life. However, its management remains challenging. OBJECTIVE: To assist health professionals who counsel patients who are ... [more ▼]

BACKGROUND: Obesity causes serious medical complications and impairs quality of life. However, its management remains challenging. OBJECTIVE: To assist health professionals who counsel patients who are overweight or obese by discussing the possible add-on value of new drugs over lifestyle interventions. METHODS: A critical analysis is made of the available evidence of the long-term efficacy of diet and exercise and/or anti-obesity agents such as orlistat, sibutramine and rimonabant. RESULTS/CONCLUSION: Lifestyle interventions remain the cornerstone of the treatment of obesity, but adherence is poor and long-term success is modest. Pharmacological agents may be useful adjuncts for improving weight loss and maintenance, and health outcomes, and should be continued in good responders. Drug therapy and lifestyle intervention are not opponent strategies, but should probably be combined to tackle obesity. [less ▲]

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See detailLe medicament du mois. Rimonabant (Acomplia): premier antagoniste des recepteurs CB1 du systeme endocannabinoide.
Scheen, André ULg; Van Gaal, L. F.

in Revue Médicale de Liège (2008), 63(1), 50-5

Rimonabant (Acomplia) is the first selective CB1 receptor blocker of the endocannabinoid system. Clinical trials showed that, compared to placebo, rimonabant 20 mg/ day consistently increases weight loss ... [more ▼]

Rimonabant (Acomplia) is the first selective CB1 receptor blocker of the endocannabinoid system. Clinical trials showed that, compared to placebo, rimonabant 20 mg/ day consistently increases weight loss, reduces waist circumference, improves atherogenic dyslipidaemia (low HDL cholesterol, high triglycerides, high small dense LDL), diminishes insulin resistance, reduces HbA1c levels, and contributes to lower blood pressure and C-reactive protein levels. Almost half of the most important metabolic effects occur beyond weight loss, suggesting direct peripheral effects of rimonabant, especially in visceral adipose tissue as suggested by the increase in adiponectin levels. Rimonabant at a daily dose of 20 mg is indicated as an adjunct to diet and exercise for the treatment of obese patients, or overweight patients with associated risk factor(s) such as type 2 diabetes or dyslipidaemia. Adverse effects concern digestive tract (nausea, mostly transient) and psychological disorders (depressed mood, anxiety), in relation to the mechanism of action of the drug. Therefore, rimonabant is contra-indicated in case of depression and/or in patients receiving antidepressants. [less ▲]

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See detailDo thiazolidinediones increase the risk of congestive heart failure and cardiovascular death?
Scheen, André ULg

in Nature Clinical Practice Endocrinology and Metabolism (2008), 4(5), 260-1

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See detailTypical and atypical antipsychotics differentially affect long-term incidence rates of the metabolic syndrome in first-episode patients with schizophrenia: a retrospective chart review.
De Hert, Marc; Schreurs, Vincent; Sweers, Kim et al

in Schizophrenia Research (2008), 101(1-3), 295-303

The presence of the metabolic syndrome (MetS) is an important risk factor for cardiovascular disease and diabetes. There are limited data on the prevalence of MetS in patients with schizophrenia at the ... [more ▼]

The presence of the metabolic syndrome (MetS) is an important risk factor for cardiovascular disease and diabetes. There are limited data on the prevalence of MetS in patients with schizophrenia at the onset of the disorder and specifically no data on patients treated in the era when only first-generation antipsychotics were available. METHODS: Data from a historic cohort of consecutively admitted first-episode patients with schizophrenia treated with first-generation antipsychotics (FGAs) were compared with an age and sex matched series of consecutive first-episode patients treated only with second-generation antipsychotics (SGAs). Rates of MetS were compared at baseline and after on average 3 years of treatment exposure. RESULTS: At first episode there was no difference in the prevalence of MetS between the historic and the current cohort. Rates of MetS increased over time in both groups, but patients started on SGAs had a three times higher incidence rate of MetS (Odds Ratio 3.6, CI 1.7-7.5). The average increase in weight and body mass index was twice as high in patients started on SGA. The difference between the FGA and SGA group was no longer significant when patients started on clozapine and olanzapine were excluded. CONCLUSION: Rates of MetS at the first episode of schizophrenia today are not different from those of patients 15 to 20 years ago. This finding counters the notion that the high rates of metabolic abnormalities in patients with schizophrenia currently reported are mainly due to lifestyle changes over time in the general population. Some SGAs have a significantly more negative impact on the incidence of MetS compared to FGAs in first-episode patients. [less ▲]

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See detailOrganization of a quality-assurance project in all Belgian multidisciplinary diabetes centres treating insulin-treated diabetes patients: 5 years' experience.
Debacker, Nathalie ULg; Nobels, F.; Vandenberghe, H. et al

in Diabetic Medicine : A Journal of the British Diabetic Association (2008), 25(2), 179-85

AIMS: To describe the IQED, a quality-assurance system started in 2001 in Belgian hospital-based multidisciplinary diabetes centres, and its effects on the quality of care. METHODS: The study was ... [more ▼]

AIMS: To describe the IQED, a quality-assurance system started in 2001 in Belgian hospital-based multidisciplinary diabetes centres, and its effects on the quality of care. METHODS: The study was conducted through four data collections (in 2001, 2002, 2004 and 2006). Approximately 120 diabetes centres provided data on a systematic random sample of 10% of their adult diabetic patients on at least two daily insulin injections. Data on patient characteristics, glycaemic control, cardiovascular risk, diabetes complications, follow-up procedures and treatment were obtained. Local quality promotion was encouraged by returning comprehensive feedback (benchmarks) and during information meetings. RESULTS: Nearly all diabetes centres (98-100%) participated. The pooled sample consisted of 9194 (32%) Type 1 and 19 828 (68%) Type 2 diabetes patients, with mean diabetes duration of 17 years and 14 years, prevalence of microvascular complications of 23% and 38% and prevalence of macrovascular complications of 9% and 26%, respectively. At the start, the quality of care was good in terms of risk-factor testing rates and moderate in terms of patients meeting goals for risk-factor management. At least 50% of the centres initiated quality-promoting initiatives. After 5 years, significant improvements were seen in risk-factor testing rates, apart from renal screening. Improvements in intermediate outcomes were less obvious, apart from an increase in patients reaching the targets for blood pressure and LDL cholesterol. CONCLUSIONS: It is feasible to implement a continuous quality-improvement project on a nationwide scale, with improvements particularly in process indicators. [less ▲]

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See detailEfficacy and safety of the weight-loss drug rimonabant.
Despres, Jean-Pierre; Van Gaal, Luc; Pi-Sunyer, Xavier et al

in Lancet (2008), 371(9612), 555556-7

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See detailEfficacy and safety of rimonabant for improvement of multiple cardiometabolic risk factors in overweight/obese patients: pooled 1-year data from the Rimonabant in Obesity (RIO) program.
Van Gaal, Luc; Pi-Sunyer, Xavier; Despres, Jean-Pierre et al

in Diabetes Care (2008), 31 Suppl 2

OBJECTIVE: To better define the efficacy and safety of rimonabant, the first selective cannabinoid type 1 (CB(1)) receptor antagonist, in a large population of overweight and obese patients using pooled ... [more ▼]

OBJECTIVE: To better define the efficacy and safety of rimonabant, the first selective cannabinoid type 1 (CB(1)) receptor antagonist, in a large population of overweight and obese patients using pooled efficacy data from three Phase III nondiabetes Rimonabant in Obesity and Related Metabolic Disorders (RIO) studies, selected efficacy data from the RIO-Diabetes study, and pooled safety data for all four RIO studies. RESEARCH DESIGN AND METHODS: The RIO studies enrolled patients who were either overweight (BMI >27 kg/m(2)) with at least one comorbidity (i.e., hypertension, dyslipidemia, or, for RIO-Diabetes, type 2 diabetes) or obese. All patients received daily treatment with rimonabant (5 or 20 mg) or placebo for 1 year plus a hypocaloric diet (600 kcal/day deficit) and advice on increased physical activity. RIO-Europe (n = 1,508), RIO-North America (n = 3,045), and RIO-Lipids (n = 1,036) excluded patients with type 2 diabetes; untreated dyslipidemia was an entry requirement for RIO-Lipids. RIO-Diabetes (n = 1,047) required the presence of type 2 diabetes inadequately controlled by sulfonylurea or metformin monotherapy. RESULTS: The pooled intention-to-treat population comprised 5,580 patients without diabetes (3,165 completed treatment) and 1,047 patients with diabetes (692 completed treatment). Most efficacy measures improved during the 4-week placebo run-in period, except that HDL cholesterol decreased as expected in the early phase of a hypocaloric diet. After 1 year of randomized treatment, changes from baseline with 20 mg rimonabant in the nondiabetic population were as follows: body weight -6.5 kg, waist circumference -6.4 cm, HDL cholesterol +16.4%, triglycerides -6.9%, fasting insulin -0.6 muU/ml, and homeostasis model assessment for insulin resistance (HOMA-IR) -0.2 (all P < 0.001 vs. placebo). In the diabetic population, 20 mg rimonabant reduced A1C levels by 0.6% (P < 0.001 vs. placebo). Regression analysis of change in HDL cholesterol, triglycerides, adiponectin (in RIO-Lipids), and A1C (in RIO-Diabetes) versus body weight at 1 year by ANCOVA suggested that 45-57% of the effect of rimonabant could not be explained by the observed weight loss. At 1 year, adverse events more frequently reported with rimonabant were gastrointestinal, neurological, and psychiatric in nature. Serious adverse events were infrequent and almost equivalent to placebo. Overall discontinuation rates were similar across treatment groups, except discontinuation from adverse events, which occurred more frequently with 20 mg rimonabant versus placebo (most commonly, depressive disorders [1.9 vs. 0.8%], nausea [1.4 vs. 0.1%], mood alterations with depressive symptoms [1.0 vs. 0.6%], and anxiety [1.0 vs. 0.3%]). A thorough review of psychiatric and neurological adverse events was performed. CONCLUSIONS: In overweight/obese patients, 20 mg/day rimonabant produced weight loss and significant improvements in multiple cardiometabolic risk factors such as waist circumference, A1C, HDL cholesterol, and triglycerides. Rimonabant was generally well tolerated, with more frequently reported adverse events being gastrointestinal, neurological, and psychiatric in nature. [less ▲]

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See detailSquatting amplifies pulse pressure increase with disease duration in patients with type 1 diabetes.
Philips, Jean-Christophe ULg; Marchand, Monique ULg; Scheen, André ULg

in Diabetes Care (2008), 31(2), 322-4

OBJECTIVE: To evaluate pulse pressure changes according to duration of type 1 diabetes and to assess the influence of posture. RESEARCH DESIGN AND METHODS: We performed continuous measurement of blood ... [more ▼]

OBJECTIVE: To evaluate pulse pressure changes according to duration of type 1 diabetes and to assess the influence of posture. RESEARCH DESIGN AND METHODS: We performed continuous measurement of blood pressure with a Finapres device during a 3 x 1 min posture test (standing, squatting, standing) in 159 type 1 diabetic patients divided into four groups according to diabetes duration (<or=10, 11-20, 21-30, and >30 years, groups 1-4, respectively) and compared the results with those of age-matched nondiabetic subjects. RESULTS: Pulse pressure progressively increased according to type 1 diabetes duration (P < 0.0001), especially in women, but not in age-matched nondiabetic subjects (NS). Pulse-pressure increase from group 1 to group 4 was amplified in the squatting position (from 50 +/- 17 to 69 +/- 14 mmHg) compared with standing (from 44 +/- 15 to 55 +/- 12 mmHg). CONCLUSIONS: Pulse pressure increases according to type 1 diabetes duration more in women than in men, and the squatting position sensitizes such pulse-pressure increase in both sexes. [less ▲]

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See detailTowards high performance virtual routers on commodity hardware
Egi, N.; Greenhalgh, A.; Handley, M. et al

in Proceedings of the 2008 ACM CoNEXT Conference (2008)

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See detailFairness issues in software virtual routers
Egi, N.; Greenhalgh, A.; Handley, M. et al

in Proceedings of the ACM workshop on Programmable routers for extensible services of tomorrow (2008)

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See detailA perturbation method for the 3D finite element modeling of electrostatically driven MEMS
Boutaayamou, Mohamed ULg; V Sabariego, Ruth ULg; Dular, Patrick ULg

in Sensors (2008), 8(2), 994-1003

In this paper, a finite element (FE) procedure for modeling electrostatically actuated MEMS is presented. It concerns a perturbation method for computing electrostatic field distortions due to moving ... [more ▼]

In this paper, a finite element (FE) procedure for modeling electrostatically actuated MEMS is presented. It concerns a perturbation method for computing electrostatic field distortions due to moving conductors. The computation is split in two steps. First, an unperturbed problem (in the absence of certain conductors) is solved with the conventional FE method in the complete domain. Second, a perturbation problem is solved in a reduced region with an additional conductor using the solution of the unperturbed problem as a source. When the perturbing region is close to the original source field, an iterative computation may be required. The developed procedure offers the advantage of solving sub-problems in reduced domains and consequently of benefiting from different problem-adapted meshes. This approach allows for computational efficiency by decreasing the size of the problem. [less ▲]

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See detailConcerns, expectations and perception regarding stature, physical appearance and psychosocial functioning before and during high-dose growth hormone treatment of short pre-pubertal children born small for gestational age.
Lagrou, K.; Froidecoeur, C.; Thomas, M. et al

in Hormone Research (2008), 69(6), 334-42

BACKGROUND/AIMS: Few data are available about parental concerns and psychosocial functioning of young children born small for gestational age (SGA) treated with growth hormone (GH). The present study ... [more ▼]

BACKGROUND/AIMS: Few data are available about parental concerns and psychosocial functioning of young children born small for gestational age (SGA) treated with growth hormone (GH). The present study focused on the perception of short stature and the concerns and expectations of the parents regarding GH treatment. METHODS: Forty prepubertal short SGA children, randomized into a GH-treated and a GH-untreated group, and their parents were evaluated by a questionnaire and a semi-structured interview at start and after 2 years of follow-up. RESULTS: Before start, 85% of the parents were concerned about short stature, 76% expected an increase in adult height of > or =10 cm and 81% expected a positive impact on well-being. Half of the parents expressed fears regarding GH treatment. After 2 years, more parents of treated children reported obvious growth and physical changes, and fewer parents reported teasing because of short stature. An improvement of well-being was reported by half of the parents of treated and untreated children. Fears about GH treatment disappeared almost completely. CONCLUSION: The perspective of GH treatment induced major adult height expectations. In treated children, the physical effects of GH treatment became obvious, teasing because of short stature decreased and initial concerns about short stature and GH therapy decreased. [less ▲]

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